|
SCREW CORT 3.0 X 16MM LP AR-8933L-16
|
Facility
|
OP
|
$1,997.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459663
|
|
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 16MM LP AR-8933L-16
|
Facility
|
IP
|
$1,997.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459663
|
|
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 18MM LP AR-8933-18
|
Facility
|
OP
|
$1,464.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459670
|
|
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 18MM LP AR-8933-18
|
Facility
|
IP
|
$1,464.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459670
|
|
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 24MM LP AR-8933-24
|
Facility
|
IP
|
$1,314.26
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6244271
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$669.75 |
| Max. Negotiated Rate |
$1,257.48 |
| Rate for Payer: Aetna Commercial |
$1,230.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,175.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$724.42
|
| Rate for Payer: Cash Price |
$394.28
|
| Rate for Payer: Cigna Commercial |
$1,257.48
|
| Rate for Payer: Health EOS Commercial |
$1,216.48
|
| Rate for Payer: HFN Commercial |
$1,257.48
|
| Rate for Payer: Multiplan Commercial |
$1,093.46
|
| Rate for Payer: Preferred Network Access Commercial |
$1,257.48
|
| Rate for Payer: Quartz Beloit One Network |
$669.75
|
| Rate for Payer: Quartz Commercial |
$820.10
|
| Rate for Payer: WEA Trust Commercial |
$751.76
|
| Rate for Payer: WPS Commercial |
$1,012.37
|
|
|
SCREW CORT 3.0 X 24MM LP AR-8933-24
|
Facility
|
OP
|
$1,314.26
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6244271
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$382.71 |
| Max. Negotiated Rate |
$1,257.48 |
| Rate for Payer: Aetna Commercial |
$1,230.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,175.47
|
| Rate for Payer: Aetna Managed Medicare |
$382.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$888.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$683.42
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$656.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$724.42
|
| Rate for Payer: Cash Price |
$394.28
|
| Rate for Payer: Cigna Commercial |
$1,257.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$764.90
|
| Rate for Payer: Health EOS Commercial |
$1,216.48
|
| Rate for Payer: HFN Commercial |
$1,257.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,025.12
|
| Rate for Payer: Multiplan Commercial |
$1,093.46
|
| Rate for Payer: NAPHCARE Commercial |
$820.10
|
| Rate for Payer: Preferred Network Access Commercial |
$1,257.48
|
| Rate for Payer: Quartz Beloit One Network |
$669.75
|
| Rate for Payer: Quartz Commercial |
$888.44
|
| Rate for Payer: Quartz Medicare Advantage |
$820.10
|
| Rate for Payer: The Alliance Commercial |
$683.42
|
| Rate for Payer: WEA Trust Commercial |
$751.76
|
| Rate for Payer: WPS Commercial |
$1,012.37
|
|
|
SCREW CORT 3.0 X 28MM LP AR-8933-28
|
Facility
|
OP
|
$1,314.26
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6244276
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$382.71 |
| Max. Negotiated Rate |
$1,257.48 |
| Rate for Payer: Aetna Commercial |
$1,230.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,175.47
|
| Rate for Payer: Aetna Managed Medicare |
$382.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$888.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$683.42
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$656.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$724.42
|
| Rate for Payer: Cash Price |
$394.28
|
| Rate for Payer: Cigna Commercial |
$1,257.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$764.90
|
| Rate for Payer: Health EOS Commercial |
$1,216.48
|
| Rate for Payer: HFN Commercial |
$1,257.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,025.12
|
| Rate for Payer: Multiplan Commercial |
$1,093.46
|
| Rate for Payer: NAPHCARE Commercial |
$820.10
|
| Rate for Payer: Preferred Network Access Commercial |
$1,257.48
|
| Rate for Payer: Quartz Beloit One Network |
$669.75
|
| Rate for Payer: Quartz Commercial |
$888.44
|
| Rate for Payer: Quartz Medicare Advantage |
$820.10
|
| Rate for Payer: The Alliance Commercial |
$683.42
|
| Rate for Payer: WEA Trust Commercial |
$751.76
|
| Rate for Payer: WPS Commercial |
$1,012.37
|
|
|
SCREW CORT 3.0 X 28MM LP AR-8933-28
|
Facility
|
IP
|
$1,314.26
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6244276
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$669.75 |
| Max. Negotiated Rate |
$1,257.48 |
| Rate for Payer: Aetna Commercial |
$1,230.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,175.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$724.42
|
| Rate for Payer: Cash Price |
$394.28
|
| Rate for Payer: Cigna Commercial |
$1,257.48
|
| Rate for Payer: Health EOS Commercial |
$1,216.48
|
| Rate for Payer: HFN Commercial |
$1,257.48
|
| Rate for Payer: Multiplan Commercial |
$1,093.46
|
| Rate for Payer: Preferred Network Access Commercial |
$1,257.48
|
| Rate for Payer: Quartz Beloit One Network |
$669.75
|
| Rate for Payer: Quartz Commercial |
$820.10
|
| Rate for Payer: WEA Trust Commercial |
$751.76
|
| Rate for Payer: WPS Commercial |
$1,012.37
|
|
|
SCREW-CORT 3.5 X 10 204.810
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966871
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.11 |
| Max. Negotiated Rate |
$118.64 |
| Rate for Payer: Aetna Commercial |
$116.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.91
|
| Rate for Payer: Aetna Managed Medicare |
$36.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$83.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$64.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$61.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$68.35
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cigna Commercial |
$118.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$72.17
|
| Rate for Payer: Health EOS Commercial |
$114.77
|
| Rate for Payer: HFN Commercial |
$118.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$96.72
|
| Rate for Payer: Multiplan Commercial |
$103.17
|
| Rate for Payer: NAPHCARE Commercial |
$77.38
|
| Rate for Payer: Preferred Network Access Commercial |
$118.64
|
| Rate for Payer: Quartz Beloit One Network |
$63.19
|
| Rate for Payer: Quartz Commercial |
$83.82
|
| Rate for Payer: Quartz Medicare Advantage |
$77.38
|
| Rate for Payer: The Alliance Commercial |
$64.48
|
| Rate for Payer: WEA Trust Commercial |
$70.93
|
| Rate for Payer: WPS Commercial |
$95.52
|
|
|
SCREW-CORT 3.5 X 10 204.810
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966871
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$63.19 |
| Max. Negotiated Rate |
$118.64 |
| Rate for Payer: Aetna Commercial |
$116.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$68.35
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cigna Commercial |
$118.64
|
| Rate for Payer: Health EOS Commercial |
$114.77
|
| Rate for Payer: HFN Commercial |
$118.64
|
| Rate for Payer: Multiplan Commercial |
$103.17
|
| Rate for Payer: Preferred Network Access Commercial |
$118.64
|
| Rate for Payer: Quartz Beloit One Network |
$63.19
|
| Rate for Payer: Quartz Commercial |
$77.38
|
| Rate for Payer: WEA Trust Commercial |
$70.93
|
| Rate for Payer: WPS Commercial |
$95.52
|
|
|
SCREW CORT 3.5 X 10MM LP AR-8835-10
|
Facility
|
OP
|
$652.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4594698
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$189.86 |
| Max. Negotiated Rate |
$623.83 |
| Rate for Payer: Aetna Commercial |
$610.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$583.15
|
| Rate for Payer: Aetna Managed Medicare |
$189.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$440.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$339.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$325.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$359.38
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cigna Commercial |
$623.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$379.46
|
| Rate for Payer: Health EOS Commercial |
$603.49
|
| Rate for Payer: HFN Commercial |
$623.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$508.56
|
| Rate for Payer: Multiplan Commercial |
$542.46
|
| Rate for Payer: NAPHCARE Commercial |
$406.85
|
| Rate for Payer: Preferred Network Access Commercial |
$623.83
|
| Rate for Payer: Quartz Beloit One Network |
$332.26
|
| Rate for Payer: Quartz Commercial |
$440.75
|
| Rate for Payer: Quartz Medicare Advantage |
$406.85
|
| Rate for Payer: The Alliance Commercial |
$339.04
|
| Rate for Payer: WEA Trust Commercial |
$372.94
|
| Rate for Payer: WPS Commercial |
$502.24
|
|
|
SCREW CORT 3.5 X 10MM LP AR-8835-10
|
Facility
|
IP
|
$652.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4594698
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$332.26 |
| Max. Negotiated Rate |
$623.83 |
| Rate for Payer: Aetna Commercial |
$610.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$583.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$359.38
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cigna Commercial |
$623.83
|
| Rate for Payer: Health EOS Commercial |
$603.49
|
| Rate for Payer: HFN Commercial |
$623.83
|
| Rate for Payer: Multiplan Commercial |
$542.46
|
| Rate for Payer: Preferred Network Access Commercial |
$623.83
|
| Rate for Payer: Quartz Beloit One Network |
$332.26
|
| Rate for Payer: Quartz Commercial |
$406.85
|
| Rate for Payer: WEA Trust Commercial |
$372.94
|
| Rate for Payer: WPS Commercial |
$502.24
|
|
|
SCREW CORT 3.5 X 10MM LP TI AR-8935-10
|
Facility
|
OP
|
$958.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414685
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$278.97 |
| Max. Negotiated Rate |
$916.61 |
| Rate for Payer: Aetna Commercial |
$896.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$856.84
|
| Rate for Payer: Aetna Managed Medicare |
$278.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$647.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$498.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$478.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$528.05
|
| Rate for Payer: Cash Price |
$287.40
|
| Rate for Payer: Cigna Commercial |
$916.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$557.56
|
| Rate for Payer: Health EOS Commercial |
$886.72
|
| Rate for Payer: HFN Commercial |
$916.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$747.24
|
| Rate for Payer: Multiplan Commercial |
$797.06
|
| Rate for Payer: NAPHCARE Commercial |
$597.79
|
| Rate for Payer: Preferred Network Access Commercial |
$916.61
|
| Rate for Payer: Quartz Beloit One Network |
$488.20
|
| Rate for Payer: Quartz Commercial |
$647.61
|
| Rate for Payer: Quartz Medicare Advantage |
$597.79
|
| Rate for Payer: The Alliance Commercial |
$498.16
|
| Rate for Payer: WEA Trust Commercial |
$547.98
|
| Rate for Payer: WPS Commercial |
$737.95
|
|
|
SCREW CORT 3.5 X 10MM LP TI AR-8935-10
|
Facility
|
IP
|
$958.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414685
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$488.20 |
| Max. Negotiated Rate |
$916.61 |
| Rate for Payer: Aetna Commercial |
$896.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$856.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$528.05
|
| Rate for Payer: Cash Price |
$287.40
|
| Rate for Payer: Cigna Commercial |
$916.61
|
| Rate for Payer: Health EOS Commercial |
$886.72
|
| Rate for Payer: HFN Commercial |
$916.61
|
| Rate for Payer: Multiplan Commercial |
$797.06
|
| Rate for Payer: Preferred Network Access Commercial |
$916.61
|
| Rate for Payer: Quartz Beloit One Network |
$488.20
|
| Rate for Payer: Quartz Commercial |
$597.79
|
| Rate for Payer: WEA Trust Commercial |
$547.98
|
| Rate for Payer: WPS Commercial |
$737.95
|
|
|
SCREW CORT 3.5 X 11MM LP TI AR-8935-11
|
Facility
|
IP
|
$958.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414684
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$488.20 |
| Max. Negotiated Rate |
$916.61 |
| Rate for Payer: Aetna Commercial |
$896.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$856.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$528.05
|
| Rate for Payer: Cash Price |
$287.40
|
| Rate for Payer: Cigna Commercial |
$916.61
|
| Rate for Payer: Health EOS Commercial |
$886.72
|
| Rate for Payer: HFN Commercial |
$916.61
|
| Rate for Payer: Multiplan Commercial |
$797.06
|
| Rate for Payer: Preferred Network Access Commercial |
$916.61
|
| Rate for Payer: Quartz Beloit One Network |
$488.20
|
| Rate for Payer: Quartz Commercial |
$597.79
|
| Rate for Payer: WEA Trust Commercial |
$547.98
|
| Rate for Payer: WPS Commercial |
$737.95
|
|
|
SCREW CORT 3.5 X 11MM LP TI AR-8935-11
|
Facility
|
OP
|
$958.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414684
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$278.97 |
| Max. Negotiated Rate |
$916.61 |
| Rate for Payer: Aetna Commercial |
$896.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$856.84
|
| Rate for Payer: Aetna Managed Medicare |
$278.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$647.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$498.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$478.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$528.05
|
| Rate for Payer: Cash Price |
$287.40
|
| Rate for Payer: Cigna Commercial |
$916.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$557.56
|
| Rate for Payer: Health EOS Commercial |
$886.72
|
| Rate for Payer: HFN Commercial |
$916.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$747.24
|
| Rate for Payer: Multiplan Commercial |
$797.06
|
| Rate for Payer: NAPHCARE Commercial |
$597.79
|
| Rate for Payer: Preferred Network Access Commercial |
$916.61
|
| Rate for Payer: Quartz Beloit One Network |
$488.20
|
| Rate for Payer: Quartz Commercial |
$647.61
|
| Rate for Payer: Quartz Medicare Advantage |
$597.79
|
| Rate for Payer: The Alliance Commercial |
$498.16
|
| Rate for Payer: WEA Trust Commercial |
$547.98
|
| Rate for Payer: WPS Commercial |
$737.95
|
|
|
SCREW-CORT 3.5 X 12 204.812
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966873
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$63.19 |
| Max. Negotiated Rate |
$118.64 |
| Rate for Payer: Aetna Commercial |
$116.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$68.35
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cigna Commercial |
$118.64
|
| Rate for Payer: Health EOS Commercial |
$114.77
|
| Rate for Payer: HFN Commercial |
$118.64
|
| Rate for Payer: Multiplan Commercial |
$103.17
|
| Rate for Payer: Preferred Network Access Commercial |
$118.64
|
| Rate for Payer: Quartz Beloit One Network |
$63.19
|
| Rate for Payer: Quartz Commercial |
$77.38
|
| Rate for Payer: WEA Trust Commercial |
$70.93
|
| Rate for Payer: WPS Commercial |
$95.52
|
|
|
SCREW-CORT 3.5 X 12 204.812
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966873
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.11 |
| Max. Negotiated Rate |
$118.64 |
| Rate for Payer: Aetna Commercial |
$116.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.91
|
| Rate for Payer: Aetna Managed Medicare |
$36.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$83.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$64.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$61.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$68.35
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cigna Commercial |
$118.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$72.17
|
| Rate for Payer: Health EOS Commercial |
$114.77
|
| Rate for Payer: HFN Commercial |
$118.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$96.72
|
| Rate for Payer: Multiplan Commercial |
$103.17
|
| Rate for Payer: NAPHCARE Commercial |
$77.38
|
| Rate for Payer: Preferred Network Access Commercial |
$118.64
|
| Rate for Payer: Quartz Beloit One Network |
$63.19
|
| Rate for Payer: Quartz Commercial |
$83.82
|
| Rate for Payer: Quartz Medicare Advantage |
$77.38
|
| Rate for Payer: The Alliance Commercial |
$64.48
|
| Rate for Payer: WEA Trust Commercial |
$70.93
|
| Rate for Payer: WPS Commercial |
$95.52
|
|
|
SCREW CORT 3.5 X 12 LP 02.206.212
|
Facility
|
OP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3323492
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$151.13 |
| Max. Negotiated Rate |
$496.58 |
| Rate for Payer: Aetna Commercial |
$485.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$464.19
|
| Rate for Payer: Aetna Managed Medicare |
$151.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$350.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$269.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$259.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$286.07
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna Commercial |
$496.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$302.06
|
| Rate for Payer: Health EOS Commercial |
$480.39
|
| Rate for Payer: HFN Commercial |
$496.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.82
|
| Rate for Payer: Multiplan Commercial |
$431.81
|
| Rate for Payer: NAPHCARE Commercial |
$323.86
|
| Rate for Payer: Preferred Network Access Commercial |
$496.58
|
| Rate for Payer: Quartz Beloit One Network |
$264.48
|
| Rate for Payer: Quartz Commercial |
$350.84
|
| Rate for Payer: Quartz Medicare Advantage |
$323.86
|
| Rate for Payer: The Alliance Commercial |
$269.88
|
| Rate for Payer: WEA Trust Commercial |
$296.87
|
| Rate for Payer: WPS Commercial |
$399.79
|
|
|
SCREW CORT 3.5 X 12 LP 02.206.212
|
Facility
|
IP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3323492
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$264.48 |
| Max. Negotiated Rate |
$496.58 |
| Rate for Payer: Aetna Commercial |
$485.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$464.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$286.07
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna Commercial |
$496.58
|
| Rate for Payer: Health EOS Commercial |
$480.39
|
| Rate for Payer: HFN Commercial |
$496.58
|
| Rate for Payer: Multiplan Commercial |
$431.81
|
| Rate for Payer: Preferred Network Access Commercial |
$496.58
|
| Rate for Payer: Quartz Beloit One Network |
$264.48
|
| Rate for Payer: Quartz Commercial |
$323.86
|
| Rate for Payer: WEA Trust Commercial |
$296.87
|
| Rate for Payer: WPS Commercial |
$399.79
|
|
|
SCREW CORT 3.5 X 12MM LP AR-8835-12
|
Facility
|
IP
|
$652.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4317087
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$332.26 |
| Max. Negotiated Rate |
$623.83 |
| Rate for Payer: Aetna Commercial |
$610.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$583.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$359.38
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cigna Commercial |
$623.83
|
| Rate for Payer: Health EOS Commercial |
$603.49
|
| Rate for Payer: HFN Commercial |
$623.83
|
| Rate for Payer: Multiplan Commercial |
$542.46
|
| Rate for Payer: Preferred Network Access Commercial |
$623.83
|
| Rate for Payer: Quartz Beloit One Network |
$332.26
|
| Rate for Payer: Quartz Commercial |
$406.85
|
| Rate for Payer: WEA Trust Commercial |
$372.94
|
| Rate for Payer: WPS Commercial |
$502.24
|
|
|
SCREW CORT 3.5 X 12MM LP AR-8835-12
|
Facility
|
OP
|
$652.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4317087
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$189.86 |
| Max. Negotiated Rate |
$623.83 |
| Rate for Payer: Aetna Commercial |
$610.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$583.15
|
| Rate for Payer: Aetna Managed Medicare |
$189.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$440.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$339.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$325.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$359.38
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cigna Commercial |
$623.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$379.46
|
| Rate for Payer: Health EOS Commercial |
$603.49
|
| Rate for Payer: HFN Commercial |
$623.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$508.56
|
| Rate for Payer: Multiplan Commercial |
$542.46
|
| Rate for Payer: NAPHCARE Commercial |
$406.85
|
| Rate for Payer: Preferred Network Access Commercial |
$623.83
|
| Rate for Payer: Quartz Beloit One Network |
$332.26
|
| Rate for Payer: Quartz Commercial |
$440.75
|
| Rate for Payer: Quartz Medicare Advantage |
$406.85
|
| Rate for Payer: The Alliance Commercial |
$339.04
|
| Rate for Payer: WEA Trust Commercial |
$372.94
|
| Rate for Payer: WPS Commercial |
$502.24
|
|
|
SCREW CORT 3.5 X 12MM LP TI AR-8935-12
|
Facility
|
IP
|
$958.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5384977
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$488.20 |
| Max. Negotiated Rate |
$916.61 |
| Rate for Payer: Aetna Commercial |
$896.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$856.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$528.05
|
| Rate for Payer: Cash Price |
$287.40
|
| Rate for Payer: Cigna Commercial |
$916.61
|
| Rate for Payer: Health EOS Commercial |
$886.72
|
| Rate for Payer: HFN Commercial |
$916.61
|
| Rate for Payer: Multiplan Commercial |
$797.06
|
| Rate for Payer: Preferred Network Access Commercial |
$916.61
|
| Rate for Payer: Quartz Beloit One Network |
$488.20
|
| Rate for Payer: Quartz Commercial |
$597.79
|
| Rate for Payer: WEA Trust Commercial |
$547.98
|
| Rate for Payer: WPS Commercial |
$737.95
|
|
|
SCREW CORT 3.5 X 12MM LP TI AR-8935-12
|
Facility
|
OP
|
$958.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5384977
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$278.97 |
| Max. Negotiated Rate |
$916.61 |
| Rate for Payer: Aetna Commercial |
$896.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$856.84
|
| Rate for Payer: Aetna Managed Medicare |
$278.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$647.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$498.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$478.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$528.05
|
| Rate for Payer: Cash Price |
$287.40
|
| Rate for Payer: Cigna Commercial |
$916.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$557.56
|
| Rate for Payer: Health EOS Commercial |
$886.72
|
| Rate for Payer: HFN Commercial |
$916.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$747.24
|
| Rate for Payer: Multiplan Commercial |
$797.06
|
| Rate for Payer: NAPHCARE Commercial |
$597.79
|
| Rate for Payer: Preferred Network Access Commercial |
$916.61
|
| Rate for Payer: Quartz Beloit One Network |
$488.20
|
| Rate for Payer: Quartz Commercial |
$647.61
|
| Rate for Payer: Quartz Medicare Advantage |
$597.79
|
| Rate for Payer: The Alliance Commercial |
$498.16
|
| Rate for Payer: WEA Trust Commercial |
$547.98
|
| Rate for Payer: WPS Commercial |
$737.95
|
|
|
SCREW CORT 3.5 X 13MM LP TI AR-8935-13
|
Facility
|
IP
|
$958.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414686
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$488.20 |
| Max. Negotiated Rate |
$916.61 |
| Rate for Payer: Aetna Commercial |
$896.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$856.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$528.05
|
| Rate for Payer: Cash Price |
$287.40
|
| Rate for Payer: Cigna Commercial |
$916.61
|
| Rate for Payer: Health EOS Commercial |
$886.72
|
| Rate for Payer: HFN Commercial |
$916.61
|
| Rate for Payer: Multiplan Commercial |
$797.06
|
| Rate for Payer: Preferred Network Access Commercial |
$916.61
|
| Rate for Payer: Quartz Beloit One Network |
$488.20
|
| Rate for Payer: Quartz Commercial |
$597.79
|
| Rate for Payer: WEA Trust Commercial |
$547.98
|
| Rate for Payer: WPS Commercial |
$737.95
|
|
