|
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 |
$141.61 |
| Max. Negotiated Rate |
$265.88 |
| Rate for Payer: Aetna Commercial |
$260.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$248.54
|
| 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: Health EOS Commercial |
$257.21
|
| Rate for Payer: HFN Commercial |
$265.88
|
| 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 |
$173.40
|
| Rate for Payer: WEA Trust Commercial |
$158.95
|
| Rate for Payer: WPS Commercial |
$214.06
|
|
|
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 |
$414.12 |
| Max. Negotiated Rate |
$5,916.00 |
| Rate for Payer: Aetna Commercial |
$1,331.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,271.94
|
| Rate for Payer: Aetna Managed Medicare |
$414.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$961.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$739.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$709.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$783.87
|
| Rate for Payer: Cash Price |
$443.70
|
| Rate for Payer: Cigna Commercial |
$1,360.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$827.65
|
| Rate for Payer: Health EOS Commercial |
$1,316.31
|
| Rate for Payer: HFN Commercial |
$1,360.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,109.25
|
| Rate for Payer: Multiplan Commercial |
$1,183.20
|
| Rate for Payer: NAPHCARE Commercial |
$887.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,360.68
|
| Rate for Payer: Quartz Beloit One Network |
$724.71
|
| Rate for Payer: Quartz Commercial |
$961.35
|
| Rate for Payer: Quartz Medicare Advantage |
$887.40
|
| Rate for Payer: The Alliance Commercial |
$5,916.00
|
| Rate for Payer: WEA Trust Commercial |
$813.45
|
| Rate for Payer: WPS Commercial |
$1,095.50
|
|
|
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 |
$724.71 |
| Max. Negotiated Rate |
$1,360.68 |
| Rate for Payer: Aetna Commercial |
$1,331.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,271.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$783.87
|
| Rate for Payer: Cash Price |
$443.70
|
| Rate for Payer: Cigna Commercial |
$1,360.68
|
| Rate for Payer: Health EOS Commercial |
$1,316.31
|
| Rate for Payer: HFN Commercial |
$1,360.68
|
| Rate for Payer: Multiplan Commercial |
$1,183.20
|
| Rate for Payer: NAPHCARE Commercial |
$887.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,360.68
|
| Rate for Payer: Quartz Beloit One Network |
$724.71
|
| Rate for Payer: Quartz Commercial |
$887.40
|
| Rate for Payer: WEA Trust Commercial |
$813.45
|
| Rate for Payer: WPS Commercial |
$1,095.50
|
|
|
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 |
$724.71 |
| Max. Negotiated Rate |
$1,360.68 |
| Rate for Payer: Aetna Commercial |
$1,331.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,271.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$783.87
|
| Rate for Payer: Cash Price |
$443.70
|
| Rate for Payer: Cigna Commercial |
$1,360.68
|
| Rate for Payer: Health EOS Commercial |
$1,316.31
|
| Rate for Payer: HFN Commercial |
$1,360.68
|
| Rate for Payer: Multiplan Commercial |
$1,183.20
|
| Rate for Payer: NAPHCARE Commercial |
$887.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,360.68
|
| Rate for Payer: Quartz Beloit One Network |
$724.71
|
| Rate for Payer: Quartz Commercial |
$887.40
|
| Rate for Payer: WEA Trust Commercial |
$813.45
|
| Rate for Payer: WPS Commercial |
$1,095.50
|
|
|
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 |
$414.12 |
| Max. Negotiated Rate |
$5,916.00 |
| Rate for Payer: Aetna Commercial |
$1,331.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,271.94
|
| Rate for Payer: Aetna Managed Medicare |
$414.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$961.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$739.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$709.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$783.87
|
| Rate for Payer: Cash Price |
$443.70
|
| Rate for Payer: Cigna Commercial |
$1,360.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$827.65
|
| Rate for Payer: Health EOS Commercial |
$1,316.31
|
| Rate for Payer: HFN Commercial |
$1,360.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,109.25
|
| Rate for Payer: Multiplan Commercial |
$1,183.20
|
| Rate for Payer: NAPHCARE Commercial |
$887.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,360.68
|
| Rate for Payer: Quartz Beloit One Network |
$724.71
|
| Rate for Payer: Quartz Commercial |
$961.35
|
| Rate for Payer: Quartz Medicare Advantage |
$887.40
|
| Rate for Payer: The Alliance Commercial |
$5,916.00
|
| Rate for Payer: WEA Trust Commercial |
$813.45
|
| Rate for Payer: WPS Commercial |
$1,095.50
|
|
|
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 |
$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
|
|
|
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 |
$1,094.66 |
| 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 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 |
$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
|
|
|
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 |
$1,094.66 |
| 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 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 |
$1,094.66 |
| 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 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 |
$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
|
|
|
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 |
$1,094.66 |
| 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 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 |
$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
|
|
|
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 |
$145.32 |
| Max. Negotiated Rate |
$2,076.00 |
| Rate for Payer: Aetna Commercial |
$467.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$446.34
|
| Rate for Payer: Aetna Managed Medicare |
$145.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$337.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$259.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$249.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$275.07
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna Commercial |
$477.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$290.43
|
| Rate for Payer: Health EOS Commercial |
$461.91
|
| Rate for Payer: HFN Commercial |
$477.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$389.25
|
| Rate for Payer: Multiplan Commercial |
$415.20
|
| Rate for Payer: NAPHCARE Commercial |
$311.40
|
| Rate for Payer: Preferred Network Access Commercial |
$477.48
|
| Rate for Payer: Quartz Beloit One Network |
$254.31
|
| Rate for Payer: Quartz Commercial |
$337.35
|
| Rate for Payer: Quartz Medicare Advantage |
$311.40
|
| Rate for Payer: The Alliance Commercial |
$2,076.00
|
| Rate for Payer: WEA Trust Commercial |
$285.45
|
| Rate for Payer: WPS Commercial |
$384.42
|
|
|
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 |
$254.31 |
| Max. Negotiated Rate |
$477.48 |
| Rate for Payer: Aetna Commercial |
$467.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$446.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$275.07
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna Commercial |
$477.48
|
| Rate for Payer: Health EOS Commercial |
$461.91
|
| Rate for Payer: HFN Commercial |
$477.48
|
| Rate for Payer: Multiplan Commercial |
$415.20
|
| Rate for Payer: NAPHCARE Commercial |
$311.40
|
| Rate for Payer: Preferred Network Access Commercial |
$477.48
|
| Rate for Payer: Quartz Beloit One Network |
$254.31
|
| Rate for Payer: Quartz Commercial |
$311.40
|
| Rate for Payer: WEA Trust Commercial |
$285.45
|
| Rate for Payer: WPS Commercial |
$384.42
|
|
|
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 |
$145.32 |
| Max. Negotiated Rate |
$2,076.00 |
| Rate for Payer: Aetna Commercial |
$467.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$446.34
|
| Rate for Payer: Aetna Managed Medicare |
$145.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$337.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$259.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$249.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$275.07
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna Commercial |
$477.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$290.43
|
| Rate for Payer: Health EOS Commercial |
$461.91
|
| Rate for Payer: HFN Commercial |
$477.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$389.25
|
| Rate for Payer: Multiplan Commercial |
$415.20
|
| Rate for Payer: NAPHCARE Commercial |
$311.40
|
| Rate for Payer: Preferred Network Access Commercial |
$477.48
|
| Rate for Payer: Quartz Beloit One Network |
$254.31
|
| Rate for Payer: Quartz Commercial |
$337.35
|
| Rate for Payer: Quartz Medicare Advantage |
$311.40
|
| Rate for Payer: The Alliance Commercial |
$2,076.00
|
| Rate for Payer: WEA Trust Commercial |
$285.45
|
| Rate for Payer: WPS Commercial |
$384.42
|
|
|
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 |
$254.31 |
| Max. Negotiated Rate |
$477.48 |
| Rate for Payer: Aetna Commercial |
$467.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$446.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$275.07
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna Commercial |
$477.48
|
| Rate for Payer: Health EOS Commercial |
$461.91
|
| Rate for Payer: HFN Commercial |
$477.48
|
| Rate for Payer: Multiplan Commercial |
$415.20
|
| Rate for Payer: NAPHCARE Commercial |
$311.40
|
| Rate for Payer: Preferred Network Access Commercial |
$477.48
|
| Rate for Payer: Quartz Beloit One Network |
$254.31
|
| Rate for Payer: Quartz Commercial |
$311.40
|
| Rate for Payer: WEA Trust Commercial |
$285.45
|
| Rate for Payer: WPS Commercial |
$384.42
|
|
|
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 |
$145.32 |
| Max. Negotiated Rate |
$2,076.00 |
| Rate for Payer: Aetna Commercial |
$467.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$446.34
|
| Rate for Payer: Aetna Managed Medicare |
$145.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$337.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$259.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$249.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$275.07
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna Commercial |
$477.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$290.43
|
| Rate for Payer: Health EOS Commercial |
$461.91
|
| Rate for Payer: HFN Commercial |
$477.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$389.25
|
| Rate for Payer: Multiplan Commercial |
$415.20
|
| Rate for Payer: NAPHCARE Commercial |
$311.40
|
| Rate for Payer: Preferred Network Access Commercial |
$477.48
|
| Rate for Payer: Quartz Beloit One Network |
$254.31
|
| Rate for Payer: Quartz Commercial |
$337.35
|
| Rate for Payer: Quartz Medicare Advantage |
$311.40
|
| Rate for Payer: The Alliance Commercial |
$2,076.00
|
| Rate for Payer: WEA Trust Commercial |
$285.45
|
| Rate for Payer: WPS Commercial |
$384.42
|
|
|
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 |
$254.31 |
| Max. Negotiated Rate |
$477.48 |
| Rate for Payer: Aetna Commercial |
$467.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$446.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$275.07
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna Commercial |
$477.48
|
| Rate for Payer: Health EOS Commercial |
$461.91
|
| Rate for Payer: HFN Commercial |
$477.48
|
| Rate for Payer: Multiplan Commercial |
$415.20
|
| Rate for Payer: NAPHCARE Commercial |
$311.40
|
| Rate for Payer: Preferred Network Access Commercial |
$477.48
|
| Rate for Payer: Quartz Beloit One Network |
$254.31
|
| Rate for Payer: Quartz Commercial |
$311.40
|
| Rate for Payer: WEA Trust Commercial |
$285.45
|
| Rate for Payer: WPS Commercial |
$384.42
|
|
|
SCREW CORT LOW PROFILE 3.5 X 30 02.206.230
|
Facility
|
IP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3265476
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$254.31 |
| Max. Negotiated Rate |
$477.48 |
| Rate for Payer: Aetna Commercial |
$467.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$446.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$275.07
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna Commercial |
$477.48
|
| Rate for Payer: Health EOS Commercial |
$461.91
|
| Rate for Payer: HFN Commercial |
$477.48
|
| Rate for Payer: Multiplan Commercial |
$415.20
|
| Rate for Payer: NAPHCARE Commercial |
$311.40
|
| Rate for Payer: Preferred Network Access Commercial |
$477.48
|
| Rate for Payer: Quartz Beloit One Network |
$254.31
|
| Rate for Payer: Quartz Commercial |
$311.40
|
| Rate for Payer: WEA Trust Commercial |
$285.45
|
| Rate for Payer: WPS Commercial |
$384.42
|
|
|
SCREW CORT LOW PROFILE 3.5 X 30 02.206.230
|
Facility
|
OP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3265476
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$145.32 |
| Max. Negotiated Rate |
$2,076.00 |
| Rate for Payer: Aetna Commercial |
$467.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$446.34
|
| Rate for Payer: Aetna Managed Medicare |
$145.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$337.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$259.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$249.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$275.07
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna Commercial |
$477.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$290.43
|
| Rate for Payer: Health EOS Commercial |
$461.91
|
| Rate for Payer: HFN Commercial |
$477.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$389.25
|
| Rate for Payer: Multiplan Commercial |
$415.20
|
| Rate for Payer: NAPHCARE Commercial |
$311.40
|
| Rate for Payer: Preferred Network Access Commercial |
$477.48
|
| Rate for Payer: Quartz Beloit One Network |
$254.31
|
| Rate for Payer: Quartz Commercial |
$337.35
|
| Rate for Payer: Quartz Medicare Advantage |
$311.40
|
| Rate for Payer: The Alliance Commercial |
$2,076.00
|
| Rate for Payer: WEA Trust Commercial |
$285.45
|
| Rate for Payer: WPS Commercial |
$384.42
|
|
|
SCREW CORT LOW PROFILE 3.5 X 36 02.206.236
|
Facility
|
OP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3265478
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$145.32 |
| Max. Negotiated Rate |
$2,076.00 |
| Rate for Payer: Aetna Commercial |
$467.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$446.34
|
| Rate for Payer: Aetna Managed Medicare |
$145.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$337.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$259.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$249.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$275.07
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna Commercial |
$477.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$290.43
|
| Rate for Payer: Health EOS Commercial |
$461.91
|
| Rate for Payer: HFN Commercial |
$477.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$389.25
|
| Rate for Payer: Multiplan Commercial |
$415.20
|
| Rate for Payer: NAPHCARE Commercial |
$311.40
|
| Rate for Payer: Preferred Network Access Commercial |
$477.48
|
| Rate for Payer: Quartz Beloit One Network |
$254.31
|
| Rate for Payer: Quartz Commercial |
$337.35
|
| Rate for Payer: Quartz Medicare Advantage |
$311.40
|
| Rate for Payer: The Alliance Commercial |
$2,076.00
|
| Rate for Payer: WEA Trust Commercial |
$285.45
|
| Rate for Payer: WPS Commercial |
$384.42
|
|
|
SCREW CORT LOW PROFILE 3.5 X 36 02.206.236
|
Facility
|
IP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3265478
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$254.31 |
| Max. Negotiated Rate |
$477.48 |
| Rate for Payer: Aetna Commercial |
$467.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$446.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$275.07
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna Commercial |
$477.48
|
| Rate for Payer: Health EOS Commercial |
$461.91
|
| Rate for Payer: HFN Commercial |
$477.48
|
| Rate for Payer: Multiplan Commercial |
$415.20
|
| Rate for Payer: NAPHCARE Commercial |
$311.40
|
| Rate for Payer: Preferred Network Access Commercial |
$477.48
|
| Rate for Payer: Quartz Beloit One Network |
$254.31
|
| Rate for Payer: Quartz Commercial |
$311.40
|
| Rate for Payer: WEA Trust Commercial |
$285.45
|
| Rate for Payer: WPS Commercial |
$384.42
|
|
|
SCREW CORT LOW PROFILE 3.5 X 46MM 02.206.246
|
Facility
|
IP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4028668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$254.31 |
| Max. Negotiated Rate |
$477.48 |
| Rate for Payer: Aetna Commercial |
$467.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$446.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$275.07
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna Commercial |
$477.48
|
| Rate for Payer: Health EOS Commercial |
$461.91
|
| Rate for Payer: HFN Commercial |
$477.48
|
| Rate for Payer: Multiplan Commercial |
$415.20
|
| Rate for Payer: NAPHCARE Commercial |
$311.40
|
| Rate for Payer: Preferred Network Access Commercial |
$477.48
|
| Rate for Payer: Quartz Beloit One Network |
$254.31
|
| Rate for Payer: Quartz Commercial |
$311.40
|
| Rate for Payer: WEA Trust Commercial |
$285.45
|
| Rate for Payer: WPS Commercial |
$384.42
|
|
|
SCREW CORT LOW PROFILE 3.5 X 46MM 02.206.246
|
Facility
|
OP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4028668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$145.32 |
| Max. Negotiated Rate |
$2,076.00 |
| Rate for Payer: Aetna Commercial |
$467.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$446.34
|
| Rate for Payer: Aetna Managed Medicare |
$145.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$337.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$259.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$249.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$275.07
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna Commercial |
$477.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$290.43
|
| Rate for Payer: Health EOS Commercial |
$461.91
|
| Rate for Payer: HFN Commercial |
$477.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$389.25
|
| Rate for Payer: Multiplan Commercial |
$415.20
|
| Rate for Payer: NAPHCARE Commercial |
$311.40
|
| Rate for Payer: Preferred Network Access Commercial |
$477.48
|
| Rate for Payer: Quartz Beloit One Network |
$254.31
|
| Rate for Payer: Quartz Commercial |
$337.35
|
| Rate for Payer: Quartz Medicare Advantage |
$311.40
|
| Rate for Payer: The Alliance Commercial |
$2,076.00
|
| Rate for Payer: WEA Trust Commercial |
$285.45
|
| Rate for Payer: WPS Commercial |
$384.42
|
|
