|
SCREW CORT 2.7 X 42MM STARDRIVE 202.962
|
Facility
|
OP
|
$579.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4452948
|
|
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 45 202.845
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966859
|
|
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 45 202.845
|
Facility
|
IP
|
$118.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966859
|
|
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 50 202.850
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966860
|
|
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 50 202.850
|
Facility
|
IP
|
$123.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966860
|
|
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 50MM STARDRIVE 202.967
|
Facility
|
OP
|
$579.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4452949
|
|
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 50MM STARDRIVE 202.967
|
Facility
|
IP
|
$579.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4452949
|
|
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 55 202.855
|
Facility
|
OP
|
$784.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3116529
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$228.30 |
| Max. Negotiated Rate |
$750.13 |
| Rate for Payer: Aetna Commercial |
$733.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$701.21
|
| Rate for Payer: Aetna Managed Medicare |
$228.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$529.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$407.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$391.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$432.14
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Cigna Commercial |
$750.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$456.29
|
| Rate for Payer: Health EOS Commercial |
$725.67
|
| Rate for Payer: HFN Commercial |
$750.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$611.52
|
| Rate for Payer: Multiplan Commercial |
$652.29
|
| Rate for Payer: NAPHCARE Commercial |
$489.22
|
| Rate for Payer: Preferred Network Access Commercial |
$750.13
|
| Rate for Payer: Quartz Beloit One Network |
$399.53
|
| Rate for Payer: Quartz Commercial |
$529.98
|
| Rate for Payer: Quartz Medicare Advantage |
$489.22
|
| Rate for Payer: The Alliance Commercial |
$407.68
|
| Rate for Payer: WEA Trust Commercial |
$448.45
|
| Rate for Payer: WPS Commercial |
$603.92
|
|
|
SCREW-CORT 2.7 X 55 202.855
|
Facility
|
IP
|
$784.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3116529
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$399.53 |
| Max. Negotiated Rate |
$750.13 |
| Rate for Payer: Aetna Commercial |
$733.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$701.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$432.14
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Cigna Commercial |
$750.13
|
| Rate for Payer: Health EOS Commercial |
$725.67
|
| Rate for Payer: HFN Commercial |
$750.13
|
| Rate for Payer: Multiplan Commercial |
$652.29
|
| Rate for Payer: Preferred Network Access Commercial |
$750.13
|
| Rate for Payer: Quartz Beloit One Network |
$399.53
|
| Rate for Payer: Quartz Commercial |
$489.22
|
| Rate for Payer: WEA Trust Commercial |
$448.45
|
| Rate for Payer: WPS Commercial |
$603.92
|
|
|
SCREW CORT 2.7 X 60 LO-PRO AR-8827-60
|
Facility
|
IP
|
$783.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6217140
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$399.02 |
| Max. Negotiated Rate |
$749.17 |
| Rate for Payer: Aetna Commercial |
$732.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$700.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$431.59
|
| Rate for Payer: Cash Price |
$234.90
|
| Rate for Payer: Cigna Commercial |
$749.17
|
| Rate for Payer: Health EOS Commercial |
$724.74
|
| Rate for Payer: HFN Commercial |
$749.17
|
| Rate for Payer: Multiplan Commercial |
$651.46
|
| Rate for Payer: Preferred Network Access Commercial |
$749.17
|
| Rate for Payer: Quartz Beloit One Network |
$399.02
|
| Rate for Payer: Quartz Commercial |
$488.59
|
| Rate for Payer: WEA Trust Commercial |
$447.88
|
| Rate for Payer: WPS Commercial |
$603.14
|
|
|
SCREW CORT 2.7 X 60 LO-PRO AR-8827-60
|
Facility
|
OP
|
$783.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6217140
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$228.01 |
| Max. Negotiated Rate |
$749.17 |
| Rate for Payer: Aetna Commercial |
$732.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$700.32
|
| Rate for Payer: Aetna Managed Medicare |
$228.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$529.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$407.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$390.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$431.59
|
| Rate for Payer: Cash Price |
$234.90
|
| Rate for Payer: Cigna Commercial |
$749.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$455.71
|
| Rate for Payer: Health EOS Commercial |
$724.74
|
| Rate for Payer: HFN Commercial |
$749.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$610.74
|
| Rate for Payer: Multiplan Commercial |
$651.46
|
| Rate for Payer: NAPHCARE Commercial |
$488.59
|
| Rate for Payer: Preferred Network Access Commercial |
$749.17
|
| Rate for Payer: Quartz Beloit One Network |
$399.02
|
| Rate for Payer: Quartz Commercial |
$529.31
|
| Rate for Payer: Quartz Medicare Advantage |
$488.59
|
| Rate for Payer: The Alliance Commercial |
$407.16
|
| Rate for Payer: WEA Trust Commercial |
$447.88
|
| Rate for Payer: WPS Commercial |
$603.14
|
|
|
SCREW CORT 2.7 X 6 202.006
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967274
|
|
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 6 202.006
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967274
|
|
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 8 202.008
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967275
|
|
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 8 202.008
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967275
|
|
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 3.0 X 10MM LP AR-8933-10
|
Facility
|
OP
|
$1,464.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459666
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$426.32 |
| Max. Negotiated Rate |
$1,400.76 |
| Rate for Payer: Aetna Commercial |
$1,370.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,309.40
|
| Rate for Payer: Aetna Managed Medicare |
$426.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$989.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$761.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$730.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$806.96
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cigna Commercial |
$1,400.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$852.05
|
| Rate for Payer: Health EOS Commercial |
$1,355.08
|
| Rate for Payer: HFN Commercial |
$1,400.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,141.92
|
| Rate for Payer: Multiplan Commercial |
$1,218.05
|
| Rate for Payer: NAPHCARE Commercial |
$913.54
|
| Rate for Payer: Preferred Network Access Commercial |
$1,400.76
|
| Rate for Payer: Quartz Beloit One Network |
$746.05
|
| Rate for Payer: Quartz Commercial |
$989.66
|
| Rate for Payer: Quartz Medicare Advantage |
$913.54
|
| Rate for Payer: The Alliance Commercial |
$761.28
|
| Rate for Payer: WEA Trust Commercial |
$837.41
|
| Rate for Payer: WPS Commercial |
$1,127.72
|
|
|
SCREW CORT 3.0 X 10MM LP AR-8933-10
|
Facility
|
IP
|
$1,464.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459666
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$746.05 |
| Max. Negotiated Rate |
$1,400.76 |
| Rate for Payer: Aetna Commercial |
$1,370.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,309.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$806.96
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cigna Commercial |
$1,400.76
|
| Rate for Payer: Health EOS Commercial |
$1,355.08
|
| Rate for Payer: HFN Commercial |
$1,400.76
|
| Rate for Payer: Multiplan Commercial |
$1,218.05
|
| Rate for Payer: Preferred Network Access Commercial |
$1,400.76
|
| Rate for Payer: Quartz Beloit One Network |
$746.05
|
| Rate for Payer: Quartz Commercial |
$913.54
|
| Rate for Payer: WEA Trust Commercial |
$837.41
|
| Rate for Payer: WPS Commercial |
$1,127.72
|
|
|
SCREW CORT 3.0 X 12MM LP AR-8933-12
|
Facility
|
OP
|
$1,464.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459667
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$426.32 |
| Max. Negotiated Rate |
$1,400.76 |
| Rate for Payer: Aetna Commercial |
$1,370.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,309.40
|
| Rate for Payer: Aetna Managed Medicare |
$426.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$989.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$761.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$730.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$806.96
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cigna Commercial |
$1,400.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$852.05
|
| Rate for Payer: Health EOS Commercial |
$1,355.08
|
| Rate for Payer: HFN Commercial |
$1,400.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,141.92
|
| Rate for Payer: Multiplan Commercial |
$1,218.05
|
| Rate for Payer: NAPHCARE Commercial |
$913.54
|
| Rate for Payer: Preferred Network Access Commercial |
$1,400.76
|
| Rate for Payer: Quartz Beloit One Network |
$746.05
|
| Rate for Payer: Quartz Commercial |
$989.66
|
| Rate for Payer: Quartz Medicare Advantage |
$913.54
|
| Rate for Payer: The Alliance Commercial |
$761.28
|
| Rate for Payer: WEA Trust Commercial |
$837.41
|
| Rate for Payer: WPS Commercial |
$1,127.72
|
|
|
SCREW CORT 3.0 X 12MM LP AR-8933-12
|
Facility
|
IP
|
$1,464.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459667
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$746.05 |
| Max. Negotiated Rate |
$1,400.76 |
| Rate for Payer: Aetna Commercial |
$1,370.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,309.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$806.96
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cigna Commercial |
$1,400.76
|
| Rate for Payer: Health EOS Commercial |
$1,355.08
|
| Rate for Payer: HFN Commercial |
$1,400.76
|
| Rate for Payer: Multiplan Commercial |
$1,218.05
|
| Rate for Payer: Preferred Network Access Commercial |
$1,400.76
|
| Rate for Payer: Quartz Beloit One Network |
$746.05
|
| Rate for Payer: Quartz Commercial |
$913.54
|
| Rate for Payer: WEA Trust Commercial |
$837.41
|
| Rate for Payer: WPS Commercial |
$1,127.72
|
|
|
SCREW CORT 3.0 X 14MM LP AR-8933-14
|
Facility
|
OP
|
$1,464.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$426.32 |
| Max. Negotiated Rate |
$1,400.76 |
| Rate for Payer: Aetna Commercial |
$1,370.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,309.40
|
| Rate for Payer: Aetna Managed Medicare |
$426.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$989.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$761.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$730.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$806.96
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cigna Commercial |
$1,400.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$852.05
|
| Rate for Payer: Health EOS Commercial |
$1,355.08
|
| Rate for Payer: HFN Commercial |
$1,400.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,141.92
|
| Rate for Payer: Multiplan Commercial |
$1,218.05
|
| Rate for Payer: NAPHCARE Commercial |
$913.54
|
| Rate for Payer: Preferred Network Access Commercial |
$1,400.76
|
| Rate for Payer: Quartz Beloit One Network |
$746.05
|
| Rate for Payer: Quartz Commercial |
$989.66
|
| Rate for Payer: Quartz Medicare Advantage |
$913.54
|
| Rate for Payer: The Alliance Commercial |
$761.28
|
| Rate for Payer: WEA Trust Commercial |
$837.41
|
| Rate for Payer: WPS Commercial |
$1,127.72
|
|
|
SCREW CORT 3.0 X 14MM LP AR-8933-14
|
Facility
|
IP
|
$1,464.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$746.05 |
| Max. Negotiated Rate |
$1,400.76 |
| Rate for Payer: Aetna Commercial |
$1,370.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,309.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$806.96
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cigna Commercial |
$1,400.76
|
| Rate for Payer: Health EOS Commercial |
$1,355.08
|
| Rate for Payer: HFN Commercial |
$1,400.76
|
| Rate for Payer: Multiplan Commercial |
$1,218.05
|
| Rate for Payer: Preferred Network Access Commercial |
$1,400.76
|
| Rate for Payer: Quartz Beloit One Network |
$746.05
|
| Rate for Payer: Quartz Commercial |
$913.54
|
| Rate for Payer: WEA Trust Commercial |
$837.41
|
| Rate for Payer: WPS Commercial |
$1,127.72
|
|
|
SCREW CORT 3.0 X 14MM LP AR-8933L-14
|
Facility
|
OP
|
$1,997.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459664
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$581.53 |
| Max. Negotiated Rate |
$1,910.73 |
| Rate for Payer: Aetna Commercial |
$1,869.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,786.12
|
| Rate for Payer: Aetna Managed Medicare |
$581.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,349.97
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,038.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$996.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,100.75
|
| Rate for Payer: Cash Price |
$599.10
|
| Rate for Payer: Cigna Commercial |
$1,910.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,162.25
|
| Rate for Payer: Health EOS Commercial |
$1,848.42
|
| Rate for Payer: HFN Commercial |
$1,910.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,557.66
|
| Rate for Payer: Multiplan Commercial |
$1,661.50
|
| Rate for Payer: NAPHCARE Commercial |
$1,246.13
|
| Rate for Payer: Preferred Network Access Commercial |
$1,910.73
|
| Rate for Payer: Quartz Beloit One Network |
$1,017.67
|
| Rate for Payer: Quartz Commercial |
$1,349.97
|
| Rate for Payer: Quartz Medicare Advantage |
$1,246.13
|
| Rate for Payer: The Alliance Commercial |
$1,038.44
|
| Rate for Payer: WEA Trust Commercial |
$1,142.28
|
| Rate for Payer: WPS Commercial |
$1,538.29
|
|
|
SCREW CORT 3.0 X 14MM LP AR-8933L-14
|
Facility
|
IP
|
$1,997.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459664
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,017.67 |
| Max. Negotiated Rate |
$1,910.73 |
| Rate for Payer: Aetna Commercial |
$1,869.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,786.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,100.75
|
| Rate for Payer: Cash Price |
$599.10
|
| Rate for Payer: Cigna Commercial |
$1,910.73
|
| Rate for Payer: Health EOS Commercial |
$1,848.42
|
| Rate for Payer: HFN Commercial |
$1,910.73
|
| Rate for Payer: Multiplan Commercial |
$1,661.50
|
| Rate for Payer: Preferred Network Access Commercial |
$1,910.73
|
| Rate for Payer: Quartz Beloit One Network |
$1,017.67
|
| Rate for Payer: Quartz Commercial |
$1,246.13
|
| Rate for Payer: WEA Trust Commercial |
$1,142.28
|
| Rate for Payer: WPS Commercial |
$1,538.29
|
|
|
SCREW CORT 3.0 X 16MM LP AR-8933-16
|
Facility
|
OP
|
$1,464.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459669
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$426.32 |
| Max. Negotiated Rate |
$1,400.76 |
| Rate for Payer: Aetna Commercial |
$1,370.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,309.40
|
| Rate for Payer: Aetna Managed Medicare |
$426.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$989.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$761.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$730.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$806.96
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cigna Commercial |
$1,400.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$852.05
|
| Rate for Payer: Health EOS Commercial |
$1,355.08
|
| Rate for Payer: HFN Commercial |
$1,400.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,141.92
|
| Rate for Payer: Multiplan Commercial |
$1,218.05
|
| Rate for Payer: NAPHCARE Commercial |
$913.54
|
| Rate for Payer: Preferred Network Access Commercial |
$1,400.76
|
| Rate for Payer: Quartz Beloit One Network |
$746.05
|
| Rate for Payer: Quartz Commercial |
$989.66
|
| Rate for Payer: Quartz Medicare Advantage |
$913.54
|
| Rate for Payer: The Alliance Commercial |
$761.28
|
| Rate for Payer: WEA Trust Commercial |
$837.41
|
| Rate for Payer: WPS Commercial |
$1,127.72
|
|
|
SCREW CORT 3.0 X 16MM LP AR-8933-16
|
Facility
|
IP
|
$1,464.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459669
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$746.05 |
| Max. Negotiated Rate |
$1,400.76 |
| Rate for Payer: Aetna Commercial |
$1,370.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,309.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$806.96
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cigna Commercial |
$1,400.76
|
| Rate for Payer: Health EOS Commercial |
$1,355.08
|
| Rate for Payer: HFN Commercial |
$1,400.76
|
| Rate for Payer: Multiplan Commercial |
$1,218.05
|
| Rate for Payer: Preferred Network Access Commercial |
$1,400.76
|
| Rate for Payer: Quartz Beloit One Network |
$746.05
|
| Rate for Payer: Quartz Commercial |
$913.54
|
| Rate for Payer: WEA Trust Commercial |
$837.41
|
| Rate for Payer: WPS Commercial |
$1,127.72
|
|
