|
PLATE DISTAL TIBIA 3.5 5HL LT
|
Facility
|
IP
|
$2,981.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966366
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,460.69 |
| Max. Negotiated Rate |
$2,742.52 |
| Rate for Payer: Aetna Commercial |
$2,682.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,563.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,579.93
|
| Rate for Payer: Cash Price |
$894.30
|
| Rate for Payer: Cigna Commercial |
$2,742.52
|
| Rate for Payer: Health EOS Commercial |
$2,653.09
|
| Rate for Payer: HFN Commercial |
$2,742.52
|
| Rate for Payer: Multiplan Commercial |
$2,384.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,788.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,742.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,460.69
|
| Rate for Payer: Quartz Commercial |
$1,788.60
|
| Rate for Payer: WEA Trust Commercial |
$1,639.55
|
| Rate for Payer: WPS Commercial |
$2,208.03
|
|
|
PLATE DISTAL TIBIA 3.5 5HL LT
|
Facility
|
OP
|
$2,981.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966366
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$834.68 |
| Max. Negotiated Rate |
$11,924.00 |
| Rate for Payer: Aetna Commercial |
$2,682.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,563.66
|
| Rate for Payer: Aetna Managed Medicare |
$834.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,937.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,490.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,430.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,579.93
|
| Rate for Payer: Cash Price |
$894.30
|
| Rate for Payer: Cigna Commercial |
$2,742.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,668.17
|
| Rate for Payer: Health EOS Commercial |
$2,653.09
|
| Rate for Payer: HFN Commercial |
$2,742.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,235.75
|
| Rate for Payer: Multiplan Commercial |
$2,384.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,788.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,742.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,460.69
|
| Rate for Payer: Quartz Commercial |
$1,937.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,788.60
|
| Rate for Payer: The Alliance Commercial |
$11,924.00
|
| Rate for Payer: WEA Trust Commercial |
$1,639.55
|
| Rate for Payer: WPS Commercial |
$2,208.03
|
|
|
PLATE DISTAL TIBIA VA 2.7/3.5MM 8H RT 02.118.206S
|
Facility
|
OP
|
$8,388.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3265464
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,348.64 |
| Max. Negotiated Rate |
$33,552.00 |
| Rate for Payer: Aetna Commercial |
$7,549.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,213.68
|
| Rate for Payer: Aetna Managed Medicare |
$2,348.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,452.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,194.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,026.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,445.64
|
| Rate for Payer: Cash Price |
$2,516.40
|
| Rate for Payer: Cigna Commercial |
$7,716.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,693.92
|
| Rate for Payer: Health EOS Commercial |
$7,465.32
|
| Rate for Payer: HFN Commercial |
$7,716.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,291.00
|
| Rate for Payer: Multiplan Commercial |
$6,710.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,032.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,716.96
|
| Rate for Payer: Quartz Beloit One Network |
$4,110.12
|
| Rate for Payer: Quartz Commercial |
$5,452.20
|
| Rate for Payer: Quartz Medicare Advantage |
$5,032.80
|
| Rate for Payer: The Alliance Commercial |
$33,552.00
|
| Rate for Payer: WEA Trust Commercial |
$4,613.40
|
| Rate for Payer: WPS Commercial |
$6,212.99
|
|
|
PLATE DISTAL TIBIA VA 2.7/3.5MM 8H RT 02.118.206S
|
Facility
|
IP
|
$8,388.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3265464
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,110.12 |
| Max. Negotiated Rate |
$7,716.96 |
| Rate for Payer: Aetna Commercial |
$7,549.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,213.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,445.64
|
| Rate for Payer: Cash Price |
$2,516.40
|
| Rate for Payer: Cigna Commercial |
$7,716.96
|
| Rate for Payer: Health EOS Commercial |
$7,465.32
|
| Rate for Payer: HFN Commercial |
$7,716.96
|
| Rate for Payer: Multiplan Commercial |
$6,710.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,032.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,716.96
|
| Rate for Payer: Quartz Beloit One Network |
$4,110.12
|
| Rate for Payer: Quartz Commercial |
$5,032.80
|
| Rate for Payer: WEA Trust Commercial |
$4,613.40
|
| Rate for Payer: WPS Commercial |
$6,212.99
|
|
|
PLATE DISTAL TIBIA VA 2.7/3.5MM MEDIAL 8H RT 02.118.006S
|
Facility
|
OP
|
$7,390.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5384651
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,069.20 |
| Max. Negotiated Rate |
$29,560.00 |
| Rate for Payer: Aetna Commercial |
$6,651.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,355.40
|
| Rate for Payer: Aetna Managed Medicare |
$2,069.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,803.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,695.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,547.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,916.70
|
| Rate for Payer: Cash Price |
$2,217.00
|
| Rate for Payer: Cigna Commercial |
$6,798.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,135.44
|
| Rate for Payer: Health EOS Commercial |
$6,577.10
|
| Rate for Payer: HFN Commercial |
$6,798.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,542.50
|
| Rate for Payer: Multiplan Commercial |
$5,912.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,434.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,798.80
|
| Rate for Payer: Quartz Beloit One Network |
$3,621.10
|
| Rate for Payer: Quartz Commercial |
$4,803.50
|
| Rate for Payer: Quartz Medicare Advantage |
$4,434.00
|
| Rate for Payer: The Alliance Commercial |
$29,560.00
|
| Rate for Payer: WEA Trust Commercial |
$4,064.50
|
| Rate for Payer: WPS Commercial |
$5,473.77
|
|
|
PLATE DISTAL TIBIA VA 2.7/3.5MM MEDIAL 8H RT 02.118.006S
|
Facility
|
IP
|
$7,390.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5384651
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,621.10 |
| Max. Negotiated Rate |
$6,798.80 |
| Rate for Payer: Aetna Commercial |
$6,651.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,355.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,916.70
|
| Rate for Payer: Cash Price |
$2,217.00
|
| Rate for Payer: Cigna Commercial |
$6,798.80
|
| Rate for Payer: Health EOS Commercial |
$6,577.10
|
| Rate for Payer: HFN Commercial |
$6,798.80
|
| Rate for Payer: Multiplan Commercial |
$5,912.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,434.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,798.80
|
| Rate for Payer: Quartz Beloit One Network |
$3,621.10
|
| Rate for Payer: Quartz Commercial |
$4,434.00
|
| Rate for Payer: WEA Trust Commercial |
$4,064.50
|
| Rate for Payer: WPS Commercial |
$5,473.77
|
|
|
PLATE DISTAL ULNA LONG LT 70-0047
|
Facility
|
OP
|
$6,306.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459105
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,765.68 |
| Max. Negotiated Rate |
$25,224.00 |
| Rate for Payer: Aetna Commercial |
$5,675.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,423.16
|
| Rate for Payer: Aetna Managed Medicare |
$1,765.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,098.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,153.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,026.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,342.18
|
| Rate for Payer: Cash Price |
$1,891.80
|
| Rate for Payer: Cigna Commercial |
$5,801.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,528.84
|
| Rate for Payer: Health EOS Commercial |
$5,612.34
|
| Rate for Payer: HFN Commercial |
$5,801.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,729.50
|
| Rate for Payer: Multiplan Commercial |
$5,044.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,783.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,801.52
|
| Rate for Payer: Quartz Beloit One Network |
$3,089.94
|
| Rate for Payer: Quartz Commercial |
$4,098.90
|
| Rate for Payer: Quartz Medicare Advantage |
$3,783.60
|
| Rate for Payer: The Alliance Commercial |
$25,224.00
|
| Rate for Payer: WEA Trust Commercial |
$3,468.30
|
| Rate for Payer: WPS Commercial |
$4,670.85
|
|
|
PLATE DISTAL ULNA LONG LT 70-0047
|
Facility
|
IP
|
$6,306.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459105
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,089.94 |
| Max. Negotiated Rate |
$5,801.52 |
| Rate for Payer: Aetna Commercial |
$5,675.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,423.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,342.18
|
| Rate for Payer: Cash Price |
$1,891.80
|
| Rate for Payer: Cigna Commercial |
$5,801.52
|
| Rate for Payer: Health EOS Commercial |
$5,612.34
|
| Rate for Payer: HFN Commercial |
$5,801.52
|
| Rate for Payer: Multiplan Commercial |
$5,044.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,783.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,801.52
|
| Rate for Payer: Quartz Beloit One Network |
$3,089.94
|
| Rate for Payer: Quartz Commercial |
$3,783.60
|
| Rate for Payer: WEA Trust Commercial |
$3,468.30
|
| Rate for Payer: WPS Commercial |
$4,670.85
|
|
|
PLATE DISTAL ULNA STD LT 70-0045
|
Facility
|
IP
|
$5,299.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3375503
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,596.51 |
| Max. Negotiated Rate |
$4,875.08 |
| Rate for Payer: Aetna Commercial |
$4,769.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,557.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,808.47
|
| Rate for Payer: Cash Price |
$1,589.70
|
| Rate for Payer: Cigna Commercial |
$4,875.08
|
| Rate for Payer: Health EOS Commercial |
$4,716.11
|
| Rate for Payer: HFN Commercial |
$4,875.08
|
| Rate for Payer: Multiplan Commercial |
$4,239.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,179.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,875.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,596.51
|
| Rate for Payer: Quartz Commercial |
$3,179.40
|
| Rate for Payer: WEA Trust Commercial |
$2,914.45
|
| Rate for Payer: WPS Commercial |
$3,924.97
|
|
|
PLATE DISTAL ULNA STD LT 70-0045
|
Facility
|
OP
|
$5,299.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3375503
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,483.72 |
| Max. Negotiated Rate |
$21,196.00 |
| Rate for Payer: Aetna Commercial |
$4,769.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,557.14
|
| Rate for Payer: Aetna Managed Medicare |
$1,483.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,444.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,649.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,543.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,808.47
|
| Rate for Payer: Cash Price |
$1,589.70
|
| Rate for Payer: Cigna Commercial |
$4,875.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,965.32
|
| Rate for Payer: Health EOS Commercial |
$4,716.11
|
| Rate for Payer: HFN Commercial |
$4,875.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,974.25
|
| Rate for Payer: Multiplan Commercial |
$4,239.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,179.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,875.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,596.51
|
| Rate for Payer: Quartz Commercial |
$3,444.35
|
| Rate for Payer: Quartz Medicare Advantage |
$3,179.40
|
| Rate for Payer: The Alliance Commercial |
$21,196.00
|
| Rate for Payer: WEA Trust Commercial |
$2,914.45
|
| Rate for Payer: WPS Commercial |
$3,924.97
|
|
|
PLATE DIST FIBULA 2.7/3.5 LT 6HL 02.112.143
|
Facility
|
OP
|
$5,929.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3072547
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,660.12 |
| Max. Negotiated Rate |
$23,716.00 |
| Rate for Payer: Aetna Commercial |
$5,336.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,098.94
|
| Rate for Payer: Aetna Managed Medicare |
$1,660.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,853.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,964.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,845.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,142.37
|
| Rate for Payer: Cash Price |
$1,778.70
|
| Rate for Payer: Cigna Commercial |
$5,454.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,317.87
|
| Rate for Payer: Health EOS Commercial |
$5,276.81
|
| Rate for Payer: HFN Commercial |
$5,454.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,446.75
|
| Rate for Payer: Multiplan Commercial |
$4,743.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,557.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,454.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,905.21
|
| Rate for Payer: Quartz Commercial |
$3,853.85
|
| Rate for Payer: Quartz Medicare Advantage |
$3,557.40
|
| Rate for Payer: The Alliance Commercial |
$23,716.00
|
| Rate for Payer: WEA Trust Commercial |
$3,260.95
|
| Rate for Payer: WPS Commercial |
$4,391.61
|
|
|
PLATE DIST FIBULA 2.7/3.5 LT 6HL 02.112.143
|
Facility
|
IP
|
$5,929.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3072547
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,905.21 |
| Max. Negotiated Rate |
$5,454.68 |
| Rate for Payer: Aetna Commercial |
$5,336.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,098.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,142.37
|
| Rate for Payer: Cash Price |
$1,778.70
|
| Rate for Payer: Cigna Commercial |
$5,454.68
|
| Rate for Payer: Health EOS Commercial |
$5,276.81
|
| Rate for Payer: HFN Commercial |
$5,454.68
|
| Rate for Payer: Multiplan Commercial |
$4,743.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,557.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,454.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,905.21
|
| Rate for Payer: Quartz Commercial |
$3,557.40
|
| Rate for Payer: WEA Trust Commercial |
$3,260.95
|
| Rate for Payer: WPS Commercial |
$4,391.61
|
|
|
PLATE DIST FIBULA LT 9HL 02.112.149
|
Facility
|
OP
|
$5,252.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3869352
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,470.56 |
| Max. Negotiated Rate |
$21,008.00 |
| Rate for Payer: Aetna Commercial |
$4,726.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,516.72
|
| Rate for Payer: Aetna Managed Medicare |
$1,470.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,413.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,626.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,520.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,783.56
|
| Rate for Payer: Cash Price |
$1,575.60
|
| Rate for Payer: Cigna Commercial |
$4,831.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,939.02
|
| Rate for Payer: Health EOS Commercial |
$4,674.28
|
| Rate for Payer: HFN Commercial |
$4,831.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,939.00
|
| Rate for Payer: Multiplan Commercial |
$4,201.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,151.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,831.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,573.48
|
| Rate for Payer: Quartz Commercial |
$3,413.80
|
| Rate for Payer: Quartz Medicare Advantage |
$3,151.20
|
| Rate for Payer: The Alliance Commercial |
$21,008.00
|
| Rate for Payer: WEA Trust Commercial |
$2,888.60
|
| Rate for Payer: WPS Commercial |
$3,890.16
|
|
|
PLATE DIST FIBULA LT 9HL 02.112.149
|
Facility
|
IP
|
$5,252.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3869352
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,573.48 |
| Max. Negotiated Rate |
$4,831.84 |
| Rate for Payer: Aetna Commercial |
$4,726.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,516.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,783.56
|
| Rate for Payer: Cash Price |
$1,575.60
|
| Rate for Payer: Cigna Commercial |
$4,831.84
|
| Rate for Payer: Health EOS Commercial |
$4,674.28
|
| Rate for Payer: HFN Commercial |
$4,831.84
|
| Rate for Payer: Multiplan Commercial |
$4,201.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,151.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,831.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,573.48
|
| Rate for Payer: Quartz Commercial |
$3,151.20
|
| Rate for Payer: WEA Trust Commercial |
$2,888.60
|
| Rate for Payer: WPS Commercial |
$3,890.16
|
|
|
PLATE DIST RAD 2.4 6HL/2HL
|
Facility
|
OP
|
$8,077.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3072513
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,261.56 |
| Max. Negotiated Rate |
$32,308.00 |
| Rate for Payer: Aetna Commercial |
$7,269.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,946.22
|
| Rate for Payer: Aetna Managed Medicare |
$2,261.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,250.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,038.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,876.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,280.81
|
| Rate for Payer: Cash Price |
$2,423.10
|
| Rate for Payer: Cigna Commercial |
$7,430.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,519.89
|
| Rate for Payer: Health EOS Commercial |
$7,188.53
|
| Rate for Payer: HFN Commercial |
$7,430.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,057.75
|
| Rate for Payer: Multiplan Commercial |
$6,461.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,846.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,430.84
|
| Rate for Payer: Quartz Beloit One Network |
$3,957.73
|
| Rate for Payer: Quartz Commercial |
$5,250.05
|
| Rate for Payer: Quartz Medicare Advantage |
$4,846.20
|
| Rate for Payer: The Alliance Commercial |
$32,308.00
|
| Rate for Payer: WEA Trust Commercial |
$4,442.35
|
| Rate for Payer: WPS Commercial |
$5,982.63
|
|
|
PLATE DIST RAD 2.4 6HL/2HL
|
Facility
|
IP
|
$8,077.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3072513
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,957.73 |
| Max. Negotiated Rate |
$7,430.84 |
| Rate for Payer: Aetna Commercial |
$7,269.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,946.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,280.81
|
| Rate for Payer: Cash Price |
$2,423.10
|
| Rate for Payer: Cigna Commercial |
$7,430.84
|
| Rate for Payer: Health EOS Commercial |
$7,188.53
|
| Rate for Payer: HFN Commercial |
$7,430.84
|
| Rate for Payer: Multiplan Commercial |
$6,461.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,846.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,430.84
|
| Rate for Payer: Quartz Beloit One Network |
$3,957.73
|
| Rate for Payer: Quartz Commercial |
$4,846.20
|
| Rate for Payer: WEA Trust Commercial |
$4,442.35
|
| Rate for Payer: WPS Commercial |
$5,982.63
|
|
|
PLATE DIST RAD 8HL LT
|
Facility
|
OP
|
$8,443.00
|
|
| Hospital Charge Code |
2966365
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,364.04 |
| Max. Negotiated Rate |
$33,772.00 |
| Rate for Payer: Aetna Commercial |
$7,598.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,260.98
|
| Rate for Payer: Aetna Managed Medicare |
$2,364.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,487.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,221.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,052.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,474.79
|
| Rate for Payer: Cash Price |
$2,532.90
|
| Rate for Payer: Cigna Commercial |
$7,767.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,724.70
|
| Rate for Payer: Health EOS Commercial |
$7,514.27
|
| Rate for Payer: HFN Commercial |
$7,767.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,332.25
|
| Rate for Payer: Multiplan Commercial |
$6,754.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,065.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,767.56
|
| Rate for Payer: Quartz Beloit One Network |
$4,137.07
|
| Rate for Payer: Quartz Commercial |
$5,487.95
|
| Rate for Payer: Quartz Medicare Advantage |
$5,065.80
|
| Rate for Payer: The Alliance Commercial |
$33,772.00
|
| Rate for Payer: WEA Trust Commercial |
$4,643.65
|
| Rate for Payer: WPS Commercial |
$6,253.73
|
|
|
PLATE DIST RAD 8HL LT
|
Facility
|
IP
|
$8,443.00
|
|
| Hospital Charge Code |
2966365
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,137.07 |
| Max. Negotiated Rate |
$7,767.56 |
| Rate for Payer: Aetna Commercial |
$7,598.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,260.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,474.79
|
| Rate for Payer: Cash Price |
$2,532.90
|
| Rate for Payer: Cigna Commercial |
$7,767.56
|
| Rate for Payer: Health EOS Commercial |
$7,514.27
|
| Rate for Payer: HFN Commercial |
$7,767.56
|
| Rate for Payer: Multiplan Commercial |
$6,754.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,065.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,767.56
|
| Rate for Payer: Quartz Beloit One Network |
$4,137.07
|
| Rate for Payer: Quartz Commercial |
$5,065.80
|
| Rate for Payer: WEA Trust Commercial |
$4,643.65
|
| Rate for Payer: WPS Commercial |
$6,253.73
|
|
|
PLATE DITAL FIBULA 2.7/3.5 10 HOLE RT LOCK 02.118.412
|
Facility
|
IP
|
$6,110.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494382
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,993.90 |
| Max. Negotiated Rate |
$5,621.20 |
| Rate for Payer: Aetna Commercial |
$5,499.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,254.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,238.30
|
| Rate for Payer: Cash Price |
$1,833.00
|
| Rate for Payer: Cigna Commercial |
$5,621.20
|
| Rate for Payer: Health EOS Commercial |
$5,437.90
|
| Rate for Payer: HFN Commercial |
$5,621.20
|
| Rate for Payer: Multiplan Commercial |
$4,888.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,666.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,621.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,993.90
|
| Rate for Payer: Quartz Commercial |
$3,666.00
|
| Rate for Payer: WEA Trust Commercial |
$3,360.50
|
| Rate for Payer: WPS Commercial |
$4,525.68
|
|
|
PLATE DITAL FIBULA 2.7/3.5 10 HOLE RT LOCK 02.118.412
|
Facility
|
OP
|
$6,110.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494382
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,710.80 |
| Max. Negotiated Rate |
$24,440.00 |
| Rate for Payer: Aetna Commercial |
$5,499.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,254.60
|
| Rate for Payer: Aetna Managed Medicare |
$1,710.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,971.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,055.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,932.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,238.30
|
| Rate for Payer: Cash Price |
$1,833.00
|
| Rate for Payer: Cigna Commercial |
$5,621.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,419.16
|
| Rate for Payer: Health EOS Commercial |
$5,437.90
|
| Rate for Payer: HFN Commercial |
$5,621.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,582.50
|
| Rate for Payer: Multiplan Commercial |
$4,888.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,666.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,621.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,993.90
|
| Rate for Payer: Quartz Commercial |
$3,971.50
|
| Rate for Payer: Quartz Medicare Advantage |
$3,666.00
|
| Rate for Payer: The Alliance Commercial |
$24,440.00
|
| Rate for Payer: WEA Trust Commercial |
$3,360.50
|
| Rate for Payer: WPS Commercial |
$4,525.68
|
|
|
PLATE FIBULA 113MM LT 5888404L
|
Facility
|
OP
|
$11,109.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6171733
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,110.52 |
| Max. Negotiated Rate |
$44,436.00 |
| Rate for Payer: Aetna Commercial |
$9,998.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,553.74
|
| Rate for Payer: Aetna Managed Medicare |
$3,110.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,220.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,554.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,332.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,887.77
|
| Rate for Payer: Cash Price |
$3,332.70
|
| Rate for Payer: Cigna Commercial |
$10,220.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,216.60
|
| Rate for Payer: Health EOS Commercial |
$9,887.01
|
| Rate for Payer: HFN Commercial |
$10,220.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,331.75
|
| Rate for Payer: Multiplan Commercial |
$8,887.20
|
| Rate for Payer: NAPHCARE Commercial |
$6,665.40
|
| Rate for Payer: Preferred Network Access Commercial |
$10,220.28
|
| Rate for Payer: Quartz Beloit One Network |
$5,443.41
|
| Rate for Payer: Quartz Commercial |
$7,220.85
|
| Rate for Payer: Quartz Medicare Advantage |
$6,665.40
|
| Rate for Payer: The Alliance Commercial |
$44,436.00
|
| Rate for Payer: WEA Trust Commercial |
$6,109.95
|
| Rate for Payer: WPS Commercial |
$8,228.44
|
|
|
PLATE FIBULA 113MM LT 5888404L
|
Facility
|
IP
|
$11,109.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6171733
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,443.41 |
| Max. Negotiated Rate |
$10,220.28 |
| Rate for Payer: Aetna Commercial |
$9,998.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,553.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,887.77
|
| Rate for Payer: Cash Price |
$3,332.70
|
| Rate for Payer: Cigna Commercial |
$10,220.28
|
| Rate for Payer: Health EOS Commercial |
$9,887.01
|
| Rate for Payer: HFN Commercial |
$10,220.28
|
| Rate for Payer: Multiplan Commercial |
$8,887.20
|
| Rate for Payer: NAPHCARE Commercial |
$6,665.40
|
| Rate for Payer: Preferred Network Access Commercial |
$10,220.28
|
| Rate for Payer: Quartz Beloit One Network |
$5,443.41
|
| Rate for Payer: Quartz Commercial |
$6,665.40
|
| Rate for Payer: WEA Trust Commercial |
$6,109.95
|
| Rate for Payer: WPS Commercial |
$8,228.44
|
|
|
PLATE FIBULA 113MM RT 5888404R
|
Facility
|
OP
|
$8,715.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6211040
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,440.20 |
| Max. Negotiated Rate |
$34,860.00 |
| Rate for Payer: Aetna Commercial |
$7,843.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,494.90
|
| Rate for Payer: Aetna Managed Medicare |
$2,440.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,664.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,357.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,183.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,618.95
|
| Rate for Payer: Cash Price |
$2,614.50
|
| Rate for Payer: Cigna Commercial |
$8,017.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,876.91
|
| Rate for Payer: Health EOS Commercial |
$7,756.35
|
| Rate for Payer: HFN Commercial |
$8,017.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,536.25
|
| Rate for Payer: Multiplan Commercial |
$6,972.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,229.00
|
| Rate for Payer: Preferred Network Access Commercial |
$8,017.80
|
| Rate for Payer: Quartz Beloit One Network |
$4,270.35
|
| Rate for Payer: Quartz Commercial |
$5,664.75
|
| Rate for Payer: Quartz Medicare Advantage |
$5,229.00
|
| Rate for Payer: The Alliance Commercial |
$34,860.00
|
| Rate for Payer: WEA Trust Commercial |
$4,793.25
|
| Rate for Payer: WPS Commercial |
$6,455.20
|
|
|
PLATE FIBULA 113MM RT 5888404R
|
Facility
|
IP
|
$8,715.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6211040
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,270.35 |
| Max. Negotiated Rate |
$8,017.80 |
| Rate for Payer: Aetna Commercial |
$7,843.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,494.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,618.95
|
| Rate for Payer: Cash Price |
$2,614.50
|
| Rate for Payer: Cigna Commercial |
$8,017.80
|
| Rate for Payer: Health EOS Commercial |
$7,756.35
|
| Rate for Payer: HFN Commercial |
$8,017.80
|
| Rate for Payer: Multiplan Commercial |
$6,972.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,229.00
|
| Rate for Payer: Preferred Network Access Commercial |
$8,017.80
|
| Rate for Payer: Quartz Beloit One Network |
$4,270.35
|
| Rate for Payer: Quartz Commercial |
$5,229.00
|
| Rate for Payer: WEA Trust Commercial |
$4,793.25
|
| Rate for Payer: WPS Commercial |
$6,455.20
|
|
|
PLATE FIBULA 2.7/3.5 5HL LT
|
Facility
|
IP
|
$5,846.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3072571
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,864.54 |
| Max. Negotiated Rate |
$5,378.32 |
| Rate for Payer: Aetna Commercial |
$5,261.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,027.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,098.38
|
| Rate for Payer: Cash Price |
$1,753.80
|
| Rate for Payer: Cigna Commercial |
$5,378.32
|
| Rate for Payer: Health EOS Commercial |
$5,202.94
|
| Rate for Payer: HFN Commercial |
$5,378.32
|
| Rate for Payer: Multiplan Commercial |
$4,676.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,507.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,378.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,864.54
|
| Rate for Payer: Quartz Commercial |
$3,507.60
|
| Rate for Payer: WEA Trust Commercial |
$3,215.30
|
| Rate for Payer: WPS Commercial |
$4,330.13
|
|
