|
PLATE PROX/HUM 3.5 10HL LONG 241.923
|
Facility
|
OP
|
$8,566.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6174861
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,494.42 |
| Max. Negotiated Rate |
$8,195.95 |
| Rate for Payer: Aetna Commercial |
$8,017.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,661.43
|
| Rate for Payer: Aetna Managed Medicare |
$2,494.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,790.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,454.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,276.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,721.58
|
| Rate for Payer: Cash Price |
$2,569.80
|
| Rate for Payer: Cigna Commercial |
$8,195.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,985.41
|
| Rate for Payer: Health EOS Commercial |
$7,928.69
|
| Rate for Payer: HFN Commercial |
$8,195.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,681.48
|
| Rate for Payer: Multiplan Commercial |
$7,126.91
|
| Rate for Payer: NAPHCARE Commercial |
$5,345.18
|
| Rate for Payer: Preferred Network Access Commercial |
$8,195.95
|
| Rate for Payer: Quartz Beloit One Network |
$4,365.23
|
| Rate for Payer: Quartz Commercial |
$5,790.62
|
| Rate for Payer: Quartz Medicare Advantage |
$5,345.18
|
| Rate for Payer: The Alliance Commercial |
$4,454.32
|
| Rate for Payer: WEA Trust Commercial |
$4,899.75
|
| Rate for Payer: WPS Commercial |
$6,598.39
|
|
|
PLATE PROX/HUM 3.5 3HL 241.901
|
Facility
|
OP
|
$7,339.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966717
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,137.12 |
| Max. Negotiated Rate |
$7,021.96 |
| Rate for Payer: Aetna Commercial |
$6,869.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,564.00
|
| Rate for Payer: Aetna Managed Medicare |
$2,137.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,961.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,816.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,663.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,045.26
|
| Rate for Payer: Cash Price |
$2,201.70
|
| Rate for Payer: Cigna Commercial |
$7,021.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,271.30
|
| Rate for Payer: Health EOS Commercial |
$6,792.98
|
| Rate for Payer: HFN Commercial |
$7,021.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,724.42
|
| Rate for Payer: Multiplan Commercial |
$6,106.05
|
| Rate for Payer: NAPHCARE Commercial |
$4,579.54
|
| Rate for Payer: Preferred Network Access Commercial |
$7,021.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,739.95
|
| Rate for Payer: Quartz Commercial |
$4,961.16
|
| Rate for Payer: Quartz Medicare Advantage |
$4,579.54
|
| Rate for Payer: The Alliance Commercial |
$3,816.28
|
| Rate for Payer: WEA Trust Commercial |
$4,197.91
|
| Rate for Payer: WPS Commercial |
$5,653.23
|
|
|
PLATE PROX/HUM 3.5 3HL 241.901
|
Facility
|
IP
|
$7,339.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966717
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,739.95 |
| Max. Negotiated Rate |
$7,021.96 |
| Rate for Payer: Aetna Commercial |
$6,869.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,564.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,045.26
|
| Rate for Payer: Cash Price |
$2,201.70
|
| Rate for Payer: Cigna Commercial |
$7,021.96
|
| Rate for Payer: Health EOS Commercial |
$6,792.98
|
| Rate for Payer: HFN Commercial |
$7,021.96
|
| Rate for Payer: Multiplan Commercial |
$6,106.05
|
| Rate for Payer: Preferred Network Access Commercial |
$7,021.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,739.95
|
| Rate for Payer: Quartz Commercial |
$4,579.54
|
| Rate for Payer: WEA Trust Commercial |
$4,197.91
|
| Rate for Payer: WPS Commercial |
$5,653.23
|
|
|
PLATE PROX/HUM 3.5 5HL 241.903
|
Facility
|
IP
|
$7,575.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966728
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,860.22 |
| Max. Negotiated Rate |
$7,247.76 |
| Rate for Payer: Aetna Commercial |
$7,090.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,775.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,175.34
|
| Rate for Payer: Cash Price |
$2,272.50
|
| Rate for Payer: Cigna Commercial |
$7,247.76
|
| Rate for Payer: Health EOS Commercial |
$7,011.42
|
| Rate for Payer: HFN Commercial |
$7,247.76
|
| Rate for Payer: Multiplan Commercial |
$6,302.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,247.76
|
| Rate for Payer: Quartz Beloit One Network |
$3,860.22
|
| Rate for Payer: Quartz Commercial |
$4,726.80
|
| Rate for Payer: WEA Trust Commercial |
$4,332.90
|
| Rate for Payer: WPS Commercial |
$5,835.02
|
|
|
PLATE PROX/HUM 3.5 5HL 241.903
|
Facility
|
OP
|
$7,575.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966728
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,205.84 |
| Max. Negotiated Rate |
$7,247.76 |
| Rate for Payer: Aetna Commercial |
$7,090.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,775.08
|
| Rate for Payer: Aetna Managed Medicare |
$2,205.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,120.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,939.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,781.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,175.34
|
| Rate for Payer: Cash Price |
$2,272.50
|
| Rate for Payer: Cigna Commercial |
$7,247.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,408.65
|
| Rate for Payer: Health EOS Commercial |
$7,011.42
|
| Rate for Payer: HFN Commercial |
$7,247.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,908.50
|
| Rate for Payer: Multiplan Commercial |
$6,302.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,726.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,247.76
|
| Rate for Payer: Quartz Beloit One Network |
$3,860.22
|
| Rate for Payer: Quartz Commercial |
$5,120.70
|
| Rate for Payer: Quartz Medicare Advantage |
$4,726.80
|
| Rate for Payer: The Alliance Commercial |
$3,939.00
|
| Rate for Payer: WEA Trust Commercial |
$4,332.90
|
| Rate for Payer: WPS Commercial |
$5,835.02
|
|
|
PLATE PROX/HUM 3.5 5HL LONG 241.918
|
Facility
|
OP
|
$7,353.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6180299
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,141.19 |
| Max. Negotiated Rate |
$7,035.35 |
| Rate for Payer: Aetna Commercial |
$6,882.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,576.52
|
| Rate for Payer: Aetna Managed Medicare |
$2,141.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,970.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,823.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,670.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,052.97
|
| Rate for Payer: Cash Price |
$2,205.90
|
| Rate for Payer: Cigna Commercial |
$7,035.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,279.45
|
| Rate for Payer: Health EOS Commercial |
$6,805.94
|
| Rate for Payer: HFN Commercial |
$7,035.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,735.34
|
| Rate for Payer: Multiplan Commercial |
$6,117.70
|
| Rate for Payer: NAPHCARE Commercial |
$4,588.27
|
| Rate for Payer: Preferred Network Access Commercial |
$7,035.35
|
| Rate for Payer: Quartz Beloit One Network |
$3,747.09
|
| Rate for Payer: Quartz Commercial |
$4,970.63
|
| Rate for Payer: Quartz Medicare Advantage |
$4,588.27
|
| Rate for Payer: The Alliance Commercial |
$3,823.56
|
| Rate for Payer: WEA Trust Commercial |
$4,205.92
|
| Rate for Payer: WPS Commercial |
$5,664.02
|
|
|
PLATE PROX/HUM 3.5 5HL LONG 241.918
|
Facility
|
IP
|
$7,353.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6180299
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,747.09 |
| Max. Negotiated Rate |
$7,035.35 |
| Rate for Payer: Aetna Commercial |
$6,882.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,576.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,052.97
|
| Rate for Payer: Cash Price |
$2,205.90
|
| Rate for Payer: Cigna Commercial |
$7,035.35
|
| Rate for Payer: Health EOS Commercial |
$6,805.94
|
| Rate for Payer: HFN Commercial |
$7,035.35
|
| Rate for Payer: Multiplan Commercial |
$6,117.70
|
| Rate for Payer: Preferred Network Access Commercial |
$7,035.35
|
| Rate for Payer: Quartz Beloit One Network |
$3,747.09
|
| Rate for Payer: Quartz Commercial |
$4,588.27
|
| Rate for Payer: WEA Trust Commercial |
$4,205.92
|
| Rate for Payer: WPS Commercial |
$5,664.02
|
|
|
PLATE PROX/HUM 3.5 8HL LONG 241.921
|
Facility
|
IP
|
$7,635.54
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6246229
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,891.07 |
| Max. Negotiated Rate |
$7,305.68 |
| Rate for Payer: Aetna Commercial |
$7,146.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,829.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,208.71
|
| Rate for Payer: Cash Price |
$2,290.66
|
| Rate for Payer: Cigna Commercial |
$7,305.68
|
| Rate for Payer: Health EOS Commercial |
$7,067.46
|
| Rate for Payer: HFN Commercial |
$7,305.68
|
| Rate for Payer: Multiplan Commercial |
$6,352.77
|
| Rate for Payer: Preferred Network Access Commercial |
$7,305.68
|
| Rate for Payer: Quartz Beloit One Network |
$3,891.07
|
| Rate for Payer: Quartz Commercial |
$4,764.58
|
| Rate for Payer: WEA Trust Commercial |
$4,367.53
|
| Rate for Payer: WPS Commercial |
$5,881.66
|
|
|
PLATE PROX/HUM 3.5 8HL LONG 241.921
|
Facility
|
OP
|
$7,635.54
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6246229
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,223.47 |
| Max. Negotiated Rate |
$7,305.68 |
| Rate for Payer: Aetna Commercial |
$7,146.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,829.23
|
| Rate for Payer: Aetna Managed Medicare |
$2,223.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,161.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,970.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,811.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,208.71
|
| Rate for Payer: Cash Price |
$2,290.66
|
| Rate for Payer: Cigna Commercial |
$7,305.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,443.88
|
| Rate for Payer: Health EOS Commercial |
$7,067.46
|
| Rate for Payer: HFN Commercial |
$7,305.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,955.72
|
| Rate for Payer: Multiplan Commercial |
$6,352.77
|
| Rate for Payer: NAPHCARE Commercial |
$4,764.58
|
| Rate for Payer: Preferred Network Access Commercial |
$7,305.68
|
| Rate for Payer: Quartz Beloit One Network |
$3,891.07
|
| Rate for Payer: Quartz Commercial |
$5,161.63
|
| Rate for Payer: Quartz Medicare Advantage |
$4,764.58
|
| Rate for Payer: The Alliance Commercial |
$3,970.48
|
| Rate for Payer: WEA Trust Commercial |
$4,367.53
|
| Rate for Payer: WPS Commercial |
$5,881.66
|
|
|
PLATE PROXIMAL HUMERUS 3.5 LCP 10HL RT 02.123.028
|
Facility
|
OP
|
$8,118.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5804332
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,363.96 |
| Max. Negotiated Rate |
$7,767.30 |
| Rate for Payer: Aetna Commercial |
$7,598.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,260.74
|
| Rate for Payer: Aetna Managed Medicare |
$2,363.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,487.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,221.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,052.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,474.64
|
| Rate for Payer: Cash Price |
$2,435.40
|
| Rate for Payer: Cigna Commercial |
$7,767.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,724.68
|
| Rate for Payer: Health EOS Commercial |
$7,514.02
|
| Rate for Payer: HFN Commercial |
$7,767.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,332.04
|
| Rate for Payer: Multiplan Commercial |
$6,754.18
|
| Rate for Payer: NAPHCARE Commercial |
$5,065.63
|
| Rate for Payer: Preferred Network Access Commercial |
$7,767.30
|
| Rate for Payer: Quartz Beloit One Network |
$4,136.93
|
| Rate for Payer: Quartz Commercial |
$5,487.77
|
| Rate for Payer: Quartz Medicare Advantage |
$5,065.63
|
| Rate for Payer: The Alliance Commercial |
$4,221.36
|
| Rate for Payer: WEA Trust Commercial |
$4,643.50
|
| Rate for Payer: WPS Commercial |
$6,253.30
|
|
|
PLATE PROXIMAL HUMERUS 3.5 LCP 10HL RT 02.123.028
|
Facility
|
IP
|
$8,118.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5804332
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,136.93 |
| Max. Negotiated Rate |
$7,767.30 |
| Rate for Payer: Aetna Commercial |
$7,598.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,260.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,474.64
|
| Rate for Payer: Cash Price |
$2,435.40
|
| Rate for Payer: Cigna Commercial |
$7,767.30
|
| Rate for Payer: Health EOS Commercial |
$7,514.02
|
| Rate for Payer: HFN Commercial |
$7,767.30
|
| Rate for Payer: Multiplan Commercial |
$6,754.18
|
| Rate for Payer: Preferred Network Access Commercial |
$7,767.30
|
| Rate for Payer: Quartz Beloit One Network |
$4,136.93
|
| Rate for Payer: Quartz Commercial |
$5,065.63
|
| Rate for Payer: WEA Trust Commercial |
$4,643.50
|
| Rate for Payer: WPS Commercial |
$6,253.30
|
|
|
PLATE PROXIMAL HUMERUS 3.5 LCP 2HL LT 02.123.021S
|
Facility
|
IP
|
$9,076.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3072615
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,625.13 |
| Max. Negotiated Rate |
$8,683.92 |
| Rate for Payer: Aetna Commercial |
$8,495.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,117.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,002.69
|
| Rate for Payer: Cash Price |
$2,722.80
|
| Rate for Payer: Cigna Commercial |
$8,683.92
|
| Rate for Payer: Health EOS Commercial |
$8,400.75
|
| Rate for Payer: HFN Commercial |
$8,683.92
|
| Rate for Payer: Multiplan Commercial |
$7,551.23
|
| Rate for Payer: Preferred Network Access Commercial |
$8,683.92
|
| Rate for Payer: Quartz Beloit One Network |
$4,625.13
|
| Rate for Payer: Quartz Commercial |
$5,663.42
|
| Rate for Payer: WEA Trust Commercial |
$5,191.47
|
| Rate for Payer: WPS Commercial |
$6,991.24
|
|
|
PLATE PROXIMAL HUMERUS 3.5 LCP 2HL LT 02.123.021S
|
Facility
|
OP
|
$9,076.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3072615
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,642.93 |
| Max. Negotiated Rate |
$8,683.92 |
| Rate for Payer: Aetna Commercial |
$8,495.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,117.57
|
| Rate for Payer: Aetna Managed Medicare |
$2,642.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,135.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,719.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,530.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,002.69
|
| Rate for Payer: Cash Price |
$2,722.80
|
| Rate for Payer: Cigna Commercial |
$8,683.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,282.23
|
| Rate for Payer: Health EOS Commercial |
$8,400.75
|
| Rate for Payer: HFN Commercial |
$8,683.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,079.28
|
| Rate for Payer: Multiplan Commercial |
$7,551.23
|
| Rate for Payer: NAPHCARE Commercial |
$5,663.42
|
| Rate for Payer: Preferred Network Access Commercial |
$8,683.92
|
| Rate for Payer: Quartz Beloit One Network |
$4,625.13
|
| Rate for Payer: Quartz Commercial |
$6,135.38
|
| Rate for Payer: Quartz Medicare Advantage |
$5,663.42
|
| Rate for Payer: The Alliance Commercial |
$4,719.52
|
| Rate for Payer: WEA Trust Commercial |
$5,191.47
|
| Rate for Payer: WPS Commercial |
$6,991.24
|
|
|
PLATE PROXIMAL HUMERUS 3.5 LCP 2HL RT 02.123.020S
|
Facility
|
OP
|
$9,076.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3072474
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,642.93 |
| Max. Negotiated Rate |
$8,683.92 |
| Rate for Payer: Aetna Commercial |
$8,495.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,117.57
|
| Rate for Payer: Aetna Managed Medicare |
$2,642.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,135.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,719.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,530.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,002.69
|
| Rate for Payer: Cash Price |
$2,722.80
|
| Rate for Payer: Cigna Commercial |
$8,683.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,282.23
|
| Rate for Payer: Health EOS Commercial |
$8,400.75
|
| Rate for Payer: HFN Commercial |
$8,683.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,079.28
|
| Rate for Payer: Multiplan Commercial |
$7,551.23
|
| Rate for Payer: NAPHCARE Commercial |
$5,663.42
|
| Rate for Payer: Preferred Network Access Commercial |
$8,683.92
|
| Rate for Payer: Quartz Beloit One Network |
$4,625.13
|
| Rate for Payer: Quartz Commercial |
$6,135.38
|
| Rate for Payer: Quartz Medicare Advantage |
$5,663.42
|
| Rate for Payer: The Alliance Commercial |
$4,719.52
|
| Rate for Payer: WEA Trust Commercial |
$5,191.47
|
| Rate for Payer: WPS Commercial |
$6,991.24
|
|
|
PLATE PROXIMAL HUMERUS 3.5 LCP 2HL RT 02.123.020S
|
Facility
|
IP
|
$9,076.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3072474
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,625.13 |
| Max. Negotiated Rate |
$8,683.92 |
| Rate for Payer: Aetna Commercial |
$8,495.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,117.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,002.69
|
| Rate for Payer: Cash Price |
$2,722.80
|
| Rate for Payer: Cigna Commercial |
$8,683.92
|
| Rate for Payer: Health EOS Commercial |
$8,400.75
|
| Rate for Payer: HFN Commercial |
$8,683.92
|
| Rate for Payer: Multiplan Commercial |
$7,551.23
|
| Rate for Payer: Preferred Network Access Commercial |
$8,683.92
|
| Rate for Payer: Quartz Beloit One Network |
$4,625.13
|
| Rate for Payer: Quartz Commercial |
$5,663.42
|
| Rate for Payer: WEA Trust Commercial |
$5,191.47
|
| Rate for Payer: WPS Commercial |
$6,991.24
|
|
|
PLATE PROXIMAL HUMERUS 3.5 LCP 3HL LT 02.123.041S
|
Facility
|
OP
|
$7,716.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3805556
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,246.90 |
| Max. Negotiated Rate |
$7,382.67 |
| Rate for Payer: Aetna Commercial |
$7,222.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,901.19
|
| Rate for Payer: Aetna Managed Medicare |
$2,246.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,216.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,012.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,851.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,253.06
|
| Rate for Payer: Cash Price |
$2,314.80
|
| Rate for Payer: Cigna Commercial |
$7,382.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,490.71
|
| Rate for Payer: Health EOS Commercial |
$7,141.93
|
| Rate for Payer: HFN Commercial |
$7,382.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,018.48
|
| Rate for Payer: Multiplan Commercial |
$6,419.71
|
| Rate for Payer: NAPHCARE Commercial |
$4,814.78
|
| Rate for Payer: Preferred Network Access Commercial |
$7,382.67
|
| Rate for Payer: Quartz Beloit One Network |
$3,932.07
|
| Rate for Payer: Quartz Commercial |
$5,216.02
|
| Rate for Payer: Quartz Medicare Advantage |
$4,814.78
|
| Rate for Payer: The Alliance Commercial |
$4,012.32
|
| Rate for Payer: WEA Trust Commercial |
$4,413.55
|
| Rate for Payer: WPS Commercial |
$5,943.63
|
|
|
PLATE PROXIMAL HUMERUS 3.5 LCP 3HL LT 02.123.041S
|
Facility
|
IP
|
$7,716.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3805556
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,932.07 |
| Max. Negotiated Rate |
$7,382.67 |
| Rate for Payer: Aetna Commercial |
$7,222.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,901.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,253.06
|
| Rate for Payer: Cash Price |
$2,314.80
|
| Rate for Payer: Cigna Commercial |
$7,382.67
|
| Rate for Payer: Health EOS Commercial |
$7,141.93
|
| Rate for Payer: HFN Commercial |
$7,382.67
|
| Rate for Payer: Multiplan Commercial |
$6,419.71
|
| Rate for Payer: Preferred Network Access Commercial |
$7,382.67
|
| Rate for Payer: Quartz Beloit One Network |
$3,932.07
|
| Rate for Payer: Quartz Commercial |
$4,814.78
|
| Rate for Payer: WEA Trust Commercial |
$4,413.55
|
| Rate for Payer: WPS Commercial |
$5,943.63
|
|
|
PLATE PROXIMAL HUMERUS 3.5 LCP 3HL RT 02.123.040S
|
Facility
|
OP
|
$9,879.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966334
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,876.76 |
| Max. Negotiated Rate |
$9,452.23 |
| Rate for Payer: Aetna Commercial |
$9,246.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,835.78
|
| Rate for Payer: Aetna Managed Medicare |
$2,876.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,678.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,137.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,931.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,445.30
|
| Rate for Payer: Cash Price |
$2,963.70
|
| Rate for Payer: Cigna Commercial |
$9,452.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,749.58
|
| Rate for Payer: Health EOS Commercial |
$9,144.00
|
| Rate for Payer: HFN Commercial |
$9,452.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,705.62
|
| Rate for Payer: Multiplan Commercial |
$8,219.33
|
| Rate for Payer: NAPHCARE Commercial |
$6,164.50
|
| Rate for Payer: Preferred Network Access Commercial |
$9,452.23
|
| Rate for Payer: Quartz Beloit One Network |
$5,034.34
|
| Rate for Payer: Quartz Commercial |
$6,678.20
|
| Rate for Payer: Quartz Medicare Advantage |
$6,164.50
|
| Rate for Payer: The Alliance Commercial |
$5,137.08
|
| Rate for Payer: WEA Trust Commercial |
$5,650.79
|
| Rate for Payer: WPS Commercial |
$7,609.79
|
|
|
PLATE PROXIMAL HUMERUS 3.5 LCP 3HL RT 02.123.040S
|
Facility
|
IP
|
$9,879.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966334
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,034.34 |
| Max. Negotiated Rate |
$9,452.23 |
| Rate for Payer: Aetna Commercial |
$9,246.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,835.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,445.30
|
| Rate for Payer: Cash Price |
$2,963.70
|
| Rate for Payer: Cigna Commercial |
$9,452.23
|
| Rate for Payer: Health EOS Commercial |
$9,144.00
|
| Rate for Payer: HFN Commercial |
$9,452.23
|
| Rate for Payer: Multiplan Commercial |
$8,219.33
|
| Rate for Payer: Preferred Network Access Commercial |
$9,452.23
|
| Rate for Payer: Quartz Beloit One Network |
$5,034.34
|
| Rate for Payer: Quartz Commercial |
$6,164.50
|
| Rate for Payer: WEA Trust Commercial |
$5,650.79
|
| Rate for Payer: WPS Commercial |
$7,609.79
|
|
|
PLATE PROXIMAL HUMERUS 3.5 LCP 6HL RT 02.123.024S
|
Facility
|
IP
|
$8,241.00
|
|
|
Service Code
|
HCPCS C1714
|
| Hospital Charge Code |
3491510
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,199.61 |
| Max. Negotiated Rate |
$7,884.99 |
| Rate for Payer: Aetna Commercial |
$7,713.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,370.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,542.44
|
| Rate for Payer: Cash Price |
$2,472.30
|
| Rate for Payer: Cigna Commercial |
$7,884.99
|
| Rate for Payer: Health EOS Commercial |
$7,627.87
|
| Rate for Payer: HFN Commercial |
$7,884.99
|
| Rate for Payer: Multiplan Commercial |
$6,856.51
|
| Rate for Payer: Preferred Network Access Commercial |
$7,884.99
|
| Rate for Payer: Quartz Beloit One Network |
$4,199.61
|
| Rate for Payer: Quartz Commercial |
$5,142.38
|
| Rate for Payer: WEA Trust Commercial |
$4,713.85
|
| Rate for Payer: WPS Commercial |
$6,348.04
|
|
|
PLATE PROXIMAL HUMERUS 3.5 LCP 6HL RT 02.123.024S
|
Facility
|
OP
|
$8,241.00
|
|
|
Service Code
|
HCPCS C1714
|
| Hospital Charge Code |
3491510
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,399.78 |
| Max. Negotiated Rate |
$7,884.99 |
| Rate for Payer: Aetna Commercial |
$7,713.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,370.75
|
| Rate for Payer: Aetna Managed Medicare |
$2,399.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,570.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,285.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,113.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,542.44
|
| Rate for Payer: Cash Price |
$2,472.30
|
| Rate for Payer: Cigna Commercial |
$7,884.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,796.26
|
| Rate for Payer: Health EOS Commercial |
$7,627.87
|
| Rate for Payer: HFN Commercial |
$7,884.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,427.98
|
| Rate for Payer: Multiplan Commercial |
$6,856.51
|
| Rate for Payer: NAPHCARE Commercial |
$5,142.38
|
| Rate for Payer: Preferred Network Access Commercial |
$7,884.99
|
| Rate for Payer: Quartz Beloit One Network |
$4,199.61
|
| Rate for Payer: Quartz Commercial |
$5,570.92
|
| Rate for Payer: Quartz Medicare Advantage |
$5,142.38
|
| Rate for Payer: The Alliance Commercial |
$4,285.32
|
| Rate for Payer: WEA Trust Commercial |
$4,713.85
|
| Rate for Payer: WPS Commercial |
$6,348.04
|
|
|
PLATE PROXIMAL TIBIAL PLATLOW BEND LCP 6HL LT 02.124.205S
|
Facility
|
OP
|
$6,549.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4518882
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,907.07 |
| Max. Negotiated Rate |
$6,266.08 |
| Rate for Payer: Aetna Commercial |
$6,129.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,857.43
|
| Rate for Payer: Aetna Managed Medicare |
$1,907.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,427.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,405.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,269.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,609.81
|
| Rate for Payer: Cash Price |
$1,964.70
|
| Rate for Payer: Cigna Commercial |
$6,266.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,811.52
|
| Rate for Payer: Health EOS Commercial |
$6,061.75
|
| Rate for Payer: HFN Commercial |
$6,266.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,108.22
|
| Rate for Payer: Multiplan Commercial |
$5,448.77
|
| Rate for Payer: NAPHCARE Commercial |
$4,086.58
|
| Rate for Payer: Preferred Network Access Commercial |
$6,266.08
|
| Rate for Payer: Quartz Beloit One Network |
$3,337.37
|
| Rate for Payer: Quartz Commercial |
$4,427.12
|
| Rate for Payer: Quartz Medicare Advantage |
$4,086.58
|
| Rate for Payer: The Alliance Commercial |
$3,405.48
|
| Rate for Payer: WEA Trust Commercial |
$3,746.03
|
| Rate for Payer: WPS Commercial |
$5,044.69
|
|
|
PLATE PROXIMAL TIBIAL PLATLOW BEND LCP 6HL LT 02.124.205S
|
Facility
|
IP
|
$6,549.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4518882
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,337.37 |
| Max. Negotiated Rate |
$6,266.08 |
| Rate for Payer: Aetna Commercial |
$6,129.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,857.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,609.81
|
| Rate for Payer: Cash Price |
$1,964.70
|
| Rate for Payer: Cigna Commercial |
$6,266.08
|
| Rate for Payer: Health EOS Commercial |
$6,061.75
|
| Rate for Payer: HFN Commercial |
$6,266.08
|
| Rate for Payer: Multiplan Commercial |
$5,448.77
|
| Rate for Payer: Preferred Network Access Commercial |
$6,266.08
|
| Rate for Payer: Quartz Beloit One Network |
$3,337.37
|
| Rate for Payer: Quartz Commercial |
$4,086.58
|
| Rate for Payer: WEA Trust Commercial |
$3,746.03
|
| Rate for Payer: WPS Commercial |
$5,044.69
|
|
|
PLATE PROXIMAL TIBIAL PLATLOW BEND LCP 6HL RT 02.124.204
|
Facility
|
OP
|
$6,549.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415315
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,907.07 |
| Max. Negotiated Rate |
$6,266.08 |
| Rate for Payer: Aetna Commercial |
$6,129.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,857.43
|
| Rate for Payer: Aetna Managed Medicare |
$1,907.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,427.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,405.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,269.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,609.81
|
| Rate for Payer: Cash Price |
$1,964.70
|
| Rate for Payer: Cigna Commercial |
$6,266.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,811.52
|
| Rate for Payer: Health EOS Commercial |
$6,061.75
|
| Rate for Payer: HFN Commercial |
$6,266.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,108.22
|
| Rate for Payer: Multiplan Commercial |
$5,448.77
|
| Rate for Payer: NAPHCARE Commercial |
$4,086.58
|
| Rate for Payer: Preferred Network Access Commercial |
$6,266.08
|
| Rate for Payer: Quartz Beloit One Network |
$3,337.37
|
| Rate for Payer: Quartz Commercial |
$4,427.12
|
| Rate for Payer: Quartz Medicare Advantage |
$4,086.58
|
| Rate for Payer: The Alliance Commercial |
$3,405.48
|
| Rate for Payer: WEA Trust Commercial |
$3,746.03
|
| Rate for Payer: WPS Commercial |
$5,044.69
|
|
|
PLATE PROXIMAL TIBIAL PLATLOW BEND LCP 6HL RT 02.124.204
|
Facility
|
IP
|
$6,549.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415315
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,337.37 |
| Max. Negotiated Rate |
$6,266.08 |
| Rate for Payer: Aetna Commercial |
$6,129.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,857.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,609.81
|
| Rate for Payer: Cash Price |
$1,964.70
|
| Rate for Payer: Cigna Commercial |
$6,266.08
|
| Rate for Payer: Health EOS Commercial |
$6,061.75
|
| Rate for Payer: HFN Commercial |
$6,266.08
|
| Rate for Payer: Multiplan Commercial |
$5,448.77
|
| Rate for Payer: Preferred Network Access Commercial |
$6,266.08
|
| Rate for Payer: Quartz Beloit One Network |
$3,337.37
|
| Rate for Payer: Quartz Commercial |
$4,086.58
|
| Rate for Payer: WEA Trust Commercial |
$3,746.03
|
| Rate for Payer: WPS Commercial |
$5,044.69
|
|
