|
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 |
$2,104.65 |
| Max. Negotiated Rate |
$3,951.58 |
| Rate for Payer: Aetna Commercial |
$3,865.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,693.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,276.46
|
| Rate for Payer: Cash Price |
$1,239.00
|
| Rate for Payer: Cigna Commercial |
$3,951.58
|
| Rate for Payer: Health EOS Commercial |
$3,822.73
|
| Rate for Payer: HFN Commercial |
$3,951.58
|
| Rate for Payer: Multiplan Commercial |
$3,436.16
|
| Rate for Payer: Preferred Network Access Commercial |
$3,951.58
|
| Rate for Payer: Quartz Beloit One Network |
$2,104.65
|
| Rate for Payer: Quartz Commercial |
$2,577.12
|
| Rate for Payer: WEA Trust Commercial |
$2,362.36
|
| Rate for Payer: WPS Commercial |
$3,181.34
|
|
|
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 |
$1,157.81 |
| Max. Negotiated Rate |
$3,804.24 |
| Rate for Payer: Aetna Commercial |
$3,721.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,556.13
|
| Rate for Payer: Aetna Managed Medicare |
$1,157.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,687.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,067.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,984.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,191.57
|
| Rate for Payer: Cash Price |
$1,192.80
|
| Rate for Payer: Cigna Commercial |
$3,804.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,314.03
|
| Rate for Payer: Health EOS Commercial |
$3,680.19
|
| Rate for Payer: HFN Commercial |
$3,804.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,101.28
|
| Rate for Payer: Multiplan Commercial |
$3,308.03
|
| Rate for Payer: NAPHCARE Commercial |
$2,481.02
|
| Rate for Payer: Preferred Network Access Commercial |
$3,804.24
|
| Rate for Payer: Quartz Beloit One Network |
$2,026.17
|
| Rate for Payer: Quartz Commercial |
$2,687.78
|
| Rate for Payer: Quartz Medicare Advantage |
$2,481.02
|
| Rate for Payer: The Alliance Commercial |
$2,067.52
|
| Rate for Payer: WEA Trust Commercial |
$2,274.27
|
| Rate for Payer: WPS Commercial |
$3,062.71
|
|
|
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 |
$2,026.17 |
| Max. Negotiated Rate |
$3,804.24 |
| Rate for Payer: Aetna Commercial |
$3,721.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,556.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,191.57
|
| Rate for Payer: Cash Price |
$1,192.80
|
| Rate for Payer: Cigna Commercial |
$3,804.24
|
| Rate for Payer: Health EOS Commercial |
$3,680.19
|
| Rate for Payer: HFN Commercial |
$3,804.24
|
| Rate for Payer: Multiplan Commercial |
$3,308.03
|
| Rate for Payer: Preferred Network Access Commercial |
$3,804.24
|
| Rate for Payer: Quartz Beloit One Network |
$2,026.17
|
| Rate for Payer: Quartz Commercial |
$2,481.02
|
| Rate for Payer: WEA Trust Commercial |
$2,274.27
|
| Rate for Payer: WPS Commercial |
$3,062.71
|
|
|
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 |
$1,654.02 |
| 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
|
|
|
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 |
$2,894.53 |
| 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
|
|
|
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 |
$2,237.14 |
| Max. Negotiated Rate |
$4,200.35 |
| Rate for Payer: Aetna Commercial |
$4,109.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,926.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,419.77
|
| Rate for Payer: Cash Price |
$1,317.00
|
| Rate for Payer: Cigna Commercial |
$4,200.35
|
| Rate for Payer: Health EOS Commercial |
$4,063.38
|
| Rate for Payer: HFN Commercial |
$4,200.35
|
| Rate for Payer: Multiplan Commercial |
$3,652.48
|
| Rate for Payer: Preferred Network Access Commercial |
$4,200.35
|
| Rate for Payer: Quartz Beloit One Network |
$2,237.14
|
| Rate for Payer: Quartz Commercial |
$2,739.36
|
| Rate for Payer: WEA Trust Commercial |
$2,511.08
|
| Rate for Payer: WPS Commercial |
$3,381.62
|
|
|
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 |
$1,278.37 |
| Max. Negotiated Rate |
$4,200.35 |
| Rate for Payer: Aetna Commercial |
$4,109.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,926.42
|
| Rate for Payer: Aetna Managed Medicare |
$1,278.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,967.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,282.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,191.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,419.77
|
| Rate for Payer: Cash Price |
$1,317.00
|
| Rate for Payer: Cigna Commercial |
$4,200.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,554.98
|
| Rate for Payer: Health EOS Commercial |
$4,063.38
|
| Rate for Payer: HFN Commercial |
$4,200.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,424.20
|
| Rate for Payer: Multiplan Commercial |
$3,652.48
|
| Rate for Payer: NAPHCARE Commercial |
$2,739.36
|
| Rate for Payer: Preferred Network Access Commercial |
$4,200.35
|
| Rate for Payer: Quartz Beloit One Network |
$2,237.14
|
| Rate for Payer: Quartz Commercial |
$2,967.64
|
| Rate for Payer: Quartz Medicare Advantage |
$2,739.36
|
| Rate for Payer: The Alliance Commercial |
$2,282.80
|
| Rate for Payer: WEA Trust Commercial |
$2,511.08
|
| Rate for Payer: WPS Commercial |
$3,381.62
|
|
|
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 |
$3,024.99 |
| Max. Negotiated Rate |
$5,679.56 |
| Rate for Payer: Aetna Commercial |
$5,556.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,309.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,271.92
|
| Rate for Payer: Cash Price |
$1,780.80
|
| Rate for Payer: Cigna Commercial |
$5,679.56
|
| Rate for Payer: Health EOS Commercial |
$5,494.36
|
| Rate for Payer: HFN Commercial |
$5,679.56
|
| Rate for Payer: Multiplan Commercial |
$4,938.75
|
| Rate for Payer: Preferred Network Access Commercial |
$5,679.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,024.99
|
| Rate for Payer: Quartz Commercial |
$3,704.06
|
| Rate for Payer: WEA Trust Commercial |
$3,395.39
|
| Rate for Payer: WPS Commercial |
$4,572.50
|
|
|
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 |
$1,728.56 |
| Max. Negotiated Rate |
$5,679.56 |
| Rate for Payer: Aetna Commercial |
$5,556.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,309.16
|
| Rate for Payer: Aetna Managed Medicare |
$1,728.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,012.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,086.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,963.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,271.92
|
| Rate for Payer: Cash Price |
$1,780.80
|
| Rate for Payer: Cigna Commercial |
$5,679.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,454.75
|
| Rate for Payer: Health EOS Commercial |
$5,494.36
|
| Rate for Payer: HFN Commercial |
$5,679.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,630.08
|
| Rate for Payer: Multiplan Commercial |
$4,938.75
|
| Rate for Payer: NAPHCARE Commercial |
$3,704.06
|
| Rate for Payer: Preferred Network Access Commercial |
$5,679.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,024.99
|
| Rate for Payer: Quartz Commercial |
$4,012.74
|
| Rate for Payer: Quartz Medicare Advantage |
$3,704.06
|
| Rate for Payer: The Alliance Commercial |
$3,086.72
|
| Rate for Payer: WEA Trust Commercial |
$3,395.39
|
| Rate for Payer: WPS Commercial |
$4,572.50
|
|
|
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 |
$1,728.56 |
| Max. Negotiated Rate |
$5,679.56 |
| Rate for Payer: Aetna Commercial |
$5,556.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,309.16
|
| Rate for Payer: Aetna Managed Medicare |
$1,728.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,012.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,086.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,963.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,271.92
|
| Rate for Payer: Cash Price |
$1,780.80
|
| Rate for Payer: Cigna Commercial |
$5,679.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,454.75
|
| Rate for Payer: Health EOS Commercial |
$5,494.36
|
| Rate for Payer: HFN Commercial |
$5,679.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,630.08
|
| Rate for Payer: Multiplan Commercial |
$4,938.75
|
| Rate for Payer: NAPHCARE Commercial |
$3,704.06
|
| Rate for Payer: Preferred Network Access Commercial |
$5,679.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,024.99
|
| Rate for Payer: Quartz Commercial |
$4,012.74
|
| Rate for Payer: Quartz Medicare Advantage |
$3,704.06
|
| Rate for Payer: The Alliance Commercial |
$3,086.72
|
| Rate for Payer: WEA Trust Commercial |
$3,395.39
|
| Rate for Payer: WPS Commercial |
$4,572.50
|
|
|
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 |
$3,024.99 |
| Max. Negotiated Rate |
$5,679.56 |
| Rate for Payer: Aetna Commercial |
$5,556.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,309.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,271.92
|
| Rate for Payer: Cash Price |
$1,780.80
|
| Rate for Payer: Cigna Commercial |
$5,679.56
|
| Rate for Payer: Health EOS Commercial |
$5,494.36
|
| Rate for Payer: HFN Commercial |
$5,679.56
|
| Rate for Payer: Multiplan Commercial |
$4,938.75
|
| Rate for Payer: Preferred Network Access Commercial |
$5,679.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,024.99
|
| Rate for Payer: Quartz Commercial |
$3,704.06
|
| Rate for Payer: WEA Trust Commercial |
$3,395.39
|
| Rate for Payer: WPS Commercial |
$4,572.50
|
|
|
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 |
$2,119.43 |
| Max. Negotiated Rate |
$3,979.33 |
| Rate for Payer: Aetna Commercial |
$3,892.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,719.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,292.44
|
| Rate for Payer: Cash Price |
$1,247.70
|
| Rate for Payer: Cigna Commercial |
$3,979.33
|
| Rate for Payer: Health EOS Commercial |
$3,849.57
|
| Rate for Payer: HFN Commercial |
$3,979.33
|
| Rate for Payer: Multiplan Commercial |
$3,460.29
|
| Rate for Payer: Preferred Network Access Commercial |
$3,979.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,119.43
|
| Rate for Payer: Quartz Commercial |
$2,595.22
|
| Rate for Payer: WEA Trust Commercial |
$2,378.95
|
| Rate for Payer: WPS Commercial |
$3,203.68
|
|
|
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 |
$1,211.10 |
| Max. Negotiated Rate |
$3,979.33 |
| Rate for Payer: Aetna Commercial |
$3,892.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,719.81
|
| Rate for Payer: Aetna Managed Medicare |
$1,211.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,811.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,162.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,076.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,292.44
|
| Rate for Payer: Cash Price |
$1,247.70
|
| Rate for Payer: Cigna Commercial |
$3,979.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,420.54
|
| Rate for Payer: Health EOS Commercial |
$3,849.57
|
| Rate for Payer: HFN Commercial |
$3,979.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,244.02
|
| Rate for Payer: Multiplan Commercial |
$3,460.29
|
| Rate for Payer: NAPHCARE Commercial |
$2,595.22
|
| Rate for Payer: Preferred Network Access Commercial |
$3,979.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,119.43
|
| Rate for Payer: Quartz Commercial |
$2,811.48
|
| Rate for Payer: Quartz Medicare Advantage |
$2,595.22
|
| Rate for Payer: The Alliance Commercial |
$2,162.68
|
| Rate for Payer: WEA Trust Commercial |
$2,378.95
|
| Rate for Payer: WPS Commercial |
$3,203.68
|
|
|
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 |
$995.90 |
| Max. Negotiated Rate |
$3,272.26 |
| Rate for Payer: Aetna Commercial |
$3,201.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,058.85
|
| Rate for Payer: Aetna Managed Medicare |
$995.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,311.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,778.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,707.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,885.10
|
| Rate for Payer: Cash Price |
$1,026.00
|
| Rate for Payer: Cigna Commercial |
$3,272.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,990.44
|
| Rate for Payer: Health EOS Commercial |
$3,165.55
|
| Rate for Payer: HFN Commercial |
$3,272.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,667.60
|
| Rate for Payer: Multiplan Commercial |
$2,845.44
|
| Rate for Payer: NAPHCARE Commercial |
$2,134.08
|
| Rate for Payer: Preferred Network Access Commercial |
$3,272.26
|
| Rate for Payer: Quartz Beloit One Network |
$1,742.83
|
| Rate for Payer: Quartz Commercial |
$2,311.92
|
| Rate for Payer: Quartz Medicare Advantage |
$2,134.08
|
| Rate for Payer: The Alliance Commercial |
$1,778.40
|
| Rate for Payer: WEA Trust Commercial |
$1,956.24
|
| Rate for Payer: WPS Commercial |
$2,634.43
|
|
|
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 |
$1,742.83 |
| Max. Negotiated Rate |
$3,272.26 |
| Rate for Payer: Aetna Commercial |
$3,201.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,058.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,885.10
|
| Rate for Payer: Cash Price |
$1,026.00
|
| Rate for Payer: Cigna Commercial |
$3,272.26
|
| Rate for Payer: Health EOS Commercial |
$3,165.55
|
| Rate for Payer: HFN Commercial |
$3,272.26
|
| Rate for Payer: Multiplan Commercial |
$2,845.44
|
| Rate for Payer: Preferred Network Access Commercial |
$3,272.26
|
| Rate for Payer: Quartz Beloit One Network |
$1,742.83
|
| Rate for Payer: Quartz Commercial |
$2,134.08
|
| Rate for Payer: WEA Trust Commercial |
$1,956.24
|
| Rate for Payer: WPS Commercial |
$2,634.43
|
|
|
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 |
$1,112.09 |
| 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
|
|
|
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 |
$1,946.16 |
| 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
|
|
|
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 |
$1,267.88 |
| Max. Negotiated Rate |
$2,380.52 |
| Rate for Payer: Aetna Commercial |
$2,328.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,225.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,371.39
|
| Rate for Payer: Cash Price |
$746.40
|
| Rate for Payer: Cigna Commercial |
$2,380.52
|
| Rate for Payer: Health EOS Commercial |
$2,302.89
|
| Rate for Payer: HFN Commercial |
$2,380.52
|
| Rate for Payer: Multiplan Commercial |
$2,070.02
|
| Rate for Payer: Preferred Network Access Commercial |
$2,380.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,267.88
|
| Rate for Payer: Quartz Commercial |
$1,552.51
|
| Rate for Payer: WEA Trust Commercial |
$1,423.14
|
| Rate for Payer: WPS Commercial |
$1,916.51
|
|
|
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 |
$724.51 |
| Max. Negotiated Rate |
$2,380.52 |
| Rate for Payer: Aetna Commercial |
$2,328.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,225.27
|
| Rate for Payer: Aetna Managed Medicare |
$724.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,681.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,293.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,242.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,371.39
|
| Rate for Payer: Cash Price |
$746.40
|
| Rate for Payer: Cigna Commercial |
$2,380.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,448.02
|
| Rate for Payer: Health EOS Commercial |
$2,302.89
|
| Rate for Payer: HFN Commercial |
$2,380.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,940.64
|
| Rate for Payer: Multiplan Commercial |
$2,070.02
|
| Rate for Payer: NAPHCARE Commercial |
$1,552.51
|
| Rate for Payer: Preferred Network Access Commercial |
$2,380.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,267.88
|
| Rate for Payer: Quartz Commercial |
$1,681.89
|
| Rate for Payer: Quartz Medicare Advantage |
$1,552.51
|
| Rate for Payer: The Alliance Commercial |
$1,293.76
|
| Rate for Payer: WEA Trust Commercial |
$1,423.14
|
| Rate for Payer: WPS Commercial |
$1,916.51
|
|
|
16 - Catheter size
|
Facility
|
OP
|
$93.00
|
|
| Hospital Charge Code |
2999975
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$27.08 |
| Max. Negotiated Rate |
$88.98 |
| Rate for Payer: Aetna Commercial |
$87.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.18
|
| Rate for Payer: Aetna Managed Medicare |
$27.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$62.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$48.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$46.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.26
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$88.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.13
|
| Rate for Payer: Health EOS Commercial |
$86.08
|
| Rate for Payer: HFN Commercial |
$88.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$72.54
|
| Rate for Payer: Multiplan Commercial |
$77.38
|
| Rate for Payer: NAPHCARE Commercial |
$58.03
|
| Rate for Payer: Preferred Network Access Commercial |
$88.98
|
| Rate for Payer: Quartz Beloit One Network |
$47.39
|
| Rate for Payer: Quartz Commercial |
$62.87
|
| Rate for Payer: Quartz Medicare Advantage |
$58.03
|
| Rate for Payer: The Alliance Commercial |
$48.36
|
| Rate for Payer: WEA Trust Commercial |
$53.20
|
| Rate for Payer: WPS Commercial |
$71.64
|
|
|
16 - Catheter size
|
Facility
|
IP
|
$93.00
|
|
| Hospital Charge Code |
2999975
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$47.39 |
| Max. Negotiated Rate |
$88.98 |
| Rate for Payer: Aetna Commercial |
$87.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.26
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$88.98
|
| Rate for Payer: Health EOS Commercial |
$86.08
|
| Rate for Payer: HFN Commercial |
$88.98
|
| Rate for Payer: Multiplan Commercial |
$77.38
|
| Rate for Payer: Preferred Network Access Commercial |
$88.98
|
| Rate for Payer: Quartz Beloit One Network |
$47.39
|
| Rate for Payer: Quartz Commercial |
$58.03
|
| Rate for Payer: WEA Trust Commercial |
$53.20
|
| Rate for Payer: WPS Commercial |
$71.64
|
|
|
17-Hydroxypregnenolone
|
Professional
|
Both
|
$425.00
|
|
|
Service Code
|
CPT 84143
|
| Hospital Charge Code |
977765
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.72 |
| Max. Negotiated Rate |
$419.90 |
| Rate for Payer: Aetna Commercial |
$419.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$380.12
|
| Rate for Payer: Aetna Managed Medicare |
$23.72
|
| Rate for Payer: Anthem Medicare Advantage |
$23.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23.72
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cigna Commercial |
$419.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$221.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23.72
|
| Rate for Payer: Health EOS Commercial |
$402.22
|
| Rate for Payer: HFN Commercial |
$419.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$83.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$23.72
|
| Rate for Payer: Multiplan Commercial |
$353.60
|
| Rate for Payer: NAPHCARE Commercial |
$35.58
|
| Rate for Payer: Preferred Network Access Commercial |
$419.90
|
| Rate for Payer: Quartz Beloit One Network |
$194.48
|
| Rate for Payer: Quartz Commercial |
$251.94
|
| Rate for Payer: Quartz Medicare Advantage |
$23.72
|
| Rate for Payer: The Alliance Commercial |
$93.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.72
|
| Rate for Payer: WEA Trust Commercial |
$243.10
|
| Rate for Payer: WPS Commercial |
$104.38
|
|
|
17-Hydroxypregnenolone
|
Facility
|
IP
|
$425.00
|
|
|
Service Code
|
CPT 84143
|
| Hospital Charge Code |
977765
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$216.58 |
| Max. Negotiated Rate |
$406.64 |
| Rate for Payer: Aetna Commercial |
$397.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$234.26
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cigna Commercial |
$406.64
|
| Rate for Payer: Health EOS Commercial |
$393.38
|
| Rate for Payer: HFN Commercial |
$406.64
|
| Rate for Payer: Multiplan Commercial |
$353.60
|
| Rate for Payer: Preferred Network Access Commercial |
$406.64
|
| Rate for Payer: Quartz Beloit One Network |
$216.58
|
| Rate for Payer: Quartz Commercial |
$265.20
|
| Rate for Payer: WEA Trust Commercial |
$243.10
|
| Rate for Payer: WPS Commercial |
$327.38
|
|
|
17-Hydroxypregnenolone
|
Facility
|
OP
|
$425.00
|
|
|
Service Code
|
CPT 84143
|
| Hospital Charge Code |
977765
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.72 |
| Max. Negotiated Rate |
$406.64 |
| Rate for Payer: Aetna Commercial |
$397.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$380.12
|
| Rate for Payer: Aetna Managed Medicare |
$23.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$88.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$41.51
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$39.38
|
| Rate for Payer: Anthem Medicare Advantage |
$23.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$234.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23.72
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cigna Commercial |
$406.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$23.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$247.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$23.72
|
| Rate for Payer: Health EOS Commercial |
$393.38
|
| Rate for Payer: HFN Commercial |
$406.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$88.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$23.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$23.72
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$23.72
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$23.72
|
| Rate for Payer: Multiplan Commercial |
$353.60
|
| Rate for Payer: NAPHCARE Commercial |
$35.58
|
| Rate for Payer: Preferred Network Access Commercial |
$406.64
|
| Rate for Payer: Quartz Beloit One Network |
$216.58
|
| Rate for Payer: Quartz Commercial |
$287.30
|
| Rate for Payer: Quartz Medicare Advantage |
$23.72
|
| Rate for Payer: The Alliance Commercial |
$94.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.72
|
| Rate for Payer: United Healthcare PPO |
$331.50
|
| Rate for Payer: WEA Trust Commercial |
$243.10
|
| Rate for Payer: Wellcare Medicare |
$23.72
|
| Rate for Payer: WPS Commercial |
$327.38
|
|
|
17-Hydroxyprogesterone
|
Facility
|
IP
|
$415.00
|
|
|
Service Code
|
CPT 83498
|
| Hospital Charge Code |
977764
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$211.48 |
| Max. Negotiated Rate |
$397.07 |
| Rate for Payer: Aetna Commercial |
$388.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$371.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$228.75
|
| Rate for Payer: Cash Price |
$124.50
|
| Rate for Payer: Cigna Commercial |
$397.07
|
| Rate for Payer: Health EOS Commercial |
$384.12
|
| Rate for Payer: HFN Commercial |
$397.07
|
| Rate for Payer: Multiplan Commercial |
$345.28
|
| Rate for Payer: Preferred Network Access Commercial |
$397.07
|
| Rate for Payer: Quartz Beloit One Network |
$211.48
|
| Rate for Payer: Quartz Commercial |
$258.96
|
| Rate for Payer: WEA Trust Commercial |
$237.38
|
| Rate for Payer: WPS Commercial |
$319.67
|
|
