|
PLATE 8HL LEFT MEDIAL DISTAL
|
Facility
|
IP
|
$9,255.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966359
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,716.35 |
| 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: 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: Health EOS Commercial |
$8,566.43
|
| Rate for Payer: HFN Commercial |
$8,855.18
|
| Rate for Payer: Multiplan Commercial |
$7,700.16
|
| 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 |
$5,775.12
|
| Rate for Payer: WEA Trust Commercial |
$5,293.86
|
| Rate for Payer: WPS Commercial |
$7,129.13
|
|
|
PLATE 8HL LG LFT CLAVICLE
|
Facility
|
IP
|
$6,468.00
|
|
| Hospital Charge Code |
2964145
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,296.09 |
| Max. Negotiated Rate |
$6,188.58 |
| Rate for Payer: Aetna Commercial |
$6,054.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,784.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,565.16
|
| Rate for Payer: Cash Price |
$1,940.40
|
| Rate for Payer: Cigna Commercial |
$6,188.58
|
| Rate for Payer: Health EOS Commercial |
$5,986.78
|
| Rate for Payer: HFN Commercial |
$6,188.58
|
| Rate for Payer: Multiplan Commercial |
$5,381.38
|
| Rate for Payer: Preferred Network Access Commercial |
$6,188.58
|
| Rate for Payer: Quartz Beloit One Network |
$3,296.09
|
| Rate for Payer: Quartz Commercial |
$4,036.03
|
| Rate for Payer: WEA Trust Commercial |
$3,699.70
|
| Rate for Payer: WPS Commercial |
$4,982.30
|
|
|
PLATE 8HL LG LFT CLAVICLE
|
Facility
|
OP
|
$6,468.00
|
|
| Hospital Charge Code |
2964145
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,883.48 |
| Max. Negotiated Rate |
$6,188.58 |
| Rate for Payer: Aetna Commercial |
$6,054.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,784.98
|
| Rate for Payer: Aetna Managed Medicare |
$1,883.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,372.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,363.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,228.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,565.16
|
| Rate for Payer: Cash Price |
$1,940.40
|
| Rate for Payer: Cigna Commercial |
$6,188.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,764.38
|
| Rate for Payer: Health EOS Commercial |
$5,986.78
|
| Rate for Payer: HFN Commercial |
$6,188.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,045.04
|
| Rate for Payer: Multiplan Commercial |
$5,381.38
|
| Rate for Payer: NAPHCARE Commercial |
$4,036.03
|
| Rate for Payer: Preferred Network Access Commercial |
$6,188.58
|
| Rate for Payer: Quartz Beloit One Network |
$3,296.09
|
| Rate for Payer: Quartz Commercial |
$4,372.37
|
| Rate for Payer: Quartz Medicare Advantage |
$4,036.03
|
| Rate for Payer: The Alliance Commercial |
$3,363.36
|
| Rate for Payer: WEA Trust Commercial |
$3,699.70
|
| Rate for Payer: WPS Commercial |
$4,982.30
|
|
|
PLATE 8HL RT 3.5 MED-DIST TIB
|
Facility
|
OP
|
$9,801.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966360
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,854.05 |
| Max. Negotiated Rate |
$9,377.60 |
| Rate for Payer: Aetna Commercial |
$9,173.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,766.01
|
| Rate for Payer: Aetna Managed Medicare |
$2,854.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,625.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,096.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,892.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,402.31
|
| Rate for Payer: Cash Price |
$2,940.30
|
| Rate for Payer: Cigna Commercial |
$9,377.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,704.18
|
| Rate for Payer: Health EOS Commercial |
$9,071.81
|
| Rate for Payer: HFN Commercial |
$9,377.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,644.78
|
| Rate for Payer: Multiplan Commercial |
$8,154.43
|
| Rate for Payer: NAPHCARE Commercial |
$6,115.82
|
| Rate for Payer: Preferred Network Access Commercial |
$9,377.60
|
| Rate for Payer: Quartz Beloit One Network |
$4,994.59
|
| Rate for Payer: Quartz Commercial |
$6,625.48
|
| Rate for Payer: Quartz Medicare Advantage |
$6,115.82
|
| Rate for Payer: The Alliance Commercial |
$5,096.52
|
| Rate for Payer: WEA Trust Commercial |
$5,606.17
|
| Rate for Payer: WPS Commercial |
$7,549.71
|
|
|
PLATE 8HL RT 3.5 MED-DIST TIB
|
Facility
|
IP
|
$9,801.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966360
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,994.59 |
| Max. Negotiated Rate |
$9,377.60 |
| Rate for Payer: Aetna Commercial |
$9,173.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,766.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,402.31
|
| Rate for Payer: Cash Price |
$2,940.30
|
| Rate for Payer: Cigna Commercial |
$9,377.60
|
| Rate for Payer: Health EOS Commercial |
$9,071.81
|
| Rate for Payer: HFN Commercial |
$9,377.60
|
| Rate for Payer: Multiplan Commercial |
$8,154.43
|
| Rate for Payer: Preferred Network Access Commercial |
$9,377.60
|
| Rate for Payer: Quartz Beloit One Network |
$4,994.59
|
| Rate for Payer: Quartz Commercial |
$6,115.82
|
| Rate for Payer: WEA Trust Commercial |
$5,606.17
|
| Rate for Payer: WPS Commercial |
$7,549.71
|
|
|
PLATE 8H LT CONDYLAR 222.659
|
Facility
|
IP
|
$4,594.00
|
|
| Hospital Charge Code |
2966740
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,341.10 |
| Max. Negotiated Rate |
$4,395.54 |
| Rate for Payer: Aetna Commercial |
$4,299.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,108.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,532.21
|
| Rate for Payer: Cash Price |
$1,378.20
|
| Rate for Payer: Cigna Commercial |
$4,395.54
|
| Rate for Payer: Health EOS Commercial |
$4,252.21
|
| Rate for Payer: HFN Commercial |
$4,395.54
|
| Rate for Payer: Multiplan Commercial |
$3,822.21
|
| Rate for Payer: Preferred Network Access Commercial |
$4,395.54
|
| Rate for Payer: Quartz Beloit One Network |
$2,341.10
|
| Rate for Payer: Quartz Commercial |
$2,866.66
|
| Rate for Payer: WEA Trust Commercial |
$2,627.77
|
| Rate for Payer: WPS Commercial |
$3,538.76
|
|
|
PLATE 8H LT CONDYLAR 222.659
|
Facility
|
OP
|
$4,594.00
|
|
| Hospital Charge Code |
2966740
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,337.77 |
| Max. Negotiated Rate |
$4,395.54 |
| Rate for Payer: Aetna Commercial |
$4,299.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,108.87
|
| Rate for Payer: Aetna Managed Medicare |
$1,337.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,105.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,388.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,293.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,532.21
|
| Rate for Payer: Cash Price |
$1,378.20
|
| Rate for Payer: Cigna Commercial |
$4,395.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,673.71
|
| Rate for Payer: Health EOS Commercial |
$4,252.21
|
| Rate for Payer: HFN Commercial |
$4,395.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,583.32
|
| Rate for Payer: Multiplan Commercial |
$3,822.21
|
| Rate for Payer: NAPHCARE Commercial |
$2,866.66
|
| Rate for Payer: Preferred Network Access Commercial |
$4,395.54
|
| Rate for Payer: Quartz Beloit One Network |
$2,341.10
|
| Rate for Payer: Quartz Commercial |
$3,105.54
|
| Rate for Payer: Quartz Medicare Advantage |
$2,866.66
|
| Rate for Payer: The Alliance Commercial |
$2,388.88
|
| Rate for Payer: WEA Trust Commercial |
$2,627.77
|
| Rate for Payer: WPS Commercial |
$3,538.76
|
|
|
PLATE 8H LT MED/DIS/TI 239.909
|
Facility
|
OP
|
$5,190.00
|
|
| Hospital Charge Code |
2966742
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,511.33 |
| Max. Negotiated Rate |
$4,965.79 |
| Rate for Payer: Aetna Commercial |
$4,857.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,641.94
|
| Rate for Payer: Aetna Managed Medicare |
$1,511.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,508.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,698.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,590.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,860.73
|
| Rate for Payer: Cash Price |
$1,557.00
|
| Rate for Payer: Cigna Commercial |
$4,965.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,020.58
|
| Rate for Payer: Health EOS Commercial |
$4,803.86
|
| Rate for Payer: HFN Commercial |
$4,965.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,048.20
|
| Rate for Payer: Multiplan Commercial |
$4,318.08
|
| Rate for Payer: NAPHCARE Commercial |
$3,238.56
|
| Rate for Payer: Preferred Network Access Commercial |
$4,965.79
|
| Rate for Payer: Quartz Beloit One Network |
$2,644.82
|
| Rate for Payer: Quartz Commercial |
$3,508.44
|
| Rate for Payer: Quartz Medicare Advantage |
$3,238.56
|
| Rate for Payer: The Alliance Commercial |
$2,698.80
|
| Rate for Payer: WEA Trust Commercial |
$2,968.68
|
| Rate for Payer: WPS Commercial |
$3,997.86
|
|
|
PLATE 8H LT MED/DIS/TI 239.909
|
Facility
|
IP
|
$5,190.00
|
|
| Hospital Charge Code |
2966742
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,644.82 |
| Max. Negotiated Rate |
$4,965.79 |
| Rate for Payer: Aetna Commercial |
$4,857.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,641.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,860.73
|
| Rate for Payer: Cash Price |
$1,557.00
|
| Rate for Payer: Cigna Commercial |
$4,965.79
|
| Rate for Payer: Health EOS Commercial |
$4,803.86
|
| Rate for Payer: HFN Commercial |
$4,965.79
|
| Rate for Payer: Multiplan Commercial |
$4,318.08
|
| Rate for Payer: Preferred Network Access Commercial |
$4,965.79
|
| Rate for Payer: Quartz Beloit One Network |
$2,644.82
|
| Rate for Payer: Quartz Commercial |
$3,238.56
|
| Rate for Payer: WEA Trust Commercial |
$2,968.68
|
| Rate for Payer: WPS Commercial |
$3,997.86
|
|
|
PLATE 8H LT PROX/TIB 240.041
|
Facility
|
IP
|
$4,681.00
|
|
| Hospital Charge Code |
2966741
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,385.44 |
| Max. Negotiated Rate |
$4,478.78 |
| Rate for Payer: Aetna Commercial |
$4,381.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,186.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,580.17
|
| Rate for Payer: Cash Price |
$1,404.30
|
| Rate for Payer: Cigna Commercial |
$4,478.78
|
| Rate for Payer: Health EOS Commercial |
$4,332.73
|
| Rate for Payer: HFN Commercial |
$4,478.78
|
| Rate for Payer: Multiplan Commercial |
$3,894.59
|
| Rate for Payer: Preferred Network Access Commercial |
$4,478.78
|
| Rate for Payer: Quartz Beloit One Network |
$2,385.44
|
| Rate for Payer: Quartz Commercial |
$2,920.94
|
| Rate for Payer: WEA Trust Commercial |
$2,677.53
|
| Rate for Payer: WPS Commercial |
$3,605.77
|
|
|
PLATE 8H LT PROX/TIB 240.041
|
Facility
|
OP
|
$4,681.00
|
|
| Hospital Charge Code |
2966741
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,363.11 |
| Max. Negotiated Rate |
$4,478.78 |
| Rate for Payer: Aetna Commercial |
$4,381.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,186.69
|
| Rate for Payer: Aetna Managed Medicare |
$1,363.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,164.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,434.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,336.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,580.17
|
| Rate for Payer: Cash Price |
$1,404.30
|
| Rate for Payer: Cigna Commercial |
$4,478.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,724.34
|
| Rate for Payer: Health EOS Commercial |
$4,332.73
|
| Rate for Payer: HFN Commercial |
$4,478.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,651.18
|
| Rate for Payer: Multiplan Commercial |
$3,894.59
|
| Rate for Payer: NAPHCARE Commercial |
$2,920.94
|
| Rate for Payer: Preferred Network Access Commercial |
$4,478.78
|
| Rate for Payer: Quartz Beloit One Network |
$2,385.44
|
| Rate for Payer: Quartz Commercial |
$3,164.36
|
| Rate for Payer: Quartz Medicare Advantage |
$2,920.94
|
| Rate for Payer: The Alliance Commercial |
$2,434.12
|
| Rate for Payer: WEA Trust Commercial |
$2,677.53
|
| Rate for Payer: WPS Commercial |
$3,605.77
|
|
|
PLATE 8HLx4HL LEFT VOLAR
|
Facility
|
IP
|
$7,992.00
|
|
| Hospital Charge Code |
2966361
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,072.72 |
| Max. Negotiated Rate |
$7,646.75 |
| Rate for Payer: Aetna Commercial |
$7,480.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,148.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,405.19
|
| Rate for Payer: Cash Price |
$2,397.60
|
| Rate for Payer: Cigna Commercial |
$7,646.75
|
| Rate for Payer: Health EOS Commercial |
$7,397.40
|
| Rate for Payer: HFN Commercial |
$7,646.75
|
| Rate for Payer: Multiplan Commercial |
$6,649.34
|
| Rate for Payer: Preferred Network Access Commercial |
$7,646.75
|
| Rate for Payer: Quartz Beloit One Network |
$4,072.72
|
| Rate for Payer: Quartz Commercial |
$4,987.01
|
| Rate for Payer: WEA Trust Commercial |
$4,571.42
|
| Rate for Payer: WPS Commercial |
$6,156.24
|
|
|
PLATE 8HLx4HL LEFT VOLAR
|
Facility
|
OP
|
$7,992.00
|
|
| Hospital Charge Code |
2966361
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,327.27 |
| Max. Negotiated Rate |
$7,646.75 |
| Rate for Payer: Aetna Commercial |
$7,480.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,148.04
|
| Rate for Payer: Aetna Managed Medicare |
$2,327.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,402.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,155.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,989.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,405.19
|
| Rate for Payer: Cash Price |
$2,397.60
|
| Rate for Payer: Cigna Commercial |
$7,646.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,651.34
|
| Rate for Payer: Health EOS Commercial |
$7,397.40
|
| Rate for Payer: HFN Commercial |
$7,646.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,233.76
|
| Rate for Payer: Multiplan Commercial |
$6,649.34
|
| Rate for Payer: NAPHCARE Commercial |
$4,987.01
|
| Rate for Payer: Preferred Network Access Commercial |
$7,646.75
|
| Rate for Payer: Quartz Beloit One Network |
$4,072.72
|
| Rate for Payer: Quartz Commercial |
$5,402.59
|
| Rate for Payer: Quartz Medicare Advantage |
$4,987.01
|
| Rate for Payer: The Alliance Commercial |
$4,155.84
|
| Rate for Payer: WEA Trust Commercial |
$4,571.42
|
| Rate for Payer: WPS Commercial |
$6,156.24
|
|
|
PLATE 8 HOLE STRAIGHT 52020308
|
Facility
|
OP
|
$5,263.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6149646
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,532.59 |
| Max. Negotiated Rate |
$5,035.64 |
| Rate for Payer: Aetna Commercial |
$4,926.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,707.23
|
| Rate for Payer: Aetna Managed Medicare |
$1,532.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,557.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,736.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,627.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,900.97
|
| Rate for Payer: Cash Price |
$1,578.90
|
| Rate for Payer: Cigna Commercial |
$5,035.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,063.07
|
| Rate for Payer: Health EOS Commercial |
$4,871.43
|
| Rate for Payer: HFN Commercial |
$5,035.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,105.14
|
| Rate for Payer: Multiplan Commercial |
$4,378.82
|
| Rate for Payer: NAPHCARE Commercial |
$3,284.11
|
| Rate for Payer: Preferred Network Access Commercial |
$5,035.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,682.02
|
| Rate for Payer: Quartz Commercial |
$3,557.79
|
| Rate for Payer: Quartz Medicare Advantage |
$3,284.11
|
| Rate for Payer: The Alliance Commercial |
$2,736.76
|
| Rate for Payer: WEA Trust Commercial |
$3,010.44
|
| Rate for Payer: WPS Commercial |
$4,054.09
|
|
|
PLATE 8 HOLE STRAIGHT 52020308
|
Facility
|
IP
|
$5,263.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6149646
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,682.02 |
| Max. Negotiated Rate |
$5,035.64 |
| Rate for Payer: Aetna Commercial |
$4,926.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,707.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,900.97
|
| Rate for Payer: Cash Price |
$1,578.90
|
| Rate for Payer: Cigna Commercial |
$5,035.64
|
| Rate for Payer: Health EOS Commercial |
$4,871.43
|
| Rate for Payer: HFN Commercial |
$5,035.64
|
| Rate for Payer: Multiplan Commercial |
$4,378.82
|
| Rate for Payer: Preferred Network Access Commercial |
$5,035.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,682.02
|
| Rate for Payer: Quartz Commercial |
$3,284.11
|
| Rate for Payer: WEA Trust Commercial |
$3,010.44
|
| Rate for Payer: WPS Commercial |
$4,054.09
|
|
|
PLATE 8H RT CONDYLAR 222.658
|
Facility
|
IP
|
$4,594.00
|
|
| Hospital Charge Code |
2966743
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,341.10 |
| Max. Negotiated Rate |
$4,395.54 |
| Rate for Payer: Aetna Commercial |
$4,299.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,108.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,532.21
|
| Rate for Payer: Cash Price |
$1,378.20
|
| Rate for Payer: Cigna Commercial |
$4,395.54
|
| Rate for Payer: Health EOS Commercial |
$4,252.21
|
| Rate for Payer: HFN Commercial |
$4,395.54
|
| Rate for Payer: Multiplan Commercial |
$3,822.21
|
| Rate for Payer: Preferred Network Access Commercial |
$4,395.54
|
| Rate for Payer: Quartz Beloit One Network |
$2,341.10
|
| Rate for Payer: Quartz Commercial |
$2,866.66
|
| Rate for Payer: WEA Trust Commercial |
$2,627.77
|
| Rate for Payer: WPS Commercial |
$3,538.76
|
|
|
PLATE 8H RT CONDYLAR 222.658
|
Facility
|
OP
|
$4,594.00
|
|
| Hospital Charge Code |
2966743
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,337.77 |
| Max. Negotiated Rate |
$4,395.54 |
| Rate for Payer: Aetna Commercial |
$4,299.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,108.87
|
| Rate for Payer: Aetna Managed Medicare |
$1,337.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,105.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,388.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,293.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,532.21
|
| Rate for Payer: Cash Price |
$1,378.20
|
| Rate for Payer: Cigna Commercial |
$4,395.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,673.71
|
| Rate for Payer: Health EOS Commercial |
$4,252.21
|
| Rate for Payer: HFN Commercial |
$4,395.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,583.32
|
| Rate for Payer: Multiplan Commercial |
$3,822.21
|
| Rate for Payer: NAPHCARE Commercial |
$2,866.66
|
| Rate for Payer: Preferred Network Access Commercial |
$4,395.54
|
| Rate for Payer: Quartz Beloit One Network |
$2,341.10
|
| Rate for Payer: Quartz Commercial |
$3,105.54
|
| Rate for Payer: Quartz Medicare Advantage |
$2,866.66
|
| Rate for Payer: The Alliance Commercial |
$2,388.88
|
| Rate for Payer: WEA Trust Commercial |
$2,627.77
|
| Rate for Payer: WPS Commercial |
$3,538.76
|
|
|
PLATE 8H RT PROX/TIB 240.040
|
Facility
|
IP
|
$4,681.00
|
|
| Hospital Charge Code |
2966744
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,385.44 |
| Max. Negotiated Rate |
$4,478.78 |
| Rate for Payer: Aetna Commercial |
$4,381.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,186.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,580.17
|
| Rate for Payer: Cash Price |
$1,404.30
|
| Rate for Payer: Cigna Commercial |
$4,478.78
|
| Rate for Payer: Health EOS Commercial |
$4,332.73
|
| Rate for Payer: HFN Commercial |
$4,478.78
|
| Rate for Payer: Multiplan Commercial |
$3,894.59
|
| Rate for Payer: Preferred Network Access Commercial |
$4,478.78
|
| Rate for Payer: Quartz Beloit One Network |
$2,385.44
|
| Rate for Payer: Quartz Commercial |
$2,920.94
|
| Rate for Payer: WEA Trust Commercial |
$2,677.53
|
| Rate for Payer: WPS Commercial |
$3,605.77
|
|
|
PLATE 8H RT PROX/TIB 240.040
|
Facility
|
OP
|
$4,681.00
|
|
| Hospital Charge Code |
2966744
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,363.11 |
| Max. Negotiated Rate |
$4,478.78 |
| Rate for Payer: Aetna Commercial |
$4,381.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,186.69
|
| Rate for Payer: Aetna Managed Medicare |
$1,363.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,164.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,434.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,336.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,580.17
|
| Rate for Payer: Cash Price |
$1,404.30
|
| Rate for Payer: Cigna Commercial |
$4,478.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,724.34
|
| Rate for Payer: Health EOS Commercial |
$4,332.73
|
| Rate for Payer: HFN Commercial |
$4,478.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,651.18
|
| Rate for Payer: Multiplan Commercial |
$3,894.59
|
| Rate for Payer: NAPHCARE Commercial |
$2,920.94
|
| Rate for Payer: Preferred Network Access Commercial |
$4,478.78
|
| Rate for Payer: Quartz Beloit One Network |
$2,385.44
|
| Rate for Payer: Quartz Commercial |
$3,164.36
|
| Rate for Payer: Quartz Medicare Advantage |
$2,920.94
|
| Rate for Payer: The Alliance Commercial |
$2,434.12
|
| Rate for Payer: WEA Trust Commercial |
$2,677.53
|
| Rate for Payer: WPS Commercial |
$3,605.77
|
|
|
PLATE 9H 3.5 LCP 223.591
|
Facility
|
OP
|
$1,579.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966746
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$459.80 |
| Max. Negotiated Rate |
$1,510.79 |
| Rate for Payer: Aetna Commercial |
$1,477.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,412.26
|
| Rate for Payer: Aetna Managed Medicare |
$459.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,067.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$821.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$788.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$870.34
|
| Rate for Payer: Cash Price |
$473.70
|
| Rate for Payer: Cigna Commercial |
$1,510.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$918.98
|
| Rate for Payer: Health EOS Commercial |
$1,461.52
|
| Rate for Payer: HFN Commercial |
$1,510.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,231.62
|
| Rate for Payer: Multiplan Commercial |
$1,313.73
|
| Rate for Payer: NAPHCARE Commercial |
$985.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,510.79
|
| Rate for Payer: Quartz Beloit One Network |
$804.66
|
| Rate for Payer: Quartz Commercial |
$1,067.40
|
| Rate for Payer: Quartz Medicare Advantage |
$985.30
|
| Rate for Payer: The Alliance Commercial |
$821.08
|
| Rate for Payer: WEA Trust Commercial |
$903.19
|
| Rate for Payer: WPS Commercial |
$1,216.30
|
|
|
PLATE 9H 3.5 LCP 223.591
|
Facility
|
IP
|
$1,579.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966746
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$804.66 |
| Max. Negotiated Rate |
$1,510.79 |
| Rate for Payer: Aetna Commercial |
$1,477.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,412.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$870.34
|
| Rate for Payer: Cash Price |
$473.70
|
| Rate for Payer: Cigna Commercial |
$1,510.79
|
| Rate for Payer: Health EOS Commercial |
$1,461.52
|
| Rate for Payer: HFN Commercial |
$1,510.79
|
| Rate for Payer: Multiplan Commercial |
$1,313.73
|
| Rate for Payer: Preferred Network Access Commercial |
$1,510.79
|
| Rate for Payer: Quartz Beloit One Network |
$804.66
|
| Rate for Payer: Quartz Commercial |
$985.30
|
| Rate for Payer: WEA Trust Commercial |
$903.19
|
| Rate for Payer: WPS Commercial |
$1,216.30
|
|
|
PLATE 9H/3H LT DISTAL RADIUS 04.110.331
|
Facility
|
OP
|
$7,985.00
|
|
| Hospital Charge Code |
2966747
|
|
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 9H/3H LT DISTAL RADIUS 04.110.331
|
Facility
|
IP
|
$7,985.00
|
|
| Hospital Charge Code |
2966747
|
|
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 9H/3H RT DISTAL RADIUS 04.110.330
|
Facility
|
IP
|
$7,985.00
|
|
| Hospital Charge Code |
2966748
|
|
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 9H/3H RT DISTAL RADIUS 04.110.330
|
Facility
|
OP
|
$7,985.00
|
|
| Hospital Charge Code |
2966748
|
|
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
|
|
