|
SCREW-CANN 4.0 X 48 207.748
|
Facility
|
OP
|
$1,947.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967164
|
|
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 48MM LONG THREAD LP AR-8840CL-48
|
Facility
|
OP
|
$2,112.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5611598
|
|
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 48MM LONG THREAD LP AR-8840CL-48
|
Facility
|
IP
|
$2,112.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5611598
|
|
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 48MM SHORT THREAD LP AR-8840C-48
|
Facility
|
IP
|
$2,031.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5977645
|
|
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 48MM SHORT THREAD LP AR-8840C-48
|
Facility
|
OP
|
$2,031.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5977645
|
|
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 50 207.650
|
Facility
|
OP
|
$1,947.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967165
|
|
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 50 207.650
|
Facility
|
IP
|
$1,947.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967165
|
|
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 50 207.750
|
Facility
|
OP
|
$1,947.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967166
|
|
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 50 207.750
|
Facility
|
IP
|
$1,947.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967166
|
|
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 50MM LONG THREAD LP AR-8840CL-50
|
Facility
|
IP
|
$2,112.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767826
|
|
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 50MM LONG THREAD LP AR-8840CL-50
|
Facility
|
OP
|
$2,112.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767826
|
|
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 50MM PART THREAD ASNIS III 604650
|
Facility
|
IP
|
$1,901.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5611551
|
|
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 50MM PART THREAD ASNIS III 604650
|
Facility
|
OP
|
$1,901.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5611551
|
|
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 50MM SHORT THREAD LP AR-8840C-50
|
Facility
|
OP
|
$2,196.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5416055
|
|
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 50MM SHORT THREAD LP AR-8840C-50
|
Facility
|
IP
|
$2,196.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5416055
|
|
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 55MM LONG THREAD LP AR-8840CL-55
|
Facility
|
OP
|
$2,209.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5591386
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$643.26 |
| Max. Negotiated Rate |
$2,113.57 |
| Rate for Payer: Aetna Commercial |
$2,067.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,975.73
|
| Rate for Payer: Aetna Managed Medicare |
$643.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,493.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,148.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,102.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,217.60
|
| Rate for Payer: Cash Price |
$662.70
|
| Rate for Payer: Cigna Commercial |
$2,113.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,285.64
|
| Rate for Payer: Health EOS Commercial |
$2,044.65
|
| Rate for Payer: HFN Commercial |
$2,113.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,723.02
|
| Rate for Payer: Multiplan Commercial |
$1,837.89
|
| Rate for Payer: NAPHCARE Commercial |
$1,378.42
|
| Rate for Payer: Preferred Network Access Commercial |
$2,113.57
|
| Rate for Payer: Quartz Beloit One Network |
$1,125.71
|
| Rate for Payer: Quartz Commercial |
$1,493.28
|
| Rate for Payer: Quartz Medicare Advantage |
$1,378.42
|
| Rate for Payer: The Alliance Commercial |
$1,148.68
|
| Rate for Payer: WEA Trust Commercial |
$1,263.55
|
| Rate for Payer: WPS Commercial |
$1,701.59
|
|
|
SCREW CANN 4.0 X 55MM LONG THREAD LP AR-8840CL-55
|
Facility
|
IP
|
$2,209.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5591386
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,125.71 |
| Max. Negotiated Rate |
$2,113.57 |
| Rate for Payer: Aetna Commercial |
$2,067.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,975.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,217.60
|
| Rate for Payer: Cash Price |
$662.70
|
| Rate for Payer: Cigna Commercial |
$2,113.57
|
| Rate for Payer: Health EOS Commercial |
$2,044.65
|
| Rate for Payer: HFN Commercial |
$2,113.57
|
| Rate for Payer: Multiplan Commercial |
$1,837.89
|
| Rate for Payer: Preferred Network Access Commercial |
$2,113.57
|
| Rate for Payer: Quartz Beloit One Network |
$1,125.71
|
| Rate for Payer: Quartz Commercial |
$1,378.42
|
| Rate for Payer: WEA Trust Commercial |
$1,263.55
|
| Rate for Payer: WPS Commercial |
$1,701.59
|
|
|
SCREW CANN 4.0 X 55MM SHORT THREAD LP AR-8840C-55
|
Facility
|
OP
|
$2,196.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5416056
|
|
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 55MM SHORT THREAD LP AR-8840C-55
|
Facility
|
IP
|
$2,196.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5416056
|
|
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 60MM LONG THREAD LP AR-8840CL-60
|
Facility
|
OP
|
$2,031.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6173857
|
|
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 60MM LONG THREAD LP AR-8840CL-60
|
Facility
|
IP
|
$2,031.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6173857
|
|
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 60MM SHORT THREAD LP AR-8840C-60
|
Facility
|
OP
|
$2,196.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5416057
|
|
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 60MM SHORT THREAD LP AR-8840C-60
|
Facility
|
IP
|
$2,196.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5416057
|
|
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 70MM PARTIAL THREAD STRYKER 604670
|
Facility
|
IP
|
$1,811.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6185027
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$922.89 |
| Max. Negotiated Rate |
$1,732.76 |
| Rate for Payer: Aetna Commercial |
$1,695.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,619.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$998.22
|
| Rate for Payer: Cash Price |
$543.30
|
| Rate for Payer: Cigna Commercial |
$1,732.76
|
| Rate for Payer: Health EOS Commercial |
$1,676.26
|
| Rate for Payer: HFN Commercial |
$1,732.76
|
| Rate for Payer: Multiplan Commercial |
$1,506.75
|
| Rate for Payer: Preferred Network Access Commercial |
$1,732.76
|
| Rate for Payer: Quartz Beloit One Network |
$922.89
|
| Rate for Payer: Quartz Commercial |
$1,130.06
|
| Rate for Payer: WEA Trust Commercial |
$1,035.89
|
| Rate for Payer: WPS Commercial |
$1,395.01
|
|
|
SCREW CANN 4.0 X 70MM PARTIAL THREAD STRYKER 604670
|
Facility
|
OP
|
$1,811.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6185027
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$527.36 |
| Max. Negotiated Rate |
$1,732.76 |
| Rate for Payer: Aetna Commercial |
$1,695.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,619.76
|
| Rate for Payer: Aetna Managed Medicare |
$527.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,224.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$941.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$904.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$998.22
|
| Rate for Payer: Cash Price |
$543.30
|
| Rate for Payer: Cigna Commercial |
$1,732.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,054.00
|
| Rate for Payer: Health EOS Commercial |
$1,676.26
|
| Rate for Payer: HFN Commercial |
$1,732.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,412.58
|
| Rate for Payer: Multiplan Commercial |
$1,506.75
|
| Rate for Payer: NAPHCARE Commercial |
$1,130.06
|
| Rate for Payer: Preferred Network Access Commercial |
$1,732.76
|
| Rate for Payer: Quartz Beloit One Network |
$922.89
|
| Rate for Payer: Quartz Commercial |
$1,224.24
|
| Rate for Payer: Quartz Medicare Advantage |
$1,130.06
|
| Rate for Payer: The Alliance Commercial |
$941.72
|
| Rate for Payer: WEA Trust Commercial |
$1,035.89
|
| Rate for Payer: WPS Commercial |
$1,395.01
|
|
