|
SCREW LOCKING VA 3.5MM X 75MM 02.127.175
|
Facility
|
OP
|
$2,803.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4462800
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$784.84 |
| Max. Negotiated Rate |
$11,212.00 |
| Rate for Payer: Aetna Commercial |
$2,522.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,410.58
|
| Rate for Payer: Aetna Managed Medicare |
$784.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,821.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,401.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,345.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,485.59
|
| Rate for Payer: Cash Price |
$840.90
|
| Rate for Payer: Cigna Commercial |
$2,578.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,568.56
|
| Rate for Payer: Health EOS Commercial |
$2,494.67
|
| Rate for Payer: HFN Commercial |
$2,578.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,102.25
|
| Rate for Payer: Multiplan Commercial |
$2,242.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,681.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,578.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,373.47
|
| Rate for Payer: Quartz Commercial |
$1,821.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,681.80
|
| Rate for Payer: The Alliance Commercial |
$11,212.00
|
| Rate for Payer: WEA Trust Commercial |
$1,541.65
|
| Rate for Payer: WPS Commercial |
$2,076.18
|
|
|
SCREW LOCKING VA 3.5MM X 75MM 02.127.175
|
Facility
|
IP
|
$2,803.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4462800
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,373.47 |
| Max. Negotiated Rate |
$2,578.76 |
| Rate for Payer: Aetna Commercial |
$2,522.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,410.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,485.59
|
| Rate for Payer: Cash Price |
$840.90
|
| Rate for Payer: Cigna Commercial |
$2,578.76
|
| Rate for Payer: Health EOS Commercial |
$2,494.67
|
| Rate for Payer: HFN Commercial |
$2,578.76
|
| Rate for Payer: Multiplan Commercial |
$2,242.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,681.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,578.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,373.47
|
| Rate for Payer: Quartz Commercial |
$1,681.80
|
| Rate for Payer: WEA Trust Commercial |
$1,541.65
|
| Rate for Payer: WPS Commercial |
$2,076.18
|
|
|
SCREW LOCKING VA 3.5MM X 80MM 02.127.180
|
Facility
|
IP
|
$1,775.00
|
|
| Hospital Charge Code |
5306642
|
|
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 80MM 02.127.180
|
Facility
|
OP
|
$1,775.00
|
|
| Hospital Charge Code |
5306642
|
|
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 85MM 02.127.185
|
Facility
|
IP
|
$1,775.00
|
|
| Hospital Charge Code |
5306643
|
|
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 85MM 02.127.185
|
Facility
|
OP
|
$1,775.00
|
|
| Hospital Charge Code |
5306643
|
|
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 90MM 02.127.190
|
Facility
|
IP
|
$1,775.00
|
|
| Hospital Charge Code |
5074830
|
|
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 90MM 02.127.190
|
Facility
|
OP
|
$1,775.00
|
|
| Hospital Charge Code |
5074830
|
|
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 LOCK LG HD 2.7 X 10MM ORTHOLOC 58802710
|
Facility
|
OP
|
$2,823.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5729832
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$790.44 |
| Max. Negotiated Rate |
$11,292.00 |
| Rate for Payer: Aetna Commercial |
$2,540.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,427.78
|
| Rate for Payer: Aetna Managed Medicare |
$790.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,834.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,411.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,355.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,496.19
|
| Rate for Payer: Cash Price |
$846.90
|
| Rate for Payer: Cigna Commercial |
$2,597.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,579.75
|
| Rate for Payer: Health EOS Commercial |
$2,512.47
|
| Rate for Payer: HFN Commercial |
$2,597.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,117.25
|
| Rate for Payer: Multiplan Commercial |
$2,258.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,693.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,597.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,383.27
|
| Rate for Payer: Quartz Commercial |
$1,834.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,693.80
|
| Rate for Payer: The Alliance Commercial |
$11,292.00
|
| Rate for Payer: WEA Trust Commercial |
$1,552.65
|
| Rate for Payer: WPS Commercial |
$2,091.00
|
|
|
SCREW LOCK LG HD 2.7 X 10MM ORTHOLOC 58802710
|
Facility
|
IP
|
$2,823.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5729832
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,383.27 |
| Max. Negotiated Rate |
$2,597.16 |
| Rate for Payer: Aetna Commercial |
$2,540.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,427.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,496.19
|
| Rate for Payer: Cash Price |
$846.90
|
| Rate for Payer: Cigna Commercial |
$2,597.16
|
| Rate for Payer: Health EOS Commercial |
$2,512.47
|
| Rate for Payer: HFN Commercial |
$2,597.16
|
| Rate for Payer: Multiplan Commercial |
$2,258.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,693.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,597.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,383.27
|
| Rate for Payer: Quartz Commercial |
$1,693.80
|
| Rate for Payer: WEA Trust Commercial |
$1,552.65
|
| Rate for Payer: WPS Commercial |
$2,091.00
|
|
|
SCREW LOCK LG HD 2.7 X 12MM ORTHOLOC 58802712
|
Facility
|
OP
|
$2,823.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5729833
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$790.44 |
| Max. Negotiated Rate |
$11,292.00 |
| Rate for Payer: Aetna Commercial |
$2,540.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,427.78
|
| Rate for Payer: Aetna Managed Medicare |
$790.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,834.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,411.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,355.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,496.19
|
| Rate for Payer: Cash Price |
$846.90
|
| Rate for Payer: Cigna Commercial |
$2,597.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,579.75
|
| Rate for Payer: Health EOS Commercial |
$2,512.47
|
| Rate for Payer: HFN Commercial |
$2,597.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,117.25
|
| Rate for Payer: Multiplan Commercial |
$2,258.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,693.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,597.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,383.27
|
| Rate for Payer: Quartz Commercial |
$1,834.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,693.80
|
| Rate for Payer: The Alliance Commercial |
$11,292.00
|
| Rate for Payer: WEA Trust Commercial |
$1,552.65
|
| Rate for Payer: WPS Commercial |
$2,091.00
|
|
|
SCREW LOCK LG HD 2.7 X 12MM ORTHOLOC 58802712
|
Facility
|
IP
|
$2,823.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5729833
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,383.27 |
| Max. Negotiated Rate |
$2,597.16 |
| Rate for Payer: Aetna Commercial |
$2,540.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,427.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,496.19
|
| Rate for Payer: Cash Price |
$846.90
|
| Rate for Payer: Cigna Commercial |
$2,597.16
|
| Rate for Payer: Health EOS Commercial |
$2,512.47
|
| Rate for Payer: HFN Commercial |
$2,597.16
|
| Rate for Payer: Multiplan Commercial |
$2,258.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,693.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,597.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,383.27
|
| Rate for Payer: Quartz Commercial |
$1,693.80
|
| Rate for Payer: WEA Trust Commercial |
$1,552.65
|
| Rate for Payer: WPS Commercial |
$2,091.00
|
|
|
SCREW LOCK LG HD 2.7 X 14MM ORTHOLOC 58802714
|
Facility
|
IP
|
$2,823.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415907
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,383.27 |
| Max. Negotiated Rate |
$2,597.16 |
| Rate for Payer: Aetna Commercial |
$2,540.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,427.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,496.19
|
| Rate for Payer: Cash Price |
$846.90
|
| Rate for Payer: Cigna Commercial |
$2,597.16
|
| Rate for Payer: Health EOS Commercial |
$2,512.47
|
| Rate for Payer: HFN Commercial |
$2,597.16
|
| Rate for Payer: Multiplan Commercial |
$2,258.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,693.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,597.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,383.27
|
| Rate for Payer: Quartz Commercial |
$1,693.80
|
| Rate for Payer: WEA Trust Commercial |
$1,552.65
|
| Rate for Payer: WPS Commercial |
$2,091.00
|
|
|
SCREW LOCK LG HD 2.7 X 14MM ORTHOLOC 58802714
|
Facility
|
OP
|
$2,823.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415907
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$790.44 |
| Max. Negotiated Rate |
$11,292.00 |
| Rate for Payer: Aetna Commercial |
$2,540.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,427.78
|
| Rate for Payer: Aetna Managed Medicare |
$790.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,834.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,411.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,355.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,496.19
|
| Rate for Payer: Cash Price |
$846.90
|
| Rate for Payer: Cigna Commercial |
$2,597.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,579.75
|
| Rate for Payer: Health EOS Commercial |
$2,512.47
|
| Rate for Payer: HFN Commercial |
$2,597.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,117.25
|
| Rate for Payer: Multiplan Commercial |
$2,258.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,693.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,597.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,383.27
|
| Rate for Payer: Quartz Commercial |
$1,834.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,693.80
|
| Rate for Payer: The Alliance Commercial |
$11,292.00
|
| Rate for Payer: WEA Trust Commercial |
$1,552.65
|
| Rate for Payer: WPS Commercial |
$2,091.00
|
|
|
SCREW LOCK LG HD 2.7 X 16MM ORTHOLOC 58802716
|
Facility
|
IP
|
$2,823.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5458983
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,383.27 |
| Max. Negotiated Rate |
$2,597.16 |
| Rate for Payer: Aetna Commercial |
$2,540.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,427.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,496.19
|
| Rate for Payer: Cash Price |
$846.90
|
| Rate for Payer: Cigna Commercial |
$2,597.16
|
| Rate for Payer: Health EOS Commercial |
$2,512.47
|
| Rate for Payer: HFN Commercial |
$2,597.16
|
| Rate for Payer: Multiplan Commercial |
$2,258.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,693.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,597.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,383.27
|
| Rate for Payer: Quartz Commercial |
$1,693.80
|
| Rate for Payer: WEA Trust Commercial |
$1,552.65
|
| Rate for Payer: WPS Commercial |
$2,091.00
|
|
|
SCREW LOCK LG HD 2.7 X 16MM ORTHOLOC 58802716
|
Facility
|
OP
|
$2,823.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5458983
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$790.44 |
| Max. Negotiated Rate |
$11,292.00 |
| Rate for Payer: Aetna Commercial |
$2,540.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,427.78
|
| Rate for Payer: Aetna Managed Medicare |
$790.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,834.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,411.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,355.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,496.19
|
| Rate for Payer: Cash Price |
$846.90
|
| Rate for Payer: Cigna Commercial |
$2,597.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,579.75
|
| Rate for Payer: Health EOS Commercial |
$2,512.47
|
| Rate for Payer: HFN Commercial |
$2,597.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,117.25
|
| Rate for Payer: Multiplan Commercial |
$2,258.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,693.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,597.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,383.27
|
| Rate for Payer: Quartz Commercial |
$1,834.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,693.80
|
| Rate for Payer: The Alliance Commercial |
$11,292.00
|
| Rate for Payer: WEA Trust Commercial |
$1,552.65
|
| Rate for Payer: WPS Commercial |
$2,091.00
|
|
|
SCREW LOCK LG HD 2.7 X 18MM ORTHOLOC 58802718
|
Facility
|
OP
|
$2,823.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415908
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$790.44 |
| Max. Negotiated Rate |
$11,292.00 |
| Rate for Payer: Aetna Commercial |
$2,540.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,427.78
|
| Rate for Payer: Aetna Managed Medicare |
$790.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,834.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,411.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,355.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,496.19
|
| Rate for Payer: Cash Price |
$846.90
|
| Rate for Payer: Cigna Commercial |
$2,597.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,579.75
|
| Rate for Payer: Health EOS Commercial |
$2,512.47
|
| Rate for Payer: HFN Commercial |
$2,597.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,117.25
|
| Rate for Payer: Multiplan Commercial |
$2,258.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,693.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,597.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,383.27
|
| Rate for Payer: Quartz Commercial |
$1,834.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,693.80
|
| Rate for Payer: The Alliance Commercial |
$11,292.00
|
| Rate for Payer: WEA Trust Commercial |
$1,552.65
|
| Rate for Payer: WPS Commercial |
$2,091.00
|
|
|
SCREW LOCK LG HD 2.7 X 18MM ORTHOLOC 58802718
|
Facility
|
IP
|
$2,823.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415908
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,383.27 |
| Max. Negotiated Rate |
$2,597.16 |
| Rate for Payer: Aetna Commercial |
$2,540.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,427.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,496.19
|
| Rate for Payer: Cash Price |
$846.90
|
| Rate for Payer: Cigna Commercial |
$2,597.16
|
| Rate for Payer: Health EOS Commercial |
$2,512.47
|
| Rate for Payer: HFN Commercial |
$2,597.16
|
| Rate for Payer: Multiplan Commercial |
$2,258.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,693.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,597.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,383.27
|
| Rate for Payer: Quartz Commercial |
$1,693.80
|
| Rate for Payer: WEA Trust Commercial |
$1,552.65
|
| Rate for Payer: WPS Commercial |
$2,091.00
|
|
|
SCREW LOCK LG HD 2.7 X 20MM ORTHOLOC 58802720
|
Facility
|
OP
|
$2,823.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459796
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$790.44 |
| Max. Negotiated Rate |
$11,292.00 |
| Rate for Payer: Aetna Commercial |
$2,540.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,427.78
|
| Rate for Payer: Aetna Managed Medicare |
$790.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,834.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,411.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,355.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,496.19
|
| Rate for Payer: Cash Price |
$846.90
|
| Rate for Payer: Cigna Commercial |
$2,597.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,579.75
|
| Rate for Payer: Health EOS Commercial |
$2,512.47
|
| Rate for Payer: HFN Commercial |
$2,597.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,117.25
|
| Rate for Payer: Multiplan Commercial |
$2,258.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,693.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,597.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,383.27
|
| Rate for Payer: Quartz Commercial |
$1,834.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,693.80
|
| Rate for Payer: The Alliance Commercial |
$11,292.00
|
| Rate for Payer: WEA Trust Commercial |
$1,552.65
|
| Rate for Payer: WPS Commercial |
$2,091.00
|
|
|
SCREW LOCK LG HD 2.7 X 20MM ORTHOLOC 58802720
|
Facility
|
IP
|
$2,823.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459796
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,383.27 |
| Max. Negotiated Rate |
$2,597.16 |
| Rate for Payer: Aetna Commercial |
$2,540.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,427.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,496.19
|
| Rate for Payer: Cash Price |
$846.90
|
| Rate for Payer: Cigna Commercial |
$2,597.16
|
| Rate for Payer: Health EOS Commercial |
$2,512.47
|
| Rate for Payer: HFN Commercial |
$2,597.16
|
| Rate for Payer: Multiplan Commercial |
$2,258.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,693.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,597.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,383.27
|
| Rate for Payer: Quartz Commercial |
$1,693.80
|
| Rate for Payer: WEA Trust Commercial |
$1,552.65
|
| Rate for Payer: WPS Commercial |
$2,091.00
|
|
|
SCREW LOCK LG HD 2.7 X 22MM ORTHOLOC 58802722
|
Facility
|
OP
|
$2,823.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415909
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$790.44 |
| Max. Negotiated Rate |
$11,292.00 |
| Rate for Payer: Aetna Commercial |
$2,540.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,427.78
|
| Rate for Payer: Aetna Managed Medicare |
$790.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,834.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,411.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,355.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,496.19
|
| Rate for Payer: Cash Price |
$846.90
|
| Rate for Payer: Cigna Commercial |
$2,597.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,579.75
|
| Rate for Payer: Health EOS Commercial |
$2,512.47
|
| Rate for Payer: HFN Commercial |
$2,597.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,117.25
|
| Rate for Payer: Multiplan Commercial |
$2,258.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,693.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,597.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,383.27
|
| Rate for Payer: Quartz Commercial |
$1,834.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,693.80
|
| Rate for Payer: The Alliance Commercial |
$11,292.00
|
| Rate for Payer: WEA Trust Commercial |
$1,552.65
|
| Rate for Payer: WPS Commercial |
$2,091.00
|
|
|
SCREW LOCK LG HD 2.7 X 22MM ORTHOLOC 58802722
|
Facility
|
IP
|
$2,823.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415909
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,383.27 |
| Max. Negotiated Rate |
$2,597.16 |
| Rate for Payer: Aetna Commercial |
$2,540.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,427.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,496.19
|
| Rate for Payer: Cash Price |
$846.90
|
| Rate for Payer: Cigna Commercial |
$2,597.16
|
| Rate for Payer: Health EOS Commercial |
$2,512.47
|
| Rate for Payer: HFN Commercial |
$2,597.16
|
| Rate for Payer: Multiplan Commercial |
$2,258.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,693.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,597.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,383.27
|
| Rate for Payer: Quartz Commercial |
$1,693.80
|
| Rate for Payer: WEA Trust Commercial |
$1,552.65
|
| Rate for Payer: WPS Commercial |
$2,091.00
|
|
|
SCREW LOCK LG HD 2.7 X 24MM ORTHOLOC 58802724
|
Facility
|
OP
|
$3,369.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3791357
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$943.32 |
| Max. Negotiated Rate |
$13,476.00 |
| Rate for Payer: Aetna Commercial |
$3,032.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,897.34
|
| Rate for Payer: Aetna Managed Medicare |
$943.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,189.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,684.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,617.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,785.57
|
| Rate for Payer: Cash Price |
$1,010.70
|
| Rate for Payer: Cigna Commercial |
$3,099.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,885.29
|
| Rate for Payer: Health EOS Commercial |
$2,998.41
|
| Rate for Payer: HFN Commercial |
$3,099.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,526.75
|
| Rate for Payer: Multiplan Commercial |
$2,695.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,021.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,099.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,650.81
|
| Rate for Payer: Quartz Commercial |
$2,189.85
|
| Rate for Payer: Quartz Medicare Advantage |
$2,021.40
|
| Rate for Payer: The Alliance Commercial |
$13,476.00
|
| Rate for Payer: WEA Trust Commercial |
$1,852.95
|
| Rate for Payer: WPS Commercial |
$2,495.42
|
|
|
SCREW LOCK LG HD 2.7 X 24MM ORTHOLOC 58802724
|
Facility
|
IP
|
$3,369.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3791357
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,650.81 |
| Max. Negotiated Rate |
$3,099.48 |
| Rate for Payer: Aetna Commercial |
$3,032.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,897.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,785.57
|
| Rate for Payer: Cash Price |
$1,010.70
|
| Rate for Payer: Cigna Commercial |
$3,099.48
|
| Rate for Payer: Health EOS Commercial |
$2,998.41
|
| Rate for Payer: HFN Commercial |
$3,099.48
|
| Rate for Payer: Multiplan Commercial |
$2,695.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,021.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,099.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,650.81
|
| Rate for Payer: Quartz Commercial |
$2,021.40
|
| Rate for Payer: WEA Trust Commercial |
$1,852.95
|
| Rate for Payer: WPS Commercial |
$2,495.42
|
|
|
SCREW LOCK LG HD 3.5 X 10MM ORTHOLOC 58803510
|
Facility
|
OP
|
$2,743.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6177952
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$768.04 |
| Max. Negotiated Rate |
$10,972.00 |
| Rate for Payer: Aetna Commercial |
$2,468.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,358.98
|
| Rate for Payer: Aetna Managed Medicare |
$768.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,782.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,371.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,316.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,453.79
|
| Rate for Payer: Cash Price |
$822.90
|
| Rate for Payer: Cigna Commercial |
$2,523.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,534.98
|
| Rate for Payer: Health EOS Commercial |
$2,441.27
|
| Rate for Payer: HFN Commercial |
$2,523.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,057.25
|
| Rate for Payer: Multiplan Commercial |
$2,194.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,645.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,523.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,344.07
|
| Rate for Payer: Quartz Commercial |
$1,782.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,645.80
|
| Rate for Payer: The Alliance Commercial |
$10,972.00
|
| Rate for Payer: WEA Trust Commercial |
$1,508.65
|
| Rate for Payer: WPS Commercial |
$2,031.74
|
|
