|
SCREW HEADLESS COMPRESSION 7.0 X 110MM LONG THREAD TI 658610
|
Facility
|
OP
|
$5,315.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685879
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,488.20 |
| Max. Negotiated Rate |
$21,260.00 |
| Rate for Payer: Aetna Commercial |
$4,783.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,570.90
|
| Rate for Payer: Aetna Managed Medicare |
$1,488.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,454.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,657.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,551.20
|
| 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: Dean Health DHI/DHP/ASO |
$2,974.27
|
| Rate for Payer: Health EOS Commercial |
$4,730.35
|
| Rate for Payer: HFN Commercial |
$4,889.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,986.25
|
| 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 |
$3,454.75
|
| Rate for Payer: Quartz Medicare Advantage |
$3,189.00
|
| Rate for Payer: The Alliance Commercial |
$21,260.00
|
| Rate for Payer: WEA Trust Commercial |
$2,923.25
|
| Rate for Payer: WPS Commercial |
$3,936.82
|
|
|
SCREW HEADLESS COMPRESSION 7.0 X 115MM LONG THREAD TI 658615
|
Facility
|
IP
|
$5,315.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685880
|
|
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
|
|
|
SCREW HEADLESS COMPRESSION 7.0 X 115MM LONG THREAD TI 658615
|
Facility
|
OP
|
$5,315.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685880
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,488.20 |
| Max. Negotiated Rate |
$21,260.00 |
| Rate for Payer: Aetna Commercial |
$4,783.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,570.90
|
| Rate for Payer: Aetna Managed Medicare |
$1,488.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,454.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,657.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,551.20
|
| 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: Dean Health DHI/DHP/ASO |
$2,974.27
|
| Rate for Payer: Health EOS Commercial |
$4,730.35
|
| Rate for Payer: HFN Commercial |
$4,889.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,986.25
|
| 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 |
$3,454.75
|
| Rate for Payer: Quartz Medicare Advantage |
$3,189.00
|
| Rate for Payer: The Alliance Commercial |
$21,260.00
|
| Rate for Payer: WEA Trust Commercial |
$2,923.25
|
| Rate for Payer: WPS Commercial |
$3,936.82
|
|
|
SCREW HEADLESS COMPRESSION 7.0 X 125MM LONG THREAD TI 658625
|
Facility
|
IP
|
$4,107.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6178086
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,012.43 |
| Max. Negotiated Rate |
$3,778.44 |
| Rate for Payer: Aetna Commercial |
$3,696.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,532.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,176.71
|
| Rate for Payer: Cash Price |
$1,232.10
|
| Rate for Payer: Cigna Commercial |
$3,778.44
|
| Rate for Payer: Health EOS Commercial |
$3,655.23
|
| Rate for Payer: HFN Commercial |
$3,778.44
|
| Rate for Payer: Multiplan Commercial |
$3,285.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,464.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,778.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,012.43
|
| Rate for Payer: Quartz Commercial |
$2,464.20
|
| Rate for Payer: WEA Trust Commercial |
$2,258.85
|
| Rate for Payer: WPS Commercial |
$3,042.05
|
|
|
SCREW HEADLESS COMPRESSION 7.0 X 125MM LONG THREAD TI 658625
|
Facility
|
OP
|
$4,107.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6178086
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,149.96 |
| Max. Negotiated Rate |
$16,428.00 |
| Rate for Payer: Aetna Commercial |
$3,696.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,532.02
|
| Rate for Payer: Aetna Managed Medicare |
$1,149.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,669.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,053.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,971.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,176.71
|
| Rate for Payer: Cash Price |
$1,232.10
|
| Rate for Payer: Cigna Commercial |
$3,778.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,298.28
|
| Rate for Payer: Health EOS Commercial |
$3,655.23
|
| Rate for Payer: HFN Commercial |
$3,778.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,080.25
|
| Rate for Payer: Multiplan Commercial |
$3,285.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,464.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,778.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,012.43
|
| Rate for Payer: Quartz Commercial |
$2,669.55
|
| Rate for Payer: Quartz Medicare Advantage |
$2,464.20
|
| Rate for Payer: The Alliance Commercial |
$16,428.00
|
| Rate for Payer: WEA Trust Commercial |
$2,258.85
|
| Rate for Payer: WPS Commercial |
$3,042.05
|
|
|
SCREW HEADLESS COMPRESSION 7.0 X 40MM SHORT THREAD TI 658340
|
Facility
|
OP
|
$5,315.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5787778
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,488.20 |
| Max. Negotiated Rate |
$21,260.00 |
| Rate for Payer: Aetna Commercial |
$4,783.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,570.90
|
| Rate for Payer: Aetna Managed Medicare |
$1,488.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,454.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,657.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,551.20
|
| 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: Dean Health DHI/DHP/ASO |
$2,974.27
|
| Rate for Payer: Health EOS Commercial |
$4,730.35
|
| Rate for Payer: HFN Commercial |
$4,889.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,986.25
|
| 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 |
$3,454.75
|
| Rate for Payer: Quartz Medicare Advantage |
$3,189.00
|
| Rate for Payer: The Alliance Commercial |
$21,260.00
|
| Rate for Payer: WEA Trust Commercial |
$2,923.25
|
| Rate for Payer: WPS Commercial |
$3,936.82
|
|
|
SCREW HEADLESS COMPRESSION 7.0 X 40MM SHORT THREAD TI 658340
|
Facility
|
IP
|
$5,315.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5787778
|
|
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
|
|
|
SCREW HEADLESS COMPRESSION 7.0 X 45MM SHORT THREAD TI 658345
|
Facility
|
OP
|
$5,315.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5787779
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,488.20 |
| Max. Negotiated Rate |
$21,260.00 |
| Rate for Payer: Aetna Commercial |
$4,783.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,570.90
|
| Rate for Payer: Aetna Managed Medicare |
$1,488.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,454.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,657.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,551.20
|
| 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: Dean Health DHI/DHP/ASO |
$2,974.27
|
| Rate for Payer: Health EOS Commercial |
$4,730.35
|
| Rate for Payer: HFN Commercial |
$4,889.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,986.25
|
| 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 |
$3,454.75
|
| Rate for Payer: Quartz Medicare Advantage |
$3,189.00
|
| Rate for Payer: The Alliance Commercial |
$21,260.00
|
| Rate for Payer: WEA Trust Commercial |
$2,923.25
|
| Rate for Payer: WPS Commercial |
$3,936.82
|
|
|
SCREW HEADLESS COMPRESSION 7.0 X 45MM SHORT THREAD TI 658345
|
Facility
|
IP
|
$5,315.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5787779
|
|
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
|
|
|
SCREW HEADLESS COMPRESSION 7.0 X 55MM SHORT THREAD TI 658355
|
Facility
|
IP
|
$4,107.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6204975
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,012.43 |
| Max. Negotiated Rate |
$3,778.44 |
| Rate for Payer: Aetna Commercial |
$3,696.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,532.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,176.71
|
| Rate for Payer: Cash Price |
$1,232.10
|
| Rate for Payer: Cigna Commercial |
$3,778.44
|
| Rate for Payer: Health EOS Commercial |
$3,655.23
|
| Rate for Payer: HFN Commercial |
$3,778.44
|
| Rate for Payer: Multiplan Commercial |
$3,285.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,464.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,778.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,012.43
|
| Rate for Payer: Quartz Commercial |
$2,464.20
|
| Rate for Payer: WEA Trust Commercial |
$2,258.85
|
| Rate for Payer: WPS Commercial |
$3,042.05
|
|
|
SCREW HEADLESS COMPRESSION 7.0 X 55MM SHORT THREAD TI 658355
|
Facility
|
OP
|
$4,107.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6204975
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,149.96 |
| Max. Negotiated Rate |
$16,428.00 |
| Rate for Payer: Aetna Commercial |
$3,696.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,532.02
|
| Rate for Payer: Aetna Managed Medicare |
$1,149.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,669.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,053.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,971.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,176.71
|
| Rate for Payer: Cash Price |
$1,232.10
|
| Rate for Payer: Cigna Commercial |
$3,778.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,298.28
|
| Rate for Payer: Health EOS Commercial |
$3,655.23
|
| Rate for Payer: HFN Commercial |
$3,778.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,080.25
|
| Rate for Payer: Multiplan Commercial |
$3,285.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,464.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,778.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,012.43
|
| Rate for Payer: Quartz Commercial |
$2,669.55
|
| Rate for Payer: Quartz Medicare Advantage |
$2,464.20
|
| Rate for Payer: The Alliance Commercial |
$16,428.00
|
| Rate for Payer: WEA Trust Commercial |
$2,258.85
|
| Rate for Payer: WPS Commercial |
$3,042.05
|
|
|
SCREW HEADLESS COMPRESSION 7.0 X 60MM SHORT THREAD TI 658360
|
Facility
|
OP
|
$4,107.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5641641
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,149.96 |
| Max. Negotiated Rate |
$16,428.00 |
| Rate for Payer: Aetna Commercial |
$3,696.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,532.02
|
| Rate for Payer: Aetna Managed Medicare |
$1,149.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,669.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,053.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,971.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,176.71
|
| Rate for Payer: Cash Price |
$1,232.10
|
| Rate for Payer: Cigna Commercial |
$3,778.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,298.28
|
| Rate for Payer: Health EOS Commercial |
$3,655.23
|
| Rate for Payer: HFN Commercial |
$3,778.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,080.25
|
| Rate for Payer: Multiplan Commercial |
$3,285.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,464.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,778.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,012.43
|
| Rate for Payer: Quartz Commercial |
$2,669.55
|
| Rate for Payer: Quartz Medicare Advantage |
$2,464.20
|
| Rate for Payer: The Alliance Commercial |
$16,428.00
|
| Rate for Payer: WEA Trust Commercial |
$2,258.85
|
| Rate for Payer: WPS Commercial |
$3,042.05
|
|
|
SCREW HEADLESS COMPRESSION 7.0 X 60MM SHORT THREAD TI 658360
|
Facility
|
IP
|
$4,107.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5641641
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,012.43 |
| Max. Negotiated Rate |
$3,778.44 |
| Rate for Payer: Aetna Commercial |
$3,696.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,532.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,176.71
|
| Rate for Payer: Cash Price |
$1,232.10
|
| Rate for Payer: Cigna Commercial |
$3,778.44
|
| Rate for Payer: Health EOS Commercial |
$3,655.23
|
| Rate for Payer: HFN Commercial |
$3,778.44
|
| Rate for Payer: Multiplan Commercial |
$3,285.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,464.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,778.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,012.43
|
| Rate for Payer: Quartz Commercial |
$2,464.20
|
| Rate for Payer: WEA Trust Commercial |
$2,258.85
|
| Rate for Payer: WPS Commercial |
$3,042.05
|
|
|
SCREW HEADLESS COMPRESSION 7.0 X 65MM LONG THREAD TI 658565
|
Facility
|
IP
|
$4,107.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6217042
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,012.43 |
| Max. Negotiated Rate |
$3,778.44 |
| Rate for Payer: Aetna Commercial |
$3,696.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,532.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,176.71
|
| Rate for Payer: Cash Price |
$1,232.10
|
| Rate for Payer: Cigna Commercial |
$3,778.44
|
| Rate for Payer: Health EOS Commercial |
$3,655.23
|
| Rate for Payer: HFN Commercial |
$3,778.44
|
| Rate for Payer: Multiplan Commercial |
$3,285.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,464.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,778.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,012.43
|
| Rate for Payer: Quartz Commercial |
$2,464.20
|
| Rate for Payer: WEA Trust Commercial |
$2,258.85
|
| Rate for Payer: WPS Commercial |
$3,042.05
|
|
|
SCREW HEADLESS COMPRESSION 7.0 X 65MM LONG THREAD TI 658565
|
Facility
|
OP
|
$4,107.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6217042
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,149.96 |
| Max. Negotiated Rate |
$16,428.00 |
| Rate for Payer: Aetna Commercial |
$3,696.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,532.02
|
| Rate for Payer: Aetna Managed Medicare |
$1,149.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,669.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,053.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,971.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,176.71
|
| Rate for Payer: Cash Price |
$1,232.10
|
| Rate for Payer: Cigna Commercial |
$3,778.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,298.28
|
| Rate for Payer: Health EOS Commercial |
$3,655.23
|
| Rate for Payer: HFN Commercial |
$3,778.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,080.25
|
| Rate for Payer: Multiplan Commercial |
$3,285.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,464.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,778.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,012.43
|
| Rate for Payer: Quartz Commercial |
$2,669.55
|
| Rate for Payer: Quartz Medicare Advantage |
$2,464.20
|
| Rate for Payer: The Alliance Commercial |
$16,428.00
|
| Rate for Payer: WEA Trust Commercial |
$2,258.85
|
| Rate for Payer: WPS Commercial |
$3,042.05
|
|
|
SCREW HEADLESS COMPRESSION 7.0 X 65MM SHORT THREAD TI 658365
|
Facility
|
IP
|
$5,315.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5861722
|
|
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
|
|
|
SCREW HEADLESS COMPRESSION 7.0 X 65MM SHORT THREAD TI 658365
|
Facility
|
OP
|
$5,315.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5861722
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,488.20 |
| Max. Negotiated Rate |
$21,260.00 |
| Rate for Payer: Aetna Commercial |
$4,783.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,570.90
|
| Rate for Payer: Aetna Managed Medicare |
$1,488.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,454.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,657.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,551.20
|
| 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: Dean Health DHI/DHP/ASO |
$2,974.27
|
| Rate for Payer: Health EOS Commercial |
$4,730.35
|
| Rate for Payer: HFN Commercial |
$4,889.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,986.25
|
| 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 |
$3,454.75
|
| Rate for Payer: Quartz Medicare Advantage |
$3,189.00
|
| Rate for Payer: The Alliance Commercial |
$21,260.00
|
| Rate for Payer: WEA Trust Commercial |
$2,923.25
|
| Rate for Payer: WPS Commercial |
$3,936.82
|
|
|
SCREW HEADLESS COMPRESSION 7.0 X 70MM SHORT THREAD TI 658370
|
Facility
|
OP
|
$5,315.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5861723
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,488.20 |
| Max. Negotiated Rate |
$21,260.00 |
| Rate for Payer: Aetna Commercial |
$4,783.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,570.90
|
| Rate for Payer: Aetna Managed Medicare |
$1,488.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,454.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,657.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,551.20
|
| 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: Dean Health DHI/DHP/ASO |
$2,974.27
|
| Rate for Payer: Health EOS Commercial |
$4,730.35
|
| Rate for Payer: HFN Commercial |
$4,889.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,986.25
|
| 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 |
$3,454.75
|
| Rate for Payer: Quartz Medicare Advantage |
$3,189.00
|
| Rate for Payer: The Alliance Commercial |
$21,260.00
|
| Rate for Payer: WEA Trust Commercial |
$2,923.25
|
| Rate for Payer: WPS Commercial |
$3,936.82
|
|
|
SCREW HEADLESS COMPRESSION 7.0 X 70MM SHORT THREAD TI 658370
|
Facility
|
IP
|
$5,315.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5861723
|
|
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
|
|
|
SCREW HEADLESS COMPRESSION 7.0 X 75MM SHORT THREAD TI 658375
|
Facility
|
IP
|
$4,271.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5861724
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,092.79 |
| Max. Negotiated Rate |
$3,929.32 |
| Rate for Payer: Aetna Commercial |
$3,843.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,673.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,263.63
|
| Rate for Payer: Cash Price |
$1,281.30
|
| Rate for Payer: Cigna Commercial |
$3,929.32
|
| Rate for Payer: Health EOS Commercial |
$3,801.19
|
| Rate for Payer: HFN Commercial |
$3,929.32
|
| Rate for Payer: Multiplan Commercial |
$3,416.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,562.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,929.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,092.79
|
| Rate for Payer: Quartz Commercial |
$2,562.60
|
| Rate for Payer: WEA Trust Commercial |
$2,349.05
|
| Rate for Payer: WPS Commercial |
$3,163.53
|
|
|
SCREW HEADLESS COMPRESSION 7.0 X 75MM SHORT THREAD TI 658375
|
Facility
|
OP
|
$4,271.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5861724
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,195.88 |
| Max. Negotiated Rate |
$17,084.00 |
| Rate for Payer: Aetna Commercial |
$3,843.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,673.06
|
| Rate for Payer: Aetna Managed Medicare |
$1,195.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,776.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,135.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,050.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,263.63
|
| Rate for Payer: Cash Price |
$1,281.30
|
| Rate for Payer: Cigna Commercial |
$3,929.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,390.05
|
| Rate for Payer: Health EOS Commercial |
$3,801.19
|
| Rate for Payer: HFN Commercial |
$3,929.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,203.25
|
| Rate for Payer: Multiplan Commercial |
$3,416.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,562.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,929.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,092.79
|
| Rate for Payer: Quartz Commercial |
$2,776.15
|
| Rate for Payer: Quartz Medicare Advantage |
$2,562.60
|
| Rate for Payer: The Alliance Commercial |
$17,084.00
|
| Rate for Payer: WEA Trust Commercial |
$2,349.05
|
| Rate for Payer: WPS Commercial |
$3,163.53
|
|
|
SCREW HEADLESS COMPRESSION 7.0 X 80MM SHORT THREAD TI 658380
|
Facility
|
OP
|
$4,271.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6166141
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,195.88 |
| Max. Negotiated Rate |
$17,084.00 |
| Rate for Payer: Aetna Commercial |
$3,843.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,673.06
|
| Rate for Payer: Aetna Managed Medicare |
$1,195.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,776.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,135.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,050.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,263.63
|
| Rate for Payer: Cash Price |
$1,281.30
|
| Rate for Payer: Cigna Commercial |
$3,929.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,390.05
|
| Rate for Payer: Health EOS Commercial |
$3,801.19
|
| Rate for Payer: HFN Commercial |
$3,929.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,203.25
|
| Rate for Payer: Multiplan Commercial |
$3,416.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,562.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,929.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,092.79
|
| Rate for Payer: Quartz Commercial |
$2,776.15
|
| Rate for Payer: Quartz Medicare Advantage |
$2,562.60
|
| Rate for Payer: The Alliance Commercial |
$17,084.00
|
| Rate for Payer: WEA Trust Commercial |
$2,349.05
|
| Rate for Payer: WPS Commercial |
$3,163.53
|
|
|
SCREW HEADLESS COMPRESSION 7.0 X 80MM SHORT THREAD TI 658380
|
Facility
|
IP
|
$4,271.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6166141
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,092.79 |
| Max. Negotiated Rate |
$3,929.32 |
| Rate for Payer: Aetna Commercial |
$3,843.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,673.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,263.63
|
| Rate for Payer: Cash Price |
$1,281.30
|
| Rate for Payer: Cigna Commercial |
$3,929.32
|
| Rate for Payer: Health EOS Commercial |
$3,801.19
|
| Rate for Payer: HFN Commercial |
$3,929.32
|
| Rate for Payer: Multiplan Commercial |
$3,416.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,562.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,929.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,092.79
|
| Rate for Payer: Quartz Commercial |
$2,562.60
|
| Rate for Payer: WEA Trust Commercial |
$2,349.05
|
| Rate for Payer: WPS Commercial |
$3,163.53
|
|
|
SCREW HEADLESS COMPRESSION 7.0 X 85MM SHORT THREAD TI 658385
|
Facility
|
OP
|
$4,107.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6181253
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,149.96 |
| Max. Negotiated Rate |
$16,428.00 |
| Rate for Payer: Aetna Commercial |
$3,696.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,532.02
|
| Rate for Payer: Aetna Managed Medicare |
$1,149.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,669.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,053.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,971.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,176.71
|
| Rate for Payer: Cash Price |
$1,232.10
|
| Rate for Payer: Cigna Commercial |
$3,778.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,298.28
|
| Rate for Payer: Health EOS Commercial |
$3,655.23
|
| Rate for Payer: HFN Commercial |
$3,778.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,080.25
|
| Rate for Payer: Multiplan Commercial |
$3,285.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,464.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,778.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,012.43
|
| Rate for Payer: Quartz Commercial |
$2,669.55
|
| Rate for Payer: Quartz Medicare Advantage |
$2,464.20
|
| Rate for Payer: The Alliance Commercial |
$16,428.00
|
| Rate for Payer: WEA Trust Commercial |
$2,258.85
|
| Rate for Payer: WPS Commercial |
$3,042.05
|
|
|
SCREW HEADLESS COMPRESSION 7.0 X 85MM SHORT THREAD TI 658385
|
Facility
|
IP
|
$4,107.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6181253
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,012.43 |
| Max. Negotiated Rate |
$3,778.44 |
| Rate for Payer: Aetna Commercial |
$3,696.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,532.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,176.71
|
| Rate for Payer: Cash Price |
$1,232.10
|
| Rate for Payer: Cigna Commercial |
$3,778.44
|
| Rate for Payer: Health EOS Commercial |
$3,655.23
|
| Rate for Payer: HFN Commercial |
$3,778.44
|
| Rate for Payer: Multiplan Commercial |
$3,285.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,464.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,778.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,012.43
|
| Rate for Payer: Quartz Commercial |
$2,464.20
|
| Rate for Payer: WEA Trust Commercial |
$2,258.85
|
| Rate for Payer: WPS Commercial |
$3,042.05
|
|
