|
PLATE DISTAL RADIUS VOLAR STD RT 3HL TI AR-8916VSR-03
|
Facility
|
IP
|
$6,344.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5384975
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,232.90 |
| Max. Negotiated Rate |
$6,069.94 |
| Rate for Payer: Aetna Commercial |
$5,937.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,674.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,496.81
|
| Rate for Payer: Cash Price |
$1,903.20
|
| Rate for Payer: Cigna Commercial |
$6,069.94
|
| Rate for Payer: Health EOS Commercial |
$5,872.01
|
| Rate for Payer: HFN Commercial |
$6,069.94
|
| Rate for Payer: Multiplan Commercial |
$5,278.21
|
| Rate for Payer: Preferred Network Access Commercial |
$6,069.94
|
| Rate for Payer: Quartz Beloit One Network |
$3,232.90
|
| Rate for Payer: Quartz Commercial |
$3,958.66
|
| Rate for Payer: WEA Trust Commercial |
$3,628.77
|
| Rate for Payer: WPS Commercial |
$4,886.78
|
|
|
PLATE DISTAL RADIUS VOLAR WIDE LT 5HL TI AR-8916VWL-05
|
Facility
|
OP
|
$6,344.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414823
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,847.37 |
| Max. Negotiated Rate |
$6,069.94 |
| Rate for Payer: Aetna Commercial |
$5,937.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,674.07
|
| Rate for Payer: Aetna Managed Medicare |
$1,847.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,288.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,298.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,166.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,496.81
|
| Rate for Payer: Cash Price |
$1,903.20
|
| Rate for Payer: Cigna Commercial |
$6,069.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,692.21
|
| Rate for Payer: Health EOS Commercial |
$5,872.01
|
| Rate for Payer: HFN Commercial |
$6,069.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,948.32
|
| Rate for Payer: Multiplan Commercial |
$5,278.21
|
| Rate for Payer: NAPHCARE Commercial |
$3,958.66
|
| Rate for Payer: Preferred Network Access Commercial |
$6,069.94
|
| Rate for Payer: Quartz Beloit One Network |
$3,232.90
|
| Rate for Payer: Quartz Commercial |
$4,288.54
|
| Rate for Payer: Quartz Medicare Advantage |
$3,958.66
|
| Rate for Payer: The Alliance Commercial |
$3,298.88
|
| Rate for Payer: WEA Trust Commercial |
$3,628.77
|
| Rate for Payer: WPS Commercial |
$4,886.78
|
|
|
PLATE DISTAL RADIUS VOLAR WIDE LT 5HL TI AR-8916VWL-05
|
Facility
|
IP
|
$6,344.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414823
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,232.90 |
| Max. Negotiated Rate |
$6,069.94 |
| Rate for Payer: Aetna Commercial |
$5,937.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,674.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,496.81
|
| Rate for Payer: Cash Price |
$1,903.20
|
| Rate for Payer: Cigna Commercial |
$6,069.94
|
| Rate for Payer: Health EOS Commercial |
$5,872.01
|
| Rate for Payer: HFN Commercial |
$6,069.94
|
| Rate for Payer: Multiplan Commercial |
$5,278.21
|
| Rate for Payer: Preferred Network Access Commercial |
$6,069.94
|
| Rate for Payer: Quartz Beloit One Network |
$3,232.90
|
| Rate for Payer: Quartz Commercial |
$3,958.66
|
| Rate for Payer: WEA Trust Commercial |
$3,628.77
|
| Rate for Payer: WPS Commercial |
$4,886.78
|
|
|
PLATE DISTAL RADIUS VOLAR WIDE RT 3HL TI AR-8916VWR-03
|
Facility
|
IP
|
$6,344.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414681
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,232.90 |
| Max. Negotiated Rate |
$6,069.94 |
| Rate for Payer: Aetna Commercial |
$5,937.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,674.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,496.81
|
| Rate for Payer: Cash Price |
$1,903.20
|
| Rate for Payer: Cigna Commercial |
$6,069.94
|
| Rate for Payer: Health EOS Commercial |
$5,872.01
|
| Rate for Payer: HFN Commercial |
$6,069.94
|
| Rate for Payer: Multiplan Commercial |
$5,278.21
|
| Rate for Payer: Preferred Network Access Commercial |
$6,069.94
|
| Rate for Payer: Quartz Beloit One Network |
$3,232.90
|
| Rate for Payer: Quartz Commercial |
$3,958.66
|
| Rate for Payer: WEA Trust Commercial |
$3,628.77
|
| Rate for Payer: WPS Commercial |
$4,886.78
|
|
|
PLATE DISTAL RADIUS VOLAR WIDE RT 3HL TI AR-8916VWR-03
|
Facility
|
OP
|
$6,344.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414681
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,847.37 |
| Max. Negotiated Rate |
$6,069.94 |
| Rate for Payer: Aetna Commercial |
$5,937.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,674.07
|
| Rate for Payer: Aetna Managed Medicare |
$1,847.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,288.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,298.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,166.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,496.81
|
| Rate for Payer: Cash Price |
$1,903.20
|
| Rate for Payer: Cigna Commercial |
$6,069.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,692.21
|
| Rate for Payer: Health EOS Commercial |
$5,872.01
|
| Rate for Payer: HFN Commercial |
$6,069.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,948.32
|
| Rate for Payer: Multiplan Commercial |
$5,278.21
|
| Rate for Payer: NAPHCARE Commercial |
$3,958.66
|
| Rate for Payer: Preferred Network Access Commercial |
$6,069.94
|
| Rate for Payer: Quartz Beloit One Network |
$3,232.90
|
| Rate for Payer: Quartz Commercial |
$4,288.54
|
| Rate for Payer: Quartz Medicare Advantage |
$3,958.66
|
| Rate for Payer: The Alliance Commercial |
$3,298.88
|
| Rate for Payer: WEA Trust Commercial |
$3,628.77
|
| Rate for Payer: WPS Commercial |
$4,886.78
|
|
|
PLATE DISTAL RADIUS VOLAR WIDE RT 5HL TI AR-8916VWR-05
|
Facility
|
IP
|
$6,344.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414731
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,232.90 |
| Max. Negotiated Rate |
$6,069.94 |
| Rate for Payer: Aetna Commercial |
$5,937.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,674.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,496.81
|
| Rate for Payer: Cash Price |
$1,903.20
|
| Rate for Payer: Cigna Commercial |
$6,069.94
|
| Rate for Payer: Health EOS Commercial |
$5,872.01
|
| Rate for Payer: HFN Commercial |
$6,069.94
|
| Rate for Payer: Multiplan Commercial |
$5,278.21
|
| Rate for Payer: Preferred Network Access Commercial |
$6,069.94
|
| Rate for Payer: Quartz Beloit One Network |
$3,232.90
|
| Rate for Payer: Quartz Commercial |
$3,958.66
|
| Rate for Payer: WEA Trust Commercial |
$3,628.77
|
| Rate for Payer: WPS Commercial |
$4,886.78
|
|
|
PLATE DISTAL RADIUS VOLAR WIDE RT 5HL TI AR-8916VWR-05
|
Facility
|
OP
|
$6,344.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414731
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,847.37 |
| Max. Negotiated Rate |
$6,069.94 |
| Rate for Payer: Aetna Commercial |
$5,937.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,674.07
|
| Rate for Payer: Aetna Managed Medicare |
$1,847.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,288.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,298.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,166.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,496.81
|
| Rate for Payer: Cash Price |
$1,903.20
|
| Rate for Payer: Cigna Commercial |
$6,069.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,692.21
|
| Rate for Payer: Health EOS Commercial |
$5,872.01
|
| Rate for Payer: HFN Commercial |
$6,069.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,948.32
|
| Rate for Payer: Multiplan Commercial |
$5,278.21
|
| Rate for Payer: NAPHCARE Commercial |
$3,958.66
|
| Rate for Payer: Preferred Network Access Commercial |
$6,069.94
|
| Rate for Payer: Quartz Beloit One Network |
$3,232.90
|
| Rate for Payer: Quartz Commercial |
$4,288.54
|
| Rate for Payer: Quartz Medicare Advantage |
$3,958.66
|
| Rate for Payer: The Alliance Commercial |
$3,298.88
|
| Rate for Payer: WEA Trust Commercial |
$3,628.77
|
| Rate for Payer: WPS Commercial |
$4,886.78
|
|
|
PLATE DISTAL TIBIA 3.5 5HL LT
|
Facility
|
OP
|
$2,981.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966366
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$868.07 |
| Max. Negotiated Rate |
$2,852.22 |
| Rate for Payer: Aetna Commercial |
$2,790.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,666.21
|
| Rate for Payer: Aetna Managed Medicare |
$868.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,015.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,550.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,488.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,643.13
|
| Rate for Payer: Cash Price |
$894.30
|
| Rate for Payer: Cigna Commercial |
$2,852.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,734.94
|
| Rate for Payer: Health EOS Commercial |
$2,759.21
|
| Rate for Payer: HFN Commercial |
$2,852.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,325.18
|
| Rate for Payer: Multiplan Commercial |
$2,480.19
|
| Rate for Payer: NAPHCARE Commercial |
$1,860.14
|
| Rate for Payer: Preferred Network Access Commercial |
$2,852.22
|
| Rate for Payer: Quartz Beloit One Network |
$1,519.12
|
| Rate for Payer: Quartz Commercial |
$2,015.16
|
| Rate for Payer: Quartz Medicare Advantage |
$1,860.14
|
| Rate for Payer: The Alliance Commercial |
$1,550.12
|
| Rate for Payer: WEA Trust Commercial |
$1,705.13
|
| Rate for Payer: WPS Commercial |
$2,296.26
|
|
|
PLATE DISTAL TIBIA 3.5 5HL LT
|
Facility
|
IP
|
$2,981.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966366
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,519.12 |
| Max. Negotiated Rate |
$2,852.22 |
| Rate for Payer: Aetna Commercial |
$2,790.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,666.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,643.13
|
| Rate for Payer: Cash Price |
$894.30
|
| Rate for Payer: Cigna Commercial |
$2,852.22
|
| Rate for Payer: Health EOS Commercial |
$2,759.21
|
| Rate for Payer: HFN Commercial |
$2,852.22
|
| Rate for Payer: Multiplan Commercial |
$2,480.19
|
| Rate for Payer: Preferred Network Access Commercial |
$2,852.22
|
| Rate for Payer: Quartz Beloit One Network |
$1,519.12
|
| Rate for Payer: Quartz Commercial |
$1,860.14
|
| Rate for Payer: WEA Trust Commercial |
$1,705.13
|
| Rate for Payer: WPS Commercial |
$2,296.26
|
|
|
PLATE DISTAL TIBIA VA 2.7/3.5MM 8H RT 02.118.206S
|
Facility
|
OP
|
$8,388.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3265464
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,442.59 |
| Max. Negotiated Rate |
$8,025.64 |
| Rate for Payer: Aetna Commercial |
$7,851.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,502.23
|
| Rate for Payer: Aetna Managed Medicare |
$2,442.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,670.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,361.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,187.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,623.47
|
| Rate for Payer: Cash Price |
$2,516.40
|
| Rate for Payer: Cigna Commercial |
$8,025.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,881.82
|
| Rate for Payer: Health EOS Commercial |
$7,763.93
|
| Rate for Payer: HFN Commercial |
$8,025.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,542.64
|
| Rate for Payer: Multiplan Commercial |
$6,978.82
|
| Rate for Payer: NAPHCARE Commercial |
$5,234.11
|
| Rate for Payer: Preferred Network Access Commercial |
$8,025.64
|
| Rate for Payer: Quartz Beloit One Network |
$4,274.52
|
| Rate for Payer: Quartz Commercial |
$5,670.29
|
| Rate for Payer: Quartz Medicare Advantage |
$5,234.11
|
| Rate for Payer: The Alliance Commercial |
$4,361.76
|
| Rate for Payer: WEA Trust Commercial |
$4,797.94
|
| Rate for Payer: WPS Commercial |
$6,461.28
|
|
|
PLATE DISTAL TIBIA VA 2.7/3.5MM 8H RT 02.118.206S
|
Facility
|
IP
|
$8,388.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3265464
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,274.52 |
| Max. Negotiated Rate |
$8,025.64 |
| Rate for Payer: Aetna Commercial |
$7,851.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,502.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,623.47
|
| Rate for Payer: Cash Price |
$2,516.40
|
| Rate for Payer: Cigna Commercial |
$8,025.64
|
| Rate for Payer: Health EOS Commercial |
$7,763.93
|
| Rate for Payer: HFN Commercial |
$8,025.64
|
| Rate for Payer: Multiplan Commercial |
$6,978.82
|
| Rate for Payer: Preferred Network Access Commercial |
$8,025.64
|
| Rate for Payer: Quartz Beloit One Network |
$4,274.52
|
| Rate for Payer: Quartz Commercial |
$5,234.11
|
| Rate for Payer: WEA Trust Commercial |
$4,797.94
|
| Rate for Payer: WPS Commercial |
$6,461.28
|
|
|
PLATE DISTAL TIBIA VA 2.7/3.5MM MEDIAL 8H RT 02.118.006S
|
Facility
|
OP
|
$7,390.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5384651
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,151.97 |
| Max. Negotiated Rate |
$7,070.75 |
| Rate for Payer: Aetna Commercial |
$6,917.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,609.62
|
| Rate for Payer: Aetna Managed Medicare |
$2,151.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,995.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,842.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,689.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,073.37
|
| Rate for Payer: Cash Price |
$2,217.00
|
| Rate for Payer: Cigna Commercial |
$7,070.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,300.98
|
| Rate for Payer: Health EOS Commercial |
$6,840.18
|
| Rate for Payer: HFN Commercial |
$7,070.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,764.20
|
| Rate for Payer: Multiplan Commercial |
$6,148.48
|
| Rate for Payer: NAPHCARE Commercial |
$4,611.36
|
| Rate for Payer: Preferred Network Access Commercial |
$7,070.75
|
| Rate for Payer: Quartz Beloit One Network |
$3,765.94
|
| Rate for Payer: Quartz Commercial |
$4,995.64
|
| Rate for Payer: Quartz Medicare Advantage |
$4,611.36
|
| Rate for Payer: The Alliance Commercial |
$3,842.80
|
| Rate for Payer: WEA Trust Commercial |
$4,227.08
|
| Rate for Payer: WPS Commercial |
$5,692.52
|
|
|
PLATE DISTAL TIBIA VA 2.7/3.5MM MEDIAL 8H RT 02.118.006S
|
Facility
|
IP
|
$7,390.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5384651
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,765.94 |
| Max. Negotiated Rate |
$7,070.75 |
| Rate for Payer: Aetna Commercial |
$6,917.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,609.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,073.37
|
| Rate for Payer: Cash Price |
$2,217.00
|
| Rate for Payer: Cigna Commercial |
$7,070.75
|
| Rate for Payer: Health EOS Commercial |
$6,840.18
|
| Rate for Payer: HFN Commercial |
$7,070.75
|
| Rate for Payer: Multiplan Commercial |
$6,148.48
|
| Rate for Payer: Preferred Network Access Commercial |
$7,070.75
|
| Rate for Payer: Quartz Beloit One Network |
$3,765.94
|
| Rate for Payer: Quartz Commercial |
$4,611.36
|
| Rate for Payer: WEA Trust Commercial |
$4,227.08
|
| Rate for Payer: WPS Commercial |
$5,692.52
|
|
|
PLATE DISTAL ULNA LONG LT 70-0047
|
Facility
|
OP
|
$6,306.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459105
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,836.31 |
| Max. Negotiated Rate |
$6,033.58 |
| Rate for Payer: Aetna Commercial |
$5,902.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,640.09
|
| Rate for Payer: Aetna Managed Medicare |
$1,836.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,262.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,279.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,147.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,475.87
|
| Rate for Payer: Cash Price |
$1,891.80
|
| Rate for Payer: Cigna Commercial |
$6,033.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,670.09
|
| Rate for Payer: Health EOS Commercial |
$5,836.83
|
| Rate for Payer: HFN Commercial |
$6,033.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,918.68
|
| Rate for Payer: Multiplan Commercial |
$5,246.59
|
| Rate for Payer: NAPHCARE Commercial |
$3,934.94
|
| Rate for Payer: Preferred Network Access Commercial |
$6,033.58
|
| Rate for Payer: Quartz Beloit One Network |
$3,213.54
|
| Rate for Payer: Quartz Commercial |
$4,262.86
|
| Rate for Payer: Quartz Medicare Advantage |
$3,934.94
|
| Rate for Payer: The Alliance Commercial |
$3,279.12
|
| Rate for Payer: WEA Trust Commercial |
$3,607.03
|
| Rate for Payer: WPS Commercial |
$4,857.51
|
|
|
PLATE DISTAL ULNA LONG LT 70-0047
|
Facility
|
IP
|
$6,306.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459105
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,213.54 |
| Max. Negotiated Rate |
$6,033.58 |
| Rate for Payer: Aetna Commercial |
$5,902.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,640.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,475.87
|
| Rate for Payer: Cash Price |
$1,891.80
|
| Rate for Payer: Cigna Commercial |
$6,033.58
|
| Rate for Payer: Health EOS Commercial |
$5,836.83
|
| Rate for Payer: HFN Commercial |
$6,033.58
|
| Rate for Payer: Multiplan Commercial |
$5,246.59
|
| Rate for Payer: Preferred Network Access Commercial |
$6,033.58
|
| Rate for Payer: Quartz Beloit One Network |
$3,213.54
|
| Rate for Payer: Quartz Commercial |
$3,934.94
|
| Rate for Payer: WEA Trust Commercial |
$3,607.03
|
| Rate for Payer: WPS Commercial |
$4,857.51
|
|
|
PLATE DISTAL ULNA STD LT 70-0045
|
Facility
|
IP
|
$5,299.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3375503
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,700.37 |
| Max. Negotiated Rate |
$5,070.08 |
| Rate for Payer: Aetna Commercial |
$4,959.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,739.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,920.81
|
| Rate for Payer: Cash Price |
$1,589.70
|
| Rate for Payer: Cigna Commercial |
$5,070.08
|
| Rate for Payer: Health EOS Commercial |
$4,904.75
|
| Rate for Payer: HFN Commercial |
$5,070.08
|
| Rate for Payer: Multiplan Commercial |
$4,408.77
|
| Rate for Payer: Preferred Network Access Commercial |
$5,070.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,700.37
|
| Rate for Payer: Quartz Commercial |
$3,306.58
|
| Rate for Payer: WEA Trust Commercial |
$3,031.03
|
| Rate for Payer: WPS Commercial |
$4,081.82
|
|
|
PLATE DISTAL ULNA STD LT 70-0045
|
Facility
|
OP
|
$5,299.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3375503
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,543.07 |
| Max. Negotiated Rate |
$5,070.08 |
| Rate for Payer: Aetna Commercial |
$4,959.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,739.43
|
| Rate for Payer: Aetna Managed Medicare |
$1,543.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,582.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,755.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,645.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,920.81
|
| Rate for Payer: Cash Price |
$1,589.70
|
| Rate for Payer: Cigna Commercial |
$5,070.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,084.02
|
| Rate for Payer: Health EOS Commercial |
$4,904.75
|
| Rate for Payer: HFN Commercial |
$5,070.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,133.22
|
| Rate for Payer: Multiplan Commercial |
$4,408.77
|
| Rate for Payer: NAPHCARE Commercial |
$3,306.58
|
| Rate for Payer: Preferred Network Access Commercial |
$5,070.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,700.37
|
| Rate for Payer: Quartz Commercial |
$3,582.12
|
| Rate for Payer: Quartz Medicare Advantage |
$3,306.58
|
| Rate for Payer: The Alliance Commercial |
$2,755.48
|
| Rate for Payer: WEA Trust Commercial |
$3,031.03
|
| Rate for Payer: WPS Commercial |
$4,081.82
|
|
|
PLATE DIST FIBULA 2.7/3.5 LT 6HL 02.112.143
|
Facility
|
IP
|
$5,929.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3072547
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,021.42 |
| Max. Negotiated Rate |
$5,672.87 |
| Rate for Payer: Aetna Commercial |
$5,549.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,302.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,268.06
|
| Rate for Payer: Cash Price |
$1,778.70
|
| Rate for Payer: Cigna Commercial |
$5,672.87
|
| Rate for Payer: Health EOS Commercial |
$5,487.88
|
| Rate for Payer: HFN Commercial |
$5,672.87
|
| Rate for Payer: Multiplan Commercial |
$4,932.93
|
| Rate for Payer: Preferred Network Access Commercial |
$5,672.87
|
| Rate for Payer: Quartz Beloit One Network |
$3,021.42
|
| Rate for Payer: Quartz Commercial |
$3,699.70
|
| Rate for Payer: WEA Trust Commercial |
$3,391.39
|
| Rate for Payer: WPS Commercial |
$4,567.11
|
|
|
PLATE DIST FIBULA 2.7/3.5 LT 6HL 02.112.143
|
Facility
|
OP
|
$5,929.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3072547
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,726.52 |
| Max. Negotiated Rate |
$5,672.87 |
| Rate for Payer: Aetna Commercial |
$5,549.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,302.90
|
| Rate for Payer: Aetna Managed Medicare |
$1,726.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,008.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,083.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,959.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,268.06
|
| Rate for Payer: Cash Price |
$1,778.70
|
| Rate for Payer: Cigna Commercial |
$5,672.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,450.68
|
| Rate for Payer: Health EOS Commercial |
$5,487.88
|
| Rate for Payer: HFN Commercial |
$5,672.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,624.62
|
| Rate for Payer: Multiplan Commercial |
$4,932.93
|
| Rate for Payer: NAPHCARE Commercial |
$3,699.70
|
| Rate for Payer: Preferred Network Access Commercial |
$5,672.87
|
| Rate for Payer: Quartz Beloit One Network |
$3,021.42
|
| Rate for Payer: Quartz Commercial |
$4,008.00
|
| Rate for Payer: Quartz Medicare Advantage |
$3,699.70
|
| Rate for Payer: The Alliance Commercial |
$3,083.08
|
| Rate for Payer: WEA Trust Commercial |
$3,391.39
|
| Rate for Payer: WPS Commercial |
$4,567.11
|
|
|
PLATE DIST FIBULA LT 9HL 02.112.149
|
Facility
|
OP
|
$5,252.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3869352
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,529.38 |
| Max. Negotiated Rate |
$5,025.11 |
| Rate for Payer: Aetna Commercial |
$4,915.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,697.39
|
| Rate for Payer: Aetna Managed Medicare |
$1,529.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,550.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,731.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,621.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,894.90
|
| Rate for Payer: Cash Price |
$1,575.60
|
| Rate for Payer: Cigna Commercial |
$5,025.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,056.66
|
| Rate for Payer: Health EOS Commercial |
$4,861.25
|
| Rate for Payer: HFN Commercial |
$5,025.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,096.56
|
| Rate for Payer: Multiplan Commercial |
$4,369.66
|
| Rate for Payer: NAPHCARE Commercial |
$3,277.25
|
| Rate for Payer: Preferred Network Access Commercial |
$5,025.11
|
| Rate for Payer: Quartz Beloit One Network |
$2,676.42
|
| Rate for Payer: Quartz Commercial |
$3,550.35
|
| Rate for Payer: Quartz Medicare Advantage |
$3,277.25
|
| Rate for Payer: The Alliance Commercial |
$2,731.04
|
| Rate for Payer: WEA Trust Commercial |
$3,004.14
|
| Rate for Payer: WPS Commercial |
$4,045.62
|
|
|
PLATE DIST FIBULA LT 9HL 02.112.149
|
Facility
|
IP
|
$5,252.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3869352
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,676.42 |
| Max. Negotiated Rate |
$5,025.11 |
| Rate for Payer: Aetna Commercial |
$4,915.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,697.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,894.90
|
| Rate for Payer: Cash Price |
$1,575.60
|
| Rate for Payer: Cigna Commercial |
$5,025.11
|
| Rate for Payer: Health EOS Commercial |
$4,861.25
|
| Rate for Payer: HFN Commercial |
$5,025.11
|
| Rate for Payer: Multiplan Commercial |
$4,369.66
|
| Rate for Payer: Preferred Network Access Commercial |
$5,025.11
|
| Rate for Payer: Quartz Beloit One Network |
$2,676.42
|
| Rate for Payer: Quartz Commercial |
$3,277.25
|
| Rate for Payer: WEA Trust Commercial |
$3,004.14
|
| Rate for Payer: WPS Commercial |
$4,045.62
|
|
|
PLATE DIST RAD 2.4 6HL/2HL
|
Facility
|
IP
|
$8,077.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3072513
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,116.04 |
| Max. Negotiated Rate |
$7,728.07 |
| Rate for Payer: Aetna Commercial |
$7,560.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,224.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,452.04
|
| Rate for Payer: Cash Price |
$2,423.10
|
| Rate for Payer: Cigna Commercial |
$7,728.07
|
| Rate for Payer: Health EOS Commercial |
$7,476.07
|
| Rate for Payer: HFN Commercial |
$7,728.07
|
| Rate for Payer: Multiplan Commercial |
$6,720.06
|
| Rate for Payer: Preferred Network Access Commercial |
$7,728.07
|
| Rate for Payer: Quartz Beloit One Network |
$4,116.04
|
| Rate for Payer: Quartz Commercial |
$5,040.05
|
| Rate for Payer: WEA Trust Commercial |
$4,620.04
|
| Rate for Payer: WPS Commercial |
$6,221.71
|
|
|
PLATE DIST RAD 2.4 6HL/2HL
|
Facility
|
OP
|
$8,077.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3072513
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,352.02 |
| Max. Negotiated Rate |
$7,728.07 |
| Rate for Payer: Aetna Commercial |
$7,560.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,224.07
|
| Rate for Payer: Aetna Managed Medicare |
$2,352.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,460.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,200.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,032.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,452.04
|
| Rate for Payer: Cash Price |
$2,423.10
|
| Rate for Payer: Cigna Commercial |
$7,728.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,700.81
|
| Rate for Payer: Health EOS Commercial |
$7,476.07
|
| Rate for Payer: HFN Commercial |
$7,728.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,300.06
|
| Rate for Payer: Multiplan Commercial |
$6,720.06
|
| Rate for Payer: NAPHCARE Commercial |
$5,040.05
|
| Rate for Payer: Preferred Network Access Commercial |
$7,728.07
|
| Rate for Payer: Quartz Beloit One Network |
$4,116.04
|
| Rate for Payer: Quartz Commercial |
$5,460.05
|
| Rate for Payer: Quartz Medicare Advantage |
$5,040.05
|
| Rate for Payer: The Alliance Commercial |
$4,200.04
|
| Rate for Payer: WEA Trust Commercial |
$4,620.04
|
| Rate for Payer: WPS Commercial |
$6,221.71
|
|
|
PLATE DIST RAD 8HL LT
|
Facility
|
OP
|
$8,443.00
|
|
| Hospital Charge Code |
2966365
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,458.60 |
| Max. Negotiated Rate |
$8,078.26 |
| Rate for Payer: Aetna Commercial |
$7,902.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,551.42
|
| Rate for Payer: Aetna Managed Medicare |
$2,458.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,707.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,390.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,214.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,653.78
|
| Rate for Payer: Cash Price |
$2,532.90
|
| Rate for Payer: Cigna Commercial |
$8,078.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,913.83
|
| Rate for Payer: Health EOS Commercial |
$7,814.84
|
| Rate for Payer: HFN Commercial |
$8,078.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,585.54
|
| Rate for Payer: Multiplan Commercial |
$7,024.58
|
| Rate for Payer: NAPHCARE Commercial |
$5,268.43
|
| Rate for Payer: Preferred Network Access Commercial |
$8,078.26
|
| Rate for Payer: Quartz Beloit One Network |
$4,302.55
|
| Rate for Payer: Quartz Commercial |
$5,707.47
|
| Rate for Payer: Quartz Medicare Advantage |
$5,268.43
|
| Rate for Payer: The Alliance Commercial |
$4,390.36
|
| Rate for Payer: WEA Trust Commercial |
$4,829.40
|
| Rate for Payer: WPS Commercial |
$6,503.64
|
|
|
PLATE DIST RAD 8HL LT
|
Facility
|
IP
|
$8,443.00
|
|
| Hospital Charge Code |
2966365
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,302.55 |
| Max. Negotiated Rate |
$8,078.26 |
| Rate for Payer: Aetna Commercial |
$7,902.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,551.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,653.78
|
| Rate for Payer: Cash Price |
$2,532.90
|
| Rate for Payer: Cigna Commercial |
$8,078.26
|
| Rate for Payer: Health EOS Commercial |
$7,814.84
|
| Rate for Payer: HFN Commercial |
$8,078.26
|
| Rate for Payer: Multiplan Commercial |
$7,024.58
|
| Rate for Payer: Preferred Network Access Commercial |
$8,078.26
|
| Rate for Payer: Quartz Beloit One Network |
$4,302.55
|
| Rate for Payer: Quartz Commercial |
$5,268.43
|
| Rate for Payer: WEA Trust Commercial |
$4,829.40
|
| Rate for Payer: WPS Commercial |
$6,503.64
|
|
