|
PLATE DISTAL FIBULA LOCK LT 6HL ARTHREX AR-8943BL-06
|
Facility
|
OP
|
$5,348.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6173858
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,557.34 |
| Max. Negotiated Rate |
$5,116.97 |
| Rate for Payer: Aetna Commercial |
$5,005.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,783.25
|
| Rate for Payer: Aetna Managed Medicare |
$1,557.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,615.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,780.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,669.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,947.82
|
| Rate for Payer: Cash Price |
$1,604.40
|
| Rate for Payer: Cigna Commercial |
$5,116.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,112.54
|
| Rate for Payer: Health EOS Commercial |
$4,950.11
|
| Rate for Payer: HFN Commercial |
$5,116.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,171.44
|
| Rate for Payer: Multiplan Commercial |
$4,449.54
|
| Rate for Payer: NAPHCARE Commercial |
$3,337.15
|
| Rate for Payer: Preferred Network Access Commercial |
$5,116.97
|
| Rate for Payer: Quartz Beloit One Network |
$2,725.34
|
| Rate for Payer: Quartz Commercial |
$3,615.25
|
| Rate for Payer: Quartz Medicare Advantage |
$3,337.15
|
| Rate for Payer: The Alliance Commercial |
$2,780.96
|
| Rate for Payer: WEA Trust Commercial |
$3,059.06
|
| Rate for Payer: WPS Commercial |
$4,119.56
|
|
|
PLATE DISTAL FIBULA LOCK RT 5HL AR-8943DR-05
|
Facility
|
IP
|
$5,142.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6179753
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,620.36 |
| Max. Negotiated Rate |
$4,919.87 |
| Rate for Payer: Aetna Commercial |
$4,812.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,599.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,834.27
|
| Rate for Payer: Cash Price |
$1,542.60
|
| Rate for Payer: Cigna Commercial |
$4,919.87
|
| Rate for Payer: Health EOS Commercial |
$4,759.44
|
| Rate for Payer: HFN Commercial |
$4,919.87
|
| Rate for Payer: Multiplan Commercial |
$4,278.14
|
| Rate for Payer: Preferred Network Access Commercial |
$4,919.87
|
| Rate for Payer: Quartz Beloit One Network |
$2,620.36
|
| Rate for Payer: Quartz Commercial |
$3,208.61
|
| Rate for Payer: WEA Trust Commercial |
$2,941.22
|
| Rate for Payer: WPS Commercial |
$3,960.88
|
|
|
PLATE DISTAL FIBULA LOCK RT 5HL AR-8943DR-05
|
Facility
|
OP
|
$5,142.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6179753
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,497.35 |
| Max. Negotiated Rate |
$4,919.87 |
| Rate for Payer: Aetna Commercial |
$4,812.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,599.00
|
| Rate for Payer: Aetna Managed Medicare |
$1,497.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,475.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,673.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,566.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,834.27
|
| Rate for Payer: Cash Price |
$1,542.60
|
| Rate for Payer: Cigna Commercial |
$4,919.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,992.64
|
| Rate for Payer: Health EOS Commercial |
$4,759.44
|
| Rate for Payer: HFN Commercial |
$4,919.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,010.76
|
| Rate for Payer: Multiplan Commercial |
$4,278.14
|
| Rate for Payer: NAPHCARE Commercial |
$3,208.61
|
| Rate for Payer: Preferred Network Access Commercial |
$4,919.87
|
| Rate for Payer: Quartz Beloit One Network |
$2,620.36
|
| Rate for Payer: Quartz Commercial |
$3,475.99
|
| Rate for Payer: Quartz Medicare Advantage |
$3,208.61
|
| Rate for Payer: The Alliance Commercial |
$2,673.84
|
| Rate for Payer: WEA Trust Commercial |
$2,941.22
|
| Rate for Payer: WPS Commercial |
$3,960.88
|
|
|
PLATE DISTAL FIBULA LOCK RT 6H AR-8943BR-06
|
Facility
|
IP
|
$5,784.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5456672
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,947.53 |
| Max. Negotiated Rate |
$5,534.13 |
| Rate for Payer: Aetna Commercial |
$5,413.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,173.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,188.14
|
| Rate for Payer: Cash Price |
$1,735.20
|
| Rate for Payer: Cigna Commercial |
$5,534.13
|
| Rate for Payer: Health EOS Commercial |
$5,353.67
|
| Rate for Payer: HFN Commercial |
$5,534.13
|
| Rate for Payer: Multiplan Commercial |
$4,812.29
|
| Rate for Payer: Preferred Network Access Commercial |
$5,534.13
|
| Rate for Payer: Quartz Beloit One Network |
$2,947.53
|
| Rate for Payer: Quartz Commercial |
$3,609.22
|
| Rate for Payer: WEA Trust Commercial |
$3,308.45
|
| Rate for Payer: WPS Commercial |
$4,455.42
|
|
|
PLATE DISTAL FIBULA LOCK RT 6H AR-8943BR-06
|
Facility
|
OP
|
$5,784.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5456672
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,684.30 |
| Max. Negotiated Rate |
$5,534.13 |
| Rate for Payer: Aetna Commercial |
$5,413.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,173.21
|
| Rate for Payer: Aetna Managed Medicare |
$1,684.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,909.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,007.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,887.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,188.14
|
| Rate for Payer: Cash Price |
$1,735.20
|
| Rate for Payer: Cigna Commercial |
$5,534.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,366.29
|
| Rate for Payer: Health EOS Commercial |
$5,353.67
|
| Rate for Payer: HFN Commercial |
$5,534.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,511.52
|
| Rate for Payer: Multiplan Commercial |
$4,812.29
|
| Rate for Payer: NAPHCARE Commercial |
$3,609.22
|
| Rate for Payer: Preferred Network Access Commercial |
$5,534.13
|
| Rate for Payer: Quartz Beloit One Network |
$2,947.53
|
| Rate for Payer: Quartz Commercial |
$3,909.98
|
| Rate for Payer: Quartz Medicare Advantage |
$3,609.22
|
| Rate for Payer: The Alliance Commercial |
$3,007.68
|
| Rate for Payer: WEA Trust Commercial |
$3,308.45
|
| Rate for Payer: WPS Commercial |
$4,455.42
|
|
|
PLATE DISTAL FIBULA LOCK RT 6HL AR-8943DR-06
|
Facility
|
OP
|
$5,674.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6185048
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,652.27 |
| Max. Negotiated Rate |
$5,428.88 |
| Rate for Payer: Aetna Commercial |
$5,310.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,074.83
|
| Rate for Payer: Aetna Managed Medicare |
$1,652.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,835.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,950.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,832.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,127.51
|
| Rate for Payer: Cash Price |
$1,702.20
|
| Rate for Payer: Cigna Commercial |
$5,428.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,302.27
|
| Rate for Payer: Health EOS Commercial |
$5,251.85
|
| Rate for Payer: HFN Commercial |
$5,428.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,425.72
|
| Rate for Payer: Multiplan Commercial |
$4,720.77
|
| Rate for Payer: NAPHCARE Commercial |
$3,540.58
|
| Rate for Payer: Preferred Network Access Commercial |
$5,428.88
|
| Rate for Payer: Quartz Beloit One Network |
$2,891.47
|
| Rate for Payer: Quartz Commercial |
$3,835.62
|
| Rate for Payer: Quartz Medicare Advantage |
$3,540.58
|
| Rate for Payer: The Alliance Commercial |
$2,950.48
|
| Rate for Payer: WEA Trust Commercial |
$3,245.53
|
| Rate for Payer: WPS Commercial |
$4,370.68
|
|
|
PLATE DISTAL FIBULA LOCK RT 6HL AR-8943DR-06
|
Facility
|
IP
|
$5,674.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6185048
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,891.47 |
| Max. Negotiated Rate |
$5,428.88 |
| Rate for Payer: Aetna Commercial |
$5,310.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,074.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,127.51
|
| Rate for Payer: Cash Price |
$1,702.20
|
| Rate for Payer: Cigna Commercial |
$5,428.88
|
| Rate for Payer: Health EOS Commercial |
$5,251.85
|
| Rate for Payer: HFN Commercial |
$5,428.88
|
| Rate for Payer: Multiplan Commercial |
$4,720.77
|
| Rate for Payer: Preferred Network Access Commercial |
$5,428.88
|
| Rate for Payer: Quartz Beloit One Network |
$2,891.47
|
| Rate for Payer: Quartz Commercial |
$3,540.58
|
| Rate for Payer: WEA Trust Commercial |
$3,245.53
|
| Rate for Payer: WPS Commercial |
$4,370.68
|
|
|
PLATE DISTAL HUMERUS 2.7/3.5 VA EXT MEDIAL LATERAL 2HL LT MEDIUM 02.117.702
|
Facility
|
OP
|
$5,535.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6248165
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,611.97 |
| Max. Negotiated Rate |
$5,296.48 |
| Rate for Payer: Aetna Commercial |
$5,181.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,951.06
|
| Rate for Payer: Aetna Managed Medicare |
$1,611.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,742.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,878.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,763.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,051.23
|
| Rate for Payer: Cash Price |
$1,660.69
|
| Rate for Payer: Cigna Commercial |
$5,296.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,221.73
|
| Rate for Payer: Health EOS Commercial |
$5,123.77
|
| Rate for Payer: HFN Commercial |
$5,296.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,317.78
|
| Rate for Payer: Multiplan Commercial |
$4,605.64
|
| Rate for Payer: NAPHCARE Commercial |
$3,454.23
|
| Rate for Payer: Preferred Network Access Commercial |
$5,296.48
|
| Rate for Payer: Quartz Beloit One Network |
$2,820.95
|
| Rate for Payer: Quartz Commercial |
$3,742.08
|
| Rate for Payer: Quartz Medicare Advantage |
$3,454.23
|
| Rate for Payer: The Alliance Commercial |
$2,878.52
|
| Rate for Payer: WEA Trust Commercial |
$3,166.37
|
| Rate for Payer: WPS Commercial |
$4,264.09
|
|
|
PLATE DISTAL HUMERUS 2.7/3.5 VA EXT MEDIAL LATERAL 2HL LT MEDIUM 02.117.702
|
Facility
|
IP
|
$5,535.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6248165
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,820.95 |
| Max. Negotiated Rate |
$5,296.48 |
| Rate for Payer: Aetna Commercial |
$5,181.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,951.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,051.23
|
| Rate for Payer: Cash Price |
$1,660.69
|
| Rate for Payer: Cigna Commercial |
$5,296.48
|
| Rate for Payer: Health EOS Commercial |
$5,123.77
|
| Rate for Payer: HFN Commercial |
$5,296.48
|
| Rate for Payer: Multiplan Commercial |
$4,605.64
|
| Rate for Payer: Preferred Network Access Commercial |
$5,296.48
|
| Rate for Payer: Quartz Beloit One Network |
$2,820.95
|
| Rate for Payer: Quartz Commercial |
$3,454.23
|
| Rate for Payer: WEA Trust Commercial |
$3,166.37
|
| Rate for Payer: WPS Commercial |
$4,264.09
|
|
|
PLATE DISTAL HUMERUS 2.7/3.5 VA POSTERIOR LATERAL 3HL lT SHORT 02.117.303
|
Facility
|
IP
|
$5,592.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5611739
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,849.68 |
| Max. Negotiated Rate |
$5,350.43 |
| Rate for Payer: Aetna Commercial |
$5,234.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,001.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,082.31
|
| Rate for Payer: Cash Price |
$1,677.60
|
| Rate for Payer: Cigna Commercial |
$5,350.43
|
| Rate for Payer: Health EOS Commercial |
$5,175.96
|
| Rate for Payer: HFN Commercial |
$5,350.43
|
| Rate for Payer: Multiplan Commercial |
$4,652.54
|
| Rate for Payer: Preferred Network Access Commercial |
$5,350.43
|
| Rate for Payer: Quartz Beloit One Network |
$2,849.68
|
| Rate for Payer: Quartz Commercial |
$3,489.41
|
| Rate for Payer: WEA Trust Commercial |
$3,198.62
|
| Rate for Payer: WPS Commercial |
$4,307.52
|
|
|
PLATE DISTAL HUMERUS 2.7/3.5 VA POSTERIOR LATERAL 3HL lT SHORT 02.117.303
|
Facility
|
OP
|
$5,592.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5611739
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,628.39 |
| Max. Negotiated Rate |
$5,350.43 |
| Rate for Payer: Aetna Commercial |
$5,234.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,001.48
|
| Rate for Payer: Aetna Managed Medicare |
$1,628.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,780.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,907.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,791.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,082.31
|
| Rate for Payer: Cash Price |
$1,677.60
|
| Rate for Payer: Cigna Commercial |
$5,350.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,254.54
|
| Rate for Payer: Health EOS Commercial |
$5,175.96
|
| Rate for Payer: HFN Commercial |
$5,350.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,361.76
|
| Rate for Payer: Multiplan Commercial |
$4,652.54
|
| Rate for Payer: NAPHCARE Commercial |
$3,489.41
|
| Rate for Payer: Preferred Network Access Commercial |
$5,350.43
|
| Rate for Payer: Quartz Beloit One Network |
$2,849.68
|
| Rate for Payer: Quartz Commercial |
$3,780.19
|
| Rate for Payer: Quartz Medicare Advantage |
$3,489.41
|
| Rate for Payer: The Alliance Commercial |
$2,907.84
|
| Rate for Payer: WEA Trust Commercial |
$3,198.62
|
| Rate for Payer: WPS Commercial |
$4,307.52
|
|
|
PLATE DISTAL HUMERUS 2.7/3.5 VA POSTERIOR LATERAL 3HL RT SHORT 02.117.203
|
Facility
|
IP
|
$5,369.34
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6248164
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,736.22 |
| Max. Negotiated Rate |
$5,137.38 |
| Rate for Payer: Aetna Commercial |
$5,025.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,802.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,959.58
|
| Rate for Payer: Cash Price |
$1,610.80
|
| Rate for Payer: Cigna Commercial |
$5,137.38
|
| Rate for Payer: Health EOS Commercial |
$4,969.86
|
| Rate for Payer: HFN Commercial |
$5,137.38
|
| Rate for Payer: Multiplan Commercial |
$4,467.29
|
| Rate for Payer: Preferred Network Access Commercial |
$5,137.38
|
| Rate for Payer: Quartz Beloit One Network |
$2,736.22
|
| Rate for Payer: Quartz Commercial |
$3,350.47
|
| Rate for Payer: WEA Trust Commercial |
$3,071.26
|
| Rate for Payer: WPS Commercial |
$4,136.00
|
|
|
PLATE DISTAL HUMERUS 2.7/3.5 VA POSTERIOR LATERAL 3HL RT SHORT 02.117.203
|
Facility
|
OP
|
$5,369.34
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6248164
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,563.55 |
| Max. Negotiated Rate |
$5,137.38 |
| Rate for Payer: Aetna Commercial |
$5,025.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,802.34
|
| Rate for Payer: Aetna Managed Medicare |
$1,563.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,629.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,792.06
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,680.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,959.58
|
| Rate for Payer: Cash Price |
$1,610.80
|
| Rate for Payer: Cigna Commercial |
$5,137.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,124.96
|
| Rate for Payer: Health EOS Commercial |
$4,969.86
|
| Rate for Payer: HFN Commercial |
$5,137.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,188.09
|
| Rate for Payer: Multiplan Commercial |
$4,467.29
|
| Rate for Payer: NAPHCARE Commercial |
$3,350.47
|
| Rate for Payer: Preferred Network Access Commercial |
$5,137.38
|
| Rate for Payer: Quartz Beloit One Network |
$2,736.22
|
| Rate for Payer: Quartz Commercial |
$3,629.67
|
| Rate for Payer: Quartz Medicare Advantage |
$3,350.47
|
| Rate for Payer: The Alliance Commercial |
$2,792.06
|
| Rate for Payer: WEA Trust Commercial |
$3,071.26
|
| Rate for Payer: WPS Commercial |
$4,136.00
|
|
|
PLATE DISTAL HUMERUS 2.7/3.5 VA POSTERIOR LATERAL 4HL RT MEDIUM 02.117.204S
|
Facility
|
IP
|
$6,190.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3265482
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,154.42 |
| Max. Negotiated Rate |
$5,922.59 |
| Rate for Payer: Aetna Commercial |
$5,793.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,536.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,411.93
|
| Rate for Payer: Cash Price |
$1,857.00
|
| Rate for Payer: Cigna Commercial |
$5,922.59
|
| Rate for Payer: Health EOS Commercial |
$5,729.46
|
| Rate for Payer: HFN Commercial |
$5,922.59
|
| Rate for Payer: Multiplan Commercial |
$5,150.08
|
| Rate for Payer: Preferred Network Access Commercial |
$5,922.59
|
| Rate for Payer: Quartz Beloit One Network |
$3,154.42
|
| Rate for Payer: Quartz Commercial |
$3,862.56
|
| Rate for Payer: WEA Trust Commercial |
$3,540.68
|
| Rate for Payer: WPS Commercial |
$4,768.16
|
|
|
PLATE DISTAL HUMERUS 2.7/3.5 VA POSTERIOR LATERAL 4HL RT MEDIUM 02.117.204S
|
Facility
|
OP
|
$6,190.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3265482
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,802.53 |
| Max. Negotiated Rate |
$5,922.59 |
| Rate for Payer: Aetna Commercial |
$5,793.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,536.34
|
| Rate for Payer: Aetna Managed Medicare |
$1,802.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,184.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,218.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,090.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,411.93
|
| Rate for Payer: Cash Price |
$1,857.00
|
| Rate for Payer: Cigna Commercial |
$5,922.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,602.58
|
| Rate for Payer: Health EOS Commercial |
$5,729.46
|
| Rate for Payer: HFN Commercial |
$5,922.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,828.20
|
| Rate for Payer: Multiplan Commercial |
$5,150.08
|
| Rate for Payer: NAPHCARE Commercial |
$3,862.56
|
| Rate for Payer: Preferred Network Access Commercial |
$5,922.59
|
| Rate for Payer: Quartz Beloit One Network |
$3,154.42
|
| Rate for Payer: Quartz Commercial |
$4,184.44
|
| Rate for Payer: Quartz Medicare Advantage |
$3,862.56
|
| Rate for Payer: The Alliance Commercial |
$3,218.80
|
| Rate for Payer: WEA Trust Commercial |
$3,540.68
|
| Rate for Payer: WPS Commercial |
$4,768.16
|
|
|
PLATE DISTAL HUMERUS 2.7/3.5 VA POSTEROLATERAL 9HL RT EXTRA LONG 02.117.209
|
Facility
|
OP
|
$5,887.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4519193
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,714.29 |
| Max. Negotiated Rate |
$5,632.68 |
| Rate for Payer: Aetna Commercial |
$5,510.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,265.33
|
| Rate for Payer: Aetna Managed Medicare |
$1,714.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,979.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,061.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,938.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,244.91
|
| Rate for Payer: Cash Price |
$1,766.10
|
| Rate for Payer: Cigna Commercial |
$5,632.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,426.23
|
| Rate for Payer: Health EOS Commercial |
$5,449.01
|
| Rate for Payer: HFN Commercial |
$5,632.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,591.86
|
| Rate for Payer: Multiplan Commercial |
$4,897.98
|
| Rate for Payer: NAPHCARE Commercial |
$3,673.49
|
| Rate for Payer: Preferred Network Access Commercial |
$5,632.68
|
| Rate for Payer: Quartz Beloit One Network |
$3,000.02
|
| Rate for Payer: Quartz Commercial |
$3,979.61
|
| Rate for Payer: Quartz Medicare Advantage |
$3,673.49
|
| Rate for Payer: The Alliance Commercial |
$3,061.24
|
| Rate for Payer: WEA Trust Commercial |
$3,367.36
|
| Rate for Payer: WPS Commercial |
$4,534.76
|
|
|
PLATE DISTAL HUMERUS 2.7/3.5 VA POSTEROLATERAL 9HL RT EXTRA LONG 02.117.209
|
Facility
|
IP
|
$5,887.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4519193
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,000.02 |
| Max. Negotiated Rate |
$5,632.68 |
| Rate for Payer: Aetna Commercial |
$5,510.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,265.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,244.91
|
| Rate for Payer: Cash Price |
$1,766.10
|
| Rate for Payer: Cigna Commercial |
$5,632.68
|
| Rate for Payer: Health EOS Commercial |
$5,449.01
|
| Rate for Payer: HFN Commercial |
$5,632.68
|
| Rate for Payer: Multiplan Commercial |
$4,897.98
|
| Rate for Payer: Preferred Network Access Commercial |
$5,632.68
|
| Rate for Payer: Quartz Beloit One Network |
$3,000.02
|
| Rate for Payer: Quartz Commercial |
$3,673.49
|
| Rate for Payer: WEA Trust Commercial |
$3,367.36
|
| Rate for Payer: WPS Commercial |
$4,534.76
|
|
|
PLATE DISTAL HUMERUS 3.5 10HL LT 02.104.030
|
Facility
|
OP
|
$7,056.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6180035
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,054.71 |
| Max. Negotiated Rate |
$6,751.18 |
| Rate for Payer: Aetna Commercial |
$6,604.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,310.89
|
| Rate for Payer: Aetna Managed Medicare |
$2,054.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,769.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,669.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,522.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,889.27
|
| Rate for Payer: Cash Price |
$2,116.80
|
| Rate for Payer: Cigna Commercial |
$6,751.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,106.59
|
| Rate for Payer: Health EOS Commercial |
$6,531.03
|
| Rate for Payer: HFN Commercial |
$6,751.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,503.68
|
| Rate for Payer: Multiplan Commercial |
$5,870.59
|
| Rate for Payer: NAPHCARE Commercial |
$4,402.94
|
| Rate for Payer: Preferred Network Access Commercial |
$6,751.18
|
| Rate for Payer: Quartz Beloit One Network |
$3,595.74
|
| Rate for Payer: Quartz Commercial |
$4,769.86
|
| Rate for Payer: Quartz Medicare Advantage |
$4,402.94
|
| Rate for Payer: The Alliance Commercial |
$3,669.12
|
| Rate for Payer: WEA Trust Commercial |
$4,036.03
|
| Rate for Payer: WPS Commercial |
$5,435.24
|
|
|
PLATE DISTAL HUMERUS 3.5 10HL LT 02.104.030
|
Facility
|
IP
|
$7,056.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6180035
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,595.74 |
| Max. Negotiated Rate |
$6,751.18 |
| Rate for Payer: Aetna Commercial |
$6,604.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,310.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,889.27
|
| Rate for Payer: Cash Price |
$2,116.80
|
| Rate for Payer: Cigna Commercial |
$6,751.18
|
| Rate for Payer: Health EOS Commercial |
$6,531.03
|
| Rate for Payer: HFN Commercial |
$6,751.18
|
| Rate for Payer: Multiplan Commercial |
$5,870.59
|
| Rate for Payer: Preferred Network Access Commercial |
$6,751.18
|
| Rate for Payer: Quartz Beloit One Network |
$3,595.74
|
| Rate for Payer: Quartz Commercial |
$4,402.94
|
| Rate for Payer: WEA Trust Commercial |
$4,036.03
|
| Rate for Payer: WPS Commercial |
$5,435.24
|
|
|
PLATE DISTAL HUMERUS 3.5 6HL LT 02.104.026S
|
Facility
|
IP
|
$8,692.00
|
|
| Hospital Charge Code |
2966338
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,429.44 |
| Max. Negotiated Rate |
$8,316.51 |
| Rate for Payer: Aetna Commercial |
$8,135.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,774.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,791.03
|
| Rate for Payer: Cash Price |
$2,607.60
|
| Rate for Payer: Cigna Commercial |
$8,316.51
|
| Rate for Payer: Health EOS Commercial |
$8,045.32
|
| Rate for Payer: HFN Commercial |
$8,316.51
|
| Rate for Payer: Multiplan Commercial |
$7,231.74
|
| Rate for Payer: Preferred Network Access Commercial |
$8,316.51
|
| Rate for Payer: Quartz Beloit One Network |
$4,429.44
|
| Rate for Payer: Quartz Commercial |
$5,423.81
|
| Rate for Payer: WEA Trust Commercial |
$4,971.82
|
| Rate for Payer: WPS Commercial |
$6,695.45
|
|
|
PLATE DISTAL HUMERUS 3.5 6HL LT 02.104.026S
|
Facility
|
OP
|
$8,692.00
|
|
| Hospital Charge Code |
2966338
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,531.11 |
| Max. Negotiated Rate |
$8,316.51 |
| Rate for Payer: Aetna Commercial |
$8,135.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,774.12
|
| Rate for Payer: Aetna Managed Medicare |
$2,531.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,875.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,519.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,339.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,791.03
|
| Rate for Payer: Cash Price |
$2,607.60
|
| Rate for Payer: Cigna Commercial |
$8,316.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,058.74
|
| Rate for Payer: Health EOS Commercial |
$8,045.32
|
| Rate for Payer: HFN Commercial |
$8,316.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,779.76
|
| Rate for Payer: Multiplan Commercial |
$7,231.74
|
| Rate for Payer: NAPHCARE Commercial |
$5,423.81
|
| Rate for Payer: Preferred Network Access Commercial |
$8,316.51
|
| Rate for Payer: Quartz Beloit One Network |
$4,429.44
|
| Rate for Payer: Quartz Commercial |
$5,875.79
|
| Rate for Payer: Quartz Medicare Advantage |
$5,423.81
|
| Rate for Payer: The Alliance Commercial |
$4,519.84
|
| Rate for Payer: WEA Trust Commercial |
$4,971.82
|
| Rate for Payer: WPS Commercial |
$6,695.45
|
|
|
PLATE DISTAL HUMERUS 6HL RT 02.104.006S
|
Facility
|
IP
|
$9,004.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966355
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,588.44 |
| Max. Negotiated Rate |
$8,615.03 |
| Rate for Payer: Aetna Commercial |
$8,427.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,053.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,963.00
|
| Rate for Payer: Cash Price |
$2,701.20
|
| Rate for Payer: Cigna Commercial |
$8,615.03
|
| Rate for Payer: Health EOS Commercial |
$8,334.10
|
| Rate for Payer: HFN Commercial |
$8,615.03
|
| Rate for Payer: Multiplan Commercial |
$7,491.33
|
| Rate for Payer: Preferred Network Access Commercial |
$8,615.03
|
| Rate for Payer: Quartz Beloit One Network |
$4,588.44
|
| Rate for Payer: Quartz Commercial |
$5,618.50
|
| Rate for Payer: WEA Trust Commercial |
$5,150.29
|
| Rate for Payer: WPS Commercial |
$6,935.78
|
|
|
PLATE DISTAL HUMERUS 6HL RT 02.104.006S
|
Facility
|
OP
|
$9,004.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966355
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,621.96 |
| Max. Negotiated Rate |
$8,615.03 |
| Rate for Payer: Aetna Commercial |
$8,427.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,053.18
|
| Rate for Payer: Aetna Managed Medicare |
$2,621.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,086.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,682.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,494.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,963.00
|
| Rate for Payer: Cash Price |
$2,701.20
|
| Rate for Payer: Cigna Commercial |
$8,615.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,240.33
|
| Rate for Payer: Health EOS Commercial |
$8,334.10
|
| Rate for Payer: HFN Commercial |
$8,615.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,023.12
|
| Rate for Payer: Multiplan Commercial |
$7,491.33
|
| Rate for Payer: NAPHCARE Commercial |
$5,618.50
|
| Rate for Payer: Preferred Network Access Commercial |
$8,615.03
|
| Rate for Payer: Quartz Beloit One Network |
$4,588.44
|
| Rate for Payer: Quartz Commercial |
$6,086.70
|
| Rate for Payer: Quartz Medicare Advantage |
$5,618.50
|
| Rate for Payer: The Alliance Commercial |
$4,682.08
|
| Rate for Payer: WEA Trust Commercial |
$5,150.29
|
| Rate for Payer: WPS Commercial |
$6,935.78
|
|
|
PLATE DISTAL MEDIAL HUMERUS 4HL 629384
|
Facility
|
OP
|
$7,456.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4006577
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,171.19 |
| Max. Negotiated Rate |
$7,133.90 |
| Rate for Payer: Aetna Commercial |
$6,978.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,668.65
|
| Rate for Payer: Aetna Managed Medicare |
$2,171.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,040.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,877.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,722.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,109.75
|
| Rate for Payer: Cash Price |
$2,236.80
|
| Rate for Payer: Cigna Commercial |
$7,133.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,339.39
|
| Rate for Payer: Health EOS Commercial |
$6,901.27
|
| Rate for Payer: HFN Commercial |
$7,133.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,815.68
|
| Rate for Payer: Multiplan Commercial |
$6,203.39
|
| Rate for Payer: NAPHCARE Commercial |
$4,652.54
|
| Rate for Payer: Preferred Network Access Commercial |
$7,133.90
|
| Rate for Payer: Quartz Beloit One Network |
$3,799.58
|
| Rate for Payer: Quartz Commercial |
$5,040.26
|
| Rate for Payer: Quartz Medicare Advantage |
$4,652.54
|
| Rate for Payer: The Alliance Commercial |
$3,877.12
|
| Rate for Payer: WEA Trust Commercial |
$4,264.83
|
| Rate for Payer: WPS Commercial |
$5,743.36
|
|
|
PLATE DISTAL MEDIAL HUMERUS 4HL 629384
|
Facility
|
IP
|
$7,456.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4006577
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,799.58 |
| Max. Negotiated Rate |
$7,133.90 |
| Rate for Payer: Aetna Commercial |
$6,978.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,668.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,109.75
|
| Rate for Payer: Cash Price |
$2,236.80
|
| Rate for Payer: Cigna Commercial |
$7,133.90
|
| Rate for Payer: Health EOS Commercial |
$6,901.27
|
| Rate for Payer: HFN Commercial |
$7,133.90
|
| Rate for Payer: Multiplan Commercial |
$6,203.39
|
| Rate for Payer: Preferred Network Access Commercial |
$7,133.90
|
| Rate for Payer: Quartz Beloit One Network |
$3,799.58
|
| Rate for Payer: Quartz Commercial |
$4,652.54
|
| Rate for Payer: WEA Trust Commercial |
$4,264.83
|
| Rate for Payer: WPS Commercial |
$5,743.36
|
|
