|
PLATE SQUARE 4 HOLE BIOMET 73-2622
|
Facility
|
IP
|
$4,320.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4205985
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,116.80 |
| Max. Negotiated Rate |
$3,974.40 |
| Rate for Payer: Aetna Commercial |
$3,888.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,715.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,289.60
|
| Rate for Payer: Cash Price |
$1,296.00
|
| Rate for Payer: Cigna Commercial |
$3,974.40
|
| Rate for Payer: Health EOS Commercial |
$3,844.80
|
| Rate for Payer: HFN Commercial |
$3,974.40
|
| Rate for Payer: Multiplan Commercial |
$3,456.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,592.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,974.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,116.80
|
| Rate for Payer: Quartz Commercial |
$2,592.00
|
| Rate for Payer: WEA Trust Commercial |
$2,376.00
|
| Rate for Payer: WPS Commercial |
$3,199.82
|
|
|
PLATE SQUARE 4 HOLE BIOMET 73-2622
|
Facility
|
OP
|
$4,320.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4205985
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,209.60 |
| Max. Negotiated Rate |
$17,280.00 |
| Rate for Payer: Aetna Commercial |
$3,888.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,715.20
|
| Rate for Payer: Aetna Managed Medicare |
$1,209.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,808.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,160.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,073.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,289.60
|
| Rate for Payer: Cash Price |
$1,296.00
|
| Rate for Payer: Cigna Commercial |
$3,974.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,417.47
|
| Rate for Payer: Health EOS Commercial |
$3,844.80
|
| Rate for Payer: HFN Commercial |
$3,974.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,240.00
|
| Rate for Payer: Multiplan Commercial |
$3,456.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,592.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,974.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,116.80
|
| Rate for Payer: Quartz Commercial |
$2,808.00
|
| Rate for Payer: Quartz Medicare Advantage |
$2,592.00
|
| Rate for Payer: The Alliance Commercial |
$17,280.00
|
| Rate for Payer: WEA Trust Commercial |
$2,376.00
|
| Rate for Payer: WPS Commercial |
$3,199.82
|
|
|
PLATE STERNALOCK 8HL STRAIGHT 73-1952
|
Facility
|
OP
|
$4,440.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5447129
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,243.20 |
| Max. Negotiated Rate |
$17,760.00 |
| Rate for Payer: Aetna Commercial |
$3,996.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,818.40
|
| Rate for Payer: Aetna Managed Medicare |
$1,243.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,886.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,220.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,131.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,353.20
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Cigna Commercial |
$4,084.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,484.62
|
| Rate for Payer: Health EOS Commercial |
$3,951.60
|
| Rate for Payer: HFN Commercial |
$4,084.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,330.00
|
| Rate for Payer: Multiplan Commercial |
$3,552.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,664.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,084.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,175.60
|
| Rate for Payer: Quartz Commercial |
$2,886.00
|
| Rate for Payer: Quartz Medicare Advantage |
$2,664.00
|
| Rate for Payer: The Alliance Commercial |
$17,760.00
|
| Rate for Payer: WEA Trust Commercial |
$2,442.00
|
| Rate for Payer: WPS Commercial |
$3,288.71
|
|
|
PLATE STERNALOCK 8HL STRAIGHT 73-1952
|
Facility
|
IP
|
$4,440.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5447129
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,175.60 |
| Max. Negotiated Rate |
$4,084.80 |
| Rate for Payer: Aetna Commercial |
$3,996.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,818.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,353.20
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Cigna Commercial |
$4,084.80
|
| Rate for Payer: Health EOS Commercial |
$3,951.60
|
| Rate for Payer: HFN Commercial |
$4,084.80
|
| Rate for Payer: Multiplan Commercial |
$3,552.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,664.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,084.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,175.60
|
| Rate for Payer: Quartz Commercial |
$2,664.00
|
| Rate for Payer: WEA Trust Commercial |
$2,442.00
|
| Rate for Payer: WPS Commercial |
$3,288.71
|
|
|
PLATE STRAIGHT 1.3MM 12HL 221.312
|
Facility
|
IP
|
$3,488.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508590
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,709.12 |
| Max. Negotiated Rate |
$3,208.96 |
| Rate for Payer: Aetna Commercial |
$3,139.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,999.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,848.64
|
| Rate for Payer: Cash Price |
$1,046.40
|
| Rate for Payer: Cigna Commercial |
$3,208.96
|
| Rate for Payer: Health EOS Commercial |
$3,104.32
|
| Rate for Payer: HFN Commercial |
$3,208.96
|
| Rate for Payer: Multiplan Commercial |
$2,790.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,092.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,208.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,709.12
|
| Rate for Payer: Quartz Commercial |
$2,092.80
|
| Rate for Payer: WEA Trust Commercial |
$1,918.40
|
| Rate for Payer: WPS Commercial |
$2,583.56
|
|
|
PLATE STRAIGHT 1.3MM 12HL 221.312
|
Facility
|
OP
|
$3,488.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508590
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$976.64 |
| Max. Negotiated Rate |
$13,952.00 |
| Rate for Payer: Aetna Commercial |
$3,139.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,999.68
|
| Rate for Payer: Aetna Managed Medicare |
$976.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,267.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,744.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,674.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,848.64
|
| Rate for Payer: Cash Price |
$1,046.40
|
| Rate for Payer: Cigna Commercial |
$3,208.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,951.88
|
| Rate for Payer: Health EOS Commercial |
$3,104.32
|
| Rate for Payer: HFN Commercial |
$3,208.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,616.00
|
| Rate for Payer: Multiplan Commercial |
$2,790.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,092.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,208.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,709.12
|
| Rate for Payer: Quartz Commercial |
$2,267.20
|
| Rate for Payer: Quartz Medicare Advantage |
$2,092.80
|
| Rate for Payer: The Alliance Commercial |
$13,952.00
|
| Rate for Payer: WEA Trust Commercial |
$1,918.40
|
| Rate for Payer: WPS Commercial |
$2,583.56
|
|
|
PLATE STRAIGHT 1.3MM 6HL 221.306
|
Facility
|
OP
|
$2,793.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508588
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$782.04 |
| Max. Negotiated Rate |
$11,172.00 |
| Rate for Payer: Aetna Commercial |
$2,513.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,401.98
|
| Rate for Payer: Aetna Managed Medicare |
$782.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,815.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,396.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,340.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,480.29
|
| Rate for Payer: Cash Price |
$837.90
|
| Rate for Payer: Cigna Commercial |
$2,569.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,562.96
|
| Rate for Payer: Health EOS Commercial |
$2,485.77
|
| Rate for Payer: HFN Commercial |
$2,569.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,094.75
|
| Rate for Payer: Multiplan Commercial |
$2,234.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,675.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,569.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,368.57
|
| Rate for Payer: Quartz Commercial |
$1,815.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,675.80
|
| Rate for Payer: The Alliance Commercial |
$11,172.00
|
| Rate for Payer: WEA Trust Commercial |
$1,536.15
|
| Rate for Payer: WPS Commercial |
$2,068.78
|
|
|
PLATE STRAIGHT 1.3MM 6HL 221.306
|
Facility
|
IP
|
$2,793.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508588
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,368.57 |
| Max. Negotiated Rate |
$2,569.56 |
| Rate for Payer: Aetna Commercial |
$2,513.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,401.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,480.29
|
| Rate for Payer: Cash Price |
$837.90
|
| Rate for Payer: Cigna Commercial |
$2,569.56
|
| Rate for Payer: Health EOS Commercial |
$2,485.77
|
| Rate for Payer: HFN Commercial |
$2,569.56
|
| Rate for Payer: Multiplan Commercial |
$2,234.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,675.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,569.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,368.57
|
| Rate for Payer: Quartz Commercial |
$1,675.80
|
| Rate for Payer: WEA Trust Commercial |
$1,536.15
|
| Rate for Payer: WPS Commercial |
$2,068.78
|
|
|
PLATE STRAIGHT 2.4MM 12HL 249.912
|
Facility
|
IP
|
$4,683.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508772
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,294.67 |
| Max. Negotiated Rate |
$4,308.36 |
| Rate for Payer: Aetna Commercial |
$4,214.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,027.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,481.99
|
| Rate for Payer: Cash Price |
$1,404.90
|
| Rate for Payer: Cigna Commercial |
$4,308.36
|
| Rate for Payer: Health EOS Commercial |
$4,167.87
|
| Rate for Payer: HFN Commercial |
$4,308.36
|
| Rate for Payer: Multiplan Commercial |
$3,746.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,809.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,308.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,294.67
|
| Rate for Payer: Quartz Commercial |
$2,809.80
|
| Rate for Payer: WEA Trust Commercial |
$2,575.65
|
| Rate for Payer: WPS Commercial |
$3,468.70
|
|
|
PLATE STRAIGHT 2.4MM 12HL 249.912
|
Facility
|
OP
|
$4,683.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508772
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,311.24 |
| Max. Negotiated Rate |
$18,732.00 |
| Rate for Payer: Aetna Commercial |
$4,214.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,027.38
|
| Rate for Payer: Aetna Managed Medicare |
$1,311.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,043.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,341.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,247.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,481.99
|
| Rate for Payer: Cash Price |
$1,404.90
|
| Rate for Payer: Cigna Commercial |
$4,308.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,620.61
|
| Rate for Payer: Health EOS Commercial |
$4,167.87
|
| Rate for Payer: HFN Commercial |
$4,308.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,512.25
|
| Rate for Payer: Multiplan Commercial |
$3,746.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,809.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,308.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,294.67
|
| Rate for Payer: Quartz Commercial |
$3,043.95
|
| Rate for Payer: Quartz Medicare Advantage |
$2,809.80
|
| Rate for Payer: The Alliance Commercial |
$18,732.00
|
| Rate for Payer: WEA Trust Commercial |
$2,575.65
|
| Rate for Payer: WPS Commercial |
$3,468.70
|
|
|
PLATE STRAIGHT 2.4MM 6HL 249.906
|
Facility
|
IP
|
$3,976.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508771
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,948.24 |
| Max. Negotiated Rate |
$3,657.92 |
| Rate for Payer: Aetna Commercial |
$3,578.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,419.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,107.28
|
| Rate for Payer: Cash Price |
$1,192.80
|
| Rate for Payer: Cigna Commercial |
$3,657.92
|
| Rate for Payer: Health EOS Commercial |
$3,538.64
|
| Rate for Payer: HFN Commercial |
$3,657.92
|
| Rate for Payer: Multiplan Commercial |
$3,180.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,385.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,657.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,948.24
|
| Rate for Payer: Quartz Commercial |
$2,385.60
|
| Rate for Payer: WEA Trust Commercial |
$2,186.80
|
| Rate for Payer: WPS Commercial |
$2,945.02
|
|
|
PLATE STRAIGHT 2.4MM 6HL 249.906
|
Facility
|
OP
|
$3,976.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508771
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,113.28 |
| Max. Negotiated Rate |
$15,904.00 |
| Rate for Payer: Aetna Commercial |
$3,578.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,419.36
|
| Rate for Payer: Aetna Managed Medicare |
$1,113.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,584.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,988.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,908.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,107.28
|
| Rate for Payer: Cash Price |
$1,192.80
|
| Rate for Payer: Cigna Commercial |
$3,657.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,224.97
|
| Rate for Payer: Health EOS Commercial |
$3,538.64
|
| Rate for Payer: HFN Commercial |
$3,657.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,982.00
|
| Rate for Payer: Multiplan Commercial |
$3,180.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,385.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,657.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,948.24
|
| Rate for Payer: Quartz Commercial |
$2,584.40
|
| Rate for Payer: Quartz Medicare Advantage |
$2,385.60
|
| Rate for Payer: The Alliance Commercial |
$15,904.00
|
| Rate for Payer: WEA Trust Commercial |
$2,186.80
|
| Rate for Payer: WPS Commercial |
$2,945.02
|
|
|
PLATE STRAIGHT 4HL BIOMET 73-2636
|
Facility
|
OP
|
$4,160.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4206003
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,164.80 |
| Max. Negotiated Rate |
$16,640.00 |
| Rate for Payer: Aetna Commercial |
$3,744.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,577.60
|
| Rate for Payer: Aetna Managed Medicare |
$1,164.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,704.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,080.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,996.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,204.80
|
| Rate for Payer: Cash Price |
$1,248.00
|
| Rate for Payer: Cigna Commercial |
$3,827.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,327.94
|
| Rate for Payer: Health EOS Commercial |
$3,702.40
|
| Rate for Payer: HFN Commercial |
$3,827.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,120.00
|
| Rate for Payer: Multiplan Commercial |
$3,328.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,496.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,827.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,038.40
|
| Rate for Payer: Quartz Commercial |
$2,704.00
|
| Rate for Payer: Quartz Medicare Advantage |
$2,496.00
|
| Rate for Payer: The Alliance Commercial |
$16,640.00
|
| Rate for Payer: WEA Trust Commercial |
$2,288.00
|
| Rate for Payer: WPS Commercial |
$3,081.31
|
|
|
PLATE STRAIGHT 4HL BIOMET 73-2636
|
Facility
|
IP
|
$4,160.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4206003
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,038.40 |
| Max. Negotiated Rate |
$3,827.20 |
| Rate for Payer: Aetna Commercial |
$3,744.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,577.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,204.80
|
| Rate for Payer: Cash Price |
$1,248.00
|
| Rate for Payer: Cigna Commercial |
$3,827.20
|
| Rate for Payer: Health EOS Commercial |
$3,702.40
|
| Rate for Payer: HFN Commercial |
$3,827.20
|
| Rate for Payer: Multiplan Commercial |
$3,328.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,496.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,827.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,038.40
|
| Rate for Payer: Quartz Commercial |
$2,496.00
|
| Rate for Payer: WEA Trust Commercial |
$2,288.00
|
| Rate for Payer: WPS Commercial |
$3,081.31
|
|
|
PLATE STRIGHT 8 HOLE RIBFIX BLUE 76-2601
|
Facility
|
IP
|
$6,857.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5563317
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,359.93 |
| Max. Negotiated Rate |
$6,308.44 |
| Rate for Payer: Aetna Commercial |
$6,171.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,897.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,634.21
|
| Rate for Payer: Cash Price |
$2,057.10
|
| Rate for Payer: Cigna Commercial |
$6,308.44
|
| Rate for Payer: Health EOS Commercial |
$6,102.73
|
| Rate for Payer: HFN Commercial |
$6,308.44
|
| Rate for Payer: Multiplan Commercial |
$5,485.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,114.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,308.44
|
| Rate for Payer: Quartz Beloit One Network |
$3,359.93
|
| Rate for Payer: Quartz Commercial |
$4,114.20
|
| Rate for Payer: WEA Trust Commercial |
$3,771.35
|
| Rate for Payer: WPS Commercial |
$5,078.98
|
|
|
PLATE STRIGHT 8 HOLE RIBFIX BLUE 76-2601
|
Facility
|
OP
|
$6,857.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5563317
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,919.96 |
| Max. Negotiated Rate |
$27,428.00 |
| Rate for Payer: Aetna Commercial |
$6,171.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,897.02
|
| Rate for Payer: Aetna Managed Medicare |
$1,919.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,457.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,428.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,291.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,634.21
|
| Rate for Payer: Cash Price |
$2,057.10
|
| Rate for Payer: Cigna Commercial |
$6,308.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,837.18
|
| Rate for Payer: Health EOS Commercial |
$6,102.73
|
| Rate for Payer: HFN Commercial |
$6,308.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,142.75
|
| Rate for Payer: Multiplan Commercial |
$5,485.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,114.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,308.44
|
| Rate for Payer: Quartz Beloit One Network |
$3,359.93
|
| Rate for Payer: Quartz Commercial |
$4,457.05
|
| Rate for Payer: Quartz Medicare Advantage |
$4,114.20
|
| Rate for Payer: The Alliance Commercial |
$27,428.00
|
| Rate for Payer: WEA Trust Commercial |
$3,771.35
|
| Rate for Payer: WPS Commercial |
$5,078.98
|
|
|
PLATE SUPERIOR LATERAL 4 HL RT 628224
|
Facility
|
OP
|
$5,232.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6167819
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,464.96 |
| Max. Negotiated Rate |
$20,928.00 |
| Rate for Payer: Aetna Commercial |
$4,708.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,499.52
|
| Rate for Payer: Aetna Managed Medicare |
$1,464.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,400.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,616.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,511.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,772.96
|
| Rate for Payer: Cash Price |
$1,569.60
|
| Rate for Payer: Cigna Commercial |
$4,813.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,927.83
|
| Rate for Payer: Health EOS Commercial |
$4,656.48
|
| Rate for Payer: HFN Commercial |
$4,813.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,924.00
|
| Rate for Payer: Multiplan Commercial |
$4,185.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,139.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,813.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,563.68
|
| Rate for Payer: Quartz Commercial |
$3,400.80
|
| Rate for Payer: Quartz Medicare Advantage |
$3,139.20
|
| Rate for Payer: The Alliance Commercial |
$20,928.00
|
| Rate for Payer: WEA Trust Commercial |
$2,877.60
|
| Rate for Payer: WPS Commercial |
$3,875.34
|
|
|
PLATE SUPERIOR LATERAL 4 HL RT 628224
|
Facility
|
IP
|
$5,232.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6167819
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,563.68 |
| Max. Negotiated Rate |
$4,813.44 |
| Rate for Payer: Aetna Commercial |
$4,708.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,499.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,772.96
|
| Rate for Payer: Cash Price |
$1,569.60
|
| Rate for Payer: Cigna Commercial |
$4,813.44
|
| Rate for Payer: Health EOS Commercial |
$4,656.48
|
| Rate for Payer: HFN Commercial |
$4,813.44
|
| Rate for Payer: Multiplan Commercial |
$4,185.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,139.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,813.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,563.68
|
| Rate for Payer: Quartz Commercial |
$3,139.20
|
| Rate for Payer: WEA Trust Commercial |
$2,877.60
|
| Rate for Payer: WPS Commercial |
$3,875.34
|
|
|
PLATE TACK CLAW II 40250010
|
Facility
|
OP
|
$2,113.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6171776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$591.64 |
| Max. Negotiated Rate |
$8,452.00 |
| Rate for Payer: Aetna Commercial |
$1,901.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,817.18
|
| Rate for Payer: Aetna Managed Medicare |
$591.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,373.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,056.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,014.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,119.89
|
| Rate for Payer: Cash Price |
$633.90
|
| Rate for Payer: Cigna Commercial |
$1,943.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,182.43
|
| Rate for Payer: Health EOS Commercial |
$1,880.57
|
| Rate for Payer: HFN Commercial |
$1,943.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,584.75
|
| Rate for Payer: Multiplan Commercial |
$1,690.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,267.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,943.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,035.37
|
| Rate for Payer: Quartz Commercial |
$1,373.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,267.80
|
| Rate for Payer: The Alliance Commercial |
$8,452.00
|
| Rate for Payer: WEA Trust Commercial |
$1,162.15
|
| Rate for Payer: WPS Commercial |
$1,565.10
|
|
|
PLATE TACK CLAW II 40250010
|
Facility
|
IP
|
$2,113.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6171776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,035.37 |
| Max. Negotiated Rate |
$1,943.96 |
| Rate for Payer: Aetna Commercial |
$1,901.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,817.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,119.89
|
| Rate for Payer: Cash Price |
$633.90
|
| Rate for Payer: Cigna Commercial |
$1,943.96
|
| Rate for Payer: Health EOS Commercial |
$1,880.57
|
| Rate for Payer: HFN Commercial |
$1,943.96
|
| Rate for Payer: Multiplan Commercial |
$1,690.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,267.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,943.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,035.37
|
| Rate for Payer: Quartz Commercial |
$1,267.80
|
| Rate for Payer: WEA Trust Commercial |
$1,162.15
|
| Rate for Payer: WPS Commercial |
$1,565.10
|
|
|
PLATE TALO-NAVICULAR TN 6HL SHORT 626761
|
Facility
|
OP
|
$5,160.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5831687
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.80 |
| Max. Negotiated Rate |
$20,640.00 |
| Rate for Payer: Aetna Commercial |
$4,644.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,437.60
|
| Rate for Payer: Aetna Managed Medicare |
$1,444.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,354.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,580.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,476.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,734.80
|
| Rate for Payer: Cash Price |
$1,548.00
|
| Rate for Payer: Cigna Commercial |
$4,747.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,887.54
|
| Rate for Payer: Health EOS Commercial |
$4,592.40
|
| Rate for Payer: HFN Commercial |
$4,747.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,870.00
|
| Rate for Payer: Multiplan Commercial |
$4,128.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,096.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,747.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,528.40
|
| Rate for Payer: Quartz Commercial |
$3,354.00
|
| Rate for Payer: Quartz Medicare Advantage |
$3,096.00
|
| Rate for Payer: The Alliance Commercial |
$20,640.00
|
| Rate for Payer: WEA Trust Commercial |
$2,838.00
|
| Rate for Payer: WPS Commercial |
$3,822.01
|
|
|
PLATE TALO-NAVICULAR TN 6HL SHORT 626761
|
Facility
|
IP
|
$5,160.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5831687
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,528.40 |
| Max. Negotiated Rate |
$4,747.20 |
| Rate for Payer: Aetna Commercial |
$4,644.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,437.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,734.80
|
| Rate for Payer: Cash Price |
$1,548.00
|
| Rate for Payer: Cigna Commercial |
$4,747.20
|
| Rate for Payer: Health EOS Commercial |
$4,592.40
|
| Rate for Payer: HFN Commercial |
$4,747.20
|
| Rate for Payer: Multiplan Commercial |
$4,128.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,096.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,747.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,528.40
|
| Rate for Payer: Quartz Commercial |
$3,096.00
|
| Rate for Payer: WEA Trust Commercial |
$2,838.00
|
| Rate for Payer: WPS Commercial |
$3,822.01
|
|
|
PLATE T DISTAL TIBIA 2.7MM 4 HL 02.118.306S
|
Facility
|
IP
|
$6,317.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5178929
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,095.33 |
| Max. Negotiated Rate |
$5,811.64 |
| Rate for Payer: Aetna Commercial |
$5,685.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,432.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,348.01
|
| Rate for Payer: Cash Price |
$1,895.10
|
| Rate for Payer: Cigna Commercial |
$5,811.64
|
| Rate for Payer: Health EOS Commercial |
$5,622.13
|
| Rate for Payer: HFN Commercial |
$5,811.64
|
| Rate for Payer: Multiplan Commercial |
$5,053.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,790.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,811.64
|
| Rate for Payer: Quartz Beloit One Network |
$3,095.33
|
| Rate for Payer: Quartz Commercial |
$3,790.20
|
| Rate for Payer: WEA Trust Commercial |
$3,474.35
|
| Rate for Payer: WPS Commercial |
$4,679.00
|
|
|
PLATE T DISTAL TIBIA 2.7MM 4 HL 02.118.306S
|
Facility
|
OP
|
$6,317.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5178929
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,768.76 |
| Max. Negotiated Rate |
$25,268.00 |
| Rate for Payer: Aetna Commercial |
$5,685.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,432.62
|
| Rate for Payer: Aetna Managed Medicare |
$1,768.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,106.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,158.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,032.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,348.01
|
| Rate for Payer: Cash Price |
$1,895.10
|
| Rate for Payer: Cigna Commercial |
$5,811.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,534.99
|
| Rate for Payer: Health EOS Commercial |
$5,622.13
|
| Rate for Payer: HFN Commercial |
$5,811.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,737.75
|
| Rate for Payer: Multiplan Commercial |
$5,053.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,790.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,811.64
|
| Rate for Payer: Quartz Beloit One Network |
$3,095.33
|
| Rate for Payer: Quartz Commercial |
$4,106.05
|
| Rate for Payer: Quartz Medicare Advantage |
$3,790.20
|
| Rate for Payer: The Alliance Commercial |
$25,268.00
|
| Rate for Payer: WEA Trust Commercial |
$3,474.35
|
| Rate for Payer: WPS Commercial |
$4,679.00
|
|
|
PLATE T-FUSION 2.4/2.7 02.211.253
|
Facility
|
IP
|
$8,260.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966379
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,047.40 |
| Max. Negotiated Rate |
$7,599.20 |
| Rate for Payer: Aetna Commercial |
$7,434.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,103.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,377.80
|
| Rate for Payer: Cash Price |
$2,478.00
|
| Rate for Payer: Cigna Commercial |
$7,599.20
|
| Rate for Payer: Health EOS Commercial |
$7,351.40
|
| Rate for Payer: HFN Commercial |
$7,599.20
|
| Rate for Payer: Multiplan Commercial |
$6,608.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,956.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,599.20
|
| Rate for Payer: Quartz Beloit One Network |
$4,047.40
|
| Rate for Payer: Quartz Commercial |
$4,956.00
|
| Rate for Payer: WEA Trust Commercial |
$4,543.00
|
| Rate for Payer: WPS Commercial |
$6,118.18
|
|
