|
SCREW CORTEX 1.3MM X 10MM 02.130.010
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5206663
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$407.68 |
| Max. Negotiated Rate |
$765.44 |
| Rate for Payer: Aetna Commercial |
$748.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$715.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$440.96
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cigna Commercial |
$765.44
|
| Rate for Payer: Health EOS Commercial |
$740.48
|
| Rate for Payer: HFN Commercial |
$765.44
|
| Rate for Payer: Multiplan Commercial |
$665.60
|
| Rate for Payer: Preferred Network Access Commercial |
$765.44
|
| Rate for Payer: Quartz Beloit One Network |
$407.68
|
| Rate for Payer: Quartz Commercial |
$499.20
|
| Rate for Payer: WEA Trust Commercial |
$457.60
|
| Rate for Payer: WPS Commercial |
$616.24
|
|
|
SCREW CORTEX 1.3MM X 12MM 02.130.012
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5206667
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$232.96 |
| Max. Negotiated Rate |
$765.44 |
| Rate for Payer: Aetna Commercial |
$748.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$715.52
|
| Rate for Payer: Aetna Managed Medicare |
$232.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$540.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$416.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$399.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$440.96
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cigna Commercial |
$765.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$465.60
|
| Rate for Payer: Health EOS Commercial |
$740.48
|
| Rate for Payer: HFN Commercial |
$765.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$624.00
|
| Rate for Payer: Multiplan Commercial |
$665.60
|
| Rate for Payer: NAPHCARE Commercial |
$499.20
|
| Rate for Payer: Preferred Network Access Commercial |
$765.44
|
| Rate for Payer: Quartz Beloit One Network |
$407.68
|
| Rate for Payer: Quartz Commercial |
$540.80
|
| Rate for Payer: Quartz Medicare Advantage |
$499.20
|
| Rate for Payer: The Alliance Commercial |
$416.00
|
| Rate for Payer: WEA Trust Commercial |
$457.60
|
| Rate for Payer: WPS Commercial |
$616.24
|
|
|
SCREW CORTEX 1.3MM X 12MM 02.130.012
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5206667
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$407.68 |
| Max. Negotiated Rate |
$765.44 |
| Rate for Payer: Aetna Commercial |
$748.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$715.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$440.96
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cigna Commercial |
$765.44
|
| Rate for Payer: Health EOS Commercial |
$740.48
|
| Rate for Payer: HFN Commercial |
$765.44
|
| Rate for Payer: Multiplan Commercial |
$665.60
|
| Rate for Payer: Preferred Network Access Commercial |
$765.44
|
| Rate for Payer: Quartz Beloit One Network |
$407.68
|
| Rate for Payer: Quartz Commercial |
$499.20
|
| Rate for Payer: WEA Trust Commercial |
$457.60
|
| Rate for Payer: WPS Commercial |
$616.24
|
|
|
SCREW CORTEX 1.3MM X 14MM 02.130.014
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5206664
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$407.68 |
| Max. Negotiated Rate |
$765.44 |
| Rate for Payer: Aetna Commercial |
$748.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$715.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$440.96
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cigna Commercial |
$765.44
|
| Rate for Payer: Health EOS Commercial |
$740.48
|
| Rate for Payer: HFN Commercial |
$765.44
|
| Rate for Payer: Multiplan Commercial |
$665.60
|
| Rate for Payer: Preferred Network Access Commercial |
$765.44
|
| Rate for Payer: Quartz Beloit One Network |
$407.68
|
| Rate for Payer: Quartz Commercial |
$499.20
|
| Rate for Payer: WEA Trust Commercial |
$457.60
|
| Rate for Payer: WPS Commercial |
$616.24
|
|
|
SCREW CORTEX 1.3MM X 14MM 02.130.014
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5206664
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$232.96 |
| Max. Negotiated Rate |
$765.44 |
| Rate for Payer: Aetna Commercial |
$748.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$715.52
|
| Rate for Payer: Aetna Managed Medicare |
$232.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$540.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$416.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$399.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$440.96
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cigna Commercial |
$765.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$465.60
|
| Rate for Payer: Health EOS Commercial |
$740.48
|
| Rate for Payer: HFN Commercial |
$765.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$624.00
|
| Rate for Payer: Multiplan Commercial |
$665.60
|
| Rate for Payer: NAPHCARE Commercial |
$499.20
|
| Rate for Payer: Preferred Network Access Commercial |
$765.44
|
| Rate for Payer: Quartz Beloit One Network |
$407.68
|
| Rate for Payer: Quartz Commercial |
$540.80
|
| Rate for Payer: Quartz Medicare Advantage |
$499.20
|
| Rate for Payer: The Alliance Commercial |
$416.00
|
| Rate for Payer: WEA Trust Commercial |
$457.60
|
| Rate for Payer: WPS Commercial |
$616.24
|
|
|
SCREW CORTEX 1.3MM X 16MM 02.130.016
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5206665
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$232.96 |
| Max. Negotiated Rate |
$765.44 |
| Rate for Payer: Aetna Commercial |
$748.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$715.52
|
| Rate for Payer: Aetna Managed Medicare |
$232.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$540.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$416.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$399.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$440.96
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cigna Commercial |
$765.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$465.60
|
| Rate for Payer: Health EOS Commercial |
$740.48
|
| Rate for Payer: HFN Commercial |
$765.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$624.00
|
| Rate for Payer: Multiplan Commercial |
$665.60
|
| Rate for Payer: NAPHCARE Commercial |
$499.20
|
| Rate for Payer: Preferred Network Access Commercial |
$765.44
|
| Rate for Payer: Quartz Beloit One Network |
$407.68
|
| Rate for Payer: Quartz Commercial |
$540.80
|
| Rate for Payer: Quartz Medicare Advantage |
$499.20
|
| Rate for Payer: The Alliance Commercial |
$416.00
|
| Rate for Payer: WEA Trust Commercial |
$457.60
|
| Rate for Payer: WPS Commercial |
$616.24
|
|
|
SCREW CORTEX 1.3MM X 16MM 02.130.016
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5206665
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$407.68 |
| Max. Negotiated Rate |
$765.44 |
| Rate for Payer: Aetna Commercial |
$748.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$715.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$440.96
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cigna Commercial |
$765.44
|
| Rate for Payer: Health EOS Commercial |
$740.48
|
| Rate for Payer: HFN Commercial |
$765.44
|
| Rate for Payer: Multiplan Commercial |
$665.60
|
| Rate for Payer: Preferred Network Access Commercial |
$765.44
|
| Rate for Payer: Quartz Beloit One Network |
$407.68
|
| Rate for Payer: Quartz Commercial |
$499.20
|
| Rate for Payer: WEA Trust Commercial |
$457.60
|
| Rate for Payer: WPS Commercial |
$616.24
|
|
|
SCREW CORTEX 2.4 X 10MM STARDRIVE 201.760
|
Facility
|
OP
|
$1,077.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966453
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$313.62 |
| Max. Negotiated Rate |
$1,030.47 |
| Rate for Payer: Aetna Commercial |
$1,008.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$963.27
|
| Rate for Payer: Aetna Managed Medicare |
$313.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$728.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$560.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$537.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$593.64
|
| Rate for Payer: Cash Price |
$323.10
|
| Rate for Payer: Cigna Commercial |
$1,030.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$626.81
|
| Rate for Payer: Health EOS Commercial |
$996.87
|
| Rate for Payer: HFN Commercial |
$1,030.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$840.06
|
| Rate for Payer: Multiplan Commercial |
$896.06
|
| Rate for Payer: NAPHCARE Commercial |
$672.05
|
| Rate for Payer: Preferred Network Access Commercial |
$1,030.47
|
| Rate for Payer: Quartz Beloit One Network |
$548.84
|
| Rate for Payer: Quartz Commercial |
$728.05
|
| Rate for Payer: Quartz Medicare Advantage |
$672.05
|
| Rate for Payer: The Alliance Commercial |
$560.04
|
| Rate for Payer: WEA Trust Commercial |
$616.04
|
| Rate for Payer: WPS Commercial |
$829.61
|
|
|
SCREW CORTEX 2.4 X 10MM STARDRIVE 201.760
|
Facility
|
IP
|
$1,077.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966453
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$548.84 |
| Max. Negotiated Rate |
$1,030.47 |
| Rate for Payer: Aetna Commercial |
$1,008.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$963.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$593.64
|
| Rate for Payer: Cash Price |
$323.10
|
| Rate for Payer: Cigna Commercial |
$1,030.47
|
| Rate for Payer: Health EOS Commercial |
$996.87
|
| Rate for Payer: HFN Commercial |
$1,030.47
|
| Rate for Payer: Multiplan Commercial |
$896.06
|
| Rate for Payer: Preferred Network Access Commercial |
$1,030.47
|
| Rate for Payer: Quartz Beloit One Network |
$548.84
|
| Rate for Payer: Quartz Commercial |
$672.05
|
| Rate for Payer: WEA Trust Commercial |
$616.04
|
| Rate for Payer: WPS Commercial |
$829.61
|
|
|
SCREW CORTEX 2.4 X 12MM STARDRIVE 201.762
|
Facility
|
IP
|
$931.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966446
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$474.44 |
| Max. Negotiated Rate |
$890.78 |
| Rate for Payer: Aetna Commercial |
$871.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$832.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$513.17
|
| Rate for Payer: Cash Price |
$279.30
|
| Rate for Payer: Cigna Commercial |
$890.78
|
| Rate for Payer: Health EOS Commercial |
$861.73
|
| Rate for Payer: HFN Commercial |
$890.78
|
| Rate for Payer: Multiplan Commercial |
$774.59
|
| Rate for Payer: Preferred Network Access Commercial |
$890.78
|
| Rate for Payer: Quartz Beloit One Network |
$474.44
|
| Rate for Payer: Quartz Commercial |
$580.94
|
| Rate for Payer: WEA Trust Commercial |
$532.53
|
| Rate for Payer: WPS Commercial |
$717.15
|
|
|
SCREW CORTEX 2.4 X 12MM STARDRIVE 201.762
|
Facility
|
OP
|
$931.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966446
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$271.11 |
| Max. Negotiated Rate |
$890.78 |
| Rate for Payer: Aetna Commercial |
$871.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$832.69
|
| Rate for Payer: Aetna Managed Medicare |
$271.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$629.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$484.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$464.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$513.17
|
| Rate for Payer: Cash Price |
$279.30
|
| Rate for Payer: Cigna Commercial |
$890.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$541.84
|
| Rate for Payer: Health EOS Commercial |
$861.73
|
| Rate for Payer: HFN Commercial |
$890.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$726.18
|
| Rate for Payer: Multiplan Commercial |
$774.59
|
| Rate for Payer: NAPHCARE Commercial |
$580.94
|
| Rate for Payer: Preferred Network Access Commercial |
$890.78
|
| Rate for Payer: Quartz Beloit One Network |
$474.44
|
| Rate for Payer: Quartz Commercial |
$629.36
|
| Rate for Payer: Quartz Medicare Advantage |
$580.94
|
| Rate for Payer: The Alliance Commercial |
$484.12
|
| Rate for Payer: WEA Trust Commercial |
$532.53
|
| Rate for Payer: WPS Commercial |
$717.15
|
|
|
SCREW CORTEX 2.4 X 14MM STARDRIVE 201.764
|
Facility
|
IP
|
$931.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966440
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$474.44 |
| Max. Negotiated Rate |
$890.78 |
| Rate for Payer: Aetna Commercial |
$871.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$832.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$513.17
|
| Rate for Payer: Cash Price |
$279.30
|
| Rate for Payer: Cigna Commercial |
$890.78
|
| Rate for Payer: Health EOS Commercial |
$861.73
|
| Rate for Payer: HFN Commercial |
$890.78
|
| Rate for Payer: Multiplan Commercial |
$774.59
|
| Rate for Payer: Preferred Network Access Commercial |
$890.78
|
| Rate for Payer: Quartz Beloit One Network |
$474.44
|
| Rate for Payer: Quartz Commercial |
$580.94
|
| Rate for Payer: WEA Trust Commercial |
$532.53
|
| Rate for Payer: WPS Commercial |
$717.15
|
|
|
SCREW CORTEX 2.4 X 14MM STARDRIVE 201.764
|
Facility
|
OP
|
$931.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966440
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$271.11 |
| Max. Negotiated Rate |
$890.78 |
| Rate for Payer: Aetna Commercial |
$871.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$832.69
|
| Rate for Payer: Aetna Managed Medicare |
$271.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$629.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$484.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$464.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$513.17
|
| Rate for Payer: Cash Price |
$279.30
|
| Rate for Payer: Cigna Commercial |
$890.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$541.84
|
| Rate for Payer: Health EOS Commercial |
$861.73
|
| Rate for Payer: HFN Commercial |
$890.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$726.18
|
| Rate for Payer: Multiplan Commercial |
$774.59
|
| Rate for Payer: NAPHCARE Commercial |
$580.94
|
| Rate for Payer: Preferred Network Access Commercial |
$890.78
|
| Rate for Payer: Quartz Beloit One Network |
$474.44
|
| Rate for Payer: Quartz Commercial |
$629.36
|
| Rate for Payer: Quartz Medicare Advantage |
$580.94
|
| Rate for Payer: The Alliance Commercial |
$484.12
|
| Rate for Payer: WEA Trust Commercial |
$532.53
|
| Rate for Payer: WPS Commercial |
$717.15
|
|
|
SCREW CORTEX 2.4 X 16MM STARDRIVE 201.766
|
Facility
|
OP
|
$999.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966442
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$290.91 |
| Max. Negotiated Rate |
$955.84 |
| Rate for Payer: Aetna Commercial |
$935.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$893.51
|
| Rate for Payer: Aetna Managed Medicare |
$290.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$675.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$519.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$498.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$550.65
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Cigna Commercial |
$955.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$581.42
|
| Rate for Payer: Health EOS Commercial |
$924.67
|
| Rate for Payer: HFN Commercial |
$955.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$779.22
|
| Rate for Payer: Multiplan Commercial |
$831.17
|
| Rate for Payer: NAPHCARE Commercial |
$623.38
|
| Rate for Payer: Preferred Network Access Commercial |
$955.84
|
| Rate for Payer: Quartz Beloit One Network |
$509.09
|
| Rate for Payer: Quartz Commercial |
$675.32
|
| Rate for Payer: Quartz Medicare Advantage |
$623.38
|
| Rate for Payer: The Alliance Commercial |
$519.48
|
| Rate for Payer: WEA Trust Commercial |
$571.43
|
| Rate for Payer: WPS Commercial |
$769.53
|
|
|
SCREW CORTEX 2.4 X 16MM STARDRIVE 201.766
|
Facility
|
IP
|
$999.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966442
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$509.09 |
| Max. Negotiated Rate |
$955.84 |
| Rate for Payer: Aetna Commercial |
$935.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$893.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$550.65
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Cigna Commercial |
$955.84
|
| Rate for Payer: Health EOS Commercial |
$924.67
|
| Rate for Payer: HFN Commercial |
$955.84
|
| Rate for Payer: Multiplan Commercial |
$831.17
|
| Rate for Payer: Preferred Network Access Commercial |
$955.84
|
| Rate for Payer: Quartz Beloit One Network |
$509.09
|
| Rate for Payer: Quartz Commercial |
$623.38
|
| Rate for Payer: WEA Trust Commercial |
$571.43
|
| Rate for Payer: WPS Commercial |
$769.53
|
|
|
SCREW CORTEX 2.4 X 18MM STARDRIVE 201.768
|
Facility
|
IP
|
$967.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966444
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$492.78 |
| Max. Negotiated Rate |
$925.23 |
| Rate for Payer: Aetna Commercial |
$905.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$864.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.01
|
| Rate for Payer: Cash Price |
$290.10
|
| Rate for Payer: Cigna Commercial |
$925.23
|
| Rate for Payer: Health EOS Commercial |
$895.06
|
| Rate for Payer: HFN Commercial |
$925.23
|
| Rate for Payer: Multiplan Commercial |
$804.54
|
| Rate for Payer: Preferred Network Access Commercial |
$925.23
|
| Rate for Payer: Quartz Beloit One Network |
$492.78
|
| Rate for Payer: Quartz Commercial |
$603.41
|
| Rate for Payer: WEA Trust Commercial |
$553.12
|
| Rate for Payer: WPS Commercial |
$744.88
|
|
|
SCREW CORTEX 2.4 X 18MM STARDRIVE 201.768
|
Facility
|
OP
|
$967.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966444
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$281.59 |
| Max. Negotiated Rate |
$925.23 |
| Rate for Payer: Aetna Commercial |
$905.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$864.88
|
| Rate for Payer: Aetna Managed Medicare |
$281.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$653.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$502.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$482.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.01
|
| Rate for Payer: Cash Price |
$290.10
|
| Rate for Payer: Cigna Commercial |
$925.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$562.79
|
| Rate for Payer: Health EOS Commercial |
$895.06
|
| Rate for Payer: HFN Commercial |
$925.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$754.26
|
| Rate for Payer: Multiplan Commercial |
$804.54
|
| Rate for Payer: NAPHCARE Commercial |
$603.41
|
| Rate for Payer: Preferred Network Access Commercial |
$925.23
|
| Rate for Payer: Quartz Beloit One Network |
$492.78
|
| Rate for Payer: Quartz Commercial |
$653.69
|
| Rate for Payer: Quartz Medicare Advantage |
$603.41
|
| Rate for Payer: The Alliance Commercial |
$502.84
|
| Rate for Payer: WEA Trust Commercial |
$553.12
|
| Rate for Payer: WPS Commercial |
$744.88
|
|
|
SCREW CORTEX 3.5mm X 18mm #404.818
|
Facility
|
IP
|
$523.00
|
|
| Hospital Charge Code |
2966553
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.52 |
| Max. Negotiated Rate |
$500.41 |
| Rate for Payer: Aetna Commercial |
$489.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$467.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$288.28
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cigna Commercial |
$500.41
|
| Rate for Payer: Health EOS Commercial |
$484.09
|
| Rate for Payer: HFN Commercial |
$500.41
|
| Rate for Payer: Multiplan Commercial |
$435.14
|
| Rate for Payer: Preferred Network Access Commercial |
$500.41
|
| Rate for Payer: Quartz Beloit One Network |
$266.52
|
| Rate for Payer: Quartz Commercial |
$326.35
|
| Rate for Payer: WEA Trust Commercial |
$299.16
|
| Rate for Payer: WPS Commercial |
$402.87
|
|
|
SCREW CORTEX 3.5mm X 18mm #404.818
|
Facility
|
OP
|
$523.00
|
|
| Hospital Charge Code |
2966553
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$152.30 |
| Max. Negotiated Rate |
$500.41 |
| Rate for Payer: Aetna Commercial |
$489.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$467.77
|
| Rate for Payer: Aetna Managed Medicare |
$152.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$353.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$271.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$261.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$288.28
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cigna Commercial |
$500.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$304.39
|
| Rate for Payer: Health EOS Commercial |
$484.09
|
| Rate for Payer: HFN Commercial |
$500.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$407.94
|
| Rate for Payer: Multiplan Commercial |
$435.14
|
| Rate for Payer: NAPHCARE Commercial |
$326.35
|
| Rate for Payer: Preferred Network Access Commercial |
$500.41
|
| Rate for Payer: Quartz Beloit One Network |
$266.52
|
| Rate for Payer: Quartz Commercial |
$353.55
|
| Rate for Payer: Quartz Medicare Advantage |
$326.35
|
| Rate for Payer: The Alliance Commercial |
$271.96
|
| Rate for Payer: WEA Trust Commercial |
$299.16
|
| Rate for Payer: WPS Commercial |
$402.87
|
|
|
SCREW CORTEX 3.5mm X 20mm
|
Facility
|
OP
|
$523.00
|
|
| Hospital Charge Code |
2966554
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$152.30 |
| Max. Negotiated Rate |
$500.41 |
| Rate for Payer: Aetna Commercial |
$489.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$467.77
|
| Rate for Payer: Aetna Managed Medicare |
$152.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$353.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$271.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$261.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$288.28
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cigna Commercial |
$500.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$304.39
|
| Rate for Payer: Health EOS Commercial |
$484.09
|
| Rate for Payer: HFN Commercial |
$500.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$407.94
|
| Rate for Payer: Multiplan Commercial |
$435.14
|
| Rate for Payer: NAPHCARE Commercial |
$326.35
|
| Rate for Payer: Preferred Network Access Commercial |
$500.41
|
| Rate for Payer: Quartz Beloit One Network |
$266.52
|
| Rate for Payer: Quartz Commercial |
$353.55
|
| Rate for Payer: Quartz Medicare Advantage |
$326.35
|
| Rate for Payer: The Alliance Commercial |
$271.96
|
| Rate for Payer: WEA Trust Commercial |
$299.16
|
| Rate for Payer: WPS Commercial |
$402.87
|
|
|
SCREW CORTEX 3.5mm X 20mm
|
Facility
|
IP
|
$523.00
|
|
| Hospital Charge Code |
2966554
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.52 |
| Max. Negotiated Rate |
$500.41 |
| Rate for Payer: Aetna Commercial |
$489.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$467.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$288.28
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cigna Commercial |
$500.41
|
| Rate for Payer: Health EOS Commercial |
$484.09
|
| Rate for Payer: HFN Commercial |
$500.41
|
| Rate for Payer: Multiplan Commercial |
$435.14
|
| Rate for Payer: Preferred Network Access Commercial |
$500.41
|
| Rate for Payer: Quartz Beloit One Network |
$266.52
|
| Rate for Payer: Quartz Commercial |
$326.35
|
| Rate for Payer: WEA Trust Commercial |
$299.16
|
| Rate for Payer: WPS Commercial |
$402.87
|
|
|
SCREW CORTEX 3.5 X 48MM LOW PROFILE 02.205.248
|
Facility
|
OP
|
$555.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3697493
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$161.62 |
| Max. Negotiated Rate |
$531.02 |
| Rate for Payer: Aetna Commercial |
$519.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$496.39
|
| Rate for Payer: Aetna Managed Medicare |
$161.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$375.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$288.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$277.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$305.92
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Cigna Commercial |
$531.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$323.01
|
| Rate for Payer: Health EOS Commercial |
$513.71
|
| Rate for Payer: HFN Commercial |
$531.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$432.90
|
| Rate for Payer: Multiplan Commercial |
$461.76
|
| Rate for Payer: NAPHCARE Commercial |
$346.32
|
| Rate for Payer: Preferred Network Access Commercial |
$531.02
|
| Rate for Payer: Quartz Beloit One Network |
$282.83
|
| Rate for Payer: Quartz Commercial |
$375.18
|
| Rate for Payer: Quartz Medicare Advantage |
$346.32
|
| Rate for Payer: The Alliance Commercial |
$288.60
|
| Rate for Payer: WEA Trust Commercial |
$317.46
|
| Rate for Payer: WPS Commercial |
$427.52
|
|
|
SCREW CORTEX 3.5 X 48MM LOW PROFILE 02.205.248
|
Facility
|
IP
|
$555.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3697493
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$282.83 |
| Max. Negotiated Rate |
$531.02 |
| Rate for Payer: Aetna Commercial |
$519.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$496.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$305.92
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Cigna Commercial |
$531.02
|
| Rate for Payer: Health EOS Commercial |
$513.71
|
| Rate for Payer: HFN Commercial |
$531.02
|
| Rate for Payer: Multiplan Commercial |
$461.76
|
| Rate for Payer: Preferred Network Access Commercial |
$531.02
|
| Rate for Payer: Quartz Beloit One Network |
$282.83
|
| Rate for Payer: Quartz Commercial |
$346.32
|
| Rate for Payer: WEA Trust Commercial |
$317.46
|
| Rate for Payer: WPS Commercial |
$427.52
|
|
|
SCREW CORT FT 3.5 X 20MM 58913520
|
Facility
|
IP
|
$1,792.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5729843
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$913.20 |
| Max. Negotiated Rate |
$1,714.59 |
| Rate for Payer: Aetna Commercial |
$1,677.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,602.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$987.75
|
| Rate for Payer: Cash Price |
$537.60
|
| Rate for Payer: Cigna Commercial |
$1,714.59
|
| Rate for Payer: Health EOS Commercial |
$1,658.68
|
| Rate for Payer: HFN Commercial |
$1,714.59
|
| Rate for Payer: Multiplan Commercial |
$1,490.94
|
| Rate for Payer: Preferred Network Access Commercial |
$1,714.59
|
| Rate for Payer: Quartz Beloit One Network |
$913.20
|
| Rate for Payer: Quartz Commercial |
$1,118.21
|
| Rate for Payer: WEA Trust Commercial |
$1,025.02
|
| Rate for Payer: WPS Commercial |
$1,380.38
|
|
|
SCREW CORT FT 3.5 X 20MM 58913520
|
Facility
|
OP
|
$1,792.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5729843
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$521.83 |
| Max. Negotiated Rate |
$1,714.59 |
| Rate for Payer: Aetna Commercial |
$1,677.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,602.76
|
| Rate for Payer: Aetna Managed Medicare |
$521.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,211.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$931.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$894.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$987.75
|
| Rate for Payer: Cash Price |
$537.60
|
| Rate for Payer: Cigna Commercial |
$1,714.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,042.94
|
| Rate for Payer: Health EOS Commercial |
$1,658.68
|
| Rate for Payer: HFN Commercial |
$1,714.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,397.76
|
| Rate for Payer: Multiplan Commercial |
$1,490.94
|
| Rate for Payer: NAPHCARE Commercial |
$1,118.21
|
| Rate for Payer: Preferred Network Access Commercial |
$1,714.59
|
| Rate for Payer: Quartz Beloit One Network |
$913.20
|
| Rate for Payer: Quartz Commercial |
$1,211.39
|
| Rate for Payer: Quartz Medicare Advantage |
$1,118.21
|
| Rate for Payer: The Alliance Commercial |
$931.84
|
| Rate for Payer: WEA Trust Commercial |
$1,025.02
|
| Rate for Payer: WPS Commercial |
$1,380.38
|
|
