|
PLATE CLAVICLE SUPERIOR LATERAL EXTERNAL 8HL LT 02.112.095S
|
Facility
|
IP
|
$6,121.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5384888
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,119.26 |
| Max. Negotiated Rate |
$5,856.57 |
| Rate for Payer: Aetna Commercial |
$5,729.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,474.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,373.90
|
| Rate for Payer: Cash Price |
$1,836.30
|
| Rate for Payer: Cigna Commercial |
$5,856.57
|
| Rate for Payer: Health EOS Commercial |
$5,665.60
|
| Rate for Payer: HFN Commercial |
$5,856.57
|
| Rate for Payer: Multiplan Commercial |
$5,092.67
|
| Rate for Payer: Preferred Network Access Commercial |
$5,856.57
|
| Rate for Payer: Quartz Beloit One Network |
$3,119.26
|
| Rate for Payer: Quartz Commercial |
$3,819.50
|
| Rate for Payer: WEA Trust Commercial |
$3,501.21
|
| Rate for Payer: WPS Commercial |
$4,715.01
|
|
|
PLATE CLAVICLE SUPERIOR LATERAL EXTERNAL 8HL LT 02.112.095S
|
Facility
|
OP
|
$6,121.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5384888
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,782.44 |
| Max. Negotiated Rate |
$5,856.57 |
| Rate for Payer: Aetna Commercial |
$5,729.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,474.62
|
| Rate for Payer: Aetna Managed Medicare |
$1,782.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,137.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,182.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,055.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,373.90
|
| Rate for Payer: Cash Price |
$1,836.30
|
| Rate for Payer: Cigna Commercial |
$5,856.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,562.42
|
| Rate for Payer: Health EOS Commercial |
$5,665.60
|
| Rate for Payer: HFN Commercial |
$5,856.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,774.38
|
| Rate for Payer: Multiplan Commercial |
$5,092.67
|
| Rate for Payer: NAPHCARE Commercial |
$3,819.50
|
| Rate for Payer: Preferred Network Access Commercial |
$5,856.57
|
| Rate for Payer: Quartz Beloit One Network |
$3,119.26
|
| Rate for Payer: Quartz Commercial |
$4,137.80
|
| Rate for Payer: Quartz Medicare Advantage |
$3,819.50
|
| Rate for Payer: The Alliance Commercial |
$3,182.92
|
| Rate for Payer: WEA Trust Commercial |
$3,501.21
|
| Rate for Payer: WPS Commercial |
$4,715.01
|
|
|
PLATE CLAVICLE SUPEROR DECREASED CURVATURE 8 HOLE BRIDGE / LEFT 628048
|
Facility
|
IP
|
$5,528.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6178000
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,817.07 |
| Max. Negotiated Rate |
$5,289.19 |
| Rate for Payer: Aetna Commercial |
$5,174.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,944.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,047.03
|
| Rate for Payer: Cash Price |
$1,658.40
|
| Rate for Payer: Cigna Commercial |
$5,289.19
|
| Rate for Payer: Health EOS Commercial |
$5,116.72
|
| Rate for Payer: HFN Commercial |
$5,289.19
|
| Rate for Payer: Multiplan Commercial |
$4,599.30
|
| Rate for Payer: Preferred Network Access Commercial |
$5,289.19
|
| Rate for Payer: Quartz Beloit One Network |
$2,817.07
|
| Rate for Payer: Quartz Commercial |
$3,449.47
|
| Rate for Payer: WEA Trust Commercial |
$3,162.02
|
| Rate for Payer: WPS Commercial |
$4,258.22
|
|
|
PLATE CLAVICLE SUPEROR DECREASED CURVATURE 8 HOLE BRIDGE / LEFT 628048
|
Facility
|
OP
|
$5,528.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6178000
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,609.75 |
| Max. Negotiated Rate |
$5,289.19 |
| Rate for Payer: Aetna Commercial |
$5,174.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,944.24
|
| Rate for Payer: Aetna Managed Medicare |
$1,609.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,736.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,874.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,759.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,047.03
|
| Rate for Payer: Cash Price |
$1,658.40
|
| Rate for Payer: Cigna Commercial |
$5,289.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,217.30
|
| Rate for Payer: Health EOS Commercial |
$5,116.72
|
| Rate for Payer: HFN Commercial |
$5,289.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,311.84
|
| Rate for Payer: Multiplan Commercial |
$4,599.30
|
| Rate for Payer: NAPHCARE Commercial |
$3,449.47
|
| Rate for Payer: Preferred Network Access Commercial |
$5,289.19
|
| Rate for Payer: Quartz Beloit One Network |
$2,817.07
|
| Rate for Payer: Quartz Commercial |
$3,736.93
|
| Rate for Payer: Quartz Medicare Advantage |
$3,449.47
|
| Rate for Payer: The Alliance Commercial |
$2,874.56
|
| Rate for Payer: WEA Trust Commercial |
$3,162.02
|
| Rate for Payer: WPS Commercial |
$4,258.22
|
|
|
PLATE CLOVERLEAF 3HL 241.83
|
Facility
|
IP
|
$1,172.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966758
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$597.25 |
| Max. Negotiated Rate |
$1,121.37 |
| Rate for Payer: Aetna Commercial |
$1,096.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,048.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$646.01
|
| Rate for Payer: Cash Price |
$351.60
|
| Rate for Payer: Cigna Commercial |
$1,121.37
|
| Rate for Payer: Health EOS Commercial |
$1,084.80
|
| Rate for Payer: HFN Commercial |
$1,121.37
|
| Rate for Payer: Multiplan Commercial |
$975.10
|
| Rate for Payer: Preferred Network Access Commercial |
$1,121.37
|
| Rate for Payer: Quartz Beloit One Network |
$597.25
|
| Rate for Payer: Quartz Commercial |
$731.33
|
| Rate for Payer: WEA Trust Commercial |
$670.38
|
| Rate for Payer: WPS Commercial |
$902.79
|
|
|
PLATE CLOVERLEAF 3HL 241.83
|
Facility
|
OP
|
$1,172.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966758
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$341.29 |
| Max. Negotiated Rate |
$1,121.37 |
| Rate for Payer: Aetna Commercial |
$1,096.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,048.24
|
| Rate for Payer: Aetna Managed Medicare |
$341.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$792.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$609.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$585.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$646.01
|
| Rate for Payer: Cash Price |
$351.60
|
| Rate for Payer: Cigna Commercial |
$1,121.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$682.10
|
| Rate for Payer: Health EOS Commercial |
$1,084.80
|
| Rate for Payer: HFN Commercial |
$1,121.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$914.16
|
| Rate for Payer: Multiplan Commercial |
$975.10
|
| Rate for Payer: NAPHCARE Commercial |
$731.33
|
| Rate for Payer: Preferred Network Access Commercial |
$1,121.37
|
| Rate for Payer: Quartz Beloit One Network |
$597.25
|
| Rate for Payer: Quartz Commercial |
$792.27
|
| Rate for Payer: Quartz Medicare Advantage |
$731.33
|
| Rate for Payer: The Alliance Commercial |
$609.44
|
| Rate for Payer: WEA Trust Commercial |
$670.38
|
| Rate for Payer: WPS Commercial |
$902.79
|
|
|
PLATE CONDYLAR 2.0 7HL 247.349
|
Facility
|
IP
|
$5,277.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767798
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,689.16 |
| Max. Negotiated Rate |
$5,049.03 |
| Rate for Payer: Aetna Commercial |
$4,939.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,719.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,908.68
|
| Rate for Payer: Cash Price |
$1,583.10
|
| Rate for Payer: Cigna Commercial |
$5,049.03
|
| Rate for Payer: Health EOS Commercial |
$4,884.39
|
| Rate for Payer: HFN Commercial |
$5,049.03
|
| Rate for Payer: Multiplan Commercial |
$4,390.46
|
| Rate for Payer: Preferred Network Access Commercial |
$5,049.03
|
| Rate for Payer: Quartz Beloit One Network |
$2,689.16
|
| Rate for Payer: Quartz Commercial |
$3,292.85
|
| Rate for Payer: WEA Trust Commercial |
$3,018.44
|
| Rate for Payer: WPS Commercial |
$4,064.87
|
|
|
PLATE CONDYLAR 2.0 7HL 247.349
|
Facility
|
OP
|
$5,277.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767798
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,536.66 |
| Max. Negotiated Rate |
$5,049.03 |
| Rate for Payer: Aetna Commercial |
$4,939.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,719.75
|
| Rate for Payer: Aetna Managed Medicare |
$1,536.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,567.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,744.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,634.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,908.68
|
| Rate for Payer: Cash Price |
$1,583.10
|
| Rate for Payer: Cigna Commercial |
$5,049.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,071.21
|
| Rate for Payer: Health EOS Commercial |
$4,884.39
|
| Rate for Payer: HFN Commercial |
$5,049.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,116.06
|
| Rate for Payer: Multiplan Commercial |
$4,390.46
|
| Rate for Payer: NAPHCARE Commercial |
$3,292.85
|
| Rate for Payer: Preferred Network Access Commercial |
$5,049.03
|
| Rate for Payer: Quartz Beloit One Network |
$2,689.16
|
| Rate for Payer: Quartz Commercial |
$3,567.25
|
| Rate for Payer: Quartz Medicare Advantage |
$3,292.85
|
| Rate for Payer: The Alliance Commercial |
$2,744.04
|
| Rate for Payer: WEA Trust Commercial |
$3,018.44
|
| Rate for Payer: WPS Commercial |
$4,064.87
|
|
|
PLATE CONDYLAR 2.0MM 7H/39MM/LEFT 243.61
|
Facility
|
OP
|
$4,354.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508691
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,267.88 |
| Max. Negotiated Rate |
$4,165.91 |
| Rate for Payer: Aetna Commercial |
$4,075.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,894.22
|
| Rate for Payer: Aetna Managed Medicare |
$1,267.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,943.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,264.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,173.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,399.92
|
| Rate for Payer: Cash Price |
$1,306.20
|
| Rate for Payer: Cigna Commercial |
$4,165.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,534.03
|
| Rate for Payer: Health EOS Commercial |
$4,030.06
|
| Rate for Payer: HFN Commercial |
$4,165.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,396.12
|
| Rate for Payer: Multiplan Commercial |
$3,622.53
|
| Rate for Payer: NAPHCARE Commercial |
$2,716.90
|
| Rate for Payer: Preferred Network Access Commercial |
$4,165.91
|
| Rate for Payer: Quartz Beloit One Network |
$2,218.80
|
| Rate for Payer: Quartz Commercial |
$2,943.30
|
| Rate for Payer: Quartz Medicare Advantage |
$2,716.90
|
| Rate for Payer: The Alliance Commercial |
$2,264.08
|
| Rate for Payer: WEA Trust Commercial |
$2,490.49
|
| Rate for Payer: WPS Commercial |
$3,353.89
|
|
|
PLATE CONDYLAR 2.0MM 7H/39MM/LEFT 243.61
|
Facility
|
IP
|
$4,354.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508691
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,218.80 |
| Max. Negotiated Rate |
$4,165.91 |
| Rate for Payer: Aetna Commercial |
$4,075.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,894.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,399.92
|
| Rate for Payer: Cash Price |
$1,306.20
|
| Rate for Payer: Cigna Commercial |
$4,165.91
|
| Rate for Payer: Health EOS Commercial |
$4,030.06
|
| Rate for Payer: HFN Commercial |
$4,165.91
|
| Rate for Payer: Multiplan Commercial |
$3,622.53
|
| Rate for Payer: Preferred Network Access Commercial |
$4,165.91
|
| Rate for Payer: Quartz Beloit One Network |
$2,218.80
|
| Rate for Payer: Quartz Commercial |
$2,716.90
|
| Rate for Payer: WEA Trust Commercial |
$2,490.49
|
| Rate for Payer: WPS Commercial |
$3,353.89
|
|
|
PLATE CONDYLAR 2.0MM 7H/39MM/RIGHT 243.62
|
Facility
|
OP
|
$4,354.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508692
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,267.88 |
| Max. Negotiated Rate |
$4,165.91 |
| Rate for Payer: Aetna Commercial |
$4,075.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,894.22
|
| Rate for Payer: Aetna Managed Medicare |
$1,267.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,943.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,264.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,173.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,399.92
|
| Rate for Payer: Cash Price |
$1,306.20
|
| Rate for Payer: Cigna Commercial |
$4,165.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,534.03
|
| Rate for Payer: Health EOS Commercial |
$4,030.06
|
| Rate for Payer: HFN Commercial |
$4,165.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,396.12
|
| Rate for Payer: Multiplan Commercial |
$3,622.53
|
| Rate for Payer: NAPHCARE Commercial |
$2,716.90
|
| Rate for Payer: Preferred Network Access Commercial |
$4,165.91
|
| Rate for Payer: Quartz Beloit One Network |
$2,218.80
|
| Rate for Payer: Quartz Commercial |
$2,943.30
|
| Rate for Payer: Quartz Medicare Advantage |
$2,716.90
|
| Rate for Payer: The Alliance Commercial |
$2,264.08
|
| Rate for Payer: WEA Trust Commercial |
$2,490.49
|
| Rate for Payer: WPS Commercial |
$3,353.89
|
|
|
PLATE CONDYLAR 2.0MM 7H/39MM/RIGHT 243.62
|
Facility
|
IP
|
$4,354.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508692
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,218.80 |
| Max. Negotiated Rate |
$4,165.91 |
| Rate for Payer: Aetna Commercial |
$4,075.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,894.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,399.92
|
| Rate for Payer: Cash Price |
$1,306.20
|
| Rate for Payer: Cigna Commercial |
$4,165.91
|
| Rate for Payer: Health EOS Commercial |
$4,030.06
|
| Rate for Payer: HFN Commercial |
$4,165.91
|
| Rate for Payer: Multiplan Commercial |
$3,622.53
|
| Rate for Payer: Preferred Network Access Commercial |
$4,165.91
|
| Rate for Payer: Quartz Beloit One Network |
$2,218.80
|
| Rate for Payer: Quartz Commercial |
$2,716.90
|
| Rate for Payer: WEA Trust Commercial |
$2,490.49
|
| Rate for Payer: WPS Commercial |
$3,353.89
|
|
|
PLATE CONDYLAR 2.4 LCP 7HL SHAFT 249.679
|
Facility
|
IP
|
$5,463.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966324
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,783.94 |
| Max. Negotiated Rate |
$5,227.00 |
| Rate for Payer: Aetna Commercial |
$5,113.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,886.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,011.21
|
| Rate for Payer: Cash Price |
$1,638.90
|
| Rate for Payer: Cigna Commercial |
$5,227.00
|
| Rate for Payer: Health EOS Commercial |
$5,056.55
|
| Rate for Payer: HFN Commercial |
$5,227.00
|
| Rate for Payer: Multiplan Commercial |
$4,545.22
|
| Rate for Payer: Preferred Network Access Commercial |
$5,227.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,783.94
|
| Rate for Payer: Quartz Commercial |
$3,408.91
|
| Rate for Payer: WEA Trust Commercial |
$3,124.84
|
| Rate for Payer: WPS Commercial |
$4,208.15
|
|
|
PLATE CONDYLAR 2.4 LCP 7HL SHAFT 249.679
|
Facility
|
OP
|
$5,463.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966324
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,590.83 |
| Max. Negotiated Rate |
$5,227.00 |
| Rate for Payer: Aetna Commercial |
$5,113.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,886.11
|
| Rate for Payer: Aetna Managed Medicare |
$1,590.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,692.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,840.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,727.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,011.21
|
| Rate for Payer: Cash Price |
$1,638.90
|
| Rate for Payer: Cigna Commercial |
$5,227.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,179.47
|
| Rate for Payer: Health EOS Commercial |
$5,056.55
|
| Rate for Payer: HFN Commercial |
$5,227.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,261.14
|
| Rate for Payer: Multiplan Commercial |
$4,545.22
|
| Rate for Payer: NAPHCARE Commercial |
$3,408.91
|
| Rate for Payer: Preferred Network Access Commercial |
$5,227.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,783.94
|
| Rate for Payer: Quartz Commercial |
$3,692.99
|
| Rate for Payer: Quartz Medicare Advantage |
$3,408.91
|
| Rate for Payer: The Alliance Commercial |
$2,840.76
|
| Rate for Payer: WEA Trust Commercial |
$3,124.84
|
| Rate for Payer: WPS Commercial |
$4,208.15
|
|
|
PLATE CONDYLAR 2.4MM 8HL LEFT 249.917
|
Facility
|
OP
|
$4,622.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508777
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,345.93 |
| Max. Negotiated Rate |
$4,422.33 |
| Rate for Payer: Aetna Commercial |
$4,326.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,133.92
|
| Rate for Payer: Aetna Managed Medicare |
$1,345.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,124.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,403.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,307.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,547.65
|
| Rate for Payer: Cash Price |
$1,386.60
|
| Rate for Payer: Cigna Commercial |
$4,422.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,690.00
|
| Rate for Payer: Health EOS Commercial |
$4,278.12
|
| Rate for Payer: HFN Commercial |
$4,422.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,605.16
|
| Rate for Payer: Multiplan Commercial |
$3,845.50
|
| Rate for Payer: NAPHCARE Commercial |
$2,884.13
|
| Rate for Payer: Preferred Network Access Commercial |
$4,422.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,355.37
|
| Rate for Payer: Quartz Commercial |
$3,124.47
|
| Rate for Payer: Quartz Medicare Advantage |
$2,884.13
|
| Rate for Payer: The Alliance Commercial |
$2,403.44
|
| Rate for Payer: WEA Trust Commercial |
$2,643.78
|
| Rate for Payer: WPS Commercial |
$3,560.33
|
|
|
PLATE CONDYLAR 2.4MM 8HL LEFT 249.917
|
Facility
|
IP
|
$4,622.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508777
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,355.37 |
| Max. Negotiated Rate |
$4,422.33 |
| Rate for Payer: Aetna Commercial |
$4,326.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,133.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,547.65
|
| Rate for Payer: Cash Price |
$1,386.60
|
| Rate for Payer: Cigna Commercial |
$4,422.33
|
| Rate for Payer: Health EOS Commercial |
$4,278.12
|
| Rate for Payer: HFN Commercial |
$4,422.33
|
| Rate for Payer: Multiplan Commercial |
$3,845.50
|
| Rate for Payer: Preferred Network Access Commercial |
$4,422.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,355.37
|
| Rate for Payer: Quartz Commercial |
$2,884.13
|
| Rate for Payer: WEA Trust Commercial |
$2,643.78
|
| Rate for Payer: WPS Commercial |
$3,560.33
|
|
|
PLATE CONDYLAR 2.4MM 8HL RIGHT 249.916
|
Facility
|
OP
|
$4,622.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,345.93 |
| Max. Negotiated Rate |
$4,422.33 |
| Rate for Payer: Aetna Commercial |
$4,326.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,133.92
|
| Rate for Payer: Aetna Managed Medicare |
$1,345.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,124.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,403.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,307.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,547.65
|
| Rate for Payer: Cash Price |
$1,386.60
|
| Rate for Payer: Cigna Commercial |
$4,422.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,690.00
|
| Rate for Payer: Health EOS Commercial |
$4,278.12
|
| Rate for Payer: HFN Commercial |
$4,422.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,605.16
|
| Rate for Payer: Multiplan Commercial |
$3,845.50
|
| Rate for Payer: NAPHCARE Commercial |
$2,884.13
|
| Rate for Payer: Preferred Network Access Commercial |
$4,422.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,355.37
|
| Rate for Payer: Quartz Commercial |
$3,124.47
|
| Rate for Payer: Quartz Medicare Advantage |
$2,884.13
|
| Rate for Payer: The Alliance Commercial |
$2,403.44
|
| Rate for Payer: WEA Trust Commercial |
$2,643.78
|
| Rate for Payer: WPS Commercial |
$3,560.33
|
|
|
PLATE CONDYLAR 2.4MM 8HL RIGHT 249.916
|
Facility
|
IP
|
$4,622.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,355.37 |
| Max. Negotiated Rate |
$4,422.33 |
| Rate for Payer: Aetna Commercial |
$4,326.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,133.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,547.65
|
| Rate for Payer: Cash Price |
$1,386.60
|
| Rate for Payer: Cigna Commercial |
$4,422.33
|
| Rate for Payer: Health EOS Commercial |
$4,278.12
|
| Rate for Payer: HFN Commercial |
$4,422.33
|
| Rate for Payer: Multiplan Commercial |
$3,845.50
|
| Rate for Payer: Preferred Network Access Commercial |
$4,422.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,355.37
|
| Rate for Payer: Quartz Commercial |
$2,884.13
|
| Rate for Payer: WEA Trust Commercial |
$2,643.78
|
| Rate for Payer: WPS Commercial |
$3,560.33
|
|
|
PLATE CONDYLAR 4.5 VA-LCP CURVED 10 HL 230MM LT 02.124.411S
|
Facility
|
OP
|
$8,928.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3333535
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,599.83 |
| Max. Negotiated Rate |
$8,542.31 |
| Rate for Payer: Aetna Commercial |
$8,356.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,985.20
|
| Rate for Payer: Aetna Managed Medicare |
$2,599.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,035.33
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,642.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,456.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,921.11
|
| Rate for Payer: Cash Price |
$2,678.40
|
| Rate for Payer: Cigna Commercial |
$8,542.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,196.10
|
| Rate for Payer: Health EOS Commercial |
$8,263.76
|
| Rate for Payer: HFN Commercial |
$8,542.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,963.84
|
| Rate for Payer: Multiplan Commercial |
$7,428.10
|
| Rate for Payer: NAPHCARE Commercial |
$5,571.07
|
| Rate for Payer: Preferred Network Access Commercial |
$8,542.31
|
| Rate for Payer: Quartz Beloit One Network |
$4,549.71
|
| Rate for Payer: Quartz Commercial |
$6,035.33
|
| Rate for Payer: Quartz Medicare Advantage |
$5,571.07
|
| Rate for Payer: The Alliance Commercial |
$4,642.56
|
| Rate for Payer: WEA Trust Commercial |
$5,106.82
|
| Rate for Payer: WPS Commercial |
$6,877.24
|
|
|
PLATE CONDYLAR 4.5 VA-LCP CURVED 10 HL 230MM LT 02.124.411S
|
Facility
|
IP
|
$8,928.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3333535
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,549.71 |
| Max. Negotiated Rate |
$8,542.31 |
| Rate for Payer: Aetna Commercial |
$8,356.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,985.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,921.11
|
| Rate for Payer: Cash Price |
$2,678.40
|
| Rate for Payer: Cigna Commercial |
$8,542.31
|
| Rate for Payer: Health EOS Commercial |
$8,263.76
|
| Rate for Payer: HFN Commercial |
$8,542.31
|
| Rate for Payer: Multiplan Commercial |
$7,428.10
|
| Rate for Payer: Preferred Network Access Commercial |
$8,542.31
|
| Rate for Payer: Quartz Beloit One Network |
$4,549.71
|
| Rate for Payer: Quartz Commercial |
$5,571.07
|
| Rate for Payer: WEA Trust Commercial |
$5,106.82
|
| Rate for Payer: WPS Commercial |
$6,877.24
|
|
|
PLATE CONDYLAR 4.5 VA-LCP CURVED 10 HL RT 02.124.410
|
Facility
|
OP
|
$7,868.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6169849
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,291.16 |
| Max. Negotiated Rate |
$7,528.10 |
| Rate for Payer: Aetna Commercial |
$7,364.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,037.14
|
| Rate for Payer: Aetna Managed Medicare |
$2,291.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,318.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,091.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,927.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,336.84
|
| Rate for Payer: Cash Price |
$2,360.40
|
| Rate for Payer: Cigna Commercial |
$7,528.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,579.18
|
| Rate for Payer: Health EOS Commercial |
$7,282.62
|
| Rate for Payer: HFN Commercial |
$7,528.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,137.04
|
| Rate for Payer: Multiplan Commercial |
$6,546.18
|
| Rate for Payer: NAPHCARE Commercial |
$4,909.63
|
| Rate for Payer: Preferred Network Access Commercial |
$7,528.10
|
| Rate for Payer: Quartz Beloit One Network |
$4,009.53
|
| Rate for Payer: Quartz Commercial |
$5,318.77
|
| Rate for Payer: Quartz Medicare Advantage |
$4,909.63
|
| Rate for Payer: The Alliance Commercial |
$4,091.36
|
| Rate for Payer: WEA Trust Commercial |
$4,500.50
|
| Rate for Payer: WPS Commercial |
$6,060.72
|
|
|
PLATE CONDYLAR 4.5 VA-LCP CURVED 10 HL RT 02.124.410
|
Facility
|
IP
|
$7,868.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6169849
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,009.53 |
| Max. Negotiated Rate |
$7,528.10 |
| Rate for Payer: Aetna Commercial |
$7,364.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,037.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,336.84
|
| Rate for Payer: Cash Price |
$2,360.40
|
| Rate for Payer: Cigna Commercial |
$7,528.10
|
| Rate for Payer: Health EOS Commercial |
$7,282.62
|
| Rate for Payer: HFN Commercial |
$7,528.10
|
| Rate for Payer: Multiplan Commercial |
$6,546.18
|
| Rate for Payer: Preferred Network Access Commercial |
$7,528.10
|
| Rate for Payer: Quartz Beloit One Network |
$4,009.53
|
| Rate for Payer: Quartz Commercial |
$4,909.63
|
| Rate for Payer: WEA Trust Commercial |
$4,500.50
|
| Rate for Payer: WPS Commercial |
$6,060.72
|
|
|
PLATE CONDYLAR 4.5 VA-LCP CURVED 12 HL 266MM RT 02.124.412S
|
Facility
|
IP
|
$8,552.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5306728
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,358.10 |
| Max. Negotiated Rate |
$8,182.55 |
| Rate for Payer: Aetna Commercial |
$8,004.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,648.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,713.86
|
| Rate for Payer: Cash Price |
$2,565.60
|
| Rate for Payer: Cigna Commercial |
$8,182.55
|
| Rate for Payer: Health EOS Commercial |
$7,915.73
|
| Rate for Payer: HFN Commercial |
$8,182.55
|
| Rate for Payer: Multiplan Commercial |
$7,115.26
|
| Rate for Payer: Preferred Network Access Commercial |
$8,182.55
|
| Rate for Payer: Quartz Beloit One Network |
$4,358.10
|
| Rate for Payer: Quartz Commercial |
$5,336.45
|
| Rate for Payer: WEA Trust Commercial |
$4,891.74
|
| Rate for Payer: WPS Commercial |
$6,587.61
|
|
|
PLATE CONDYLAR 4.5 VA-LCP CURVED 12 HL 266MM RT 02.124.412S
|
Facility
|
OP
|
$8,552.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5306728
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,490.34 |
| Max. Negotiated Rate |
$8,182.55 |
| Rate for Payer: Aetna Commercial |
$8,004.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,648.91
|
| Rate for Payer: Aetna Managed Medicare |
$2,490.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,781.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,447.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,269.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,713.86
|
| Rate for Payer: Cash Price |
$2,565.60
|
| Rate for Payer: Cigna Commercial |
$8,182.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,977.26
|
| Rate for Payer: Health EOS Commercial |
$7,915.73
|
| Rate for Payer: HFN Commercial |
$8,182.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,670.56
|
| Rate for Payer: Multiplan Commercial |
$7,115.26
|
| Rate for Payer: NAPHCARE Commercial |
$5,336.45
|
| Rate for Payer: Preferred Network Access Commercial |
$8,182.55
|
| Rate for Payer: Quartz Beloit One Network |
$4,358.10
|
| Rate for Payer: Quartz Commercial |
$5,781.15
|
| Rate for Payer: Quartz Medicare Advantage |
$5,336.45
|
| Rate for Payer: The Alliance Commercial |
$4,447.04
|
| Rate for Payer: WEA Trust Commercial |
$4,891.74
|
| Rate for Payer: WPS Commercial |
$6,587.61
|
|
|
PLATE CONDYLAR 4.5 VA-LCP CURVED 12 HL LT 02.124.413
|
Facility
|
OP
|
$9,037.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4778610
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,631.57 |
| Max. Negotiated Rate |
$8,646.60 |
| Rate for Payer: Aetna Commercial |
$8,458.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,082.69
|
| Rate for Payer: Aetna Managed Medicare |
$2,631.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,109.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,699.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,511.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,981.19
|
| Rate for Payer: Cash Price |
$2,711.10
|
| Rate for Payer: Cigna Commercial |
$8,646.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,259.53
|
| Rate for Payer: Health EOS Commercial |
$8,364.65
|
| Rate for Payer: HFN Commercial |
$8,646.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,048.86
|
| Rate for Payer: Multiplan Commercial |
$7,518.78
|
| Rate for Payer: NAPHCARE Commercial |
$5,639.09
|
| Rate for Payer: Preferred Network Access Commercial |
$8,646.60
|
| Rate for Payer: Quartz Beloit One Network |
$4,605.26
|
| Rate for Payer: Quartz Commercial |
$6,109.01
|
| Rate for Payer: Quartz Medicare Advantage |
$5,639.09
|
| Rate for Payer: The Alliance Commercial |
$4,699.24
|
| Rate for Payer: WEA Trust Commercial |
$5,169.16
|
| Rate for Payer: WPS Commercial |
$6,961.20
|
|
