|
SCREW COMPRESSION HEADLESS 4.3 X 44MM PT AR-8643-44
|
Facility
|
IP
|
$3,989.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5591390
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,954.61 |
| Max. Negotiated Rate |
$3,669.88 |
| Rate for Payer: Aetna Commercial |
$3,590.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,430.54
|
| 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: Health EOS Commercial |
$3,550.21
|
| Rate for Payer: HFN Commercial |
$3,669.88
|
| 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 |
$2,393.40
|
| Rate for Payer: WEA Trust Commercial |
$2,193.95
|
| Rate for Payer: WPS Commercial |
$2,954.65
|
|
|
SCREW COMPRESSION HEADLESS 6.5 X50MM PT AR-8665-1850
|
Facility
|
IP
|
$4,282.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6234121
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,098.18 |
| Max. Negotiated Rate |
$3,939.44 |
| Rate for Payer: Aetna Commercial |
$3,853.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,682.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,269.46
|
| Rate for Payer: Cash Price |
$1,284.60
|
| Rate for Payer: Cigna Commercial |
$3,939.44
|
| Rate for Payer: Health EOS Commercial |
$3,810.98
|
| Rate for Payer: HFN Commercial |
$3,939.44
|
| Rate for Payer: Multiplan Commercial |
$3,425.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,569.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,939.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,098.18
|
| Rate for Payer: Quartz Commercial |
$2,569.20
|
| Rate for Payer: WEA Trust Commercial |
$2,355.10
|
| Rate for Payer: WPS Commercial |
$3,171.68
|
|
|
SCREW COMPRESSION HEADLESS 6.5 X50MM PT AR-8665-1850
|
Facility
|
OP
|
$4,282.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6234121
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,198.96 |
| Max. Negotiated Rate |
$17,128.00 |
| Rate for Payer: Aetna Commercial |
$3,853.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,682.52
|
| Rate for Payer: Aetna Managed Medicare |
$1,198.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,783.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,141.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,055.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,269.46
|
| Rate for Payer: Cash Price |
$1,284.60
|
| Rate for Payer: Cigna Commercial |
$3,939.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,396.21
|
| Rate for Payer: Health EOS Commercial |
$3,810.98
|
| Rate for Payer: HFN Commercial |
$3,939.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,211.50
|
| Rate for Payer: Multiplan Commercial |
$3,425.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,569.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,939.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,098.18
|
| Rate for Payer: Quartz Commercial |
$2,783.30
|
| Rate for Payer: Quartz Medicare Advantage |
$2,569.20
|
| Rate for Payer: The Alliance Commercial |
$17,128.00
|
| Rate for Payer: WEA Trust Commercial |
$2,355.10
|
| Rate for Payer: WPS Commercial |
$3,171.68
|
|
|
SCREW COMPRESSION HEADLESS 6.5 X55MM PT AR-8665-1855
|
Facility
|
IP
|
$4,282.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6234122
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,098.18 |
| Max. Negotiated Rate |
$3,939.44 |
| Rate for Payer: Aetna Commercial |
$3,853.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,682.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,269.46
|
| Rate for Payer: Cash Price |
$1,284.60
|
| Rate for Payer: Cigna Commercial |
$3,939.44
|
| Rate for Payer: Health EOS Commercial |
$3,810.98
|
| Rate for Payer: HFN Commercial |
$3,939.44
|
| Rate for Payer: Multiplan Commercial |
$3,425.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,569.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,939.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,098.18
|
| Rate for Payer: Quartz Commercial |
$2,569.20
|
| Rate for Payer: WEA Trust Commercial |
$2,355.10
|
| Rate for Payer: WPS Commercial |
$3,171.68
|
|
|
SCREW COMPRESSION HEADLESS 6.5 X55MM PT AR-8665-1855
|
Facility
|
OP
|
$4,282.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6234122
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,198.96 |
| Max. Negotiated Rate |
$17,128.00 |
| Rate for Payer: Aetna Commercial |
$3,853.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,682.52
|
| Rate for Payer: Aetna Managed Medicare |
$1,198.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,783.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,141.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,055.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,269.46
|
| Rate for Payer: Cash Price |
$1,284.60
|
| Rate for Payer: Cigna Commercial |
$3,939.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,396.21
|
| Rate for Payer: Health EOS Commercial |
$3,810.98
|
| Rate for Payer: HFN Commercial |
$3,939.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,211.50
|
| Rate for Payer: Multiplan Commercial |
$3,425.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,569.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,939.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,098.18
|
| Rate for Payer: Quartz Commercial |
$2,783.30
|
| Rate for Payer: Quartz Medicare Advantage |
$2,569.20
|
| Rate for Payer: The Alliance Commercial |
$17,128.00
|
| Rate for Payer: WEA Trust Commercial |
$2,355.10
|
| Rate for Payer: WPS Commercial |
$3,171.68
|
|
|
SCREW COMPRESSION HEADLESS 6.5 X60MM PT AR-8665-1860
|
Facility
|
IP
|
$4,282.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6236128
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,098.18 |
| Max. Negotiated Rate |
$3,939.44 |
| Rate for Payer: Aetna Commercial |
$3,853.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,682.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,269.46
|
| Rate for Payer: Cash Price |
$1,284.60
|
| Rate for Payer: Cigna Commercial |
$3,939.44
|
| Rate for Payer: Health EOS Commercial |
$3,810.98
|
| Rate for Payer: HFN Commercial |
$3,939.44
|
| Rate for Payer: Multiplan Commercial |
$3,425.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,569.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,939.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,098.18
|
| Rate for Payer: Quartz Commercial |
$2,569.20
|
| Rate for Payer: WEA Trust Commercial |
$2,355.10
|
| Rate for Payer: WPS Commercial |
$3,171.68
|
|
|
SCREW COMPRESSION HEADLESS 6.5 X60MM PT AR-8665-1860
|
Facility
|
OP
|
$4,282.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6236128
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,198.96 |
| Max. Negotiated Rate |
$17,128.00 |
| Rate for Payer: Aetna Commercial |
$3,853.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,682.52
|
| Rate for Payer: Aetna Managed Medicare |
$1,198.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,783.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,141.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,055.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,269.46
|
| Rate for Payer: Cash Price |
$1,284.60
|
| Rate for Payer: Cigna Commercial |
$3,939.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,396.21
|
| Rate for Payer: Health EOS Commercial |
$3,810.98
|
| Rate for Payer: HFN Commercial |
$3,939.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,211.50
|
| Rate for Payer: Multiplan Commercial |
$3,425.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,569.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,939.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,098.18
|
| Rate for Payer: Quartz Commercial |
$2,783.30
|
| Rate for Payer: Quartz Medicare Advantage |
$2,569.20
|
| Rate for Payer: The Alliance Commercial |
$17,128.00
|
| Rate for Payer: WEA Trust Commercial |
$2,355.10
|
| Rate for Payer: WPS Commercial |
$3,171.68
|
|
|
SCREW COMPRESSION HEADLESS 6.5 X 65MM PT AR-8665-1865
|
Facility
|
OP
|
$4,587.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5603631
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,284.36 |
| Max. Negotiated Rate |
$18,348.00 |
| Rate for Payer: Aetna Commercial |
$4,128.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,944.82
|
| Rate for Payer: Aetna Managed Medicare |
$1,284.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,981.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,293.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,201.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,431.11
|
| Rate for Payer: Cash Price |
$1,376.10
|
| Rate for Payer: Cigna Commercial |
$4,220.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,566.89
|
| Rate for Payer: Health EOS Commercial |
$4,082.43
|
| Rate for Payer: HFN Commercial |
$4,220.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,440.25
|
| Rate for Payer: Multiplan Commercial |
$3,669.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,752.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,220.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,247.63
|
| Rate for Payer: Quartz Commercial |
$2,981.55
|
| Rate for Payer: Quartz Medicare Advantage |
$2,752.20
|
| Rate for Payer: The Alliance Commercial |
$18,348.00
|
| Rate for Payer: WEA Trust Commercial |
$2,522.85
|
| Rate for Payer: WPS Commercial |
$3,397.59
|
|
|
SCREW COMPRESSION HEADLESS 6.5 X 65MM PT AR-8665-1865
|
Facility
|
IP
|
$4,587.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5603631
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,247.63 |
| Max. Negotiated Rate |
$4,220.04 |
| Rate for Payer: Aetna Commercial |
$4,128.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,944.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,431.11
|
| Rate for Payer: Cash Price |
$1,376.10
|
| Rate for Payer: Cigna Commercial |
$4,220.04
|
| Rate for Payer: Health EOS Commercial |
$4,082.43
|
| Rate for Payer: HFN Commercial |
$4,220.04
|
| Rate for Payer: Multiplan Commercial |
$3,669.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,752.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,220.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,247.63
|
| Rate for Payer: Quartz Commercial |
$2,752.20
|
| Rate for Payer: WEA Trust Commercial |
$2,522.85
|
| Rate for Payer: WPS Commercial |
$3,397.59
|
|
|
SCREW COMPRESSION HEADLESS 6.5 X 70MM LONG THREAD AR-8665-2870
|
Facility
|
IP
|
$4,411.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5729736
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,161.39 |
| Max. Negotiated Rate |
$4,058.12 |
| Rate for Payer: Aetna Commercial |
$3,969.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,793.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,337.83
|
| Rate for Payer: Cash Price |
$1,323.30
|
| Rate for Payer: Cigna Commercial |
$4,058.12
|
| Rate for Payer: Health EOS Commercial |
$3,925.79
|
| Rate for Payer: HFN Commercial |
$4,058.12
|
| Rate for Payer: Multiplan Commercial |
$3,528.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,646.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,058.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,161.39
|
| Rate for Payer: Quartz Commercial |
$2,646.60
|
| Rate for Payer: WEA Trust Commercial |
$2,426.05
|
| Rate for Payer: WPS Commercial |
$3,267.23
|
|
|
SCREW COMPRESSION HEADLESS 6.5 X 70MM LONG THREAD AR-8665-2870
|
Facility
|
OP
|
$4,411.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5729736
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,235.08 |
| Max. Negotiated Rate |
$17,644.00 |
| Rate for Payer: Aetna Commercial |
$3,969.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,793.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,235.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,867.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,205.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,117.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,337.83
|
| Rate for Payer: Cash Price |
$1,323.30
|
| Rate for Payer: Cigna Commercial |
$4,058.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,468.40
|
| Rate for Payer: Health EOS Commercial |
$3,925.79
|
| Rate for Payer: HFN Commercial |
$4,058.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,308.25
|
| Rate for Payer: Multiplan Commercial |
$3,528.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,646.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,058.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,161.39
|
| Rate for Payer: Quartz Commercial |
$2,867.15
|
| Rate for Payer: Quartz Medicare Advantage |
$2,646.60
|
| Rate for Payer: The Alliance Commercial |
$17,644.00
|
| Rate for Payer: WEA Trust Commercial |
$2,426.05
|
| Rate for Payer: WPS Commercial |
$3,267.23
|
|
|
SCREW COMPRESSION HEADLESS 6.5 X 70MM PT AR-8665-1870
|
Facility
|
OP
|
$4,587.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5591391
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,284.36 |
| Max. Negotiated Rate |
$18,348.00 |
| Rate for Payer: Aetna Commercial |
$4,128.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,944.82
|
| Rate for Payer: Aetna Managed Medicare |
$1,284.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,981.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,293.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,201.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,431.11
|
| Rate for Payer: Cash Price |
$1,376.10
|
| Rate for Payer: Cigna Commercial |
$4,220.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,566.89
|
| Rate for Payer: Health EOS Commercial |
$4,082.43
|
| Rate for Payer: HFN Commercial |
$4,220.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,440.25
|
| Rate for Payer: Multiplan Commercial |
$3,669.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,752.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,220.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,247.63
|
| Rate for Payer: Quartz Commercial |
$2,981.55
|
| Rate for Payer: Quartz Medicare Advantage |
$2,752.20
|
| Rate for Payer: The Alliance Commercial |
$18,348.00
|
| Rate for Payer: WEA Trust Commercial |
$2,522.85
|
| Rate for Payer: WPS Commercial |
$3,397.59
|
|
|
SCREW COMPRESSION HEADLESS 6.5 X 70MM PT AR-8665-1870
|
Facility
|
IP
|
$4,587.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5591391
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,247.63 |
| Max. Negotiated Rate |
$4,220.04 |
| Rate for Payer: Aetna Commercial |
$4,128.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,944.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,431.11
|
| Rate for Payer: Cash Price |
$1,376.10
|
| Rate for Payer: Cigna Commercial |
$4,220.04
|
| Rate for Payer: Health EOS Commercial |
$4,082.43
|
| Rate for Payer: HFN Commercial |
$4,220.04
|
| Rate for Payer: Multiplan Commercial |
$3,669.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,752.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,220.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,247.63
|
| Rate for Payer: Quartz Commercial |
$2,752.20
|
| Rate for Payer: WEA Trust Commercial |
$2,522.85
|
| Rate for Payer: WPS Commercial |
$3,397.59
|
|
|
SCREW COMPRESSION HEADLESS 6.5 X 75MM LONG THREAD AR-8665-2875
|
Facility
|
IP
|
$4,411.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5729737
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,161.39 |
| Max. Negotiated Rate |
$4,058.12 |
| Rate for Payer: Aetna Commercial |
$3,969.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,793.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,337.83
|
| Rate for Payer: Cash Price |
$1,323.30
|
| Rate for Payer: Cigna Commercial |
$4,058.12
|
| Rate for Payer: Health EOS Commercial |
$3,925.79
|
| Rate for Payer: HFN Commercial |
$4,058.12
|
| Rate for Payer: Multiplan Commercial |
$3,528.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,646.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,058.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,161.39
|
| Rate for Payer: Quartz Commercial |
$2,646.60
|
| Rate for Payer: WEA Trust Commercial |
$2,426.05
|
| Rate for Payer: WPS Commercial |
$3,267.23
|
|
|
SCREW COMPRESSION HEADLESS 6.5 X 75MM LONG THREAD AR-8665-2875
|
Facility
|
OP
|
$4,411.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5729737
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,235.08 |
| Max. Negotiated Rate |
$17,644.00 |
| Rate for Payer: Aetna Commercial |
$3,969.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,793.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,235.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,867.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,205.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,117.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,337.83
|
| Rate for Payer: Cash Price |
$1,323.30
|
| Rate for Payer: Cigna Commercial |
$4,058.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,468.40
|
| Rate for Payer: Health EOS Commercial |
$3,925.79
|
| Rate for Payer: HFN Commercial |
$4,058.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,308.25
|
| Rate for Payer: Multiplan Commercial |
$3,528.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,646.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,058.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,161.39
|
| Rate for Payer: Quartz Commercial |
$2,867.15
|
| Rate for Payer: Quartz Medicare Advantage |
$2,646.60
|
| Rate for Payer: The Alliance Commercial |
$17,644.00
|
| Rate for Payer: WEA Trust Commercial |
$2,426.05
|
| Rate for Payer: WPS Commercial |
$3,267.23
|
|
|
SCREW COMPRESSION HEADLESS 6.5 X 75MM PT AR-8665-1875
|
Facility
|
IP
|
$4,587.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5603632
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,247.63 |
| Max. Negotiated Rate |
$4,220.04 |
| Rate for Payer: Aetna Commercial |
$4,128.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,944.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,431.11
|
| Rate for Payer: Cash Price |
$1,376.10
|
| Rate for Payer: Cigna Commercial |
$4,220.04
|
| Rate for Payer: Health EOS Commercial |
$4,082.43
|
| Rate for Payer: HFN Commercial |
$4,220.04
|
| Rate for Payer: Multiplan Commercial |
$3,669.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,752.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,220.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,247.63
|
| Rate for Payer: Quartz Commercial |
$2,752.20
|
| Rate for Payer: WEA Trust Commercial |
$2,522.85
|
| Rate for Payer: WPS Commercial |
$3,397.59
|
|
|
SCREW COMPRESSION HEADLESS 6.5 X 75MM PT AR-8665-1875
|
Facility
|
OP
|
$4,587.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5603632
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,284.36 |
| Max. Negotiated Rate |
$18,348.00 |
| Rate for Payer: Aetna Commercial |
$4,128.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,944.82
|
| Rate for Payer: Aetna Managed Medicare |
$1,284.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,981.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,293.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,201.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,431.11
|
| Rate for Payer: Cash Price |
$1,376.10
|
| Rate for Payer: Cigna Commercial |
$4,220.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,566.89
|
| Rate for Payer: Health EOS Commercial |
$4,082.43
|
| Rate for Payer: HFN Commercial |
$4,220.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,440.25
|
| Rate for Payer: Multiplan Commercial |
$3,669.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,752.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,220.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,247.63
|
| Rate for Payer: Quartz Commercial |
$2,981.55
|
| Rate for Payer: Quartz Medicare Advantage |
$2,752.20
|
| Rate for Payer: The Alliance Commercial |
$18,348.00
|
| Rate for Payer: WEA Trust Commercial |
$2,522.85
|
| Rate for Payer: WPS Commercial |
$3,397.59
|
|
|
SCREW COMPRESSION HEADLESS 6.5 X 80MM LONG THREAD AR-8665-2880
|
Facility
|
IP
|
$4,411.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5729738
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,161.39 |
| Max. Negotiated Rate |
$4,058.12 |
| Rate for Payer: Aetna Commercial |
$3,969.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,793.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,337.83
|
| Rate for Payer: Cash Price |
$1,323.30
|
| Rate for Payer: Cigna Commercial |
$4,058.12
|
| Rate for Payer: Health EOS Commercial |
$3,925.79
|
| Rate for Payer: HFN Commercial |
$4,058.12
|
| Rate for Payer: Multiplan Commercial |
$3,528.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,646.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,058.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,161.39
|
| Rate for Payer: Quartz Commercial |
$2,646.60
|
| Rate for Payer: WEA Trust Commercial |
$2,426.05
|
| Rate for Payer: WPS Commercial |
$3,267.23
|
|
|
SCREW COMPRESSION HEADLESS 6.5 X 80MM LONG THREAD AR-8665-2880
|
Facility
|
OP
|
$4,411.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5729738
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,235.08 |
| Max. Negotiated Rate |
$17,644.00 |
| Rate for Payer: Aetna Commercial |
$3,969.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,793.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,235.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,867.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,205.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,117.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,337.83
|
| Rate for Payer: Cash Price |
$1,323.30
|
| Rate for Payer: Cigna Commercial |
$4,058.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,468.40
|
| Rate for Payer: Health EOS Commercial |
$3,925.79
|
| Rate for Payer: HFN Commercial |
$4,058.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,308.25
|
| Rate for Payer: Multiplan Commercial |
$3,528.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,646.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,058.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,161.39
|
| Rate for Payer: Quartz Commercial |
$2,867.15
|
| Rate for Payer: Quartz Medicare Advantage |
$2,646.60
|
| Rate for Payer: The Alliance Commercial |
$17,644.00
|
| Rate for Payer: WEA Trust Commercial |
$2,426.05
|
| Rate for Payer: WPS Commercial |
$3,267.23
|
|
|
SCREW COMPRESSION HEADLESS 6.5 X 80MM PT AR-8665-1880
|
Facility
|
OP
|
$6,117.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5591392
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,712.76 |
| Max. Negotiated Rate |
$24,468.00 |
| Rate for Payer: Aetna Commercial |
$5,505.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,260.62
|
| Rate for Payer: Aetna Managed Medicare |
$1,712.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,976.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,058.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,936.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,242.01
|
| Rate for Payer: Cash Price |
$1,835.10
|
| Rate for Payer: Cigna Commercial |
$5,627.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,423.07
|
| Rate for Payer: Health EOS Commercial |
$5,444.13
|
| Rate for Payer: HFN Commercial |
$5,627.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,587.75
|
| Rate for Payer: Multiplan Commercial |
$4,893.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,670.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,627.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,997.33
|
| Rate for Payer: Quartz Commercial |
$3,976.05
|
| Rate for Payer: Quartz Medicare Advantage |
$3,670.20
|
| Rate for Payer: The Alliance Commercial |
$24,468.00
|
| Rate for Payer: WEA Trust Commercial |
$3,364.35
|
| Rate for Payer: WPS Commercial |
$4,530.86
|
|
|
SCREW COMPRESSION HEADLESS 6.5 X 80MM PT AR-8665-1880
|
Facility
|
IP
|
$6,117.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5591392
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,997.33 |
| Max. Negotiated Rate |
$5,627.64 |
| Rate for Payer: Aetna Commercial |
$5,505.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,260.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,242.01
|
| Rate for Payer: Cash Price |
$1,835.10
|
| Rate for Payer: Cigna Commercial |
$5,627.64
|
| Rate for Payer: Health EOS Commercial |
$5,444.13
|
| Rate for Payer: HFN Commercial |
$5,627.64
|
| Rate for Payer: Multiplan Commercial |
$4,893.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,670.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,627.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,997.33
|
| Rate for Payer: Quartz Commercial |
$3,670.20
|
| Rate for Payer: WEA Trust Commercial |
$3,364.35
|
| Rate for Payer: WPS Commercial |
$4,530.86
|
|
|
SCREW COMPRESSION SCREW CANN T2 1818-0001S
|
Facility
|
OP
|
$1,645.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5611629
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$460.60 |
| Max. Negotiated Rate |
$6,580.00 |
| Rate for Payer: Aetna Commercial |
$1,480.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,414.70
|
| Rate for Payer: Aetna Managed Medicare |
$460.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,069.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$822.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$789.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$871.85
|
| Rate for Payer: Cash Price |
$493.50
|
| Rate for Payer: Cigna Commercial |
$1,513.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$920.54
|
| Rate for Payer: Health EOS Commercial |
$1,464.05
|
| Rate for Payer: HFN Commercial |
$1,513.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,233.75
|
| Rate for Payer: Multiplan Commercial |
$1,316.00
|
| Rate for Payer: NAPHCARE Commercial |
$987.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,513.40
|
| Rate for Payer: Quartz Beloit One Network |
$806.05
|
| Rate for Payer: Quartz Commercial |
$1,069.25
|
| Rate for Payer: Quartz Medicare Advantage |
$987.00
|
| Rate for Payer: The Alliance Commercial |
$6,580.00
|
| Rate for Payer: WEA Trust Commercial |
$904.75
|
| Rate for Payer: WPS Commercial |
$1,218.45
|
|
|
SCREW COMPRESSION SCREW CANN T2 1818-0001S
|
Facility
|
IP
|
$1,645.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5611629
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$806.05 |
| Max. Negotiated Rate |
$1,513.40 |
| Rate for Payer: Aetna Commercial |
$1,480.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,414.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$871.85
|
| Rate for Payer: Cash Price |
$493.50
|
| Rate for Payer: Cigna Commercial |
$1,513.40
|
| Rate for Payer: Health EOS Commercial |
$1,464.05
|
| Rate for Payer: HFN Commercial |
$1,513.40
|
| Rate for Payer: Multiplan Commercial |
$1,316.00
|
| Rate for Payer: NAPHCARE Commercial |
$987.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,513.40
|
| Rate for Payer: Quartz Beloit One Network |
$806.05
|
| Rate for Payer: Quartz Commercial |
$987.00
|
| Rate for Payer: WEA Trust Commercial |
$904.75
|
| Rate for Payer: WPS Commercial |
$1,218.45
|
|
|
SCREW CORT 1.0 X 10 ST 200.530
|
Facility
|
OP
|
$1,020.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494519
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$285.60 |
| Max. Negotiated Rate |
$4,080.00 |
| Rate for Payer: Aetna Commercial |
$918.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$877.20
|
| Rate for Payer: Aetna Managed Medicare |
$285.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$663.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$510.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$489.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$540.60
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$938.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$570.79
|
| Rate for Payer: Health EOS Commercial |
$907.80
|
| Rate for Payer: HFN Commercial |
$938.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$765.00
|
| Rate for Payer: Multiplan Commercial |
$816.00
|
| Rate for Payer: NAPHCARE Commercial |
$612.00
|
| Rate for Payer: Preferred Network Access Commercial |
$938.40
|
| Rate for Payer: Quartz Beloit One Network |
$499.80
|
| Rate for Payer: Quartz Commercial |
$663.00
|
| Rate for Payer: Quartz Medicare Advantage |
$612.00
|
| Rate for Payer: The Alliance Commercial |
$4,080.00
|
| Rate for Payer: WEA Trust Commercial |
$561.00
|
| Rate for Payer: WPS Commercial |
$755.51
|
|
|
SCREW CORT 1.0 X 10 ST 200.530
|
Facility
|
IP
|
$1,020.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494519
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$499.80 |
| Max. Negotiated Rate |
$938.40 |
| Rate for Payer: Aetna Commercial |
$918.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$877.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$540.60
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$938.40
|
| Rate for Payer: Health EOS Commercial |
$907.80
|
| Rate for Payer: HFN Commercial |
$938.40
|
| Rate for Payer: Multiplan Commercial |
$816.00
|
| Rate for Payer: NAPHCARE Commercial |
$612.00
|
| Rate for Payer: Preferred Network Access Commercial |
$938.40
|
| Rate for Payer: Quartz Beloit One Network |
$499.80
|
| Rate for Payer: Quartz Commercial |
$612.00
|
| Rate for Payer: WEA Trust Commercial |
$561.00
|
| Rate for Payer: WPS Commercial |
$755.51
|
|
