|
PLATE 8H 3.5 LCP 223.581
|
Facility
|
IP
|
$1,461.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966738
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$715.89 |
| Max. Negotiated Rate |
$1,344.12 |
| Rate for Payer: Aetna Commercial |
$1,314.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,256.46
|
| 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: Health EOS Commercial |
$1,300.29
|
| Rate for Payer: HFN Commercial |
$1,344.12
|
| 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 |
$876.60
|
| Rate for Payer: WEA Trust Commercial |
$803.55
|
| Rate for Payer: WPS Commercial |
$1,082.16
|
|
|
PLATE 8H 3.5 LCP RECON 245.081
|
Facility
|
IP
|
$2,347.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966739
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,150.03 |
| Max. Negotiated Rate |
$2,159.24 |
| Rate for Payer: Aetna Commercial |
$2,112.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,018.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,243.91
|
| Rate for Payer: Cash Price |
$704.10
|
| Rate for Payer: Cigna Commercial |
$2,159.24
|
| Rate for Payer: Health EOS Commercial |
$2,088.83
|
| Rate for Payer: HFN Commercial |
$2,159.24
|
| Rate for Payer: Multiplan Commercial |
$1,877.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,408.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,159.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,150.03
|
| Rate for Payer: Quartz Commercial |
$1,408.20
|
| Rate for Payer: WEA Trust Commercial |
$1,290.85
|
| Rate for Payer: WPS Commercial |
$1,738.42
|
|
|
PLATE 8H 3.5 LCP RECON 245.081
|
Facility
|
OP
|
$2,347.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966739
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$657.16 |
| Max. Negotiated Rate |
$9,388.00 |
| Rate for Payer: Aetna Commercial |
$2,112.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,018.42
|
| Rate for Payer: Aetna Managed Medicare |
$657.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,525.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,173.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,126.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,243.91
|
| Rate for Payer: Cash Price |
$704.10
|
| Rate for Payer: Cigna Commercial |
$2,159.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,313.38
|
| Rate for Payer: Health EOS Commercial |
$2,088.83
|
| Rate for Payer: HFN Commercial |
$2,159.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,760.25
|
| Rate for Payer: Multiplan Commercial |
$1,877.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,408.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,159.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,150.03
|
| Rate for Payer: Quartz Commercial |
$1,525.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,408.20
|
| Rate for Payer: The Alliance Commercial |
$9,388.00
|
| Rate for Payer: WEA Trust Commercial |
$1,290.85
|
| Rate for Payer: WPS Commercial |
$1,738.42
|
|
|
PLATE 8H/3H LT DISTAL RADIUS 04.110.431
|
Facility
|
OP
|
$7,985.00
|
|
| Hospital Charge Code |
2966784
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,235.80 |
| Max. Negotiated Rate |
$31,940.00 |
| Rate for Payer: Aetna Commercial |
$7,186.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,867.10
|
| Rate for Payer: Aetna Managed Medicare |
$2,235.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,190.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,992.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,832.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,232.05
|
| Rate for Payer: Cash Price |
$2,395.50
|
| Rate for Payer: Cigna Commercial |
$7,346.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,468.41
|
| Rate for Payer: Health EOS Commercial |
$7,106.65
|
| Rate for Payer: HFN Commercial |
$7,346.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,988.75
|
| Rate for Payer: Multiplan Commercial |
$6,388.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,791.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,346.20
|
| Rate for Payer: Quartz Beloit One Network |
$3,912.65
|
| Rate for Payer: Quartz Commercial |
$5,190.25
|
| Rate for Payer: Quartz Medicare Advantage |
$4,791.00
|
| Rate for Payer: The Alliance Commercial |
$31,940.00
|
| Rate for Payer: WEA Trust Commercial |
$4,391.75
|
| Rate for Payer: WPS Commercial |
$5,914.49
|
|
|
PLATE 8H/3H LT DISTAL RADIUS 04.110.431
|
Facility
|
IP
|
$7,985.00
|
|
| Hospital Charge Code |
2966784
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,912.65 |
| Max. Negotiated Rate |
$7,346.20 |
| Rate for Payer: Aetna Commercial |
$7,186.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,867.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,232.05
|
| Rate for Payer: Cash Price |
$2,395.50
|
| Rate for Payer: Cigna Commercial |
$7,346.20
|
| Rate for Payer: Health EOS Commercial |
$7,106.65
|
| Rate for Payer: HFN Commercial |
$7,346.20
|
| Rate for Payer: Multiplan Commercial |
$6,388.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,791.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,346.20
|
| Rate for Payer: Quartz Beloit One Network |
$3,912.65
|
| Rate for Payer: Quartz Commercial |
$4,791.00
|
| Rate for Payer: WEA Trust Commercial |
$4,391.75
|
| Rate for Payer: WPS Commercial |
$5,914.49
|
|
|
PLATE 8H/3H RT DISTAL RADIUS 04.110.430
|
Facility
|
IP
|
$7,985.00
|
|
| Hospital Charge Code |
2966785
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,912.65 |
| Max. Negotiated Rate |
$7,346.20 |
| Rate for Payer: Aetna Commercial |
$7,186.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,867.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,232.05
|
| Rate for Payer: Cash Price |
$2,395.50
|
| Rate for Payer: Cigna Commercial |
$7,346.20
|
| Rate for Payer: Health EOS Commercial |
$7,106.65
|
| Rate for Payer: HFN Commercial |
$7,346.20
|
| Rate for Payer: Multiplan Commercial |
$6,388.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,791.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,346.20
|
| Rate for Payer: Quartz Beloit One Network |
$3,912.65
|
| Rate for Payer: Quartz Commercial |
$4,791.00
|
| Rate for Payer: WEA Trust Commercial |
$4,391.75
|
| Rate for Payer: WPS Commercial |
$5,914.49
|
|
|
PLATE 8H/3H RT DISTAL RADIUS 04.110.430
|
Facility
|
OP
|
$7,985.00
|
|
| Hospital Charge Code |
2966785
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,235.80 |
| Max. Negotiated Rate |
$31,940.00 |
| Rate for Payer: Aetna Commercial |
$7,186.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,867.10
|
| Rate for Payer: Aetna Managed Medicare |
$2,235.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,190.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,992.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,832.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,232.05
|
| Rate for Payer: Cash Price |
$2,395.50
|
| Rate for Payer: Cigna Commercial |
$7,346.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,468.41
|
| Rate for Payer: Health EOS Commercial |
$7,106.65
|
| Rate for Payer: HFN Commercial |
$7,346.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,988.75
|
| Rate for Payer: Multiplan Commercial |
$6,388.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,791.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,346.20
|
| Rate for Payer: Quartz Beloit One Network |
$3,912.65
|
| Rate for Payer: Quartz Commercial |
$5,190.25
|
| Rate for Payer: Quartz Medicare Advantage |
$4,791.00
|
| Rate for Payer: The Alliance Commercial |
$31,940.00
|
| Rate for Payer: WEA Trust Commercial |
$4,391.75
|
| Rate for Payer: WPS Commercial |
$5,914.49
|
|
|
PLATE 8H/4H LT DISTAL RADIUS 04.110.441
|
Facility
|
OP
|
$7,985.00
|
|
| Hospital Charge Code |
2966786
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,235.80 |
| Max. Negotiated Rate |
$31,940.00 |
| Rate for Payer: Aetna Commercial |
$7,186.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,867.10
|
| Rate for Payer: Aetna Managed Medicare |
$2,235.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,190.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,992.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,832.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,232.05
|
| Rate for Payer: Cash Price |
$2,395.50
|
| Rate for Payer: Cigna Commercial |
$7,346.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,468.41
|
| Rate for Payer: Health EOS Commercial |
$7,106.65
|
| Rate for Payer: HFN Commercial |
$7,346.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,988.75
|
| Rate for Payer: Multiplan Commercial |
$6,388.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,791.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,346.20
|
| Rate for Payer: Quartz Beloit One Network |
$3,912.65
|
| Rate for Payer: Quartz Commercial |
$5,190.25
|
| Rate for Payer: Quartz Medicare Advantage |
$4,791.00
|
| Rate for Payer: The Alliance Commercial |
$31,940.00
|
| Rate for Payer: WEA Trust Commercial |
$4,391.75
|
| Rate for Payer: WPS Commercial |
$5,914.49
|
|
|
PLATE 8H/4H LT DISTAL RADIUS 04.110.441
|
Facility
|
IP
|
$7,985.00
|
|
| Hospital Charge Code |
2966786
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,912.65 |
| Max. Negotiated Rate |
$7,346.20 |
| Rate for Payer: Aetna Commercial |
$7,186.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,867.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,232.05
|
| Rate for Payer: Cash Price |
$2,395.50
|
| Rate for Payer: Cigna Commercial |
$7,346.20
|
| Rate for Payer: Health EOS Commercial |
$7,106.65
|
| Rate for Payer: HFN Commercial |
$7,346.20
|
| Rate for Payer: Multiplan Commercial |
$6,388.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,791.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,346.20
|
| Rate for Payer: Quartz Beloit One Network |
$3,912.65
|
| Rate for Payer: Quartz Commercial |
$4,791.00
|
| Rate for Payer: WEA Trust Commercial |
$4,391.75
|
| Rate for Payer: WPS Commercial |
$5,914.49
|
|
|
PLATE 8H/4H RT DISTAL RADIUS 04.110.440
|
Facility
|
OP
|
$7,985.00
|
|
| Hospital Charge Code |
2966787
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,235.80 |
| Max. Negotiated Rate |
$31,940.00 |
| Rate for Payer: Aetna Commercial |
$7,186.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,867.10
|
| Rate for Payer: Aetna Managed Medicare |
$2,235.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,190.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,992.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,832.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,232.05
|
| Rate for Payer: Cash Price |
$2,395.50
|
| Rate for Payer: Cigna Commercial |
$7,346.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,468.41
|
| Rate for Payer: Health EOS Commercial |
$7,106.65
|
| Rate for Payer: HFN Commercial |
$7,346.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,988.75
|
| Rate for Payer: Multiplan Commercial |
$6,388.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,791.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,346.20
|
| Rate for Payer: Quartz Beloit One Network |
$3,912.65
|
| Rate for Payer: Quartz Commercial |
$5,190.25
|
| Rate for Payer: Quartz Medicare Advantage |
$4,791.00
|
| Rate for Payer: The Alliance Commercial |
$31,940.00
|
| Rate for Payer: WEA Trust Commercial |
$4,391.75
|
| Rate for Payer: WPS Commercial |
$5,914.49
|
|
|
PLATE 8H/4H RT DISTAL RADIUS 04.110.440
|
Facility
|
IP
|
$7,985.00
|
|
| Hospital Charge Code |
2966787
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,912.65 |
| Max. Negotiated Rate |
$7,346.20 |
| Rate for Payer: Aetna Commercial |
$7,186.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,867.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,232.05
|
| Rate for Payer: Cash Price |
$2,395.50
|
| Rate for Payer: Cigna Commercial |
$7,346.20
|
| Rate for Payer: Health EOS Commercial |
$7,106.65
|
| Rate for Payer: HFN Commercial |
$7,346.20
|
| Rate for Payer: Multiplan Commercial |
$6,388.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,791.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,346.20
|
| Rate for Payer: Quartz Beloit One Network |
$3,912.65
|
| Rate for Payer: Quartz Commercial |
$4,791.00
|
| Rate for Payer: WEA Trust Commercial |
$4,391.75
|
| Rate for Payer: WPS Commercial |
$5,914.49
|
|
|
PLATE 8H/5H LT DISTAL RADIUS 04.110.451
|
Facility
|
OP
|
$7,985.00
|
|
| Hospital Charge Code |
2966788
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,235.80 |
| Max. Negotiated Rate |
$31,940.00 |
| Rate for Payer: Aetna Commercial |
$7,186.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,867.10
|
| Rate for Payer: Aetna Managed Medicare |
$2,235.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,190.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,992.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,832.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,232.05
|
| Rate for Payer: Cash Price |
$2,395.50
|
| Rate for Payer: Cigna Commercial |
$7,346.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,468.41
|
| Rate for Payer: Health EOS Commercial |
$7,106.65
|
| Rate for Payer: HFN Commercial |
$7,346.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,988.75
|
| Rate for Payer: Multiplan Commercial |
$6,388.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,791.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,346.20
|
| Rate for Payer: Quartz Beloit One Network |
$3,912.65
|
| Rate for Payer: Quartz Commercial |
$5,190.25
|
| Rate for Payer: Quartz Medicare Advantage |
$4,791.00
|
| Rate for Payer: The Alliance Commercial |
$31,940.00
|
| Rate for Payer: WEA Trust Commercial |
$4,391.75
|
| Rate for Payer: WPS Commercial |
$5,914.49
|
|
|
PLATE 8H/5H LT DISTAL RADIUS 04.110.451
|
Facility
|
IP
|
$7,985.00
|
|
| Hospital Charge Code |
2966788
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,912.65 |
| Max. Negotiated Rate |
$7,346.20 |
| Rate for Payer: Aetna Commercial |
$7,186.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,867.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,232.05
|
| Rate for Payer: Cash Price |
$2,395.50
|
| Rate for Payer: Cigna Commercial |
$7,346.20
|
| Rate for Payer: Health EOS Commercial |
$7,106.65
|
| Rate for Payer: HFN Commercial |
$7,346.20
|
| Rate for Payer: Multiplan Commercial |
$6,388.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,791.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,346.20
|
| Rate for Payer: Quartz Beloit One Network |
$3,912.65
|
| Rate for Payer: Quartz Commercial |
$4,791.00
|
| Rate for Payer: WEA Trust Commercial |
$4,391.75
|
| Rate for Payer: WPS Commercial |
$5,914.49
|
|
|
PLATE 8H/5H RT DISTAL RADIUS 04.110.450
|
Facility
|
OP
|
$7,985.00
|
|
| Hospital Charge Code |
2966789
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,235.80 |
| Max. Negotiated Rate |
$31,940.00 |
| Rate for Payer: Aetna Commercial |
$7,186.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,867.10
|
| Rate for Payer: Aetna Managed Medicare |
$2,235.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,190.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,992.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,832.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,232.05
|
| Rate for Payer: Cash Price |
$2,395.50
|
| Rate for Payer: Cigna Commercial |
$7,346.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,468.41
|
| Rate for Payer: Health EOS Commercial |
$7,106.65
|
| Rate for Payer: HFN Commercial |
$7,346.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,988.75
|
| Rate for Payer: Multiplan Commercial |
$6,388.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,791.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,346.20
|
| Rate for Payer: Quartz Beloit One Network |
$3,912.65
|
| Rate for Payer: Quartz Commercial |
$5,190.25
|
| Rate for Payer: Quartz Medicare Advantage |
$4,791.00
|
| Rate for Payer: The Alliance Commercial |
$31,940.00
|
| Rate for Payer: WEA Trust Commercial |
$4,391.75
|
| Rate for Payer: WPS Commercial |
$5,914.49
|
|
|
PLATE 8H/5H RT DISTAL RADIUS 04.110.450
|
Facility
|
IP
|
$7,985.00
|
|
| Hospital Charge Code |
2966789
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,912.65 |
| Max. Negotiated Rate |
$7,346.20 |
| Rate for Payer: Aetna Commercial |
$7,186.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,867.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,232.05
|
| Rate for Payer: Cash Price |
$2,395.50
|
| Rate for Payer: Cigna Commercial |
$7,346.20
|
| Rate for Payer: Health EOS Commercial |
$7,106.65
|
| Rate for Payer: HFN Commercial |
$7,346.20
|
| Rate for Payer: Multiplan Commercial |
$6,388.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,791.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,346.20
|
| Rate for Payer: Quartz Beloit One Network |
$3,912.65
|
| Rate for Payer: Quartz Commercial |
$4,791.00
|
| Rate for Payer: WEA Trust Commercial |
$4,391.75
|
| Rate for Payer: WPS Commercial |
$5,914.49
|
|
|
PLATE 8HL 3.5 RT M/D/T 239.908
|
Facility
|
OP
|
$7,458.00
|
|
| Hospital Charge Code |
2966745
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,088.24 |
| Max. Negotiated Rate |
$29,832.00 |
| Rate for Payer: Aetna Commercial |
$6,712.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,413.88
|
| Rate for Payer: Aetna Managed Medicare |
$2,088.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,847.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,729.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,579.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,952.74
|
| Rate for Payer: Cash Price |
$2,237.40
|
| Rate for Payer: Cigna Commercial |
$6,861.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,173.50
|
| Rate for Payer: Health EOS Commercial |
$6,637.62
|
| Rate for Payer: HFN Commercial |
$6,861.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,593.50
|
| Rate for Payer: Multiplan Commercial |
$5,966.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,474.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,861.36
|
| Rate for Payer: Quartz Beloit One Network |
$3,654.42
|
| Rate for Payer: Quartz Commercial |
$4,847.70
|
| Rate for Payer: Quartz Medicare Advantage |
$4,474.80
|
| Rate for Payer: The Alliance Commercial |
$29,832.00
|
| Rate for Payer: WEA Trust Commercial |
$4,101.90
|
| Rate for Payer: WPS Commercial |
$5,524.14
|
|
|
PLATE 8HL 3.5 RT M/D/T 239.908
|
Facility
|
IP
|
$7,458.00
|
|
| Hospital Charge Code |
2966745
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,654.42 |
| Max. Negotiated Rate |
$6,861.36 |
| Rate for Payer: Aetna Commercial |
$6,712.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,413.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,952.74
|
| Rate for Payer: Cash Price |
$2,237.40
|
| Rate for Payer: Cigna Commercial |
$6,861.36
|
| Rate for Payer: Health EOS Commercial |
$6,637.62
|
| Rate for Payer: HFN Commercial |
$6,861.36
|
| Rate for Payer: Multiplan Commercial |
$5,966.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,474.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,861.36
|
| Rate for Payer: Quartz Beloit One Network |
$3,654.42
|
| Rate for Payer: Quartz Commercial |
$4,474.80
|
| Rate for Payer: WEA Trust Commercial |
$4,101.90
|
| Rate for Payer: WPS Commercial |
$5,524.14
|
|
|
PLATE 8HL LEFT MEDIAL DISTAL
|
Facility
|
OP
|
$9,255.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966359
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,591.40 |
| Max. Negotiated Rate |
$37,020.00 |
| Rate for Payer: Aetna Commercial |
$8,329.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,959.30
|
| Rate for Payer: Aetna Managed Medicare |
$2,591.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,015.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,627.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,442.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,905.15
|
| Rate for Payer: Cash Price |
$2,776.50
|
| Rate for Payer: Cigna Commercial |
$8,514.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,179.10
|
| Rate for Payer: Health EOS Commercial |
$8,236.95
|
| Rate for Payer: HFN Commercial |
$8,514.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,941.25
|
| Rate for Payer: Multiplan Commercial |
$7,404.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,553.00
|
| Rate for Payer: Preferred Network Access Commercial |
$8,514.60
|
| Rate for Payer: Quartz Beloit One Network |
$4,534.95
|
| Rate for Payer: Quartz Commercial |
$6,015.75
|
| Rate for Payer: Quartz Medicare Advantage |
$5,553.00
|
| Rate for Payer: The Alliance Commercial |
$37,020.00
|
| Rate for Payer: WEA Trust Commercial |
$5,090.25
|
| Rate for Payer: WPS Commercial |
$6,855.18
|
|
|
PLATE 8HL LEFT MEDIAL DISTAL
|
Facility
|
IP
|
$9,255.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966359
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,534.95 |
| Max. Negotiated Rate |
$8,514.60 |
| Rate for Payer: Aetna Commercial |
$8,329.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,959.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,905.15
|
| Rate for Payer: Cash Price |
$2,776.50
|
| Rate for Payer: Cigna Commercial |
$8,514.60
|
| Rate for Payer: Health EOS Commercial |
$8,236.95
|
| Rate for Payer: HFN Commercial |
$8,514.60
|
| Rate for Payer: Multiplan Commercial |
$7,404.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,553.00
|
| Rate for Payer: Preferred Network Access Commercial |
$8,514.60
|
| Rate for Payer: Quartz Beloit One Network |
$4,534.95
|
| Rate for Payer: Quartz Commercial |
$5,553.00
|
| Rate for Payer: WEA Trust Commercial |
$5,090.25
|
| Rate for Payer: WPS Commercial |
$6,855.18
|
|
|
PLATE 8HL LG LFT CLAVICLE
|
Facility
|
OP
|
$6,468.00
|
|
| Hospital Charge Code |
2964145
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,811.04 |
| Max. Negotiated Rate |
$25,872.00 |
| Rate for Payer: Aetna Commercial |
$5,821.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,562.48
|
| Rate for Payer: Aetna Managed Medicare |
$1,811.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,204.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,234.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,104.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,428.04
|
| Rate for Payer: Cash Price |
$1,940.40
|
| Rate for Payer: Cigna Commercial |
$5,950.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,619.49
|
| Rate for Payer: Health EOS Commercial |
$5,756.52
|
| Rate for Payer: HFN Commercial |
$5,950.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,851.00
|
| Rate for Payer: Multiplan Commercial |
$5,174.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,880.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,950.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,169.32
|
| Rate for Payer: Quartz Commercial |
$4,204.20
|
| Rate for Payer: Quartz Medicare Advantage |
$3,880.80
|
| Rate for Payer: The Alliance Commercial |
$25,872.00
|
| Rate for Payer: WEA Trust Commercial |
$3,557.40
|
| Rate for Payer: WPS Commercial |
$4,790.85
|
|
|
PLATE 8HL LG LFT CLAVICLE
|
Facility
|
IP
|
$6,468.00
|
|
| Hospital Charge Code |
2964145
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,169.32 |
| Max. Negotiated Rate |
$5,950.56 |
| Rate for Payer: Aetna Commercial |
$5,821.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,562.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,428.04
|
| Rate for Payer: Cash Price |
$1,940.40
|
| Rate for Payer: Cigna Commercial |
$5,950.56
|
| Rate for Payer: Health EOS Commercial |
$5,756.52
|
| Rate for Payer: HFN Commercial |
$5,950.56
|
| Rate for Payer: Multiplan Commercial |
$5,174.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,880.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,950.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,169.32
|
| Rate for Payer: Quartz Commercial |
$3,880.80
|
| Rate for Payer: WEA Trust Commercial |
$3,557.40
|
| Rate for Payer: WPS Commercial |
$4,790.85
|
|
|
PLATE 8HL RT 3.5 MED-DIST TIB
|
Facility
|
IP
|
$9,801.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966360
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,802.49 |
| Max. Negotiated Rate |
$9,016.92 |
| Rate for Payer: Aetna Commercial |
$8,820.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,428.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,194.53
|
| Rate for Payer: Cash Price |
$2,940.30
|
| Rate for Payer: Cigna Commercial |
$9,016.92
|
| Rate for Payer: Health EOS Commercial |
$8,722.89
|
| Rate for Payer: HFN Commercial |
$9,016.92
|
| Rate for Payer: Multiplan Commercial |
$7,840.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,880.60
|
| Rate for Payer: Preferred Network Access Commercial |
$9,016.92
|
| Rate for Payer: Quartz Beloit One Network |
$4,802.49
|
| Rate for Payer: Quartz Commercial |
$5,880.60
|
| Rate for Payer: WEA Trust Commercial |
$5,390.55
|
| Rate for Payer: WPS Commercial |
$7,259.60
|
|
|
PLATE 8HL RT 3.5 MED-DIST TIB
|
Facility
|
OP
|
$9,801.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966360
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,744.28 |
| Max. Negotiated Rate |
$39,204.00 |
| Rate for Payer: Aetna Commercial |
$8,820.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,428.86
|
| Rate for Payer: Aetna Managed Medicare |
$2,744.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,370.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,900.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,704.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,194.53
|
| Rate for Payer: Cash Price |
$2,940.30
|
| Rate for Payer: Cigna Commercial |
$9,016.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,484.64
|
| Rate for Payer: Health EOS Commercial |
$8,722.89
|
| Rate for Payer: HFN Commercial |
$9,016.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,350.75
|
| Rate for Payer: Multiplan Commercial |
$7,840.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,880.60
|
| Rate for Payer: Preferred Network Access Commercial |
$9,016.92
|
| Rate for Payer: Quartz Beloit One Network |
$4,802.49
|
| Rate for Payer: Quartz Commercial |
$6,370.65
|
| Rate for Payer: Quartz Medicare Advantage |
$5,880.60
|
| Rate for Payer: The Alliance Commercial |
$39,204.00
|
| Rate for Payer: WEA Trust Commercial |
$5,390.55
|
| Rate for Payer: WPS Commercial |
$7,259.60
|
|
|
PLATE 8H LT CONDYLAR 222.659
|
Facility
|
IP
|
$4,594.00
|
|
| Hospital Charge Code |
2966740
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,251.06 |
| Max. Negotiated Rate |
$4,226.48 |
| Rate for Payer: Aetna Commercial |
$4,134.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,950.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,434.82
|
| Rate for Payer: Cash Price |
$1,378.20
|
| Rate for Payer: Cigna Commercial |
$4,226.48
|
| Rate for Payer: Health EOS Commercial |
$4,088.66
|
| Rate for Payer: HFN Commercial |
$4,226.48
|
| Rate for Payer: Multiplan Commercial |
$3,675.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,756.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,226.48
|
| Rate for Payer: Quartz Beloit One Network |
$2,251.06
|
| Rate for Payer: Quartz Commercial |
$2,756.40
|
| Rate for Payer: WEA Trust Commercial |
$2,526.70
|
| Rate for Payer: WPS Commercial |
$3,402.78
|
|
|
PLATE 8H LT CONDYLAR 222.659
|
Facility
|
OP
|
$4,594.00
|
|
| Hospital Charge Code |
2966740
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,286.32 |
| Max. Negotiated Rate |
$18,376.00 |
| Rate for Payer: Aetna Commercial |
$4,134.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,950.84
|
| Rate for Payer: Aetna Managed Medicare |
$1,286.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,986.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,297.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,205.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,434.82
|
| Rate for Payer: Cash Price |
$1,378.20
|
| Rate for Payer: Cigna Commercial |
$4,226.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,570.80
|
| Rate for Payer: Health EOS Commercial |
$4,088.66
|
| Rate for Payer: HFN Commercial |
$4,226.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,445.50
|
| Rate for Payer: Multiplan Commercial |
$3,675.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,756.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,226.48
|
| Rate for Payer: Quartz Beloit One Network |
$2,251.06
|
| Rate for Payer: Quartz Commercial |
$2,986.10
|
| Rate for Payer: Quartz Medicare Advantage |
$2,756.40
|
| Rate for Payer: The Alliance Commercial |
$18,376.00
|
| Rate for Payer: WEA Trust Commercial |
$2,526.70
|
| Rate for Payer: WPS Commercial |
$3,402.78
|
|
