|
SCREW CORT LOW-PROFILE 2.7 X 16MM GREY ORTHOLOC 58812716
|
Facility
|
OP
|
$2,234.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459797
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$625.52 |
| Max. Negotiated Rate |
$8,936.00 |
| Rate for Payer: Aetna Commercial |
$2,010.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,921.24
|
| Rate for Payer: Aetna Managed Medicare |
$625.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,452.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,117.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,072.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,184.02
|
| Rate for Payer: Cash Price |
$670.20
|
| Rate for Payer: Cigna Commercial |
$2,055.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,250.15
|
| Rate for Payer: Health EOS Commercial |
$1,988.26
|
| Rate for Payer: HFN Commercial |
$2,055.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,675.50
|
| Rate for Payer: Multiplan Commercial |
$1,787.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,340.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,055.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,094.66
|
| Rate for Payer: Quartz Commercial |
$1,452.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,340.40
|
| Rate for Payer: The Alliance Commercial |
$8,936.00
|
| Rate for Payer: WEA Trust Commercial |
$1,228.70
|
| Rate for Payer: WPS Commercial |
$1,654.72
|
|
|
SCREW CORT LOW-PROFILE 2.7 X 16MM GREY ORTHOLOC 58812716
|
Facility
|
IP
|
$2,234.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459797
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,094.66 |
| Max. Negotiated Rate |
$2,055.28 |
| Rate for Payer: Aetna Commercial |
$2,010.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,921.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,184.02
|
| Rate for Payer: Cash Price |
$670.20
|
| Rate for Payer: Cigna Commercial |
$2,055.28
|
| Rate for Payer: Health EOS Commercial |
$1,988.26
|
| Rate for Payer: HFN Commercial |
$2,055.28
|
| Rate for Payer: Multiplan Commercial |
$1,787.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,340.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,055.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,094.66
|
| Rate for Payer: Quartz Commercial |
$1,340.40
|
| Rate for Payer: WEA Trust Commercial |
$1,228.70
|
| Rate for Payer: WPS Commercial |
$1,654.72
|
|
|
SCREW CORT LOW-PROFILE 2.7 X 18MM GREY ORTHOLOC 58812718
|
Facility
|
OP
|
$2,234.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415910
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$625.52 |
| Max. Negotiated Rate |
$8,936.00 |
| Rate for Payer: Aetna Commercial |
$2,010.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,921.24
|
| Rate for Payer: Aetna Managed Medicare |
$625.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,452.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,117.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,072.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,184.02
|
| Rate for Payer: Cash Price |
$670.20
|
| Rate for Payer: Cigna Commercial |
$2,055.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,250.15
|
| Rate for Payer: Health EOS Commercial |
$1,988.26
|
| Rate for Payer: HFN Commercial |
$2,055.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,675.50
|
| Rate for Payer: Multiplan Commercial |
$1,787.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,340.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,055.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,094.66
|
| Rate for Payer: Quartz Commercial |
$1,452.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,340.40
|
| Rate for Payer: The Alliance Commercial |
$8,936.00
|
| Rate for Payer: WEA Trust Commercial |
$1,228.70
|
| Rate for Payer: WPS Commercial |
$1,654.72
|
|
|
SCREW CORT LOW-PROFILE 2.7 X 18MM GREY ORTHOLOC 58812718
|
Facility
|
IP
|
$2,234.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415910
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,094.66 |
| Max. Negotiated Rate |
$2,055.28 |
| Rate for Payer: Aetna Commercial |
$2,010.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,921.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,184.02
|
| Rate for Payer: Cash Price |
$670.20
|
| Rate for Payer: Cigna Commercial |
$2,055.28
|
| Rate for Payer: Health EOS Commercial |
$1,988.26
|
| Rate for Payer: HFN Commercial |
$2,055.28
|
| Rate for Payer: Multiplan Commercial |
$1,787.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,340.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,055.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,094.66
|
| Rate for Payer: Quartz Commercial |
$1,340.40
|
| Rate for Payer: WEA Trust Commercial |
$1,228.70
|
| Rate for Payer: WPS Commercial |
$1,654.72
|
|
|
SCREW CORT LOW-PROFILE 2.7 X 20MM GREY ORTHOLOC 58812720
|
Facility
|
IP
|
$2,234.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459798
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,094.66 |
| Max. Negotiated Rate |
$2,055.28 |
| Rate for Payer: Aetna Commercial |
$2,010.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,921.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,184.02
|
| Rate for Payer: Cash Price |
$670.20
|
| Rate for Payer: Cigna Commercial |
$2,055.28
|
| Rate for Payer: Health EOS Commercial |
$1,988.26
|
| Rate for Payer: HFN Commercial |
$2,055.28
|
| Rate for Payer: Multiplan Commercial |
$1,787.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,340.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,055.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,094.66
|
| Rate for Payer: Quartz Commercial |
$1,340.40
|
| Rate for Payer: WEA Trust Commercial |
$1,228.70
|
| Rate for Payer: WPS Commercial |
$1,654.72
|
|
|
SCREW CORT LOW-PROFILE 2.7 X 20MM GREY ORTHOLOC 58812720
|
Facility
|
OP
|
$2,234.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459798
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$625.52 |
| Max. Negotiated Rate |
$8,936.00 |
| Rate for Payer: Aetna Commercial |
$2,010.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,921.24
|
| Rate for Payer: Aetna Managed Medicare |
$625.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,452.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,117.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,072.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,184.02
|
| Rate for Payer: Cash Price |
$670.20
|
| Rate for Payer: Cigna Commercial |
$2,055.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,250.15
|
| Rate for Payer: Health EOS Commercial |
$1,988.26
|
| Rate for Payer: HFN Commercial |
$2,055.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,675.50
|
| Rate for Payer: Multiplan Commercial |
$1,787.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,340.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,055.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,094.66
|
| Rate for Payer: Quartz Commercial |
$1,452.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,340.40
|
| Rate for Payer: The Alliance Commercial |
$8,936.00
|
| Rate for Payer: WEA Trust Commercial |
$1,228.70
|
| Rate for Payer: WPS Commercial |
$1,654.72
|
|
|
SCREW CORT LOW PROFILE 3.5 X 16 02.206.216
|
Facility
|
OP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3259478
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$145.32 |
| Max. Negotiated Rate |
$2,076.00 |
| Rate for Payer: Aetna Commercial |
$467.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$446.34
|
| Rate for Payer: Aetna Managed Medicare |
$145.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$337.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$259.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$249.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$275.07
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna Commercial |
$477.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$290.43
|
| Rate for Payer: Health EOS Commercial |
$461.91
|
| Rate for Payer: HFN Commercial |
$477.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$389.25
|
| Rate for Payer: Multiplan Commercial |
$415.20
|
| Rate for Payer: NAPHCARE Commercial |
$311.40
|
| Rate for Payer: Preferred Network Access Commercial |
$477.48
|
| Rate for Payer: Quartz Beloit One Network |
$254.31
|
| Rate for Payer: Quartz Commercial |
$337.35
|
| Rate for Payer: Quartz Medicare Advantage |
$311.40
|
| Rate for Payer: The Alliance Commercial |
$2,076.00
|
| Rate for Payer: WEA Trust Commercial |
$285.45
|
| Rate for Payer: WPS Commercial |
$384.42
|
|
|
SCREW CORT LOW PROFILE 3.5 X 16 02.206.216
|
Facility
|
IP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3259478
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$254.31 |
| Max. Negotiated Rate |
$477.48 |
| Rate for Payer: Aetna Commercial |
$467.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$446.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$275.07
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna Commercial |
$477.48
|
| Rate for Payer: Health EOS Commercial |
$461.91
|
| Rate for Payer: HFN Commercial |
$477.48
|
| Rate for Payer: Multiplan Commercial |
$415.20
|
| Rate for Payer: NAPHCARE Commercial |
$311.40
|
| Rate for Payer: Preferred Network Access Commercial |
$477.48
|
| Rate for Payer: Quartz Beloit One Network |
$254.31
|
| Rate for Payer: Quartz Commercial |
$311.40
|
| Rate for Payer: WEA Trust Commercial |
$285.45
|
| Rate for Payer: WPS Commercial |
$384.42
|
|
|
SCREW CORT LOW PROFILE 3.5 X 24 02.206.224
|
Facility
|
OP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4017912
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$145.32 |
| Max. Negotiated Rate |
$2,076.00 |
| Rate for Payer: Aetna Commercial |
$467.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$446.34
|
| Rate for Payer: Aetna Managed Medicare |
$145.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$337.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$259.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$249.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$275.07
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna Commercial |
$477.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$290.43
|
| Rate for Payer: Health EOS Commercial |
$461.91
|
| Rate for Payer: HFN Commercial |
$477.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$389.25
|
| Rate for Payer: Multiplan Commercial |
$415.20
|
| Rate for Payer: NAPHCARE Commercial |
$311.40
|
| Rate for Payer: Preferred Network Access Commercial |
$477.48
|
| Rate for Payer: Quartz Beloit One Network |
$254.31
|
| Rate for Payer: Quartz Commercial |
$337.35
|
| Rate for Payer: Quartz Medicare Advantage |
$311.40
|
| Rate for Payer: The Alliance Commercial |
$2,076.00
|
| Rate for Payer: WEA Trust Commercial |
$285.45
|
| Rate for Payer: WPS Commercial |
$384.42
|
|
|
SCREW CORT LOW PROFILE 3.5 X 24 02.206.224
|
Facility
|
IP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4017912
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$254.31 |
| Max. Negotiated Rate |
$477.48 |
| Rate for Payer: Aetna Commercial |
$467.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$446.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$275.07
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna Commercial |
$477.48
|
| Rate for Payer: Health EOS Commercial |
$461.91
|
| Rate for Payer: HFN Commercial |
$477.48
|
| Rate for Payer: Multiplan Commercial |
$415.20
|
| Rate for Payer: NAPHCARE Commercial |
$311.40
|
| Rate for Payer: Preferred Network Access Commercial |
$477.48
|
| Rate for Payer: Quartz Beloit One Network |
$254.31
|
| Rate for Payer: Quartz Commercial |
$311.40
|
| Rate for Payer: WEA Trust Commercial |
$285.45
|
| Rate for Payer: WPS Commercial |
$384.42
|
|
|
SCREW CORT LOW PROFILE 3.5 X 28 02.206.228
|
Facility
|
IP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3265475
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$254.31 |
| Max. Negotiated Rate |
$477.48 |
| Rate for Payer: Aetna Commercial |
$467.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$446.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$275.07
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna Commercial |
$477.48
|
| Rate for Payer: Health EOS Commercial |
$461.91
|
| Rate for Payer: HFN Commercial |
$477.48
|
| Rate for Payer: Multiplan Commercial |
$415.20
|
| Rate for Payer: NAPHCARE Commercial |
$311.40
|
| Rate for Payer: Preferred Network Access Commercial |
$477.48
|
| Rate for Payer: Quartz Beloit One Network |
$254.31
|
| Rate for Payer: Quartz Commercial |
$311.40
|
| Rate for Payer: WEA Trust Commercial |
$285.45
|
| Rate for Payer: WPS Commercial |
$384.42
|
|
|
SCREW CORT LOW PROFILE 3.5 X 28 02.206.228
|
Facility
|
OP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3265475
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$145.32 |
| Max. Negotiated Rate |
$2,076.00 |
| Rate for Payer: Aetna Commercial |
$467.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$446.34
|
| Rate for Payer: Aetna Managed Medicare |
$145.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$337.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$259.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$249.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$275.07
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna Commercial |
$477.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$290.43
|
| Rate for Payer: Health EOS Commercial |
$461.91
|
| Rate for Payer: HFN Commercial |
$477.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$389.25
|
| Rate for Payer: Multiplan Commercial |
$415.20
|
| Rate for Payer: NAPHCARE Commercial |
$311.40
|
| Rate for Payer: Preferred Network Access Commercial |
$477.48
|
| Rate for Payer: Quartz Beloit One Network |
$254.31
|
| Rate for Payer: Quartz Commercial |
$337.35
|
| Rate for Payer: Quartz Medicare Advantage |
$311.40
|
| Rate for Payer: The Alliance Commercial |
$2,076.00
|
| Rate for Payer: WEA Trust Commercial |
$285.45
|
| Rate for Payer: WPS Commercial |
$384.42
|
|
|
SCREW CORT LOW PROFILE 3.5 X 30 02.206.230
|
Facility
|
OP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3265476
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$145.32 |
| Max. Negotiated Rate |
$2,076.00 |
| Rate for Payer: Aetna Commercial |
$467.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$446.34
|
| Rate for Payer: Aetna Managed Medicare |
$145.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$337.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$259.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$249.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$275.07
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna Commercial |
$477.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$290.43
|
| Rate for Payer: Health EOS Commercial |
$461.91
|
| Rate for Payer: HFN Commercial |
$477.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$389.25
|
| Rate for Payer: Multiplan Commercial |
$415.20
|
| Rate for Payer: NAPHCARE Commercial |
$311.40
|
| Rate for Payer: Preferred Network Access Commercial |
$477.48
|
| Rate for Payer: Quartz Beloit One Network |
$254.31
|
| Rate for Payer: Quartz Commercial |
$337.35
|
| Rate for Payer: Quartz Medicare Advantage |
$311.40
|
| Rate for Payer: The Alliance Commercial |
$2,076.00
|
| Rate for Payer: WEA Trust Commercial |
$285.45
|
| Rate for Payer: WPS Commercial |
$384.42
|
|
|
SCREW CORT LOW PROFILE 3.5 X 30 02.206.230
|
Facility
|
IP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3265476
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$254.31 |
| Max. Negotiated Rate |
$477.48 |
| Rate for Payer: Aetna Commercial |
$467.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$446.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$275.07
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna Commercial |
$477.48
|
| Rate for Payer: Health EOS Commercial |
$461.91
|
| Rate for Payer: HFN Commercial |
$477.48
|
| Rate for Payer: Multiplan Commercial |
$415.20
|
| Rate for Payer: NAPHCARE Commercial |
$311.40
|
| Rate for Payer: Preferred Network Access Commercial |
$477.48
|
| Rate for Payer: Quartz Beloit One Network |
$254.31
|
| Rate for Payer: Quartz Commercial |
$311.40
|
| Rate for Payer: WEA Trust Commercial |
$285.45
|
| Rate for Payer: WPS Commercial |
$384.42
|
|
|
SCREW CORT LOW PROFILE 3.5 X 36 02.206.236
|
Facility
|
OP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3265478
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$145.32 |
| Max. Negotiated Rate |
$2,076.00 |
| Rate for Payer: Aetna Commercial |
$467.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$446.34
|
| Rate for Payer: Aetna Managed Medicare |
$145.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$337.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$259.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$249.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$275.07
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna Commercial |
$477.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$290.43
|
| Rate for Payer: Health EOS Commercial |
$461.91
|
| Rate for Payer: HFN Commercial |
$477.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$389.25
|
| Rate for Payer: Multiplan Commercial |
$415.20
|
| Rate for Payer: NAPHCARE Commercial |
$311.40
|
| Rate for Payer: Preferred Network Access Commercial |
$477.48
|
| Rate for Payer: Quartz Beloit One Network |
$254.31
|
| Rate for Payer: Quartz Commercial |
$337.35
|
| Rate for Payer: Quartz Medicare Advantage |
$311.40
|
| Rate for Payer: The Alliance Commercial |
$2,076.00
|
| Rate for Payer: WEA Trust Commercial |
$285.45
|
| Rate for Payer: WPS Commercial |
$384.42
|
|
|
SCREW CORT LOW PROFILE 3.5 X 36 02.206.236
|
Facility
|
IP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3265478
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$254.31 |
| Max. Negotiated Rate |
$477.48 |
| Rate for Payer: Aetna Commercial |
$467.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$446.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$275.07
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna Commercial |
$477.48
|
| Rate for Payer: Health EOS Commercial |
$461.91
|
| Rate for Payer: HFN Commercial |
$477.48
|
| Rate for Payer: Multiplan Commercial |
$415.20
|
| Rate for Payer: NAPHCARE Commercial |
$311.40
|
| Rate for Payer: Preferred Network Access Commercial |
$477.48
|
| Rate for Payer: Quartz Beloit One Network |
$254.31
|
| Rate for Payer: Quartz Commercial |
$311.40
|
| Rate for Payer: WEA Trust Commercial |
$285.45
|
| Rate for Payer: WPS Commercial |
$384.42
|
|
|
SCREW CORT LOW PROFILE 3.5 X 46MM 02.206.246
|
Facility
|
IP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4028668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$254.31 |
| Max. Negotiated Rate |
$477.48 |
| Rate for Payer: Aetna Commercial |
$467.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$446.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$275.07
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna Commercial |
$477.48
|
| Rate for Payer: Health EOS Commercial |
$461.91
|
| Rate for Payer: HFN Commercial |
$477.48
|
| Rate for Payer: Multiplan Commercial |
$415.20
|
| Rate for Payer: NAPHCARE Commercial |
$311.40
|
| Rate for Payer: Preferred Network Access Commercial |
$477.48
|
| Rate for Payer: Quartz Beloit One Network |
$254.31
|
| Rate for Payer: Quartz Commercial |
$311.40
|
| Rate for Payer: WEA Trust Commercial |
$285.45
|
| Rate for Payer: WPS Commercial |
$384.42
|
|
|
SCREW CORT LOW PROFILE 3.5 X 46MM 02.206.246
|
Facility
|
OP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4028668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$145.32 |
| Max. Negotiated Rate |
$2,076.00 |
| Rate for Payer: Aetna Commercial |
$467.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$446.34
|
| Rate for Payer: Aetna Managed Medicare |
$145.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$337.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$259.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$249.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$275.07
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna Commercial |
$477.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$290.43
|
| Rate for Payer: Health EOS Commercial |
$461.91
|
| Rate for Payer: HFN Commercial |
$477.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$389.25
|
| Rate for Payer: Multiplan Commercial |
$415.20
|
| Rate for Payer: NAPHCARE Commercial |
$311.40
|
| Rate for Payer: Preferred Network Access Commercial |
$477.48
|
| Rate for Payer: Quartz Beloit One Network |
$254.31
|
| Rate for Payer: Quartz Commercial |
$337.35
|
| Rate for Payer: Quartz Medicare Advantage |
$311.40
|
| Rate for Payer: The Alliance Commercial |
$2,076.00
|
| Rate for Payer: WEA Trust Commercial |
$285.45
|
| Rate for Payer: WPS Commercial |
$384.42
|
|
|
SCREW CORT LOW PROFILE 3.5 X 50 02.206.250
|
Facility
|
IP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3259479
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$254.31 |
| Max. Negotiated Rate |
$477.48 |
| Rate for Payer: Aetna Commercial |
$467.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$446.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$275.07
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna Commercial |
$477.48
|
| Rate for Payer: Health EOS Commercial |
$461.91
|
| Rate for Payer: HFN Commercial |
$477.48
|
| Rate for Payer: Multiplan Commercial |
$415.20
|
| Rate for Payer: NAPHCARE Commercial |
$311.40
|
| Rate for Payer: Preferred Network Access Commercial |
$477.48
|
| Rate for Payer: Quartz Beloit One Network |
$254.31
|
| Rate for Payer: Quartz Commercial |
$311.40
|
| Rate for Payer: WEA Trust Commercial |
$285.45
|
| Rate for Payer: WPS Commercial |
$384.42
|
|
|
SCREW CORT LOW PROFILE 3.5 X 50 02.206.250
|
Facility
|
OP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3259479
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$145.32 |
| Max. Negotiated Rate |
$2,076.00 |
| Rate for Payer: Aetna Commercial |
$467.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$446.34
|
| Rate for Payer: Aetna Managed Medicare |
$145.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$337.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$259.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$249.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$275.07
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna Commercial |
$477.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$290.43
|
| Rate for Payer: Health EOS Commercial |
$461.91
|
| Rate for Payer: HFN Commercial |
$477.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$389.25
|
| Rate for Payer: Multiplan Commercial |
$415.20
|
| Rate for Payer: NAPHCARE Commercial |
$311.40
|
| Rate for Payer: Preferred Network Access Commercial |
$477.48
|
| Rate for Payer: Quartz Beloit One Network |
$254.31
|
| Rate for Payer: Quartz Commercial |
$337.35
|
| Rate for Payer: Quartz Medicare Advantage |
$311.40
|
| Rate for Payer: The Alliance Commercial |
$2,076.00
|
| Rate for Payer: WEA Trust Commercial |
$285.45
|
| Rate for Payer: WPS Commercial |
$384.42
|
|
|
SCREW CORT PELVIC 3.5 X 65 204.665
|
Facility
|
IP
|
$452.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599768
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$221.48 |
| Max. Negotiated Rate |
$415.84 |
| Rate for Payer: Aetna Commercial |
$406.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$388.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$239.56
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cigna Commercial |
$415.84
|
| Rate for Payer: Health EOS Commercial |
$402.28
|
| Rate for Payer: HFN Commercial |
$415.84
|
| Rate for Payer: Multiplan Commercial |
$361.60
|
| Rate for Payer: NAPHCARE Commercial |
$271.20
|
| Rate for Payer: Preferred Network Access Commercial |
$415.84
|
| Rate for Payer: Quartz Beloit One Network |
$221.48
|
| Rate for Payer: Quartz Commercial |
$271.20
|
| Rate for Payer: WEA Trust Commercial |
$248.60
|
| Rate for Payer: WPS Commercial |
$334.80
|
|
|
SCREW CORT PELVIC 3.5 X 65 204.665
|
Facility
|
OP
|
$452.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599768
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$126.56 |
| Max. Negotiated Rate |
$1,808.00 |
| Rate for Payer: Aetna Commercial |
$406.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$388.72
|
| Rate for Payer: Aetna Managed Medicare |
$126.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$293.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$226.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$216.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$239.56
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cigna Commercial |
$415.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$252.94
|
| Rate for Payer: Health EOS Commercial |
$402.28
|
| Rate for Payer: HFN Commercial |
$415.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$339.00
|
| Rate for Payer: Multiplan Commercial |
$361.60
|
| Rate for Payer: NAPHCARE Commercial |
$271.20
|
| Rate for Payer: Preferred Network Access Commercial |
$415.84
|
| Rate for Payer: Quartz Beloit One Network |
$221.48
|
| Rate for Payer: Quartz Commercial |
$293.80
|
| Rate for Payer: Quartz Medicare Advantage |
$271.20
|
| Rate for Payer: The Alliance Commercial |
$1,808.00
|
| Rate for Payer: WEA Trust Commercial |
$248.60
|
| Rate for Payer: WPS Commercial |
$334.80
|
|
|
SCREW CP 4.1MM X 30MM T10 626830
|
Facility
|
OP
|
$3,372.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5583323
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$944.16 |
| Max. Negotiated Rate |
$13,488.00 |
| Rate for Payer: Aetna Commercial |
$3,034.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,899.92
|
| Rate for Payer: Aetna Managed Medicare |
$944.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,191.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,686.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,618.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,787.16
|
| Rate for Payer: Cash Price |
$1,011.60
|
| Rate for Payer: Cigna Commercial |
$3,102.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,886.97
|
| Rate for Payer: Health EOS Commercial |
$3,001.08
|
| Rate for Payer: HFN Commercial |
$3,102.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,529.00
|
| Rate for Payer: Multiplan Commercial |
$2,697.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,023.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,102.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,652.28
|
| Rate for Payer: Quartz Commercial |
$2,191.80
|
| Rate for Payer: Quartz Medicare Advantage |
$2,023.20
|
| Rate for Payer: The Alliance Commercial |
$13,488.00
|
| Rate for Payer: WEA Trust Commercial |
$1,854.60
|
| Rate for Payer: WPS Commercial |
$2,497.64
|
|
|
SCREW CP 4.1MM X 30MM T10 626830
|
Facility
|
IP
|
$3,372.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5583323
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,652.28 |
| Max. Negotiated Rate |
$3,102.24 |
| Rate for Payer: Aetna Commercial |
$3,034.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,899.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,787.16
|
| Rate for Payer: Cash Price |
$1,011.60
|
| Rate for Payer: Cigna Commercial |
$3,102.24
|
| Rate for Payer: Health EOS Commercial |
$3,001.08
|
| Rate for Payer: HFN Commercial |
$3,102.24
|
| Rate for Payer: Multiplan Commercial |
$2,697.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,023.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,102.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,652.28
|
| Rate for Payer: Quartz Commercial |
$2,023.20
|
| Rate for Payer: WEA Trust Commercial |
$1,854.60
|
| Rate for Payer: WPS Commercial |
$2,497.64
|
|
|
SCREW CP 4.1MM X 32MM T10 626832
|
Facility
|
IP
|
$3,372.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5547407
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,652.28 |
| Max. Negotiated Rate |
$3,102.24 |
| Rate for Payer: Aetna Commercial |
$3,034.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,899.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,787.16
|
| Rate for Payer: Cash Price |
$1,011.60
|
| Rate for Payer: Cigna Commercial |
$3,102.24
|
| Rate for Payer: Health EOS Commercial |
$3,001.08
|
| Rate for Payer: HFN Commercial |
$3,102.24
|
| Rate for Payer: Multiplan Commercial |
$2,697.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,023.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,102.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,652.28
|
| Rate for Payer: Quartz Commercial |
$2,023.20
|
| Rate for Payer: WEA Trust Commercial |
$1,854.60
|
| Rate for Payer: WPS Commercial |
$2,497.64
|
|
