|
SCREW SNAP OFF 2.0 X 14 WS14
|
Facility
|
IP
|
$5,270.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5583418
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,582.30 |
| Max. Negotiated Rate |
$4,848.40 |
| Rate for Payer: Aetna Commercial |
$4,743.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,532.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,793.10
|
| Rate for Payer: Cash Price |
$1,581.00
|
| Rate for Payer: Cigna Commercial |
$4,848.40
|
| Rate for Payer: Health EOS Commercial |
$4,690.30
|
| Rate for Payer: HFN Commercial |
$4,848.40
|
| Rate for Payer: Multiplan Commercial |
$4,216.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,162.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,848.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,582.30
|
| Rate for Payer: Quartz Commercial |
$3,162.00
|
| Rate for Payer: WEA Trust Commercial |
$2,898.50
|
| Rate for Payer: WPS Commercial |
$3,903.49
|
|
|
SCREW SNAP-OFF 2.7 X 13MM CHARLOTTE F & A 45110004
|
Facility
|
IP
|
$2,563.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6199062
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,255.87 |
| Max. Negotiated Rate |
$2,357.96 |
| Rate for Payer: Aetna Commercial |
$2,306.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,204.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,358.39
|
| Rate for Payer: Cash Price |
$768.90
|
| Rate for Payer: Cigna Commercial |
$2,357.96
|
| Rate for Payer: Health EOS Commercial |
$2,281.07
|
| Rate for Payer: HFN Commercial |
$2,357.96
|
| Rate for Payer: Multiplan Commercial |
$2,050.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,537.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,357.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,255.87
|
| Rate for Payer: Quartz Commercial |
$1,537.80
|
| Rate for Payer: WEA Trust Commercial |
$1,409.65
|
| Rate for Payer: WPS Commercial |
$1,898.41
|
|
|
SCREW SNAP-OFF 2.7 X 13MM CHARLOTTE F & A 45110004
|
Facility
|
OP
|
$2,563.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6199062
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$717.64 |
| Max. Negotiated Rate |
$10,252.00 |
| Rate for Payer: Aetna Commercial |
$2,306.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,204.18
|
| Rate for Payer: Aetna Managed Medicare |
$717.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,665.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,281.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,230.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,358.39
|
| Rate for Payer: Cash Price |
$768.90
|
| Rate for Payer: Cigna Commercial |
$2,357.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,434.25
|
| Rate for Payer: Health EOS Commercial |
$2,281.07
|
| Rate for Payer: HFN Commercial |
$2,357.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,922.25
|
| Rate for Payer: Multiplan Commercial |
$2,050.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,537.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,357.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,255.87
|
| Rate for Payer: Quartz Commercial |
$1,665.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,537.80
|
| Rate for Payer: The Alliance Commercial |
$10,252.00
|
| Rate for Payer: WEA Trust Commercial |
$1,409.65
|
| Rate for Payer: WPS Commercial |
$1,898.41
|
|
|
SCREW SNAP-OFF 2.7 X 14MM CHARLOTTE F & A 45112714
|
Facility
|
OP
|
$2,563.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6199063
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$717.64 |
| Max. Negotiated Rate |
$10,252.00 |
| Rate for Payer: Aetna Commercial |
$2,306.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,204.18
|
| Rate for Payer: Aetna Managed Medicare |
$717.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,665.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,281.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,230.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,358.39
|
| Rate for Payer: Cash Price |
$768.90
|
| Rate for Payer: Cigna Commercial |
$2,357.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,434.25
|
| Rate for Payer: Health EOS Commercial |
$2,281.07
|
| Rate for Payer: HFN Commercial |
$2,357.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,922.25
|
| Rate for Payer: Multiplan Commercial |
$2,050.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,537.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,357.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,255.87
|
| Rate for Payer: Quartz Commercial |
$1,665.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,537.80
|
| Rate for Payer: The Alliance Commercial |
$10,252.00
|
| Rate for Payer: WEA Trust Commercial |
$1,409.65
|
| Rate for Payer: WPS Commercial |
$1,898.41
|
|
|
SCREW SNAP-OFF 2.7 X 14MM CHARLOTTE F & A 45112714
|
Facility
|
IP
|
$2,563.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6199063
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,255.87 |
| Max. Negotiated Rate |
$2,357.96 |
| Rate for Payer: Aetna Commercial |
$2,306.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,204.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,358.39
|
| Rate for Payer: Cash Price |
$768.90
|
| Rate for Payer: Cigna Commercial |
$2,357.96
|
| Rate for Payer: Health EOS Commercial |
$2,281.07
|
| Rate for Payer: HFN Commercial |
$2,357.96
|
| Rate for Payer: Multiplan Commercial |
$2,050.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,537.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,357.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,255.87
|
| Rate for Payer: Quartz Commercial |
$1,537.80
|
| Rate for Payer: WEA Trust Commercial |
$1,409.65
|
| Rate for Payer: WPS Commercial |
$1,898.41
|
|
|
SCREW TENODESIS 3 X 8MM BIOCOMPOSITE AR-1530BC
|
Facility
|
IP
|
$4,787.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3814428
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,345.63 |
| Max. Negotiated Rate |
$4,404.04 |
| Rate for Payer: Aetna Commercial |
$4,308.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,116.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,537.11
|
| Rate for Payer: Cash Price |
$1,436.10
|
| Rate for Payer: Cigna Commercial |
$4,404.04
|
| Rate for Payer: Health EOS Commercial |
$4,260.43
|
| Rate for Payer: HFN Commercial |
$4,404.04
|
| Rate for Payer: Multiplan Commercial |
$3,829.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,872.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,404.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,345.63
|
| Rate for Payer: Quartz Commercial |
$2,872.20
|
| Rate for Payer: WEA Trust Commercial |
$2,632.85
|
| Rate for Payer: WPS Commercial |
$3,545.73
|
|
|
SCREW TENODESIS 3 X 8MM BIOCOMPOSITE AR-1530BC
|
Facility
|
OP
|
$4,787.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3814428
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,340.36 |
| Max. Negotiated Rate |
$19,148.00 |
| Rate for Payer: Aetna Commercial |
$4,308.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,116.82
|
| Rate for Payer: Aetna Managed Medicare |
$1,340.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,111.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,393.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,297.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,537.11
|
| Rate for Payer: Cash Price |
$1,436.10
|
| Rate for Payer: Cigna Commercial |
$4,404.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,678.81
|
| Rate for Payer: Health EOS Commercial |
$4,260.43
|
| Rate for Payer: HFN Commercial |
$4,404.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,590.25
|
| Rate for Payer: Multiplan Commercial |
$3,829.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,872.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,404.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,345.63
|
| Rate for Payer: Quartz Commercial |
$3,111.55
|
| Rate for Payer: Quartz Medicare Advantage |
$2,872.20
|
| Rate for Payer: The Alliance Commercial |
$19,148.00
|
| Rate for Payer: WEA Trust Commercial |
$2,632.85
|
| Rate for Payer: WPS Commercial |
$3,545.73
|
|
|
SCREW TENODESIS 4.0 X 10MM W DISP DRIVER AR-1540CDS
|
Facility
|
IP
|
$4,442.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5611626
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,176.58 |
| Max. Negotiated Rate |
$4,086.64 |
| Rate for Payer: Aetna Commercial |
$3,997.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,820.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,354.26
|
| Rate for Payer: Cash Price |
$1,332.60
|
| Rate for Payer: Cigna Commercial |
$4,086.64
|
| Rate for Payer: Health EOS Commercial |
$3,953.38
|
| Rate for Payer: HFN Commercial |
$4,086.64
|
| Rate for Payer: Multiplan Commercial |
$3,553.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,665.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,086.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,176.58
|
| Rate for Payer: Quartz Commercial |
$2,665.20
|
| Rate for Payer: WEA Trust Commercial |
$2,443.10
|
| Rate for Payer: WPS Commercial |
$3,290.19
|
|
|
SCREW TENODESIS 4.0 X 10MM W DISP DRIVER AR-1540CDS
|
Facility
|
OP
|
$4,442.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5611626
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,243.76 |
| Max. Negotiated Rate |
$17,768.00 |
| Rate for Payer: Aetna Commercial |
$3,997.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,820.12
|
| Rate for Payer: Aetna Managed Medicare |
$1,243.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,887.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,221.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,132.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,354.26
|
| Rate for Payer: Cash Price |
$1,332.60
|
| Rate for Payer: Cigna Commercial |
$4,086.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,485.74
|
| Rate for Payer: Health EOS Commercial |
$3,953.38
|
| Rate for Payer: HFN Commercial |
$4,086.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,331.50
|
| Rate for Payer: Multiplan Commercial |
$3,553.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,665.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,086.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,176.58
|
| Rate for Payer: Quartz Commercial |
$2,887.30
|
| Rate for Payer: Quartz Medicare Advantage |
$2,665.20
|
| Rate for Payer: The Alliance Commercial |
$17,768.00
|
| Rate for Payer: WEA Trust Commercial |
$2,443.10
|
| Rate for Payer: WPS Commercial |
$3,290.19
|
|
|
SCREW TENODESIS 4.75 X 15MM PEEK VENTED AR-1547PS
|
Facility
|
IP
|
$4,787.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5107207
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,345.63 |
| Max. Negotiated Rate |
$4,404.04 |
| Rate for Payer: Aetna Commercial |
$4,308.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,116.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,537.11
|
| Rate for Payer: Cash Price |
$1,436.10
|
| Rate for Payer: Cigna Commercial |
$4,404.04
|
| Rate for Payer: Health EOS Commercial |
$4,260.43
|
| Rate for Payer: HFN Commercial |
$4,404.04
|
| Rate for Payer: Multiplan Commercial |
$3,829.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,872.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,404.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,345.63
|
| Rate for Payer: Quartz Commercial |
$2,872.20
|
| Rate for Payer: WEA Trust Commercial |
$2,632.85
|
| Rate for Payer: WPS Commercial |
$3,545.73
|
|
|
SCREW TENODESIS 4.75 X 15MM PEEK VENTED AR-1547PS
|
Facility
|
OP
|
$4,787.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5107207
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,340.36 |
| Max. Negotiated Rate |
$19,148.00 |
| Rate for Payer: Aetna Commercial |
$4,308.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,116.82
|
| Rate for Payer: Aetna Managed Medicare |
$1,340.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,111.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,393.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,297.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,537.11
|
| Rate for Payer: Cash Price |
$1,436.10
|
| Rate for Payer: Cigna Commercial |
$4,404.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,678.81
|
| Rate for Payer: Health EOS Commercial |
$4,260.43
|
| Rate for Payer: HFN Commercial |
$4,404.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,590.25
|
| Rate for Payer: Multiplan Commercial |
$3,829.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,872.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,404.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,345.63
|
| Rate for Payer: Quartz Commercial |
$3,111.55
|
| Rate for Payer: Quartz Medicare Advantage |
$2,872.20
|
| Rate for Payer: The Alliance Commercial |
$19,148.00
|
| Rate for Payer: WEA Trust Commercial |
$2,632.85
|
| Rate for Payer: WPS Commercial |
$3,545.73
|
|
|
SCREW TENODESIS 4.75 X 15MM W DISP DRIVER PACK AR-1547CDS
|
Facility
|
OP
|
$4,620.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5583391
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,293.60 |
| Max. Negotiated Rate |
$18,480.00 |
| Rate for Payer: Aetna Commercial |
$4,158.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,973.20
|
| Rate for Payer: Aetna Managed Medicare |
$1,293.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,003.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,310.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,217.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,448.60
|
| Rate for Payer: Cash Price |
$1,386.00
|
| Rate for Payer: Cigna Commercial |
$4,250.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,585.35
|
| Rate for Payer: Health EOS Commercial |
$4,111.80
|
| Rate for Payer: HFN Commercial |
$4,250.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,465.00
|
| Rate for Payer: Multiplan Commercial |
$3,696.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,772.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,250.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,263.80
|
| Rate for Payer: Quartz Commercial |
$3,003.00
|
| Rate for Payer: Quartz Medicare Advantage |
$2,772.00
|
| Rate for Payer: The Alliance Commercial |
$18,480.00
|
| Rate for Payer: WEA Trust Commercial |
$2,541.00
|
| Rate for Payer: WPS Commercial |
$3,422.03
|
|
|
SCREW TENODESIS 4.75 X 15MM W DISP DRIVER PACK AR-1547CDS
|
Facility
|
IP
|
$4,620.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5583391
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,263.80 |
| Max. Negotiated Rate |
$4,250.40 |
| Rate for Payer: Aetna Commercial |
$4,158.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,973.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,448.60
|
| Rate for Payer: Cash Price |
$1,386.00
|
| Rate for Payer: Cigna Commercial |
$4,250.40
|
| Rate for Payer: Health EOS Commercial |
$4,111.80
|
| Rate for Payer: HFN Commercial |
$4,250.40
|
| Rate for Payer: Multiplan Commercial |
$3,696.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,772.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,250.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,263.80
|
| Rate for Payer: Quartz Commercial |
$2,772.00
|
| Rate for Payer: WEA Trust Commercial |
$2,541.00
|
| Rate for Payer: WPS Commercial |
$3,422.03
|
|
|
SCREW TENODESIS 5.5 X 15MM PEEK AR-1655PS
|
Facility
|
IP
|
$4,174.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5797643
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,045.26 |
| Max. Negotiated Rate |
$3,840.08 |
| Rate for Payer: Aetna Commercial |
$3,756.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,589.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,212.22
|
| Rate for Payer: Cash Price |
$1,252.20
|
| Rate for Payer: Cigna Commercial |
$3,840.08
|
| Rate for Payer: Health EOS Commercial |
$3,714.86
|
| Rate for Payer: HFN Commercial |
$3,840.08
|
| Rate for Payer: Multiplan Commercial |
$3,339.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,504.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,840.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,045.26
|
| Rate for Payer: Quartz Commercial |
$2,504.40
|
| Rate for Payer: WEA Trust Commercial |
$2,295.70
|
| Rate for Payer: WPS Commercial |
$3,091.68
|
|
|
SCREW TENODESIS 5.5 X 15MM PEEK AR-1655PS
|
Facility
|
OP
|
$4,174.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5797643
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,168.72 |
| Max. Negotiated Rate |
$16,696.00 |
| Rate for Payer: Aetna Commercial |
$3,756.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,589.64
|
| Rate for Payer: Aetna Managed Medicare |
$1,168.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,713.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,087.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,003.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,212.22
|
| Rate for Payer: Cash Price |
$1,252.20
|
| Rate for Payer: Cigna Commercial |
$3,840.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,335.77
|
| Rate for Payer: Health EOS Commercial |
$3,714.86
|
| Rate for Payer: HFN Commercial |
$3,840.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,130.50
|
| Rate for Payer: Multiplan Commercial |
$3,339.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,504.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,840.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,045.26
|
| Rate for Payer: Quartz Commercial |
$2,713.10
|
| Rate for Payer: Quartz Medicare Advantage |
$2,504.40
|
| Rate for Payer: The Alliance Commercial |
$16,696.00
|
| Rate for Payer: WEA Trust Commercial |
$2,295.70
|
| Rate for Payer: WPS Commercial |
$3,091.68
|
|
|
SCREW TENODESIS 6.25 X 15MM PEEK VENTED AR-1562PS
|
Facility
|
IP
|
$4,787.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5179292
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,345.63 |
| Max. Negotiated Rate |
$4,404.04 |
| Rate for Payer: Aetna Commercial |
$4,308.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,116.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,537.11
|
| Rate for Payer: Cash Price |
$1,436.10
|
| Rate for Payer: Cigna Commercial |
$4,404.04
|
| Rate for Payer: Health EOS Commercial |
$4,260.43
|
| Rate for Payer: HFN Commercial |
$4,404.04
|
| Rate for Payer: Multiplan Commercial |
$3,829.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,872.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,404.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,345.63
|
| Rate for Payer: Quartz Commercial |
$2,872.20
|
| Rate for Payer: WEA Trust Commercial |
$2,632.85
|
| Rate for Payer: WPS Commercial |
$3,545.73
|
|
|
SCREW TENODESIS 6.25 X 15MM PEEK VENTED AR-1562PS
|
Facility
|
OP
|
$4,787.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5179292
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,340.36 |
| Max. Negotiated Rate |
$19,148.00 |
| Rate for Payer: Aetna Commercial |
$4,308.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,116.82
|
| Rate for Payer: Aetna Managed Medicare |
$1,340.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,111.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,393.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,297.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,537.11
|
| Rate for Payer: Cash Price |
$1,436.10
|
| Rate for Payer: Cigna Commercial |
$4,404.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,678.81
|
| Rate for Payer: Health EOS Commercial |
$4,260.43
|
| Rate for Payer: HFN Commercial |
$4,404.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,590.25
|
| Rate for Payer: Multiplan Commercial |
$3,829.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,872.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,404.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,345.63
|
| Rate for Payer: Quartz Commercial |
$3,111.55
|
| Rate for Payer: Quartz Medicare Advantage |
$2,872.20
|
| Rate for Payer: The Alliance Commercial |
$19,148.00
|
| Rate for Payer: WEA Trust Commercial |
$2,632.85
|
| Rate for Payer: WPS Commercial |
$3,545.73
|
|
|
SCREW TENODESIS 6.25 X 15MM WITH DISP DRIVER AR-1562CDS
|
Facility
|
OP
|
$7,180.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5787711
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,010.40 |
| Max. Negotiated Rate |
$28,720.00 |
| Rate for Payer: Aetna Commercial |
$6,462.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,174.80
|
| Rate for Payer: Aetna Managed Medicare |
$2,010.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,667.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,590.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,446.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,805.40
|
| Rate for Payer: Cash Price |
$2,154.00
|
| Rate for Payer: Cigna Commercial |
$6,605.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,017.93
|
| Rate for Payer: Health EOS Commercial |
$6,390.20
|
| Rate for Payer: HFN Commercial |
$6,605.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,385.00
|
| Rate for Payer: Multiplan Commercial |
$5,744.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,308.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,605.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,518.20
|
| Rate for Payer: Quartz Commercial |
$4,667.00
|
| Rate for Payer: Quartz Medicare Advantage |
$4,308.00
|
| Rate for Payer: The Alliance Commercial |
$28,720.00
|
| Rate for Payer: WEA Trust Commercial |
$3,949.00
|
| Rate for Payer: WPS Commercial |
$5,318.23
|
|
|
SCREW TENODESIS 6.25 X 15MM WITH DISP DRIVER AR-1562CDS
|
Facility
|
IP
|
$7,180.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5787711
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,518.20 |
| Max. Negotiated Rate |
$6,605.60 |
| Rate for Payer: Aetna Commercial |
$6,462.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,174.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,805.40
|
| Rate for Payer: Cash Price |
$2,154.00
|
| Rate for Payer: Cigna Commercial |
$6,605.60
|
| Rate for Payer: Health EOS Commercial |
$6,390.20
|
| Rate for Payer: HFN Commercial |
$6,605.60
|
| Rate for Payer: Multiplan Commercial |
$5,744.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,308.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,605.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,518.20
|
| Rate for Payer: Quartz Commercial |
$4,308.00
|
| Rate for Payer: WEA Trust Commercial |
$3,949.00
|
| Rate for Payer: WPS Commercial |
$5,318.23
|
|
|
SCREW TENODESIS 7.0 X 10MM BIOCOMPOSITE AR-1670BC
|
Facility
|
OP
|
$5,042.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5617623
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,411.76 |
| Max. Negotiated Rate |
$20,168.00 |
| Rate for Payer: Aetna Commercial |
$4,537.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,336.12
|
| Rate for Payer: Aetna Managed Medicare |
$1,411.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,277.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,521.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,420.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,672.26
|
| Rate for Payer: Cash Price |
$1,512.60
|
| Rate for Payer: Cigna Commercial |
$4,638.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,821.50
|
| Rate for Payer: Health EOS Commercial |
$4,487.38
|
| Rate for Payer: HFN Commercial |
$4,638.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,781.50
|
| Rate for Payer: Multiplan Commercial |
$4,033.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,025.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,638.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,470.58
|
| Rate for Payer: Quartz Commercial |
$3,277.30
|
| Rate for Payer: Quartz Medicare Advantage |
$3,025.20
|
| Rate for Payer: The Alliance Commercial |
$20,168.00
|
| Rate for Payer: WEA Trust Commercial |
$2,773.10
|
| Rate for Payer: WPS Commercial |
$3,734.61
|
|
|
SCREW TENODESIS 7.0 X 10MM BIOCOMPOSITE AR-1670BC
|
Facility
|
IP
|
$5,042.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5617623
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,470.58 |
| Max. Negotiated Rate |
$4,638.64 |
| Rate for Payer: Aetna Commercial |
$4,537.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,336.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,672.26
|
| Rate for Payer: Cash Price |
$1,512.60
|
| Rate for Payer: Cigna Commercial |
$4,638.64
|
| Rate for Payer: Health EOS Commercial |
$4,487.38
|
| Rate for Payer: HFN Commercial |
$4,638.64
|
| Rate for Payer: Multiplan Commercial |
$4,033.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,025.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,638.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,470.58
|
| Rate for Payer: Quartz Commercial |
$3,025.20
|
| Rate for Payer: WEA Trust Commercial |
$2,773.10
|
| Rate for Payer: WPS Commercial |
$3,734.61
|
|
|
SCREW TFN 11MM X 105MM 04.032.105S
|
Facility
|
IP
|
$5,041.00
|
|
| Hospital Charge Code |
3563494
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,470.09 |
| Max. Negotiated Rate |
$4,637.72 |
| Rate for Payer: Aetna Commercial |
$4,536.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,335.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,671.73
|
| Rate for Payer: Cash Price |
$1,512.30
|
| Rate for Payer: Cigna Commercial |
$4,637.72
|
| Rate for Payer: Health EOS Commercial |
$4,486.49
|
| Rate for Payer: HFN Commercial |
$4,637.72
|
| Rate for Payer: Multiplan Commercial |
$4,032.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,024.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,637.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,470.09
|
| Rate for Payer: Quartz Commercial |
$3,024.60
|
| Rate for Payer: WEA Trust Commercial |
$2,772.55
|
| Rate for Payer: WPS Commercial |
$3,733.87
|
|
|
SCREW TFN 11MM X 105MM 04.032.105S
|
Facility
|
OP
|
$5,041.00
|
|
| Hospital Charge Code |
3563494
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,411.48 |
| Max. Negotiated Rate |
$20,164.00 |
| Rate for Payer: Aetna Commercial |
$4,536.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,335.26
|
| Rate for Payer: Aetna Managed Medicare |
$1,411.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,276.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,520.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,419.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,671.73
|
| Rate for Payer: Cash Price |
$1,512.30
|
| Rate for Payer: Cigna Commercial |
$4,637.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,820.94
|
| Rate for Payer: Health EOS Commercial |
$4,486.49
|
| Rate for Payer: HFN Commercial |
$4,637.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,780.75
|
| Rate for Payer: Multiplan Commercial |
$4,032.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,024.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,637.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,470.09
|
| Rate for Payer: Quartz Commercial |
$3,276.65
|
| Rate for Payer: Quartz Medicare Advantage |
$3,024.60
|
| Rate for Payer: The Alliance Commercial |
$20,164.00
|
| Rate for Payer: WEA Trust Commercial |
$2,772.55
|
| Rate for Payer: WPS Commercial |
$3,733.87
|
|
|
SCREW TI LOCKING 4.0MM X 42MM 04.005.432S
|
Facility
|
IP
|
$1,968.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4208659
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$964.32 |
| Max. Negotiated Rate |
$1,810.56 |
| Rate for Payer: Aetna Commercial |
$1,771.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,692.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,043.04
|
| Rate for Payer: Cash Price |
$590.40
|
| Rate for Payer: Cigna Commercial |
$1,810.56
|
| Rate for Payer: Health EOS Commercial |
$1,751.52
|
| Rate for Payer: HFN Commercial |
$1,810.56
|
| Rate for Payer: Multiplan Commercial |
$1,574.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,180.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,810.56
|
| Rate for Payer: Quartz Beloit One Network |
$964.32
|
| Rate for Payer: Quartz Commercial |
$1,180.80
|
| Rate for Payer: WEA Trust Commercial |
$1,082.40
|
| Rate for Payer: WPS Commercial |
$1,457.70
|
|
|
SCREW TI LOCKING 4.0MM X 42MM 04.005.432S
|
Facility
|
OP
|
$1,968.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4208659
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$551.04 |
| Max. Negotiated Rate |
$7,872.00 |
| Rate for Payer: Aetna Commercial |
$1,771.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,692.48
|
| Rate for Payer: Aetna Managed Medicare |
$551.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,279.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$984.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$944.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,043.04
|
| Rate for Payer: Cash Price |
$590.40
|
| Rate for Payer: Cigna Commercial |
$1,810.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,101.29
|
| Rate for Payer: Health EOS Commercial |
$1,751.52
|
| Rate for Payer: HFN Commercial |
$1,810.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,476.00
|
| Rate for Payer: Multiplan Commercial |
$1,574.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,180.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,810.56
|
| Rate for Payer: Quartz Beloit One Network |
$964.32
|
| Rate for Payer: Quartz Commercial |
$1,279.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,180.80
|
| Rate for Payer: The Alliance Commercial |
$7,872.00
|
| Rate for Payer: WEA Trust Commercial |
$1,082.40
|
| Rate for Payer: WPS Commercial |
$1,457.70
|
|
