|
SCREW CORT 1.0 X 11 ST 200.531
|
Facility
|
IP
|
$1,020.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494520
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$499.80 |
| Max. Negotiated Rate |
$938.40 |
| Rate for Payer: Aetna Commercial |
$918.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$877.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$540.60
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$938.40
|
| Rate for Payer: Health EOS Commercial |
$907.80
|
| Rate for Payer: HFN Commercial |
$938.40
|
| Rate for Payer: Multiplan Commercial |
$816.00
|
| Rate for Payer: NAPHCARE Commercial |
$612.00
|
| Rate for Payer: Preferred Network Access Commercial |
$938.40
|
| Rate for Payer: Quartz Beloit One Network |
$499.80
|
| Rate for Payer: Quartz Commercial |
$612.00
|
| Rate for Payer: WEA Trust Commercial |
$561.00
|
| Rate for Payer: WPS Commercial |
$755.51
|
|
|
SCREW CORT 1.0 X 11 ST 200.531
|
Facility
|
OP
|
$1,020.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494520
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$285.60 |
| Max. Negotiated Rate |
$4,080.00 |
| Rate for Payer: Aetna Commercial |
$918.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$877.20
|
| Rate for Payer: Aetna Managed Medicare |
$285.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$663.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$510.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$489.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$540.60
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$938.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$570.79
|
| Rate for Payer: Health EOS Commercial |
$907.80
|
| Rate for Payer: HFN Commercial |
$938.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$765.00
|
| Rate for Payer: Multiplan Commercial |
$816.00
|
| Rate for Payer: NAPHCARE Commercial |
$612.00
|
| Rate for Payer: Preferred Network Access Commercial |
$938.40
|
| Rate for Payer: Quartz Beloit One Network |
$499.80
|
| Rate for Payer: Quartz Commercial |
$663.00
|
| Rate for Payer: Quartz Medicare Advantage |
$612.00
|
| Rate for Payer: The Alliance Commercial |
$4,080.00
|
| Rate for Payer: WEA Trust Commercial |
$561.00
|
| Rate for Payer: WPS Commercial |
$755.51
|
|
|
SCREW CORT 1.0 X 12 ST 200.532
|
Facility
|
IP
|
$1,020.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494521
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$499.80 |
| Max. Negotiated Rate |
$938.40 |
| Rate for Payer: Aetna Commercial |
$918.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$877.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$540.60
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$938.40
|
| Rate for Payer: Health EOS Commercial |
$907.80
|
| Rate for Payer: HFN Commercial |
$938.40
|
| Rate for Payer: Multiplan Commercial |
$816.00
|
| Rate for Payer: NAPHCARE Commercial |
$612.00
|
| Rate for Payer: Preferred Network Access Commercial |
$938.40
|
| Rate for Payer: Quartz Beloit One Network |
$499.80
|
| Rate for Payer: Quartz Commercial |
$612.00
|
| Rate for Payer: WEA Trust Commercial |
$561.00
|
| Rate for Payer: WPS Commercial |
$755.51
|
|
|
SCREW CORT 1.0 X 12 ST 200.532
|
Facility
|
OP
|
$1,020.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494521
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$285.60 |
| Max. Negotiated Rate |
$4,080.00 |
| Rate for Payer: Aetna Commercial |
$918.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$877.20
|
| Rate for Payer: Aetna Managed Medicare |
$285.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$663.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$510.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$489.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$540.60
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$938.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$570.79
|
| Rate for Payer: Health EOS Commercial |
$907.80
|
| Rate for Payer: HFN Commercial |
$938.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$765.00
|
| Rate for Payer: Multiplan Commercial |
$816.00
|
| Rate for Payer: NAPHCARE Commercial |
$612.00
|
| Rate for Payer: Preferred Network Access Commercial |
$938.40
|
| Rate for Payer: Quartz Beloit One Network |
$499.80
|
| Rate for Payer: Quartz Commercial |
$663.00
|
| Rate for Payer: Quartz Medicare Advantage |
$612.00
|
| Rate for Payer: The Alliance Commercial |
$4,080.00
|
| Rate for Payer: WEA Trust Commercial |
$561.00
|
| Rate for Payer: WPS Commercial |
$755.51
|
|
|
SCREW CORT 1.0 X 13 ST 200.533
|
Facility
|
IP
|
$1,020.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494522
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$499.80 |
| Max. Negotiated Rate |
$938.40 |
| Rate for Payer: Aetna Commercial |
$918.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$877.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$540.60
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$938.40
|
| Rate for Payer: Health EOS Commercial |
$907.80
|
| Rate for Payer: HFN Commercial |
$938.40
|
| Rate for Payer: Multiplan Commercial |
$816.00
|
| Rate for Payer: NAPHCARE Commercial |
$612.00
|
| Rate for Payer: Preferred Network Access Commercial |
$938.40
|
| Rate for Payer: Quartz Beloit One Network |
$499.80
|
| Rate for Payer: Quartz Commercial |
$612.00
|
| Rate for Payer: WEA Trust Commercial |
$561.00
|
| Rate for Payer: WPS Commercial |
$755.51
|
|
|
SCREW CORT 1.0 X 13 ST 200.533
|
Facility
|
OP
|
$1,020.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494522
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$285.60 |
| Max. Negotiated Rate |
$4,080.00 |
| Rate for Payer: Aetna Commercial |
$918.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$877.20
|
| Rate for Payer: Aetna Managed Medicare |
$285.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$663.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$510.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$489.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$540.60
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$938.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$570.79
|
| Rate for Payer: Health EOS Commercial |
$907.80
|
| Rate for Payer: HFN Commercial |
$938.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$765.00
|
| Rate for Payer: Multiplan Commercial |
$816.00
|
| Rate for Payer: NAPHCARE Commercial |
$612.00
|
| Rate for Payer: Preferred Network Access Commercial |
$938.40
|
| Rate for Payer: Quartz Beloit One Network |
$499.80
|
| Rate for Payer: Quartz Commercial |
$663.00
|
| Rate for Payer: Quartz Medicare Advantage |
$612.00
|
| Rate for Payer: The Alliance Commercial |
$4,080.00
|
| Rate for Payer: WEA Trust Commercial |
$561.00
|
| Rate for Payer: WPS Commercial |
$755.51
|
|
|
SCREW CORT 1.0 X 14 ST 200.534
|
Facility
|
IP
|
$1,020.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494523
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$499.80 |
| Max. Negotiated Rate |
$938.40 |
| Rate for Payer: Aetna Commercial |
$918.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$877.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$540.60
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$938.40
|
| Rate for Payer: Health EOS Commercial |
$907.80
|
| Rate for Payer: HFN Commercial |
$938.40
|
| Rate for Payer: Multiplan Commercial |
$816.00
|
| Rate for Payer: NAPHCARE Commercial |
$612.00
|
| Rate for Payer: Preferred Network Access Commercial |
$938.40
|
| Rate for Payer: Quartz Beloit One Network |
$499.80
|
| Rate for Payer: Quartz Commercial |
$612.00
|
| Rate for Payer: WEA Trust Commercial |
$561.00
|
| Rate for Payer: WPS Commercial |
$755.51
|
|
|
SCREW CORT 1.0 X 14 ST 200.534
|
Facility
|
OP
|
$1,020.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494523
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$285.60 |
| Max. Negotiated Rate |
$4,080.00 |
| Rate for Payer: Aetna Commercial |
$918.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$877.20
|
| Rate for Payer: Aetna Managed Medicare |
$285.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$663.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$510.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$489.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$540.60
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$938.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$570.79
|
| Rate for Payer: Health EOS Commercial |
$907.80
|
| Rate for Payer: HFN Commercial |
$938.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$765.00
|
| Rate for Payer: Multiplan Commercial |
$816.00
|
| Rate for Payer: NAPHCARE Commercial |
$612.00
|
| Rate for Payer: Preferred Network Access Commercial |
$938.40
|
| Rate for Payer: Quartz Beloit One Network |
$499.80
|
| Rate for Payer: Quartz Commercial |
$663.00
|
| Rate for Payer: Quartz Medicare Advantage |
$612.00
|
| Rate for Payer: The Alliance Commercial |
$4,080.00
|
| Rate for Payer: WEA Trust Commercial |
$561.00
|
| Rate for Payer: WPS Commercial |
$755.51
|
|
|
SCREW CORT 1.0 X 6 ST 200.526
|
Facility
|
IP
|
$1,020.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494515
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$499.80 |
| Max. Negotiated Rate |
$938.40 |
| Rate for Payer: Aetna Commercial |
$918.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$877.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$540.60
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$938.40
|
| Rate for Payer: Health EOS Commercial |
$907.80
|
| Rate for Payer: HFN Commercial |
$938.40
|
| Rate for Payer: Multiplan Commercial |
$816.00
|
| Rate for Payer: NAPHCARE Commercial |
$612.00
|
| Rate for Payer: Preferred Network Access Commercial |
$938.40
|
| Rate for Payer: Quartz Beloit One Network |
$499.80
|
| Rate for Payer: Quartz Commercial |
$612.00
|
| Rate for Payer: WEA Trust Commercial |
$561.00
|
| Rate for Payer: WPS Commercial |
$755.51
|
|
|
SCREW CORT 1.0 X 6 ST 200.526
|
Facility
|
OP
|
$1,020.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494515
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$285.60 |
| Max. Negotiated Rate |
$4,080.00 |
| Rate for Payer: Aetna Commercial |
$918.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$877.20
|
| Rate for Payer: Aetna Managed Medicare |
$285.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$663.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$510.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$489.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$540.60
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$938.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$570.79
|
| Rate for Payer: Health EOS Commercial |
$907.80
|
| Rate for Payer: HFN Commercial |
$938.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$765.00
|
| Rate for Payer: Multiplan Commercial |
$816.00
|
| Rate for Payer: NAPHCARE Commercial |
$612.00
|
| Rate for Payer: Preferred Network Access Commercial |
$938.40
|
| Rate for Payer: Quartz Beloit One Network |
$499.80
|
| Rate for Payer: Quartz Commercial |
$663.00
|
| Rate for Payer: Quartz Medicare Advantage |
$612.00
|
| Rate for Payer: The Alliance Commercial |
$4,080.00
|
| Rate for Payer: WEA Trust Commercial |
$561.00
|
| Rate for Payer: WPS Commercial |
$755.51
|
|
|
SCREW CORT 1.0 X 7 ST 200.527
|
Facility
|
IP
|
$1,020.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494516
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$499.80 |
| Max. Negotiated Rate |
$938.40 |
| Rate for Payer: Aetna Commercial |
$918.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$877.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$540.60
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$938.40
|
| Rate for Payer: Health EOS Commercial |
$907.80
|
| Rate for Payer: HFN Commercial |
$938.40
|
| Rate for Payer: Multiplan Commercial |
$816.00
|
| Rate for Payer: NAPHCARE Commercial |
$612.00
|
| Rate for Payer: Preferred Network Access Commercial |
$938.40
|
| Rate for Payer: Quartz Beloit One Network |
$499.80
|
| Rate for Payer: Quartz Commercial |
$612.00
|
| Rate for Payer: WEA Trust Commercial |
$561.00
|
| Rate for Payer: WPS Commercial |
$755.51
|
|
|
SCREW CORT 1.0 X 7 ST 200.527
|
Facility
|
OP
|
$1,020.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494516
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$285.60 |
| Max. Negotiated Rate |
$4,080.00 |
| Rate for Payer: Aetna Commercial |
$918.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$877.20
|
| Rate for Payer: Aetna Managed Medicare |
$285.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$663.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$510.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$489.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$540.60
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$938.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$570.79
|
| Rate for Payer: Health EOS Commercial |
$907.80
|
| Rate for Payer: HFN Commercial |
$938.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$765.00
|
| Rate for Payer: Multiplan Commercial |
$816.00
|
| Rate for Payer: NAPHCARE Commercial |
$612.00
|
| Rate for Payer: Preferred Network Access Commercial |
$938.40
|
| Rate for Payer: Quartz Beloit One Network |
$499.80
|
| Rate for Payer: Quartz Commercial |
$663.00
|
| Rate for Payer: Quartz Medicare Advantage |
$612.00
|
| Rate for Payer: The Alliance Commercial |
$4,080.00
|
| Rate for Payer: WEA Trust Commercial |
$561.00
|
| Rate for Payer: WPS Commercial |
$755.51
|
|
|
SCREW CORT 1.0 X 8 ST 200.528
|
Facility
|
IP
|
$1,020.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494517
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$499.80 |
| Max. Negotiated Rate |
$938.40 |
| Rate for Payer: Aetna Commercial |
$918.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$877.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$540.60
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$938.40
|
| Rate for Payer: Health EOS Commercial |
$907.80
|
| Rate for Payer: HFN Commercial |
$938.40
|
| Rate for Payer: Multiplan Commercial |
$816.00
|
| Rate for Payer: NAPHCARE Commercial |
$612.00
|
| Rate for Payer: Preferred Network Access Commercial |
$938.40
|
| Rate for Payer: Quartz Beloit One Network |
$499.80
|
| Rate for Payer: Quartz Commercial |
$612.00
|
| Rate for Payer: WEA Trust Commercial |
$561.00
|
| Rate for Payer: WPS Commercial |
$755.51
|
|
|
SCREW CORT 1.0 X 8 ST 200.528
|
Facility
|
OP
|
$1,020.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494517
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$285.60 |
| Max. Negotiated Rate |
$4,080.00 |
| Rate for Payer: Aetna Commercial |
$918.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$877.20
|
| Rate for Payer: Aetna Managed Medicare |
$285.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$663.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$510.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$489.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$540.60
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$938.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$570.79
|
| Rate for Payer: Health EOS Commercial |
$907.80
|
| Rate for Payer: HFN Commercial |
$938.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$765.00
|
| Rate for Payer: Multiplan Commercial |
$816.00
|
| Rate for Payer: NAPHCARE Commercial |
$612.00
|
| Rate for Payer: Preferred Network Access Commercial |
$938.40
|
| Rate for Payer: Quartz Beloit One Network |
$499.80
|
| Rate for Payer: Quartz Commercial |
$663.00
|
| Rate for Payer: Quartz Medicare Advantage |
$612.00
|
| Rate for Payer: The Alliance Commercial |
$4,080.00
|
| Rate for Payer: WEA Trust Commercial |
$561.00
|
| Rate for Payer: WPS Commercial |
$755.51
|
|
|
SCREW CORT 1.0 X 9 ST 200.529
|
Facility
|
IP
|
$1,020.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494518
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$499.80 |
| Max. Negotiated Rate |
$938.40 |
| Rate for Payer: Aetna Commercial |
$918.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$877.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$540.60
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$938.40
|
| Rate for Payer: Health EOS Commercial |
$907.80
|
| Rate for Payer: HFN Commercial |
$938.40
|
| Rate for Payer: Multiplan Commercial |
$816.00
|
| Rate for Payer: NAPHCARE Commercial |
$612.00
|
| Rate for Payer: Preferred Network Access Commercial |
$938.40
|
| Rate for Payer: Quartz Beloit One Network |
$499.80
|
| Rate for Payer: Quartz Commercial |
$612.00
|
| Rate for Payer: WEA Trust Commercial |
$561.00
|
| Rate for Payer: WPS Commercial |
$755.51
|
|
|
SCREW CORT 1.0 X 9 ST 200.529
|
Facility
|
OP
|
$1,020.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494518
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$285.60 |
| Max. Negotiated Rate |
$4,080.00 |
| Rate for Payer: Aetna Commercial |
$918.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$877.20
|
| Rate for Payer: Aetna Managed Medicare |
$285.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$663.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$510.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$489.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$540.60
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$938.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$570.79
|
| Rate for Payer: Health EOS Commercial |
$907.80
|
| Rate for Payer: HFN Commercial |
$938.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$765.00
|
| Rate for Payer: Multiplan Commercial |
$816.00
|
| Rate for Payer: NAPHCARE Commercial |
$612.00
|
| Rate for Payer: Preferred Network Access Commercial |
$938.40
|
| Rate for Payer: Quartz Beloit One Network |
$499.80
|
| Rate for Payer: Quartz Commercial |
$663.00
|
| Rate for Payer: Quartz Medicare Advantage |
$612.00
|
| Rate for Payer: The Alliance Commercial |
$4,080.00
|
| Rate for Payer: WEA Trust Commercial |
$561.00
|
| Rate for Payer: WPS Commercial |
$755.51
|
|
|
SCREW CORT 1.3 X 10MM TITANIUM 400.690
|
Facility
|
OP
|
$1,454.00
|
|
| Hospital Charge Code |
2966398
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$407.12 |
| Max. Negotiated Rate |
$5,816.00 |
| Rate for Payer: Aetna Commercial |
$1,308.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,250.44
|
| Rate for Payer: Aetna Managed Medicare |
$407.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$945.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$727.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$697.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$770.62
|
| Rate for Payer: Cash Price |
$436.20
|
| Rate for Payer: Cigna Commercial |
$1,337.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$813.66
|
| Rate for Payer: Health EOS Commercial |
$1,294.06
|
| Rate for Payer: HFN Commercial |
$1,337.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,090.50
|
| Rate for Payer: Multiplan Commercial |
$1,163.20
|
| Rate for Payer: NAPHCARE Commercial |
$872.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,337.68
|
| Rate for Payer: Quartz Beloit One Network |
$712.46
|
| Rate for Payer: Quartz Commercial |
$945.10
|
| Rate for Payer: Quartz Medicare Advantage |
$872.40
|
| Rate for Payer: The Alliance Commercial |
$5,816.00
|
| Rate for Payer: WEA Trust Commercial |
$799.70
|
| Rate for Payer: WPS Commercial |
$1,076.98
|
|
|
SCREW CORT 1.3 X 10MM TITANIUM 400.690
|
Facility
|
IP
|
$1,454.00
|
|
| Hospital Charge Code |
2966398
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$712.46 |
| Max. Negotiated Rate |
$1,337.68 |
| Rate for Payer: Aetna Commercial |
$1,308.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,250.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$770.62
|
| Rate for Payer: Cash Price |
$436.20
|
| Rate for Payer: Cigna Commercial |
$1,337.68
|
| Rate for Payer: Health EOS Commercial |
$1,294.06
|
| Rate for Payer: HFN Commercial |
$1,337.68
|
| Rate for Payer: Multiplan Commercial |
$1,163.20
|
| Rate for Payer: NAPHCARE Commercial |
$872.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,337.68
|
| Rate for Payer: Quartz Beloit One Network |
$712.46
|
| Rate for Payer: Quartz Commercial |
$872.40
|
| Rate for Payer: WEA Trust Commercial |
$799.70
|
| Rate for Payer: WPS Commercial |
$1,076.98
|
|
|
SCREW CORT 1.3 X 10 ST 200.690
|
Facility
|
OP
|
$1,070.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494528
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$299.60 |
| Max. Negotiated Rate |
$4,280.00 |
| Rate for Payer: Aetna Commercial |
$963.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$920.20
|
| Rate for Payer: Aetna Managed Medicare |
$299.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$695.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$535.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$513.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$567.10
|
| Rate for Payer: Cash Price |
$321.00
|
| Rate for Payer: Cigna Commercial |
$984.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$598.77
|
| Rate for Payer: Health EOS Commercial |
$952.30
|
| Rate for Payer: HFN Commercial |
$984.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$802.50
|
| Rate for Payer: Multiplan Commercial |
$856.00
|
| Rate for Payer: NAPHCARE Commercial |
$642.00
|
| Rate for Payer: Preferred Network Access Commercial |
$984.40
|
| Rate for Payer: Quartz Beloit One Network |
$524.30
|
| Rate for Payer: Quartz Commercial |
$695.50
|
| Rate for Payer: Quartz Medicare Advantage |
$642.00
|
| Rate for Payer: The Alliance Commercial |
$4,280.00
|
| Rate for Payer: WEA Trust Commercial |
$588.50
|
| Rate for Payer: WPS Commercial |
$792.55
|
|
|
SCREW CORT 1.3 X 10 ST 200.690
|
Facility
|
IP
|
$1,070.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494528
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.30 |
| Max. Negotiated Rate |
$984.40 |
| Rate for Payer: Aetna Commercial |
$963.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$920.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$567.10
|
| Rate for Payer: Cash Price |
$321.00
|
| Rate for Payer: Cigna Commercial |
$984.40
|
| Rate for Payer: Health EOS Commercial |
$952.30
|
| Rate for Payer: HFN Commercial |
$984.40
|
| Rate for Payer: Multiplan Commercial |
$856.00
|
| Rate for Payer: NAPHCARE Commercial |
$642.00
|
| Rate for Payer: Preferred Network Access Commercial |
$984.40
|
| Rate for Payer: Quartz Beloit One Network |
$524.30
|
| Rate for Payer: Quartz Commercial |
$642.00
|
| Rate for Payer: WEA Trust Commercial |
$588.50
|
| Rate for Payer: WPS Commercial |
$792.55
|
|
|
SCREW CORT 1.3 X 11 ST 200.691
|
Facility
|
IP
|
$1,070.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494529
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.30 |
| Max. Negotiated Rate |
$984.40 |
| Rate for Payer: Aetna Commercial |
$963.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$920.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$567.10
|
| Rate for Payer: Cash Price |
$321.00
|
| Rate for Payer: Cigna Commercial |
$984.40
|
| Rate for Payer: Health EOS Commercial |
$952.30
|
| Rate for Payer: HFN Commercial |
$984.40
|
| Rate for Payer: Multiplan Commercial |
$856.00
|
| Rate for Payer: NAPHCARE Commercial |
$642.00
|
| Rate for Payer: Preferred Network Access Commercial |
$984.40
|
| Rate for Payer: Quartz Beloit One Network |
$524.30
|
| Rate for Payer: Quartz Commercial |
$642.00
|
| Rate for Payer: WEA Trust Commercial |
$588.50
|
| Rate for Payer: WPS Commercial |
$792.55
|
|
|
SCREW CORT 1.3 X 11 ST 200.691
|
Facility
|
OP
|
$1,070.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494529
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$299.60 |
| Max. Negotiated Rate |
$4,280.00 |
| Rate for Payer: Aetna Commercial |
$963.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$920.20
|
| Rate for Payer: Aetna Managed Medicare |
$299.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$695.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$535.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$513.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$567.10
|
| Rate for Payer: Cash Price |
$321.00
|
| Rate for Payer: Cigna Commercial |
$984.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$598.77
|
| Rate for Payer: Health EOS Commercial |
$952.30
|
| Rate for Payer: HFN Commercial |
$984.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$802.50
|
| Rate for Payer: Multiplan Commercial |
$856.00
|
| Rate for Payer: NAPHCARE Commercial |
$642.00
|
| Rate for Payer: Preferred Network Access Commercial |
$984.40
|
| Rate for Payer: Quartz Beloit One Network |
$524.30
|
| Rate for Payer: Quartz Commercial |
$695.50
|
| Rate for Payer: Quartz Medicare Advantage |
$642.00
|
| Rate for Payer: The Alliance Commercial |
$4,280.00
|
| Rate for Payer: WEA Trust Commercial |
$588.50
|
| Rate for Payer: WPS Commercial |
$792.55
|
|
|
SCREW CORT 1.3 X 12MM TITANIUM 400.692
|
Facility
|
OP
|
$1,454.00
|
|
| Hospital Charge Code |
2966399
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$407.12 |
| Max. Negotiated Rate |
$5,816.00 |
| Rate for Payer: Aetna Commercial |
$1,308.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,250.44
|
| Rate for Payer: Aetna Managed Medicare |
$407.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$945.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$727.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$697.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$770.62
|
| Rate for Payer: Cash Price |
$436.20
|
| Rate for Payer: Cigna Commercial |
$1,337.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$813.66
|
| Rate for Payer: Health EOS Commercial |
$1,294.06
|
| Rate for Payer: HFN Commercial |
$1,337.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,090.50
|
| Rate for Payer: Multiplan Commercial |
$1,163.20
|
| Rate for Payer: NAPHCARE Commercial |
$872.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,337.68
|
| Rate for Payer: Quartz Beloit One Network |
$712.46
|
| Rate for Payer: Quartz Commercial |
$945.10
|
| Rate for Payer: Quartz Medicare Advantage |
$872.40
|
| Rate for Payer: The Alliance Commercial |
$5,816.00
|
| Rate for Payer: WEA Trust Commercial |
$799.70
|
| Rate for Payer: WPS Commercial |
$1,076.98
|
|
|
SCREW CORT 1.3 X 12MM TITANIUM 400.692
|
Facility
|
IP
|
$1,454.00
|
|
| Hospital Charge Code |
2966399
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$712.46 |
| Max. Negotiated Rate |
$1,337.68 |
| Rate for Payer: Aetna Commercial |
$1,308.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,250.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$770.62
|
| Rate for Payer: Cash Price |
$436.20
|
| Rate for Payer: Cigna Commercial |
$1,337.68
|
| Rate for Payer: Health EOS Commercial |
$1,294.06
|
| Rate for Payer: HFN Commercial |
$1,337.68
|
| Rate for Payer: Multiplan Commercial |
$1,163.20
|
| Rate for Payer: NAPHCARE Commercial |
$872.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,337.68
|
| Rate for Payer: Quartz Beloit One Network |
$712.46
|
| Rate for Payer: Quartz Commercial |
$872.40
|
| Rate for Payer: WEA Trust Commercial |
$799.70
|
| Rate for Payer: WPS Commercial |
$1,076.98
|
|
|
SCREW CORT 1.3 X 12 ST 200.692
|
Facility
|
IP
|
$1,070.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494530
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.30 |
| Max. Negotiated Rate |
$984.40 |
| Rate for Payer: Aetna Commercial |
$963.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$920.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$567.10
|
| Rate for Payer: Cash Price |
$321.00
|
| Rate for Payer: Cigna Commercial |
$984.40
|
| Rate for Payer: Health EOS Commercial |
$952.30
|
| Rate for Payer: HFN Commercial |
$984.40
|
| Rate for Payer: Multiplan Commercial |
$856.00
|
| Rate for Payer: NAPHCARE Commercial |
$642.00
|
| Rate for Payer: Preferred Network Access Commercial |
$984.40
|
| Rate for Payer: Quartz Beloit One Network |
$524.30
|
| Rate for Payer: Quartz Commercial |
$642.00
|
| Rate for Payer: WEA Trust Commercial |
$588.50
|
| Rate for Payer: WPS Commercial |
$792.55
|
|
