|
SCREW LOCK MATRIX MANDIBLE 2.4 X 16MM 04.503.646.01
|
Facility
|
OP
|
$2,847.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6185032
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$797.16 |
| Max. Negotiated Rate |
$11,388.00 |
| Rate for Payer: Aetna Commercial |
$2,562.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,448.42
|
| Rate for Payer: Aetna Managed Medicare |
$797.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,850.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,423.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,366.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,508.91
|
| Rate for Payer: Cash Price |
$854.10
|
| Rate for Payer: Cigna Commercial |
$2,619.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,593.18
|
| Rate for Payer: Health EOS Commercial |
$2,533.83
|
| Rate for Payer: HFN Commercial |
$2,619.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,135.25
|
| Rate for Payer: Multiplan Commercial |
$2,277.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,708.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,619.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,395.03
|
| Rate for Payer: Quartz Commercial |
$1,850.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,708.20
|
| Rate for Payer: The Alliance Commercial |
$11,388.00
|
| Rate for Payer: WEA Trust Commercial |
$1,565.85
|
| Rate for Payer: WPS Commercial |
$2,108.77
|
|
|
SCREW LOCK MATRIX MANDIBLE 2.4 X 16MM 04.503.646.01
|
Facility
|
IP
|
$2,847.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6185032
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,395.03 |
| Max. Negotiated Rate |
$2,619.24 |
| Rate for Payer: Aetna Commercial |
$2,562.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,448.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,508.91
|
| Rate for Payer: Cash Price |
$854.10
|
| Rate for Payer: Cigna Commercial |
$2,619.24
|
| Rate for Payer: Health EOS Commercial |
$2,533.83
|
| Rate for Payer: HFN Commercial |
$2,619.24
|
| Rate for Payer: Multiplan Commercial |
$2,277.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,708.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,619.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,395.03
|
| Rate for Payer: Quartz Commercial |
$1,708.20
|
| Rate for Payer: WEA Trust Commercial |
$1,565.85
|
| Rate for Payer: WPS Commercial |
$2,108.77
|
|
|
SCREW LOCK VA 2.4 X 12MM TI AR-8724V-12
|
Facility
|
OP
|
$1,864.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414674
|
|
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 VA 2.4 X 12MM TI AR-8724V-12
|
Facility
|
IP
|
$1,864.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414674
|
|
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 VA 2.4 X 14MM TI AR-8724V-14
|
Facility
|
IP
|
$1,864.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5200621
|
|
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 VA 2.4 X 14MM TI AR-8724V-14
|
Facility
|
OP
|
$1,864.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5200621
|
|
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 VA 2.4 X 16MM TI AR-8724V-16
|
Facility
|
IP
|
$1,740.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5384971
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$852.60 |
| Max. Negotiated Rate |
$1,600.80 |
| Rate for Payer: Aetna Commercial |
$1,566.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,496.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$922.20
|
| Rate for Payer: Cash Price |
$522.00
|
| Rate for Payer: Cigna Commercial |
$1,600.80
|
| Rate for Payer: Health EOS Commercial |
$1,548.60
|
| Rate for Payer: HFN Commercial |
$1,600.80
|
| Rate for Payer: Multiplan Commercial |
$1,392.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,044.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,600.80
|
| Rate for Payer: Quartz Beloit One Network |
$852.60
|
| Rate for Payer: Quartz Commercial |
$1,044.00
|
| Rate for Payer: WEA Trust Commercial |
$957.00
|
| Rate for Payer: WPS Commercial |
$1,288.82
|
|
|
SCREW LOCK VA 2.4 X 16MM TI AR-8724V-16
|
Facility
|
OP
|
$1,740.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5384971
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$487.20 |
| Max. Negotiated Rate |
$6,960.00 |
| Rate for Payer: Aetna Commercial |
$1,566.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,496.40
|
| Rate for Payer: Aetna Managed Medicare |
$487.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,131.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$870.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$835.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$922.20
|
| Rate for Payer: Cash Price |
$522.00
|
| Rate for Payer: Cigna Commercial |
$1,600.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$973.70
|
| Rate for Payer: Health EOS Commercial |
$1,548.60
|
| Rate for Payer: HFN Commercial |
$1,600.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,305.00
|
| Rate for Payer: Multiplan Commercial |
$1,392.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,044.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,600.80
|
| Rate for Payer: Quartz Beloit One Network |
$852.60
|
| Rate for Payer: Quartz Commercial |
$1,131.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,044.00
|
| Rate for Payer: The Alliance Commercial |
$6,960.00
|
| Rate for Payer: WEA Trust Commercial |
$957.00
|
| Rate for Payer: WPS Commercial |
$1,288.82
|
|
|
SCREW LOCK VA 2.4 X 18MM TI AR-8724V-18
|
Facility
|
OP
|
$1,864.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414663
|
|
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 VA 2.4 X 18MM TI AR-8724V-18
|
Facility
|
IP
|
$1,864.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414663
|
|
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 VA 2.4 X 20MM TI AR-8724V-20
|
Facility
|
OP
|
$1,864.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5384972
|
|
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 VA 2.4 X 20MM TI AR-8724V-20
|
Facility
|
IP
|
$1,864.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5384972
|
|
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 VA 2.4 X 22MM TI AR-8724V-22
|
Facility
|
IP
|
$1,864.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5384970
|
|
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 VA 2.4 X 22MM TI AR-8724V-22
|
Facility
|
OP
|
$1,864.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5384970
|
|
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 VA 2.4 X 26MM TI AR-8724V-26
|
Facility
|
IP
|
$1,864.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5384973
|
|
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 VA 2.4 X 26MM TI AR-8724V-26
|
Facility
|
OP
|
$1,864.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5384973
|
|
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 VA 2.4 X 8MM TI AR-8724V-08
|
Facility
|
IP
|
$1,864.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5597610
|
|
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 VA 2.4 X 8MM TI AR-8724V-08
|
Facility
|
OP
|
$1,864.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5597610
|
|
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 VA 3.5 X 12MM TI AR-8735L-12
|
Facility
|
OP
|
$1,255.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599751
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$351.40 |
| Max. Negotiated Rate |
$5,020.00 |
| Rate for Payer: Aetna Commercial |
$1,129.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,079.30
|
| Rate for Payer: Aetna Managed Medicare |
$351.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$815.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$627.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$602.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$665.15
|
| Rate for Payer: Cash Price |
$376.50
|
| Rate for Payer: Cigna Commercial |
$1,154.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$702.30
|
| Rate for Payer: Health EOS Commercial |
$1,116.95
|
| Rate for Payer: HFN Commercial |
$1,154.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$941.25
|
| Rate for Payer: Multiplan Commercial |
$1,004.00
|
| Rate for Payer: NAPHCARE Commercial |
$753.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,154.60
|
| Rate for Payer: Quartz Beloit One Network |
$614.95
|
| Rate for Payer: Quartz Commercial |
$815.75
|
| Rate for Payer: Quartz Medicare Advantage |
$753.00
|
| Rate for Payer: The Alliance Commercial |
$5,020.00
|
| Rate for Payer: WEA Trust Commercial |
$690.25
|
| Rate for Payer: WPS Commercial |
$929.58
|
|
|
SCREW LOCK VA 3.5 X 12MM TI AR-8735L-12
|
Facility
|
IP
|
$1,255.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599751
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$614.95 |
| Max. Negotiated Rate |
$1,154.60 |
| Rate for Payer: Aetna Commercial |
$1,129.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,079.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$665.15
|
| Rate for Payer: Cash Price |
$376.50
|
| Rate for Payer: Cigna Commercial |
$1,154.60
|
| Rate for Payer: Health EOS Commercial |
$1,116.95
|
| Rate for Payer: HFN Commercial |
$1,154.60
|
| Rate for Payer: Multiplan Commercial |
$1,004.00
|
| Rate for Payer: NAPHCARE Commercial |
$753.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,154.60
|
| Rate for Payer: Quartz Beloit One Network |
$614.95
|
| Rate for Payer: Quartz Commercial |
$753.00
|
| Rate for Payer: WEA Trust Commercial |
$690.25
|
| Rate for Payer: WPS Commercial |
$929.58
|
|
|
SCREW LOCK VA 3.5 X 14MM TI AR-8735L-14
|
Facility
|
OP
|
$1,255.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599752
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$351.40 |
| Max. Negotiated Rate |
$5,020.00 |
| Rate for Payer: Aetna Commercial |
$1,129.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,079.30
|
| Rate for Payer: Aetna Managed Medicare |
$351.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$815.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$627.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$602.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$665.15
|
| Rate for Payer: Cash Price |
$376.50
|
| Rate for Payer: Cigna Commercial |
$1,154.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$702.30
|
| Rate for Payer: Health EOS Commercial |
$1,116.95
|
| Rate for Payer: HFN Commercial |
$1,154.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$941.25
|
| Rate for Payer: Multiplan Commercial |
$1,004.00
|
| Rate for Payer: NAPHCARE Commercial |
$753.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,154.60
|
| Rate for Payer: Quartz Beloit One Network |
$614.95
|
| Rate for Payer: Quartz Commercial |
$815.75
|
| Rate for Payer: Quartz Medicare Advantage |
$753.00
|
| Rate for Payer: The Alliance Commercial |
$5,020.00
|
| Rate for Payer: WEA Trust Commercial |
$690.25
|
| Rate for Payer: WPS Commercial |
$929.58
|
|
|
SCREW LOCK VA 3.5 X 14MM TI AR-8735L-14
|
Facility
|
IP
|
$1,255.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599752
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$614.95 |
| Max. Negotiated Rate |
$1,154.60 |
| Rate for Payer: Aetna Commercial |
$1,129.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,079.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$665.15
|
| Rate for Payer: Cash Price |
$376.50
|
| Rate for Payer: Cigna Commercial |
$1,154.60
|
| Rate for Payer: Health EOS Commercial |
$1,116.95
|
| Rate for Payer: HFN Commercial |
$1,154.60
|
| Rate for Payer: Multiplan Commercial |
$1,004.00
|
| Rate for Payer: NAPHCARE Commercial |
$753.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,154.60
|
| Rate for Payer: Quartz Beloit One Network |
$614.95
|
| Rate for Payer: Quartz Commercial |
$753.00
|
| Rate for Payer: WEA Trust Commercial |
$690.25
|
| Rate for Payer: WPS Commercial |
$929.58
|
|
|
SCREW LOCK VA 3.5 X 16MM TI AR-8735L-16
|
Facility
|
IP
|
$1,255.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6175178
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$614.95 |
| Max. Negotiated Rate |
$1,154.60 |
| Rate for Payer: Aetna Commercial |
$1,129.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,079.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$665.15
|
| Rate for Payer: Cash Price |
$376.50
|
| Rate for Payer: Cigna Commercial |
$1,154.60
|
| Rate for Payer: Health EOS Commercial |
$1,116.95
|
| Rate for Payer: HFN Commercial |
$1,154.60
|
| Rate for Payer: Multiplan Commercial |
$1,004.00
|
| Rate for Payer: NAPHCARE Commercial |
$753.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,154.60
|
| Rate for Payer: Quartz Beloit One Network |
$614.95
|
| Rate for Payer: Quartz Commercial |
$753.00
|
| Rate for Payer: WEA Trust Commercial |
$690.25
|
| Rate for Payer: WPS Commercial |
$929.58
|
|
|
SCREW LOCK VA 3.5 X 16MM TI AR-8735L-16
|
Facility
|
OP
|
$1,255.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6175178
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$351.40 |
| Max. Negotiated Rate |
$5,020.00 |
| Rate for Payer: Aetna Commercial |
$1,129.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,079.30
|
| Rate for Payer: Aetna Managed Medicare |
$351.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$815.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$627.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$602.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$665.15
|
| Rate for Payer: Cash Price |
$376.50
|
| Rate for Payer: Cigna Commercial |
$1,154.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$702.30
|
| Rate for Payer: Health EOS Commercial |
$1,116.95
|
| Rate for Payer: HFN Commercial |
$1,154.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$941.25
|
| Rate for Payer: Multiplan Commercial |
$1,004.00
|
| Rate for Payer: NAPHCARE Commercial |
$753.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,154.60
|
| Rate for Payer: Quartz Beloit One Network |
$614.95
|
| Rate for Payer: Quartz Commercial |
$815.75
|
| Rate for Payer: Quartz Medicare Advantage |
$753.00
|
| Rate for Payer: The Alliance Commercial |
$5,020.00
|
| Rate for Payer: WEA Trust Commercial |
$690.25
|
| Rate for Payer: WPS Commercial |
$929.58
|
|
|
SCREW LOCK VA 3.5 X 18MM TI AR-8735L-18
|
Facility
|
IP
|
$1,255.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6175179
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$614.95 |
| Max. Negotiated Rate |
$1,154.60 |
| Rate for Payer: Aetna Commercial |
$1,129.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,079.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$665.15
|
| Rate for Payer: Cash Price |
$376.50
|
| Rate for Payer: Cigna Commercial |
$1,154.60
|
| Rate for Payer: Health EOS Commercial |
$1,116.95
|
| Rate for Payer: HFN Commercial |
$1,154.60
|
| Rate for Payer: Multiplan Commercial |
$1,004.00
|
| Rate for Payer: NAPHCARE Commercial |
$753.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,154.60
|
| Rate for Payer: Quartz Beloit One Network |
$614.95
|
| Rate for Payer: Quartz Commercial |
$753.00
|
| Rate for Payer: WEA Trust Commercial |
$690.25
|
| Rate for Payer: WPS Commercial |
$929.58
|
|
