|
PLATE 7H 3.5 LCP RECON 245.071
|
Facility
|
OP
|
$2,253.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966737
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$656.07 |
| Max. Negotiated Rate |
$2,155.67 |
| Rate for Payer: Aetna Commercial |
$2,108.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,015.08
|
| Rate for Payer: Aetna Managed Medicare |
$656.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,523.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,171.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,124.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,241.85
|
| Rate for Payer: Cash Price |
$675.90
|
| Rate for Payer: Cigna Commercial |
$2,155.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,311.25
|
| Rate for Payer: Health EOS Commercial |
$2,085.38
|
| Rate for Payer: HFN Commercial |
$2,155.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,757.34
|
| Rate for Payer: Multiplan Commercial |
$1,874.50
|
| Rate for Payer: NAPHCARE Commercial |
$1,405.87
|
| Rate for Payer: Preferred Network Access Commercial |
$2,155.67
|
| Rate for Payer: Quartz Beloit One Network |
$1,148.13
|
| Rate for Payer: Quartz Commercial |
$1,523.03
|
| Rate for Payer: Quartz Medicare Advantage |
$1,405.87
|
| Rate for Payer: The Alliance Commercial |
$1,171.56
|
| Rate for Payer: WEA Trust Commercial |
$1,288.72
|
| Rate for Payer: WPS Commercial |
$1,735.49
|
|
|
PLATE 7H 3.5 LCP RECON 245.071
|
Facility
|
IP
|
$2,253.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966737
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,148.13 |
| Max. Negotiated Rate |
$2,155.67 |
| Rate for Payer: Aetna Commercial |
$2,108.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,015.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,241.85
|
| Rate for Payer: Cash Price |
$675.90
|
| Rate for Payer: Cigna Commercial |
$2,155.67
|
| Rate for Payer: Health EOS Commercial |
$2,085.38
|
| Rate for Payer: HFN Commercial |
$2,155.67
|
| Rate for Payer: Multiplan Commercial |
$1,874.50
|
| Rate for Payer: Preferred Network Access Commercial |
$2,155.67
|
| Rate for Payer: Quartz Beloit One Network |
$1,148.13
|
| Rate for Payer: Quartz Commercial |
$1,405.87
|
| Rate for Payer: WEA Trust Commercial |
$1,288.72
|
| Rate for Payer: WPS Commercial |
$1,735.49
|
|
|
PLATE 7HL LT LCP DISTAL FEMUR
|
Facility
|
OP
|
$10,912.00
|
|
| Hospital Charge Code |
2966357
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,177.57 |
| Max. Negotiated Rate |
$10,440.60 |
| Rate for Payer: Aetna Commercial |
$10,213.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,759.69
|
| Rate for Payer: Aetna Managed Medicare |
$3,177.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,376.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,674.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,447.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,014.69
|
| Rate for Payer: Cash Price |
$3,273.60
|
| Rate for Payer: Cigna Commercial |
$10,440.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,350.78
|
| Rate for Payer: Health EOS Commercial |
$10,100.15
|
| Rate for Payer: HFN Commercial |
$10,440.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,511.36
|
| Rate for Payer: Multiplan Commercial |
$9,078.78
|
| Rate for Payer: NAPHCARE Commercial |
$6,809.09
|
| Rate for Payer: Preferred Network Access Commercial |
$10,440.60
|
| Rate for Payer: Quartz Beloit One Network |
$5,560.76
|
| Rate for Payer: Quartz Commercial |
$7,376.51
|
| Rate for Payer: Quartz Medicare Advantage |
$6,809.09
|
| Rate for Payer: The Alliance Commercial |
$5,674.24
|
| Rate for Payer: WEA Trust Commercial |
$6,241.66
|
| Rate for Payer: WPS Commercial |
$8,405.51
|
|
|
PLATE 7HL LT LCP DISTAL FEMUR
|
Facility
|
IP
|
$10,912.00
|
|
| Hospital Charge Code |
2966357
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,560.76 |
| Max. Negotiated Rate |
$10,440.60 |
| Rate for Payer: Aetna Commercial |
$10,213.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,759.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,014.69
|
| Rate for Payer: Cash Price |
$3,273.60
|
| Rate for Payer: Cigna Commercial |
$10,440.60
|
| Rate for Payer: Health EOS Commercial |
$10,100.15
|
| Rate for Payer: HFN Commercial |
$10,440.60
|
| Rate for Payer: Multiplan Commercial |
$9,078.78
|
| Rate for Payer: Preferred Network Access Commercial |
$10,440.60
|
| Rate for Payer: Quartz Beloit One Network |
$5,560.76
|
| Rate for Payer: Quartz Commercial |
$6,809.09
|
| Rate for Payer: WEA Trust Commercial |
$6,241.66
|
| Rate for Payer: WPS Commercial |
$8,405.51
|
|
|
PLATE 7HL RT DISTAL FEMUR
|
Facility
|
IP
|
$10,886.00
|
|
| Hospital Charge Code |
2966358
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,547.51 |
| Max. Negotiated Rate |
$10,415.72 |
| Rate for Payer: Aetna Commercial |
$10,189.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,736.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,000.36
|
| Rate for Payer: Cash Price |
$3,265.80
|
| Rate for Payer: Cigna Commercial |
$10,415.72
|
| Rate for Payer: Health EOS Commercial |
$10,076.08
|
| Rate for Payer: HFN Commercial |
$10,415.72
|
| Rate for Payer: Multiplan Commercial |
$9,057.15
|
| Rate for Payer: Preferred Network Access Commercial |
$10,415.72
|
| Rate for Payer: Quartz Beloit One Network |
$5,547.51
|
| Rate for Payer: Quartz Commercial |
$6,792.86
|
| Rate for Payer: WEA Trust Commercial |
$6,226.79
|
| Rate for Payer: WPS Commercial |
$8,385.49
|
|
|
PLATE 7HL RT DISTAL FEMUR
|
Facility
|
OP
|
$10,886.00
|
|
| Hospital Charge Code |
2966358
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,170.00 |
| Max. Negotiated Rate |
$10,415.72 |
| Rate for Payer: Aetna Commercial |
$10,189.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,736.44
|
| Rate for Payer: Aetna Managed Medicare |
$3,170.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,358.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,660.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,434.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,000.36
|
| Rate for Payer: Cash Price |
$3,265.80
|
| Rate for Payer: Cigna Commercial |
$10,415.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,335.65
|
| Rate for Payer: Health EOS Commercial |
$10,076.08
|
| Rate for Payer: HFN Commercial |
$10,415.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,491.08
|
| Rate for Payer: Multiplan Commercial |
$9,057.15
|
| Rate for Payer: NAPHCARE Commercial |
$6,792.86
|
| Rate for Payer: Preferred Network Access Commercial |
$10,415.72
|
| Rate for Payer: Quartz Beloit One Network |
$5,547.51
|
| Rate for Payer: Quartz Commercial |
$7,358.94
|
| Rate for Payer: Quartz Medicare Advantage |
$6,792.86
|
| Rate for Payer: The Alliance Commercial |
$5,660.72
|
| Rate for Payer: WEA Trust Commercial |
$6,226.79
|
| Rate for Payer: WPS Commercial |
$8,385.49
|
|
|
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 |
$744.53 |
| Max. Negotiated Rate |
$1,397.88 |
| Rate for Payer: Aetna Commercial |
$1,367.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,306.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$805.30
|
| Rate for Payer: Cash Price |
$438.30
|
| Rate for Payer: Cigna Commercial |
$1,397.88
|
| Rate for Payer: Health EOS Commercial |
$1,352.30
|
| Rate for Payer: HFN Commercial |
$1,397.88
|
| Rate for Payer: Multiplan Commercial |
$1,215.55
|
| Rate for Payer: Preferred Network Access Commercial |
$1,397.88
|
| Rate for Payer: Quartz Beloit One Network |
$744.53
|
| Rate for Payer: Quartz Commercial |
$911.66
|
| Rate for Payer: WEA Trust Commercial |
$835.69
|
| Rate for Payer: WPS Commercial |
$1,125.41
|
|
|
PLATE 8H 3.5 LCP 223.581
|
Facility
|
OP
|
$1,461.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966738
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$425.44 |
| Max. Negotiated Rate |
$1,397.88 |
| Rate for Payer: Aetna Commercial |
$1,367.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,306.72
|
| Rate for Payer: Aetna Managed Medicare |
$425.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$987.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$759.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$729.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$805.30
|
| Rate for Payer: Cash Price |
$438.30
|
| Rate for Payer: Cigna Commercial |
$1,397.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$850.30
|
| Rate for Payer: Health EOS Commercial |
$1,352.30
|
| Rate for Payer: HFN Commercial |
$1,397.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,139.58
|
| Rate for Payer: Multiplan Commercial |
$1,215.55
|
| Rate for Payer: NAPHCARE Commercial |
$911.66
|
| Rate for Payer: Preferred Network Access Commercial |
$1,397.88
|
| Rate for Payer: Quartz Beloit One Network |
$744.53
|
| Rate for Payer: Quartz Commercial |
$987.64
|
| Rate for Payer: Quartz Medicare Advantage |
$911.66
|
| Rate for Payer: The Alliance Commercial |
$759.72
|
| Rate for Payer: WEA Trust Commercial |
$835.69
|
| Rate for Payer: WPS Commercial |
$1,125.41
|
|
|
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 |
$1,196.03 |
| Max. Negotiated Rate |
$2,245.61 |
| Rate for Payer: Aetna Commercial |
$2,196.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,099.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,293.67
|
| Rate for Payer: Cash Price |
$704.10
|
| Rate for Payer: Cigna Commercial |
$2,245.61
|
| Rate for Payer: Health EOS Commercial |
$2,172.38
|
| Rate for Payer: HFN Commercial |
$2,245.61
|
| Rate for Payer: Multiplan Commercial |
$1,952.70
|
| Rate for Payer: Preferred Network Access Commercial |
$2,245.61
|
| Rate for Payer: Quartz Beloit One Network |
$1,196.03
|
| Rate for Payer: Quartz Commercial |
$1,464.53
|
| Rate for Payer: WEA Trust Commercial |
$1,342.48
|
| Rate for Payer: WPS Commercial |
$1,807.89
|
|
|
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 |
$683.45 |
| Max. Negotiated Rate |
$2,245.61 |
| Rate for Payer: Aetna Commercial |
$2,196.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,099.16
|
| Rate for Payer: Aetna Managed Medicare |
$683.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,586.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,220.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,171.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,293.67
|
| Rate for Payer: Cash Price |
$704.10
|
| Rate for Payer: Cigna Commercial |
$2,245.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,365.95
|
| Rate for Payer: Health EOS Commercial |
$2,172.38
|
| Rate for Payer: HFN Commercial |
$2,245.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,830.66
|
| Rate for Payer: Multiplan Commercial |
$1,952.70
|
| Rate for Payer: NAPHCARE Commercial |
$1,464.53
|
| Rate for Payer: Preferred Network Access Commercial |
$2,245.61
|
| Rate for Payer: Quartz Beloit One Network |
$1,196.03
|
| Rate for Payer: Quartz Commercial |
$1,586.57
|
| Rate for Payer: Quartz Medicare Advantage |
$1,464.53
|
| Rate for Payer: The Alliance Commercial |
$1,220.44
|
| Rate for Payer: WEA Trust Commercial |
$1,342.48
|
| Rate for Payer: WPS Commercial |
$1,807.89
|
|
|
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 |
$4,069.16 |
| Max. Negotiated Rate |
$7,640.05 |
| Rate for Payer: Aetna Commercial |
$7,473.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,141.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,401.33
|
| Rate for Payer: Cash Price |
$2,395.50
|
| Rate for Payer: Cigna Commercial |
$7,640.05
|
| Rate for Payer: Health EOS Commercial |
$7,390.92
|
| Rate for Payer: HFN Commercial |
$7,640.05
|
| Rate for Payer: Multiplan Commercial |
$6,643.52
|
| Rate for Payer: Preferred Network Access Commercial |
$7,640.05
|
| Rate for Payer: Quartz Beloit One Network |
$4,069.16
|
| Rate for Payer: Quartz Commercial |
$4,982.64
|
| Rate for Payer: WEA Trust Commercial |
$4,567.42
|
| Rate for Payer: WPS Commercial |
$6,150.85
|
|
|
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 |
$2,325.23 |
| Max. Negotiated Rate |
$7,640.05 |
| Rate for Payer: Aetna Commercial |
$7,473.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,141.78
|
| Rate for Payer: Aetna Managed Medicare |
$2,325.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,397.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,152.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,986.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,401.33
|
| Rate for Payer: Cash Price |
$2,395.50
|
| Rate for Payer: Cigna Commercial |
$7,640.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,647.27
|
| Rate for Payer: Health EOS Commercial |
$7,390.92
|
| Rate for Payer: HFN Commercial |
$7,640.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,228.30
|
| Rate for Payer: Multiplan Commercial |
$6,643.52
|
| Rate for Payer: NAPHCARE Commercial |
$4,982.64
|
| Rate for Payer: Preferred Network Access Commercial |
$7,640.05
|
| Rate for Payer: Quartz Beloit One Network |
$4,069.16
|
| Rate for Payer: Quartz Commercial |
$5,397.86
|
| Rate for Payer: Quartz Medicare Advantage |
$4,982.64
|
| Rate for Payer: The Alliance Commercial |
$4,152.20
|
| Rate for Payer: WEA Trust Commercial |
$4,567.42
|
| Rate for Payer: WPS Commercial |
$6,150.85
|
|
|
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 |
$4,069.16 |
| Max. Negotiated Rate |
$7,640.05 |
| Rate for Payer: Aetna Commercial |
$7,473.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,141.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,401.33
|
| Rate for Payer: Cash Price |
$2,395.50
|
| Rate for Payer: Cigna Commercial |
$7,640.05
|
| Rate for Payer: Health EOS Commercial |
$7,390.92
|
| Rate for Payer: HFN Commercial |
$7,640.05
|
| Rate for Payer: Multiplan Commercial |
$6,643.52
|
| Rate for Payer: Preferred Network Access Commercial |
$7,640.05
|
| Rate for Payer: Quartz Beloit One Network |
$4,069.16
|
| Rate for Payer: Quartz Commercial |
$4,982.64
|
| Rate for Payer: WEA Trust Commercial |
$4,567.42
|
| Rate for Payer: WPS Commercial |
$6,150.85
|
|
|
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 |
$2,325.23 |
| Max. Negotiated Rate |
$7,640.05 |
| Rate for Payer: Aetna Commercial |
$7,473.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,141.78
|
| Rate for Payer: Aetna Managed Medicare |
$2,325.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,397.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,152.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,986.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,401.33
|
| Rate for Payer: Cash Price |
$2,395.50
|
| Rate for Payer: Cigna Commercial |
$7,640.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,647.27
|
| Rate for Payer: Health EOS Commercial |
$7,390.92
|
| Rate for Payer: HFN Commercial |
$7,640.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,228.30
|
| Rate for Payer: Multiplan Commercial |
$6,643.52
|
| Rate for Payer: NAPHCARE Commercial |
$4,982.64
|
| Rate for Payer: Preferred Network Access Commercial |
$7,640.05
|
| Rate for Payer: Quartz Beloit One Network |
$4,069.16
|
| Rate for Payer: Quartz Commercial |
$5,397.86
|
| Rate for Payer: Quartz Medicare Advantage |
$4,982.64
|
| Rate for Payer: The Alliance Commercial |
$4,152.20
|
| Rate for Payer: WEA Trust Commercial |
$4,567.42
|
| Rate for Payer: WPS Commercial |
$6,150.85
|
|
|
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 |
$2,325.23 |
| Max. Negotiated Rate |
$7,640.05 |
| Rate for Payer: Aetna Commercial |
$7,473.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,141.78
|
| Rate for Payer: Aetna Managed Medicare |
$2,325.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,397.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,152.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,986.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,401.33
|
| Rate for Payer: Cash Price |
$2,395.50
|
| Rate for Payer: Cigna Commercial |
$7,640.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,647.27
|
| Rate for Payer: Health EOS Commercial |
$7,390.92
|
| Rate for Payer: HFN Commercial |
$7,640.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,228.30
|
| Rate for Payer: Multiplan Commercial |
$6,643.52
|
| Rate for Payer: NAPHCARE Commercial |
$4,982.64
|
| Rate for Payer: Preferred Network Access Commercial |
$7,640.05
|
| Rate for Payer: Quartz Beloit One Network |
$4,069.16
|
| Rate for Payer: Quartz Commercial |
$5,397.86
|
| Rate for Payer: Quartz Medicare Advantage |
$4,982.64
|
| Rate for Payer: The Alliance Commercial |
$4,152.20
|
| Rate for Payer: WEA Trust Commercial |
$4,567.42
|
| Rate for Payer: WPS Commercial |
$6,150.85
|
|
|
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 |
$4,069.16 |
| Max. Negotiated Rate |
$7,640.05 |
| Rate for Payer: Aetna Commercial |
$7,473.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,141.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,401.33
|
| Rate for Payer: Cash Price |
$2,395.50
|
| Rate for Payer: Cigna Commercial |
$7,640.05
|
| Rate for Payer: Health EOS Commercial |
$7,390.92
|
| Rate for Payer: HFN Commercial |
$7,640.05
|
| Rate for Payer: Multiplan Commercial |
$6,643.52
|
| Rate for Payer: Preferred Network Access Commercial |
$7,640.05
|
| Rate for Payer: Quartz Beloit One Network |
$4,069.16
|
| Rate for Payer: Quartz Commercial |
$4,982.64
|
| Rate for Payer: WEA Trust Commercial |
$4,567.42
|
| Rate for Payer: WPS Commercial |
$6,150.85
|
|
|
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 |
$4,069.16 |
| Max. Negotiated Rate |
$7,640.05 |
| Rate for Payer: Aetna Commercial |
$7,473.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,141.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,401.33
|
| Rate for Payer: Cash Price |
$2,395.50
|
| Rate for Payer: Cigna Commercial |
$7,640.05
|
| Rate for Payer: Health EOS Commercial |
$7,390.92
|
| Rate for Payer: HFN Commercial |
$7,640.05
|
| Rate for Payer: Multiplan Commercial |
$6,643.52
|
| Rate for Payer: Preferred Network Access Commercial |
$7,640.05
|
| Rate for Payer: Quartz Beloit One Network |
$4,069.16
|
| Rate for Payer: Quartz Commercial |
$4,982.64
|
| Rate for Payer: WEA Trust Commercial |
$4,567.42
|
| Rate for Payer: WPS Commercial |
$6,150.85
|
|
|
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 |
$2,325.23 |
| Max. Negotiated Rate |
$7,640.05 |
| Rate for Payer: Aetna Commercial |
$7,473.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,141.78
|
| Rate for Payer: Aetna Managed Medicare |
$2,325.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,397.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,152.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,986.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,401.33
|
| Rate for Payer: Cash Price |
$2,395.50
|
| Rate for Payer: Cigna Commercial |
$7,640.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,647.27
|
| Rate for Payer: Health EOS Commercial |
$7,390.92
|
| Rate for Payer: HFN Commercial |
$7,640.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,228.30
|
| Rate for Payer: Multiplan Commercial |
$6,643.52
|
| Rate for Payer: NAPHCARE Commercial |
$4,982.64
|
| Rate for Payer: Preferred Network Access Commercial |
$7,640.05
|
| Rate for Payer: Quartz Beloit One Network |
$4,069.16
|
| Rate for Payer: Quartz Commercial |
$5,397.86
|
| Rate for Payer: Quartz Medicare Advantage |
$4,982.64
|
| Rate for Payer: The Alliance Commercial |
$4,152.20
|
| Rate for Payer: WEA Trust Commercial |
$4,567.42
|
| Rate for Payer: WPS Commercial |
$6,150.85
|
|
|
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 |
$2,325.23 |
| Max. Negotiated Rate |
$7,640.05 |
| Rate for Payer: Aetna Commercial |
$7,473.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,141.78
|
| Rate for Payer: Aetna Managed Medicare |
$2,325.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,397.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,152.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,986.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,401.33
|
| Rate for Payer: Cash Price |
$2,395.50
|
| Rate for Payer: Cigna Commercial |
$7,640.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,647.27
|
| Rate for Payer: Health EOS Commercial |
$7,390.92
|
| Rate for Payer: HFN Commercial |
$7,640.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,228.30
|
| Rate for Payer: Multiplan Commercial |
$6,643.52
|
| Rate for Payer: NAPHCARE Commercial |
$4,982.64
|
| Rate for Payer: Preferred Network Access Commercial |
$7,640.05
|
| Rate for Payer: Quartz Beloit One Network |
$4,069.16
|
| Rate for Payer: Quartz Commercial |
$5,397.86
|
| Rate for Payer: Quartz Medicare Advantage |
$4,982.64
|
| Rate for Payer: The Alliance Commercial |
$4,152.20
|
| Rate for Payer: WEA Trust Commercial |
$4,567.42
|
| Rate for Payer: WPS Commercial |
$6,150.85
|
|
|
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 |
$4,069.16 |
| Max. Negotiated Rate |
$7,640.05 |
| Rate for Payer: Aetna Commercial |
$7,473.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,141.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,401.33
|
| Rate for Payer: Cash Price |
$2,395.50
|
| Rate for Payer: Cigna Commercial |
$7,640.05
|
| Rate for Payer: Health EOS Commercial |
$7,390.92
|
| Rate for Payer: HFN Commercial |
$7,640.05
|
| Rate for Payer: Multiplan Commercial |
$6,643.52
|
| Rate for Payer: Preferred Network Access Commercial |
$7,640.05
|
| Rate for Payer: Quartz Beloit One Network |
$4,069.16
|
| Rate for Payer: Quartz Commercial |
$4,982.64
|
| Rate for Payer: WEA Trust Commercial |
$4,567.42
|
| Rate for Payer: WPS Commercial |
$6,150.85
|
|
|
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 |
$4,069.16 |
| Max. Negotiated Rate |
$7,640.05 |
| Rate for Payer: Aetna Commercial |
$7,473.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,141.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,401.33
|
| Rate for Payer: Cash Price |
$2,395.50
|
| Rate for Payer: Cigna Commercial |
$7,640.05
|
| Rate for Payer: Health EOS Commercial |
$7,390.92
|
| Rate for Payer: HFN Commercial |
$7,640.05
|
| Rate for Payer: Multiplan Commercial |
$6,643.52
|
| Rate for Payer: Preferred Network Access Commercial |
$7,640.05
|
| Rate for Payer: Quartz Beloit One Network |
$4,069.16
|
| Rate for Payer: Quartz Commercial |
$4,982.64
|
| Rate for Payer: WEA Trust Commercial |
$4,567.42
|
| Rate for Payer: WPS Commercial |
$6,150.85
|
|
|
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 |
$2,325.23 |
| Max. Negotiated Rate |
$7,640.05 |
| Rate for Payer: Aetna Commercial |
$7,473.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,141.78
|
| Rate for Payer: Aetna Managed Medicare |
$2,325.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,397.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,152.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,986.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,401.33
|
| Rate for Payer: Cash Price |
$2,395.50
|
| Rate for Payer: Cigna Commercial |
$7,640.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,647.27
|
| Rate for Payer: Health EOS Commercial |
$7,390.92
|
| Rate for Payer: HFN Commercial |
$7,640.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,228.30
|
| Rate for Payer: Multiplan Commercial |
$6,643.52
|
| Rate for Payer: NAPHCARE Commercial |
$4,982.64
|
| Rate for Payer: Preferred Network Access Commercial |
$7,640.05
|
| Rate for Payer: Quartz Beloit One Network |
$4,069.16
|
| Rate for Payer: Quartz Commercial |
$5,397.86
|
| Rate for Payer: Quartz Medicare Advantage |
$4,982.64
|
| Rate for Payer: The Alliance Commercial |
$4,152.20
|
| Rate for Payer: WEA Trust Commercial |
$4,567.42
|
| Rate for Payer: WPS Commercial |
$6,150.85
|
|
|
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 |
$2,171.77 |
| Max. Negotiated Rate |
$7,135.81 |
| Rate for Payer: Aetna Commercial |
$6,980.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,670.44
|
| Rate for Payer: Aetna Managed Medicare |
$2,171.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,041.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,878.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,723.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,110.85
|
| Rate for Payer: Cash Price |
$2,237.40
|
| Rate for Payer: Cigna Commercial |
$7,135.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,340.56
|
| Rate for Payer: Health EOS Commercial |
$6,903.12
|
| Rate for Payer: HFN Commercial |
$7,135.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,817.24
|
| Rate for Payer: Multiplan Commercial |
$6,205.06
|
| Rate for Payer: NAPHCARE Commercial |
$4,653.79
|
| Rate for Payer: Preferred Network Access Commercial |
$7,135.81
|
| Rate for Payer: Quartz Beloit One Network |
$3,800.60
|
| Rate for Payer: Quartz Commercial |
$5,041.61
|
| Rate for Payer: Quartz Medicare Advantage |
$4,653.79
|
| Rate for Payer: The Alliance Commercial |
$3,878.16
|
| Rate for Payer: WEA Trust Commercial |
$4,265.98
|
| Rate for Payer: WPS Commercial |
$5,744.90
|
|
|
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 |
$3,800.60 |
| Max. Negotiated Rate |
$7,135.81 |
| Rate for Payer: Aetna Commercial |
$6,980.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,670.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,110.85
|
| Rate for Payer: Cash Price |
$2,237.40
|
| Rate for Payer: Cigna Commercial |
$7,135.81
|
| Rate for Payer: Health EOS Commercial |
$6,903.12
|
| Rate for Payer: HFN Commercial |
$7,135.81
|
| Rate for Payer: Multiplan Commercial |
$6,205.06
|
| Rate for Payer: Preferred Network Access Commercial |
$7,135.81
|
| Rate for Payer: Quartz Beloit One Network |
$3,800.60
|
| Rate for Payer: Quartz Commercial |
$4,653.79
|
| Rate for Payer: WEA Trust Commercial |
$4,265.98
|
| Rate for Payer: WPS Commercial |
$5,744.90
|
|
|
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 |
$2,695.06 |
| Max. Negotiated Rate |
$8,855.18 |
| Rate for Payer: Aetna Commercial |
$8,662.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,277.67
|
| Rate for Payer: Aetna Managed Medicare |
$2,695.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,256.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,812.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,620.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,101.36
|
| Rate for Payer: Cash Price |
$2,776.50
|
| Rate for Payer: Cigna Commercial |
$8,855.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,386.41
|
| Rate for Payer: Health EOS Commercial |
$8,566.43
|
| Rate for Payer: HFN Commercial |
$8,855.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,218.90
|
| Rate for Payer: Multiplan Commercial |
$7,700.16
|
| Rate for Payer: NAPHCARE Commercial |
$5,775.12
|
| Rate for Payer: Preferred Network Access Commercial |
$8,855.18
|
| Rate for Payer: Quartz Beloit One Network |
$4,716.35
|
| Rate for Payer: Quartz Commercial |
$6,256.38
|
| Rate for Payer: Quartz Medicare Advantage |
$5,775.12
|
| Rate for Payer: The Alliance Commercial |
$4,812.60
|
| Rate for Payer: WEA Trust Commercial |
$5,293.86
|
| Rate for Payer: WPS Commercial |
$7,129.13
|
|
