|
SCREW CORT 1.5 X 20 ST 200.820
|
Facility
|
OP
|
$388.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494547
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$112.99 |
| Max. Negotiated Rate |
$371.24 |
| Rate for Payer: Aetna Commercial |
$363.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$347.03
|
| Rate for Payer: Aetna Managed Medicare |
$112.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$262.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$201.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$193.69
|
| 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: Dean Health DHI/DHP/ASO |
$225.82
|
| Rate for Payer: Health EOS Commercial |
$359.13
|
| Rate for Payer: HFN Commercial |
$371.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$302.64
|
| Rate for Payer: Multiplan Commercial |
$322.82
|
| Rate for Payer: NAPHCARE Commercial |
$242.11
|
| Rate for Payer: Preferred Network Access Commercial |
$371.24
|
| Rate for Payer: Quartz Beloit One Network |
$197.72
|
| Rate for Payer: Quartz Commercial |
$262.29
|
| Rate for Payer: Quartz Medicare Advantage |
$242.11
|
| Rate for Payer: The Alliance Commercial |
$201.76
|
| Rate for Payer: WEA Trust Commercial |
$221.94
|
| Rate for Payer: WPS Commercial |
$298.88
|
|
|
SCREW CORT 1.5 X 20 ST 200.820
|
Facility
|
IP
|
$388.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494547
|
|
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
|
|
|
SCREW CORT 1.5 X 22MM 02.214.122
|
Facility
|
OP
|
$1,135.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508917
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$330.51 |
| Max. Negotiated Rate |
$1,085.97 |
| Rate for Payer: Aetna Commercial |
$1,062.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,015.14
|
| Rate for Payer: Aetna Managed Medicare |
$330.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$767.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$590.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$566.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$625.61
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cigna Commercial |
$1,085.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$660.57
|
| Rate for Payer: Health EOS Commercial |
$1,050.56
|
| Rate for Payer: HFN Commercial |
$1,085.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$885.30
|
| Rate for Payer: Multiplan Commercial |
$944.32
|
| Rate for Payer: NAPHCARE Commercial |
$708.24
|
| Rate for Payer: Preferred Network Access Commercial |
$1,085.97
|
| Rate for Payer: Quartz Beloit One Network |
$578.40
|
| Rate for Payer: Quartz Commercial |
$767.26
|
| Rate for Payer: Quartz Medicare Advantage |
$708.24
|
| Rate for Payer: The Alliance Commercial |
$590.20
|
| Rate for Payer: WEA Trust Commercial |
$649.22
|
| Rate for Payer: WPS Commercial |
$874.29
|
|
|
SCREW CORT 1.5 X 22MM 02.214.122
|
Facility
|
IP
|
$1,135.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508917
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$578.40 |
| Max. Negotiated Rate |
$1,085.97 |
| Rate for Payer: Aetna Commercial |
$1,062.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,015.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$625.61
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cigna Commercial |
$1,085.97
|
| Rate for Payer: Health EOS Commercial |
$1,050.56
|
| Rate for Payer: HFN Commercial |
$1,085.97
|
| Rate for Payer: Multiplan Commercial |
$944.32
|
| Rate for Payer: Preferred Network Access Commercial |
$1,085.97
|
| Rate for Payer: Quartz Beloit One Network |
$578.40
|
| Rate for Payer: Quartz Commercial |
$708.24
|
| Rate for Payer: WEA Trust Commercial |
$649.22
|
| Rate for Payer: WPS Commercial |
$874.29
|
|
|
SCREW CORT 1.5 X 22 ST 200.822
|
Facility
|
OP
|
$388.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494548
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$112.99 |
| Max. Negotiated Rate |
$371.24 |
| Rate for Payer: Aetna Commercial |
$363.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$347.03
|
| Rate for Payer: Aetna Managed Medicare |
$112.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$262.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$201.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$193.69
|
| 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: Dean Health DHI/DHP/ASO |
$225.82
|
| Rate for Payer: Health EOS Commercial |
$359.13
|
| Rate for Payer: HFN Commercial |
$371.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$302.64
|
| Rate for Payer: Multiplan Commercial |
$322.82
|
| Rate for Payer: NAPHCARE Commercial |
$242.11
|
| Rate for Payer: Preferred Network Access Commercial |
$371.24
|
| Rate for Payer: Quartz Beloit One Network |
$197.72
|
| Rate for Payer: Quartz Commercial |
$262.29
|
| Rate for Payer: Quartz Medicare Advantage |
$242.11
|
| Rate for Payer: The Alliance Commercial |
$201.76
|
| Rate for Payer: WEA Trust Commercial |
$221.94
|
| Rate for Payer: WPS Commercial |
$298.88
|
|
|
SCREW CORT 1.5 X 22 ST 200.822
|
Facility
|
IP
|
$388.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494548
|
|
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
|
|
|
SCREW CORT 1.5 X 24MM 02.214.124
|
Facility
|
IP
|
$1,135.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508918
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$578.40 |
| Max. Negotiated Rate |
$1,085.97 |
| Rate for Payer: Aetna Commercial |
$1,062.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,015.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$625.61
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cigna Commercial |
$1,085.97
|
| Rate for Payer: Health EOS Commercial |
$1,050.56
|
| Rate for Payer: HFN Commercial |
$1,085.97
|
| Rate for Payer: Multiplan Commercial |
$944.32
|
| Rate for Payer: Preferred Network Access Commercial |
$1,085.97
|
| Rate for Payer: Quartz Beloit One Network |
$578.40
|
| Rate for Payer: Quartz Commercial |
$708.24
|
| Rate for Payer: WEA Trust Commercial |
$649.22
|
| Rate for Payer: WPS Commercial |
$874.29
|
|
|
SCREW CORT 1.5 X 24MM 02.214.124
|
Facility
|
OP
|
$1,135.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508918
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$330.51 |
| Max. Negotiated Rate |
$1,085.97 |
| Rate for Payer: Aetna Commercial |
$1,062.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,015.14
|
| Rate for Payer: Aetna Managed Medicare |
$330.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$767.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$590.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$566.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$625.61
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cigna Commercial |
$1,085.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$660.57
|
| Rate for Payer: Health EOS Commercial |
$1,050.56
|
| Rate for Payer: HFN Commercial |
$1,085.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$885.30
|
| Rate for Payer: Multiplan Commercial |
$944.32
|
| Rate for Payer: NAPHCARE Commercial |
$708.24
|
| Rate for Payer: Preferred Network Access Commercial |
$1,085.97
|
| Rate for Payer: Quartz Beloit One Network |
$578.40
|
| Rate for Payer: Quartz Commercial |
$767.26
|
| Rate for Payer: Quartz Medicare Advantage |
$708.24
|
| Rate for Payer: The Alliance Commercial |
$590.20
|
| Rate for Payer: WEA Trust Commercial |
$649.22
|
| Rate for Payer: WPS Commercial |
$874.29
|
|
|
SCREW CORT 1.5 X 24 ST 200.824
|
Facility
|
OP
|
$388.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494549
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$112.99 |
| Max. Negotiated Rate |
$371.24 |
| Rate for Payer: Aetna Commercial |
$363.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$347.03
|
| Rate for Payer: Aetna Managed Medicare |
$112.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$262.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$201.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$193.69
|
| 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: Dean Health DHI/DHP/ASO |
$225.82
|
| Rate for Payer: Health EOS Commercial |
$359.13
|
| Rate for Payer: HFN Commercial |
$371.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$302.64
|
| Rate for Payer: Multiplan Commercial |
$322.82
|
| Rate for Payer: NAPHCARE Commercial |
$242.11
|
| Rate for Payer: Preferred Network Access Commercial |
$371.24
|
| Rate for Payer: Quartz Beloit One Network |
$197.72
|
| Rate for Payer: Quartz Commercial |
$262.29
|
| Rate for Payer: Quartz Medicare Advantage |
$242.11
|
| Rate for Payer: The Alliance Commercial |
$201.76
|
| Rate for Payer: WEA Trust Commercial |
$221.94
|
| Rate for Payer: WPS Commercial |
$298.88
|
|
|
SCREW CORT 1.5 X 24 ST 200.824
|
Facility
|
IP
|
$388.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494549
|
|
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
|
|
|
SCREW-CORT 1.5 X 6 200.006
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967250
|
|
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 6 200.006
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967250
|
|
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 6MM 02.214.106
|
Facility
|
OP
|
$1,135.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508913
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$330.51 |
| Max. Negotiated Rate |
$1,085.97 |
| Rate for Payer: Aetna Commercial |
$1,062.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,015.14
|
| Rate for Payer: Aetna Managed Medicare |
$330.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$767.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$590.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$566.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$625.61
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cigna Commercial |
$1,085.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$660.57
|
| Rate for Payer: Health EOS Commercial |
$1,050.56
|
| Rate for Payer: HFN Commercial |
$1,085.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$885.30
|
| Rate for Payer: Multiplan Commercial |
$944.32
|
| Rate for Payer: NAPHCARE Commercial |
$708.24
|
| Rate for Payer: Preferred Network Access Commercial |
$1,085.97
|
| Rate for Payer: Quartz Beloit One Network |
$578.40
|
| Rate for Payer: Quartz Commercial |
$767.26
|
| Rate for Payer: Quartz Medicare Advantage |
$708.24
|
| Rate for Payer: The Alliance Commercial |
$590.20
|
| Rate for Payer: WEA Trust Commercial |
$649.22
|
| Rate for Payer: WPS Commercial |
$874.29
|
|
|
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 |
$578.40 |
| Max. Negotiated Rate |
$1,085.97 |
| Rate for Payer: Aetna Commercial |
$1,062.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,015.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$625.61
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cigna Commercial |
$1,085.97
|
| Rate for Payer: Health EOS Commercial |
$1,050.56
|
| Rate for Payer: HFN Commercial |
$1,085.97
|
| Rate for Payer: Multiplan Commercial |
$944.32
|
| Rate for Payer: Preferred Network Access Commercial |
$1,085.97
|
| Rate for Payer: Quartz Beloit One Network |
$578.40
|
| Rate for Payer: Quartz Commercial |
$708.24
|
| Rate for Payer: WEA Trust Commercial |
$649.22
|
| Rate for Payer: WPS Commercial |
$874.29
|
|
|
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 |
$112.99 |
| Max. Negotiated Rate |
$371.24 |
| Rate for Payer: Aetna Commercial |
$363.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$347.03
|
| Rate for Payer: Aetna Managed Medicare |
$112.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$262.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$201.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$193.69
|
| 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: Dean Health DHI/DHP/ASO |
$225.82
|
| Rate for Payer: Health EOS Commercial |
$359.13
|
| Rate for Payer: HFN Commercial |
$371.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$302.64
|
| Rate for Payer: Multiplan Commercial |
$322.82
|
| Rate for Payer: NAPHCARE Commercial |
$242.11
|
| Rate for Payer: Preferred Network Access Commercial |
$371.24
|
| Rate for Payer: Quartz Beloit One Network |
$197.72
|
| Rate for Payer: Quartz Commercial |
$262.29
|
| Rate for Payer: Quartz Medicare Advantage |
$242.11
|
| Rate for Payer: The Alliance Commercial |
$201.76
|
| Rate for Payer: WEA Trust Commercial |
$221.94
|
| Rate for Payer: WPS Commercial |
$298.88
|
|
|
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 |
$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
|
|
|
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 |
$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 7 200.007
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967251
|
|
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 7MM 02.214.107
|
Facility
|
IP
|
$1,016.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966418
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$517.75 |
| Max. Negotiated Rate |
$972.11 |
| Rate for Payer: Aetna Commercial |
$950.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$908.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$560.02
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cigna Commercial |
$972.11
|
| Rate for Payer: Health EOS Commercial |
$940.41
|
| Rate for Payer: HFN Commercial |
$972.11
|
| Rate for Payer: Multiplan Commercial |
$845.31
|
| Rate for Payer: Preferred Network Access Commercial |
$972.11
|
| Rate for Payer: Quartz Beloit One Network |
$517.75
|
| Rate for Payer: Quartz Commercial |
$633.98
|
| Rate for Payer: WEA Trust Commercial |
$581.15
|
| Rate for Payer: WPS Commercial |
$782.62
|
|
|
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 |
$295.86 |
| Max. Negotiated Rate |
$972.11 |
| Rate for Payer: Aetna Commercial |
$950.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$908.71
|
| Rate for Payer: Aetna Managed Medicare |
$295.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$686.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$528.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$507.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$560.02
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cigna Commercial |
$972.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$591.31
|
| Rate for Payer: Health EOS Commercial |
$940.41
|
| Rate for Payer: HFN Commercial |
$972.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$792.48
|
| Rate for Payer: Multiplan Commercial |
$845.31
|
| Rate for Payer: NAPHCARE Commercial |
$633.98
|
| Rate for Payer: Preferred Network Access Commercial |
$972.11
|
| Rate for Payer: Quartz Beloit One Network |
$517.75
|
| Rate for Payer: Quartz Commercial |
$686.82
|
| Rate for Payer: Quartz Medicare Advantage |
$633.98
|
| Rate for Payer: The Alliance Commercial |
$528.32
|
| Rate for Payer: WEA Trust Commercial |
$581.15
|
| Rate for Payer: WPS Commercial |
$782.62
|
|
|
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 |
$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
|
|
|
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 |
$112.99 |
| Max. Negotiated Rate |
$371.24 |
| Rate for Payer: Aetna Commercial |
$363.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$347.03
|
| Rate for Payer: Aetna Managed Medicare |
$112.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$262.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$201.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$193.69
|
| 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: Dean Health DHI/DHP/ASO |
$225.82
|
| Rate for Payer: Health EOS Commercial |
$359.13
|
| Rate for Payer: HFN Commercial |
$371.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$302.64
|
| Rate for Payer: Multiplan Commercial |
$322.82
|
| Rate for Payer: NAPHCARE Commercial |
$242.11
|
| Rate for Payer: Preferred Network Access Commercial |
$371.24
|
| Rate for Payer: Quartz Beloit One Network |
$197.72
|
| Rate for Payer: Quartz Commercial |
$262.29
|
| Rate for Payer: Quartz Medicare Advantage |
$242.11
|
| Rate for Payer: The Alliance Commercial |
$201.76
|
| Rate for Payer: WEA Trust Commercial |
$221.94
|
| Rate for Payer: WPS Commercial |
$298.88
|
|
|
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 |
$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 8 200.008
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967252
|
|
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 8MM 02.130.008
|
Facility
|
OP
|
$790.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5861727
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$230.05 |
| Max. Negotiated Rate |
$755.87 |
| Rate for Payer: Aetna Commercial |
$739.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$706.58
|
| Rate for Payer: Aetna Managed Medicare |
$230.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$534.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$410.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$394.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$435.45
|
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cigna Commercial |
$755.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$459.78
|
| Rate for Payer: Health EOS Commercial |
$731.22
|
| Rate for Payer: HFN Commercial |
$755.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$616.20
|
| Rate for Payer: Multiplan Commercial |
$657.28
|
| Rate for Payer: NAPHCARE Commercial |
$492.96
|
| Rate for Payer: Preferred Network Access Commercial |
$755.87
|
| Rate for Payer: Quartz Beloit One Network |
$402.58
|
| Rate for Payer: Quartz Commercial |
$534.04
|
| Rate for Payer: Quartz Medicare Advantage |
$492.96
|
| Rate for Payer: The Alliance Commercial |
$410.80
|
| Rate for Payer: WEA Trust Commercial |
$451.88
|
| Rate for Payer: WPS Commercial |
$608.54
|
|
