|
SCREW LOCK CANN 5.0 X 70 02.205.070
|
Facility
|
OP
|
$827.00
|
|
| Hospital Charge Code |
2966999
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$231.56 |
| Max. Negotiated Rate |
$3,308.00 |
| Rate for Payer: Aetna Commercial |
$744.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$711.22
|
| Rate for Payer: Aetna Managed Medicare |
$231.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$537.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$413.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$396.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$438.31
|
| Rate for Payer: Cash Price |
$248.10
|
| Rate for Payer: Cigna Commercial |
$760.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$462.79
|
| Rate for Payer: Health EOS Commercial |
$736.03
|
| Rate for Payer: HFN Commercial |
$760.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$620.25
|
| Rate for Payer: Multiplan Commercial |
$661.60
|
| Rate for Payer: NAPHCARE Commercial |
$496.20
|
| Rate for Payer: Preferred Network Access Commercial |
$760.84
|
| Rate for Payer: Quartz Beloit One Network |
$405.23
|
| Rate for Payer: Quartz Commercial |
$537.55
|
| Rate for Payer: Quartz Medicare Advantage |
$496.20
|
| Rate for Payer: The Alliance Commercial |
$3,308.00
|
| Rate for Payer: WEA Trust Commercial |
$454.85
|
| Rate for Payer: WPS Commercial |
$612.56
|
|
|
SCREW LOCK CANN 5.0 X 70 02.205.070
|
Facility
|
IP
|
$827.00
|
|
| Hospital Charge Code |
2966999
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$405.23 |
| Max. Negotiated Rate |
$760.84 |
| Rate for Payer: Aetna Commercial |
$744.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$711.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$438.31
|
| Rate for Payer: Cash Price |
$248.10
|
| Rate for Payer: Cigna Commercial |
$760.84
|
| Rate for Payer: Health EOS Commercial |
$736.03
|
| Rate for Payer: HFN Commercial |
$760.84
|
| Rate for Payer: Multiplan Commercial |
$661.60
|
| Rate for Payer: NAPHCARE Commercial |
$496.20
|
| Rate for Payer: Preferred Network Access Commercial |
$760.84
|
| Rate for Payer: Quartz Beloit One Network |
$405.23
|
| Rate for Payer: Quartz Commercial |
$496.20
|
| Rate for Payer: WEA Trust Commercial |
$454.85
|
| Rate for Payer: WPS Commercial |
$612.56
|
|
|
SCREW LOCK CORT VA 2.4 X 18MM TI AR-8916VNC-18
|
Facility
|
OP
|
$1,864.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5456671
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$521.92 |
| Max. Negotiated Rate |
$7,456.00 |
| Rate for Payer: Aetna Commercial |
$1,677.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,603.04
|
| Rate for Payer: Aetna Managed Medicare |
$521.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,211.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$932.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$894.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$987.92
|
| Rate for Payer: Cash Price |
$559.20
|
| Rate for Payer: Cigna Commercial |
$1,714.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,043.09
|
| Rate for Payer: Health EOS Commercial |
$1,658.96
|
| Rate for Payer: HFN Commercial |
$1,714.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,398.00
|
| Rate for Payer: Multiplan Commercial |
$1,491.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,118.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,714.88
|
| Rate for Payer: Quartz Beloit One Network |
$913.36
|
| Rate for Payer: Quartz Commercial |
$1,211.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,118.40
|
| Rate for Payer: The Alliance Commercial |
$7,456.00
|
| Rate for Payer: WEA Trust Commercial |
$1,025.20
|
| Rate for Payer: WPS Commercial |
$1,380.66
|
|
|
SCREW LOCK CORT VA 2.4 X 18MM TI AR-8916VNC-18
|
Facility
|
IP
|
$1,864.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5456671
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$913.36 |
| Max. Negotiated Rate |
$1,714.88 |
| Rate for Payer: Aetna Commercial |
$1,677.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,603.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$987.92
|
| Rate for Payer: Cash Price |
$559.20
|
| Rate for Payer: Cigna Commercial |
$1,714.88
|
| Rate for Payer: Health EOS Commercial |
$1,658.96
|
| Rate for Payer: HFN Commercial |
$1,714.88
|
| Rate for Payer: Multiplan Commercial |
$1,491.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,118.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,714.88
|
| Rate for Payer: Quartz Beloit One Network |
$913.36
|
| Rate for Payer: Quartz Commercial |
$1,118.40
|
| Rate for Payer: WEA Trust Commercial |
$1,025.20
|
| Rate for Payer: WPS Commercial |
$1,380.66
|
|
|
SCREW LOCK IMN 5.0 X 25MM 2360-5025S
|
Facility
|
OP
|
$2,062.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6201045
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$577.36 |
| Max. Negotiated Rate |
$8,248.00 |
| Rate for Payer: Aetna Commercial |
$1,855.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,773.32
|
| Rate for Payer: Aetna Managed Medicare |
$577.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,340.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,031.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$989.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,092.86
|
| Rate for Payer: Cash Price |
$618.60
|
| Rate for Payer: Cigna Commercial |
$1,897.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,153.90
|
| Rate for Payer: Health EOS Commercial |
$1,835.18
|
| Rate for Payer: HFN Commercial |
$1,897.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,546.50
|
| Rate for Payer: Multiplan Commercial |
$1,649.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,237.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,897.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,010.38
|
| Rate for Payer: Quartz Commercial |
$1,340.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,237.20
|
| Rate for Payer: The Alliance Commercial |
$8,248.00
|
| Rate for Payer: WEA Trust Commercial |
$1,134.10
|
| Rate for Payer: WPS Commercial |
$1,527.32
|
|
|
SCREW LOCK IMN 5.0 X 25MM 2360-5025S
|
Facility
|
IP
|
$2,062.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6201045
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,010.38 |
| Max. Negotiated Rate |
$1,897.04 |
| Rate for Payer: Aetna Commercial |
$1,855.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,773.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,092.86
|
| Rate for Payer: Cash Price |
$618.60
|
| Rate for Payer: Cigna Commercial |
$1,897.04
|
| Rate for Payer: Health EOS Commercial |
$1,835.18
|
| Rate for Payer: HFN Commercial |
$1,897.04
|
| Rate for Payer: Multiplan Commercial |
$1,649.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,237.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,897.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,010.38
|
| Rate for Payer: Quartz Commercial |
$1,237.20
|
| Rate for Payer: WEA Trust Commercial |
$1,134.10
|
| Rate for Payer: WPS Commercial |
$1,527.32
|
|
|
SCREW LOCK IMN 5.0 X 32.5MM 2361-5032S
|
Facility
|
OP
|
$2,676.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6177990
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$749.28 |
| Max. Negotiated Rate |
$10,704.00 |
| Rate for Payer: Aetna Commercial |
$2,408.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,301.36
|
| Rate for Payer: Aetna Managed Medicare |
$749.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,739.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,338.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,284.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,418.28
|
| Rate for Payer: Cash Price |
$802.80
|
| Rate for Payer: Cigna Commercial |
$2,461.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,497.49
|
| Rate for Payer: Health EOS Commercial |
$2,381.64
|
| Rate for Payer: HFN Commercial |
$2,461.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,007.00
|
| Rate for Payer: Multiplan Commercial |
$2,140.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,605.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,461.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,311.24
|
| Rate for Payer: Quartz Commercial |
$1,739.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,605.60
|
| Rate for Payer: The Alliance Commercial |
$10,704.00
|
| Rate for Payer: WEA Trust Commercial |
$1,471.80
|
| Rate for Payer: WPS Commercial |
$1,982.11
|
|
|
SCREW LOCK IMN 5.0 X 32.5MM 2361-5032S
|
Facility
|
IP
|
$2,676.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6177990
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,311.24 |
| Max. Negotiated Rate |
$2,461.92 |
| Rate for Payer: Aetna Commercial |
$2,408.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,301.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,418.28
|
| Rate for Payer: Cash Price |
$802.80
|
| Rate for Payer: Cigna Commercial |
$2,461.92
|
| Rate for Payer: Health EOS Commercial |
$2,381.64
|
| Rate for Payer: HFN Commercial |
$2,461.92
|
| Rate for Payer: Multiplan Commercial |
$2,140.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,605.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,461.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,311.24
|
| Rate for Payer: Quartz Commercial |
$1,605.60
|
| Rate for Payer: WEA Trust Commercial |
$1,471.80
|
| Rate for Payer: WPS Commercial |
$1,982.11
|
|
|
SCREW LOCK IMN 5.0 X 35MM 2360-5035S
|
Facility
|
OP
|
$2,703.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599790
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$756.84 |
| Max. Negotiated Rate |
$10,812.00 |
| Rate for Payer: Aetna Commercial |
$2,432.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,324.58
|
| Rate for Payer: Aetna Managed Medicare |
$756.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,756.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,351.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,297.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,432.59
|
| Rate for Payer: Cash Price |
$810.90
|
| Rate for Payer: Cigna Commercial |
$2,486.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,512.60
|
| Rate for Payer: Health EOS Commercial |
$2,405.67
|
| Rate for Payer: HFN Commercial |
$2,486.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,027.25
|
| Rate for Payer: Multiplan Commercial |
$2,162.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,621.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,486.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,324.47
|
| Rate for Payer: Quartz Commercial |
$1,756.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,621.80
|
| Rate for Payer: The Alliance Commercial |
$10,812.00
|
| Rate for Payer: WEA Trust Commercial |
$1,486.65
|
| Rate for Payer: WPS Commercial |
$2,002.11
|
|
|
SCREW LOCK IMN 5.0 X 35MM 2360-5035S
|
Facility
|
IP
|
$2,703.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599790
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,324.47 |
| Max. Negotiated Rate |
$2,486.76 |
| Rate for Payer: Aetna Commercial |
$2,432.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,324.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,432.59
|
| Rate for Payer: Cash Price |
$810.90
|
| Rate for Payer: Cigna Commercial |
$2,486.76
|
| Rate for Payer: Health EOS Commercial |
$2,405.67
|
| Rate for Payer: HFN Commercial |
$2,486.76
|
| Rate for Payer: Multiplan Commercial |
$2,162.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,621.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,486.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,324.47
|
| Rate for Payer: Quartz Commercial |
$1,621.80
|
| Rate for Payer: WEA Trust Commercial |
$1,486.65
|
| Rate for Payer: WPS Commercial |
$2,002.11
|
|
|
SCREW LOCK IMN 5.0 X 35MM 2361-5035S
|
Facility
|
OP
|
$2,676.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6201031
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$749.28 |
| Max. Negotiated Rate |
$10,704.00 |
| Rate for Payer: Aetna Commercial |
$2,408.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,301.36
|
| Rate for Payer: Aetna Managed Medicare |
$749.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,739.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,338.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,284.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,418.28
|
| Rate for Payer: Cash Price |
$802.80
|
| Rate for Payer: Cigna Commercial |
$2,461.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,497.49
|
| Rate for Payer: Health EOS Commercial |
$2,381.64
|
| Rate for Payer: HFN Commercial |
$2,461.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,007.00
|
| Rate for Payer: Multiplan Commercial |
$2,140.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,605.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,461.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,311.24
|
| Rate for Payer: Quartz Commercial |
$1,739.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,605.60
|
| Rate for Payer: The Alliance Commercial |
$10,704.00
|
| Rate for Payer: WEA Trust Commercial |
$1,471.80
|
| Rate for Payer: WPS Commercial |
$1,982.11
|
|
|
SCREW LOCK IMN 5.0 X 35MM 2361-5035S
|
Facility
|
IP
|
$2,676.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6201031
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,311.24 |
| Max. Negotiated Rate |
$2,461.92 |
| Rate for Payer: Aetna Commercial |
$2,408.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,301.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,418.28
|
| Rate for Payer: Cash Price |
$802.80
|
| Rate for Payer: Cigna Commercial |
$2,461.92
|
| Rate for Payer: Health EOS Commercial |
$2,381.64
|
| Rate for Payer: HFN Commercial |
$2,461.92
|
| Rate for Payer: Multiplan Commercial |
$2,140.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,605.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,461.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,311.24
|
| Rate for Payer: Quartz Commercial |
$1,605.60
|
| Rate for Payer: WEA Trust Commercial |
$1,471.80
|
| Rate for Payer: WPS Commercial |
$1,982.11
|
|
|
SCREW LOCK IMN 5.0 X 37.5MM 2360-5037S
|
Facility
|
IP
|
$2,599.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5797678
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,273.51 |
| Max. Negotiated Rate |
$2,391.08 |
| Rate for Payer: Aetna Commercial |
$2,339.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,235.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,377.47
|
| Rate for Payer: Cash Price |
$779.70
|
| Rate for Payer: Cigna Commercial |
$2,391.08
|
| Rate for Payer: Health EOS Commercial |
$2,313.11
|
| Rate for Payer: HFN Commercial |
$2,391.08
|
| Rate for Payer: Multiplan Commercial |
$2,079.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,559.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,391.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,273.51
|
| Rate for Payer: Quartz Commercial |
$1,559.40
|
| Rate for Payer: WEA Trust Commercial |
$1,429.45
|
| Rate for Payer: WPS Commercial |
$1,925.08
|
|
|
SCREW LOCK IMN 5.0 X 37.5MM 2360-5037S
|
Facility
|
OP
|
$2,599.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5797678
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$727.72 |
| Max. Negotiated Rate |
$10,396.00 |
| Rate for Payer: Aetna Commercial |
$2,339.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,235.14
|
| Rate for Payer: Aetna Managed Medicare |
$727.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,689.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,299.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,247.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,377.47
|
| Rate for Payer: Cash Price |
$779.70
|
| Rate for Payer: Cigna Commercial |
$2,391.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,454.40
|
| Rate for Payer: Health EOS Commercial |
$2,313.11
|
| Rate for Payer: HFN Commercial |
$2,391.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,949.25
|
| Rate for Payer: Multiplan Commercial |
$2,079.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,559.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,391.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,273.51
|
| Rate for Payer: Quartz Commercial |
$1,689.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,559.40
|
| Rate for Payer: The Alliance Commercial |
$10,396.00
|
| Rate for Payer: WEA Trust Commercial |
$1,429.45
|
| Rate for Payer: WPS Commercial |
$1,925.08
|
|
|
SCREW LOCK IMN 5.0 X 37.5MM 2361-5037S
|
Facility
|
IP
|
$2,676.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6201032
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,311.24 |
| Max. Negotiated Rate |
$2,461.92 |
| Rate for Payer: Aetna Commercial |
$2,408.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,301.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,418.28
|
| Rate for Payer: Cash Price |
$802.80
|
| Rate for Payer: Cigna Commercial |
$2,461.92
|
| Rate for Payer: Health EOS Commercial |
$2,381.64
|
| Rate for Payer: HFN Commercial |
$2,461.92
|
| Rate for Payer: Multiplan Commercial |
$2,140.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,605.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,461.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,311.24
|
| Rate for Payer: Quartz Commercial |
$1,605.60
|
| Rate for Payer: WEA Trust Commercial |
$1,471.80
|
| Rate for Payer: WPS Commercial |
$1,982.11
|
|
|
SCREW LOCK IMN 5.0 X 37.5MM 2361-5037S
|
Facility
|
OP
|
$2,676.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6201032
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$749.28 |
| Max. Negotiated Rate |
$10,704.00 |
| Rate for Payer: Aetna Commercial |
$2,408.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,301.36
|
| Rate for Payer: Aetna Managed Medicare |
$749.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,739.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,338.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,284.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,418.28
|
| Rate for Payer: Cash Price |
$802.80
|
| Rate for Payer: Cigna Commercial |
$2,461.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,497.49
|
| Rate for Payer: Health EOS Commercial |
$2,381.64
|
| Rate for Payer: HFN Commercial |
$2,461.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,007.00
|
| Rate for Payer: Multiplan Commercial |
$2,140.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,605.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,461.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,311.24
|
| Rate for Payer: Quartz Commercial |
$1,739.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,605.60
|
| Rate for Payer: The Alliance Commercial |
$10,704.00
|
| Rate for Payer: WEA Trust Commercial |
$1,471.80
|
| Rate for Payer: WPS Commercial |
$1,982.11
|
|
|
SCREW LOCK IMN 5.0 X 40MM 2360-5040S
|
Facility
|
OP
|
$2,703.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599791
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$756.84 |
| Max. Negotiated Rate |
$10,812.00 |
| Rate for Payer: Aetna Commercial |
$2,432.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,324.58
|
| Rate for Payer: Aetna Managed Medicare |
$756.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,756.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,351.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,297.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,432.59
|
| Rate for Payer: Cash Price |
$810.90
|
| Rate for Payer: Cigna Commercial |
$2,486.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,512.60
|
| Rate for Payer: Health EOS Commercial |
$2,405.67
|
| Rate for Payer: HFN Commercial |
$2,486.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,027.25
|
| Rate for Payer: Multiplan Commercial |
$2,162.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,621.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,486.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,324.47
|
| Rate for Payer: Quartz Commercial |
$1,756.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,621.80
|
| Rate for Payer: The Alliance Commercial |
$10,812.00
|
| Rate for Payer: WEA Trust Commercial |
$1,486.65
|
| Rate for Payer: WPS Commercial |
$2,002.11
|
|
|
SCREW LOCK IMN 5.0 X 40MM 2360-5040S
|
Facility
|
IP
|
$2,703.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599791
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,324.47 |
| Max. Negotiated Rate |
$2,486.76 |
| Rate for Payer: Aetna Commercial |
$2,432.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,324.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,432.59
|
| Rate for Payer: Cash Price |
$810.90
|
| Rate for Payer: Cigna Commercial |
$2,486.76
|
| Rate for Payer: Health EOS Commercial |
$2,405.67
|
| Rate for Payer: HFN Commercial |
$2,486.76
|
| Rate for Payer: Multiplan Commercial |
$2,162.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,621.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,486.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,324.47
|
| Rate for Payer: Quartz Commercial |
$1,621.80
|
| Rate for Payer: WEA Trust Commercial |
$1,486.65
|
| Rate for Payer: WPS Commercial |
$2,002.11
|
|
|
SCREW LOCK IMN 5.0 X 42.5MM 2360-5042S
|
Facility
|
OP
|
$2,703.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599789
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$756.84 |
| Max. Negotiated Rate |
$10,812.00 |
| Rate for Payer: Aetna Commercial |
$2,432.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,324.58
|
| Rate for Payer: Aetna Managed Medicare |
$756.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,756.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,351.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,297.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,432.59
|
| Rate for Payer: Cash Price |
$810.90
|
| Rate for Payer: Cigna Commercial |
$2,486.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,512.60
|
| Rate for Payer: Health EOS Commercial |
$2,405.67
|
| Rate for Payer: HFN Commercial |
$2,486.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,027.25
|
| Rate for Payer: Multiplan Commercial |
$2,162.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,621.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,486.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,324.47
|
| Rate for Payer: Quartz Commercial |
$1,756.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,621.80
|
| Rate for Payer: The Alliance Commercial |
$10,812.00
|
| Rate for Payer: WEA Trust Commercial |
$1,486.65
|
| Rate for Payer: WPS Commercial |
$2,002.11
|
|
|
SCREW LOCK IMN 5.0 X 42.5MM 2360-5042S
|
Facility
|
IP
|
$2,703.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599789
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,324.47 |
| Max. Negotiated Rate |
$2,486.76 |
| Rate for Payer: Aetna Commercial |
$2,432.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,324.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,432.59
|
| Rate for Payer: Cash Price |
$810.90
|
| Rate for Payer: Cigna Commercial |
$2,486.76
|
| Rate for Payer: Health EOS Commercial |
$2,405.67
|
| Rate for Payer: HFN Commercial |
$2,486.76
|
| Rate for Payer: Multiplan Commercial |
$2,162.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,621.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,486.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,324.47
|
| Rate for Payer: Quartz Commercial |
$1,621.80
|
| Rate for Payer: WEA Trust Commercial |
$1,486.65
|
| Rate for Payer: WPS Commercial |
$2,002.11
|
|
|
SCREW LOCK IMN 5.0 X 42.5MM 2361-5042S
|
Facility
|
OP
|
$2,676.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6177991
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$749.28 |
| Max. Negotiated Rate |
$10,704.00 |
| Rate for Payer: Aetna Commercial |
$2,408.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,301.36
|
| Rate for Payer: Aetna Managed Medicare |
$749.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,739.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,338.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,284.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,418.28
|
| Rate for Payer: Cash Price |
$802.80
|
| Rate for Payer: Cigna Commercial |
$2,461.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,497.49
|
| Rate for Payer: Health EOS Commercial |
$2,381.64
|
| Rate for Payer: HFN Commercial |
$2,461.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,007.00
|
| Rate for Payer: Multiplan Commercial |
$2,140.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,605.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,461.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,311.24
|
| Rate for Payer: Quartz Commercial |
$1,739.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,605.60
|
| Rate for Payer: The Alliance Commercial |
$10,704.00
|
| Rate for Payer: WEA Trust Commercial |
$1,471.80
|
| Rate for Payer: WPS Commercial |
$1,982.11
|
|
|
SCREW LOCK IMN 5.0 X 42.5MM 2361-5042S
|
Facility
|
IP
|
$2,676.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6177991
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,311.24 |
| Max. Negotiated Rate |
$2,461.92 |
| Rate for Payer: Aetna Commercial |
$2,408.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,301.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,418.28
|
| Rate for Payer: Cash Price |
$802.80
|
| Rate for Payer: Cigna Commercial |
$2,461.92
|
| Rate for Payer: Health EOS Commercial |
$2,381.64
|
| Rate for Payer: HFN Commercial |
$2,461.92
|
| Rate for Payer: Multiplan Commercial |
$2,140.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,605.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,461.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,311.24
|
| Rate for Payer: Quartz Commercial |
$1,605.60
|
| Rate for Payer: WEA Trust Commercial |
$1,471.80
|
| Rate for Payer: WPS Commercial |
$1,982.11
|
|
|
SCREW LOCK IMN 5.0 X 45MM 2361-5045S
|
Facility
|
OP
|
$2,676.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6201030
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$749.28 |
| Max. Negotiated Rate |
$10,704.00 |
| Rate for Payer: Aetna Commercial |
$2,408.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,301.36
|
| Rate for Payer: Aetna Managed Medicare |
$749.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,739.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,338.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,284.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,418.28
|
| Rate for Payer: Cash Price |
$802.80
|
| Rate for Payer: Cigna Commercial |
$2,461.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,497.49
|
| Rate for Payer: Health EOS Commercial |
$2,381.64
|
| Rate for Payer: HFN Commercial |
$2,461.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,007.00
|
| Rate for Payer: Multiplan Commercial |
$2,140.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,605.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,461.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,311.24
|
| Rate for Payer: Quartz Commercial |
$1,739.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,605.60
|
| Rate for Payer: The Alliance Commercial |
$10,704.00
|
| Rate for Payer: WEA Trust Commercial |
$1,471.80
|
| Rate for Payer: WPS Commercial |
$1,982.11
|
|
|
SCREW LOCK IMN 5.0 X 45MM 2361-5045S
|
Facility
|
IP
|
$2,676.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6201030
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,311.24 |
| Max. Negotiated Rate |
$2,461.92 |
| Rate for Payer: Aetna Commercial |
$2,408.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,301.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,418.28
|
| Rate for Payer: Cash Price |
$802.80
|
| Rate for Payer: Cigna Commercial |
$2,461.92
|
| Rate for Payer: Health EOS Commercial |
$2,381.64
|
| Rate for Payer: HFN Commercial |
$2,461.92
|
| Rate for Payer: Multiplan Commercial |
$2,140.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,605.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,461.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,311.24
|
| Rate for Payer: Quartz Commercial |
$1,605.60
|
| Rate for Payer: WEA Trust Commercial |
$1,471.80
|
| Rate for Payer: WPS Commercial |
$1,982.11
|
|
|
SCREW LOCK IMN 5.0 X 47.5MM 2360-5047S
|
Facility
|
OP
|
$3,756.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599792
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,051.68 |
| Max. Negotiated Rate |
$15,024.00 |
| Rate for Payer: Aetna Commercial |
$3,380.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,230.16
|
| Rate for Payer: Aetna Managed Medicare |
$1,051.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,441.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,878.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,802.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,990.68
|
| Rate for Payer: Cash Price |
$1,126.80
|
| Rate for Payer: Cigna Commercial |
$3,455.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,101.86
|
| Rate for Payer: Health EOS Commercial |
$3,342.84
|
| Rate for Payer: HFN Commercial |
$3,455.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,817.00
|
| Rate for Payer: Multiplan Commercial |
$3,004.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,253.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,455.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,840.44
|
| Rate for Payer: Quartz Commercial |
$2,441.40
|
| Rate for Payer: Quartz Medicare Advantage |
$2,253.60
|
| Rate for Payer: The Alliance Commercial |
$15,024.00
|
| Rate for Payer: WEA Trust Commercial |
$2,065.80
|
| Rate for Payer: WPS Commercial |
$2,782.07
|
|
