|
LAG SCREW CANN 4MM X 24MM BLUNT TIP SS AR-5051-24
|
Facility
|
IP
|
$2,031.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6171770
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$995.19 |
| Max. Negotiated Rate |
$1,868.52 |
| Rate for Payer: Aetna Commercial |
$1,827.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,746.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,076.43
|
| Rate for Payer: Cash Price |
$609.30
|
| Rate for Payer: Cigna Commercial |
$1,868.52
|
| Rate for Payer: Health EOS Commercial |
$1,807.59
|
| Rate for Payer: HFN Commercial |
$1,868.52
|
| Rate for Payer: Multiplan Commercial |
$1,624.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,218.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,868.52
|
| Rate for Payer: Quartz Beloit One Network |
$995.19
|
| Rate for Payer: Quartz Commercial |
$1,218.60
|
| Rate for Payer: WEA Trust Commercial |
$1,117.05
|
| Rate for Payer: WPS Commercial |
$1,504.36
|
|
|
LAG SCREW CANN 4MM X 30MM BLUNT TIP SS AR-5051-30
|
Facility
|
OP
|
$2,511.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5496978
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$703.08 |
| Max. Negotiated Rate |
$10,044.00 |
| Rate for Payer: Aetna Commercial |
$2,259.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,159.46
|
| Rate for Payer: Aetna Managed Medicare |
$703.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,632.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,255.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,205.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,330.83
|
| Rate for Payer: Cash Price |
$753.30
|
| Rate for Payer: Cigna Commercial |
$2,310.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,405.16
|
| Rate for Payer: Health EOS Commercial |
$2,234.79
|
| Rate for Payer: HFN Commercial |
$2,310.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,883.25
|
| Rate for Payer: Multiplan Commercial |
$2,008.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,506.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,310.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,230.39
|
| Rate for Payer: Quartz Commercial |
$1,632.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,506.60
|
| Rate for Payer: The Alliance Commercial |
$10,044.00
|
| Rate for Payer: WEA Trust Commercial |
$1,381.05
|
| Rate for Payer: WPS Commercial |
$1,859.90
|
|
|
LAG SCREW CANN 4MM X 30MM BLUNT TIP SS AR-5051-30
|
Facility
|
IP
|
$2,511.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5496978
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,230.39 |
| Max. Negotiated Rate |
$2,310.12 |
| Rate for Payer: Aetna Commercial |
$2,259.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,159.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,330.83
|
| Rate for Payer: Cash Price |
$753.30
|
| Rate for Payer: Cigna Commercial |
$2,310.12
|
| Rate for Payer: Health EOS Commercial |
$2,234.79
|
| Rate for Payer: HFN Commercial |
$2,310.12
|
| Rate for Payer: Multiplan Commercial |
$2,008.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,506.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,310.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,230.39
|
| Rate for Payer: Quartz Commercial |
$1,506.60
|
| Rate for Payer: WEA Trust Commercial |
$1,381.05
|
| Rate for Payer: WPS Commercial |
$1,859.90
|
|
|
LAG SCREW CANN 4MM X 32MM BLUNT TIP SS AR-5051-32
|
Facility
|
OP
|
$2,511.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459425
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$703.08 |
| Max. Negotiated Rate |
$10,044.00 |
| Rate for Payer: Aetna Commercial |
$2,259.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,159.46
|
| Rate for Payer: Aetna Managed Medicare |
$703.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,632.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,255.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,205.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,330.83
|
| Rate for Payer: Cash Price |
$753.30
|
| Rate for Payer: Cigna Commercial |
$2,310.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,405.16
|
| Rate for Payer: Health EOS Commercial |
$2,234.79
|
| Rate for Payer: HFN Commercial |
$2,310.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,883.25
|
| Rate for Payer: Multiplan Commercial |
$2,008.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,506.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,310.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,230.39
|
| Rate for Payer: Quartz Commercial |
$1,632.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,506.60
|
| Rate for Payer: The Alliance Commercial |
$10,044.00
|
| Rate for Payer: WEA Trust Commercial |
$1,381.05
|
| Rate for Payer: WPS Commercial |
$1,859.90
|
|
|
LAG SCREW CANN 4MM X 32MM BLUNT TIP SS AR-5051-32
|
Facility
|
IP
|
$2,511.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459425
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,230.39 |
| Max. Negotiated Rate |
$2,310.12 |
| Rate for Payer: Aetna Commercial |
$2,259.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,159.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,330.83
|
| Rate for Payer: Cash Price |
$753.30
|
| Rate for Payer: Cigna Commercial |
$2,310.12
|
| Rate for Payer: Health EOS Commercial |
$2,234.79
|
| Rate for Payer: HFN Commercial |
$2,310.12
|
| Rate for Payer: Multiplan Commercial |
$2,008.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,506.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,310.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,230.39
|
| Rate for Payer: Quartz Commercial |
$1,506.60
|
| Rate for Payer: WEA Trust Commercial |
$1,381.05
|
| Rate for Payer: WPS Commercial |
$1,859.90
|
|
|
LAG SCREW CANN 4MM X 34MM BLUNT TIP SS AR-5051-34
|
Facility
|
OP
|
$2,321.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6153691
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$649.88 |
| Max. Negotiated Rate |
$9,284.00 |
| Rate for Payer: Aetna Commercial |
$2,088.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,996.06
|
| Rate for Payer: Aetna Managed Medicare |
$649.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,508.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,160.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,114.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,230.13
|
| Rate for Payer: Cash Price |
$696.30
|
| Rate for Payer: Cigna Commercial |
$2,135.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,298.83
|
| Rate for Payer: Health EOS Commercial |
$2,065.69
|
| Rate for Payer: HFN Commercial |
$2,135.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,740.75
|
| Rate for Payer: Multiplan Commercial |
$1,856.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,392.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,135.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,137.29
|
| Rate for Payer: Quartz Commercial |
$1,508.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,392.60
|
| Rate for Payer: The Alliance Commercial |
$9,284.00
|
| Rate for Payer: WEA Trust Commercial |
$1,276.55
|
| Rate for Payer: WPS Commercial |
$1,719.16
|
|
|
LAG SCREW CANN 4MM X 34MM BLUNT TIP SS AR-5051-34
|
Facility
|
IP
|
$2,321.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6153691
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,137.29 |
| Max. Negotiated Rate |
$2,135.32 |
| Rate for Payer: Aetna Commercial |
$2,088.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,996.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,230.13
|
| Rate for Payer: Cash Price |
$696.30
|
| Rate for Payer: Cigna Commercial |
$2,135.32
|
| Rate for Payer: Health EOS Commercial |
$2,065.69
|
| Rate for Payer: HFN Commercial |
$2,135.32
|
| Rate for Payer: Multiplan Commercial |
$1,856.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,392.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,135.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,137.29
|
| Rate for Payer: Quartz Commercial |
$1,392.60
|
| Rate for Payer: WEA Trust Commercial |
$1,276.55
|
| Rate for Payer: WPS Commercial |
$1,719.16
|
|
|
LAG SCREW CANN 4MM X 36MM BLUNT TIP SS AR-5051-36
|
Facility
|
IP
|
$2,511.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459426
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,230.39 |
| Max. Negotiated Rate |
$2,310.12 |
| Rate for Payer: Aetna Commercial |
$2,259.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,159.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,330.83
|
| Rate for Payer: Cash Price |
$753.30
|
| Rate for Payer: Cigna Commercial |
$2,310.12
|
| Rate for Payer: Health EOS Commercial |
$2,234.79
|
| Rate for Payer: HFN Commercial |
$2,310.12
|
| Rate for Payer: Multiplan Commercial |
$2,008.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,506.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,310.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,230.39
|
| Rate for Payer: Quartz Commercial |
$1,506.60
|
| Rate for Payer: WEA Trust Commercial |
$1,381.05
|
| Rate for Payer: WPS Commercial |
$1,859.90
|
|
|
LAG SCREW CANN 4MM X 36MM BLUNT TIP SS AR-5051-36
|
Facility
|
OP
|
$2,511.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459426
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$703.08 |
| Max. Negotiated Rate |
$10,044.00 |
| Rate for Payer: Aetna Commercial |
$2,259.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,159.46
|
| Rate for Payer: Aetna Managed Medicare |
$703.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,632.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,255.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,205.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,330.83
|
| Rate for Payer: Cash Price |
$753.30
|
| Rate for Payer: Cigna Commercial |
$2,310.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,405.16
|
| Rate for Payer: Health EOS Commercial |
$2,234.79
|
| Rate for Payer: HFN Commercial |
$2,310.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,883.25
|
| Rate for Payer: Multiplan Commercial |
$2,008.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,506.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,310.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,230.39
|
| Rate for Payer: Quartz Commercial |
$1,632.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,506.60
|
| Rate for Payer: The Alliance Commercial |
$10,044.00
|
| Rate for Payer: WEA Trust Commercial |
$1,381.05
|
| Rate for Payer: WPS Commercial |
$1,859.90
|
|
|
LAG SCREW CANN 4MM X 38MM BLUNT TIP SS AR-5051-38
|
Facility
|
IP
|
$2,511.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459427
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,230.39 |
| Max. Negotiated Rate |
$2,310.12 |
| Rate for Payer: Aetna Commercial |
$2,259.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,159.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,330.83
|
| Rate for Payer: Cash Price |
$753.30
|
| Rate for Payer: Cigna Commercial |
$2,310.12
|
| Rate for Payer: Health EOS Commercial |
$2,234.79
|
| Rate for Payer: HFN Commercial |
$2,310.12
|
| Rate for Payer: Multiplan Commercial |
$2,008.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,506.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,310.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,230.39
|
| Rate for Payer: Quartz Commercial |
$1,506.60
|
| Rate for Payer: WEA Trust Commercial |
$1,381.05
|
| Rate for Payer: WPS Commercial |
$1,859.90
|
|
|
LAG SCREW CANN 4MM X 38MM BLUNT TIP SS AR-5051-38
|
Facility
|
OP
|
$2,511.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459427
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$703.08 |
| Max. Negotiated Rate |
$10,044.00 |
| Rate for Payer: Aetna Commercial |
$2,259.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,159.46
|
| Rate for Payer: Aetna Managed Medicare |
$703.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,632.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,255.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,205.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,330.83
|
| Rate for Payer: Cash Price |
$753.30
|
| Rate for Payer: Cigna Commercial |
$2,310.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,405.16
|
| Rate for Payer: Health EOS Commercial |
$2,234.79
|
| Rate for Payer: HFN Commercial |
$2,310.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,883.25
|
| Rate for Payer: Multiplan Commercial |
$2,008.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,506.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,310.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,230.39
|
| Rate for Payer: Quartz Commercial |
$1,632.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,506.60
|
| Rate for Payer: The Alliance Commercial |
$10,044.00
|
| Rate for Payer: WEA Trust Commercial |
$1,381.05
|
| Rate for Payer: WPS Commercial |
$1,859.90
|
|
|
LAG SCREW CANN 4MM X 40MM BLUNT TIP SS AR-5051-40
|
Facility
|
OP
|
$2,511.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5563514
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$703.08 |
| Max. Negotiated Rate |
$10,044.00 |
| Rate for Payer: Aetna Commercial |
$2,259.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,159.46
|
| Rate for Payer: Aetna Managed Medicare |
$703.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,632.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,255.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,205.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,330.83
|
| Rate for Payer: Cash Price |
$753.30
|
| Rate for Payer: Cigna Commercial |
$2,310.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,405.16
|
| Rate for Payer: Health EOS Commercial |
$2,234.79
|
| Rate for Payer: HFN Commercial |
$2,310.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,883.25
|
| Rate for Payer: Multiplan Commercial |
$2,008.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,506.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,310.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,230.39
|
| Rate for Payer: Quartz Commercial |
$1,632.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,506.60
|
| Rate for Payer: The Alliance Commercial |
$10,044.00
|
| Rate for Payer: WEA Trust Commercial |
$1,381.05
|
| Rate for Payer: WPS Commercial |
$1,859.90
|
|
|
LAG SCREW CANN 4MM X 40MM BLUNT TIP SS AR-5051-40
|
Facility
|
IP
|
$2,511.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5563514
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,230.39 |
| Max. Negotiated Rate |
$2,310.12 |
| Rate for Payer: Aetna Commercial |
$2,259.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,159.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,330.83
|
| Rate for Payer: Cash Price |
$753.30
|
| Rate for Payer: Cigna Commercial |
$2,310.12
|
| Rate for Payer: Health EOS Commercial |
$2,234.79
|
| Rate for Payer: HFN Commercial |
$2,310.12
|
| Rate for Payer: Multiplan Commercial |
$2,008.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,506.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,310.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,230.39
|
| Rate for Payer: Quartz Commercial |
$1,506.60
|
| Rate for Payer: WEA Trust Commercial |
$1,381.05
|
| Rate for Payer: WPS Commercial |
$1,859.90
|
|
|
LAG SCREW CANN 4MM X 42MM BLUNT TIP SS AR-5051-42
|
Facility
|
OP
|
$2,031.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6174843
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$568.68 |
| Max. Negotiated Rate |
$8,124.00 |
| Rate for Payer: Aetna Commercial |
$1,827.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,746.66
|
| Rate for Payer: Aetna Managed Medicare |
$568.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,320.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,015.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$974.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,076.43
|
| Rate for Payer: Cash Price |
$609.30
|
| Rate for Payer: Cigna Commercial |
$1,868.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,136.55
|
| Rate for Payer: Health EOS Commercial |
$1,807.59
|
| Rate for Payer: HFN Commercial |
$1,868.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,523.25
|
| Rate for Payer: Multiplan Commercial |
$1,624.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,218.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,868.52
|
| Rate for Payer: Quartz Beloit One Network |
$995.19
|
| Rate for Payer: Quartz Commercial |
$1,320.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,218.60
|
| Rate for Payer: The Alliance Commercial |
$8,124.00
|
| Rate for Payer: WEA Trust Commercial |
$1,117.05
|
| Rate for Payer: WPS Commercial |
$1,504.36
|
|
|
LAG SCREW CANN 4MM X 42MM BLUNT TIP SS AR-5051-42
|
Facility
|
IP
|
$2,031.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6174843
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$995.19 |
| Max. Negotiated Rate |
$1,868.52 |
| Rate for Payer: Aetna Commercial |
$1,827.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,746.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,076.43
|
| Rate for Payer: Cash Price |
$609.30
|
| Rate for Payer: Cigna Commercial |
$1,868.52
|
| Rate for Payer: Health EOS Commercial |
$1,807.59
|
| Rate for Payer: HFN Commercial |
$1,868.52
|
| Rate for Payer: Multiplan Commercial |
$1,624.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,218.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,868.52
|
| Rate for Payer: Quartz Beloit One Network |
$995.19
|
| Rate for Payer: Quartz Commercial |
$1,218.60
|
| Rate for Payer: WEA Trust Commercial |
$1,117.05
|
| Rate for Payer: WPS Commercial |
$1,504.36
|
|
|
LAG SCREW CANN 4MM X 44MM BLUNT TIP SS AR-5051-44
|
Facility
|
OP
|
$2,511.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459428
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$703.08 |
| Max. Negotiated Rate |
$10,044.00 |
| Rate for Payer: Aetna Commercial |
$2,259.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,159.46
|
| Rate for Payer: Aetna Managed Medicare |
$703.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,632.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,255.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,205.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,330.83
|
| Rate for Payer: Cash Price |
$753.30
|
| Rate for Payer: Cigna Commercial |
$2,310.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,405.16
|
| Rate for Payer: Health EOS Commercial |
$2,234.79
|
| Rate for Payer: HFN Commercial |
$2,310.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,883.25
|
| Rate for Payer: Multiplan Commercial |
$2,008.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,506.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,310.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,230.39
|
| Rate for Payer: Quartz Commercial |
$1,632.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,506.60
|
| Rate for Payer: The Alliance Commercial |
$10,044.00
|
| Rate for Payer: WEA Trust Commercial |
$1,381.05
|
| Rate for Payer: WPS Commercial |
$1,859.90
|
|
|
LAG SCREW CANN 4MM X 44MM BLUNT TIP SS AR-5051-44
|
Facility
|
IP
|
$2,511.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459428
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,230.39 |
| Max. Negotiated Rate |
$2,310.12 |
| Rate for Payer: Aetna Commercial |
$2,259.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,159.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,330.83
|
| Rate for Payer: Cash Price |
$753.30
|
| Rate for Payer: Cigna Commercial |
$2,310.12
|
| Rate for Payer: Health EOS Commercial |
$2,234.79
|
| Rate for Payer: HFN Commercial |
$2,310.12
|
| Rate for Payer: Multiplan Commercial |
$2,008.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,506.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,310.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,230.39
|
| Rate for Payer: Quartz Commercial |
$1,506.60
|
| Rate for Payer: WEA Trust Commercial |
$1,381.05
|
| Rate for Payer: WPS Commercial |
$1,859.90
|
|
|
LAG SCREW CP 4.1MM X 38MM 626838
|
Facility
|
OP
|
$3,160.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5787773
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$884.80 |
| Max. Negotiated Rate |
$12,640.00 |
| Rate for Payer: Aetna Commercial |
$2,844.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,717.60
|
| Rate for Payer: Aetna Managed Medicare |
$884.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,054.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,580.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,516.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,674.80
|
| Rate for Payer: Cash Price |
$948.00
|
| Rate for Payer: Cigna Commercial |
$2,907.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,768.34
|
| Rate for Payer: Health EOS Commercial |
$2,812.40
|
| Rate for Payer: HFN Commercial |
$2,907.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,370.00
|
| Rate for Payer: Multiplan Commercial |
$2,528.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,896.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,907.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,548.40
|
| Rate for Payer: Quartz Commercial |
$2,054.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,896.00
|
| Rate for Payer: The Alliance Commercial |
$12,640.00
|
| Rate for Payer: WEA Trust Commercial |
$1,738.00
|
| Rate for Payer: WPS Commercial |
$2,340.61
|
|
|
LAG SCREW CP 4.1MM X 38MM 626838
|
Facility
|
IP
|
$3,160.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5787773
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,548.40 |
| Max. Negotiated Rate |
$2,907.20 |
| Rate for Payer: Aetna Commercial |
$2,844.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,717.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,674.80
|
| Rate for Payer: Cash Price |
$948.00
|
| Rate for Payer: Cigna Commercial |
$2,907.20
|
| Rate for Payer: Health EOS Commercial |
$2,812.40
|
| Rate for Payer: HFN Commercial |
$2,907.20
|
| Rate for Payer: Multiplan Commercial |
$2,528.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,896.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,907.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,548.40
|
| Rate for Payer: Quartz Commercial |
$1,896.00
|
| Rate for Payer: WEA Trust Commercial |
$1,738.00
|
| Rate for Payer: WPS Commercial |
$2,340.61
|
|
|
LAG SCREW CROSSPLATE 3.6MM X 28MM 626928
|
Facility
|
IP
|
$2,638.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5787772
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,292.62 |
| Max. Negotiated Rate |
$2,426.96 |
| Rate for Payer: Aetna Commercial |
$2,374.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,268.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,398.14
|
| Rate for Payer: Cash Price |
$791.40
|
| Rate for Payer: Cigna Commercial |
$2,426.96
|
| Rate for Payer: Health EOS Commercial |
$2,347.82
|
| Rate for Payer: HFN Commercial |
$2,426.96
|
| Rate for Payer: Multiplan Commercial |
$2,110.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,582.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,426.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,292.62
|
| Rate for Payer: Quartz Commercial |
$1,582.80
|
| Rate for Payer: WEA Trust Commercial |
$1,450.90
|
| Rate for Payer: WPS Commercial |
$1,953.97
|
|
|
LAG SCREW CROSSPLATE 3.6MM X 28MM 626928
|
Facility
|
OP
|
$2,638.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5787772
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$738.64 |
| Max. Negotiated Rate |
$10,552.00 |
| Rate for Payer: Aetna Commercial |
$2,374.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,268.68
|
| Rate for Payer: Aetna Managed Medicare |
$738.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,714.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,319.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,266.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,398.14
|
| Rate for Payer: Cash Price |
$791.40
|
| Rate for Payer: Cigna Commercial |
$2,426.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,476.22
|
| Rate for Payer: Health EOS Commercial |
$2,347.82
|
| Rate for Payer: HFN Commercial |
$2,426.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,978.50
|
| Rate for Payer: Multiplan Commercial |
$2,110.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,582.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,426.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,292.62
|
| Rate for Payer: Quartz Commercial |
$1,714.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,582.80
|
| Rate for Payer: The Alliance Commercial |
$10,552.00
|
| Rate for Payer: WEA Trust Commercial |
$1,450.90
|
| Rate for Payer: WPS Commercial |
$1,953.97
|
|
|
LAG SCREW DHS 85MM 280.285
|
Facility
|
OP
|
$4,324.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2966263
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,210.72 |
| Max. Negotiated Rate |
$17,296.00 |
| Rate for Payer: Aetna Commercial |
$3,891.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,718.64
|
| Rate for Payer: Aetna Managed Medicare |
$1,210.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,810.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,162.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,075.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,291.72
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$3,978.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,419.71
|
| Rate for Payer: Health EOS Commercial |
$3,848.36
|
| Rate for Payer: HFN Commercial |
$3,978.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,243.00
|
| Rate for Payer: Multiplan Commercial |
$3,459.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,594.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,978.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,118.76
|
| Rate for Payer: Quartz Commercial |
$2,810.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2,594.40
|
| Rate for Payer: The Alliance Commercial |
$17,296.00
|
| Rate for Payer: WEA Trust Commercial |
$2,378.20
|
| Rate for Payer: WPS Commercial |
$3,202.79
|
|
|
LAG SCREW DHS 85MM 280.285
|
Facility
|
IP
|
$4,324.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2966263
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,118.76 |
| Max. Negotiated Rate |
$3,978.08 |
| Rate for Payer: Aetna Commercial |
$3,891.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,718.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,291.72
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$3,978.08
|
| Rate for Payer: Health EOS Commercial |
$3,848.36
|
| Rate for Payer: HFN Commercial |
$3,978.08
|
| Rate for Payer: Multiplan Commercial |
$3,459.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,594.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,978.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,118.76
|
| Rate for Payer: Quartz Commercial |
$2,594.40
|
| Rate for Payer: WEA Trust Commercial |
$2,378.20
|
| Rate for Payer: WPS Commercial |
$3,202.79
|
|
|
LAG SCREW DHS/DCS 12.7MM X 95MM 280.950
|
Facility
|
IP
|
$2,936.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5458987
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,438.64 |
| Max. Negotiated Rate |
$2,701.12 |
| Rate for Payer: Aetna Commercial |
$2,642.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,524.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,556.08
|
| Rate for Payer: Cash Price |
$880.80
|
| Rate for Payer: Cigna Commercial |
$2,701.12
|
| Rate for Payer: Health EOS Commercial |
$2,613.04
|
| Rate for Payer: HFN Commercial |
$2,701.12
|
| Rate for Payer: Multiplan Commercial |
$2,348.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,761.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,701.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,438.64
|
| Rate for Payer: Quartz Commercial |
$1,761.60
|
| Rate for Payer: WEA Trust Commercial |
$1,614.80
|
| Rate for Payer: WPS Commercial |
$2,174.70
|
|
|
LAG SCREW DHS/DCS 12.7MM X 95MM 280.950
|
Facility
|
OP
|
$2,936.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5458987
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$822.08 |
| Max. Negotiated Rate |
$11,744.00 |
| Rate for Payer: Aetna Commercial |
$2,642.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,524.96
|
| Rate for Payer: Aetna Managed Medicare |
$822.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,908.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,468.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,409.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,556.08
|
| Rate for Payer: Cash Price |
$880.80
|
| Rate for Payer: Cigna Commercial |
$2,701.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,642.99
|
| Rate for Payer: Health EOS Commercial |
$2,613.04
|
| Rate for Payer: HFN Commercial |
$2,701.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,202.00
|
| Rate for Payer: Multiplan Commercial |
$2,348.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,761.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,701.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,438.64
|
| Rate for Payer: Quartz Commercial |
$1,908.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,761.60
|
| Rate for Payer: The Alliance Commercial |
$11,744.00
|
| Rate for Payer: WEA Trust Commercial |
$1,614.80
|
| Rate for Payer: WPS Commercial |
$2,174.70
|
|
