|
SCREW COMPRESSION HEADLESS 6.5 X 80MM PT AR-8665-1880
|
Facility
|
OP
|
$6,117.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5591392
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,781.27 |
| Max. Negotiated Rate |
$5,852.75 |
| Rate for Payer: Aetna Commercial |
$5,725.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,471.04
|
| Rate for Payer: Aetna Managed Medicare |
$1,781.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,135.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,180.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,053.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,371.69
|
| Rate for Payer: Cash Price |
$1,835.10
|
| Rate for Payer: Cigna Commercial |
$5,852.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,560.09
|
| Rate for Payer: Health EOS Commercial |
$5,661.90
|
| Rate for Payer: HFN Commercial |
$5,852.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,771.26
|
| Rate for Payer: Multiplan Commercial |
$5,089.34
|
| Rate for Payer: NAPHCARE Commercial |
$3,817.01
|
| Rate for Payer: Preferred Network Access Commercial |
$5,852.75
|
| Rate for Payer: Quartz Beloit One Network |
$3,117.22
|
| Rate for Payer: Quartz Commercial |
$4,135.09
|
| Rate for Payer: Quartz Medicare Advantage |
$3,817.01
|
| Rate for Payer: The Alliance Commercial |
$3,180.84
|
| Rate for Payer: WEA Trust Commercial |
$3,498.92
|
| Rate for Payer: WPS Commercial |
$4,711.93
|
|
|
SCREW COMPRESSION HEADLESS 6.5 X 80MM PT AR-8665-1880
|
Facility
|
IP
|
$6,117.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5591392
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,117.22 |
| Max. Negotiated Rate |
$5,852.75 |
| Rate for Payer: Aetna Commercial |
$5,725.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,471.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,371.69
|
| Rate for Payer: Cash Price |
$1,835.10
|
| Rate for Payer: Cigna Commercial |
$5,852.75
|
| Rate for Payer: Health EOS Commercial |
$5,661.90
|
| Rate for Payer: HFN Commercial |
$5,852.75
|
| Rate for Payer: Multiplan Commercial |
$5,089.34
|
| Rate for Payer: Preferred Network Access Commercial |
$5,852.75
|
| Rate for Payer: Quartz Beloit One Network |
$3,117.22
|
| Rate for Payer: Quartz Commercial |
$3,817.01
|
| Rate for Payer: WEA Trust Commercial |
$3,498.92
|
| Rate for Payer: WPS Commercial |
$4,711.93
|
|
|
SCREW COMPRESSION SCREW CANN T2 1818-0001S
|
Facility
|
OP
|
$1,645.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5611629
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$479.02 |
| Max. Negotiated Rate |
$1,573.94 |
| Rate for Payer: Aetna Commercial |
$1,539.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,471.29
|
| Rate for Payer: Aetna Managed Medicare |
$479.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,112.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$855.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$821.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$906.72
|
| Rate for Payer: Cash Price |
$493.50
|
| Rate for Payer: Cigna Commercial |
$1,573.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$957.39
|
| Rate for Payer: Health EOS Commercial |
$1,522.61
|
| Rate for Payer: HFN Commercial |
$1,573.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,283.10
|
| Rate for Payer: Multiplan Commercial |
$1,368.64
|
| Rate for Payer: NAPHCARE Commercial |
$1,026.48
|
| Rate for Payer: Preferred Network Access Commercial |
$1,573.94
|
| Rate for Payer: Quartz Beloit One Network |
$838.29
|
| Rate for Payer: Quartz Commercial |
$1,112.02
|
| Rate for Payer: Quartz Medicare Advantage |
$1,026.48
|
| Rate for Payer: The Alliance Commercial |
$855.40
|
| Rate for Payer: WEA Trust Commercial |
$940.94
|
| Rate for Payer: WPS Commercial |
$1,267.14
|
|
|
SCREW COMPRESSION SCREW CANN T2 1818-0001S
|
Facility
|
IP
|
$1,645.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5611629
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.29 |
| Max. Negotiated Rate |
$1,573.94 |
| Rate for Payer: Aetna Commercial |
$1,539.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,471.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$906.72
|
| Rate for Payer: Cash Price |
$493.50
|
| Rate for Payer: Cigna Commercial |
$1,573.94
|
| Rate for Payer: Health EOS Commercial |
$1,522.61
|
| Rate for Payer: HFN Commercial |
$1,573.94
|
| Rate for Payer: Multiplan Commercial |
$1,368.64
|
| Rate for Payer: Preferred Network Access Commercial |
$1,573.94
|
| Rate for Payer: Quartz Beloit One Network |
$838.29
|
| Rate for Payer: Quartz Commercial |
$1,026.48
|
| Rate for Payer: WEA Trust Commercial |
$940.94
|
| Rate for Payer: WPS Commercial |
$1,267.14
|
|
|
SCREW CORT 1.0 X 10 ST 200.530
|
Facility
|
OP
|
$1,020.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494519
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$297.02 |
| Max. Negotiated Rate |
$975.94 |
| Rate for Payer: Aetna Commercial |
$954.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$912.29
|
| Rate for Payer: Aetna Managed Medicare |
$297.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$689.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$530.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$509.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$562.22
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$975.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$593.64
|
| Rate for Payer: Health EOS Commercial |
$944.11
|
| Rate for Payer: HFN Commercial |
$975.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$795.60
|
| Rate for Payer: Multiplan Commercial |
$848.64
|
| Rate for Payer: NAPHCARE Commercial |
$636.48
|
| Rate for Payer: Preferred Network Access Commercial |
$975.94
|
| Rate for Payer: Quartz Beloit One Network |
$519.79
|
| Rate for Payer: Quartz Commercial |
$689.52
|
| Rate for Payer: Quartz Medicare Advantage |
$636.48
|
| Rate for Payer: The Alliance Commercial |
$530.40
|
| Rate for Payer: WEA Trust Commercial |
$583.44
|
| Rate for Payer: WPS Commercial |
$785.71
|
|
|
SCREW CORT 1.0 X 10 ST 200.530
|
Facility
|
IP
|
$1,020.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494519
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$519.79 |
| Max. Negotiated Rate |
$975.94 |
| Rate for Payer: Aetna Commercial |
$954.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$912.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$562.22
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$975.94
|
| Rate for Payer: Health EOS Commercial |
$944.11
|
| Rate for Payer: HFN Commercial |
$975.94
|
| Rate for Payer: Multiplan Commercial |
$848.64
|
| Rate for Payer: Preferred Network Access Commercial |
$975.94
|
| Rate for Payer: Quartz Beloit One Network |
$519.79
|
| Rate for Payer: Quartz Commercial |
$636.48
|
| Rate for Payer: WEA Trust Commercial |
$583.44
|
| Rate for Payer: WPS Commercial |
$785.71
|
|
|
SCREW CORT 1.0 X 11 ST 200.531
|
Facility
|
IP
|
$1,020.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494520
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$519.79 |
| Max. Negotiated Rate |
$975.94 |
| Rate for Payer: Aetna Commercial |
$954.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$912.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$562.22
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$975.94
|
| Rate for Payer: Health EOS Commercial |
$944.11
|
| Rate for Payer: HFN Commercial |
$975.94
|
| Rate for Payer: Multiplan Commercial |
$848.64
|
| Rate for Payer: Preferred Network Access Commercial |
$975.94
|
| Rate for Payer: Quartz Beloit One Network |
$519.79
|
| Rate for Payer: Quartz Commercial |
$636.48
|
| Rate for Payer: WEA Trust Commercial |
$583.44
|
| Rate for Payer: WPS Commercial |
$785.71
|
|
|
SCREW CORT 1.0 X 11 ST 200.531
|
Facility
|
OP
|
$1,020.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494520
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$297.02 |
| Max. Negotiated Rate |
$975.94 |
| Rate for Payer: Aetna Commercial |
$954.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$912.29
|
| Rate for Payer: Aetna Managed Medicare |
$297.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$689.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$530.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$509.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$562.22
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$975.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$593.64
|
| Rate for Payer: Health EOS Commercial |
$944.11
|
| Rate for Payer: HFN Commercial |
$975.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$795.60
|
| Rate for Payer: Multiplan Commercial |
$848.64
|
| Rate for Payer: NAPHCARE Commercial |
$636.48
|
| Rate for Payer: Preferred Network Access Commercial |
$975.94
|
| Rate for Payer: Quartz Beloit One Network |
$519.79
|
| Rate for Payer: Quartz Commercial |
$689.52
|
| Rate for Payer: Quartz Medicare Advantage |
$636.48
|
| Rate for Payer: The Alliance Commercial |
$530.40
|
| Rate for Payer: WEA Trust Commercial |
$583.44
|
| Rate for Payer: WPS Commercial |
$785.71
|
|
|
SCREW CORT 1.0 X 12 ST 200.532
|
Facility
|
OP
|
$1,020.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494521
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$297.02 |
| Max. Negotiated Rate |
$975.94 |
| Rate for Payer: Aetna Commercial |
$954.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$912.29
|
| Rate for Payer: Aetna Managed Medicare |
$297.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$689.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$530.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$509.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$562.22
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$975.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$593.64
|
| Rate for Payer: Health EOS Commercial |
$944.11
|
| Rate for Payer: HFN Commercial |
$975.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$795.60
|
| Rate for Payer: Multiplan Commercial |
$848.64
|
| Rate for Payer: NAPHCARE Commercial |
$636.48
|
| Rate for Payer: Preferred Network Access Commercial |
$975.94
|
| Rate for Payer: Quartz Beloit One Network |
$519.79
|
| Rate for Payer: Quartz Commercial |
$689.52
|
| Rate for Payer: Quartz Medicare Advantage |
$636.48
|
| Rate for Payer: The Alliance Commercial |
$530.40
|
| Rate for Payer: WEA Trust Commercial |
$583.44
|
| Rate for Payer: WPS Commercial |
$785.71
|
|
|
SCREW CORT 1.0 X 12 ST 200.532
|
Facility
|
IP
|
$1,020.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494521
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$519.79 |
| Max. Negotiated Rate |
$975.94 |
| Rate for Payer: Aetna Commercial |
$954.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$912.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$562.22
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$975.94
|
| Rate for Payer: Health EOS Commercial |
$944.11
|
| Rate for Payer: HFN Commercial |
$975.94
|
| Rate for Payer: Multiplan Commercial |
$848.64
|
| Rate for Payer: Preferred Network Access Commercial |
$975.94
|
| Rate for Payer: Quartz Beloit One Network |
$519.79
|
| Rate for Payer: Quartz Commercial |
$636.48
|
| Rate for Payer: WEA Trust Commercial |
$583.44
|
| Rate for Payer: WPS Commercial |
$785.71
|
|
|
SCREW CORT 1.0 X 13 ST 200.533
|
Facility
|
IP
|
$1,020.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494522
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$519.79 |
| Max. Negotiated Rate |
$975.94 |
| Rate for Payer: Aetna Commercial |
$954.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$912.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$562.22
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$975.94
|
| Rate for Payer: Health EOS Commercial |
$944.11
|
| Rate for Payer: HFN Commercial |
$975.94
|
| Rate for Payer: Multiplan Commercial |
$848.64
|
| Rate for Payer: Preferred Network Access Commercial |
$975.94
|
| Rate for Payer: Quartz Beloit One Network |
$519.79
|
| Rate for Payer: Quartz Commercial |
$636.48
|
| Rate for Payer: WEA Trust Commercial |
$583.44
|
| Rate for Payer: WPS Commercial |
$785.71
|
|
|
SCREW CORT 1.0 X 13 ST 200.533
|
Facility
|
OP
|
$1,020.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494522
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$297.02 |
| Max. Negotiated Rate |
$975.94 |
| Rate for Payer: Aetna Commercial |
$954.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$912.29
|
| Rate for Payer: Aetna Managed Medicare |
$297.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$689.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$530.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$509.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$562.22
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$975.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$593.64
|
| Rate for Payer: Health EOS Commercial |
$944.11
|
| Rate for Payer: HFN Commercial |
$975.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$795.60
|
| Rate for Payer: Multiplan Commercial |
$848.64
|
| Rate for Payer: NAPHCARE Commercial |
$636.48
|
| Rate for Payer: Preferred Network Access Commercial |
$975.94
|
| Rate for Payer: Quartz Beloit One Network |
$519.79
|
| Rate for Payer: Quartz Commercial |
$689.52
|
| Rate for Payer: Quartz Medicare Advantage |
$636.48
|
| Rate for Payer: The Alliance Commercial |
$530.40
|
| Rate for Payer: WEA Trust Commercial |
$583.44
|
| Rate for Payer: WPS Commercial |
$785.71
|
|
|
SCREW CORT 1.0 X 14 ST 200.534
|
Facility
|
IP
|
$1,020.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494523
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$519.79 |
| Max. Negotiated Rate |
$975.94 |
| Rate for Payer: Aetna Commercial |
$954.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$912.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$562.22
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$975.94
|
| Rate for Payer: Health EOS Commercial |
$944.11
|
| Rate for Payer: HFN Commercial |
$975.94
|
| Rate for Payer: Multiplan Commercial |
$848.64
|
| Rate for Payer: Preferred Network Access Commercial |
$975.94
|
| Rate for Payer: Quartz Beloit One Network |
$519.79
|
| Rate for Payer: Quartz Commercial |
$636.48
|
| Rate for Payer: WEA Trust Commercial |
$583.44
|
| Rate for Payer: WPS Commercial |
$785.71
|
|
|
SCREW CORT 1.0 X 14 ST 200.534
|
Facility
|
OP
|
$1,020.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494523
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$297.02 |
| Max. Negotiated Rate |
$975.94 |
| Rate for Payer: Aetna Commercial |
$954.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$912.29
|
| Rate for Payer: Aetna Managed Medicare |
$297.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$689.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$530.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$509.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$562.22
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$975.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$593.64
|
| Rate for Payer: Health EOS Commercial |
$944.11
|
| Rate for Payer: HFN Commercial |
$975.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$795.60
|
| Rate for Payer: Multiplan Commercial |
$848.64
|
| Rate for Payer: NAPHCARE Commercial |
$636.48
|
| Rate for Payer: Preferred Network Access Commercial |
$975.94
|
| Rate for Payer: Quartz Beloit One Network |
$519.79
|
| Rate for Payer: Quartz Commercial |
$689.52
|
| Rate for Payer: Quartz Medicare Advantage |
$636.48
|
| Rate for Payer: The Alliance Commercial |
$530.40
|
| Rate for Payer: WEA Trust Commercial |
$583.44
|
| Rate for Payer: WPS Commercial |
$785.71
|
|
|
SCREW CORT 1.0 X 6 ST 200.526
|
Facility
|
OP
|
$1,020.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494515
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$297.02 |
| Max. Negotiated Rate |
$975.94 |
| Rate for Payer: Aetna Commercial |
$954.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$912.29
|
| Rate for Payer: Aetna Managed Medicare |
$297.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$689.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$530.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$509.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$562.22
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$975.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$593.64
|
| Rate for Payer: Health EOS Commercial |
$944.11
|
| Rate for Payer: HFN Commercial |
$975.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$795.60
|
| Rate for Payer: Multiplan Commercial |
$848.64
|
| Rate for Payer: NAPHCARE Commercial |
$636.48
|
| Rate for Payer: Preferred Network Access Commercial |
$975.94
|
| Rate for Payer: Quartz Beloit One Network |
$519.79
|
| Rate for Payer: Quartz Commercial |
$689.52
|
| Rate for Payer: Quartz Medicare Advantage |
$636.48
|
| Rate for Payer: The Alliance Commercial |
$530.40
|
| Rate for Payer: WEA Trust Commercial |
$583.44
|
| Rate for Payer: WPS Commercial |
$785.71
|
|
|
SCREW CORT 1.0 X 6 ST 200.526
|
Facility
|
IP
|
$1,020.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494515
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$519.79 |
| Max. Negotiated Rate |
$975.94 |
| Rate for Payer: Aetna Commercial |
$954.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$912.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$562.22
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$975.94
|
| Rate for Payer: Health EOS Commercial |
$944.11
|
| Rate for Payer: HFN Commercial |
$975.94
|
| Rate for Payer: Multiplan Commercial |
$848.64
|
| Rate for Payer: Preferred Network Access Commercial |
$975.94
|
| Rate for Payer: Quartz Beloit One Network |
$519.79
|
| Rate for Payer: Quartz Commercial |
$636.48
|
| Rate for Payer: WEA Trust Commercial |
$583.44
|
| Rate for Payer: WPS Commercial |
$785.71
|
|
|
SCREW CORT 1.0 X 7 ST 200.527
|
Facility
|
IP
|
$1,020.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494516
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$519.79 |
| Max. Negotiated Rate |
$975.94 |
| Rate for Payer: Aetna Commercial |
$954.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$912.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$562.22
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$975.94
|
| Rate for Payer: Health EOS Commercial |
$944.11
|
| Rate for Payer: HFN Commercial |
$975.94
|
| Rate for Payer: Multiplan Commercial |
$848.64
|
| Rate for Payer: Preferred Network Access Commercial |
$975.94
|
| Rate for Payer: Quartz Beloit One Network |
$519.79
|
| Rate for Payer: Quartz Commercial |
$636.48
|
| Rate for Payer: WEA Trust Commercial |
$583.44
|
| Rate for Payer: WPS Commercial |
$785.71
|
|
|
SCREW CORT 1.0 X 7 ST 200.527
|
Facility
|
OP
|
$1,020.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494516
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$297.02 |
| Max. Negotiated Rate |
$975.94 |
| Rate for Payer: Aetna Commercial |
$954.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$912.29
|
| Rate for Payer: Aetna Managed Medicare |
$297.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$689.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$530.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$509.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$562.22
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$975.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$593.64
|
| Rate for Payer: Health EOS Commercial |
$944.11
|
| Rate for Payer: HFN Commercial |
$975.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$795.60
|
| Rate for Payer: Multiplan Commercial |
$848.64
|
| Rate for Payer: NAPHCARE Commercial |
$636.48
|
| Rate for Payer: Preferred Network Access Commercial |
$975.94
|
| Rate for Payer: Quartz Beloit One Network |
$519.79
|
| Rate for Payer: Quartz Commercial |
$689.52
|
| Rate for Payer: Quartz Medicare Advantage |
$636.48
|
| Rate for Payer: The Alliance Commercial |
$530.40
|
| Rate for Payer: WEA Trust Commercial |
$583.44
|
| Rate for Payer: WPS Commercial |
$785.71
|
|
|
SCREW CORT 1.0 X 8 ST 200.528
|
Facility
|
IP
|
$1,020.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494517
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$519.79 |
| Max. Negotiated Rate |
$975.94 |
| Rate for Payer: Aetna Commercial |
$954.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$912.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$562.22
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$975.94
|
| Rate for Payer: Health EOS Commercial |
$944.11
|
| Rate for Payer: HFN Commercial |
$975.94
|
| Rate for Payer: Multiplan Commercial |
$848.64
|
| Rate for Payer: Preferred Network Access Commercial |
$975.94
|
| Rate for Payer: Quartz Beloit One Network |
$519.79
|
| Rate for Payer: Quartz Commercial |
$636.48
|
| Rate for Payer: WEA Trust Commercial |
$583.44
|
| Rate for Payer: WPS Commercial |
$785.71
|
|
|
SCREW CORT 1.0 X 8 ST 200.528
|
Facility
|
OP
|
$1,020.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494517
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$297.02 |
| Max. Negotiated Rate |
$975.94 |
| Rate for Payer: Aetna Commercial |
$954.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$912.29
|
| Rate for Payer: Aetna Managed Medicare |
$297.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$689.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$530.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$509.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$562.22
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$975.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$593.64
|
| Rate for Payer: Health EOS Commercial |
$944.11
|
| Rate for Payer: HFN Commercial |
$975.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$795.60
|
| Rate for Payer: Multiplan Commercial |
$848.64
|
| Rate for Payer: NAPHCARE Commercial |
$636.48
|
| Rate for Payer: Preferred Network Access Commercial |
$975.94
|
| Rate for Payer: Quartz Beloit One Network |
$519.79
|
| Rate for Payer: Quartz Commercial |
$689.52
|
| Rate for Payer: Quartz Medicare Advantage |
$636.48
|
| Rate for Payer: The Alliance Commercial |
$530.40
|
| Rate for Payer: WEA Trust Commercial |
$583.44
|
| Rate for Payer: WPS Commercial |
$785.71
|
|
|
SCREW CORT 1.0 X 9 ST 200.529
|
Facility
|
IP
|
$1,020.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494518
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$519.79 |
| Max. Negotiated Rate |
$975.94 |
| Rate for Payer: Aetna Commercial |
$954.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$912.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$562.22
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$975.94
|
| Rate for Payer: Health EOS Commercial |
$944.11
|
| Rate for Payer: HFN Commercial |
$975.94
|
| Rate for Payer: Multiplan Commercial |
$848.64
|
| Rate for Payer: Preferred Network Access Commercial |
$975.94
|
| Rate for Payer: Quartz Beloit One Network |
$519.79
|
| Rate for Payer: Quartz Commercial |
$636.48
|
| Rate for Payer: WEA Trust Commercial |
$583.44
|
| Rate for Payer: WPS Commercial |
$785.71
|
|
|
SCREW CORT 1.0 X 9 ST 200.529
|
Facility
|
OP
|
$1,020.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494518
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$297.02 |
| Max. Negotiated Rate |
$975.94 |
| Rate for Payer: Aetna Commercial |
$954.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$912.29
|
| Rate for Payer: Aetna Managed Medicare |
$297.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$689.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$530.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$509.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$562.22
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$975.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$593.64
|
| Rate for Payer: Health EOS Commercial |
$944.11
|
| Rate for Payer: HFN Commercial |
$975.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$795.60
|
| Rate for Payer: Multiplan Commercial |
$848.64
|
| Rate for Payer: NAPHCARE Commercial |
$636.48
|
| Rate for Payer: Preferred Network Access Commercial |
$975.94
|
| Rate for Payer: Quartz Beloit One Network |
$519.79
|
| Rate for Payer: Quartz Commercial |
$689.52
|
| Rate for Payer: Quartz Medicare Advantage |
$636.48
|
| Rate for Payer: The Alliance Commercial |
$530.40
|
| Rate for Payer: WEA Trust Commercial |
$583.44
|
| Rate for Payer: WPS Commercial |
$785.71
|
|
|
SCREW CORT 1.3 X 10MM TITANIUM 400.690
|
Facility
|
IP
|
$1,454.00
|
|
| Hospital Charge Code |
2966398
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$740.96 |
| Max. Negotiated Rate |
$1,391.19 |
| Rate for Payer: Aetna Commercial |
$1,360.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,300.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$801.44
|
| Rate for Payer: Cash Price |
$436.20
|
| Rate for Payer: Cigna Commercial |
$1,391.19
|
| Rate for Payer: Health EOS Commercial |
$1,345.82
|
| Rate for Payer: HFN Commercial |
$1,391.19
|
| Rate for Payer: Multiplan Commercial |
$1,209.73
|
| Rate for Payer: Preferred Network Access Commercial |
$1,391.19
|
| Rate for Payer: Quartz Beloit One Network |
$740.96
|
| Rate for Payer: Quartz Commercial |
$907.30
|
| Rate for Payer: WEA Trust Commercial |
$831.69
|
| Rate for Payer: WPS Commercial |
$1,120.02
|
|
|
SCREW CORT 1.3 X 10MM TITANIUM 400.690
|
Facility
|
OP
|
$1,454.00
|
|
| Hospital Charge Code |
2966398
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$423.40 |
| Max. Negotiated Rate |
$1,391.19 |
| Rate for Payer: Aetna Commercial |
$1,360.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,300.46
|
| Rate for Payer: Aetna Managed Medicare |
$423.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$982.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$756.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$725.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$801.44
|
| Rate for Payer: Cash Price |
$436.20
|
| Rate for Payer: Cigna Commercial |
$1,391.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$846.23
|
| Rate for Payer: Health EOS Commercial |
$1,345.82
|
| Rate for Payer: HFN Commercial |
$1,391.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,134.12
|
| Rate for Payer: Multiplan Commercial |
$1,209.73
|
| Rate for Payer: NAPHCARE Commercial |
$907.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,391.19
|
| Rate for Payer: Quartz Beloit One Network |
$740.96
|
| Rate for Payer: Quartz Commercial |
$982.90
|
| Rate for Payer: Quartz Medicare Advantage |
$907.30
|
| Rate for Payer: The Alliance Commercial |
$756.08
|
| Rate for Payer: WEA Trust Commercial |
$831.69
|
| Rate for Payer: WPS Commercial |
$1,120.02
|
|
|
SCREW CORT 1.3 X 10 ST 200.690
|
Facility
|
IP
|
$1,070.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494528
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$545.27 |
| Max. Negotiated Rate |
$1,023.78 |
| Rate for Payer: Aetna Commercial |
$1,001.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$957.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$589.78
|
| Rate for Payer: Cash Price |
$321.00
|
| Rate for Payer: Cigna Commercial |
$1,023.78
|
| Rate for Payer: Health EOS Commercial |
$990.39
|
| Rate for Payer: HFN Commercial |
$1,023.78
|
| Rate for Payer: Multiplan Commercial |
$890.24
|
| Rate for Payer: Preferred Network Access Commercial |
$1,023.78
|
| Rate for Payer: Quartz Beloit One Network |
$545.27
|
| Rate for Payer: Quartz Commercial |
$667.68
|
| Rate for Payer: WEA Trust Commercial |
$612.04
|
| Rate for Payer: WPS Commercial |
$824.22
|
|
