|
SCREW CORT 1.5 X 14 ST 200.814
|
Facility
|
OP
|
$610.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494544
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$170.80 |
| Max. Negotiated Rate |
$2,440.00 |
| Rate for Payer: Aetna Commercial |
$549.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$524.60
|
| Rate for Payer: Aetna Managed Medicare |
$170.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$396.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$305.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$292.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$323.30
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$561.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$341.36
|
| Rate for Payer: Health EOS Commercial |
$542.90
|
| Rate for Payer: HFN Commercial |
$561.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$457.50
|
| Rate for Payer: Multiplan Commercial |
$488.00
|
| Rate for Payer: NAPHCARE Commercial |
$366.00
|
| Rate for Payer: Preferred Network Access Commercial |
$561.20
|
| Rate for Payer: Quartz Beloit One Network |
$298.90
|
| Rate for Payer: Quartz Commercial |
$396.50
|
| Rate for Payer: Quartz Medicare Advantage |
$366.00
|
| Rate for Payer: The Alliance Commercial |
$2,440.00
|
| Rate for Payer: WEA Trust Commercial |
$335.50
|
| Rate for Payer: WPS Commercial |
$451.83
|
|
|
SCREW CORT 1.5 X 15MM 02.214.115
|
Facility
|
OP
|
$977.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966415
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$273.56 |
| Max. Negotiated Rate |
$3,908.00 |
| Rate for Payer: Aetna Commercial |
$879.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$840.22
|
| Rate for Payer: Aetna Managed Medicare |
$273.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$635.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$488.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$468.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$517.81
|
| Rate for Payer: Cash Price |
$293.10
|
| Rate for Payer: Cigna Commercial |
$898.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$546.73
|
| Rate for Payer: Health EOS Commercial |
$869.53
|
| Rate for Payer: HFN Commercial |
$898.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$732.75
|
| Rate for Payer: Multiplan Commercial |
$781.60
|
| Rate for Payer: NAPHCARE Commercial |
$586.20
|
| Rate for Payer: Preferred Network Access Commercial |
$898.84
|
| Rate for Payer: Quartz Beloit One Network |
$478.73
|
| Rate for Payer: Quartz Commercial |
$635.05
|
| Rate for Payer: Quartz Medicare Advantage |
$586.20
|
| Rate for Payer: The Alliance Commercial |
$3,908.00
|
| Rate for Payer: WEA Trust Commercial |
$537.35
|
| Rate for Payer: WPS Commercial |
$723.66
|
|
|
SCREW CORT 1.5 X 15MM 02.214.115
|
Facility
|
IP
|
$977.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966415
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$478.73 |
| Max. Negotiated Rate |
$898.84 |
| Rate for Payer: Aetna Commercial |
$879.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$840.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$517.81
|
| Rate for Payer: Cash Price |
$293.10
|
| Rate for Payer: Cigna Commercial |
$898.84
|
| Rate for Payer: Health EOS Commercial |
$869.53
|
| Rate for Payer: HFN Commercial |
$898.84
|
| Rate for Payer: Multiplan Commercial |
$781.60
|
| Rate for Payer: NAPHCARE Commercial |
$586.20
|
| Rate for Payer: Preferred Network Access Commercial |
$898.84
|
| Rate for Payer: Quartz Beloit One Network |
$478.73
|
| Rate for Payer: Quartz Commercial |
$586.20
|
| Rate for Payer: WEA Trust Commercial |
$537.35
|
| Rate for Payer: WPS Commercial |
$723.66
|
|
|
SCREW-CORT 1.5 X 16 200.016
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967247
|
|
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 16 200.016
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967247
|
|
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
|
|
|
SCREW CORT 1.5 X 16MM 02.214.116
|
Facility
|
IP
|
$940.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966416
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$460.60 |
| Max. Negotiated Rate |
$864.80 |
| Rate for Payer: Aetna Commercial |
$846.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$808.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$498.20
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cigna Commercial |
$864.80
|
| Rate for Payer: Health EOS Commercial |
$836.60
|
| Rate for Payer: HFN Commercial |
$864.80
|
| Rate for Payer: Multiplan Commercial |
$752.00
|
| Rate for Payer: NAPHCARE Commercial |
$564.00
|
| Rate for Payer: Preferred Network Access Commercial |
$864.80
|
| Rate for Payer: Quartz Beloit One Network |
$460.60
|
| Rate for Payer: Quartz Commercial |
$564.00
|
| Rate for Payer: WEA Trust Commercial |
$517.00
|
| Rate for Payer: WPS Commercial |
$696.26
|
|
|
SCREW CORT 1.5 X 16MM 02.214.116
|
Facility
|
OP
|
$940.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966416
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$263.20 |
| Max. Negotiated Rate |
$3,760.00 |
| Rate for Payer: Aetna Commercial |
$846.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$808.40
|
| Rate for Payer: Aetna Managed Medicare |
$263.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$611.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$470.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$451.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$498.20
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cigna Commercial |
$864.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$526.02
|
| Rate for Payer: Health EOS Commercial |
$836.60
|
| Rate for Payer: HFN Commercial |
$864.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$705.00
|
| Rate for Payer: Multiplan Commercial |
$752.00
|
| Rate for Payer: NAPHCARE Commercial |
$564.00
|
| Rate for Payer: Preferred Network Access Commercial |
$864.80
|
| Rate for Payer: Quartz Beloit One Network |
$460.60
|
| Rate for Payer: Quartz Commercial |
$611.00
|
| Rate for Payer: Quartz Medicare Advantage |
$564.00
|
| Rate for Payer: The Alliance Commercial |
$3,760.00
|
| Rate for Payer: WEA Trust Commercial |
$517.00
|
| Rate for Payer: WPS Commercial |
$696.26
|
|
|
SCREW CORT 1.5 X 16 ST 200.816
|
Facility
|
OP
|
$388.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494545
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$108.64 |
| Max. Negotiated Rate |
$1,552.00 |
| Rate for Payer: Aetna Commercial |
$349.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$333.68
|
| Rate for Payer: Aetna Managed Medicare |
$108.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$252.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$194.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$186.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$205.64
|
| Rate for Payer: Cash Price |
$116.40
|
| Rate for Payer: Cigna Commercial |
$356.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$217.12
|
| Rate for Payer: Health EOS Commercial |
$345.32
|
| Rate for Payer: HFN Commercial |
$356.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$291.00
|
| Rate for Payer: Multiplan Commercial |
$310.40
|
| Rate for Payer: NAPHCARE Commercial |
$232.80
|
| Rate for Payer: Preferred Network Access Commercial |
$356.96
|
| Rate for Payer: Quartz Beloit One Network |
$190.12
|
| Rate for Payer: Quartz Commercial |
$252.20
|
| Rate for Payer: Quartz Medicare Advantage |
$232.80
|
| Rate for Payer: The Alliance Commercial |
$1,552.00
|
| Rate for Payer: WEA Trust Commercial |
$213.40
|
| Rate for Payer: WPS Commercial |
$287.39
|
|
|
SCREW CORT 1.5 X 16 ST 200.816
|
Facility
|
IP
|
$388.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494545
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$190.12 |
| Max. Negotiated Rate |
$356.96 |
| Rate for Payer: Aetna Commercial |
$349.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$333.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$205.64
|
| Rate for Payer: Cash Price |
$116.40
|
| Rate for Payer: Cigna Commercial |
$356.96
|
| Rate for Payer: Health EOS Commercial |
$345.32
|
| Rate for Payer: HFN Commercial |
$356.96
|
| Rate for Payer: Multiplan Commercial |
$310.40
|
| Rate for Payer: NAPHCARE Commercial |
$232.80
|
| Rate for Payer: Preferred Network Access Commercial |
$356.96
|
| Rate for Payer: Quartz Beloit One Network |
$190.12
|
| Rate for Payer: Quartz Commercial |
$232.80
|
| Rate for Payer: WEA Trust Commercial |
$213.40
|
| Rate for Payer: WPS Commercial |
$287.39
|
|
|
SCREW-CORT 1.5 X 18 200.018
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967248
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$65.17 |
| Max. Negotiated Rate |
$122.36 |
| Rate for Payer: Aetna Commercial |
$119.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$114.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$70.49
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cigna Commercial |
$122.36
|
| Rate for Payer: Health EOS Commercial |
$118.37
|
| Rate for Payer: HFN Commercial |
$122.36
|
| Rate for Payer: Multiplan Commercial |
$106.40
|
| Rate for Payer: NAPHCARE Commercial |
$79.80
|
| Rate for Payer: Preferred Network Access Commercial |
$122.36
|
| Rate for Payer: Quartz Beloit One Network |
$65.17
|
| Rate for Payer: Quartz Commercial |
$79.80
|
| Rate for Payer: WEA Trust Commercial |
$73.15
|
| Rate for Payer: WPS Commercial |
$98.51
|
|
|
SCREW-CORT 1.5 X 18 200.018
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967248
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$37.24 |
| Max. Negotiated Rate |
$532.00 |
| Rate for Payer: Aetna Commercial |
$119.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$114.38
|
| Rate for Payer: Aetna Managed Medicare |
$37.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$86.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$66.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$63.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$70.49
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cigna Commercial |
$122.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$74.43
|
| Rate for Payer: Health EOS Commercial |
$118.37
|
| Rate for Payer: HFN Commercial |
$122.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$99.75
|
| Rate for Payer: Multiplan Commercial |
$106.40
|
| Rate for Payer: NAPHCARE Commercial |
$79.80
|
| Rate for Payer: Preferred Network Access Commercial |
$122.36
|
| Rate for Payer: Quartz Beloit One Network |
$65.17
|
| Rate for Payer: Quartz Commercial |
$86.45
|
| Rate for Payer: Quartz Medicare Advantage |
$79.80
|
| Rate for Payer: The Alliance Commercial |
$532.00
|
| Rate for Payer: WEA Trust Commercial |
$73.15
|
| Rate for Payer: WPS Commercial |
$98.51
|
|
|
SCREW CORT 1.5 X 18MM 02.214.118
|
Facility
|
OP
|
$1,135.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508914
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$317.80 |
| Max. Negotiated Rate |
$4,540.00 |
| Rate for Payer: Aetna Commercial |
$1,021.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$976.10
|
| Rate for Payer: Aetna Managed Medicare |
$317.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$737.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$567.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$544.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$601.55
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cigna Commercial |
$1,044.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$635.15
|
| Rate for Payer: Health EOS Commercial |
$1,010.15
|
| Rate for Payer: HFN Commercial |
$1,044.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$851.25
|
| Rate for Payer: Multiplan Commercial |
$908.00
|
| Rate for Payer: NAPHCARE Commercial |
$681.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,044.20
|
| Rate for Payer: Quartz Beloit One Network |
$556.15
|
| Rate for Payer: Quartz Commercial |
$737.75
|
| Rate for Payer: Quartz Medicare Advantage |
$681.00
|
| Rate for Payer: The Alliance Commercial |
$4,540.00
|
| Rate for Payer: WEA Trust Commercial |
$624.25
|
| Rate for Payer: WPS Commercial |
$840.69
|
|
|
SCREW CORT 1.5 X 18MM 02.214.118
|
Facility
|
IP
|
$1,135.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508914
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$556.15 |
| Max. Negotiated Rate |
$1,044.20 |
| Rate for Payer: Aetna Commercial |
$1,021.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$976.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$601.55
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cigna Commercial |
$1,044.20
|
| Rate for Payer: Health EOS Commercial |
$1,010.15
|
| Rate for Payer: HFN Commercial |
$1,044.20
|
| Rate for Payer: Multiplan Commercial |
$908.00
|
| Rate for Payer: NAPHCARE Commercial |
$681.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,044.20
|
| Rate for Payer: Quartz Beloit One Network |
$556.15
|
| Rate for Payer: Quartz Commercial |
$681.00
|
| Rate for Payer: WEA Trust Commercial |
$624.25
|
| Rate for Payer: WPS Commercial |
$840.69
|
|
|
SCREW CORT 1.5 X 18 ST 200.818
|
Facility
|
IP
|
$388.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494546
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$190.12 |
| Max. Negotiated Rate |
$356.96 |
| Rate for Payer: Aetna Commercial |
$349.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$333.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$205.64
|
| Rate for Payer: Cash Price |
$116.40
|
| Rate for Payer: Cigna Commercial |
$356.96
|
| Rate for Payer: Health EOS Commercial |
$345.32
|
| Rate for Payer: HFN Commercial |
$356.96
|
| Rate for Payer: Multiplan Commercial |
$310.40
|
| Rate for Payer: NAPHCARE Commercial |
$232.80
|
| Rate for Payer: Preferred Network Access Commercial |
$356.96
|
| Rate for Payer: Quartz Beloit One Network |
$190.12
|
| Rate for Payer: Quartz Commercial |
$232.80
|
| Rate for Payer: WEA Trust Commercial |
$213.40
|
| Rate for Payer: WPS Commercial |
$287.39
|
|
|
SCREW CORT 1.5 X 18 ST 200.818
|
Facility
|
OP
|
$388.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494546
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$108.64 |
| Max. Negotiated Rate |
$1,552.00 |
| Rate for Payer: Aetna Commercial |
$349.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$333.68
|
| Rate for Payer: Aetna Managed Medicare |
$108.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$252.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$194.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$186.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$205.64
|
| Rate for Payer: Cash Price |
$116.40
|
| Rate for Payer: Cigna Commercial |
$356.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$217.12
|
| Rate for Payer: Health EOS Commercial |
$345.32
|
| Rate for Payer: HFN Commercial |
$356.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$291.00
|
| Rate for Payer: Multiplan Commercial |
$310.40
|
| Rate for Payer: NAPHCARE Commercial |
$232.80
|
| Rate for Payer: Preferred Network Access Commercial |
$356.96
|
| Rate for Payer: Quartz Beloit One Network |
$190.12
|
| Rate for Payer: Quartz Commercial |
$252.20
|
| Rate for Payer: Quartz Medicare Advantage |
$232.80
|
| Rate for Payer: The Alliance Commercial |
$1,552.00
|
| Rate for Payer: WEA Trust Commercial |
$213.40
|
| Rate for Payer: WPS Commercial |
$287.39
|
|
|
SCREW-CORT 1.5 X 20 200.020
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967249
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$65.17 |
| Max. Negotiated Rate |
$122.36 |
| Rate for Payer: Aetna Commercial |
$119.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$114.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$70.49
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cigna Commercial |
$122.36
|
| Rate for Payer: Health EOS Commercial |
$118.37
|
| Rate for Payer: HFN Commercial |
$122.36
|
| Rate for Payer: Multiplan Commercial |
$106.40
|
| Rate for Payer: NAPHCARE Commercial |
$79.80
|
| Rate for Payer: Preferred Network Access Commercial |
$122.36
|
| Rate for Payer: Quartz Beloit One Network |
$65.17
|
| Rate for Payer: Quartz Commercial |
$79.80
|
| Rate for Payer: WEA Trust Commercial |
$73.15
|
| Rate for Payer: WPS Commercial |
$98.51
|
|
|
SCREW-CORT 1.5 X 20 200.020
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967249
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$37.24 |
| Max. Negotiated Rate |
$532.00 |
| Rate for Payer: Aetna Commercial |
$119.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$114.38
|
| Rate for Payer: Aetna Managed Medicare |
$37.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$86.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$66.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$63.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$70.49
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cigna Commercial |
$122.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$74.43
|
| Rate for Payer: Health EOS Commercial |
$118.37
|
| Rate for Payer: HFN Commercial |
$122.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$99.75
|
| Rate for Payer: Multiplan Commercial |
$106.40
|
| Rate for Payer: NAPHCARE Commercial |
$79.80
|
| Rate for Payer: Preferred Network Access Commercial |
$122.36
|
| Rate for Payer: Quartz Beloit One Network |
$65.17
|
| Rate for Payer: Quartz Commercial |
$86.45
|
| Rate for Payer: Quartz Medicare Advantage |
$79.80
|
| Rate for Payer: The Alliance Commercial |
$532.00
|
| Rate for Payer: WEA Trust Commercial |
$73.15
|
| Rate for Payer: WPS Commercial |
$98.51
|
|
|
SCREW CORT 1.5 X 20MM 02.214.120
|
Facility
|
IP
|
$1,135.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508915
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$556.15 |
| Max. Negotiated Rate |
$1,044.20 |
| Rate for Payer: Aetna Commercial |
$1,021.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$976.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$601.55
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cigna Commercial |
$1,044.20
|
| Rate for Payer: Health EOS Commercial |
$1,010.15
|
| Rate for Payer: HFN Commercial |
$1,044.20
|
| Rate for Payer: Multiplan Commercial |
$908.00
|
| Rate for Payer: NAPHCARE Commercial |
$681.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,044.20
|
| Rate for Payer: Quartz Beloit One Network |
$556.15
|
| Rate for Payer: Quartz Commercial |
$681.00
|
| Rate for Payer: WEA Trust Commercial |
$624.25
|
| Rate for Payer: WPS Commercial |
$840.69
|
|
|
SCREW CORT 1.5 X 20MM 02.214.120
|
Facility
|
OP
|
$1,135.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508915
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$317.80 |
| Max. Negotiated Rate |
$4,540.00 |
| Rate for Payer: Aetna Commercial |
$1,021.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$976.10
|
| Rate for Payer: Aetna Managed Medicare |
$317.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$737.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$567.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$544.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$601.55
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cigna Commercial |
$1,044.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$635.15
|
| Rate for Payer: Health EOS Commercial |
$1,010.15
|
| Rate for Payer: HFN Commercial |
$1,044.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$851.25
|
| Rate for Payer: Multiplan Commercial |
$908.00
|
| Rate for Payer: NAPHCARE Commercial |
$681.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,044.20
|
| Rate for Payer: Quartz Beloit One Network |
$556.15
|
| Rate for Payer: Quartz Commercial |
$737.75
|
| Rate for Payer: Quartz Medicare Advantage |
$681.00
|
| Rate for Payer: The Alliance Commercial |
$4,540.00
|
| Rate for Payer: WEA Trust Commercial |
$624.25
|
| Rate for Payer: WPS Commercial |
$840.69
|
|
|
SCREW CORT 1.5 X 20 ST 200.820
|
Facility
|
OP
|
$388.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494547
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$108.64 |
| Max. Negotiated Rate |
$1,552.00 |
| Rate for Payer: Aetna Commercial |
$349.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$333.68
|
| Rate for Payer: Aetna Managed Medicare |
$108.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$252.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$194.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$186.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$205.64
|
| Rate for Payer: Cash Price |
$116.40
|
| Rate for Payer: Cigna Commercial |
$356.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$217.12
|
| Rate for Payer: Health EOS Commercial |
$345.32
|
| Rate for Payer: HFN Commercial |
$356.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$291.00
|
| Rate for Payer: Multiplan Commercial |
$310.40
|
| Rate for Payer: NAPHCARE Commercial |
$232.80
|
| Rate for Payer: Preferred Network Access Commercial |
$356.96
|
| Rate for Payer: Quartz Beloit One Network |
$190.12
|
| Rate for Payer: Quartz Commercial |
$252.20
|
| Rate for Payer: Quartz Medicare Advantage |
$232.80
|
| Rate for Payer: The Alliance Commercial |
$1,552.00
|
| Rate for Payer: WEA Trust Commercial |
$213.40
|
| Rate for Payer: WPS Commercial |
$287.39
|
|
|
SCREW CORT 1.5 X 20 ST 200.820
|
Facility
|
IP
|
$388.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494547
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$190.12 |
| Max. Negotiated Rate |
$356.96 |
| Rate for Payer: Aetna Commercial |
$349.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$333.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$205.64
|
| Rate for Payer: Cash Price |
$116.40
|
| Rate for Payer: Cigna Commercial |
$356.96
|
| Rate for Payer: Health EOS Commercial |
$345.32
|
| Rate for Payer: HFN Commercial |
$356.96
|
| Rate for Payer: Multiplan Commercial |
$310.40
|
| Rate for Payer: NAPHCARE Commercial |
$232.80
|
| Rate for Payer: Preferred Network Access Commercial |
$356.96
|
| Rate for Payer: Quartz Beloit One Network |
$190.12
|
| Rate for Payer: Quartz Commercial |
$232.80
|
| Rate for Payer: WEA Trust Commercial |
$213.40
|
| Rate for Payer: WPS Commercial |
$287.39
|
|
|
SCREW CORT 1.5 X 22MM 02.214.122
|
Facility
|
IP
|
$1,135.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508917
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$556.15 |
| Max. Negotiated Rate |
$1,044.20 |
| Rate for Payer: Aetna Commercial |
$1,021.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$976.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$601.55
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cigna Commercial |
$1,044.20
|
| Rate for Payer: Health EOS Commercial |
$1,010.15
|
| Rate for Payer: HFN Commercial |
$1,044.20
|
| Rate for Payer: Multiplan Commercial |
$908.00
|
| Rate for Payer: NAPHCARE Commercial |
$681.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,044.20
|
| Rate for Payer: Quartz Beloit One Network |
$556.15
|
| Rate for Payer: Quartz Commercial |
$681.00
|
| Rate for Payer: WEA Trust Commercial |
$624.25
|
| Rate for Payer: WPS Commercial |
$840.69
|
|
|
SCREW CORT 1.5 X 22MM 02.214.122
|
Facility
|
OP
|
$1,135.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508917
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$317.80 |
| Max. Negotiated Rate |
$4,540.00 |
| Rate for Payer: Aetna Commercial |
$1,021.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$976.10
|
| Rate for Payer: Aetna Managed Medicare |
$317.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$737.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$567.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$544.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$601.55
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cigna Commercial |
$1,044.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$635.15
|
| Rate for Payer: Health EOS Commercial |
$1,010.15
|
| Rate for Payer: HFN Commercial |
$1,044.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$851.25
|
| Rate for Payer: Multiplan Commercial |
$908.00
|
| Rate for Payer: NAPHCARE Commercial |
$681.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,044.20
|
| Rate for Payer: Quartz Beloit One Network |
$556.15
|
| Rate for Payer: Quartz Commercial |
$737.75
|
| Rate for Payer: Quartz Medicare Advantage |
$681.00
|
| Rate for Payer: The Alliance Commercial |
$4,540.00
|
| Rate for Payer: WEA Trust Commercial |
$624.25
|
| Rate for Payer: WPS Commercial |
$840.69
|
|
|
SCREW CORT 1.5 X 22 ST 200.822
|
Facility
|
IP
|
$388.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494548
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$190.12 |
| Max. Negotiated Rate |
$356.96 |
| Rate for Payer: Aetna Commercial |
$349.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$333.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$205.64
|
| Rate for Payer: Cash Price |
$116.40
|
| Rate for Payer: Cigna Commercial |
$356.96
|
| Rate for Payer: Health EOS Commercial |
$345.32
|
| Rate for Payer: HFN Commercial |
$356.96
|
| Rate for Payer: Multiplan Commercial |
$310.40
|
| Rate for Payer: NAPHCARE Commercial |
$232.80
|
| Rate for Payer: Preferred Network Access Commercial |
$356.96
|
| Rate for Payer: Quartz Beloit One Network |
$190.12
|
| Rate for Payer: Quartz Commercial |
$232.80
|
| Rate for Payer: WEA Trust Commercial |
$213.40
|
| Rate for Payer: WPS Commercial |
$287.39
|
|
|
SCREW CORT 1.5 X 22 ST 200.822
|
Facility
|
OP
|
$388.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494548
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$108.64 |
| Max. Negotiated Rate |
$1,552.00 |
| Rate for Payer: Aetna Commercial |
$349.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$333.68
|
| Rate for Payer: Aetna Managed Medicare |
$108.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$252.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$194.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$186.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$205.64
|
| Rate for Payer: Cash Price |
$116.40
|
| Rate for Payer: Cigna Commercial |
$356.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$217.12
|
| Rate for Payer: Health EOS Commercial |
$345.32
|
| Rate for Payer: HFN Commercial |
$356.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$291.00
|
| Rate for Payer: Multiplan Commercial |
$310.40
|
| Rate for Payer: NAPHCARE Commercial |
$232.80
|
| Rate for Payer: Preferred Network Access Commercial |
$356.96
|
| Rate for Payer: Quartz Beloit One Network |
$190.12
|
| Rate for Payer: Quartz Commercial |
$252.20
|
| Rate for Payer: Quartz Medicare Advantage |
$232.80
|
| Rate for Payer: The Alliance Commercial |
$1,552.00
|
| Rate for Payer: WEA Trust Commercial |
$213.40
|
| Rate for Payer: WPS Commercial |
$287.39
|
|
