|
SCREW INTERFERENCE BIOTRANSFIX
|
Facility
|
IP
|
$2,747.00
|
|
| Hospital Charge Code |
2964699
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,346.03 |
| Max. Negotiated Rate |
$2,527.24 |
| Rate for Payer: Aetna Commercial |
$2,472.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,362.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,455.91
|
| Rate for Payer: Cash Price |
$824.10
|
| Rate for Payer: Cigna Commercial |
$2,527.24
|
| Rate for Payer: Health EOS Commercial |
$2,444.83
|
| Rate for Payer: HFN Commercial |
$2,527.24
|
| Rate for Payer: Multiplan Commercial |
$2,197.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,648.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,527.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,346.03
|
| Rate for Payer: Quartz Commercial |
$1,648.20
|
| Rate for Payer: WEA Trust Commercial |
$1,510.85
|
| Rate for Payer: WPS Commercial |
$2,034.70
|
|
|
SCREW INTERFERENCE BIOTRANSFIX
|
Facility
|
OP
|
$2,747.00
|
|
| Hospital Charge Code |
2964699
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$769.16 |
| Max. Negotiated Rate |
$10,988.00 |
| Rate for Payer: Aetna Commercial |
$2,472.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,362.42
|
| Rate for Payer: Aetna Managed Medicare |
$769.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,785.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,373.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,318.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,455.91
|
| Rate for Payer: Cash Price |
$824.10
|
| Rate for Payer: Cigna Commercial |
$2,527.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,537.22
|
| Rate for Payer: Health EOS Commercial |
$2,444.83
|
| Rate for Payer: HFN Commercial |
$2,527.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,060.25
|
| Rate for Payer: Multiplan Commercial |
$2,197.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,648.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,527.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,346.03
|
| Rate for Payer: Quartz Commercial |
$1,785.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,648.20
|
| Rate for Payer: The Alliance Commercial |
$10,988.00
|
| Rate for Payer: WEA Trust Commercial |
$1,510.85
|
| Rate for Payer: WPS Commercial |
$2,034.70
|
|
|
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 |
$2,139.34 |
| Max. Negotiated Rate |
$4,016.72 |
| Rate for Payer: Aetna Commercial |
$3,929.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,754.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,313.98
|
| Rate for Payer: Cash Price |
$1,309.80
|
| Rate for Payer: Cigna Commercial |
$4,016.72
|
| Rate for Payer: Health EOS Commercial |
$3,885.74
|
| Rate for Payer: HFN Commercial |
$4,016.72
|
| Rate for Payer: Multiplan Commercial |
$3,492.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,619.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,016.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,139.34
|
| Rate for Payer: Quartz Commercial |
$2,619.60
|
| Rate for Payer: WEA Trust Commercial |
$2,401.30
|
| Rate for Payer: WPS Commercial |
$3,233.90
|
|
|
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 |
$1,222.48 |
| Max. Negotiated Rate |
$17,464.00 |
| Rate for Payer: Aetna Commercial |
$3,929.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,754.76
|
| Rate for Payer: Aetna Managed Medicare |
$1,222.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,837.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,183.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,095.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,313.98
|
| Rate for Payer: Cash Price |
$1,309.80
|
| Rate for Payer: Cigna Commercial |
$4,016.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,443.21
|
| Rate for Payer: Health EOS Commercial |
$3,885.74
|
| Rate for Payer: HFN Commercial |
$4,016.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,274.50
|
| Rate for Payer: Multiplan Commercial |
$3,492.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,619.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,016.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,139.34
|
| Rate for Payer: Quartz Commercial |
$2,837.90
|
| Rate for Payer: Quartz Medicare Advantage |
$2,619.60
|
| Rate for Payer: The Alliance Commercial |
$17,464.00
|
| Rate for Payer: WEA Trust Commercial |
$2,401.30
|
| Rate for Payer: WPS Commercial |
$3,233.90
|
|
|
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 |
$2,139.34 |
| Max. Negotiated Rate |
$4,016.72 |
| Rate for Payer: Aetna Commercial |
$3,929.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,754.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,313.98
|
| Rate for Payer: Cash Price |
$1,309.80
|
| Rate for Payer: Cigna Commercial |
$4,016.72
|
| Rate for Payer: Health EOS Commercial |
$3,885.74
|
| Rate for Payer: HFN Commercial |
$4,016.72
|
| Rate for Payer: Multiplan Commercial |
$3,492.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,619.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,016.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,139.34
|
| Rate for Payer: Quartz Commercial |
$2,619.60
|
| Rate for Payer: WEA Trust Commercial |
$2,401.30
|
| Rate for Payer: WPS Commercial |
$3,233.90
|
|
|
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 |
$1,222.48 |
| Max. Negotiated Rate |
$17,464.00 |
| Rate for Payer: Aetna Commercial |
$3,929.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,754.76
|
| Rate for Payer: Aetna Managed Medicare |
$1,222.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,837.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,183.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,095.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,313.98
|
| Rate for Payer: Cash Price |
$1,309.80
|
| Rate for Payer: Cigna Commercial |
$4,016.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,443.21
|
| Rate for Payer: Health EOS Commercial |
$3,885.74
|
| Rate for Payer: HFN Commercial |
$4,016.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,274.50
|
| Rate for Payer: Multiplan Commercial |
$3,492.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,619.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,016.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,139.34
|
| Rate for Payer: Quartz Commercial |
$2,837.90
|
| Rate for Payer: Quartz Medicare Advantage |
$2,619.60
|
| Rate for Payer: The Alliance Commercial |
$17,464.00
|
| Rate for Payer: WEA Trust Commercial |
$2,401.30
|
| Rate for Payer: WPS Commercial |
$3,233.90
|
|
|
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 |
$2,139.34 |
| Max. Negotiated Rate |
$4,016.72 |
| Rate for Payer: Aetna Commercial |
$3,929.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,754.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,313.98
|
| Rate for Payer: Cash Price |
$1,309.80
|
| Rate for Payer: Cigna Commercial |
$4,016.72
|
| Rate for Payer: Health EOS Commercial |
$3,885.74
|
| Rate for Payer: HFN Commercial |
$4,016.72
|
| Rate for Payer: Multiplan Commercial |
$3,492.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,619.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,016.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,139.34
|
| Rate for Payer: Quartz Commercial |
$2,619.60
|
| Rate for Payer: WEA Trust Commercial |
$2,401.30
|
| Rate for Payer: WPS Commercial |
$3,233.90
|
|
|
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 |
$1,222.48 |
| Max. Negotiated Rate |
$17,464.00 |
| Rate for Payer: Aetna Commercial |
$3,929.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,754.76
|
| Rate for Payer: Aetna Managed Medicare |
$1,222.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,837.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,183.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,095.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,313.98
|
| Rate for Payer: Cash Price |
$1,309.80
|
| Rate for Payer: Cigna Commercial |
$4,016.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,443.21
|
| Rate for Payer: Health EOS Commercial |
$3,885.74
|
| Rate for Payer: HFN Commercial |
$4,016.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,274.50
|
| Rate for Payer: Multiplan Commercial |
$3,492.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,619.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,016.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,139.34
|
| Rate for Payer: Quartz Commercial |
$2,837.90
|
| Rate for Payer: Quartz Medicare Advantage |
$2,619.60
|
| Rate for Payer: The Alliance Commercial |
$17,464.00
|
| Rate for Payer: WEA Trust Commercial |
$2,401.30
|
| Rate for Payer: WPS Commercial |
$3,233.90
|
|
|
SCREW INTRAFIX PEEK 8-10 X 30 254654
|
Facility
|
OP
|
$3,633.00
|
|
| Hospital Charge Code |
4520590
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,017.24 |
| Max. Negotiated Rate |
$14,532.00 |
| Rate for Payer: Aetna Commercial |
$3,269.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,124.38
|
| Rate for Payer: Aetna Managed Medicare |
$1,017.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,361.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,816.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,743.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,925.49
|
| Rate for Payer: Cash Price |
$1,089.90
|
| Rate for Payer: Cigna Commercial |
$3,342.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,033.03
|
| Rate for Payer: Health EOS Commercial |
$3,233.37
|
| Rate for Payer: HFN Commercial |
$3,342.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,724.75
|
| Rate for Payer: Multiplan Commercial |
$2,906.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,179.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,342.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,780.17
|
| Rate for Payer: Quartz Commercial |
$2,361.45
|
| Rate for Payer: Quartz Medicare Advantage |
$2,179.80
|
| Rate for Payer: The Alliance Commercial |
$14,532.00
|
| Rate for Payer: WEA Trust Commercial |
$1,998.15
|
| Rate for Payer: WPS Commercial |
$2,690.96
|
|
|
SCREW INTRAFIX PEEK 8-10 X 30 254654
|
Facility
|
IP
|
$3,633.00
|
|
| Hospital Charge Code |
4520590
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,780.17 |
| Max. Negotiated Rate |
$3,342.36 |
| Rate for Payer: Aetna Commercial |
$3,269.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,124.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,925.49
|
| Rate for Payer: Cash Price |
$1,089.90
|
| Rate for Payer: Cigna Commercial |
$3,342.36
|
| Rate for Payer: Health EOS Commercial |
$3,233.37
|
| Rate for Payer: HFN Commercial |
$3,342.36
|
| Rate for Payer: Multiplan Commercial |
$2,906.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,179.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,342.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,780.17
|
| Rate for Payer: Quartz Commercial |
$2,179.80
|
| Rate for Payer: WEA Trust Commercial |
$1,998.15
|
| Rate for Payer: WPS Commercial |
$2,690.96
|
|
|
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 |
$2,989.00 |
| Max. Negotiated Rate |
$5,612.00 |
| Rate for Payer: Aetna Commercial |
$5,490.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,246.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,233.00
|
| Rate for Payer: Cash Price |
$1,830.00
|
| Rate for Payer: Cigna Commercial |
$5,612.00
|
| Rate for Payer: Health EOS Commercial |
$5,429.00
|
| Rate for Payer: HFN Commercial |
$5,612.00
|
| Rate for Payer: Multiplan Commercial |
$4,880.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,660.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,612.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,989.00
|
| Rate for Payer: Quartz Commercial |
$3,660.00
|
| Rate for Payer: WEA Trust Commercial |
$3,355.00
|
| Rate for Payer: WPS Commercial |
$4,518.27
|
|
|
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 |
$1,708.00 |
| Max. Negotiated Rate |
$24,400.00 |
| Rate for Payer: Aetna Commercial |
$5,490.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,246.00
|
| Rate for Payer: Aetna Managed Medicare |
$1,708.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,965.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,050.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,928.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,233.00
|
| Rate for Payer: Cash Price |
$1,830.00
|
| Rate for Payer: Cigna Commercial |
$5,612.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,413.56
|
| Rate for Payer: Health EOS Commercial |
$5,429.00
|
| Rate for Payer: HFN Commercial |
$5,612.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,575.00
|
| Rate for Payer: Multiplan Commercial |
$4,880.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,660.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,612.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,989.00
|
| Rate for Payer: Quartz Commercial |
$3,965.00
|
| Rate for Payer: Quartz Medicare Advantage |
$3,660.00
|
| Rate for Payer: The Alliance Commercial |
$24,400.00
|
| Rate for Payer: WEA Trust Commercial |
$3,355.00
|
| Rate for Payer: WPS Commercial |
$4,518.27
|
|
|
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 |
$1,776.32 |
| Max. Negotiated Rate |
$25,376.00 |
| 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 |
$1,903.20
|
| Rate for Payer: Cigna Commercial |
$5,836.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,550.10
|
| 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 |
$25,376.00
|
| Rate for Payer: WEA Trust Commercial |
$3,489.20
|
| Rate for Payer: WPS Commercial |
$4,699.00
|
|
|
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 |
$3,108.56 |
| 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 |
$1,903.20
|
| 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: 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 |
$3,806.40
|
| Rate for Payer: WEA Trust Commercial |
$3,489.20
|
| Rate for Payer: WPS Commercial |
$4,699.00
|
|
|
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 |
$1,002.55 |
| Max. Negotiated Rate |
$1,882.35 |
| Rate for Payer: Aetna Commercial |
$1,841.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,759.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,084.40
|
| Rate for Payer: Cash Price |
$613.81
|
| Rate for Payer: Cigna Commercial |
$1,882.35
|
| Rate for Payer: Health EOS Commercial |
$1,820.97
|
| Rate for Payer: HFN Commercial |
$1,882.35
|
| Rate for Payer: Multiplan Commercial |
$1,636.82
|
| Rate for Payer: NAPHCARE Commercial |
$1,227.62
|
| Rate for Payer: Preferred Network Access Commercial |
$1,882.35
|
| Rate for Payer: Quartz Beloit One Network |
$1,002.55
|
| Rate for Payer: Quartz Commercial |
$1,227.62
|
| Rate for Payer: WEA Trust Commercial |
$1,125.32
|
| Rate for Payer: WPS Commercial |
$1,515.49
|
|
|
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 |
$572.89 |
| Max. Negotiated Rate |
$8,184.12 |
| Rate for Payer: Aetna Commercial |
$1,841.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,759.59
|
| Rate for Payer: Aetna Managed Medicare |
$572.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,329.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,023.02
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$982.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,084.40
|
| Rate for Payer: Cash Price |
$613.81
|
| Rate for Payer: Cigna Commercial |
$1,882.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,144.96
|
| Rate for Payer: Health EOS Commercial |
$1,820.97
|
| Rate for Payer: HFN Commercial |
$1,882.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,534.52
|
| Rate for Payer: Multiplan Commercial |
$1,636.82
|
| Rate for Payer: NAPHCARE Commercial |
$1,227.62
|
| Rate for Payer: Preferred Network Access Commercial |
$1,882.35
|
| Rate for Payer: Quartz Beloit One Network |
$1,002.55
|
| Rate for Payer: Quartz Commercial |
$1,329.92
|
| Rate for Payer: Quartz Medicare Advantage |
$1,227.62
|
| Rate for Payer: The Alliance Commercial |
$8,184.12
|
| Rate for Payer: WEA Trust Commercial |
$1,125.32
|
| Rate for Payer: WPS Commercial |
$1,515.49
|
|
|
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 |
$812.56 |
| Max. Negotiated Rate |
$11,608.00 |
| Rate for Payer: Aetna Commercial |
$2,611.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,495.72
|
| Rate for Payer: Aetna Managed Medicare |
$812.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,886.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,451.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,392.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,538.06
|
| Rate for Payer: Cash Price |
$870.60
|
| Rate for Payer: Cigna Commercial |
$2,669.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,623.96
|
| Rate for Payer: Health EOS Commercial |
$2,582.78
|
| Rate for Payer: HFN Commercial |
$2,669.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,176.50
|
| Rate for Payer: Multiplan Commercial |
$2,321.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,741.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,669.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,421.98
|
| Rate for Payer: Quartz Commercial |
$1,886.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,741.20
|
| Rate for Payer: The Alliance Commercial |
$11,608.00
|
| Rate for Payer: WEA Trust Commercial |
$1,596.10
|
| Rate for Payer: WPS Commercial |
$2,149.51
|
|
|
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 |
$1,421.98 |
| Max. Negotiated Rate |
$2,669.84 |
| Rate for Payer: Aetna Commercial |
$2,611.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,495.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,538.06
|
| Rate for Payer: Cash Price |
$870.60
|
| Rate for Payer: Cigna Commercial |
$2,669.84
|
| Rate for Payer: Health EOS Commercial |
$2,582.78
|
| Rate for Payer: HFN Commercial |
$2,669.84
|
| Rate for Payer: Multiplan Commercial |
$2,321.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,741.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,669.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,421.98
|
| Rate for Payer: Quartz Commercial |
$1,741.20
|
| Rate for Payer: WEA Trust Commercial |
$1,596.10
|
| Rate for Payer: WPS Commercial |
$2,149.51
|
|
|
SCREW KREULOCK COMPRESSION 2.4 X 18MM VAL AR-8724VCL-18
|
Facility
|
OP
|
$2,902.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6173605
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$812.56 |
| Max. Negotiated Rate |
$11,608.00 |
| Rate for Payer: Aetna Commercial |
$2,611.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,495.72
|
| Rate for Payer: Aetna Managed Medicare |
$812.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,886.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,451.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,392.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,538.06
|
| Rate for Payer: Cash Price |
$870.60
|
| Rate for Payer: Cigna Commercial |
$2,669.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,623.96
|
| Rate for Payer: Health EOS Commercial |
$2,582.78
|
| Rate for Payer: HFN Commercial |
$2,669.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,176.50
|
| Rate for Payer: Multiplan Commercial |
$2,321.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,741.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,669.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,421.98
|
| Rate for Payer: Quartz Commercial |
$1,886.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,741.20
|
| Rate for Payer: The Alliance Commercial |
$11,608.00
|
| Rate for Payer: WEA Trust Commercial |
$1,596.10
|
| Rate for Payer: WPS Commercial |
$2,149.51
|
|
|
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 |
$1,421.98 |
| Max. Negotiated Rate |
$2,669.84 |
| Rate for Payer: Aetna Commercial |
$2,611.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,495.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,538.06
|
| Rate for Payer: Cash Price |
$870.60
|
| Rate for Payer: Cigna Commercial |
$2,669.84
|
| Rate for Payer: Health EOS Commercial |
$2,582.78
|
| Rate for Payer: HFN Commercial |
$2,669.84
|
| Rate for Payer: Multiplan Commercial |
$2,321.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,741.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,669.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,421.98
|
| Rate for Payer: Quartz Commercial |
$1,741.20
|
| Rate for Payer: WEA Trust Commercial |
$1,596.10
|
| Rate for Payer: WPS Commercial |
$2,149.51
|
|
|
SCREW KREULOCK COMPRESSION 2.4 X 20MM VAL AR-8724VCL-20
|
Facility
|
IP
|
$2,902.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6173606
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,421.98 |
| Max. Negotiated Rate |
$2,669.84 |
| Rate for Payer: Aetna Commercial |
$2,611.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,495.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,538.06
|
| Rate for Payer: Cash Price |
$870.60
|
| Rate for Payer: Cigna Commercial |
$2,669.84
|
| Rate for Payer: Health EOS Commercial |
$2,582.78
|
| Rate for Payer: HFN Commercial |
$2,669.84
|
| Rate for Payer: Multiplan Commercial |
$2,321.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,741.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,669.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,421.98
|
| Rate for Payer: Quartz Commercial |
$1,741.20
|
| Rate for Payer: WEA Trust Commercial |
$1,596.10
|
| Rate for Payer: WPS Commercial |
$2,149.51
|
|
|
SCREW KREULOCK COMPRESSION 2.4 X 20MM VAL AR-8724VCL-20
|
Facility
|
OP
|
$2,902.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6173606
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$812.56 |
| Max. Negotiated Rate |
$11,608.00 |
| Rate for Payer: Aetna Commercial |
$2,611.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,495.72
|
| Rate for Payer: Aetna Managed Medicare |
$812.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,886.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,451.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,392.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,538.06
|
| Rate for Payer: Cash Price |
$870.60
|
| Rate for Payer: Cigna Commercial |
$2,669.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,623.96
|
| Rate for Payer: Health EOS Commercial |
$2,582.78
|
| Rate for Payer: HFN Commercial |
$2,669.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,176.50
|
| Rate for Payer: Multiplan Commercial |
$2,321.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,741.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,669.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,421.98
|
| Rate for Payer: Quartz Commercial |
$1,886.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,741.20
|
| Rate for Payer: The Alliance Commercial |
$11,608.00
|
| Rate for Payer: WEA Trust Commercial |
$1,596.10
|
| Rate for Payer: WPS Commercial |
$2,149.51
|
|
|
SCREW KREULOCK COMPRESSION 2.4 X 22MM VAL AR-8724VCL-22
|
Facility
|
OP
|
$2,902.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6175177
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$812.56 |
| Max. Negotiated Rate |
$11,608.00 |
| Rate for Payer: Aetna Commercial |
$2,611.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,495.72
|
| Rate for Payer: Aetna Managed Medicare |
$812.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,886.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,451.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,392.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,538.06
|
| Rate for Payer: Cash Price |
$870.60
|
| Rate for Payer: Cigna Commercial |
$2,669.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,623.96
|
| Rate for Payer: Health EOS Commercial |
$2,582.78
|
| Rate for Payer: HFN Commercial |
$2,669.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,176.50
|
| Rate for Payer: Multiplan Commercial |
$2,321.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,741.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,669.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,421.98
|
| Rate for Payer: Quartz Commercial |
$1,886.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,741.20
|
| Rate for Payer: The Alliance Commercial |
$11,608.00
|
| Rate for Payer: WEA Trust Commercial |
$1,596.10
|
| Rate for Payer: WPS Commercial |
$2,149.51
|
|
|
SCREW KREULOCK COMPRESSION 2.4 X 22MM VAL AR-8724VCL-22
|
Facility
|
IP
|
$2,902.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6175177
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,421.98 |
| Max. Negotiated Rate |
$2,669.84 |
| Rate for Payer: Aetna Commercial |
$2,611.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,495.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,538.06
|
| Rate for Payer: Cash Price |
$870.60
|
| Rate for Payer: Cigna Commercial |
$2,669.84
|
| Rate for Payer: Health EOS Commercial |
$2,582.78
|
| Rate for Payer: HFN Commercial |
$2,669.84
|
| Rate for Payer: Multiplan Commercial |
$2,321.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,741.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,669.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,421.98
|
| Rate for Payer: Quartz Commercial |
$1,741.20
|
| Rate for Payer: WEA Trust Commercial |
$1,596.10
|
| Rate for Payer: WPS Commercial |
$2,149.51
|
|
|
SCREW KREULOCK COMPRESSION 2.4 X 24MM VAL AR-8724VCL-24
|
Facility
|
OP
|
$2,929.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6217072
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$820.12 |
| Max. Negotiated Rate |
$11,716.00 |
| Rate for Payer: Aetna Commercial |
$2,636.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,518.94
|
| Rate for Payer: Aetna Managed Medicare |
$820.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,903.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,464.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,405.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,552.37
|
| Rate for Payer: Cash Price |
$878.70
|
| Rate for Payer: Cigna Commercial |
$2,694.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,639.07
|
| Rate for Payer: Health EOS Commercial |
$2,606.81
|
| Rate for Payer: HFN Commercial |
$2,694.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,196.75
|
| Rate for Payer: Multiplan Commercial |
$2,343.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,757.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,694.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,435.21
|
| Rate for Payer: Quartz Commercial |
$1,903.85
|
| Rate for Payer: Quartz Medicare Advantage |
$1,757.40
|
| Rate for Payer: The Alliance Commercial |
$11,716.00
|
| Rate for Payer: WEA Trust Commercial |
$1,610.95
|
| Rate for Payer: WPS Commercial |
$2,169.51
|
|
