|
PLATE VA OLECRANON 2.7MM/ 3.5MM LT 4HL 02.107.304S
|
Facility
|
IP
|
$4,885.67
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5248719
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,489.74 |
| Max. Negotiated Rate |
$4,674.61 |
| Rate for Payer: Aetna Commercial |
$4,572.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,369.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,692.98
|
| Rate for Payer: Cash Price |
$1,465.70
|
| Rate for Payer: Cigna Commercial |
$4,674.61
|
| Rate for Payer: Health EOS Commercial |
$4,522.18
|
| Rate for Payer: HFN Commercial |
$4,674.61
|
| Rate for Payer: Multiplan Commercial |
$4,064.88
|
| Rate for Payer: Preferred Network Access Commercial |
$4,674.61
|
| Rate for Payer: Quartz Beloit One Network |
$2,489.74
|
| Rate for Payer: Quartz Commercial |
$3,048.66
|
| Rate for Payer: WEA Trust Commercial |
$2,794.60
|
| Rate for Payer: WPS Commercial |
$3,763.43
|
|
|
PLATE VA OLECRANON 2.7MM/ 3.5MM LT 4HL 02.107.304S
|
Facility
|
OP
|
$4,885.67
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5248719
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,422.71 |
| Max. Negotiated Rate |
$4,674.61 |
| Rate for Payer: Aetna Commercial |
$4,572.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,369.74
|
| Rate for Payer: Aetna Managed Medicare |
$1,422.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,302.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,540.55
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,438.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,692.98
|
| Rate for Payer: Cash Price |
$1,465.70
|
| Rate for Payer: Cigna Commercial |
$4,674.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,843.46
|
| Rate for Payer: Health EOS Commercial |
$4,522.18
|
| Rate for Payer: HFN Commercial |
$4,674.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,810.82
|
| Rate for Payer: Multiplan Commercial |
$4,064.88
|
| Rate for Payer: NAPHCARE Commercial |
$3,048.66
|
| Rate for Payer: Preferred Network Access Commercial |
$4,674.61
|
| Rate for Payer: Quartz Beloit One Network |
$2,489.74
|
| Rate for Payer: Quartz Commercial |
$3,302.71
|
| Rate for Payer: Quartz Medicare Advantage |
$3,048.66
|
| Rate for Payer: The Alliance Commercial |
$2,540.55
|
| Rate for Payer: WEA Trust Commercial |
$2,794.60
|
| Rate for Payer: WPS Commercial |
$3,763.43
|
|
|
PLATE VA OLECRANON PROXIMAL 2.7/3.5 2HL LT 02.107.102
|
Facility
|
IP
|
$11,007.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5248648
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,609.17 |
| Max. Negotiated Rate |
$10,531.50 |
| Rate for Payer: Aetna Commercial |
$10,302.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,844.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,067.06
|
| Rate for Payer: Cash Price |
$3,302.10
|
| Rate for Payer: Cigna Commercial |
$10,531.50
|
| Rate for Payer: Health EOS Commercial |
$10,188.08
|
| Rate for Payer: HFN Commercial |
$10,531.50
|
| Rate for Payer: Multiplan Commercial |
$9,157.82
|
| Rate for Payer: Preferred Network Access Commercial |
$10,531.50
|
| Rate for Payer: Quartz Beloit One Network |
$5,609.17
|
| Rate for Payer: Quartz Commercial |
$6,868.37
|
| Rate for Payer: WEA Trust Commercial |
$6,296.00
|
| Rate for Payer: WPS Commercial |
$8,478.69
|
|
|
PLATE VA OLECRANON PROXIMAL 2.7/3.5 2HL LT 02.107.102
|
Facility
|
OP
|
$11,007.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5248648
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,205.24 |
| Max. Negotiated Rate |
$10,531.50 |
| Rate for Payer: Aetna Commercial |
$10,302.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,844.66
|
| Rate for Payer: Aetna Managed Medicare |
$3,205.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,440.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,723.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,494.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,067.06
|
| Rate for Payer: Cash Price |
$3,302.10
|
| Rate for Payer: Cigna Commercial |
$10,531.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,406.07
|
| Rate for Payer: Health EOS Commercial |
$10,188.08
|
| Rate for Payer: HFN Commercial |
$10,531.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,585.46
|
| Rate for Payer: Multiplan Commercial |
$9,157.82
|
| Rate for Payer: NAPHCARE Commercial |
$6,868.37
|
| Rate for Payer: Preferred Network Access Commercial |
$10,531.50
|
| Rate for Payer: Quartz Beloit One Network |
$5,609.17
|
| Rate for Payer: Quartz Commercial |
$7,440.73
|
| Rate for Payer: Quartz Medicare Advantage |
$6,868.37
|
| Rate for Payer: The Alliance Commercial |
$5,723.64
|
| Rate for Payer: WEA Trust Commercial |
$6,296.00
|
| Rate for Payer: WPS Commercial |
$8,478.69
|
|
|
PLATE VOLAR 9HL HEAD/5 HL SHAF
|
Facility
|
OP
|
$8,223.00
|
|
| Hospital Charge Code |
2966380
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,394.54 |
| Max. Negotiated Rate |
$7,867.77 |
| Rate for Payer: Aetna Commercial |
$7,696.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,354.65
|
| Rate for Payer: Aetna Managed Medicare |
$2,394.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,558.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,275.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,104.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,532.52
|
| Rate for Payer: Cash Price |
$2,466.90
|
| Rate for Payer: Cigna Commercial |
$7,867.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,785.79
|
| Rate for Payer: Health EOS Commercial |
$7,611.21
|
| Rate for Payer: HFN Commercial |
$7,867.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,413.94
|
| Rate for Payer: Multiplan Commercial |
$6,841.54
|
| Rate for Payer: NAPHCARE Commercial |
$5,131.15
|
| Rate for Payer: Preferred Network Access Commercial |
$7,867.77
|
| Rate for Payer: Quartz Beloit One Network |
$4,190.44
|
| Rate for Payer: Quartz Commercial |
$5,558.75
|
| Rate for Payer: Quartz Medicare Advantage |
$5,131.15
|
| Rate for Payer: The Alliance Commercial |
$4,275.96
|
| Rate for Payer: WEA Trust Commercial |
$4,703.56
|
| Rate for Payer: WPS Commercial |
$6,334.18
|
|
|
PLATE VOLAR 9HL HEAD/5 HL SHAF
|
Facility
|
IP
|
$8,223.00
|
|
| Hospital Charge Code |
2966380
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,190.44 |
| Max. Negotiated Rate |
$7,867.77 |
| Rate for Payer: Aetna Commercial |
$7,696.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,354.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,532.52
|
| Rate for Payer: Cash Price |
$2,466.90
|
| Rate for Payer: Cigna Commercial |
$7,867.77
|
| Rate for Payer: Health EOS Commercial |
$7,611.21
|
| Rate for Payer: HFN Commercial |
$7,867.77
|
| Rate for Payer: Multiplan Commercial |
$6,841.54
|
| Rate for Payer: Preferred Network Access Commercial |
$7,867.77
|
| Rate for Payer: Quartz Beloit One Network |
$4,190.44
|
| Rate for Payer: Quartz Commercial |
$5,131.15
|
| Rate for Payer: WEA Trust Commercial |
$4,703.56
|
| Rate for Payer: WPS Commercial |
$6,334.18
|
|
|
PLATE VOLAR DISTAL RADIUS
|
Facility
|
OP
|
$9,068.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966381
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,640.60 |
| Max. Negotiated Rate |
$8,676.26 |
| Rate for Payer: Aetna Commercial |
$8,487.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,110.42
|
| Rate for Payer: Aetna Managed Medicare |
$2,640.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,129.97
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,715.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,526.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,998.28
|
| Rate for Payer: Cash Price |
$2,720.40
|
| Rate for Payer: Cigna Commercial |
$8,676.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,277.58
|
| Rate for Payer: Health EOS Commercial |
$8,393.34
|
| Rate for Payer: HFN Commercial |
$8,676.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,073.04
|
| Rate for Payer: Multiplan Commercial |
$7,544.58
|
| Rate for Payer: NAPHCARE Commercial |
$5,658.43
|
| Rate for Payer: Preferred Network Access Commercial |
$8,676.26
|
| Rate for Payer: Quartz Beloit One Network |
$4,621.05
|
| Rate for Payer: Quartz Commercial |
$6,129.97
|
| Rate for Payer: Quartz Medicare Advantage |
$5,658.43
|
| Rate for Payer: The Alliance Commercial |
$4,715.36
|
| Rate for Payer: WEA Trust Commercial |
$5,186.90
|
| Rate for Payer: WPS Commercial |
$6,985.08
|
|
|
PLATE VOLAR DISTAL RADIUS
|
Facility
|
IP
|
$9,068.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966381
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,621.05 |
| Max. Negotiated Rate |
$8,676.26 |
| Rate for Payer: Aetna Commercial |
$8,487.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,110.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,998.28
|
| Rate for Payer: Cash Price |
$2,720.40
|
| Rate for Payer: Cigna Commercial |
$8,676.26
|
| Rate for Payer: Health EOS Commercial |
$8,393.34
|
| Rate for Payer: HFN Commercial |
$8,676.26
|
| Rate for Payer: Multiplan Commercial |
$7,544.58
|
| Rate for Payer: Preferred Network Access Commercial |
$8,676.26
|
| Rate for Payer: Quartz Beloit One Network |
$4,621.05
|
| Rate for Payer: Quartz Commercial |
$5,658.43
|
| Rate for Payer: WEA Trust Commercial |
$5,186.90
|
| Rate for Payer: WPS Commercial |
$6,985.08
|
|
|
PLATE VOLAR DISTAL RADIUS 2.4 02.111.631
|
Facility
|
IP
|
$6,518.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2969454
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,321.57 |
| Max. Negotiated Rate |
$6,236.42 |
| Rate for Payer: Aetna Commercial |
$6,100.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,829.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,592.72
|
| Rate for Payer: Cash Price |
$1,955.40
|
| Rate for Payer: Cigna Commercial |
$6,236.42
|
| Rate for Payer: Health EOS Commercial |
$6,033.06
|
| Rate for Payer: HFN Commercial |
$6,236.42
|
| Rate for Payer: Multiplan Commercial |
$5,422.98
|
| Rate for Payer: Preferred Network Access Commercial |
$6,236.42
|
| Rate for Payer: Quartz Beloit One Network |
$3,321.57
|
| Rate for Payer: Quartz Commercial |
$4,067.23
|
| Rate for Payer: WEA Trust Commercial |
$3,728.30
|
| Rate for Payer: WPS Commercial |
$5,020.82
|
|
|
PLATE VOLAR DISTAL RADIUS 2.4 02.111.631
|
Facility
|
OP
|
$6,518.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2969454
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,898.04 |
| Max. Negotiated Rate |
$6,236.42 |
| Rate for Payer: Aetna Commercial |
$6,100.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,829.70
|
| Rate for Payer: Aetna Managed Medicare |
$1,898.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,406.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,389.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,253.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,592.72
|
| Rate for Payer: Cash Price |
$1,955.40
|
| Rate for Payer: Cigna Commercial |
$6,236.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,793.48
|
| Rate for Payer: Health EOS Commercial |
$6,033.06
|
| Rate for Payer: HFN Commercial |
$6,236.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,084.04
|
| Rate for Payer: Multiplan Commercial |
$5,422.98
|
| Rate for Payer: NAPHCARE Commercial |
$4,067.23
|
| Rate for Payer: Preferred Network Access Commercial |
$6,236.42
|
| Rate for Payer: Quartz Beloit One Network |
$3,321.57
|
| Rate for Payer: Quartz Commercial |
$4,406.17
|
| Rate for Payer: Quartz Medicare Advantage |
$4,067.23
|
| Rate for Payer: The Alliance Commercial |
$3,389.36
|
| Rate for Payer: WEA Trust Commercial |
$3,728.30
|
| Rate for Payer: WPS Commercial |
$5,020.82
|
|
|
PLATE VOLAR DISTAL RADIUS 2.4 7HL HEAD/3HL SHAFT LT 02.111.731
|
Facility
|
OP
|
$6,276.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2969455
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,827.57 |
| Max. Negotiated Rate |
$6,004.88 |
| Rate for Payer: Aetna Commercial |
$5,874.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,613.25
|
| Rate for Payer: Aetna Managed Medicare |
$1,827.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,242.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,263.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,132.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,459.33
|
| Rate for Payer: Cash Price |
$1,882.80
|
| Rate for Payer: Cigna Commercial |
$6,004.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,652.63
|
| Rate for Payer: Health EOS Commercial |
$5,809.07
|
| Rate for Payer: HFN Commercial |
$6,004.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,895.28
|
| Rate for Payer: Multiplan Commercial |
$5,221.63
|
| Rate for Payer: NAPHCARE Commercial |
$3,916.22
|
| Rate for Payer: Preferred Network Access Commercial |
$6,004.88
|
| Rate for Payer: Quartz Beloit One Network |
$3,198.25
|
| Rate for Payer: Quartz Commercial |
$4,242.58
|
| Rate for Payer: Quartz Medicare Advantage |
$3,916.22
|
| Rate for Payer: The Alliance Commercial |
$3,263.52
|
| Rate for Payer: WEA Trust Commercial |
$3,589.87
|
| Rate for Payer: WPS Commercial |
$4,834.40
|
|
|
PLATE VOLAR DISTAL RADIUS 2.4 7HL HEAD/3HL SHAFT LT 02.111.731
|
Facility
|
IP
|
$6,276.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2969455
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,198.25 |
| Max. Negotiated Rate |
$6,004.88 |
| Rate for Payer: Aetna Commercial |
$5,874.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,613.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,459.33
|
| Rate for Payer: Cash Price |
$1,882.80
|
| Rate for Payer: Cigna Commercial |
$6,004.88
|
| Rate for Payer: Health EOS Commercial |
$5,809.07
|
| Rate for Payer: HFN Commercial |
$6,004.88
|
| Rate for Payer: Multiplan Commercial |
$5,221.63
|
| Rate for Payer: Preferred Network Access Commercial |
$6,004.88
|
| Rate for Payer: Quartz Beloit One Network |
$3,198.25
|
| Rate for Payer: Quartz Commercial |
$3,916.22
|
| Rate for Payer: WEA Trust Commercial |
$3,589.87
|
| Rate for Payer: WPS Commercial |
$4,834.40
|
|
|
PLATE VOLAR DISTAL RADIUS 2.4 7HL HEAD/3HL SHAFT RT 02.111.730
|
Facility
|
OP
|
$6,276.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966328
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,827.57 |
| Max. Negotiated Rate |
$6,004.88 |
| Rate for Payer: Aetna Commercial |
$5,874.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,613.25
|
| Rate for Payer: Aetna Managed Medicare |
$1,827.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,242.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,263.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,132.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,459.33
|
| Rate for Payer: Cash Price |
$1,882.80
|
| Rate for Payer: Cigna Commercial |
$6,004.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,652.63
|
| Rate for Payer: Health EOS Commercial |
$5,809.07
|
| Rate for Payer: HFN Commercial |
$6,004.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,895.28
|
| Rate for Payer: Multiplan Commercial |
$5,221.63
|
| Rate for Payer: NAPHCARE Commercial |
$3,916.22
|
| Rate for Payer: Preferred Network Access Commercial |
$6,004.88
|
| Rate for Payer: Quartz Beloit One Network |
$3,198.25
|
| Rate for Payer: Quartz Commercial |
$4,242.58
|
| Rate for Payer: Quartz Medicare Advantage |
$3,916.22
|
| Rate for Payer: The Alliance Commercial |
$3,263.52
|
| Rate for Payer: WEA Trust Commercial |
$3,589.87
|
| Rate for Payer: WPS Commercial |
$4,834.40
|
|
|
PLATE VOLAR DISTAL RADIUS 2.4 7HL HEAD/3HL SHAFT RT 02.111.730
|
Facility
|
IP
|
$6,276.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966328
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,198.25 |
| Max. Negotiated Rate |
$6,004.88 |
| Rate for Payer: Aetna Commercial |
$5,874.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,613.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,459.33
|
| Rate for Payer: Cash Price |
$1,882.80
|
| Rate for Payer: Cigna Commercial |
$6,004.88
|
| Rate for Payer: Health EOS Commercial |
$5,809.07
|
| Rate for Payer: HFN Commercial |
$6,004.88
|
| Rate for Payer: Multiplan Commercial |
$5,221.63
|
| Rate for Payer: Preferred Network Access Commercial |
$6,004.88
|
| Rate for Payer: Quartz Beloit One Network |
$3,198.25
|
| Rate for Payer: Quartz Commercial |
$3,916.22
|
| Rate for Payer: WEA Trust Commercial |
$3,589.87
|
| Rate for Payer: WPS Commercial |
$4,834.40
|
|
|
PLATE VOLAR DISTAL RADIUS 2.4 7HL HEAD/4HL SHAFT LT 02.111.741
|
Facility
|
OP
|
$5,424.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6105633
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,579.47 |
| Max. Negotiated Rate |
$5,189.68 |
| Rate for Payer: Aetna Commercial |
$5,076.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,851.23
|
| Rate for Payer: Aetna Managed Medicare |
$1,579.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,666.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,820.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,707.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,989.71
|
| Rate for Payer: Cash Price |
$1,627.20
|
| Rate for Payer: Cigna Commercial |
$5,189.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,156.77
|
| Rate for Payer: Health EOS Commercial |
$5,020.45
|
| Rate for Payer: HFN Commercial |
$5,189.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,230.72
|
| Rate for Payer: Multiplan Commercial |
$4,512.77
|
| Rate for Payer: NAPHCARE Commercial |
$3,384.58
|
| Rate for Payer: Preferred Network Access Commercial |
$5,189.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,764.07
|
| Rate for Payer: Quartz Commercial |
$3,666.62
|
| Rate for Payer: Quartz Medicare Advantage |
$3,384.58
|
| Rate for Payer: The Alliance Commercial |
$2,820.48
|
| Rate for Payer: WEA Trust Commercial |
$3,102.53
|
| Rate for Payer: WPS Commercial |
$4,178.11
|
|
|
PLATE VOLAR DISTAL RADIUS 2.4 7HL HEAD/4HL SHAFT LT 02.111.741
|
Facility
|
IP
|
$5,424.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6105633
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,764.07 |
| Max. Negotiated Rate |
$5,189.68 |
| Rate for Payer: Aetna Commercial |
$5,076.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,851.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,989.71
|
| Rate for Payer: Cash Price |
$1,627.20
|
| Rate for Payer: Cigna Commercial |
$5,189.68
|
| Rate for Payer: Health EOS Commercial |
$5,020.45
|
| Rate for Payer: HFN Commercial |
$5,189.68
|
| Rate for Payer: Multiplan Commercial |
$4,512.77
|
| Rate for Payer: Preferred Network Access Commercial |
$5,189.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,764.07
|
| Rate for Payer: Quartz Commercial |
$3,384.58
|
| Rate for Payer: WEA Trust Commercial |
$3,102.53
|
| Rate for Payer: WPS Commercial |
$4,178.11
|
|
|
PLATE VOLAR DISTAL RADIUS 2.4 7HL HEAD/4HL SHAFT RT 02.111.740
|
Facility
|
OP
|
$6,729.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966327
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,959.48 |
| Max. Negotiated Rate |
$6,438.31 |
| Rate for Payer: Aetna Commercial |
$6,298.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,018.42
|
| Rate for Payer: Aetna Managed Medicare |
$1,959.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,548.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,499.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,359.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,709.02
|
| Rate for Payer: Cash Price |
$2,018.70
|
| Rate for Payer: Cigna Commercial |
$6,438.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,916.28
|
| Rate for Payer: Health EOS Commercial |
$6,228.36
|
| Rate for Payer: HFN Commercial |
$6,438.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,248.62
|
| Rate for Payer: Multiplan Commercial |
$5,598.53
|
| Rate for Payer: NAPHCARE Commercial |
$4,198.90
|
| Rate for Payer: Preferred Network Access Commercial |
$6,438.31
|
| Rate for Payer: Quartz Beloit One Network |
$3,429.10
|
| Rate for Payer: Quartz Commercial |
$4,548.80
|
| Rate for Payer: Quartz Medicare Advantage |
$4,198.90
|
| Rate for Payer: The Alliance Commercial |
$3,499.08
|
| Rate for Payer: WEA Trust Commercial |
$3,848.99
|
| Rate for Payer: WPS Commercial |
$5,183.35
|
|
|
PLATE VOLAR DISTAL RADIUS 2.4 7HL HEAD/4HL SHAFT RT 02.111.740
|
Facility
|
IP
|
$6,729.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966327
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,429.10 |
| Max. Negotiated Rate |
$6,438.31 |
| Rate for Payer: Aetna Commercial |
$6,298.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,018.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,709.02
|
| Rate for Payer: Cash Price |
$2,018.70
|
| Rate for Payer: Cigna Commercial |
$6,438.31
|
| Rate for Payer: Health EOS Commercial |
$6,228.36
|
| Rate for Payer: HFN Commercial |
$6,438.31
|
| Rate for Payer: Multiplan Commercial |
$5,598.53
|
| Rate for Payer: Preferred Network Access Commercial |
$6,438.31
|
| Rate for Payer: Quartz Beloit One Network |
$3,429.10
|
| Rate for Payer: Quartz Commercial |
$4,198.90
|
| Rate for Payer: WEA Trust Commercial |
$3,848.99
|
| Rate for Payer: WPS Commercial |
$5,183.35
|
|
|
PLATE VOLAR DISTAL RADIUS 2.4 7HL HEAD/5HL SHAFT RT 02.111.750
|
Facility
|
IP
|
$5,195.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3945322
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,647.37 |
| Max. Negotiated Rate |
$4,970.58 |
| Rate for Payer: Aetna Commercial |
$4,862.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,646.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,863.48
|
| Rate for Payer: Cash Price |
$1,558.50
|
| Rate for Payer: Cigna Commercial |
$4,970.58
|
| Rate for Payer: Health EOS Commercial |
$4,808.49
|
| Rate for Payer: HFN Commercial |
$4,970.58
|
| Rate for Payer: Multiplan Commercial |
$4,322.24
|
| Rate for Payer: Preferred Network Access Commercial |
$4,970.58
|
| Rate for Payer: Quartz Beloit One Network |
$2,647.37
|
| Rate for Payer: Quartz Commercial |
$3,241.68
|
| Rate for Payer: WEA Trust Commercial |
$2,971.54
|
| Rate for Payer: WPS Commercial |
$4,001.71
|
|
|
PLATE VOLAR DISTAL RADIUS 2.4 7HL HEAD/5HL SHAFT RT 02.111.750
|
Facility
|
OP
|
$5,195.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3945322
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,512.78 |
| Max. Negotiated Rate |
$4,970.58 |
| Rate for Payer: Aetna Commercial |
$4,862.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,646.41
|
| Rate for Payer: Aetna Managed Medicare |
$1,512.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,511.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,701.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,593.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,863.48
|
| Rate for Payer: Cash Price |
$1,558.50
|
| Rate for Payer: Cigna Commercial |
$4,970.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,023.49
|
| Rate for Payer: Health EOS Commercial |
$4,808.49
|
| Rate for Payer: HFN Commercial |
$4,970.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,052.10
|
| Rate for Payer: Multiplan Commercial |
$4,322.24
|
| Rate for Payer: NAPHCARE Commercial |
$3,241.68
|
| Rate for Payer: Preferred Network Access Commercial |
$4,970.58
|
| Rate for Payer: Quartz Beloit One Network |
$2,647.37
|
| Rate for Payer: Quartz Commercial |
$3,511.82
|
| Rate for Payer: Quartz Medicare Advantage |
$3,241.68
|
| Rate for Payer: The Alliance Commercial |
$2,701.40
|
| Rate for Payer: WEA Trust Commercial |
$2,971.54
|
| Rate for Payer: WPS Commercial |
$4,001.71
|
|
|
PLATE VOLAR DISTAL RADIUS 7HL 02.110.107
|
Facility
|
IP
|
$10,770.00
|
|
| Hospital Charge Code |
2966356
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,488.39 |
| Max. Negotiated Rate |
$10,304.74 |
| Rate for Payer: Aetna Commercial |
$10,080.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,632.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,936.42
|
| Rate for Payer: Cash Price |
$3,231.00
|
| Rate for Payer: Cigna Commercial |
$10,304.74
|
| Rate for Payer: Health EOS Commercial |
$9,968.71
|
| Rate for Payer: HFN Commercial |
$10,304.74
|
| Rate for Payer: Multiplan Commercial |
$8,960.64
|
| Rate for Payer: Preferred Network Access Commercial |
$10,304.74
|
| Rate for Payer: Quartz Beloit One Network |
$5,488.39
|
| Rate for Payer: Quartz Commercial |
$6,720.48
|
| Rate for Payer: WEA Trust Commercial |
$6,160.44
|
| Rate for Payer: WPS Commercial |
$8,296.13
|
|
|
PLATE VOLAR DISTAL RADIUS 7HL 02.110.107
|
Facility
|
OP
|
$10,770.00
|
|
| Hospital Charge Code |
2966356
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,136.22 |
| Max. Negotiated Rate |
$10,304.74 |
| Rate for Payer: Aetna Commercial |
$10,080.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,632.69
|
| Rate for Payer: Aetna Managed Medicare |
$3,136.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,280.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,600.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,376.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,936.42
|
| Rate for Payer: Cash Price |
$3,231.00
|
| Rate for Payer: Cigna Commercial |
$10,304.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,268.14
|
| Rate for Payer: Health EOS Commercial |
$9,968.71
|
| Rate for Payer: HFN Commercial |
$10,304.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,400.60
|
| Rate for Payer: Multiplan Commercial |
$8,960.64
|
| Rate for Payer: NAPHCARE Commercial |
$6,720.48
|
| Rate for Payer: Preferred Network Access Commercial |
$10,304.74
|
| Rate for Payer: Quartz Beloit One Network |
$5,488.39
|
| Rate for Payer: Quartz Commercial |
$7,280.52
|
| Rate for Payer: Quartz Medicare Advantage |
$6,720.48
|
| Rate for Payer: The Alliance Commercial |
$5,600.40
|
| Rate for Payer: WEA Trust Commercial |
$6,160.44
|
| Rate for Payer: WPS Commercial |
$8,296.13
|
|
|
PLATE WAVE CALCANEAL MED TORNIER ZPML
|
Facility
|
OP
|
$7,780.00
|
|
| Hospital Charge Code |
2967359
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,265.54 |
| Max. Negotiated Rate |
$7,443.90 |
| Rate for Payer: Aetna Commercial |
$7,282.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,958.43
|
| Rate for Payer: Aetna Managed Medicare |
$2,265.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,259.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,045.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,883.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,288.34
|
| Rate for Payer: Cash Price |
$2,334.00
|
| Rate for Payer: Cigna Commercial |
$7,443.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,527.96
|
| Rate for Payer: Health EOS Commercial |
$7,201.17
|
| Rate for Payer: HFN Commercial |
$7,443.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,068.40
|
| Rate for Payer: Multiplan Commercial |
$6,472.96
|
| Rate for Payer: NAPHCARE Commercial |
$4,854.72
|
| Rate for Payer: Preferred Network Access Commercial |
$7,443.90
|
| Rate for Payer: Quartz Beloit One Network |
$3,964.69
|
| Rate for Payer: Quartz Commercial |
$5,259.28
|
| Rate for Payer: Quartz Medicare Advantage |
$4,854.72
|
| Rate for Payer: The Alliance Commercial |
$4,045.60
|
| Rate for Payer: WEA Trust Commercial |
$4,450.16
|
| Rate for Payer: WPS Commercial |
$5,992.93
|
|
|
PLATE WAVE CALCANEAL MED TORNIER ZPML
|
Facility
|
IP
|
$7,780.00
|
|
| Hospital Charge Code |
2967359
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,964.69 |
| Max. Negotiated Rate |
$7,443.90 |
| Rate for Payer: Aetna Commercial |
$7,282.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,958.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,288.34
|
| Rate for Payer: Cash Price |
$2,334.00
|
| Rate for Payer: Cigna Commercial |
$7,443.90
|
| Rate for Payer: Health EOS Commercial |
$7,201.17
|
| Rate for Payer: HFN Commercial |
$7,443.90
|
| Rate for Payer: Multiplan Commercial |
$6,472.96
|
| Rate for Payer: Preferred Network Access Commercial |
$7,443.90
|
| Rate for Payer: Quartz Beloit One Network |
$3,964.69
|
| Rate for Payer: Quartz Commercial |
$4,854.72
|
| Rate for Payer: WEA Trust Commercial |
$4,450.16
|
| Rate for Payer: WPS Commercial |
$5,992.93
|
|
|
PLATE WIDE 12HL BIOMET 73-2634
|
Facility
|
IP
|
$4,584.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4206002
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,336.01 |
| Max. Negotiated Rate |
$4,385.97 |
| Rate for Payer: Aetna Commercial |
$4,290.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,099.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,526.70
|
| Rate for Payer: Cash Price |
$1,375.20
|
| Rate for Payer: Cigna Commercial |
$4,385.97
|
| Rate for Payer: Health EOS Commercial |
$4,242.95
|
| Rate for Payer: HFN Commercial |
$4,385.97
|
| Rate for Payer: Multiplan Commercial |
$3,813.89
|
| Rate for Payer: Preferred Network Access Commercial |
$4,385.97
|
| Rate for Payer: Quartz Beloit One Network |
$2,336.01
|
| Rate for Payer: Quartz Commercial |
$2,860.42
|
| Rate for Payer: WEA Trust Commercial |
$2,622.05
|
| Rate for Payer: WPS Commercial |
$3,531.06
|
|
