|
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 |
$2,388.40 |
| Max. Negotiated Rate |
$34,120.00 |
| Rate for Payer: Aetna Commercial |
$7,677.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,335.80
|
| Rate for Payer: Aetna Managed Medicare |
$2,388.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,544.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,265.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,094.40
|
| 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: Dean Health DHI/DHP/ASO |
$4,773.39
|
| Rate for Payer: Health EOS Commercial |
$7,591.70
|
| Rate for Payer: HFN Commercial |
$7,847.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,397.50
|
| 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 |
$5,544.50
|
| Rate for Payer: Quartz Medicare Advantage |
$5,118.00
|
| Rate for Payer: The Alliance Commercial |
$34,120.00
|
| Rate for Payer: WEA Trust Commercial |
$4,691.50
|
| Rate for Payer: WPS Commercial |
$6,318.17
|
|
|
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 |
$4,270.35 |
| 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 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 |
$2,440.20 |
| 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 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 |
$1,802.08 |
| Max. Negotiated Rate |
$25,744.00 |
| Rate for Payer: Aetna Commercial |
$5,792.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,534.96
|
| Rate for Payer: Aetna Managed Medicare |
$1,802.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,183.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,218.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,089.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,411.08
|
| Rate for Payer: Cash Price |
$1,930.80
|
| Rate for Payer: Cigna Commercial |
$5,921.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,601.59
|
| Rate for Payer: Health EOS Commercial |
$5,728.04
|
| Rate for Payer: HFN Commercial |
$5,921.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,827.00
|
| Rate for Payer: Multiplan Commercial |
$5,148.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,861.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,921.12
|
| Rate for Payer: Quartz Beloit One Network |
$3,153.64
|
| Rate for Payer: Quartz Commercial |
$4,183.40
|
| Rate for Payer: Quartz Medicare Advantage |
$3,861.60
|
| Rate for Payer: The Alliance Commercial |
$25,744.00
|
| Rate for Payer: WEA Trust Commercial |
$3,539.80
|
| Rate for Payer: WPS Commercial |
$4,767.15
|
|
|
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 |
$3,153.64 |
| Max. Negotiated Rate |
$5,921.12 |
| Rate for Payer: Aetna Commercial |
$5,792.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,534.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,411.08
|
| Rate for Payer: Cash Price |
$1,930.80
|
| Rate for Payer: Cigna Commercial |
$5,921.12
|
| Rate for Payer: Health EOS Commercial |
$5,728.04
|
| Rate for Payer: HFN Commercial |
$5,921.12
|
| Rate for Payer: Multiplan Commercial |
$5,148.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,861.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,921.12
|
| Rate for Payer: Quartz Beloit One Network |
$3,153.64
|
| Rate for Payer: Quartz Commercial |
$3,861.60
|
| Rate for Payer: WEA Trust Commercial |
$3,539.80
|
| Rate for Payer: WPS Commercial |
$4,767.15
|
|
|
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 |
$1,479.24 |
| Max. Negotiated Rate |
$21,132.00 |
| Rate for Payer: Aetna Commercial |
$4,754.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,543.38
|
| Rate for Payer: Aetna Managed Medicare |
$1,479.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,433.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,641.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,535.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,799.99
|
| Rate for Payer: Cash Price |
$1,584.90
|
| Rate for Payer: Cigna Commercial |
$4,860.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,956.37
|
| Rate for Payer: Health EOS Commercial |
$4,701.87
|
| Rate for Payer: HFN Commercial |
$4,860.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,962.25
|
| Rate for Payer: Multiplan Commercial |
$4,226.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,169.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,860.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,588.67
|
| Rate for Payer: Quartz Commercial |
$3,433.95
|
| Rate for Payer: Quartz Medicare Advantage |
$3,169.80
|
| Rate for Payer: The Alliance Commercial |
$21,132.00
|
| Rate for Payer: WEA Trust Commercial |
$2,905.65
|
| Rate for Payer: WPS Commercial |
$3,913.12
|
|
|
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 |
$2,588.67 |
| Max. Negotiated Rate |
$4,860.36 |
| Rate for Payer: Aetna Commercial |
$4,754.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,543.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,799.99
|
| Rate for Payer: Cash Price |
$1,584.90
|
| Rate for Payer: Cigna Commercial |
$4,860.36
|
| Rate for Payer: Health EOS Commercial |
$4,701.87
|
| Rate for Payer: HFN Commercial |
$4,860.36
|
| Rate for Payer: Multiplan Commercial |
$4,226.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,169.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,860.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,588.67
|
| Rate for Payer: Quartz Commercial |
$3,169.80
|
| Rate for Payer: WEA Trust Commercial |
$2,905.65
|
| Rate for Payer: WPS Commercial |
$3,913.12
|
|
|
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 |
$1,479.24 |
| Max. Negotiated Rate |
$21,132.00 |
| Rate for Payer: Aetna Commercial |
$4,754.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,543.38
|
| Rate for Payer: Aetna Managed Medicare |
$1,479.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,433.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,641.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,535.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,799.99
|
| Rate for Payer: Cash Price |
$1,584.90
|
| Rate for Payer: Cigna Commercial |
$4,860.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,956.37
|
| Rate for Payer: Health EOS Commercial |
$4,701.87
|
| Rate for Payer: HFN Commercial |
$4,860.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,962.25
|
| Rate for Payer: Multiplan Commercial |
$4,226.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,169.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,860.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,588.67
|
| Rate for Payer: Quartz Commercial |
$3,433.95
|
| Rate for Payer: Quartz Medicare Advantage |
$3,169.80
|
| Rate for Payer: The Alliance Commercial |
$21,132.00
|
| Rate for Payer: WEA Trust Commercial |
$2,905.65
|
| Rate for Payer: WPS Commercial |
$3,913.12
|
|
|
PLATE HOOK 3.5MM CLAVICLE LCP 4HL 18MM HOOK DEPTH 44MM RT 241.076S
|
Facility
|
IP
|
$5,283.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5106784
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,588.67 |
| Max. Negotiated Rate |
$4,860.36 |
| Rate for Payer: Aetna Commercial |
$4,754.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,543.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,799.99
|
| Rate for Payer: Cash Price |
$1,584.90
|
| Rate for Payer: Cigna Commercial |
$4,860.36
|
| Rate for Payer: Health EOS Commercial |
$4,701.87
|
| Rate for Payer: HFN Commercial |
$4,860.36
|
| Rate for Payer: Multiplan Commercial |
$4,226.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,169.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,860.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,588.67
|
| Rate for Payer: Quartz Commercial |
$3,169.80
|
| Rate for Payer: WEA Trust Commercial |
$2,905.65
|
| Rate for Payer: WPS Commercial |
$3,913.12
|
|
|
PLATE HOOK LATERAL LOCK 5HL ARTHREX AR-8943TH-05
|
Facility
|
OP
|
$5,586.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5496979
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,564.08 |
| Max. Negotiated Rate |
$22,344.00 |
| Rate for Payer: Aetna Commercial |
$5,027.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,803.96
|
| Rate for Payer: Aetna Managed Medicare |
$1,564.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,630.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,793.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,681.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,960.58
|
| Rate for Payer: Cash Price |
$1,675.80
|
| Rate for Payer: Cigna Commercial |
$5,139.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,125.93
|
| Rate for Payer: Health EOS Commercial |
$4,971.54
|
| Rate for Payer: HFN Commercial |
$5,139.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,189.50
|
| Rate for Payer: Multiplan Commercial |
$4,468.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,351.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,139.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,737.14
|
| Rate for Payer: Quartz Commercial |
$3,630.90
|
| Rate for Payer: Quartz Medicare Advantage |
$3,351.60
|
| Rate for Payer: The Alliance Commercial |
$22,344.00
|
| Rate for Payer: WEA Trust Commercial |
$3,072.30
|
| Rate for Payer: WPS Commercial |
$4,137.55
|
|
|
PLATE HOOK LATERAL LOCK 5HL ARTHREX AR-8943TH-05
|
Facility
|
IP
|
$5,586.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5496979
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,737.14 |
| Max. Negotiated Rate |
$5,139.12 |
| Rate for Payer: Aetna Commercial |
$5,027.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,803.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,960.58
|
| Rate for Payer: Cash Price |
$1,675.80
|
| Rate for Payer: Cigna Commercial |
$5,139.12
|
| Rate for Payer: Health EOS Commercial |
$4,971.54
|
| Rate for Payer: HFN Commercial |
$5,139.12
|
| Rate for Payer: Multiplan Commercial |
$4,468.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,351.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,139.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,737.14
|
| Rate for Payer: Quartz Commercial |
$3,351.60
|
| Rate for Payer: WEA Trust Commercial |
$3,072.30
|
| Rate for Payer: WPS Commercial |
$4,137.55
|
|
|
PLATE HOOK LCP 3HL 02.113.103
|
Facility
|
OP
|
$6,063.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3365525
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,697.64 |
| Max. Negotiated Rate |
$24,252.00 |
| Rate for Payer: Aetna Commercial |
$5,456.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,214.18
|
| Rate for Payer: Aetna Managed Medicare |
$1,697.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,940.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,031.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,910.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,213.39
|
| Rate for Payer: Cash Price |
$1,818.90
|
| Rate for Payer: Cigna Commercial |
$5,577.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,392.85
|
| Rate for Payer: Health EOS Commercial |
$5,396.07
|
| Rate for Payer: HFN Commercial |
$5,577.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,547.25
|
| Rate for Payer: Multiplan Commercial |
$4,850.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,637.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,577.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,970.87
|
| Rate for Payer: Quartz Commercial |
$3,940.95
|
| Rate for Payer: Quartz Medicare Advantage |
$3,637.80
|
| Rate for Payer: The Alliance Commercial |
$24,252.00
|
| Rate for Payer: WEA Trust Commercial |
$3,334.65
|
| Rate for Payer: WPS Commercial |
$4,490.86
|
|
|
PLATE HOOK LCP 3HL 02.113.103
|
Facility
|
IP
|
$6,063.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3365525
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,970.87 |
| Max. Negotiated Rate |
$5,577.96 |
| Rate for Payer: Aetna Commercial |
$5,456.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,214.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,213.39
|
| Rate for Payer: Cash Price |
$1,818.90
|
| Rate for Payer: Cigna Commercial |
$5,577.96
|
| Rate for Payer: Health EOS Commercial |
$5,396.07
|
| Rate for Payer: HFN Commercial |
$5,577.96
|
| Rate for Payer: Multiplan Commercial |
$4,850.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,637.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,577.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,970.87
|
| Rate for Payer: Quartz Commercial |
$3,637.80
|
| Rate for Payer: WEA Trust Commercial |
$3,334.65
|
| Rate for Payer: WPS Commercial |
$4,490.86
|
|
|
PLATE HOOK LG 58882030
|
Facility
|
OP
|
$8,911.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6171782
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,495.08 |
| Max. Negotiated Rate |
$35,644.00 |
| Rate for Payer: Aetna Commercial |
$8,019.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,663.46
|
| Rate for Payer: Aetna Managed Medicare |
$2,495.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,792.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,455.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,277.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,722.83
|
| Rate for Payer: Cash Price |
$2,673.30
|
| Rate for Payer: Cigna Commercial |
$8,198.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,986.60
|
| Rate for Payer: Health EOS Commercial |
$7,930.79
|
| Rate for Payer: HFN Commercial |
$8,198.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,683.25
|
| Rate for Payer: Multiplan Commercial |
$7,128.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,346.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,198.12
|
| Rate for Payer: Quartz Beloit One Network |
$4,366.39
|
| Rate for Payer: Quartz Commercial |
$5,792.15
|
| Rate for Payer: Quartz Medicare Advantage |
$5,346.60
|
| Rate for Payer: The Alliance Commercial |
$35,644.00
|
| Rate for Payer: WEA Trust Commercial |
$4,901.05
|
| Rate for Payer: WPS Commercial |
$6,600.38
|
|
|
PLATE HOOK LG 58882030
|
Facility
|
IP
|
$8,911.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6171782
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,366.39 |
| Max. Negotiated Rate |
$8,198.12 |
| Rate for Payer: Aetna Commercial |
$8,019.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,663.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,722.83
|
| Rate for Payer: Cash Price |
$2,673.30
|
| Rate for Payer: Cigna Commercial |
$8,198.12
|
| Rate for Payer: Health EOS Commercial |
$7,930.79
|
| Rate for Payer: HFN Commercial |
$8,198.12
|
| Rate for Payer: Multiplan Commercial |
$7,128.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,346.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,198.12
|
| Rate for Payer: Quartz Beloit One Network |
$4,366.39
|
| Rate for Payer: Quartz Commercial |
$5,346.60
|
| Rate for Payer: WEA Trust Commercial |
$4,901.05
|
| Rate for Payer: WPS Commercial |
$6,600.38
|
|
|
PLATE HOOK MEDIAL LOCK 3HL ARTHREX AR-8943H-03
|
Facility
|
IP
|
$6,086.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5977646
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,982.14 |
| Max. Negotiated Rate |
$5,599.12 |
| Rate for Payer: Aetna Commercial |
$5,477.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,233.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,225.58
|
| Rate for Payer: Cash Price |
$1,825.80
|
| Rate for Payer: Cigna Commercial |
$5,599.12
|
| Rate for Payer: Health EOS Commercial |
$5,416.54
|
| Rate for Payer: HFN Commercial |
$5,599.12
|
| Rate for Payer: Multiplan Commercial |
$4,868.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,651.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,599.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,982.14
|
| Rate for Payer: Quartz Commercial |
$3,651.60
|
| Rate for Payer: WEA Trust Commercial |
$3,347.30
|
| Rate for Payer: WPS Commercial |
$4,507.90
|
|
|
PLATE HOOK MEDIAL LOCK 3HL ARTHREX AR-8943H-03
|
Facility
|
OP
|
$6,086.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5977646
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,704.08 |
| Max. Negotiated Rate |
$24,344.00 |
| Rate for Payer: Aetna Commercial |
$5,477.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,233.96
|
| Rate for Payer: Aetna Managed Medicare |
$1,704.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,955.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,921.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,225.58
|
| Rate for Payer: Cash Price |
$1,825.80
|
| Rate for Payer: Cigna Commercial |
$5,599.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,405.73
|
| Rate for Payer: Health EOS Commercial |
$5,416.54
|
| Rate for Payer: HFN Commercial |
$5,599.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,564.50
|
| Rate for Payer: Multiplan Commercial |
$4,868.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,651.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,599.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,982.14
|
| Rate for Payer: Quartz Commercial |
$3,955.90
|
| Rate for Payer: Quartz Medicare Advantage |
$3,651.60
|
| Rate for Payer: The Alliance Commercial |
$24,344.00
|
| Rate for Payer: WEA Trust Commercial |
$3,347.30
|
| Rate for Payer: WPS Commercial |
$4,507.90
|
|
|
PLATE HOOK MEDIAL LOCK 5HL ARTHREX AR-8943H-05
|
Facility
|
IP
|
$6,582.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5496980
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,225.18 |
| Max. Negotiated Rate |
$6,055.44 |
| Rate for Payer: Aetna Commercial |
$5,923.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,660.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,488.46
|
| Rate for Payer: Cash Price |
$1,974.60
|
| Rate for Payer: Cigna Commercial |
$6,055.44
|
| Rate for Payer: Health EOS Commercial |
$5,857.98
|
| Rate for Payer: HFN Commercial |
$6,055.44
|
| Rate for Payer: Multiplan Commercial |
$5,265.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,949.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,055.44
|
| Rate for Payer: Quartz Beloit One Network |
$3,225.18
|
| Rate for Payer: Quartz Commercial |
$3,949.20
|
| Rate for Payer: WEA Trust Commercial |
$3,620.10
|
| Rate for Payer: WPS Commercial |
$4,875.29
|
|
|
PLATE HOOK MEDIAL LOCK 5HL ARTHREX AR-8943H-05
|
Facility
|
OP
|
$6,582.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5496980
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,842.96 |
| Max. Negotiated Rate |
$26,328.00 |
| Rate for Payer: Aetna Commercial |
$5,923.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,660.52
|
| Rate for Payer: Aetna Managed Medicare |
$1,842.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,278.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,291.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,159.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,488.46
|
| Rate for Payer: Cash Price |
$1,974.60
|
| Rate for Payer: Cigna Commercial |
$6,055.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,683.29
|
| Rate for Payer: Health EOS Commercial |
$5,857.98
|
| Rate for Payer: HFN Commercial |
$6,055.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,936.50
|
| Rate for Payer: Multiplan Commercial |
$5,265.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,949.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,055.44
|
| Rate for Payer: Quartz Beloit One Network |
$3,225.18
|
| Rate for Payer: Quartz Commercial |
$4,278.30
|
| Rate for Payer: Quartz Medicare Advantage |
$3,949.20
|
| Rate for Payer: The Alliance Commercial |
$26,328.00
|
| Rate for Payer: WEA Trust Commercial |
$3,620.10
|
| Rate for Payer: WPS Commercial |
$4,875.29
|
|
|
PLATE HOOK UNIVERSAL 5TH METATARSAL AR-8956-01
|
Facility
|
IP
|
$7,380.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5200618
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,616.20 |
| Max. Negotiated Rate |
$6,789.60 |
| Rate for Payer: Aetna Commercial |
$6,642.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,346.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,911.40
|
| Rate for Payer: Cash Price |
$2,214.00
|
| Rate for Payer: Cigna Commercial |
$6,789.60
|
| Rate for Payer: Health EOS Commercial |
$6,568.20
|
| Rate for Payer: HFN Commercial |
$6,789.60
|
| Rate for Payer: Multiplan Commercial |
$5,904.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,428.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,789.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,616.20
|
| Rate for Payer: Quartz Commercial |
$4,428.00
|
| Rate for Payer: WEA Trust Commercial |
$4,059.00
|
| Rate for Payer: WPS Commercial |
$5,466.37
|
|
|
PLATE HOOK UNIVERSAL 5TH METATARSAL AR-8956-01
|
Facility
|
OP
|
$7,380.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5200618
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,066.40 |
| Max. Negotiated Rate |
$29,520.00 |
| Rate for Payer: Aetna Commercial |
$6,642.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,346.80
|
| Rate for Payer: Aetna Managed Medicare |
$2,066.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,797.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,690.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,542.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,911.40
|
| Rate for Payer: Cash Price |
$2,214.00
|
| Rate for Payer: Cigna Commercial |
$6,789.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,129.85
|
| Rate for Payer: Health EOS Commercial |
$6,568.20
|
| Rate for Payer: HFN Commercial |
$6,789.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,535.00
|
| Rate for Payer: Multiplan Commercial |
$5,904.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,428.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,789.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,616.20
|
| Rate for Payer: Quartz Commercial |
$4,797.00
|
| Rate for Payer: Quartz Medicare Advantage |
$4,428.00
|
| Rate for Payer: The Alliance Commercial |
$29,520.00
|
| Rate for Payer: WEA Trust Commercial |
$4,059.00
|
| Rate for Payer: WPS Commercial |
$5,466.37
|
|
|
PLATE HUMERAL PROXIMAL LATERAL 3HL RT 627233
|
Facility
|
OP
|
$9,602.57
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6246234
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,688.72 |
| Max. Negotiated Rate |
$38,410.28 |
| Rate for Payer: Aetna Commercial |
$8,642.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,258.21
|
| Rate for Payer: Aetna Managed Medicare |
$2,688.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,241.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,801.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,609.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,089.36
|
| Rate for Payer: Cash Price |
$2,880.77
|
| Rate for Payer: Cigna Commercial |
$8,834.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,373.60
|
| Rate for Payer: Health EOS Commercial |
$8,546.29
|
| Rate for Payer: HFN Commercial |
$8,834.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,201.93
|
| Rate for Payer: Multiplan Commercial |
$7,682.06
|
| Rate for Payer: NAPHCARE Commercial |
$5,761.54
|
| Rate for Payer: Preferred Network Access Commercial |
$8,834.36
|
| Rate for Payer: Quartz Beloit One Network |
$4,705.26
|
| Rate for Payer: Quartz Commercial |
$6,241.67
|
| Rate for Payer: Quartz Medicare Advantage |
$5,761.54
|
| Rate for Payer: The Alliance Commercial |
$38,410.28
|
| Rate for Payer: WEA Trust Commercial |
$5,281.41
|
| Rate for Payer: WPS Commercial |
$7,112.62
|
|
|
PLATE HUMERAL PROXIMAL LATERAL 3HL RT 627233
|
Facility
|
IP
|
$9,602.57
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6246234
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,705.26 |
| Max. Negotiated Rate |
$8,834.36 |
| Rate for Payer: Aetna Commercial |
$8,642.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,258.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,089.36
|
| Rate for Payer: Cash Price |
$2,880.77
|
| Rate for Payer: Cigna Commercial |
$8,834.36
|
| Rate for Payer: Health EOS Commercial |
$8,546.29
|
| Rate for Payer: HFN Commercial |
$8,834.36
|
| Rate for Payer: Multiplan Commercial |
$7,682.06
|
| Rate for Payer: NAPHCARE Commercial |
$5,761.54
|
| Rate for Payer: Preferred Network Access Commercial |
$8,834.36
|
| Rate for Payer: Quartz Beloit One Network |
$4,705.26
|
| Rate for Payer: Quartz Commercial |
$5,761.54
|
| Rate for Payer: WEA Trust Commercial |
$5,281.41
|
| Rate for Payer: WPS Commercial |
$7,112.62
|
|
|
PLATE HUMERAL PROXIMAL LATERAL 4HL RT 627234
|
Facility
|
OP
|
$12,582.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5458962
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,522.96 |
| Max. Negotiated Rate |
$50,328.00 |
| Rate for Payer: Aetna Commercial |
$11,323.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,820.52
|
| Rate for Payer: Aetna Managed Medicare |
$3,522.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,178.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,291.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,039.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,668.46
|
| Rate for Payer: Cash Price |
$3,774.60
|
| Rate for Payer: Cigna Commercial |
$11,575.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,040.89
|
| Rate for Payer: Health EOS Commercial |
$11,197.98
|
| Rate for Payer: HFN Commercial |
$11,575.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,436.50
|
| Rate for Payer: Multiplan Commercial |
$10,065.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,549.20
|
| Rate for Payer: Preferred Network Access Commercial |
$11,575.44
|
| Rate for Payer: Quartz Beloit One Network |
$6,165.18
|
| Rate for Payer: Quartz Commercial |
$8,178.30
|
| Rate for Payer: Quartz Medicare Advantage |
$7,549.20
|
| Rate for Payer: The Alliance Commercial |
$50,328.00
|
| Rate for Payer: WEA Trust Commercial |
$6,920.10
|
| Rate for Payer: WPS Commercial |
$9,319.49
|
|
|
PLATE HUMERAL PROXIMAL LATERAL 4HL RT 627234
|
Facility
|
IP
|
$12,582.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5458962
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,165.18 |
| Max. Negotiated Rate |
$11,575.44 |
| Rate for Payer: Aetna Commercial |
$11,323.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,820.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,668.46
|
| Rate for Payer: Cash Price |
$3,774.60
|
| Rate for Payer: Cigna Commercial |
$11,575.44
|
| Rate for Payer: Health EOS Commercial |
$11,197.98
|
| Rate for Payer: HFN Commercial |
$11,575.44
|
| Rate for Payer: Multiplan Commercial |
$10,065.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,549.20
|
| Rate for Payer: Preferred Network Access Commercial |
$11,575.44
|
| Rate for Payer: Quartz Beloit One Network |
$6,165.18
|
| Rate for Payer: Quartz Commercial |
$7,549.20
|
| Rate for Payer: WEA Trust Commercial |
$6,920.10
|
| Rate for Payer: WPS Commercial |
$9,319.49
|
|
