|
PLATE PROX/HUM 3.5 10HL LONG 241.923
|
Facility
|
IP
|
$8,566.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6174861
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,197.34 |
| Max. Negotiated Rate |
$7,880.72 |
| Rate for Payer: Aetna Commercial |
$7,709.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,366.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,539.98
|
| Rate for Payer: Cash Price |
$2,569.80
|
| Rate for Payer: Cigna Commercial |
$7,880.72
|
| Rate for Payer: Health EOS Commercial |
$7,623.74
|
| Rate for Payer: HFN Commercial |
$7,880.72
|
| Rate for Payer: Multiplan Commercial |
$6,852.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,139.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,880.72
|
| Rate for Payer: Quartz Beloit One Network |
$4,197.34
|
| Rate for Payer: Quartz Commercial |
$5,139.60
|
| Rate for Payer: WEA Trust Commercial |
$4,711.30
|
| Rate for Payer: WPS Commercial |
$6,344.84
|
|
|
PLATE PROX/HUM 3.5 10HL LONG 241.923
|
Facility
|
OP
|
$8,566.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6174861
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,398.48 |
| Max. Negotiated Rate |
$34,264.00 |
| Rate for Payer: Aetna Commercial |
$7,709.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,366.76
|
| Rate for Payer: Aetna Managed Medicare |
$2,398.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,567.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,283.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,111.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,539.98
|
| Rate for Payer: Cash Price |
$2,569.80
|
| Rate for Payer: Cigna Commercial |
$7,880.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,793.53
|
| Rate for Payer: Health EOS Commercial |
$7,623.74
|
| Rate for Payer: HFN Commercial |
$7,880.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,424.50
|
| Rate for Payer: Multiplan Commercial |
$6,852.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,139.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,880.72
|
| Rate for Payer: Quartz Beloit One Network |
$4,197.34
|
| Rate for Payer: Quartz Commercial |
$5,567.90
|
| Rate for Payer: Quartz Medicare Advantage |
$5,139.60
|
| Rate for Payer: The Alliance Commercial |
$34,264.00
|
| Rate for Payer: WEA Trust Commercial |
$4,711.30
|
| Rate for Payer: WPS Commercial |
$6,344.84
|
|
|
PLATE PROX/HUM 3.5 3HL 241.901
|
Facility
|
IP
|
$7,339.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966717
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,596.11 |
| Max. Negotiated Rate |
$6,751.88 |
| Rate for Payer: Aetna Commercial |
$6,605.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,311.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,889.67
|
| Rate for Payer: Cash Price |
$2,201.70
|
| Rate for Payer: Cigna Commercial |
$6,751.88
|
| Rate for Payer: Health EOS Commercial |
$6,531.71
|
| Rate for Payer: HFN Commercial |
$6,751.88
|
| Rate for Payer: Multiplan Commercial |
$5,871.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,403.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,751.88
|
| Rate for Payer: Quartz Beloit One Network |
$3,596.11
|
| Rate for Payer: Quartz Commercial |
$4,403.40
|
| Rate for Payer: WEA Trust Commercial |
$4,036.45
|
| Rate for Payer: WPS Commercial |
$5,436.00
|
|
|
PLATE PROX/HUM 3.5 3HL 241.901
|
Facility
|
OP
|
$7,339.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966717
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,054.92 |
| Max. Negotiated Rate |
$29,356.00 |
| Rate for Payer: Aetna Commercial |
$6,605.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,311.54
|
| Rate for Payer: Aetna Managed Medicare |
$2,054.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,770.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,669.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,522.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,889.67
|
| Rate for Payer: Cash Price |
$2,201.70
|
| Rate for Payer: Cigna Commercial |
$6,751.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,106.90
|
| Rate for Payer: Health EOS Commercial |
$6,531.71
|
| Rate for Payer: HFN Commercial |
$6,751.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,504.25
|
| Rate for Payer: Multiplan Commercial |
$5,871.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,403.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,751.88
|
| Rate for Payer: Quartz Beloit One Network |
$3,596.11
|
| Rate for Payer: Quartz Commercial |
$4,770.35
|
| Rate for Payer: Quartz Medicare Advantage |
$4,403.40
|
| Rate for Payer: The Alliance Commercial |
$29,356.00
|
| Rate for Payer: WEA Trust Commercial |
$4,036.45
|
| Rate for Payer: WPS Commercial |
$5,436.00
|
|
|
PLATE PROX/HUM 3.5 5HL 241.903
|
Facility
|
IP
|
$7,575.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966728
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,711.75 |
| Max. Negotiated Rate |
$6,969.00 |
| Rate for Payer: Aetna Commercial |
$6,817.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,514.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,014.75
|
| Rate for Payer: Cash Price |
$2,272.50
|
| Rate for Payer: Cigna Commercial |
$6,969.00
|
| Rate for Payer: Health EOS Commercial |
$6,741.75
|
| Rate for Payer: HFN Commercial |
$6,969.00
|
| Rate for Payer: Multiplan Commercial |
$6,060.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,545.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,969.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,711.75
|
| Rate for Payer: Quartz Commercial |
$4,545.00
|
| Rate for Payer: WEA Trust Commercial |
$4,166.25
|
| Rate for Payer: WPS Commercial |
$5,610.80
|
|
|
PLATE PROX/HUM 3.5 5HL 241.903
|
Facility
|
OP
|
$7,575.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966728
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,121.00 |
| Max. Negotiated Rate |
$30,300.00 |
| Rate for Payer: Aetna Commercial |
$6,817.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,514.50
|
| Rate for Payer: Aetna Managed Medicare |
$2,121.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,923.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,787.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,636.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,014.75
|
| Rate for Payer: Cash Price |
$2,272.50
|
| Rate for Payer: Cigna Commercial |
$6,969.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,238.97
|
| Rate for Payer: Health EOS Commercial |
$6,741.75
|
| Rate for Payer: HFN Commercial |
$6,969.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,681.25
|
| Rate for Payer: Multiplan Commercial |
$6,060.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,545.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,969.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,711.75
|
| Rate for Payer: Quartz Commercial |
$4,923.75
|
| Rate for Payer: Quartz Medicare Advantage |
$4,545.00
|
| Rate for Payer: The Alliance Commercial |
$30,300.00
|
| Rate for Payer: WEA Trust Commercial |
$4,166.25
|
| Rate for Payer: WPS Commercial |
$5,610.80
|
|
|
PLATE PROX/HUM 3.5 5HL LONG 241.918
|
Facility
|
OP
|
$7,353.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6180299
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,058.84 |
| Max. Negotiated Rate |
$29,412.00 |
| Rate for Payer: Aetna Commercial |
$6,617.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,323.58
|
| Rate for Payer: Aetna Managed Medicare |
$2,058.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,779.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,676.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,529.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,897.09
|
| Rate for Payer: Cash Price |
$2,205.90
|
| Rate for Payer: Cigna Commercial |
$6,764.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,114.74
|
| Rate for Payer: Health EOS Commercial |
$6,544.17
|
| Rate for Payer: HFN Commercial |
$6,764.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,514.75
|
| Rate for Payer: Multiplan Commercial |
$5,882.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,411.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,764.76
|
| Rate for Payer: Quartz Beloit One Network |
$3,602.97
|
| Rate for Payer: Quartz Commercial |
$4,779.45
|
| Rate for Payer: Quartz Medicare Advantage |
$4,411.80
|
| Rate for Payer: The Alliance Commercial |
$29,412.00
|
| Rate for Payer: WEA Trust Commercial |
$4,044.15
|
| Rate for Payer: WPS Commercial |
$5,446.37
|
|
|
PLATE PROX/HUM 3.5 5HL LONG 241.918
|
Facility
|
IP
|
$7,353.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6180299
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,602.97 |
| Max. Negotiated Rate |
$6,764.76 |
| Rate for Payer: Aetna Commercial |
$6,617.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,323.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,897.09
|
| Rate for Payer: Cash Price |
$2,205.90
|
| Rate for Payer: Cigna Commercial |
$6,764.76
|
| Rate for Payer: Health EOS Commercial |
$6,544.17
|
| Rate for Payer: HFN Commercial |
$6,764.76
|
| Rate for Payer: Multiplan Commercial |
$5,882.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,411.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,764.76
|
| Rate for Payer: Quartz Beloit One Network |
$3,602.97
|
| Rate for Payer: Quartz Commercial |
$4,411.80
|
| Rate for Payer: WEA Trust Commercial |
$4,044.15
|
| Rate for Payer: WPS Commercial |
$5,446.37
|
|
|
PLATE PROX/HUM 3.5 8HL LONG 241.921
|
Facility
|
IP
|
$7,635.54
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6246229
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,741.41 |
| Max. Negotiated Rate |
$7,024.70 |
| Rate for Payer: Aetna Commercial |
$6,871.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,566.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,046.84
|
| Rate for Payer: Cash Price |
$2,290.66
|
| Rate for Payer: Cigna Commercial |
$7,024.70
|
| Rate for Payer: Health EOS Commercial |
$6,795.63
|
| Rate for Payer: HFN Commercial |
$7,024.70
|
| Rate for Payer: Multiplan Commercial |
$6,108.43
|
| Rate for Payer: NAPHCARE Commercial |
$4,581.32
|
| Rate for Payer: Preferred Network Access Commercial |
$7,024.70
|
| Rate for Payer: Quartz Beloit One Network |
$3,741.41
|
| Rate for Payer: Quartz Commercial |
$4,581.32
|
| Rate for Payer: WEA Trust Commercial |
$4,199.55
|
| Rate for Payer: WPS Commercial |
$5,655.64
|
|
|
PLATE PROX/HUM 3.5 8HL LONG 241.921
|
Facility
|
OP
|
$7,635.54
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6246229
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,137.95 |
| Max. Negotiated Rate |
$30,542.16 |
| Rate for Payer: Aetna Commercial |
$6,871.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,566.56
|
| Rate for Payer: Aetna Managed Medicare |
$2,137.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,963.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,817.77
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,665.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,046.84
|
| Rate for Payer: Cash Price |
$2,290.66
|
| Rate for Payer: Cigna Commercial |
$7,024.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,272.85
|
| Rate for Payer: Health EOS Commercial |
$6,795.63
|
| Rate for Payer: HFN Commercial |
$7,024.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,726.66
|
| Rate for Payer: Multiplan Commercial |
$6,108.43
|
| Rate for Payer: NAPHCARE Commercial |
$4,581.32
|
| Rate for Payer: Preferred Network Access Commercial |
$7,024.70
|
| Rate for Payer: Quartz Beloit One Network |
$3,741.41
|
| Rate for Payer: Quartz Commercial |
$4,963.10
|
| Rate for Payer: Quartz Medicare Advantage |
$4,581.32
|
| Rate for Payer: The Alliance Commercial |
$30,542.16
|
| Rate for Payer: WEA Trust Commercial |
$4,199.55
|
| Rate for Payer: WPS Commercial |
$5,655.64
|
|
|
PLATE PROXIMAL HUMERUS 3.5 LCP 10HL RT 02.123.028
|
Facility
|
OP
|
$8,118.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5804332
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,273.04 |
| Max. Negotiated Rate |
$32,472.00 |
| Rate for Payer: Aetna Commercial |
$7,306.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,981.48
|
| Rate for Payer: Aetna Managed Medicare |
$2,273.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,276.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,059.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,896.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,302.54
|
| Rate for Payer: Cash Price |
$2,435.40
|
| Rate for Payer: Cigna Commercial |
$7,468.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,542.83
|
| Rate for Payer: Health EOS Commercial |
$7,225.02
|
| Rate for Payer: HFN Commercial |
$7,468.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,088.50
|
| Rate for Payer: Multiplan Commercial |
$6,494.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,870.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,468.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,977.82
|
| Rate for Payer: Quartz Commercial |
$5,276.70
|
| Rate for Payer: Quartz Medicare Advantage |
$4,870.80
|
| Rate for Payer: The Alliance Commercial |
$32,472.00
|
| Rate for Payer: WEA Trust Commercial |
$4,464.90
|
| Rate for Payer: WPS Commercial |
$6,013.00
|
|
|
PLATE PROXIMAL HUMERUS 3.5 LCP 10HL RT 02.123.028
|
Facility
|
IP
|
$8,118.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5804332
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,977.82 |
| Max. Negotiated Rate |
$7,468.56 |
| Rate for Payer: Aetna Commercial |
$7,306.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,981.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,302.54
|
| Rate for Payer: Cash Price |
$2,435.40
|
| Rate for Payer: Cigna Commercial |
$7,468.56
|
| Rate for Payer: Health EOS Commercial |
$7,225.02
|
| Rate for Payer: HFN Commercial |
$7,468.56
|
| Rate for Payer: Multiplan Commercial |
$6,494.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,870.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,468.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,977.82
|
| Rate for Payer: Quartz Commercial |
$4,870.80
|
| Rate for Payer: WEA Trust Commercial |
$4,464.90
|
| Rate for Payer: WPS Commercial |
$6,013.00
|
|
|
PLATE PROXIMAL HUMERUS 3.5 LCP 2HL LT 02.123.021S
|
Facility
|
IP
|
$9,076.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3072615
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,447.24 |
| Max. Negotiated Rate |
$8,349.92 |
| Rate for Payer: Aetna Commercial |
$8,168.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,805.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,810.28
|
| Rate for Payer: Cash Price |
$2,722.80
|
| Rate for Payer: Cigna Commercial |
$8,349.92
|
| Rate for Payer: Health EOS Commercial |
$8,077.64
|
| Rate for Payer: HFN Commercial |
$8,349.92
|
| Rate for Payer: Multiplan Commercial |
$7,260.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,445.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,349.92
|
| Rate for Payer: Quartz Beloit One Network |
$4,447.24
|
| Rate for Payer: Quartz Commercial |
$5,445.60
|
| Rate for Payer: WEA Trust Commercial |
$4,991.80
|
| Rate for Payer: WPS Commercial |
$6,722.59
|
|
|
PLATE PROXIMAL HUMERUS 3.5 LCP 2HL LT 02.123.021S
|
Facility
|
OP
|
$9,076.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3072615
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,541.28 |
| Max. Negotiated Rate |
$36,304.00 |
| Rate for Payer: Aetna Commercial |
$8,168.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,805.36
|
| Rate for Payer: Aetna Managed Medicare |
$2,541.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,899.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,538.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,356.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,810.28
|
| Rate for Payer: Cash Price |
$2,722.80
|
| Rate for Payer: Cigna Commercial |
$8,349.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,078.93
|
| Rate for Payer: Health EOS Commercial |
$8,077.64
|
| Rate for Payer: HFN Commercial |
$8,349.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,807.00
|
| Rate for Payer: Multiplan Commercial |
$7,260.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,445.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,349.92
|
| Rate for Payer: Quartz Beloit One Network |
$4,447.24
|
| Rate for Payer: Quartz Commercial |
$5,899.40
|
| Rate for Payer: Quartz Medicare Advantage |
$5,445.60
|
| Rate for Payer: The Alliance Commercial |
$36,304.00
|
| Rate for Payer: WEA Trust Commercial |
$4,991.80
|
| Rate for Payer: WPS Commercial |
$6,722.59
|
|
|
PLATE PROXIMAL HUMERUS 3.5 LCP 2HL RT 02.123.020S
|
Facility
|
OP
|
$9,076.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3072474
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,541.28 |
| Max. Negotiated Rate |
$36,304.00 |
| Rate for Payer: Aetna Commercial |
$8,168.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,805.36
|
| Rate for Payer: Aetna Managed Medicare |
$2,541.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,899.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,538.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,356.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,810.28
|
| Rate for Payer: Cash Price |
$2,722.80
|
| Rate for Payer: Cigna Commercial |
$8,349.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,078.93
|
| Rate for Payer: Health EOS Commercial |
$8,077.64
|
| Rate for Payer: HFN Commercial |
$8,349.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,807.00
|
| Rate for Payer: Multiplan Commercial |
$7,260.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,445.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,349.92
|
| Rate for Payer: Quartz Beloit One Network |
$4,447.24
|
| Rate for Payer: Quartz Commercial |
$5,899.40
|
| Rate for Payer: Quartz Medicare Advantage |
$5,445.60
|
| Rate for Payer: The Alliance Commercial |
$36,304.00
|
| Rate for Payer: WEA Trust Commercial |
$4,991.80
|
| Rate for Payer: WPS Commercial |
$6,722.59
|
|
|
PLATE PROXIMAL HUMERUS 3.5 LCP 2HL RT 02.123.020S
|
Facility
|
IP
|
$9,076.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3072474
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,447.24 |
| Max. Negotiated Rate |
$8,349.92 |
| Rate for Payer: Aetna Commercial |
$8,168.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,805.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,810.28
|
| Rate for Payer: Cash Price |
$2,722.80
|
| Rate for Payer: Cigna Commercial |
$8,349.92
|
| Rate for Payer: Health EOS Commercial |
$8,077.64
|
| Rate for Payer: HFN Commercial |
$8,349.92
|
| Rate for Payer: Multiplan Commercial |
$7,260.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,445.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,349.92
|
| Rate for Payer: Quartz Beloit One Network |
$4,447.24
|
| Rate for Payer: Quartz Commercial |
$5,445.60
|
| Rate for Payer: WEA Trust Commercial |
$4,991.80
|
| Rate for Payer: WPS Commercial |
$6,722.59
|
|
|
PLATE PROXIMAL HUMERUS 3.5 LCP 3HL LT 02.123.041S
|
Facility
|
IP
|
$7,716.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3805556
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,780.84 |
| Max. Negotiated Rate |
$7,098.72 |
| Rate for Payer: Aetna Commercial |
$6,944.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,635.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,089.48
|
| Rate for Payer: Cash Price |
$2,314.80
|
| Rate for Payer: Cigna Commercial |
$7,098.72
|
| Rate for Payer: Health EOS Commercial |
$6,867.24
|
| Rate for Payer: HFN Commercial |
$7,098.72
|
| Rate for Payer: Multiplan Commercial |
$6,172.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,629.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,098.72
|
| Rate for Payer: Quartz Beloit One Network |
$3,780.84
|
| Rate for Payer: Quartz Commercial |
$4,629.60
|
| Rate for Payer: WEA Trust Commercial |
$4,243.80
|
| Rate for Payer: WPS Commercial |
$5,715.24
|
|
|
PLATE PROXIMAL HUMERUS 3.5 LCP 3HL LT 02.123.041S
|
Facility
|
OP
|
$7,716.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3805556
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,160.48 |
| Max. Negotiated Rate |
$30,864.00 |
| Rate for Payer: Aetna Commercial |
$6,944.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,635.76
|
| Rate for Payer: Aetna Managed Medicare |
$2,160.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,015.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,858.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,703.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,089.48
|
| Rate for Payer: Cash Price |
$2,314.80
|
| Rate for Payer: Cigna Commercial |
$7,098.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,317.87
|
| Rate for Payer: Health EOS Commercial |
$6,867.24
|
| Rate for Payer: HFN Commercial |
$7,098.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,787.00
|
| Rate for Payer: Multiplan Commercial |
$6,172.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,629.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,098.72
|
| Rate for Payer: Quartz Beloit One Network |
$3,780.84
|
| Rate for Payer: Quartz Commercial |
$5,015.40
|
| Rate for Payer: Quartz Medicare Advantage |
$4,629.60
|
| Rate for Payer: The Alliance Commercial |
$30,864.00
|
| Rate for Payer: WEA Trust Commercial |
$4,243.80
|
| Rate for Payer: WPS Commercial |
$5,715.24
|
|
|
PLATE PROXIMAL HUMERUS 3.5 LCP 3HL RT 02.123.040S
|
Facility
|
OP
|
$9,879.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966334
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,766.12 |
| Max. Negotiated Rate |
$39,516.00 |
| Rate for Payer: Aetna Commercial |
$8,891.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,495.94
|
| Rate for Payer: Aetna Managed Medicare |
$2,766.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,421.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,939.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,741.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,235.87
|
| Rate for Payer: Cash Price |
$2,963.70
|
| Rate for Payer: Cigna Commercial |
$9,088.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,528.29
|
| Rate for Payer: Health EOS Commercial |
$8,792.31
|
| Rate for Payer: HFN Commercial |
$9,088.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,409.25
|
| Rate for Payer: Multiplan Commercial |
$7,903.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,927.40
|
| Rate for Payer: Preferred Network Access Commercial |
$9,088.68
|
| Rate for Payer: Quartz Beloit One Network |
$4,840.71
|
| Rate for Payer: Quartz Commercial |
$6,421.35
|
| Rate for Payer: Quartz Medicare Advantage |
$5,927.40
|
| Rate for Payer: The Alliance Commercial |
$39,516.00
|
| Rate for Payer: WEA Trust Commercial |
$5,433.45
|
| Rate for Payer: WPS Commercial |
$7,317.38
|
|
|
PLATE PROXIMAL HUMERUS 3.5 LCP 3HL RT 02.123.040S
|
Facility
|
IP
|
$9,879.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966334
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,840.71 |
| Max. Negotiated Rate |
$9,088.68 |
| Rate for Payer: Aetna Commercial |
$8,891.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,495.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,235.87
|
| Rate for Payer: Cash Price |
$2,963.70
|
| Rate for Payer: Cigna Commercial |
$9,088.68
|
| Rate for Payer: Health EOS Commercial |
$8,792.31
|
| Rate for Payer: HFN Commercial |
$9,088.68
|
| Rate for Payer: Multiplan Commercial |
$7,903.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,927.40
|
| Rate for Payer: Preferred Network Access Commercial |
$9,088.68
|
| Rate for Payer: Quartz Beloit One Network |
$4,840.71
|
| Rate for Payer: Quartz Commercial |
$5,927.40
|
| Rate for Payer: WEA Trust Commercial |
$5,433.45
|
| Rate for Payer: WPS Commercial |
$7,317.38
|
|
|
PLATE PROXIMAL HUMERUS 3.5 LCP 6HL RT 02.123.024S
|
Facility
|
OP
|
$8,241.00
|
|
|
Service Code
|
HCPCS C1714
|
| Hospital Charge Code |
3491510
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,307.48 |
| Max. Negotiated Rate |
$32,964.00 |
| Rate for Payer: Aetna Commercial |
$7,416.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,087.26
|
| Rate for Payer: Aetna Managed Medicare |
$2,307.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,356.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,120.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,955.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,367.73
|
| Rate for Payer: Cash Price |
$2,472.30
|
| Rate for Payer: Cigna Commercial |
$7,581.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,611.66
|
| Rate for Payer: Health EOS Commercial |
$7,334.49
|
| Rate for Payer: HFN Commercial |
$7,581.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,180.75
|
| Rate for Payer: Multiplan Commercial |
$6,592.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,944.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,581.72
|
| Rate for Payer: Quartz Beloit One Network |
$4,038.09
|
| Rate for Payer: Quartz Commercial |
$5,356.65
|
| Rate for Payer: Quartz Medicare Advantage |
$4,944.60
|
| Rate for Payer: The Alliance Commercial |
$32,964.00
|
| Rate for Payer: WEA Trust Commercial |
$4,532.55
|
| Rate for Payer: WPS Commercial |
$6,104.11
|
|
|
PLATE PROXIMAL HUMERUS 3.5 LCP 6HL RT 02.123.024S
|
Facility
|
IP
|
$8,241.00
|
|
|
Service Code
|
HCPCS C1714
|
| Hospital Charge Code |
3491510
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,038.09 |
| Max. Negotiated Rate |
$7,581.72 |
| Rate for Payer: Aetna Commercial |
$7,416.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,087.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,367.73
|
| Rate for Payer: Cash Price |
$2,472.30
|
| Rate for Payer: Cigna Commercial |
$7,581.72
|
| Rate for Payer: Health EOS Commercial |
$7,334.49
|
| Rate for Payer: HFN Commercial |
$7,581.72
|
| Rate for Payer: Multiplan Commercial |
$6,592.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,944.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,581.72
|
| Rate for Payer: Quartz Beloit One Network |
$4,038.09
|
| Rate for Payer: Quartz Commercial |
$4,944.60
|
| Rate for Payer: WEA Trust Commercial |
$4,532.55
|
| Rate for Payer: WPS Commercial |
$6,104.11
|
|
|
PLATE PROXIMAL TIBIAL PLATLOW BEND LCP 6HL LT 02.124.205S
|
Facility
|
OP
|
$6,549.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4518882
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,833.72 |
| Max. Negotiated Rate |
$26,196.00 |
| Rate for Payer: Aetna Commercial |
$5,894.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,632.14
|
| Rate for Payer: Aetna Managed Medicare |
$1,833.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,256.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,274.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,143.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,470.97
|
| Rate for Payer: Cash Price |
$1,964.70
|
| Rate for Payer: Cigna Commercial |
$6,025.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,664.82
|
| Rate for Payer: Health EOS Commercial |
$5,828.61
|
| Rate for Payer: HFN Commercial |
$6,025.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,911.75
|
| Rate for Payer: Multiplan Commercial |
$5,239.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,929.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,025.08
|
| Rate for Payer: Quartz Beloit One Network |
$3,209.01
|
| Rate for Payer: Quartz Commercial |
$4,256.85
|
| Rate for Payer: Quartz Medicare Advantage |
$3,929.40
|
| Rate for Payer: The Alliance Commercial |
$26,196.00
|
| Rate for Payer: WEA Trust Commercial |
$3,601.95
|
| Rate for Payer: WPS Commercial |
$4,850.84
|
|
|
PLATE PROXIMAL TIBIAL PLATLOW BEND LCP 6HL LT 02.124.205S
|
Facility
|
IP
|
$6,549.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4518882
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,209.01 |
| Max. Negotiated Rate |
$6,025.08 |
| Rate for Payer: Aetna Commercial |
$5,894.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,632.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,470.97
|
| Rate for Payer: Cash Price |
$1,964.70
|
| Rate for Payer: Cigna Commercial |
$6,025.08
|
| Rate for Payer: Health EOS Commercial |
$5,828.61
|
| Rate for Payer: HFN Commercial |
$6,025.08
|
| Rate for Payer: Multiplan Commercial |
$5,239.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,929.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,025.08
|
| Rate for Payer: Quartz Beloit One Network |
$3,209.01
|
| Rate for Payer: Quartz Commercial |
$3,929.40
|
| Rate for Payer: WEA Trust Commercial |
$3,601.95
|
| Rate for Payer: WPS Commercial |
$4,850.84
|
|
|
PLATE PROXIMAL TIBIAL PLATLOW BEND LCP 6HL RT 02.124.204
|
Facility
|
IP
|
$6,549.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415315
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,209.01 |
| Max. Negotiated Rate |
$6,025.08 |
| Rate for Payer: Aetna Commercial |
$5,894.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,632.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,470.97
|
| Rate for Payer: Cash Price |
$1,964.70
|
| Rate for Payer: Cigna Commercial |
$6,025.08
|
| Rate for Payer: Health EOS Commercial |
$5,828.61
|
| Rate for Payer: HFN Commercial |
$6,025.08
|
| Rate for Payer: Multiplan Commercial |
$5,239.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,929.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,025.08
|
| Rate for Payer: Quartz Beloit One Network |
$3,209.01
|
| Rate for Payer: Quartz Commercial |
$3,929.40
|
| Rate for Payer: WEA Trust Commercial |
$3,601.95
|
| Rate for Payer: WPS Commercial |
$4,850.84
|
|
