|
SCREW CANN 4.0 X 44MM LONG THREAD LP AR-8840CL-44
|
Facility
|
IP
|
$2,196.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5563355
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,076.04 |
| Max. Negotiated Rate |
$2,020.32 |
| Rate for Payer: Aetna Commercial |
$1,976.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,888.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,163.88
|
| Rate for Payer: Cash Price |
$658.80
|
| Rate for Payer: Cigna Commercial |
$2,020.32
|
| Rate for Payer: Health EOS Commercial |
$1,954.44
|
| Rate for Payer: HFN Commercial |
$2,020.32
|
| Rate for Payer: Multiplan Commercial |
$1,756.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,317.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,020.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,076.04
|
| Rate for Payer: Quartz Commercial |
$1,317.60
|
| Rate for Payer: WEA Trust Commercial |
$1,207.80
|
| Rate for Payer: WPS Commercial |
$1,626.58
|
|
|
SCREW CANN 4.0 X 44MM LONG THREAD LP AR-8840CL-44
|
Facility
|
OP
|
$2,196.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5563355
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$614.88 |
| Max. Negotiated Rate |
$8,784.00 |
| Rate for Payer: Aetna Commercial |
$1,976.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,888.56
|
| Rate for Payer: Aetna Managed Medicare |
$614.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,427.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,098.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,054.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,163.88
|
| Rate for Payer: Cash Price |
$658.80
|
| Rate for Payer: Cigna Commercial |
$2,020.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,228.88
|
| Rate for Payer: Health EOS Commercial |
$1,954.44
|
| Rate for Payer: HFN Commercial |
$2,020.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,647.00
|
| Rate for Payer: Multiplan Commercial |
$1,756.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,317.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,020.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,076.04
|
| Rate for Payer: Quartz Commercial |
$1,427.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,317.60
|
| Rate for Payer: The Alliance Commercial |
$8,784.00
|
| Rate for Payer: WEA Trust Commercial |
$1,207.80
|
| Rate for Payer: WPS Commercial |
$1,626.58
|
|
|
SCREW CANN 4.0 X 44MM SHORT THREAD LP AR-8840C-44
|
Facility
|
OP
|
$2,112.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5611701
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$591.36 |
| Max. Negotiated Rate |
$8,448.00 |
| Rate for Payer: Aetna Commercial |
$1,900.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,816.32
|
| Rate for Payer: Aetna Managed Medicare |
$591.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,372.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,056.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,013.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,119.36
|
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Cigna Commercial |
$1,943.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,181.88
|
| Rate for Payer: Health EOS Commercial |
$1,879.68
|
| Rate for Payer: HFN Commercial |
$1,943.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,584.00
|
| Rate for Payer: Multiplan Commercial |
$1,689.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,267.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,943.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,034.88
|
| Rate for Payer: Quartz Commercial |
$1,372.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,267.20
|
| Rate for Payer: The Alliance Commercial |
$8,448.00
|
| Rate for Payer: WEA Trust Commercial |
$1,161.60
|
| Rate for Payer: WPS Commercial |
$1,564.36
|
|
|
SCREW CANN 4.0 X 44MM SHORT THREAD LP AR-8840C-44
|
Facility
|
IP
|
$2,112.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5611701
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,034.88 |
| Max. Negotiated Rate |
$1,943.04 |
| Rate for Payer: Aetna Commercial |
$1,900.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,816.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,119.36
|
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Cigna Commercial |
$1,943.04
|
| Rate for Payer: Health EOS Commercial |
$1,879.68
|
| Rate for Payer: HFN Commercial |
$1,943.04
|
| Rate for Payer: Multiplan Commercial |
$1,689.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,267.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,943.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,034.88
|
| Rate for Payer: Quartz Commercial |
$1,267.20
|
| Rate for Payer: WEA Trust Commercial |
$1,161.60
|
| Rate for Payer: WPS Commercial |
$1,564.36
|
|
|
SCREW CANN 4.0 X 45MM LONG THREAD LP AR-8840CL-45
|
Facility
|
OP
|
$1,953.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5627657
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$546.84 |
| Max. Negotiated Rate |
$7,812.00 |
| Rate for Payer: Aetna Commercial |
$1,757.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,679.58
|
| Rate for Payer: Aetna Managed Medicare |
$546.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,269.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$976.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$937.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,035.09
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Cigna Commercial |
$1,796.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,092.90
|
| Rate for Payer: Health EOS Commercial |
$1,738.17
|
| Rate for Payer: HFN Commercial |
$1,796.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,464.75
|
| Rate for Payer: Multiplan Commercial |
$1,562.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,171.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,796.76
|
| Rate for Payer: Quartz Beloit One Network |
$956.97
|
| Rate for Payer: Quartz Commercial |
$1,269.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,171.80
|
| Rate for Payer: The Alliance Commercial |
$7,812.00
|
| Rate for Payer: WEA Trust Commercial |
$1,074.15
|
| Rate for Payer: WPS Commercial |
$1,446.59
|
|
|
SCREW CANN 4.0 X 45MM LONG THREAD LP AR-8840CL-45
|
Facility
|
IP
|
$1,953.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5627657
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$956.97 |
| Max. Negotiated Rate |
$1,796.76 |
| Rate for Payer: Aetna Commercial |
$1,757.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,679.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,035.09
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Cigna Commercial |
$1,796.76
|
| Rate for Payer: Health EOS Commercial |
$1,738.17
|
| Rate for Payer: HFN Commercial |
$1,796.76
|
| Rate for Payer: Multiplan Commercial |
$1,562.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,171.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,796.76
|
| Rate for Payer: Quartz Beloit One Network |
$956.97
|
| Rate for Payer: Quartz Commercial |
$1,171.80
|
| Rate for Payer: WEA Trust Commercial |
$1,074.15
|
| Rate for Payer: WPS Commercial |
$1,446.59
|
|
|
SCREW CANN 4.0 X 45MM SHORT THREAD LP AR-8840C-45
|
Facility
|
IP
|
$2,050.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6217088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,004.50 |
| Max. Negotiated Rate |
$1,886.00 |
| Rate for Payer: Aetna Commercial |
$1,845.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,763.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,086.50
|
| Rate for Payer: Cash Price |
$615.00
|
| Rate for Payer: Cigna Commercial |
$1,886.00
|
| Rate for Payer: Health EOS Commercial |
$1,824.50
|
| Rate for Payer: HFN Commercial |
$1,886.00
|
| Rate for Payer: Multiplan Commercial |
$1,640.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,230.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,886.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,004.50
|
| Rate for Payer: Quartz Commercial |
$1,230.00
|
| Rate for Payer: WEA Trust Commercial |
$1,127.50
|
| Rate for Payer: WPS Commercial |
$1,518.44
|
|
|
SCREW CANN 4.0 X 45MM SHORT THREAD LP AR-8840C-45
|
Facility
|
OP
|
$2,050.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6217088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$574.00 |
| Max. Negotiated Rate |
$8,200.00 |
| Rate for Payer: Aetna Commercial |
$1,845.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,763.00
|
| Rate for Payer: Aetna Managed Medicare |
$574.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,332.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,025.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$984.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,086.50
|
| Rate for Payer: Cash Price |
$615.00
|
| Rate for Payer: Cigna Commercial |
$1,886.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,147.18
|
| Rate for Payer: Health EOS Commercial |
$1,824.50
|
| Rate for Payer: HFN Commercial |
$1,886.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,537.50
|
| Rate for Payer: Multiplan Commercial |
$1,640.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,230.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,886.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,004.50
|
| Rate for Payer: Quartz Commercial |
$1,332.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,230.00
|
| Rate for Payer: The Alliance Commercial |
$8,200.00
|
| Rate for Payer: WEA Trust Commercial |
$1,127.50
|
| Rate for Payer: WPS Commercial |
$1,518.44
|
|
|
SCREW CANN 4.0 X 46 207.646
|
Facility
|
IP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967161
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$918.75 |
| Max. Negotiated Rate |
$1,725.00 |
| Rate for Payer: Aetna Commercial |
$1,687.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,612.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$993.75
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,725.00
|
| Rate for Payer: Health EOS Commercial |
$1,668.75
|
| Rate for Payer: HFN Commercial |
$1,725.00
|
| Rate for Payer: Multiplan Commercial |
$1,500.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,125.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,725.00
|
| Rate for Payer: Quartz Beloit One Network |
$918.75
|
| Rate for Payer: Quartz Commercial |
$1,125.00
|
| Rate for Payer: WEA Trust Commercial |
$1,031.25
|
| Rate for Payer: WPS Commercial |
$1,388.81
|
|
|
SCREW CANN 4.0 X 46 207.646
|
Facility
|
OP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967161
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$7,500.00 |
| Rate for Payer: Aetna Commercial |
$1,687.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,612.50
|
| Rate for Payer: Aetna Managed Medicare |
$525.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,218.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$937.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$993.75
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,725.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,049.25
|
| Rate for Payer: Health EOS Commercial |
$1,668.75
|
| Rate for Payer: HFN Commercial |
$1,725.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,406.25
|
| Rate for Payer: Multiplan Commercial |
$1,500.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,125.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,725.00
|
| Rate for Payer: Quartz Beloit One Network |
$918.75
|
| Rate for Payer: Quartz Commercial |
$1,218.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,125.00
|
| Rate for Payer: The Alliance Commercial |
$7,500.00
|
| Rate for Payer: WEA Trust Commercial |
$1,031.25
|
| Rate for Payer: WPS Commercial |
$1,388.81
|
|
|
SCREW-CANN 4.0 X 46 207.746
|
Facility
|
OP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967162
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$7,500.00 |
| Rate for Payer: Aetna Commercial |
$1,687.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,612.50
|
| Rate for Payer: Aetna Managed Medicare |
$525.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,218.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$937.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$993.75
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,725.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,049.25
|
| Rate for Payer: Health EOS Commercial |
$1,668.75
|
| Rate for Payer: HFN Commercial |
$1,725.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,406.25
|
| Rate for Payer: Multiplan Commercial |
$1,500.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,125.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,725.00
|
| Rate for Payer: Quartz Beloit One Network |
$918.75
|
| Rate for Payer: Quartz Commercial |
$1,218.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,125.00
|
| Rate for Payer: The Alliance Commercial |
$7,500.00
|
| Rate for Payer: WEA Trust Commercial |
$1,031.25
|
| Rate for Payer: WPS Commercial |
$1,388.81
|
|
|
SCREW-CANN 4.0 X 46 207.746
|
Facility
|
IP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967162
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$918.75 |
| Max. Negotiated Rate |
$1,725.00 |
| Rate for Payer: Aetna Commercial |
$1,687.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,612.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$993.75
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,725.00
|
| Rate for Payer: Health EOS Commercial |
$1,668.75
|
| Rate for Payer: HFN Commercial |
$1,725.00
|
| Rate for Payer: Multiplan Commercial |
$1,500.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,125.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,725.00
|
| Rate for Payer: Quartz Beloit One Network |
$918.75
|
| Rate for Payer: Quartz Commercial |
$1,125.00
|
| Rate for Payer: WEA Trust Commercial |
$1,031.25
|
| Rate for Payer: WPS Commercial |
$1,388.81
|
|
|
SCREW CANN 4.0 X 46MM LONG THREAD LP AR-8840CL-46
|
Facility
|
OP
|
$1,687.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5861651
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$472.36 |
| Max. Negotiated Rate |
$6,748.00 |
| Rate for Payer: Aetna Commercial |
$1,518.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,450.82
|
| Rate for Payer: Aetna Managed Medicare |
$472.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,096.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$843.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$809.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$894.11
|
| Rate for Payer: Cash Price |
$506.10
|
| Rate for Payer: Cigna Commercial |
$1,552.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$944.05
|
| Rate for Payer: Health EOS Commercial |
$1,501.43
|
| Rate for Payer: HFN Commercial |
$1,552.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,265.25
|
| Rate for Payer: Multiplan Commercial |
$1,349.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,012.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,552.04
|
| Rate for Payer: Quartz Beloit One Network |
$826.63
|
| Rate for Payer: Quartz Commercial |
$1,096.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,012.20
|
| Rate for Payer: The Alliance Commercial |
$6,748.00
|
| Rate for Payer: WEA Trust Commercial |
$927.85
|
| Rate for Payer: WPS Commercial |
$1,249.56
|
|
|
SCREW CANN 4.0 X 46MM LONG THREAD LP AR-8840CL-46
|
Facility
|
IP
|
$1,687.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5861651
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$826.63 |
| Max. Negotiated Rate |
$1,552.04 |
| Rate for Payer: Aetna Commercial |
$1,518.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,450.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$894.11
|
| Rate for Payer: Cash Price |
$506.10
|
| Rate for Payer: Cigna Commercial |
$1,552.04
|
| Rate for Payer: Health EOS Commercial |
$1,501.43
|
| Rate for Payer: HFN Commercial |
$1,552.04
|
| Rate for Payer: Multiplan Commercial |
$1,349.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,012.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,552.04
|
| Rate for Payer: Quartz Beloit One Network |
$826.63
|
| Rate for Payer: Quartz Commercial |
$1,012.20
|
| Rate for Payer: WEA Trust Commercial |
$927.85
|
| Rate for Payer: WPS Commercial |
$1,249.56
|
|
|
SCREW CANN 4.0 X 46MM SHORT THREAD LP AR-8840C-46
|
Facility
|
IP
|
$2,112.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5797644
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,034.88 |
| Max. Negotiated Rate |
$1,943.04 |
| Rate for Payer: Aetna Commercial |
$1,900.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,816.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,119.36
|
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Cigna Commercial |
$1,943.04
|
| Rate for Payer: Health EOS Commercial |
$1,879.68
|
| Rate for Payer: HFN Commercial |
$1,943.04
|
| Rate for Payer: Multiplan Commercial |
$1,689.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,267.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,943.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,034.88
|
| Rate for Payer: Quartz Commercial |
$1,267.20
|
| Rate for Payer: WEA Trust Commercial |
$1,161.60
|
| Rate for Payer: WPS Commercial |
$1,564.36
|
|
|
SCREW CANN 4.0 X 46MM SHORT THREAD LP AR-8840C-46
|
Facility
|
OP
|
$2,112.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5797644
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$591.36 |
| Max. Negotiated Rate |
$8,448.00 |
| Rate for Payer: Aetna Commercial |
$1,900.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,816.32
|
| Rate for Payer: Aetna Managed Medicare |
$591.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,372.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,056.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,013.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,119.36
|
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Cigna Commercial |
$1,943.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,181.88
|
| Rate for Payer: Health EOS Commercial |
$1,879.68
|
| Rate for Payer: HFN Commercial |
$1,943.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,584.00
|
| Rate for Payer: Multiplan Commercial |
$1,689.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,267.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,943.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,034.88
|
| Rate for Payer: Quartz Commercial |
$1,372.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,267.20
|
| Rate for Payer: The Alliance Commercial |
$8,448.00
|
| Rate for Payer: WEA Trust Commercial |
$1,161.60
|
| Rate for Payer: WPS Commercial |
$1,564.36
|
|
|
SCREW-CANN 4.0 X 48 207.648
|
Facility
|
IP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967163
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$918.75 |
| Max. Negotiated Rate |
$1,725.00 |
| Rate for Payer: Aetna Commercial |
$1,687.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,612.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$993.75
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,725.00
|
| Rate for Payer: Health EOS Commercial |
$1,668.75
|
| Rate for Payer: HFN Commercial |
$1,725.00
|
| Rate for Payer: Multiplan Commercial |
$1,500.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,125.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,725.00
|
| Rate for Payer: Quartz Beloit One Network |
$918.75
|
| Rate for Payer: Quartz Commercial |
$1,125.00
|
| Rate for Payer: WEA Trust Commercial |
$1,031.25
|
| Rate for Payer: WPS Commercial |
$1,388.81
|
|
|
SCREW-CANN 4.0 X 48 207.648
|
Facility
|
OP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967163
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$7,500.00 |
| Rate for Payer: Aetna Commercial |
$1,687.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,612.50
|
| Rate for Payer: Aetna Managed Medicare |
$525.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,218.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$937.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$993.75
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,725.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,049.25
|
| Rate for Payer: Health EOS Commercial |
$1,668.75
|
| Rate for Payer: HFN Commercial |
$1,725.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,406.25
|
| Rate for Payer: Multiplan Commercial |
$1,500.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,125.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,725.00
|
| Rate for Payer: Quartz Beloit One Network |
$918.75
|
| Rate for Payer: Quartz Commercial |
$1,218.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,125.00
|
| Rate for Payer: The Alliance Commercial |
$7,500.00
|
| Rate for Payer: WEA Trust Commercial |
$1,031.25
|
| Rate for Payer: WPS Commercial |
$1,388.81
|
|
|
SCREW-CANN 4.0 X 48 207.748
|
Facility
|
IP
|
$1,947.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967164
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$954.03 |
| Max. Negotiated Rate |
$1,791.24 |
| Rate for Payer: Aetna Commercial |
$1,752.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,674.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,031.91
|
| Rate for Payer: Cash Price |
$584.10
|
| Rate for Payer: Cigna Commercial |
$1,791.24
|
| Rate for Payer: Health EOS Commercial |
$1,732.83
|
| Rate for Payer: HFN Commercial |
$1,791.24
|
| Rate for Payer: Multiplan Commercial |
$1,557.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,168.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,791.24
|
| Rate for Payer: Quartz Beloit One Network |
$954.03
|
| Rate for Payer: Quartz Commercial |
$1,168.20
|
| Rate for Payer: WEA Trust Commercial |
$1,070.85
|
| Rate for Payer: WPS Commercial |
$1,442.14
|
|
|
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 |
$545.16 |
| Max. Negotiated Rate |
$7,788.00 |
| Rate for Payer: Aetna Commercial |
$1,752.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,674.42
|
| Rate for Payer: Aetna Managed Medicare |
$545.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,265.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$973.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$934.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,031.91
|
| Rate for Payer: Cash Price |
$584.10
|
| Rate for Payer: Cigna Commercial |
$1,791.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,089.54
|
| Rate for Payer: Health EOS Commercial |
$1,732.83
|
| Rate for Payer: HFN Commercial |
$1,791.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,460.25
|
| Rate for Payer: Multiplan Commercial |
$1,557.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,168.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,791.24
|
| Rate for Payer: Quartz Beloit One Network |
$954.03
|
| Rate for Payer: Quartz Commercial |
$1,265.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,168.20
|
| Rate for Payer: The Alliance Commercial |
$7,788.00
|
| Rate for Payer: WEA Trust Commercial |
$1,070.85
|
| Rate for Payer: WPS Commercial |
$1,442.14
|
|
|
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 |
$1,034.88 |
| Max. Negotiated Rate |
$1,943.04 |
| Rate for Payer: Aetna Commercial |
$1,900.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,816.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,119.36
|
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Cigna Commercial |
$1,943.04
|
| Rate for Payer: Health EOS Commercial |
$1,879.68
|
| Rate for Payer: HFN Commercial |
$1,943.04
|
| Rate for Payer: Multiplan Commercial |
$1,689.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,267.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,943.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,034.88
|
| Rate for Payer: Quartz Commercial |
$1,267.20
|
| Rate for Payer: WEA Trust Commercial |
$1,161.60
|
| Rate for Payer: WPS Commercial |
$1,564.36
|
|
|
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 |
$591.36 |
| Max. Negotiated Rate |
$8,448.00 |
| Rate for Payer: Aetna Commercial |
$1,900.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,816.32
|
| Rate for Payer: Aetna Managed Medicare |
$591.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,372.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,056.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,013.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,119.36
|
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Cigna Commercial |
$1,943.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,181.88
|
| Rate for Payer: Health EOS Commercial |
$1,879.68
|
| Rate for Payer: HFN Commercial |
$1,943.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,584.00
|
| Rate for Payer: Multiplan Commercial |
$1,689.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,267.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,943.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,034.88
|
| Rate for Payer: Quartz Commercial |
$1,372.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,267.20
|
| Rate for Payer: The Alliance Commercial |
$8,448.00
|
| Rate for Payer: WEA Trust Commercial |
$1,161.60
|
| Rate for Payer: WPS Commercial |
$1,564.36
|
|
|
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 |
$568.68 |
| Max. Negotiated Rate |
$8,124.00 |
| Rate for Payer: Aetna Commercial |
$1,827.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,746.66
|
| Rate for Payer: Aetna Managed Medicare |
$568.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,320.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,015.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$974.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,076.43
|
| Rate for Payer: Cash Price |
$609.30
|
| Rate for Payer: Cigna Commercial |
$1,868.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,136.55
|
| Rate for Payer: Health EOS Commercial |
$1,807.59
|
| Rate for Payer: HFN Commercial |
$1,868.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,523.25
|
| Rate for Payer: Multiplan Commercial |
$1,624.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,218.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,868.52
|
| Rate for Payer: Quartz Beloit One Network |
$995.19
|
| Rate for Payer: Quartz Commercial |
$1,320.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,218.60
|
| Rate for Payer: The Alliance Commercial |
$8,124.00
|
| Rate for Payer: WEA Trust Commercial |
$1,117.05
|
| Rate for Payer: WPS Commercial |
$1,504.36
|
|
|
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 |
$995.19 |
| Max. Negotiated Rate |
$1,868.52 |
| Rate for Payer: Aetna Commercial |
$1,827.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,746.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,076.43
|
| Rate for Payer: Cash Price |
$609.30
|
| Rate for Payer: Cigna Commercial |
$1,868.52
|
| Rate for Payer: Health EOS Commercial |
$1,807.59
|
| Rate for Payer: HFN Commercial |
$1,868.52
|
| Rate for Payer: Multiplan Commercial |
$1,624.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,218.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,868.52
|
| Rate for Payer: Quartz Beloit One Network |
$995.19
|
| Rate for Payer: Quartz Commercial |
$1,218.60
|
| Rate for Payer: WEA Trust Commercial |
$1,117.05
|
| Rate for Payer: WPS Commercial |
$1,504.36
|
|
|
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 |
$545.16 |
| Max. Negotiated Rate |
$7,788.00 |
| Rate for Payer: Aetna Commercial |
$1,752.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,674.42
|
| Rate for Payer: Aetna Managed Medicare |
$545.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,265.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$973.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$934.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,031.91
|
| Rate for Payer: Cash Price |
$584.10
|
| Rate for Payer: Cigna Commercial |
$1,791.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,089.54
|
| Rate for Payer: Health EOS Commercial |
$1,732.83
|
| Rate for Payer: HFN Commercial |
$1,791.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,460.25
|
| Rate for Payer: Multiplan Commercial |
$1,557.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,168.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,791.24
|
| Rate for Payer: Quartz Beloit One Network |
$954.03
|
| Rate for Payer: Quartz Commercial |
$1,265.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,168.20
|
| Rate for Payer: The Alliance Commercial |
$7,788.00
|
| Rate for Payer: WEA Trust Commercial |
$1,070.85
|
| Rate for Payer: WPS Commercial |
$1,442.14
|
|
