|
PLATE PROXIMAL HUMERUS 3.5 LCP 3HL RT 02.123.040S
|
Facility
|
OP
|
$9,879.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966334
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,876.76 |
| Max. Negotiated Rate |
$9,452.23 |
| Rate for Payer: Aetna Commercial |
$9,246.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,835.78
|
| Rate for Payer: Aetna Managed Medicare |
$2,876.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,678.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,137.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,931.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,445.30
|
| Rate for Payer: Cash Price |
$2,963.70
|
| Rate for Payer: Cigna Commercial |
$9,452.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,749.58
|
| Rate for Payer: Health EOS Commercial |
$9,144.00
|
| Rate for Payer: HFN Commercial |
$9,452.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,705.62
|
| Rate for Payer: Multiplan Commercial |
$8,219.33
|
| Rate for Payer: NAPHCARE Commercial |
$6,164.50
|
| Rate for Payer: Preferred Network Access Commercial |
$9,452.23
|
| Rate for Payer: Quartz Beloit One Network |
$5,034.34
|
| Rate for Payer: Quartz Commercial |
$6,678.20
|
| Rate for Payer: Quartz Medicare Advantage |
$6,164.50
|
| Rate for Payer: The Alliance Commercial |
$5,137.08
|
| Rate for Payer: WEA Trust Commercial |
$5,650.79
|
| Rate for Payer: WPS Commercial |
$7,609.79
|
|
|
PLATE PROXIMAL HUMERUS 3.5 LCP 3HL RT 02.123.040S
|
Facility
|
IP
|
$9,879.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966334
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,034.34 |
| Max. Negotiated Rate |
$9,452.23 |
| Rate for Payer: Aetna Commercial |
$9,246.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,835.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,445.30
|
| Rate for Payer: Cash Price |
$2,963.70
|
| Rate for Payer: Cigna Commercial |
$9,452.23
|
| Rate for Payer: Health EOS Commercial |
$9,144.00
|
| Rate for Payer: HFN Commercial |
$9,452.23
|
| Rate for Payer: Multiplan Commercial |
$8,219.33
|
| Rate for Payer: Preferred Network Access Commercial |
$9,452.23
|
| Rate for Payer: Quartz Beloit One Network |
$5,034.34
|
| Rate for Payer: Quartz Commercial |
$6,164.50
|
| Rate for Payer: WEA Trust Commercial |
$5,650.79
|
| Rate for Payer: WPS Commercial |
$7,609.79
|
|
|
PLATE PROXIMAL HUMERUS 3.5 LCP 6HL RT 02.123.024S
|
Facility
|
OP
|
$8,241.00
|
|
|
Service Code
|
HCPCS C1714
|
| Hospital Charge Code |
3491510
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,399.78 |
| Max. Negotiated Rate |
$7,884.99 |
| Rate for Payer: Aetna Commercial |
$7,713.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,370.75
|
| Rate for Payer: Aetna Managed Medicare |
$2,399.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,570.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,285.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,113.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,542.44
|
| Rate for Payer: Cash Price |
$2,472.30
|
| Rate for Payer: Cigna Commercial |
$7,884.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,796.26
|
| Rate for Payer: Health EOS Commercial |
$7,627.87
|
| Rate for Payer: HFN Commercial |
$7,884.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,427.98
|
| Rate for Payer: Multiplan Commercial |
$6,856.51
|
| Rate for Payer: NAPHCARE Commercial |
$5,142.38
|
| Rate for Payer: Preferred Network Access Commercial |
$7,884.99
|
| Rate for Payer: Quartz Beloit One Network |
$4,199.61
|
| Rate for Payer: Quartz Commercial |
$5,570.92
|
| Rate for Payer: Quartz Medicare Advantage |
$5,142.38
|
| Rate for Payer: The Alliance Commercial |
$4,285.32
|
| Rate for Payer: WEA Trust Commercial |
$4,713.85
|
| Rate for Payer: WPS Commercial |
$6,348.04
|
|
|
PLATE PROXIMAL HUMERUS 3.5 LCP 6HL RT 02.123.024S
|
Facility
|
IP
|
$8,241.00
|
|
|
Service Code
|
HCPCS C1714
|
| Hospital Charge Code |
3491510
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,199.61 |
| Max. Negotiated Rate |
$7,884.99 |
| Rate for Payer: Aetna Commercial |
$7,713.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,370.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,542.44
|
| Rate for Payer: Cash Price |
$2,472.30
|
| Rate for Payer: Cigna Commercial |
$7,884.99
|
| Rate for Payer: Health EOS Commercial |
$7,627.87
|
| Rate for Payer: HFN Commercial |
$7,884.99
|
| Rate for Payer: Multiplan Commercial |
$6,856.51
|
| Rate for Payer: Preferred Network Access Commercial |
$7,884.99
|
| Rate for Payer: Quartz Beloit One Network |
$4,199.61
|
| Rate for Payer: Quartz Commercial |
$5,142.38
|
| Rate for Payer: WEA Trust Commercial |
$4,713.85
|
| Rate for Payer: WPS Commercial |
$6,348.04
|
|
|
PLATE PROXIMAL TIBIAL PLATLOW BEND LCP 6HL LT 02.124.205S
|
Facility
|
IP
|
$6,549.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4518882
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,337.37 |
| Max. Negotiated Rate |
$6,266.08 |
| Rate for Payer: Aetna Commercial |
$6,129.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,857.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,609.81
|
| Rate for Payer: Cash Price |
$1,964.70
|
| Rate for Payer: Cigna Commercial |
$6,266.08
|
| Rate for Payer: Health EOS Commercial |
$6,061.75
|
| Rate for Payer: HFN Commercial |
$6,266.08
|
| Rate for Payer: Multiplan Commercial |
$5,448.77
|
| Rate for Payer: Preferred Network Access Commercial |
$6,266.08
|
| Rate for Payer: Quartz Beloit One Network |
$3,337.37
|
| Rate for Payer: Quartz Commercial |
$4,086.58
|
| Rate for Payer: WEA Trust Commercial |
$3,746.03
|
| Rate for Payer: WPS Commercial |
$5,044.69
|
|
|
PLATE PROXIMAL TIBIAL PLATLOW BEND LCP 6HL LT 02.124.205S
|
Facility
|
OP
|
$6,549.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4518882
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,907.07 |
| Max. Negotiated Rate |
$6,266.08 |
| Rate for Payer: Aetna Commercial |
$6,129.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,857.43
|
| Rate for Payer: Aetna Managed Medicare |
$1,907.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,427.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,405.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,269.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,609.81
|
| Rate for Payer: Cash Price |
$1,964.70
|
| Rate for Payer: Cigna Commercial |
$6,266.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,811.52
|
| Rate for Payer: Health EOS Commercial |
$6,061.75
|
| Rate for Payer: HFN Commercial |
$6,266.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,108.22
|
| Rate for Payer: Multiplan Commercial |
$5,448.77
|
| Rate for Payer: NAPHCARE Commercial |
$4,086.58
|
| Rate for Payer: Preferred Network Access Commercial |
$6,266.08
|
| Rate for Payer: Quartz Beloit One Network |
$3,337.37
|
| Rate for Payer: Quartz Commercial |
$4,427.12
|
| Rate for Payer: Quartz Medicare Advantage |
$4,086.58
|
| Rate for Payer: The Alliance Commercial |
$3,405.48
|
| Rate for Payer: WEA Trust Commercial |
$3,746.03
|
| Rate for Payer: WPS Commercial |
$5,044.69
|
|
|
PLATE PROXIMAL TIBIAL PLATLOW BEND LCP 6HL RT 02.124.204
|
Facility
|
OP
|
$6,549.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415315
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,907.07 |
| Max. Negotiated Rate |
$6,266.08 |
| Rate for Payer: Aetna Commercial |
$6,129.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,857.43
|
| Rate for Payer: Aetna Managed Medicare |
$1,907.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,427.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,405.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,269.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,609.81
|
| Rate for Payer: Cash Price |
$1,964.70
|
| Rate for Payer: Cigna Commercial |
$6,266.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,811.52
|
| Rate for Payer: Health EOS Commercial |
$6,061.75
|
| Rate for Payer: HFN Commercial |
$6,266.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,108.22
|
| Rate for Payer: Multiplan Commercial |
$5,448.77
|
| Rate for Payer: NAPHCARE Commercial |
$4,086.58
|
| Rate for Payer: Preferred Network Access Commercial |
$6,266.08
|
| Rate for Payer: Quartz Beloit One Network |
$3,337.37
|
| Rate for Payer: Quartz Commercial |
$4,427.12
|
| Rate for Payer: Quartz Medicare Advantage |
$4,086.58
|
| Rate for Payer: The Alliance Commercial |
$3,405.48
|
| Rate for Payer: WEA Trust Commercial |
$3,746.03
|
| Rate for Payer: WPS Commercial |
$5,044.69
|
|
|
PLATE PROXIMAL TIBIAL PLATLOW BEND LCP 6HL RT 02.124.204
|
Facility
|
IP
|
$6,549.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415315
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,337.37 |
| Max. Negotiated Rate |
$6,266.08 |
| Rate for Payer: Aetna Commercial |
$6,129.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,857.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,609.81
|
| Rate for Payer: Cash Price |
$1,964.70
|
| Rate for Payer: Cigna Commercial |
$6,266.08
|
| Rate for Payer: Health EOS Commercial |
$6,061.75
|
| Rate for Payer: HFN Commercial |
$6,266.08
|
| Rate for Payer: Multiplan Commercial |
$5,448.77
|
| Rate for Payer: Preferred Network Access Commercial |
$6,266.08
|
| Rate for Payer: Quartz Beloit One Network |
$3,337.37
|
| Rate for Payer: Quartz Commercial |
$4,086.58
|
| Rate for Payer: WEA Trust Commercial |
$3,746.03
|
| Rate for Payer: WPS Commercial |
$5,044.69
|
|
|
PLATE RADIAL HEAD LOCKING 3HL SM CURVATURE 70-0099
|
Facility
|
OP
|
$8,581.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5611757
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,498.79 |
| Max. Negotiated Rate |
$8,210.30 |
| Rate for Payer: Aetna Commercial |
$8,031.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,674.85
|
| Rate for Payer: Aetna Managed Medicare |
$2,498.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,800.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,462.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,283.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,729.85
|
| Rate for Payer: Cash Price |
$2,574.30
|
| Rate for Payer: Cigna Commercial |
$8,210.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,994.14
|
| Rate for Payer: Health EOS Commercial |
$7,942.57
|
| Rate for Payer: HFN Commercial |
$8,210.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,693.18
|
| Rate for Payer: Multiplan Commercial |
$7,139.39
|
| Rate for Payer: NAPHCARE Commercial |
$5,354.54
|
| Rate for Payer: Preferred Network Access Commercial |
$8,210.30
|
| Rate for Payer: Quartz Beloit One Network |
$4,372.88
|
| Rate for Payer: Quartz Commercial |
$5,800.76
|
| Rate for Payer: Quartz Medicare Advantage |
$5,354.54
|
| Rate for Payer: The Alliance Commercial |
$4,462.12
|
| Rate for Payer: WEA Trust Commercial |
$4,908.33
|
| Rate for Payer: WPS Commercial |
$6,609.94
|
|
|
PLATE RADIAL HEAD LOCKING 3HL SM CURVATURE 70-0099
|
Facility
|
IP
|
$8,581.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5611757
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,372.88 |
| Max. Negotiated Rate |
$8,210.30 |
| Rate for Payer: Aetna Commercial |
$8,031.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,674.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,729.85
|
| Rate for Payer: Cash Price |
$2,574.30
|
| Rate for Payer: Cigna Commercial |
$8,210.30
|
| Rate for Payer: Health EOS Commercial |
$7,942.57
|
| Rate for Payer: HFN Commercial |
$8,210.30
|
| Rate for Payer: Multiplan Commercial |
$7,139.39
|
| Rate for Payer: Preferred Network Access Commercial |
$8,210.30
|
| Rate for Payer: Quartz Beloit One Network |
$4,372.88
|
| Rate for Payer: Quartz Commercial |
$5,354.54
|
| Rate for Payer: WEA Trust Commercial |
$4,908.33
|
| Rate for Payer: WPS Commercial |
$6,609.94
|
|
|
PLATE RECONSTRUCTION 5HL 245.15
|
Facility
|
IP
|
$953.00
|
|
| Hospital Charge Code |
2966772
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$485.65 |
| Max. Negotiated Rate |
$911.83 |
| Rate for Payer: Aetna Commercial |
$892.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$852.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$525.29
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: Cigna Commercial |
$911.83
|
| Rate for Payer: Health EOS Commercial |
$882.10
|
| Rate for Payer: HFN Commercial |
$911.83
|
| Rate for Payer: Multiplan Commercial |
$792.90
|
| Rate for Payer: Preferred Network Access Commercial |
$911.83
|
| Rate for Payer: Quartz Beloit One Network |
$485.65
|
| Rate for Payer: Quartz Commercial |
$594.67
|
| Rate for Payer: WEA Trust Commercial |
$545.12
|
| Rate for Payer: WPS Commercial |
$734.10
|
|
|
PLATE RECONSTRUCTION 5HL 245.15
|
Facility
|
OP
|
$953.00
|
|
| Hospital Charge Code |
2966772
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$277.51 |
| Max. Negotiated Rate |
$911.83 |
| Rate for Payer: Aetna Commercial |
$892.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$852.36
|
| Rate for Payer: Aetna Managed Medicare |
$277.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$644.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$495.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$475.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$525.29
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: Cigna Commercial |
$911.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$554.65
|
| Rate for Payer: Health EOS Commercial |
$882.10
|
| Rate for Payer: HFN Commercial |
$911.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$743.34
|
| Rate for Payer: Multiplan Commercial |
$792.90
|
| Rate for Payer: NAPHCARE Commercial |
$594.67
|
| Rate for Payer: Preferred Network Access Commercial |
$911.83
|
| Rate for Payer: Quartz Beloit One Network |
$485.65
|
| Rate for Payer: Quartz Commercial |
$644.23
|
| Rate for Payer: Quartz Medicare Advantage |
$594.67
|
| Rate for Payer: The Alliance Commercial |
$495.56
|
| Rate for Payer: WEA Trust Commercial |
$545.12
|
| Rate for Payer: WPS Commercial |
$734.10
|
|
|
PLATE RECONSTRUCTION 6HL 245.16
|
Facility
|
OP
|
$1,862.00
|
|
| Hospital Charge Code |
2966773
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$542.21 |
| Max. Negotiated Rate |
$1,781.56 |
| Rate for Payer: Aetna Commercial |
$1,742.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,665.37
|
| Rate for Payer: Aetna Managed Medicare |
$542.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,258.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$968.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$929.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,026.33
|
| Rate for Payer: Cash Price |
$558.60
|
| Rate for Payer: Cigna Commercial |
$1,781.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,083.68
|
| Rate for Payer: Health EOS Commercial |
$1,723.47
|
| Rate for Payer: HFN Commercial |
$1,781.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,452.36
|
| Rate for Payer: Multiplan Commercial |
$1,549.18
|
| Rate for Payer: NAPHCARE Commercial |
$1,161.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,781.56
|
| Rate for Payer: Quartz Beloit One Network |
$948.88
|
| Rate for Payer: Quartz Commercial |
$1,258.71
|
| Rate for Payer: Quartz Medicare Advantage |
$1,161.89
|
| Rate for Payer: The Alliance Commercial |
$968.24
|
| Rate for Payer: WEA Trust Commercial |
$1,065.06
|
| Rate for Payer: WPS Commercial |
$1,434.30
|
|
|
PLATE RECONSTRUCTION 6HL 245.16
|
Facility
|
IP
|
$1,862.00
|
|
| Hospital Charge Code |
2966773
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$948.88 |
| Max. Negotiated Rate |
$1,781.56 |
| Rate for Payer: Aetna Commercial |
$1,742.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,665.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,026.33
|
| Rate for Payer: Cash Price |
$558.60
|
| Rate for Payer: Cigna Commercial |
$1,781.56
|
| Rate for Payer: Health EOS Commercial |
$1,723.47
|
| Rate for Payer: HFN Commercial |
$1,781.56
|
| Rate for Payer: Multiplan Commercial |
$1,549.18
|
| Rate for Payer: Preferred Network Access Commercial |
$1,781.56
|
| Rate for Payer: Quartz Beloit One Network |
$948.88
|
| Rate for Payer: Quartz Commercial |
$1,161.89
|
| Rate for Payer: WEA Trust Commercial |
$1,065.06
|
| Rate for Payer: WPS Commercial |
$1,434.30
|
|
|
PLATE RECONSTRUCTION 7HL 245.17
|
Facility
|
OP
|
$3,380.00
|
|
| Hospital Charge Code |
2966774
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$984.26 |
| Max. Negotiated Rate |
$3,233.98 |
| Rate for Payer: Aetna Commercial |
$3,163.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,023.07
|
| Rate for Payer: Aetna Managed Medicare |
$984.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,284.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,757.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,687.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,863.06
|
| Rate for Payer: Cash Price |
$1,014.00
|
| Rate for Payer: Cigna Commercial |
$3,233.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,967.16
|
| Rate for Payer: Health EOS Commercial |
$3,128.53
|
| Rate for Payer: HFN Commercial |
$3,233.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,636.40
|
| Rate for Payer: Multiplan Commercial |
$2,812.16
|
| Rate for Payer: NAPHCARE Commercial |
$2,109.12
|
| Rate for Payer: Preferred Network Access Commercial |
$3,233.98
|
| Rate for Payer: Quartz Beloit One Network |
$1,722.45
|
| Rate for Payer: Quartz Commercial |
$2,284.88
|
| Rate for Payer: Quartz Medicare Advantage |
$2,109.12
|
| Rate for Payer: The Alliance Commercial |
$1,757.60
|
| Rate for Payer: WEA Trust Commercial |
$1,933.36
|
| Rate for Payer: WPS Commercial |
$2,603.61
|
|
|
PLATE RECONSTRUCTION 7HL 245.17
|
Facility
|
IP
|
$3,380.00
|
|
| Hospital Charge Code |
2966774
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,722.45 |
| Max. Negotiated Rate |
$3,233.98 |
| Rate for Payer: Aetna Commercial |
$3,163.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,023.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,863.06
|
| Rate for Payer: Cash Price |
$1,014.00
|
| Rate for Payer: Cigna Commercial |
$3,233.98
|
| Rate for Payer: Health EOS Commercial |
$3,128.53
|
| Rate for Payer: HFN Commercial |
$3,233.98
|
| Rate for Payer: Multiplan Commercial |
$2,812.16
|
| Rate for Payer: Preferred Network Access Commercial |
$3,233.98
|
| Rate for Payer: Quartz Beloit One Network |
$1,722.45
|
| Rate for Payer: Quartz Commercial |
$2,109.12
|
| Rate for Payer: WEA Trust Commercial |
$1,933.36
|
| Rate for Payer: WPS Commercial |
$2,603.61
|
|
|
PLATE RECONSTRUCTION 8HL 245.18
|
Facility
|
IP
|
$4,078.00
|
|
| Hospital Charge Code |
2966775
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,078.15 |
| Max. Negotiated Rate |
$3,901.83 |
| Rate for Payer: Aetna Commercial |
$3,817.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,647.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,247.79
|
| Rate for Payer: Cash Price |
$1,223.40
|
| Rate for Payer: Cigna Commercial |
$3,901.83
|
| Rate for Payer: Health EOS Commercial |
$3,774.60
|
| Rate for Payer: HFN Commercial |
$3,901.83
|
| Rate for Payer: Multiplan Commercial |
$3,392.90
|
| Rate for Payer: Preferred Network Access Commercial |
$3,901.83
|
| Rate for Payer: Quartz Beloit One Network |
$2,078.15
|
| Rate for Payer: Quartz Commercial |
$2,544.67
|
| Rate for Payer: WEA Trust Commercial |
$2,332.62
|
| Rate for Payer: WPS Commercial |
$3,141.28
|
|
|
PLATE RECONSTRUCTION 8HL 245.18
|
Facility
|
OP
|
$4,078.00
|
|
| Hospital Charge Code |
2966775
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,187.51 |
| Max. Negotiated Rate |
$3,901.83 |
| Rate for Payer: Aetna Commercial |
$3,817.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,647.36
|
| Rate for Payer: Aetna Managed Medicare |
$1,187.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,756.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,120.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,035.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,247.79
|
| Rate for Payer: Cash Price |
$1,223.40
|
| Rate for Payer: Cigna Commercial |
$3,901.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,373.40
|
| Rate for Payer: Health EOS Commercial |
$3,774.60
|
| Rate for Payer: HFN Commercial |
$3,901.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,180.84
|
| Rate for Payer: Multiplan Commercial |
$3,392.90
|
| Rate for Payer: NAPHCARE Commercial |
$2,544.67
|
| Rate for Payer: Preferred Network Access Commercial |
$3,901.83
|
| Rate for Payer: Quartz Beloit One Network |
$2,078.15
|
| Rate for Payer: Quartz Commercial |
$2,756.73
|
| Rate for Payer: Quartz Medicare Advantage |
$2,544.67
|
| Rate for Payer: The Alliance Commercial |
$2,120.56
|
| Rate for Payer: WEA Trust Commercial |
$2,332.62
|
| Rate for Payer: WPS Commercial |
$3,141.28
|
|
|
PLATE RT CALCANEAL 241.622
|
Facility
|
IP
|
$6,359.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966377
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,240.55 |
| Max. Negotiated Rate |
$6,084.29 |
| Rate for Payer: Aetna Commercial |
$5,952.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,687.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,505.08
|
| Rate for Payer: Cash Price |
$1,907.70
|
| Rate for Payer: Cigna Commercial |
$6,084.29
|
| Rate for Payer: Health EOS Commercial |
$5,885.89
|
| Rate for Payer: HFN Commercial |
$6,084.29
|
| Rate for Payer: Multiplan Commercial |
$5,290.69
|
| Rate for Payer: Preferred Network Access Commercial |
$6,084.29
|
| Rate for Payer: Quartz Beloit One Network |
$3,240.55
|
| Rate for Payer: Quartz Commercial |
$3,968.02
|
| Rate for Payer: WEA Trust Commercial |
$3,637.35
|
| Rate for Payer: WPS Commercial |
$4,898.34
|
|
|
PLATE RT CALCANEAL 241.622
|
Facility
|
OP
|
$6,359.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966377
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,851.74 |
| Max. Negotiated Rate |
$6,084.29 |
| Rate for Payer: Aetna Commercial |
$5,952.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,687.49
|
| Rate for Payer: Aetna Managed Medicare |
$1,851.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,298.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,306.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,174.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,505.08
|
| Rate for Payer: Cash Price |
$1,907.70
|
| Rate for Payer: Cigna Commercial |
$6,084.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,700.94
|
| Rate for Payer: Health EOS Commercial |
$5,885.89
|
| Rate for Payer: HFN Commercial |
$6,084.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,960.02
|
| Rate for Payer: Multiplan Commercial |
$5,290.69
|
| Rate for Payer: NAPHCARE Commercial |
$3,968.02
|
| Rate for Payer: Preferred Network Access Commercial |
$6,084.29
|
| Rate for Payer: Quartz Beloit One Network |
$3,240.55
|
| Rate for Payer: Quartz Commercial |
$4,298.68
|
| Rate for Payer: Quartz Medicare Advantage |
$3,968.02
|
| Rate for Payer: The Alliance Commercial |
$3,306.68
|
| Rate for Payer: WEA Trust Commercial |
$3,637.35
|
| Rate for Payer: WPS Commercial |
$4,898.34
|
|
|
PLATE SEMI TUBULAR 10HL 222.10
|
Facility
|
OP
|
$496.00
|
|
| Hospital Charge Code |
2966776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$144.44 |
| Max. Negotiated Rate |
$474.57 |
| Rate for Payer: Aetna Commercial |
$464.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$443.62
|
| Rate for Payer: Aetna Managed Medicare |
$144.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$335.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$257.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$247.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$273.40
|
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Cigna Commercial |
$474.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$288.67
|
| Rate for Payer: Health EOS Commercial |
$459.10
|
| Rate for Payer: HFN Commercial |
$474.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$386.88
|
| Rate for Payer: Multiplan Commercial |
$412.67
|
| Rate for Payer: NAPHCARE Commercial |
$309.50
|
| Rate for Payer: Preferred Network Access Commercial |
$474.57
|
| Rate for Payer: Quartz Beloit One Network |
$252.76
|
| Rate for Payer: Quartz Commercial |
$335.30
|
| Rate for Payer: Quartz Medicare Advantage |
$309.50
|
| Rate for Payer: The Alliance Commercial |
$257.92
|
| Rate for Payer: WEA Trust Commercial |
$283.71
|
| Rate for Payer: WPS Commercial |
$382.07
|
|
|
PLATE SEMI TUBULAR 10HL 222.10
|
Facility
|
IP
|
$496.00
|
|
| Hospital Charge Code |
2966776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$252.76 |
| Max. Negotiated Rate |
$474.57 |
| Rate for Payer: Aetna Commercial |
$464.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$443.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$273.40
|
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Cigna Commercial |
$474.57
|
| Rate for Payer: Health EOS Commercial |
$459.10
|
| Rate for Payer: HFN Commercial |
$474.57
|
| Rate for Payer: Multiplan Commercial |
$412.67
|
| Rate for Payer: Preferred Network Access Commercial |
$474.57
|
| Rate for Payer: Quartz Beloit One Network |
$252.76
|
| Rate for Payer: Quartz Commercial |
$309.50
|
| Rate for Payer: WEA Trust Commercial |
$283.71
|
| Rate for Payer: WPS Commercial |
$382.07
|
|
|
PLATE SEMI TUBULAR 2HL 222.02
|
Facility
|
OP
|
$359.00
|
|
| Hospital Charge Code |
2966777
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$104.54 |
| Max. Negotiated Rate |
$343.49 |
| Rate for Payer: Aetna Commercial |
$336.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$321.09
|
| Rate for Payer: Aetna Managed Medicare |
$104.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$242.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$186.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$179.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$197.88
|
| Rate for Payer: Cash Price |
$107.70
|
| Rate for Payer: Cigna Commercial |
$343.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$208.94
|
| Rate for Payer: Health EOS Commercial |
$332.29
|
| Rate for Payer: HFN Commercial |
$343.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$280.02
|
| Rate for Payer: Multiplan Commercial |
$298.69
|
| Rate for Payer: NAPHCARE Commercial |
$224.02
|
| Rate for Payer: Preferred Network Access Commercial |
$343.49
|
| Rate for Payer: Quartz Beloit One Network |
$182.95
|
| Rate for Payer: Quartz Commercial |
$242.68
|
| Rate for Payer: Quartz Medicare Advantage |
$224.02
|
| Rate for Payer: The Alliance Commercial |
$186.68
|
| Rate for Payer: WEA Trust Commercial |
$205.35
|
| Rate for Payer: WPS Commercial |
$276.54
|
|
|
PLATE SEMI TUBULAR 2HL 222.02
|
Facility
|
IP
|
$359.00
|
|
| Hospital Charge Code |
2966777
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$182.95 |
| Max. Negotiated Rate |
$343.49 |
| Rate for Payer: Aetna Commercial |
$336.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$321.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$197.88
|
| Rate for Payer: Cash Price |
$107.70
|
| Rate for Payer: Cigna Commercial |
$343.49
|
| Rate for Payer: Health EOS Commercial |
$332.29
|
| Rate for Payer: HFN Commercial |
$343.49
|
| Rate for Payer: Multiplan Commercial |
$298.69
|
| Rate for Payer: Preferred Network Access Commercial |
$343.49
|
| Rate for Payer: Quartz Beloit One Network |
$182.95
|
| Rate for Payer: Quartz Commercial |
$224.02
|
| Rate for Payer: WEA Trust Commercial |
$205.35
|
| Rate for Payer: WPS Commercial |
$276.54
|
|
|
PLATE SEMI TUBULAR 3HL 222.03
|
Facility
|
IP
|
$373.00
|
|
| Hospital Charge Code |
2966778
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$190.08 |
| Max. Negotiated Rate |
$356.89 |
| Rate for Payer: Aetna Commercial |
$349.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$333.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$205.60
|
| Rate for Payer: Cash Price |
$111.90
|
| Rate for Payer: Cigna Commercial |
$356.89
|
| Rate for Payer: Health EOS Commercial |
$345.25
|
| Rate for Payer: HFN Commercial |
$356.89
|
| Rate for Payer: Multiplan Commercial |
$310.34
|
| Rate for Payer: Preferred Network Access Commercial |
$356.89
|
| Rate for Payer: Quartz Beloit One Network |
$190.08
|
| Rate for Payer: Quartz Commercial |
$232.75
|
| Rate for Payer: WEA Trust Commercial |
$213.36
|
| Rate for Payer: WPS Commercial |
$287.32
|
|
