|
PLANTAR FASCIOTOMY
|
Facility
|
IP
|
$1,337.00
|
|
| Hospital Charge Code |
2960054
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$681.34 |
| Max. Negotiated Rate |
$1,279.24 |
| Rate for Payer: Aetna Commercial |
$1,251.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,195.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$736.95
|
| Rate for Payer: Cash Price |
$401.10
|
| Rate for Payer: Cigna Commercial |
$1,279.24
|
| Rate for Payer: Health EOS Commercial |
$1,237.53
|
| Rate for Payer: HFN Commercial |
$1,279.24
|
| Rate for Payer: Multiplan Commercial |
$1,112.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,279.24
|
| Rate for Payer: Quartz Beloit One Network |
$681.34
|
| Rate for Payer: Quartz Commercial |
$834.29
|
| Rate for Payer: WEA Trust Commercial |
$764.76
|
| Rate for Payer: WPS Commercial |
$1,029.89
|
|
|
Plantinol AQ 10 mg Charge
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
HCPCS J9060
|
| Hospital Charge Code |
2958961
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.70 |
| Max. Negotiated Rate |
$20.09 |
| Rate for Payer: Aetna Commercial |
$19.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.58
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna Commercial |
$20.09
|
| Rate for Payer: Health EOS Commercial |
$19.44
|
| Rate for Payer: HFN Commercial |
$20.09
|
| Rate for Payer: Multiplan Commercial |
$17.47
|
| Rate for Payer: Preferred Network Access Commercial |
$20.09
|
| Rate for Payer: Quartz Beloit One Network |
$10.70
|
| Rate for Payer: Quartz Commercial |
$13.10
|
| Rate for Payer: WEA Trust Commercial |
$12.01
|
| Rate for Payer: WPS Commercial |
$16.18
|
|
|
Plantinol AQ 10 mg Charge
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
HCPCS J9060
|
| Hospital Charge Code |
2958961
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$20.09 |
| Rate for Payer: Aetna Commercial |
$19.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.78
|
| Rate for Payer: Aetna Managed Medicare |
$6.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.58
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna Commercial |
$20.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.50
|
| Rate for Payer: Health EOS Commercial |
$19.44
|
| Rate for Payer: HFN Commercial |
$20.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16.38
|
| Rate for Payer: Multiplan Commercial |
$17.47
|
| Rate for Payer: NAPHCARE Commercial |
$13.10
|
| Rate for Payer: Preferred Network Access Commercial |
$20.09
|
| Rate for Payer: Quartz Beloit One Network |
$10.70
|
| Rate for Payer: Quartz Commercial |
$14.20
|
| Rate for Payer: Quartz Medicare Advantage |
$13.10
|
| Rate for Payer: The Alliance Commercial |
$8.78
|
| Rate for Payer: WEA Trust Commercial |
$12.01
|
| Rate for Payer: WPS Commercial |
$8.50
|
|
|
Plantinol AQ 10 mg Charge
|
Professional
|
Both
|
$21.00
|
|
|
Service Code
|
HCPCS J9060
|
| Hospital Charge Code |
2958961
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$20.75 |
| Rate for Payer: Aetna Commercial |
$20.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.78
|
| Rate for Payer: Aetna Managed Medicare |
$2.19
|
| Rate for Payer: Anthem Medicare Advantage |
$2.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2.19
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna Commercial |
$20.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.40
|
| Rate for Payer: Health EOS Commercial |
$19.87
|
| Rate for Payer: HFN Commercial |
$20.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2.19
|
| Rate for Payer: Multiplan Commercial |
$17.47
|
| Rate for Payer: NAPHCARE Commercial |
$3.29
|
| Rate for Payer: Preferred Network Access Commercial |
$20.75
|
| Rate for Payer: Quartz Beloit One Network |
$9.61
|
| Rate for Payer: Quartz Commercial |
$12.45
|
| Rate for Payer: Quartz Medicare Advantage |
$2.19
|
| Rate for Payer: The Alliance Commercial |
$6.03
|
| Rate for Payer: United Healthcare Medicaid |
$2.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.19
|
| Rate for Payer: WEA Trust Commercial |
$12.01
|
| Rate for Payer: WPS Commercial |
$8.50
|
|
|
Plasma CPD Cryo Red
|
Facility
|
OP
|
$385.00
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
1052808
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$88.57 |
| Max. Negotiated Rate |
$368.37 |
| Rate for Payer: Aetna Commercial |
$360.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$344.34
|
| Rate for Payer: Aetna Managed Medicare |
$88.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$260.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$200.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$192.19
|
| Rate for Payer: Anthem Medicare Advantage |
$88.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$212.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$88.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$88.57
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna Commercial |
$368.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$88.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$224.07
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$88.57
|
| Rate for Payer: Health EOS Commercial |
$356.36
|
| Rate for Payer: HFN Commercial |
$368.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$329.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$88.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$88.57
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$88.57
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$88.57
|
| Rate for Payer: Multiplan Commercial |
$320.32
|
| Rate for Payer: NAPHCARE Commercial |
$132.85
|
| Rate for Payer: Preferred Network Access Commercial |
$368.37
|
| Rate for Payer: Quartz Beloit One Network |
$196.20
|
| Rate for Payer: Quartz Commercial |
$260.26
|
| Rate for Payer: Quartz Medicare Advantage |
$88.57
|
| Rate for Payer: The Alliance Commercial |
$354.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$88.57
|
| Rate for Payer: United Healthcare PPO |
$300.30
|
| Rate for Payer: WEA Trust Commercial |
$220.22
|
| Rate for Payer: Wellcare Medicare |
$88.57
|
| Rate for Payer: WPS Commercial |
$296.57
|
|
|
Plasma CPD Cryo Red
|
Facility
|
IP
|
$385.00
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
1052808
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$196.20 |
| Max. Negotiated Rate |
$368.37 |
| Rate for Payer: Aetna Commercial |
$360.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$344.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$212.21
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna Commercial |
$368.37
|
| Rate for Payer: Health EOS Commercial |
$356.36
|
| Rate for Payer: HFN Commercial |
$368.37
|
| Rate for Payer: Multiplan Commercial |
$320.32
|
| Rate for Payer: Preferred Network Access Commercial |
$368.37
|
| Rate for Payer: Quartz Beloit One Network |
$196.20
|
| Rate for Payer: Quartz Commercial |
$240.24
|
| Rate for Payer: WEA Trust Commercial |
$220.22
|
| Rate for Payer: WPS Commercial |
$296.57
|
|
|
Plastic mod low ext pad/line L2275
|
Facility
|
IP
|
$445.00
|
|
|
Service Code
|
HCPCS L2275
|
| Hospital Charge Code |
4524748
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$226.77 |
| Max. Negotiated Rate |
$425.78 |
| Rate for Payer: Aetna Commercial |
$416.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$398.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$245.28
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cigna Commercial |
$425.78
|
| Rate for Payer: Health EOS Commercial |
$411.89
|
| Rate for Payer: HFN Commercial |
$425.78
|
| Rate for Payer: Multiplan Commercial |
$370.24
|
| Rate for Payer: Preferred Network Access Commercial |
$425.78
|
| Rate for Payer: Quartz Beloit One Network |
$226.77
|
| Rate for Payer: Quartz Commercial |
$277.68
|
| Rate for Payer: WEA Trust Commercial |
$254.54
|
| Rate for Payer: WPS Commercial |
$342.78
|
|
|
Plastic mod low ext pad/line L2275
|
Professional
|
Both
|
$445.00
|
|
|
Service Code
|
HCPCS L2275
|
| Hospital Charge Code |
4524748
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$166.60 |
| Max. Negotiated Rate |
$480.38 |
| Rate for Payer: Aetna Commercial |
$439.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$398.01
|
| Rate for Payer: Aetna Managed Medicare |
$166.60
|
| Rate for Payer: Anthem Medicare Advantage |
$166.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$166.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$166.60
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cigna Commercial |
$439.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$231.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$166.60
|
| Rate for Payer: Health EOS Commercial |
$421.15
|
| Rate for Payer: HFN Commercial |
$439.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$480.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$480.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$166.60
|
| Rate for Payer: Multiplan Commercial |
$370.24
|
| Rate for Payer: NAPHCARE Commercial |
$249.90
|
| Rate for Payer: Preferred Network Access Commercial |
$439.66
|
| Rate for Payer: Quartz Beloit One Network |
$203.63
|
| Rate for Payer: Quartz Commercial |
$263.80
|
| Rate for Payer: Quartz Medicare Advantage |
$166.60
|
| Rate for Payer: The Alliance Commercial |
$458.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$166.60
|
| Rate for Payer: WEA Trust Commercial |
$254.54
|
| Rate for Payer: WPS Commercial |
$291.55
|
|
|
Plastic mod low ext pad/line L2275
|
Facility
|
OP
|
$445.00
|
|
|
Service Code
|
HCPCS L2275
|
| Hospital Charge Code |
4524748
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$95.28 |
| Max. Negotiated Rate |
$666.39 |
| Rate for Payer: Aetna Commercial |
$416.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$398.01
|
| Rate for Payer: Aetna Managed Medicare |
$129.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$95.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$95.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$95.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$245.28
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cigna Commercial |
$425.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$258.99
|
| Rate for Payer: Health EOS Commercial |
$411.89
|
| Rate for Payer: HFN Commercial |
$425.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$347.10
|
| Rate for Payer: Multiplan Commercial |
$370.24
|
| Rate for Payer: NAPHCARE Commercial |
$277.68
|
| Rate for Payer: Preferred Network Access Commercial |
$425.78
|
| Rate for Payer: Quartz Beloit One Network |
$226.77
|
| Rate for Payer: Quartz Commercial |
$300.82
|
| Rate for Payer: Quartz Medicare Advantage |
$277.68
|
| Rate for Payer: The Alliance Commercial |
$666.39
|
| Rate for Payer: WEA Trust Commercial |
$254.54
|
| Rate for Payer: WPS Commercial |
$342.78
|
|
|
PLASTIC OPERATION ON URETHRAL SPHINCTER, VAGINAL APPROACH (EG, KELLY URETHRAL PLICATION)
|
Facility
|
OP
|
$21,058.09
|
|
|
Service Code
|
CPT 57220
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,409.60 |
| Max. Negotiated Rate |
$21,058.09 |
| Rate for Payer: Aetna Managed Medicare |
$5,264.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,727.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,350.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,781.68
|
| Rate for Payer: Anthem Medicare Advantage |
$5,264.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,264.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,264.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,264.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,264.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19,584.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,264.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,264.52
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,264.52
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,264.52
|
| Rate for Payer: NAPHCARE Commercial |
$7,896.78
|
| Rate for Payer: Quartz Medicare Advantage |
$5,264.52
|
| Rate for Payer: The Alliance Commercial |
$21,058.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,264.52
|
| Rate for Payer: United Healthcare PPO |
$4,409.60
|
| Rate for Payer: Wellcare Medicare |
$5,264.52
|
|
|
PLASTO FIX
|
Facility
|
OP
|
$675.00
|
|
| Hospital Charge Code |
2971519
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$196.56 |
| Max. Negotiated Rate |
$645.84 |
| Rate for Payer: Aetna Commercial |
$631.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$603.72
|
| Rate for Payer: Aetna Managed Medicare |
$196.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$456.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$351.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$336.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$372.06
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cigna Commercial |
$645.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$392.85
|
| Rate for Payer: Health EOS Commercial |
$624.78
|
| Rate for Payer: HFN Commercial |
$645.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$526.50
|
| Rate for Payer: Multiplan Commercial |
$561.60
|
| Rate for Payer: NAPHCARE Commercial |
$421.20
|
| Rate for Payer: Preferred Network Access Commercial |
$645.84
|
| Rate for Payer: Quartz Beloit One Network |
$343.98
|
| Rate for Payer: Quartz Commercial |
$456.30
|
| Rate for Payer: Quartz Medicare Advantage |
$421.20
|
| Rate for Payer: The Alliance Commercial |
$351.00
|
| Rate for Payer: WEA Trust Commercial |
$386.10
|
| Rate for Payer: WPS Commercial |
$519.95
|
|
|
PLASTO FIX
|
Facility
|
IP
|
$675.00
|
|
| Hospital Charge Code |
2971519
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$343.98 |
| Max. Negotiated Rate |
$645.84 |
| Rate for Payer: Aetna Commercial |
$631.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$603.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$372.06
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cigna Commercial |
$645.84
|
| Rate for Payer: Health EOS Commercial |
$624.78
|
| Rate for Payer: HFN Commercial |
$645.84
|
| Rate for Payer: Multiplan Commercial |
$561.60
|
| Rate for Payer: Preferred Network Access Commercial |
$645.84
|
| Rate for Payer: Quartz Beloit One Network |
$343.98
|
| Rate for Payer: Quartz Commercial |
$421.20
|
| Rate for Payer: WEA Trust Commercial |
$386.10
|
| Rate for Payer: WPS Commercial |
$519.95
|
|
|
PLATE 10H 3.5 LCP 223.601
|
Facility
|
OP
|
$1,623.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966662
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$472.62 |
| Max. Negotiated Rate |
$1,552.89 |
| Rate for Payer: Aetna Commercial |
$1,519.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,451.61
|
| Rate for Payer: Aetna Managed Medicare |
$472.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,097.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$843.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$810.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$894.60
|
| Rate for Payer: Cash Price |
$486.90
|
| Rate for Payer: Cigna Commercial |
$1,552.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$944.59
|
| Rate for Payer: Health EOS Commercial |
$1,502.25
|
| Rate for Payer: HFN Commercial |
$1,552.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,265.94
|
| Rate for Payer: Multiplan Commercial |
$1,350.34
|
| Rate for Payer: NAPHCARE Commercial |
$1,012.75
|
| Rate for Payer: Preferred Network Access Commercial |
$1,552.89
|
| Rate for Payer: Quartz Beloit One Network |
$827.08
|
| Rate for Payer: Quartz Commercial |
$1,097.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,012.75
|
| Rate for Payer: The Alliance Commercial |
$843.96
|
| Rate for Payer: WEA Trust Commercial |
$928.36
|
| Rate for Payer: WPS Commercial |
$1,250.20
|
|
|
PLATE 10H 3.5 LCP 223.601
|
Facility
|
IP
|
$1,623.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966662
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$827.08 |
| Max. Negotiated Rate |
$1,552.89 |
| Rate for Payer: Aetna Commercial |
$1,519.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,451.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$894.60
|
| Rate for Payer: Cash Price |
$486.90
|
| Rate for Payer: Cigna Commercial |
$1,552.89
|
| Rate for Payer: Health EOS Commercial |
$1,502.25
|
| Rate for Payer: HFN Commercial |
$1,552.89
|
| Rate for Payer: Multiplan Commercial |
$1,350.34
|
| Rate for Payer: Preferred Network Access Commercial |
$1,552.89
|
| Rate for Payer: Quartz Beloit One Network |
$827.08
|
| Rate for Payer: Quartz Commercial |
$1,012.75
|
| Rate for Payer: WEA Trust Commercial |
$928.36
|
| Rate for Payer: WPS Commercial |
$1,250.20
|
|
|
PLATE 10H 3.5 LCP RECON 245.101
|
Facility
|
IP
|
$2,419.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966663
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,232.72 |
| Max. Negotiated Rate |
$2,314.50 |
| Rate for Payer: Aetna Commercial |
$2,264.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,163.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,333.35
|
| Rate for Payer: Cash Price |
$725.70
|
| Rate for Payer: Cigna Commercial |
$2,314.50
|
| Rate for Payer: Health EOS Commercial |
$2,239.03
|
| Rate for Payer: HFN Commercial |
$2,314.50
|
| Rate for Payer: Multiplan Commercial |
$2,012.61
|
| Rate for Payer: Preferred Network Access Commercial |
$2,314.50
|
| Rate for Payer: Quartz Beloit One Network |
$1,232.72
|
| Rate for Payer: Quartz Commercial |
$1,509.46
|
| Rate for Payer: WEA Trust Commercial |
$1,383.67
|
| Rate for Payer: WPS Commercial |
$1,863.36
|
|
|
PLATE 10H 3.5 LCP RECON 245.101
|
Facility
|
OP
|
$2,419.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966663
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$704.41 |
| Max. Negotiated Rate |
$2,314.50 |
| Rate for Payer: Aetna Commercial |
$2,264.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,163.55
|
| Rate for Payer: Aetna Managed Medicare |
$704.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,635.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,257.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,207.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,333.35
|
| Rate for Payer: Cash Price |
$725.70
|
| Rate for Payer: Cigna Commercial |
$2,314.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,407.86
|
| Rate for Payer: Health EOS Commercial |
$2,239.03
|
| Rate for Payer: HFN Commercial |
$2,314.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,886.82
|
| Rate for Payer: Multiplan Commercial |
$2,012.61
|
| Rate for Payer: NAPHCARE Commercial |
$1,509.46
|
| Rate for Payer: Preferred Network Access Commercial |
$2,314.50
|
| Rate for Payer: Quartz Beloit One Network |
$1,232.72
|
| Rate for Payer: Quartz Commercial |
$1,635.24
|
| Rate for Payer: Quartz Medicare Advantage |
$1,509.46
|
| Rate for Payer: The Alliance Commercial |
$1,257.88
|
| Rate for Payer: WEA Trust Commercial |
$1,383.67
|
| Rate for Payer: WPS Commercial |
$1,863.36
|
|
|
PLATE 10 HL 1/3 COLLAR 121mm
|
Facility
|
IP
|
$5,386.00
|
|
| Hospital Charge Code |
2966317
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,744.71 |
| Max. Negotiated Rate |
$5,153.32 |
| Rate for Payer: Aetna Commercial |
$5,041.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,817.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,968.76
|
| Rate for Payer: Cash Price |
$1,615.80
|
| Rate for Payer: Cigna Commercial |
$5,153.32
|
| Rate for Payer: Health EOS Commercial |
$4,985.28
|
| Rate for Payer: HFN Commercial |
$5,153.32
|
| Rate for Payer: Multiplan Commercial |
$4,481.15
|
| Rate for Payer: Preferred Network Access Commercial |
$5,153.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,744.71
|
| Rate for Payer: Quartz Commercial |
$3,360.86
|
| Rate for Payer: WEA Trust Commercial |
$3,080.79
|
| Rate for Payer: WPS Commercial |
$4,148.84
|
|
|
PLATE 10 HL 1/3 COLLAR 121mm
|
Facility
|
OP
|
$5,386.00
|
|
| Hospital Charge Code |
2966317
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,568.40 |
| Max. Negotiated Rate |
$5,153.32 |
| Rate for Payer: Aetna Commercial |
$5,041.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,817.24
|
| Rate for Payer: Aetna Managed Medicare |
$1,568.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,640.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,800.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,688.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,968.76
|
| Rate for Payer: Cash Price |
$1,615.80
|
| Rate for Payer: Cigna Commercial |
$5,153.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,134.65
|
| Rate for Payer: Health EOS Commercial |
$4,985.28
|
| Rate for Payer: HFN Commercial |
$5,153.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,201.08
|
| Rate for Payer: Multiplan Commercial |
$4,481.15
|
| Rate for Payer: NAPHCARE Commercial |
$3,360.86
|
| Rate for Payer: Preferred Network Access Commercial |
$5,153.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,744.71
|
| Rate for Payer: Quartz Commercial |
$3,640.94
|
| Rate for Payer: Quartz Medicare Advantage |
$3,360.86
|
| Rate for Payer: The Alliance Commercial |
$2,800.72
|
| Rate for Payer: WEA Trust Commercial |
$3,080.79
|
| Rate for Payer: WPS Commercial |
$4,148.84
|
|
|
PLATE 10H LT CONDYLAR 222.661
|
Facility
|
OP
|
$4,678.00
|
|
| Hospital Charge Code |
2966664
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,362.23 |
| Max. Negotiated Rate |
$4,475.91 |
| Rate for Payer: Aetna Commercial |
$4,378.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,184.00
|
| Rate for Payer: Aetna Managed Medicare |
$1,362.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,162.33
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,432.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,335.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,578.51
|
| Rate for Payer: Cash Price |
$1,403.40
|
| Rate for Payer: Cigna Commercial |
$4,475.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,722.60
|
| Rate for Payer: Health EOS Commercial |
$4,329.96
|
| Rate for Payer: HFN Commercial |
$4,475.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,648.84
|
| Rate for Payer: Multiplan Commercial |
$3,892.10
|
| Rate for Payer: NAPHCARE Commercial |
$2,919.07
|
| Rate for Payer: Preferred Network Access Commercial |
$4,475.91
|
| Rate for Payer: Quartz Beloit One Network |
$2,383.91
|
| Rate for Payer: Quartz Commercial |
$3,162.33
|
| Rate for Payer: Quartz Medicare Advantage |
$2,919.07
|
| Rate for Payer: The Alliance Commercial |
$2,432.56
|
| Rate for Payer: WEA Trust Commercial |
$2,675.82
|
| Rate for Payer: WPS Commercial |
$3,603.46
|
|
|
PLATE 10H LT CONDYLAR 222.661
|
Facility
|
IP
|
$4,678.00
|
|
| Hospital Charge Code |
2966664
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,383.91 |
| Max. Negotiated Rate |
$4,475.91 |
| Rate for Payer: Aetna Commercial |
$4,378.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,184.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,578.51
|
| Rate for Payer: Cash Price |
$1,403.40
|
| Rate for Payer: Cigna Commercial |
$4,475.91
|
| Rate for Payer: Health EOS Commercial |
$4,329.96
|
| Rate for Payer: HFN Commercial |
$4,475.91
|
| Rate for Payer: Multiplan Commercial |
$3,892.10
|
| Rate for Payer: Preferred Network Access Commercial |
$4,475.91
|
| Rate for Payer: Quartz Beloit One Network |
$2,383.91
|
| Rate for Payer: Quartz Commercial |
$2,919.07
|
| Rate for Payer: WEA Trust Commercial |
$2,675.82
|
| Rate for Payer: WPS Commercial |
$3,603.46
|
|
|
PLATE 10H LT PROX/TIB 240.043
|
Facility
|
IP
|
$4,732.00
|
|
| Hospital Charge Code |
2966665
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,411.43 |
| Max. Negotiated Rate |
$4,527.58 |
| Rate for Payer: Aetna Commercial |
$4,429.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,232.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,608.28
|
| Rate for Payer: Cash Price |
$1,419.60
|
| Rate for Payer: Cigna Commercial |
$4,527.58
|
| Rate for Payer: Health EOS Commercial |
$4,379.94
|
| Rate for Payer: HFN Commercial |
$4,527.58
|
| Rate for Payer: Multiplan Commercial |
$3,937.02
|
| Rate for Payer: Preferred Network Access Commercial |
$4,527.58
|
| Rate for Payer: Quartz Beloit One Network |
$2,411.43
|
| Rate for Payer: Quartz Commercial |
$2,952.77
|
| Rate for Payer: WEA Trust Commercial |
$2,706.70
|
| Rate for Payer: WPS Commercial |
$3,645.06
|
|
|
PLATE 10H LT PROX/TIB 240.043
|
Facility
|
OP
|
$4,732.00
|
|
| Hospital Charge Code |
2966665
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,377.96 |
| Max. Negotiated Rate |
$4,527.58 |
| Rate for Payer: Aetna Commercial |
$4,429.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,232.30
|
| Rate for Payer: Aetna Managed Medicare |
$1,377.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,198.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,460.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,362.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,608.28
|
| Rate for Payer: Cash Price |
$1,419.60
|
| Rate for Payer: Cigna Commercial |
$4,527.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,754.02
|
| Rate for Payer: Health EOS Commercial |
$4,379.94
|
| Rate for Payer: HFN Commercial |
$4,527.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,690.96
|
| Rate for Payer: Multiplan Commercial |
$3,937.02
|
| Rate for Payer: NAPHCARE Commercial |
$2,952.77
|
| Rate for Payer: Preferred Network Access Commercial |
$4,527.58
|
| Rate for Payer: Quartz Beloit One Network |
$2,411.43
|
| Rate for Payer: Quartz Commercial |
$3,198.83
|
| Rate for Payer: Quartz Medicare Advantage |
$2,952.77
|
| Rate for Payer: The Alliance Commercial |
$2,460.64
|
| Rate for Payer: WEA Trust Commercial |
$2,706.70
|
| Rate for Payer: WPS Commercial |
$3,645.06
|
|
|
PLATE 10H RT CONDYLAR 222.660
|
Facility
|
IP
|
$4,678.00
|
|
| Hospital Charge Code |
2966666
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,383.91 |
| Max. Negotiated Rate |
$4,475.91 |
| Rate for Payer: Aetna Commercial |
$4,378.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,184.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,578.51
|
| Rate for Payer: Cash Price |
$1,403.40
|
| Rate for Payer: Cigna Commercial |
$4,475.91
|
| Rate for Payer: Health EOS Commercial |
$4,329.96
|
| Rate for Payer: HFN Commercial |
$4,475.91
|
| Rate for Payer: Multiplan Commercial |
$3,892.10
|
| Rate for Payer: Preferred Network Access Commercial |
$4,475.91
|
| Rate for Payer: Quartz Beloit One Network |
$2,383.91
|
| Rate for Payer: Quartz Commercial |
$2,919.07
|
| Rate for Payer: WEA Trust Commercial |
$2,675.82
|
| Rate for Payer: WPS Commercial |
$3,603.46
|
|
|
PLATE 10H RT CONDYLAR 222.660
|
Facility
|
OP
|
$4,678.00
|
|
| Hospital Charge Code |
2966666
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,362.23 |
| Max. Negotiated Rate |
$4,475.91 |
| Rate for Payer: Aetna Commercial |
$4,378.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,184.00
|
| Rate for Payer: Aetna Managed Medicare |
$1,362.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,162.33
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,432.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,335.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,578.51
|
| Rate for Payer: Cash Price |
$1,403.40
|
| Rate for Payer: Cigna Commercial |
$4,475.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,722.60
|
| Rate for Payer: Health EOS Commercial |
$4,329.96
|
| Rate for Payer: HFN Commercial |
$4,475.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,648.84
|
| Rate for Payer: Multiplan Commercial |
$3,892.10
|
| Rate for Payer: NAPHCARE Commercial |
$2,919.07
|
| Rate for Payer: Preferred Network Access Commercial |
$4,475.91
|
| Rate for Payer: Quartz Beloit One Network |
$2,383.91
|
| Rate for Payer: Quartz Commercial |
$3,162.33
|
| Rate for Payer: Quartz Medicare Advantage |
$2,919.07
|
| Rate for Payer: The Alliance Commercial |
$2,432.56
|
| Rate for Payer: WEA Trust Commercial |
$2,675.82
|
| Rate for Payer: WPS Commercial |
$3,603.46
|
|
|
PLATE 10H RT PROX/TIB 240.042
|
Facility
|
IP
|
$4,732.00
|
|
| Hospital Charge Code |
2966667
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,411.43 |
| Max. Negotiated Rate |
$4,527.58 |
| Rate for Payer: Aetna Commercial |
$4,429.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,232.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,608.28
|
| Rate for Payer: Cash Price |
$1,419.60
|
| Rate for Payer: Cigna Commercial |
$4,527.58
|
| Rate for Payer: Health EOS Commercial |
$4,379.94
|
| Rate for Payer: HFN Commercial |
$4,527.58
|
| Rate for Payer: Multiplan Commercial |
$3,937.02
|
| Rate for Payer: Preferred Network Access Commercial |
$4,527.58
|
| Rate for Payer: Quartz Beloit One Network |
$2,411.43
|
| Rate for Payer: Quartz Commercial |
$2,952.77
|
| Rate for Payer: WEA Trust Commercial |
$2,706.70
|
| Rate for Payer: WPS Commercial |
$3,645.06
|
|
