|
PLATE 9H/4H LT DISTAL RADIUS 04.110.341
|
Facility
|
IP
|
$7,985.00
|
|
| Hospital Charge Code |
2966790
|
|
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/4H LT DISTAL RADIUS 04.110.341
|
Facility
|
OP
|
$7,985.00
|
|
| Hospital Charge Code |
2966790
|
|
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/4H RT DISTAL RADIUS 04.110.340
|
Facility
|
IP
|
$7,985.00
|
|
| Hospital Charge Code |
2966791
|
|
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/4H RT DISTAL RADIUS 04.110.340
|
Facility
|
OP
|
$7,985.00
|
|
| Hospital Charge Code |
2966791
|
|
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/5H LT DISTAL RADIUS 04.110.351
|
Facility
|
IP
|
$7,985.00
|
|
| Hospital Charge Code |
2966792
|
|
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/5H LT DISTAL RADIUS 04.110.351
|
Facility
|
OP
|
$7,985.00
|
|
| Hospital Charge Code |
2966792
|
|
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/5H RT DISTAL RADIUS 04.110.350
|
Facility
|
OP
|
$7,985.00
|
|
| Hospital Charge Code |
2966793
|
|
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/5H RT DISTAL RADIUS 04.110.350
|
Facility
|
IP
|
$7,985.00
|
|
| Hospital Charge Code |
2966793
|
|
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 ACULOC 2 STD LT 70-0356
|
Facility
|
OP
|
$7,503.00
|
|
| Hospital Charge Code |
2967388
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,184.87 |
| Max. Negotiated Rate |
$7,178.87 |
| Rate for Payer: Aetna Commercial |
$7,022.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,710.68
|
| Rate for Payer: Aetna Managed Medicare |
$2,184.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,072.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,901.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,745.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,135.65
|
| Rate for Payer: Cash Price |
$2,250.90
|
| Rate for Payer: Cigna Commercial |
$7,178.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,366.75
|
| Rate for Payer: Health EOS Commercial |
$6,944.78
|
| Rate for Payer: HFN Commercial |
$7,178.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,852.34
|
| Rate for Payer: Multiplan Commercial |
$6,242.50
|
| Rate for Payer: NAPHCARE Commercial |
$4,681.87
|
| Rate for Payer: Preferred Network Access Commercial |
$7,178.87
|
| Rate for Payer: Quartz Beloit One Network |
$3,823.53
|
| Rate for Payer: Quartz Commercial |
$5,072.03
|
| Rate for Payer: Quartz Medicare Advantage |
$4,681.87
|
| Rate for Payer: The Alliance Commercial |
$3,901.56
|
| Rate for Payer: WEA Trust Commercial |
$4,291.72
|
| Rate for Payer: WPS Commercial |
$5,779.56
|
|
|
PLATE ACULOC 2 STD LT 70-0356
|
Facility
|
IP
|
$7,503.00
|
|
| Hospital Charge Code |
2967388
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,823.53 |
| Max. Negotiated Rate |
$7,178.87 |
| Rate for Payer: Aetna Commercial |
$7,022.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,710.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,135.65
|
| Rate for Payer: Cash Price |
$2,250.90
|
| Rate for Payer: Cigna Commercial |
$7,178.87
|
| Rate for Payer: Health EOS Commercial |
$6,944.78
|
| Rate for Payer: HFN Commercial |
$7,178.87
|
| Rate for Payer: Multiplan Commercial |
$6,242.50
|
| Rate for Payer: Preferred Network Access Commercial |
$7,178.87
|
| Rate for Payer: Quartz Beloit One Network |
$3,823.53
|
| Rate for Payer: Quartz Commercial |
$4,681.87
|
| Rate for Payer: WEA Trust Commercial |
$4,291.72
|
| Rate for Payer: WPS Commercial |
$5,779.56
|
|
|
PLATE ACULOC 2 VDR EXTENTION NEUTRAL 70-0364
|
Facility
|
OP
|
$6,790.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415718
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,977.25 |
| Max. Negotiated Rate |
$6,496.67 |
| Rate for Payer: Aetna Commercial |
$6,355.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,072.98
|
| Rate for Payer: Aetna Managed Medicare |
$1,977.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,590.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,530.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,389.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,742.65
|
| Rate for Payer: Cash Price |
$2,037.00
|
| Rate for Payer: Cigna Commercial |
$6,496.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,951.78
|
| Rate for Payer: Health EOS Commercial |
$6,284.82
|
| Rate for Payer: HFN Commercial |
$6,496.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,296.20
|
| Rate for Payer: Multiplan Commercial |
$5,649.28
|
| Rate for Payer: NAPHCARE Commercial |
$4,236.96
|
| Rate for Payer: Preferred Network Access Commercial |
$6,496.67
|
| Rate for Payer: Quartz Beloit One Network |
$3,460.18
|
| Rate for Payer: Quartz Commercial |
$4,590.04
|
| Rate for Payer: Quartz Medicare Advantage |
$4,236.96
|
| Rate for Payer: The Alliance Commercial |
$3,530.80
|
| Rate for Payer: WEA Trust Commercial |
$3,883.88
|
| Rate for Payer: WPS Commercial |
$5,230.34
|
|
|
PLATE ACULOC 2 VDR EXTENTION NEUTRAL 70-0364
|
Facility
|
IP
|
$6,790.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415718
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,460.18 |
| Max. Negotiated Rate |
$6,496.67 |
| Rate for Payer: Aetna Commercial |
$6,355.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,072.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,742.65
|
| Rate for Payer: Cash Price |
$2,037.00
|
| Rate for Payer: Cigna Commercial |
$6,496.67
|
| Rate for Payer: Health EOS Commercial |
$6,284.82
|
| Rate for Payer: HFN Commercial |
$6,496.67
|
| Rate for Payer: Multiplan Commercial |
$5,649.28
|
| Rate for Payer: Preferred Network Access Commercial |
$6,496.67
|
| Rate for Payer: Quartz Beloit One Network |
$3,460.18
|
| Rate for Payer: Quartz Commercial |
$4,236.96
|
| Rate for Payer: WEA Trust Commercial |
$3,883.88
|
| Rate for Payer: WPS Commercial |
$5,230.34
|
|
|
PLATE ACU-LOC 2 VDR NARROW LONG LT 70-0370
|
Facility
|
OP
|
$8,524.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5385155
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,482.19 |
| Max. Negotiated Rate |
$8,155.76 |
| Rate for Payer: Aetna Commercial |
$7,978.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,623.87
|
| Rate for Payer: Aetna Managed Medicare |
$2,482.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,762.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,432.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,255.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,698.43
|
| Rate for Payer: Cash Price |
$2,557.20
|
| Rate for Payer: Cigna Commercial |
$8,155.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,960.97
|
| Rate for Payer: Health EOS Commercial |
$7,889.81
|
| Rate for Payer: HFN Commercial |
$8,155.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,648.72
|
| Rate for Payer: Multiplan Commercial |
$7,091.97
|
| Rate for Payer: NAPHCARE Commercial |
$5,318.98
|
| Rate for Payer: Preferred Network Access Commercial |
$8,155.76
|
| Rate for Payer: Quartz Beloit One Network |
$4,343.83
|
| Rate for Payer: Quartz Commercial |
$5,762.22
|
| Rate for Payer: Quartz Medicare Advantage |
$5,318.98
|
| Rate for Payer: The Alliance Commercial |
$4,432.48
|
| Rate for Payer: WEA Trust Commercial |
$4,875.73
|
| Rate for Payer: WPS Commercial |
$6,566.04
|
|
|
PLATE ACU-LOC 2 VDR NARROW LONG LT 70-0370
|
Facility
|
IP
|
$8,524.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5385155
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,343.83 |
| Max. Negotiated Rate |
$8,155.76 |
| Rate for Payer: Aetna Commercial |
$7,978.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,623.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,698.43
|
| Rate for Payer: Cash Price |
$2,557.20
|
| Rate for Payer: Cigna Commercial |
$8,155.76
|
| Rate for Payer: Health EOS Commercial |
$7,889.81
|
| Rate for Payer: HFN Commercial |
$8,155.76
|
| Rate for Payer: Multiplan Commercial |
$7,091.97
|
| Rate for Payer: Preferred Network Access Commercial |
$8,155.76
|
| Rate for Payer: Quartz Beloit One Network |
$4,343.83
|
| Rate for Payer: Quartz Commercial |
$5,318.98
|
| Rate for Payer: WEA Trust Commercial |
$4,875.73
|
| Rate for Payer: WPS Commercial |
$6,566.04
|
|
|
PLATE ACU-LOC 2 VDR NARROW LT 70-0358
|
Facility
|
IP
|
$8,524.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4520324
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,343.83 |
| Max. Negotiated Rate |
$8,155.76 |
| Rate for Payer: Aetna Commercial |
$7,978.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,623.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,698.43
|
| Rate for Payer: Cash Price |
$2,557.20
|
| Rate for Payer: Cigna Commercial |
$8,155.76
|
| Rate for Payer: Health EOS Commercial |
$7,889.81
|
| Rate for Payer: HFN Commercial |
$8,155.76
|
| Rate for Payer: Multiplan Commercial |
$7,091.97
|
| Rate for Payer: Preferred Network Access Commercial |
$8,155.76
|
| Rate for Payer: Quartz Beloit One Network |
$4,343.83
|
| Rate for Payer: Quartz Commercial |
$5,318.98
|
| Rate for Payer: WEA Trust Commercial |
$4,875.73
|
| Rate for Payer: WPS Commercial |
$6,566.04
|
|
|
PLATE ACU-LOC 2 VDR NARROW LT 70-0358
|
Facility
|
OP
|
$8,524.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4520324
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,482.19 |
| Max. Negotiated Rate |
$8,155.76 |
| Rate for Payer: Aetna Commercial |
$7,978.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,623.87
|
| Rate for Payer: Aetna Managed Medicare |
$2,482.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,762.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,432.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,255.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,698.43
|
| Rate for Payer: Cash Price |
$2,557.20
|
| Rate for Payer: Cigna Commercial |
$8,155.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,960.97
|
| Rate for Payer: Health EOS Commercial |
$7,889.81
|
| Rate for Payer: HFN Commercial |
$8,155.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,648.72
|
| Rate for Payer: Multiplan Commercial |
$7,091.97
|
| Rate for Payer: NAPHCARE Commercial |
$5,318.98
|
| Rate for Payer: Preferred Network Access Commercial |
$8,155.76
|
| Rate for Payer: Quartz Beloit One Network |
$4,343.83
|
| Rate for Payer: Quartz Commercial |
$5,762.22
|
| Rate for Payer: Quartz Medicare Advantage |
$5,318.98
|
| Rate for Payer: The Alliance Commercial |
$4,432.48
|
| Rate for Payer: WEA Trust Commercial |
$4,875.73
|
| Rate for Payer: WPS Commercial |
$6,566.04
|
|
|
PLATE ACU-LOC 2 VDR NARROW RT 70-0359
|
Facility
|
IP
|
$8,852.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414972
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,510.98 |
| Max. Negotiated Rate |
$8,469.59 |
| Rate for Payer: Aetna Commercial |
$8,285.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,917.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,879.22
|
| Rate for Payer: Cash Price |
$2,655.60
|
| Rate for Payer: Cigna Commercial |
$8,469.59
|
| Rate for Payer: Health EOS Commercial |
$8,193.41
|
| Rate for Payer: HFN Commercial |
$8,469.59
|
| Rate for Payer: Multiplan Commercial |
$7,364.86
|
| Rate for Payer: Preferred Network Access Commercial |
$8,469.59
|
| Rate for Payer: Quartz Beloit One Network |
$4,510.98
|
| Rate for Payer: Quartz Commercial |
$5,523.65
|
| Rate for Payer: WEA Trust Commercial |
$5,063.34
|
| Rate for Payer: WPS Commercial |
$6,818.70
|
|
|
PLATE ACU-LOC 2 VDR NARROW RT 70-0359
|
Facility
|
OP
|
$8,852.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414972
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,577.70 |
| Max. Negotiated Rate |
$8,469.59 |
| Rate for Payer: Aetna Commercial |
$8,285.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,917.23
|
| Rate for Payer: Aetna Managed Medicare |
$2,577.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,983.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,603.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,418.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,879.22
|
| Rate for Payer: Cash Price |
$2,655.60
|
| Rate for Payer: Cigna Commercial |
$8,469.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,151.86
|
| Rate for Payer: Health EOS Commercial |
$8,193.41
|
| Rate for Payer: HFN Commercial |
$8,469.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,904.56
|
| Rate for Payer: Multiplan Commercial |
$7,364.86
|
| Rate for Payer: NAPHCARE Commercial |
$5,523.65
|
| Rate for Payer: Preferred Network Access Commercial |
$8,469.59
|
| Rate for Payer: Quartz Beloit One Network |
$4,510.98
|
| Rate for Payer: Quartz Commercial |
$5,983.95
|
| Rate for Payer: Quartz Medicare Advantage |
$5,523.65
|
| Rate for Payer: The Alliance Commercial |
$4,603.04
|
| Rate for Payer: WEA Trust Commercial |
$5,063.34
|
| Rate for Payer: WPS Commercial |
$6,818.70
|
|
|
PLATE ACU-LOC 2 VDR PROXIMAL STD LT 70-0350
|
Facility
|
IP
|
$11,493.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6175440
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,856.83 |
| Max. Negotiated Rate |
$10,996.50 |
| Rate for Payer: Aetna Commercial |
$10,757.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,279.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,334.94
|
| Rate for Payer: Cash Price |
$3,447.90
|
| Rate for Payer: Cigna Commercial |
$10,996.50
|
| Rate for Payer: Health EOS Commercial |
$10,637.92
|
| Rate for Payer: HFN Commercial |
$10,996.50
|
| Rate for Payer: Multiplan Commercial |
$9,562.18
|
| Rate for Payer: Preferred Network Access Commercial |
$10,996.50
|
| Rate for Payer: Quartz Beloit One Network |
$5,856.83
|
| Rate for Payer: Quartz Commercial |
$7,171.63
|
| Rate for Payer: WEA Trust Commercial |
$6,574.00
|
| Rate for Payer: WPS Commercial |
$8,853.06
|
|
|
PLATE ACU-LOC 2 VDR PROXIMAL STD LT 70-0350
|
Facility
|
OP
|
$11,493.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6175440
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,346.76 |
| Max. Negotiated Rate |
$10,996.50 |
| Rate for Payer: Aetna Commercial |
$10,757.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,279.34
|
| Rate for Payer: Aetna Managed Medicare |
$3,346.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,769.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,976.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,737.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,334.94
|
| Rate for Payer: Cash Price |
$3,447.90
|
| Rate for Payer: Cigna Commercial |
$10,996.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,688.93
|
| Rate for Payer: Health EOS Commercial |
$10,637.92
|
| Rate for Payer: HFN Commercial |
$10,996.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,964.54
|
| Rate for Payer: Multiplan Commercial |
$9,562.18
|
| Rate for Payer: NAPHCARE Commercial |
$7,171.63
|
| Rate for Payer: Preferred Network Access Commercial |
$10,996.50
|
| Rate for Payer: Quartz Beloit One Network |
$5,856.83
|
| Rate for Payer: Quartz Commercial |
$7,769.27
|
| Rate for Payer: Quartz Medicare Advantage |
$7,171.63
|
| Rate for Payer: The Alliance Commercial |
$5,976.36
|
| Rate for Payer: WEA Trust Commercial |
$6,574.00
|
| Rate for Payer: WPS Commercial |
$8,853.06
|
|
|
PLATE ACU-LOC 2 VDR PROXIMAL STD RT 70-0351
|
Facility
|
OP
|
$8,823.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5611627
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,569.26 |
| Max. Negotiated Rate |
$8,441.85 |
| Rate for Payer: Aetna Commercial |
$8,258.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,891.29
|
| Rate for Payer: Aetna Managed Medicare |
$2,569.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,964.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,587.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,404.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,863.24
|
| Rate for Payer: Cash Price |
$2,646.90
|
| Rate for Payer: Cigna Commercial |
$8,441.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,134.99
|
| Rate for Payer: Health EOS Commercial |
$8,166.57
|
| Rate for Payer: HFN Commercial |
$8,441.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,881.94
|
| Rate for Payer: Multiplan Commercial |
$7,340.74
|
| Rate for Payer: NAPHCARE Commercial |
$5,505.55
|
| Rate for Payer: Preferred Network Access Commercial |
$8,441.85
|
| Rate for Payer: Quartz Beloit One Network |
$4,496.20
|
| Rate for Payer: Quartz Commercial |
$5,964.35
|
| Rate for Payer: Quartz Medicare Advantage |
$5,505.55
|
| Rate for Payer: The Alliance Commercial |
$4,587.96
|
| Rate for Payer: WEA Trust Commercial |
$5,046.76
|
| Rate for Payer: WPS Commercial |
$6,796.36
|
|
|
PLATE ACU-LOC 2 VDR PROXIMAL STD RT 70-0351
|
Facility
|
IP
|
$8,823.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5611627
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,496.20 |
| Max. Negotiated Rate |
$8,441.85 |
| Rate for Payer: Aetna Commercial |
$8,258.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,891.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,863.24
|
| Rate for Payer: Cash Price |
$2,646.90
|
| Rate for Payer: Cigna Commercial |
$8,441.85
|
| Rate for Payer: Health EOS Commercial |
$8,166.57
|
| Rate for Payer: HFN Commercial |
$8,441.85
|
| Rate for Payer: Multiplan Commercial |
$7,340.74
|
| Rate for Payer: Preferred Network Access Commercial |
$8,441.85
|
| Rate for Payer: Quartz Beloit One Network |
$4,496.20
|
| Rate for Payer: Quartz Commercial |
$5,505.55
|
| Rate for Payer: WEA Trust Commercial |
$5,046.76
|
| Rate for Payer: WPS Commercial |
$6,796.36
|
|
|
PLATE ACU-LOC 2 VDR PROXIMAL WIDE RT 70-0355
|
Facility
|
IP
|
$11,051.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6192975
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,631.59 |
| Max. Negotiated Rate |
$10,573.60 |
| Rate for Payer: Aetna Commercial |
$10,343.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,884.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,091.31
|
| Rate for Payer: Cash Price |
$3,315.30
|
| Rate for Payer: Cigna Commercial |
$10,573.60
|
| Rate for Payer: Health EOS Commercial |
$10,228.81
|
| Rate for Payer: HFN Commercial |
$10,573.60
|
| Rate for Payer: Multiplan Commercial |
$9,194.43
|
| Rate for Payer: Preferred Network Access Commercial |
$10,573.60
|
| Rate for Payer: Quartz Beloit One Network |
$5,631.59
|
| Rate for Payer: Quartz Commercial |
$6,895.82
|
| Rate for Payer: WEA Trust Commercial |
$6,321.17
|
| Rate for Payer: WPS Commercial |
$8,512.59
|
|
|
PLATE ACU-LOC 2 VDR PROXIMAL WIDE RT 70-0355
|
Facility
|
OP
|
$11,051.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6192975
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,218.05 |
| Max. Negotiated Rate |
$10,573.60 |
| Rate for Payer: Aetna Commercial |
$10,343.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,884.01
|
| Rate for Payer: Aetna Managed Medicare |
$3,218.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,470.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,746.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,516.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,091.31
|
| Rate for Payer: Cash Price |
$3,315.30
|
| Rate for Payer: Cigna Commercial |
$10,573.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,431.68
|
| Rate for Payer: Health EOS Commercial |
$10,228.81
|
| Rate for Payer: HFN Commercial |
$10,573.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,619.78
|
| Rate for Payer: Multiplan Commercial |
$9,194.43
|
| Rate for Payer: NAPHCARE Commercial |
$6,895.82
|
| Rate for Payer: Preferred Network Access Commercial |
$10,573.60
|
| Rate for Payer: Quartz Beloit One Network |
$5,631.59
|
| Rate for Payer: Quartz Commercial |
$7,470.48
|
| Rate for Payer: Quartz Medicare Advantage |
$6,895.82
|
| Rate for Payer: The Alliance Commercial |
$5,746.52
|
| Rate for Payer: WEA Trust Commercial |
$6,321.17
|
| Rate for Payer: WPS Commercial |
$8,512.59
|
|
|
PLATE ACU-LOC 2 VDR PROX STD LONG RT 70-0373
|
Facility
|
OP
|
$11,051.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6181295
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,218.05 |
| Max. Negotiated Rate |
$10,573.60 |
| Rate for Payer: Aetna Commercial |
$10,343.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,884.01
|
| Rate for Payer: Aetna Managed Medicare |
$3,218.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,470.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,746.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,516.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,091.31
|
| Rate for Payer: Cash Price |
$3,315.30
|
| Rate for Payer: Cigna Commercial |
$10,573.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,431.68
|
| Rate for Payer: Health EOS Commercial |
$10,228.81
|
| Rate for Payer: HFN Commercial |
$10,573.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,619.78
|
| Rate for Payer: Multiplan Commercial |
$9,194.43
|
| Rate for Payer: NAPHCARE Commercial |
$6,895.82
|
| Rate for Payer: Preferred Network Access Commercial |
$10,573.60
|
| Rate for Payer: Quartz Beloit One Network |
$5,631.59
|
| Rate for Payer: Quartz Commercial |
$7,470.48
|
| Rate for Payer: Quartz Medicare Advantage |
$6,895.82
|
| Rate for Payer: The Alliance Commercial |
$5,746.52
|
| Rate for Payer: WEA Trust Commercial |
$6,321.17
|
| Rate for Payer: WPS Commercial |
$8,512.59
|
|
