|
LAG SCREW 95MM OMEGA 3362-5-095
|
Facility
|
IP
|
$2,536.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5459547
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,292.35 |
| Max. Negotiated Rate |
$2,426.44 |
| Rate for Payer: Aetna Commercial |
$2,373.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,268.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,397.84
|
| Rate for Payer: Cash Price |
$760.80
|
| Rate for Payer: Cigna Commercial |
$2,426.44
|
| Rate for Payer: Health EOS Commercial |
$2,347.32
|
| Rate for Payer: HFN Commercial |
$2,426.44
|
| Rate for Payer: Multiplan Commercial |
$2,109.95
|
| Rate for Payer: Preferred Network Access Commercial |
$2,426.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,292.35
|
| Rate for Payer: Quartz Commercial |
$1,582.46
|
| Rate for Payer: WEA Trust Commercial |
$1,450.59
|
| Rate for Payer: WPS Commercial |
$1,953.48
|
|
|
LAG SCREW 95MM OMEGA 3362-5-095
|
Facility
|
OP
|
$2,536.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5459547
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$738.48 |
| Max. Negotiated Rate |
$2,426.44 |
| Rate for Payer: Aetna Commercial |
$2,373.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,268.20
|
| Rate for Payer: Aetna Managed Medicare |
$738.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,714.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,318.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,265.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,397.84
|
| Rate for Payer: Cash Price |
$760.80
|
| Rate for Payer: Cigna Commercial |
$2,426.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,475.95
|
| Rate for Payer: Health EOS Commercial |
$2,347.32
|
| Rate for Payer: HFN Commercial |
$2,426.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,978.08
|
| Rate for Payer: Multiplan Commercial |
$2,109.95
|
| Rate for Payer: NAPHCARE Commercial |
$1,582.46
|
| Rate for Payer: Preferred Network Access Commercial |
$2,426.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,292.35
|
| Rate for Payer: Quartz Commercial |
$1,714.34
|
| Rate for Payer: Quartz Medicare Advantage |
$1,582.46
|
| Rate for Payer: The Alliance Commercial |
$1,318.72
|
| Rate for Payer: WEA Trust Commercial |
$1,450.59
|
| Rate for Payer: WPS Commercial |
$1,953.48
|
|
|
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 |
$1,035.00 |
| Max. Negotiated Rate |
$1,943.26 |
| Rate for Payer: Aetna Commercial |
$1,901.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,816.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,119.49
|
| Rate for Payer: Cash Price |
$609.30
|
| Rate for Payer: Cigna Commercial |
$1,943.26
|
| Rate for Payer: Health EOS Commercial |
$1,879.89
|
| Rate for Payer: HFN Commercial |
$1,943.26
|
| Rate for Payer: Multiplan Commercial |
$1,689.79
|
| Rate for Payer: Preferred Network Access Commercial |
$1,943.26
|
| Rate for Payer: Quartz Beloit One Network |
$1,035.00
|
| Rate for Payer: Quartz Commercial |
$1,267.34
|
| Rate for Payer: WEA Trust Commercial |
$1,161.73
|
| Rate for Payer: WPS Commercial |
$1,564.48
|
|
|
LAG SCREW CANN 4MM X 24MM BLUNT TIP SS AR-5051-24
|
Facility
|
OP
|
$2,031.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6171770
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$591.43 |
| Max. Negotiated Rate |
$1,943.26 |
| Rate for Payer: Aetna Commercial |
$1,901.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,816.53
|
| Rate for Payer: Aetna Managed Medicare |
$591.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,372.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,056.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,013.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,119.49
|
| Rate for Payer: Cash Price |
$609.30
|
| Rate for Payer: Cigna Commercial |
$1,943.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,182.04
|
| Rate for Payer: Health EOS Commercial |
$1,879.89
|
| Rate for Payer: HFN Commercial |
$1,943.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,584.18
|
| Rate for Payer: Multiplan Commercial |
$1,689.79
|
| Rate for Payer: NAPHCARE Commercial |
$1,267.34
|
| Rate for Payer: Preferred Network Access Commercial |
$1,943.26
|
| Rate for Payer: Quartz Beloit One Network |
$1,035.00
|
| Rate for Payer: Quartz Commercial |
$1,372.96
|
| Rate for Payer: Quartz Medicare Advantage |
$1,267.34
|
| Rate for Payer: The Alliance Commercial |
$1,056.12
|
| Rate for Payer: WEA Trust Commercial |
$1,161.73
|
| Rate for Payer: WPS Commercial |
$1,564.48
|
|
|
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 |
$1,279.61 |
| Max. Negotiated Rate |
$2,402.52 |
| Rate for Payer: Aetna Commercial |
$2,350.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,245.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,384.06
|
| Rate for Payer: Cash Price |
$753.30
|
| Rate for Payer: Cigna Commercial |
$2,402.52
|
| Rate for Payer: Health EOS Commercial |
$2,324.18
|
| Rate for Payer: HFN Commercial |
$2,402.52
|
| Rate for Payer: Multiplan Commercial |
$2,089.15
|
| Rate for Payer: Preferred Network Access Commercial |
$2,402.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,279.61
|
| Rate for Payer: Quartz Commercial |
$1,566.86
|
| Rate for Payer: WEA Trust Commercial |
$1,436.29
|
| Rate for Payer: WPS Commercial |
$1,934.22
|
|
|
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 |
$731.20 |
| Max. Negotiated Rate |
$2,402.52 |
| Rate for Payer: Aetna Commercial |
$2,350.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,245.84
|
| Rate for Payer: Aetna Managed Medicare |
$731.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,697.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,305.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,253.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,384.06
|
| Rate for Payer: Cash Price |
$753.30
|
| Rate for Payer: Cigna Commercial |
$2,402.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,461.40
|
| Rate for Payer: Health EOS Commercial |
$2,324.18
|
| Rate for Payer: HFN Commercial |
$2,402.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,958.58
|
| Rate for Payer: Multiplan Commercial |
$2,089.15
|
| Rate for Payer: NAPHCARE Commercial |
$1,566.86
|
| Rate for Payer: Preferred Network Access Commercial |
$2,402.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,279.61
|
| Rate for Payer: Quartz Commercial |
$1,697.44
|
| Rate for Payer: Quartz Medicare Advantage |
$1,566.86
|
| Rate for Payer: The Alliance Commercial |
$1,305.72
|
| Rate for Payer: WEA Trust Commercial |
$1,436.29
|
| Rate for Payer: WPS Commercial |
$1,934.22
|
|
|
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 |
$731.20 |
| Max. Negotiated Rate |
$2,402.52 |
| Rate for Payer: Aetna Commercial |
$2,350.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,245.84
|
| Rate for Payer: Aetna Managed Medicare |
$731.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,697.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,305.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,253.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,384.06
|
| Rate for Payer: Cash Price |
$753.30
|
| Rate for Payer: Cigna Commercial |
$2,402.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,461.40
|
| Rate for Payer: Health EOS Commercial |
$2,324.18
|
| Rate for Payer: HFN Commercial |
$2,402.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,958.58
|
| Rate for Payer: Multiplan Commercial |
$2,089.15
|
| Rate for Payer: NAPHCARE Commercial |
$1,566.86
|
| Rate for Payer: Preferred Network Access Commercial |
$2,402.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,279.61
|
| Rate for Payer: Quartz Commercial |
$1,697.44
|
| Rate for Payer: Quartz Medicare Advantage |
$1,566.86
|
| Rate for Payer: The Alliance Commercial |
$1,305.72
|
| Rate for Payer: WEA Trust Commercial |
$1,436.29
|
| Rate for Payer: WPS Commercial |
$1,934.22
|
|
|
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 |
$1,279.61 |
| Max. Negotiated Rate |
$2,402.52 |
| Rate for Payer: Aetna Commercial |
$2,350.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,245.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,384.06
|
| Rate for Payer: Cash Price |
$753.30
|
| Rate for Payer: Cigna Commercial |
$2,402.52
|
| Rate for Payer: Health EOS Commercial |
$2,324.18
|
| Rate for Payer: HFN Commercial |
$2,402.52
|
| Rate for Payer: Multiplan Commercial |
$2,089.15
|
| Rate for Payer: Preferred Network Access Commercial |
$2,402.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,279.61
|
| Rate for Payer: Quartz Commercial |
$1,566.86
|
| Rate for Payer: WEA Trust Commercial |
$1,436.29
|
| Rate for Payer: WPS Commercial |
$1,934.22
|
|
|
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 |
$1,182.78 |
| Max. Negotiated Rate |
$2,220.73 |
| Rate for Payer: Aetna Commercial |
$2,172.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,075.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,279.34
|
| Rate for Payer: Cash Price |
$696.30
|
| Rate for Payer: Cigna Commercial |
$2,220.73
|
| Rate for Payer: Health EOS Commercial |
$2,148.32
|
| Rate for Payer: HFN Commercial |
$2,220.73
|
| Rate for Payer: Multiplan Commercial |
$1,931.07
|
| Rate for Payer: Preferred Network Access Commercial |
$2,220.73
|
| Rate for Payer: Quartz Beloit One Network |
$1,182.78
|
| Rate for Payer: Quartz Commercial |
$1,448.30
|
| Rate for Payer: WEA Trust Commercial |
$1,327.61
|
| Rate for Payer: WPS Commercial |
$1,787.87
|
|
|
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 |
$675.88 |
| Max. Negotiated Rate |
$2,220.73 |
| Rate for Payer: Aetna Commercial |
$2,172.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,075.90
|
| Rate for Payer: Aetna Managed Medicare |
$675.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,569.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,206.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,158.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,279.34
|
| Rate for Payer: Cash Price |
$696.30
|
| Rate for Payer: Cigna Commercial |
$2,220.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,350.82
|
| Rate for Payer: Health EOS Commercial |
$2,148.32
|
| Rate for Payer: HFN Commercial |
$2,220.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,810.38
|
| Rate for Payer: Multiplan Commercial |
$1,931.07
|
| Rate for Payer: NAPHCARE Commercial |
$1,448.30
|
| Rate for Payer: Preferred Network Access Commercial |
$2,220.73
|
| Rate for Payer: Quartz Beloit One Network |
$1,182.78
|
| Rate for Payer: Quartz Commercial |
$1,569.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,448.30
|
| Rate for Payer: The Alliance Commercial |
$1,206.92
|
| Rate for Payer: WEA Trust Commercial |
$1,327.61
|
| Rate for Payer: WPS Commercial |
$1,787.87
|
|
|
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 |
$1,279.61 |
| Max. Negotiated Rate |
$2,402.52 |
| Rate for Payer: Aetna Commercial |
$2,350.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,245.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,384.06
|
| Rate for Payer: Cash Price |
$753.30
|
| Rate for Payer: Cigna Commercial |
$2,402.52
|
| Rate for Payer: Health EOS Commercial |
$2,324.18
|
| Rate for Payer: HFN Commercial |
$2,402.52
|
| Rate for Payer: Multiplan Commercial |
$2,089.15
|
| Rate for Payer: Preferred Network Access Commercial |
$2,402.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,279.61
|
| Rate for Payer: Quartz Commercial |
$1,566.86
|
| Rate for Payer: WEA Trust Commercial |
$1,436.29
|
| Rate for Payer: WPS Commercial |
$1,934.22
|
|
|
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 |
$731.20 |
| Max. Negotiated Rate |
$2,402.52 |
| Rate for Payer: Aetna Commercial |
$2,350.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,245.84
|
| Rate for Payer: Aetna Managed Medicare |
$731.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,697.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,305.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,253.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,384.06
|
| Rate for Payer: Cash Price |
$753.30
|
| Rate for Payer: Cigna Commercial |
$2,402.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,461.40
|
| Rate for Payer: Health EOS Commercial |
$2,324.18
|
| Rate for Payer: HFN Commercial |
$2,402.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,958.58
|
| Rate for Payer: Multiplan Commercial |
$2,089.15
|
| Rate for Payer: NAPHCARE Commercial |
$1,566.86
|
| Rate for Payer: Preferred Network Access Commercial |
$2,402.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,279.61
|
| Rate for Payer: Quartz Commercial |
$1,697.44
|
| Rate for Payer: Quartz Medicare Advantage |
$1,566.86
|
| Rate for Payer: The Alliance Commercial |
$1,305.72
|
| Rate for Payer: WEA Trust Commercial |
$1,436.29
|
| Rate for Payer: WPS Commercial |
$1,934.22
|
|
|
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 |
$731.20 |
| Max. Negotiated Rate |
$2,402.52 |
| Rate for Payer: Aetna Commercial |
$2,350.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,245.84
|
| Rate for Payer: Aetna Managed Medicare |
$731.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,697.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,305.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,253.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,384.06
|
| Rate for Payer: Cash Price |
$753.30
|
| Rate for Payer: Cigna Commercial |
$2,402.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,461.40
|
| Rate for Payer: Health EOS Commercial |
$2,324.18
|
| Rate for Payer: HFN Commercial |
$2,402.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,958.58
|
| Rate for Payer: Multiplan Commercial |
$2,089.15
|
| Rate for Payer: NAPHCARE Commercial |
$1,566.86
|
| Rate for Payer: Preferred Network Access Commercial |
$2,402.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,279.61
|
| Rate for Payer: Quartz Commercial |
$1,697.44
|
| Rate for Payer: Quartz Medicare Advantage |
$1,566.86
|
| Rate for Payer: The Alliance Commercial |
$1,305.72
|
| Rate for Payer: WEA Trust Commercial |
$1,436.29
|
| Rate for Payer: WPS Commercial |
$1,934.22
|
|
|
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 |
$1,279.61 |
| Max. Negotiated Rate |
$2,402.52 |
| Rate for Payer: Aetna Commercial |
$2,350.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,245.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,384.06
|
| Rate for Payer: Cash Price |
$753.30
|
| Rate for Payer: Cigna Commercial |
$2,402.52
|
| Rate for Payer: Health EOS Commercial |
$2,324.18
|
| Rate for Payer: HFN Commercial |
$2,402.52
|
| Rate for Payer: Multiplan Commercial |
$2,089.15
|
| Rate for Payer: Preferred Network Access Commercial |
$2,402.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,279.61
|
| Rate for Payer: Quartz Commercial |
$1,566.86
|
| Rate for Payer: WEA Trust Commercial |
$1,436.29
|
| Rate for Payer: WPS Commercial |
$1,934.22
|
|
|
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 |
$731.20 |
| Max. Negotiated Rate |
$2,402.52 |
| Rate for Payer: Aetna Commercial |
$2,350.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,245.84
|
| Rate for Payer: Aetna Managed Medicare |
$731.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,697.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,305.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,253.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,384.06
|
| Rate for Payer: Cash Price |
$753.30
|
| Rate for Payer: Cigna Commercial |
$2,402.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,461.40
|
| Rate for Payer: Health EOS Commercial |
$2,324.18
|
| Rate for Payer: HFN Commercial |
$2,402.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,958.58
|
| Rate for Payer: Multiplan Commercial |
$2,089.15
|
| Rate for Payer: NAPHCARE Commercial |
$1,566.86
|
| Rate for Payer: Preferred Network Access Commercial |
$2,402.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,279.61
|
| Rate for Payer: Quartz Commercial |
$1,697.44
|
| Rate for Payer: Quartz Medicare Advantage |
$1,566.86
|
| Rate for Payer: The Alliance Commercial |
$1,305.72
|
| Rate for Payer: WEA Trust Commercial |
$1,436.29
|
| Rate for Payer: WPS Commercial |
$1,934.22
|
|
|
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 |
$1,279.61 |
| Max. Negotiated Rate |
$2,402.52 |
| Rate for Payer: Aetna Commercial |
$2,350.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,245.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,384.06
|
| Rate for Payer: Cash Price |
$753.30
|
| Rate for Payer: Cigna Commercial |
$2,402.52
|
| Rate for Payer: Health EOS Commercial |
$2,324.18
|
| Rate for Payer: HFN Commercial |
$2,402.52
|
| Rate for Payer: Multiplan Commercial |
$2,089.15
|
| Rate for Payer: Preferred Network Access Commercial |
$2,402.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,279.61
|
| Rate for Payer: Quartz Commercial |
$1,566.86
|
| Rate for Payer: WEA Trust Commercial |
$1,436.29
|
| Rate for Payer: WPS Commercial |
$1,934.22
|
|
|
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 |
$1,035.00 |
| Max. Negotiated Rate |
$1,943.26 |
| Rate for Payer: Aetna Commercial |
$1,901.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,816.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,119.49
|
| Rate for Payer: Cash Price |
$609.30
|
| Rate for Payer: Cigna Commercial |
$1,943.26
|
| Rate for Payer: Health EOS Commercial |
$1,879.89
|
| Rate for Payer: HFN Commercial |
$1,943.26
|
| Rate for Payer: Multiplan Commercial |
$1,689.79
|
| Rate for Payer: Preferred Network Access Commercial |
$1,943.26
|
| Rate for Payer: Quartz Beloit One Network |
$1,035.00
|
| Rate for Payer: Quartz Commercial |
$1,267.34
|
| Rate for Payer: WEA Trust Commercial |
$1,161.73
|
| Rate for Payer: WPS Commercial |
$1,564.48
|
|
|
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 |
$591.43 |
| Max. Negotiated Rate |
$1,943.26 |
| Rate for Payer: Aetna Commercial |
$1,901.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,816.53
|
| Rate for Payer: Aetna Managed Medicare |
$591.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,372.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,056.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,013.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,119.49
|
| Rate for Payer: Cash Price |
$609.30
|
| Rate for Payer: Cigna Commercial |
$1,943.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,182.04
|
| Rate for Payer: Health EOS Commercial |
$1,879.89
|
| Rate for Payer: HFN Commercial |
$1,943.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,584.18
|
| Rate for Payer: Multiplan Commercial |
$1,689.79
|
| Rate for Payer: NAPHCARE Commercial |
$1,267.34
|
| Rate for Payer: Preferred Network Access Commercial |
$1,943.26
|
| Rate for Payer: Quartz Beloit One Network |
$1,035.00
|
| Rate for Payer: Quartz Commercial |
$1,372.96
|
| Rate for Payer: Quartz Medicare Advantage |
$1,267.34
|
| Rate for Payer: The Alliance Commercial |
$1,056.12
|
| Rate for Payer: WEA Trust Commercial |
$1,161.73
|
| Rate for Payer: WPS Commercial |
$1,564.48
|
|
|
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 |
$1,279.61 |
| Max. Negotiated Rate |
$2,402.52 |
| Rate for Payer: Aetna Commercial |
$2,350.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,245.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,384.06
|
| Rate for Payer: Cash Price |
$753.30
|
| Rate for Payer: Cigna Commercial |
$2,402.52
|
| Rate for Payer: Health EOS Commercial |
$2,324.18
|
| Rate for Payer: HFN Commercial |
$2,402.52
|
| Rate for Payer: Multiplan Commercial |
$2,089.15
|
| Rate for Payer: Preferred Network Access Commercial |
$2,402.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,279.61
|
| Rate for Payer: Quartz Commercial |
$1,566.86
|
| Rate for Payer: WEA Trust Commercial |
$1,436.29
|
| Rate for Payer: WPS Commercial |
$1,934.22
|
|
|
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 |
$731.20 |
| Max. Negotiated Rate |
$2,402.52 |
| Rate for Payer: Aetna Commercial |
$2,350.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,245.84
|
| Rate for Payer: Aetna Managed Medicare |
$731.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,697.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,305.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,253.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,384.06
|
| Rate for Payer: Cash Price |
$753.30
|
| Rate for Payer: Cigna Commercial |
$2,402.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,461.40
|
| Rate for Payer: Health EOS Commercial |
$2,324.18
|
| Rate for Payer: HFN Commercial |
$2,402.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,958.58
|
| Rate for Payer: Multiplan Commercial |
$2,089.15
|
| Rate for Payer: NAPHCARE Commercial |
$1,566.86
|
| Rate for Payer: Preferred Network Access Commercial |
$2,402.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,279.61
|
| Rate for Payer: Quartz Commercial |
$1,697.44
|
| Rate for Payer: Quartz Medicare Advantage |
$1,566.86
|
| Rate for Payer: The Alliance Commercial |
$1,305.72
|
| Rate for Payer: WEA Trust Commercial |
$1,436.29
|
| Rate for Payer: WPS Commercial |
$1,934.22
|
|
|
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 |
$1,610.34 |
| Max. Negotiated Rate |
$3,023.49 |
| Rate for Payer: Aetna Commercial |
$2,957.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,826.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,741.79
|
| Rate for Payer: Cash Price |
$948.00
|
| Rate for Payer: Cigna Commercial |
$3,023.49
|
| Rate for Payer: Health EOS Commercial |
$2,924.90
|
| Rate for Payer: HFN Commercial |
$3,023.49
|
| Rate for Payer: Multiplan Commercial |
$2,629.12
|
| Rate for Payer: Preferred Network Access Commercial |
$3,023.49
|
| Rate for Payer: Quartz Beloit One Network |
$1,610.34
|
| Rate for Payer: Quartz Commercial |
$1,971.84
|
| Rate for Payer: WEA Trust Commercial |
$1,807.52
|
| Rate for Payer: WPS Commercial |
$2,434.15
|
|
|
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 |
$920.19 |
| Max. Negotiated Rate |
$3,023.49 |
| Rate for Payer: Aetna Commercial |
$2,957.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,826.30
|
| Rate for Payer: Aetna Managed Medicare |
$920.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,136.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,643.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,577.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,741.79
|
| Rate for Payer: Cash Price |
$948.00
|
| Rate for Payer: Cigna Commercial |
$3,023.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,839.12
|
| Rate for Payer: Health EOS Commercial |
$2,924.90
|
| Rate for Payer: HFN Commercial |
$3,023.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,464.80
|
| Rate for Payer: Multiplan Commercial |
$2,629.12
|
| Rate for Payer: NAPHCARE Commercial |
$1,971.84
|
| Rate for Payer: Preferred Network Access Commercial |
$3,023.49
|
| Rate for Payer: Quartz Beloit One Network |
$1,610.34
|
| Rate for Payer: Quartz Commercial |
$2,136.16
|
| Rate for Payer: Quartz Medicare Advantage |
$1,971.84
|
| Rate for Payer: The Alliance Commercial |
$1,643.20
|
| Rate for Payer: WEA Trust Commercial |
$1,807.52
|
| Rate for Payer: WPS Commercial |
$2,434.15
|
|
|
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 |
$768.19 |
| Max. Negotiated Rate |
$2,524.04 |
| Rate for Payer: Aetna Commercial |
$2,469.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,359.43
|
| Rate for Payer: Aetna Managed Medicare |
$768.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,783.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,371.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,316.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,454.07
|
| Rate for Payer: Cash Price |
$791.40
|
| Rate for Payer: Cigna Commercial |
$2,524.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,535.32
|
| Rate for Payer: Health EOS Commercial |
$2,441.73
|
| Rate for Payer: HFN Commercial |
$2,524.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,057.64
|
| Rate for Payer: Multiplan Commercial |
$2,194.82
|
| Rate for Payer: NAPHCARE Commercial |
$1,646.11
|
| Rate for Payer: Preferred Network Access Commercial |
$2,524.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,344.32
|
| Rate for Payer: Quartz Commercial |
$1,783.29
|
| Rate for Payer: Quartz Medicare Advantage |
$1,646.11
|
| Rate for Payer: The Alliance Commercial |
$1,371.76
|
| Rate for Payer: WEA Trust Commercial |
$1,508.94
|
| Rate for Payer: WPS Commercial |
$2,032.05
|
|
|
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 |
$1,344.32 |
| Max. Negotiated Rate |
$2,524.04 |
| Rate for Payer: Aetna Commercial |
$2,469.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,359.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,454.07
|
| Rate for Payer: Cash Price |
$791.40
|
| Rate for Payer: Cigna Commercial |
$2,524.04
|
| Rate for Payer: Health EOS Commercial |
$2,441.73
|
| Rate for Payer: HFN Commercial |
$2,524.04
|
| Rate for Payer: Multiplan Commercial |
$2,194.82
|
| Rate for Payer: Preferred Network Access Commercial |
$2,524.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,344.32
|
| Rate for Payer: Quartz Commercial |
$1,646.11
|
| Rate for Payer: WEA Trust Commercial |
$1,508.94
|
| Rate for Payer: WPS Commercial |
$2,032.05
|
|
|
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 |
$2,203.51 |
| Max. Negotiated Rate |
$4,137.20 |
| Rate for Payer: Aetna Commercial |
$4,047.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,867.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,383.39
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$4,137.20
|
| Rate for Payer: Health EOS Commercial |
$4,002.29
|
| Rate for Payer: HFN Commercial |
$4,137.20
|
| Rate for Payer: Multiplan Commercial |
$3,597.57
|
| Rate for Payer: Preferred Network Access Commercial |
$4,137.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,203.51
|
| Rate for Payer: Quartz Commercial |
$2,698.18
|
| Rate for Payer: WEA Trust Commercial |
$2,473.33
|
| Rate for Payer: WPS Commercial |
$3,330.78
|
|
