|
SCREW-CORT 2.0 X 18 201.018
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967258
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$37.24 |
| Max. Negotiated Rate |
$532.00 |
| Rate for Payer: Aetna Commercial |
$119.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$114.38
|
| Rate for Payer: Aetna Managed Medicare |
$37.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$86.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$66.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$63.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$70.49
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cigna Commercial |
$122.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$74.43
|
| Rate for Payer: Health EOS Commercial |
$118.37
|
| Rate for Payer: HFN Commercial |
$122.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$99.75
|
| Rate for Payer: Multiplan Commercial |
$106.40
|
| Rate for Payer: NAPHCARE Commercial |
$79.80
|
| Rate for Payer: Preferred Network Access Commercial |
$122.36
|
| Rate for Payer: Quartz Beloit One Network |
$65.17
|
| Rate for Payer: Quartz Commercial |
$86.45
|
| Rate for Payer: Quartz Medicare Advantage |
$79.80
|
| Rate for Payer: The Alliance Commercial |
$532.00
|
| Rate for Payer: WEA Trust Commercial |
$73.15
|
| Rate for Payer: WPS Commercial |
$98.51
|
|
|
SCREW-CORT 2.0 X 18 201.018
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967258
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$65.17 |
| Max. Negotiated Rate |
$122.36 |
| Rate for Payer: Aetna Commercial |
$119.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$114.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$70.49
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cigna Commercial |
$122.36
|
| Rate for Payer: Health EOS Commercial |
$118.37
|
| Rate for Payer: HFN Commercial |
$122.36
|
| Rate for Payer: Multiplan Commercial |
$106.40
|
| Rate for Payer: NAPHCARE Commercial |
$79.80
|
| Rate for Payer: Preferred Network Access Commercial |
$122.36
|
| Rate for Payer: Quartz Beloit One Network |
$65.17
|
| Rate for Payer: Quartz Commercial |
$79.80
|
| Rate for Payer: WEA Trust Commercial |
$73.15
|
| Rate for Payer: WPS Commercial |
$98.51
|
|
|
SCREW CORT 2.0 X 18MM 201.368.97
|
Facility
|
OP
|
$563.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414984
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$157.64 |
| Max. Negotiated Rate |
$2,252.00 |
| 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
|
| 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
|
|
|
SCREW CORT 2.0 X 18MM 201.368.97
|
Facility
|
IP
|
$563.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414984
|
|
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 18MM STARDRIVE 401.368.97
|
Facility
|
IP
|
$961.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966435
|
|
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 18MM STARDRIVE 401.368.97
|
Facility
|
OP
|
$961.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966435
|
|
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 20 201.020
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967259
|
|
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 20 201.020
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967259
|
|
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 20MM 201.370.97
|
Facility
|
OP
|
$681.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966437
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$190.68 |
| Max. Negotiated Rate |
$2,724.00 |
| Rate for Payer: Aetna Commercial |
$612.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$585.66
|
| Rate for Payer: Aetna Managed Medicare |
$190.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$442.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$340.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$326.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$360.93
|
| Rate for Payer: Cash Price |
$204.30
|
| Rate for Payer: Cigna Commercial |
$626.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$381.09
|
| Rate for Payer: Health EOS Commercial |
$606.09
|
| Rate for Payer: HFN Commercial |
$626.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$510.75
|
| Rate for Payer: Multiplan Commercial |
$544.80
|
| Rate for Payer: NAPHCARE Commercial |
$408.60
|
| Rate for Payer: Preferred Network Access Commercial |
$626.52
|
| Rate for Payer: Quartz Beloit One Network |
$333.69
|
| Rate for Payer: Quartz Commercial |
$442.65
|
| Rate for Payer: Quartz Medicare Advantage |
$408.60
|
| Rate for Payer: The Alliance Commercial |
$2,724.00
|
| Rate for Payer: WEA Trust Commercial |
$374.55
|
| Rate for Payer: WPS Commercial |
$504.42
|
|
|
SCREW CORT 2.0 X 20MM 201.370.97
|
Facility
|
IP
|
$681.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966437
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$333.69 |
| Max. Negotiated Rate |
$626.52 |
| Rate for Payer: Aetna Commercial |
$612.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$585.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$360.93
|
| Rate for Payer: Cash Price |
$204.30
|
| Rate for Payer: Cigna Commercial |
$626.52
|
| Rate for Payer: Health EOS Commercial |
$606.09
|
| Rate for Payer: HFN Commercial |
$626.52
|
| Rate for Payer: Multiplan Commercial |
$544.80
|
| Rate for Payer: NAPHCARE Commercial |
$408.60
|
| Rate for Payer: Preferred Network Access Commercial |
$626.52
|
| Rate for Payer: Quartz Beloit One Network |
$333.69
|
| Rate for Payer: Quartz Commercial |
$408.60
|
| Rate for Payer: WEA Trust Commercial |
$374.55
|
| Rate for Payer: WPS Commercial |
$504.42
|
|
|
SCREW CORT 2.0 X 22MM 201.372.97
|
Facility
|
IP
|
$563.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767810
|
|
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 22MM 201.372.97
|
Facility
|
OP
|
$563.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767810
|
|
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 24MM 201.374.97
|
Facility
|
OP
|
$563.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414985
|
|
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 24MM 201.374.97
|
Facility
|
IP
|
$563.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414985
|
|
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 26MM 201.375.97
|
Facility
|
IP
|
$563.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767811
|
|
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 26MM 201.375.97
|
Facility
|
OP
|
$563.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767811
|
|
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 28MM 201.376.97
|
Facility
|
IP
|
$563.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767812
|
|
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 28MM 201.376.97
|
Facility
|
OP
|
$563.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767812
|
|
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 30MM 201.377.97
|
Facility
|
IP
|
$563.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414986
|
|
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 30MM 201.377.97
|
Facility
|
OP
|
$563.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414986
|
|
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 34MM 201.379.97
|
Facility
|
IP
|
$563.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414987
|
|
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 34MM 201.379.97
|
Facility
|
OP
|
$563.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414987
|
|
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 6 201.006
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967260
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$37.24 |
| Max. Negotiated Rate |
$532.00 |
| Rate for Payer: Aetna Commercial |
$119.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$114.38
|
| Rate for Payer: Aetna Managed Medicare |
$37.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$86.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$66.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$63.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$70.49
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cigna Commercial |
$122.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$74.43
|
| Rate for Payer: Health EOS Commercial |
$118.37
|
| Rate for Payer: HFN Commercial |
$122.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$99.75
|
| Rate for Payer: Multiplan Commercial |
$106.40
|
| Rate for Payer: NAPHCARE Commercial |
$79.80
|
| Rate for Payer: Preferred Network Access Commercial |
$122.36
|
| Rate for Payer: Quartz Beloit One Network |
$65.17
|
| Rate for Payer: Quartz Commercial |
$86.45
|
| Rate for Payer: Quartz Medicare Advantage |
$79.80
|
| Rate for Payer: The Alliance Commercial |
$532.00
|
| Rate for Payer: WEA Trust Commercial |
$73.15
|
| Rate for Payer: WPS Commercial |
$98.51
|
|
|
SCREW-CORT 2.0 X 6 201.006
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967260
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$65.17 |
| Max. Negotiated Rate |
$122.36 |
| Rate for Payer: Aetna Commercial |
$119.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$114.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$70.49
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cigna Commercial |
$122.36
|
| Rate for Payer: Health EOS Commercial |
$118.37
|
| Rate for Payer: HFN Commercial |
$122.36
|
| Rate for Payer: Multiplan Commercial |
$106.40
|
| Rate for Payer: NAPHCARE Commercial |
$79.80
|
| Rate for Payer: Preferred Network Access Commercial |
$122.36
|
| Rate for Payer: Quartz Beloit One Network |
$65.17
|
| Rate for Payer: Quartz Commercial |
$79.80
|
| Rate for Payer: WEA Trust Commercial |
$73.15
|
| Rate for Payer: WPS Commercial |
$98.51
|
|
|
SCREW CORT 2.0 X 6MM 201.356.97
|
Facility
|
IP
|
$563.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767807
|
|
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
|
|
