|
PLATE BROAD LCP 7HL 226.571
|
Facility
|
OP
|
$9,066.00
|
|
| Hospital Charge Code |
2966755
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,640.02 |
| Max. Negotiated Rate |
$8,674.35 |
| Rate for Payer: Aetna Commercial |
$8,485.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,108.63
|
| Rate for Payer: Aetna Managed Medicare |
$2,640.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,128.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,714.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,525.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,997.18
|
| Rate for Payer: Cash Price |
$2,719.80
|
| Rate for Payer: Cigna Commercial |
$8,674.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,276.41
|
| Rate for Payer: Health EOS Commercial |
$8,391.49
|
| Rate for Payer: HFN Commercial |
$8,674.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,071.48
|
| Rate for Payer: Multiplan Commercial |
$7,542.91
|
| Rate for Payer: NAPHCARE Commercial |
$5,657.18
|
| Rate for Payer: Preferred Network Access Commercial |
$8,674.35
|
| Rate for Payer: Quartz Beloit One Network |
$4,620.03
|
| Rate for Payer: Quartz Commercial |
$6,128.62
|
| Rate for Payer: Quartz Medicare Advantage |
$5,657.18
|
| Rate for Payer: The Alliance Commercial |
$4,714.32
|
| Rate for Payer: WEA Trust Commercial |
$5,185.75
|
| Rate for Payer: WPS Commercial |
$6,983.54
|
|
|
PLATE BROAD LCP 7HL 226.571
|
Facility
|
IP
|
$9,066.00
|
|
| Hospital Charge Code |
2966755
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,620.03 |
| Max. Negotiated Rate |
$8,674.35 |
| Rate for Payer: Aetna Commercial |
$8,485.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,108.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,997.18
|
| Rate for Payer: Cash Price |
$2,719.80
|
| Rate for Payer: Cigna Commercial |
$8,674.35
|
| Rate for Payer: Health EOS Commercial |
$8,391.49
|
| Rate for Payer: HFN Commercial |
$8,674.35
|
| Rate for Payer: Multiplan Commercial |
$7,542.91
|
| Rate for Payer: Preferred Network Access Commercial |
$8,674.35
|
| Rate for Payer: Quartz Beloit One Network |
$4,620.03
|
| Rate for Payer: Quartz Commercial |
$5,657.18
|
| Rate for Payer: WEA Trust Commercial |
$5,185.75
|
| Rate for Payer: WPS Commercial |
$6,983.54
|
|
|
PLATE BROAD LCP 8HL 226.581
|
Facility
|
OP
|
$9,066.00
|
|
| Hospital Charge Code |
2966756
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,640.02 |
| Max. Negotiated Rate |
$8,674.35 |
| Rate for Payer: Aetna Commercial |
$8,485.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,108.63
|
| Rate for Payer: Aetna Managed Medicare |
$2,640.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,128.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,714.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,525.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,997.18
|
| Rate for Payer: Cash Price |
$2,719.80
|
| Rate for Payer: Cigna Commercial |
$8,674.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,276.41
|
| Rate for Payer: Health EOS Commercial |
$8,391.49
|
| Rate for Payer: HFN Commercial |
$8,674.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,071.48
|
| Rate for Payer: Multiplan Commercial |
$7,542.91
|
| Rate for Payer: NAPHCARE Commercial |
$5,657.18
|
| Rate for Payer: Preferred Network Access Commercial |
$8,674.35
|
| Rate for Payer: Quartz Beloit One Network |
$4,620.03
|
| Rate for Payer: Quartz Commercial |
$6,128.62
|
| Rate for Payer: Quartz Medicare Advantage |
$5,657.18
|
| Rate for Payer: The Alliance Commercial |
$4,714.32
|
| Rate for Payer: WEA Trust Commercial |
$5,185.75
|
| Rate for Payer: WPS Commercial |
$6,983.54
|
|
|
PLATE BROAD LCP 8HL 226.581
|
Facility
|
IP
|
$9,066.00
|
|
| Hospital Charge Code |
2966756
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,620.03 |
| Max. Negotiated Rate |
$8,674.35 |
| Rate for Payer: Aetna Commercial |
$8,485.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,108.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,997.18
|
| Rate for Payer: Cash Price |
$2,719.80
|
| Rate for Payer: Cigna Commercial |
$8,674.35
|
| Rate for Payer: Health EOS Commercial |
$8,391.49
|
| Rate for Payer: HFN Commercial |
$8,674.35
|
| Rate for Payer: Multiplan Commercial |
$7,542.91
|
| Rate for Payer: Preferred Network Access Commercial |
$8,674.35
|
| Rate for Payer: Quartz Beloit One Network |
$4,620.03
|
| Rate for Payer: Quartz Commercial |
$5,657.18
|
| Rate for Payer: WEA Trust Commercial |
$5,185.75
|
| Rate for Payer: WPS Commercial |
$6,983.54
|
|
|
PLATE BROAD LCP 9HL 226.591
|
Facility
|
IP
|
$9,066.00
|
|
| Hospital Charge Code |
2966757
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,620.03 |
| Max. Negotiated Rate |
$8,674.35 |
| Rate for Payer: Aetna Commercial |
$8,485.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,108.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,997.18
|
| Rate for Payer: Cash Price |
$2,719.80
|
| Rate for Payer: Cigna Commercial |
$8,674.35
|
| Rate for Payer: Health EOS Commercial |
$8,391.49
|
| Rate for Payer: HFN Commercial |
$8,674.35
|
| Rate for Payer: Multiplan Commercial |
$7,542.91
|
| Rate for Payer: Preferred Network Access Commercial |
$8,674.35
|
| Rate for Payer: Quartz Beloit One Network |
$4,620.03
|
| Rate for Payer: Quartz Commercial |
$5,657.18
|
| Rate for Payer: WEA Trust Commercial |
$5,185.75
|
| Rate for Payer: WPS Commercial |
$6,983.54
|
|
|
PLATE BROAD LCP 9HL 226.591
|
Facility
|
OP
|
$9,066.00
|
|
| Hospital Charge Code |
2966757
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,640.02 |
| Max. Negotiated Rate |
$8,674.35 |
| Rate for Payer: Aetna Commercial |
$8,485.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,108.63
|
| Rate for Payer: Aetna Managed Medicare |
$2,640.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,128.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,714.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,525.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,997.18
|
| Rate for Payer: Cash Price |
$2,719.80
|
| Rate for Payer: Cigna Commercial |
$8,674.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,276.41
|
| Rate for Payer: Health EOS Commercial |
$8,391.49
|
| Rate for Payer: HFN Commercial |
$8,674.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,071.48
|
| Rate for Payer: Multiplan Commercial |
$7,542.91
|
| Rate for Payer: NAPHCARE Commercial |
$5,657.18
|
| Rate for Payer: Preferred Network Access Commercial |
$8,674.35
|
| Rate for Payer: Quartz Beloit One Network |
$4,620.03
|
| Rate for Payer: Quartz Commercial |
$6,128.62
|
| Rate for Payer: Quartz Medicare Advantage |
$5,657.18
|
| Rate for Payer: The Alliance Commercial |
$4,714.32
|
| Rate for Payer: WEA Trust Commercial |
$5,185.75
|
| Rate for Payer: WPS Commercial |
$6,983.54
|
|
|
PLATE BROAD STRAIGHT 5 HL 626975
|
Facility
|
IP
|
$5,980.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6169642
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,047.41 |
| Max. Negotiated Rate |
$5,721.66 |
| Rate for Payer: Aetna Commercial |
$5,597.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,348.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,296.18
|
| Rate for Payer: Cash Price |
$1,794.00
|
| Rate for Payer: Cigna Commercial |
$5,721.66
|
| Rate for Payer: Health EOS Commercial |
$5,535.09
|
| Rate for Payer: HFN Commercial |
$5,721.66
|
| Rate for Payer: Multiplan Commercial |
$4,975.36
|
| Rate for Payer: Preferred Network Access Commercial |
$5,721.66
|
| Rate for Payer: Quartz Beloit One Network |
$3,047.41
|
| Rate for Payer: Quartz Commercial |
$3,731.52
|
| Rate for Payer: WEA Trust Commercial |
$3,420.56
|
| Rate for Payer: WPS Commercial |
$4,606.39
|
|
|
PLATE BROAD STRAIGHT 5 HL 626975
|
Facility
|
OP
|
$5,980.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6169642
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,741.38 |
| Max. Negotiated Rate |
$5,721.66 |
| Rate for Payer: Aetna Commercial |
$5,597.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,348.51
|
| Rate for Payer: Aetna Managed Medicare |
$1,741.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,042.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,109.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,985.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,296.18
|
| Rate for Payer: Cash Price |
$1,794.00
|
| Rate for Payer: Cigna Commercial |
$5,721.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,480.36
|
| Rate for Payer: Health EOS Commercial |
$5,535.09
|
| Rate for Payer: HFN Commercial |
$5,721.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,664.40
|
| Rate for Payer: Multiplan Commercial |
$4,975.36
|
| Rate for Payer: NAPHCARE Commercial |
$3,731.52
|
| Rate for Payer: Preferred Network Access Commercial |
$5,721.66
|
| Rate for Payer: Quartz Beloit One Network |
$3,047.41
|
| Rate for Payer: Quartz Commercial |
$4,042.48
|
| Rate for Payer: Quartz Medicare Advantage |
$3,731.52
|
| Rate for Payer: The Alliance Commercial |
$3,109.60
|
| Rate for Payer: WEA Trust Commercial |
$3,420.56
|
| Rate for Payer: WPS Commercial |
$4,606.39
|
|
|
PLATE BROAD STRAIGHT 7 HL 626977
|
Facility
|
OP
|
$5,980.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6177676
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,741.38 |
| Max. Negotiated Rate |
$5,721.66 |
| Rate for Payer: Aetna Commercial |
$5,597.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,348.51
|
| Rate for Payer: Aetna Managed Medicare |
$1,741.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,042.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,109.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,985.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,296.18
|
| Rate for Payer: Cash Price |
$1,794.00
|
| Rate for Payer: Cigna Commercial |
$5,721.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,480.36
|
| Rate for Payer: Health EOS Commercial |
$5,535.09
|
| Rate for Payer: HFN Commercial |
$5,721.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,664.40
|
| Rate for Payer: Multiplan Commercial |
$4,975.36
|
| Rate for Payer: NAPHCARE Commercial |
$3,731.52
|
| Rate for Payer: Preferred Network Access Commercial |
$5,721.66
|
| Rate for Payer: Quartz Beloit One Network |
$3,047.41
|
| Rate for Payer: Quartz Commercial |
$4,042.48
|
| Rate for Payer: Quartz Medicare Advantage |
$3,731.52
|
| Rate for Payer: The Alliance Commercial |
$3,109.60
|
| Rate for Payer: WEA Trust Commercial |
$3,420.56
|
| Rate for Payer: WPS Commercial |
$4,606.39
|
|
|
PLATE BROAD STRAIGHT 7 HL 626977
|
Facility
|
IP
|
$5,980.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6177676
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,047.41 |
| Max. Negotiated Rate |
$5,721.66 |
| Rate for Payer: Aetna Commercial |
$5,597.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,348.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,296.18
|
| Rate for Payer: Cash Price |
$1,794.00
|
| Rate for Payer: Cigna Commercial |
$5,721.66
|
| Rate for Payer: Health EOS Commercial |
$5,535.09
|
| Rate for Payer: HFN Commercial |
$5,721.66
|
| Rate for Payer: Multiplan Commercial |
$4,975.36
|
| Rate for Payer: Preferred Network Access Commercial |
$5,721.66
|
| Rate for Payer: Quartz Beloit One Network |
$3,047.41
|
| Rate for Payer: Quartz Commercial |
$3,731.52
|
| Rate for Payer: WEA Trust Commercial |
$3,420.56
|
| Rate for Payer: WPS Commercial |
$4,606.39
|
|
|
PLATE BROAD Y 3 SHAFT HOLE 626993
|
Facility
|
OP
|
$6,213.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6181249
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,809.23 |
| Max. Negotiated Rate |
$5,944.60 |
| Rate for Payer: Aetna Commercial |
$5,815.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,556.91
|
| Rate for Payer: Aetna Managed Medicare |
$1,809.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,199.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,230.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,101.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,424.61
|
| Rate for Payer: Cash Price |
$1,863.90
|
| Rate for Payer: Cigna Commercial |
$5,944.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,615.97
|
| Rate for Payer: Health EOS Commercial |
$5,750.75
|
| Rate for Payer: HFN Commercial |
$5,944.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,846.14
|
| Rate for Payer: Multiplan Commercial |
$5,169.22
|
| Rate for Payer: NAPHCARE Commercial |
$3,876.91
|
| Rate for Payer: Preferred Network Access Commercial |
$5,944.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,166.14
|
| Rate for Payer: Quartz Commercial |
$4,199.99
|
| Rate for Payer: Quartz Medicare Advantage |
$3,876.91
|
| Rate for Payer: The Alliance Commercial |
$3,230.76
|
| Rate for Payer: WEA Trust Commercial |
$3,553.84
|
| Rate for Payer: WPS Commercial |
$4,785.87
|
|
|
PLATE BROAD Y 3 SHAFT HOLE 626993
|
Facility
|
IP
|
$6,213.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6181249
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,166.14 |
| Max. Negotiated Rate |
$5,944.60 |
| Rate for Payer: Aetna Commercial |
$5,815.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,556.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,424.61
|
| Rate for Payer: Cash Price |
$1,863.90
|
| Rate for Payer: Cigna Commercial |
$5,944.60
|
| Rate for Payer: Health EOS Commercial |
$5,750.75
|
| Rate for Payer: HFN Commercial |
$5,944.60
|
| Rate for Payer: Multiplan Commercial |
$5,169.22
|
| Rate for Payer: Preferred Network Access Commercial |
$5,944.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,166.14
|
| Rate for Payer: Quartz Commercial |
$3,876.91
|
| Rate for Payer: WEA Trust Commercial |
$3,553.84
|
| Rate for Payer: WPS Commercial |
$4,785.87
|
|
|
PLATE CALCANEAL 2.7 SMALL 58MM LT 02.211.401
|
Facility
|
OP
|
$5,393.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5264697
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,570.44 |
| Max. Negotiated Rate |
$5,160.02 |
| Rate for Payer: Aetna Commercial |
$5,047.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,823.50
|
| Rate for Payer: Aetna Managed Medicare |
$1,570.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,645.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,804.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,692.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,972.62
|
| Rate for Payer: Cash Price |
$1,617.90
|
| Rate for Payer: Cigna Commercial |
$5,160.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,138.73
|
| Rate for Payer: Health EOS Commercial |
$4,991.76
|
| Rate for Payer: HFN Commercial |
$5,160.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,206.54
|
| Rate for Payer: Multiplan Commercial |
$4,486.98
|
| Rate for Payer: NAPHCARE Commercial |
$3,365.23
|
| Rate for Payer: Preferred Network Access Commercial |
$5,160.02
|
| Rate for Payer: Quartz Beloit One Network |
$2,748.27
|
| Rate for Payer: Quartz Commercial |
$3,645.67
|
| Rate for Payer: Quartz Medicare Advantage |
$3,365.23
|
| Rate for Payer: The Alliance Commercial |
$2,804.36
|
| Rate for Payer: WEA Trust Commercial |
$3,084.80
|
| Rate for Payer: WPS Commercial |
$4,154.23
|
|
|
PLATE CALCANEAL 2.7 SMALL 58MM LT 02.211.401
|
Facility
|
IP
|
$5,393.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5264697
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,748.27 |
| Max. Negotiated Rate |
$5,160.02 |
| Rate for Payer: Aetna Commercial |
$5,047.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,823.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,972.62
|
| Rate for Payer: Cash Price |
$1,617.90
|
| Rate for Payer: Cigna Commercial |
$5,160.02
|
| Rate for Payer: Health EOS Commercial |
$4,991.76
|
| Rate for Payer: HFN Commercial |
$5,160.02
|
| Rate for Payer: Multiplan Commercial |
$4,486.98
|
| Rate for Payer: Preferred Network Access Commercial |
$5,160.02
|
| Rate for Payer: Quartz Beloit One Network |
$2,748.27
|
| Rate for Payer: Quartz Commercial |
$3,365.23
|
| Rate for Payer: WEA Trust Commercial |
$3,084.80
|
| Rate for Payer: WPS Commercial |
$4,154.23
|
|
|
PLATE CALCANEAL 2.7 SMALL 58MM RT 02.211.400
|
Facility
|
IP
|
$5,393.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4452950
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,748.27 |
| Max. Negotiated Rate |
$5,160.02 |
| Rate for Payer: Aetna Commercial |
$5,047.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,823.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,972.62
|
| Rate for Payer: Cash Price |
$1,617.90
|
| Rate for Payer: Cigna Commercial |
$5,160.02
|
| Rate for Payer: Health EOS Commercial |
$4,991.76
|
| Rate for Payer: HFN Commercial |
$5,160.02
|
| Rate for Payer: Multiplan Commercial |
$4,486.98
|
| Rate for Payer: Preferred Network Access Commercial |
$5,160.02
|
| Rate for Payer: Quartz Beloit One Network |
$2,748.27
|
| Rate for Payer: Quartz Commercial |
$3,365.23
|
| Rate for Payer: WEA Trust Commercial |
$3,084.80
|
| Rate for Payer: WPS Commercial |
$4,154.23
|
|
|
PLATE CALCANEAL 2.7 SMALL 58MM RT 02.211.400
|
Facility
|
OP
|
$5,393.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4452950
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,570.44 |
| Max. Negotiated Rate |
$5,160.02 |
| Rate for Payer: Aetna Commercial |
$5,047.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,823.50
|
| Rate for Payer: Aetna Managed Medicare |
$1,570.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,645.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,804.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,692.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,972.62
|
| Rate for Payer: Cash Price |
$1,617.90
|
| Rate for Payer: Cigna Commercial |
$5,160.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,138.73
|
| Rate for Payer: Health EOS Commercial |
$4,991.76
|
| Rate for Payer: HFN Commercial |
$5,160.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,206.54
|
| Rate for Payer: Multiplan Commercial |
$4,486.98
|
| Rate for Payer: NAPHCARE Commercial |
$3,365.23
|
| Rate for Payer: Preferred Network Access Commercial |
$5,160.02
|
| Rate for Payer: Quartz Beloit One Network |
$2,748.27
|
| Rate for Payer: Quartz Commercial |
$3,645.67
|
| Rate for Payer: Quartz Medicare Advantage |
$3,365.23
|
| Rate for Payer: The Alliance Commercial |
$2,804.36
|
| Rate for Payer: WEA Trust Commercial |
$3,084.80
|
| Rate for Payer: WPS Commercial |
$4,154.23
|
|
|
PLATE CALCANEAL STD RT CLX-002-SR
|
Facility
|
OP
|
$13,706.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5729846
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,991.19 |
| Max. Negotiated Rate |
$13,113.90 |
| Rate for Payer: Aetna Commercial |
$12,828.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,258.65
|
| Rate for Payer: Aetna Managed Medicare |
$3,991.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,265.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,127.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,842.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,554.75
|
| Rate for Payer: Cash Price |
$4,111.80
|
| Rate for Payer: Cigna Commercial |
$13,113.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,976.89
|
| Rate for Payer: Health EOS Commercial |
$12,686.27
|
| Rate for Payer: HFN Commercial |
$13,113.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,690.68
|
| Rate for Payer: Multiplan Commercial |
$11,403.39
|
| Rate for Payer: NAPHCARE Commercial |
$8,552.54
|
| Rate for Payer: Preferred Network Access Commercial |
$13,113.90
|
| Rate for Payer: Quartz Beloit One Network |
$6,984.58
|
| Rate for Payer: Quartz Commercial |
$9,265.26
|
| Rate for Payer: Quartz Medicare Advantage |
$8,552.54
|
| Rate for Payer: The Alliance Commercial |
$7,127.12
|
| Rate for Payer: WEA Trust Commercial |
$7,839.83
|
| Rate for Payer: WPS Commercial |
$10,557.73
|
|
|
PLATE CALCANEAL STD RT CLX-002-SR
|
Facility
|
IP
|
$13,706.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5729846
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,984.58 |
| Max. Negotiated Rate |
$13,113.90 |
| Rate for Payer: Aetna Commercial |
$12,828.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,258.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,554.75
|
| Rate for Payer: Cash Price |
$4,111.80
|
| Rate for Payer: Cigna Commercial |
$13,113.90
|
| Rate for Payer: Health EOS Commercial |
$12,686.27
|
| Rate for Payer: HFN Commercial |
$13,113.90
|
| Rate for Payer: Multiplan Commercial |
$11,403.39
|
| Rate for Payer: Preferred Network Access Commercial |
$13,113.90
|
| Rate for Payer: Quartz Beloit One Network |
$6,984.58
|
| Rate for Payer: Quartz Commercial |
$8,552.54
|
| Rate for Payer: WEA Trust Commercial |
$7,839.83
|
| Rate for Payer: WPS Commercial |
$10,557.73
|
|
|
PLATE CLAVICLE 3.5 3HL LT 02.112.007S
|
Facility
|
IP
|
$7,903.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966332
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,027.37 |
| Max. Negotiated Rate |
$7,561.59 |
| Rate for Payer: Aetna Commercial |
$7,397.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,068.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,356.13
|
| Rate for Payer: Cash Price |
$2,370.90
|
| Rate for Payer: Cigna Commercial |
$7,561.59
|
| Rate for Payer: Health EOS Commercial |
$7,315.02
|
| Rate for Payer: HFN Commercial |
$7,561.59
|
| Rate for Payer: Multiplan Commercial |
$6,575.30
|
| Rate for Payer: Preferred Network Access Commercial |
$7,561.59
|
| Rate for Payer: Quartz Beloit One Network |
$4,027.37
|
| Rate for Payer: Quartz Commercial |
$4,931.47
|
| Rate for Payer: WEA Trust Commercial |
$4,520.52
|
| Rate for Payer: WPS Commercial |
$6,087.68
|
|
|
PLATE CLAVICLE 3.5 3HL LT 02.112.007S
|
Facility
|
OP
|
$7,903.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966332
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,301.35 |
| Max. Negotiated Rate |
$7,561.59 |
| Rate for Payer: Aetna Commercial |
$7,397.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,068.44
|
| Rate for Payer: Aetna Managed Medicare |
$2,301.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,342.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,109.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,945.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,356.13
|
| Rate for Payer: Cash Price |
$2,370.90
|
| Rate for Payer: Cigna Commercial |
$7,561.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,599.55
|
| Rate for Payer: Health EOS Commercial |
$7,315.02
|
| Rate for Payer: HFN Commercial |
$7,561.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,164.34
|
| Rate for Payer: Multiplan Commercial |
$6,575.30
|
| Rate for Payer: NAPHCARE Commercial |
$4,931.47
|
| Rate for Payer: Preferred Network Access Commercial |
$7,561.59
|
| Rate for Payer: Quartz Beloit One Network |
$4,027.37
|
| Rate for Payer: Quartz Commercial |
$5,342.43
|
| Rate for Payer: Quartz Medicare Advantage |
$4,931.47
|
| Rate for Payer: The Alliance Commercial |
$4,109.56
|
| Rate for Payer: WEA Trust Commercial |
$4,520.52
|
| Rate for Payer: WPS Commercial |
$6,087.68
|
|
|
PLATE CLAVICLE 3.5 LCP SUPERIOR 6HL LEFT 02.112.081S
|
Facility
|
IP
|
$6,371.00
|
|
| Hospital Charge Code |
2966340
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,246.66 |
| Max. Negotiated Rate |
$6,095.77 |
| Rate for Payer: Aetna Commercial |
$5,963.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,698.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,511.70
|
| Rate for Payer: Cash Price |
$1,911.30
|
| Rate for Payer: Cigna Commercial |
$6,095.77
|
| Rate for Payer: Health EOS Commercial |
$5,897.00
|
| Rate for Payer: HFN Commercial |
$6,095.77
|
| Rate for Payer: Multiplan Commercial |
$5,300.67
|
| Rate for Payer: Preferred Network Access Commercial |
$6,095.77
|
| Rate for Payer: Quartz Beloit One Network |
$3,246.66
|
| Rate for Payer: Quartz Commercial |
$3,975.50
|
| Rate for Payer: WEA Trust Commercial |
$3,644.21
|
| Rate for Payer: WPS Commercial |
$4,907.58
|
|
|
PLATE CLAVICLE 3.5 LCP SUPERIOR 6HL LEFT 02.112.081S
|
Facility
|
OP
|
$6,371.00
|
|
| Hospital Charge Code |
2966340
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,855.24 |
| Max. Negotiated Rate |
$6,095.77 |
| Rate for Payer: Aetna Commercial |
$5,963.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,698.22
|
| Rate for Payer: Aetna Managed Medicare |
$1,855.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,306.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,312.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,180.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,511.70
|
| Rate for Payer: Cash Price |
$1,911.30
|
| Rate for Payer: Cigna Commercial |
$6,095.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,707.92
|
| Rate for Payer: Health EOS Commercial |
$5,897.00
|
| Rate for Payer: HFN Commercial |
$6,095.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,969.38
|
| Rate for Payer: Multiplan Commercial |
$5,300.67
|
| Rate for Payer: NAPHCARE Commercial |
$3,975.50
|
| Rate for Payer: Preferred Network Access Commercial |
$6,095.77
|
| Rate for Payer: Quartz Beloit One Network |
$3,246.66
|
| Rate for Payer: Quartz Commercial |
$4,306.80
|
| Rate for Payer: Quartz Medicare Advantage |
$3,975.50
|
| Rate for Payer: The Alliance Commercial |
$3,312.92
|
| Rate for Payer: WEA Trust Commercial |
$3,644.21
|
| Rate for Payer: WPS Commercial |
$4,907.58
|
|
|
PLATE CLAVICLE 3.5 LCP SUPERIOR ANTERIOR 02.112.029
|
Facility
|
OP
|
$6,686.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3937362
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,946.96 |
| Max. Negotiated Rate |
$6,397.16 |
| Rate for Payer: Aetna Commercial |
$6,258.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,979.96
|
| Rate for Payer: Aetna Managed Medicare |
$1,946.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,519.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,476.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,337.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,685.32
|
| Rate for Payer: Cash Price |
$2,005.80
|
| Rate for Payer: Cigna Commercial |
$6,397.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,891.25
|
| Rate for Payer: Health EOS Commercial |
$6,188.56
|
| Rate for Payer: HFN Commercial |
$6,397.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,215.08
|
| Rate for Payer: Multiplan Commercial |
$5,562.75
|
| Rate for Payer: NAPHCARE Commercial |
$4,172.06
|
| Rate for Payer: Preferred Network Access Commercial |
$6,397.16
|
| Rate for Payer: Quartz Beloit One Network |
$3,407.19
|
| Rate for Payer: Quartz Commercial |
$4,519.74
|
| Rate for Payer: Quartz Medicare Advantage |
$4,172.06
|
| Rate for Payer: The Alliance Commercial |
$3,476.72
|
| Rate for Payer: WEA Trust Commercial |
$3,824.39
|
| Rate for Payer: WPS Commercial |
$5,150.23
|
|
|
PLATE CLAVICLE 3.5 LCP SUPERIOR ANTERIOR 02.112.029
|
Facility
|
IP
|
$6,686.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3937362
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,407.19 |
| Max. Negotiated Rate |
$6,397.16 |
| Rate for Payer: Aetna Commercial |
$6,258.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,979.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,685.32
|
| Rate for Payer: Cash Price |
$2,005.80
|
| Rate for Payer: Cigna Commercial |
$6,397.16
|
| Rate for Payer: Health EOS Commercial |
$6,188.56
|
| Rate for Payer: HFN Commercial |
$6,397.16
|
| Rate for Payer: Multiplan Commercial |
$5,562.75
|
| Rate for Payer: Preferred Network Access Commercial |
$6,397.16
|
| Rate for Payer: Quartz Beloit One Network |
$3,407.19
|
| Rate for Payer: Quartz Commercial |
$4,172.06
|
| Rate for Payer: WEA Trust Commercial |
$3,824.39
|
| Rate for Payer: WPS Commercial |
$5,150.23
|
|
|
PLATE CLAVICLE 3.5MM 6HL RT 02.112.008
|
Facility
|
IP
|
$5,116.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414899
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,607.11 |
| Max. Negotiated Rate |
$4,894.99 |
| Rate for Payer: Aetna Commercial |
$4,788.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,575.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,819.94
|
| Rate for Payer: Cash Price |
$1,534.80
|
| Rate for Payer: Cigna Commercial |
$4,894.99
|
| Rate for Payer: Health EOS Commercial |
$4,735.37
|
| Rate for Payer: HFN Commercial |
$4,894.99
|
| Rate for Payer: Multiplan Commercial |
$4,256.51
|
| Rate for Payer: Preferred Network Access Commercial |
$4,894.99
|
| Rate for Payer: Quartz Beloit One Network |
$2,607.11
|
| Rate for Payer: Quartz Commercial |
$3,192.38
|
| Rate for Payer: WEA Trust Commercial |
$2,926.35
|
| Rate for Payer: WPS Commercial |
$3,940.85
|
|
