|
SCREW TRANSVERSE LAPIPLASTY 3.5MM SK19
|
Facility
|
IP
|
$6,491.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767696
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,307.81 |
| Max. Negotiated Rate |
$6,210.59 |
| Rate for Payer: Aetna Commercial |
$6,075.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,805.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,577.84
|
| Rate for Payer: Cash Price |
$1,947.30
|
| Rate for Payer: Cigna Commercial |
$6,210.59
|
| Rate for Payer: Health EOS Commercial |
$6,008.07
|
| Rate for Payer: HFN Commercial |
$6,210.59
|
| Rate for Payer: Multiplan Commercial |
$5,400.51
|
| Rate for Payer: Preferred Network Access Commercial |
$6,210.59
|
| Rate for Payer: Quartz Beloit One Network |
$3,307.81
|
| Rate for Payer: Quartz Commercial |
$4,050.38
|
| Rate for Payer: WEA Trust Commercial |
$3,712.85
|
| Rate for Payer: WPS Commercial |
$5,000.02
|
|
|
SCREW TRANSVERSE LAPIPLASTY 3.5MM SK19
|
Facility
|
OP
|
$6,491.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767696
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,890.18 |
| Max. Negotiated Rate |
$6,210.59 |
| Rate for Payer: Aetna Commercial |
$6,075.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,805.55
|
| Rate for Payer: Aetna Managed Medicare |
$1,890.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,387.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,375.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,240.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,577.84
|
| Rate for Payer: Cash Price |
$1,947.30
|
| Rate for Payer: Cigna Commercial |
$6,210.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,777.76
|
| Rate for Payer: Health EOS Commercial |
$6,008.07
|
| Rate for Payer: HFN Commercial |
$6,210.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,062.98
|
| Rate for Payer: Multiplan Commercial |
$5,400.51
|
| Rate for Payer: NAPHCARE Commercial |
$4,050.38
|
| Rate for Payer: Preferred Network Access Commercial |
$6,210.59
|
| Rate for Payer: Quartz Beloit One Network |
$3,307.81
|
| Rate for Payer: Quartz Commercial |
$4,387.92
|
| Rate for Payer: Quartz Medicare Advantage |
$4,050.38
|
| Rate for Payer: The Alliance Commercial |
$3,375.32
|
| Rate for Payer: WEA Trust Commercial |
$3,712.85
|
| Rate for Payer: WPS Commercial |
$5,000.02
|
|
|
SCREW VAL 2.4 X 16MM TI AR-18724V-16
|
Facility
|
OP
|
$1,723.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6165901
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$501.74 |
| Max. Negotiated Rate |
$1,648.57 |
| Rate for Payer: Aetna Commercial |
$1,612.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,541.05
|
| Rate for Payer: Aetna Managed Medicare |
$501.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,164.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$895.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$860.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$949.72
|
| Rate for Payer: Cash Price |
$516.90
|
| Rate for Payer: Cigna Commercial |
$1,648.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,002.79
|
| Rate for Payer: Health EOS Commercial |
$1,594.81
|
| Rate for Payer: HFN Commercial |
$1,648.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,343.94
|
| Rate for Payer: Multiplan Commercial |
$1,433.54
|
| Rate for Payer: NAPHCARE Commercial |
$1,075.15
|
| Rate for Payer: Preferred Network Access Commercial |
$1,648.57
|
| Rate for Payer: Quartz Beloit One Network |
$878.04
|
| Rate for Payer: Quartz Commercial |
$1,164.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,075.15
|
| Rate for Payer: The Alliance Commercial |
$895.96
|
| Rate for Payer: WEA Trust Commercial |
$985.56
|
| Rate for Payer: WPS Commercial |
$1,327.23
|
|
|
SCREW VAL 2.4 X 16MM TI AR-18724V-16
|
Facility
|
IP
|
$1,723.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6165901
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$878.04 |
| Max. Negotiated Rate |
$1,648.57 |
| Rate for Payer: Aetna Commercial |
$1,612.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,541.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$949.72
|
| Rate for Payer: Cash Price |
$516.90
|
| Rate for Payer: Cigna Commercial |
$1,648.57
|
| Rate for Payer: Health EOS Commercial |
$1,594.81
|
| Rate for Payer: HFN Commercial |
$1,648.57
|
| Rate for Payer: Multiplan Commercial |
$1,433.54
|
| Rate for Payer: Preferred Network Access Commercial |
$1,648.57
|
| Rate for Payer: Quartz Beloit One Network |
$878.04
|
| Rate for Payer: Quartz Commercial |
$1,075.15
|
| Rate for Payer: WEA Trust Commercial |
$985.56
|
| Rate for Payer: WPS Commercial |
$1,327.23
|
|
|
SCREW VAL 2.4 X 18MM TI AR-18724V-18
|
Facility
|
OP
|
$1,723.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6165902
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$501.74 |
| Max. Negotiated Rate |
$1,648.57 |
| Rate for Payer: Aetna Commercial |
$1,612.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,541.05
|
| Rate for Payer: Aetna Managed Medicare |
$501.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,164.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$895.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$860.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$949.72
|
| Rate for Payer: Cash Price |
$516.90
|
| Rate for Payer: Cigna Commercial |
$1,648.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,002.79
|
| Rate for Payer: Health EOS Commercial |
$1,594.81
|
| Rate for Payer: HFN Commercial |
$1,648.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,343.94
|
| Rate for Payer: Multiplan Commercial |
$1,433.54
|
| Rate for Payer: NAPHCARE Commercial |
$1,075.15
|
| Rate for Payer: Preferred Network Access Commercial |
$1,648.57
|
| Rate for Payer: Quartz Beloit One Network |
$878.04
|
| Rate for Payer: Quartz Commercial |
$1,164.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,075.15
|
| Rate for Payer: The Alliance Commercial |
$895.96
|
| Rate for Payer: WEA Trust Commercial |
$985.56
|
| Rate for Payer: WPS Commercial |
$1,327.23
|
|
|
SCREW VAL 2.4 X 18MM TI AR-18724V-18
|
Facility
|
IP
|
$1,723.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6165902
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$878.04 |
| Max. Negotiated Rate |
$1,648.57 |
| Rate for Payer: Aetna Commercial |
$1,612.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,541.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$949.72
|
| Rate for Payer: Cash Price |
$516.90
|
| Rate for Payer: Cigna Commercial |
$1,648.57
|
| Rate for Payer: Health EOS Commercial |
$1,594.81
|
| Rate for Payer: HFN Commercial |
$1,648.57
|
| Rate for Payer: Multiplan Commercial |
$1,433.54
|
| Rate for Payer: Preferred Network Access Commercial |
$1,648.57
|
| Rate for Payer: Quartz Beloit One Network |
$878.04
|
| Rate for Payer: Quartz Commercial |
$1,075.15
|
| Rate for Payer: WEA Trust Commercial |
$985.56
|
| Rate for Payer: WPS Commercial |
$1,327.23
|
|
|
SCREW VAL 2.4 X 20MM TI AR-18724V-20
|
Facility
|
IP
|
$1,723.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6165903
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$878.04 |
| Max. Negotiated Rate |
$1,648.57 |
| Rate for Payer: Aetna Commercial |
$1,612.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,541.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$949.72
|
| Rate for Payer: Cash Price |
$516.90
|
| Rate for Payer: Cigna Commercial |
$1,648.57
|
| Rate for Payer: Health EOS Commercial |
$1,594.81
|
| Rate for Payer: HFN Commercial |
$1,648.57
|
| Rate for Payer: Multiplan Commercial |
$1,433.54
|
| Rate for Payer: Preferred Network Access Commercial |
$1,648.57
|
| Rate for Payer: Quartz Beloit One Network |
$878.04
|
| Rate for Payer: Quartz Commercial |
$1,075.15
|
| Rate for Payer: WEA Trust Commercial |
$985.56
|
| Rate for Payer: WPS Commercial |
$1,327.23
|
|
|
SCREW VAL 2.4 X 20MM TI AR-18724V-20
|
Facility
|
OP
|
$1,723.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6165903
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$501.74 |
| Max. Negotiated Rate |
$1,648.57 |
| Rate for Payer: Aetna Commercial |
$1,612.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,541.05
|
| Rate for Payer: Aetna Managed Medicare |
$501.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,164.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$895.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$860.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$949.72
|
| Rate for Payer: Cash Price |
$516.90
|
| Rate for Payer: Cigna Commercial |
$1,648.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,002.79
|
| Rate for Payer: Health EOS Commercial |
$1,594.81
|
| Rate for Payer: HFN Commercial |
$1,648.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,343.94
|
| Rate for Payer: Multiplan Commercial |
$1,433.54
|
| Rate for Payer: NAPHCARE Commercial |
$1,075.15
|
| Rate for Payer: Preferred Network Access Commercial |
$1,648.57
|
| Rate for Payer: Quartz Beloit One Network |
$878.04
|
| Rate for Payer: Quartz Commercial |
$1,164.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,075.15
|
| Rate for Payer: The Alliance Commercial |
$895.96
|
| Rate for Payer: WEA Trust Commercial |
$985.56
|
| Rate for Payer: WPS Commercial |
$1,327.23
|
|
|
SCREW VAL 2.7 X 18MM COLINK AFX P72 ST218
|
Facility
|
OP
|
$2,105.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6172087
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.98 |
| Max. Negotiated Rate |
$2,014.06 |
| Rate for Payer: Aetna Commercial |
$1,970.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,882.71
|
| Rate for Payer: Aetna Managed Medicare |
$612.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,422.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,094.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,050.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,160.28
|
| Rate for Payer: Cash Price |
$631.50
|
| Rate for Payer: Cigna Commercial |
$2,014.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,225.11
|
| Rate for Payer: Health EOS Commercial |
$1,948.39
|
| Rate for Payer: HFN Commercial |
$2,014.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,641.90
|
| Rate for Payer: Multiplan Commercial |
$1,751.36
|
| Rate for Payer: NAPHCARE Commercial |
$1,313.52
|
| Rate for Payer: Preferred Network Access Commercial |
$2,014.06
|
| Rate for Payer: Quartz Beloit One Network |
$1,072.71
|
| Rate for Payer: Quartz Commercial |
$1,422.98
|
| Rate for Payer: Quartz Medicare Advantage |
$1,313.52
|
| Rate for Payer: The Alliance Commercial |
$1,094.60
|
| Rate for Payer: WEA Trust Commercial |
$1,204.06
|
| Rate for Payer: WPS Commercial |
$1,621.48
|
|
|
SCREW VAL 2.7 X 18MM COLINK AFX P72 ST218
|
Facility
|
IP
|
$2,105.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6172087
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,072.71 |
| Max. Negotiated Rate |
$2,014.06 |
| Rate for Payer: Aetna Commercial |
$1,970.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,882.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,160.28
|
| Rate for Payer: Cash Price |
$631.50
|
| Rate for Payer: Cigna Commercial |
$2,014.06
|
| Rate for Payer: Health EOS Commercial |
$1,948.39
|
| Rate for Payer: HFN Commercial |
$2,014.06
|
| Rate for Payer: Multiplan Commercial |
$1,751.36
|
| Rate for Payer: Preferred Network Access Commercial |
$2,014.06
|
| Rate for Payer: Quartz Beloit One Network |
$1,072.71
|
| Rate for Payer: Quartz Commercial |
$1,313.52
|
| Rate for Payer: WEA Trust Commercial |
$1,204.06
|
| Rate for Payer: WPS Commercial |
$1,621.48
|
|
|
SCREW VAL 4.5 X 40MM OPTILINK ST TI 42.231.240
|
Facility
|
OP
|
$1,830.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6244144
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$532.91 |
| Max. Negotiated Rate |
$1,751.00 |
| Rate for Payer: Aetna Commercial |
$1,712.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,636.81
|
| Rate for Payer: Aetna Managed Medicare |
$532.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,237.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$951.63
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$913.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,008.73
|
| Rate for Payer: Cash Price |
$549.02
|
| Rate for Payer: Cigna Commercial |
$1,751.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,065.09
|
| Rate for Payer: Health EOS Commercial |
$1,693.90
|
| Rate for Payer: HFN Commercial |
$1,751.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,427.45
|
| Rate for Payer: Multiplan Commercial |
$1,522.61
|
| Rate for Payer: NAPHCARE Commercial |
$1,141.96
|
| Rate for Payer: Preferred Network Access Commercial |
$1,751.00
|
| Rate for Payer: Quartz Beloit One Network |
$932.60
|
| Rate for Payer: Quartz Commercial |
$1,237.12
|
| Rate for Payer: Quartz Medicare Advantage |
$1,141.96
|
| Rate for Payer: The Alliance Commercial |
$951.63
|
| Rate for Payer: WEA Trust Commercial |
$1,046.79
|
| Rate for Payer: WPS Commercial |
$1,409.70
|
|
|
SCREW VAL 4.5 X 40MM OPTILINK ST TI 42.231.240
|
Facility
|
IP
|
$1,830.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6244144
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$932.60 |
| Max. Negotiated Rate |
$1,751.00 |
| Rate for Payer: Aetna Commercial |
$1,712.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,636.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,008.73
|
| Rate for Payer: Cash Price |
$549.02
|
| Rate for Payer: Cigna Commercial |
$1,751.00
|
| Rate for Payer: Health EOS Commercial |
$1,693.90
|
| Rate for Payer: HFN Commercial |
$1,751.00
|
| Rate for Payer: Multiplan Commercial |
$1,522.61
|
| Rate for Payer: Preferred Network Access Commercial |
$1,751.00
|
| Rate for Payer: Quartz Beloit One Network |
$932.60
|
| Rate for Payer: Quartz Commercial |
$1,141.96
|
| Rate for Payer: WEA Trust Commercial |
$1,046.79
|
| Rate for Payer: WPS Commercial |
$1,409.70
|
|
|
SCREW VAL 4.5 X 44MM OPTILINK ST TI 42.231.244
|
Facility
|
IP
|
$1,830.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6244145
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$932.60 |
| Max. Negotiated Rate |
$1,751.00 |
| Rate for Payer: Aetna Commercial |
$1,712.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,636.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,008.73
|
| Rate for Payer: Cash Price |
$549.02
|
| Rate for Payer: Cigna Commercial |
$1,751.00
|
| Rate for Payer: Health EOS Commercial |
$1,693.90
|
| Rate for Payer: HFN Commercial |
$1,751.00
|
| Rate for Payer: Multiplan Commercial |
$1,522.61
|
| Rate for Payer: Preferred Network Access Commercial |
$1,751.00
|
| Rate for Payer: Quartz Beloit One Network |
$932.60
|
| Rate for Payer: Quartz Commercial |
$1,141.96
|
| Rate for Payer: WEA Trust Commercial |
$1,046.79
|
| Rate for Payer: WPS Commercial |
$1,409.70
|
|
|
SCREW VAL 4.5 X 44MM OPTILINK ST TI 42.231.244
|
Facility
|
OP
|
$1,830.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6244145
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$532.91 |
| Max. Negotiated Rate |
$1,751.00 |
| Rate for Payer: Aetna Commercial |
$1,712.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,636.81
|
| Rate for Payer: Aetna Managed Medicare |
$532.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,237.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$951.63
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$913.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,008.73
|
| Rate for Payer: Cash Price |
$549.02
|
| Rate for Payer: Cigna Commercial |
$1,751.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,065.09
|
| Rate for Payer: Health EOS Commercial |
$1,693.90
|
| Rate for Payer: HFN Commercial |
$1,751.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,427.45
|
| Rate for Payer: Multiplan Commercial |
$1,522.61
|
| Rate for Payer: NAPHCARE Commercial |
$1,141.96
|
| Rate for Payer: Preferred Network Access Commercial |
$1,751.00
|
| Rate for Payer: Quartz Beloit One Network |
$932.60
|
| Rate for Payer: Quartz Commercial |
$1,237.12
|
| Rate for Payer: Quartz Medicare Advantage |
$1,141.96
|
| Rate for Payer: The Alliance Commercial |
$951.63
|
| Rate for Payer: WEA Trust Commercial |
$1,046.79
|
| Rate for Payer: WPS Commercial |
$1,409.70
|
|
|
SCREW VAL 4.5 X 46MM OPTILINK ST TI 42.231.246
|
Facility
|
OP
|
$1,830.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6244146
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$532.91 |
| Max. Negotiated Rate |
$1,751.00 |
| Rate for Payer: Aetna Commercial |
$1,712.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,636.81
|
| Rate for Payer: Aetna Managed Medicare |
$532.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,237.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$951.63
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$913.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,008.73
|
| Rate for Payer: Cash Price |
$549.02
|
| Rate for Payer: Cigna Commercial |
$1,751.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,065.09
|
| Rate for Payer: Health EOS Commercial |
$1,693.90
|
| Rate for Payer: HFN Commercial |
$1,751.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,427.45
|
| Rate for Payer: Multiplan Commercial |
$1,522.61
|
| Rate for Payer: NAPHCARE Commercial |
$1,141.96
|
| Rate for Payer: Preferred Network Access Commercial |
$1,751.00
|
| Rate for Payer: Quartz Beloit One Network |
$932.60
|
| Rate for Payer: Quartz Commercial |
$1,237.12
|
| Rate for Payer: Quartz Medicare Advantage |
$1,141.96
|
| Rate for Payer: The Alliance Commercial |
$951.63
|
| Rate for Payer: WEA Trust Commercial |
$1,046.79
|
| Rate for Payer: WPS Commercial |
$1,409.70
|
|
|
SCREW VAL 4.5 X 46MM OPTILINK ST TI 42.231.246
|
Facility
|
IP
|
$1,830.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6244146
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$932.60 |
| Max. Negotiated Rate |
$1,751.00 |
| Rate for Payer: Aetna Commercial |
$1,712.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,636.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,008.73
|
| Rate for Payer: Cash Price |
$549.02
|
| Rate for Payer: Cigna Commercial |
$1,751.00
|
| Rate for Payer: Health EOS Commercial |
$1,693.90
|
| Rate for Payer: HFN Commercial |
$1,751.00
|
| Rate for Payer: Multiplan Commercial |
$1,522.61
|
| Rate for Payer: Preferred Network Access Commercial |
$1,751.00
|
| Rate for Payer: Quartz Beloit One Network |
$932.60
|
| Rate for Payer: Quartz Commercial |
$1,141.96
|
| Rate for Payer: WEA Trust Commercial |
$1,046.79
|
| Rate for Payer: WPS Commercial |
$1,409.70
|
|
|
SCREW VAL 4.5 X 60MM OPTILINK ST TI 42.231.260
|
Facility
|
IP
|
$2,257.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6169853
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,150.17 |
| Max. Negotiated Rate |
$2,159.50 |
| Rate for Payer: Aetna Commercial |
$2,112.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,018.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,244.06
|
| Rate for Payer: Cash Price |
$677.10
|
| Rate for Payer: Cigna Commercial |
$2,159.50
|
| Rate for Payer: Health EOS Commercial |
$2,089.08
|
| Rate for Payer: HFN Commercial |
$2,159.50
|
| Rate for Payer: Multiplan Commercial |
$1,877.82
|
| Rate for Payer: Preferred Network Access Commercial |
$2,159.50
|
| Rate for Payer: Quartz Beloit One Network |
$1,150.17
|
| Rate for Payer: Quartz Commercial |
$1,408.37
|
| Rate for Payer: WEA Trust Commercial |
$1,291.00
|
| Rate for Payer: WPS Commercial |
$1,738.57
|
|
|
SCREW VAL 4.5 X 60MM OPTILINK ST TI 42.231.260
|
Facility
|
OP
|
$2,257.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6169853
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$657.24 |
| Max. Negotiated Rate |
$2,159.50 |
| Rate for Payer: Aetna Commercial |
$2,112.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,018.66
|
| Rate for Payer: Aetna Managed Medicare |
$657.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,525.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,173.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,126.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,244.06
|
| Rate for Payer: Cash Price |
$677.10
|
| Rate for Payer: Cigna Commercial |
$2,159.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,313.57
|
| Rate for Payer: Health EOS Commercial |
$2,089.08
|
| Rate for Payer: HFN Commercial |
$2,159.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,760.46
|
| Rate for Payer: Multiplan Commercial |
$1,877.82
|
| Rate for Payer: NAPHCARE Commercial |
$1,408.37
|
| Rate for Payer: Preferred Network Access Commercial |
$2,159.50
|
| Rate for Payer: Quartz Beloit One Network |
$1,150.17
|
| Rate for Payer: Quartz Commercial |
$1,525.73
|
| Rate for Payer: Quartz Medicare Advantage |
$1,408.37
|
| Rate for Payer: The Alliance Commercial |
$1,173.64
|
| Rate for Payer: WEA Trust Commercial |
$1,291.00
|
| Rate for Payer: WPS Commercial |
$1,738.57
|
|
|
SCREW VAL 4.5 X 65MM OPTILINK ST TI 42.231.265
|
Facility
|
OP
|
$2,257.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6169851
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$657.24 |
| Max. Negotiated Rate |
$2,159.50 |
| Rate for Payer: Aetna Commercial |
$2,112.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,018.66
|
| Rate for Payer: Aetna Managed Medicare |
$657.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,525.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,173.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,126.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,244.06
|
| Rate for Payer: Cash Price |
$677.10
|
| Rate for Payer: Cigna Commercial |
$2,159.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,313.57
|
| Rate for Payer: Health EOS Commercial |
$2,089.08
|
| Rate for Payer: HFN Commercial |
$2,159.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,760.46
|
| Rate for Payer: Multiplan Commercial |
$1,877.82
|
| Rate for Payer: NAPHCARE Commercial |
$1,408.37
|
| Rate for Payer: Preferred Network Access Commercial |
$2,159.50
|
| Rate for Payer: Quartz Beloit One Network |
$1,150.17
|
| Rate for Payer: Quartz Commercial |
$1,525.73
|
| Rate for Payer: Quartz Medicare Advantage |
$1,408.37
|
| Rate for Payer: The Alliance Commercial |
$1,173.64
|
| Rate for Payer: WEA Trust Commercial |
$1,291.00
|
| Rate for Payer: WPS Commercial |
$1,738.57
|
|
|
SCREW VAL 4.5 X 65MM OPTILINK ST TI 42.231.265
|
Facility
|
IP
|
$2,257.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6169851
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,150.17 |
| Max. Negotiated Rate |
$2,159.50 |
| Rate for Payer: Aetna Commercial |
$2,112.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,018.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,244.06
|
| Rate for Payer: Cash Price |
$677.10
|
| Rate for Payer: Cigna Commercial |
$2,159.50
|
| Rate for Payer: Health EOS Commercial |
$2,089.08
|
| Rate for Payer: HFN Commercial |
$2,159.50
|
| Rate for Payer: Multiplan Commercial |
$1,877.82
|
| Rate for Payer: Preferred Network Access Commercial |
$2,159.50
|
| Rate for Payer: Quartz Beloit One Network |
$1,150.17
|
| Rate for Payer: Quartz Commercial |
$1,408.37
|
| Rate for Payer: WEA Trust Commercial |
$1,291.00
|
| Rate for Payer: WPS Commercial |
$1,738.57
|
|
|
SCREW VAL 4.5 X 70MM OPTILINK ST TI 42.231.270
|
Facility
|
IP
|
$1,903.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6226142
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$969.77 |
| Max. Negotiated Rate |
$1,820.79 |
| Rate for Payer: Aetna Commercial |
$1,781.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,702.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,048.93
|
| Rate for Payer: Cash Price |
$570.90
|
| Rate for Payer: Cigna Commercial |
$1,820.79
|
| Rate for Payer: Health EOS Commercial |
$1,761.42
|
| Rate for Payer: HFN Commercial |
$1,820.79
|
| Rate for Payer: Multiplan Commercial |
$1,583.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,820.79
|
| Rate for Payer: Quartz Beloit One Network |
$969.77
|
| Rate for Payer: Quartz Commercial |
$1,187.47
|
| Rate for Payer: WEA Trust Commercial |
$1,088.52
|
| Rate for Payer: WPS Commercial |
$1,465.88
|
|
|
SCREW VAL 4.5 X 70MM OPTILINK ST TI 42.231.270
|
Facility
|
OP
|
$1,903.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6226142
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$554.15 |
| Max. Negotiated Rate |
$1,820.79 |
| Rate for Payer: Aetna Commercial |
$1,781.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,702.04
|
| Rate for Payer: Aetna Managed Medicare |
$554.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,286.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$989.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$949.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,048.93
|
| Rate for Payer: Cash Price |
$570.90
|
| Rate for Payer: Cigna Commercial |
$1,820.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,107.55
|
| Rate for Payer: Health EOS Commercial |
$1,761.42
|
| Rate for Payer: HFN Commercial |
$1,820.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,484.34
|
| Rate for Payer: Multiplan Commercial |
$1,583.30
|
| Rate for Payer: NAPHCARE Commercial |
$1,187.47
|
| Rate for Payer: Preferred Network Access Commercial |
$1,820.79
|
| Rate for Payer: Quartz Beloit One Network |
$969.77
|
| Rate for Payer: Quartz Commercial |
$1,286.43
|
| Rate for Payer: Quartz Medicare Advantage |
$1,187.47
|
| Rate for Payer: The Alliance Commercial |
$989.56
|
| Rate for Payer: WEA Trust Commercial |
$1,088.52
|
| Rate for Payer: WPS Commercial |
$1,465.88
|
|
|
SCREW VAL 4.5 X 75MM OPTILINK ST TI 42.231.275
|
Facility
|
IP
|
$2,257.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6169852
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,150.17 |
| Max. Negotiated Rate |
$2,159.50 |
| Rate for Payer: Aetna Commercial |
$2,112.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,018.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,244.06
|
| Rate for Payer: Cash Price |
$677.10
|
| Rate for Payer: Cigna Commercial |
$2,159.50
|
| Rate for Payer: Health EOS Commercial |
$2,089.08
|
| Rate for Payer: HFN Commercial |
$2,159.50
|
| Rate for Payer: Multiplan Commercial |
$1,877.82
|
| Rate for Payer: Preferred Network Access Commercial |
$2,159.50
|
| Rate for Payer: Quartz Beloit One Network |
$1,150.17
|
| Rate for Payer: Quartz Commercial |
$1,408.37
|
| Rate for Payer: WEA Trust Commercial |
$1,291.00
|
| Rate for Payer: WPS Commercial |
$1,738.57
|
|
|
SCREW VAL 4.5 X 75MM OPTILINK ST TI 42.231.275
|
Facility
|
OP
|
$2,257.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6169852
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$657.24 |
| Max. Negotiated Rate |
$2,159.50 |
| Rate for Payer: Aetna Commercial |
$2,112.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,018.66
|
| Rate for Payer: Aetna Managed Medicare |
$657.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,525.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,173.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,126.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,244.06
|
| Rate for Payer: Cash Price |
$677.10
|
| Rate for Payer: Cigna Commercial |
$2,159.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,313.57
|
| Rate for Payer: Health EOS Commercial |
$2,089.08
|
| Rate for Payer: HFN Commercial |
$2,159.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,760.46
|
| Rate for Payer: Multiplan Commercial |
$1,877.82
|
| Rate for Payer: NAPHCARE Commercial |
$1,408.37
|
| Rate for Payer: Preferred Network Access Commercial |
$2,159.50
|
| Rate for Payer: Quartz Beloit One Network |
$1,150.17
|
| Rate for Payer: Quartz Commercial |
$1,525.73
|
| Rate for Payer: Quartz Medicare Advantage |
$1,408.37
|
| Rate for Payer: The Alliance Commercial |
$1,173.64
|
| Rate for Payer: WEA Trust Commercial |
$1,291.00
|
| Rate for Payer: WPS Commercial |
$1,738.57
|
|
|
SCREW VAL 4.5 X 80MM OPTILINK ST TI 42.231.280
|
Facility
|
OP
|
$1,903.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6201050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$554.15 |
| Max. Negotiated Rate |
$1,820.79 |
| Rate for Payer: Aetna Commercial |
$1,781.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,702.04
|
| Rate for Payer: Aetna Managed Medicare |
$554.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,286.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$989.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$949.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,048.93
|
| Rate for Payer: Cash Price |
$570.90
|
| Rate for Payer: Cigna Commercial |
$1,820.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,107.55
|
| Rate for Payer: Health EOS Commercial |
$1,761.42
|
| Rate for Payer: HFN Commercial |
$1,820.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,484.34
|
| Rate for Payer: Multiplan Commercial |
$1,583.30
|
| Rate for Payer: NAPHCARE Commercial |
$1,187.47
|
| Rate for Payer: Preferred Network Access Commercial |
$1,820.79
|
| Rate for Payer: Quartz Beloit One Network |
$969.77
|
| Rate for Payer: Quartz Commercial |
$1,286.43
|
| Rate for Payer: Quartz Medicare Advantage |
$1,187.47
|
| Rate for Payer: The Alliance Commercial |
$989.56
|
| Rate for Payer: WEA Trust Commercial |
$1,088.52
|
| Rate for Payer: WPS Commercial |
$1,465.88
|
|
