|
SCREW HEX HEADED 3.5MM X 48MM 00-5901-035-48
|
Facility
|
OP
|
$2,174.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6192963
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$608.72 |
| Max. Negotiated Rate |
$8,696.00 |
| Rate for Payer: Aetna Commercial |
$1,956.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,869.64
|
| Rate for Payer: Aetna Managed Medicare |
$608.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,413.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,087.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,043.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,152.22
|
| Rate for Payer: Cash Price |
$652.20
|
| Rate for Payer: Cigna Commercial |
$2,000.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,216.57
|
| Rate for Payer: Health EOS Commercial |
$1,934.86
|
| Rate for Payer: HFN Commercial |
$2,000.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,630.50
|
| Rate for Payer: Multiplan Commercial |
$1,739.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,304.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,000.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,065.26
|
| Rate for Payer: Quartz Commercial |
$1,413.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,304.40
|
| Rate for Payer: The Alliance Commercial |
$8,696.00
|
| Rate for Payer: WEA Trust Commercial |
$1,195.70
|
| Rate for Payer: WPS Commercial |
$1,610.28
|
|
|
SCREW HEX HEADED 3.5MM X 48MM 00-5901-035-48
|
Facility
|
IP
|
$2,174.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6192963
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,065.26 |
| Max. Negotiated Rate |
$2,000.08 |
| Rate for Payer: Aetna Commercial |
$1,956.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,869.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,152.22
|
| Rate for Payer: Cash Price |
$652.20
|
| Rate for Payer: Cigna Commercial |
$2,000.08
|
| Rate for Payer: Health EOS Commercial |
$1,934.86
|
| Rate for Payer: HFN Commercial |
$2,000.08
|
| Rate for Payer: Multiplan Commercial |
$1,739.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,304.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,000.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,065.26
|
| Rate for Payer: Quartz Commercial |
$1,304.40
|
| Rate for Payer: WEA Trust Commercial |
$1,195.70
|
| Rate for Payer: WPS Commercial |
$1,610.28
|
|
|
SCREW HOLE PLUG CONTINUUM 00-8757-000-02
|
Facility
|
OP
|
$2,230.00
|
|
| Hospital Charge Code |
2967810
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$624.40 |
| Max. Negotiated Rate |
$8,920.00 |
| Rate for Payer: Aetna Commercial |
$2,007.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,917.80
|
| Rate for Payer: Aetna Managed Medicare |
$624.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,449.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,115.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,070.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,181.90
|
| Rate for Payer: Cash Price |
$669.00
|
| Rate for Payer: Cigna Commercial |
$2,051.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,247.91
|
| Rate for Payer: Health EOS Commercial |
$1,984.70
|
| Rate for Payer: HFN Commercial |
$2,051.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,672.50
|
| Rate for Payer: Multiplan Commercial |
$1,784.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,338.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,051.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,092.70
|
| Rate for Payer: Quartz Commercial |
$1,449.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,338.00
|
| Rate for Payer: The Alliance Commercial |
$8,920.00
|
| Rate for Payer: WEA Trust Commercial |
$1,226.50
|
| Rate for Payer: WPS Commercial |
$1,651.76
|
|
|
SCREW HOLE PLUG CONTINUUM 00-8757-000-02
|
Facility
|
IP
|
$2,230.00
|
|
| Hospital Charge Code |
2967810
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,092.70 |
| Max. Negotiated Rate |
$2,051.60 |
| Rate for Payer: Aetna Commercial |
$2,007.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,917.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,181.90
|
| Rate for Payer: Cash Price |
$669.00
|
| Rate for Payer: Cigna Commercial |
$2,051.60
|
| Rate for Payer: Health EOS Commercial |
$1,984.70
|
| Rate for Payer: HFN Commercial |
$2,051.60
|
| Rate for Payer: Multiplan Commercial |
$1,784.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,338.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,051.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,092.70
|
| Rate for Payer: Quartz Commercial |
$1,338.00
|
| Rate for Payer: WEA Trust Commercial |
$1,226.50
|
| Rate for Payer: WPS Commercial |
$1,651.76
|
|
|
SCREW INTERFERENCE 10 X 28 FULL THREAD AR-1400TC
|
Facility
|
OP
|
$6,041.00
|
|
| Hospital Charge Code |
2964695
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,691.48 |
| Max. Negotiated Rate |
$24,164.00 |
| Rate for Payer: Aetna Commercial |
$5,436.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,195.26
|
| Rate for Payer: Aetna Managed Medicare |
$1,691.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,926.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,020.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,899.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,201.73
|
| Rate for Payer: Cash Price |
$1,812.30
|
| Rate for Payer: Cigna Commercial |
$5,557.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,380.54
|
| Rate for Payer: Health EOS Commercial |
$5,376.49
|
| Rate for Payer: HFN Commercial |
$5,557.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,530.75
|
| Rate for Payer: Multiplan Commercial |
$4,832.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,624.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,557.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,960.09
|
| Rate for Payer: Quartz Commercial |
$3,926.65
|
| Rate for Payer: Quartz Medicare Advantage |
$3,624.60
|
| Rate for Payer: The Alliance Commercial |
$24,164.00
|
| Rate for Payer: WEA Trust Commercial |
$3,322.55
|
| Rate for Payer: WPS Commercial |
$4,474.57
|
|
|
SCREW INTERFERENCE 10 X 28 FULL THREAD AR-1400TC
|
Facility
|
IP
|
$6,041.00
|
|
| Hospital Charge Code |
2964695
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,960.09 |
| Max. Negotiated Rate |
$5,557.72 |
| Rate for Payer: Aetna Commercial |
$5,436.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,195.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,201.73
|
| Rate for Payer: Cash Price |
$1,812.30
|
| Rate for Payer: Cigna Commercial |
$5,557.72
|
| Rate for Payer: Health EOS Commercial |
$5,376.49
|
| Rate for Payer: HFN Commercial |
$5,557.72
|
| Rate for Payer: Multiplan Commercial |
$4,832.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,624.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,557.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,960.09
|
| Rate for Payer: Quartz Commercial |
$3,624.60
|
| Rate for Payer: WEA Trust Commercial |
$3,322.55
|
| Rate for Payer: WPS Commercial |
$4,474.57
|
|
|
SCREW INTERFERENCE 10 X 30MM FASTTHREAD AR-4030C-10
|
Facility
|
IP
|
$3,139.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5496692
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,538.11 |
| Max. Negotiated Rate |
$2,887.88 |
| Rate for Payer: Aetna Commercial |
$2,825.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,699.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,663.67
|
| Rate for Payer: Cash Price |
$941.70
|
| Rate for Payer: Cigna Commercial |
$2,887.88
|
| Rate for Payer: Health EOS Commercial |
$2,793.71
|
| Rate for Payer: HFN Commercial |
$2,887.88
|
| Rate for Payer: Multiplan Commercial |
$2,511.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,883.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,887.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,538.11
|
| Rate for Payer: Quartz Commercial |
$1,883.40
|
| Rate for Payer: WEA Trust Commercial |
$1,726.45
|
| Rate for Payer: WPS Commercial |
$2,325.06
|
|
|
SCREW INTERFERENCE 10 X 30MM FASTTHREAD AR-4030C-10
|
Facility
|
OP
|
$3,139.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5496692
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$878.92 |
| Max. Negotiated Rate |
$12,556.00 |
| Rate for Payer: Aetna Commercial |
$2,825.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,699.54
|
| Rate for Payer: Aetna Managed Medicare |
$878.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,040.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,569.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,506.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,663.67
|
| Rate for Payer: Cash Price |
$941.70
|
| Rate for Payer: Cigna Commercial |
$2,887.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,756.58
|
| Rate for Payer: Health EOS Commercial |
$2,793.71
|
| Rate for Payer: HFN Commercial |
$2,887.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,354.25
|
| Rate for Payer: Multiplan Commercial |
$2,511.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,883.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,887.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,538.11
|
| Rate for Payer: Quartz Commercial |
$2,040.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,883.40
|
| Rate for Payer: The Alliance Commercial |
$12,556.00
|
| Rate for Payer: WEA Trust Commercial |
$1,726.45
|
| Rate for Payer: WPS Commercial |
$2,325.06
|
|
|
SCREW INTERFERENCE 7 X 20MM BC VENTED AR-4020C-07
|
Facility
|
OP
|
$3,139.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5563557
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$878.92 |
| Max. Negotiated Rate |
$12,556.00 |
| Rate for Payer: Aetna Commercial |
$2,825.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,699.54
|
| Rate for Payer: Aetna Managed Medicare |
$878.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,040.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,569.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,506.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,663.67
|
| Rate for Payer: Cash Price |
$941.70
|
| Rate for Payer: Cigna Commercial |
$2,887.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,756.58
|
| Rate for Payer: Health EOS Commercial |
$2,793.71
|
| Rate for Payer: HFN Commercial |
$2,887.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,354.25
|
| Rate for Payer: Multiplan Commercial |
$2,511.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,883.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,887.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,538.11
|
| Rate for Payer: Quartz Commercial |
$2,040.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,883.40
|
| Rate for Payer: The Alliance Commercial |
$12,556.00
|
| Rate for Payer: WEA Trust Commercial |
$1,726.45
|
| Rate for Payer: WPS Commercial |
$2,325.06
|
|
|
SCREW INTERFERENCE 7 X 20MM BC VENTED AR-4020C-07
|
Facility
|
IP
|
$3,139.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5563557
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,538.11 |
| Max. Negotiated Rate |
$2,887.88 |
| Rate for Payer: Aetna Commercial |
$2,825.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,699.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,663.67
|
| Rate for Payer: Cash Price |
$941.70
|
| Rate for Payer: Cigna Commercial |
$2,887.88
|
| Rate for Payer: Health EOS Commercial |
$2,793.71
|
| Rate for Payer: HFN Commercial |
$2,887.88
|
| Rate for Payer: Multiplan Commercial |
$2,511.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,883.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,887.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,538.11
|
| Rate for Payer: Quartz Commercial |
$1,883.40
|
| Rate for Payer: WEA Trust Commercial |
$1,726.45
|
| Rate for Payer: WPS Commercial |
$2,325.06
|
|
|
SCREW INTERFERENCE 7 X 30MM BC VENTED AR-4030C-07
|
Facility
|
OP
|
$3,139.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5563558
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$878.92 |
| Max. Negotiated Rate |
$12,556.00 |
| Rate for Payer: Aetna Commercial |
$2,825.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,699.54
|
| Rate for Payer: Aetna Managed Medicare |
$878.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,040.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,569.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,506.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,663.67
|
| Rate for Payer: Cash Price |
$941.70
|
| Rate for Payer: Cigna Commercial |
$2,887.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,756.58
|
| Rate for Payer: Health EOS Commercial |
$2,793.71
|
| Rate for Payer: HFN Commercial |
$2,887.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,354.25
|
| Rate for Payer: Multiplan Commercial |
$2,511.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,883.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,887.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,538.11
|
| Rate for Payer: Quartz Commercial |
$2,040.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,883.40
|
| Rate for Payer: The Alliance Commercial |
$12,556.00
|
| Rate for Payer: WEA Trust Commercial |
$1,726.45
|
| Rate for Payer: WPS Commercial |
$2,325.06
|
|
|
SCREW INTERFERENCE 7 X 30MM BC VENTED AR-4030C-07
|
Facility
|
IP
|
$3,139.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5563558
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,538.11 |
| Max. Negotiated Rate |
$2,887.88 |
| Rate for Payer: Aetna Commercial |
$2,825.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,699.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,663.67
|
| Rate for Payer: Cash Price |
$941.70
|
| Rate for Payer: Cigna Commercial |
$2,887.88
|
| Rate for Payer: Health EOS Commercial |
$2,793.71
|
| Rate for Payer: HFN Commercial |
$2,887.88
|
| Rate for Payer: Multiplan Commercial |
$2,511.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,883.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,887.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,538.11
|
| Rate for Payer: Quartz Commercial |
$1,883.40
|
| Rate for Payer: WEA Trust Commercial |
$1,726.45
|
| Rate for Payer: WPS Commercial |
$2,325.06
|
|
|
SCREW INTERFERENCE 8 X 20MM BC VENTED AR-4020C-08
|
Facility
|
IP
|
$3,139.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5456676
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,538.11 |
| Max. Negotiated Rate |
$2,887.88 |
| Rate for Payer: Aetna Commercial |
$2,825.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,699.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,663.67
|
| Rate for Payer: Cash Price |
$941.70
|
| Rate for Payer: Cigna Commercial |
$2,887.88
|
| Rate for Payer: Health EOS Commercial |
$2,793.71
|
| Rate for Payer: HFN Commercial |
$2,887.88
|
| Rate for Payer: Multiplan Commercial |
$2,511.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,883.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,887.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,538.11
|
| Rate for Payer: Quartz Commercial |
$1,883.40
|
| Rate for Payer: WEA Trust Commercial |
$1,726.45
|
| Rate for Payer: WPS Commercial |
$2,325.06
|
|
|
SCREW INTERFERENCE 8 X 20MM BC VENTED AR-4020C-08
|
Facility
|
OP
|
$3,139.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5456676
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$878.92 |
| Max. Negotiated Rate |
$12,556.00 |
| Rate for Payer: Aetna Commercial |
$2,825.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,699.54
|
| Rate for Payer: Aetna Managed Medicare |
$878.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,040.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,569.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,506.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,663.67
|
| Rate for Payer: Cash Price |
$941.70
|
| Rate for Payer: Cigna Commercial |
$2,887.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,756.58
|
| Rate for Payer: Health EOS Commercial |
$2,793.71
|
| Rate for Payer: HFN Commercial |
$2,887.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,354.25
|
| Rate for Payer: Multiplan Commercial |
$2,511.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,883.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,887.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,538.11
|
| Rate for Payer: Quartz Commercial |
$2,040.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,883.40
|
| Rate for Payer: The Alliance Commercial |
$12,556.00
|
| Rate for Payer: WEA Trust Commercial |
$1,726.45
|
| Rate for Payer: WPS Commercial |
$2,325.06
|
|
|
SCREW INTERFERENCE 8 X 30MM FASTTHREAD AR-4030C-08
|
Facility
|
OP
|
$3,139.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5547219
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$878.92 |
| Max. Negotiated Rate |
$12,556.00 |
| Rate for Payer: Aetna Commercial |
$2,825.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,699.54
|
| Rate for Payer: Aetna Managed Medicare |
$878.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,040.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,569.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,506.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,663.67
|
| Rate for Payer: Cash Price |
$941.70
|
| Rate for Payer: Cigna Commercial |
$2,887.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,756.58
|
| Rate for Payer: Health EOS Commercial |
$2,793.71
|
| Rate for Payer: HFN Commercial |
$2,887.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,354.25
|
| Rate for Payer: Multiplan Commercial |
$2,511.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,883.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,887.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,538.11
|
| Rate for Payer: Quartz Commercial |
$2,040.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,883.40
|
| Rate for Payer: The Alliance Commercial |
$12,556.00
|
| Rate for Payer: WEA Trust Commercial |
$1,726.45
|
| Rate for Payer: WPS Commercial |
$2,325.06
|
|
|
SCREW INTERFERENCE 8 X 30MM FASTTHREAD AR-4030C-08
|
Facility
|
IP
|
$3,139.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5547219
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,538.11 |
| Max. Negotiated Rate |
$2,887.88 |
| Rate for Payer: Aetna Commercial |
$2,825.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,699.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,663.67
|
| Rate for Payer: Cash Price |
$941.70
|
| Rate for Payer: Cigna Commercial |
$2,887.88
|
| Rate for Payer: Health EOS Commercial |
$2,793.71
|
| Rate for Payer: HFN Commercial |
$2,887.88
|
| Rate for Payer: Multiplan Commercial |
$2,511.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,883.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,887.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,538.11
|
| Rate for Payer: Quartz Commercial |
$1,883.40
|
| Rate for Payer: WEA Trust Commercial |
$1,726.45
|
| Rate for Payer: WPS Commercial |
$2,325.06
|
|
|
SCREW INTERFERENCE 9 X 30MM FASTTHREAD AR-4030C-09
|
Facility
|
IP
|
$3,139.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5456918
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,538.11 |
| Max. Negotiated Rate |
$2,887.88 |
| Rate for Payer: Aetna Commercial |
$2,825.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,699.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,663.67
|
| Rate for Payer: Cash Price |
$941.70
|
| Rate for Payer: Cigna Commercial |
$2,887.88
|
| Rate for Payer: Health EOS Commercial |
$2,793.71
|
| Rate for Payer: HFN Commercial |
$2,887.88
|
| Rate for Payer: Multiplan Commercial |
$2,511.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,883.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,887.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,538.11
|
| Rate for Payer: Quartz Commercial |
$1,883.40
|
| Rate for Payer: WEA Trust Commercial |
$1,726.45
|
| Rate for Payer: WPS Commercial |
$2,325.06
|
|
|
SCREW INTERFERENCE 9 X 30MM FASTTHREAD AR-4030C-09
|
Facility
|
OP
|
$3,139.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5456918
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$878.92 |
| Max. Negotiated Rate |
$12,556.00 |
| Rate for Payer: Aetna Commercial |
$2,825.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,699.54
|
| Rate for Payer: Aetna Managed Medicare |
$878.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,040.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,569.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,506.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,663.67
|
| Rate for Payer: Cash Price |
$941.70
|
| Rate for Payer: Cigna Commercial |
$2,887.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,756.58
|
| Rate for Payer: Health EOS Commercial |
$2,793.71
|
| Rate for Payer: HFN Commercial |
$2,887.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,354.25
|
| Rate for Payer: Multiplan Commercial |
$2,511.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,883.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,887.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,538.11
|
| Rate for Payer: Quartz Commercial |
$2,040.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,883.40
|
| Rate for Payer: The Alliance Commercial |
$12,556.00
|
| Rate for Payer: WEA Trust Commercial |
$1,726.45
|
| Rate for Payer: WPS Commercial |
$2,325.06
|
|
|
SCREW INTERFERENCE BIOTRANSFIX
|
Facility
|
OP
|
$2,747.00
|
|
| Hospital Charge Code |
2964699
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$769.16 |
| Max. Negotiated Rate |
$10,988.00 |
| Rate for Payer: Aetna Commercial |
$2,472.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,362.42
|
| Rate for Payer: Aetna Managed Medicare |
$769.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,785.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,373.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,318.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,455.91
|
| Rate for Payer: Cash Price |
$824.10
|
| Rate for Payer: Cigna Commercial |
$2,527.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,537.22
|
| Rate for Payer: Health EOS Commercial |
$2,444.83
|
| Rate for Payer: HFN Commercial |
$2,527.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,060.25
|
| Rate for Payer: Multiplan Commercial |
$2,197.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,648.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,527.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,346.03
|
| Rate for Payer: Quartz Commercial |
$1,785.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,648.20
|
| Rate for Payer: The Alliance Commercial |
$10,988.00
|
| Rate for Payer: WEA Trust Commercial |
$1,510.85
|
| Rate for Payer: WPS Commercial |
$2,034.70
|
|
|
SCREW INTERFERENCE BIOTRANSFIX
|
Facility
|
IP
|
$2,747.00
|
|
| Hospital Charge Code |
2964699
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,346.03 |
| Max. Negotiated Rate |
$2,527.24 |
| Rate for Payer: Aetna Commercial |
$2,472.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,362.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,455.91
|
| Rate for Payer: Cash Price |
$824.10
|
| Rate for Payer: Cigna Commercial |
$2,527.24
|
| Rate for Payer: Health EOS Commercial |
$2,444.83
|
| Rate for Payer: HFN Commercial |
$2,527.24
|
| Rate for Payer: Multiplan Commercial |
$2,197.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,648.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,527.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,346.03
|
| Rate for Payer: Quartz Commercial |
$1,648.20
|
| Rate for Payer: WEA Trust Commercial |
$1,510.85
|
| Rate for Payer: WPS Commercial |
$2,034.70
|
|
|
SCREW INTERFERENCE ROUND DELTA 10 X 28MM WITH SHEATH AR-5028P-10
|
Facility
|
OP
|
$4,366.00
|
|
| Hospital Charge Code |
4519924
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,222.48 |
| Max. Negotiated Rate |
$17,464.00 |
| Rate for Payer: Aetna Commercial |
$3,929.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,754.76
|
| Rate for Payer: Aetna Managed Medicare |
$1,222.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,837.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,183.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,095.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,313.98
|
| Rate for Payer: Cash Price |
$1,309.80
|
| Rate for Payer: Cigna Commercial |
$4,016.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,443.21
|
| Rate for Payer: Health EOS Commercial |
$3,885.74
|
| Rate for Payer: HFN Commercial |
$4,016.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,274.50
|
| Rate for Payer: Multiplan Commercial |
$3,492.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,619.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,016.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,139.34
|
| Rate for Payer: Quartz Commercial |
$2,837.90
|
| Rate for Payer: Quartz Medicare Advantage |
$2,619.60
|
| Rate for Payer: The Alliance Commercial |
$17,464.00
|
| Rate for Payer: WEA Trust Commercial |
$2,401.30
|
| Rate for Payer: WPS Commercial |
$3,233.90
|
|
|
SCREW INTERFERENCE ROUND DELTA 10 X 28MM WITH SHEATH AR-5028P-10
|
Facility
|
IP
|
$4,366.00
|
|
| Hospital Charge Code |
4519924
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,139.34 |
| Max. Negotiated Rate |
$4,016.72 |
| Rate for Payer: Aetna Commercial |
$3,929.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,754.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,313.98
|
| Rate for Payer: Cash Price |
$1,309.80
|
| Rate for Payer: Cigna Commercial |
$4,016.72
|
| Rate for Payer: Health EOS Commercial |
$3,885.74
|
| Rate for Payer: HFN Commercial |
$4,016.72
|
| Rate for Payer: Multiplan Commercial |
$3,492.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,619.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,016.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,139.34
|
| Rate for Payer: Quartz Commercial |
$2,619.60
|
| Rate for Payer: WEA Trust Commercial |
$2,401.30
|
| Rate for Payer: WPS Commercial |
$3,233.90
|
|
|
SCREW INTERFERENCE ROUND DELTA 11 X 28MM WITH SHEATH AR-5028P-11
|
Facility
|
OP
|
$4,366.00
|
|
| Hospital Charge Code |
5107077
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,222.48 |
| Max. Negotiated Rate |
$17,464.00 |
| Rate for Payer: Aetna Commercial |
$3,929.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,754.76
|
| Rate for Payer: Aetna Managed Medicare |
$1,222.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,837.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,183.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,095.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,313.98
|
| Rate for Payer: Cash Price |
$1,309.80
|
| Rate for Payer: Cigna Commercial |
$4,016.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,443.21
|
| Rate for Payer: Health EOS Commercial |
$3,885.74
|
| Rate for Payer: HFN Commercial |
$4,016.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,274.50
|
| Rate for Payer: Multiplan Commercial |
$3,492.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,619.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,016.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,139.34
|
| Rate for Payer: Quartz Commercial |
$2,837.90
|
| Rate for Payer: Quartz Medicare Advantage |
$2,619.60
|
| Rate for Payer: The Alliance Commercial |
$17,464.00
|
| Rate for Payer: WEA Trust Commercial |
$2,401.30
|
| Rate for Payer: WPS Commercial |
$3,233.90
|
|
|
SCREW INTERFERENCE ROUND DELTA 11 X 28MM WITH SHEATH AR-5028P-11
|
Facility
|
IP
|
$4,366.00
|
|
| Hospital Charge Code |
5107077
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,139.34 |
| Max. Negotiated Rate |
$4,016.72 |
| Rate for Payer: Aetna Commercial |
$3,929.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,754.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,313.98
|
| Rate for Payer: Cash Price |
$1,309.80
|
| Rate for Payer: Cigna Commercial |
$4,016.72
|
| Rate for Payer: Health EOS Commercial |
$3,885.74
|
| Rate for Payer: HFN Commercial |
$4,016.72
|
| Rate for Payer: Multiplan Commercial |
$3,492.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,619.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,016.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,139.34
|
| Rate for Payer: Quartz Commercial |
$2,619.60
|
| Rate for Payer: WEA Trust Commercial |
$2,401.30
|
| Rate for Payer: WPS Commercial |
$3,233.90
|
|
|
SCREW INTERFERENCE ROUND DELTA 9 X 28MM WITH SHEATH AR-5028P-09
|
Facility
|
OP
|
$4,366.00
|
|
| Hospital Charge Code |
4520293
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,222.48 |
| Max. Negotiated Rate |
$17,464.00 |
| Rate for Payer: Aetna Commercial |
$3,929.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,754.76
|
| Rate for Payer: Aetna Managed Medicare |
$1,222.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,837.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,183.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,095.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,313.98
|
| Rate for Payer: Cash Price |
$1,309.80
|
| Rate for Payer: Cigna Commercial |
$4,016.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,443.21
|
| Rate for Payer: Health EOS Commercial |
$3,885.74
|
| Rate for Payer: HFN Commercial |
$4,016.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,274.50
|
| Rate for Payer: Multiplan Commercial |
$3,492.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,619.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,016.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,139.34
|
| Rate for Payer: Quartz Commercial |
$2,837.90
|
| Rate for Payer: Quartz Medicare Advantage |
$2,619.60
|
| Rate for Payer: The Alliance Commercial |
$17,464.00
|
| Rate for Payer: WEA Trust Commercial |
$2,401.30
|
| Rate for Payer: WPS Commercial |
$3,233.90
|
|
