|
SCREW CORT FT 4.0 X 48MM 58924048
|
Facility
|
OP
|
$1,792.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5729845
|
|
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 4.0 X 48MM 58924048
|
Facility
|
IP
|
$1,792.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5729845
|
|
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 4.0 X 52MM 58924052
|
Facility
|
IP
|
$1,792.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5729844
|
|
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 4.0 X 52MM 58924052
|
Facility
|
OP
|
$1,792.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5729844
|
|
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 CORTICAL 2.4 X 10 MS-2410
|
Facility
|
IP
|
$1,613.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5264780
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$790.37 |
| Max. Negotiated Rate |
$1,483.96 |
| Rate for Payer: Aetna Commercial |
$1,451.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,387.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$854.89
|
| Rate for Payer: Cash Price |
$483.90
|
| Rate for Payer: Cigna Commercial |
$1,483.96
|
| Rate for Payer: Health EOS Commercial |
$1,435.57
|
| Rate for Payer: HFN Commercial |
$1,483.96
|
| Rate for Payer: Multiplan Commercial |
$1,290.40
|
| Rate for Payer: NAPHCARE Commercial |
$967.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,483.96
|
| Rate for Payer: Quartz Beloit One Network |
$790.37
|
| Rate for Payer: Quartz Commercial |
$967.80
|
| Rate for Payer: WEA Trust Commercial |
$887.15
|
| Rate for Payer: WPS Commercial |
$1,194.75
|
|
|
SCREW CORTICAL 2.4 X 10 MS-2410
|
Facility
|
OP
|
$1,613.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5264780
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$451.64 |
| Max. Negotiated Rate |
$6,452.00 |
| Rate for Payer: Aetna Commercial |
$1,451.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,387.18
|
| Rate for Payer: Aetna Managed Medicare |
$451.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,048.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$806.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$774.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$854.89
|
| Rate for Payer: Cash Price |
$483.90
|
| Rate for Payer: Cigna Commercial |
$1,483.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$902.63
|
| Rate for Payer: Health EOS Commercial |
$1,435.57
|
| Rate for Payer: HFN Commercial |
$1,483.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,209.75
|
| Rate for Payer: Multiplan Commercial |
$1,290.40
|
| Rate for Payer: NAPHCARE Commercial |
$967.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,483.96
|
| Rate for Payer: Quartz Beloit One Network |
$790.37
|
| Rate for Payer: Quartz Commercial |
$1,048.45
|
| Rate for Payer: Quartz Medicare Advantage |
$967.80
|
| Rate for Payer: The Alliance Commercial |
$6,452.00
|
| Rate for Payer: WEA Trust Commercial |
$887.15
|
| Rate for Payer: WPS Commercial |
$1,194.75
|
|
|
SCREW CORTICAL 2.4 X 12 MS-2412
|
Facility
|
OP
|
$1,613.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5264779
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$451.64 |
| Max. Negotiated Rate |
$6,452.00 |
| Rate for Payer: Aetna Commercial |
$1,451.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,387.18
|
| Rate for Payer: Aetna Managed Medicare |
$451.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,048.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$806.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$774.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$854.89
|
| Rate for Payer: Cash Price |
$483.90
|
| Rate for Payer: Cigna Commercial |
$1,483.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$902.63
|
| Rate for Payer: Health EOS Commercial |
$1,435.57
|
| Rate for Payer: HFN Commercial |
$1,483.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,209.75
|
| Rate for Payer: Multiplan Commercial |
$1,290.40
|
| Rate for Payer: NAPHCARE Commercial |
$967.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,483.96
|
| Rate for Payer: Quartz Beloit One Network |
$790.37
|
| Rate for Payer: Quartz Commercial |
$1,048.45
|
| Rate for Payer: Quartz Medicare Advantage |
$967.80
|
| Rate for Payer: The Alliance Commercial |
$6,452.00
|
| Rate for Payer: WEA Trust Commercial |
$887.15
|
| Rate for Payer: WPS Commercial |
$1,194.75
|
|
|
SCREW CORTICAL 2.4 X 12 MS-2412
|
Facility
|
IP
|
$1,613.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5264779
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$790.37 |
| Max. Negotiated Rate |
$1,483.96 |
| Rate for Payer: Aetna Commercial |
$1,451.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,387.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$854.89
|
| Rate for Payer: Cash Price |
$483.90
|
| Rate for Payer: Cigna Commercial |
$1,483.96
|
| Rate for Payer: Health EOS Commercial |
$1,435.57
|
| Rate for Payer: HFN Commercial |
$1,483.96
|
| Rate for Payer: Multiplan Commercial |
$1,290.40
|
| Rate for Payer: NAPHCARE Commercial |
$967.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,483.96
|
| Rate for Payer: Quartz Beloit One Network |
$790.37
|
| Rate for Payer: Quartz Commercial |
$967.80
|
| Rate for Payer: WEA Trust Commercial |
$887.15
|
| Rate for Payer: WPS Commercial |
$1,194.75
|
|
|
SCREW CORTICAL 2.4 X 14 MS-2414
|
Facility
|
IP
|
$1,613.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5729672
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$790.37 |
| Max. Negotiated Rate |
$1,483.96 |
| Rate for Payer: Aetna Commercial |
$1,451.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,387.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$854.89
|
| Rate for Payer: Cash Price |
$483.90
|
| Rate for Payer: Cigna Commercial |
$1,483.96
|
| Rate for Payer: Health EOS Commercial |
$1,435.57
|
| Rate for Payer: HFN Commercial |
$1,483.96
|
| Rate for Payer: Multiplan Commercial |
$1,290.40
|
| Rate for Payer: NAPHCARE Commercial |
$967.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,483.96
|
| Rate for Payer: Quartz Beloit One Network |
$790.37
|
| Rate for Payer: Quartz Commercial |
$967.80
|
| Rate for Payer: WEA Trust Commercial |
$887.15
|
| Rate for Payer: WPS Commercial |
$1,194.75
|
|
|
SCREW CORTICAL 2.4 X 14 MS-2414
|
Facility
|
OP
|
$1,613.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5729672
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$451.64 |
| Max. Negotiated Rate |
$6,452.00 |
| Rate for Payer: Aetna Commercial |
$1,451.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,387.18
|
| Rate for Payer: Aetna Managed Medicare |
$451.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,048.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$806.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$774.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$854.89
|
| Rate for Payer: Cash Price |
$483.90
|
| Rate for Payer: Cigna Commercial |
$1,483.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$902.63
|
| Rate for Payer: Health EOS Commercial |
$1,435.57
|
| Rate for Payer: HFN Commercial |
$1,483.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,209.75
|
| Rate for Payer: Multiplan Commercial |
$1,290.40
|
| Rate for Payer: NAPHCARE Commercial |
$967.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,483.96
|
| Rate for Payer: Quartz Beloit One Network |
$790.37
|
| Rate for Payer: Quartz Commercial |
$1,048.45
|
| Rate for Payer: Quartz Medicare Advantage |
$967.80
|
| Rate for Payer: The Alliance Commercial |
$6,452.00
|
| Rate for Payer: WEA Trust Commercial |
$887.15
|
| Rate for Payer: WPS Commercial |
$1,194.75
|
|
|
SCREW CORTICAL 2.4 X 16 MS-2416
|
Facility
|
IP
|
$1,613.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5510697
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$790.37 |
| Max. Negotiated Rate |
$1,483.96 |
| Rate for Payer: Aetna Commercial |
$1,451.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,387.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$854.89
|
| Rate for Payer: Cash Price |
$483.90
|
| Rate for Payer: Cigna Commercial |
$1,483.96
|
| Rate for Payer: Health EOS Commercial |
$1,435.57
|
| Rate for Payer: HFN Commercial |
$1,483.96
|
| Rate for Payer: Multiplan Commercial |
$1,290.40
|
| Rate for Payer: NAPHCARE Commercial |
$967.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,483.96
|
| Rate for Payer: Quartz Beloit One Network |
$790.37
|
| Rate for Payer: Quartz Commercial |
$967.80
|
| Rate for Payer: WEA Trust Commercial |
$887.15
|
| Rate for Payer: WPS Commercial |
$1,194.75
|
|
|
SCREW CORTICAL 2.4 X 16 MS-2416
|
Facility
|
OP
|
$1,613.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5510697
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$451.64 |
| Max. Negotiated Rate |
$6,452.00 |
| Rate for Payer: Aetna Commercial |
$1,451.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,387.18
|
| Rate for Payer: Aetna Managed Medicare |
$451.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,048.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$806.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$774.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$854.89
|
| Rate for Payer: Cash Price |
$483.90
|
| Rate for Payer: Cigna Commercial |
$1,483.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$902.63
|
| Rate for Payer: Health EOS Commercial |
$1,435.57
|
| Rate for Payer: HFN Commercial |
$1,483.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,209.75
|
| Rate for Payer: Multiplan Commercial |
$1,290.40
|
| Rate for Payer: NAPHCARE Commercial |
$967.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,483.96
|
| Rate for Payer: Quartz Beloit One Network |
$790.37
|
| Rate for Payer: Quartz Commercial |
$1,048.45
|
| Rate for Payer: Quartz Medicare Advantage |
$967.80
|
| Rate for Payer: The Alliance Commercial |
$6,452.00
|
| Rate for Payer: WEA Trust Commercial |
$887.15
|
| Rate for Payer: WPS Commercial |
$1,194.75
|
|
|
SCREW CORTICAL 3.5MM X 30MM 338630
|
Facility
|
IP
|
$414.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3983340
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$202.86 |
| Max. Negotiated Rate |
$380.88 |
| Rate for Payer: Aetna Commercial |
$372.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$356.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$219.42
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cigna Commercial |
$380.88
|
| Rate for Payer: Health EOS Commercial |
$368.46
|
| Rate for Payer: HFN Commercial |
$380.88
|
| Rate for Payer: Multiplan Commercial |
$331.20
|
| Rate for Payer: NAPHCARE Commercial |
$248.40
|
| Rate for Payer: Preferred Network Access Commercial |
$380.88
|
| Rate for Payer: Quartz Beloit One Network |
$202.86
|
| Rate for Payer: Quartz Commercial |
$248.40
|
| Rate for Payer: WEA Trust Commercial |
$227.70
|
| Rate for Payer: WPS Commercial |
$306.65
|
|
|
SCREW CORTICAL 3.5MM X 30MM 338630
|
Facility
|
OP
|
$414.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3983340
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$115.92 |
| Max. Negotiated Rate |
$1,656.00 |
| Rate for Payer: Aetna Commercial |
$372.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$356.04
|
| Rate for Payer: Aetna Managed Medicare |
$115.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$269.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$207.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$198.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$219.42
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cigna Commercial |
$380.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$231.67
|
| Rate for Payer: Health EOS Commercial |
$368.46
|
| Rate for Payer: HFN Commercial |
$380.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$310.50
|
| Rate for Payer: Multiplan Commercial |
$331.20
|
| Rate for Payer: NAPHCARE Commercial |
$248.40
|
| Rate for Payer: Preferred Network Access Commercial |
$380.88
|
| Rate for Payer: Quartz Beloit One Network |
$202.86
|
| Rate for Payer: Quartz Commercial |
$269.10
|
| Rate for Payer: Quartz Medicare Advantage |
$248.40
|
| Rate for Payer: The Alliance Commercial |
$1,656.00
|
| Rate for Payer: WEA Trust Commercial |
$227.70
|
| Rate for Payer: WPS Commercial |
$306.65
|
|
|
SCREW CORTICAL 3.5MM X 36MM 338636
|
Facility
|
IP
|
$414.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6198980
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$202.86 |
| Max. Negotiated Rate |
$380.88 |
| Rate for Payer: Aetna Commercial |
$372.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$356.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$219.42
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cigna Commercial |
$380.88
|
| Rate for Payer: Health EOS Commercial |
$368.46
|
| Rate for Payer: HFN Commercial |
$380.88
|
| Rate for Payer: Multiplan Commercial |
$331.20
|
| Rate for Payer: NAPHCARE Commercial |
$248.40
|
| Rate for Payer: Preferred Network Access Commercial |
$380.88
|
| Rate for Payer: Quartz Beloit One Network |
$202.86
|
| Rate for Payer: Quartz Commercial |
$248.40
|
| Rate for Payer: WEA Trust Commercial |
$227.70
|
| Rate for Payer: WPS Commercial |
$306.65
|
|
|
SCREW CORTICAL 3.5MM X 36MM 338636
|
Facility
|
OP
|
$414.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6198980
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$115.92 |
| Max. Negotiated Rate |
$1,656.00 |
| Rate for Payer: Aetna Commercial |
$372.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$356.04
|
| Rate for Payer: Aetna Managed Medicare |
$115.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$269.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$207.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$198.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$219.42
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cigna Commercial |
$380.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$231.67
|
| Rate for Payer: Health EOS Commercial |
$368.46
|
| Rate for Payer: HFN Commercial |
$380.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$310.50
|
| Rate for Payer: Multiplan Commercial |
$331.20
|
| Rate for Payer: NAPHCARE Commercial |
$248.40
|
| Rate for Payer: Preferred Network Access Commercial |
$380.88
|
| Rate for Payer: Quartz Beloit One Network |
$202.86
|
| Rate for Payer: Quartz Commercial |
$269.10
|
| Rate for Payer: Quartz Medicare Advantage |
$248.40
|
| Rate for Payer: The Alliance Commercial |
$1,656.00
|
| Rate for Payer: WEA Trust Commercial |
$227.70
|
| Rate for Payer: WPS Commercial |
$306.65
|
|
|
SCREW CORTICAL 3.5MM X 38MM 338638
|
Facility
|
OP
|
$414.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3983341
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$115.92 |
| Max. Negotiated Rate |
$1,656.00 |
| Rate for Payer: Aetna Commercial |
$372.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$356.04
|
| Rate for Payer: Aetna Managed Medicare |
$115.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$269.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$207.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$198.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$219.42
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cigna Commercial |
$380.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$231.67
|
| Rate for Payer: Health EOS Commercial |
$368.46
|
| Rate for Payer: HFN Commercial |
$380.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$310.50
|
| Rate for Payer: Multiplan Commercial |
$331.20
|
| Rate for Payer: NAPHCARE Commercial |
$248.40
|
| Rate for Payer: Preferred Network Access Commercial |
$380.88
|
| Rate for Payer: Quartz Beloit One Network |
$202.86
|
| Rate for Payer: Quartz Commercial |
$269.10
|
| Rate for Payer: Quartz Medicare Advantage |
$248.40
|
| Rate for Payer: The Alliance Commercial |
$1,656.00
|
| Rate for Payer: WEA Trust Commercial |
$227.70
|
| Rate for Payer: WPS Commercial |
$306.65
|
|
|
SCREW CORTICAL 3.5MM X 38MM 338638
|
Facility
|
IP
|
$414.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3983341
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$202.86 |
| Max. Negotiated Rate |
$380.88 |
| Rate for Payer: Aetna Commercial |
$372.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$356.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$219.42
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cigna Commercial |
$380.88
|
| Rate for Payer: Health EOS Commercial |
$368.46
|
| Rate for Payer: HFN Commercial |
$380.88
|
| Rate for Payer: Multiplan Commercial |
$331.20
|
| Rate for Payer: NAPHCARE Commercial |
$248.40
|
| Rate for Payer: Preferred Network Access Commercial |
$380.88
|
| Rate for Payer: Quartz Beloit One Network |
$202.86
|
| Rate for Payer: Quartz Commercial |
$248.40
|
| Rate for Payer: WEA Trust Commercial |
$227.70
|
| Rate for Payer: WPS Commercial |
$306.65
|
|
|
SCREW CORTICAL 3.5MM X 46MM 338646
|
Facility
|
OP
|
$414.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6198981
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$115.92 |
| Max. Negotiated Rate |
$1,656.00 |
| Rate for Payer: Aetna Commercial |
$372.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$356.04
|
| Rate for Payer: Aetna Managed Medicare |
$115.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$269.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$207.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$198.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$219.42
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cigna Commercial |
$380.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$231.67
|
| Rate for Payer: Health EOS Commercial |
$368.46
|
| Rate for Payer: HFN Commercial |
$380.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$310.50
|
| Rate for Payer: Multiplan Commercial |
$331.20
|
| Rate for Payer: NAPHCARE Commercial |
$248.40
|
| Rate for Payer: Preferred Network Access Commercial |
$380.88
|
| Rate for Payer: Quartz Beloit One Network |
$202.86
|
| Rate for Payer: Quartz Commercial |
$269.10
|
| Rate for Payer: Quartz Medicare Advantage |
$248.40
|
| Rate for Payer: The Alliance Commercial |
$1,656.00
|
| Rate for Payer: WEA Trust Commercial |
$227.70
|
| Rate for Payer: WPS Commercial |
$306.65
|
|
|
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 |
$202.86 |
| Max. Negotiated Rate |
$380.88 |
| Rate for Payer: Aetna Commercial |
$372.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$356.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$219.42
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cigna Commercial |
$380.88
|
| Rate for Payer: Health EOS Commercial |
$368.46
|
| Rate for Payer: HFN Commercial |
$380.88
|
| Rate for Payer: Multiplan Commercial |
$331.20
|
| Rate for Payer: NAPHCARE Commercial |
$248.40
|
| Rate for Payer: Preferred Network Access Commercial |
$380.88
|
| Rate for Payer: Quartz Beloit One Network |
$202.86
|
| Rate for Payer: Quartz Commercial |
$248.40
|
| Rate for Payer: WEA Trust Commercial |
$227.70
|
| Rate for Payer: WPS Commercial |
$306.65
|
|
|
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 |
$202.86 |
| Max. Negotiated Rate |
$380.88 |
| Rate for Payer: Aetna Commercial |
$372.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$356.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$219.42
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cigna Commercial |
$380.88
|
| Rate for Payer: Health EOS Commercial |
$368.46
|
| Rate for Payer: HFN Commercial |
$380.88
|
| Rate for Payer: Multiplan Commercial |
$331.20
|
| Rate for Payer: NAPHCARE Commercial |
$248.40
|
| Rate for Payer: Preferred Network Access Commercial |
$380.88
|
| Rate for Payer: Quartz Beloit One Network |
$202.86
|
| Rate for Payer: Quartz Commercial |
$248.40
|
| Rate for Payer: WEA Trust Commercial |
$227.70
|
| Rate for Payer: WPS Commercial |
$306.65
|
|
|
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 |
$115.92 |
| Max. Negotiated Rate |
$1,656.00 |
| Rate for Payer: Aetna Commercial |
$372.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$356.04
|
| Rate for Payer: Aetna Managed Medicare |
$115.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$269.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$207.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$198.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$219.42
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cigna Commercial |
$380.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$231.67
|
| Rate for Payer: Health EOS Commercial |
$368.46
|
| Rate for Payer: HFN Commercial |
$380.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$310.50
|
| Rate for Payer: Multiplan Commercial |
$331.20
|
| Rate for Payer: NAPHCARE Commercial |
$248.40
|
| Rate for Payer: Preferred Network Access Commercial |
$380.88
|
| Rate for Payer: Quartz Beloit One Network |
$202.86
|
| Rate for Payer: Quartz Commercial |
$269.10
|
| Rate for Payer: Quartz Medicare Advantage |
$248.40
|
| Rate for Payer: The Alliance Commercial |
$1,656.00
|
| Rate for Payer: WEA Trust Commercial |
$227.70
|
| Rate for Payer: WPS Commercial |
$306.65
|
|
|
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 |
$202.86 |
| Max. Negotiated Rate |
$380.88 |
| Rate for Payer: Aetna Commercial |
$372.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$356.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$219.42
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cigna Commercial |
$380.88
|
| Rate for Payer: Health EOS Commercial |
$368.46
|
| Rate for Payer: HFN Commercial |
$380.88
|
| Rate for Payer: Multiplan Commercial |
$331.20
|
| Rate for Payer: NAPHCARE Commercial |
$248.40
|
| Rate for Payer: Preferred Network Access Commercial |
$380.88
|
| Rate for Payer: Quartz Beloit One Network |
$202.86
|
| Rate for Payer: Quartz Commercial |
$248.40
|
| Rate for Payer: WEA Trust Commercial |
$227.70
|
| Rate for Payer: WPS Commercial |
$306.65
|
|
|
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 |
$115.92 |
| Max. Negotiated Rate |
$1,656.00 |
| Rate for Payer: Aetna Commercial |
$372.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$356.04
|
| Rate for Payer: Aetna Managed Medicare |
$115.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$269.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$207.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$198.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$219.42
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cigna Commercial |
$380.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$231.67
|
| Rate for Payer: Health EOS Commercial |
$368.46
|
| Rate for Payer: HFN Commercial |
$380.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$310.50
|
| Rate for Payer: Multiplan Commercial |
$331.20
|
| Rate for Payer: NAPHCARE Commercial |
$248.40
|
| Rate for Payer: Preferred Network Access Commercial |
$380.88
|
| Rate for Payer: Quartz Beloit One Network |
$202.86
|
| Rate for Payer: Quartz Commercial |
$269.10
|
| Rate for Payer: Quartz Medicare Advantage |
$248.40
|
| Rate for Payer: The Alliance Commercial |
$1,656.00
|
| Rate for Payer: WEA Trust Commercial |
$227.70
|
| Rate for Payer: WPS Commercial |
$306.65
|
|
|
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 |
$80.92 |
| Max. Negotiated Rate |
$1,156.00 |
| Rate for Payer: Aetna Commercial |
$260.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$248.54
|
| Rate for Payer: Aetna Managed Medicare |
$80.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$187.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$144.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$138.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$153.17
|
| Rate for Payer: Cash Price |
$86.70
|
| Rate for Payer: Cigna Commercial |
$265.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$161.72
|
| Rate for Payer: Health EOS Commercial |
$257.21
|
| Rate for Payer: HFN Commercial |
$265.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$216.75
|
| Rate for Payer: Multiplan Commercial |
$231.20
|
| Rate for Payer: NAPHCARE Commercial |
$173.40
|
| Rate for Payer: Preferred Network Access Commercial |
$265.88
|
| Rate for Payer: Quartz Beloit One Network |
$141.61
|
| Rate for Payer: Quartz Commercial |
$187.85
|
| Rate for Payer: Quartz Medicare Advantage |
$173.40
|
| Rate for Payer: The Alliance Commercial |
$1,156.00
|
| Rate for Payer: WEA Trust Commercial |
$158.95
|
| Rate for Payer: WPS Commercial |
$214.06
|
|
