|
BONE REMOVER INBONE SCREW IB200051
|
Facility
|
IP
|
$2,248.00
|
|
| Hospital Charge Code |
5831723
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,145.58 |
| Max. Negotiated Rate |
$2,150.89 |
| Rate for Payer: Aetna Commercial |
$2,104.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,010.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,239.10
|
| Rate for Payer: Cash Price |
$674.40
|
| Rate for Payer: Cigna Commercial |
$2,150.89
|
| Rate for Payer: Health EOS Commercial |
$2,080.75
|
| Rate for Payer: HFN Commercial |
$2,150.89
|
| Rate for Payer: Multiplan Commercial |
$1,870.34
|
| Rate for Payer: Preferred Network Access Commercial |
$2,150.89
|
| Rate for Payer: Quartz Beloit One Network |
$1,145.58
|
| Rate for Payer: Quartz Commercial |
$1,402.75
|
| Rate for Payer: WEA Trust Commercial |
$1,285.86
|
| Rate for Payer: WPS Commercial |
$1,731.63
|
|
|
BONE SCREW 15MM 6250-65-15
|
Facility
|
OP
|
$1,144.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967632
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$333.13 |
| Max. Negotiated Rate |
$1,094.58 |
| Rate for Payer: Aetna Commercial |
$1,070.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,023.19
|
| Rate for Payer: Aetna Managed Medicare |
$333.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$773.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$594.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$571.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$630.57
|
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Cigna Commercial |
$1,094.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$665.81
|
| Rate for Payer: Health EOS Commercial |
$1,058.89
|
| Rate for Payer: HFN Commercial |
$1,094.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$892.32
|
| Rate for Payer: Multiplan Commercial |
$951.81
|
| Rate for Payer: NAPHCARE Commercial |
$713.86
|
| Rate for Payer: Preferred Network Access Commercial |
$1,094.58
|
| Rate for Payer: Quartz Beloit One Network |
$582.98
|
| Rate for Payer: Quartz Commercial |
$773.34
|
| Rate for Payer: Quartz Medicare Advantage |
$713.86
|
| Rate for Payer: The Alliance Commercial |
$594.88
|
| Rate for Payer: WEA Trust Commercial |
$654.37
|
| Rate for Payer: WPS Commercial |
$881.22
|
|
|
BONE SCREW 15MM 6250-65-15
|
Facility
|
IP
|
$1,144.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967632
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$582.98 |
| Max. Negotiated Rate |
$1,094.58 |
| Rate for Payer: Aetna Commercial |
$1,070.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,023.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$630.57
|
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Cigna Commercial |
$1,094.58
|
| Rate for Payer: Health EOS Commercial |
$1,058.89
|
| Rate for Payer: HFN Commercial |
$1,094.58
|
| Rate for Payer: Multiplan Commercial |
$951.81
|
| Rate for Payer: Preferred Network Access Commercial |
$1,094.58
|
| Rate for Payer: Quartz Beloit One Network |
$582.98
|
| Rate for Payer: Quartz Commercial |
$713.86
|
| Rate for Payer: WEA Trust Commercial |
$654.37
|
| Rate for Payer: WPS Commercial |
$881.22
|
|
|
BONE SCREW 20MM 6250-65-20
|
Facility
|
IP
|
$1,188.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967633
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$605.40 |
| Max. Negotiated Rate |
$1,136.68 |
| Rate for Payer: Aetna Commercial |
$1,111.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,062.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$654.83
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cigna Commercial |
$1,136.68
|
| Rate for Payer: Health EOS Commercial |
$1,099.61
|
| Rate for Payer: HFN Commercial |
$1,136.68
|
| Rate for Payer: Multiplan Commercial |
$988.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,136.68
|
| Rate for Payer: Quartz Beloit One Network |
$605.40
|
| Rate for Payer: Quartz Commercial |
$741.31
|
| Rate for Payer: WEA Trust Commercial |
$679.54
|
| Rate for Payer: WPS Commercial |
$915.12
|
|
|
BONE SCREW 20MM 6250-65-20
|
Facility
|
OP
|
$1,188.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967633
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$345.95 |
| Max. Negotiated Rate |
$1,136.68 |
| Rate for Payer: Aetna Commercial |
$1,111.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,062.55
|
| Rate for Payer: Aetna Managed Medicare |
$345.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$803.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$617.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$593.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$654.83
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cigna Commercial |
$1,136.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$691.42
|
| Rate for Payer: Health EOS Commercial |
$1,099.61
|
| Rate for Payer: HFN Commercial |
$1,136.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$926.64
|
| Rate for Payer: Multiplan Commercial |
$988.42
|
| Rate for Payer: NAPHCARE Commercial |
$741.31
|
| Rate for Payer: Preferred Network Access Commercial |
$1,136.68
|
| Rate for Payer: Quartz Beloit One Network |
$605.40
|
| Rate for Payer: Quartz Commercial |
$803.09
|
| Rate for Payer: Quartz Medicare Advantage |
$741.31
|
| Rate for Payer: The Alliance Commercial |
$617.76
|
| Rate for Payer: WEA Trust Commercial |
$679.54
|
| Rate for Payer: WPS Commercial |
$915.12
|
|
|
BONE SCREW 25MM 6250-65-25
|
Facility
|
OP
|
$1,188.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967634
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$345.95 |
| Max. Negotiated Rate |
$1,136.68 |
| Rate for Payer: Aetna Commercial |
$1,111.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,062.55
|
| Rate for Payer: Aetna Managed Medicare |
$345.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$803.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$617.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$593.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$654.83
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cigna Commercial |
$1,136.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$691.42
|
| Rate for Payer: Health EOS Commercial |
$1,099.61
|
| Rate for Payer: HFN Commercial |
$1,136.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$926.64
|
| Rate for Payer: Multiplan Commercial |
$988.42
|
| Rate for Payer: NAPHCARE Commercial |
$741.31
|
| Rate for Payer: Preferred Network Access Commercial |
$1,136.68
|
| Rate for Payer: Quartz Beloit One Network |
$605.40
|
| Rate for Payer: Quartz Commercial |
$803.09
|
| Rate for Payer: Quartz Medicare Advantage |
$741.31
|
| Rate for Payer: The Alliance Commercial |
$617.76
|
| Rate for Payer: WEA Trust Commercial |
$679.54
|
| Rate for Payer: WPS Commercial |
$915.12
|
|
|
BONE SCREW 25MM 6250-65-25
|
Facility
|
IP
|
$1,188.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967634
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$605.40 |
| Max. Negotiated Rate |
$1,136.68 |
| Rate for Payer: Aetna Commercial |
$1,111.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,062.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$654.83
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cigna Commercial |
$1,136.68
|
| Rate for Payer: Health EOS Commercial |
$1,099.61
|
| Rate for Payer: HFN Commercial |
$1,136.68
|
| Rate for Payer: Multiplan Commercial |
$988.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,136.68
|
| Rate for Payer: Quartz Beloit One Network |
$605.40
|
| Rate for Payer: Quartz Commercial |
$741.31
|
| Rate for Payer: WEA Trust Commercial |
$679.54
|
| Rate for Payer: WPS Commercial |
$915.12
|
|
|
BONE SCREW 30MM 6250-65-30
|
Facility
|
IP
|
$1,188.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967635
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$605.40 |
| Max. Negotiated Rate |
$1,136.68 |
| Rate for Payer: Aetna Commercial |
$1,111.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,062.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$654.83
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cigna Commercial |
$1,136.68
|
| Rate for Payer: Health EOS Commercial |
$1,099.61
|
| Rate for Payer: HFN Commercial |
$1,136.68
|
| Rate for Payer: Multiplan Commercial |
$988.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,136.68
|
| Rate for Payer: Quartz Beloit One Network |
$605.40
|
| Rate for Payer: Quartz Commercial |
$741.31
|
| Rate for Payer: WEA Trust Commercial |
$679.54
|
| Rate for Payer: WPS Commercial |
$915.12
|
|
|
BONE SCREW 30MM 6250-65-30
|
Facility
|
OP
|
$1,188.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967635
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$345.95 |
| Max. Negotiated Rate |
$1,136.68 |
| Rate for Payer: Aetna Commercial |
$1,111.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,062.55
|
| Rate for Payer: Aetna Managed Medicare |
$345.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$803.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$617.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$593.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$654.83
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cigna Commercial |
$1,136.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$691.42
|
| Rate for Payer: Health EOS Commercial |
$1,099.61
|
| Rate for Payer: HFN Commercial |
$1,136.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$926.64
|
| Rate for Payer: Multiplan Commercial |
$988.42
|
| Rate for Payer: NAPHCARE Commercial |
$741.31
|
| Rate for Payer: Preferred Network Access Commercial |
$1,136.68
|
| Rate for Payer: Quartz Beloit One Network |
$605.40
|
| Rate for Payer: Quartz Commercial |
$803.09
|
| Rate for Payer: Quartz Medicare Advantage |
$741.31
|
| Rate for Payer: The Alliance Commercial |
$617.76
|
| Rate for Payer: WEA Trust Commercial |
$679.54
|
| Rate for Payer: WPS Commercial |
$915.12
|
|
|
BONE SCREW 35MM 6250-65-35
|
Facility
|
IP
|
$1,188.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967636
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$605.40 |
| Max. Negotiated Rate |
$1,136.68 |
| Rate for Payer: Aetna Commercial |
$1,111.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,062.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$654.83
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cigna Commercial |
$1,136.68
|
| Rate for Payer: Health EOS Commercial |
$1,099.61
|
| Rate for Payer: HFN Commercial |
$1,136.68
|
| Rate for Payer: Multiplan Commercial |
$988.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,136.68
|
| Rate for Payer: Quartz Beloit One Network |
$605.40
|
| Rate for Payer: Quartz Commercial |
$741.31
|
| Rate for Payer: WEA Trust Commercial |
$679.54
|
| Rate for Payer: WPS Commercial |
$915.12
|
|
|
BONE SCREW 35MM 6250-65-35
|
Facility
|
OP
|
$1,188.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967636
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$345.95 |
| Max. Negotiated Rate |
$1,136.68 |
| Rate for Payer: Aetna Commercial |
$1,111.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,062.55
|
| Rate for Payer: Aetna Managed Medicare |
$345.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$803.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$617.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$593.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$654.83
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cigna Commercial |
$1,136.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$691.42
|
| Rate for Payer: Health EOS Commercial |
$1,099.61
|
| Rate for Payer: HFN Commercial |
$1,136.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$926.64
|
| Rate for Payer: Multiplan Commercial |
$988.42
|
| Rate for Payer: NAPHCARE Commercial |
$741.31
|
| Rate for Payer: Preferred Network Access Commercial |
$1,136.68
|
| Rate for Payer: Quartz Beloit One Network |
$605.40
|
| Rate for Payer: Quartz Commercial |
$803.09
|
| Rate for Payer: Quartz Medicare Advantage |
$741.31
|
| Rate for Payer: The Alliance Commercial |
$617.76
|
| Rate for Payer: WEA Trust Commercial |
$679.54
|
| Rate for Payer: WPS Commercial |
$915.12
|
|
|
BONE SCREW 40MM 6250-65-40
|
Facility
|
OP
|
$1,188.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967637
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$345.95 |
| Max. Negotiated Rate |
$1,136.68 |
| Rate for Payer: Aetna Commercial |
$1,111.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,062.55
|
| Rate for Payer: Aetna Managed Medicare |
$345.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$803.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$617.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$593.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$654.83
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cigna Commercial |
$1,136.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$691.42
|
| Rate for Payer: Health EOS Commercial |
$1,099.61
|
| Rate for Payer: HFN Commercial |
$1,136.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$926.64
|
| Rate for Payer: Multiplan Commercial |
$988.42
|
| Rate for Payer: NAPHCARE Commercial |
$741.31
|
| Rate for Payer: Preferred Network Access Commercial |
$1,136.68
|
| Rate for Payer: Quartz Beloit One Network |
$605.40
|
| Rate for Payer: Quartz Commercial |
$803.09
|
| Rate for Payer: Quartz Medicare Advantage |
$741.31
|
| Rate for Payer: The Alliance Commercial |
$617.76
|
| Rate for Payer: WEA Trust Commercial |
$679.54
|
| Rate for Payer: WPS Commercial |
$915.12
|
|
|
BONE SCREW 40MM 6250-65-40
|
Facility
|
IP
|
$1,188.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967637
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$605.40 |
| Max. Negotiated Rate |
$1,136.68 |
| Rate for Payer: Aetna Commercial |
$1,111.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,062.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$654.83
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cigna Commercial |
$1,136.68
|
| Rate for Payer: Health EOS Commercial |
$1,099.61
|
| Rate for Payer: HFN Commercial |
$1,136.68
|
| Rate for Payer: Multiplan Commercial |
$988.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,136.68
|
| Rate for Payer: Quartz Beloit One Network |
$605.40
|
| Rate for Payer: Quartz Commercial |
$741.31
|
| Rate for Payer: WEA Trust Commercial |
$679.54
|
| Rate for Payer: WPS Commercial |
$915.12
|
|
|
BONE SCREW 50MM 6250-65-50
|
Facility
|
IP
|
$1,144.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967638
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$582.98 |
| Max. Negotiated Rate |
$1,094.58 |
| Rate for Payer: Aetna Commercial |
$1,070.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,023.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$630.57
|
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Cigna Commercial |
$1,094.58
|
| Rate for Payer: Health EOS Commercial |
$1,058.89
|
| Rate for Payer: HFN Commercial |
$1,094.58
|
| Rate for Payer: Multiplan Commercial |
$951.81
|
| Rate for Payer: Preferred Network Access Commercial |
$1,094.58
|
| Rate for Payer: Quartz Beloit One Network |
$582.98
|
| Rate for Payer: Quartz Commercial |
$713.86
|
| Rate for Payer: WEA Trust Commercial |
$654.37
|
| Rate for Payer: WPS Commercial |
$881.22
|
|
|
BONE SCREW 50MM 6250-65-50
|
Facility
|
OP
|
$1,144.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967638
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$333.13 |
| Max. Negotiated Rate |
$1,094.58 |
| Rate for Payer: Aetna Commercial |
$1,070.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,023.19
|
| Rate for Payer: Aetna Managed Medicare |
$333.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$773.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$594.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$571.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$630.57
|
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Cigna Commercial |
$1,094.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$665.81
|
| Rate for Payer: Health EOS Commercial |
$1,058.89
|
| Rate for Payer: HFN Commercial |
$1,094.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$892.32
|
| Rate for Payer: Multiplan Commercial |
$951.81
|
| Rate for Payer: NAPHCARE Commercial |
$713.86
|
| Rate for Payer: Preferred Network Access Commercial |
$1,094.58
|
| Rate for Payer: Quartz Beloit One Network |
$582.98
|
| Rate for Payer: Quartz Commercial |
$773.34
|
| Rate for Payer: Quartz Medicare Advantage |
$713.86
|
| Rate for Payer: The Alliance Commercial |
$594.88
|
| Rate for Payer: WEA Trust Commercial |
$654.37
|
| Rate for Payer: WPS Commercial |
$881.22
|
|
|
BONE SCREW 60MM 6250-65-60
|
Facility
|
OP
|
$1,144.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967639
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$333.13 |
| Max. Negotiated Rate |
$1,094.58 |
| Rate for Payer: Aetna Commercial |
$1,070.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,023.19
|
| Rate for Payer: Aetna Managed Medicare |
$333.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$773.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$594.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$571.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$630.57
|
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Cigna Commercial |
$1,094.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$665.81
|
| Rate for Payer: Health EOS Commercial |
$1,058.89
|
| Rate for Payer: HFN Commercial |
$1,094.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$892.32
|
| Rate for Payer: Multiplan Commercial |
$951.81
|
| Rate for Payer: NAPHCARE Commercial |
$713.86
|
| Rate for Payer: Preferred Network Access Commercial |
$1,094.58
|
| Rate for Payer: Quartz Beloit One Network |
$582.98
|
| Rate for Payer: Quartz Commercial |
$773.34
|
| Rate for Payer: Quartz Medicare Advantage |
$713.86
|
| Rate for Payer: The Alliance Commercial |
$594.88
|
| Rate for Payer: WEA Trust Commercial |
$654.37
|
| Rate for Payer: WPS Commercial |
$881.22
|
|
|
BONE SCREW 60MM 6250-65-60
|
Facility
|
IP
|
$1,144.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967639
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$582.98 |
| Max. Negotiated Rate |
$1,094.58 |
| Rate for Payer: Aetna Commercial |
$1,070.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,023.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$630.57
|
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Cigna Commercial |
$1,094.58
|
| Rate for Payer: Health EOS Commercial |
$1,058.89
|
| Rate for Payer: HFN Commercial |
$1,094.58
|
| Rate for Payer: Multiplan Commercial |
$951.81
|
| Rate for Payer: Preferred Network Access Commercial |
$1,094.58
|
| Rate for Payer: Quartz Beloit One Network |
$582.98
|
| Rate for Payer: Quartz Commercial |
$713.86
|
| Rate for Payer: WEA Trust Commercial |
$654.37
|
| Rate for Payer: WPS Commercial |
$881.22
|
|
|
BONE SCREW LOW PROFILE HEX 6.5 X 30MM 7030-6530
|
Facility
|
OP
|
$753.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5659659
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$219.27 |
| Max. Negotiated Rate |
$720.47 |
| Rate for Payer: Aetna Commercial |
$704.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$673.48
|
| Rate for Payer: Aetna Managed Medicare |
$219.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$509.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$391.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$375.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$415.05
|
| Rate for Payer: Cash Price |
$225.90
|
| Rate for Payer: Cigna Commercial |
$720.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$438.25
|
| Rate for Payer: Health EOS Commercial |
$696.98
|
| Rate for Payer: HFN Commercial |
$720.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$587.34
|
| Rate for Payer: Multiplan Commercial |
$626.50
|
| Rate for Payer: NAPHCARE Commercial |
$469.87
|
| Rate for Payer: Preferred Network Access Commercial |
$720.47
|
| Rate for Payer: Quartz Beloit One Network |
$383.73
|
| Rate for Payer: Quartz Commercial |
$509.03
|
| Rate for Payer: Quartz Medicare Advantage |
$469.87
|
| Rate for Payer: The Alliance Commercial |
$391.56
|
| Rate for Payer: WEA Trust Commercial |
$430.72
|
| Rate for Payer: WPS Commercial |
$580.04
|
|
|
BONE SCREW LOW PROFILE HEX 6.5 X 30MM 7030-6530
|
Facility
|
IP
|
$753.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5659659
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$383.73 |
| Max. Negotiated Rate |
$720.47 |
| Rate for Payer: Aetna Commercial |
$704.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$673.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$415.05
|
| Rate for Payer: Cash Price |
$225.90
|
| Rate for Payer: Cigna Commercial |
$720.47
|
| Rate for Payer: Health EOS Commercial |
$696.98
|
| Rate for Payer: HFN Commercial |
$720.47
|
| Rate for Payer: Multiplan Commercial |
$626.50
|
| Rate for Payer: Preferred Network Access Commercial |
$720.47
|
| Rate for Payer: Quartz Beloit One Network |
$383.73
|
| Rate for Payer: Quartz Commercial |
$469.87
|
| Rate for Payer: WEA Trust Commercial |
$430.72
|
| Rate for Payer: WPS Commercial |
$580.04
|
|
|
BONE SCREW TORX 6.5 X 20MM 2030-6520-1
|
Facility
|
IP
|
$952.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3297464
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$485.14 |
| Max. Negotiated Rate |
$910.87 |
| Rate for Payer: Aetna Commercial |
$891.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$851.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$524.74
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cigna Commercial |
$910.87
|
| Rate for Payer: Health EOS Commercial |
$881.17
|
| Rate for Payer: HFN Commercial |
$910.87
|
| Rate for Payer: Multiplan Commercial |
$792.06
|
| Rate for Payer: Preferred Network Access Commercial |
$910.87
|
| Rate for Payer: Quartz Beloit One Network |
$485.14
|
| Rate for Payer: Quartz Commercial |
$594.05
|
| Rate for Payer: WEA Trust Commercial |
$544.54
|
| Rate for Payer: WPS Commercial |
$733.33
|
|
|
BONE SCREW TORX 6.5 X 20MM 2030-6520-1
|
Facility
|
OP
|
$952.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3297464
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$277.22 |
| Max. Negotiated Rate |
$910.87 |
| Rate for Payer: Aetna Commercial |
$891.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$851.47
|
| Rate for Payer: Aetna Managed Medicare |
$277.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$643.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$495.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$475.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$524.74
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cigna Commercial |
$910.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$554.06
|
| Rate for Payer: Health EOS Commercial |
$881.17
|
| Rate for Payer: HFN Commercial |
$910.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$742.56
|
| Rate for Payer: Multiplan Commercial |
$792.06
|
| Rate for Payer: NAPHCARE Commercial |
$594.05
|
| Rate for Payer: Preferred Network Access Commercial |
$910.87
|
| Rate for Payer: Quartz Beloit One Network |
$485.14
|
| Rate for Payer: Quartz Commercial |
$643.55
|
| Rate for Payer: Quartz Medicare Advantage |
$594.05
|
| Rate for Payer: The Alliance Commercial |
$495.04
|
| Rate for Payer: WEA Trust Commercial |
$544.54
|
| Rate for Payer: WPS Commercial |
$733.33
|
|
|
BONE SCREW TORX 6.5 X 25MM 2030-6525-1
|
Facility
|
IP
|
$951.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3127480
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$484.63 |
| Max. Negotiated Rate |
$909.92 |
| Rate for Payer: Aetna Commercial |
$890.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$850.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$524.19
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Cigna Commercial |
$909.92
|
| Rate for Payer: Health EOS Commercial |
$880.25
|
| Rate for Payer: HFN Commercial |
$909.92
|
| Rate for Payer: Multiplan Commercial |
$791.23
|
| Rate for Payer: Preferred Network Access Commercial |
$909.92
|
| Rate for Payer: Quartz Beloit One Network |
$484.63
|
| Rate for Payer: Quartz Commercial |
$593.42
|
| Rate for Payer: WEA Trust Commercial |
$543.97
|
| Rate for Payer: WPS Commercial |
$732.56
|
|
|
BONE SCREW TORX 6.5 X 25MM 2030-6525-1
|
Facility
|
OP
|
$951.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3127480
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$276.93 |
| Max. Negotiated Rate |
$909.92 |
| Rate for Payer: Aetna Commercial |
$890.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$850.57
|
| Rate for Payer: Aetna Managed Medicare |
$276.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$642.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$494.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$474.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$524.19
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Cigna Commercial |
$909.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$553.48
|
| Rate for Payer: Health EOS Commercial |
$880.25
|
| Rate for Payer: HFN Commercial |
$909.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$741.78
|
| Rate for Payer: Multiplan Commercial |
$791.23
|
| Rate for Payer: NAPHCARE Commercial |
$593.42
|
| Rate for Payer: Preferred Network Access Commercial |
$909.92
|
| Rate for Payer: Quartz Beloit One Network |
$484.63
|
| Rate for Payer: Quartz Commercial |
$642.88
|
| Rate for Payer: Quartz Medicare Advantage |
$593.42
|
| Rate for Payer: The Alliance Commercial |
$494.52
|
| Rate for Payer: WEA Trust Commercial |
$543.97
|
| Rate for Payer: WPS Commercial |
$732.56
|
|
|
BONE SCREW TORX 6.5 X 30MM 2030-6530-1
|
Facility
|
IP
|
$951.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3297465
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$484.63 |
| Max. Negotiated Rate |
$909.92 |
| Rate for Payer: Aetna Commercial |
$890.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$850.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$524.19
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Cigna Commercial |
$909.92
|
| Rate for Payer: Health EOS Commercial |
$880.25
|
| Rate for Payer: HFN Commercial |
$909.92
|
| Rate for Payer: Multiplan Commercial |
$791.23
|
| Rate for Payer: Preferred Network Access Commercial |
$909.92
|
| Rate for Payer: Quartz Beloit One Network |
$484.63
|
| Rate for Payer: Quartz Commercial |
$593.42
|
| Rate for Payer: WEA Trust Commercial |
$543.97
|
| Rate for Payer: WPS Commercial |
$732.56
|
|
|
BONE SCREW TORX 6.5 X 30MM 2030-6530-1
|
Facility
|
OP
|
$951.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3297465
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$276.93 |
| Max. Negotiated Rate |
$909.92 |
| Rate for Payer: Aetna Commercial |
$890.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$850.57
|
| Rate for Payer: Aetna Managed Medicare |
$276.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$642.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$494.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$474.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$524.19
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Cigna Commercial |
$909.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$553.48
|
| Rate for Payer: Health EOS Commercial |
$880.25
|
| Rate for Payer: HFN Commercial |
$909.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$741.78
|
| Rate for Payer: Multiplan Commercial |
$791.23
|
| Rate for Payer: NAPHCARE Commercial |
$593.42
|
| Rate for Payer: Preferred Network Access Commercial |
$909.92
|
| Rate for Payer: Quartz Beloit One Network |
$484.63
|
| Rate for Payer: Quartz Commercial |
$642.88
|
| Rate for Payer: Quartz Medicare Advantage |
$593.42
|
| Rate for Payer: The Alliance Commercial |
$494.52
|
| Rate for Payer: WEA Trust Commercial |
$543.97
|
| Rate for Payer: WPS Commercial |
$732.56
|
|
