|
PLATE CLAVICLE 3.5MM 6HL RT 02.112.008
|
Facility
|
IP
|
$5,116.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414899
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,506.84 |
| Max. Negotiated Rate |
$4,706.72 |
| Rate for Payer: Aetna Commercial |
$4,604.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,399.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,711.48
|
| Rate for Payer: Cash Price |
$1,534.80
|
| Rate for Payer: Cigna Commercial |
$4,706.72
|
| Rate for Payer: Health EOS Commercial |
$4,553.24
|
| Rate for Payer: HFN Commercial |
$4,706.72
|
| Rate for Payer: Multiplan Commercial |
$4,092.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,069.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,706.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,506.84
|
| Rate for Payer: Quartz Commercial |
$3,069.60
|
| Rate for Payer: WEA Trust Commercial |
$2,813.80
|
| Rate for Payer: WPS Commercial |
$3,789.42
|
|
|
PLATE CLAVICLE 7 HOLE
|
Facility
|
IP
|
$8,997.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966362
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,408.53 |
| Max. Negotiated Rate |
$8,277.24 |
| Rate for Payer: Aetna Commercial |
$8,097.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,737.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,768.41
|
| Rate for Payer: Cash Price |
$2,699.10
|
| Rate for Payer: Cigna Commercial |
$8,277.24
|
| Rate for Payer: Health EOS Commercial |
$8,007.33
|
| Rate for Payer: HFN Commercial |
$8,277.24
|
| Rate for Payer: Multiplan Commercial |
$7,197.60
|
| Rate for Payer: NAPHCARE Commercial |
$5,398.20
|
| Rate for Payer: Preferred Network Access Commercial |
$8,277.24
|
| Rate for Payer: Quartz Beloit One Network |
$4,408.53
|
| Rate for Payer: Quartz Commercial |
$5,398.20
|
| Rate for Payer: WEA Trust Commercial |
$4,948.35
|
| Rate for Payer: WPS Commercial |
$6,664.08
|
|
|
PLATE CLAVICLE 7 HOLE
|
Facility
|
OP
|
$8,997.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966362
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,519.16 |
| Max. Negotiated Rate |
$35,988.00 |
| Rate for Payer: Aetna Commercial |
$8,097.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,737.42
|
| Rate for Payer: Aetna Managed Medicare |
$2,519.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,848.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,498.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,318.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,768.41
|
| Rate for Payer: Cash Price |
$2,699.10
|
| Rate for Payer: Cigna Commercial |
$8,277.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,034.72
|
| Rate for Payer: Health EOS Commercial |
$8,007.33
|
| Rate for Payer: HFN Commercial |
$8,277.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,747.75
|
| Rate for Payer: Multiplan Commercial |
$7,197.60
|
| Rate for Payer: NAPHCARE Commercial |
$5,398.20
|
| Rate for Payer: Preferred Network Access Commercial |
$8,277.24
|
| Rate for Payer: Quartz Beloit One Network |
$4,408.53
|
| Rate for Payer: Quartz Commercial |
$5,848.05
|
| Rate for Payer: Quartz Medicare Advantage |
$5,398.20
|
| Rate for Payer: The Alliance Commercial |
$35,988.00
|
| Rate for Payer: WEA Trust Commercial |
$4,948.35
|
| Rate for Payer: WPS Commercial |
$6,664.08
|
|
|
PLATE CLAVICLE 8 HOLE
|
Facility
|
OP
|
$6,153.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966363
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,722.84 |
| Max. Negotiated Rate |
$24,612.00 |
| Rate for Payer: Aetna Commercial |
$5,537.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,291.58
|
| Rate for Payer: Aetna Managed Medicare |
$1,722.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,999.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,076.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,953.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,261.09
|
| Rate for Payer: Cash Price |
$1,845.90
|
| Rate for Payer: Cigna Commercial |
$5,660.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,443.22
|
| Rate for Payer: Health EOS Commercial |
$5,476.17
|
| Rate for Payer: HFN Commercial |
$5,660.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,614.75
|
| Rate for Payer: Multiplan Commercial |
$4,922.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,691.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,660.76
|
| Rate for Payer: Quartz Beloit One Network |
$3,014.97
|
| Rate for Payer: Quartz Commercial |
$3,999.45
|
| Rate for Payer: Quartz Medicare Advantage |
$3,691.80
|
| Rate for Payer: The Alliance Commercial |
$24,612.00
|
| Rate for Payer: WEA Trust Commercial |
$3,384.15
|
| Rate for Payer: WPS Commercial |
$4,557.53
|
|
|
PLATE CLAVICLE 8 HOLE
|
Facility
|
IP
|
$6,153.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966363
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,014.97 |
| Max. Negotiated Rate |
$5,660.76 |
| Rate for Payer: Aetna Commercial |
$5,537.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,291.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,261.09
|
| Rate for Payer: Cash Price |
$1,845.90
|
| Rate for Payer: Cigna Commercial |
$5,660.76
|
| Rate for Payer: Health EOS Commercial |
$5,476.17
|
| Rate for Payer: HFN Commercial |
$5,660.76
|
| Rate for Payer: Multiplan Commercial |
$4,922.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,691.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,660.76
|
| Rate for Payer: Quartz Beloit One Network |
$3,014.97
|
| Rate for Payer: Quartz Commercial |
$3,691.80
|
| Rate for Payer: WEA Trust Commercial |
$3,384.15
|
| Rate for Payer: WPS Commercial |
$4,557.53
|
|
|
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 |
$2,709.70 |
| Max. Negotiated Rate |
$5,087.60 |
| Rate for Payer: Aetna Commercial |
$4,977.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,755.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,930.90
|
| Rate for Payer: Cash Price |
$1,659.00
|
| Rate for Payer: Cigna Commercial |
$5,087.60
|
| Rate for Payer: Health EOS Commercial |
$4,921.70
|
| Rate for Payer: HFN Commercial |
$5,087.60
|
| Rate for Payer: Multiplan Commercial |
$4,424.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,318.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,087.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,709.70
|
| Rate for Payer: Quartz Commercial |
$3,318.00
|
| Rate for Payer: WEA Trust Commercial |
$3,041.50
|
| Rate for Payer: WPS Commercial |
$4,096.07
|
|
|
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 |
$1,548.40 |
| Max. Negotiated Rate |
$22,120.00 |
| Rate for Payer: Aetna Commercial |
$4,977.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,755.80
|
| Rate for Payer: Aetna Managed Medicare |
$1,548.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,594.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,765.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,654.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,930.90
|
| Rate for Payer: Cash Price |
$1,659.00
|
| Rate for Payer: Cigna Commercial |
$5,087.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,094.59
|
| Rate for Payer: Health EOS Commercial |
$4,921.70
|
| Rate for Payer: HFN Commercial |
$5,087.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,147.50
|
| Rate for Payer: Multiplan Commercial |
$4,424.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,318.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,087.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,709.70
|
| Rate for Payer: Quartz Commercial |
$3,594.50
|
| Rate for Payer: Quartz Medicare Advantage |
$3,318.00
|
| Rate for Payer: The Alliance Commercial |
$22,120.00
|
| Rate for Payer: WEA Trust Commercial |
$3,041.50
|
| Rate for Payer: WPS Commercial |
$4,096.07
|
|
|
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
|
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 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 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
|
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 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 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
|
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 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 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
|
|
