|
SCREW-COMPRESSION AMBI 28.5MM 121117
|
Facility
|
OP
|
$335.00
|
|
| Hospital Charge Code |
2966040
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$97.55 |
| Max. Negotiated Rate |
$320.53 |
| Rate for Payer: Aetna Commercial |
$313.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$299.62
|
| Rate for Payer: Aetna Managed Medicare |
$97.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$226.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$174.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$167.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$184.65
|
| Rate for Payer: Cash Price |
$100.50
|
| Rate for Payer: Cigna Commercial |
$320.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$194.97
|
| Rate for Payer: Health EOS Commercial |
$310.08
|
| Rate for Payer: HFN Commercial |
$320.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$261.30
|
| Rate for Payer: Multiplan Commercial |
$278.72
|
| Rate for Payer: NAPHCARE Commercial |
$209.04
|
| Rate for Payer: Preferred Network Access Commercial |
$320.53
|
| Rate for Payer: Quartz Beloit One Network |
$170.72
|
| Rate for Payer: Quartz Commercial |
$226.46
|
| Rate for Payer: Quartz Medicare Advantage |
$209.04
|
| Rate for Payer: The Alliance Commercial |
$174.20
|
| Rate for Payer: WEA Trust Commercial |
$191.62
|
| Rate for Payer: WPS Commercial |
$258.05
|
|
|
SCREW COMPRESSION DHS/DCS 36MM 280.990S
|
Facility
|
IP
|
$1,003.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2966512
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$511.13 |
| Max. Negotiated Rate |
$959.67 |
| Rate for Payer: Aetna Commercial |
$938.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$897.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$552.85
|
| Rate for Payer: Cash Price |
$300.90
|
| Rate for Payer: Cigna Commercial |
$959.67
|
| Rate for Payer: Health EOS Commercial |
$928.38
|
| Rate for Payer: HFN Commercial |
$959.67
|
| Rate for Payer: Multiplan Commercial |
$834.50
|
| Rate for Payer: Preferred Network Access Commercial |
$959.67
|
| Rate for Payer: Quartz Beloit One Network |
$511.13
|
| Rate for Payer: Quartz Commercial |
$625.87
|
| Rate for Payer: WEA Trust Commercial |
$573.72
|
| Rate for Payer: WPS Commercial |
$772.61
|
|
|
SCREW COMPRESSION DHS/DCS 36MM 280.990S
|
Facility
|
OP
|
$1,003.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2966512
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$292.07 |
| Max. Negotiated Rate |
$959.67 |
| Rate for Payer: Aetna Commercial |
$938.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$897.08
|
| Rate for Payer: Aetna Managed Medicare |
$292.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$678.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$521.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$500.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$552.85
|
| Rate for Payer: Cash Price |
$300.90
|
| Rate for Payer: Cigna Commercial |
$959.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$583.75
|
| Rate for Payer: Health EOS Commercial |
$928.38
|
| Rate for Payer: HFN Commercial |
$959.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$782.34
|
| Rate for Payer: Multiplan Commercial |
$834.50
|
| Rate for Payer: NAPHCARE Commercial |
$625.87
|
| Rate for Payer: Preferred Network Access Commercial |
$959.67
|
| Rate for Payer: Quartz Beloit One Network |
$511.13
|
| Rate for Payer: Quartz Commercial |
$678.03
|
| Rate for Payer: Quartz Medicare Advantage |
$625.87
|
| Rate for Payer: The Alliance Commercial |
$521.56
|
| Rate for Payer: WEA Trust Commercial |
$573.72
|
| Rate for Payer: WPS Commercial |
$772.61
|
|
|
SCREW COMPRESSION DHS LCP DHHS
|
Facility
|
OP
|
$965.00
|
|
| Hospital Charge Code |
2966552
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$281.01 |
| Max. Negotiated Rate |
$923.31 |
| Rate for Payer: Aetna Commercial |
$903.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$863.10
|
| Rate for Payer: Aetna Managed Medicare |
$281.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$652.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$501.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$481.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$531.91
|
| Rate for Payer: Cash Price |
$289.50
|
| Rate for Payer: Cigna Commercial |
$923.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$561.63
|
| Rate for Payer: Health EOS Commercial |
$893.20
|
| Rate for Payer: HFN Commercial |
$923.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$752.70
|
| Rate for Payer: Multiplan Commercial |
$802.88
|
| Rate for Payer: NAPHCARE Commercial |
$602.16
|
| Rate for Payer: Preferred Network Access Commercial |
$923.31
|
| Rate for Payer: Quartz Beloit One Network |
$491.76
|
| Rate for Payer: Quartz Commercial |
$652.34
|
| Rate for Payer: Quartz Medicare Advantage |
$602.16
|
| Rate for Payer: The Alliance Commercial |
$501.80
|
| Rate for Payer: WEA Trust Commercial |
$551.98
|
| Rate for Payer: WPS Commercial |
$743.34
|
|
|
SCREW COMPRESSION DHS LCP DHHS
|
Facility
|
IP
|
$965.00
|
|
| Hospital Charge Code |
2966552
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$491.76 |
| Max. Negotiated Rate |
$923.31 |
| Rate for Payer: Aetna Commercial |
$903.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$863.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$531.91
|
| Rate for Payer: Cash Price |
$289.50
|
| Rate for Payer: Cigna Commercial |
$923.31
|
| Rate for Payer: Health EOS Commercial |
$893.20
|
| Rate for Payer: HFN Commercial |
$923.31
|
| Rate for Payer: Multiplan Commercial |
$802.88
|
| Rate for Payer: Preferred Network Access Commercial |
$923.31
|
| Rate for Payer: Quartz Beloit One Network |
$491.76
|
| Rate for Payer: Quartz Commercial |
$602.16
|
| Rate for Payer: WEA Trust Commercial |
$551.98
|
| Rate for Payer: WPS Commercial |
$743.34
|
|
|
SCREW COMPRESSION HEADLESS 4.3 X 44MM PT AR-8643-44
|
Facility
|
OP
|
$3,989.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5591390
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.60 |
| Max. Negotiated Rate |
$3,816.68 |
| Rate for Payer: Aetna Commercial |
$3,733.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,567.76
|
| Rate for Payer: Aetna Managed Medicare |
$1,161.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,696.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,074.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,991.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,198.74
|
| Rate for Payer: Cash Price |
$1,196.70
|
| Rate for Payer: Cigna Commercial |
$3,816.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,321.60
|
| Rate for Payer: Health EOS Commercial |
$3,692.22
|
| Rate for Payer: HFN Commercial |
$3,816.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,111.42
|
| Rate for Payer: Multiplan Commercial |
$3,318.85
|
| Rate for Payer: NAPHCARE Commercial |
$2,489.14
|
| Rate for Payer: Preferred Network Access Commercial |
$3,816.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,032.79
|
| Rate for Payer: Quartz Commercial |
$2,696.56
|
| Rate for Payer: Quartz Medicare Advantage |
$2,489.14
|
| Rate for Payer: The Alliance Commercial |
$2,074.28
|
| Rate for Payer: WEA Trust Commercial |
$2,281.71
|
| Rate for Payer: WPS Commercial |
$3,072.73
|
|
|
SCREW COMPRESSION HEADLESS 4.3 X 44MM PT AR-8643-44
|
Facility
|
IP
|
$3,989.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5591390
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,032.79 |
| Max. Negotiated Rate |
$3,816.68 |
| Rate for Payer: Aetna Commercial |
$3,733.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,567.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,198.74
|
| Rate for Payer: Cash Price |
$1,196.70
|
| Rate for Payer: Cigna Commercial |
$3,816.68
|
| Rate for Payer: Health EOS Commercial |
$3,692.22
|
| Rate for Payer: HFN Commercial |
$3,816.68
|
| Rate for Payer: Multiplan Commercial |
$3,318.85
|
| Rate for Payer: Preferred Network Access Commercial |
$3,816.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,032.79
|
| Rate for Payer: Quartz Commercial |
$2,489.14
|
| Rate for Payer: WEA Trust Commercial |
$2,281.71
|
| Rate for Payer: WPS Commercial |
$3,072.73
|
|
|
SCREW COMPRESSION HEADLESS 6.5 X50MM PT AR-8665-1850
|
Facility
|
IP
|
$4,282.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6234121
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,182.11 |
| Max. Negotiated Rate |
$4,097.02 |
| Rate for Payer: Aetna Commercial |
$4,007.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,829.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,360.24
|
| Rate for Payer: Cash Price |
$1,284.60
|
| Rate for Payer: Cigna Commercial |
$4,097.02
|
| Rate for Payer: Health EOS Commercial |
$3,963.42
|
| Rate for Payer: HFN Commercial |
$4,097.02
|
| Rate for Payer: Multiplan Commercial |
$3,562.62
|
| Rate for Payer: Preferred Network Access Commercial |
$4,097.02
|
| Rate for Payer: Quartz Beloit One Network |
$2,182.11
|
| Rate for Payer: Quartz Commercial |
$2,671.97
|
| Rate for Payer: WEA Trust Commercial |
$2,449.30
|
| Rate for Payer: WPS Commercial |
$3,298.42
|
|
|
SCREW COMPRESSION HEADLESS 6.5 X50MM PT AR-8665-1850
|
Facility
|
OP
|
$4,282.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6234121
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,246.92 |
| Max. Negotiated Rate |
$4,097.02 |
| Rate for Payer: Aetna Commercial |
$4,007.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,829.82
|
| Rate for Payer: Aetna Managed Medicare |
$1,246.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,894.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,226.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,137.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,360.24
|
| Rate for Payer: Cash Price |
$1,284.60
|
| Rate for Payer: Cigna Commercial |
$4,097.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,492.12
|
| Rate for Payer: Health EOS Commercial |
$3,963.42
|
| Rate for Payer: HFN Commercial |
$4,097.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,339.96
|
| Rate for Payer: Multiplan Commercial |
$3,562.62
|
| Rate for Payer: NAPHCARE Commercial |
$2,671.97
|
| Rate for Payer: Preferred Network Access Commercial |
$4,097.02
|
| Rate for Payer: Quartz Beloit One Network |
$2,182.11
|
| Rate for Payer: Quartz Commercial |
$2,894.63
|
| Rate for Payer: Quartz Medicare Advantage |
$2,671.97
|
| Rate for Payer: The Alliance Commercial |
$2,226.64
|
| Rate for Payer: WEA Trust Commercial |
$2,449.30
|
| Rate for Payer: WPS Commercial |
$3,298.42
|
|
|
SCREW COMPRESSION HEADLESS 6.5 X55MM PT AR-8665-1855
|
Facility
|
OP
|
$4,282.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6234122
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,246.92 |
| Max. Negotiated Rate |
$4,097.02 |
| Rate for Payer: Aetna Commercial |
$4,007.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,829.82
|
| Rate for Payer: Aetna Managed Medicare |
$1,246.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,894.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,226.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,137.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,360.24
|
| Rate for Payer: Cash Price |
$1,284.60
|
| Rate for Payer: Cigna Commercial |
$4,097.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,492.12
|
| Rate for Payer: Health EOS Commercial |
$3,963.42
|
| Rate for Payer: HFN Commercial |
$4,097.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,339.96
|
| Rate for Payer: Multiplan Commercial |
$3,562.62
|
| Rate for Payer: NAPHCARE Commercial |
$2,671.97
|
| Rate for Payer: Preferred Network Access Commercial |
$4,097.02
|
| Rate for Payer: Quartz Beloit One Network |
$2,182.11
|
| Rate for Payer: Quartz Commercial |
$2,894.63
|
| Rate for Payer: Quartz Medicare Advantage |
$2,671.97
|
| Rate for Payer: The Alliance Commercial |
$2,226.64
|
| Rate for Payer: WEA Trust Commercial |
$2,449.30
|
| Rate for Payer: WPS Commercial |
$3,298.42
|
|
|
SCREW COMPRESSION HEADLESS 6.5 X55MM PT AR-8665-1855
|
Facility
|
IP
|
$4,282.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6234122
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,182.11 |
| Max. Negotiated Rate |
$4,097.02 |
| Rate for Payer: Aetna Commercial |
$4,007.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,829.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,360.24
|
| Rate for Payer: Cash Price |
$1,284.60
|
| Rate for Payer: Cigna Commercial |
$4,097.02
|
| Rate for Payer: Health EOS Commercial |
$3,963.42
|
| Rate for Payer: HFN Commercial |
$4,097.02
|
| Rate for Payer: Multiplan Commercial |
$3,562.62
|
| Rate for Payer: Preferred Network Access Commercial |
$4,097.02
|
| Rate for Payer: Quartz Beloit One Network |
$2,182.11
|
| Rate for Payer: Quartz Commercial |
$2,671.97
|
| Rate for Payer: WEA Trust Commercial |
$2,449.30
|
| Rate for Payer: WPS Commercial |
$3,298.42
|
|
|
SCREW COMPRESSION HEADLESS 6.5 X60MM PT AR-8665-1860
|
Facility
|
OP
|
$4,282.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6236128
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,246.92 |
| Max. Negotiated Rate |
$4,097.02 |
| Rate for Payer: Aetna Commercial |
$4,007.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,829.82
|
| Rate for Payer: Aetna Managed Medicare |
$1,246.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,894.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,226.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,137.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,360.24
|
| Rate for Payer: Cash Price |
$1,284.60
|
| Rate for Payer: Cigna Commercial |
$4,097.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,492.12
|
| Rate for Payer: Health EOS Commercial |
$3,963.42
|
| Rate for Payer: HFN Commercial |
$4,097.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,339.96
|
| Rate for Payer: Multiplan Commercial |
$3,562.62
|
| Rate for Payer: NAPHCARE Commercial |
$2,671.97
|
| Rate for Payer: Preferred Network Access Commercial |
$4,097.02
|
| Rate for Payer: Quartz Beloit One Network |
$2,182.11
|
| Rate for Payer: Quartz Commercial |
$2,894.63
|
| Rate for Payer: Quartz Medicare Advantage |
$2,671.97
|
| Rate for Payer: The Alliance Commercial |
$2,226.64
|
| Rate for Payer: WEA Trust Commercial |
$2,449.30
|
| Rate for Payer: WPS Commercial |
$3,298.42
|
|
|
SCREW COMPRESSION HEADLESS 6.5 X60MM PT AR-8665-1860
|
Facility
|
IP
|
$4,282.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6236128
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,182.11 |
| Max. Negotiated Rate |
$4,097.02 |
| Rate for Payer: Aetna Commercial |
$4,007.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,829.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,360.24
|
| Rate for Payer: Cash Price |
$1,284.60
|
| Rate for Payer: Cigna Commercial |
$4,097.02
|
| Rate for Payer: Health EOS Commercial |
$3,963.42
|
| Rate for Payer: HFN Commercial |
$4,097.02
|
| Rate for Payer: Multiplan Commercial |
$3,562.62
|
| Rate for Payer: Preferred Network Access Commercial |
$4,097.02
|
| Rate for Payer: Quartz Beloit One Network |
$2,182.11
|
| Rate for Payer: Quartz Commercial |
$2,671.97
|
| Rate for Payer: WEA Trust Commercial |
$2,449.30
|
| Rate for Payer: WPS Commercial |
$3,298.42
|
|
|
SCREW COMPRESSION HEADLESS 6.5 X 65MM PT AR-8665-1865
|
Facility
|
OP
|
$4,587.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5603631
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,335.73 |
| Max. Negotiated Rate |
$4,388.84 |
| Rate for Payer: Aetna Commercial |
$4,293.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,102.61
|
| Rate for Payer: Aetna Managed Medicare |
$1,335.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,100.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,385.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,289.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,528.35
|
| Rate for Payer: Cash Price |
$1,376.10
|
| Rate for Payer: Cigna Commercial |
$4,388.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,669.63
|
| Rate for Payer: Health EOS Commercial |
$4,245.73
|
| Rate for Payer: HFN Commercial |
$4,388.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,577.86
|
| Rate for Payer: Multiplan Commercial |
$3,816.38
|
| Rate for Payer: NAPHCARE Commercial |
$2,862.29
|
| Rate for Payer: Preferred Network Access Commercial |
$4,388.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,337.54
|
| Rate for Payer: Quartz Commercial |
$3,100.81
|
| Rate for Payer: Quartz Medicare Advantage |
$2,862.29
|
| Rate for Payer: The Alliance Commercial |
$2,385.24
|
| Rate for Payer: WEA Trust Commercial |
$2,623.76
|
| Rate for Payer: WPS Commercial |
$3,533.37
|
|
|
SCREW COMPRESSION HEADLESS 6.5 X 65MM PT AR-8665-1865
|
Facility
|
IP
|
$4,587.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5603631
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,337.54 |
| Max. Negotiated Rate |
$4,388.84 |
| Rate for Payer: Aetna Commercial |
$4,293.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,102.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,528.35
|
| Rate for Payer: Cash Price |
$1,376.10
|
| Rate for Payer: Cigna Commercial |
$4,388.84
|
| Rate for Payer: Health EOS Commercial |
$4,245.73
|
| Rate for Payer: HFN Commercial |
$4,388.84
|
| Rate for Payer: Multiplan Commercial |
$3,816.38
|
| Rate for Payer: Preferred Network Access Commercial |
$4,388.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,337.54
|
| Rate for Payer: Quartz Commercial |
$2,862.29
|
| Rate for Payer: WEA Trust Commercial |
$2,623.76
|
| Rate for Payer: WPS Commercial |
$3,533.37
|
|
|
SCREW COMPRESSION HEADLESS 6.5 X 70MM LONG THREAD AR-8665-2870
|
Facility
|
OP
|
$4,411.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5729736
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,284.48 |
| Max. Negotiated Rate |
$4,220.44 |
| Rate for Payer: Aetna Commercial |
$4,128.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,945.20
|
| Rate for Payer: Aetna Managed Medicare |
$1,284.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,981.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,293.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,201.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,431.34
|
| Rate for Payer: Cash Price |
$1,323.30
|
| Rate for Payer: Cigna Commercial |
$4,220.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,567.20
|
| Rate for Payer: Health EOS Commercial |
$4,082.82
|
| Rate for Payer: HFN Commercial |
$4,220.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,440.58
|
| Rate for Payer: Multiplan Commercial |
$3,669.95
|
| Rate for Payer: NAPHCARE Commercial |
$2,752.46
|
| Rate for Payer: Preferred Network Access Commercial |
$4,220.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,247.85
|
| Rate for Payer: Quartz Commercial |
$2,981.84
|
| Rate for Payer: Quartz Medicare Advantage |
$2,752.46
|
| Rate for Payer: The Alliance Commercial |
$2,293.72
|
| Rate for Payer: WEA Trust Commercial |
$2,523.09
|
| Rate for Payer: WPS Commercial |
$3,397.79
|
|
|
SCREW COMPRESSION HEADLESS 6.5 X 70MM LONG THREAD AR-8665-2870
|
Facility
|
IP
|
$4,411.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5729736
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,247.85 |
| Max. Negotiated Rate |
$4,220.44 |
| Rate for Payer: Aetna Commercial |
$4,128.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,945.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,431.34
|
| Rate for Payer: Cash Price |
$1,323.30
|
| Rate for Payer: Cigna Commercial |
$4,220.44
|
| Rate for Payer: Health EOS Commercial |
$4,082.82
|
| Rate for Payer: HFN Commercial |
$4,220.44
|
| Rate for Payer: Multiplan Commercial |
$3,669.95
|
| Rate for Payer: Preferred Network Access Commercial |
$4,220.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,247.85
|
| Rate for Payer: Quartz Commercial |
$2,752.46
|
| Rate for Payer: WEA Trust Commercial |
$2,523.09
|
| Rate for Payer: WPS Commercial |
$3,397.79
|
|
|
SCREW COMPRESSION HEADLESS 6.5 X 70MM PT AR-8665-1870
|
Facility
|
IP
|
$4,587.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5591391
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,337.54 |
| Max. Negotiated Rate |
$4,388.84 |
| Rate for Payer: Aetna Commercial |
$4,293.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,102.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,528.35
|
| Rate for Payer: Cash Price |
$1,376.10
|
| Rate for Payer: Cigna Commercial |
$4,388.84
|
| Rate for Payer: Health EOS Commercial |
$4,245.73
|
| Rate for Payer: HFN Commercial |
$4,388.84
|
| Rate for Payer: Multiplan Commercial |
$3,816.38
|
| Rate for Payer: Preferred Network Access Commercial |
$4,388.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,337.54
|
| Rate for Payer: Quartz Commercial |
$2,862.29
|
| Rate for Payer: WEA Trust Commercial |
$2,623.76
|
| Rate for Payer: WPS Commercial |
$3,533.37
|
|
|
SCREW COMPRESSION HEADLESS 6.5 X 70MM PT AR-8665-1870
|
Facility
|
OP
|
$4,587.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5591391
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,335.73 |
| Max. Negotiated Rate |
$4,388.84 |
| Rate for Payer: Aetna Commercial |
$4,293.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,102.61
|
| Rate for Payer: Aetna Managed Medicare |
$1,335.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,100.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,385.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,289.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,528.35
|
| Rate for Payer: Cash Price |
$1,376.10
|
| Rate for Payer: Cigna Commercial |
$4,388.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,669.63
|
| Rate for Payer: Health EOS Commercial |
$4,245.73
|
| Rate for Payer: HFN Commercial |
$4,388.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,577.86
|
| Rate for Payer: Multiplan Commercial |
$3,816.38
|
| Rate for Payer: NAPHCARE Commercial |
$2,862.29
|
| Rate for Payer: Preferred Network Access Commercial |
$4,388.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,337.54
|
| Rate for Payer: Quartz Commercial |
$3,100.81
|
| Rate for Payer: Quartz Medicare Advantage |
$2,862.29
|
| Rate for Payer: The Alliance Commercial |
$2,385.24
|
| Rate for Payer: WEA Trust Commercial |
$2,623.76
|
| Rate for Payer: WPS Commercial |
$3,533.37
|
|
|
SCREW COMPRESSION HEADLESS 6.5 X 75MM LONG THREAD AR-8665-2875
|
Facility
|
IP
|
$4,411.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5729737
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,247.85 |
| Max. Negotiated Rate |
$4,220.44 |
| Rate for Payer: Aetna Commercial |
$4,128.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,945.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,431.34
|
| Rate for Payer: Cash Price |
$1,323.30
|
| Rate for Payer: Cigna Commercial |
$4,220.44
|
| Rate for Payer: Health EOS Commercial |
$4,082.82
|
| Rate for Payer: HFN Commercial |
$4,220.44
|
| Rate for Payer: Multiplan Commercial |
$3,669.95
|
| Rate for Payer: Preferred Network Access Commercial |
$4,220.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,247.85
|
| Rate for Payer: Quartz Commercial |
$2,752.46
|
| Rate for Payer: WEA Trust Commercial |
$2,523.09
|
| Rate for Payer: WPS Commercial |
$3,397.79
|
|
|
SCREW COMPRESSION HEADLESS 6.5 X 75MM LONG THREAD AR-8665-2875
|
Facility
|
OP
|
$4,411.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5729737
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,284.48 |
| Max. Negotiated Rate |
$4,220.44 |
| Rate for Payer: Aetna Commercial |
$4,128.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,945.20
|
| Rate for Payer: Aetna Managed Medicare |
$1,284.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,981.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,293.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,201.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,431.34
|
| Rate for Payer: Cash Price |
$1,323.30
|
| Rate for Payer: Cigna Commercial |
$4,220.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,567.20
|
| Rate for Payer: Health EOS Commercial |
$4,082.82
|
| Rate for Payer: HFN Commercial |
$4,220.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,440.58
|
| Rate for Payer: Multiplan Commercial |
$3,669.95
|
| Rate for Payer: NAPHCARE Commercial |
$2,752.46
|
| Rate for Payer: Preferred Network Access Commercial |
$4,220.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,247.85
|
| Rate for Payer: Quartz Commercial |
$2,981.84
|
| Rate for Payer: Quartz Medicare Advantage |
$2,752.46
|
| Rate for Payer: The Alliance Commercial |
$2,293.72
|
| Rate for Payer: WEA Trust Commercial |
$2,523.09
|
| Rate for Payer: WPS Commercial |
$3,397.79
|
|
|
SCREW COMPRESSION HEADLESS 6.5 X 75MM PT AR-8665-1875
|
Facility
|
OP
|
$4,587.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5603632
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,335.73 |
| Max. Negotiated Rate |
$4,388.84 |
| Rate for Payer: Aetna Commercial |
$4,293.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,102.61
|
| Rate for Payer: Aetna Managed Medicare |
$1,335.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,100.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,385.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,289.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,528.35
|
| Rate for Payer: Cash Price |
$1,376.10
|
| Rate for Payer: Cigna Commercial |
$4,388.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,669.63
|
| Rate for Payer: Health EOS Commercial |
$4,245.73
|
| Rate for Payer: HFN Commercial |
$4,388.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,577.86
|
| Rate for Payer: Multiplan Commercial |
$3,816.38
|
| Rate for Payer: NAPHCARE Commercial |
$2,862.29
|
| Rate for Payer: Preferred Network Access Commercial |
$4,388.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,337.54
|
| Rate for Payer: Quartz Commercial |
$3,100.81
|
| Rate for Payer: Quartz Medicare Advantage |
$2,862.29
|
| Rate for Payer: The Alliance Commercial |
$2,385.24
|
| Rate for Payer: WEA Trust Commercial |
$2,623.76
|
| Rate for Payer: WPS Commercial |
$3,533.37
|
|
|
SCREW COMPRESSION HEADLESS 6.5 X 75MM PT AR-8665-1875
|
Facility
|
IP
|
$4,587.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5603632
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,337.54 |
| Max. Negotiated Rate |
$4,388.84 |
| Rate for Payer: Aetna Commercial |
$4,293.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,102.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,528.35
|
| Rate for Payer: Cash Price |
$1,376.10
|
| Rate for Payer: Cigna Commercial |
$4,388.84
|
| Rate for Payer: Health EOS Commercial |
$4,245.73
|
| Rate for Payer: HFN Commercial |
$4,388.84
|
| Rate for Payer: Multiplan Commercial |
$3,816.38
|
| Rate for Payer: Preferred Network Access Commercial |
$4,388.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,337.54
|
| Rate for Payer: Quartz Commercial |
$2,862.29
|
| Rate for Payer: WEA Trust Commercial |
$2,623.76
|
| Rate for Payer: WPS Commercial |
$3,533.37
|
|
|
SCREW COMPRESSION HEADLESS 6.5 X 80MM LONG THREAD AR-8665-2880
|
Facility
|
OP
|
$4,411.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5729738
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,284.48 |
| Max. Negotiated Rate |
$4,220.44 |
| Rate for Payer: Aetna Commercial |
$4,128.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,945.20
|
| Rate for Payer: Aetna Managed Medicare |
$1,284.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,981.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,293.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,201.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,431.34
|
| Rate for Payer: Cash Price |
$1,323.30
|
| Rate for Payer: Cigna Commercial |
$4,220.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,567.20
|
| Rate for Payer: Health EOS Commercial |
$4,082.82
|
| Rate for Payer: HFN Commercial |
$4,220.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,440.58
|
| Rate for Payer: Multiplan Commercial |
$3,669.95
|
| Rate for Payer: NAPHCARE Commercial |
$2,752.46
|
| Rate for Payer: Preferred Network Access Commercial |
$4,220.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,247.85
|
| Rate for Payer: Quartz Commercial |
$2,981.84
|
| Rate for Payer: Quartz Medicare Advantage |
$2,752.46
|
| Rate for Payer: The Alliance Commercial |
$2,293.72
|
| Rate for Payer: WEA Trust Commercial |
$2,523.09
|
| Rate for Payer: WPS Commercial |
$3,397.79
|
|
|
SCREW COMPRESSION HEADLESS 6.5 X 80MM LONG THREAD AR-8665-2880
|
Facility
|
IP
|
$4,411.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5729738
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,247.85 |
| Max. Negotiated Rate |
$4,220.44 |
| Rate for Payer: Aetna Commercial |
$4,128.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,945.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,431.34
|
| Rate for Payer: Cash Price |
$1,323.30
|
| Rate for Payer: Cigna Commercial |
$4,220.44
|
| Rate for Payer: Health EOS Commercial |
$4,082.82
|
| Rate for Payer: HFN Commercial |
$4,220.44
|
| Rate for Payer: Multiplan Commercial |
$3,669.95
|
| Rate for Payer: Preferred Network Access Commercial |
$4,220.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,247.85
|
| Rate for Payer: Quartz Commercial |
$2,752.46
|
| Rate for Payer: WEA Trust Commercial |
$2,523.09
|
| Rate for Payer: WPS Commercial |
$3,397.79
|
|
