|
1.5MM EXT H-PLATE/LT 246.483
|
Facility
IP
|
$4,130.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508671
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,023.70 |
| Max. Negotiated Rate |
$3,799.60 |
| Rate for Payer: Aetna Commercial |
$3,717.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,188.90
|
| Rate for Payer: Cash Price |
$1,239.00
|
| Rate for Payer: Cigna Commercial |
$3,799.60
|
| Rate for Payer: Health EOS Commercial |
$3,675.70
|
| Rate for Payer: HFN Commercial |
$3,799.60
|
| Rate for Payer: Multiplan Commercial |
$3,304.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,478.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,799.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,023.70
|
| Rate for Payer: Quartz Commercial |
$2,478.00
|
| Rate for Payer: WEA Trust Commercial |
$2,271.50
|
| Rate for Payer: WPS Commercial |
$3,059.09
|
|
|
1.5MM EXT H-PLATE/RT 246.482
|
Facility
OP
|
$3,976.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508670
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,113.28 |
| Max. Negotiated Rate |
$3,657.92 |
| Rate for Payer: Aetna Commercial |
$3,578.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,419.36
|
| Rate for Payer: Aetna Managed Medicare |
$1,113.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,584.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,988.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,908.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,107.28
|
| Rate for Payer: Cash Price |
$1,192.80
|
| Rate for Payer: Cigna Commercial |
$3,657.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,224.97
|
| Rate for Payer: Health EOS Commercial |
$3,538.64
|
| Rate for Payer: HFN Commercial |
$3,657.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,982.00
|
| Rate for Payer: Multiplan Commercial |
$3,180.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,385.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,657.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,948.24
|
| Rate for Payer: Quartz Commercial |
$2,584.40
|
| Rate for Payer: Quartz Medicare Advantage |
$2,385.60
|
| Rate for Payer: WEA Trust Commercial |
$2,186.80
|
| Rate for Payer: WPS Commercial |
$2,945.02
|
|
|
1.5MM EXT H-PLATE/RT 246.482
|
Facility
IP
|
$3,976.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508670
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,948.24 |
| Max. Negotiated Rate |
$3,657.92 |
| Rate for Payer: Aetna Commercial |
$3,578.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,107.28
|
| Rate for Payer: Cash Price |
$1,192.80
|
| Rate for Payer: Cigna Commercial |
$3,657.92
|
| Rate for Payer: Health EOS Commercial |
$3,538.64
|
| Rate for Payer: HFN Commercial |
$3,657.92
|
| Rate for Payer: Multiplan Commercial |
$3,180.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,385.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,657.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,948.24
|
| Rate for Payer: Quartz Commercial |
$2,385.60
|
| Rate for Payer: WEA Trust Commercial |
$2,186.80
|
| Rate for Payer: WPS Commercial |
$2,945.02
|
|
|
1.5MM LCP EXT H-PLATE LT 02.114.509
|
Facility
OP
|
$5,680.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508925
|
|
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
|
|
|
1.5MM LCP EXT H-PLATE LT 02.114.509
|
Facility
IP
|
$5,680.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508925
|
|
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
|
|
|
1.5MM LCP PLATE / 4H 02.114.502
|
Facility
OP
|
$4,390.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508921
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,229.20 |
| Max. Negotiated Rate |
$4,038.80 |
| Rate for Payer: Aetna Commercial |
$3,951.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,775.40
|
| Rate for Payer: Aetna Managed Medicare |
$1,229.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,853.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,195.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,107.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,326.70
|
| Rate for Payer: Cash Price |
$1,317.00
|
| Rate for Payer: Cigna Commercial |
$4,038.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,456.64
|
| Rate for Payer: Health EOS Commercial |
$3,907.10
|
| Rate for Payer: HFN Commercial |
$4,038.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,292.50
|
| Rate for Payer: Multiplan Commercial |
$3,512.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,634.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,038.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,151.10
|
| Rate for Payer: Quartz Commercial |
$2,853.50
|
| Rate for Payer: Quartz Medicare Advantage |
$2,634.00
|
| Rate for Payer: WEA Trust Commercial |
$2,414.50
|
| Rate for Payer: WPS Commercial |
$3,251.67
|
|
|
1.5MM LCP PLATE / 4H 02.114.502
|
Facility
IP
|
$4,390.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508921
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,151.10 |
| Max. Negotiated Rate |
$4,038.80 |
| Rate for Payer: Aetna Commercial |
$3,951.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,326.70
|
| Rate for Payer: Cash Price |
$1,317.00
|
| Rate for Payer: Cigna Commercial |
$4,038.80
|
| Rate for Payer: Health EOS Commercial |
$3,907.10
|
| Rate for Payer: HFN Commercial |
$4,038.80
|
| Rate for Payer: Multiplan Commercial |
$3,512.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,634.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,038.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,151.10
|
| Rate for Payer: Quartz Commercial |
$2,634.00
|
| Rate for Payer: WEA Trust Commercial |
$2,414.50
|
| Rate for Payer: WPS Commercial |
$3,251.67
|
|
|
1.5MM LCP T-PLATE 3H HEAD/8H SHAFT 02.114.506
|
Facility
IP
|
$5,936.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508923
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,908.64 |
| Max. Negotiated Rate |
$5,461.12 |
| Rate for Payer: Aetna Commercial |
$5,342.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,146.08
|
| Rate for Payer: Cash Price |
$1,780.80
|
| Rate for Payer: Cigna Commercial |
$5,461.12
|
| Rate for Payer: Health EOS Commercial |
$5,283.04
|
| Rate for Payer: HFN Commercial |
$5,461.12
|
| Rate for Payer: Multiplan Commercial |
$4,748.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,561.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,461.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,908.64
|
| Rate for Payer: Quartz Commercial |
$3,561.60
|
| Rate for Payer: WEA Trust Commercial |
$3,264.80
|
| Rate for Payer: WPS Commercial |
$4,396.80
|
|
|
1.5MM LCP T-PLATE 3H HEAD/8H SHAFT 02.114.506
|
Facility
OP
|
$5,936.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508923
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,662.08 |
| Max. Negotiated Rate |
$5,461.12 |
| Rate for Payer: Aetna Commercial |
$5,342.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,104.96
|
| Rate for Payer: Aetna Managed Medicare |
$1,662.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,858.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,968.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,849.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,146.08
|
| Rate for Payer: Cash Price |
$1,780.80
|
| Rate for Payer: Cigna Commercial |
$5,461.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,321.79
|
| Rate for Payer: Health EOS Commercial |
$5,283.04
|
| Rate for Payer: HFN Commercial |
$5,461.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,452.00
|
| Rate for Payer: Multiplan Commercial |
$4,748.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,561.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,461.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,908.64
|
| Rate for Payer: Quartz Commercial |
$3,858.40
|
| Rate for Payer: Quartz Medicare Advantage |
$3,561.60
|
| Rate for Payer: WEA Trust Commercial |
$3,264.80
|
| Rate for Payer: WPS Commercial |
$4,396.80
|
|
|
1.5MM LCP T-PLATE 4H HEAD/8H SHAFT 02.114.507
|
Facility
OP
|
$5,936.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508924
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,662.08 |
| Max. Negotiated Rate |
$5,461.12 |
| Rate for Payer: Aetna Commercial |
$5,342.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,104.96
|
| Rate for Payer: Aetna Managed Medicare |
$1,662.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,858.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,968.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,849.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,146.08
|
| Rate for Payer: Cash Price |
$1,780.80
|
| Rate for Payer: Cigna Commercial |
$5,461.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,321.79
|
| Rate for Payer: Health EOS Commercial |
$5,283.04
|
| Rate for Payer: HFN Commercial |
$5,461.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,452.00
|
| Rate for Payer: Multiplan Commercial |
$4,748.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,561.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,461.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,908.64
|
| Rate for Payer: Quartz Commercial |
$3,858.40
|
| Rate for Payer: Quartz Medicare Advantage |
$3,561.60
|
| Rate for Payer: WEA Trust Commercial |
$3,264.80
|
| Rate for Payer: WPS Commercial |
$4,396.80
|
|
|
1.5MM LCP T-PLATE 4H HEAD/8H SHAFT 02.114.507
|
Facility
IP
|
$5,936.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508924
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,908.64 |
| Max. Negotiated Rate |
$5,461.12 |
| Rate for Payer: Aetna Commercial |
$5,342.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,146.08
|
| Rate for Payer: Cash Price |
$1,780.80
|
| Rate for Payer: Cigna Commercial |
$5,461.12
|
| Rate for Payer: Health EOS Commercial |
$5,283.04
|
| Rate for Payer: HFN Commercial |
$5,461.12
|
| Rate for Payer: Multiplan Commercial |
$4,748.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,561.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,461.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,908.64
|
| Rate for Payer: Quartz Commercial |
$3,561.60
|
| Rate for Payer: WEA Trust Commercial |
$3,264.80
|
| Rate for Payer: WPS Commercial |
$4,396.80
|
|
|
1.5MM STR PLATE 12 HOLE 246.191
|
Facility
OP
|
$4,159.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508602
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,164.52 |
| Max. Negotiated Rate |
$3,826.28 |
| Rate for Payer: Aetna Commercial |
$3,743.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,576.74
|
| Rate for Payer: Aetna Managed Medicare |
$1,164.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,703.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,079.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,996.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,204.27
|
| Rate for Payer: Cash Price |
$1,247.70
|
| Rate for Payer: Cigna Commercial |
$3,826.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,327.38
|
| Rate for Payer: Health EOS Commercial |
$3,701.51
|
| Rate for Payer: HFN Commercial |
$3,826.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,119.25
|
| Rate for Payer: Multiplan Commercial |
$3,327.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,495.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,826.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,037.91
|
| Rate for Payer: Quartz Commercial |
$2,703.35
|
| Rate for Payer: Quartz Medicare Advantage |
$2,495.40
|
| Rate for Payer: WEA Trust Commercial |
$2,287.45
|
| Rate for Payer: WPS Commercial |
$3,080.57
|
|
|
1.5MM STR PLATE 12 HOLE 246.191
|
Facility
IP
|
$4,159.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508602
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,037.91 |
| Max. Negotiated Rate |
$3,826.28 |
| Rate for Payer: Aetna Commercial |
$3,743.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,204.27
|
| Rate for Payer: Cash Price |
$1,247.70
|
| Rate for Payer: Cigna Commercial |
$3,826.28
|
| Rate for Payer: Health EOS Commercial |
$3,701.51
|
| Rate for Payer: HFN Commercial |
$3,826.28
|
| Rate for Payer: Multiplan Commercial |
$3,327.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,495.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,826.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,037.91
|
| Rate for Payer: Quartz Commercial |
$2,495.40
|
| Rate for Payer: WEA Trust Commercial |
$2,287.45
|
| Rate for Payer: WPS Commercial |
$3,080.57
|
|
|
1.5MM STR PLATE 6 HOLE 246.031
|
Facility
OP
|
$3,420.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508600
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$957.60 |
| Max. Negotiated Rate |
$3,146.40 |
| Rate for Payer: Aetna Commercial |
$3,078.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,941.20
|
| Rate for Payer: Aetna Managed Medicare |
$957.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,223.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,710.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,641.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,812.60
|
| Rate for Payer: Cash Price |
$1,026.00
|
| Rate for Payer: Cigna Commercial |
$3,146.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,913.83
|
| Rate for Payer: Health EOS Commercial |
$3,043.80
|
| Rate for Payer: HFN Commercial |
$3,146.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,565.00
|
| Rate for Payer: Multiplan Commercial |
$2,736.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,052.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,146.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,675.80
|
| Rate for Payer: Quartz Commercial |
$2,223.00
|
| Rate for Payer: Quartz Medicare Advantage |
$2,052.00
|
| Rate for Payer: WEA Trust Commercial |
$1,881.00
|
| Rate for Payer: WPS Commercial |
$2,533.19
|
|
|
1.5MM STR PLATE 6 HOLE 246.031
|
Facility
IP
|
$3,420.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508600
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,675.80 |
| Max. Negotiated Rate |
$3,146.40 |
| Rate for Payer: Aetna Commercial |
$3,078.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,812.60
|
| Rate for Payer: Cash Price |
$1,026.00
|
| Rate for Payer: Cigna Commercial |
$3,146.40
|
| Rate for Payer: Health EOS Commercial |
$3,043.80
|
| Rate for Payer: HFN Commercial |
$3,146.40
|
| Rate for Payer: Multiplan Commercial |
$2,736.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,052.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,146.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,675.80
|
| Rate for Payer: Quartz Commercial |
$2,052.00
|
| Rate for Payer: WEA Trust Commercial |
$1,881.00
|
| Rate for Payer: WPS Commercial |
$2,533.19
|
|
|
1.5MM T PLATE 3 HOLE HEAD 8 HOLE SHAFT 246.233
|
Facility
OP
|
$3,819.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508667
|
|
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
|
|
|
1.5MM T PLATE 3 HOLE HEAD 8 HOLE SHAFT 246.233
|
Facility
IP
|
$3,819.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508667
|
|
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
|
|
|
1.5MM T PLATE 4 HOLE HEAD 8 HOLE SHAFT 246.234
|
Facility
IP
|
$2,488.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,219.12 |
| Max. Negotiated Rate |
$2,288.96 |
| Rate for Payer: Aetna Commercial |
$2,239.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,318.64
|
| Rate for Payer: Cash Price |
$746.40
|
| Rate for Payer: Cigna Commercial |
$2,288.96
|
| Rate for Payer: Health EOS Commercial |
$2,214.32
|
| Rate for Payer: HFN Commercial |
$2,288.96
|
| Rate for Payer: Multiplan Commercial |
$1,990.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,492.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,288.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,219.12
|
| Rate for Payer: Quartz Commercial |
$1,492.80
|
| Rate for Payer: WEA Trust Commercial |
$1,368.40
|
| Rate for Payer: WPS Commercial |
$1,842.86
|
|
|
1.5MM T PLATE 4 HOLE HEAD 8 HOLE SHAFT 246.234
|
Facility
OP
|
$2,488.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$696.64 |
| Max. Negotiated Rate |
$2,288.96 |
| Rate for Payer: Aetna Commercial |
$2,239.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,139.68
|
| Rate for Payer: Aetna Managed Medicare |
$696.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,617.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,244.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,194.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,318.64
|
| Rate for Payer: Cash Price |
$746.40
|
| Rate for Payer: Cigna Commercial |
$2,288.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,392.28
|
| Rate for Payer: Health EOS Commercial |
$2,214.32
|
| Rate for Payer: HFN Commercial |
$2,288.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,866.00
|
| Rate for Payer: Multiplan Commercial |
$1,990.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,492.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,288.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,219.12
|
| Rate for Payer: Quartz Commercial |
$1,617.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,492.80
|
| Rate for Payer: WEA Trust Commercial |
$1,368.40
|
| Rate for Payer: WPS Commercial |
$1,842.86
|
|
|
16 - Catheter size
|
Facility
IP
|
$93.00
|
|
| Hospital Charge Code |
2999975
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$45.57 |
| Max. Negotiated Rate |
$85.56 |
| Rate for Payer: Aetna Commercial |
$83.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.29
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$85.56
|
| Rate for Payer: Health EOS Commercial |
$82.77
|
| Rate for Payer: HFN Commercial |
$85.56
|
| Rate for Payer: Multiplan Commercial |
$74.40
|
| Rate for Payer: NAPHCARE Commercial |
$55.80
|
| Rate for Payer: Preferred Network Access Commercial |
$85.56
|
| Rate for Payer: Quartz Beloit One Network |
$45.57
|
| Rate for Payer: Quartz Commercial |
$55.80
|
| Rate for Payer: WEA Trust Commercial |
$51.15
|
| Rate for Payer: WPS Commercial |
$68.89
|
|
|
16 - Catheter size
|
Facility
OP
|
$93.00
|
|
| Hospital Charge Code |
2999975
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$26.04 |
| Max. Negotiated Rate |
$372.00 |
| Rate for Payer: Quartz Commercial |
$60.45
|
| Rate for Payer: Aetna Commercial |
$83.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.98
|
| Rate for Payer: Aetna Managed Medicare |
$26.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$60.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$46.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$44.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.29
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$85.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$52.04
|
| Rate for Payer: Health EOS Commercial |
$82.77
|
| Rate for Payer: HFN Commercial |
$85.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.75
|
| Rate for Payer: Multiplan Commercial |
$74.40
|
| Rate for Payer: NAPHCARE Commercial |
$55.80
|
| Rate for Payer: Preferred Network Access Commercial |
$85.56
|
| Rate for Payer: Quartz Beloit One Network |
$45.57
|
| Rate for Payer: Quartz Medicare Advantage |
$55.80
|
| Rate for Payer: The Alliance Commercial |
$372.00
|
| Rate for Payer: WEA Trust Commercial |
$51.15
|
| Rate for Payer: WPS Commercial |
$68.89
|
|
|
17-Hydroxypregnenolone
|
Facility
OP
|
$425.00
|
|
|
Service Code
|
CPT 84143
|
| Hospital Charge Code |
977765
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.81 |
| Max. Negotiated Rate |
$1,700.00 |
| Rate for Payer: Aetna Commercial |
$382.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$365.50
|
| Rate for Payer: Aetna Managed Medicare |
$22.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$85.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$39.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$37.86
|
| Rate for Payer: Anthem Medicaid |
$23.57
|
| Rate for Payer: Anthem Medicare Advantage |
$22.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$225.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22.81
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cigna Commercial |
$391.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$22.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$23.57
|
| Rate for Payer: Dean Health Medicaid |
$23.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$22.81
|
| Rate for Payer: Health EOS Commercial |
$378.25
|
| Rate for Payer: HFN Commercial |
$391.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$84.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$22.81
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$23.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22.81
|
| Rate for Payer: Managed Health Services Medicaid |
$24.51
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$22.81
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$22.81
|
| Rate for Payer: Multiplan Commercial |
$340.00
|
| Rate for Payer: NAPHCARE Commercial |
$34.22
|
| Rate for Payer: Preferred Network Access Commercial |
$391.00
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$23.57
|
| Rate for Payer: Quartz Beloit One Network |
$208.25
|
| Rate for Payer: Quartz Commercial |
$276.25
|
| Rate for Payer: Quartz Medicare Advantage |
$22.81
|
| Rate for Payer: The Alliance Commercial |
$1,700.00
|
| Rate for Payer: United Healthcare Medicaid |
$23.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.81
|
| Rate for Payer: United Healthcare PPO |
$318.75
|
| Rate for Payer: WEA Trust Commercial |
$233.75
|
| Rate for Payer: Wellcare Medicare |
$22.81
|
| Rate for Payer: WMAP Medicaid |
$23.57
|
| Rate for Payer: WPS Commercial |
$314.80
|
|
|
17-Hydroxypregnenolone
|
Professional
|
$425.00
|
|
|
Service Code
|
CPT 84143
|
| Hospital Charge Code |
977765
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.81 |
| Max. Negotiated Rate |
$403.75 |
| Rate for Payer: Aetna Commercial |
$403.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$365.50
|
| Rate for Payer: Aetna Managed Medicare |
$22.81
|
| Rate for Payer: Anthem Medicare Advantage |
$22.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22.81
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cigna Commercial |
$403.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$212.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22.81
|
| Rate for Payer: Health EOS Commercial |
$386.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$80.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22.81
|
| Rate for Payer: Multiplan Commercial |
$340.00
|
| Rate for Payer: Preferred Network Access Commercial |
$403.75
|
| Rate for Payer: Quartz Beloit One Network |
$187.00
|
| Rate for Payer: Quartz Commercial |
$242.25
|
| Rate for Payer: Quartz Medicare Advantage |
$22.81
|
| Rate for Payer: The Alliance Commercial |
$90.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.81
|
| Rate for Payer: WEA Trust Commercial |
$233.75
|
| Rate for Payer: WPS Commercial |
$100.36
|
|
|
17-Hydroxypregnenolone
|
Facility
IP
|
$425.00
|
|
|
Service Code
|
CPT 84143
|
| Hospital Charge Code |
977765
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$208.25 |
| Max. Negotiated Rate |
$391.00 |
| Rate for Payer: Aetna Commercial |
$382.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$225.25
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cigna Commercial |
$391.00
|
| Rate for Payer: Health EOS Commercial |
$378.25
|
| Rate for Payer: HFN Commercial |
$391.00
|
| Rate for Payer: Multiplan Commercial |
$340.00
|
| Rate for Payer: NAPHCARE Commercial |
$255.00
|
| Rate for Payer: Preferred Network Access Commercial |
$391.00
|
| Rate for Payer: Quartz Beloit One Network |
$208.25
|
| Rate for Payer: Quartz Commercial |
$255.00
|
| Rate for Payer: WEA Trust Commercial |
$233.75
|
| Rate for Payer: WPS Commercial |
$314.80
|
|
|
17-Hydroxyprogesterone
|
Facility
OP
|
$415.00
|
|
|
Service Code
|
CPT 83498
|
| Hospital Charge Code |
977764
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.17 |
| Max. Negotiated Rate |
$1,660.00 |
| Rate for Payer: Aetna Commercial |
$373.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$356.90
|
| Rate for Payer: Aetna Managed Medicare |
$27.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$101.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$47.55
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$45.10
|
| Rate for Payer: Anthem Medicaid |
$28.07
|
| Rate for Payer: Anthem Medicare Advantage |
$27.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$219.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27.17
|
| Rate for Payer: Cash Price |
$124.50
|
| Rate for Payer: Cash Price |
$124.50
|
| Rate for Payer: Cigna Commercial |
$381.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$27.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$28.07
|
| Rate for Payer: Dean Health Medicaid |
$28.07
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$27.17
|
| Rate for Payer: Health EOS Commercial |
$369.35
|
| Rate for Payer: HFN Commercial |
$381.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$101.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$27.17
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$28.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27.17
|
| Rate for Payer: Managed Health Services Medicaid |
$29.19
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$27.17
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$27.17
|
| Rate for Payer: Multiplan Commercial |
$332.00
|
| Rate for Payer: NAPHCARE Commercial |
$40.76
|
| Rate for Payer: Preferred Network Access Commercial |
$381.80
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$28.07
|
| Rate for Payer: Quartz Beloit One Network |
$203.35
|
| Rate for Payer: Quartz Commercial |
$269.75
|
| Rate for Payer: Quartz Medicare Advantage |
$27.17
|
| Rate for Payer: The Alliance Commercial |
$1,660.00
|
| Rate for Payer: United Healthcare Medicaid |
$28.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.17
|
| Rate for Payer: United Healthcare PPO |
$311.25
|
| Rate for Payer: WEA Trust Commercial |
$228.25
|
| Rate for Payer: Wellcare Medicare |
$27.17
|
| Rate for Payer: WMAP Medicaid |
$28.07
|
| Rate for Payer: WPS Commercial |
$307.39
|
|
