|
SCREW CORTICAL 3.5MM X 46MM 338646
|
Facility
|
IP
|
$414.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6198981
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$210.97 |
| Max. Negotiated Rate |
$396.12 |
| Rate for Payer: Aetna Commercial |
$387.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$370.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$228.20
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cigna Commercial |
$396.12
|
| Rate for Payer: Health EOS Commercial |
$383.20
|
| Rate for Payer: HFN Commercial |
$396.12
|
| Rate for Payer: Multiplan Commercial |
$344.45
|
| Rate for Payer: Preferred Network Access Commercial |
$396.12
|
| Rate for Payer: Quartz Beloit One Network |
$210.97
|
| Rate for Payer: Quartz Commercial |
$258.34
|
| Rate for Payer: WEA Trust Commercial |
$236.81
|
| Rate for Payer: WPS Commercial |
$318.90
|
|
|
SCREW CORTICAL 3.5MM X 50MM 338650
|
Facility
|
OP
|
$414.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6198982
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$120.56 |
| Max. Negotiated Rate |
$396.12 |
| Rate for Payer: Aetna Commercial |
$387.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$370.28
|
| Rate for Payer: Aetna Managed Medicare |
$120.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$279.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$215.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$206.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$228.20
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cigna Commercial |
$396.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$240.95
|
| Rate for Payer: Health EOS Commercial |
$383.20
|
| Rate for Payer: HFN Commercial |
$396.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$322.92
|
| Rate for Payer: Multiplan Commercial |
$344.45
|
| Rate for Payer: NAPHCARE Commercial |
$258.34
|
| Rate for Payer: Preferred Network Access Commercial |
$396.12
|
| Rate for Payer: Quartz Beloit One Network |
$210.97
|
| Rate for Payer: Quartz Commercial |
$279.86
|
| Rate for Payer: Quartz Medicare Advantage |
$258.34
|
| Rate for Payer: The Alliance Commercial |
$215.28
|
| Rate for Payer: WEA Trust Commercial |
$236.81
|
| Rate for Payer: WPS Commercial |
$318.90
|
|
|
SCREW CORTICAL 3.5MM X 50MM 338650
|
Facility
|
IP
|
$414.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6198982
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$210.97 |
| Max. Negotiated Rate |
$396.12 |
| Rate for Payer: Aetna Commercial |
$387.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$370.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$228.20
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cigna Commercial |
$396.12
|
| Rate for Payer: Health EOS Commercial |
$383.20
|
| Rate for Payer: HFN Commercial |
$396.12
|
| Rate for Payer: Multiplan Commercial |
$344.45
|
| Rate for Payer: Preferred Network Access Commercial |
$396.12
|
| Rate for Payer: Quartz Beloit One Network |
$210.97
|
| Rate for Payer: Quartz Commercial |
$258.34
|
| Rate for Payer: WEA Trust Commercial |
$236.81
|
| Rate for Payer: WPS Commercial |
$318.90
|
|
|
SCREW CORTICAL 3.5MM X 55MM 338655
|
Facility
|
IP
|
$414.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6198983
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$210.97 |
| Max. Negotiated Rate |
$396.12 |
| Rate for Payer: Aetna Commercial |
$387.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$370.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$228.20
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cigna Commercial |
$396.12
|
| Rate for Payer: Health EOS Commercial |
$383.20
|
| Rate for Payer: HFN Commercial |
$396.12
|
| Rate for Payer: Multiplan Commercial |
$344.45
|
| Rate for Payer: Preferred Network Access Commercial |
$396.12
|
| Rate for Payer: Quartz Beloit One Network |
$210.97
|
| Rate for Payer: Quartz Commercial |
$258.34
|
| Rate for Payer: WEA Trust Commercial |
$236.81
|
| Rate for Payer: WPS Commercial |
$318.90
|
|
|
SCREW CORTICAL 3.5MM X 55MM 338655
|
Facility
|
OP
|
$414.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6198983
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$120.56 |
| Max. Negotiated Rate |
$396.12 |
| Rate for Payer: Aetna Commercial |
$387.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$370.28
|
| Rate for Payer: Aetna Managed Medicare |
$120.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$279.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$215.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$206.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$228.20
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cigna Commercial |
$396.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$240.95
|
| Rate for Payer: Health EOS Commercial |
$383.20
|
| Rate for Payer: HFN Commercial |
$396.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$322.92
|
| Rate for Payer: Multiplan Commercial |
$344.45
|
| Rate for Payer: NAPHCARE Commercial |
$258.34
|
| Rate for Payer: Preferred Network Access Commercial |
$396.12
|
| Rate for Payer: Quartz Beloit One Network |
$210.97
|
| Rate for Payer: Quartz Commercial |
$279.86
|
| Rate for Payer: Quartz Medicare Advantage |
$258.34
|
| Rate for Payer: The Alliance Commercial |
$215.28
|
| Rate for Payer: WEA Trust Commercial |
$236.81
|
| Rate for Payer: WPS Commercial |
$318.90
|
|
|
SCREW CORTICAL 4.5MM X 64MM 214.064
|
Facility
|
OP
|
$289.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4160428
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$84.16 |
| Max. Negotiated Rate |
$276.52 |
| Rate for Payer: Aetna Commercial |
$270.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$258.48
|
| Rate for Payer: Aetna Managed Medicare |
$84.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$195.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$150.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$144.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$159.30
|
| Rate for Payer: Cash Price |
$86.70
|
| Rate for Payer: Cigna Commercial |
$276.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$168.20
|
| Rate for Payer: Health EOS Commercial |
$267.50
|
| Rate for Payer: HFN Commercial |
$276.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$225.42
|
| Rate for Payer: Multiplan Commercial |
$240.45
|
| Rate for Payer: NAPHCARE Commercial |
$180.34
|
| Rate for Payer: Preferred Network Access Commercial |
$276.52
|
| Rate for Payer: Quartz Beloit One Network |
$147.27
|
| Rate for Payer: Quartz Commercial |
$195.36
|
| Rate for Payer: Quartz Medicare Advantage |
$180.34
|
| Rate for Payer: The Alliance Commercial |
$150.28
|
| Rate for Payer: WEA Trust Commercial |
$165.31
|
| Rate for Payer: WPS Commercial |
$222.62
|
|
|
SCREW CORTICAL 4.5MM X 64MM 214.064
|
Facility
|
IP
|
$289.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4160428
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.27 |
| Max. Negotiated Rate |
$276.52 |
| Rate for Payer: Aetna Commercial |
$270.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$258.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$159.30
|
| Rate for Payer: Cash Price |
$86.70
|
| Rate for Payer: Cigna Commercial |
$276.52
|
| Rate for Payer: Health EOS Commercial |
$267.50
|
| Rate for Payer: HFN Commercial |
$276.52
|
| Rate for Payer: Multiplan Commercial |
$240.45
|
| Rate for Payer: Preferred Network Access Commercial |
$276.52
|
| Rate for Payer: Quartz Beloit One Network |
$147.27
|
| Rate for Payer: Quartz Commercial |
$180.34
|
| Rate for Payer: WEA Trust Commercial |
$165.31
|
| Rate for Payer: WPS Commercial |
$222.62
|
|
|
SCREW CORTICAL 5.5 X 45MM ORTHOLOC 59225545
|
Facility
|
IP
|
$1,479.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6201063
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$753.70 |
| Max. Negotiated Rate |
$1,415.11 |
| Rate for Payer: Aetna Commercial |
$1,384.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,322.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$815.22
|
| Rate for Payer: Cash Price |
$443.70
|
| Rate for Payer: Cigna Commercial |
$1,415.11
|
| Rate for Payer: Health EOS Commercial |
$1,368.96
|
| Rate for Payer: HFN Commercial |
$1,415.11
|
| Rate for Payer: Multiplan Commercial |
$1,230.53
|
| Rate for Payer: Preferred Network Access Commercial |
$1,415.11
|
| Rate for Payer: Quartz Beloit One Network |
$753.70
|
| Rate for Payer: Quartz Commercial |
$922.90
|
| Rate for Payer: WEA Trust Commercial |
$845.99
|
| Rate for Payer: WPS Commercial |
$1,139.27
|
|
|
SCREW CORTICAL 5.5 X 45MM ORTHOLOC 59225545
|
Facility
|
OP
|
$1,479.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6201063
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$430.68 |
| Max. Negotiated Rate |
$1,415.11 |
| Rate for Payer: Aetna Commercial |
$1,384.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,322.82
|
| Rate for Payer: Aetna Managed Medicare |
$430.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$999.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$769.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$738.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$815.22
|
| Rate for Payer: Cash Price |
$443.70
|
| Rate for Payer: Cigna Commercial |
$1,415.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$860.78
|
| Rate for Payer: Health EOS Commercial |
$1,368.96
|
| Rate for Payer: HFN Commercial |
$1,415.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,153.62
|
| Rate for Payer: Multiplan Commercial |
$1,230.53
|
| Rate for Payer: NAPHCARE Commercial |
$922.90
|
| Rate for Payer: Preferred Network Access Commercial |
$1,415.11
|
| Rate for Payer: Quartz Beloit One Network |
$753.70
|
| Rate for Payer: Quartz Commercial |
$999.80
|
| Rate for Payer: Quartz Medicare Advantage |
$922.90
|
| Rate for Payer: The Alliance Commercial |
$769.08
|
| Rate for Payer: WEA Trust Commercial |
$845.99
|
| Rate for Payer: WPS Commercial |
$1,139.27
|
|
|
SCREW CORTICAL 5.5 X 60MM ORTHOLOC 59225560
|
Facility
|
OP
|
$1,479.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6201064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$430.68 |
| Max. Negotiated Rate |
$1,415.11 |
| Rate for Payer: Aetna Commercial |
$1,384.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,322.82
|
| Rate for Payer: Aetna Managed Medicare |
$430.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$999.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$769.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$738.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$815.22
|
| Rate for Payer: Cash Price |
$443.70
|
| Rate for Payer: Cigna Commercial |
$1,415.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$860.78
|
| Rate for Payer: Health EOS Commercial |
$1,368.96
|
| Rate for Payer: HFN Commercial |
$1,415.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,153.62
|
| Rate for Payer: Multiplan Commercial |
$1,230.53
|
| Rate for Payer: NAPHCARE Commercial |
$922.90
|
| Rate for Payer: Preferred Network Access Commercial |
$1,415.11
|
| Rate for Payer: Quartz Beloit One Network |
$753.70
|
| Rate for Payer: Quartz Commercial |
$999.80
|
| Rate for Payer: Quartz Medicare Advantage |
$922.90
|
| Rate for Payer: The Alliance Commercial |
$769.08
|
| Rate for Payer: WEA Trust Commercial |
$845.99
|
| Rate for Payer: WPS Commercial |
$1,139.27
|
|
|
SCREW CORTICAL 5.5 X 60MM ORTHOLOC 59225560
|
Facility
|
IP
|
$1,479.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6201064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$753.70 |
| Max. Negotiated Rate |
$1,415.11 |
| Rate for Payer: Aetna Commercial |
$1,384.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,322.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$815.22
|
| Rate for Payer: Cash Price |
$443.70
|
| Rate for Payer: Cigna Commercial |
$1,415.11
|
| Rate for Payer: Health EOS Commercial |
$1,368.96
|
| Rate for Payer: HFN Commercial |
$1,415.11
|
| Rate for Payer: Multiplan Commercial |
$1,230.53
|
| Rate for Payer: Preferred Network Access Commercial |
$1,415.11
|
| Rate for Payer: Quartz Beloit One Network |
$753.70
|
| Rate for Payer: Quartz Commercial |
$922.90
|
| Rate for Payer: WEA Trust Commercial |
$845.99
|
| Rate for Payer: WPS Commercial |
$1,139.27
|
|
|
SCREW CORT LOW-PROFILE 2.7 X 14MM GREY ORTHOLOC 58812714
|
Facility
|
OP
|
$2,234.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6169640
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.54 |
| Max. Negotiated Rate |
$2,137.49 |
| Rate for Payer: Aetna Commercial |
$2,091.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,998.09
|
| Rate for Payer: Aetna Managed Medicare |
$650.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,510.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,161.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,115.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,231.38
|
| Rate for Payer: Cash Price |
$670.20
|
| Rate for Payer: Cigna Commercial |
$2,137.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,300.19
|
| Rate for Payer: Health EOS Commercial |
$2,067.79
|
| Rate for Payer: HFN Commercial |
$2,137.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,742.52
|
| Rate for Payer: Multiplan Commercial |
$1,858.69
|
| Rate for Payer: NAPHCARE Commercial |
$1,394.02
|
| Rate for Payer: Preferred Network Access Commercial |
$2,137.49
|
| Rate for Payer: Quartz Beloit One Network |
$1,138.45
|
| Rate for Payer: Quartz Commercial |
$1,510.18
|
| Rate for Payer: Quartz Medicare Advantage |
$1,394.02
|
| Rate for Payer: The Alliance Commercial |
$1,161.68
|
| Rate for Payer: WEA Trust Commercial |
$1,277.85
|
| Rate for Payer: WPS Commercial |
$1,720.85
|
|
|
SCREW CORT LOW-PROFILE 2.7 X 14MM GREY ORTHOLOC 58812714
|
Facility
|
IP
|
$2,234.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6169640
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,138.45 |
| Max. Negotiated Rate |
$2,137.49 |
| Rate for Payer: Aetna Commercial |
$2,091.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,998.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,231.38
|
| Rate for Payer: Cash Price |
$670.20
|
| Rate for Payer: Cigna Commercial |
$2,137.49
|
| Rate for Payer: Health EOS Commercial |
$2,067.79
|
| Rate for Payer: HFN Commercial |
$2,137.49
|
| Rate for Payer: Multiplan Commercial |
$1,858.69
|
| Rate for Payer: Preferred Network Access Commercial |
$2,137.49
|
| Rate for Payer: Quartz Beloit One Network |
$1,138.45
|
| Rate for Payer: Quartz Commercial |
$1,394.02
|
| Rate for Payer: WEA Trust Commercial |
$1,277.85
|
| Rate for Payer: WPS Commercial |
$1,720.85
|
|
|
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 |
$650.54 |
| Max. Negotiated Rate |
$2,137.49 |
| Rate for Payer: Aetna Commercial |
$2,091.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,998.09
|
| Rate for Payer: Aetna Managed Medicare |
$650.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,510.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,161.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,115.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,231.38
|
| Rate for Payer: Cash Price |
$670.20
|
| Rate for Payer: Cigna Commercial |
$2,137.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,300.19
|
| Rate for Payer: Health EOS Commercial |
$2,067.79
|
| Rate for Payer: HFN Commercial |
$2,137.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,742.52
|
| Rate for Payer: Multiplan Commercial |
$1,858.69
|
| Rate for Payer: NAPHCARE Commercial |
$1,394.02
|
| Rate for Payer: Preferred Network Access Commercial |
$2,137.49
|
| Rate for Payer: Quartz Beloit One Network |
$1,138.45
|
| Rate for Payer: Quartz Commercial |
$1,510.18
|
| Rate for Payer: Quartz Medicare Advantage |
$1,394.02
|
| Rate for Payer: The Alliance Commercial |
$1,161.68
|
| Rate for Payer: WEA Trust Commercial |
$1,277.85
|
| Rate for Payer: WPS Commercial |
$1,720.85
|
|
|
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 |
$1,138.45 |
| Max. Negotiated Rate |
$2,137.49 |
| Rate for Payer: Aetna Commercial |
$2,091.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,998.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,231.38
|
| Rate for Payer: Cash Price |
$670.20
|
| Rate for Payer: Cigna Commercial |
$2,137.49
|
| Rate for Payer: Health EOS Commercial |
$2,067.79
|
| Rate for Payer: HFN Commercial |
$2,137.49
|
| Rate for Payer: Multiplan Commercial |
$1,858.69
|
| Rate for Payer: Preferred Network Access Commercial |
$2,137.49
|
| Rate for Payer: Quartz Beloit One Network |
$1,138.45
|
| Rate for Payer: Quartz Commercial |
$1,394.02
|
| Rate for Payer: WEA Trust Commercial |
$1,277.85
|
| Rate for Payer: WPS Commercial |
$1,720.85
|
|
|
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 |
$650.54 |
| Max. Negotiated Rate |
$2,137.49 |
| Rate for Payer: Aetna Commercial |
$2,091.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,998.09
|
| Rate for Payer: Aetna Managed Medicare |
$650.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,510.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,161.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,115.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,231.38
|
| Rate for Payer: Cash Price |
$670.20
|
| Rate for Payer: Cigna Commercial |
$2,137.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,300.19
|
| Rate for Payer: Health EOS Commercial |
$2,067.79
|
| Rate for Payer: HFN Commercial |
$2,137.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,742.52
|
| Rate for Payer: Multiplan Commercial |
$1,858.69
|
| Rate for Payer: NAPHCARE Commercial |
$1,394.02
|
| Rate for Payer: Preferred Network Access Commercial |
$2,137.49
|
| Rate for Payer: Quartz Beloit One Network |
$1,138.45
|
| Rate for Payer: Quartz Commercial |
$1,510.18
|
| Rate for Payer: Quartz Medicare Advantage |
$1,394.02
|
| Rate for Payer: The Alliance Commercial |
$1,161.68
|
| Rate for Payer: WEA Trust Commercial |
$1,277.85
|
| Rate for Payer: WPS Commercial |
$1,720.85
|
|
|
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 |
$1,138.45 |
| Max. Negotiated Rate |
$2,137.49 |
| Rate for Payer: Aetna Commercial |
$2,091.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,998.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,231.38
|
| Rate for Payer: Cash Price |
$670.20
|
| Rate for Payer: Cigna Commercial |
$2,137.49
|
| Rate for Payer: Health EOS Commercial |
$2,067.79
|
| Rate for Payer: HFN Commercial |
$2,137.49
|
| Rate for Payer: Multiplan Commercial |
$1,858.69
|
| Rate for Payer: Preferred Network Access Commercial |
$2,137.49
|
| Rate for Payer: Quartz Beloit One Network |
$1,138.45
|
| Rate for Payer: Quartz Commercial |
$1,394.02
|
| Rate for Payer: WEA Trust Commercial |
$1,277.85
|
| Rate for Payer: WPS Commercial |
$1,720.85
|
|
|
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 |
$650.54 |
| Max. Negotiated Rate |
$2,137.49 |
| Rate for Payer: Aetna Commercial |
$2,091.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,998.09
|
| Rate for Payer: Aetna Managed Medicare |
$650.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,510.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,161.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,115.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,231.38
|
| Rate for Payer: Cash Price |
$670.20
|
| Rate for Payer: Cigna Commercial |
$2,137.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,300.19
|
| Rate for Payer: Health EOS Commercial |
$2,067.79
|
| Rate for Payer: HFN Commercial |
$2,137.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,742.52
|
| Rate for Payer: Multiplan Commercial |
$1,858.69
|
| Rate for Payer: NAPHCARE Commercial |
$1,394.02
|
| Rate for Payer: Preferred Network Access Commercial |
$2,137.49
|
| Rate for Payer: Quartz Beloit One Network |
$1,138.45
|
| Rate for Payer: Quartz Commercial |
$1,510.18
|
| Rate for Payer: Quartz Medicare Advantage |
$1,394.02
|
| Rate for Payer: The Alliance Commercial |
$1,161.68
|
| Rate for Payer: WEA Trust Commercial |
$1,277.85
|
| Rate for Payer: WPS Commercial |
$1,720.85
|
|
|
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 |
$1,138.45 |
| Max. Negotiated Rate |
$2,137.49 |
| Rate for Payer: Aetna Commercial |
$2,091.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,998.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,231.38
|
| Rate for Payer: Cash Price |
$670.20
|
| Rate for Payer: Cigna Commercial |
$2,137.49
|
| Rate for Payer: Health EOS Commercial |
$2,067.79
|
| Rate for Payer: HFN Commercial |
$2,137.49
|
| Rate for Payer: Multiplan Commercial |
$1,858.69
|
| Rate for Payer: Preferred Network Access Commercial |
$2,137.49
|
| Rate for Payer: Quartz Beloit One Network |
$1,138.45
|
| Rate for Payer: Quartz Commercial |
$1,394.02
|
| Rate for Payer: WEA Trust Commercial |
$1,277.85
|
| Rate for Payer: WPS Commercial |
$1,720.85
|
|
|
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 |
$151.13 |
| Max. Negotiated Rate |
$496.58 |
| Rate for Payer: Aetna Commercial |
$485.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$464.19
|
| Rate for Payer: Aetna Managed Medicare |
$151.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$350.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$269.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$259.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$286.07
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna Commercial |
$496.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$302.06
|
| Rate for Payer: Health EOS Commercial |
$480.39
|
| Rate for Payer: HFN Commercial |
$496.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.82
|
| Rate for Payer: Multiplan Commercial |
$431.81
|
| Rate for Payer: NAPHCARE Commercial |
$323.86
|
| Rate for Payer: Preferred Network Access Commercial |
$496.58
|
| Rate for Payer: Quartz Beloit One Network |
$264.48
|
| Rate for Payer: Quartz Commercial |
$350.84
|
| Rate for Payer: Quartz Medicare Advantage |
$323.86
|
| Rate for Payer: The Alliance Commercial |
$269.88
|
| Rate for Payer: WEA Trust Commercial |
$296.87
|
| Rate for Payer: WPS Commercial |
$399.79
|
|
|
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 |
$264.48 |
| Max. Negotiated Rate |
$496.58 |
| Rate for Payer: Aetna Commercial |
$485.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$464.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$286.07
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna Commercial |
$496.58
|
| Rate for Payer: Health EOS Commercial |
$480.39
|
| Rate for Payer: HFN Commercial |
$496.58
|
| Rate for Payer: Multiplan Commercial |
$431.81
|
| Rate for Payer: Preferred Network Access Commercial |
$496.58
|
| Rate for Payer: Quartz Beloit One Network |
$264.48
|
| Rate for Payer: Quartz Commercial |
$323.86
|
| Rate for Payer: WEA Trust Commercial |
$296.87
|
| Rate for Payer: WPS Commercial |
$399.79
|
|
|
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 |
$151.13 |
| Max. Negotiated Rate |
$496.58 |
| Rate for Payer: Aetna Commercial |
$485.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$464.19
|
| Rate for Payer: Aetna Managed Medicare |
$151.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$350.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$269.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$259.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$286.07
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna Commercial |
$496.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$302.06
|
| Rate for Payer: Health EOS Commercial |
$480.39
|
| Rate for Payer: HFN Commercial |
$496.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.82
|
| Rate for Payer: Multiplan Commercial |
$431.81
|
| Rate for Payer: NAPHCARE Commercial |
$323.86
|
| Rate for Payer: Preferred Network Access Commercial |
$496.58
|
| Rate for Payer: Quartz Beloit One Network |
$264.48
|
| Rate for Payer: Quartz Commercial |
$350.84
|
| Rate for Payer: Quartz Medicare Advantage |
$323.86
|
| Rate for Payer: The Alliance Commercial |
$269.88
|
| Rate for Payer: WEA Trust Commercial |
$296.87
|
| Rate for Payer: WPS Commercial |
$399.79
|
|
|
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 |
$264.48 |
| Max. Negotiated Rate |
$496.58 |
| Rate for Payer: Aetna Commercial |
$485.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$464.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$286.07
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna Commercial |
$496.58
|
| Rate for Payer: Health EOS Commercial |
$480.39
|
| Rate for Payer: HFN Commercial |
$496.58
|
| Rate for Payer: Multiplan Commercial |
$431.81
|
| Rate for Payer: Preferred Network Access Commercial |
$496.58
|
| Rate for Payer: Quartz Beloit One Network |
$264.48
|
| Rate for Payer: Quartz Commercial |
$323.86
|
| Rate for Payer: WEA Trust Commercial |
$296.87
|
| Rate for Payer: WPS Commercial |
$399.79
|
|
|
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 |
$151.13 |
| Max. Negotiated Rate |
$496.58 |
| Rate for Payer: Aetna Commercial |
$485.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$464.19
|
| Rate for Payer: Aetna Managed Medicare |
$151.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$350.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$269.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$259.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$286.07
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna Commercial |
$496.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$302.06
|
| Rate for Payer: Health EOS Commercial |
$480.39
|
| Rate for Payer: HFN Commercial |
$496.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.82
|
| Rate for Payer: Multiplan Commercial |
$431.81
|
| Rate for Payer: NAPHCARE Commercial |
$323.86
|
| Rate for Payer: Preferred Network Access Commercial |
$496.58
|
| Rate for Payer: Quartz Beloit One Network |
$264.48
|
| Rate for Payer: Quartz Commercial |
$350.84
|
| Rate for Payer: Quartz Medicare Advantage |
$323.86
|
| Rate for Payer: The Alliance Commercial |
$269.88
|
| Rate for Payer: WEA Trust Commercial |
$296.87
|
| Rate for Payer: WPS Commercial |
$399.79
|
|
|
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 |
$264.48 |
| Max. Negotiated Rate |
$496.58 |
| Rate for Payer: Aetna Commercial |
$485.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$464.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$286.07
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna Commercial |
$496.58
|
| Rate for Payer: Health EOS Commercial |
$480.39
|
| Rate for Payer: HFN Commercial |
$496.58
|
| Rate for Payer: Multiplan Commercial |
$431.81
|
| Rate for Payer: Preferred Network Access Commercial |
$496.58
|
| Rate for Payer: Quartz Beloit One Network |
$264.48
|
| Rate for Payer: Quartz Commercial |
$323.86
|
| Rate for Payer: WEA Trust Commercial |
$296.87
|
| Rate for Payer: WPS Commercial |
$399.79
|
|
