|
SCREW PERIPHERAL NON-LOCKING MODULAR GLENOID 4.5X44MM AR-9562-44NL
|
Facility
|
IP
|
$1,536.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5831756
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$752.64 |
| Max. Negotiated Rate |
$1,413.12 |
| Rate for Payer: Aetna Commercial |
$1,382.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,320.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$814.08
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Cigna Commercial |
$1,413.12
|
| Rate for Payer: Health EOS Commercial |
$1,367.04
|
| Rate for Payer: HFN Commercial |
$1,413.12
|
| Rate for Payer: Multiplan Commercial |
$1,228.80
|
| Rate for Payer: NAPHCARE Commercial |
$921.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,413.12
|
| Rate for Payer: Quartz Beloit One Network |
$752.64
|
| Rate for Payer: Quartz Commercial |
$921.60
|
| Rate for Payer: WEA Trust Commercial |
$844.80
|
| Rate for Payer: WPS Commercial |
$1,137.72
|
|
|
SCREW PERIPHERAL NON-LOCKING UNIVERS GLENOID 4.5X24MM AR-9145-24NL
|
Facility
|
OP
|
$1,597.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5196621
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$447.16 |
| Max. Negotiated Rate |
$6,388.00 |
| Rate for Payer: Aetna Commercial |
$1,437.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,373.42
|
| Rate for Payer: Aetna Managed Medicare |
$447.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,038.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$798.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$766.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$846.41
|
| Rate for Payer: Cash Price |
$479.10
|
| Rate for Payer: Cigna Commercial |
$1,469.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$893.68
|
| Rate for Payer: Health EOS Commercial |
$1,421.33
|
| Rate for Payer: HFN Commercial |
$1,469.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,197.75
|
| Rate for Payer: Multiplan Commercial |
$1,277.60
|
| Rate for Payer: NAPHCARE Commercial |
$958.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,469.24
|
| Rate for Payer: Quartz Beloit One Network |
$782.53
|
| Rate for Payer: Quartz Commercial |
$1,038.05
|
| Rate for Payer: Quartz Medicare Advantage |
$958.20
|
| Rate for Payer: The Alliance Commercial |
$6,388.00
|
| Rate for Payer: WEA Trust Commercial |
$878.35
|
| Rate for Payer: WPS Commercial |
$1,182.90
|
|
|
SCREW PERIPHERAL NON-LOCKING UNIVERS GLENOID 4.5X24MM AR-9145-24NL
|
Facility
|
IP
|
$1,597.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5196621
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$782.53 |
| Max. Negotiated Rate |
$1,469.24 |
| Rate for Payer: Aetna Commercial |
$1,437.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,373.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$846.41
|
| Rate for Payer: Cash Price |
$479.10
|
| Rate for Payer: Cigna Commercial |
$1,469.24
|
| Rate for Payer: Health EOS Commercial |
$1,421.33
|
| Rate for Payer: HFN Commercial |
$1,469.24
|
| Rate for Payer: Multiplan Commercial |
$1,277.60
|
| Rate for Payer: NAPHCARE Commercial |
$958.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,469.24
|
| Rate for Payer: Quartz Beloit One Network |
$782.53
|
| Rate for Payer: Quartz Commercial |
$958.20
|
| Rate for Payer: WEA Trust Commercial |
$878.35
|
| Rate for Payer: WPS Commercial |
$1,182.90
|
|
|
SCREW PERIPHERAL NON-LOCKING UNIVERS GLENOID 4.5X30MM AR-9145-30NL
|
Facility
|
OP
|
$1,597.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4595650
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$447.16 |
| Max. Negotiated Rate |
$6,388.00 |
| Rate for Payer: Aetna Commercial |
$1,437.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,373.42
|
| Rate for Payer: Aetna Managed Medicare |
$447.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,038.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$798.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$766.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$846.41
|
| Rate for Payer: Cash Price |
$479.10
|
| Rate for Payer: Cigna Commercial |
$1,469.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$893.68
|
| Rate for Payer: Health EOS Commercial |
$1,421.33
|
| Rate for Payer: HFN Commercial |
$1,469.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,197.75
|
| Rate for Payer: Multiplan Commercial |
$1,277.60
|
| Rate for Payer: NAPHCARE Commercial |
$958.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,469.24
|
| Rate for Payer: Quartz Beloit One Network |
$782.53
|
| Rate for Payer: Quartz Commercial |
$1,038.05
|
| Rate for Payer: Quartz Medicare Advantage |
$958.20
|
| Rate for Payer: The Alliance Commercial |
$6,388.00
|
| Rate for Payer: WEA Trust Commercial |
$878.35
|
| Rate for Payer: WPS Commercial |
$1,182.90
|
|
|
SCREW PERIPHERAL NON-LOCKING UNIVERS GLENOID 4.5X30MM AR-9145-30NL
|
Facility
|
IP
|
$1,597.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4595650
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$782.53 |
| Max. Negotiated Rate |
$1,469.24 |
| Rate for Payer: Aetna Commercial |
$1,437.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,373.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$846.41
|
| Rate for Payer: Cash Price |
$479.10
|
| Rate for Payer: Cigna Commercial |
$1,469.24
|
| Rate for Payer: Health EOS Commercial |
$1,421.33
|
| Rate for Payer: HFN Commercial |
$1,469.24
|
| Rate for Payer: Multiplan Commercial |
$1,277.60
|
| Rate for Payer: NAPHCARE Commercial |
$958.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,469.24
|
| Rate for Payer: Quartz Beloit One Network |
$782.53
|
| Rate for Payer: Quartz Commercial |
$958.20
|
| Rate for Payer: WEA Trust Commercial |
$878.35
|
| Rate for Payer: WPS Commercial |
$1,182.90
|
|
|
SCREW PERIPHERAL NON-LOCKING UNIVERS GLENOID 4.5X36MM AR-9145-36NL
|
Facility
|
OP
|
$1,597.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4595651
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$447.16 |
| Max. Negotiated Rate |
$6,388.00 |
| Rate for Payer: Aetna Commercial |
$1,437.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,373.42
|
| Rate for Payer: Aetna Managed Medicare |
$447.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,038.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$798.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$766.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$846.41
|
| Rate for Payer: Cash Price |
$479.10
|
| Rate for Payer: Cigna Commercial |
$1,469.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$893.68
|
| Rate for Payer: Health EOS Commercial |
$1,421.33
|
| Rate for Payer: HFN Commercial |
$1,469.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,197.75
|
| Rate for Payer: Multiplan Commercial |
$1,277.60
|
| Rate for Payer: NAPHCARE Commercial |
$958.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,469.24
|
| Rate for Payer: Quartz Beloit One Network |
$782.53
|
| Rate for Payer: Quartz Commercial |
$1,038.05
|
| Rate for Payer: Quartz Medicare Advantage |
$958.20
|
| Rate for Payer: The Alliance Commercial |
$6,388.00
|
| Rate for Payer: WEA Trust Commercial |
$878.35
|
| Rate for Payer: WPS Commercial |
$1,182.90
|
|
|
SCREW PERIPHERAL NON-LOCKING UNIVERS GLENOID 4.5X36MM AR-9145-36NL
|
Facility
|
IP
|
$1,597.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4595651
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$782.53 |
| Max. Negotiated Rate |
$1,469.24 |
| Rate for Payer: Aetna Commercial |
$1,437.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,373.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$846.41
|
| Rate for Payer: Cash Price |
$479.10
|
| Rate for Payer: Cigna Commercial |
$1,469.24
|
| Rate for Payer: Health EOS Commercial |
$1,421.33
|
| Rate for Payer: HFN Commercial |
$1,469.24
|
| Rate for Payer: Multiplan Commercial |
$1,277.60
|
| Rate for Payer: NAPHCARE Commercial |
$958.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,469.24
|
| Rate for Payer: Quartz Beloit One Network |
$782.53
|
| Rate for Payer: Quartz Commercial |
$958.20
|
| Rate for Payer: WEA Trust Commercial |
$878.35
|
| Rate for Payer: WPS Commercial |
$1,182.90
|
|
|
SCREW PERIPR VAL 5.0 X 10MM OPTILINK ST SD 42.231.010
|
Facility
|
IP
|
$2,614.37
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6246191
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,281.04 |
| Max. Negotiated Rate |
$2,405.22 |
| Rate for Payer: Aetna Commercial |
$2,352.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,248.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,385.62
|
| Rate for Payer: Cash Price |
$784.31
|
| Rate for Payer: Cigna Commercial |
$2,405.22
|
| Rate for Payer: Health EOS Commercial |
$2,326.79
|
| Rate for Payer: HFN Commercial |
$2,405.22
|
| Rate for Payer: Multiplan Commercial |
$2,091.50
|
| Rate for Payer: NAPHCARE Commercial |
$1,568.62
|
| Rate for Payer: Preferred Network Access Commercial |
$2,405.22
|
| Rate for Payer: Quartz Beloit One Network |
$1,281.04
|
| Rate for Payer: Quartz Commercial |
$1,568.62
|
| Rate for Payer: WEA Trust Commercial |
$1,437.90
|
| Rate for Payer: WPS Commercial |
$1,936.46
|
|
|
SCREW PERIPR VAL 5.0 X 10MM OPTILINK ST SD 42.231.010
|
Facility
|
OP
|
$2,614.37
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6246191
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$732.02 |
| Max. Negotiated Rate |
$10,457.48 |
| Rate for Payer: Aetna Commercial |
$2,352.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,248.36
|
| Rate for Payer: Aetna Managed Medicare |
$732.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,699.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,307.18
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,254.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,385.62
|
| Rate for Payer: Cash Price |
$784.31
|
| Rate for Payer: Cigna Commercial |
$2,405.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,463.00
|
| Rate for Payer: Health EOS Commercial |
$2,326.79
|
| Rate for Payer: HFN Commercial |
$2,405.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,960.78
|
| Rate for Payer: Multiplan Commercial |
$2,091.50
|
| Rate for Payer: NAPHCARE Commercial |
$1,568.62
|
| Rate for Payer: Preferred Network Access Commercial |
$2,405.22
|
| Rate for Payer: Quartz Beloit One Network |
$1,281.04
|
| Rate for Payer: Quartz Commercial |
$1,699.34
|
| Rate for Payer: Quartz Medicare Advantage |
$1,568.62
|
| Rate for Payer: The Alliance Commercial |
$10,457.48
|
| Rate for Payer: WEA Trust Commercial |
$1,437.90
|
| Rate for Payer: WPS Commercial |
$1,936.46
|
|
|
SCREW PERIPR VAL 5.0 X 12MM OPTILINK ST SD 42.231.012
|
Facility
|
IP
|
$2,614.37
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6246192
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,281.04 |
| Max. Negotiated Rate |
$2,405.22 |
| Rate for Payer: Aetna Commercial |
$2,352.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,248.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,385.62
|
| Rate for Payer: Cash Price |
$784.31
|
| Rate for Payer: Cigna Commercial |
$2,405.22
|
| Rate for Payer: Health EOS Commercial |
$2,326.79
|
| Rate for Payer: HFN Commercial |
$2,405.22
|
| Rate for Payer: Multiplan Commercial |
$2,091.50
|
| Rate for Payer: NAPHCARE Commercial |
$1,568.62
|
| Rate for Payer: Preferred Network Access Commercial |
$2,405.22
|
| Rate for Payer: Quartz Beloit One Network |
$1,281.04
|
| Rate for Payer: Quartz Commercial |
$1,568.62
|
| Rate for Payer: WEA Trust Commercial |
$1,437.90
|
| Rate for Payer: WPS Commercial |
$1,936.46
|
|
|
SCREW PERIPR VAL 5.0 X 12MM OPTILINK ST SD 42.231.012
|
Facility
|
OP
|
$2,614.37
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6246192
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$732.02 |
| Max. Negotiated Rate |
$10,457.48 |
| Rate for Payer: Aetna Commercial |
$2,352.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,248.36
|
| Rate for Payer: Aetna Managed Medicare |
$732.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,699.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,307.18
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,254.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,385.62
|
| Rate for Payer: Cash Price |
$784.31
|
| Rate for Payer: Cigna Commercial |
$2,405.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,463.00
|
| Rate for Payer: Health EOS Commercial |
$2,326.79
|
| Rate for Payer: HFN Commercial |
$2,405.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,960.78
|
| Rate for Payer: Multiplan Commercial |
$2,091.50
|
| Rate for Payer: NAPHCARE Commercial |
$1,568.62
|
| Rate for Payer: Preferred Network Access Commercial |
$2,405.22
|
| Rate for Payer: Quartz Beloit One Network |
$1,281.04
|
| Rate for Payer: Quartz Commercial |
$1,699.34
|
| Rate for Payer: Quartz Medicare Advantage |
$1,568.62
|
| Rate for Payer: The Alliance Commercial |
$10,457.48
|
| Rate for Payer: WEA Trust Commercial |
$1,437.90
|
| Rate for Payer: WPS Commercial |
$1,936.46
|
|
|
SCREW PERIPR VAL 5.0 X 14MM OPTILINK ST SD 42.231.014
|
Facility
|
OP
|
$2,614.37
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6246193
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$732.02 |
| Max. Negotiated Rate |
$10,457.48 |
| Rate for Payer: Aetna Commercial |
$2,352.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,248.36
|
| Rate for Payer: Aetna Managed Medicare |
$732.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,699.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,307.18
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,254.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,385.62
|
| Rate for Payer: Cash Price |
$784.31
|
| Rate for Payer: Cigna Commercial |
$2,405.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,463.00
|
| Rate for Payer: Health EOS Commercial |
$2,326.79
|
| Rate for Payer: HFN Commercial |
$2,405.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,960.78
|
| Rate for Payer: Multiplan Commercial |
$2,091.50
|
| Rate for Payer: NAPHCARE Commercial |
$1,568.62
|
| Rate for Payer: Preferred Network Access Commercial |
$2,405.22
|
| Rate for Payer: Quartz Beloit One Network |
$1,281.04
|
| Rate for Payer: Quartz Commercial |
$1,699.34
|
| Rate for Payer: Quartz Medicare Advantage |
$1,568.62
|
| Rate for Payer: The Alliance Commercial |
$10,457.48
|
| Rate for Payer: WEA Trust Commercial |
$1,437.90
|
| Rate for Payer: WPS Commercial |
$1,936.46
|
|
|
SCREW PERIPR VAL 5.0 X 14MM OPTILINK ST SD 42.231.014
|
Facility
|
IP
|
$2,614.37
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6246193
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,281.04 |
| Max. Negotiated Rate |
$2,405.22 |
| Rate for Payer: Aetna Commercial |
$2,352.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,248.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,385.62
|
| Rate for Payer: Cash Price |
$784.31
|
| Rate for Payer: Cigna Commercial |
$2,405.22
|
| Rate for Payer: Health EOS Commercial |
$2,326.79
|
| Rate for Payer: HFN Commercial |
$2,405.22
|
| Rate for Payer: Multiplan Commercial |
$2,091.50
|
| Rate for Payer: NAPHCARE Commercial |
$1,568.62
|
| Rate for Payer: Preferred Network Access Commercial |
$2,405.22
|
| Rate for Payer: Quartz Beloit One Network |
$1,281.04
|
| Rate for Payer: Quartz Commercial |
$1,568.62
|
| Rate for Payer: WEA Trust Commercial |
$1,437.90
|
| Rate for Payer: WPS Commercial |
$1,936.46
|
|
|
SCREW PERIPR VAL 5.0 X 16MM OPTILINK ST SD 42.231.016
|
Facility
|
OP
|
$2,614.37
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6246194
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$732.02 |
| Max. Negotiated Rate |
$10,457.48 |
| Rate for Payer: Aetna Commercial |
$2,352.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,248.36
|
| Rate for Payer: Aetna Managed Medicare |
$732.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,699.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,307.18
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,254.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,385.62
|
| Rate for Payer: Cash Price |
$784.31
|
| Rate for Payer: Cigna Commercial |
$2,405.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,463.00
|
| Rate for Payer: Health EOS Commercial |
$2,326.79
|
| Rate for Payer: HFN Commercial |
$2,405.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,960.78
|
| Rate for Payer: Multiplan Commercial |
$2,091.50
|
| Rate for Payer: NAPHCARE Commercial |
$1,568.62
|
| Rate for Payer: Preferred Network Access Commercial |
$2,405.22
|
| Rate for Payer: Quartz Beloit One Network |
$1,281.04
|
| Rate for Payer: Quartz Commercial |
$1,699.34
|
| Rate for Payer: Quartz Medicare Advantage |
$1,568.62
|
| Rate for Payer: The Alliance Commercial |
$10,457.48
|
| Rate for Payer: WEA Trust Commercial |
$1,437.90
|
| Rate for Payer: WPS Commercial |
$1,936.46
|
|
|
SCREW PERIPR VAL 5.0 X 16MM OPTILINK ST SD 42.231.016
|
Facility
|
IP
|
$2,614.37
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6246194
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,281.04 |
| Max. Negotiated Rate |
$2,405.22 |
| Rate for Payer: Aetna Commercial |
$2,352.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,248.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,385.62
|
| Rate for Payer: Cash Price |
$784.31
|
| Rate for Payer: Cigna Commercial |
$2,405.22
|
| Rate for Payer: Health EOS Commercial |
$2,326.79
|
| Rate for Payer: HFN Commercial |
$2,405.22
|
| Rate for Payer: Multiplan Commercial |
$2,091.50
|
| Rate for Payer: NAPHCARE Commercial |
$1,568.62
|
| Rate for Payer: Preferred Network Access Commercial |
$2,405.22
|
| Rate for Payer: Quartz Beloit One Network |
$1,281.04
|
| Rate for Payer: Quartz Commercial |
$1,568.62
|
| Rate for Payer: WEA Trust Commercial |
$1,437.90
|
| Rate for Payer: WPS Commercial |
$1,936.46
|
|
|
SCREW PERI VA LCKNG 5.0MM X 16MM 02.231.016S
|
Facility
|
IP
|
$2,333.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5264612
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,143.17 |
| Max. Negotiated Rate |
$2,146.36 |
| Rate for Payer: Aetna Commercial |
$2,099.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,006.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,236.49
|
| Rate for Payer: Cash Price |
$699.90
|
| Rate for Payer: Cigna Commercial |
$2,146.36
|
| Rate for Payer: Health EOS Commercial |
$2,076.37
|
| Rate for Payer: HFN Commercial |
$2,146.36
|
| Rate for Payer: Multiplan Commercial |
$1,866.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,399.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,146.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,143.17
|
| Rate for Payer: Quartz Commercial |
$1,399.80
|
| Rate for Payer: WEA Trust Commercial |
$1,283.15
|
| Rate for Payer: WPS Commercial |
$1,728.05
|
|
|
SCREW PERI VA LCKNG 5.0MM X 16MM 02.231.016S
|
Facility
|
OP
|
$2,333.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5264612
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$653.24 |
| Max. Negotiated Rate |
$9,332.00 |
| Rate for Payer: Aetna Commercial |
$2,099.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,006.38
|
| Rate for Payer: Aetna Managed Medicare |
$653.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,516.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,166.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,119.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,236.49
|
| Rate for Payer: Cash Price |
$699.90
|
| Rate for Payer: Cigna Commercial |
$2,146.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,305.55
|
| Rate for Payer: Health EOS Commercial |
$2,076.37
|
| Rate for Payer: HFN Commercial |
$2,146.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,749.75
|
| Rate for Payer: Multiplan Commercial |
$1,866.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,399.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,146.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,143.17
|
| Rate for Payer: Quartz Commercial |
$1,516.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,399.80
|
| Rate for Payer: The Alliance Commercial |
$9,332.00
|
| Rate for Payer: WEA Trust Commercial |
$1,283.15
|
| Rate for Payer: WPS Commercial |
$1,728.05
|
|
|
SCREW PINNACLE CANC 6.5 X15 1217-15-500
|
Facility
|
OP
|
$1,437.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563223
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$402.36 |
| Max. Negotiated Rate |
$5,748.00 |
| Rate for Payer: Aetna Commercial |
$1,293.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,235.82
|
| Rate for Payer: Aetna Managed Medicare |
$402.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$934.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$718.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$689.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$761.61
|
| Rate for Payer: Cash Price |
$431.10
|
| Rate for Payer: Cigna Commercial |
$1,322.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$804.15
|
| Rate for Payer: Health EOS Commercial |
$1,278.93
|
| Rate for Payer: HFN Commercial |
$1,322.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,077.75
|
| Rate for Payer: Multiplan Commercial |
$1,149.60
|
| Rate for Payer: NAPHCARE Commercial |
$862.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,322.04
|
| Rate for Payer: Quartz Beloit One Network |
$704.13
|
| Rate for Payer: Quartz Commercial |
$934.05
|
| Rate for Payer: Quartz Medicare Advantage |
$862.20
|
| Rate for Payer: The Alliance Commercial |
$5,748.00
|
| Rate for Payer: WEA Trust Commercial |
$790.35
|
| Rate for Payer: WPS Commercial |
$1,064.39
|
|
|
SCREW PINNACLE CANC 6.5 X15 1217-15-500
|
Facility
|
IP
|
$1,437.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563223
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$704.13 |
| Max. Negotiated Rate |
$1,322.04 |
| Rate for Payer: Aetna Commercial |
$1,293.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,235.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$761.61
|
| Rate for Payer: Cash Price |
$431.10
|
| Rate for Payer: Cigna Commercial |
$1,322.04
|
| Rate for Payer: Health EOS Commercial |
$1,278.93
|
| Rate for Payer: HFN Commercial |
$1,322.04
|
| Rate for Payer: Multiplan Commercial |
$1,149.60
|
| Rate for Payer: NAPHCARE Commercial |
$862.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,322.04
|
| Rate for Payer: Quartz Beloit One Network |
$704.13
|
| Rate for Payer: Quartz Commercial |
$862.20
|
| Rate for Payer: WEA Trust Commercial |
$790.35
|
| Rate for Payer: WPS Commercial |
$1,064.39
|
|
|
SCREW PINNACLE CANC 6.5 X 20 1217-20-500
|
Facility
|
IP
|
$1,494.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459456
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$732.06 |
| Max. Negotiated Rate |
$1,374.48 |
| Rate for Payer: Aetna Commercial |
$1,344.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,284.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$791.82
|
| Rate for Payer: Cash Price |
$448.20
|
| Rate for Payer: Cigna Commercial |
$1,374.48
|
| Rate for Payer: Health EOS Commercial |
$1,329.66
|
| Rate for Payer: HFN Commercial |
$1,374.48
|
| Rate for Payer: Multiplan Commercial |
$1,195.20
|
| Rate for Payer: NAPHCARE Commercial |
$896.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,374.48
|
| Rate for Payer: Quartz Beloit One Network |
$732.06
|
| Rate for Payer: Quartz Commercial |
$896.40
|
| Rate for Payer: WEA Trust Commercial |
$821.70
|
| Rate for Payer: WPS Commercial |
$1,106.61
|
|
|
SCREW PINNACLE CANC 6.5 X 20 1217-20-500
|
Facility
|
OP
|
$1,494.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459456
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$418.32 |
| Max. Negotiated Rate |
$5,976.00 |
| Rate for Payer: Aetna Commercial |
$1,344.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,284.84
|
| Rate for Payer: Aetna Managed Medicare |
$418.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$971.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$747.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$717.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$791.82
|
| Rate for Payer: Cash Price |
$448.20
|
| Rate for Payer: Cigna Commercial |
$1,374.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$836.04
|
| Rate for Payer: Health EOS Commercial |
$1,329.66
|
| Rate for Payer: HFN Commercial |
$1,374.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,120.50
|
| Rate for Payer: Multiplan Commercial |
$1,195.20
|
| Rate for Payer: NAPHCARE Commercial |
$896.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,374.48
|
| Rate for Payer: Quartz Beloit One Network |
$732.06
|
| Rate for Payer: Quartz Commercial |
$971.10
|
| Rate for Payer: Quartz Medicare Advantage |
$896.40
|
| Rate for Payer: The Alliance Commercial |
$5,976.00
|
| Rate for Payer: WEA Trust Commercial |
$821.70
|
| Rate for Payer: WPS Commercial |
$1,106.61
|
|
|
SCREW PINNACLE CANC 6.5 X 25 1217-25-500
|
Facility
|
IP
|
$1,552.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459303
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$760.48 |
| Max. Negotiated Rate |
$1,427.84 |
| Rate for Payer: Aetna Commercial |
$1,396.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,334.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$822.56
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Cigna Commercial |
$1,427.84
|
| Rate for Payer: Health EOS Commercial |
$1,381.28
|
| Rate for Payer: HFN Commercial |
$1,427.84
|
| Rate for Payer: Multiplan Commercial |
$1,241.60
|
| Rate for Payer: NAPHCARE Commercial |
$931.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,427.84
|
| Rate for Payer: Quartz Beloit One Network |
$760.48
|
| Rate for Payer: Quartz Commercial |
$931.20
|
| Rate for Payer: WEA Trust Commercial |
$853.60
|
| Rate for Payer: WPS Commercial |
$1,149.57
|
|
|
SCREW PINNACLE CANC 6.5 X 25 1217-25-500
|
Facility
|
OP
|
$1,552.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459303
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$434.56 |
| Max. Negotiated Rate |
$6,208.00 |
| Rate for Payer: Aetna Commercial |
$1,396.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,334.72
|
| Rate for Payer: Aetna Managed Medicare |
$434.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,008.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$776.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$744.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$822.56
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Cigna Commercial |
$1,427.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$868.50
|
| Rate for Payer: Health EOS Commercial |
$1,381.28
|
| Rate for Payer: HFN Commercial |
$1,427.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,164.00
|
| Rate for Payer: Multiplan Commercial |
$1,241.60
|
| Rate for Payer: NAPHCARE Commercial |
$931.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,427.84
|
| Rate for Payer: Quartz Beloit One Network |
$760.48
|
| Rate for Payer: Quartz Commercial |
$1,008.80
|
| Rate for Payer: Quartz Medicare Advantage |
$931.20
|
| Rate for Payer: The Alliance Commercial |
$6,208.00
|
| Rate for Payer: WEA Trust Commercial |
$853.60
|
| Rate for Payer: WPS Commercial |
$1,149.57
|
|
|
SCREW PINNACLE CANC 6.5 X 30 1217-30-500
|
Facility
|
IP
|
$1,552.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459458
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$760.48 |
| Max. Negotiated Rate |
$1,427.84 |
| Rate for Payer: Aetna Commercial |
$1,396.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,334.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$822.56
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Cigna Commercial |
$1,427.84
|
| Rate for Payer: Health EOS Commercial |
$1,381.28
|
| Rate for Payer: HFN Commercial |
$1,427.84
|
| Rate for Payer: Multiplan Commercial |
$1,241.60
|
| Rate for Payer: NAPHCARE Commercial |
$931.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,427.84
|
| Rate for Payer: Quartz Beloit One Network |
$760.48
|
| Rate for Payer: Quartz Commercial |
$931.20
|
| Rate for Payer: WEA Trust Commercial |
$853.60
|
| Rate for Payer: WPS Commercial |
$1,149.57
|
|
|
SCREW PINNACLE CANC 6.5 X 30 1217-30-500
|
Facility
|
OP
|
$1,552.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459458
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$434.56 |
| Max. Negotiated Rate |
$6,208.00 |
| Rate for Payer: Aetna Commercial |
$1,396.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,334.72
|
| Rate for Payer: Aetna Managed Medicare |
$434.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,008.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$776.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$744.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$822.56
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Cigna Commercial |
$1,427.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$868.50
|
| Rate for Payer: Health EOS Commercial |
$1,381.28
|
| Rate for Payer: HFN Commercial |
$1,427.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,164.00
|
| Rate for Payer: Multiplan Commercial |
$1,241.60
|
| Rate for Payer: NAPHCARE Commercial |
$931.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,427.84
|
| Rate for Payer: Quartz Beloit One Network |
$760.48
|
| Rate for Payer: Quartz Commercial |
$1,008.80
|
| Rate for Payer: Quartz Medicare Advantage |
$931.20
|
| Rate for Payer: The Alliance Commercial |
$6,208.00
|
| Rate for Payer: WEA Trust Commercial |
$853.60
|
| Rate for Payer: WPS Commercial |
$1,149.57
|
|
