|
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 |
$4,534.95 |
| Max. Negotiated Rate |
$8,514.60 |
| Rate for Payer: Aetna Commercial |
$8,329.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,959.30
|
| 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: Health EOS Commercial |
$8,236.95
|
| Rate for Payer: HFN Commercial |
$8,514.60
|
| 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 |
$5,553.00
|
| Rate for Payer: WEA Trust Commercial |
$5,090.25
|
| Rate for Payer: WPS Commercial |
$6,855.18
|
|
|
PLATE 8HL LG LFT CLAVICLE
|
Facility
|
IP
|
$6,468.00
|
|
| Hospital Charge Code |
2964145
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,169.32 |
| Max. Negotiated Rate |
$5,950.56 |
| Rate for Payer: Aetna Commercial |
$5,821.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,562.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,428.04
|
| Rate for Payer: Cash Price |
$1,940.40
|
| Rate for Payer: Cigna Commercial |
$5,950.56
|
| Rate for Payer: Health EOS Commercial |
$5,756.52
|
| Rate for Payer: HFN Commercial |
$5,950.56
|
| Rate for Payer: Multiplan Commercial |
$5,174.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,880.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,950.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,169.32
|
| Rate for Payer: Quartz Commercial |
$3,880.80
|
| Rate for Payer: WEA Trust Commercial |
$3,557.40
|
| Rate for Payer: WPS Commercial |
$4,790.85
|
|
|
PLATE 8HL LG LFT CLAVICLE
|
Facility
|
OP
|
$6,468.00
|
|
| Hospital Charge Code |
2964145
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,811.04 |
| Max. Negotiated Rate |
$25,872.00 |
| Rate for Payer: Aetna Commercial |
$5,821.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,562.48
|
| Rate for Payer: Aetna Managed Medicare |
$1,811.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,204.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,234.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,104.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,428.04
|
| Rate for Payer: Cash Price |
$1,940.40
|
| Rate for Payer: Cigna Commercial |
$5,950.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,619.49
|
| Rate for Payer: Health EOS Commercial |
$5,756.52
|
| Rate for Payer: HFN Commercial |
$5,950.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,851.00
|
| Rate for Payer: Multiplan Commercial |
$5,174.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,880.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,950.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,169.32
|
| Rate for Payer: Quartz Commercial |
$4,204.20
|
| Rate for Payer: Quartz Medicare Advantage |
$3,880.80
|
| Rate for Payer: The Alliance Commercial |
$25,872.00
|
| Rate for Payer: WEA Trust Commercial |
$3,557.40
|
| Rate for Payer: WPS Commercial |
$4,790.85
|
|
|
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 |
$2,744.28 |
| Max. Negotiated Rate |
$39,204.00 |
| Rate for Payer: Aetna Commercial |
$8,820.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,428.86
|
| Rate for Payer: Aetna Managed Medicare |
$2,744.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,370.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,900.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,704.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,194.53
|
| Rate for Payer: Cash Price |
$2,940.30
|
| Rate for Payer: Cigna Commercial |
$9,016.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,484.64
|
| Rate for Payer: Health EOS Commercial |
$8,722.89
|
| Rate for Payer: HFN Commercial |
$9,016.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,350.75
|
| Rate for Payer: Multiplan Commercial |
$7,840.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,880.60
|
| Rate for Payer: Preferred Network Access Commercial |
$9,016.92
|
| Rate for Payer: Quartz Beloit One Network |
$4,802.49
|
| Rate for Payer: Quartz Commercial |
$6,370.65
|
| Rate for Payer: Quartz Medicare Advantage |
$5,880.60
|
| Rate for Payer: The Alliance Commercial |
$39,204.00
|
| Rate for Payer: WEA Trust Commercial |
$5,390.55
|
| Rate for Payer: WPS Commercial |
$7,259.60
|
|
|
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 |
$4,802.49 |
| Max. Negotiated Rate |
$9,016.92 |
| Rate for Payer: Aetna Commercial |
$8,820.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,428.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,194.53
|
| Rate for Payer: Cash Price |
$2,940.30
|
| Rate for Payer: Cigna Commercial |
$9,016.92
|
| Rate for Payer: Health EOS Commercial |
$8,722.89
|
| Rate for Payer: HFN Commercial |
$9,016.92
|
| Rate for Payer: Multiplan Commercial |
$7,840.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,880.60
|
| Rate for Payer: Preferred Network Access Commercial |
$9,016.92
|
| Rate for Payer: Quartz Beloit One Network |
$4,802.49
|
| Rate for Payer: Quartz Commercial |
$5,880.60
|
| Rate for Payer: WEA Trust Commercial |
$5,390.55
|
| Rate for Payer: WPS Commercial |
$7,259.60
|
|
|
PLATE 8H LT CONDYLAR 222.659
|
Facility
|
IP
|
$4,594.00
|
|
| Hospital Charge Code |
2966740
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,251.06 |
| Max. Negotiated Rate |
$4,226.48 |
| Rate for Payer: Aetna Commercial |
$4,134.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,950.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,434.82
|
| Rate for Payer: Cash Price |
$1,378.20
|
| Rate for Payer: Cigna Commercial |
$4,226.48
|
| Rate for Payer: Health EOS Commercial |
$4,088.66
|
| Rate for Payer: HFN Commercial |
$4,226.48
|
| Rate for Payer: Multiplan Commercial |
$3,675.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,756.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,226.48
|
| Rate for Payer: Quartz Beloit One Network |
$2,251.06
|
| Rate for Payer: Quartz Commercial |
$2,756.40
|
| Rate for Payer: WEA Trust Commercial |
$2,526.70
|
| Rate for Payer: WPS Commercial |
$3,402.78
|
|
|
PLATE 8H LT CONDYLAR 222.659
|
Facility
|
OP
|
$4,594.00
|
|
| Hospital Charge Code |
2966740
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,286.32 |
| Max. Negotiated Rate |
$18,376.00 |
| Rate for Payer: Aetna Commercial |
$4,134.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,950.84
|
| Rate for Payer: Aetna Managed Medicare |
$1,286.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,986.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,297.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,205.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,434.82
|
| Rate for Payer: Cash Price |
$1,378.20
|
| Rate for Payer: Cigna Commercial |
$4,226.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,570.80
|
| Rate for Payer: Health EOS Commercial |
$4,088.66
|
| Rate for Payer: HFN Commercial |
$4,226.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,445.50
|
| Rate for Payer: Multiplan Commercial |
$3,675.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,756.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,226.48
|
| Rate for Payer: Quartz Beloit One Network |
$2,251.06
|
| Rate for Payer: Quartz Commercial |
$2,986.10
|
| Rate for Payer: Quartz Medicare Advantage |
$2,756.40
|
| Rate for Payer: The Alliance Commercial |
$18,376.00
|
| Rate for Payer: WEA Trust Commercial |
$2,526.70
|
| Rate for Payer: WPS Commercial |
$3,402.78
|
|
|
PLATE 8H LT MED/DIS/TI 239.909
|
Facility
|
IP
|
$5,190.00
|
|
| Hospital Charge Code |
2966742
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,543.10 |
| Max. Negotiated Rate |
$4,774.80 |
| Rate for Payer: Aetna Commercial |
$4,671.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,463.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,750.70
|
| Rate for Payer: Cash Price |
$1,557.00
|
| Rate for Payer: Cigna Commercial |
$4,774.80
|
| Rate for Payer: Health EOS Commercial |
$4,619.10
|
| Rate for Payer: HFN Commercial |
$4,774.80
|
| Rate for Payer: Multiplan Commercial |
$4,152.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,114.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,774.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,543.10
|
| Rate for Payer: Quartz Commercial |
$3,114.00
|
| Rate for Payer: WEA Trust Commercial |
$2,854.50
|
| Rate for Payer: WPS Commercial |
$3,844.23
|
|
|
PLATE 8H LT MED/DIS/TI 239.909
|
Facility
|
OP
|
$5,190.00
|
|
| Hospital Charge Code |
2966742
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,453.20 |
| Max. Negotiated Rate |
$20,760.00 |
| Rate for Payer: Aetna Commercial |
$4,671.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,463.40
|
| Rate for Payer: Aetna Managed Medicare |
$1,453.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,373.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,595.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,491.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,750.70
|
| Rate for Payer: Cash Price |
$1,557.00
|
| Rate for Payer: Cigna Commercial |
$4,774.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,904.32
|
| Rate for Payer: Health EOS Commercial |
$4,619.10
|
| Rate for Payer: HFN Commercial |
$4,774.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,892.50
|
| Rate for Payer: Multiplan Commercial |
$4,152.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,114.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,774.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,543.10
|
| Rate for Payer: Quartz Commercial |
$3,373.50
|
| Rate for Payer: Quartz Medicare Advantage |
$3,114.00
|
| Rate for Payer: The Alliance Commercial |
$20,760.00
|
| Rate for Payer: WEA Trust Commercial |
$2,854.50
|
| Rate for Payer: WPS Commercial |
$3,844.23
|
|
|
PLATE 8H LT PROX/TIB 240.041
|
Facility
|
IP
|
$4,681.00
|
|
| Hospital Charge Code |
2966741
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,293.69 |
| Max. Negotiated Rate |
$4,306.52 |
| Rate for Payer: Aetna Commercial |
$4,212.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,025.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,480.93
|
| Rate for Payer: Cash Price |
$1,404.30
|
| Rate for Payer: Cigna Commercial |
$4,306.52
|
| Rate for Payer: Health EOS Commercial |
$4,166.09
|
| Rate for Payer: HFN Commercial |
$4,306.52
|
| Rate for Payer: Multiplan Commercial |
$3,744.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,808.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,306.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,293.69
|
| Rate for Payer: Quartz Commercial |
$2,808.60
|
| Rate for Payer: WEA Trust Commercial |
$2,574.55
|
| Rate for Payer: WPS Commercial |
$3,467.22
|
|
|
PLATE 8H LT PROX/TIB 240.041
|
Facility
|
OP
|
$4,681.00
|
|
| Hospital Charge Code |
2966741
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,310.68 |
| Max. Negotiated Rate |
$18,724.00 |
| Rate for Payer: Aetna Commercial |
$4,212.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,025.66
|
| Rate for Payer: Aetna Managed Medicare |
$1,310.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,042.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,340.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,246.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,480.93
|
| Rate for Payer: Cash Price |
$1,404.30
|
| Rate for Payer: Cigna Commercial |
$4,306.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,619.49
|
| Rate for Payer: Health EOS Commercial |
$4,166.09
|
| Rate for Payer: HFN Commercial |
$4,306.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,510.75
|
| Rate for Payer: Multiplan Commercial |
$3,744.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,808.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,306.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,293.69
|
| Rate for Payer: Quartz Commercial |
$3,042.65
|
| Rate for Payer: Quartz Medicare Advantage |
$2,808.60
|
| Rate for Payer: The Alliance Commercial |
$18,724.00
|
| Rate for Payer: WEA Trust Commercial |
$2,574.55
|
| Rate for Payer: WPS Commercial |
$3,467.22
|
|
|
PLATE 8HLx4HL LEFT VOLAR
|
Facility
|
IP
|
$7,992.00
|
|
| Hospital Charge Code |
2966361
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,916.08 |
| Max. Negotiated Rate |
$7,352.64 |
| Rate for Payer: Aetna Commercial |
$7,192.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,873.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,235.76
|
| Rate for Payer: Cash Price |
$2,397.60
|
| Rate for Payer: Cigna Commercial |
$7,352.64
|
| Rate for Payer: Health EOS Commercial |
$7,112.88
|
| Rate for Payer: HFN Commercial |
$7,352.64
|
| Rate for Payer: Multiplan Commercial |
$6,393.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,795.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,352.64
|
| Rate for Payer: Quartz Beloit One Network |
$3,916.08
|
| Rate for Payer: Quartz Commercial |
$4,795.20
|
| Rate for Payer: WEA Trust Commercial |
$4,395.60
|
| Rate for Payer: WPS Commercial |
$5,919.67
|
|
|
PLATE 8HLx4HL LEFT VOLAR
|
Facility
|
OP
|
$7,992.00
|
|
| Hospital Charge Code |
2966361
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,237.76 |
| Max. Negotiated Rate |
$31,968.00 |
| Rate for Payer: Aetna Commercial |
$7,192.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,873.12
|
| Rate for Payer: Aetna Managed Medicare |
$2,237.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,194.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,996.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,836.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,235.76
|
| Rate for Payer: Cash Price |
$2,397.60
|
| Rate for Payer: Cigna Commercial |
$7,352.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,472.32
|
| Rate for Payer: Health EOS Commercial |
$7,112.88
|
| Rate for Payer: HFN Commercial |
$7,352.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,994.00
|
| Rate for Payer: Multiplan Commercial |
$6,393.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,795.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,352.64
|
| Rate for Payer: Quartz Beloit One Network |
$3,916.08
|
| Rate for Payer: Quartz Commercial |
$5,194.80
|
| Rate for Payer: Quartz Medicare Advantage |
$4,795.20
|
| Rate for Payer: The Alliance Commercial |
$31,968.00
|
| Rate for Payer: WEA Trust Commercial |
$4,395.60
|
| Rate for Payer: WPS Commercial |
$5,919.67
|
|
|
PLATE 8 HOLE STRAIGHT 52020308
|
Facility
|
IP
|
$5,263.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6149646
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,578.87 |
| Max. Negotiated Rate |
$4,841.96 |
| Rate for Payer: Aetna Commercial |
$4,736.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,526.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,789.39
|
| Rate for Payer: Cash Price |
$1,578.90
|
| Rate for Payer: Cigna Commercial |
$4,841.96
|
| Rate for Payer: Health EOS Commercial |
$4,684.07
|
| Rate for Payer: HFN Commercial |
$4,841.96
|
| Rate for Payer: Multiplan Commercial |
$4,210.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,157.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,841.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,578.87
|
| Rate for Payer: Quartz Commercial |
$3,157.80
|
| Rate for Payer: WEA Trust Commercial |
$2,894.65
|
| Rate for Payer: WPS Commercial |
$3,898.30
|
|
|
PLATE 8 HOLE STRAIGHT 52020308
|
Facility
|
OP
|
$5,263.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6149646
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,473.64 |
| Max. Negotiated Rate |
$21,052.00 |
| Rate for Payer: Aetna Commercial |
$4,736.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,526.18
|
| Rate for Payer: Aetna Managed Medicare |
$1,473.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,420.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,631.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,526.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,789.39
|
| Rate for Payer: Cash Price |
$1,578.90
|
| Rate for Payer: Cigna Commercial |
$4,841.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,945.17
|
| Rate for Payer: Health EOS Commercial |
$4,684.07
|
| Rate for Payer: HFN Commercial |
$4,841.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,947.25
|
| Rate for Payer: Multiplan Commercial |
$4,210.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,157.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,841.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,578.87
|
| Rate for Payer: Quartz Commercial |
$3,420.95
|
| Rate for Payer: Quartz Medicare Advantage |
$3,157.80
|
| Rate for Payer: The Alliance Commercial |
$21,052.00
|
| Rate for Payer: WEA Trust Commercial |
$2,894.65
|
| Rate for Payer: WPS Commercial |
$3,898.30
|
|
|
PLATE 8H RT CONDYLAR 222.658
|
Facility
|
IP
|
$4,594.00
|
|
| Hospital Charge Code |
2966743
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,251.06 |
| Max. Negotiated Rate |
$4,226.48 |
| Rate for Payer: Aetna Commercial |
$4,134.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,950.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,434.82
|
| Rate for Payer: Cash Price |
$1,378.20
|
| Rate for Payer: Cigna Commercial |
$4,226.48
|
| Rate for Payer: Health EOS Commercial |
$4,088.66
|
| Rate for Payer: HFN Commercial |
$4,226.48
|
| Rate for Payer: Multiplan Commercial |
$3,675.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,756.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,226.48
|
| Rate for Payer: Quartz Beloit One Network |
$2,251.06
|
| Rate for Payer: Quartz Commercial |
$2,756.40
|
| Rate for Payer: WEA Trust Commercial |
$2,526.70
|
| Rate for Payer: WPS Commercial |
$3,402.78
|
|
|
PLATE 8H RT CONDYLAR 222.658
|
Facility
|
OP
|
$4,594.00
|
|
| Hospital Charge Code |
2966743
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,286.32 |
| Max. Negotiated Rate |
$18,376.00 |
| Rate for Payer: Aetna Commercial |
$4,134.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,950.84
|
| Rate for Payer: Aetna Managed Medicare |
$1,286.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,986.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,297.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,205.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,434.82
|
| Rate for Payer: Cash Price |
$1,378.20
|
| Rate for Payer: Cigna Commercial |
$4,226.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,570.80
|
| Rate for Payer: Health EOS Commercial |
$4,088.66
|
| Rate for Payer: HFN Commercial |
$4,226.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,445.50
|
| Rate for Payer: Multiplan Commercial |
$3,675.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,756.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,226.48
|
| Rate for Payer: Quartz Beloit One Network |
$2,251.06
|
| Rate for Payer: Quartz Commercial |
$2,986.10
|
| Rate for Payer: Quartz Medicare Advantage |
$2,756.40
|
| Rate for Payer: The Alliance Commercial |
$18,376.00
|
| Rate for Payer: WEA Trust Commercial |
$2,526.70
|
| Rate for Payer: WPS Commercial |
$3,402.78
|
|
|
PLATE 8H RT PROX/TIB 240.040
|
Facility
|
IP
|
$4,681.00
|
|
| Hospital Charge Code |
2966744
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,293.69 |
| Max. Negotiated Rate |
$4,306.52 |
| Rate for Payer: Aetna Commercial |
$4,212.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,025.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,480.93
|
| Rate for Payer: Cash Price |
$1,404.30
|
| Rate for Payer: Cigna Commercial |
$4,306.52
|
| Rate for Payer: Health EOS Commercial |
$4,166.09
|
| Rate for Payer: HFN Commercial |
$4,306.52
|
| Rate for Payer: Multiplan Commercial |
$3,744.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,808.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,306.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,293.69
|
| Rate for Payer: Quartz Commercial |
$2,808.60
|
| Rate for Payer: WEA Trust Commercial |
$2,574.55
|
| Rate for Payer: WPS Commercial |
$3,467.22
|
|
|
PLATE 8H RT PROX/TIB 240.040
|
Facility
|
OP
|
$4,681.00
|
|
| Hospital Charge Code |
2966744
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,310.68 |
| Max. Negotiated Rate |
$18,724.00 |
| Rate for Payer: Aetna Commercial |
$4,212.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,025.66
|
| Rate for Payer: Aetna Managed Medicare |
$1,310.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,042.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,340.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,246.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,480.93
|
| Rate for Payer: Cash Price |
$1,404.30
|
| Rate for Payer: Cigna Commercial |
$4,306.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,619.49
|
| Rate for Payer: Health EOS Commercial |
$4,166.09
|
| Rate for Payer: HFN Commercial |
$4,306.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,510.75
|
| Rate for Payer: Multiplan Commercial |
$3,744.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,808.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,306.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,293.69
|
| Rate for Payer: Quartz Commercial |
$3,042.65
|
| Rate for Payer: Quartz Medicare Advantage |
$2,808.60
|
| Rate for Payer: The Alliance Commercial |
$18,724.00
|
| Rate for Payer: WEA Trust Commercial |
$2,574.55
|
| Rate for Payer: WPS Commercial |
$3,467.22
|
|
|
PLATE 9H 3.5 LCP 223.591
|
Facility
|
OP
|
$1,579.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966746
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$442.12 |
| Max. Negotiated Rate |
$6,316.00 |
| Rate for Payer: Aetna Commercial |
$1,421.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,357.94
|
| Rate for Payer: Aetna Managed Medicare |
$442.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,026.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$789.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$757.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$836.87
|
| Rate for Payer: Cash Price |
$473.70
|
| Rate for Payer: Cigna Commercial |
$1,452.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$883.61
|
| Rate for Payer: Health EOS Commercial |
$1,405.31
|
| Rate for Payer: HFN Commercial |
$1,452.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,184.25
|
| Rate for Payer: Multiplan Commercial |
$1,263.20
|
| Rate for Payer: NAPHCARE Commercial |
$947.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,452.68
|
| Rate for Payer: Quartz Beloit One Network |
$773.71
|
| Rate for Payer: Quartz Commercial |
$1,026.35
|
| Rate for Payer: Quartz Medicare Advantage |
$947.40
|
| Rate for Payer: The Alliance Commercial |
$6,316.00
|
| Rate for Payer: WEA Trust Commercial |
$868.45
|
| Rate for Payer: WPS Commercial |
$1,169.57
|
|
|
PLATE 9H 3.5 LCP 223.591
|
Facility
|
IP
|
$1,579.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966746
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$773.71 |
| Max. Negotiated Rate |
$1,452.68 |
| Rate for Payer: Aetna Commercial |
$1,421.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,357.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$836.87
|
| Rate for Payer: Cash Price |
$473.70
|
| Rate for Payer: Cigna Commercial |
$1,452.68
|
| Rate for Payer: Health EOS Commercial |
$1,405.31
|
| Rate for Payer: HFN Commercial |
$1,452.68
|
| Rate for Payer: Multiplan Commercial |
$1,263.20
|
| Rate for Payer: NAPHCARE Commercial |
$947.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,452.68
|
| Rate for Payer: Quartz Beloit One Network |
$773.71
|
| Rate for Payer: Quartz Commercial |
$947.40
|
| Rate for Payer: WEA Trust Commercial |
$868.45
|
| Rate for Payer: WPS Commercial |
$1,169.57
|
|
|
PLATE 9H/3H LT DISTAL RADIUS 04.110.331
|
Facility
|
IP
|
$7,985.00
|
|
| Hospital Charge Code |
2966747
|
|
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 9H/3H LT DISTAL RADIUS 04.110.331
|
Facility
|
OP
|
$7,985.00
|
|
| Hospital Charge Code |
2966747
|
|
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 9H/3H RT DISTAL RADIUS 04.110.330
|
Facility
|
IP
|
$7,985.00
|
|
| Hospital Charge Code |
2966748
|
|
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 9H/3H RT DISTAL RADIUS 04.110.330
|
Facility
|
OP
|
$7,985.00
|
|
| Hospital Charge Code |
2966748
|
|
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
|
|
