|
SCREW-CANN 3.0 X 38 202.738
|
Facility
|
IP
|
$2,202.00
|
|
| Hospital Charge Code |
2967123
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,078.98 |
| Max. Negotiated Rate |
$2,025.84 |
| Rate for Payer: Aetna Commercial |
$1,981.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,893.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,167.06
|
| Rate for Payer: Cash Price |
$660.60
|
| Rate for Payer: Cigna Commercial |
$2,025.84
|
| Rate for Payer: Health EOS Commercial |
$1,959.78
|
| Rate for Payer: HFN Commercial |
$2,025.84
|
| Rate for Payer: Multiplan Commercial |
$1,761.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,321.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,025.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,078.98
|
| Rate for Payer: Quartz Commercial |
$1,321.20
|
| Rate for Payer: WEA Trust Commercial |
$1,211.10
|
| Rate for Payer: WPS Commercial |
$1,631.02
|
|
|
SCREW CANN 3.0 X 38 TIGER 200-30-038
|
Facility
|
IP
|
$2,059.00
|
|
| Hospital Charge Code |
3784160
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,008.91 |
| Max. Negotiated Rate |
$1,894.28 |
| Rate for Payer: Aetna Commercial |
$1,853.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,770.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,091.27
|
| Rate for Payer: Cash Price |
$617.70
|
| Rate for Payer: Cigna Commercial |
$1,894.28
|
| Rate for Payer: Health EOS Commercial |
$1,832.51
|
| Rate for Payer: HFN Commercial |
$1,894.28
|
| Rate for Payer: Multiplan Commercial |
$1,647.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,235.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,894.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,008.91
|
| Rate for Payer: Quartz Commercial |
$1,235.40
|
| Rate for Payer: WEA Trust Commercial |
$1,132.45
|
| Rate for Payer: WPS Commercial |
$1,525.10
|
|
|
SCREW CANN 3.0 X 38 TIGER 200-30-038
|
Facility
|
OP
|
$2,059.00
|
|
| Hospital Charge Code |
3784160
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$576.52 |
| Max. Negotiated Rate |
$8,236.00 |
| Rate for Payer: Aetna Commercial |
$1,853.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,770.74
|
| Rate for Payer: Aetna Managed Medicare |
$576.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,338.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,029.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$988.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,091.27
|
| Rate for Payer: Cash Price |
$617.70
|
| Rate for Payer: Cigna Commercial |
$1,894.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,152.22
|
| Rate for Payer: Health EOS Commercial |
$1,832.51
|
| Rate for Payer: HFN Commercial |
$1,894.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,544.25
|
| Rate for Payer: Multiplan Commercial |
$1,647.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,235.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,894.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,008.91
|
| Rate for Payer: Quartz Commercial |
$1,338.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,235.40
|
| Rate for Payer: The Alliance Commercial |
$8,236.00
|
| Rate for Payer: WEA Trust Commercial |
$1,132.45
|
| Rate for Payer: WPS Commercial |
$1,525.10
|
|
|
SCREW-CANN 3.0 X 40 202.640
|
Facility
|
IP
|
$2,121.00
|
|
| Hospital Charge Code |
2967124
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,039.29 |
| Max. Negotiated Rate |
$1,951.32 |
| Rate for Payer: Aetna Commercial |
$1,908.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,824.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,124.13
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cigna Commercial |
$1,951.32
|
| Rate for Payer: Health EOS Commercial |
$1,887.69
|
| Rate for Payer: HFN Commercial |
$1,951.32
|
| Rate for Payer: Multiplan Commercial |
$1,696.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,272.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,951.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,039.29
|
| Rate for Payer: Quartz Commercial |
$1,272.60
|
| Rate for Payer: WEA Trust Commercial |
$1,166.55
|
| Rate for Payer: WPS Commercial |
$1,571.02
|
|
|
SCREW-CANN 3.0 X 40 202.640
|
Facility
|
OP
|
$2,121.00
|
|
| Hospital Charge Code |
2967124
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$593.88 |
| Max. Negotiated Rate |
$8,484.00 |
| Rate for Payer: Aetna Commercial |
$1,908.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,824.06
|
| Rate for Payer: Aetna Managed Medicare |
$593.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,378.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,060.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,018.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,124.13
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cigna Commercial |
$1,951.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,186.91
|
| Rate for Payer: Health EOS Commercial |
$1,887.69
|
| Rate for Payer: HFN Commercial |
$1,951.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,590.75
|
| Rate for Payer: Multiplan Commercial |
$1,696.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,272.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,951.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,039.29
|
| Rate for Payer: Quartz Commercial |
$1,378.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,272.60
|
| Rate for Payer: The Alliance Commercial |
$8,484.00
|
| Rate for Payer: WEA Trust Commercial |
$1,166.55
|
| Rate for Payer: WPS Commercial |
$1,571.02
|
|
|
SCREW-CANN 3.0 X 40 202.740
|
Facility
|
OP
|
$2,121.00
|
|
| Hospital Charge Code |
2967125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$593.88 |
| Max. Negotiated Rate |
$8,484.00 |
| Rate for Payer: Aetna Commercial |
$1,908.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,824.06
|
| Rate for Payer: Aetna Managed Medicare |
$593.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,378.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,060.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,018.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,124.13
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cigna Commercial |
$1,951.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,186.91
|
| Rate for Payer: Health EOS Commercial |
$1,887.69
|
| Rate for Payer: HFN Commercial |
$1,951.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,590.75
|
| Rate for Payer: Multiplan Commercial |
$1,696.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,272.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,951.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,039.29
|
| Rate for Payer: Quartz Commercial |
$1,378.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,272.60
|
| Rate for Payer: The Alliance Commercial |
$8,484.00
|
| Rate for Payer: WEA Trust Commercial |
$1,166.55
|
| Rate for Payer: WPS Commercial |
$1,571.02
|
|
|
SCREW-CANN 3.0 X 40 202.740
|
Facility
|
IP
|
$2,121.00
|
|
| Hospital Charge Code |
2967125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,039.29 |
| Max. Negotiated Rate |
$1,951.32 |
| Rate for Payer: Aetna Commercial |
$1,908.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,824.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,124.13
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cigna Commercial |
$1,951.32
|
| Rate for Payer: Health EOS Commercial |
$1,887.69
|
| Rate for Payer: HFN Commercial |
$1,951.32
|
| Rate for Payer: Multiplan Commercial |
$1,696.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,272.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,951.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,039.29
|
| Rate for Payer: Quartz Commercial |
$1,272.60
|
| Rate for Payer: WEA Trust Commercial |
$1,166.55
|
| Rate for Payer: WPS Commercial |
$1,571.02
|
|
|
SCREW CANN 3.0 X 40 TIGER 200-30-040
|
Facility
|
IP
|
$2,139.00
|
|
| Hospital Charge Code |
3784161
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,048.11 |
| Max. Negotiated Rate |
$1,967.88 |
| Rate for Payer: Aetna Commercial |
$1,925.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,839.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,133.67
|
| Rate for Payer: Cash Price |
$641.70
|
| Rate for Payer: Cigna Commercial |
$1,967.88
|
| Rate for Payer: Health EOS Commercial |
$1,903.71
|
| Rate for Payer: HFN Commercial |
$1,967.88
|
| Rate for Payer: Multiplan Commercial |
$1,711.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,283.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,967.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,048.11
|
| Rate for Payer: Quartz Commercial |
$1,283.40
|
| Rate for Payer: WEA Trust Commercial |
$1,176.45
|
| Rate for Payer: WPS Commercial |
$1,584.36
|
|
|
SCREW CANN 3.0 X 40 TIGER 200-30-040
|
Facility
|
OP
|
$2,139.00
|
|
| Hospital Charge Code |
3784161
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$598.92 |
| Max. Negotiated Rate |
$8,556.00 |
| Rate for Payer: Aetna Commercial |
$1,925.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,839.54
|
| Rate for Payer: Aetna Managed Medicare |
$598.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,390.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,069.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,026.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,133.67
|
| Rate for Payer: Cash Price |
$641.70
|
| Rate for Payer: Cigna Commercial |
$1,967.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,196.98
|
| Rate for Payer: Health EOS Commercial |
$1,903.71
|
| Rate for Payer: HFN Commercial |
$1,967.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,604.25
|
| Rate for Payer: Multiplan Commercial |
$1,711.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,283.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,967.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,048.11
|
| Rate for Payer: Quartz Commercial |
$1,390.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,283.40
|
| Rate for Payer: The Alliance Commercial |
$8,556.00
|
| Rate for Payer: WEA Trust Commercial |
$1,176.45
|
| Rate for Payer: WPS Commercial |
$1,584.36
|
|
|
SCREW CANN 3.0 X 55MM LONG THREAD TI 04.354.255TS
|
Facility
|
IP
|
$3,948.83
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6248160
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,934.93 |
| Max. Negotiated Rate |
$3,632.92 |
| Rate for Payer: Aetna Commercial |
$3,553.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,395.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,092.88
|
| Rate for Payer: Cash Price |
$1,184.65
|
| Rate for Payer: Cigna Commercial |
$3,632.92
|
| Rate for Payer: Health EOS Commercial |
$3,514.46
|
| Rate for Payer: HFN Commercial |
$3,632.92
|
| Rate for Payer: Multiplan Commercial |
$3,159.06
|
| Rate for Payer: NAPHCARE Commercial |
$2,369.30
|
| Rate for Payer: Preferred Network Access Commercial |
$3,632.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,934.93
|
| Rate for Payer: Quartz Commercial |
$2,369.30
|
| Rate for Payer: WEA Trust Commercial |
$2,171.86
|
| Rate for Payer: WPS Commercial |
$2,924.90
|
|
|
SCREW CANN 3.0 X 55MM LONG THREAD TI 04.354.255TS
|
Facility
|
OP
|
$3,948.83
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6248160
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,105.67 |
| Max. Negotiated Rate |
$15,795.32 |
| Rate for Payer: Aetna Commercial |
$3,553.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,395.99
|
| Rate for Payer: Aetna Managed Medicare |
$1,105.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,566.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,974.42
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,895.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,092.88
|
| Rate for Payer: Cash Price |
$1,184.65
|
| Rate for Payer: Cigna Commercial |
$3,632.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,209.77
|
| Rate for Payer: Health EOS Commercial |
$3,514.46
|
| Rate for Payer: HFN Commercial |
$3,632.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,961.62
|
| Rate for Payer: Multiplan Commercial |
$3,159.06
|
| Rate for Payer: NAPHCARE Commercial |
$2,369.30
|
| Rate for Payer: Preferred Network Access Commercial |
$3,632.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,934.93
|
| Rate for Payer: Quartz Commercial |
$2,566.74
|
| Rate for Payer: Quartz Medicare Advantage |
$2,369.30
|
| Rate for Payer: The Alliance Commercial |
$15,795.32
|
| Rate for Payer: WEA Trust Commercial |
$2,171.86
|
| Rate for Payer: WPS Commercial |
$2,924.90
|
|
|
SCREW-CANN 3.0 X 8 202.608
|
Facility
|
IP
|
$2,121.00
|
|
| Hospital Charge Code |
2967126
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,039.29 |
| Max. Negotiated Rate |
$1,951.32 |
| Rate for Payer: Aetna Commercial |
$1,908.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,824.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,124.13
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cigna Commercial |
$1,951.32
|
| Rate for Payer: Health EOS Commercial |
$1,887.69
|
| Rate for Payer: HFN Commercial |
$1,951.32
|
| Rate for Payer: Multiplan Commercial |
$1,696.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,272.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,951.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,039.29
|
| Rate for Payer: Quartz Commercial |
$1,272.60
|
| Rate for Payer: WEA Trust Commercial |
$1,166.55
|
| Rate for Payer: WPS Commercial |
$1,571.02
|
|
|
SCREW-CANN 3.0 X 8 202.608
|
Facility
|
OP
|
$2,121.00
|
|
| Hospital Charge Code |
2967126
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$593.88 |
| Max. Negotiated Rate |
$8,484.00 |
| Rate for Payer: Aetna Commercial |
$1,908.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,824.06
|
| Rate for Payer: Aetna Managed Medicare |
$593.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,378.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,060.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,018.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,124.13
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cigna Commercial |
$1,951.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,186.91
|
| Rate for Payer: Health EOS Commercial |
$1,887.69
|
| Rate for Payer: HFN Commercial |
$1,951.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,590.75
|
| Rate for Payer: Multiplan Commercial |
$1,696.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,272.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,951.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,039.29
|
| Rate for Payer: Quartz Commercial |
$1,378.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,272.60
|
| Rate for Payer: The Alliance Commercial |
$8,484.00
|
| Rate for Payer: WEA Trust Commercial |
$1,166.55
|
| Rate for Payer: WPS Commercial |
$1,571.02
|
|
|
SCREW-CANN 3.0 X 9 202.609
|
Facility
|
OP
|
$2,121.00
|
|
| Hospital Charge Code |
2967127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$593.88 |
| Max. Negotiated Rate |
$8,484.00 |
| Rate for Payer: Aetna Commercial |
$1,908.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,824.06
|
| Rate for Payer: Aetna Managed Medicare |
$593.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,378.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,060.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,018.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,124.13
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cigna Commercial |
$1,951.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,186.91
|
| Rate for Payer: Health EOS Commercial |
$1,887.69
|
| Rate for Payer: HFN Commercial |
$1,951.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,590.75
|
| Rate for Payer: Multiplan Commercial |
$1,696.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,272.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,951.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,039.29
|
| Rate for Payer: Quartz Commercial |
$1,378.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,272.60
|
| Rate for Payer: The Alliance Commercial |
$8,484.00
|
| Rate for Payer: WEA Trust Commercial |
$1,166.55
|
| Rate for Payer: WPS Commercial |
$1,571.02
|
|
|
SCREW-CANN 3.0 X 9 202.609
|
Facility
|
IP
|
$2,121.00
|
|
| Hospital Charge Code |
2967127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,039.29 |
| Max. Negotiated Rate |
$1,951.32 |
| Rate for Payer: Aetna Commercial |
$1,908.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,824.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,124.13
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cigna Commercial |
$1,951.32
|
| Rate for Payer: Health EOS Commercial |
$1,887.69
|
| Rate for Payer: HFN Commercial |
$1,951.32
|
| Rate for Payer: Multiplan Commercial |
$1,696.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,272.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,951.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,039.29
|
| Rate for Payer: Quartz Commercial |
$1,272.60
|
| Rate for Payer: WEA Trust Commercial |
$1,166.55
|
| Rate for Payer: WPS Commercial |
$1,571.02
|
|
|
SCREW CANN 3.75 X 30MM FULL THREAD AR-7000-30FT
|
Facility
|
OP
|
$2,926.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4595733
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$819.28 |
| Max. Negotiated Rate |
$11,704.00 |
| Rate for Payer: Aetna Commercial |
$2,633.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,516.36
|
| Rate for Payer: Aetna Managed Medicare |
$819.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,901.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,463.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,404.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,550.78
|
| Rate for Payer: Cash Price |
$877.80
|
| Rate for Payer: Cigna Commercial |
$2,691.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,637.39
|
| Rate for Payer: Health EOS Commercial |
$2,604.14
|
| Rate for Payer: HFN Commercial |
$2,691.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,194.50
|
| Rate for Payer: Multiplan Commercial |
$2,340.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,755.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,691.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,433.74
|
| Rate for Payer: Quartz Commercial |
$1,901.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,755.60
|
| Rate for Payer: The Alliance Commercial |
$11,704.00
|
| Rate for Payer: WEA Trust Commercial |
$1,609.30
|
| Rate for Payer: WPS Commercial |
$2,167.29
|
|
|
SCREW CANN 3.75 X 30MM FULL THREAD AR-7000-30FT
|
Facility
|
IP
|
$2,926.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4595733
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,433.74 |
| Max. Negotiated Rate |
$2,691.92 |
| Rate for Payer: Aetna Commercial |
$2,633.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,516.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,550.78
|
| Rate for Payer: Cash Price |
$877.80
|
| Rate for Payer: Cigna Commercial |
$2,691.92
|
| Rate for Payer: Health EOS Commercial |
$2,604.14
|
| Rate for Payer: HFN Commercial |
$2,691.92
|
| Rate for Payer: Multiplan Commercial |
$2,340.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,755.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,691.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,433.74
|
| Rate for Payer: Quartz Commercial |
$1,755.60
|
| Rate for Payer: WEA Trust Commercial |
$1,609.30
|
| Rate for Payer: WPS Commercial |
$2,167.29
|
|
|
SCREW CANN 3.75 X 30MM PARTIAL THREAD AR-7000-30
|
Facility
|
IP
|
$2,046.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508884
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,002.54 |
| Max. Negotiated Rate |
$1,882.32 |
| Rate for Payer: Aetna Commercial |
$1,841.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,759.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,084.38
|
| Rate for Payer: Cash Price |
$613.80
|
| Rate for Payer: Cigna Commercial |
$1,882.32
|
| Rate for Payer: Health EOS Commercial |
$1,820.94
|
| Rate for Payer: HFN Commercial |
$1,882.32
|
| Rate for Payer: Multiplan Commercial |
$1,636.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,227.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,882.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,002.54
|
| Rate for Payer: Quartz Commercial |
$1,227.60
|
| Rate for Payer: WEA Trust Commercial |
$1,125.30
|
| Rate for Payer: WPS Commercial |
$1,515.47
|
|
|
SCREW CANN 3.75 X 30MM PARTIAL THREAD AR-7000-30
|
Facility
|
OP
|
$2,046.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508884
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$572.88 |
| Max. Negotiated Rate |
$8,184.00 |
| Rate for Payer: Aetna Commercial |
$1,841.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,759.56
|
| Rate for Payer: Aetna Managed Medicare |
$572.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,329.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,023.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$982.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,084.38
|
| Rate for Payer: Cash Price |
$613.80
|
| Rate for Payer: Cigna Commercial |
$1,882.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,144.94
|
| Rate for Payer: Health EOS Commercial |
$1,820.94
|
| Rate for Payer: HFN Commercial |
$1,882.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,534.50
|
| Rate for Payer: Multiplan Commercial |
$1,636.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,227.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,882.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,002.54
|
| Rate for Payer: Quartz Commercial |
$1,329.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,227.60
|
| Rate for Payer: The Alliance Commercial |
$8,184.00
|
| Rate for Payer: WEA Trust Commercial |
$1,125.30
|
| Rate for Payer: WPS Commercial |
$1,515.47
|
|
|
SCREW CANN 3.75 X 32MM FULLY THREAD AR-7000-32FT
|
Facility
|
OP
|
$2,926.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4264789
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$819.28 |
| Max. Negotiated Rate |
$11,704.00 |
| Rate for Payer: Aetna Commercial |
$2,633.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,516.36
|
| Rate for Payer: Aetna Managed Medicare |
$819.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,901.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,463.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,404.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,550.78
|
| Rate for Payer: Cash Price |
$877.80
|
| Rate for Payer: Cigna Commercial |
$2,691.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,637.39
|
| Rate for Payer: Health EOS Commercial |
$2,604.14
|
| Rate for Payer: HFN Commercial |
$2,691.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,194.50
|
| Rate for Payer: Multiplan Commercial |
$2,340.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,755.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,691.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,433.74
|
| Rate for Payer: Quartz Commercial |
$1,901.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,755.60
|
| Rate for Payer: The Alliance Commercial |
$11,704.00
|
| Rate for Payer: WEA Trust Commercial |
$1,609.30
|
| Rate for Payer: WPS Commercial |
$2,167.29
|
|
|
SCREW CANN 3.75 X 32MM FULLY THREAD AR-7000-32FT
|
Facility
|
IP
|
$2,926.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4264789
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,433.74 |
| Max. Negotiated Rate |
$2,691.92 |
| Rate for Payer: Aetna Commercial |
$2,633.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,516.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,550.78
|
| Rate for Payer: Cash Price |
$877.80
|
| Rate for Payer: Cigna Commercial |
$2,691.92
|
| Rate for Payer: Health EOS Commercial |
$2,604.14
|
| Rate for Payer: HFN Commercial |
$2,691.92
|
| Rate for Payer: Multiplan Commercial |
$2,340.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,755.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,691.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,433.74
|
| Rate for Payer: Quartz Commercial |
$1,755.60
|
| Rate for Payer: WEA Trust Commercial |
$1,609.30
|
| Rate for Payer: WPS Commercial |
$2,167.29
|
|
|
SCREW CANN 3.75 X 34MM FULLY THREAD AR-7000-34FT
|
Facility
|
IP
|
$2,926.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4595505
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,433.74 |
| Max. Negotiated Rate |
$2,691.92 |
| Rate for Payer: Aetna Commercial |
$2,633.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,516.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,550.78
|
| Rate for Payer: Cash Price |
$877.80
|
| Rate for Payer: Cigna Commercial |
$2,691.92
|
| Rate for Payer: Health EOS Commercial |
$2,604.14
|
| Rate for Payer: HFN Commercial |
$2,691.92
|
| Rate for Payer: Multiplan Commercial |
$2,340.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,755.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,691.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,433.74
|
| Rate for Payer: Quartz Commercial |
$1,755.60
|
| Rate for Payer: WEA Trust Commercial |
$1,609.30
|
| Rate for Payer: WPS Commercial |
$2,167.29
|
|
|
SCREW CANN 3.75 X 34MM FULLY THREAD AR-7000-34FT
|
Facility
|
OP
|
$2,926.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4595505
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$819.28 |
| Max. Negotiated Rate |
$11,704.00 |
| Rate for Payer: Aetna Commercial |
$2,633.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,516.36
|
| Rate for Payer: Aetna Managed Medicare |
$819.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,901.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,463.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,404.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,550.78
|
| Rate for Payer: Cash Price |
$877.80
|
| Rate for Payer: Cigna Commercial |
$2,691.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,637.39
|
| Rate for Payer: Health EOS Commercial |
$2,604.14
|
| Rate for Payer: HFN Commercial |
$2,691.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,194.50
|
| Rate for Payer: Multiplan Commercial |
$2,340.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,755.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,691.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,433.74
|
| Rate for Payer: Quartz Commercial |
$1,901.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,755.60
|
| Rate for Payer: The Alliance Commercial |
$11,704.00
|
| Rate for Payer: WEA Trust Commercial |
$1,609.30
|
| Rate for Payer: WPS Commercial |
$2,167.29
|
|
|
SCREW CANN 3.75 X 34MM PARTIAL THREAD AR-7000-34
|
Facility
|
IP
|
$2,046.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508886
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,002.54 |
| Max. Negotiated Rate |
$1,882.32 |
| Rate for Payer: Aetna Commercial |
$1,841.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,759.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,084.38
|
| Rate for Payer: Cash Price |
$613.80
|
| Rate for Payer: Cigna Commercial |
$1,882.32
|
| Rate for Payer: Health EOS Commercial |
$1,820.94
|
| Rate for Payer: HFN Commercial |
$1,882.32
|
| Rate for Payer: Multiplan Commercial |
$1,636.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,227.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,882.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,002.54
|
| Rate for Payer: Quartz Commercial |
$1,227.60
|
| Rate for Payer: WEA Trust Commercial |
$1,125.30
|
| Rate for Payer: WPS Commercial |
$1,515.47
|
|
|
SCREW CANN 3.75 X 34MM PARTIAL THREAD AR-7000-34
|
Facility
|
OP
|
$2,046.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508886
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$572.88 |
| Max. Negotiated Rate |
$8,184.00 |
| Rate for Payer: Aetna Commercial |
$1,841.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,759.56
|
| Rate for Payer: Aetna Managed Medicare |
$572.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,329.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,023.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$982.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,084.38
|
| Rate for Payer: Cash Price |
$613.80
|
| Rate for Payer: Cigna Commercial |
$1,882.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,144.94
|
| Rate for Payer: Health EOS Commercial |
$1,820.94
|
| Rate for Payer: HFN Commercial |
$1,882.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,534.50
|
| Rate for Payer: Multiplan Commercial |
$1,636.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,227.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,882.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,002.54
|
| Rate for Payer: Quartz Commercial |
$1,329.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,227.60
|
| Rate for Payer: The Alliance Commercial |
$8,184.00
|
| Rate for Payer: WEA Trust Commercial |
$1,125.30
|
| Rate for Payer: WPS Commercial |
$1,515.47
|
|
