|
SCREW SNAP OFF 2.0 X 11 WS11
|
Facility
|
IP
|
$4,264.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685738
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,172.93 |
| Max. Negotiated Rate |
$4,079.80 |
| Rate for Payer: Aetna Commercial |
$3,991.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,813.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,350.32
|
| Rate for Payer: Cash Price |
$1,279.20
|
| Rate for Payer: Cigna Commercial |
$4,079.80
|
| Rate for Payer: Health EOS Commercial |
$3,946.76
|
| Rate for Payer: HFN Commercial |
$4,079.80
|
| Rate for Payer: Multiplan Commercial |
$3,547.65
|
| Rate for Payer: Preferred Network Access Commercial |
$4,079.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,172.93
|
| Rate for Payer: Quartz Commercial |
$2,660.74
|
| Rate for Payer: WEA Trust Commercial |
$2,439.01
|
| Rate for Payer: WPS Commercial |
$3,284.56
|
|
|
SCREW SNAP OFF 2.0 X 11 WS11
|
Facility
|
OP
|
$4,264.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685738
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,241.68 |
| Max. Negotiated Rate |
$4,079.80 |
| Rate for Payer: Aetna Commercial |
$3,991.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,813.72
|
| Rate for Payer: Aetna Managed Medicare |
$1,241.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,882.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,217.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,128.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,350.32
|
| Rate for Payer: Cash Price |
$1,279.20
|
| Rate for Payer: Cigna Commercial |
$4,079.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,481.65
|
| Rate for Payer: Health EOS Commercial |
$3,946.76
|
| Rate for Payer: HFN Commercial |
$4,079.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,325.92
|
| Rate for Payer: Multiplan Commercial |
$3,547.65
|
| Rate for Payer: NAPHCARE Commercial |
$2,660.74
|
| Rate for Payer: Preferred Network Access Commercial |
$4,079.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,172.93
|
| Rate for Payer: Quartz Commercial |
$2,882.46
|
| Rate for Payer: Quartz Medicare Advantage |
$2,660.74
|
| Rate for Payer: The Alliance Commercial |
$2,217.28
|
| Rate for Payer: WEA Trust Commercial |
$2,439.01
|
| Rate for Payer: WPS Commercial |
$3,284.56
|
|
|
SCREW SNAP-OFF 2.0 X 12MM CHARLOTTE F & A 45110002
|
Facility
|
OP
|
$2,563.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6199054
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$746.35 |
| Max. Negotiated Rate |
$2,452.28 |
| Rate for Payer: Aetna Commercial |
$2,398.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,292.35
|
| Rate for Payer: Aetna Managed Medicare |
$746.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,732.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,332.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,279.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,412.73
|
| Rate for Payer: Cash Price |
$768.90
|
| Rate for Payer: Cigna Commercial |
$2,452.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,491.67
|
| Rate for Payer: Health EOS Commercial |
$2,372.31
|
| Rate for Payer: HFN Commercial |
$2,452.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,999.14
|
| Rate for Payer: Multiplan Commercial |
$2,132.42
|
| Rate for Payer: NAPHCARE Commercial |
$1,599.31
|
| Rate for Payer: Preferred Network Access Commercial |
$2,452.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,306.10
|
| Rate for Payer: Quartz Commercial |
$1,732.59
|
| Rate for Payer: Quartz Medicare Advantage |
$1,599.31
|
| Rate for Payer: The Alliance Commercial |
$1,332.76
|
| Rate for Payer: WEA Trust Commercial |
$1,466.04
|
| Rate for Payer: WPS Commercial |
$1,974.28
|
|
|
SCREW SNAP-OFF 2.0 X 12MM CHARLOTTE F & A 45110002
|
Facility
|
IP
|
$2,563.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6199054
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,306.10 |
| Max. Negotiated Rate |
$2,452.28 |
| Rate for Payer: Aetna Commercial |
$2,398.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,292.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,412.73
|
| Rate for Payer: Cash Price |
$768.90
|
| Rate for Payer: Cigna Commercial |
$2,452.28
|
| Rate for Payer: Health EOS Commercial |
$2,372.31
|
| Rate for Payer: HFN Commercial |
$2,452.28
|
| Rate for Payer: Multiplan Commercial |
$2,132.42
|
| Rate for Payer: Preferred Network Access Commercial |
$2,452.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,306.10
|
| Rate for Payer: Quartz Commercial |
$1,599.31
|
| Rate for Payer: WEA Trust Commercial |
$1,466.04
|
| Rate for Payer: WPS Commercial |
$1,974.28
|
|
|
SCREW SNAP OFF 2.0 X 12 WS12
|
Facility
|
OP
|
$5,270.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5583417
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,534.62 |
| Max. Negotiated Rate |
$5,042.34 |
| Rate for Payer: Aetna Commercial |
$4,932.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,713.49
|
| Rate for Payer: Aetna Managed Medicare |
$1,534.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,562.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,740.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,630.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,904.82
|
| Rate for Payer: Cash Price |
$1,581.00
|
| Rate for Payer: Cigna Commercial |
$5,042.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,067.14
|
| Rate for Payer: Health EOS Commercial |
$4,877.91
|
| Rate for Payer: HFN Commercial |
$5,042.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,110.60
|
| Rate for Payer: Multiplan Commercial |
$4,384.64
|
| Rate for Payer: NAPHCARE Commercial |
$3,288.48
|
| Rate for Payer: Preferred Network Access Commercial |
$5,042.34
|
| Rate for Payer: Quartz Beloit One Network |
$2,685.59
|
| Rate for Payer: Quartz Commercial |
$3,562.52
|
| Rate for Payer: Quartz Medicare Advantage |
$3,288.48
|
| Rate for Payer: The Alliance Commercial |
$2,740.40
|
| Rate for Payer: WEA Trust Commercial |
$3,014.44
|
| Rate for Payer: WPS Commercial |
$4,059.48
|
|
|
SCREW SNAP OFF 2.0 X 12 WS12
|
Facility
|
IP
|
$5,270.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5583417
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,685.59 |
| Max. Negotiated Rate |
$5,042.34 |
| Rate for Payer: Aetna Commercial |
$4,932.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,713.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,904.82
|
| Rate for Payer: Cash Price |
$1,581.00
|
| Rate for Payer: Cigna Commercial |
$5,042.34
|
| Rate for Payer: Health EOS Commercial |
$4,877.91
|
| Rate for Payer: HFN Commercial |
$5,042.34
|
| Rate for Payer: Multiplan Commercial |
$4,384.64
|
| Rate for Payer: Preferred Network Access Commercial |
$5,042.34
|
| Rate for Payer: Quartz Beloit One Network |
$2,685.59
|
| Rate for Payer: Quartz Commercial |
$3,288.48
|
| Rate for Payer: WEA Trust Commercial |
$3,014.44
|
| Rate for Payer: WPS Commercial |
$4,059.48
|
|
|
SCREW SNAP-OFF 2.0 X 13MM CHARLOTTE F & A 45112013
|
Facility
|
OP
|
$2,563.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6199055
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$746.35 |
| Max. Negotiated Rate |
$2,452.28 |
| Rate for Payer: Aetna Commercial |
$2,398.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,292.35
|
| Rate for Payer: Aetna Managed Medicare |
$746.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,732.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,332.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,279.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,412.73
|
| Rate for Payer: Cash Price |
$768.90
|
| Rate for Payer: Cigna Commercial |
$2,452.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,491.67
|
| Rate for Payer: Health EOS Commercial |
$2,372.31
|
| Rate for Payer: HFN Commercial |
$2,452.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,999.14
|
| Rate for Payer: Multiplan Commercial |
$2,132.42
|
| Rate for Payer: NAPHCARE Commercial |
$1,599.31
|
| Rate for Payer: Preferred Network Access Commercial |
$2,452.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,306.10
|
| Rate for Payer: Quartz Commercial |
$1,732.59
|
| Rate for Payer: Quartz Medicare Advantage |
$1,599.31
|
| Rate for Payer: The Alliance Commercial |
$1,332.76
|
| Rate for Payer: WEA Trust Commercial |
$1,466.04
|
| Rate for Payer: WPS Commercial |
$1,974.28
|
|
|
SCREW SNAP-OFF 2.0 X 13MM CHARLOTTE F & A 45112013
|
Facility
|
IP
|
$2,563.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6199055
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,306.10 |
| Max. Negotiated Rate |
$2,452.28 |
| Rate for Payer: Aetna Commercial |
$2,398.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,292.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,412.73
|
| Rate for Payer: Cash Price |
$768.90
|
| Rate for Payer: Cigna Commercial |
$2,452.28
|
| Rate for Payer: Health EOS Commercial |
$2,372.31
|
| Rate for Payer: HFN Commercial |
$2,452.28
|
| Rate for Payer: Multiplan Commercial |
$2,132.42
|
| Rate for Payer: Preferred Network Access Commercial |
$2,452.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,306.10
|
| Rate for Payer: Quartz Commercial |
$1,599.31
|
| Rate for Payer: WEA Trust Commercial |
$1,466.04
|
| Rate for Payer: WPS Commercial |
$1,974.28
|
|
|
SCREW SNAP OFF 2.0 X 13 WS13
|
Facility
|
IP
|
$4,264.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685739
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,172.93 |
| Max. Negotiated Rate |
$4,079.80 |
| Rate for Payer: Aetna Commercial |
$3,991.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,813.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,350.32
|
| Rate for Payer: Cash Price |
$1,279.20
|
| Rate for Payer: Cigna Commercial |
$4,079.80
|
| Rate for Payer: Health EOS Commercial |
$3,946.76
|
| Rate for Payer: HFN Commercial |
$4,079.80
|
| Rate for Payer: Multiplan Commercial |
$3,547.65
|
| Rate for Payer: Preferred Network Access Commercial |
$4,079.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,172.93
|
| Rate for Payer: Quartz Commercial |
$2,660.74
|
| Rate for Payer: WEA Trust Commercial |
$2,439.01
|
| Rate for Payer: WPS Commercial |
$3,284.56
|
|
|
SCREW SNAP OFF 2.0 X 13 WS13
|
Facility
|
OP
|
$4,264.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685739
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,241.68 |
| Max. Negotiated Rate |
$4,079.80 |
| Rate for Payer: Aetna Commercial |
$3,991.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,813.72
|
| Rate for Payer: Aetna Managed Medicare |
$1,241.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,882.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,217.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,128.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,350.32
|
| Rate for Payer: Cash Price |
$1,279.20
|
| Rate for Payer: Cigna Commercial |
$4,079.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,481.65
|
| Rate for Payer: Health EOS Commercial |
$3,946.76
|
| Rate for Payer: HFN Commercial |
$4,079.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,325.92
|
| Rate for Payer: Multiplan Commercial |
$3,547.65
|
| Rate for Payer: NAPHCARE Commercial |
$2,660.74
|
| Rate for Payer: Preferred Network Access Commercial |
$4,079.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,172.93
|
| Rate for Payer: Quartz Commercial |
$2,882.46
|
| Rate for Payer: Quartz Medicare Advantage |
$2,660.74
|
| Rate for Payer: The Alliance Commercial |
$2,217.28
|
| Rate for Payer: WEA Trust Commercial |
$2,439.01
|
| Rate for Payer: WPS Commercial |
$3,284.56
|
|
|
SCREW SNAP-OFF 2.0 X 14MM CHARLOTTE F & A 45110003
|
Facility
|
OP
|
$2,563.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6217044
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$746.35 |
| Max. Negotiated Rate |
$2,452.28 |
| Rate for Payer: Aetna Commercial |
$2,398.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,292.35
|
| Rate for Payer: Aetna Managed Medicare |
$746.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,732.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,332.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,279.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,412.73
|
| Rate for Payer: Cash Price |
$768.90
|
| Rate for Payer: Cigna Commercial |
$2,452.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,491.67
|
| Rate for Payer: Health EOS Commercial |
$2,372.31
|
| Rate for Payer: HFN Commercial |
$2,452.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,999.14
|
| Rate for Payer: Multiplan Commercial |
$2,132.42
|
| Rate for Payer: NAPHCARE Commercial |
$1,599.31
|
| Rate for Payer: Preferred Network Access Commercial |
$2,452.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,306.10
|
| Rate for Payer: Quartz Commercial |
$1,732.59
|
| Rate for Payer: Quartz Medicare Advantage |
$1,599.31
|
| Rate for Payer: The Alliance Commercial |
$1,332.76
|
| Rate for Payer: WEA Trust Commercial |
$1,466.04
|
| Rate for Payer: WPS Commercial |
$1,974.28
|
|
|
SCREW SNAP-OFF 2.0 X 14MM CHARLOTTE F & A 45110003
|
Facility
|
IP
|
$2,563.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6217044
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,306.10 |
| Max. Negotiated Rate |
$2,452.28 |
| Rate for Payer: Aetna Commercial |
$2,398.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,292.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,412.73
|
| Rate for Payer: Cash Price |
$768.90
|
| Rate for Payer: Cigna Commercial |
$2,452.28
|
| Rate for Payer: Health EOS Commercial |
$2,372.31
|
| Rate for Payer: HFN Commercial |
$2,452.28
|
| Rate for Payer: Multiplan Commercial |
$2,132.42
|
| Rate for Payer: Preferred Network Access Commercial |
$2,452.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,306.10
|
| Rate for Payer: Quartz Commercial |
$1,599.31
|
| Rate for Payer: WEA Trust Commercial |
$1,466.04
|
| Rate for Payer: WPS Commercial |
$1,974.28
|
|
|
SCREW SNAP OFF 2.0 X 14 WS14
|
Facility
|
IP
|
$5,270.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5583418
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,685.59 |
| Max. Negotiated Rate |
$5,042.34 |
| Rate for Payer: Aetna Commercial |
$4,932.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,713.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,904.82
|
| Rate for Payer: Cash Price |
$1,581.00
|
| Rate for Payer: Cigna Commercial |
$5,042.34
|
| Rate for Payer: Health EOS Commercial |
$4,877.91
|
| Rate for Payer: HFN Commercial |
$5,042.34
|
| Rate for Payer: Multiplan Commercial |
$4,384.64
|
| Rate for Payer: Preferred Network Access Commercial |
$5,042.34
|
| Rate for Payer: Quartz Beloit One Network |
$2,685.59
|
| Rate for Payer: Quartz Commercial |
$3,288.48
|
| Rate for Payer: WEA Trust Commercial |
$3,014.44
|
| Rate for Payer: WPS Commercial |
$4,059.48
|
|
|
SCREW SNAP OFF 2.0 X 14 WS14
|
Facility
|
OP
|
$5,270.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5583418
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,534.62 |
| Max. Negotiated Rate |
$5,042.34 |
| Rate for Payer: Aetna Commercial |
$4,932.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,713.49
|
| Rate for Payer: Aetna Managed Medicare |
$1,534.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,562.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,740.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,630.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,904.82
|
| Rate for Payer: Cash Price |
$1,581.00
|
| Rate for Payer: Cigna Commercial |
$5,042.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,067.14
|
| Rate for Payer: Health EOS Commercial |
$4,877.91
|
| Rate for Payer: HFN Commercial |
$5,042.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,110.60
|
| Rate for Payer: Multiplan Commercial |
$4,384.64
|
| Rate for Payer: NAPHCARE Commercial |
$3,288.48
|
| Rate for Payer: Preferred Network Access Commercial |
$5,042.34
|
| Rate for Payer: Quartz Beloit One Network |
$2,685.59
|
| Rate for Payer: Quartz Commercial |
$3,562.52
|
| Rate for Payer: Quartz Medicare Advantage |
$3,288.48
|
| Rate for Payer: The Alliance Commercial |
$2,740.40
|
| Rate for Payer: WEA Trust Commercial |
$3,014.44
|
| Rate for Payer: WPS Commercial |
$4,059.48
|
|
|
SCREW SNAP-OFF 2.7 X 13MM CHARLOTTE F & A 45110004
|
Facility
|
OP
|
$2,563.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6199062
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$746.35 |
| Max. Negotiated Rate |
$2,452.28 |
| Rate for Payer: Aetna Commercial |
$2,398.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,292.35
|
| Rate for Payer: Aetna Managed Medicare |
$746.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,732.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,332.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,279.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,412.73
|
| Rate for Payer: Cash Price |
$768.90
|
| Rate for Payer: Cigna Commercial |
$2,452.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,491.67
|
| Rate for Payer: Health EOS Commercial |
$2,372.31
|
| Rate for Payer: HFN Commercial |
$2,452.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,999.14
|
| Rate for Payer: Multiplan Commercial |
$2,132.42
|
| Rate for Payer: NAPHCARE Commercial |
$1,599.31
|
| Rate for Payer: Preferred Network Access Commercial |
$2,452.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,306.10
|
| Rate for Payer: Quartz Commercial |
$1,732.59
|
| Rate for Payer: Quartz Medicare Advantage |
$1,599.31
|
| Rate for Payer: The Alliance Commercial |
$1,332.76
|
| Rate for Payer: WEA Trust Commercial |
$1,466.04
|
| Rate for Payer: WPS Commercial |
$1,974.28
|
|
|
SCREW SNAP-OFF 2.7 X 13MM CHARLOTTE F & A 45110004
|
Facility
|
IP
|
$2,563.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6199062
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,306.10 |
| Max. Negotiated Rate |
$2,452.28 |
| Rate for Payer: Aetna Commercial |
$2,398.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,292.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,412.73
|
| Rate for Payer: Cash Price |
$768.90
|
| Rate for Payer: Cigna Commercial |
$2,452.28
|
| Rate for Payer: Health EOS Commercial |
$2,372.31
|
| Rate for Payer: HFN Commercial |
$2,452.28
|
| Rate for Payer: Multiplan Commercial |
$2,132.42
|
| Rate for Payer: Preferred Network Access Commercial |
$2,452.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,306.10
|
| Rate for Payer: Quartz Commercial |
$1,599.31
|
| Rate for Payer: WEA Trust Commercial |
$1,466.04
|
| Rate for Payer: WPS Commercial |
$1,974.28
|
|
|
SCREW SNAP-OFF 2.7 X 14MM CHARLOTTE F & A 45112714
|
Facility
|
OP
|
$2,563.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6199063
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$746.35 |
| Max. Negotiated Rate |
$2,452.28 |
| Rate for Payer: Aetna Commercial |
$2,398.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,292.35
|
| Rate for Payer: Aetna Managed Medicare |
$746.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,732.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,332.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,279.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,412.73
|
| Rate for Payer: Cash Price |
$768.90
|
| Rate for Payer: Cigna Commercial |
$2,452.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,491.67
|
| Rate for Payer: Health EOS Commercial |
$2,372.31
|
| Rate for Payer: HFN Commercial |
$2,452.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,999.14
|
| Rate for Payer: Multiplan Commercial |
$2,132.42
|
| Rate for Payer: NAPHCARE Commercial |
$1,599.31
|
| Rate for Payer: Preferred Network Access Commercial |
$2,452.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,306.10
|
| Rate for Payer: Quartz Commercial |
$1,732.59
|
| Rate for Payer: Quartz Medicare Advantage |
$1,599.31
|
| Rate for Payer: The Alliance Commercial |
$1,332.76
|
| Rate for Payer: WEA Trust Commercial |
$1,466.04
|
| Rate for Payer: WPS Commercial |
$1,974.28
|
|
|
SCREW SNAP-OFF 2.7 X 14MM CHARLOTTE F & A 45112714
|
Facility
|
IP
|
$2,563.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6199063
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,306.10 |
| Max. Negotiated Rate |
$2,452.28 |
| Rate for Payer: Aetna Commercial |
$2,398.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,292.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,412.73
|
| Rate for Payer: Cash Price |
$768.90
|
| Rate for Payer: Cigna Commercial |
$2,452.28
|
| Rate for Payer: Health EOS Commercial |
$2,372.31
|
| Rate for Payer: HFN Commercial |
$2,452.28
|
| Rate for Payer: Multiplan Commercial |
$2,132.42
|
| Rate for Payer: Preferred Network Access Commercial |
$2,452.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,306.10
|
| Rate for Payer: Quartz Commercial |
$1,599.31
|
| Rate for Payer: WEA Trust Commercial |
$1,466.04
|
| Rate for Payer: WPS Commercial |
$1,974.28
|
|
|
SCREW TENODESIS 3 X 8MM BIOCOMPOSITE AR-1530BC
|
Facility
|
IP
|
$4,787.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3814428
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,439.46 |
| Max. Negotiated Rate |
$4,580.20 |
| Rate for Payer: Aetna Commercial |
$4,480.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,281.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,638.59
|
| Rate for Payer: Cash Price |
$1,436.10
|
| Rate for Payer: Cigna Commercial |
$4,580.20
|
| Rate for Payer: Health EOS Commercial |
$4,430.85
|
| Rate for Payer: HFN Commercial |
$4,580.20
|
| Rate for Payer: Multiplan Commercial |
$3,982.78
|
| Rate for Payer: Preferred Network Access Commercial |
$4,580.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,439.46
|
| Rate for Payer: Quartz Commercial |
$2,987.09
|
| Rate for Payer: WEA Trust Commercial |
$2,738.16
|
| Rate for Payer: WPS Commercial |
$3,687.43
|
|
|
SCREW TENODESIS 3 X 8MM BIOCOMPOSITE AR-1530BC
|
Facility
|
OP
|
$4,787.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3814428
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,393.97 |
| Max. Negotiated Rate |
$4,580.20 |
| Rate for Payer: Aetna Commercial |
$4,480.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,281.49
|
| Rate for Payer: Aetna Managed Medicare |
$1,393.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,236.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,489.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,389.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,638.59
|
| Rate for Payer: Cash Price |
$1,436.10
|
| Rate for Payer: Cigna Commercial |
$4,580.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,786.03
|
| Rate for Payer: Health EOS Commercial |
$4,430.85
|
| Rate for Payer: HFN Commercial |
$4,580.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,733.86
|
| Rate for Payer: Multiplan Commercial |
$3,982.78
|
| Rate for Payer: NAPHCARE Commercial |
$2,987.09
|
| Rate for Payer: Preferred Network Access Commercial |
$4,580.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,439.46
|
| Rate for Payer: Quartz Commercial |
$3,236.01
|
| Rate for Payer: Quartz Medicare Advantage |
$2,987.09
|
| Rate for Payer: The Alliance Commercial |
$2,489.24
|
| Rate for Payer: WEA Trust Commercial |
$2,738.16
|
| Rate for Payer: WPS Commercial |
$3,687.43
|
|
|
SCREW TENODESIS 4.0 X 10MM W DISP DRIVER AR-1540CDS
|
Facility
|
OP
|
$4,442.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5611626
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,293.51 |
| Max. Negotiated Rate |
$4,250.11 |
| Rate for Payer: Aetna Commercial |
$4,157.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,972.92
|
| Rate for Payer: Aetna Managed Medicare |
$1,293.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,002.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,309.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,217.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,448.43
|
| Rate for Payer: Cash Price |
$1,332.60
|
| Rate for Payer: Cigna Commercial |
$4,250.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,585.24
|
| Rate for Payer: Health EOS Commercial |
$4,111.52
|
| Rate for Payer: HFN Commercial |
$4,250.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,464.76
|
| Rate for Payer: Multiplan Commercial |
$3,695.74
|
| Rate for Payer: NAPHCARE Commercial |
$2,771.81
|
| Rate for Payer: Preferred Network Access Commercial |
$4,250.11
|
| Rate for Payer: Quartz Beloit One Network |
$2,263.64
|
| Rate for Payer: Quartz Commercial |
$3,002.79
|
| Rate for Payer: Quartz Medicare Advantage |
$2,771.81
|
| Rate for Payer: The Alliance Commercial |
$2,309.84
|
| Rate for Payer: WEA Trust Commercial |
$2,540.82
|
| Rate for Payer: WPS Commercial |
$3,421.67
|
|
|
SCREW TENODESIS 4.0 X 10MM W DISP DRIVER AR-1540CDS
|
Facility
|
IP
|
$4,442.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5611626
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,263.64 |
| Max. Negotiated Rate |
$4,250.11 |
| Rate for Payer: Aetna Commercial |
$4,157.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,972.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,448.43
|
| Rate for Payer: Cash Price |
$1,332.60
|
| Rate for Payer: Cigna Commercial |
$4,250.11
|
| Rate for Payer: Health EOS Commercial |
$4,111.52
|
| Rate for Payer: HFN Commercial |
$4,250.11
|
| Rate for Payer: Multiplan Commercial |
$3,695.74
|
| Rate for Payer: Preferred Network Access Commercial |
$4,250.11
|
| Rate for Payer: Quartz Beloit One Network |
$2,263.64
|
| Rate for Payer: Quartz Commercial |
$2,771.81
|
| Rate for Payer: WEA Trust Commercial |
$2,540.82
|
| Rate for Payer: WPS Commercial |
$3,421.67
|
|
|
SCREW TENODESIS 4.75 X 15MM PEEK VENTED AR-1547PS
|
Facility
|
IP
|
$4,787.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5107207
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,439.46 |
| Max. Negotiated Rate |
$4,580.20 |
| Rate for Payer: Aetna Commercial |
$4,480.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,281.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,638.59
|
| Rate for Payer: Cash Price |
$1,436.10
|
| Rate for Payer: Cigna Commercial |
$4,580.20
|
| Rate for Payer: Health EOS Commercial |
$4,430.85
|
| Rate for Payer: HFN Commercial |
$4,580.20
|
| Rate for Payer: Multiplan Commercial |
$3,982.78
|
| Rate for Payer: Preferred Network Access Commercial |
$4,580.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,439.46
|
| Rate for Payer: Quartz Commercial |
$2,987.09
|
| Rate for Payer: WEA Trust Commercial |
$2,738.16
|
| Rate for Payer: WPS Commercial |
$3,687.43
|
|
|
SCREW TENODESIS 4.75 X 15MM PEEK VENTED AR-1547PS
|
Facility
|
OP
|
$4,787.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5107207
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,393.97 |
| Max. Negotiated Rate |
$4,580.20 |
| Rate for Payer: Aetna Commercial |
$4,480.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,281.49
|
| Rate for Payer: Aetna Managed Medicare |
$1,393.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,236.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,489.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,389.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,638.59
|
| Rate for Payer: Cash Price |
$1,436.10
|
| Rate for Payer: Cigna Commercial |
$4,580.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,786.03
|
| Rate for Payer: Health EOS Commercial |
$4,430.85
|
| Rate for Payer: HFN Commercial |
$4,580.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,733.86
|
| Rate for Payer: Multiplan Commercial |
$3,982.78
|
| Rate for Payer: NAPHCARE Commercial |
$2,987.09
|
| Rate for Payer: Preferred Network Access Commercial |
$4,580.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,439.46
|
| Rate for Payer: Quartz Commercial |
$3,236.01
|
| Rate for Payer: Quartz Medicare Advantage |
$2,987.09
|
| Rate for Payer: The Alliance Commercial |
$2,489.24
|
| Rate for Payer: WEA Trust Commercial |
$2,738.16
|
| Rate for Payer: WPS Commercial |
$3,687.43
|
|
|
SCREW TENODESIS 4.75 X 15MM W DISP DRIVER PACK AR-1547CDS
|
Facility
|
OP
|
$4,620.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5583391
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,345.34 |
| Max. Negotiated Rate |
$4,420.42 |
| Rate for Payer: Aetna Commercial |
$4,324.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,132.13
|
| Rate for Payer: Aetna Managed Medicare |
$1,345.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,123.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,402.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,306.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,546.54
|
| Rate for Payer: Cash Price |
$1,386.00
|
| Rate for Payer: Cigna Commercial |
$4,420.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,688.84
|
| Rate for Payer: Health EOS Commercial |
$4,276.27
|
| Rate for Payer: HFN Commercial |
$4,420.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,603.60
|
| Rate for Payer: Multiplan Commercial |
$3,843.84
|
| Rate for Payer: NAPHCARE Commercial |
$2,882.88
|
| Rate for Payer: Preferred Network Access Commercial |
$4,420.42
|
| Rate for Payer: Quartz Beloit One Network |
$2,354.35
|
| Rate for Payer: Quartz Commercial |
$3,123.12
|
| Rate for Payer: Quartz Medicare Advantage |
$2,882.88
|
| Rate for Payer: The Alliance Commercial |
$2,402.40
|
| Rate for Payer: WEA Trust Commercial |
$2,642.64
|
| Rate for Payer: WPS Commercial |
$3,558.79
|
|
