|
SCREW BIO-TRANSFIX 5 X 40mm
|
Facility
|
IP
|
$2,183.00
|
|
| Hospital Charge Code |
2964717
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,112.46 |
| Max. Negotiated Rate |
$2,088.69 |
| Rate for Payer: Aetna Commercial |
$2,043.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,952.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,203.27
|
| Rate for Payer: Cash Price |
$654.90
|
| Rate for Payer: Cigna Commercial |
$2,088.69
|
| Rate for Payer: Health EOS Commercial |
$2,020.58
|
| Rate for Payer: HFN Commercial |
$2,088.69
|
| Rate for Payer: Multiplan Commercial |
$1,816.26
|
| Rate for Payer: Preferred Network Access Commercial |
$2,088.69
|
| Rate for Payer: Quartz Beloit One Network |
$1,112.46
|
| Rate for Payer: Quartz Commercial |
$1,362.19
|
| Rate for Payer: WEA Trust Commercial |
$1,248.68
|
| Rate for Payer: WPS Commercial |
$1,681.56
|
|
|
SCREW BIO-TRANSFIX 5 X 40mm
|
Facility
|
OP
|
$2,183.00
|
|
| Hospital Charge Code |
2964717
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$635.69 |
| Max. Negotiated Rate |
$2,088.69 |
| Rate for Payer: Aetna Commercial |
$2,043.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,952.48
|
| Rate for Payer: Aetna Managed Medicare |
$635.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,475.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,135.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,089.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,203.27
|
| Rate for Payer: Cash Price |
$654.90
|
| Rate for Payer: Cigna Commercial |
$2,088.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,270.51
|
| Rate for Payer: Health EOS Commercial |
$2,020.58
|
| Rate for Payer: HFN Commercial |
$2,088.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,702.74
|
| Rate for Payer: Multiplan Commercial |
$1,816.26
|
| Rate for Payer: NAPHCARE Commercial |
$1,362.19
|
| Rate for Payer: Preferred Network Access Commercial |
$2,088.69
|
| Rate for Payer: Quartz Beloit One Network |
$1,112.46
|
| Rate for Payer: Quartz Commercial |
$1,475.71
|
| Rate for Payer: Quartz Medicare Advantage |
$1,362.19
|
| Rate for Payer: The Alliance Commercial |
$1,135.16
|
| Rate for Payer: WEA Trust Commercial |
$1,248.68
|
| Rate for Payer: WPS Commercial |
$1,681.56
|
|
|
SCREW BIO-TRANSFIX AR-1351LB
|
Facility
|
OP
|
$3,929.00
|
|
| Hospital Charge Code |
2964698
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,144.12 |
| Max. Negotiated Rate |
$3,759.27 |
| Rate for Payer: Aetna Commercial |
$3,677.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,514.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,144.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,656.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,043.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,961.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,165.66
|
| Rate for Payer: Cash Price |
$1,178.70
|
| Rate for Payer: Cigna Commercial |
$3,759.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,286.68
|
| Rate for Payer: Health EOS Commercial |
$3,636.68
|
| Rate for Payer: HFN Commercial |
$3,759.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,064.62
|
| Rate for Payer: Multiplan Commercial |
$3,268.93
|
| Rate for Payer: NAPHCARE Commercial |
$2,451.70
|
| Rate for Payer: Preferred Network Access Commercial |
$3,759.27
|
| Rate for Payer: Quartz Beloit One Network |
$2,002.22
|
| Rate for Payer: Quartz Commercial |
$2,656.00
|
| Rate for Payer: Quartz Medicare Advantage |
$2,451.70
|
| Rate for Payer: The Alliance Commercial |
$2,043.08
|
| Rate for Payer: WEA Trust Commercial |
$2,247.39
|
| Rate for Payer: WPS Commercial |
$3,026.51
|
|
|
SCREW BIO-TRANSFIX AR-1351LB
|
Facility
|
IP
|
$3,929.00
|
|
| Hospital Charge Code |
2964698
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,002.22 |
| Max. Negotiated Rate |
$3,759.27 |
| Rate for Payer: Aetna Commercial |
$3,677.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,514.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,165.66
|
| Rate for Payer: Cash Price |
$1,178.70
|
| Rate for Payer: Cigna Commercial |
$3,759.27
|
| Rate for Payer: Health EOS Commercial |
$3,636.68
|
| Rate for Payer: HFN Commercial |
$3,759.27
|
| Rate for Payer: Multiplan Commercial |
$3,268.93
|
| Rate for Payer: Preferred Network Access Commercial |
$3,759.27
|
| Rate for Payer: Quartz Beloit One Network |
$2,002.22
|
| Rate for Payer: Quartz Commercial |
$2,451.70
|
| Rate for Payer: WEA Trust Commercial |
$2,247.39
|
| Rate for Payer: WPS Commercial |
$3,026.51
|
|
|
SCREW CAGE LARGE 40MM AR-9301-03
|
Facility
|
OP
|
$17,653.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5563217
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,140.55 |
| Max. Negotiated Rate |
$16,890.39 |
| Rate for Payer: Aetna Commercial |
$16,523.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,788.84
|
| Rate for Payer: Aetna Managed Medicare |
$5,140.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,933.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,179.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,812.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,730.33
|
| Rate for Payer: Cash Price |
$5,295.90
|
| Rate for Payer: Cigna Commercial |
$16,890.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,274.05
|
| Rate for Payer: Health EOS Commercial |
$16,339.62
|
| Rate for Payer: HFN Commercial |
$16,890.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,769.34
|
| Rate for Payer: Multiplan Commercial |
$14,687.30
|
| Rate for Payer: NAPHCARE Commercial |
$11,015.47
|
| Rate for Payer: Preferred Network Access Commercial |
$16,890.39
|
| Rate for Payer: Quartz Beloit One Network |
$8,995.97
|
| Rate for Payer: Quartz Commercial |
$11,933.43
|
| Rate for Payer: Quartz Medicare Advantage |
$11,015.47
|
| Rate for Payer: The Alliance Commercial |
$9,179.56
|
| Rate for Payer: WEA Trust Commercial |
$10,097.52
|
| Rate for Payer: WPS Commercial |
$13,598.11
|
|
|
SCREW CAGE LARGE 40MM AR-9301-03
|
Facility
|
IP
|
$17,653.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5563217
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,995.97 |
| Max. Negotiated Rate |
$16,890.39 |
| Rate for Payer: Aetna Commercial |
$16,523.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,788.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,730.33
|
| Rate for Payer: Cash Price |
$5,295.90
|
| Rate for Payer: Cigna Commercial |
$16,890.39
|
| Rate for Payer: Health EOS Commercial |
$16,339.62
|
| Rate for Payer: HFN Commercial |
$16,890.39
|
| Rate for Payer: Multiplan Commercial |
$14,687.30
|
| Rate for Payer: Preferred Network Access Commercial |
$16,890.39
|
| Rate for Payer: Quartz Beloit One Network |
$8,995.97
|
| Rate for Payer: Quartz Commercial |
$11,015.47
|
| Rate for Payer: WEA Trust Commercial |
$10,097.52
|
| Rate for Payer: WPS Commercial |
$13,598.11
|
|
|
SCREW CAGE MEDIUM 35MM AR-9301-02
|
Facility
|
OP
|
$17,653.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5603586
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,140.55 |
| Max. Negotiated Rate |
$16,890.39 |
| Rate for Payer: Aetna Commercial |
$16,523.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,788.84
|
| Rate for Payer: Aetna Managed Medicare |
$5,140.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,933.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,179.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,812.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,730.33
|
| Rate for Payer: Cash Price |
$5,295.90
|
| Rate for Payer: Cigna Commercial |
$16,890.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,274.05
|
| Rate for Payer: Health EOS Commercial |
$16,339.62
|
| Rate for Payer: HFN Commercial |
$16,890.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,769.34
|
| Rate for Payer: Multiplan Commercial |
$14,687.30
|
| Rate for Payer: NAPHCARE Commercial |
$11,015.47
|
| Rate for Payer: Preferred Network Access Commercial |
$16,890.39
|
| Rate for Payer: Quartz Beloit One Network |
$8,995.97
|
| Rate for Payer: Quartz Commercial |
$11,933.43
|
| Rate for Payer: Quartz Medicare Advantage |
$11,015.47
|
| Rate for Payer: The Alliance Commercial |
$9,179.56
|
| Rate for Payer: WEA Trust Commercial |
$10,097.52
|
| Rate for Payer: WPS Commercial |
$13,598.11
|
|
|
SCREW CAGE MEDIUM 35MM AR-9301-02
|
Facility
|
IP
|
$17,653.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5603586
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,995.97 |
| Max. Negotiated Rate |
$16,890.39 |
| Rate for Payer: Aetna Commercial |
$16,523.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,788.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,730.33
|
| Rate for Payer: Cash Price |
$5,295.90
|
| Rate for Payer: Cigna Commercial |
$16,890.39
|
| Rate for Payer: Health EOS Commercial |
$16,339.62
|
| Rate for Payer: HFN Commercial |
$16,890.39
|
| Rate for Payer: Multiplan Commercial |
$14,687.30
|
| Rate for Payer: Preferred Network Access Commercial |
$16,890.39
|
| Rate for Payer: Quartz Beloit One Network |
$8,995.97
|
| Rate for Payer: Quartz Commercial |
$11,015.47
|
| Rate for Payer: WEA Trust Commercial |
$10,097.52
|
| Rate for Payer: WPS Commercial |
$13,598.11
|
|
|
SCREW CANC 3.0 X 12MM SS FT AR-8830-12
|
Facility
|
IP
|
$799.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508982
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$407.17 |
| Max. Negotiated Rate |
$764.48 |
| Rate for Payer: Aetna Commercial |
$747.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$714.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$440.41
|
| Rate for Payer: Cash Price |
$239.70
|
| Rate for Payer: Cigna Commercial |
$764.48
|
| Rate for Payer: Health EOS Commercial |
$739.55
|
| Rate for Payer: HFN Commercial |
$764.48
|
| Rate for Payer: Multiplan Commercial |
$664.77
|
| Rate for Payer: Preferred Network Access Commercial |
$764.48
|
| Rate for Payer: Quartz Beloit One Network |
$407.17
|
| Rate for Payer: Quartz Commercial |
$498.58
|
| Rate for Payer: WEA Trust Commercial |
$457.03
|
| Rate for Payer: WPS Commercial |
$615.47
|
|
|
SCREW CANC 3.0 X 12MM SS FT AR-8830-12
|
Facility
|
OP
|
$799.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508982
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$232.67 |
| Max. Negotiated Rate |
$764.48 |
| Rate for Payer: Aetna Commercial |
$747.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$714.63
|
| Rate for Payer: Aetna Managed Medicare |
$232.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$540.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$415.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$398.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$440.41
|
| Rate for Payer: Cash Price |
$239.70
|
| Rate for Payer: Cigna Commercial |
$764.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$465.02
|
| Rate for Payer: Health EOS Commercial |
$739.55
|
| Rate for Payer: HFN Commercial |
$764.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$623.22
|
| Rate for Payer: Multiplan Commercial |
$664.77
|
| Rate for Payer: NAPHCARE Commercial |
$498.58
|
| Rate for Payer: Preferred Network Access Commercial |
$764.48
|
| Rate for Payer: Quartz Beloit One Network |
$407.17
|
| Rate for Payer: Quartz Commercial |
$540.12
|
| Rate for Payer: Quartz Medicare Advantage |
$498.58
|
| Rate for Payer: The Alliance Commercial |
$415.48
|
| Rate for Payer: WEA Trust Commercial |
$457.03
|
| Rate for Payer: WPS Commercial |
$615.47
|
|
|
SCREW CANC 3.0 X 14MM SS FT AR-8830-14
|
Facility
|
OP
|
$799.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508983
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$232.67 |
| Max. Negotiated Rate |
$764.48 |
| Rate for Payer: Aetna Commercial |
$747.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$714.63
|
| Rate for Payer: Aetna Managed Medicare |
$232.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$540.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$415.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$398.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$440.41
|
| Rate for Payer: Cash Price |
$239.70
|
| Rate for Payer: Cigna Commercial |
$764.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$465.02
|
| Rate for Payer: Health EOS Commercial |
$739.55
|
| Rate for Payer: HFN Commercial |
$764.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$623.22
|
| Rate for Payer: Multiplan Commercial |
$664.77
|
| Rate for Payer: NAPHCARE Commercial |
$498.58
|
| Rate for Payer: Preferred Network Access Commercial |
$764.48
|
| Rate for Payer: Quartz Beloit One Network |
$407.17
|
| Rate for Payer: Quartz Commercial |
$540.12
|
| Rate for Payer: Quartz Medicare Advantage |
$498.58
|
| Rate for Payer: The Alliance Commercial |
$415.48
|
| Rate for Payer: WEA Trust Commercial |
$457.03
|
| Rate for Payer: WPS Commercial |
$615.47
|
|
|
SCREW CANC 3.0 X 14MM SS FT AR-8830-14
|
Facility
|
IP
|
$799.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508983
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$407.17 |
| Max. Negotiated Rate |
$764.48 |
| Rate for Payer: Aetna Commercial |
$747.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$714.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$440.41
|
| Rate for Payer: Cash Price |
$239.70
|
| Rate for Payer: Cigna Commercial |
$764.48
|
| Rate for Payer: Health EOS Commercial |
$739.55
|
| Rate for Payer: HFN Commercial |
$764.48
|
| Rate for Payer: Multiplan Commercial |
$664.77
|
| Rate for Payer: Preferred Network Access Commercial |
$764.48
|
| Rate for Payer: Quartz Beloit One Network |
$407.17
|
| Rate for Payer: Quartz Commercial |
$498.58
|
| Rate for Payer: WEA Trust Commercial |
$457.03
|
| Rate for Payer: WPS Commercial |
$615.47
|
|
|
SCREW CANC 3.0 X 16MM SS FT AR-8830-16
|
Facility
|
IP
|
$799.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4509008
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$407.17 |
| Max. Negotiated Rate |
$764.48 |
| Rate for Payer: Aetna Commercial |
$747.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$714.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$440.41
|
| Rate for Payer: Cash Price |
$239.70
|
| Rate for Payer: Cigna Commercial |
$764.48
|
| Rate for Payer: Health EOS Commercial |
$739.55
|
| Rate for Payer: HFN Commercial |
$764.48
|
| Rate for Payer: Multiplan Commercial |
$664.77
|
| Rate for Payer: Preferred Network Access Commercial |
$764.48
|
| Rate for Payer: Quartz Beloit One Network |
$407.17
|
| Rate for Payer: Quartz Commercial |
$498.58
|
| Rate for Payer: WEA Trust Commercial |
$457.03
|
| Rate for Payer: WPS Commercial |
$615.47
|
|
|
SCREW CANC 3.0 X 16MM SS FT AR-8830-16
|
Facility
|
OP
|
$799.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4509008
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$232.67 |
| Max. Negotiated Rate |
$764.48 |
| Rate for Payer: Aetna Commercial |
$747.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$714.63
|
| Rate for Payer: Aetna Managed Medicare |
$232.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$540.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$415.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$398.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$440.41
|
| Rate for Payer: Cash Price |
$239.70
|
| Rate for Payer: Cigna Commercial |
$764.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$465.02
|
| Rate for Payer: Health EOS Commercial |
$739.55
|
| Rate for Payer: HFN Commercial |
$764.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$623.22
|
| Rate for Payer: Multiplan Commercial |
$664.77
|
| Rate for Payer: NAPHCARE Commercial |
$498.58
|
| Rate for Payer: Preferred Network Access Commercial |
$764.48
|
| Rate for Payer: Quartz Beloit One Network |
$407.17
|
| Rate for Payer: Quartz Commercial |
$540.12
|
| Rate for Payer: Quartz Medicare Advantage |
$498.58
|
| Rate for Payer: The Alliance Commercial |
$415.48
|
| Rate for Payer: WEA Trust Commercial |
$457.03
|
| Rate for Payer: WPS Commercial |
$615.47
|
|
|
SCREW CANC 3.0 X 18MM SS FT AR-8830-18
|
Facility
|
OP
|
$738.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6153644
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$214.91 |
| Max. Negotiated Rate |
$706.12 |
| Rate for Payer: Aetna Commercial |
$690.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$660.07
|
| Rate for Payer: Aetna Managed Medicare |
$214.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$498.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$383.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$368.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$406.79
|
| Rate for Payer: Cash Price |
$221.40
|
| Rate for Payer: Cigna Commercial |
$706.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$429.52
|
| Rate for Payer: Health EOS Commercial |
$683.09
|
| Rate for Payer: HFN Commercial |
$706.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$575.64
|
| Rate for Payer: Multiplan Commercial |
$614.02
|
| Rate for Payer: NAPHCARE Commercial |
$460.51
|
| Rate for Payer: Preferred Network Access Commercial |
$706.12
|
| Rate for Payer: Quartz Beloit One Network |
$376.08
|
| Rate for Payer: Quartz Commercial |
$498.89
|
| Rate for Payer: Quartz Medicare Advantage |
$460.51
|
| Rate for Payer: The Alliance Commercial |
$383.76
|
| Rate for Payer: WEA Trust Commercial |
$422.14
|
| Rate for Payer: WPS Commercial |
$568.48
|
|
|
SCREW CANC 3.0 X 18MM SS FT AR-8830-18
|
Facility
|
IP
|
$738.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6153644
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$376.08 |
| Max. Negotiated Rate |
$706.12 |
| Rate for Payer: Aetna Commercial |
$690.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$660.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$406.79
|
| Rate for Payer: Cash Price |
$221.40
|
| Rate for Payer: Cigna Commercial |
$706.12
|
| Rate for Payer: Health EOS Commercial |
$683.09
|
| Rate for Payer: HFN Commercial |
$706.12
|
| Rate for Payer: Multiplan Commercial |
$614.02
|
| Rate for Payer: Preferred Network Access Commercial |
$706.12
|
| Rate for Payer: Quartz Beloit One Network |
$376.08
|
| Rate for Payer: Quartz Commercial |
$460.51
|
| Rate for Payer: WEA Trust Commercial |
$422.14
|
| Rate for Payer: WPS Commercial |
$568.48
|
|
|
SCREW CANC 3.0 X 30MM SS FT AR-8830-30
|
Facility
|
IP
|
$627.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5861648
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$319.52 |
| Max. Negotiated Rate |
$599.91 |
| Rate for Payer: Aetna Commercial |
$586.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$560.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$345.60
|
| Rate for Payer: Cash Price |
$188.10
|
| Rate for Payer: Cigna Commercial |
$599.91
|
| Rate for Payer: Health EOS Commercial |
$580.35
|
| Rate for Payer: HFN Commercial |
$599.91
|
| Rate for Payer: Multiplan Commercial |
$521.66
|
| Rate for Payer: Preferred Network Access Commercial |
$599.91
|
| Rate for Payer: Quartz Beloit One Network |
$319.52
|
| Rate for Payer: Quartz Commercial |
$391.25
|
| Rate for Payer: WEA Trust Commercial |
$358.64
|
| Rate for Payer: WPS Commercial |
$482.98
|
|
|
SCREW CANC 3.0 X 30MM SS FT AR-8830-30
|
Facility
|
OP
|
$627.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5861648
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$182.58 |
| Max. Negotiated Rate |
$599.91 |
| Rate for Payer: Aetna Commercial |
$586.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$560.79
|
| Rate for Payer: Aetna Managed Medicare |
$182.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$423.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$326.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$313.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$345.60
|
| Rate for Payer: Cash Price |
$188.10
|
| Rate for Payer: Cigna Commercial |
$599.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$364.91
|
| Rate for Payer: Health EOS Commercial |
$580.35
|
| Rate for Payer: HFN Commercial |
$599.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$489.06
|
| Rate for Payer: Multiplan Commercial |
$521.66
|
| Rate for Payer: NAPHCARE Commercial |
$391.25
|
| Rate for Payer: Preferred Network Access Commercial |
$599.91
|
| Rate for Payer: Quartz Beloit One Network |
$319.52
|
| Rate for Payer: Quartz Commercial |
$423.85
|
| Rate for Payer: Quartz Medicare Advantage |
$391.25
|
| Rate for Payer: The Alliance Commercial |
$326.04
|
| Rate for Payer: WEA Trust Commercial |
$358.64
|
| Rate for Payer: WPS Commercial |
$482.98
|
|
|
SCREW CANC 4.0 X 10 FULL THREAD 206.010
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967025
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$49.80 |
| Max. Negotiated Rate |
$163.61 |
| Rate for Payer: Aetna Commercial |
$160.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$152.94
|
| Rate for Payer: Aetna Managed Medicare |
$49.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$115.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$88.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$85.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$94.26
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cigna Commercial |
$163.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$99.52
|
| Rate for Payer: Health EOS Commercial |
$158.28
|
| Rate for Payer: HFN Commercial |
$163.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$133.38
|
| Rate for Payer: Multiplan Commercial |
$142.27
|
| Rate for Payer: NAPHCARE Commercial |
$106.70
|
| Rate for Payer: Preferred Network Access Commercial |
$163.61
|
| Rate for Payer: Quartz Beloit One Network |
$87.14
|
| Rate for Payer: Quartz Commercial |
$115.60
|
| Rate for Payer: Quartz Medicare Advantage |
$106.70
|
| Rate for Payer: The Alliance Commercial |
$88.92
|
| Rate for Payer: WEA Trust Commercial |
$97.81
|
| Rate for Payer: WPS Commercial |
$131.72
|
|
|
SCREW CANC 4.0 X 10 FULL THREAD 206.010
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967025
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$87.14 |
| Max. Negotiated Rate |
$163.61 |
| Rate for Payer: Aetna Commercial |
$160.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$152.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$94.26
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cigna Commercial |
$163.61
|
| Rate for Payer: Health EOS Commercial |
$158.28
|
| Rate for Payer: HFN Commercial |
$163.61
|
| Rate for Payer: Multiplan Commercial |
$142.27
|
| Rate for Payer: Preferred Network Access Commercial |
$163.61
|
| Rate for Payer: Quartz Beloit One Network |
$87.14
|
| Rate for Payer: Quartz Commercial |
$106.70
|
| Rate for Payer: WEA Trust Commercial |
$97.81
|
| Rate for Payer: WPS Commercial |
$131.72
|
|
|
SCREW CANC 4.0 X 10 PART THREAD 207.010
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967026
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$107.02 |
| Max. Negotiated Rate |
$200.93 |
| Rate for Payer: Aetna Commercial |
$196.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$187.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.75
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$200.93
|
| Rate for Payer: Health EOS Commercial |
$194.38
|
| Rate for Payer: HFN Commercial |
$200.93
|
| Rate for Payer: Multiplan Commercial |
$174.72
|
| Rate for Payer: Preferred Network Access Commercial |
$200.93
|
| Rate for Payer: Quartz Beloit One Network |
$107.02
|
| Rate for Payer: Quartz Commercial |
$131.04
|
| Rate for Payer: WEA Trust Commercial |
$120.12
|
| Rate for Payer: WPS Commercial |
$161.76
|
|
|
SCREW CANC 4.0 X 10 PART THREAD 207.010
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967026
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$61.15 |
| Max. Negotiated Rate |
$200.93 |
| Rate for Payer: Aetna Commercial |
$196.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$187.82
|
| Rate for Payer: Aetna Managed Medicare |
$61.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$141.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$109.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$104.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.75
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$200.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$122.22
|
| Rate for Payer: Health EOS Commercial |
$194.38
|
| Rate for Payer: HFN Commercial |
$200.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$163.80
|
| Rate for Payer: Multiplan Commercial |
$174.72
|
| Rate for Payer: NAPHCARE Commercial |
$131.04
|
| Rate for Payer: Preferred Network Access Commercial |
$200.93
|
| Rate for Payer: Quartz Beloit One Network |
$107.02
|
| Rate for Payer: Quartz Commercial |
$141.96
|
| Rate for Payer: Quartz Medicare Advantage |
$131.04
|
| Rate for Payer: The Alliance Commercial |
$109.20
|
| Rate for Payer: WEA Trust Commercial |
$120.12
|
| Rate for Payer: WPS Commercial |
$161.76
|
|
|
SCREW CANC 4.0 X 12 FULL THREAD 206.012
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967027
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$90.71 |
| Max. Negotiated Rate |
$170.31 |
| Rate for Payer: Aetna Commercial |
$166.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$159.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.11
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cigna Commercial |
$170.31
|
| Rate for Payer: Health EOS Commercial |
$164.76
|
| Rate for Payer: HFN Commercial |
$170.31
|
| Rate for Payer: Multiplan Commercial |
$148.10
|
| Rate for Payer: Preferred Network Access Commercial |
$170.31
|
| Rate for Payer: Quartz Beloit One Network |
$90.71
|
| Rate for Payer: Quartz Commercial |
$111.07
|
| Rate for Payer: WEA Trust Commercial |
$101.82
|
| Rate for Payer: WPS Commercial |
$137.11
|
|
|
SCREW CANC 4.0 X 12 FULL THREAD 206.012
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967027
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$51.83 |
| Max. Negotiated Rate |
$170.31 |
| Rate for Payer: Aetna Commercial |
$166.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$159.20
|
| Rate for Payer: Aetna Managed Medicare |
$51.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$120.33
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$92.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$88.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.11
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cigna Commercial |
$170.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$103.60
|
| Rate for Payer: Health EOS Commercial |
$164.76
|
| Rate for Payer: HFN Commercial |
$170.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$138.84
|
| Rate for Payer: Multiplan Commercial |
$148.10
|
| Rate for Payer: NAPHCARE Commercial |
$111.07
|
| Rate for Payer: Preferred Network Access Commercial |
$170.31
|
| Rate for Payer: Quartz Beloit One Network |
$90.71
|
| Rate for Payer: Quartz Commercial |
$120.33
|
| Rate for Payer: Quartz Medicare Advantage |
$111.07
|
| Rate for Payer: The Alliance Commercial |
$92.56
|
| Rate for Payer: WEA Trust Commercial |
$101.82
|
| Rate for Payer: WPS Commercial |
$137.11
|
|
|
SCREW CANC 4.0 X 12 LP AR-8840-12
|
Facility
|
IP
|
$627.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5627648
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$319.52 |
| Max. Negotiated Rate |
$599.91 |
| Rate for Payer: Aetna Commercial |
$586.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$560.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$345.60
|
| Rate for Payer: Cash Price |
$188.10
|
| Rate for Payer: Cigna Commercial |
$599.91
|
| Rate for Payer: Health EOS Commercial |
$580.35
|
| Rate for Payer: HFN Commercial |
$599.91
|
| Rate for Payer: Multiplan Commercial |
$521.66
|
| Rate for Payer: Preferred Network Access Commercial |
$599.91
|
| Rate for Payer: Quartz Beloit One Network |
$319.52
|
| Rate for Payer: Quartz Commercial |
$391.25
|
| Rate for Payer: WEA Trust Commercial |
$358.64
|
| Rate for Payer: WPS Commercial |
$482.98
|
|
