|
SCREW CORT 2.7 X 8 202.008
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967275
|
|
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 8 202.008
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967275
|
|
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 3.0 X 10MM LP AR-8933-10
|
Facility
|
OP
|
$1,464.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459666
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$409.92 |
| Max. Negotiated Rate |
$5,856.00 |
| Rate for Payer: Aetna Commercial |
$1,317.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,259.04
|
| Rate for Payer: Aetna Managed Medicare |
$409.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$951.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$732.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$702.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$775.92
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cigna Commercial |
$1,346.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$819.25
|
| Rate for Payer: Health EOS Commercial |
$1,302.96
|
| Rate for Payer: HFN Commercial |
$1,346.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,098.00
|
| Rate for Payer: Multiplan Commercial |
$1,171.20
|
| Rate for Payer: NAPHCARE Commercial |
$878.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,346.88
|
| Rate for Payer: Quartz Beloit One Network |
$717.36
|
| Rate for Payer: Quartz Commercial |
$951.60
|
| Rate for Payer: Quartz Medicare Advantage |
$878.40
|
| Rate for Payer: The Alliance Commercial |
$5,856.00
|
| Rate for Payer: WEA Trust Commercial |
$805.20
|
| Rate for Payer: WPS Commercial |
$1,084.38
|
|
|
SCREW CORT 3.0 X 10MM LP AR-8933-10
|
Facility
|
IP
|
$1,464.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459666
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$717.36 |
| Max. Negotiated Rate |
$1,346.88 |
| Rate for Payer: Aetna Commercial |
$1,317.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,259.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$775.92
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cigna Commercial |
$1,346.88
|
| Rate for Payer: Health EOS Commercial |
$1,302.96
|
| Rate for Payer: HFN Commercial |
$1,346.88
|
| Rate for Payer: Multiplan Commercial |
$1,171.20
|
| Rate for Payer: NAPHCARE Commercial |
$878.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,346.88
|
| Rate for Payer: Quartz Beloit One Network |
$717.36
|
| Rate for Payer: Quartz Commercial |
$878.40
|
| Rate for Payer: WEA Trust Commercial |
$805.20
|
| Rate for Payer: WPS Commercial |
$1,084.38
|
|
|
SCREW CORT 3.0 X 12MM LP AR-8933-12
|
Facility
|
IP
|
$1,464.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459667
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$717.36 |
| Max. Negotiated Rate |
$1,346.88 |
| Rate for Payer: Aetna Commercial |
$1,317.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,259.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$775.92
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cigna Commercial |
$1,346.88
|
| Rate for Payer: Health EOS Commercial |
$1,302.96
|
| Rate for Payer: HFN Commercial |
$1,346.88
|
| Rate for Payer: Multiplan Commercial |
$1,171.20
|
| Rate for Payer: NAPHCARE Commercial |
$878.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,346.88
|
| Rate for Payer: Quartz Beloit One Network |
$717.36
|
| Rate for Payer: Quartz Commercial |
$878.40
|
| Rate for Payer: WEA Trust Commercial |
$805.20
|
| Rate for Payer: WPS Commercial |
$1,084.38
|
|
|
SCREW CORT 3.0 X 12MM LP AR-8933-12
|
Facility
|
OP
|
$1,464.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459667
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$409.92 |
| Max. Negotiated Rate |
$5,856.00 |
| Rate for Payer: Aetna Commercial |
$1,317.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,259.04
|
| Rate for Payer: Aetna Managed Medicare |
$409.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$951.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$732.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$702.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$775.92
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cigna Commercial |
$1,346.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$819.25
|
| Rate for Payer: Health EOS Commercial |
$1,302.96
|
| Rate for Payer: HFN Commercial |
$1,346.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,098.00
|
| Rate for Payer: Multiplan Commercial |
$1,171.20
|
| Rate for Payer: NAPHCARE Commercial |
$878.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,346.88
|
| Rate for Payer: Quartz Beloit One Network |
$717.36
|
| Rate for Payer: Quartz Commercial |
$951.60
|
| Rate for Payer: Quartz Medicare Advantage |
$878.40
|
| Rate for Payer: The Alliance Commercial |
$5,856.00
|
| Rate for Payer: WEA Trust Commercial |
$805.20
|
| Rate for Payer: WPS Commercial |
$1,084.38
|
|
|
SCREW CORT 3.0 X 14MM LP AR-8933-14
|
Facility
|
IP
|
$1,464.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$717.36 |
| Max. Negotiated Rate |
$1,346.88 |
| Rate for Payer: Aetna Commercial |
$1,317.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,259.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$775.92
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cigna Commercial |
$1,346.88
|
| Rate for Payer: Health EOS Commercial |
$1,302.96
|
| Rate for Payer: HFN Commercial |
$1,346.88
|
| Rate for Payer: Multiplan Commercial |
$1,171.20
|
| Rate for Payer: NAPHCARE Commercial |
$878.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,346.88
|
| Rate for Payer: Quartz Beloit One Network |
$717.36
|
| Rate for Payer: Quartz Commercial |
$878.40
|
| Rate for Payer: WEA Trust Commercial |
$805.20
|
| Rate for Payer: WPS Commercial |
$1,084.38
|
|
|
SCREW CORT 3.0 X 14MM LP AR-8933-14
|
Facility
|
OP
|
$1,464.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$409.92 |
| Max. Negotiated Rate |
$5,856.00 |
| Rate for Payer: Aetna Commercial |
$1,317.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,259.04
|
| Rate for Payer: Aetna Managed Medicare |
$409.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$951.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$732.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$702.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$775.92
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cigna Commercial |
$1,346.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$819.25
|
| Rate for Payer: Health EOS Commercial |
$1,302.96
|
| Rate for Payer: HFN Commercial |
$1,346.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,098.00
|
| Rate for Payer: Multiplan Commercial |
$1,171.20
|
| Rate for Payer: NAPHCARE Commercial |
$878.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,346.88
|
| Rate for Payer: Quartz Beloit One Network |
$717.36
|
| Rate for Payer: Quartz Commercial |
$951.60
|
| Rate for Payer: Quartz Medicare Advantage |
$878.40
|
| Rate for Payer: The Alliance Commercial |
$5,856.00
|
| Rate for Payer: WEA Trust Commercial |
$805.20
|
| Rate for Payer: WPS Commercial |
$1,084.38
|
|
|
SCREW CORT 3.0 X 14MM LP AR-8933L-14
|
Facility
|
IP
|
$1,997.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459664
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$978.53 |
| Max. Negotiated Rate |
$1,837.24 |
| Rate for Payer: Aetna Commercial |
$1,797.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,717.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,058.41
|
| Rate for Payer: Cash Price |
$599.10
|
| Rate for Payer: Cigna Commercial |
$1,837.24
|
| Rate for Payer: Health EOS Commercial |
$1,777.33
|
| Rate for Payer: HFN Commercial |
$1,837.24
|
| Rate for Payer: Multiplan Commercial |
$1,597.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,198.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,837.24
|
| Rate for Payer: Quartz Beloit One Network |
$978.53
|
| Rate for Payer: Quartz Commercial |
$1,198.20
|
| Rate for Payer: WEA Trust Commercial |
$1,098.35
|
| Rate for Payer: WPS Commercial |
$1,479.18
|
|
|
SCREW CORT 3.0 X 14MM LP AR-8933L-14
|
Facility
|
OP
|
$1,997.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459664
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$559.16 |
| Max. Negotiated Rate |
$7,988.00 |
| Rate for Payer: Aetna Commercial |
$1,797.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,717.42
|
| Rate for Payer: Aetna Managed Medicare |
$559.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,298.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$998.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$958.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,058.41
|
| Rate for Payer: Cash Price |
$599.10
|
| Rate for Payer: Cigna Commercial |
$1,837.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,117.52
|
| Rate for Payer: Health EOS Commercial |
$1,777.33
|
| Rate for Payer: HFN Commercial |
$1,837.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,497.75
|
| Rate for Payer: Multiplan Commercial |
$1,597.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,198.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,837.24
|
| Rate for Payer: Quartz Beloit One Network |
$978.53
|
| Rate for Payer: Quartz Commercial |
$1,298.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,198.20
|
| Rate for Payer: The Alliance Commercial |
$7,988.00
|
| Rate for Payer: WEA Trust Commercial |
$1,098.35
|
| Rate for Payer: WPS Commercial |
$1,479.18
|
|
|
SCREW CORT 3.0 X 16MM LP AR-8933-16
|
Facility
|
OP
|
$1,464.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459669
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$409.92 |
| Max. Negotiated Rate |
$5,856.00 |
| Rate for Payer: Aetna Commercial |
$1,317.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,259.04
|
| Rate for Payer: Aetna Managed Medicare |
$409.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$951.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$732.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$702.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$775.92
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cigna Commercial |
$1,346.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$819.25
|
| Rate for Payer: Health EOS Commercial |
$1,302.96
|
| Rate for Payer: HFN Commercial |
$1,346.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,098.00
|
| Rate for Payer: Multiplan Commercial |
$1,171.20
|
| Rate for Payer: NAPHCARE Commercial |
$878.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,346.88
|
| Rate for Payer: Quartz Beloit One Network |
$717.36
|
| Rate for Payer: Quartz Commercial |
$951.60
|
| Rate for Payer: Quartz Medicare Advantage |
$878.40
|
| Rate for Payer: The Alliance Commercial |
$5,856.00
|
| Rate for Payer: WEA Trust Commercial |
$805.20
|
| Rate for Payer: WPS Commercial |
$1,084.38
|
|
|
SCREW CORT 3.0 X 16MM LP AR-8933-16
|
Facility
|
IP
|
$1,464.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459669
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$717.36 |
| Max. Negotiated Rate |
$1,346.88 |
| Rate for Payer: Aetna Commercial |
$1,317.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,259.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$775.92
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cigna Commercial |
$1,346.88
|
| Rate for Payer: Health EOS Commercial |
$1,302.96
|
| Rate for Payer: HFN Commercial |
$1,346.88
|
| Rate for Payer: Multiplan Commercial |
$1,171.20
|
| Rate for Payer: NAPHCARE Commercial |
$878.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,346.88
|
| Rate for Payer: Quartz Beloit One Network |
$717.36
|
| Rate for Payer: Quartz Commercial |
$878.40
|
| Rate for Payer: WEA Trust Commercial |
$805.20
|
| Rate for Payer: WPS Commercial |
$1,084.38
|
|
|
SCREW CORT 3.0 X 16MM LP AR-8933L-16
|
Facility
|
IP
|
$1,997.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459663
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$978.53 |
| Max. Negotiated Rate |
$1,837.24 |
| Rate for Payer: Aetna Commercial |
$1,797.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,717.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,058.41
|
| Rate for Payer: Cash Price |
$599.10
|
| Rate for Payer: Cigna Commercial |
$1,837.24
|
| Rate for Payer: Health EOS Commercial |
$1,777.33
|
| Rate for Payer: HFN Commercial |
$1,837.24
|
| Rate for Payer: Multiplan Commercial |
$1,597.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,198.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,837.24
|
| Rate for Payer: Quartz Beloit One Network |
$978.53
|
| Rate for Payer: Quartz Commercial |
$1,198.20
|
| Rate for Payer: WEA Trust Commercial |
$1,098.35
|
| Rate for Payer: WPS Commercial |
$1,479.18
|
|
|
SCREW CORT 3.0 X 16MM LP AR-8933L-16
|
Facility
|
OP
|
$1,997.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459663
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$559.16 |
| Max. Negotiated Rate |
$7,988.00 |
| Rate for Payer: Aetna Commercial |
$1,797.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,717.42
|
| Rate for Payer: Aetna Managed Medicare |
$559.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,298.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$998.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$958.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,058.41
|
| Rate for Payer: Cash Price |
$599.10
|
| Rate for Payer: Cigna Commercial |
$1,837.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,117.52
|
| Rate for Payer: Health EOS Commercial |
$1,777.33
|
| Rate for Payer: HFN Commercial |
$1,837.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,497.75
|
| Rate for Payer: Multiplan Commercial |
$1,597.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,198.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,837.24
|
| Rate for Payer: Quartz Beloit One Network |
$978.53
|
| Rate for Payer: Quartz Commercial |
$1,298.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,198.20
|
| Rate for Payer: The Alliance Commercial |
$7,988.00
|
| Rate for Payer: WEA Trust Commercial |
$1,098.35
|
| Rate for Payer: WPS Commercial |
$1,479.18
|
|
|
SCREW CORT 3.0 X 18MM LP AR-8933-18
|
Facility
|
OP
|
$1,464.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459670
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$409.92 |
| Max. Negotiated Rate |
$5,856.00 |
| Rate for Payer: Aetna Commercial |
$1,317.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,259.04
|
| Rate for Payer: Aetna Managed Medicare |
$409.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$951.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$732.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$702.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$775.92
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cigna Commercial |
$1,346.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$819.25
|
| Rate for Payer: Health EOS Commercial |
$1,302.96
|
| Rate for Payer: HFN Commercial |
$1,346.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,098.00
|
| Rate for Payer: Multiplan Commercial |
$1,171.20
|
| Rate for Payer: NAPHCARE Commercial |
$878.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,346.88
|
| Rate for Payer: Quartz Beloit One Network |
$717.36
|
| Rate for Payer: Quartz Commercial |
$951.60
|
| Rate for Payer: Quartz Medicare Advantage |
$878.40
|
| Rate for Payer: The Alliance Commercial |
$5,856.00
|
| Rate for Payer: WEA Trust Commercial |
$805.20
|
| Rate for Payer: WPS Commercial |
$1,084.38
|
|
|
SCREW CORT 3.0 X 18MM LP AR-8933-18
|
Facility
|
IP
|
$1,464.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459670
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$717.36 |
| Max. Negotiated Rate |
$1,346.88 |
| Rate for Payer: Aetna Commercial |
$1,317.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,259.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$775.92
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cigna Commercial |
$1,346.88
|
| Rate for Payer: Health EOS Commercial |
$1,302.96
|
| Rate for Payer: HFN Commercial |
$1,346.88
|
| Rate for Payer: Multiplan Commercial |
$1,171.20
|
| Rate for Payer: NAPHCARE Commercial |
$878.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,346.88
|
| Rate for Payer: Quartz Beloit One Network |
$717.36
|
| Rate for Payer: Quartz Commercial |
$878.40
|
| Rate for Payer: WEA Trust Commercial |
$805.20
|
| Rate for Payer: WPS Commercial |
$1,084.38
|
|
|
SCREW CORT 3.0 X 24MM LP AR-8933-24
|
Facility
|
OP
|
$1,314.26
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6244271
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$367.99 |
| Max. Negotiated Rate |
$5,257.04 |
| Rate for Payer: Aetna Commercial |
$1,182.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,130.26
|
| Rate for Payer: Aetna Managed Medicare |
$367.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$854.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$657.13
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$630.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$696.56
|
| Rate for Payer: Cash Price |
$394.28
|
| Rate for Payer: Cigna Commercial |
$1,209.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$735.46
|
| Rate for Payer: Health EOS Commercial |
$1,169.69
|
| Rate for Payer: HFN Commercial |
$1,209.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$985.70
|
| Rate for Payer: Multiplan Commercial |
$1,051.41
|
| Rate for Payer: NAPHCARE Commercial |
$788.56
|
| Rate for Payer: Preferred Network Access Commercial |
$1,209.12
|
| Rate for Payer: Quartz Beloit One Network |
$643.99
|
| Rate for Payer: Quartz Commercial |
$854.27
|
| Rate for Payer: Quartz Medicare Advantage |
$788.56
|
| Rate for Payer: The Alliance Commercial |
$5,257.04
|
| Rate for Payer: WEA Trust Commercial |
$722.84
|
| Rate for Payer: WPS Commercial |
$973.47
|
|
|
SCREW CORT 3.0 X 24MM LP AR-8933-24
|
Facility
|
IP
|
$1,314.26
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6244271
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$643.99 |
| Max. Negotiated Rate |
$1,209.12 |
| Rate for Payer: Aetna Commercial |
$1,182.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,130.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$696.56
|
| Rate for Payer: Cash Price |
$394.28
|
| Rate for Payer: Cigna Commercial |
$1,209.12
|
| Rate for Payer: Health EOS Commercial |
$1,169.69
|
| Rate for Payer: HFN Commercial |
$1,209.12
|
| Rate for Payer: Multiplan Commercial |
$1,051.41
|
| Rate for Payer: NAPHCARE Commercial |
$788.56
|
| Rate for Payer: Preferred Network Access Commercial |
$1,209.12
|
| Rate for Payer: Quartz Beloit One Network |
$643.99
|
| Rate for Payer: Quartz Commercial |
$788.56
|
| Rate for Payer: WEA Trust Commercial |
$722.84
|
| Rate for Payer: WPS Commercial |
$973.47
|
|
|
SCREW CORT 3.0 X 28MM LP AR-8933-28
|
Facility
|
OP
|
$1,314.26
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6244276
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$367.99 |
| Max. Negotiated Rate |
$5,257.04 |
| Rate for Payer: Aetna Commercial |
$1,182.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,130.26
|
| Rate for Payer: Aetna Managed Medicare |
$367.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$854.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$657.13
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$630.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$696.56
|
| Rate for Payer: Cash Price |
$394.28
|
| Rate for Payer: Cigna Commercial |
$1,209.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$735.46
|
| Rate for Payer: Health EOS Commercial |
$1,169.69
|
| Rate for Payer: HFN Commercial |
$1,209.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$985.70
|
| Rate for Payer: Multiplan Commercial |
$1,051.41
|
| Rate for Payer: NAPHCARE Commercial |
$788.56
|
| Rate for Payer: Preferred Network Access Commercial |
$1,209.12
|
| Rate for Payer: Quartz Beloit One Network |
$643.99
|
| Rate for Payer: Quartz Commercial |
$854.27
|
| Rate for Payer: Quartz Medicare Advantage |
$788.56
|
| Rate for Payer: The Alliance Commercial |
$5,257.04
|
| Rate for Payer: WEA Trust Commercial |
$722.84
|
| Rate for Payer: WPS Commercial |
$973.47
|
|
|
SCREW CORT 3.0 X 28MM LP AR-8933-28
|
Facility
|
IP
|
$1,314.26
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6244276
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$643.99 |
| Max. Negotiated Rate |
$1,209.12 |
| Rate for Payer: Aetna Commercial |
$1,182.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,130.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$696.56
|
| Rate for Payer: Cash Price |
$394.28
|
| Rate for Payer: Cigna Commercial |
$1,209.12
|
| Rate for Payer: Health EOS Commercial |
$1,169.69
|
| Rate for Payer: HFN Commercial |
$1,209.12
|
| Rate for Payer: Multiplan Commercial |
$1,051.41
|
| Rate for Payer: NAPHCARE Commercial |
$788.56
|
| Rate for Payer: Preferred Network Access Commercial |
$1,209.12
|
| Rate for Payer: Quartz Beloit One Network |
$643.99
|
| Rate for Payer: Quartz Commercial |
$788.56
|
| Rate for Payer: WEA Trust Commercial |
$722.84
|
| Rate for Payer: WPS Commercial |
$973.47
|
|
|
SCREW-CORT 3.5 X 10 204.810
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966871
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.76 |
| Max. Negotiated Rate |
$114.08 |
| Rate for Payer: Aetna Commercial |
$111.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$106.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.72
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cigna Commercial |
$114.08
|
| Rate for Payer: Health EOS Commercial |
$110.36
|
| Rate for Payer: HFN Commercial |
$114.08
|
| Rate for Payer: Multiplan Commercial |
$99.20
|
| Rate for Payer: NAPHCARE Commercial |
$74.40
|
| Rate for Payer: Preferred Network Access Commercial |
$114.08
|
| Rate for Payer: Quartz Beloit One Network |
$60.76
|
| Rate for Payer: Quartz Commercial |
$74.40
|
| Rate for Payer: WEA Trust Commercial |
$68.20
|
| Rate for Payer: WPS Commercial |
$91.85
|
|
|
SCREW-CORT 3.5 X 10 204.810
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966871
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$34.72 |
| Max. Negotiated Rate |
$496.00 |
| Rate for Payer: Aetna Commercial |
$111.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$106.64
|
| Rate for Payer: Aetna Managed Medicare |
$34.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$80.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$62.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$59.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.72
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cigna Commercial |
$114.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$69.39
|
| Rate for Payer: Health EOS Commercial |
$110.36
|
| Rate for Payer: HFN Commercial |
$114.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$93.00
|
| Rate for Payer: Multiplan Commercial |
$99.20
|
| Rate for Payer: NAPHCARE Commercial |
$74.40
|
| Rate for Payer: Preferred Network Access Commercial |
$114.08
|
| Rate for Payer: Quartz Beloit One Network |
$60.76
|
| Rate for Payer: Quartz Commercial |
$80.60
|
| Rate for Payer: Quartz Medicare Advantage |
$74.40
|
| Rate for Payer: The Alliance Commercial |
$496.00
|
| Rate for Payer: WEA Trust Commercial |
$68.20
|
| Rate for Payer: WPS Commercial |
$91.85
|
|
|
SCREW CORT 3.5 X 10MM LP AR-8835-10
|
Facility
|
IP
|
$652.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4594698
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$319.48 |
| Max. Negotiated Rate |
$599.84 |
| Rate for Payer: Aetna Commercial |
$586.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$560.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$345.56
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cigna Commercial |
$599.84
|
| Rate for Payer: Health EOS Commercial |
$580.28
|
| Rate for Payer: HFN Commercial |
$599.84
|
| Rate for Payer: Multiplan Commercial |
$521.60
|
| Rate for Payer: NAPHCARE Commercial |
$391.20
|
| Rate for Payer: Preferred Network Access Commercial |
$599.84
|
| Rate for Payer: Quartz Beloit One Network |
$319.48
|
| Rate for Payer: Quartz Commercial |
$391.20
|
| Rate for Payer: WEA Trust Commercial |
$358.60
|
| Rate for Payer: WPS Commercial |
$482.94
|
|
|
SCREW CORT 3.5 X 10MM LP AR-8835-10
|
Facility
|
OP
|
$652.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4594698
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$182.56 |
| Max. Negotiated Rate |
$2,608.00 |
| Rate for Payer: Aetna Commercial |
$586.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$560.72
|
| Rate for Payer: Aetna Managed Medicare |
$182.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$423.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$326.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$312.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$345.56
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cigna Commercial |
$599.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$364.86
|
| Rate for Payer: Health EOS Commercial |
$580.28
|
| Rate for Payer: HFN Commercial |
$599.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$489.00
|
| Rate for Payer: Multiplan Commercial |
$521.60
|
| Rate for Payer: NAPHCARE Commercial |
$391.20
|
| Rate for Payer: Preferred Network Access Commercial |
$599.84
|
| Rate for Payer: Quartz Beloit One Network |
$319.48
|
| Rate for Payer: Quartz Commercial |
$423.80
|
| Rate for Payer: Quartz Medicare Advantage |
$391.20
|
| Rate for Payer: The Alliance Commercial |
$2,608.00
|
| Rate for Payer: WEA Trust Commercial |
$358.60
|
| Rate for Payer: WPS Commercial |
$482.94
|
|
|
SCREW CORT 3.5 X 10MM LP TI AR-8935-10
|
Facility
|
OP
|
$958.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414685
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$268.24 |
| Max. Negotiated Rate |
$3,832.00 |
| Rate for Payer: Aetna Commercial |
$862.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$823.88
|
| Rate for Payer: Aetna Managed Medicare |
$268.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$622.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$479.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$459.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$507.74
|
| Rate for Payer: Cash Price |
$287.40
|
| Rate for Payer: Cigna Commercial |
$881.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$536.10
|
| Rate for Payer: Health EOS Commercial |
$852.62
|
| Rate for Payer: HFN Commercial |
$881.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$718.50
|
| Rate for Payer: Multiplan Commercial |
$766.40
|
| Rate for Payer: NAPHCARE Commercial |
$574.80
|
| Rate for Payer: Preferred Network Access Commercial |
$881.36
|
| Rate for Payer: Quartz Beloit One Network |
$469.42
|
| Rate for Payer: Quartz Commercial |
$622.70
|
| Rate for Payer: Quartz Medicare Advantage |
$574.80
|
| Rate for Payer: The Alliance Commercial |
$3,832.00
|
| Rate for Payer: WEA Trust Commercial |
$526.90
|
| Rate for Payer: WPS Commercial |
$709.59
|
|
