|
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 |
$6,233.29 |
| Max. Negotiated Rate |
$11,703.32 |
| Rate for Payer: Aetna Commercial |
$11,448.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,940.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,742.13
|
| Rate for Payer: Cash Price |
$3,816.30
|
| Rate for Payer: Cigna Commercial |
$11,703.32
|
| Rate for Payer: Health EOS Commercial |
$11,321.69
|
| Rate for Payer: HFN Commercial |
$11,703.32
|
| Rate for Payer: Multiplan Commercial |
$10,176.80
|
| Rate for Payer: NAPHCARE Commercial |
$7,632.60
|
| Rate for Payer: Preferred Network Access Commercial |
$11,703.32
|
| Rate for Payer: Quartz Beloit One Network |
$6,233.29
|
| Rate for Payer: Quartz Commercial |
$7,632.60
|
| Rate for Payer: WEA Trust Commercial |
$6,996.55
|
| Rate for Payer: WPS Commercial |
$9,422.44
|
|
|
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 |
$3,561.88 |
| Max. Negotiated Rate |
$50,884.00 |
| Rate for Payer: Aetna Commercial |
$11,448.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,940.06
|
| Rate for Payer: Aetna Managed Medicare |
$3,561.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,268.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,360.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,106.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,742.13
|
| Rate for Payer: Cash Price |
$3,816.30
|
| Rate for Payer: Cigna Commercial |
$11,703.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,118.67
|
| Rate for Payer: Health EOS Commercial |
$11,321.69
|
| Rate for Payer: HFN Commercial |
$11,703.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,540.75
|
| Rate for Payer: Multiplan Commercial |
$10,176.80
|
| Rate for Payer: NAPHCARE Commercial |
$7,632.60
|
| Rate for Payer: Preferred Network Access Commercial |
$11,703.32
|
| Rate for Payer: Quartz Beloit One Network |
$6,233.29
|
| Rate for Payer: Quartz Commercial |
$8,268.65
|
| Rate for Payer: Quartz Medicare Advantage |
$7,632.60
|
| Rate for Payer: The Alliance Commercial |
$50,884.00
|
| Rate for Payer: WEA Trust Commercial |
$6,996.55
|
| Rate for Payer: WPS Commercial |
$9,422.44
|
|
|
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 |
$6,893.81 |
| Max. Negotiated Rate |
$12,943.48 |
| Rate for Payer: Aetna Commercial |
$12,662.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,099.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,456.57
|
| Rate for Payer: Cash Price |
$4,220.70
|
| Rate for Payer: Cigna Commercial |
$12,943.48
|
| Rate for Payer: Health EOS Commercial |
$12,521.41
|
| Rate for Payer: HFN Commercial |
$12,943.48
|
| Rate for Payer: Multiplan Commercial |
$11,255.20
|
| Rate for Payer: NAPHCARE Commercial |
$8,441.40
|
| Rate for Payer: Preferred Network Access Commercial |
$12,943.48
|
| Rate for Payer: Quartz Beloit One Network |
$6,893.81
|
| Rate for Payer: Quartz Commercial |
$8,441.40
|
| Rate for Payer: WEA Trust Commercial |
$7,737.95
|
| Rate for Payer: WPS Commercial |
$10,420.91
|
|
|
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 |
$3,939.32 |
| Max. Negotiated Rate |
$56,276.00 |
| Rate for Payer: Aetna Commercial |
$12,662.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,099.34
|
| Rate for Payer: Aetna Managed Medicare |
$3,939.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,144.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,034.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,753.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,456.57
|
| Rate for Payer: Cash Price |
$4,220.70
|
| Rate for Payer: Cigna Commercial |
$12,943.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,873.01
|
| Rate for Payer: Health EOS Commercial |
$12,521.41
|
| Rate for Payer: HFN Commercial |
$12,943.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,551.75
|
| Rate for Payer: Multiplan Commercial |
$11,255.20
|
| Rate for Payer: NAPHCARE Commercial |
$8,441.40
|
| Rate for Payer: Preferred Network Access Commercial |
$12,943.48
|
| Rate for Payer: Quartz Beloit One Network |
$6,893.81
|
| Rate for Payer: Quartz Commercial |
$9,144.85
|
| Rate for Payer: Quartz Medicare Advantage |
$8,441.40
|
| Rate for Payer: The Alliance Commercial |
$56,276.00
|
| Rate for Payer: WEA Trust Commercial |
$7,737.95
|
| Rate for Payer: WPS Commercial |
$10,420.91
|
|
|
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 |
$4,296.32 |
| Max. Negotiated Rate |
$8,066.56 |
| Rate for Payer: Aetna Commercial |
$7,891.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,540.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,647.04
|
| Rate for Payer: Cash Price |
$2,630.40
|
| Rate for Payer: Cigna Commercial |
$8,066.56
|
| Rate for Payer: Health EOS Commercial |
$7,803.52
|
| Rate for Payer: HFN Commercial |
$8,066.56
|
| Rate for Payer: Multiplan Commercial |
$7,014.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,260.80
|
| Rate for Payer: Preferred Network Access Commercial |
$8,066.56
|
| Rate for Payer: Quartz Beloit One Network |
$4,296.32
|
| Rate for Payer: Quartz Commercial |
$5,260.80
|
| Rate for Payer: WEA Trust Commercial |
$4,822.40
|
| Rate for Payer: WPS Commercial |
$6,494.46
|
|
|
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 |
$2,455.04 |
| Max. Negotiated Rate |
$35,072.00 |
| Rate for Payer: Aetna Commercial |
$7,891.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,540.48
|
| Rate for Payer: Aetna Managed Medicare |
$2,455.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,699.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,384.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,208.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,647.04
|
| Rate for Payer: Cash Price |
$2,630.40
|
| Rate for Payer: Cigna Commercial |
$8,066.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,906.57
|
| Rate for Payer: Health EOS Commercial |
$7,803.52
|
| Rate for Payer: HFN Commercial |
$8,066.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,576.00
|
| Rate for Payer: Multiplan Commercial |
$7,014.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,260.80
|
| Rate for Payer: Preferred Network Access Commercial |
$8,066.56
|
| Rate for Payer: Quartz Beloit One Network |
$4,296.32
|
| Rate for Payer: Quartz Commercial |
$5,699.20
|
| Rate for Payer: Quartz Medicare Advantage |
$5,260.80
|
| Rate for Payer: The Alliance Commercial |
$35,072.00
|
| Rate for Payer: WEA Trust Commercial |
$4,822.40
|
| Rate for Payer: WPS Commercial |
$6,494.46
|
|
|
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 |
$3,889.62 |
| Max. Negotiated Rate |
$7,302.96 |
| Rate for Payer: Aetna Commercial |
$7,144.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,826.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,207.14
|
| Rate for Payer: Cash Price |
$2,381.40
|
| Rate for Payer: Cigna Commercial |
$7,302.96
|
| Rate for Payer: Health EOS Commercial |
$7,064.82
|
| Rate for Payer: HFN Commercial |
$7,302.96
|
| Rate for Payer: Multiplan Commercial |
$6,350.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,762.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,302.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,889.62
|
| Rate for Payer: Quartz Commercial |
$4,762.80
|
| Rate for Payer: WEA Trust Commercial |
$4,365.90
|
| Rate for Payer: WPS Commercial |
$5,879.68
|
|
|
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 |
$2,222.64 |
| Max. Negotiated Rate |
$31,752.00 |
| Rate for Payer: Aetna Commercial |
$7,144.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,826.68
|
| Rate for Payer: Aetna Managed Medicare |
$2,222.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,159.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,969.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,810.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,207.14
|
| Rate for Payer: Cash Price |
$2,381.40
|
| Rate for Payer: Cigna Commercial |
$7,302.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,442.10
|
| Rate for Payer: Health EOS Commercial |
$7,064.82
|
| Rate for Payer: HFN Commercial |
$7,302.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,953.50
|
| Rate for Payer: Multiplan Commercial |
$6,350.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,762.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,302.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,889.62
|
| Rate for Payer: Quartz Commercial |
$5,159.70
|
| Rate for Payer: Quartz Medicare Advantage |
$4,762.80
|
| Rate for Payer: The Alliance Commercial |
$31,752.00
|
| Rate for Payer: WEA Trust Commercial |
$4,365.90
|
| Rate for Payer: WPS Commercial |
$5,879.68
|
|
|
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 |
$2,393.98 |
| Max. Negotiated Rate |
$4,494.82 |
| Rate for Payer: Aetna Commercial |
$4,397.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,201.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,589.41
|
| Rate for Payer: Cash Price |
$1,465.70
|
| Rate for Payer: Cigna Commercial |
$4,494.82
|
| Rate for Payer: Health EOS Commercial |
$4,348.25
|
| Rate for Payer: HFN Commercial |
$4,494.82
|
| Rate for Payer: Multiplan Commercial |
$3,908.54
|
| Rate for Payer: NAPHCARE Commercial |
$2,931.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,494.82
|
| Rate for Payer: Quartz Beloit One Network |
$2,393.98
|
| Rate for Payer: Quartz Commercial |
$2,931.40
|
| Rate for Payer: WEA Trust Commercial |
$2,687.12
|
| Rate for Payer: WPS Commercial |
$3,618.82
|
|
|
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 |
$1,367.99 |
| Max. Negotiated Rate |
$19,542.68 |
| Rate for Payer: Aetna Commercial |
$4,397.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,201.68
|
| Rate for Payer: Aetna Managed Medicare |
$1,367.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,175.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,442.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,345.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,589.41
|
| Rate for Payer: Cash Price |
$1,465.70
|
| Rate for Payer: Cigna Commercial |
$4,494.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,734.02
|
| Rate for Payer: Health EOS Commercial |
$4,348.25
|
| Rate for Payer: HFN Commercial |
$4,494.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,664.25
|
| Rate for Payer: Multiplan Commercial |
$3,908.54
|
| Rate for Payer: NAPHCARE Commercial |
$2,931.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,494.82
|
| Rate for Payer: Quartz Beloit One Network |
$2,393.98
|
| Rate for Payer: Quartz Commercial |
$3,175.69
|
| Rate for Payer: Quartz Medicare Advantage |
$2,931.40
|
| Rate for Payer: The Alliance Commercial |
$19,542.68
|
| Rate for Payer: WEA Trust Commercial |
$2,687.12
|
| Rate for Payer: WPS Commercial |
$3,618.82
|
|
|
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 |
$3,081.96 |
| Max. Negotiated Rate |
$44,028.00 |
| Rate for Payer: Aetna Commercial |
$9,906.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,466.02
|
| Rate for Payer: Aetna Managed Medicare |
$3,081.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,154.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,503.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,283.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,833.71
|
| Rate for Payer: Cash Price |
$3,302.10
|
| Rate for Payer: Cigna Commercial |
$10,126.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,159.52
|
| Rate for Payer: Health EOS Commercial |
$9,796.23
|
| Rate for Payer: HFN Commercial |
$10,126.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,255.25
|
| Rate for Payer: Multiplan Commercial |
$8,805.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,604.20
|
| Rate for Payer: Preferred Network Access Commercial |
$10,126.44
|
| Rate for Payer: Quartz Beloit One Network |
$5,393.43
|
| Rate for Payer: Quartz Commercial |
$7,154.55
|
| Rate for Payer: Quartz Medicare Advantage |
$6,604.20
|
| Rate for Payer: The Alliance Commercial |
$44,028.00
|
| Rate for Payer: WEA Trust Commercial |
$6,053.85
|
| Rate for Payer: WPS Commercial |
$8,152.88
|
|
|
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 |
$5,393.43 |
| Max. Negotiated Rate |
$10,126.44 |
| Rate for Payer: Aetna Commercial |
$9,906.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,466.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,833.71
|
| Rate for Payer: Cash Price |
$3,302.10
|
| Rate for Payer: Cigna Commercial |
$10,126.44
|
| Rate for Payer: Health EOS Commercial |
$9,796.23
|
| Rate for Payer: HFN Commercial |
$10,126.44
|
| Rate for Payer: Multiplan Commercial |
$8,805.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,604.20
|
| Rate for Payer: Preferred Network Access Commercial |
$10,126.44
|
| Rate for Payer: Quartz Beloit One Network |
$5,393.43
|
| Rate for Payer: Quartz Commercial |
$6,604.20
|
| Rate for Payer: WEA Trust Commercial |
$6,053.85
|
| Rate for Payer: WPS Commercial |
$8,152.88
|
|
|
PLATE VOLAR 9HL HEAD/5 HL SHAF
|
Facility
|
IP
|
$8,223.00
|
|
| Hospital Charge Code |
2966380
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,029.27 |
| Max. Negotiated Rate |
$7,565.16 |
| Rate for Payer: Aetna Commercial |
$7,400.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,071.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,358.19
|
| Rate for Payer: Cash Price |
$2,466.90
|
| Rate for Payer: Cigna Commercial |
$7,565.16
|
| Rate for Payer: Health EOS Commercial |
$7,318.47
|
| Rate for Payer: HFN Commercial |
$7,565.16
|
| Rate for Payer: Multiplan Commercial |
$6,578.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,933.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,565.16
|
| Rate for Payer: Quartz Beloit One Network |
$4,029.27
|
| Rate for Payer: Quartz Commercial |
$4,933.80
|
| Rate for Payer: WEA Trust Commercial |
$4,522.65
|
| Rate for Payer: WPS Commercial |
$6,090.78
|
|
|
PLATE VOLAR 9HL HEAD/5 HL SHAF
|
Facility
|
OP
|
$8,223.00
|
|
| Hospital Charge Code |
2966380
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,302.44 |
| Max. Negotiated Rate |
$32,892.00 |
| Rate for Payer: Aetna Commercial |
$7,400.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,071.78
|
| Rate for Payer: Aetna Managed Medicare |
$2,302.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,344.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,111.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,947.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,358.19
|
| Rate for Payer: Cash Price |
$2,466.90
|
| Rate for Payer: Cigna Commercial |
$7,565.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,601.59
|
| Rate for Payer: Health EOS Commercial |
$7,318.47
|
| Rate for Payer: HFN Commercial |
$7,565.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,167.25
|
| Rate for Payer: Multiplan Commercial |
$6,578.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,933.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,565.16
|
| Rate for Payer: Quartz Beloit One Network |
$4,029.27
|
| Rate for Payer: Quartz Commercial |
$5,344.95
|
| Rate for Payer: Quartz Medicare Advantage |
$4,933.80
|
| Rate for Payer: The Alliance Commercial |
$32,892.00
|
| Rate for Payer: WEA Trust Commercial |
$4,522.65
|
| Rate for Payer: WPS Commercial |
$6,090.78
|
|
|
PLATE VOLAR DISTAL RADIUS
|
Facility
|
IP
|
$9,068.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966381
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,443.32 |
| Max. Negotiated Rate |
$8,342.56 |
| Rate for Payer: Aetna Commercial |
$8,161.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,798.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,806.04
|
| Rate for Payer: Cash Price |
$2,720.40
|
| Rate for Payer: Cigna Commercial |
$8,342.56
|
| Rate for Payer: Health EOS Commercial |
$8,070.52
|
| Rate for Payer: HFN Commercial |
$8,342.56
|
| Rate for Payer: Multiplan Commercial |
$7,254.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,440.80
|
| Rate for Payer: Preferred Network Access Commercial |
$8,342.56
|
| Rate for Payer: Quartz Beloit One Network |
$4,443.32
|
| Rate for Payer: Quartz Commercial |
$5,440.80
|
| Rate for Payer: WEA Trust Commercial |
$4,987.40
|
| Rate for Payer: WPS Commercial |
$6,716.67
|
|
|
PLATE VOLAR DISTAL RADIUS
|
Facility
|
OP
|
$9,068.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966381
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,539.04 |
| Max. Negotiated Rate |
$36,272.00 |
| Rate for Payer: Aetna Commercial |
$8,161.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,798.48
|
| Rate for Payer: Aetna Managed Medicare |
$2,539.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,894.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,534.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,352.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,806.04
|
| Rate for Payer: Cash Price |
$2,720.40
|
| Rate for Payer: Cigna Commercial |
$8,342.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,074.45
|
| Rate for Payer: Health EOS Commercial |
$8,070.52
|
| Rate for Payer: HFN Commercial |
$8,342.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,801.00
|
| Rate for Payer: Multiplan Commercial |
$7,254.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,440.80
|
| Rate for Payer: Preferred Network Access Commercial |
$8,342.56
|
| Rate for Payer: Quartz Beloit One Network |
$4,443.32
|
| Rate for Payer: Quartz Commercial |
$5,894.20
|
| Rate for Payer: Quartz Medicare Advantage |
$5,440.80
|
| Rate for Payer: The Alliance Commercial |
$36,272.00
|
| Rate for Payer: WEA Trust Commercial |
$4,987.40
|
| Rate for Payer: WPS Commercial |
$6,716.67
|
|
|
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 |
$3,193.82 |
| Max. Negotiated Rate |
$5,996.56 |
| Rate for Payer: Aetna Commercial |
$5,866.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,605.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,454.54
|
| Rate for Payer: Cash Price |
$1,955.40
|
| Rate for Payer: Cigna Commercial |
$5,996.56
|
| Rate for Payer: Health EOS Commercial |
$5,801.02
|
| Rate for Payer: HFN Commercial |
$5,996.56
|
| Rate for Payer: Multiplan Commercial |
$5,214.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,910.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,996.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,193.82
|
| Rate for Payer: Quartz Commercial |
$3,910.80
|
| Rate for Payer: WEA Trust Commercial |
$3,584.90
|
| Rate for Payer: WPS Commercial |
$4,827.88
|
|
|
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 |
$1,825.04 |
| Max. Negotiated Rate |
$26,072.00 |
| Rate for Payer: Aetna Commercial |
$5,866.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,605.48
|
| Rate for Payer: Aetna Managed Medicare |
$1,825.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,236.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,259.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,128.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,454.54
|
| Rate for Payer: Cash Price |
$1,955.40
|
| Rate for Payer: Cigna Commercial |
$5,996.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,647.47
|
| Rate for Payer: Health EOS Commercial |
$5,801.02
|
| Rate for Payer: HFN Commercial |
$5,996.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,888.50
|
| Rate for Payer: Multiplan Commercial |
$5,214.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,910.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,996.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,193.82
|
| Rate for Payer: Quartz Commercial |
$4,236.70
|
| Rate for Payer: Quartz Medicare Advantage |
$3,910.80
|
| Rate for Payer: The Alliance Commercial |
$26,072.00
|
| Rate for Payer: WEA Trust Commercial |
$3,584.90
|
| Rate for Payer: WPS Commercial |
$4,827.88
|
|
|
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 |
$3,075.24 |
| Max. Negotiated Rate |
$5,773.92 |
| Rate for Payer: Aetna Commercial |
$5,648.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,397.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,326.28
|
| Rate for Payer: Cash Price |
$1,882.80
|
| Rate for Payer: Cigna Commercial |
$5,773.92
|
| Rate for Payer: Health EOS Commercial |
$5,585.64
|
| Rate for Payer: HFN Commercial |
$5,773.92
|
| Rate for Payer: Multiplan Commercial |
$5,020.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,765.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,773.92
|
| Rate for Payer: Quartz Beloit One Network |
$3,075.24
|
| Rate for Payer: Quartz Commercial |
$3,765.60
|
| Rate for Payer: WEA Trust Commercial |
$3,451.80
|
| Rate for Payer: WPS Commercial |
$4,648.63
|
|
|
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 |
$1,757.28 |
| Max. Negotiated Rate |
$25,104.00 |
| Rate for Payer: Aetna Commercial |
$5,648.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,397.36
|
| Rate for Payer: Aetna Managed Medicare |
$1,757.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,079.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,138.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,012.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,326.28
|
| Rate for Payer: Cash Price |
$1,882.80
|
| Rate for Payer: Cigna Commercial |
$5,773.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,512.05
|
| Rate for Payer: Health EOS Commercial |
$5,585.64
|
| Rate for Payer: HFN Commercial |
$5,773.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,707.00
|
| Rate for Payer: Multiplan Commercial |
$5,020.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,765.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,773.92
|
| Rate for Payer: Quartz Beloit One Network |
$3,075.24
|
| Rate for Payer: Quartz Commercial |
$4,079.40
|
| Rate for Payer: Quartz Medicare Advantage |
$3,765.60
|
| Rate for Payer: The Alliance Commercial |
$25,104.00
|
| Rate for Payer: WEA Trust Commercial |
$3,451.80
|
| Rate for Payer: WPS Commercial |
$4,648.63
|
|
|
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 |
$1,757.28 |
| Max. Negotiated Rate |
$25,104.00 |
| Rate for Payer: Aetna Commercial |
$5,648.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,397.36
|
| Rate for Payer: Aetna Managed Medicare |
$1,757.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,079.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,138.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,012.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,326.28
|
| Rate for Payer: Cash Price |
$1,882.80
|
| Rate for Payer: Cigna Commercial |
$5,773.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,512.05
|
| Rate for Payer: Health EOS Commercial |
$5,585.64
|
| Rate for Payer: HFN Commercial |
$5,773.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,707.00
|
| Rate for Payer: Multiplan Commercial |
$5,020.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,765.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,773.92
|
| Rate for Payer: Quartz Beloit One Network |
$3,075.24
|
| Rate for Payer: Quartz Commercial |
$4,079.40
|
| Rate for Payer: Quartz Medicare Advantage |
$3,765.60
|
| Rate for Payer: The Alliance Commercial |
$25,104.00
|
| Rate for Payer: WEA Trust Commercial |
$3,451.80
|
| Rate for Payer: WPS Commercial |
$4,648.63
|
|
|
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 |
$3,075.24 |
| Max. Negotiated Rate |
$5,773.92 |
| Rate for Payer: Aetna Commercial |
$5,648.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,397.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,326.28
|
| Rate for Payer: Cash Price |
$1,882.80
|
| Rate for Payer: Cigna Commercial |
$5,773.92
|
| Rate for Payer: Health EOS Commercial |
$5,585.64
|
| Rate for Payer: HFN Commercial |
$5,773.92
|
| Rate for Payer: Multiplan Commercial |
$5,020.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,765.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,773.92
|
| Rate for Payer: Quartz Beloit One Network |
$3,075.24
|
| Rate for Payer: Quartz Commercial |
$3,765.60
|
| Rate for Payer: WEA Trust Commercial |
$3,451.80
|
| Rate for Payer: WPS Commercial |
$4,648.63
|
|
|
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 |
$2,657.76 |
| Max. Negotiated Rate |
$4,990.08 |
| Rate for Payer: Aetna Commercial |
$4,881.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,664.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,874.72
|
| Rate for Payer: Cash Price |
$1,627.20
|
| Rate for Payer: Cigna Commercial |
$4,990.08
|
| Rate for Payer: Health EOS Commercial |
$4,827.36
|
| Rate for Payer: HFN Commercial |
$4,990.08
|
| Rate for Payer: Multiplan Commercial |
$4,339.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,254.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,990.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,657.76
|
| Rate for Payer: Quartz Commercial |
$3,254.40
|
| Rate for Payer: WEA Trust Commercial |
$2,983.20
|
| Rate for Payer: WPS Commercial |
$4,017.56
|
|
|
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 |
$1,518.72 |
| Max. Negotiated Rate |
$21,696.00 |
| Rate for Payer: Aetna Commercial |
$4,881.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,664.64
|
| Rate for Payer: Aetna Managed Medicare |
$1,518.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,525.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,712.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,603.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,874.72
|
| Rate for Payer: Cash Price |
$1,627.20
|
| Rate for Payer: Cigna Commercial |
$4,990.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,035.27
|
| Rate for Payer: Health EOS Commercial |
$4,827.36
|
| Rate for Payer: HFN Commercial |
$4,990.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,068.00
|
| Rate for Payer: Multiplan Commercial |
$4,339.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,254.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,990.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,657.76
|
| Rate for Payer: Quartz Commercial |
$3,525.60
|
| Rate for Payer: Quartz Medicare Advantage |
$3,254.40
|
| Rate for Payer: The Alliance Commercial |
$21,696.00
|
| Rate for Payer: WEA Trust Commercial |
$2,983.20
|
| Rate for Payer: WPS Commercial |
$4,017.56
|
|
|
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 |
$1,884.12 |
| Max. Negotiated Rate |
$26,916.00 |
| Rate for Payer: Aetna Commercial |
$6,056.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,786.94
|
| Rate for Payer: Aetna Managed Medicare |
$1,884.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,373.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,364.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,229.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,566.37
|
| Rate for Payer: Cash Price |
$2,018.70
|
| Rate for Payer: Cigna Commercial |
$6,190.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,765.55
|
| Rate for Payer: Health EOS Commercial |
$5,988.81
|
| Rate for Payer: HFN Commercial |
$6,190.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,046.75
|
| Rate for Payer: Multiplan Commercial |
$5,383.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,037.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,190.68
|
| Rate for Payer: Quartz Beloit One Network |
$3,297.21
|
| Rate for Payer: Quartz Commercial |
$4,373.85
|
| Rate for Payer: Quartz Medicare Advantage |
$4,037.40
|
| Rate for Payer: The Alliance Commercial |
$26,916.00
|
| Rate for Payer: WEA Trust Commercial |
$3,700.95
|
| Rate for Payer: WPS Commercial |
$4,984.17
|
|
