|
PLATE 1/4 TUBULAR 5HL 242.05
|
Facility
|
OP
|
$547.00
|
|
| Hospital Charge Code |
2966658
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$153.16 |
| Max. Negotiated Rate |
$2,188.00 |
| Rate for Payer: Aetna Commercial |
$492.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$470.42
|
| Rate for Payer: Aetna Managed Medicare |
$153.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$355.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$273.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$262.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$289.91
|
| Rate for Payer: Cash Price |
$164.10
|
| Rate for Payer: Cigna Commercial |
$503.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$306.10
|
| Rate for Payer: Health EOS Commercial |
$486.83
|
| Rate for Payer: HFN Commercial |
$503.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$410.25
|
| Rate for Payer: Multiplan Commercial |
$437.60
|
| Rate for Payer: NAPHCARE Commercial |
$328.20
|
| Rate for Payer: Preferred Network Access Commercial |
$503.24
|
| Rate for Payer: Quartz Beloit One Network |
$268.03
|
| Rate for Payer: Quartz Commercial |
$355.55
|
| Rate for Payer: Quartz Medicare Advantage |
$328.20
|
| Rate for Payer: The Alliance Commercial |
$2,188.00
|
| Rate for Payer: WEA Trust Commercial |
$300.85
|
| Rate for Payer: WPS Commercial |
$405.16
|
|
|
PLATE 1/4 TUBULAR 5HL 242.05
|
Facility
|
IP
|
$547.00
|
|
| Hospital Charge Code |
2966658
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$268.03 |
| Max. Negotiated Rate |
$503.24 |
| Rate for Payer: Aetna Commercial |
$492.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$470.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$289.91
|
| Rate for Payer: Cash Price |
$164.10
|
| Rate for Payer: Cigna Commercial |
$503.24
|
| Rate for Payer: Health EOS Commercial |
$486.83
|
| Rate for Payer: HFN Commercial |
$503.24
|
| Rate for Payer: Multiplan Commercial |
$437.60
|
| Rate for Payer: NAPHCARE Commercial |
$328.20
|
| Rate for Payer: Preferred Network Access Commercial |
$503.24
|
| Rate for Payer: Quartz Beloit One Network |
$268.03
|
| Rate for Payer: Quartz Commercial |
$328.20
|
| Rate for Payer: WEA Trust Commercial |
$300.85
|
| Rate for Payer: WPS Commercial |
$405.16
|
|
|
PLATE 1/4 TUBULAR 6HL 242.06
|
Facility
|
OP
|
$1,145.00
|
|
| Hospital Charge Code |
2966659
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$320.60 |
| Max. Negotiated Rate |
$4,580.00 |
| Rate for Payer: Aetna Commercial |
$1,030.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$984.70
|
| Rate for Payer: Aetna Managed Medicare |
$320.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$744.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$572.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$549.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$606.85
|
| Rate for Payer: Cash Price |
$343.50
|
| Rate for Payer: Cigna Commercial |
$1,053.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$640.74
|
| Rate for Payer: Health EOS Commercial |
$1,019.05
|
| Rate for Payer: HFN Commercial |
$1,053.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$858.75
|
| Rate for Payer: Multiplan Commercial |
$916.00
|
| Rate for Payer: NAPHCARE Commercial |
$687.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,053.40
|
| Rate for Payer: Quartz Beloit One Network |
$561.05
|
| Rate for Payer: Quartz Commercial |
$744.25
|
| Rate for Payer: Quartz Medicare Advantage |
$687.00
|
| Rate for Payer: The Alliance Commercial |
$4,580.00
|
| Rate for Payer: WEA Trust Commercial |
$629.75
|
| Rate for Payer: WPS Commercial |
$848.10
|
|
|
PLATE 1/4 TUBULAR 6HL 242.06
|
Facility
|
IP
|
$1,145.00
|
|
| Hospital Charge Code |
2966659
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$561.05 |
| Max. Negotiated Rate |
$1,053.40 |
| Rate for Payer: Aetna Commercial |
$1,030.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$984.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$606.85
|
| Rate for Payer: Cash Price |
$343.50
|
| Rate for Payer: Cigna Commercial |
$1,053.40
|
| Rate for Payer: Health EOS Commercial |
$1,019.05
|
| Rate for Payer: HFN Commercial |
$1,053.40
|
| Rate for Payer: Multiplan Commercial |
$916.00
|
| Rate for Payer: NAPHCARE Commercial |
$687.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,053.40
|
| Rate for Payer: Quartz Beloit One Network |
$561.05
|
| Rate for Payer: Quartz Commercial |
$687.00
|
| Rate for Payer: WEA Trust Commercial |
$629.75
|
| Rate for Payer: WPS Commercial |
$848.10
|
|
|
PLATE 1/4 TUBULAR 7HL 242.07
|
Facility
|
OP
|
$627.00
|
|
| Hospital Charge Code |
2966660
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$175.56 |
| Max. Negotiated Rate |
$2,508.00 |
| Rate for Payer: Aetna Commercial |
$564.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$539.22
|
| Rate for Payer: Aetna Managed Medicare |
$175.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$407.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$313.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$300.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$332.31
|
| Rate for Payer: Cash Price |
$188.10
|
| Rate for Payer: Cigna Commercial |
$576.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$350.87
|
| Rate for Payer: Health EOS Commercial |
$558.03
|
| Rate for Payer: HFN Commercial |
$576.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$470.25
|
| Rate for Payer: Multiplan Commercial |
$501.60
|
| Rate for Payer: NAPHCARE Commercial |
$376.20
|
| Rate for Payer: Preferred Network Access Commercial |
$576.84
|
| Rate for Payer: Quartz Beloit One Network |
$307.23
|
| Rate for Payer: Quartz Commercial |
$407.55
|
| Rate for Payer: Quartz Medicare Advantage |
$376.20
|
| Rate for Payer: The Alliance Commercial |
$2,508.00
|
| Rate for Payer: WEA Trust Commercial |
$344.85
|
| Rate for Payer: WPS Commercial |
$464.42
|
|
|
PLATE 1/4 TUBULAR 7HL 242.07
|
Facility
|
IP
|
$627.00
|
|
| Hospital Charge Code |
2966660
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$307.23 |
| Max. Negotiated Rate |
$576.84 |
| Rate for Payer: Aetna Commercial |
$564.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$539.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$332.31
|
| Rate for Payer: Cash Price |
$188.10
|
| Rate for Payer: Cigna Commercial |
$576.84
|
| Rate for Payer: Health EOS Commercial |
$558.03
|
| Rate for Payer: HFN Commercial |
$576.84
|
| Rate for Payer: Multiplan Commercial |
$501.60
|
| Rate for Payer: NAPHCARE Commercial |
$376.20
|
| Rate for Payer: Preferred Network Access Commercial |
$576.84
|
| Rate for Payer: Quartz Beloit One Network |
$307.23
|
| Rate for Payer: Quartz Commercial |
$376.20
|
| Rate for Payer: WEA Trust Commercial |
$344.85
|
| Rate for Payer: WPS Commercial |
$464.42
|
|
|
PLATE 1/4 TUBULAR 8HL 242.08
|
Facility
|
OP
|
$1,776.00
|
|
| Hospital Charge Code |
2966661
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$497.28 |
| Max. Negotiated Rate |
$7,104.00 |
| Rate for Payer: Aetna Commercial |
$1,598.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,527.36
|
| Rate for Payer: Aetna Managed Medicare |
$497.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,154.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$888.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$852.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$941.28
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Cigna Commercial |
$1,633.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$993.85
|
| Rate for Payer: Health EOS Commercial |
$1,580.64
|
| Rate for Payer: HFN Commercial |
$1,633.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,332.00
|
| Rate for Payer: Multiplan Commercial |
$1,420.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,065.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,633.92
|
| Rate for Payer: Quartz Beloit One Network |
$870.24
|
| Rate for Payer: Quartz Commercial |
$1,154.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,065.60
|
| Rate for Payer: The Alliance Commercial |
$7,104.00
|
| Rate for Payer: WEA Trust Commercial |
$976.80
|
| Rate for Payer: WPS Commercial |
$1,315.48
|
|
|
PLATE 1/4 TUBULAR 8HL 242.08
|
Facility
|
IP
|
$1,776.00
|
|
| Hospital Charge Code |
2966661
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$870.24 |
| Max. Negotiated Rate |
$1,633.92 |
| Rate for Payer: Aetna Commercial |
$1,598.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,527.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$941.28
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Cigna Commercial |
$1,633.92
|
| Rate for Payer: Health EOS Commercial |
$1,580.64
|
| Rate for Payer: HFN Commercial |
$1,633.92
|
| Rate for Payer: Multiplan Commercial |
$1,420.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,065.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,633.92
|
| Rate for Payer: Quartz Beloit One Network |
$870.24
|
| Rate for Payer: Quartz Commercial |
$1,065.60
|
| Rate for Payer: WEA Trust Commercial |
$976.80
|
| Rate for Payer: WPS Commercial |
$1,315.48
|
|
|
PLATE 1.5 6HL CONDYLAR SYNTHES
|
Facility
|
IP
|
$5,227.00
|
|
| Hospital Charge Code |
2966310
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,561.23 |
| Max. Negotiated Rate |
$4,808.84 |
| Rate for Payer: Aetna Commercial |
$4,704.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,495.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,770.31
|
| Rate for Payer: Cash Price |
$1,568.10
|
| Rate for Payer: Cigna Commercial |
$4,808.84
|
| Rate for Payer: Health EOS Commercial |
$4,652.03
|
| Rate for Payer: HFN Commercial |
$4,808.84
|
| Rate for Payer: Multiplan Commercial |
$4,181.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,136.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,808.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,561.23
|
| Rate for Payer: Quartz Commercial |
$3,136.20
|
| Rate for Payer: WEA Trust Commercial |
$2,874.85
|
| Rate for Payer: WPS Commercial |
$3,871.64
|
|
|
PLATE 1.5 6HL CONDYLAR SYNTHES
|
Facility
|
OP
|
$5,227.00
|
|
| Hospital Charge Code |
2966310
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,463.56 |
| Max. Negotiated Rate |
$20,908.00 |
| Rate for Payer: Aetna Commercial |
$4,704.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,495.22
|
| Rate for Payer: Aetna Managed Medicare |
$1,463.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,397.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,613.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,508.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,770.31
|
| Rate for Payer: Cash Price |
$1,568.10
|
| Rate for Payer: Cigna Commercial |
$4,808.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,925.03
|
| Rate for Payer: Health EOS Commercial |
$4,652.03
|
| Rate for Payer: HFN Commercial |
$4,808.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,920.25
|
| Rate for Payer: Multiplan Commercial |
$4,181.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,136.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,808.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,561.23
|
| Rate for Payer: Quartz Commercial |
$3,397.55
|
| Rate for Payer: Quartz Medicare Advantage |
$3,136.20
|
| Rate for Payer: The Alliance Commercial |
$20,908.00
|
| Rate for Payer: WEA Trust Commercial |
$2,874.85
|
| Rate for Payer: WPS Commercial |
$3,871.64
|
|
|
PLATE 1.5 EXT H-PLATE RT
|
Facility
|
IP
|
$5,051.00
|
|
| Hospital Charge Code |
2966311
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,474.99 |
| Max. Negotiated Rate |
$4,646.92 |
| Rate for Payer: Aetna Commercial |
$4,545.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,343.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,677.03
|
| Rate for Payer: Cash Price |
$1,515.30
|
| Rate for Payer: Cigna Commercial |
$4,646.92
|
| Rate for Payer: Health EOS Commercial |
$4,495.39
|
| Rate for Payer: HFN Commercial |
$4,646.92
|
| Rate for Payer: Multiplan Commercial |
$4,040.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,030.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,646.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,474.99
|
| Rate for Payer: Quartz Commercial |
$3,030.60
|
| Rate for Payer: WEA Trust Commercial |
$2,778.05
|
| Rate for Payer: WPS Commercial |
$3,741.28
|
|
|
PLATE 1.5 EXT H-PLATE RT
|
Facility
|
OP
|
$5,051.00
|
|
| Hospital Charge Code |
2966311
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,414.28 |
| Max. Negotiated Rate |
$20,204.00 |
| Rate for Payer: Aetna Commercial |
$4,545.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,343.86
|
| Rate for Payer: Aetna Managed Medicare |
$1,414.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,283.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,525.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,424.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,677.03
|
| Rate for Payer: Cash Price |
$1,515.30
|
| Rate for Payer: Cigna Commercial |
$4,646.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,826.54
|
| Rate for Payer: Health EOS Commercial |
$4,495.39
|
| Rate for Payer: HFN Commercial |
$4,646.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,788.25
|
| Rate for Payer: Multiplan Commercial |
$4,040.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,030.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,646.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,474.99
|
| Rate for Payer: Quartz Commercial |
$3,283.15
|
| Rate for Payer: Quartz Medicare Advantage |
$3,030.60
|
| Rate for Payer: The Alliance Commercial |
$20,204.00
|
| Rate for Payer: WEA Trust Commercial |
$2,778.05
|
| Rate for Payer: WPS Commercial |
$3,741.28
|
|
|
PLATE 1.5 LCP ADAPTION 6HOLES 02.114.503
|
Facility
|
IP
|
$5,809.00
|
|
| Hospital Charge Code |
2966312
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,846.41 |
| Max. Negotiated Rate |
$5,344.28 |
| Rate for Payer: Aetna Commercial |
$5,228.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,995.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,078.77
|
| Rate for Payer: Cash Price |
$1,742.70
|
| Rate for Payer: Cigna Commercial |
$5,344.28
|
| Rate for Payer: Health EOS Commercial |
$5,170.01
|
| Rate for Payer: HFN Commercial |
$5,344.28
|
| Rate for Payer: Multiplan Commercial |
$4,647.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,485.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,344.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,846.41
|
| Rate for Payer: Quartz Commercial |
$3,485.40
|
| Rate for Payer: WEA Trust Commercial |
$3,194.95
|
| Rate for Payer: WPS Commercial |
$4,302.73
|
|
|
PLATE 1.5 LCP ADAPTION 6HOLES 02.114.503
|
Facility
|
OP
|
$5,809.00
|
|
| Hospital Charge Code |
2966312
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,626.52 |
| Max. Negotiated Rate |
$23,236.00 |
| Rate for Payer: Aetna Commercial |
$5,228.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,995.74
|
| Rate for Payer: Aetna Managed Medicare |
$1,626.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,775.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,904.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,788.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,078.77
|
| Rate for Payer: Cash Price |
$1,742.70
|
| Rate for Payer: Cigna Commercial |
$5,344.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,250.72
|
| Rate for Payer: Health EOS Commercial |
$5,170.01
|
| Rate for Payer: HFN Commercial |
$5,344.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,356.75
|
| Rate for Payer: Multiplan Commercial |
$4,647.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,485.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,344.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,846.41
|
| Rate for Payer: Quartz Commercial |
$3,775.85
|
| Rate for Payer: Quartz Medicare Advantage |
$3,485.40
|
| Rate for Payer: The Alliance Commercial |
$23,236.00
|
| Rate for Payer: WEA Trust Commercial |
$3,194.95
|
| Rate for Payer: WPS Commercial |
$4,302.73
|
|
|
PLATE 1.5 LCP CONDYLAR 6H 02.114.514
|
Facility
|
OP
|
$5,208.00
|
|
| Hospital Charge Code |
2966313
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,458.24 |
| Max. Negotiated Rate |
$20,832.00 |
| Rate for Payer: Aetna Commercial |
$4,687.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,478.88
|
| Rate for Payer: Aetna Managed Medicare |
$1,458.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,385.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,604.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,499.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,760.24
|
| Rate for Payer: Cash Price |
$1,562.40
|
| Rate for Payer: Cigna Commercial |
$4,791.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,914.40
|
| Rate for Payer: Health EOS Commercial |
$4,635.12
|
| Rate for Payer: HFN Commercial |
$4,791.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,906.00
|
| Rate for Payer: Multiplan Commercial |
$4,166.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,124.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,791.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,551.92
|
| Rate for Payer: Quartz Commercial |
$3,385.20
|
| Rate for Payer: Quartz Medicare Advantage |
$3,124.80
|
| Rate for Payer: The Alliance Commercial |
$20,832.00
|
| Rate for Payer: WEA Trust Commercial |
$2,864.40
|
| Rate for Payer: WPS Commercial |
$3,857.57
|
|
|
PLATE 1.5 LCP CONDYLAR 6H 02.114.514
|
Facility
|
IP
|
$5,208.00
|
|
| Hospital Charge Code |
2966313
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,551.92 |
| Max. Negotiated Rate |
$4,791.36 |
| Rate for Payer: Aetna Commercial |
$4,687.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,478.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,760.24
|
| Rate for Payer: Cash Price |
$1,562.40
|
| Rate for Payer: Cigna Commercial |
$4,791.36
|
| Rate for Payer: Health EOS Commercial |
$4,635.12
|
| Rate for Payer: HFN Commercial |
$4,791.36
|
| Rate for Payer: Multiplan Commercial |
$4,166.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,124.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,791.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,551.92
|
| Rate for Payer: Quartz Commercial |
$3,124.80
|
| Rate for Payer: WEA Trust Commercial |
$2,864.40
|
| Rate for Payer: WPS Commercial |
$3,857.57
|
|
|
PLATE 1.5MM 6HL ADAPTION
|
Facility
|
IP
|
$5,917.00
|
|
| Hospital Charge Code |
2966315
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,899.33 |
| Max. Negotiated Rate |
$5,443.64 |
| Rate for Payer: Aetna Commercial |
$5,325.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,088.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,136.01
|
| Rate for Payer: Cash Price |
$1,775.10
|
| Rate for Payer: Cigna Commercial |
$5,443.64
|
| Rate for Payer: Health EOS Commercial |
$5,266.13
|
| Rate for Payer: HFN Commercial |
$5,443.64
|
| Rate for Payer: Multiplan Commercial |
$4,733.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,550.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,443.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,899.33
|
| Rate for Payer: Quartz Commercial |
$3,550.20
|
| Rate for Payer: WEA Trust Commercial |
$3,254.35
|
| Rate for Payer: WPS Commercial |
$4,382.72
|
|
|
PLATE 1.5MM 6HL ADAPTION
|
Facility
|
OP
|
$5,917.00
|
|
| Hospital Charge Code |
2966315
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,656.76 |
| Max. Negotiated Rate |
$23,668.00 |
| Rate for Payer: Aetna Commercial |
$5,325.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,088.62
|
| Rate for Payer: Aetna Managed Medicare |
$1,656.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,846.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,958.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,840.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,136.01
|
| Rate for Payer: Cash Price |
$1,775.10
|
| Rate for Payer: Cigna Commercial |
$5,443.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,311.15
|
| Rate for Payer: Health EOS Commercial |
$5,266.13
|
| Rate for Payer: HFN Commercial |
$5,443.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,437.75
|
| Rate for Payer: Multiplan Commercial |
$4,733.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,550.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,443.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,899.33
|
| Rate for Payer: Quartz Commercial |
$3,846.05
|
| Rate for Payer: Quartz Medicare Advantage |
$3,550.20
|
| Rate for Payer: The Alliance Commercial |
$23,668.00
|
| Rate for Payer: WEA Trust Commercial |
$3,254.35
|
| Rate for Payer: WPS Commercial |
$4,382.72
|
|
|
PLATE 1.5 T 421.333
|
Facility
|
OP
|
$2,775.00
|
|
| Hospital Charge Code |
2966314
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$777.00 |
| Max. Negotiated Rate |
$11,100.00 |
| Rate for Payer: Aetna Commercial |
$2,497.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,386.50
|
| Rate for Payer: Aetna Managed Medicare |
$777.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,803.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,387.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,332.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,470.75
|
| Rate for Payer: Cash Price |
$832.50
|
| Rate for Payer: Cigna Commercial |
$2,553.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,552.89
|
| Rate for Payer: Health EOS Commercial |
$2,469.75
|
| Rate for Payer: HFN Commercial |
$2,553.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,081.25
|
| Rate for Payer: Multiplan Commercial |
$2,220.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,665.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,553.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,359.75
|
| Rate for Payer: Quartz Commercial |
$1,803.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,665.00
|
| Rate for Payer: The Alliance Commercial |
$11,100.00
|
| Rate for Payer: WEA Trust Commercial |
$1,526.25
|
| Rate for Payer: WPS Commercial |
$2,055.44
|
|
|
PLATE 1.5 T 421.333
|
Facility
|
IP
|
$2,775.00
|
|
| Hospital Charge Code |
2966314
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,359.75 |
| Max. Negotiated Rate |
$2,553.00 |
| Rate for Payer: Aetna Commercial |
$2,497.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,386.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,470.75
|
| Rate for Payer: Cash Price |
$832.50
|
| Rate for Payer: Cigna Commercial |
$2,553.00
|
| Rate for Payer: Health EOS Commercial |
$2,469.75
|
| Rate for Payer: HFN Commercial |
$2,553.00
|
| Rate for Payer: Multiplan Commercial |
$2,220.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,665.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,553.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,359.75
|
| Rate for Payer: Quartz Commercial |
$1,665.00
|
| Rate for Payer: WEA Trust Commercial |
$1,526.25
|
| Rate for Payer: WPS Commercial |
$2,055.44
|
|
|
PLATE 2.0MM LCP DISTAL ULNA 7HL 242.531S
|
Facility
|
IP
|
$8,104.00
|
|
| Hospital Charge Code |
2966321
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,970.96 |
| Max. Negotiated Rate |
$7,455.68 |
| Rate for Payer: Aetna Commercial |
$7,293.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,969.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,295.12
|
| Rate for Payer: Cash Price |
$2,431.20
|
| Rate for Payer: Cigna Commercial |
$7,455.68
|
| Rate for Payer: Health EOS Commercial |
$7,212.56
|
| Rate for Payer: HFN Commercial |
$7,455.68
|
| Rate for Payer: Multiplan Commercial |
$6,483.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,862.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,455.68
|
| Rate for Payer: Quartz Beloit One Network |
$3,970.96
|
| Rate for Payer: Quartz Commercial |
$4,862.40
|
| Rate for Payer: WEA Trust Commercial |
$4,457.20
|
| Rate for Payer: WPS Commercial |
$6,002.63
|
|
|
PLATE 2.0MM LCP DISTAL ULNA 7HL 242.531S
|
Facility
|
OP
|
$8,104.00
|
|
| Hospital Charge Code |
2966321
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,269.12 |
| Max. Negotiated Rate |
$32,416.00 |
| Rate for Payer: Aetna Commercial |
$7,293.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,969.44
|
| Rate for Payer: Aetna Managed Medicare |
$2,269.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,267.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,052.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,889.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,295.12
|
| Rate for Payer: Cash Price |
$2,431.20
|
| Rate for Payer: Cigna Commercial |
$7,455.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,535.00
|
| Rate for Payer: Health EOS Commercial |
$7,212.56
|
| Rate for Payer: HFN Commercial |
$7,455.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,078.00
|
| Rate for Payer: Multiplan Commercial |
$6,483.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,862.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,455.68
|
| Rate for Payer: Quartz Beloit One Network |
$3,970.96
|
| Rate for Payer: Quartz Commercial |
$5,267.60
|
| Rate for Payer: Quartz Medicare Advantage |
$4,862.40
|
| Rate for Payer: The Alliance Commercial |
$32,416.00
|
| Rate for Payer: WEA Trust Commercial |
$4,457.20
|
| Rate for Payer: WPS Commercial |
$6,002.63
|
|
|
PLATE 2.0 STRAIGHT 12 HL VA 02.130.351S
|
Facility
|
OP
|
$5,408.00
|
|
| Hospital Charge Code |
4858884
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,514.24 |
| Max. Negotiated Rate |
$21,632.00 |
| Rate for Payer: Aetna Commercial |
$4,867.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,650.88
|
| Rate for Payer: Aetna Managed Medicare |
$1,514.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,515.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,704.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,595.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,866.24
|
| Rate for Payer: Cash Price |
$1,622.40
|
| Rate for Payer: Cigna Commercial |
$4,975.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,026.32
|
| Rate for Payer: Health EOS Commercial |
$4,813.12
|
| Rate for Payer: HFN Commercial |
$4,975.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,056.00
|
| Rate for Payer: Multiplan Commercial |
$4,326.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,244.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,975.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,649.92
|
| Rate for Payer: Quartz Commercial |
$3,515.20
|
| Rate for Payer: Quartz Medicare Advantage |
$3,244.80
|
| Rate for Payer: The Alliance Commercial |
$21,632.00
|
| Rate for Payer: WEA Trust Commercial |
$2,974.40
|
| Rate for Payer: WPS Commercial |
$4,005.71
|
|
|
PLATE 2.0 STRAIGHT 12 HL VA 02.130.351S
|
Facility
|
IP
|
$5,408.00
|
|
| Hospital Charge Code |
4858884
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,649.92 |
| Max. Negotiated Rate |
$4,975.36 |
| Rate for Payer: Aetna Commercial |
$4,867.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,650.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,866.24
|
| Rate for Payer: Cash Price |
$1,622.40
|
| Rate for Payer: Cigna Commercial |
$4,975.36
|
| Rate for Payer: Health EOS Commercial |
$4,813.12
|
| Rate for Payer: HFN Commercial |
$4,975.36
|
| Rate for Payer: Multiplan Commercial |
$4,326.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,244.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,975.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,649.92
|
| Rate for Payer: Quartz Commercial |
$3,244.80
|
| Rate for Payer: WEA Trust Commercial |
$2,974.40
|
| Rate for Payer: WPS Commercial |
$4,005.71
|
|
|
PLATE 2.4 6HL/2H LT 04.111.621
|
Facility
|
IP
|
$6,236.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966679
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,055.64 |
| Max. Negotiated Rate |
$5,737.12 |
| Rate for Payer: Aetna Commercial |
$5,612.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,362.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,305.08
|
| Rate for Payer: Cash Price |
$1,870.80
|
| Rate for Payer: Cigna Commercial |
$5,737.12
|
| Rate for Payer: Health EOS Commercial |
$5,550.04
|
| Rate for Payer: HFN Commercial |
$5,737.12
|
| Rate for Payer: Multiplan Commercial |
$4,988.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,741.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,737.12
|
| Rate for Payer: Quartz Beloit One Network |
$3,055.64
|
| Rate for Payer: Quartz Commercial |
$3,741.60
|
| Rate for Payer: WEA Trust Commercial |
$3,429.80
|
| Rate for Payer: WPS Commercial |
$4,619.01
|
|
