|
PLATE DISTAL HUMERUS 2.7/3.5 VA EXT MEDIAL LATERAL 2HL LT MEDIUM 02.117.702
|
Facility
|
IP
|
$5,535.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6248165
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,712.45 |
| Max. Negotiated Rate |
$5,092.77 |
| Rate for Payer: Aetna Commercial |
$4,982.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,760.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,933.88
|
| Rate for Payer: Cash Price |
$1,660.69
|
| Rate for Payer: Cigna Commercial |
$5,092.77
|
| Rate for Payer: Health EOS Commercial |
$4,926.70
|
| Rate for Payer: HFN Commercial |
$5,092.77
|
| Rate for Payer: Multiplan Commercial |
$4,428.50
|
| Rate for Payer: NAPHCARE Commercial |
$3,321.37
|
| Rate for Payer: Preferred Network Access Commercial |
$5,092.77
|
| Rate for Payer: Quartz Beloit One Network |
$2,712.45
|
| Rate for Payer: Quartz Commercial |
$3,321.37
|
| Rate for Payer: WEA Trust Commercial |
$3,044.59
|
| Rate for Payer: WPS Commercial |
$4,100.23
|
|
|
PLATE DISTAL HUMERUS 2.7/3.5 VA EXT MEDIAL LATERAL 2HL LT MEDIUM 02.117.702
|
Facility
|
OP
|
$5,535.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6248165
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,549.97 |
| Max. Negotiated Rate |
$22,142.48 |
| Rate for Payer: Aetna Commercial |
$4,982.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,760.63
|
| Rate for Payer: Aetna Managed Medicare |
$1,549.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,598.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,767.81
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,657.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,933.88
|
| Rate for Payer: Cash Price |
$1,660.69
|
| Rate for Payer: Cigna Commercial |
$5,092.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,097.73
|
| Rate for Payer: Health EOS Commercial |
$4,926.70
|
| Rate for Payer: HFN Commercial |
$5,092.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,151.72
|
| Rate for Payer: Multiplan Commercial |
$4,428.50
|
| Rate for Payer: NAPHCARE Commercial |
$3,321.37
|
| Rate for Payer: Preferred Network Access Commercial |
$5,092.77
|
| Rate for Payer: Quartz Beloit One Network |
$2,712.45
|
| Rate for Payer: Quartz Commercial |
$3,598.15
|
| Rate for Payer: Quartz Medicare Advantage |
$3,321.37
|
| Rate for Payer: The Alliance Commercial |
$22,142.48
|
| Rate for Payer: WEA Trust Commercial |
$3,044.59
|
| Rate for Payer: WPS Commercial |
$4,100.23
|
|
|
PLATE DISTAL HUMERUS 2.7/3.5 VA POSTERIOR LATERAL 3HL lT SHORT 02.117.303
|
Facility
|
OP
|
$5,592.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5611739
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,565.76 |
| Max. Negotiated Rate |
$22,368.00 |
| Rate for Payer: Aetna Commercial |
$5,032.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,809.12
|
| Rate for Payer: Aetna Managed Medicare |
$1,565.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,634.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,796.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,684.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,963.76
|
| Rate for Payer: Cash Price |
$1,677.60
|
| Rate for Payer: Cigna Commercial |
$5,144.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,129.28
|
| Rate for Payer: Health EOS Commercial |
$4,976.88
|
| Rate for Payer: HFN Commercial |
$5,144.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,194.00
|
| Rate for Payer: Multiplan Commercial |
$4,473.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,355.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,144.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,740.08
|
| Rate for Payer: Quartz Commercial |
$3,634.80
|
| Rate for Payer: Quartz Medicare Advantage |
$3,355.20
|
| Rate for Payer: The Alliance Commercial |
$22,368.00
|
| Rate for Payer: WEA Trust Commercial |
$3,075.60
|
| Rate for Payer: WPS Commercial |
$4,141.99
|
|
|
PLATE DISTAL HUMERUS 2.7/3.5 VA POSTERIOR LATERAL 3HL lT SHORT 02.117.303
|
Facility
|
IP
|
$5,592.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5611739
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,740.08 |
| Max. Negotiated Rate |
$5,144.64 |
| Rate for Payer: Aetna Commercial |
$5,032.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,809.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,963.76
|
| Rate for Payer: Cash Price |
$1,677.60
|
| Rate for Payer: Cigna Commercial |
$5,144.64
|
| Rate for Payer: Health EOS Commercial |
$4,976.88
|
| Rate for Payer: HFN Commercial |
$5,144.64
|
| Rate for Payer: Multiplan Commercial |
$4,473.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,355.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,144.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,740.08
|
| Rate for Payer: Quartz Commercial |
$3,355.20
|
| Rate for Payer: WEA Trust Commercial |
$3,075.60
|
| Rate for Payer: WPS Commercial |
$4,141.99
|
|
|
PLATE DISTAL HUMERUS 2.7/3.5 VA POSTERIOR LATERAL 3HL RT SHORT 02.117.203
|
Facility
|
IP
|
$5,369.34
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6248164
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,630.98 |
| Max. Negotiated Rate |
$4,939.79 |
| Rate for Payer: Aetna Commercial |
$4,832.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,617.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,845.75
|
| Rate for Payer: Cash Price |
$1,610.80
|
| Rate for Payer: Cigna Commercial |
$4,939.79
|
| Rate for Payer: Health EOS Commercial |
$4,778.71
|
| Rate for Payer: HFN Commercial |
$4,939.79
|
| Rate for Payer: Multiplan Commercial |
$4,295.47
|
| Rate for Payer: NAPHCARE Commercial |
$3,221.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,939.79
|
| Rate for Payer: Quartz Beloit One Network |
$2,630.98
|
| Rate for Payer: Quartz Commercial |
$3,221.60
|
| Rate for Payer: WEA Trust Commercial |
$2,953.14
|
| Rate for Payer: WPS Commercial |
$3,977.07
|
|
|
PLATE DISTAL HUMERUS 2.7/3.5 VA POSTERIOR LATERAL 3HL RT SHORT 02.117.203
|
Facility
|
OP
|
$5,369.34
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6248164
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,503.42 |
| Max. Negotiated Rate |
$21,477.36 |
| Rate for Payer: Aetna Commercial |
$4,832.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,617.63
|
| Rate for Payer: Aetna Managed Medicare |
$1,503.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,490.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,684.67
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,577.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,845.75
|
| Rate for Payer: Cash Price |
$1,610.80
|
| Rate for Payer: Cigna Commercial |
$4,939.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,004.68
|
| Rate for Payer: Health EOS Commercial |
$4,778.71
|
| Rate for Payer: HFN Commercial |
$4,939.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,027.00
|
| Rate for Payer: Multiplan Commercial |
$4,295.47
|
| Rate for Payer: NAPHCARE Commercial |
$3,221.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,939.79
|
| Rate for Payer: Quartz Beloit One Network |
$2,630.98
|
| Rate for Payer: Quartz Commercial |
$3,490.07
|
| Rate for Payer: Quartz Medicare Advantage |
$3,221.60
|
| Rate for Payer: The Alliance Commercial |
$21,477.36
|
| Rate for Payer: WEA Trust Commercial |
$2,953.14
|
| Rate for Payer: WPS Commercial |
$3,977.07
|
|
|
PLATE DISTAL HUMERUS 2.7/3.5 VA POSTERIOR LATERAL 4HL RT MEDIUM 02.117.204S
|
Facility
|
OP
|
$6,190.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3265482
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,733.20 |
| Max. Negotiated Rate |
$24,760.00 |
| Rate for Payer: Aetna Commercial |
$5,571.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,323.40
|
| Rate for Payer: Aetna Managed Medicare |
$1,733.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,023.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,095.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,971.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,280.70
|
| Rate for Payer: Cash Price |
$1,857.00
|
| Rate for Payer: Cigna Commercial |
$5,694.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,463.92
|
| Rate for Payer: Health EOS Commercial |
$5,509.10
|
| Rate for Payer: HFN Commercial |
$5,694.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,642.50
|
| Rate for Payer: Multiplan Commercial |
$4,952.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,714.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,694.80
|
| Rate for Payer: Quartz Beloit One Network |
$3,033.10
|
| Rate for Payer: Quartz Commercial |
$4,023.50
|
| Rate for Payer: Quartz Medicare Advantage |
$3,714.00
|
| Rate for Payer: The Alliance Commercial |
$24,760.00
|
| Rate for Payer: WEA Trust Commercial |
$3,404.50
|
| Rate for Payer: WPS Commercial |
$4,584.93
|
|
|
PLATE DISTAL HUMERUS 2.7/3.5 VA POSTERIOR LATERAL 4HL RT MEDIUM 02.117.204S
|
Facility
|
IP
|
$6,190.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3265482
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,033.10 |
| Max. Negotiated Rate |
$5,694.80 |
| Rate for Payer: Aetna Commercial |
$5,571.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,323.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,280.70
|
| Rate for Payer: Cash Price |
$1,857.00
|
| Rate for Payer: Cigna Commercial |
$5,694.80
|
| Rate for Payer: Health EOS Commercial |
$5,509.10
|
| Rate for Payer: HFN Commercial |
$5,694.80
|
| Rate for Payer: Multiplan Commercial |
$4,952.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,714.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,694.80
|
| Rate for Payer: Quartz Beloit One Network |
$3,033.10
|
| Rate for Payer: Quartz Commercial |
$3,714.00
|
| Rate for Payer: WEA Trust Commercial |
$3,404.50
|
| Rate for Payer: WPS Commercial |
$4,584.93
|
|
|
PLATE DISTAL HUMERUS 2.7/3.5 VA POSTEROLATERAL 9HL RT EXTRA LONG 02.117.209
|
Facility
|
OP
|
$5,887.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4519193
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,648.36 |
| Max. Negotiated Rate |
$23,548.00 |
| Rate for Payer: Aetna Commercial |
$5,298.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,062.82
|
| Rate for Payer: Aetna Managed Medicare |
$1,648.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,826.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,943.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,825.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,120.11
|
| Rate for Payer: Cash Price |
$1,766.10
|
| Rate for Payer: Cigna Commercial |
$5,416.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,294.37
|
| Rate for Payer: Health EOS Commercial |
$5,239.43
|
| Rate for Payer: HFN Commercial |
$5,416.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,415.25
|
| Rate for Payer: Multiplan Commercial |
$4,709.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,532.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,416.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,884.63
|
| Rate for Payer: Quartz Commercial |
$3,826.55
|
| Rate for Payer: Quartz Medicare Advantage |
$3,532.20
|
| Rate for Payer: The Alliance Commercial |
$23,548.00
|
| Rate for Payer: WEA Trust Commercial |
$3,237.85
|
| Rate for Payer: WPS Commercial |
$4,360.50
|
|
|
PLATE DISTAL HUMERUS 2.7/3.5 VA POSTEROLATERAL 9HL RT EXTRA LONG 02.117.209
|
Facility
|
IP
|
$5,887.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4519193
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,884.63 |
| Max. Negotiated Rate |
$5,416.04 |
| Rate for Payer: Aetna Commercial |
$5,298.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,062.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,120.11
|
| Rate for Payer: Cash Price |
$1,766.10
|
| Rate for Payer: Cigna Commercial |
$5,416.04
|
| Rate for Payer: Health EOS Commercial |
$5,239.43
|
| Rate for Payer: HFN Commercial |
$5,416.04
|
| Rate for Payer: Multiplan Commercial |
$4,709.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,532.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,416.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,884.63
|
| Rate for Payer: Quartz Commercial |
$3,532.20
|
| Rate for Payer: WEA Trust Commercial |
$3,237.85
|
| Rate for Payer: WPS Commercial |
$4,360.50
|
|
|
PLATE DISTAL HUMERUS 3.5 10HL LT 02.104.030
|
Facility
|
OP
|
$7,056.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6180035
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,975.68 |
| Max. Negotiated Rate |
$28,224.00 |
| Rate for Payer: Aetna Commercial |
$6,350.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,068.16
|
| Rate for Payer: Aetna Managed Medicare |
$1,975.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,586.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,528.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,386.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,739.68
|
| Rate for Payer: Cash Price |
$2,116.80
|
| Rate for Payer: Cigna Commercial |
$6,491.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,948.54
|
| Rate for Payer: Health EOS Commercial |
$6,279.84
|
| Rate for Payer: HFN Commercial |
$6,491.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,292.00
|
| Rate for Payer: Multiplan Commercial |
$5,644.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,233.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,491.52
|
| Rate for Payer: Quartz Beloit One Network |
$3,457.44
|
| Rate for Payer: Quartz Commercial |
$4,586.40
|
| Rate for Payer: Quartz Medicare Advantage |
$4,233.60
|
| Rate for Payer: The Alliance Commercial |
$28,224.00
|
| Rate for Payer: WEA Trust Commercial |
$3,880.80
|
| Rate for Payer: WPS Commercial |
$5,226.38
|
|
|
PLATE DISTAL HUMERUS 3.5 10HL LT 02.104.030
|
Facility
|
IP
|
$7,056.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6180035
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,457.44 |
| Max. Negotiated Rate |
$6,491.52 |
| Rate for Payer: Aetna Commercial |
$6,350.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,068.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,739.68
|
| Rate for Payer: Cash Price |
$2,116.80
|
| Rate for Payer: Cigna Commercial |
$6,491.52
|
| Rate for Payer: Health EOS Commercial |
$6,279.84
|
| Rate for Payer: HFN Commercial |
$6,491.52
|
| Rate for Payer: Multiplan Commercial |
$5,644.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,233.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,491.52
|
| Rate for Payer: Quartz Beloit One Network |
$3,457.44
|
| Rate for Payer: Quartz Commercial |
$4,233.60
|
| Rate for Payer: WEA Trust Commercial |
$3,880.80
|
| Rate for Payer: WPS Commercial |
$5,226.38
|
|
|
PLATE DISTAL HUMERUS 3.5 6HL LT 02.104.026S
|
Facility
|
OP
|
$8,692.00
|
|
| Hospital Charge Code |
2966338
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,433.76 |
| Max. Negotiated Rate |
$34,768.00 |
| Rate for Payer: Aetna Commercial |
$7,822.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,475.12
|
| Rate for Payer: Aetna Managed Medicare |
$2,433.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,649.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,346.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,172.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,606.76
|
| Rate for Payer: Cash Price |
$2,607.60
|
| Rate for Payer: Cigna Commercial |
$7,996.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,864.04
|
| Rate for Payer: Health EOS Commercial |
$7,735.88
|
| Rate for Payer: HFN Commercial |
$7,996.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,519.00
|
| Rate for Payer: Multiplan Commercial |
$6,953.60
|
| Rate for Payer: NAPHCARE Commercial |
$5,215.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,996.64
|
| Rate for Payer: Quartz Beloit One Network |
$4,259.08
|
| Rate for Payer: Quartz Commercial |
$5,649.80
|
| Rate for Payer: Quartz Medicare Advantage |
$5,215.20
|
| Rate for Payer: The Alliance Commercial |
$34,768.00
|
| Rate for Payer: WEA Trust Commercial |
$4,780.60
|
| Rate for Payer: WPS Commercial |
$6,438.16
|
|
|
PLATE DISTAL HUMERUS 3.5 6HL LT 02.104.026S
|
Facility
|
IP
|
$8,692.00
|
|
| Hospital Charge Code |
2966338
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,259.08 |
| Max. Negotiated Rate |
$7,996.64 |
| Rate for Payer: Aetna Commercial |
$7,822.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,475.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,606.76
|
| Rate for Payer: Cash Price |
$2,607.60
|
| Rate for Payer: Cigna Commercial |
$7,996.64
|
| Rate for Payer: Health EOS Commercial |
$7,735.88
|
| Rate for Payer: HFN Commercial |
$7,996.64
|
| Rate for Payer: Multiplan Commercial |
$6,953.60
|
| Rate for Payer: NAPHCARE Commercial |
$5,215.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,996.64
|
| Rate for Payer: Quartz Beloit One Network |
$4,259.08
|
| Rate for Payer: Quartz Commercial |
$5,215.20
|
| Rate for Payer: WEA Trust Commercial |
$4,780.60
|
| Rate for Payer: WPS Commercial |
$6,438.16
|
|
|
PLATE DISTAL HUMERUS 6HL RT 02.104.006S
|
Facility
|
OP
|
$9,004.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966355
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,521.12 |
| Max. Negotiated Rate |
$36,016.00 |
| Rate for Payer: Aetna Commercial |
$8,103.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,743.44
|
| Rate for Payer: Aetna Managed Medicare |
$2,521.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,852.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,502.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,321.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,772.12
|
| Rate for Payer: Cash Price |
$2,701.20
|
| Rate for Payer: Cigna Commercial |
$8,283.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,038.64
|
| Rate for Payer: Health EOS Commercial |
$8,013.56
|
| Rate for Payer: HFN Commercial |
$8,283.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,753.00
|
| Rate for Payer: Multiplan Commercial |
$7,203.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,402.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,283.68
|
| Rate for Payer: Quartz Beloit One Network |
$4,411.96
|
| Rate for Payer: Quartz Commercial |
$5,852.60
|
| Rate for Payer: Quartz Medicare Advantage |
$5,402.40
|
| Rate for Payer: The Alliance Commercial |
$36,016.00
|
| Rate for Payer: WEA Trust Commercial |
$4,952.20
|
| Rate for Payer: WPS Commercial |
$6,669.26
|
|
|
PLATE DISTAL HUMERUS 6HL RT 02.104.006S
|
Facility
|
IP
|
$9,004.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966355
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,411.96 |
| Max. Negotiated Rate |
$8,283.68 |
| Rate for Payer: Aetna Commercial |
$8,103.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,743.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,772.12
|
| Rate for Payer: Cash Price |
$2,701.20
|
| Rate for Payer: Cigna Commercial |
$8,283.68
|
| Rate for Payer: Health EOS Commercial |
$8,013.56
|
| Rate for Payer: HFN Commercial |
$8,283.68
|
| Rate for Payer: Multiplan Commercial |
$7,203.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,402.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,283.68
|
| Rate for Payer: Quartz Beloit One Network |
$4,411.96
|
| Rate for Payer: Quartz Commercial |
$5,402.40
|
| Rate for Payer: WEA Trust Commercial |
$4,952.20
|
| Rate for Payer: WPS Commercial |
$6,669.26
|
|
|
PLATE DISTAL MEDIAL HUMERUS 4HL 629384
|
Facility
|
OP
|
$7,456.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4006577
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,087.68 |
| Max. Negotiated Rate |
$29,824.00 |
| Rate for Payer: Aetna Commercial |
$6,710.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,412.16
|
| Rate for Payer: Aetna Managed Medicare |
$2,087.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,846.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,728.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,578.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,951.68
|
| Rate for Payer: Cash Price |
$2,236.80
|
| Rate for Payer: Cigna Commercial |
$6,859.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,172.38
|
| Rate for Payer: Health EOS Commercial |
$6,635.84
|
| Rate for Payer: HFN Commercial |
$6,859.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,592.00
|
| Rate for Payer: Multiplan Commercial |
$5,964.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,473.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,859.52
|
| Rate for Payer: Quartz Beloit One Network |
$3,653.44
|
| Rate for Payer: Quartz Commercial |
$4,846.40
|
| Rate for Payer: Quartz Medicare Advantage |
$4,473.60
|
| Rate for Payer: The Alliance Commercial |
$29,824.00
|
| Rate for Payer: WEA Trust Commercial |
$4,100.80
|
| Rate for Payer: WPS Commercial |
$5,522.66
|
|
|
PLATE DISTAL MEDIAL HUMERUS 4HL 629384
|
Facility
|
IP
|
$7,456.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4006577
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,653.44 |
| Max. Negotiated Rate |
$6,859.52 |
| Rate for Payer: Aetna Commercial |
$6,710.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,412.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,951.68
|
| Rate for Payer: Cash Price |
$2,236.80
|
| Rate for Payer: Cigna Commercial |
$6,859.52
|
| Rate for Payer: Health EOS Commercial |
$6,635.84
|
| Rate for Payer: HFN Commercial |
$6,859.52
|
| Rate for Payer: Multiplan Commercial |
$5,964.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,473.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,859.52
|
| Rate for Payer: Quartz Beloit One Network |
$3,653.44
|
| Rate for Payer: Quartz Commercial |
$4,473.60
|
| Rate for Payer: WEA Trust Commercial |
$4,100.80
|
| Rate for Payer: WPS Commercial |
$5,522.66
|
|
|
PLATE DISTAL MEDIAL HUMERUS 6HL 629386
|
Facility
|
OP
|
$7,456.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4006557
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,087.68 |
| Max. Negotiated Rate |
$29,824.00 |
| Rate for Payer: Aetna Commercial |
$6,710.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,412.16
|
| Rate for Payer: Aetna Managed Medicare |
$2,087.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,846.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,728.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,578.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,951.68
|
| Rate for Payer: Cash Price |
$2,236.80
|
| Rate for Payer: Cigna Commercial |
$6,859.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,172.38
|
| Rate for Payer: Health EOS Commercial |
$6,635.84
|
| Rate for Payer: HFN Commercial |
$6,859.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,592.00
|
| Rate for Payer: Multiplan Commercial |
$5,964.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,473.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,859.52
|
| Rate for Payer: Quartz Beloit One Network |
$3,653.44
|
| Rate for Payer: Quartz Commercial |
$4,846.40
|
| Rate for Payer: Quartz Medicare Advantage |
$4,473.60
|
| Rate for Payer: The Alliance Commercial |
$29,824.00
|
| Rate for Payer: WEA Trust Commercial |
$4,100.80
|
| Rate for Payer: WPS Commercial |
$5,522.66
|
|
|
PLATE DISTAL MEDIAL HUMERUS 6HL 629386
|
Facility
|
IP
|
$7,456.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4006557
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,653.44 |
| Max. Negotiated Rate |
$6,859.52 |
| Rate for Payer: Aetna Commercial |
$6,710.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,412.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,951.68
|
| Rate for Payer: Cash Price |
$2,236.80
|
| Rate for Payer: Cigna Commercial |
$6,859.52
|
| Rate for Payer: Health EOS Commercial |
$6,635.84
|
| Rate for Payer: HFN Commercial |
$6,859.52
|
| Rate for Payer: Multiplan Commercial |
$5,964.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,473.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,859.52
|
| Rate for Payer: Quartz Beloit One Network |
$3,653.44
|
| Rate for Payer: Quartz Commercial |
$4,473.60
|
| Rate for Payer: WEA Trust Commercial |
$4,100.80
|
| Rate for Payer: WPS Commercial |
$5,522.66
|
|
|
PLATE DISTAL RADIUS DORSAL NAR LT 4HL TI AR-8916DNL-04
|
Facility
|
OP
|
$6,430.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6217071
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,800.40 |
| Max. Negotiated Rate |
$25,720.00 |
| Rate for Payer: Aetna Commercial |
$5,787.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,529.80
|
| Rate for Payer: Aetna Managed Medicare |
$1,800.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,179.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,215.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,086.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,407.90
|
| Rate for Payer: Cash Price |
$1,929.00
|
| Rate for Payer: Cigna Commercial |
$5,915.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,598.23
|
| Rate for Payer: Health EOS Commercial |
$5,722.70
|
| Rate for Payer: HFN Commercial |
$5,915.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,822.50
|
| Rate for Payer: Multiplan Commercial |
$5,144.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,858.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,915.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,150.70
|
| Rate for Payer: Quartz Commercial |
$4,179.50
|
| Rate for Payer: Quartz Medicare Advantage |
$3,858.00
|
| Rate for Payer: The Alliance Commercial |
$25,720.00
|
| Rate for Payer: WEA Trust Commercial |
$3,536.50
|
| Rate for Payer: WPS Commercial |
$4,762.70
|
|
|
PLATE DISTAL RADIUS DORSAL NAR LT 4HL TI AR-8916DNL-04
|
Facility
|
IP
|
$6,430.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6217071
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,150.70 |
| Max. Negotiated Rate |
$5,915.60 |
| Rate for Payer: Aetna Commercial |
$5,787.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,529.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,407.90
|
| Rate for Payer: Cash Price |
$1,929.00
|
| Rate for Payer: Cigna Commercial |
$5,915.60
|
| Rate for Payer: Health EOS Commercial |
$5,722.70
|
| Rate for Payer: HFN Commercial |
$5,915.60
|
| Rate for Payer: Multiplan Commercial |
$5,144.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,858.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,915.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,150.70
|
| Rate for Payer: Quartz Commercial |
$3,858.00
|
| Rate for Payer: WEA Trust Commercial |
$3,536.50
|
| Rate for Payer: WPS Commercial |
$4,762.70
|
|
|
PLATE DISTAL RADIUS LONG/VOLAR LT TI 442.492
|
Facility
|
IP
|
$6,463.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3853336
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,166.87 |
| Max. Negotiated Rate |
$5,945.96 |
| Rate for Payer: Aetna Commercial |
$5,816.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,558.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,425.39
|
| Rate for Payer: Cash Price |
$1,938.90
|
| Rate for Payer: Cigna Commercial |
$5,945.96
|
| Rate for Payer: Health EOS Commercial |
$5,752.07
|
| Rate for Payer: HFN Commercial |
$5,945.96
|
| Rate for Payer: Multiplan Commercial |
$5,170.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,877.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,945.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,166.87
|
| Rate for Payer: Quartz Commercial |
$3,877.80
|
| Rate for Payer: WEA Trust Commercial |
$3,554.65
|
| Rate for Payer: WPS Commercial |
$4,787.14
|
|
|
PLATE DISTAL RADIUS LONG/VOLAR LT TI 442.492
|
Facility
|
OP
|
$6,463.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3853336
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,809.64 |
| Max. Negotiated Rate |
$25,852.00 |
| Rate for Payer: Aetna Commercial |
$5,816.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,558.18
|
| Rate for Payer: Aetna Managed Medicare |
$1,809.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,200.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,231.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,102.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,425.39
|
| Rate for Payer: Cash Price |
$1,938.90
|
| Rate for Payer: Cigna Commercial |
$5,945.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,616.69
|
| Rate for Payer: Health EOS Commercial |
$5,752.07
|
| Rate for Payer: HFN Commercial |
$5,945.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,847.25
|
| Rate for Payer: Multiplan Commercial |
$5,170.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,877.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,945.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,166.87
|
| Rate for Payer: Quartz Commercial |
$4,200.95
|
| Rate for Payer: Quartz Medicare Advantage |
$3,877.80
|
| Rate for Payer: The Alliance Commercial |
$25,852.00
|
| Rate for Payer: WEA Trust Commercial |
$3,554.65
|
| Rate for Payer: WPS Commercial |
$4,787.14
|
|
|
PLATE DISTAL RADIUS RADIAL STYLOID 5HL AR-8916RSTY-05
|
Facility
|
IP
|
$6,602.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6165906
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,234.98 |
| Max. Negotiated Rate |
$6,073.84 |
| Rate for Payer: Aetna Commercial |
$5,941.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,677.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,499.06
|
| Rate for Payer: Cash Price |
$1,980.60
|
| Rate for Payer: Cigna Commercial |
$6,073.84
|
| Rate for Payer: Health EOS Commercial |
$5,875.78
|
| Rate for Payer: HFN Commercial |
$6,073.84
|
| Rate for Payer: Multiplan Commercial |
$5,281.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,961.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,073.84
|
| Rate for Payer: Quartz Beloit One Network |
$3,234.98
|
| Rate for Payer: Quartz Commercial |
$3,961.20
|
| Rate for Payer: WEA Trust Commercial |
$3,631.10
|
| Rate for Payer: WPS Commercial |
$4,890.10
|
|
