|
SCREW CORT 2.7 X 32 LO-PRO AR-8827-32
|
Facility
|
IP
|
$753.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6244120
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$368.99 |
| Max. Negotiated Rate |
$692.81 |
| Rate for Payer: Aetna Commercial |
$677.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$647.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$399.12
|
| Rate for Payer: Cash Price |
$225.92
|
| Rate for Payer: Cigna Commercial |
$692.81
|
| Rate for Payer: Health EOS Commercial |
$670.21
|
| Rate for Payer: HFN Commercial |
$692.81
|
| Rate for Payer: Multiplan Commercial |
$602.44
|
| Rate for Payer: NAPHCARE Commercial |
$451.83
|
| Rate for Payer: Preferred Network Access Commercial |
$692.81
|
| Rate for Payer: Quartz Beloit One Network |
$368.99
|
| Rate for Payer: Quartz Commercial |
$451.83
|
| Rate for Payer: WEA Trust Commercial |
$414.18
|
| Rate for Payer: WPS Commercial |
$557.78
|
|
|
SCREW CORT 2.7 X 32 STARDRIVE 202.892
|
Facility
|
IP
|
$579.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4493841
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$283.71 |
| Max. Negotiated Rate |
$532.68 |
| Rate for Payer: Aetna Commercial |
$521.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$497.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$306.87
|
| Rate for Payer: Cash Price |
$173.70
|
| Rate for Payer: Cigna Commercial |
$532.68
|
| Rate for Payer: Health EOS Commercial |
$515.31
|
| Rate for Payer: HFN Commercial |
$532.68
|
| Rate for Payer: Multiplan Commercial |
$463.20
|
| Rate for Payer: NAPHCARE Commercial |
$347.40
|
| Rate for Payer: Preferred Network Access Commercial |
$532.68
|
| Rate for Payer: Quartz Beloit One Network |
$283.71
|
| Rate for Payer: Quartz Commercial |
$347.40
|
| Rate for Payer: WEA Trust Commercial |
$318.45
|
| Rate for Payer: WPS Commercial |
$428.87
|
|
|
SCREW CORT 2.7 X 32 STARDRIVE 202.892
|
Facility
|
OP
|
$579.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4493841
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$162.12 |
| Max. Negotiated Rate |
$2,316.00 |
| Rate for Payer: Aetna Commercial |
$521.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$497.94
|
| Rate for Payer: Aetna Managed Medicare |
$162.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$376.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$289.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$277.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$306.87
|
| Rate for Payer: Cash Price |
$173.70
|
| Rate for Payer: Cigna Commercial |
$532.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$324.01
|
| Rate for Payer: Health EOS Commercial |
$515.31
|
| Rate for Payer: HFN Commercial |
$532.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$434.25
|
| Rate for Payer: Multiplan Commercial |
$463.20
|
| Rate for Payer: NAPHCARE Commercial |
$347.40
|
| Rate for Payer: Preferred Network Access Commercial |
$532.68
|
| Rate for Payer: Quartz Beloit One Network |
$283.71
|
| Rate for Payer: Quartz Commercial |
$376.35
|
| Rate for Payer: Quartz Medicare Advantage |
$347.40
|
| Rate for Payer: The Alliance Commercial |
$2,316.00
|
| Rate for Payer: WEA Trust Commercial |
$318.45
|
| Rate for Payer: WPS Commercial |
$428.87
|
|
|
SCREW-CORT 2.7 X 34 202.834
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966855
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$34.44 |
| Max. Negotiated Rate |
$492.00 |
| Rate for Payer: Aetna Commercial |
$110.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$105.78
|
| Rate for Payer: Aetna Managed Medicare |
$34.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$79.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$61.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$59.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.19
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna Commercial |
$113.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$68.83
|
| Rate for Payer: Health EOS Commercial |
$109.47
|
| Rate for Payer: HFN Commercial |
$113.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$92.25
|
| Rate for Payer: Multiplan Commercial |
$98.40
|
| Rate for Payer: NAPHCARE Commercial |
$73.80
|
| Rate for Payer: Preferred Network Access Commercial |
$113.16
|
| Rate for Payer: Quartz Beloit One Network |
$60.27
|
| Rate for Payer: Quartz Commercial |
$79.95
|
| Rate for Payer: Quartz Medicare Advantage |
$73.80
|
| Rate for Payer: The Alliance Commercial |
$492.00
|
| Rate for Payer: WEA Trust Commercial |
$67.65
|
| Rate for Payer: WPS Commercial |
$91.11
|
|
|
SCREW-CORT 2.7 X 34 202.834
|
Facility
|
IP
|
$123.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966855
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.27 |
| Max. Negotiated Rate |
$113.16 |
| Rate for Payer: Aetna Commercial |
$110.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$105.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.19
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna Commercial |
$113.16
|
| Rate for Payer: Health EOS Commercial |
$109.47
|
| Rate for Payer: HFN Commercial |
$113.16
|
| Rate for Payer: Multiplan Commercial |
$98.40
|
| Rate for Payer: NAPHCARE Commercial |
$73.80
|
| Rate for Payer: Preferred Network Access Commercial |
$113.16
|
| Rate for Payer: Quartz Beloit One Network |
$60.27
|
| Rate for Payer: Quartz Commercial |
$73.80
|
| Rate for Payer: WEA Trust Commercial |
$67.65
|
| Rate for Payer: WPS Commercial |
$91.11
|
|
|
SCREW-CORT 2.7 X 36 202.836
|
Facility
|
IP
|
$118.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966856
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$57.82 |
| Max. Negotiated Rate |
$108.56 |
| Rate for Payer: Aetna Commercial |
$106.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.54
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$108.56
|
| Rate for Payer: Health EOS Commercial |
$105.02
|
| Rate for Payer: HFN Commercial |
$108.56
|
| Rate for Payer: Multiplan Commercial |
$94.40
|
| Rate for Payer: NAPHCARE Commercial |
$70.80
|
| Rate for Payer: Preferred Network Access Commercial |
$108.56
|
| Rate for Payer: Quartz Beloit One Network |
$57.82
|
| Rate for Payer: Quartz Commercial |
$70.80
|
| Rate for Payer: WEA Trust Commercial |
$64.90
|
| Rate for Payer: WPS Commercial |
$87.40
|
|
|
SCREW-CORT 2.7 X 36 202.836
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966856
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$33.04 |
| Max. Negotiated Rate |
$472.00 |
| Rate for Payer: Aetna Commercial |
$106.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.48
|
| Rate for Payer: Aetna Managed Medicare |
$33.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$76.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$59.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$56.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.54
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$108.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66.03
|
| Rate for Payer: Health EOS Commercial |
$105.02
|
| Rate for Payer: HFN Commercial |
$108.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$88.50
|
| Rate for Payer: Multiplan Commercial |
$94.40
|
| Rate for Payer: NAPHCARE Commercial |
$70.80
|
| Rate for Payer: Preferred Network Access Commercial |
$108.56
|
| Rate for Payer: Quartz Beloit One Network |
$57.82
|
| Rate for Payer: Quartz Commercial |
$76.70
|
| Rate for Payer: Quartz Medicare Advantage |
$70.80
|
| Rate for Payer: The Alliance Commercial |
$472.00
|
| Rate for Payer: WEA Trust Commercial |
$64.90
|
| Rate for Payer: WPS Commercial |
$87.40
|
|
|
SCREW-CORT 2.7 X 38 202.838
|
Facility
|
IP
|
$118.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966857
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$57.82 |
| Max. Negotiated Rate |
$108.56 |
| Rate for Payer: Aetna Commercial |
$106.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.54
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$108.56
|
| Rate for Payer: Health EOS Commercial |
$105.02
|
| Rate for Payer: HFN Commercial |
$108.56
|
| Rate for Payer: Multiplan Commercial |
$94.40
|
| Rate for Payer: NAPHCARE Commercial |
$70.80
|
| Rate for Payer: Preferred Network Access Commercial |
$108.56
|
| Rate for Payer: Quartz Beloit One Network |
$57.82
|
| Rate for Payer: Quartz Commercial |
$70.80
|
| Rate for Payer: WEA Trust Commercial |
$64.90
|
| Rate for Payer: WPS Commercial |
$87.40
|
|
|
SCREW-CORT 2.7 X 38 202.838
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966857
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$33.04 |
| Max. Negotiated Rate |
$472.00 |
| Rate for Payer: Aetna Commercial |
$106.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.48
|
| Rate for Payer: Aetna Managed Medicare |
$33.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$76.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$59.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$56.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.54
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$108.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66.03
|
| Rate for Payer: Health EOS Commercial |
$105.02
|
| Rate for Payer: HFN Commercial |
$108.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$88.50
|
| Rate for Payer: Multiplan Commercial |
$94.40
|
| Rate for Payer: NAPHCARE Commercial |
$70.80
|
| Rate for Payer: Preferred Network Access Commercial |
$108.56
|
| Rate for Payer: Quartz Beloit One Network |
$57.82
|
| Rate for Payer: Quartz Commercial |
$76.70
|
| Rate for Payer: Quartz Medicare Advantage |
$70.80
|
| Rate for Payer: The Alliance Commercial |
$472.00
|
| Rate for Payer: WEA Trust Commercial |
$64.90
|
| Rate for Payer: WPS Commercial |
$87.40
|
|
|
SCREW-CORT 2.7 X 40 202.840
|
Facility
|
IP
|
$118.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966858
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$57.82 |
| Max. Negotiated Rate |
$108.56 |
| Rate for Payer: Aetna Commercial |
$106.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.54
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$108.56
|
| Rate for Payer: Health EOS Commercial |
$105.02
|
| Rate for Payer: HFN Commercial |
$108.56
|
| Rate for Payer: Multiplan Commercial |
$94.40
|
| Rate for Payer: NAPHCARE Commercial |
$70.80
|
| Rate for Payer: Preferred Network Access Commercial |
$108.56
|
| Rate for Payer: Quartz Beloit One Network |
$57.82
|
| Rate for Payer: Quartz Commercial |
$70.80
|
| Rate for Payer: WEA Trust Commercial |
$64.90
|
| Rate for Payer: WPS Commercial |
$87.40
|
|
|
SCREW-CORT 2.7 X 40 202.840
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966858
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$33.04 |
| Max. Negotiated Rate |
$472.00 |
| Rate for Payer: Aetna Commercial |
$106.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.48
|
| Rate for Payer: Aetna Managed Medicare |
$33.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$76.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$59.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$56.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.54
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$108.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66.03
|
| Rate for Payer: Health EOS Commercial |
$105.02
|
| Rate for Payer: HFN Commercial |
$108.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$88.50
|
| Rate for Payer: Multiplan Commercial |
$94.40
|
| Rate for Payer: NAPHCARE Commercial |
$70.80
|
| Rate for Payer: Preferred Network Access Commercial |
$108.56
|
| Rate for Payer: Quartz Beloit One Network |
$57.82
|
| Rate for Payer: Quartz Commercial |
$76.70
|
| Rate for Payer: Quartz Medicare Advantage |
$70.80
|
| Rate for Payer: The Alliance Commercial |
$472.00
|
| Rate for Payer: WEA Trust Commercial |
$64.90
|
| Rate for Payer: WPS Commercial |
$87.40
|
|
|
SCREW CORT 2.7 X 42MM STARDRIVE 202.962
|
Facility
|
IP
|
$579.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4452948
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$283.71 |
| Max. Negotiated Rate |
$532.68 |
| Rate for Payer: Aetna Commercial |
$521.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$497.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$306.87
|
| Rate for Payer: Cash Price |
$173.70
|
| Rate for Payer: Cigna Commercial |
$532.68
|
| Rate for Payer: Health EOS Commercial |
$515.31
|
| Rate for Payer: HFN Commercial |
$532.68
|
| Rate for Payer: Multiplan Commercial |
$463.20
|
| Rate for Payer: NAPHCARE Commercial |
$347.40
|
| Rate for Payer: Preferred Network Access Commercial |
$532.68
|
| Rate for Payer: Quartz Beloit One Network |
$283.71
|
| Rate for Payer: Quartz Commercial |
$347.40
|
| Rate for Payer: WEA Trust Commercial |
$318.45
|
| Rate for Payer: WPS Commercial |
$428.87
|
|
|
SCREW CORT 2.7 X 42MM STARDRIVE 202.962
|
Facility
|
OP
|
$579.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4452948
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$162.12 |
| Max. Negotiated Rate |
$2,316.00 |
| Rate for Payer: Aetna Commercial |
$521.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$497.94
|
| Rate for Payer: Aetna Managed Medicare |
$162.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$376.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$289.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$277.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$306.87
|
| Rate for Payer: Cash Price |
$173.70
|
| Rate for Payer: Cigna Commercial |
$532.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$324.01
|
| Rate for Payer: Health EOS Commercial |
$515.31
|
| Rate for Payer: HFN Commercial |
$532.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$434.25
|
| Rate for Payer: Multiplan Commercial |
$463.20
|
| Rate for Payer: NAPHCARE Commercial |
$347.40
|
| Rate for Payer: Preferred Network Access Commercial |
$532.68
|
| Rate for Payer: Quartz Beloit One Network |
$283.71
|
| Rate for Payer: Quartz Commercial |
$376.35
|
| Rate for Payer: Quartz Medicare Advantage |
$347.40
|
| Rate for Payer: The Alliance Commercial |
$2,316.00
|
| Rate for Payer: WEA Trust Commercial |
$318.45
|
| Rate for Payer: WPS Commercial |
$428.87
|
|
|
SCREW-CORT 2.7 X 45 202.845
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966859
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$33.04 |
| Max. Negotiated Rate |
$472.00 |
| Rate for Payer: Aetna Commercial |
$106.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.48
|
| Rate for Payer: Aetna Managed Medicare |
$33.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$76.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$59.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$56.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.54
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$108.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66.03
|
| Rate for Payer: Health EOS Commercial |
$105.02
|
| Rate for Payer: HFN Commercial |
$108.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$88.50
|
| Rate for Payer: Multiplan Commercial |
$94.40
|
| Rate for Payer: NAPHCARE Commercial |
$70.80
|
| Rate for Payer: Preferred Network Access Commercial |
$108.56
|
| Rate for Payer: Quartz Beloit One Network |
$57.82
|
| Rate for Payer: Quartz Commercial |
$76.70
|
| Rate for Payer: Quartz Medicare Advantage |
$70.80
|
| Rate for Payer: The Alliance Commercial |
$472.00
|
| Rate for Payer: WEA Trust Commercial |
$64.90
|
| Rate for Payer: WPS Commercial |
$87.40
|
|
|
SCREW-CORT 2.7 X 45 202.845
|
Facility
|
IP
|
$118.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966859
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$57.82 |
| Max. Negotiated Rate |
$108.56 |
| Rate for Payer: Aetna Commercial |
$106.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.54
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$108.56
|
| Rate for Payer: Health EOS Commercial |
$105.02
|
| Rate for Payer: HFN Commercial |
$108.56
|
| Rate for Payer: Multiplan Commercial |
$94.40
|
| Rate for Payer: NAPHCARE Commercial |
$70.80
|
| Rate for Payer: Preferred Network Access Commercial |
$108.56
|
| Rate for Payer: Quartz Beloit One Network |
$57.82
|
| Rate for Payer: Quartz Commercial |
$70.80
|
| Rate for Payer: WEA Trust Commercial |
$64.90
|
| Rate for Payer: WPS Commercial |
$87.40
|
|
|
SCREW-CORT 2.7 X 50 202.850
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966860
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$34.44 |
| Max. Negotiated Rate |
$492.00 |
| Rate for Payer: Aetna Commercial |
$110.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$105.78
|
| Rate for Payer: Aetna Managed Medicare |
$34.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$79.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$61.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$59.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.19
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna Commercial |
$113.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$68.83
|
| Rate for Payer: Health EOS Commercial |
$109.47
|
| Rate for Payer: HFN Commercial |
$113.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$92.25
|
| Rate for Payer: Multiplan Commercial |
$98.40
|
| Rate for Payer: NAPHCARE Commercial |
$73.80
|
| Rate for Payer: Preferred Network Access Commercial |
$113.16
|
| Rate for Payer: Quartz Beloit One Network |
$60.27
|
| Rate for Payer: Quartz Commercial |
$79.95
|
| Rate for Payer: Quartz Medicare Advantage |
$73.80
|
| Rate for Payer: The Alliance Commercial |
$492.00
|
| Rate for Payer: WEA Trust Commercial |
$67.65
|
| Rate for Payer: WPS Commercial |
$91.11
|
|
|
SCREW-CORT 2.7 X 50 202.850
|
Facility
|
IP
|
$123.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966860
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.27 |
| Max. Negotiated Rate |
$113.16 |
| Rate for Payer: Aetna Commercial |
$110.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$105.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.19
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna Commercial |
$113.16
|
| Rate for Payer: Health EOS Commercial |
$109.47
|
| Rate for Payer: HFN Commercial |
$113.16
|
| Rate for Payer: Multiplan Commercial |
$98.40
|
| Rate for Payer: NAPHCARE Commercial |
$73.80
|
| Rate for Payer: Preferred Network Access Commercial |
$113.16
|
| Rate for Payer: Quartz Beloit One Network |
$60.27
|
| Rate for Payer: Quartz Commercial |
$73.80
|
| Rate for Payer: WEA Trust Commercial |
$67.65
|
| Rate for Payer: WPS Commercial |
$91.11
|
|
|
SCREW CORT 2.7 X 50MM STARDRIVE 202.967
|
Facility
|
OP
|
$579.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4452949
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$162.12 |
| Max. Negotiated Rate |
$2,316.00 |
| Rate for Payer: Aetna Commercial |
$521.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$497.94
|
| Rate for Payer: Aetna Managed Medicare |
$162.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$376.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$289.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$277.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$306.87
|
| Rate for Payer: Cash Price |
$173.70
|
| Rate for Payer: Cigna Commercial |
$532.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$324.01
|
| Rate for Payer: Health EOS Commercial |
$515.31
|
| Rate for Payer: HFN Commercial |
$532.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$434.25
|
| Rate for Payer: Multiplan Commercial |
$463.20
|
| Rate for Payer: NAPHCARE Commercial |
$347.40
|
| Rate for Payer: Preferred Network Access Commercial |
$532.68
|
| Rate for Payer: Quartz Beloit One Network |
$283.71
|
| Rate for Payer: Quartz Commercial |
$376.35
|
| Rate for Payer: Quartz Medicare Advantage |
$347.40
|
| Rate for Payer: The Alliance Commercial |
$2,316.00
|
| Rate for Payer: WEA Trust Commercial |
$318.45
|
| Rate for Payer: WPS Commercial |
$428.87
|
|
|
SCREW CORT 2.7 X 50MM STARDRIVE 202.967
|
Facility
|
IP
|
$579.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4452949
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$283.71 |
| Max. Negotiated Rate |
$532.68 |
| Rate for Payer: Aetna Commercial |
$521.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$497.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$306.87
|
| Rate for Payer: Cash Price |
$173.70
|
| Rate for Payer: Cigna Commercial |
$532.68
|
| Rate for Payer: Health EOS Commercial |
$515.31
|
| Rate for Payer: HFN Commercial |
$532.68
|
| Rate for Payer: Multiplan Commercial |
$463.20
|
| Rate for Payer: NAPHCARE Commercial |
$347.40
|
| Rate for Payer: Preferred Network Access Commercial |
$532.68
|
| Rate for Payer: Quartz Beloit One Network |
$283.71
|
| Rate for Payer: Quartz Commercial |
$347.40
|
| Rate for Payer: WEA Trust Commercial |
$318.45
|
| Rate for Payer: WPS Commercial |
$428.87
|
|
|
SCREW-CORT 2.7 X 55 202.855
|
Facility
|
IP
|
$784.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3116529
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$384.16 |
| Max. Negotiated Rate |
$721.28 |
| Rate for Payer: Aetna Commercial |
$705.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$674.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$415.52
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Cigna Commercial |
$721.28
|
| Rate for Payer: Health EOS Commercial |
$697.76
|
| Rate for Payer: HFN Commercial |
$721.28
|
| Rate for Payer: Multiplan Commercial |
$627.20
|
| Rate for Payer: NAPHCARE Commercial |
$470.40
|
| Rate for Payer: Preferred Network Access Commercial |
$721.28
|
| Rate for Payer: Quartz Beloit One Network |
$384.16
|
| Rate for Payer: Quartz Commercial |
$470.40
|
| Rate for Payer: WEA Trust Commercial |
$431.20
|
| Rate for Payer: WPS Commercial |
$580.71
|
|
|
SCREW-CORT 2.7 X 55 202.855
|
Facility
|
OP
|
$784.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3116529
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$219.52 |
| Max. Negotiated Rate |
$3,136.00 |
| Rate for Payer: Aetna Commercial |
$705.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$674.24
|
| Rate for Payer: Aetna Managed Medicare |
$219.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$509.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$392.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$376.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$415.52
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Cigna Commercial |
$721.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$438.73
|
| Rate for Payer: Health EOS Commercial |
$697.76
|
| Rate for Payer: HFN Commercial |
$721.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$588.00
|
| Rate for Payer: Multiplan Commercial |
$627.20
|
| Rate for Payer: NAPHCARE Commercial |
$470.40
|
| Rate for Payer: Preferred Network Access Commercial |
$721.28
|
| Rate for Payer: Quartz Beloit One Network |
$384.16
|
| Rate for Payer: Quartz Commercial |
$509.60
|
| Rate for Payer: Quartz Medicare Advantage |
$470.40
|
| Rate for Payer: The Alliance Commercial |
$3,136.00
|
| Rate for Payer: WEA Trust Commercial |
$431.20
|
| Rate for Payer: WPS Commercial |
$580.71
|
|
|
SCREW CORT 2.7 X 60 LO-PRO AR-8827-60
|
Facility
|
OP
|
$783.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6217140
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$219.24 |
| Max. Negotiated Rate |
$3,132.00 |
| Rate for Payer: Aetna Commercial |
$704.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$673.38
|
| Rate for Payer: Aetna Managed Medicare |
$219.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$508.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$391.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$375.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$414.99
|
| Rate for Payer: Cash Price |
$234.90
|
| Rate for Payer: Cigna Commercial |
$720.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$438.17
|
| Rate for Payer: Health EOS Commercial |
$696.87
|
| Rate for Payer: HFN Commercial |
$720.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$587.25
|
| Rate for Payer: Multiplan Commercial |
$626.40
|
| Rate for Payer: NAPHCARE Commercial |
$469.80
|
| Rate for Payer: Preferred Network Access Commercial |
$720.36
|
| Rate for Payer: Quartz Beloit One Network |
$383.67
|
| Rate for Payer: Quartz Commercial |
$508.95
|
| Rate for Payer: Quartz Medicare Advantage |
$469.80
|
| Rate for Payer: The Alliance Commercial |
$3,132.00
|
| Rate for Payer: WEA Trust Commercial |
$430.65
|
| Rate for Payer: WPS Commercial |
$579.97
|
|
|
SCREW CORT 2.7 X 60 LO-PRO AR-8827-60
|
Facility
|
IP
|
$783.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6217140
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$383.67 |
| Max. Negotiated Rate |
$720.36 |
| Rate for Payer: Aetna Commercial |
$704.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$673.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$414.99
|
| Rate for Payer: Cash Price |
$234.90
|
| Rate for Payer: Cigna Commercial |
$720.36
|
| Rate for Payer: Health EOS Commercial |
$696.87
|
| Rate for Payer: HFN Commercial |
$720.36
|
| Rate for Payer: Multiplan Commercial |
$626.40
|
| Rate for Payer: NAPHCARE Commercial |
$469.80
|
| Rate for Payer: Preferred Network Access Commercial |
$720.36
|
| Rate for Payer: Quartz Beloit One Network |
$383.67
|
| Rate for Payer: Quartz Commercial |
$469.80
|
| Rate for Payer: WEA Trust Commercial |
$430.65
|
| Rate for Payer: WPS Commercial |
$579.97
|
|
|
SCREW CORT 2.7 X 6 202.006
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967274
|
|
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 2.7 X 6 202.006
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967274
|
|
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
|
|
