|
PLATE NCM SHORT/RIGHT 9 HL 626772
|
Facility
|
OP
|
$6,720.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5861715
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,956.86 |
| Max. Negotiated Rate |
$6,429.70 |
| Rate for Payer: Aetna Commercial |
$6,289.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,010.37
|
| Rate for Payer: Aetna Managed Medicare |
$1,956.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,542.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,494.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,354.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,704.06
|
| Rate for Payer: Cash Price |
$2,016.00
|
| Rate for Payer: Cigna Commercial |
$6,429.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,911.04
|
| Rate for Payer: Health EOS Commercial |
$6,220.03
|
| Rate for Payer: HFN Commercial |
$6,429.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,241.60
|
| Rate for Payer: Multiplan Commercial |
$5,591.04
|
| Rate for Payer: NAPHCARE Commercial |
$4,193.28
|
| Rate for Payer: Preferred Network Access Commercial |
$6,429.70
|
| Rate for Payer: Quartz Beloit One Network |
$3,424.51
|
| Rate for Payer: Quartz Commercial |
$4,542.72
|
| Rate for Payer: Quartz Medicare Advantage |
$4,193.28
|
| Rate for Payer: The Alliance Commercial |
$3,494.40
|
| Rate for Payer: WEA Trust Commercial |
$3,843.84
|
| Rate for Payer: WPS Commercial |
$5,176.42
|
|
|
PLATE NCM SHORT/RIGHT 9 HL 626772
|
Facility
|
IP
|
$6,720.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5861715
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,424.51 |
| Max. Negotiated Rate |
$6,429.70 |
| Rate for Payer: Aetna Commercial |
$6,289.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,010.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,704.06
|
| Rate for Payer: Cash Price |
$2,016.00
|
| Rate for Payer: Cigna Commercial |
$6,429.70
|
| Rate for Payer: Health EOS Commercial |
$6,220.03
|
| Rate for Payer: HFN Commercial |
$6,429.70
|
| Rate for Payer: Multiplan Commercial |
$5,591.04
|
| Rate for Payer: Preferred Network Access Commercial |
$6,429.70
|
| Rate for Payer: Quartz Beloit One Network |
$3,424.51
|
| Rate for Payer: Quartz Commercial |
$4,193.28
|
| Rate for Payer: WEA Trust Commercial |
$3,843.84
|
| Rate for Payer: WPS Commercial |
$5,176.42
|
|
|
PLATE OBLIQ LT T 3H 3H 241.931
|
Facility
|
IP
|
$1,514.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966703
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$771.53 |
| Max. Negotiated Rate |
$1,448.60 |
| Rate for Payer: Aetna Commercial |
$1,417.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,354.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$834.52
|
| Rate for Payer: Cash Price |
$454.20
|
| Rate for Payer: Cigna Commercial |
$1,448.60
|
| Rate for Payer: Health EOS Commercial |
$1,401.36
|
| Rate for Payer: HFN Commercial |
$1,448.60
|
| Rate for Payer: Multiplan Commercial |
$1,259.65
|
| Rate for Payer: Preferred Network Access Commercial |
$1,448.60
|
| Rate for Payer: Quartz Beloit One Network |
$771.53
|
| Rate for Payer: Quartz Commercial |
$944.74
|
| Rate for Payer: WEA Trust Commercial |
$866.01
|
| Rate for Payer: WPS Commercial |
$1,166.23
|
|
|
PLATE OBLIQ LT T 3H 3H 241.931
|
Facility
|
OP
|
$1,514.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966703
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$440.88 |
| Max. Negotiated Rate |
$1,448.60 |
| Rate for Payer: Aetna Commercial |
$1,417.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,354.12
|
| Rate for Payer: Aetna Managed Medicare |
$440.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,023.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$787.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$755.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$834.52
|
| Rate for Payer: Cash Price |
$454.20
|
| Rate for Payer: Cigna Commercial |
$1,448.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$881.15
|
| Rate for Payer: Health EOS Commercial |
$1,401.36
|
| Rate for Payer: HFN Commercial |
$1,448.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,180.92
|
| Rate for Payer: Multiplan Commercial |
$1,259.65
|
| Rate for Payer: NAPHCARE Commercial |
$944.74
|
| Rate for Payer: Preferred Network Access Commercial |
$1,448.60
|
| Rate for Payer: Quartz Beloit One Network |
$771.53
|
| Rate for Payer: Quartz Commercial |
$1,023.46
|
| Rate for Payer: Quartz Medicare Advantage |
$944.74
|
| Rate for Payer: The Alliance Commercial |
$787.28
|
| Rate for Payer: WEA Trust Commercial |
$866.01
|
| Rate for Payer: WPS Commercial |
$1,166.23
|
|
|
PLATE OBLIQ LT T 3H 4H 241.941
|
Facility
|
IP
|
$1,591.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966705
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$810.77 |
| Max. Negotiated Rate |
$1,522.27 |
| Rate for Payer: Aetna Commercial |
$1,489.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,422.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$876.96
|
| Rate for Payer: Cash Price |
$477.30
|
| Rate for Payer: Cigna Commercial |
$1,522.27
|
| Rate for Payer: Health EOS Commercial |
$1,472.63
|
| Rate for Payer: HFN Commercial |
$1,522.27
|
| Rate for Payer: Multiplan Commercial |
$1,323.71
|
| Rate for Payer: Preferred Network Access Commercial |
$1,522.27
|
| Rate for Payer: Quartz Beloit One Network |
$810.77
|
| Rate for Payer: Quartz Commercial |
$992.78
|
| Rate for Payer: WEA Trust Commercial |
$910.05
|
| Rate for Payer: WPS Commercial |
$1,225.55
|
|
|
PLATE OBLIQ LT T 3H 4H 241.941
|
Facility
|
OP
|
$1,591.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966705
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$463.30 |
| Max. Negotiated Rate |
$1,522.27 |
| Rate for Payer: Aetna Commercial |
$1,489.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,422.99
|
| Rate for Payer: Aetna Managed Medicare |
$463.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,075.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$827.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$794.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$876.96
|
| Rate for Payer: Cash Price |
$477.30
|
| Rate for Payer: Cigna Commercial |
$1,522.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$925.96
|
| Rate for Payer: Health EOS Commercial |
$1,472.63
|
| Rate for Payer: HFN Commercial |
$1,522.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,240.98
|
| Rate for Payer: Multiplan Commercial |
$1,323.71
|
| Rate for Payer: NAPHCARE Commercial |
$992.78
|
| Rate for Payer: Preferred Network Access Commercial |
$1,522.27
|
| Rate for Payer: Quartz Beloit One Network |
$810.77
|
| Rate for Payer: Quartz Commercial |
$1,075.52
|
| Rate for Payer: Quartz Medicare Advantage |
$992.78
|
| Rate for Payer: The Alliance Commercial |
$827.32
|
| Rate for Payer: WEA Trust Commercial |
$910.05
|
| Rate for Payer: WPS Commercial |
$1,225.55
|
|
|
PLATE OBLIQ LT T 3H 5H 241.951
|
Facility
|
IP
|
$1,650.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966707
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$840.84 |
| Max. Negotiated Rate |
$1,578.72 |
| Rate for Payer: Aetna Commercial |
$1,544.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,475.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$909.48
|
| Rate for Payer: Cash Price |
$495.00
|
| Rate for Payer: Cigna Commercial |
$1,578.72
|
| Rate for Payer: Health EOS Commercial |
$1,527.24
|
| Rate for Payer: HFN Commercial |
$1,578.72
|
| Rate for Payer: Multiplan Commercial |
$1,372.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,578.72
|
| Rate for Payer: Quartz Beloit One Network |
$840.84
|
| Rate for Payer: Quartz Commercial |
$1,029.60
|
| Rate for Payer: WEA Trust Commercial |
$943.80
|
| Rate for Payer: WPS Commercial |
$1,270.99
|
|
|
PLATE OBLIQ LT T 3H 5H 241.951
|
Facility
|
OP
|
$1,650.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966707
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$480.48 |
| Max. Negotiated Rate |
$1,578.72 |
| Rate for Payer: Aetna Commercial |
$1,544.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,475.76
|
| Rate for Payer: Aetna Managed Medicare |
$480.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,115.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$858.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$823.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$909.48
|
| Rate for Payer: Cash Price |
$495.00
|
| Rate for Payer: Cigna Commercial |
$1,578.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$960.30
|
| Rate for Payer: Health EOS Commercial |
$1,527.24
|
| Rate for Payer: HFN Commercial |
$1,578.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,287.00
|
| Rate for Payer: Multiplan Commercial |
$1,372.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,029.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,578.72
|
| Rate for Payer: Quartz Beloit One Network |
$840.84
|
| Rate for Payer: Quartz Commercial |
$1,115.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,029.60
|
| Rate for Payer: The Alliance Commercial |
$858.00
|
| Rate for Payer: WEA Trust Commercial |
$943.80
|
| Rate for Payer: WPS Commercial |
$1,270.99
|
|
|
PLATE OBLIQ LT T 3H 7H 241.971
|
Facility
|
OP
|
$1,797.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966710
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$523.29 |
| Max. Negotiated Rate |
$1,719.37 |
| Rate for Payer: Aetna Commercial |
$1,681.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,607.24
|
| Rate for Payer: Aetna Managed Medicare |
$523.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,214.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$934.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$897.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$990.51
|
| Rate for Payer: Cash Price |
$539.10
|
| Rate for Payer: Cigna Commercial |
$1,719.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,045.85
|
| Rate for Payer: Health EOS Commercial |
$1,663.30
|
| Rate for Payer: HFN Commercial |
$1,719.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,401.66
|
| Rate for Payer: Multiplan Commercial |
$1,495.10
|
| Rate for Payer: NAPHCARE Commercial |
$1,121.33
|
| Rate for Payer: Preferred Network Access Commercial |
$1,719.37
|
| Rate for Payer: Quartz Beloit One Network |
$915.75
|
| Rate for Payer: Quartz Commercial |
$1,214.77
|
| Rate for Payer: Quartz Medicare Advantage |
$1,121.33
|
| Rate for Payer: The Alliance Commercial |
$934.44
|
| Rate for Payer: WEA Trust Commercial |
$1,027.88
|
| Rate for Payer: WPS Commercial |
$1,384.23
|
|
|
PLATE OBLIQ LT T 3H 7H 241.971
|
Facility
|
IP
|
$1,797.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966710
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$915.75 |
| Max. Negotiated Rate |
$1,719.37 |
| Rate for Payer: Aetna Commercial |
$1,681.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,607.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$990.51
|
| Rate for Payer: Cash Price |
$539.10
|
| Rate for Payer: Cigna Commercial |
$1,719.37
|
| Rate for Payer: Health EOS Commercial |
$1,663.30
|
| Rate for Payer: HFN Commercial |
$1,719.37
|
| Rate for Payer: Multiplan Commercial |
$1,495.10
|
| Rate for Payer: Preferred Network Access Commercial |
$1,719.37
|
| Rate for Payer: Quartz Beloit One Network |
$915.75
|
| Rate for Payer: Quartz Commercial |
$1,121.33
|
| Rate for Payer: WEA Trust Commercial |
$1,027.88
|
| Rate for Payer: WPS Commercial |
$1,384.23
|
|
|
PLATE OLECRANON 11HOLE LT 70-0308
|
Facility
|
IP
|
$1,904.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4500789
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$970.28 |
| Max. Negotiated Rate |
$1,821.75 |
| Rate for Payer: Aetna Commercial |
$1,782.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,702.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,049.48
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cigna Commercial |
$1,821.75
|
| Rate for Payer: Health EOS Commercial |
$1,762.34
|
| Rate for Payer: HFN Commercial |
$1,821.75
|
| Rate for Payer: Multiplan Commercial |
$1,584.13
|
| Rate for Payer: Preferred Network Access Commercial |
$1,821.75
|
| Rate for Payer: Quartz Beloit One Network |
$970.28
|
| Rate for Payer: Quartz Commercial |
$1,188.10
|
| Rate for Payer: WEA Trust Commercial |
$1,089.09
|
| Rate for Payer: WPS Commercial |
$1,466.65
|
|
|
PLATE OLECRANON 11HOLE LT 70-0308
|
Facility
|
OP
|
$1,904.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4500789
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$554.44 |
| Max. Negotiated Rate |
$1,821.75 |
| Rate for Payer: Aetna Commercial |
$1,782.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,702.94
|
| Rate for Payer: Aetna Managed Medicare |
$554.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,287.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$990.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$950.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,049.48
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cigna Commercial |
$1,821.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,108.13
|
| Rate for Payer: Health EOS Commercial |
$1,762.34
|
| Rate for Payer: HFN Commercial |
$1,821.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,485.12
|
| Rate for Payer: Multiplan Commercial |
$1,584.13
|
| Rate for Payer: NAPHCARE Commercial |
$1,188.10
|
| Rate for Payer: Preferred Network Access Commercial |
$1,821.75
|
| Rate for Payer: Quartz Beloit One Network |
$970.28
|
| Rate for Payer: Quartz Commercial |
$1,287.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,188.10
|
| Rate for Payer: The Alliance Commercial |
$990.08
|
| Rate for Payer: WEA Trust Commercial |
$1,089.09
|
| Rate for Payer: WPS Commercial |
$1,466.65
|
|
|
PLATE OLECRANON 15 HOLE LT 70-0310
|
Facility
|
IP
|
$1,904.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4595309
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$970.28 |
| Max. Negotiated Rate |
$1,821.75 |
| Rate for Payer: Aetna Commercial |
$1,782.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,702.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,049.48
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cigna Commercial |
$1,821.75
|
| Rate for Payer: Health EOS Commercial |
$1,762.34
|
| Rate for Payer: HFN Commercial |
$1,821.75
|
| Rate for Payer: Multiplan Commercial |
$1,584.13
|
| Rate for Payer: Preferred Network Access Commercial |
$1,821.75
|
| Rate for Payer: Quartz Beloit One Network |
$970.28
|
| Rate for Payer: Quartz Commercial |
$1,188.10
|
| Rate for Payer: WEA Trust Commercial |
$1,089.09
|
| Rate for Payer: WPS Commercial |
$1,466.65
|
|
|
PLATE OLECRANON 15 HOLE LT 70-0310
|
Facility
|
OP
|
$1,904.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4595309
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$554.44 |
| Max. Negotiated Rate |
$1,821.75 |
| Rate for Payer: Aetna Commercial |
$1,782.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,702.94
|
| Rate for Payer: Aetna Managed Medicare |
$554.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,287.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$990.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$950.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,049.48
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cigna Commercial |
$1,821.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,108.13
|
| Rate for Payer: Health EOS Commercial |
$1,762.34
|
| Rate for Payer: HFN Commercial |
$1,821.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,485.12
|
| Rate for Payer: Multiplan Commercial |
$1,584.13
|
| Rate for Payer: NAPHCARE Commercial |
$1,188.10
|
| Rate for Payer: Preferred Network Access Commercial |
$1,821.75
|
| Rate for Payer: Quartz Beloit One Network |
$970.28
|
| Rate for Payer: Quartz Commercial |
$1,287.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,188.10
|
| Rate for Payer: The Alliance Commercial |
$990.08
|
| Rate for Payer: WEA Trust Commercial |
$1,089.09
|
| Rate for Payer: WPS Commercial |
$1,466.65
|
|
|
PLATE OLECRANON 6 HL LT 629346
|
Facility
|
OP
|
$7,151.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3939329
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,082.37 |
| Max. Negotiated Rate |
$6,842.08 |
| Rate for Payer: Aetna Commercial |
$6,693.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,395.85
|
| Rate for Payer: Aetna Managed Medicare |
$2,082.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,834.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,718.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,569.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,941.63
|
| Rate for Payer: Cash Price |
$2,145.30
|
| Rate for Payer: Cigna Commercial |
$6,842.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,161.88
|
| Rate for Payer: Health EOS Commercial |
$6,618.97
|
| Rate for Payer: HFN Commercial |
$6,842.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,577.78
|
| Rate for Payer: Multiplan Commercial |
$5,949.63
|
| Rate for Payer: NAPHCARE Commercial |
$4,462.22
|
| Rate for Payer: Preferred Network Access Commercial |
$6,842.08
|
| Rate for Payer: Quartz Beloit One Network |
$3,644.15
|
| Rate for Payer: Quartz Commercial |
$4,834.08
|
| Rate for Payer: Quartz Medicare Advantage |
$4,462.22
|
| Rate for Payer: The Alliance Commercial |
$3,718.52
|
| Rate for Payer: WEA Trust Commercial |
$4,090.37
|
| Rate for Payer: WPS Commercial |
$5,508.42
|
|
|
PLATE OLECRANON 6 HL LT 629346
|
Facility
|
IP
|
$7,151.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3939329
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,644.15 |
| Max. Negotiated Rate |
$6,842.08 |
| Rate for Payer: Aetna Commercial |
$6,693.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,395.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,941.63
|
| Rate for Payer: Cash Price |
$2,145.30
|
| Rate for Payer: Cigna Commercial |
$6,842.08
|
| Rate for Payer: Health EOS Commercial |
$6,618.97
|
| Rate for Payer: HFN Commercial |
$6,842.08
|
| Rate for Payer: Multiplan Commercial |
$5,949.63
|
| Rate for Payer: Preferred Network Access Commercial |
$6,842.08
|
| Rate for Payer: Quartz Beloit One Network |
$3,644.15
|
| Rate for Payer: Quartz Commercial |
$4,462.22
|
| Rate for Payer: WEA Trust Commercial |
$4,090.37
|
| Rate for Payer: WPS Commercial |
$5,508.42
|
|
|
PLATE OLECRANON LEFT 2 HOLE
|
Facility
|
IP
|
$8,278.00
|
|
| Hospital Charge Code |
2966374
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,218.47 |
| Max. Negotiated Rate |
$7,920.39 |
| Rate for Payer: Aetna Commercial |
$7,748.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,403.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,562.83
|
| Rate for Payer: Cash Price |
$2,483.40
|
| Rate for Payer: Cigna Commercial |
$7,920.39
|
| Rate for Payer: Health EOS Commercial |
$7,662.12
|
| Rate for Payer: HFN Commercial |
$7,920.39
|
| Rate for Payer: Multiplan Commercial |
$6,887.30
|
| Rate for Payer: Preferred Network Access Commercial |
$7,920.39
|
| Rate for Payer: Quartz Beloit One Network |
$4,218.47
|
| Rate for Payer: Quartz Commercial |
$5,165.47
|
| Rate for Payer: WEA Trust Commercial |
$4,735.02
|
| Rate for Payer: WPS Commercial |
$6,376.54
|
|
|
PLATE OLECRANON LEFT 2 HOLE
|
Facility
|
OP
|
$8,278.00
|
|
| Hospital Charge Code |
2966374
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,410.55 |
| Max. Negotiated Rate |
$7,920.39 |
| Rate for Payer: Aetna Commercial |
$7,748.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,403.84
|
| Rate for Payer: Aetna Managed Medicare |
$2,410.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,595.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,304.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,132.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,562.83
|
| Rate for Payer: Cash Price |
$2,483.40
|
| Rate for Payer: Cigna Commercial |
$7,920.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,817.80
|
| Rate for Payer: Health EOS Commercial |
$7,662.12
|
| Rate for Payer: HFN Commercial |
$7,920.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,456.84
|
| Rate for Payer: Multiplan Commercial |
$6,887.30
|
| Rate for Payer: NAPHCARE Commercial |
$5,165.47
|
| Rate for Payer: Preferred Network Access Commercial |
$7,920.39
|
| Rate for Payer: Quartz Beloit One Network |
$4,218.47
|
| Rate for Payer: Quartz Commercial |
$5,595.93
|
| Rate for Payer: Quartz Medicare Advantage |
$5,165.47
|
| Rate for Payer: The Alliance Commercial |
$4,304.56
|
| Rate for Payer: WEA Trust Commercial |
$4,735.02
|
| Rate for Payer: WPS Commercial |
$6,376.54
|
|
|
PLATE OLECRANON PROXIMAL 2.7/3.5 2HL RT 02.107.202S
|
Facility
|
OP
|
$7,339.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3127490
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,137.12 |
| Max. Negotiated Rate |
$7,021.96 |
| Rate for Payer: Aetna Commercial |
$6,869.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,564.00
|
| Rate for Payer: Aetna Managed Medicare |
$2,137.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,961.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,816.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,663.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,045.26
|
| Rate for Payer: Cash Price |
$2,201.70
|
| Rate for Payer: Cigna Commercial |
$7,021.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,271.30
|
| Rate for Payer: Health EOS Commercial |
$6,792.98
|
| Rate for Payer: HFN Commercial |
$7,021.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,724.42
|
| Rate for Payer: Multiplan Commercial |
$6,106.05
|
| Rate for Payer: NAPHCARE Commercial |
$4,579.54
|
| Rate for Payer: Preferred Network Access Commercial |
$7,021.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,739.95
|
| Rate for Payer: Quartz Commercial |
$4,961.16
|
| Rate for Payer: Quartz Medicare Advantage |
$4,579.54
|
| Rate for Payer: The Alliance Commercial |
$3,816.28
|
| Rate for Payer: WEA Trust Commercial |
$4,197.91
|
| Rate for Payer: WPS Commercial |
$5,653.23
|
|
|
PLATE OLECRANON PROXIMAL 2.7/3.5 2HL RT 02.107.202S
|
Facility
|
IP
|
$7,339.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3127490
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,739.95 |
| Max. Negotiated Rate |
$7,021.96 |
| Rate for Payer: Aetna Commercial |
$6,869.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,564.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,045.26
|
| Rate for Payer: Cash Price |
$2,201.70
|
| Rate for Payer: Cigna Commercial |
$7,021.96
|
| Rate for Payer: Health EOS Commercial |
$6,792.98
|
| Rate for Payer: HFN Commercial |
$7,021.96
|
| Rate for Payer: Multiplan Commercial |
$6,106.05
|
| Rate for Payer: Preferred Network Access Commercial |
$7,021.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,739.95
|
| Rate for Payer: Quartz Commercial |
$4,579.54
|
| Rate for Payer: WEA Trust Commercial |
$4,197.91
|
| Rate for Payer: WPS Commercial |
$5,653.23
|
|
|
PLATE PERI. PROXIMAL HUMEROUS 3HL RT 02.123.040
|
Facility
|
IP
|
$10,665.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966375
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,434.88 |
| Max. Negotiated Rate |
$10,204.27 |
| Rate for Payer: Aetna Commercial |
$9,982.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,538.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,878.55
|
| Rate for Payer: Cash Price |
$3,199.50
|
| Rate for Payer: Cigna Commercial |
$10,204.27
|
| Rate for Payer: Health EOS Commercial |
$9,871.52
|
| Rate for Payer: HFN Commercial |
$10,204.27
|
| Rate for Payer: Multiplan Commercial |
$8,873.28
|
| Rate for Payer: Preferred Network Access Commercial |
$10,204.27
|
| Rate for Payer: Quartz Beloit One Network |
$5,434.88
|
| Rate for Payer: Quartz Commercial |
$6,654.96
|
| Rate for Payer: WEA Trust Commercial |
$6,100.38
|
| Rate for Payer: WPS Commercial |
$8,215.25
|
|
|
PLATE PERI. PROXIMAL HUMEROUS 3HL RT 02.123.040
|
Facility
|
OP
|
$10,665.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966375
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,105.65 |
| Max. Negotiated Rate |
$10,204.27 |
| Rate for Payer: Aetna Commercial |
$9,982.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,538.78
|
| Rate for Payer: Aetna Managed Medicare |
$3,105.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,209.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,545.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,323.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,878.55
|
| Rate for Payer: Cash Price |
$3,199.50
|
| Rate for Payer: Cigna Commercial |
$10,204.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,207.03
|
| Rate for Payer: Health EOS Commercial |
$9,871.52
|
| Rate for Payer: HFN Commercial |
$10,204.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,318.70
|
| Rate for Payer: Multiplan Commercial |
$8,873.28
|
| Rate for Payer: NAPHCARE Commercial |
$6,654.96
|
| Rate for Payer: Preferred Network Access Commercial |
$10,204.27
|
| Rate for Payer: Quartz Beloit One Network |
$5,434.88
|
| Rate for Payer: Quartz Commercial |
$7,209.54
|
| Rate for Payer: Quartz Medicare Advantage |
$6,654.96
|
| Rate for Payer: The Alliance Commercial |
$5,545.80
|
| Rate for Payer: WEA Trust Commercial |
$6,100.38
|
| Rate for Payer: WPS Commercial |
$8,215.25
|
|
|
PLATE POSTERIAL LATERAL DISTAL
|
Facility
|
IP
|
$7,274.00
|
|
| Hospital Charge Code |
2966376
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,706.83 |
| Max. Negotiated Rate |
$6,959.76 |
| Rate for Payer: Aetna Commercial |
$6,808.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,505.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,009.43
|
| Rate for Payer: Cash Price |
$2,182.20
|
| Rate for Payer: Cigna Commercial |
$6,959.76
|
| Rate for Payer: Health EOS Commercial |
$6,732.81
|
| Rate for Payer: HFN Commercial |
$6,959.76
|
| Rate for Payer: Multiplan Commercial |
$6,051.97
|
| Rate for Payer: Preferred Network Access Commercial |
$6,959.76
|
| Rate for Payer: Quartz Beloit One Network |
$3,706.83
|
| Rate for Payer: Quartz Commercial |
$4,538.98
|
| Rate for Payer: WEA Trust Commercial |
$4,160.73
|
| Rate for Payer: WPS Commercial |
$5,603.16
|
|
|
PLATE POSTERIAL LATERAL DISTAL
|
Facility
|
OP
|
$7,274.00
|
|
| Hospital Charge Code |
2966376
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,118.19 |
| Max. Negotiated Rate |
$6,959.76 |
| Rate for Payer: Aetna Commercial |
$6,808.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,505.87
|
| Rate for Payer: Aetna Managed Medicare |
$2,118.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,917.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,782.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,631.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,009.43
|
| Rate for Payer: Cash Price |
$2,182.20
|
| Rate for Payer: Cigna Commercial |
$6,959.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,233.47
|
| Rate for Payer: Health EOS Commercial |
$6,732.81
|
| Rate for Payer: HFN Commercial |
$6,959.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,673.72
|
| Rate for Payer: Multiplan Commercial |
$6,051.97
|
| Rate for Payer: NAPHCARE Commercial |
$4,538.98
|
| Rate for Payer: Preferred Network Access Commercial |
$6,959.76
|
| Rate for Payer: Quartz Beloit One Network |
$3,706.83
|
| Rate for Payer: Quartz Commercial |
$4,917.22
|
| Rate for Payer: Quartz Medicare Advantage |
$4,538.98
|
| Rate for Payer: The Alliance Commercial |
$3,782.48
|
| Rate for Payer: WEA Trust Commercial |
$4,160.73
|
| Rate for Payer: WPS Commercial |
$5,603.16
|
|
|
PLATE POSTERIOR LATERAL 3 HOLE RT 629263
|
Facility
|
IP
|
$6,761.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599675
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,445.41 |
| Max. Negotiated Rate |
$6,468.92 |
| Rate for Payer: Aetna Commercial |
$6,328.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,047.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,726.66
|
| Rate for Payer: Cash Price |
$2,028.30
|
| Rate for Payer: Cigna Commercial |
$6,468.92
|
| Rate for Payer: Health EOS Commercial |
$6,257.98
|
| Rate for Payer: HFN Commercial |
$6,468.92
|
| Rate for Payer: Multiplan Commercial |
$5,625.15
|
| Rate for Payer: Preferred Network Access Commercial |
$6,468.92
|
| Rate for Payer: Quartz Beloit One Network |
$3,445.41
|
| Rate for Payer: Quartz Commercial |
$4,218.86
|
| Rate for Payer: WEA Trust Commercial |
$3,867.29
|
| Rate for Payer: WPS Commercial |
$5,208.00
|
|
