|
SCREW CANN LOCK VA 5.0 X 80 02.231.680
|
Facility
|
IP
|
$2,263.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3181496
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,108.87 |
| Max. Negotiated Rate |
$2,081.96 |
| Rate for Payer: Aetna Commercial |
$2,036.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,946.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,199.39
|
| Rate for Payer: Cash Price |
$678.90
|
| Rate for Payer: Cigna Commercial |
$2,081.96
|
| Rate for Payer: Health EOS Commercial |
$2,014.07
|
| Rate for Payer: HFN Commercial |
$2,081.96
|
| Rate for Payer: Multiplan Commercial |
$1,810.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,357.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,081.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,108.87
|
| Rate for Payer: Quartz Commercial |
$1,357.80
|
| Rate for Payer: WEA Trust Commercial |
$1,244.65
|
| Rate for Payer: WPS Commercial |
$1,676.20
|
|
|
SCREW CANN LOCK VA 5.0 X 85 02.231.685
|
Facility
|
OP
|
$2,301.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5286727
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$644.28 |
| Max. Negotiated Rate |
$9,204.00 |
| Rate for Payer: Aetna Commercial |
$2,070.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,978.86
|
| Rate for Payer: Aetna Managed Medicare |
$644.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,495.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,150.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,104.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,219.53
|
| Rate for Payer: Cash Price |
$690.30
|
| Rate for Payer: Cigna Commercial |
$2,116.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,287.64
|
| Rate for Payer: Health EOS Commercial |
$2,047.89
|
| Rate for Payer: HFN Commercial |
$2,116.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,725.75
|
| Rate for Payer: Multiplan Commercial |
$1,840.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,380.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,116.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,127.49
|
| Rate for Payer: Quartz Commercial |
$1,495.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,380.60
|
| Rate for Payer: The Alliance Commercial |
$9,204.00
|
| Rate for Payer: WEA Trust Commercial |
$1,265.55
|
| Rate for Payer: WPS Commercial |
$1,704.35
|
|
|
SCREW CANN LOCK VA 5.0 X 85 02.231.685
|
Facility
|
IP
|
$2,301.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5286727
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,127.49 |
| Max. Negotiated Rate |
$2,116.92 |
| Rate for Payer: Aetna Commercial |
$2,070.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,978.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,219.53
|
| Rate for Payer: Cash Price |
$690.30
|
| Rate for Payer: Cigna Commercial |
$2,116.92
|
| Rate for Payer: Health EOS Commercial |
$2,047.89
|
| Rate for Payer: HFN Commercial |
$2,116.92
|
| Rate for Payer: Multiplan Commercial |
$1,840.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,380.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,116.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,127.49
|
| Rate for Payer: Quartz Commercial |
$1,380.60
|
| Rate for Payer: WEA Trust Commercial |
$1,265.55
|
| Rate for Payer: WPS Commercial |
$1,704.35
|
|
|
SCREW CANN LOCK VA 5.0 X 90 02.231.690
|
Facility
|
OP
|
$2,176.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6167935
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$609.28 |
| Max. Negotiated Rate |
$8,704.00 |
| Rate for Payer: Aetna Commercial |
$1,958.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,871.36
|
| Rate for Payer: Aetna Managed Medicare |
$609.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,414.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,088.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,044.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,153.28
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Cigna Commercial |
$2,001.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,217.69
|
| Rate for Payer: Health EOS Commercial |
$1,936.64
|
| Rate for Payer: HFN Commercial |
$2,001.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,632.00
|
| Rate for Payer: Multiplan Commercial |
$1,740.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,305.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,001.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,066.24
|
| Rate for Payer: Quartz Commercial |
$1,414.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,305.60
|
| Rate for Payer: The Alliance Commercial |
$8,704.00
|
| Rate for Payer: WEA Trust Commercial |
$1,196.80
|
| Rate for Payer: WPS Commercial |
$1,611.76
|
|
|
SCREW CANN LOCK VA 5.0 X 90 02.231.690
|
Facility
|
IP
|
$2,176.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6167935
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,066.24 |
| Max. Negotiated Rate |
$2,001.92 |
| Rate for Payer: Aetna Commercial |
$1,958.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,871.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,153.28
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Cigna Commercial |
$2,001.92
|
| Rate for Payer: Health EOS Commercial |
$1,936.64
|
| Rate for Payer: HFN Commercial |
$2,001.92
|
| Rate for Payer: Multiplan Commercial |
$1,740.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,305.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,001.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,066.24
|
| Rate for Payer: Quartz Commercial |
$1,305.60
|
| Rate for Payer: WEA Trust Commercial |
$1,196.80
|
| Rate for Payer: WPS Commercial |
$1,611.76
|
|
|
SCREW CANN LP PARTIAL THREAD AR-8933-26PT
|
Facility
|
IP
|
$1,597.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459665
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$782.53 |
| Max. Negotiated Rate |
$1,469.24 |
| Rate for Payer: Aetna Commercial |
$1,437.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,373.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$846.41
|
| Rate for Payer: Cash Price |
$479.10
|
| Rate for Payer: Cigna Commercial |
$1,469.24
|
| Rate for Payer: Health EOS Commercial |
$1,421.33
|
| Rate for Payer: HFN Commercial |
$1,469.24
|
| Rate for Payer: Multiplan Commercial |
$1,277.60
|
| Rate for Payer: NAPHCARE Commercial |
$958.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,469.24
|
| Rate for Payer: Quartz Beloit One Network |
$782.53
|
| Rate for Payer: Quartz Commercial |
$958.20
|
| Rate for Payer: WEA Trust Commercial |
$878.35
|
| Rate for Payer: WPS Commercial |
$1,182.90
|
|
|
SCREW CANN LP PARTIAL THREAD AR-8933-26PT
|
Facility
|
OP
|
$1,597.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459665
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$447.16 |
| Max. Negotiated Rate |
$6,388.00 |
| Rate for Payer: Aetna Commercial |
$1,437.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,373.42
|
| Rate for Payer: Aetna Managed Medicare |
$447.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,038.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$798.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$766.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$846.41
|
| Rate for Payer: Cash Price |
$479.10
|
| Rate for Payer: Cigna Commercial |
$1,469.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$893.68
|
| Rate for Payer: Health EOS Commercial |
$1,421.33
|
| Rate for Payer: HFN Commercial |
$1,469.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,197.75
|
| Rate for Payer: Multiplan Commercial |
$1,277.60
|
| Rate for Payer: NAPHCARE Commercial |
$958.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,469.24
|
| Rate for Payer: Quartz Beloit One Network |
$782.53
|
| Rate for Payer: Quartz Commercial |
$1,038.05
|
| Rate for Payer: Quartz Medicare Advantage |
$958.20
|
| Rate for Payer: The Alliance Commercial |
$6,388.00
|
| Rate for Payer: WEA Trust Commercial |
$878.35
|
| Rate for Payer: WPS Commercial |
$1,182.90
|
|
|
SCREW CANN MINI 3.0 X 16MM HEADED IC3016
|
Facility
|
IP
|
$2,021.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6175596
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$990.29 |
| Max. Negotiated Rate |
$1,859.32 |
| Rate for Payer: Aetna Commercial |
$1,818.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,738.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,071.13
|
| Rate for Payer: Cash Price |
$606.30
|
| Rate for Payer: Cigna Commercial |
$1,859.32
|
| Rate for Payer: Health EOS Commercial |
$1,798.69
|
| Rate for Payer: HFN Commercial |
$1,859.32
|
| Rate for Payer: Multiplan Commercial |
$1,616.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,212.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,859.32
|
| Rate for Payer: Quartz Beloit One Network |
$990.29
|
| Rate for Payer: Quartz Commercial |
$1,212.60
|
| Rate for Payer: WEA Trust Commercial |
$1,111.55
|
| Rate for Payer: WPS Commercial |
$1,496.95
|
|
|
SCREW CANN MINI 3.0 X 16MM HEADED IC3016
|
Facility
|
OP
|
$2,021.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6175596
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.88 |
| Max. Negotiated Rate |
$8,084.00 |
| Rate for Payer: Aetna Commercial |
$1,818.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,738.06
|
| Rate for Payer: Aetna Managed Medicare |
$565.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,313.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,010.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$970.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,071.13
|
| Rate for Payer: Cash Price |
$606.30
|
| Rate for Payer: Cigna Commercial |
$1,859.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,130.95
|
| Rate for Payer: Health EOS Commercial |
$1,798.69
|
| Rate for Payer: HFN Commercial |
$1,859.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,515.75
|
| Rate for Payer: Multiplan Commercial |
$1,616.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,212.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,859.32
|
| Rate for Payer: Quartz Beloit One Network |
$990.29
|
| Rate for Payer: Quartz Commercial |
$1,313.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,212.60
|
| Rate for Payer: The Alliance Commercial |
$8,084.00
|
| Rate for Payer: WEA Trust Commercial |
$1,111.55
|
| Rate for Payer: WPS Commercial |
$1,496.95
|
|
|
SCREW CANN MINI 3.0 X 18MM HEADED IC3018
|
Facility
|
IP
|
$2,021.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6175597
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$990.29 |
| Max. Negotiated Rate |
$1,859.32 |
| Rate for Payer: Aetna Commercial |
$1,818.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,738.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,071.13
|
| Rate for Payer: Cash Price |
$606.30
|
| Rate for Payer: Cigna Commercial |
$1,859.32
|
| Rate for Payer: Health EOS Commercial |
$1,798.69
|
| Rate for Payer: HFN Commercial |
$1,859.32
|
| Rate for Payer: Multiplan Commercial |
$1,616.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,212.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,859.32
|
| Rate for Payer: Quartz Beloit One Network |
$990.29
|
| Rate for Payer: Quartz Commercial |
$1,212.60
|
| Rate for Payer: WEA Trust Commercial |
$1,111.55
|
| Rate for Payer: WPS Commercial |
$1,496.95
|
|
|
SCREW CANN MINI 3.0 X 18MM HEADED IC3018
|
Facility
|
OP
|
$2,021.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6175597
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.88 |
| Max. Negotiated Rate |
$8,084.00 |
| Rate for Payer: Aetna Commercial |
$1,818.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,738.06
|
| Rate for Payer: Aetna Managed Medicare |
$565.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,313.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,010.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$970.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,071.13
|
| Rate for Payer: Cash Price |
$606.30
|
| Rate for Payer: Cigna Commercial |
$1,859.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,130.95
|
| Rate for Payer: Health EOS Commercial |
$1,798.69
|
| Rate for Payer: HFN Commercial |
$1,859.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,515.75
|
| Rate for Payer: Multiplan Commercial |
$1,616.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,212.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,859.32
|
| Rate for Payer: Quartz Beloit One Network |
$990.29
|
| Rate for Payer: Quartz Commercial |
$1,313.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,212.60
|
| Rate for Payer: The Alliance Commercial |
$8,084.00
|
| Rate for Payer: WEA Trust Commercial |
$1,111.55
|
| Rate for Payer: WPS Commercial |
$1,496.95
|
|
|
SCREW CANN MINI 3.0 X 22MM HEADED IC3022
|
Facility
|
OP
|
$2,186.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599634
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.08 |
| Max. Negotiated Rate |
$8,744.00 |
| Rate for Payer: Aetna Commercial |
$1,967.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,879.96
|
| Rate for Payer: Aetna Managed Medicare |
$612.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,420.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,093.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,049.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,158.58
|
| Rate for Payer: Cash Price |
$655.80
|
| Rate for Payer: Cigna Commercial |
$2,011.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,223.29
|
| Rate for Payer: Health EOS Commercial |
$1,945.54
|
| Rate for Payer: HFN Commercial |
$2,011.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,639.50
|
| Rate for Payer: Multiplan Commercial |
$1,748.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,311.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,011.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,071.14
|
| Rate for Payer: Quartz Commercial |
$1,420.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,311.60
|
| Rate for Payer: The Alliance Commercial |
$8,744.00
|
| Rate for Payer: WEA Trust Commercial |
$1,202.30
|
| Rate for Payer: WPS Commercial |
$1,619.17
|
|
|
SCREW CANN MINI 3.0 X 22MM HEADED IC3022
|
Facility
|
IP
|
$2,186.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599634
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,071.14 |
| Max. Negotiated Rate |
$2,011.12 |
| Rate for Payer: Aetna Commercial |
$1,967.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,879.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,158.58
|
| Rate for Payer: Cash Price |
$655.80
|
| Rate for Payer: Cigna Commercial |
$2,011.12
|
| Rate for Payer: Health EOS Commercial |
$1,945.54
|
| Rate for Payer: HFN Commercial |
$2,011.12
|
| Rate for Payer: Multiplan Commercial |
$1,748.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,311.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,011.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,071.14
|
| Rate for Payer: Quartz Commercial |
$1,311.60
|
| Rate for Payer: WEA Trust Commercial |
$1,202.30
|
| Rate for Payer: WPS Commercial |
$1,619.17
|
|
|
SCREW CANN MINI 3.0 X 24MM HEADED IC3024
|
Facility
|
IP
|
$2,186.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599635
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,071.14 |
| Max. Negotiated Rate |
$2,011.12 |
| Rate for Payer: Aetna Commercial |
$1,967.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,879.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,158.58
|
| Rate for Payer: Cash Price |
$655.80
|
| Rate for Payer: Cigna Commercial |
$2,011.12
|
| Rate for Payer: Health EOS Commercial |
$1,945.54
|
| Rate for Payer: HFN Commercial |
$2,011.12
|
| Rate for Payer: Multiplan Commercial |
$1,748.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,311.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,011.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,071.14
|
| Rate for Payer: Quartz Commercial |
$1,311.60
|
| Rate for Payer: WEA Trust Commercial |
$1,202.30
|
| Rate for Payer: WPS Commercial |
$1,619.17
|
|
|
SCREW CANN MINI 3.0 X 24MM HEADED IC3024
|
Facility
|
OP
|
$2,186.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599635
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.08 |
| Max. Negotiated Rate |
$8,744.00 |
| Rate for Payer: Aetna Commercial |
$1,967.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,879.96
|
| Rate for Payer: Aetna Managed Medicare |
$612.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,420.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,093.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,049.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,158.58
|
| Rate for Payer: Cash Price |
$655.80
|
| Rate for Payer: Cigna Commercial |
$2,011.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,223.29
|
| Rate for Payer: Health EOS Commercial |
$1,945.54
|
| Rate for Payer: HFN Commercial |
$2,011.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,639.50
|
| Rate for Payer: Multiplan Commercial |
$1,748.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,311.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,011.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,071.14
|
| Rate for Payer: Quartz Commercial |
$1,420.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,311.60
|
| Rate for Payer: The Alliance Commercial |
$8,744.00
|
| Rate for Payer: WEA Trust Commercial |
$1,202.30
|
| Rate for Payer: WPS Commercial |
$1,619.17
|
|
|
SCREW CANNULATED LAG
|
Facility
|
IP
|
$2,837.00
|
|
| Hospital Charge Code |
2965019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,390.13 |
| Max. Negotiated Rate |
$2,610.04 |
| Rate for Payer: Aetna Commercial |
$2,553.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,439.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,503.61
|
| Rate for Payer: Cash Price |
$851.10
|
| Rate for Payer: Cigna Commercial |
$2,610.04
|
| Rate for Payer: Health EOS Commercial |
$2,524.93
|
| Rate for Payer: HFN Commercial |
$2,610.04
|
| Rate for Payer: Multiplan Commercial |
$2,269.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,702.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,610.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,390.13
|
| Rate for Payer: Quartz Commercial |
$1,702.20
|
| Rate for Payer: WEA Trust Commercial |
$1,560.35
|
| Rate for Payer: WPS Commercial |
$2,101.37
|
|
|
SCREW CANNULATED LAG
|
Facility
|
OP
|
$2,837.00
|
|
| Hospital Charge Code |
2965019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$794.36 |
| Max. Negotiated Rate |
$11,348.00 |
| Rate for Payer: Aetna Commercial |
$2,553.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,439.82
|
| Rate for Payer: Aetna Managed Medicare |
$794.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,844.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,418.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,361.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,503.61
|
| Rate for Payer: Cash Price |
$851.10
|
| Rate for Payer: Cigna Commercial |
$2,610.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,587.59
|
| Rate for Payer: Health EOS Commercial |
$2,524.93
|
| Rate for Payer: HFN Commercial |
$2,610.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,127.75
|
| Rate for Payer: Multiplan Commercial |
$2,269.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,702.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,610.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,390.13
|
| Rate for Payer: Quartz Commercial |
$1,844.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,702.20
|
| Rate for Payer: The Alliance Commercial |
$11,348.00
|
| Rate for Payer: WEA Trust Commercial |
$1,560.35
|
| Rate for Payer: WPS Commercial |
$2,101.37
|
|
|
SCREW CANN VAL 5.0 X 40MM OPTILINK TI 42.231.640
|
Facility
|
OP
|
$2,477.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6244142
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$693.73 |
| Max. Negotiated Rate |
$9,910.40 |
| Rate for Payer: Aetna Commercial |
$2,229.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,130.74
|
| Rate for Payer: Aetna Managed Medicare |
$693.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,610.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,238.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,189.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,313.13
|
| Rate for Payer: Cash Price |
$743.28
|
| Rate for Payer: Cigna Commercial |
$2,279.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,386.46
|
| Rate for Payer: Health EOS Commercial |
$2,205.06
|
| Rate for Payer: HFN Commercial |
$2,279.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,858.20
|
| Rate for Payer: Multiplan Commercial |
$1,982.08
|
| Rate for Payer: NAPHCARE Commercial |
$1,486.56
|
| Rate for Payer: Preferred Network Access Commercial |
$2,279.39
|
| Rate for Payer: Quartz Beloit One Network |
$1,214.02
|
| Rate for Payer: Quartz Commercial |
$1,610.44
|
| Rate for Payer: Quartz Medicare Advantage |
$1,486.56
|
| Rate for Payer: The Alliance Commercial |
$9,910.40
|
| Rate for Payer: WEA Trust Commercial |
$1,362.68
|
| Rate for Payer: WPS Commercial |
$1,835.16
|
|
|
SCREW CANN VAL 5.0 X 40MM OPTILINK TI 42.231.640
|
Facility
|
IP
|
$2,477.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6244142
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,214.02 |
| Max. Negotiated Rate |
$2,279.39 |
| Rate for Payer: Aetna Commercial |
$2,229.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,130.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,313.13
|
| Rate for Payer: Cash Price |
$743.28
|
| Rate for Payer: Cigna Commercial |
$2,279.39
|
| Rate for Payer: Health EOS Commercial |
$2,205.06
|
| Rate for Payer: HFN Commercial |
$2,279.39
|
| Rate for Payer: Multiplan Commercial |
$1,982.08
|
| Rate for Payer: NAPHCARE Commercial |
$1,486.56
|
| Rate for Payer: Preferred Network Access Commercial |
$2,279.39
|
| Rate for Payer: Quartz Beloit One Network |
$1,214.02
|
| Rate for Payer: Quartz Commercial |
$1,486.56
|
| Rate for Payer: WEA Trust Commercial |
$1,362.68
|
| Rate for Payer: WPS Commercial |
$1,835.16
|
|
|
SCREW CANN VAL 5.0 X 70MM OPTILINK TI 42.231.670
|
Facility
|
OP
|
$2,577.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6201049
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$721.56 |
| Max. Negotiated Rate |
$10,308.00 |
| Rate for Payer: Aetna Commercial |
$2,319.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,216.22
|
| Rate for Payer: Aetna Managed Medicare |
$721.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,675.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,288.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,236.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,365.81
|
| Rate for Payer: Cash Price |
$773.10
|
| Rate for Payer: Cigna Commercial |
$2,370.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,442.09
|
| Rate for Payer: Health EOS Commercial |
$2,293.53
|
| Rate for Payer: HFN Commercial |
$2,370.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,932.75
|
| Rate for Payer: Multiplan Commercial |
$2,061.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,546.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,370.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,262.73
|
| Rate for Payer: Quartz Commercial |
$1,675.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,546.20
|
| Rate for Payer: The Alliance Commercial |
$10,308.00
|
| Rate for Payer: WEA Trust Commercial |
$1,417.35
|
| Rate for Payer: WPS Commercial |
$1,908.78
|
|
|
SCREW CANN VAL 5.0 X 70MM OPTILINK TI 42.231.670
|
Facility
|
IP
|
$2,577.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6201049
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,262.73 |
| Max. Negotiated Rate |
$2,370.84 |
| Rate for Payer: Aetna Commercial |
$2,319.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,216.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,365.81
|
| Rate for Payer: Cash Price |
$773.10
|
| Rate for Payer: Cigna Commercial |
$2,370.84
|
| Rate for Payer: Health EOS Commercial |
$2,293.53
|
| Rate for Payer: HFN Commercial |
$2,370.84
|
| Rate for Payer: Multiplan Commercial |
$2,061.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,546.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,370.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,262.73
|
| Rate for Payer: Quartz Commercial |
$1,546.20
|
| Rate for Payer: WEA Trust Commercial |
$1,417.35
|
| Rate for Payer: WPS Commercial |
$1,908.78
|
|
|
SCREW CANN VAL 5.0 X 75MM OPTILINK TI 42.231.675
|
Facility
|
OP
|
$2,436.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6169850
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$682.08 |
| Max. Negotiated Rate |
$9,744.00 |
| Rate for Payer: Aetna Commercial |
$2,192.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,094.96
|
| Rate for Payer: Aetna Managed Medicare |
$682.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,583.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,218.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,169.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,291.08
|
| Rate for Payer: Cash Price |
$730.80
|
| Rate for Payer: Cigna Commercial |
$2,241.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,363.19
|
| Rate for Payer: Health EOS Commercial |
$2,168.04
|
| Rate for Payer: HFN Commercial |
$2,241.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,827.00
|
| Rate for Payer: Multiplan Commercial |
$1,948.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,461.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,241.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,193.64
|
| Rate for Payer: Quartz Commercial |
$1,583.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,461.60
|
| Rate for Payer: The Alliance Commercial |
$9,744.00
|
| Rate for Payer: WEA Trust Commercial |
$1,339.80
|
| Rate for Payer: WPS Commercial |
$1,804.35
|
|
|
SCREW CANN VAL 5.0 X 75MM OPTILINK TI 42.231.675
|
Facility
|
IP
|
$2,436.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6169850
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,193.64 |
| Max. Negotiated Rate |
$2,241.12 |
| Rate for Payer: Aetna Commercial |
$2,192.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,094.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,291.08
|
| Rate for Payer: Cash Price |
$730.80
|
| Rate for Payer: Cigna Commercial |
$2,241.12
|
| Rate for Payer: Health EOS Commercial |
$2,168.04
|
| Rate for Payer: HFN Commercial |
$2,241.12
|
| Rate for Payer: Multiplan Commercial |
$1,948.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,461.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,241.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,193.64
|
| Rate for Payer: Quartz Commercial |
$1,461.60
|
| Rate for Payer: WEA Trust Commercial |
$1,339.80
|
| Rate for Payer: WPS Commercial |
$1,804.35
|
|
|
SCREW CANN VAL 5.0 X 80MM OPTILINK TI 42.231.680
|
Facility
|
OP
|
$2,577.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6226143
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$721.56 |
| Max. Negotiated Rate |
$10,308.00 |
| Rate for Payer: Aetna Commercial |
$2,319.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,216.22
|
| Rate for Payer: Aetna Managed Medicare |
$721.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,675.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,288.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,236.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,365.81
|
| Rate for Payer: Cash Price |
$773.10
|
| Rate for Payer: Cigna Commercial |
$2,370.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,442.09
|
| Rate for Payer: Health EOS Commercial |
$2,293.53
|
| Rate for Payer: HFN Commercial |
$2,370.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,932.75
|
| Rate for Payer: Multiplan Commercial |
$2,061.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,546.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,370.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,262.73
|
| Rate for Payer: Quartz Commercial |
$1,675.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,546.20
|
| Rate for Payer: The Alliance Commercial |
$10,308.00
|
| Rate for Payer: WEA Trust Commercial |
$1,417.35
|
| Rate for Payer: WPS Commercial |
$1,908.78
|
|
|
SCREW CANN VAL 5.0 X 80MM OPTILINK TI 42.231.680
|
Facility
|
IP
|
$2,577.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6226143
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,262.73 |
| Max. Negotiated Rate |
$2,370.84 |
| Rate for Payer: Aetna Commercial |
$2,319.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,216.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,365.81
|
| Rate for Payer: Cash Price |
$773.10
|
| Rate for Payer: Cigna Commercial |
$2,370.84
|
| Rate for Payer: Health EOS Commercial |
$2,293.53
|
| Rate for Payer: HFN Commercial |
$2,370.84
|
| Rate for Payer: Multiplan Commercial |
$2,061.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,546.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,370.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,262.73
|
| Rate for Payer: Quartz Commercial |
$1,546.20
|
| Rate for Payer: WEA Trust Commercial |
$1,417.35
|
| Rate for Payer: WPS Commercial |
$1,908.78
|
|
