|
PLATE CLAVICLE 3.5MM 6HL RT 02.112.008
|
Facility
|
OP
|
$5,116.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414899
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,489.78 |
| Max. Negotiated Rate |
$4,894.99 |
| Rate for Payer: Aetna Commercial |
$4,788.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,575.75
|
| Rate for Payer: Aetna Managed Medicare |
$1,489.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,458.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,660.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,553.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,819.94
|
| Rate for Payer: Cash Price |
$1,534.80
|
| Rate for Payer: Cigna Commercial |
$4,894.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,977.51
|
| Rate for Payer: Health EOS Commercial |
$4,735.37
|
| Rate for Payer: HFN Commercial |
$4,894.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,990.48
|
| Rate for Payer: Multiplan Commercial |
$4,256.51
|
| Rate for Payer: NAPHCARE Commercial |
$3,192.38
|
| Rate for Payer: Preferred Network Access Commercial |
$4,894.99
|
| Rate for Payer: Quartz Beloit One Network |
$2,607.11
|
| Rate for Payer: Quartz Commercial |
$3,458.42
|
| Rate for Payer: Quartz Medicare Advantage |
$3,192.38
|
| Rate for Payer: The Alliance Commercial |
$2,660.32
|
| Rate for Payer: WEA Trust Commercial |
$2,926.35
|
| Rate for Payer: WPS Commercial |
$3,940.85
|
|
|
PLATE CLAVICLE 7 HOLE
|
Facility
|
IP
|
$8,997.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966362
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,584.87 |
| Max. Negotiated Rate |
$8,608.33 |
| Rate for Payer: Aetna Commercial |
$8,421.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,046.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,959.15
|
| Rate for Payer: Cash Price |
$2,699.10
|
| Rate for Payer: Cigna Commercial |
$8,608.33
|
| Rate for Payer: Health EOS Commercial |
$8,327.62
|
| Rate for Payer: HFN Commercial |
$8,608.33
|
| Rate for Payer: Multiplan Commercial |
$7,485.50
|
| Rate for Payer: Preferred Network Access Commercial |
$8,608.33
|
| Rate for Payer: Quartz Beloit One Network |
$4,584.87
|
| Rate for Payer: Quartz Commercial |
$5,614.13
|
| Rate for Payer: WEA Trust Commercial |
$5,146.28
|
| Rate for Payer: WPS Commercial |
$6,930.39
|
|
|
PLATE CLAVICLE 7 HOLE
|
Facility
|
OP
|
$8,997.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966362
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,619.93 |
| Max. Negotiated Rate |
$8,608.33 |
| Rate for Payer: Aetna Commercial |
$8,421.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,046.92
|
| Rate for Payer: Aetna Managed Medicare |
$2,619.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,081.97
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,678.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,491.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,959.15
|
| Rate for Payer: Cash Price |
$2,699.10
|
| Rate for Payer: Cigna Commercial |
$8,608.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,236.25
|
| Rate for Payer: Health EOS Commercial |
$8,327.62
|
| Rate for Payer: HFN Commercial |
$8,608.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,017.66
|
| Rate for Payer: Multiplan Commercial |
$7,485.50
|
| Rate for Payer: NAPHCARE Commercial |
$5,614.13
|
| Rate for Payer: Preferred Network Access Commercial |
$8,608.33
|
| Rate for Payer: Quartz Beloit One Network |
$4,584.87
|
| Rate for Payer: Quartz Commercial |
$6,081.97
|
| Rate for Payer: Quartz Medicare Advantage |
$5,614.13
|
| Rate for Payer: The Alliance Commercial |
$4,678.44
|
| Rate for Payer: WEA Trust Commercial |
$5,146.28
|
| Rate for Payer: WPS Commercial |
$6,930.39
|
|
|
PLATE CLAVICLE 8 HOLE
|
Facility
|
IP
|
$6,153.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966363
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,135.57 |
| Max. Negotiated Rate |
$5,887.19 |
| Rate for Payer: Aetna Commercial |
$5,759.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,503.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,391.53
|
| Rate for Payer: Cash Price |
$1,845.90
|
| Rate for Payer: Cigna Commercial |
$5,887.19
|
| Rate for Payer: Health EOS Commercial |
$5,695.22
|
| Rate for Payer: HFN Commercial |
$5,887.19
|
| Rate for Payer: Multiplan Commercial |
$5,119.30
|
| Rate for Payer: Preferred Network Access Commercial |
$5,887.19
|
| Rate for Payer: Quartz Beloit One Network |
$3,135.57
|
| Rate for Payer: Quartz Commercial |
$3,839.47
|
| Rate for Payer: WEA Trust Commercial |
$3,519.52
|
| Rate for Payer: WPS Commercial |
$4,739.66
|
|
|
PLATE CLAVICLE 8 HOLE
|
Facility
|
OP
|
$6,153.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966363
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,791.75 |
| Max. Negotiated Rate |
$5,887.19 |
| Rate for Payer: Aetna Commercial |
$5,759.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,503.24
|
| Rate for Payer: Aetna Managed Medicare |
$1,791.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,159.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,199.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,071.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,391.53
|
| Rate for Payer: Cash Price |
$1,845.90
|
| Rate for Payer: Cigna Commercial |
$5,887.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,581.05
|
| Rate for Payer: Health EOS Commercial |
$5,695.22
|
| Rate for Payer: HFN Commercial |
$5,887.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,799.34
|
| Rate for Payer: Multiplan Commercial |
$5,119.30
|
| Rate for Payer: NAPHCARE Commercial |
$3,839.47
|
| Rate for Payer: Preferred Network Access Commercial |
$5,887.19
|
| Rate for Payer: Quartz Beloit One Network |
$3,135.57
|
| Rate for Payer: Quartz Commercial |
$4,159.43
|
| Rate for Payer: Quartz Medicare Advantage |
$3,839.47
|
| Rate for Payer: The Alliance Commercial |
$3,199.56
|
| Rate for Payer: WEA Trust Commercial |
$3,519.52
|
| Rate for Payer: WPS Commercial |
$4,739.66
|
|
|
PLATE CLAVICLE MIDSHAFT SUPEROR DECREASED CURVATURE 6 HOLE BRIDGE 628046
|
Facility
|
IP
|
$5,530.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6151689
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,818.09 |
| Max. Negotiated Rate |
$5,291.10 |
| Rate for Payer: Aetna Commercial |
$5,176.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,946.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,048.14
|
| Rate for Payer: Cash Price |
$1,659.00
|
| Rate for Payer: Cigna Commercial |
$5,291.10
|
| Rate for Payer: Health EOS Commercial |
$5,118.57
|
| Rate for Payer: HFN Commercial |
$5,291.10
|
| Rate for Payer: Multiplan Commercial |
$4,600.96
|
| Rate for Payer: Preferred Network Access Commercial |
$5,291.10
|
| Rate for Payer: Quartz Beloit One Network |
$2,818.09
|
| Rate for Payer: Quartz Commercial |
$3,450.72
|
| Rate for Payer: WEA Trust Commercial |
$3,163.16
|
| Rate for Payer: WPS Commercial |
$4,259.76
|
|
|
PLATE CLAVICLE MIDSHAFT SUPEROR DECREASED CURVATURE 6 HOLE BRIDGE 628046
|
Facility
|
OP
|
$5,530.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6151689
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,610.34 |
| Max. Negotiated Rate |
$5,291.10 |
| Rate for Payer: Aetna Commercial |
$5,176.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,946.03
|
| Rate for Payer: Aetna Managed Medicare |
$1,610.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,738.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,875.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,760.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,048.14
|
| Rate for Payer: Cash Price |
$1,659.00
|
| Rate for Payer: Cigna Commercial |
$5,291.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,218.46
|
| Rate for Payer: Health EOS Commercial |
$5,118.57
|
| Rate for Payer: HFN Commercial |
$5,291.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,313.40
|
| Rate for Payer: Multiplan Commercial |
$4,600.96
|
| Rate for Payer: NAPHCARE Commercial |
$3,450.72
|
| Rate for Payer: Preferred Network Access Commercial |
$5,291.10
|
| Rate for Payer: Quartz Beloit One Network |
$2,818.09
|
| Rate for Payer: Quartz Commercial |
$3,738.28
|
| Rate for Payer: Quartz Medicare Advantage |
$3,450.72
|
| Rate for Payer: The Alliance Commercial |
$2,875.60
|
| Rate for Payer: WEA Trust Commercial |
$3,163.16
|
| Rate for Payer: WPS Commercial |
$4,259.76
|
|
|
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 |
$2,056.45 |
| Max. Negotiated Rate |
$6,756.92 |
| Rate for Payer: Aetna Commercial |
$6,610.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,316.25
|
| Rate for Payer: Aetna Managed Medicare |
$2,056.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,773.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,672.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,525.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,892.57
|
| Rate for Payer: Cash Price |
$2,118.60
|
| Rate for Payer: Cigna Commercial |
$6,756.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,110.08
|
| Rate for Payer: Health EOS Commercial |
$6,536.59
|
| Rate for Payer: HFN Commercial |
$6,756.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,508.36
|
| Rate for Payer: Multiplan Commercial |
$5,875.58
|
| Rate for Payer: NAPHCARE Commercial |
$4,406.69
|
| Rate for Payer: Preferred Network Access Commercial |
$6,756.92
|
| Rate for Payer: Quartz Beloit One Network |
$3,598.80
|
| Rate for Payer: Quartz Commercial |
$4,773.91
|
| Rate for Payer: Quartz Medicare Advantage |
$4,406.69
|
| Rate for Payer: The Alliance Commercial |
$3,672.24
|
| Rate for Payer: WEA Trust Commercial |
$4,039.46
|
| Rate for Payer: WPS Commercial |
$5,439.86
|
|
|
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 |
$3,598.80 |
| Max. Negotiated Rate |
$6,756.92 |
| Rate for Payer: Aetna Commercial |
$6,610.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,316.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,892.57
|
| Rate for Payer: Cash Price |
$2,118.60
|
| Rate for Payer: Cigna Commercial |
$6,756.92
|
| Rate for Payer: Health EOS Commercial |
$6,536.59
|
| Rate for Payer: HFN Commercial |
$6,756.92
|
| Rate for Payer: Multiplan Commercial |
$5,875.58
|
| Rate for Payer: Preferred Network Access Commercial |
$6,756.92
|
| Rate for Payer: Quartz Beloit One Network |
$3,598.80
|
| Rate for Payer: Quartz Commercial |
$4,406.69
|
| Rate for Payer: WEA Trust Commercial |
$4,039.46
|
| Rate for Payer: WPS Commercial |
$5,439.86
|
|
|
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 |
$3,236.98 |
| Max. Negotiated Rate |
$6,077.59 |
| Rate for Payer: Aetna Commercial |
$5,945.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,681.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,501.22
|
| Rate for Payer: Cash Price |
$1,905.60
|
| Rate for Payer: Cigna Commercial |
$6,077.59
|
| Rate for Payer: Health EOS Commercial |
$5,879.41
|
| Rate for Payer: HFN Commercial |
$6,077.59
|
| Rate for Payer: Multiplan Commercial |
$5,284.86
|
| Rate for Payer: Preferred Network Access Commercial |
$6,077.59
|
| Rate for Payer: Quartz Beloit One Network |
$3,236.98
|
| Rate for Payer: Quartz Commercial |
$3,963.65
|
| Rate for Payer: WEA Trust Commercial |
$3,633.34
|
| Rate for Payer: WPS Commercial |
$4,892.95
|
|
|
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 |
$1,849.70 |
| Max. Negotiated Rate |
$6,077.59 |
| Rate for Payer: Aetna Commercial |
$5,945.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,681.23
|
| Rate for Payer: Aetna Managed Medicare |
$1,849.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,293.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,303.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,170.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,501.22
|
| Rate for Payer: Cash Price |
$1,905.60
|
| Rate for Payer: Cigna Commercial |
$6,077.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,696.86
|
| Rate for Payer: Health EOS Commercial |
$5,879.41
|
| Rate for Payer: HFN Commercial |
$6,077.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,954.56
|
| Rate for Payer: Multiplan Commercial |
$5,284.86
|
| Rate for Payer: NAPHCARE Commercial |
$3,963.65
|
| Rate for Payer: Preferred Network Access Commercial |
$6,077.59
|
| Rate for Payer: Quartz Beloit One Network |
$3,236.98
|
| Rate for Payer: Quartz Commercial |
$4,293.95
|
| Rate for Payer: Quartz Medicare Advantage |
$3,963.65
|
| Rate for Payer: The Alliance Commercial |
$3,303.04
|
| Rate for Payer: WEA Trust Commercial |
$3,633.34
|
| Rate for Payer: WPS Commercial |
$4,892.95
|
|
|
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 |
$3,236.98 |
| Max. Negotiated Rate |
$6,077.59 |
| Rate for Payer: Aetna Commercial |
$5,945.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,681.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,501.22
|
| Rate for Payer: Cash Price |
$1,905.60
|
| Rate for Payer: Cigna Commercial |
$6,077.59
|
| Rate for Payer: Health EOS Commercial |
$5,879.41
|
| Rate for Payer: HFN Commercial |
$6,077.59
|
| Rate for Payer: Multiplan Commercial |
$5,284.86
|
| Rate for Payer: Preferred Network Access Commercial |
$6,077.59
|
| Rate for Payer: Quartz Beloit One Network |
$3,236.98
|
| Rate for Payer: Quartz Commercial |
$3,963.65
|
| Rate for Payer: WEA Trust Commercial |
$3,633.34
|
| Rate for Payer: WPS Commercial |
$4,892.95
|
|
|
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 |
$1,849.70 |
| Max. Negotiated Rate |
$6,077.59 |
| Rate for Payer: Aetna Commercial |
$5,945.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,681.23
|
| Rate for Payer: Aetna Managed Medicare |
$1,849.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,293.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,303.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,170.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,501.22
|
| Rate for Payer: Cash Price |
$1,905.60
|
| Rate for Payer: Cigna Commercial |
$6,077.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,696.86
|
| Rate for Payer: Health EOS Commercial |
$5,879.41
|
| Rate for Payer: HFN Commercial |
$6,077.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,954.56
|
| Rate for Payer: Multiplan Commercial |
$5,284.86
|
| Rate for Payer: NAPHCARE Commercial |
$3,963.65
|
| Rate for Payer: Preferred Network Access Commercial |
$6,077.59
|
| Rate for Payer: Quartz Beloit One Network |
$3,236.98
|
| Rate for Payer: Quartz Commercial |
$4,293.95
|
| Rate for Payer: Quartz Medicare Advantage |
$3,963.65
|
| Rate for Payer: The Alliance Commercial |
$3,303.04
|
| Rate for Payer: WEA Trust Commercial |
$3,633.34
|
| Rate for Payer: WPS Commercial |
$4,892.95
|
|
|
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 |
$1,997.92 |
| Max. Negotiated Rate |
$6,564.60 |
| Rate for Payer: Aetna Commercial |
$6,421.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,136.48
|
| Rate for Payer: Aetna Managed Medicare |
$1,997.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,638.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,567.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,425.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,781.78
|
| Rate for Payer: Cash Price |
$2,058.30
|
| Rate for Payer: Cigna Commercial |
$6,564.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,993.10
|
| Rate for Payer: Health EOS Commercial |
$6,350.54
|
| Rate for Payer: HFN Commercial |
$6,564.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,351.58
|
| Rate for Payer: Multiplan Commercial |
$5,708.35
|
| Rate for Payer: NAPHCARE Commercial |
$4,281.26
|
| Rate for Payer: Preferred Network Access Commercial |
$6,564.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,496.37
|
| Rate for Payer: Quartz Commercial |
$4,638.04
|
| Rate for Payer: Quartz Medicare Advantage |
$4,281.26
|
| Rate for Payer: The Alliance Commercial |
$3,567.72
|
| Rate for Payer: WEA Trust Commercial |
$3,924.49
|
| Rate for Payer: WPS Commercial |
$5,285.03
|
|
|
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 |
$3,496.37 |
| Max. Negotiated Rate |
$6,564.60 |
| Rate for Payer: Aetna Commercial |
$6,421.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,136.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,781.78
|
| Rate for Payer: Cash Price |
$2,058.30
|
| Rate for Payer: Cigna Commercial |
$6,564.60
|
| Rate for Payer: Health EOS Commercial |
$6,350.54
|
| Rate for Payer: HFN Commercial |
$6,564.60
|
| Rate for Payer: Multiplan Commercial |
$5,708.35
|
| Rate for Payer: Preferred Network Access Commercial |
$6,564.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,496.37
|
| Rate for Payer: Quartz Commercial |
$4,281.26
|
| Rate for Payer: WEA Trust Commercial |
$3,924.49
|
| Rate for Payer: WPS Commercial |
$5,285.03
|
|
|
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 |
$3,151.37 |
| Max. Negotiated Rate |
$5,916.85 |
| Rate for Payer: Aetna Commercial |
$5,788.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,530.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,408.62
|
| Rate for Payer: Cash Price |
$1,855.20
|
| Rate for Payer: Cigna Commercial |
$5,916.85
|
| Rate for Payer: Health EOS Commercial |
$5,723.91
|
| Rate for Payer: HFN Commercial |
$5,916.85
|
| Rate for Payer: Multiplan Commercial |
$5,145.09
|
| Rate for Payer: Preferred Network Access Commercial |
$5,916.85
|
| Rate for Payer: Quartz Beloit One Network |
$3,151.37
|
| Rate for Payer: Quartz Commercial |
$3,858.82
|
| Rate for Payer: WEA Trust Commercial |
$3,537.25
|
| Rate for Payer: WPS Commercial |
$4,763.54
|
|
|
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 |
$1,800.78 |
| Max. Negotiated Rate |
$5,916.85 |
| Rate for Payer: Aetna Commercial |
$5,788.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,530.97
|
| Rate for Payer: Aetna Managed Medicare |
$1,800.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,180.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,215.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,087.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,408.62
|
| Rate for Payer: Cash Price |
$1,855.20
|
| Rate for Payer: Cigna Commercial |
$5,916.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,599.09
|
| Rate for Payer: Health EOS Commercial |
$5,723.91
|
| Rate for Payer: HFN Commercial |
$5,916.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,823.52
|
| Rate for Payer: Multiplan Commercial |
$5,145.09
|
| Rate for Payer: NAPHCARE Commercial |
$3,858.82
|
| Rate for Payer: Preferred Network Access Commercial |
$5,916.85
|
| Rate for Payer: Quartz Beloit One Network |
$3,151.37
|
| Rate for Payer: Quartz Commercial |
$4,180.38
|
| Rate for Payer: Quartz Medicare Advantage |
$3,858.82
|
| Rate for Payer: The Alliance Commercial |
$3,215.68
|
| Rate for Payer: WEA Trust Commercial |
$3,537.25
|
| Rate for Payer: WPS Commercial |
$4,763.54
|
|
|
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 |
$3,119.26 |
| Max. Negotiated Rate |
$5,856.57 |
| Rate for Payer: Aetna Commercial |
$5,729.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,474.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,373.90
|
| Rate for Payer: Cash Price |
$1,836.30
|
| Rate for Payer: Cigna Commercial |
$5,856.57
|
| Rate for Payer: Health EOS Commercial |
$5,665.60
|
| Rate for Payer: HFN Commercial |
$5,856.57
|
| Rate for Payer: Multiplan Commercial |
$5,092.67
|
| Rate for Payer: Preferred Network Access Commercial |
$5,856.57
|
| Rate for Payer: Quartz Beloit One Network |
$3,119.26
|
| Rate for Payer: Quartz Commercial |
$3,819.50
|
| Rate for Payer: WEA Trust Commercial |
$3,501.21
|
| Rate for Payer: WPS Commercial |
$4,715.01
|
|
|
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 |
$1,782.44 |
| Max. Negotiated Rate |
$5,856.57 |
| Rate for Payer: Aetna Commercial |
$5,729.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,474.62
|
| Rate for Payer: Aetna Managed Medicare |
$1,782.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,137.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,182.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,055.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,373.90
|
| Rate for Payer: Cash Price |
$1,836.30
|
| Rate for Payer: Cigna Commercial |
$5,856.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,562.42
|
| Rate for Payer: Health EOS Commercial |
$5,665.60
|
| Rate for Payer: HFN Commercial |
$5,856.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,774.38
|
| Rate for Payer: Multiplan Commercial |
$5,092.67
|
| Rate for Payer: NAPHCARE Commercial |
$3,819.50
|
| Rate for Payer: Preferred Network Access Commercial |
$5,856.57
|
| Rate for Payer: Quartz Beloit One Network |
$3,119.26
|
| Rate for Payer: Quartz Commercial |
$4,137.80
|
| Rate for Payer: Quartz Medicare Advantage |
$3,819.50
|
| Rate for Payer: The Alliance Commercial |
$3,182.92
|
| Rate for Payer: WEA Trust Commercial |
$3,501.21
|
| Rate for Payer: WPS Commercial |
$4,715.01
|
|
|
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 |
$3,609.50 |
| Max. Negotiated Rate |
$6,777.01 |
| Rate for Payer: Aetna Commercial |
$6,629.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,335.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,904.15
|
| Rate for Payer: Cash Price |
$2,124.90
|
| Rate for Payer: Cigna Commercial |
$6,777.01
|
| Rate for Payer: Health EOS Commercial |
$6,556.02
|
| Rate for Payer: HFN Commercial |
$6,777.01
|
| Rate for Payer: Multiplan Commercial |
$5,893.06
|
| Rate for Payer: Preferred Network Access Commercial |
$6,777.01
|
| Rate for Payer: Quartz Beloit One Network |
$3,609.50
|
| Rate for Payer: Quartz Commercial |
$4,419.79
|
| Rate for Payer: WEA Trust Commercial |
$4,051.48
|
| Rate for Payer: WPS Commercial |
$5,456.03
|
|
|
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 |
$2,062.57 |
| Max. Negotiated Rate |
$6,777.01 |
| Rate for Payer: Aetna Commercial |
$6,629.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,335.04
|
| Rate for Payer: Aetna Managed Medicare |
$2,062.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,788.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,683.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,535.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,904.15
|
| Rate for Payer: Cash Price |
$2,124.90
|
| Rate for Payer: Cigna Commercial |
$6,777.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,122.31
|
| Rate for Payer: Health EOS Commercial |
$6,556.02
|
| Rate for Payer: HFN Commercial |
$6,777.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,524.74
|
| Rate for Payer: Multiplan Commercial |
$5,893.06
|
| Rate for Payer: NAPHCARE Commercial |
$4,419.79
|
| Rate for Payer: Preferred Network Access Commercial |
$6,777.01
|
| Rate for Payer: Quartz Beloit One Network |
$3,609.50
|
| Rate for Payer: Quartz Commercial |
$4,788.11
|
| Rate for Payer: Quartz Medicare Advantage |
$4,419.79
|
| Rate for Payer: The Alliance Commercial |
$3,683.16
|
| Rate for Payer: WEA Trust Commercial |
$4,051.48
|
| Rate for Payer: WPS Commercial |
$5,456.03
|
|
|
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 |
$1,803.11 |
| Max. Negotiated Rate |
$5,924.51 |
| Rate for Payer: Aetna Commercial |
$5,795.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,538.12
|
| Rate for Payer: Aetna Managed Medicare |
$1,803.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,185.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,219.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,091.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,413.03
|
| Rate for Payer: Cash Price |
$1,857.60
|
| Rate for Payer: Cigna Commercial |
$5,924.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,603.74
|
| Rate for Payer: Health EOS Commercial |
$5,731.32
|
| Rate for Payer: HFN Commercial |
$5,924.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,829.76
|
| Rate for Payer: Multiplan Commercial |
$5,151.74
|
| Rate for Payer: NAPHCARE Commercial |
$3,863.81
|
| Rate for Payer: Preferred Network Access Commercial |
$5,924.51
|
| Rate for Payer: Quartz Beloit One Network |
$3,155.44
|
| Rate for Payer: Quartz Commercial |
$4,185.79
|
| Rate for Payer: Quartz Medicare Advantage |
$3,863.81
|
| Rate for Payer: The Alliance Commercial |
$3,219.84
|
| Rate for Payer: WEA Trust Commercial |
$3,541.82
|
| Rate for Payer: WPS Commercial |
$4,769.70
|
|
|
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 |
$3,155.44 |
| Max. Negotiated Rate |
$5,924.51 |
| Rate for Payer: Aetna Commercial |
$5,795.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,538.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,413.03
|
| Rate for Payer: Cash Price |
$1,857.60
|
| Rate for Payer: Cigna Commercial |
$5,924.51
|
| Rate for Payer: Health EOS Commercial |
$5,731.32
|
| Rate for Payer: HFN Commercial |
$5,924.51
|
| Rate for Payer: Multiplan Commercial |
$5,151.74
|
| Rate for Payer: Preferred Network Access Commercial |
$5,924.51
|
| Rate for Payer: Quartz Beloit One Network |
$3,155.44
|
| Rate for Payer: Quartz Commercial |
$3,863.81
|
| Rate for Payer: WEA Trust Commercial |
$3,541.82
|
| Rate for Payer: WPS Commercial |
$4,769.70
|
|
|
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 |
$3,315.97 |
| Max. Negotiated Rate |
$6,225.90 |
| Rate for Payer: Aetna Commercial |
$6,090.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,819.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,586.66
|
| Rate for Payer: Cash Price |
$1,952.10
|
| Rate for Payer: Cigna Commercial |
$6,225.90
|
| Rate for Payer: Health EOS Commercial |
$6,022.88
|
| Rate for Payer: HFN Commercial |
$6,225.90
|
| Rate for Payer: Multiplan Commercial |
$5,413.82
|
| Rate for Payer: Preferred Network Access Commercial |
$6,225.90
|
| Rate for Payer: Quartz Beloit One Network |
$3,315.97
|
| Rate for Payer: Quartz Commercial |
$4,060.37
|
| Rate for Payer: WEA Trust Commercial |
$3,722.00
|
| Rate for Payer: WPS Commercial |
$5,012.34
|
|
|
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 |
$1,894.84 |
| Max. Negotiated Rate |
$6,225.90 |
| Rate for Payer: Aetna Commercial |
$6,090.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,819.86
|
| Rate for Payer: Aetna Managed Medicare |
$1,894.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,398.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,383.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,248.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,586.66
|
| Rate for Payer: Cash Price |
$1,952.10
|
| Rate for Payer: Cigna Commercial |
$6,225.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,787.07
|
| Rate for Payer: Health EOS Commercial |
$6,022.88
|
| Rate for Payer: HFN Commercial |
$6,225.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,075.46
|
| Rate for Payer: Multiplan Commercial |
$5,413.82
|
| Rate for Payer: NAPHCARE Commercial |
$4,060.37
|
| Rate for Payer: Preferred Network Access Commercial |
$6,225.90
|
| Rate for Payer: Quartz Beloit One Network |
$3,315.97
|
| Rate for Payer: Quartz Commercial |
$4,398.73
|
| Rate for Payer: Quartz Medicare Advantage |
$4,060.37
|
| Rate for Payer: The Alliance Commercial |
$3,383.64
|
| Rate for Payer: WEA Trust Commercial |
$3,722.00
|
| Rate for Payer: WPS Commercial |
$5,012.34
|
|
