|
SCREW CORT 2.0 X 30MM 201.377.97
|
Facility
|
OP
|
$563.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414986
|
|
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 34MM 201.379.97
|
Facility
|
IP
|
$563.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414987
|
|
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 34MM 201.379.97
|
Facility
|
OP
|
$563.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414987
|
|
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 6 201.006
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967260
|
|
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 6 201.006
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967260
|
|
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 6MM 201.356.97
|
Facility
|
IP
|
$563.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767807
|
|
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 6MM 201.356.97
|
Facility
|
OP
|
$563.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767807
|
|
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 7MM 201.357.97
|
Facility
|
OP
|
$563.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767808
|
|
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 7MM 201.357.97
|
Facility
|
IP
|
$563.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767808
|
|
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 7MM STARDRVE 401.357.97
|
Facility
|
OP
|
$730.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4268740
|
|
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 7MM STARDRVE 401.357.97
|
Facility
|
IP
|
$730.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4268740
|
|
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 8 201.008
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967261
|
|
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 8 201.008
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967261
|
|
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 8MM 201.358.97
|
Facility
|
IP
|
$563.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767809
|
|
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 8MM 201.358.97
|
Facility
|
OP
|
$563.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767809
|
|
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 9MM 201.359.97
|
Facility
|
OP
|
$655.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4858888
|
|
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 9MM 201.359.97
|
Facility
|
IP
|
$655.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4858888
|
|
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 9MM STARDRIVE 401.359.97
|
Facility
|
OP
|
$730.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4640856
|
|
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 9MM STARDRIVE 401.359.97
|
Facility
|
IP
|
$730.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4640856
|
|
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 2.3 X 14 NON-TOGGLE CO-N2314
|
Facility
|
OP
|
$1,536.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5611755
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$447.28 |
| Max. Negotiated Rate |
$1,469.64 |
| Rate for Payer: Aetna Commercial |
$1,437.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,373.80
|
| Rate for Payer: Aetna Managed Medicare |
$447.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,038.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$798.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$766.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$846.64
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Cigna Commercial |
$1,469.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$893.95
|
| Rate for Payer: Health EOS Commercial |
$1,421.72
|
| Rate for Payer: HFN Commercial |
$1,469.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,198.08
|
| Rate for Payer: Multiplan Commercial |
$1,277.95
|
| Rate for Payer: NAPHCARE Commercial |
$958.46
|
| Rate for Payer: Preferred Network Access Commercial |
$1,469.64
|
| Rate for Payer: Quartz Beloit One Network |
$782.75
|
| Rate for Payer: Quartz Commercial |
$1,038.34
|
| Rate for Payer: Quartz Medicare Advantage |
$958.46
|
| Rate for Payer: The Alliance Commercial |
$798.72
|
| Rate for Payer: WEA Trust Commercial |
$878.59
|
| Rate for Payer: WPS Commercial |
$1,183.18
|
|
|
SCREW CORT 2.3 X 14 NON-TOGGLE CO-N2314
|
Facility
|
IP
|
$1,536.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5611755
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$782.75 |
| Max. Negotiated Rate |
$1,469.64 |
| Rate for Payer: Aetna Commercial |
$1,437.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,373.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$846.64
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Cigna Commercial |
$1,469.64
|
| Rate for Payer: Health EOS Commercial |
$1,421.72
|
| Rate for Payer: HFN Commercial |
$1,469.64
|
| Rate for Payer: Multiplan Commercial |
$1,277.95
|
| Rate for Payer: Preferred Network Access Commercial |
$1,469.64
|
| Rate for Payer: Quartz Beloit One Network |
$782.75
|
| Rate for Payer: Quartz Commercial |
$958.46
|
| Rate for Payer: WEA Trust Commercial |
$878.59
|
| Rate for Payer: WPS Commercial |
$1,183.18
|
|
|
SCREW CORT 2.3 X 16 NON-TOGGLE CO-N2316
|
Facility
|
IP
|
$1,429.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2964150
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$728.22 |
| Max. Negotiated Rate |
$1,367.27 |
| Rate for Payer: Aetna Commercial |
$1,337.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,278.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$787.66
|
| Rate for Payer: Cash Price |
$428.70
|
| Rate for Payer: Cigna Commercial |
$1,367.27
|
| Rate for Payer: Health EOS Commercial |
$1,322.68
|
| Rate for Payer: HFN Commercial |
$1,367.27
|
| Rate for Payer: Multiplan Commercial |
$1,188.93
|
| Rate for Payer: Preferred Network Access Commercial |
$1,367.27
|
| Rate for Payer: Quartz Beloit One Network |
$728.22
|
| Rate for Payer: Quartz Commercial |
$891.70
|
| Rate for Payer: WEA Trust Commercial |
$817.39
|
| Rate for Payer: WPS Commercial |
$1,100.76
|
|
|
SCREW CORT 2.3 X 16 NON-TOGGLE CO-N2316
|
Facility
|
OP
|
$1,429.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2964150
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$416.12 |
| Max. Negotiated Rate |
$1,367.27 |
| Rate for Payer: Aetna Commercial |
$1,337.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,278.10
|
| Rate for Payer: Aetna Managed Medicare |
$416.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$966.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$743.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$713.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$787.66
|
| Rate for Payer: Cash Price |
$428.70
|
| Rate for Payer: Cigna Commercial |
$1,367.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$831.68
|
| Rate for Payer: Health EOS Commercial |
$1,322.68
|
| Rate for Payer: HFN Commercial |
$1,367.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,114.62
|
| Rate for Payer: Multiplan Commercial |
$1,188.93
|
| Rate for Payer: NAPHCARE Commercial |
$891.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,367.27
|
| Rate for Payer: Quartz Beloit One Network |
$728.22
|
| Rate for Payer: Quartz Commercial |
$966.00
|
| Rate for Payer: Quartz Medicare Advantage |
$891.70
|
| Rate for Payer: The Alliance Commercial |
$743.08
|
| Rate for Payer: WEA Trust Commercial |
$817.39
|
| Rate for Payer: WPS Commercial |
$1,100.76
|
|
|
SCREW CORT 2.3 X 18 NON-TOGGLE CO-N2318
|
Facility
|
OP
|
$1,536.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4632656
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$447.28 |
| Max. Negotiated Rate |
$1,469.64 |
| Rate for Payer: Aetna Commercial |
$1,437.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,373.80
|
| Rate for Payer: Aetna Managed Medicare |
$447.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,038.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$798.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$766.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$846.64
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Cigna Commercial |
$1,469.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$893.95
|
| Rate for Payer: Health EOS Commercial |
$1,421.72
|
| Rate for Payer: HFN Commercial |
$1,469.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,198.08
|
| Rate for Payer: Multiplan Commercial |
$1,277.95
|
| Rate for Payer: NAPHCARE Commercial |
$958.46
|
| Rate for Payer: Preferred Network Access Commercial |
$1,469.64
|
| Rate for Payer: Quartz Beloit One Network |
$782.75
|
| Rate for Payer: Quartz Commercial |
$1,038.34
|
| Rate for Payer: Quartz Medicare Advantage |
$958.46
|
| Rate for Payer: The Alliance Commercial |
$798.72
|
| Rate for Payer: WEA Trust Commercial |
$878.59
|
| Rate for Payer: WPS Commercial |
$1,183.18
|
|
|
SCREW CORT 2.3 X 18 NON-TOGGLE CO-N2318
|
Facility
|
IP
|
$1,536.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4632656
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$782.75 |
| Max. Negotiated Rate |
$1,469.64 |
| Rate for Payer: Aetna Commercial |
$1,437.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,373.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$846.64
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Cigna Commercial |
$1,469.64
|
| Rate for Payer: Health EOS Commercial |
$1,421.72
|
| Rate for Payer: HFN Commercial |
$1,469.64
|
| Rate for Payer: Multiplan Commercial |
$1,277.95
|
| Rate for Payer: Preferred Network Access Commercial |
$1,469.64
|
| Rate for Payer: Quartz Beloit One Network |
$782.75
|
| Rate for Payer: Quartz Commercial |
$958.46
|
| Rate for Payer: WEA Trust Commercial |
$878.59
|
| Rate for Payer: WPS Commercial |
$1,183.18
|
|
