|
SCREW CORT 1.3 X 9 ST 200.689
|
Facility
|
OP
|
$1,070.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494527
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$311.58 |
| Max. Negotiated Rate |
$1,023.78 |
| Rate for Payer: Aetna Commercial |
$1,001.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$957.01
|
| Rate for Payer: Aetna Managed Medicare |
$311.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$723.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$556.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$534.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$589.78
|
| Rate for Payer: Cash Price |
$321.00
|
| Rate for Payer: Cigna Commercial |
$1,023.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$622.74
|
| Rate for Payer: Health EOS Commercial |
$990.39
|
| Rate for Payer: HFN Commercial |
$1,023.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$834.60
|
| Rate for Payer: Multiplan Commercial |
$890.24
|
| Rate for Payer: NAPHCARE Commercial |
$667.68
|
| Rate for Payer: Preferred Network Access Commercial |
$1,023.78
|
| Rate for Payer: Quartz Beloit One Network |
$545.27
|
| Rate for Payer: Quartz Commercial |
$723.32
|
| Rate for Payer: Quartz Medicare Advantage |
$667.68
|
| Rate for Payer: The Alliance Commercial |
$556.40
|
| Rate for Payer: WEA Trust Commercial |
$612.04
|
| Rate for Payer: WPS Commercial |
$824.22
|
|
|
SCREW CORT 1.3 X 9 ST 200.689
|
Facility
|
IP
|
$1,070.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494527
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$545.27 |
| Max. Negotiated Rate |
$1,023.78 |
| Rate for Payer: Aetna Commercial |
$1,001.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$957.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$589.78
|
| Rate for Payer: Cash Price |
$321.00
|
| Rate for Payer: Cigna Commercial |
$1,023.78
|
| Rate for Payer: Health EOS Commercial |
$990.39
|
| Rate for Payer: HFN Commercial |
$1,023.78
|
| Rate for Payer: Multiplan Commercial |
$890.24
|
| Rate for Payer: Preferred Network Access Commercial |
$1,023.78
|
| Rate for Payer: Quartz Beloit One Network |
$545.27
|
| Rate for Payer: Quartz Commercial |
$667.68
|
| Rate for Payer: WEA Trust Commercial |
$612.04
|
| Rate for Payer: WPS Commercial |
$824.22
|
|
|
SCREW CORT 1.5MM X 15MM 02.214.115
|
Facility
|
IP
|
$719.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5206659
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$366.40 |
| Max. Negotiated Rate |
$687.94 |
| Rate for Payer: Aetna Commercial |
$672.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$643.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$396.31
|
| Rate for Payer: Cash Price |
$215.70
|
| Rate for Payer: Cigna Commercial |
$687.94
|
| Rate for Payer: Health EOS Commercial |
$665.51
|
| Rate for Payer: HFN Commercial |
$687.94
|
| Rate for Payer: Multiplan Commercial |
$598.21
|
| Rate for Payer: Preferred Network Access Commercial |
$687.94
|
| Rate for Payer: Quartz Beloit One Network |
$366.40
|
| Rate for Payer: Quartz Commercial |
$448.66
|
| Rate for Payer: WEA Trust Commercial |
$411.27
|
| Rate for Payer: WPS Commercial |
$553.85
|
|
|
SCREW CORT 1.5MM X 15MM 02.214.115
|
Facility
|
OP
|
$719.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5206659
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$209.37 |
| Max. Negotiated Rate |
$687.94 |
| Rate for Payer: Aetna Commercial |
$672.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$643.07
|
| Rate for Payer: Aetna Managed Medicare |
$209.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$486.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$373.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$358.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$396.31
|
| Rate for Payer: Cash Price |
$215.70
|
| Rate for Payer: Cigna Commercial |
$687.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$418.46
|
| Rate for Payer: Health EOS Commercial |
$665.51
|
| Rate for Payer: HFN Commercial |
$687.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$560.82
|
| Rate for Payer: Multiplan Commercial |
$598.21
|
| Rate for Payer: NAPHCARE Commercial |
$448.66
|
| Rate for Payer: Preferred Network Access Commercial |
$687.94
|
| Rate for Payer: Quartz Beloit One Network |
$366.40
|
| Rate for Payer: Quartz Commercial |
$486.04
|
| Rate for Payer: Quartz Medicare Advantage |
$448.66
|
| Rate for Payer: The Alliance Commercial |
$373.88
|
| Rate for Payer: WEA Trust Commercial |
$411.27
|
| Rate for Payer: WPS Commercial |
$553.85
|
|
|
SCREW-CORT 1.5 X 10 200.010
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967243
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$69.82 |
| Max. Negotiated Rate |
$131.08 |
| Rate for Payer: Aetna Commercial |
$128.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$122.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$75.51
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cigna Commercial |
$131.08
|
| Rate for Payer: Health EOS Commercial |
$126.81
|
| Rate for Payer: HFN Commercial |
$131.08
|
| Rate for Payer: Multiplan Commercial |
$113.98
|
| Rate for Payer: Preferred Network Access Commercial |
$131.08
|
| Rate for Payer: Quartz Beloit One Network |
$69.82
|
| Rate for Payer: Quartz Commercial |
$85.49
|
| Rate for Payer: WEA Trust Commercial |
$78.36
|
| Rate for Payer: WPS Commercial |
$105.53
|
|
|
SCREW-CORT 1.5 X 10 200.010
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967243
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$39.89 |
| Max. Negotiated Rate |
$131.08 |
| Rate for Payer: Aetna Commercial |
$128.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$122.53
|
| Rate for Payer: Aetna Managed Medicare |
$39.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$92.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$71.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$68.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$75.51
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cigna Commercial |
$131.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$79.73
|
| Rate for Payer: Health EOS Commercial |
$126.81
|
| Rate for Payer: HFN Commercial |
$131.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$106.86
|
| Rate for Payer: Multiplan Commercial |
$113.98
|
| Rate for Payer: NAPHCARE Commercial |
$85.49
|
| Rate for Payer: Preferred Network Access Commercial |
$131.08
|
| Rate for Payer: Quartz Beloit One Network |
$69.82
|
| Rate for Payer: Quartz Commercial |
$92.61
|
| Rate for Payer: Quartz Medicare Advantage |
$85.49
|
| Rate for Payer: The Alliance Commercial |
$71.24
|
| Rate for Payer: WEA Trust Commercial |
$78.36
|
| Rate for Payer: WPS Commercial |
$105.53
|
|
|
SCREW CORT 1.5 X 10MM 02.214.110
|
Facility
|
IP
|
$977.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966403
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$497.88 |
| Max. Negotiated Rate |
$934.79 |
| Rate for Payer: Aetna Commercial |
$914.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$873.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$538.52
|
| Rate for Payer: Cash Price |
$293.10
|
| Rate for Payer: Cigna Commercial |
$934.79
|
| Rate for Payer: Health EOS Commercial |
$904.31
|
| Rate for Payer: HFN Commercial |
$934.79
|
| Rate for Payer: Multiplan Commercial |
$812.86
|
| Rate for Payer: Preferred Network Access Commercial |
$934.79
|
| Rate for Payer: Quartz Beloit One Network |
$497.88
|
| Rate for Payer: Quartz Commercial |
$609.65
|
| Rate for Payer: WEA Trust Commercial |
$558.84
|
| Rate for Payer: WPS Commercial |
$752.58
|
|
|
SCREW CORT 1.5 X 10MM 02.214.110
|
Facility
|
OP
|
$977.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966403
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$284.50 |
| Max. Negotiated Rate |
$934.79 |
| Rate for Payer: Aetna Commercial |
$914.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$873.83
|
| Rate for Payer: Aetna Managed Medicare |
$284.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$660.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$508.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$487.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$538.52
|
| Rate for Payer: Cash Price |
$293.10
|
| Rate for Payer: Cigna Commercial |
$934.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$568.61
|
| Rate for Payer: Health EOS Commercial |
$904.31
|
| Rate for Payer: HFN Commercial |
$934.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$762.06
|
| Rate for Payer: Multiplan Commercial |
$812.86
|
| Rate for Payer: NAPHCARE Commercial |
$609.65
|
| Rate for Payer: Preferred Network Access Commercial |
$934.79
|
| Rate for Payer: Quartz Beloit One Network |
$497.88
|
| Rate for Payer: Quartz Commercial |
$660.45
|
| Rate for Payer: Quartz Medicare Advantage |
$609.65
|
| Rate for Payer: The Alliance Commercial |
$508.04
|
| Rate for Payer: WEA Trust Commercial |
$558.84
|
| Rate for Payer: WPS Commercial |
$752.58
|
|
|
SCREW CORT 1.5 X 10 ST 200.810
|
Facility
|
OP
|
$610.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494540
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$177.63 |
| Max. Negotiated Rate |
$583.65 |
| Rate for Payer: Aetna Commercial |
$570.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$545.58
|
| Rate for Payer: Aetna Managed Medicare |
$177.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$412.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$317.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$304.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$336.23
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$583.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$355.02
|
| Rate for Payer: Health EOS Commercial |
$564.62
|
| Rate for Payer: HFN Commercial |
$583.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$475.80
|
| Rate for Payer: Multiplan Commercial |
$507.52
|
| Rate for Payer: NAPHCARE Commercial |
$380.64
|
| Rate for Payer: Preferred Network Access Commercial |
$583.65
|
| Rate for Payer: Quartz Beloit One Network |
$310.86
|
| Rate for Payer: Quartz Commercial |
$412.36
|
| Rate for Payer: Quartz Medicare Advantage |
$380.64
|
| Rate for Payer: The Alliance Commercial |
$317.20
|
| Rate for Payer: WEA Trust Commercial |
$348.92
|
| Rate for Payer: WPS Commercial |
$469.88
|
|
|
SCREW CORT 1.5 X 10 ST 200.810
|
Facility
|
IP
|
$610.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494540
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$310.86 |
| Max. Negotiated Rate |
$583.65 |
| Rate for Payer: Aetna Commercial |
$570.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$545.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$336.23
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$583.65
|
| Rate for Payer: Health EOS Commercial |
$564.62
|
| Rate for Payer: HFN Commercial |
$583.65
|
| Rate for Payer: Multiplan Commercial |
$507.52
|
| Rate for Payer: Preferred Network Access Commercial |
$583.65
|
| Rate for Payer: Quartz Beloit One Network |
$310.86
|
| Rate for Payer: Quartz Commercial |
$380.64
|
| Rate for Payer: WEA Trust Commercial |
$348.92
|
| Rate for Payer: WPS Commercial |
$469.88
|
|
|
SCREW-CORT 1.5 X 11 200.011
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967244
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$38.73 |
| Max. Negotiated Rate |
$127.25 |
| Rate for Payer: Aetna Commercial |
$124.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$118.96
|
| Rate for Payer: Aetna Managed Medicare |
$38.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$89.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$69.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$66.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.31
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cigna Commercial |
$127.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$77.41
|
| Rate for Payer: Health EOS Commercial |
$123.10
|
| Rate for Payer: HFN Commercial |
$127.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$103.74
|
| Rate for Payer: Multiplan Commercial |
$110.66
|
| Rate for Payer: NAPHCARE Commercial |
$82.99
|
| Rate for Payer: Preferred Network Access Commercial |
$127.25
|
| Rate for Payer: Quartz Beloit One Network |
$67.78
|
| Rate for Payer: Quartz Commercial |
$89.91
|
| Rate for Payer: Quartz Medicare Advantage |
$82.99
|
| Rate for Payer: The Alliance Commercial |
$69.16
|
| Rate for Payer: WEA Trust Commercial |
$76.08
|
| Rate for Payer: WPS Commercial |
$102.45
|
|
|
SCREW-CORT 1.5 X 11 200.011
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967244
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$67.78 |
| Max. Negotiated Rate |
$127.25 |
| Rate for Payer: Aetna Commercial |
$124.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$118.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.31
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cigna Commercial |
$127.25
|
| Rate for Payer: Health EOS Commercial |
$123.10
|
| Rate for Payer: HFN Commercial |
$127.25
|
| Rate for Payer: Multiplan Commercial |
$110.66
|
| Rate for Payer: Preferred Network Access Commercial |
$127.25
|
| Rate for Payer: Quartz Beloit One Network |
$67.78
|
| Rate for Payer: Quartz Commercial |
$82.99
|
| Rate for Payer: WEA Trust Commercial |
$76.08
|
| Rate for Payer: WPS Commercial |
$102.45
|
|
|
SCREW CORT 1.5 X 11MM 02.214.111
|
Facility
|
OP
|
$940.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3072413
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$273.73 |
| Max. Negotiated Rate |
$899.39 |
| Rate for Payer: Aetna Commercial |
$879.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$840.74
|
| Rate for Payer: Aetna Managed Medicare |
$273.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$635.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$488.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$469.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$518.13
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cigna Commercial |
$899.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$547.08
|
| Rate for Payer: Health EOS Commercial |
$870.06
|
| Rate for Payer: HFN Commercial |
$899.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$733.20
|
| Rate for Payer: Multiplan Commercial |
$782.08
|
| Rate for Payer: NAPHCARE Commercial |
$586.56
|
| Rate for Payer: Preferred Network Access Commercial |
$899.39
|
| Rate for Payer: Quartz Beloit One Network |
$479.02
|
| Rate for Payer: Quartz Commercial |
$635.44
|
| Rate for Payer: Quartz Medicare Advantage |
$586.56
|
| Rate for Payer: The Alliance Commercial |
$488.80
|
| Rate for Payer: WEA Trust Commercial |
$537.68
|
| Rate for Payer: WPS Commercial |
$724.08
|
|
|
SCREW CORT 1.5 X 11MM 02.214.111
|
Facility
|
IP
|
$940.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3072413
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$479.02 |
| Max. Negotiated Rate |
$899.39 |
| Rate for Payer: Aetna Commercial |
$879.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$840.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$518.13
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cigna Commercial |
$899.39
|
| Rate for Payer: Health EOS Commercial |
$870.06
|
| Rate for Payer: HFN Commercial |
$899.39
|
| Rate for Payer: Multiplan Commercial |
$782.08
|
| Rate for Payer: Preferred Network Access Commercial |
$899.39
|
| Rate for Payer: Quartz Beloit One Network |
$479.02
|
| Rate for Payer: Quartz Commercial |
$586.56
|
| Rate for Payer: WEA Trust Commercial |
$537.68
|
| Rate for Payer: WPS Commercial |
$724.08
|
|
|
SCREW CORT 1.5 X 11 ST 200.811
|
Facility
|
IP
|
$610.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494541
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$310.86 |
| Max. Negotiated Rate |
$583.65 |
| Rate for Payer: Aetna Commercial |
$570.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$545.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$336.23
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$583.65
|
| Rate for Payer: Health EOS Commercial |
$564.62
|
| Rate for Payer: HFN Commercial |
$583.65
|
| Rate for Payer: Multiplan Commercial |
$507.52
|
| Rate for Payer: Preferred Network Access Commercial |
$583.65
|
| Rate for Payer: Quartz Beloit One Network |
$310.86
|
| Rate for Payer: Quartz Commercial |
$380.64
|
| Rate for Payer: WEA Trust Commercial |
$348.92
|
| Rate for Payer: WPS Commercial |
$469.88
|
|
|
SCREW CORT 1.5 X 11 ST 200.811
|
Facility
|
OP
|
$610.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494541
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$177.63 |
| Max. Negotiated Rate |
$583.65 |
| Rate for Payer: Aetna Commercial |
$570.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$545.58
|
| Rate for Payer: Aetna Managed Medicare |
$177.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$412.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$317.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$304.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$336.23
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$583.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$355.02
|
| Rate for Payer: Health EOS Commercial |
$564.62
|
| Rate for Payer: HFN Commercial |
$583.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$475.80
|
| Rate for Payer: Multiplan Commercial |
$507.52
|
| Rate for Payer: NAPHCARE Commercial |
$380.64
|
| Rate for Payer: Preferred Network Access Commercial |
$583.65
|
| Rate for Payer: Quartz Beloit One Network |
$310.86
|
| Rate for Payer: Quartz Commercial |
$412.36
|
| Rate for Payer: Quartz Medicare Advantage |
$380.64
|
| Rate for Payer: The Alliance Commercial |
$317.20
|
| Rate for Payer: WEA Trust Commercial |
$348.92
|
| Rate for Payer: WPS Commercial |
$469.88
|
|
|
SCREW-CORT 1.5 X 12 200.012
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967245
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$69.82 |
| Max. Negotiated Rate |
$131.08 |
| Rate for Payer: Aetna Commercial |
$128.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$122.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$75.51
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cigna Commercial |
$131.08
|
| Rate for Payer: Health EOS Commercial |
$126.81
|
| Rate for Payer: HFN Commercial |
$131.08
|
| Rate for Payer: Multiplan Commercial |
$113.98
|
| Rate for Payer: Preferred Network Access Commercial |
$131.08
|
| Rate for Payer: Quartz Beloit One Network |
$69.82
|
| Rate for Payer: Quartz Commercial |
$85.49
|
| Rate for Payer: WEA Trust Commercial |
$78.36
|
| Rate for Payer: WPS Commercial |
$105.53
|
|
|
SCREW-CORT 1.5 X 12 200.012
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967245
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$39.89 |
| Max. Negotiated Rate |
$131.08 |
| Rate for Payer: Aetna Commercial |
$128.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$122.53
|
| Rate for Payer: Aetna Managed Medicare |
$39.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$92.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$71.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$68.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$75.51
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cigna Commercial |
$131.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$79.73
|
| Rate for Payer: Health EOS Commercial |
$126.81
|
| Rate for Payer: HFN Commercial |
$131.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$106.86
|
| Rate for Payer: Multiplan Commercial |
$113.98
|
| Rate for Payer: NAPHCARE Commercial |
$85.49
|
| Rate for Payer: Preferred Network Access Commercial |
$131.08
|
| Rate for Payer: Quartz Beloit One Network |
$69.82
|
| Rate for Payer: Quartz Commercial |
$92.61
|
| Rate for Payer: Quartz Medicare Advantage |
$85.49
|
| Rate for Payer: The Alliance Commercial |
$71.24
|
| Rate for Payer: WEA Trust Commercial |
$78.36
|
| Rate for Payer: WPS Commercial |
$105.53
|
|
|
SCREW CORT 1.5 X 12MM 02.214.112
|
Facility
|
IP
|
$977.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966407
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$497.88 |
| Max. Negotiated Rate |
$934.79 |
| Rate for Payer: Aetna Commercial |
$914.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$873.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$538.52
|
| Rate for Payer: Cash Price |
$293.10
|
| Rate for Payer: Cigna Commercial |
$934.79
|
| Rate for Payer: Health EOS Commercial |
$904.31
|
| Rate for Payer: HFN Commercial |
$934.79
|
| Rate for Payer: Multiplan Commercial |
$812.86
|
| Rate for Payer: Preferred Network Access Commercial |
$934.79
|
| Rate for Payer: Quartz Beloit One Network |
$497.88
|
| Rate for Payer: Quartz Commercial |
$609.65
|
| Rate for Payer: WEA Trust Commercial |
$558.84
|
| Rate for Payer: WPS Commercial |
$752.58
|
|
|
SCREW CORT 1.5 X 12MM 02.214.112
|
Facility
|
OP
|
$977.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966407
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$284.50 |
| Max. Negotiated Rate |
$934.79 |
| Rate for Payer: Aetna Commercial |
$914.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$873.83
|
| Rate for Payer: Aetna Managed Medicare |
$284.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$660.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$508.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$487.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$538.52
|
| Rate for Payer: Cash Price |
$293.10
|
| Rate for Payer: Cigna Commercial |
$934.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$568.61
|
| Rate for Payer: Health EOS Commercial |
$904.31
|
| Rate for Payer: HFN Commercial |
$934.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$762.06
|
| Rate for Payer: Multiplan Commercial |
$812.86
|
| Rate for Payer: NAPHCARE Commercial |
$609.65
|
| Rate for Payer: Preferred Network Access Commercial |
$934.79
|
| Rate for Payer: Quartz Beloit One Network |
$497.88
|
| Rate for Payer: Quartz Commercial |
$660.45
|
| Rate for Payer: Quartz Medicare Advantage |
$609.65
|
| Rate for Payer: The Alliance Commercial |
$508.04
|
| Rate for Payer: WEA Trust Commercial |
$558.84
|
| Rate for Payer: WPS Commercial |
$752.58
|
|
|
SCREW CORT 1.5 X 12 ST 200.812
|
Facility
|
IP
|
$387.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494542
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$197.22 |
| Max. Negotiated Rate |
$370.28 |
| Rate for Payer: Aetna Commercial |
$362.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$346.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$213.31
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Cigna Commercial |
$370.28
|
| Rate for Payer: Health EOS Commercial |
$358.21
|
| Rate for Payer: HFN Commercial |
$370.28
|
| Rate for Payer: Multiplan Commercial |
$321.98
|
| Rate for Payer: Preferred Network Access Commercial |
$370.28
|
| Rate for Payer: Quartz Beloit One Network |
$197.22
|
| Rate for Payer: Quartz Commercial |
$241.49
|
| Rate for Payer: WEA Trust Commercial |
$221.36
|
| Rate for Payer: WPS Commercial |
$298.11
|
|
|
SCREW CORT 1.5 X 12 ST 200.812
|
Facility
|
OP
|
$387.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494542
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$112.69 |
| Max. Negotiated Rate |
$370.28 |
| Rate for Payer: Aetna Commercial |
$362.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$346.13
|
| Rate for Payer: Aetna Managed Medicare |
$112.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$261.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$201.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$193.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$213.31
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Cigna Commercial |
$370.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$225.23
|
| Rate for Payer: Health EOS Commercial |
$358.21
|
| Rate for Payer: HFN Commercial |
$370.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$301.86
|
| Rate for Payer: Multiplan Commercial |
$321.98
|
| Rate for Payer: NAPHCARE Commercial |
$241.49
|
| Rate for Payer: Preferred Network Access Commercial |
$370.28
|
| Rate for Payer: Quartz Beloit One Network |
$197.22
|
| Rate for Payer: Quartz Commercial |
$261.61
|
| Rate for Payer: Quartz Medicare Advantage |
$241.49
|
| Rate for Payer: The Alliance Commercial |
$201.24
|
| Rate for Payer: WEA Trust Commercial |
$221.36
|
| Rate for Payer: WPS Commercial |
$298.11
|
|
|
SCREW CORT 1.5 X 13MM 02.214.113
|
Facility
|
IP
|
$1,054.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966411
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$537.12 |
| Max. Negotiated Rate |
$1,008.47 |
| Rate for Payer: Aetna Commercial |
$986.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$942.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$580.96
|
| Rate for Payer: Cash Price |
$316.20
|
| Rate for Payer: Cigna Commercial |
$1,008.47
|
| Rate for Payer: Health EOS Commercial |
$975.58
|
| Rate for Payer: HFN Commercial |
$1,008.47
|
| Rate for Payer: Multiplan Commercial |
$876.93
|
| Rate for Payer: Preferred Network Access Commercial |
$1,008.47
|
| Rate for Payer: Quartz Beloit One Network |
$537.12
|
| Rate for Payer: Quartz Commercial |
$657.70
|
| Rate for Payer: WEA Trust Commercial |
$602.89
|
| Rate for Payer: WPS Commercial |
$811.90
|
|
|
SCREW CORT 1.5 X 13MM 02.214.113
|
Facility
|
OP
|
$1,054.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966411
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$306.92 |
| Max. Negotiated Rate |
$1,008.47 |
| Rate for Payer: Aetna Commercial |
$986.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$942.70
|
| Rate for Payer: Aetna Managed Medicare |
$306.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$712.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$548.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$526.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$580.96
|
| Rate for Payer: Cash Price |
$316.20
|
| Rate for Payer: Cigna Commercial |
$1,008.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$613.43
|
| Rate for Payer: Health EOS Commercial |
$975.58
|
| Rate for Payer: HFN Commercial |
$1,008.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$822.12
|
| Rate for Payer: Multiplan Commercial |
$876.93
|
| Rate for Payer: NAPHCARE Commercial |
$657.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,008.47
|
| Rate for Payer: Quartz Beloit One Network |
$537.12
|
| Rate for Payer: Quartz Commercial |
$712.50
|
| Rate for Payer: Quartz Medicare Advantage |
$657.70
|
| Rate for Payer: The Alliance Commercial |
$548.08
|
| Rate for Payer: WEA Trust Commercial |
$602.89
|
| Rate for Payer: WPS Commercial |
$811.90
|
|
|
SCREW CORT 1.5 X 13 ST 200.813
|
Facility
|
IP
|
$388.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494543
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$197.72 |
| Max. Negotiated Rate |
$371.24 |
| Rate for Payer: Aetna Commercial |
$363.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$347.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$213.87
|
| Rate for Payer: Cash Price |
$116.40
|
| Rate for Payer: Cigna Commercial |
$371.24
|
| Rate for Payer: Health EOS Commercial |
$359.13
|
| Rate for Payer: HFN Commercial |
$371.24
|
| Rate for Payer: Multiplan Commercial |
$322.82
|
| Rate for Payer: Preferred Network Access Commercial |
$371.24
|
| Rate for Payer: Quartz Beloit One Network |
$197.72
|
| Rate for Payer: Quartz Commercial |
$242.11
|
| Rate for Payer: WEA Trust Commercial |
$221.94
|
| Rate for Payer: WPS Commercial |
$298.88
|
|
