|
SCREW METAPHYSEAL 2.7 X 48MM 02.118.548
|
Facility
|
OP
|
$817.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5106910
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$237.91 |
| Max. Negotiated Rate |
$781.71 |
| Rate for Payer: Aetna Commercial |
$764.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$730.72
|
| Rate for Payer: Aetna Managed Medicare |
$237.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$552.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$424.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$407.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$450.33
|
| Rate for Payer: Cash Price |
$245.10
|
| Rate for Payer: Cigna Commercial |
$781.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$475.49
|
| Rate for Payer: Health EOS Commercial |
$756.22
|
| Rate for Payer: HFN Commercial |
$781.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$637.26
|
| Rate for Payer: Multiplan Commercial |
$679.74
|
| Rate for Payer: NAPHCARE Commercial |
$509.81
|
| Rate for Payer: Preferred Network Access Commercial |
$781.71
|
| Rate for Payer: Quartz Beloit One Network |
$416.34
|
| Rate for Payer: Quartz Commercial |
$552.29
|
| Rate for Payer: Quartz Medicare Advantage |
$509.81
|
| Rate for Payer: The Alliance Commercial |
$424.84
|
| Rate for Payer: WEA Trust Commercial |
$467.32
|
| Rate for Payer: WPS Commercial |
$629.34
|
|
|
SCREW METAPHYSEAL 2.7 X 48MM 02.118.548
|
Facility
|
IP
|
$817.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5106910
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$416.34 |
| Max. Negotiated Rate |
$781.71 |
| Rate for Payer: Aetna Commercial |
$764.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$730.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$450.33
|
| Rate for Payer: Cash Price |
$245.10
|
| Rate for Payer: Cigna Commercial |
$781.71
|
| Rate for Payer: Health EOS Commercial |
$756.22
|
| Rate for Payer: HFN Commercial |
$781.71
|
| Rate for Payer: Multiplan Commercial |
$679.74
|
| Rate for Payer: Preferred Network Access Commercial |
$781.71
|
| Rate for Payer: Quartz Beloit One Network |
$416.34
|
| Rate for Payer: Quartz Commercial |
$509.81
|
| Rate for Payer: WEA Trust Commercial |
$467.32
|
| Rate for Payer: WPS Commercial |
$629.34
|
|
|
SCREW METAPHYSEAL 2.7 X 50MM 02.118.550
|
Facility
|
OP
|
$817.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4317096
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$237.91 |
| Max. Negotiated Rate |
$781.71 |
| Rate for Payer: Aetna Commercial |
$764.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$730.72
|
| Rate for Payer: Aetna Managed Medicare |
$237.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$552.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$424.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$407.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$450.33
|
| Rate for Payer: Cash Price |
$245.10
|
| Rate for Payer: Cigna Commercial |
$781.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$475.49
|
| Rate for Payer: Health EOS Commercial |
$756.22
|
| Rate for Payer: HFN Commercial |
$781.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$637.26
|
| Rate for Payer: Multiplan Commercial |
$679.74
|
| Rate for Payer: NAPHCARE Commercial |
$509.81
|
| Rate for Payer: Preferred Network Access Commercial |
$781.71
|
| Rate for Payer: Quartz Beloit One Network |
$416.34
|
| Rate for Payer: Quartz Commercial |
$552.29
|
| Rate for Payer: Quartz Medicare Advantage |
$509.81
|
| Rate for Payer: The Alliance Commercial |
$424.84
|
| Rate for Payer: WEA Trust Commercial |
$467.32
|
| Rate for Payer: WPS Commercial |
$629.34
|
|
|
SCREW METAPHYSEAL 2.7 X 50MM 02.118.550
|
Facility
|
IP
|
$817.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4317096
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$416.34 |
| Max. Negotiated Rate |
$781.71 |
| Rate for Payer: Aetna Commercial |
$764.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$730.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$450.33
|
| Rate for Payer: Cash Price |
$245.10
|
| Rate for Payer: Cigna Commercial |
$781.71
|
| Rate for Payer: Health EOS Commercial |
$756.22
|
| Rate for Payer: HFN Commercial |
$781.71
|
| Rate for Payer: Multiplan Commercial |
$679.74
|
| Rate for Payer: Preferred Network Access Commercial |
$781.71
|
| Rate for Payer: Quartz Beloit One Network |
$416.34
|
| Rate for Payer: Quartz Commercial |
$509.81
|
| Rate for Payer: WEA Trust Commercial |
$467.32
|
| Rate for Payer: WPS Commercial |
$629.34
|
|
|
SCREW METAPHYSEAL 2.7 X 52MM 02.118.552
|
Facility
|
OP
|
$817.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5248647
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$237.91 |
| Max. Negotiated Rate |
$781.71 |
| Rate for Payer: Aetna Commercial |
$764.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$730.72
|
| Rate for Payer: Aetna Managed Medicare |
$237.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$552.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$424.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$407.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$450.33
|
| Rate for Payer: Cash Price |
$245.10
|
| Rate for Payer: Cigna Commercial |
$781.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$475.49
|
| Rate for Payer: Health EOS Commercial |
$756.22
|
| Rate for Payer: HFN Commercial |
$781.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$637.26
|
| Rate for Payer: Multiplan Commercial |
$679.74
|
| Rate for Payer: NAPHCARE Commercial |
$509.81
|
| Rate for Payer: Preferred Network Access Commercial |
$781.71
|
| Rate for Payer: Quartz Beloit One Network |
$416.34
|
| Rate for Payer: Quartz Commercial |
$552.29
|
| Rate for Payer: Quartz Medicare Advantage |
$509.81
|
| Rate for Payer: The Alliance Commercial |
$424.84
|
| Rate for Payer: WEA Trust Commercial |
$467.32
|
| Rate for Payer: WPS Commercial |
$629.34
|
|
|
SCREW METAPHYSEAL 2.7 X 52MM 02.118.552
|
Facility
|
IP
|
$817.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5248647
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$416.34 |
| Max. Negotiated Rate |
$781.71 |
| Rate for Payer: Aetna Commercial |
$764.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$730.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$450.33
|
| Rate for Payer: Cash Price |
$245.10
|
| Rate for Payer: Cigna Commercial |
$781.71
|
| Rate for Payer: Health EOS Commercial |
$756.22
|
| Rate for Payer: HFN Commercial |
$781.71
|
| Rate for Payer: Multiplan Commercial |
$679.74
|
| Rate for Payer: Preferred Network Access Commercial |
$781.71
|
| Rate for Payer: Quartz Beloit One Network |
$416.34
|
| Rate for Payer: Quartz Commercial |
$509.81
|
| Rate for Payer: WEA Trust Commercial |
$467.32
|
| Rate for Payer: WPS Commercial |
$629.34
|
|
|
SCREW METAPHYSEAL 2.7 X 70MM 02.118.570
|
Facility
|
IP
|
$817.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3265485
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$416.34 |
| Max. Negotiated Rate |
$781.71 |
| Rate for Payer: Aetna Commercial |
$764.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$730.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$450.33
|
| Rate for Payer: Cash Price |
$245.10
|
| Rate for Payer: Cigna Commercial |
$781.71
|
| Rate for Payer: Health EOS Commercial |
$756.22
|
| Rate for Payer: HFN Commercial |
$781.71
|
| Rate for Payer: Multiplan Commercial |
$679.74
|
| Rate for Payer: Preferred Network Access Commercial |
$781.71
|
| Rate for Payer: Quartz Beloit One Network |
$416.34
|
| Rate for Payer: Quartz Commercial |
$509.81
|
| Rate for Payer: WEA Trust Commercial |
$467.32
|
| Rate for Payer: WPS Commercial |
$629.34
|
|
|
SCREW METAPHYSEAL 2.7 X 70MM 02.118.570
|
Facility
|
OP
|
$817.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3265485
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$237.91 |
| Max. Negotiated Rate |
$781.71 |
| Rate for Payer: Aetna Commercial |
$764.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$730.72
|
| Rate for Payer: Aetna Managed Medicare |
$237.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$552.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$424.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$407.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$450.33
|
| Rate for Payer: Cash Price |
$245.10
|
| Rate for Payer: Cigna Commercial |
$781.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$475.49
|
| Rate for Payer: Health EOS Commercial |
$756.22
|
| Rate for Payer: HFN Commercial |
$781.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$637.26
|
| Rate for Payer: Multiplan Commercial |
$679.74
|
| Rate for Payer: NAPHCARE Commercial |
$509.81
|
| Rate for Payer: Preferred Network Access Commercial |
$781.71
|
| Rate for Payer: Quartz Beloit One Network |
$416.34
|
| Rate for Payer: Quartz Commercial |
$552.29
|
| Rate for Payer: Quartz Medicare Advantage |
$509.81
|
| Rate for Payer: The Alliance Commercial |
$424.84
|
| Rate for Payer: WEA Trust Commercial |
$467.32
|
| Rate for Payer: WPS Commercial |
$629.34
|
|
|
SCREW MICRO CANN 2.0 X 15 6MM THREAD LENGTH ASNIS TI 40-20115
|
Facility
|
IP
|
$1,845.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6171703
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$940.21 |
| Max. Negotiated Rate |
$1,765.30 |
| Rate for Payer: Aetna Commercial |
$1,726.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,650.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,016.96
|
| Rate for Payer: Cash Price |
$553.50
|
| Rate for Payer: Cigna Commercial |
$1,765.30
|
| Rate for Payer: Health EOS Commercial |
$1,707.73
|
| Rate for Payer: HFN Commercial |
$1,765.30
|
| Rate for Payer: Multiplan Commercial |
$1,535.04
|
| Rate for Payer: Preferred Network Access Commercial |
$1,765.30
|
| Rate for Payer: Quartz Beloit One Network |
$940.21
|
| Rate for Payer: Quartz Commercial |
$1,151.28
|
| Rate for Payer: WEA Trust Commercial |
$1,055.34
|
| Rate for Payer: WPS Commercial |
$1,421.20
|
|
|
SCREW MICRO CANN 2.0 X 15 6MM THREAD LENGTH ASNIS TI 40-20115
|
Facility
|
OP
|
$1,845.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6171703
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$537.26 |
| Max. Negotiated Rate |
$1,765.30 |
| Rate for Payer: Aetna Commercial |
$1,726.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,650.17
|
| Rate for Payer: Aetna Managed Medicare |
$537.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,247.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$959.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$921.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,016.96
|
| Rate for Payer: Cash Price |
$553.50
|
| Rate for Payer: Cigna Commercial |
$1,765.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,073.79
|
| Rate for Payer: Health EOS Commercial |
$1,707.73
|
| Rate for Payer: HFN Commercial |
$1,765.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,439.10
|
| Rate for Payer: Multiplan Commercial |
$1,535.04
|
| Rate for Payer: NAPHCARE Commercial |
$1,151.28
|
| Rate for Payer: Preferred Network Access Commercial |
$1,765.30
|
| Rate for Payer: Quartz Beloit One Network |
$940.21
|
| Rate for Payer: Quartz Commercial |
$1,247.22
|
| Rate for Payer: Quartz Medicare Advantage |
$1,151.28
|
| Rate for Payer: The Alliance Commercial |
$959.40
|
| Rate for Payer: WEA Trust Commercial |
$1,055.34
|
| Rate for Payer: WPS Commercial |
$1,421.20
|
|
|
SCREW MICRO CANN 2.0 X 16 7MM THREAD LENGTH ASNIS TI 40-20116
|
Facility
|
IP
|
$1,845.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6171704
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$940.21 |
| Max. Negotiated Rate |
$1,765.30 |
| Rate for Payer: Aetna Commercial |
$1,726.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,650.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,016.96
|
| Rate for Payer: Cash Price |
$553.50
|
| Rate for Payer: Cigna Commercial |
$1,765.30
|
| Rate for Payer: Health EOS Commercial |
$1,707.73
|
| Rate for Payer: HFN Commercial |
$1,765.30
|
| Rate for Payer: Multiplan Commercial |
$1,535.04
|
| Rate for Payer: Preferred Network Access Commercial |
$1,765.30
|
| Rate for Payer: Quartz Beloit One Network |
$940.21
|
| Rate for Payer: Quartz Commercial |
$1,151.28
|
| Rate for Payer: WEA Trust Commercial |
$1,055.34
|
| Rate for Payer: WPS Commercial |
$1,421.20
|
|
|
SCREW MICRO CANN 2.0 X 16 7MM THREAD LENGTH ASNIS TI 40-20116
|
Facility
|
OP
|
$1,845.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6171704
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$537.26 |
| Max. Negotiated Rate |
$1,765.30 |
| Rate for Payer: Aetna Commercial |
$1,726.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,650.17
|
| Rate for Payer: Aetna Managed Medicare |
$537.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,247.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$959.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$921.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,016.96
|
| Rate for Payer: Cash Price |
$553.50
|
| Rate for Payer: Cigna Commercial |
$1,765.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,073.79
|
| Rate for Payer: Health EOS Commercial |
$1,707.73
|
| Rate for Payer: HFN Commercial |
$1,765.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,439.10
|
| Rate for Payer: Multiplan Commercial |
$1,535.04
|
| Rate for Payer: NAPHCARE Commercial |
$1,151.28
|
| Rate for Payer: Preferred Network Access Commercial |
$1,765.30
|
| Rate for Payer: Quartz Beloit One Network |
$940.21
|
| Rate for Payer: Quartz Commercial |
$1,247.22
|
| Rate for Payer: Quartz Medicare Advantage |
$1,151.28
|
| Rate for Payer: The Alliance Commercial |
$959.40
|
| Rate for Payer: WEA Trust Commercial |
$1,055.34
|
| Rate for Payer: WPS Commercial |
$1,421.20
|
|
|
SCREW MICRO CANN 2.0 X 24MM X 6MM THREAD ASNIS 40-20124
|
Facility
|
IP
|
$2,102.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767635
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,071.18 |
| Max. Negotiated Rate |
$2,011.19 |
| Rate for Payer: Aetna Commercial |
$1,967.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,880.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,158.62
|
| Rate for Payer: Cash Price |
$630.60
|
| Rate for Payer: Cigna Commercial |
$2,011.19
|
| Rate for Payer: Health EOS Commercial |
$1,945.61
|
| Rate for Payer: HFN Commercial |
$2,011.19
|
| Rate for Payer: Multiplan Commercial |
$1,748.86
|
| Rate for Payer: Preferred Network Access Commercial |
$2,011.19
|
| Rate for Payer: Quartz Beloit One Network |
$1,071.18
|
| Rate for Payer: Quartz Commercial |
$1,311.65
|
| Rate for Payer: WEA Trust Commercial |
$1,202.34
|
| Rate for Payer: WPS Commercial |
$1,619.17
|
|
|
SCREW MICRO CANN 2.0 X 24MM X 6MM THREAD ASNIS 40-20124
|
Facility
|
OP
|
$2,102.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767635
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.10 |
| Max. Negotiated Rate |
$2,011.19 |
| Rate for Payer: Aetna Commercial |
$1,967.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,880.03
|
| Rate for Payer: Aetna Managed Medicare |
$612.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,420.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,093.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,049.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,158.62
|
| Rate for Payer: Cash Price |
$630.60
|
| Rate for Payer: Cigna Commercial |
$2,011.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,223.36
|
| Rate for Payer: Health EOS Commercial |
$1,945.61
|
| Rate for Payer: HFN Commercial |
$2,011.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,639.56
|
| Rate for Payer: Multiplan Commercial |
$1,748.86
|
| Rate for Payer: NAPHCARE Commercial |
$1,311.65
|
| Rate for Payer: Preferred Network Access Commercial |
$2,011.19
|
| Rate for Payer: Quartz Beloit One Network |
$1,071.18
|
| Rate for Payer: Quartz Commercial |
$1,420.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,311.65
|
| Rate for Payer: The Alliance Commercial |
$1,093.04
|
| Rate for Payer: WEA Trust Commercial |
$1,202.34
|
| Rate for Payer: WPS Commercial |
$1,619.17
|
|
|
SCREW MICRO CANN 2.0 X 28MM X 6MMTHREAD ASNIS 40-20128
|
Facility
|
OP
|
$2,102.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767636
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.10 |
| Max. Negotiated Rate |
$2,011.19 |
| Rate for Payer: Aetna Commercial |
$1,967.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,880.03
|
| Rate for Payer: Aetna Managed Medicare |
$612.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,420.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,093.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,049.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,158.62
|
| Rate for Payer: Cash Price |
$630.60
|
| Rate for Payer: Cigna Commercial |
$2,011.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,223.36
|
| Rate for Payer: Health EOS Commercial |
$1,945.61
|
| Rate for Payer: HFN Commercial |
$2,011.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,639.56
|
| Rate for Payer: Multiplan Commercial |
$1,748.86
|
| Rate for Payer: NAPHCARE Commercial |
$1,311.65
|
| Rate for Payer: Preferred Network Access Commercial |
$2,011.19
|
| Rate for Payer: Quartz Beloit One Network |
$1,071.18
|
| Rate for Payer: Quartz Commercial |
$1,420.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,311.65
|
| Rate for Payer: The Alliance Commercial |
$1,093.04
|
| Rate for Payer: WEA Trust Commercial |
$1,202.34
|
| Rate for Payer: WPS Commercial |
$1,619.17
|
|
|
SCREW MICRO CANN 2.0 X 28MM X 6MMTHREAD ASNIS 40-20128
|
Facility
|
IP
|
$2,102.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767636
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,071.18 |
| Max. Negotiated Rate |
$2,011.19 |
| Rate for Payer: Aetna Commercial |
$1,967.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,880.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,158.62
|
| Rate for Payer: Cash Price |
$630.60
|
| Rate for Payer: Cigna Commercial |
$2,011.19
|
| Rate for Payer: Health EOS Commercial |
$1,945.61
|
| Rate for Payer: HFN Commercial |
$2,011.19
|
| Rate for Payer: Multiplan Commercial |
$1,748.86
|
| Rate for Payer: Preferred Network Access Commercial |
$2,011.19
|
| Rate for Payer: Quartz Beloit One Network |
$1,071.18
|
| Rate for Payer: Quartz Commercial |
$1,311.65
|
| Rate for Payer: WEA Trust Commercial |
$1,202.34
|
| Rate for Payer: WPS Commercial |
$1,619.17
|
|
|
SCREW MINI CANN 2.5 X 12 HEADLESS IH2512
|
Facility
|
IP
|
$2,814.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5947649
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,434.01 |
| Max. Negotiated Rate |
$2,692.44 |
| Rate for Payer: Aetna Commercial |
$2,633.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,516.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,551.08
|
| Rate for Payer: Cash Price |
$844.20
|
| Rate for Payer: Cigna Commercial |
$2,692.44
|
| Rate for Payer: Health EOS Commercial |
$2,604.64
|
| Rate for Payer: HFN Commercial |
$2,692.44
|
| Rate for Payer: Multiplan Commercial |
$2,341.25
|
| Rate for Payer: Preferred Network Access Commercial |
$2,692.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,434.01
|
| Rate for Payer: Quartz Commercial |
$1,755.94
|
| Rate for Payer: WEA Trust Commercial |
$1,609.61
|
| Rate for Payer: WPS Commercial |
$2,167.62
|
|
|
SCREW MINI CANN 2.5 X 12 HEADLESS IH2512
|
Facility
|
OP
|
$2,814.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5947649
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$819.44 |
| Max. Negotiated Rate |
$2,692.44 |
| Rate for Payer: Aetna Commercial |
$2,633.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,516.84
|
| Rate for Payer: Aetna Managed Medicare |
$819.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,902.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,463.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,404.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,551.08
|
| Rate for Payer: Cash Price |
$844.20
|
| Rate for Payer: Cigna Commercial |
$2,692.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,637.75
|
| Rate for Payer: Health EOS Commercial |
$2,604.64
|
| Rate for Payer: HFN Commercial |
$2,692.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,194.92
|
| Rate for Payer: Multiplan Commercial |
$2,341.25
|
| Rate for Payer: NAPHCARE Commercial |
$1,755.94
|
| Rate for Payer: Preferred Network Access Commercial |
$2,692.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,434.01
|
| Rate for Payer: Quartz Commercial |
$1,902.26
|
| Rate for Payer: Quartz Medicare Advantage |
$1,755.94
|
| Rate for Payer: The Alliance Commercial |
$1,463.28
|
| Rate for Payer: WEA Trust Commercial |
$1,609.61
|
| Rate for Payer: WPS Commercial |
$2,167.62
|
|
|
SCREW MINI CANN 2.5 X 14 HEADLESS IH2514
|
Facility
|
OP
|
$2,814.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5947650
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$819.44 |
| Max. Negotiated Rate |
$2,692.44 |
| Rate for Payer: Aetna Commercial |
$2,633.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,516.84
|
| Rate for Payer: Aetna Managed Medicare |
$819.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,902.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,463.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,404.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,551.08
|
| Rate for Payer: Cash Price |
$844.20
|
| Rate for Payer: Cigna Commercial |
$2,692.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,637.75
|
| Rate for Payer: Health EOS Commercial |
$2,604.64
|
| Rate for Payer: HFN Commercial |
$2,692.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,194.92
|
| Rate for Payer: Multiplan Commercial |
$2,341.25
|
| Rate for Payer: NAPHCARE Commercial |
$1,755.94
|
| Rate for Payer: Preferred Network Access Commercial |
$2,692.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,434.01
|
| Rate for Payer: Quartz Commercial |
$1,902.26
|
| Rate for Payer: Quartz Medicare Advantage |
$1,755.94
|
| Rate for Payer: The Alliance Commercial |
$1,463.28
|
| Rate for Payer: WEA Trust Commercial |
$1,609.61
|
| Rate for Payer: WPS Commercial |
$2,167.62
|
|
|
SCREW MINI CANN 2.5 X 14 HEADLESS IH2514
|
Facility
|
IP
|
$2,814.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5947650
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,434.01 |
| Max. Negotiated Rate |
$2,692.44 |
| Rate for Payer: Aetna Commercial |
$2,633.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,516.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,551.08
|
| Rate for Payer: Cash Price |
$844.20
|
| Rate for Payer: Cigna Commercial |
$2,692.44
|
| Rate for Payer: Health EOS Commercial |
$2,604.64
|
| Rate for Payer: HFN Commercial |
$2,692.44
|
| Rate for Payer: Multiplan Commercial |
$2,341.25
|
| Rate for Payer: Preferred Network Access Commercial |
$2,692.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,434.01
|
| Rate for Payer: Quartz Commercial |
$1,755.94
|
| Rate for Payer: WEA Trust Commercial |
$1,609.61
|
| Rate for Payer: WPS Commercial |
$2,167.62
|
|
|
SCREW MINI CANN 2.5 X 16 HEADLESS IH2516
|
Facility
|
OP
|
$2,814.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6153683
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$819.44 |
| Max. Negotiated Rate |
$2,692.44 |
| Rate for Payer: Aetna Commercial |
$2,633.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,516.84
|
| Rate for Payer: Aetna Managed Medicare |
$819.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,902.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,463.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,404.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,551.08
|
| Rate for Payer: Cash Price |
$844.20
|
| Rate for Payer: Cigna Commercial |
$2,692.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,637.75
|
| Rate for Payer: Health EOS Commercial |
$2,604.64
|
| Rate for Payer: HFN Commercial |
$2,692.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,194.92
|
| Rate for Payer: Multiplan Commercial |
$2,341.25
|
| Rate for Payer: NAPHCARE Commercial |
$1,755.94
|
| Rate for Payer: Preferred Network Access Commercial |
$2,692.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,434.01
|
| Rate for Payer: Quartz Commercial |
$1,902.26
|
| Rate for Payer: Quartz Medicare Advantage |
$1,755.94
|
| Rate for Payer: The Alliance Commercial |
$1,463.28
|
| Rate for Payer: WEA Trust Commercial |
$1,609.61
|
| Rate for Payer: WPS Commercial |
$2,167.62
|
|
|
SCREW MINI CANN 2.5 X 16 HEADLESS IH2516
|
Facility
|
IP
|
$2,814.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6153683
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,434.01 |
| Max. Negotiated Rate |
$2,692.44 |
| Rate for Payer: Aetna Commercial |
$2,633.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,516.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,551.08
|
| Rate for Payer: Cash Price |
$844.20
|
| Rate for Payer: Cigna Commercial |
$2,692.44
|
| Rate for Payer: Health EOS Commercial |
$2,604.64
|
| Rate for Payer: HFN Commercial |
$2,692.44
|
| Rate for Payer: Multiplan Commercial |
$2,341.25
|
| Rate for Payer: Preferred Network Access Commercial |
$2,692.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,434.01
|
| Rate for Payer: Quartz Commercial |
$1,755.94
|
| Rate for Payer: WEA Trust Commercial |
$1,609.61
|
| Rate for Payer: WPS Commercial |
$2,167.62
|
|
|
SCREW MINI CANN 2.5 X 18 HEADLESS IH2518
|
Facility
|
IP
|
$2,814.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6166134
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,434.01 |
| Max. Negotiated Rate |
$2,692.44 |
| Rate for Payer: Aetna Commercial |
$2,633.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,516.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,551.08
|
| Rate for Payer: Cash Price |
$844.20
|
| Rate for Payer: Cigna Commercial |
$2,692.44
|
| Rate for Payer: Health EOS Commercial |
$2,604.64
|
| Rate for Payer: HFN Commercial |
$2,692.44
|
| Rate for Payer: Multiplan Commercial |
$2,341.25
|
| Rate for Payer: Preferred Network Access Commercial |
$2,692.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,434.01
|
| Rate for Payer: Quartz Commercial |
$1,755.94
|
| Rate for Payer: WEA Trust Commercial |
$1,609.61
|
| Rate for Payer: WPS Commercial |
$2,167.62
|
|
|
SCREW MINI CANN 2.5 X 18 HEADLESS IH2518
|
Facility
|
OP
|
$2,814.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6166134
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$819.44 |
| Max. Negotiated Rate |
$2,692.44 |
| Rate for Payer: Aetna Commercial |
$2,633.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,516.84
|
| Rate for Payer: Aetna Managed Medicare |
$819.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,902.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,463.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,404.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,551.08
|
| Rate for Payer: Cash Price |
$844.20
|
| Rate for Payer: Cigna Commercial |
$2,692.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,637.75
|
| Rate for Payer: Health EOS Commercial |
$2,604.64
|
| Rate for Payer: HFN Commercial |
$2,692.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,194.92
|
| Rate for Payer: Multiplan Commercial |
$2,341.25
|
| Rate for Payer: NAPHCARE Commercial |
$1,755.94
|
| Rate for Payer: Preferred Network Access Commercial |
$2,692.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,434.01
|
| Rate for Payer: Quartz Commercial |
$1,902.26
|
| Rate for Payer: Quartz Medicare Advantage |
$1,755.94
|
| Rate for Payer: The Alliance Commercial |
$1,463.28
|
| Rate for Payer: WEA Trust Commercial |
$1,609.61
|
| Rate for Payer: WPS Commercial |
$2,167.62
|
|
|
SCREW MINI CANN 2.5 X 20 HEADLESS IH2520
|
Facility
|
IP
|
$2,927.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685825
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,491.60 |
| Max. Negotiated Rate |
$2,800.55 |
| Rate for Payer: Aetna Commercial |
$2,739.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,617.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,613.36
|
| Rate for Payer: Cash Price |
$878.10
|
| Rate for Payer: Cigna Commercial |
$2,800.55
|
| Rate for Payer: Health EOS Commercial |
$2,709.23
|
| Rate for Payer: HFN Commercial |
$2,800.55
|
| Rate for Payer: Multiplan Commercial |
$2,435.26
|
| Rate for Payer: Preferred Network Access Commercial |
$2,800.55
|
| Rate for Payer: Quartz Beloit One Network |
$1,491.60
|
| Rate for Payer: Quartz Commercial |
$1,826.45
|
| Rate for Payer: WEA Trust Commercial |
$1,674.24
|
| Rate for Payer: WPS Commercial |
$2,254.67
|
|
