|
SCREW LOCK LP 3.5 X 48MM BRONZE ORTHOLOC 58813548
|
Facility
|
IP
|
$1,751.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6228142
|
|
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 MATRIX MANDIBLE 2.0 X 12MM 04.503.612.01
|
Facility
|
OP
|
$2,308.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6192960
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$672.09 |
| Max. Negotiated Rate |
$2,208.29 |
| Rate for Payer: Aetna Commercial |
$2,160.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,064.28
|
| Rate for Payer: Aetna Managed Medicare |
$672.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,560.21
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,200.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,152.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,272.17
|
| Rate for Payer: Cash Price |
$692.40
|
| Rate for Payer: Cigna Commercial |
$2,208.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,343.26
|
| Rate for Payer: Health EOS Commercial |
$2,136.28
|
| Rate for Payer: HFN Commercial |
$2,208.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,800.24
|
| Rate for Payer: Multiplan Commercial |
$1,920.26
|
| Rate for Payer: NAPHCARE Commercial |
$1,440.19
|
| Rate for Payer: Preferred Network Access Commercial |
$2,208.29
|
| Rate for Payer: Quartz Beloit One Network |
$1,176.16
|
| Rate for Payer: Quartz Commercial |
$1,560.21
|
| Rate for Payer: Quartz Medicare Advantage |
$1,440.19
|
| Rate for Payer: The Alliance Commercial |
$1,200.16
|
| Rate for Payer: WEA Trust Commercial |
$1,320.18
|
| Rate for Payer: WPS Commercial |
$1,777.85
|
|
|
SCREW LOCK MATRIX MANDIBLE 2.0 X 12MM 04.503.612.01
|
Facility
|
IP
|
$2,308.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6192960
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,176.16 |
| Max. Negotiated Rate |
$2,208.29 |
| Rate for Payer: Aetna Commercial |
$2,160.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,064.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,272.17
|
| Rate for Payer: Cash Price |
$692.40
|
| Rate for Payer: Cigna Commercial |
$2,208.29
|
| Rate for Payer: Health EOS Commercial |
$2,136.28
|
| Rate for Payer: HFN Commercial |
$2,208.29
|
| Rate for Payer: Multiplan Commercial |
$1,920.26
|
| Rate for Payer: Preferred Network Access Commercial |
$2,208.29
|
| Rate for Payer: Quartz Beloit One Network |
$1,176.16
|
| Rate for Payer: Quartz Commercial |
$1,440.19
|
| Rate for Payer: WEA Trust Commercial |
$1,320.18
|
| Rate for Payer: WPS Commercial |
$1,777.85
|
|
|
SCREW LOCK MATRIX MANDIBLE 2.0 X 14MM 04.503.614.01
|
Facility
|
OP
|
$2,308.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6192961
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$672.09 |
| Max. Negotiated Rate |
$2,208.29 |
| Rate for Payer: Aetna Commercial |
$2,160.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,064.28
|
| Rate for Payer: Aetna Managed Medicare |
$672.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,560.21
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,200.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,152.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,272.17
|
| Rate for Payer: Cash Price |
$692.40
|
| Rate for Payer: Cigna Commercial |
$2,208.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,343.26
|
| Rate for Payer: Health EOS Commercial |
$2,136.28
|
| Rate for Payer: HFN Commercial |
$2,208.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,800.24
|
| Rate for Payer: Multiplan Commercial |
$1,920.26
|
| Rate for Payer: NAPHCARE Commercial |
$1,440.19
|
| Rate for Payer: Preferred Network Access Commercial |
$2,208.29
|
| Rate for Payer: Quartz Beloit One Network |
$1,176.16
|
| Rate for Payer: Quartz Commercial |
$1,560.21
|
| Rate for Payer: Quartz Medicare Advantage |
$1,440.19
|
| Rate for Payer: The Alliance Commercial |
$1,200.16
|
| Rate for Payer: WEA Trust Commercial |
$1,320.18
|
| Rate for Payer: WPS Commercial |
$1,777.85
|
|
|
SCREW LOCK MATRIX MANDIBLE 2.0 X 14MM 04.503.614.01
|
Facility
|
IP
|
$2,308.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6192961
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,176.16 |
| Max. Negotiated Rate |
$2,208.29 |
| Rate for Payer: Aetna Commercial |
$2,160.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,064.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,272.17
|
| Rate for Payer: Cash Price |
$692.40
|
| Rate for Payer: Cigna Commercial |
$2,208.29
|
| Rate for Payer: Health EOS Commercial |
$2,136.28
|
| Rate for Payer: HFN Commercial |
$2,208.29
|
| Rate for Payer: Multiplan Commercial |
$1,920.26
|
| Rate for Payer: Preferred Network Access Commercial |
$2,208.29
|
| Rate for Payer: Quartz Beloit One Network |
$1,176.16
|
| Rate for Payer: Quartz Commercial |
$1,440.19
|
| Rate for Payer: WEA Trust Commercial |
$1,320.18
|
| Rate for Payer: WPS Commercial |
$1,777.85
|
|
|
SCREW LOCK MATRIX MANDIBLE 2.0 X 6MM 04.503.606.01
|
Facility
|
IP
|
$2,222.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6172584
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,132.33 |
| Max. Negotiated Rate |
$2,126.01 |
| Rate for Payer: Aetna Commercial |
$2,079.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,987.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,224.77
|
| Rate for Payer: Cash Price |
$666.60
|
| Rate for Payer: Cigna Commercial |
$2,126.01
|
| Rate for Payer: Health EOS Commercial |
$2,056.68
|
| Rate for Payer: HFN Commercial |
$2,126.01
|
| Rate for Payer: Multiplan Commercial |
$1,848.70
|
| Rate for Payer: Preferred Network Access Commercial |
$2,126.01
|
| Rate for Payer: Quartz Beloit One Network |
$1,132.33
|
| Rate for Payer: Quartz Commercial |
$1,386.53
|
| Rate for Payer: WEA Trust Commercial |
$1,270.98
|
| Rate for Payer: WPS Commercial |
$1,711.61
|
|
|
SCREW LOCK MATRIX MANDIBLE 2.0 X 6MM 04.503.606.01
|
Facility
|
OP
|
$2,222.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6172584
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.05 |
| Max. Negotiated Rate |
$2,126.01 |
| Rate for Payer: Aetna Commercial |
$2,079.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,987.36
|
| Rate for Payer: Aetna Managed Medicare |
$647.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,502.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,155.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,109.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,224.77
|
| Rate for Payer: Cash Price |
$666.60
|
| Rate for Payer: Cigna Commercial |
$2,126.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,293.20
|
| Rate for Payer: Health EOS Commercial |
$2,056.68
|
| Rate for Payer: HFN Commercial |
$2,126.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,733.16
|
| Rate for Payer: Multiplan Commercial |
$1,848.70
|
| Rate for Payer: NAPHCARE Commercial |
$1,386.53
|
| Rate for Payer: Preferred Network Access Commercial |
$2,126.01
|
| Rate for Payer: Quartz Beloit One Network |
$1,132.33
|
| Rate for Payer: Quartz Commercial |
$1,502.07
|
| Rate for Payer: Quartz Medicare Advantage |
$1,386.53
|
| Rate for Payer: The Alliance Commercial |
$1,155.44
|
| Rate for Payer: WEA Trust Commercial |
$1,270.98
|
| Rate for Payer: WPS Commercial |
$1,711.61
|
|
|
SCREW LOCK MATRIX MANDIBLE 2.4 X 10MM 04.503.640.01
|
Facility
|
IP
|
$2,598.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5831666
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,323.94 |
| Max. Negotiated Rate |
$2,485.77 |
| Rate for Payer: Aetna Commercial |
$2,431.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,323.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,432.02
|
| Rate for Payer: Cash Price |
$779.40
|
| Rate for Payer: Cigna Commercial |
$2,485.77
|
| Rate for Payer: Health EOS Commercial |
$2,404.71
|
| Rate for Payer: HFN Commercial |
$2,485.77
|
| Rate for Payer: Multiplan Commercial |
$2,161.54
|
| Rate for Payer: Preferred Network Access Commercial |
$2,485.77
|
| Rate for Payer: Quartz Beloit One Network |
$1,323.94
|
| Rate for Payer: Quartz Commercial |
$1,621.15
|
| Rate for Payer: WEA Trust Commercial |
$1,486.06
|
| Rate for Payer: WPS Commercial |
$2,001.24
|
|
|
SCREW LOCK MATRIX MANDIBLE 2.4 X 10MM 04.503.640.01
|
Facility
|
OP
|
$2,598.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5831666
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$756.54 |
| Max. Negotiated Rate |
$2,485.77 |
| Rate for Payer: Aetna Commercial |
$2,431.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,323.65
|
| Rate for Payer: Aetna Managed Medicare |
$756.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,756.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,350.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,296.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,432.02
|
| Rate for Payer: Cash Price |
$779.40
|
| Rate for Payer: Cigna Commercial |
$2,485.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,512.04
|
| Rate for Payer: Health EOS Commercial |
$2,404.71
|
| Rate for Payer: HFN Commercial |
$2,485.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,026.44
|
| Rate for Payer: Multiplan Commercial |
$2,161.54
|
| Rate for Payer: NAPHCARE Commercial |
$1,621.15
|
| Rate for Payer: Preferred Network Access Commercial |
$2,485.77
|
| Rate for Payer: Quartz Beloit One Network |
$1,323.94
|
| Rate for Payer: Quartz Commercial |
$1,756.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,621.15
|
| Rate for Payer: The Alliance Commercial |
$1,350.96
|
| Rate for Payer: WEA Trust Commercial |
$1,486.06
|
| Rate for Payer: WPS Commercial |
$2,001.24
|
|
|
SCREW LOCK MATRIX MANDIBLE 2.4 X 12MM 04.503.642.01
|
Facility
|
IP
|
$2,598.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5831667
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,323.94 |
| Max. Negotiated Rate |
$2,485.77 |
| Rate for Payer: Aetna Commercial |
$2,431.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,323.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,432.02
|
| Rate for Payer: Cash Price |
$779.40
|
| Rate for Payer: Cigna Commercial |
$2,485.77
|
| Rate for Payer: Health EOS Commercial |
$2,404.71
|
| Rate for Payer: HFN Commercial |
$2,485.77
|
| Rate for Payer: Multiplan Commercial |
$2,161.54
|
| Rate for Payer: Preferred Network Access Commercial |
$2,485.77
|
| Rate for Payer: Quartz Beloit One Network |
$1,323.94
|
| Rate for Payer: Quartz Commercial |
$1,621.15
|
| Rate for Payer: WEA Trust Commercial |
$1,486.06
|
| Rate for Payer: WPS Commercial |
$2,001.24
|
|
|
SCREW LOCK MATRIX MANDIBLE 2.4 X 12MM 04.503.642.01
|
Facility
|
OP
|
$2,598.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5831667
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$756.54 |
| Max. Negotiated Rate |
$2,485.77 |
| Rate for Payer: Aetna Commercial |
$2,431.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,323.65
|
| Rate for Payer: Aetna Managed Medicare |
$756.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,756.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,350.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,296.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,432.02
|
| Rate for Payer: Cash Price |
$779.40
|
| Rate for Payer: Cigna Commercial |
$2,485.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,512.04
|
| Rate for Payer: Health EOS Commercial |
$2,404.71
|
| Rate for Payer: HFN Commercial |
$2,485.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,026.44
|
| Rate for Payer: Multiplan Commercial |
$2,161.54
|
| Rate for Payer: NAPHCARE Commercial |
$1,621.15
|
| Rate for Payer: Preferred Network Access Commercial |
$2,485.77
|
| Rate for Payer: Quartz Beloit One Network |
$1,323.94
|
| Rate for Payer: Quartz Commercial |
$1,756.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,621.15
|
| Rate for Payer: The Alliance Commercial |
$1,350.96
|
| Rate for Payer: WEA Trust Commercial |
$1,486.06
|
| Rate for Payer: WPS Commercial |
$2,001.24
|
|
|
SCREW LOCK MATRIX MANDIBLE 2.4 X 14MM 04.503.644.01
|
Facility
|
IP
|
$2,598.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5831668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,323.94 |
| Max. Negotiated Rate |
$2,485.77 |
| Rate for Payer: Aetna Commercial |
$2,431.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,323.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,432.02
|
| Rate for Payer: Cash Price |
$779.40
|
| Rate for Payer: Cigna Commercial |
$2,485.77
|
| Rate for Payer: Health EOS Commercial |
$2,404.71
|
| Rate for Payer: HFN Commercial |
$2,485.77
|
| Rate for Payer: Multiplan Commercial |
$2,161.54
|
| Rate for Payer: Preferred Network Access Commercial |
$2,485.77
|
| Rate for Payer: Quartz Beloit One Network |
$1,323.94
|
| Rate for Payer: Quartz Commercial |
$1,621.15
|
| Rate for Payer: WEA Trust Commercial |
$1,486.06
|
| Rate for Payer: WPS Commercial |
$2,001.24
|
|
|
SCREW LOCK MATRIX MANDIBLE 2.4 X 14MM 04.503.644.01
|
Facility
|
OP
|
$2,598.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5831668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$756.54 |
| Max. Negotiated Rate |
$2,485.77 |
| Rate for Payer: Aetna Commercial |
$2,431.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,323.65
|
| Rate for Payer: Aetna Managed Medicare |
$756.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,756.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,350.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,296.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,432.02
|
| Rate for Payer: Cash Price |
$779.40
|
| Rate for Payer: Cigna Commercial |
$2,485.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,512.04
|
| Rate for Payer: Health EOS Commercial |
$2,404.71
|
| Rate for Payer: HFN Commercial |
$2,485.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,026.44
|
| Rate for Payer: Multiplan Commercial |
$2,161.54
|
| Rate for Payer: NAPHCARE Commercial |
$1,621.15
|
| Rate for Payer: Preferred Network Access Commercial |
$2,485.77
|
| Rate for Payer: Quartz Beloit One Network |
$1,323.94
|
| Rate for Payer: Quartz Commercial |
$1,756.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,621.15
|
| Rate for Payer: The Alliance Commercial |
$1,350.96
|
| Rate for Payer: WEA Trust Commercial |
$1,486.06
|
| Rate for Payer: WPS Commercial |
$2,001.24
|
|
|
SCREW LOCK MATRIX MANDIBLE 2.4 X 16MM 04.503.646.01
|
Facility
|
IP
|
$2,847.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6185032
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,450.83 |
| Max. Negotiated Rate |
$2,724.01 |
| Rate for Payer: Aetna Commercial |
$2,664.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,546.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,569.27
|
| Rate for Payer: Cash Price |
$854.10
|
| Rate for Payer: Cigna Commercial |
$2,724.01
|
| Rate for Payer: Health EOS Commercial |
$2,635.18
|
| Rate for Payer: HFN Commercial |
$2,724.01
|
| Rate for Payer: Multiplan Commercial |
$2,368.70
|
| Rate for Payer: Preferred Network Access Commercial |
$2,724.01
|
| Rate for Payer: Quartz Beloit One Network |
$1,450.83
|
| Rate for Payer: Quartz Commercial |
$1,776.53
|
| Rate for Payer: WEA Trust Commercial |
$1,628.48
|
| Rate for Payer: WPS Commercial |
$2,193.04
|
|
|
SCREW LOCK MATRIX MANDIBLE 2.4 X 16MM 04.503.646.01
|
Facility
|
OP
|
$2,847.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6185032
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$829.05 |
| Max. Negotiated Rate |
$2,724.01 |
| Rate for Payer: Aetna Commercial |
$2,664.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,546.36
|
| Rate for Payer: Aetna Managed Medicare |
$829.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,924.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,480.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,421.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,569.27
|
| Rate for Payer: Cash Price |
$854.10
|
| Rate for Payer: Cigna Commercial |
$2,724.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,656.95
|
| Rate for Payer: Health EOS Commercial |
$2,635.18
|
| Rate for Payer: HFN Commercial |
$2,724.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,220.66
|
| Rate for Payer: Multiplan Commercial |
$2,368.70
|
| Rate for Payer: NAPHCARE Commercial |
$1,776.53
|
| Rate for Payer: Preferred Network Access Commercial |
$2,724.01
|
| Rate for Payer: Quartz Beloit One Network |
$1,450.83
|
| Rate for Payer: Quartz Commercial |
$1,924.57
|
| Rate for Payer: Quartz Medicare Advantage |
$1,776.53
|
| Rate for Payer: The Alliance Commercial |
$1,480.44
|
| Rate for Payer: WEA Trust Commercial |
$1,628.48
|
| Rate for Payer: WPS Commercial |
$2,193.04
|
|
|
SCREW LOCK VA 2.4 X 12MM TI AR-8724V-12
|
Facility
|
OP
|
$1,864.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414674
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$542.80 |
| Max. Negotiated Rate |
$1,783.48 |
| Rate for Payer: Aetna Commercial |
$1,744.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,667.16
|
| Rate for Payer: Aetna Managed Medicare |
$542.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,260.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$969.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$930.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,027.44
|
| Rate for Payer: Cash Price |
$559.20
|
| Rate for Payer: Cigna Commercial |
$1,783.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,084.85
|
| Rate for Payer: Health EOS Commercial |
$1,725.32
|
| Rate for Payer: HFN Commercial |
$1,783.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,453.92
|
| Rate for Payer: Multiplan Commercial |
$1,550.85
|
| Rate for Payer: NAPHCARE Commercial |
$1,163.14
|
| Rate for Payer: Preferred Network Access Commercial |
$1,783.48
|
| Rate for Payer: Quartz Beloit One Network |
$949.89
|
| Rate for Payer: Quartz Commercial |
$1,260.06
|
| Rate for Payer: Quartz Medicare Advantage |
$1,163.14
|
| Rate for Payer: The Alliance Commercial |
$969.28
|
| Rate for Payer: WEA Trust Commercial |
$1,066.21
|
| Rate for Payer: WPS Commercial |
$1,435.84
|
|
|
SCREW LOCK VA 2.4 X 12MM TI AR-8724V-12
|
Facility
|
IP
|
$1,864.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414674
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$949.89 |
| Max. Negotiated Rate |
$1,783.48 |
| Rate for Payer: Aetna Commercial |
$1,744.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,667.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,027.44
|
| Rate for Payer: Cash Price |
$559.20
|
| Rate for Payer: Cigna Commercial |
$1,783.48
|
| Rate for Payer: Health EOS Commercial |
$1,725.32
|
| Rate for Payer: HFN Commercial |
$1,783.48
|
| Rate for Payer: Multiplan Commercial |
$1,550.85
|
| Rate for Payer: Preferred Network Access Commercial |
$1,783.48
|
| Rate for Payer: Quartz Beloit One Network |
$949.89
|
| Rate for Payer: Quartz Commercial |
$1,163.14
|
| Rate for Payer: WEA Trust Commercial |
$1,066.21
|
| Rate for Payer: WPS Commercial |
$1,435.84
|
|
|
SCREW LOCK VA 2.4 X 14MM TI AR-8724V-14
|
Facility
|
OP
|
$1,864.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5200621
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$542.80 |
| Max. Negotiated Rate |
$1,783.48 |
| Rate for Payer: Aetna Commercial |
$1,744.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,667.16
|
| Rate for Payer: Aetna Managed Medicare |
$542.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,260.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$969.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$930.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,027.44
|
| Rate for Payer: Cash Price |
$559.20
|
| Rate for Payer: Cigna Commercial |
$1,783.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,084.85
|
| Rate for Payer: Health EOS Commercial |
$1,725.32
|
| Rate for Payer: HFN Commercial |
$1,783.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,453.92
|
| Rate for Payer: Multiplan Commercial |
$1,550.85
|
| Rate for Payer: NAPHCARE Commercial |
$1,163.14
|
| Rate for Payer: Preferred Network Access Commercial |
$1,783.48
|
| Rate for Payer: Quartz Beloit One Network |
$949.89
|
| Rate for Payer: Quartz Commercial |
$1,260.06
|
| Rate for Payer: Quartz Medicare Advantage |
$1,163.14
|
| Rate for Payer: The Alliance Commercial |
$969.28
|
| Rate for Payer: WEA Trust Commercial |
$1,066.21
|
| Rate for Payer: WPS Commercial |
$1,435.84
|
|
|
SCREW LOCK VA 2.4 X 14MM TI AR-8724V-14
|
Facility
|
IP
|
$1,864.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5200621
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$949.89 |
| Max. Negotiated Rate |
$1,783.48 |
| Rate for Payer: Aetna Commercial |
$1,744.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,667.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,027.44
|
| Rate for Payer: Cash Price |
$559.20
|
| Rate for Payer: Cigna Commercial |
$1,783.48
|
| Rate for Payer: Health EOS Commercial |
$1,725.32
|
| Rate for Payer: HFN Commercial |
$1,783.48
|
| Rate for Payer: Multiplan Commercial |
$1,550.85
|
| Rate for Payer: Preferred Network Access Commercial |
$1,783.48
|
| Rate for Payer: Quartz Beloit One Network |
$949.89
|
| Rate for Payer: Quartz Commercial |
$1,163.14
|
| Rate for Payer: WEA Trust Commercial |
$1,066.21
|
| Rate for Payer: WPS Commercial |
$1,435.84
|
|
|
SCREW LOCK VA 2.4 X 16MM TI AR-8724V-16
|
Facility
|
OP
|
$1,740.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5384971
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$506.69 |
| Max. Negotiated Rate |
$1,664.83 |
| Rate for Payer: Aetna Commercial |
$1,628.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,556.26
|
| Rate for Payer: Aetna Managed Medicare |
$506.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,176.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$904.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$868.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$959.09
|
| Rate for Payer: Cash Price |
$522.00
|
| Rate for Payer: Cigna Commercial |
$1,664.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,012.68
|
| Rate for Payer: Health EOS Commercial |
$1,610.54
|
| Rate for Payer: HFN Commercial |
$1,664.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,357.20
|
| Rate for Payer: Multiplan Commercial |
$1,447.68
|
| Rate for Payer: NAPHCARE Commercial |
$1,085.76
|
| Rate for Payer: Preferred Network Access Commercial |
$1,664.83
|
| Rate for Payer: Quartz Beloit One Network |
$886.70
|
| Rate for Payer: Quartz Commercial |
$1,176.24
|
| Rate for Payer: Quartz Medicare Advantage |
$1,085.76
|
| Rate for Payer: The Alliance Commercial |
$904.80
|
| Rate for Payer: WEA Trust Commercial |
$995.28
|
| Rate for Payer: WPS Commercial |
$1,340.32
|
|
|
SCREW LOCK VA 2.4 X 16MM TI AR-8724V-16
|
Facility
|
IP
|
$1,740.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5384971
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$886.70 |
| Max. Negotiated Rate |
$1,664.83 |
| Rate for Payer: Aetna Commercial |
$1,628.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,556.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$959.09
|
| Rate for Payer: Cash Price |
$522.00
|
| Rate for Payer: Cigna Commercial |
$1,664.83
|
| Rate for Payer: Health EOS Commercial |
$1,610.54
|
| Rate for Payer: HFN Commercial |
$1,664.83
|
| Rate for Payer: Multiplan Commercial |
$1,447.68
|
| Rate for Payer: Preferred Network Access Commercial |
$1,664.83
|
| Rate for Payer: Quartz Beloit One Network |
$886.70
|
| Rate for Payer: Quartz Commercial |
$1,085.76
|
| Rate for Payer: WEA Trust Commercial |
$995.28
|
| Rate for Payer: WPS Commercial |
$1,340.32
|
|
|
SCREW LOCK VA 2.4 X 18MM TI AR-8724V-18
|
Facility
|
OP
|
$1,864.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414663
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$542.80 |
| Max. Negotiated Rate |
$1,783.48 |
| Rate for Payer: Aetna Commercial |
$1,744.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,667.16
|
| Rate for Payer: Aetna Managed Medicare |
$542.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,260.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$969.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$930.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,027.44
|
| Rate for Payer: Cash Price |
$559.20
|
| Rate for Payer: Cigna Commercial |
$1,783.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,084.85
|
| Rate for Payer: Health EOS Commercial |
$1,725.32
|
| Rate for Payer: HFN Commercial |
$1,783.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,453.92
|
| Rate for Payer: Multiplan Commercial |
$1,550.85
|
| Rate for Payer: NAPHCARE Commercial |
$1,163.14
|
| Rate for Payer: Preferred Network Access Commercial |
$1,783.48
|
| Rate for Payer: Quartz Beloit One Network |
$949.89
|
| Rate for Payer: Quartz Commercial |
$1,260.06
|
| Rate for Payer: Quartz Medicare Advantage |
$1,163.14
|
| Rate for Payer: The Alliance Commercial |
$969.28
|
| Rate for Payer: WEA Trust Commercial |
$1,066.21
|
| Rate for Payer: WPS Commercial |
$1,435.84
|
|
|
SCREW LOCK VA 2.4 X 18MM TI AR-8724V-18
|
Facility
|
IP
|
$1,864.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414663
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$949.89 |
| Max. Negotiated Rate |
$1,783.48 |
| Rate for Payer: Aetna Commercial |
$1,744.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,667.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,027.44
|
| Rate for Payer: Cash Price |
$559.20
|
| Rate for Payer: Cigna Commercial |
$1,783.48
|
| Rate for Payer: Health EOS Commercial |
$1,725.32
|
| Rate for Payer: HFN Commercial |
$1,783.48
|
| Rate for Payer: Multiplan Commercial |
$1,550.85
|
| Rate for Payer: Preferred Network Access Commercial |
$1,783.48
|
| Rate for Payer: Quartz Beloit One Network |
$949.89
|
| Rate for Payer: Quartz Commercial |
$1,163.14
|
| Rate for Payer: WEA Trust Commercial |
$1,066.21
|
| Rate for Payer: WPS Commercial |
$1,435.84
|
|
|
SCREW LOCK VA 2.4 X 20MM TI AR-8724V-20
|
Facility
|
OP
|
$1,864.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5384972
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$542.80 |
| Max. Negotiated Rate |
$1,783.48 |
| Rate for Payer: Aetna Commercial |
$1,744.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,667.16
|
| Rate for Payer: Aetna Managed Medicare |
$542.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,260.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$969.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$930.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,027.44
|
| Rate for Payer: Cash Price |
$559.20
|
| Rate for Payer: Cigna Commercial |
$1,783.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,084.85
|
| Rate for Payer: Health EOS Commercial |
$1,725.32
|
| Rate for Payer: HFN Commercial |
$1,783.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,453.92
|
| Rate for Payer: Multiplan Commercial |
$1,550.85
|
| Rate for Payer: NAPHCARE Commercial |
$1,163.14
|
| Rate for Payer: Preferred Network Access Commercial |
$1,783.48
|
| Rate for Payer: Quartz Beloit One Network |
$949.89
|
| Rate for Payer: Quartz Commercial |
$1,260.06
|
| Rate for Payer: Quartz Medicare Advantage |
$1,163.14
|
| Rate for Payer: The Alliance Commercial |
$969.28
|
| Rate for Payer: WEA Trust Commercial |
$1,066.21
|
| Rate for Payer: WPS Commercial |
$1,435.84
|
|
|
SCREW LOCK VA 2.4 X 20MM TI AR-8724V-20
|
Facility
|
IP
|
$1,864.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5384972
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$949.89 |
| Max. Negotiated Rate |
$1,783.48 |
| Rate for Payer: Aetna Commercial |
$1,744.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,667.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,027.44
|
| Rate for Payer: Cash Price |
$559.20
|
| Rate for Payer: Cigna Commercial |
$1,783.48
|
| Rate for Payer: Health EOS Commercial |
$1,725.32
|
| Rate for Payer: HFN Commercial |
$1,783.48
|
| Rate for Payer: Multiplan Commercial |
$1,550.85
|
| Rate for Payer: Preferred Network Access Commercial |
$1,783.48
|
| Rate for Payer: Quartz Beloit One Network |
$949.89
|
| Rate for Payer: Quartz Commercial |
$1,163.14
|
| Rate for Payer: WEA Trust Commercial |
$1,066.21
|
| Rate for Payer: WPS Commercial |
$1,435.84
|
|
