|
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 |
$396.47 |
| Max. Negotiated Rate |
$744.39 |
| Rate for Payer: Aetna Commercial |
$728.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$695.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$428.83
|
| Rate for Payer: Cash Price |
$233.40
|
| Rate for Payer: Cigna Commercial |
$744.39
|
| Rate for Payer: Health EOS Commercial |
$720.12
|
| Rate for Payer: HFN Commercial |
$744.39
|
| Rate for Payer: Multiplan Commercial |
$647.30
|
| Rate for Payer: Preferred Network Access Commercial |
$744.39
|
| Rate for Payer: Quartz Beloit One Network |
$396.47
|
| Rate for Payer: Quartz Commercial |
$485.47
|
| Rate for Payer: WEA Trust Commercial |
$445.02
|
| Rate for Payer: WPS Commercial |
$599.29
|
|
|
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 |
$226.55 |
| Max. Negotiated Rate |
$744.39 |
| Rate for Payer: Aetna Commercial |
$728.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$695.84
|
| Rate for Payer: Aetna Managed Medicare |
$226.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$525.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$404.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$388.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$428.83
|
| Rate for Payer: Cash Price |
$233.40
|
| Rate for Payer: Cigna Commercial |
$744.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$452.80
|
| Rate for Payer: Health EOS Commercial |
$720.12
|
| Rate for Payer: HFN Commercial |
$744.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$606.84
|
| Rate for Payer: Multiplan Commercial |
$647.30
|
| Rate for Payer: NAPHCARE Commercial |
$485.47
|
| Rate for Payer: Preferred Network Access Commercial |
$744.39
|
| Rate for Payer: Quartz Beloit One Network |
$396.47
|
| Rate for Payer: Quartz Commercial |
$525.93
|
| Rate for Payer: Quartz Medicare Advantage |
$485.47
|
| Rate for Payer: The Alliance Commercial |
$404.56
|
| Rate for Payer: WEA Trust Commercial |
$445.02
|
| Rate for Payer: WPS Commercial |
$599.29
|
|
|
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 |
$410.74 |
| Max. Negotiated Rate |
$771.18 |
| Rate for Payer: Aetna Commercial |
$754.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$720.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$444.27
|
| Rate for Payer: Cash Price |
$241.80
|
| Rate for Payer: Cigna Commercial |
$771.18
|
| Rate for Payer: Health EOS Commercial |
$746.03
|
| Rate for Payer: HFN Commercial |
$771.18
|
| Rate for Payer: Multiplan Commercial |
$670.59
|
| Rate for Payer: Preferred Network Access Commercial |
$771.18
|
| Rate for Payer: Quartz Beloit One Network |
$410.74
|
| Rate for Payer: Quartz Commercial |
$502.94
|
| Rate for Payer: WEA Trust Commercial |
$461.03
|
| Rate for Payer: WPS Commercial |
$620.86
|
|
|
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 |
$234.71 |
| Max. Negotiated Rate |
$771.18 |
| Rate for Payer: Aetna Commercial |
$754.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$720.89
|
| Rate for Payer: Aetna Managed Medicare |
$234.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$544.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$419.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$402.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$444.27
|
| Rate for Payer: Cash Price |
$241.80
|
| Rate for Payer: Cigna Commercial |
$771.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$469.09
|
| Rate for Payer: Health EOS Commercial |
$746.03
|
| Rate for Payer: HFN Commercial |
$771.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$628.68
|
| Rate for Payer: Multiplan Commercial |
$670.59
|
| Rate for Payer: NAPHCARE Commercial |
$502.94
|
| Rate for Payer: Preferred Network Access Commercial |
$771.18
|
| Rate for Payer: Quartz Beloit One Network |
$410.74
|
| Rate for Payer: Quartz Commercial |
$544.86
|
| Rate for Payer: Quartz Medicare Advantage |
$502.94
|
| Rate for Payer: The Alliance Commercial |
$419.12
|
| Rate for Payer: WEA Trust Commercial |
$461.03
|
| Rate for Payer: WPS Commercial |
$620.86
|
|
|
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 |
$1,420.76 |
| Max. Negotiated Rate |
$4,668.23 |
| Rate for Payer: Aetna Commercial |
$4,566.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,363.78
|
| Rate for Payer: Aetna Managed Medicare |
$1,420.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,298.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,537.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,435.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,689.30
|
| Rate for Payer: Cash Price |
$1,463.70
|
| Rate for Payer: Cigna Commercial |
$4,668.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,839.58
|
| Rate for Payer: Health EOS Commercial |
$4,516.00
|
| Rate for Payer: HFN Commercial |
$4,668.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,805.62
|
| Rate for Payer: Multiplan Commercial |
$4,059.33
|
| Rate for Payer: NAPHCARE Commercial |
$3,044.50
|
| Rate for Payer: Preferred Network Access Commercial |
$4,668.23
|
| Rate for Payer: Quartz Beloit One Network |
$2,486.34
|
| Rate for Payer: Quartz Commercial |
$3,298.20
|
| Rate for Payer: Quartz Medicare Advantage |
$3,044.50
|
| Rate for Payer: The Alliance Commercial |
$2,537.08
|
| Rate for Payer: WEA Trust Commercial |
$2,790.79
|
| Rate for Payer: WPS Commercial |
$3,758.29
|
|
|
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 |
$2,486.34 |
| Max. Negotiated Rate |
$4,668.23 |
| Rate for Payer: Aetna Commercial |
$4,566.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,363.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,689.30
|
| Rate for Payer: Cash Price |
$1,463.70
|
| Rate for Payer: Cigna Commercial |
$4,668.23
|
| Rate for Payer: Health EOS Commercial |
$4,516.00
|
| Rate for Payer: HFN Commercial |
$4,668.23
|
| Rate for Payer: Multiplan Commercial |
$4,059.33
|
| Rate for Payer: Preferred Network Access Commercial |
$4,668.23
|
| Rate for Payer: Quartz Beloit One Network |
$2,486.34
|
| Rate for Payer: Quartz Commercial |
$3,044.50
|
| Rate for Payer: WEA Trust Commercial |
$2,790.79
|
| Rate for Payer: WPS Commercial |
$3,758.29
|
|
|
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 |
$2,115.57 |
| Max. Negotiated Rate |
$6,951.15 |
| Rate for Payer: Aetna Commercial |
$6,800.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,497.82
|
| Rate for Payer: Aetna Managed Medicare |
$2,115.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,911.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,777.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,626.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,004.47
|
| Rate for Payer: Cash Price |
$2,179.50
|
| Rate for Payer: Cigna Commercial |
$6,951.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,228.23
|
| Rate for Payer: Health EOS Commercial |
$6,724.48
|
| Rate for Payer: HFN Commercial |
$6,951.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,666.70
|
| Rate for Payer: Multiplan Commercial |
$6,044.48
|
| Rate for Payer: NAPHCARE Commercial |
$4,533.36
|
| Rate for Payer: Preferred Network Access Commercial |
$6,951.15
|
| Rate for Payer: Quartz Beloit One Network |
$3,702.24
|
| Rate for Payer: Quartz Commercial |
$4,911.14
|
| Rate for Payer: Quartz Medicare Advantage |
$4,533.36
|
| Rate for Payer: The Alliance Commercial |
$3,777.80
|
| Rate for Payer: WEA Trust Commercial |
$4,155.58
|
| Rate for Payer: WPS Commercial |
$5,596.23
|
|
|
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 |
$3,702.24 |
| Max. Negotiated Rate |
$6,951.15 |
| Rate for Payer: Aetna Commercial |
$6,800.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,497.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,004.47
|
| Rate for Payer: Cash Price |
$2,179.50
|
| Rate for Payer: Cigna Commercial |
$6,951.15
|
| Rate for Payer: Health EOS Commercial |
$6,724.48
|
| Rate for Payer: HFN Commercial |
$6,951.15
|
| Rate for Payer: Multiplan Commercial |
$6,044.48
|
| Rate for Payer: Preferred Network Access Commercial |
$6,951.15
|
| Rate for Payer: Quartz Beloit One Network |
$3,702.24
|
| Rate for Payer: Quartz Commercial |
$4,533.36
|
| Rate for Payer: WEA Trust Commercial |
$4,155.58
|
| Rate for Payer: WPS Commercial |
$5,596.23
|
|
|
T-PLATE LCP 4.5 4HL 240.141
|
Facility
|
IP
|
$7,509.00
|
|
| Hospital Charge Code |
2967328
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,826.59 |
| Max. Negotiated Rate |
$7,184.61 |
| Rate for Payer: Aetna Commercial |
$7,028.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,716.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,138.96
|
| Rate for Payer: Cash Price |
$2,252.70
|
| Rate for Payer: Cigna Commercial |
$7,184.61
|
| Rate for Payer: Health EOS Commercial |
$6,950.33
|
| Rate for Payer: HFN Commercial |
$7,184.61
|
| Rate for Payer: Multiplan Commercial |
$6,247.49
|
| Rate for Payer: Preferred Network Access Commercial |
$7,184.61
|
| Rate for Payer: Quartz Beloit One Network |
$3,826.59
|
| Rate for Payer: Quartz Commercial |
$4,685.62
|
| Rate for Payer: WEA Trust Commercial |
$4,295.15
|
| Rate for Payer: WPS Commercial |
$5,784.18
|
|
|
T-PLATE LCP 4.5 4HL 240.141
|
Facility
|
OP
|
$7,509.00
|
|
| Hospital Charge Code |
2967328
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,186.62 |
| Max. Negotiated Rate |
$7,184.61 |
| Rate for Payer: Aetna Commercial |
$7,028.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,716.05
|
| Rate for Payer: Aetna Managed Medicare |
$2,186.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,076.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,904.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,748.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,138.96
|
| Rate for Payer: Cash Price |
$2,252.70
|
| Rate for Payer: Cigna Commercial |
$7,184.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,370.24
|
| Rate for Payer: Health EOS Commercial |
$6,950.33
|
| Rate for Payer: HFN Commercial |
$7,184.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,857.02
|
| Rate for Payer: Multiplan Commercial |
$6,247.49
|
| Rate for Payer: NAPHCARE Commercial |
$4,685.62
|
| Rate for Payer: Preferred Network Access Commercial |
$7,184.61
|
| Rate for Payer: Quartz Beloit One Network |
$3,826.59
|
| Rate for Payer: Quartz Commercial |
$5,076.08
|
| Rate for Payer: Quartz Medicare Advantage |
$4,685.62
|
| Rate for Payer: The Alliance Commercial |
$3,904.68
|
| Rate for Payer: WEA Trust Commercial |
$4,295.15
|
| Rate for Payer: WPS Commercial |
$5,784.18
|
|
|
T-PLATE LCP 4.5 6HL 240.161
|
Facility
|
IP
|
$7,509.00
|
|
| Hospital Charge Code |
2967329
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,826.59 |
| Max. Negotiated Rate |
$7,184.61 |
| Rate for Payer: Aetna Commercial |
$7,028.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,716.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,138.96
|
| Rate for Payer: Cash Price |
$2,252.70
|
| Rate for Payer: Cigna Commercial |
$7,184.61
|
| Rate for Payer: Health EOS Commercial |
$6,950.33
|
| Rate for Payer: HFN Commercial |
$7,184.61
|
| Rate for Payer: Multiplan Commercial |
$6,247.49
|
| Rate for Payer: Preferred Network Access Commercial |
$7,184.61
|
| Rate for Payer: Quartz Beloit One Network |
$3,826.59
|
| Rate for Payer: Quartz Commercial |
$4,685.62
|
| Rate for Payer: WEA Trust Commercial |
$4,295.15
|
| Rate for Payer: WPS Commercial |
$5,784.18
|
|
|
T-PLATE LCP 4.5 6HL 240.161
|
Facility
|
OP
|
$7,509.00
|
|
| Hospital Charge Code |
2967329
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,186.62 |
| Max. Negotiated Rate |
$7,184.61 |
| Rate for Payer: Aetna Commercial |
$7,028.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,716.05
|
| Rate for Payer: Aetna Managed Medicare |
$2,186.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,076.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,904.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,748.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,138.96
|
| Rate for Payer: Cash Price |
$2,252.70
|
| Rate for Payer: Cigna Commercial |
$7,184.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,370.24
|
| Rate for Payer: Health EOS Commercial |
$6,950.33
|
| Rate for Payer: HFN Commercial |
$7,184.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,857.02
|
| Rate for Payer: Multiplan Commercial |
$6,247.49
|
| Rate for Payer: NAPHCARE Commercial |
$4,685.62
|
| Rate for Payer: Preferred Network Access Commercial |
$7,184.61
|
| Rate for Payer: Quartz Beloit One Network |
$3,826.59
|
| Rate for Payer: Quartz Commercial |
$5,076.08
|
| Rate for Payer: Quartz Medicare Advantage |
$4,685.62
|
| Rate for Payer: The Alliance Commercial |
$3,904.68
|
| Rate for Payer: WEA Trust Commercial |
$4,295.15
|
| Rate for Payer: WPS Commercial |
$5,784.18
|
|
|
T-PLATE LCP 4.5 8HL 240.181
|
Facility
|
IP
|
$7,509.00
|
|
| Hospital Charge Code |
2967330
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,826.59 |
| Max. Negotiated Rate |
$7,184.61 |
| Rate for Payer: Aetna Commercial |
$7,028.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,716.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,138.96
|
| Rate for Payer: Cash Price |
$2,252.70
|
| Rate for Payer: Cigna Commercial |
$7,184.61
|
| Rate for Payer: Health EOS Commercial |
$6,950.33
|
| Rate for Payer: HFN Commercial |
$7,184.61
|
| Rate for Payer: Multiplan Commercial |
$6,247.49
|
| Rate for Payer: Preferred Network Access Commercial |
$7,184.61
|
| Rate for Payer: Quartz Beloit One Network |
$3,826.59
|
| Rate for Payer: Quartz Commercial |
$4,685.62
|
| Rate for Payer: WEA Trust Commercial |
$4,295.15
|
| Rate for Payer: WPS Commercial |
$5,784.18
|
|
|
T-PLATE LCP 4.5 8HL 240.181
|
Facility
|
OP
|
$7,509.00
|
|
| Hospital Charge Code |
2967330
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,186.62 |
| Max. Negotiated Rate |
$7,184.61 |
| Rate for Payer: Aetna Commercial |
$7,028.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,716.05
|
| Rate for Payer: Aetna Managed Medicare |
$2,186.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,076.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,904.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,748.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,138.96
|
| Rate for Payer: Cash Price |
$2,252.70
|
| Rate for Payer: Cigna Commercial |
$7,184.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,370.24
|
| Rate for Payer: Health EOS Commercial |
$6,950.33
|
| Rate for Payer: HFN Commercial |
$7,184.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,857.02
|
| Rate for Payer: Multiplan Commercial |
$6,247.49
|
| Rate for Payer: NAPHCARE Commercial |
$4,685.62
|
| Rate for Payer: Preferred Network Access Commercial |
$7,184.61
|
| Rate for Payer: Quartz Beloit One Network |
$3,826.59
|
| Rate for Payer: Quartz Commercial |
$5,076.08
|
| Rate for Payer: Quartz Medicare Advantage |
$4,685.62
|
| Rate for Payer: The Alliance Commercial |
$3,904.68
|
| Rate for Payer: WEA Trust Commercial |
$4,295.15
|
| Rate for Payer: WPS Commercial |
$5,784.18
|
|
|
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 |
$2,580.61 |
| Max. Negotiated Rate |
$4,845.24 |
| Rate for Payer: Aetna Commercial |
$4,739.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,529.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,791.28
|
| Rate for Payer: Cash Price |
$1,519.20
|
| Rate for Payer: Cigna Commercial |
$4,845.24
|
| Rate for Payer: Health EOS Commercial |
$4,687.24
|
| Rate for Payer: HFN Commercial |
$4,845.24
|
| Rate for Payer: Multiplan Commercial |
$4,213.25
|
| Rate for Payer: Preferred Network Access Commercial |
$4,845.24
|
| Rate for Payer: Quartz Beloit One Network |
$2,580.61
|
| Rate for Payer: Quartz Commercial |
$3,159.94
|
| Rate for Payer: WEA Trust Commercial |
$2,896.61
|
| Rate for Payer: WPS Commercial |
$3,900.80
|
|
|
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 |
$1,474.64 |
| Max. Negotiated Rate |
$4,845.24 |
| Rate for Payer: Aetna Commercial |
$4,739.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,529.24
|
| Rate for Payer: Aetna Managed Medicare |
$1,474.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,423.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,633.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,527.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,791.28
|
| Rate for Payer: Cash Price |
$1,519.20
|
| Rate for Payer: Cigna Commercial |
$4,845.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,947.25
|
| Rate for Payer: Health EOS Commercial |
$4,687.24
|
| Rate for Payer: HFN Commercial |
$4,845.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,949.92
|
| Rate for Payer: Multiplan Commercial |
$4,213.25
|
| Rate for Payer: NAPHCARE Commercial |
$3,159.94
|
| Rate for Payer: Preferred Network Access Commercial |
$4,845.24
|
| Rate for Payer: Quartz Beloit One Network |
$2,580.61
|
| Rate for Payer: Quartz Commercial |
$3,423.26
|
| Rate for Payer: Quartz Medicare Advantage |
$3,159.94
|
| Rate for Payer: The Alliance Commercial |
$2,633.28
|
| Rate for Payer: WEA Trust Commercial |
$2,896.61
|
| Rate for Payer: WPS Commercial |
$3,900.80
|
|
|
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 |
$1,647.32 |
| Max. Negotiated Rate |
$5,412.62 |
| Rate for Payer: Aetna Commercial |
$5,294.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,059.62
|
| Rate for Payer: Aetna Managed Medicare |
$1,647.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,824.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,941.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,823.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,118.14
|
| Rate for Payer: Cash Price |
$1,697.10
|
| Rate for Payer: Cigna Commercial |
$5,412.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,292.37
|
| Rate for Payer: Health EOS Commercial |
$5,236.12
|
| Rate for Payer: HFN Commercial |
$5,412.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,412.46
|
| Rate for Payer: Multiplan Commercial |
$4,706.62
|
| Rate for Payer: NAPHCARE Commercial |
$3,529.97
|
| Rate for Payer: Preferred Network Access Commercial |
$5,412.62
|
| Rate for Payer: Quartz Beloit One Network |
$2,882.81
|
| Rate for Payer: Quartz Commercial |
$3,824.13
|
| Rate for Payer: Quartz Medicare Advantage |
$3,529.97
|
| Rate for Payer: The Alliance Commercial |
$2,941.64
|
| Rate for Payer: WEA Trust Commercial |
$3,235.80
|
| Rate for Payer: WPS Commercial |
$4,357.59
|
|
|
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 |
$2,882.81 |
| Max. Negotiated Rate |
$5,412.62 |
| Rate for Payer: Aetna Commercial |
$5,294.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,059.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,118.14
|
| Rate for Payer: Cash Price |
$1,697.10
|
| Rate for Payer: Cigna Commercial |
$5,412.62
|
| Rate for Payer: Health EOS Commercial |
$5,236.12
|
| Rate for Payer: HFN Commercial |
$5,412.62
|
| Rate for Payer: Multiplan Commercial |
$4,706.62
|
| Rate for Payer: Preferred Network Access Commercial |
$5,412.62
|
| Rate for Payer: Quartz Beloit One Network |
$2,882.81
|
| Rate for Payer: Quartz Commercial |
$3,529.97
|
| Rate for Payer: WEA Trust Commercial |
$3,235.80
|
| Rate for Payer: WPS Commercial |
$4,357.59
|
|
|
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 |
$232.67 |
| Max. Negotiated Rate |
$764.48 |
| Rate for Payer: Aetna Commercial |
$747.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$714.63
|
| Rate for Payer: Aetna Managed Medicare |
$232.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$540.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$415.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$398.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$440.41
|
| Rate for Payer: Cash Price |
$239.70
|
| Rate for Payer: Cigna Commercial |
$764.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$465.02
|
| Rate for Payer: Health EOS Commercial |
$739.55
|
| Rate for Payer: HFN Commercial |
$764.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$623.22
|
| Rate for Payer: Multiplan Commercial |
$664.77
|
| Rate for Payer: NAPHCARE Commercial |
$498.58
|
| Rate for Payer: Preferred Network Access Commercial |
$764.48
|
| Rate for Payer: Quartz Beloit One Network |
$407.17
|
| Rate for Payer: Quartz Commercial |
$540.12
|
| Rate for Payer: Quartz Medicare Advantage |
$498.58
|
| Rate for Payer: The Alliance Commercial |
$415.48
|
| Rate for Payer: WEA Trust Commercial |
$457.03
|
| Rate for Payer: WPS Commercial |
$615.47
|
|
|
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 |
$407.17 |
| Max. Negotiated Rate |
$764.48 |
| Rate for Payer: Aetna Commercial |
$747.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$714.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$440.41
|
| Rate for Payer: Cash Price |
$239.70
|
| Rate for Payer: Cigna Commercial |
$764.48
|
| Rate for Payer: Health EOS Commercial |
$739.55
|
| Rate for Payer: HFN Commercial |
$764.48
|
| Rate for Payer: Multiplan Commercial |
$664.77
|
| Rate for Payer: Preferred Network Access Commercial |
$764.48
|
| Rate for Payer: Quartz Beloit One Network |
$407.17
|
| Rate for Payer: Quartz Commercial |
$498.58
|
| Rate for Payer: WEA Trust Commercial |
$457.03
|
| Rate for Payer: WPS Commercial |
$615.47
|
|
|
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 |
$212.58 |
| Max. Negotiated Rate |
$698.46 |
| Rate for Payer: Aetna Commercial |
$683.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$652.91
|
| Rate for Payer: Aetna Managed Medicare |
$212.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$493.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$379.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$364.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$402.38
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cigna Commercial |
$698.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$424.86
|
| Rate for Payer: Health EOS Commercial |
$675.69
|
| Rate for Payer: HFN Commercial |
$698.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$569.40
|
| Rate for Payer: Multiplan Commercial |
$607.36
|
| Rate for Payer: NAPHCARE Commercial |
$455.52
|
| Rate for Payer: Preferred Network Access Commercial |
$698.46
|
| Rate for Payer: Quartz Beloit One Network |
$372.01
|
| Rate for Payer: Quartz Commercial |
$493.48
|
| Rate for Payer: Quartz Medicare Advantage |
$455.52
|
| Rate for Payer: The Alliance Commercial |
$379.60
|
| Rate for Payer: WEA Trust Commercial |
$417.56
|
| Rate for Payer: WPS Commercial |
$562.32
|
|
|
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 |
$372.01 |
| Max. Negotiated Rate |
$698.46 |
| Rate for Payer: Aetna Commercial |
$683.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$652.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$402.38
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cigna Commercial |
$698.46
|
| Rate for Payer: Health EOS Commercial |
$675.69
|
| Rate for Payer: HFN Commercial |
$698.46
|
| Rate for Payer: Multiplan Commercial |
$607.36
|
| Rate for Payer: Preferred Network Access Commercial |
$698.46
|
| Rate for Payer: Quartz Beloit One Network |
$372.01
|
| Rate for Payer: Quartz Commercial |
$455.52
|
| Rate for Payer: WEA Trust Commercial |
$417.56
|
| Rate for Payer: WPS Commercial |
$562.32
|
|
|
TPMT Activity
|
Professional
|
Both
|
$564.00
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
5438799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.06 |
| Max. Negotiated Rate |
$557.23 |
| Rate for Payer: Aetna Commercial |
$557.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$504.44
|
| Rate for Payer: Aetna Managed Medicare |
$23.06
|
| Rate for Payer: Anthem Medicare Advantage |
$23.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23.06
|
| Rate for Payer: Cash Price |
$169.20
|
| Rate for Payer: Cash Price |
$169.20
|
| Rate for Payer: Cigna Commercial |
$557.23
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$293.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23.06
|
| Rate for Payer: Health EOS Commercial |
$533.77
|
| Rate for Payer: HFN Commercial |
$557.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$81.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$81.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$23.06
|
| Rate for Payer: Multiplan Commercial |
$469.25
|
| Rate for Payer: NAPHCARE Commercial |
$34.59
|
| Rate for Payer: Preferred Network Access Commercial |
$557.23
|
| Rate for Payer: Quartz Beloit One Network |
$258.09
|
| Rate for Payer: Quartz Commercial |
$334.34
|
| Rate for Payer: Quartz Medicare Advantage |
$23.06
|
| Rate for Payer: The Alliance Commercial |
$91.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.06
|
| Rate for Payer: WEA Trust Commercial |
$322.61
|
| Rate for Payer: WPS Commercial |
$101.45
|
|
|
TPMT Activity
|
Facility
|
IP
|
$564.00
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
5438799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$287.41 |
| Max. Negotiated Rate |
$539.64 |
| Rate for Payer: Aetna Commercial |
$527.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$504.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$310.88
|
| Rate for Payer: Cash Price |
$169.20
|
| Rate for Payer: Cigna Commercial |
$539.64
|
| Rate for Payer: Health EOS Commercial |
$522.04
|
| Rate for Payer: HFN Commercial |
$539.64
|
| Rate for Payer: Multiplan Commercial |
$469.25
|
| Rate for Payer: Preferred Network Access Commercial |
$539.64
|
| Rate for Payer: Quartz Beloit One Network |
$287.41
|
| Rate for Payer: Quartz Commercial |
$351.94
|
| Rate for Payer: WEA Trust Commercial |
$322.61
|
| Rate for Payer: WPS Commercial |
$434.45
|
|
|
TPMT Activity
|
Facility
|
OP
|
$564.00
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
5438799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.06 |
| Max. Negotiated Rate |
$539.64 |
| Rate for Payer: Aetna Commercial |
$527.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$504.44
|
| Rate for Payer: Aetna Managed Medicare |
$23.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$86.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$40.35
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$38.27
|
| Rate for Payer: Anthem Medicare Advantage |
$23.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$310.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23.06
|
| Rate for Payer: Cash Price |
$169.20
|
| Rate for Payer: Cash Price |
$169.20
|
| Rate for Payer: Cigna Commercial |
$539.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$23.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$328.25
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$23.06
|
| Rate for Payer: Health EOS Commercial |
$522.04
|
| Rate for Payer: HFN Commercial |
$539.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$85.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$23.06
|
| Rate for Payer: Independent Care Health Plan Medicare |
$23.06
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$23.06
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$23.06
|
| Rate for Payer: Multiplan Commercial |
$469.25
|
| Rate for Payer: NAPHCARE Commercial |
$34.59
|
| Rate for Payer: Preferred Network Access Commercial |
$539.64
|
| Rate for Payer: Quartz Beloit One Network |
$287.41
|
| Rate for Payer: Quartz Commercial |
$381.26
|
| Rate for Payer: Quartz Medicare Advantage |
$23.06
|
| Rate for Payer: The Alliance Commercial |
$92.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.06
|
| Rate for Payer: United Healthcare PPO |
$439.92
|
| Rate for Payer: WEA Trust Commercial |
$322.61
|
| Rate for Payer: Wellcare Medicare |
$23.06
|
| Rate for Payer: WPS Commercial |
$434.45
|
|
