|
YID
|
Professional
|
Both
|
$83.00
|
|
|
Service Code
|
CPT 87106
|
| Hospital Charge Code |
5313599
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.73 |
| Max. Negotiated Rate |
$82.00 |
| Rate for Payer: Aetna Commercial |
$82.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.24
|
| Rate for Payer: Aetna Managed Medicare |
$10.73
|
| Rate for Payer: Anthem Medicare Advantage |
$10.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.73
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$82.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$43.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.73
|
| Rate for Payer: Health EOS Commercial |
$78.55
|
| Rate for Payer: HFN Commercial |
$82.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.73
|
| Rate for Payer: Multiplan Commercial |
$69.06
|
| Rate for Payer: NAPHCARE Commercial |
$16.10
|
| Rate for Payer: Preferred Network Access Commercial |
$82.00
|
| Rate for Payer: Quartz Beloit One Network |
$37.98
|
| Rate for Payer: Quartz Commercial |
$49.20
|
| Rate for Payer: Quartz Medicare Advantage |
$10.73
|
| Rate for Payer: The Alliance Commercial |
$42.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.73
|
| Rate for Payer: WEA Trust Commercial |
$47.48
|
| Rate for Payer: WPS Commercial |
$47.22
|
|
|
YID
|
Facility
|
IP
|
$83.00
|
|
|
Service Code
|
CPT 87106
|
| Hospital Charge Code |
5313599
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.30 |
| Max. Negotiated Rate |
$79.41 |
| Rate for Payer: Aetna Commercial |
$77.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.75
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$79.41
|
| Rate for Payer: Health EOS Commercial |
$76.82
|
| Rate for Payer: HFN Commercial |
$79.41
|
| Rate for Payer: Multiplan Commercial |
$69.06
|
| Rate for Payer: Preferred Network Access Commercial |
$79.41
|
| Rate for Payer: Quartz Beloit One Network |
$42.30
|
| Rate for Payer: Quartz Commercial |
$51.79
|
| Rate for Payer: WEA Trust Commercial |
$47.48
|
| Rate for Payer: WPS Commercial |
$63.93
|
|
|
YID
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
CPT 87106
|
| Hospital Charge Code |
5313599
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.73 |
| Max. Negotiated Rate |
$79.41 |
| Rate for Payer: Aetna Commercial |
$77.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.24
|
| Rate for Payer: Aetna Managed Medicare |
$10.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$40.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18.78
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17.82
|
| Rate for Payer: Anthem Medicare Advantage |
$10.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.73
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$79.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.31
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10.73
|
| Rate for Payer: Health EOS Commercial |
$76.82
|
| Rate for Payer: HFN Commercial |
$79.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.73
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10.73
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10.73
|
| Rate for Payer: Multiplan Commercial |
$69.06
|
| Rate for Payer: NAPHCARE Commercial |
$16.10
|
| Rate for Payer: Preferred Network Access Commercial |
$79.41
|
| Rate for Payer: Quartz Beloit One Network |
$42.30
|
| Rate for Payer: Quartz Commercial |
$56.11
|
| Rate for Payer: Quartz Medicare Advantage |
$10.73
|
| Rate for Payer: The Alliance Commercial |
$42.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.73
|
| Rate for Payer: United Healthcare PPO |
$64.74
|
| Rate for Payer: WEA Trust Commercial |
$47.48
|
| Rate for Payer: Wellcare Medicare |
$10.73
|
| Rate for Payer: WPS Commercial |
$63.93
|
|
|
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 |
$1,631.23 |
| Max. Negotiated Rate |
$3,062.72 |
| Rate for Payer: Aetna Commercial |
$2,996.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,862.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,764.39
|
| Rate for Payer: Cash Price |
$960.30
|
| Rate for Payer: Cigna Commercial |
$3,062.72
|
| Rate for Payer: Health EOS Commercial |
$2,962.85
|
| Rate for Payer: HFN Commercial |
$3,062.72
|
| Rate for Payer: Multiplan Commercial |
$2,663.23
|
| Rate for Payer: Preferred Network Access Commercial |
$3,062.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,631.23
|
| Rate for Payer: Quartz Commercial |
$1,997.42
|
| Rate for Payer: WEA Trust Commercial |
$1,830.97
|
| Rate for Payer: WPS Commercial |
$2,465.73
|
|
|
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 |
$932.13 |
| Max. Negotiated Rate |
$3,062.72 |
| Rate for Payer: Aetna Commercial |
$2,996.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,862.97
|
| Rate for Payer: Aetna Managed Medicare |
$932.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,163.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,664.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,597.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,764.39
|
| Rate for Payer: Cash Price |
$960.30
|
| Rate for Payer: Cigna Commercial |
$3,062.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,862.98
|
| Rate for Payer: Health EOS Commercial |
$2,962.85
|
| Rate for Payer: HFN Commercial |
$3,062.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,496.78
|
| Rate for Payer: Multiplan Commercial |
$2,663.23
|
| Rate for Payer: NAPHCARE Commercial |
$1,997.42
|
| Rate for Payer: Preferred Network Access Commercial |
$3,062.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,631.23
|
| Rate for Payer: Quartz Commercial |
$2,163.88
|
| Rate for Payer: Quartz Medicare Advantage |
$1,997.42
|
| Rate for Payer: The Alliance Commercial |
$1,664.52
|
| Rate for Payer: WEA Trust Commercial |
$1,830.97
|
| Rate for Payer: WPS Commercial |
$2,465.73
|
|
|
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 |
$1,112.09 |
| Max. Negotiated Rate |
$3,654.02 |
| Rate for Payer: Aetna Commercial |
$3,574.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,415.71
|
| Rate for Payer: Aetna Managed Medicare |
$1,112.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,581.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,985.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,906.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,105.03
|
| Rate for Payer: Cash Price |
$1,145.70
|
| Rate for Payer: Cigna Commercial |
$3,654.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,222.66
|
| Rate for Payer: Health EOS Commercial |
$3,534.87
|
| Rate for Payer: HFN Commercial |
$3,654.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,978.82
|
| Rate for Payer: Multiplan Commercial |
$3,177.41
|
| Rate for Payer: NAPHCARE Commercial |
$2,383.06
|
| Rate for Payer: Preferred Network Access Commercial |
$3,654.02
|
| Rate for Payer: Quartz Beloit One Network |
$1,946.16
|
| Rate for Payer: Quartz Commercial |
$2,581.64
|
| Rate for Payer: Quartz Medicare Advantage |
$2,383.06
|
| Rate for Payer: The Alliance Commercial |
$1,985.88
|
| Rate for Payer: WEA Trust Commercial |
$2,184.47
|
| Rate for Payer: WPS Commercial |
$2,941.78
|
|
|
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 |
$1,946.16 |
| Max. Negotiated Rate |
$3,654.02 |
| Rate for Payer: Aetna Commercial |
$3,574.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,415.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,105.03
|
| Rate for Payer: Cash Price |
$1,145.70
|
| Rate for Payer: Cigna Commercial |
$3,654.02
|
| Rate for Payer: Health EOS Commercial |
$3,534.87
|
| Rate for Payer: HFN Commercial |
$3,654.02
|
| Rate for Payer: Multiplan Commercial |
$3,177.41
|
| Rate for Payer: Preferred Network Access Commercial |
$3,654.02
|
| Rate for Payer: Quartz Beloit One Network |
$1,946.16
|
| Rate for Payer: Quartz Commercial |
$2,383.06
|
| Rate for Payer: WEA Trust Commercial |
$2,184.47
|
| Rate for Payer: WPS Commercial |
$2,941.78
|
|
|
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 |
$1,654.02 |
| Max. Negotiated Rate |
$5,434.62 |
| Rate for Payer: Aetna Commercial |
$5,316.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,080.19
|
| Rate for Payer: Aetna Managed Medicare |
$1,654.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,839.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,953.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,130.82
|
| Rate for Payer: Cash Price |
$1,704.00
|
| Rate for Payer: Cigna Commercial |
$5,434.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,305.76
|
| Rate for Payer: Health EOS Commercial |
$5,257.41
|
| Rate for Payer: HFN Commercial |
$5,434.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,430.40
|
| Rate for Payer: Multiplan Commercial |
$4,725.76
|
| Rate for Payer: NAPHCARE Commercial |
$3,544.32
|
| Rate for Payer: Preferred Network Access Commercial |
$5,434.62
|
| Rate for Payer: Quartz Beloit One Network |
$2,894.53
|
| Rate for Payer: Quartz Commercial |
$3,839.68
|
| Rate for Payer: Quartz Medicare Advantage |
$3,544.32
|
| Rate for Payer: The Alliance Commercial |
$2,953.60
|
| Rate for Payer: WEA Trust Commercial |
$3,248.96
|
| Rate for Payer: WPS Commercial |
$4,375.30
|
|
|
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 |
$2,894.53 |
| Max. Negotiated Rate |
$5,434.62 |
| Rate for Payer: Aetna Commercial |
$5,316.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,080.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,130.82
|
| Rate for Payer: Cash Price |
$1,704.00
|
| Rate for Payer: Cigna Commercial |
$5,434.62
|
| Rate for Payer: Health EOS Commercial |
$5,257.41
|
| Rate for Payer: HFN Commercial |
$5,434.62
|
| Rate for Payer: Multiplan Commercial |
$4,725.76
|
| Rate for Payer: Preferred Network Access Commercial |
$5,434.62
|
| Rate for Payer: Quartz Beloit One Network |
$2,894.53
|
| Rate for Payer: Quartz Commercial |
$3,544.32
|
| Rate for Payer: WEA Trust Commercial |
$3,248.96
|
| Rate for Payer: WPS Commercial |
$4,375.30
|
|
|
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 |
$2,009.86 |
| Max. Negotiated Rate |
$3,773.62 |
| Rate for Payer: Aetna Commercial |
$3,691.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,527.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,173.93
|
| Rate for Payer: Cash Price |
$1,183.20
|
| Rate for Payer: Cigna Commercial |
$3,773.62
|
| Rate for Payer: Health EOS Commercial |
$3,650.57
|
| Rate for Payer: HFN Commercial |
$3,773.62
|
| Rate for Payer: Multiplan Commercial |
$3,281.41
|
| Rate for Payer: Preferred Network Access Commercial |
$3,773.62
|
| Rate for Payer: Quartz Beloit One Network |
$2,009.86
|
| Rate for Payer: Quartz Commercial |
$2,461.06
|
| Rate for Payer: WEA Trust Commercial |
$2,255.97
|
| Rate for Payer: WPS Commercial |
$3,038.06
|
|
|
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 |
$1,148.49 |
| Max. Negotiated Rate |
$3,773.62 |
| Rate for Payer: Aetna Commercial |
$3,691.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,527.51
|
| Rate for Payer: Aetna Managed Medicare |
$1,148.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,666.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,050.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,968.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,173.93
|
| Rate for Payer: Cash Price |
$1,183.20
|
| Rate for Payer: Cigna Commercial |
$3,773.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,295.41
|
| Rate for Payer: Health EOS Commercial |
$3,650.57
|
| Rate for Payer: HFN Commercial |
$3,773.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,076.32
|
| Rate for Payer: Multiplan Commercial |
$3,281.41
|
| Rate for Payer: NAPHCARE Commercial |
$2,461.06
|
| Rate for Payer: Preferred Network Access Commercial |
$3,773.62
|
| Rate for Payer: Quartz Beloit One Network |
$2,009.86
|
| Rate for Payer: Quartz Commercial |
$2,666.14
|
| Rate for Payer: Quartz Medicare Advantage |
$2,461.06
|
| Rate for Payer: The Alliance Commercial |
$2,050.88
|
| Rate for Payer: WEA Trust Commercial |
$2,255.97
|
| Rate for Payer: WPS Commercial |
$3,038.06
|
|
|
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 |
$1,260.90 |
| Max. Negotiated Rate |
$4,142.94 |
| Rate for Payer: Aetna Commercial |
$4,052.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,872.75
|
| Rate for Payer: Aetna Managed Medicare |
$1,260.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,927.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,251.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,161.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,386.70
|
| Rate for Payer: Cash Price |
$1,299.00
|
| Rate for Payer: Cigna Commercial |
$4,142.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,520.06
|
| Rate for Payer: Health EOS Commercial |
$4,007.85
|
| Rate for Payer: HFN Commercial |
$4,142.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,377.40
|
| Rate for Payer: Multiplan Commercial |
$3,602.56
|
| Rate for Payer: NAPHCARE Commercial |
$2,701.92
|
| Rate for Payer: Preferred Network Access Commercial |
$4,142.94
|
| Rate for Payer: Quartz Beloit One Network |
$2,206.57
|
| Rate for Payer: Quartz Commercial |
$2,927.08
|
| Rate for Payer: Quartz Medicare Advantage |
$2,701.92
|
| Rate for Payer: The Alliance Commercial |
$2,251.60
|
| Rate for Payer: WEA Trust Commercial |
$2,476.76
|
| Rate for Payer: WPS Commercial |
$3,335.40
|
|
|
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 |
$2,206.57 |
| Max. Negotiated Rate |
$4,142.94 |
| Rate for Payer: Aetna Commercial |
$4,052.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,872.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,386.70
|
| Rate for Payer: Cash Price |
$1,299.00
|
| Rate for Payer: Cigna Commercial |
$4,142.94
|
| Rate for Payer: Health EOS Commercial |
$4,007.85
|
| Rate for Payer: HFN Commercial |
$4,142.94
|
| Rate for Payer: Multiplan Commercial |
$3,602.56
|
| Rate for Payer: Preferred Network Access Commercial |
$4,142.94
|
| Rate for Payer: Quartz Beloit One Network |
$2,206.57
|
| Rate for Payer: Quartz Commercial |
$2,701.92
|
| Rate for Payer: WEA Trust Commercial |
$2,476.76
|
| Rate for Payer: WPS Commercial |
$3,335.40
|
|
|
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 |
$2,342.63 |
| Max. Negotiated Rate |
$4,398.41 |
| Rate for Payer: Aetna Commercial |
$4,302.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,111.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,533.87
|
| Rate for Payer: Cash Price |
$1,379.10
|
| Rate for Payer: Cigna Commercial |
$4,398.41
|
| Rate for Payer: Health EOS Commercial |
$4,254.98
|
| Rate for Payer: HFN Commercial |
$4,398.41
|
| Rate for Payer: Multiplan Commercial |
$3,824.70
|
| Rate for Payer: Preferred Network Access Commercial |
$4,398.41
|
| Rate for Payer: Quartz Beloit One Network |
$2,342.63
|
| Rate for Payer: Quartz Commercial |
$2,868.53
|
| Rate for Payer: WEA Trust Commercial |
$2,629.48
|
| Rate for Payer: WPS Commercial |
$3,541.07
|
|
|
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 |
$1,338.65 |
| Max. Negotiated Rate |
$4,398.41 |
| Rate for Payer: Aetna Commercial |
$4,302.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,111.56
|
| Rate for Payer: Aetna Managed Medicare |
$1,338.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,107.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,390.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,294.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,533.87
|
| Rate for Payer: Cash Price |
$1,379.10
|
| Rate for Payer: Cigna Commercial |
$4,398.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,675.45
|
| Rate for Payer: Health EOS Commercial |
$4,254.98
|
| Rate for Payer: HFN Commercial |
$4,398.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,585.66
|
| Rate for Payer: Multiplan Commercial |
$3,824.70
|
| Rate for Payer: NAPHCARE Commercial |
$2,868.53
|
| Rate for Payer: Preferred Network Access Commercial |
$4,398.41
|
| Rate for Payer: Quartz Beloit One Network |
$2,342.63
|
| Rate for Payer: Quartz Commercial |
$3,107.57
|
| Rate for Payer: Quartz Medicare Advantage |
$2,868.53
|
| Rate for Payer: The Alliance Commercial |
$2,390.44
|
| Rate for Payer: WEA Trust Commercial |
$2,629.48
|
| Rate for Payer: WPS Commercial |
$3,541.07
|
|
|
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 |
$3,353.75 |
| Max. Negotiated Rate |
$11,019.47 |
| Rate for Payer: Aetna Commercial |
$10,779.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,300.80
|
| Rate for Payer: Aetna Managed Medicare |
$3,353.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,785.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,988.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,749.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,348.17
|
| Rate for Payer: Cash Price |
$3,455.10
|
| Rate for Payer: Cigna Commercial |
$11,019.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,702.89
|
| Rate for Payer: Health EOS Commercial |
$10,660.14
|
| Rate for Payer: HFN Commercial |
$11,019.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,983.26
|
| Rate for Payer: Multiplan Commercial |
$9,582.14
|
| Rate for Payer: NAPHCARE Commercial |
$7,186.61
|
| Rate for Payer: Preferred Network Access Commercial |
$11,019.47
|
| Rate for Payer: Quartz Beloit One Network |
$5,869.06
|
| Rate for Payer: Quartz Commercial |
$7,785.49
|
| Rate for Payer: Quartz Medicare Advantage |
$7,186.61
|
| Rate for Payer: The Alliance Commercial |
$5,988.84
|
| Rate for Payer: WEA Trust Commercial |
$6,587.72
|
| Rate for Payer: WPS Commercial |
$8,871.55
|
|
|
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 |
$5,869.06 |
| Max. Negotiated Rate |
$11,019.47 |
| Rate for Payer: Aetna Commercial |
$10,779.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,300.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,348.17
|
| Rate for Payer: Cash Price |
$3,455.10
|
| Rate for Payer: Cigna Commercial |
$11,019.47
|
| Rate for Payer: Health EOS Commercial |
$10,660.14
|
| Rate for Payer: HFN Commercial |
$11,019.47
|
| Rate for Payer: Multiplan Commercial |
$9,582.14
|
| Rate for Payer: Preferred Network Access Commercial |
$11,019.47
|
| Rate for Payer: Quartz Beloit One Network |
$5,869.06
|
| Rate for Payer: Quartz Commercial |
$7,186.61
|
| Rate for Payer: WEA Trust Commercial |
$6,587.72
|
| Rate for Payer: WPS Commercial |
$8,871.55
|
|
|
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 |
$3,543.25 |
| Max. Negotiated Rate |
$6,652.63 |
| Rate for Payer: Aetna Commercial |
$6,508.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,218.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,832.49
|
| Rate for Payer: Cash Price |
$2,085.90
|
| Rate for Payer: Cigna Commercial |
$6,652.63
|
| Rate for Payer: Health EOS Commercial |
$6,435.70
|
| Rate for Payer: HFN Commercial |
$6,652.63
|
| Rate for Payer: Multiplan Commercial |
$5,784.90
|
| Rate for Payer: Preferred Network Access Commercial |
$6,652.63
|
| Rate for Payer: Quartz Beloit One Network |
$3,543.25
|
| Rate for Payer: Quartz Commercial |
$4,338.67
|
| Rate for Payer: WEA Trust Commercial |
$3,977.12
|
| Rate for Payer: WPS Commercial |
$5,355.90
|
|
|
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 |
$2,024.71 |
| Max. Negotiated Rate |
$6,652.63 |
| Rate for Payer: Aetna Commercial |
$6,508.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,218.76
|
| Rate for Payer: Aetna Managed Medicare |
$2,024.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,700.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,615.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,470.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,832.49
|
| Rate for Payer: Cash Price |
$2,085.90
|
| Rate for Payer: Cigna Commercial |
$6,652.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,046.65
|
| Rate for Payer: Health EOS Commercial |
$6,435.70
|
| Rate for Payer: HFN Commercial |
$6,652.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,423.34
|
| Rate for Payer: Multiplan Commercial |
$5,784.90
|
| Rate for Payer: NAPHCARE Commercial |
$4,338.67
|
| Rate for Payer: Preferred Network Access Commercial |
$6,652.63
|
| Rate for Payer: Quartz Beloit One Network |
$3,543.25
|
| Rate for Payer: Quartz Commercial |
$4,700.23
|
| Rate for Payer: Quartz Medicare Advantage |
$4,338.67
|
| Rate for Payer: The Alliance Commercial |
$3,615.56
|
| Rate for Payer: WEA Trust Commercial |
$3,977.12
|
| Rate for Payer: WPS Commercial |
$5,355.90
|
|
|
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 |
$1,286.23 |
| Max. Negotiated Rate |
$2,414.96 |
| Rate for Payer: Aetna Commercial |
$2,362.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,257.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,391.23
|
| Rate for Payer: Cash Price |
$757.20
|
| Rate for Payer: Cigna Commercial |
$2,414.96
|
| Rate for Payer: Health EOS Commercial |
$2,336.21
|
| Rate for Payer: HFN Commercial |
$2,414.96
|
| Rate for Payer: Multiplan Commercial |
$2,099.97
|
| Rate for Payer: Preferred Network Access Commercial |
$2,414.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,286.23
|
| Rate for Payer: Quartz Commercial |
$1,574.98
|
| Rate for Payer: WEA Trust Commercial |
$1,443.73
|
| Rate for Payer: WPS Commercial |
$1,944.24
|
|
|
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 |
$734.99 |
| Max. Negotiated Rate |
$2,414.96 |
| Rate for Payer: Aetna Commercial |
$2,362.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,257.47
|
| Rate for Payer: Aetna Managed Medicare |
$734.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,706.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,312.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,259.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,391.23
|
| Rate for Payer: Cash Price |
$757.20
|
| Rate for Payer: Cigna Commercial |
$2,414.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,468.97
|
| Rate for Payer: Health EOS Commercial |
$2,336.21
|
| Rate for Payer: HFN Commercial |
$2,414.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,968.72
|
| Rate for Payer: Multiplan Commercial |
$2,099.97
|
| Rate for Payer: NAPHCARE Commercial |
$1,574.98
|
| Rate for Payer: Preferred Network Access Commercial |
$2,414.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,286.23
|
| Rate for Payer: Quartz Commercial |
$1,706.22
|
| Rate for Payer: Quartz Medicare Advantage |
$1,574.98
|
| Rate for Payer: The Alliance Commercial |
$1,312.48
|
| Rate for Payer: WEA Trust Commercial |
$1,443.73
|
| Rate for Payer: WPS Commercial |
$1,944.24
|
|
|
Zantac 25 mg Charge
|
Professional
|
Both
|
$87.00
|
|
|
Service Code
|
HCPCS J2780
|
| Hospital Charge Code |
2958939
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.81 |
| Max. Negotiated Rate |
$85.96 |
| Rate for Payer: Aetna Commercial |
$85.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$77.81
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna Commercial |
$85.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$45.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.29
|
| Rate for Payer: Health EOS Commercial |
$82.34
|
| Rate for Payer: HFN Commercial |
$85.96
|
| Rate for Payer: Multiplan Commercial |
$72.38
|
| Rate for Payer: Preferred Network Access Commercial |
$85.96
|
| Rate for Payer: Quartz Beloit One Network |
$39.81
|
| Rate for Payer: Quartz Commercial |
$51.57
|
| Rate for Payer: The Alliance Commercial |
$45.24
|
| Rate for Payer: WEA Trust Commercial |
$49.76
|
| Rate for Payer: WPS Commercial |
$67.02
|
|
|
Zantac 25 mg Charge
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
HCPCS J2780
|
| Hospital Charge Code |
2958939
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.34 |
| Max. Negotiated Rate |
$83.24 |
| Rate for Payer: Aetna Commercial |
$81.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$77.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.95
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna Commercial |
$83.24
|
| Rate for Payer: Health EOS Commercial |
$80.53
|
| Rate for Payer: HFN Commercial |
$83.24
|
| Rate for Payer: Multiplan Commercial |
$72.38
|
| Rate for Payer: Preferred Network Access Commercial |
$83.24
|
| Rate for Payer: Quartz Beloit One Network |
$44.34
|
| Rate for Payer: Quartz Commercial |
$54.29
|
| Rate for Payer: WEA Trust Commercial |
$49.76
|
| Rate for Payer: WPS Commercial |
$67.02
|
|
|
Zantac 25 mg Charge
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
HCPCS J2780
|
| Hospital Charge Code |
2958939
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.33 |
| Max. Negotiated Rate |
$83.24 |
| Rate for Payer: Aetna Commercial |
$81.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$77.81
|
| Rate for Payer: Aetna Managed Medicare |
$25.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$58.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$45.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$43.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.95
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna Commercial |
$83.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50.63
|
| Rate for Payer: Health EOS Commercial |
$80.53
|
| Rate for Payer: HFN Commercial |
$83.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$67.86
|
| Rate for Payer: Multiplan Commercial |
$72.38
|
| Rate for Payer: NAPHCARE Commercial |
$54.29
|
| Rate for Payer: Preferred Network Access Commercial |
$83.24
|
| Rate for Payer: Quartz Beloit One Network |
$44.34
|
| Rate for Payer: Quartz Commercial |
$58.81
|
| Rate for Payer: Quartz Medicare Advantage |
$54.29
|
| Rate for Payer: The Alliance Commercial |
$45.24
|
| Rate for Payer: WEA Trust Commercial |
$49.76
|
| Rate for Payer: WPS Commercial |
$67.02
|
|
|
Zemplar Supplies
|
Facility
|
IP
|
$5.00
|
|
| Hospital Charge Code |
3005576
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$4.78 |
| Rate for Payer: Aetna Commercial |
$4.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.76
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cigna Commercial |
$4.78
|
| Rate for Payer: Health EOS Commercial |
$4.63
|
| Rate for Payer: HFN Commercial |
$4.78
|
| Rate for Payer: Multiplan Commercial |
$4.16
|
| Rate for Payer: Preferred Network Access Commercial |
$4.78
|
| Rate for Payer: Quartz Beloit One Network |
$2.55
|
| Rate for Payer: Quartz Commercial |
$3.12
|
| Rate for Payer: WEA Trust Commercial |
$2.86
|
| Rate for Payer: WPS Commercial |
$3.85
|
|
