|
SCREW-CORT 2.7 X 30 202.030
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967272
|
|
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 30 202.030
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967272
|
|
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 30 202.830
|
Facility
|
IP
|
$123.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966852
|
|
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 30 202.830
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966852
|
|
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 30 402.890
|
Facility
|
IP
|
$342.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966853
|
|
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 30 402.890
|
Facility
|
OP
|
$342.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966853
|
|
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
|
|
|
SCREW CORT 2.7 X 30 STARDRIVE 202.890
|
Facility
|
IP
|
$853.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966487
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$434.69 |
| Max. Negotiated Rate |
$816.15 |
| Rate for Payer: Aetna Commercial |
$798.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$762.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$470.17
|
| Rate for Payer: Cash Price |
$255.90
|
| Rate for Payer: Cigna Commercial |
$816.15
|
| Rate for Payer: Health EOS Commercial |
$789.54
|
| Rate for Payer: HFN Commercial |
$816.15
|
| Rate for Payer: Multiplan Commercial |
$709.70
|
| Rate for Payer: Preferred Network Access Commercial |
$816.15
|
| Rate for Payer: Quartz Beloit One Network |
$434.69
|
| Rate for Payer: Quartz Commercial |
$532.27
|
| Rate for Payer: WEA Trust Commercial |
$487.92
|
| Rate for Payer: WPS Commercial |
$657.07
|
|
|
SCREW CORT 2.7 X 30 STARDRIVE 202.890
|
Facility
|
OP
|
$853.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966487
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$248.39 |
| Max. Negotiated Rate |
$816.15 |
| Rate for Payer: Aetna Commercial |
$798.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$762.92
|
| Rate for Payer: Aetna Managed Medicare |
$248.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$576.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$443.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$425.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$470.17
|
| Rate for Payer: Cash Price |
$255.90
|
| Rate for Payer: Cigna Commercial |
$816.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$496.45
|
| Rate for Payer: Health EOS Commercial |
$789.54
|
| Rate for Payer: HFN Commercial |
$816.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$665.34
|
| Rate for Payer: Multiplan Commercial |
$709.70
|
| Rate for Payer: NAPHCARE Commercial |
$532.27
|
| Rate for Payer: Preferred Network Access Commercial |
$816.15
|
| Rate for Payer: Quartz Beloit One Network |
$434.69
|
| Rate for Payer: Quartz Commercial |
$576.63
|
| Rate for Payer: Quartz Medicare Advantage |
$532.27
|
| Rate for Payer: The Alliance Commercial |
$443.56
|
| Rate for Payer: WEA Trust Commercial |
$487.92
|
| Rate for Payer: WPS Commercial |
$657.07
|
|
|
SCREW-CORT 2.7 X 32 202.032
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967273
|
|
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 32 202.032
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967273
|
|
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 32 202.832
|
Facility
|
IP
|
$118.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966854
|
|
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 32 202.832
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966854
|
|
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 32 LO-PRO AR-8827-32
|
Facility
|
OP
|
$753.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6244120
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$219.29 |
| Max. Negotiated Rate |
$720.52 |
| Rate for Payer: Aetna Commercial |
$704.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$673.53
|
| Rate for Payer: Aetna Managed Medicare |
$219.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$509.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$391.59
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$375.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$415.08
|
| Rate for Payer: Cash Price |
$225.92
|
| Rate for Payer: Cigna Commercial |
$720.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$438.28
|
| Rate for Payer: Health EOS Commercial |
$697.02
|
| Rate for Payer: HFN Commercial |
$720.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$587.38
|
| Rate for Payer: Multiplan Commercial |
$626.54
|
| Rate for Payer: NAPHCARE Commercial |
$469.90
|
| Rate for Payer: Preferred Network Access Commercial |
$720.52
|
| Rate for Payer: Quartz Beloit One Network |
$383.75
|
| Rate for Payer: Quartz Commercial |
$509.06
|
| Rate for Payer: Quartz Medicare Advantage |
$469.90
|
| Rate for Payer: The Alliance Commercial |
$391.59
|
| Rate for Payer: WEA Trust Commercial |
$430.74
|
| Rate for Payer: WPS Commercial |
$580.07
|
|
|
SCREW CORT 2.7 X 32 LO-PRO AR-8827-32
|
Facility
|
IP
|
$753.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6244120
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$383.75 |
| Max. Negotiated Rate |
$720.52 |
| Rate for Payer: Aetna Commercial |
$704.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$673.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$415.08
|
| Rate for Payer: Cash Price |
$225.92
|
| Rate for Payer: Cigna Commercial |
$720.52
|
| Rate for Payer: Health EOS Commercial |
$697.02
|
| Rate for Payer: HFN Commercial |
$720.52
|
| Rate for Payer: Multiplan Commercial |
$626.54
|
| Rate for Payer: Preferred Network Access Commercial |
$720.52
|
| Rate for Payer: Quartz Beloit One Network |
$383.75
|
| Rate for Payer: Quartz Commercial |
$469.90
|
| Rate for Payer: WEA Trust Commercial |
$430.74
|
| Rate for Payer: WPS Commercial |
$580.07
|
|
|
SCREW CORT 2.7 X 32 STARDRIVE 202.892
|
Facility
|
OP
|
$579.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4493841
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.60 |
| Max. Negotiated Rate |
$553.99 |
| Rate for Payer: Aetna Commercial |
$541.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$517.86
|
| Rate for Payer: Aetna Managed Medicare |
$168.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$391.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$301.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$289.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$319.14
|
| Rate for Payer: Cash Price |
$173.70
|
| Rate for Payer: Cigna Commercial |
$553.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$336.98
|
| Rate for Payer: Health EOS Commercial |
$535.92
|
| Rate for Payer: HFN Commercial |
$553.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$451.62
|
| Rate for Payer: Multiplan Commercial |
$481.73
|
| Rate for Payer: NAPHCARE Commercial |
$361.30
|
| Rate for Payer: Preferred Network Access Commercial |
$553.99
|
| Rate for Payer: Quartz Beloit One Network |
$295.06
|
| Rate for Payer: Quartz Commercial |
$391.40
|
| Rate for Payer: Quartz Medicare Advantage |
$361.30
|
| Rate for Payer: The Alliance Commercial |
$301.08
|
| Rate for Payer: WEA Trust Commercial |
$331.19
|
| Rate for Payer: WPS Commercial |
$446.00
|
|
|
SCREW CORT 2.7 X 32 STARDRIVE 202.892
|
Facility
|
IP
|
$579.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4493841
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$295.06 |
| Max. Negotiated Rate |
$553.99 |
| Rate for Payer: Aetna Commercial |
$541.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$517.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$319.14
|
| Rate for Payer: Cash Price |
$173.70
|
| Rate for Payer: Cigna Commercial |
$553.99
|
| Rate for Payer: Health EOS Commercial |
$535.92
|
| Rate for Payer: HFN Commercial |
$553.99
|
| Rate for Payer: Multiplan Commercial |
$481.73
|
| Rate for Payer: Preferred Network Access Commercial |
$553.99
|
| Rate for Payer: Quartz Beloit One Network |
$295.06
|
| Rate for Payer: Quartz Commercial |
$361.30
|
| Rate for Payer: WEA Trust Commercial |
$331.19
|
| Rate for Payer: WPS Commercial |
$446.00
|
|
|
SCREW-CORT 2.7 X 34 202.834
|
Facility
|
IP
|
$123.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966855
|
|
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 34 202.834
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966855
|
|
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 36 202.836
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966856
|
|
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 36 202.836
|
Facility
|
IP
|
$118.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966856
|
|
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 38 202.838
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966857
|
|
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 38 202.838
|
Facility
|
IP
|
$118.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966857
|
|
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 40 202.840
|
Facility
|
IP
|
$118.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966858
|
|
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 40 202.840
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966858
|
|
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 42MM STARDRIVE 202.962
|
Facility
|
IP
|
$579.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4452948
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$295.06 |
| Max. Negotiated Rate |
$553.99 |
| Rate for Payer: Aetna Commercial |
$541.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$517.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$319.14
|
| Rate for Payer: Cash Price |
$173.70
|
| Rate for Payer: Cigna Commercial |
$553.99
|
| Rate for Payer: Health EOS Commercial |
$535.92
|
| Rate for Payer: HFN Commercial |
$553.99
|
| Rate for Payer: Multiplan Commercial |
$481.73
|
| Rate for Payer: Preferred Network Access Commercial |
$553.99
|
| Rate for Payer: Quartz Beloit One Network |
$295.06
|
| Rate for Payer: Quartz Commercial |
$361.30
|
| Rate for Payer: WEA Trust Commercial |
$331.19
|
| Rate for Payer: WPS Commercial |
$446.00
|
|
