|
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 |
$2,010.40 |
| Max. Negotiated Rate |
$28,720.00 |
| Rate for Payer: Aetna Commercial |
$6,462.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,174.80
|
| Rate for Payer: Aetna Managed Medicare |
$2,010.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,667.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,590.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,446.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,805.40
|
| Rate for Payer: Cash Price |
$2,154.00
|
| Rate for Payer: Cigna Commercial |
$6,605.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,017.93
|
| Rate for Payer: Health EOS Commercial |
$6,390.20
|
| Rate for Payer: HFN Commercial |
$6,605.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,385.00
|
| Rate for Payer: Multiplan Commercial |
$5,744.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,308.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,605.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,518.20
|
| Rate for Payer: Quartz Commercial |
$4,667.00
|
| Rate for Payer: Quartz Medicare Advantage |
$4,308.00
|
| Rate for Payer: The Alliance Commercial |
$28,720.00
|
| Rate for Payer: WEA Trust Commercial |
$3,949.00
|
| Rate for Payer: WPS Commercial |
$5,318.23
|
|
|
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 |
$2,470.58 |
| Max. Negotiated Rate |
$4,638.64 |
| Rate for Payer: Aetna Commercial |
$4,537.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,336.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,672.26
|
| Rate for Payer: Cash Price |
$1,512.60
|
| Rate for Payer: Cigna Commercial |
$4,638.64
|
| Rate for Payer: Health EOS Commercial |
$4,487.38
|
| Rate for Payer: HFN Commercial |
$4,638.64
|
| Rate for Payer: Multiplan Commercial |
$4,033.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,025.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,638.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,470.58
|
| Rate for Payer: Quartz Commercial |
$3,025.20
|
| Rate for Payer: WEA Trust Commercial |
$2,773.10
|
| Rate for Payer: WPS Commercial |
$3,734.61
|
|
|
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 |
$1,411.76 |
| Max. Negotiated Rate |
$20,168.00 |
| Rate for Payer: Aetna Commercial |
$4,537.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,336.12
|
| Rate for Payer: Aetna Managed Medicare |
$1,411.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,277.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,521.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,420.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,672.26
|
| Rate for Payer: Cash Price |
$1,512.60
|
| Rate for Payer: Cigna Commercial |
$4,638.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,821.50
|
| Rate for Payer: Health EOS Commercial |
$4,487.38
|
| Rate for Payer: HFN Commercial |
$4,638.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,781.50
|
| Rate for Payer: Multiplan Commercial |
$4,033.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,025.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,638.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,470.58
|
| Rate for Payer: Quartz Commercial |
$3,277.30
|
| Rate for Payer: Quartz Medicare Advantage |
$3,025.20
|
| Rate for Payer: The Alliance Commercial |
$20,168.00
|
| Rate for Payer: WEA Trust Commercial |
$2,773.10
|
| Rate for Payer: WPS Commercial |
$3,734.61
|
|
|
SCREW TFN 11MM X 105MM 04.032.105S
|
Facility
|
IP
|
$5,041.00
|
|
| Hospital Charge Code |
3563494
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,470.09 |
| Max. Negotiated Rate |
$4,637.72 |
| Rate for Payer: Aetna Commercial |
$4,536.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,335.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,671.73
|
| Rate for Payer: Cash Price |
$1,512.30
|
| Rate for Payer: Cigna Commercial |
$4,637.72
|
| Rate for Payer: Health EOS Commercial |
$4,486.49
|
| Rate for Payer: HFN Commercial |
$4,637.72
|
| Rate for Payer: Multiplan Commercial |
$4,032.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,024.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,637.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,470.09
|
| Rate for Payer: Quartz Commercial |
$3,024.60
|
| Rate for Payer: WEA Trust Commercial |
$2,772.55
|
| Rate for Payer: WPS Commercial |
$3,733.87
|
|
|
SCREW TFN 11MM X 105MM 04.032.105S
|
Facility
|
OP
|
$5,041.00
|
|
| Hospital Charge Code |
3563494
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,411.48 |
| Max. Negotiated Rate |
$20,164.00 |
| Rate for Payer: Aetna Commercial |
$4,536.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,335.26
|
| Rate for Payer: Aetna Managed Medicare |
$1,411.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,276.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,520.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,419.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,671.73
|
| Rate for Payer: Cash Price |
$1,512.30
|
| Rate for Payer: Cigna Commercial |
$4,637.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,820.94
|
| Rate for Payer: Health EOS Commercial |
$4,486.49
|
| Rate for Payer: HFN Commercial |
$4,637.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,780.75
|
| Rate for Payer: Multiplan Commercial |
$4,032.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,024.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,637.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,470.09
|
| Rate for Payer: Quartz Commercial |
$3,276.65
|
| Rate for Payer: Quartz Medicare Advantage |
$3,024.60
|
| Rate for Payer: The Alliance Commercial |
$20,164.00
|
| Rate for Payer: WEA Trust Commercial |
$2,772.55
|
| Rate for Payer: WPS Commercial |
$3,733.87
|
|
|
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 |
$964.32 |
| Max. Negotiated Rate |
$1,810.56 |
| Rate for Payer: Aetna Commercial |
$1,771.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,692.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,043.04
|
| Rate for Payer: Cash Price |
$590.40
|
| Rate for Payer: Cigna Commercial |
$1,810.56
|
| Rate for Payer: Health EOS Commercial |
$1,751.52
|
| Rate for Payer: HFN Commercial |
$1,810.56
|
| Rate for Payer: Multiplan Commercial |
$1,574.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,180.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,810.56
|
| Rate for Payer: Quartz Beloit One Network |
$964.32
|
| Rate for Payer: Quartz Commercial |
$1,180.80
|
| Rate for Payer: WEA Trust Commercial |
$1,082.40
|
| Rate for Payer: WPS Commercial |
$1,457.70
|
|
|
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 |
$551.04 |
| Max. Negotiated Rate |
$7,872.00 |
| Rate for Payer: Aetna Commercial |
$1,771.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,692.48
|
| Rate for Payer: Aetna Managed Medicare |
$551.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,279.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$984.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$944.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,043.04
|
| Rate for Payer: Cash Price |
$590.40
|
| Rate for Payer: Cigna Commercial |
$1,810.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,101.29
|
| Rate for Payer: Health EOS Commercial |
$1,751.52
|
| Rate for Payer: HFN Commercial |
$1,810.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,476.00
|
| Rate for Payer: Multiplan Commercial |
$1,574.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,180.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,810.56
|
| Rate for Payer: Quartz Beloit One Network |
$964.32
|
| Rate for Payer: Quartz Commercial |
$1,279.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,180.80
|
| Rate for Payer: The Alliance Commercial |
$7,872.00
|
| Rate for Payer: WEA Trust Commercial |
$1,082.40
|
| Rate for Payer: WPS Commercial |
$1,457.70
|
|
|
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 |
$964.32 |
| Max. Negotiated Rate |
$1,810.56 |
| Rate for Payer: Aetna Commercial |
$1,771.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,692.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,043.04
|
| Rate for Payer: Cash Price |
$590.40
|
| Rate for Payer: Cigna Commercial |
$1,810.56
|
| Rate for Payer: Health EOS Commercial |
$1,751.52
|
| Rate for Payer: HFN Commercial |
$1,810.56
|
| Rate for Payer: Multiplan Commercial |
$1,574.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,180.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,810.56
|
| Rate for Payer: Quartz Beloit One Network |
$964.32
|
| Rate for Payer: Quartz Commercial |
$1,180.80
|
| Rate for Payer: WEA Trust Commercial |
$1,082.40
|
| Rate for Payer: WPS Commercial |
$1,457.70
|
|
|
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 |
$551.04 |
| Max. Negotiated Rate |
$7,872.00 |
| Rate for Payer: Aetna Commercial |
$1,771.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,692.48
|
| Rate for Payer: Aetna Managed Medicare |
$551.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,279.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$984.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$944.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,043.04
|
| Rate for Payer: Cash Price |
$590.40
|
| Rate for Payer: Cigna Commercial |
$1,810.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,101.29
|
| Rate for Payer: Health EOS Commercial |
$1,751.52
|
| Rate for Payer: HFN Commercial |
$1,810.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,476.00
|
| Rate for Payer: Multiplan Commercial |
$1,574.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,180.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,810.56
|
| Rate for Payer: Quartz Beloit One Network |
$964.32
|
| Rate for Payer: Quartz Commercial |
$1,279.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,180.80
|
| Rate for Payer: The Alliance Commercial |
$7,872.00
|
| Rate for Payer: WEA Trust Commercial |
$1,082.40
|
| Rate for Payer: WPS Commercial |
$1,457.70
|
|
|
SCREW TI RECON 6.5X100
|
Facility
|
OP
|
$2,810.00
|
|
| Hospital Charge Code |
2966566
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$786.80 |
| Max. Negotiated Rate |
$11,240.00 |
| Rate for Payer: Aetna Commercial |
$2,529.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,416.60
|
| Rate for Payer: Aetna Managed Medicare |
$786.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,826.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,405.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,348.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,489.30
|
| Rate for Payer: Cash Price |
$843.00
|
| Rate for Payer: Cigna Commercial |
$2,585.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,572.48
|
| Rate for Payer: Health EOS Commercial |
$2,500.90
|
| Rate for Payer: HFN Commercial |
$2,585.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,107.50
|
| Rate for Payer: Multiplan Commercial |
$2,248.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,686.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,585.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,376.90
|
| Rate for Payer: Quartz Commercial |
$1,826.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,686.00
|
| Rate for Payer: The Alliance Commercial |
$11,240.00
|
| Rate for Payer: WEA Trust Commercial |
$1,545.50
|
| Rate for Payer: WPS Commercial |
$2,081.37
|
|
|
SCREW TI RECON 6.5X100
|
Facility
|
IP
|
$2,810.00
|
|
| Hospital Charge Code |
2966566
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,376.90 |
| Max. Negotiated Rate |
$2,585.20 |
| Rate for Payer: Aetna Commercial |
$2,529.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,416.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,489.30
|
| Rate for Payer: Cash Price |
$843.00
|
| Rate for Payer: Cigna Commercial |
$2,585.20
|
| Rate for Payer: Health EOS Commercial |
$2,500.90
|
| Rate for Payer: HFN Commercial |
$2,585.20
|
| Rate for Payer: Multiplan Commercial |
$2,248.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,686.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,585.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,376.90
|
| Rate for Payer: Quartz Commercial |
$1,686.00
|
| Rate for Payer: WEA Trust Commercial |
$1,545.50
|
| Rate for Payer: WPS Commercial |
$2,081.37
|
|
|
SCREW TI RECON 6.5X110
|
Facility
|
IP
|
$2,810.00
|
|
| Hospital Charge Code |
2966567
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,376.90 |
| Max. Negotiated Rate |
$2,585.20 |
| Rate for Payer: Aetna Commercial |
$2,529.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,416.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,489.30
|
| Rate for Payer: Cash Price |
$843.00
|
| Rate for Payer: Cigna Commercial |
$2,585.20
|
| Rate for Payer: Health EOS Commercial |
$2,500.90
|
| Rate for Payer: HFN Commercial |
$2,585.20
|
| Rate for Payer: Multiplan Commercial |
$2,248.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,686.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,585.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,376.90
|
| Rate for Payer: Quartz Commercial |
$1,686.00
|
| Rate for Payer: WEA Trust Commercial |
$1,545.50
|
| Rate for Payer: WPS Commercial |
$2,081.37
|
|
|
SCREW TI RECON 6.5X110
|
Facility
|
OP
|
$2,810.00
|
|
| Hospital Charge Code |
2966567
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$786.80 |
| Max. Negotiated Rate |
$11,240.00 |
| Rate for Payer: Aetna Commercial |
$2,529.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,416.60
|
| Rate for Payer: Aetna Managed Medicare |
$786.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,826.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,405.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,348.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,489.30
|
| Rate for Payer: Cash Price |
$843.00
|
| Rate for Payer: Cigna Commercial |
$2,585.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,572.48
|
| Rate for Payer: Health EOS Commercial |
$2,500.90
|
| Rate for Payer: HFN Commercial |
$2,585.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,107.50
|
| Rate for Payer: Multiplan Commercial |
$2,248.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,686.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,585.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,376.90
|
| Rate for Payer: Quartz Commercial |
$1,826.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,686.00
|
| Rate for Payer: The Alliance Commercial |
$11,240.00
|
| Rate for Payer: WEA Trust Commercial |
$1,545.50
|
| Rate for Payer: WPS Commercial |
$2,081.37
|
|
|
SCREW TITANIUM 4.0x20MM CANC
|
Facility
|
IP
|
$1,099.00
|
|
| Hospital Charge Code |
2966568
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$538.51 |
| Max. Negotiated Rate |
$1,011.08 |
| Rate for Payer: Aetna Commercial |
$989.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$945.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$582.47
|
| Rate for Payer: Cash Price |
$329.70
|
| Rate for Payer: Cigna Commercial |
$1,011.08
|
| Rate for Payer: Health EOS Commercial |
$978.11
|
| Rate for Payer: HFN Commercial |
$1,011.08
|
| Rate for Payer: Multiplan Commercial |
$879.20
|
| Rate for Payer: NAPHCARE Commercial |
$659.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,011.08
|
| Rate for Payer: Quartz Beloit One Network |
$538.51
|
| Rate for Payer: Quartz Commercial |
$659.40
|
| Rate for Payer: WEA Trust Commercial |
$604.45
|
| Rate for Payer: WPS Commercial |
$814.03
|
|
|
SCREW TITANIUM 4.0x20MM CANC
|
Facility
|
OP
|
$1,099.00
|
|
| Hospital Charge Code |
2966568
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$307.72 |
| Max. Negotiated Rate |
$4,396.00 |
| Rate for Payer: Aetna Commercial |
$989.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$945.14
|
| Rate for Payer: Aetna Managed Medicare |
$307.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$714.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$549.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$527.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$582.47
|
| Rate for Payer: Cash Price |
$329.70
|
| Rate for Payer: Cigna Commercial |
$1,011.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$615.00
|
| Rate for Payer: Health EOS Commercial |
$978.11
|
| Rate for Payer: HFN Commercial |
$1,011.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$824.25
|
| Rate for Payer: Multiplan Commercial |
$879.20
|
| Rate for Payer: NAPHCARE Commercial |
$659.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,011.08
|
| Rate for Payer: Quartz Beloit One Network |
$538.51
|
| Rate for Payer: Quartz Commercial |
$714.35
|
| Rate for Payer: Quartz Medicare Advantage |
$659.40
|
| Rate for Payer: The Alliance Commercial |
$4,396.00
|
| Rate for Payer: WEA Trust Commercial |
$604.45
|
| Rate for Payer: WPS Commercial |
$814.03
|
|
|
SCREW TITANIUM 5.0x36 CANCELLO 71755036
|
Facility
|
IP
|
$2,340.00
|
|
| Hospital Charge Code |
2966042
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,146.60 |
| Max. Negotiated Rate |
$2,152.80 |
| Rate for Payer: Aetna Commercial |
$2,106.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,012.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,240.20
|
| Rate for Payer: Cash Price |
$702.00
|
| Rate for Payer: Cigna Commercial |
$2,152.80
|
| Rate for Payer: Health EOS Commercial |
$2,082.60
|
| Rate for Payer: HFN Commercial |
$2,152.80
|
| Rate for Payer: Multiplan Commercial |
$1,872.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,404.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,152.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,146.60
|
| Rate for Payer: Quartz Commercial |
$1,404.00
|
| Rate for Payer: WEA Trust Commercial |
$1,287.00
|
| Rate for Payer: WPS Commercial |
$1,733.24
|
|
|
SCREW TITANIUM 5.0x36 CANCELLO 71755036
|
Facility
|
OP
|
$2,340.00
|
|
| Hospital Charge Code |
2966042
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$655.20 |
| Max. Negotiated Rate |
$9,360.00 |
| Rate for Payer: Aetna Commercial |
$2,106.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,012.40
|
| Rate for Payer: Aetna Managed Medicare |
$655.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,521.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,170.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,123.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,240.20
|
| Rate for Payer: Cash Price |
$702.00
|
| Rate for Payer: Cigna Commercial |
$2,152.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,309.46
|
| Rate for Payer: Health EOS Commercial |
$2,082.60
|
| Rate for Payer: HFN Commercial |
$2,152.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,755.00
|
| Rate for Payer: Multiplan Commercial |
$1,872.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,404.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,152.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,146.60
|
| Rate for Payer: Quartz Commercial |
$1,521.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,404.00
|
| Rate for Payer: The Alliance Commercial |
$9,360.00
|
| Rate for Payer: WEA Trust Commercial |
$1,287.00
|
| Rate for Payer: WPS Commercial |
$1,733.24
|
|
|
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 |
$1,680.28 |
| Max. Negotiated Rate |
$24,004.00 |
| Rate for Payer: Aetna Commercial |
$5,400.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,160.86
|
| Rate for Payer: Aetna Managed Medicare |
$1,680.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,900.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,000.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,880.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,180.53
|
| Rate for Payer: Cash Price |
$1,800.30
|
| Rate for Payer: Cigna Commercial |
$5,520.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,358.16
|
| Rate for Payer: Health EOS Commercial |
$5,340.89
|
| Rate for Payer: HFN Commercial |
$5,520.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,500.75
|
| Rate for Payer: Multiplan Commercial |
$4,800.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,600.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,520.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,940.49
|
| Rate for Payer: Quartz Commercial |
$3,900.65
|
| Rate for Payer: Quartz Medicare Advantage |
$3,600.60
|
| Rate for Payer: The Alliance Commercial |
$24,004.00
|
| Rate for Payer: WEA Trust Commercial |
$3,300.55
|
| Rate for Payer: WPS Commercial |
$4,444.94
|
|
|
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 |
$2,940.49 |
| Max. Negotiated Rate |
$5,520.92 |
| Rate for Payer: Aetna Commercial |
$5,400.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,160.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,180.53
|
| Rate for Payer: Cash Price |
$1,800.30
|
| Rate for Payer: Cigna Commercial |
$5,520.92
|
| Rate for Payer: Health EOS Commercial |
$5,340.89
|
| Rate for Payer: HFN Commercial |
$5,520.92
|
| Rate for Payer: Multiplan Commercial |
$4,800.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,600.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,520.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,940.49
|
| Rate for Payer: Quartz Commercial |
$3,600.60
|
| Rate for Payer: WEA Trust Commercial |
$3,300.55
|
| Rate for Payer: WPS Commercial |
$4,444.94
|
|
|
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 |
$1,817.48 |
| Max. Negotiated Rate |
$25,964.00 |
| Rate for Payer: Aetna Commercial |
$5,841.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,582.26
|
| Rate for Payer: Aetna Managed Medicare |
$1,817.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,219.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,245.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,115.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,440.23
|
| Rate for Payer: Cash Price |
$1,947.30
|
| Rate for Payer: Cigna Commercial |
$5,971.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,632.36
|
| Rate for Payer: Health EOS Commercial |
$5,776.99
|
| Rate for Payer: HFN Commercial |
$5,971.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,868.25
|
| Rate for Payer: Multiplan Commercial |
$5,192.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,894.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,971.72
|
| Rate for Payer: Quartz Beloit One Network |
$3,180.59
|
| Rate for Payer: Quartz Commercial |
$4,219.15
|
| Rate for Payer: Quartz Medicare Advantage |
$3,894.60
|
| Rate for Payer: The Alliance Commercial |
$25,964.00
|
| Rate for Payer: WEA Trust Commercial |
$3,570.05
|
| Rate for Payer: WPS Commercial |
$4,807.88
|
|
|
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 |
$3,180.59 |
| Max. Negotiated Rate |
$5,971.72 |
| Rate for Payer: Aetna Commercial |
$5,841.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,582.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,440.23
|
| Rate for Payer: Cash Price |
$1,947.30
|
| Rate for Payer: Cigna Commercial |
$5,971.72
|
| Rate for Payer: Health EOS Commercial |
$5,776.99
|
| Rate for Payer: HFN Commercial |
$5,971.72
|
| Rate for Payer: Multiplan Commercial |
$5,192.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,894.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,971.72
|
| Rate for Payer: Quartz Beloit One Network |
$3,180.59
|
| Rate for Payer: Quartz Commercial |
$3,894.60
|
| Rate for Payer: WEA Trust Commercial |
$3,570.05
|
| Rate for Payer: WPS Commercial |
$4,807.88
|
|
|
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 |
$482.44 |
| Max. Negotiated Rate |
$6,892.00 |
| Rate for Payer: Aetna Commercial |
$1,550.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,481.78
|
| Rate for Payer: Aetna Managed Medicare |
$482.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,119.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$861.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$827.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$913.19
|
| Rate for Payer: Cash Price |
$516.90
|
| Rate for Payer: Cigna Commercial |
$1,585.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$964.19
|
| Rate for Payer: Health EOS Commercial |
$1,533.47
|
| Rate for Payer: HFN Commercial |
$1,585.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,292.25
|
| Rate for Payer: Multiplan Commercial |
$1,378.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,033.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,585.16
|
| Rate for Payer: Quartz Beloit One Network |
$844.27
|
| Rate for Payer: Quartz Commercial |
$1,119.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,033.80
|
| Rate for Payer: The Alliance Commercial |
$6,892.00
|
| Rate for Payer: WEA Trust Commercial |
$947.65
|
| Rate for Payer: WPS Commercial |
$1,276.23
|
|
|
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 |
$844.27 |
| Max. Negotiated Rate |
$1,585.16 |
| Rate for Payer: Aetna Commercial |
$1,550.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,481.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$913.19
|
| Rate for Payer: Cash Price |
$516.90
|
| Rate for Payer: Cigna Commercial |
$1,585.16
|
| Rate for Payer: Health EOS Commercial |
$1,533.47
|
| Rate for Payer: HFN Commercial |
$1,585.16
|
| Rate for Payer: Multiplan Commercial |
$1,378.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,033.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,585.16
|
| Rate for Payer: Quartz Beloit One Network |
$844.27
|
| Rate for Payer: Quartz Commercial |
$1,033.80
|
| Rate for Payer: WEA Trust Commercial |
$947.65
|
| Rate for Payer: WPS Commercial |
$1,276.23
|
|
|
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 |
$844.27 |
| Max. Negotiated Rate |
$1,585.16 |
| Rate for Payer: Aetna Commercial |
$1,550.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,481.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$913.19
|
| Rate for Payer: Cash Price |
$516.90
|
| Rate for Payer: Cigna Commercial |
$1,585.16
|
| Rate for Payer: Health EOS Commercial |
$1,533.47
|
| Rate for Payer: HFN Commercial |
$1,585.16
|
| Rate for Payer: Multiplan Commercial |
$1,378.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,033.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,585.16
|
| Rate for Payer: Quartz Beloit One Network |
$844.27
|
| Rate for Payer: Quartz Commercial |
$1,033.80
|
| Rate for Payer: WEA Trust Commercial |
$947.65
|
| Rate for Payer: WPS Commercial |
$1,276.23
|
|
|
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 |
$482.44 |
| Max. Negotiated Rate |
$6,892.00 |
| Rate for Payer: Aetna Commercial |
$1,550.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,481.78
|
| Rate for Payer: Aetna Managed Medicare |
$482.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,119.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$861.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$827.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$913.19
|
| Rate for Payer: Cash Price |
$516.90
|
| Rate for Payer: Cigna Commercial |
$1,585.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$964.19
|
| Rate for Payer: Health EOS Commercial |
$1,533.47
|
| Rate for Payer: HFN Commercial |
$1,585.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,292.25
|
| Rate for Payer: Multiplan Commercial |
$1,378.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,033.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,585.16
|
| Rate for Payer: Quartz Beloit One Network |
$844.27
|
| Rate for Payer: Quartz Commercial |
$1,119.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,033.80
|
| Rate for Payer: The Alliance Commercial |
$6,892.00
|
| Rate for Payer: WEA Trust Commercial |
$947.65
|
| Rate for Payer: WPS Commercial |
$1,276.23
|
|
