|
SCREW CORT 1.5 X 6MM 02.214.106
|
Facility
|
IP
|
$1,135.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508913
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$556.15 |
| Max. Negotiated Rate |
$1,044.20 |
| Rate for Payer: Aetna Commercial |
$1,021.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$976.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$601.55
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cigna Commercial |
$1,044.20
|
| Rate for Payer: Health EOS Commercial |
$1,010.15
|
| Rate for Payer: HFN Commercial |
$1,044.20
|
| Rate for Payer: Multiplan Commercial |
$908.00
|
| Rate for Payer: NAPHCARE Commercial |
$681.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,044.20
|
| Rate for Payer: Quartz Beloit One Network |
$556.15
|
| Rate for Payer: Quartz Commercial |
$681.00
|
| Rate for Payer: WEA Trust Commercial |
$624.25
|
| Rate for Payer: WPS Commercial |
$840.69
|
|
|
SCREW CORT 1.5 X 6 ST 200.806
|
Facility
|
OP
|
$388.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494535
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$108.64 |
| Max. Negotiated Rate |
$1,552.00 |
| Rate for Payer: Aetna Commercial |
$349.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$333.68
|
| Rate for Payer: Aetna Managed Medicare |
$108.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$252.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$194.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$186.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$205.64
|
| Rate for Payer: Cash Price |
$116.40
|
| Rate for Payer: Cigna Commercial |
$356.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$217.12
|
| Rate for Payer: Health EOS Commercial |
$345.32
|
| Rate for Payer: HFN Commercial |
$356.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$291.00
|
| Rate for Payer: Multiplan Commercial |
$310.40
|
| Rate for Payer: NAPHCARE Commercial |
$232.80
|
| Rate for Payer: Preferred Network Access Commercial |
$356.96
|
| Rate for Payer: Quartz Beloit One Network |
$190.12
|
| Rate for Payer: Quartz Commercial |
$252.20
|
| Rate for Payer: Quartz Medicare Advantage |
$232.80
|
| Rate for Payer: The Alliance Commercial |
$1,552.00
|
| Rate for Payer: WEA Trust Commercial |
$213.40
|
| Rate for Payer: WPS Commercial |
$287.39
|
|
|
SCREW CORT 1.5 X 6 ST 200.806
|
Facility
|
IP
|
$388.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494535
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$190.12 |
| Max. Negotiated Rate |
$356.96 |
| Rate for Payer: Aetna Commercial |
$349.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$333.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$205.64
|
| Rate for Payer: Cash Price |
$116.40
|
| Rate for Payer: Cigna Commercial |
$356.96
|
| Rate for Payer: Health EOS Commercial |
$345.32
|
| Rate for Payer: HFN Commercial |
$356.96
|
| Rate for Payer: Multiplan Commercial |
$310.40
|
| Rate for Payer: NAPHCARE Commercial |
$232.80
|
| Rate for Payer: Preferred Network Access Commercial |
$356.96
|
| Rate for Payer: Quartz Beloit One Network |
$190.12
|
| Rate for Payer: Quartz Commercial |
$232.80
|
| Rate for Payer: WEA Trust Commercial |
$213.40
|
| Rate for Payer: WPS Commercial |
$287.39
|
|
|
SCREW-CORT 1.5 X 7 200.007
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967251
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$37.24 |
| Max. Negotiated Rate |
$532.00 |
| Rate for Payer: Aetna Commercial |
$119.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$114.38
|
| Rate for Payer: Aetna Managed Medicare |
$37.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$86.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$66.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$63.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$70.49
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cigna Commercial |
$122.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$74.43
|
| Rate for Payer: Health EOS Commercial |
$118.37
|
| Rate for Payer: HFN Commercial |
$122.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$99.75
|
| Rate for Payer: Multiplan Commercial |
$106.40
|
| Rate for Payer: NAPHCARE Commercial |
$79.80
|
| Rate for Payer: Preferred Network Access Commercial |
$122.36
|
| Rate for Payer: Quartz Beloit One Network |
$65.17
|
| Rate for Payer: Quartz Commercial |
$86.45
|
| Rate for Payer: Quartz Medicare Advantage |
$79.80
|
| Rate for Payer: The Alliance Commercial |
$532.00
|
| Rate for Payer: WEA Trust Commercial |
$73.15
|
| Rate for Payer: WPS Commercial |
$98.51
|
|
|
SCREW-CORT 1.5 X 7 200.007
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967251
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$65.17 |
| Max. Negotiated Rate |
$122.36 |
| Rate for Payer: Aetna Commercial |
$119.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$114.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$70.49
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cigna Commercial |
$122.36
|
| Rate for Payer: Health EOS Commercial |
$118.37
|
| Rate for Payer: HFN Commercial |
$122.36
|
| Rate for Payer: Multiplan Commercial |
$106.40
|
| Rate for Payer: NAPHCARE Commercial |
$79.80
|
| Rate for Payer: Preferred Network Access Commercial |
$122.36
|
| Rate for Payer: Quartz Beloit One Network |
$65.17
|
| Rate for Payer: Quartz Commercial |
$79.80
|
| Rate for Payer: WEA Trust Commercial |
$73.15
|
| Rate for Payer: WPS Commercial |
$98.51
|
|
|
SCREW CORT 1.5 X 7MM 02.214.107
|
Facility
|
IP
|
$1,016.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966418
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$497.84 |
| Max. Negotiated Rate |
$934.72 |
| Rate for Payer: Aetna Commercial |
$914.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$873.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$538.48
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cigna Commercial |
$934.72
|
| Rate for Payer: Health EOS Commercial |
$904.24
|
| Rate for Payer: HFN Commercial |
$934.72
|
| Rate for Payer: Multiplan Commercial |
$812.80
|
| Rate for Payer: NAPHCARE Commercial |
$609.60
|
| Rate for Payer: Preferred Network Access Commercial |
$934.72
|
| Rate for Payer: Quartz Beloit One Network |
$497.84
|
| Rate for Payer: Quartz Commercial |
$609.60
|
| Rate for Payer: WEA Trust Commercial |
$558.80
|
| Rate for Payer: WPS Commercial |
$752.55
|
|
|
SCREW CORT 1.5 X 7MM 02.214.107
|
Facility
|
OP
|
$1,016.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966418
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$284.48 |
| Max. Negotiated Rate |
$4,064.00 |
| Rate for Payer: Aetna Commercial |
$914.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$873.76
|
| Rate for Payer: Aetna Managed Medicare |
$284.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$660.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$508.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$487.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$538.48
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cigna Commercial |
$934.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$568.55
|
| Rate for Payer: Health EOS Commercial |
$904.24
|
| Rate for Payer: HFN Commercial |
$934.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$762.00
|
| Rate for Payer: Multiplan Commercial |
$812.80
|
| Rate for Payer: NAPHCARE Commercial |
$609.60
|
| Rate for Payer: Preferred Network Access Commercial |
$934.72
|
| Rate for Payer: Quartz Beloit One Network |
$497.84
|
| Rate for Payer: Quartz Commercial |
$660.40
|
| Rate for Payer: Quartz Medicare Advantage |
$609.60
|
| Rate for Payer: The Alliance Commercial |
$4,064.00
|
| Rate for Payer: WEA Trust Commercial |
$558.80
|
| Rate for Payer: WPS Commercial |
$752.55
|
|
|
SCREW CORT 1.5 X 7 ST 200.807
|
Facility
|
OP
|
$388.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494536
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$108.64 |
| Max. Negotiated Rate |
$1,552.00 |
| Rate for Payer: Aetna Commercial |
$349.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$333.68
|
| Rate for Payer: Aetna Managed Medicare |
$108.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$252.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$194.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$186.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$205.64
|
| Rate for Payer: Cash Price |
$116.40
|
| Rate for Payer: Cigna Commercial |
$356.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$217.12
|
| Rate for Payer: Health EOS Commercial |
$345.32
|
| Rate for Payer: HFN Commercial |
$356.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$291.00
|
| Rate for Payer: Multiplan Commercial |
$310.40
|
| Rate for Payer: NAPHCARE Commercial |
$232.80
|
| Rate for Payer: Preferred Network Access Commercial |
$356.96
|
| Rate for Payer: Quartz Beloit One Network |
$190.12
|
| Rate for Payer: Quartz Commercial |
$252.20
|
| Rate for Payer: Quartz Medicare Advantage |
$232.80
|
| Rate for Payer: The Alliance Commercial |
$1,552.00
|
| Rate for Payer: WEA Trust Commercial |
$213.40
|
| Rate for Payer: WPS Commercial |
$287.39
|
|
|
SCREW CORT 1.5 X 7 ST 200.807
|
Facility
|
IP
|
$388.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494536
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$190.12 |
| Max. Negotiated Rate |
$356.96 |
| Rate for Payer: Aetna Commercial |
$349.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$333.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$205.64
|
| Rate for Payer: Cash Price |
$116.40
|
| Rate for Payer: Cigna Commercial |
$356.96
|
| Rate for Payer: Health EOS Commercial |
$345.32
|
| Rate for Payer: HFN Commercial |
$356.96
|
| Rate for Payer: Multiplan Commercial |
$310.40
|
| Rate for Payer: NAPHCARE Commercial |
$232.80
|
| Rate for Payer: Preferred Network Access Commercial |
$356.96
|
| Rate for Payer: Quartz Beloit One Network |
$190.12
|
| Rate for Payer: Quartz Commercial |
$232.80
|
| Rate for Payer: WEA Trust Commercial |
$213.40
|
| Rate for Payer: WPS Commercial |
$287.39
|
|
|
SCREW-CORT 1.5 X 8 200.008
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967252
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$65.17 |
| Max. Negotiated Rate |
$122.36 |
| Rate for Payer: Aetna Commercial |
$119.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$114.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$70.49
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cigna Commercial |
$122.36
|
| Rate for Payer: Health EOS Commercial |
$118.37
|
| Rate for Payer: HFN Commercial |
$122.36
|
| Rate for Payer: Multiplan Commercial |
$106.40
|
| Rate for Payer: NAPHCARE Commercial |
$79.80
|
| Rate for Payer: Preferred Network Access Commercial |
$122.36
|
| Rate for Payer: Quartz Beloit One Network |
$65.17
|
| Rate for Payer: Quartz Commercial |
$79.80
|
| Rate for Payer: WEA Trust Commercial |
$73.15
|
| Rate for Payer: WPS Commercial |
$98.51
|
|
|
SCREW-CORT 1.5 X 8 200.008
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967252
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$37.24 |
| Max. Negotiated Rate |
$532.00 |
| Rate for Payer: Aetna Commercial |
$119.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$114.38
|
| Rate for Payer: Aetna Managed Medicare |
$37.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$86.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$66.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$63.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$70.49
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cigna Commercial |
$122.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$74.43
|
| Rate for Payer: Health EOS Commercial |
$118.37
|
| Rate for Payer: HFN Commercial |
$122.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$99.75
|
| Rate for Payer: Multiplan Commercial |
$106.40
|
| Rate for Payer: NAPHCARE Commercial |
$79.80
|
| Rate for Payer: Preferred Network Access Commercial |
$122.36
|
| Rate for Payer: Quartz Beloit One Network |
$65.17
|
| Rate for Payer: Quartz Commercial |
$86.45
|
| Rate for Payer: Quartz Medicare Advantage |
$79.80
|
| Rate for Payer: The Alliance Commercial |
$532.00
|
| Rate for Payer: WEA Trust Commercial |
$73.15
|
| Rate for Payer: WPS Commercial |
$98.51
|
|
|
SCREW CORT 1.5 X 8MM 02.130.008
|
Facility
|
OP
|
$790.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5861727
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$221.20 |
| Max. Negotiated Rate |
$3,160.00 |
| Rate for Payer: Aetna Commercial |
$711.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$679.40
|
| Rate for Payer: Aetna Managed Medicare |
$221.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$513.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$395.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$379.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$418.70
|
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cigna Commercial |
$726.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$442.08
|
| Rate for Payer: Health EOS Commercial |
$703.10
|
| Rate for Payer: HFN Commercial |
$726.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$592.50
|
| Rate for Payer: Multiplan Commercial |
$632.00
|
| Rate for Payer: NAPHCARE Commercial |
$474.00
|
| Rate for Payer: Preferred Network Access Commercial |
$726.80
|
| Rate for Payer: Quartz Beloit One Network |
$387.10
|
| Rate for Payer: Quartz Commercial |
$513.50
|
| Rate for Payer: Quartz Medicare Advantage |
$474.00
|
| Rate for Payer: The Alliance Commercial |
$3,160.00
|
| Rate for Payer: WEA Trust Commercial |
$434.50
|
| Rate for Payer: WPS Commercial |
$585.15
|
|
|
SCREW CORT 1.5 X 8MM 02.130.008
|
Facility
|
IP
|
$790.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5861727
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$387.10 |
| Max. Negotiated Rate |
$726.80 |
| Rate for Payer: Aetna Commercial |
$711.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$679.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$418.70
|
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cigna Commercial |
$726.80
|
| Rate for Payer: Health EOS Commercial |
$703.10
|
| Rate for Payer: HFN Commercial |
$726.80
|
| Rate for Payer: Multiplan Commercial |
$632.00
|
| Rate for Payer: NAPHCARE Commercial |
$474.00
|
| Rate for Payer: Preferred Network Access Commercial |
$726.80
|
| Rate for Payer: Quartz Beloit One Network |
$387.10
|
| Rate for Payer: Quartz Commercial |
$474.00
|
| Rate for Payer: WEA Trust Commercial |
$434.50
|
| Rate for Payer: WPS Commercial |
$585.15
|
|
|
SCREW CORT 1.5 X 8MM 02.214.108
|
Facility
|
IP
|
$977.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966419
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$478.73 |
| Max. Negotiated Rate |
$898.84 |
| Rate for Payer: Aetna Commercial |
$879.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$840.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$517.81
|
| Rate for Payer: Cash Price |
$293.10
|
| Rate for Payer: Cigna Commercial |
$898.84
|
| Rate for Payer: Health EOS Commercial |
$869.53
|
| Rate for Payer: HFN Commercial |
$898.84
|
| Rate for Payer: Multiplan Commercial |
$781.60
|
| Rate for Payer: NAPHCARE Commercial |
$586.20
|
| Rate for Payer: Preferred Network Access Commercial |
$898.84
|
| Rate for Payer: Quartz Beloit One Network |
$478.73
|
| Rate for Payer: Quartz Commercial |
$586.20
|
| Rate for Payer: WEA Trust Commercial |
$537.35
|
| Rate for Payer: WPS Commercial |
$723.66
|
|
|
SCREW CORT 1.5 X 8MM 02.214.108
|
Facility
|
OP
|
$977.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966419
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$273.56 |
| Max. Negotiated Rate |
$3,908.00 |
| Rate for Payer: Aetna Commercial |
$879.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$840.22
|
| Rate for Payer: Aetna Managed Medicare |
$273.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$635.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$488.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$468.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$517.81
|
| Rate for Payer: Cash Price |
$293.10
|
| Rate for Payer: Cigna Commercial |
$898.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$546.73
|
| Rate for Payer: Health EOS Commercial |
$869.53
|
| Rate for Payer: HFN Commercial |
$898.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$732.75
|
| Rate for Payer: Multiplan Commercial |
$781.60
|
| Rate for Payer: NAPHCARE Commercial |
$586.20
|
| Rate for Payer: Preferred Network Access Commercial |
$898.84
|
| Rate for Payer: Quartz Beloit One Network |
$478.73
|
| Rate for Payer: Quartz Commercial |
$635.05
|
| Rate for Payer: Quartz Medicare Advantage |
$586.20
|
| Rate for Payer: The Alliance Commercial |
$3,908.00
|
| Rate for Payer: WEA Trust Commercial |
$537.35
|
| Rate for Payer: WPS Commercial |
$723.66
|
|
|
SCREW CORT 1.5 X 8 ST 200.808
|
Facility
|
IP
|
$388.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494538
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$190.12 |
| Max. Negotiated Rate |
$356.96 |
| Rate for Payer: Aetna Commercial |
$349.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$333.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$205.64
|
| Rate for Payer: Cash Price |
$116.40
|
| Rate for Payer: Cigna Commercial |
$356.96
|
| Rate for Payer: Health EOS Commercial |
$345.32
|
| Rate for Payer: HFN Commercial |
$356.96
|
| Rate for Payer: Multiplan Commercial |
$310.40
|
| Rate for Payer: NAPHCARE Commercial |
$232.80
|
| Rate for Payer: Preferred Network Access Commercial |
$356.96
|
| Rate for Payer: Quartz Beloit One Network |
$190.12
|
| Rate for Payer: Quartz Commercial |
$232.80
|
| Rate for Payer: WEA Trust Commercial |
$213.40
|
| Rate for Payer: WPS Commercial |
$287.39
|
|
|
SCREW CORT 1.5 X 8 ST 200.808
|
Facility
|
OP
|
$388.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494538
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$108.64 |
| Max. Negotiated Rate |
$1,552.00 |
| Rate for Payer: Aetna Commercial |
$349.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$333.68
|
| Rate for Payer: Aetna Managed Medicare |
$108.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$252.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$194.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$186.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$205.64
|
| Rate for Payer: Cash Price |
$116.40
|
| Rate for Payer: Cigna Commercial |
$356.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$217.12
|
| Rate for Payer: Health EOS Commercial |
$345.32
|
| Rate for Payer: HFN Commercial |
$356.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$291.00
|
| Rate for Payer: Multiplan Commercial |
$310.40
|
| Rate for Payer: NAPHCARE Commercial |
$232.80
|
| Rate for Payer: Preferred Network Access Commercial |
$356.96
|
| Rate for Payer: Quartz Beloit One Network |
$190.12
|
| Rate for Payer: Quartz Commercial |
$252.20
|
| Rate for Payer: Quartz Medicare Advantage |
$232.80
|
| Rate for Payer: The Alliance Commercial |
$1,552.00
|
| Rate for Payer: WEA Trust Commercial |
$213.40
|
| Rate for Payer: WPS Commercial |
$287.39
|
|
|
SCREW-CORT 1.5 X 9 200.009
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967253
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$65.17 |
| Max. Negotiated Rate |
$122.36 |
| Rate for Payer: Aetna Commercial |
$119.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$114.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$70.49
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cigna Commercial |
$122.36
|
| Rate for Payer: Health EOS Commercial |
$118.37
|
| Rate for Payer: HFN Commercial |
$122.36
|
| Rate for Payer: Multiplan Commercial |
$106.40
|
| Rate for Payer: NAPHCARE Commercial |
$79.80
|
| Rate for Payer: Preferred Network Access Commercial |
$122.36
|
| Rate for Payer: Quartz Beloit One Network |
$65.17
|
| Rate for Payer: Quartz Commercial |
$79.80
|
| Rate for Payer: WEA Trust Commercial |
$73.15
|
| Rate for Payer: WPS Commercial |
$98.51
|
|
|
SCREW-CORT 1.5 X 9 200.009
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967253
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$37.24 |
| Max. Negotiated Rate |
$532.00 |
| Rate for Payer: Aetna Commercial |
$119.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$114.38
|
| Rate for Payer: Aetna Managed Medicare |
$37.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$86.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$66.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$63.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$70.49
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cigna Commercial |
$122.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$74.43
|
| Rate for Payer: Health EOS Commercial |
$118.37
|
| Rate for Payer: HFN Commercial |
$122.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$99.75
|
| Rate for Payer: Multiplan Commercial |
$106.40
|
| Rate for Payer: NAPHCARE Commercial |
$79.80
|
| Rate for Payer: Preferred Network Access Commercial |
$122.36
|
| Rate for Payer: Quartz Beloit One Network |
$65.17
|
| Rate for Payer: Quartz Commercial |
$86.45
|
| Rate for Payer: Quartz Medicare Advantage |
$79.80
|
| Rate for Payer: The Alliance Commercial |
$532.00
|
| Rate for Payer: WEA Trust Commercial |
$73.15
|
| Rate for Payer: WPS Commercial |
$98.51
|
|
|
SCREW CORT 1.5 X 9MM 02.214.109
|
Facility
|
IP
|
$977.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966423
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$478.73 |
| Max. Negotiated Rate |
$898.84 |
| Rate for Payer: Aetna Commercial |
$879.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$840.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$517.81
|
| Rate for Payer: Cash Price |
$293.10
|
| Rate for Payer: Cigna Commercial |
$898.84
|
| Rate for Payer: Health EOS Commercial |
$869.53
|
| Rate for Payer: HFN Commercial |
$898.84
|
| Rate for Payer: Multiplan Commercial |
$781.60
|
| Rate for Payer: NAPHCARE Commercial |
$586.20
|
| Rate for Payer: Preferred Network Access Commercial |
$898.84
|
| Rate for Payer: Quartz Beloit One Network |
$478.73
|
| Rate for Payer: Quartz Commercial |
$586.20
|
| Rate for Payer: WEA Trust Commercial |
$537.35
|
| Rate for Payer: WPS Commercial |
$723.66
|
|
|
SCREW CORT 1.5 X 9MM 02.214.109
|
Facility
|
OP
|
$977.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966423
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$273.56 |
| Max. Negotiated Rate |
$3,908.00 |
| Rate for Payer: Aetna Commercial |
$879.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$840.22
|
| Rate for Payer: Aetna Managed Medicare |
$273.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$635.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$488.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$468.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$517.81
|
| Rate for Payer: Cash Price |
$293.10
|
| Rate for Payer: Cigna Commercial |
$898.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$546.73
|
| Rate for Payer: Health EOS Commercial |
$869.53
|
| Rate for Payer: HFN Commercial |
$898.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$732.75
|
| Rate for Payer: Multiplan Commercial |
$781.60
|
| Rate for Payer: NAPHCARE Commercial |
$586.20
|
| Rate for Payer: Preferred Network Access Commercial |
$898.84
|
| Rate for Payer: Quartz Beloit One Network |
$478.73
|
| Rate for Payer: Quartz Commercial |
$635.05
|
| Rate for Payer: Quartz Medicare Advantage |
$586.20
|
| Rate for Payer: The Alliance Commercial |
$3,908.00
|
| Rate for Payer: WEA Trust Commercial |
$537.35
|
| Rate for Payer: WPS Commercial |
$723.66
|
|
|
SCREW CORT1.5 X 9MM 400.809.96
|
Facility
|
OP
|
$1,032.00
|
|
| Hospital Charge Code |
2966422
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$288.96 |
| Max. Negotiated Rate |
$4,128.00 |
| Rate for Payer: Aetna Commercial |
$928.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$887.52
|
| Rate for Payer: Aetna Managed Medicare |
$288.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$670.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$516.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$495.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$546.96
|
| Rate for Payer: Cash Price |
$309.60
|
| Rate for Payer: Cigna Commercial |
$949.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$577.51
|
| Rate for Payer: Health EOS Commercial |
$918.48
|
| Rate for Payer: HFN Commercial |
$949.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$774.00
|
| Rate for Payer: Multiplan Commercial |
$825.60
|
| Rate for Payer: NAPHCARE Commercial |
$619.20
|
| Rate for Payer: Preferred Network Access Commercial |
$949.44
|
| Rate for Payer: Quartz Beloit One Network |
$505.68
|
| Rate for Payer: Quartz Commercial |
$670.80
|
| Rate for Payer: Quartz Medicare Advantage |
$619.20
|
| Rate for Payer: The Alliance Commercial |
$4,128.00
|
| Rate for Payer: WEA Trust Commercial |
$567.60
|
| Rate for Payer: WPS Commercial |
$764.40
|
|
|
SCREW CORT1.5 X 9MM 400.809.96
|
Facility
|
IP
|
$1,032.00
|
|
| Hospital Charge Code |
2966422
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$505.68 |
| Max. Negotiated Rate |
$949.44 |
| Rate for Payer: Aetna Commercial |
$928.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$887.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$546.96
|
| Rate for Payer: Cash Price |
$309.60
|
| Rate for Payer: Cigna Commercial |
$949.44
|
| Rate for Payer: Health EOS Commercial |
$918.48
|
| Rate for Payer: HFN Commercial |
$949.44
|
| Rate for Payer: Multiplan Commercial |
$825.60
|
| Rate for Payer: NAPHCARE Commercial |
$619.20
|
| Rate for Payer: Preferred Network Access Commercial |
$949.44
|
| Rate for Payer: Quartz Beloit One Network |
$505.68
|
| Rate for Payer: Quartz Commercial |
$619.20
|
| Rate for Payer: WEA Trust Commercial |
$567.60
|
| Rate for Payer: WPS Commercial |
$764.40
|
|
|
SCREW CORT 1.5 X 9 ST 200.809
|
Facility
|
OP
|
$610.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494539
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$170.80 |
| Max. Negotiated Rate |
$2,440.00 |
| Rate for Payer: Aetna Commercial |
$549.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$524.60
|
| Rate for Payer: Aetna Managed Medicare |
$170.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$396.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$305.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$292.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$323.30
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$561.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$341.36
|
| Rate for Payer: Health EOS Commercial |
$542.90
|
| Rate for Payer: HFN Commercial |
$561.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$457.50
|
| Rate for Payer: Multiplan Commercial |
$488.00
|
| Rate for Payer: NAPHCARE Commercial |
$366.00
|
| Rate for Payer: Preferred Network Access Commercial |
$561.20
|
| Rate for Payer: Quartz Beloit One Network |
$298.90
|
| Rate for Payer: Quartz Commercial |
$396.50
|
| Rate for Payer: Quartz Medicare Advantage |
$366.00
|
| Rate for Payer: The Alliance Commercial |
$2,440.00
|
| Rate for Payer: WEA Trust Commercial |
$335.50
|
| Rate for Payer: WPS Commercial |
$451.83
|
|
|
SCREW CORT 1.5 X 9 ST 200.809
|
Facility
|
IP
|
$610.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494539
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$298.90 |
| Max. Negotiated Rate |
$561.20 |
| Rate for Payer: Aetna Commercial |
$549.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$524.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$323.30
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$561.20
|
| Rate for Payer: Health EOS Commercial |
$542.90
|
| Rate for Payer: HFN Commercial |
$561.20
|
| Rate for Payer: Multiplan Commercial |
$488.00
|
| Rate for Payer: NAPHCARE Commercial |
$366.00
|
| Rate for Payer: Preferred Network Access Commercial |
$561.20
|
| Rate for Payer: Quartz Beloit One Network |
$298.90
|
| Rate for Payer: Quartz Commercial |
$366.00
|
| Rate for Payer: WEA Trust Commercial |
$335.50
|
| Rate for Payer: WPS Commercial |
$451.83
|
|
