|
PLATE CONDYLAR 2.0 7HL 247.349
|
Facility
|
IP
|
$5,277.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767798
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,585.73 |
| Max. Negotiated Rate |
$4,854.84 |
| Rate for Payer: Aetna Commercial |
$4,749.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,538.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,796.81
|
| Rate for Payer: Cash Price |
$1,583.10
|
| Rate for Payer: Cigna Commercial |
$4,854.84
|
| Rate for Payer: Health EOS Commercial |
$4,696.53
|
| Rate for Payer: HFN Commercial |
$4,854.84
|
| Rate for Payer: Multiplan Commercial |
$4,221.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,166.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,854.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,585.73
|
| Rate for Payer: Quartz Commercial |
$3,166.20
|
| Rate for Payer: WEA Trust Commercial |
$2,902.35
|
| Rate for Payer: WPS Commercial |
$3,908.67
|
|
|
PLATE CONDYLAR 2.0MM 7H/39MM/LEFT 243.61
|
Facility
|
OP
|
$4,354.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508691
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,219.12 |
| Max. Negotiated Rate |
$17,416.00 |
| Rate for Payer: Aetna Commercial |
$3,918.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,744.44
|
| Rate for Payer: Aetna Managed Medicare |
$1,219.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,830.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,177.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,089.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,307.62
|
| Rate for Payer: Cash Price |
$1,306.20
|
| Rate for Payer: Cigna Commercial |
$4,005.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,436.50
|
| Rate for Payer: Health EOS Commercial |
$3,875.06
|
| Rate for Payer: HFN Commercial |
$4,005.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,265.50
|
| Rate for Payer: Multiplan Commercial |
$3,483.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,612.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,005.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,133.46
|
| Rate for Payer: Quartz Commercial |
$2,830.10
|
| Rate for Payer: Quartz Medicare Advantage |
$2,612.40
|
| Rate for Payer: The Alliance Commercial |
$17,416.00
|
| Rate for Payer: WEA Trust Commercial |
$2,394.70
|
| Rate for Payer: WPS Commercial |
$3,225.01
|
|
|
PLATE CONDYLAR 2.0MM 7H/39MM/LEFT 243.61
|
Facility
|
IP
|
$4,354.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508691
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,133.46 |
| Max. Negotiated Rate |
$4,005.68 |
| Rate for Payer: Aetna Commercial |
$3,918.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,744.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,307.62
|
| Rate for Payer: Cash Price |
$1,306.20
|
| Rate for Payer: Cigna Commercial |
$4,005.68
|
| Rate for Payer: Health EOS Commercial |
$3,875.06
|
| Rate for Payer: HFN Commercial |
$4,005.68
|
| Rate for Payer: Multiplan Commercial |
$3,483.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,612.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,005.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,133.46
|
| Rate for Payer: Quartz Commercial |
$2,612.40
|
| Rate for Payer: WEA Trust Commercial |
$2,394.70
|
| Rate for Payer: WPS Commercial |
$3,225.01
|
|
|
PLATE CONDYLAR 2.0MM 7H/39MM/RIGHT 243.62
|
Facility
|
OP
|
$4,354.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508692
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,219.12 |
| Max. Negotiated Rate |
$17,416.00 |
| Rate for Payer: Aetna Commercial |
$3,918.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,744.44
|
| Rate for Payer: Aetna Managed Medicare |
$1,219.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,830.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,177.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,089.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,307.62
|
| Rate for Payer: Cash Price |
$1,306.20
|
| Rate for Payer: Cigna Commercial |
$4,005.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,436.50
|
| Rate for Payer: Health EOS Commercial |
$3,875.06
|
| Rate for Payer: HFN Commercial |
$4,005.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,265.50
|
| Rate for Payer: Multiplan Commercial |
$3,483.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,612.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,005.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,133.46
|
| Rate for Payer: Quartz Commercial |
$2,830.10
|
| Rate for Payer: Quartz Medicare Advantage |
$2,612.40
|
| Rate for Payer: The Alliance Commercial |
$17,416.00
|
| Rate for Payer: WEA Trust Commercial |
$2,394.70
|
| Rate for Payer: WPS Commercial |
$3,225.01
|
|
|
PLATE CONDYLAR 2.0MM 7H/39MM/RIGHT 243.62
|
Facility
|
IP
|
$4,354.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508692
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,133.46 |
| Max. Negotiated Rate |
$4,005.68 |
| Rate for Payer: Aetna Commercial |
$3,918.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,744.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,307.62
|
| Rate for Payer: Cash Price |
$1,306.20
|
| Rate for Payer: Cigna Commercial |
$4,005.68
|
| Rate for Payer: Health EOS Commercial |
$3,875.06
|
| Rate for Payer: HFN Commercial |
$4,005.68
|
| Rate for Payer: Multiplan Commercial |
$3,483.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,612.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,005.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,133.46
|
| Rate for Payer: Quartz Commercial |
$2,612.40
|
| Rate for Payer: WEA Trust Commercial |
$2,394.70
|
| Rate for Payer: WPS Commercial |
$3,225.01
|
|
|
PLATE CONDYLAR 2.4 LCP 7HL SHAFT 249.679
|
Facility
|
IP
|
$5,463.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966324
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,676.87 |
| Max. Negotiated Rate |
$5,025.96 |
| Rate for Payer: Aetna Commercial |
$4,916.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,698.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,895.39
|
| Rate for Payer: Cash Price |
$1,638.90
|
| Rate for Payer: Cigna Commercial |
$5,025.96
|
| Rate for Payer: Health EOS Commercial |
$4,862.07
|
| Rate for Payer: HFN Commercial |
$5,025.96
|
| Rate for Payer: Multiplan Commercial |
$4,370.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,277.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,025.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,676.87
|
| Rate for Payer: Quartz Commercial |
$3,277.80
|
| Rate for Payer: WEA Trust Commercial |
$3,004.65
|
| Rate for Payer: WPS Commercial |
$4,046.44
|
|
|
PLATE CONDYLAR 2.4 LCP 7HL SHAFT 249.679
|
Facility
|
OP
|
$5,463.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966324
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,529.64 |
| Max. Negotiated Rate |
$21,852.00 |
| Rate for Payer: Aetna Commercial |
$4,916.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,698.18
|
| Rate for Payer: Aetna Managed Medicare |
$1,529.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,550.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,731.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,622.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,895.39
|
| Rate for Payer: Cash Price |
$1,638.90
|
| Rate for Payer: Cigna Commercial |
$5,025.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,057.09
|
| Rate for Payer: Health EOS Commercial |
$4,862.07
|
| Rate for Payer: HFN Commercial |
$5,025.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,097.25
|
| Rate for Payer: Multiplan Commercial |
$4,370.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,277.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,025.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,676.87
|
| Rate for Payer: Quartz Commercial |
$3,550.95
|
| Rate for Payer: Quartz Medicare Advantage |
$3,277.80
|
| Rate for Payer: The Alliance Commercial |
$21,852.00
|
| Rate for Payer: WEA Trust Commercial |
$3,004.65
|
| Rate for Payer: WPS Commercial |
$4,046.44
|
|
|
PLATE CONDYLAR 2.4MM 8HL LEFT 249.917
|
Facility
|
IP
|
$4,622.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508777
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,264.78 |
| Max. Negotiated Rate |
$4,252.24 |
| Rate for Payer: Aetna Commercial |
$4,159.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,974.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,449.66
|
| Rate for Payer: Cash Price |
$1,386.60
|
| Rate for Payer: Cigna Commercial |
$4,252.24
|
| Rate for Payer: Health EOS Commercial |
$4,113.58
|
| Rate for Payer: HFN Commercial |
$4,252.24
|
| Rate for Payer: Multiplan Commercial |
$3,697.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,773.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,252.24
|
| Rate for Payer: Quartz Beloit One Network |
$2,264.78
|
| Rate for Payer: Quartz Commercial |
$2,773.20
|
| Rate for Payer: WEA Trust Commercial |
$2,542.10
|
| Rate for Payer: WPS Commercial |
$3,423.52
|
|
|
PLATE CONDYLAR 2.4MM 8HL LEFT 249.917
|
Facility
|
OP
|
$4,622.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508777
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,294.16 |
| Max. Negotiated Rate |
$18,488.00 |
| Rate for Payer: Aetna Commercial |
$4,159.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,974.92
|
| Rate for Payer: Aetna Managed Medicare |
$1,294.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,004.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,311.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,218.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,449.66
|
| Rate for Payer: Cash Price |
$1,386.60
|
| Rate for Payer: Cigna Commercial |
$4,252.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,586.47
|
| Rate for Payer: Health EOS Commercial |
$4,113.58
|
| Rate for Payer: HFN Commercial |
$4,252.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,466.50
|
| Rate for Payer: Multiplan Commercial |
$3,697.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,773.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,252.24
|
| Rate for Payer: Quartz Beloit One Network |
$2,264.78
|
| Rate for Payer: Quartz Commercial |
$3,004.30
|
| Rate for Payer: Quartz Medicare Advantage |
$2,773.20
|
| Rate for Payer: The Alliance Commercial |
$18,488.00
|
| Rate for Payer: WEA Trust Commercial |
$2,542.10
|
| Rate for Payer: WPS Commercial |
$3,423.52
|
|
|
PLATE CONDYLAR 2.4MM 8HL RIGHT 249.916
|
Facility
|
OP
|
$4,622.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,294.16 |
| Max. Negotiated Rate |
$18,488.00 |
| Rate for Payer: Aetna Commercial |
$4,159.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,974.92
|
| Rate for Payer: Aetna Managed Medicare |
$1,294.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,004.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,311.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,218.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,449.66
|
| Rate for Payer: Cash Price |
$1,386.60
|
| Rate for Payer: Cigna Commercial |
$4,252.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,586.47
|
| Rate for Payer: Health EOS Commercial |
$4,113.58
|
| Rate for Payer: HFN Commercial |
$4,252.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,466.50
|
| Rate for Payer: Multiplan Commercial |
$3,697.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,773.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,252.24
|
| Rate for Payer: Quartz Beloit One Network |
$2,264.78
|
| Rate for Payer: Quartz Commercial |
$3,004.30
|
| Rate for Payer: Quartz Medicare Advantage |
$2,773.20
|
| Rate for Payer: The Alliance Commercial |
$18,488.00
|
| Rate for Payer: WEA Trust Commercial |
$2,542.10
|
| Rate for Payer: WPS Commercial |
$3,423.52
|
|
|
PLATE CONDYLAR 2.4MM 8HL RIGHT 249.916
|
Facility
|
IP
|
$4,622.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,264.78 |
| Max. Negotiated Rate |
$4,252.24 |
| Rate for Payer: Aetna Commercial |
$4,159.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,974.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,449.66
|
| Rate for Payer: Cash Price |
$1,386.60
|
| Rate for Payer: Cigna Commercial |
$4,252.24
|
| Rate for Payer: Health EOS Commercial |
$4,113.58
|
| Rate for Payer: HFN Commercial |
$4,252.24
|
| Rate for Payer: Multiplan Commercial |
$3,697.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,773.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,252.24
|
| Rate for Payer: Quartz Beloit One Network |
$2,264.78
|
| Rate for Payer: Quartz Commercial |
$2,773.20
|
| Rate for Payer: WEA Trust Commercial |
$2,542.10
|
| Rate for Payer: WPS Commercial |
$3,423.52
|
|
|
PLATE CONDYLAR 4.5 VA-LCP CURVED 10 HL 230MM LT 02.124.411S
|
Facility
|
OP
|
$8,928.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3333535
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,499.84 |
| Max. Negotiated Rate |
$35,712.00 |
| Rate for Payer: Aetna Commercial |
$8,035.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,678.08
|
| Rate for Payer: Aetna Managed Medicare |
$2,499.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,803.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,464.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,285.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,731.84
|
| Rate for Payer: Cash Price |
$2,678.40
|
| Rate for Payer: Cigna Commercial |
$8,213.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,996.11
|
| Rate for Payer: Health EOS Commercial |
$7,945.92
|
| Rate for Payer: HFN Commercial |
$8,213.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,696.00
|
| Rate for Payer: Multiplan Commercial |
$7,142.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,356.80
|
| Rate for Payer: Preferred Network Access Commercial |
$8,213.76
|
| Rate for Payer: Quartz Beloit One Network |
$4,374.72
|
| Rate for Payer: Quartz Commercial |
$5,803.20
|
| Rate for Payer: Quartz Medicare Advantage |
$5,356.80
|
| Rate for Payer: The Alliance Commercial |
$35,712.00
|
| Rate for Payer: WEA Trust Commercial |
$4,910.40
|
| Rate for Payer: WPS Commercial |
$6,612.97
|
|
|
PLATE CONDYLAR 4.5 VA-LCP CURVED 10 HL 230MM LT 02.124.411S
|
Facility
|
IP
|
$8,928.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3333535
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,374.72 |
| Max. Negotiated Rate |
$8,213.76 |
| Rate for Payer: Aetna Commercial |
$8,035.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,678.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,731.84
|
| Rate for Payer: Cash Price |
$2,678.40
|
| Rate for Payer: Cigna Commercial |
$8,213.76
|
| Rate for Payer: Health EOS Commercial |
$7,945.92
|
| Rate for Payer: HFN Commercial |
$8,213.76
|
| Rate for Payer: Multiplan Commercial |
$7,142.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,356.80
|
| Rate for Payer: Preferred Network Access Commercial |
$8,213.76
|
| Rate for Payer: Quartz Beloit One Network |
$4,374.72
|
| Rate for Payer: Quartz Commercial |
$5,356.80
|
| Rate for Payer: WEA Trust Commercial |
$4,910.40
|
| Rate for Payer: WPS Commercial |
$6,612.97
|
|
|
PLATE CONDYLAR 4.5 VA-LCP CURVED 10 HL RT 02.124.410
|
Facility
|
OP
|
$7,868.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6169849
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,203.04 |
| Max. Negotiated Rate |
$31,472.00 |
| Rate for Payer: Aetna Commercial |
$7,081.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,766.48
|
| Rate for Payer: Aetna Managed Medicare |
$2,203.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,114.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,934.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,776.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,170.04
|
| Rate for Payer: Cash Price |
$2,360.40
|
| Rate for Payer: Cigna Commercial |
$7,238.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,402.93
|
| Rate for Payer: Health EOS Commercial |
$7,002.52
|
| Rate for Payer: HFN Commercial |
$7,238.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,901.00
|
| Rate for Payer: Multiplan Commercial |
$6,294.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,720.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,238.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,855.32
|
| Rate for Payer: Quartz Commercial |
$5,114.20
|
| Rate for Payer: Quartz Medicare Advantage |
$4,720.80
|
| Rate for Payer: The Alliance Commercial |
$31,472.00
|
| Rate for Payer: WEA Trust Commercial |
$4,327.40
|
| Rate for Payer: WPS Commercial |
$5,827.83
|
|
|
PLATE CONDYLAR 4.5 VA-LCP CURVED 10 HL RT 02.124.410
|
Facility
|
IP
|
$7,868.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6169849
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,855.32 |
| Max. Negotiated Rate |
$7,238.56 |
| Rate for Payer: Aetna Commercial |
$7,081.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,766.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,170.04
|
| Rate for Payer: Cash Price |
$2,360.40
|
| Rate for Payer: Cigna Commercial |
$7,238.56
|
| Rate for Payer: Health EOS Commercial |
$7,002.52
|
| Rate for Payer: HFN Commercial |
$7,238.56
|
| Rate for Payer: Multiplan Commercial |
$6,294.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,720.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,238.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,855.32
|
| Rate for Payer: Quartz Commercial |
$4,720.80
|
| Rate for Payer: WEA Trust Commercial |
$4,327.40
|
| Rate for Payer: WPS Commercial |
$5,827.83
|
|
|
PLATE CONDYLAR 4.5 VA-LCP CURVED 12 HL 266MM RT 02.124.412S
|
Facility
|
OP
|
$8,552.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5306728
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,394.56 |
| Max. Negotiated Rate |
$34,208.00 |
| Rate for Payer: Aetna Commercial |
$7,696.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,354.72
|
| Rate for Payer: Aetna Managed Medicare |
$2,394.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,558.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,276.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,104.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,532.56
|
| Rate for Payer: Cash Price |
$2,565.60
|
| Rate for Payer: Cigna Commercial |
$7,867.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,785.70
|
| Rate for Payer: Health EOS Commercial |
$7,611.28
|
| Rate for Payer: HFN Commercial |
$7,867.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,414.00
|
| Rate for Payer: Multiplan Commercial |
$6,841.60
|
| Rate for Payer: NAPHCARE Commercial |
$5,131.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,867.84
|
| Rate for Payer: Quartz Beloit One Network |
$4,190.48
|
| Rate for Payer: Quartz Commercial |
$5,558.80
|
| Rate for Payer: Quartz Medicare Advantage |
$5,131.20
|
| Rate for Payer: The Alliance Commercial |
$34,208.00
|
| Rate for Payer: WEA Trust Commercial |
$4,703.60
|
| Rate for Payer: WPS Commercial |
$6,334.47
|
|
|
PLATE CONDYLAR 4.5 VA-LCP CURVED 12 HL 266MM RT 02.124.412S
|
Facility
|
IP
|
$8,552.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5306728
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,190.48 |
| Max. Negotiated Rate |
$7,867.84 |
| Rate for Payer: Aetna Commercial |
$7,696.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,354.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,532.56
|
| Rate for Payer: Cash Price |
$2,565.60
|
| Rate for Payer: Cigna Commercial |
$7,867.84
|
| Rate for Payer: Health EOS Commercial |
$7,611.28
|
| Rate for Payer: HFN Commercial |
$7,867.84
|
| Rate for Payer: Multiplan Commercial |
$6,841.60
|
| Rate for Payer: NAPHCARE Commercial |
$5,131.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,867.84
|
| Rate for Payer: Quartz Beloit One Network |
$4,190.48
|
| Rate for Payer: Quartz Commercial |
$5,131.20
|
| Rate for Payer: WEA Trust Commercial |
$4,703.60
|
| Rate for Payer: WPS Commercial |
$6,334.47
|
|
|
PLATE CONDYLAR 4.5 VA-LCP CURVED 12 HL LT 02.124.413
|
Facility
|
OP
|
$9,037.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4778610
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,530.36 |
| Max. Negotiated Rate |
$36,148.00 |
| Rate for Payer: Aetna Commercial |
$8,133.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,771.82
|
| Rate for Payer: Aetna Managed Medicare |
$2,530.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,874.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,518.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,337.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,789.61
|
| Rate for Payer: Cash Price |
$2,711.10
|
| Rate for Payer: Cigna Commercial |
$8,314.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,057.11
|
| Rate for Payer: Health EOS Commercial |
$8,042.93
|
| Rate for Payer: HFN Commercial |
$8,314.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,777.75
|
| Rate for Payer: Multiplan Commercial |
$7,229.60
|
| Rate for Payer: NAPHCARE Commercial |
$5,422.20
|
| Rate for Payer: Preferred Network Access Commercial |
$8,314.04
|
| Rate for Payer: Quartz Beloit One Network |
$4,428.13
|
| Rate for Payer: Quartz Commercial |
$5,874.05
|
| Rate for Payer: Quartz Medicare Advantage |
$5,422.20
|
| Rate for Payer: The Alliance Commercial |
$36,148.00
|
| Rate for Payer: WEA Trust Commercial |
$4,970.35
|
| Rate for Payer: WPS Commercial |
$6,693.71
|
|
|
PLATE CONDYLAR 4.5 VA-LCP CURVED 12 HL LT 02.124.413
|
Facility
|
IP
|
$9,037.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4778610
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,428.13 |
| Max. Negotiated Rate |
$8,314.04 |
| Rate for Payer: Aetna Commercial |
$8,133.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,771.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,789.61
|
| Rate for Payer: Cash Price |
$2,711.10
|
| Rate for Payer: Cigna Commercial |
$8,314.04
|
| Rate for Payer: Health EOS Commercial |
$8,042.93
|
| Rate for Payer: HFN Commercial |
$8,314.04
|
| Rate for Payer: Multiplan Commercial |
$7,229.60
|
| Rate for Payer: NAPHCARE Commercial |
$5,422.20
|
| Rate for Payer: Preferred Network Access Commercial |
$8,314.04
|
| Rate for Payer: Quartz Beloit One Network |
$4,428.13
|
| Rate for Payer: Quartz Commercial |
$5,422.20
|
| Rate for Payer: WEA Trust Commercial |
$4,970.35
|
| Rate for Payer: WPS Commercial |
$6,693.71
|
|
|
PLATE CONDYLAR 4.5 VA-LCP CURVED 14 HL LT 02.124.415
|
Facility
|
IP
|
$9,644.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3393528
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,725.56 |
| Max. Negotiated Rate |
$8,872.48 |
| Rate for Payer: Aetna Commercial |
$8,679.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,293.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,111.32
|
| Rate for Payer: Cash Price |
$2,893.20
|
| Rate for Payer: Cigna Commercial |
$8,872.48
|
| Rate for Payer: Health EOS Commercial |
$8,583.16
|
| Rate for Payer: HFN Commercial |
$8,872.48
|
| Rate for Payer: Multiplan Commercial |
$7,715.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,786.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,872.48
|
| Rate for Payer: Quartz Beloit One Network |
$4,725.56
|
| Rate for Payer: Quartz Commercial |
$5,786.40
|
| Rate for Payer: WEA Trust Commercial |
$5,304.20
|
| Rate for Payer: WPS Commercial |
$7,143.31
|
|
|
PLATE CONDYLAR 4.5 VA-LCP CURVED 14 HL LT 02.124.415
|
Facility
|
OP
|
$9,644.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3393528
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,700.32 |
| Max. Negotiated Rate |
$38,576.00 |
| Rate for Payer: Aetna Commercial |
$8,679.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,293.84
|
| Rate for Payer: Aetna Managed Medicare |
$2,700.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,268.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,822.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,629.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,111.32
|
| Rate for Payer: Cash Price |
$2,893.20
|
| Rate for Payer: Cigna Commercial |
$8,872.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,396.78
|
| Rate for Payer: Health EOS Commercial |
$8,583.16
|
| Rate for Payer: HFN Commercial |
$8,872.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,233.00
|
| Rate for Payer: Multiplan Commercial |
$7,715.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,786.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,872.48
|
| Rate for Payer: Quartz Beloit One Network |
$4,725.56
|
| Rate for Payer: Quartz Commercial |
$6,268.60
|
| Rate for Payer: Quartz Medicare Advantage |
$5,786.40
|
| Rate for Payer: The Alliance Commercial |
$38,576.00
|
| Rate for Payer: WEA Trust Commercial |
$5,304.20
|
| Rate for Payer: WPS Commercial |
$7,143.31
|
|
|
PLATE CONDYLAR 4.5 VA-LCP CURVED 8 HL 230MM LT 02.124.409S
|
Facility
|
OP
|
$7,814.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5286725
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,187.92 |
| Max. Negotiated Rate |
$31,256.00 |
| Rate for Payer: Aetna Commercial |
$7,032.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,720.04
|
| Rate for Payer: Aetna Managed Medicare |
$2,187.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,079.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,907.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,750.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,141.42
|
| Rate for Payer: Cash Price |
$2,344.20
|
| Rate for Payer: Cigna Commercial |
$7,188.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,372.71
|
| Rate for Payer: Health EOS Commercial |
$6,954.46
|
| Rate for Payer: HFN Commercial |
$7,188.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,860.50
|
| Rate for Payer: Multiplan Commercial |
$6,251.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,688.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,188.88
|
| Rate for Payer: Quartz Beloit One Network |
$3,828.86
|
| Rate for Payer: Quartz Commercial |
$5,079.10
|
| Rate for Payer: Quartz Medicare Advantage |
$4,688.40
|
| Rate for Payer: The Alliance Commercial |
$31,256.00
|
| Rate for Payer: WEA Trust Commercial |
$4,297.70
|
| Rate for Payer: WPS Commercial |
$5,787.83
|
|
|
PLATE CONDYLAR 4.5 VA-LCP CURVED 8 HL 230MM LT 02.124.409S
|
Facility
|
IP
|
$7,814.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5286725
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,828.86 |
| Max. Negotiated Rate |
$7,188.88 |
| Rate for Payer: Aetna Commercial |
$7,032.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,720.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,141.42
|
| Rate for Payer: Cash Price |
$2,344.20
|
| Rate for Payer: Cigna Commercial |
$7,188.88
|
| Rate for Payer: Health EOS Commercial |
$6,954.46
|
| Rate for Payer: HFN Commercial |
$7,188.88
|
| Rate for Payer: Multiplan Commercial |
$6,251.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,688.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,188.88
|
| Rate for Payer: Quartz Beloit One Network |
$3,828.86
|
| Rate for Payer: Quartz Commercial |
$4,688.40
|
| Rate for Payer: WEA Trust Commercial |
$4,297.70
|
| Rate for Payer: WPS Commercial |
$5,787.83
|
|
|
PLATE CONDYLAR CRV 10 HL LT 02.001.300
|
Facility
|
OP
|
$10,068.00
|
|
| Hospital Charge Code |
2966364
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,819.04 |
| Max. Negotiated Rate |
$40,272.00 |
| Rate for Payer: Aetna Commercial |
$9,061.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,658.48
|
| Rate for Payer: Aetna Managed Medicare |
$2,819.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,544.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,034.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,832.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,336.04
|
| Rate for Payer: Cash Price |
$3,020.40
|
| Rate for Payer: Cigna Commercial |
$9,262.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,634.05
|
| Rate for Payer: Health EOS Commercial |
$8,960.52
|
| Rate for Payer: HFN Commercial |
$9,262.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,551.00
|
| Rate for Payer: Multiplan Commercial |
$8,054.40
|
| Rate for Payer: NAPHCARE Commercial |
$6,040.80
|
| Rate for Payer: Preferred Network Access Commercial |
$9,262.56
|
| Rate for Payer: Quartz Beloit One Network |
$4,933.32
|
| Rate for Payer: Quartz Commercial |
$6,544.20
|
| Rate for Payer: Quartz Medicare Advantage |
$6,040.80
|
| Rate for Payer: The Alliance Commercial |
$40,272.00
|
| Rate for Payer: WEA Trust Commercial |
$5,537.40
|
| Rate for Payer: WPS Commercial |
$7,457.37
|
|
|
PLATE CONDYLAR CRV 10 HL LT 02.001.300
|
Facility
|
IP
|
$10,068.00
|
|
| Hospital Charge Code |
2966364
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,933.32 |
| Max. Negotiated Rate |
$9,262.56 |
| Rate for Payer: Aetna Commercial |
$9,061.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,658.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,336.04
|
| Rate for Payer: Cash Price |
$3,020.40
|
| Rate for Payer: Cigna Commercial |
$9,262.56
|
| Rate for Payer: Health EOS Commercial |
$8,960.52
|
| Rate for Payer: HFN Commercial |
$9,262.56
|
| Rate for Payer: Multiplan Commercial |
$8,054.40
|
| Rate for Payer: NAPHCARE Commercial |
$6,040.80
|
| Rate for Payer: Preferred Network Access Commercial |
$9,262.56
|
| Rate for Payer: Quartz Beloit One Network |
$4,933.32
|
| Rate for Payer: Quartz Commercial |
$6,040.80
|
| Rate for Payer: WEA Trust Commercial |
$5,537.40
|
| Rate for Payer: WPS Commercial |
$7,457.37
|
|
