|
SCREW CANN 4.0 X 36MM SHORT THREAD LP AR-8840C-36
|
Facility
|
IP
|
$2,112.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5627641
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,076.28 |
| Max. Negotiated Rate |
$2,020.76 |
| Rate for Payer: Aetna Commercial |
$1,976.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,888.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,164.13
|
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Cigna Commercial |
$2,020.76
|
| Rate for Payer: Health EOS Commercial |
$1,954.87
|
| Rate for Payer: HFN Commercial |
$2,020.76
|
| Rate for Payer: Multiplan Commercial |
$1,757.18
|
| Rate for Payer: Preferred Network Access Commercial |
$2,020.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,076.28
|
| Rate for Payer: Quartz Commercial |
$1,317.89
|
| Rate for Payer: WEA Trust Commercial |
$1,208.06
|
| Rate for Payer: WPS Commercial |
$1,626.87
|
|
|
SCREW CANN 4.0 X 38 207.638
|
Facility
|
OP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967153
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$546.00 |
| Max. Negotiated Rate |
$1,794.00 |
| Rate for Payer: Aetna Commercial |
$1,755.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,677.00
|
| Rate for Payer: Aetna Managed Medicare |
$546.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,267.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$975.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$936.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,033.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,794.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,091.25
|
| Rate for Payer: Health EOS Commercial |
$1,735.50
|
| Rate for Payer: HFN Commercial |
$1,794.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,462.50
|
| Rate for Payer: Multiplan Commercial |
$1,560.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,170.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,794.00
|
| Rate for Payer: Quartz Beloit One Network |
$955.50
|
| Rate for Payer: Quartz Commercial |
$1,267.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,170.00
|
| Rate for Payer: The Alliance Commercial |
$975.00
|
| Rate for Payer: WEA Trust Commercial |
$1,072.50
|
| Rate for Payer: WPS Commercial |
$1,444.31
|
|
|
SCREW CANN 4.0 X 38 207.638
|
Facility
|
IP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967153
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$955.50 |
| Max. Negotiated Rate |
$1,794.00 |
| Rate for Payer: Aetna Commercial |
$1,755.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,677.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,033.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,794.00
|
| Rate for Payer: Health EOS Commercial |
$1,735.50
|
| Rate for Payer: HFN Commercial |
$1,794.00
|
| Rate for Payer: Multiplan Commercial |
$1,560.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,794.00
|
| Rate for Payer: Quartz Beloit One Network |
$955.50
|
| Rate for Payer: Quartz Commercial |
$1,170.00
|
| Rate for Payer: WEA Trust Commercial |
$1,072.50
|
| Rate for Payer: WPS Commercial |
$1,444.31
|
|
|
SCREW-CANN 4.0 X 38 207.738
|
Facility
|
IP
|
$1,947.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967154
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$992.19 |
| Max. Negotiated Rate |
$1,862.89 |
| Rate for Payer: Aetna Commercial |
$1,822.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,741.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,073.19
|
| Rate for Payer: Cash Price |
$584.10
|
| Rate for Payer: Cigna Commercial |
$1,862.89
|
| Rate for Payer: Health EOS Commercial |
$1,802.14
|
| Rate for Payer: HFN Commercial |
$1,862.89
|
| Rate for Payer: Multiplan Commercial |
$1,619.90
|
| Rate for Payer: Preferred Network Access Commercial |
$1,862.89
|
| Rate for Payer: Quartz Beloit One Network |
$992.19
|
| Rate for Payer: Quartz Commercial |
$1,214.93
|
| Rate for Payer: WEA Trust Commercial |
$1,113.68
|
| Rate for Payer: WPS Commercial |
$1,499.77
|
|
|
SCREW-CANN 4.0 X 38 207.738
|
Facility
|
OP
|
$1,947.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967154
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$566.97 |
| Max. Negotiated Rate |
$1,862.89 |
| Rate for Payer: Aetna Commercial |
$1,822.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,741.40
|
| Rate for Payer: Aetna Managed Medicare |
$566.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,316.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,012.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$971.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,073.19
|
| Rate for Payer: Cash Price |
$584.10
|
| Rate for Payer: Cigna Commercial |
$1,862.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,133.15
|
| Rate for Payer: Health EOS Commercial |
$1,802.14
|
| Rate for Payer: HFN Commercial |
$1,862.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,518.66
|
| Rate for Payer: Multiplan Commercial |
$1,619.90
|
| Rate for Payer: NAPHCARE Commercial |
$1,214.93
|
| Rate for Payer: Preferred Network Access Commercial |
$1,862.89
|
| Rate for Payer: Quartz Beloit One Network |
$992.19
|
| Rate for Payer: Quartz Commercial |
$1,316.17
|
| Rate for Payer: Quartz Medicare Advantage |
$1,214.93
|
| Rate for Payer: The Alliance Commercial |
$1,012.44
|
| Rate for Payer: WEA Trust Commercial |
$1,113.68
|
| Rate for Payer: WPS Commercial |
$1,499.77
|
|
|
SCREW CANN 4.0 X 38MM LONG THREAD LP AR-8840CL-38
|
Facility
|
OP
|
$2,112.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5627637
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$615.01 |
| Max. Negotiated Rate |
$2,020.76 |
| Rate for Payer: Aetna Commercial |
$1,976.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,888.97
|
| Rate for Payer: Aetna Managed Medicare |
$615.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,427.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,098.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,054.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,164.13
|
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Cigna Commercial |
$2,020.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,229.18
|
| Rate for Payer: Health EOS Commercial |
$1,954.87
|
| Rate for Payer: HFN Commercial |
$2,020.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,647.36
|
| Rate for Payer: Multiplan Commercial |
$1,757.18
|
| Rate for Payer: NAPHCARE Commercial |
$1,317.89
|
| Rate for Payer: Preferred Network Access Commercial |
$2,020.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,076.28
|
| Rate for Payer: Quartz Commercial |
$1,427.71
|
| Rate for Payer: Quartz Medicare Advantage |
$1,317.89
|
| Rate for Payer: The Alliance Commercial |
$1,098.24
|
| Rate for Payer: WEA Trust Commercial |
$1,208.06
|
| Rate for Payer: WPS Commercial |
$1,626.87
|
|
|
SCREW CANN 4.0 X 38MM LONG THREAD LP AR-8840CL-38
|
Facility
|
IP
|
$2,112.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5627637
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,076.28 |
| Max. Negotiated Rate |
$2,020.76 |
| Rate for Payer: Aetna Commercial |
$1,976.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,888.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,164.13
|
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Cigna Commercial |
$2,020.76
|
| Rate for Payer: Health EOS Commercial |
$1,954.87
|
| Rate for Payer: HFN Commercial |
$2,020.76
|
| Rate for Payer: Multiplan Commercial |
$1,757.18
|
| Rate for Payer: Preferred Network Access Commercial |
$2,020.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,076.28
|
| Rate for Payer: Quartz Commercial |
$1,317.89
|
| Rate for Payer: WEA Trust Commercial |
$1,208.06
|
| Rate for Payer: WPS Commercial |
$1,626.87
|
|
|
SCREW CANN 4.0 X 38MM SHORT THREAD LP AR-8840C-38
|
Facility
|
OP
|
$2,196.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5496985
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$639.48 |
| Max. Negotiated Rate |
$2,101.13 |
| Rate for Payer: Aetna Commercial |
$2,055.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,964.10
|
| Rate for Payer: Aetna Managed Medicare |
$639.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,484.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,141.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,096.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,210.44
|
| Rate for Payer: Cash Price |
$658.80
|
| Rate for Payer: Cigna Commercial |
$2,101.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,278.07
|
| Rate for Payer: Health EOS Commercial |
$2,032.62
|
| Rate for Payer: HFN Commercial |
$2,101.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,712.88
|
| Rate for Payer: Multiplan Commercial |
$1,827.07
|
| Rate for Payer: NAPHCARE Commercial |
$1,370.30
|
| Rate for Payer: Preferred Network Access Commercial |
$2,101.13
|
| Rate for Payer: Quartz Beloit One Network |
$1,119.08
|
| Rate for Payer: Quartz Commercial |
$1,484.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,370.30
|
| Rate for Payer: The Alliance Commercial |
$1,141.92
|
| Rate for Payer: WEA Trust Commercial |
$1,256.11
|
| Rate for Payer: WPS Commercial |
$1,691.58
|
|
|
SCREW CANN 4.0 X 38MM SHORT THREAD LP AR-8840C-38
|
Facility
|
IP
|
$2,196.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5496985
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.08 |
| Max. Negotiated Rate |
$2,101.13 |
| Rate for Payer: Aetna Commercial |
$2,055.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,964.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,210.44
|
| Rate for Payer: Cash Price |
$658.80
|
| Rate for Payer: Cigna Commercial |
$2,101.13
|
| Rate for Payer: Health EOS Commercial |
$2,032.62
|
| Rate for Payer: HFN Commercial |
$2,101.13
|
| Rate for Payer: Multiplan Commercial |
$1,827.07
|
| Rate for Payer: Preferred Network Access Commercial |
$2,101.13
|
| Rate for Payer: Quartz Beloit One Network |
$1,119.08
|
| Rate for Payer: Quartz Commercial |
$1,370.30
|
| Rate for Payer: WEA Trust Commercial |
$1,256.11
|
| Rate for Payer: WPS Commercial |
$1,691.58
|
|
|
SCREW-CANN 4.0 X 40 207.640
|
Facility
|
OP
|
$1,947.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967155
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$566.97 |
| Max. Negotiated Rate |
$1,862.89 |
| Rate for Payer: Aetna Commercial |
$1,822.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,741.40
|
| Rate for Payer: Aetna Managed Medicare |
$566.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,316.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,012.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$971.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,073.19
|
| Rate for Payer: Cash Price |
$584.10
|
| Rate for Payer: Cigna Commercial |
$1,862.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,133.15
|
| Rate for Payer: Health EOS Commercial |
$1,802.14
|
| Rate for Payer: HFN Commercial |
$1,862.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,518.66
|
| Rate for Payer: Multiplan Commercial |
$1,619.90
|
| Rate for Payer: NAPHCARE Commercial |
$1,214.93
|
| Rate for Payer: Preferred Network Access Commercial |
$1,862.89
|
| Rate for Payer: Quartz Beloit One Network |
$992.19
|
| Rate for Payer: Quartz Commercial |
$1,316.17
|
| Rate for Payer: Quartz Medicare Advantage |
$1,214.93
|
| Rate for Payer: The Alliance Commercial |
$1,012.44
|
| Rate for Payer: WEA Trust Commercial |
$1,113.68
|
| Rate for Payer: WPS Commercial |
$1,499.77
|
|
|
SCREW-CANN 4.0 X 40 207.640
|
Facility
|
IP
|
$1,947.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967155
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$992.19 |
| Max. Negotiated Rate |
$1,862.89 |
| Rate for Payer: Aetna Commercial |
$1,822.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,741.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,073.19
|
| Rate for Payer: Cash Price |
$584.10
|
| Rate for Payer: Cigna Commercial |
$1,862.89
|
| Rate for Payer: Health EOS Commercial |
$1,802.14
|
| Rate for Payer: HFN Commercial |
$1,862.89
|
| Rate for Payer: Multiplan Commercial |
$1,619.90
|
| Rate for Payer: Preferred Network Access Commercial |
$1,862.89
|
| Rate for Payer: Quartz Beloit One Network |
$992.19
|
| Rate for Payer: Quartz Commercial |
$1,214.93
|
| Rate for Payer: WEA Trust Commercial |
$1,113.68
|
| Rate for Payer: WPS Commercial |
$1,499.77
|
|
|
SCREW-CANN 4.0 X 40 207.740
|
Facility
|
IP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967156
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$955.50 |
| Max. Negotiated Rate |
$1,794.00 |
| Rate for Payer: Aetna Commercial |
$1,755.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,677.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,033.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,794.00
|
| Rate for Payer: Health EOS Commercial |
$1,735.50
|
| Rate for Payer: HFN Commercial |
$1,794.00
|
| Rate for Payer: Multiplan Commercial |
$1,560.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,794.00
|
| Rate for Payer: Quartz Beloit One Network |
$955.50
|
| Rate for Payer: Quartz Commercial |
$1,170.00
|
| Rate for Payer: WEA Trust Commercial |
$1,072.50
|
| Rate for Payer: WPS Commercial |
$1,444.31
|
|
|
SCREW-CANN 4.0 X 40 207.740
|
Facility
|
OP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967156
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$546.00 |
| Max. Negotiated Rate |
$1,794.00 |
| Rate for Payer: Aetna Commercial |
$1,755.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,677.00
|
| Rate for Payer: Aetna Managed Medicare |
$546.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,267.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$975.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$936.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,033.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,794.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,091.25
|
| Rate for Payer: Health EOS Commercial |
$1,735.50
|
| Rate for Payer: HFN Commercial |
$1,794.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,462.50
|
| Rate for Payer: Multiplan Commercial |
$1,560.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,170.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,794.00
|
| Rate for Payer: Quartz Beloit One Network |
$955.50
|
| Rate for Payer: Quartz Commercial |
$1,267.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,170.00
|
| Rate for Payer: The Alliance Commercial |
$975.00
|
| Rate for Payer: WEA Trust Commercial |
$1,072.50
|
| Rate for Payer: WPS Commercial |
$1,444.31
|
|
|
SCREW CANN 4.0 X 40MM LONG THREAD LP AR-8840CL-40
|
Facility
|
OP
|
$2,196.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5496988
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$639.48 |
| Max. Negotiated Rate |
$2,101.13 |
| Rate for Payer: Aetna Commercial |
$2,055.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,964.10
|
| Rate for Payer: Aetna Managed Medicare |
$639.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,484.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,141.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,096.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,210.44
|
| Rate for Payer: Cash Price |
$658.80
|
| Rate for Payer: Cigna Commercial |
$2,101.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,278.07
|
| Rate for Payer: Health EOS Commercial |
$2,032.62
|
| Rate for Payer: HFN Commercial |
$2,101.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,712.88
|
| Rate for Payer: Multiplan Commercial |
$1,827.07
|
| Rate for Payer: NAPHCARE Commercial |
$1,370.30
|
| Rate for Payer: Preferred Network Access Commercial |
$2,101.13
|
| Rate for Payer: Quartz Beloit One Network |
$1,119.08
|
| Rate for Payer: Quartz Commercial |
$1,484.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,370.30
|
| Rate for Payer: The Alliance Commercial |
$1,141.92
|
| Rate for Payer: WEA Trust Commercial |
$1,256.11
|
| Rate for Payer: WPS Commercial |
$1,691.58
|
|
|
SCREW CANN 4.0 X 40MM LONG THREAD LP AR-8840CL-40
|
Facility
|
IP
|
$2,196.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5496988
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.08 |
| Max. Negotiated Rate |
$2,101.13 |
| Rate for Payer: Aetna Commercial |
$2,055.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,964.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,210.44
|
| Rate for Payer: Cash Price |
$658.80
|
| Rate for Payer: Cigna Commercial |
$2,101.13
|
| Rate for Payer: Health EOS Commercial |
$2,032.62
|
| Rate for Payer: HFN Commercial |
$2,101.13
|
| Rate for Payer: Multiplan Commercial |
$1,827.07
|
| Rate for Payer: Preferred Network Access Commercial |
$2,101.13
|
| Rate for Payer: Quartz Beloit One Network |
$1,119.08
|
| Rate for Payer: Quartz Commercial |
$1,370.30
|
| Rate for Payer: WEA Trust Commercial |
$1,256.11
|
| Rate for Payer: WPS Commercial |
$1,691.58
|
|
|
SCREW CANN 4.0 X 40MM PART THREAD ASNIS III 604640
|
Facility
|
IP
|
$1,901.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5611550
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$968.75 |
| Max. Negotiated Rate |
$1,818.88 |
| Rate for Payer: Aetna Commercial |
$1,779.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,700.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,047.83
|
| Rate for Payer: Cash Price |
$570.30
|
| Rate for Payer: Cigna Commercial |
$1,818.88
|
| Rate for Payer: Health EOS Commercial |
$1,759.57
|
| Rate for Payer: HFN Commercial |
$1,818.88
|
| Rate for Payer: Multiplan Commercial |
$1,581.63
|
| Rate for Payer: Preferred Network Access Commercial |
$1,818.88
|
| Rate for Payer: Quartz Beloit One Network |
$968.75
|
| Rate for Payer: Quartz Commercial |
$1,186.22
|
| Rate for Payer: WEA Trust Commercial |
$1,087.37
|
| Rate for Payer: WPS Commercial |
$1,464.34
|
|
|
SCREW CANN 4.0 X 40MM PART THREAD ASNIS III 604640
|
Facility
|
OP
|
$1,901.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5611550
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$553.57 |
| Max. Negotiated Rate |
$1,818.88 |
| Rate for Payer: Aetna Commercial |
$1,779.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,700.25
|
| Rate for Payer: Aetna Managed Medicare |
$553.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,285.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$988.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$948.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,047.83
|
| Rate for Payer: Cash Price |
$570.30
|
| Rate for Payer: Cigna Commercial |
$1,818.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,106.38
|
| Rate for Payer: Health EOS Commercial |
$1,759.57
|
| Rate for Payer: HFN Commercial |
$1,818.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,482.78
|
| Rate for Payer: Multiplan Commercial |
$1,581.63
|
| Rate for Payer: NAPHCARE Commercial |
$1,186.22
|
| Rate for Payer: Preferred Network Access Commercial |
$1,818.88
|
| Rate for Payer: Quartz Beloit One Network |
$968.75
|
| Rate for Payer: Quartz Commercial |
$1,285.08
|
| Rate for Payer: Quartz Medicare Advantage |
$1,186.22
|
| Rate for Payer: The Alliance Commercial |
$988.52
|
| Rate for Payer: WEA Trust Commercial |
$1,087.37
|
| Rate for Payer: WPS Commercial |
$1,464.34
|
|
|
SCREW CANN 4.0 X 40MM SHORT THREAD LP AR-8840C-40
|
Facility
|
IP
|
$2,031.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6177675
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,035.00 |
| Max. Negotiated Rate |
$1,943.26 |
| Rate for Payer: Aetna Commercial |
$1,901.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,816.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,119.49
|
| Rate for Payer: Cash Price |
$609.30
|
| Rate for Payer: Cigna Commercial |
$1,943.26
|
| Rate for Payer: Health EOS Commercial |
$1,879.89
|
| Rate for Payer: HFN Commercial |
$1,943.26
|
| Rate for Payer: Multiplan Commercial |
$1,689.79
|
| Rate for Payer: Preferred Network Access Commercial |
$1,943.26
|
| Rate for Payer: Quartz Beloit One Network |
$1,035.00
|
| Rate for Payer: Quartz Commercial |
$1,267.34
|
| Rate for Payer: WEA Trust Commercial |
$1,161.73
|
| Rate for Payer: WPS Commercial |
$1,564.48
|
|
|
SCREW CANN 4.0 X 40MM SHORT THREAD LP AR-8840C-40
|
Facility
|
OP
|
$2,031.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6177675
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$591.43 |
| Max. Negotiated Rate |
$1,943.26 |
| Rate for Payer: Aetna Commercial |
$1,901.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,816.53
|
| Rate for Payer: Aetna Managed Medicare |
$591.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,372.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,056.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,013.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,119.49
|
| Rate for Payer: Cash Price |
$609.30
|
| Rate for Payer: Cigna Commercial |
$1,943.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,182.04
|
| Rate for Payer: Health EOS Commercial |
$1,879.89
|
| Rate for Payer: HFN Commercial |
$1,943.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,584.18
|
| Rate for Payer: Multiplan Commercial |
$1,689.79
|
| Rate for Payer: NAPHCARE Commercial |
$1,267.34
|
| Rate for Payer: Preferred Network Access Commercial |
$1,943.26
|
| Rate for Payer: Quartz Beloit One Network |
$1,035.00
|
| Rate for Payer: Quartz Commercial |
$1,372.96
|
| Rate for Payer: Quartz Medicare Advantage |
$1,267.34
|
| Rate for Payer: The Alliance Commercial |
$1,056.12
|
| Rate for Payer: WEA Trust Commercial |
$1,161.73
|
| Rate for Payer: WPS Commercial |
$1,564.48
|
|
|
SCREW-CANN 4.0 X 42 207.642
|
Facility
|
IP
|
$1,947.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967157
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$992.19 |
| Max. Negotiated Rate |
$1,862.89 |
| Rate for Payer: Aetna Commercial |
$1,822.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,741.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,073.19
|
| Rate for Payer: Cash Price |
$584.10
|
| Rate for Payer: Cigna Commercial |
$1,862.89
|
| Rate for Payer: Health EOS Commercial |
$1,802.14
|
| Rate for Payer: HFN Commercial |
$1,862.89
|
| Rate for Payer: Multiplan Commercial |
$1,619.90
|
| Rate for Payer: Preferred Network Access Commercial |
$1,862.89
|
| Rate for Payer: Quartz Beloit One Network |
$992.19
|
| Rate for Payer: Quartz Commercial |
$1,214.93
|
| Rate for Payer: WEA Trust Commercial |
$1,113.68
|
| Rate for Payer: WPS Commercial |
$1,499.77
|
|
|
SCREW-CANN 4.0 X 42 207.642
|
Facility
|
OP
|
$1,947.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967157
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$566.97 |
| Max. Negotiated Rate |
$1,862.89 |
| Rate for Payer: Aetna Commercial |
$1,822.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,741.40
|
| Rate for Payer: Aetna Managed Medicare |
$566.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,316.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,012.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$971.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,073.19
|
| Rate for Payer: Cash Price |
$584.10
|
| Rate for Payer: Cigna Commercial |
$1,862.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,133.15
|
| Rate for Payer: Health EOS Commercial |
$1,802.14
|
| Rate for Payer: HFN Commercial |
$1,862.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,518.66
|
| Rate for Payer: Multiplan Commercial |
$1,619.90
|
| Rate for Payer: NAPHCARE Commercial |
$1,214.93
|
| Rate for Payer: Preferred Network Access Commercial |
$1,862.89
|
| Rate for Payer: Quartz Beloit One Network |
$992.19
|
| Rate for Payer: Quartz Commercial |
$1,316.17
|
| Rate for Payer: Quartz Medicare Advantage |
$1,214.93
|
| Rate for Payer: The Alliance Commercial |
$1,012.44
|
| Rate for Payer: WEA Trust Commercial |
$1,113.68
|
| Rate for Payer: WPS Commercial |
$1,499.77
|
|
|
SCREW-CANN 4.0 X 42 207.742
|
Facility
|
OP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967158
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$546.00 |
| Max. Negotiated Rate |
$1,794.00 |
| Rate for Payer: Aetna Commercial |
$1,755.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,677.00
|
| Rate for Payer: Aetna Managed Medicare |
$546.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,267.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$975.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$936.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,033.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,794.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,091.25
|
| Rate for Payer: Health EOS Commercial |
$1,735.50
|
| Rate for Payer: HFN Commercial |
$1,794.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,462.50
|
| Rate for Payer: Multiplan Commercial |
$1,560.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,170.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,794.00
|
| Rate for Payer: Quartz Beloit One Network |
$955.50
|
| Rate for Payer: Quartz Commercial |
$1,267.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,170.00
|
| Rate for Payer: The Alliance Commercial |
$975.00
|
| Rate for Payer: WEA Trust Commercial |
$1,072.50
|
| Rate for Payer: WPS Commercial |
$1,444.31
|
|
|
SCREW-CANN 4.0 X 42 207.742
|
Facility
|
IP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967158
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$955.50 |
| Max. Negotiated Rate |
$1,794.00 |
| Rate for Payer: Aetna Commercial |
$1,755.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,677.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,033.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,794.00
|
| Rate for Payer: Health EOS Commercial |
$1,735.50
|
| Rate for Payer: HFN Commercial |
$1,794.00
|
| Rate for Payer: Multiplan Commercial |
$1,560.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,794.00
|
| Rate for Payer: Quartz Beloit One Network |
$955.50
|
| Rate for Payer: Quartz Commercial |
$1,170.00
|
| Rate for Payer: WEA Trust Commercial |
$1,072.50
|
| Rate for Payer: WPS Commercial |
$1,444.31
|
|
|
SCREW CANN 4.0 X 42MM LONG THREAD LP AR-8840CL-42
|
Facility
|
IP
|
$2,112.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5861696
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,076.28 |
| Max. Negotiated Rate |
$2,020.76 |
| Rate for Payer: Aetna Commercial |
$1,976.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,888.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,164.13
|
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Cigna Commercial |
$2,020.76
|
| Rate for Payer: Health EOS Commercial |
$1,954.87
|
| Rate for Payer: HFN Commercial |
$2,020.76
|
| Rate for Payer: Multiplan Commercial |
$1,757.18
|
| Rate for Payer: Preferred Network Access Commercial |
$2,020.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,076.28
|
| Rate for Payer: Quartz Commercial |
$1,317.89
|
| Rate for Payer: WEA Trust Commercial |
$1,208.06
|
| Rate for Payer: WPS Commercial |
$1,626.87
|
|
|
SCREW CANN 4.0 X 42MM LONG THREAD LP AR-8840CL-42
|
Facility
|
OP
|
$2,112.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5861696
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$615.01 |
| Max. Negotiated Rate |
$2,020.76 |
| Rate for Payer: Aetna Commercial |
$1,976.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,888.97
|
| Rate for Payer: Aetna Managed Medicare |
$615.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,427.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,098.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,054.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,164.13
|
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Cigna Commercial |
$2,020.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,229.18
|
| Rate for Payer: Health EOS Commercial |
$1,954.87
|
| Rate for Payer: HFN Commercial |
$2,020.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,647.36
|
| Rate for Payer: Multiplan Commercial |
$1,757.18
|
| Rate for Payer: NAPHCARE Commercial |
$1,317.89
|
| Rate for Payer: Preferred Network Access Commercial |
$2,020.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,076.28
|
| Rate for Payer: Quartz Commercial |
$1,427.71
|
| Rate for Payer: Quartz Medicare Advantage |
$1,317.89
|
| Rate for Payer: The Alliance Commercial |
$1,098.24
|
| Rate for Payer: WEA Trust Commercial |
$1,208.06
|
| Rate for Payer: WPS Commercial |
$1,626.87
|
|
