|
PLATE POSTERIOR LATERAL 3 HOLE RT 629263
|
Facility
|
OP
|
$6,761.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599675
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,893.08 |
| Max. Negotiated Rate |
$27,044.00 |
| Rate for Payer: Aetna Commercial |
$6,084.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,814.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,893.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,394.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,380.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,245.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,583.33
|
| Rate for Payer: Cash Price |
$2,028.30
|
| Rate for Payer: Cigna Commercial |
$6,220.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,783.46
|
| Rate for Payer: Health EOS Commercial |
$6,017.29
|
| Rate for Payer: HFN Commercial |
$6,220.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,070.75
|
| Rate for Payer: Multiplan Commercial |
$5,408.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,056.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,220.12
|
| Rate for Payer: Quartz Beloit One Network |
$3,312.89
|
| Rate for Payer: Quartz Commercial |
$4,394.65
|
| Rate for Payer: Quartz Medicare Advantage |
$4,056.60
|
| Rate for Payer: The Alliance Commercial |
$27,044.00
|
| Rate for Payer: WEA Trust Commercial |
$3,718.55
|
| Rate for Payer: WPS Commercial |
$5,007.87
|
|
|
PLATE POSTERIOR LATERAL 4 HOLE LT 629244
|
Facility
|
IP
|
$2,547.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4006580
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,248.03 |
| Max. Negotiated Rate |
$2,343.24 |
| Rate for Payer: Aetna Commercial |
$2,292.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,190.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,349.91
|
| Rate for Payer: Cash Price |
$764.10
|
| Rate for Payer: Cigna Commercial |
$2,343.24
|
| Rate for Payer: Health EOS Commercial |
$2,266.83
|
| Rate for Payer: HFN Commercial |
$2,343.24
|
| Rate for Payer: Multiplan Commercial |
$2,037.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,528.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,343.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,248.03
|
| Rate for Payer: Quartz Commercial |
$1,528.20
|
| Rate for Payer: WEA Trust Commercial |
$1,400.85
|
| Rate for Payer: WPS Commercial |
$1,886.56
|
|
|
PLATE POSTERIOR LATERAL 4 HOLE LT 629244
|
Facility
|
OP
|
$2,547.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4006580
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$713.16 |
| Max. Negotiated Rate |
$10,188.00 |
| Rate for Payer: Aetna Commercial |
$2,292.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,190.42
|
| Rate for Payer: Aetna Managed Medicare |
$713.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,655.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,273.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,222.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,349.91
|
| Rate for Payer: Cash Price |
$764.10
|
| Rate for Payer: Cigna Commercial |
$2,343.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,425.30
|
| Rate for Payer: Health EOS Commercial |
$2,266.83
|
| Rate for Payer: HFN Commercial |
$2,343.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,910.25
|
| Rate for Payer: Multiplan Commercial |
$2,037.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,528.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,343.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,248.03
|
| Rate for Payer: Quartz Commercial |
$1,655.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,528.20
|
| Rate for Payer: The Alliance Commercial |
$10,188.00
|
| Rate for Payer: WEA Trust Commercial |
$1,400.85
|
| Rate for Payer: WPS Commercial |
$1,886.56
|
|
|
PLATE POSTERIOR LATERAL 6 HOLE LT 629246
|
Facility
|
IP
|
$7,018.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4006558
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,438.82 |
| Max. Negotiated Rate |
$6,456.56 |
| Rate for Payer: Aetna Commercial |
$6,316.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,035.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,719.54
|
| Rate for Payer: Cash Price |
$2,105.40
|
| Rate for Payer: Cigna Commercial |
$6,456.56
|
| Rate for Payer: Health EOS Commercial |
$6,246.02
|
| Rate for Payer: HFN Commercial |
$6,456.56
|
| Rate for Payer: Multiplan Commercial |
$5,614.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,210.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,456.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,438.82
|
| Rate for Payer: Quartz Commercial |
$4,210.80
|
| Rate for Payer: WEA Trust Commercial |
$3,859.90
|
| Rate for Payer: WPS Commercial |
$5,198.23
|
|
|
PLATE POSTERIOR LATERAL 6 HOLE LT 629246
|
Facility
|
OP
|
$7,018.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4006558
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,965.04 |
| Max. Negotiated Rate |
$28,072.00 |
| Rate for Payer: Aetna Commercial |
$6,316.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,035.48
|
| Rate for Payer: Aetna Managed Medicare |
$1,965.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,561.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,509.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,368.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,719.54
|
| Rate for Payer: Cash Price |
$2,105.40
|
| Rate for Payer: Cigna Commercial |
$6,456.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,927.27
|
| Rate for Payer: Health EOS Commercial |
$6,246.02
|
| Rate for Payer: HFN Commercial |
$6,456.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,263.50
|
| Rate for Payer: Multiplan Commercial |
$5,614.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,210.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,456.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,438.82
|
| Rate for Payer: Quartz Commercial |
$4,561.70
|
| Rate for Payer: Quartz Medicare Advantage |
$4,210.80
|
| Rate for Payer: The Alliance Commercial |
$28,072.00
|
| Rate for Payer: WEA Trust Commercial |
$3,859.90
|
| Rate for Payer: WPS Commercial |
$5,198.23
|
|
|
PLATE PRE-CONTOURED 12 HOLE RIBFIX BLUE 76-2602
|
Facility
|
OP
|
$8,996.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5627636
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,518.88 |
| Max. Negotiated Rate |
$35,984.00 |
| Rate for Payer: Aetna Commercial |
$8,096.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,736.56
|
| Rate for Payer: Aetna Managed Medicare |
$2,518.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,847.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,498.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,318.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,767.88
|
| Rate for Payer: Cash Price |
$2,698.80
|
| Rate for Payer: Cigna Commercial |
$8,276.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,034.16
|
| Rate for Payer: Health EOS Commercial |
$8,006.44
|
| Rate for Payer: HFN Commercial |
$8,276.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,747.00
|
| Rate for Payer: Multiplan Commercial |
$7,196.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,397.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,276.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,408.04
|
| Rate for Payer: Quartz Commercial |
$5,847.40
|
| Rate for Payer: Quartz Medicare Advantage |
$5,397.60
|
| Rate for Payer: The Alliance Commercial |
$35,984.00
|
| Rate for Payer: WEA Trust Commercial |
$4,947.80
|
| Rate for Payer: WPS Commercial |
$6,663.34
|
|
|
PLATE PRE-CONTOURED 12 HOLE RIBFIX BLUE 76-2602
|
Facility
|
IP
|
$8,996.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5627636
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,408.04 |
| Max. Negotiated Rate |
$8,276.32 |
| Rate for Payer: Aetna Commercial |
$8,096.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,736.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,767.88
|
| Rate for Payer: Cash Price |
$2,698.80
|
| Rate for Payer: Cigna Commercial |
$8,276.32
|
| Rate for Payer: Health EOS Commercial |
$8,006.44
|
| Rate for Payer: HFN Commercial |
$8,276.32
|
| Rate for Payer: Multiplan Commercial |
$7,196.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,397.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,276.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,408.04
|
| Rate for Payer: Quartz Commercial |
$5,397.60
|
| Rate for Payer: WEA Trust Commercial |
$4,947.80
|
| Rate for Payer: WPS Commercial |
$6,663.34
|
|
|
PLATE PROX/HUM 3.5 10HL LONG 241.923
|
Facility
|
IP
|
$8,566.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6174861
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,197.34 |
| Max. Negotiated Rate |
$7,880.72 |
| Rate for Payer: Aetna Commercial |
$7,709.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,366.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,539.98
|
| Rate for Payer: Cash Price |
$2,569.80
|
| Rate for Payer: Cigna Commercial |
$7,880.72
|
| Rate for Payer: Health EOS Commercial |
$7,623.74
|
| Rate for Payer: HFN Commercial |
$7,880.72
|
| Rate for Payer: Multiplan Commercial |
$6,852.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,139.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,880.72
|
| Rate for Payer: Quartz Beloit One Network |
$4,197.34
|
| Rate for Payer: Quartz Commercial |
$5,139.60
|
| Rate for Payer: WEA Trust Commercial |
$4,711.30
|
| Rate for Payer: WPS Commercial |
$6,344.84
|
|
|
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 |
$2,398.48 |
| Max. Negotiated Rate |
$34,264.00 |
| Rate for Payer: Aetna Commercial |
$7,709.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,366.76
|
| Rate for Payer: Aetna Managed Medicare |
$2,398.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,567.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,283.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,111.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,539.98
|
| Rate for Payer: Cash Price |
$2,569.80
|
| Rate for Payer: Cigna Commercial |
$7,880.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,793.53
|
| Rate for Payer: Health EOS Commercial |
$7,623.74
|
| Rate for Payer: HFN Commercial |
$7,880.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,424.50
|
| Rate for Payer: Multiplan Commercial |
$6,852.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,139.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,880.72
|
| Rate for Payer: Quartz Beloit One Network |
$4,197.34
|
| Rate for Payer: Quartz Commercial |
$5,567.90
|
| Rate for Payer: Quartz Medicare Advantage |
$5,139.60
|
| Rate for Payer: The Alliance Commercial |
$34,264.00
|
| Rate for Payer: WEA Trust Commercial |
$4,711.30
|
| Rate for Payer: WPS Commercial |
$6,344.84
|
|
|
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 |
$3,596.11 |
| Max. Negotiated Rate |
$6,751.88 |
| Rate for Payer: Aetna Commercial |
$6,605.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,311.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,889.67
|
| Rate for Payer: Cash Price |
$2,201.70
|
| Rate for Payer: Cigna Commercial |
$6,751.88
|
| Rate for Payer: Health EOS Commercial |
$6,531.71
|
| Rate for Payer: HFN Commercial |
$6,751.88
|
| Rate for Payer: Multiplan Commercial |
$5,871.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,403.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,751.88
|
| Rate for Payer: Quartz Beloit One Network |
$3,596.11
|
| Rate for Payer: Quartz Commercial |
$4,403.40
|
| Rate for Payer: WEA Trust Commercial |
$4,036.45
|
| Rate for Payer: WPS Commercial |
$5,436.00
|
|
|
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 |
$2,054.92 |
| Max. Negotiated Rate |
$29,356.00 |
| Rate for Payer: Aetna Commercial |
$6,605.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,311.54
|
| Rate for Payer: Aetna Managed Medicare |
$2,054.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,770.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,669.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,522.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,889.67
|
| Rate for Payer: Cash Price |
$2,201.70
|
| Rate for Payer: Cigna Commercial |
$6,751.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,106.90
|
| Rate for Payer: Health EOS Commercial |
$6,531.71
|
| Rate for Payer: HFN Commercial |
$6,751.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,504.25
|
| Rate for Payer: Multiplan Commercial |
$5,871.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,403.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,751.88
|
| Rate for Payer: Quartz Beloit One Network |
$3,596.11
|
| Rate for Payer: Quartz Commercial |
$4,770.35
|
| Rate for Payer: Quartz Medicare Advantage |
$4,403.40
|
| Rate for Payer: The Alliance Commercial |
$29,356.00
|
| Rate for Payer: WEA Trust Commercial |
$4,036.45
|
| Rate for Payer: WPS Commercial |
$5,436.00
|
|
|
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 |
$3,711.75 |
| Max. Negotiated Rate |
$6,969.00 |
| Rate for Payer: Aetna Commercial |
$6,817.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,514.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,014.75
|
| Rate for Payer: Cash Price |
$2,272.50
|
| Rate for Payer: Cigna Commercial |
$6,969.00
|
| Rate for Payer: Health EOS Commercial |
$6,741.75
|
| Rate for Payer: HFN Commercial |
$6,969.00
|
| Rate for Payer: Multiplan Commercial |
$6,060.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,545.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,969.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,711.75
|
| Rate for Payer: Quartz Commercial |
$4,545.00
|
| Rate for Payer: WEA Trust Commercial |
$4,166.25
|
| Rate for Payer: WPS Commercial |
$5,610.80
|
|
|
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 |
$2,121.00 |
| Max. Negotiated Rate |
$30,300.00 |
| Rate for Payer: Aetna Commercial |
$6,817.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,514.50
|
| Rate for Payer: Aetna Managed Medicare |
$2,121.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,923.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,787.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,636.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,014.75
|
| Rate for Payer: Cash Price |
$2,272.50
|
| Rate for Payer: Cigna Commercial |
$6,969.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,238.97
|
| Rate for Payer: Health EOS Commercial |
$6,741.75
|
| Rate for Payer: HFN Commercial |
$6,969.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,681.25
|
| Rate for Payer: Multiplan Commercial |
$6,060.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,545.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,969.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,711.75
|
| Rate for Payer: Quartz Commercial |
$4,923.75
|
| Rate for Payer: Quartz Medicare Advantage |
$4,545.00
|
| Rate for Payer: The Alliance Commercial |
$30,300.00
|
| Rate for Payer: WEA Trust Commercial |
$4,166.25
|
| Rate for Payer: WPS Commercial |
$5,610.80
|
|
|
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 |
$3,602.97 |
| Max. Negotiated Rate |
$6,764.76 |
| Rate for Payer: Aetna Commercial |
$6,617.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,323.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,897.09
|
| Rate for Payer: Cash Price |
$2,205.90
|
| Rate for Payer: Cigna Commercial |
$6,764.76
|
| Rate for Payer: Health EOS Commercial |
$6,544.17
|
| Rate for Payer: HFN Commercial |
$6,764.76
|
| Rate for Payer: Multiplan Commercial |
$5,882.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,411.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,764.76
|
| Rate for Payer: Quartz Beloit One Network |
$3,602.97
|
| Rate for Payer: Quartz Commercial |
$4,411.80
|
| Rate for Payer: WEA Trust Commercial |
$4,044.15
|
| Rate for Payer: WPS Commercial |
$5,446.37
|
|
|
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 |
$2,058.84 |
| Max. Negotiated Rate |
$29,412.00 |
| Rate for Payer: Aetna Commercial |
$6,617.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,323.58
|
| Rate for Payer: Aetna Managed Medicare |
$2,058.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,779.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,676.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,529.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,897.09
|
| Rate for Payer: Cash Price |
$2,205.90
|
| Rate for Payer: Cigna Commercial |
$6,764.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,114.74
|
| Rate for Payer: Health EOS Commercial |
$6,544.17
|
| Rate for Payer: HFN Commercial |
$6,764.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,514.75
|
| Rate for Payer: Multiplan Commercial |
$5,882.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,411.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,764.76
|
| Rate for Payer: Quartz Beloit One Network |
$3,602.97
|
| Rate for Payer: Quartz Commercial |
$4,779.45
|
| Rate for Payer: Quartz Medicare Advantage |
$4,411.80
|
| Rate for Payer: The Alliance Commercial |
$29,412.00
|
| Rate for Payer: WEA Trust Commercial |
$4,044.15
|
| Rate for Payer: WPS Commercial |
$5,446.37
|
|
|
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 |
$2,137.95 |
| Max. Negotiated Rate |
$30,542.16 |
| Rate for Payer: Aetna Commercial |
$6,871.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,566.56
|
| Rate for Payer: Aetna Managed Medicare |
$2,137.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,963.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,817.77
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,665.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,046.84
|
| Rate for Payer: Cash Price |
$2,290.66
|
| Rate for Payer: Cigna Commercial |
$7,024.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,272.85
|
| Rate for Payer: Health EOS Commercial |
$6,795.63
|
| Rate for Payer: HFN Commercial |
$7,024.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,726.66
|
| Rate for Payer: Multiplan Commercial |
$6,108.43
|
| Rate for Payer: NAPHCARE Commercial |
$4,581.32
|
| Rate for Payer: Preferred Network Access Commercial |
$7,024.70
|
| Rate for Payer: Quartz Beloit One Network |
$3,741.41
|
| Rate for Payer: Quartz Commercial |
$4,963.10
|
| Rate for Payer: Quartz Medicare Advantage |
$4,581.32
|
| Rate for Payer: The Alliance Commercial |
$30,542.16
|
| Rate for Payer: WEA Trust Commercial |
$4,199.55
|
| Rate for Payer: WPS Commercial |
$5,655.64
|
|
|
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 |
$3,741.41 |
| Max. Negotiated Rate |
$7,024.70 |
| Rate for Payer: Aetna Commercial |
$6,871.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,566.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,046.84
|
| Rate for Payer: Cash Price |
$2,290.66
|
| Rate for Payer: Cigna Commercial |
$7,024.70
|
| Rate for Payer: Health EOS Commercial |
$6,795.63
|
| Rate for Payer: HFN Commercial |
$7,024.70
|
| Rate for Payer: Multiplan Commercial |
$6,108.43
|
| Rate for Payer: NAPHCARE Commercial |
$4,581.32
|
| Rate for Payer: Preferred Network Access Commercial |
$7,024.70
|
| Rate for Payer: Quartz Beloit One Network |
$3,741.41
|
| Rate for Payer: Quartz Commercial |
$4,581.32
|
| Rate for Payer: WEA Trust Commercial |
$4,199.55
|
| Rate for Payer: WPS Commercial |
$5,655.64
|
|
|
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 |
$3,977.82 |
| Max. Negotiated Rate |
$7,468.56 |
| Rate for Payer: Aetna Commercial |
$7,306.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,981.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,302.54
|
| Rate for Payer: Cash Price |
$2,435.40
|
| Rate for Payer: Cigna Commercial |
$7,468.56
|
| Rate for Payer: Health EOS Commercial |
$7,225.02
|
| Rate for Payer: HFN Commercial |
$7,468.56
|
| Rate for Payer: Multiplan Commercial |
$6,494.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,870.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,468.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,977.82
|
| Rate for Payer: Quartz Commercial |
$4,870.80
|
| Rate for Payer: WEA Trust Commercial |
$4,464.90
|
| Rate for Payer: WPS Commercial |
$6,013.00
|
|
|
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 |
$2,273.04 |
| Max. Negotiated Rate |
$32,472.00 |
| Rate for Payer: Aetna Commercial |
$7,306.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,981.48
|
| Rate for Payer: Aetna Managed Medicare |
$2,273.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,276.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,059.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,896.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,302.54
|
| Rate for Payer: Cash Price |
$2,435.40
|
| Rate for Payer: Cigna Commercial |
$7,468.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,542.83
|
| Rate for Payer: Health EOS Commercial |
$7,225.02
|
| Rate for Payer: HFN Commercial |
$7,468.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,088.50
|
| Rate for Payer: Multiplan Commercial |
$6,494.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,870.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,468.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,977.82
|
| Rate for Payer: Quartz Commercial |
$5,276.70
|
| Rate for Payer: Quartz Medicare Advantage |
$4,870.80
|
| Rate for Payer: The Alliance Commercial |
$32,472.00
|
| Rate for Payer: WEA Trust Commercial |
$4,464.90
|
| Rate for Payer: WPS Commercial |
$6,013.00
|
|
|
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 |
$2,541.28 |
| Max. Negotiated Rate |
$36,304.00 |
| Rate for Payer: Aetna Commercial |
$8,168.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,805.36
|
| Rate for Payer: Aetna Managed Medicare |
$2,541.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,899.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,538.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,356.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,810.28
|
| Rate for Payer: Cash Price |
$2,722.80
|
| Rate for Payer: Cigna Commercial |
$8,349.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,078.93
|
| Rate for Payer: Health EOS Commercial |
$8,077.64
|
| Rate for Payer: HFN Commercial |
$8,349.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,807.00
|
| Rate for Payer: Multiplan Commercial |
$7,260.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,445.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,349.92
|
| Rate for Payer: Quartz Beloit One Network |
$4,447.24
|
| Rate for Payer: Quartz Commercial |
$5,899.40
|
| Rate for Payer: Quartz Medicare Advantage |
$5,445.60
|
| Rate for Payer: The Alliance Commercial |
$36,304.00
|
| Rate for Payer: WEA Trust Commercial |
$4,991.80
|
| Rate for Payer: WPS Commercial |
$6,722.59
|
|
|
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 |
$4,447.24 |
| Max. Negotiated Rate |
$8,349.92 |
| Rate for Payer: Aetna Commercial |
$8,168.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,805.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,810.28
|
| Rate for Payer: Cash Price |
$2,722.80
|
| Rate for Payer: Cigna Commercial |
$8,349.92
|
| Rate for Payer: Health EOS Commercial |
$8,077.64
|
| Rate for Payer: HFN Commercial |
$8,349.92
|
| Rate for Payer: Multiplan Commercial |
$7,260.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,445.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,349.92
|
| Rate for Payer: Quartz Beloit One Network |
$4,447.24
|
| Rate for Payer: Quartz Commercial |
$5,445.60
|
| Rate for Payer: WEA Trust Commercial |
$4,991.80
|
| Rate for Payer: WPS Commercial |
$6,722.59
|
|
|
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 |
$4,447.24 |
| Max. Negotiated Rate |
$8,349.92 |
| Rate for Payer: Aetna Commercial |
$8,168.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,805.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,810.28
|
| Rate for Payer: Cash Price |
$2,722.80
|
| Rate for Payer: Cigna Commercial |
$8,349.92
|
| Rate for Payer: Health EOS Commercial |
$8,077.64
|
| Rate for Payer: HFN Commercial |
$8,349.92
|
| Rate for Payer: Multiplan Commercial |
$7,260.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,445.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,349.92
|
| Rate for Payer: Quartz Beloit One Network |
$4,447.24
|
| Rate for Payer: Quartz Commercial |
$5,445.60
|
| Rate for Payer: WEA Trust Commercial |
$4,991.80
|
| Rate for Payer: WPS Commercial |
$6,722.59
|
|
|
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 |
$2,541.28 |
| Max. Negotiated Rate |
$36,304.00 |
| Rate for Payer: Aetna Commercial |
$8,168.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,805.36
|
| Rate for Payer: Aetna Managed Medicare |
$2,541.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,899.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,538.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,356.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,810.28
|
| Rate for Payer: Cash Price |
$2,722.80
|
| Rate for Payer: Cigna Commercial |
$8,349.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,078.93
|
| Rate for Payer: Health EOS Commercial |
$8,077.64
|
| Rate for Payer: HFN Commercial |
$8,349.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,807.00
|
| Rate for Payer: Multiplan Commercial |
$7,260.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,445.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,349.92
|
| Rate for Payer: Quartz Beloit One Network |
$4,447.24
|
| Rate for Payer: Quartz Commercial |
$5,899.40
|
| Rate for Payer: Quartz Medicare Advantage |
$5,445.60
|
| Rate for Payer: The Alliance Commercial |
$36,304.00
|
| Rate for Payer: WEA Trust Commercial |
$4,991.80
|
| Rate for Payer: WPS Commercial |
$6,722.59
|
|
|
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 |
$2,160.48 |
| Max. Negotiated Rate |
$30,864.00 |
| Rate for Payer: Aetna Commercial |
$6,944.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,635.76
|
| Rate for Payer: Aetna Managed Medicare |
$2,160.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,015.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,858.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,703.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,089.48
|
| Rate for Payer: Cash Price |
$2,314.80
|
| Rate for Payer: Cigna Commercial |
$7,098.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,317.87
|
| Rate for Payer: Health EOS Commercial |
$6,867.24
|
| Rate for Payer: HFN Commercial |
$7,098.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,787.00
|
| Rate for Payer: Multiplan Commercial |
$6,172.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,629.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,098.72
|
| Rate for Payer: Quartz Beloit One Network |
$3,780.84
|
| Rate for Payer: Quartz Commercial |
$5,015.40
|
| Rate for Payer: Quartz Medicare Advantage |
$4,629.60
|
| Rate for Payer: The Alliance Commercial |
$30,864.00
|
| Rate for Payer: WEA Trust Commercial |
$4,243.80
|
| Rate for Payer: WPS Commercial |
$5,715.24
|
|
|
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 |
$3,780.84 |
| Max. Negotiated Rate |
$7,098.72 |
| Rate for Payer: Aetna Commercial |
$6,944.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,635.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,089.48
|
| Rate for Payer: Cash Price |
$2,314.80
|
| Rate for Payer: Cigna Commercial |
$7,098.72
|
| Rate for Payer: Health EOS Commercial |
$6,867.24
|
| Rate for Payer: HFN Commercial |
$7,098.72
|
| Rate for Payer: Multiplan Commercial |
$6,172.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,629.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,098.72
|
| Rate for Payer: Quartz Beloit One Network |
$3,780.84
|
| Rate for Payer: Quartz Commercial |
$4,629.60
|
| Rate for Payer: WEA Trust Commercial |
$4,243.80
|
| Rate for Payer: WPS Commercial |
$5,715.24
|
|
