|
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 |
$224.00 |
| Max. Negotiated Rate |
$3,200.00 |
| Rate for Payer: Aetna Commercial |
$720.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$688.00
|
| Rate for Payer: Aetna Managed Medicare |
$224.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$520.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$400.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$384.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$424.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cigna Commercial |
$736.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$447.68
|
| Rate for Payer: Health EOS Commercial |
$712.00
|
| Rate for Payer: HFN Commercial |
$736.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$600.00
|
| Rate for Payer: Multiplan Commercial |
$640.00
|
| Rate for Payer: NAPHCARE Commercial |
$480.00
|
| Rate for Payer: Preferred Network Access Commercial |
$736.00
|
| Rate for Payer: Quartz Beloit One Network |
$392.00
|
| Rate for Payer: Quartz Commercial |
$520.00
|
| Rate for Payer: Quartz Medicare Advantage |
$480.00
|
| Rate for Payer: The Alliance Commercial |
$3,200.00
|
| Rate for Payer: WEA Trust Commercial |
$440.00
|
| Rate for Payer: WPS Commercial |
$592.56
|
|
|
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 |
$527.73 |
| Max. Negotiated Rate |
$990.84 |
| Rate for Payer: Aetna Commercial |
$969.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$926.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$570.81
|
| Rate for Payer: Cash Price |
$323.10
|
| Rate for Payer: Cigna Commercial |
$990.84
|
| Rate for Payer: Health EOS Commercial |
$958.53
|
| Rate for Payer: HFN Commercial |
$990.84
|
| Rate for Payer: Multiplan Commercial |
$861.60
|
| Rate for Payer: NAPHCARE Commercial |
$646.20
|
| Rate for Payer: Preferred Network Access Commercial |
$990.84
|
| Rate for Payer: Quartz Beloit One Network |
$527.73
|
| Rate for Payer: Quartz Commercial |
$646.20
|
| Rate for Payer: WEA Trust Commercial |
$592.35
|
| Rate for Payer: WPS Commercial |
$797.73
|
|
|
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 |
$301.56 |
| Max. Negotiated Rate |
$4,308.00 |
| Rate for Payer: Aetna Commercial |
$969.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$926.22
|
| Rate for Payer: Aetna Managed Medicare |
$301.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$700.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$538.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$516.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$570.81
|
| Rate for Payer: Cash Price |
$323.10
|
| Rate for Payer: Cigna Commercial |
$990.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$602.69
|
| Rate for Payer: Health EOS Commercial |
$958.53
|
| Rate for Payer: HFN Commercial |
$990.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$807.75
|
| Rate for Payer: Multiplan Commercial |
$861.60
|
| Rate for Payer: NAPHCARE Commercial |
$646.20
|
| Rate for Payer: Preferred Network Access Commercial |
$990.84
|
| Rate for Payer: Quartz Beloit One Network |
$527.73
|
| Rate for Payer: Quartz Commercial |
$700.05
|
| Rate for Payer: Quartz Medicare Advantage |
$646.20
|
| Rate for Payer: The Alliance Commercial |
$4,308.00
|
| Rate for Payer: WEA Trust Commercial |
$592.35
|
| Rate for Payer: WPS Commercial |
$797.73
|
|
|
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 |
$260.68 |
| Max. Negotiated Rate |
$3,724.00 |
| Rate for Payer: Aetna Commercial |
$837.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$800.66
|
| Rate for Payer: Aetna Managed Medicare |
$260.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$605.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$465.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$446.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$493.43
|
| Rate for Payer: Cash Price |
$279.30
|
| Rate for Payer: Cigna Commercial |
$856.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$520.99
|
| Rate for Payer: Health EOS Commercial |
$828.59
|
| Rate for Payer: HFN Commercial |
$856.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$698.25
|
| Rate for Payer: Multiplan Commercial |
$744.80
|
| Rate for Payer: NAPHCARE Commercial |
$558.60
|
| Rate for Payer: Preferred Network Access Commercial |
$856.52
|
| Rate for Payer: Quartz Beloit One Network |
$456.19
|
| Rate for Payer: Quartz Commercial |
$605.15
|
| Rate for Payer: Quartz Medicare Advantage |
$558.60
|
| Rate for Payer: The Alliance Commercial |
$3,724.00
|
| Rate for Payer: WEA Trust Commercial |
$512.05
|
| Rate for Payer: WPS Commercial |
$689.59
|
|
|
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 |
$456.19 |
| Max. Negotiated Rate |
$856.52 |
| Rate for Payer: Aetna Commercial |
$837.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$800.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$493.43
|
| Rate for Payer: Cash Price |
$279.30
|
| Rate for Payer: Cigna Commercial |
$856.52
|
| Rate for Payer: Health EOS Commercial |
$828.59
|
| Rate for Payer: HFN Commercial |
$856.52
|
| Rate for Payer: Multiplan Commercial |
$744.80
|
| Rate for Payer: NAPHCARE Commercial |
$558.60
|
| Rate for Payer: Preferred Network Access Commercial |
$856.52
|
| Rate for Payer: Quartz Beloit One Network |
$456.19
|
| Rate for Payer: Quartz Commercial |
$558.60
|
| Rate for Payer: WEA Trust Commercial |
$512.05
|
| Rate for Payer: WPS Commercial |
$689.59
|
|
|
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 |
$456.19 |
| Max. Negotiated Rate |
$856.52 |
| Rate for Payer: Aetna Commercial |
$837.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$800.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$493.43
|
| Rate for Payer: Cash Price |
$279.30
|
| Rate for Payer: Cigna Commercial |
$856.52
|
| Rate for Payer: Health EOS Commercial |
$828.59
|
| Rate for Payer: HFN Commercial |
$856.52
|
| Rate for Payer: Multiplan Commercial |
$744.80
|
| Rate for Payer: NAPHCARE Commercial |
$558.60
|
| Rate for Payer: Preferred Network Access Commercial |
$856.52
|
| Rate for Payer: Quartz Beloit One Network |
$456.19
|
| Rate for Payer: Quartz Commercial |
$558.60
|
| Rate for Payer: WEA Trust Commercial |
$512.05
|
| Rate for Payer: WPS Commercial |
$689.59
|
|
|
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 |
$260.68 |
| Max. Negotiated Rate |
$3,724.00 |
| Rate for Payer: Aetna Commercial |
$837.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$800.66
|
| Rate for Payer: Aetna Managed Medicare |
$260.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$605.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$465.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$446.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$493.43
|
| Rate for Payer: Cash Price |
$279.30
|
| Rate for Payer: Cigna Commercial |
$856.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$520.99
|
| Rate for Payer: Health EOS Commercial |
$828.59
|
| Rate for Payer: HFN Commercial |
$856.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$698.25
|
| Rate for Payer: Multiplan Commercial |
$744.80
|
| Rate for Payer: NAPHCARE Commercial |
$558.60
|
| Rate for Payer: Preferred Network Access Commercial |
$856.52
|
| Rate for Payer: Quartz Beloit One Network |
$456.19
|
| Rate for Payer: Quartz Commercial |
$605.15
|
| Rate for Payer: Quartz Medicare Advantage |
$558.60
|
| Rate for Payer: The Alliance Commercial |
$3,724.00
|
| Rate for Payer: WEA Trust Commercial |
$512.05
|
| Rate for Payer: WPS Commercial |
$689.59
|
|
|
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 |
$489.51 |
| Max. Negotiated Rate |
$919.08 |
| Rate for Payer: Aetna Commercial |
$899.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$859.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$529.47
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Cigna Commercial |
$919.08
|
| Rate for Payer: Health EOS Commercial |
$889.11
|
| Rate for Payer: HFN Commercial |
$919.08
|
| Rate for Payer: Multiplan Commercial |
$799.20
|
| Rate for Payer: NAPHCARE Commercial |
$599.40
|
| Rate for Payer: Preferred Network Access Commercial |
$919.08
|
| Rate for Payer: Quartz Beloit One Network |
$489.51
|
| Rate for Payer: Quartz Commercial |
$599.40
|
| Rate for Payer: WEA Trust Commercial |
$549.45
|
| Rate for Payer: WPS Commercial |
$739.96
|
|
|
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 |
$279.72 |
| Max. Negotiated Rate |
$3,996.00 |
| Rate for Payer: Aetna Commercial |
$899.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$859.14
|
| Rate for Payer: Aetna Managed Medicare |
$279.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$649.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$499.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$479.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$529.47
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Cigna Commercial |
$919.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$559.04
|
| Rate for Payer: Health EOS Commercial |
$889.11
|
| Rate for Payer: HFN Commercial |
$919.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$749.25
|
| Rate for Payer: Multiplan Commercial |
$799.20
|
| Rate for Payer: NAPHCARE Commercial |
$599.40
|
| Rate for Payer: Preferred Network Access Commercial |
$919.08
|
| Rate for Payer: Quartz Beloit One Network |
$489.51
|
| Rate for Payer: Quartz Commercial |
$649.35
|
| Rate for Payer: Quartz Medicare Advantage |
$599.40
|
| Rate for Payer: The Alliance Commercial |
$3,996.00
|
| Rate for Payer: WEA Trust Commercial |
$549.45
|
| Rate for Payer: WPS Commercial |
$739.96
|
|
|
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 |
$270.76 |
| Max. Negotiated Rate |
$3,868.00 |
| Rate for Payer: Aetna Commercial |
$870.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$831.62
|
| Rate for Payer: Aetna Managed Medicare |
$270.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$628.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$483.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$464.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$512.51
|
| Rate for Payer: Cash Price |
$290.10
|
| Rate for Payer: Cigna Commercial |
$889.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$541.13
|
| Rate for Payer: Health EOS Commercial |
$860.63
|
| Rate for Payer: HFN Commercial |
$889.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$725.25
|
| Rate for Payer: Multiplan Commercial |
$773.60
|
| Rate for Payer: NAPHCARE Commercial |
$580.20
|
| Rate for Payer: Preferred Network Access Commercial |
$889.64
|
| Rate for Payer: Quartz Beloit One Network |
$473.83
|
| Rate for Payer: Quartz Commercial |
$628.55
|
| Rate for Payer: Quartz Medicare Advantage |
$580.20
|
| Rate for Payer: The Alliance Commercial |
$3,868.00
|
| Rate for Payer: WEA Trust Commercial |
$531.85
|
| Rate for Payer: WPS Commercial |
$716.26
|
|
|
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 |
$473.83 |
| Max. Negotiated Rate |
$889.64 |
| Rate for Payer: Aetna Commercial |
$870.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$831.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$512.51
|
| Rate for Payer: Cash Price |
$290.10
|
| Rate for Payer: Cigna Commercial |
$889.64
|
| Rate for Payer: Health EOS Commercial |
$860.63
|
| Rate for Payer: HFN Commercial |
$889.64
|
| Rate for Payer: Multiplan Commercial |
$773.60
|
| Rate for Payer: NAPHCARE Commercial |
$580.20
|
| Rate for Payer: Preferred Network Access Commercial |
$889.64
|
| Rate for Payer: Quartz Beloit One Network |
$473.83
|
| Rate for Payer: Quartz Commercial |
$580.20
|
| Rate for Payer: WEA Trust Commercial |
$531.85
|
| Rate for Payer: WPS Commercial |
$716.26
|
|
|
SCREW CORTEX 3.5mm X 18mm #404.818
|
Facility
|
IP
|
$523.00
|
|
| Hospital Charge Code |
2966553
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$256.27 |
| Max. Negotiated Rate |
$481.16 |
| Rate for Payer: Aetna Commercial |
$470.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$449.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$277.19
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cigna Commercial |
$481.16
|
| Rate for Payer: Health EOS Commercial |
$465.47
|
| Rate for Payer: HFN Commercial |
$481.16
|
| Rate for Payer: Multiplan Commercial |
$418.40
|
| Rate for Payer: NAPHCARE Commercial |
$313.80
|
| Rate for Payer: Preferred Network Access Commercial |
$481.16
|
| Rate for Payer: Quartz Beloit One Network |
$256.27
|
| Rate for Payer: Quartz Commercial |
$313.80
|
| Rate for Payer: WEA Trust Commercial |
$287.65
|
| Rate for Payer: WPS Commercial |
$387.39
|
|
|
SCREW CORTEX 3.5mm X 18mm #404.818
|
Facility
|
OP
|
$523.00
|
|
| Hospital Charge Code |
2966553
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$146.44 |
| Max. Negotiated Rate |
$2,092.00 |
| Rate for Payer: Aetna Commercial |
$470.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$449.78
|
| Rate for Payer: Aetna Managed Medicare |
$146.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$339.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$261.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$251.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$277.19
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cigna Commercial |
$481.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$292.67
|
| Rate for Payer: Health EOS Commercial |
$465.47
|
| Rate for Payer: HFN Commercial |
$481.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$392.25
|
| Rate for Payer: Multiplan Commercial |
$418.40
|
| Rate for Payer: NAPHCARE Commercial |
$313.80
|
| Rate for Payer: Preferred Network Access Commercial |
$481.16
|
| Rate for Payer: Quartz Beloit One Network |
$256.27
|
| Rate for Payer: Quartz Commercial |
$339.95
|
| Rate for Payer: Quartz Medicare Advantage |
$313.80
|
| Rate for Payer: The Alliance Commercial |
$2,092.00
|
| Rate for Payer: WEA Trust Commercial |
$287.65
|
| Rate for Payer: WPS Commercial |
$387.39
|
|
|
SCREW CORTEX 3.5mm X 20mm
|
Facility
|
OP
|
$523.00
|
|
| Hospital Charge Code |
2966554
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$146.44 |
| Max. Negotiated Rate |
$2,092.00 |
| Rate for Payer: Aetna Commercial |
$470.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$449.78
|
| Rate for Payer: Aetna Managed Medicare |
$146.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$339.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$261.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$251.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$277.19
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cigna Commercial |
$481.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$292.67
|
| Rate for Payer: Health EOS Commercial |
$465.47
|
| Rate for Payer: HFN Commercial |
$481.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$392.25
|
| Rate for Payer: Multiplan Commercial |
$418.40
|
| Rate for Payer: NAPHCARE Commercial |
$313.80
|
| Rate for Payer: Preferred Network Access Commercial |
$481.16
|
| Rate for Payer: Quartz Beloit One Network |
$256.27
|
| Rate for Payer: Quartz Commercial |
$339.95
|
| Rate for Payer: Quartz Medicare Advantage |
$313.80
|
| Rate for Payer: The Alliance Commercial |
$2,092.00
|
| Rate for Payer: WEA Trust Commercial |
$287.65
|
| Rate for Payer: WPS Commercial |
$387.39
|
|
|
SCREW CORTEX 3.5mm X 20mm
|
Facility
|
IP
|
$523.00
|
|
| Hospital Charge Code |
2966554
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$256.27 |
| Max. Negotiated Rate |
$481.16 |
| Rate for Payer: Aetna Commercial |
$470.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$449.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$277.19
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cigna Commercial |
$481.16
|
| Rate for Payer: Health EOS Commercial |
$465.47
|
| Rate for Payer: HFN Commercial |
$481.16
|
| Rate for Payer: Multiplan Commercial |
$418.40
|
| Rate for Payer: NAPHCARE Commercial |
$313.80
|
| Rate for Payer: Preferred Network Access Commercial |
$481.16
|
| Rate for Payer: Quartz Beloit One Network |
$256.27
|
| Rate for Payer: Quartz Commercial |
$313.80
|
| Rate for Payer: WEA Trust Commercial |
$287.65
|
| Rate for Payer: WPS Commercial |
$387.39
|
|
|
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 |
$271.95 |
| Max. Negotiated Rate |
$510.60 |
| Rate for Payer: Aetna Commercial |
$499.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$477.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$294.15
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Cigna Commercial |
$510.60
|
| Rate for Payer: Health EOS Commercial |
$493.95
|
| Rate for Payer: HFN Commercial |
$510.60
|
| Rate for Payer: Multiplan Commercial |
$444.00
|
| Rate for Payer: NAPHCARE Commercial |
$333.00
|
| Rate for Payer: Preferred Network Access Commercial |
$510.60
|
| Rate for Payer: Quartz Beloit One Network |
$271.95
|
| Rate for Payer: Quartz Commercial |
$333.00
|
| Rate for Payer: WEA Trust Commercial |
$305.25
|
| Rate for Payer: WPS Commercial |
$411.09
|
|
|
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 |
$155.40 |
| Max. Negotiated Rate |
$2,220.00 |
| Rate for Payer: Aetna Commercial |
$499.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$477.30
|
| Rate for Payer: Aetna Managed Medicare |
$155.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$360.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$277.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$266.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$294.15
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Cigna Commercial |
$510.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$310.58
|
| Rate for Payer: Health EOS Commercial |
$493.95
|
| Rate for Payer: HFN Commercial |
$510.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$416.25
|
| Rate for Payer: Multiplan Commercial |
$444.00
|
| Rate for Payer: NAPHCARE Commercial |
$333.00
|
| Rate for Payer: Preferred Network Access Commercial |
$510.60
|
| Rate for Payer: Quartz Beloit One Network |
$271.95
|
| Rate for Payer: Quartz Commercial |
$360.75
|
| Rate for Payer: Quartz Medicare Advantage |
$333.00
|
| Rate for Payer: The Alliance Commercial |
$2,220.00
|
| Rate for Payer: WEA Trust Commercial |
$305.25
|
| Rate for Payer: WPS Commercial |
$411.09
|
|
|
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 |
$878.08 |
| Max. Negotiated Rate |
$1,648.64 |
| Rate for Payer: Aetna Commercial |
$1,612.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,541.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$949.76
|
| Rate for Payer: Cash Price |
$537.60
|
| Rate for Payer: Cigna Commercial |
$1,648.64
|
| Rate for Payer: Health EOS Commercial |
$1,594.88
|
| Rate for Payer: HFN Commercial |
$1,648.64
|
| Rate for Payer: Multiplan Commercial |
$1,433.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,075.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,648.64
|
| Rate for Payer: Quartz Beloit One Network |
$878.08
|
| Rate for Payer: Quartz Commercial |
$1,075.20
|
| Rate for Payer: WEA Trust Commercial |
$985.60
|
| Rate for Payer: WPS Commercial |
$1,327.33
|
|
|
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 |
$501.76 |
| Max. Negotiated Rate |
$7,168.00 |
| Rate for Payer: Aetna Commercial |
$1,612.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,541.12
|
| Rate for Payer: Aetna Managed Medicare |
$501.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,164.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$896.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$860.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$949.76
|
| Rate for Payer: Cash Price |
$537.60
|
| Rate for Payer: Cigna Commercial |
$1,648.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,002.80
|
| Rate for Payer: Health EOS Commercial |
$1,594.88
|
| Rate for Payer: HFN Commercial |
$1,648.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,344.00
|
| Rate for Payer: Multiplan Commercial |
$1,433.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,075.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,648.64
|
| Rate for Payer: Quartz Beloit One Network |
$878.08
|
| Rate for Payer: Quartz Commercial |
$1,164.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,075.20
|
| Rate for Payer: The Alliance Commercial |
$7,168.00
|
| Rate for Payer: WEA Trust Commercial |
$985.60
|
| Rate for Payer: WPS Commercial |
$1,327.33
|
|
|
SCREW CORT FT 3.5 X 24MM 58913524
|
Facility
|
OP
|
$1,751.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6234164
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$490.28 |
| Max. Negotiated Rate |
$7,004.00 |
| Rate for Payer: Aetna Commercial |
$1,575.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,505.86
|
| Rate for Payer: Aetna Managed Medicare |
$490.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,138.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$875.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$840.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$928.03
|
| Rate for Payer: Cash Price |
$525.30
|
| Rate for Payer: Cigna Commercial |
$1,610.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$979.86
|
| Rate for Payer: Health EOS Commercial |
$1,558.39
|
| Rate for Payer: HFN Commercial |
$1,610.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,313.25
|
| Rate for Payer: Multiplan Commercial |
$1,400.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,050.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,610.92
|
| Rate for Payer: Quartz Beloit One Network |
$857.99
|
| Rate for Payer: Quartz Commercial |
$1,138.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,050.60
|
| Rate for Payer: The Alliance Commercial |
$7,004.00
|
| Rate for Payer: WEA Trust Commercial |
$963.05
|
| Rate for Payer: WPS Commercial |
$1,296.97
|
|
|
SCREW CORT FT 3.5 X 24MM 58913524
|
Facility
|
IP
|
$1,751.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6234164
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$857.99 |
| Max. Negotiated Rate |
$1,610.92 |
| Rate for Payer: Aetna Commercial |
$1,575.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,505.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$928.03
|
| Rate for Payer: Cash Price |
$525.30
|
| Rate for Payer: Cigna Commercial |
$1,610.92
|
| Rate for Payer: Health EOS Commercial |
$1,558.39
|
| Rate for Payer: HFN Commercial |
$1,610.92
|
| Rate for Payer: Multiplan Commercial |
$1,400.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,050.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,610.92
|
| Rate for Payer: Quartz Beloit One Network |
$857.99
|
| Rate for Payer: Quartz Commercial |
$1,050.60
|
| Rate for Payer: WEA Trust Commercial |
$963.05
|
| Rate for Payer: WPS Commercial |
$1,296.97
|
|
|
SCREW CORT FT 3.5 X 26MM 58913526
|
Facility
|
IP
|
$2,068.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6149649
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,013.32 |
| Max. Negotiated Rate |
$1,902.56 |
| Rate for Payer: Aetna Commercial |
$1,861.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,778.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,096.04
|
| Rate for Payer: Cash Price |
$620.40
|
| Rate for Payer: Cigna Commercial |
$1,902.56
|
| Rate for Payer: Health EOS Commercial |
$1,840.52
|
| Rate for Payer: HFN Commercial |
$1,902.56
|
| Rate for Payer: Multiplan Commercial |
$1,654.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,240.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,902.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,013.32
|
| Rate for Payer: Quartz Commercial |
$1,240.80
|
| Rate for Payer: WEA Trust Commercial |
$1,137.40
|
| Rate for Payer: WPS Commercial |
$1,531.77
|
|
|
SCREW CORT FT 3.5 X 26MM 58913526
|
Facility
|
OP
|
$2,068.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6149649
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$579.04 |
| Max. Negotiated Rate |
$8,272.00 |
| Rate for Payer: Aetna Commercial |
$1,861.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,778.48
|
| Rate for Payer: Aetna Managed Medicare |
$579.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,344.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,034.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$992.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,096.04
|
| Rate for Payer: Cash Price |
$620.40
|
| Rate for Payer: Cigna Commercial |
$1,902.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,157.25
|
| Rate for Payer: Health EOS Commercial |
$1,840.52
|
| Rate for Payer: HFN Commercial |
$1,902.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,551.00
|
| Rate for Payer: Multiplan Commercial |
$1,654.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,240.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,902.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,013.32
|
| Rate for Payer: Quartz Commercial |
$1,344.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,240.80
|
| Rate for Payer: The Alliance Commercial |
$8,272.00
|
| Rate for Payer: WEA Trust Commercial |
$1,137.40
|
| Rate for Payer: WPS Commercial |
$1,531.77
|
|
|
SCREW CORT FT 4.0 X 42MM 58924042
|
Facility
|
IP
|
$2,234.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6171781
|
|
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 FT 4.0 X 42MM 58924042
|
Facility
|
OP
|
$2,234.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6171781
|
|
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
|
|
