|
SCREW PERIPHERAL NON-LOCKING MODULAR GLENOID 4.5X32MM AR-9562-32NL
|
Facility
|
OP
|
$1,597.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5563392
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$465.05 |
| Max. Negotiated Rate |
$1,528.01 |
| Rate for Payer: Aetna Commercial |
$1,494.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,428.36
|
| Rate for Payer: Aetna Managed Medicare |
$465.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,079.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$830.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$797.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$880.27
|
| Rate for Payer: Cash Price |
$479.10
|
| Rate for Payer: Cigna Commercial |
$1,528.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$929.45
|
| Rate for Payer: Health EOS Commercial |
$1,478.18
|
| Rate for Payer: HFN Commercial |
$1,528.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,245.66
|
| Rate for Payer: Multiplan Commercial |
$1,328.70
|
| Rate for Payer: NAPHCARE Commercial |
$996.53
|
| Rate for Payer: Preferred Network Access Commercial |
$1,528.01
|
| Rate for Payer: Quartz Beloit One Network |
$813.83
|
| Rate for Payer: Quartz Commercial |
$1,079.57
|
| Rate for Payer: Quartz Medicare Advantage |
$996.53
|
| Rate for Payer: The Alliance Commercial |
$830.44
|
| Rate for Payer: WEA Trust Commercial |
$913.48
|
| Rate for Payer: WPS Commercial |
$1,230.17
|
|
|
SCREW PERIPHERAL NON-LOCKING MODULAR GLENOID 4.5X36MM AR-9562-36NL
|
Facility
|
IP
|
$1,536.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5659645
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$782.75 |
| Max. Negotiated Rate |
$1,469.64 |
| Rate for Payer: Aetna Commercial |
$1,437.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,373.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$846.64
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Cigna Commercial |
$1,469.64
|
| Rate for Payer: Health EOS Commercial |
$1,421.72
|
| Rate for Payer: HFN Commercial |
$1,469.64
|
| Rate for Payer: Multiplan Commercial |
$1,277.95
|
| Rate for Payer: Preferred Network Access Commercial |
$1,469.64
|
| Rate for Payer: Quartz Beloit One Network |
$782.75
|
| Rate for Payer: Quartz Commercial |
$958.46
|
| Rate for Payer: WEA Trust Commercial |
$878.59
|
| Rate for Payer: WPS Commercial |
$1,183.18
|
|
|
SCREW PERIPHERAL NON-LOCKING MODULAR GLENOID 4.5X36MM AR-9562-36NL
|
Facility
|
OP
|
$1,536.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5659645
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$447.28 |
| Max. Negotiated Rate |
$1,469.64 |
| Rate for Payer: Aetna Commercial |
$1,437.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,373.80
|
| Rate for Payer: Aetna Managed Medicare |
$447.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,038.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$798.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$766.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$846.64
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Cigna Commercial |
$1,469.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$893.95
|
| Rate for Payer: Health EOS Commercial |
$1,421.72
|
| Rate for Payer: HFN Commercial |
$1,469.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,198.08
|
| Rate for Payer: Multiplan Commercial |
$1,277.95
|
| Rate for Payer: NAPHCARE Commercial |
$958.46
|
| Rate for Payer: Preferred Network Access Commercial |
$1,469.64
|
| Rate for Payer: Quartz Beloit One Network |
$782.75
|
| Rate for Payer: Quartz Commercial |
$1,038.34
|
| Rate for Payer: Quartz Medicare Advantage |
$958.46
|
| Rate for Payer: The Alliance Commercial |
$798.72
|
| Rate for Payer: WEA Trust Commercial |
$878.59
|
| Rate for Payer: WPS Commercial |
$1,183.18
|
|
|
SCREW PERIPHERAL NON-LOCKING MODULAR GLENOID 4.5X40MM AR-9562-40NL
|
Facility
|
OP
|
$1,536.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5861689
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$447.28 |
| Max. Negotiated Rate |
$1,469.64 |
| Rate for Payer: Aetna Commercial |
$1,437.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,373.80
|
| Rate for Payer: Aetna Managed Medicare |
$447.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,038.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$798.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$766.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$846.64
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Cigna Commercial |
$1,469.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$893.95
|
| Rate for Payer: Health EOS Commercial |
$1,421.72
|
| Rate for Payer: HFN Commercial |
$1,469.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,198.08
|
| Rate for Payer: Multiplan Commercial |
$1,277.95
|
| Rate for Payer: NAPHCARE Commercial |
$958.46
|
| Rate for Payer: Preferred Network Access Commercial |
$1,469.64
|
| Rate for Payer: Quartz Beloit One Network |
$782.75
|
| Rate for Payer: Quartz Commercial |
$1,038.34
|
| Rate for Payer: Quartz Medicare Advantage |
$958.46
|
| Rate for Payer: The Alliance Commercial |
$798.72
|
| Rate for Payer: WEA Trust Commercial |
$878.59
|
| Rate for Payer: WPS Commercial |
$1,183.18
|
|
|
SCREW PERIPHERAL NON-LOCKING MODULAR GLENOID 4.5X40MM AR-9562-40NL
|
Facility
|
IP
|
$1,536.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5861689
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$782.75 |
| Max. Negotiated Rate |
$1,469.64 |
| Rate for Payer: Aetna Commercial |
$1,437.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,373.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$846.64
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Cigna Commercial |
$1,469.64
|
| Rate for Payer: Health EOS Commercial |
$1,421.72
|
| Rate for Payer: HFN Commercial |
$1,469.64
|
| Rate for Payer: Multiplan Commercial |
$1,277.95
|
| Rate for Payer: Preferred Network Access Commercial |
$1,469.64
|
| Rate for Payer: Quartz Beloit One Network |
$782.75
|
| Rate for Payer: Quartz Commercial |
$958.46
|
| Rate for Payer: WEA Trust Commercial |
$878.59
|
| Rate for Payer: WPS Commercial |
$1,183.18
|
|
|
SCREW PERIPHERAL NON-LOCKING MODULAR GLENOID 4.5X44MM AR-9562-44NL
|
Facility
|
IP
|
$1,536.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5831756
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$782.75 |
| Max. Negotiated Rate |
$1,469.64 |
| Rate for Payer: Aetna Commercial |
$1,437.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,373.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$846.64
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Cigna Commercial |
$1,469.64
|
| Rate for Payer: Health EOS Commercial |
$1,421.72
|
| Rate for Payer: HFN Commercial |
$1,469.64
|
| Rate for Payer: Multiplan Commercial |
$1,277.95
|
| Rate for Payer: Preferred Network Access Commercial |
$1,469.64
|
| Rate for Payer: Quartz Beloit One Network |
$782.75
|
| Rate for Payer: Quartz Commercial |
$958.46
|
| Rate for Payer: WEA Trust Commercial |
$878.59
|
| Rate for Payer: WPS Commercial |
$1,183.18
|
|
|
SCREW PERIPHERAL NON-LOCKING MODULAR GLENOID 4.5X44MM AR-9562-44NL
|
Facility
|
OP
|
$1,536.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5831756
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$447.28 |
| Max. Negotiated Rate |
$1,469.64 |
| Rate for Payer: Aetna Commercial |
$1,437.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,373.80
|
| Rate for Payer: Aetna Managed Medicare |
$447.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,038.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$798.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$766.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$846.64
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Cigna Commercial |
$1,469.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$893.95
|
| Rate for Payer: Health EOS Commercial |
$1,421.72
|
| Rate for Payer: HFN Commercial |
$1,469.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,198.08
|
| Rate for Payer: Multiplan Commercial |
$1,277.95
|
| Rate for Payer: NAPHCARE Commercial |
$958.46
|
| Rate for Payer: Preferred Network Access Commercial |
$1,469.64
|
| Rate for Payer: Quartz Beloit One Network |
$782.75
|
| Rate for Payer: Quartz Commercial |
$1,038.34
|
| Rate for Payer: Quartz Medicare Advantage |
$958.46
|
| Rate for Payer: The Alliance Commercial |
$798.72
|
| Rate for Payer: WEA Trust Commercial |
$878.59
|
| Rate for Payer: WPS Commercial |
$1,183.18
|
|
|
SCREW PERIPHERAL NON-LOCKING UNIVERS GLENOID 4.5X24MM AR-9145-24NL
|
Facility
|
OP
|
$1,597.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5196621
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$465.05 |
| Max. Negotiated Rate |
$1,528.01 |
| Rate for Payer: Aetna Commercial |
$1,494.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,428.36
|
| Rate for Payer: Aetna Managed Medicare |
$465.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,079.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$830.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$797.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$880.27
|
| Rate for Payer: Cash Price |
$479.10
|
| Rate for Payer: Cigna Commercial |
$1,528.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$929.45
|
| Rate for Payer: Health EOS Commercial |
$1,478.18
|
| Rate for Payer: HFN Commercial |
$1,528.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,245.66
|
| Rate for Payer: Multiplan Commercial |
$1,328.70
|
| Rate for Payer: NAPHCARE Commercial |
$996.53
|
| Rate for Payer: Preferred Network Access Commercial |
$1,528.01
|
| Rate for Payer: Quartz Beloit One Network |
$813.83
|
| Rate for Payer: Quartz Commercial |
$1,079.57
|
| Rate for Payer: Quartz Medicare Advantage |
$996.53
|
| Rate for Payer: The Alliance Commercial |
$830.44
|
| Rate for Payer: WEA Trust Commercial |
$913.48
|
| Rate for Payer: WPS Commercial |
$1,230.17
|
|
|
SCREW PERIPHERAL NON-LOCKING UNIVERS GLENOID 4.5X24MM AR-9145-24NL
|
Facility
|
IP
|
$1,597.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5196621
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$813.83 |
| Max. Negotiated Rate |
$1,528.01 |
| Rate for Payer: Aetna Commercial |
$1,494.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,428.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$880.27
|
| Rate for Payer: Cash Price |
$479.10
|
| Rate for Payer: Cigna Commercial |
$1,528.01
|
| Rate for Payer: Health EOS Commercial |
$1,478.18
|
| Rate for Payer: HFN Commercial |
$1,528.01
|
| Rate for Payer: Multiplan Commercial |
$1,328.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,528.01
|
| Rate for Payer: Quartz Beloit One Network |
$813.83
|
| Rate for Payer: Quartz Commercial |
$996.53
|
| Rate for Payer: WEA Trust Commercial |
$913.48
|
| Rate for Payer: WPS Commercial |
$1,230.17
|
|
|
SCREW PERIPHERAL NON-LOCKING UNIVERS GLENOID 4.5X30MM AR-9145-30NL
|
Facility
|
OP
|
$1,597.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4595650
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$465.05 |
| Max. Negotiated Rate |
$1,528.01 |
| Rate for Payer: Aetna Commercial |
$1,494.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,428.36
|
| Rate for Payer: Aetna Managed Medicare |
$465.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,079.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$830.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$797.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$880.27
|
| Rate for Payer: Cash Price |
$479.10
|
| Rate for Payer: Cigna Commercial |
$1,528.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$929.45
|
| Rate for Payer: Health EOS Commercial |
$1,478.18
|
| Rate for Payer: HFN Commercial |
$1,528.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,245.66
|
| Rate for Payer: Multiplan Commercial |
$1,328.70
|
| Rate for Payer: NAPHCARE Commercial |
$996.53
|
| Rate for Payer: Preferred Network Access Commercial |
$1,528.01
|
| Rate for Payer: Quartz Beloit One Network |
$813.83
|
| Rate for Payer: Quartz Commercial |
$1,079.57
|
| Rate for Payer: Quartz Medicare Advantage |
$996.53
|
| Rate for Payer: The Alliance Commercial |
$830.44
|
| Rate for Payer: WEA Trust Commercial |
$913.48
|
| Rate for Payer: WPS Commercial |
$1,230.17
|
|
|
SCREW PERIPHERAL NON-LOCKING UNIVERS GLENOID 4.5X30MM AR-9145-30NL
|
Facility
|
IP
|
$1,597.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4595650
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$813.83 |
| Max. Negotiated Rate |
$1,528.01 |
| Rate for Payer: Aetna Commercial |
$1,494.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,428.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$880.27
|
| Rate for Payer: Cash Price |
$479.10
|
| Rate for Payer: Cigna Commercial |
$1,528.01
|
| Rate for Payer: Health EOS Commercial |
$1,478.18
|
| Rate for Payer: HFN Commercial |
$1,528.01
|
| Rate for Payer: Multiplan Commercial |
$1,328.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,528.01
|
| Rate for Payer: Quartz Beloit One Network |
$813.83
|
| Rate for Payer: Quartz Commercial |
$996.53
|
| Rate for Payer: WEA Trust Commercial |
$913.48
|
| Rate for Payer: WPS Commercial |
$1,230.17
|
|
|
SCREW PERIPHERAL NON-LOCKING UNIVERS GLENOID 4.5X36MM AR-9145-36NL
|
Facility
|
OP
|
$1,597.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4595651
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$465.05 |
| Max. Negotiated Rate |
$1,528.01 |
| Rate for Payer: Aetna Commercial |
$1,494.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,428.36
|
| Rate for Payer: Aetna Managed Medicare |
$465.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,079.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$830.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$797.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$880.27
|
| Rate for Payer: Cash Price |
$479.10
|
| Rate for Payer: Cigna Commercial |
$1,528.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$929.45
|
| Rate for Payer: Health EOS Commercial |
$1,478.18
|
| Rate for Payer: HFN Commercial |
$1,528.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,245.66
|
| Rate for Payer: Multiplan Commercial |
$1,328.70
|
| Rate for Payer: NAPHCARE Commercial |
$996.53
|
| Rate for Payer: Preferred Network Access Commercial |
$1,528.01
|
| Rate for Payer: Quartz Beloit One Network |
$813.83
|
| Rate for Payer: Quartz Commercial |
$1,079.57
|
| Rate for Payer: Quartz Medicare Advantage |
$996.53
|
| Rate for Payer: The Alliance Commercial |
$830.44
|
| Rate for Payer: WEA Trust Commercial |
$913.48
|
| Rate for Payer: WPS Commercial |
$1,230.17
|
|
|
SCREW PERIPHERAL NON-LOCKING UNIVERS GLENOID 4.5X36MM AR-9145-36NL
|
Facility
|
IP
|
$1,597.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4595651
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$813.83 |
| Max. Negotiated Rate |
$1,528.01 |
| Rate for Payer: Aetna Commercial |
$1,494.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,428.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$880.27
|
| Rate for Payer: Cash Price |
$479.10
|
| Rate for Payer: Cigna Commercial |
$1,528.01
|
| Rate for Payer: Health EOS Commercial |
$1,478.18
|
| Rate for Payer: HFN Commercial |
$1,528.01
|
| Rate for Payer: Multiplan Commercial |
$1,328.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,528.01
|
| Rate for Payer: Quartz Beloit One Network |
$813.83
|
| Rate for Payer: Quartz Commercial |
$996.53
|
| Rate for Payer: WEA Trust Commercial |
$913.48
|
| Rate for Payer: WPS Commercial |
$1,230.17
|
|
|
SCREW PERIPR VAL 5.0 X 10MM OPTILINK ST SD 42.231.010
|
Facility
|
IP
|
$2,614.37
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6246191
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,332.28 |
| Max. Negotiated Rate |
$2,501.43 |
| Rate for Payer: Aetna Commercial |
$2,447.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,338.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,441.04
|
| Rate for Payer: Cash Price |
$784.31
|
| Rate for Payer: Cigna Commercial |
$2,501.43
|
| Rate for Payer: Health EOS Commercial |
$2,419.86
|
| Rate for Payer: HFN Commercial |
$2,501.43
|
| Rate for Payer: Multiplan Commercial |
$2,175.16
|
| Rate for Payer: Preferred Network Access Commercial |
$2,501.43
|
| Rate for Payer: Quartz Beloit One Network |
$1,332.28
|
| Rate for Payer: Quartz Commercial |
$1,631.37
|
| Rate for Payer: WEA Trust Commercial |
$1,495.42
|
| Rate for Payer: WPS Commercial |
$2,013.85
|
|
|
SCREW PERIPR VAL 5.0 X 10MM OPTILINK ST SD 42.231.010
|
Facility
|
OP
|
$2,614.37
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6246191
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$761.30 |
| Max. Negotiated Rate |
$2,501.43 |
| Rate for Payer: Aetna Commercial |
$2,447.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,338.29
|
| Rate for Payer: Aetna Managed Medicare |
$761.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,767.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,359.47
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,305.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,441.04
|
| Rate for Payer: Cash Price |
$784.31
|
| Rate for Payer: Cigna Commercial |
$2,501.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,521.56
|
| Rate for Payer: Health EOS Commercial |
$2,419.86
|
| Rate for Payer: HFN Commercial |
$2,501.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,039.21
|
| Rate for Payer: Multiplan Commercial |
$2,175.16
|
| Rate for Payer: NAPHCARE Commercial |
$1,631.37
|
| Rate for Payer: Preferred Network Access Commercial |
$2,501.43
|
| Rate for Payer: Quartz Beloit One Network |
$1,332.28
|
| Rate for Payer: Quartz Commercial |
$1,767.31
|
| Rate for Payer: Quartz Medicare Advantage |
$1,631.37
|
| Rate for Payer: The Alliance Commercial |
$1,359.47
|
| Rate for Payer: WEA Trust Commercial |
$1,495.42
|
| Rate for Payer: WPS Commercial |
$2,013.85
|
|
|
SCREW PERIPR VAL 5.0 X 12MM OPTILINK ST SD 42.231.012
|
Facility
|
OP
|
$2,614.37
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6246192
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$761.30 |
| Max. Negotiated Rate |
$2,501.43 |
| Rate for Payer: Aetna Commercial |
$2,447.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,338.29
|
| Rate for Payer: Aetna Managed Medicare |
$761.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,767.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,359.47
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,305.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,441.04
|
| Rate for Payer: Cash Price |
$784.31
|
| Rate for Payer: Cigna Commercial |
$2,501.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,521.56
|
| Rate for Payer: Health EOS Commercial |
$2,419.86
|
| Rate for Payer: HFN Commercial |
$2,501.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,039.21
|
| Rate for Payer: Multiplan Commercial |
$2,175.16
|
| Rate for Payer: NAPHCARE Commercial |
$1,631.37
|
| Rate for Payer: Preferred Network Access Commercial |
$2,501.43
|
| Rate for Payer: Quartz Beloit One Network |
$1,332.28
|
| Rate for Payer: Quartz Commercial |
$1,767.31
|
| Rate for Payer: Quartz Medicare Advantage |
$1,631.37
|
| Rate for Payer: The Alliance Commercial |
$1,359.47
|
| Rate for Payer: WEA Trust Commercial |
$1,495.42
|
| Rate for Payer: WPS Commercial |
$2,013.85
|
|
|
SCREW PERIPR VAL 5.0 X 12MM OPTILINK ST SD 42.231.012
|
Facility
|
IP
|
$2,614.37
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6246192
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,332.28 |
| Max. Negotiated Rate |
$2,501.43 |
| Rate for Payer: Aetna Commercial |
$2,447.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,338.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,441.04
|
| Rate for Payer: Cash Price |
$784.31
|
| Rate for Payer: Cigna Commercial |
$2,501.43
|
| Rate for Payer: Health EOS Commercial |
$2,419.86
|
| Rate for Payer: HFN Commercial |
$2,501.43
|
| Rate for Payer: Multiplan Commercial |
$2,175.16
|
| Rate for Payer: Preferred Network Access Commercial |
$2,501.43
|
| Rate for Payer: Quartz Beloit One Network |
$1,332.28
|
| Rate for Payer: Quartz Commercial |
$1,631.37
|
| Rate for Payer: WEA Trust Commercial |
$1,495.42
|
| Rate for Payer: WPS Commercial |
$2,013.85
|
|
|
SCREW PERIPR VAL 5.0 X 14MM OPTILINK ST SD 42.231.014
|
Facility
|
IP
|
$2,614.37
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6246193
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,332.28 |
| Max. Negotiated Rate |
$2,501.43 |
| Rate for Payer: Aetna Commercial |
$2,447.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,338.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,441.04
|
| Rate for Payer: Cash Price |
$784.31
|
| Rate for Payer: Cigna Commercial |
$2,501.43
|
| Rate for Payer: Health EOS Commercial |
$2,419.86
|
| Rate for Payer: HFN Commercial |
$2,501.43
|
| Rate for Payer: Multiplan Commercial |
$2,175.16
|
| Rate for Payer: Preferred Network Access Commercial |
$2,501.43
|
| Rate for Payer: Quartz Beloit One Network |
$1,332.28
|
| Rate for Payer: Quartz Commercial |
$1,631.37
|
| Rate for Payer: WEA Trust Commercial |
$1,495.42
|
| Rate for Payer: WPS Commercial |
$2,013.85
|
|
|
SCREW PERIPR VAL 5.0 X 14MM OPTILINK ST SD 42.231.014
|
Facility
|
OP
|
$2,614.37
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6246193
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$761.30 |
| Max. Negotiated Rate |
$2,501.43 |
| Rate for Payer: Aetna Commercial |
$2,447.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,338.29
|
| Rate for Payer: Aetna Managed Medicare |
$761.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,767.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,359.47
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,305.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,441.04
|
| Rate for Payer: Cash Price |
$784.31
|
| Rate for Payer: Cigna Commercial |
$2,501.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,521.56
|
| Rate for Payer: Health EOS Commercial |
$2,419.86
|
| Rate for Payer: HFN Commercial |
$2,501.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,039.21
|
| Rate for Payer: Multiplan Commercial |
$2,175.16
|
| Rate for Payer: NAPHCARE Commercial |
$1,631.37
|
| Rate for Payer: Preferred Network Access Commercial |
$2,501.43
|
| Rate for Payer: Quartz Beloit One Network |
$1,332.28
|
| Rate for Payer: Quartz Commercial |
$1,767.31
|
| Rate for Payer: Quartz Medicare Advantage |
$1,631.37
|
| Rate for Payer: The Alliance Commercial |
$1,359.47
|
| Rate for Payer: WEA Trust Commercial |
$1,495.42
|
| Rate for Payer: WPS Commercial |
$2,013.85
|
|
|
SCREW PERIPR VAL 5.0 X 16MM OPTILINK ST SD 42.231.016
|
Facility
|
IP
|
$2,614.37
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6246194
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,332.28 |
| Max. Negotiated Rate |
$2,501.43 |
| Rate for Payer: Aetna Commercial |
$2,447.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,338.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,441.04
|
| Rate for Payer: Cash Price |
$784.31
|
| Rate for Payer: Cigna Commercial |
$2,501.43
|
| Rate for Payer: Health EOS Commercial |
$2,419.86
|
| Rate for Payer: HFN Commercial |
$2,501.43
|
| Rate for Payer: Multiplan Commercial |
$2,175.16
|
| Rate for Payer: Preferred Network Access Commercial |
$2,501.43
|
| Rate for Payer: Quartz Beloit One Network |
$1,332.28
|
| Rate for Payer: Quartz Commercial |
$1,631.37
|
| Rate for Payer: WEA Trust Commercial |
$1,495.42
|
| Rate for Payer: WPS Commercial |
$2,013.85
|
|
|
SCREW PERIPR VAL 5.0 X 16MM OPTILINK ST SD 42.231.016
|
Facility
|
OP
|
$2,614.37
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6246194
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$761.30 |
| Max. Negotiated Rate |
$2,501.43 |
| Rate for Payer: Aetna Commercial |
$2,447.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,338.29
|
| Rate for Payer: Aetna Managed Medicare |
$761.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,767.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,359.47
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,305.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,441.04
|
| Rate for Payer: Cash Price |
$784.31
|
| Rate for Payer: Cigna Commercial |
$2,501.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,521.56
|
| Rate for Payer: Health EOS Commercial |
$2,419.86
|
| Rate for Payer: HFN Commercial |
$2,501.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,039.21
|
| Rate for Payer: Multiplan Commercial |
$2,175.16
|
| Rate for Payer: NAPHCARE Commercial |
$1,631.37
|
| Rate for Payer: Preferred Network Access Commercial |
$2,501.43
|
| Rate for Payer: Quartz Beloit One Network |
$1,332.28
|
| Rate for Payer: Quartz Commercial |
$1,767.31
|
| Rate for Payer: Quartz Medicare Advantage |
$1,631.37
|
| Rate for Payer: The Alliance Commercial |
$1,359.47
|
| Rate for Payer: WEA Trust Commercial |
$1,495.42
|
| Rate for Payer: WPS Commercial |
$2,013.85
|
|
|
SCREW PERI VA LCKNG 5.0MM X 16MM 02.231.016S
|
Facility
|
OP
|
$2,333.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5264612
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$679.37 |
| Max. Negotiated Rate |
$2,232.21 |
| Rate for Payer: Aetna Commercial |
$2,183.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,086.64
|
| Rate for Payer: Aetna Managed Medicare |
$679.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,577.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,213.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,164.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,285.95
|
| Rate for Payer: Cash Price |
$699.90
|
| Rate for Payer: Cigna Commercial |
$2,232.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,357.81
|
| Rate for Payer: Health EOS Commercial |
$2,159.42
|
| Rate for Payer: HFN Commercial |
$2,232.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,819.74
|
| Rate for Payer: Multiplan Commercial |
$1,941.06
|
| Rate for Payer: NAPHCARE Commercial |
$1,455.79
|
| Rate for Payer: Preferred Network Access Commercial |
$2,232.21
|
| Rate for Payer: Quartz Beloit One Network |
$1,188.90
|
| Rate for Payer: Quartz Commercial |
$1,577.11
|
| Rate for Payer: Quartz Medicare Advantage |
$1,455.79
|
| Rate for Payer: The Alliance Commercial |
$1,213.16
|
| Rate for Payer: WEA Trust Commercial |
$1,334.48
|
| Rate for Payer: WPS Commercial |
$1,797.11
|
|
|
SCREW PERI VA LCKNG 5.0MM X 16MM 02.231.016S
|
Facility
|
IP
|
$2,333.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5264612
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,188.90 |
| Max. Negotiated Rate |
$2,232.21 |
| Rate for Payer: Aetna Commercial |
$2,183.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,086.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,285.95
|
| Rate for Payer: Cash Price |
$699.90
|
| Rate for Payer: Cigna Commercial |
$2,232.21
|
| Rate for Payer: Health EOS Commercial |
$2,159.42
|
| Rate for Payer: HFN Commercial |
$2,232.21
|
| Rate for Payer: Multiplan Commercial |
$1,941.06
|
| Rate for Payer: Preferred Network Access Commercial |
$2,232.21
|
| Rate for Payer: Quartz Beloit One Network |
$1,188.90
|
| Rate for Payer: Quartz Commercial |
$1,455.79
|
| Rate for Payer: WEA Trust Commercial |
$1,334.48
|
| Rate for Payer: WPS Commercial |
$1,797.11
|
|
|
SCREW PINNACLE CANC 6.5 X15 1217-15-500
|
Facility
|
OP
|
$1,437.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563223
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$418.45 |
| Max. Negotiated Rate |
$1,374.92 |
| Rate for Payer: Aetna Commercial |
$1,345.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,285.25
|
| Rate for Payer: Aetna Managed Medicare |
$418.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$971.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$747.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$717.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$792.07
|
| Rate for Payer: Cash Price |
$431.10
|
| Rate for Payer: Cigna Commercial |
$1,374.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$836.33
|
| Rate for Payer: Health EOS Commercial |
$1,330.09
|
| Rate for Payer: HFN Commercial |
$1,374.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,120.86
|
| Rate for Payer: Multiplan Commercial |
$1,195.58
|
| Rate for Payer: NAPHCARE Commercial |
$896.69
|
| Rate for Payer: Preferred Network Access Commercial |
$1,374.92
|
| Rate for Payer: Quartz Beloit One Network |
$732.30
|
| Rate for Payer: Quartz Commercial |
$971.41
|
| Rate for Payer: Quartz Medicare Advantage |
$896.69
|
| Rate for Payer: The Alliance Commercial |
$747.24
|
| Rate for Payer: WEA Trust Commercial |
$821.96
|
| Rate for Payer: WPS Commercial |
$1,106.92
|
|
|
SCREW PINNACLE CANC 6.5 X15 1217-15-500
|
Facility
|
IP
|
$1,437.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563223
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$732.30 |
| Max. Negotiated Rate |
$1,374.92 |
| Rate for Payer: Aetna Commercial |
$1,345.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,285.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$792.07
|
| Rate for Payer: Cash Price |
$431.10
|
| Rate for Payer: Cigna Commercial |
$1,374.92
|
| Rate for Payer: Health EOS Commercial |
$1,330.09
|
| Rate for Payer: HFN Commercial |
$1,374.92
|
| Rate for Payer: Multiplan Commercial |
$1,195.58
|
| Rate for Payer: Preferred Network Access Commercial |
$1,374.92
|
| Rate for Payer: Quartz Beloit One Network |
$732.30
|
| Rate for Payer: Quartz Commercial |
$896.69
|
| Rate for Payer: WEA Trust Commercial |
$821.96
|
| Rate for Payer: WPS Commercial |
$1,106.92
|
|
