|
PLATE HUMERAL PROXIMAL LATERAL 5HL RT 627235
|
Facility
|
OP
|
$12,582.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5458925
|
|
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 5HL RT 627235
|
Facility
|
IP
|
$12,582.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5458925
|
|
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
|
|
|
PLATE HUMERAL PROXIMAL LATERAL 6HL LT 627206
|
Facility
|
IP
|
$12,582.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599550
|
|
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
|
|
|
PLATE HUMERAL PROXIMAL LATERAL 6HL LT 627206
|
Facility
|
OP
|
$12,582.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599550
|
|
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 6HL RT 627236
|
Facility
|
IP
|
$12,582.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5520853
|
|
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
|
|
|
PLATE HUMERAL PROXIMAL LATERAL 6HL RT 627236
|
Facility
|
OP
|
$12,582.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5520853
|
|
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 HUMERUS DISTAL LATERAL 2HL LT MEDIUM 02.117.902S
|
Facility
|
OP
|
$5,592.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5803647
|
|
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 HUMERUS DISTAL LATERAL 2HL LT MEDIUM 02.117.902S
|
Facility
|
IP
|
$5,592.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5803647
|
|
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 HUMERUS DISTAL MEDIAL 1HL LT SHORT 02.117.501
|
Facility
|
OP
|
$5,592.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5611734
|
|
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 HUMERUS DISTAL MEDIAL 1HL LT SHORT 02.117.501
|
Facility
|
IP
|
$5,592.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5611734
|
|
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 HUMERUS DISTAL MEDIAL 4HL LT LONG 02.117.504S
|
Facility
|
OP
|
$5,592.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5803646
|
|
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 HUMERUS DISTAL MEDIAL 4HL LT LONG 02.117.504S
|
Facility
|
IP
|
$5,592.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5803646
|
|
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 HUMERUS DISTAL MEDIAL 4HL RT LONG 02.117.404
|
Facility
|
OP
|
$5,887.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4519190
|
|
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 HUMERUS DISTAL MEDIAL 4HL RT LONG 02.117.404
|
Facility
|
IP
|
$5,887.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4519190
|
|
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 HUMERUS DISTAL MEDIAL 4HL RT LONG 02.117.404S
|
Facility
|
IP
|
$5,887.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3265483
|
|
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 HUMERUS DISTAL MEDIAL 4HL RT LONG 02.117.404S
|
Facility
|
OP
|
$5,887.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3265483
|
|
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 HUMERUS PROXIMAL LATERAL 14HL RT 627244S
|
Facility
|
OP
|
$13,460.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5627649
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,919.55 |
| Max. Negotiated Rate |
$12,878.53 |
| Rate for Payer: Aetna Commercial |
$12,598.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,038.62
|
| Rate for Payer: Aetna Managed Medicare |
$3,919.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,098.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,999.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,719.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,419.15
|
| Rate for Payer: Cash Price |
$4,038.00
|
| Rate for Payer: Cigna Commercial |
$12,878.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,833.72
|
| Rate for Payer: Health EOS Commercial |
$12,458.58
|
| Rate for Payer: HFN Commercial |
$12,878.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,498.80
|
| Rate for Payer: Multiplan Commercial |
$11,198.72
|
| Rate for Payer: NAPHCARE Commercial |
$8,399.04
|
| Rate for Payer: Preferred Network Access Commercial |
$12,878.53
|
| Rate for Payer: Quartz Beloit One Network |
$6,859.22
|
| Rate for Payer: Quartz Commercial |
$9,098.96
|
| Rate for Payer: Quartz Medicare Advantage |
$8,399.04
|
| Rate for Payer: The Alliance Commercial |
$6,999.20
|
| Rate for Payer: WEA Trust Commercial |
$7,699.12
|
| Rate for Payer: WPS Commercial |
$10,368.24
|
|
|
PLATE HUMERUS PROXIMAL LATERAL 14HL RT 627244S
|
Facility
|
IP
|
$13,460.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5627649
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,859.22 |
| Max. Negotiated Rate |
$12,878.53 |
| Rate for Payer: Aetna Commercial |
$12,598.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,038.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,419.15
|
| Rate for Payer: Cash Price |
$4,038.00
|
| Rate for Payer: Cigna Commercial |
$12,878.53
|
| Rate for Payer: Health EOS Commercial |
$12,458.58
|
| Rate for Payer: HFN Commercial |
$12,878.53
|
| Rate for Payer: Multiplan Commercial |
$11,198.72
|
| Rate for Payer: Preferred Network Access Commercial |
$12,878.53
|
| Rate for Payer: Quartz Beloit One Network |
$6,859.22
|
| Rate for Payer: Quartz Commercial |
$8,399.04
|
| Rate for Payer: WEA Trust Commercial |
$7,699.12
|
| Rate for Payer: WPS Commercial |
$10,368.24
|
|
|
PLATE JL 8HL BIOMET 73-2645
|
Facility
|
IP
|
$5,255.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5447130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,677.95 |
| Max. Negotiated Rate |
$5,027.98 |
| Rate for Payer: Aetna Commercial |
$4,918.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,700.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,896.56
|
| Rate for Payer: Cash Price |
$1,576.50
|
| Rate for Payer: Cigna Commercial |
$5,027.98
|
| Rate for Payer: Health EOS Commercial |
$4,864.03
|
| Rate for Payer: HFN Commercial |
$5,027.98
|
| Rate for Payer: Multiplan Commercial |
$4,372.16
|
| Rate for Payer: Preferred Network Access Commercial |
$5,027.98
|
| Rate for Payer: Quartz Beloit One Network |
$2,677.95
|
| Rate for Payer: Quartz Commercial |
$3,279.12
|
| Rate for Payer: WEA Trust Commercial |
$3,005.86
|
| Rate for Payer: WPS Commercial |
$4,047.93
|
|
|
PLATE JL 8HL BIOMET 73-2645
|
Facility
|
OP
|
$5,255.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5447130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,530.26 |
| Max. Negotiated Rate |
$5,027.98 |
| Rate for Payer: Aetna Commercial |
$4,918.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,700.07
|
| Rate for Payer: Aetna Managed Medicare |
$1,530.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,552.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,732.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,623.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,896.56
|
| Rate for Payer: Cash Price |
$1,576.50
|
| Rate for Payer: Cigna Commercial |
$5,027.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,058.41
|
| Rate for Payer: Health EOS Commercial |
$4,864.03
|
| Rate for Payer: HFN Commercial |
$5,027.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,098.90
|
| Rate for Payer: Multiplan Commercial |
$4,372.16
|
| Rate for Payer: NAPHCARE Commercial |
$3,279.12
|
| Rate for Payer: Preferred Network Access Commercial |
$5,027.98
|
| Rate for Payer: Quartz Beloit One Network |
$2,677.95
|
| Rate for Payer: Quartz Commercial |
$3,552.38
|
| Rate for Payer: Quartz Medicare Advantage |
$3,279.12
|
| Rate for Payer: The Alliance Commercial |
$2,732.60
|
| Rate for Payer: WEA Trust Commercial |
$3,005.86
|
| Rate for Payer: WPS Commercial |
$4,047.93
|
|
|
PLATE L 4HL BIOMET 73-2643
|
Facility
|
OP
|
$4,320.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4206004
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,257.98 |
| Max. Negotiated Rate |
$4,133.38 |
| Rate for Payer: Aetna Commercial |
$4,043.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,863.81
|
| Rate for Payer: Aetna Managed Medicare |
$1,257.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,920.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,246.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,156.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,381.18
|
| Rate for Payer: Cash Price |
$1,296.00
|
| Rate for Payer: Cigna Commercial |
$4,133.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,514.24
|
| Rate for Payer: Health EOS Commercial |
$3,998.59
|
| Rate for Payer: HFN Commercial |
$4,133.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,369.60
|
| Rate for Payer: Multiplan Commercial |
$3,594.24
|
| Rate for Payer: NAPHCARE Commercial |
$2,695.68
|
| Rate for Payer: Preferred Network Access Commercial |
$4,133.38
|
| Rate for Payer: Quartz Beloit One Network |
$2,201.47
|
| Rate for Payer: Quartz Commercial |
$2,920.32
|
| Rate for Payer: Quartz Medicare Advantage |
$2,695.68
|
| Rate for Payer: The Alliance Commercial |
$2,246.40
|
| Rate for Payer: WEA Trust Commercial |
$2,471.04
|
| Rate for Payer: WPS Commercial |
$3,327.70
|
|
|
PLATE L 4HL BIOMET 73-2643
|
Facility
|
IP
|
$4,320.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4206004
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,201.47 |
| Max. Negotiated Rate |
$4,133.38 |
| Rate for Payer: Aetna Commercial |
$4,043.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,863.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,381.18
|
| Rate for Payer: Cash Price |
$1,296.00
|
| Rate for Payer: Cigna Commercial |
$4,133.38
|
| Rate for Payer: Health EOS Commercial |
$3,998.59
|
| Rate for Payer: HFN Commercial |
$4,133.38
|
| Rate for Payer: Multiplan Commercial |
$3,594.24
|
| Rate for Payer: Preferred Network Access Commercial |
$4,133.38
|
| Rate for Payer: Quartz Beloit One Network |
$2,201.47
|
| Rate for Payer: Quartz Commercial |
$2,695.68
|
| Rate for Payer: WEA Trust Commercial |
$2,471.04
|
| Rate for Payer: WPS Commercial |
$3,327.70
|
|
|
PLATE LADDER 12HL BIOMET 73-2632
|
Facility
|
IP
|
$4,584.00
|
|
| Hospital Charge Code |
5349381
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,336.01 |
| Max. Negotiated Rate |
$4,385.97 |
| Rate for Payer: Aetna Commercial |
$4,290.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,099.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,526.70
|
| Rate for Payer: Cash Price |
$1,375.20
|
| Rate for Payer: Cigna Commercial |
$4,385.97
|
| Rate for Payer: Health EOS Commercial |
$4,242.95
|
| Rate for Payer: HFN Commercial |
$4,385.97
|
| Rate for Payer: Multiplan Commercial |
$3,813.89
|
| Rate for Payer: Preferred Network Access Commercial |
$4,385.97
|
| Rate for Payer: Quartz Beloit One Network |
$2,336.01
|
| Rate for Payer: Quartz Commercial |
$2,860.42
|
| Rate for Payer: WEA Trust Commercial |
$2,622.05
|
| Rate for Payer: WPS Commercial |
$3,531.06
|
|
|
PLATE LADDER 12HL BIOMET 73-2632
|
Facility
|
OP
|
$4,584.00
|
|
| Hospital Charge Code |
5349381
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,334.86 |
| Max. Negotiated Rate |
$4,385.97 |
| Rate for Payer: Aetna Commercial |
$4,290.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,099.93
|
| Rate for Payer: Aetna Managed Medicare |
$1,334.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,098.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,383.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,288.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,526.70
|
| Rate for Payer: Cash Price |
$1,375.20
|
| Rate for Payer: Cigna Commercial |
$4,385.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,667.89
|
| Rate for Payer: Health EOS Commercial |
$4,242.95
|
| Rate for Payer: HFN Commercial |
$4,385.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,575.52
|
| Rate for Payer: Multiplan Commercial |
$3,813.89
|
| Rate for Payer: NAPHCARE Commercial |
$2,860.42
|
| Rate for Payer: Preferred Network Access Commercial |
$4,385.97
|
| Rate for Payer: Quartz Beloit One Network |
$2,336.01
|
| Rate for Payer: Quartz Commercial |
$3,098.78
|
| Rate for Payer: Quartz Medicare Advantage |
$2,860.42
|
| Rate for Payer: The Alliance Commercial |
$2,383.68
|
| Rate for Payer: WEA Trust Commercial |
$2,622.05
|
| Rate for Payer: WPS Commercial |
$3,531.06
|
|
|
PLATE LAPIDUS CP 2MM STEP RT (T10) 5HL 626902
|
Facility
|
IP
|
$14,057.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5547406
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,163.45 |
| Max. Negotiated Rate |
$13,449.74 |
| Rate for Payer: Aetna Commercial |
$13,157.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,572.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,748.22
|
| Rate for Payer: Cash Price |
$4,217.10
|
| Rate for Payer: Cigna Commercial |
$13,449.74
|
| Rate for Payer: Health EOS Commercial |
$13,011.16
|
| Rate for Payer: HFN Commercial |
$13,449.74
|
| Rate for Payer: Multiplan Commercial |
$11,695.42
|
| Rate for Payer: Preferred Network Access Commercial |
$13,449.74
|
| Rate for Payer: Quartz Beloit One Network |
$7,163.45
|
| Rate for Payer: Quartz Commercial |
$8,771.57
|
| Rate for Payer: WEA Trust Commercial |
$8,040.60
|
| Rate for Payer: WPS Commercial |
$10,828.11
|
|
