|
SCREW CORT LOW PROFILE 3.5 X 30 02.206.230
|
Facility
|
IP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3265476
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$264.48 |
| Max. Negotiated Rate |
$496.58 |
| Rate for Payer: Aetna Commercial |
$485.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$464.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$286.07
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna Commercial |
$496.58
|
| Rate for Payer: Health EOS Commercial |
$480.39
|
| Rate for Payer: HFN Commercial |
$496.58
|
| Rate for Payer: Multiplan Commercial |
$431.81
|
| Rate for Payer: Preferred Network Access Commercial |
$496.58
|
| Rate for Payer: Quartz Beloit One Network |
$264.48
|
| Rate for Payer: Quartz Commercial |
$323.86
|
| Rate for Payer: WEA Trust Commercial |
$296.87
|
| Rate for Payer: WPS Commercial |
$399.79
|
|
|
SCREW CORT LOW PROFILE 3.5 X 30 02.206.230
|
Facility
|
OP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3265476
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$151.13 |
| Max. Negotiated Rate |
$496.58 |
| Rate for Payer: Aetna Commercial |
$485.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$464.19
|
| Rate for Payer: Aetna Managed Medicare |
$151.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$350.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$269.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$259.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$286.07
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna Commercial |
$496.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$302.06
|
| Rate for Payer: Health EOS Commercial |
$480.39
|
| Rate for Payer: HFN Commercial |
$496.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.82
|
| Rate for Payer: Multiplan Commercial |
$431.81
|
| Rate for Payer: NAPHCARE Commercial |
$323.86
|
| Rate for Payer: Preferred Network Access Commercial |
$496.58
|
| Rate for Payer: Quartz Beloit One Network |
$264.48
|
| Rate for Payer: Quartz Commercial |
$350.84
|
| Rate for Payer: Quartz Medicare Advantage |
$323.86
|
| Rate for Payer: The Alliance Commercial |
$269.88
|
| Rate for Payer: WEA Trust Commercial |
$296.87
|
| Rate for Payer: WPS Commercial |
$399.79
|
|
|
SCREW CORT LOW PROFILE 3.5 X 36 02.206.236
|
Facility
|
IP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3265478
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$264.48 |
| Max. Negotiated Rate |
$496.58 |
| Rate for Payer: Aetna Commercial |
$485.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$464.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$286.07
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna Commercial |
$496.58
|
| Rate for Payer: Health EOS Commercial |
$480.39
|
| Rate for Payer: HFN Commercial |
$496.58
|
| Rate for Payer: Multiplan Commercial |
$431.81
|
| Rate for Payer: Preferred Network Access Commercial |
$496.58
|
| Rate for Payer: Quartz Beloit One Network |
$264.48
|
| Rate for Payer: Quartz Commercial |
$323.86
|
| Rate for Payer: WEA Trust Commercial |
$296.87
|
| Rate for Payer: WPS Commercial |
$399.79
|
|
|
SCREW CORT LOW PROFILE 3.5 X 36 02.206.236
|
Facility
|
OP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3265478
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$151.13 |
| Max. Negotiated Rate |
$496.58 |
| Rate for Payer: Aetna Commercial |
$485.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$464.19
|
| Rate for Payer: Aetna Managed Medicare |
$151.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$350.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$269.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$259.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$286.07
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna Commercial |
$496.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$302.06
|
| Rate for Payer: Health EOS Commercial |
$480.39
|
| Rate for Payer: HFN Commercial |
$496.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.82
|
| Rate for Payer: Multiplan Commercial |
$431.81
|
| Rate for Payer: NAPHCARE Commercial |
$323.86
|
| Rate for Payer: Preferred Network Access Commercial |
$496.58
|
| Rate for Payer: Quartz Beloit One Network |
$264.48
|
| Rate for Payer: Quartz Commercial |
$350.84
|
| Rate for Payer: Quartz Medicare Advantage |
$323.86
|
| Rate for Payer: The Alliance Commercial |
$269.88
|
| Rate for Payer: WEA Trust Commercial |
$296.87
|
| Rate for Payer: WPS Commercial |
$399.79
|
|
|
SCREW CORT LOW PROFILE 3.5 X 46MM 02.206.246
|
Facility
|
OP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4028668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$151.13 |
| Max. Negotiated Rate |
$496.58 |
| Rate for Payer: Aetna Commercial |
$485.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$464.19
|
| Rate for Payer: Aetna Managed Medicare |
$151.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$350.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$269.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$259.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$286.07
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna Commercial |
$496.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$302.06
|
| Rate for Payer: Health EOS Commercial |
$480.39
|
| Rate for Payer: HFN Commercial |
$496.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.82
|
| Rate for Payer: Multiplan Commercial |
$431.81
|
| Rate for Payer: NAPHCARE Commercial |
$323.86
|
| Rate for Payer: Preferred Network Access Commercial |
$496.58
|
| Rate for Payer: Quartz Beloit One Network |
$264.48
|
| Rate for Payer: Quartz Commercial |
$350.84
|
| Rate for Payer: Quartz Medicare Advantage |
$323.86
|
| Rate for Payer: The Alliance Commercial |
$269.88
|
| Rate for Payer: WEA Trust Commercial |
$296.87
|
| Rate for Payer: WPS Commercial |
$399.79
|
|
|
SCREW CORT LOW PROFILE 3.5 X 46MM 02.206.246
|
Facility
|
IP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4028668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$264.48 |
| Max. Negotiated Rate |
$496.58 |
| Rate for Payer: Aetna Commercial |
$485.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$464.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$286.07
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna Commercial |
$496.58
|
| Rate for Payer: Health EOS Commercial |
$480.39
|
| Rate for Payer: HFN Commercial |
$496.58
|
| Rate for Payer: Multiplan Commercial |
$431.81
|
| Rate for Payer: Preferred Network Access Commercial |
$496.58
|
| Rate for Payer: Quartz Beloit One Network |
$264.48
|
| Rate for Payer: Quartz Commercial |
$323.86
|
| Rate for Payer: WEA Trust Commercial |
$296.87
|
| Rate for Payer: WPS Commercial |
$399.79
|
|
|
SCREW CORT LOW PROFILE 3.5 X 50 02.206.250
|
Facility
|
IP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3259479
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$264.48 |
| Max. Negotiated Rate |
$496.58 |
| Rate for Payer: Aetna Commercial |
$485.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$464.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$286.07
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna Commercial |
$496.58
|
| Rate for Payer: Health EOS Commercial |
$480.39
|
| Rate for Payer: HFN Commercial |
$496.58
|
| Rate for Payer: Multiplan Commercial |
$431.81
|
| Rate for Payer: Preferred Network Access Commercial |
$496.58
|
| Rate for Payer: Quartz Beloit One Network |
$264.48
|
| Rate for Payer: Quartz Commercial |
$323.86
|
| Rate for Payer: WEA Trust Commercial |
$296.87
|
| Rate for Payer: WPS Commercial |
$399.79
|
|
|
SCREW CORT LOW PROFILE 3.5 X 50 02.206.250
|
Facility
|
OP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3259479
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$151.13 |
| Max. Negotiated Rate |
$496.58 |
| Rate for Payer: Aetna Commercial |
$485.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$464.19
|
| Rate for Payer: Aetna Managed Medicare |
$151.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$350.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$269.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$259.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$286.07
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna Commercial |
$496.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$302.06
|
| Rate for Payer: Health EOS Commercial |
$480.39
|
| Rate for Payer: HFN Commercial |
$496.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.82
|
| Rate for Payer: Multiplan Commercial |
$431.81
|
| Rate for Payer: NAPHCARE Commercial |
$323.86
|
| Rate for Payer: Preferred Network Access Commercial |
$496.58
|
| Rate for Payer: Quartz Beloit One Network |
$264.48
|
| Rate for Payer: Quartz Commercial |
$350.84
|
| Rate for Payer: Quartz Medicare Advantage |
$323.86
|
| Rate for Payer: The Alliance Commercial |
$269.88
|
| Rate for Payer: WEA Trust Commercial |
$296.87
|
| Rate for Payer: WPS Commercial |
$399.79
|
|
|
SCREW CORT PELVIC 3.5 X 65 204.665
|
Facility
|
OP
|
$452.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599768
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$131.62 |
| Max. Negotiated Rate |
$432.47 |
| Rate for Payer: Aetna Commercial |
$423.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$404.27
|
| Rate for Payer: Aetna Managed Medicare |
$131.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$305.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$235.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$225.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$249.14
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cigna Commercial |
$432.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$263.06
|
| Rate for Payer: Health EOS Commercial |
$418.37
|
| Rate for Payer: HFN Commercial |
$432.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$352.56
|
| Rate for Payer: Multiplan Commercial |
$376.06
|
| Rate for Payer: NAPHCARE Commercial |
$282.05
|
| Rate for Payer: Preferred Network Access Commercial |
$432.47
|
| Rate for Payer: Quartz Beloit One Network |
$230.34
|
| Rate for Payer: Quartz Commercial |
$305.55
|
| Rate for Payer: Quartz Medicare Advantage |
$282.05
|
| Rate for Payer: The Alliance Commercial |
$235.04
|
| Rate for Payer: WEA Trust Commercial |
$258.54
|
| Rate for Payer: WPS Commercial |
$348.18
|
|
|
SCREW CORT PELVIC 3.5 X 65 204.665
|
Facility
|
IP
|
$452.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599768
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$230.34 |
| Max. Negotiated Rate |
$432.47 |
| Rate for Payer: Aetna Commercial |
$423.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$404.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$249.14
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cigna Commercial |
$432.47
|
| Rate for Payer: Health EOS Commercial |
$418.37
|
| Rate for Payer: HFN Commercial |
$432.47
|
| Rate for Payer: Multiplan Commercial |
$376.06
|
| Rate for Payer: Preferred Network Access Commercial |
$432.47
|
| Rate for Payer: Quartz Beloit One Network |
$230.34
|
| Rate for Payer: Quartz Commercial |
$282.05
|
| Rate for Payer: WEA Trust Commercial |
$258.54
|
| Rate for Payer: WPS Commercial |
$348.18
|
|
|
SCREW CP 4.1MM X 30MM T10 626830
|
Facility
|
OP
|
$3,372.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5583323
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$981.93 |
| Max. Negotiated Rate |
$3,226.33 |
| Rate for Payer: Aetna Commercial |
$3,156.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,015.92
|
| Rate for Payer: Aetna Managed Medicare |
$981.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,279.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,753.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,683.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,858.65
|
| Rate for Payer: Cash Price |
$1,011.60
|
| Rate for Payer: Cigna Commercial |
$3,226.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,962.50
|
| Rate for Payer: Health EOS Commercial |
$3,121.12
|
| Rate for Payer: HFN Commercial |
$3,226.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,630.16
|
| Rate for Payer: Multiplan Commercial |
$2,805.50
|
| Rate for Payer: NAPHCARE Commercial |
$2,104.13
|
| Rate for Payer: Preferred Network Access Commercial |
$3,226.33
|
| Rate for Payer: Quartz Beloit One Network |
$1,718.37
|
| Rate for Payer: Quartz Commercial |
$2,279.47
|
| Rate for Payer: Quartz Medicare Advantage |
$2,104.13
|
| Rate for Payer: The Alliance Commercial |
$1,753.44
|
| Rate for Payer: WEA Trust Commercial |
$1,928.78
|
| Rate for Payer: WPS Commercial |
$2,597.45
|
|
|
SCREW CP 4.1MM X 30MM T10 626830
|
Facility
|
IP
|
$3,372.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5583323
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,718.37 |
| Max. Negotiated Rate |
$3,226.33 |
| Rate for Payer: Aetna Commercial |
$3,156.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,015.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,858.65
|
| Rate for Payer: Cash Price |
$1,011.60
|
| Rate for Payer: Cigna Commercial |
$3,226.33
|
| Rate for Payer: Health EOS Commercial |
$3,121.12
|
| Rate for Payer: HFN Commercial |
$3,226.33
|
| Rate for Payer: Multiplan Commercial |
$2,805.50
|
| Rate for Payer: Preferred Network Access Commercial |
$3,226.33
|
| Rate for Payer: Quartz Beloit One Network |
$1,718.37
|
| Rate for Payer: Quartz Commercial |
$2,104.13
|
| Rate for Payer: WEA Trust Commercial |
$1,928.78
|
| Rate for Payer: WPS Commercial |
$2,597.45
|
|
|
SCREW CP 4.1MM X 32MM T10 626832
|
Facility
|
OP
|
$3,372.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5547407
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$981.93 |
| Max. Negotiated Rate |
$3,226.33 |
| Rate for Payer: Aetna Commercial |
$3,156.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,015.92
|
| Rate for Payer: Aetna Managed Medicare |
$981.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,279.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,753.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,683.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,858.65
|
| Rate for Payer: Cash Price |
$1,011.60
|
| Rate for Payer: Cigna Commercial |
$3,226.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,962.50
|
| Rate for Payer: Health EOS Commercial |
$3,121.12
|
| Rate for Payer: HFN Commercial |
$3,226.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,630.16
|
| Rate for Payer: Multiplan Commercial |
$2,805.50
|
| Rate for Payer: NAPHCARE Commercial |
$2,104.13
|
| Rate for Payer: Preferred Network Access Commercial |
$3,226.33
|
| Rate for Payer: Quartz Beloit One Network |
$1,718.37
|
| Rate for Payer: Quartz Commercial |
$2,279.47
|
| Rate for Payer: Quartz Medicare Advantage |
$2,104.13
|
| Rate for Payer: The Alliance Commercial |
$1,753.44
|
| Rate for Payer: WEA Trust Commercial |
$1,928.78
|
| Rate for Payer: WPS Commercial |
$2,597.45
|
|
|
SCREW CP 4.1MM X 32MM T10 626832
|
Facility
|
IP
|
$3,372.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5547407
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,718.37 |
| Max. Negotiated Rate |
$3,226.33 |
| Rate for Payer: Aetna Commercial |
$3,156.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,015.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,858.65
|
| Rate for Payer: Cash Price |
$1,011.60
|
| Rate for Payer: Cigna Commercial |
$3,226.33
|
| Rate for Payer: Health EOS Commercial |
$3,121.12
|
| Rate for Payer: HFN Commercial |
$3,226.33
|
| Rate for Payer: Multiplan Commercial |
$2,805.50
|
| Rate for Payer: Preferred Network Access Commercial |
$3,226.33
|
| Rate for Payer: Quartz Beloit One Network |
$1,718.37
|
| Rate for Payer: Quartz Commercial |
$2,104.13
|
| Rate for Payer: WEA Trust Commercial |
$1,928.78
|
| Rate for Payer: WPS Commercial |
$2,597.45
|
|
|
SCREWDRIVER CANN 2.0MM AO 45-20001S
|
Facility
|
IP
|
$1,555.00
|
|
| Hospital Charge Code |
6171706
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$792.43 |
| Max. Negotiated Rate |
$1,487.82 |
| Rate for Payer: Aetna Commercial |
$1,455.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,390.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$857.12
|
| Rate for Payer: Cash Price |
$466.50
|
| Rate for Payer: Cigna Commercial |
$1,487.82
|
| Rate for Payer: Health EOS Commercial |
$1,439.31
|
| Rate for Payer: HFN Commercial |
$1,487.82
|
| Rate for Payer: Multiplan Commercial |
$1,293.76
|
| Rate for Payer: Preferred Network Access Commercial |
$1,487.82
|
| Rate for Payer: Quartz Beloit One Network |
$792.43
|
| Rate for Payer: Quartz Commercial |
$970.32
|
| Rate for Payer: WEA Trust Commercial |
$889.46
|
| Rate for Payer: WPS Commercial |
$1,197.82
|
|
|
SCREWDRIVER CANN 2.0MM AO 45-20001S
|
Facility
|
OP
|
$1,555.00
|
|
| Hospital Charge Code |
6171706
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$452.82 |
| Max. Negotiated Rate |
$1,487.82 |
| Rate for Payer: Aetna Commercial |
$1,455.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,390.79
|
| Rate for Payer: Aetna Managed Medicare |
$452.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,051.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$808.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$776.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$857.12
|
| Rate for Payer: Cash Price |
$466.50
|
| Rate for Payer: Cigna Commercial |
$1,487.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$905.01
|
| Rate for Payer: Health EOS Commercial |
$1,439.31
|
| Rate for Payer: HFN Commercial |
$1,487.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,212.90
|
| Rate for Payer: Multiplan Commercial |
$1,293.76
|
| Rate for Payer: NAPHCARE Commercial |
$970.32
|
| Rate for Payer: Preferred Network Access Commercial |
$1,487.82
|
| Rate for Payer: Quartz Beloit One Network |
$792.43
|
| Rate for Payer: Quartz Commercial |
$1,051.18
|
| Rate for Payer: Quartz Medicare Advantage |
$970.32
|
| Rate for Payer: The Alliance Commercial |
$808.60
|
| Rate for Payer: WEA Trust Commercial |
$889.46
|
| Rate for Payer: WPS Commercial |
$1,197.82
|
|
|
SCREWDRIVER SHAFT TRILLIANT 3.0/4.0 210-40-003
|
Facility
|
OP
|
$3,048.00
|
|
| Hospital Charge Code |
3241471
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$887.58 |
| Max. Negotiated Rate |
$2,916.33 |
| Rate for Payer: Aetna Commercial |
$2,852.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,726.13
|
| Rate for Payer: Aetna Managed Medicare |
$887.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,060.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,584.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,521.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,680.06
|
| Rate for Payer: Cash Price |
$914.40
|
| Rate for Payer: Cigna Commercial |
$2,916.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,773.94
|
| Rate for Payer: Health EOS Commercial |
$2,821.23
|
| Rate for Payer: HFN Commercial |
$2,916.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,377.44
|
| Rate for Payer: Multiplan Commercial |
$2,535.94
|
| Rate for Payer: NAPHCARE Commercial |
$1,901.95
|
| Rate for Payer: Preferred Network Access Commercial |
$2,916.33
|
| Rate for Payer: Quartz Beloit One Network |
$1,553.26
|
| Rate for Payer: Quartz Commercial |
$2,060.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,901.95
|
| Rate for Payer: The Alliance Commercial |
$1,584.96
|
| Rate for Payer: WEA Trust Commercial |
$1,743.46
|
| Rate for Payer: WPS Commercial |
$2,347.87
|
|
|
SCREWDRIVER SHAFT TRILLIANT 3.0/4.0 210-40-003
|
Facility
|
IP
|
$3,048.00
|
|
| Hospital Charge Code |
3241471
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,553.26 |
| Max. Negotiated Rate |
$2,916.33 |
| Rate for Payer: Aetna Commercial |
$2,852.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,726.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,680.06
|
| Rate for Payer: Cash Price |
$914.40
|
| Rate for Payer: Cigna Commercial |
$2,916.33
|
| Rate for Payer: Health EOS Commercial |
$2,821.23
|
| Rate for Payer: HFN Commercial |
$2,916.33
|
| Rate for Payer: Multiplan Commercial |
$2,535.94
|
| Rate for Payer: Preferred Network Access Commercial |
$2,916.33
|
| Rate for Payer: Quartz Beloit One Network |
$1,553.26
|
| Rate for Payer: Quartz Commercial |
$1,901.95
|
| Rate for Payer: WEA Trust Commercial |
$1,743.46
|
| Rate for Payer: WPS Commercial |
$2,347.87
|
|
|
SCREWDRIVER SHAFT TRILLIANT 3.0/4.0 CANNULATED 210-40-003
|
Facility
|
IP
|
$2,660.00
|
|
| Hospital Charge Code |
3241470
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,355.54 |
| Max. Negotiated Rate |
$2,545.09 |
| Rate for Payer: Aetna Commercial |
$2,489.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,379.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,466.19
|
| Rate for Payer: Cash Price |
$798.00
|
| Rate for Payer: Cigna Commercial |
$2,545.09
|
| Rate for Payer: Health EOS Commercial |
$2,462.10
|
| Rate for Payer: HFN Commercial |
$2,545.09
|
| Rate for Payer: Multiplan Commercial |
$2,213.12
|
| Rate for Payer: Preferred Network Access Commercial |
$2,545.09
|
| Rate for Payer: Quartz Beloit One Network |
$1,355.54
|
| Rate for Payer: Quartz Commercial |
$1,659.84
|
| Rate for Payer: WEA Trust Commercial |
$1,521.52
|
| Rate for Payer: WPS Commercial |
$2,049.00
|
|
|
SCREWDRIVER SHAFT TRILLIANT 3.0/4.0 CANNULATED 210-40-003
|
Facility
|
OP
|
$2,660.00
|
|
| Hospital Charge Code |
3241470
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$774.59 |
| Max. Negotiated Rate |
$2,545.09 |
| Rate for Payer: Aetna Commercial |
$2,489.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,379.10
|
| Rate for Payer: Aetna Managed Medicare |
$774.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,798.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,383.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,327.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,466.19
|
| Rate for Payer: Cash Price |
$798.00
|
| Rate for Payer: Cigna Commercial |
$2,545.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,548.12
|
| Rate for Payer: Health EOS Commercial |
$2,462.10
|
| Rate for Payer: HFN Commercial |
$2,545.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,074.80
|
| Rate for Payer: Multiplan Commercial |
$2,213.12
|
| Rate for Payer: NAPHCARE Commercial |
$1,659.84
|
| Rate for Payer: Preferred Network Access Commercial |
$2,545.09
|
| Rate for Payer: Quartz Beloit One Network |
$1,355.54
|
| Rate for Payer: Quartz Commercial |
$1,798.16
|
| Rate for Payer: Quartz Medicare Advantage |
$1,659.84
|
| Rate for Payer: The Alliance Commercial |
$1,383.20
|
| Rate for Payer: WEA Trust Commercial |
$1,521.52
|
| Rate for Payer: WPS Commercial |
$2,049.00
|
|
|
SCREWDRIVER SHAFT TRILLLIANT 2.0/2.4 210-24-003
|
Facility
|
IP
|
$3,166.00
|
|
| Hospital Charge Code |
3241469
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,613.39 |
| Max. Negotiated Rate |
$3,029.23 |
| Rate for Payer: Aetna Commercial |
$2,963.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,831.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,745.10
|
| Rate for Payer: Cash Price |
$949.80
|
| Rate for Payer: Cigna Commercial |
$3,029.23
|
| Rate for Payer: Health EOS Commercial |
$2,930.45
|
| Rate for Payer: HFN Commercial |
$3,029.23
|
| Rate for Payer: Multiplan Commercial |
$2,634.11
|
| Rate for Payer: Preferred Network Access Commercial |
$3,029.23
|
| Rate for Payer: Quartz Beloit One Network |
$1,613.39
|
| Rate for Payer: Quartz Commercial |
$1,975.58
|
| Rate for Payer: WEA Trust Commercial |
$1,810.95
|
| Rate for Payer: WPS Commercial |
$2,438.77
|
|
|
SCREWDRIVER SHAFT TRILLLIANT 2.0/2.4 210-24-003
|
Facility
|
OP
|
$3,166.00
|
|
| Hospital Charge Code |
3241469
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$921.94 |
| Max. Negotiated Rate |
$3,029.23 |
| Rate for Payer: Aetna Commercial |
$2,963.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,831.67
|
| Rate for Payer: Aetna Managed Medicare |
$921.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,140.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,646.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,580.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,745.10
|
| Rate for Payer: Cash Price |
$949.80
|
| Rate for Payer: Cigna Commercial |
$3,029.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,842.61
|
| Rate for Payer: Health EOS Commercial |
$2,930.45
|
| Rate for Payer: HFN Commercial |
$3,029.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,469.48
|
| Rate for Payer: Multiplan Commercial |
$2,634.11
|
| Rate for Payer: NAPHCARE Commercial |
$1,975.58
|
| Rate for Payer: Preferred Network Access Commercial |
$3,029.23
|
| Rate for Payer: Quartz Beloit One Network |
$1,613.39
|
| Rate for Payer: Quartz Commercial |
$2,140.22
|
| Rate for Payer: Quartz Medicare Advantage |
$1,975.58
|
| Rate for Payer: The Alliance Commercial |
$1,646.32
|
| Rate for Payer: WEA Trust Commercial |
$1,810.95
|
| Rate for Payer: WPS Commercial |
$2,438.77
|
|
|
SCREW FASTPITCH 2.7MM HIGH PITCH LOCKING SD21
|
Facility
|
OP
|
$5,960.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5861734
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,735.55 |
| Max. Negotiated Rate |
$5,702.53 |
| Rate for Payer: Aetna Commercial |
$5,578.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,330.62
|
| Rate for Payer: Aetna Managed Medicare |
$1,735.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,028.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,099.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,975.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,285.15
|
| Rate for Payer: Cash Price |
$1,788.00
|
| Rate for Payer: Cigna Commercial |
$5,702.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,468.72
|
| Rate for Payer: Health EOS Commercial |
$5,516.58
|
| Rate for Payer: HFN Commercial |
$5,702.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,648.80
|
| Rate for Payer: Multiplan Commercial |
$4,958.72
|
| Rate for Payer: NAPHCARE Commercial |
$3,719.04
|
| Rate for Payer: Preferred Network Access Commercial |
$5,702.53
|
| Rate for Payer: Quartz Beloit One Network |
$3,037.22
|
| Rate for Payer: Quartz Commercial |
$4,028.96
|
| Rate for Payer: Quartz Medicare Advantage |
$3,719.04
|
| Rate for Payer: The Alliance Commercial |
$3,099.20
|
| Rate for Payer: WEA Trust Commercial |
$3,409.12
|
| Rate for Payer: WPS Commercial |
$4,590.99
|
|
|
SCREW FASTPITCH 2.7MM HIGH PITCH LOCKING SD21
|
Facility
|
IP
|
$5,960.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5861734
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,037.22 |
| Max. Negotiated Rate |
$5,702.53 |
| Rate for Payer: Aetna Commercial |
$5,578.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,330.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,285.15
|
| Rate for Payer: Cash Price |
$1,788.00
|
| Rate for Payer: Cigna Commercial |
$5,702.53
|
| Rate for Payer: Health EOS Commercial |
$5,516.58
|
| Rate for Payer: HFN Commercial |
$5,702.53
|
| Rate for Payer: Multiplan Commercial |
$4,958.72
|
| Rate for Payer: Preferred Network Access Commercial |
$5,702.53
|
| Rate for Payer: Quartz Beloit One Network |
$3,037.22
|
| Rate for Payer: Quartz Commercial |
$3,719.04
|
| Rate for Payer: WEA Trust Commercial |
$3,409.12
|
| Rate for Payer: WPS Commercial |
$4,590.99
|
|
|
SCREW FASTPITCH 2.7MM X 22MM HIGH PITCH LOCKING SD22
|
Facility
|
IP
|
$5,511.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6180092
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,808.41 |
| Max. Negotiated Rate |
$5,272.92 |
| Rate for Payer: Aetna Commercial |
$5,158.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,929.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,037.66
|
| Rate for Payer: Cash Price |
$1,653.30
|
| Rate for Payer: Cigna Commercial |
$5,272.92
|
| Rate for Payer: Health EOS Commercial |
$5,100.98
|
| Rate for Payer: HFN Commercial |
$5,272.92
|
| Rate for Payer: Multiplan Commercial |
$4,585.15
|
| Rate for Payer: Preferred Network Access Commercial |
$5,272.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,808.41
|
| Rate for Payer: Quartz Commercial |
$3,438.86
|
| Rate for Payer: WEA Trust Commercial |
$3,152.29
|
| Rate for Payer: WPS Commercial |
$4,245.12
|
|
