|
SCREW-CORT 2.7 X 14 202.814
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966837
|
|
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 14 402.874
|
Facility
|
IP
|
$355.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966838
|
|
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 14 402.874
|
Facility
|
OP
|
$355.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966838
|
|
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 14 LO-PRO AR-8827-14
|
Facility
|
IP
|
$776.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6153645
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$395.45 |
| Max. Negotiated Rate |
$742.48 |
| Rate for Payer: Aetna Commercial |
$726.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$694.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$427.73
|
| Rate for Payer: Cash Price |
$232.80
|
| Rate for Payer: Cigna Commercial |
$742.48
|
| Rate for Payer: Health EOS Commercial |
$718.27
|
| Rate for Payer: HFN Commercial |
$742.48
|
| Rate for Payer: Multiplan Commercial |
$645.63
|
| Rate for Payer: Preferred Network Access Commercial |
$742.48
|
| Rate for Payer: Quartz Beloit One Network |
$395.45
|
| Rate for Payer: Quartz Commercial |
$484.22
|
| Rate for Payer: WEA Trust Commercial |
$443.87
|
| Rate for Payer: WPS Commercial |
$597.75
|
|
|
SCREW CORT 2.7 X 14 LO-PRO AR-8827-14
|
Facility
|
OP
|
$776.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6153645
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$225.97 |
| Max. Negotiated Rate |
$742.48 |
| Rate for Payer: Aetna Commercial |
$726.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$694.05
|
| Rate for Payer: Aetna Managed Medicare |
$225.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$524.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$403.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$387.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$427.73
|
| Rate for Payer: Cash Price |
$232.80
|
| Rate for Payer: Cigna Commercial |
$742.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$451.63
|
| Rate for Payer: Health EOS Commercial |
$718.27
|
| Rate for Payer: HFN Commercial |
$742.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$605.28
|
| Rate for Payer: Multiplan Commercial |
$645.63
|
| Rate for Payer: NAPHCARE Commercial |
$484.22
|
| Rate for Payer: Preferred Network Access Commercial |
$742.48
|
| Rate for Payer: Quartz Beloit One Network |
$395.45
|
| Rate for Payer: Quartz Commercial |
$524.58
|
| Rate for Payer: Quartz Medicare Advantage |
$484.22
|
| Rate for Payer: The Alliance Commercial |
$403.52
|
| Rate for Payer: WEA Trust Commercial |
$443.87
|
| Rate for Payer: WPS Commercial |
$597.75
|
|
|
SCREW CORT 2.7 X 14 STARDRIVE 202.874
|
Facility
|
OP
|
$790.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966469
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$230.05 |
| Max. Negotiated Rate |
$755.87 |
| Rate for Payer: Aetna Commercial |
$739.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$706.58
|
| Rate for Payer: Aetna Managed Medicare |
$230.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$534.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$410.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$394.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$435.45
|
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cigna Commercial |
$755.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$459.78
|
| Rate for Payer: Health EOS Commercial |
$731.22
|
| Rate for Payer: HFN Commercial |
$755.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$616.20
|
| Rate for Payer: Multiplan Commercial |
$657.28
|
| Rate for Payer: NAPHCARE Commercial |
$492.96
|
| Rate for Payer: Preferred Network Access Commercial |
$755.87
|
| Rate for Payer: Quartz Beloit One Network |
$402.58
|
| Rate for Payer: Quartz Commercial |
$534.04
|
| Rate for Payer: Quartz Medicare Advantage |
$492.96
|
| Rate for Payer: The Alliance Commercial |
$410.80
|
| Rate for Payer: WEA Trust Commercial |
$451.88
|
| Rate for Payer: WPS Commercial |
$608.54
|
|
|
SCREW CORT 2.7 X 14 STARDRIVE 202.874
|
Facility
|
IP
|
$790.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966469
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$402.58 |
| Max. Negotiated Rate |
$755.87 |
| Rate for Payer: Aetna Commercial |
$739.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$706.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$435.45
|
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cigna Commercial |
$755.87
|
| Rate for Payer: Health EOS Commercial |
$731.22
|
| Rate for Payer: HFN Commercial |
$755.87
|
| Rate for Payer: Multiplan Commercial |
$657.28
|
| Rate for Payer: Preferred Network Access Commercial |
$755.87
|
| Rate for Payer: Quartz Beloit One Network |
$402.58
|
| Rate for Payer: Quartz Commercial |
$492.96
|
| Rate for Payer: WEA Trust Commercial |
$451.88
|
| Rate for Payer: WPS Commercial |
$608.54
|
|
|
SCREW-CORT 2.7 X 16 202.016
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967265
|
|
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 16 202.016
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967265
|
|
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 16 202.816
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966839
|
|
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 16 202.816
|
Facility
|
IP
|
$123.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966839
|
|
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 16 402.876
|
Facility
|
IP
|
$355.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2990954
|
|
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 16 402.876
|
Facility
|
OP
|
$355.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2990954
|
|
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 16 LO-PRO AR-8827-16
|
Facility
|
IP
|
$839.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5520831
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$427.55 |
| Max. Negotiated Rate |
$802.76 |
| Rate for Payer: Aetna Commercial |
$785.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$750.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$462.46
|
| Rate for Payer: Cash Price |
$251.70
|
| Rate for Payer: Cigna Commercial |
$802.76
|
| Rate for Payer: Health EOS Commercial |
$776.58
|
| Rate for Payer: HFN Commercial |
$802.76
|
| Rate for Payer: Multiplan Commercial |
$698.05
|
| Rate for Payer: Preferred Network Access Commercial |
$802.76
|
| Rate for Payer: Quartz Beloit One Network |
$427.55
|
| Rate for Payer: Quartz Commercial |
$523.54
|
| Rate for Payer: WEA Trust Commercial |
$479.91
|
| Rate for Payer: WPS Commercial |
$646.28
|
|
|
SCREW CORT 2.7 X 16 LO-PRO AR-8827-16
|
Facility
|
OP
|
$839.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5520831
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$244.32 |
| Max. Negotiated Rate |
$802.76 |
| Rate for Payer: Aetna Commercial |
$785.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$750.40
|
| Rate for Payer: Aetna Managed Medicare |
$244.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$567.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$436.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$418.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$462.46
|
| Rate for Payer: Cash Price |
$251.70
|
| Rate for Payer: Cigna Commercial |
$802.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$488.30
|
| Rate for Payer: Health EOS Commercial |
$776.58
|
| Rate for Payer: HFN Commercial |
$802.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$654.42
|
| Rate for Payer: Multiplan Commercial |
$698.05
|
| Rate for Payer: NAPHCARE Commercial |
$523.54
|
| Rate for Payer: Preferred Network Access Commercial |
$802.76
|
| Rate for Payer: Quartz Beloit One Network |
$427.55
|
| Rate for Payer: Quartz Commercial |
$567.16
|
| Rate for Payer: Quartz Medicare Advantage |
$523.54
|
| Rate for Payer: The Alliance Commercial |
$436.28
|
| Rate for Payer: WEA Trust Commercial |
$479.91
|
| Rate for Payer: WPS Commercial |
$646.28
|
|
|
SCREW CORT 2.7 X 16MM COLINK AFX LOW-PRO P72 ST016
|
Facility
|
IP
|
$1,932.00
|
|
|
Service Code
|
HCPCS C1714
|
| Hospital Charge Code |
6172085
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$984.55 |
| Max. Negotiated Rate |
$1,848.54 |
| Rate for Payer: Aetna Commercial |
$1,808.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,727.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,064.92
|
| Rate for Payer: Cash Price |
$579.60
|
| Rate for Payer: Cigna Commercial |
$1,848.54
|
| Rate for Payer: Health EOS Commercial |
$1,788.26
|
| Rate for Payer: HFN Commercial |
$1,848.54
|
| Rate for Payer: Multiplan Commercial |
$1,607.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,848.54
|
| Rate for Payer: Quartz Beloit One Network |
$984.55
|
| Rate for Payer: Quartz Commercial |
$1,205.57
|
| Rate for Payer: WEA Trust Commercial |
$1,105.10
|
| Rate for Payer: WPS Commercial |
$1,488.22
|
|
|
SCREW CORT 2.7 X 16MM COLINK AFX LOW-PRO P72 ST016
|
Facility
|
OP
|
$1,932.00
|
|
|
Service Code
|
HCPCS C1714
|
| Hospital Charge Code |
6172085
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$562.60 |
| Max. Negotiated Rate |
$1,848.54 |
| Rate for Payer: Aetna Commercial |
$1,808.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,727.98
|
| Rate for Payer: Aetna Managed Medicare |
$562.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,306.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,004.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$964.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,064.92
|
| Rate for Payer: Cash Price |
$579.60
|
| Rate for Payer: Cigna Commercial |
$1,848.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,124.42
|
| Rate for Payer: Health EOS Commercial |
$1,788.26
|
| Rate for Payer: HFN Commercial |
$1,848.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,506.96
|
| Rate for Payer: Multiplan Commercial |
$1,607.42
|
| Rate for Payer: NAPHCARE Commercial |
$1,205.57
|
| Rate for Payer: Preferred Network Access Commercial |
$1,848.54
|
| Rate for Payer: Quartz Beloit One Network |
$984.55
|
| Rate for Payer: Quartz Commercial |
$1,306.03
|
| Rate for Payer: Quartz Medicare Advantage |
$1,205.57
|
| Rate for Payer: The Alliance Commercial |
$1,004.64
|
| Rate for Payer: WEA Trust Commercial |
$1,105.10
|
| Rate for Payer: WPS Commercial |
$1,488.22
|
|
|
SCREW CORT 2.7 X 16 STARDRIVE 202.876
|
Facility
|
IP
|
$790.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966470
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$402.58 |
| Max. Negotiated Rate |
$755.87 |
| Rate for Payer: Aetna Commercial |
$739.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$706.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$435.45
|
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cigna Commercial |
$755.87
|
| Rate for Payer: Health EOS Commercial |
$731.22
|
| Rate for Payer: HFN Commercial |
$755.87
|
| Rate for Payer: Multiplan Commercial |
$657.28
|
| Rate for Payer: Preferred Network Access Commercial |
$755.87
|
| Rate for Payer: Quartz Beloit One Network |
$402.58
|
| Rate for Payer: Quartz Commercial |
$492.96
|
| Rate for Payer: WEA Trust Commercial |
$451.88
|
| Rate for Payer: WPS Commercial |
$608.54
|
|
|
SCREW CORT 2.7 X 16 STARDRIVE 202.876
|
Facility
|
OP
|
$790.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966470
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$230.05 |
| Max. Negotiated Rate |
$755.87 |
| Rate for Payer: Aetna Commercial |
$739.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$706.58
|
| Rate for Payer: Aetna Managed Medicare |
$230.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$534.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$410.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$394.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$435.45
|
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cigna Commercial |
$755.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$459.78
|
| Rate for Payer: Health EOS Commercial |
$731.22
|
| Rate for Payer: HFN Commercial |
$755.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$616.20
|
| Rate for Payer: Multiplan Commercial |
$657.28
|
| Rate for Payer: NAPHCARE Commercial |
$492.96
|
| Rate for Payer: Preferred Network Access Commercial |
$755.87
|
| Rate for Payer: Quartz Beloit One Network |
$402.58
|
| Rate for Payer: Quartz Commercial |
$534.04
|
| Rate for Payer: Quartz Medicare Advantage |
$492.96
|
| Rate for Payer: The Alliance Commercial |
$410.80
|
| Rate for Payer: WEA Trust Commercial |
$451.88
|
| Rate for Payer: WPS Commercial |
$608.54
|
|
|
SCREW-CORT 2.7 X 18 202.018
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967266
|
|
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 18 202.018
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967266
|
|
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 18 202.818
|
Facility
|
IP
|
$123.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966840
|
|
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 18 202.818
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966840
|
|
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 18 402.878
|
Facility
|
IP
|
$342.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966841
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$174.28 |
| Max. Negotiated Rate |
$327.23 |
| Rate for Payer: Aetna Commercial |
$320.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$305.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$188.51
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cigna Commercial |
$327.23
|
| Rate for Payer: Health EOS Commercial |
$316.56
|
| Rate for Payer: HFN Commercial |
$327.23
|
| Rate for Payer: Multiplan Commercial |
$284.54
|
| Rate for Payer: Preferred Network Access Commercial |
$327.23
|
| Rate for Payer: Quartz Beloit One Network |
$174.28
|
| Rate for Payer: Quartz Commercial |
$213.41
|
| Rate for Payer: WEA Trust Commercial |
$195.62
|
| Rate for Payer: WPS Commercial |
$263.44
|
|
|
SCREW-CORT 2.7 X 18 402.878
|
Facility
|
OP
|
$342.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966841
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$99.59 |
| Max. Negotiated Rate |
$327.23 |
| Rate for Payer: Aetna Commercial |
$320.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$305.88
|
| Rate for Payer: Aetna Managed Medicare |
$99.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$231.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$177.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$170.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$188.51
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cigna Commercial |
$327.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$199.04
|
| Rate for Payer: Health EOS Commercial |
$316.56
|
| Rate for Payer: HFN Commercial |
$327.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$266.76
|
| Rate for Payer: Multiplan Commercial |
$284.54
|
| Rate for Payer: NAPHCARE Commercial |
$213.41
|
| Rate for Payer: Preferred Network Access Commercial |
$327.23
|
| Rate for Payer: Quartz Beloit One Network |
$174.28
|
| Rate for Payer: Quartz Commercial |
$231.19
|
| Rate for Payer: Quartz Medicare Advantage |
$213.41
|
| Rate for Payer: The Alliance Commercial |
$177.84
|
| Rate for Payer: WEA Trust Commercial |
$195.62
|
| Rate for Payer: WPS Commercial |
$263.44
|
|
