|
SCREW INTERFERENCE 8 X 20MM BC VENTED AR-4020C-08
|
Facility
|
OP
|
$3,139.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5456676
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$914.08 |
| Max. Negotiated Rate |
$3,003.40 |
| Rate for Payer: Aetna Commercial |
$2,938.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,807.52
|
| Rate for Payer: Aetna Managed Medicare |
$914.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,121.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,632.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,566.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,730.22
|
| Rate for Payer: Cash Price |
$941.70
|
| Rate for Payer: Cigna Commercial |
$3,003.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,826.90
|
| Rate for Payer: Health EOS Commercial |
$2,905.46
|
| Rate for Payer: HFN Commercial |
$3,003.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,448.42
|
| Rate for Payer: Multiplan Commercial |
$2,611.65
|
| Rate for Payer: NAPHCARE Commercial |
$1,958.74
|
| Rate for Payer: Preferred Network Access Commercial |
$3,003.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,599.63
|
| Rate for Payer: Quartz Commercial |
$2,121.96
|
| Rate for Payer: Quartz Medicare Advantage |
$1,958.74
|
| Rate for Payer: The Alliance Commercial |
$1,632.28
|
| Rate for Payer: WEA Trust Commercial |
$1,795.51
|
| Rate for Payer: WPS Commercial |
$2,417.97
|
|
|
SCREW INTERFERENCE 8 X 20MM BC VENTED AR-4020C-08
|
Facility
|
IP
|
$3,139.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5456676
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,599.63 |
| Max. Negotiated Rate |
$3,003.40 |
| Rate for Payer: Aetna Commercial |
$2,938.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,807.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,730.22
|
| Rate for Payer: Cash Price |
$941.70
|
| Rate for Payer: Cigna Commercial |
$3,003.40
|
| Rate for Payer: Health EOS Commercial |
$2,905.46
|
| Rate for Payer: HFN Commercial |
$3,003.40
|
| Rate for Payer: Multiplan Commercial |
$2,611.65
|
| Rate for Payer: Preferred Network Access Commercial |
$3,003.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,599.63
|
| Rate for Payer: Quartz Commercial |
$1,958.74
|
| Rate for Payer: WEA Trust Commercial |
$1,795.51
|
| Rate for Payer: WPS Commercial |
$2,417.97
|
|
|
SCREW INTERFERENCE 8 X 30MM FASTTHREAD AR-4030C-08
|
Facility
|
OP
|
$3,139.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5547219
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$914.08 |
| Max. Negotiated Rate |
$3,003.40 |
| Rate for Payer: Aetna Commercial |
$2,938.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,807.52
|
| Rate for Payer: Aetna Managed Medicare |
$914.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,121.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,632.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,566.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,730.22
|
| Rate for Payer: Cash Price |
$941.70
|
| Rate for Payer: Cigna Commercial |
$3,003.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,826.90
|
| Rate for Payer: Health EOS Commercial |
$2,905.46
|
| Rate for Payer: HFN Commercial |
$3,003.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,448.42
|
| Rate for Payer: Multiplan Commercial |
$2,611.65
|
| Rate for Payer: NAPHCARE Commercial |
$1,958.74
|
| Rate for Payer: Preferred Network Access Commercial |
$3,003.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,599.63
|
| Rate for Payer: Quartz Commercial |
$2,121.96
|
| Rate for Payer: Quartz Medicare Advantage |
$1,958.74
|
| Rate for Payer: The Alliance Commercial |
$1,632.28
|
| Rate for Payer: WEA Trust Commercial |
$1,795.51
|
| Rate for Payer: WPS Commercial |
$2,417.97
|
|
|
SCREW INTERFERENCE 8 X 30MM FASTTHREAD AR-4030C-08
|
Facility
|
IP
|
$3,139.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5547219
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,599.63 |
| Max. Negotiated Rate |
$3,003.40 |
| Rate for Payer: Aetna Commercial |
$2,938.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,807.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,730.22
|
| Rate for Payer: Cash Price |
$941.70
|
| Rate for Payer: Cigna Commercial |
$3,003.40
|
| Rate for Payer: Health EOS Commercial |
$2,905.46
|
| Rate for Payer: HFN Commercial |
$3,003.40
|
| Rate for Payer: Multiplan Commercial |
$2,611.65
|
| Rate for Payer: Preferred Network Access Commercial |
$3,003.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,599.63
|
| Rate for Payer: Quartz Commercial |
$1,958.74
|
| Rate for Payer: WEA Trust Commercial |
$1,795.51
|
| Rate for Payer: WPS Commercial |
$2,417.97
|
|
|
SCREW INTERFERENCE 9 X 30MM FASTTHREAD AR-4030C-09
|
Facility
|
IP
|
$3,139.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5456918
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,599.63 |
| Max. Negotiated Rate |
$3,003.40 |
| Rate for Payer: Aetna Commercial |
$2,938.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,807.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,730.22
|
| Rate for Payer: Cash Price |
$941.70
|
| Rate for Payer: Cigna Commercial |
$3,003.40
|
| Rate for Payer: Health EOS Commercial |
$2,905.46
|
| Rate for Payer: HFN Commercial |
$3,003.40
|
| Rate for Payer: Multiplan Commercial |
$2,611.65
|
| Rate for Payer: Preferred Network Access Commercial |
$3,003.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,599.63
|
| Rate for Payer: Quartz Commercial |
$1,958.74
|
| Rate for Payer: WEA Trust Commercial |
$1,795.51
|
| Rate for Payer: WPS Commercial |
$2,417.97
|
|
|
SCREW INTERFERENCE 9 X 30MM FASTTHREAD AR-4030C-09
|
Facility
|
OP
|
$3,139.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5456918
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$914.08 |
| Max. Negotiated Rate |
$3,003.40 |
| Rate for Payer: Aetna Commercial |
$2,938.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,807.52
|
| Rate for Payer: Aetna Managed Medicare |
$914.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,121.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,632.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,566.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,730.22
|
| Rate for Payer: Cash Price |
$941.70
|
| Rate for Payer: Cigna Commercial |
$3,003.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,826.90
|
| Rate for Payer: Health EOS Commercial |
$2,905.46
|
| Rate for Payer: HFN Commercial |
$3,003.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,448.42
|
| Rate for Payer: Multiplan Commercial |
$2,611.65
|
| Rate for Payer: NAPHCARE Commercial |
$1,958.74
|
| Rate for Payer: Preferred Network Access Commercial |
$3,003.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,599.63
|
| Rate for Payer: Quartz Commercial |
$2,121.96
|
| Rate for Payer: Quartz Medicare Advantage |
$1,958.74
|
| Rate for Payer: The Alliance Commercial |
$1,632.28
|
| Rate for Payer: WEA Trust Commercial |
$1,795.51
|
| Rate for Payer: WPS Commercial |
$2,417.97
|
|
|
SCREW INTERFERENCE BIOTRANSFIX
|
Facility
|
OP
|
$2,747.00
|
|
| Hospital Charge Code |
2964699
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$799.93 |
| Max. Negotiated Rate |
$2,628.33 |
| Rate for Payer: Aetna Commercial |
$2,571.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,456.92
|
| Rate for Payer: Aetna Managed Medicare |
$799.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,856.97
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,428.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,371.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,514.15
|
| Rate for Payer: Cash Price |
$824.10
|
| Rate for Payer: Cigna Commercial |
$2,628.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,598.75
|
| Rate for Payer: Health EOS Commercial |
$2,542.62
|
| Rate for Payer: HFN Commercial |
$2,628.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,142.66
|
| Rate for Payer: Multiplan Commercial |
$2,285.50
|
| Rate for Payer: NAPHCARE Commercial |
$1,714.13
|
| Rate for Payer: Preferred Network Access Commercial |
$2,628.33
|
| Rate for Payer: Quartz Beloit One Network |
$1,399.87
|
| Rate for Payer: Quartz Commercial |
$1,856.97
|
| Rate for Payer: Quartz Medicare Advantage |
$1,714.13
|
| Rate for Payer: The Alliance Commercial |
$1,428.44
|
| Rate for Payer: WEA Trust Commercial |
$1,571.28
|
| Rate for Payer: WPS Commercial |
$2,116.01
|
|
|
SCREW INTERFERENCE BIOTRANSFIX
|
Facility
|
IP
|
$2,747.00
|
|
| Hospital Charge Code |
2964699
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,399.87 |
| Max. Negotiated Rate |
$2,628.33 |
| Rate for Payer: Aetna Commercial |
$2,571.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,456.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,514.15
|
| Rate for Payer: Cash Price |
$824.10
|
| Rate for Payer: Cigna Commercial |
$2,628.33
|
| Rate for Payer: Health EOS Commercial |
$2,542.62
|
| Rate for Payer: HFN Commercial |
$2,628.33
|
| Rate for Payer: Multiplan Commercial |
$2,285.50
|
| Rate for Payer: Preferred Network Access Commercial |
$2,628.33
|
| Rate for Payer: Quartz Beloit One Network |
$1,399.87
|
| Rate for Payer: Quartz Commercial |
$1,714.13
|
| Rate for Payer: WEA Trust Commercial |
$1,571.28
|
| Rate for Payer: WPS Commercial |
$2,116.01
|
|
|
SCREW INTERFERENCE ROUND DELTA 10 X 28MM WITH SHEATH AR-5028P-10
|
Facility
|
IP
|
$4,366.00
|
|
| Hospital Charge Code |
4519924
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,224.91 |
| Max. Negotiated Rate |
$4,177.39 |
| Rate for Payer: Aetna Commercial |
$4,086.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,904.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,406.54
|
| Rate for Payer: Cash Price |
$1,309.80
|
| Rate for Payer: Cigna Commercial |
$4,177.39
|
| Rate for Payer: Health EOS Commercial |
$4,041.17
|
| Rate for Payer: HFN Commercial |
$4,177.39
|
| Rate for Payer: Multiplan Commercial |
$3,632.51
|
| Rate for Payer: Preferred Network Access Commercial |
$4,177.39
|
| Rate for Payer: Quartz Beloit One Network |
$2,224.91
|
| Rate for Payer: Quartz Commercial |
$2,724.38
|
| Rate for Payer: WEA Trust Commercial |
$2,497.35
|
| Rate for Payer: WPS Commercial |
$3,363.13
|
|
|
SCREW INTERFERENCE ROUND DELTA 10 X 28MM WITH SHEATH AR-5028P-10
|
Facility
|
OP
|
$4,366.00
|
|
| Hospital Charge Code |
4519924
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,271.38 |
| Max. Negotiated Rate |
$4,177.39 |
| Rate for Payer: Aetna Commercial |
$4,086.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,904.95
|
| Rate for Payer: Aetna Managed Medicare |
$1,271.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,951.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,270.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,179.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,406.54
|
| Rate for Payer: Cash Price |
$1,309.80
|
| Rate for Payer: Cigna Commercial |
$4,177.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,541.01
|
| Rate for Payer: Health EOS Commercial |
$4,041.17
|
| Rate for Payer: HFN Commercial |
$4,177.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,405.48
|
| Rate for Payer: Multiplan Commercial |
$3,632.51
|
| Rate for Payer: NAPHCARE Commercial |
$2,724.38
|
| Rate for Payer: Preferred Network Access Commercial |
$4,177.39
|
| Rate for Payer: Quartz Beloit One Network |
$2,224.91
|
| Rate for Payer: Quartz Commercial |
$2,951.42
|
| Rate for Payer: Quartz Medicare Advantage |
$2,724.38
|
| Rate for Payer: The Alliance Commercial |
$2,270.32
|
| Rate for Payer: WEA Trust Commercial |
$2,497.35
|
| Rate for Payer: WPS Commercial |
$3,363.13
|
|
|
SCREW INTERFERENCE ROUND DELTA 11 X 28MM WITH SHEATH AR-5028P-11
|
Facility
|
IP
|
$4,366.00
|
|
| Hospital Charge Code |
5107077
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,224.91 |
| Max. Negotiated Rate |
$4,177.39 |
| Rate for Payer: Aetna Commercial |
$4,086.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,904.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,406.54
|
| Rate for Payer: Cash Price |
$1,309.80
|
| Rate for Payer: Cigna Commercial |
$4,177.39
|
| Rate for Payer: Health EOS Commercial |
$4,041.17
|
| Rate for Payer: HFN Commercial |
$4,177.39
|
| Rate for Payer: Multiplan Commercial |
$3,632.51
|
| Rate for Payer: Preferred Network Access Commercial |
$4,177.39
|
| Rate for Payer: Quartz Beloit One Network |
$2,224.91
|
| Rate for Payer: Quartz Commercial |
$2,724.38
|
| Rate for Payer: WEA Trust Commercial |
$2,497.35
|
| Rate for Payer: WPS Commercial |
$3,363.13
|
|
|
SCREW INTERFERENCE ROUND DELTA 11 X 28MM WITH SHEATH AR-5028P-11
|
Facility
|
OP
|
$4,366.00
|
|
| Hospital Charge Code |
5107077
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,271.38 |
| Max. Negotiated Rate |
$4,177.39 |
| Rate for Payer: Aetna Commercial |
$4,086.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,904.95
|
| Rate for Payer: Aetna Managed Medicare |
$1,271.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,951.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,270.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,179.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,406.54
|
| Rate for Payer: Cash Price |
$1,309.80
|
| Rate for Payer: Cigna Commercial |
$4,177.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,541.01
|
| Rate for Payer: Health EOS Commercial |
$4,041.17
|
| Rate for Payer: HFN Commercial |
$4,177.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,405.48
|
| Rate for Payer: Multiplan Commercial |
$3,632.51
|
| Rate for Payer: NAPHCARE Commercial |
$2,724.38
|
| Rate for Payer: Preferred Network Access Commercial |
$4,177.39
|
| Rate for Payer: Quartz Beloit One Network |
$2,224.91
|
| Rate for Payer: Quartz Commercial |
$2,951.42
|
| Rate for Payer: Quartz Medicare Advantage |
$2,724.38
|
| Rate for Payer: The Alliance Commercial |
$2,270.32
|
| Rate for Payer: WEA Trust Commercial |
$2,497.35
|
| Rate for Payer: WPS Commercial |
$3,363.13
|
|
|
SCREW INTERFERENCE ROUND DELTA 9 X 28MM WITH SHEATH AR-5028P-09
|
Facility
|
OP
|
$4,366.00
|
|
| Hospital Charge Code |
4520293
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,271.38 |
| Max. Negotiated Rate |
$4,177.39 |
| Rate for Payer: Aetna Commercial |
$4,086.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,904.95
|
| Rate for Payer: Aetna Managed Medicare |
$1,271.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,951.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,270.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,179.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,406.54
|
| Rate for Payer: Cash Price |
$1,309.80
|
| Rate for Payer: Cigna Commercial |
$4,177.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,541.01
|
| Rate for Payer: Health EOS Commercial |
$4,041.17
|
| Rate for Payer: HFN Commercial |
$4,177.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,405.48
|
| Rate for Payer: Multiplan Commercial |
$3,632.51
|
| Rate for Payer: NAPHCARE Commercial |
$2,724.38
|
| Rate for Payer: Preferred Network Access Commercial |
$4,177.39
|
| Rate for Payer: Quartz Beloit One Network |
$2,224.91
|
| Rate for Payer: Quartz Commercial |
$2,951.42
|
| Rate for Payer: Quartz Medicare Advantage |
$2,724.38
|
| Rate for Payer: The Alliance Commercial |
$2,270.32
|
| Rate for Payer: WEA Trust Commercial |
$2,497.35
|
| Rate for Payer: WPS Commercial |
$3,363.13
|
|
|
SCREW INTERFERENCE ROUND DELTA 9 X 28MM WITH SHEATH AR-5028P-09
|
Facility
|
IP
|
$4,366.00
|
|
| Hospital Charge Code |
4520293
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,224.91 |
| Max. Negotiated Rate |
$4,177.39 |
| Rate for Payer: Aetna Commercial |
$4,086.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,904.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,406.54
|
| Rate for Payer: Cash Price |
$1,309.80
|
| Rate for Payer: Cigna Commercial |
$4,177.39
|
| Rate for Payer: Health EOS Commercial |
$4,041.17
|
| Rate for Payer: HFN Commercial |
$4,177.39
|
| Rate for Payer: Multiplan Commercial |
$3,632.51
|
| Rate for Payer: Preferred Network Access Commercial |
$4,177.39
|
| Rate for Payer: Quartz Beloit One Network |
$2,224.91
|
| Rate for Payer: Quartz Commercial |
$2,724.38
|
| Rate for Payer: WEA Trust Commercial |
$2,497.35
|
| Rate for Payer: WPS Commercial |
$3,363.13
|
|
|
SCREW INTRAFIX PEEK 8-10 X 30 254654
|
Facility
|
IP
|
$3,633.00
|
|
| Hospital Charge Code |
4520590
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,851.38 |
| Max. Negotiated Rate |
$3,476.05 |
| Rate for Payer: Aetna Commercial |
$3,400.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,249.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,002.51
|
| Rate for Payer: Cash Price |
$1,089.90
|
| Rate for Payer: Cigna Commercial |
$3,476.05
|
| Rate for Payer: Health EOS Commercial |
$3,362.70
|
| Rate for Payer: HFN Commercial |
$3,476.05
|
| Rate for Payer: Multiplan Commercial |
$3,022.66
|
| Rate for Payer: Preferred Network Access Commercial |
$3,476.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,851.38
|
| Rate for Payer: Quartz Commercial |
$2,266.99
|
| Rate for Payer: WEA Trust Commercial |
$2,078.08
|
| Rate for Payer: WPS Commercial |
$2,798.50
|
|
|
SCREW INTRAFIX PEEK 8-10 X 30 254654
|
Facility
|
OP
|
$3,633.00
|
|
| Hospital Charge Code |
4520590
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,057.93 |
| Max. Negotiated Rate |
$3,476.05 |
| Rate for Payer: Aetna Commercial |
$3,400.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,249.36
|
| Rate for Payer: Aetna Managed Medicare |
$1,057.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,455.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,889.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,813.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,002.51
|
| Rate for Payer: Cash Price |
$1,089.90
|
| Rate for Payer: Cigna Commercial |
$3,476.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,114.41
|
| Rate for Payer: Health EOS Commercial |
$3,362.70
|
| Rate for Payer: HFN Commercial |
$3,476.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,833.74
|
| Rate for Payer: Multiplan Commercial |
$3,022.66
|
| Rate for Payer: NAPHCARE Commercial |
$2,266.99
|
| Rate for Payer: Preferred Network Access Commercial |
$3,476.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,851.38
|
| Rate for Payer: Quartz Commercial |
$2,455.91
|
| Rate for Payer: Quartz Medicare Advantage |
$2,266.99
|
| Rate for Payer: The Alliance Commercial |
$1,889.16
|
| Rate for Payer: WEA Trust Commercial |
$2,078.08
|
| Rate for Payer: WPS Commercial |
$2,798.50
|
|
|
SCREW JONES 5.5 X 45MM LP PT TI AR-9055-45PT
|
Facility
|
IP
|
$6,100.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685703
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,108.56 |
| Max. Negotiated Rate |
$5,836.48 |
| Rate for Payer: Aetna Commercial |
$5,709.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,455.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,362.32
|
| Rate for Payer: Cash Price |
$1,830.00
|
| Rate for Payer: Cigna Commercial |
$5,836.48
|
| Rate for Payer: Health EOS Commercial |
$5,646.16
|
| Rate for Payer: HFN Commercial |
$5,836.48
|
| Rate for Payer: Multiplan Commercial |
$5,075.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,836.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,108.56
|
| Rate for Payer: Quartz Commercial |
$3,806.40
|
| Rate for Payer: WEA Trust Commercial |
$3,489.20
|
| Rate for Payer: WPS Commercial |
$4,698.83
|
|
|
SCREW JONES 5.5 X 45MM LP PT TI AR-9055-45PT
|
Facility
|
OP
|
$6,100.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685703
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,776.32 |
| Max. Negotiated Rate |
$5,836.48 |
| Rate for Payer: Aetna Commercial |
$5,709.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,455.84
|
| Rate for Payer: Aetna Managed Medicare |
$1,776.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,123.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,172.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,045.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,362.32
|
| Rate for Payer: Cash Price |
$1,830.00
|
| Rate for Payer: Cigna Commercial |
$5,836.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,550.20
|
| Rate for Payer: Health EOS Commercial |
$5,646.16
|
| Rate for Payer: HFN Commercial |
$5,836.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,758.00
|
| Rate for Payer: Multiplan Commercial |
$5,075.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,806.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,836.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,108.56
|
| Rate for Payer: Quartz Commercial |
$4,123.60
|
| Rate for Payer: Quartz Medicare Advantage |
$3,806.40
|
| Rate for Payer: The Alliance Commercial |
$3,172.00
|
| Rate for Payer: WEA Trust Commercial |
$3,489.20
|
| Rate for Payer: WPS Commercial |
$4,698.83
|
|
|
SCREW JONES 5.5 X 60MM LP PT TI AR-9055-60PT
|
Facility
|
IP
|
$6,344.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599718
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,232.90 |
| Max. Negotiated Rate |
$6,069.94 |
| Rate for Payer: Aetna Commercial |
$5,937.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,674.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,496.81
|
| Rate for Payer: Cash Price |
$1,903.20
|
| Rate for Payer: Cigna Commercial |
$6,069.94
|
| Rate for Payer: Health EOS Commercial |
$5,872.01
|
| Rate for Payer: HFN Commercial |
$6,069.94
|
| Rate for Payer: Multiplan Commercial |
$5,278.21
|
| Rate for Payer: Preferred Network Access Commercial |
$6,069.94
|
| Rate for Payer: Quartz Beloit One Network |
$3,232.90
|
| Rate for Payer: Quartz Commercial |
$3,958.66
|
| Rate for Payer: WEA Trust Commercial |
$3,628.77
|
| Rate for Payer: WPS Commercial |
$4,886.78
|
|
|
SCREW JONES 5.5 X 60MM LP PT TI AR-9055-60PT
|
Facility
|
OP
|
$6,344.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599718
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,847.37 |
| Max. Negotiated Rate |
$6,069.94 |
| Rate for Payer: Aetna Commercial |
$5,937.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,674.07
|
| Rate for Payer: Aetna Managed Medicare |
$1,847.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,288.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,298.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,166.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,496.81
|
| Rate for Payer: Cash Price |
$1,903.20
|
| Rate for Payer: Cigna Commercial |
$6,069.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,692.21
|
| Rate for Payer: Health EOS Commercial |
$5,872.01
|
| Rate for Payer: HFN Commercial |
$6,069.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,948.32
|
| Rate for Payer: Multiplan Commercial |
$5,278.21
|
| Rate for Payer: NAPHCARE Commercial |
$3,958.66
|
| Rate for Payer: Preferred Network Access Commercial |
$6,069.94
|
| Rate for Payer: Quartz Beloit One Network |
$3,232.90
|
| Rate for Payer: Quartz Commercial |
$4,288.54
|
| Rate for Payer: Quartz Medicare Advantage |
$3,958.66
|
| Rate for Payer: The Alliance Commercial |
$3,298.88
|
| Rate for Payer: WEA Trust Commercial |
$3,628.77
|
| Rate for Payer: WPS Commercial |
$4,886.78
|
|
|
SCREW KIT FIXED ANGLE TORQUE DEFINING EQUINOXE REVERSE SHOULDER 320-20-00
|
Facility
|
OP
|
$2,046.03
|
|
| Hospital Charge Code |
6240167
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$595.80 |
| Max. Negotiated Rate |
$1,957.64 |
| Rate for Payer: Aetna Commercial |
$1,915.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,829.97
|
| Rate for Payer: Aetna Managed Medicare |
$595.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,383.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,063.94
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,021.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,127.77
|
| Rate for Payer: Cash Price |
$613.81
|
| Rate for Payer: Cigna Commercial |
$1,957.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,190.79
|
| Rate for Payer: Health EOS Commercial |
$1,893.81
|
| Rate for Payer: HFN Commercial |
$1,957.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,595.90
|
| Rate for Payer: Multiplan Commercial |
$1,702.30
|
| Rate for Payer: NAPHCARE Commercial |
$1,276.72
|
| Rate for Payer: Preferred Network Access Commercial |
$1,957.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,042.66
|
| Rate for Payer: Quartz Commercial |
$1,383.12
|
| Rate for Payer: Quartz Medicare Advantage |
$1,276.72
|
| Rate for Payer: The Alliance Commercial |
$1,063.94
|
| Rate for Payer: WEA Trust Commercial |
$1,170.33
|
| Rate for Payer: WPS Commercial |
$1,576.06
|
|
|
SCREW KIT FIXED ANGLE TORQUE DEFINING EQUINOXE REVERSE SHOULDER 320-20-00
|
Facility
|
IP
|
$2,046.03
|
|
| Hospital Charge Code |
6240167
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,042.66 |
| Max. Negotiated Rate |
$1,957.64 |
| Rate for Payer: Aetna Commercial |
$1,915.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,829.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,127.77
|
| Rate for Payer: Cash Price |
$613.81
|
| Rate for Payer: Cigna Commercial |
$1,957.64
|
| Rate for Payer: Health EOS Commercial |
$1,893.81
|
| Rate for Payer: HFN Commercial |
$1,957.64
|
| Rate for Payer: Multiplan Commercial |
$1,702.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,957.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,042.66
|
| Rate for Payer: Quartz Commercial |
$1,276.72
|
| Rate for Payer: WEA Trust Commercial |
$1,170.33
|
| Rate for Payer: WPS Commercial |
$1,576.06
|
|
|
SCREW KREULOCK COMPRESSION 2.4 X 16MM VAL AR-8724VCL-16
|
Facility
|
OP
|
$2,902.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6175176
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$845.06 |
| Max. Negotiated Rate |
$2,776.63 |
| Rate for Payer: Aetna Commercial |
$2,716.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,595.55
|
| Rate for Payer: Aetna Managed Medicare |
$845.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,961.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,509.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,448.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,599.58
|
| Rate for Payer: Cash Price |
$870.60
|
| Rate for Payer: Cigna Commercial |
$2,776.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,688.96
|
| Rate for Payer: Health EOS Commercial |
$2,686.09
|
| Rate for Payer: HFN Commercial |
$2,776.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,263.56
|
| Rate for Payer: Multiplan Commercial |
$2,414.46
|
| Rate for Payer: NAPHCARE Commercial |
$1,810.85
|
| Rate for Payer: Preferred Network Access Commercial |
$2,776.63
|
| Rate for Payer: Quartz Beloit One Network |
$1,478.86
|
| Rate for Payer: Quartz Commercial |
$1,961.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,810.85
|
| Rate for Payer: The Alliance Commercial |
$1,509.04
|
| Rate for Payer: WEA Trust Commercial |
$1,659.94
|
| Rate for Payer: WPS Commercial |
$2,235.41
|
|
|
SCREW KREULOCK COMPRESSION 2.4 X 16MM VAL AR-8724VCL-16
|
Facility
|
IP
|
$2,902.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6175176
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,478.86 |
| Max. Negotiated Rate |
$2,776.63 |
| Rate for Payer: Aetna Commercial |
$2,716.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,595.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,599.58
|
| Rate for Payer: Cash Price |
$870.60
|
| Rate for Payer: Cigna Commercial |
$2,776.63
|
| Rate for Payer: Health EOS Commercial |
$2,686.09
|
| Rate for Payer: HFN Commercial |
$2,776.63
|
| Rate for Payer: Multiplan Commercial |
$2,414.46
|
| Rate for Payer: Preferred Network Access Commercial |
$2,776.63
|
| Rate for Payer: Quartz Beloit One Network |
$1,478.86
|
| Rate for Payer: Quartz Commercial |
$1,810.85
|
| Rate for Payer: WEA Trust Commercial |
$1,659.94
|
| Rate for Payer: WPS Commercial |
$2,235.41
|
|
|
SCREW KREULOCK COMPRESSION 2.4 X 18MM VAL AR-8724VCL-18
|
Facility
|
IP
|
$2,902.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6173605
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,478.86 |
| Max. Negotiated Rate |
$2,776.63 |
| Rate for Payer: Aetna Commercial |
$2,716.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,595.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,599.58
|
| Rate for Payer: Cash Price |
$870.60
|
| Rate for Payer: Cigna Commercial |
$2,776.63
|
| Rate for Payer: Health EOS Commercial |
$2,686.09
|
| Rate for Payer: HFN Commercial |
$2,776.63
|
| Rate for Payer: Multiplan Commercial |
$2,414.46
|
| Rate for Payer: Preferred Network Access Commercial |
$2,776.63
|
| Rate for Payer: Quartz Beloit One Network |
$1,478.86
|
| Rate for Payer: Quartz Commercial |
$1,810.85
|
| Rate for Payer: WEA Trust Commercial |
$1,659.94
|
| Rate for Payer: WPS Commercial |
$2,235.41
|
|
