|
PLATE HUMERUS DISTAL LATERAL 2HL LT MEDIUM 02.117.902S
|
Facility
|
IP
|
$5,592.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5803647
|
|
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 HUMERUS DISTAL MEDIAL 1HL LT SHORT 02.117.501
|
Facility
|
OP
|
$5,592.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5611734
|
|
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 HUMERUS DISTAL MEDIAL 1HL LT SHORT 02.117.501
|
Facility
|
IP
|
$5,592.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5611734
|
|
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 HUMERUS DISTAL MEDIAL 4HL LT LONG 02.117.504S
|
Facility
|
IP
|
$5,592.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5803646
|
|
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 HUMERUS DISTAL MEDIAL 4HL LT LONG 02.117.504S
|
Facility
|
OP
|
$5,592.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5803646
|
|
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 HUMERUS DISTAL MEDIAL 4HL RT LONG 02.117.404
|
Facility
|
OP
|
$5,887.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4519190
|
|
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 HUMERUS DISTAL MEDIAL 4HL RT LONG 02.117.404
|
Facility
|
IP
|
$5,887.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4519190
|
|
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 HUMERUS DISTAL MEDIAL 4HL RT LONG 02.117.404S
|
Facility
|
OP
|
$5,887.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3265483
|
|
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 HUMERUS DISTAL MEDIAL 4HL RT LONG 02.117.404S
|
Facility
|
IP
|
$5,887.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3265483
|
|
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 HUMERUS PROXIMAL LATERAL 14HL RT 627244S
|
Facility
|
IP
|
$13,460.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5627649
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,595.40 |
| Max. Negotiated Rate |
$12,383.20 |
| Rate for Payer: Aetna Commercial |
$12,114.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,575.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,133.80
|
| Rate for Payer: Cash Price |
$4,038.00
|
| Rate for Payer: Cigna Commercial |
$12,383.20
|
| Rate for Payer: Health EOS Commercial |
$11,979.40
|
| Rate for Payer: HFN Commercial |
$12,383.20
|
| Rate for Payer: Multiplan Commercial |
$10,768.00
|
| Rate for Payer: NAPHCARE Commercial |
$8,076.00
|
| Rate for Payer: Preferred Network Access Commercial |
$12,383.20
|
| Rate for Payer: Quartz Beloit One Network |
$6,595.40
|
| Rate for Payer: Quartz Commercial |
$8,076.00
|
| Rate for Payer: WEA Trust Commercial |
$7,403.00
|
| Rate for Payer: WPS Commercial |
$9,969.82
|
|
|
PLATE HUMERUS PROXIMAL LATERAL 14HL RT 627244S
|
Facility
|
OP
|
$13,460.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5627649
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,768.80 |
| Max. Negotiated Rate |
$53,840.00 |
| Rate for Payer: Aetna Commercial |
$12,114.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,575.60
|
| Rate for Payer: Aetna Managed Medicare |
$3,768.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,749.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,730.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,460.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,133.80
|
| Rate for Payer: Cash Price |
$4,038.00
|
| Rate for Payer: Cigna Commercial |
$12,383.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,532.22
|
| Rate for Payer: Health EOS Commercial |
$11,979.40
|
| Rate for Payer: HFN Commercial |
$12,383.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,095.00
|
| Rate for Payer: Multiplan Commercial |
$10,768.00
|
| Rate for Payer: NAPHCARE Commercial |
$8,076.00
|
| Rate for Payer: Preferred Network Access Commercial |
$12,383.20
|
| Rate for Payer: Quartz Beloit One Network |
$6,595.40
|
| Rate for Payer: Quartz Commercial |
$8,749.00
|
| Rate for Payer: Quartz Medicare Advantage |
$8,076.00
|
| Rate for Payer: The Alliance Commercial |
$53,840.00
|
| Rate for Payer: WEA Trust Commercial |
$7,403.00
|
| Rate for Payer: WPS Commercial |
$9,969.82
|
|
|
PLATE JL 8HL BIOMET 73-2645
|
Facility
|
OP
|
$5,255.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5447130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,471.40 |
| Max. Negotiated Rate |
$21,020.00 |
| Rate for Payer: Aetna Commercial |
$4,729.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,519.30
|
| Rate for Payer: Aetna Managed Medicare |
$1,471.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,415.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,627.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,522.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,785.15
|
| Rate for Payer: Cash Price |
$1,576.50
|
| Rate for Payer: Cigna Commercial |
$4,834.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,940.70
|
| Rate for Payer: Health EOS Commercial |
$4,676.95
|
| Rate for Payer: HFN Commercial |
$4,834.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,941.25
|
| Rate for Payer: Multiplan Commercial |
$4,204.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,153.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,834.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,574.95
|
| Rate for Payer: Quartz Commercial |
$3,415.75
|
| Rate for Payer: Quartz Medicare Advantage |
$3,153.00
|
| Rate for Payer: The Alliance Commercial |
$21,020.00
|
| Rate for Payer: WEA Trust Commercial |
$2,890.25
|
| Rate for Payer: WPS Commercial |
$3,892.38
|
|
|
PLATE JL 8HL BIOMET 73-2645
|
Facility
|
IP
|
$5,255.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5447130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,574.95 |
| Max. Negotiated Rate |
$4,834.60 |
| Rate for Payer: Aetna Commercial |
$4,729.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,519.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,785.15
|
| Rate for Payer: Cash Price |
$1,576.50
|
| Rate for Payer: Cigna Commercial |
$4,834.60
|
| Rate for Payer: Health EOS Commercial |
$4,676.95
|
| Rate for Payer: HFN Commercial |
$4,834.60
|
| Rate for Payer: Multiplan Commercial |
$4,204.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,153.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,834.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,574.95
|
| Rate for Payer: Quartz Commercial |
$3,153.00
|
| Rate for Payer: WEA Trust Commercial |
$2,890.25
|
| Rate for Payer: WPS Commercial |
$3,892.38
|
|
|
PLATE L 4HL BIOMET 73-2643
|
Facility
|
IP
|
$4,320.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4206004
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,116.80 |
| Max. Negotiated Rate |
$3,974.40 |
| Rate for Payer: Aetna Commercial |
$3,888.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,715.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,289.60
|
| Rate for Payer: Cash Price |
$1,296.00
|
| Rate for Payer: Cigna Commercial |
$3,974.40
|
| Rate for Payer: Health EOS Commercial |
$3,844.80
|
| Rate for Payer: HFN Commercial |
$3,974.40
|
| Rate for Payer: Multiplan Commercial |
$3,456.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,592.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,974.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,116.80
|
| Rate for Payer: Quartz Commercial |
$2,592.00
|
| Rate for Payer: WEA Trust Commercial |
$2,376.00
|
| Rate for Payer: WPS Commercial |
$3,199.82
|
|
|
PLATE L 4HL BIOMET 73-2643
|
Facility
|
OP
|
$4,320.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4206004
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,209.60 |
| Max. Negotiated Rate |
$17,280.00 |
| Rate for Payer: Aetna Commercial |
$3,888.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,715.20
|
| Rate for Payer: Aetna Managed Medicare |
$1,209.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,808.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,160.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,073.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,289.60
|
| Rate for Payer: Cash Price |
$1,296.00
|
| Rate for Payer: Cigna Commercial |
$3,974.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,417.47
|
| Rate for Payer: Health EOS Commercial |
$3,844.80
|
| Rate for Payer: HFN Commercial |
$3,974.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,240.00
|
| Rate for Payer: Multiplan Commercial |
$3,456.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,592.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,974.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,116.80
|
| Rate for Payer: Quartz Commercial |
$2,808.00
|
| Rate for Payer: Quartz Medicare Advantage |
$2,592.00
|
| Rate for Payer: The Alliance Commercial |
$17,280.00
|
| Rate for Payer: WEA Trust Commercial |
$2,376.00
|
| Rate for Payer: WPS Commercial |
$3,199.82
|
|
|
PLATE LADDER 12HL BIOMET 73-2632
|
Facility
|
IP
|
$4,584.00
|
|
| Hospital Charge Code |
5349381
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,246.16 |
| Max. Negotiated Rate |
$4,217.28 |
| Rate for Payer: Aetna Commercial |
$4,125.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,942.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,429.52
|
| Rate for Payer: Cash Price |
$1,375.20
|
| Rate for Payer: Cigna Commercial |
$4,217.28
|
| Rate for Payer: Health EOS Commercial |
$4,079.76
|
| Rate for Payer: HFN Commercial |
$4,217.28
|
| Rate for Payer: Multiplan Commercial |
$3,667.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,750.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,217.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,246.16
|
| Rate for Payer: Quartz Commercial |
$2,750.40
|
| Rate for Payer: WEA Trust Commercial |
$2,521.20
|
| Rate for Payer: WPS Commercial |
$3,395.37
|
|
|
PLATE LADDER 12HL BIOMET 73-2632
|
Facility
|
OP
|
$4,584.00
|
|
| Hospital Charge Code |
5349381
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,283.52 |
| Max. Negotiated Rate |
$18,336.00 |
| Rate for Payer: Aetna Commercial |
$4,125.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,942.24
|
| Rate for Payer: Aetna Managed Medicare |
$1,283.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,979.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,292.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,200.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,429.52
|
| Rate for Payer: Cash Price |
$1,375.20
|
| Rate for Payer: Cigna Commercial |
$4,217.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,565.21
|
| Rate for Payer: Health EOS Commercial |
$4,079.76
|
| Rate for Payer: HFN Commercial |
$4,217.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,438.00
|
| Rate for Payer: Multiplan Commercial |
$3,667.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,750.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,217.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,246.16
|
| Rate for Payer: Quartz Commercial |
$2,979.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2,750.40
|
| Rate for Payer: The Alliance Commercial |
$18,336.00
|
| Rate for Payer: WEA Trust Commercial |
$2,521.20
|
| Rate for Payer: WPS Commercial |
$3,395.37
|
|
|
PLATE LAPIDUS CP 2MM STEP RT (T10) 5HL 626902
|
Facility
|
IP
|
$14,057.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5547406
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,887.93 |
| Max. Negotiated Rate |
$12,932.44 |
| Rate for Payer: Aetna Commercial |
$12,651.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,089.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,450.21
|
| Rate for Payer: Cash Price |
$4,217.10
|
| Rate for Payer: Cigna Commercial |
$12,932.44
|
| Rate for Payer: Health EOS Commercial |
$12,510.73
|
| Rate for Payer: HFN Commercial |
$12,932.44
|
| Rate for Payer: Multiplan Commercial |
$11,245.60
|
| Rate for Payer: NAPHCARE Commercial |
$8,434.20
|
| Rate for Payer: Preferred Network Access Commercial |
$12,932.44
|
| Rate for Payer: Quartz Beloit One Network |
$6,887.93
|
| Rate for Payer: Quartz Commercial |
$8,434.20
|
| Rate for Payer: WEA Trust Commercial |
$7,731.35
|
| Rate for Payer: WPS Commercial |
$10,412.02
|
|
|
PLATE LAPIDUS CP 2MM STEP RT (T10) 5HL 626902
|
Facility
|
OP
|
$14,057.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5547406
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,935.96 |
| Max. Negotiated Rate |
$56,228.00 |
| Rate for Payer: Aetna Commercial |
$12,651.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,089.02
|
| Rate for Payer: Aetna Managed Medicare |
$3,935.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,137.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,028.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,747.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,450.21
|
| Rate for Payer: Cash Price |
$4,217.10
|
| Rate for Payer: Cigna Commercial |
$12,932.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,866.30
|
| Rate for Payer: Health EOS Commercial |
$12,510.73
|
| Rate for Payer: HFN Commercial |
$12,932.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,542.75
|
| Rate for Payer: Multiplan Commercial |
$11,245.60
|
| Rate for Payer: NAPHCARE Commercial |
$8,434.20
|
| Rate for Payer: Preferred Network Access Commercial |
$12,932.44
|
| Rate for Payer: Quartz Beloit One Network |
$6,887.93
|
| Rate for Payer: Quartz Commercial |
$9,137.05
|
| Rate for Payer: Quartz Medicare Advantage |
$8,434.20
|
| Rate for Payer: The Alliance Commercial |
$56,228.00
|
| Rate for Payer: WEA Trust Commercial |
$7,731.35
|
| Rate for Payer: WPS Commercial |
$10,412.02
|
|
|
PLATE LAPIDUS CP LT (T10) 5HL 626893
|
Facility
|
IP
|
$14,057.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5583322
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,887.93 |
| Max. Negotiated Rate |
$12,932.44 |
| Rate for Payer: Aetna Commercial |
$12,651.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,089.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,450.21
|
| Rate for Payer: Cash Price |
$4,217.10
|
| Rate for Payer: Cigna Commercial |
$12,932.44
|
| Rate for Payer: Health EOS Commercial |
$12,510.73
|
| Rate for Payer: HFN Commercial |
$12,932.44
|
| Rate for Payer: Multiplan Commercial |
$11,245.60
|
| Rate for Payer: NAPHCARE Commercial |
$8,434.20
|
| Rate for Payer: Preferred Network Access Commercial |
$12,932.44
|
| Rate for Payer: Quartz Beloit One Network |
$6,887.93
|
| Rate for Payer: Quartz Commercial |
$8,434.20
|
| Rate for Payer: WEA Trust Commercial |
$7,731.35
|
| Rate for Payer: WPS Commercial |
$10,412.02
|
|
|
PLATE LAPIDUS CP LT (T10) 5HL 626893
|
Facility
|
OP
|
$14,057.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5583322
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,935.96 |
| Max. Negotiated Rate |
$56,228.00 |
| Rate for Payer: Aetna Commercial |
$12,651.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,089.02
|
| Rate for Payer: Aetna Managed Medicare |
$3,935.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,137.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,028.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,747.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,450.21
|
| Rate for Payer: Cash Price |
$4,217.10
|
| Rate for Payer: Cigna Commercial |
$12,932.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,866.30
|
| Rate for Payer: Health EOS Commercial |
$12,510.73
|
| Rate for Payer: HFN Commercial |
$12,932.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,542.75
|
| Rate for Payer: Multiplan Commercial |
$11,245.60
|
| Rate for Payer: NAPHCARE Commercial |
$8,434.20
|
| Rate for Payer: Preferred Network Access Commercial |
$12,932.44
|
| Rate for Payer: Quartz Beloit One Network |
$6,887.93
|
| Rate for Payer: Quartz Commercial |
$9,137.05
|
| Rate for Payer: Quartz Medicare Advantage |
$8,434.20
|
| Rate for Payer: The Alliance Commercial |
$56,228.00
|
| Rate for Payer: WEA Trust Commercial |
$7,731.35
|
| Rate for Payer: WPS Commercial |
$10,412.02
|
|
|
PLATE LAPIDUS STEP 1 LT PLP213141
|
Facility
|
IP
|
$9,271.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5729728
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,542.79 |
| Max. Negotiated Rate |
$8,529.32 |
| Rate for Payer: Aetna Commercial |
$8,343.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,973.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,913.63
|
| Rate for Payer: Cash Price |
$2,781.30
|
| Rate for Payer: Cigna Commercial |
$8,529.32
|
| Rate for Payer: Health EOS Commercial |
$8,251.19
|
| Rate for Payer: HFN Commercial |
$8,529.32
|
| Rate for Payer: Multiplan Commercial |
$7,416.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,562.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,529.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,542.79
|
| Rate for Payer: Quartz Commercial |
$5,562.60
|
| Rate for Payer: WEA Trust Commercial |
$5,099.05
|
| Rate for Payer: WPS Commercial |
$6,867.03
|
|
|
PLATE LAPIDUS STEP 1 LT PLP213141
|
Facility
|
OP
|
$9,271.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5729728
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,595.88 |
| Max. Negotiated Rate |
$37,084.00 |
| Rate for Payer: Aetna Commercial |
$8,343.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,973.06
|
| Rate for Payer: Aetna Managed Medicare |
$2,595.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,026.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,635.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,450.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,913.63
|
| Rate for Payer: Cash Price |
$2,781.30
|
| Rate for Payer: Cigna Commercial |
$8,529.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,188.05
|
| Rate for Payer: Health EOS Commercial |
$8,251.19
|
| Rate for Payer: HFN Commercial |
$8,529.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,953.25
|
| Rate for Payer: Multiplan Commercial |
$7,416.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,562.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,529.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,542.79
|
| Rate for Payer: Quartz Commercial |
$6,026.15
|
| Rate for Payer: Quartz Medicare Advantage |
$5,562.60
|
| Rate for Payer: The Alliance Commercial |
$37,084.00
|
| Rate for Payer: WEA Trust Commercial |
$5,099.05
|
| Rate for Payer: WPS Commercial |
$6,867.03
|
|
|
PLATE LAT/DIS/FIB 9H RT 02.112.148
|
Facility
|
OP
|
$5,252.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4520505
|
|
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 LAT/DIS/FIB 9H RT 02.112.148
|
Facility
|
IP
|
$5,252.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4520505
|
|
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
|
|
