|
SCREW CORT 1.3 X 12 ST 200.692
|
Facility
|
OP
|
$1,070.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494530
|
|
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 14MM 400.694
|
Facility
|
OP
|
$1,454.00
|
|
| Hospital Charge Code |
2966400
|
|
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 14MM 400.694
|
Facility
|
IP
|
$1,454.00
|
|
| Hospital Charge Code |
2966400
|
|
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 14 ST 200.694
|
Facility
|
OP
|
$953.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494532
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.84 |
| Max. Negotiated Rate |
$3,812.00 |
| Rate for Payer: Aetna Commercial |
$857.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$819.58
|
| Rate for Payer: Aetna Managed Medicare |
$266.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$619.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$476.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$457.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$505.09
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: Cigna Commercial |
$876.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$533.30
|
| Rate for Payer: Health EOS Commercial |
$848.17
|
| Rate for Payer: HFN Commercial |
$876.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$714.75
|
| Rate for Payer: Multiplan Commercial |
$762.40
|
| Rate for Payer: NAPHCARE Commercial |
$571.80
|
| Rate for Payer: Preferred Network Access Commercial |
$876.76
|
| Rate for Payer: Quartz Beloit One Network |
$466.97
|
| Rate for Payer: Quartz Commercial |
$619.45
|
| Rate for Payer: Quartz Medicare Advantage |
$571.80
|
| Rate for Payer: The Alliance Commercial |
$3,812.00
|
| Rate for Payer: WEA Trust Commercial |
$524.15
|
| Rate for Payer: WPS Commercial |
$705.89
|
|
|
SCREW CORT 1.3 X 14 ST 200.694
|
Facility
|
IP
|
$953.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494532
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$466.97 |
| Max. Negotiated Rate |
$876.76 |
| Rate for Payer: Aetna Commercial |
$857.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$819.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$505.09
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: Cigna Commercial |
$876.76
|
| Rate for Payer: Health EOS Commercial |
$848.17
|
| Rate for Payer: HFN Commercial |
$876.76
|
| Rate for Payer: Multiplan Commercial |
$762.40
|
| Rate for Payer: NAPHCARE Commercial |
$571.80
|
| Rate for Payer: Preferred Network Access Commercial |
$876.76
|
| Rate for Payer: Quartz Beloit One Network |
$466.97
|
| Rate for Payer: Quartz Commercial |
$571.80
|
| Rate for Payer: WEA Trust Commercial |
$524.15
|
| Rate for Payer: WPS Commercial |
$705.89
|
|
|
SCREW CORT 1.3 X 15 ST 200.695
|
Facility
|
OP
|
$953.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508971
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.84 |
| Max. Negotiated Rate |
$3,812.00 |
| Rate for Payer: Aetna Commercial |
$857.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$819.58
|
| Rate for Payer: Aetna Managed Medicare |
$266.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$619.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$476.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$457.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$505.09
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: Cigna Commercial |
$876.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$533.30
|
| Rate for Payer: Health EOS Commercial |
$848.17
|
| Rate for Payer: HFN Commercial |
$876.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$714.75
|
| Rate for Payer: Multiplan Commercial |
$762.40
|
| Rate for Payer: NAPHCARE Commercial |
$571.80
|
| Rate for Payer: Preferred Network Access Commercial |
$876.76
|
| Rate for Payer: Quartz Beloit One Network |
$466.97
|
| Rate for Payer: Quartz Commercial |
$619.45
|
| Rate for Payer: Quartz Medicare Advantage |
$571.80
|
| Rate for Payer: The Alliance Commercial |
$3,812.00
|
| Rate for Payer: WEA Trust Commercial |
$524.15
|
| Rate for Payer: WPS Commercial |
$705.89
|
|
|
SCREW CORT 1.3 X 15 ST 200.695
|
Facility
|
IP
|
$953.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508971
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$466.97 |
| Max. Negotiated Rate |
$876.76 |
| Rate for Payer: Aetna Commercial |
$857.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$819.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$505.09
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: Cigna Commercial |
$876.76
|
| Rate for Payer: Health EOS Commercial |
$848.17
|
| Rate for Payer: HFN Commercial |
$876.76
|
| Rate for Payer: Multiplan Commercial |
$762.40
|
| Rate for Payer: NAPHCARE Commercial |
$571.80
|
| Rate for Payer: Preferred Network Access Commercial |
$876.76
|
| Rate for Payer: Quartz Beloit One Network |
$466.97
|
| Rate for Payer: Quartz Commercial |
$571.80
|
| Rate for Payer: WEA Trust Commercial |
$524.15
|
| Rate for Payer: WPS Commercial |
$705.89
|
|
|
SCREW CORT 1.3 X 16 ST 200.696
|
Facility
|
OP
|
$1,070.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494533
|
|
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 16 ST 200.696
|
Facility
|
IP
|
$1,070.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494533
|
|
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 18 ST 200.698
|
Facility
|
OP
|
$1,070.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494534
|
|
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 18 ST 200.698
|
Facility
|
IP
|
$1,070.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494534
|
|
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 6 ST 200.686
|
Facility
|
IP
|
$1,070.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494524
|
|
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 6 ST 200.686
|
Facility
|
OP
|
$1,070.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494524
|
|
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 7 ST 200.687
|
Facility
|
OP
|
$1,070.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494525
|
|
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 7 ST 200.687
|
Facility
|
IP
|
$1,070.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494525
|
|
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 8MM TITANIUM 400.688
|
Facility
|
IP
|
$1,454.00
|
|
| Hospital Charge Code |
2966401
|
|
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 8MM TITANIUM 400.688
|
Facility
|
OP
|
$1,454.00
|
|
| Hospital Charge Code |
2966401
|
|
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 8 ST 200.688
|
Facility
|
IP
|
$1,070.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494526
|
|
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 8 ST 200.688
|
Facility
|
OP
|
$1,070.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494526
|
|
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 9 ST 200.689
|
Facility
|
IP
|
$1,070.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494527
|
|
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 9 ST 200.689
|
Facility
|
OP
|
$1,070.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494527
|
|
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 1.5MM X 15MM 02.214.115
|
Facility
|
OP
|
$719.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5206659
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$201.32 |
| Max. Negotiated Rate |
$2,876.00 |
| Rate for Payer: Aetna Commercial |
$647.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$618.34
|
| Rate for Payer: Aetna Managed Medicare |
$201.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$467.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$359.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$345.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$381.07
|
| Rate for Payer: Cash Price |
$215.70
|
| Rate for Payer: Cigna Commercial |
$661.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$402.35
|
| Rate for Payer: Health EOS Commercial |
$639.91
|
| Rate for Payer: HFN Commercial |
$661.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$539.25
|
| Rate for Payer: Multiplan Commercial |
$575.20
|
| Rate for Payer: NAPHCARE Commercial |
$431.40
|
| Rate for Payer: Preferred Network Access Commercial |
$661.48
|
| Rate for Payer: Quartz Beloit One Network |
$352.31
|
| Rate for Payer: Quartz Commercial |
$467.35
|
| Rate for Payer: Quartz Medicare Advantage |
$431.40
|
| Rate for Payer: The Alliance Commercial |
$2,876.00
|
| Rate for Payer: WEA Trust Commercial |
$395.45
|
| Rate for Payer: WPS Commercial |
$532.56
|
|
|
SCREW CORT 1.5MM X 15MM 02.214.115
|
Facility
|
IP
|
$719.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5206659
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$352.31 |
| Max. Negotiated Rate |
$661.48 |
| Rate for Payer: Aetna Commercial |
$647.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$618.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$381.07
|
| Rate for Payer: Cash Price |
$215.70
|
| Rate for Payer: Cigna Commercial |
$661.48
|
| Rate for Payer: Health EOS Commercial |
$639.91
|
| Rate for Payer: HFN Commercial |
$661.48
|
| Rate for Payer: Multiplan Commercial |
$575.20
|
| Rate for Payer: NAPHCARE Commercial |
$431.40
|
| Rate for Payer: Preferred Network Access Commercial |
$661.48
|
| Rate for Payer: Quartz Beloit One Network |
$352.31
|
| Rate for Payer: Quartz Commercial |
$431.40
|
| Rate for Payer: WEA Trust Commercial |
$395.45
|
| Rate for Payer: WPS Commercial |
$532.56
|
|
|
SCREW-CORT 1.5 X 10 200.010
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967243
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$67.13 |
| Max. Negotiated Rate |
$126.04 |
| Rate for Payer: Aetna Commercial |
$123.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$117.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$72.61
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cigna Commercial |
$126.04
|
| Rate for Payer: Health EOS Commercial |
$121.93
|
| Rate for Payer: HFN Commercial |
$126.04
|
| Rate for Payer: Multiplan Commercial |
$109.60
|
| Rate for Payer: NAPHCARE Commercial |
$82.20
|
| Rate for Payer: Preferred Network Access Commercial |
$126.04
|
| Rate for Payer: Quartz Beloit One Network |
$67.13
|
| Rate for Payer: Quartz Commercial |
$82.20
|
| Rate for Payer: WEA Trust Commercial |
$75.35
|
| Rate for Payer: WPS Commercial |
$101.48
|
|
|
SCREW-CORT 1.5 X 10 200.010
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967243
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$38.36 |
| Max. Negotiated Rate |
$548.00 |
| Rate for Payer: Aetna Commercial |
$123.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$117.82
|
| Rate for Payer: Aetna Managed Medicare |
$38.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$89.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$68.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$65.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$72.61
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cigna Commercial |
$126.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$76.67
|
| Rate for Payer: Health EOS Commercial |
$121.93
|
| Rate for Payer: HFN Commercial |
$126.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$102.75
|
| Rate for Payer: Multiplan Commercial |
$109.60
|
| Rate for Payer: NAPHCARE Commercial |
$82.20
|
| Rate for Payer: Preferred Network Access Commercial |
$126.04
|
| Rate for Payer: Quartz Beloit One Network |
$67.13
|
| Rate for Payer: Quartz Commercial |
$89.05
|
| Rate for Payer: Quartz Medicare Advantage |
$82.20
|
| Rate for Payer: The Alliance Commercial |
$548.00
|
| Rate for Payer: WEA Trust Commercial |
$75.35
|
| Rate for Payer: WPS Commercial |
$101.48
|
|
