|
SCREW CORT 2.0 X 11MM 201.361.97
|
Facility
|
IP
|
$655.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966428
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$320.95 |
| Max. Negotiated Rate |
$602.60 |
| Rate for Payer: Aetna Commercial |
$589.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$563.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$347.15
|
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: Cigna Commercial |
$602.60
|
| Rate for Payer: Health EOS Commercial |
$582.95
|
| Rate for Payer: HFN Commercial |
$602.60
|
| Rate for Payer: Multiplan Commercial |
$524.00
|
| Rate for Payer: NAPHCARE Commercial |
$393.00
|
| Rate for Payer: Preferred Network Access Commercial |
$602.60
|
| Rate for Payer: Quartz Beloit One Network |
$320.95
|
| Rate for Payer: Quartz Commercial |
$393.00
|
| Rate for Payer: WEA Trust Commercial |
$360.25
|
| Rate for Payer: WPS Commercial |
$485.16
|
|
|
SCREW CORT 2.0 X 11MM STARDRIVE 401.361.97
|
Facility
|
IP
|
$730.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3313466
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$357.70 |
| Max. Negotiated Rate |
$671.60 |
| Rate for Payer: Aetna Commercial |
$657.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$627.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$386.90
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cigna Commercial |
$671.60
|
| Rate for Payer: Health EOS Commercial |
$649.70
|
| Rate for Payer: HFN Commercial |
$671.60
|
| Rate for Payer: Multiplan Commercial |
$584.00
|
| Rate for Payer: NAPHCARE Commercial |
$438.00
|
| Rate for Payer: Preferred Network Access Commercial |
$671.60
|
| Rate for Payer: Quartz Beloit One Network |
$357.70
|
| Rate for Payer: Quartz Commercial |
$438.00
|
| Rate for Payer: WEA Trust Commercial |
$401.50
|
| Rate for Payer: WPS Commercial |
$540.71
|
|
|
SCREW CORT 2.0 X 11MM STARDRIVE 401.361.97
|
Facility
|
OP
|
$730.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3313466
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$204.40 |
| Max. Negotiated Rate |
$2,920.00 |
| Rate for Payer: Aetna Commercial |
$657.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$627.80
|
| Rate for Payer: Aetna Managed Medicare |
$204.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$474.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$365.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$350.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$386.90
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cigna Commercial |
$671.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$408.51
|
| Rate for Payer: Health EOS Commercial |
$649.70
|
| Rate for Payer: HFN Commercial |
$671.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$547.50
|
| Rate for Payer: Multiplan Commercial |
$584.00
|
| Rate for Payer: NAPHCARE Commercial |
$438.00
|
| Rate for Payer: Preferred Network Access Commercial |
$671.60
|
| Rate for Payer: Quartz Beloit One Network |
$357.70
|
| Rate for Payer: Quartz Commercial |
$474.50
|
| Rate for Payer: Quartz Medicare Advantage |
$438.00
|
| Rate for Payer: The Alliance Commercial |
$2,920.00
|
| Rate for Payer: WEA Trust Commercial |
$401.50
|
| Rate for Payer: WPS Commercial |
$540.71
|
|
|
SCREW-CORT 2.0 X 12 201.012
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967255
|
|
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 2.0 X 12 201.012
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967255
|
|
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 2.0 X 12MM 201.362.97
|
Facility
|
OP
|
$655.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3313463
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$183.40 |
| Max. Negotiated Rate |
$2,620.00 |
| Rate for Payer: Aetna Commercial |
$589.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$563.30
|
| Rate for Payer: Aetna Managed Medicare |
$183.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$425.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$327.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$314.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$347.15
|
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: Cigna Commercial |
$602.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$366.54
|
| Rate for Payer: Health EOS Commercial |
$582.95
|
| Rate for Payer: HFN Commercial |
$602.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$491.25
|
| Rate for Payer: Multiplan Commercial |
$524.00
|
| Rate for Payer: NAPHCARE Commercial |
$393.00
|
| Rate for Payer: Preferred Network Access Commercial |
$602.60
|
| Rate for Payer: Quartz Beloit One Network |
$320.95
|
| Rate for Payer: Quartz Commercial |
$425.75
|
| Rate for Payer: Quartz Medicare Advantage |
$393.00
|
| Rate for Payer: The Alliance Commercial |
$2,620.00
|
| Rate for Payer: WEA Trust Commercial |
$360.25
|
| Rate for Payer: WPS Commercial |
$485.16
|
|
|
SCREW CORT 2.0 X 12MM 201.362.97
|
Facility
|
IP
|
$655.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3313463
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$320.95 |
| Max. Negotiated Rate |
$602.60 |
| Rate for Payer: Aetna Commercial |
$589.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$563.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$347.15
|
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: Cigna Commercial |
$602.60
|
| Rate for Payer: Health EOS Commercial |
$582.95
|
| Rate for Payer: HFN Commercial |
$602.60
|
| Rate for Payer: Multiplan Commercial |
$524.00
|
| Rate for Payer: NAPHCARE Commercial |
$393.00
|
| Rate for Payer: Preferred Network Access Commercial |
$602.60
|
| Rate for Payer: Quartz Beloit One Network |
$320.95
|
| Rate for Payer: Quartz Commercial |
$393.00
|
| Rate for Payer: WEA Trust Commercial |
$360.25
|
| Rate for Payer: WPS Commercial |
$485.16
|
|
|
SCREW CORT 2.0 X 12MM STARDRIVE 401.362.97
|
Facility
|
IP
|
$961.00
|
|
| Hospital Charge Code |
2966430
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$470.89 |
| Max. Negotiated Rate |
$884.12 |
| Rate for Payer: Aetna Commercial |
$864.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$826.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$509.33
|
| Rate for Payer: Cash Price |
$288.30
|
| Rate for Payer: Cigna Commercial |
$884.12
|
| Rate for Payer: Health EOS Commercial |
$855.29
|
| Rate for Payer: HFN Commercial |
$884.12
|
| Rate for Payer: Multiplan Commercial |
$768.80
|
| Rate for Payer: NAPHCARE Commercial |
$576.60
|
| Rate for Payer: Preferred Network Access Commercial |
$884.12
|
| Rate for Payer: Quartz Beloit One Network |
$470.89
|
| Rate for Payer: Quartz Commercial |
$576.60
|
| Rate for Payer: WEA Trust Commercial |
$528.55
|
| Rate for Payer: WPS Commercial |
$711.81
|
|
|
SCREW CORT 2.0 X 12MM STARDRIVE 401.362.97
|
Facility
|
OP
|
$961.00
|
|
| Hospital Charge Code |
2966430
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$269.08 |
| Max. Negotiated Rate |
$3,844.00 |
| Rate for Payer: Aetna Commercial |
$864.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$826.46
|
| Rate for Payer: Aetna Managed Medicare |
$269.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$624.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$480.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$461.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$509.33
|
| Rate for Payer: Cash Price |
$288.30
|
| Rate for Payer: Cigna Commercial |
$884.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$537.78
|
| Rate for Payer: Health EOS Commercial |
$855.29
|
| Rate for Payer: HFN Commercial |
$884.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$720.75
|
| Rate for Payer: Multiplan Commercial |
$768.80
|
| Rate for Payer: NAPHCARE Commercial |
$576.60
|
| Rate for Payer: Preferred Network Access Commercial |
$884.12
|
| Rate for Payer: Quartz Beloit One Network |
$470.89
|
| Rate for Payer: Quartz Commercial |
$624.65
|
| Rate for Payer: Quartz Medicare Advantage |
$576.60
|
| Rate for Payer: The Alliance Commercial |
$3,844.00
|
| Rate for Payer: WEA Trust Commercial |
$528.55
|
| Rate for Payer: WPS Commercial |
$711.81
|
|
|
SCREW CORT 2.0 X 13MM 201.363.97
|
Facility
|
IP
|
$655.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4858883
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$320.95 |
| Max. Negotiated Rate |
$602.60 |
| Rate for Payer: Aetna Commercial |
$589.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$563.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$347.15
|
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: Cigna Commercial |
$602.60
|
| Rate for Payer: Health EOS Commercial |
$582.95
|
| Rate for Payer: HFN Commercial |
$602.60
|
| Rate for Payer: Multiplan Commercial |
$524.00
|
| Rate for Payer: NAPHCARE Commercial |
$393.00
|
| Rate for Payer: Preferred Network Access Commercial |
$602.60
|
| Rate for Payer: Quartz Beloit One Network |
$320.95
|
| Rate for Payer: Quartz Commercial |
$393.00
|
| Rate for Payer: WEA Trust Commercial |
$360.25
|
| Rate for Payer: WPS Commercial |
$485.16
|
|
|
SCREW CORT 2.0 X 13MM 201.363.97
|
Facility
|
OP
|
$655.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4858883
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$183.40 |
| Max. Negotiated Rate |
$2,620.00 |
| Rate for Payer: Aetna Commercial |
$589.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$563.30
|
| Rate for Payer: Aetna Managed Medicare |
$183.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$425.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$327.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$314.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$347.15
|
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: Cigna Commercial |
$602.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$366.54
|
| Rate for Payer: Health EOS Commercial |
$582.95
|
| Rate for Payer: HFN Commercial |
$602.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$491.25
|
| Rate for Payer: Multiplan Commercial |
$524.00
|
| Rate for Payer: NAPHCARE Commercial |
$393.00
|
| Rate for Payer: Preferred Network Access Commercial |
$602.60
|
| Rate for Payer: Quartz Beloit One Network |
$320.95
|
| Rate for Payer: Quartz Commercial |
$425.75
|
| Rate for Payer: Quartz Medicare Advantage |
$393.00
|
| Rate for Payer: The Alliance Commercial |
$2,620.00
|
| Rate for Payer: WEA Trust Commercial |
$360.25
|
| Rate for Payer: WPS Commercial |
$485.16
|
|
|
SCREW CORT 2.0 X 13MM STARDRIVE 401.363.97
|
Facility
|
IP
|
$730.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3313465
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$357.70 |
| Max. Negotiated Rate |
$671.60 |
| Rate for Payer: Aetna Commercial |
$657.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$627.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$386.90
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cigna Commercial |
$671.60
|
| Rate for Payer: Health EOS Commercial |
$649.70
|
| Rate for Payer: HFN Commercial |
$671.60
|
| Rate for Payer: Multiplan Commercial |
$584.00
|
| Rate for Payer: NAPHCARE Commercial |
$438.00
|
| Rate for Payer: Preferred Network Access Commercial |
$671.60
|
| Rate for Payer: Quartz Beloit One Network |
$357.70
|
| Rate for Payer: Quartz Commercial |
$438.00
|
| Rate for Payer: WEA Trust Commercial |
$401.50
|
| Rate for Payer: WPS Commercial |
$540.71
|
|
|
SCREW CORT 2.0 X 13MM STARDRIVE 401.363.97
|
Facility
|
OP
|
$730.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3313465
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$204.40 |
| Max. Negotiated Rate |
$2,920.00 |
| Rate for Payer: Aetna Commercial |
$657.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$627.80
|
| Rate for Payer: Aetna Managed Medicare |
$204.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$474.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$365.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$350.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$386.90
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cigna Commercial |
$671.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$408.51
|
| Rate for Payer: Health EOS Commercial |
$649.70
|
| Rate for Payer: HFN Commercial |
$671.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$547.50
|
| Rate for Payer: Multiplan Commercial |
$584.00
|
| Rate for Payer: NAPHCARE Commercial |
$438.00
|
| Rate for Payer: Preferred Network Access Commercial |
$671.60
|
| Rate for Payer: Quartz Beloit One Network |
$357.70
|
| Rate for Payer: Quartz Commercial |
$474.50
|
| Rate for Payer: Quartz Medicare Advantage |
$438.00
|
| Rate for Payer: The Alliance Commercial |
$2,920.00
|
| Rate for Payer: WEA Trust Commercial |
$401.50
|
| Rate for Payer: WPS Commercial |
$540.71
|
|
|
SCREW-CORT 2.0 X 14 201.014
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967256
|
|
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 2.0 X 14 201.014
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967256
|
|
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 2.0 X 14MM 201.364.97
|
Facility
|
IP
|
$563.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767792
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$275.87 |
| Max. Negotiated Rate |
$517.96 |
| Rate for Payer: Aetna Commercial |
$506.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$484.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$298.39
|
| Rate for Payer: Cash Price |
$168.90
|
| Rate for Payer: Cigna Commercial |
$517.96
|
| Rate for Payer: Health EOS Commercial |
$501.07
|
| Rate for Payer: HFN Commercial |
$517.96
|
| Rate for Payer: Multiplan Commercial |
$450.40
|
| Rate for Payer: NAPHCARE Commercial |
$337.80
|
| Rate for Payer: Preferred Network Access Commercial |
$517.96
|
| Rate for Payer: Quartz Beloit One Network |
$275.87
|
| Rate for Payer: Quartz Commercial |
$337.80
|
| Rate for Payer: WEA Trust Commercial |
$309.65
|
| Rate for Payer: WPS Commercial |
$417.01
|
|
|
SCREW CORT 2.0 X 14MM 201.364.97
|
Facility
|
OP
|
$563.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767792
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$157.64 |
| Max. Negotiated Rate |
$2,252.00 |
| Rate for Payer: Aetna Commercial |
$506.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$484.18
|
| Rate for Payer: Aetna Managed Medicare |
$157.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$365.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$281.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$270.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$298.39
|
| Rate for Payer: Cash Price |
$168.90
|
| Rate for Payer: Cigna Commercial |
$517.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$315.05
|
| Rate for Payer: Health EOS Commercial |
$501.07
|
| Rate for Payer: HFN Commercial |
$517.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$422.25
|
| Rate for Payer: Multiplan Commercial |
$450.40
|
| Rate for Payer: NAPHCARE Commercial |
$337.80
|
| Rate for Payer: Preferred Network Access Commercial |
$517.96
|
| Rate for Payer: Quartz Beloit One Network |
$275.87
|
| Rate for Payer: Quartz Commercial |
$365.95
|
| Rate for Payer: Quartz Medicare Advantage |
$337.80
|
| Rate for Payer: The Alliance Commercial |
$2,252.00
|
| Rate for Payer: WEA Trust Commercial |
$309.65
|
| Rate for Payer: WPS Commercial |
$417.01
|
|
|
SCREW CORT 2.0 X 14MM STARDRIVE 401.364.97
|
Facility
|
OP
|
$730.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3813013
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$204.40 |
| Max. Negotiated Rate |
$2,920.00 |
| Rate for Payer: Aetna Commercial |
$657.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$627.80
|
| Rate for Payer: Aetna Managed Medicare |
$204.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$474.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$365.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$350.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$386.90
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cigna Commercial |
$671.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$408.51
|
| Rate for Payer: Health EOS Commercial |
$649.70
|
| Rate for Payer: HFN Commercial |
$671.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$547.50
|
| Rate for Payer: Multiplan Commercial |
$584.00
|
| Rate for Payer: NAPHCARE Commercial |
$438.00
|
| Rate for Payer: Preferred Network Access Commercial |
$671.60
|
| Rate for Payer: Quartz Beloit One Network |
$357.70
|
| Rate for Payer: Quartz Commercial |
$474.50
|
| Rate for Payer: Quartz Medicare Advantage |
$438.00
|
| Rate for Payer: The Alliance Commercial |
$2,920.00
|
| Rate for Payer: WEA Trust Commercial |
$401.50
|
| Rate for Payer: WPS Commercial |
$540.71
|
|
|
SCREW CORT 2.0 X 14MM STARDRIVE 401.364.97
|
Facility
|
IP
|
$730.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3813013
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$357.70 |
| Max. Negotiated Rate |
$671.60 |
| Rate for Payer: Aetna Commercial |
$657.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$627.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$386.90
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cigna Commercial |
$671.60
|
| Rate for Payer: Health EOS Commercial |
$649.70
|
| Rate for Payer: HFN Commercial |
$671.60
|
| Rate for Payer: Multiplan Commercial |
$584.00
|
| Rate for Payer: NAPHCARE Commercial |
$438.00
|
| Rate for Payer: Preferred Network Access Commercial |
$671.60
|
| Rate for Payer: Quartz Beloit One Network |
$357.70
|
| Rate for Payer: Quartz Commercial |
$438.00
|
| Rate for Payer: WEA Trust Commercial |
$401.50
|
| Rate for Payer: WPS Commercial |
$540.71
|
|
|
SCREW CORT 2.0 X 15MM 201.365.97
|
Facility
|
OP
|
$748.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6181463
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$209.44 |
| Max. Negotiated Rate |
$2,992.00 |
| Rate for Payer: Aetna Commercial |
$673.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$643.28
|
| Rate for Payer: Aetna Managed Medicare |
$209.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$486.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$374.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$359.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$396.44
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cigna Commercial |
$688.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$418.58
|
| Rate for Payer: Health EOS Commercial |
$665.72
|
| Rate for Payer: HFN Commercial |
$688.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$561.00
|
| Rate for Payer: Multiplan Commercial |
$598.40
|
| Rate for Payer: NAPHCARE Commercial |
$448.80
|
| Rate for Payer: Preferred Network Access Commercial |
$688.16
|
| Rate for Payer: Quartz Beloit One Network |
$366.52
|
| Rate for Payer: Quartz Commercial |
$486.20
|
| Rate for Payer: Quartz Medicare Advantage |
$448.80
|
| Rate for Payer: The Alliance Commercial |
$2,992.00
|
| Rate for Payer: WEA Trust Commercial |
$411.40
|
| Rate for Payer: WPS Commercial |
$554.04
|
|
|
SCREW CORT 2.0 X 15MM 201.365.97
|
Facility
|
IP
|
$748.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6181463
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$366.52 |
| Max. Negotiated Rate |
$688.16 |
| Rate for Payer: Aetna Commercial |
$673.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$643.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$396.44
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cigna Commercial |
$688.16
|
| Rate for Payer: Health EOS Commercial |
$665.72
|
| Rate for Payer: HFN Commercial |
$688.16
|
| Rate for Payer: Multiplan Commercial |
$598.40
|
| Rate for Payer: NAPHCARE Commercial |
$448.80
|
| Rate for Payer: Preferred Network Access Commercial |
$688.16
|
| Rate for Payer: Quartz Beloit One Network |
$366.52
|
| Rate for Payer: Quartz Commercial |
$448.80
|
| Rate for Payer: WEA Trust Commercial |
$411.40
|
| Rate for Payer: WPS Commercial |
$554.04
|
|
|
SCREW-CORT 2.0 X 16 201.016
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967257
|
|
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 2.0 X 16 201.016
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967257
|
|
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 2.0 X 16MM 201.366.97
|
Facility
|
OP
|
$655.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966433
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$183.40 |
| Max. Negotiated Rate |
$2,620.00 |
| Rate for Payer: Aetna Commercial |
$589.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$563.30
|
| Rate for Payer: Aetna Managed Medicare |
$183.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$425.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$327.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$314.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$347.15
|
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: Cigna Commercial |
$602.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$366.54
|
| Rate for Payer: Health EOS Commercial |
$582.95
|
| Rate for Payer: HFN Commercial |
$602.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$491.25
|
| Rate for Payer: Multiplan Commercial |
$524.00
|
| Rate for Payer: NAPHCARE Commercial |
$393.00
|
| Rate for Payer: Preferred Network Access Commercial |
$602.60
|
| Rate for Payer: Quartz Beloit One Network |
$320.95
|
| Rate for Payer: Quartz Commercial |
$425.75
|
| Rate for Payer: Quartz Medicare Advantage |
$393.00
|
| Rate for Payer: The Alliance Commercial |
$2,620.00
|
| Rate for Payer: WEA Trust Commercial |
$360.25
|
| Rate for Payer: WPS Commercial |
$485.16
|
|
|
SCREW CORT 2.0 X 16MM 201.366.97
|
Facility
|
IP
|
$655.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966433
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$320.95 |
| Max. Negotiated Rate |
$602.60 |
| Rate for Payer: Aetna Commercial |
$589.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$563.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$347.15
|
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: Cigna Commercial |
$602.60
|
| Rate for Payer: Health EOS Commercial |
$582.95
|
| Rate for Payer: HFN Commercial |
$602.60
|
| Rate for Payer: Multiplan Commercial |
$524.00
|
| Rate for Payer: NAPHCARE Commercial |
$393.00
|
| Rate for Payer: Preferred Network Access Commercial |
$602.60
|
| Rate for Payer: Quartz Beloit One Network |
$320.95
|
| Rate for Payer: Quartz Commercial |
$393.00
|
| Rate for Payer: WEA Trust Commercial |
$360.25
|
| Rate for Payer: WPS Commercial |
$485.16
|
|
