|
PLATE ANKLE FUSION ANTERIOR TIBIOTALAR SHORT 3HL RT AR-8970AS-03
|
Facility
|
OP
|
$10,612.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5803668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,971.36 |
| Max. Negotiated Rate |
$42,448.00 |
| Rate for Payer: Aetna Commercial |
$9,550.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,126.32
|
| Rate for Payer: Aetna Managed Medicare |
$2,971.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,897.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,306.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,093.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,624.36
|
| Rate for Payer: Cash Price |
$3,183.60
|
| Rate for Payer: Cigna Commercial |
$9,763.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,938.48
|
| Rate for Payer: Health EOS Commercial |
$9,444.68
|
| Rate for Payer: HFN Commercial |
$9,763.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,959.00
|
| Rate for Payer: Multiplan Commercial |
$8,489.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,367.20
|
| Rate for Payer: Preferred Network Access Commercial |
$9,763.04
|
| Rate for Payer: Quartz Beloit One Network |
$5,199.88
|
| Rate for Payer: Quartz Commercial |
$6,897.80
|
| Rate for Payer: Quartz Medicare Advantage |
$6,367.20
|
| Rate for Payer: The Alliance Commercial |
$42,448.00
|
| Rate for Payer: WEA Trust Commercial |
$5,836.60
|
| Rate for Payer: WPS Commercial |
$7,860.31
|
|
|
PLATE ANKLE FUSION ANTERIOR TIBIOTALAR SHORT 3HL RT AR-8970AS-03
|
Facility
|
IP
|
$10,612.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5803668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,199.88 |
| Max. Negotiated Rate |
$9,763.04 |
| Rate for Payer: Aetna Commercial |
$9,550.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,126.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,624.36
|
| Rate for Payer: Cash Price |
$3,183.60
|
| Rate for Payer: Cigna Commercial |
$9,763.04
|
| Rate for Payer: Health EOS Commercial |
$9,444.68
|
| Rate for Payer: HFN Commercial |
$9,763.04
|
| Rate for Payer: Multiplan Commercial |
$8,489.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,367.20
|
| Rate for Payer: Preferred Network Access Commercial |
$9,763.04
|
| Rate for Payer: Quartz Beloit One Network |
$5,199.88
|
| Rate for Payer: Quartz Commercial |
$6,367.20
|
| Rate for Payer: WEA Trust Commercial |
$5,836.60
|
| Rate for Payer: WPS Commercial |
$7,860.31
|
|
|
PLATE ANKLE FUSION ANTERIOR TIBIOTALAR STD RT AR-8970AR
|
Facility
|
OP
|
$10,612.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5611704
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,971.36 |
| Max. Negotiated Rate |
$42,448.00 |
| Rate for Payer: Aetna Commercial |
$9,550.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,126.32
|
| Rate for Payer: Aetna Managed Medicare |
$2,971.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,897.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,306.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,093.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,624.36
|
| Rate for Payer: Cash Price |
$3,183.60
|
| Rate for Payer: Cigna Commercial |
$9,763.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,938.48
|
| Rate for Payer: Health EOS Commercial |
$9,444.68
|
| Rate for Payer: HFN Commercial |
$9,763.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,959.00
|
| Rate for Payer: Multiplan Commercial |
$8,489.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,367.20
|
| Rate for Payer: Preferred Network Access Commercial |
$9,763.04
|
| Rate for Payer: Quartz Beloit One Network |
$5,199.88
|
| Rate for Payer: Quartz Commercial |
$6,897.80
|
| Rate for Payer: Quartz Medicare Advantage |
$6,367.20
|
| Rate for Payer: The Alliance Commercial |
$42,448.00
|
| Rate for Payer: WEA Trust Commercial |
$5,836.60
|
| Rate for Payer: WPS Commercial |
$7,860.31
|
|
|
PLATE ANKLE FUSION ANTERIOR TIBIOTALAR STD RT AR-8970AR
|
Facility
|
IP
|
$10,612.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5611704
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,199.88 |
| Max. Negotiated Rate |
$9,763.04 |
| Rate for Payer: Aetna Commercial |
$9,550.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,126.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,624.36
|
| Rate for Payer: Cash Price |
$3,183.60
|
| Rate for Payer: Cigna Commercial |
$9,763.04
|
| Rate for Payer: Health EOS Commercial |
$9,444.68
|
| Rate for Payer: HFN Commercial |
$9,763.04
|
| Rate for Payer: Multiplan Commercial |
$8,489.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,367.20
|
| Rate for Payer: Preferred Network Access Commercial |
$9,763.04
|
| Rate for Payer: Quartz Beloit One Network |
$5,199.88
|
| Rate for Payer: Quartz Commercial |
$6,367.20
|
| Rate for Payer: WEA Trust Commercial |
$5,836.60
|
| Rate for Payer: WPS Commercial |
$7,860.31
|
|
|
PLATE BROAD 10HL CRV 629560
|
Facility
|
OP
|
$4,572.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599755
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,280.16 |
| Max. Negotiated Rate |
$18,288.00 |
| Rate for Payer: Aetna Commercial |
$4,114.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,931.92
|
| Rate for Payer: Aetna Managed Medicare |
$1,280.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,971.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,286.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,194.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,423.16
|
| Rate for Payer: Cash Price |
$1,371.60
|
| Rate for Payer: Cigna Commercial |
$4,206.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,558.49
|
| Rate for Payer: Health EOS Commercial |
$4,069.08
|
| Rate for Payer: HFN Commercial |
$4,206.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,429.00
|
| Rate for Payer: Multiplan Commercial |
$3,657.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,743.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,206.24
|
| Rate for Payer: Quartz Beloit One Network |
$2,240.28
|
| Rate for Payer: Quartz Commercial |
$2,971.80
|
| Rate for Payer: Quartz Medicare Advantage |
$2,743.20
|
| Rate for Payer: The Alliance Commercial |
$18,288.00
|
| Rate for Payer: WEA Trust Commercial |
$2,514.60
|
| Rate for Payer: WPS Commercial |
$3,386.48
|
|
|
PLATE BROAD 10HL CRV 629560
|
Facility
|
IP
|
$4,572.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599755
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,240.28 |
| Max. Negotiated Rate |
$4,206.24 |
| Rate for Payer: Aetna Commercial |
$4,114.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,931.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,423.16
|
| Rate for Payer: Cash Price |
$1,371.60
|
| Rate for Payer: Cigna Commercial |
$4,206.24
|
| Rate for Payer: Health EOS Commercial |
$4,069.08
|
| Rate for Payer: HFN Commercial |
$4,206.24
|
| Rate for Payer: Multiplan Commercial |
$3,657.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,743.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,206.24
|
| Rate for Payer: Quartz Beloit One Network |
$2,240.28
|
| Rate for Payer: Quartz Commercial |
$2,743.20
|
| Rate for Payer: WEA Trust Commercial |
$2,514.60
|
| Rate for Payer: WPS Commercial |
$3,386.48
|
|
|
PLATE BROAD LCP 10HL 226.601
|
Facility
|
IP
|
$9,066.00
|
|
| Hospital Charge Code |
2966750
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,442.34 |
| Max. Negotiated Rate |
$8,340.72 |
| Rate for Payer: Aetna Commercial |
$8,159.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,796.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,804.98
|
| Rate for Payer: Cash Price |
$2,719.80
|
| Rate for Payer: Cigna Commercial |
$8,340.72
|
| Rate for Payer: Health EOS Commercial |
$8,068.74
|
| Rate for Payer: HFN Commercial |
$8,340.72
|
| Rate for Payer: Multiplan Commercial |
$7,252.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,439.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,340.72
|
| Rate for Payer: Quartz Beloit One Network |
$4,442.34
|
| Rate for Payer: Quartz Commercial |
$5,439.60
|
| Rate for Payer: WEA Trust Commercial |
$4,986.30
|
| Rate for Payer: WPS Commercial |
$6,715.19
|
|
|
PLATE BROAD LCP 10HL 226.601
|
Facility
|
OP
|
$9,066.00
|
|
| Hospital Charge Code |
2966750
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,538.48 |
| Max. Negotiated Rate |
$36,264.00 |
| Rate for Payer: Aetna Commercial |
$8,159.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,796.76
|
| Rate for Payer: Aetna Managed Medicare |
$2,538.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,892.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,533.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,351.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,804.98
|
| Rate for Payer: Cash Price |
$2,719.80
|
| Rate for Payer: Cigna Commercial |
$8,340.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,073.33
|
| Rate for Payer: Health EOS Commercial |
$8,068.74
|
| Rate for Payer: HFN Commercial |
$8,340.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,799.50
|
| Rate for Payer: Multiplan Commercial |
$7,252.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,439.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,340.72
|
| Rate for Payer: Quartz Beloit One Network |
$4,442.34
|
| Rate for Payer: Quartz Commercial |
$5,892.90
|
| Rate for Payer: Quartz Medicare Advantage |
$5,439.60
|
| Rate for Payer: The Alliance Commercial |
$36,264.00
|
| Rate for Payer: WEA Trust Commercial |
$4,986.30
|
| Rate for Payer: WPS Commercial |
$6,715.19
|
|
|
PLATE BROAD LCP 11HL 226.611
|
Facility
|
OP
|
$9,066.00
|
|
| Hospital Charge Code |
2966751
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,538.48 |
| Max. Negotiated Rate |
$36,264.00 |
| Rate for Payer: Aetna Commercial |
$8,159.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,796.76
|
| Rate for Payer: Aetna Managed Medicare |
$2,538.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,892.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,533.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,351.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,804.98
|
| Rate for Payer: Cash Price |
$2,719.80
|
| Rate for Payer: Cigna Commercial |
$8,340.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,073.33
|
| Rate for Payer: Health EOS Commercial |
$8,068.74
|
| Rate for Payer: HFN Commercial |
$8,340.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,799.50
|
| Rate for Payer: Multiplan Commercial |
$7,252.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,439.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,340.72
|
| Rate for Payer: Quartz Beloit One Network |
$4,442.34
|
| Rate for Payer: Quartz Commercial |
$5,892.90
|
| Rate for Payer: Quartz Medicare Advantage |
$5,439.60
|
| Rate for Payer: The Alliance Commercial |
$36,264.00
|
| Rate for Payer: WEA Trust Commercial |
$4,986.30
|
| Rate for Payer: WPS Commercial |
$6,715.19
|
|
|
PLATE BROAD LCP 11HL 226.611
|
Facility
|
IP
|
$9,066.00
|
|
| Hospital Charge Code |
2966751
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,442.34 |
| Max. Negotiated Rate |
$8,340.72 |
| Rate for Payer: Aetna Commercial |
$8,159.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,796.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,804.98
|
| Rate for Payer: Cash Price |
$2,719.80
|
| Rate for Payer: Cigna Commercial |
$8,340.72
|
| Rate for Payer: Health EOS Commercial |
$8,068.74
|
| Rate for Payer: HFN Commercial |
$8,340.72
|
| Rate for Payer: Multiplan Commercial |
$7,252.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,439.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,340.72
|
| Rate for Payer: Quartz Beloit One Network |
$4,442.34
|
| Rate for Payer: Quartz Commercial |
$5,439.60
|
| Rate for Payer: WEA Trust Commercial |
$4,986.30
|
| Rate for Payer: WPS Commercial |
$6,715.19
|
|
|
PLATE BROAD LCP 12HL 226.621
|
Facility
|
IP
|
$9,066.00
|
|
| Hospital Charge Code |
2966752
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,442.34 |
| Max. Negotiated Rate |
$8,340.72 |
| Rate for Payer: Aetna Commercial |
$8,159.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,796.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,804.98
|
| Rate for Payer: Cash Price |
$2,719.80
|
| Rate for Payer: Cigna Commercial |
$8,340.72
|
| Rate for Payer: Health EOS Commercial |
$8,068.74
|
| Rate for Payer: HFN Commercial |
$8,340.72
|
| Rate for Payer: Multiplan Commercial |
$7,252.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,439.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,340.72
|
| Rate for Payer: Quartz Beloit One Network |
$4,442.34
|
| Rate for Payer: Quartz Commercial |
$5,439.60
|
| Rate for Payer: WEA Trust Commercial |
$4,986.30
|
| Rate for Payer: WPS Commercial |
$6,715.19
|
|
|
PLATE BROAD LCP 12HL 226.621
|
Facility
|
OP
|
$9,066.00
|
|
| Hospital Charge Code |
2966752
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,538.48 |
| Max. Negotiated Rate |
$36,264.00 |
| Rate for Payer: Aetna Commercial |
$8,159.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,796.76
|
| Rate for Payer: Aetna Managed Medicare |
$2,538.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,892.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,533.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,351.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,804.98
|
| Rate for Payer: Cash Price |
$2,719.80
|
| Rate for Payer: Cigna Commercial |
$8,340.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,073.33
|
| Rate for Payer: Health EOS Commercial |
$8,068.74
|
| Rate for Payer: HFN Commercial |
$8,340.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,799.50
|
| Rate for Payer: Multiplan Commercial |
$7,252.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,439.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,340.72
|
| Rate for Payer: Quartz Beloit One Network |
$4,442.34
|
| Rate for Payer: Quartz Commercial |
$5,892.90
|
| Rate for Payer: Quartz Medicare Advantage |
$5,439.60
|
| Rate for Payer: The Alliance Commercial |
$36,264.00
|
| Rate for Payer: WEA Trust Commercial |
$4,986.30
|
| Rate for Payer: WPS Commercial |
$6,715.19
|
|
|
PLATE BROAD LCP 14HL 226.641
|
Facility
|
IP
|
$9,066.00
|
|
| Hospital Charge Code |
2966753
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,442.34 |
| Max. Negotiated Rate |
$8,340.72 |
| Rate for Payer: Aetna Commercial |
$8,159.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,796.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,804.98
|
| Rate for Payer: Cash Price |
$2,719.80
|
| Rate for Payer: Cigna Commercial |
$8,340.72
|
| Rate for Payer: Health EOS Commercial |
$8,068.74
|
| Rate for Payer: HFN Commercial |
$8,340.72
|
| Rate for Payer: Multiplan Commercial |
$7,252.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,439.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,340.72
|
| Rate for Payer: Quartz Beloit One Network |
$4,442.34
|
| Rate for Payer: Quartz Commercial |
$5,439.60
|
| Rate for Payer: WEA Trust Commercial |
$4,986.30
|
| Rate for Payer: WPS Commercial |
$6,715.19
|
|
|
PLATE BROAD LCP 14HL 226.641
|
Facility
|
OP
|
$9,066.00
|
|
| Hospital Charge Code |
2966753
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,538.48 |
| Max. Negotiated Rate |
$36,264.00 |
| Rate for Payer: Aetna Commercial |
$8,159.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,796.76
|
| Rate for Payer: Aetna Managed Medicare |
$2,538.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,892.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,533.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,351.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,804.98
|
| Rate for Payer: Cash Price |
$2,719.80
|
| Rate for Payer: Cigna Commercial |
$8,340.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,073.33
|
| Rate for Payer: Health EOS Commercial |
$8,068.74
|
| Rate for Payer: HFN Commercial |
$8,340.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,799.50
|
| Rate for Payer: Multiplan Commercial |
$7,252.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,439.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,340.72
|
| Rate for Payer: Quartz Beloit One Network |
$4,442.34
|
| Rate for Payer: Quartz Commercial |
$5,892.90
|
| Rate for Payer: Quartz Medicare Advantage |
$5,439.60
|
| Rate for Payer: The Alliance Commercial |
$36,264.00
|
| Rate for Payer: WEA Trust Commercial |
$4,986.30
|
| Rate for Payer: WPS Commercial |
$6,715.19
|
|
|
PLATE BROAD LCP 16HL 226.661
|
Facility
|
OP
|
$9,066.00
|
|
| Hospital Charge Code |
2966754
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,538.48 |
| Max. Negotiated Rate |
$36,264.00 |
| Rate for Payer: Aetna Commercial |
$8,159.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,796.76
|
| Rate for Payer: Aetna Managed Medicare |
$2,538.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,892.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,533.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,351.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,804.98
|
| Rate for Payer: Cash Price |
$2,719.80
|
| Rate for Payer: Cigna Commercial |
$8,340.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,073.33
|
| Rate for Payer: Health EOS Commercial |
$8,068.74
|
| Rate for Payer: HFN Commercial |
$8,340.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,799.50
|
| Rate for Payer: Multiplan Commercial |
$7,252.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,439.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,340.72
|
| Rate for Payer: Quartz Beloit One Network |
$4,442.34
|
| Rate for Payer: Quartz Commercial |
$5,892.90
|
| Rate for Payer: Quartz Medicare Advantage |
$5,439.60
|
| Rate for Payer: The Alliance Commercial |
$36,264.00
|
| Rate for Payer: WEA Trust Commercial |
$4,986.30
|
| Rate for Payer: WPS Commercial |
$6,715.19
|
|
|
PLATE BROAD LCP 16HL 226.661
|
Facility
|
IP
|
$9,066.00
|
|
| Hospital Charge Code |
2966754
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,442.34 |
| Max. Negotiated Rate |
$8,340.72 |
| Rate for Payer: Aetna Commercial |
$8,159.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,796.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,804.98
|
| Rate for Payer: Cash Price |
$2,719.80
|
| Rate for Payer: Cigna Commercial |
$8,340.72
|
| Rate for Payer: Health EOS Commercial |
$8,068.74
|
| Rate for Payer: HFN Commercial |
$8,340.72
|
| Rate for Payer: Multiplan Commercial |
$7,252.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,439.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,340.72
|
| Rate for Payer: Quartz Beloit One Network |
$4,442.34
|
| Rate for Payer: Quartz Commercial |
$5,439.60
|
| Rate for Payer: WEA Trust Commercial |
$4,986.30
|
| Rate for Payer: WPS Commercial |
$6,715.19
|
|
|
PLATE BROAD LCP 6HL 226.561
|
Facility
|
OP
|
$9,066.00
|
|
| Hospital Charge Code |
2966749
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,538.48 |
| Max. Negotiated Rate |
$36,264.00 |
| Rate for Payer: Aetna Commercial |
$8,159.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,796.76
|
| Rate for Payer: Aetna Managed Medicare |
$2,538.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,892.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,533.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,351.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,804.98
|
| Rate for Payer: Cash Price |
$2,719.80
|
| Rate for Payer: Cigna Commercial |
$8,340.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,073.33
|
| Rate for Payer: Health EOS Commercial |
$8,068.74
|
| Rate for Payer: HFN Commercial |
$8,340.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,799.50
|
| Rate for Payer: Multiplan Commercial |
$7,252.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,439.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,340.72
|
| Rate for Payer: Quartz Beloit One Network |
$4,442.34
|
| Rate for Payer: Quartz Commercial |
$5,892.90
|
| Rate for Payer: Quartz Medicare Advantage |
$5,439.60
|
| Rate for Payer: The Alliance Commercial |
$36,264.00
|
| Rate for Payer: WEA Trust Commercial |
$4,986.30
|
| Rate for Payer: WPS Commercial |
$6,715.19
|
|
|
PLATE BROAD LCP 6HL 226.561
|
Facility
|
IP
|
$9,066.00
|
|
| Hospital Charge Code |
2966749
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,442.34 |
| Max. Negotiated Rate |
$8,340.72 |
| Rate for Payer: Aetna Commercial |
$8,159.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,796.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,804.98
|
| Rate for Payer: Cash Price |
$2,719.80
|
| Rate for Payer: Cigna Commercial |
$8,340.72
|
| Rate for Payer: Health EOS Commercial |
$8,068.74
|
| Rate for Payer: HFN Commercial |
$8,340.72
|
| Rate for Payer: Multiplan Commercial |
$7,252.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,439.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,340.72
|
| Rate for Payer: Quartz Beloit One Network |
$4,442.34
|
| Rate for Payer: Quartz Commercial |
$5,439.60
|
| Rate for Payer: WEA Trust Commercial |
$4,986.30
|
| Rate for Payer: WPS Commercial |
$6,715.19
|
|
|
PLATE BROAD LCP 7HL 226.571
|
Facility
|
IP
|
$9,066.00
|
|
| Hospital Charge Code |
2966755
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,442.34 |
| Max. Negotiated Rate |
$8,340.72 |
| Rate for Payer: Aetna Commercial |
$8,159.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,796.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,804.98
|
| Rate for Payer: Cash Price |
$2,719.80
|
| Rate for Payer: Cigna Commercial |
$8,340.72
|
| Rate for Payer: Health EOS Commercial |
$8,068.74
|
| Rate for Payer: HFN Commercial |
$8,340.72
|
| Rate for Payer: Multiplan Commercial |
$7,252.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,439.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,340.72
|
| Rate for Payer: Quartz Beloit One Network |
$4,442.34
|
| Rate for Payer: Quartz Commercial |
$5,439.60
|
| Rate for Payer: WEA Trust Commercial |
$4,986.30
|
| Rate for Payer: WPS Commercial |
$6,715.19
|
|
|
PLATE BROAD LCP 7HL 226.571
|
Facility
|
OP
|
$9,066.00
|
|
| Hospital Charge Code |
2966755
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,538.48 |
| Max. Negotiated Rate |
$36,264.00 |
| Rate for Payer: Aetna Commercial |
$8,159.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,796.76
|
| Rate for Payer: Aetna Managed Medicare |
$2,538.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,892.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,533.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,351.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,804.98
|
| Rate for Payer: Cash Price |
$2,719.80
|
| Rate for Payer: Cigna Commercial |
$8,340.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,073.33
|
| Rate for Payer: Health EOS Commercial |
$8,068.74
|
| Rate for Payer: HFN Commercial |
$8,340.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,799.50
|
| Rate for Payer: Multiplan Commercial |
$7,252.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,439.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,340.72
|
| Rate for Payer: Quartz Beloit One Network |
$4,442.34
|
| Rate for Payer: Quartz Commercial |
$5,892.90
|
| Rate for Payer: Quartz Medicare Advantage |
$5,439.60
|
| Rate for Payer: The Alliance Commercial |
$36,264.00
|
| Rate for Payer: WEA Trust Commercial |
$4,986.30
|
| Rate for Payer: WPS Commercial |
$6,715.19
|
|
|
PLATE BROAD LCP 8HL 226.581
|
Facility
|
IP
|
$9,066.00
|
|
| Hospital Charge Code |
2966756
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,442.34 |
| Max. Negotiated Rate |
$8,340.72 |
| Rate for Payer: Aetna Commercial |
$8,159.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,796.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,804.98
|
| Rate for Payer: Cash Price |
$2,719.80
|
| Rate for Payer: Cigna Commercial |
$8,340.72
|
| Rate for Payer: Health EOS Commercial |
$8,068.74
|
| Rate for Payer: HFN Commercial |
$8,340.72
|
| Rate for Payer: Multiplan Commercial |
$7,252.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,439.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,340.72
|
| Rate for Payer: Quartz Beloit One Network |
$4,442.34
|
| Rate for Payer: Quartz Commercial |
$5,439.60
|
| Rate for Payer: WEA Trust Commercial |
$4,986.30
|
| Rate for Payer: WPS Commercial |
$6,715.19
|
|
|
PLATE BROAD LCP 8HL 226.581
|
Facility
|
OP
|
$9,066.00
|
|
| Hospital Charge Code |
2966756
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,538.48 |
| Max. Negotiated Rate |
$36,264.00 |
| Rate for Payer: Aetna Commercial |
$8,159.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,796.76
|
| Rate for Payer: Aetna Managed Medicare |
$2,538.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,892.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,533.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,351.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,804.98
|
| Rate for Payer: Cash Price |
$2,719.80
|
| Rate for Payer: Cigna Commercial |
$8,340.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,073.33
|
| Rate for Payer: Health EOS Commercial |
$8,068.74
|
| Rate for Payer: HFN Commercial |
$8,340.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,799.50
|
| Rate for Payer: Multiplan Commercial |
$7,252.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,439.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,340.72
|
| Rate for Payer: Quartz Beloit One Network |
$4,442.34
|
| Rate for Payer: Quartz Commercial |
$5,892.90
|
| Rate for Payer: Quartz Medicare Advantage |
$5,439.60
|
| Rate for Payer: The Alliance Commercial |
$36,264.00
|
| Rate for Payer: WEA Trust Commercial |
$4,986.30
|
| Rate for Payer: WPS Commercial |
$6,715.19
|
|
|
PLATE BROAD LCP 9HL 226.591
|
Facility
|
IP
|
$9,066.00
|
|
| Hospital Charge Code |
2966757
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,442.34 |
| Max. Negotiated Rate |
$8,340.72 |
| Rate for Payer: Aetna Commercial |
$8,159.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,796.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,804.98
|
| Rate for Payer: Cash Price |
$2,719.80
|
| Rate for Payer: Cigna Commercial |
$8,340.72
|
| Rate for Payer: Health EOS Commercial |
$8,068.74
|
| Rate for Payer: HFN Commercial |
$8,340.72
|
| Rate for Payer: Multiplan Commercial |
$7,252.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,439.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,340.72
|
| Rate for Payer: Quartz Beloit One Network |
$4,442.34
|
| Rate for Payer: Quartz Commercial |
$5,439.60
|
| Rate for Payer: WEA Trust Commercial |
$4,986.30
|
| Rate for Payer: WPS Commercial |
$6,715.19
|
|
|
PLATE BROAD LCP 9HL 226.591
|
Facility
|
OP
|
$9,066.00
|
|
| Hospital Charge Code |
2966757
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,538.48 |
| Max. Negotiated Rate |
$36,264.00 |
| Rate for Payer: Aetna Commercial |
$8,159.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,796.76
|
| Rate for Payer: Aetna Managed Medicare |
$2,538.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,892.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,533.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,351.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,804.98
|
| Rate for Payer: Cash Price |
$2,719.80
|
| Rate for Payer: Cigna Commercial |
$8,340.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,073.33
|
| Rate for Payer: Health EOS Commercial |
$8,068.74
|
| Rate for Payer: HFN Commercial |
$8,340.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,799.50
|
| Rate for Payer: Multiplan Commercial |
$7,252.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,439.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,340.72
|
| Rate for Payer: Quartz Beloit One Network |
$4,442.34
|
| Rate for Payer: Quartz Commercial |
$5,892.90
|
| Rate for Payer: Quartz Medicare Advantage |
$5,439.60
|
| Rate for Payer: The Alliance Commercial |
$36,264.00
|
| Rate for Payer: WEA Trust Commercial |
$4,986.30
|
| Rate for Payer: WPS Commercial |
$6,715.19
|
|
|
PLATE BROAD STRAIGHT 5 HL 626975
|
Facility
|
IP
|
$5,980.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6169642
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,930.20 |
| Max. Negotiated Rate |
$5,501.60 |
| Rate for Payer: Aetna Commercial |
$5,382.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,142.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,169.40
|
| Rate for Payer: Cash Price |
$1,794.00
|
| Rate for Payer: Cigna Commercial |
$5,501.60
|
| Rate for Payer: Health EOS Commercial |
$5,322.20
|
| Rate for Payer: HFN Commercial |
$5,501.60
|
| Rate for Payer: Multiplan Commercial |
$4,784.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,588.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,501.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,930.20
|
| Rate for Payer: Quartz Commercial |
$3,588.00
|
| Rate for Payer: WEA Trust Commercial |
$3,289.00
|
| Rate for Payer: WPS Commercial |
$4,429.39
|
|
