|
PLATE 8H 3.5 LCP RECON 245.081
|
Facility
|
OP
|
$2,347.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966739
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$683.45 |
| Max. Negotiated Rate |
$2,245.61 |
| Rate for Payer: Aetna Commercial |
$2,196.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,099.16
|
| Rate for Payer: Aetna Managed Medicare |
$683.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,586.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,220.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,171.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,293.67
|
| Rate for Payer: Cash Price |
$704.10
|
| Rate for Payer: Cigna Commercial |
$2,245.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,365.95
|
| Rate for Payer: Health EOS Commercial |
$2,172.38
|
| Rate for Payer: HFN Commercial |
$2,245.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,830.66
|
| Rate for Payer: Multiplan Commercial |
$1,952.70
|
| Rate for Payer: NAPHCARE Commercial |
$1,464.53
|
| Rate for Payer: Preferred Network Access Commercial |
$2,245.61
|
| Rate for Payer: Quartz Beloit One Network |
$1,196.03
|
| Rate for Payer: Quartz Commercial |
$1,586.57
|
| Rate for Payer: Quartz Medicare Advantage |
$1,464.53
|
| Rate for Payer: The Alliance Commercial |
$1,220.44
|
| Rate for Payer: WEA Trust Commercial |
$1,342.48
|
| Rate for Payer: WPS Commercial |
$1,807.89
|
|
|
PLATE 8H 3.5 LCP RECON 245.081
|
Facility
|
IP
|
$2,347.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966739
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,196.03 |
| Max. Negotiated Rate |
$2,245.61 |
| Rate for Payer: Aetna Commercial |
$2,196.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,099.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,293.67
|
| Rate for Payer: Cash Price |
$704.10
|
| Rate for Payer: Cigna Commercial |
$2,245.61
|
| Rate for Payer: Health EOS Commercial |
$2,172.38
|
| Rate for Payer: HFN Commercial |
$2,245.61
|
| Rate for Payer: Multiplan Commercial |
$1,952.70
|
| Rate for Payer: Preferred Network Access Commercial |
$2,245.61
|
| Rate for Payer: Quartz Beloit One Network |
$1,196.03
|
| Rate for Payer: Quartz Commercial |
$1,464.53
|
| Rate for Payer: WEA Trust Commercial |
$1,342.48
|
| Rate for Payer: WPS Commercial |
$1,807.89
|
|
|
PLATE 8H/3H LT DISTAL RADIUS 04.110.431
|
Facility
|
IP
|
$7,985.00
|
|
| Hospital Charge Code |
2966784
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,069.16 |
| Max. Negotiated Rate |
$7,640.05 |
| Rate for Payer: Aetna Commercial |
$7,473.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,141.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,401.33
|
| Rate for Payer: Cash Price |
$2,395.50
|
| Rate for Payer: Cigna Commercial |
$7,640.05
|
| Rate for Payer: Health EOS Commercial |
$7,390.92
|
| Rate for Payer: HFN Commercial |
$7,640.05
|
| Rate for Payer: Multiplan Commercial |
$6,643.52
|
| Rate for Payer: Preferred Network Access Commercial |
$7,640.05
|
| Rate for Payer: Quartz Beloit One Network |
$4,069.16
|
| Rate for Payer: Quartz Commercial |
$4,982.64
|
| Rate for Payer: WEA Trust Commercial |
$4,567.42
|
| Rate for Payer: WPS Commercial |
$6,150.85
|
|
|
PLATE 8H/3H LT DISTAL RADIUS 04.110.431
|
Facility
|
OP
|
$7,985.00
|
|
| Hospital Charge Code |
2966784
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,325.23 |
| Max. Negotiated Rate |
$7,640.05 |
| Rate for Payer: Aetna Commercial |
$7,473.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,141.78
|
| Rate for Payer: Aetna Managed Medicare |
$2,325.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,397.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,152.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,986.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,401.33
|
| Rate for Payer: Cash Price |
$2,395.50
|
| Rate for Payer: Cigna Commercial |
$7,640.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,647.27
|
| Rate for Payer: Health EOS Commercial |
$7,390.92
|
| Rate for Payer: HFN Commercial |
$7,640.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,228.30
|
| Rate for Payer: Multiplan Commercial |
$6,643.52
|
| Rate for Payer: NAPHCARE Commercial |
$4,982.64
|
| Rate for Payer: Preferred Network Access Commercial |
$7,640.05
|
| Rate for Payer: Quartz Beloit One Network |
$4,069.16
|
| Rate for Payer: Quartz Commercial |
$5,397.86
|
| Rate for Payer: Quartz Medicare Advantage |
$4,982.64
|
| Rate for Payer: The Alliance Commercial |
$4,152.20
|
| Rate for Payer: WEA Trust Commercial |
$4,567.42
|
| Rate for Payer: WPS Commercial |
$6,150.85
|
|
|
PLATE 8H/3H RT DISTAL RADIUS 04.110.430
|
Facility
|
IP
|
$7,985.00
|
|
| Hospital Charge Code |
2966785
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,069.16 |
| Max. Negotiated Rate |
$7,640.05 |
| Rate for Payer: Aetna Commercial |
$7,473.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,141.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,401.33
|
| Rate for Payer: Cash Price |
$2,395.50
|
| Rate for Payer: Cigna Commercial |
$7,640.05
|
| Rate for Payer: Health EOS Commercial |
$7,390.92
|
| Rate for Payer: HFN Commercial |
$7,640.05
|
| Rate for Payer: Multiplan Commercial |
$6,643.52
|
| Rate for Payer: Preferred Network Access Commercial |
$7,640.05
|
| Rate for Payer: Quartz Beloit One Network |
$4,069.16
|
| Rate for Payer: Quartz Commercial |
$4,982.64
|
| Rate for Payer: WEA Trust Commercial |
$4,567.42
|
| Rate for Payer: WPS Commercial |
$6,150.85
|
|
|
PLATE 8H/3H RT DISTAL RADIUS 04.110.430
|
Facility
|
OP
|
$7,985.00
|
|
| Hospital Charge Code |
2966785
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,325.23 |
| Max. Negotiated Rate |
$7,640.05 |
| Rate for Payer: Aetna Commercial |
$7,473.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,141.78
|
| Rate for Payer: Aetna Managed Medicare |
$2,325.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,397.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,152.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,986.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,401.33
|
| Rate for Payer: Cash Price |
$2,395.50
|
| Rate for Payer: Cigna Commercial |
$7,640.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,647.27
|
| Rate for Payer: Health EOS Commercial |
$7,390.92
|
| Rate for Payer: HFN Commercial |
$7,640.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,228.30
|
| Rate for Payer: Multiplan Commercial |
$6,643.52
|
| Rate for Payer: NAPHCARE Commercial |
$4,982.64
|
| Rate for Payer: Preferred Network Access Commercial |
$7,640.05
|
| Rate for Payer: Quartz Beloit One Network |
$4,069.16
|
| Rate for Payer: Quartz Commercial |
$5,397.86
|
| Rate for Payer: Quartz Medicare Advantage |
$4,982.64
|
| Rate for Payer: The Alliance Commercial |
$4,152.20
|
| Rate for Payer: WEA Trust Commercial |
$4,567.42
|
| Rate for Payer: WPS Commercial |
$6,150.85
|
|
|
PLATE 8H/4H LT DISTAL RADIUS 04.110.441
|
Facility
|
IP
|
$7,985.00
|
|
| Hospital Charge Code |
2966786
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,069.16 |
| Max. Negotiated Rate |
$7,640.05 |
| Rate for Payer: Aetna Commercial |
$7,473.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,141.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,401.33
|
| Rate for Payer: Cash Price |
$2,395.50
|
| Rate for Payer: Cigna Commercial |
$7,640.05
|
| Rate for Payer: Health EOS Commercial |
$7,390.92
|
| Rate for Payer: HFN Commercial |
$7,640.05
|
| Rate for Payer: Multiplan Commercial |
$6,643.52
|
| Rate for Payer: Preferred Network Access Commercial |
$7,640.05
|
| Rate for Payer: Quartz Beloit One Network |
$4,069.16
|
| Rate for Payer: Quartz Commercial |
$4,982.64
|
| Rate for Payer: WEA Trust Commercial |
$4,567.42
|
| Rate for Payer: WPS Commercial |
$6,150.85
|
|
|
PLATE 8H/4H LT DISTAL RADIUS 04.110.441
|
Facility
|
OP
|
$7,985.00
|
|
| Hospital Charge Code |
2966786
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,325.23 |
| Max. Negotiated Rate |
$7,640.05 |
| Rate for Payer: Aetna Commercial |
$7,473.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,141.78
|
| Rate for Payer: Aetna Managed Medicare |
$2,325.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,397.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,152.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,986.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,401.33
|
| Rate for Payer: Cash Price |
$2,395.50
|
| Rate for Payer: Cigna Commercial |
$7,640.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,647.27
|
| Rate for Payer: Health EOS Commercial |
$7,390.92
|
| Rate for Payer: HFN Commercial |
$7,640.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,228.30
|
| Rate for Payer: Multiplan Commercial |
$6,643.52
|
| Rate for Payer: NAPHCARE Commercial |
$4,982.64
|
| Rate for Payer: Preferred Network Access Commercial |
$7,640.05
|
| Rate for Payer: Quartz Beloit One Network |
$4,069.16
|
| Rate for Payer: Quartz Commercial |
$5,397.86
|
| Rate for Payer: Quartz Medicare Advantage |
$4,982.64
|
| Rate for Payer: The Alliance Commercial |
$4,152.20
|
| Rate for Payer: WEA Trust Commercial |
$4,567.42
|
| Rate for Payer: WPS Commercial |
$6,150.85
|
|
|
PLATE 8H/4H RT DISTAL RADIUS 04.110.440
|
Facility
|
IP
|
$7,985.00
|
|
| Hospital Charge Code |
2966787
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,069.16 |
| Max. Negotiated Rate |
$7,640.05 |
| Rate for Payer: Aetna Commercial |
$7,473.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,141.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,401.33
|
| Rate for Payer: Cash Price |
$2,395.50
|
| Rate for Payer: Cigna Commercial |
$7,640.05
|
| Rate for Payer: Health EOS Commercial |
$7,390.92
|
| Rate for Payer: HFN Commercial |
$7,640.05
|
| Rate for Payer: Multiplan Commercial |
$6,643.52
|
| Rate for Payer: Preferred Network Access Commercial |
$7,640.05
|
| Rate for Payer: Quartz Beloit One Network |
$4,069.16
|
| Rate for Payer: Quartz Commercial |
$4,982.64
|
| Rate for Payer: WEA Trust Commercial |
$4,567.42
|
| Rate for Payer: WPS Commercial |
$6,150.85
|
|
|
PLATE 8H/4H RT DISTAL RADIUS 04.110.440
|
Facility
|
OP
|
$7,985.00
|
|
| Hospital Charge Code |
2966787
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,325.23 |
| Max. Negotiated Rate |
$7,640.05 |
| Rate for Payer: Quartz Beloit One Network |
$4,069.16
|
| 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 Commercial |
$5,397.86
|
| Rate for Payer: Quartz Medicare Advantage |
$4,982.64
|
| Rate for Payer: The Alliance Commercial |
$4,152.20
|
| Rate for Payer: WEA Trust Commercial |
$4,567.42
|
| Rate for Payer: WPS Commercial |
$6,150.85
|
|
|
PLATE 8H/5H LT DISTAL RADIUS 04.110.451
|
Facility
|
IP
|
$7,985.00
|
|
| Hospital Charge Code |
2966788
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,069.16 |
| Max. Negotiated Rate |
$7,640.05 |
| Rate for Payer: Aetna Commercial |
$7,473.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,141.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,401.33
|
| Rate for Payer: Cash Price |
$2,395.50
|
| Rate for Payer: Cigna Commercial |
$7,640.05
|
| Rate for Payer: Health EOS Commercial |
$7,390.92
|
| Rate for Payer: HFN Commercial |
$7,640.05
|
| Rate for Payer: Multiplan Commercial |
$6,643.52
|
| Rate for Payer: Preferred Network Access Commercial |
$7,640.05
|
| Rate for Payer: Quartz Beloit One Network |
$4,069.16
|
| Rate for Payer: Quartz Commercial |
$4,982.64
|
| Rate for Payer: WEA Trust Commercial |
$4,567.42
|
| Rate for Payer: WPS Commercial |
$6,150.85
|
|
|
PLATE 8H/5H LT DISTAL RADIUS 04.110.451
|
Facility
|
OP
|
$7,985.00
|
|
| Hospital Charge Code |
2966788
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,325.23 |
| Max. Negotiated Rate |
$7,640.05 |
| Rate for Payer: Aetna Commercial |
$7,473.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,141.78
|
| Rate for Payer: Aetna Managed Medicare |
$2,325.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,397.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,152.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,986.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,401.33
|
| Rate for Payer: Cash Price |
$2,395.50
|
| Rate for Payer: Cigna Commercial |
$7,640.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,647.27
|
| Rate for Payer: Health EOS Commercial |
$7,390.92
|
| Rate for Payer: HFN Commercial |
$7,640.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,228.30
|
| Rate for Payer: Multiplan Commercial |
$6,643.52
|
| Rate for Payer: NAPHCARE Commercial |
$4,982.64
|
| Rate for Payer: Preferred Network Access Commercial |
$7,640.05
|
| Rate for Payer: Quartz Beloit One Network |
$4,069.16
|
| Rate for Payer: Quartz Commercial |
$5,397.86
|
| Rate for Payer: Quartz Medicare Advantage |
$4,982.64
|
| Rate for Payer: The Alliance Commercial |
$4,152.20
|
| Rate for Payer: WEA Trust Commercial |
$4,567.42
|
| Rate for Payer: WPS Commercial |
$6,150.85
|
|
|
PLATE 8H/5H RT DISTAL RADIUS 04.110.450
|
Facility
|
IP
|
$7,985.00
|
|
| Hospital Charge Code |
2966789
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,069.16 |
| Max. Negotiated Rate |
$7,640.05 |
| Rate for Payer: Aetna Commercial |
$7,473.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,141.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,401.33
|
| Rate for Payer: Cash Price |
$2,395.50
|
| Rate for Payer: Cigna Commercial |
$7,640.05
|
| Rate for Payer: Health EOS Commercial |
$7,390.92
|
| Rate for Payer: HFN Commercial |
$7,640.05
|
| Rate for Payer: Multiplan Commercial |
$6,643.52
|
| Rate for Payer: Preferred Network Access Commercial |
$7,640.05
|
| Rate for Payer: Quartz Beloit One Network |
$4,069.16
|
| Rate for Payer: Quartz Commercial |
$4,982.64
|
| Rate for Payer: WEA Trust Commercial |
$4,567.42
|
| Rate for Payer: WPS Commercial |
$6,150.85
|
|
|
PLATE 8H/5H RT DISTAL RADIUS 04.110.450
|
Facility
|
OP
|
$7,985.00
|
|
| Hospital Charge Code |
2966789
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,325.23 |
| Max. Negotiated Rate |
$7,640.05 |
| Rate for Payer: Aetna Commercial |
$7,473.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,141.78
|
| Rate for Payer: Aetna Managed Medicare |
$2,325.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,397.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,152.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,986.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,401.33
|
| Rate for Payer: Cash Price |
$2,395.50
|
| Rate for Payer: Cigna Commercial |
$7,640.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,647.27
|
| Rate for Payer: Health EOS Commercial |
$7,390.92
|
| Rate for Payer: HFN Commercial |
$7,640.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,228.30
|
| Rate for Payer: Multiplan Commercial |
$6,643.52
|
| Rate for Payer: NAPHCARE Commercial |
$4,982.64
|
| Rate for Payer: Preferred Network Access Commercial |
$7,640.05
|
| Rate for Payer: Quartz Beloit One Network |
$4,069.16
|
| Rate for Payer: Quartz Commercial |
$5,397.86
|
| Rate for Payer: Quartz Medicare Advantage |
$4,982.64
|
| Rate for Payer: The Alliance Commercial |
$4,152.20
|
| Rate for Payer: WEA Trust Commercial |
$4,567.42
|
| Rate for Payer: WPS Commercial |
$6,150.85
|
|
|
PLATE 8HL 3.5 RT M/D/T 239.908
|
Facility
|
OP
|
$7,458.00
|
|
| Hospital Charge Code |
2966745
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,171.77 |
| Max. Negotiated Rate |
$7,135.81 |
| Rate for Payer: Aetna Commercial |
$6,980.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,670.44
|
| Rate for Payer: Aetna Managed Medicare |
$2,171.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,041.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,878.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,723.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,110.85
|
| Rate for Payer: Cash Price |
$2,237.40
|
| Rate for Payer: Cigna Commercial |
$7,135.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,340.56
|
| Rate for Payer: Health EOS Commercial |
$6,903.12
|
| Rate for Payer: HFN Commercial |
$7,135.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,817.24
|
| Rate for Payer: Multiplan Commercial |
$6,205.06
|
| Rate for Payer: NAPHCARE Commercial |
$4,653.79
|
| Rate for Payer: Preferred Network Access Commercial |
$7,135.81
|
| Rate for Payer: Quartz Beloit One Network |
$3,800.60
|
| Rate for Payer: Quartz Commercial |
$5,041.61
|
| Rate for Payer: Quartz Medicare Advantage |
$4,653.79
|
| Rate for Payer: The Alliance Commercial |
$3,878.16
|
| Rate for Payer: WEA Trust Commercial |
$4,265.98
|
| Rate for Payer: WPS Commercial |
$5,744.90
|
|
|
PLATE 8HL 3.5 RT M/D/T 239.908
|
Facility
|
IP
|
$7,458.00
|
|
| Hospital Charge Code |
2966745
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,800.60 |
| Max. Negotiated Rate |
$7,135.81 |
| Rate for Payer: Aetna Commercial |
$6,980.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,670.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,110.85
|
| Rate for Payer: Cash Price |
$2,237.40
|
| Rate for Payer: Cigna Commercial |
$7,135.81
|
| Rate for Payer: Health EOS Commercial |
$6,903.12
|
| Rate for Payer: HFN Commercial |
$7,135.81
|
| Rate for Payer: Multiplan Commercial |
$6,205.06
|
| Rate for Payer: Preferred Network Access Commercial |
$7,135.81
|
| Rate for Payer: Quartz Beloit One Network |
$3,800.60
|
| Rate for Payer: Quartz Commercial |
$4,653.79
|
| Rate for Payer: WEA Trust Commercial |
$4,265.98
|
| Rate for Payer: WPS Commercial |
$5,744.90
|
|
|
PLATE 8HL LEFT MEDIAL DISTAL
|
Facility
|
OP
|
$9,255.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966359
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,695.06 |
| Max. Negotiated Rate |
$8,855.18 |
| Rate for Payer: Aetna Commercial |
$8,662.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,277.67
|
| Rate for Payer: Aetna Managed Medicare |
$2,695.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,256.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,812.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,620.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,101.36
|
| Rate for Payer: Cash Price |
$2,776.50
|
| Rate for Payer: Cigna Commercial |
$8,855.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,386.41
|
| Rate for Payer: Health EOS Commercial |
$8,566.43
|
| Rate for Payer: HFN Commercial |
$8,855.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,218.90
|
| Rate for Payer: Multiplan Commercial |
$7,700.16
|
| Rate for Payer: NAPHCARE Commercial |
$5,775.12
|
| Rate for Payer: Preferred Network Access Commercial |
$8,855.18
|
| Rate for Payer: Quartz Beloit One Network |
$4,716.35
|
| Rate for Payer: Quartz Commercial |
$6,256.38
|
| Rate for Payer: Quartz Medicare Advantage |
$5,775.12
|
| Rate for Payer: The Alliance Commercial |
$4,812.60
|
| Rate for Payer: WEA Trust Commercial |
$5,293.86
|
| Rate for Payer: WPS Commercial |
$7,129.13
|
|
|
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
|
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 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 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 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 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
|
|
