|
PLATE DISTAL RADIUS VOLAR 2-COLUMN RT 6HL HEAD/3HL SHAFT NRW 02.111.530S
|
Facility
|
IP
|
$6,546.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6185023
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,335.84 |
| Max. Negotiated Rate |
$6,263.21 |
| Rate for Payer: Aetna Commercial |
$6,127.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,854.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,608.16
|
| Rate for Payer: Cash Price |
$1,963.80
|
| Rate for Payer: Cigna Commercial |
$6,263.21
|
| Rate for Payer: Health EOS Commercial |
$6,058.98
|
| Rate for Payer: HFN Commercial |
$6,263.21
|
| Rate for Payer: Multiplan Commercial |
$5,446.27
|
| Rate for Payer: Preferred Network Access Commercial |
$6,263.21
|
| Rate for Payer: Quartz Beloit One Network |
$3,335.84
|
| Rate for Payer: Quartz Commercial |
$4,084.70
|
| Rate for Payer: WEA Trust Commercial |
$3,744.31
|
| Rate for Payer: WPS Commercial |
$5,042.38
|
|
|
PLATE DISTAL RADIUS VOLAR 2-COLUMN RT 6HL HEAD/3HL SHAFT NRW 02.111.530S
|
Facility
|
OP
|
$6,546.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6185023
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,906.20 |
| Max. Negotiated Rate |
$6,263.21 |
| Rate for Payer: Aetna Commercial |
$6,127.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,854.74
|
| Rate for Payer: Aetna Managed Medicare |
$1,906.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,425.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,403.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,267.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,608.16
|
| Rate for Payer: Cash Price |
$1,963.80
|
| Rate for Payer: Cigna Commercial |
$6,263.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,809.77
|
| Rate for Payer: Health EOS Commercial |
$6,058.98
|
| Rate for Payer: HFN Commercial |
$6,263.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,105.88
|
| Rate for Payer: Multiplan Commercial |
$5,446.27
|
| Rate for Payer: NAPHCARE Commercial |
$4,084.70
|
| Rate for Payer: Preferred Network Access Commercial |
$6,263.21
|
| Rate for Payer: Quartz Beloit One Network |
$3,335.84
|
| Rate for Payer: Quartz Commercial |
$4,425.10
|
| Rate for Payer: Quartz Medicare Advantage |
$4,084.70
|
| Rate for Payer: The Alliance Commercial |
$3,403.92
|
| Rate for Payer: WEA Trust Commercial |
$3,744.31
|
| Rate for Payer: WPS Commercial |
$5,042.38
|
|
|
PLATE DISTAL RADIUS VOLAR 2-COLUMN RT 6HL HEAD/4HL SHAFT NRW 02.111.540
|
Facility
|
OP
|
$7,128.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5591367
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,075.67 |
| Max. Negotiated Rate |
$6,820.07 |
| Rate for Payer: Aetna Commercial |
$6,671.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,375.28
|
| Rate for Payer: Aetna Managed Medicare |
$2,075.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,818.53
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,706.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,558.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,928.95
|
| Rate for Payer: Cash Price |
$2,138.40
|
| Rate for Payer: Cigna Commercial |
$6,820.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,148.50
|
| Rate for Payer: Health EOS Commercial |
$6,597.68
|
| Rate for Payer: HFN Commercial |
$6,820.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,559.84
|
| Rate for Payer: Multiplan Commercial |
$5,930.50
|
| Rate for Payer: NAPHCARE Commercial |
$4,447.87
|
| Rate for Payer: Preferred Network Access Commercial |
$6,820.07
|
| Rate for Payer: Quartz Beloit One Network |
$3,632.43
|
| Rate for Payer: Quartz Commercial |
$4,818.53
|
| Rate for Payer: Quartz Medicare Advantage |
$4,447.87
|
| Rate for Payer: The Alliance Commercial |
$3,706.56
|
| Rate for Payer: WEA Trust Commercial |
$4,077.22
|
| Rate for Payer: WPS Commercial |
$5,490.70
|
|
|
PLATE DISTAL RADIUS VOLAR 2-COLUMN RT 6HL HEAD/4HL SHAFT NRW 02.111.540
|
Facility
|
IP
|
$7,128.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5591367
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,632.43 |
| Max. Negotiated Rate |
$6,820.07 |
| Rate for Payer: Aetna Commercial |
$6,671.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,375.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,928.95
|
| Rate for Payer: Cash Price |
$2,138.40
|
| Rate for Payer: Cigna Commercial |
$6,820.07
|
| Rate for Payer: Health EOS Commercial |
$6,597.68
|
| Rate for Payer: HFN Commercial |
$6,820.07
|
| Rate for Payer: Multiplan Commercial |
$5,930.50
|
| Rate for Payer: Preferred Network Access Commercial |
$6,820.07
|
| Rate for Payer: Quartz Beloit One Network |
$3,632.43
|
| Rate for Payer: Quartz Commercial |
$4,447.87
|
| Rate for Payer: WEA Trust Commercial |
$4,077.22
|
| Rate for Payer: WPS Commercial |
$5,490.70
|
|
|
PLATE DISTAL RADIUS VOLAR LOCK 2.4 VA 6HL RT 02.111.630
|
Facility
|
OP
|
$6,276.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966367
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,827.57 |
| Max. Negotiated Rate |
$6,004.88 |
| Rate for Payer: Aetna Commercial |
$5,874.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,613.25
|
| Rate for Payer: Aetna Managed Medicare |
$1,827.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,242.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,263.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,132.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,459.33
|
| Rate for Payer: Cash Price |
$1,882.80
|
| Rate for Payer: Cigna Commercial |
$6,004.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,652.63
|
| Rate for Payer: Health EOS Commercial |
$5,809.07
|
| Rate for Payer: HFN Commercial |
$6,004.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,895.28
|
| Rate for Payer: Multiplan Commercial |
$5,221.63
|
| Rate for Payer: NAPHCARE Commercial |
$3,916.22
|
| Rate for Payer: Preferred Network Access Commercial |
$6,004.88
|
| Rate for Payer: Quartz Beloit One Network |
$3,198.25
|
| Rate for Payer: Quartz Commercial |
$4,242.58
|
| Rate for Payer: Quartz Medicare Advantage |
$3,916.22
|
| Rate for Payer: The Alliance Commercial |
$3,263.52
|
| Rate for Payer: WEA Trust Commercial |
$3,589.87
|
| Rate for Payer: WPS Commercial |
$4,834.40
|
|
|
PLATE DISTAL RADIUS VOLAR LOCK 2.4 VA 6HL RT 02.111.630
|
Facility
|
IP
|
$6,276.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966367
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,198.25 |
| Max. Negotiated Rate |
$6,004.88 |
| Rate for Payer: Aetna Commercial |
$5,874.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,613.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,459.33
|
| Rate for Payer: Cash Price |
$1,882.80
|
| Rate for Payer: Cigna Commercial |
$6,004.88
|
| Rate for Payer: Health EOS Commercial |
$5,809.07
|
| Rate for Payer: HFN Commercial |
$6,004.88
|
| Rate for Payer: Multiplan Commercial |
$5,221.63
|
| Rate for Payer: Preferred Network Access Commercial |
$6,004.88
|
| Rate for Payer: Quartz Beloit One Network |
$3,198.25
|
| Rate for Payer: Quartz Commercial |
$3,916.22
|
| Rate for Payer: WEA Trust Commercial |
$3,589.87
|
| Rate for Payer: WPS Commercial |
$4,834.40
|
|
|
PLATE DISTAL RADIUS VOLAR NAR LT 3HL TI AR-8916VNL-03
|
Facility
|
OP
|
$6,344.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5456670
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,847.37 |
| Max. Negotiated Rate |
$6,069.94 |
| Rate for Payer: Aetna Commercial |
$5,937.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,674.07
|
| Rate for Payer: Aetna Managed Medicare |
$1,847.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,288.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,298.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,166.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,496.81
|
| Rate for Payer: Cash Price |
$1,903.20
|
| Rate for Payer: Cigna Commercial |
$6,069.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,692.21
|
| Rate for Payer: Health EOS Commercial |
$5,872.01
|
| Rate for Payer: HFN Commercial |
$6,069.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,948.32
|
| Rate for Payer: Multiplan Commercial |
$5,278.21
|
| Rate for Payer: NAPHCARE Commercial |
$3,958.66
|
| Rate for Payer: Preferred Network Access Commercial |
$6,069.94
|
| Rate for Payer: Quartz Beloit One Network |
$3,232.90
|
| Rate for Payer: Quartz Commercial |
$4,288.54
|
| Rate for Payer: Quartz Medicare Advantage |
$3,958.66
|
| Rate for Payer: The Alliance Commercial |
$3,298.88
|
| Rate for Payer: WEA Trust Commercial |
$3,628.77
|
| Rate for Payer: WPS Commercial |
$4,886.78
|
|
|
PLATE DISTAL RADIUS VOLAR NAR LT 3HL TI AR-8916VNL-03
|
Facility
|
IP
|
$6,344.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5456670
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,232.90 |
| Max. Negotiated Rate |
$6,069.94 |
| Rate for Payer: Aetna Commercial |
$5,937.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,674.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,496.81
|
| Rate for Payer: Cash Price |
$1,903.20
|
| Rate for Payer: Cigna Commercial |
$6,069.94
|
| Rate for Payer: Health EOS Commercial |
$5,872.01
|
| Rate for Payer: HFN Commercial |
$6,069.94
|
| Rate for Payer: Multiplan Commercial |
$5,278.21
|
| Rate for Payer: Preferred Network Access Commercial |
$6,069.94
|
| Rate for Payer: Quartz Beloit One Network |
$3,232.90
|
| Rate for Payer: Quartz Commercial |
$3,958.66
|
| Rate for Payer: WEA Trust Commercial |
$3,628.77
|
| Rate for Payer: WPS Commercial |
$4,886.78
|
|
|
PLATE DISTAL RADIUS VOLAR NAR LT 5H TI AR-8916VNL-05
|
Facility
|
IP
|
$6,344.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5458932
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,232.90 |
| Max. Negotiated Rate |
$6,069.94 |
| Rate for Payer: Aetna Commercial |
$5,937.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,674.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,496.81
|
| Rate for Payer: Cash Price |
$1,903.20
|
| Rate for Payer: Cigna Commercial |
$6,069.94
|
| Rate for Payer: Health EOS Commercial |
$5,872.01
|
| Rate for Payer: HFN Commercial |
$6,069.94
|
| Rate for Payer: Multiplan Commercial |
$5,278.21
|
| Rate for Payer: Preferred Network Access Commercial |
$6,069.94
|
| Rate for Payer: Quartz Beloit One Network |
$3,232.90
|
| Rate for Payer: Quartz Commercial |
$3,958.66
|
| Rate for Payer: WEA Trust Commercial |
$3,628.77
|
| Rate for Payer: WPS Commercial |
$4,886.78
|
|
|
PLATE DISTAL RADIUS VOLAR NAR LT 5H TI AR-8916VNL-05
|
Facility
|
OP
|
$6,344.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5458932
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,847.37 |
| Max. Negotiated Rate |
$6,069.94 |
| Rate for Payer: Aetna Commercial |
$5,937.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,674.07
|
| Rate for Payer: Aetna Managed Medicare |
$1,847.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,288.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,298.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,166.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,496.81
|
| Rate for Payer: Cash Price |
$1,903.20
|
| Rate for Payer: Cigna Commercial |
$6,069.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,692.21
|
| Rate for Payer: Health EOS Commercial |
$5,872.01
|
| Rate for Payer: HFN Commercial |
$6,069.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,948.32
|
| Rate for Payer: Multiplan Commercial |
$5,278.21
|
| Rate for Payer: NAPHCARE Commercial |
$3,958.66
|
| Rate for Payer: Preferred Network Access Commercial |
$6,069.94
|
| Rate for Payer: Quartz Beloit One Network |
$3,232.90
|
| Rate for Payer: Quartz Commercial |
$4,288.54
|
| Rate for Payer: Quartz Medicare Advantage |
$3,958.66
|
| Rate for Payer: The Alliance Commercial |
$3,298.88
|
| Rate for Payer: WEA Trust Commercial |
$3,628.77
|
| Rate for Payer: WPS Commercial |
$4,886.78
|
|
|
PLATE DISTAL RADIUS VOLAR NAR RT 3H TI AR-8916VNR-03
|
Facility
|
IP
|
$6,344.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5547317
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,232.90 |
| Max. Negotiated Rate |
$6,069.94 |
| Rate for Payer: Aetna Commercial |
$5,937.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,674.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,496.81
|
| Rate for Payer: Cash Price |
$1,903.20
|
| Rate for Payer: Cigna Commercial |
$6,069.94
|
| Rate for Payer: Health EOS Commercial |
$5,872.01
|
| Rate for Payer: HFN Commercial |
$6,069.94
|
| Rate for Payer: Multiplan Commercial |
$5,278.21
|
| Rate for Payer: Preferred Network Access Commercial |
$6,069.94
|
| Rate for Payer: Quartz Beloit One Network |
$3,232.90
|
| Rate for Payer: Quartz Commercial |
$3,958.66
|
| Rate for Payer: WEA Trust Commercial |
$3,628.77
|
| Rate for Payer: WPS Commercial |
$4,886.78
|
|
|
PLATE DISTAL RADIUS VOLAR NAR RT 3H TI AR-8916VNR-03
|
Facility
|
OP
|
$6,344.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5547317
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,847.37 |
| Max. Negotiated Rate |
$6,069.94 |
| Rate for Payer: Aetna Commercial |
$5,937.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,674.07
|
| Rate for Payer: Aetna Managed Medicare |
$1,847.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,288.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,298.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,166.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,496.81
|
| Rate for Payer: Cash Price |
$1,903.20
|
| Rate for Payer: Cigna Commercial |
$6,069.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,692.21
|
| Rate for Payer: Health EOS Commercial |
$5,872.01
|
| Rate for Payer: HFN Commercial |
$6,069.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,948.32
|
| Rate for Payer: Multiplan Commercial |
$5,278.21
|
| Rate for Payer: NAPHCARE Commercial |
$3,958.66
|
| Rate for Payer: Preferred Network Access Commercial |
$6,069.94
|
| Rate for Payer: Quartz Beloit One Network |
$3,232.90
|
| Rate for Payer: Quartz Commercial |
$4,288.54
|
| Rate for Payer: Quartz Medicare Advantage |
$3,958.66
|
| Rate for Payer: The Alliance Commercial |
$3,298.88
|
| Rate for Payer: WEA Trust Commercial |
$3,628.77
|
| Rate for Payer: WPS Commercial |
$4,886.78
|
|
|
PLATE DISTAL RADIUS VOLAR STD LT 3HL TI AR-8916VSL-03
|
Facility
|
IP
|
$6,344.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599748
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,232.90 |
| Max. Negotiated Rate |
$6,069.94 |
| Rate for Payer: Aetna Commercial |
$5,937.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,674.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,496.81
|
| Rate for Payer: Cash Price |
$1,903.20
|
| Rate for Payer: Cigna Commercial |
$6,069.94
|
| Rate for Payer: Health EOS Commercial |
$5,872.01
|
| Rate for Payer: HFN Commercial |
$6,069.94
|
| Rate for Payer: Multiplan Commercial |
$5,278.21
|
| Rate for Payer: Preferred Network Access Commercial |
$6,069.94
|
| Rate for Payer: Quartz Beloit One Network |
$3,232.90
|
| Rate for Payer: Quartz Commercial |
$3,958.66
|
| Rate for Payer: WEA Trust Commercial |
$3,628.77
|
| Rate for Payer: WPS Commercial |
$4,886.78
|
|
|
PLATE DISTAL RADIUS VOLAR STD LT 3HL TI AR-8916VSL-03
|
Facility
|
OP
|
$6,344.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599748
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,847.37 |
| Max. Negotiated Rate |
$6,069.94 |
| Rate for Payer: Aetna Commercial |
$5,937.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,674.07
|
| Rate for Payer: Aetna Managed Medicare |
$1,847.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,288.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,298.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,166.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,496.81
|
| Rate for Payer: Cash Price |
$1,903.20
|
| Rate for Payer: Cigna Commercial |
$6,069.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,692.21
|
| Rate for Payer: Health EOS Commercial |
$5,872.01
|
| Rate for Payer: HFN Commercial |
$6,069.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,948.32
|
| Rate for Payer: Multiplan Commercial |
$5,278.21
|
| Rate for Payer: NAPHCARE Commercial |
$3,958.66
|
| Rate for Payer: Preferred Network Access Commercial |
$6,069.94
|
| Rate for Payer: Quartz Beloit One Network |
$3,232.90
|
| Rate for Payer: Quartz Commercial |
$4,288.54
|
| Rate for Payer: Quartz Medicare Advantage |
$3,958.66
|
| Rate for Payer: The Alliance Commercial |
$3,298.88
|
| Rate for Payer: WEA Trust Commercial |
$3,628.77
|
| Rate for Payer: WPS Commercial |
$4,886.78
|
|
|
PLATE DISTAL RADIUS VOLAR STD LT 5HL TI AR-8916VSL-05
|
Facility
|
IP
|
$6,344.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459465
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,232.90 |
| Max. Negotiated Rate |
$6,069.94 |
| Rate for Payer: Aetna Commercial |
$5,937.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,674.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,496.81
|
| Rate for Payer: Cash Price |
$1,903.20
|
| Rate for Payer: Cigna Commercial |
$6,069.94
|
| Rate for Payer: Health EOS Commercial |
$5,872.01
|
| Rate for Payer: HFN Commercial |
$6,069.94
|
| Rate for Payer: Multiplan Commercial |
$5,278.21
|
| Rate for Payer: Preferred Network Access Commercial |
$6,069.94
|
| Rate for Payer: Quartz Beloit One Network |
$3,232.90
|
| Rate for Payer: Quartz Commercial |
$3,958.66
|
| Rate for Payer: WEA Trust Commercial |
$3,628.77
|
| Rate for Payer: WPS Commercial |
$4,886.78
|
|
|
PLATE DISTAL RADIUS VOLAR STD LT 5HL TI AR-8916VSL-05
|
Facility
|
OP
|
$6,344.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459465
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,847.37 |
| Max. Negotiated Rate |
$6,069.94 |
| Rate for Payer: Aetna Commercial |
$5,937.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,674.07
|
| Rate for Payer: Aetna Managed Medicare |
$1,847.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,288.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,298.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,166.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,496.81
|
| Rate for Payer: Cash Price |
$1,903.20
|
| Rate for Payer: Cigna Commercial |
$6,069.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,692.21
|
| Rate for Payer: Health EOS Commercial |
$5,872.01
|
| Rate for Payer: HFN Commercial |
$6,069.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,948.32
|
| Rate for Payer: Multiplan Commercial |
$5,278.21
|
| Rate for Payer: NAPHCARE Commercial |
$3,958.66
|
| Rate for Payer: Preferred Network Access Commercial |
$6,069.94
|
| Rate for Payer: Quartz Beloit One Network |
$3,232.90
|
| Rate for Payer: Quartz Commercial |
$4,288.54
|
| Rate for Payer: Quartz Medicare Advantage |
$3,958.66
|
| Rate for Payer: The Alliance Commercial |
$3,298.88
|
| Rate for Payer: WEA Trust Commercial |
$3,628.77
|
| Rate for Payer: WPS Commercial |
$4,886.78
|
|
|
PLATE DISTAL RADIUS VOLAR STD RT 3HL TI AR-8916VSR-03
|
Facility
|
OP
|
$6,344.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5384975
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,847.37 |
| Max. Negotiated Rate |
$6,069.94 |
| Rate for Payer: Aetna Commercial |
$5,937.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,674.07
|
| Rate for Payer: Aetna Managed Medicare |
$1,847.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,288.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,298.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,166.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,496.81
|
| Rate for Payer: Cash Price |
$1,903.20
|
| Rate for Payer: Cigna Commercial |
$6,069.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,692.21
|
| Rate for Payer: Health EOS Commercial |
$5,872.01
|
| Rate for Payer: HFN Commercial |
$6,069.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,948.32
|
| Rate for Payer: Multiplan Commercial |
$5,278.21
|
| Rate for Payer: NAPHCARE Commercial |
$3,958.66
|
| Rate for Payer: Preferred Network Access Commercial |
$6,069.94
|
| Rate for Payer: Quartz Beloit One Network |
$3,232.90
|
| Rate for Payer: Quartz Commercial |
$4,288.54
|
| Rate for Payer: Quartz Medicare Advantage |
$3,958.66
|
| Rate for Payer: The Alliance Commercial |
$3,298.88
|
| Rate for Payer: WEA Trust Commercial |
$3,628.77
|
| Rate for Payer: WPS Commercial |
$4,886.78
|
|
|
PLATE DISTAL RADIUS VOLAR STD RT 3HL TI AR-8916VSR-03
|
Facility
|
IP
|
$6,344.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5384975
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,232.90 |
| Max. Negotiated Rate |
$6,069.94 |
| Rate for Payer: Aetna Commercial |
$5,937.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,674.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,496.81
|
| Rate for Payer: Cash Price |
$1,903.20
|
| Rate for Payer: Cigna Commercial |
$6,069.94
|
| Rate for Payer: Health EOS Commercial |
$5,872.01
|
| Rate for Payer: HFN Commercial |
$6,069.94
|
| Rate for Payer: Multiplan Commercial |
$5,278.21
|
| Rate for Payer: Preferred Network Access Commercial |
$6,069.94
|
| Rate for Payer: Quartz Beloit One Network |
$3,232.90
|
| Rate for Payer: Quartz Commercial |
$3,958.66
|
| Rate for Payer: WEA Trust Commercial |
$3,628.77
|
| Rate for Payer: WPS Commercial |
$4,886.78
|
|
|
PLATE DISTAL RADIUS VOLAR WIDE LT 5HL TI AR-8916VWL-05
|
Facility
|
OP
|
$6,344.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414823
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,847.37 |
| Max. Negotiated Rate |
$6,069.94 |
| Rate for Payer: Aetna Commercial |
$5,937.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,674.07
|
| Rate for Payer: Aetna Managed Medicare |
$1,847.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,288.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,298.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,166.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,496.81
|
| Rate for Payer: Cash Price |
$1,903.20
|
| Rate for Payer: Cigna Commercial |
$6,069.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,692.21
|
| Rate for Payer: Health EOS Commercial |
$5,872.01
|
| Rate for Payer: HFN Commercial |
$6,069.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,948.32
|
| Rate for Payer: Multiplan Commercial |
$5,278.21
|
| Rate for Payer: NAPHCARE Commercial |
$3,958.66
|
| Rate for Payer: Preferred Network Access Commercial |
$6,069.94
|
| Rate for Payer: Quartz Beloit One Network |
$3,232.90
|
| Rate for Payer: Quartz Commercial |
$4,288.54
|
| Rate for Payer: Quartz Medicare Advantage |
$3,958.66
|
| Rate for Payer: The Alliance Commercial |
$3,298.88
|
| Rate for Payer: WEA Trust Commercial |
$3,628.77
|
| Rate for Payer: WPS Commercial |
$4,886.78
|
|
|
PLATE DISTAL RADIUS VOLAR WIDE LT 5HL TI AR-8916VWL-05
|
Facility
|
IP
|
$6,344.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414823
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,232.90 |
| Max. Negotiated Rate |
$6,069.94 |
| Rate for Payer: Aetna Commercial |
$5,937.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,674.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,496.81
|
| Rate for Payer: Cash Price |
$1,903.20
|
| Rate for Payer: Cigna Commercial |
$6,069.94
|
| Rate for Payer: Health EOS Commercial |
$5,872.01
|
| Rate for Payer: HFN Commercial |
$6,069.94
|
| Rate for Payer: Multiplan Commercial |
$5,278.21
|
| Rate for Payer: Preferred Network Access Commercial |
$6,069.94
|
| Rate for Payer: Quartz Beloit One Network |
$3,232.90
|
| Rate for Payer: Quartz Commercial |
$3,958.66
|
| Rate for Payer: WEA Trust Commercial |
$3,628.77
|
| Rate for Payer: WPS Commercial |
$4,886.78
|
|
|
PLATE DISTAL RADIUS VOLAR WIDE RT 3HL TI AR-8916VWR-03
|
Facility
|
OP
|
$6,344.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414681
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,847.37 |
| Max. Negotiated Rate |
$6,069.94 |
| Rate for Payer: Aetna Commercial |
$5,937.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,674.07
|
| Rate for Payer: Aetna Managed Medicare |
$1,847.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,288.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,298.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,166.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,496.81
|
| Rate for Payer: Cash Price |
$1,903.20
|
| Rate for Payer: Cigna Commercial |
$6,069.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,692.21
|
| Rate for Payer: Health EOS Commercial |
$5,872.01
|
| Rate for Payer: HFN Commercial |
$6,069.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,948.32
|
| Rate for Payer: Multiplan Commercial |
$5,278.21
|
| Rate for Payer: NAPHCARE Commercial |
$3,958.66
|
| Rate for Payer: Preferred Network Access Commercial |
$6,069.94
|
| Rate for Payer: Quartz Beloit One Network |
$3,232.90
|
| Rate for Payer: Quartz Commercial |
$4,288.54
|
| Rate for Payer: Quartz Medicare Advantage |
$3,958.66
|
| Rate for Payer: The Alliance Commercial |
$3,298.88
|
| Rate for Payer: WEA Trust Commercial |
$3,628.77
|
| Rate for Payer: WPS Commercial |
$4,886.78
|
|
|
PLATE DISTAL RADIUS VOLAR WIDE RT 3HL TI AR-8916VWR-03
|
Facility
|
IP
|
$6,344.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414681
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,232.90 |
| Max. Negotiated Rate |
$6,069.94 |
| Rate for Payer: Aetna Commercial |
$5,937.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,674.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,496.81
|
| Rate for Payer: Cash Price |
$1,903.20
|
| Rate for Payer: Cigna Commercial |
$6,069.94
|
| Rate for Payer: Health EOS Commercial |
$5,872.01
|
| Rate for Payer: HFN Commercial |
$6,069.94
|
| Rate for Payer: Multiplan Commercial |
$5,278.21
|
| Rate for Payer: Preferred Network Access Commercial |
$6,069.94
|
| Rate for Payer: Quartz Beloit One Network |
$3,232.90
|
| Rate for Payer: Quartz Commercial |
$3,958.66
|
| Rate for Payer: WEA Trust Commercial |
$3,628.77
|
| Rate for Payer: WPS Commercial |
$4,886.78
|
|
|
PLATE DISTAL RADIUS VOLAR WIDE RT 5HL TI AR-8916VWR-05
|
Facility
|
IP
|
$6,344.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414731
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,232.90 |
| Max. Negotiated Rate |
$6,069.94 |
| Rate for Payer: Aetna Commercial |
$5,937.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,674.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,496.81
|
| Rate for Payer: Cash Price |
$1,903.20
|
| Rate for Payer: Cigna Commercial |
$6,069.94
|
| Rate for Payer: Health EOS Commercial |
$5,872.01
|
| Rate for Payer: HFN Commercial |
$6,069.94
|
| Rate for Payer: Multiplan Commercial |
$5,278.21
|
| Rate for Payer: Preferred Network Access Commercial |
$6,069.94
|
| Rate for Payer: Quartz Beloit One Network |
$3,232.90
|
| Rate for Payer: Quartz Commercial |
$3,958.66
|
| Rate for Payer: WEA Trust Commercial |
$3,628.77
|
| Rate for Payer: WPS Commercial |
$4,886.78
|
|
|
PLATE DISTAL RADIUS VOLAR WIDE RT 5HL TI AR-8916VWR-05
|
Facility
|
OP
|
$6,344.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414731
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,847.37 |
| Max. Negotiated Rate |
$6,069.94 |
| Rate for Payer: Aetna Commercial |
$5,937.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,674.07
|
| Rate for Payer: Aetna Managed Medicare |
$1,847.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,288.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,298.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,166.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,496.81
|
| Rate for Payer: Cash Price |
$1,903.20
|
| Rate for Payer: Cigna Commercial |
$6,069.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,692.21
|
| Rate for Payer: Health EOS Commercial |
$5,872.01
|
| Rate for Payer: HFN Commercial |
$6,069.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,948.32
|
| Rate for Payer: Multiplan Commercial |
$5,278.21
|
| Rate for Payer: NAPHCARE Commercial |
$3,958.66
|
| Rate for Payer: Preferred Network Access Commercial |
$6,069.94
|
| Rate for Payer: Quartz Beloit One Network |
$3,232.90
|
| Rate for Payer: Quartz Commercial |
$4,288.54
|
| Rate for Payer: Quartz Medicare Advantage |
$3,958.66
|
| Rate for Payer: The Alliance Commercial |
$3,298.88
|
| Rate for Payer: WEA Trust Commercial |
$3,628.77
|
| Rate for Payer: WPS Commercial |
$4,886.78
|
|
|
PLATE DISTAL TIBIA 3.5 5HL LT
|
Facility
|
OP
|
$2,981.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966366
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$868.07 |
| Max. Negotiated Rate |
$2,852.22 |
| Rate for Payer: Aetna Commercial |
$2,790.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,666.21
|
| Rate for Payer: Aetna Managed Medicare |
$868.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,015.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,550.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,488.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,643.13
|
| Rate for Payer: Cash Price |
$894.30
|
| Rate for Payer: Cigna Commercial |
$2,852.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,734.94
|
| Rate for Payer: Health EOS Commercial |
$2,759.21
|
| Rate for Payer: HFN Commercial |
$2,852.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,325.18
|
| Rate for Payer: Multiplan Commercial |
$2,480.19
|
| Rate for Payer: NAPHCARE Commercial |
$1,860.14
|
| Rate for Payer: Preferred Network Access Commercial |
$2,852.22
|
| Rate for Payer: Quartz Beloit One Network |
$1,519.12
|
| Rate for Payer: Quartz Commercial |
$2,015.16
|
| Rate for Payer: Quartz Medicare Advantage |
$1,860.14
|
| Rate for Payer: The Alliance Commercial |
$1,550.12
|
| Rate for Payer: WEA Trust Commercial |
$1,705.13
|
| Rate for Payer: WPS Commercial |
$2,296.26
|
|
