|
SCREW 4.0 CANNULATED 44MM
|
Facility
|
IP
|
$2,747.00
|
|
| Hospital Charge Code |
2965016
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,399.87 |
| Max. Negotiated Rate |
$2,628.33 |
| Rate for Payer: Aetna Commercial |
$2,571.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,456.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,514.15
|
| Rate for Payer: Cash Price |
$824.10
|
| Rate for Payer: Cigna Commercial |
$2,628.33
|
| Rate for Payer: Health EOS Commercial |
$2,542.62
|
| Rate for Payer: HFN Commercial |
$2,628.33
|
| Rate for Payer: Multiplan Commercial |
$2,285.50
|
| Rate for Payer: Preferred Network Access Commercial |
$2,628.33
|
| Rate for Payer: Quartz Beloit One Network |
$1,399.87
|
| Rate for Payer: Quartz Commercial |
$1,714.13
|
| Rate for Payer: WEA Trust Commercial |
$1,571.28
|
| Rate for Payer: WPS Commercial |
$2,116.01
|
|
|
SCREW 4.0x18 TITANIUM CANCELLO
|
Facility
|
OP
|
$472.00
|
|
| Hospital Charge Code |
2966514
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$137.45 |
| Max. Negotiated Rate |
$451.61 |
| Rate for Payer: Aetna Commercial |
$441.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$422.16
|
| Rate for Payer: Aetna Managed Medicare |
$137.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$319.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$245.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$235.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$260.17
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cigna Commercial |
$451.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$274.70
|
| Rate for Payer: Health EOS Commercial |
$436.88
|
| Rate for Payer: HFN Commercial |
$451.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$368.16
|
| Rate for Payer: Multiplan Commercial |
$392.70
|
| Rate for Payer: NAPHCARE Commercial |
$294.53
|
| Rate for Payer: Preferred Network Access Commercial |
$451.61
|
| Rate for Payer: Quartz Beloit One Network |
$240.53
|
| Rate for Payer: Quartz Commercial |
$319.07
|
| Rate for Payer: Quartz Medicare Advantage |
$294.53
|
| Rate for Payer: The Alliance Commercial |
$245.44
|
| Rate for Payer: WEA Trust Commercial |
$269.98
|
| Rate for Payer: WPS Commercial |
$363.58
|
|
|
SCREW 4.0x18 TITANIUM CANCELLO
|
Facility
|
IP
|
$472.00
|
|
| Hospital Charge Code |
2966514
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$240.53 |
| Max. Negotiated Rate |
$451.61 |
| Rate for Payer: Aetna Commercial |
$441.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$422.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$260.17
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cigna Commercial |
$451.61
|
| Rate for Payer: Health EOS Commercial |
$436.88
|
| Rate for Payer: HFN Commercial |
$451.61
|
| Rate for Payer: Multiplan Commercial |
$392.70
|
| Rate for Payer: Preferred Network Access Commercial |
$451.61
|
| Rate for Payer: Quartz Beloit One Network |
$240.53
|
| Rate for Payer: Quartz Commercial |
$294.53
|
| Rate for Payer: WEA Trust Commercial |
$269.98
|
| Rate for Payer: WPS Commercial |
$363.58
|
|
|
SCREW 4.0 X 20 CORTICAL
|
Facility
|
IP
|
$2,340.00
|
|
| Hospital Charge Code |
2966035
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,192.46 |
| Max. Negotiated Rate |
$2,238.91 |
| Rate for Payer: Aetna Commercial |
$2,190.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,092.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,289.81
|
| Rate for Payer: Cash Price |
$702.00
|
| Rate for Payer: Cigna Commercial |
$2,238.91
|
| Rate for Payer: Health EOS Commercial |
$2,165.90
|
| Rate for Payer: HFN Commercial |
$2,238.91
|
| Rate for Payer: Multiplan Commercial |
$1,946.88
|
| Rate for Payer: Preferred Network Access Commercial |
$2,238.91
|
| Rate for Payer: Quartz Beloit One Network |
$1,192.46
|
| Rate for Payer: Quartz Commercial |
$1,460.16
|
| Rate for Payer: WEA Trust Commercial |
$1,338.48
|
| Rate for Payer: WPS Commercial |
$1,802.50
|
|
|
SCREW 4.0 X 20 CORTICAL
|
Facility
|
OP
|
$2,340.00
|
|
| Hospital Charge Code |
2966035
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$681.41 |
| Max. Negotiated Rate |
$2,238.91 |
| Rate for Payer: Aetna Commercial |
$2,190.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,092.90
|
| Rate for Payer: Aetna Managed Medicare |
$681.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,581.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,216.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,168.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,289.81
|
| Rate for Payer: Cash Price |
$702.00
|
| Rate for Payer: Cigna Commercial |
$2,238.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,361.88
|
| Rate for Payer: Health EOS Commercial |
$2,165.90
|
| Rate for Payer: HFN Commercial |
$2,238.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,825.20
|
| Rate for Payer: Multiplan Commercial |
$1,946.88
|
| Rate for Payer: NAPHCARE Commercial |
$1,460.16
|
| Rate for Payer: Preferred Network Access Commercial |
$2,238.91
|
| Rate for Payer: Quartz Beloit One Network |
$1,192.46
|
| Rate for Payer: Quartz Commercial |
$1,581.84
|
| Rate for Payer: Quartz Medicare Advantage |
$1,460.16
|
| Rate for Payer: The Alliance Commercial |
$1,216.80
|
| Rate for Payer: WEA Trust Commercial |
$1,338.48
|
| Rate for Payer: WPS Commercial |
$1,802.50
|
|
|
SCREW 4.0x34 LOCKING TORNIER
|
Facility
|
OP
|
$1,373.00
|
|
| Hospital Charge Code |
2967363
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$399.82 |
| Max. Negotiated Rate |
$1,313.69 |
| Rate for Payer: Aetna Commercial |
$1,285.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,228.01
|
| Rate for Payer: Aetna Managed Medicare |
$399.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$928.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$713.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$685.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$756.80
|
| Rate for Payer: Cash Price |
$411.90
|
| Rate for Payer: Cigna Commercial |
$1,313.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$799.09
|
| Rate for Payer: Health EOS Commercial |
$1,270.85
|
| Rate for Payer: HFN Commercial |
$1,313.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,070.94
|
| Rate for Payer: Multiplan Commercial |
$1,142.34
|
| Rate for Payer: NAPHCARE Commercial |
$856.75
|
| Rate for Payer: Preferred Network Access Commercial |
$1,313.69
|
| Rate for Payer: Quartz Beloit One Network |
$699.68
|
| Rate for Payer: Quartz Commercial |
$928.15
|
| Rate for Payer: Quartz Medicare Advantage |
$856.75
|
| Rate for Payer: The Alliance Commercial |
$713.96
|
| Rate for Payer: WEA Trust Commercial |
$785.36
|
| Rate for Payer: WPS Commercial |
$1,057.62
|
|
|
SCREW 4.0x34 LOCKING TORNIER
|
Facility
|
IP
|
$1,373.00
|
|
| Hospital Charge Code |
2967363
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$699.68 |
| Max. Negotiated Rate |
$1,313.69 |
| Rate for Payer: Aetna Commercial |
$1,285.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,228.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$756.80
|
| Rate for Payer: Cash Price |
$411.90
|
| Rate for Payer: Cigna Commercial |
$1,313.69
|
| Rate for Payer: Health EOS Commercial |
$1,270.85
|
| Rate for Payer: HFN Commercial |
$1,313.69
|
| Rate for Payer: Multiplan Commercial |
$1,142.34
|
| Rate for Payer: Preferred Network Access Commercial |
$1,313.69
|
| Rate for Payer: Quartz Beloit One Network |
$699.68
|
| Rate for Payer: Quartz Commercial |
$856.75
|
| Rate for Payer: WEA Trust Commercial |
$785.36
|
| Rate for Payer: WPS Commercial |
$1,057.62
|
|
|
SCREW 4.0 X 38MM LONG THREAD LP AR-8840PL-38
|
Facility
|
IP
|
$652.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5416058
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$332.26 |
| Max. Negotiated Rate |
$623.83 |
| Rate for Payer: Aetna Commercial |
$610.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$583.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$359.38
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cigna Commercial |
$623.83
|
| Rate for Payer: Health EOS Commercial |
$603.49
|
| Rate for Payer: HFN Commercial |
$623.83
|
| Rate for Payer: Multiplan Commercial |
$542.46
|
| Rate for Payer: Preferred Network Access Commercial |
$623.83
|
| Rate for Payer: Quartz Beloit One Network |
$332.26
|
| Rate for Payer: Quartz Commercial |
$406.85
|
| Rate for Payer: WEA Trust Commercial |
$372.94
|
| Rate for Payer: WPS Commercial |
$502.24
|
|
|
SCREW 4.0 X 38MM LONG THREAD LP AR-8840PL-38
|
Facility
|
OP
|
$652.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5416058
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$189.86 |
| Max. Negotiated Rate |
$623.83 |
| Rate for Payer: Aetna Commercial |
$610.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$583.15
|
| Rate for Payer: Aetna Managed Medicare |
$189.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$440.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$339.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$325.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$359.38
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cigna Commercial |
$623.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$379.46
|
| Rate for Payer: Health EOS Commercial |
$603.49
|
| Rate for Payer: HFN Commercial |
$623.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$508.56
|
| Rate for Payer: Multiplan Commercial |
$542.46
|
| Rate for Payer: NAPHCARE Commercial |
$406.85
|
| Rate for Payer: Preferred Network Access Commercial |
$623.83
|
| Rate for Payer: Quartz Beloit One Network |
$332.26
|
| Rate for Payer: Quartz Commercial |
$440.75
|
| Rate for Payer: Quartz Medicare Advantage |
$406.85
|
| Rate for Payer: The Alliance Commercial |
$339.04
|
| Rate for Payer: WEA Trust Commercial |
$372.94
|
| Rate for Payer: WPS Commercial |
$502.24
|
|
|
SCREW 4.0 X 40MM CANN TRILLIANT 200-40-040
|
Facility
|
IP
|
$2,289.00
|
|
| Hospital Charge Code |
4595750
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,166.47 |
| Max. Negotiated Rate |
$2,190.12 |
| Rate for Payer: Aetna Commercial |
$2,142.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,047.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,261.70
|
| Rate for Payer: Cash Price |
$686.70
|
| Rate for Payer: Cigna Commercial |
$2,190.12
|
| Rate for Payer: Health EOS Commercial |
$2,118.70
|
| Rate for Payer: HFN Commercial |
$2,190.12
|
| Rate for Payer: Multiplan Commercial |
$1,904.45
|
| Rate for Payer: Preferred Network Access Commercial |
$2,190.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,166.47
|
| Rate for Payer: Quartz Commercial |
$1,428.34
|
| Rate for Payer: WEA Trust Commercial |
$1,309.31
|
| Rate for Payer: WPS Commercial |
$1,763.22
|
|
|
SCREW 4.0 X 40MM CANN TRILLIANT 200-40-040
|
Facility
|
OP
|
$2,289.00
|
|
| Hospital Charge Code |
4595750
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$666.56 |
| Max. Negotiated Rate |
$2,190.12 |
| Rate for Payer: Aetna Commercial |
$2,142.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,047.28
|
| Rate for Payer: Aetna Managed Medicare |
$666.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,547.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,190.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,142.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,261.70
|
| Rate for Payer: Cash Price |
$686.70
|
| Rate for Payer: Cigna Commercial |
$2,190.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,332.20
|
| Rate for Payer: Health EOS Commercial |
$2,118.70
|
| Rate for Payer: HFN Commercial |
$2,190.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,785.42
|
| Rate for Payer: Multiplan Commercial |
$1,904.45
|
| Rate for Payer: NAPHCARE Commercial |
$1,428.34
|
| Rate for Payer: Preferred Network Access Commercial |
$2,190.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,166.47
|
| Rate for Payer: Quartz Commercial |
$1,547.36
|
| Rate for Payer: Quartz Medicare Advantage |
$1,428.34
|
| Rate for Payer: The Alliance Commercial |
$1,190.28
|
| Rate for Payer: WEA Trust Commercial |
$1,309.31
|
| Rate for Payer: WPS Commercial |
$1,763.22
|
|
|
SCREW 4.0x42 CANNULATED
|
Facility
|
OP
|
$1,922.00
|
|
| Hospital Charge Code |
2965017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$559.69 |
| Max. Negotiated Rate |
$1,838.97 |
| Rate for Payer: Aetna Commercial |
$1,798.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,719.04
|
| Rate for Payer: Aetna Managed Medicare |
$559.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,299.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$999.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$959.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,059.41
|
| Rate for Payer: Cash Price |
$576.60
|
| Rate for Payer: Cigna Commercial |
$1,838.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,118.60
|
| Rate for Payer: Health EOS Commercial |
$1,779.00
|
| Rate for Payer: HFN Commercial |
$1,838.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,499.16
|
| Rate for Payer: Multiplan Commercial |
$1,599.10
|
| Rate for Payer: NAPHCARE Commercial |
$1,199.33
|
| Rate for Payer: Preferred Network Access Commercial |
$1,838.97
|
| Rate for Payer: Quartz Beloit One Network |
$979.45
|
| Rate for Payer: Quartz Commercial |
$1,299.27
|
| Rate for Payer: Quartz Medicare Advantage |
$1,199.33
|
| Rate for Payer: The Alliance Commercial |
$999.44
|
| Rate for Payer: WEA Trust Commercial |
$1,099.38
|
| Rate for Payer: WPS Commercial |
$1,480.52
|
|
|
SCREW 4.0x42 CANNULATED
|
Facility
|
IP
|
$1,922.00
|
|
| Hospital Charge Code |
2965017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$979.45 |
| Max. Negotiated Rate |
$1,838.97 |
| Rate for Payer: Aetna Commercial |
$1,798.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,719.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,059.41
|
| Rate for Payer: Cash Price |
$576.60
|
| Rate for Payer: Cigna Commercial |
$1,838.97
|
| Rate for Payer: Health EOS Commercial |
$1,779.00
|
| Rate for Payer: HFN Commercial |
$1,838.97
|
| Rate for Payer: Multiplan Commercial |
$1,599.10
|
| Rate for Payer: Preferred Network Access Commercial |
$1,838.97
|
| Rate for Payer: Quartz Beloit One Network |
$979.45
|
| Rate for Payer: Quartz Commercial |
$1,199.33
|
| Rate for Payer: WEA Trust Commercial |
$1,099.38
|
| Rate for Payer: WPS Commercial |
$1,480.52
|
|
|
SCREW 4.0 X 42MM CANN TRILLIANT 200-40-042
|
Facility
|
OP
|
$2,289.00
|
|
| Hospital Charge Code |
4740608
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$666.56 |
| Max. Negotiated Rate |
$2,190.12 |
| Rate for Payer: Aetna Commercial |
$2,142.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,047.28
|
| Rate for Payer: Aetna Managed Medicare |
$666.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,547.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,190.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,142.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,261.70
|
| Rate for Payer: Cash Price |
$686.70
|
| Rate for Payer: Cigna Commercial |
$2,190.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,332.20
|
| Rate for Payer: Health EOS Commercial |
$2,118.70
|
| Rate for Payer: HFN Commercial |
$2,190.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,785.42
|
| Rate for Payer: Multiplan Commercial |
$1,904.45
|
| Rate for Payer: NAPHCARE Commercial |
$1,428.34
|
| Rate for Payer: Preferred Network Access Commercial |
$2,190.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,166.47
|
| Rate for Payer: Quartz Commercial |
$1,547.36
|
| Rate for Payer: Quartz Medicare Advantage |
$1,428.34
|
| Rate for Payer: The Alliance Commercial |
$1,190.28
|
| Rate for Payer: WEA Trust Commercial |
$1,309.31
|
| Rate for Payer: WPS Commercial |
$1,763.22
|
|
|
SCREW 4.0 X 42MM CANN TRILLIANT 200-40-042
|
Facility
|
IP
|
$2,289.00
|
|
| Hospital Charge Code |
4740608
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,166.47 |
| Max. Negotiated Rate |
$2,190.12 |
| Rate for Payer: Aetna Commercial |
$2,142.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,047.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,261.70
|
| Rate for Payer: Cash Price |
$686.70
|
| Rate for Payer: Cigna Commercial |
$2,190.12
|
| Rate for Payer: Health EOS Commercial |
$2,118.70
|
| Rate for Payer: HFN Commercial |
$2,190.12
|
| Rate for Payer: Multiplan Commercial |
$1,904.45
|
| Rate for Payer: Preferred Network Access Commercial |
$2,190.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,166.47
|
| Rate for Payer: Quartz Commercial |
$1,428.34
|
| Rate for Payer: WEA Trust Commercial |
$1,309.31
|
| Rate for Payer: WPS Commercial |
$1,763.22
|
|
|
SCREW 4.0 X 44MM CANN TRILLIANT 200-40-044
|
Facility
|
OP
|
$2,378.00
|
|
| Hospital Charge Code |
4858865
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$692.47 |
| Max. Negotiated Rate |
$2,275.27 |
| Rate for Payer: Aetna Commercial |
$2,225.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,126.88
|
| Rate for Payer: Aetna Managed Medicare |
$692.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,607.53
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,236.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,187.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,310.75
|
| Rate for Payer: Cash Price |
$713.40
|
| Rate for Payer: Cigna Commercial |
$2,275.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,384.00
|
| Rate for Payer: Health EOS Commercial |
$2,201.08
|
| Rate for Payer: HFN Commercial |
$2,275.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,854.84
|
| Rate for Payer: Multiplan Commercial |
$1,978.50
|
| Rate for Payer: NAPHCARE Commercial |
$1,483.87
|
| Rate for Payer: Preferred Network Access Commercial |
$2,275.27
|
| Rate for Payer: Quartz Beloit One Network |
$1,211.83
|
| Rate for Payer: Quartz Commercial |
$1,607.53
|
| Rate for Payer: Quartz Medicare Advantage |
$1,483.87
|
| Rate for Payer: The Alliance Commercial |
$1,236.56
|
| Rate for Payer: WEA Trust Commercial |
$1,360.22
|
| Rate for Payer: WPS Commercial |
$1,831.77
|
|
|
SCREW 4.0 X 44MM CANN TRILLIANT 200-40-044
|
Facility
|
IP
|
$2,378.00
|
|
| Hospital Charge Code |
4858865
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,211.83 |
| Max. Negotiated Rate |
$2,275.27 |
| Rate for Payer: Aetna Commercial |
$2,225.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,126.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,310.75
|
| Rate for Payer: Cash Price |
$713.40
|
| Rate for Payer: Cigna Commercial |
$2,275.27
|
| Rate for Payer: Health EOS Commercial |
$2,201.08
|
| Rate for Payer: HFN Commercial |
$2,275.27
|
| Rate for Payer: Multiplan Commercial |
$1,978.50
|
| Rate for Payer: Preferred Network Access Commercial |
$2,275.27
|
| Rate for Payer: Quartz Beloit One Network |
$1,211.83
|
| Rate for Payer: Quartz Commercial |
$1,483.87
|
| Rate for Payer: WEA Trust Commercial |
$1,360.22
|
| Rate for Payer: WPS Commercial |
$1,831.77
|
|
|
SCREW 4.0x45 TI CANC FULL THR
|
Facility
|
IP
|
$472.00
|
|
| Hospital Charge Code |
2966519
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$240.53 |
| Max. Negotiated Rate |
$451.61 |
| Rate for Payer: Aetna Commercial |
$441.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$422.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$260.17
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cigna Commercial |
$451.61
|
| Rate for Payer: Health EOS Commercial |
$436.88
|
| Rate for Payer: HFN Commercial |
$451.61
|
| Rate for Payer: Multiplan Commercial |
$392.70
|
| Rate for Payer: Preferred Network Access Commercial |
$451.61
|
| Rate for Payer: Quartz Beloit One Network |
$240.53
|
| Rate for Payer: Quartz Commercial |
$294.53
|
| Rate for Payer: WEA Trust Commercial |
$269.98
|
| Rate for Payer: WPS Commercial |
$363.58
|
|
|
SCREW 4.0x45 TI CANC FULL THR
|
Facility
|
OP
|
$472.00
|
|
| Hospital Charge Code |
2966519
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$137.45 |
| Max. Negotiated Rate |
$451.61 |
| Rate for Payer: Aetna Commercial |
$441.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$422.16
|
| Rate for Payer: Aetna Managed Medicare |
$137.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$319.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$245.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$235.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$260.17
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cigna Commercial |
$451.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$274.70
|
| Rate for Payer: Health EOS Commercial |
$436.88
|
| Rate for Payer: HFN Commercial |
$451.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$368.16
|
| Rate for Payer: Multiplan Commercial |
$392.70
|
| Rate for Payer: NAPHCARE Commercial |
$294.53
|
| Rate for Payer: Preferred Network Access Commercial |
$451.61
|
| Rate for Payer: Quartz Beloit One Network |
$240.53
|
| Rate for Payer: Quartz Commercial |
$319.07
|
| Rate for Payer: Quartz Medicare Advantage |
$294.53
|
| Rate for Payer: The Alliance Commercial |
$245.44
|
| Rate for Payer: WEA Trust Commercial |
$269.98
|
| Rate for Payer: WPS Commercial |
$363.58
|
|
|
SCREW 4.0 X 46MM LONG THREAD LP AR-8840PL-46
|
Facility
|
OP
|
$652.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5591323
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$189.86 |
| Max. Negotiated Rate |
$623.83 |
| Rate for Payer: Aetna Commercial |
$610.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$583.15
|
| Rate for Payer: Aetna Managed Medicare |
$189.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$440.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$339.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$325.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$359.38
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cigna Commercial |
$623.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$379.46
|
| Rate for Payer: Health EOS Commercial |
$603.49
|
| Rate for Payer: HFN Commercial |
$623.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$508.56
|
| Rate for Payer: Multiplan Commercial |
$542.46
|
| Rate for Payer: NAPHCARE Commercial |
$406.85
|
| Rate for Payer: Preferred Network Access Commercial |
$623.83
|
| Rate for Payer: Quartz Beloit One Network |
$332.26
|
| Rate for Payer: Quartz Commercial |
$440.75
|
| Rate for Payer: Quartz Medicare Advantage |
$406.85
|
| Rate for Payer: The Alliance Commercial |
$339.04
|
| Rate for Payer: WEA Trust Commercial |
$372.94
|
| Rate for Payer: WPS Commercial |
$502.24
|
|
|
SCREW 4.0 X 46MM LONG THREAD LP AR-8840PL-46
|
Facility
|
IP
|
$652.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5591323
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$332.26 |
| Max. Negotiated Rate |
$623.83 |
| Rate for Payer: Aetna Commercial |
$610.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$583.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$359.38
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cigna Commercial |
$623.83
|
| Rate for Payer: Health EOS Commercial |
$603.49
|
| Rate for Payer: HFN Commercial |
$623.83
|
| Rate for Payer: Multiplan Commercial |
$542.46
|
| Rate for Payer: Preferred Network Access Commercial |
$623.83
|
| Rate for Payer: Quartz Beloit One Network |
$332.26
|
| Rate for Payer: Quartz Commercial |
$406.85
|
| Rate for Payer: WEA Trust Commercial |
$372.94
|
| Rate for Payer: WPS Commercial |
$502.24
|
|
|
SCREW 4.0 X 55MM LONG THREAD LP AR-8840PL-55
|
Facility
|
IP
|
$652.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5591324
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$332.26 |
| Max. Negotiated Rate |
$623.83 |
| Rate for Payer: Aetna Commercial |
$610.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$583.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$359.38
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cigna Commercial |
$623.83
|
| Rate for Payer: Health EOS Commercial |
$603.49
|
| Rate for Payer: HFN Commercial |
$623.83
|
| Rate for Payer: Multiplan Commercial |
$542.46
|
| Rate for Payer: Preferred Network Access Commercial |
$623.83
|
| Rate for Payer: Quartz Beloit One Network |
$332.26
|
| Rate for Payer: Quartz Commercial |
$406.85
|
| Rate for Payer: WEA Trust Commercial |
$372.94
|
| Rate for Payer: WPS Commercial |
$502.24
|
|
|
SCREW 4.0 X 55MM LONG THREAD LP AR-8840PL-55
|
Facility
|
OP
|
$652.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5591324
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$189.86 |
| Max. Negotiated Rate |
$623.83 |
| Rate for Payer: Aetna Commercial |
$610.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$583.15
|
| Rate for Payer: Aetna Managed Medicare |
$189.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$440.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$339.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$325.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$359.38
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cigna Commercial |
$623.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$379.46
|
| Rate for Payer: Health EOS Commercial |
$603.49
|
| Rate for Payer: HFN Commercial |
$623.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$508.56
|
| Rate for Payer: Multiplan Commercial |
$542.46
|
| Rate for Payer: NAPHCARE Commercial |
$406.85
|
| Rate for Payer: Preferred Network Access Commercial |
$623.83
|
| Rate for Payer: Quartz Beloit One Network |
$332.26
|
| Rate for Payer: Quartz Commercial |
$440.75
|
| Rate for Payer: Quartz Medicare Advantage |
$406.85
|
| Rate for Payer: The Alliance Commercial |
$339.04
|
| Rate for Payer: WEA Trust Commercial |
$372.94
|
| Rate for Payer: WPS Commercial |
$502.24
|
|
|
SCREW 4.0x60 TI CANC FULL THR
|
Facility
|
IP
|
$472.00
|
|
| Hospital Charge Code |
2966520
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$240.53 |
| Max. Negotiated Rate |
$451.61 |
| Rate for Payer: Aetna Commercial |
$441.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$422.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$260.17
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cigna Commercial |
$451.61
|
| Rate for Payer: Health EOS Commercial |
$436.88
|
| Rate for Payer: HFN Commercial |
$451.61
|
| Rate for Payer: Multiplan Commercial |
$392.70
|
| Rate for Payer: Preferred Network Access Commercial |
$451.61
|
| Rate for Payer: Quartz Beloit One Network |
$240.53
|
| Rate for Payer: Quartz Commercial |
$294.53
|
| Rate for Payer: WEA Trust Commercial |
$269.98
|
| Rate for Payer: WPS Commercial |
$363.58
|
|
|
SCREW 4.0x60 TI CANC FULL THR
|
Facility
|
OP
|
$472.00
|
|
| Hospital Charge Code |
2966520
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$137.45 |
| Max. Negotiated Rate |
$451.61 |
| Rate for Payer: Aetna Commercial |
$441.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$422.16
|
| Rate for Payer: Aetna Managed Medicare |
$137.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$319.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$245.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$235.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$260.17
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cigna Commercial |
$451.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$274.70
|
| Rate for Payer: Health EOS Commercial |
$436.88
|
| Rate for Payer: HFN Commercial |
$451.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$368.16
|
| Rate for Payer: Multiplan Commercial |
$392.70
|
| Rate for Payer: NAPHCARE Commercial |
$294.53
|
| Rate for Payer: Preferred Network Access Commercial |
$451.61
|
| Rate for Payer: Quartz Beloit One Network |
$240.53
|
| Rate for Payer: Quartz Commercial |
$319.07
|
| Rate for Payer: Quartz Medicare Advantage |
$294.53
|
| Rate for Payer: The Alliance Commercial |
$245.44
|
| Rate for Payer: WEA Trust Commercial |
$269.98
|
| Rate for Payer: WPS Commercial |
$363.58
|
|
