|
SCREW CORT 3.5 X 13MM LP TI AR-8935-13
|
Facility
|
OP
|
$958.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414686
|
|
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 14 204.814
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966875
|
|
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 14 204.814
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966875
|
|
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 14MM LP AR-8835-14
|
Facility
|
IP
|
$652.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4317088
|
|
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 14MM LP AR-8835-14
|
Facility
|
OP
|
$652.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4317088
|
|
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 14MM LP TI AR-8935-14
|
Facility
|
OP
|
$958.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414665
|
|
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 14MM LP TI AR-8935-14
|
Facility
|
IP
|
$958.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414665
|
|
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 14MM STAR DRIVE 02.206.214
|
Facility
|
OP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3444848
|
|
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 14MM STAR DRIVE 02.206.214
|
Facility
|
IP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3444848
|
|
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 14MM TI AR-8735-14
|
Facility
|
OP
|
$886.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599753
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$258.00 |
| Max. Negotiated Rate |
$847.72 |
| Rate for Payer: Aetna Commercial |
$829.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$792.44
|
| Rate for Payer: Aetna Managed Medicare |
$258.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$598.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$460.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$442.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$488.36
|
| Rate for Payer: Cash Price |
$265.80
|
| Rate for Payer: Cigna Commercial |
$847.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$515.65
|
| Rate for Payer: Health EOS Commercial |
$820.08
|
| Rate for Payer: HFN Commercial |
$847.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$691.08
|
| Rate for Payer: Multiplan Commercial |
$737.15
|
| Rate for Payer: NAPHCARE Commercial |
$552.86
|
| Rate for Payer: Preferred Network Access Commercial |
$847.72
|
| Rate for Payer: Quartz Beloit One Network |
$451.51
|
| Rate for Payer: Quartz Commercial |
$598.94
|
| Rate for Payer: Quartz Medicare Advantage |
$552.86
|
| Rate for Payer: The Alliance Commercial |
$460.72
|
| Rate for Payer: WEA Trust Commercial |
$506.79
|
| Rate for Payer: WPS Commercial |
$682.49
|
|
|
SCREW CORT 3.5 X 14MM TI AR-8735-14
|
Facility
|
IP
|
$886.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599753
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$451.51 |
| Max. Negotiated Rate |
$847.72 |
| Rate for Payer: Aetna Commercial |
$829.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$792.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$488.36
|
| Rate for Payer: Cash Price |
$265.80
|
| Rate for Payer: Cigna Commercial |
$847.72
|
| Rate for Payer: Health EOS Commercial |
$820.08
|
| Rate for Payer: HFN Commercial |
$847.72
|
| Rate for Payer: Multiplan Commercial |
$737.15
|
| Rate for Payer: Preferred Network Access Commercial |
$847.72
|
| Rate for Payer: Quartz Beloit One Network |
$451.51
|
| Rate for Payer: Quartz Commercial |
$552.86
|
| Rate for Payer: WEA Trust Commercial |
$506.79
|
| Rate for Payer: WPS Commercial |
$682.49
|
|
|
SCREW CORT 3.5 X 14 STARDRIVE 02.200.014
|
Facility
|
IP
|
$404.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4047411
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$205.88 |
| Max. Negotiated Rate |
$386.55 |
| Rate for Payer: Aetna Commercial |
$378.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$361.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$222.68
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cigna Commercial |
$386.55
|
| Rate for Payer: Health EOS Commercial |
$373.94
|
| Rate for Payer: HFN Commercial |
$386.55
|
| Rate for Payer: Multiplan Commercial |
$336.13
|
| Rate for Payer: Preferred Network Access Commercial |
$386.55
|
| Rate for Payer: Quartz Beloit One Network |
$205.88
|
| Rate for Payer: Quartz Commercial |
$252.10
|
| Rate for Payer: WEA Trust Commercial |
$231.09
|
| Rate for Payer: WPS Commercial |
$311.20
|
|
|
SCREW CORT 3.5 X 14 STARDRIVE 02.200.014
|
Facility
|
OP
|
$404.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4047411
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$117.64 |
| Max. Negotiated Rate |
$386.55 |
| Rate for Payer: Aetna Commercial |
$378.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$361.34
|
| Rate for Payer: Aetna Managed Medicare |
$117.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$273.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$210.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$201.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$222.68
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cigna Commercial |
$386.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$235.13
|
| Rate for Payer: Health EOS Commercial |
$373.94
|
| Rate for Payer: HFN Commercial |
$386.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$315.12
|
| Rate for Payer: Multiplan Commercial |
$336.13
|
| Rate for Payer: NAPHCARE Commercial |
$252.10
|
| Rate for Payer: Preferred Network Access Commercial |
$386.55
|
| Rate for Payer: Quartz Beloit One Network |
$205.88
|
| Rate for Payer: Quartz Commercial |
$273.10
|
| Rate for Payer: Quartz Medicare Advantage |
$252.10
|
| Rate for Payer: The Alliance Commercial |
$210.08
|
| Rate for Payer: WEA Trust Commercial |
$231.09
|
| Rate for Payer: WPS Commercial |
$311.20
|
|
|
SCREW-CORT 3.5 X 16 204.216
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966861
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$32.91 |
| Max. Negotiated Rate |
$108.12 |
| Rate for Payer: Aetna Commercial |
$105.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.07
|
| Rate for Payer: Aetna Managed Medicare |
$32.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$76.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$58.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$56.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.29
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cigna Commercial |
$108.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$65.77
|
| Rate for Payer: Health EOS Commercial |
$104.59
|
| Rate for Payer: HFN Commercial |
$108.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$88.14
|
| Rate for Payer: Multiplan Commercial |
$94.02
|
| Rate for Payer: NAPHCARE Commercial |
$70.51
|
| Rate for Payer: Preferred Network Access Commercial |
$108.12
|
| Rate for Payer: Quartz Beloit One Network |
$57.58
|
| Rate for Payer: Quartz Commercial |
$76.39
|
| Rate for Payer: Quartz Medicare Advantage |
$70.51
|
| Rate for Payer: The Alliance Commercial |
$58.76
|
| Rate for Payer: WEA Trust Commercial |
$64.64
|
| Rate for Payer: WPS Commercial |
$87.04
|
|
|
SCREW-CORT 3.5 X 16 204.216
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966861
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$57.58 |
| Max. Negotiated Rate |
$108.12 |
| Rate for Payer: Aetna Commercial |
$105.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.29
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cigna Commercial |
$108.12
|
| Rate for Payer: Health EOS Commercial |
$104.59
|
| Rate for Payer: HFN Commercial |
$108.12
|
| Rate for Payer: Multiplan Commercial |
$94.02
|
| Rate for Payer: Preferred Network Access Commercial |
$108.12
|
| Rate for Payer: Quartz Beloit One Network |
$57.58
|
| Rate for Payer: Quartz Commercial |
$70.51
|
| Rate for Payer: WEA Trust Commercial |
$64.64
|
| Rate for Payer: WPS Commercial |
$87.04
|
|
|
SCREW CORT 3.5 X 16 204.816
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966877
|
|
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 16 204.816
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966877
|
|
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 16MM LP AR-8835-16
|
Facility
|
IP
|
$652.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5306833
|
|
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 16MM LP AR-8835-16
|
Facility
|
OP
|
$652.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5306833
|
|
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 16MM LP TI AR-8935-16
|
Facility
|
OP
|
$921.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414666
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$268.20 |
| Max. Negotiated Rate |
$881.21 |
| Rate for Payer: Aetna Commercial |
$862.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$823.74
|
| Rate for Payer: Aetna Managed Medicare |
$268.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$622.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$478.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$459.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$507.66
|
| Rate for Payer: Cash Price |
$276.30
|
| Rate for Payer: Cigna Commercial |
$881.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$536.02
|
| Rate for Payer: Health EOS Commercial |
$852.48
|
| Rate for Payer: HFN Commercial |
$881.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$718.38
|
| Rate for Payer: Multiplan Commercial |
$766.27
|
| Rate for Payer: NAPHCARE Commercial |
$574.70
|
| Rate for Payer: Preferred Network Access Commercial |
$881.21
|
| Rate for Payer: Quartz Beloit One Network |
$469.34
|
| Rate for Payer: Quartz Commercial |
$622.60
|
| Rate for Payer: Quartz Medicare Advantage |
$574.70
|
| Rate for Payer: The Alliance Commercial |
$478.92
|
| Rate for Payer: WEA Trust Commercial |
$526.81
|
| Rate for Payer: WPS Commercial |
$709.45
|
|
|
SCREW CORT 3.5 X 16MM LP TI AR-8935-16
|
Facility
|
IP
|
$921.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414666
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$469.34 |
| Max. Negotiated Rate |
$881.21 |
| Rate for Payer: Aetna Commercial |
$862.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$823.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$507.66
|
| Rate for Payer: Cash Price |
$276.30
|
| Rate for Payer: Cigna Commercial |
$881.21
|
| Rate for Payer: Health EOS Commercial |
$852.48
|
| Rate for Payer: HFN Commercial |
$881.21
|
| Rate for Payer: Multiplan Commercial |
$766.27
|
| Rate for Payer: Preferred Network Access Commercial |
$881.21
|
| Rate for Payer: Quartz Beloit One Network |
$469.34
|
| Rate for Payer: Quartz Commercial |
$574.70
|
| Rate for Payer: WEA Trust Commercial |
$526.81
|
| Rate for Payer: WPS Commercial |
$709.45
|
|
|
SCREW CORT 3.5 X 16MM TI AR-8735-16
|
Facility
|
OP
|
$886.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5659670
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$258.00 |
| Max. Negotiated Rate |
$847.72 |
| Rate for Payer: Aetna Commercial |
$829.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$792.44
|
| Rate for Payer: Aetna Managed Medicare |
$258.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$598.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$460.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$442.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$488.36
|
| Rate for Payer: Cash Price |
$265.80
|
| Rate for Payer: Cigna Commercial |
$847.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$515.65
|
| Rate for Payer: Health EOS Commercial |
$820.08
|
| Rate for Payer: HFN Commercial |
$847.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$691.08
|
| Rate for Payer: Multiplan Commercial |
$737.15
|
| Rate for Payer: NAPHCARE Commercial |
$552.86
|
| Rate for Payer: Preferred Network Access Commercial |
$847.72
|
| Rate for Payer: Quartz Beloit One Network |
$451.51
|
| Rate for Payer: Quartz Commercial |
$598.94
|
| Rate for Payer: Quartz Medicare Advantage |
$552.86
|
| Rate for Payer: The Alliance Commercial |
$460.72
|
| Rate for Payer: WEA Trust Commercial |
$506.79
|
| Rate for Payer: WPS Commercial |
$682.49
|
|
|
SCREW CORT 3.5 X 16MM TI AR-8735-16
|
Facility
|
IP
|
$886.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5659670
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$451.51 |
| Max. Negotiated Rate |
$847.72 |
| Rate for Payer: Aetna Commercial |
$829.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$792.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$488.36
|
| Rate for Payer: Cash Price |
$265.80
|
| Rate for Payer: Cigna Commercial |
$847.72
|
| Rate for Payer: Health EOS Commercial |
$820.08
|
| Rate for Payer: HFN Commercial |
$847.72
|
| Rate for Payer: Multiplan Commercial |
$737.15
|
| Rate for Payer: Preferred Network Access Commercial |
$847.72
|
| Rate for Payer: Quartz Beloit One Network |
$451.51
|
| Rate for Payer: Quartz Commercial |
$552.86
|
| Rate for Payer: WEA Trust Commercial |
$506.79
|
| Rate for Payer: WPS Commercial |
$682.49
|
|
|
SCREW CORT 3.5 X 16 STARDRIVE 02.200.016
|
Facility
|
IP
|
$404.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4040820
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$205.88 |
| Max. Negotiated Rate |
$386.55 |
| Rate for Payer: Aetna Commercial |
$378.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$361.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$222.68
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cigna Commercial |
$386.55
|
| Rate for Payer: Health EOS Commercial |
$373.94
|
| Rate for Payer: HFN Commercial |
$386.55
|
| Rate for Payer: Multiplan Commercial |
$336.13
|
| Rate for Payer: Preferred Network Access Commercial |
$386.55
|
| Rate for Payer: Quartz Beloit One Network |
$205.88
|
| Rate for Payer: Quartz Commercial |
$252.10
|
| Rate for Payer: WEA Trust Commercial |
$231.09
|
| Rate for Payer: WPS Commercial |
$311.20
|
|
|
SCREW CORT 3.5 X 16 STARDRIVE 02.200.016
|
Facility
|
OP
|
$404.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4040820
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$117.64 |
| Max. Negotiated Rate |
$386.55 |
| Rate for Payer: Aetna Commercial |
$378.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$361.34
|
| Rate for Payer: Aetna Managed Medicare |
$117.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$273.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$210.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$201.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$222.68
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cigna Commercial |
$386.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$235.13
|
| Rate for Payer: Health EOS Commercial |
$373.94
|
| Rate for Payer: HFN Commercial |
$386.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$315.12
|
| Rate for Payer: Multiplan Commercial |
$336.13
|
| Rate for Payer: NAPHCARE Commercial |
$252.10
|
| Rate for Payer: Preferred Network Access Commercial |
$386.55
|
| Rate for Payer: Quartz Beloit One Network |
$205.88
|
| Rate for Payer: Quartz Commercial |
$273.10
|
| Rate for Payer: Quartz Medicare Advantage |
$252.10
|
| Rate for Payer: The Alliance Commercial |
$210.08
|
| Rate for Payer: WEA Trust Commercial |
$231.09
|
| Rate for Payer: WPS Commercial |
$311.20
|
|
