|
SCREW LOCK LG HD 2.7 X 20MM ORTHOLOC 58802720
|
Facility
|
OP
|
$2,823.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459796
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$822.06 |
| Max. Negotiated Rate |
$2,701.05 |
| Rate for Payer: Aetna Commercial |
$2,642.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,524.89
|
| Rate for Payer: Aetna Managed Medicare |
$822.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,908.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,467.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,409.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,556.04
|
| Rate for Payer: Cash Price |
$846.90
|
| Rate for Payer: Cigna Commercial |
$2,701.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,642.99
|
| Rate for Payer: Health EOS Commercial |
$2,612.97
|
| Rate for Payer: HFN Commercial |
$2,701.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,201.94
|
| Rate for Payer: Multiplan Commercial |
$2,348.74
|
| Rate for Payer: NAPHCARE Commercial |
$1,761.55
|
| Rate for Payer: Preferred Network Access Commercial |
$2,701.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,438.60
|
| Rate for Payer: Quartz Commercial |
$1,908.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,761.55
|
| Rate for Payer: The Alliance Commercial |
$1,467.96
|
| Rate for Payer: WEA Trust Commercial |
$1,614.76
|
| Rate for Payer: WPS Commercial |
$2,174.56
|
|
|
SCREW LOCK LG HD 2.7 X 22MM ORTHOLOC 58802722
|
Facility
|
IP
|
$2,823.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415909
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,438.60 |
| Max. Negotiated Rate |
$2,701.05 |
| Rate for Payer: Aetna Commercial |
$2,642.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,524.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,556.04
|
| Rate for Payer: Cash Price |
$846.90
|
| Rate for Payer: Cigna Commercial |
$2,701.05
|
| Rate for Payer: Health EOS Commercial |
$2,612.97
|
| Rate for Payer: HFN Commercial |
$2,701.05
|
| Rate for Payer: Multiplan Commercial |
$2,348.74
|
| Rate for Payer: Preferred Network Access Commercial |
$2,701.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,438.60
|
| Rate for Payer: Quartz Commercial |
$1,761.55
|
| Rate for Payer: WEA Trust Commercial |
$1,614.76
|
| Rate for Payer: WPS Commercial |
$2,174.56
|
|
|
SCREW LOCK LG HD 2.7 X 22MM ORTHOLOC 58802722
|
Facility
|
OP
|
$2,823.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415909
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$822.06 |
| Max. Negotiated Rate |
$2,701.05 |
| Rate for Payer: Aetna Commercial |
$2,642.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,524.89
|
| Rate for Payer: Aetna Managed Medicare |
$822.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,908.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,467.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,409.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,556.04
|
| Rate for Payer: Cash Price |
$846.90
|
| Rate for Payer: Cigna Commercial |
$2,701.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,642.99
|
| Rate for Payer: Health EOS Commercial |
$2,612.97
|
| Rate for Payer: HFN Commercial |
$2,701.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,201.94
|
| Rate for Payer: Multiplan Commercial |
$2,348.74
|
| Rate for Payer: NAPHCARE Commercial |
$1,761.55
|
| Rate for Payer: Preferred Network Access Commercial |
$2,701.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,438.60
|
| Rate for Payer: Quartz Commercial |
$1,908.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,761.55
|
| Rate for Payer: The Alliance Commercial |
$1,467.96
|
| Rate for Payer: WEA Trust Commercial |
$1,614.76
|
| Rate for Payer: WPS Commercial |
$2,174.56
|
|
|
SCREW LOCK LG HD 2.7 X 24MM ORTHOLOC 58802724
|
Facility
|
OP
|
$3,369.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3791357
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$981.05 |
| Max. Negotiated Rate |
$3,223.46 |
| Rate for Payer: Aetna Commercial |
$3,153.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,013.23
|
| Rate for Payer: Aetna Managed Medicare |
$981.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,277.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,751.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,681.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,856.99
|
| Rate for Payer: Cash Price |
$1,010.70
|
| Rate for Payer: Cigna Commercial |
$3,223.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,960.76
|
| Rate for Payer: Health EOS Commercial |
$3,118.35
|
| Rate for Payer: HFN Commercial |
$3,223.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,627.82
|
| Rate for Payer: Multiplan Commercial |
$2,803.01
|
| Rate for Payer: NAPHCARE Commercial |
$2,102.26
|
| Rate for Payer: Preferred Network Access Commercial |
$3,223.46
|
| Rate for Payer: Quartz Beloit One Network |
$1,716.84
|
| Rate for Payer: Quartz Commercial |
$2,277.44
|
| Rate for Payer: Quartz Medicare Advantage |
$2,102.26
|
| Rate for Payer: The Alliance Commercial |
$1,751.88
|
| Rate for Payer: WEA Trust Commercial |
$1,927.07
|
| Rate for Payer: WPS Commercial |
$2,595.14
|
|
|
SCREW LOCK LG HD 2.7 X 24MM ORTHOLOC 58802724
|
Facility
|
IP
|
$3,369.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3791357
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,716.84 |
| Max. Negotiated Rate |
$3,223.46 |
| Rate for Payer: Aetna Commercial |
$3,153.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,013.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,856.99
|
| Rate for Payer: Cash Price |
$1,010.70
|
| Rate for Payer: Cigna Commercial |
$3,223.46
|
| Rate for Payer: Health EOS Commercial |
$3,118.35
|
| Rate for Payer: HFN Commercial |
$3,223.46
|
| Rate for Payer: Multiplan Commercial |
$2,803.01
|
| Rate for Payer: Preferred Network Access Commercial |
$3,223.46
|
| Rate for Payer: Quartz Beloit One Network |
$1,716.84
|
| Rate for Payer: Quartz Commercial |
$2,102.26
|
| Rate for Payer: WEA Trust Commercial |
$1,927.07
|
| Rate for Payer: WPS Commercial |
$2,595.14
|
|
|
SCREW LOCK LG HD 3.5 X 10MM ORTHOLOC 58803510
|
Facility
|
OP
|
$2,743.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6177952
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$798.76 |
| Max. Negotiated Rate |
$2,624.50 |
| Rate for Payer: Aetna Commercial |
$2,567.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,453.34
|
| Rate for Payer: Aetna Managed Medicare |
$798.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,854.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,426.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,369.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,511.94
|
| Rate for Payer: Cash Price |
$822.90
|
| Rate for Payer: Cigna Commercial |
$2,624.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,596.43
|
| Rate for Payer: Health EOS Commercial |
$2,538.92
|
| Rate for Payer: HFN Commercial |
$2,624.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,139.54
|
| Rate for Payer: Multiplan Commercial |
$2,282.18
|
| Rate for Payer: NAPHCARE Commercial |
$1,711.63
|
| Rate for Payer: Preferred Network Access Commercial |
$2,624.50
|
| Rate for Payer: Quartz Beloit One Network |
$1,397.83
|
| Rate for Payer: Quartz Commercial |
$1,854.27
|
| Rate for Payer: Quartz Medicare Advantage |
$1,711.63
|
| Rate for Payer: The Alliance Commercial |
$1,426.36
|
| Rate for Payer: WEA Trust Commercial |
$1,569.00
|
| Rate for Payer: WPS Commercial |
$2,112.93
|
|
|
SCREW LOCK LG HD 3.5 X 10MM ORTHOLOC 58803510
|
Facility
|
IP
|
$2,743.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6177952
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,397.83 |
| Max. Negotiated Rate |
$2,624.50 |
| Rate for Payer: Aetna Commercial |
$2,567.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,453.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,511.94
|
| Rate for Payer: Cash Price |
$822.90
|
| Rate for Payer: Cigna Commercial |
$2,624.50
|
| Rate for Payer: Health EOS Commercial |
$2,538.92
|
| Rate for Payer: HFN Commercial |
$2,624.50
|
| Rate for Payer: Multiplan Commercial |
$2,282.18
|
| Rate for Payer: Preferred Network Access Commercial |
$2,624.50
|
| Rate for Payer: Quartz Beloit One Network |
$1,397.83
|
| Rate for Payer: Quartz Commercial |
$1,711.63
|
| Rate for Payer: WEA Trust Commercial |
$1,569.00
|
| Rate for Payer: WPS Commercial |
$2,112.93
|
|
|
SCREW LOCK LG HD 3.5 X 12MM ORTHOLOC 58803512
|
Facility
|
IP
|
$3,369.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5895660
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,716.84 |
| Max. Negotiated Rate |
$3,223.46 |
| Rate for Payer: Aetna Commercial |
$3,153.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,013.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,856.99
|
| Rate for Payer: Cash Price |
$1,010.70
|
| Rate for Payer: Cigna Commercial |
$3,223.46
|
| Rate for Payer: Health EOS Commercial |
$3,118.35
|
| Rate for Payer: HFN Commercial |
$3,223.46
|
| Rate for Payer: Multiplan Commercial |
$2,803.01
|
| Rate for Payer: Preferred Network Access Commercial |
$3,223.46
|
| Rate for Payer: Quartz Beloit One Network |
$1,716.84
|
| Rate for Payer: Quartz Commercial |
$2,102.26
|
| Rate for Payer: WEA Trust Commercial |
$1,927.07
|
| Rate for Payer: WPS Commercial |
$2,595.14
|
|
|
SCREW LOCK LG HD 3.5 X 12MM ORTHOLOC 58803512
|
Facility
|
OP
|
$3,369.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5895660
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$981.05 |
| Max. Negotiated Rate |
$3,223.46 |
| Rate for Payer: Aetna Commercial |
$3,153.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,013.23
|
| Rate for Payer: Aetna Managed Medicare |
$981.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,277.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,751.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,681.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,856.99
|
| Rate for Payer: Cash Price |
$1,010.70
|
| Rate for Payer: Cigna Commercial |
$3,223.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,960.76
|
| Rate for Payer: Health EOS Commercial |
$3,118.35
|
| Rate for Payer: HFN Commercial |
$3,223.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,627.82
|
| Rate for Payer: Multiplan Commercial |
$2,803.01
|
| Rate for Payer: NAPHCARE Commercial |
$2,102.26
|
| Rate for Payer: Preferred Network Access Commercial |
$3,223.46
|
| Rate for Payer: Quartz Beloit One Network |
$1,716.84
|
| Rate for Payer: Quartz Commercial |
$2,277.44
|
| Rate for Payer: Quartz Medicare Advantage |
$2,102.26
|
| Rate for Payer: The Alliance Commercial |
$1,751.88
|
| Rate for Payer: WEA Trust Commercial |
$1,927.07
|
| Rate for Payer: WPS Commercial |
$2,595.14
|
|
|
SCREW LOCK LG HD 3.5 X 14MM ORTHOLOC 58803514
|
Facility
|
OP
|
$3,496.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6171777
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,018.04 |
| Max. Negotiated Rate |
$3,344.97 |
| Rate for Payer: Aetna Commercial |
$3,272.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,126.82
|
| Rate for Payer: Aetna Managed Medicare |
$1,018.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,363.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,817.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,745.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,927.00
|
| Rate for Payer: Cash Price |
$1,048.80
|
| Rate for Payer: Cigna Commercial |
$3,344.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,034.67
|
| Rate for Payer: Health EOS Commercial |
$3,235.90
|
| Rate for Payer: HFN Commercial |
$3,344.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,726.88
|
| Rate for Payer: Multiplan Commercial |
$2,908.67
|
| Rate for Payer: NAPHCARE Commercial |
$2,181.50
|
| Rate for Payer: Preferred Network Access Commercial |
$3,344.97
|
| Rate for Payer: Quartz Beloit One Network |
$1,781.56
|
| Rate for Payer: Quartz Commercial |
$2,363.30
|
| Rate for Payer: Quartz Medicare Advantage |
$2,181.50
|
| Rate for Payer: The Alliance Commercial |
$1,817.92
|
| Rate for Payer: WEA Trust Commercial |
$1,999.71
|
| Rate for Payer: WPS Commercial |
$2,692.97
|
|
|
SCREW LOCK LG HD 3.5 X 14MM ORTHOLOC 58803514
|
Facility
|
IP
|
$3,496.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6171777
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,781.56 |
| Max. Negotiated Rate |
$3,344.97 |
| Rate for Payer: Aetna Commercial |
$3,272.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,126.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,927.00
|
| Rate for Payer: Cash Price |
$1,048.80
|
| Rate for Payer: Cigna Commercial |
$3,344.97
|
| Rate for Payer: Health EOS Commercial |
$3,235.90
|
| Rate for Payer: HFN Commercial |
$3,344.97
|
| Rate for Payer: Multiplan Commercial |
$2,908.67
|
| Rate for Payer: Preferred Network Access Commercial |
$3,344.97
|
| Rate for Payer: Quartz Beloit One Network |
$1,781.56
|
| Rate for Payer: Quartz Commercial |
$2,181.50
|
| Rate for Payer: WEA Trust Commercial |
$1,999.71
|
| Rate for Payer: WPS Commercial |
$2,692.97
|
|
|
SCREW LOCK LG HD 3.5 X 16MM ORTHOLOC 58803516
|
Facility
|
IP
|
$3,369.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5547334
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,716.84 |
| Max. Negotiated Rate |
$3,223.46 |
| Rate for Payer: Aetna Commercial |
$3,153.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,013.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,856.99
|
| Rate for Payer: Cash Price |
$1,010.70
|
| Rate for Payer: Cigna Commercial |
$3,223.46
|
| Rate for Payer: Health EOS Commercial |
$3,118.35
|
| Rate for Payer: HFN Commercial |
$3,223.46
|
| Rate for Payer: Multiplan Commercial |
$2,803.01
|
| Rate for Payer: Preferred Network Access Commercial |
$3,223.46
|
| Rate for Payer: Quartz Beloit One Network |
$1,716.84
|
| Rate for Payer: Quartz Commercial |
$2,102.26
|
| Rate for Payer: WEA Trust Commercial |
$1,927.07
|
| Rate for Payer: WPS Commercial |
$2,595.14
|
|
|
SCREW LOCK LG HD 3.5 X 16MM ORTHOLOC 58803516
|
Facility
|
OP
|
$3,369.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5547334
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$981.05 |
| Max. Negotiated Rate |
$3,223.46 |
| Rate for Payer: Aetna Commercial |
$3,153.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,013.23
|
| Rate for Payer: Aetna Managed Medicare |
$981.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,277.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,751.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,681.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,856.99
|
| Rate for Payer: Cash Price |
$1,010.70
|
| Rate for Payer: Cigna Commercial |
$3,223.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,960.76
|
| Rate for Payer: Health EOS Commercial |
$3,118.35
|
| Rate for Payer: HFN Commercial |
$3,223.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,627.82
|
| Rate for Payer: Multiplan Commercial |
$2,803.01
|
| Rate for Payer: NAPHCARE Commercial |
$2,102.26
|
| Rate for Payer: Preferred Network Access Commercial |
$3,223.46
|
| Rate for Payer: Quartz Beloit One Network |
$1,716.84
|
| Rate for Payer: Quartz Commercial |
$2,277.44
|
| Rate for Payer: Quartz Medicare Advantage |
$2,102.26
|
| Rate for Payer: The Alliance Commercial |
$1,751.88
|
| Rate for Payer: WEA Trust Commercial |
$1,927.07
|
| Rate for Payer: WPS Commercial |
$2,595.14
|
|
|
SCREW LOCK LG HD 3.5 X 18MM ORTHOLOC 58803518
|
Facility
|
IP
|
$3,369.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5895661
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,716.84 |
| Max. Negotiated Rate |
$3,223.46 |
| Rate for Payer: Aetna Commercial |
$3,153.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,013.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,856.99
|
| Rate for Payer: Cash Price |
$1,010.70
|
| Rate for Payer: Cigna Commercial |
$3,223.46
|
| Rate for Payer: Health EOS Commercial |
$3,118.35
|
| Rate for Payer: HFN Commercial |
$3,223.46
|
| Rate for Payer: Multiplan Commercial |
$2,803.01
|
| Rate for Payer: Preferred Network Access Commercial |
$3,223.46
|
| Rate for Payer: Quartz Beloit One Network |
$1,716.84
|
| Rate for Payer: Quartz Commercial |
$2,102.26
|
| Rate for Payer: WEA Trust Commercial |
$1,927.07
|
| Rate for Payer: WPS Commercial |
$2,595.14
|
|
|
SCREW LOCK LG HD 3.5 X 18MM ORTHOLOC 58803518
|
Facility
|
OP
|
$3,369.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5895661
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$981.05 |
| Max. Negotiated Rate |
$3,223.46 |
| Rate for Payer: Aetna Commercial |
$3,153.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,013.23
|
| Rate for Payer: Aetna Managed Medicare |
$981.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,277.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,751.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,681.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,856.99
|
| Rate for Payer: Cash Price |
$1,010.70
|
| Rate for Payer: Cigna Commercial |
$3,223.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,960.76
|
| Rate for Payer: Health EOS Commercial |
$3,118.35
|
| Rate for Payer: HFN Commercial |
$3,223.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,627.82
|
| Rate for Payer: Multiplan Commercial |
$2,803.01
|
| Rate for Payer: NAPHCARE Commercial |
$2,102.26
|
| Rate for Payer: Preferred Network Access Commercial |
$3,223.46
|
| Rate for Payer: Quartz Beloit One Network |
$1,716.84
|
| Rate for Payer: Quartz Commercial |
$2,277.44
|
| Rate for Payer: Quartz Medicare Advantage |
$2,102.26
|
| Rate for Payer: The Alliance Commercial |
$1,751.88
|
| Rate for Payer: WEA Trust Commercial |
$1,927.07
|
| Rate for Payer: WPS Commercial |
$2,595.14
|
|
|
SCREW LOCK LG HD 3.5 X 24MM ORTHOLOC 58803524
|
Facility
|
IP
|
$2,853.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6175188
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,453.89 |
| Max. Negotiated Rate |
$2,729.75 |
| Rate for Payer: Aetna Commercial |
$2,670.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,551.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,572.57
|
| Rate for Payer: Cash Price |
$855.90
|
| Rate for Payer: Cigna Commercial |
$2,729.75
|
| Rate for Payer: Health EOS Commercial |
$2,640.74
|
| Rate for Payer: HFN Commercial |
$2,729.75
|
| Rate for Payer: Multiplan Commercial |
$2,373.70
|
| Rate for Payer: Preferred Network Access Commercial |
$2,729.75
|
| Rate for Payer: Quartz Beloit One Network |
$1,453.89
|
| Rate for Payer: Quartz Commercial |
$1,780.27
|
| Rate for Payer: WEA Trust Commercial |
$1,631.92
|
| Rate for Payer: WPS Commercial |
$2,197.67
|
|
|
SCREW LOCK LG HD 3.5 X 24MM ORTHOLOC 58803524
|
Facility
|
OP
|
$2,853.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6175188
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$830.79 |
| Max. Negotiated Rate |
$2,729.75 |
| Rate for Payer: Aetna Commercial |
$2,670.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,551.72
|
| Rate for Payer: Aetna Managed Medicare |
$830.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,928.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,483.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,424.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,572.57
|
| Rate for Payer: Cash Price |
$855.90
|
| Rate for Payer: Cigna Commercial |
$2,729.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,660.45
|
| Rate for Payer: Health EOS Commercial |
$2,640.74
|
| Rate for Payer: HFN Commercial |
$2,729.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,225.34
|
| Rate for Payer: Multiplan Commercial |
$2,373.70
|
| Rate for Payer: NAPHCARE Commercial |
$1,780.27
|
| Rate for Payer: Preferred Network Access Commercial |
$2,729.75
|
| Rate for Payer: Quartz Beloit One Network |
$1,453.89
|
| Rate for Payer: Quartz Commercial |
$1,928.63
|
| Rate for Payer: Quartz Medicare Advantage |
$1,780.27
|
| Rate for Payer: The Alliance Commercial |
$1,483.56
|
| Rate for Payer: WEA Trust Commercial |
$1,631.92
|
| Rate for Payer: WPS Commercial |
$2,197.67
|
|
|
SCREW LOCK LG HD 3.5 X 30MM ORTHOLOC 58803530
|
Facility
|
IP
|
$3,496.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6171778
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,781.56 |
| Max. Negotiated Rate |
$3,344.97 |
| Rate for Payer: Aetna Commercial |
$3,272.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,126.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,927.00
|
| Rate for Payer: Cash Price |
$1,048.80
|
| Rate for Payer: Cigna Commercial |
$3,344.97
|
| Rate for Payer: Health EOS Commercial |
$3,235.90
|
| Rate for Payer: HFN Commercial |
$3,344.97
|
| Rate for Payer: Multiplan Commercial |
$2,908.67
|
| Rate for Payer: Preferred Network Access Commercial |
$3,344.97
|
| Rate for Payer: Quartz Beloit One Network |
$1,781.56
|
| Rate for Payer: Quartz Commercial |
$2,181.50
|
| Rate for Payer: WEA Trust Commercial |
$1,999.71
|
| Rate for Payer: WPS Commercial |
$2,692.97
|
|
|
SCREW LOCK LG HD 3.5 X 30MM ORTHOLOC 58803530
|
Facility
|
OP
|
$3,496.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6171778
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,018.04 |
| Max. Negotiated Rate |
$3,344.97 |
| Rate for Payer: Aetna Commercial |
$3,272.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,126.82
|
| Rate for Payer: Aetna Managed Medicare |
$1,018.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,363.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,817.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,745.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,927.00
|
| Rate for Payer: Cash Price |
$1,048.80
|
| Rate for Payer: Cigna Commercial |
$3,344.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,034.67
|
| Rate for Payer: Health EOS Commercial |
$3,235.90
|
| Rate for Payer: HFN Commercial |
$3,344.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,726.88
|
| Rate for Payer: Multiplan Commercial |
$2,908.67
|
| Rate for Payer: NAPHCARE Commercial |
$2,181.50
|
| Rate for Payer: Preferred Network Access Commercial |
$3,344.97
|
| Rate for Payer: Quartz Beloit One Network |
$1,781.56
|
| Rate for Payer: Quartz Commercial |
$2,363.30
|
| Rate for Payer: Quartz Medicare Advantage |
$2,181.50
|
| Rate for Payer: The Alliance Commercial |
$1,817.92
|
| Rate for Payer: WEA Trust Commercial |
$1,999.71
|
| Rate for Payer: WPS Commercial |
$2,692.97
|
|
|
SCREW LOCK LG HD 3.5 X 32MM ORTHOLOC 58803532
|
Facility
|
IP
|
$1,751.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6185018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$892.31 |
| Max. Negotiated Rate |
$1,675.36 |
| Rate for Payer: Aetna Commercial |
$1,638.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,566.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$965.15
|
| Rate for Payer: Cash Price |
$525.30
|
| Rate for Payer: Cigna Commercial |
$1,675.36
|
| Rate for Payer: Health EOS Commercial |
$1,620.73
|
| Rate for Payer: HFN Commercial |
$1,675.36
|
| Rate for Payer: Multiplan Commercial |
$1,456.83
|
| Rate for Payer: Preferred Network Access Commercial |
$1,675.36
|
| Rate for Payer: Quartz Beloit One Network |
$892.31
|
| Rate for Payer: Quartz Commercial |
$1,092.62
|
| Rate for Payer: WEA Trust Commercial |
$1,001.57
|
| Rate for Payer: WPS Commercial |
$1,348.80
|
|
|
SCREW LOCK LG HD 3.5 X 32MM ORTHOLOC 58803532
|
Facility
|
OP
|
$1,751.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6185018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$509.89 |
| Max. Negotiated Rate |
$1,675.36 |
| Rate for Payer: Aetna Commercial |
$1,638.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,566.09
|
| Rate for Payer: Aetna Managed Medicare |
$509.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,183.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$910.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$874.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$965.15
|
| Rate for Payer: Cash Price |
$525.30
|
| Rate for Payer: Cigna Commercial |
$1,675.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,019.08
|
| Rate for Payer: Health EOS Commercial |
$1,620.73
|
| Rate for Payer: HFN Commercial |
$1,675.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,365.78
|
| Rate for Payer: Multiplan Commercial |
$1,456.83
|
| Rate for Payer: NAPHCARE Commercial |
$1,092.62
|
| Rate for Payer: Preferred Network Access Commercial |
$1,675.36
|
| Rate for Payer: Quartz Beloit One Network |
$892.31
|
| Rate for Payer: Quartz Commercial |
$1,183.68
|
| Rate for Payer: Quartz Medicare Advantage |
$1,092.62
|
| Rate for Payer: The Alliance Commercial |
$910.52
|
| Rate for Payer: WEA Trust Commercial |
$1,001.57
|
| Rate for Payer: WPS Commercial |
$1,348.80
|
|
|
SCREW LOCK LG HD 3.5 X 34MM ORTHOLOC 58803534
|
Facility
|
IP
|
$1,751.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6185019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$892.31 |
| Max. Negotiated Rate |
$1,675.36 |
| Rate for Payer: Aetna Commercial |
$1,638.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,566.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$965.15
|
| Rate for Payer: Cash Price |
$525.30
|
| Rate for Payer: Cigna Commercial |
$1,675.36
|
| Rate for Payer: Health EOS Commercial |
$1,620.73
|
| Rate for Payer: HFN Commercial |
$1,675.36
|
| Rate for Payer: Multiplan Commercial |
$1,456.83
|
| Rate for Payer: Preferred Network Access Commercial |
$1,675.36
|
| Rate for Payer: Quartz Beloit One Network |
$892.31
|
| Rate for Payer: Quartz Commercial |
$1,092.62
|
| Rate for Payer: WEA Trust Commercial |
$1,001.57
|
| Rate for Payer: WPS Commercial |
$1,348.80
|
|
|
SCREW LOCK LG HD 3.5 X 34MM ORTHOLOC 58803534
|
Facility
|
OP
|
$1,751.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6185019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$509.89 |
| Max. Negotiated Rate |
$1,675.36 |
| Rate for Payer: Aetna Commercial |
$1,638.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,566.09
|
| Rate for Payer: Aetna Managed Medicare |
$509.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,183.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$910.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$874.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$965.15
|
| Rate for Payer: Cash Price |
$525.30
|
| Rate for Payer: Cigna Commercial |
$1,675.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,019.08
|
| Rate for Payer: Health EOS Commercial |
$1,620.73
|
| Rate for Payer: HFN Commercial |
$1,675.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,365.78
|
| Rate for Payer: Multiplan Commercial |
$1,456.83
|
| Rate for Payer: NAPHCARE Commercial |
$1,092.62
|
| Rate for Payer: Preferred Network Access Commercial |
$1,675.36
|
| Rate for Payer: Quartz Beloit One Network |
$892.31
|
| Rate for Payer: Quartz Commercial |
$1,183.68
|
| Rate for Payer: Quartz Medicare Advantage |
$1,092.62
|
| Rate for Payer: The Alliance Commercial |
$910.52
|
| Rate for Payer: WEA Trust Commercial |
$1,001.57
|
| Rate for Payer: WPS Commercial |
$1,348.80
|
|
|
SCREW LOCK LG HD 3.5 X 36MM ORTHOLOC 58803536
|
Facility
|
IP
|
$1,751.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6185020
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$892.31 |
| Max. Negotiated Rate |
$1,675.36 |
| Rate for Payer: Aetna Commercial |
$1,638.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,566.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$965.15
|
| Rate for Payer: Cash Price |
$525.30
|
| Rate for Payer: Cigna Commercial |
$1,675.36
|
| Rate for Payer: Health EOS Commercial |
$1,620.73
|
| Rate for Payer: HFN Commercial |
$1,675.36
|
| Rate for Payer: Multiplan Commercial |
$1,456.83
|
| Rate for Payer: Preferred Network Access Commercial |
$1,675.36
|
| Rate for Payer: Quartz Beloit One Network |
$892.31
|
| Rate for Payer: Quartz Commercial |
$1,092.62
|
| Rate for Payer: WEA Trust Commercial |
$1,001.57
|
| Rate for Payer: WPS Commercial |
$1,348.80
|
|
|
SCREW LOCK LG HD 3.5 X 36MM ORTHOLOC 58803536
|
Facility
|
OP
|
$1,751.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6185020
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$509.89 |
| Max. Negotiated Rate |
$1,675.36 |
| Rate for Payer: Aetna Commercial |
$1,638.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,566.09
|
| Rate for Payer: Aetna Managed Medicare |
$509.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,183.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$910.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$874.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$965.15
|
| Rate for Payer: Cash Price |
$525.30
|
| Rate for Payer: Cigna Commercial |
$1,675.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,019.08
|
| Rate for Payer: Health EOS Commercial |
$1,620.73
|
| Rate for Payer: HFN Commercial |
$1,675.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,365.78
|
| Rate for Payer: Multiplan Commercial |
$1,456.83
|
| Rate for Payer: NAPHCARE Commercial |
$1,092.62
|
| Rate for Payer: Preferred Network Access Commercial |
$1,675.36
|
| Rate for Payer: Quartz Beloit One Network |
$892.31
|
| Rate for Payer: Quartz Commercial |
$1,183.68
|
| Rate for Payer: Quartz Medicare Advantage |
$1,092.62
|
| Rate for Payer: The Alliance Commercial |
$910.52
|
| Rate for Payer: WEA Trust Commercial |
$1,001.57
|
| Rate for Payer: WPS Commercial |
$1,348.80
|
|
