|
PLATE POSTERIOR LATERAL 3 HOLE RT 629263
|
Facility
|
OP
|
$6,761.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599675
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,968.80 |
| 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: Aetna Managed Medicare |
$1,968.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,570.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,515.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,375.09
|
| 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: Dean Health DHI/DHP/ASO |
$3,934.90
|
| Rate for Payer: Health EOS Commercial |
$6,257.98
|
| Rate for Payer: HFN Commercial |
$6,468.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,273.58
|
| Rate for Payer: Multiplan Commercial |
$5,625.15
|
| Rate for Payer: NAPHCARE Commercial |
$4,218.86
|
| 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 |
$4,570.44
|
| Rate for Payer: Quartz Medicare Advantage |
$4,218.86
|
| Rate for Payer: The Alliance Commercial |
$3,515.72
|
| Rate for Payer: WEA Trust Commercial |
$3,867.29
|
| Rate for Payer: WPS Commercial |
$5,208.00
|
|
|
PLATE POSTERIOR LATERAL 4 HOLE LT 629244
|
Facility
|
OP
|
$2,547.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4006580
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$741.69 |
| Max. Negotiated Rate |
$2,436.97 |
| Rate for Payer: Aetna Commercial |
$2,383.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,278.04
|
| Rate for Payer: Aetna Managed Medicare |
$741.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,721.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,324.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,271.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,403.91
|
| Rate for Payer: Cash Price |
$764.10
|
| Rate for Payer: Cigna Commercial |
$2,436.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,482.35
|
| Rate for Payer: Health EOS Commercial |
$2,357.50
|
| Rate for Payer: HFN Commercial |
$2,436.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,986.66
|
| Rate for Payer: Multiplan Commercial |
$2,119.10
|
| Rate for Payer: NAPHCARE Commercial |
$1,589.33
|
| Rate for Payer: Preferred Network Access Commercial |
$2,436.97
|
| Rate for Payer: Quartz Beloit One Network |
$1,297.95
|
| Rate for Payer: Quartz Commercial |
$1,721.77
|
| Rate for Payer: Quartz Medicare Advantage |
$1,589.33
|
| Rate for Payer: The Alliance Commercial |
$1,324.44
|
| Rate for Payer: WEA Trust Commercial |
$1,456.88
|
| Rate for Payer: WPS Commercial |
$1,961.95
|
|
|
PLATE POSTERIOR LATERAL 4 HOLE LT 629244
|
Facility
|
IP
|
$2,547.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4006580
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,297.95 |
| Max. Negotiated Rate |
$2,436.97 |
| Rate for Payer: Aetna Commercial |
$2,383.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,278.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,403.91
|
| Rate for Payer: Cash Price |
$764.10
|
| Rate for Payer: Cigna Commercial |
$2,436.97
|
| Rate for Payer: Health EOS Commercial |
$2,357.50
|
| Rate for Payer: HFN Commercial |
$2,436.97
|
| Rate for Payer: Multiplan Commercial |
$2,119.10
|
| Rate for Payer: Preferred Network Access Commercial |
$2,436.97
|
| Rate for Payer: Quartz Beloit One Network |
$1,297.95
|
| Rate for Payer: Quartz Commercial |
$1,589.33
|
| Rate for Payer: WEA Trust Commercial |
$1,456.88
|
| Rate for Payer: WPS Commercial |
$1,961.95
|
|
|
PLATE POSTERIOR LATERAL 6 HOLE LT 629246
|
Facility
|
OP
|
$7,018.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4006558
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,043.64 |
| Max. Negotiated Rate |
$6,714.82 |
| Rate for Payer: Aetna Commercial |
$6,568.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,276.90
|
| Rate for Payer: Aetna Managed Medicare |
$2,043.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,744.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,649.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,503.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,868.32
|
| Rate for Payer: Cash Price |
$2,105.40
|
| Rate for Payer: Cigna Commercial |
$6,714.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,084.48
|
| Rate for Payer: Health EOS Commercial |
$6,495.86
|
| Rate for Payer: HFN Commercial |
$6,714.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,474.04
|
| Rate for Payer: Multiplan Commercial |
$5,838.98
|
| Rate for Payer: NAPHCARE Commercial |
$4,379.23
|
| Rate for Payer: Preferred Network Access Commercial |
$6,714.82
|
| Rate for Payer: Quartz Beloit One Network |
$3,576.37
|
| Rate for Payer: Quartz Commercial |
$4,744.17
|
| Rate for Payer: Quartz Medicare Advantage |
$4,379.23
|
| Rate for Payer: The Alliance Commercial |
$3,649.36
|
| Rate for Payer: WEA Trust Commercial |
$4,014.30
|
| Rate for Payer: WPS Commercial |
$5,405.97
|
|
|
PLATE POSTERIOR LATERAL 6 HOLE LT 629246
|
Facility
|
IP
|
$7,018.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4006558
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,576.37 |
| Max. Negotiated Rate |
$6,714.82 |
| Rate for Payer: Aetna Commercial |
$6,568.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,276.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,868.32
|
| Rate for Payer: Cash Price |
$2,105.40
|
| Rate for Payer: Cigna Commercial |
$6,714.82
|
| Rate for Payer: Health EOS Commercial |
$6,495.86
|
| Rate for Payer: HFN Commercial |
$6,714.82
|
| Rate for Payer: Multiplan Commercial |
$5,838.98
|
| Rate for Payer: Preferred Network Access Commercial |
$6,714.82
|
| Rate for Payer: Quartz Beloit One Network |
$3,576.37
|
| Rate for Payer: Quartz Commercial |
$4,379.23
|
| Rate for Payer: WEA Trust Commercial |
$4,014.30
|
| Rate for Payer: WPS Commercial |
$5,405.97
|
|
|
PLATE PRE-CONTOURED 12 HOLE RIBFIX BLUE 76-2602
|
Facility
|
IP
|
$8,996.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5627636
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,584.36 |
| Max. Negotiated Rate |
$8,607.37 |
| Rate for Payer: Aetna Commercial |
$8,420.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,046.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,958.60
|
| Rate for Payer: Cash Price |
$2,698.80
|
| Rate for Payer: Cigna Commercial |
$8,607.37
|
| Rate for Payer: Health EOS Commercial |
$8,326.70
|
| Rate for Payer: HFN Commercial |
$8,607.37
|
| Rate for Payer: Multiplan Commercial |
$7,484.67
|
| Rate for Payer: Preferred Network Access Commercial |
$8,607.37
|
| Rate for Payer: Quartz Beloit One Network |
$4,584.36
|
| Rate for Payer: Quartz Commercial |
$5,613.50
|
| Rate for Payer: WEA Trust Commercial |
$5,145.71
|
| Rate for Payer: WPS Commercial |
$6,929.62
|
|
|
PLATE PRE-CONTOURED 12 HOLE RIBFIX BLUE 76-2602
|
Facility
|
OP
|
$8,996.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5627636
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,619.64 |
| Max. Negotiated Rate |
$8,607.37 |
| Rate for Payer: Quartz Beloit One Network |
$4,584.36
|
| Rate for Payer: Quartz Commercial |
$6,081.30
|
| Rate for Payer: Quartz Medicare Advantage |
$5,613.50
|
| Rate for Payer: The Alliance Commercial |
$4,677.92
|
| Rate for Payer: WEA Trust Commercial |
$5,145.71
|
| Rate for Payer: WPS Commercial |
$6,929.62
|
| Rate for Payer: Aetna Commercial |
$8,420.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,046.02
|
| Rate for Payer: Aetna Managed Medicare |
$2,619.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,081.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,677.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,490.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,958.60
|
| Rate for Payer: Cash Price |
$2,698.80
|
| Rate for Payer: Cigna Commercial |
$8,607.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,235.67
|
| Rate for Payer: Health EOS Commercial |
$8,326.70
|
| Rate for Payer: HFN Commercial |
$8,607.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,016.88
|
| Rate for Payer: Multiplan Commercial |
$7,484.67
|
| Rate for Payer: NAPHCARE Commercial |
$5,613.50
|
| Rate for Payer: Preferred Network Access Commercial |
$8,607.37
|
|
|
PLATE PROX/HUM 3.5 10HL LONG 241.923
|
Facility
|
OP
|
$8,566.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6174861
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,494.42 |
| Max. Negotiated Rate |
$8,195.95 |
| Rate for Payer: Aetna Commercial |
$8,017.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,661.43
|
| Rate for Payer: Aetna Managed Medicare |
$2,494.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,790.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,454.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,276.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,721.58
|
| Rate for Payer: Cash Price |
$2,569.80
|
| Rate for Payer: Cigna Commercial |
$8,195.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,985.41
|
| Rate for Payer: Health EOS Commercial |
$7,928.69
|
| Rate for Payer: HFN Commercial |
$8,195.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,681.48
|
| Rate for Payer: Multiplan Commercial |
$7,126.91
|
| Rate for Payer: NAPHCARE Commercial |
$5,345.18
|
| Rate for Payer: Preferred Network Access Commercial |
$8,195.95
|
| Rate for Payer: Quartz Beloit One Network |
$4,365.23
|
| Rate for Payer: Quartz Commercial |
$5,790.62
|
| Rate for Payer: Quartz Medicare Advantage |
$5,345.18
|
| Rate for Payer: The Alliance Commercial |
$4,454.32
|
| Rate for Payer: WEA Trust Commercial |
$4,899.75
|
| Rate for Payer: WPS Commercial |
$6,598.39
|
|
|
PLATE PROX/HUM 3.5 10HL LONG 241.923
|
Facility
|
IP
|
$8,566.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6174861
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,365.23 |
| Max. Negotiated Rate |
$8,195.95 |
| Rate for Payer: Aetna Commercial |
$8,017.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,661.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,721.58
|
| Rate for Payer: Cash Price |
$2,569.80
|
| Rate for Payer: Cigna Commercial |
$8,195.95
|
| Rate for Payer: Health EOS Commercial |
$7,928.69
|
| Rate for Payer: HFN Commercial |
$8,195.95
|
| Rate for Payer: Multiplan Commercial |
$7,126.91
|
| Rate for Payer: Preferred Network Access Commercial |
$8,195.95
|
| Rate for Payer: Quartz Beloit One Network |
$4,365.23
|
| Rate for Payer: Quartz Commercial |
$5,345.18
|
| Rate for Payer: WEA Trust Commercial |
$4,899.75
|
| Rate for Payer: WPS Commercial |
$6,598.39
|
|
|
PLATE PROX/HUM 3.5 3HL 241.901
|
Facility
|
OP
|
$7,339.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966717
|
|
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 PROX/HUM 3.5 3HL 241.901
|
Facility
|
IP
|
$7,339.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966717
|
|
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 PROX/HUM 3.5 5HL 241.903
|
Facility
|
IP
|
$7,575.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966728
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,860.22 |
| Max. Negotiated Rate |
$7,247.76 |
| Rate for Payer: Aetna Commercial |
$7,090.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,775.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,175.34
|
| Rate for Payer: Cash Price |
$2,272.50
|
| Rate for Payer: Cigna Commercial |
$7,247.76
|
| Rate for Payer: Health EOS Commercial |
$7,011.42
|
| Rate for Payer: HFN Commercial |
$7,247.76
|
| Rate for Payer: Multiplan Commercial |
$6,302.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,247.76
|
| Rate for Payer: Quartz Beloit One Network |
$3,860.22
|
| Rate for Payer: Quartz Commercial |
$4,726.80
|
| Rate for Payer: WEA Trust Commercial |
$4,332.90
|
| Rate for Payer: WPS Commercial |
$5,835.02
|
|
|
PLATE PROX/HUM 3.5 5HL 241.903
|
Facility
|
OP
|
$7,575.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966728
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,205.84 |
| Max. Negotiated Rate |
$7,247.76 |
| Rate for Payer: Aetna Commercial |
$7,090.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,775.08
|
| Rate for Payer: Aetna Managed Medicare |
$2,205.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,120.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,939.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,781.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,175.34
|
| Rate for Payer: Cash Price |
$2,272.50
|
| Rate for Payer: Cigna Commercial |
$7,247.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,408.65
|
| Rate for Payer: Health EOS Commercial |
$7,011.42
|
| Rate for Payer: HFN Commercial |
$7,247.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,908.50
|
| Rate for Payer: Multiplan Commercial |
$6,302.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,726.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,247.76
|
| Rate for Payer: Quartz Beloit One Network |
$3,860.22
|
| Rate for Payer: Quartz Commercial |
$5,120.70
|
| Rate for Payer: Quartz Medicare Advantage |
$4,726.80
|
| Rate for Payer: The Alliance Commercial |
$3,939.00
|
| Rate for Payer: WEA Trust Commercial |
$4,332.90
|
| Rate for Payer: WPS Commercial |
$5,835.02
|
|
|
PLATE PROX/HUM 3.5 5HL LONG 241.918
|
Facility
|
OP
|
$7,353.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6180299
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,141.19 |
| Max. Negotiated Rate |
$7,035.35 |
| Rate for Payer: Aetna Commercial |
$6,882.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,576.52
|
| Rate for Payer: Aetna Managed Medicare |
$2,141.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,970.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,823.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,670.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,052.97
|
| Rate for Payer: Cash Price |
$2,205.90
|
| Rate for Payer: Cigna Commercial |
$7,035.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,279.45
|
| Rate for Payer: Health EOS Commercial |
$6,805.94
|
| Rate for Payer: HFN Commercial |
$7,035.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,735.34
|
| Rate for Payer: Multiplan Commercial |
$6,117.70
|
| Rate for Payer: NAPHCARE Commercial |
$4,588.27
|
| Rate for Payer: Preferred Network Access Commercial |
$7,035.35
|
| Rate for Payer: Quartz Beloit One Network |
$3,747.09
|
| Rate for Payer: Quartz Commercial |
$4,970.63
|
| Rate for Payer: Quartz Medicare Advantage |
$4,588.27
|
| Rate for Payer: The Alliance Commercial |
$3,823.56
|
| Rate for Payer: WEA Trust Commercial |
$4,205.92
|
| Rate for Payer: WPS Commercial |
$5,664.02
|
|
|
PLATE PROX/HUM 3.5 5HL LONG 241.918
|
Facility
|
IP
|
$7,353.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6180299
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,747.09 |
| Max. Negotiated Rate |
$7,035.35 |
| Rate for Payer: Aetna Commercial |
$6,882.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,576.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,052.97
|
| Rate for Payer: Cash Price |
$2,205.90
|
| Rate for Payer: Cigna Commercial |
$7,035.35
|
| Rate for Payer: Health EOS Commercial |
$6,805.94
|
| Rate for Payer: HFN Commercial |
$7,035.35
|
| Rate for Payer: Multiplan Commercial |
$6,117.70
|
| Rate for Payer: Preferred Network Access Commercial |
$7,035.35
|
| Rate for Payer: Quartz Beloit One Network |
$3,747.09
|
| Rate for Payer: Quartz Commercial |
$4,588.27
|
| Rate for Payer: WEA Trust Commercial |
$4,205.92
|
| Rate for Payer: WPS Commercial |
$5,664.02
|
|
|
PLATE PROX/HUM 3.5 8HL LONG 241.921
|
Facility
|
IP
|
$7,635.54
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6246229
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,891.07 |
| Max. Negotiated Rate |
$7,305.68 |
| Rate for Payer: Aetna Commercial |
$7,146.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,829.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,208.71
|
| Rate for Payer: Cash Price |
$2,290.66
|
| Rate for Payer: Cigna Commercial |
$7,305.68
|
| Rate for Payer: Health EOS Commercial |
$7,067.46
|
| Rate for Payer: HFN Commercial |
$7,305.68
|
| Rate for Payer: Multiplan Commercial |
$6,352.77
|
| Rate for Payer: Preferred Network Access Commercial |
$7,305.68
|
| Rate for Payer: Quartz Beloit One Network |
$3,891.07
|
| Rate for Payer: Quartz Commercial |
$4,764.58
|
| Rate for Payer: WEA Trust Commercial |
$4,367.53
|
| Rate for Payer: WPS Commercial |
$5,881.66
|
|
|
PLATE PROX/HUM 3.5 8HL LONG 241.921
|
Facility
|
OP
|
$7,635.54
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6246229
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,223.47 |
| Max. Negotiated Rate |
$7,305.68 |
| Rate for Payer: Aetna Commercial |
$7,146.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,829.23
|
| Rate for Payer: Aetna Managed Medicare |
$2,223.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,161.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,970.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,811.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,208.71
|
| Rate for Payer: Cash Price |
$2,290.66
|
| Rate for Payer: Cigna Commercial |
$7,305.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,443.88
|
| Rate for Payer: Health EOS Commercial |
$7,067.46
|
| Rate for Payer: HFN Commercial |
$7,305.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,955.72
|
| Rate for Payer: Multiplan Commercial |
$6,352.77
|
| Rate for Payer: NAPHCARE Commercial |
$4,764.58
|
| Rate for Payer: Preferred Network Access Commercial |
$7,305.68
|
| Rate for Payer: Quartz Beloit One Network |
$3,891.07
|
| Rate for Payer: Quartz Commercial |
$5,161.63
|
| Rate for Payer: Quartz Medicare Advantage |
$4,764.58
|
| Rate for Payer: The Alliance Commercial |
$3,970.48
|
| Rate for Payer: WEA Trust Commercial |
$4,367.53
|
| Rate for Payer: WPS Commercial |
$5,881.66
|
|
|
PLATE PROXIMAL HUMERUS 3.5 LCP 10HL RT 02.123.028
|
Facility
|
IP
|
$8,118.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5804332
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,136.93 |
| Max. Negotiated Rate |
$7,767.30 |
| Rate for Payer: Aetna Commercial |
$7,598.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,260.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,474.64
|
| Rate for Payer: Cash Price |
$2,435.40
|
| Rate for Payer: Cigna Commercial |
$7,767.30
|
| Rate for Payer: Health EOS Commercial |
$7,514.02
|
| Rate for Payer: HFN Commercial |
$7,767.30
|
| Rate for Payer: Multiplan Commercial |
$6,754.18
|
| Rate for Payer: Preferred Network Access Commercial |
$7,767.30
|
| Rate for Payer: Quartz Beloit One Network |
$4,136.93
|
| Rate for Payer: Quartz Commercial |
$5,065.63
|
| Rate for Payer: WEA Trust Commercial |
$4,643.50
|
| Rate for Payer: WPS Commercial |
$6,253.30
|
|
|
PLATE PROXIMAL HUMERUS 3.5 LCP 10HL RT 02.123.028
|
Facility
|
OP
|
$8,118.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5804332
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,363.96 |
| Max. Negotiated Rate |
$7,767.30 |
| Rate for Payer: Aetna Commercial |
$7,598.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,260.74
|
| Rate for Payer: Aetna Managed Medicare |
$2,363.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,487.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,221.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,052.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,474.64
|
| Rate for Payer: Cash Price |
$2,435.40
|
| Rate for Payer: Cigna Commercial |
$7,767.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,724.68
|
| Rate for Payer: Health EOS Commercial |
$7,514.02
|
| Rate for Payer: HFN Commercial |
$7,767.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,332.04
|
| Rate for Payer: Multiplan Commercial |
$6,754.18
|
| Rate for Payer: NAPHCARE Commercial |
$5,065.63
|
| Rate for Payer: Preferred Network Access Commercial |
$7,767.30
|
| Rate for Payer: Quartz Beloit One Network |
$4,136.93
|
| Rate for Payer: Quartz Commercial |
$5,487.77
|
| Rate for Payer: Quartz Medicare Advantage |
$5,065.63
|
| Rate for Payer: The Alliance Commercial |
$4,221.36
|
| Rate for Payer: WEA Trust Commercial |
$4,643.50
|
| Rate for Payer: WPS Commercial |
$6,253.30
|
|
|
PLATE PROXIMAL HUMERUS 3.5 LCP 2HL LT 02.123.021S
|
Facility
|
OP
|
$9,076.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3072615
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,642.93 |
| Max. Negotiated Rate |
$8,683.92 |
| Rate for Payer: Aetna Commercial |
$8,495.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,117.57
|
| Rate for Payer: Aetna Managed Medicare |
$2,642.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,135.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,719.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,530.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,002.69
|
| Rate for Payer: Cash Price |
$2,722.80
|
| Rate for Payer: Cigna Commercial |
$8,683.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,282.23
|
| Rate for Payer: Health EOS Commercial |
$8,400.75
|
| Rate for Payer: HFN Commercial |
$8,683.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,079.28
|
| Rate for Payer: Multiplan Commercial |
$7,551.23
|
| Rate for Payer: NAPHCARE Commercial |
$5,663.42
|
| Rate for Payer: Preferred Network Access Commercial |
$8,683.92
|
| Rate for Payer: Quartz Beloit One Network |
$4,625.13
|
| Rate for Payer: Quartz Commercial |
$6,135.38
|
| Rate for Payer: Quartz Medicare Advantage |
$5,663.42
|
| Rate for Payer: The Alliance Commercial |
$4,719.52
|
| Rate for Payer: WEA Trust Commercial |
$5,191.47
|
| Rate for Payer: WPS Commercial |
$6,991.24
|
|
|
PLATE PROXIMAL HUMERUS 3.5 LCP 2HL LT 02.123.021S
|
Facility
|
IP
|
$9,076.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3072615
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,625.13 |
| Max. Negotiated Rate |
$8,683.92 |
| Rate for Payer: Aetna Commercial |
$8,495.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,117.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,002.69
|
| Rate for Payer: Cash Price |
$2,722.80
|
| Rate for Payer: Cigna Commercial |
$8,683.92
|
| Rate for Payer: Health EOS Commercial |
$8,400.75
|
| Rate for Payer: HFN Commercial |
$8,683.92
|
| Rate for Payer: Multiplan Commercial |
$7,551.23
|
| Rate for Payer: Preferred Network Access Commercial |
$8,683.92
|
| Rate for Payer: Quartz Beloit One Network |
$4,625.13
|
| Rate for Payer: Quartz Commercial |
$5,663.42
|
| Rate for Payer: WEA Trust Commercial |
$5,191.47
|
| Rate for Payer: WPS Commercial |
$6,991.24
|
|
|
PLATE PROXIMAL HUMERUS 3.5 LCP 2HL RT 02.123.020S
|
Facility
|
IP
|
$9,076.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3072474
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,625.13 |
| Max. Negotiated Rate |
$8,683.92 |
| Rate for Payer: Aetna Commercial |
$8,495.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,117.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,002.69
|
| Rate for Payer: Cash Price |
$2,722.80
|
| Rate for Payer: Cigna Commercial |
$8,683.92
|
| Rate for Payer: Health EOS Commercial |
$8,400.75
|
| Rate for Payer: HFN Commercial |
$8,683.92
|
| Rate for Payer: Multiplan Commercial |
$7,551.23
|
| Rate for Payer: Preferred Network Access Commercial |
$8,683.92
|
| Rate for Payer: Quartz Beloit One Network |
$4,625.13
|
| Rate for Payer: Quartz Commercial |
$5,663.42
|
| Rate for Payer: WEA Trust Commercial |
$5,191.47
|
| Rate for Payer: WPS Commercial |
$6,991.24
|
|
|
PLATE PROXIMAL HUMERUS 3.5 LCP 2HL RT 02.123.020S
|
Facility
|
OP
|
$9,076.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3072474
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,642.93 |
| Max. Negotiated Rate |
$8,683.92 |
| Rate for Payer: Aetna Commercial |
$8,495.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,117.57
|
| Rate for Payer: Aetna Managed Medicare |
$2,642.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,135.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,719.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,530.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,002.69
|
| Rate for Payer: Cash Price |
$2,722.80
|
| Rate for Payer: Cigna Commercial |
$8,683.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,282.23
|
| Rate for Payer: Health EOS Commercial |
$8,400.75
|
| Rate for Payer: HFN Commercial |
$8,683.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,079.28
|
| Rate for Payer: Multiplan Commercial |
$7,551.23
|
| Rate for Payer: NAPHCARE Commercial |
$5,663.42
|
| Rate for Payer: Preferred Network Access Commercial |
$8,683.92
|
| Rate for Payer: Quartz Beloit One Network |
$4,625.13
|
| Rate for Payer: Quartz Commercial |
$6,135.38
|
| Rate for Payer: Quartz Medicare Advantage |
$5,663.42
|
| Rate for Payer: The Alliance Commercial |
$4,719.52
|
| Rate for Payer: WEA Trust Commercial |
$5,191.47
|
| Rate for Payer: WPS Commercial |
$6,991.24
|
|
|
PLATE PROXIMAL HUMERUS 3.5 LCP 3HL LT 02.123.041S
|
Facility
|
IP
|
$7,716.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3805556
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,932.07 |
| Max. Negotiated Rate |
$7,382.67 |
| Rate for Payer: Aetna Commercial |
$7,222.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,901.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,253.06
|
| Rate for Payer: Cash Price |
$2,314.80
|
| Rate for Payer: Cigna Commercial |
$7,382.67
|
| Rate for Payer: Health EOS Commercial |
$7,141.93
|
| Rate for Payer: HFN Commercial |
$7,382.67
|
| Rate for Payer: Multiplan Commercial |
$6,419.71
|
| Rate for Payer: Preferred Network Access Commercial |
$7,382.67
|
| Rate for Payer: Quartz Beloit One Network |
$3,932.07
|
| Rate for Payer: Quartz Commercial |
$4,814.78
|
| Rate for Payer: WEA Trust Commercial |
$4,413.55
|
| Rate for Payer: WPS Commercial |
$5,943.63
|
|
|
PLATE PROXIMAL HUMERUS 3.5 LCP 3HL LT 02.123.041S
|
Facility
|
OP
|
$7,716.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3805556
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,246.90 |
| Max. Negotiated Rate |
$7,382.67 |
| Rate for Payer: Aetna Commercial |
$7,222.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,901.19
|
| Rate for Payer: Aetna Managed Medicare |
$2,246.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,216.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,012.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,851.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,253.06
|
| Rate for Payer: Cash Price |
$2,314.80
|
| Rate for Payer: Cigna Commercial |
$7,382.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,490.71
|
| Rate for Payer: Health EOS Commercial |
$7,141.93
|
| Rate for Payer: HFN Commercial |
$7,382.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,018.48
|
| Rate for Payer: Multiplan Commercial |
$6,419.71
|
| Rate for Payer: NAPHCARE Commercial |
$4,814.78
|
| Rate for Payer: Preferred Network Access Commercial |
$7,382.67
|
| Rate for Payer: Quartz Beloit One Network |
$3,932.07
|
| Rate for Payer: Quartz Commercial |
$5,216.02
|
| Rate for Payer: Quartz Medicare Advantage |
$4,814.78
|
| Rate for Payer: The Alliance Commercial |
$4,012.32
|
| Rate for Payer: WEA Trust Commercial |
$4,413.55
|
| Rate for Payer: WPS Commercial |
$5,943.63
|
|
