|
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 |
$705.88 |
| Max. Negotiated Rate |
$10,084.00 |
| Rate for Payer: Aetna Commercial |
$2,268.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,168.06
|
| Rate for Payer: Aetna Managed Medicare |
$705.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,638.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,260.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,210.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,336.13
|
| Rate for Payer: Cash Price |
$756.30
|
| Rate for Payer: Cigna Commercial |
$2,319.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,410.75
|
| Rate for Payer: Health EOS Commercial |
$2,243.69
|
| Rate for Payer: HFN Commercial |
$2,319.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,890.75
|
| Rate for Payer: Multiplan Commercial |
$2,016.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,512.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,319.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,235.29
|
| Rate for Payer: Quartz Commercial |
$1,638.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,512.60
|
| Rate for Payer: The Alliance Commercial |
$10,084.00
|
| Rate for Payer: WEA Trust Commercial |
$1,386.55
|
| Rate for Payer: WPS Commercial |
$1,867.30
|
|
|
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 |
$1,235.29 |
| Max. Negotiated Rate |
$2,319.32 |
| Rate for Payer: Aetna Commercial |
$2,268.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,168.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,336.13
|
| Rate for Payer: Cash Price |
$756.30
|
| Rate for Payer: Cigna Commercial |
$2,319.32
|
| Rate for Payer: Health EOS Commercial |
$2,243.69
|
| Rate for Payer: HFN Commercial |
$2,319.32
|
| Rate for Payer: Multiplan Commercial |
$2,016.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,512.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,319.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,235.29
|
| Rate for Payer: Quartz Commercial |
$1,512.60
|
| Rate for Payer: WEA Trust Commercial |
$1,386.55
|
| Rate for Payer: WPS Commercial |
$1,867.30
|
|
|
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 |
$1,241.80 |
| Max. Negotiated Rate |
$17,740.00 |
| Rate for Payer: Aetna Commercial |
$3,991.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,814.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,241.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,882.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,217.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,128.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,350.55
|
| Rate for Payer: Cash Price |
$1,330.50
|
| Rate for Payer: Cigna Commercial |
$4,080.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,481.83
|
| Rate for Payer: Health EOS Commercial |
$3,947.15
|
| Rate for Payer: HFN Commercial |
$4,080.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,326.25
|
| Rate for Payer: Multiplan Commercial |
$3,548.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,661.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,080.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,173.15
|
| Rate for Payer: Quartz Commercial |
$2,882.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,661.00
|
| Rate for Payer: The Alliance Commercial |
$17,740.00
|
| Rate for Payer: WEA Trust Commercial |
$2,439.25
|
| Rate for Payer: WPS Commercial |
$3,285.00
|
|
|
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 |
$2,173.15 |
| Max. Negotiated Rate |
$4,080.20 |
| Rate for Payer: Aetna Commercial |
$3,991.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,814.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,350.55
|
| Rate for Payer: Cash Price |
$1,330.50
|
| Rate for Payer: Cigna Commercial |
$4,080.20
|
| Rate for Payer: Health EOS Commercial |
$3,947.15
|
| Rate for Payer: HFN Commercial |
$4,080.20
|
| Rate for Payer: Multiplan Commercial |
$3,548.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,661.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,080.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,173.15
|
| Rate for Payer: Quartz Commercial |
$2,661.00
|
| Rate for Payer: WEA Trust Commercial |
$2,439.25
|
| Rate for Payer: WPS Commercial |
$3,285.00
|
|
|
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 |
$830.20 |
| Max. Negotiated Rate |
$11,860.00 |
| Rate for Payer: Aetna Commercial |
$2,668.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,549.90
|
| Rate for Payer: Aetna Managed Medicare |
$830.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,927.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,482.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,423.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,571.45
|
| Rate for Payer: Cash Price |
$889.50
|
| Rate for Payer: Cigna Commercial |
$2,727.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,659.21
|
| Rate for Payer: Health EOS Commercial |
$2,638.85
|
| Rate for Payer: HFN Commercial |
$2,727.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,223.75
|
| Rate for Payer: Multiplan Commercial |
$2,372.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,779.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,727.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,452.85
|
| Rate for Payer: Quartz Commercial |
$1,927.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,779.00
|
| Rate for Payer: The Alliance Commercial |
$11,860.00
|
| Rate for Payer: WEA Trust Commercial |
$1,630.75
|
| Rate for Payer: WPS Commercial |
$2,196.18
|
|
|
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 |
$1,452.85 |
| Max. Negotiated Rate |
$2,727.80 |
| Rate for Payer: Aetna Commercial |
$2,668.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,549.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,571.45
|
| Rate for Payer: Cash Price |
$889.50
|
| Rate for Payer: Cigna Commercial |
$2,727.80
|
| Rate for Payer: Health EOS Commercial |
$2,638.85
|
| Rate for Payer: HFN Commercial |
$2,727.80
|
| Rate for Payer: Multiplan Commercial |
$2,372.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,779.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,727.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,452.85
|
| Rate for Payer: Quartz Commercial |
$1,779.00
|
| Rate for Payer: WEA Trust Commercial |
$1,630.75
|
| Rate for Payer: WPS Commercial |
$2,196.18
|
|
|
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 |
$2,604.35 |
| Max. Negotiated Rate |
$4,889.80 |
| Rate for Payer: Aetna Commercial |
$4,783.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,570.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,816.95
|
| Rate for Payer: Cash Price |
$1,594.50
|
| Rate for Payer: Cigna Commercial |
$4,889.80
|
| Rate for Payer: Health EOS Commercial |
$4,730.35
|
| Rate for Payer: HFN Commercial |
$4,889.80
|
| Rate for Payer: Multiplan Commercial |
$4,252.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,189.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,889.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,604.35
|
| Rate for Payer: Quartz Commercial |
$3,189.00
|
| Rate for Payer: WEA Trust Commercial |
$2,923.25
|
| Rate for Payer: WPS Commercial |
$3,936.82
|
|
|
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 |
$1,488.20 |
| Max. Negotiated Rate |
$21,260.00 |
| Rate for Payer: Aetna Commercial |
$4,783.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,570.90
|
| Rate for Payer: Aetna Managed Medicare |
$1,488.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,454.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,657.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,551.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,816.95
|
| Rate for Payer: Cash Price |
$1,594.50
|
| Rate for Payer: Cigna Commercial |
$4,889.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,974.27
|
| Rate for Payer: Health EOS Commercial |
$4,730.35
|
| Rate for Payer: HFN Commercial |
$4,889.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,986.25
|
| Rate for Payer: Multiplan Commercial |
$4,252.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,189.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,889.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,604.35
|
| Rate for Payer: Quartz Commercial |
$3,454.75
|
| Rate for Payer: Quartz Medicare Advantage |
$3,189.00
|
| Rate for Payer: The Alliance Commercial |
$21,260.00
|
| Rate for Payer: WEA Trust Commercial |
$2,923.25
|
| Rate for Payer: WPS Commercial |
$3,936.82
|
|
|
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 |
$1,488.20 |
| Max. Negotiated Rate |
$21,260.00 |
| Rate for Payer: Aetna Commercial |
$4,783.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,570.90
|
| Rate for Payer: Aetna Managed Medicare |
$1,488.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,454.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,657.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,551.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,816.95
|
| Rate for Payer: Cash Price |
$1,594.50
|
| Rate for Payer: Cigna Commercial |
$4,889.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,974.27
|
| Rate for Payer: Health EOS Commercial |
$4,730.35
|
| Rate for Payer: HFN Commercial |
$4,889.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,986.25
|
| Rate for Payer: Multiplan Commercial |
$4,252.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,189.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,889.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,604.35
|
| Rate for Payer: Quartz Commercial |
$3,454.75
|
| Rate for Payer: Quartz Medicare Advantage |
$3,189.00
|
| Rate for Payer: The Alliance Commercial |
$21,260.00
|
| Rate for Payer: WEA Trust Commercial |
$2,923.25
|
| Rate for Payer: WPS Commercial |
$3,936.82
|
|
|
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 |
$2,604.35 |
| Max. Negotiated Rate |
$4,889.80 |
| Rate for Payer: Aetna Commercial |
$4,783.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,570.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,816.95
|
| Rate for Payer: Cash Price |
$1,594.50
|
| Rate for Payer: Cigna Commercial |
$4,889.80
|
| Rate for Payer: Health EOS Commercial |
$4,730.35
|
| Rate for Payer: HFN Commercial |
$4,889.80
|
| Rate for Payer: Multiplan Commercial |
$4,252.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,189.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,889.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,604.35
|
| Rate for Payer: Quartz Commercial |
$3,189.00
|
| Rate for Payer: WEA Trust Commercial |
$2,923.25
|
| Rate for Payer: WPS Commercial |
$3,936.82
|
|
|
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 |
$2,012.43 |
| Max. Negotiated Rate |
$3,778.44 |
| Rate for Payer: Aetna Commercial |
$3,696.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,532.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,176.71
|
| Rate for Payer: Cash Price |
$1,232.10
|
| Rate for Payer: Cigna Commercial |
$3,778.44
|
| Rate for Payer: Health EOS Commercial |
$3,655.23
|
| Rate for Payer: HFN Commercial |
$3,778.44
|
| Rate for Payer: Multiplan Commercial |
$3,285.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,464.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,778.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,012.43
|
| Rate for Payer: Quartz Commercial |
$2,464.20
|
| Rate for Payer: WEA Trust Commercial |
$2,258.85
|
| Rate for Payer: WPS Commercial |
$3,042.05
|
|
|
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 |
$1,149.96 |
| Max. Negotiated Rate |
$16,428.00 |
| Rate for Payer: Aetna Commercial |
$3,696.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,532.02
|
| Rate for Payer: Aetna Managed Medicare |
$1,149.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,669.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,053.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,971.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,176.71
|
| Rate for Payer: Cash Price |
$1,232.10
|
| Rate for Payer: Cigna Commercial |
$3,778.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,298.28
|
| Rate for Payer: Health EOS Commercial |
$3,655.23
|
| Rate for Payer: HFN Commercial |
$3,778.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,080.25
|
| Rate for Payer: Multiplan Commercial |
$3,285.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,464.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,778.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,012.43
|
| Rate for Payer: Quartz Commercial |
$2,669.55
|
| Rate for Payer: Quartz Medicare Advantage |
$2,464.20
|
| Rate for Payer: The Alliance Commercial |
$16,428.00
|
| Rate for Payer: WEA Trust Commercial |
$2,258.85
|
| Rate for Payer: WPS Commercial |
$3,042.05
|
|
|
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 |
$1,488.20 |
| Max. Negotiated Rate |
$21,260.00 |
| Rate for Payer: Aetna Commercial |
$4,783.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,570.90
|
| Rate for Payer: Aetna Managed Medicare |
$1,488.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,454.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,657.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,551.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,816.95
|
| Rate for Payer: Cash Price |
$1,594.50
|
| Rate for Payer: Cigna Commercial |
$4,889.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,974.27
|
| Rate for Payer: Health EOS Commercial |
$4,730.35
|
| Rate for Payer: HFN Commercial |
$4,889.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,986.25
|
| Rate for Payer: Multiplan Commercial |
$4,252.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,189.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,889.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,604.35
|
| Rate for Payer: Quartz Commercial |
$3,454.75
|
| Rate for Payer: Quartz Medicare Advantage |
$3,189.00
|
| Rate for Payer: The Alliance Commercial |
$21,260.00
|
| Rate for Payer: WEA Trust Commercial |
$2,923.25
|
| Rate for Payer: WPS Commercial |
$3,936.82
|
|
|
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 |
$2,604.35 |
| Max. Negotiated Rate |
$4,889.80 |
| Rate for Payer: Aetna Commercial |
$4,783.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,570.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,816.95
|
| Rate for Payer: Cash Price |
$1,594.50
|
| Rate for Payer: Cigna Commercial |
$4,889.80
|
| Rate for Payer: Health EOS Commercial |
$4,730.35
|
| Rate for Payer: HFN Commercial |
$4,889.80
|
| Rate for Payer: Multiplan Commercial |
$4,252.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,189.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,889.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,604.35
|
| Rate for Payer: Quartz Commercial |
$3,189.00
|
| Rate for Payer: WEA Trust Commercial |
$2,923.25
|
| Rate for Payer: WPS Commercial |
$3,936.82
|
|
|
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 |
$1,488.20 |
| Max. Negotiated Rate |
$21,260.00 |
| Rate for Payer: Aetna Commercial |
$4,783.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,570.90
|
| Rate for Payer: Aetna Managed Medicare |
$1,488.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,454.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,657.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,551.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,816.95
|
| Rate for Payer: Cash Price |
$1,594.50
|
| Rate for Payer: Cigna Commercial |
$4,889.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,974.27
|
| Rate for Payer: Health EOS Commercial |
$4,730.35
|
| Rate for Payer: HFN Commercial |
$4,889.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,986.25
|
| Rate for Payer: Multiplan Commercial |
$4,252.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,189.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,889.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,604.35
|
| Rate for Payer: Quartz Commercial |
$3,454.75
|
| Rate for Payer: Quartz Medicare Advantage |
$3,189.00
|
| Rate for Payer: The Alliance Commercial |
$21,260.00
|
| Rate for Payer: WEA Trust Commercial |
$2,923.25
|
| Rate for Payer: WPS Commercial |
$3,936.82
|
|
|
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 |
$2,604.35 |
| Max. Negotiated Rate |
$4,889.80 |
| Rate for Payer: Aetna Commercial |
$4,783.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,570.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,816.95
|
| Rate for Payer: Cash Price |
$1,594.50
|
| Rate for Payer: Cigna Commercial |
$4,889.80
|
| Rate for Payer: Health EOS Commercial |
$4,730.35
|
| Rate for Payer: HFN Commercial |
$4,889.80
|
| Rate for Payer: Multiplan Commercial |
$4,252.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,189.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,889.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,604.35
|
| Rate for Payer: Quartz Commercial |
$3,189.00
|
| Rate for Payer: WEA Trust Commercial |
$2,923.25
|
| Rate for Payer: WPS Commercial |
$3,936.82
|
|
|
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 |
$1,149.96 |
| Max. Negotiated Rate |
$16,428.00 |
| Rate for Payer: Aetna Commercial |
$3,696.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,532.02
|
| Rate for Payer: Aetna Managed Medicare |
$1,149.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,669.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,053.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,971.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,176.71
|
| Rate for Payer: Cash Price |
$1,232.10
|
| Rate for Payer: Cigna Commercial |
$3,778.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,298.28
|
| Rate for Payer: Health EOS Commercial |
$3,655.23
|
| Rate for Payer: HFN Commercial |
$3,778.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,080.25
|
| Rate for Payer: Multiplan Commercial |
$3,285.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,464.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,778.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,012.43
|
| Rate for Payer: Quartz Commercial |
$2,669.55
|
| Rate for Payer: Quartz Medicare Advantage |
$2,464.20
|
| Rate for Payer: The Alliance Commercial |
$16,428.00
|
| Rate for Payer: WEA Trust Commercial |
$2,258.85
|
| Rate for Payer: WPS Commercial |
$3,042.05
|
|
|
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 |
$2,012.43 |
| Max. Negotiated Rate |
$3,778.44 |
| Rate for Payer: Aetna Commercial |
$3,696.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,532.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,176.71
|
| Rate for Payer: Cash Price |
$1,232.10
|
| Rate for Payer: Cigna Commercial |
$3,778.44
|
| Rate for Payer: Health EOS Commercial |
$3,655.23
|
| Rate for Payer: HFN Commercial |
$3,778.44
|
| Rate for Payer: Multiplan Commercial |
$3,285.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,464.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,778.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,012.43
|
| Rate for Payer: Quartz Commercial |
$2,464.20
|
| Rate for Payer: WEA Trust Commercial |
$2,258.85
|
| Rate for Payer: WPS Commercial |
$3,042.05
|
|
|
SCREW HEADLESS COMPRESSION 7.0 X 60MM SHORT THREAD TI 658360
|
Facility
|
OP
|
$4,107.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5641641
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,149.96 |
| Max. Negotiated Rate |
$16,428.00 |
| Rate for Payer: Aetna Commercial |
$3,696.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,532.02
|
| Rate for Payer: Aetna Managed Medicare |
$1,149.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,669.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,053.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,971.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,176.71
|
| Rate for Payer: Cash Price |
$1,232.10
|
| Rate for Payer: Cigna Commercial |
$3,778.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,298.28
|
| Rate for Payer: Health EOS Commercial |
$3,655.23
|
| Rate for Payer: HFN Commercial |
$3,778.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,080.25
|
| Rate for Payer: Multiplan Commercial |
$3,285.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,464.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,778.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,012.43
|
| Rate for Payer: Quartz Commercial |
$2,669.55
|
| Rate for Payer: Quartz Medicare Advantage |
$2,464.20
|
| Rate for Payer: The Alliance Commercial |
$16,428.00
|
| Rate for Payer: WEA Trust Commercial |
$2,258.85
|
| Rate for Payer: WPS Commercial |
$3,042.05
|
|
|
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 |
$2,012.43 |
| Max. Negotiated Rate |
$3,778.44 |
| Rate for Payer: Aetna Commercial |
$3,696.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,532.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,176.71
|
| Rate for Payer: Cash Price |
$1,232.10
|
| Rate for Payer: Cigna Commercial |
$3,778.44
|
| Rate for Payer: Health EOS Commercial |
$3,655.23
|
| Rate for Payer: HFN Commercial |
$3,778.44
|
| Rate for Payer: Multiplan Commercial |
$3,285.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,464.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,778.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,012.43
|
| Rate for Payer: Quartz Commercial |
$2,464.20
|
| Rate for Payer: WEA Trust Commercial |
$2,258.85
|
| Rate for Payer: WPS Commercial |
$3,042.05
|
|
|
SCREW HEADLESS COMPRESSION 7.0 X 65MM LONG THREAD TI 658565
|
Facility
|
IP
|
$4,107.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6217042
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,012.43 |
| Max. Negotiated Rate |
$3,778.44 |
| Rate for Payer: Aetna Commercial |
$3,696.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,532.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,176.71
|
| Rate for Payer: Cash Price |
$1,232.10
|
| Rate for Payer: Cigna Commercial |
$3,778.44
|
| Rate for Payer: Health EOS Commercial |
$3,655.23
|
| Rate for Payer: HFN Commercial |
$3,778.44
|
| Rate for Payer: Multiplan Commercial |
$3,285.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,464.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,778.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,012.43
|
| Rate for Payer: Quartz Commercial |
$2,464.20
|
| Rate for Payer: WEA Trust Commercial |
$2,258.85
|
| Rate for Payer: WPS Commercial |
$3,042.05
|
|
|
SCREW HEADLESS COMPRESSION 7.0 X 65MM LONG THREAD TI 658565
|
Facility
|
OP
|
$4,107.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6217042
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,149.96 |
| Max. Negotiated Rate |
$16,428.00 |
| Rate for Payer: Aetna Commercial |
$3,696.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,532.02
|
| Rate for Payer: Aetna Managed Medicare |
$1,149.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,669.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,053.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,971.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,176.71
|
| Rate for Payer: Cash Price |
$1,232.10
|
| Rate for Payer: Cigna Commercial |
$3,778.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,298.28
|
| Rate for Payer: Health EOS Commercial |
$3,655.23
|
| Rate for Payer: HFN Commercial |
$3,778.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,080.25
|
| Rate for Payer: Multiplan Commercial |
$3,285.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,464.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,778.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,012.43
|
| Rate for Payer: Quartz Commercial |
$2,669.55
|
| Rate for Payer: Quartz Medicare Advantage |
$2,464.20
|
| Rate for Payer: The Alliance Commercial |
$16,428.00
|
| Rate for Payer: WEA Trust Commercial |
$2,258.85
|
| Rate for Payer: WPS Commercial |
$3,042.05
|
|
|
SCREW HEADLESS COMPRESSION 7.0 X 65MM SHORT THREAD TI 658365
|
Facility
|
OP
|
$5,315.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5861722
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,488.20 |
| Max. Negotiated Rate |
$21,260.00 |
| Rate for Payer: Aetna Commercial |
$4,783.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,570.90
|
| Rate for Payer: Aetna Managed Medicare |
$1,488.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,454.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,657.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,551.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,816.95
|
| Rate for Payer: Cash Price |
$1,594.50
|
| Rate for Payer: Cigna Commercial |
$4,889.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,974.27
|
| Rate for Payer: Health EOS Commercial |
$4,730.35
|
| Rate for Payer: HFN Commercial |
$4,889.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,986.25
|
| Rate for Payer: Multiplan Commercial |
$4,252.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,189.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,889.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,604.35
|
| Rate for Payer: Quartz Commercial |
$3,454.75
|
| Rate for Payer: Quartz Medicare Advantage |
$3,189.00
|
| Rate for Payer: The Alliance Commercial |
$21,260.00
|
| Rate for Payer: WEA Trust Commercial |
$2,923.25
|
| Rate for Payer: WPS Commercial |
$3,936.82
|
|
|
SCREW HEADLESS COMPRESSION 7.0 X 65MM SHORT THREAD TI 658365
|
Facility
|
IP
|
$5,315.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5861722
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,604.35 |
| Max. Negotiated Rate |
$4,889.80 |
| Rate for Payer: Aetna Commercial |
$4,783.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,570.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,816.95
|
| Rate for Payer: Cash Price |
$1,594.50
|
| Rate for Payer: Cigna Commercial |
$4,889.80
|
| Rate for Payer: Health EOS Commercial |
$4,730.35
|
| Rate for Payer: HFN Commercial |
$4,889.80
|
| Rate for Payer: Multiplan Commercial |
$4,252.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,189.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,889.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,604.35
|
| Rate for Payer: Quartz Commercial |
$3,189.00
|
| Rate for Payer: WEA Trust Commercial |
$2,923.25
|
| Rate for Payer: WPS Commercial |
$3,936.82
|
|
|
SCREW HEADLESS COMPRESSION 7.0 X 70MM SHORT THREAD TI 658370
|
Facility
|
OP
|
$5,315.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5861723
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,488.20 |
| Max. Negotiated Rate |
$21,260.00 |
| Rate for Payer: Aetna Commercial |
$4,783.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,570.90
|
| Rate for Payer: Aetna Managed Medicare |
$1,488.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,454.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,657.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,551.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,816.95
|
| Rate for Payer: Cash Price |
$1,594.50
|
| Rate for Payer: Cigna Commercial |
$4,889.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,974.27
|
| Rate for Payer: Health EOS Commercial |
$4,730.35
|
| Rate for Payer: HFN Commercial |
$4,889.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,986.25
|
| Rate for Payer: Multiplan Commercial |
$4,252.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,189.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,889.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,604.35
|
| Rate for Payer: Quartz Commercial |
$3,454.75
|
| Rate for Payer: Quartz Medicare Advantage |
$3,189.00
|
| Rate for Payer: The Alliance Commercial |
$21,260.00
|
| Rate for Payer: WEA Trust Commercial |
$2,923.25
|
| Rate for Payer: WPS Commercial |
$3,936.82
|
|
