|
SCREW CANN LOCK 3.7 X 50MM 02.240.050
|
Facility
|
IP
|
$2,953.00
|
|
| Hospital Charge Code |
2966510
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,446.97 |
| Max. Negotiated Rate |
$2,716.76 |
| Rate for Payer: Aetna Commercial |
$2,657.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,539.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,565.09
|
| Rate for Payer: Cash Price |
$885.90
|
| Rate for Payer: Cigna Commercial |
$2,716.76
|
| Rate for Payer: Health EOS Commercial |
$2,628.17
|
| Rate for Payer: HFN Commercial |
$2,716.76
|
| Rate for Payer: Multiplan Commercial |
$2,362.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,771.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,716.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,446.97
|
| Rate for Payer: Quartz Commercial |
$1,771.80
|
| Rate for Payer: WEA Trust Commercial |
$1,624.15
|
| Rate for Payer: WPS Commercial |
$2,187.29
|
|
|
SCREW CANN LOCK 3.7 X 50MM 02.240.050
|
Facility
|
OP
|
$2,953.00
|
|
| Hospital Charge Code |
2966510
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$826.84 |
| Max. Negotiated Rate |
$11,812.00 |
| Rate for Payer: Aetna Commercial |
$2,657.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,539.58
|
| Rate for Payer: Aetna Managed Medicare |
$826.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,919.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,476.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,417.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,565.09
|
| Rate for Payer: Cash Price |
$885.90
|
| Rate for Payer: Cigna Commercial |
$2,716.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,652.50
|
| Rate for Payer: Health EOS Commercial |
$2,628.17
|
| Rate for Payer: HFN Commercial |
$2,716.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,214.75
|
| Rate for Payer: Multiplan Commercial |
$2,362.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,771.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,716.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,446.97
|
| Rate for Payer: Quartz Commercial |
$1,919.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,771.80
|
| Rate for Payer: The Alliance Commercial |
$11,812.00
|
| Rate for Payer: WEA Trust Commercial |
$1,624.15
|
| Rate for Payer: WPS Commercial |
$2,187.29
|
|
|
SCREW CANN LOCK 3.7 X 54MM 02.240.054
|
Facility
|
IP
|
$2,953.00
|
|
| Hospital Charge Code |
2966511
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,446.97 |
| Max. Negotiated Rate |
$2,716.76 |
| Rate for Payer: Aetna Commercial |
$2,657.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,539.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,565.09
|
| Rate for Payer: Cash Price |
$885.90
|
| Rate for Payer: Cigna Commercial |
$2,716.76
|
| Rate for Payer: Health EOS Commercial |
$2,628.17
|
| Rate for Payer: HFN Commercial |
$2,716.76
|
| Rate for Payer: Multiplan Commercial |
$2,362.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,771.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,716.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,446.97
|
| Rate for Payer: Quartz Commercial |
$1,771.80
|
| Rate for Payer: WEA Trust Commercial |
$1,624.15
|
| Rate for Payer: WPS Commercial |
$2,187.29
|
|
|
SCREW CANN LOCK 3.7 X 54MM 02.240.054
|
Facility
|
OP
|
$2,953.00
|
|
| Hospital Charge Code |
2966511
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$826.84 |
| Max. Negotiated Rate |
$11,812.00 |
| Rate for Payer: Aetna Commercial |
$2,657.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,539.58
|
| Rate for Payer: Aetna Managed Medicare |
$826.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,919.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,476.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,417.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,565.09
|
| Rate for Payer: Cash Price |
$885.90
|
| Rate for Payer: Cigna Commercial |
$2,716.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,652.50
|
| Rate for Payer: Health EOS Commercial |
$2,628.17
|
| Rate for Payer: HFN Commercial |
$2,716.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,214.75
|
| Rate for Payer: Multiplan Commercial |
$2,362.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,771.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,716.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,446.97
|
| Rate for Payer: Quartz Commercial |
$1,919.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,771.80
|
| Rate for Payer: The Alliance Commercial |
$11,812.00
|
| Rate for Payer: WEA Trust Commercial |
$1,624.15
|
| Rate for Payer: WPS Commercial |
$2,187.29
|
|
|
SCREW CANN LOCK VA 5.0 X 45 02.231.645
|
Facility
|
IP
|
$2,877.00
|
|
| Hospital Charge Code |
3072543
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,409.73 |
| Max. Negotiated Rate |
$2,646.84 |
| Rate for Payer: Aetna Commercial |
$2,589.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,474.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,524.81
|
| Rate for Payer: Cash Price |
$863.10
|
| Rate for Payer: Cigna Commercial |
$2,646.84
|
| Rate for Payer: Health EOS Commercial |
$2,560.53
|
| Rate for Payer: HFN Commercial |
$2,646.84
|
| Rate for Payer: Multiplan Commercial |
$2,301.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,726.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,646.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,409.73
|
| Rate for Payer: Quartz Commercial |
$1,726.20
|
| Rate for Payer: WEA Trust Commercial |
$1,582.35
|
| Rate for Payer: WPS Commercial |
$2,130.99
|
|
|
SCREW CANN LOCK VA 5.0 X 45 02.231.645
|
Facility
|
OP
|
$2,877.00
|
|
| Hospital Charge Code |
3072543
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$805.56 |
| Max. Negotiated Rate |
$11,508.00 |
| Rate for Payer: Aetna Commercial |
$2,589.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,474.22
|
| Rate for Payer: Aetna Managed Medicare |
$805.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,870.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,438.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,380.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,524.81
|
| Rate for Payer: Cash Price |
$863.10
|
| Rate for Payer: Cigna Commercial |
$2,646.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,609.97
|
| Rate for Payer: Health EOS Commercial |
$2,560.53
|
| Rate for Payer: HFN Commercial |
$2,646.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,157.75
|
| Rate for Payer: Multiplan Commercial |
$2,301.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,726.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,646.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,409.73
|
| Rate for Payer: Quartz Commercial |
$1,870.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,726.20
|
| Rate for Payer: The Alliance Commercial |
$11,508.00
|
| Rate for Payer: WEA Trust Commercial |
$1,582.35
|
| Rate for Payer: WPS Commercial |
$2,130.99
|
|
|
SCREW CANN LOCK VA 5.0 X 80 02.231.680
|
Facility
|
IP
|
$2,263.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3181496
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,108.87 |
| Max. Negotiated Rate |
$2,081.96 |
| Rate for Payer: Aetna Commercial |
$2,036.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,946.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,199.39
|
| Rate for Payer: Cash Price |
$678.90
|
| Rate for Payer: Cigna Commercial |
$2,081.96
|
| Rate for Payer: Health EOS Commercial |
$2,014.07
|
| Rate for Payer: HFN Commercial |
$2,081.96
|
| Rate for Payer: Multiplan Commercial |
$1,810.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,357.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,081.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,108.87
|
| Rate for Payer: Quartz Commercial |
$1,357.80
|
| Rate for Payer: WEA Trust Commercial |
$1,244.65
|
| Rate for Payer: WPS Commercial |
$1,676.20
|
|
|
SCREW CANN LOCK VA 5.0 X 80 02.231.680
|
Facility
|
OP
|
$2,263.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3181496
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$633.64 |
| Max. Negotiated Rate |
$9,052.00 |
| Rate for Payer: Aetna Commercial |
$2,036.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,946.18
|
| Rate for Payer: Aetna Managed Medicare |
$633.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,470.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,131.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,086.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,199.39
|
| Rate for Payer: Cash Price |
$678.90
|
| Rate for Payer: Cigna Commercial |
$2,081.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,266.37
|
| Rate for Payer: Health EOS Commercial |
$2,014.07
|
| Rate for Payer: HFN Commercial |
$2,081.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,697.25
|
| Rate for Payer: Multiplan Commercial |
$1,810.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,357.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,081.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,108.87
|
| Rate for Payer: Quartz Commercial |
$1,470.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,357.80
|
| Rate for Payer: The Alliance Commercial |
$9,052.00
|
| Rate for Payer: WEA Trust Commercial |
$1,244.65
|
| Rate for Payer: WPS Commercial |
$1,676.20
|
|
|
SCREW CANN LOCK VA 5.0 X 85 02.231.685
|
Facility
|
OP
|
$2,301.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5286727
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$644.28 |
| Max. Negotiated Rate |
$9,204.00 |
| Rate for Payer: Aetna Commercial |
$2,070.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,978.86
|
| Rate for Payer: Aetna Managed Medicare |
$644.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,495.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,150.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,104.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,219.53
|
| Rate for Payer: Cash Price |
$690.30
|
| Rate for Payer: Cigna Commercial |
$2,116.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,287.64
|
| Rate for Payer: Health EOS Commercial |
$2,047.89
|
| Rate for Payer: HFN Commercial |
$2,116.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,725.75
|
| Rate for Payer: Multiplan Commercial |
$1,840.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,380.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,116.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,127.49
|
| Rate for Payer: Quartz Commercial |
$1,495.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,380.60
|
| Rate for Payer: The Alliance Commercial |
$9,204.00
|
| Rate for Payer: WEA Trust Commercial |
$1,265.55
|
| Rate for Payer: WPS Commercial |
$1,704.35
|
|
|
SCREW CANN LOCK VA 5.0 X 85 02.231.685
|
Facility
|
IP
|
$2,301.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5286727
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,127.49 |
| Max. Negotiated Rate |
$2,116.92 |
| Rate for Payer: Aetna Commercial |
$2,070.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,978.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,219.53
|
| Rate for Payer: Cash Price |
$690.30
|
| Rate for Payer: Cigna Commercial |
$2,116.92
|
| Rate for Payer: Health EOS Commercial |
$2,047.89
|
| Rate for Payer: HFN Commercial |
$2,116.92
|
| Rate for Payer: Multiplan Commercial |
$1,840.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,380.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,116.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,127.49
|
| Rate for Payer: Quartz Commercial |
$1,380.60
|
| Rate for Payer: WEA Trust Commercial |
$1,265.55
|
| Rate for Payer: WPS Commercial |
$1,704.35
|
|
|
SCREW CANN LOCK VA 5.0 X 90 02.231.690
|
Facility
|
OP
|
$2,176.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6167935
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$609.28 |
| Max. Negotiated Rate |
$8,704.00 |
| Rate for Payer: Aetna Commercial |
$1,958.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,871.36
|
| Rate for Payer: Aetna Managed Medicare |
$609.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,414.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,088.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,044.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,153.28
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Cigna Commercial |
$2,001.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,217.69
|
| Rate for Payer: Health EOS Commercial |
$1,936.64
|
| Rate for Payer: HFN Commercial |
$2,001.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,632.00
|
| Rate for Payer: Multiplan Commercial |
$1,740.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,305.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,001.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,066.24
|
| Rate for Payer: Quartz Commercial |
$1,414.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,305.60
|
| Rate for Payer: The Alliance Commercial |
$8,704.00
|
| Rate for Payer: WEA Trust Commercial |
$1,196.80
|
| Rate for Payer: WPS Commercial |
$1,611.76
|
|
|
SCREW CANN LOCK VA 5.0 X 90 02.231.690
|
Facility
|
IP
|
$2,176.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6167935
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,066.24 |
| Max. Negotiated Rate |
$2,001.92 |
| Rate for Payer: Aetna Commercial |
$1,958.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,871.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,153.28
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Cigna Commercial |
$2,001.92
|
| Rate for Payer: Health EOS Commercial |
$1,936.64
|
| Rate for Payer: HFN Commercial |
$2,001.92
|
| Rate for Payer: Multiplan Commercial |
$1,740.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,305.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,001.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,066.24
|
| Rate for Payer: Quartz Commercial |
$1,305.60
|
| Rate for Payer: WEA Trust Commercial |
$1,196.80
|
| Rate for Payer: WPS Commercial |
$1,611.76
|
|
|
SCREW CANN LP PARTIAL THREAD AR-8933-26PT
|
Facility
|
IP
|
$1,597.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459665
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$782.53 |
| Max. Negotiated Rate |
$1,469.24 |
| Rate for Payer: Aetna Commercial |
$1,437.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,373.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$846.41
|
| Rate for Payer: Cash Price |
$479.10
|
| Rate for Payer: Cigna Commercial |
$1,469.24
|
| Rate for Payer: Health EOS Commercial |
$1,421.33
|
| Rate for Payer: HFN Commercial |
$1,469.24
|
| Rate for Payer: Multiplan Commercial |
$1,277.60
|
| Rate for Payer: NAPHCARE Commercial |
$958.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,469.24
|
| Rate for Payer: Quartz Beloit One Network |
$782.53
|
| Rate for Payer: Quartz Commercial |
$958.20
|
| Rate for Payer: WEA Trust Commercial |
$878.35
|
| Rate for Payer: WPS Commercial |
$1,182.90
|
|
|
SCREW CANN LP PARTIAL THREAD AR-8933-26PT
|
Facility
|
OP
|
$1,597.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459665
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$447.16 |
| Max. Negotiated Rate |
$6,388.00 |
| Rate for Payer: Aetna Commercial |
$1,437.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,373.42
|
| Rate for Payer: Aetna Managed Medicare |
$447.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,038.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$798.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$766.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$846.41
|
| Rate for Payer: Cash Price |
$479.10
|
| Rate for Payer: Cigna Commercial |
$1,469.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$893.68
|
| Rate for Payer: Health EOS Commercial |
$1,421.33
|
| Rate for Payer: HFN Commercial |
$1,469.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,197.75
|
| Rate for Payer: Multiplan Commercial |
$1,277.60
|
| Rate for Payer: NAPHCARE Commercial |
$958.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,469.24
|
| Rate for Payer: Quartz Beloit One Network |
$782.53
|
| Rate for Payer: Quartz Commercial |
$1,038.05
|
| Rate for Payer: Quartz Medicare Advantage |
$958.20
|
| Rate for Payer: The Alliance Commercial |
$6,388.00
|
| Rate for Payer: WEA Trust Commercial |
$878.35
|
| Rate for Payer: WPS Commercial |
$1,182.90
|
|
|
SCREW CANN MINI 3.0 X 16MM HEADED IC3016
|
Facility
|
IP
|
$2,021.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6175596
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$990.29 |
| Max. Negotiated Rate |
$1,859.32 |
| Rate for Payer: Aetna Commercial |
$1,818.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,738.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,071.13
|
| Rate for Payer: Cash Price |
$606.30
|
| Rate for Payer: Cigna Commercial |
$1,859.32
|
| Rate for Payer: Health EOS Commercial |
$1,798.69
|
| Rate for Payer: HFN Commercial |
$1,859.32
|
| Rate for Payer: Multiplan Commercial |
$1,616.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,212.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,859.32
|
| Rate for Payer: Quartz Beloit One Network |
$990.29
|
| Rate for Payer: Quartz Commercial |
$1,212.60
|
| Rate for Payer: WEA Trust Commercial |
$1,111.55
|
| Rate for Payer: WPS Commercial |
$1,496.95
|
|
|
SCREW CANN MINI 3.0 X 16MM HEADED IC3016
|
Facility
|
OP
|
$2,021.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6175596
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.88 |
| Max. Negotiated Rate |
$8,084.00 |
| Rate for Payer: Aetna Commercial |
$1,818.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,738.06
|
| Rate for Payer: Aetna Managed Medicare |
$565.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,313.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,010.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$970.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,071.13
|
| Rate for Payer: Cash Price |
$606.30
|
| Rate for Payer: Cigna Commercial |
$1,859.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,130.95
|
| Rate for Payer: Health EOS Commercial |
$1,798.69
|
| Rate for Payer: HFN Commercial |
$1,859.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,515.75
|
| Rate for Payer: Multiplan Commercial |
$1,616.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,212.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,859.32
|
| Rate for Payer: Quartz Beloit One Network |
$990.29
|
| Rate for Payer: Quartz Commercial |
$1,313.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,212.60
|
| Rate for Payer: The Alliance Commercial |
$8,084.00
|
| Rate for Payer: WEA Trust Commercial |
$1,111.55
|
| Rate for Payer: WPS Commercial |
$1,496.95
|
|
|
SCREW CANN MINI 3.0 X 18MM HEADED IC3018
|
Facility
|
OP
|
$2,021.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6175597
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.88 |
| Max. Negotiated Rate |
$8,084.00 |
| Rate for Payer: Aetna Commercial |
$1,818.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,738.06
|
| Rate for Payer: Aetna Managed Medicare |
$565.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,313.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,010.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$970.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,071.13
|
| Rate for Payer: Cash Price |
$606.30
|
| Rate for Payer: Cigna Commercial |
$1,859.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,130.95
|
| Rate for Payer: Health EOS Commercial |
$1,798.69
|
| Rate for Payer: HFN Commercial |
$1,859.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,515.75
|
| Rate for Payer: Multiplan Commercial |
$1,616.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,212.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,859.32
|
| Rate for Payer: Quartz Beloit One Network |
$990.29
|
| Rate for Payer: Quartz Commercial |
$1,313.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,212.60
|
| Rate for Payer: The Alliance Commercial |
$8,084.00
|
| Rate for Payer: WEA Trust Commercial |
$1,111.55
|
| Rate for Payer: WPS Commercial |
$1,496.95
|
|
|
SCREW CANN MINI 3.0 X 18MM HEADED IC3018
|
Facility
|
IP
|
$2,021.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6175597
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$990.29 |
| Max. Negotiated Rate |
$1,859.32 |
| Rate for Payer: Aetna Commercial |
$1,818.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,738.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,071.13
|
| Rate for Payer: Cash Price |
$606.30
|
| Rate for Payer: Cigna Commercial |
$1,859.32
|
| Rate for Payer: Health EOS Commercial |
$1,798.69
|
| Rate for Payer: HFN Commercial |
$1,859.32
|
| Rate for Payer: Multiplan Commercial |
$1,616.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,212.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,859.32
|
| Rate for Payer: Quartz Beloit One Network |
$990.29
|
| Rate for Payer: Quartz Commercial |
$1,212.60
|
| Rate for Payer: WEA Trust Commercial |
$1,111.55
|
| Rate for Payer: WPS Commercial |
$1,496.95
|
|
|
SCREW CANN MINI 3.0 X 22MM HEADED IC3022
|
Facility
|
OP
|
$2,186.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599634
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.08 |
| Max. Negotiated Rate |
$8,744.00 |
| Rate for Payer: Aetna Commercial |
$1,967.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,879.96
|
| Rate for Payer: Aetna Managed Medicare |
$612.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,420.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,093.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,049.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,158.58
|
| Rate for Payer: Cash Price |
$655.80
|
| Rate for Payer: Cigna Commercial |
$2,011.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,223.29
|
| Rate for Payer: Health EOS Commercial |
$1,945.54
|
| Rate for Payer: HFN Commercial |
$2,011.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,639.50
|
| Rate for Payer: Multiplan Commercial |
$1,748.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,311.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,011.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,071.14
|
| Rate for Payer: Quartz Commercial |
$1,420.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,311.60
|
| Rate for Payer: The Alliance Commercial |
$8,744.00
|
| Rate for Payer: WEA Trust Commercial |
$1,202.30
|
| Rate for Payer: WPS Commercial |
$1,619.17
|
|
|
SCREW CANN MINI 3.0 X 22MM HEADED IC3022
|
Facility
|
IP
|
$2,186.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599634
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,071.14 |
| Max. Negotiated Rate |
$2,011.12 |
| Rate for Payer: Aetna Commercial |
$1,967.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,879.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,158.58
|
| Rate for Payer: Cash Price |
$655.80
|
| Rate for Payer: Cigna Commercial |
$2,011.12
|
| Rate for Payer: Health EOS Commercial |
$1,945.54
|
| Rate for Payer: HFN Commercial |
$2,011.12
|
| Rate for Payer: Multiplan Commercial |
$1,748.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,311.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,011.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,071.14
|
| Rate for Payer: Quartz Commercial |
$1,311.60
|
| Rate for Payer: WEA Trust Commercial |
$1,202.30
|
| Rate for Payer: WPS Commercial |
$1,619.17
|
|
|
SCREW CANN MINI 3.0 X 24MM HEADED IC3024
|
Facility
|
IP
|
$2,186.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599635
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,071.14 |
| Max. Negotiated Rate |
$2,011.12 |
| Rate for Payer: Aetna Commercial |
$1,967.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,879.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,158.58
|
| Rate for Payer: Cash Price |
$655.80
|
| Rate for Payer: Cigna Commercial |
$2,011.12
|
| Rate for Payer: Health EOS Commercial |
$1,945.54
|
| Rate for Payer: HFN Commercial |
$2,011.12
|
| Rate for Payer: Multiplan Commercial |
$1,748.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,311.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,011.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,071.14
|
| Rate for Payer: Quartz Commercial |
$1,311.60
|
| Rate for Payer: WEA Trust Commercial |
$1,202.30
|
| Rate for Payer: WPS Commercial |
$1,619.17
|
|
|
SCREW CANN MINI 3.0 X 24MM HEADED IC3024
|
Facility
|
OP
|
$2,186.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599635
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.08 |
| Max. Negotiated Rate |
$8,744.00 |
| Rate for Payer: Aetna Commercial |
$1,967.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,879.96
|
| Rate for Payer: Aetna Managed Medicare |
$612.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,420.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,093.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,049.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,158.58
|
| Rate for Payer: Cash Price |
$655.80
|
| Rate for Payer: Cigna Commercial |
$2,011.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,223.29
|
| Rate for Payer: Health EOS Commercial |
$1,945.54
|
| Rate for Payer: HFN Commercial |
$2,011.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,639.50
|
| Rate for Payer: Multiplan Commercial |
$1,748.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,311.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,011.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,071.14
|
| Rate for Payer: Quartz Commercial |
$1,420.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,311.60
|
| Rate for Payer: The Alliance Commercial |
$8,744.00
|
| Rate for Payer: WEA Trust Commercial |
$1,202.30
|
| Rate for Payer: WPS Commercial |
$1,619.17
|
|
|
SCREW CANNULATED LAG
|
Facility
|
OP
|
$2,837.00
|
|
| Hospital Charge Code |
2965019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$794.36 |
| Max. Negotiated Rate |
$11,348.00 |
| Rate for Payer: Aetna Commercial |
$2,553.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,439.82
|
| Rate for Payer: Aetna Managed Medicare |
$794.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,844.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,418.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,361.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,503.61
|
| Rate for Payer: Cash Price |
$851.10
|
| Rate for Payer: Cigna Commercial |
$2,610.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,587.59
|
| Rate for Payer: Health EOS Commercial |
$2,524.93
|
| Rate for Payer: HFN Commercial |
$2,610.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,127.75
|
| Rate for Payer: Multiplan Commercial |
$2,269.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,702.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,610.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,390.13
|
| Rate for Payer: Quartz Commercial |
$1,844.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,702.20
|
| Rate for Payer: The Alliance Commercial |
$11,348.00
|
| Rate for Payer: WEA Trust Commercial |
$1,560.35
|
| Rate for Payer: WPS Commercial |
$2,101.37
|
|
|
SCREW CANNULATED LAG
|
Facility
|
IP
|
$2,837.00
|
|
| Hospital Charge Code |
2965019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,390.13 |
| Max. Negotiated Rate |
$2,610.04 |
| Rate for Payer: Aetna Commercial |
$2,553.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,439.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,503.61
|
| Rate for Payer: Cash Price |
$851.10
|
| Rate for Payer: Cigna Commercial |
$2,610.04
|
| Rate for Payer: Health EOS Commercial |
$2,524.93
|
| Rate for Payer: HFN Commercial |
$2,610.04
|
| Rate for Payer: Multiplan Commercial |
$2,269.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,702.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,610.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,390.13
|
| Rate for Payer: Quartz Commercial |
$1,702.20
|
| Rate for Payer: WEA Trust Commercial |
$1,560.35
|
| Rate for Payer: WPS Commercial |
$2,101.37
|
|
|
SCREW CANN VAL 5.0 X 40MM OPTILINK TI 42.231.640
|
Facility
|
IP
|
$2,477.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6244142
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,214.02 |
| Max. Negotiated Rate |
$2,279.39 |
| Rate for Payer: Aetna Commercial |
$2,229.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,130.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,313.13
|
| Rate for Payer: Cash Price |
$743.28
|
| Rate for Payer: Cigna Commercial |
$2,279.39
|
| Rate for Payer: Health EOS Commercial |
$2,205.06
|
| Rate for Payer: HFN Commercial |
$2,279.39
|
| Rate for Payer: Multiplan Commercial |
$1,982.08
|
| Rate for Payer: NAPHCARE Commercial |
$1,486.56
|
| Rate for Payer: Preferred Network Access Commercial |
$2,279.39
|
| Rate for Payer: Quartz Beloit One Network |
$1,214.02
|
| Rate for Payer: Quartz Commercial |
$1,486.56
|
| Rate for Payer: WEA Trust Commercial |
$1,362.68
|
| Rate for Payer: WPS Commercial |
$1,835.16
|
|
