|
SCREW TENODESIS 4.75 X 15MM W DISP DRIVER PACK AR-1547CDS
|
Facility
|
IP
|
$4,620.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5583391
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,354.35 |
| 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: 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: Health EOS Commercial |
$4,276.27
|
| Rate for Payer: HFN Commercial |
$4,420.42
|
| Rate for Payer: Multiplan Commercial |
$3,843.84
|
| 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 |
$2,882.88
|
| Rate for Payer: WEA Trust Commercial |
$2,642.64
|
| Rate for Payer: WPS Commercial |
$3,558.79
|
|
|
SCREW TENODESIS 5.5 X 15MM PEEK AR-1655PS
|
Facility
|
IP
|
$4,174.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5797643
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,127.07 |
| Max. Negotiated Rate |
$3,993.68 |
| Rate for Payer: Aetna Commercial |
$3,906.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,733.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,300.71
|
| Rate for Payer: Cash Price |
$1,252.20
|
| Rate for Payer: Cigna Commercial |
$3,993.68
|
| Rate for Payer: Health EOS Commercial |
$3,863.45
|
| Rate for Payer: HFN Commercial |
$3,993.68
|
| Rate for Payer: Multiplan Commercial |
$3,472.77
|
| Rate for Payer: Preferred Network Access Commercial |
$3,993.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,127.07
|
| Rate for Payer: Quartz Commercial |
$2,604.58
|
| Rate for Payer: WEA Trust Commercial |
$2,387.53
|
| Rate for Payer: WPS Commercial |
$3,215.23
|
|
|
SCREW TENODESIS 5.5 X 15MM PEEK AR-1655PS
|
Facility
|
OP
|
$4,174.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5797643
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,215.47 |
| Max. Negotiated Rate |
$3,993.68 |
| Rate for Payer: Aetna Commercial |
$3,906.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,733.23
|
| Rate for Payer: Aetna Managed Medicare |
$1,215.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,821.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,170.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,083.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,300.71
|
| Rate for Payer: Cash Price |
$1,252.20
|
| Rate for Payer: Cigna Commercial |
$3,993.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,429.27
|
| Rate for Payer: Health EOS Commercial |
$3,863.45
|
| Rate for Payer: HFN Commercial |
$3,993.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,255.72
|
| Rate for Payer: Multiplan Commercial |
$3,472.77
|
| Rate for Payer: NAPHCARE Commercial |
$2,604.58
|
| Rate for Payer: Preferred Network Access Commercial |
$3,993.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,127.07
|
| Rate for Payer: Quartz Commercial |
$2,821.62
|
| Rate for Payer: Quartz Medicare Advantage |
$2,604.58
|
| Rate for Payer: The Alliance Commercial |
$2,170.48
|
| Rate for Payer: WEA Trust Commercial |
$2,387.53
|
| Rate for Payer: WPS Commercial |
$3,215.23
|
|
|
SCREW TENODESIS 6.25 X 15MM PEEK VENTED AR-1562PS
|
Facility
|
OP
|
$4,787.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5179292
|
|
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 6.25 X 15MM PEEK VENTED AR-1562PS
|
Facility
|
IP
|
$4,787.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5179292
|
|
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 6.25 X 15MM WITH DISP DRIVER AR-1562CDS
|
Facility
|
OP
|
$7,180.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5787711
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,090.82 |
| Max. Negotiated Rate |
$6,869.82 |
| Rate for Payer: Aetna Commercial |
$6,720.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,421.79
|
| Rate for Payer: Aetna Managed Medicare |
$2,090.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,853.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,733.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,584.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,957.62
|
| Rate for Payer: Cash Price |
$2,154.00
|
| Rate for Payer: Cigna Commercial |
$6,869.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,178.76
|
| Rate for Payer: Health EOS Commercial |
$6,645.81
|
| Rate for Payer: HFN Commercial |
$6,869.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,600.40
|
| Rate for Payer: Multiplan Commercial |
$5,973.76
|
| Rate for Payer: NAPHCARE Commercial |
$4,480.32
|
| Rate for Payer: Preferred Network Access Commercial |
$6,869.82
|
| Rate for Payer: Quartz Beloit One Network |
$3,658.93
|
| Rate for Payer: Quartz Commercial |
$4,853.68
|
| Rate for Payer: Quartz Medicare Advantage |
$4,480.32
|
| Rate for Payer: The Alliance Commercial |
$3,733.60
|
| Rate for Payer: WEA Trust Commercial |
$4,106.96
|
| Rate for Payer: WPS Commercial |
$5,530.75
|
|
|
SCREW TENODESIS 6.25 X 15MM WITH DISP DRIVER AR-1562CDS
|
Facility
|
IP
|
$7,180.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5787711
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,658.93 |
| Max. Negotiated Rate |
$6,869.82 |
| Rate for Payer: Aetna Commercial |
$6,720.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,421.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,957.62
|
| Rate for Payer: Cash Price |
$2,154.00
|
| Rate for Payer: Cigna Commercial |
$6,869.82
|
| Rate for Payer: Health EOS Commercial |
$6,645.81
|
| Rate for Payer: HFN Commercial |
$6,869.82
|
| Rate for Payer: Multiplan Commercial |
$5,973.76
|
| Rate for Payer: Preferred Network Access Commercial |
$6,869.82
|
| Rate for Payer: Quartz Beloit One Network |
$3,658.93
|
| Rate for Payer: Quartz Commercial |
$4,480.32
|
| Rate for Payer: WEA Trust Commercial |
$4,106.96
|
| Rate for Payer: WPS Commercial |
$5,530.75
|
|
|
SCREW TENODESIS 7.0 X 10MM BIOCOMPOSITE AR-1670BC
|
Facility
|
IP
|
$5,042.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5617623
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,569.40 |
| Max. Negotiated Rate |
$4,824.19 |
| Rate for Payer: Aetna Commercial |
$4,719.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,509.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,779.15
|
| Rate for Payer: Cash Price |
$1,512.60
|
| Rate for Payer: Cigna Commercial |
$4,824.19
|
| Rate for Payer: Health EOS Commercial |
$4,666.88
|
| Rate for Payer: HFN Commercial |
$4,824.19
|
| Rate for Payer: Multiplan Commercial |
$4,194.94
|
| Rate for Payer: Preferred Network Access Commercial |
$4,824.19
|
| Rate for Payer: Quartz Beloit One Network |
$2,569.40
|
| Rate for Payer: Quartz Commercial |
$3,146.21
|
| Rate for Payer: WEA Trust Commercial |
$2,884.02
|
| Rate for Payer: WPS Commercial |
$3,883.85
|
|
|
SCREW TENODESIS 7.0 X 10MM BIOCOMPOSITE AR-1670BC
|
Facility
|
OP
|
$5,042.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5617623
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,468.23 |
| Max. Negotiated Rate |
$4,824.19 |
| Rate for Payer: Aetna Commercial |
$4,719.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,509.56
|
| Rate for Payer: Aetna Managed Medicare |
$1,468.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,408.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,621.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,516.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,779.15
|
| Rate for Payer: Cash Price |
$1,512.60
|
| Rate for Payer: Cigna Commercial |
$4,824.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,934.44
|
| Rate for Payer: Health EOS Commercial |
$4,666.88
|
| Rate for Payer: HFN Commercial |
$4,824.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,932.76
|
| Rate for Payer: Multiplan Commercial |
$4,194.94
|
| Rate for Payer: NAPHCARE Commercial |
$3,146.21
|
| Rate for Payer: Preferred Network Access Commercial |
$4,824.19
|
| Rate for Payer: Quartz Beloit One Network |
$2,569.40
|
| Rate for Payer: Quartz Commercial |
$3,408.39
|
| Rate for Payer: Quartz Medicare Advantage |
$3,146.21
|
| Rate for Payer: The Alliance Commercial |
$2,621.84
|
| Rate for Payer: WEA Trust Commercial |
$2,884.02
|
| Rate for Payer: WPS Commercial |
$3,883.85
|
|
|
SCREW TFN 11MM X 105MM 04.032.105S
|
Facility
|
OP
|
$5,041.00
|
|
| Hospital Charge Code |
3563494
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,467.94 |
| Max. Negotiated Rate |
$4,823.23 |
| Rate for Payer: Aetna Commercial |
$4,718.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,508.67
|
| Rate for Payer: Aetna Managed Medicare |
$1,467.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,407.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,621.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,516.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,778.60
|
| Rate for Payer: Cash Price |
$1,512.30
|
| Rate for Payer: Cigna Commercial |
$4,823.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,933.86
|
| Rate for Payer: Health EOS Commercial |
$4,665.95
|
| Rate for Payer: HFN Commercial |
$4,823.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,931.98
|
| Rate for Payer: Multiplan Commercial |
$4,194.11
|
| Rate for Payer: NAPHCARE Commercial |
$3,145.58
|
| Rate for Payer: Preferred Network Access Commercial |
$4,823.23
|
| Rate for Payer: Quartz Beloit One Network |
$2,568.89
|
| Rate for Payer: Quartz Commercial |
$3,407.72
|
| Rate for Payer: Quartz Medicare Advantage |
$3,145.58
|
| Rate for Payer: The Alliance Commercial |
$2,621.32
|
| Rate for Payer: WEA Trust Commercial |
$2,883.45
|
| Rate for Payer: WPS Commercial |
$3,883.08
|
|
|
SCREW TFN 11MM X 105MM 04.032.105S
|
Facility
|
IP
|
$5,041.00
|
|
| Hospital Charge Code |
3563494
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,568.89 |
| Max. Negotiated Rate |
$4,823.23 |
| Rate for Payer: Aetna Commercial |
$4,718.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,508.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,778.60
|
| Rate for Payer: Cash Price |
$1,512.30
|
| Rate for Payer: Cigna Commercial |
$4,823.23
|
| Rate for Payer: Health EOS Commercial |
$4,665.95
|
| Rate for Payer: HFN Commercial |
$4,823.23
|
| Rate for Payer: Multiplan Commercial |
$4,194.11
|
| Rate for Payer: Preferred Network Access Commercial |
$4,823.23
|
| Rate for Payer: Quartz Beloit One Network |
$2,568.89
|
| Rate for Payer: Quartz Commercial |
$3,145.58
|
| Rate for Payer: WEA Trust Commercial |
$2,883.45
|
| Rate for Payer: WPS Commercial |
$3,883.08
|
|
|
SCREW TI LOCKING 4.0MM X 42MM 04.005.432S
|
Facility
|
IP
|
$1,968.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4208659
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,002.89 |
| Max. Negotiated Rate |
$1,882.98 |
| Rate for Payer: Aetna Commercial |
$1,842.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,760.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,084.76
|
| Rate for Payer: Cash Price |
$590.40
|
| Rate for Payer: Cigna Commercial |
$1,882.98
|
| Rate for Payer: Health EOS Commercial |
$1,821.58
|
| Rate for Payer: HFN Commercial |
$1,882.98
|
| Rate for Payer: Multiplan Commercial |
$1,637.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,882.98
|
| Rate for Payer: Quartz Beloit One Network |
$1,002.89
|
| Rate for Payer: Quartz Commercial |
$1,228.03
|
| Rate for Payer: WEA Trust Commercial |
$1,125.70
|
| Rate for Payer: WPS Commercial |
$1,515.95
|
|
|
SCREW TI LOCKING 4.0MM X 42MM 04.005.432S
|
Facility
|
OP
|
$1,968.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4208659
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$573.08 |
| Max. Negotiated Rate |
$1,882.98 |
| Rate for Payer: Aetna Commercial |
$1,842.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,760.18
|
| Rate for Payer: Aetna Managed Medicare |
$573.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,330.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,023.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$982.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,084.76
|
| Rate for Payer: Cash Price |
$590.40
|
| Rate for Payer: Cigna Commercial |
$1,882.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,145.38
|
| Rate for Payer: Health EOS Commercial |
$1,821.58
|
| Rate for Payer: HFN Commercial |
$1,882.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,535.04
|
| Rate for Payer: Multiplan Commercial |
$1,637.38
|
| Rate for Payer: NAPHCARE Commercial |
$1,228.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,882.98
|
| Rate for Payer: Quartz Beloit One Network |
$1,002.89
|
| Rate for Payer: Quartz Commercial |
$1,330.37
|
| Rate for Payer: Quartz Medicare Advantage |
$1,228.03
|
| Rate for Payer: The Alliance Commercial |
$1,023.36
|
| Rate for Payer: WEA Trust Commercial |
$1,125.70
|
| Rate for Payer: WPS Commercial |
$1,515.95
|
|
|
SCREW TI LOCKING 4.0MM X 54MM 04.005.444S
|
Facility
|
OP
|
$1,968.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4208658
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$573.08 |
| Max. Negotiated Rate |
$1,882.98 |
| Rate for Payer: Aetna Commercial |
$1,842.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,760.18
|
| Rate for Payer: Aetna Managed Medicare |
$573.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,330.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,023.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$982.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,084.76
|
| Rate for Payer: Cash Price |
$590.40
|
| Rate for Payer: Cigna Commercial |
$1,882.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,145.38
|
| Rate for Payer: Health EOS Commercial |
$1,821.58
|
| Rate for Payer: HFN Commercial |
$1,882.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,535.04
|
| Rate for Payer: Multiplan Commercial |
$1,637.38
|
| Rate for Payer: NAPHCARE Commercial |
$1,228.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,882.98
|
| Rate for Payer: Quartz Beloit One Network |
$1,002.89
|
| Rate for Payer: Quartz Commercial |
$1,330.37
|
| Rate for Payer: Quartz Medicare Advantage |
$1,228.03
|
| Rate for Payer: The Alliance Commercial |
$1,023.36
|
| Rate for Payer: WEA Trust Commercial |
$1,125.70
|
| Rate for Payer: WPS Commercial |
$1,515.95
|
|
|
SCREW TI LOCKING 4.0MM X 54MM 04.005.444S
|
Facility
|
IP
|
$1,968.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4208658
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,002.89 |
| Max. Negotiated Rate |
$1,882.98 |
| Rate for Payer: Aetna Commercial |
$1,842.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,760.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,084.76
|
| Rate for Payer: Cash Price |
$590.40
|
| Rate for Payer: Cigna Commercial |
$1,882.98
|
| Rate for Payer: Health EOS Commercial |
$1,821.58
|
| Rate for Payer: HFN Commercial |
$1,882.98
|
| Rate for Payer: Multiplan Commercial |
$1,637.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,882.98
|
| Rate for Payer: Quartz Beloit One Network |
$1,002.89
|
| Rate for Payer: Quartz Commercial |
$1,228.03
|
| Rate for Payer: WEA Trust Commercial |
$1,125.70
|
| Rate for Payer: WPS Commercial |
$1,515.95
|
|
|
SCREW TI RECON 6.5X100
|
Facility
|
OP
|
$2,810.00
|
|
| Hospital Charge Code |
2966566
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$818.27 |
| Max. Negotiated Rate |
$2,688.61 |
| Rate for Payer: Aetna Commercial |
$2,630.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,513.26
|
| Rate for Payer: Aetna Managed Medicare |
$818.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,899.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,461.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,402.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,548.87
|
| Rate for Payer: Cash Price |
$843.00
|
| Rate for Payer: Cigna Commercial |
$2,688.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,635.42
|
| Rate for Payer: Health EOS Commercial |
$2,600.94
|
| Rate for Payer: HFN Commercial |
$2,688.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,191.80
|
| Rate for Payer: Multiplan Commercial |
$2,337.92
|
| Rate for Payer: NAPHCARE Commercial |
$1,753.44
|
| Rate for Payer: Preferred Network Access Commercial |
$2,688.61
|
| Rate for Payer: Quartz Beloit One Network |
$1,431.98
|
| Rate for Payer: Quartz Commercial |
$1,899.56
|
| Rate for Payer: Quartz Medicare Advantage |
$1,753.44
|
| Rate for Payer: The Alliance Commercial |
$1,461.20
|
| Rate for Payer: WEA Trust Commercial |
$1,607.32
|
| Rate for Payer: WPS Commercial |
$2,164.54
|
|
|
SCREW TI RECON 6.5X100
|
Facility
|
IP
|
$2,810.00
|
|
| Hospital Charge Code |
2966566
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,431.98 |
| Max. Negotiated Rate |
$2,688.61 |
| Rate for Payer: Aetna Commercial |
$2,630.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,513.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,548.87
|
| Rate for Payer: Cash Price |
$843.00
|
| Rate for Payer: Cigna Commercial |
$2,688.61
|
| Rate for Payer: Health EOS Commercial |
$2,600.94
|
| Rate for Payer: HFN Commercial |
$2,688.61
|
| Rate for Payer: Multiplan Commercial |
$2,337.92
|
| Rate for Payer: Preferred Network Access Commercial |
$2,688.61
|
| Rate for Payer: Quartz Beloit One Network |
$1,431.98
|
| Rate for Payer: Quartz Commercial |
$1,753.44
|
| Rate for Payer: WEA Trust Commercial |
$1,607.32
|
| Rate for Payer: WPS Commercial |
$2,164.54
|
|
|
SCREW TI RECON 6.5X110
|
Facility
|
OP
|
$2,810.00
|
|
| Hospital Charge Code |
2966567
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$818.27 |
| Max. Negotiated Rate |
$2,688.61 |
| Rate for Payer: Aetna Commercial |
$2,630.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,513.26
|
| Rate for Payer: Aetna Managed Medicare |
$818.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,899.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,461.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,402.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,548.87
|
| Rate for Payer: Cash Price |
$843.00
|
| Rate for Payer: Cigna Commercial |
$2,688.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,635.42
|
| Rate for Payer: Health EOS Commercial |
$2,600.94
|
| Rate for Payer: HFN Commercial |
$2,688.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,191.80
|
| Rate for Payer: Multiplan Commercial |
$2,337.92
|
| Rate for Payer: NAPHCARE Commercial |
$1,753.44
|
| Rate for Payer: Preferred Network Access Commercial |
$2,688.61
|
| Rate for Payer: Quartz Beloit One Network |
$1,431.98
|
| Rate for Payer: Quartz Commercial |
$1,899.56
|
| Rate for Payer: Quartz Medicare Advantage |
$1,753.44
|
| Rate for Payer: The Alliance Commercial |
$1,461.20
|
| Rate for Payer: WEA Trust Commercial |
$1,607.32
|
| Rate for Payer: WPS Commercial |
$2,164.54
|
|
|
SCREW TI RECON 6.5X110
|
Facility
|
IP
|
$2,810.00
|
|
| Hospital Charge Code |
2966567
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,431.98 |
| Max. Negotiated Rate |
$2,688.61 |
| Rate for Payer: Aetna Commercial |
$2,630.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,513.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,548.87
|
| Rate for Payer: Cash Price |
$843.00
|
| Rate for Payer: Cigna Commercial |
$2,688.61
|
| Rate for Payer: Health EOS Commercial |
$2,600.94
|
| Rate for Payer: HFN Commercial |
$2,688.61
|
| Rate for Payer: Multiplan Commercial |
$2,337.92
|
| Rate for Payer: Preferred Network Access Commercial |
$2,688.61
|
| Rate for Payer: Quartz Beloit One Network |
$1,431.98
|
| Rate for Payer: Quartz Commercial |
$1,753.44
|
| Rate for Payer: WEA Trust Commercial |
$1,607.32
|
| Rate for Payer: WPS Commercial |
$2,164.54
|
|
|
SCREW TITANIUM 4.0x20MM CANC
|
Facility
|
OP
|
$1,099.00
|
|
| Hospital Charge Code |
2966568
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$320.03 |
| Max. Negotiated Rate |
$1,051.52 |
| Rate for Payer: Aetna Commercial |
$1,028.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$982.95
|
| Rate for Payer: Aetna Managed Medicare |
$320.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$742.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$571.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$548.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$605.77
|
| Rate for Payer: Cash Price |
$329.70
|
| Rate for Payer: Cigna Commercial |
$1,051.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$639.62
|
| Rate for Payer: Health EOS Commercial |
$1,017.23
|
| Rate for Payer: HFN Commercial |
$1,051.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$857.22
|
| Rate for Payer: Multiplan Commercial |
$914.37
|
| Rate for Payer: NAPHCARE Commercial |
$685.78
|
| Rate for Payer: Preferred Network Access Commercial |
$1,051.52
|
| Rate for Payer: Quartz Beloit One Network |
$560.05
|
| Rate for Payer: Quartz Commercial |
$742.92
|
| Rate for Payer: Quartz Medicare Advantage |
$685.78
|
| Rate for Payer: The Alliance Commercial |
$571.48
|
| Rate for Payer: WEA Trust Commercial |
$628.63
|
| Rate for Payer: WPS Commercial |
$846.56
|
|
|
SCREW TITANIUM 4.0x20MM CANC
|
Facility
|
IP
|
$1,099.00
|
|
| Hospital Charge Code |
2966568
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$560.05 |
| Max. Negotiated Rate |
$1,051.52 |
| Rate for Payer: Aetna Commercial |
$1,028.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$982.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$605.77
|
| Rate for Payer: Cash Price |
$329.70
|
| Rate for Payer: Cigna Commercial |
$1,051.52
|
| Rate for Payer: Health EOS Commercial |
$1,017.23
|
| Rate for Payer: HFN Commercial |
$1,051.52
|
| Rate for Payer: Multiplan Commercial |
$914.37
|
| Rate for Payer: Preferred Network Access Commercial |
$1,051.52
|
| Rate for Payer: Quartz Beloit One Network |
$560.05
|
| Rate for Payer: Quartz Commercial |
$685.78
|
| Rate for Payer: WEA Trust Commercial |
$628.63
|
| Rate for Payer: WPS Commercial |
$846.56
|
|
|
SCREW TITANIUM 5.0x36 CANCELLO 71755036
|
Facility
|
IP
|
$2,340.00
|
|
| Hospital Charge Code |
2966042
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,192.46 |
| Max. Negotiated Rate |
$2,238.91 |
| Rate for Payer: Aetna Commercial |
$2,190.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,092.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,289.81
|
| Rate for Payer: Cash Price |
$702.00
|
| Rate for Payer: Cigna Commercial |
$2,238.91
|
| Rate for Payer: Health EOS Commercial |
$2,165.90
|
| Rate for Payer: HFN Commercial |
$2,238.91
|
| Rate for Payer: Multiplan Commercial |
$1,946.88
|
| Rate for Payer: Preferred Network Access Commercial |
$2,238.91
|
| Rate for Payer: Quartz Beloit One Network |
$1,192.46
|
| Rate for Payer: Quartz Commercial |
$1,460.16
|
| Rate for Payer: WEA Trust Commercial |
$1,338.48
|
| Rate for Payer: WPS Commercial |
$1,802.50
|
|
|
SCREW TITANIUM 5.0x36 CANCELLO 71755036
|
Facility
|
OP
|
$2,340.00
|
|
| Hospital Charge Code |
2966042
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$681.41 |
| Max. Negotiated Rate |
$2,238.91 |
| Rate for Payer: Aetna Commercial |
$2,190.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,092.90
|
| Rate for Payer: Aetna Managed Medicare |
$681.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,581.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,216.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,168.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,289.81
|
| Rate for Payer: Cash Price |
$702.00
|
| Rate for Payer: Cigna Commercial |
$2,238.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,361.88
|
| Rate for Payer: Health EOS Commercial |
$2,165.90
|
| Rate for Payer: HFN Commercial |
$2,238.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,825.20
|
| Rate for Payer: Multiplan Commercial |
$1,946.88
|
| Rate for Payer: NAPHCARE Commercial |
$1,460.16
|
| Rate for Payer: Preferred Network Access Commercial |
$2,238.91
|
| Rate for Payer: Quartz Beloit One Network |
$1,192.46
|
| Rate for Payer: Quartz Commercial |
$1,581.84
|
| Rate for Payer: Quartz Medicare Advantage |
$1,460.16
|
| Rate for Payer: The Alliance Commercial |
$1,216.80
|
| Rate for Payer: WEA Trust Commercial |
$1,338.48
|
| Rate for Payer: WPS Commercial |
$1,802.50
|
|
|
SCREW TRANSVERSE LAPIPLASTY 2.5MM SK20
|
Facility
|
IP
|
$6,001.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6181248
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,058.11 |
| Max. Negotiated Rate |
$5,741.76 |
| Rate for Payer: Aetna Commercial |
$5,616.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,367.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,307.75
|
| Rate for Payer: Cash Price |
$1,800.30
|
| Rate for Payer: Cigna Commercial |
$5,741.76
|
| Rate for Payer: Health EOS Commercial |
$5,554.53
|
| Rate for Payer: HFN Commercial |
$5,741.76
|
| Rate for Payer: Multiplan Commercial |
$4,992.83
|
| Rate for Payer: Preferred Network Access Commercial |
$5,741.76
|
| Rate for Payer: Quartz Beloit One Network |
$3,058.11
|
| Rate for Payer: Quartz Commercial |
$3,744.62
|
| Rate for Payer: WEA Trust Commercial |
$3,432.57
|
| Rate for Payer: WPS Commercial |
$4,622.57
|
|
|
SCREW TRANSVERSE LAPIPLASTY 2.5MM SK20
|
Facility
|
OP
|
$6,001.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6181248
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,747.49 |
| Max. Negotiated Rate |
$5,741.76 |
| Rate for Payer: Aetna Commercial |
$5,616.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,367.29
|
| Rate for Payer: Aetna Managed Medicare |
$1,747.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,056.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,120.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,995.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,307.75
|
| Rate for Payer: Cash Price |
$1,800.30
|
| Rate for Payer: Cigna Commercial |
$5,741.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,492.58
|
| Rate for Payer: Health EOS Commercial |
$5,554.53
|
| Rate for Payer: HFN Commercial |
$5,741.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,680.78
|
| Rate for Payer: Multiplan Commercial |
$4,992.83
|
| Rate for Payer: NAPHCARE Commercial |
$3,744.62
|
| Rate for Payer: Preferred Network Access Commercial |
$5,741.76
|
| Rate for Payer: Quartz Beloit One Network |
$3,058.11
|
| Rate for Payer: Quartz Commercial |
$4,056.68
|
| Rate for Payer: Quartz Medicare Advantage |
$3,744.62
|
| Rate for Payer: The Alliance Commercial |
$3,120.52
|
| Rate for Payer: WEA Trust Commercial |
$3,432.57
|
| Rate for Payer: WPS Commercial |
$4,622.57
|
|
