|
SCREW LOCKING 3.5 X 26 213.026
|
Facility
|
IP
|
$2,002.00
|
|
| Hospital Charge Code |
2966557
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$980.98 |
| Max. Negotiated Rate |
$1,841.84 |
| Rate for Payer: Aetna Commercial |
$1,801.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,721.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,061.06
|
| Rate for Payer: Cash Price |
$600.60
|
| Rate for Payer: Cigna Commercial |
$1,841.84
|
| Rate for Payer: Health EOS Commercial |
$1,781.78
|
| Rate for Payer: HFN Commercial |
$1,841.84
|
| Rate for Payer: Multiplan Commercial |
$1,601.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,201.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,841.84
|
| Rate for Payer: Quartz Beloit One Network |
$980.98
|
| Rate for Payer: Quartz Commercial |
$1,201.20
|
| Rate for Payer: WEA Trust Commercial |
$1,101.10
|
| Rate for Payer: WPS Commercial |
$1,482.88
|
|
|
SCREW LOCKING 3.5 X 26 213.026
|
Facility
|
OP
|
$2,002.00
|
|
| Hospital Charge Code |
2966557
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$560.56 |
| Max. Negotiated Rate |
$8,008.00 |
| Rate for Payer: Aetna Commercial |
$1,801.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,721.72
|
| Rate for Payer: Aetna Managed Medicare |
$560.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,301.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,001.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$960.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,061.06
|
| Rate for Payer: Cash Price |
$600.60
|
| Rate for Payer: Cigna Commercial |
$1,841.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,120.32
|
| Rate for Payer: Health EOS Commercial |
$1,781.78
|
| Rate for Payer: HFN Commercial |
$1,841.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,501.50
|
| Rate for Payer: Multiplan Commercial |
$1,601.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,201.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,841.84
|
| Rate for Payer: Quartz Beloit One Network |
$980.98
|
| Rate for Payer: Quartz Commercial |
$1,301.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,201.20
|
| Rate for Payer: The Alliance Commercial |
$8,008.00
|
| Rate for Payer: WEA Trust Commercial |
$1,101.10
|
| Rate for Payer: WPS Commercial |
$1,482.88
|
|
|
SCREW LOCKING 3.5 X 28 213.028
|
Facility
|
OP
|
$2,002.00
|
|
| Hospital Charge Code |
2966558
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$560.56 |
| Max. Negotiated Rate |
$8,008.00 |
| Rate for Payer: Aetna Commercial |
$1,801.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,721.72
|
| Rate for Payer: Aetna Managed Medicare |
$560.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,301.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,001.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$960.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,061.06
|
| Rate for Payer: Cash Price |
$600.60
|
| Rate for Payer: Cigna Commercial |
$1,841.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,120.32
|
| Rate for Payer: Health EOS Commercial |
$1,781.78
|
| Rate for Payer: HFN Commercial |
$1,841.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,501.50
|
| Rate for Payer: Multiplan Commercial |
$1,601.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,201.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,841.84
|
| Rate for Payer: Quartz Beloit One Network |
$980.98
|
| Rate for Payer: Quartz Commercial |
$1,301.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,201.20
|
| Rate for Payer: The Alliance Commercial |
$8,008.00
|
| Rate for Payer: WEA Trust Commercial |
$1,101.10
|
| Rate for Payer: WPS Commercial |
$1,482.88
|
|
|
SCREW LOCKING 3.5 X 28 213.028
|
Facility
|
IP
|
$2,002.00
|
|
| Hospital Charge Code |
2966558
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$980.98 |
| Max. Negotiated Rate |
$1,841.84 |
| Rate for Payer: Aetna Commercial |
$1,801.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,721.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,061.06
|
| Rate for Payer: Cash Price |
$600.60
|
| Rate for Payer: Cigna Commercial |
$1,841.84
|
| Rate for Payer: Health EOS Commercial |
$1,781.78
|
| Rate for Payer: HFN Commercial |
$1,841.84
|
| Rate for Payer: Multiplan Commercial |
$1,601.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,201.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,841.84
|
| Rate for Payer: Quartz Beloit One Network |
$980.98
|
| Rate for Payer: Quartz Commercial |
$1,201.20
|
| Rate for Payer: WEA Trust Commercial |
$1,101.10
|
| Rate for Payer: WPS Commercial |
$1,482.88
|
|
|
SCREW LOCKING 5.0 VA 02.231.220
|
Facility
|
OP
|
$2,118.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6178023
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$593.04 |
| Max. Negotiated Rate |
$8,472.00 |
| Rate for Payer: Aetna Commercial |
$1,906.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,821.48
|
| Rate for Payer: Aetna Managed Medicare |
$593.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,376.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,059.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,016.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,122.54
|
| Rate for Payer: Cash Price |
$635.40
|
| Rate for Payer: Cigna Commercial |
$1,948.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,185.23
|
| Rate for Payer: Health EOS Commercial |
$1,885.02
|
| Rate for Payer: HFN Commercial |
$1,948.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,588.50
|
| Rate for Payer: Multiplan Commercial |
$1,694.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,270.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,948.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,037.82
|
| Rate for Payer: Quartz Commercial |
$1,376.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,270.80
|
| Rate for Payer: The Alliance Commercial |
$8,472.00
|
| Rate for Payer: WEA Trust Commercial |
$1,164.90
|
| Rate for Payer: WPS Commercial |
$1,568.80
|
|
|
SCREW LOCKING 5.0 VA 02.231.220
|
Facility
|
IP
|
$2,118.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6178023
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,037.82 |
| Max. Negotiated Rate |
$1,948.56 |
| Rate for Payer: Aetna Commercial |
$1,906.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,821.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,122.54
|
| Rate for Payer: Cash Price |
$635.40
|
| Rate for Payer: Cigna Commercial |
$1,948.56
|
| Rate for Payer: Health EOS Commercial |
$1,885.02
|
| Rate for Payer: HFN Commercial |
$1,948.56
|
| Rate for Payer: Multiplan Commercial |
$1,694.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,270.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,948.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,037.82
|
| Rate for Payer: Quartz Commercial |
$1,270.80
|
| Rate for Payer: WEA Trust Commercial |
$1,164.90
|
| Rate for Payer: WPS Commercial |
$1,568.80
|
|
|
SCREW LOCKING 5.5 X 38MM ORTHOLOC 59215538
|
Facility
|
IP
|
$2,790.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6201059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,367.10 |
| Max. Negotiated Rate |
$2,566.80 |
| Rate for Payer: Aetna Commercial |
$2,511.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,399.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,478.70
|
| Rate for Payer: Cash Price |
$837.00
|
| Rate for Payer: Cigna Commercial |
$2,566.80
|
| Rate for Payer: Health EOS Commercial |
$2,483.10
|
| Rate for Payer: HFN Commercial |
$2,566.80
|
| Rate for Payer: Multiplan Commercial |
$2,232.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,674.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,566.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,367.10
|
| Rate for Payer: Quartz Commercial |
$1,674.00
|
| Rate for Payer: WEA Trust Commercial |
$1,534.50
|
| Rate for Payer: WPS Commercial |
$2,066.55
|
|
|
SCREW LOCKING 5.5 X 38MM ORTHOLOC 59215538
|
Facility
|
OP
|
$2,790.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6201059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$781.20 |
| Max. Negotiated Rate |
$11,160.00 |
| Rate for Payer: Aetna Commercial |
$2,511.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,399.40
|
| Rate for Payer: Aetna Managed Medicare |
$781.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,813.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,395.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,339.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,478.70
|
| Rate for Payer: Cash Price |
$837.00
|
| Rate for Payer: Cigna Commercial |
$2,566.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,561.28
|
| Rate for Payer: Health EOS Commercial |
$2,483.10
|
| Rate for Payer: HFN Commercial |
$2,566.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,092.50
|
| Rate for Payer: Multiplan Commercial |
$2,232.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,674.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,566.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,367.10
|
| Rate for Payer: Quartz Commercial |
$1,813.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,674.00
|
| Rate for Payer: The Alliance Commercial |
$11,160.00
|
| Rate for Payer: WEA Trust Commercial |
$1,534.50
|
| Rate for Payer: WPS Commercial |
$2,066.55
|
|
|
SCREW LOCKING 5.5 X 40MM ORTHOLOC 59215540
|
Facility
|
OP
|
$2,790.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6201060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$781.20 |
| Max. Negotiated Rate |
$11,160.00 |
| Rate for Payer: Aetna Commercial |
$2,511.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,399.40
|
| Rate for Payer: Aetna Managed Medicare |
$781.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,813.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,395.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,339.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,478.70
|
| Rate for Payer: Cash Price |
$837.00
|
| Rate for Payer: Cigna Commercial |
$2,566.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,561.28
|
| Rate for Payer: Health EOS Commercial |
$2,483.10
|
| Rate for Payer: HFN Commercial |
$2,566.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,092.50
|
| Rate for Payer: Multiplan Commercial |
$2,232.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,674.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,566.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,367.10
|
| Rate for Payer: Quartz Commercial |
$1,813.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,674.00
|
| Rate for Payer: The Alliance Commercial |
$11,160.00
|
| Rate for Payer: WEA Trust Commercial |
$1,534.50
|
| Rate for Payer: WPS Commercial |
$2,066.55
|
|
|
SCREW LOCKING 5.5 X 40MM ORTHOLOC 59215540
|
Facility
|
IP
|
$2,790.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6201060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,367.10 |
| Max. Negotiated Rate |
$2,566.80 |
| Rate for Payer: Aetna Commercial |
$2,511.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,399.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,478.70
|
| Rate for Payer: Cash Price |
$837.00
|
| Rate for Payer: Cigna Commercial |
$2,566.80
|
| Rate for Payer: Health EOS Commercial |
$2,483.10
|
| Rate for Payer: HFN Commercial |
$2,566.80
|
| Rate for Payer: Multiplan Commercial |
$2,232.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,674.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,566.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,367.10
|
| Rate for Payer: Quartz Commercial |
$1,674.00
|
| Rate for Payer: WEA Trust Commercial |
$1,534.50
|
| Rate for Payer: WPS Commercial |
$2,066.55
|
|
|
SCREW LOCKING 5.5 X 45MM ORTHOLOC 59215545
|
Facility
|
IP
|
$2,790.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6201061
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,367.10 |
| Max. Negotiated Rate |
$2,566.80 |
| Rate for Payer: Aetna Commercial |
$2,511.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,399.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,478.70
|
| Rate for Payer: Cash Price |
$837.00
|
| Rate for Payer: Cigna Commercial |
$2,566.80
|
| Rate for Payer: Health EOS Commercial |
$2,483.10
|
| Rate for Payer: HFN Commercial |
$2,566.80
|
| Rate for Payer: Multiplan Commercial |
$2,232.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,674.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,566.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,367.10
|
| Rate for Payer: Quartz Commercial |
$1,674.00
|
| Rate for Payer: WEA Trust Commercial |
$1,534.50
|
| Rate for Payer: WPS Commercial |
$2,066.55
|
|
|
SCREW LOCKING 5.5 X 45MM ORTHOLOC 59215545
|
Facility
|
OP
|
$2,790.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6201061
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$781.20 |
| Max. Negotiated Rate |
$11,160.00 |
| Rate for Payer: Aetna Commercial |
$2,511.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,399.40
|
| Rate for Payer: Aetna Managed Medicare |
$781.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,813.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,395.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,339.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,478.70
|
| Rate for Payer: Cash Price |
$837.00
|
| Rate for Payer: Cigna Commercial |
$2,566.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,561.28
|
| Rate for Payer: Health EOS Commercial |
$2,483.10
|
| Rate for Payer: HFN Commercial |
$2,566.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,092.50
|
| Rate for Payer: Multiplan Commercial |
$2,232.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,674.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,566.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,367.10
|
| Rate for Payer: Quartz Commercial |
$1,813.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,674.00
|
| Rate for Payer: The Alliance Commercial |
$11,160.00
|
| Rate for Payer: WEA Trust Commercial |
$1,534.50
|
| Rate for Payer: WPS Commercial |
$2,066.55
|
|
|
SCREW LOCKING 5.5 X 50MM ORTHOLOC 59215550
|
Facility
|
OP
|
$2,790.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6201062
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$781.20 |
| Max. Negotiated Rate |
$11,160.00 |
| Rate for Payer: Aetna Commercial |
$2,511.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,399.40
|
| Rate for Payer: Aetna Managed Medicare |
$781.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,813.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,395.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,339.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,478.70
|
| Rate for Payer: Cash Price |
$837.00
|
| Rate for Payer: Cigna Commercial |
$2,566.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,561.28
|
| Rate for Payer: Health EOS Commercial |
$2,483.10
|
| Rate for Payer: HFN Commercial |
$2,566.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,092.50
|
| Rate for Payer: Multiplan Commercial |
$2,232.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,674.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,566.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,367.10
|
| Rate for Payer: Quartz Commercial |
$1,813.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,674.00
|
| Rate for Payer: The Alliance Commercial |
$11,160.00
|
| Rate for Payer: WEA Trust Commercial |
$1,534.50
|
| Rate for Payer: WPS Commercial |
$2,066.55
|
|
|
SCREW LOCKING 5.5 X 50MM ORTHOLOC 59215550
|
Facility
|
IP
|
$2,790.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6201062
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,367.10 |
| Max. Negotiated Rate |
$2,566.80 |
| Rate for Payer: Aetna Commercial |
$2,511.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,399.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,478.70
|
| Rate for Payer: Cash Price |
$837.00
|
| Rate for Payer: Cigna Commercial |
$2,566.80
|
| Rate for Payer: Health EOS Commercial |
$2,483.10
|
| Rate for Payer: HFN Commercial |
$2,566.80
|
| Rate for Payer: Multiplan Commercial |
$2,232.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,674.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,566.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,367.10
|
| Rate for Payer: Quartz Commercial |
$1,674.00
|
| Rate for Payer: WEA Trust Commercial |
$1,534.50
|
| Rate for Payer: WPS Commercial |
$2,066.55
|
|
|
SCREW LOCKING VA 3.5MM X 12MM 02.127.112
|
Facility
|
OP
|
$2,115.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6234200
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$592.20 |
| Max. Negotiated Rate |
$8,460.00 |
| Rate for Payer: Aetna Commercial |
$1,903.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,818.90
|
| Rate for Payer: Aetna Managed Medicare |
$592.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,374.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,057.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,015.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,120.95
|
| Rate for Payer: Cash Price |
$634.50
|
| Rate for Payer: Cigna Commercial |
$1,945.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,183.55
|
| Rate for Payer: Health EOS Commercial |
$1,882.35
|
| Rate for Payer: HFN Commercial |
$1,945.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,586.25
|
| Rate for Payer: Multiplan Commercial |
$1,692.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,269.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,945.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,036.35
|
| Rate for Payer: Quartz Commercial |
$1,374.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,269.00
|
| Rate for Payer: The Alliance Commercial |
$8,460.00
|
| Rate for Payer: WEA Trust Commercial |
$1,163.25
|
| Rate for Payer: WPS Commercial |
$1,566.58
|
|
|
SCREW LOCKING VA 3.5MM X 12MM 02.127.112
|
Facility
|
IP
|
$2,115.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6234200
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,036.35 |
| Max. Negotiated Rate |
$1,945.80 |
| Rate for Payer: Aetna Commercial |
$1,903.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,818.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,120.95
|
| Rate for Payer: Cash Price |
$634.50
|
| Rate for Payer: Cigna Commercial |
$1,945.80
|
| Rate for Payer: Health EOS Commercial |
$1,882.35
|
| Rate for Payer: HFN Commercial |
$1,945.80
|
| Rate for Payer: Multiplan Commercial |
$1,692.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,269.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,945.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,036.35
|
| Rate for Payer: Quartz Commercial |
$1,269.00
|
| Rate for Payer: WEA Trust Commercial |
$1,163.25
|
| Rate for Payer: WPS Commercial |
$1,566.58
|
|
|
SCREW LOCKING VA 3.5MM X 16MM 02.127.116
|
Facility
|
IP
|
$1,805.71
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6246159
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$884.80 |
| Max. Negotiated Rate |
$1,661.25 |
| Rate for Payer: Aetna Commercial |
$1,625.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,552.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$957.03
|
| Rate for Payer: Cash Price |
$541.71
|
| Rate for Payer: Cigna Commercial |
$1,661.25
|
| Rate for Payer: Health EOS Commercial |
$1,607.08
|
| Rate for Payer: HFN Commercial |
$1,661.25
|
| Rate for Payer: Multiplan Commercial |
$1,444.57
|
| Rate for Payer: NAPHCARE Commercial |
$1,083.43
|
| Rate for Payer: Preferred Network Access Commercial |
$1,661.25
|
| Rate for Payer: Quartz Beloit One Network |
$884.80
|
| Rate for Payer: Quartz Commercial |
$1,083.43
|
| Rate for Payer: WEA Trust Commercial |
$993.14
|
| Rate for Payer: WPS Commercial |
$1,337.49
|
|
|
SCREW LOCKING VA 3.5MM X 16MM 02.127.116
|
Facility
|
OP
|
$1,805.71
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6246159
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$505.60 |
| Max. Negotiated Rate |
$7,222.84 |
| Rate for Payer: Aetna Commercial |
$1,625.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,552.91
|
| Rate for Payer: Aetna Managed Medicare |
$505.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,173.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$902.86
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$866.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$957.03
|
| Rate for Payer: Cash Price |
$541.71
|
| Rate for Payer: Cigna Commercial |
$1,661.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,010.48
|
| Rate for Payer: Health EOS Commercial |
$1,607.08
|
| Rate for Payer: HFN Commercial |
$1,661.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,354.28
|
| Rate for Payer: Multiplan Commercial |
$1,444.57
|
| Rate for Payer: NAPHCARE Commercial |
$1,083.43
|
| Rate for Payer: Preferred Network Access Commercial |
$1,661.25
|
| Rate for Payer: Quartz Beloit One Network |
$884.80
|
| Rate for Payer: Quartz Commercial |
$1,173.71
|
| Rate for Payer: Quartz Medicare Advantage |
$1,083.43
|
| Rate for Payer: The Alliance Commercial |
$7,222.84
|
| Rate for Payer: WEA Trust Commercial |
$993.14
|
| Rate for Payer: WPS Commercial |
$1,337.49
|
|
|
SCREW LOCKING VA 3.5MM X 20MM 02.127.120
|
Facility
|
OP
|
$1,878.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6234158
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$525.84 |
| Max. Negotiated Rate |
$7,512.00 |
| Rate for Payer: Aetna Commercial |
$1,690.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,615.08
|
| Rate for Payer: Aetna Managed Medicare |
$525.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,220.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$939.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$901.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$995.34
|
| Rate for Payer: Cash Price |
$563.40
|
| Rate for Payer: Cigna Commercial |
$1,727.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,050.93
|
| Rate for Payer: Health EOS Commercial |
$1,671.42
|
| Rate for Payer: HFN Commercial |
$1,727.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,408.50
|
| Rate for Payer: Multiplan Commercial |
$1,502.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,126.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,727.76
|
| Rate for Payer: Quartz Beloit One Network |
$920.22
|
| Rate for Payer: Quartz Commercial |
$1,220.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,126.80
|
| Rate for Payer: The Alliance Commercial |
$7,512.00
|
| Rate for Payer: WEA Trust Commercial |
$1,032.90
|
| Rate for Payer: WPS Commercial |
$1,391.03
|
|
|
SCREW LOCKING VA 3.5MM X 20MM 02.127.120
|
Facility
|
IP
|
$1,878.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6234158
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$920.22 |
| Max. Negotiated Rate |
$1,727.76 |
| Rate for Payer: Aetna Commercial |
$1,690.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,615.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$995.34
|
| Rate for Payer: Cash Price |
$563.40
|
| Rate for Payer: Cigna Commercial |
$1,727.76
|
| Rate for Payer: Health EOS Commercial |
$1,671.42
|
| Rate for Payer: HFN Commercial |
$1,727.76
|
| Rate for Payer: Multiplan Commercial |
$1,502.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,126.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,727.76
|
| Rate for Payer: Quartz Beloit One Network |
$920.22
|
| Rate for Payer: Quartz Commercial |
$1,126.80
|
| Rate for Payer: WEA Trust Commercial |
$1,032.90
|
| Rate for Payer: WPS Commercial |
$1,391.03
|
|
|
SCREW LOCKING VA 3.5MM X 24MM 02.127.124
|
Facility
|
OP
|
$1,775.00
|
|
| Hospital Charge Code |
4028669
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$497.00 |
| Max. Negotiated Rate |
$7,100.00 |
| Rate for Payer: Aetna Commercial |
$1,597.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,526.50
|
| Rate for Payer: Aetna Managed Medicare |
$497.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,153.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$887.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$852.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$940.75
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$1,633.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$993.29
|
| Rate for Payer: Health EOS Commercial |
$1,579.75
|
| Rate for Payer: HFN Commercial |
$1,633.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,331.25
|
| Rate for Payer: Multiplan Commercial |
$1,420.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,065.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,633.00
|
| Rate for Payer: Quartz Beloit One Network |
$869.75
|
| Rate for Payer: Quartz Commercial |
$1,153.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,065.00
|
| Rate for Payer: The Alliance Commercial |
$7,100.00
|
| Rate for Payer: WEA Trust Commercial |
$976.25
|
| Rate for Payer: WPS Commercial |
$1,314.74
|
|
|
SCREW LOCKING VA 3.5MM X 24MM 02.127.124
|
Facility
|
IP
|
$1,775.00
|
|
| Hospital Charge Code |
4028669
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$869.75 |
| Max. Negotiated Rate |
$1,633.00 |
| Rate for Payer: Aetna Commercial |
$1,597.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,526.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$940.75
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$1,633.00
|
| Rate for Payer: Health EOS Commercial |
$1,579.75
|
| Rate for Payer: HFN Commercial |
$1,633.00
|
| Rate for Payer: Multiplan Commercial |
$1,420.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,065.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,633.00
|
| Rate for Payer: Quartz Beloit One Network |
$869.75
|
| Rate for Payer: Quartz Commercial |
$1,065.00
|
| Rate for Payer: WEA Trust Commercial |
$976.25
|
| Rate for Payer: WPS Commercial |
$1,314.74
|
|
|
SCREW LOCKING VA 3.5MM X 26MM 02.127.126
|
Facility
|
IP
|
$1,775.00
|
|
| Hospital Charge Code |
4028670
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$869.75 |
| Max. Negotiated Rate |
$1,633.00 |
| Rate for Payer: Aetna Commercial |
$1,597.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,526.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$940.75
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$1,633.00
|
| Rate for Payer: Health EOS Commercial |
$1,579.75
|
| Rate for Payer: HFN Commercial |
$1,633.00
|
| Rate for Payer: Multiplan Commercial |
$1,420.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,065.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,633.00
|
| Rate for Payer: Quartz Beloit One Network |
$869.75
|
| Rate for Payer: Quartz Commercial |
$1,065.00
|
| Rate for Payer: WEA Trust Commercial |
$976.25
|
| Rate for Payer: WPS Commercial |
$1,314.74
|
|
|
SCREW LOCKING VA 3.5MM X 26MM 02.127.126
|
Facility
|
OP
|
$1,775.00
|
|
| Hospital Charge Code |
4028670
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$497.00 |
| Max. Negotiated Rate |
$7,100.00 |
| Rate for Payer: Aetna Commercial |
$1,597.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,526.50
|
| Rate for Payer: Aetna Managed Medicare |
$497.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,153.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$887.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$852.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$940.75
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$1,633.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$993.29
|
| Rate for Payer: Health EOS Commercial |
$1,579.75
|
| Rate for Payer: HFN Commercial |
$1,633.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,331.25
|
| Rate for Payer: Multiplan Commercial |
$1,420.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,065.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,633.00
|
| Rate for Payer: Quartz Beloit One Network |
$869.75
|
| Rate for Payer: Quartz Commercial |
$1,153.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,065.00
|
| Rate for Payer: The Alliance Commercial |
$7,100.00
|
| Rate for Payer: WEA Trust Commercial |
$976.25
|
| Rate for Payer: WPS Commercial |
$1,314.74
|
|
|
SCREW LOCKING VA 3.5MM X 28MM 02.127.128
|
Facility
|
IP
|
$1,775.00
|
|
| Hospital Charge Code |
3265472
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$869.75 |
| Max. Negotiated Rate |
$1,633.00 |
| Rate for Payer: Aetna Commercial |
$1,597.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,526.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$940.75
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$1,633.00
|
| Rate for Payer: Health EOS Commercial |
$1,579.75
|
| Rate for Payer: HFN Commercial |
$1,633.00
|
| Rate for Payer: Multiplan Commercial |
$1,420.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,065.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,633.00
|
| Rate for Payer: Quartz Beloit One Network |
$869.75
|
| Rate for Payer: Quartz Commercial |
$1,065.00
|
| Rate for Payer: WEA Trust Commercial |
$976.25
|
| Rate for Payer: WPS Commercial |
$1,314.74
|
|
