|
SCREW ANCHORAGE NON-LOCK 3MMX16MM FT T8 BLUE PLSS3016
|
Facility
|
OP
|
$2,279.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5617699
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.12 |
| Max. Negotiated Rate |
$9,116.00 |
| Rate for Payer: Aetna Commercial |
$2,051.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,959.94
|
| Rate for Payer: Aetna Managed Medicare |
$638.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,481.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,139.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,093.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,207.87
|
| Rate for Payer: Cash Price |
$683.70
|
| Rate for Payer: Cigna Commercial |
$2,096.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,275.33
|
| Rate for Payer: Health EOS Commercial |
$2,028.31
|
| Rate for Payer: HFN Commercial |
$2,096.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,709.25
|
| Rate for Payer: Multiplan Commercial |
$1,823.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,367.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,096.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,116.71
|
| Rate for Payer: Quartz Commercial |
$1,481.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,367.40
|
| Rate for Payer: The Alliance Commercial |
$9,116.00
|
| Rate for Payer: WEA Trust Commercial |
$1,253.45
|
| Rate for Payer: WPS Commercial |
$1,688.06
|
|
|
SCREW ANCHORAGE NON-LOCK 3MMX18MM FT T8 BLUE PLSS3018
|
Facility
|
IP
|
$2,279.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685828
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,116.71 |
| Max. Negotiated Rate |
$2,096.68 |
| Rate for Payer: Aetna Commercial |
$2,051.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,959.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,207.87
|
| Rate for Payer: Cash Price |
$683.70
|
| Rate for Payer: Cigna Commercial |
$2,096.68
|
| Rate for Payer: Health EOS Commercial |
$2,028.31
|
| Rate for Payer: HFN Commercial |
$2,096.68
|
| Rate for Payer: Multiplan Commercial |
$1,823.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,367.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,096.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,116.71
|
| Rate for Payer: Quartz Commercial |
$1,367.40
|
| Rate for Payer: WEA Trust Commercial |
$1,253.45
|
| Rate for Payer: WPS Commercial |
$1,688.06
|
|
|
SCREW ANCHORAGE NON-LOCK 3MMX18MM FT T8 BLUE PLSS3018
|
Facility
|
OP
|
$2,279.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685828
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.12 |
| Max. Negotiated Rate |
$9,116.00 |
| Rate for Payer: Aetna Commercial |
$2,051.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,959.94
|
| Rate for Payer: Aetna Managed Medicare |
$638.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,481.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,139.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,093.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,207.87
|
| Rate for Payer: Cash Price |
$683.70
|
| Rate for Payer: Cigna Commercial |
$2,096.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,275.33
|
| Rate for Payer: Health EOS Commercial |
$2,028.31
|
| Rate for Payer: HFN Commercial |
$2,096.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,709.25
|
| Rate for Payer: Multiplan Commercial |
$1,823.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,367.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,096.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,116.71
|
| Rate for Payer: Quartz Commercial |
$1,481.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,367.40
|
| Rate for Payer: The Alliance Commercial |
$9,116.00
|
| Rate for Payer: WEA Trust Commercial |
$1,253.45
|
| Rate for Payer: WPS Commercial |
$1,688.06
|
|
|
SCREW ANCHORAGE NON-LOCK 3MMX20MM FT T8 BLUE PLSS3020
|
Facility
|
OP
|
$2,435.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5611634
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$681.80 |
| Max. Negotiated Rate |
$9,740.00 |
| Rate for Payer: Aetna Commercial |
$2,191.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,094.10
|
| Rate for Payer: Aetna Managed Medicare |
$681.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,582.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,217.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,168.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,290.55
|
| Rate for Payer: Cash Price |
$730.50
|
| Rate for Payer: Cigna Commercial |
$2,240.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,362.63
|
| Rate for Payer: Health EOS Commercial |
$2,167.15
|
| Rate for Payer: HFN Commercial |
$2,240.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,826.25
|
| Rate for Payer: Multiplan Commercial |
$1,948.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,461.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,240.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,193.15
|
| Rate for Payer: Quartz Commercial |
$1,582.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,461.00
|
| Rate for Payer: The Alliance Commercial |
$9,740.00
|
| Rate for Payer: WEA Trust Commercial |
$1,339.25
|
| Rate for Payer: WPS Commercial |
$1,803.60
|
|
|
SCREW ANCHORAGE NON-LOCK 3MMX20MM FT T8 BLUE PLSS3020
|
Facility
|
IP
|
$2,435.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5611634
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,193.15 |
| Max. Negotiated Rate |
$2,240.20 |
| Rate for Payer: Aetna Commercial |
$2,191.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,094.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,290.55
|
| Rate for Payer: Cash Price |
$730.50
|
| Rate for Payer: Cigna Commercial |
$2,240.20
|
| Rate for Payer: Health EOS Commercial |
$2,167.15
|
| Rate for Payer: HFN Commercial |
$2,240.20
|
| Rate for Payer: Multiplan Commercial |
$1,948.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,461.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,240.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,193.15
|
| Rate for Payer: Quartz Commercial |
$1,461.00
|
| Rate for Payer: WEA Trust Commercial |
$1,339.25
|
| Rate for Payer: WPS Commercial |
$1,803.60
|
|
|
SCREW ANCHORAGE NON-LOCK 3MMX22MM FT T8 BLUE PLSS3022
|
Facility
|
IP
|
$2,232.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5729729
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,093.68 |
| Max. Negotiated Rate |
$2,053.44 |
| Rate for Payer: Aetna Commercial |
$2,008.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,919.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,182.96
|
| Rate for Payer: Cash Price |
$669.60
|
| Rate for Payer: Cigna Commercial |
$2,053.44
|
| Rate for Payer: Health EOS Commercial |
$1,986.48
|
| Rate for Payer: HFN Commercial |
$2,053.44
|
| Rate for Payer: Multiplan Commercial |
$1,785.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,339.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,053.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,093.68
|
| Rate for Payer: Quartz Commercial |
$1,339.20
|
| Rate for Payer: WEA Trust Commercial |
$1,227.60
|
| Rate for Payer: WPS Commercial |
$1,653.24
|
|
|
SCREW ANCHORAGE NON-LOCK 3MMX22MM FT T8 BLUE PLSS3022
|
Facility
|
OP
|
$2,232.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5729729
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$624.96 |
| Max. Negotiated Rate |
$8,928.00 |
| Rate for Payer: Aetna Commercial |
$2,008.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,919.52
|
| Rate for Payer: Aetna Managed Medicare |
$624.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,450.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,116.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,071.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,182.96
|
| Rate for Payer: Cash Price |
$669.60
|
| Rate for Payer: Cigna Commercial |
$2,053.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,249.03
|
| Rate for Payer: Health EOS Commercial |
$1,986.48
|
| Rate for Payer: HFN Commercial |
$2,053.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,674.00
|
| Rate for Payer: Multiplan Commercial |
$1,785.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,339.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,053.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,093.68
|
| Rate for Payer: Quartz Commercial |
$1,450.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,339.20
|
| Rate for Payer: The Alliance Commercial |
$8,928.00
|
| Rate for Payer: WEA Trust Commercial |
$1,227.60
|
| Rate for Payer: WPS Commercial |
$1,653.24
|
|
|
SCREW ANCHORAGE NON-LOCK 3MMX26MM FT T8 BLUE PLSS3026
|
Facility
|
OP
|
$2,586.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5265001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$724.08 |
| Max. Negotiated Rate |
$10,344.00 |
| Rate for Payer: Aetna Commercial |
$2,327.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,223.96
|
| Rate for Payer: Aetna Managed Medicare |
$724.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,680.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,293.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,241.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,370.58
|
| Rate for Payer: Cash Price |
$775.80
|
| Rate for Payer: Cigna Commercial |
$2,379.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,447.13
|
| Rate for Payer: Health EOS Commercial |
$2,301.54
|
| Rate for Payer: HFN Commercial |
$2,379.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,939.50
|
| Rate for Payer: Multiplan Commercial |
$2,068.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,551.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,379.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,267.14
|
| Rate for Payer: Quartz Commercial |
$1,680.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,551.60
|
| Rate for Payer: The Alliance Commercial |
$10,344.00
|
| Rate for Payer: WEA Trust Commercial |
$1,422.30
|
| Rate for Payer: WPS Commercial |
$1,915.45
|
|
|
SCREW ANCHORAGE NON-LOCK 3MMX26MM FT T8 BLUE PLSS3026
|
Facility
|
IP
|
$2,586.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5265001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,267.14 |
| Max. Negotiated Rate |
$2,379.12 |
| Rate for Payer: Aetna Commercial |
$2,327.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,223.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,370.58
|
| Rate for Payer: Cash Price |
$775.80
|
| Rate for Payer: Cigna Commercial |
$2,379.12
|
| Rate for Payer: Health EOS Commercial |
$2,301.54
|
| Rate for Payer: HFN Commercial |
$2,379.12
|
| Rate for Payer: Multiplan Commercial |
$2,068.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,551.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,379.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,267.14
|
| Rate for Payer: Quartz Commercial |
$1,551.60
|
| Rate for Payer: WEA Trust Commercial |
$1,422.30
|
| Rate for Payer: WPS Commercial |
$1,915.45
|
|
|
SCREW ANCHORAGE NON-LOCK 3MMX30MM FT T8 BLUE PLSS3030
|
Facility
|
IP
|
$2,232.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5831731
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,093.68 |
| Max. Negotiated Rate |
$2,053.44 |
| Rate for Payer: Aetna Commercial |
$2,008.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,919.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,182.96
|
| Rate for Payer: Cash Price |
$669.60
|
| Rate for Payer: Cigna Commercial |
$2,053.44
|
| Rate for Payer: Health EOS Commercial |
$1,986.48
|
| Rate for Payer: HFN Commercial |
$2,053.44
|
| Rate for Payer: Multiplan Commercial |
$1,785.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,339.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,053.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,093.68
|
| Rate for Payer: Quartz Commercial |
$1,339.20
|
| Rate for Payer: WEA Trust Commercial |
$1,227.60
|
| Rate for Payer: WPS Commercial |
$1,653.24
|
|
|
SCREW ANCHORAGE NON-LOCK 3MMX30MM FT T8 BLUE PLSS3030
|
Facility
|
OP
|
$2,232.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5831731
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$624.96 |
| Max. Negotiated Rate |
$8,928.00 |
| Rate for Payer: Aetna Commercial |
$2,008.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,919.52
|
| Rate for Payer: Aetna Managed Medicare |
$624.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,450.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,116.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,071.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,182.96
|
| Rate for Payer: Cash Price |
$669.60
|
| Rate for Payer: Cigna Commercial |
$2,053.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,249.03
|
| Rate for Payer: Health EOS Commercial |
$1,986.48
|
| Rate for Payer: HFN Commercial |
$2,053.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,674.00
|
| Rate for Payer: Multiplan Commercial |
$1,785.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,339.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,053.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,093.68
|
| Rate for Payer: Quartz Commercial |
$1,450.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,339.20
|
| Rate for Payer: The Alliance Commercial |
$8,928.00
|
| Rate for Payer: WEA Trust Commercial |
$1,227.60
|
| Rate for Payer: WPS Commercial |
$1,653.24
|
|
|
SCREW ART SURF LOCK 5950-90
|
Facility
|
IP
|
$1,641.00
|
|
| Hospital Charge Code |
2967809
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$804.09 |
| Max. Negotiated Rate |
$1,509.72 |
| Rate for Payer: Aetna Commercial |
$1,476.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,411.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$869.73
|
| Rate for Payer: Cash Price |
$492.30
|
| Rate for Payer: Cigna Commercial |
$1,509.72
|
| Rate for Payer: Health EOS Commercial |
$1,460.49
|
| Rate for Payer: HFN Commercial |
$1,509.72
|
| Rate for Payer: Multiplan Commercial |
$1,312.80
|
| Rate for Payer: NAPHCARE Commercial |
$984.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,509.72
|
| Rate for Payer: Quartz Beloit One Network |
$804.09
|
| Rate for Payer: Quartz Commercial |
$984.60
|
| Rate for Payer: WEA Trust Commercial |
$902.55
|
| Rate for Payer: WPS Commercial |
$1,215.49
|
|
|
SCREW ART SURF LOCK 5950-90
|
Facility
|
OP
|
$1,641.00
|
|
| Hospital Charge Code |
2967809
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$459.48 |
| Max. Negotiated Rate |
$6,564.00 |
| Rate for Payer: Aetna Commercial |
$1,476.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,411.26
|
| Rate for Payer: Aetna Managed Medicare |
$459.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,066.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$820.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$787.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$869.73
|
| Rate for Payer: Cash Price |
$492.30
|
| Rate for Payer: Cigna Commercial |
$1,509.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$918.30
|
| Rate for Payer: Health EOS Commercial |
$1,460.49
|
| Rate for Payer: HFN Commercial |
$1,509.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,230.75
|
| Rate for Payer: Multiplan Commercial |
$1,312.80
|
| Rate for Payer: NAPHCARE Commercial |
$984.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,509.72
|
| Rate for Payer: Quartz Beloit One Network |
$804.09
|
| Rate for Payer: Quartz Commercial |
$1,066.65
|
| Rate for Payer: Quartz Medicare Advantage |
$984.60
|
| Rate for Payer: The Alliance Commercial |
$6,564.00
|
| Rate for Payer: WEA Trust Commercial |
$902.55
|
| Rate for Payer: WPS Commercial |
$1,215.49
|
|
|
SCREW BIO-COMPOSITE 2.7 X 20MM AR-5025B-20
|
Facility
|
IP
|
$3,922.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6220124
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,921.78 |
| Max. Negotiated Rate |
$3,608.24 |
| Rate for Payer: Aetna Commercial |
$3,529.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,372.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,078.66
|
| Rate for Payer: Cash Price |
$1,176.60
|
| Rate for Payer: Cigna Commercial |
$3,608.24
|
| Rate for Payer: Health EOS Commercial |
$3,490.58
|
| Rate for Payer: HFN Commercial |
$3,608.24
|
| Rate for Payer: Multiplan Commercial |
$3,137.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,353.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,608.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,921.78
|
| Rate for Payer: Quartz Commercial |
$2,353.20
|
| Rate for Payer: WEA Trust Commercial |
$2,157.10
|
| Rate for Payer: WPS Commercial |
$2,905.03
|
|
|
SCREW BIO-COMPOSITE 2.7 X 20MM AR-5025B-20
|
Facility
|
OP
|
$3,922.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6220124
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,098.16 |
| Max. Negotiated Rate |
$15,688.00 |
| Rate for Payer: Aetna Commercial |
$3,529.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,372.92
|
| Rate for Payer: Aetna Managed Medicare |
$1,098.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,549.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,961.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,882.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,078.66
|
| Rate for Payer: Cash Price |
$1,176.60
|
| Rate for Payer: Cigna Commercial |
$3,608.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,194.75
|
| Rate for Payer: Health EOS Commercial |
$3,490.58
|
| Rate for Payer: HFN Commercial |
$3,608.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,941.50
|
| Rate for Payer: Multiplan Commercial |
$3,137.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,353.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,608.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,921.78
|
| Rate for Payer: Quartz Commercial |
$2,549.30
|
| Rate for Payer: Quartz Medicare Advantage |
$2,353.20
|
| Rate for Payer: The Alliance Commercial |
$15,688.00
|
| Rate for Payer: WEA Trust Commercial |
$2,157.10
|
| Rate for Payer: WPS Commercial |
$2,905.03
|
|
|
SCREW BIO-COMPOSITE 3 X 16MM AR-5025B-16
|
Facility
|
OP
|
$4,335.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5885645
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,213.80 |
| Max. Negotiated Rate |
$17,340.00 |
| Rate for Payer: Aetna Commercial |
$3,901.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,728.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,213.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,817.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,167.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,080.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,297.55
|
| Rate for Payer: Cash Price |
$1,300.50
|
| Rate for Payer: Cigna Commercial |
$3,988.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,425.87
|
| Rate for Payer: Health EOS Commercial |
$3,858.15
|
| Rate for Payer: HFN Commercial |
$3,988.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,251.25
|
| Rate for Payer: Multiplan Commercial |
$3,468.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,601.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,988.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,124.15
|
| Rate for Payer: Quartz Commercial |
$2,817.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,601.00
|
| Rate for Payer: The Alliance Commercial |
$17,340.00
|
| Rate for Payer: WEA Trust Commercial |
$2,384.25
|
| Rate for Payer: WPS Commercial |
$3,210.93
|
|
|
SCREW BIO-COMPOSITE 3 X 16MM AR-5025B-16
|
Facility
|
IP
|
$4,335.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5885645
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,124.15 |
| Max. Negotiated Rate |
$3,988.20 |
| Rate for Payer: Aetna Commercial |
$3,901.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,728.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,297.55
|
| Rate for Payer: Cash Price |
$1,300.50
|
| Rate for Payer: Cigna Commercial |
$3,988.20
|
| Rate for Payer: Health EOS Commercial |
$3,858.15
|
| Rate for Payer: HFN Commercial |
$3,988.20
|
| Rate for Payer: Multiplan Commercial |
$3,468.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,601.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,988.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,124.15
|
| Rate for Payer: Quartz Commercial |
$2,601.00
|
| Rate for Payer: WEA Trust Commercial |
$2,384.25
|
| Rate for Payer: WPS Commercial |
$3,210.93
|
|
|
SCREW BIO-COMPOSITE 3 X 18MM AR-5025B-18
|
Facility
|
IP
|
$4,335.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5885646
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,124.15 |
| Max. Negotiated Rate |
$3,988.20 |
| Rate for Payer: Aetna Commercial |
$3,901.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,728.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,297.55
|
| Rate for Payer: Cash Price |
$1,300.50
|
| Rate for Payer: Cigna Commercial |
$3,988.20
|
| Rate for Payer: Health EOS Commercial |
$3,858.15
|
| Rate for Payer: HFN Commercial |
$3,988.20
|
| Rate for Payer: Multiplan Commercial |
$3,468.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,601.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,988.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,124.15
|
| Rate for Payer: Quartz Commercial |
$2,601.00
|
| Rate for Payer: WEA Trust Commercial |
$2,384.25
|
| Rate for Payer: WPS Commercial |
$3,210.93
|
|
|
SCREW BIO-COMPOSITE 3 X 18MM AR-5025B-18
|
Facility
|
OP
|
$4,335.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5885646
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,213.80 |
| Max. Negotiated Rate |
$17,340.00 |
| Rate for Payer: Aetna Commercial |
$3,901.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,728.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,213.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,817.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,167.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,080.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,297.55
|
| Rate for Payer: Cash Price |
$1,300.50
|
| Rate for Payer: Cigna Commercial |
$3,988.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,425.87
|
| Rate for Payer: Health EOS Commercial |
$3,858.15
|
| Rate for Payer: HFN Commercial |
$3,988.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,251.25
|
| Rate for Payer: Multiplan Commercial |
$3,468.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,601.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,988.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,124.15
|
| Rate for Payer: Quartz Commercial |
$2,817.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,601.00
|
| Rate for Payer: The Alliance Commercial |
$17,340.00
|
| Rate for Payer: WEA Trust Commercial |
$2,384.25
|
| Rate for Payer: WPS Commercial |
$3,210.93
|
|
|
SCREW BIO-COMPOSITE 3 X 22MM AR-5025B-22
|
Facility
|
IP
|
$3,885.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6177697
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,903.65 |
| Max. Negotiated Rate |
$3,574.20 |
| Rate for Payer: Aetna Commercial |
$3,496.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,341.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,059.05
|
| Rate for Payer: Cash Price |
$1,165.50
|
| Rate for Payer: Cigna Commercial |
$3,574.20
|
| Rate for Payer: Health EOS Commercial |
$3,457.65
|
| Rate for Payer: HFN Commercial |
$3,574.20
|
| Rate for Payer: Multiplan Commercial |
$3,108.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,331.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,574.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,903.65
|
| Rate for Payer: Quartz Commercial |
$2,331.00
|
| Rate for Payer: WEA Trust Commercial |
$2,136.75
|
| Rate for Payer: WPS Commercial |
$2,877.62
|
|
|
SCREW BIO-COMPOSITE 3 X 22MM AR-5025B-22
|
Facility
|
OP
|
$3,885.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6177697
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,087.80 |
| Max. Negotiated Rate |
$15,540.00 |
| Rate for Payer: Aetna Commercial |
$3,496.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,341.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,087.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,525.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,942.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,864.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,059.05
|
| Rate for Payer: Cash Price |
$1,165.50
|
| Rate for Payer: Cigna Commercial |
$3,574.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,174.05
|
| Rate for Payer: Health EOS Commercial |
$3,457.65
|
| Rate for Payer: HFN Commercial |
$3,574.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,913.75
|
| Rate for Payer: Multiplan Commercial |
$3,108.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,331.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,574.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,903.65
|
| Rate for Payer: Quartz Commercial |
$2,525.25
|
| Rate for Payer: Quartz Medicare Advantage |
$2,331.00
|
| Rate for Payer: The Alliance Commercial |
$15,540.00
|
| Rate for Payer: WEA Trust Commercial |
$2,136.75
|
| Rate for Payer: WPS Commercial |
$2,877.62
|
|
|
SCREW BIOMET LOCK 2.4 X 10MM ST GREEN 76-2410
|
Facility
|
OP
|
$2,182.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5583269
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.96 |
| Max. Negotiated Rate |
$8,728.00 |
| Rate for Payer: Aetna Commercial |
$1,963.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,876.52
|
| Rate for Payer: Aetna Managed Medicare |
$610.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,418.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,091.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,047.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,156.46
|
| Rate for Payer: Cash Price |
$654.60
|
| Rate for Payer: Cigna Commercial |
$2,007.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,221.05
|
| Rate for Payer: Health EOS Commercial |
$1,941.98
|
| Rate for Payer: HFN Commercial |
$2,007.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,636.50
|
| Rate for Payer: Multiplan Commercial |
$1,745.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,309.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,007.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,069.18
|
| Rate for Payer: Quartz Commercial |
$1,418.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,309.20
|
| Rate for Payer: The Alliance Commercial |
$8,728.00
|
| Rate for Payer: WEA Trust Commercial |
$1,200.10
|
| Rate for Payer: WPS Commercial |
$1,616.21
|
|
|
SCREW BIOMET LOCK 2.4 X 10MM ST GREEN 76-2410
|
Facility
|
IP
|
$2,182.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5583269
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,069.18 |
| Max. Negotiated Rate |
$2,007.44 |
| Rate for Payer: Aetna Commercial |
$1,963.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,876.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,156.46
|
| Rate for Payer: Cash Price |
$654.60
|
| Rate for Payer: Cigna Commercial |
$2,007.44
|
| Rate for Payer: Health EOS Commercial |
$1,941.98
|
| Rate for Payer: HFN Commercial |
$2,007.44
|
| Rate for Payer: Multiplan Commercial |
$1,745.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,309.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,007.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,069.18
|
| Rate for Payer: Quartz Commercial |
$1,309.20
|
| Rate for Payer: WEA Trust Commercial |
$1,200.10
|
| Rate for Payer: WPS Commercial |
$1,616.21
|
|
|
SCREW BIOMET LOCK 2.4 X 12MM ST GREEN 76-2412
|
Facility
|
IP
|
$1,971.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5583268
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$965.79 |
| Max. Negotiated Rate |
$1,813.32 |
| Rate for Payer: Aetna Commercial |
$1,773.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,695.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,044.63
|
| Rate for Payer: Cash Price |
$591.30
|
| Rate for Payer: Cigna Commercial |
$1,813.32
|
| Rate for Payer: Health EOS Commercial |
$1,754.19
|
| Rate for Payer: HFN Commercial |
$1,813.32
|
| Rate for Payer: Multiplan Commercial |
$1,576.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,182.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,813.32
|
| Rate for Payer: Quartz Beloit One Network |
$965.79
|
| Rate for Payer: Quartz Commercial |
$1,182.60
|
| Rate for Payer: WEA Trust Commercial |
$1,084.05
|
| Rate for Payer: WPS Commercial |
$1,459.92
|
|
|
SCREW BIOMET LOCK 2.4 X 12MM ST GREEN 76-2412
|
Facility
|
OP
|
$1,971.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5583268
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$551.88 |
| Max. Negotiated Rate |
$7,884.00 |
| Rate for Payer: Aetna Commercial |
$1,773.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,695.06
|
| Rate for Payer: Aetna Managed Medicare |
$551.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,281.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$985.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$946.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,044.63
|
| Rate for Payer: Cash Price |
$591.30
|
| Rate for Payer: Cigna Commercial |
$1,813.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,102.97
|
| Rate for Payer: Health EOS Commercial |
$1,754.19
|
| Rate for Payer: HFN Commercial |
$1,813.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,478.25
|
| Rate for Payer: Multiplan Commercial |
$1,576.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,182.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,813.32
|
| Rate for Payer: Quartz Beloit One Network |
$965.79
|
| Rate for Payer: Quartz Commercial |
$1,281.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,182.60
|
| Rate for Payer: The Alliance Commercial |
$7,884.00
|
| Rate for Payer: WEA Trust Commercial |
$1,084.05
|
| Rate for Payer: WPS Commercial |
$1,459.92
|
|
