|
SCREW CORT 2.0 X 15MM 201.365.97
|
Facility
|
IP
|
$748.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6181463
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$381.18 |
| Max. Negotiated Rate |
$715.69 |
| Rate for Payer: Aetna Commercial |
$700.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$669.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$412.30
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cigna Commercial |
$715.69
|
| Rate for Payer: Health EOS Commercial |
$692.35
|
| Rate for Payer: HFN Commercial |
$715.69
|
| Rate for Payer: Multiplan Commercial |
$622.34
|
| Rate for Payer: Preferred Network Access Commercial |
$715.69
|
| Rate for Payer: Quartz Beloit One Network |
$381.18
|
| Rate for Payer: Quartz Commercial |
$466.75
|
| Rate for Payer: WEA Trust Commercial |
$427.86
|
| Rate for Payer: WPS Commercial |
$576.18
|
|
|
SCREW CORT 2.0 X 15MM 201.365.97
|
Facility
|
OP
|
$748.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6181463
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$217.82 |
| Max. Negotiated Rate |
$715.69 |
| Rate for Payer: Aetna Commercial |
$700.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$669.01
|
| Rate for Payer: Aetna Managed Medicare |
$217.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$505.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$388.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$373.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$412.30
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cigna Commercial |
$715.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$435.34
|
| Rate for Payer: Health EOS Commercial |
$692.35
|
| Rate for Payer: HFN Commercial |
$715.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$583.44
|
| Rate for Payer: Multiplan Commercial |
$622.34
|
| Rate for Payer: NAPHCARE Commercial |
$466.75
|
| Rate for Payer: Preferred Network Access Commercial |
$715.69
|
| Rate for Payer: Quartz Beloit One Network |
$381.18
|
| Rate for Payer: Quartz Commercial |
$505.65
|
| Rate for Payer: Quartz Medicare Advantage |
$466.75
|
| Rate for Payer: The Alliance Commercial |
$388.96
|
| Rate for Payer: WEA Trust Commercial |
$427.86
|
| Rate for Payer: WPS Commercial |
$576.18
|
|
|
SCREW-CORT 2.0 X 16 201.016
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967257
|
|
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 16 201.016
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967257
|
|
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 16MM 201.366.97
|
Facility
|
OP
|
$655.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966433
|
|
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 16MM 201.366.97
|
Facility
|
IP
|
$655.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966433
|
|
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 18 201.018
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967258
|
|
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 18 201.018
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967258
|
|
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 2.0 X 18MM 201.368.97
|
Facility
|
IP
|
$563.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414984
|
|
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 18MM 201.368.97
|
Facility
|
OP
|
$563.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414984
|
|
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 18MM STARDRIVE 401.368.97
|
Facility
|
IP
|
$961.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966435
|
|
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 18MM STARDRIVE 401.368.97
|
Facility
|
OP
|
$961.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966435
|
|
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 20 201.020
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967259
|
|
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 20 201.020
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967259
|
|
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 20MM 201.370.97
|
Facility
|
IP
|
$681.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966437
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$347.04 |
| Max. Negotiated Rate |
$651.58 |
| Rate for Payer: Aetna Commercial |
$637.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$609.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$375.37
|
| Rate for Payer: Cash Price |
$204.30
|
| Rate for Payer: Cigna Commercial |
$651.58
|
| Rate for Payer: Health EOS Commercial |
$630.33
|
| Rate for Payer: HFN Commercial |
$651.58
|
| Rate for Payer: Multiplan Commercial |
$566.59
|
| Rate for Payer: Preferred Network Access Commercial |
$651.58
|
| Rate for Payer: Quartz Beloit One Network |
$347.04
|
| Rate for Payer: Quartz Commercial |
$424.94
|
| Rate for Payer: WEA Trust Commercial |
$389.53
|
| Rate for Payer: WPS Commercial |
$524.57
|
|
|
SCREW CORT 2.0 X 20MM 201.370.97
|
Facility
|
OP
|
$681.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966437
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.31 |
| Max. Negotiated Rate |
$651.58 |
| Rate for Payer: Aetna Commercial |
$637.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$609.09
|
| Rate for Payer: Aetna Managed Medicare |
$198.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$460.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$354.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$339.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$375.37
|
| Rate for Payer: Cash Price |
$204.30
|
| Rate for Payer: Cigna Commercial |
$651.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$396.34
|
| Rate for Payer: Health EOS Commercial |
$630.33
|
| Rate for Payer: HFN Commercial |
$651.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$531.18
|
| Rate for Payer: Multiplan Commercial |
$566.59
|
| Rate for Payer: NAPHCARE Commercial |
$424.94
|
| Rate for Payer: Preferred Network Access Commercial |
$651.58
|
| Rate for Payer: Quartz Beloit One Network |
$347.04
|
| Rate for Payer: Quartz Commercial |
$460.36
|
| Rate for Payer: Quartz Medicare Advantage |
$424.94
|
| Rate for Payer: The Alliance Commercial |
$354.12
|
| Rate for Payer: WEA Trust Commercial |
$389.53
|
| Rate for Payer: WPS Commercial |
$524.57
|
|
|
SCREW CORT 2.0 X 22MM 201.372.97
|
Facility
|
IP
|
$563.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767810
|
|
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 22MM 201.372.97
|
Facility
|
OP
|
$563.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767810
|
|
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 24MM 201.374.97
|
Facility
|
OP
|
$563.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414985
|
|
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 24MM 201.374.97
|
Facility
|
IP
|
$563.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414985
|
|
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 26MM 201.375.97
|
Facility
|
OP
|
$563.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767811
|
|
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 26MM 201.375.97
|
Facility
|
IP
|
$563.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767811
|
|
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 28MM 201.376.97
|
Facility
|
IP
|
$563.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767812
|
|
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 28MM 201.376.97
|
Facility
|
OP
|
$563.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767812
|
|
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 30MM 201.377.97
|
Facility
|
IP
|
$563.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414986
|
|
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
|
|
