|
PLATE DISTAL FIBULA LATERAL 3HL 40-20903
|
Facility
|
IP
|
$4,216.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415586
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,148.47 |
| Max. Negotiated Rate |
$4,033.87 |
| Rate for Payer: Aetna Commercial |
$3,946.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,770.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,323.86
|
| Rate for Payer: Cash Price |
$1,264.80
|
| Rate for Payer: Cigna Commercial |
$4,033.87
|
| Rate for Payer: Health EOS Commercial |
$3,902.33
|
| Rate for Payer: HFN Commercial |
$4,033.87
|
| Rate for Payer: Multiplan Commercial |
$3,507.71
|
| Rate for Payer: Preferred Network Access Commercial |
$4,033.87
|
| Rate for Payer: Quartz Beloit One Network |
$2,148.47
|
| Rate for Payer: Quartz Commercial |
$2,630.78
|
| Rate for Payer: WEA Trust Commercial |
$2,411.55
|
| Rate for Payer: WPS Commercial |
$3,247.58
|
|
|
PLATE DISTAL FIBULA LATERAL 3HL 40-20903
|
Facility
|
OP
|
$4,216.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415586
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,227.70 |
| Max. Negotiated Rate |
$4,033.87 |
| Rate for Payer: Aetna Commercial |
$3,946.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,770.79
|
| Rate for Payer: Aetna Managed Medicare |
$1,227.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,850.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,192.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,104.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,323.86
|
| Rate for Payer: Cash Price |
$1,264.80
|
| Rate for Payer: Cigna Commercial |
$4,033.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,453.71
|
| Rate for Payer: Health EOS Commercial |
$3,902.33
|
| Rate for Payer: HFN Commercial |
$4,033.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,288.48
|
| Rate for Payer: Multiplan Commercial |
$3,507.71
|
| Rate for Payer: NAPHCARE Commercial |
$2,630.78
|
| Rate for Payer: Preferred Network Access Commercial |
$4,033.87
|
| Rate for Payer: Quartz Beloit One Network |
$2,148.47
|
| Rate for Payer: Quartz Commercial |
$2,850.02
|
| Rate for Payer: Quartz Medicare Advantage |
$2,630.78
|
| Rate for Payer: The Alliance Commercial |
$2,192.32
|
| Rate for Payer: WEA Trust Commercial |
$2,411.55
|
| Rate for Payer: WPS Commercial |
$3,247.58
|
|
|
PLATE DISTAL FIBULA LATERAL 4HL 40-20904
|
Facility
|
OP
|
$4,213.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6185026
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,226.83 |
| Max. Negotiated Rate |
$4,031.00 |
| Rate for Payer: Aetna Commercial |
$3,943.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,768.11
|
| Rate for Payer: Aetna Managed Medicare |
$1,226.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,847.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,190.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,103.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,322.21
|
| Rate for Payer: Cash Price |
$1,263.90
|
| Rate for Payer: Cigna Commercial |
$4,031.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,451.97
|
| Rate for Payer: Health EOS Commercial |
$3,899.55
|
| Rate for Payer: HFN Commercial |
$4,031.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,286.14
|
| Rate for Payer: Multiplan Commercial |
$3,505.22
|
| Rate for Payer: NAPHCARE Commercial |
$2,628.91
|
| Rate for Payer: Preferred Network Access Commercial |
$4,031.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,146.94
|
| Rate for Payer: Quartz Commercial |
$2,847.99
|
| Rate for Payer: Quartz Medicare Advantage |
$2,628.91
|
| Rate for Payer: The Alliance Commercial |
$2,190.76
|
| Rate for Payer: WEA Trust Commercial |
$2,409.84
|
| Rate for Payer: WPS Commercial |
$3,245.27
|
|
|
PLATE DISTAL FIBULA LATERAL 4HL 40-20904
|
Facility
|
IP
|
$4,213.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6185026
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,146.94 |
| Max. Negotiated Rate |
$4,031.00 |
| Rate for Payer: Aetna Commercial |
$3,943.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,768.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,322.21
|
| Rate for Payer: Cash Price |
$1,263.90
|
| Rate for Payer: Cigna Commercial |
$4,031.00
|
| Rate for Payer: Health EOS Commercial |
$3,899.55
|
| Rate for Payer: HFN Commercial |
$4,031.00
|
| Rate for Payer: Multiplan Commercial |
$3,505.22
|
| Rate for Payer: Preferred Network Access Commercial |
$4,031.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,146.94
|
| Rate for Payer: Quartz Commercial |
$2,628.91
|
| Rate for Payer: WEA Trust Commercial |
$2,409.84
|
| Rate for Payer: WPS Commercial |
$3,245.27
|
|
|
PLATE DISTAL FIBULA LATERAL 5HL 40-20905
|
Facility
|
IP
|
$4,560.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5603671
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,323.78 |
| Max. Negotiated Rate |
$4,363.01 |
| Rate for Payer: Aetna Commercial |
$4,268.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,078.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,513.47
|
| Rate for Payer: Cash Price |
$1,368.00
|
| Rate for Payer: Cigna Commercial |
$4,363.01
|
| Rate for Payer: Health EOS Commercial |
$4,220.74
|
| Rate for Payer: HFN Commercial |
$4,363.01
|
| Rate for Payer: Multiplan Commercial |
$3,793.92
|
| Rate for Payer: Preferred Network Access Commercial |
$4,363.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,323.78
|
| Rate for Payer: Quartz Commercial |
$2,845.44
|
| Rate for Payer: WEA Trust Commercial |
$2,608.32
|
| Rate for Payer: WPS Commercial |
$3,512.57
|
|
|
PLATE DISTAL FIBULA LATERAL 5HL 40-20905
|
Facility
|
OP
|
$4,560.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5603671
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,327.87 |
| Max. Negotiated Rate |
$4,363.01 |
| Rate for Payer: Aetna Commercial |
$4,268.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,078.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,327.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,082.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,371.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,276.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,513.47
|
| Rate for Payer: Cash Price |
$1,368.00
|
| Rate for Payer: Cigna Commercial |
$4,363.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,653.92
|
| Rate for Payer: Health EOS Commercial |
$4,220.74
|
| Rate for Payer: HFN Commercial |
$4,363.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,556.80
|
| Rate for Payer: Multiplan Commercial |
$3,793.92
|
| Rate for Payer: NAPHCARE Commercial |
$2,845.44
|
| Rate for Payer: Preferred Network Access Commercial |
$4,363.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,323.78
|
| Rate for Payer: Quartz Commercial |
$3,082.56
|
| Rate for Payer: Quartz Medicare Advantage |
$2,845.44
|
| Rate for Payer: The Alliance Commercial |
$2,371.20
|
| Rate for Payer: WEA Trust Commercial |
$2,608.32
|
| Rate for Payer: WPS Commercial |
$3,512.57
|
|
|
PLATE DISTAL FIBULA LOCK 4HL RT ARTHREX AR-8943BR-04
|
Facility
|
IP
|
$4,388.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5416060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,236.12 |
| Max. Negotiated Rate |
$4,198.44 |
| Rate for Payer: Aetna Commercial |
$4,107.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,924.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,418.67
|
| Rate for Payer: Cash Price |
$1,316.40
|
| Rate for Payer: Cigna Commercial |
$4,198.44
|
| Rate for Payer: Health EOS Commercial |
$4,061.53
|
| Rate for Payer: HFN Commercial |
$4,198.44
|
| Rate for Payer: Multiplan Commercial |
$3,650.82
|
| Rate for Payer: Preferred Network Access Commercial |
$4,198.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,236.12
|
| Rate for Payer: Quartz Commercial |
$2,738.11
|
| Rate for Payer: WEA Trust Commercial |
$2,509.94
|
| Rate for Payer: WPS Commercial |
$3,380.08
|
|
|
PLATE DISTAL FIBULA LOCK 4HL RT ARTHREX AR-8943BR-04
|
Facility
|
OP
|
$4,388.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5416060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,277.79 |
| Max. Negotiated Rate |
$4,198.44 |
| Rate for Payer: The Alliance Commercial |
$2,281.76
|
| Rate for Payer: Aetna Commercial |
$4,107.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,924.63
|
| Rate for Payer: Aetna Managed Medicare |
$1,277.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,966.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,281.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,190.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,418.67
|
| Rate for Payer: Cash Price |
$1,316.40
|
| Rate for Payer: Cigna Commercial |
$4,198.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,553.82
|
| Rate for Payer: Health EOS Commercial |
$4,061.53
|
| Rate for Payer: HFN Commercial |
$4,198.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,422.64
|
| Rate for Payer: Multiplan Commercial |
$3,650.82
|
| Rate for Payer: NAPHCARE Commercial |
$2,738.11
|
| Rate for Payer: Preferred Network Access Commercial |
$4,198.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,236.12
|
| Rate for Payer: Quartz Commercial |
$2,966.29
|
| Rate for Payer: Quartz Medicare Advantage |
$2,738.11
|
| Rate for Payer: WEA Trust Commercial |
$2,509.94
|
| Rate for Payer: WPS Commercial |
$3,380.08
|
|
|
PLATE DISTAL FIBULA LOCK 5HL RT ARTHREX AR-8943BR-05
|
Facility
|
IP
|
$4,986.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415026
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,540.87 |
| Max. Negotiated Rate |
$4,770.60 |
| Rate for Payer: Aetna Commercial |
$4,666.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,459.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,748.28
|
| Rate for Payer: Cash Price |
$1,495.80
|
| Rate for Payer: Cigna Commercial |
$4,770.60
|
| Rate for Payer: Health EOS Commercial |
$4,615.04
|
| Rate for Payer: HFN Commercial |
$4,770.60
|
| Rate for Payer: Multiplan Commercial |
$4,148.35
|
| Rate for Payer: Preferred Network Access Commercial |
$4,770.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,540.87
|
| Rate for Payer: Quartz Commercial |
$3,111.26
|
| Rate for Payer: WEA Trust Commercial |
$2,851.99
|
| Rate for Payer: WPS Commercial |
$3,840.72
|
|
|
PLATE DISTAL FIBULA LOCK 5HL RT ARTHREX AR-8943BR-05
|
Facility
|
OP
|
$4,986.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415026
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,451.92 |
| Max. Negotiated Rate |
$4,770.60 |
| Rate for Payer: Aetna Commercial |
$4,666.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,459.48
|
| Rate for Payer: Aetna Managed Medicare |
$1,451.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,370.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,592.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,489.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,748.28
|
| Rate for Payer: Cash Price |
$1,495.80
|
| Rate for Payer: Cigna Commercial |
$4,770.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,901.85
|
| Rate for Payer: Health EOS Commercial |
$4,615.04
|
| Rate for Payer: HFN Commercial |
$4,770.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,889.08
|
| Rate for Payer: Multiplan Commercial |
$4,148.35
|
| Rate for Payer: NAPHCARE Commercial |
$3,111.26
|
| Rate for Payer: Preferred Network Access Commercial |
$4,770.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,540.87
|
| Rate for Payer: Quartz Commercial |
$3,370.54
|
| Rate for Payer: Quartz Medicare Advantage |
$3,111.26
|
| Rate for Payer: The Alliance Commercial |
$2,592.72
|
| Rate for Payer: WEA Trust Commercial |
$2,851.99
|
| Rate for Payer: WPS Commercial |
$3,840.72
|
|
|
PLATE DISTAL FIBULA LOCK LT 5HL AR-8943DL-05
|
Facility
|
IP
|
$5,194.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6199044
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,646.86 |
| Max. Negotiated Rate |
$4,969.62 |
| Rate for Payer: Aetna Commercial |
$4,861.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,645.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,862.93
|
| Rate for Payer: Cash Price |
$1,558.20
|
| Rate for Payer: Cigna Commercial |
$4,969.62
|
| Rate for Payer: Health EOS Commercial |
$4,807.57
|
| Rate for Payer: HFN Commercial |
$4,969.62
|
| Rate for Payer: Multiplan Commercial |
$4,321.41
|
| Rate for Payer: Preferred Network Access Commercial |
$4,969.62
|
| Rate for Payer: Quartz Beloit One Network |
$2,646.86
|
| Rate for Payer: Quartz Commercial |
$3,241.06
|
| Rate for Payer: WEA Trust Commercial |
$2,970.97
|
| Rate for Payer: WPS Commercial |
$4,000.94
|
|
|
PLATE DISTAL FIBULA LOCK LT 5HL AR-8943DL-05
|
Facility
|
OP
|
$5,194.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6199044
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,512.49 |
| Max. Negotiated Rate |
$4,969.62 |
| Rate for Payer: Aetna Commercial |
$4,861.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,645.51
|
| Rate for Payer: Aetna Managed Medicare |
$1,512.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,511.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,700.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,592.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,862.93
|
| Rate for Payer: Cash Price |
$1,558.20
|
| Rate for Payer: Cigna Commercial |
$4,969.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,022.91
|
| Rate for Payer: Health EOS Commercial |
$4,807.57
|
| Rate for Payer: HFN Commercial |
$4,969.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,051.32
|
| Rate for Payer: Multiplan Commercial |
$4,321.41
|
| Rate for Payer: NAPHCARE Commercial |
$3,241.06
|
| Rate for Payer: Preferred Network Access Commercial |
$4,969.62
|
| Rate for Payer: Quartz Beloit One Network |
$2,646.86
|
| Rate for Payer: Quartz Commercial |
$3,511.14
|
| Rate for Payer: Quartz Medicare Advantage |
$3,241.06
|
| Rate for Payer: The Alliance Commercial |
$2,700.88
|
| Rate for Payer: WEA Trust Commercial |
$2,970.97
|
| Rate for Payer: WPS Commercial |
$4,000.94
|
|
|
PLATE DISTAL FIBULA LOCK LT 5HL ARTHREX AR-8943BL-05
|
Facility
|
OP
|
$5,185.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5349250
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,509.87 |
| Max. Negotiated Rate |
$4,961.01 |
| Rate for Payer: Aetna Commercial |
$4,853.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,637.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,509.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,505.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,696.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,588.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,857.97
|
| Rate for Payer: Cash Price |
$1,555.50
|
| Rate for Payer: Cigna Commercial |
$4,961.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,017.67
|
| Rate for Payer: Health EOS Commercial |
$4,799.24
|
| Rate for Payer: HFN Commercial |
$4,961.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,044.30
|
| Rate for Payer: Multiplan Commercial |
$4,313.92
|
| Rate for Payer: NAPHCARE Commercial |
$3,235.44
|
| Rate for Payer: Preferred Network Access Commercial |
$4,961.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,642.28
|
| Rate for Payer: Quartz Commercial |
$3,505.06
|
| Rate for Payer: Quartz Medicare Advantage |
$3,235.44
|
| Rate for Payer: The Alliance Commercial |
$2,696.20
|
| Rate for Payer: WEA Trust Commercial |
$2,965.82
|
| Rate for Payer: WPS Commercial |
$3,994.01
|
|
|
PLATE DISTAL FIBULA LOCK LT 5HL ARTHREX AR-8943BL-05
|
Facility
|
IP
|
$5,185.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5349250
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,642.28 |
| Max. Negotiated Rate |
$4,961.01 |
| Rate for Payer: Aetna Commercial |
$4,853.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,637.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,857.97
|
| Rate for Payer: Cash Price |
$1,555.50
|
| Rate for Payer: Cigna Commercial |
$4,961.01
|
| Rate for Payer: Health EOS Commercial |
$4,799.24
|
| Rate for Payer: HFN Commercial |
$4,961.01
|
| Rate for Payer: Multiplan Commercial |
$4,313.92
|
| Rate for Payer: Preferred Network Access Commercial |
$4,961.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,642.28
|
| Rate for Payer: Quartz Commercial |
$3,235.44
|
| Rate for Payer: WEA Trust Commercial |
$2,965.82
|
| Rate for Payer: WPS Commercial |
$3,994.01
|
|
|
PLATE DISTAL FIBULA LOCK LT 6HL AR-8943DL-06
|
Facility
|
OP
|
$5,901.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6172090
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,718.37 |
| Max. Negotiated Rate |
$5,646.08 |
| Rate for Payer: Aetna Commercial |
$5,523.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,277.85
|
| Rate for Payer: Aetna Managed Medicare |
$1,718.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,989.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,068.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,945.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,252.63
|
| Rate for Payer: Cash Price |
$1,770.30
|
| Rate for Payer: Cigna Commercial |
$5,646.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,434.38
|
| Rate for Payer: Health EOS Commercial |
$5,461.97
|
| Rate for Payer: HFN Commercial |
$5,646.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,602.78
|
| Rate for Payer: Multiplan Commercial |
$4,909.63
|
| Rate for Payer: NAPHCARE Commercial |
$3,682.22
|
| Rate for Payer: Preferred Network Access Commercial |
$5,646.08
|
| Rate for Payer: Quartz Beloit One Network |
$3,007.15
|
| Rate for Payer: Quartz Commercial |
$3,989.08
|
| Rate for Payer: Quartz Medicare Advantage |
$3,682.22
|
| Rate for Payer: The Alliance Commercial |
$3,068.52
|
| Rate for Payer: WEA Trust Commercial |
$3,375.37
|
| Rate for Payer: WPS Commercial |
$4,545.54
|
|
|
PLATE DISTAL FIBULA LOCK LT 6HL AR-8943DL-06
|
Facility
|
IP
|
$5,901.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6172090
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,007.15 |
| Max. Negotiated Rate |
$5,646.08 |
| Rate for Payer: Aetna Commercial |
$5,523.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,277.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,252.63
|
| Rate for Payer: Cash Price |
$1,770.30
|
| Rate for Payer: Cigna Commercial |
$5,646.08
|
| Rate for Payer: Health EOS Commercial |
$5,461.97
|
| Rate for Payer: HFN Commercial |
$5,646.08
|
| Rate for Payer: Multiplan Commercial |
$4,909.63
|
| Rate for Payer: Preferred Network Access Commercial |
$5,646.08
|
| Rate for Payer: Quartz Beloit One Network |
$3,007.15
|
| Rate for Payer: Quartz Commercial |
$3,682.22
|
| Rate for Payer: WEA Trust Commercial |
$3,375.37
|
| Rate for Payer: WPS Commercial |
$4,545.54
|
|
|
PLATE DISTAL FIBULA LOCK LT 6HL ARTHREX AR-8943BL-06
|
Facility
|
IP
|
$5,348.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6173858
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,725.34 |
| Max. Negotiated Rate |
$5,116.97 |
| Rate for Payer: Aetna Commercial |
$5,005.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,783.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,947.82
|
| Rate for Payer: Cash Price |
$1,604.40
|
| Rate for Payer: Cigna Commercial |
$5,116.97
|
| Rate for Payer: Health EOS Commercial |
$4,950.11
|
| Rate for Payer: HFN Commercial |
$5,116.97
|
| Rate for Payer: Multiplan Commercial |
$4,449.54
|
| Rate for Payer: Preferred Network Access Commercial |
$5,116.97
|
| Rate for Payer: Quartz Beloit One Network |
$2,725.34
|
| Rate for Payer: Quartz Commercial |
$3,337.15
|
| Rate for Payer: WEA Trust Commercial |
$3,059.06
|
| Rate for Payer: WPS Commercial |
$4,119.56
|
|
|
PLATE DISTAL FIBULA LOCK LT 6HL ARTHREX AR-8943BL-06
|
Facility
|
OP
|
$5,348.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6173858
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,557.34 |
| Max. Negotiated Rate |
$5,116.97 |
| Rate for Payer: Aetna Commercial |
$5,005.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,783.25
|
| Rate for Payer: Aetna Managed Medicare |
$1,557.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,615.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,780.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,669.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,947.82
|
| Rate for Payer: Cash Price |
$1,604.40
|
| Rate for Payer: Cigna Commercial |
$5,116.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,112.54
|
| Rate for Payer: Health EOS Commercial |
$4,950.11
|
| Rate for Payer: HFN Commercial |
$5,116.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,171.44
|
| Rate for Payer: Multiplan Commercial |
$4,449.54
|
| Rate for Payer: NAPHCARE Commercial |
$3,337.15
|
| Rate for Payer: Preferred Network Access Commercial |
$5,116.97
|
| Rate for Payer: Quartz Beloit One Network |
$2,725.34
|
| Rate for Payer: Quartz Commercial |
$3,615.25
|
| Rate for Payer: Quartz Medicare Advantage |
$3,337.15
|
| Rate for Payer: The Alliance Commercial |
$2,780.96
|
| Rate for Payer: WEA Trust Commercial |
$3,059.06
|
| Rate for Payer: WPS Commercial |
$4,119.56
|
|
|
PLATE DISTAL FIBULA LOCK RT 5HL AR-8943DR-05
|
Facility
|
OP
|
$5,142.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6179753
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,497.35 |
| Max. Negotiated Rate |
$4,919.87 |
| Rate for Payer: Aetna Commercial |
$4,812.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,599.00
|
| Rate for Payer: Aetna Managed Medicare |
$1,497.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,475.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,673.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,566.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,834.27
|
| Rate for Payer: Cash Price |
$1,542.60
|
| Rate for Payer: Cigna Commercial |
$4,919.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,992.64
|
| Rate for Payer: Health EOS Commercial |
$4,759.44
|
| Rate for Payer: HFN Commercial |
$4,919.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,010.76
|
| Rate for Payer: Multiplan Commercial |
$4,278.14
|
| Rate for Payer: NAPHCARE Commercial |
$3,208.61
|
| Rate for Payer: Preferred Network Access Commercial |
$4,919.87
|
| Rate for Payer: Quartz Beloit One Network |
$2,620.36
|
| Rate for Payer: Quartz Commercial |
$3,475.99
|
| Rate for Payer: Quartz Medicare Advantage |
$3,208.61
|
| Rate for Payer: The Alliance Commercial |
$2,673.84
|
| Rate for Payer: WEA Trust Commercial |
$2,941.22
|
| Rate for Payer: WPS Commercial |
$3,960.88
|
|
|
PLATE DISTAL FIBULA LOCK RT 5HL AR-8943DR-05
|
Facility
|
IP
|
$5,142.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6179753
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,620.36 |
| Max. Negotiated Rate |
$4,919.87 |
| Rate for Payer: Aetna Commercial |
$4,812.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,599.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,834.27
|
| Rate for Payer: Cash Price |
$1,542.60
|
| Rate for Payer: Cigna Commercial |
$4,919.87
|
| Rate for Payer: Health EOS Commercial |
$4,759.44
|
| Rate for Payer: HFN Commercial |
$4,919.87
|
| Rate for Payer: Multiplan Commercial |
$4,278.14
|
| Rate for Payer: Preferred Network Access Commercial |
$4,919.87
|
| Rate for Payer: Quartz Beloit One Network |
$2,620.36
|
| Rate for Payer: Quartz Commercial |
$3,208.61
|
| Rate for Payer: WEA Trust Commercial |
$2,941.22
|
| Rate for Payer: WPS Commercial |
$3,960.88
|
|
|
PLATE DISTAL FIBULA LOCK RT 6H AR-8943BR-06
|
Facility
|
OP
|
$5,784.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5456672
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,684.30 |
| Max. Negotiated Rate |
$5,534.13 |
| Rate for Payer: Aetna Commercial |
$5,413.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,173.21
|
| Rate for Payer: Aetna Managed Medicare |
$1,684.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,909.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,007.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,887.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,188.14
|
| Rate for Payer: Cash Price |
$1,735.20
|
| Rate for Payer: Cigna Commercial |
$5,534.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,366.29
|
| Rate for Payer: Health EOS Commercial |
$5,353.67
|
| Rate for Payer: HFN Commercial |
$5,534.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,511.52
|
| Rate for Payer: Multiplan Commercial |
$4,812.29
|
| Rate for Payer: NAPHCARE Commercial |
$3,609.22
|
| Rate for Payer: Preferred Network Access Commercial |
$5,534.13
|
| Rate for Payer: Quartz Beloit One Network |
$2,947.53
|
| Rate for Payer: Quartz Commercial |
$3,909.98
|
| Rate for Payer: Quartz Medicare Advantage |
$3,609.22
|
| Rate for Payer: The Alliance Commercial |
$3,007.68
|
| Rate for Payer: WEA Trust Commercial |
$3,308.45
|
| Rate for Payer: WPS Commercial |
$4,455.42
|
|
|
PLATE DISTAL FIBULA LOCK RT 6H AR-8943BR-06
|
Facility
|
IP
|
$5,784.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5456672
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,947.53 |
| Max. Negotiated Rate |
$5,534.13 |
| Rate for Payer: Aetna Commercial |
$5,413.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,173.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,188.14
|
| Rate for Payer: Cash Price |
$1,735.20
|
| Rate for Payer: Cigna Commercial |
$5,534.13
|
| Rate for Payer: Health EOS Commercial |
$5,353.67
|
| Rate for Payer: HFN Commercial |
$5,534.13
|
| Rate for Payer: Multiplan Commercial |
$4,812.29
|
| Rate for Payer: Preferred Network Access Commercial |
$5,534.13
|
| Rate for Payer: Quartz Beloit One Network |
$2,947.53
|
| Rate for Payer: Quartz Commercial |
$3,609.22
|
| Rate for Payer: WEA Trust Commercial |
$3,308.45
|
| Rate for Payer: WPS Commercial |
$4,455.42
|
|
|
PLATE DISTAL FIBULA LOCK RT 6HL AR-8943DR-06
|
Facility
|
IP
|
$5,674.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6185048
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,891.47 |
| Max. Negotiated Rate |
$5,428.88 |
| Rate for Payer: Aetna Commercial |
$5,310.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,074.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,127.51
|
| Rate for Payer: Cash Price |
$1,702.20
|
| Rate for Payer: Cigna Commercial |
$5,428.88
|
| Rate for Payer: Health EOS Commercial |
$5,251.85
|
| Rate for Payer: HFN Commercial |
$5,428.88
|
| Rate for Payer: Multiplan Commercial |
$4,720.77
|
| Rate for Payer: Preferred Network Access Commercial |
$5,428.88
|
| Rate for Payer: Quartz Beloit One Network |
$2,891.47
|
| Rate for Payer: Quartz Commercial |
$3,540.58
|
| Rate for Payer: WEA Trust Commercial |
$3,245.53
|
| Rate for Payer: WPS Commercial |
$4,370.68
|
|
|
PLATE DISTAL FIBULA LOCK RT 6HL AR-8943DR-06
|
Facility
|
OP
|
$5,674.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6185048
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,652.27 |
| Max. Negotiated Rate |
$5,428.88 |
| Rate for Payer: Aetna Commercial |
$5,310.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,074.83
|
| Rate for Payer: Aetna Managed Medicare |
$1,652.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,835.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,950.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,832.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,127.51
|
| Rate for Payer: Cash Price |
$1,702.20
|
| Rate for Payer: Cigna Commercial |
$5,428.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,302.27
|
| Rate for Payer: Health EOS Commercial |
$5,251.85
|
| Rate for Payer: HFN Commercial |
$5,428.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,425.72
|
| Rate for Payer: Multiplan Commercial |
$4,720.77
|
| Rate for Payer: NAPHCARE Commercial |
$3,540.58
|
| Rate for Payer: Preferred Network Access Commercial |
$5,428.88
|
| Rate for Payer: Quartz Beloit One Network |
$2,891.47
|
| Rate for Payer: Quartz Commercial |
$3,835.62
|
| Rate for Payer: Quartz Medicare Advantage |
$3,540.58
|
| Rate for Payer: The Alliance Commercial |
$2,950.48
|
| Rate for Payer: WEA Trust Commercial |
$3,245.53
|
| Rate for Payer: WPS Commercial |
$4,370.68
|
|
|
PLATE DISTAL HUMERUS 2.7/3.5 VA EXT MEDIAL LATERAL 2HL LT MEDIUM 02.117.702
|
Facility
|
OP
|
$5,535.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6248165
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,611.97 |
| Max. Negotiated Rate |
$5,296.48 |
| Rate for Payer: Aetna Commercial |
$5,181.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,951.06
|
| Rate for Payer: Aetna Managed Medicare |
$1,611.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,742.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,878.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,763.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,051.23
|
| Rate for Payer: Cash Price |
$1,660.69
|
| Rate for Payer: Cigna Commercial |
$5,296.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,221.73
|
| Rate for Payer: Health EOS Commercial |
$5,123.77
|
| Rate for Payer: HFN Commercial |
$5,296.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,317.78
|
| Rate for Payer: Multiplan Commercial |
$4,605.64
|
| Rate for Payer: NAPHCARE Commercial |
$3,454.23
|
| Rate for Payer: Preferred Network Access Commercial |
$5,296.48
|
| Rate for Payer: Quartz Beloit One Network |
$2,820.95
|
| Rate for Payer: Quartz Commercial |
$3,742.08
|
| Rate for Payer: Quartz Medicare Advantage |
$3,454.23
|
| Rate for Payer: The Alliance Commercial |
$2,878.52
|
| Rate for Payer: WEA Trust Commercial |
$3,166.37
|
| Rate for Payer: WPS Commercial |
$4,264.09
|
|
