|
PLATE TIBIA 3.5MM LCP POST/MEDIAL/PROX 1HL 02.120.701
|
Facility
|
OP
|
$6,419.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6173129
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,869.21 |
| Max. Negotiated Rate |
$6,141.70 |
| Rate for Payer: Aetna Commercial |
$6,008.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,741.15
|
| Rate for Payer: Aetna Managed Medicare |
$1,869.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,339.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,337.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,204.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,538.15
|
| Rate for Payer: Cash Price |
$1,925.70
|
| Rate for Payer: Cigna Commercial |
$6,141.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,735.86
|
| Rate for Payer: Health EOS Commercial |
$5,941.43
|
| Rate for Payer: HFN Commercial |
$6,141.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,006.82
|
| Rate for Payer: Multiplan Commercial |
$5,340.61
|
| Rate for Payer: NAPHCARE Commercial |
$4,005.46
|
| Rate for Payer: Preferred Network Access Commercial |
$6,141.70
|
| Rate for Payer: Quartz Beloit One Network |
$3,271.12
|
| Rate for Payer: Quartz Commercial |
$4,339.24
|
| Rate for Payer: Quartz Medicare Advantage |
$4,005.46
|
| Rate for Payer: The Alliance Commercial |
$3,337.88
|
| Rate for Payer: WEA Trust Commercial |
$3,671.67
|
| Rate for Payer: WPS Commercial |
$4,944.56
|
|
|
PLATE TIBIAL MIS NEXGEN SZ 3 5950-37-01
|
Facility
|
OP
|
$7,868.00
|
|
| Hospital Charge Code |
2967776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,291.16 |
| Max. Negotiated Rate |
$7,528.10 |
| Rate for Payer: Multiplan Commercial |
$6,546.18
|
| Rate for Payer: Aetna Commercial |
$7,364.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,037.14
|
| Rate for Payer: Aetna Managed Medicare |
$2,291.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,318.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,091.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,927.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,336.84
|
| Rate for Payer: Cash Price |
$2,360.40
|
| Rate for Payer: Cigna Commercial |
$7,528.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,579.18
|
| Rate for Payer: Health EOS Commercial |
$7,282.62
|
| Rate for Payer: HFN Commercial |
$7,528.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,137.04
|
| Rate for Payer: NAPHCARE Commercial |
$4,909.63
|
| Rate for Payer: Preferred Network Access Commercial |
$7,528.10
|
| Rate for Payer: Quartz Beloit One Network |
$4,009.53
|
| Rate for Payer: Quartz Commercial |
$5,318.77
|
| Rate for Payer: Quartz Medicare Advantage |
$4,909.63
|
| Rate for Payer: The Alliance Commercial |
$4,091.36
|
| Rate for Payer: WEA Trust Commercial |
$4,500.50
|
| Rate for Payer: WPS Commercial |
$6,060.72
|
|
|
PLATE TIBIAL MIS NEXGEN SZ 3 5950-37-01
|
Facility
|
IP
|
$7,868.00
|
|
| Hospital Charge Code |
2967776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,009.53 |
| Max. Negotiated Rate |
$7,528.10 |
| Rate for Payer: Aetna Commercial |
$7,364.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,037.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,336.84
|
| Rate for Payer: Cash Price |
$2,360.40
|
| Rate for Payer: Cigna Commercial |
$7,528.10
|
| Rate for Payer: Health EOS Commercial |
$7,282.62
|
| Rate for Payer: HFN Commercial |
$7,528.10
|
| Rate for Payer: Multiplan Commercial |
$6,546.18
|
| Rate for Payer: Preferred Network Access Commercial |
$7,528.10
|
| Rate for Payer: Quartz Beloit One Network |
$4,009.53
|
| Rate for Payer: Quartz Commercial |
$4,909.63
|
| Rate for Payer: WEA Trust Commercial |
$4,500.50
|
| Rate for Payer: WPS Commercial |
$6,060.72
|
|
|
PLATE TIBIAL MIS NEXGEN SZ 4 5950-037-02
|
Facility
|
OP
|
$7,868.00
|
|
| Hospital Charge Code |
2967777
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,291.16 |
| Max. Negotiated Rate |
$7,528.10 |
| Rate for Payer: Aetna Commercial |
$7,364.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,037.14
|
| Rate for Payer: Aetna Managed Medicare |
$2,291.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,318.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,091.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,927.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,336.84
|
| Rate for Payer: Cash Price |
$2,360.40
|
| Rate for Payer: Cigna Commercial |
$7,528.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,579.18
|
| Rate for Payer: Health EOS Commercial |
$7,282.62
|
| Rate for Payer: HFN Commercial |
$7,528.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,137.04
|
| Rate for Payer: Multiplan Commercial |
$6,546.18
|
| Rate for Payer: NAPHCARE Commercial |
$4,909.63
|
| Rate for Payer: Preferred Network Access Commercial |
$7,528.10
|
| Rate for Payer: Quartz Beloit One Network |
$4,009.53
|
| Rate for Payer: Quartz Commercial |
$5,318.77
|
| Rate for Payer: Quartz Medicare Advantage |
$4,909.63
|
| Rate for Payer: The Alliance Commercial |
$4,091.36
|
| Rate for Payer: WEA Trust Commercial |
$4,500.50
|
| Rate for Payer: WPS Commercial |
$6,060.72
|
|
|
PLATE TIBIAL MIS NEXGEN SZ 4 5950-037-02
|
Facility
|
IP
|
$7,868.00
|
|
| Hospital Charge Code |
2967777
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,009.53 |
| Max. Negotiated Rate |
$7,528.10 |
| Rate for Payer: Aetna Commercial |
$7,364.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,037.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,336.84
|
| Rate for Payer: Cash Price |
$2,360.40
|
| Rate for Payer: Cigna Commercial |
$7,528.10
|
| Rate for Payer: Health EOS Commercial |
$7,282.62
|
| Rate for Payer: HFN Commercial |
$7,528.10
|
| Rate for Payer: Multiplan Commercial |
$6,546.18
|
| Rate for Payer: Preferred Network Access Commercial |
$7,528.10
|
| Rate for Payer: Quartz Beloit One Network |
$4,009.53
|
| Rate for Payer: Quartz Commercial |
$4,909.63
|
| Rate for Payer: WEA Trust Commercial |
$4,500.50
|
| Rate for Payer: WPS Commercial |
$6,060.72
|
|
|
PLATE TIBIAL MIS NEXGEN SZ 5 5950-47-01
|
Facility
|
OP
|
$7,868.00
|
|
| Hospital Charge Code |
2967778
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,291.16 |
| Max. Negotiated Rate |
$7,528.10 |
| Rate for Payer: Aetna Commercial |
$7,364.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,037.14
|
| Rate for Payer: Aetna Managed Medicare |
$2,291.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,318.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,091.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,927.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,336.84
|
| Rate for Payer: Cash Price |
$2,360.40
|
| Rate for Payer: Cigna Commercial |
$7,528.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,579.18
|
| Rate for Payer: Health EOS Commercial |
$7,282.62
|
| Rate for Payer: HFN Commercial |
$7,528.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,137.04
|
| Rate for Payer: Multiplan Commercial |
$6,546.18
|
| Rate for Payer: NAPHCARE Commercial |
$4,909.63
|
| Rate for Payer: Preferred Network Access Commercial |
$7,528.10
|
| Rate for Payer: Quartz Beloit One Network |
$4,009.53
|
| Rate for Payer: Quartz Commercial |
$5,318.77
|
| Rate for Payer: Quartz Medicare Advantage |
$4,909.63
|
| Rate for Payer: The Alliance Commercial |
$4,091.36
|
| Rate for Payer: WEA Trust Commercial |
$4,500.50
|
| Rate for Payer: WPS Commercial |
$6,060.72
|
|
|
PLATE TIBIAL MIS NEXGEN SZ 5 5950-47-01
|
Facility
|
IP
|
$7,868.00
|
|
| Hospital Charge Code |
2967778
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,009.53 |
| Max. Negotiated Rate |
$7,528.10 |
| Rate for Payer: Aetna Commercial |
$7,364.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,037.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,336.84
|
| Rate for Payer: Cash Price |
$2,360.40
|
| Rate for Payer: Cigna Commercial |
$7,528.10
|
| Rate for Payer: Health EOS Commercial |
$7,282.62
|
| Rate for Payer: HFN Commercial |
$7,528.10
|
| Rate for Payer: Multiplan Commercial |
$6,546.18
|
| Rate for Payer: Preferred Network Access Commercial |
$7,528.10
|
| Rate for Payer: Quartz Beloit One Network |
$4,009.53
|
| Rate for Payer: Quartz Commercial |
$4,909.63
|
| Rate for Payer: WEA Trust Commercial |
$4,500.50
|
| Rate for Payer: WPS Commercial |
$6,060.72
|
|
|
PLATE TIBIAL MIS NEXGEN SZ 6 5950-47-02
|
Facility
|
OP
|
$7,868.00
|
|
| Hospital Charge Code |
2967779
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,291.16 |
| Max. Negotiated Rate |
$7,528.10 |
| Rate for Payer: Aetna Commercial |
$7,364.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,037.14
|
| Rate for Payer: Aetna Managed Medicare |
$2,291.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,318.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,091.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,927.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,336.84
|
| Rate for Payer: Cash Price |
$2,360.40
|
| Rate for Payer: Cigna Commercial |
$7,528.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,579.18
|
| Rate for Payer: Health EOS Commercial |
$7,282.62
|
| Rate for Payer: HFN Commercial |
$7,528.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,137.04
|
| Rate for Payer: Multiplan Commercial |
$6,546.18
|
| Rate for Payer: NAPHCARE Commercial |
$4,909.63
|
| Rate for Payer: Preferred Network Access Commercial |
$7,528.10
|
| Rate for Payer: Quartz Beloit One Network |
$4,009.53
|
| Rate for Payer: Quartz Commercial |
$5,318.77
|
| Rate for Payer: Quartz Medicare Advantage |
$4,909.63
|
| Rate for Payer: The Alliance Commercial |
$4,091.36
|
| Rate for Payer: WEA Trust Commercial |
$4,500.50
|
| Rate for Payer: WPS Commercial |
$6,060.72
|
|
|
PLATE TIBIAL MIS NEXGEN SZ 6 5950-47-02
|
Facility
|
IP
|
$7,868.00
|
|
| Hospital Charge Code |
2967779
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,009.53 |
| Max. Negotiated Rate |
$7,528.10 |
| Rate for Payer: Aetna Commercial |
$7,364.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,037.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,336.84
|
| Rate for Payer: Cash Price |
$2,360.40
|
| Rate for Payer: Cigna Commercial |
$7,528.10
|
| Rate for Payer: Health EOS Commercial |
$7,282.62
|
| Rate for Payer: HFN Commercial |
$7,528.10
|
| Rate for Payer: Multiplan Commercial |
$6,546.18
|
| Rate for Payer: Preferred Network Access Commercial |
$7,528.10
|
| Rate for Payer: Quartz Beloit One Network |
$4,009.53
|
| Rate for Payer: Quartz Commercial |
$4,909.63
|
| Rate for Payer: WEA Trust Commercial |
$4,500.50
|
| Rate for Payer: WPS Commercial |
$6,060.72
|
|
|
PLATE TIBIAL MIS NEXGEN SZ 7 5950-57-01
|
Facility
|
IP
|
$7,868.00
|
|
| Hospital Charge Code |
2967780
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,009.53 |
| Max. Negotiated Rate |
$7,528.10 |
| Rate for Payer: Aetna Commercial |
$7,364.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,037.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,336.84
|
| Rate for Payer: Cash Price |
$2,360.40
|
| Rate for Payer: Cigna Commercial |
$7,528.10
|
| Rate for Payer: Health EOS Commercial |
$7,282.62
|
| Rate for Payer: HFN Commercial |
$7,528.10
|
| Rate for Payer: Multiplan Commercial |
$6,546.18
|
| Rate for Payer: Preferred Network Access Commercial |
$7,528.10
|
| Rate for Payer: Quartz Beloit One Network |
$4,009.53
|
| Rate for Payer: Quartz Commercial |
$4,909.63
|
| Rate for Payer: WEA Trust Commercial |
$4,500.50
|
| Rate for Payer: WPS Commercial |
$6,060.72
|
|
|
PLATE TIBIAL MIS NEXGEN SZ 7 5950-57-01
|
Facility
|
OP
|
$7,868.00
|
|
| Hospital Charge Code |
2967780
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,291.16 |
| Max. Negotiated Rate |
$7,528.10 |
| Rate for Payer: Aetna Commercial |
$7,364.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,037.14
|
| Rate for Payer: Aetna Managed Medicare |
$2,291.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,318.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,091.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,927.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,336.84
|
| Rate for Payer: Cash Price |
$2,360.40
|
| Rate for Payer: Cigna Commercial |
$7,528.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,579.18
|
| Rate for Payer: Health EOS Commercial |
$7,282.62
|
| Rate for Payer: HFN Commercial |
$7,528.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,137.04
|
| Rate for Payer: Multiplan Commercial |
$6,546.18
|
| Rate for Payer: NAPHCARE Commercial |
$4,909.63
|
| Rate for Payer: Preferred Network Access Commercial |
$7,528.10
|
| Rate for Payer: Quartz Beloit One Network |
$4,009.53
|
| Rate for Payer: Quartz Commercial |
$5,318.77
|
| Rate for Payer: Quartz Medicare Advantage |
$4,909.63
|
| Rate for Payer: The Alliance Commercial |
$4,091.36
|
| Rate for Payer: WEA Trust Commercial |
$4,500.50
|
| Rate for Payer: WPS Commercial |
$6,060.72
|
|
|
PLATE TIBIAL MIS NEXGEN SZ 8 5950-57-02
|
Facility
|
OP
|
$7,868.00
|
|
| Hospital Charge Code |
2967781
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,291.16 |
| Max. Negotiated Rate |
$7,528.10 |
| Rate for Payer: Aetna Commercial |
$7,364.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,037.14
|
| Rate for Payer: Aetna Managed Medicare |
$2,291.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,318.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,091.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,927.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,336.84
|
| Rate for Payer: Cash Price |
$2,360.40
|
| Rate for Payer: Cigna Commercial |
$7,528.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,579.18
|
| Rate for Payer: Health EOS Commercial |
$7,282.62
|
| Rate for Payer: HFN Commercial |
$7,528.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,137.04
|
| Rate for Payer: Multiplan Commercial |
$6,546.18
|
| Rate for Payer: NAPHCARE Commercial |
$4,909.63
|
| Rate for Payer: Preferred Network Access Commercial |
$7,528.10
|
| Rate for Payer: Quartz Beloit One Network |
$4,009.53
|
| Rate for Payer: Quartz Commercial |
$5,318.77
|
| Rate for Payer: Quartz Medicare Advantage |
$4,909.63
|
| Rate for Payer: The Alliance Commercial |
$4,091.36
|
| Rate for Payer: WEA Trust Commercial |
$4,500.50
|
| Rate for Payer: WPS Commercial |
$6,060.72
|
|
|
PLATE TIBIAL MIS NEXGEN SZ 8 5950-57-02
|
Facility
|
IP
|
$7,868.00
|
|
| Hospital Charge Code |
2967781
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,009.53 |
| Max. Negotiated Rate |
$7,528.10 |
| Rate for Payer: Aetna Commercial |
$7,364.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,037.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,336.84
|
| Rate for Payer: Cash Price |
$2,360.40
|
| Rate for Payer: Cigna Commercial |
$7,528.10
|
| Rate for Payer: Health EOS Commercial |
$7,282.62
|
| Rate for Payer: HFN Commercial |
$7,528.10
|
| Rate for Payer: Multiplan Commercial |
$6,546.18
|
| Rate for Payer: Preferred Network Access Commercial |
$7,528.10
|
| Rate for Payer: Quartz Beloit One Network |
$4,009.53
|
| Rate for Payer: Quartz Commercial |
$4,909.63
|
| Rate for Payer: WEA Trust Commercial |
$4,500.50
|
| Rate for Payer: WPS Commercial |
$6,060.72
|
|
|
PLATE TWO HOLE SS AR-8958-01S
|
Facility
|
IP
|
$6,463.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414794
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,293.54 |
| Max. Negotiated Rate |
$6,183.80 |
| Rate for Payer: Aetna Commercial |
$6,049.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,780.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,562.41
|
| Rate for Payer: Cash Price |
$1,938.90
|
| Rate for Payer: Cigna Commercial |
$6,183.80
|
| Rate for Payer: Health EOS Commercial |
$5,982.15
|
| Rate for Payer: HFN Commercial |
$6,183.80
|
| Rate for Payer: Multiplan Commercial |
$5,377.22
|
| Rate for Payer: Preferred Network Access Commercial |
$6,183.80
|
| Rate for Payer: Quartz Beloit One Network |
$3,293.54
|
| Rate for Payer: Quartz Commercial |
$4,032.91
|
| Rate for Payer: WEA Trust Commercial |
$3,696.84
|
| Rate for Payer: WPS Commercial |
$4,978.45
|
|
|
PLATE TWO HOLE SS AR-8958-01S
|
Facility
|
OP
|
$6,463.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414794
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,882.03 |
| Max. Negotiated Rate |
$6,183.80 |
| Rate for Payer: Aetna Commercial |
$6,049.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,780.51
|
| Rate for Payer: Aetna Managed Medicare |
$1,882.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,368.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,360.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,226.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,562.41
|
| Rate for Payer: Cash Price |
$1,938.90
|
| Rate for Payer: Cigna Commercial |
$6,183.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,761.47
|
| Rate for Payer: Health EOS Commercial |
$5,982.15
|
| Rate for Payer: HFN Commercial |
$6,183.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,041.14
|
| Rate for Payer: Multiplan Commercial |
$5,377.22
|
| Rate for Payer: NAPHCARE Commercial |
$4,032.91
|
| Rate for Payer: Preferred Network Access Commercial |
$6,183.80
|
| Rate for Payer: Quartz Beloit One Network |
$3,293.54
|
| Rate for Payer: Quartz Commercial |
$4,368.99
|
| Rate for Payer: Quartz Medicare Advantage |
$4,032.91
|
| Rate for Payer: The Alliance Commercial |
$3,360.76
|
| Rate for Payer: WEA Trust Commercial |
$3,696.84
|
| Rate for Payer: WPS Commercial |
$4,978.45
|
|
|
PLATE ULNA OSTEOTOMY 2.7MM 8 HOLE 02.111.901
|
Facility
|
OP
|
$9,974.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494346
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,904.43 |
| Max. Negotiated Rate |
$9,543.12 |
| Rate for Payer: Aetna Commercial |
$9,335.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,920.75
|
| Rate for Payer: Aetna Managed Medicare |
$2,904.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,742.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,186.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,979.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,497.67
|
| Rate for Payer: Cash Price |
$2,992.20
|
| Rate for Payer: Cigna Commercial |
$9,543.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,804.87
|
| Rate for Payer: Health EOS Commercial |
$9,231.93
|
| Rate for Payer: HFN Commercial |
$9,543.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,779.72
|
| Rate for Payer: Multiplan Commercial |
$8,298.37
|
| Rate for Payer: NAPHCARE Commercial |
$6,223.78
|
| Rate for Payer: Preferred Network Access Commercial |
$9,543.12
|
| Rate for Payer: Quartz Beloit One Network |
$5,082.75
|
| Rate for Payer: Quartz Commercial |
$6,742.42
|
| Rate for Payer: Quartz Medicare Advantage |
$6,223.78
|
| Rate for Payer: The Alliance Commercial |
$5,186.48
|
| Rate for Payer: WEA Trust Commercial |
$5,705.13
|
| Rate for Payer: WPS Commercial |
$7,682.97
|
|
|
PLATE ULNA OSTEOTOMY 2.7MM 8 HOLE 02.111.901
|
Facility
|
IP
|
$9,974.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494346
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,082.75 |
| Max. Negotiated Rate |
$9,543.12 |
| Rate for Payer: Aetna Commercial |
$9,335.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,920.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,497.67
|
| Rate for Payer: Cash Price |
$2,992.20
|
| Rate for Payer: Cigna Commercial |
$9,543.12
|
| Rate for Payer: Health EOS Commercial |
$9,231.93
|
| Rate for Payer: HFN Commercial |
$9,543.12
|
| Rate for Payer: Multiplan Commercial |
$8,298.37
|
| Rate for Payer: Preferred Network Access Commercial |
$9,543.12
|
| Rate for Payer: Quartz Beloit One Network |
$5,082.75
|
| Rate for Payer: Quartz Commercial |
$6,223.78
|
| Rate for Payer: WEA Trust Commercial |
$5,705.13
|
| Rate for Payer: WPS Commercial |
$7,682.97
|
|
|
PLATE UNIVERSAL CROSSPLATE 5HL 626895
|
Facility
|
OP
|
$12,721.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5787771
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,704.36 |
| Max. Negotiated Rate |
$12,171.45 |
| Rate for Payer: Aetna Commercial |
$11,906.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,377.66
|
| Rate for Payer: Aetna Managed Medicare |
$3,704.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,599.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,614.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,350.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,011.82
|
| Rate for Payer: Cash Price |
$3,816.30
|
| Rate for Payer: Cigna Commercial |
$12,171.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,403.62
|
| Rate for Payer: Health EOS Commercial |
$11,774.56
|
| Rate for Payer: HFN Commercial |
$12,171.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,922.38
|
| Rate for Payer: Multiplan Commercial |
$10,583.87
|
| Rate for Payer: NAPHCARE Commercial |
$7,937.90
|
| Rate for Payer: Preferred Network Access Commercial |
$12,171.45
|
| Rate for Payer: Quartz Beloit One Network |
$6,482.62
|
| Rate for Payer: Quartz Commercial |
$8,599.40
|
| Rate for Payer: Quartz Medicare Advantage |
$7,937.90
|
| Rate for Payer: The Alliance Commercial |
$6,614.92
|
| Rate for Payer: WEA Trust Commercial |
$7,276.41
|
| Rate for Payer: WPS Commercial |
$9,798.99
|
|
|
PLATE UNIVERSAL CROSSPLATE 5HL 626895
|
Facility
|
IP
|
$12,721.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5787771
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,482.62 |
| Max. Negotiated Rate |
$12,171.45 |
| Rate for Payer: Aetna Commercial |
$11,906.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,377.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,011.82
|
| Rate for Payer: Cash Price |
$3,816.30
|
| Rate for Payer: Cigna Commercial |
$12,171.45
|
| Rate for Payer: Health EOS Commercial |
$11,774.56
|
| Rate for Payer: HFN Commercial |
$12,171.45
|
| Rate for Payer: Multiplan Commercial |
$10,583.87
|
| Rate for Payer: Preferred Network Access Commercial |
$12,171.45
|
| Rate for Payer: Quartz Beloit One Network |
$6,482.62
|
| Rate for Payer: Quartz Commercial |
$7,937.90
|
| Rate for Payer: WEA Trust Commercial |
$7,276.41
|
| Rate for Payer: WPS Commercial |
$9,798.99
|
|
|
PLATE VA-LCP 3.5MM PROX TIBIA 4H 87MM LT 02.127.311S
|
Facility
|
OP
|
$14,069.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5264864
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,096.89 |
| Max. Negotiated Rate |
$13,461.22 |
| Rate for Payer: Aetna Commercial |
$13,168.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,583.31
|
| Rate for Payer: Aetna Managed Medicare |
$4,096.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,510.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,315.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,023.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,754.83
|
| Rate for Payer: Cash Price |
$4,220.70
|
| Rate for Payer: Cigna Commercial |
$13,461.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,188.16
|
| Rate for Payer: Health EOS Commercial |
$13,022.27
|
| Rate for Payer: HFN Commercial |
$13,461.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,973.82
|
| Rate for Payer: Multiplan Commercial |
$11,705.41
|
| Rate for Payer: NAPHCARE Commercial |
$8,779.06
|
| Rate for Payer: Preferred Network Access Commercial |
$13,461.22
|
| Rate for Payer: Quartz Beloit One Network |
$7,169.56
|
| Rate for Payer: Quartz Commercial |
$9,510.64
|
| Rate for Payer: Quartz Medicare Advantage |
$8,779.06
|
| Rate for Payer: The Alliance Commercial |
$7,315.88
|
| Rate for Payer: WEA Trust Commercial |
$8,047.47
|
| Rate for Payer: WPS Commercial |
$10,837.35
|
|
|
PLATE VA-LCP 3.5MM PROX TIBIA 4H 87MM LT 02.127.311S
|
Facility
|
IP
|
$14,069.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5264864
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,169.56 |
| Max. Negotiated Rate |
$13,461.22 |
| Rate for Payer: Aetna Commercial |
$13,168.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,583.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,754.83
|
| Rate for Payer: Cash Price |
$4,220.70
|
| Rate for Payer: Cigna Commercial |
$13,461.22
|
| Rate for Payer: Health EOS Commercial |
$13,022.27
|
| Rate for Payer: HFN Commercial |
$13,461.22
|
| Rate for Payer: Multiplan Commercial |
$11,705.41
|
| Rate for Payer: Preferred Network Access Commercial |
$13,461.22
|
| Rate for Payer: Quartz Beloit One Network |
$7,169.56
|
| Rate for Payer: Quartz Commercial |
$8,779.06
|
| Rate for Payer: WEA Trust Commercial |
$8,047.47
|
| Rate for Payer: WPS Commercial |
$10,837.35
|
|
|
PLATE VALLUX COLINK P90 ST031
|
Facility
|
IP
|
$8,768.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6172084
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,468.17 |
| Max. Negotiated Rate |
$8,389.22 |
| Rate for Payer: Aetna Commercial |
$8,206.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,842.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,832.92
|
| Rate for Payer: Cash Price |
$2,630.40
|
| Rate for Payer: Cigna Commercial |
$8,389.22
|
| Rate for Payer: Health EOS Commercial |
$8,115.66
|
| Rate for Payer: HFN Commercial |
$8,389.22
|
| Rate for Payer: Multiplan Commercial |
$7,294.98
|
| Rate for Payer: Preferred Network Access Commercial |
$8,389.22
|
| Rate for Payer: Quartz Beloit One Network |
$4,468.17
|
| Rate for Payer: Quartz Commercial |
$5,471.23
|
| Rate for Payer: WEA Trust Commercial |
$5,015.30
|
| Rate for Payer: WPS Commercial |
$6,753.99
|
|
|
PLATE VALLUX COLINK P90 ST031
|
Facility
|
OP
|
$8,768.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6172084
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,553.24 |
| Max. Negotiated Rate |
$8,389.22 |
| Rate for Payer: Aetna Commercial |
$8,206.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,842.10
|
| Rate for Payer: Aetna Managed Medicare |
$2,553.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,927.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,559.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,376.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,832.92
|
| Rate for Payer: Cash Price |
$2,630.40
|
| Rate for Payer: Cigna Commercial |
$8,389.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,102.98
|
| Rate for Payer: Health EOS Commercial |
$8,115.66
|
| Rate for Payer: HFN Commercial |
$8,389.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,839.04
|
| Rate for Payer: Multiplan Commercial |
$7,294.98
|
| Rate for Payer: NAPHCARE Commercial |
$5,471.23
|
| Rate for Payer: Preferred Network Access Commercial |
$8,389.22
|
| Rate for Payer: Quartz Beloit One Network |
$4,468.17
|
| Rate for Payer: Quartz Commercial |
$5,927.17
|
| Rate for Payer: Quartz Medicare Advantage |
$5,471.23
|
| Rate for Payer: The Alliance Commercial |
$4,559.36
|
| Rate for Payer: WEA Trust Commercial |
$5,015.30
|
| Rate for Payer: WPS Commercial |
$6,753.99
|
|
|
PLATE VA OLECRANON 2.7MM/ 3.5MM LT 2HL 02.107.302S
|
Facility
|
OP
|
$7,938.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5563547
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,311.55 |
| Max. Negotiated Rate |
$7,595.08 |
| Rate for Payer: Aetna Commercial |
$7,429.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,099.75
|
| Rate for Payer: Aetna Managed Medicare |
$2,311.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,366.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,127.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,962.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,375.43
|
| Rate for Payer: Cash Price |
$2,381.40
|
| Rate for Payer: Cigna Commercial |
$7,595.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,619.92
|
| Rate for Payer: Health EOS Commercial |
$7,347.41
|
| Rate for Payer: HFN Commercial |
$7,595.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,191.64
|
| Rate for Payer: Multiplan Commercial |
$6,604.42
|
| Rate for Payer: NAPHCARE Commercial |
$4,953.31
|
| Rate for Payer: Preferred Network Access Commercial |
$7,595.08
|
| Rate for Payer: Quartz Beloit One Network |
$4,045.20
|
| Rate for Payer: Quartz Commercial |
$5,366.09
|
| Rate for Payer: Quartz Medicare Advantage |
$4,953.31
|
| Rate for Payer: The Alliance Commercial |
$4,127.76
|
| Rate for Payer: WEA Trust Commercial |
$4,540.54
|
| Rate for Payer: WPS Commercial |
$6,114.64
|
|
|
PLATE VA OLECRANON 2.7MM/ 3.5MM LT 2HL 02.107.302S
|
Facility
|
IP
|
$7,938.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5563547
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,045.20 |
| Max. Negotiated Rate |
$7,595.08 |
| Rate for Payer: Aetna Commercial |
$7,429.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,099.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,375.43
|
| Rate for Payer: Cash Price |
$2,381.40
|
| Rate for Payer: Cigna Commercial |
$7,595.08
|
| Rate for Payer: Health EOS Commercial |
$7,347.41
|
| Rate for Payer: HFN Commercial |
$7,595.08
|
| Rate for Payer: Multiplan Commercial |
$6,604.42
|
| Rate for Payer: Preferred Network Access Commercial |
$7,595.08
|
| Rate for Payer: Quartz Beloit One Network |
$4,045.20
|
| Rate for Payer: Quartz Commercial |
$4,953.31
|
| Rate for Payer: WEA Trust Commercial |
$4,540.54
|
| Rate for Payer: WPS Commercial |
$6,114.64
|
|
