|
SCREW CENTRAL MODULAR UNIVERS REVERS MODULAR GLENOID 25MM AR-9561-25S
|
Facility
|
IP
|
$7,580.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5496842
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,714.20 |
| Max. Negotiated Rate |
$6,973.60 |
| Rate for Payer: Aetna Commercial |
$6,822.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,518.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,017.40
|
| Rate for Payer: Cash Price |
$2,274.00
|
| Rate for Payer: Cigna Commercial |
$6,973.60
|
| Rate for Payer: Health EOS Commercial |
$6,746.20
|
| Rate for Payer: HFN Commercial |
$6,973.60
|
| Rate for Payer: Multiplan Commercial |
$6,064.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,548.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,973.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,714.20
|
| Rate for Payer: Quartz Commercial |
$4,548.00
|
| Rate for Payer: WEA Trust Commercial |
$4,169.00
|
| Rate for Payer: WPS Commercial |
$5,614.51
|
|
|
SCREW CENTRAL MODULAR UNIVERS REVERS MODULAR GLENOID 25MM AR-9561-25S
|
Facility
|
OP
|
$7,580.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5496842
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,122.40 |
| Max. Negotiated Rate |
$30,320.00 |
| Rate for Payer: Aetna Commercial |
$6,822.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,518.80
|
| Rate for Payer: Aetna Managed Medicare |
$2,122.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,927.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,790.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,638.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,017.40
|
| Rate for Payer: Cash Price |
$2,274.00
|
| Rate for Payer: Cigna Commercial |
$6,973.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,241.77
|
| Rate for Payer: Health EOS Commercial |
$6,746.20
|
| Rate for Payer: HFN Commercial |
$6,973.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,685.00
|
| Rate for Payer: Multiplan Commercial |
$6,064.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,548.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,973.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,714.20
|
| Rate for Payer: Quartz Commercial |
$4,927.00
|
| Rate for Payer: Quartz Medicare Advantage |
$4,548.00
|
| Rate for Payer: The Alliance Commercial |
$30,320.00
|
| Rate for Payer: WEA Trust Commercial |
$4,169.00
|
| Rate for Payer: WPS Commercial |
$5,614.51
|
|
|
SCREW CENTRAL MODULAR UNIVERS REVERS MODULAR GLENOID 30MM AR-9561-30S
|
Facility
|
OP
|
$7,288.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5641645
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,040.64 |
| Max. Negotiated Rate |
$29,152.00 |
| Rate for Payer: Aetna Commercial |
$6,559.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,267.68
|
| Rate for Payer: Aetna Managed Medicare |
$2,040.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,737.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,644.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,498.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,862.64
|
| Rate for Payer: Cash Price |
$2,186.40
|
| Rate for Payer: Cigna Commercial |
$6,704.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,078.36
|
| Rate for Payer: Health EOS Commercial |
$6,486.32
|
| Rate for Payer: HFN Commercial |
$6,704.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,466.00
|
| Rate for Payer: Multiplan Commercial |
$5,830.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,372.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,704.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,571.12
|
| Rate for Payer: Quartz Commercial |
$4,737.20
|
| Rate for Payer: Quartz Medicare Advantage |
$4,372.80
|
| Rate for Payer: The Alliance Commercial |
$29,152.00
|
| Rate for Payer: WEA Trust Commercial |
$4,008.40
|
| Rate for Payer: WPS Commercial |
$5,398.22
|
|
|
SCREW CENTRAL MODULAR UNIVERS REVERS MODULAR GLENOID 30MM AR-9561-30S
|
Facility
|
IP
|
$7,288.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5641645
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,571.12 |
| Max. Negotiated Rate |
$6,704.96 |
| Rate for Payer: Aetna Commercial |
$6,559.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,267.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,862.64
|
| Rate for Payer: Cash Price |
$2,186.40
|
| Rate for Payer: Cigna Commercial |
$6,704.96
|
| Rate for Payer: Health EOS Commercial |
$6,486.32
|
| Rate for Payer: HFN Commercial |
$6,704.96
|
| Rate for Payer: Multiplan Commercial |
$5,830.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,372.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,704.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,571.12
|
| Rate for Payer: Quartz Commercial |
$4,372.80
|
| Rate for Payer: WEA Trust Commercial |
$4,008.40
|
| Rate for Payer: WPS Commercial |
$5,398.22
|
|
|
SCREW CENTRAL MODULAR UNIVERS REVERS MODULAR GLENOID 35MM AR-9561-35S
|
Facility
|
OP
|
$7,580.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5490706
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,122.40 |
| Max. Negotiated Rate |
$30,320.00 |
| Rate for Payer: Aetna Commercial |
$6,822.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,518.80
|
| Rate for Payer: Aetna Managed Medicare |
$2,122.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,927.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,790.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,638.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,017.40
|
| Rate for Payer: Cash Price |
$2,274.00
|
| Rate for Payer: Cigna Commercial |
$6,973.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,241.77
|
| Rate for Payer: Health EOS Commercial |
$6,746.20
|
| Rate for Payer: HFN Commercial |
$6,973.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,685.00
|
| Rate for Payer: Multiplan Commercial |
$6,064.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,548.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,973.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,714.20
|
| Rate for Payer: Quartz Commercial |
$4,927.00
|
| Rate for Payer: Quartz Medicare Advantage |
$4,548.00
|
| Rate for Payer: The Alliance Commercial |
$30,320.00
|
| Rate for Payer: WEA Trust Commercial |
$4,169.00
|
| Rate for Payer: WPS Commercial |
$5,614.51
|
|
|
SCREW CENTRAL MODULAR UNIVERS REVERS MODULAR GLENOID 35MM AR-9561-35S
|
Facility
|
IP
|
$7,580.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5490706
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,714.20 |
| Max. Negotiated Rate |
$6,973.60 |
| Rate for Payer: Aetna Commercial |
$6,822.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,518.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,017.40
|
| Rate for Payer: Cash Price |
$2,274.00
|
| Rate for Payer: Cigna Commercial |
$6,973.60
|
| Rate for Payer: Health EOS Commercial |
$6,746.20
|
| Rate for Payer: HFN Commercial |
$6,973.60
|
| Rate for Payer: Multiplan Commercial |
$6,064.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,548.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,973.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,714.20
|
| Rate for Payer: Quartz Commercial |
$4,548.00
|
| Rate for Payer: WEA Trust Commercial |
$4,169.00
|
| Rate for Payer: WPS Commercial |
$5,614.51
|
|
|
SCREW CENTRAL NON-LOCKING UNIVERSAL GLENOID 25MM AR-9165-25NL
|
Facility
|
IP
|
$2,263.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4595206
|
|
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 CENTRAL NON-LOCKING UNIVERSAL GLENOID 25MM AR-9165-25NL
|
Facility
|
OP
|
$2,263.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4595206
|
|
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 CENTRAL UNIVERSAL GLENOID 20MM AR-9165-20
|
Facility
|
IP
|
$2,263.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4220567
|
|
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 CENTRAL UNIVERSAL GLENOID 20MM AR-9165-20
|
Facility
|
OP
|
$2,263.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4220567
|
|
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 CENTRAL UNIVERSAL GLENOID NL 20MM AR-9165-20NL
|
Facility
|
IP
|
$2,263.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4519224
|
|
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 CENTRAL UNIVERSAL GLENOID NL 20MM AR-9165-20NL
|
Facility
|
OP
|
$2,263.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4519224
|
|
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 CHAMFERED 5.5 X 55MM 56025555
|
Facility
|
OP
|
$7,878.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6166132
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,205.84 |
| Max. Negotiated Rate |
$31,512.00 |
| Rate for Payer: Aetna Commercial |
$7,090.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,775.08
|
| Rate for Payer: Aetna Managed Medicare |
$2,205.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,120.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,939.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,781.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,175.34
|
| Rate for Payer: Cash Price |
$2,363.40
|
| Rate for Payer: Cigna Commercial |
$7,247.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,408.53
|
| Rate for Payer: Health EOS Commercial |
$7,011.42
|
| Rate for Payer: HFN Commercial |
$7,247.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,908.50
|
| Rate for Payer: Multiplan Commercial |
$6,302.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,726.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,247.76
|
| Rate for Payer: Quartz Beloit One Network |
$3,860.22
|
| Rate for Payer: Quartz Commercial |
$5,120.70
|
| Rate for Payer: Quartz Medicare Advantage |
$4,726.80
|
| Rate for Payer: The Alliance Commercial |
$31,512.00
|
| Rate for Payer: WEA Trust Commercial |
$4,332.90
|
| Rate for Payer: WPS Commercial |
$5,835.23
|
|
|
SCREW CHAMFERED 5.5 X 55MM 56025555
|
Facility
|
IP
|
$7,878.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6166132
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,860.22 |
| Max. Negotiated Rate |
$7,247.76 |
| Rate for Payer: Aetna Commercial |
$7,090.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,775.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,175.34
|
| Rate for Payer: Cash Price |
$2,363.40
|
| Rate for Payer: Cigna Commercial |
$7,247.76
|
| Rate for Payer: Health EOS Commercial |
$7,011.42
|
| Rate for Payer: HFN Commercial |
$7,247.76
|
| Rate for Payer: Multiplan Commercial |
$6,302.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,726.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,247.76
|
| Rate for Payer: Quartz Beloit One Network |
$3,860.22
|
| Rate for Payer: Quartz Commercial |
$4,726.80
|
| Rate for Payer: WEA Trust Commercial |
$4,332.90
|
| Rate for Payer: WPS Commercial |
$5,835.23
|
|
|
SCREW COMPRESSION 7.0 XL 50MM FULL-THREAD AR-8770-55H
|
Facility
|
OP
|
$5,176.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6234125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,449.28 |
| Max. Negotiated Rate |
$20,704.00 |
| Rate for Payer: Aetna Commercial |
$4,658.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,451.36
|
| Rate for Payer: Aetna Managed Medicare |
$1,449.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,364.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,588.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,484.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,743.28
|
| Rate for Payer: Cash Price |
$1,552.80
|
| Rate for Payer: Cigna Commercial |
$4,761.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,896.49
|
| Rate for Payer: Health EOS Commercial |
$4,606.64
|
| Rate for Payer: HFN Commercial |
$4,761.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,882.00
|
| Rate for Payer: Multiplan Commercial |
$4,140.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,105.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,761.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,536.24
|
| Rate for Payer: Quartz Commercial |
$3,364.40
|
| Rate for Payer: Quartz Medicare Advantage |
$3,105.60
|
| Rate for Payer: The Alliance Commercial |
$20,704.00
|
| Rate for Payer: WEA Trust Commercial |
$2,846.80
|
| Rate for Payer: WPS Commercial |
$3,833.86
|
|
|
SCREW COMPRESSION 7.0 XL 50MM FULL-THREAD AR-8770-55H
|
Facility
|
IP
|
$5,176.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6234125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,536.24 |
| Max. Negotiated Rate |
$4,761.92 |
| Rate for Payer: Aetna Commercial |
$4,658.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,451.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,743.28
|
| Rate for Payer: Cash Price |
$1,552.80
|
| Rate for Payer: Cigna Commercial |
$4,761.92
|
| Rate for Payer: Health EOS Commercial |
$4,606.64
|
| Rate for Payer: HFN Commercial |
$4,761.92
|
| Rate for Payer: Multiplan Commercial |
$4,140.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,105.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,761.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,536.24
|
| Rate for Payer: Quartz Commercial |
$3,105.60
|
| Rate for Payer: WEA Trust Commercial |
$2,846.80
|
| Rate for Payer: WPS Commercial |
$3,833.86
|
|
|
SCREW-COMPRESSION AMBI 19.0MM 121116
|
Facility
|
IP
|
$546.00
|
|
| Hospital Charge Code |
2966039
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$267.54 |
| Max. Negotiated Rate |
$502.32 |
| Rate for Payer: Aetna Commercial |
$491.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$469.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$289.38
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cigna Commercial |
$502.32
|
| Rate for Payer: Health EOS Commercial |
$485.94
|
| Rate for Payer: HFN Commercial |
$502.32
|
| Rate for Payer: Multiplan Commercial |
$436.80
|
| Rate for Payer: NAPHCARE Commercial |
$327.60
|
| Rate for Payer: Preferred Network Access Commercial |
$502.32
|
| Rate for Payer: Quartz Beloit One Network |
$267.54
|
| Rate for Payer: Quartz Commercial |
$327.60
|
| Rate for Payer: WEA Trust Commercial |
$300.30
|
| Rate for Payer: WPS Commercial |
$404.42
|
|
|
SCREW-COMPRESSION AMBI 19.0MM 121116
|
Facility
|
OP
|
$546.00
|
|
| Hospital Charge Code |
2966039
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$152.88 |
| Max. Negotiated Rate |
$2,184.00 |
| Rate for Payer: Aetna Commercial |
$491.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$469.56
|
| Rate for Payer: Aetna Managed Medicare |
$152.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$354.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$273.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$262.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$289.38
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cigna Commercial |
$502.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$305.54
|
| Rate for Payer: Health EOS Commercial |
$485.94
|
| Rate for Payer: HFN Commercial |
$502.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$409.50
|
| Rate for Payer: Multiplan Commercial |
$436.80
|
| Rate for Payer: NAPHCARE Commercial |
$327.60
|
| Rate for Payer: Preferred Network Access Commercial |
$502.32
|
| Rate for Payer: Quartz Beloit One Network |
$267.54
|
| Rate for Payer: Quartz Commercial |
$354.90
|
| Rate for Payer: Quartz Medicare Advantage |
$327.60
|
| Rate for Payer: The Alliance Commercial |
$2,184.00
|
| Rate for Payer: WEA Trust Commercial |
$300.30
|
| Rate for Payer: WPS Commercial |
$404.42
|
|
|
SCREW-COMPRESSION AMBI 28.5MM 121117
|
Facility
|
IP
|
$335.00
|
|
| Hospital Charge Code |
2966040
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$164.15 |
| Max. Negotiated Rate |
$308.20 |
| Rate for Payer: Aetna Commercial |
$301.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$288.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$177.55
|
| Rate for Payer: Cash Price |
$100.50
|
| Rate for Payer: Cigna Commercial |
$308.20
|
| Rate for Payer: Health EOS Commercial |
$298.15
|
| Rate for Payer: HFN Commercial |
$308.20
|
| Rate for Payer: Multiplan Commercial |
$268.00
|
| Rate for Payer: NAPHCARE Commercial |
$201.00
|
| Rate for Payer: Preferred Network Access Commercial |
$308.20
|
| Rate for Payer: Quartz Beloit One Network |
$164.15
|
| Rate for Payer: Quartz Commercial |
$201.00
|
| Rate for Payer: WEA Trust Commercial |
$184.25
|
| Rate for Payer: WPS Commercial |
$248.13
|
|
|
SCREW-COMPRESSION AMBI 28.5MM 121117
|
Facility
|
OP
|
$335.00
|
|
| Hospital Charge Code |
2966040
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$93.80 |
| Max. Negotiated Rate |
$1,340.00 |
| Rate for Payer: Aetna Commercial |
$301.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$288.10
|
| Rate for Payer: Aetna Managed Medicare |
$93.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$217.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$167.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$160.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$177.55
|
| Rate for Payer: Cash Price |
$100.50
|
| Rate for Payer: Cigna Commercial |
$308.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$187.47
|
| Rate for Payer: Health EOS Commercial |
$298.15
|
| Rate for Payer: HFN Commercial |
$308.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$251.25
|
| Rate for Payer: Multiplan Commercial |
$268.00
|
| Rate for Payer: NAPHCARE Commercial |
$201.00
|
| Rate for Payer: Preferred Network Access Commercial |
$308.20
|
| Rate for Payer: Quartz Beloit One Network |
$164.15
|
| Rate for Payer: Quartz Commercial |
$217.75
|
| Rate for Payer: Quartz Medicare Advantage |
$201.00
|
| Rate for Payer: The Alliance Commercial |
$1,340.00
|
| Rate for Payer: WEA Trust Commercial |
$184.25
|
| Rate for Payer: WPS Commercial |
$248.13
|
|
|
SCREW COMPRESSION DHS/DCS 36MM 280.990S
|
Facility
|
IP
|
$1,003.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2966512
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$491.47 |
| Max. Negotiated Rate |
$922.76 |
| Rate for Payer: Aetna Commercial |
$902.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$862.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$531.59
|
| Rate for Payer: Cash Price |
$300.90
|
| Rate for Payer: Cigna Commercial |
$922.76
|
| Rate for Payer: Health EOS Commercial |
$892.67
|
| Rate for Payer: HFN Commercial |
$922.76
|
| Rate for Payer: Multiplan Commercial |
$802.40
|
| Rate for Payer: NAPHCARE Commercial |
$601.80
|
| Rate for Payer: Preferred Network Access Commercial |
$922.76
|
| Rate for Payer: Quartz Beloit One Network |
$491.47
|
| Rate for Payer: Quartz Commercial |
$601.80
|
| Rate for Payer: WEA Trust Commercial |
$551.65
|
| Rate for Payer: WPS Commercial |
$742.92
|
|
|
SCREW COMPRESSION DHS/DCS 36MM 280.990S
|
Facility
|
OP
|
$1,003.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2966512
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$280.84 |
| Max. Negotiated Rate |
$4,012.00 |
| Rate for Payer: Aetna Commercial |
$902.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$862.58
|
| Rate for Payer: Aetna Managed Medicare |
$280.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$651.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$501.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$481.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$531.59
|
| Rate for Payer: Cash Price |
$300.90
|
| Rate for Payer: Cigna Commercial |
$922.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$561.28
|
| Rate for Payer: Health EOS Commercial |
$892.67
|
| Rate for Payer: HFN Commercial |
$922.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$752.25
|
| Rate for Payer: Multiplan Commercial |
$802.40
|
| Rate for Payer: NAPHCARE Commercial |
$601.80
|
| Rate for Payer: Preferred Network Access Commercial |
$922.76
|
| Rate for Payer: Quartz Beloit One Network |
$491.47
|
| Rate for Payer: Quartz Commercial |
$651.95
|
| Rate for Payer: Quartz Medicare Advantage |
$601.80
|
| Rate for Payer: The Alliance Commercial |
$4,012.00
|
| Rate for Payer: WEA Trust Commercial |
$551.65
|
| Rate for Payer: WPS Commercial |
$742.92
|
|
|
SCREW COMPRESSION DHS LCP DHHS
|
Facility
|
OP
|
$965.00
|
|
| Hospital Charge Code |
2966552
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$270.20 |
| Max. Negotiated Rate |
$3,860.00 |
| Rate for Payer: Aetna Commercial |
$868.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$829.90
|
| Rate for Payer: Aetna Managed Medicare |
$270.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$627.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$482.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$463.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$511.45
|
| Rate for Payer: Cash Price |
$289.50
|
| Rate for Payer: Cigna Commercial |
$887.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$540.01
|
| Rate for Payer: Health EOS Commercial |
$858.85
|
| Rate for Payer: HFN Commercial |
$887.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$723.75
|
| Rate for Payer: Multiplan Commercial |
$772.00
|
| Rate for Payer: NAPHCARE Commercial |
$579.00
|
| Rate for Payer: Preferred Network Access Commercial |
$887.80
|
| Rate for Payer: Quartz Beloit One Network |
$472.85
|
| Rate for Payer: Quartz Commercial |
$627.25
|
| Rate for Payer: Quartz Medicare Advantage |
$579.00
|
| Rate for Payer: The Alliance Commercial |
$3,860.00
|
| Rate for Payer: WEA Trust Commercial |
$530.75
|
| Rate for Payer: WPS Commercial |
$714.78
|
|
|
SCREW COMPRESSION DHS LCP DHHS
|
Facility
|
IP
|
$965.00
|
|
| Hospital Charge Code |
2966552
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$472.85 |
| Max. Negotiated Rate |
$887.80 |
| Rate for Payer: Aetna Commercial |
$868.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$829.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$511.45
|
| Rate for Payer: Cash Price |
$289.50
|
| Rate for Payer: Cigna Commercial |
$887.80
|
| Rate for Payer: Health EOS Commercial |
$858.85
|
| Rate for Payer: HFN Commercial |
$887.80
|
| Rate for Payer: Multiplan Commercial |
$772.00
|
| Rate for Payer: NAPHCARE Commercial |
$579.00
|
| Rate for Payer: Preferred Network Access Commercial |
$887.80
|
| Rate for Payer: Quartz Beloit One Network |
$472.85
|
| Rate for Payer: Quartz Commercial |
$579.00
|
| Rate for Payer: WEA Trust Commercial |
$530.75
|
| Rate for Payer: WPS Commercial |
$714.78
|
|
|
SCREW COMPRESSION HEADLESS 4.3 X 44MM PT AR-8643-44
|
Facility
|
OP
|
$3,989.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5591390
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,116.92 |
| Max. Negotiated Rate |
$15,956.00 |
| Rate for Payer: Aetna Commercial |
$3,590.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,430.54
|
| Rate for Payer: Aetna Managed Medicare |
$1,116.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,592.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,994.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,914.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,114.17
|
| Rate for Payer: Cash Price |
$1,196.70
|
| Rate for Payer: Cigna Commercial |
$3,669.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,232.24
|
| Rate for Payer: Health EOS Commercial |
$3,550.21
|
| Rate for Payer: HFN Commercial |
$3,669.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,991.75
|
| Rate for Payer: Multiplan Commercial |
$3,191.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,393.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,669.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,954.61
|
| Rate for Payer: Quartz Commercial |
$2,592.85
|
| Rate for Payer: Quartz Medicare Advantage |
$2,393.40
|
| Rate for Payer: The Alliance Commercial |
$15,956.00
|
| Rate for Payer: WEA Trust Commercial |
$2,193.95
|
| Rate for Payer: WPS Commercial |
$2,954.65
|
|
