|
SCREW 4.0x34 LOCKING TORNIER
|
Facility
|
OP
|
$1,373.00
|
|
| Hospital Charge Code |
2967363
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$384.44 |
| Max. Negotiated Rate |
$5,492.00 |
| Rate for Payer: Aetna Commercial |
$1,235.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,180.78
|
| Rate for Payer: Aetna Managed Medicare |
$384.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$892.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$686.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$659.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$727.69
|
| Rate for Payer: Cash Price |
$411.90
|
| Rate for Payer: Cigna Commercial |
$1,263.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$768.33
|
| Rate for Payer: Health EOS Commercial |
$1,221.97
|
| Rate for Payer: HFN Commercial |
$1,263.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,029.75
|
| Rate for Payer: Multiplan Commercial |
$1,098.40
|
| Rate for Payer: NAPHCARE Commercial |
$823.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,263.16
|
| Rate for Payer: Quartz Beloit One Network |
$672.77
|
| Rate for Payer: Quartz Commercial |
$892.45
|
| Rate for Payer: Quartz Medicare Advantage |
$823.80
|
| Rate for Payer: The Alliance Commercial |
$5,492.00
|
| Rate for Payer: WEA Trust Commercial |
$755.15
|
| Rate for Payer: WPS Commercial |
$1,016.98
|
|
|
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 |
$319.48 |
| Max. Negotiated Rate |
$599.84 |
| Rate for Payer: Aetna Commercial |
$586.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$560.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$345.56
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cigna Commercial |
$599.84
|
| Rate for Payer: Health EOS Commercial |
$580.28
|
| Rate for Payer: HFN Commercial |
$599.84
|
| Rate for Payer: Multiplan Commercial |
$521.60
|
| Rate for Payer: NAPHCARE Commercial |
$391.20
|
| Rate for Payer: Preferred Network Access Commercial |
$599.84
|
| Rate for Payer: Quartz Beloit One Network |
$319.48
|
| Rate for Payer: Quartz Commercial |
$391.20
|
| Rate for Payer: WEA Trust Commercial |
$358.60
|
| Rate for Payer: WPS Commercial |
$482.94
|
|
|
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 |
$182.56 |
| Max. Negotiated Rate |
$2,608.00 |
| Rate for Payer: Aetna Commercial |
$586.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$560.72
|
| Rate for Payer: Aetna Managed Medicare |
$182.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$423.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$326.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$312.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$345.56
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cigna Commercial |
$599.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$364.86
|
| Rate for Payer: Health EOS Commercial |
$580.28
|
| Rate for Payer: HFN Commercial |
$599.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$489.00
|
| Rate for Payer: Multiplan Commercial |
$521.60
|
| Rate for Payer: NAPHCARE Commercial |
$391.20
|
| Rate for Payer: Preferred Network Access Commercial |
$599.84
|
| Rate for Payer: Quartz Beloit One Network |
$319.48
|
| Rate for Payer: Quartz Commercial |
$423.80
|
| Rate for Payer: Quartz Medicare Advantage |
$391.20
|
| Rate for Payer: The Alliance Commercial |
$2,608.00
|
| Rate for Payer: WEA Trust Commercial |
$358.60
|
| Rate for Payer: WPS Commercial |
$482.94
|
|
|
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 |
$640.92 |
| Max. Negotiated Rate |
$9,156.00 |
| Rate for Payer: Aetna Commercial |
$2,060.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,968.54
|
| Rate for Payer: Aetna Managed Medicare |
$640.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,487.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,144.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,098.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,213.17
|
| Rate for Payer: Cash Price |
$686.70
|
| Rate for Payer: Cigna Commercial |
$2,105.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,280.92
|
| Rate for Payer: Health EOS Commercial |
$2,037.21
|
| Rate for Payer: HFN Commercial |
$2,105.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,716.75
|
| Rate for Payer: Multiplan Commercial |
$1,831.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,373.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,105.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,121.61
|
| Rate for Payer: Quartz Commercial |
$1,487.85
|
| Rate for Payer: Quartz Medicare Advantage |
$1,373.40
|
| Rate for Payer: The Alliance Commercial |
$9,156.00
|
| Rate for Payer: WEA Trust Commercial |
$1,258.95
|
| Rate for Payer: WPS Commercial |
$1,695.46
|
|
|
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 |
$1,121.61 |
| Max. Negotiated Rate |
$2,105.88 |
| Rate for Payer: Aetna Commercial |
$2,060.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,968.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,213.17
|
| Rate for Payer: Cash Price |
$686.70
|
| Rate for Payer: Cigna Commercial |
$2,105.88
|
| Rate for Payer: Health EOS Commercial |
$2,037.21
|
| Rate for Payer: HFN Commercial |
$2,105.88
|
| Rate for Payer: Multiplan Commercial |
$1,831.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,373.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,105.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,121.61
|
| Rate for Payer: Quartz Commercial |
$1,373.40
|
| Rate for Payer: WEA Trust Commercial |
$1,258.95
|
| Rate for Payer: WPS Commercial |
$1,695.46
|
|
|
SCREW 4.0x42 CANNULATED
|
Facility
|
IP
|
$1,922.00
|
|
| Hospital Charge Code |
2965017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$941.78 |
| Max. Negotiated Rate |
$1,768.24 |
| Rate for Payer: Aetna Commercial |
$1,729.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,652.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,018.66
|
| Rate for Payer: Cash Price |
$576.60
|
| Rate for Payer: Cigna Commercial |
$1,768.24
|
| Rate for Payer: Health EOS Commercial |
$1,710.58
|
| Rate for Payer: HFN Commercial |
$1,768.24
|
| Rate for Payer: Multiplan Commercial |
$1,537.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,153.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,768.24
|
| Rate for Payer: Quartz Beloit One Network |
$941.78
|
| Rate for Payer: Quartz Commercial |
$1,153.20
|
| Rate for Payer: WEA Trust Commercial |
$1,057.10
|
| Rate for Payer: WPS Commercial |
$1,423.63
|
|
|
SCREW 4.0x42 CANNULATED
|
Facility
|
OP
|
$1,922.00
|
|
| Hospital Charge Code |
2965017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$538.16 |
| Max. Negotiated Rate |
$7,688.00 |
| Rate for Payer: Aetna Commercial |
$1,729.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,652.92
|
| Rate for Payer: Aetna Managed Medicare |
$538.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,249.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$961.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$922.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,018.66
|
| Rate for Payer: Cash Price |
$576.60
|
| Rate for Payer: Cigna Commercial |
$1,768.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,075.55
|
| Rate for Payer: Health EOS Commercial |
$1,710.58
|
| Rate for Payer: HFN Commercial |
$1,768.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,441.50
|
| Rate for Payer: Multiplan Commercial |
$1,537.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,153.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,768.24
|
| Rate for Payer: Quartz Beloit One Network |
$941.78
|
| Rate for Payer: Quartz Commercial |
$1,249.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,153.20
|
| Rate for Payer: The Alliance Commercial |
$7,688.00
|
| Rate for Payer: WEA Trust Commercial |
$1,057.10
|
| Rate for Payer: WPS Commercial |
$1,423.63
|
|
|
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 |
$640.92 |
| Max. Negotiated Rate |
$9,156.00 |
| Rate for Payer: Aetna Commercial |
$2,060.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,968.54
|
| Rate for Payer: Aetna Managed Medicare |
$640.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,487.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,144.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,098.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,213.17
|
| Rate for Payer: Cash Price |
$686.70
|
| Rate for Payer: Cigna Commercial |
$2,105.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,280.92
|
| Rate for Payer: Health EOS Commercial |
$2,037.21
|
| Rate for Payer: HFN Commercial |
$2,105.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,716.75
|
| Rate for Payer: Multiplan Commercial |
$1,831.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,373.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,105.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,121.61
|
| Rate for Payer: Quartz Commercial |
$1,487.85
|
| Rate for Payer: Quartz Medicare Advantage |
$1,373.40
|
| Rate for Payer: The Alliance Commercial |
$9,156.00
|
| Rate for Payer: WEA Trust Commercial |
$1,258.95
|
| Rate for Payer: WPS Commercial |
$1,695.46
|
|
|
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 |
$1,121.61 |
| Max. Negotiated Rate |
$2,105.88 |
| Rate for Payer: Aetna Commercial |
$2,060.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,968.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,213.17
|
| Rate for Payer: Cash Price |
$686.70
|
| Rate for Payer: Cigna Commercial |
$2,105.88
|
| Rate for Payer: Health EOS Commercial |
$2,037.21
|
| Rate for Payer: HFN Commercial |
$2,105.88
|
| Rate for Payer: Multiplan Commercial |
$1,831.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,373.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,105.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,121.61
|
| Rate for Payer: Quartz Commercial |
$1,373.40
|
| Rate for Payer: WEA Trust Commercial |
$1,258.95
|
| Rate for Payer: WPS Commercial |
$1,695.46
|
|
|
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 |
$665.84 |
| Max. Negotiated Rate |
$9,512.00 |
| Rate for Payer: Aetna Commercial |
$2,140.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,045.08
|
| Rate for Payer: Aetna Managed Medicare |
$665.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,545.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,189.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,141.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,260.34
|
| Rate for Payer: Cash Price |
$713.40
|
| Rate for Payer: Cigna Commercial |
$2,187.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,330.73
|
| Rate for Payer: Health EOS Commercial |
$2,116.42
|
| Rate for Payer: HFN Commercial |
$2,187.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,783.50
|
| Rate for Payer: Multiplan Commercial |
$1,902.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,426.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,187.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,165.22
|
| Rate for Payer: Quartz Commercial |
$1,545.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,426.80
|
| Rate for Payer: The Alliance Commercial |
$9,512.00
|
| Rate for Payer: WEA Trust Commercial |
$1,307.90
|
| Rate for Payer: WPS Commercial |
$1,761.38
|
|
|
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 |
$1,165.22 |
| Max. Negotiated Rate |
$2,187.76 |
| Rate for Payer: Aetna Commercial |
$2,140.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,045.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,260.34
|
| Rate for Payer: Cash Price |
$713.40
|
| Rate for Payer: Cigna Commercial |
$2,187.76
|
| Rate for Payer: Health EOS Commercial |
$2,116.42
|
| Rate for Payer: HFN Commercial |
$2,187.76
|
| Rate for Payer: Multiplan Commercial |
$1,902.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,426.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,187.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,165.22
|
| Rate for Payer: Quartz Commercial |
$1,426.80
|
| Rate for Payer: WEA Trust Commercial |
$1,307.90
|
| Rate for Payer: WPS Commercial |
$1,761.38
|
|
|
SCREW 4.0x45 TI CANC FULL THR
|
Facility
|
OP
|
$472.00
|
|
| Hospital Charge Code |
2966519
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$132.16 |
| Max. Negotiated Rate |
$1,888.00 |
| Rate for Payer: Aetna Commercial |
$424.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$405.92
|
| Rate for Payer: Aetna Managed Medicare |
$132.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$306.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$236.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$226.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$250.16
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cigna Commercial |
$434.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$264.13
|
| Rate for Payer: Health EOS Commercial |
$420.08
|
| Rate for Payer: HFN Commercial |
$434.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$354.00
|
| Rate for Payer: Multiplan Commercial |
$377.60
|
| Rate for Payer: NAPHCARE Commercial |
$283.20
|
| Rate for Payer: Preferred Network Access Commercial |
$434.24
|
| Rate for Payer: Quartz Beloit One Network |
$231.28
|
| Rate for Payer: Quartz Commercial |
$306.80
|
| Rate for Payer: Quartz Medicare Advantage |
$283.20
|
| Rate for Payer: The Alliance Commercial |
$1,888.00
|
| Rate for Payer: WEA Trust Commercial |
$259.60
|
| Rate for Payer: WPS Commercial |
$349.61
|
|
|
SCREW 4.0x45 TI CANC FULL THR
|
Facility
|
IP
|
$472.00
|
|
| Hospital Charge Code |
2966519
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$231.28 |
| Max. Negotiated Rate |
$434.24 |
| Rate for Payer: Aetna Commercial |
$424.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$405.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$250.16
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cigna Commercial |
$434.24
|
| Rate for Payer: Health EOS Commercial |
$420.08
|
| Rate for Payer: HFN Commercial |
$434.24
|
| Rate for Payer: Multiplan Commercial |
$377.60
|
| Rate for Payer: NAPHCARE Commercial |
$283.20
|
| Rate for Payer: Preferred Network Access Commercial |
$434.24
|
| Rate for Payer: Quartz Beloit One Network |
$231.28
|
| Rate for Payer: Quartz Commercial |
$283.20
|
| Rate for Payer: WEA Trust Commercial |
$259.60
|
| Rate for Payer: WPS Commercial |
$349.61
|
|
|
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 |
$182.56 |
| Max. Negotiated Rate |
$2,608.00 |
| Rate for Payer: Aetna Commercial |
$586.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$560.72
|
| Rate for Payer: Aetna Managed Medicare |
$182.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$423.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$326.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$312.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$345.56
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cigna Commercial |
$599.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$364.86
|
| Rate for Payer: Health EOS Commercial |
$580.28
|
| Rate for Payer: HFN Commercial |
$599.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$489.00
|
| Rate for Payer: Multiplan Commercial |
$521.60
|
| Rate for Payer: NAPHCARE Commercial |
$391.20
|
| Rate for Payer: Preferred Network Access Commercial |
$599.84
|
| Rate for Payer: Quartz Beloit One Network |
$319.48
|
| Rate for Payer: Quartz Commercial |
$423.80
|
| Rate for Payer: Quartz Medicare Advantage |
$391.20
|
| Rate for Payer: The Alliance Commercial |
$2,608.00
|
| Rate for Payer: WEA Trust Commercial |
$358.60
|
| Rate for Payer: WPS Commercial |
$482.94
|
|
|
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 |
$319.48 |
| Max. Negotiated Rate |
$599.84 |
| Rate for Payer: Aetna Commercial |
$586.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$560.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$345.56
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cigna Commercial |
$599.84
|
| Rate for Payer: Health EOS Commercial |
$580.28
|
| Rate for Payer: HFN Commercial |
$599.84
|
| Rate for Payer: Multiplan Commercial |
$521.60
|
| Rate for Payer: NAPHCARE Commercial |
$391.20
|
| Rate for Payer: Preferred Network Access Commercial |
$599.84
|
| Rate for Payer: Quartz Beloit One Network |
$319.48
|
| Rate for Payer: Quartz Commercial |
$391.20
|
| Rate for Payer: WEA Trust Commercial |
$358.60
|
| Rate for Payer: WPS Commercial |
$482.94
|
|
|
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 |
$182.56 |
| Max. Negotiated Rate |
$2,608.00 |
| Rate for Payer: Aetna Commercial |
$586.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$560.72
|
| Rate for Payer: Aetna Managed Medicare |
$182.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$423.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$326.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$312.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$345.56
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cigna Commercial |
$599.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$364.86
|
| Rate for Payer: Health EOS Commercial |
$580.28
|
| Rate for Payer: HFN Commercial |
$599.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$489.00
|
| Rate for Payer: Multiplan Commercial |
$521.60
|
| Rate for Payer: NAPHCARE Commercial |
$391.20
|
| Rate for Payer: Preferred Network Access Commercial |
$599.84
|
| Rate for Payer: Quartz Beloit One Network |
$319.48
|
| Rate for Payer: Quartz Commercial |
$423.80
|
| Rate for Payer: Quartz Medicare Advantage |
$391.20
|
| Rate for Payer: The Alliance Commercial |
$2,608.00
|
| Rate for Payer: WEA Trust Commercial |
$358.60
|
| Rate for Payer: WPS Commercial |
$482.94
|
|
|
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 |
$319.48 |
| Max. Negotiated Rate |
$599.84 |
| Rate for Payer: Aetna Commercial |
$586.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$560.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$345.56
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cigna Commercial |
$599.84
|
| Rate for Payer: Health EOS Commercial |
$580.28
|
| Rate for Payer: HFN Commercial |
$599.84
|
| Rate for Payer: Multiplan Commercial |
$521.60
|
| Rate for Payer: NAPHCARE Commercial |
$391.20
|
| Rate for Payer: Preferred Network Access Commercial |
$599.84
|
| Rate for Payer: Quartz Beloit One Network |
$319.48
|
| Rate for Payer: Quartz Commercial |
$391.20
|
| Rate for Payer: WEA Trust Commercial |
$358.60
|
| Rate for Payer: WPS Commercial |
$482.94
|
|
|
SCREW 4.0x60 TI CANC FULL THR
|
Facility
|
OP
|
$472.00
|
|
| Hospital Charge Code |
2966520
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$132.16 |
| Max. Negotiated Rate |
$1,888.00 |
| Rate for Payer: Aetna Commercial |
$424.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$405.92
|
| Rate for Payer: Aetna Managed Medicare |
$132.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$306.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$236.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$226.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$250.16
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cigna Commercial |
$434.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$264.13
|
| Rate for Payer: Health EOS Commercial |
$420.08
|
| Rate for Payer: HFN Commercial |
$434.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$354.00
|
| Rate for Payer: Multiplan Commercial |
$377.60
|
| Rate for Payer: NAPHCARE Commercial |
$283.20
|
| Rate for Payer: Preferred Network Access Commercial |
$434.24
|
| Rate for Payer: Quartz Beloit One Network |
$231.28
|
| Rate for Payer: Quartz Commercial |
$306.80
|
| Rate for Payer: Quartz Medicare Advantage |
$283.20
|
| Rate for Payer: The Alliance Commercial |
$1,888.00
|
| Rate for Payer: WEA Trust Commercial |
$259.60
|
| Rate for Payer: WPS Commercial |
$349.61
|
|
|
SCREW 4.0x60 TI CANC FULL THR
|
Facility
|
IP
|
$472.00
|
|
| Hospital Charge Code |
2966520
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$231.28 |
| Max. Negotiated Rate |
$434.24 |
| Rate for Payer: Aetna Commercial |
$424.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$405.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$250.16
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cigna Commercial |
$434.24
|
| Rate for Payer: Health EOS Commercial |
$420.08
|
| Rate for Payer: HFN Commercial |
$434.24
|
| Rate for Payer: Multiplan Commercial |
$377.60
|
| Rate for Payer: NAPHCARE Commercial |
$283.20
|
| Rate for Payer: Preferred Network Access Commercial |
$434.24
|
| Rate for Payer: Quartz Beloit One Network |
$231.28
|
| Rate for Payer: Quartz Commercial |
$283.20
|
| Rate for Payer: WEA Trust Commercial |
$259.60
|
| Rate for Payer: WPS Commercial |
$349.61
|
|
|
SCREW 4.5X16 214.816
|
Facility
|
IP
|
$484.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966921
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$237.16 |
| Max. Negotiated Rate |
$445.28 |
| Rate for Payer: Aetna Commercial |
$435.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$416.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$256.52
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$445.28
|
| Rate for Payer: Health EOS Commercial |
$430.76
|
| Rate for Payer: HFN Commercial |
$445.28
|
| Rate for Payer: Multiplan Commercial |
$387.20
|
| Rate for Payer: NAPHCARE Commercial |
$290.40
|
| Rate for Payer: Preferred Network Access Commercial |
$445.28
|
| Rate for Payer: Quartz Beloit One Network |
$237.16
|
| Rate for Payer: Quartz Commercial |
$290.40
|
| Rate for Payer: WEA Trust Commercial |
$266.20
|
| Rate for Payer: WPS Commercial |
$358.50
|
|
|
SCREW 4.5X16 214.816
|
Facility
|
OP
|
$484.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966921
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$135.52 |
| Max. Negotiated Rate |
$1,936.00 |
| Rate for Payer: Aetna Commercial |
$435.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$416.24
|
| Rate for Payer: Aetna Managed Medicare |
$135.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$314.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$242.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$232.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$256.52
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$445.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$270.85
|
| Rate for Payer: Health EOS Commercial |
$430.76
|
| Rate for Payer: HFN Commercial |
$445.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$363.00
|
| Rate for Payer: Multiplan Commercial |
$387.20
|
| Rate for Payer: NAPHCARE Commercial |
$290.40
|
| Rate for Payer: Preferred Network Access Commercial |
$445.28
|
| Rate for Payer: Quartz Beloit One Network |
$237.16
|
| Rate for Payer: Quartz Commercial |
$314.60
|
| Rate for Payer: Quartz Medicare Advantage |
$290.40
|
| Rate for Payer: The Alliance Commercial |
$1,936.00
|
| Rate for Payer: WEA Trust Commercial |
$266.20
|
| Rate for Payer: WPS Commercial |
$358.50
|
|
|
SCREW 4.5X18 214.818
|
Facility
|
OP
|
$466.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966922
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$130.48 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$419.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$400.76
|
| Rate for Payer: Aetna Managed Medicare |
$130.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$302.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$233.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$223.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$246.98
|
| Rate for Payer: Cash Price |
$139.80
|
| Rate for Payer: Cigna Commercial |
$428.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$260.77
|
| Rate for Payer: Health EOS Commercial |
$414.74
|
| Rate for Payer: HFN Commercial |
$428.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$349.50
|
| Rate for Payer: Multiplan Commercial |
$372.80
|
| Rate for Payer: NAPHCARE Commercial |
$279.60
|
| Rate for Payer: Preferred Network Access Commercial |
$428.72
|
| Rate for Payer: Quartz Beloit One Network |
$228.34
|
| Rate for Payer: Quartz Commercial |
$302.90
|
| Rate for Payer: Quartz Medicare Advantage |
$279.60
|
| Rate for Payer: The Alliance Commercial |
$1,864.00
|
| Rate for Payer: WEA Trust Commercial |
$256.30
|
| Rate for Payer: WPS Commercial |
$345.17
|
|
|
SCREW 4.5X18 214.818
|
Facility
|
IP
|
$466.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966922
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$228.34 |
| Max. Negotiated Rate |
$428.72 |
| Rate for Payer: Aetna Commercial |
$419.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$400.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$246.98
|
| Rate for Payer: Cash Price |
$139.80
|
| Rate for Payer: Cigna Commercial |
$428.72
|
| Rate for Payer: Health EOS Commercial |
$414.74
|
| Rate for Payer: HFN Commercial |
$428.72
|
| Rate for Payer: Multiplan Commercial |
$372.80
|
| Rate for Payer: NAPHCARE Commercial |
$279.60
|
| Rate for Payer: Preferred Network Access Commercial |
$428.72
|
| Rate for Payer: Quartz Beloit One Network |
$228.34
|
| Rate for Payer: Quartz Commercial |
$279.60
|
| Rate for Payer: WEA Trust Commercial |
$256.30
|
| Rate for Payer: WPS Commercial |
$345.17
|
|
|
SCREW 4.5X20 214.820
|
Facility
|
OP
|
$466.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966923
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$130.48 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$419.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$400.76
|
| Rate for Payer: Aetna Managed Medicare |
$130.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$302.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$233.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$223.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$246.98
|
| Rate for Payer: Cash Price |
$139.80
|
| Rate for Payer: Cigna Commercial |
$428.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$260.77
|
| Rate for Payer: Health EOS Commercial |
$414.74
|
| Rate for Payer: HFN Commercial |
$428.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$349.50
|
| Rate for Payer: Multiplan Commercial |
$372.80
|
| Rate for Payer: NAPHCARE Commercial |
$279.60
|
| Rate for Payer: Preferred Network Access Commercial |
$428.72
|
| Rate for Payer: Quartz Beloit One Network |
$228.34
|
| Rate for Payer: Quartz Commercial |
$302.90
|
| Rate for Payer: Quartz Medicare Advantage |
$279.60
|
| Rate for Payer: The Alliance Commercial |
$1,864.00
|
| Rate for Payer: WEA Trust Commercial |
$256.30
|
| Rate for Payer: WPS Commercial |
$345.17
|
|
|
SCREW 4.5X20 214.820
|
Facility
|
IP
|
$466.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966923
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$228.34 |
| Max. Negotiated Rate |
$428.72 |
| Rate for Payer: Aetna Commercial |
$419.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$400.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$246.98
|
| Rate for Payer: Cash Price |
$139.80
|
| Rate for Payer: Cigna Commercial |
$428.72
|
| Rate for Payer: Health EOS Commercial |
$414.74
|
| Rate for Payer: HFN Commercial |
$428.72
|
| Rate for Payer: Multiplan Commercial |
$372.80
|
| Rate for Payer: NAPHCARE Commercial |
$279.60
|
| Rate for Payer: Preferred Network Access Commercial |
$428.72
|
| Rate for Payer: Quartz Beloit One Network |
$228.34
|
| Rate for Payer: Quartz Commercial |
$279.60
|
| Rate for Payer: WEA Trust Commercial |
$256.30
|
| Rate for Payer: WPS Commercial |
$345.17
|
|
