|
SCREW-CORT 2.4 X 6 401.756
|
Facility
|
OP
|
$478.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966828
|
|
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 6 401.756
|
Facility
|
IP
|
$478.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966828
|
|
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 8 401.758
|
Facility
|
IP
|
$478.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966830
|
|
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 8 401.758
|
Facility
|
OP
|
$478.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966830
|
|
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 8MM STARDRIVE 201.758
|
Facility
|
OP
|
$1,040.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966466
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$302.85 |
| Max. Negotiated Rate |
$995.07 |
| Rate for Payer: Aetna Commercial |
$973.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$930.18
|
| Rate for Payer: Aetna Managed Medicare |
$302.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$703.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$540.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$519.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$573.25
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Cigna Commercial |
$995.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$605.28
|
| Rate for Payer: Health EOS Commercial |
$962.62
|
| Rate for Payer: HFN Commercial |
$995.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$811.20
|
| Rate for Payer: Multiplan Commercial |
$865.28
|
| Rate for Payer: NAPHCARE Commercial |
$648.96
|
| Rate for Payer: Preferred Network Access Commercial |
$995.07
|
| Rate for Payer: Quartz Beloit One Network |
$529.98
|
| Rate for Payer: Quartz Commercial |
$703.04
|
| Rate for Payer: Quartz Medicare Advantage |
$648.96
|
| Rate for Payer: The Alliance Commercial |
$540.80
|
| Rate for Payer: WEA Trust Commercial |
$594.88
|
| Rate for Payer: WPS Commercial |
$801.11
|
|
|
SCREW CORT 2.4 X 8MM STARDRIVE 201.758
|
Facility
|
IP
|
$1,040.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966466
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$529.98 |
| Max. Negotiated Rate |
$995.07 |
| Rate for Payer: Aetna Commercial |
$973.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$930.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$573.25
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Cigna Commercial |
$995.07
|
| Rate for Payer: Health EOS Commercial |
$962.62
|
| Rate for Payer: HFN Commercial |
$995.07
|
| Rate for Payer: Multiplan Commercial |
$865.28
|
| Rate for Payer: Preferred Network Access Commercial |
$995.07
|
| Rate for Payer: Quartz Beloit One Network |
$529.98
|
| Rate for Payer: Quartz Commercial |
$648.96
|
| Rate for Payer: WEA Trust Commercial |
$594.88
|
| Rate for Payer: WPS Commercial |
$801.11
|
|
|
SCREW CORT 2.7 X 10 202.010
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967262
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$38.73 |
| Max. Negotiated Rate |
$127.25 |
| Rate for Payer: Aetna Commercial |
$124.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$118.96
|
| Rate for Payer: Aetna Managed Medicare |
$38.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$89.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$69.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$66.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.31
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cigna Commercial |
$127.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$77.41
|
| Rate for Payer: Health EOS Commercial |
$123.10
|
| Rate for Payer: HFN Commercial |
$127.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$103.74
|
| Rate for Payer: Multiplan Commercial |
$110.66
|
| Rate for Payer: NAPHCARE Commercial |
$82.99
|
| Rate for Payer: Preferred Network Access Commercial |
$127.25
|
| Rate for Payer: Quartz Beloit One Network |
$67.78
|
| Rate for Payer: Quartz Commercial |
$89.91
|
| Rate for Payer: Quartz Medicare Advantage |
$82.99
|
| Rate for Payer: The Alliance Commercial |
$69.16
|
| Rate for Payer: WEA Trust Commercial |
$76.08
|
| Rate for Payer: WPS Commercial |
$102.45
|
|
|
SCREW CORT 2.7 X 10 202.010
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967262
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$67.78 |
| Max. Negotiated Rate |
$127.25 |
| Rate for Payer: Aetna Commercial |
$124.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$118.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.31
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cigna Commercial |
$127.25
|
| Rate for Payer: Health EOS Commercial |
$123.10
|
| Rate for Payer: HFN Commercial |
$127.25
|
| Rate for Payer: Multiplan Commercial |
$110.66
|
| Rate for Payer: Preferred Network Access Commercial |
$127.25
|
| Rate for Payer: Quartz Beloit One Network |
$67.78
|
| Rate for Payer: Quartz Commercial |
$82.99
|
| Rate for Payer: WEA Trust Commercial |
$76.08
|
| Rate for Payer: WPS Commercial |
$102.45
|
|
|
SCREW CORT 2.7 X 10 202.810
|
Facility
|
IP
|
$118.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966833
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.13 |
| Max. Negotiated Rate |
$112.90 |
| Rate for Payer: Aetna Commercial |
$110.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$105.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.04
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$112.90
|
| Rate for Payer: Health EOS Commercial |
$109.22
|
| Rate for Payer: HFN Commercial |
$112.90
|
| Rate for Payer: Multiplan Commercial |
$98.18
|
| Rate for Payer: Preferred Network Access Commercial |
$112.90
|
| Rate for Payer: Quartz Beloit One Network |
$60.13
|
| Rate for Payer: Quartz Commercial |
$73.63
|
| Rate for Payer: WEA Trust Commercial |
$67.50
|
| Rate for Payer: WPS Commercial |
$90.90
|
|
|
SCREW CORT 2.7 X 10 202.810
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966833
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$34.36 |
| Max. Negotiated Rate |
$112.90 |
| Rate for Payer: Aetna Commercial |
$110.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$105.54
|
| Rate for Payer: Aetna Managed Medicare |
$34.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$79.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$61.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$58.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.04
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$112.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$68.68
|
| Rate for Payer: Health EOS Commercial |
$109.22
|
| Rate for Payer: HFN Commercial |
$112.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$92.04
|
| Rate for Payer: Multiplan Commercial |
$98.18
|
| Rate for Payer: NAPHCARE Commercial |
$73.63
|
| Rate for Payer: Preferred Network Access Commercial |
$112.90
|
| Rate for Payer: Quartz Beloit One Network |
$60.13
|
| Rate for Payer: Quartz Commercial |
$79.77
|
| Rate for Payer: Quartz Medicare Advantage |
$73.63
|
| Rate for Payer: The Alliance Commercial |
$61.36
|
| Rate for Payer: WEA Trust Commercial |
$67.50
|
| Rate for Payer: WPS Commercial |
$90.90
|
|
|
SCREW CORT 2.7 X 10 402.870
|
Facility
|
IP
|
$355.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966834
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$180.91 |
| Max. Negotiated Rate |
$339.66 |
| Rate for Payer: Aetna Commercial |
$332.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$317.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$195.68
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cigna Commercial |
$339.66
|
| Rate for Payer: Health EOS Commercial |
$328.59
|
| Rate for Payer: HFN Commercial |
$339.66
|
| Rate for Payer: Multiplan Commercial |
$295.36
|
| Rate for Payer: Preferred Network Access Commercial |
$339.66
|
| Rate for Payer: Quartz Beloit One Network |
$180.91
|
| Rate for Payer: Quartz Commercial |
$221.52
|
| Rate for Payer: WEA Trust Commercial |
$203.06
|
| Rate for Payer: WPS Commercial |
$273.46
|
|
|
SCREW CORT 2.7 X 10 402.870
|
Facility
|
OP
|
$355.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966834
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$103.38 |
| Max. Negotiated Rate |
$339.66 |
| Rate for Payer: Aetna Commercial |
$332.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$317.51
|
| Rate for Payer: Aetna Managed Medicare |
$103.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$239.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$184.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$177.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$195.68
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cigna Commercial |
$339.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$206.61
|
| Rate for Payer: Health EOS Commercial |
$328.59
|
| Rate for Payer: HFN Commercial |
$339.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$276.90
|
| Rate for Payer: Multiplan Commercial |
$295.36
|
| Rate for Payer: NAPHCARE Commercial |
$221.52
|
| Rate for Payer: Preferred Network Access Commercial |
$339.66
|
| Rate for Payer: Quartz Beloit One Network |
$180.91
|
| Rate for Payer: Quartz Commercial |
$239.98
|
| Rate for Payer: Quartz Medicare Advantage |
$221.52
|
| Rate for Payer: The Alliance Commercial |
$184.60
|
| Rate for Payer: WEA Trust Commercial |
$203.06
|
| Rate for Payer: WPS Commercial |
$273.46
|
|
|
SCREW CORT 2.7 X 10 STARDRIVE 202.870
|
Facility
|
OP
|
$801.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966477
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$233.25 |
| Max. Negotiated Rate |
$766.40 |
| Rate for Payer: Aetna Commercial |
$749.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$716.41
|
| Rate for Payer: Aetna Managed Medicare |
$233.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$541.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$416.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$399.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$441.51
|
| Rate for Payer: Cash Price |
$240.30
|
| Rate for Payer: Cigna Commercial |
$766.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$466.18
|
| Rate for Payer: Health EOS Commercial |
$741.41
|
| Rate for Payer: HFN Commercial |
$766.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$624.78
|
| Rate for Payer: Multiplan Commercial |
$666.43
|
| Rate for Payer: NAPHCARE Commercial |
$499.82
|
| Rate for Payer: Preferred Network Access Commercial |
$766.40
|
| Rate for Payer: Quartz Beloit One Network |
$408.19
|
| Rate for Payer: Quartz Commercial |
$541.48
|
| Rate for Payer: Quartz Medicare Advantage |
$499.82
|
| Rate for Payer: The Alliance Commercial |
$416.52
|
| Rate for Payer: WEA Trust Commercial |
$458.17
|
| Rate for Payer: WPS Commercial |
$617.01
|
|
|
SCREW CORT 2.7 X 10 STARDRIVE 202.870
|
Facility
|
IP
|
$801.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966477
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$408.19 |
| Max. Negotiated Rate |
$766.40 |
| Rate for Payer: Aetna Commercial |
$749.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$716.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$441.51
|
| Rate for Payer: Cash Price |
$240.30
|
| Rate for Payer: Cigna Commercial |
$766.40
|
| Rate for Payer: Health EOS Commercial |
$741.41
|
| Rate for Payer: HFN Commercial |
$766.40
|
| Rate for Payer: Multiplan Commercial |
$666.43
|
| Rate for Payer: Preferred Network Access Commercial |
$766.40
|
| Rate for Payer: Quartz Beloit One Network |
$408.19
|
| Rate for Payer: Quartz Commercial |
$499.82
|
| Rate for Payer: WEA Trust Commercial |
$458.17
|
| Rate for Payer: WPS Commercial |
$617.01
|
|
|
SCREW-CORT 2.7 X 12 202.012
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967263
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$38.73 |
| Max. Negotiated Rate |
$127.25 |
| Rate for Payer: Aetna Commercial |
$124.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$118.96
|
| Rate for Payer: Aetna Managed Medicare |
$38.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$89.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$69.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$66.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.31
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cigna Commercial |
$127.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$77.41
|
| Rate for Payer: Health EOS Commercial |
$123.10
|
| Rate for Payer: HFN Commercial |
$127.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$103.74
|
| Rate for Payer: Multiplan Commercial |
$110.66
|
| Rate for Payer: NAPHCARE Commercial |
$82.99
|
| Rate for Payer: Preferred Network Access Commercial |
$127.25
|
| Rate for Payer: Quartz Beloit One Network |
$67.78
|
| Rate for Payer: Quartz Commercial |
$89.91
|
| Rate for Payer: Quartz Medicare Advantage |
$82.99
|
| Rate for Payer: The Alliance Commercial |
$69.16
|
| Rate for Payer: WEA Trust Commercial |
$76.08
|
| Rate for Payer: WPS Commercial |
$102.45
|
|
|
SCREW-CORT 2.7 X 12 202.012
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967263
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$67.78 |
| Max. Negotiated Rate |
$127.25 |
| Rate for Payer: Aetna Commercial |
$124.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$118.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.31
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cigna Commercial |
$127.25
|
| Rate for Payer: Health EOS Commercial |
$123.10
|
| Rate for Payer: HFN Commercial |
$127.25
|
| Rate for Payer: Multiplan Commercial |
$110.66
|
| Rate for Payer: Preferred Network Access Commercial |
$127.25
|
| Rate for Payer: Quartz Beloit One Network |
$67.78
|
| Rate for Payer: Quartz Commercial |
$82.99
|
| Rate for Payer: WEA Trust Commercial |
$76.08
|
| Rate for Payer: WPS Commercial |
$102.45
|
|
|
SCREW-CORT 2.7 X 12 202.812
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966835
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$35.82 |
| Max. Negotiated Rate |
$117.69 |
| Rate for Payer: Aetna Commercial |
$115.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.01
|
| Rate for Payer: Aetna Managed Medicare |
$35.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$83.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$63.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$61.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$67.80
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna Commercial |
$117.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$71.59
|
| Rate for Payer: Health EOS Commercial |
$113.85
|
| Rate for Payer: HFN Commercial |
$117.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$95.94
|
| Rate for Payer: Multiplan Commercial |
$102.34
|
| Rate for Payer: NAPHCARE Commercial |
$76.75
|
| Rate for Payer: Preferred Network Access Commercial |
$117.69
|
| Rate for Payer: Quartz Beloit One Network |
$62.68
|
| Rate for Payer: Quartz Commercial |
$83.15
|
| Rate for Payer: Quartz Medicare Advantage |
$76.75
|
| Rate for Payer: The Alliance Commercial |
$63.96
|
| Rate for Payer: WEA Trust Commercial |
$70.36
|
| Rate for Payer: WPS Commercial |
$94.75
|
|
|
SCREW-CORT 2.7 X 12 202.812
|
Facility
|
IP
|
$123.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966835
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$62.68 |
| Max. Negotiated Rate |
$117.69 |
| Rate for Payer: Aetna Commercial |
$115.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$67.80
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna Commercial |
$117.69
|
| Rate for Payer: Health EOS Commercial |
$113.85
|
| Rate for Payer: HFN Commercial |
$117.69
|
| Rate for Payer: Multiplan Commercial |
$102.34
|
| Rate for Payer: Preferred Network Access Commercial |
$117.69
|
| Rate for Payer: Quartz Beloit One Network |
$62.68
|
| Rate for Payer: Quartz Commercial |
$76.75
|
| Rate for Payer: WEA Trust Commercial |
$70.36
|
| Rate for Payer: WPS Commercial |
$94.75
|
|
|
SCREW-CORT 2.7 X 12 402.872
|
Facility
|
IP
|
$355.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966836
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$180.91 |
| Max. Negotiated Rate |
$339.66 |
| Rate for Payer: Aetna Commercial |
$332.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$317.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$195.68
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cigna Commercial |
$339.66
|
| Rate for Payer: Health EOS Commercial |
$328.59
|
| Rate for Payer: HFN Commercial |
$339.66
|
| Rate for Payer: Multiplan Commercial |
$295.36
|
| Rate for Payer: Preferred Network Access Commercial |
$339.66
|
| Rate for Payer: Quartz Beloit One Network |
$180.91
|
| Rate for Payer: Quartz Commercial |
$221.52
|
| Rate for Payer: WEA Trust Commercial |
$203.06
|
| Rate for Payer: WPS Commercial |
$273.46
|
|
|
SCREW-CORT 2.7 X 12 402.872
|
Facility
|
OP
|
$355.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966836
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$103.38 |
| Max. Negotiated Rate |
$339.66 |
| Rate for Payer: Aetna Commercial |
$332.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$317.51
|
| Rate for Payer: Aetna Managed Medicare |
$103.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$239.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$184.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$177.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$195.68
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cigna Commercial |
$339.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$206.61
|
| Rate for Payer: Health EOS Commercial |
$328.59
|
| Rate for Payer: HFN Commercial |
$339.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$276.90
|
| Rate for Payer: Multiplan Commercial |
$295.36
|
| Rate for Payer: NAPHCARE Commercial |
$221.52
|
| Rate for Payer: Preferred Network Access Commercial |
$339.66
|
| Rate for Payer: Quartz Beloit One Network |
$180.91
|
| Rate for Payer: Quartz Commercial |
$239.98
|
| Rate for Payer: Quartz Medicare Advantage |
$221.52
|
| Rate for Payer: The Alliance Commercial |
$184.60
|
| Rate for Payer: WEA Trust Commercial |
$203.06
|
| Rate for Payer: WPS Commercial |
$273.46
|
|
|
SCREW CORT 2.7 X 12 STARDRIVE 202.872
|
Facility
|
IP
|
$821.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966467
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$418.38 |
| Max. Negotiated Rate |
$785.53 |
| Rate for Payer: Aetna Commercial |
$768.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$734.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$452.54
|
| Rate for Payer: Cash Price |
$246.30
|
| Rate for Payer: Cigna Commercial |
$785.53
|
| Rate for Payer: Health EOS Commercial |
$759.92
|
| Rate for Payer: HFN Commercial |
$785.53
|
| Rate for Payer: Multiplan Commercial |
$683.07
|
| Rate for Payer: Preferred Network Access Commercial |
$785.53
|
| Rate for Payer: Quartz Beloit One Network |
$418.38
|
| Rate for Payer: Quartz Commercial |
$512.30
|
| Rate for Payer: WEA Trust Commercial |
$469.61
|
| Rate for Payer: WPS Commercial |
$632.42
|
|
|
SCREW CORT 2.7 X 12 STARDRIVE 202.872
|
Facility
|
OP
|
$821.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966467
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$239.08 |
| Max. Negotiated Rate |
$785.53 |
| Rate for Payer: Aetna Commercial |
$768.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$734.30
|
| Rate for Payer: Aetna Managed Medicare |
$239.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$555.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$426.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$409.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$452.54
|
| Rate for Payer: Cash Price |
$246.30
|
| Rate for Payer: Cigna Commercial |
$785.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$477.82
|
| Rate for Payer: Health EOS Commercial |
$759.92
|
| Rate for Payer: HFN Commercial |
$785.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$640.38
|
| Rate for Payer: Multiplan Commercial |
$683.07
|
| Rate for Payer: NAPHCARE Commercial |
$512.30
|
| Rate for Payer: Preferred Network Access Commercial |
$785.53
|
| Rate for Payer: Quartz Beloit One Network |
$418.38
|
| Rate for Payer: Quartz Commercial |
$555.00
|
| Rate for Payer: Quartz Medicare Advantage |
$512.30
|
| Rate for Payer: The Alliance Commercial |
$426.92
|
| Rate for Payer: WEA Trust Commercial |
$469.61
|
| Rate for Payer: WPS Commercial |
$632.42
|
|
|
SCREW-CORT 2.7 X 14 202.014
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967264
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$67.78 |
| Max. Negotiated Rate |
$127.25 |
| Rate for Payer: Aetna Commercial |
$124.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$118.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.31
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cigna Commercial |
$127.25
|
| Rate for Payer: Health EOS Commercial |
$123.10
|
| Rate for Payer: HFN Commercial |
$127.25
|
| Rate for Payer: Multiplan Commercial |
$110.66
|
| Rate for Payer: Preferred Network Access Commercial |
$127.25
|
| Rate for Payer: Quartz Beloit One Network |
$67.78
|
| Rate for Payer: Quartz Commercial |
$82.99
|
| Rate for Payer: WEA Trust Commercial |
$76.08
|
| Rate for Payer: WPS Commercial |
$102.45
|
|
|
SCREW-CORT 2.7 X 14 202.014
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967264
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$38.73 |
| Max. Negotiated Rate |
$127.25 |
| Rate for Payer: Aetna Commercial |
$124.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$118.96
|
| Rate for Payer: Aetna Managed Medicare |
$38.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$89.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$69.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$66.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.31
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cigna Commercial |
$127.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$77.41
|
| Rate for Payer: Health EOS Commercial |
$123.10
|
| Rate for Payer: HFN Commercial |
$127.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$103.74
|
| Rate for Payer: Multiplan Commercial |
$110.66
|
| Rate for Payer: NAPHCARE Commercial |
$82.99
|
| Rate for Payer: Preferred Network Access Commercial |
$127.25
|
| Rate for Payer: Quartz Beloit One Network |
$67.78
|
| Rate for Payer: Quartz Commercial |
$89.91
|
| Rate for Payer: Quartz Medicare Advantage |
$82.99
|
| Rate for Payer: The Alliance Commercial |
$69.16
|
| Rate for Payer: WEA Trust Commercial |
$76.08
|
| Rate for Payer: WPS Commercial |
$102.45
|
|
|
SCREW-CORT 2.7 X 14 202.814
|
Facility
|
IP
|
$123.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966837
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$62.68 |
| Max. Negotiated Rate |
$117.69 |
| Rate for Payer: Aetna Commercial |
$115.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$67.80
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna Commercial |
$117.69
|
| Rate for Payer: Health EOS Commercial |
$113.85
|
| Rate for Payer: HFN Commercial |
$117.69
|
| Rate for Payer: Multiplan Commercial |
$102.34
|
| Rate for Payer: Preferred Network Access Commercial |
$117.69
|
| Rate for Payer: Quartz Beloit One Network |
$62.68
|
| Rate for Payer: Quartz Commercial |
$76.75
|
| Rate for Payer: WEA Trust Commercial |
$70.36
|
| Rate for Payer: WPS Commercial |
$94.75
|
|
