|
SCREW CANN MINI 3.0 X 22MM HEADED IC3022
|
Facility
|
IP
|
$2,186.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599634
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,113.99 |
| Max. Negotiated Rate |
$2,091.56 |
| Rate for Payer: Aetna Commercial |
$2,046.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,955.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,204.92
|
| Rate for Payer: Cash Price |
$655.80
|
| Rate for Payer: Cigna Commercial |
$2,091.56
|
| Rate for Payer: Health EOS Commercial |
$2,023.36
|
| Rate for Payer: HFN Commercial |
$2,091.56
|
| Rate for Payer: Multiplan Commercial |
$1,818.75
|
| Rate for Payer: Preferred Network Access Commercial |
$2,091.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,113.99
|
| Rate for Payer: Quartz Commercial |
$1,364.06
|
| Rate for Payer: WEA Trust Commercial |
$1,250.39
|
| Rate for Payer: WPS Commercial |
$1,683.88
|
|
|
SCREW CANN MINI 3.0 X 24MM HEADED IC3024
|
Facility
|
IP
|
$2,186.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599635
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,113.99 |
| Max. Negotiated Rate |
$2,091.56 |
| Rate for Payer: Aetna Commercial |
$2,046.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,955.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,204.92
|
| Rate for Payer: Cash Price |
$655.80
|
| Rate for Payer: Cigna Commercial |
$2,091.56
|
| Rate for Payer: Health EOS Commercial |
$2,023.36
|
| Rate for Payer: HFN Commercial |
$2,091.56
|
| Rate for Payer: Multiplan Commercial |
$1,818.75
|
| Rate for Payer: Preferred Network Access Commercial |
$2,091.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,113.99
|
| Rate for Payer: Quartz Commercial |
$1,364.06
|
| Rate for Payer: WEA Trust Commercial |
$1,250.39
|
| Rate for Payer: WPS Commercial |
$1,683.88
|
|
|
SCREW CANN MINI 3.0 X 24MM HEADED IC3024
|
Facility
|
OP
|
$2,186.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599635
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$636.56 |
| Max. Negotiated Rate |
$2,091.56 |
| Rate for Payer: Aetna Commercial |
$2,046.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,955.16
|
| Rate for Payer: Aetna Managed Medicare |
$636.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,477.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,136.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,091.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,204.92
|
| Rate for Payer: Cash Price |
$655.80
|
| Rate for Payer: Cigna Commercial |
$2,091.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,272.25
|
| Rate for Payer: Health EOS Commercial |
$2,023.36
|
| Rate for Payer: HFN Commercial |
$2,091.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,705.08
|
| Rate for Payer: Multiplan Commercial |
$1,818.75
|
| Rate for Payer: NAPHCARE Commercial |
$1,364.06
|
| Rate for Payer: Preferred Network Access Commercial |
$2,091.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,113.99
|
| Rate for Payer: Quartz Commercial |
$1,477.74
|
| Rate for Payer: Quartz Medicare Advantage |
$1,364.06
|
| Rate for Payer: The Alliance Commercial |
$1,136.72
|
| Rate for Payer: WEA Trust Commercial |
$1,250.39
|
| Rate for Payer: WPS Commercial |
$1,683.88
|
|
|
SCREW CANNULATED LAG
|
Facility
|
IP
|
$2,837.00
|
|
| Hospital Charge Code |
2965019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,445.74 |
| Max. Negotiated Rate |
$2,714.44 |
| Rate for Payer: Aetna Commercial |
$2,655.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,537.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,563.75
|
| Rate for Payer: Cash Price |
$851.10
|
| Rate for Payer: Cigna Commercial |
$2,714.44
|
| Rate for Payer: Health EOS Commercial |
$2,625.93
|
| Rate for Payer: HFN Commercial |
$2,714.44
|
| Rate for Payer: Multiplan Commercial |
$2,360.38
|
| Rate for Payer: Preferred Network Access Commercial |
$2,714.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,445.74
|
| Rate for Payer: Quartz Commercial |
$1,770.29
|
| Rate for Payer: WEA Trust Commercial |
$1,622.76
|
| Rate for Payer: WPS Commercial |
$2,185.34
|
|
|
SCREW CANNULATED LAG
|
Facility
|
OP
|
$2,837.00
|
|
| Hospital Charge Code |
2965019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$826.13 |
| Max. Negotiated Rate |
$2,714.44 |
| Rate for Payer: Aetna Commercial |
$2,655.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,537.41
|
| Rate for Payer: Aetna Managed Medicare |
$826.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,917.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,475.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,416.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,563.75
|
| Rate for Payer: Cash Price |
$851.10
|
| Rate for Payer: Cigna Commercial |
$2,714.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,651.13
|
| Rate for Payer: Health EOS Commercial |
$2,625.93
|
| Rate for Payer: HFN Commercial |
$2,714.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,212.86
|
| Rate for Payer: Multiplan Commercial |
$2,360.38
|
| Rate for Payer: NAPHCARE Commercial |
$1,770.29
|
| Rate for Payer: Preferred Network Access Commercial |
$2,714.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,445.74
|
| Rate for Payer: Quartz Commercial |
$1,917.81
|
| Rate for Payer: Quartz Medicare Advantage |
$1,770.29
|
| Rate for Payer: The Alliance Commercial |
$1,475.24
|
| Rate for Payer: WEA Trust Commercial |
$1,622.76
|
| Rate for Payer: WPS Commercial |
$2,185.34
|
|
|
SCREW CANN VAL 5.0 X 40MM OPTILINK TI 42.231.640
|
Facility
|
OP
|
$2,477.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6244142
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$721.48 |
| Max. Negotiated Rate |
$2,370.57 |
| Rate for Payer: Aetna Commercial |
$2,319.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,215.97
|
| Rate for Payer: Aetna Managed Medicare |
$721.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,674.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,288.35
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,236.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,365.65
|
| Rate for Payer: Cash Price |
$743.28
|
| Rate for Payer: Cigna Commercial |
$2,370.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,441.96
|
| Rate for Payer: Health EOS Commercial |
$2,293.27
|
| Rate for Payer: HFN Commercial |
$2,370.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,932.53
|
| Rate for Payer: Multiplan Commercial |
$2,061.36
|
| Rate for Payer: NAPHCARE Commercial |
$1,546.02
|
| Rate for Payer: Preferred Network Access Commercial |
$2,370.57
|
| Rate for Payer: Quartz Beloit One Network |
$1,262.58
|
| Rate for Payer: Quartz Commercial |
$1,674.86
|
| Rate for Payer: Quartz Medicare Advantage |
$1,546.02
|
| Rate for Payer: The Alliance Commercial |
$1,288.35
|
| Rate for Payer: WEA Trust Commercial |
$1,417.19
|
| Rate for Payer: WPS Commercial |
$1,908.50
|
|
|
SCREW CANN VAL 5.0 X 40MM OPTILINK TI 42.231.640
|
Facility
|
IP
|
$2,477.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6244142
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,262.58 |
| Max. Negotiated Rate |
$2,370.57 |
| Rate for Payer: Aetna Commercial |
$2,319.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,215.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,365.65
|
| Rate for Payer: Cash Price |
$743.28
|
| Rate for Payer: Cigna Commercial |
$2,370.57
|
| Rate for Payer: Health EOS Commercial |
$2,293.27
|
| Rate for Payer: HFN Commercial |
$2,370.57
|
| Rate for Payer: Multiplan Commercial |
$2,061.36
|
| Rate for Payer: Preferred Network Access Commercial |
$2,370.57
|
| Rate for Payer: Quartz Beloit One Network |
$1,262.58
|
| Rate for Payer: Quartz Commercial |
$1,546.02
|
| Rate for Payer: WEA Trust Commercial |
$1,417.19
|
| Rate for Payer: WPS Commercial |
$1,908.50
|
|
|
SCREW CANN VAL 5.0 X 70MM OPTILINK TI 42.231.670
|
Facility
|
IP
|
$2,577.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6201049
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,313.24 |
| Max. Negotiated Rate |
$2,465.67 |
| Rate for Payer: Aetna Commercial |
$2,412.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,304.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,420.44
|
| Rate for Payer: Cash Price |
$773.10
|
| Rate for Payer: Cigna Commercial |
$2,465.67
|
| Rate for Payer: Health EOS Commercial |
$2,385.27
|
| Rate for Payer: HFN Commercial |
$2,465.67
|
| Rate for Payer: Multiplan Commercial |
$2,144.06
|
| Rate for Payer: Preferred Network Access Commercial |
$2,465.67
|
| Rate for Payer: Quartz Beloit One Network |
$1,313.24
|
| Rate for Payer: Quartz Commercial |
$1,608.05
|
| Rate for Payer: WEA Trust Commercial |
$1,474.04
|
| Rate for Payer: WPS Commercial |
$1,985.06
|
|
|
SCREW CANN VAL 5.0 X 70MM OPTILINK TI 42.231.670
|
Facility
|
OP
|
$2,577.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6201049
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$750.42 |
| Max. Negotiated Rate |
$2,465.67 |
| Rate for Payer: Aetna Commercial |
$2,412.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,304.87
|
| Rate for Payer: Aetna Managed Medicare |
$750.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,742.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,340.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,286.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,420.44
|
| Rate for Payer: Cash Price |
$773.10
|
| Rate for Payer: Cigna Commercial |
$2,465.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,499.81
|
| Rate for Payer: Health EOS Commercial |
$2,385.27
|
| Rate for Payer: HFN Commercial |
$2,465.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,010.06
|
| Rate for Payer: Multiplan Commercial |
$2,144.06
|
| Rate for Payer: NAPHCARE Commercial |
$1,608.05
|
| Rate for Payer: Preferred Network Access Commercial |
$2,465.67
|
| Rate for Payer: Quartz Beloit One Network |
$1,313.24
|
| Rate for Payer: Quartz Commercial |
$1,742.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,608.05
|
| Rate for Payer: The Alliance Commercial |
$1,340.04
|
| Rate for Payer: WEA Trust Commercial |
$1,474.04
|
| Rate for Payer: WPS Commercial |
$1,985.06
|
|
|
SCREW CANN VAL 5.0 X 75MM OPTILINK TI 42.231.675
|
Facility
|
IP
|
$2,436.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6169850
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,241.39 |
| Max. Negotiated Rate |
$2,330.76 |
| Rate for Payer: Aetna Commercial |
$2,280.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,178.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,342.72
|
| Rate for Payer: Cash Price |
$730.80
|
| Rate for Payer: Cigna Commercial |
$2,330.76
|
| Rate for Payer: Health EOS Commercial |
$2,254.76
|
| Rate for Payer: HFN Commercial |
$2,330.76
|
| Rate for Payer: Multiplan Commercial |
$2,026.75
|
| Rate for Payer: Preferred Network Access Commercial |
$2,330.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,241.39
|
| Rate for Payer: Quartz Commercial |
$1,520.06
|
| Rate for Payer: WEA Trust Commercial |
$1,393.39
|
| Rate for Payer: WPS Commercial |
$1,876.45
|
|
|
SCREW CANN VAL 5.0 X 75MM OPTILINK TI 42.231.675
|
Facility
|
OP
|
$2,436.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6169850
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$709.36 |
| Max. Negotiated Rate |
$2,330.76 |
| Rate for Payer: Aetna Commercial |
$2,280.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,178.76
|
| Rate for Payer: Aetna Managed Medicare |
$709.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,646.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,266.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,216.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,342.72
|
| Rate for Payer: Cash Price |
$730.80
|
| Rate for Payer: Cigna Commercial |
$2,330.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,417.75
|
| Rate for Payer: Health EOS Commercial |
$2,254.76
|
| Rate for Payer: HFN Commercial |
$2,330.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,900.08
|
| Rate for Payer: Multiplan Commercial |
$2,026.75
|
| Rate for Payer: NAPHCARE Commercial |
$1,520.06
|
| Rate for Payer: Preferred Network Access Commercial |
$2,330.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,241.39
|
| Rate for Payer: Quartz Commercial |
$1,646.74
|
| Rate for Payer: Quartz Medicare Advantage |
$1,520.06
|
| Rate for Payer: The Alliance Commercial |
$1,266.72
|
| Rate for Payer: WEA Trust Commercial |
$1,393.39
|
| Rate for Payer: WPS Commercial |
$1,876.45
|
|
|
SCREW CANN VAL 5.0 X 80MM OPTILINK TI 42.231.680
|
Facility
|
IP
|
$2,577.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6226143
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,313.24 |
| Max. Negotiated Rate |
$2,465.67 |
| Rate for Payer: Aetna Commercial |
$2,412.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,304.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,420.44
|
| Rate for Payer: Cash Price |
$773.10
|
| Rate for Payer: Cigna Commercial |
$2,465.67
|
| Rate for Payer: Health EOS Commercial |
$2,385.27
|
| Rate for Payer: HFN Commercial |
$2,465.67
|
| Rate for Payer: Multiplan Commercial |
$2,144.06
|
| Rate for Payer: Preferred Network Access Commercial |
$2,465.67
|
| Rate for Payer: Quartz Beloit One Network |
$1,313.24
|
| Rate for Payer: Quartz Commercial |
$1,608.05
|
| Rate for Payer: WEA Trust Commercial |
$1,474.04
|
| Rate for Payer: WPS Commercial |
$1,985.06
|
|
|
SCREW CANN VAL 5.0 X 80MM OPTILINK TI 42.231.680
|
Facility
|
OP
|
$2,577.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6226143
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$750.42 |
| Max. Negotiated Rate |
$2,465.67 |
| Rate for Payer: Aetna Commercial |
$2,412.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,304.87
|
| Rate for Payer: Aetna Managed Medicare |
$750.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,742.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,340.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,286.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,420.44
|
| Rate for Payer: Cash Price |
$773.10
|
| Rate for Payer: Cigna Commercial |
$2,465.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,499.81
|
| Rate for Payer: Health EOS Commercial |
$2,385.27
|
| Rate for Payer: HFN Commercial |
$2,465.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,010.06
|
| Rate for Payer: Multiplan Commercial |
$2,144.06
|
| Rate for Payer: NAPHCARE Commercial |
$1,608.05
|
| Rate for Payer: Preferred Network Access Commercial |
$2,465.67
|
| Rate for Payer: Quartz Beloit One Network |
$1,313.24
|
| Rate for Payer: Quartz Commercial |
$1,742.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,608.05
|
| Rate for Payer: The Alliance Commercial |
$1,340.04
|
| Rate for Payer: WEA Trust Commercial |
$1,474.04
|
| Rate for Payer: WPS Commercial |
$1,985.06
|
|
|
SCREW CANN VAL 5.0 X 85MM OPTILINK TI 42.231.685
|
Facility
|
IP
|
$2,477.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6244143
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,262.58 |
| Max. Negotiated Rate |
$2,370.57 |
| Rate for Payer: Aetna Commercial |
$2,319.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,215.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,365.65
|
| Rate for Payer: Cash Price |
$743.28
|
| Rate for Payer: Cigna Commercial |
$2,370.57
|
| Rate for Payer: Health EOS Commercial |
$2,293.27
|
| Rate for Payer: HFN Commercial |
$2,370.57
|
| Rate for Payer: Multiplan Commercial |
$2,061.36
|
| Rate for Payer: Preferred Network Access Commercial |
$2,370.57
|
| Rate for Payer: Quartz Beloit One Network |
$1,262.58
|
| Rate for Payer: Quartz Commercial |
$1,546.02
|
| Rate for Payer: WEA Trust Commercial |
$1,417.19
|
| Rate for Payer: WPS Commercial |
$1,908.50
|
|
|
SCREW CANN VAL 5.0 X 85MM OPTILINK TI 42.231.685
|
Facility
|
OP
|
$2,477.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6244143
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$721.48 |
| Max. Negotiated Rate |
$2,370.57 |
| Rate for Payer: Aetna Commercial |
$2,319.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,215.97
|
| Rate for Payer: Aetna Managed Medicare |
$721.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,674.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,288.35
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,236.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,365.65
|
| Rate for Payer: Cash Price |
$743.28
|
| Rate for Payer: Cigna Commercial |
$2,370.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,441.96
|
| Rate for Payer: Health EOS Commercial |
$2,293.27
|
| Rate for Payer: HFN Commercial |
$2,370.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,932.53
|
| Rate for Payer: Multiplan Commercial |
$2,061.36
|
| Rate for Payer: NAPHCARE Commercial |
$1,546.02
|
| Rate for Payer: Preferred Network Access Commercial |
$2,370.57
|
| Rate for Payer: Quartz Beloit One Network |
$1,262.58
|
| Rate for Payer: Quartz Commercial |
$1,674.86
|
| Rate for Payer: Quartz Medicare Advantage |
$1,546.02
|
| Rate for Payer: The Alliance Commercial |
$1,288.35
|
| Rate for Payer: WEA Trust Commercial |
$1,417.19
|
| Rate for Payer: WPS Commercial |
$1,908.50
|
|
|
SCREW CAPTURED CORTICAL 5.0MM X 38MM 8001-038
|
Facility
|
OP
|
$2,483.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6234132
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$723.05 |
| Max. Negotiated Rate |
$2,375.73 |
| Rate for Payer: Aetna Commercial |
$2,324.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,220.80
|
| Rate for Payer: Aetna Managed Medicare |
$723.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,678.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,291.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,239.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,368.63
|
| Rate for Payer: Cash Price |
$744.90
|
| Rate for Payer: Cigna Commercial |
$2,375.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,445.11
|
| Rate for Payer: Health EOS Commercial |
$2,298.26
|
| Rate for Payer: HFN Commercial |
$2,375.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,936.74
|
| Rate for Payer: Multiplan Commercial |
$2,065.86
|
| Rate for Payer: NAPHCARE Commercial |
$1,549.39
|
| Rate for Payer: Preferred Network Access Commercial |
$2,375.73
|
| Rate for Payer: Quartz Beloit One Network |
$1,265.34
|
| Rate for Payer: Quartz Commercial |
$1,678.51
|
| Rate for Payer: Quartz Medicare Advantage |
$1,549.39
|
| Rate for Payer: The Alliance Commercial |
$1,291.16
|
| Rate for Payer: WEA Trust Commercial |
$1,420.28
|
| Rate for Payer: WPS Commercial |
$1,912.65
|
|
|
SCREW CAPTURED CORTICAL 5.0MM X 38MM 8001-038
|
Facility
|
IP
|
$2,483.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6234132
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,265.34 |
| Max. Negotiated Rate |
$2,375.73 |
| Rate for Payer: Aetna Commercial |
$2,324.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,220.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,368.63
|
| Rate for Payer: Cash Price |
$744.90
|
| Rate for Payer: Cigna Commercial |
$2,375.73
|
| Rate for Payer: Health EOS Commercial |
$2,298.26
|
| Rate for Payer: HFN Commercial |
$2,375.73
|
| Rate for Payer: Multiplan Commercial |
$2,065.86
|
| Rate for Payer: Preferred Network Access Commercial |
$2,375.73
|
| Rate for Payer: Quartz Beloit One Network |
$1,265.34
|
| Rate for Payer: Quartz Commercial |
$1,549.39
|
| Rate for Payer: WEA Trust Commercial |
$1,420.28
|
| Rate for Payer: WPS Commercial |
$1,912.65
|
|
|
SCREW CAPTURED CORTICAL 5.0MM X 40MM 8001-040
|
Facility
|
OP
|
$2,483.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6232141
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$723.05 |
| Max. Negotiated Rate |
$2,375.73 |
| Rate for Payer: Aetna Commercial |
$2,324.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,220.80
|
| Rate for Payer: Aetna Managed Medicare |
$723.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,678.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,291.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,239.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,368.63
|
| Rate for Payer: Cash Price |
$744.90
|
| Rate for Payer: Cigna Commercial |
$2,375.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,445.11
|
| Rate for Payer: Health EOS Commercial |
$2,298.26
|
| Rate for Payer: HFN Commercial |
$2,375.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,936.74
|
| Rate for Payer: Multiplan Commercial |
$2,065.86
|
| Rate for Payer: NAPHCARE Commercial |
$1,549.39
|
| Rate for Payer: Preferred Network Access Commercial |
$2,375.73
|
| Rate for Payer: Quartz Beloit One Network |
$1,265.34
|
| Rate for Payer: Quartz Commercial |
$1,678.51
|
| Rate for Payer: Quartz Medicare Advantage |
$1,549.39
|
| Rate for Payer: The Alliance Commercial |
$1,291.16
|
| Rate for Payer: WEA Trust Commercial |
$1,420.28
|
| Rate for Payer: WPS Commercial |
$1,912.65
|
|
|
SCREW CAPTURED CORTICAL 5.0MM X 40MM 8001-040
|
Facility
|
IP
|
$2,483.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6232141
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,265.34 |
| Max. Negotiated Rate |
$2,375.73 |
| Rate for Payer: Aetna Commercial |
$2,324.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,220.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,368.63
|
| Rate for Payer: Cash Price |
$744.90
|
| Rate for Payer: Cigna Commercial |
$2,375.73
|
| Rate for Payer: Health EOS Commercial |
$2,298.26
|
| Rate for Payer: HFN Commercial |
$2,375.73
|
| Rate for Payer: Multiplan Commercial |
$2,065.86
|
| Rate for Payer: Preferred Network Access Commercial |
$2,375.73
|
| Rate for Payer: Quartz Beloit One Network |
$1,265.34
|
| Rate for Payer: Quartz Commercial |
$1,549.39
|
| Rate for Payer: WEA Trust Commercial |
$1,420.28
|
| Rate for Payer: WPS Commercial |
$1,912.65
|
|
|
SCREW CAPTURE HEADLESS 2.5 X 16MM AH2516
|
Facility
|
OP
|
$2,788.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5627643
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$811.87 |
| Max. Negotiated Rate |
$2,667.56 |
| Rate for Payer: Aetna Commercial |
$2,609.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,493.59
|
| Rate for Payer: Aetna Managed Medicare |
$811.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,884.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,449.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,391.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,536.75
|
| Rate for Payer: Cash Price |
$836.40
|
| Rate for Payer: Cigna Commercial |
$2,667.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,622.62
|
| Rate for Payer: Health EOS Commercial |
$2,580.57
|
| Rate for Payer: HFN Commercial |
$2,667.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,174.64
|
| Rate for Payer: Multiplan Commercial |
$2,319.62
|
| Rate for Payer: NAPHCARE Commercial |
$1,739.71
|
| Rate for Payer: Preferred Network Access Commercial |
$2,667.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,420.76
|
| Rate for Payer: Quartz Commercial |
$1,884.69
|
| Rate for Payer: Quartz Medicare Advantage |
$1,739.71
|
| Rate for Payer: The Alliance Commercial |
$1,449.76
|
| Rate for Payer: WEA Trust Commercial |
$1,594.74
|
| Rate for Payer: WPS Commercial |
$2,147.60
|
|
|
SCREW CAPTURE HEADLESS 2.5 X 16MM AH2516
|
Facility
|
IP
|
$2,788.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5627643
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,420.76 |
| Max. Negotiated Rate |
$2,667.56 |
| Rate for Payer: Aetna Commercial |
$2,609.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,493.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,536.75
|
| Rate for Payer: Cash Price |
$836.40
|
| Rate for Payer: Cigna Commercial |
$2,667.56
|
| Rate for Payer: Health EOS Commercial |
$2,580.57
|
| Rate for Payer: HFN Commercial |
$2,667.56
|
| Rate for Payer: Multiplan Commercial |
$2,319.62
|
| Rate for Payer: Preferred Network Access Commercial |
$2,667.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,420.76
|
| Rate for Payer: Quartz Commercial |
$1,739.71
|
| Rate for Payer: WEA Trust Commercial |
$1,594.74
|
| Rate for Payer: WPS Commercial |
$2,147.60
|
|
|
SCREW CENTRAL COMPREHENSIVE REVERSE SHOULDER 6.5MM X 20MM 115394
|
Facility
|
IP
|
$1,113.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6165994
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$567.18 |
| Max. Negotiated Rate |
$1,064.92 |
| Rate for Payer: Aetna Commercial |
$1,041.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$995.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$613.49
|
| Rate for Payer: Cash Price |
$333.90
|
| Rate for Payer: Cigna Commercial |
$1,064.92
|
| Rate for Payer: Health EOS Commercial |
$1,030.19
|
| Rate for Payer: HFN Commercial |
$1,064.92
|
| Rate for Payer: Multiplan Commercial |
$926.02
|
| Rate for Payer: Preferred Network Access Commercial |
$1,064.92
|
| Rate for Payer: Quartz Beloit One Network |
$567.18
|
| Rate for Payer: Quartz Commercial |
$694.51
|
| Rate for Payer: WEA Trust Commercial |
$636.64
|
| Rate for Payer: WPS Commercial |
$857.34
|
|
|
SCREW CENTRAL COMPREHENSIVE REVERSE SHOULDER 6.5MM X 20MM 115394
|
Facility
|
OP
|
$1,113.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6165994
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$324.11 |
| Max. Negotiated Rate |
$1,064.92 |
| Rate for Payer: Aetna Commercial |
$1,041.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$995.47
|
| Rate for Payer: Aetna Managed Medicare |
$324.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$752.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$578.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$555.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$613.49
|
| Rate for Payer: Cash Price |
$333.90
|
| Rate for Payer: Cigna Commercial |
$1,064.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$647.77
|
| Rate for Payer: Health EOS Commercial |
$1,030.19
|
| Rate for Payer: HFN Commercial |
$1,064.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$868.14
|
| Rate for Payer: Multiplan Commercial |
$926.02
|
| Rate for Payer: NAPHCARE Commercial |
$694.51
|
| Rate for Payer: Preferred Network Access Commercial |
$1,064.92
|
| Rate for Payer: Quartz Beloit One Network |
$567.18
|
| Rate for Payer: Quartz Commercial |
$752.39
|
| Rate for Payer: Quartz Medicare Advantage |
$694.51
|
| Rate for Payer: The Alliance Commercial |
$578.76
|
| Rate for Payer: WEA Trust Commercial |
$636.64
|
| Rate for Payer: WPS Commercial |
$857.34
|
|
|
SCREW CENTRAL LOCKING UNIVERSAL GLENOID 15MM AR-9165-15
|
Facility
|
OP
|
$2,263.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4433204
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$658.99 |
| Max. Negotiated Rate |
$2,165.24 |
| Rate for Payer: Aetna Commercial |
$2,118.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,024.03
|
| Rate for Payer: Aetna Managed Medicare |
$658.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,529.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,176.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,129.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,247.37
|
| Rate for Payer: Cash Price |
$678.90
|
| Rate for Payer: Cigna Commercial |
$2,165.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,317.07
|
| Rate for Payer: Health EOS Commercial |
$2,094.63
|
| Rate for Payer: HFN Commercial |
$2,165.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,765.14
|
| Rate for Payer: Multiplan Commercial |
$1,882.82
|
| Rate for Payer: NAPHCARE Commercial |
$1,412.11
|
| Rate for Payer: Preferred Network Access Commercial |
$2,165.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,153.22
|
| Rate for Payer: Quartz Commercial |
$1,529.79
|
| Rate for Payer: Quartz Medicare Advantage |
$1,412.11
|
| Rate for Payer: The Alliance Commercial |
$1,176.76
|
| Rate for Payer: WEA Trust Commercial |
$1,294.44
|
| Rate for Payer: WPS Commercial |
$1,743.19
|
|
|
SCREW CENTRAL LOCKING UNIVERSAL GLENOID 15MM AR-9165-15
|
Facility
|
IP
|
$2,263.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4433204
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,153.22 |
| Max. Negotiated Rate |
$2,165.24 |
| Rate for Payer: Aetna Commercial |
$2,118.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,024.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,247.37
|
| Rate for Payer: Cash Price |
$678.90
|
| Rate for Payer: Cigna Commercial |
$2,165.24
|
| Rate for Payer: Health EOS Commercial |
$2,094.63
|
| Rate for Payer: HFN Commercial |
$2,165.24
|
| Rate for Payer: Multiplan Commercial |
$1,882.82
|
| Rate for Payer: Preferred Network Access Commercial |
$2,165.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,153.22
|
| Rate for Payer: Quartz Commercial |
$1,412.11
|
| Rate for Payer: WEA Trust Commercial |
$1,294.44
|
| Rate for Payer: WPS Commercial |
$1,743.19
|
|
