|
SCREW-CORT 2.0 X 10 201.010
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967254
|
|
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 2.0 X 10MM 201.360.97
|
Facility
|
IP
|
$655.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966425
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$333.79 |
| Max. Negotiated Rate |
$626.70 |
| Rate for Payer: Aetna Commercial |
$613.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$585.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$361.04
|
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: Cigna Commercial |
$626.70
|
| Rate for Payer: Health EOS Commercial |
$606.27
|
| Rate for Payer: HFN Commercial |
$626.70
|
| Rate for Payer: Multiplan Commercial |
$544.96
|
| Rate for Payer: Preferred Network Access Commercial |
$626.70
|
| Rate for Payer: Quartz Beloit One Network |
$333.79
|
| Rate for Payer: Quartz Commercial |
$408.72
|
| Rate for Payer: WEA Trust Commercial |
$374.66
|
| Rate for Payer: WPS Commercial |
$504.55
|
|
|
SCREW CORT 2.0 X 10MM 201.360.97
|
Facility
|
OP
|
$655.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966425
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$190.74 |
| Max. Negotiated Rate |
$626.70 |
| Rate for Payer: Aetna Commercial |
$613.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$585.83
|
| Rate for Payer: Aetna Managed Medicare |
$190.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$442.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$340.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$326.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$361.04
|
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: Cigna Commercial |
$626.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$381.21
|
| Rate for Payer: Health EOS Commercial |
$606.27
|
| Rate for Payer: HFN Commercial |
$626.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$510.90
|
| Rate for Payer: Multiplan Commercial |
$544.96
|
| Rate for Payer: NAPHCARE Commercial |
$408.72
|
| Rate for Payer: Preferred Network Access Commercial |
$626.70
|
| Rate for Payer: Quartz Beloit One Network |
$333.79
|
| Rate for Payer: Quartz Commercial |
$442.78
|
| Rate for Payer: Quartz Medicare Advantage |
$408.72
|
| Rate for Payer: The Alliance Commercial |
$340.60
|
| Rate for Payer: WEA Trust Commercial |
$374.66
|
| Rate for Payer: WPS Commercial |
$504.55
|
|
|
SCREW CORT 2.0 X 10MM STARDRIVE 401.360.97
|
Facility
|
IP
|
$730.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3313467
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$372.01 |
| Max. Negotiated Rate |
$698.46 |
| Rate for Payer: Aetna Commercial |
$683.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$652.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$402.38
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cigna Commercial |
$698.46
|
| Rate for Payer: Health EOS Commercial |
$675.69
|
| Rate for Payer: HFN Commercial |
$698.46
|
| Rate for Payer: Multiplan Commercial |
$607.36
|
| Rate for Payer: Preferred Network Access Commercial |
$698.46
|
| Rate for Payer: Quartz Beloit One Network |
$372.01
|
| Rate for Payer: Quartz Commercial |
$455.52
|
| Rate for Payer: WEA Trust Commercial |
$417.56
|
| Rate for Payer: WPS Commercial |
$562.32
|
|
|
SCREW CORT 2.0 X 10MM STARDRIVE 401.360.97
|
Facility
|
OP
|
$730.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3313467
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$212.58 |
| Max. Negotiated Rate |
$698.46 |
| Rate for Payer: Aetna Commercial |
$683.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$652.91
|
| Rate for Payer: Aetna Managed Medicare |
$212.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$493.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$379.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$364.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$402.38
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cigna Commercial |
$698.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$424.86
|
| Rate for Payer: Health EOS Commercial |
$675.69
|
| Rate for Payer: HFN Commercial |
$698.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$569.40
|
| Rate for Payer: Multiplan Commercial |
$607.36
|
| Rate for Payer: NAPHCARE Commercial |
$455.52
|
| Rate for Payer: Preferred Network Access Commercial |
$698.46
|
| Rate for Payer: Quartz Beloit One Network |
$372.01
|
| Rate for Payer: Quartz Commercial |
$493.48
|
| Rate for Payer: Quartz Medicare Advantage |
$455.52
|
| Rate for Payer: The Alliance Commercial |
$379.60
|
| Rate for Payer: WEA Trust Commercial |
$417.56
|
| Rate for Payer: WPS Commercial |
$562.32
|
|
|
SCREW CORT 2.0 X 11MM 201.361.97
|
Facility
|
OP
|
$655.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966428
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$190.74 |
| Max. Negotiated Rate |
$626.70 |
| Rate for Payer: Aetna Commercial |
$613.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$585.83
|
| Rate for Payer: Aetna Managed Medicare |
$190.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$442.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$340.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$326.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$361.04
|
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: Cigna Commercial |
$626.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$381.21
|
| Rate for Payer: Health EOS Commercial |
$606.27
|
| Rate for Payer: HFN Commercial |
$626.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$510.90
|
| Rate for Payer: Multiplan Commercial |
$544.96
|
| Rate for Payer: NAPHCARE Commercial |
$408.72
|
| Rate for Payer: Preferred Network Access Commercial |
$626.70
|
| Rate for Payer: Quartz Beloit One Network |
$333.79
|
| Rate for Payer: Quartz Commercial |
$442.78
|
| Rate for Payer: Quartz Medicare Advantage |
$408.72
|
| Rate for Payer: The Alliance Commercial |
$340.60
|
| Rate for Payer: WEA Trust Commercial |
$374.66
|
| Rate for Payer: WPS Commercial |
$504.55
|
|
|
SCREW CORT 2.0 X 11MM 201.361.97
|
Facility
|
IP
|
$655.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966428
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$333.79 |
| Max. Negotiated Rate |
$626.70 |
| Rate for Payer: Aetna Commercial |
$613.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$585.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$361.04
|
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: Cigna Commercial |
$626.70
|
| Rate for Payer: Health EOS Commercial |
$606.27
|
| Rate for Payer: HFN Commercial |
$626.70
|
| Rate for Payer: Multiplan Commercial |
$544.96
|
| Rate for Payer: Preferred Network Access Commercial |
$626.70
|
| Rate for Payer: Quartz Beloit One Network |
$333.79
|
| Rate for Payer: Quartz Commercial |
$408.72
|
| Rate for Payer: WEA Trust Commercial |
$374.66
|
| Rate for Payer: WPS Commercial |
$504.55
|
|
|
SCREW CORT 2.0 X 11MM STARDRIVE 401.361.97
|
Facility
|
IP
|
$730.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3313466
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$372.01 |
| Max. Negotiated Rate |
$698.46 |
| Rate for Payer: Aetna Commercial |
$683.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$652.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$402.38
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cigna Commercial |
$698.46
|
| Rate for Payer: Health EOS Commercial |
$675.69
|
| Rate for Payer: HFN Commercial |
$698.46
|
| Rate for Payer: Multiplan Commercial |
$607.36
|
| Rate for Payer: Preferred Network Access Commercial |
$698.46
|
| Rate for Payer: Quartz Beloit One Network |
$372.01
|
| Rate for Payer: Quartz Commercial |
$455.52
|
| Rate for Payer: WEA Trust Commercial |
$417.56
|
| Rate for Payer: WPS Commercial |
$562.32
|
|
|
SCREW CORT 2.0 X 11MM STARDRIVE 401.361.97
|
Facility
|
OP
|
$730.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3313466
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$212.58 |
| Max. Negotiated Rate |
$698.46 |
| Rate for Payer: Aetna Commercial |
$683.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$652.91
|
| Rate for Payer: Aetna Managed Medicare |
$212.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$493.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$379.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$364.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$402.38
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cigna Commercial |
$698.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$424.86
|
| Rate for Payer: Health EOS Commercial |
$675.69
|
| Rate for Payer: HFN Commercial |
$698.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$569.40
|
| Rate for Payer: Multiplan Commercial |
$607.36
|
| Rate for Payer: NAPHCARE Commercial |
$455.52
|
| Rate for Payer: Preferred Network Access Commercial |
$698.46
|
| Rate for Payer: Quartz Beloit One Network |
$372.01
|
| Rate for Payer: Quartz Commercial |
$493.48
|
| Rate for Payer: Quartz Medicare Advantage |
$455.52
|
| Rate for Payer: The Alliance Commercial |
$379.60
|
| Rate for Payer: WEA Trust Commercial |
$417.56
|
| Rate for Payer: WPS Commercial |
$562.32
|
|
|
SCREW-CORT 2.0 X 12 201.012
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967255
|
|
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 2.0 X 12 201.012
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967255
|
|
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 2.0 X 12MM 201.362.97
|
Facility
|
IP
|
$655.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3313463
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$333.79 |
| Max. Negotiated Rate |
$626.70 |
| Rate for Payer: Aetna Commercial |
$613.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$585.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$361.04
|
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: Cigna Commercial |
$626.70
|
| Rate for Payer: Health EOS Commercial |
$606.27
|
| Rate for Payer: HFN Commercial |
$626.70
|
| Rate for Payer: Multiplan Commercial |
$544.96
|
| Rate for Payer: Preferred Network Access Commercial |
$626.70
|
| Rate for Payer: Quartz Beloit One Network |
$333.79
|
| Rate for Payer: Quartz Commercial |
$408.72
|
| Rate for Payer: WEA Trust Commercial |
$374.66
|
| Rate for Payer: WPS Commercial |
$504.55
|
|
|
SCREW CORT 2.0 X 12MM 201.362.97
|
Facility
|
OP
|
$655.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3313463
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$190.74 |
| Max. Negotiated Rate |
$626.70 |
| Rate for Payer: Aetna Commercial |
$613.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$585.83
|
| Rate for Payer: Aetna Managed Medicare |
$190.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$442.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$340.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$326.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$361.04
|
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: Cigna Commercial |
$626.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$381.21
|
| Rate for Payer: Health EOS Commercial |
$606.27
|
| Rate for Payer: HFN Commercial |
$626.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$510.90
|
| Rate for Payer: Multiplan Commercial |
$544.96
|
| Rate for Payer: NAPHCARE Commercial |
$408.72
|
| Rate for Payer: Preferred Network Access Commercial |
$626.70
|
| Rate for Payer: Quartz Beloit One Network |
$333.79
|
| Rate for Payer: Quartz Commercial |
$442.78
|
| Rate for Payer: Quartz Medicare Advantage |
$408.72
|
| Rate for Payer: The Alliance Commercial |
$340.60
|
| Rate for Payer: WEA Trust Commercial |
$374.66
|
| Rate for Payer: WPS Commercial |
$504.55
|
|
|
SCREW CORT 2.0 X 12MM STARDRIVE 401.362.97
|
Facility
|
IP
|
$961.00
|
|
| Hospital Charge Code |
2966430
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$489.73 |
| Max. Negotiated Rate |
$919.48 |
| Rate for Payer: Aetna Commercial |
$899.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$859.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$529.70
|
| Rate for Payer: Cash Price |
$288.30
|
| Rate for Payer: Cigna Commercial |
$919.48
|
| Rate for Payer: Health EOS Commercial |
$889.50
|
| Rate for Payer: HFN Commercial |
$919.48
|
| Rate for Payer: Multiplan Commercial |
$799.55
|
| Rate for Payer: Preferred Network Access Commercial |
$919.48
|
| Rate for Payer: Quartz Beloit One Network |
$489.73
|
| Rate for Payer: Quartz Commercial |
$599.66
|
| Rate for Payer: WEA Trust Commercial |
$549.69
|
| Rate for Payer: WPS Commercial |
$740.26
|
|
|
SCREW CORT 2.0 X 12MM STARDRIVE 401.362.97
|
Facility
|
OP
|
$961.00
|
|
| Hospital Charge Code |
2966430
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$279.84 |
| Max. Negotiated Rate |
$919.48 |
| Rate for Payer: Aetna Commercial |
$899.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$859.52
|
| Rate for Payer: Aetna Managed Medicare |
$279.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$649.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$499.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$479.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$529.70
|
| Rate for Payer: Cash Price |
$288.30
|
| Rate for Payer: Cigna Commercial |
$919.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$559.30
|
| Rate for Payer: Health EOS Commercial |
$889.50
|
| Rate for Payer: HFN Commercial |
$919.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$749.58
|
| Rate for Payer: Multiplan Commercial |
$799.55
|
| Rate for Payer: NAPHCARE Commercial |
$599.66
|
| Rate for Payer: Preferred Network Access Commercial |
$919.48
|
| Rate for Payer: Quartz Beloit One Network |
$489.73
|
| Rate for Payer: Quartz Commercial |
$649.64
|
| Rate for Payer: Quartz Medicare Advantage |
$599.66
|
| Rate for Payer: The Alliance Commercial |
$499.72
|
| Rate for Payer: WEA Trust Commercial |
$549.69
|
| Rate for Payer: WPS Commercial |
$740.26
|
|
|
SCREW CORT 2.0 X 13MM 201.363.97
|
Facility
|
OP
|
$655.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4858883
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$190.74 |
| Max. Negotiated Rate |
$626.70 |
| Rate for Payer: Aetna Commercial |
$613.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$585.83
|
| Rate for Payer: Aetna Managed Medicare |
$190.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$442.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$340.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$326.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$361.04
|
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: Cigna Commercial |
$626.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$381.21
|
| Rate for Payer: Health EOS Commercial |
$606.27
|
| Rate for Payer: HFN Commercial |
$626.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$510.90
|
| Rate for Payer: Multiplan Commercial |
$544.96
|
| Rate for Payer: NAPHCARE Commercial |
$408.72
|
| Rate for Payer: Preferred Network Access Commercial |
$626.70
|
| Rate for Payer: Quartz Beloit One Network |
$333.79
|
| Rate for Payer: Quartz Commercial |
$442.78
|
| Rate for Payer: Quartz Medicare Advantage |
$408.72
|
| Rate for Payer: The Alliance Commercial |
$340.60
|
| Rate for Payer: WEA Trust Commercial |
$374.66
|
| Rate for Payer: WPS Commercial |
$504.55
|
|
|
SCREW CORT 2.0 X 13MM 201.363.97
|
Facility
|
IP
|
$655.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4858883
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$333.79 |
| Max. Negotiated Rate |
$626.70 |
| Rate for Payer: Aetna Commercial |
$613.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$585.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$361.04
|
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: Cigna Commercial |
$626.70
|
| Rate for Payer: Health EOS Commercial |
$606.27
|
| Rate for Payer: HFN Commercial |
$626.70
|
| Rate for Payer: Multiplan Commercial |
$544.96
|
| Rate for Payer: Preferred Network Access Commercial |
$626.70
|
| Rate for Payer: Quartz Beloit One Network |
$333.79
|
| Rate for Payer: Quartz Commercial |
$408.72
|
| Rate for Payer: WEA Trust Commercial |
$374.66
|
| Rate for Payer: WPS Commercial |
$504.55
|
|
|
SCREW CORT 2.0 X 13MM STARDRIVE 401.363.97
|
Facility
|
OP
|
$730.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3313465
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$212.58 |
| Max. Negotiated Rate |
$698.46 |
| Rate for Payer: Aetna Commercial |
$683.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$652.91
|
| Rate for Payer: Aetna Managed Medicare |
$212.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$493.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$379.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$364.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$402.38
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cigna Commercial |
$698.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$424.86
|
| Rate for Payer: Health EOS Commercial |
$675.69
|
| Rate for Payer: HFN Commercial |
$698.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$569.40
|
| Rate for Payer: Multiplan Commercial |
$607.36
|
| Rate for Payer: NAPHCARE Commercial |
$455.52
|
| Rate for Payer: Preferred Network Access Commercial |
$698.46
|
| Rate for Payer: Quartz Beloit One Network |
$372.01
|
| Rate for Payer: Quartz Commercial |
$493.48
|
| Rate for Payer: Quartz Medicare Advantage |
$455.52
|
| Rate for Payer: The Alliance Commercial |
$379.60
|
| Rate for Payer: WEA Trust Commercial |
$417.56
|
| Rate for Payer: WPS Commercial |
$562.32
|
|
|
SCREW CORT 2.0 X 13MM STARDRIVE 401.363.97
|
Facility
|
IP
|
$730.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3313465
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$372.01 |
| Max. Negotiated Rate |
$698.46 |
| Rate for Payer: Aetna Commercial |
$683.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$652.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$402.38
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cigna Commercial |
$698.46
|
| Rate for Payer: Health EOS Commercial |
$675.69
|
| Rate for Payer: HFN Commercial |
$698.46
|
| Rate for Payer: Multiplan Commercial |
$607.36
|
| Rate for Payer: Preferred Network Access Commercial |
$698.46
|
| Rate for Payer: Quartz Beloit One Network |
$372.01
|
| Rate for Payer: Quartz Commercial |
$455.52
|
| Rate for Payer: WEA Trust Commercial |
$417.56
|
| Rate for Payer: WPS Commercial |
$562.32
|
|
|
SCREW-CORT 2.0 X 14 201.014
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967256
|
|
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 2.0 X 14 201.014
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967256
|
|
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 2.0 X 14MM 201.364.97
|
Facility
|
OP
|
$563.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767792
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$163.95 |
| Max. Negotiated Rate |
$538.68 |
| Rate for Payer: Aetna Commercial |
$526.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$503.55
|
| Rate for Payer: Aetna Managed Medicare |
$163.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$380.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$292.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$281.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$310.33
|
| Rate for Payer: Cash Price |
$168.90
|
| Rate for Payer: Cigna Commercial |
$538.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$327.67
|
| Rate for Payer: Health EOS Commercial |
$521.11
|
| Rate for Payer: HFN Commercial |
$538.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$439.14
|
| Rate for Payer: Multiplan Commercial |
$468.42
|
| Rate for Payer: NAPHCARE Commercial |
$351.31
|
| Rate for Payer: Preferred Network Access Commercial |
$538.68
|
| Rate for Payer: Quartz Beloit One Network |
$286.90
|
| Rate for Payer: Quartz Commercial |
$380.59
|
| Rate for Payer: Quartz Medicare Advantage |
$351.31
|
| Rate for Payer: The Alliance Commercial |
$292.76
|
| Rate for Payer: WEA Trust Commercial |
$322.04
|
| Rate for Payer: WPS Commercial |
$433.68
|
|
|
SCREW CORT 2.0 X 14MM 201.364.97
|
Facility
|
IP
|
$563.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767792
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$286.90 |
| Max. Negotiated Rate |
$538.68 |
| Rate for Payer: Aetna Commercial |
$526.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$503.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$310.33
|
| Rate for Payer: Cash Price |
$168.90
|
| Rate for Payer: Cigna Commercial |
$538.68
|
| Rate for Payer: Health EOS Commercial |
$521.11
|
| Rate for Payer: HFN Commercial |
$538.68
|
| Rate for Payer: Multiplan Commercial |
$468.42
|
| Rate for Payer: Preferred Network Access Commercial |
$538.68
|
| Rate for Payer: Quartz Beloit One Network |
$286.90
|
| Rate for Payer: Quartz Commercial |
$351.31
|
| Rate for Payer: WEA Trust Commercial |
$322.04
|
| Rate for Payer: WPS Commercial |
$433.68
|
|
|
SCREW CORT 2.0 X 14MM STARDRIVE 401.364.97
|
Facility
|
IP
|
$730.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3813013
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$372.01 |
| Max. Negotiated Rate |
$698.46 |
| Rate for Payer: Aetna Commercial |
$683.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$652.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$402.38
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cigna Commercial |
$698.46
|
| Rate for Payer: Health EOS Commercial |
$675.69
|
| Rate for Payer: HFN Commercial |
$698.46
|
| Rate for Payer: Multiplan Commercial |
$607.36
|
| Rate for Payer: Preferred Network Access Commercial |
$698.46
|
| Rate for Payer: Quartz Beloit One Network |
$372.01
|
| Rate for Payer: Quartz Commercial |
$455.52
|
| Rate for Payer: WEA Trust Commercial |
$417.56
|
| Rate for Payer: WPS Commercial |
$562.32
|
|
|
SCREW CORT 2.0 X 14MM STARDRIVE 401.364.97
|
Facility
|
OP
|
$730.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3813013
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$212.58 |
| Max. Negotiated Rate |
$698.46 |
| Rate for Payer: Aetna Commercial |
$683.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$652.91
|
| Rate for Payer: Aetna Managed Medicare |
$212.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$493.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$379.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$364.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$402.38
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cigna Commercial |
$698.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$424.86
|
| Rate for Payer: Health EOS Commercial |
$675.69
|
| Rate for Payer: HFN Commercial |
$698.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$569.40
|
| Rate for Payer: Multiplan Commercial |
$607.36
|
| Rate for Payer: NAPHCARE Commercial |
$455.52
|
| Rate for Payer: Preferred Network Access Commercial |
$698.46
|
| Rate for Payer: Quartz Beloit One Network |
$372.01
|
| Rate for Payer: Quartz Commercial |
$493.48
|
| Rate for Payer: Quartz Medicare Advantage |
$455.52
|
| Rate for Payer: The Alliance Commercial |
$379.60
|
| Rate for Payer: WEA Trust Commercial |
$417.56
|
| Rate for Payer: WPS Commercial |
$562.32
|
|
