|
PLATE SQUARE 4 HOLE BIOMET 73-2622
|
Facility
|
OP
|
$4,320.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4205985
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,257.98 |
| Max. Negotiated Rate |
$4,133.38 |
| Rate for Payer: Aetna Commercial |
$4,043.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,863.81
|
| Rate for Payer: Aetna Managed Medicare |
$1,257.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,920.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,246.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,156.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,381.18
|
| Rate for Payer: Cash Price |
$1,296.00
|
| Rate for Payer: Cigna Commercial |
$4,133.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,514.24
|
| Rate for Payer: Health EOS Commercial |
$3,998.59
|
| Rate for Payer: HFN Commercial |
$4,133.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,369.60
|
| Rate for Payer: Multiplan Commercial |
$3,594.24
|
| Rate for Payer: NAPHCARE Commercial |
$2,695.68
|
| Rate for Payer: Preferred Network Access Commercial |
$4,133.38
|
| Rate for Payer: Quartz Beloit One Network |
$2,201.47
|
| Rate for Payer: Quartz Commercial |
$2,920.32
|
| Rate for Payer: Quartz Medicare Advantage |
$2,695.68
|
| Rate for Payer: The Alliance Commercial |
$2,246.40
|
| Rate for Payer: WEA Trust Commercial |
$2,471.04
|
| Rate for Payer: WPS Commercial |
$3,327.70
|
|
|
PLATE SQUARE 4 HOLE BIOMET 73-2622
|
Facility
|
IP
|
$4,320.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4205985
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,201.47 |
| Max. Negotiated Rate |
$4,133.38 |
| Rate for Payer: Aetna Commercial |
$4,043.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,863.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,381.18
|
| Rate for Payer: Cash Price |
$1,296.00
|
| Rate for Payer: Cigna Commercial |
$4,133.38
|
| Rate for Payer: Health EOS Commercial |
$3,998.59
|
| Rate for Payer: HFN Commercial |
$4,133.38
|
| Rate for Payer: Multiplan Commercial |
$3,594.24
|
| Rate for Payer: Preferred Network Access Commercial |
$4,133.38
|
| Rate for Payer: Quartz Beloit One Network |
$2,201.47
|
| Rate for Payer: Quartz Commercial |
$2,695.68
|
| Rate for Payer: WEA Trust Commercial |
$2,471.04
|
| Rate for Payer: WPS Commercial |
$3,327.70
|
|
|
PLATE STERNALOCK 8HL STRAIGHT 73-1952
|
Facility
|
IP
|
$4,440.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5447129
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,262.62 |
| Max. Negotiated Rate |
$4,248.19 |
| Rate for Payer: Aetna Commercial |
$4,155.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,971.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,447.33
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Cigna Commercial |
$4,248.19
|
| Rate for Payer: Health EOS Commercial |
$4,109.66
|
| Rate for Payer: HFN Commercial |
$4,248.19
|
| Rate for Payer: Multiplan Commercial |
$3,694.08
|
| Rate for Payer: Preferred Network Access Commercial |
$4,248.19
|
| Rate for Payer: Quartz Beloit One Network |
$2,262.62
|
| Rate for Payer: Quartz Commercial |
$2,770.56
|
| Rate for Payer: WEA Trust Commercial |
$2,539.68
|
| Rate for Payer: WPS Commercial |
$3,420.13
|
|
|
PLATE STERNALOCK 8HL STRAIGHT 73-1952
|
Facility
|
OP
|
$4,440.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5447129
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,292.93 |
| Max. Negotiated Rate |
$4,248.19 |
| Rate for Payer: Aetna Commercial |
$4,155.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,971.14
|
| Rate for Payer: Aetna Managed Medicare |
$1,292.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,001.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,308.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,216.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,447.33
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Cigna Commercial |
$4,248.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,584.08
|
| Rate for Payer: Health EOS Commercial |
$4,109.66
|
| Rate for Payer: HFN Commercial |
$4,248.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,463.20
|
| Rate for Payer: Multiplan Commercial |
$3,694.08
|
| Rate for Payer: NAPHCARE Commercial |
$2,770.56
|
| Rate for Payer: Preferred Network Access Commercial |
$4,248.19
|
| Rate for Payer: Quartz Beloit One Network |
$2,262.62
|
| Rate for Payer: Quartz Commercial |
$3,001.44
|
| Rate for Payer: Quartz Medicare Advantage |
$2,770.56
|
| Rate for Payer: The Alliance Commercial |
$2,308.80
|
| Rate for Payer: WEA Trust Commercial |
$2,539.68
|
| Rate for Payer: WPS Commercial |
$3,420.13
|
|
|
PLATE STRAIGHT 1.3MM 12HL 221.312
|
Facility
|
IP
|
$3,488.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508590
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,777.48 |
| Max. Negotiated Rate |
$3,337.32 |
| Rate for Payer: Aetna Commercial |
$3,264.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,119.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,922.59
|
| Rate for Payer: Cash Price |
$1,046.40
|
| Rate for Payer: Cigna Commercial |
$3,337.32
|
| Rate for Payer: Health EOS Commercial |
$3,228.49
|
| Rate for Payer: HFN Commercial |
$3,337.32
|
| Rate for Payer: Multiplan Commercial |
$2,902.02
|
| Rate for Payer: Preferred Network Access Commercial |
$3,337.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,777.48
|
| Rate for Payer: Quartz Commercial |
$2,176.51
|
| Rate for Payer: WEA Trust Commercial |
$1,995.14
|
| Rate for Payer: WPS Commercial |
$2,686.81
|
|
|
PLATE STRAIGHT 1.3MM 12HL 221.312
|
Facility
|
OP
|
$3,488.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508590
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,015.71 |
| Max. Negotiated Rate |
$3,337.32 |
| Rate for Payer: Aetna Commercial |
$3,264.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,119.67
|
| Rate for Payer: Aetna Managed Medicare |
$1,015.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,357.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,813.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,741.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,922.59
|
| Rate for Payer: Cash Price |
$1,046.40
|
| Rate for Payer: Cigna Commercial |
$3,337.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,030.02
|
| Rate for Payer: Health EOS Commercial |
$3,228.49
|
| Rate for Payer: HFN Commercial |
$3,337.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,720.64
|
| Rate for Payer: Multiplan Commercial |
$2,902.02
|
| Rate for Payer: NAPHCARE Commercial |
$2,176.51
|
| Rate for Payer: Preferred Network Access Commercial |
$3,337.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,777.48
|
| Rate for Payer: Quartz Commercial |
$2,357.89
|
| Rate for Payer: Quartz Medicare Advantage |
$2,176.51
|
| Rate for Payer: The Alliance Commercial |
$1,813.76
|
| Rate for Payer: WEA Trust Commercial |
$1,995.14
|
| Rate for Payer: WPS Commercial |
$2,686.81
|
|
|
PLATE STRAIGHT 1.3MM 6HL 221.306
|
Facility
|
IP
|
$2,793.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508588
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,423.31 |
| Max. Negotiated Rate |
$2,672.34 |
| Rate for Payer: Aetna Commercial |
$2,614.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,498.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,539.50
|
| Rate for Payer: Cash Price |
$837.90
|
| Rate for Payer: Cigna Commercial |
$2,672.34
|
| Rate for Payer: Health EOS Commercial |
$2,585.20
|
| Rate for Payer: HFN Commercial |
$2,672.34
|
| Rate for Payer: Multiplan Commercial |
$2,323.78
|
| Rate for Payer: Preferred Network Access Commercial |
$2,672.34
|
| Rate for Payer: Quartz Beloit One Network |
$1,423.31
|
| Rate for Payer: Quartz Commercial |
$1,742.83
|
| Rate for Payer: WEA Trust Commercial |
$1,597.60
|
| Rate for Payer: WPS Commercial |
$2,151.45
|
|
|
PLATE STRAIGHT 1.3MM 6HL 221.306
|
Facility
|
OP
|
$2,793.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508588
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$813.32 |
| Max. Negotiated Rate |
$2,672.34 |
| Rate for Payer: Aetna Commercial |
$2,614.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,498.06
|
| Rate for Payer: Aetna Managed Medicare |
$813.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,888.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,452.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,394.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,539.50
|
| Rate for Payer: Cash Price |
$837.90
|
| Rate for Payer: Cigna Commercial |
$2,672.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,625.53
|
| Rate for Payer: Health EOS Commercial |
$2,585.20
|
| Rate for Payer: HFN Commercial |
$2,672.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,178.54
|
| Rate for Payer: Multiplan Commercial |
$2,323.78
|
| Rate for Payer: NAPHCARE Commercial |
$1,742.83
|
| Rate for Payer: Preferred Network Access Commercial |
$2,672.34
|
| Rate for Payer: Quartz Beloit One Network |
$1,423.31
|
| Rate for Payer: Quartz Commercial |
$1,888.07
|
| Rate for Payer: Quartz Medicare Advantage |
$1,742.83
|
| Rate for Payer: The Alliance Commercial |
$1,452.36
|
| Rate for Payer: WEA Trust Commercial |
$1,597.60
|
| Rate for Payer: WPS Commercial |
$2,151.45
|
|
|
PLATE STRAIGHT 2.4MM 12HL 249.912
|
Facility
|
OP
|
$4,683.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508772
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,363.69 |
| Max. Negotiated Rate |
$4,480.69 |
| Rate for Payer: Aetna Commercial |
$4,383.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,188.48
|
| Rate for Payer: Aetna Managed Medicare |
$1,363.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,165.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,435.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,337.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,581.27
|
| Rate for Payer: Cash Price |
$1,404.90
|
| Rate for Payer: Cigna Commercial |
$4,480.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,725.51
|
| Rate for Payer: Health EOS Commercial |
$4,334.58
|
| Rate for Payer: HFN Commercial |
$4,480.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,652.74
|
| Rate for Payer: Multiplan Commercial |
$3,896.26
|
| Rate for Payer: NAPHCARE Commercial |
$2,922.19
|
| Rate for Payer: Preferred Network Access Commercial |
$4,480.69
|
| Rate for Payer: Quartz Beloit One Network |
$2,386.46
|
| Rate for Payer: Quartz Commercial |
$3,165.71
|
| Rate for Payer: Quartz Medicare Advantage |
$2,922.19
|
| Rate for Payer: The Alliance Commercial |
$2,435.16
|
| Rate for Payer: WEA Trust Commercial |
$2,678.68
|
| Rate for Payer: WPS Commercial |
$3,607.31
|
|
|
PLATE STRAIGHT 2.4MM 12HL 249.912
|
Facility
|
IP
|
$4,683.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508772
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,386.46 |
| Max. Negotiated Rate |
$4,480.69 |
| Rate for Payer: Aetna Commercial |
$4,383.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,188.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,581.27
|
| Rate for Payer: Cash Price |
$1,404.90
|
| Rate for Payer: Cigna Commercial |
$4,480.69
|
| Rate for Payer: Health EOS Commercial |
$4,334.58
|
| Rate for Payer: HFN Commercial |
$4,480.69
|
| Rate for Payer: Multiplan Commercial |
$3,896.26
|
| Rate for Payer: Preferred Network Access Commercial |
$4,480.69
|
| Rate for Payer: Quartz Beloit One Network |
$2,386.46
|
| Rate for Payer: Quartz Commercial |
$2,922.19
|
| Rate for Payer: WEA Trust Commercial |
$2,678.68
|
| Rate for Payer: WPS Commercial |
$3,607.31
|
|
|
PLATE STRAIGHT 2.4MM 6HL 249.906
|
Facility
|
OP
|
$3,976.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508771
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,157.81 |
| Max. Negotiated Rate |
$3,804.24 |
| Rate for Payer: Aetna Commercial |
$3,721.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,556.13
|
| Rate for Payer: Aetna Managed Medicare |
$1,157.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,687.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,067.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,984.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,191.57
|
| Rate for Payer: Cash Price |
$1,192.80
|
| Rate for Payer: Cigna Commercial |
$3,804.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,314.03
|
| Rate for Payer: Health EOS Commercial |
$3,680.19
|
| Rate for Payer: HFN Commercial |
$3,804.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,101.28
|
| Rate for Payer: Multiplan Commercial |
$3,308.03
|
| Rate for Payer: NAPHCARE Commercial |
$2,481.02
|
| Rate for Payer: Preferred Network Access Commercial |
$3,804.24
|
| Rate for Payer: Quartz Beloit One Network |
$2,026.17
|
| Rate for Payer: Quartz Commercial |
$2,687.78
|
| Rate for Payer: Quartz Medicare Advantage |
$2,481.02
|
| Rate for Payer: The Alliance Commercial |
$2,067.52
|
| Rate for Payer: WEA Trust Commercial |
$2,274.27
|
| Rate for Payer: WPS Commercial |
$3,062.71
|
|
|
PLATE STRAIGHT 2.4MM 6HL 249.906
|
Facility
|
IP
|
$3,976.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508771
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,026.17 |
| Max. Negotiated Rate |
$3,804.24 |
| Rate for Payer: Aetna Commercial |
$3,721.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,556.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,191.57
|
| Rate for Payer: Cash Price |
$1,192.80
|
| Rate for Payer: Cigna Commercial |
$3,804.24
|
| Rate for Payer: Health EOS Commercial |
$3,680.19
|
| Rate for Payer: HFN Commercial |
$3,804.24
|
| Rate for Payer: Multiplan Commercial |
$3,308.03
|
| Rate for Payer: Preferred Network Access Commercial |
$3,804.24
|
| Rate for Payer: Quartz Beloit One Network |
$2,026.17
|
| Rate for Payer: Quartz Commercial |
$2,481.02
|
| Rate for Payer: WEA Trust Commercial |
$2,274.27
|
| Rate for Payer: WPS Commercial |
$3,062.71
|
|
|
PLATE STRAIGHT 4HL BIOMET 73-2636
|
Facility
|
OP
|
$4,160.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4206003
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,211.39 |
| Max. Negotiated Rate |
$3,980.29 |
| Rate for Payer: Aetna Commercial |
$3,893.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,720.70
|
| Rate for Payer: Aetna Managed Medicare |
$1,211.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,812.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,163.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,076.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,292.99
|
| Rate for Payer: Cash Price |
$1,248.00
|
| Rate for Payer: Cigna Commercial |
$3,980.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,421.12
|
| Rate for Payer: Health EOS Commercial |
$3,850.50
|
| Rate for Payer: HFN Commercial |
$3,980.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,244.80
|
| Rate for Payer: Multiplan Commercial |
$3,461.12
|
| Rate for Payer: NAPHCARE Commercial |
$2,595.84
|
| Rate for Payer: Preferred Network Access Commercial |
$3,980.29
|
| Rate for Payer: Quartz Beloit One Network |
$2,119.94
|
| Rate for Payer: Quartz Commercial |
$2,812.16
|
| Rate for Payer: Quartz Medicare Advantage |
$2,595.84
|
| Rate for Payer: The Alliance Commercial |
$2,163.20
|
| Rate for Payer: WEA Trust Commercial |
$2,379.52
|
| Rate for Payer: WPS Commercial |
$3,204.45
|
|
|
PLATE STRAIGHT 4HL BIOMET 73-2636
|
Facility
|
IP
|
$4,160.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4206003
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,119.94 |
| Max. Negotiated Rate |
$3,980.29 |
| Rate for Payer: Aetna Commercial |
$3,893.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,720.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,292.99
|
| Rate for Payer: Cash Price |
$1,248.00
|
| Rate for Payer: Cigna Commercial |
$3,980.29
|
| Rate for Payer: Health EOS Commercial |
$3,850.50
|
| Rate for Payer: HFN Commercial |
$3,980.29
|
| Rate for Payer: Multiplan Commercial |
$3,461.12
|
| Rate for Payer: Preferred Network Access Commercial |
$3,980.29
|
| Rate for Payer: Quartz Beloit One Network |
$2,119.94
|
| Rate for Payer: Quartz Commercial |
$2,595.84
|
| Rate for Payer: WEA Trust Commercial |
$2,379.52
|
| Rate for Payer: WPS Commercial |
$3,204.45
|
|
|
PLATE STRIGHT 8 HOLE RIBFIX BLUE 76-2601
|
Facility
|
OP
|
$6,857.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5563317
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,996.76 |
| Max. Negotiated Rate |
$6,560.78 |
| Rate for Payer: Aetna Commercial |
$6,418.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,132.90
|
| Rate for Payer: Aetna Managed Medicare |
$1,996.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,635.33
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,565.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,423.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,779.58
|
| Rate for Payer: Cash Price |
$2,057.10
|
| Rate for Payer: Cigna Commercial |
$6,560.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,990.77
|
| Rate for Payer: Health EOS Commercial |
$6,346.84
|
| Rate for Payer: HFN Commercial |
$6,560.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,348.46
|
| Rate for Payer: Multiplan Commercial |
$5,705.02
|
| Rate for Payer: NAPHCARE Commercial |
$4,278.77
|
| Rate for Payer: Preferred Network Access Commercial |
$6,560.78
|
| Rate for Payer: Quartz Beloit One Network |
$3,494.33
|
| Rate for Payer: Quartz Commercial |
$4,635.33
|
| Rate for Payer: Quartz Medicare Advantage |
$4,278.77
|
| Rate for Payer: The Alliance Commercial |
$3,565.64
|
| Rate for Payer: WEA Trust Commercial |
$3,922.20
|
| Rate for Payer: WPS Commercial |
$5,281.95
|
|
|
PLATE STRIGHT 8 HOLE RIBFIX BLUE 76-2601
|
Facility
|
IP
|
$6,857.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5563317
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,494.33 |
| Max. Negotiated Rate |
$6,560.78 |
| Rate for Payer: Aetna Commercial |
$6,418.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,132.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,779.58
|
| Rate for Payer: Cash Price |
$2,057.10
|
| Rate for Payer: Cigna Commercial |
$6,560.78
|
| Rate for Payer: Health EOS Commercial |
$6,346.84
|
| Rate for Payer: HFN Commercial |
$6,560.78
|
| Rate for Payer: Multiplan Commercial |
$5,705.02
|
| Rate for Payer: Preferred Network Access Commercial |
$6,560.78
|
| Rate for Payer: Quartz Beloit One Network |
$3,494.33
|
| Rate for Payer: Quartz Commercial |
$4,278.77
|
| Rate for Payer: WEA Trust Commercial |
$3,922.20
|
| Rate for Payer: WPS Commercial |
$5,281.95
|
|
|
PLATE SUPERIOR LATERAL 4 HL RT 628224
|
Facility
|
IP
|
$5,232.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6167819
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,666.23 |
| Max. Negotiated Rate |
$5,005.98 |
| Rate for Payer: Aetna Commercial |
$4,897.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,679.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,883.88
|
| Rate for Payer: Cash Price |
$1,569.60
|
| Rate for Payer: Cigna Commercial |
$5,005.98
|
| Rate for Payer: Health EOS Commercial |
$4,842.74
|
| Rate for Payer: HFN Commercial |
$5,005.98
|
| Rate for Payer: Multiplan Commercial |
$4,353.02
|
| Rate for Payer: Preferred Network Access Commercial |
$5,005.98
|
| Rate for Payer: Quartz Beloit One Network |
$2,666.23
|
| Rate for Payer: Quartz Commercial |
$3,264.77
|
| Rate for Payer: WEA Trust Commercial |
$2,992.70
|
| Rate for Payer: WPS Commercial |
$4,030.21
|
|
|
PLATE SUPERIOR LATERAL 4 HL RT 628224
|
Facility
|
OP
|
$5,232.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6167819
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,523.56 |
| Max. Negotiated Rate |
$5,005.98 |
| Rate for Payer: Aetna Commercial |
$4,897.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,679.50
|
| Rate for Payer: Aetna Managed Medicare |
$1,523.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,536.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,720.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,611.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,883.88
|
| Rate for Payer: Cash Price |
$1,569.60
|
| Rate for Payer: Cigna Commercial |
$5,005.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,045.02
|
| Rate for Payer: Health EOS Commercial |
$4,842.74
|
| Rate for Payer: HFN Commercial |
$5,005.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,080.96
|
| Rate for Payer: Multiplan Commercial |
$4,353.02
|
| Rate for Payer: NAPHCARE Commercial |
$3,264.77
|
| Rate for Payer: Preferred Network Access Commercial |
$5,005.98
|
| Rate for Payer: Quartz Beloit One Network |
$2,666.23
|
| Rate for Payer: Quartz Commercial |
$3,536.83
|
| Rate for Payer: Quartz Medicare Advantage |
$3,264.77
|
| Rate for Payer: The Alliance Commercial |
$2,720.64
|
| Rate for Payer: WEA Trust Commercial |
$2,992.70
|
| Rate for Payer: WPS Commercial |
$4,030.21
|
|
|
PLATE TACK CLAW II 40250010
|
Facility
|
OP
|
$2,113.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6171776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$615.31 |
| Max. Negotiated Rate |
$2,021.72 |
| Rate for Payer: Aetna Commercial |
$1,977.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,889.87
|
| Rate for Payer: Aetna Managed Medicare |
$615.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,428.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,098.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,054.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,164.69
|
| Rate for Payer: Cash Price |
$633.90
|
| Rate for Payer: Cigna Commercial |
$2,021.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,229.77
|
| Rate for Payer: Health EOS Commercial |
$1,955.79
|
| Rate for Payer: HFN Commercial |
$2,021.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,648.14
|
| Rate for Payer: Multiplan Commercial |
$1,758.02
|
| Rate for Payer: NAPHCARE Commercial |
$1,318.51
|
| Rate for Payer: Preferred Network Access Commercial |
$2,021.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,076.78
|
| Rate for Payer: Quartz Commercial |
$1,428.39
|
| Rate for Payer: Quartz Medicare Advantage |
$1,318.51
|
| Rate for Payer: The Alliance Commercial |
$1,098.76
|
| Rate for Payer: WEA Trust Commercial |
$1,208.64
|
| Rate for Payer: WPS Commercial |
$1,627.64
|
|
|
PLATE TACK CLAW II 40250010
|
Facility
|
IP
|
$2,113.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6171776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,076.78 |
| Max. Negotiated Rate |
$2,021.72 |
| Rate for Payer: Aetna Commercial |
$1,977.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,889.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,164.69
|
| Rate for Payer: Cash Price |
$633.90
|
| Rate for Payer: Cigna Commercial |
$2,021.72
|
| Rate for Payer: Health EOS Commercial |
$1,955.79
|
| Rate for Payer: HFN Commercial |
$2,021.72
|
| Rate for Payer: Multiplan Commercial |
$1,758.02
|
| Rate for Payer: Preferred Network Access Commercial |
$2,021.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,076.78
|
| Rate for Payer: Quartz Commercial |
$1,318.51
|
| Rate for Payer: WEA Trust Commercial |
$1,208.64
|
| Rate for Payer: WPS Commercial |
$1,627.64
|
|
|
PLATE TALO-NAVICULAR TN 6HL SHORT 626761
|
Facility
|
OP
|
$5,160.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5831687
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,502.59 |
| Max. Negotiated Rate |
$4,937.09 |
| Rate for Payer: Aetna Commercial |
$4,829.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,615.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,502.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,488.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,683.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,575.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,844.19
|
| Rate for Payer: Cash Price |
$1,548.00
|
| Rate for Payer: Cigna Commercial |
$4,937.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,003.12
|
| Rate for Payer: Health EOS Commercial |
$4,776.10
|
| Rate for Payer: HFN Commercial |
$4,937.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,024.80
|
| Rate for Payer: Multiplan Commercial |
$4,293.12
|
| Rate for Payer: NAPHCARE Commercial |
$3,219.84
|
| Rate for Payer: Preferred Network Access Commercial |
$4,937.09
|
| Rate for Payer: Quartz Beloit One Network |
$2,629.54
|
| Rate for Payer: Quartz Commercial |
$3,488.16
|
| Rate for Payer: Quartz Medicare Advantage |
$3,219.84
|
| Rate for Payer: The Alliance Commercial |
$2,683.20
|
| Rate for Payer: WEA Trust Commercial |
$2,951.52
|
| Rate for Payer: WPS Commercial |
$3,974.75
|
|
|
PLATE TALO-NAVICULAR TN 6HL SHORT 626761
|
Facility
|
IP
|
$5,160.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5831687
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,629.54 |
| Max. Negotiated Rate |
$4,937.09 |
| Rate for Payer: Aetna Commercial |
$4,829.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,615.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,844.19
|
| Rate for Payer: Cash Price |
$1,548.00
|
| Rate for Payer: Cigna Commercial |
$4,937.09
|
| Rate for Payer: Health EOS Commercial |
$4,776.10
|
| Rate for Payer: HFN Commercial |
$4,937.09
|
| Rate for Payer: Multiplan Commercial |
$4,293.12
|
| Rate for Payer: Preferred Network Access Commercial |
$4,937.09
|
| Rate for Payer: Quartz Beloit One Network |
$2,629.54
|
| Rate for Payer: Quartz Commercial |
$3,219.84
|
| Rate for Payer: WEA Trust Commercial |
$2,951.52
|
| Rate for Payer: WPS Commercial |
$3,974.75
|
|
|
PLATE T DISTAL TIBIA 2.7MM 4 HL 02.118.306S
|
Facility
|
IP
|
$6,317.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5178929
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,219.14 |
| Max. Negotiated Rate |
$6,044.11 |
| Rate for Payer: Aetna Commercial |
$5,912.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,649.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,481.93
|
| Rate for Payer: Cash Price |
$1,895.10
|
| Rate for Payer: Cigna Commercial |
$6,044.11
|
| Rate for Payer: Health EOS Commercial |
$5,847.02
|
| Rate for Payer: HFN Commercial |
$6,044.11
|
| Rate for Payer: Multiplan Commercial |
$5,255.74
|
| Rate for Payer: Preferred Network Access Commercial |
$6,044.11
|
| Rate for Payer: Quartz Beloit One Network |
$3,219.14
|
| Rate for Payer: Quartz Commercial |
$3,941.81
|
| Rate for Payer: WEA Trust Commercial |
$3,613.32
|
| Rate for Payer: WPS Commercial |
$4,865.99
|
|
|
PLATE T DISTAL TIBIA 2.7MM 4 HL 02.118.306S
|
Facility
|
OP
|
$6,317.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5178929
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,839.51 |
| Max. Negotiated Rate |
$6,044.11 |
| Rate for Payer: Aetna Commercial |
$5,912.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,649.92
|
| Rate for Payer: Aetna Managed Medicare |
$1,839.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,270.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,284.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,153.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,481.93
|
| Rate for Payer: Cash Price |
$1,895.10
|
| Rate for Payer: Cigna Commercial |
$6,044.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,676.49
|
| Rate for Payer: Health EOS Commercial |
$5,847.02
|
| Rate for Payer: HFN Commercial |
$6,044.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,927.26
|
| Rate for Payer: Multiplan Commercial |
$5,255.74
|
| Rate for Payer: NAPHCARE Commercial |
$3,941.81
|
| Rate for Payer: Preferred Network Access Commercial |
$6,044.11
|
| Rate for Payer: Quartz Beloit One Network |
$3,219.14
|
| Rate for Payer: Quartz Commercial |
$4,270.29
|
| Rate for Payer: Quartz Medicare Advantage |
$3,941.81
|
| Rate for Payer: The Alliance Commercial |
$3,284.84
|
| Rate for Payer: WEA Trust Commercial |
$3,613.32
|
| Rate for Payer: WPS Commercial |
$4,865.99
|
|
|
PLATE T-FUSION 2.4/2.7 02.211.253
|
Facility
|
OP
|
$8,260.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966379
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,405.31 |
| Max. Negotiated Rate |
$7,903.17 |
| Rate for Payer: Aetna Commercial |
$7,731.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,387.74
|
| Rate for Payer: Aetna Managed Medicare |
$2,405.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,583.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,295.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,123.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,552.91
|
| Rate for Payer: Cash Price |
$2,478.00
|
| Rate for Payer: Cigna Commercial |
$7,903.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,807.32
|
| Rate for Payer: Health EOS Commercial |
$7,645.46
|
| Rate for Payer: HFN Commercial |
$7,903.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,442.80
|
| Rate for Payer: Multiplan Commercial |
$6,872.32
|
| Rate for Payer: NAPHCARE Commercial |
$5,154.24
|
| Rate for Payer: Preferred Network Access Commercial |
$7,903.17
|
| Rate for Payer: Quartz Beloit One Network |
$4,209.30
|
| Rate for Payer: Quartz Commercial |
$5,583.76
|
| Rate for Payer: Quartz Medicare Advantage |
$5,154.24
|
| Rate for Payer: The Alliance Commercial |
$4,295.20
|
| Rate for Payer: WEA Trust Commercial |
$4,724.72
|
| Rate for Payer: WPS Commercial |
$6,362.68
|
|
