|
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 |
$1,103.97 |
| Max. Negotiated Rate |
$2,072.76 |
| Rate for Payer: Aetna Commercial |
$2,027.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,937.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,194.09
|
| Rate for Payer: Cash Price |
$675.90
|
| Rate for Payer: Cigna Commercial |
$2,072.76
|
| Rate for Payer: Health EOS Commercial |
$2,005.17
|
| Rate for Payer: HFN Commercial |
$2,072.76
|
| Rate for Payer: Multiplan Commercial |
$1,802.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,351.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,072.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,103.97
|
| Rate for Payer: Quartz Commercial |
$1,351.80
|
| Rate for Payer: WEA Trust Commercial |
$1,239.15
|
| Rate for Payer: WPS Commercial |
$1,668.80
|
|
|
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 |
$630.84 |
| Max. Negotiated Rate |
$9,012.00 |
| Rate for Payer: Aetna Commercial |
$2,027.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,937.58
|
| Rate for Payer: Aetna Managed Medicare |
$630.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,464.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,126.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,081.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,194.09
|
| Rate for Payer: Cash Price |
$675.90
|
| Rate for Payer: Cigna Commercial |
$2,072.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,260.78
|
| Rate for Payer: Health EOS Commercial |
$2,005.17
|
| Rate for Payer: HFN Commercial |
$2,072.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,689.75
|
| Rate for Payer: Multiplan Commercial |
$1,802.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,351.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,072.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,103.97
|
| Rate for Payer: Quartz Commercial |
$1,464.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,351.80
|
| Rate for Payer: The Alliance Commercial |
$9,012.00
|
| Rate for Payer: WEA Trust Commercial |
$1,239.15
|
| Rate for Payer: WPS Commercial |
$1,668.80
|
|
|
PLATE 7HL LT LCP DISTAL FEMUR
|
Facility
|
IP
|
$10,912.00
|
|
| Hospital Charge Code |
2966357
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,346.88 |
| Max. Negotiated Rate |
$10,039.04 |
| Rate for Payer: Aetna Commercial |
$9,820.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,384.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,783.36
|
| Rate for Payer: Cash Price |
$3,273.60
|
| Rate for Payer: Cigna Commercial |
$10,039.04
|
| Rate for Payer: Health EOS Commercial |
$9,711.68
|
| Rate for Payer: HFN Commercial |
$10,039.04
|
| Rate for Payer: Multiplan Commercial |
$8,729.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,547.20
|
| Rate for Payer: Preferred Network Access Commercial |
$10,039.04
|
| Rate for Payer: Quartz Beloit One Network |
$5,346.88
|
| Rate for Payer: Quartz Commercial |
$6,547.20
|
| Rate for Payer: WEA Trust Commercial |
$6,001.60
|
| Rate for Payer: WPS Commercial |
$8,082.52
|
|
|
PLATE 7HL LT LCP DISTAL FEMUR
|
Facility
|
OP
|
$10,912.00
|
|
| Hospital Charge Code |
2966357
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,055.36 |
| Max. Negotiated Rate |
$43,648.00 |
| Rate for Payer: Aetna Commercial |
$9,820.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,384.32
|
| Rate for Payer: Aetna Managed Medicare |
$3,055.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,092.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,456.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,237.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,783.36
|
| Rate for Payer: Cash Price |
$3,273.60
|
| Rate for Payer: Cigna Commercial |
$10,039.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,106.36
|
| Rate for Payer: Health EOS Commercial |
$9,711.68
|
| Rate for Payer: HFN Commercial |
$10,039.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,184.00
|
| Rate for Payer: Multiplan Commercial |
$8,729.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,547.20
|
| Rate for Payer: Preferred Network Access Commercial |
$10,039.04
|
| Rate for Payer: Quartz Beloit One Network |
$5,346.88
|
| Rate for Payer: Quartz Commercial |
$7,092.80
|
| Rate for Payer: Quartz Medicare Advantage |
$6,547.20
|
| Rate for Payer: The Alliance Commercial |
$43,648.00
|
| Rate for Payer: WEA Trust Commercial |
$6,001.60
|
| Rate for Payer: WPS Commercial |
$8,082.52
|
|
|
PLATE 7HL RT DISTAL FEMUR
|
Facility
|
OP
|
$10,886.00
|
|
| Hospital Charge Code |
2966358
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,048.08 |
| Max. Negotiated Rate |
$43,544.00 |
| Rate for Payer: Aetna Commercial |
$9,797.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,361.96
|
| Rate for Payer: Aetna Managed Medicare |
$3,048.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,075.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,443.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,225.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,769.58
|
| Rate for Payer: Cash Price |
$3,265.80
|
| Rate for Payer: Cigna Commercial |
$10,015.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,091.81
|
| Rate for Payer: Health EOS Commercial |
$9,688.54
|
| Rate for Payer: HFN Commercial |
$10,015.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,164.50
|
| Rate for Payer: Multiplan Commercial |
$8,708.80
|
| Rate for Payer: NAPHCARE Commercial |
$6,531.60
|
| Rate for Payer: Preferred Network Access Commercial |
$10,015.12
|
| Rate for Payer: Quartz Beloit One Network |
$5,334.14
|
| Rate for Payer: Quartz Commercial |
$7,075.90
|
| Rate for Payer: Quartz Medicare Advantage |
$6,531.60
|
| Rate for Payer: The Alliance Commercial |
$43,544.00
|
| Rate for Payer: WEA Trust Commercial |
$5,987.30
|
| Rate for Payer: WPS Commercial |
$8,063.26
|
|
|
PLATE 7HL RT DISTAL FEMUR
|
Facility
|
IP
|
$10,886.00
|
|
| Hospital Charge Code |
2966358
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,334.14 |
| Max. Negotiated Rate |
$10,015.12 |
| Rate for Payer: Aetna Commercial |
$9,797.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,361.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,769.58
|
| Rate for Payer: Cash Price |
$3,265.80
|
| Rate for Payer: Cigna Commercial |
$10,015.12
|
| Rate for Payer: Health EOS Commercial |
$9,688.54
|
| Rate for Payer: HFN Commercial |
$10,015.12
|
| Rate for Payer: Multiplan Commercial |
$8,708.80
|
| Rate for Payer: NAPHCARE Commercial |
$6,531.60
|
| Rate for Payer: Preferred Network Access Commercial |
$10,015.12
|
| Rate for Payer: Quartz Beloit One Network |
$5,334.14
|
| Rate for Payer: Quartz Commercial |
$6,531.60
|
| Rate for Payer: WEA Trust Commercial |
$5,987.30
|
| Rate for Payer: WPS Commercial |
$8,063.26
|
|
|
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 |
$715.89 |
| Max. Negotiated Rate |
$1,344.12 |
| Rate for Payer: Aetna Commercial |
$1,314.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,256.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$774.33
|
| Rate for Payer: Cash Price |
$438.30
|
| Rate for Payer: Cigna Commercial |
$1,344.12
|
| Rate for Payer: Health EOS Commercial |
$1,300.29
|
| Rate for Payer: HFN Commercial |
$1,344.12
|
| Rate for Payer: Multiplan Commercial |
$1,168.80
|
| Rate for Payer: NAPHCARE Commercial |
$876.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,344.12
|
| Rate for Payer: Quartz Beloit One Network |
$715.89
|
| Rate for Payer: Quartz Commercial |
$876.60
|
| Rate for Payer: WEA Trust Commercial |
$803.55
|
| Rate for Payer: WPS Commercial |
$1,082.16
|
|
|
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 |
$409.08 |
| Max. Negotiated Rate |
$5,844.00 |
| Rate for Payer: Aetna Commercial |
$1,314.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,256.46
|
| Rate for Payer: Aetna Managed Medicare |
$409.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$949.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$730.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$701.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$774.33
|
| Rate for Payer: Cash Price |
$438.30
|
| Rate for Payer: Cigna Commercial |
$1,344.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$817.58
|
| Rate for Payer: Health EOS Commercial |
$1,300.29
|
| Rate for Payer: HFN Commercial |
$1,344.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,095.75
|
| Rate for Payer: Multiplan Commercial |
$1,168.80
|
| Rate for Payer: NAPHCARE Commercial |
$876.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,344.12
|
| Rate for Payer: Quartz Beloit One Network |
$715.89
|
| Rate for Payer: Quartz Commercial |
$949.65
|
| Rate for Payer: Quartz Medicare Advantage |
$876.60
|
| Rate for Payer: The Alliance Commercial |
$5,844.00
|
| Rate for Payer: WEA Trust Commercial |
$803.55
|
| Rate for Payer: WPS Commercial |
$1,082.16
|
|
|
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 |
$657.16 |
| Max. Negotiated Rate |
$9,388.00 |
| Rate for Payer: Aetna Commercial |
$2,112.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,018.42
|
| Rate for Payer: Aetna Managed Medicare |
$657.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,525.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,173.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,126.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,243.91
|
| Rate for Payer: Cash Price |
$704.10
|
| Rate for Payer: Cigna Commercial |
$2,159.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,313.38
|
| Rate for Payer: Health EOS Commercial |
$2,088.83
|
| Rate for Payer: HFN Commercial |
$2,159.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,760.25
|
| Rate for Payer: Multiplan Commercial |
$1,877.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,408.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,159.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,150.03
|
| Rate for Payer: Quartz Commercial |
$1,525.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,408.20
|
| Rate for Payer: The Alliance Commercial |
$9,388.00
|
| Rate for Payer: WEA Trust Commercial |
$1,290.85
|
| Rate for Payer: WPS Commercial |
$1,738.42
|
|
|
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 |
$1,150.03 |
| Max. Negotiated Rate |
$2,159.24 |
| Rate for Payer: Aetna Commercial |
$2,112.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,018.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,243.91
|
| Rate for Payer: Cash Price |
$704.10
|
| Rate for Payer: Cigna Commercial |
$2,159.24
|
| Rate for Payer: Health EOS Commercial |
$2,088.83
|
| Rate for Payer: HFN Commercial |
$2,159.24
|
| Rate for Payer: Multiplan Commercial |
$1,877.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,408.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,159.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,150.03
|
| Rate for Payer: Quartz Commercial |
$1,408.20
|
| Rate for Payer: WEA Trust Commercial |
$1,290.85
|
| Rate for Payer: WPS Commercial |
$1,738.42
|
|
|
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 |
$3,912.65 |
| Max. Negotiated Rate |
$7,346.20 |
| Rate for Payer: Aetna Commercial |
$7,186.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,867.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,232.05
|
| Rate for Payer: Cash Price |
$2,395.50
|
| Rate for Payer: Cigna Commercial |
$7,346.20
|
| Rate for Payer: Health EOS Commercial |
$7,106.65
|
| Rate for Payer: HFN Commercial |
$7,346.20
|
| Rate for Payer: Multiplan Commercial |
$6,388.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,791.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,346.20
|
| Rate for Payer: Quartz Beloit One Network |
$3,912.65
|
| Rate for Payer: Quartz Commercial |
$4,791.00
|
| Rate for Payer: WEA Trust Commercial |
$4,391.75
|
| Rate for Payer: WPS Commercial |
$5,914.49
|
|
|
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 |
$2,235.80 |
| Max. Negotiated Rate |
$31,940.00 |
| Rate for Payer: Aetna Commercial |
$7,186.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,867.10
|
| Rate for Payer: Aetna Managed Medicare |
$2,235.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,190.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,992.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,832.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,232.05
|
| Rate for Payer: Cash Price |
$2,395.50
|
| Rate for Payer: Cigna Commercial |
$7,346.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,468.41
|
| Rate for Payer: Health EOS Commercial |
$7,106.65
|
| Rate for Payer: HFN Commercial |
$7,346.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,988.75
|
| Rate for Payer: Multiplan Commercial |
$6,388.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,791.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,346.20
|
| Rate for Payer: Quartz Beloit One Network |
$3,912.65
|
| Rate for Payer: Quartz Commercial |
$5,190.25
|
| Rate for Payer: Quartz Medicare Advantage |
$4,791.00
|
| Rate for Payer: The Alliance Commercial |
$31,940.00
|
| Rate for Payer: WEA Trust Commercial |
$4,391.75
|
| Rate for Payer: WPS Commercial |
$5,914.49
|
|
|
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 |
$3,912.65 |
| Max. Negotiated Rate |
$7,346.20 |
| Rate for Payer: Aetna Commercial |
$7,186.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,867.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,232.05
|
| Rate for Payer: Cash Price |
$2,395.50
|
| Rate for Payer: Cigna Commercial |
$7,346.20
|
| Rate for Payer: Health EOS Commercial |
$7,106.65
|
| Rate for Payer: HFN Commercial |
$7,346.20
|
| Rate for Payer: Multiplan Commercial |
$6,388.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,791.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,346.20
|
| Rate for Payer: Quartz Beloit One Network |
$3,912.65
|
| Rate for Payer: Quartz Commercial |
$4,791.00
|
| Rate for Payer: WEA Trust Commercial |
$4,391.75
|
| Rate for Payer: WPS Commercial |
$5,914.49
|
|
|
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 |
$2,235.80 |
| Max. Negotiated Rate |
$31,940.00 |
| Rate for Payer: Aetna Commercial |
$7,186.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,867.10
|
| Rate for Payer: Aetna Managed Medicare |
$2,235.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,190.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,992.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,832.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,232.05
|
| Rate for Payer: Cash Price |
$2,395.50
|
| Rate for Payer: Cigna Commercial |
$7,346.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,468.41
|
| Rate for Payer: Health EOS Commercial |
$7,106.65
|
| Rate for Payer: HFN Commercial |
$7,346.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,988.75
|
| Rate for Payer: Multiplan Commercial |
$6,388.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,791.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,346.20
|
| Rate for Payer: Quartz Beloit One Network |
$3,912.65
|
| Rate for Payer: Quartz Commercial |
$5,190.25
|
| Rate for Payer: Quartz Medicare Advantage |
$4,791.00
|
| Rate for Payer: The Alliance Commercial |
$31,940.00
|
| Rate for Payer: WEA Trust Commercial |
$4,391.75
|
| Rate for Payer: WPS Commercial |
$5,914.49
|
|
|
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 |
$2,235.80 |
| Max. Negotiated Rate |
$31,940.00 |
| Rate for Payer: Aetna Commercial |
$7,186.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,867.10
|
| Rate for Payer: Aetna Managed Medicare |
$2,235.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,190.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,992.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,832.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,232.05
|
| Rate for Payer: Cash Price |
$2,395.50
|
| Rate for Payer: Cigna Commercial |
$7,346.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,468.41
|
| Rate for Payer: Health EOS Commercial |
$7,106.65
|
| Rate for Payer: HFN Commercial |
$7,346.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,988.75
|
| Rate for Payer: Multiplan Commercial |
$6,388.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,791.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,346.20
|
| Rate for Payer: Quartz Beloit One Network |
$3,912.65
|
| Rate for Payer: Quartz Commercial |
$5,190.25
|
| Rate for Payer: Quartz Medicare Advantage |
$4,791.00
|
| Rate for Payer: The Alliance Commercial |
$31,940.00
|
| Rate for Payer: WEA Trust Commercial |
$4,391.75
|
| Rate for Payer: WPS Commercial |
$5,914.49
|
|
|
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 |
$3,912.65 |
| Max. Negotiated Rate |
$7,346.20 |
| Rate for Payer: Aetna Commercial |
$7,186.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,867.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,232.05
|
| Rate for Payer: Cash Price |
$2,395.50
|
| Rate for Payer: Cigna Commercial |
$7,346.20
|
| Rate for Payer: Health EOS Commercial |
$7,106.65
|
| Rate for Payer: HFN Commercial |
$7,346.20
|
| Rate for Payer: Multiplan Commercial |
$6,388.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,791.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,346.20
|
| Rate for Payer: Quartz Beloit One Network |
$3,912.65
|
| Rate for Payer: Quartz Commercial |
$4,791.00
|
| Rate for Payer: WEA Trust Commercial |
$4,391.75
|
| Rate for Payer: WPS Commercial |
$5,914.49
|
|
|
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 |
$3,912.65 |
| Max. Negotiated Rate |
$7,346.20 |
| Rate for Payer: Aetna Commercial |
$7,186.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,867.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,232.05
|
| Rate for Payer: Cash Price |
$2,395.50
|
| Rate for Payer: Cigna Commercial |
$7,346.20
|
| Rate for Payer: Health EOS Commercial |
$7,106.65
|
| Rate for Payer: HFN Commercial |
$7,346.20
|
| Rate for Payer: Multiplan Commercial |
$6,388.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,791.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,346.20
|
| Rate for Payer: Quartz Beloit One Network |
$3,912.65
|
| Rate for Payer: Quartz Commercial |
$4,791.00
|
| Rate for Payer: WEA Trust Commercial |
$4,391.75
|
| Rate for Payer: WPS Commercial |
$5,914.49
|
|
|
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 |
$2,235.80 |
| Max. Negotiated Rate |
$31,940.00 |
| Rate for Payer: Aetna Commercial |
$7,186.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,867.10
|
| Rate for Payer: Aetna Managed Medicare |
$2,235.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,190.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,992.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,832.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,232.05
|
| Rate for Payer: Cash Price |
$2,395.50
|
| Rate for Payer: Cigna Commercial |
$7,346.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,468.41
|
| Rate for Payer: Health EOS Commercial |
$7,106.65
|
| Rate for Payer: HFN Commercial |
$7,346.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,988.75
|
| Rate for Payer: Multiplan Commercial |
$6,388.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,791.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,346.20
|
| Rate for Payer: Quartz Beloit One Network |
$3,912.65
|
| Rate for Payer: Quartz Commercial |
$5,190.25
|
| Rate for Payer: Quartz Medicare Advantage |
$4,791.00
|
| Rate for Payer: The Alliance Commercial |
$31,940.00
|
| Rate for Payer: WEA Trust Commercial |
$4,391.75
|
| Rate for Payer: WPS Commercial |
$5,914.49
|
|
|
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 |
$2,235.80 |
| Max. Negotiated Rate |
$31,940.00 |
| Rate for Payer: Aetna Commercial |
$7,186.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,867.10
|
| Rate for Payer: Aetna Managed Medicare |
$2,235.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,190.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,992.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,832.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,232.05
|
| Rate for Payer: Cash Price |
$2,395.50
|
| Rate for Payer: Cigna Commercial |
$7,346.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,468.41
|
| Rate for Payer: Health EOS Commercial |
$7,106.65
|
| Rate for Payer: HFN Commercial |
$7,346.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,988.75
|
| Rate for Payer: Multiplan Commercial |
$6,388.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,791.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,346.20
|
| Rate for Payer: Quartz Beloit One Network |
$3,912.65
|
| Rate for Payer: Quartz Commercial |
$5,190.25
|
| Rate for Payer: Quartz Medicare Advantage |
$4,791.00
|
| Rate for Payer: The Alliance Commercial |
$31,940.00
|
| Rate for Payer: WEA Trust Commercial |
$4,391.75
|
| Rate for Payer: WPS Commercial |
$5,914.49
|
|
|
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 |
$3,912.65 |
| Max. Negotiated Rate |
$7,346.20 |
| Rate for Payer: Aetna Commercial |
$7,186.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,867.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,232.05
|
| Rate for Payer: Cash Price |
$2,395.50
|
| Rate for Payer: Cigna Commercial |
$7,346.20
|
| Rate for Payer: Health EOS Commercial |
$7,106.65
|
| Rate for Payer: HFN Commercial |
$7,346.20
|
| Rate for Payer: Multiplan Commercial |
$6,388.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,791.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,346.20
|
| Rate for Payer: Quartz Beloit One Network |
$3,912.65
|
| Rate for Payer: Quartz Commercial |
$4,791.00
|
| Rate for Payer: WEA Trust Commercial |
$4,391.75
|
| Rate for Payer: WPS Commercial |
$5,914.49
|
|
|
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 |
$2,235.80 |
| Max. Negotiated Rate |
$31,940.00 |
| Rate for Payer: Aetna Commercial |
$7,186.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,867.10
|
| Rate for Payer: Aetna Managed Medicare |
$2,235.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,190.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,992.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,832.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,232.05
|
| Rate for Payer: Cash Price |
$2,395.50
|
| Rate for Payer: Cigna Commercial |
$7,346.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,468.41
|
| Rate for Payer: Health EOS Commercial |
$7,106.65
|
| Rate for Payer: HFN Commercial |
$7,346.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,988.75
|
| Rate for Payer: Multiplan Commercial |
$6,388.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,791.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,346.20
|
| Rate for Payer: Quartz Beloit One Network |
$3,912.65
|
| Rate for Payer: Quartz Commercial |
$5,190.25
|
| Rate for Payer: Quartz Medicare Advantage |
$4,791.00
|
| Rate for Payer: The Alliance Commercial |
$31,940.00
|
| Rate for Payer: WEA Trust Commercial |
$4,391.75
|
| Rate for Payer: WPS Commercial |
$5,914.49
|
|
|
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 |
$3,912.65 |
| Max. Negotiated Rate |
$7,346.20 |
| Rate for Payer: Aetna Commercial |
$7,186.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,867.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,232.05
|
| Rate for Payer: Cash Price |
$2,395.50
|
| Rate for Payer: Cigna Commercial |
$7,346.20
|
| Rate for Payer: Health EOS Commercial |
$7,106.65
|
| Rate for Payer: HFN Commercial |
$7,346.20
|
| Rate for Payer: Multiplan Commercial |
$6,388.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,791.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,346.20
|
| Rate for Payer: Quartz Beloit One Network |
$3,912.65
|
| Rate for Payer: Quartz Commercial |
$4,791.00
|
| Rate for Payer: WEA Trust Commercial |
$4,391.75
|
| Rate for Payer: WPS Commercial |
$5,914.49
|
|
|
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 |
$3,654.42 |
| Max. Negotiated Rate |
$6,861.36 |
| Rate for Payer: Aetna Commercial |
$6,712.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,413.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,952.74
|
| Rate for Payer: Cash Price |
$2,237.40
|
| Rate for Payer: Cigna Commercial |
$6,861.36
|
| Rate for Payer: Health EOS Commercial |
$6,637.62
|
| Rate for Payer: HFN Commercial |
$6,861.36
|
| Rate for Payer: Multiplan Commercial |
$5,966.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,474.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,861.36
|
| Rate for Payer: Quartz Beloit One Network |
$3,654.42
|
| Rate for Payer: Quartz Commercial |
$4,474.80
|
| Rate for Payer: WEA Trust Commercial |
$4,101.90
|
| Rate for Payer: WPS Commercial |
$5,524.14
|
|
|
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 |
$2,088.24 |
| Max. Negotiated Rate |
$29,832.00 |
| Rate for Payer: Aetna Commercial |
$6,712.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,413.88
|
| Rate for Payer: Aetna Managed Medicare |
$2,088.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,847.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,729.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,579.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,952.74
|
| Rate for Payer: Cash Price |
$2,237.40
|
| Rate for Payer: Cigna Commercial |
$6,861.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,173.50
|
| Rate for Payer: Health EOS Commercial |
$6,637.62
|
| Rate for Payer: HFN Commercial |
$6,861.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,593.50
|
| Rate for Payer: Multiplan Commercial |
$5,966.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,474.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,861.36
|
| Rate for Payer: Quartz Beloit One Network |
$3,654.42
|
| Rate for Payer: Quartz Commercial |
$4,847.70
|
| Rate for Payer: Quartz Medicare Advantage |
$4,474.80
|
| Rate for Payer: The Alliance Commercial |
$29,832.00
|
| Rate for Payer: WEA Trust Commercial |
$4,101.90
|
| Rate for Payer: WPS Commercial |
$5,524.14
|
|
|
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 |
$2,591.40 |
| Max. Negotiated Rate |
$37,020.00 |
| Rate for Payer: Aetna Commercial |
$8,329.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,959.30
|
| Rate for Payer: Aetna Managed Medicare |
$2,591.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,015.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,627.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,442.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,905.15
|
| Rate for Payer: Cash Price |
$2,776.50
|
| Rate for Payer: Cigna Commercial |
$8,514.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,179.10
|
| Rate for Payer: Health EOS Commercial |
$8,236.95
|
| Rate for Payer: HFN Commercial |
$8,514.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,941.25
|
| Rate for Payer: Multiplan Commercial |
$7,404.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,553.00
|
| Rate for Payer: Preferred Network Access Commercial |
$8,514.60
|
| Rate for Payer: Quartz Beloit One Network |
$4,534.95
|
| Rate for Payer: Quartz Commercial |
$6,015.75
|
| Rate for Payer: Quartz Medicare Advantage |
$5,553.00
|
| Rate for Payer: The Alliance Commercial |
$37,020.00
|
| Rate for Payer: WEA Trust Commercial |
$5,090.25
|
| Rate for Payer: WPS Commercial |
$6,855.18
|
|
