|
PLATE DITAL FIBULA 2.7/3.5 10 HOLE RT LOCK 02.118.412
|
Facility
|
IP
|
$6,110.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494382
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,993.90 |
| Max. Negotiated Rate |
$5,621.20 |
| Rate for Payer: Aetna Commercial |
$5,499.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,254.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,238.30
|
| Rate for Payer: Cash Price |
$1,833.00
|
| Rate for Payer: Cigna Commercial |
$5,621.20
|
| Rate for Payer: Health EOS Commercial |
$5,437.90
|
| Rate for Payer: HFN Commercial |
$5,621.20
|
| Rate for Payer: Multiplan Commercial |
$4,888.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,666.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,621.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,993.90
|
| Rate for Payer: Quartz Commercial |
$3,666.00
|
| Rate for Payer: WEA Trust Commercial |
$3,360.50
|
| Rate for Payer: WPS Commercial |
$4,525.68
|
|
|
PLATE DITAL FIBULA 2.7/3.5 10 HOLE RT LOCK 02.118.412
|
Facility
|
OP
|
$6,110.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494382
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,710.80 |
| Max. Negotiated Rate |
$24,440.00 |
| Rate for Payer: Aetna Commercial |
$5,499.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,254.60
|
| Rate for Payer: Aetna Managed Medicare |
$1,710.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,971.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,055.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,932.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,238.30
|
| Rate for Payer: Cash Price |
$1,833.00
|
| Rate for Payer: Cigna Commercial |
$5,621.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,419.16
|
| Rate for Payer: Health EOS Commercial |
$5,437.90
|
| Rate for Payer: HFN Commercial |
$5,621.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,582.50
|
| Rate for Payer: Multiplan Commercial |
$4,888.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,666.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,621.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,993.90
|
| Rate for Payer: Quartz Commercial |
$3,971.50
|
| Rate for Payer: Quartz Medicare Advantage |
$3,666.00
|
| Rate for Payer: The Alliance Commercial |
$24,440.00
|
| Rate for Payer: WEA Trust Commercial |
$3,360.50
|
| Rate for Payer: WPS Commercial |
$4,525.68
|
|
|
PLATE FIBULA 113MM LT 5888404L
|
Facility
|
IP
|
$11,109.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6171733
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,443.41 |
| Max. Negotiated Rate |
$10,220.28 |
| Rate for Payer: Aetna Commercial |
$9,998.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,553.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,887.77
|
| Rate for Payer: Cash Price |
$3,332.70
|
| Rate for Payer: Cigna Commercial |
$10,220.28
|
| Rate for Payer: Health EOS Commercial |
$9,887.01
|
| Rate for Payer: HFN Commercial |
$10,220.28
|
| Rate for Payer: Multiplan Commercial |
$8,887.20
|
| Rate for Payer: NAPHCARE Commercial |
$6,665.40
|
| Rate for Payer: Preferred Network Access Commercial |
$10,220.28
|
| Rate for Payer: Quartz Beloit One Network |
$5,443.41
|
| Rate for Payer: Quartz Commercial |
$6,665.40
|
| Rate for Payer: WEA Trust Commercial |
$6,109.95
|
| Rate for Payer: WPS Commercial |
$8,228.44
|
|
|
PLATE FIBULA 113MM LT 5888404L
|
Facility
|
OP
|
$11,109.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6171733
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,110.52 |
| Max. Negotiated Rate |
$44,436.00 |
| Rate for Payer: Aetna Commercial |
$9,998.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,553.74
|
| Rate for Payer: Aetna Managed Medicare |
$3,110.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,220.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,554.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,332.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,887.77
|
| Rate for Payer: Cash Price |
$3,332.70
|
| Rate for Payer: Cigna Commercial |
$10,220.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,216.60
|
| Rate for Payer: Health EOS Commercial |
$9,887.01
|
| Rate for Payer: HFN Commercial |
$10,220.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,331.75
|
| Rate for Payer: Multiplan Commercial |
$8,887.20
|
| Rate for Payer: NAPHCARE Commercial |
$6,665.40
|
| Rate for Payer: Preferred Network Access Commercial |
$10,220.28
|
| Rate for Payer: Quartz Beloit One Network |
$5,443.41
|
| Rate for Payer: Quartz Commercial |
$7,220.85
|
| Rate for Payer: Quartz Medicare Advantage |
$6,665.40
|
| Rate for Payer: The Alliance Commercial |
$44,436.00
|
| Rate for Payer: WEA Trust Commercial |
$6,109.95
|
| Rate for Payer: WPS Commercial |
$8,228.44
|
|
|
PLATE FIBULA 113MM RT 5888404R
|
Facility
|
OP
|
$8,715.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6211040
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,440.20 |
| Max. Negotiated Rate |
$34,860.00 |
| Rate for Payer: Aetna Commercial |
$7,843.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,494.90
|
| Rate for Payer: Aetna Managed Medicare |
$2,440.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,664.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,357.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,183.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,618.95
|
| Rate for Payer: Cash Price |
$2,614.50
|
| Rate for Payer: Cigna Commercial |
$8,017.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,876.91
|
| Rate for Payer: Health EOS Commercial |
$7,756.35
|
| Rate for Payer: HFN Commercial |
$8,017.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,536.25
|
| Rate for Payer: Multiplan Commercial |
$6,972.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,229.00
|
| Rate for Payer: Preferred Network Access Commercial |
$8,017.80
|
| Rate for Payer: Quartz Beloit One Network |
$4,270.35
|
| Rate for Payer: Quartz Commercial |
$5,664.75
|
| Rate for Payer: Quartz Medicare Advantage |
$5,229.00
|
| Rate for Payer: The Alliance Commercial |
$34,860.00
|
| Rate for Payer: WEA Trust Commercial |
$4,793.25
|
| Rate for Payer: WPS Commercial |
$6,455.20
|
|
|
PLATE FIBULA 113MM RT 5888404R
|
Facility
|
IP
|
$8,715.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6211040
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,270.35 |
| Max. Negotiated Rate |
$8,017.80 |
| Rate for Payer: Aetna Commercial |
$7,843.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,494.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,618.95
|
| Rate for Payer: Cash Price |
$2,614.50
|
| Rate for Payer: Cigna Commercial |
$8,017.80
|
| Rate for Payer: Health EOS Commercial |
$7,756.35
|
| Rate for Payer: HFN Commercial |
$8,017.80
|
| Rate for Payer: Multiplan Commercial |
$6,972.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,229.00
|
| Rate for Payer: Preferred Network Access Commercial |
$8,017.80
|
| Rate for Payer: Quartz Beloit One Network |
$4,270.35
|
| Rate for Payer: Quartz Commercial |
$5,229.00
|
| Rate for Payer: WEA Trust Commercial |
$4,793.25
|
| Rate for Payer: WPS Commercial |
$6,455.20
|
|
|
PLATE FIBULA 2.7/3.5 5HL LT
|
Facility
|
OP
|
$5,846.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3072571
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,636.88 |
| Max. Negotiated Rate |
$23,384.00 |
| Rate for Payer: Aetna Commercial |
$5,261.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,027.56
|
| Rate for Payer: Aetna Managed Medicare |
$1,636.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,799.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,923.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,806.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,098.38
|
| Rate for Payer: Cash Price |
$1,753.80
|
| Rate for Payer: Cigna Commercial |
$5,378.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,271.42
|
| Rate for Payer: Health EOS Commercial |
$5,202.94
|
| Rate for Payer: HFN Commercial |
$5,378.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,384.50
|
| Rate for Payer: Multiplan Commercial |
$4,676.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,507.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,378.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,864.54
|
| Rate for Payer: Quartz Commercial |
$3,799.90
|
| Rate for Payer: Quartz Medicare Advantage |
$3,507.60
|
| Rate for Payer: The Alliance Commercial |
$23,384.00
|
| Rate for Payer: WEA Trust Commercial |
$3,215.30
|
| Rate for Payer: WPS Commercial |
$4,330.13
|
|
|
PLATE FIBULA 2.7/3.5 5HL LT
|
Facility
|
IP
|
$5,846.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3072571
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,864.54 |
| Max. Negotiated Rate |
$5,378.32 |
| Rate for Payer: Aetna Commercial |
$5,261.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,027.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,098.38
|
| Rate for Payer: Cash Price |
$1,753.80
|
| Rate for Payer: Cigna Commercial |
$5,378.32
|
| Rate for Payer: Health EOS Commercial |
$5,202.94
|
| Rate for Payer: HFN Commercial |
$5,378.32
|
| Rate for Payer: Multiplan Commercial |
$4,676.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,507.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,378.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,864.54
|
| Rate for Payer: Quartz Commercial |
$3,507.60
|
| Rate for Payer: WEA Trust Commercial |
$3,215.30
|
| Rate for Payer: WPS Commercial |
$4,330.13
|
|
|
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 |
$2,864.54 |
| Max. Negotiated Rate |
$5,378.32 |
| Rate for Payer: Aetna Commercial |
$5,261.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,027.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,098.38
|
| Rate for Payer: Cash Price |
$1,753.80
|
| Rate for Payer: Cigna Commercial |
$5,378.32
|
| Rate for Payer: Health EOS Commercial |
$5,202.94
|
| Rate for Payer: HFN Commercial |
$5,378.32
|
| Rate for Payer: Multiplan Commercial |
$4,676.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,507.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,378.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,864.54
|
| Rate for Payer: Quartz Commercial |
$3,507.60
|
| Rate for Payer: WEA Trust Commercial |
$3,215.30
|
| Rate for Payer: WPS Commercial |
$4,330.13
|
|
|
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 |
$1,636.88 |
| Max. Negotiated Rate |
$23,384.00 |
| Rate for Payer: Aetna Commercial |
$5,261.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,027.56
|
| Rate for Payer: Aetna Managed Medicare |
$1,636.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,799.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,923.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,806.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,098.38
|
| Rate for Payer: Cash Price |
$1,753.80
|
| Rate for Payer: Cigna Commercial |
$5,378.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,271.42
|
| Rate for Payer: Health EOS Commercial |
$5,202.94
|
| Rate for Payer: HFN Commercial |
$5,378.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,384.50
|
| Rate for Payer: Multiplan Commercial |
$4,676.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,507.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,378.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,864.54
|
| Rate for Payer: Quartz Commercial |
$3,799.90
|
| Rate for Payer: Quartz Medicare Advantage |
$3,507.60
|
| Rate for Payer: The Alliance Commercial |
$23,384.00
|
| Rate for Payer: WEA Trust Commercial |
$3,215.30
|
| Rate for Payer: WPS Commercial |
$4,330.13
|
|
|
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 |
$4,720.66 |
| Max. Negotiated Rate |
$8,863.28 |
| Rate for Payer: Aetna Commercial |
$8,670.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,285.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,106.02
|
| Rate for Payer: Cash Price |
$2,890.20
|
| Rate for Payer: Cigna Commercial |
$8,863.28
|
| Rate for Payer: Health EOS Commercial |
$8,574.26
|
| Rate for Payer: HFN Commercial |
$8,863.28
|
| Rate for Payer: Multiplan Commercial |
$7,707.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,780.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,863.28
|
| Rate for Payer: Quartz Beloit One Network |
$4,720.66
|
| Rate for Payer: Quartz Commercial |
$5,780.40
|
| Rate for Payer: WEA Trust Commercial |
$5,298.70
|
| Rate for Payer: WPS Commercial |
$7,135.90
|
|
|
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 |
$2,697.52 |
| Max. Negotiated Rate |
$38,536.00 |
| Rate for Payer: Aetna Commercial |
$8,670.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,285.24
|
| Rate for Payer: Aetna Managed Medicare |
$2,697.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,262.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,817.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,624.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,106.02
|
| Rate for Payer: Cash Price |
$2,890.20
|
| Rate for Payer: Cigna Commercial |
$8,863.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,391.19
|
| Rate for Payer: Health EOS Commercial |
$8,574.26
|
| Rate for Payer: HFN Commercial |
$8,863.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,225.50
|
| Rate for Payer: Multiplan Commercial |
$7,707.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,780.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,863.28
|
| Rate for Payer: Quartz Beloit One Network |
$4,720.66
|
| Rate for Payer: Quartz Commercial |
$6,262.10
|
| Rate for Payer: Quartz Medicare Advantage |
$5,780.40
|
| Rate for Payer: The Alliance Commercial |
$38,536.00
|
| Rate for Payer: WEA Trust Commercial |
$5,298.70
|
| Rate for Payer: WPS Commercial |
$7,135.90
|
|
|
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 |
$1,448.72 |
| Max. Negotiated Rate |
$20,696.00 |
| Rate for Payer: Aetna Commercial |
$4,656.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,449.64
|
| Rate for Payer: Aetna Managed Medicare |
$1,448.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,363.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,587.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,483.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,742.22
|
| Rate for Payer: Cash Price |
$1,552.20
|
| Rate for Payer: Cigna Commercial |
$4,760.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,895.37
|
| Rate for Payer: Health EOS Commercial |
$4,604.86
|
| Rate for Payer: HFN Commercial |
$4,760.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,880.50
|
| Rate for Payer: Multiplan Commercial |
$4,139.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,104.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,760.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,535.26
|
| Rate for Payer: Quartz Commercial |
$3,363.10
|
| Rate for Payer: Quartz Medicare Advantage |
$3,104.40
|
| Rate for Payer: The Alliance Commercial |
$20,696.00
|
| Rate for Payer: WEA Trust Commercial |
$2,845.70
|
| Rate for Payer: WPS Commercial |
$3,832.38
|
|
|
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 |
$2,535.26 |
| Max. Negotiated Rate |
$4,760.08 |
| Rate for Payer: Aetna Commercial |
$4,656.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,449.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,742.22
|
| Rate for Payer: Cash Price |
$1,552.20
|
| Rate for Payer: Cigna Commercial |
$4,760.08
|
| Rate for Payer: Health EOS Commercial |
$4,604.86
|
| Rate for Payer: HFN Commercial |
$4,760.08
|
| Rate for Payer: Multiplan Commercial |
$4,139.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,104.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,760.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,535.26
|
| Rate for Payer: Quartz Commercial |
$3,104.40
|
| Rate for Payer: WEA Trust Commercial |
$2,845.70
|
| Rate for Payer: WPS Commercial |
$3,832.38
|
|
|
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 |
$4,089.54 |
| Max. Negotiated Rate |
$7,678.32 |
| Rate for Payer: Aetna Commercial |
$7,511.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,177.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,423.38
|
| Rate for Payer: Cash Price |
$2,503.80
|
| Rate for Payer: Cigna Commercial |
$7,678.32
|
| Rate for Payer: Health EOS Commercial |
$7,427.94
|
| Rate for Payer: HFN Commercial |
$7,678.32
|
| Rate for Payer: Multiplan Commercial |
$6,676.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,007.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,678.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,089.54
|
| Rate for Payer: Quartz Commercial |
$5,007.60
|
| Rate for Payer: WEA Trust Commercial |
$4,590.30
|
| Rate for Payer: WPS Commercial |
$6,181.88
|
|
|
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 |
$2,336.88 |
| Max. Negotiated Rate |
$33,384.00 |
| Rate for Payer: Aetna Commercial |
$7,511.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,177.56
|
| Rate for Payer: Aetna Managed Medicare |
$2,336.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,424.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,173.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,006.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,423.38
|
| Rate for Payer: Cash Price |
$2,503.80
|
| Rate for Payer: Cigna Commercial |
$7,678.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,670.42
|
| Rate for Payer: Health EOS Commercial |
$7,427.94
|
| Rate for Payer: HFN Commercial |
$7,678.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,259.50
|
| Rate for Payer: Multiplan Commercial |
$6,676.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,007.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,678.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,089.54
|
| Rate for Payer: Quartz Commercial |
$5,424.90
|
| Rate for Payer: Quartz Medicare Advantage |
$5,007.60
|
| Rate for Payer: The Alliance Commercial |
$33,384.00
|
| Rate for Payer: WEA Trust Commercial |
$4,590.30
|
| Rate for Payer: WPS Commercial |
$6,181.88
|
|
|
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 |
$2,192.26 |
| Max. Negotiated Rate |
$4,116.08 |
| Rate for Payer: Aetna Commercial |
$4,026.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,847.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,371.22
|
| Rate for Payer: Cash Price |
$1,342.20
|
| Rate for Payer: Cigna Commercial |
$4,116.08
|
| Rate for Payer: Health EOS Commercial |
$3,981.86
|
| Rate for Payer: HFN Commercial |
$4,116.08
|
| Rate for Payer: Multiplan Commercial |
$3,579.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,684.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,116.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,192.26
|
| Rate for Payer: Quartz Commercial |
$2,684.40
|
| Rate for Payer: WEA Trust Commercial |
$2,460.70
|
| Rate for Payer: WPS Commercial |
$3,313.89
|
|
|
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 |
$1,252.72 |
| Max. Negotiated Rate |
$17,896.00 |
| Rate for Payer: Aetna Commercial |
$4,026.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,847.64
|
| Rate for Payer: Aetna Managed Medicare |
$1,252.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,908.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,237.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,147.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,371.22
|
| Rate for Payer: Cash Price |
$1,342.20
|
| Rate for Payer: Cigna Commercial |
$4,116.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,503.65
|
| Rate for Payer: Health EOS Commercial |
$3,981.86
|
| Rate for Payer: HFN Commercial |
$4,116.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,355.50
|
| Rate for Payer: Multiplan Commercial |
$3,579.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,684.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,116.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,192.26
|
| Rate for Payer: Quartz Commercial |
$2,908.10
|
| Rate for Payer: Quartz Medicare Advantage |
$2,684.40
|
| Rate for Payer: The Alliance Commercial |
$17,896.00
|
| Rate for Payer: WEA Trust Commercial |
$2,460.70
|
| Rate for Payer: WPS Commercial |
$3,313.89
|
|
|
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 |
$3,958.71 |
| Max. Negotiated Rate |
$7,432.68 |
| Rate for Payer: Aetna Commercial |
$7,271.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,947.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,281.87
|
| Rate for Payer: Cash Price |
$2,423.70
|
| Rate for Payer: Cigna Commercial |
$7,432.68
|
| Rate for Payer: Health EOS Commercial |
$7,190.31
|
| Rate for Payer: HFN Commercial |
$7,432.68
|
| Rate for Payer: Multiplan Commercial |
$6,463.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,847.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,432.68
|
| Rate for Payer: Quartz Beloit One Network |
$3,958.71
|
| Rate for Payer: Quartz Commercial |
$4,847.40
|
| Rate for Payer: WEA Trust Commercial |
$4,443.45
|
| Rate for Payer: WPS Commercial |
$5,984.12
|
|
|
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 |
$2,262.12 |
| Max. Negotiated Rate |
$32,316.00 |
| Rate for Payer: Aetna Commercial |
$7,271.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,947.94
|
| Rate for Payer: Aetna Managed Medicare |
$2,262.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,251.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,039.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,877.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,281.87
|
| Rate for Payer: Cash Price |
$2,423.70
|
| Rate for Payer: Cigna Commercial |
$7,432.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,521.01
|
| Rate for Payer: Health EOS Commercial |
$7,190.31
|
| Rate for Payer: HFN Commercial |
$7,432.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,059.25
|
| Rate for Payer: Multiplan Commercial |
$6,463.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,847.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,432.68
|
| Rate for Payer: Quartz Beloit One Network |
$3,958.71
|
| Rate for Payer: Quartz Commercial |
$5,251.35
|
| Rate for Payer: Quartz Medicare Advantage |
$4,847.40
|
| Rate for Payer: The Alliance Commercial |
$32,316.00
|
| Rate for Payer: WEA Trust Commercial |
$4,443.45
|
| Rate for Payer: WPS Commercial |
$5,984.12
|
|
|
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 |
$4,360.51 |
| Max. Negotiated Rate |
$8,187.08 |
| Rate for Payer: Aetna Commercial |
$8,009.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,653.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,716.47
|
| Rate for Payer: Cash Price |
$2,669.70
|
| Rate for Payer: Cigna Commercial |
$8,187.08
|
| Rate for Payer: Health EOS Commercial |
$7,920.11
|
| Rate for Payer: HFN Commercial |
$8,187.08
|
| Rate for Payer: Multiplan Commercial |
$7,119.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,339.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,187.08
|
| Rate for Payer: Quartz Beloit One Network |
$4,360.51
|
| Rate for Payer: Quartz Commercial |
$5,339.40
|
| Rate for Payer: WEA Trust Commercial |
$4,894.45
|
| Rate for Payer: WPS Commercial |
$6,591.49
|
|
|
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 |
$2,491.72 |
| Max. Negotiated Rate |
$35,596.00 |
| Rate for Payer: Aetna Commercial |
$8,009.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,653.14
|
| Rate for Payer: Aetna Managed Medicare |
$2,491.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,784.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,449.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,271.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,716.47
|
| Rate for Payer: Cash Price |
$2,669.70
|
| Rate for Payer: Cigna Commercial |
$8,187.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,979.88
|
| Rate for Payer: Health EOS Commercial |
$7,920.11
|
| Rate for Payer: HFN Commercial |
$8,187.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,674.25
|
| Rate for Payer: Multiplan Commercial |
$7,119.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,339.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,187.08
|
| Rate for Payer: Quartz Beloit One Network |
$4,360.51
|
| Rate for Payer: Quartz Commercial |
$5,784.35
|
| Rate for Payer: Quartz Medicare Advantage |
$5,339.40
|
| Rate for Payer: The Alliance Commercial |
$35,596.00
|
| Rate for Payer: WEA Trust Commercial |
$4,894.45
|
| Rate for Payer: WPS Commercial |
$6,591.49
|
|
|
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 |
$2,166.64 |
| Max. Negotiated Rate |
$30,952.00 |
| Rate for Payer: Aetna Commercial |
$6,964.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,654.68
|
| Rate for Payer: Aetna Managed Medicare |
$2,166.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,029.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,869.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,714.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,101.14
|
| Rate for Payer: Cash Price |
$2,321.40
|
| Rate for Payer: Cigna Commercial |
$7,118.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,330.18
|
| Rate for Payer: Health EOS Commercial |
$6,886.82
|
| Rate for Payer: HFN Commercial |
$7,118.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,803.50
|
| Rate for Payer: Multiplan Commercial |
$6,190.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,642.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,118.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,791.62
|
| Rate for Payer: Quartz Commercial |
$5,029.70
|
| Rate for Payer: Quartz Medicare Advantage |
$4,642.80
|
| Rate for Payer: The Alliance Commercial |
$30,952.00
|
| Rate for Payer: WEA Trust Commercial |
$4,255.90
|
| Rate for Payer: WPS Commercial |
$5,731.54
|
|
|
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 |
$3,791.62 |
| Max. Negotiated Rate |
$7,118.96 |
| Rate for Payer: Aetna Commercial |
$6,964.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,654.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,101.14
|
| Rate for Payer: Cash Price |
$2,321.40
|
| Rate for Payer: Cigna Commercial |
$7,118.96
|
| Rate for Payer: Health EOS Commercial |
$6,886.82
|
| Rate for Payer: HFN Commercial |
$7,118.96
|
| Rate for Payer: Multiplan Commercial |
$6,190.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,642.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,118.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,791.62
|
| Rate for Payer: Quartz Commercial |
$4,642.80
|
| Rate for Payer: WEA Trust Commercial |
$4,255.90
|
| Rate for Payer: WPS Commercial |
$5,731.54
|
|
|
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 |
$4,179.70 |
| Max. Negotiated Rate |
$7,847.60 |
| Rate for Payer: Aetna Commercial |
$7,677.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,335.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,520.90
|
| Rate for Payer: Cash Price |
$2,559.00
|
| Rate for Payer: Cigna Commercial |
$7,847.60
|
| Rate for Payer: Health EOS Commercial |
$7,591.70
|
| Rate for Payer: HFN Commercial |
$7,847.60
|
| Rate for Payer: Multiplan Commercial |
$6,824.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,118.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,847.60
|
| Rate for Payer: Quartz Beloit One Network |
$4,179.70
|
| Rate for Payer: Quartz Commercial |
$5,118.00
|
| Rate for Payer: WEA Trust Commercial |
$4,691.50
|
| Rate for Payer: WPS Commercial |
$6,318.17
|
|
