|
PLATE 6H 3.5 LCP RECON 245.061
|
Facility
|
IP
|
$2,136.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966730
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,088.51 |
| Max. Negotiated Rate |
$2,043.72 |
| Rate for Payer: Aetna Commercial |
$1,999.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,910.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,177.36
|
| Rate for Payer: Cash Price |
$640.80
|
| Rate for Payer: Cigna Commercial |
$2,043.72
|
| Rate for Payer: Health EOS Commercial |
$1,977.08
|
| Rate for Payer: HFN Commercial |
$2,043.72
|
| Rate for Payer: Multiplan Commercial |
$1,777.15
|
| Rate for Payer: Preferred Network Access Commercial |
$2,043.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,088.51
|
| Rate for Payer: Quartz Commercial |
$1,332.86
|
| Rate for Payer: WEA Trust Commercial |
$1,221.79
|
| Rate for Payer: WPS Commercial |
$1,645.36
|
|
|
PLATE 6HL 3.5 RT M/D/T 239.904
|
Facility
|
OP
|
$7,386.00
|
|
| Hospital Charge Code |
2966736
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,150.80 |
| Max. Negotiated Rate |
$7,066.92 |
| Rate for Payer: Aetna Commercial |
$6,913.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,606.04
|
| Rate for Payer: Aetna Managed Medicare |
$2,150.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,992.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,840.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,687.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,071.16
|
| Rate for Payer: Cash Price |
$2,215.80
|
| Rate for Payer: Cigna Commercial |
$7,066.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,298.65
|
| Rate for Payer: Health EOS Commercial |
$6,836.48
|
| Rate for Payer: HFN Commercial |
$7,066.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,761.08
|
| Rate for Payer: Multiplan Commercial |
$6,145.15
|
| Rate for Payer: NAPHCARE Commercial |
$4,608.86
|
| Rate for Payer: Preferred Network Access Commercial |
$7,066.92
|
| Rate for Payer: Quartz Beloit One Network |
$3,763.91
|
| Rate for Payer: Quartz Commercial |
$4,992.94
|
| Rate for Payer: Quartz Medicare Advantage |
$4,608.86
|
| Rate for Payer: The Alliance Commercial |
$3,840.72
|
| Rate for Payer: WEA Trust Commercial |
$4,224.79
|
| Rate for Payer: WPS Commercial |
$5,689.44
|
|
|
PLATE 6HL 3.5 RT M/D/T 239.904
|
Facility
|
IP
|
$7,386.00
|
|
| Hospital Charge Code |
2966736
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,763.91 |
| Max. Negotiated Rate |
$7,066.92 |
| Rate for Payer: Aetna Commercial |
$6,913.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,606.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,071.16
|
| Rate for Payer: Cash Price |
$2,215.80
|
| Rate for Payer: Cigna Commercial |
$7,066.92
|
| Rate for Payer: Health EOS Commercial |
$6,836.48
|
| Rate for Payer: HFN Commercial |
$7,066.92
|
| Rate for Payer: Multiplan Commercial |
$6,145.15
|
| Rate for Payer: Preferred Network Access Commercial |
$7,066.92
|
| Rate for Payer: Quartz Beloit One Network |
$3,763.91
|
| Rate for Payer: Quartz Commercial |
$4,608.86
|
| Rate for Payer: WEA Trust Commercial |
$4,224.79
|
| Rate for Payer: WPS Commercial |
$5,689.44
|
|
|
PLATE 6 HL LFT PROX FEMUR
|
Facility
|
IP
|
$8,933.00
|
|
| Hospital Charge Code |
2966353
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,552.26 |
| Max. Negotiated Rate |
$8,547.09 |
| Rate for Payer: Aetna Commercial |
$8,361.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,989.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,923.87
|
| Rate for Payer: Cash Price |
$2,679.90
|
| Rate for Payer: Cigna Commercial |
$8,547.09
|
| Rate for Payer: Health EOS Commercial |
$8,268.38
|
| Rate for Payer: HFN Commercial |
$8,547.09
|
| Rate for Payer: Multiplan Commercial |
$7,432.26
|
| Rate for Payer: Preferred Network Access Commercial |
$8,547.09
|
| Rate for Payer: Quartz Beloit One Network |
$4,552.26
|
| Rate for Payer: Quartz Commercial |
$5,574.19
|
| Rate for Payer: WEA Trust Commercial |
$5,109.68
|
| Rate for Payer: WPS Commercial |
$6,881.09
|
|
|
PLATE 6 HL LFT PROX FEMUR
|
Facility
|
OP
|
$8,933.00
|
|
| Hospital Charge Code |
2966353
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,601.29 |
| Max. Negotiated Rate |
$8,547.09 |
| Rate for Payer: Aetna Commercial |
$8,361.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,989.68
|
| Rate for Payer: Aetna Managed Medicare |
$2,601.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,038.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,645.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,459.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,923.87
|
| Rate for Payer: Cash Price |
$2,679.90
|
| Rate for Payer: Cigna Commercial |
$8,547.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,199.01
|
| Rate for Payer: Health EOS Commercial |
$8,268.38
|
| Rate for Payer: HFN Commercial |
$8,547.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,967.74
|
| Rate for Payer: Multiplan Commercial |
$7,432.26
|
| Rate for Payer: NAPHCARE Commercial |
$5,574.19
|
| Rate for Payer: Preferred Network Access Commercial |
$8,547.09
|
| Rate for Payer: Quartz Beloit One Network |
$4,552.26
|
| Rate for Payer: Quartz Commercial |
$6,038.71
|
| Rate for Payer: Quartz Medicare Advantage |
$5,574.19
|
| Rate for Payer: The Alliance Commercial |
$4,645.16
|
| Rate for Payer: WEA Trust Commercial |
$5,109.68
|
| Rate for Payer: WPS Commercial |
$6,881.09
|
|
|
PLATE 6 HL RT OLECRANON
|
Facility
|
OP
|
$6,224.00
|
|
| Hospital Charge Code |
2966354
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,812.43 |
| Max. Negotiated Rate |
$5,955.12 |
| Rate for Payer: Aetna Commercial |
$5,825.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,566.75
|
| Rate for Payer: Aetna Managed Medicare |
$1,812.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,207.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,236.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,107.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,430.67
|
| Rate for Payer: Cash Price |
$1,867.20
|
| Rate for Payer: Cigna Commercial |
$5,955.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,622.37
|
| Rate for Payer: Health EOS Commercial |
$5,760.93
|
| Rate for Payer: HFN Commercial |
$5,955.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,854.72
|
| Rate for Payer: Multiplan Commercial |
$5,178.37
|
| Rate for Payer: NAPHCARE Commercial |
$3,883.78
|
| Rate for Payer: Preferred Network Access Commercial |
$5,955.12
|
| Rate for Payer: Quartz Beloit One Network |
$3,171.75
|
| Rate for Payer: Quartz Commercial |
$4,207.42
|
| Rate for Payer: Quartz Medicare Advantage |
$3,883.78
|
| Rate for Payer: The Alliance Commercial |
$3,236.48
|
| Rate for Payer: WEA Trust Commercial |
$3,560.13
|
| Rate for Payer: WPS Commercial |
$4,794.35
|
|
|
PLATE 6 HL RT OLECRANON
|
Facility
|
IP
|
$6,224.00
|
|
| Hospital Charge Code |
2966354
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,171.75 |
| Max. Negotiated Rate |
$5,955.12 |
| Rate for Payer: Aetna Commercial |
$5,825.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,566.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,430.67
|
| Rate for Payer: Cash Price |
$1,867.20
|
| Rate for Payer: Cigna Commercial |
$5,955.12
|
| Rate for Payer: Health EOS Commercial |
$5,760.93
|
| Rate for Payer: HFN Commercial |
$5,955.12
|
| Rate for Payer: Multiplan Commercial |
$5,178.37
|
| Rate for Payer: Preferred Network Access Commercial |
$5,955.12
|
| Rate for Payer: Quartz Beloit One Network |
$3,171.75
|
| Rate for Payer: Quartz Commercial |
$3,883.78
|
| Rate for Payer: WEA Trust Commercial |
$3,560.13
|
| Rate for Payer: WPS Commercial |
$4,794.35
|
|
|
PLATE 6H LT CONDYLAR 222.657
|
Facility
|
IP
|
$4,507.00
|
|
| Hospital Charge Code |
2966731
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,296.77 |
| Max. Negotiated Rate |
$4,312.30 |
| Rate for Payer: Aetna Commercial |
$4,218.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,031.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,484.26
|
| Rate for Payer: Cash Price |
$1,352.10
|
| Rate for Payer: Cigna Commercial |
$4,312.30
|
| Rate for Payer: Health EOS Commercial |
$4,171.68
|
| Rate for Payer: HFN Commercial |
$4,312.30
|
| Rate for Payer: Multiplan Commercial |
$3,749.82
|
| Rate for Payer: Preferred Network Access Commercial |
$4,312.30
|
| Rate for Payer: Quartz Beloit One Network |
$2,296.77
|
| Rate for Payer: Quartz Commercial |
$2,812.37
|
| Rate for Payer: WEA Trust Commercial |
$2,578.00
|
| Rate for Payer: WPS Commercial |
$3,471.74
|
|
|
PLATE 6H LT CONDYLAR 222.657
|
Facility
|
OP
|
$4,507.00
|
|
| Hospital Charge Code |
2966731
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,312.44 |
| Max. Negotiated Rate |
$4,312.30 |
| Rate for Payer: Aetna Commercial |
$4,218.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,031.06
|
| Rate for Payer: Aetna Managed Medicare |
$1,312.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,046.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,343.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,249.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,484.26
|
| Rate for Payer: Cash Price |
$1,352.10
|
| Rate for Payer: Cigna Commercial |
$4,312.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,623.07
|
| Rate for Payer: Health EOS Commercial |
$4,171.68
|
| Rate for Payer: HFN Commercial |
$4,312.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,515.46
|
| Rate for Payer: Multiplan Commercial |
$3,749.82
|
| Rate for Payer: NAPHCARE Commercial |
$2,812.37
|
| Rate for Payer: Preferred Network Access Commercial |
$4,312.30
|
| Rate for Payer: Quartz Beloit One Network |
$2,296.77
|
| Rate for Payer: Quartz Commercial |
$3,046.73
|
| Rate for Payer: Quartz Medicare Advantage |
$2,812.37
|
| Rate for Payer: The Alliance Commercial |
$2,343.64
|
| Rate for Payer: WEA Trust Commercial |
$2,578.00
|
| Rate for Payer: WPS Commercial |
$3,471.74
|
|
|
PLATE 6H LT MED/DIS/TI 239.905
|
Facility
|
OP
|
$5,140.00
|
|
| Hospital Charge Code |
2966733
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,496.77 |
| Max. Negotiated Rate |
$4,917.95 |
| Rate for Payer: Aetna Commercial |
$4,811.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,597.22
|
| Rate for Payer: Aetna Managed Medicare |
$1,496.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,474.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,672.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,565.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,833.17
|
| Rate for Payer: Cash Price |
$1,542.00
|
| Rate for Payer: Cigna Commercial |
$4,917.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,991.48
|
| Rate for Payer: Health EOS Commercial |
$4,757.58
|
| Rate for Payer: HFN Commercial |
$4,917.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,009.20
|
| Rate for Payer: Multiplan Commercial |
$4,276.48
|
| Rate for Payer: NAPHCARE Commercial |
$3,207.36
|
| Rate for Payer: Preferred Network Access Commercial |
$4,917.95
|
| Rate for Payer: Quartz Beloit One Network |
$2,619.34
|
| Rate for Payer: Quartz Commercial |
$3,474.64
|
| Rate for Payer: Quartz Medicare Advantage |
$3,207.36
|
| Rate for Payer: The Alliance Commercial |
$2,672.80
|
| Rate for Payer: WEA Trust Commercial |
$2,940.08
|
| Rate for Payer: WPS Commercial |
$3,959.34
|
|
|
PLATE 6H LT MED/DIS/TI 239.905
|
Facility
|
IP
|
$5,140.00
|
|
| Hospital Charge Code |
2966733
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,619.34 |
| Max. Negotiated Rate |
$4,917.95 |
| Rate for Payer: Aetna Commercial |
$4,811.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,597.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,833.17
|
| Rate for Payer: Cash Price |
$1,542.00
|
| Rate for Payer: Cigna Commercial |
$4,917.95
|
| Rate for Payer: Health EOS Commercial |
$4,757.58
|
| Rate for Payer: HFN Commercial |
$4,917.95
|
| Rate for Payer: Multiplan Commercial |
$4,276.48
|
| Rate for Payer: Preferred Network Access Commercial |
$4,917.95
|
| Rate for Payer: Quartz Beloit One Network |
$2,619.34
|
| Rate for Payer: Quartz Commercial |
$3,207.36
|
| Rate for Payer: WEA Trust Commercial |
$2,940.08
|
| Rate for Payer: WPS Commercial |
$3,959.34
|
|
|
PLATE 6H LT PROX/TIB 240.039
|
Facility
|
OP
|
$4,625.00
|
|
| Hospital Charge Code |
2966732
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,346.80 |
| Max. Negotiated Rate |
$4,425.20 |
| Rate for Payer: Aetna Commercial |
$4,329.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,136.60
|
| Rate for Payer: Aetna Managed Medicare |
$1,346.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,126.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,405.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,308.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,549.30
|
| Rate for Payer: Cash Price |
$1,387.50
|
| Rate for Payer: Cigna Commercial |
$4,425.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,691.75
|
| Rate for Payer: Health EOS Commercial |
$4,280.90
|
| Rate for Payer: HFN Commercial |
$4,425.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,607.50
|
| Rate for Payer: Multiplan Commercial |
$3,848.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,886.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,425.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,356.90
|
| Rate for Payer: Quartz Commercial |
$3,126.50
|
| Rate for Payer: Quartz Medicare Advantage |
$2,886.00
|
| Rate for Payer: The Alliance Commercial |
$2,405.00
|
| Rate for Payer: WEA Trust Commercial |
$2,645.50
|
| Rate for Payer: WPS Commercial |
$3,562.64
|
|
|
PLATE 6H LT PROX/TIB 240.039
|
Facility
|
IP
|
$4,625.00
|
|
| Hospital Charge Code |
2966732
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,356.90 |
| Max. Negotiated Rate |
$4,425.20 |
| Rate for Payer: Aetna Commercial |
$4,329.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,136.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,549.30
|
| Rate for Payer: Cash Price |
$1,387.50
|
| Rate for Payer: Cigna Commercial |
$4,425.20
|
| Rate for Payer: Health EOS Commercial |
$4,280.90
|
| Rate for Payer: HFN Commercial |
$4,425.20
|
| Rate for Payer: Multiplan Commercial |
$3,848.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,425.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,356.90
|
| Rate for Payer: Quartz Commercial |
$2,886.00
|
| Rate for Payer: WEA Trust Commercial |
$2,645.50
|
| Rate for Payer: WPS Commercial |
$3,562.64
|
|
|
PLATE 6H RT CONDYLAR 222.656
|
Facility
|
IP
|
$4,507.00
|
|
| Hospital Charge Code |
2966734
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,296.77 |
| Max. Negotiated Rate |
$4,312.30 |
| Rate for Payer: Aetna Commercial |
$4,218.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,031.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,484.26
|
| Rate for Payer: Cash Price |
$1,352.10
|
| Rate for Payer: Cigna Commercial |
$4,312.30
|
| Rate for Payer: Health EOS Commercial |
$4,171.68
|
| Rate for Payer: HFN Commercial |
$4,312.30
|
| Rate for Payer: Multiplan Commercial |
$3,749.82
|
| Rate for Payer: Preferred Network Access Commercial |
$4,312.30
|
| Rate for Payer: Quartz Beloit One Network |
$2,296.77
|
| Rate for Payer: Quartz Commercial |
$2,812.37
|
| Rate for Payer: WEA Trust Commercial |
$2,578.00
|
| Rate for Payer: WPS Commercial |
$3,471.74
|
|
|
PLATE 6H RT CONDYLAR 222.656
|
Facility
|
OP
|
$4,507.00
|
|
| Hospital Charge Code |
2966734
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,312.44 |
| Max. Negotiated Rate |
$4,312.30 |
| Rate for Payer: Aetna Commercial |
$4,218.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,031.06
|
| Rate for Payer: Aetna Managed Medicare |
$1,312.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,046.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,343.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,249.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,484.26
|
| Rate for Payer: Cash Price |
$1,352.10
|
| Rate for Payer: Cigna Commercial |
$4,312.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,623.07
|
| Rate for Payer: Health EOS Commercial |
$4,171.68
|
| Rate for Payer: HFN Commercial |
$4,312.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,515.46
|
| Rate for Payer: Multiplan Commercial |
$3,749.82
|
| Rate for Payer: NAPHCARE Commercial |
$2,812.37
|
| Rate for Payer: Preferred Network Access Commercial |
$4,312.30
|
| Rate for Payer: Quartz Beloit One Network |
$2,296.77
|
| Rate for Payer: Quartz Commercial |
$3,046.73
|
| Rate for Payer: Quartz Medicare Advantage |
$2,812.37
|
| Rate for Payer: The Alliance Commercial |
$2,343.64
|
| Rate for Payer: WEA Trust Commercial |
$2,578.00
|
| Rate for Payer: WPS Commercial |
$3,471.74
|
|
|
PLATE 6H RT PROX/TIB 240.038
|
Facility
|
OP
|
$4,625.00
|
|
| Hospital Charge Code |
2966735
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,346.80 |
| Max. Negotiated Rate |
$4,425.20 |
| Rate for Payer: Aetna Commercial |
$4,329.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,136.60
|
| Rate for Payer: Aetna Managed Medicare |
$1,346.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,126.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,405.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,308.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,549.30
|
| Rate for Payer: Cash Price |
$1,387.50
|
| Rate for Payer: Cigna Commercial |
$4,425.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,691.75
|
| Rate for Payer: Health EOS Commercial |
$4,280.90
|
| Rate for Payer: HFN Commercial |
$4,425.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,607.50
|
| Rate for Payer: Multiplan Commercial |
$3,848.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,886.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,425.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,356.90
|
| Rate for Payer: Quartz Commercial |
$3,126.50
|
| Rate for Payer: Quartz Medicare Advantage |
$2,886.00
|
| Rate for Payer: The Alliance Commercial |
$2,405.00
|
| Rate for Payer: WEA Trust Commercial |
$2,645.50
|
| Rate for Payer: WPS Commercial |
$3,562.64
|
|
|
PLATE 6H RT PROX/TIB 240.038
|
Facility
|
IP
|
$4,625.00
|
|
| Hospital Charge Code |
2966735
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,356.90 |
| Max. Negotiated Rate |
$4,425.20 |
| Rate for Payer: Aetna Commercial |
$4,329.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,136.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,549.30
|
| Rate for Payer: Cash Price |
$1,387.50
|
| Rate for Payer: Cigna Commercial |
$4,425.20
|
| Rate for Payer: Health EOS Commercial |
$4,280.90
|
| Rate for Payer: HFN Commercial |
$4,425.20
|
| Rate for Payer: Multiplan Commercial |
$3,848.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,425.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,356.90
|
| Rate for Payer: Quartz Commercial |
$2,886.00
|
| Rate for Payer: WEA Trust Commercial |
$2,645.50
|
| Rate for Payer: WPS Commercial |
$3,562.64
|
|
|
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 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 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
|
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 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 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 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
|
|
