|
PLATE UNIVERSAL CROSSPLATE 5HL 626895
|
Facility
|
OP
|
$12,721.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5787771
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,704.36 |
| Max. Negotiated Rate |
$12,171.45 |
| Rate for Payer: Aetna Commercial |
$11,906.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,377.66
|
| Rate for Payer: Aetna Managed Medicare |
$3,704.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,599.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,614.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,350.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,011.82
|
| Rate for Payer: Cash Price |
$3,816.30
|
| Rate for Payer: Cigna Commercial |
$12,171.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,403.62
|
| Rate for Payer: Health EOS Commercial |
$11,774.56
|
| Rate for Payer: HFN Commercial |
$12,171.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,922.38
|
| Rate for Payer: Multiplan Commercial |
$10,583.87
|
| Rate for Payer: NAPHCARE Commercial |
$7,937.90
|
| Rate for Payer: Preferred Network Access Commercial |
$12,171.45
|
| Rate for Payer: Quartz Beloit One Network |
$6,482.62
|
| Rate for Payer: Quartz Commercial |
$8,599.40
|
| Rate for Payer: Quartz Medicare Advantage |
$7,937.90
|
| Rate for Payer: The Alliance Commercial |
$6,614.92
|
| Rate for Payer: WEA Trust Commercial |
$7,276.41
|
| Rate for Payer: WPS Commercial |
$9,798.99
|
|
|
PLATE UNIVERSAL CROSSPLATE 5HL 626895
|
Facility
|
IP
|
$12,721.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5787771
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,482.62 |
| Max. Negotiated Rate |
$12,171.45 |
| Rate for Payer: Aetna Commercial |
$11,906.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,377.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,011.82
|
| Rate for Payer: Cash Price |
$3,816.30
|
| Rate for Payer: Cigna Commercial |
$12,171.45
|
| Rate for Payer: Health EOS Commercial |
$11,774.56
|
| Rate for Payer: HFN Commercial |
$12,171.45
|
| Rate for Payer: Multiplan Commercial |
$10,583.87
|
| Rate for Payer: Preferred Network Access Commercial |
$12,171.45
|
| Rate for Payer: Quartz Beloit One Network |
$6,482.62
|
| Rate for Payer: Quartz Commercial |
$7,937.90
|
| Rate for Payer: WEA Trust Commercial |
$7,276.41
|
| Rate for Payer: WPS Commercial |
$9,798.99
|
|
|
PLATE VA-LCP 3.5MM PROX TIBIA 4H 87MM LT 02.127.311S
|
Facility
|
OP
|
$14,069.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5264864
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,096.89 |
| Max. Negotiated Rate |
$13,461.22 |
| Rate for Payer: Aetna Commercial |
$13,168.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,583.31
|
| Rate for Payer: Aetna Managed Medicare |
$4,096.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,510.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,315.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,023.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,754.83
|
| Rate for Payer: Cash Price |
$4,220.70
|
| Rate for Payer: Cigna Commercial |
$13,461.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,188.16
|
| Rate for Payer: Health EOS Commercial |
$13,022.27
|
| Rate for Payer: HFN Commercial |
$13,461.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,973.82
|
| Rate for Payer: Multiplan Commercial |
$11,705.41
|
| Rate for Payer: NAPHCARE Commercial |
$8,779.06
|
| Rate for Payer: Preferred Network Access Commercial |
$13,461.22
|
| Rate for Payer: Quartz Beloit One Network |
$7,169.56
|
| Rate for Payer: Quartz Commercial |
$9,510.64
|
| Rate for Payer: Quartz Medicare Advantage |
$8,779.06
|
| Rate for Payer: The Alliance Commercial |
$7,315.88
|
| Rate for Payer: WEA Trust Commercial |
$8,047.47
|
| Rate for Payer: WPS Commercial |
$10,837.35
|
|
|
PLATE VA-LCP 3.5MM PROX TIBIA 4H 87MM LT 02.127.311S
|
Facility
|
IP
|
$14,069.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5264864
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,169.56 |
| Max. Negotiated Rate |
$13,461.22 |
| Rate for Payer: Aetna Commercial |
$13,168.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,583.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,754.83
|
| Rate for Payer: Cash Price |
$4,220.70
|
| Rate for Payer: Cigna Commercial |
$13,461.22
|
| Rate for Payer: Health EOS Commercial |
$13,022.27
|
| Rate for Payer: HFN Commercial |
$13,461.22
|
| Rate for Payer: Multiplan Commercial |
$11,705.41
|
| Rate for Payer: Preferred Network Access Commercial |
$13,461.22
|
| Rate for Payer: Quartz Beloit One Network |
$7,169.56
|
| Rate for Payer: Quartz Commercial |
$8,779.06
|
| Rate for Payer: WEA Trust Commercial |
$8,047.47
|
| Rate for Payer: WPS Commercial |
$10,837.35
|
|
|
PLATE VALLUX COLINK P90 ST031
|
Facility
|
OP
|
$8,768.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6172084
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,553.24 |
| Max. Negotiated Rate |
$8,389.22 |
| Rate for Payer: Aetna Commercial |
$8,206.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,842.10
|
| Rate for Payer: Aetna Managed Medicare |
$2,553.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,927.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,559.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,376.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,832.92
|
| Rate for Payer: Cash Price |
$2,630.40
|
| Rate for Payer: Cigna Commercial |
$8,389.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,102.98
|
| Rate for Payer: Health EOS Commercial |
$8,115.66
|
| Rate for Payer: HFN Commercial |
$8,389.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,839.04
|
| Rate for Payer: Multiplan Commercial |
$7,294.98
|
| Rate for Payer: NAPHCARE Commercial |
$5,471.23
|
| Rate for Payer: Preferred Network Access Commercial |
$8,389.22
|
| Rate for Payer: Quartz Beloit One Network |
$4,468.17
|
| Rate for Payer: Quartz Commercial |
$5,927.17
|
| Rate for Payer: Quartz Medicare Advantage |
$5,471.23
|
| Rate for Payer: The Alliance Commercial |
$4,559.36
|
| Rate for Payer: WEA Trust Commercial |
$5,015.30
|
| Rate for Payer: WPS Commercial |
$6,753.99
|
|
|
PLATE VALLUX COLINK P90 ST031
|
Facility
|
IP
|
$8,768.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6172084
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,468.17 |
| Max. Negotiated Rate |
$8,389.22 |
| Rate for Payer: Aetna Commercial |
$8,206.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,842.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,832.92
|
| Rate for Payer: Cash Price |
$2,630.40
|
| Rate for Payer: Cigna Commercial |
$8,389.22
|
| Rate for Payer: Health EOS Commercial |
$8,115.66
|
| Rate for Payer: HFN Commercial |
$8,389.22
|
| Rate for Payer: Multiplan Commercial |
$7,294.98
|
| Rate for Payer: Preferred Network Access Commercial |
$8,389.22
|
| Rate for Payer: Quartz Beloit One Network |
$4,468.17
|
| Rate for Payer: Quartz Commercial |
$5,471.23
|
| Rate for Payer: WEA Trust Commercial |
$5,015.30
|
| Rate for Payer: WPS Commercial |
$6,753.99
|
|
|
PLATE VA OLECRANON 2.7MM/ 3.5MM LT 2HL 02.107.302S
|
Facility
|
IP
|
$7,938.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5563547
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,045.20 |
| Max. Negotiated Rate |
$7,595.08 |
| Rate for Payer: Aetna Commercial |
$7,429.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,099.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,375.43
|
| Rate for Payer: Cash Price |
$2,381.40
|
| Rate for Payer: Cigna Commercial |
$7,595.08
|
| Rate for Payer: Health EOS Commercial |
$7,347.41
|
| Rate for Payer: HFN Commercial |
$7,595.08
|
| Rate for Payer: Multiplan Commercial |
$6,604.42
|
| Rate for Payer: Preferred Network Access Commercial |
$7,595.08
|
| Rate for Payer: Quartz Beloit One Network |
$4,045.20
|
| Rate for Payer: Quartz Commercial |
$4,953.31
|
| Rate for Payer: WEA Trust Commercial |
$4,540.54
|
| Rate for Payer: WPS Commercial |
$6,114.64
|
|
|
PLATE VA OLECRANON 2.7MM/ 3.5MM LT 2HL 02.107.302S
|
Facility
|
OP
|
$7,938.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5563547
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,311.55 |
| Max. Negotiated Rate |
$7,595.08 |
| Rate for Payer: Aetna Commercial |
$7,429.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,099.75
|
| Rate for Payer: Aetna Managed Medicare |
$2,311.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,366.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,127.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,962.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,375.43
|
| Rate for Payer: Cash Price |
$2,381.40
|
| Rate for Payer: Cigna Commercial |
$7,595.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,619.92
|
| Rate for Payer: Health EOS Commercial |
$7,347.41
|
| Rate for Payer: HFN Commercial |
$7,595.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,191.64
|
| Rate for Payer: Multiplan Commercial |
$6,604.42
|
| Rate for Payer: NAPHCARE Commercial |
$4,953.31
|
| Rate for Payer: Preferred Network Access Commercial |
$7,595.08
|
| Rate for Payer: Quartz Beloit One Network |
$4,045.20
|
| Rate for Payer: Quartz Commercial |
$5,366.09
|
| Rate for Payer: Quartz Medicare Advantage |
$4,953.31
|
| Rate for Payer: The Alliance Commercial |
$4,127.76
|
| Rate for Payer: WEA Trust Commercial |
$4,540.54
|
| Rate for Payer: WPS Commercial |
$6,114.64
|
|
|
PLATE VA OLECRANON 2.7MM/ 3.5MM LT 4HL 02.107.304S
|
Facility
|
IP
|
$4,885.67
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5248719
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,489.74 |
| Max. Negotiated Rate |
$4,674.61 |
| Rate for Payer: Aetna Commercial |
$4,572.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,369.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,692.98
|
| Rate for Payer: Cash Price |
$1,465.70
|
| Rate for Payer: Cigna Commercial |
$4,674.61
|
| Rate for Payer: Health EOS Commercial |
$4,522.18
|
| Rate for Payer: HFN Commercial |
$4,674.61
|
| Rate for Payer: Multiplan Commercial |
$4,064.88
|
| Rate for Payer: Preferred Network Access Commercial |
$4,674.61
|
| Rate for Payer: Quartz Beloit One Network |
$2,489.74
|
| Rate for Payer: Quartz Commercial |
$3,048.66
|
| Rate for Payer: WEA Trust Commercial |
$2,794.60
|
| Rate for Payer: WPS Commercial |
$3,763.43
|
|
|
PLATE VA OLECRANON 2.7MM/ 3.5MM LT 4HL 02.107.304S
|
Facility
|
OP
|
$4,885.67
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5248719
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,422.71 |
| Max. Negotiated Rate |
$4,674.61 |
| Rate for Payer: Aetna Commercial |
$4,572.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,369.74
|
| Rate for Payer: Aetna Managed Medicare |
$1,422.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,302.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,540.55
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,438.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,692.98
|
| Rate for Payer: Cash Price |
$1,465.70
|
| Rate for Payer: Cigna Commercial |
$4,674.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,843.46
|
| Rate for Payer: Health EOS Commercial |
$4,522.18
|
| Rate for Payer: HFN Commercial |
$4,674.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,810.82
|
| Rate for Payer: Multiplan Commercial |
$4,064.88
|
| Rate for Payer: NAPHCARE Commercial |
$3,048.66
|
| Rate for Payer: Preferred Network Access Commercial |
$4,674.61
|
| Rate for Payer: Quartz Beloit One Network |
$2,489.74
|
| Rate for Payer: Quartz Commercial |
$3,302.71
|
| Rate for Payer: Quartz Medicare Advantage |
$3,048.66
|
| Rate for Payer: The Alliance Commercial |
$2,540.55
|
| Rate for Payer: WEA Trust Commercial |
$2,794.60
|
| Rate for Payer: WPS Commercial |
$3,763.43
|
|
|
PLATE VA OLECRANON PROXIMAL 2.7/3.5 2HL LT 02.107.102
|
Facility
|
IP
|
$11,007.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5248648
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,609.17 |
| Max. Negotiated Rate |
$10,531.50 |
| Rate for Payer: Aetna Commercial |
$10,302.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,844.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,067.06
|
| Rate for Payer: Cash Price |
$3,302.10
|
| Rate for Payer: Cigna Commercial |
$10,531.50
|
| Rate for Payer: Health EOS Commercial |
$10,188.08
|
| Rate for Payer: HFN Commercial |
$10,531.50
|
| Rate for Payer: Multiplan Commercial |
$9,157.82
|
| Rate for Payer: Preferred Network Access Commercial |
$10,531.50
|
| Rate for Payer: Quartz Beloit One Network |
$5,609.17
|
| Rate for Payer: Quartz Commercial |
$6,868.37
|
| Rate for Payer: WEA Trust Commercial |
$6,296.00
|
| Rate for Payer: WPS Commercial |
$8,478.69
|
|
|
PLATE VA OLECRANON PROXIMAL 2.7/3.5 2HL LT 02.107.102
|
Facility
|
OP
|
$11,007.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5248648
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,205.24 |
| Max. Negotiated Rate |
$10,531.50 |
| Rate for Payer: Aetna Commercial |
$10,302.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,844.66
|
| Rate for Payer: Aetna Managed Medicare |
$3,205.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,440.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,723.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,494.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,067.06
|
| Rate for Payer: Cash Price |
$3,302.10
|
| Rate for Payer: Cigna Commercial |
$10,531.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,406.07
|
| Rate for Payer: Health EOS Commercial |
$10,188.08
|
| Rate for Payer: HFN Commercial |
$10,531.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,585.46
|
| Rate for Payer: Multiplan Commercial |
$9,157.82
|
| Rate for Payer: NAPHCARE Commercial |
$6,868.37
|
| Rate for Payer: Preferred Network Access Commercial |
$10,531.50
|
| Rate for Payer: Quartz Beloit One Network |
$5,609.17
|
| Rate for Payer: Quartz Commercial |
$7,440.73
|
| Rate for Payer: Quartz Medicare Advantage |
$6,868.37
|
| Rate for Payer: The Alliance Commercial |
$5,723.64
|
| Rate for Payer: WEA Trust Commercial |
$6,296.00
|
| Rate for Payer: WPS Commercial |
$8,478.69
|
|
|
PLATE VOLAR 9HL HEAD/5 HL SHAF
|
Facility
|
OP
|
$8,223.00
|
|
| Hospital Charge Code |
2966380
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,394.54 |
| Max. Negotiated Rate |
$7,867.77 |
| Rate for Payer: Aetna Commercial |
$7,696.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,354.65
|
| Rate for Payer: Aetna Managed Medicare |
$2,394.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,558.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,275.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,104.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,532.52
|
| Rate for Payer: Cash Price |
$2,466.90
|
| Rate for Payer: Cigna Commercial |
$7,867.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,785.79
|
| Rate for Payer: Health EOS Commercial |
$7,611.21
|
| Rate for Payer: HFN Commercial |
$7,867.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,413.94
|
| Rate for Payer: Multiplan Commercial |
$6,841.54
|
| Rate for Payer: NAPHCARE Commercial |
$5,131.15
|
| Rate for Payer: Preferred Network Access Commercial |
$7,867.77
|
| Rate for Payer: Quartz Beloit One Network |
$4,190.44
|
| Rate for Payer: Quartz Commercial |
$5,558.75
|
| Rate for Payer: Quartz Medicare Advantage |
$5,131.15
|
| Rate for Payer: The Alliance Commercial |
$4,275.96
|
| Rate for Payer: WEA Trust Commercial |
$4,703.56
|
| Rate for Payer: WPS Commercial |
$6,334.18
|
|
|
PLATE VOLAR 9HL HEAD/5 HL SHAF
|
Facility
|
IP
|
$8,223.00
|
|
| Hospital Charge Code |
2966380
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,190.44 |
| Max. Negotiated Rate |
$7,867.77 |
| Rate for Payer: Aetna Commercial |
$7,696.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,354.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,532.52
|
| Rate for Payer: Cash Price |
$2,466.90
|
| Rate for Payer: Cigna Commercial |
$7,867.77
|
| Rate for Payer: Health EOS Commercial |
$7,611.21
|
| Rate for Payer: HFN Commercial |
$7,867.77
|
| Rate for Payer: Multiplan Commercial |
$6,841.54
|
| Rate for Payer: Preferred Network Access Commercial |
$7,867.77
|
| Rate for Payer: Quartz Beloit One Network |
$4,190.44
|
| Rate for Payer: Quartz Commercial |
$5,131.15
|
| Rate for Payer: WEA Trust Commercial |
$4,703.56
|
| Rate for Payer: WPS Commercial |
$6,334.18
|
|
|
PLATE VOLAR DISTAL RADIUS
|
Facility
|
OP
|
$9,068.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966381
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,640.60 |
| Max. Negotiated Rate |
$8,676.26 |
| Rate for Payer: Aetna Commercial |
$8,487.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,110.42
|
| Rate for Payer: Aetna Managed Medicare |
$2,640.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,129.97
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,715.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,526.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,998.28
|
| Rate for Payer: Cash Price |
$2,720.40
|
| Rate for Payer: Cigna Commercial |
$8,676.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,277.58
|
| Rate for Payer: Health EOS Commercial |
$8,393.34
|
| Rate for Payer: HFN Commercial |
$8,676.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,073.04
|
| Rate for Payer: Multiplan Commercial |
$7,544.58
|
| Rate for Payer: NAPHCARE Commercial |
$5,658.43
|
| Rate for Payer: Preferred Network Access Commercial |
$8,676.26
|
| Rate for Payer: Quartz Beloit One Network |
$4,621.05
|
| Rate for Payer: Quartz Commercial |
$6,129.97
|
| Rate for Payer: Quartz Medicare Advantage |
$5,658.43
|
| Rate for Payer: The Alliance Commercial |
$4,715.36
|
| Rate for Payer: WEA Trust Commercial |
$5,186.90
|
| Rate for Payer: WPS Commercial |
$6,985.08
|
|
|
PLATE VOLAR DISTAL RADIUS
|
Facility
|
IP
|
$9,068.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966381
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,621.05 |
| Max. Negotiated Rate |
$8,676.26 |
| Rate for Payer: Aetna Commercial |
$8,487.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,110.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,998.28
|
| Rate for Payer: Cash Price |
$2,720.40
|
| Rate for Payer: Cigna Commercial |
$8,676.26
|
| Rate for Payer: Health EOS Commercial |
$8,393.34
|
| Rate for Payer: HFN Commercial |
$8,676.26
|
| Rate for Payer: Multiplan Commercial |
$7,544.58
|
| Rate for Payer: Preferred Network Access Commercial |
$8,676.26
|
| Rate for Payer: Quartz Beloit One Network |
$4,621.05
|
| Rate for Payer: Quartz Commercial |
$5,658.43
|
| Rate for Payer: WEA Trust Commercial |
$5,186.90
|
| Rate for Payer: WPS Commercial |
$6,985.08
|
|
|
PLATE VOLAR DISTAL RADIUS 2.4 02.111.631
|
Facility
|
OP
|
$6,518.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2969454
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,898.04 |
| Max. Negotiated Rate |
$6,236.42 |
| Rate for Payer: Aetna Commercial |
$6,100.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,829.70
|
| Rate for Payer: Aetna Managed Medicare |
$1,898.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,406.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,389.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,253.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,592.72
|
| Rate for Payer: Cash Price |
$1,955.40
|
| Rate for Payer: Cigna Commercial |
$6,236.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,793.48
|
| Rate for Payer: Health EOS Commercial |
$6,033.06
|
| Rate for Payer: HFN Commercial |
$6,236.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,084.04
|
| Rate for Payer: Multiplan Commercial |
$5,422.98
|
| Rate for Payer: NAPHCARE Commercial |
$4,067.23
|
| Rate for Payer: Preferred Network Access Commercial |
$6,236.42
|
| Rate for Payer: Quartz Beloit One Network |
$3,321.57
|
| Rate for Payer: Quartz Commercial |
$4,406.17
|
| Rate for Payer: Quartz Medicare Advantage |
$4,067.23
|
| Rate for Payer: The Alliance Commercial |
$3,389.36
|
| Rate for Payer: WEA Trust Commercial |
$3,728.30
|
| Rate for Payer: WPS Commercial |
$5,020.82
|
|
|
PLATE VOLAR DISTAL RADIUS 2.4 02.111.631
|
Facility
|
IP
|
$6,518.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2969454
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,321.57 |
| Max. Negotiated Rate |
$6,236.42 |
| Rate for Payer: Aetna Commercial |
$6,100.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,829.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,592.72
|
| Rate for Payer: Cash Price |
$1,955.40
|
| Rate for Payer: Cigna Commercial |
$6,236.42
|
| Rate for Payer: Health EOS Commercial |
$6,033.06
|
| Rate for Payer: HFN Commercial |
$6,236.42
|
| Rate for Payer: Multiplan Commercial |
$5,422.98
|
| Rate for Payer: Preferred Network Access Commercial |
$6,236.42
|
| Rate for Payer: Quartz Beloit One Network |
$3,321.57
|
| Rate for Payer: Quartz Commercial |
$4,067.23
|
| Rate for Payer: WEA Trust Commercial |
$3,728.30
|
| Rate for Payer: WPS Commercial |
$5,020.82
|
|
|
PLATE VOLAR DISTAL RADIUS 2.4 7HL HEAD/3HL SHAFT LT 02.111.731
|
Facility
|
IP
|
$6,276.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2969455
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,198.25 |
| Max. Negotiated Rate |
$6,004.88 |
| Rate for Payer: Aetna Commercial |
$5,874.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,613.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,459.33
|
| Rate for Payer: Cash Price |
$1,882.80
|
| Rate for Payer: Cigna Commercial |
$6,004.88
|
| Rate for Payer: Health EOS Commercial |
$5,809.07
|
| Rate for Payer: HFN Commercial |
$6,004.88
|
| Rate for Payer: Multiplan Commercial |
$5,221.63
|
| Rate for Payer: Preferred Network Access Commercial |
$6,004.88
|
| Rate for Payer: Quartz Beloit One Network |
$3,198.25
|
| Rate for Payer: Quartz Commercial |
$3,916.22
|
| Rate for Payer: WEA Trust Commercial |
$3,589.87
|
| Rate for Payer: WPS Commercial |
$4,834.40
|
|
|
PLATE VOLAR DISTAL RADIUS 2.4 7HL HEAD/3HL SHAFT LT 02.111.731
|
Facility
|
OP
|
$6,276.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2969455
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,827.57 |
| Max. Negotiated Rate |
$6,004.88 |
| Rate for Payer: Aetna Commercial |
$5,874.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,613.25
|
| Rate for Payer: Aetna Managed Medicare |
$1,827.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,242.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,263.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,132.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,459.33
|
| Rate for Payer: Cash Price |
$1,882.80
|
| Rate for Payer: Cigna Commercial |
$6,004.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,652.63
|
| Rate for Payer: Health EOS Commercial |
$5,809.07
|
| Rate for Payer: HFN Commercial |
$6,004.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,895.28
|
| Rate for Payer: Multiplan Commercial |
$5,221.63
|
| Rate for Payer: NAPHCARE Commercial |
$3,916.22
|
| Rate for Payer: Preferred Network Access Commercial |
$6,004.88
|
| Rate for Payer: Quartz Beloit One Network |
$3,198.25
|
| Rate for Payer: Quartz Commercial |
$4,242.58
|
| Rate for Payer: Quartz Medicare Advantage |
$3,916.22
|
| Rate for Payer: The Alliance Commercial |
$3,263.52
|
| Rate for Payer: WEA Trust Commercial |
$3,589.87
|
| Rate for Payer: WPS Commercial |
$4,834.40
|
|
|
PLATE VOLAR DISTAL RADIUS 2.4 7HL HEAD/3HL SHAFT RT 02.111.730
|
Facility
|
IP
|
$6,276.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966328
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,198.25 |
| Max. Negotiated Rate |
$6,004.88 |
| Rate for Payer: Aetna Commercial |
$5,874.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,613.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,459.33
|
| Rate for Payer: Cash Price |
$1,882.80
|
| Rate for Payer: Cigna Commercial |
$6,004.88
|
| Rate for Payer: Health EOS Commercial |
$5,809.07
|
| Rate for Payer: HFN Commercial |
$6,004.88
|
| Rate for Payer: Multiplan Commercial |
$5,221.63
|
| Rate for Payer: Preferred Network Access Commercial |
$6,004.88
|
| Rate for Payer: Quartz Beloit One Network |
$3,198.25
|
| Rate for Payer: Quartz Commercial |
$3,916.22
|
| Rate for Payer: WEA Trust Commercial |
$3,589.87
|
| Rate for Payer: WPS Commercial |
$4,834.40
|
|
|
PLATE VOLAR DISTAL RADIUS 2.4 7HL HEAD/3HL SHAFT RT 02.111.730
|
Facility
|
OP
|
$6,276.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966328
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,827.57 |
| Max. Negotiated Rate |
$6,004.88 |
| Rate for Payer: Aetna Commercial |
$5,874.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,613.25
|
| Rate for Payer: Aetna Managed Medicare |
$1,827.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,242.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,263.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,132.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,459.33
|
| Rate for Payer: Cash Price |
$1,882.80
|
| Rate for Payer: Cigna Commercial |
$6,004.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,652.63
|
| Rate for Payer: Health EOS Commercial |
$5,809.07
|
| Rate for Payer: HFN Commercial |
$6,004.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,895.28
|
| Rate for Payer: Multiplan Commercial |
$5,221.63
|
| Rate for Payer: NAPHCARE Commercial |
$3,916.22
|
| Rate for Payer: Preferred Network Access Commercial |
$6,004.88
|
| Rate for Payer: Quartz Beloit One Network |
$3,198.25
|
| Rate for Payer: Quartz Commercial |
$4,242.58
|
| Rate for Payer: Quartz Medicare Advantage |
$3,916.22
|
| Rate for Payer: The Alliance Commercial |
$3,263.52
|
| Rate for Payer: WEA Trust Commercial |
$3,589.87
|
| Rate for Payer: WPS Commercial |
$4,834.40
|
|
|
PLATE VOLAR DISTAL RADIUS 2.4 7HL HEAD/4HL SHAFT LT 02.111.741
|
Facility
|
IP
|
$5,424.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6105633
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,764.07 |
| Max. Negotiated Rate |
$5,189.68 |
| Rate for Payer: Aetna Commercial |
$5,076.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,851.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,989.71
|
| Rate for Payer: Cash Price |
$1,627.20
|
| Rate for Payer: Cigna Commercial |
$5,189.68
|
| Rate for Payer: Health EOS Commercial |
$5,020.45
|
| Rate for Payer: HFN Commercial |
$5,189.68
|
| Rate for Payer: Multiplan Commercial |
$4,512.77
|
| Rate for Payer: Preferred Network Access Commercial |
$5,189.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,764.07
|
| Rate for Payer: Quartz Commercial |
$3,384.58
|
| Rate for Payer: WEA Trust Commercial |
$3,102.53
|
| Rate for Payer: WPS Commercial |
$4,178.11
|
|
|
PLATE VOLAR DISTAL RADIUS 2.4 7HL HEAD/4HL SHAFT LT 02.111.741
|
Facility
|
OP
|
$5,424.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6105633
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,579.47 |
| Max. Negotiated Rate |
$5,189.68 |
| Rate for Payer: Aetna Commercial |
$5,076.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,851.23
|
| Rate for Payer: Aetna Managed Medicare |
$1,579.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,666.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,820.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,707.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,989.71
|
| Rate for Payer: Cash Price |
$1,627.20
|
| Rate for Payer: Cigna Commercial |
$5,189.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,156.77
|
| Rate for Payer: Health EOS Commercial |
$5,020.45
|
| Rate for Payer: HFN Commercial |
$5,189.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,230.72
|
| Rate for Payer: Multiplan Commercial |
$4,512.77
|
| Rate for Payer: NAPHCARE Commercial |
$3,384.58
|
| Rate for Payer: Preferred Network Access Commercial |
$5,189.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,764.07
|
| Rate for Payer: Quartz Commercial |
$3,666.62
|
| Rate for Payer: Quartz Medicare Advantage |
$3,384.58
|
| Rate for Payer: The Alliance Commercial |
$2,820.48
|
| Rate for Payer: WEA Trust Commercial |
$3,102.53
|
| Rate for Payer: WPS Commercial |
$4,178.11
|
|
|
PLATE VOLAR DISTAL RADIUS 2.4 7HL HEAD/4HL SHAFT RT 02.111.740
|
Facility
|
OP
|
$6,729.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966327
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,959.48 |
| Max. Negotiated Rate |
$6,438.31 |
| Rate for Payer: Aetna Commercial |
$6,298.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,018.42
|
| Rate for Payer: Aetna Managed Medicare |
$1,959.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,548.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,499.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,359.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,709.02
|
| Rate for Payer: Cash Price |
$2,018.70
|
| Rate for Payer: Cigna Commercial |
$6,438.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,916.28
|
| Rate for Payer: Health EOS Commercial |
$6,228.36
|
| Rate for Payer: HFN Commercial |
$6,438.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,248.62
|
| Rate for Payer: Multiplan Commercial |
$5,598.53
|
| Rate for Payer: NAPHCARE Commercial |
$4,198.90
|
| Rate for Payer: Preferred Network Access Commercial |
$6,438.31
|
| Rate for Payer: Quartz Beloit One Network |
$3,429.10
|
| Rate for Payer: Quartz Commercial |
$4,548.80
|
| Rate for Payer: Quartz Medicare Advantage |
$4,198.90
|
| Rate for Payer: The Alliance Commercial |
$3,499.08
|
| Rate for Payer: WEA Trust Commercial |
$3,848.99
|
| Rate for Payer: WPS Commercial |
$5,183.35
|
|
