|
PLATE DISTAL MEDIAL HUMERUS 6HL 629386
|
Facility
|
OP
|
$7,456.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4006557
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,087.68 |
| Max. Negotiated Rate |
$29,824.00 |
| Rate for Payer: Aetna Commercial |
$6,710.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,412.16
|
| Rate for Payer: Aetna Managed Medicare |
$2,087.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,846.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,728.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,578.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,951.68
|
| Rate for Payer: Cash Price |
$2,236.80
|
| Rate for Payer: Cigna Commercial |
$6,859.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,172.38
|
| Rate for Payer: Health EOS Commercial |
$6,635.84
|
| Rate for Payer: HFN Commercial |
$6,859.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,592.00
|
| Rate for Payer: Multiplan Commercial |
$5,964.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,473.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,859.52
|
| Rate for Payer: Quartz Beloit One Network |
$3,653.44
|
| Rate for Payer: Quartz Commercial |
$4,846.40
|
| Rate for Payer: Quartz Medicare Advantage |
$4,473.60
|
| Rate for Payer: The Alliance Commercial |
$29,824.00
|
| Rate for Payer: WEA Trust Commercial |
$4,100.80
|
| Rate for Payer: WPS Commercial |
$5,522.66
|
|
|
PLATE DISTAL MEDIAL HUMERUS 6HL 629386
|
Facility
|
IP
|
$7,456.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4006557
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,653.44 |
| Max. Negotiated Rate |
$6,859.52 |
| Rate for Payer: Aetna Commercial |
$6,710.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,412.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,951.68
|
| Rate for Payer: Cash Price |
$2,236.80
|
| Rate for Payer: Cigna Commercial |
$6,859.52
|
| Rate for Payer: Health EOS Commercial |
$6,635.84
|
| Rate for Payer: HFN Commercial |
$6,859.52
|
| Rate for Payer: Multiplan Commercial |
$5,964.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,473.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,859.52
|
| Rate for Payer: Quartz Beloit One Network |
$3,653.44
|
| Rate for Payer: Quartz Commercial |
$4,473.60
|
| Rate for Payer: WEA Trust Commercial |
$4,100.80
|
| Rate for Payer: WPS Commercial |
$5,522.66
|
|
|
PLATE DISTAL RADIUS DORSAL NAR LT 4HL TI AR-8916DNL-04
|
Facility
|
IP
|
$6,430.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6217071
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,150.70 |
| Max. Negotiated Rate |
$5,915.60 |
| Rate for Payer: Aetna Commercial |
$5,787.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,529.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,407.90
|
| Rate for Payer: Cash Price |
$1,929.00
|
| Rate for Payer: Cigna Commercial |
$5,915.60
|
| Rate for Payer: Health EOS Commercial |
$5,722.70
|
| Rate for Payer: HFN Commercial |
$5,915.60
|
| Rate for Payer: Multiplan Commercial |
$5,144.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,858.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,915.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,150.70
|
| Rate for Payer: Quartz Commercial |
$3,858.00
|
| Rate for Payer: WEA Trust Commercial |
$3,536.50
|
| Rate for Payer: WPS Commercial |
$4,762.70
|
|
|
PLATE DISTAL RADIUS DORSAL NAR LT 4HL TI AR-8916DNL-04
|
Facility
|
OP
|
$6,430.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6217071
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,800.40 |
| Max. Negotiated Rate |
$25,720.00 |
| Rate for Payer: Aetna Commercial |
$5,787.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,529.80
|
| Rate for Payer: Aetna Managed Medicare |
$1,800.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,179.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,215.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,086.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,407.90
|
| Rate for Payer: Cash Price |
$1,929.00
|
| Rate for Payer: Cigna Commercial |
$5,915.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,598.23
|
| Rate for Payer: Health EOS Commercial |
$5,722.70
|
| Rate for Payer: HFN Commercial |
$5,915.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,822.50
|
| Rate for Payer: Multiplan Commercial |
$5,144.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,858.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,915.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,150.70
|
| Rate for Payer: Quartz Commercial |
$4,179.50
|
| Rate for Payer: Quartz Medicare Advantage |
$3,858.00
|
| Rate for Payer: The Alliance Commercial |
$25,720.00
|
| Rate for Payer: WEA Trust Commercial |
$3,536.50
|
| Rate for Payer: WPS Commercial |
$4,762.70
|
|
|
PLATE DISTAL RADIUS LONG/VOLAR LT TI 442.492
|
Facility
|
OP
|
$6,463.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3853336
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,809.64 |
| Max. Negotiated Rate |
$25,852.00 |
| Rate for Payer: Aetna Commercial |
$5,816.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,558.18
|
| Rate for Payer: Aetna Managed Medicare |
$1,809.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,200.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,231.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,102.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,425.39
|
| Rate for Payer: Cash Price |
$1,938.90
|
| Rate for Payer: Cigna Commercial |
$5,945.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,616.69
|
| Rate for Payer: Health EOS Commercial |
$5,752.07
|
| Rate for Payer: HFN Commercial |
$5,945.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,847.25
|
| Rate for Payer: Multiplan Commercial |
$5,170.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,877.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,945.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,166.87
|
| Rate for Payer: Quartz Commercial |
$4,200.95
|
| Rate for Payer: Quartz Medicare Advantage |
$3,877.80
|
| Rate for Payer: The Alliance Commercial |
$25,852.00
|
| Rate for Payer: WEA Trust Commercial |
$3,554.65
|
| Rate for Payer: WPS Commercial |
$4,787.14
|
|
|
PLATE DISTAL RADIUS LONG/VOLAR LT TI 442.492
|
Facility
|
IP
|
$6,463.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3853336
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,166.87 |
| Max. Negotiated Rate |
$5,945.96 |
| Rate for Payer: Aetna Commercial |
$5,816.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,558.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,425.39
|
| Rate for Payer: Cash Price |
$1,938.90
|
| Rate for Payer: Cigna Commercial |
$5,945.96
|
| Rate for Payer: Health EOS Commercial |
$5,752.07
|
| Rate for Payer: HFN Commercial |
$5,945.96
|
| Rate for Payer: Multiplan Commercial |
$5,170.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,877.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,945.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,166.87
|
| Rate for Payer: Quartz Commercial |
$3,877.80
|
| Rate for Payer: WEA Trust Commercial |
$3,554.65
|
| Rate for Payer: WPS Commercial |
$4,787.14
|
|
|
PLATE DISTAL RADIUS RADIAL STYLOID 5HL AR-8916RSTY-05
|
Facility
|
IP
|
$6,602.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6165906
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,234.98 |
| Max. Negotiated Rate |
$6,073.84 |
| Rate for Payer: Aetna Commercial |
$5,941.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,677.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,499.06
|
| Rate for Payer: Cash Price |
$1,980.60
|
| Rate for Payer: Cigna Commercial |
$6,073.84
|
| Rate for Payer: Health EOS Commercial |
$5,875.78
|
| Rate for Payer: HFN Commercial |
$6,073.84
|
| Rate for Payer: Multiplan Commercial |
$5,281.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,961.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,073.84
|
| Rate for Payer: Quartz Beloit One Network |
$3,234.98
|
| Rate for Payer: Quartz Commercial |
$3,961.20
|
| Rate for Payer: WEA Trust Commercial |
$3,631.10
|
| Rate for Payer: WPS Commercial |
$4,890.10
|
|
|
PLATE DISTAL RADIUS RADIAL STYLOID 5HL AR-8916RSTY-05
|
Facility
|
OP
|
$6,602.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6165906
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,848.56 |
| Max. Negotiated Rate |
$26,408.00 |
| Rate for Payer: Aetna Commercial |
$5,941.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,677.72
|
| Rate for Payer: Aetna Managed Medicare |
$1,848.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,291.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,301.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,168.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,499.06
|
| Rate for Payer: Cash Price |
$1,980.60
|
| Rate for Payer: Cigna Commercial |
$6,073.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,694.48
|
| Rate for Payer: Health EOS Commercial |
$5,875.78
|
| Rate for Payer: HFN Commercial |
$6,073.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,951.50
|
| Rate for Payer: Multiplan Commercial |
$5,281.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,961.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,073.84
|
| Rate for Payer: Quartz Beloit One Network |
$3,234.98
|
| Rate for Payer: Quartz Commercial |
$4,291.30
|
| Rate for Payer: Quartz Medicare Advantage |
$3,961.20
|
| Rate for Payer: The Alliance Commercial |
$26,408.00
|
| Rate for Payer: WEA Trust Commercial |
$3,631.10
|
| Rate for Payer: WPS Commercial |
$4,890.10
|
|
|
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 |
$1,832.88 |
| Max. Negotiated Rate |
$26,184.00 |
| Rate for Payer: Aetna Commercial |
$5,891.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,629.56
|
| Rate for Payer: Aetna Managed Medicare |
$1,832.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,254.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,273.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,142.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,469.38
|
| Rate for Payer: Cash Price |
$1,963.80
|
| Rate for Payer: Cigna Commercial |
$6,022.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,663.14
|
| Rate for Payer: Health EOS Commercial |
$5,825.94
|
| Rate for Payer: HFN Commercial |
$6,022.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,909.50
|
| Rate for Payer: Multiplan Commercial |
$5,236.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,927.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,022.32
|
| Rate for Payer: Quartz Beloit One Network |
$3,207.54
|
| Rate for Payer: Quartz Commercial |
$4,254.90
|
| Rate for Payer: Quartz Medicare Advantage |
$3,927.60
|
| Rate for Payer: The Alliance Commercial |
$26,184.00
|
| Rate for Payer: WEA Trust Commercial |
$3,600.30
|
| Rate for Payer: WPS Commercial |
$4,848.62
|
|
|
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 |
$3,207.54 |
| Max. Negotiated Rate |
$6,022.32 |
| Rate for Payer: Aetna Commercial |
$5,891.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,629.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,469.38
|
| Rate for Payer: Cash Price |
$1,963.80
|
| Rate for Payer: Cigna Commercial |
$6,022.32
|
| Rate for Payer: Health EOS Commercial |
$5,825.94
|
| Rate for Payer: HFN Commercial |
$6,022.32
|
| Rate for Payer: Multiplan Commercial |
$5,236.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,927.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,022.32
|
| Rate for Payer: Quartz Beloit One Network |
$3,207.54
|
| Rate for Payer: Quartz Commercial |
$3,927.60
|
| Rate for Payer: WEA Trust Commercial |
$3,600.30
|
| Rate for Payer: WPS Commercial |
$4,848.62
|
|
|
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 |
$3,492.72 |
| Max. Negotiated Rate |
$6,557.76 |
| Rate for Payer: Aetna Commercial |
$6,415.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,130.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,777.84
|
| Rate for Payer: Cash Price |
$2,138.40
|
| Rate for Payer: Cigna Commercial |
$6,557.76
|
| Rate for Payer: Health EOS Commercial |
$6,343.92
|
| Rate for Payer: HFN Commercial |
$6,557.76
|
| Rate for Payer: Multiplan Commercial |
$5,702.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,276.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,557.76
|
| Rate for Payer: Quartz Beloit One Network |
$3,492.72
|
| Rate for Payer: Quartz Commercial |
$4,276.80
|
| Rate for Payer: WEA Trust Commercial |
$3,920.40
|
| Rate for Payer: WPS Commercial |
$5,279.71
|
|
|
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 |
$1,995.84 |
| Max. Negotiated Rate |
$28,512.00 |
| Rate for Payer: Aetna Commercial |
$6,415.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,130.08
|
| Rate for Payer: Aetna Managed Medicare |
$1,995.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,633.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,564.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,421.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,777.84
|
| Rate for Payer: Cash Price |
$2,138.40
|
| Rate for Payer: Cigna Commercial |
$6,557.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,988.83
|
| Rate for Payer: Health EOS Commercial |
$6,343.92
|
| Rate for Payer: HFN Commercial |
$6,557.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,346.00
|
| Rate for Payer: Multiplan Commercial |
$5,702.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,276.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,557.76
|
| Rate for Payer: Quartz Beloit One Network |
$3,492.72
|
| Rate for Payer: Quartz Commercial |
$4,633.20
|
| Rate for Payer: Quartz Medicare Advantage |
$4,276.80
|
| Rate for Payer: The Alliance Commercial |
$28,512.00
|
| Rate for Payer: WEA Trust Commercial |
$3,920.40
|
| Rate for Payer: WPS Commercial |
$5,279.71
|
|
|
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 |
$1,757.28 |
| Max. Negotiated Rate |
$25,104.00 |
| Rate for Payer: Aetna Commercial |
$5,648.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,397.36
|
| Rate for Payer: Aetna Managed Medicare |
$1,757.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,079.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,138.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,012.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,326.28
|
| Rate for Payer: Cash Price |
$1,882.80
|
| Rate for Payer: Cigna Commercial |
$5,773.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,512.05
|
| Rate for Payer: Health EOS Commercial |
$5,585.64
|
| Rate for Payer: HFN Commercial |
$5,773.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,707.00
|
| Rate for Payer: Multiplan Commercial |
$5,020.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,765.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,773.92
|
| Rate for Payer: Quartz Beloit One Network |
$3,075.24
|
| Rate for Payer: Quartz Commercial |
$4,079.40
|
| Rate for Payer: Quartz Medicare Advantage |
$3,765.60
|
| Rate for Payer: The Alliance Commercial |
$25,104.00
|
| Rate for Payer: WEA Trust Commercial |
$3,451.80
|
| Rate for Payer: WPS Commercial |
$4,648.63
|
|
|
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 |
$3,075.24 |
| Max. Negotiated Rate |
$5,773.92 |
| Rate for Payer: Aetna Commercial |
$5,648.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,397.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,326.28
|
| Rate for Payer: Cash Price |
$1,882.80
|
| Rate for Payer: Cigna Commercial |
$5,773.92
|
| Rate for Payer: Health EOS Commercial |
$5,585.64
|
| Rate for Payer: HFN Commercial |
$5,773.92
|
| Rate for Payer: Multiplan Commercial |
$5,020.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,765.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,773.92
|
| Rate for Payer: Quartz Beloit One Network |
$3,075.24
|
| Rate for Payer: Quartz Commercial |
$3,765.60
|
| Rate for Payer: WEA Trust Commercial |
$3,451.80
|
| Rate for Payer: WPS Commercial |
$4,648.63
|
|
|
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 |
$3,108.56 |
| Max. Negotiated Rate |
$5,836.48 |
| Rate for Payer: Aetna Commercial |
$5,709.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,455.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,362.32
|
| Rate for Payer: Cash Price |
$1,903.20
|
| Rate for Payer: Cigna Commercial |
$5,836.48
|
| Rate for Payer: Health EOS Commercial |
$5,646.16
|
| Rate for Payer: HFN Commercial |
$5,836.48
|
| Rate for Payer: Multiplan Commercial |
$5,075.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,806.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,836.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,108.56
|
| Rate for Payer: Quartz Commercial |
$3,806.40
|
| Rate for Payer: WEA Trust Commercial |
$3,489.20
|
| Rate for Payer: WPS Commercial |
$4,699.00
|
|
|
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 |
$1,776.32 |
| Max. Negotiated Rate |
$25,376.00 |
| Rate for Payer: Aetna Commercial |
$5,709.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,455.84
|
| Rate for Payer: Aetna Managed Medicare |
$1,776.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,123.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,172.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,045.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,362.32
|
| Rate for Payer: Cash Price |
$1,903.20
|
| Rate for Payer: Cigna Commercial |
$5,836.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,550.10
|
| Rate for Payer: Health EOS Commercial |
$5,646.16
|
| Rate for Payer: HFN Commercial |
$5,836.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,758.00
|
| Rate for Payer: Multiplan Commercial |
$5,075.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,806.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,836.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,108.56
|
| Rate for Payer: Quartz Commercial |
$4,123.60
|
| Rate for Payer: Quartz Medicare Advantage |
$3,806.40
|
| Rate for Payer: The Alliance Commercial |
$25,376.00
|
| Rate for Payer: WEA Trust Commercial |
$3,489.20
|
| Rate for Payer: WPS Commercial |
$4,699.00
|
|
|
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 |
$1,776.32 |
| Max. Negotiated Rate |
$25,376.00 |
| Rate for Payer: Aetna Commercial |
$5,709.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,455.84
|
| Rate for Payer: Aetna Managed Medicare |
$1,776.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,123.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,172.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,045.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,362.32
|
| Rate for Payer: Cash Price |
$1,903.20
|
| Rate for Payer: Cigna Commercial |
$5,836.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,550.10
|
| Rate for Payer: Health EOS Commercial |
$5,646.16
|
| Rate for Payer: HFN Commercial |
$5,836.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,758.00
|
| Rate for Payer: Multiplan Commercial |
$5,075.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,806.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,836.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,108.56
|
| Rate for Payer: Quartz Commercial |
$4,123.60
|
| Rate for Payer: Quartz Medicare Advantage |
$3,806.40
|
| Rate for Payer: The Alliance Commercial |
$25,376.00
|
| Rate for Payer: WEA Trust Commercial |
$3,489.20
|
| Rate for Payer: WPS Commercial |
$4,699.00
|
|
|
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 |
$3,108.56 |
| Max. Negotiated Rate |
$5,836.48 |
| Rate for Payer: Aetna Commercial |
$5,709.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,455.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,362.32
|
| Rate for Payer: Cash Price |
$1,903.20
|
| Rate for Payer: Cigna Commercial |
$5,836.48
|
| Rate for Payer: Health EOS Commercial |
$5,646.16
|
| Rate for Payer: HFN Commercial |
$5,836.48
|
| Rate for Payer: Multiplan Commercial |
$5,075.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,806.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,836.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,108.56
|
| Rate for Payer: Quartz Commercial |
$3,806.40
|
| Rate for Payer: WEA Trust Commercial |
$3,489.20
|
| Rate for Payer: WPS Commercial |
$4,699.00
|
|
|
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 |
$1,776.32 |
| Max. Negotiated Rate |
$25,376.00 |
| Rate for Payer: Aetna Commercial |
$5,709.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,455.84
|
| Rate for Payer: Aetna Managed Medicare |
$1,776.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,123.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,172.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,045.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,362.32
|
| Rate for Payer: Cash Price |
$1,903.20
|
| Rate for Payer: Cigna Commercial |
$5,836.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,550.10
|
| Rate for Payer: Health EOS Commercial |
$5,646.16
|
| Rate for Payer: HFN Commercial |
$5,836.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,758.00
|
| Rate for Payer: Multiplan Commercial |
$5,075.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,806.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,836.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,108.56
|
| Rate for Payer: Quartz Commercial |
$4,123.60
|
| Rate for Payer: Quartz Medicare Advantage |
$3,806.40
|
| Rate for Payer: The Alliance Commercial |
$25,376.00
|
| Rate for Payer: WEA Trust Commercial |
$3,489.20
|
| Rate for Payer: WPS Commercial |
$4,699.00
|
|
|
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 |
$3,108.56 |
| Max. Negotiated Rate |
$5,836.48 |
| Rate for Payer: Aetna Commercial |
$5,709.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,455.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,362.32
|
| Rate for Payer: Cash Price |
$1,903.20
|
| Rate for Payer: Cigna Commercial |
$5,836.48
|
| Rate for Payer: Health EOS Commercial |
$5,646.16
|
| Rate for Payer: HFN Commercial |
$5,836.48
|
| Rate for Payer: Multiplan Commercial |
$5,075.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,806.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,836.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,108.56
|
| Rate for Payer: Quartz Commercial |
$3,806.40
|
| Rate for Payer: WEA Trust Commercial |
$3,489.20
|
| Rate for Payer: WPS Commercial |
$4,699.00
|
|
|
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 |
$1,776.32 |
| Max. Negotiated Rate |
$25,376.00 |
| Rate for Payer: Aetna Commercial |
$5,709.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,455.84
|
| Rate for Payer: Aetna Managed Medicare |
$1,776.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,123.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,172.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,045.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,362.32
|
| Rate for Payer: Cash Price |
$1,903.20
|
| Rate for Payer: Cigna Commercial |
$5,836.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,550.10
|
| Rate for Payer: Health EOS Commercial |
$5,646.16
|
| Rate for Payer: HFN Commercial |
$5,836.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,758.00
|
| Rate for Payer: Multiplan Commercial |
$5,075.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,806.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,836.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,108.56
|
| Rate for Payer: Quartz Commercial |
$4,123.60
|
| Rate for Payer: Quartz Medicare Advantage |
$3,806.40
|
| Rate for Payer: The Alliance Commercial |
$25,376.00
|
| Rate for Payer: WEA Trust Commercial |
$3,489.20
|
| Rate for Payer: WPS Commercial |
$4,699.00
|
|
|
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 |
$3,108.56 |
| Max. Negotiated Rate |
$5,836.48 |
| Rate for Payer: Aetna Commercial |
$5,709.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,455.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,362.32
|
| Rate for Payer: Cash Price |
$1,903.20
|
| Rate for Payer: Cigna Commercial |
$5,836.48
|
| Rate for Payer: Health EOS Commercial |
$5,646.16
|
| Rate for Payer: HFN Commercial |
$5,836.48
|
| Rate for Payer: Multiplan Commercial |
$5,075.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,806.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,836.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,108.56
|
| Rate for Payer: Quartz Commercial |
$3,806.40
|
| Rate for Payer: WEA Trust Commercial |
$3,489.20
|
| Rate for Payer: WPS Commercial |
$4,699.00
|
|
|
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 |
$1,776.32 |
| Max. Negotiated Rate |
$25,376.00 |
| Rate for Payer: Aetna Commercial |
$5,709.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,455.84
|
| Rate for Payer: Aetna Managed Medicare |
$1,776.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,123.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,172.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,045.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,362.32
|
| Rate for Payer: Cash Price |
$1,903.20
|
| Rate for Payer: Cigna Commercial |
$5,836.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,550.10
|
| Rate for Payer: Health EOS Commercial |
$5,646.16
|
| Rate for Payer: HFN Commercial |
$5,836.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,758.00
|
| Rate for Payer: Multiplan Commercial |
$5,075.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,806.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,836.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,108.56
|
| Rate for Payer: Quartz Commercial |
$4,123.60
|
| Rate for Payer: Quartz Medicare Advantage |
$3,806.40
|
| Rate for Payer: The Alliance Commercial |
$25,376.00
|
| Rate for Payer: WEA Trust Commercial |
$3,489.20
|
| Rate for Payer: WPS Commercial |
$4,699.00
|
|
|
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 |
$3,108.56 |
| Max. Negotiated Rate |
$5,836.48 |
| Rate for Payer: Aetna Commercial |
$5,709.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,455.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,362.32
|
| Rate for Payer: Cash Price |
$1,903.20
|
| Rate for Payer: Cigna Commercial |
$5,836.48
|
| Rate for Payer: Health EOS Commercial |
$5,646.16
|
| Rate for Payer: HFN Commercial |
$5,836.48
|
| Rate for Payer: Multiplan Commercial |
$5,075.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,806.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,836.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,108.56
|
| Rate for Payer: Quartz Commercial |
$3,806.40
|
| Rate for Payer: WEA Trust Commercial |
$3,489.20
|
| Rate for Payer: WPS Commercial |
$4,699.00
|
|
|
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 |
$1,776.32 |
| Max. Negotiated Rate |
$25,376.00 |
| Rate for Payer: Aetna Commercial |
$5,709.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,455.84
|
| Rate for Payer: Aetna Managed Medicare |
$1,776.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,123.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,172.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,045.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,362.32
|
| Rate for Payer: Cash Price |
$1,903.20
|
| Rate for Payer: Cigna Commercial |
$5,836.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,550.10
|
| Rate for Payer: Health EOS Commercial |
$5,646.16
|
| Rate for Payer: HFN Commercial |
$5,836.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,758.00
|
| Rate for Payer: Multiplan Commercial |
$5,075.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,806.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,836.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,108.56
|
| Rate for Payer: Quartz Commercial |
$4,123.60
|
| Rate for Payer: Quartz Medicare Advantage |
$3,806.40
|
| Rate for Payer: The Alliance Commercial |
$25,376.00
|
| Rate for Payer: WEA Trust Commercial |
$3,489.20
|
| Rate for Payer: WPS Commercial |
$4,699.00
|
|
