|
SCREW-CORT 2.4 X 14 401.764
|
Facility
|
IP
|
$478.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966801
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$243.59 |
| Max. Negotiated Rate |
$457.35 |
| Rate for Payer: Aetna Commercial |
$447.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$427.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$263.47
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cigna Commercial |
$457.35
|
| Rate for Payer: Health EOS Commercial |
$442.44
|
| Rate for Payer: HFN Commercial |
$457.35
|
| Rate for Payer: Multiplan Commercial |
$397.70
|
| Rate for Payer: Preferred Network Access Commercial |
$457.35
|
| Rate for Payer: Quartz Beloit One Network |
$243.59
|
| Rate for Payer: Quartz Commercial |
$298.27
|
| Rate for Payer: WEA Trust Commercial |
$273.42
|
| Rate for Payer: WPS Commercial |
$368.20
|
|
|
SCREW-CORT 2.4 X 14 401.764
|
Facility
|
OP
|
$478.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966801
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$139.19 |
| Max. Negotiated Rate |
$457.35 |
| Rate for Payer: Aetna Commercial |
$447.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$427.52
|
| Rate for Payer: Aetna Managed Medicare |
$139.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$323.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$248.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$238.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$263.47
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cigna Commercial |
$457.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$278.20
|
| Rate for Payer: Health EOS Commercial |
$442.44
|
| Rate for Payer: HFN Commercial |
$457.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$372.84
|
| Rate for Payer: Multiplan Commercial |
$397.70
|
| Rate for Payer: NAPHCARE Commercial |
$298.27
|
| Rate for Payer: Preferred Network Access Commercial |
$457.35
|
| Rate for Payer: Quartz Beloit One Network |
$243.59
|
| Rate for Payer: Quartz Commercial |
$323.13
|
| Rate for Payer: Quartz Medicare Advantage |
$298.27
|
| Rate for Payer: The Alliance Commercial |
$248.56
|
| Rate for Payer: WEA Trust Commercial |
$273.42
|
| Rate for Payer: WPS Commercial |
$368.20
|
|
|
SCREW-CORT 2.4 X 16 401.766
|
Facility
|
IP
|
$478.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966804
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$243.59 |
| Max. Negotiated Rate |
$457.35 |
| Rate for Payer: Aetna Commercial |
$447.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$427.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$263.47
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cigna Commercial |
$457.35
|
| Rate for Payer: Health EOS Commercial |
$442.44
|
| Rate for Payer: HFN Commercial |
$457.35
|
| Rate for Payer: Multiplan Commercial |
$397.70
|
| Rate for Payer: Preferred Network Access Commercial |
$457.35
|
| Rate for Payer: Quartz Beloit One Network |
$243.59
|
| Rate for Payer: Quartz Commercial |
$298.27
|
| Rate for Payer: WEA Trust Commercial |
$273.42
|
| Rate for Payer: WPS Commercial |
$368.20
|
|
|
SCREW-CORT 2.4 X 16 401.766
|
Facility
|
OP
|
$478.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966804
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$139.19 |
| Max. Negotiated Rate |
$457.35 |
| Rate for Payer: Aetna Commercial |
$447.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$427.52
|
| Rate for Payer: Aetna Managed Medicare |
$139.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$323.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$248.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$238.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$263.47
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cigna Commercial |
$457.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$278.20
|
| Rate for Payer: Health EOS Commercial |
$442.44
|
| Rate for Payer: HFN Commercial |
$457.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$372.84
|
| Rate for Payer: Multiplan Commercial |
$397.70
|
| Rate for Payer: NAPHCARE Commercial |
$298.27
|
| Rate for Payer: Preferred Network Access Commercial |
$457.35
|
| Rate for Payer: Quartz Beloit One Network |
$243.59
|
| Rate for Payer: Quartz Commercial |
$323.13
|
| Rate for Payer: Quartz Medicare Advantage |
$298.27
|
| Rate for Payer: The Alliance Commercial |
$248.56
|
| Rate for Payer: WEA Trust Commercial |
$273.42
|
| Rate for Payer: WPS Commercial |
$368.20
|
|
|
SCREW CORT 2.4 X 16MM LP TI AR-8916CX24-16
|
Facility
|
OP
|
$1,354.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6165905
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$394.28 |
| Max. Negotiated Rate |
$1,295.51 |
| Rate for Payer: Aetna Commercial |
$1,267.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,211.02
|
| Rate for Payer: Aetna Managed Medicare |
$394.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$915.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$704.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$675.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$746.32
|
| Rate for Payer: Cash Price |
$406.20
|
| Rate for Payer: Cigna Commercial |
$1,295.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$788.03
|
| Rate for Payer: Health EOS Commercial |
$1,253.26
|
| Rate for Payer: HFN Commercial |
$1,295.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,056.12
|
| Rate for Payer: Multiplan Commercial |
$1,126.53
|
| Rate for Payer: NAPHCARE Commercial |
$844.90
|
| Rate for Payer: Preferred Network Access Commercial |
$1,295.51
|
| Rate for Payer: Quartz Beloit One Network |
$690.00
|
| Rate for Payer: Quartz Commercial |
$915.30
|
| Rate for Payer: Quartz Medicare Advantage |
$844.90
|
| Rate for Payer: The Alliance Commercial |
$704.08
|
| Rate for Payer: WEA Trust Commercial |
$774.49
|
| Rate for Payer: WPS Commercial |
$1,042.99
|
|
|
SCREW CORT 2.4 X 16MM LP TI AR-8916CX24-16
|
Facility
|
IP
|
$1,354.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6165905
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$690.00 |
| Max. Negotiated Rate |
$1,295.51 |
| Rate for Payer: Aetna Commercial |
$1,267.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,211.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$746.32
|
| Rate for Payer: Cash Price |
$406.20
|
| Rate for Payer: Cigna Commercial |
$1,295.51
|
| Rate for Payer: Health EOS Commercial |
$1,253.26
|
| Rate for Payer: HFN Commercial |
$1,295.51
|
| Rate for Payer: Multiplan Commercial |
$1,126.53
|
| Rate for Payer: Preferred Network Access Commercial |
$1,295.51
|
| Rate for Payer: Quartz Beloit One Network |
$690.00
|
| Rate for Payer: Quartz Commercial |
$844.90
|
| Rate for Payer: WEA Trust Commercial |
$774.49
|
| Rate for Payer: WPS Commercial |
$1,042.99
|
|
|
SCREW-CORT 2.4 X 18 401.768
|
Facility
|
IP
|
$478.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966807
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$243.59 |
| Max. Negotiated Rate |
$457.35 |
| Rate for Payer: Aetna Commercial |
$447.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$427.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$263.47
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cigna Commercial |
$457.35
|
| Rate for Payer: Health EOS Commercial |
$442.44
|
| Rate for Payer: HFN Commercial |
$457.35
|
| Rate for Payer: Multiplan Commercial |
$397.70
|
| Rate for Payer: Preferred Network Access Commercial |
$457.35
|
| Rate for Payer: Quartz Beloit One Network |
$243.59
|
| Rate for Payer: Quartz Commercial |
$298.27
|
| Rate for Payer: WEA Trust Commercial |
$273.42
|
| Rate for Payer: WPS Commercial |
$368.20
|
|
|
SCREW-CORT 2.4 X 18 401.768
|
Facility
|
OP
|
$478.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966807
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$139.19 |
| Max. Negotiated Rate |
$457.35 |
| Rate for Payer: Aetna Commercial |
$447.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$427.52
|
| Rate for Payer: Aetna Managed Medicare |
$139.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$323.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$248.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$238.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$263.47
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cigna Commercial |
$457.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$278.20
|
| Rate for Payer: Health EOS Commercial |
$442.44
|
| Rate for Payer: HFN Commercial |
$457.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$372.84
|
| Rate for Payer: Multiplan Commercial |
$397.70
|
| Rate for Payer: NAPHCARE Commercial |
$298.27
|
| Rate for Payer: Preferred Network Access Commercial |
$457.35
|
| Rate for Payer: Quartz Beloit One Network |
$243.59
|
| Rate for Payer: Quartz Commercial |
$323.13
|
| Rate for Payer: Quartz Medicare Advantage |
$298.27
|
| Rate for Payer: The Alliance Commercial |
$248.56
|
| Rate for Payer: WEA Trust Commercial |
$273.42
|
| Rate for Payer: WPS Commercial |
$368.20
|
|
|
SCREW CORT 2.4 X 18MM LP TI AR-8916CX24-18
|
Facility
|
OP
|
$1,367.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6217081
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$398.07 |
| Max. Negotiated Rate |
$1,307.95 |
| Rate for Payer: Aetna Commercial |
$1,279.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,222.64
|
| Rate for Payer: Aetna Managed Medicare |
$398.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$924.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$710.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$682.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$753.49
|
| Rate for Payer: Cash Price |
$410.10
|
| Rate for Payer: Cigna Commercial |
$1,307.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$795.59
|
| Rate for Payer: Health EOS Commercial |
$1,265.30
|
| Rate for Payer: HFN Commercial |
$1,307.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,066.26
|
| Rate for Payer: Multiplan Commercial |
$1,137.34
|
| Rate for Payer: NAPHCARE Commercial |
$853.01
|
| Rate for Payer: Preferred Network Access Commercial |
$1,307.95
|
| Rate for Payer: Quartz Beloit One Network |
$696.62
|
| Rate for Payer: Quartz Commercial |
$924.09
|
| Rate for Payer: Quartz Medicare Advantage |
$853.01
|
| Rate for Payer: The Alliance Commercial |
$710.84
|
| Rate for Payer: WEA Trust Commercial |
$781.92
|
| Rate for Payer: WPS Commercial |
$1,053.00
|
|
|
SCREW CORT 2.4 X 18MM LP TI AR-8916CX24-18
|
Facility
|
IP
|
$1,367.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6217081
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$696.62 |
| Max. Negotiated Rate |
$1,307.95 |
| Rate for Payer: Aetna Commercial |
$1,279.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,222.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$753.49
|
| Rate for Payer: Cash Price |
$410.10
|
| Rate for Payer: Cigna Commercial |
$1,307.95
|
| Rate for Payer: Health EOS Commercial |
$1,265.30
|
| Rate for Payer: HFN Commercial |
$1,307.95
|
| Rate for Payer: Multiplan Commercial |
$1,137.34
|
| Rate for Payer: Preferred Network Access Commercial |
$1,307.95
|
| Rate for Payer: Quartz Beloit One Network |
$696.62
|
| Rate for Payer: Quartz Commercial |
$853.01
|
| Rate for Payer: WEA Trust Commercial |
$781.92
|
| Rate for Payer: WPS Commercial |
$1,053.00
|
|
|
SCREW CORT 2.4 X 20 401.770
|
Facility
|
OP
|
$497.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966810
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$144.73 |
| Max. Negotiated Rate |
$475.53 |
| Rate for Payer: Aetna Commercial |
$465.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$444.52
|
| Rate for Payer: Aetna Managed Medicare |
$144.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$335.97
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$258.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$248.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$273.95
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cigna Commercial |
$475.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$289.25
|
| Rate for Payer: Health EOS Commercial |
$460.02
|
| Rate for Payer: HFN Commercial |
$475.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$387.66
|
| Rate for Payer: Multiplan Commercial |
$413.50
|
| Rate for Payer: NAPHCARE Commercial |
$310.13
|
| Rate for Payer: Preferred Network Access Commercial |
$475.53
|
| Rate for Payer: Quartz Beloit One Network |
$253.27
|
| Rate for Payer: Quartz Commercial |
$335.97
|
| Rate for Payer: Quartz Medicare Advantage |
$310.13
|
| Rate for Payer: The Alliance Commercial |
$258.44
|
| Rate for Payer: WEA Trust Commercial |
$284.28
|
| Rate for Payer: WPS Commercial |
$382.84
|
|
|
SCREW CORT 2.4 X 20 401.770
|
Facility
|
IP
|
$497.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966810
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$253.27 |
| Max. Negotiated Rate |
$475.53 |
| Rate for Payer: Aetna Commercial |
$465.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$444.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$273.95
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cigna Commercial |
$475.53
|
| Rate for Payer: Health EOS Commercial |
$460.02
|
| Rate for Payer: HFN Commercial |
$475.53
|
| Rate for Payer: Multiplan Commercial |
$413.50
|
| Rate for Payer: Preferred Network Access Commercial |
$475.53
|
| Rate for Payer: Quartz Beloit One Network |
$253.27
|
| Rate for Payer: Quartz Commercial |
$310.13
|
| Rate for Payer: WEA Trust Commercial |
$284.28
|
| Rate for Payer: WPS Commercial |
$382.84
|
|
|
SCREW CORT 2.4 X 20MM 201.770
|
Facility
|
OP
|
$999.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966445
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$290.91 |
| Max. Negotiated Rate |
$955.84 |
| Rate for Payer: Aetna Commercial |
$935.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$893.51
|
| Rate for Payer: Aetna Managed Medicare |
$290.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$675.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$519.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$498.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$550.65
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Cigna Commercial |
$955.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$581.42
|
| Rate for Payer: Health EOS Commercial |
$924.67
|
| Rate for Payer: HFN Commercial |
$955.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$779.22
|
| Rate for Payer: Multiplan Commercial |
$831.17
|
| Rate for Payer: NAPHCARE Commercial |
$623.38
|
| Rate for Payer: Preferred Network Access Commercial |
$955.84
|
| Rate for Payer: Quartz Beloit One Network |
$509.09
|
| Rate for Payer: Quartz Commercial |
$675.32
|
| Rate for Payer: Quartz Medicare Advantage |
$623.38
|
| Rate for Payer: The Alliance Commercial |
$519.48
|
| Rate for Payer: WEA Trust Commercial |
$571.43
|
| Rate for Payer: WPS Commercial |
$769.53
|
|
|
SCREW CORT 2.4 X 20MM 201.770
|
Facility
|
IP
|
$999.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966445
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$509.09 |
| Max. Negotiated Rate |
$955.84 |
| Rate for Payer: Aetna Commercial |
$935.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$893.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$550.65
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Cigna Commercial |
$955.84
|
| Rate for Payer: Health EOS Commercial |
$924.67
|
| Rate for Payer: HFN Commercial |
$955.84
|
| Rate for Payer: Multiplan Commercial |
$831.17
|
| Rate for Payer: Preferred Network Access Commercial |
$955.84
|
| Rate for Payer: Quartz Beloit One Network |
$509.09
|
| Rate for Payer: Quartz Commercial |
$623.38
|
| Rate for Payer: WEA Trust Commercial |
$571.43
|
| Rate for Payer: WPS Commercial |
$769.53
|
|
|
SCREW CORT 2.4 X 20MM LP TI AR-8916CX24-20
|
Facility
|
OP
|
$1,464.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5456669
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$426.32 |
| Max. Negotiated Rate |
$1,400.76 |
| Rate for Payer: Aetna Commercial |
$1,370.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,309.40
|
| Rate for Payer: Aetna Managed Medicare |
$426.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$989.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$761.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$730.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$806.96
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cigna Commercial |
$1,400.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$852.05
|
| Rate for Payer: Health EOS Commercial |
$1,355.08
|
| Rate for Payer: HFN Commercial |
$1,400.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,141.92
|
| Rate for Payer: Multiplan Commercial |
$1,218.05
|
| Rate for Payer: NAPHCARE Commercial |
$913.54
|
| Rate for Payer: Preferred Network Access Commercial |
$1,400.76
|
| Rate for Payer: Quartz Beloit One Network |
$746.05
|
| Rate for Payer: Quartz Commercial |
$989.66
|
| Rate for Payer: Quartz Medicare Advantage |
$913.54
|
| Rate for Payer: The Alliance Commercial |
$761.28
|
| Rate for Payer: WEA Trust Commercial |
$837.41
|
| Rate for Payer: WPS Commercial |
$1,127.72
|
|
|
SCREW CORT 2.4 X 20MM LP TI AR-8916CX24-20
|
Facility
|
IP
|
$1,464.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5456669
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$746.05 |
| Max. Negotiated Rate |
$1,400.76 |
| Rate for Payer: Aetna Commercial |
$1,370.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,309.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$806.96
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cigna Commercial |
$1,400.76
|
| Rate for Payer: Health EOS Commercial |
$1,355.08
|
| Rate for Payer: HFN Commercial |
$1,400.76
|
| Rate for Payer: Multiplan Commercial |
$1,218.05
|
| Rate for Payer: Preferred Network Access Commercial |
$1,400.76
|
| Rate for Payer: Quartz Beloit One Network |
$746.05
|
| Rate for Payer: Quartz Commercial |
$913.54
|
| Rate for Payer: WEA Trust Commercial |
$837.41
|
| Rate for Payer: WPS Commercial |
$1,127.72
|
|
|
SCREW-CORT 2.4 X 22 401.772
|
Facility
|
OP
|
$497.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966813
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$144.73 |
| Max. Negotiated Rate |
$475.53 |
| Rate for Payer: Aetna Commercial |
$465.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$444.52
|
| Rate for Payer: Aetna Managed Medicare |
$144.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$335.97
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$258.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$248.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$273.95
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cigna Commercial |
$475.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$289.25
|
| Rate for Payer: Health EOS Commercial |
$460.02
|
| Rate for Payer: HFN Commercial |
$475.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$387.66
|
| Rate for Payer: Multiplan Commercial |
$413.50
|
| Rate for Payer: NAPHCARE Commercial |
$310.13
|
| Rate for Payer: Preferred Network Access Commercial |
$475.53
|
| Rate for Payer: Quartz Beloit One Network |
$253.27
|
| Rate for Payer: Quartz Commercial |
$335.97
|
| Rate for Payer: Quartz Medicare Advantage |
$310.13
|
| Rate for Payer: The Alliance Commercial |
$258.44
|
| Rate for Payer: WEA Trust Commercial |
$284.28
|
| Rate for Payer: WPS Commercial |
$382.84
|
|
|
SCREW-CORT 2.4 X 22 401.772
|
Facility
|
IP
|
$497.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966813
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$253.27 |
| Max. Negotiated Rate |
$475.53 |
| Rate for Payer: Aetna Commercial |
$465.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$444.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$273.95
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cigna Commercial |
$475.53
|
| Rate for Payer: Health EOS Commercial |
$460.02
|
| Rate for Payer: HFN Commercial |
$475.53
|
| Rate for Payer: Multiplan Commercial |
$413.50
|
| Rate for Payer: Preferred Network Access Commercial |
$475.53
|
| Rate for Payer: Quartz Beloit One Network |
$253.27
|
| Rate for Payer: Quartz Commercial |
$310.13
|
| Rate for Payer: WEA Trust Commercial |
$284.28
|
| Rate for Payer: WPS Commercial |
$382.84
|
|
|
SCREW CORT 2.4 X 22MM 201.772
|
Facility
|
OP
|
$1,037.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966457
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$301.97 |
| Max. Negotiated Rate |
$992.20 |
| Rate for Payer: Aetna Commercial |
$970.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$927.49
|
| Rate for Payer: Aetna Managed Medicare |
$301.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$701.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$539.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$517.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$571.59
|
| Rate for Payer: Cash Price |
$311.10
|
| Rate for Payer: Cigna Commercial |
$992.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$603.53
|
| Rate for Payer: Health EOS Commercial |
$959.85
|
| Rate for Payer: HFN Commercial |
$992.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$808.86
|
| Rate for Payer: Multiplan Commercial |
$862.78
|
| Rate for Payer: NAPHCARE Commercial |
$647.09
|
| Rate for Payer: Preferred Network Access Commercial |
$992.20
|
| Rate for Payer: Quartz Beloit One Network |
$528.46
|
| Rate for Payer: Quartz Commercial |
$701.01
|
| Rate for Payer: Quartz Medicare Advantage |
$647.09
|
| Rate for Payer: The Alliance Commercial |
$539.24
|
| Rate for Payer: WEA Trust Commercial |
$593.16
|
| Rate for Payer: WPS Commercial |
$798.80
|
|
|
SCREW CORT 2.4 X 22MM 201.772
|
Facility
|
IP
|
$1,037.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966457
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$528.46 |
| Max. Negotiated Rate |
$992.20 |
| Rate for Payer: Aetna Commercial |
$970.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$927.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$571.59
|
| Rate for Payer: Cash Price |
$311.10
|
| Rate for Payer: Cigna Commercial |
$992.20
|
| Rate for Payer: Health EOS Commercial |
$959.85
|
| Rate for Payer: HFN Commercial |
$992.20
|
| Rate for Payer: Multiplan Commercial |
$862.78
|
| Rate for Payer: Preferred Network Access Commercial |
$992.20
|
| Rate for Payer: Quartz Beloit One Network |
$528.46
|
| Rate for Payer: Quartz Commercial |
$647.09
|
| Rate for Payer: WEA Trust Commercial |
$593.16
|
| Rate for Payer: WPS Commercial |
$798.80
|
|
|
SCREW CORT 2.4 X 22MM LP TI AR-8724-18
|
Facility
|
OP
|
$1,464.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5597608
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$426.32 |
| Max. Negotiated Rate |
$1,400.76 |
| Rate for Payer: Aetna Commercial |
$1,370.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,309.40
|
| Rate for Payer: Aetna Managed Medicare |
$426.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$989.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$761.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$730.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$806.96
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cigna Commercial |
$1,400.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$852.05
|
| Rate for Payer: Health EOS Commercial |
$1,355.08
|
| Rate for Payer: HFN Commercial |
$1,400.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,141.92
|
| Rate for Payer: Multiplan Commercial |
$1,218.05
|
| Rate for Payer: NAPHCARE Commercial |
$913.54
|
| Rate for Payer: Preferred Network Access Commercial |
$1,400.76
|
| Rate for Payer: Quartz Beloit One Network |
$746.05
|
| Rate for Payer: Quartz Commercial |
$989.66
|
| Rate for Payer: Quartz Medicare Advantage |
$913.54
|
| Rate for Payer: The Alliance Commercial |
$761.28
|
| Rate for Payer: WEA Trust Commercial |
$837.41
|
| Rate for Payer: WPS Commercial |
$1,127.72
|
|
|
SCREW CORT 2.4 X 22MM LP TI AR-8724-18
|
Facility
|
IP
|
$1,464.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5597608
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$746.05 |
| Max. Negotiated Rate |
$1,400.76 |
| Rate for Payer: Aetna Commercial |
$1,370.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,309.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$806.96
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cigna Commercial |
$1,400.76
|
| Rate for Payer: Health EOS Commercial |
$1,355.08
|
| Rate for Payer: HFN Commercial |
$1,400.76
|
| Rate for Payer: Multiplan Commercial |
$1,218.05
|
| Rate for Payer: Preferred Network Access Commercial |
$1,400.76
|
| Rate for Payer: Quartz Beloit One Network |
$746.05
|
| Rate for Payer: Quartz Commercial |
$913.54
|
| Rate for Payer: WEA Trust Commercial |
$837.41
|
| Rate for Payer: WPS Commercial |
$1,127.72
|
|
|
SCREW CORT 2.4 X 22MM LP TI AR-8916CX24-22
|
Facility
|
IP
|
$1,464.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414664
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$746.05 |
| Max. Negotiated Rate |
$1,400.76 |
| Rate for Payer: Aetna Commercial |
$1,370.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,309.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$806.96
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cigna Commercial |
$1,400.76
|
| Rate for Payer: Health EOS Commercial |
$1,355.08
|
| Rate for Payer: HFN Commercial |
$1,400.76
|
| Rate for Payer: Multiplan Commercial |
$1,218.05
|
| Rate for Payer: Preferred Network Access Commercial |
$1,400.76
|
| Rate for Payer: Quartz Beloit One Network |
$746.05
|
| Rate for Payer: Quartz Commercial |
$913.54
|
| Rate for Payer: WEA Trust Commercial |
$837.41
|
| Rate for Payer: WPS Commercial |
$1,127.72
|
|
|
SCREW CORT 2.4 X 22MM LP TI AR-8916CX24-22
|
Facility
|
OP
|
$1,464.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414664
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$426.32 |
| Max. Negotiated Rate |
$1,400.76 |
| Rate for Payer: Aetna Commercial |
$1,370.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,309.40
|
| Rate for Payer: Aetna Managed Medicare |
$426.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$989.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$761.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$730.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$806.96
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cigna Commercial |
$1,400.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$852.05
|
| Rate for Payer: Health EOS Commercial |
$1,355.08
|
| Rate for Payer: HFN Commercial |
$1,400.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,141.92
|
| Rate for Payer: Multiplan Commercial |
$1,218.05
|
| Rate for Payer: NAPHCARE Commercial |
$913.54
|
| Rate for Payer: Preferred Network Access Commercial |
$1,400.76
|
| Rate for Payer: Quartz Beloit One Network |
$746.05
|
| Rate for Payer: Quartz Commercial |
$989.66
|
| Rate for Payer: Quartz Medicare Advantage |
$913.54
|
| Rate for Payer: The Alliance Commercial |
$761.28
|
| Rate for Payer: WEA Trust Commercial |
$837.41
|
| Rate for Payer: WPS Commercial |
$1,127.72
|
|
|
SCREW-CORT 2.4 X 24 401.774
|
Facility
|
IP
|
$497.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966816
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$253.27 |
| Max. Negotiated Rate |
$475.53 |
| Rate for Payer: Aetna Commercial |
$465.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$444.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$273.95
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cigna Commercial |
$475.53
|
| Rate for Payer: Health EOS Commercial |
$460.02
|
| Rate for Payer: HFN Commercial |
$475.53
|
| Rate for Payer: Multiplan Commercial |
$413.50
|
| Rate for Payer: Preferred Network Access Commercial |
$475.53
|
| Rate for Payer: Quartz Beloit One Network |
$253.27
|
| Rate for Payer: Quartz Commercial |
$310.13
|
| Rate for Payer: WEA Trust Commercial |
$284.28
|
| Rate for Payer: WPS Commercial |
$382.84
|
|
