|
SCREW VAL 4.5 X 44MM OPTILINK ST TI 42.231.244
|
Facility
|
IP
|
$1,830.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6244145
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$896.73 |
| Max. Negotiated Rate |
$1,683.66 |
| Rate for Payer: Aetna Commercial |
$1,647.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,573.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$969.93
|
| Rate for Payer: Cash Price |
$549.02
|
| Rate for Payer: Cigna Commercial |
$1,683.66
|
| Rate for Payer: Health EOS Commercial |
$1,628.75
|
| Rate for Payer: HFN Commercial |
$1,683.66
|
| Rate for Payer: Multiplan Commercial |
$1,464.05
|
| Rate for Payer: NAPHCARE Commercial |
$1,098.04
|
| Rate for Payer: Preferred Network Access Commercial |
$1,683.66
|
| Rate for Payer: Quartz Beloit One Network |
$896.73
|
| Rate for Payer: Quartz Commercial |
$1,098.04
|
| Rate for Payer: WEA Trust Commercial |
$1,006.53
|
| Rate for Payer: WPS Commercial |
$1,355.53
|
|
|
SCREW VAL 4.5 X 46MM OPTILINK ST TI 42.231.246
|
Facility
|
OP
|
$1,830.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6244146
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$512.42 |
| Max. Negotiated Rate |
$7,320.24 |
| Rate for Payer: Aetna Commercial |
$1,647.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,573.85
|
| Rate for Payer: Aetna Managed Medicare |
$512.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,189.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$915.03
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$878.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$969.93
|
| Rate for Payer: Cash Price |
$549.02
|
| Rate for Payer: Cigna Commercial |
$1,683.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,024.10
|
| Rate for Payer: Health EOS Commercial |
$1,628.75
|
| Rate for Payer: HFN Commercial |
$1,683.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,372.54
|
| Rate for Payer: Multiplan Commercial |
$1,464.05
|
| Rate for Payer: NAPHCARE Commercial |
$1,098.04
|
| Rate for Payer: Preferred Network Access Commercial |
$1,683.66
|
| Rate for Payer: Quartz Beloit One Network |
$896.73
|
| Rate for Payer: Quartz Commercial |
$1,189.54
|
| Rate for Payer: Quartz Medicare Advantage |
$1,098.04
|
| Rate for Payer: The Alliance Commercial |
$7,320.24
|
| Rate for Payer: WEA Trust Commercial |
$1,006.53
|
| Rate for Payer: WPS Commercial |
$1,355.53
|
|
|
SCREW VAL 4.5 X 46MM OPTILINK ST TI 42.231.246
|
Facility
|
IP
|
$1,830.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6244146
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$896.73 |
| Max. Negotiated Rate |
$1,683.66 |
| Rate for Payer: Aetna Commercial |
$1,647.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,573.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$969.93
|
| Rate for Payer: Cash Price |
$549.02
|
| Rate for Payer: Cigna Commercial |
$1,683.66
|
| Rate for Payer: Health EOS Commercial |
$1,628.75
|
| Rate for Payer: HFN Commercial |
$1,683.66
|
| Rate for Payer: Multiplan Commercial |
$1,464.05
|
| Rate for Payer: NAPHCARE Commercial |
$1,098.04
|
| Rate for Payer: Preferred Network Access Commercial |
$1,683.66
|
| Rate for Payer: Quartz Beloit One Network |
$896.73
|
| Rate for Payer: Quartz Commercial |
$1,098.04
|
| Rate for Payer: WEA Trust Commercial |
$1,006.53
|
| Rate for Payer: WPS Commercial |
$1,355.53
|
|
|
SCREW VAL 4.5 X 60MM OPTILINK ST TI 42.231.260
|
Facility
|
OP
|
$2,257.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6169853
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$631.96 |
| Max. Negotiated Rate |
$9,028.00 |
| Rate for Payer: Aetna Commercial |
$2,031.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,941.02
|
| Rate for Payer: Aetna Managed Medicare |
$631.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,467.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,128.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,083.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,196.21
|
| Rate for Payer: Cash Price |
$677.10
|
| Rate for Payer: Cigna Commercial |
$2,076.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,263.02
|
| Rate for Payer: Health EOS Commercial |
$2,008.73
|
| Rate for Payer: HFN Commercial |
$2,076.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,692.75
|
| Rate for Payer: Multiplan Commercial |
$1,805.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,354.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,076.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,105.93
|
| Rate for Payer: Quartz Commercial |
$1,467.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,354.20
|
| Rate for Payer: The Alliance Commercial |
$9,028.00
|
| Rate for Payer: WEA Trust Commercial |
$1,241.35
|
| Rate for Payer: WPS Commercial |
$1,671.76
|
|
|
SCREW VAL 4.5 X 60MM OPTILINK ST TI 42.231.260
|
Facility
|
IP
|
$2,257.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6169853
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,105.93 |
| Max. Negotiated Rate |
$2,076.44 |
| Rate for Payer: Aetna Commercial |
$2,031.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,941.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,196.21
|
| Rate for Payer: Cash Price |
$677.10
|
| Rate for Payer: Cigna Commercial |
$2,076.44
|
| Rate for Payer: Health EOS Commercial |
$2,008.73
|
| Rate for Payer: HFN Commercial |
$2,076.44
|
| Rate for Payer: Multiplan Commercial |
$1,805.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,354.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,076.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,105.93
|
| Rate for Payer: Quartz Commercial |
$1,354.20
|
| Rate for Payer: WEA Trust Commercial |
$1,241.35
|
| Rate for Payer: WPS Commercial |
$1,671.76
|
|
|
SCREW VAL 4.5 X 65MM OPTILINK ST TI 42.231.265
|
Facility
|
IP
|
$2,257.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6169851
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,105.93 |
| Max. Negotiated Rate |
$2,076.44 |
| Rate for Payer: Aetna Commercial |
$2,031.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,941.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,196.21
|
| Rate for Payer: Cash Price |
$677.10
|
| Rate for Payer: Cigna Commercial |
$2,076.44
|
| Rate for Payer: Health EOS Commercial |
$2,008.73
|
| Rate for Payer: HFN Commercial |
$2,076.44
|
| Rate for Payer: Multiplan Commercial |
$1,805.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,354.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,076.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,105.93
|
| Rate for Payer: Quartz Commercial |
$1,354.20
|
| Rate for Payer: WEA Trust Commercial |
$1,241.35
|
| Rate for Payer: WPS Commercial |
$1,671.76
|
|
|
SCREW VAL 4.5 X 65MM OPTILINK ST TI 42.231.265
|
Facility
|
OP
|
$2,257.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6169851
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$631.96 |
| Max. Negotiated Rate |
$9,028.00 |
| Rate for Payer: Aetna Commercial |
$2,031.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,941.02
|
| Rate for Payer: Aetna Managed Medicare |
$631.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,467.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,128.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,083.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,196.21
|
| Rate for Payer: Cash Price |
$677.10
|
| Rate for Payer: Cigna Commercial |
$2,076.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,263.02
|
| Rate for Payer: Health EOS Commercial |
$2,008.73
|
| Rate for Payer: HFN Commercial |
$2,076.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,692.75
|
| Rate for Payer: Multiplan Commercial |
$1,805.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,354.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,076.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,105.93
|
| Rate for Payer: Quartz Commercial |
$1,467.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,354.20
|
| Rate for Payer: The Alliance Commercial |
$9,028.00
|
| Rate for Payer: WEA Trust Commercial |
$1,241.35
|
| Rate for Payer: WPS Commercial |
$1,671.76
|
|
|
SCREW VAL 4.5 X 70MM OPTILINK ST TI 42.231.270
|
Facility
|
OP
|
$1,903.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6226142
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$532.84 |
| Max. Negotiated Rate |
$7,612.00 |
| Rate for Payer: Aetna Commercial |
$1,712.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,636.58
|
| Rate for Payer: Aetna Managed Medicare |
$532.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,236.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$951.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$913.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,008.59
|
| Rate for Payer: Cash Price |
$570.90
|
| Rate for Payer: Cigna Commercial |
$1,750.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,064.92
|
| Rate for Payer: Health EOS Commercial |
$1,693.67
|
| Rate for Payer: HFN Commercial |
$1,750.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,427.25
|
| Rate for Payer: Multiplan Commercial |
$1,522.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,141.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,750.76
|
| Rate for Payer: Quartz Beloit One Network |
$932.47
|
| Rate for Payer: Quartz Commercial |
$1,236.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,141.80
|
| Rate for Payer: The Alliance Commercial |
$7,612.00
|
| Rate for Payer: WEA Trust Commercial |
$1,046.65
|
| Rate for Payer: WPS Commercial |
$1,409.55
|
|
|
SCREW VAL 4.5 X 70MM OPTILINK ST TI 42.231.270
|
Facility
|
IP
|
$1,903.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6226142
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$932.47 |
| Max. Negotiated Rate |
$1,750.76 |
| Rate for Payer: Aetna Commercial |
$1,712.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,636.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,008.59
|
| Rate for Payer: Cash Price |
$570.90
|
| Rate for Payer: Cigna Commercial |
$1,750.76
|
| Rate for Payer: Health EOS Commercial |
$1,693.67
|
| Rate for Payer: HFN Commercial |
$1,750.76
|
| Rate for Payer: Multiplan Commercial |
$1,522.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,141.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,750.76
|
| Rate for Payer: Quartz Beloit One Network |
$932.47
|
| Rate for Payer: Quartz Commercial |
$1,141.80
|
| Rate for Payer: WEA Trust Commercial |
$1,046.65
|
| Rate for Payer: WPS Commercial |
$1,409.55
|
|
|
SCREW VAL 4.5 X 75MM OPTILINK ST TI 42.231.275
|
Facility
|
OP
|
$2,257.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6169852
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$631.96 |
| Max. Negotiated Rate |
$9,028.00 |
| Rate for Payer: Aetna Commercial |
$2,031.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,941.02
|
| Rate for Payer: Aetna Managed Medicare |
$631.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,467.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,128.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,083.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,196.21
|
| Rate for Payer: Cash Price |
$677.10
|
| Rate for Payer: Cigna Commercial |
$2,076.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,263.02
|
| Rate for Payer: Health EOS Commercial |
$2,008.73
|
| Rate for Payer: HFN Commercial |
$2,076.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,692.75
|
| Rate for Payer: Multiplan Commercial |
$1,805.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,354.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,076.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,105.93
|
| Rate for Payer: Quartz Commercial |
$1,467.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,354.20
|
| Rate for Payer: The Alliance Commercial |
$9,028.00
|
| Rate for Payer: WEA Trust Commercial |
$1,241.35
|
| Rate for Payer: WPS Commercial |
$1,671.76
|
|
|
SCREW VAL 4.5 X 75MM OPTILINK ST TI 42.231.275
|
Facility
|
IP
|
$2,257.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6169852
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,105.93 |
| Max. Negotiated Rate |
$2,076.44 |
| Rate for Payer: Aetna Commercial |
$2,031.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,941.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,196.21
|
| Rate for Payer: Cash Price |
$677.10
|
| Rate for Payer: Cigna Commercial |
$2,076.44
|
| Rate for Payer: Health EOS Commercial |
$2,008.73
|
| Rate for Payer: HFN Commercial |
$2,076.44
|
| Rate for Payer: Multiplan Commercial |
$1,805.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,354.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,076.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,105.93
|
| Rate for Payer: Quartz Commercial |
$1,354.20
|
| Rate for Payer: WEA Trust Commercial |
$1,241.35
|
| Rate for Payer: WPS Commercial |
$1,671.76
|
|
|
SCREW VAL 4.5 X 80MM OPTILINK ST TI 42.231.280
|
Facility
|
OP
|
$1,903.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6201050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$532.84 |
| Max. Negotiated Rate |
$7,612.00 |
| Rate for Payer: Aetna Commercial |
$1,712.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,636.58
|
| Rate for Payer: Aetna Managed Medicare |
$532.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,236.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$951.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$913.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,008.59
|
| Rate for Payer: Cash Price |
$570.90
|
| Rate for Payer: Cigna Commercial |
$1,750.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,064.92
|
| Rate for Payer: Health EOS Commercial |
$1,693.67
|
| Rate for Payer: HFN Commercial |
$1,750.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,427.25
|
| Rate for Payer: Multiplan Commercial |
$1,522.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,141.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,750.76
|
| Rate for Payer: Quartz Beloit One Network |
$932.47
|
| Rate for Payer: Quartz Commercial |
$1,236.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,141.80
|
| Rate for Payer: The Alliance Commercial |
$7,612.00
|
| Rate for Payer: WEA Trust Commercial |
$1,046.65
|
| Rate for Payer: WPS Commercial |
$1,409.55
|
|
|
SCREW VAL 4.5 X 80MM OPTILINK ST TI 42.231.280
|
Facility
|
IP
|
$1,903.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6201050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$932.47 |
| Max. Negotiated Rate |
$1,750.76 |
| Rate for Payer: Aetna Commercial |
$1,712.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,636.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,008.59
|
| Rate for Payer: Cash Price |
$570.90
|
| Rate for Payer: Cigna Commercial |
$1,750.76
|
| Rate for Payer: Health EOS Commercial |
$1,693.67
|
| Rate for Payer: HFN Commercial |
$1,750.76
|
| Rate for Payer: Multiplan Commercial |
$1,522.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,141.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,750.76
|
| Rate for Payer: Quartz Beloit One Network |
$932.47
|
| Rate for Payer: Quartz Commercial |
$1,141.80
|
| Rate for Payer: WEA Trust Commercial |
$1,046.65
|
| Rate for Payer: WPS Commercial |
$1,409.55
|
|
|
SCREW VAL KREULOCK 3.0 X 10MM TI AR-8933VCL-10
|
Facility
|
OP
|
$2,816.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6244272
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$788.68 |
| Max. Negotiated Rate |
$11,266.80 |
| Rate for Payer: Aetna Commercial |
$2,535.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,422.36
|
| Rate for Payer: Aetna Managed Medicare |
$788.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,830.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,408.35
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,352.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,492.85
|
| Rate for Payer: Cash Price |
$845.01
|
| Rate for Payer: Cigna Commercial |
$2,591.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,576.23
|
| Rate for Payer: Health EOS Commercial |
$2,506.86
|
| Rate for Payer: HFN Commercial |
$2,591.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,112.52
|
| Rate for Payer: Multiplan Commercial |
$2,253.36
|
| Rate for Payer: NAPHCARE Commercial |
$1,690.02
|
| Rate for Payer: Preferred Network Access Commercial |
$2,591.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,380.18
|
| Rate for Payer: Quartz Commercial |
$1,830.86
|
| Rate for Payer: Quartz Medicare Advantage |
$1,690.02
|
| Rate for Payer: The Alliance Commercial |
$11,266.80
|
| Rate for Payer: WEA Trust Commercial |
$1,549.18
|
| Rate for Payer: WPS Commercial |
$2,086.33
|
|
|
SCREW VAL KREULOCK 3.0 X 10MM TI AR-8933VCL-10
|
Facility
|
IP
|
$2,816.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6244272
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,380.18 |
| Max. Negotiated Rate |
$2,591.36 |
| Rate for Payer: Aetna Commercial |
$2,535.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,422.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,492.85
|
| Rate for Payer: Cash Price |
$845.01
|
| Rate for Payer: Cigna Commercial |
$2,591.36
|
| Rate for Payer: Health EOS Commercial |
$2,506.86
|
| Rate for Payer: HFN Commercial |
$2,591.36
|
| Rate for Payer: Multiplan Commercial |
$2,253.36
|
| Rate for Payer: NAPHCARE Commercial |
$1,690.02
|
| Rate for Payer: Preferred Network Access Commercial |
$2,591.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,380.18
|
| Rate for Payer: Quartz Commercial |
$1,690.02
|
| Rate for Payer: WEA Trust Commercial |
$1,549.18
|
| Rate for Payer: WPS Commercial |
$2,086.33
|
|
|
SCREW VAL KREULOCK 3.0 X 12MM TI AR-8933VCL-12
|
Facility
|
IP
|
$2,816.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6244273
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,380.18 |
| Max. Negotiated Rate |
$2,591.36 |
| Rate for Payer: Aetna Commercial |
$2,535.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,422.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,492.85
|
| Rate for Payer: Cash Price |
$845.01
|
| Rate for Payer: Cigna Commercial |
$2,591.36
|
| Rate for Payer: Health EOS Commercial |
$2,506.86
|
| Rate for Payer: HFN Commercial |
$2,591.36
|
| Rate for Payer: Multiplan Commercial |
$2,253.36
|
| Rate for Payer: NAPHCARE Commercial |
$1,690.02
|
| Rate for Payer: Preferred Network Access Commercial |
$2,591.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,380.18
|
| Rate for Payer: Quartz Commercial |
$1,690.02
|
| Rate for Payer: WEA Trust Commercial |
$1,549.18
|
| Rate for Payer: WPS Commercial |
$2,086.33
|
|
|
SCREW VAL KREULOCK 3.0 X 12MM TI AR-8933VCL-12
|
Facility
|
OP
|
$2,816.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6244273
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$788.68 |
| Max. Negotiated Rate |
$11,266.80 |
| Rate for Payer: Aetna Commercial |
$2,535.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,422.36
|
| Rate for Payer: Aetna Managed Medicare |
$788.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,830.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,408.35
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,352.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,492.85
|
| Rate for Payer: Cash Price |
$845.01
|
| Rate for Payer: Cigna Commercial |
$2,591.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,576.23
|
| Rate for Payer: Health EOS Commercial |
$2,506.86
|
| Rate for Payer: HFN Commercial |
$2,591.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,112.52
|
| Rate for Payer: Multiplan Commercial |
$2,253.36
|
| Rate for Payer: NAPHCARE Commercial |
$1,690.02
|
| Rate for Payer: Preferred Network Access Commercial |
$2,591.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,380.18
|
| Rate for Payer: Quartz Commercial |
$1,830.86
|
| Rate for Payer: Quartz Medicare Advantage |
$1,690.02
|
| Rate for Payer: The Alliance Commercial |
$11,266.80
|
| Rate for Payer: WEA Trust Commercial |
$1,549.18
|
| Rate for Payer: WPS Commercial |
$2,086.33
|
|
|
SCREW VAL KREULOCK 3.0 X 14MM TI AR-8933VCL-14
|
Facility
|
IP
|
$2,816.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6244274
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,380.18 |
| Max. Negotiated Rate |
$2,591.36 |
| Rate for Payer: Aetna Commercial |
$2,535.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,422.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,492.85
|
| Rate for Payer: Cash Price |
$845.01
|
| Rate for Payer: Cigna Commercial |
$2,591.36
|
| Rate for Payer: Health EOS Commercial |
$2,506.86
|
| Rate for Payer: HFN Commercial |
$2,591.36
|
| Rate for Payer: Multiplan Commercial |
$2,253.36
|
| Rate for Payer: NAPHCARE Commercial |
$1,690.02
|
| Rate for Payer: Preferred Network Access Commercial |
$2,591.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,380.18
|
| Rate for Payer: Quartz Commercial |
$1,690.02
|
| Rate for Payer: WEA Trust Commercial |
$1,549.18
|
| Rate for Payer: WPS Commercial |
$2,086.33
|
|
|
SCREW VAL KREULOCK 3.0 X 14MM TI AR-8933VCL-14
|
Facility
|
OP
|
$2,816.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6244274
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$788.68 |
| Max. Negotiated Rate |
$11,266.80 |
| Rate for Payer: Aetna Commercial |
$2,535.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,422.36
|
| Rate for Payer: Aetna Managed Medicare |
$788.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,830.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,408.35
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,352.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,492.85
|
| Rate for Payer: Cash Price |
$845.01
|
| Rate for Payer: Cigna Commercial |
$2,591.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,576.23
|
| Rate for Payer: Health EOS Commercial |
$2,506.86
|
| Rate for Payer: HFN Commercial |
$2,591.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,112.52
|
| Rate for Payer: Multiplan Commercial |
$2,253.36
|
| Rate for Payer: NAPHCARE Commercial |
$1,690.02
|
| Rate for Payer: Preferred Network Access Commercial |
$2,591.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,380.18
|
| Rate for Payer: Quartz Commercial |
$1,830.86
|
| Rate for Payer: Quartz Medicare Advantage |
$1,690.02
|
| Rate for Payer: The Alliance Commercial |
$11,266.80
|
| Rate for Payer: WEA Trust Commercial |
$1,549.18
|
| Rate for Payer: WPS Commercial |
$2,086.33
|
|
|
SCREW VARIAX 2 MINI 2.4MM X 10MM 656010
|
Facility
|
IP
|
$1,889.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685846
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$925.61 |
| Max. Negotiated Rate |
$1,737.88 |
| Rate for Payer: Aetna Commercial |
$1,700.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,624.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,001.17
|
| Rate for Payer: Cash Price |
$566.70
|
| Rate for Payer: Cigna Commercial |
$1,737.88
|
| Rate for Payer: Health EOS Commercial |
$1,681.21
|
| Rate for Payer: HFN Commercial |
$1,737.88
|
| Rate for Payer: Multiplan Commercial |
$1,511.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,133.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,737.88
|
| Rate for Payer: Quartz Beloit One Network |
$925.61
|
| Rate for Payer: Quartz Commercial |
$1,133.40
|
| Rate for Payer: WEA Trust Commercial |
$1,038.95
|
| Rate for Payer: WPS Commercial |
$1,399.18
|
|
|
SCREW VARIAX 2 MINI 2.4MM X 10MM 656010
|
Facility
|
OP
|
$1,889.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685846
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$528.92 |
| Max. Negotiated Rate |
$7,556.00 |
| Rate for Payer: Aetna Commercial |
$1,700.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,624.54
|
| Rate for Payer: Aetna Managed Medicare |
$528.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,227.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$944.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$906.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,001.17
|
| Rate for Payer: Cash Price |
$566.70
|
| Rate for Payer: Cigna Commercial |
$1,737.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,057.08
|
| Rate for Payer: Health EOS Commercial |
$1,681.21
|
| Rate for Payer: HFN Commercial |
$1,737.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,416.75
|
| Rate for Payer: Multiplan Commercial |
$1,511.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,133.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,737.88
|
| Rate for Payer: Quartz Beloit One Network |
$925.61
|
| Rate for Payer: Quartz Commercial |
$1,227.85
|
| Rate for Payer: Quartz Medicare Advantage |
$1,133.40
|
| Rate for Payer: The Alliance Commercial |
$7,556.00
|
| Rate for Payer: WEA Trust Commercial |
$1,038.95
|
| Rate for Payer: WPS Commercial |
$1,399.18
|
|
|
SCREW VARIAX 2 MINI 2.4MM X 12MM 656012
|
Facility
|
IP
|
$1,889.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685847
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$925.61 |
| Max. Negotiated Rate |
$1,737.88 |
| Rate for Payer: Aetna Commercial |
$1,700.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,624.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,001.17
|
| Rate for Payer: Cash Price |
$566.70
|
| Rate for Payer: Cigna Commercial |
$1,737.88
|
| Rate for Payer: Health EOS Commercial |
$1,681.21
|
| Rate for Payer: HFN Commercial |
$1,737.88
|
| Rate for Payer: Multiplan Commercial |
$1,511.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,133.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,737.88
|
| Rate for Payer: Quartz Beloit One Network |
$925.61
|
| Rate for Payer: Quartz Commercial |
$1,133.40
|
| Rate for Payer: WEA Trust Commercial |
$1,038.95
|
| Rate for Payer: WPS Commercial |
$1,399.18
|
|
|
SCREW VARIAX 2 MINI 2.4MM X 12MM 656012
|
Facility
|
OP
|
$1,889.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685847
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$528.92 |
| Max. Negotiated Rate |
$7,556.00 |
| Rate for Payer: Aetna Commercial |
$1,700.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,624.54
|
| Rate for Payer: Aetna Managed Medicare |
$528.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,227.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$944.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$906.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,001.17
|
| Rate for Payer: Cash Price |
$566.70
|
| Rate for Payer: Cigna Commercial |
$1,737.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,057.08
|
| Rate for Payer: Health EOS Commercial |
$1,681.21
|
| Rate for Payer: HFN Commercial |
$1,737.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,416.75
|
| Rate for Payer: Multiplan Commercial |
$1,511.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,133.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,737.88
|
| Rate for Payer: Quartz Beloit One Network |
$925.61
|
| Rate for Payer: Quartz Commercial |
$1,227.85
|
| Rate for Payer: Quartz Medicare Advantage |
$1,133.40
|
| Rate for Payer: The Alliance Commercial |
$7,556.00
|
| Rate for Payer: WEA Trust Commercial |
$1,038.95
|
| Rate for Payer: WPS Commercial |
$1,399.18
|
|
|
SCREW VARIAX 2 MINI 2.4MM X 14MM 656014
|
Facility
|
IP
|
$1,888.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685848
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$925.12 |
| Max. Negotiated Rate |
$1,736.96 |
| Rate for Payer: Aetna Commercial |
$1,699.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,623.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,000.64
|
| Rate for Payer: Cash Price |
$566.40
|
| Rate for Payer: Cigna Commercial |
$1,736.96
|
| Rate for Payer: Health EOS Commercial |
$1,680.32
|
| Rate for Payer: HFN Commercial |
$1,736.96
|
| Rate for Payer: Multiplan Commercial |
$1,510.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,132.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,736.96
|
| Rate for Payer: Quartz Beloit One Network |
$925.12
|
| Rate for Payer: Quartz Commercial |
$1,132.80
|
| Rate for Payer: WEA Trust Commercial |
$1,038.40
|
| Rate for Payer: WPS Commercial |
$1,398.44
|
|
|
SCREW VARIAX 2 MINI 2.4MM X 14MM 656014
|
Facility
|
OP
|
$1,888.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685848
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$528.64 |
| Max. Negotiated Rate |
$7,552.00 |
| Rate for Payer: Aetna Commercial |
$1,699.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,623.68
|
| Rate for Payer: Aetna Managed Medicare |
$528.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,227.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$944.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$906.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,000.64
|
| Rate for Payer: Cash Price |
$566.40
|
| Rate for Payer: Cigna Commercial |
$1,736.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,056.52
|
| Rate for Payer: Health EOS Commercial |
$1,680.32
|
| Rate for Payer: HFN Commercial |
$1,736.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,416.00
|
| Rate for Payer: Multiplan Commercial |
$1,510.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,132.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,736.96
|
| Rate for Payer: Quartz Beloit One Network |
$925.12
|
| Rate for Payer: Quartz Commercial |
$1,227.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,132.80
|
| Rate for Payer: The Alliance Commercial |
$7,552.00
|
| Rate for Payer: WEA Trust Commercial |
$1,038.40
|
| Rate for Payer: WPS Commercial |
$1,398.44
|
|
