|
PLATE FIBULA 2.7/3.5 5HL RT 02.112.140
|
Facility
|
OP
|
$5,846.00
|
|
| Hospital Charge Code |
2966368
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,702.36 |
| Max. Negotiated Rate |
$5,593.45 |
| Rate for Payer: Aetna Commercial |
$5,471.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,228.66
|
| Rate for Payer: Aetna Managed Medicare |
$1,702.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,951.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,039.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,918.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,222.32
|
| Rate for Payer: Cash Price |
$1,753.80
|
| Rate for Payer: Cigna Commercial |
$5,593.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,402.37
|
| Rate for Payer: Health EOS Commercial |
$5,411.06
|
| Rate for Payer: HFN Commercial |
$5,593.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,559.88
|
| Rate for Payer: Multiplan Commercial |
$4,863.87
|
| Rate for Payer: NAPHCARE Commercial |
$3,647.90
|
| Rate for Payer: Preferred Network Access Commercial |
$5,593.45
|
| Rate for Payer: Quartz Beloit One Network |
$2,979.12
|
| Rate for Payer: Quartz Commercial |
$3,951.90
|
| Rate for Payer: Quartz Medicare Advantage |
$3,647.90
|
| Rate for Payer: The Alliance Commercial |
$3,039.92
|
| Rate for Payer: WEA Trust Commercial |
$3,343.91
|
| Rate for Payer: WPS Commercial |
$4,503.17
|
|
|
PLATE FIBULA 2.7/3.5 5HL RT 02.112.140
|
Facility
|
IP
|
$5,846.00
|
|
| Hospital Charge Code |
2966368
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,979.12 |
| Max. Negotiated Rate |
$5,593.45 |
| Rate for Payer: Aetna Commercial |
$5,471.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,228.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,222.32
|
| Rate for Payer: Cash Price |
$1,753.80
|
| Rate for Payer: Cigna Commercial |
$5,593.45
|
| Rate for Payer: Health EOS Commercial |
$5,411.06
|
| Rate for Payer: HFN Commercial |
$5,593.45
|
| Rate for Payer: Multiplan Commercial |
$4,863.87
|
| Rate for Payer: Preferred Network Access Commercial |
$5,593.45
|
| Rate for Payer: Quartz Beloit One Network |
$2,979.12
|
| Rate for Payer: Quartz Commercial |
$3,647.90
|
| Rate for Payer: WEA Trust Commercial |
$3,343.91
|
| Rate for Payer: WPS Commercial |
$4,503.17
|
|
|
PLATE FIBULA 77MM RT 5888401R
|
Facility
|
IP
|
$9,634.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6149648
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,909.49 |
| Max. Negotiated Rate |
$9,217.81 |
| Rate for Payer: Aetna Commercial |
$9,017.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,616.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,310.26
|
| Rate for Payer: Cash Price |
$2,890.20
|
| Rate for Payer: Cigna Commercial |
$9,217.81
|
| Rate for Payer: Health EOS Commercial |
$8,917.23
|
| Rate for Payer: HFN Commercial |
$9,217.81
|
| Rate for Payer: Multiplan Commercial |
$8,015.49
|
| Rate for Payer: Preferred Network Access Commercial |
$9,217.81
|
| Rate for Payer: Quartz Beloit One Network |
$4,909.49
|
| Rate for Payer: Quartz Commercial |
$6,011.62
|
| Rate for Payer: WEA Trust Commercial |
$5,510.65
|
| Rate for Payer: WPS Commercial |
$7,421.07
|
|
|
PLATE FIBULA 77MM RT 5888401R
|
Facility
|
OP
|
$9,634.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6149648
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,805.42 |
| Max. Negotiated Rate |
$9,217.81 |
| Rate for Payer: Aetna Commercial |
$9,017.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,616.65
|
| Rate for Payer: Aetna Managed Medicare |
$2,805.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,512.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,009.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,809.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,310.26
|
| Rate for Payer: Cash Price |
$2,890.20
|
| Rate for Payer: Cigna Commercial |
$9,217.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,606.99
|
| Rate for Payer: Health EOS Commercial |
$8,917.23
|
| Rate for Payer: HFN Commercial |
$9,217.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,514.52
|
| Rate for Payer: Multiplan Commercial |
$8,015.49
|
| Rate for Payer: NAPHCARE Commercial |
$6,011.62
|
| Rate for Payer: Preferred Network Access Commercial |
$9,217.81
|
| Rate for Payer: Quartz Beloit One Network |
$4,909.49
|
| Rate for Payer: Quartz Commercial |
$6,512.58
|
| Rate for Payer: Quartz Medicare Advantage |
$6,011.62
|
| Rate for Payer: The Alliance Commercial |
$5,009.68
|
| Rate for Payer: WEA Trust Commercial |
$5,510.65
|
| Rate for Payer: WPS Commercial |
$7,421.07
|
|
|
PLATE FIBULA 7 HOLE LEFT 02.112.145
|
Facility
|
OP
|
$5,174.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3869353
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,506.67 |
| Max. Negotiated Rate |
$4,950.48 |
| Rate for Payer: Aetna Commercial |
$4,842.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,627.63
|
| Rate for Payer: Aetna Managed Medicare |
$1,506.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,497.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,690.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,582.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,851.91
|
| Rate for Payer: Cash Price |
$1,552.20
|
| Rate for Payer: Cigna Commercial |
$4,950.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,011.27
|
| Rate for Payer: Health EOS Commercial |
$4,789.05
|
| Rate for Payer: HFN Commercial |
$4,950.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,035.72
|
| Rate for Payer: Multiplan Commercial |
$4,304.77
|
| Rate for Payer: NAPHCARE Commercial |
$3,228.58
|
| Rate for Payer: Preferred Network Access Commercial |
$4,950.48
|
| Rate for Payer: Quartz Beloit One Network |
$2,636.67
|
| Rate for Payer: Quartz Commercial |
$3,497.62
|
| Rate for Payer: Quartz Medicare Advantage |
$3,228.58
|
| Rate for Payer: The Alliance Commercial |
$2,690.48
|
| Rate for Payer: WEA Trust Commercial |
$2,959.53
|
| Rate for Payer: WPS Commercial |
$3,985.53
|
|
|
PLATE FIBULA 7 HOLE LEFT 02.112.145
|
Facility
|
IP
|
$5,174.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3869353
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,636.67 |
| Max. Negotiated Rate |
$4,950.48 |
| Rate for Payer: Aetna Commercial |
$4,842.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,627.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,851.91
|
| Rate for Payer: Cash Price |
$1,552.20
|
| Rate for Payer: Cigna Commercial |
$4,950.48
|
| Rate for Payer: Health EOS Commercial |
$4,789.05
|
| Rate for Payer: HFN Commercial |
$4,950.48
|
| Rate for Payer: Multiplan Commercial |
$4,304.77
|
| Rate for Payer: Preferred Network Access Commercial |
$4,950.48
|
| Rate for Payer: Quartz Beloit One Network |
$2,636.67
|
| Rate for Payer: Quartz Commercial |
$3,228.58
|
| Rate for Payer: WEA Trust Commercial |
$2,959.53
|
| Rate for Payer: WPS Commercial |
$3,985.53
|
|
|
PLATE FIBULA 89MM RT 5888402R
|
Facility
|
OP
|
$8,346.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6179908
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,430.36 |
| Max. Negotiated Rate |
$7,985.45 |
| Rate for Payer: Aetna Commercial |
$7,811.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,464.66
|
| Rate for Payer: Aetna Managed Medicare |
$2,430.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,641.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,339.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,166.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,600.32
|
| Rate for Payer: Cash Price |
$2,503.80
|
| Rate for Payer: Cigna Commercial |
$7,985.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,857.37
|
| Rate for Payer: Health EOS Commercial |
$7,725.06
|
| Rate for Payer: HFN Commercial |
$7,985.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,509.88
|
| Rate for Payer: Multiplan Commercial |
$6,943.87
|
| Rate for Payer: NAPHCARE Commercial |
$5,207.90
|
| Rate for Payer: Preferred Network Access Commercial |
$7,985.45
|
| Rate for Payer: Quartz Beloit One Network |
$4,253.12
|
| Rate for Payer: Quartz Commercial |
$5,641.90
|
| Rate for Payer: Quartz Medicare Advantage |
$5,207.90
|
| Rate for Payer: The Alliance Commercial |
$4,339.92
|
| Rate for Payer: WEA Trust Commercial |
$4,773.91
|
| Rate for Payer: WPS Commercial |
$6,428.92
|
|
|
PLATE FIBULA 89MM RT 5888402R
|
Facility
|
IP
|
$8,346.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6179908
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,253.12 |
| Max. Negotiated Rate |
$7,985.45 |
| Rate for Payer: Aetna Commercial |
$7,811.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,464.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,600.32
|
| Rate for Payer: Cash Price |
$2,503.80
|
| Rate for Payer: Cigna Commercial |
$7,985.45
|
| Rate for Payer: Health EOS Commercial |
$7,725.06
|
| Rate for Payer: HFN Commercial |
$7,985.45
|
| Rate for Payer: Multiplan Commercial |
$6,943.87
|
| Rate for Payer: Preferred Network Access Commercial |
$7,985.45
|
| Rate for Payer: Quartz Beloit One Network |
$4,253.12
|
| Rate for Payer: Quartz Commercial |
$5,207.90
|
| Rate for Payer: WEA Trust Commercial |
$4,773.91
|
| Rate for Payer: WPS Commercial |
$6,428.92
|
|
|
PLATE FIBULA DISTAL LATERAL 2.7/3.5 3HL RT 02.112.136S
|
Facility
|
OP
|
$4,474.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3127493
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,302.83 |
| Max. Negotiated Rate |
$4,280.72 |
| Rate for Payer: Aetna Commercial |
$4,187.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,001.55
|
| Rate for Payer: Aetna Managed Medicare |
$1,302.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,024.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,326.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,233.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,466.07
|
| Rate for Payer: Cash Price |
$1,342.20
|
| Rate for Payer: Cigna Commercial |
$4,280.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,603.87
|
| Rate for Payer: Health EOS Commercial |
$4,141.13
|
| Rate for Payer: HFN Commercial |
$4,280.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,489.72
|
| Rate for Payer: Multiplan Commercial |
$3,722.37
|
| Rate for Payer: NAPHCARE Commercial |
$2,791.78
|
| Rate for Payer: Preferred Network Access Commercial |
$4,280.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,279.95
|
| Rate for Payer: Quartz Commercial |
$3,024.42
|
| Rate for Payer: Quartz Medicare Advantage |
$2,791.78
|
| Rate for Payer: The Alliance Commercial |
$2,326.48
|
| Rate for Payer: WEA Trust Commercial |
$2,559.13
|
| Rate for Payer: WPS Commercial |
$3,446.32
|
|
|
PLATE FIBULA DISTAL LATERAL 2.7/3.5 3HL RT 02.112.136S
|
Facility
|
IP
|
$4,474.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3127493
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,279.95 |
| Max. Negotiated Rate |
$4,280.72 |
| Rate for Payer: Aetna Commercial |
$4,187.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,001.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,466.07
|
| Rate for Payer: Cash Price |
$1,342.20
|
| Rate for Payer: Cigna Commercial |
$4,280.72
|
| Rate for Payer: Health EOS Commercial |
$4,141.13
|
| Rate for Payer: HFN Commercial |
$4,280.72
|
| Rate for Payer: Multiplan Commercial |
$3,722.37
|
| Rate for Payer: Preferred Network Access Commercial |
$4,280.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,279.95
|
| Rate for Payer: Quartz Commercial |
$2,791.78
|
| Rate for Payer: WEA Trust Commercial |
$2,559.13
|
| Rate for Payer: WPS Commercial |
$3,446.32
|
|
|
PLATE FIBULA LATERAL DISTAL 2.7 4HOLE LEFT 02.118.403
|
Facility
|
IP
|
$8,079.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3697494
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,117.06 |
| Max. Negotiated Rate |
$7,729.99 |
| Rate for Payer: Aetna Commercial |
$7,561.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,225.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,453.14
|
| Rate for Payer: Cash Price |
$2,423.70
|
| Rate for Payer: Cigna Commercial |
$7,729.99
|
| Rate for Payer: Health EOS Commercial |
$7,477.92
|
| Rate for Payer: HFN Commercial |
$7,729.99
|
| Rate for Payer: Multiplan Commercial |
$6,721.73
|
| Rate for Payer: Preferred Network Access Commercial |
$7,729.99
|
| Rate for Payer: Quartz Beloit One Network |
$4,117.06
|
| Rate for Payer: Quartz Commercial |
$5,041.30
|
| Rate for Payer: WEA Trust Commercial |
$4,621.19
|
| Rate for Payer: WPS Commercial |
$6,223.25
|
|
|
PLATE FIBULA LATERAL DISTAL 2.7 4HOLE LEFT 02.118.403
|
Facility
|
OP
|
$8,079.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3697494
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,352.60 |
| Max. Negotiated Rate |
$7,729.99 |
| Rate for Payer: Aetna Commercial |
$7,561.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,225.86
|
| Rate for Payer: Aetna Managed Medicare |
$2,352.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,461.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,201.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,033.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,453.14
|
| Rate for Payer: Cash Price |
$2,423.70
|
| Rate for Payer: Cigna Commercial |
$7,729.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,701.98
|
| Rate for Payer: Health EOS Commercial |
$7,477.92
|
| Rate for Payer: HFN Commercial |
$7,729.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,301.62
|
| Rate for Payer: Multiplan Commercial |
$6,721.73
|
| Rate for Payer: NAPHCARE Commercial |
$5,041.30
|
| Rate for Payer: Preferred Network Access Commercial |
$7,729.99
|
| Rate for Payer: Quartz Beloit One Network |
$4,117.06
|
| Rate for Payer: Quartz Commercial |
$5,461.40
|
| Rate for Payer: Quartz Medicare Advantage |
$5,041.30
|
| Rate for Payer: The Alliance Commercial |
$4,201.08
|
| Rate for Payer: WEA Trust Commercial |
$4,621.19
|
| Rate for Payer: WPS Commercial |
$6,223.25
|
|
|
PLATE FIBULA LATERAL OFFSET 101MM LT 5888503L
|
Facility
|
OP
|
$8,899.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6178987
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,591.39 |
| Max. Negotiated Rate |
$8,514.56 |
| Rate for Payer: Aetna Commercial |
$8,329.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,959.27
|
| Rate for Payer: Aetna Managed Medicare |
$2,591.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,015.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,627.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,442.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,905.13
|
| Rate for Payer: Cash Price |
$2,669.70
|
| Rate for Payer: Cigna Commercial |
$8,514.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,179.22
|
| Rate for Payer: Health EOS Commercial |
$8,236.91
|
| Rate for Payer: HFN Commercial |
$8,514.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,941.22
|
| Rate for Payer: Multiplan Commercial |
$7,403.97
|
| Rate for Payer: NAPHCARE Commercial |
$5,552.98
|
| Rate for Payer: Preferred Network Access Commercial |
$8,514.56
|
| Rate for Payer: Quartz Beloit One Network |
$4,534.93
|
| Rate for Payer: Quartz Commercial |
$6,015.72
|
| Rate for Payer: Quartz Medicare Advantage |
$5,552.98
|
| Rate for Payer: The Alliance Commercial |
$4,627.48
|
| Rate for Payer: WEA Trust Commercial |
$5,090.23
|
| Rate for Payer: WPS Commercial |
$6,854.90
|
|
|
PLATE FIBULA LATERAL OFFSET 101MM LT 5888503L
|
Facility
|
IP
|
$8,899.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6178987
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,534.93 |
| Max. Negotiated Rate |
$8,514.56 |
| Rate for Payer: Aetna Commercial |
$8,329.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,959.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,905.13
|
| Rate for Payer: Cash Price |
$2,669.70
|
| Rate for Payer: Cigna Commercial |
$8,514.56
|
| Rate for Payer: Health EOS Commercial |
$8,236.91
|
| Rate for Payer: HFN Commercial |
$8,514.56
|
| Rate for Payer: Multiplan Commercial |
$7,403.97
|
| Rate for Payer: Preferred Network Access Commercial |
$8,514.56
|
| Rate for Payer: Quartz Beloit One Network |
$4,534.93
|
| Rate for Payer: Quartz Commercial |
$5,552.98
|
| Rate for Payer: WEA Trust Commercial |
$5,090.23
|
| Rate for Payer: WPS Commercial |
$6,854.90
|
|
|
PLATE FIBULA LATERAL OFFSET 101MM RT 5888503R
|
Facility
|
IP
|
$7,738.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5729835
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,943.28 |
| Max. Negotiated Rate |
$7,403.72 |
| Rate for Payer: Aetna Commercial |
$7,242.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,920.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,265.19
|
| Rate for Payer: Cash Price |
$2,321.40
|
| Rate for Payer: Cigna Commercial |
$7,403.72
|
| Rate for Payer: Health EOS Commercial |
$7,162.29
|
| Rate for Payer: HFN Commercial |
$7,403.72
|
| Rate for Payer: Multiplan Commercial |
$6,438.02
|
| Rate for Payer: Preferred Network Access Commercial |
$7,403.72
|
| Rate for Payer: Quartz Beloit One Network |
$3,943.28
|
| Rate for Payer: Quartz Commercial |
$4,828.51
|
| Rate for Payer: WEA Trust Commercial |
$4,426.14
|
| Rate for Payer: WPS Commercial |
$5,960.58
|
|
|
PLATE FIBULA LATERAL OFFSET 101MM RT 5888503R
|
Facility
|
OP
|
$7,738.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5729835
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,253.31 |
| Max. Negotiated Rate |
$7,403.72 |
| Rate for Payer: Aetna Commercial |
$7,242.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,920.87
|
| Rate for Payer: Aetna Managed Medicare |
$2,253.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,230.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,023.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,862.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,265.19
|
| Rate for Payer: Cash Price |
$2,321.40
|
| Rate for Payer: Cigna Commercial |
$7,403.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,503.52
|
| Rate for Payer: Health EOS Commercial |
$7,162.29
|
| Rate for Payer: HFN Commercial |
$7,403.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,035.64
|
| Rate for Payer: Multiplan Commercial |
$6,438.02
|
| Rate for Payer: NAPHCARE Commercial |
$4,828.51
|
| Rate for Payer: Preferred Network Access Commercial |
$7,403.72
|
| Rate for Payer: Quartz Beloit One Network |
$3,943.28
|
| Rate for Payer: Quartz Commercial |
$5,230.89
|
| Rate for Payer: Quartz Medicare Advantage |
$4,828.51
|
| Rate for Payer: The Alliance Commercial |
$4,023.76
|
| Rate for Payer: WEA Trust Commercial |
$4,426.14
|
| Rate for Payer: WPS Commercial |
$5,960.58
|
|
|
PLATE FIBULA LATERAL OFFSET 77MM RT ORTHOLOC 3DI SYSTEM 5888501R
|
Facility
|
OP
|
$8,530.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6206994
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,483.94 |
| Max. Negotiated Rate |
$8,161.50 |
| Rate for Payer: Aetna Commercial |
$7,984.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,629.23
|
| Rate for Payer: Aetna Managed Medicare |
$2,483.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,766.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,435.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,258.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,701.74
|
| Rate for Payer: Cash Price |
$2,559.00
|
| Rate for Payer: Cigna Commercial |
$8,161.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,964.46
|
| Rate for Payer: Health EOS Commercial |
$7,895.37
|
| Rate for Payer: HFN Commercial |
$8,161.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,653.40
|
| Rate for Payer: Multiplan Commercial |
$7,096.96
|
| Rate for Payer: NAPHCARE Commercial |
$5,322.72
|
| Rate for Payer: Preferred Network Access Commercial |
$8,161.50
|
| Rate for Payer: Quartz Beloit One Network |
$4,346.89
|
| Rate for Payer: Quartz Commercial |
$5,766.28
|
| Rate for Payer: Quartz Medicare Advantage |
$5,322.72
|
| Rate for Payer: The Alliance Commercial |
$4,435.60
|
| Rate for Payer: WEA Trust Commercial |
$4,879.16
|
| Rate for Payer: WPS Commercial |
$6,570.66
|
|
|
PLATE FIBULA LATERAL OFFSET 77MM RT ORTHOLOC 3DI SYSTEM 5888501R
|
Facility
|
IP
|
$8,530.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6206994
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,346.89 |
| Max. Negotiated Rate |
$8,161.50 |
| Rate for Payer: Aetna Commercial |
$7,984.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,629.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,701.74
|
| Rate for Payer: Cash Price |
$2,559.00
|
| Rate for Payer: Cigna Commercial |
$8,161.50
|
| Rate for Payer: Health EOS Commercial |
$7,895.37
|
| Rate for Payer: HFN Commercial |
$8,161.50
|
| Rate for Payer: Multiplan Commercial |
$7,096.96
|
| Rate for Payer: Preferred Network Access Commercial |
$8,161.50
|
| Rate for Payer: Quartz Beloit One Network |
$4,346.89
|
| Rate for Payer: Quartz Commercial |
$5,322.72
|
| Rate for Payer: WEA Trust Commercial |
$4,879.16
|
| Rate for Payer: WPS Commercial |
$6,570.66
|
|
|
PLATE FIBULA LATERAL OFFSET 89MM RT ORTHOLOC 3DI SYSTEM 5888502R
|
Facility
|
IP
|
$8,715.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6200967
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,441.16 |
| Max. Negotiated Rate |
$8,338.51 |
| Rate for Payer: Aetna Commercial |
$8,157.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,794.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,803.71
|
| Rate for Payer: Cash Price |
$2,614.50
|
| Rate for Payer: Cigna Commercial |
$8,338.51
|
| Rate for Payer: Health EOS Commercial |
$8,066.60
|
| Rate for Payer: HFN Commercial |
$8,338.51
|
| Rate for Payer: Multiplan Commercial |
$7,250.88
|
| Rate for Payer: Preferred Network Access Commercial |
$8,338.51
|
| Rate for Payer: Quartz Beloit One Network |
$4,441.16
|
| Rate for Payer: Quartz Commercial |
$5,438.16
|
| Rate for Payer: WEA Trust Commercial |
$4,984.98
|
| Rate for Payer: WPS Commercial |
$6,713.16
|
|
|
PLATE FIBULA LATERAL OFFSET 89MM RT ORTHOLOC 3DI SYSTEM 5888502R
|
Facility
|
OP
|
$8,715.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6200967
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,537.81 |
| Max. Negotiated Rate |
$8,338.51 |
| Rate for Payer: Aetna Commercial |
$8,157.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,794.70
|
| Rate for Payer: Aetna Managed Medicare |
$2,537.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,891.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,531.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,350.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,803.71
|
| Rate for Payer: Cash Price |
$2,614.50
|
| Rate for Payer: Cigna Commercial |
$8,338.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,072.13
|
| Rate for Payer: Health EOS Commercial |
$8,066.60
|
| Rate for Payer: HFN Commercial |
$8,338.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,797.70
|
| Rate for Payer: Multiplan Commercial |
$7,250.88
|
| Rate for Payer: NAPHCARE Commercial |
$5,438.16
|
| Rate for Payer: Preferred Network Access Commercial |
$8,338.51
|
| Rate for Payer: Quartz Beloit One Network |
$4,441.16
|
| Rate for Payer: Quartz Commercial |
$5,891.34
|
| Rate for Payer: Quartz Medicare Advantage |
$5,438.16
|
| Rate for Payer: The Alliance Commercial |
$4,531.80
|
| Rate for Payer: WEA Trust Commercial |
$4,984.98
|
| Rate for Payer: WPS Commercial |
$6,713.16
|
|
|
PLATE FIBULA RT 2.7/3.5 6HL 02.112.142
|
Facility
|
OP
|
$6,436.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966369
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,874.16 |
| Max. Negotiated Rate |
$6,157.96 |
| Rate for Payer: Aetna Commercial |
$6,024.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,756.36
|
| Rate for Payer: Aetna Managed Medicare |
$1,874.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,350.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,346.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,212.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,547.52
|
| Rate for Payer: Cash Price |
$1,930.80
|
| Rate for Payer: Cigna Commercial |
$6,157.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,745.75
|
| Rate for Payer: Health EOS Commercial |
$5,957.16
|
| Rate for Payer: HFN Commercial |
$6,157.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,020.08
|
| Rate for Payer: Multiplan Commercial |
$5,354.75
|
| Rate for Payer: NAPHCARE Commercial |
$4,016.06
|
| Rate for Payer: Preferred Network Access Commercial |
$6,157.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,279.79
|
| Rate for Payer: Quartz Commercial |
$4,350.74
|
| Rate for Payer: Quartz Medicare Advantage |
$4,016.06
|
| Rate for Payer: The Alliance Commercial |
$3,346.72
|
| Rate for Payer: WEA Trust Commercial |
$3,681.39
|
| Rate for Payer: WPS Commercial |
$4,957.65
|
|
|
PLATE FIBULA RT 2.7/3.5 6HL 02.112.142
|
Facility
|
IP
|
$6,436.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966369
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,279.79 |
| Max. Negotiated Rate |
$6,157.96 |
| Rate for Payer: Aetna Commercial |
$6,024.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,756.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,547.52
|
| Rate for Payer: Cash Price |
$1,930.80
|
| Rate for Payer: Cigna Commercial |
$6,157.96
|
| Rate for Payer: Health EOS Commercial |
$5,957.16
|
| Rate for Payer: HFN Commercial |
$6,157.96
|
| Rate for Payer: Multiplan Commercial |
$5,354.75
|
| Rate for Payer: Preferred Network Access Commercial |
$6,157.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,279.79
|
| Rate for Payer: Quartz Commercial |
$4,016.06
|
| Rate for Payer: WEA Trust Commercial |
$3,681.39
|
| Rate for Payer: WPS Commercial |
$4,957.65
|
|
|
PLATE HOOK 3.5MM CLAVICLE LCP 4HL 15MM HOOK DEPTH 44MM RT 241.074S
|
Facility
|
IP
|
$5,283.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4594988
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,692.22 |
| Max. Negotiated Rate |
$5,054.77 |
| Rate for Payer: Aetna Commercial |
$4,944.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,725.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,911.99
|
| Rate for Payer: Cash Price |
$1,584.90
|
| Rate for Payer: Cigna Commercial |
$5,054.77
|
| Rate for Payer: Health EOS Commercial |
$4,889.94
|
| Rate for Payer: HFN Commercial |
$5,054.77
|
| Rate for Payer: Multiplan Commercial |
$4,395.46
|
| Rate for Payer: Preferred Network Access Commercial |
$5,054.77
|
| Rate for Payer: Quartz Beloit One Network |
$2,692.22
|
| Rate for Payer: Quartz Commercial |
$3,296.59
|
| Rate for Payer: WEA Trust Commercial |
$3,021.88
|
| Rate for Payer: WPS Commercial |
$4,069.49
|
|
|
PLATE HOOK 3.5MM CLAVICLE LCP 4HL 15MM HOOK DEPTH 44MM RT 241.074S
|
Facility
|
OP
|
$5,283.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4594988
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,538.41 |
| Max. Negotiated Rate |
$5,054.77 |
| Rate for Payer: Aetna Commercial |
$4,944.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,725.12
|
| Rate for Payer: Aetna Managed Medicare |
$1,538.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,571.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,747.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,637.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,911.99
|
| Rate for Payer: Cash Price |
$1,584.90
|
| Rate for Payer: Cigna Commercial |
$5,054.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,074.71
|
| Rate for Payer: Health EOS Commercial |
$4,889.94
|
| Rate for Payer: HFN Commercial |
$5,054.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,120.74
|
| Rate for Payer: Multiplan Commercial |
$4,395.46
|
| Rate for Payer: NAPHCARE Commercial |
$3,296.59
|
| Rate for Payer: Preferred Network Access Commercial |
$5,054.77
|
| Rate for Payer: Quartz Beloit One Network |
$2,692.22
|
| Rate for Payer: Quartz Commercial |
$3,571.31
|
| Rate for Payer: Quartz Medicare Advantage |
$3,296.59
|
| Rate for Payer: The Alliance Commercial |
$2,747.16
|
| Rate for Payer: WEA Trust Commercial |
$3,021.88
|
| Rate for Payer: WPS Commercial |
$4,069.49
|
|
|
PLATE HOOK 3.5MM CLAVICLE LCP 4HL 18MM HOOK DEPTH 44MM RT 241.076S
|
Facility
|
OP
|
$5,283.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5106784
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,538.41 |
| Max. Negotiated Rate |
$5,054.77 |
| Rate for Payer: Aetna Commercial |
$4,944.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,725.12
|
| Rate for Payer: Aetna Managed Medicare |
$1,538.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,571.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,747.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,637.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,911.99
|
| Rate for Payer: Cash Price |
$1,584.90
|
| Rate for Payer: Cigna Commercial |
$5,054.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,074.71
|
| Rate for Payer: Health EOS Commercial |
$4,889.94
|
| Rate for Payer: HFN Commercial |
$5,054.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,120.74
|
| Rate for Payer: Multiplan Commercial |
$4,395.46
|
| Rate for Payer: NAPHCARE Commercial |
$3,296.59
|
| Rate for Payer: Preferred Network Access Commercial |
$5,054.77
|
| Rate for Payer: Quartz Beloit One Network |
$2,692.22
|
| Rate for Payer: Quartz Commercial |
$3,571.31
|
| Rate for Payer: Quartz Medicare Advantage |
$3,296.59
|
| Rate for Payer: The Alliance Commercial |
$2,747.16
|
| Rate for Payer: WEA Trust Commercial |
$3,021.88
|
| Rate for Payer: WPS Commercial |
$4,069.49
|
|
