|
PLATE 6H 3.5 LCP RECON 245.061
|
Facility
|
OP
|
$2,136.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966730
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$598.08 |
| Max. Negotiated Rate |
$8,544.00 |
| Rate for Payer: Aetna Commercial |
$1,922.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,836.96
|
| Rate for Payer: Aetna Managed Medicare |
$598.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,388.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,068.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,025.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,132.08
|
| Rate for Payer: Cash Price |
$640.80
|
| Rate for Payer: Cigna Commercial |
$1,965.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,195.31
|
| Rate for Payer: Health EOS Commercial |
$1,901.04
|
| Rate for Payer: HFN Commercial |
$1,965.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,602.00
|
| Rate for Payer: Multiplan Commercial |
$1,708.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,281.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,965.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,046.64
|
| Rate for Payer: Quartz Commercial |
$1,388.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,281.60
|
| Rate for Payer: The Alliance Commercial |
$8,544.00
|
| Rate for Payer: WEA Trust Commercial |
$1,174.80
|
| Rate for Payer: WPS Commercial |
$1,582.14
|
|
|
PLATE 6H 3.5 LCP RECON 245.061
|
Facility
|
IP
|
$2,136.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966730
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,046.64 |
| Max. Negotiated Rate |
$1,965.12 |
| Rate for Payer: Aetna Commercial |
$1,922.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,836.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,132.08
|
| Rate for Payer: Cash Price |
$640.80
|
| Rate for Payer: Cigna Commercial |
$1,965.12
|
| Rate for Payer: Health EOS Commercial |
$1,901.04
|
| Rate for Payer: HFN Commercial |
$1,965.12
|
| Rate for Payer: Multiplan Commercial |
$1,708.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,281.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,965.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,046.64
|
| Rate for Payer: Quartz Commercial |
$1,281.60
|
| Rate for Payer: WEA Trust Commercial |
$1,174.80
|
| Rate for Payer: WPS Commercial |
$1,582.14
|
|
|
PLATE 6HL 3.5 RT M/D/T 239.904
|
Facility
|
OP
|
$7,386.00
|
|
| Hospital Charge Code |
2966736
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,068.08 |
| Max. Negotiated Rate |
$29,544.00 |
| Rate for Payer: Aetna Commercial |
$6,647.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,351.96
|
| Rate for Payer: Aetna Managed Medicare |
$2,068.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,800.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,693.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,545.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,914.58
|
| Rate for Payer: Cash Price |
$2,215.80
|
| Rate for Payer: Cigna Commercial |
$6,795.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,133.21
|
| Rate for Payer: Health EOS Commercial |
$6,573.54
|
| Rate for Payer: HFN Commercial |
$6,795.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,539.50
|
| Rate for Payer: Multiplan Commercial |
$5,908.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,431.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,795.12
|
| Rate for Payer: Quartz Beloit One Network |
$3,619.14
|
| Rate for Payer: Quartz Commercial |
$4,800.90
|
| Rate for Payer: Quartz Medicare Advantage |
$4,431.60
|
| Rate for Payer: The Alliance Commercial |
$29,544.00
|
| Rate for Payer: WEA Trust Commercial |
$4,062.30
|
| Rate for Payer: WPS Commercial |
$5,470.81
|
|
|
PLATE 6HL 3.5 RT M/D/T 239.904
|
Facility
|
IP
|
$7,386.00
|
|
| Hospital Charge Code |
2966736
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,619.14 |
| Max. Negotiated Rate |
$6,795.12 |
| Rate for Payer: Aetna Commercial |
$6,647.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,351.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,914.58
|
| Rate for Payer: Cash Price |
$2,215.80
|
| Rate for Payer: Cigna Commercial |
$6,795.12
|
| Rate for Payer: Health EOS Commercial |
$6,573.54
|
| Rate for Payer: HFN Commercial |
$6,795.12
|
| Rate for Payer: Multiplan Commercial |
$5,908.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,431.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,795.12
|
| Rate for Payer: Quartz Beloit One Network |
$3,619.14
|
| Rate for Payer: Quartz Commercial |
$4,431.60
|
| Rate for Payer: WEA Trust Commercial |
$4,062.30
|
| Rate for Payer: WPS Commercial |
$5,470.81
|
|
|
PLATE 6 HL LFT PROX FEMUR
|
Facility
|
IP
|
$8,933.00
|
|
| Hospital Charge Code |
2966353
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,377.17 |
| Max. Negotiated Rate |
$8,218.36 |
| Rate for Payer: Aetna Commercial |
$8,039.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,682.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,734.49
|
| Rate for Payer: Cash Price |
$2,679.90
|
| Rate for Payer: Cigna Commercial |
$8,218.36
|
| Rate for Payer: Health EOS Commercial |
$7,950.37
|
| Rate for Payer: HFN Commercial |
$8,218.36
|
| Rate for Payer: Multiplan Commercial |
$7,146.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,359.80
|
| Rate for Payer: Preferred Network Access Commercial |
$8,218.36
|
| Rate for Payer: Quartz Beloit One Network |
$4,377.17
|
| Rate for Payer: Quartz Commercial |
$5,359.80
|
| Rate for Payer: WEA Trust Commercial |
$4,913.15
|
| Rate for Payer: WPS Commercial |
$6,616.67
|
|
|
PLATE 6 HL LFT PROX FEMUR
|
Facility
|
OP
|
$8,933.00
|
|
| Hospital Charge Code |
2966353
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,501.24 |
| Max. Negotiated Rate |
$35,732.00 |
| Rate for Payer: Aetna Commercial |
$8,039.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,682.38
|
| Rate for Payer: Aetna Managed Medicare |
$2,501.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,806.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,466.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,287.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,734.49
|
| Rate for Payer: Cash Price |
$2,679.90
|
| Rate for Payer: Cigna Commercial |
$8,218.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,998.91
|
| Rate for Payer: Health EOS Commercial |
$7,950.37
|
| Rate for Payer: HFN Commercial |
$8,218.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,699.75
|
| Rate for Payer: Multiplan Commercial |
$7,146.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,359.80
|
| Rate for Payer: Preferred Network Access Commercial |
$8,218.36
|
| Rate for Payer: Quartz Beloit One Network |
$4,377.17
|
| Rate for Payer: Quartz Commercial |
$5,806.45
|
| Rate for Payer: Quartz Medicare Advantage |
$5,359.80
|
| Rate for Payer: The Alliance Commercial |
$35,732.00
|
| Rate for Payer: WEA Trust Commercial |
$4,913.15
|
| Rate for Payer: WPS Commercial |
$6,616.67
|
|
|
PLATE 6 HL RT OLECRANON
|
Facility
|
IP
|
$6,224.00
|
|
| Hospital Charge Code |
2966354
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,049.76 |
| Max. Negotiated Rate |
$5,726.08 |
| Rate for Payer: Aetna Commercial |
$5,601.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,352.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,298.72
|
| Rate for Payer: Cash Price |
$1,867.20
|
| Rate for Payer: Cigna Commercial |
$5,726.08
|
| Rate for Payer: Health EOS Commercial |
$5,539.36
|
| Rate for Payer: HFN Commercial |
$5,726.08
|
| Rate for Payer: Multiplan Commercial |
$4,979.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,734.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,726.08
|
| Rate for Payer: Quartz Beloit One Network |
$3,049.76
|
| Rate for Payer: Quartz Commercial |
$3,734.40
|
| Rate for Payer: WEA Trust Commercial |
$3,423.20
|
| Rate for Payer: WPS Commercial |
$4,610.12
|
|
|
PLATE 6 HL RT OLECRANON
|
Facility
|
OP
|
$6,224.00
|
|
| Hospital Charge Code |
2966354
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,742.72 |
| Max. Negotiated Rate |
$24,896.00 |
| Rate for Payer: Aetna Commercial |
$5,601.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,352.64
|
| Rate for Payer: Aetna Managed Medicare |
$1,742.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,045.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,112.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,987.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,298.72
|
| Rate for Payer: Cash Price |
$1,867.20
|
| Rate for Payer: Cigna Commercial |
$5,726.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,482.95
|
| Rate for Payer: Health EOS Commercial |
$5,539.36
|
| Rate for Payer: HFN Commercial |
$5,726.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,668.00
|
| Rate for Payer: Multiplan Commercial |
$4,979.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,734.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,726.08
|
| Rate for Payer: Quartz Beloit One Network |
$3,049.76
|
| Rate for Payer: Quartz Commercial |
$4,045.60
|
| Rate for Payer: Quartz Medicare Advantage |
$3,734.40
|
| Rate for Payer: The Alliance Commercial |
$24,896.00
|
| Rate for Payer: WEA Trust Commercial |
$3,423.20
|
| Rate for Payer: WPS Commercial |
$4,610.12
|
|
|
PLATE 6H LT CONDYLAR 222.657
|
Facility
|
OP
|
$4,507.00
|
|
| Hospital Charge Code |
2966731
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,261.96 |
| Max. Negotiated Rate |
$18,028.00 |
| Rate for Payer: Aetna Commercial |
$4,056.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,876.02
|
| Rate for Payer: Aetna Managed Medicare |
$1,261.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,929.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,253.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,163.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,388.71
|
| Rate for Payer: Cash Price |
$1,352.10
|
| Rate for Payer: Cigna Commercial |
$4,146.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,522.12
|
| Rate for Payer: Health EOS Commercial |
$4,011.23
|
| Rate for Payer: HFN Commercial |
$4,146.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,380.25
|
| Rate for Payer: Multiplan Commercial |
$3,605.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,704.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,146.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,208.43
|
| Rate for Payer: Quartz Commercial |
$2,929.55
|
| Rate for Payer: Quartz Medicare Advantage |
$2,704.20
|
| Rate for Payer: The Alliance Commercial |
$18,028.00
|
| Rate for Payer: WEA Trust Commercial |
$2,478.85
|
| Rate for Payer: WPS Commercial |
$3,338.33
|
|
|
PLATE 6H LT CONDYLAR 222.657
|
Facility
|
IP
|
$4,507.00
|
|
| Hospital Charge Code |
2966731
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,208.43 |
| Max. Negotiated Rate |
$4,146.44 |
| Rate for Payer: Aetna Commercial |
$4,056.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,876.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,388.71
|
| Rate for Payer: Cash Price |
$1,352.10
|
| Rate for Payer: Cigna Commercial |
$4,146.44
|
| Rate for Payer: Health EOS Commercial |
$4,011.23
|
| Rate for Payer: HFN Commercial |
$4,146.44
|
| Rate for Payer: Multiplan Commercial |
$3,605.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,704.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,146.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,208.43
|
| Rate for Payer: Quartz Commercial |
$2,704.20
|
| Rate for Payer: WEA Trust Commercial |
$2,478.85
|
| Rate for Payer: WPS Commercial |
$3,338.33
|
|
|
PLATE 6H LT MED/DIS/TI 239.905
|
Facility
|
IP
|
$5,140.00
|
|
| Hospital Charge Code |
2966733
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,518.60 |
| Max. Negotiated Rate |
$4,728.80 |
| Rate for Payer: Aetna Commercial |
$4,626.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,420.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,724.20
|
| Rate for Payer: Cash Price |
$1,542.00
|
| Rate for Payer: Cigna Commercial |
$4,728.80
|
| Rate for Payer: Health EOS Commercial |
$4,574.60
|
| Rate for Payer: HFN Commercial |
$4,728.80
|
| Rate for Payer: Multiplan Commercial |
$4,112.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,084.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,728.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,518.60
|
| Rate for Payer: Quartz Commercial |
$3,084.00
|
| Rate for Payer: WEA Trust Commercial |
$2,827.00
|
| Rate for Payer: WPS Commercial |
$3,807.20
|
|
|
PLATE 6H LT MED/DIS/TI 239.905
|
Facility
|
OP
|
$5,140.00
|
|
| Hospital Charge Code |
2966733
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,439.20 |
| Max. Negotiated Rate |
$20,560.00 |
| Rate for Payer: Aetna Commercial |
$4,626.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,420.40
|
| Rate for Payer: Aetna Managed Medicare |
$1,439.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,341.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,570.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,467.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,724.20
|
| Rate for Payer: Cash Price |
$1,542.00
|
| Rate for Payer: Cigna Commercial |
$4,728.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,876.34
|
| Rate for Payer: Health EOS Commercial |
$4,574.60
|
| Rate for Payer: HFN Commercial |
$4,728.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,855.00
|
| Rate for Payer: Multiplan Commercial |
$4,112.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,084.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,728.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,518.60
|
| Rate for Payer: Quartz Commercial |
$3,341.00
|
| Rate for Payer: Quartz Medicare Advantage |
$3,084.00
|
| Rate for Payer: The Alliance Commercial |
$20,560.00
|
| Rate for Payer: WEA Trust Commercial |
$2,827.00
|
| Rate for Payer: WPS Commercial |
$3,807.20
|
|
|
PLATE 6H LT PROX/TIB 240.039
|
Facility
|
OP
|
$4,625.00
|
|
| Hospital Charge Code |
2966732
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,295.00 |
| Max. Negotiated Rate |
$18,500.00 |
| Rate for Payer: Aetna Commercial |
$4,162.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,977.50
|
| Rate for Payer: Aetna Managed Medicare |
$1,295.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,006.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,312.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,220.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,451.25
|
| Rate for Payer: Cash Price |
$1,387.50
|
| Rate for Payer: Cigna Commercial |
$4,255.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,588.15
|
| Rate for Payer: Health EOS Commercial |
$4,116.25
|
| Rate for Payer: HFN Commercial |
$4,255.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,468.75
|
| Rate for Payer: Multiplan Commercial |
$3,700.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,775.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,255.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,266.25
|
| Rate for Payer: Quartz Commercial |
$3,006.25
|
| Rate for Payer: Quartz Medicare Advantage |
$2,775.00
|
| Rate for Payer: The Alliance Commercial |
$18,500.00
|
| Rate for Payer: WEA Trust Commercial |
$2,543.75
|
| Rate for Payer: WPS Commercial |
$3,425.74
|
|
|
PLATE 6H LT PROX/TIB 240.039
|
Facility
|
IP
|
$4,625.00
|
|
| Hospital Charge Code |
2966732
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,266.25 |
| Max. Negotiated Rate |
$4,255.00 |
| Rate for Payer: Aetna Commercial |
$4,162.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,977.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,451.25
|
| Rate for Payer: Cash Price |
$1,387.50
|
| Rate for Payer: Cigna Commercial |
$4,255.00
|
| Rate for Payer: Health EOS Commercial |
$4,116.25
|
| Rate for Payer: HFN Commercial |
$4,255.00
|
| Rate for Payer: Multiplan Commercial |
$3,700.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,775.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,255.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,266.25
|
| Rate for Payer: Quartz Commercial |
$2,775.00
|
| Rate for Payer: WEA Trust Commercial |
$2,543.75
|
| Rate for Payer: WPS Commercial |
$3,425.74
|
|
|
PLATE 6H RT CONDYLAR 222.656
|
Facility
|
IP
|
$4,507.00
|
|
| Hospital Charge Code |
2966734
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,208.43 |
| Max. Negotiated Rate |
$4,146.44 |
| Rate for Payer: Aetna Commercial |
$4,056.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,876.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,388.71
|
| Rate for Payer: Cash Price |
$1,352.10
|
| Rate for Payer: Cigna Commercial |
$4,146.44
|
| Rate for Payer: Health EOS Commercial |
$4,011.23
|
| Rate for Payer: HFN Commercial |
$4,146.44
|
| Rate for Payer: Multiplan Commercial |
$3,605.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,704.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,146.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,208.43
|
| Rate for Payer: Quartz Commercial |
$2,704.20
|
| Rate for Payer: WEA Trust Commercial |
$2,478.85
|
| Rate for Payer: WPS Commercial |
$3,338.33
|
|
|
PLATE 6H RT CONDYLAR 222.656
|
Facility
|
OP
|
$4,507.00
|
|
| Hospital Charge Code |
2966734
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,261.96 |
| Max. Negotiated Rate |
$18,028.00 |
| Rate for Payer: Aetna Commercial |
$4,056.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,876.02
|
| Rate for Payer: Aetna Managed Medicare |
$1,261.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,929.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,253.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,163.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,388.71
|
| Rate for Payer: Cash Price |
$1,352.10
|
| Rate for Payer: Cigna Commercial |
$4,146.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,522.12
|
| Rate for Payer: Health EOS Commercial |
$4,011.23
|
| Rate for Payer: HFN Commercial |
$4,146.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,380.25
|
| Rate for Payer: Multiplan Commercial |
$3,605.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,704.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,146.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,208.43
|
| Rate for Payer: Quartz Commercial |
$2,929.55
|
| Rate for Payer: Quartz Medicare Advantage |
$2,704.20
|
| Rate for Payer: The Alliance Commercial |
$18,028.00
|
| Rate for Payer: WEA Trust Commercial |
$2,478.85
|
| Rate for Payer: WPS Commercial |
$3,338.33
|
|
|
PLATE 6H RT PROX/TIB 240.038
|
Facility
|
IP
|
$4,625.00
|
|
| Hospital Charge Code |
2966735
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,266.25 |
| Max. Negotiated Rate |
$4,255.00 |
| Rate for Payer: Aetna Commercial |
$4,162.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,977.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,451.25
|
| Rate for Payer: Cash Price |
$1,387.50
|
| Rate for Payer: Cigna Commercial |
$4,255.00
|
| Rate for Payer: Health EOS Commercial |
$4,116.25
|
| Rate for Payer: HFN Commercial |
$4,255.00
|
| Rate for Payer: Multiplan Commercial |
$3,700.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,775.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,255.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,266.25
|
| Rate for Payer: Quartz Commercial |
$2,775.00
|
| Rate for Payer: WEA Trust Commercial |
$2,543.75
|
| Rate for Payer: WPS Commercial |
$3,425.74
|
|
|
PLATE 6H RT PROX/TIB 240.038
|
Facility
|
OP
|
$4,625.00
|
|
| Hospital Charge Code |
2966735
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,295.00 |
| Max. Negotiated Rate |
$18,500.00 |
| Rate for Payer: Aetna Commercial |
$4,162.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,977.50
|
| Rate for Payer: Aetna Managed Medicare |
$1,295.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,006.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,312.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,220.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,451.25
|
| Rate for Payer: Cash Price |
$1,387.50
|
| Rate for Payer: Cigna Commercial |
$4,255.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,588.15
|
| Rate for Payer: Health EOS Commercial |
$4,116.25
|
| Rate for Payer: HFN Commercial |
$4,255.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,468.75
|
| Rate for Payer: Multiplan Commercial |
$3,700.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,775.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,255.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,266.25
|
| Rate for Payer: Quartz Commercial |
$3,006.25
|
| Rate for Payer: Quartz Medicare Advantage |
$2,775.00
|
| Rate for Payer: The Alliance Commercial |
$18,500.00
|
| Rate for Payer: WEA Trust Commercial |
$2,543.75
|
| Rate for Payer: WPS Commercial |
$3,425.74
|
|
|
PLATE 7H 3.5 LCP RECON 245.071
|
Facility
|
IP
|
$2,253.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966737
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,103.97 |
| Max. Negotiated Rate |
$2,072.76 |
| Rate for Payer: Aetna Commercial |
$2,027.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,937.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,194.09
|
| Rate for Payer: Cash Price |
$675.90
|
| Rate for Payer: Cigna Commercial |
$2,072.76
|
| Rate for Payer: Health EOS Commercial |
$2,005.17
|
| Rate for Payer: HFN Commercial |
$2,072.76
|
| Rate for Payer: Multiplan Commercial |
$1,802.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,351.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,072.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,103.97
|
| Rate for Payer: Quartz Commercial |
$1,351.80
|
| Rate for Payer: WEA Trust Commercial |
$1,239.15
|
| Rate for Payer: WPS Commercial |
$1,668.80
|
|
|
PLATE 7H 3.5 LCP RECON 245.071
|
Facility
|
OP
|
$2,253.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966737
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$630.84 |
| Max. Negotiated Rate |
$9,012.00 |
| Rate for Payer: Aetna Commercial |
$2,027.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,937.58
|
| Rate for Payer: Aetna Managed Medicare |
$630.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,464.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,126.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,081.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,194.09
|
| Rate for Payer: Cash Price |
$675.90
|
| Rate for Payer: Cigna Commercial |
$2,072.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,260.78
|
| Rate for Payer: Health EOS Commercial |
$2,005.17
|
| Rate for Payer: HFN Commercial |
$2,072.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,689.75
|
| Rate for Payer: Multiplan Commercial |
$1,802.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,351.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,072.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,103.97
|
| Rate for Payer: Quartz Commercial |
$1,464.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,351.80
|
| Rate for Payer: The Alliance Commercial |
$9,012.00
|
| Rate for Payer: WEA Trust Commercial |
$1,239.15
|
| Rate for Payer: WPS Commercial |
$1,668.80
|
|
|
PLATE 7HL LT LCP DISTAL FEMUR
|
Facility
|
IP
|
$10,912.00
|
|
| Hospital Charge Code |
2966357
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,346.88 |
| Max. Negotiated Rate |
$10,039.04 |
| Rate for Payer: Aetna Commercial |
$9,820.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,384.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,783.36
|
| Rate for Payer: Cash Price |
$3,273.60
|
| Rate for Payer: Cigna Commercial |
$10,039.04
|
| Rate for Payer: Health EOS Commercial |
$9,711.68
|
| Rate for Payer: HFN Commercial |
$10,039.04
|
| Rate for Payer: Multiplan Commercial |
$8,729.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,547.20
|
| Rate for Payer: Preferred Network Access Commercial |
$10,039.04
|
| Rate for Payer: Quartz Beloit One Network |
$5,346.88
|
| Rate for Payer: Quartz Commercial |
$6,547.20
|
| Rate for Payer: WEA Trust Commercial |
$6,001.60
|
| Rate for Payer: WPS Commercial |
$8,082.52
|
|
|
PLATE 7HL LT LCP DISTAL FEMUR
|
Facility
|
OP
|
$10,912.00
|
|
| Hospital Charge Code |
2966357
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,055.36 |
| Max. Negotiated Rate |
$43,648.00 |
| Rate for Payer: Aetna Commercial |
$9,820.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,384.32
|
| Rate for Payer: Aetna Managed Medicare |
$3,055.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,092.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,456.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,237.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,783.36
|
| Rate for Payer: Cash Price |
$3,273.60
|
| Rate for Payer: Cigna Commercial |
$10,039.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,106.36
|
| Rate for Payer: Health EOS Commercial |
$9,711.68
|
| Rate for Payer: HFN Commercial |
$10,039.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,184.00
|
| Rate for Payer: Multiplan Commercial |
$8,729.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,547.20
|
| Rate for Payer: Preferred Network Access Commercial |
$10,039.04
|
| Rate for Payer: Quartz Beloit One Network |
$5,346.88
|
| Rate for Payer: Quartz Commercial |
$7,092.80
|
| Rate for Payer: Quartz Medicare Advantage |
$6,547.20
|
| Rate for Payer: The Alliance Commercial |
$43,648.00
|
| Rate for Payer: WEA Trust Commercial |
$6,001.60
|
| Rate for Payer: WPS Commercial |
$8,082.52
|
|
|
PLATE 7HL RT DISTAL FEMUR
|
Facility
|
OP
|
$10,886.00
|
|
| Hospital Charge Code |
2966358
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,048.08 |
| Max. Negotiated Rate |
$43,544.00 |
| Rate for Payer: Aetna Commercial |
$9,797.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,361.96
|
| Rate for Payer: Aetna Managed Medicare |
$3,048.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,075.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,443.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,225.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,769.58
|
| Rate for Payer: Cash Price |
$3,265.80
|
| Rate for Payer: Cigna Commercial |
$10,015.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,091.81
|
| Rate for Payer: Health EOS Commercial |
$9,688.54
|
| Rate for Payer: HFN Commercial |
$10,015.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,164.50
|
| Rate for Payer: Multiplan Commercial |
$8,708.80
|
| Rate for Payer: NAPHCARE Commercial |
$6,531.60
|
| Rate for Payer: Preferred Network Access Commercial |
$10,015.12
|
| Rate for Payer: Quartz Beloit One Network |
$5,334.14
|
| Rate for Payer: Quartz Commercial |
$7,075.90
|
| Rate for Payer: Quartz Medicare Advantage |
$6,531.60
|
| Rate for Payer: The Alliance Commercial |
$43,544.00
|
| Rate for Payer: WEA Trust Commercial |
$5,987.30
|
| Rate for Payer: WPS Commercial |
$8,063.26
|
|
|
PLATE 7HL RT DISTAL FEMUR
|
Facility
|
IP
|
$10,886.00
|
|
| Hospital Charge Code |
2966358
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,334.14 |
| Max. Negotiated Rate |
$10,015.12 |
| Rate for Payer: Aetna Commercial |
$9,797.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,361.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,769.58
|
| Rate for Payer: Cash Price |
$3,265.80
|
| Rate for Payer: Cigna Commercial |
$10,015.12
|
| Rate for Payer: Health EOS Commercial |
$9,688.54
|
| Rate for Payer: HFN Commercial |
$10,015.12
|
| Rate for Payer: Multiplan Commercial |
$8,708.80
|
| Rate for Payer: NAPHCARE Commercial |
$6,531.60
|
| Rate for Payer: Preferred Network Access Commercial |
$10,015.12
|
| Rate for Payer: Quartz Beloit One Network |
$5,334.14
|
| Rate for Payer: Quartz Commercial |
$6,531.60
|
| Rate for Payer: WEA Trust Commercial |
$5,987.30
|
| Rate for Payer: WPS Commercial |
$8,063.26
|
|
|
PLATE 8H 3.5 LCP 223.581
|
Facility
|
OP
|
$1,461.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966738
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$409.08 |
| Max. Negotiated Rate |
$5,844.00 |
| Rate for Payer: Aetna Commercial |
$1,314.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,256.46
|
| Rate for Payer: Aetna Managed Medicare |
$409.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$949.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$730.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$701.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$774.33
|
| Rate for Payer: Cash Price |
$438.30
|
| Rate for Payer: Cigna Commercial |
$1,344.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$817.58
|
| Rate for Payer: Health EOS Commercial |
$1,300.29
|
| Rate for Payer: HFN Commercial |
$1,344.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,095.75
|
| Rate for Payer: Multiplan Commercial |
$1,168.80
|
| Rate for Payer: NAPHCARE Commercial |
$876.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,344.12
|
| Rate for Payer: Quartz Beloit One Network |
$715.89
|
| Rate for Payer: Quartz Commercial |
$949.65
|
| Rate for Payer: Quartz Medicare Advantage |
$876.60
|
| Rate for Payer: The Alliance Commercial |
$5,844.00
|
| Rate for Payer: WEA Trust Commercial |
$803.55
|
| Rate for Payer: WPS Commercial |
$1,082.16
|
|
