|
PLATE FIBULA LATERAL OFFSET 77MM RT ORTHOLOC 3DI SYSTEM 5888501R
|
Facility
|
IP
|
$8,530.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6206994
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,346.89 |
| Max. Negotiated Rate |
$8,161.50 |
| Rate for Payer: Aetna Commercial |
$7,984.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,629.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,701.74
|
| Rate for Payer: Cash Price |
$2,559.00
|
| Rate for Payer: Cigna Commercial |
$8,161.50
|
| Rate for Payer: Health EOS Commercial |
$7,895.37
|
| Rate for Payer: HFN Commercial |
$8,161.50
|
| Rate for Payer: Multiplan Commercial |
$7,096.96
|
| Rate for Payer: Preferred Network Access Commercial |
$8,161.50
|
| Rate for Payer: Quartz Beloit One Network |
$4,346.89
|
| Rate for Payer: Quartz Commercial |
$5,322.72
|
| Rate for Payer: WEA Trust Commercial |
$4,879.16
|
| Rate for Payer: WPS Commercial |
$6,570.66
|
|
|
PLATE FIBULA LATERAL OFFSET 89MM RT ORTHOLOC 3DI SYSTEM 5888502R
|
Facility
|
IP
|
$8,715.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6200967
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,441.16 |
| Max. Negotiated Rate |
$8,338.51 |
| Rate for Payer: Aetna Commercial |
$8,157.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,794.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,803.71
|
| Rate for Payer: Cash Price |
$2,614.50
|
| Rate for Payer: Cigna Commercial |
$8,338.51
|
| Rate for Payer: Health EOS Commercial |
$8,066.60
|
| Rate for Payer: HFN Commercial |
$8,338.51
|
| Rate for Payer: Multiplan Commercial |
$7,250.88
|
| Rate for Payer: Preferred Network Access Commercial |
$8,338.51
|
| Rate for Payer: Quartz Beloit One Network |
$4,441.16
|
| Rate for Payer: Quartz Commercial |
$5,438.16
|
| Rate for Payer: WEA Trust Commercial |
$4,984.98
|
| Rate for Payer: WPS Commercial |
$6,713.16
|
|
|
PLATE FIBULA LATERAL OFFSET 89MM RT ORTHOLOC 3DI SYSTEM 5888502R
|
Facility
|
OP
|
$8,715.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6200967
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,537.81 |
| Max. Negotiated Rate |
$8,338.51 |
| Rate for Payer: Aetna Commercial |
$8,157.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,794.70
|
| Rate for Payer: Aetna Managed Medicare |
$2,537.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,891.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,531.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,350.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,803.71
|
| Rate for Payer: Cash Price |
$2,614.50
|
| Rate for Payer: Cigna Commercial |
$8,338.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,072.13
|
| Rate for Payer: Health EOS Commercial |
$8,066.60
|
| Rate for Payer: HFN Commercial |
$8,338.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,797.70
|
| Rate for Payer: Multiplan Commercial |
$7,250.88
|
| Rate for Payer: NAPHCARE Commercial |
$5,438.16
|
| Rate for Payer: Preferred Network Access Commercial |
$8,338.51
|
| Rate for Payer: Quartz Beloit One Network |
$4,441.16
|
| Rate for Payer: Quartz Commercial |
$5,891.34
|
| Rate for Payer: Quartz Medicare Advantage |
$5,438.16
|
| Rate for Payer: The Alliance Commercial |
$4,531.80
|
| Rate for Payer: WEA Trust Commercial |
$4,984.98
|
| Rate for Payer: WPS Commercial |
$6,713.16
|
|
|
PLATE FIBULA RT 2.7/3.5 6HL 02.112.142
|
Facility
|
OP
|
$6,436.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966369
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,874.16 |
| Max. Negotiated Rate |
$6,157.96 |
| Rate for Payer: Aetna Commercial |
$6,024.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,756.36
|
| Rate for Payer: Aetna Managed Medicare |
$1,874.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,350.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,346.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,212.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,547.52
|
| Rate for Payer: Cash Price |
$1,930.80
|
| Rate for Payer: Cigna Commercial |
$6,157.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,745.75
|
| Rate for Payer: Health EOS Commercial |
$5,957.16
|
| Rate for Payer: HFN Commercial |
$6,157.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,020.08
|
| Rate for Payer: Multiplan Commercial |
$5,354.75
|
| Rate for Payer: NAPHCARE Commercial |
$4,016.06
|
| Rate for Payer: Preferred Network Access Commercial |
$6,157.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,279.79
|
| Rate for Payer: Quartz Commercial |
$4,350.74
|
| Rate for Payer: Quartz Medicare Advantage |
$4,016.06
|
| Rate for Payer: The Alliance Commercial |
$3,346.72
|
| Rate for Payer: WEA Trust Commercial |
$3,681.39
|
| Rate for Payer: WPS Commercial |
$4,957.65
|
|
|
PLATE FIBULA RT 2.7/3.5 6HL 02.112.142
|
Facility
|
IP
|
$6,436.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966369
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,279.79 |
| Max. Negotiated Rate |
$6,157.96 |
| Rate for Payer: Aetna Commercial |
$6,024.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,756.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,547.52
|
| Rate for Payer: Cash Price |
$1,930.80
|
| Rate for Payer: Cigna Commercial |
$6,157.96
|
| Rate for Payer: Health EOS Commercial |
$5,957.16
|
| Rate for Payer: HFN Commercial |
$6,157.96
|
| Rate for Payer: Multiplan Commercial |
$5,354.75
|
| Rate for Payer: Preferred Network Access Commercial |
$6,157.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,279.79
|
| Rate for Payer: Quartz Commercial |
$4,016.06
|
| Rate for Payer: WEA Trust Commercial |
$3,681.39
|
| Rate for Payer: WPS Commercial |
$4,957.65
|
|
|
PLATE HOOK 3.5MM CLAVICLE LCP 4HL 15MM HOOK DEPTH 44MM RT 241.074S
|
Facility
|
IP
|
$5,283.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4594988
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,692.22 |
| Max. Negotiated Rate |
$5,054.77 |
| Rate for Payer: Aetna Commercial |
$4,944.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,725.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,911.99
|
| Rate for Payer: Cash Price |
$1,584.90
|
| Rate for Payer: Cigna Commercial |
$5,054.77
|
| Rate for Payer: Health EOS Commercial |
$4,889.94
|
| Rate for Payer: HFN Commercial |
$5,054.77
|
| Rate for Payer: Multiplan Commercial |
$4,395.46
|
| Rate for Payer: Preferred Network Access Commercial |
$5,054.77
|
| Rate for Payer: Quartz Beloit One Network |
$2,692.22
|
| Rate for Payer: Quartz Commercial |
$3,296.59
|
| Rate for Payer: WEA Trust Commercial |
$3,021.88
|
| Rate for Payer: WPS Commercial |
$4,069.49
|
|
|
PLATE HOOK 3.5MM CLAVICLE LCP 4HL 15MM HOOK DEPTH 44MM RT 241.074S
|
Facility
|
OP
|
$5,283.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4594988
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,538.41 |
| Max. Negotiated Rate |
$5,054.77 |
| Rate for Payer: Aetna Commercial |
$4,944.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,725.12
|
| Rate for Payer: Aetna Managed Medicare |
$1,538.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,571.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,747.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,637.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,911.99
|
| Rate for Payer: Cash Price |
$1,584.90
|
| Rate for Payer: Cigna Commercial |
$5,054.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,074.71
|
| Rate for Payer: Health EOS Commercial |
$4,889.94
|
| Rate for Payer: HFN Commercial |
$5,054.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,120.74
|
| Rate for Payer: Multiplan Commercial |
$4,395.46
|
| Rate for Payer: NAPHCARE Commercial |
$3,296.59
|
| Rate for Payer: Preferred Network Access Commercial |
$5,054.77
|
| Rate for Payer: Quartz Beloit One Network |
$2,692.22
|
| Rate for Payer: Quartz Commercial |
$3,571.31
|
| Rate for Payer: Quartz Medicare Advantage |
$3,296.59
|
| Rate for Payer: The Alliance Commercial |
$2,747.16
|
| Rate for Payer: WEA Trust Commercial |
$3,021.88
|
| Rate for Payer: WPS Commercial |
$4,069.49
|
|
|
PLATE HOOK 3.5MM CLAVICLE LCP 4HL 18MM HOOK DEPTH 44MM RT 241.076S
|
Facility
|
IP
|
$5,283.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5106784
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,692.22 |
| Max. Negotiated Rate |
$5,054.77 |
| Rate for Payer: Aetna Commercial |
$4,944.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,725.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,911.99
|
| Rate for Payer: Cash Price |
$1,584.90
|
| Rate for Payer: Cigna Commercial |
$5,054.77
|
| Rate for Payer: Health EOS Commercial |
$4,889.94
|
| Rate for Payer: HFN Commercial |
$5,054.77
|
| Rate for Payer: Multiplan Commercial |
$4,395.46
|
| Rate for Payer: Preferred Network Access Commercial |
$5,054.77
|
| Rate for Payer: Quartz Beloit One Network |
$2,692.22
|
| Rate for Payer: Quartz Commercial |
$3,296.59
|
| Rate for Payer: WEA Trust Commercial |
$3,021.88
|
| Rate for Payer: WPS Commercial |
$4,069.49
|
|
|
PLATE HOOK 3.5MM CLAVICLE LCP 4HL 18MM HOOK DEPTH 44MM RT 241.076S
|
Facility
|
OP
|
$5,283.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5106784
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,538.41 |
| Max. Negotiated Rate |
$5,054.77 |
| Rate for Payer: Aetna Commercial |
$4,944.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,725.12
|
| Rate for Payer: Aetna Managed Medicare |
$1,538.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,571.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,747.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,637.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,911.99
|
| Rate for Payer: Cash Price |
$1,584.90
|
| Rate for Payer: Cigna Commercial |
$5,054.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,074.71
|
| Rate for Payer: Health EOS Commercial |
$4,889.94
|
| Rate for Payer: HFN Commercial |
$5,054.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,120.74
|
| Rate for Payer: Multiplan Commercial |
$4,395.46
|
| Rate for Payer: NAPHCARE Commercial |
$3,296.59
|
| Rate for Payer: Preferred Network Access Commercial |
$5,054.77
|
| Rate for Payer: Quartz Beloit One Network |
$2,692.22
|
| Rate for Payer: Quartz Commercial |
$3,571.31
|
| Rate for Payer: Quartz Medicare Advantage |
$3,296.59
|
| Rate for Payer: The Alliance Commercial |
$2,747.16
|
| Rate for Payer: WEA Trust Commercial |
$3,021.88
|
| Rate for Payer: WPS Commercial |
$4,069.49
|
|
|
PLATE HOOK LATERAL LOCK 5HL ARTHREX AR-8943TH-05
|
Facility
|
IP
|
$5,586.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5496979
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,846.63 |
| Max. Negotiated Rate |
$5,344.68 |
| Rate for Payer: Aetna Commercial |
$5,228.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,996.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,079.00
|
| Rate for Payer: Cash Price |
$1,675.80
|
| Rate for Payer: Cigna Commercial |
$5,344.68
|
| Rate for Payer: Health EOS Commercial |
$5,170.40
|
| Rate for Payer: HFN Commercial |
$5,344.68
|
| Rate for Payer: Multiplan Commercial |
$4,647.55
|
| Rate for Payer: Preferred Network Access Commercial |
$5,344.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,846.63
|
| Rate for Payer: Quartz Commercial |
$3,485.66
|
| Rate for Payer: WEA Trust Commercial |
$3,195.19
|
| Rate for Payer: WPS Commercial |
$4,302.90
|
|
|
PLATE HOOK LATERAL LOCK 5HL ARTHREX AR-8943TH-05
|
Facility
|
OP
|
$5,586.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5496979
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,626.64 |
| Max. Negotiated Rate |
$5,344.68 |
| Rate for Payer: Aetna Commercial |
$5,228.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,996.12
|
| Rate for Payer: Aetna Managed Medicare |
$1,626.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,776.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,904.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,788.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,079.00
|
| Rate for Payer: Cash Price |
$1,675.80
|
| Rate for Payer: Cigna Commercial |
$5,344.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,251.05
|
| Rate for Payer: Health EOS Commercial |
$5,170.40
|
| Rate for Payer: HFN Commercial |
$5,344.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,357.08
|
| Rate for Payer: Multiplan Commercial |
$4,647.55
|
| Rate for Payer: NAPHCARE Commercial |
$3,485.66
|
| Rate for Payer: Preferred Network Access Commercial |
$5,344.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,846.63
|
| Rate for Payer: Quartz Commercial |
$3,776.14
|
| Rate for Payer: Quartz Medicare Advantage |
$3,485.66
|
| Rate for Payer: The Alliance Commercial |
$2,904.72
|
| Rate for Payer: WEA Trust Commercial |
$3,195.19
|
| Rate for Payer: WPS Commercial |
$4,302.90
|
|
|
PLATE HOOK LCP 3HL 02.113.103
|
Facility
|
OP
|
$6,063.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3365525
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,765.55 |
| Max. Negotiated Rate |
$5,801.08 |
| Rate for Payer: Aetna Commercial |
$5,674.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,422.75
|
| Rate for Payer: Aetna Managed Medicare |
$1,765.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,098.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,152.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,026.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,341.93
|
| Rate for Payer: Cash Price |
$1,818.90
|
| Rate for Payer: Cigna Commercial |
$5,801.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,528.67
|
| Rate for Payer: Health EOS Commercial |
$5,611.91
|
| Rate for Payer: HFN Commercial |
$5,801.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,729.14
|
| Rate for Payer: Multiplan Commercial |
$5,044.42
|
| Rate for Payer: NAPHCARE Commercial |
$3,783.31
|
| Rate for Payer: Preferred Network Access Commercial |
$5,801.08
|
| Rate for Payer: Quartz Beloit One Network |
$3,089.70
|
| Rate for Payer: Quartz Commercial |
$4,098.59
|
| Rate for Payer: Quartz Medicare Advantage |
$3,783.31
|
| Rate for Payer: The Alliance Commercial |
$3,152.76
|
| Rate for Payer: WEA Trust Commercial |
$3,468.04
|
| Rate for Payer: WPS Commercial |
$4,670.33
|
|
|
PLATE HOOK LCP 3HL 02.113.103
|
Facility
|
IP
|
$6,063.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3365525
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,089.70 |
| Max. Negotiated Rate |
$5,801.08 |
| Rate for Payer: Aetna Commercial |
$5,674.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,422.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,341.93
|
| Rate for Payer: Cash Price |
$1,818.90
|
| Rate for Payer: Cigna Commercial |
$5,801.08
|
| Rate for Payer: Health EOS Commercial |
$5,611.91
|
| Rate for Payer: HFN Commercial |
$5,801.08
|
| Rate for Payer: Multiplan Commercial |
$5,044.42
|
| Rate for Payer: Preferred Network Access Commercial |
$5,801.08
|
| Rate for Payer: Quartz Beloit One Network |
$3,089.70
|
| Rate for Payer: Quartz Commercial |
$3,783.31
|
| Rate for Payer: WEA Trust Commercial |
$3,468.04
|
| Rate for Payer: WPS Commercial |
$4,670.33
|
|
|
PLATE HOOK LG 58882030
|
Facility
|
OP
|
$8,911.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6171782
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,594.88 |
| Max. Negotiated Rate |
$8,526.04 |
| Rate for Payer: Aetna Commercial |
$8,340.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,970.00
|
| Rate for Payer: Aetna Managed Medicare |
$2,594.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,023.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,633.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,448.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,911.74
|
| Rate for Payer: Cash Price |
$2,673.30
|
| Rate for Payer: Cigna Commercial |
$8,526.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,186.20
|
| Rate for Payer: Health EOS Commercial |
$8,248.02
|
| Rate for Payer: HFN Commercial |
$8,526.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,950.58
|
| Rate for Payer: Multiplan Commercial |
$7,413.95
|
| Rate for Payer: NAPHCARE Commercial |
$5,560.46
|
| Rate for Payer: Preferred Network Access Commercial |
$8,526.04
|
| Rate for Payer: Quartz Beloit One Network |
$4,541.05
|
| Rate for Payer: Quartz Commercial |
$6,023.84
|
| Rate for Payer: Quartz Medicare Advantage |
$5,560.46
|
| Rate for Payer: The Alliance Commercial |
$4,633.72
|
| Rate for Payer: WEA Trust Commercial |
$5,097.09
|
| Rate for Payer: WPS Commercial |
$6,864.14
|
|
|
PLATE HOOK LG 58882030
|
Facility
|
IP
|
$8,911.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6171782
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,541.05 |
| Max. Negotiated Rate |
$8,526.04 |
| Rate for Payer: Aetna Commercial |
$8,340.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,970.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,911.74
|
| Rate for Payer: Cash Price |
$2,673.30
|
| Rate for Payer: Cigna Commercial |
$8,526.04
|
| Rate for Payer: Health EOS Commercial |
$8,248.02
|
| Rate for Payer: HFN Commercial |
$8,526.04
|
| Rate for Payer: Multiplan Commercial |
$7,413.95
|
| Rate for Payer: Preferred Network Access Commercial |
$8,526.04
|
| Rate for Payer: Quartz Beloit One Network |
$4,541.05
|
| Rate for Payer: Quartz Commercial |
$5,560.46
|
| Rate for Payer: WEA Trust Commercial |
$5,097.09
|
| Rate for Payer: WPS Commercial |
$6,864.14
|
|
|
PLATE HOOK MEDIAL LOCK 3HL ARTHREX AR-8943H-03
|
Facility
|
OP
|
$6,086.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5977646
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,772.24 |
| Max. Negotiated Rate |
$5,823.08 |
| Rate for Payer: Aetna Commercial |
$5,696.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,443.32
|
| Rate for Payer: Aetna Managed Medicare |
$1,772.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,114.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,164.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,038.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,354.60
|
| Rate for Payer: Cash Price |
$1,825.80
|
| Rate for Payer: Cigna Commercial |
$5,823.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,542.05
|
| Rate for Payer: Health EOS Commercial |
$5,633.20
|
| Rate for Payer: HFN Commercial |
$5,823.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,747.08
|
| Rate for Payer: Multiplan Commercial |
$5,063.55
|
| Rate for Payer: NAPHCARE Commercial |
$3,797.66
|
| Rate for Payer: Preferred Network Access Commercial |
$5,823.08
|
| Rate for Payer: Quartz Beloit One Network |
$3,101.43
|
| Rate for Payer: Quartz Commercial |
$4,114.14
|
| Rate for Payer: Quartz Medicare Advantage |
$3,797.66
|
| Rate for Payer: The Alliance Commercial |
$3,164.72
|
| Rate for Payer: WEA Trust Commercial |
$3,481.19
|
| Rate for Payer: WPS Commercial |
$4,688.05
|
|
|
PLATE HOOK MEDIAL LOCK 3HL ARTHREX AR-8943H-03
|
Facility
|
IP
|
$6,086.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5977646
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,101.43 |
| Max. Negotiated Rate |
$5,823.08 |
| Rate for Payer: Aetna Commercial |
$5,696.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,443.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,354.60
|
| Rate for Payer: Cash Price |
$1,825.80
|
| Rate for Payer: Cigna Commercial |
$5,823.08
|
| Rate for Payer: Health EOS Commercial |
$5,633.20
|
| Rate for Payer: HFN Commercial |
$5,823.08
|
| Rate for Payer: Multiplan Commercial |
$5,063.55
|
| Rate for Payer: Preferred Network Access Commercial |
$5,823.08
|
| Rate for Payer: Quartz Beloit One Network |
$3,101.43
|
| Rate for Payer: Quartz Commercial |
$3,797.66
|
| Rate for Payer: WEA Trust Commercial |
$3,481.19
|
| Rate for Payer: WPS Commercial |
$4,688.05
|
|
|
PLATE HOOK MEDIAL LOCK 5HL ARTHREX AR-8943H-05
|
Facility
|
IP
|
$6,582.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5496980
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,354.19 |
| Max. Negotiated Rate |
$6,297.66 |
| Rate for Payer: Aetna Commercial |
$6,160.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,886.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,628.00
|
| Rate for Payer: Cash Price |
$1,974.60
|
| Rate for Payer: Cigna Commercial |
$6,297.66
|
| Rate for Payer: Health EOS Commercial |
$6,092.30
|
| Rate for Payer: HFN Commercial |
$6,297.66
|
| Rate for Payer: Multiplan Commercial |
$5,476.22
|
| Rate for Payer: Preferred Network Access Commercial |
$6,297.66
|
| Rate for Payer: Quartz Beloit One Network |
$3,354.19
|
| Rate for Payer: Quartz Commercial |
$4,107.17
|
| Rate for Payer: WEA Trust Commercial |
$3,764.90
|
| Rate for Payer: WPS Commercial |
$5,070.11
|
|
|
PLATE HOOK MEDIAL LOCK 5HL ARTHREX AR-8943H-05
|
Facility
|
OP
|
$6,582.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5496980
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,916.68 |
| Max. Negotiated Rate |
$6,297.66 |
| Rate for Payer: Aetna Commercial |
$6,160.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,886.94
|
| Rate for Payer: Aetna Managed Medicare |
$1,916.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,449.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,422.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,285.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,628.00
|
| Rate for Payer: Cash Price |
$1,974.60
|
| Rate for Payer: Cigna Commercial |
$6,297.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,830.72
|
| Rate for Payer: Health EOS Commercial |
$6,092.30
|
| Rate for Payer: HFN Commercial |
$6,297.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,133.96
|
| Rate for Payer: Multiplan Commercial |
$5,476.22
|
| Rate for Payer: NAPHCARE Commercial |
$4,107.17
|
| Rate for Payer: Preferred Network Access Commercial |
$6,297.66
|
| Rate for Payer: Quartz Beloit One Network |
$3,354.19
|
| Rate for Payer: Quartz Commercial |
$4,449.43
|
| Rate for Payer: Quartz Medicare Advantage |
$4,107.17
|
| Rate for Payer: The Alliance Commercial |
$3,422.64
|
| Rate for Payer: WEA Trust Commercial |
$3,764.90
|
| Rate for Payer: WPS Commercial |
$5,070.11
|
|
|
PLATE HOOK UNIVERSAL 5TH METATARSAL AR-8956-01
|
Facility
|
IP
|
$7,380.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5200618
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,760.85 |
| Max. Negotiated Rate |
$7,061.18 |
| Rate for Payer: Aetna Commercial |
$6,907.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,600.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,067.86
|
| Rate for Payer: Cash Price |
$2,214.00
|
| Rate for Payer: Cigna Commercial |
$7,061.18
|
| Rate for Payer: Health EOS Commercial |
$6,830.93
|
| Rate for Payer: HFN Commercial |
$7,061.18
|
| Rate for Payer: Multiplan Commercial |
$6,140.16
|
| Rate for Payer: Preferred Network Access Commercial |
$7,061.18
|
| Rate for Payer: Quartz Beloit One Network |
$3,760.85
|
| Rate for Payer: Quartz Commercial |
$4,605.12
|
| Rate for Payer: WEA Trust Commercial |
$4,221.36
|
| Rate for Payer: WPS Commercial |
$5,684.81
|
|
|
PLATE HOOK UNIVERSAL 5TH METATARSAL AR-8956-01
|
Facility
|
OP
|
$7,380.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5200618
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,149.06 |
| Max. Negotiated Rate |
$7,061.18 |
| Rate for Payer: Aetna Commercial |
$6,907.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,600.67
|
| Rate for Payer: Aetna Managed Medicare |
$2,149.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,988.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,837.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,684.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,067.86
|
| Rate for Payer: Cash Price |
$2,214.00
|
| Rate for Payer: Cigna Commercial |
$7,061.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,295.16
|
| Rate for Payer: Health EOS Commercial |
$6,830.93
|
| Rate for Payer: HFN Commercial |
$7,061.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,756.40
|
| Rate for Payer: Multiplan Commercial |
$6,140.16
|
| Rate for Payer: NAPHCARE Commercial |
$4,605.12
|
| Rate for Payer: Preferred Network Access Commercial |
$7,061.18
|
| Rate for Payer: Quartz Beloit One Network |
$3,760.85
|
| Rate for Payer: Quartz Commercial |
$4,988.88
|
| Rate for Payer: Quartz Medicare Advantage |
$4,605.12
|
| Rate for Payer: The Alliance Commercial |
$3,837.60
|
| Rate for Payer: WEA Trust Commercial |
$4,221.36
|
| Rate for Payer: WPS Commercial |
$5,684.81
|
|
|
PLATE HUMERAL PROXIMAL LATERAL 3HL RT 627233
|
Facility
|
OP
|
$9,602.57
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6246234
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,796.27 |
| Max. Negotiated Rate |
$9,187.74 |
| Rate for Payer: Aetna Commercial |
$8,988.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,588.54
|
| Rate for Payer: Aetna Managed Medicare |
$2,796.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,491.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,993.34
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,793.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,292.94
|
| Rate for Payer: Cash Price |
$2,880.77
|
| Rate for Payer: Cigna Commercial |
$9,187.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,588.70
|
| Rate for Payer: Health EOS Commercial |
$8,888.14
|
| Rate for Payer: HFN Commercial |
$9,187.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,490.00
|
| Rate for Payer: Multiplan Commercial |
$7,989.34
|
| Rate for Payer: NAPHCARE Commercial |
$5,992.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9,187.74
|
| Rate for Payer: Quartz Beloit One Network |
$4,893.47
|
| Rate for Payer: Quartz Commercial |
$6,491.34
|
| Rate for Payer: Quartz Medicare Advantage |
$5,992.00
|
| Rate for Payer: The Alliance Commercial |
$4,993.34
|
| Rate for Payer: WEA Trust Commercial |
$5,492.67
|
| Rate for Payer: WPS Commercial |
$7,396.86
|
|
|
PLATE HUMERAL PROXIMAL LATERAL 3HL RT 627233
|
Facility
|
IP
|
$9,602.57
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6246234
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,893.47 |
| Max. Negotiated Rate |
$9,187.74 |
| Rate for Payer: Aetna Commercial |
$8,988.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,588.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,292.94
|
| Rate for Payer: Cash Price |
$2,880.77
|
| Rate for Payer: Cigna Commercial |
$9,187.74
|
| Rate for Payer: Health EOS Commercial |
$8,888.14
|
| Rate for Payer: HFN Commercial |
$9,187.74
|
| Rate for Payer: Multiplan Commercial |
$7,989.34
|
| Rate for Payer: Preferred Network Access Commercial |
$9,187.74
|
| Rate for Payer: Quartz Beloit One Network |
$4,893.47
|
| Rate for Payer: Quartz Commercial |
$5,992.00
|
| Rate for Payer: WEA Trust Commercial |
$5,492.67
|
| Rate for Payer: WPS Commercial |
$7,396.86
|
|
|
PLATE HUMERAL PROXIMAL LATERAL 4HL RT 627234
|
Facility
|
OP
|
$12,582.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5458962
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,663.88 |
| Max. Negotiated Rate |
$12,038.46 |
| Rate for Payer: Aetna Commercial |
$11,776.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,253.34
|
| Rate for Payer: Aetna Managed Medicare |
$3,663.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,505.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,542.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,280.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,935.20
|
| Rate for Payer: Cash Price |
$3,774.60
|
| Rate for Payer: Cigna Commercial |
$12,038.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,322.72
|
| Rate for Payer: Health EOS Commercial |
$11,645.90
|
| Rate for Payer: HFN Commercial |
$12,038.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,813.96
|
| Rate for Payer: Multiplan Commercial |
$10,468.22
|
| Rate for Payer: NAPHCARE Commercial |
$7,851.17
|
| Rate for Payer: Preferred Network Access Commercial |
$12,038.46
|
| Rate for Payer: Quartz Beloit One Network |
$6,411.79
|
| Rate for Payer: Quartz Commercial |
$8,505.43
|
| Rate for Payer: Quartz Medicare Advantage |
$7,851.17
|
| Rate for Payer: The Alliance Commercial |
$6,542.64
|
| Rate for Payer: WEA Trust Commercial |
$7,196.90
|
| Rate for Payer: WPS Commercial |
$9,691.91
|
|
|
PLATE HUMERAL PROXIMAL LATERAL 4HL RT 627234
|
Facility
|
IP
|
$12,582.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5458962
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,411.79 |
| Max. Negotiated Rate |
$12,038.46 |
| Rate for Payer: Aetna Commercial |
$11,776.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,253.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,935.20
|
| Rate for Payer: Cash Price |
$3,774.60
|
| Rate for Payer: Cigna Commercial |
$12,038.46
|
| Rate for Payer: Health EOS Commercial |
$11,645.90
|
| Rate for Payer: HFN Commercial |
$12,038.46
|
| Rate for Payer: Multiplan Commercial |
$10,468.22
|
| Rate for Payer: Preferred Network Access Commercial |
$12,038.46
|
| Rate for Payer: Quartz Beloit One Network |
$6,411.79
|
| Rate for Payer: Quartz Commercial |
$7,851.17
|
| Rate for Payer: WEA Trust Commercial |
$7,196.90
|
| Rate for Payer: WPS Commercial |
$9,691.91
|
|
