|
SCREW HEADLESS 3.0 x 26 #AH3026
|
Facility
|
IP
|
$2,593.00
|
|
| Hospital Charge Code |
2964746
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,270.57 |
| Max. Negotiated Rate |
$2,385.56 |
| Rate for Payer: Aetna Commercial |
$2,333.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,229.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,374.29
|
| Rate for Payer: Cash Price |
$777.90
|
| Rate for Payer: Cigna Commercial |
$2,385.56
|
| Rate for Payer: Health EOS Commercial |
$2,307.77
|
| Rate for Payer: HFN Commercial |
$2,385.56
|
| Rate for Payer: Multiplan Commercial |
$2,074.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,555.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,385.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,270.57
|
| Rate for Payer: Quartz Commercial |
$1,555.80
|
| Rate for Payer: WEA Trust Commercial |
$1,426.15
|
| Rate for Payer: WPS Commercial |
$1,920.64
|
|
|
SCREW HEADLESS 3.0 x 26 #AH3026
|
Facility
|
OP
|
$2,593.00
|
|
| Hospital Charge Code |
2964746
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$726.04 |
| Max. Negotiated Rate |
$10,372.00 |
| Rate for Payer: Aetna Commercial |
$2,333.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,229.98
|
| Rate for Payer: Aetna Managed Medicare |
$726.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,685.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,296.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,244.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,374.29
|
| Rate for Payer: Cash Price |
$777.90
|
| Rate for Payer: Cigna Commercial |
$2,385.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,451.04
|
| Rate for Payer: Health EOS Commercial |
$2,307.77
|
| Rate for Payer: HFN Commercial |
$2,385.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,944.75
|
| Rate for Payer: Multiplan Commercial |
$2,074.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,555.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,385.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,270.57
|
| Rate for Payer: Quartz Commercial |
$1,685.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,555.80
|
| Rate for Payer: The Alliance Commercial |
$10,372.00
|
| Rate for Payer: WEA Trust Commercial |
$1,426.15
|
| Rate for Payer: WPS Commercial |
$1,920.64
|
|
|
SCREW HEADLESS 3.0 x 30
|
Facility
|
OP
|
$2,593.00
|
|
| Hospital Charge Code |
2964747
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$726.04 |
| Max. Negotiated Rate |
$10,372.00 |
| Rate for Payer: Aetna Commercial |
$2,333.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,229.98
|
| Rate for Payer: Aetna Managed Medicare |
$726.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,685.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,296.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,244.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,374.29
|
| Rate for Payer: Cash Price |
$777.90
|
| Rate for Payer: Cigna Commercial |
$2,385.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,451.04
|
| Rate for Payer: Health EOS Commercial |
$2,307.77
|
| Rate for Payer: HFN Commercial |
$2,385.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,944.75
|
| Rate for Payer: Multiplan Commercial |
$2,074.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,555.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,385.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,270.57
|
| Rate for Payer: Quartz Commercial |
$1,685.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,555.80
|
| Rate for Payer: The Alliance Commercial |
$10,372.00
|
| Rate for Payer: WEA Trust Commercial |
$1,426.15
|
| Rate for Payer: WPS Commercial |
$1,920.64
|
|
|
SCREW HEADLESS 3.0 x 30
|
Facility
|
IP
|
$2,593.00
|
|
| Hospital Charge Code |
2964747
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,270.57 |
| Max. Negotiated Rate |
$2,385.56 |
| Rate for Payer: Aetna Commercial |
$2,333.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,229.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,374.29
|
| Rate for Payer: Cash Price |
$777.90
|
| Rate for Payer: Cigna Commercial |
$2,385.56
|
| Rate for Payer: Health EOS Commercial |
$2,307.77
|
| Rate for Payer: HFN Commercial |
$2,385.56
|
| Rate for Payer: Multiplan Commercial |
$2,074.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,555.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,385.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,270.57
|
| Rate for Payer: Quartz Commercial |
$1,555.80
|
| Rate for Payer: WEA Trust Commercial |
$1,426.15
|
| Rate for Payer: WPS Commercial |
$1,920.64
|
|
|
SCREW HEADLESS CANN 2.0 X 24 202-20-024
|
Facility
|
OP
|
$2,902.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6175006
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$812.56 |
| Max. Negotiated Rate |
$11,608.00 |
| Rate for Payer: Aetna Commercial |
$2,611.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,495.72
|
| Rate for Payer: Aetna Managed Medicare |
$812.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,886.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,451.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,392.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,538.06
|
| Rate for Payer: Cash Price |
$870.60
|
| Rate for Payer: Cigna Commercial |
$2,669.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,623.96
|
| Rate for Payer: Health EOS Commercial |
$2,582.78
|
| Rate for Payer: HFN Commercial |
$2,669.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,176.50
|
| Rate for Payer: Multiplan Commercial |
$2,321.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,741.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,669.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,421.98
|
| Rate for Payer: Quartz Commercial |
$1,886.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,741.20
|
| Rate for Payer: The Alliance Commercial |
$11,608.00
|
| Rate for Payer: WEA Trust Commercial |
$1,596.10
|
| Rate for Payer: WPS Commercial |
$2,149.51
|
|
|
SCREW HEADLESS CANN 2.0 X 24 202-20-024
|
Facility
|
IP
|
$2,902.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6175006
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,421.98 |
| Max. Negotiated Rate |
$2,669.84 |
| Rate for Payer: Aetna Commercial |
$2,611.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,495.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,538.06
|
| Rate for Payer: Cash Price |
$870.60
|
| Rate for Payer: Cigna Commercial |
$2,669.84
|
| Rate for Payer: Health EOS Commercial |
$2,582.78
|
| Rate for Payer: HFN Commercial |
$2,669.84
|
| Rate for Payer: Multiplan Commercial |
$2,321.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,741.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,669.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,421.98
|
| Rate for Payer: Quartz Commercial |
$1,741.20
|
| Rate for Payer: WEA Trust Commercial |
$1,596.10
|
| Rate for Payer: WPS Commercial |
$2,149.51
|
|
|
SCREW HEADLESS COMPRESSION 4.0MM X 32MM TI 658032
|
Facility
|
IP
|
$4,236.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5729730
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,075.64 |
| Max. Negotiated Rate |
$3,897.12 |
| Rate for Payer: Aetna Commercial |
$3,812.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,642.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,245.08
|
| Rate for Payer: Cash Price |
$1,270.80
|
| Rate for Payer: Cigna Commercial |
$3,897.12
|
| Rate for Payer: Health EOS Commercial |
$3,770.04
|
| Rate for Payer: HFN Commercial |
$3,897.12
|
| Rate for Payer: Multiplan Commercial |
$3,388.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,541.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,897.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,075.64
|
| Rate for Payer: Quartz Commercial |
$2,541.60
|
| Rate for Payer: WEA Trust Commercial |
$2,329.80
|
| Rate for Payer: WPS Commercial |
$3,137.61
|
|
|
SCREW HEADLESS COMPRESSION 4.0MM X 32MM TI 658032
|
Facility
|
OP
|
$4,236.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5729730
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,186.08 |
| Max. Negotiated Rate |
$16,944.00 |
| Rate for Payer: Aetna Commercial |
$3,812.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,642.96
|
| Rate for Payer: Aetna Managed Medicare |
$1,186.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,753.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,118.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,033.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,245.08
|
| Rate for Payer: Cash Price |
$1,270.80
|
| Rate for Payer: Cigna Commercial |
$3,897.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,370.47
|
| Rate for Payer: Health EOS Commercial |
$3,770.04
|
| Rate for Payer: HFN Commercial |
$3,897.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,177.00
|
| Rate for Payer: Multiplan Commercial |
$3,388.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,541.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,897.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,075.64
|
| Rate for Payer: Quartz Commercial |
$2,753.40
|
| Rate for Payer: Quartz Medicare Advantage |
$2,541.60
|
| Rate for Payer: The Alliance Commercial |
$16,944.00
|
| Rate for Payer: WEA Trust Commercial |
$2,329.80
|
| Rate for Payer: WPS Commercial |
$3,137.61
|
|
|
SCREW HEADLESS COMPRESSION 4.0MM X 42MM TI 658042
|
Facility
|
IP
|
$2,408.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6201048
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,179.92 |
| Max. Negotiated Rate |
$2,215.36 |
| Rate for Payer: Aetna Commercial |
$2,167.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,070.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,276.24
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cigna Commercial |
$2,215.36
|
| Rate for Payer: Health EOS Commercial |
$2,143.12
|
| Rate for Payer: HFN Commercial |
$2,215.36
|
| Rate for Payer: Multiplan Commercial |
$1,926.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,444.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,215.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,179.92
|
| Rate for Payer: Quartz Commercial |
$1,444.80
|
| Rate for Payer: WEA Trust Commercial |
$1,324.40
|
| Rate for Payer: WPS Commercial |
$1,783.61
|
|
|
SCREW HEADLESS COMPRESSION 4.0MM X 42MM TI 658042
|
Facility
|
OP
|
$2,408.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6201048
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$674.24 |
| Max. Negotiated Rate |
$9,632.00 |
| Rate for Payer: Aetna Commercial |
$2,167.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,070.88
|
| Rate for Payer: Aetna Managed Medicare |
$674.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,565.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,204.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,155.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,276.24
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cigna Commercial |
$2,215.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,347.52
|
| Rate for Payer: Health EOS Commercial |
$2,143.12
|
| Rate for Payer: HFN Commercial |
$2,215.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,806.00
|
| Rate for Payer: Multiplan Commercial |
$1,926.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,444.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,215.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,179.92
|
| Rate for Payer: Quartz Commercial |
$1,565.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,444.80
|
| Rate for Payer: The Alliance Commercial |
$9,632.00
|
| Rate for Payer: WEA Trust Commercial |
$1,324.40
|
| Rate for Payer: WPS Commercial |
$1,783.61
|
|
|
SCREW HEADLESS COMPRESSION 4.0MM X 44MM TI 658044
|
Facility
|
IP
|
$4,236.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5861720
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,075.64 |
| Max. Negotiated Rate |
$3,897.12 |
| Rate for Payer: Aetna Commercial |
$3,812.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,642.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,245.08
|
| Rate for Payer: Cash Price |
$1,270.80
|
| Rate for Payer: Cigna Commercial |
$3,897.12
|
| Rate for Payer: Health EOS Commercial |
$3,770.04
|
| Rate for Payer: HFN Commercial |
$3,897.12
|
| Rate for Payer: Multiplan Commercial |
$3,388.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,541.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,897.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,075.64
|
| Rate for Payer: Quartz Commercial |
$2,541.60
|
| Rate for Payer: WEA Trust Commercial |
$2,329.80
|
| Rate for Payer: WPS Commercial |
$3,137.61
|
|
|
SCREW HEADLESS COMPRESSION 4.0MM X 44MM TI 658044
|
Facility
|
OP
|
$4,236.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5861720
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,186.08 |
| Max. Negotiated Rate |
$16,944.00 |
| Rate for Payer: Aetna Commercial |
$3,812.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,642.96
|
| Rate for Payer: Aetna Managed Medicare |
$1,186.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,753.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,118.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,033.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,245.08
|
| Rate for Payer: Cash Price |
$1,270.80
|
| Rate for Payer: Cigna Commercial |
$3,897.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,370.47
|
| Rate for Payer: Health EOS Commercial |
$3,770.04
|
| Rate for Payer: HFN Commercial |
$3,897.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,177.00
|
| Rate for Payer: Multiplan Commercial |
$3,388.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,541.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,897.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,075.64
|
| Rate for Payer: Quartz Commercial |
$2,753.40
|
| Rate for Payer: Quartz Medicare Advantage |
$2,541.60
|
| Rate for Payer: The Alliance Commercial |
$16,944.00
|
| Rate for Payer: WEA Trust Commercial |
$2,329.80
|
| Rate for Payer: WPS Commercial |
$3,137.61
|
|
|
SCREW HEADLESS COMPRESSION 4.0MM X 60MM TI 658060
|
Facility
|
IP
|
$4,236.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5861721
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,075.64 |
| Max. Negotiated Rate |
$3,897.12 |
| Rate for Payer: Aetna Commercial |
$3,812.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,642.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,245.08
|
| Rate for Payer: Cash Price |
$1,270.80
|
| Rate for Payer: Cigna Commercial |
$3,897.12
|
| Rate for Payer: Health EOS Commercial |
$3,770.04
|
| Rate for Payer: HFN Commercial |
$3,897.12
|
| Rate for Payer: Multiplan Commercial |
$3,388.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,541.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,897.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,075.64
|
| Rate for Payer: Quartz Commercial |
$2,541.60
|
| Rate for Payer: WEA Trust Commercial |
$2,329.80
|
| Rate for Payer: WPS Commercial |
$3,137.61
|
|
|
SCREW HEADLESS COMPRESSION 4.0MM X 60MM TI 658060
|
Facility
|
OP
|
$4,236.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5861721
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,186.08 |
| Max. Negotiated Rate |
$16,944.00 |
| Rate for Payer: Aetna Commercial |
$3,812.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,642.96
|
| Rate for Payer: Aetna Managed Medicare |
$1,186.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,753.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,118.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,033.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,245.08
|
| Rate for Payer: Cash Price |
$1,270.80
|
| Rate for Payer: Cigna Commercial |
$3,897.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,370.47
|
| Rate for Payer: Health EOS Commercial |
$3,770.04
|
| Rate for Payer: HFN Commercial |
$3,897.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,177.00
|
| Rate for Payer: Multiplan Commercial |
$3,388.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,541.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,897.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,075.64
|
| Rate for Payer: Quartz Commercial |
$2,753.40
|
| Rate for Payer: Quartz Medicare Advantage |
$2,541.60
|
| Rate for Payer: The Alliance Commercial |
$16,944.00
|
| Rate for Payer: WEA Trust Commercial |
$2,329.80
|
| Rate for Payer: WPS Commercial |
$3,137.61
|
|
|
SCREW HEADLESS COMPRESSION 5.0 X 44MM TI 658144
|
Facility
|
OP
|
$2,673.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6049654
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$748.44 |
| Max. Negotiated Rate |
$10,692.00 |
| Rate for Payer: Aetna Commercial |
$2,405.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,298.78
|
| Rate for Payer: Aetna Managed Medicare |
$748.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,737.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,336.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,283.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,416.69
|
| Rate for Payer: Cash Price |
$801.90
|
| Rate for Payer: Cigna Commercial |
$2,459.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,495.81
|
| Rate for Payer: Health EOS Commercial |
$2,378.97
|
| Rate for Payer: HFN Commercial |
$2,459.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,004.75
|
| Rate for Payer: Multiplan Commercial |
$2,138.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,603.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,459.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,309.77
|
| Rate for Payer: Quartz Commercial |
$1,737.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,603.80
|
| Rate for Payer: The Alliance Commercial |
$10,692.00
|
| Rate for Payer: WEA Trust Commercial |
$1,470.15
|
| Rate for Payer: WPS Commercial |
$1,979.89
|
|
|
SCREW HEADLESS COMPRESSION 5.0 X 44MM TI 658144
|
Facility
|
IP
|
$2,673.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6049654
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,309.77 |
| Max. Negotiated Rate |
$2,459.16 |
| Rate for Payer: Aetna Commercial |
$2,405.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,298.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,416.69
|
| Rate for Payer: Cash Price |
$801.90
|
| Rate for Payer: Cigna Commercial |
$2,459.16
|
| Rate for Payer: Health EOS Commercial |
$2,378.97
|
| Rate for Payer: HFN Commercial |
$2,459.16
|
| Rate for Payer: Multiplan Commercial |
$2,138.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,603.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,459.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,309.77
|
| Rate for Payer: Quartz Commercial |
$1,603.80
|
| Rate for Payer: WEA Trust Commercial |
$1,470.15
|
| Rate for Payer: WPS Commercial |
$1,979.89
|
|
|
SCREW HEADLESS COMPRESSION 5.0 X 48MM TI 658148
|
Facility
|
IP
|
$4,435.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5611678
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,173.15 |
| Max. Negotiated Rate |
$4,080.20 |
| Rate for Payer: Aetna Commercial |
$3,991.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,814.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,350.55
|
| Rate for Payer: Cash Price |
$1,330.50
|
| Rate for Payer: Cigna Commercial |
$4,080.20
|
| Rate for Payer: Health EOS Commercial |
$3,947.15
|
| Rate for Payer: HFN Commercial |
$4,080.20
|
| Rate for Payer: Multiplan Commercial |
$3,548.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,661.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,080.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,173.15
|
| Rate for Payer: Quartz Commercial |
$2,661.00
|
| Rate for Payer: WEA Trust Commercial |
$2,439.25
|
| Rate for Payer: WPS Commercial |
$3,285.00
|
|
|
SCREW HEADLESS COMPRESSION 5.0 X 48MM TI 658148
|
Facility
|
OP
|
$4,435.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5611678
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,241.80 |
| Max. Negotiated Rate |
$17,740.00 |
| Rate for Payer: Aetna Commercial |
$3,991.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,814.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,241.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,882.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,217.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,128.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,350.55
|
| Rate for Payer: Cash Price |
$1,330.50
|
| Rate for Payer: Cigna Commercial |
$4,080.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,481.83
|
| Rate for Payer: Health EOS Commercial |
$3,947.15
|
| Rate for Payer: HFN Commercial |
$4,080.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,326.25
|
| Rate for Payer: Multiplan Commercial |
$3,548.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,661.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,080.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,173.15
|
| Rate for Payer: Quartz Commercial |
$2,882.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,661.00
|
| Rate for Payer: The Alliance Commercial |
$17,740.00
|
| Rate for Payer: WEA Trust Commercial |
$2,439.25
|
| Rate for Payer: WPS Commercial |
$3,285.00
|
|
|
SCREW HEADLESS COMPRESSION 5.0 X 60MM TI 658160
|
Facility
|
OP
|
$2,521.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6199064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$705.88 |
| Max. Negotiated Rate |
$10,084.00 |
| Rate for Payer: Aetna Commercial |
$2,268.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,168.06
|
| Rate for Payer: Aetna Managed Medicare |
$705.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,638.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,260.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,210.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,336.13
|
| Rate for Payer: Cash Price |
$756.30
|
| Rate for Payer: Cigna Commercial |
$2,319.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,410.75
|
| Rate for Payer: Health EOS Commercial |
$2,243.69
|
| Rate for Payer: HFN Commercial |
$2,319.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,890.75
|
| Rate for Payer: Multiplan Commercial |
$2,016.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,512.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,319.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,235.29
|
| Rate for Payer: Quartz Commercial |
$1,638.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,512.60
|
| Rate for Payer: The Alliance Commercial |
$10,084.00
|
| Rate for Payer: WEA Trust Commercial |
$1,386.55
|
| Rate for Payer: WPS Commercial |
$1,867.30
|
|
|
SCREW HEADLESS COMPRESSION 5.0 X 60MM TI 658160
|
Facility
|
IP
|
$2,521.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6199064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,235.29 |
| Max. Negotiated Rate |
$2,319.32 |
| Rate for Payer: Aetna Commercial |
$2,268.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,168.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,336.13
|
| Rate for Payer: Cash Price |
$756.30
|
| Rate for Payer: Cigna Commercial |
$2,319.32
|
| Rate for Payer: Health EOS Commercial |
$2,243.69
|
| Rate for Payer: HFN Commercial |
$2,319.32
|
| Rate for Payer: Multiplan Commercial |
$2,016.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,512.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,319.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,235.29
|
| Rate for Payer: Quartz Commercial |
$1,512.60
|
| Rate for Payer: WEA Trust Commercial |
$1,386.55
|
| Rate for Payer: WPS Commercial |
$1,867.30
|
|
|
SCREW HEADLESS COMPRESSION 5.0 X 65MM TI 658165
|
Facility
|
IP
|
$4,435.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5611679
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,173.15 |
| Max. Negotiated Rate |
$4,080.20 |
| Rate for Payer: Aetna Commercial |
$3,991.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,814.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,350.55
|
| Rate for Payer: Cash Price |
$1,330.50
|
| Rate for Payer: Cigna Commercial |
$4,080.20
|
| Rate for Payer: Health EOS Commercial |
$3,947.15
|
| Rate for Payer: HFN Commercial |
$4,080.20
|
| Rate for Payer: Multiplan Commercial |
$3,548.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,661.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,080.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,173.15
|
| Rate for Payer: Quartz Commercial |
$2,661.00
|
| Rate for Payer: WEA Trust Commercial |
$2,439.25
|
| Rate for Payer: WPS Commercial |
$3,285.00
|
|
|
SCREW HEADLESS COMPRESSION 5.0 X 65MM TI 658165
|
Facility
|
OP
|
$4,435.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5611679
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,241.80 |
| Max. Negotiated Rate |
$17,740.00 |
| Rate for Payer: Aetna Commercial |
$3,991.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,814.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,241.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,882.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,217.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,128.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,350.55
|
| Rate for Payer: Cash Price |
$1,330.50
|
| Rate for Payer: Cigna Commercial |
$4,080.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,481.83
|
| Rate for Payer: Health EOS Commercial |
$3,947.15
|
| Rate for Payer: HFN Commercial |
$4,080.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,326.25
|
| Rate for Payer: Multiplan Commercial |
$3,548.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,661.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,080.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,173.15
|
| Rate for Payer: Quartz Commercial |
$2,882.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,661.00
|
| Rate for Payer: The Alliance Commercial |
$17,740.00
|
| Rate for Payer: WEA Trust Commercial |
$2,439.25
|
| Rate for Payer: WPS Commercial |
$3,285.00
|
|
|
SCREW HEADLESS COMPRESSION 5.0 X 75MM TI 658175
|
Facility
|
IP
|
$2,965.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6049655
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,452.85 |
| Max. Negotiated Rate |
$2,727.80 |
| Rate for Payer: Aetna Commercial |
$2,668.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,549.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,571.45
|
| Rate for Payer: Cash Price |
$889.50
|
| Rate for Payer: Cigna Commercial |
$2,727.80
|
| Rate for Payer: Health EOS Commercial |
$2,638.85
|
| Rate for Payer: HFN Commercial |
$2,727.80
|
| Rate for Payer: Multiplan Commercial |
$2,372.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,779.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,727.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,452.85
|
| Rate for Payer: Quartz Commercial |
$1,779.00
|
| Rate for Payer: WEA Trust Commercial |
$1,630.75
|
| Rate for Payer: WPS Commercial |
$2,196.18
|
|
|
SCREW HEADLESS COMPRESSION 5.0 X 75MM TI 658175
|
Facility
|
OP
|
$2,965.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6049655
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$830.20 |
| Max. Negotiated Rate |
$11,860.00 |
| Rate for Payer: Aetna Commercial |
$2,668.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,549.90
|
| Rate for Payer: Aetna Managed Medicare |
$830.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,927.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,482.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,423.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,571.45
|
| Rate for Payer: Cash Price |
$889.50
|
| Rate for Payer: Cigna Commercial |
$2,727.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,659.21
|
| Rate for Payer: Health EOS Commercial |
$2,638.85
|
| Rate for Payer: HFN Commercial |
$2,727.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,223.75
|
| Rate for Payer: Multiplan Commercial |
$2,372.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,779.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,727.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,452.85
|
| Rate for Payer: Quartz Commercial |
$1,927.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,779.00
|
| Rate for Payer: The Alliance Commercial |
$11,860.00
|
| Rate for Payer: WEA Trust Commercial |
$1,630.75
|
| Rate for Payer: WPS Commercial |
$2,196.18
|
|
|
SCREW HEADLESS COMPRESSION 7.0 X 110MM LONG THREAD TI 658610
|
Facility
|
IP
|
$5,315.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685879
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,604.35 |
| Max. Negotiated Rate |
$4,889.80 |
| Rate for Payer: Aetna Commercial |
$4,783.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,570.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,816.95
|
| Rate for Payer: Cash Price |
$1,594.50
|
| Rate for Payer: Cigna Commercial |
$4,889.80
|
| Rate for Payer: Health EOS Commercial |
$4,730.35
|
| Rate for Payer: HFN Commercial |
$4,889.80
|
| Rate for Payer: Multiplan Commercial |
$4,252.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,189.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,889.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,604.35
|
| Rate for Payer: Quartz Commercial |
$3,189.00
|
| Rate for Payer: WEA Trust Commercial |
$2,923.25
|
| Rate for Payer: WPS Commercial |
$3,936.82
|
|
