|
PLATE BROAD LCP 7HL 226.571
|
Facility
|
IP
|
$9,066.00
|
|
| Hospital Charge Code |
2966755
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,442.34 |
| Max. Negotiated Rate |
$8,340.72 |
| Rate for Payer: Aetna Commercial |
$8,159.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,796.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,804.98
|
| Rate for Payer: Cash Price |
$2,719.80
|
| Rate for Payer: Cigna Commercial |
$8,340.72
|
| Rate for Payer: Health EOS Commercial |
$8,068.74
|
| Rate for Payer: HFN Commercial |
$8,340.72
|
| Rate for Payer: Multiplan Commercial |
$7,252.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,439.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,340.72
|
| Rate for Payer: Quartz Beloit One Network |
$4,442.34
|
| Rate for Payer: Quartz Commercial |
$5,439.60
|
| Rate for Payer: WEA Trust Commercial |
$4,986.30
|
| Rate for Payer: WPS Commercial |
$6,715.19
|
|
|
PLATE BROAD LCP 7HL 226.571
|
Facility
|
OP
|
$9,066.00
|
|
| Hospital Charge Code |
2966755
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,538.48 |
| Max. Negotiated Rate |
$36,264.00 |
| Rate for Payer: Aetna Commercial |
$8,159.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,796.76
|
| Rate for Payer: Aetna Managed Medicare |
$2,538.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,892.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,533.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,351.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,804.98
|
| Rate for Payer: Cash Price |
$2,719.80
|
| Rate for Payer: Cigna Commercial |
$8,340.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,073.33
|
| Rate for Payer: Health EOS Commercial |
$8,068.74
|
| Rate for Payer: HFN Commercial |
$8,340.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,799.50
|
| Rate for Payer: Multiplan Commercial |
$7,252.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,439.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,340.72
|
| Rate for Payer: Quartz Beloit One Network |
$4,442.34
|
| Rate for Payer: Quartz Commercial |
$5,892.90
|
| Rate for Payer: Quartz Medicare Advantage |
$5,439.60
|
| Rate for Payer: The Alliance Commercial |
$36,264.00
|
| Rate for Payer: WEA Trust Commercial |
$4,986.30
|
| Rate for Payer: WPS Commercial |
$6,715.19
|
|
|
PLATE BROAD LCP 8HL 226.581
|
Facility
|
OP
|
$9,066.00
|
|
| Hospital Charge Code |
2966756
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,538.48 |
| Max. Negotiated Rate |
$36,264.00 |
| Rate for Payer: Aetna Commercial |
$8,159.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,796.76
|
| Rate for Payer: Aetna Managed Medicare |
$2,538.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,892.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,533.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,351.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,804.98
|
| Rate for Payer: Cash Price |
$2,719.80
|
| Rate for Payer: Cigna Commercial |
$8,340.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,073.33
|
| Rate for Payer: Health EOS Commercial |
$8,068.74
|
| Rate for Payer: HFN Commercial |
$8,340.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,799.50
|
| Rate for Payer: Multiplan Commercial |
$7,252.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,439.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,340.72
|
| Rate for Payer: Quartz Beloit One Network |
$4,442.34
|
| Rate for Payer: Quartz Commercial |
$5,892.90
|
| Rate for Payer: Quartz Medicare Advantage |
$5,439.60
|
| Rate for Payer: The Alliance Commercial |
$36,264.00
|
| Rate for Payer: WEA Trust Commercial |
$4,986.30
|
| Rate for Payer: WPS Commercial |
$6,715.19
|
|
|
PLATE BROAD LCP 8HL 226.581
|
Facility
|
IP
|
$9,066.00
|
|
| Hospital Charge Code |
2966756
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,442.34 |
| Max. Negotiated Rate |
$8,340.72 |
| Rate for Payer: Aetna Commercial |
$8,159.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,796.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,804.98
|
| Rate for Payer: Cash Price |
$2,719.80
|
| Rate for Payer: Cigna Commercial |
$8,340.72
|
| Rate for Payer: Health EOS Commercial |
$8,068.74
|
| Rate for Payer: HFN Commercial |
$8,340.72
|
| Rate for Payer: Multiplan Commercial |
$7,252.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,439.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,340.72
|
| Rate for Payer: Quartz Beloit One Network |
$4,442.34
|
| Rate for Payer: Quartz Commercial |
$5,439.60
|
| Rate for Payer: WEA Trust Commercial |
$4,986.30
|
| Rate for Payer: WPS Commercial |
$6,715.19
|
|
|
PLATE BROAD LCP 9HL 226.591
|
Facility
|
OP
|
$9,066.00
|
|
| Hospital Charge Code |
2966757
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,538.48 |
| Max. Negotiated Rate |
$36,264.00 |
| Rate for Payer: Aetna Commercial |
$8,159.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,796.76
|
| Rate for Payer: Aetna Managed Medicare |
$2,538.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,892.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,533.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,351.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,804.98
|
| Rate for Payer: Cash Price |
$2,719.80
|
| Rate for Payer: Cigna Commercial |
$8,340.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,073.33
|
| Rate for Payer: Health EOS Commercial |
$8,068.74
|
| Rate for Payer: HFN Commercial |
$8,340.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,799.50
|
| Rate for Payer: Multiplan Commercial |
$7,252.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,439.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,340.72
|
| Rate for Payer: Quartz Beloit One Network |
$4,442.34
|
| Rate for Payer: Quartz Commercial |
$5,892.90
|
| Rate for Payer: Quartz Medicare Advantage |
$5,439.60
|
| Rate for Payer: The Alliance Commercial |
$36,264.00
|
| Rate for Payer: WEA Trust Commercial |
$4,986.30
|
| Rate for Payer: WPS Commercial |
$6,715.19
|
|
|
PLATE BROAD LCP 9HL 226.591
|
Facility
|
IP
|
$9,066.00
|
|
| Hospital Charge Code |
2966757
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,442.34 |
| Max. Negotiated Rate |
$8,340.72 |
| Rate for Payer: Aetna Commercial |
$8,159.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,796.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,804.98
|
| Rate for Payer: Cash Price |
$2,719.80
|
| Rate for Payer: Cigna Commercial |
$8,340.72
|
| Rate for Payer: Health EOS Commercial |
$8,068.74
|
| Rate for Payer: HFN Commercial |
$8,340.72
|
| Rate for Payer: Multiplan Commercial |
$7,252.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,439.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,340.72
|
| Rate for Payer: Quartz Beloit One Network |
$4,442.34
|
| Rate for Payer: Quartz Commercial |
$5,439.60
|
| Rate for Payer: WEA Trust Commercial |
$4,986.30
|
| Rate for Payer: WPS Commercial |
$6,715.19
|
|
|
PLATE BROAD STRAIGHT 5 HL 626975
|
Facility
|
OP
|
$5,980.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6169642
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,674.40 |
| Max. Negotiated Rate |
$23,920.00 |
| Rate for Payer: Aetna Commercial |
$5,382.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,142.80
|
| Rate for Payer: Aetna Managed Medicare |
$1,674.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,887.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,990.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,870.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,169.40
|
| Rate for Payer: Cash Price |
$1,794.00
|
| Rate for Payer: Cigna Commercial |
$5,501.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,346.41
|
| Rate for Payer: Health EOS Commercial |
$5,322.20
|
| Rate for Payer: HFN Commercial |
$5,501.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,485.00
|
| Rate for Payer: Multiplan Commercial |
$4,784.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,588.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,501.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,930.20
|
| Rate for Payer: Quartz Commercial |
$3,887.00
|
| Rate for Payer: Quartz Medicare Advantage |
$3,588.00
|
| Rate for Payer: The Alliance Commercial |
$23,920.00
|
| Rate for Payer: WEA Trust Commercial |
$3,289.00
|
| Rate for Payer: WPS Commercial |
$4,429.39
|
|
|
PLATE BROAD STRAIGHT 5 HL 626975
|
Facility
|
IP
|
$5,980.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6169642
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,930.20 |
| Max. Negotiated Rate |
$5,501.60 |
| Rate for Payer: Aetna Commercial |
$5,382.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,142.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,169.40
|
| Rate for Payer: Cash Price |
$1,794.00
|
| Rate for Payer: Cigna Commercial |
$5,501.60
|
| Rate for Payer: Health EOS Commercial |
$5,322.20
|
| Rate for Payer: HFN Commercial |
$5,501.60
|
| Rate for Payer: Multiplan Commercial |
$4,784.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,588.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,501.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,930.20
|
| Rate for Payer: Quartz Commercial |
$3,588.00
|
| Rate for Payer: WEA Trust Commercial |
$3,289.00
|
| Rate for Payer: WPS Commercial |
$4,429.39
|
|
|
PLATE BROAD STRAIGHT 7 HL 626977
|
Facility
|
OP
|
$5,980.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6177676
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,674.40 |
| Max. Negotiated Rate |
$23,920.00 |
| Rate for Payer: Aetna Commercial |
$5,382.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,142.80
|
| Rate for Payer: Aetna Managed Medicare |
$1,674.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,887.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,990.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,870.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,169.40
|
| Rate for Payer: Cash Price |
$1,794.00
|
| Rate for Payer: Cigna Commercial |
$5,501.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,346.41
|
| Rate for Payer: Health EOS Commercial |
$5,322.20
|
| Rate for Payer: HFN Commercial |
$5,501.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,485.00
|
| Rate for Payer: Multiplan Commercial |
$4,784.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,588.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,501.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,930.20
|
| Rate for Payer: Quartz Commercial |
$3,887.00
|
| Rate for Payer: Quartz Medicare Advantage |
$3,588.00
|
| Rate for Payer: The Alliance Commercial |
$23,920.00
|
| Rate for Payer: WEA Trust Commercial |
$3,289.00
|
| Rate for Payer: WPS Commercial |
$4,429.39
|
|
|
PLATE BROAD STRAIGHT 7 HL 626977
|
Facility
|
IP
|
$5,980.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6177676
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,930.20 |
| Max. Negotiated Rate |
$5,501.60 |
| Rate for Payer: Aetna Commercial |
$5,382.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,142.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,169.40
|
| Rate for Payer: Cash Price |
$1,794.00
|
| Rate for Payer: Cigna Commercial |
$5,501.60
|
| Rate for Payer: Health EOS Commercial |
$5,322.20
|
| Rate for Payer: HFN Commercial |
$5,501.60
|
| Rate for Payer: Multiplan Commercial |
$4,784.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,588.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,501.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,930.20
|
| Rate for Payer: Quartz Commercial |
$3,588.00
|
| Rate for Payer: WEA Trust Commercial |
$3,289.00
|
| Rate for Payer: WPS Commercial |
$4,429.39
|
|
|
PLATE BROAD Y 3 SHAFT HOLE 626993
|
Facility
|
OP
|
$6,213.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6181249
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,739.64 |
| Max. Negotiated Rate |
$24,852.00 |
| Rate for Payer: Aetna Commercial |
$5,591.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,343.18
|
| Rate for Payer: Aetna Managed Medicare |
$1,739.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,038.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,106.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,982.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,292.89
|
| Rate for Payer: Cash Price |
$1,863.90
|
| Rate for Payer: Cigna Commercial |
$5,715.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,476.79
|
| Rate for Payer: Health EOS Commercial |
$5,529.57
|
| Rate for Payer: HFN Commercial |
$5,715.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,659.75
|
| Rate for Payer: Multiplan Commercial |
$4,970.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,727.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,715.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,044.37
|
| Rate for Payer: Quartz Commercial |
$4,038.45
|
| Rate for Payer: Quartz Medicare Advantage |
$3,727.80
|
| Rate for Payer: The Alliance Commercial |
$24,852.00
|
| Rate for Payer: WEA Trust Commercial |
$3,417.15
|
| Rate for Payer: WPS Commercial |
$4,601.97
|
|
|
PLATE BROAD Y 3 SHAFT HOLE 626993
|
Facility
|
IP
|
$6,213.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6181249
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,044.37 |
| Max. Negotiated Rate |
$5,715.96 |
| Rate for Payer: Aetna Commercial |
$5,591.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,343.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,292.89
|
| Rate for Payer: Cash Price |
$1,863.90
|
| Rate for Payer: Cigna Commercial |
$5,715.96
|
| Rate for Payer: Health EOS Commercial |
$5,529.57
|
| Rate for Payer: HFN Commercial |
$5,715.96
|
| Rate for Payer: Multiplan Commercial |
$4,970.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,727.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,715.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,044.37
|
| Rate for Payer: Quartz Commercial |
$3,727.80
|
| Rate for Payer: WEA Trust Commercial |
$3,417.15
|
| Rate for Payer: WPS Commercial |
$4,601.97
|
|
|
PLATE CALCANEAL 2.7 SMALL 58MM LT 02.211.401
|
Facility
|
IP
|
$5,393.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5264697
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,642.57 |
| Max. Negotiated Rate |
$4,961.56 |
| Rate for Payer: Aetna Commercial |
$4,853.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,637.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,858.29
|
| Rate for Payer: Cash Price |
$1,617.90
|
| Rate for Payer: Cigna Commercial |
$4,961.56
|
| Rate for Payer: Health EOS Commercial |
$4,799.77
|
| Rate for Payer: HFN Commercial |
$4,961.56
|
| Rate for Payer: Multiplan Commercial |
$4,314.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,235.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,961.56
|
| Rate for Payer: Quartz Beloit One Network |
$2,642.57
|
| Rate for Payer: Quartz Commercial |
$3,235.80
|
| Rate for Payer: WEA Trust Commercial |
$2,966.15
|
| Rate for Payer: WPS Commercial |
$3,994.60
|
|
|
PLATE CALCANEAL 2.7 SMALL 58MM LT 02.211.401
|
Facility
|
OP
|
$5,393.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5264697
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,510.04 |
| Max. Negotiated Rate |
$21,572.00 |
| Rate for Payer: Aetna Commercial |
$4,853.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,637.98
|
| Rate for Payer: Aetna Managed Medicare |
$1,510.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,505.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,696.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,588.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,858.29
|
| Rate for Payer: Cash Price |
$1,617.90
|
| Rate for Payer: Cigna Commercial |
$4,961.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,017.92
|
| Rate for Payer: Health EOS Commercial |
$4,799.77
|
| Rate for Payer: HFN Commercial |
$4,961.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,044.75
|
| Rate for Payer: Multiplan Commercial |
$4,314.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,235.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,961.56
|
| Rate for Payer: Quartz Beloit One Network |
$2,642.57
|
| Rate for Payer: Quartz Commercial |
$3,505.45
|
| Rate for Payer: Quartz Medicare Advantage |
$3,235.80
|
| Rate for Payer: The Alliance Commercial |
$21,572.00
|
| Rate for Payer: WEA Trust Commercial |
$2,966.15
|
| Rate for Payer: WPS Commercial |
$3,994.60
|
|
|
PLATE CALCANEAL 2.7 SMALL 58MM RT 02.211.400
|
Facility
|
OP
|
$5,393.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4452950
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,510.04 |
| Max. Negotiated Rate |
$21,572.00 |
| Rate for Payer: Aetna Commercial |
$4,853.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,637.98
|
| Rate for Payer: Aetna Managed Medicare |
$1,510.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,505.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,696.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,588.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,858.29
|
| Rate for Payer: Cash Price |
$1,617.90
|
| Rate for Payer: Cigna Commercial |
$4,961.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,017.92
|
| Rate for Payer: Health EOS Commercial |
$4,799.77
|
| Rate for Payer: HFN Commercial |
$4,961.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,044.75
|
| Rate for Payer: Multiplan Commercial |
$4,314.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,235.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,961.56
|
| Rate for Payer: Quartz Beloit One Network |
$2,642.57
|
| Rate for Payer: Quartz Commercial |
$3,505.45
|
| Rate for Payer: Quartz Medicare Advantage |
$3,235.80
|
| Rate for Payer: The Alliance Commercial |
$21,572.00
|
| Rate for Payer: WEA Trust Commercial |
$2,966.15
|
| Rate for Payer: WPS Commercial |
$3,994.60
|
|
|
PLATE CALCANEAL 2.7 SMALL 58MM RT 02.211.400
|
Facility
|
IP
|
$5,393.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4452950
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,642.57 |
| Max. Negotiated Rate |
$4,961.56 |
| Rate for Payer: Aetna Commercial |
$4,853.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,637.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,858.29
|
| Rate for Payer: Cash Price |
$1,617.90
|
| Rate for Payer: Cigna Commercial |
$4,961.56
|
| Rate for Payer: Health EOS Commercial |
$4,799.77
|
| Rate for Payer: HFN Commercial |
$4,961.56
|
| Rate for Payer: Multiplan Commercial |
$4,314.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,235.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,961.56
|
| Rate for Payer: Quartz Beloit One Network |
$2,642.57
|
| Rate for Payer: Quartz Commercial |
$3,235.80
|
| Rate for Payer: WEA Trust Commercial |
$2,966.15
|
| Rate for Payer: WPS Commercial |
$3,994.60
|
|
|
PLATE CALCANEAL STD RT CLX-002-SR
|
Facility
|
OP
|
$13,706.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5729846
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,837.68 |
| Max. Negotiated Rate |
$54,824.00 |
| Rate for Payer: Aetna Commercial |
$12,335.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,787.16
|
| Rate for Payer: Aetna Managed Medicare |
$3,837.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,908.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,853.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,578.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,264.18
|
| Rate for Payer: Cash Price |
$4,111.80
|
| Rate for Payer: Cigna Commercial |
$12,609.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,669.88
|
| Rate for Payer: Health EOS Commercial |
$12,198.34
|
| Rate for Payer: HFN Commercial |
$12,609.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,279.50
|
| Rate for Payer: Multiplan Commercial |
$10,964.80
|
| Rate for Payer: NAPHCARE Commercial |
$8,223.60
|
| Rate for Payer: Preferred Network Access Commercial |
$12,609.52
|
| Rate for Payer: Quartz Beloit One Network |
$6,715.94
|
| Rate for Payer: Quartz Commercial |
$8,908.90
|
| Rate for Payer: Quartz Medicare Advantage |
$8,223.60
|
| Rate for Payer: The Alliance Commercial |
$54,824.00
|
| Rate for Payer: WEA Trust Commercial |
$7,538.30
|
| Rate for Payer: WPS Commercial |
$10,152.03
|
|
|
PLATE CALCANEAL STD RT CLX-002-SR
|
Facility
|
IP
|
$13,706.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5729846
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,715.94 |
| Max. Negotiated Rate |
$12,609.52 |
| Rate for Payer: Aetna Commercial |
$12,335.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,787.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,264.18
|
| Rate for Payer: Cash Price |
$4,111.80
|
| Rate for Payer: Cigna Commercial |
$12,609.52
|
| Rate for Payer: Health EOS Commercial |
$12,198.34
|
| Rate for Payer: HFN Commercial |
$12,609.52
|
| Rate for Payer: Multiplan Commercial |
$10,964.80
|
| Rate for Payer: NAPHCARE Commercial |
$8,223.60
|
| Rate for Payer: Preferred Network Access Commercial |
$12,609.52
|
| Rate for Payer: Quartz Beloit One Network |
$6,715.94
|
| Rate for Payer: Quartz Commercial |
$8,223.60
|
| Rate for Payer: WEA Trust Commercial |
$7,538.30
|
| Rate for Payer: WPS Commercial |
$10,152.03
|
|
|
PLATE CLAVICLE 3.5 3HL LT 02.112.007S
|
Facility
|
OP
|
$7,903.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966332
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,212.84 |
| Max. Negotiated Rate |
$31,612.00 |
| Rate for Payer: Aetna Commercial |
$7,112.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,796.58
|
| Rate for Payer: Aetna Managed Medicare |
$2,212.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,136.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,951.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,793.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,188.59
|
| Rate for Payer: Cash Price |
$2,370.90
|
| Rate for Payer: Cigna Commercial |
$7,270.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,422.52
|
| Rate for Payer: Health EOS Commercial |
$7,033.67
|
| Rate for Payer: HFN Commercial |
$7,270.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,927.25
|
| Rate for Payer: Multiplan Commercial |
$6,322.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,741.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,270.76
|
| Rate for Payer: Quartz Beloit One Network |
$3,872.47
|
| Rate for Payer: Quartz Commercial |
$5,136.95
|
| Rate for Payer: Quartz Medicare Advantage |
$4,741.80
|
| Rate for Payer: The Alliance Commercial |
$31,612.00
|
| Rate for Payer: WEA Trust Commercial |
$4,346.65
|
| Rate for Payer: WPS Commercial |
$5,853.75
|
|
|
PLATE CLAVICLE 3.5 3HL LT 02.112.007S
|
Facility
|
IP
|
$7,903.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966332
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,872.47 |
| Max. Negotiated Rate |
$7,270.76 |
| Rate for Payer: Aetna Commercial |
$7,112.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,796.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,188.59
|
| Rate for Payer: Cash Price |
$2,370.90
|
| Rate for Payer: Cigna Commercial |
$7,270.76
|
| Rate for Payer: Health EOS Commercial |
$7,033.67
|
| Rate for Payer: HFN Commercial |
$7,270.76
|
| Rate for Payer: Multiplan Commercial |
$6,322.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,741.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,270.76
|
| Rate for Payer: Quartz Beloit One Network |
$3,872.47
|
| Rate for Payer: Quartz Commercial |
$4,741.80
|
| Rate for Payer: WEA Trust Commercial |
$4,346.65
|
| Rate for Payer: WPS Commercial |
$5,853.75
|
|
|
PLATE CLAVICLE 3.5 LCP SUPERIOR 6HL LEFT 02.112.081S
|
Facility
|
OP
|
$6,371.00
|
|
| Hospital Charge Code |
2966340
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,783.88 |
| Max. Negotiated Rate |
$25,484.00 |
| Rate for Payer: Aetna Commercial |
$5,733.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,479.06
|
| Rate for Payer: Aetna Managed Medicare |
$1,783.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,141.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,185.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,058.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,376.63
|
| Rate for Payer: Cash Price |
$1,911.30
|
| Rate for Payer: Cigna Commercial |
$5,861.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,565.21
|
| Rate for Payer: Health EOS Commercial |
$5,670.19
|
| Rate for Payer: HFN Commercial |
$5,861.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,778.25
|
| Rate for Payer: Multiplan Commercial |
$5,096.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,822.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,861.32
|
| Rate for Payer: Quartz Beloit One Network |
$3,121.79
|
| Rate for Payer: Quartz Commercial |
$4,141.15
|
| Rate for Payer: Quartz Medicare Advantage |
$3,822.60
|
| Rate for Payer: The Alliance Commercial |
$25,484.00
|
| Rate for Payer: WEA Trust Commercial |
$3,504.05
|
| Rate for Payer: WPS Commercial |
$4,719.00
|
|
|
PLATE CLAVICLE 3.5 LCP SUPERIOR 6HL LEFT 02.112.081S
|
Facility
|
IP
|
$6,371.00
|
|
| Hospital Charge Code |
2966340
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,121.79 |
| Max. Negotiated Rate |
$5,861.32 |
| Rate for Payer: Aetna Commercial |
$5,733.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,479.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,376.63
|
| Rate for Payer: Cash Price |
$1,911.30
|
| Rate for Payer: Cigna Commercial |
$5,861.32
|
| Rate for Payer: Health EOS Commercial |
$5,670.19
|
| Rate for Payer: HFN Commercial |
$5,861.32
|
| Rate for Payer: Multiplan Commercial |
$5,096.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,822.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,861.32
|
| Rate for Payer: Quartz Beloit One Network |
$3,121.79
|
| Rate for Payer: Quartz Commercial |
$3,822.60
|
| Rate for Payer: WEA Trust Commercial |
$3,504.05
|
| Rate for Payer: WPS Commercial |
$4,719.00
|
|
|
PLATE CLAVICLE 3.5 LCP SUPERIOR ANTERIOR 02.112.029
|
Facility
|
OP
|
$6,686.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3937362
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,872.08 |
| Max. Negotiated Rate |
$26,744.00 |
| Rate for Payer: Aetna Commercial |
$6,017.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,749.96
|
| Rate for Payer: Aetna Managed Medicare |
$1,872.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,345.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,343.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,209.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,543.58
|
| Rate for Payer: Cash Price |
$2,005.80
|
| Rate for Payer: Cigna Commercial |
$6,151.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,741.49
|
| Rate for Payer: Health EOS Commercial |
$5,950.54
|
| Rate for Payer: HFN Commercial |
$6,151.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,014.50
|
| Rate for Payer: Multiplan Commercial |
$5,348.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,011.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,151.12
|
| Rate for Payer: Quartz Beloit One Network |
$3,276.14
|
| Rate for Payer: Quartz Commercial |
$4,345.90
|
| Rate for Payer: Quartz Medicare Advantage |
$4,011.60
|
| Rate for Payer: The Alliance Commercial |
$26,744.00
|
| Rate for Payer: WEA Trust Commercial |
$3,677.30
|
| Rate for Payer: WPS Commercial |
$4,952.32
|
|
|
PLATE CLAVICLE 3.5 LCP SUPERIOR ANTERIOR 02.112.029
|
Facility
|
IP
|
$6,686.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3937362
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,276.14 |
| Max. Negotiated Rate |
$6,151.12 |
| Rate for Payer: Aetna Commercial |
$6,017.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,749.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,543.58
|
| Rate for Payer: Cash Price |
$2,005.80
|
| Rate for Payer: Cigna Commercial |
$6,151.12
|
| Rate for Payer: Health EOS Commercial |
$5,950.54
|
| Rate for Payer: HFN Commercial |
$6,151.12
|
| Rate for Payer: Multiplan Commercial |
$5,348.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,011.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,151.12
|
| Rate for Payer: Quartz Beloit One Network |
$3,276.14
|
| Rate for Payer: Quartz Commercial |
$4,011.60
|
| Rate for Payer: WEA Trust Commercial |
$3,677.30
|
| Rate for Payer: WPS Commercial |
$4,952.32
|
|
|
PLATE CLAVICLE 3.5MM 6HL RT 02.112.008
|
Facility
|
OP
|
$5,116.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414899
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,432.48 |
| Max. Negotiated Rate |
$20,464.00 |
| Rate for Payer: Aetna Commercial |
$4,604.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,399.76
|
| Rate for Payer: Aetna Managed Medicare |
$1,432.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,325.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,558.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,455.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,711.48
|
| Rate for Payer: Cash Price |
$1,534.80
|
| Rate for Payer: Cigna Commercial |
$4,706.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,862.91
|
| Rate for Payer: Health EOS Commercial |
$4,553.24
|
| Rate for Payer: HFN Commercial |
$4,706.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,837.00
|
| Rate for Payer: Multiplan Commercial |
$4,092.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,069.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,706.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,506.84
|
| Rate for Payer: Quartz Commercial |
$3,325.40
|
| Rate for Payer: Quartz Medicare Advantage |
$3,069.60
|
| Rate for Payer: The Alliance Commercial |
$20,464.00
|
| Rate for Payer: WEA Trust Commercial |
$2,813.80
|
| Rate for Payer: WPS Commercial |
$3,789.42
|
|
