|
YID
|
Facility
OP
|
$83.00
|
|
|
Service Code
|
CPT 87106
|
| Hospital Charge Code |
5313599
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$332.00 |
| Rate for Payer: Aetna Commercial |
$74.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.38
|
| Rate for Payer: Aetna Managed Medicare |
$10.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$38.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18.06
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17.13
|
| Rate for Payer: Anthem Medicaid |
$10.66
|
| Rate for Payer: Anthem Medicare Advantage |
$10.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.32
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$76.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10.66
|
| Rate for Payer: Dean Health Medicaid |
$10.66
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10.32
|
| Rate for Payer: Health EOS Commercial |
$73.87
|
| Rate for Payer: HFN Commercial |
$76.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$38.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10.32
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$10.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.32
|
| Rate for Payer: Managed Health Services Medicaid |
$11.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10.32
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10.32
|
| Rate for Payer: Multiplan Commercial |
$66.40
|
| Rate for Payer: NAPHCARE Commercial |
$15.48
|
| Rate for Payer: Preferred Network Access Commercial |
$76.36
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$10.66
|
| Rate for Payer: Quartz Beloit One Network |
$40.67
|
| Rate for Payer: Quartz Commercial |
$53.95
|
| Rate for Payer: Quartz Medicare Advantage |
$10.32
|
| Rate for Payer: The Alliance Commercial |
$332.00
|
| Rate for Payer: United Healthcare Medicaid |
$10.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.32
|
| Rate for Payer: United Healthcare PPO |
$62.25
|
| Rate for Payer: WEA Trust Commercial |
$45.65
|
| Rate for Payer: Wellcare Medicare |
$10.32
|
| Rate for Payer: WMAP Medicaid |
$10.66
|
| Rate for Payer: WPS Commercial |
$61.48
|
|
|
Y-PLATE 1.3MM 3H HEAD/8H SHAFT 221.335
|
Facility
IP
|
$3,201.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508598
|
|
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
|
|
|
Y-PLATE 1.3MM 3H HEAD/8H SHAFT 221.335
|
Facility
OP
|
$3,201.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508598
|
|
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
|
|
|
Y-PLATE 1.5MM 3H HEAD 8H SHAFT 246.612
|
Facility
OP
|
$3,819.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508669
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,069.32 |
| Max. Negotiated Rate |
$3,513.48 |
| Rate for Payer: Aetna Commercial |
$3,437.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,284.34
|
| Rate for Payer: Aetna Managed Medicare |
$1,069.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,482.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,909.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,833.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,024.07
|
| Rate for Payer: Cash Price |
$1,145.70
|
| Rate for Payer: Cigna Commercial |
$3,513.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,137.11
|
| Rate for Payer: Health EOS Commercial |
$3,398.91
|
| Rate for Payer: HFN Commercial |
$3,513.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,864.25
|
| Rate for Payer: Multiplan Commercial |
$3,055.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,291.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,513.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,871.31
|
| Rate for Payer: Quartz Commercial |
$2,482.35
|
| Rate for Payer: Quartz Medicare Advantage |
$2,291.40
|
| Rate for Payer: WEA Trust Commercial |
$2,100.45
|
| Rate for Payer: WPS Commercial |
$2,828.73
|
|
|
Y-PLATE 1.5MM 3H HEAD 8H SHAFT 246.612
|
Facility
IP
|
$3,819.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508669
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,871.31 |
| Max. Negotiated Rate |
$3,513.48 |
| Rate for Payer: Aetna Commercial |
$3,437.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,024.07
|
| Rate for Payer: Cash Price |
$1,145.70
|
| Rate for Payer: Cigna Commercial |
$3,513.48
|
| Rate for Payer: Health EOS Commercial |
$3,398.91
|
| Rate for Payer: HFN Commercial |
$3,513.48
|
| Rate for Payer: Multiplan Commercial |
$3,055.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,291.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,513.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,871.31
|
| Rate for Payer: Quartz Commercial |
$2,291.40
|
| Rate for Payer: WEA Trust Commercial |
$2,100.45
|
| Rate for Payer: WPS Commercial |
$2,828.73
|
|
|
Y-PLATE 1.5MM LCP 3H HEAD/8H SHAFT 02.114.513
|
Facility
IP
|
$5,680.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508926
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,783.20 |
| Max. Negotiated Rate |
$5,225.60 |
| Rate for Payer: Aetna Commercial |
$5,112.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,010.40
|
| Rate for Payer: Cash Price |
$1,704.00
|
| Rate for Payer: Cigna Commercial |
$5,225.60
|
| Rate for Payer: Health EOS Commercial |
$5,055.20
|
| Rate for Payer: HFN Commercial |
$5,225.60
|
| Rate for Payer: Multiplan Commercial |
$4,544.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,408.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,225.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,783.20
|
| Rate for Payer: Quartz Commercial |
$3,408.00
|
| Rate for Payer: WEA Trust Commercial |
$3,124.00
|
| Rate for Payer: WPS Commercial |
$4,207.18
|
|
|
Y-PLATE 1.5MM LCP 3H HEAD/8H SHAFT 02.114.513
|
Facility
OP
|
$5,680.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508926
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,590.40 |
| Max. Negotiated Rate |
$5,225.60 |
| Rate for Payer: Aetna Commercial |
$5,112.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,884.80
|
| Rate for Payer: Aetna Managed Medicare |
$1,590.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,692.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,840.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,010.40
|
| Rate for Payer: Cash Price |
$1,704.00
|
| Rate for Payer: Cigna Commercial |
$5,225.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,178.53
|
| Rate for Payer: Health EOS Commercial |
$5,055.20
|
| Rate for Payer: HFN Commercial |
$5,225.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,260.00
|
| Rate for Payer: Multiplan Commercial |
$4,544.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,408.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,225.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,783.20
|
| Rate for Payer: Quartz Commercial |
$3,692.00
|
| Rate for Payer: Quartz Medicare Advantage |
$3,408.00
|
| Rate for Payer: WEA Trust Commercial |
$3,124.00
|
| Rate for Payer: WPS Commercial |
$4,207.18
|
|
|
Y-PLATE 2.0 3HEAD 7HL 247.350
|
Facility
IP
|
$3,944.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767802
|
|
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
|
|
|
Y-PLATE 2.0 3HEAD 7HL 247.350
|
Facility
OP
|
$3,944.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767802
|
|
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
|
|
|
Y-PLATE 2.0MM 3H HEAD/ 8H SHAFT 247.612
|
Facility
IP
|
$4,330.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508690
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,121.70 |
| Max. Negotiated Rate |
$3,983.60 |
| Rate for Payer: Aetna Commercial |
$3,897.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,294.90
|
| Rate for Payer: Cash Price |
$1,299.00
|
| Rate for Payer: Cigna Commercial |
$3,983.60
|
| Rate for Payer: Health EOS Commercial |
$3,853.70
|
| Rate for Payer: HFN Commercial |
$3,983.60
|
| Rate for Payer: Multiplan Commercial |
$3,464.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,598.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,983.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,121.70
|
| Rate for Payer: Quartz Commercial |
$2,598.00
|
| Rate for Payer: WEA Trust Commercial |
$2,381.50
|
| Rate for Payer: WPS Commercial |
$3,207.23
|
|
|
Y-PLATE 2.0MM 3H HEAD/ 8H SHAFT 247.612
|
Facility
OP
|
$4,330.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508690
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,212.40 |
| Max. Negotiated Rate |
$3,983.60 |
| Rate for Payer: Aetna Commercial |
$3,897.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,723.80
|
| Rate for Payer: Aetna Managed Medicare |
$1,212.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,814.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,165.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,078.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,294.90
|
| Rate for Payer: Cash Price |
$1,299.00
|
| Rate for Payer: Cigna Commercial |
$3,983.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,423.07
|
| Rate for Payer: Health EOS Commercial |
$3,853.70
|
| Rate for Payer: HFN Commercial |
$3,983.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,247.50
|
| Rate for Payer: Multiplan Commercial |
$3,464.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,598.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,983.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,121.70
|
| Rate for Payer: Quartz Commercial |
$2,814.50
|
| Rate for Payer: Quartz Medicare Advantage |
$2,598.00
|
| Rate for Payer: WEA Trust Commercial |
$2,381.50
|
| Rate for Payer: WPS Commercial |
$3,207.23
|
|
|
Y-PLATE 2.4MM 3HL HEAD/8HL SHAFT 249.915
|
Facility
OP
|
$4,597.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508775
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,287.16 |
| Max. Negotiated Rate |
$4,229.24 |
| Rate for Payer: Aetna Commercial |
$4,137.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,953.42
|
| Rate for Payer: Aetna Managed Medicare |
$1,287.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,988.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,298.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,206.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,436.41
|
| Rate for Payer: Cash Price |
$1,379.10
|
| Rate for Payer: Cigna Commercial |
$4,229.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,572.48
|
| Rate for Payer: Health EOS Commercial |
$4,091.33
|
| Rate for Payer: HFN Commercial |
$4,229.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,447.75
|
| Rate for Payer: Multiplan Commercial |
$3,677.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,758.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,229.24
|
| Rate for Payer: Quartz Beloit One Network |
$2,252.53
|
| Rate for Payer: Quartz Commercial |
$2,988.05
|
| Rate for Payer: Quartz Medicare Advantage |
$2,758.20
|
| Rate for Payer: WEA Trust Commercial |
$2,528.35
|
| Rate for Payer: WPS Commercial |
$3,405.00
|
|
|
Y-PLATE 2.4MM 3HL HEAD/8HL SHAFT 249.915
|
Facility
IP
|
$4,597.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508775
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,252.53 |
| Max. Negotiated Rate |
$4,229.24 |
| Rate for Payer: Aetna Commercial |
$4,137.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,436.41
|
| Rate for Payer: Cash Price |
$1,379.10
|
| Rate for Payer: Cigna Commercial |
$4,229.24
|
| Rate for Payer: Health EOS Commercial |
$4,091.33
|
| Rate for Payer: HFN Commercial |
$4,229.24
|
| Rate for Payer: Multiplan Commercial |
$3,677.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,758.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,229.24
|
| Rate for Payer: Quartz Beloit One Network |
$2,252.53
|
| Rate for Payer: Quartz Commercial |
$2,758.20
|
| Rate for Payer: WEA Trust Commercial |
$2,528.35
|
| Rate for Payer: WPS Commercial |
$3,405.00
|
|
|
Y-PLATE 3Di CROSSCHECK 5820YPX1
|
Facility
IP
|
$11,517.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6185022
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,643.33 |
| Max. Negotiated Rate |
$10,595.64 |
| Rate for Payer: Aetna Commercial |
$10,365.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,104.01
|
| Rate for Payer: Cash Price |
$3,455.10
|
| Rate for Payer: Cigna Commercial |
$10,595.64
|
| Rate for Payer: Health EOS Commercial |
$10,250.13
|
| Rate for Payer: HFN Commercial |
$10,595.64
|
| Rate for Payer: Multiplan Commercial |
$9,213.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,910.20
|
| Rate for Payer: Preferred Network Access Commercial |
$10,595.64
|
| Rate for Payer: Quartz Beloit One Network |
$5,643.33
|
| Rate for Payer: Quartz Commercial |
$6,910.20
|
| Rate for Payer: WEA Trust Commercial |
$6,334.35
|
| Rate for Payer: WPS Commercial |
$8,530.64
|
|
|
Y-PLATE 3Di CROSSCHECK 5820YPX1
|
Facility
OP
|
$11,517.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6185022
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,224.76 |
| Max. Negotiated Rate |
$10,595.64 |
| Rate for Payer: Aetna Commercial |
$10,365.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,904.62
|
| Rate for Payer: Aetna Managed Medicare |
$3,224.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,486.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,758.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,528.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,104.01
|
| Rate for Payer: Cash Price |
$3,455.10
|
| Rate for Payer: Cigna Commercial |
$10,595.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,444.91
|
| Rate for Payer: Health EOS Commercial |
$10,250.13
|
| Rate for Payer: HFN Commercial |
$10,595.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,637.75
|
| Rate for Payer: Multiplan Commercial |
$9,213.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,910.20
|
| Rate for Payer: Preferred Network Access Commercial |
$10,595.64
|
| Rate for Payer: Quartz Beloit One Network |
$5,643.33
|
| Rate for Payer: Quartz Commercial |
$7,486.05
|
| Rate for Payer: Quartz Medicare Advantage |
$6,910.20
|
| Rate for Payer: WEA Trust Commercial |
$6,334.35
|
| Rate for Payer: WPS Commercial |
$8,530.64
|
|
|
Y-PLATE 5TH METATARSAL RT 5202500R
|
Facility
IP
|
$6,953.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6172201
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,406.97 |
| Max. Negotiated Rate |
$6,396.76 |
| Rate for Payer: Aetna Commercial |
$6,257.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,685.09
|
| Rate for Payer: Cash Price |
$2,085.90
|
| Rate for Payer: Cigna Commercial |
$6,396.76
|
| Rate for Payer: Health EOS Commercial |
$6,188.17
|
| Rate for Payer: HFN Commercial |
$6,396.76
|
| Rate for Payer: Multiplan Commercial |
$5,562.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,171.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,396.76
|
| Rate for Payer: Quartz Beloit One Network |
$3,406.97
|
| Rate for Payer: Quartz Commercial |
$4,171.80
|
| Rate for Payer: WEA Trust Commercial |
$3,824.15
|
| Rate for Payer: WPS Commercial |
$5,150.09
|
|
|
Y-PLATE 5TH METATARSAL RT 5202500R
|
Facility
OP
|
$6,953.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6172201
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,946.84 |
| Max. Negotiated Rate |
$6,396.76 |
| Rate for Payer: Aetna Commercial |
$6,257.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,979.58
|
| Rate for Payer: Aetna Managed Medicare |
$1,946.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,519.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,476.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,337.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,685.09
|
| Rate for Payer: Cash Price |
$2,085.90
|
| Rate for Payer: Cigna Commercial |
$6,396.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,890.90
|
| Rate for Payer: Health EOS Commercial |
$6,188.17
|
| Rate for Payer: HFN Commercial |
$6,396.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,214.75
|
| Rate for Payer: Multiplan Commercial |
$5,562.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,171.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,396.76
|
| Rate for Payer: Quartz Beloit One Network |
$3,406.97
|
| Rate for Payer: Quartz Commercial |
$4,519.45
|
| Rate for Payer: Quartz Medicare Advantage |
$4,171.80
|
| Rate for Payer: WEA Trust Commercial |
$3,824.15
|
| Rate for Payer: WPS Commercial |
$5,150.09
|
|
|
Y-PLATE MATRIX MIDFACE 1.0 X 3HL 0.7MM THICK TI 04.503.377
|
Facility
OP
|
$2,524.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5349172
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$706.72 |
| Max. Negotiated Rate |
$2,322.08 |
| Rate for Payer: Aetna Commercial |
$2,271.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,170.64
|
| Rate for Payer: Aetna Managed Medicare |
$706.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,640.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,262.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,211.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,337.72
|
| Rate for Payer: Cash Price |
$757.20
|
| Rate for Payer: Cigna Commercial |
$2,322.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,412.43
|
| Rate for Payer: Health EOS Commercial |
$2,246.36
|
| Rate for Payer: HFN Commercial |
$2,322.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,893.00
|
| Rate for Payer: Multiplan Commercial |
$2,019.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,514.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,322.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,236.76
|
| Rate for Payer: Quartz Commercial |
$1,640.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,514.40
|
| Rate for Payer: WEA Trust Commercial |
$1,388.20
|
| Rate for Payer: WPS Commercial |
$1,869.53
|
|
|
Y-PLATE MATRIX MIDFACE 1.0 X 3HL 0.7MM THICK TI 04.503.377
|
Facility
IP
|
$2,524.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5349172
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,236.76 |
| Max. Negotiated Rate |
$2,322.08 |
| Rate for Payer: Aetna Commercial |
$2,271.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,337.72
|
| Rate for Payer: Cash Price |
$757.20
|
| Rate for Payer: Cigna Commercial |
$2,322.08
|
| Rate for Payer: Health EOS Commercial |
$2,246.36
|
| Rate for Payer: HFN Commercial |
$2,322.08
|
| Rate for Payer: Multiplan Commercial |
$2,019.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,514.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,322.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,236.76
|
| Rate for Payer: Quartz Commercial |
$1,514.40
|
| Rate for Payer: WEA Trust Commercial |
$1,388.20
|
| Rate for Payer: WPS Commercial |
$1,869.53
|
|
|
Zantac 25 mg Charge
|
Facility
IP
|
$87.00
|
|
|
Service Code
|
HCPCS J2780
|
| Hospital Charge Code |
2958939
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.63 |
| Max. Negotiated Rate |
$80.04 |
| Rate for Payer: Aetna Commercial |
$78.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.11
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna Commercial |
$80.04
|
| Rate for Payer: Health EOS Commercial |
$77.43
|
| Rate for Payer: HFN Commercial |
$80.04
|
| Rate for Payer: Multiplan Commercial |
$69.60
|
| Rate for Payer: NAPHCARE Commercial |
$52.20
|
| Rate for Payer: Preferred Network Access Commercial |
$80.04
|
| Rate for Payer: Quartz Beloit One Network |
$42.63
|
| Rate for Payer: Quartz Commercial |
$52.20
|
| Rate for Payer: WEA Trust Commercial |
$47.85
|
| Rate for Payer: WPS Commercial |
$64.44
|
|
|
Zantac 25 mg Charge
|
Professional
|
$87.00
|
|
|
Service Code
|
HCPCS J2780
|
| Hospital Charge Code |
2958939
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.12 |
| Max. Negotiated Rate |
$82.65 |
| Rate for Payer: Aetna Commercial |
$82.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.82
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna Commercial |
$82.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$43.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$52.20
|
| Rate for Payer: Health EOS Commercial |
$79.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.94
|
| Rate for Payer: Multiplan Commercial |
$69.60
|
| Rate for Payer: Preferred Network Access Commercial |
$82.65
|
| Rate for Payer: Quartz Beloit One Network |
$38.28
|
| Rate for Payer: Quartz Commercial |
$49.59
|
| Rate for Payer: The Alliance Commercial |
$43.50
|
| Rate for Payer: United Healthcare Medicaid |
$6.12
|
| Rate for Payer: WEA Trust Commercial |
$47.85
|
| Rate for Payer: WPS Commercial |
$64.44
|
|
|
Zantac 25 mg Charge
|
Facility
OP
|
$87.00
|
|
|
Service Code
|
HCPCS J2780
|
| Hospital Charge Code |
2958939
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.36 |
| Max. Negotiated Rate |
$1,024.24 |
| Rate for Payer: Aetna Commercial |
$78.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.82
|
| Rate for Payer: Aetna Managed Medicare |
$24.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$43.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$41.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.11
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna Commercial |
$80.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.69
|
| Rate for Payer: Health EOS Commercial |
$77.43
|
| Rate for Payer: HFN Commercial |
$80.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.25
|
| Rate for Payer: Multiplan Commercial |
$69.60
|
| Rate for Payer: NAPHCARE Commercial |
$52.20
|
| Rate for Payer: Preferred Network Access Commercial |
$80.04
|
| Rate for Payer: Quartz Beloit One Network |
$42.63
|
| Rate for Payer: Quartz Commercial |
$56.55
|
| Rate for Payer: Quartz Medicare Advantage |
$52.20
|
| Rate for Payer: The Alliance Commercial |
$1,024.24
|
| Rate for Payer: WEA Trust Commercial |
$47.85
|
| Rate for Payer: WPS Commercial |
$64.44
|
|
|
Zemplar Supplies
|
Facility
OP
|
$5.00
|
|
| Hospital Charge Code |
3005576
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Aetna Commercial |
$4.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4.30
|
| Rate for Payer: Aetna Managed Medicare |
$1.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.65
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cigna Commercial |
$4.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.80
|
| Rate for Payer: Health EOS Commercial |
$4.45
|
| Rate for Payer: HFN Commercial |
$4.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3.75
|
| Rate for Payer: Multiplan Commercial |
$4.00
|
| Rate for Payer: NAPHCARE Commercial |
$3.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4.60
|
| Rate for Payer: Quartz Beloit One Network |
$2.45
|
| Rate for Payer: Quartz Commercial |
$3.25
|
| Rate for Payer: Quartz Medicare Advantage |
$3.00
|
| Rate for Payer: The Alliance Commercial |
$20.00
|
| Rate for Payer: WEA Trust Commercial |
$2.75
|
| Rate for Payer: WPS Commercial |
$3.70
|
|
|
Zemplar Supplies
|
Facility
IP
|
$5.00
|
|
| Hospital Charge Code |
3005576
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$4.60 |
| Rate for Payer: Aetna Commercial |
$4.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.65
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cigna Commercial |
$4.60
|
| Rate for Payer: Health EOS Commercial |
$4.45
|
| Rate for Payer: HFN Commercial |
$4.60
|
| Rate for Payer: Multiplan Commercial |
$4.00
|
| Rate for Payer: NAPHCARE Commercial |
$3.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4.60
|
| Rate for Payer: Quartz Beloit One Network |
$2.45
|
| Rate for Payer: Quartz Commercial |
$3.00
|
| Rate for Payer: WEA Trust Commercial |
$2.75
|
| Rate for Payer: WPS Commercial |
$3.70
|
|
|
ZENKERS DIVERTICULECTOMY
|
Facility
IP
|
$4,460.00
|
|
| Hospital Charge Code |
2960514
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,185.40 |
| Max. Negotiated Rate |
$4,103.20 |
| Rate for Payer: Aetna Commercial |
$4,014.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,363.80
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$4,103.20
|
| Rate for Payer: Health EOS Commercial |
$3,969.40
|
| Rate for Payer: HFN Commercial |
$4,103.20
|
| Rate for Payer: Multiplan Commercial |
$3,568.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,676.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,103.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,185.40
|
| Rate for Payer: Quartz Commercial |
$2,676.00
|
| Rate for Payer: WEA Trust Commercial |
$2,453.00
|
| Rate for Payer: WPS Commercial |
$3,303.52
|
|
