|
SCREW HEADLESS COMPRESSION 4.0MM X 60MM TI 658060
|
Facility
|
OP
|
$4,236.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5861721
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,233.52 |
| Max. Negotiated Rate |
$4,053.00 |
| Rate for Payer: Aetna Commercial |
$3,964.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,788.68
|
| Rate for Payer: Aetna Managed Medicare |
$1,233.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,863.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,202.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,114.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,334.88
|
| Rate for Payer: Cash Price |
$1,270.80
|
| Rate for Payer: Cigna Commercial |
$4,053.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,465.35
|
| Rate for Payer: Health EOS Commercial |
$3,920.84
|
| Rate for Payer: HFN Commercial |
$4,053.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,304.08
|
| Rate for Payer: Multiplan Commercial |
$3,524.35
|
| Rate for Payer: NAPHCARE Commercial |
$2,643.26
|
| Rate for Payer: Preferred Network Access Commercial |
$4,053.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,158.67
|
| Rate for Payer: Quartz Commercial |
$2,863.54
|
| Rate for Payer: Quartz Medicare Advantage |
$2,643.26
|
| Rate for Payer: The Alliance Commercial |
$2,202.72
|
| Rate for Payer: WEA Trust Commercial |
$2,422.99
|
| Rate for Payer: WPS Commercial |
$3,262.99
|
|
|
SCREW HEADLESS COMPRESSION 4.0MM X 60MM TI 658060
|
Facility
|
IP
|
$4,236.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5861721
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,158.67 |
| Max. Negotiated Rate |
$4,053.00 |
| Rate for Payer: Aetna Commercial |
$3,964.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,788.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,334.88
|
| Rate for Payer: Cash Price |
$1,270.80
|
| Rate for Payer: Cigna Commercial |
$4,053.00
|
| Rate for Payer: Health EOS Commercial |
$3,920.84
|
| Rate for Payer: HFN Commercial |
$4,053.00
|
| Rate for Payer: Multiplan Commercial |
$3,524.35
|
| Rate for Payer: Preferred Network Access Commercial |
$4,053.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,158.67
|
| Rate for Payer: Quartz Commercial |
$2,643.26
|
| Rate for Payer: WEA Trust Commercial |
$2,422.99
|
| Rate for Payer: WPS Commercial |
$3,262.99
|
|
|
SCREW HEADLESS COMPRESSION 5.0 X 44MM TI 658144
|
Facility
|
OP
|
$2,673.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6049654
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$778.38 |
| Max. Negotiated Rate |
$2,557.53 |
| Rate for Payer: Aetna Commercial |
$2,501.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,390.73
|
| Rate for Payer: Aetna Managed Medicare |
$778.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,806.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,389.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,334.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,473.36
|
| Rate for Payer: Cash Price |
$801.90
|
| Rate for Payer: Cigna Commercial |
$2,557.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,555.69
|
| Rate for Payer: Health EOS Commercial |
$2,474.13
|
| Rate for Payer: HFN Commercial |
$2,557.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,084.94
|
| Rate for Payer: Multiplan Commercial |
$2,223.94
|
| Rate for Payer: NAPHCARE Commercial |
$1,667.95
|
| Rate for Payer: Preferred Network Access Commercial |
$2,557.53
|
| Rate for Payer: Quartz Beloit One Network |
$1,362.16
|
| Rate for Payer: Quartz Commercial |
$1,806.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,667.95
|
| Rate for Payer: The Alliance Commercial |
$1,389.96
|
| Rate for Payer: WEA Trust Commercial |
$1,528.96
|
| Rate for Payer: WPS Commercial |
$2,059.01
|
|
|
SCREW HEADLESS COMPRESSION 5.0 X 44MM TI 658144
|
Facility
|
IP
|
$2,673.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6049654
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,362.16 |
| Max. Negotiated Rate |
$2,557.53 |
| Rate for Payer: Aetna Commercial |
$2,501.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,390.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,473.36
|
| Rate for Payer: Cash Price |
$801.90
|
| Rate for Payer: Cigna Commercial |
$2,557.53
|
| Rate for Payer: Health EOS Commercial |
$2,474.13
|
| Rate for Payer: HFN Commercial |
$2,557.53
|
| Rate for Payer: Multiplan Commercial |
$2,223.94
|
| Rate for Payer: Preferred Network Access Commercial |
$2,557.53
|
| Rate for Payer: Quartz Beloit One Network |
$1,362.16
|
| Rate for Payer: Quartz Commercial |
$1,667.95
|
| Rate for Payer: WEA Trust Commercial |
$1,528.96
|
| Rate for Payer: WPS Commercial |
$2,059.01
|
|
|
SCREW HEADLESS COMPRESSION 5.0 X 48MM TI 658148
|
Facility
|
OP
|
$4,435.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5611678
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,291.47 |
| Max. Negotiated Rate |
$4,243.41 |
| Rate for Payer: Aetna Commercial |
$4,151.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,966.66
|
| Rate for Payer: Aetna Managed Medicare |
$1,291.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,998.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,306.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,213.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,444.57
|
| Rate for Payer: Cash Price |
$1,330.50
|
| Rate for Payer: Cigna Commercial |
$4,243.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,581.17
|
| Rate for Payer: Health EOS Commercial |
$4,105.04
|
| Rate for Payer: HFN Commercial |
$4,243.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,459.30
|
| Rate for Payer: Multiplan Commercial |
$3,689.92
|
| Rate for Payer: NAPHCARE Commercial |
$2,767.44
|
| Rate for Payer: Preferred Network Access Commercial |
$4,243.41
|
| Rate for Payer: Quartz Beloit One Network |
$2,260.08
|
| Rate for Payer: Quartz Commercial |
$2,998.06
|
| Rate for Payer: Quartz Medicare Advantage |
$2,767.44
|
| Rate for Payer: The Alliance Commercial |
$2,306.20
|
| Rate for Payer: WEA Trust Commercial |
$2,536.82
|
| Rate for Payer: WPS Commercial |
$3,416.28
|
|
|
SCREW HEADLESS COMPRESSION 5.0 X 48MM TI 658148
|
Facility
|
IP
|
$4,435.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5611678
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,260.08 |
| Max. Negotiated Rate |
$4,243.41 |
| Rate for Payer: Aetna Commercial |
$4,151.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,966.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,444.57
|
| Rate for Payer: Cash Price |
$1,330.50
|
| Rate for Payer: Cigna Commercial |
$4,243.41
|
| Rate for Payer: Health EOS Commercial |
$4,105.04
|
| Rate for Payer: HFN Commercial |
$4,243.41
|
| Rate for Payer: Multiplan Commercial |
$3,689.92
|
| Rate for Payer: Preferred Network Access Commercial |
$4,243.41
|
| Rate for Payer: Quartz Beloit One Network |
$2,260.08
|
| Rate for Payer: Quartz Commercial |
$2,767.44
|
| Rate for Payer: WEA Trust Commercial |
$2,536.82
|
| Rate for Payer: WPS Commercial |
$3,416.28
|
|
|
SCREW HEADLESS COMPRESSION 5.0 X 60MM TI 658160
|
Facility
|
OP
|
$2,521.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6199064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$734.12 |
| Max. Negotiated Rate |
$2,412.09 |
| Rate for Payer: Aetna Commercial |
$2,359.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,254.78
|
| Rate for Payer: Aetna Managed Medicare |
$734.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,704.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,310.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,258.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,389.58
|
| Rate for Payer: Cash Price |
$756.30
|
| Rate for Payer: Cigna Commercial |
$2,412.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,467.22
|
| Rate for Payer: Health EOS Commercial |
$2,333.44
|
| Rate for Payer: HFN Commercial |
$2,412.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,966.38
|
| Rate for Payer: Multiplan Commercial |
$2,097.47
|
| Rate for Payer: NAPHCARE Commercial |
$1,573.10
|
| Rate for Payer: Preferred Network Access Commercial |
$2,412.09
|
| Rate for Payer: Quartz Beloit One Network |
$1,284.70
|
| Rate for Payer: Quartz Commercial |
$1,704.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,573.10
|
| Rate for Payer: The Alliance Commercial |
$1,310.92
|
| Rate for Payer: WEA Trust Commercial |
$1,442.01
|
| Rate for Payer: WPS Commercial |
$1,941.93
|
|
|
SCREW HEADLESS COMPRESSION 5.0 X 60MM TI 658160
|
Facility
|
IP
|
$2,521.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6199064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,284.70 |
| Max. Negotiated Rate |
$2,412.09 |
| Rate for Payer: Aetna Commercial |
$2,359.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,254.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,389.58
|
| Rate for Payer: Cash Price |
$756.30
|
| Rate for Payer: Cigna Commercial |
$2,412.09
|
| Rate for Payer: Health EOS Commercial |
$2,333.44
|
| Rate for Payer: HFN Commercial |
$2,412.09
|
| Rate for Payer: Multiplan Commercial |
$2,097.47
|
| Rate for Payer: Preferred Network Access Commercial |
$2,412.09
|
| Rate for Payer: Quartz Beloit One Network |
$1,284.70
|
| Rate for Payer: Quartz Commercial |
$1,573.10
|
| Rate for Payer: WEA Trust Commercial |
$1,442.01
|
| Rate for Payer: WPS Commercial |
$1,941.93
|
|
|
SCREW HEADLESS COMPRESSION 5.0 X 65MM TI 658165
|
Facility
|
OP
|
$4,435.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5611679
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,291.47 |
| Max. Negotiated Rate |
$4,243.41 |
| Rate for Payer: Aetna Commercial |
$4,151.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,966.66
|
| Rate for Payer: Aetna Managed Medicare |
$1,291.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,998.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,306.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,213.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,444.57
|
| Rate for Payer: Cash Price |
$1,330.50
|
| Rate for Payer: Cigna Commercial |
$4,243.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,581.17
|
| Rate for Payer: Health EOS Commercial |
$4,105.04
|
| Rate for Payer: HFN Commercial |
$4,243.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,459.30
|
| Rate for Payer: Multiplan Commercial |
$3,689.92
|
| Rate for Payer: NAPHCARE Commercial |
$2,767.44
|
| Rate for Payer: Preferred Network Access Commercial |
$4,243.41
|
| Rate for Payer: Quartz Beloit One Network |
$2,260.08
|
| Rate for Payer: Quartz Commercial |
$2,998.06
|
| Rate for Payer: Quartz Medicare Advantage |
$2,767.44
|
| Rate for Payer: The Alliance Commercial |
$2,306.20
|
| Rate for Payer: WEA Trust Commercial |
$2,536.82
|
| Rate for Payer: WPS Commercial |
$3,416.28
|
|
|
SCREW HEADLESS COMPRESSION 5.0 X 65MM TI 658165
|
Facility
|
IP
|
$4,435.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5611679
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,260.08 |
| Max. Negotiated Rate |
$4,243.41 |
| Rate for Payer: Aetna Commercial |
$4,151.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,966.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,444.57
|
| Rate for Payer: Cash Price |
$1,330.50
|
| Rate for Payer: Cigna Commercial |
$4,243.41
|
| Rate for Payer: Health EOS Commercial |
$4,105.04
|
| Rate for Payer: HFN Commercial |
$4,243.41
|
| Rate for Payer: Multiplan Commercial |
$3,689.92
|
| Rate for Payer: Preferred Network Access Commercial |
$4,243.41
|
| Rate for Payer: Quartz Beloit One Network |
$2,260.08
|
| Rate for Payer: Quartz Commercial |
$2,767.44
|
| Rate for Payer: WEA Trust Commercial |
$2,536.82
|
| Rate for Payer: WPS Commercial |
$3,416.28
|
|
|
SCREW HEADLESS COMPRESSION 5.0 X 75MM TI 658175
|
Facility
|
IP
|
$2,965.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6049655
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,510.96 |
| Max. Negotiated Rate |
$2,836.91 |
| Rate for Payer: Aetna Commercial |
$2,775.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,651.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,634.31
|
| Rate for Payer: Cash Price |
$889.50
|
| Rate for Payer: Cigna Commercial |
$2,836.91
|
| Rate for Payer: Health EOS Commercial |
$2,744.40
|
| Rate for Payer: HFN Commercial |
$2,836.91
|
| Rate for Payer: Multiplan Commercial |
$2,466.88
|
| Rate for Payer: Preferred Network Access Commercial |
$2,836.91
|
| Rate for Payer: Quartz Beloit One Network |
$1,510.96
|
| Rate for Payer: Quartz Commercial |
$1,850.16
|
| Rate for Payer: WEA Trust Commercial |
$1,695.98
|
| Rate for Payer: WPS Commercial |
$2,283.94
|
|
|
SCREW HEADLESS COMPRESSION 5.0 X 75MM TI 658175
|
Facility
|
OP
|
$2,965.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6049655
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$863.41 |
| Max. Negotiated Rate |
$2,836.91 |
| Rate for Payer: Aetna Commercial |
$2,775.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,651.90
|
| Rate for Payer: Aetna Managed Medicare |
$863.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,004.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,541.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,480.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,634.31
|
| Rate for Payer: Cash Price |
$889.50
|
| Rate for Payer: Cigna Commercial |
$2,836.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,725.63
|
| Rate for Payer: Health EOS Commercial |
$2,744.40
|
| Rate for Payer: HFN Commercial |
$2,836.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,312.70
|
| Rate for Payer: Multiplan Commercial |
$2,466.88
|
| Rate for Payer: NAPHCARE Commercial |
$1,850.16
|
| Rate for Payer: Preferred Network Access Commercial |
$2,836.91
|
| Rate for Payer: Quartz Beloit One Network |
$1,510.96
|
| Rate for Payer: Quartz Commercial |
$2,004.34
|
| Rate for Payer: Quartz Medicare Advantage |
$1,850.16
|
| Rate for Payer: The Alliance Commercial |
$1,541.80
|
| Rate for Payer: WEA Trust Commercial |
$1,695.98
|
| Rate for Payer: WPS Commercial |
$2,283.94
|
|
|
SCREW HEADLESS COMPRESSION 7.0 X 110MM LONG THREAD TI 658610
|
Facility
|
IP
|
$5,315.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685879
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,708.52 |
| Max. Negotiated Rate |
$5,085.39 |
| Rate for Payer: Aetna Commercial |
$4,974.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,753.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,929.63
|
| Rate for Payer: Cash Price |
$1,594.50
|
| Rate for Payer: Cigna Commercial |
$5,085.39
|
| Rate for Payer: Health EOS Commercial |
$4,919.56
|
| Rate for Payer: HFN Commercial |
$5,085.39
|
| Rate for Payer: Multiplan Commercial |
$4,422.08
|
| Rate for Payer: Preferred Network Access Commercial |
$5,085.39
|
| Rate for Payer: Quartz Beloit One Network |
$2,708.52
|
| Rate for Payer: Quartz Commercial |
$3,316.56
|
| Rate for Payer: WEA Trust Commercial |
$3,040.18
|
| Rate for Payer: WPS Commercial |
$4,094.14
|
|
|
SCREW HEADLESS COMPRESSION 7.0 X 110MM LONG THREAD TI 658610
|
Facility
|
OP
|
$5,315.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685879
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,547.73 |
| Max. Negotiated Rate |
$5,085.39 |
| Rate for Payer: Aetna Commercial |
$4,974.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,753.74
|
| Rate for Payer: Aetna Managed Medicare |
$1,547.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,592.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,763.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,653.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,929.63
|
| Rate for Payer: Cash Price |
$1,594.50
|
| Rate for Payer: Cigna Commercial |
$5,085.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,093.33
|
| Rate for Payer: Health EOS Commercial |
$4,919.56
|
| Rate for Payer: HFN Commercial |
$5,085.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,145.70
|
| Rate for Payer: Multiplan Commercial |
$4,422.08
|
| Rate for Payer: NAPHCARE Commercial |
$3,316.56
|
| Rate for Payer: Preferred Network Access Commercial |
$5,085.39
|
| Rate for Payer: Quartz Beloit One Network |
$2,708.52
|
| Rate for Payer: Quartz Commercial |
$3,592.94
|
| Rate for Payer: Quartz Medicare Advantage |
$3,316.56
|
| Rate for Payer: The Alliance Commercial |
$2,763.80
|
| Rate for Payer: WEA Trust Commercial |
$3,040.18
|
| Rate for Payer: WPS Commercial |
$4,094.14
|
|
|
SCREW HEADLESS COMPRESSION 7.0 X 115MM LONG THREAD TI 658615
|
Facility
|
OP
|
$5,315.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685880
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,547.73 |
| Max. Negotiated Rate |
$5,085.39 |
| Rate for Payer: Aetna Commercial |
$4,974.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,753.74
|
| Rate for Payer: Aetna Managed Medicare |
$1,547.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,592.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,763.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,653.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,929.63
|
| Rate for Payer: Cash Price |
$1,594.50
|
| Rate for Payer: Cigna Commercial |
$5,085.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,093.33
|
| Rate for Payer: Health EOS Commercial |
$4,919.56
|
| Rate for Payer: HFN Commercial |
$5,085.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,145.70
|
| Rate for Payer: Multiplan Commercial |
$4,422.08
|
| Rate for Payer: NAPHCARE Commercial |
$3,316.56
|
| Rate for Payer: Preferred Network Access Commercial |
$5,085.39
|
| Rate for Payer: Quartz Beloit One Network |
$2,708.52
|
| Rate for Payer: Quartz Commercial |
$3,592.94
|
| Rate for Payer: Quartz Medicare Advantage |
$3,316.56
|
| Rate for Payer: The Alliance Commercial |
$2,763.80
|
| Rate for Payer: WEA Trust Commercial |
$3,040.18
|
| Rate for Payer: WPS Commercial |
$4,094.14
|
|
|
SCREW HEADLESS COMPRESSION 7.0 X 115MM LONG THREAD TI 658615
|
Facility
|
IP
|
$5,315.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685880
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,708.52 |
| Max. Negotiated Rate |
$5,085.39 |
| Rate for Payer: Aetna Commercial |
$4,974.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,753.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,929.63
|
| Rate for Payer: Cash Price |
$1,594.50
|
| Rate for Payer: Cigna Commercial |
$5,085.39
|
| Rate for Payer: Health EOS Commercial |
$4,919.56
|
| Rate for Payer: HFN Commercial |
$5,085.39
|
| Rate for Payer: Multiplan Commercial |
$4,422.08
|
| Rate for Payer: Preferred Network Access Commercial |
$5,085.39
|
| Rate for Payer: Quartz Beloit One Network |
$2,708.52
|
| Rate for Payer: Quartz Commercial |
$3,316.56
|
| Rate for Payer: WEA Trust Commercial |
$3,040.18
|
| Rate for Payer: WPS Commercial |
$4,094.14
|
|
|
SCREW HEADLESS COMPRESSION 7.0 X 125MM LONG THREAD TI 658625
|
Facility
|
IP
|
$4,107.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6178086
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,092.93 |
| Max. Negotiated Rate |
$3,929.58 |
| Rate for Payer: Aetna Commercial |
$3,844.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,673.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,263.78
|
| Rate for Payer: Cash Price |
$1,232.10
|
| Rate for Payer: Cigna Commercial |
$3,929.58
|
| Rate for Payer: Health EOS Commercial |
$3,801.44
|
| Rate for Payer: HFN Commercial |
$3,929.58
|
| Rate for Payer: Multiplan Commercial |
$3,417.02
|
| Rate for Payer: Preferred Network Access Commercial |
$3,929.58
|
| Rate for Payer: Quartz Beloit One Network |
$2,092.93
|
| Rate for Payer: Quartz Commercial |
$2,562.77
|
| Rate for Payer: WEA Trust Commercial |
$2,349.20
|
| Rate for Payer: WPS Commercial |
$3,163.62
|
|
|
SCREW HEADLESS COMPRESSION 7.0 X 125MM LONG THREAD TI 658625
|
Facility
|
OP
|
$4,107.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6178086
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,195.96 |
| Max. Negotiated Rate |
$3,929.58 |
| Rate for Payer: Aetna Commercial |
$3,844.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,673.30
|
| Rate for Payer: Aetna Managed Medicare |
$1,195.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,776.33
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,135.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,050.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,263.78
|
| Rate for Payer: Cash Price |
$1,232.10
|
| Rate for Payer: Cigna Commercial |
$3,929.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,390.27
|
| Rate for Payer: Health EOS Commercial |
$3,801.44
|
| Rate for Payer: HFN Commercial |
$3,929.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,203.46
|
| Rate for Payer: Multiplan Commercial |
$3,417.02
|
| Rate for Payer: NAPHCARE Commercial |
$2,562.77
|
| Rate for Payer: Preferred Network Access Commercial |
$3,929.58
|
| Rate for Payer: Quartz Beloit One Network |
$2,092.93
|
| Rate for Payer: Quartz Commercial |
$2,776.33
|
| Rate for Payer: Quartz Medicare Advantage |
$2,562.77
|
| Rate for Payer: The Alliance Commercial |
$2,135.64
|
| Rate for Payer: WEA Trust Commercial |
$2,349.20
|
| Rate for Payer: WPS Commercial |
$3,163.62
|
|
|
SCREW HEADLESS COMPRESSION 7.0 X 40MM SHORT THREAD TI 658340
|
Facility
|
OP
|
$5,315.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5787778
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,547.73 |
| Max. Negotiated Rate |
$5,085.39 |
| Rate for Payer: Aetna Commercial |
$4,974.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,753.74
|
| Rate for Payer: Aetna Managed Medicare |
$1,547.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,592.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,763.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,653.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,929.63
|
| Rate for Payer: Cash Price |
$1,594.50
|
| Rate for Payer: Cigna Commercial |
$5,085.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,093.33
|
| Rate for Payer: Health EOS Commercial |
$4,919.56
|
| Rate for Payer: HFN Commercial |
$5,085.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,145.70
|
| Rate for Payer: Multiplan Commercial |
$4,422.08
|
| Rate for Payer: NAPHCARE Commercial |
$3,316.56
|
| Rate for Payer: Preferred Network Access Commercial |
$5,085.39
|
| Rate for Payer: Quartz Beloit One Network |
$2,708.52
|
| Rate for Payer: Quartz Commercial |
$3,592.94
|
| Rate for Payer: Quartz Medicare Advantage |
$3,316.56
|
| Rate for Payer: The Alliance Commercial |
$2,763.80
|
| Rate for Payer: WEA Trust Commercial |
$3,040.18
|
| Rate for Payer: WPS Commercial |
$4,094.14
|
|
|
SCREW HEADLESS COMPRESSION 7.0 X 40MM SHORT THREAD TI 658340
|
Facility
|
IP
|
$5,315.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5787778
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,708.52 |
| Max. Negotiated Rate |
$5,085.39 |
| Rate for Payer: Aetna Commercial |
$4,974.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,753.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,929.63
|
| Rate for Payer: Cash Price |
$1,594.50
|
| Rate for Payer: Cigna Commercial |
$5,085.39
|
| Rate for Payer: Health EOS Commercial |
$4,919.56
|
| Rate for Payer: HFN Commercial |
$5,085.39
|
| Rate for Payer: Multiplan Commercial |
$4,422.08
|
| Rate for Payer: Preferred Network Access Commercial |
$5,085.39
|
| Rate for Payer: Quartz Beloit One Network |
$2,708.52
|
| Rate for Payer: Quartz Commercial |
$3,316.56
|
| Rate for Payer: WEA Trust Commercial |
$3,040.18
|
| Rate for Payer: WPS Commercial |
$4,094.14
|
|
|
SCREW HEADLESS COMPRESSION 7.0 X 45MM SHORT THREAD TI 658345
|
Facility
|
OP
|
$5,315.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5787779
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,547.73 |
| Max. Negotiated Rate |
$5,085.39 |
| Rate for Payer: Aetna Commercial |
$4,974.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,753.74
|
| Rate for Payer: Aetna Managed Medicare |
$1,547.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,592.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,763.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,653.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,929.63
|
| Rate for Payer: Cash Price |
$1,594.50
|
| Rate for Payer: Cigna Commercial |
$5,085.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,093.33
|
| Rate for Payer: Health EOS Commercial |
$4,919.56
|
| Rate for Payer: HFN Commercial |
$5,085.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,145.70
|
| Rate for Payer: Multiplan Commercial |
$4,422.08
|
| Rate for Payer: NAPHCARE Commercial |
$3,316.56
|
| Rate for Payer: Preferred Network Access Commercial |
$5,085.39
|
| Rate for Payer: Quartz Beloit One Network |
$2,708.52
|
| Rate for Payer: Quartz Commercial |
$3,592.94
|
| Rate for Payer: Quartz Medicare Advantage |
$3,316.56
|
| Rate for Payer: The Alliance Commercial |
$2,763.80
|
| Rate for Payer: WEA Trust Commercial |
$3,040.18
|
| Rate for Payer: WPS Commercial |
$4,094.14
|
|
|
SCREW HEADLESS COMPRESSION 7.0 X 45MM SHORT THREAD TI 658345
|
Facility
|
IP
|
$5,315.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5787779
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,708.52 |
| Max. Negotiated Rate |
$5,085.39 |
| Rate for Payer: Aetna Commercial |
$4,974.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,753.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,929.63
|
| Rate for Payer: Cash Price |
$1,594.50
|
| Rate for Payer: Cigna Commercial |
$5,085.39
|
| Rate for Payer: Health EOS Commercial |
$4,919.56
|
| Rate for Payer: HFN Commercial |
$5,085.39
|
| Rate for Payer: Multiplan Commercial |
$4,422.08
|
| Rate for Payer: Preferred Network Access Commercial |
$5,085.39
|
| Rate for Payer: Quartz Beloit One Network |
$2,708.52
|
| Rate for Payer: Quartz Commercial |
$3,316.56
|
| Rate for Payer: WEA Trust Commercial |
$3,040.18
|
| Rate for Payer: WPS Commercial |
$4,094.14
|
|
|
SCREW HEADLESS COMPRESSION 7.0 X 55MM SHORT THREAD TI 658355
|
Facility
|
OP
|
$4,107.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6204975
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,195.96 |
| Max. Negotiated Rate |
$3,929.58 |
| Rate for Payer: Aetna Commercial |
$3,844.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,673.30
|
| Rate for Payer: Aetna Managed Medicare |
$1,195.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,776.33
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,135.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,050.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,263.78
|
| Rate for Payer: Cash Price |
$1,232.10
|
| Rate for Payer: Cigna Commercial |
$3,929.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,390.27
|
| Rate for Payer: Health EOS Commercial |
$3,801.44
|
| Rate for Payer: HFN Commercial |
$3,929.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,203.46
|
| Rate for Payer: Multiplan Commercial |
$3,417.02
|
| Rate for Payer: NAPHCARE Commercial |
$2,562.77
|
| Rate for Payer: Preferred Network Access Commercial |
$3,929.58
|
| Rate for Payer: Quartz Beloit One Network |
$2,092.93
|
| Rate for Payer: Quartz Commercial |
$2,776.33
|
| Rate for Payer: Quartz Medicare Advantage |
$2,562.77
|
| Rate for Payer: The Alliance Commercial |
$2,135.64
|
| Rate for Payer: WEA Trust Commercial |
$2,349.20
|
| Rate for Payer: WPS Commercial |
$3,163.62
|
|
|
SCREW HEADLESS COMPRESSION 7.0 X 55MM SHORT THREAD TI 658355
|
Facility
|
IP
|
$4,107.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6204975
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,092.93 |
| Max. Negotiated Rate |
$3,929.58 |
| Rate for Payer: Aetna Commercial |
$3,844.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,673.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,263.78
|
| Rate for Payer: Cash Price |
$1,232.10
|
| Rate for Payer: Cigna Commercial |
$3,929.58
|
| Rate for Payer: Health EOS Commercial |
$3,801.44
|
| Rate for Payer: HFN Commercial |
$3,929.58
|
| Rate for Payer: Multiplan Commercial |
$3,417.02
|
| Rate for Payer: Preferred Network Access Commercial |
$3,929.58
|
| Rate for Payer: Quartz Beloit One Network |
$2,092.93
|
| Rate for Payer: Quartz Commercial |
$2,562.77
|
| Rate for Payer: WEA Trust Commercial |
$2,349.20
|
| Rate for Payer: WPS Commercial |
$3,163.62
|
|
|
SCREW HEADLESS COMPRESSION 7.0 X 60MM SHORT THREAD TI 658360
|
Facility
|
IP
|
$4,107.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5641641
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,092.93 |
| Max. Negotiated Rate |
$3,929.58 |
| Rate for Payer: Aetna Commercial |
$3,844.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,673.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,263.78
|
| Rate for Payer: Cash Price |
$1,232.10
|
| Rate for Payer: Cigna Commercial |
$3,929.58
|
| Rate for Payer: Health EOS Commercial |
$3,801.44
|
| Rate for Payer: HFN Commercial |
$3,929.58
|
| Rate for Payer: Multiplan Commercial |
$3,417.02
|
| Rate for Payer: Preferred Network Access Commercial |
$3,929.58
|
| Rate for Payer: Quartz Beloit One Network |
$2,092.93
|
| Rate for Payer: Quartz Commercial |
$2,562.77
|
| Rate for Payer: WEA Trust Commercial |
$2,349.20
|
| Rate for Payer: WPS Commercial |
$3,163.62
|
|
