|
PLATE CLAVICLE MIDSHAFT SUPEROR DECREASED CURVATURE 7 HOLE STD 628007
|
Facility
|
IP
|
$7,062.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5861647
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,460.38 |
| Max. Negotiated Rate |
$6,497.04 |
| Rate for Payer: Aetna Commercial |
$6,355.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,073.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,742.86
|
| Rate for Payer: Cash Price |
$2,118.60
|
| Rate for Payer: Cigna Commercial |
$6,497.04
|
| Rate for Payer: Health EOS Commercial |
$6,285.18
|
| Rate for Payer: HFN Commercial |
$6,497.04
|
| Rate for Payer: Multiplan Commercial |
$5,649.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,237.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,497.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,460.38
|
| Rate for Payer: Quartz Commercial |
$4,237.20
|
| Rate for Payer: WEA Trust Commercial |
$3,884.10
|
| Rate for Payer: WPS Commercial |
$5,230.82
|
|
|
PLATE CLAVICLE MIDSHAFT SUPEROR DECREASED CURVATURE 7 HOLE STD 628007
|
Facility
|
OP
|
$7,062.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5861647
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,977.36 |
| Max. Negotiated Rate |
$28,248.00 |
| Rate for Payer: Aetna Commercial |
$6,355.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,073.32
|
| Rate for Payer: Aetna Managed Medicare |
$1,977.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,590.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,531.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,389.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,742.86
|
| Rate for Payer: Cash Price |
$2,118.60
|
| Rate for Payer: Cigna Commercial |
$6,497.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,951.90
|
| Rate for Payer: Health EOS Commercial |
$6,285.18
|
| Rate for Payer: HFN Commercial |
$6,497.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,296.50
|
| Rate for Payer: Multiplan Commercial |
$5,649.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,237.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,497.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,460.38
|
| Rate for Payer: Quartz Commercial |
$4,590.30
|
| Rate for Payer: Quartz Medicare Advantage |
$4,237.20
|
| Rate for Payer: The Alliance Commercial |
$28,248.00
|
| Rate for Payer: WEA Trust Commercial |
$3,884.10
|
| Rate for Payer: WPS Commercial |
$5,230.82
|
|
|
PLATE CLAVICLE SUPERIOR 3.5 LCP 7 HOLE LEFT 02.112.083
|
Facility
|
OP
|
$6,352.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4317104
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,778.56 |
| Max. Negotiated Rate |
$25,408.00 |
| Rate for Payer: Aetna Commercial |
$5,716.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,462.72
|
| Rate for Payer: Aetna Managed Medicare |
$1,778.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,128.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,176.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,048.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,366.56
|
| Rate for Payer: Cash Price |
$1,905.60
|
| Rate for Payer: Cigna Commercial |
$5,843.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,554.58
|
| Rate for Payer: Health EOS Commercial |
$5,653.28
|
| Rate for Payer: HFN Commercial |
$5,843.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,764.00
|
| Rate for Payer: Multiplan Commercial |
$5,081.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,811.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,843.84
|
| Rate for Payer: Quartz Beloit One Network |
$3,112.48
|
| Rate for Payer: Quartz Commercial |
$4,128.80
|
| Rate for Payer: Quartz Medicare Advantage |
$3,811.20
|
| Rate for Payer: The Alliance Commercial |
$25,408.00
|
| Rate for Payer: WEA Trust Commercial |
$3,493.60
|
| Rate for Payer: WPS Commercial |
$4,704.93
|
|
|
PLATE CLAVICLE SUPERIOR 3.5 LCP 7 HOLE LEFT 02.112.083
|
Facility
|
IP
|
$6,352.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4317104
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,112.48 |
| Max. Negotiated Rate |
$5,843.84 |
| Rate for Payer: Aetna Commercial |
$5,716.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,462.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,366.56
|
| Rate for Payer: Cash Price |
$1,905.60
|
| Rate for Payer: Cigna Commercial |
$5,843.84
|
| Rate for Payer: Health EOS Commercial |
$5,653.28
|
| Rate for Payer: HFN Commercial |
$5,843.84
|
| Rate for Payer: Multiplan Commercial |
$5,081.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,811.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,843.84
|
| Rate for Payer: Quartz Beloit One Network |
$3,112.48
|
| Rate for Payer: Quartz Commercial |
$3,811.20
|
| Rate for Payer: WEA Trust Commercial |
$3,493.60
|
| Rate for Payer: WPS Commercial |
$4,704.93
|
|
|
PLATE CLAVICLE SUPERIOR 3.5 LCP 7 HOLE RT 02.112.082
|
Facility
|
OP
|
$6,352.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5306730
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,778.56 |
| Max. Negotiated Rate |
$25,408.00 |
| Rate for Payer: Aetna Commercial |
$5,716.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,462.72
|
| Rate for Payer: Aetna Managed Medicare |
$1,778.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,128.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,176.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,048.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,366.56
|
| Rate for Payer: Cash Price |
$1,905.60
|
| Rate for Payer: Cigna Commercial |
$5,843.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,554.58
|
| Rate for Payer: Health EOS Commercial |
$5,653.28
|
| Rate for Payer: HFN Commercial |
$5,843.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,764.00
|
| Rate for Payer: Multiplan Commercial |
$5,081.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,811.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,843.84
|
| Rate for Payer: Quartz Beloit One Network |
$3,112.48
|
| Rate for Payer: Quartz Commercial |
$4,128.80
|
| Rate for Payer: Quartz Medicare Advantage |
$3,811.20
|
| Rate for Payer: The Alliance Commercial |
$25,408.00
|
| Rate for Payer: WEA Trust Commercial |
$3,493.60
|
| Rate for Payer: WPS Commercial |
$4,704.93
|
|
|
PLATE CLAVICLE SUPERIOR 3.5 LCP 7 HOLE RT 02.112.082
|
Facility
|
IP
|
$6,352.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5306730
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,112.48 |
| Max. Negotiated Rate |
$5,843.84 |
| Rate for Payer: Aetna Commercial |
$5,716.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,462.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,366.56
|
| Rate for Payer: Cash Price |
$1,905.60
|
| Rate for Payer: Cigna Commercial |
$5,843.84
|
| Rate for Payer: Health EOS Commercial |
$5,653.28
|
| Rate for Payer: HFN Commercial |
$5,843.84
|
| Rate for Payer: Multiplan Commercial |
$5,081.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,811.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,843.84
|
| Rate for Payer: Quartz Beloit One Network |
$3,112.48
|
| Rate for Payer: Quartz Commercial |
$3,811.20
|
| Rate for Payer: WEA Trust Commercial |
$3,493.60
|
| Rate for Payer: WPS Commercial |
$4,704.93
|
|
|
PLATE CLAVICLE SUPERIOR 3.5 LCP 8 HOLE RIGHT 02.112.084
|
Facility
|
OP
|
$6,861.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494345
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,921.08 |
| Max. Negotiated Rate |
$27,444.00 |
| Rate for Payer: Aetna Commercial |
$6,174.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,900.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,921.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,459.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,430.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,293.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,636.33
|
| Rate for Payer: Cash Price |
$2,058.30
|
| Rate for Payer: Cigna Commercial |
$6,312.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,839.42
|
| Rate for Payer: Health EOS Commercial |
$6,106.29
|
| Rate for Payer: HFN Commercial |
$6,312.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,145.75
|
| Rate for Payer: Multiplan Commercial |
$5,488.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,116.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,312.12
|
| Rate for Payer: Quartz Beloit One Network |
$3,361.89
|
| Rate for Payer: Quartz Commercial |
$4,459.65
|
| Rate for Payer: Quartz Medicare Advantage |
$4,116.60
|
| Rate for Payer: The Alliance Commercial |
$27,444.00
|
| Rate for Payer: WEA Trust Commercial |
$3,773.55
|
| Rate for Payer: WPS Commercial |
$5,081.94
|
|
|
PLATE CLAVICLE SUPERIOR 3.5 LCP 8 HOLE RIGHT 02.112.084
|
Facility
|
IP
|
$6,861.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494345
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,361.89 |
| Max. Negotiated Rate |
$6,312.12 |
| Rate for Payer: Aetna Commercial |
$6,174.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,900.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,636.33
|
| Rate for Payer: Cash Price |
$2,058.30
|
| Rate for Payer: Cigna Commercial |
$6,312.12
|
| Rate for Payer: Health EOS Commercial |
$6,106.29
|
| Rate for Payer: HFN Commercial |
$6,312.12
|
| Rate for Payer: Multiplan Commercial |
$5,488.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,116.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,312.12
|
| Rate for Payer: Quartz Beloit One Network |
$3,361.89
|
| Rate for Payer: Quartz Commercial |
$4,116.60
|
| Rate for Payer: WEA Trust Commercial |
$3,773.55
|
| Rate for Payer: WPS Commercial |
$5,081.94
|
|
|
PLATE CLAVICLE SUPERIOR ANTERIOR 3.5 4HOLE LEFT 02.112.011S
|
Facility
|
IP
|
$6,184.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5106889
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,030.16 |
| Max. Negotiated Rate |
$5,689.28 |
| Rate for Payer: Aetna Commercial |
$5,565.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,318.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,277.52
|
| Rate for Payer: Cash Price |
$1,855.20
|
| Rate for Payer: Cigna Commercial |
$5,689.28
|
| Rate for Payer: Health EOS Commercial |
$5,503.76
|
| Rate for Payer: HFN Commercial |
$5,689.28
|
| Rate for Payer: Multiplan Commercial |
$4,947.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,710.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,689.28
|
| Rate for Payer: Quartz Beloit One Network |
$3,030.16
|
| Rate for Payer: Quartz Commercial |
$3,710.40
|
| Rate for Payer: WEA Trust Commercial |
$3,401.20
|
| Rate for Payer: WPS Commercial |
$4,580.49
|
|
|
PLATE CLAVICLE SUPERIOR ANTERIOR 3.5 4HOLE LEFT 02.112.011S
|
Facility
|
OP
|
$6,184.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5106889
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,731.52 |
| Max. Negotiated Rate |
$24,736.00 |
| Rate for Payer: Aetna Commercial |
$5,565.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,318.24
|
| Rate for Payer: Aetna Managed Medicare |
$1,731.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,019.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,092.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,968.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,277.52
|
| Rate for Payer: Cash Price |
$1,855.20
|
| Rate for Payer: Cigna Commercial |
$5,689.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,460.57
|
| Rate for Payer: Health EOS Commercial |
$5,503.76
|
| Rate for Payer: HFN Commercial |
$5,689.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,638.00
|
| Rate for Payer: Multiplan Commercial |
$4,947.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,710.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,689.28
|
| Rate for Payer: Quartz Beloit One Network |
$3,030.16
|
| Rate for Payer: Quartz Commercial |
$4,019.60
|
| Rate for Payer: Quartz Medicare Advantage |
$3,710.40
|
| Rate for Payer: The Alliance Commercial |
$24,736.00
|
| Rate for Payer: WEA Trust Commercial |
$3,401.20
|
| Rate for Payer: WPS Commercial |
$4,580.49
|
|
|
PLATE CLAVICLE SUPERIOR ANTERIOR 3.5 5HOLE RIGHT 02.112.012
|
Facility
|
IP
|
$6,121.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459569
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,999.29 |
| Max. Negotiated Rate |
$5,631.32 |
| Rate for Payer: Aetna Commercial |
$5,508.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,264.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,244.13
|
| Rate for Payer: Cash Price |
$1,836.30
|
| Rate for Payer: Cigna Commercial |
$5,631.32
|
| Rate for Payer: Health EOS Commercial |
$5,447.69
|
| Rate for Payer: HFN Commercial |
$5,631.32
|
| Rate for Payer: Multiplan Commercial |
$4,896.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,672.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,631.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,999.29
|
| Rate for Payer: Quartz Commercial |
$3,672.60
|
| Rate for Payer: WEA Trust Commercial |
$3,366.55
|
| Rate for Payer: WPS Commercial |
$4,533.82
|
|
|
PLATE CLAVICLE SUPERIOR ANTERIOR 3.5 5HOLE RIGHT 02.112.012
|
Facility
|
OP
|
$6,121.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459569
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,713.88 |
| Max. Negotiated Rate |
$24,484.00 |
| Rate for Payer: Aetna Commercial |
$5,508.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,264.06
|
| Rate for Payer: Aetna Managed Medicare |
$1,713.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,978.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,060.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,938.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,244.13
|
| Rate for Payer: Cash Price |
$1,836.30
|
| Rate for Payer: Cigna Commercial |
$5,631.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,425.31
|
| Rate for Payer: Health EOS Commercial |
$5,447.69
|
| Rate for Payer: HFN Commercial |
$5,631.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,590.75
|
| Rate for Payer: Multiplan Commercial |
$4,896.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,672.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,631.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,999.29
|
| Rate for Payer: Quartz Commercial |
$3,978.65
|
| Rate for Payer: Quartz Medicare Advantage |
$3,672.60
|
| Rate for Payer: The Alliance Commercial |
$24,484.00
|
| Rate for Payer: WEA Trust Commercial |
$3,366.55
|
| Rate for Payer: WPS Commercial |
$4,533.82
|
|
|
PLATE CLAVICLE SUPERIOR ANTERIOR 3.5 7HOLE LEFT 02.112.019S
|
Facility
|
IP
|
$7,083.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3323494
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,470.67 |
| Max. Negotiated Rate |
$6,516.36 |
| Rate for Payer: Aetna Commercial |
$6,374.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,091.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,753.99
|
| Rate for Payer: Cash Price |
$2,124.90
|
| Rate for Payer: Cigna Commercial |
$6,516.36
|
| Rate for Payer: Health EOS Commercial |
$6,303.87
|
| Rate for Payer: HFN Commercial |
$6,516.36
|
| Rate for Payer: Multiplan Commercial |
$5,666.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,249.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,516.36
|
| Rate for Payer: Quartz Beloit One Network |
$3,470.67
|
| Rate for Payer: Quartz Commercial |
$4,249.80
|
| Rate for Payer: WEA Trust Commercial |
$3,895.65
|
| Rate for Payer: WPS Commercial |
$5,246.38
|
|
|
PLATE CLAVICLE SUPERIOR ANTERIOR 3.5 7HOLE LEFT 02.112.019S
|
Facility
|
OP
|
$7,083.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3323494
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,983.24 |
| Max. Negotiated Rate |
$28,332.00 |
| Rate for Payer: Aetna Commercial |
$6,374.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,091.38
|
| Rate for Payer: Aetna Managed Medicare |
$1,983.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,603.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,541.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,399.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,753.99
|
| Rate for Payer: Cash Price |
$2,124.90
|
| Rate for Payer: Cigna Commercial |
$6,516.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,963.65
|
| Rate for Payer: Health EOS Commercial |
$6,303.87
|
| Rate for Payer: HFN Commercial |
$6,516.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,312.25
|
| Rate for Payer: Multiplan Commercial |
$5,666.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,249.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,516.36
|
| Rate for Payer: Quartz Beloit One Network |
$3,470.67
|
| Rate for Payer: Quartz Commercial |
$4,603.95
|
| Rate for Payer: Quartz Medicare Advantage |
$4,249.80
|
| Rate for Payer: The Alliance Commercial |
$28,332.00
|
| Rate for Payer: WEA Trust Commercial |
$3,895.65
|
| Rate for Payer: WPS Commercial |
$5,246.38
|
|
|
PLATE CLAVICLE SUPERIOR LATERAL ELTERNAL 6HL LT 02.112.091S
|
Facility
|
OP
|
$6,192.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3451515
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,733.76 |
| Max. Negotiated Rate |
$24,768.00 |
| Rate for Payer: Aetna Commercial |
$5,572.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,325.12
|
| Rate for Payer: Aetna Managed Medicare |
$1,733.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,024.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,096.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,972.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,281.76
|
| Rate for Payer: Cash Price |
$1,857.60
|
| Rate for Payer: Cigna Commercial |
$5,696.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,465.04
|
| Rate for Payer: Health EOS Commercial |
$5,510.88
|
| Rate for Payer: HFN Commercial |
$5,696.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,644.00
|
| Rate for Payer: Multiplan Commercial |
$4,953.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,715.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,696.64
|
| Rate for Payer: Quartz Beloit One Network |
$3,034.08
|
| Rate for Payer: Quartz Commercial |
$4,024.80
|
| Rate for Payer: Quartz Medicare Advantage |
$3,715.20
|
| Rate for Payer: The Alliance Commercial |
$24,768.00
|
| Rate for Payer: WEA Trust Commercial |
$3,405.60
|
| Rate for Payer: WPS Commercial |
$4,586.41
|
|
|
PLATE CLAVICLE SUPERIOR LATERAL ELTERNAL 6HL LT 02.112.091S
|
Facility
|
IP
|
$6,192.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3451515
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,034.08 |
| Max. Negotiated Rate |
$5,696.64 |
| Rate for Payer: Aetna Commercial |
$5,572.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,325.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,281.76
|
| Rate for Payer: Cash Price |
$1,857.60
|
| Rate for Payer: Cigna Commercial |
$5,696.64
|
| Rate for Payer: Health EOS Commercial |
$5,510.88
|
| Rate for Payer: HFN Commercial |
$5,696.64
|
| Rate for Payer: Multiplan Commercial |
$4,953.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,715.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,696.64
|
| Rate for Payer: Quartz Beloit One Network |
$3,034.08
|
| Rate for Payer: Quartz Commercial |
$3,715.20
|
| Rate for Payer: WEA Trust Commercial |
$3,405.60
|
| Rate for Payer: WPS Commercial |
$4,586.41
|
|
|
PLATE CLAVICLE SUPERIOR LATERAL ELTERNAL 7HL LT 02.112.092S
|
Facility
|
IP
|
$6,507.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4520178
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,188.43 |
| Max. Negotiated Rate |
$5,986.44 |
| Rate for Payer: Aetna Commercial |
$5,856.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,596.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,448.71
|
| Rate for Payer: Cash Price |
$1,952.10
|
| Rate for Payer: Cigna Commercial |
$5,986.44
|
| Rate for Payer: Health EOS Commercial |
$5,791.23
|
| Rate for Payer: HFN Commercial |
$5,986.44
|
| Rate for Payer: Multiplan Commercial |
$5,205.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,904.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,986.44
|
| Rate for Payer: Quartz Beloit One Network |
$3,188.43
|
| Rate for Payer: Quartz Commercial |
$3,904.20
|
| Rate for Payer: WEA Trust Commercial |
$3,578.85
|
| Rate for Payer: WPS Commercial |
$4,819.73
|
|
|
PLATE CLAVICLE SUPERIOR LATERAL ELTERNAL 7HL LT 02.112.092S
|
Facility
|
OP
|
$6,507.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4520178
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,821.96 |
| Max. Negotiated Rate |
$26,028.00 |
| Rate for Payer: Aetna Commercial |
$5,856.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,596.02
|
| Rate for Payer: Aetna Managed Medicare |
$1,821.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,229.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,253.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,123.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,448.71
|
| Rate for Payer: Cash Price |
$1,952.10
|
| Rate for Payer: Cigna Commercial |
$5,986.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,641.32
|
| Rate for Payer: Health EOS Commercial |
$5,791.23
|
| Rate for Payer: HFN Commercial |
$5,986.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,880.25
|
| Rate for Payer: Multiplan Commercial |
$5,205.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,904.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,986.44
|
| Rate for Payer: Quartz Beloit One Network |
$3,188.43
|
| Rate for Payer: Quartz Commercial |
$4,229.55
|
| Rate for Payer: Quartz Medicare Advantage |
$3,904.20
|
| Rate for Payer: The Alliance Commercial |
$26,028.00
|
| Rate for Payer: WEA Trust Commercial |
$3,578.85
|
| Rate for Payer: WPS Commercial |
$4,819.73
|
|
|
PLATE CLAVICLE SUPERIOR LATERAL EXTERNAL 8HL LT 02.112.095S
|
Facility
|
IP
|
$6,121.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5384888
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,999.29 |
| Max. Negotiated Rate |
$5,631.32 |
| Rate for Payer: Aetna Commercial |
$5,508.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,264.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,244.13
|
| Rate for Payer: Cash Price |
$1,836.30
|
| Rate for Payer: Cigna Commercial |
$5,631.32
|
| Rate for Payer: Health EOS Commercial |
$5,447.69
|
| Rate for Payer: HFN Commercial |
$5,631.32
|
| Rate for Payer: Multiplan Commercial |
$4,896.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,672.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,631.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,999.29
|
| Rate for Payer: Quartz Commercial |
$3,672.60
|
| Rate for Payer: WEA Trust Commercial |
$3,366.55
|
| Rate for Payer: WPS Commercial |
$4,533.82
|
|
|
PLATE CLAVICLE SUPERIOR LATERAL EXTERNAL 8HL LT 02.112.095S
|
Facility
|
OP
|
$6,121.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5384888
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,713.88 |
| Max. Negotiated Rate |
$24,484.00 |
| Rate for Payer: Aetna Commercial |
$5,508.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,264.06
|
| Rate for Payer: Aetna Managed Medicare |
$1,713.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,978.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,060.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,938.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,244.13
|
| Rate for Payer: Cash Price |
$1,836.30
|
| Rate for Payer: Cigna Commercial |
$5,631.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,425.31
|
| Rate for Payer: Health EOS Commercial |
$5,447.69
|
| Rate for Payer: HFN Commercial |
$5,631.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,590.75
|
| Rate for Payer: Multiplan Commercial |
$4,896.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,672.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,631.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,999.29
|
| Rate for Payer: Quartz Commercial |
$3,978.65
|
| Rate for Payer: Quartz Medicare Advantage |
$3,672.60
|
| Rate for Payer: The Alliance Commercial |
$24,484.00
|
| Rate for Payer: WEA Trust Commercial |
$3,366.55
|
| Rate for Payer: WPS Commercial |
$4,533.82
|
|
|
PLATE CLAVICLE SUPEROR DECREASED CURVATURE 8 HOLE BRIDGE / LEFT 628048
|
Facility
|
IP
|
$5,528.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6178000
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,708.72 |
| Max. Negotiated Rate |
$5,085.76 |
| Rate for Payer: Aetna Commercial |
$4,975.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,754.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,929.84
|
| Rate for Payer: Cash Price |
$1,658.40
|
| Rate for Payer: Cigna Commercial |
$5,085.76
|
| Rate for Payer: Health EOS Commercial |
$4,919.92
|
| Rate for Payer: HFN Commercial |
$5,085.76
|
| Rate for Payer: Multiplan Commercial |
$4,422.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,316.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,085.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,708.72
|
| Rate for Payer: Quartz Commercial |
$3,316.80
|
| Rate for Payer: WEA Trust Commercial |
$3,040.40
|
| Rate for Payer: WPS Commercial |
$4,094.59
|
|
|
PLATE CLAVICLE SUPEROR DECREASED CURVATURE 8 HOLE BRIDGE / LEFT 628048
|
Facility
|
OP
|
$5,528.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6178000
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,547.84 |
| Max. Negotiated Rate |
$22,112.00 |
| Rate for Payer: Aetna Commercial |
$4,975.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,754.08
|
| Rate for Payer: Aetna Managed Medicare |
$1,547.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,593.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,764.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,653.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,929.84
|
| Rate for Payer: Cash Price |
$1,658.40
|
| Rate for Payer: Cigna Commercial |
$5,085.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,093.47
|
| Rate for Payer: Health EOS Commercial |
$4,919.92
|
| Rate for Payer: HFN Commercial |
$5,085.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,146.00
|
| Rate for Payer: Multiplan Commercial |
$4,422.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,316.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,085.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,708.72
|
| Rate for Payer: Quartz Commercial |
$3,593.20
|
| Rate for Payer: Quartz Medicare Advantage |
$3,316.80
|
| Rate for Payer: The Alliance Commercial |
$22,112.00
|
| Rate for Payer: WEA Trust Commercial |
$3,040.40
|
| Rate for Payer: WPS Commercial |
$4,094.59
|
|
|
PLATE CLOVERLEAF 3HL 241.83
|
Facility
|
OP
|
$1,172.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966758
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$328.16 |
| Max. Negotiated Rate |
$4,688.00 |
| Rate for Payer: Aetna Commercial |
$1,054.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,007.92
|
| Rate for Payer: Aetna Managed Medicare |
$328.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$761.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$562.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$621.16
|
| Rate for Payer: Cash Price |
$351.60
|
| Rate for Payer: Cigna Commercial |
$1,078.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$655.85
|
| Rate for Payer: Health EOS Commercial |
$1,043.08
|
| Rate for Payer: HFN Commercial |
$1,078.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$879.00
|
| Rate for Payer: Multiplan Commercial |
$937.60
|
| Rate for Payer: NAPHCARE Commercial |
$703.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,078.24
|
| Rate for Payer: Quartz Beloit One Network |
$574.28
|
| Rate for Payer: Quartz Commercial |
$761.80
|
| Rate for Payer: Quartz Medicare Advantage |
$703.20
|
| Rate for Payer: The Alliance Commercial |
$4,688.00
|
| Rate for Payer: WEA Trust Commercial |
$644.60
|
| Rate for Payer: WPS Commercial |
$868.10
|
|
|
PLATE CLOVERLEAF 3HL 241.83
|
Facility
|
IP
|
$1,172.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966758
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$574.28 |
| Max. Negotiated Rate |
$1,078.24 |
| Rate for Payer: Aetna Commercial |
$1,054.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,007.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$621.16
|
| Rate for Payer: Cash Price |
$351.60
|
| Rate for Payer: Cigna Commercial |
$1,078.24
|
| Rate for Payer: Health EOS Commercial |
$1,043.08
|
| Rate for Payer: HFN Commercial |
$1,078.24
|
| Rate for Payer: Multiplan Commercial |
$937.60
|
| Rate for Payer: NAPHCARE Commercial |
$703.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,078.24
|
| Rate for Payer: Quartz Beloit One Network |
$574.28
|
| Rate for Payer: Quartz Commercial |
$703.20
|
| Rate for Payer: WEA Trust Commercial |
$644.60
|
| Rate for Payer: WPS Commercial |
$868.10
|
|
|
PLATE CONDYLAR 2.0 7HL 247.349
|
Facility
|
IP
|
$5,277.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767798
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,585.73 |
| Max. Negotiated Rate |
$4,854.84 |
| Rate for Payer: Aetna Commercial |
$4,749.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,538.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,796.81
|
| Rate for Payer: Cash Price |
$1,583.10
|
| Rate for Payer: Cigna Commercial |
$4,854.84
|
| Rate for Payer: Health EOS Commercial |
$4,696.53
|
| Rate for Payer: HFN Commercial |
$4,854.84
|
| Rate for Payer: Multiplan Commercial |
$4,221.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,166.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,854.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,585.73
|
| Rate for Payer: Quartz Commercial |
$3,166.20
|
| Rate for Payer: WEA Trust Commercial |
$2,902.35
|
| Rate for Payer: WPS Commercial |
$3,908.67
|
|
