|
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 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
|
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 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 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 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 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 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 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 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 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 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 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 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 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
|
|
|
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 |
$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 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 |
$1,782.44 |
| 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 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 |
$1,609.75 |
| Max. Negotiated Rate |
$5,289.19 |
| Rate for Payer: Aetna Commercial |
$5,174.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,944.24
|
| Rate for Payer: Aetna Managed Medicare |
$1,609.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,736.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,874.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,759.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,047.03
|
| Rate for Payer: Cash Price |
$1,658.40
|
| Rate for Payer: Cigna Commercial |
$5,289.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,217.30
|
| Rate for Payer: Health EOS Commercial |
$5,116.72
|
| Rate for Payer: HFN Commercial |
$5,289.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,311.84
|
| Rate for Payer: Multiplan Commercial |
$4,599.30
|
| Rate for Payer: NAPHCARE Commercial |
$3,449.47
|
| Rate for Payer: Preferred Network Access Commercial |
$5,289.19
|
| Rate for Payer: Quartz Beloit One Network |
$2,817.07
|
| Rate for Payer: Quartz Commercial |
$3,736.93
|
| Rate for Payer: Quartz Medicare Advantage |
$3,449.47
|
| Rate for Payer: The Alliance Commercial |
$2,874.56
|
| Rate for Payer: WEA Trust Commercial |
$3,162.02
|
| Rate for Payer: WPS Commercial |
$4,258.22
|
|
|
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 |
$2,817.07 |
| Max. Negotiated Rate |
$5,289.19 |
| Rate for Payer: Aetna Commercial |
$5,174.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,944.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,047.03
|
| Rate for Payer: Cash Price |
$1,658.40
|
| Rate for Payer: Cigna Commercial |
$5,289.19
|
| Rate for Payer: Health EOS Commercial |
$5,116.72
|
| Rate for Payer: HFN Commercial |
$5,289.19
|
| Rate for Payer: Multiplan Commercial |
$4,599.30
|
| Rate for Payer: Preferred Network Access Commercial |
$5,289.19
|
| Rate for Payer: Quartz Beloit One Network |
$2,817.07
|
| Rate for Payer: Quartz Commercial |
$3,449.47
|
| Rate for Payer: WEA Trust Commercial |
$3,162.02
|
| Rate for Payer: WPS Commercial |
$4,258.22
|
|
|
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 |
$597.25 |
| Max. Negotiated Rate |
$1,121.37 |
| Rate for Payer: Aetna Commercial |
$1,096.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,048.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$646.01
|
| Rate for Payer: Cash Price |
$351.60
|
| Rate for Payer: Cigna Commercial |
$1,121.37
|
| Rate for Payer: Health EOS Commercial |
$1,084.80
|
| Rate for Payer: HFN Commercial |
$1,121.37
|
| Rate for Payer: Multiplan Commercial |
$975.10
|
| Rate for Payer: Preferred Network Access Commercial |
$1,121.37
|
| Rate for Payer: Quartz Beloit One Network |
$597.25
|
| Rate for Payer: Quartz Commercial |
$731.33
|
| Rate for Payer: WEA Trust Commercial |
$670.38
|
| Rate for Payer: WPS Commercial |
$902.79
|
|
|
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 |
$341.29 |
| Max. Negotiated Rate |
$1,121.37 |
| Rate for Payer: Aetna Commercial |
$1,096.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,048.24
|
| Rate for Payer: Aetna Managed Medicare |
$341.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$792.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$609.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$585.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$646.01
|
| Rate for Payer: Cash Price |
$351.60
|
| Rate for Payer: Cigna Commercial |
$1,121.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$682.10
|
| Rate for Payer: Health EOS Commercial |
$1,084.80
|
| Rate for Payer: HFN Commercial |
$1,121.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$914.16
|
| Rate for Payer: Multiplan Commercial |
$975.10
|
| Rate for Payer: NAPHCARE Commercial |
$731.33
|
| Rate for Payer: Preferred Network Access Commercial |
$1,121.37
|
| Rate for Payer: Quartz Beloit One Network |
$597.25
|
| Rate for Payer: Quartz Commercial |
$792.27
|
| Rate for Payer: Quartz Medicare Advantage |
$731.33
|
| Rate for Payer: The Alliance Commercial |
$609.44
|
| Rate for Payer: WEA Trust Commercial |
$670.38
|
| Rate for Payer: WPS Commercial |
$902.79
|
|
|
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 |
$2,689.16 |
| Max. Negotiated Rate |
$5,049.03 |
| Rate for Payer: Aetna Commercial |
$4,939.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,719.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,908.68
|
| Rate for Payer: Cash Price |
$1,583.10
|
| Rate for Payer: Cigna Commercial |
$5,049.03
|
| Rate for Payer: Health EOS Commercial |
$4,884.39
|
| Rate for Payer: HFN Commercial |
$5,049.03
|
| Rate for Payer: Multiplan Commercial |
$4,390.46
|
| Rate for Payer: Preferred Network Access Commercial |
$5,049.03
|
| Rate for Payer: Quartz Beloit One Network |
$2,689.16
|
| Rate for Payer: Quartz Commercial |
$3,292.85
|
| Rate for Payer: WEA Trust Commercial |
$3,018.44
|
| Rate for Payer: WPS Commercial |
$4,064.87
|
|
|
PLATE CONDYLAR 2.0 7HL 247.349
|
Facility
|
OP
|
$5,277.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767798
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,536.66 |
| Max. Negotiated Rate |
$5,049.03 |
| Rate for Payer: Aetna Commercial |
$4,939.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,719.75
|
| Rate for Payer: Aetna Managed Medicare |
$1,536.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,567.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,744.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,634.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,908.68
|
| Rate for Payer: Cash Price |
$1,583.10
|
| Rate for Payer: Cigna Commercial |
$5,049.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,071.21
|
| Rate for Payer: Health EOS Commercial |
$4,884.39
|
| Rate for Payer: HFN Commercial |
$5,049.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,116.06
|
| Rate for Payer: Multiplan Commercial |
$4,390.46
|
| Rate for Payer: NAPHCARE Commercial |
$3,292.85
|
| Rate for Payer: Preferred Network Access Commercial |
$5,049.03
|
| Rate for Payer: Quartz Beloit One Network |
$2,689.16
|
| Rate for Payer: Quartz Commercial |
$3,567.25
|
| Rate for Payer: Quartz Medicare Advantage |
$3,292.85
|
| Rate for Payer: The Alliance Commercial |
$2,744.04
|
| Rate for Payer: WEA Trust Commercial |
$3,018.44
|
| Rate for Payer: WPS Commercial |
$4,064.87
|
|
