|
SCREW CORT 2.4MM X 6MM SELF TAPPING 201.636
|
Facility
|
OP
|
$1,245.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494550
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$348.60 |
| Max. Negotiated Rate |
$4,980.00 |
| Rate for Payer: Aetna Commercial |
$1,120.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,070.70
|
| Rate for Payer: Aetna Managed Medicare |
$348.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$809.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$622.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$597.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$659.85
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Cigna Commercial |
$1,145.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$696.70
|
| Rate for Payer: Health EOS Commercial |
$1,108.05
|
| Rate for Payer: HFN Commercial |
$1,145.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$933.75
|
| Rate for Payer: Multiplan Commercial |
$996.00
|
| Rate for Payer: NAPHCARE Commercial |
$747.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,145.40
|
| Rate for Payer: Quartz Beloit One Network |
$610.05
|
| Rate for Payer: Quartz Commercial |
$809.25
|
| Rate for Payer: Quartz Medicare Advantage |
$747.00
|
| Rate for Payer: The Alliance Commercial |
$4,980.00
|
| Rate for Payer: WEA Trust Commercial |
$684.75
|
| Rate for Payer: WPS Commercial |
$922.17
|
|
|
SCREW CORT 2.4MM X 7MM SELF TAPPING 201.637
|
Facility
|
OP
|
$1,245.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494551
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$348.60 |
| Max. Negotiated Rate |
$4,980.00 |
| Rate for Payer: Aetna Commercial |
$1,120.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,070.70
|
| Rate for Payer: Aetna Managed Medicare |
$348.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$809.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$622.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$597.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$659.85
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Cigna Commercial |
$1,145.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$696.70
|
| Rate for Payer: Health EOS Commercial |
$1,108.05
|
| Rate for Payer: HFN Commercial |
$1,145.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$933.75
|
| Rate for Payer: Multiplan Commercial |
$996.00
|
| Rate for Payer: NAPHCARE Commercial |
$747.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,145.40
|
| Rate for Payer: Quartz Beloit One Network |
$610.05
|
| Rate for Payer: Quartz Commercial |
$809.25
|
| Rate for Payer: Quartz Medicare Advantage |
$747.00
|
| Rate for Payer: The Alliance Commercial |
$4,980.00
|
| Rate for Payer: WEA Trust Commercial |
$684.75
|
| Rate for Payer: WPS Commercial |
$922.17
|
|
|
SCREW CORT 2.4MM X 7MM SELF TAPPING 201.637
|
Facility
|
IP
|
$1,245.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494551
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.05 |
| Max. Negotiated Rate |
$1,145.40 |
| Rate for Payer: Aetna Commercial |
$1,120.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,070.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$659.85
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Cigna Commercial |
$1,145.40
|
| Rate for Payer: Health EOS Commercial |
$1,108.05
|
| Rate for Payer: HFN Commercial |
$1,145.40
|
| Rate for Payer: Multiplan Commercial |
$996.00
|
| Rate for Payer: NAPHCARE Commercial |
$747.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,145.40
|
| Rate for Payer: Quartz Beloit One Network |
$610.05
|
| Rate for Payer: Quartz Commercial |
$747.00
|
| Rate for Payer: WEA Trust Commercial |
$684.75
|
| Rate for Payer: WPS Commercial |
$922.17
|
|
|
SCREW CORT 2.4MM X 8MM SELF TAPPING 201.638
|
Facility
|
OP
|
$1,245.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494552
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$348.60 |
| Max. Negotiated Rate |
$4,980.00 |
| Rate for Payer: Aetna Commercial |
$1,120.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,070.70
|
| Rate for Payer: Aetna Managed Medicare |
$348.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$809.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$622.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$597.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$659.85
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Cigna Commercial |
$1,145.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$696.70
|
| Rate for Payer: Health EOS Commercial |
$1,108.05
|
| Rate for Payer: HFN Commercial |
$1,145.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$933.75
|
| Rate for Payer: Multiplan Commercial |
$996.00
|
| Rate for Payer: NAPHCARE Commercial |
$747.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,145.40
|
| Rate for Payer: Quartz Beloit One Network |
$610.05
|
| Rate for Payer: Quartz Commercial |
$809.25
|
| Rate for Payer: Quartz Medicare Advantage |
$747.00
|
| Rate for Payer: The Alliance Commercial |
$4,980.00
|
| Rate for Payer: WEA Trust Commercial |
$684.75
|
| Rate for Payer: WPS Commercial |
$922.17
|
|
|
SCREW CORT 2.4MM X 8MM SELF TAPPING 201.638
|
Facility
|
IP
|
$1,245.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494552
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.05 |
| Max. Negotiated Rate |
$1,145.40 |
| Rate for Payer: Aetna Commercial |
$1,120.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,070.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$659.85
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Cigna Commercial |
$1,145.40
|
| Rate for Payer: Health EOS Commercial |
$1,108.05
|
| Rate for Payer: HFN Commercial |
$1,145.40
|
| Rate for Payer: Multiplan Commercial |
$996.00
|
| Rate for Payer: NAPHCARE Commercial |
$747.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,145.40
|
| Rate for Payer: Quartz Beloit One Network |
$610.05
|
| Rate for Payer: Quartz Commercial |
$747.00
|
| Rate for Payer: WEA Trust Commercial |
$684.75
|
| Rate for Payer: WPS Commercial |
$922.17
|
|
|
SCREW CORT 2.4MM X 9MM SELF TAPPING 201.639
|
Facility
|
OP
|
$1,245.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494553
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$348.60 |
| Max. Negotiated Rate |
$4,980.00 |
| Rate for Payer: Aetna Commercial |
$1,120.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,070.70
|
| Rate for Payer: Aetna Managed Medicare |
$348.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$809.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$622.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$597.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$659.85
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Cigna Commercial |
$1,145.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$696.70
|
| Rate for Payer: Health EOS Commercial |
$1,108.05
|
| Rate for Payer: HFN Commercial |
$1,145.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$933.75
|
| Rate for Payer: Multiplan Commercial |
$996.00
|
| Rate for Payer: NAPHCARE Commercial |
$747.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,145.40
|
| Rate for Payer: Quartz Beloit One Network |
$610.05
|
| Rate for Payer: Quartz Commercial |
$809.25
|
| Rate for Payer: Quartz Medicare Advantage |
$747.00
|
| Rate for Payer: The Alliance Commercial |
$4,980.00
|
| Rate for Payer: WEA Trust Commercial |
$684.75
|
| Rate for Payer: WPS Commercial |
$922.17
|
|
|
SCREW CORT 2.4MM X 9MM SELF TAPPING 201.639
|
Facility
|
IP
|
$1,245.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494553
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.05 |
| Max. Negotiated Rate |
$1,145.40 |
| Rate for Payer: Aetna Commercial |
$1,120.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,070.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$659.85
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Cigna Commercial |
$1,145.40
|
| Rate for Payer: Health EOS Commercial |
$1,108.05
|
| Rate for Payer: HFN Commercial |
$1,145.40
|
| Rate for Payer: Multiplan Commercial |
$996.00
|
| Rate for Payer: NAPHCARE Commercial |
$747.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,145.40
|
| Rate for Payer: Quartz Beloit One Network |
$610.05
|
| Rate for Payer: Quartz Commercial |
$747.00
|
| Rate for Payer: WEA Trust Commercial |
$684.75
|
| Rate for Payer: WPS Commercial |
$922.17
|
|
|
SCREW-CORT 2.4 X 10 401.760
|
Facility
|
OP
|
$478.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966795
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$133.84 |
| Max. Negotiated Rate |
$1,912.00 |
| Rate for Payer: Aetna Commercial |
$430.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$411.08
|
| Rate for Payer: Aetna Managed Medicare |
$133.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$310.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$239.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$229.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$253.34
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cigna Commercial |
$439.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$267.49
|
| Rate for Payer: Health EOS Commercial |
$425.42
|
| Rate for Payer: HFN Commercial |
$439.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$358.50
|
| Rate for Payer: Multiplan Commercial |
$382.40
|
| Rate for Payer: NAPHCARE Commercial |
$286.80
|
| Rate for Payer: Preferred Network Access Commercial |
$439.76
|
| Rate for Payer: Quartz Beloit One Network |
$234.22
|
| Rate for Payer: Quartz Commercial |
$310.70
|
| Rate for Payer: Quartz Medicare Advantage |
$286.80
|
| Rate for Payer: The Alliance Commercial |
$1,912.00
|
| Rate for Payer: WEA Trust Commercial |
$262.90
|
| Rate for Payer: WPS Commercial |
$354.05
|
|
|
SCREW-CORT 2.4 X 10 401.760
|
Facility
|
IP
|
$478.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966795
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$234.22 |
| Max. Negotiated Rate |
$439.76 |
| Rate for Payer: Aetna Commercial |
$430.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$411.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$253.34
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cigna Commercial |
$439.76
|
| Rate for Payer: Health EOS Commercial |
$425.42
|
| Rate for Payer: HFN Commercial |
$439.76
|
| Rate for Payer: Multiplan Commercial |
$382.40
|
| Rate for Payer: NAPHCARE Commercial |
$286.80
|
| Rate for Payer: Preferred Network Access Commercial |
$439.76
|
| Rate for Payer: Quartz Beloit One Network |
$234.22
|
| Rate for Payer: Quartz Commercial |
$286.80
|
| Rate for Payer: WEA Trust Commercial |
$262.90
|
| Rate for Payer: WPS Commercial |
$354.05
|
|
|
SCREW CORT 2.4 X 10MM AR-8956-10
|
Facility
|
OP
|
$1,464.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5286716
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$409.92 |
| Max. Negotiated Rate |
$5,856.00 |
| Rate for Payer: Aetna Commercial |
$1,317.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,259.04
|
| Rate for Payer: Aetna Managed Medicare |
$409.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$951.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$732.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$702.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$775.92
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cigna Commercial |
$1,346.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$819.25
|
| Rate for Payer: Health EOS Commercial |
$1,302.96
|
| Rate for Payer: HFN Commercial |
$1,346.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,098.00
|
| Rate for Payer: Multiplan Commercial |
$1,171.20
|
| Rate for Payer: NAPHCARE Commercial |
$878.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,346.88
|
| Rate for Payer: Quartz Beloit One Network |
$717.36
|
| Rate for Payer: Quartz Commercial |
$951.60
|
| Rate for Payer: Quartz Medicare Advantage |
$878.40
|
| Rate for Payer: The Alliance Commercial |
$5,856.00
|
| Rate for Payer: WEA Trust Commercial |
$805.20
|
| Rate for Payer: WPS Commercial |
$1,084.38
|
|
|
SCREW CORT 2.4 X 10MM AR-8956-10
|
Facility
|
IP
|
$1,464.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5286716
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$717.36 |
| Max. Negotiated Rate |
$1,346.88 |
| Rate for Payer: Aetna Commercial |
$1,317.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,259.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$775.92
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cigna Commercial |
$1,346.88
|
| Rate for Payer: Health EOS Commercial |
$1,302.96
|
| Rate for Payer: HFN Commercial |
$1,346.88
|
| Rate for Payer: Multiplan Commercial |
$1,171.20
|
| Rate for Payer: NAPHCARE Commercial |
$878.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,346.88
|
| Rate for Payer: Quartz Beloit One Network |
$717.36
|
| Rate for Payer: Quartz Commercial |
$878.40
|
| Rate for Payer: WEA Trust Commercial |
$805.20
|
| Rate for Payer: WPS Commercial |
$1,084.38
|
|
|
SCREW CORT 2.4 X 10MM LP TI AR-8724-10
|
Facility
|
OP
|
$1,464.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5286788
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$409.92 |
| Max. Negotiated Rate |
$5,856.00 |
| Rate for Payer: Aetna Commercial |
$1,317.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,259.04
|
| Rate for Payer: Aetna Managed Medicare |
$409.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$951.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$732.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$702.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$775.92
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cigna Commercial |
$1,346.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$819.25
|
| Rate for Payer: Health EOS Commercial |
$1,302.96
|
| Rate for Payer: HFN Commercial |
$1,346.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,098.00
|
| Rate for Payer: Multiplan Commercial |
$1,171.20
|
| Rate for Payer: NAPHCARE Commercial |
$878.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,346.88
|
| Rate for Payer: Quartz Beloit One Network |
$717.36
|
| Rate for Payer: Quartz Commercial |
$951.60
|
| Rate for Payer: Quartz Medicare Advantage |
$878.40
|
| Rate for Payer: The Alliance Commercial |
$5,856.00
|
| Rate for Payer: WEA Trust Commercial |
$805.20
|
| Rate for Payer: WPS Commercial |
$1,084.38
|
|
|
SCREW CORT 2.4 X 10MM LP TI AR-8724-10
|
Facility
|
IP
|
$1,464.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5286788
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$717.36 |
| Max. Negotiated Rate |
$1,346.88 |
| Rate for Payer: Aetna Commercial |
$1,317.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,259.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$775.92
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cigna Commercial |
$1,346.88
|
| Rate for Payer: Health EOS Commercial |
$1,302.96
|
| Rate for Payer: HFN Commercial |
$1,346.88
|
| Rate for Payer: Multiplan Commercial |
$1,171.20
|
| Rate for Payer: NAPHCARE Commercial |
$878.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,346.88
|
| Rate for Payer: Quartz Beloit One Network |
$717.36
|
| Rate for Payer: Quartz Commercial |
$878.40
|
| Rate for Payer: WEA Trust Commercial |
$805.20
|
| Rate for Payer: WPS Commercial |
$1,084.38
|
|
|
SCREW-CORT 2.4 X 12 401.762
|
Facility
|
OP
|
$497.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966798
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$139.16 |
| Max. Negotiated Rate |
$1,988.00 |
| Rate for Payer: Aetna Commercial |
$447.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$427.42
|
| Rate for Payer: Aetna Managed Medicare |
$139.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$323.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$248.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$238.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$263.41
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cigna Commercial |
$457.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$278.12
|
| Rate for Payer: Health EOS Commercial |
$442.33
|
| Rate for Payer: HFN Commercial |
$457.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$372.75
|
| Rate for Payer: Multiplan Commercial |
$397.60
|
| Rate for Payer: NAPHCARE Commercial |
$298.20
|
| Rate for Payer: Preferred Network Access Commercial |
$457.24
|
| Rate for Payer: Quartz Beloit One Network |
$243.53
|
| Rate for Payer: Quartz Commercial |
$323.05
|
| Rate for Payer: Quartz Medicare Advantage |
$298.20
|
| Rate for Payer: The Alliance Commercial |
$1,988.00
|
| Rate for Payer: WEA Trust Commercial |
$273.35
|
| Rate for Payer: WPS Commercial |
$368.13
|
|
|
SCREW-CORT 2.4 X 12 401.762
|
Facility
|
IP
|
$497.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966798
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$243.53 |
| Max. Negotiated Rate |
$457.24 |
| Rate for Payer: Aetna Commercial |
$447.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$427.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$263.41
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cigna Commercial |
$457.24
|
| Rate for Payer: Health EOS Commercial |
$442.33
|
| Rate for Payer: HFN Commercial |
$457.24
|
| Rate for Payer: Multiplan Commercial |
$397.60
|
| Rate for Payer: NAPHCARE Commercial |
$298.20
|
| Rate for Payer: Preferred Network Access Commercial |
$457.24
|
| Rate for Payer: Quartz Beloit One Network |
$243.53
|
| Rate for Payer: Quartz Commercial |
$298.20
|
| Rate for Payer: WEA Trust Commercial |
$273.35
|
| Rate for Payer: WPS Commercial |
$368.13
|
|
|
SCREW CORT 2.4 X 12MM AR-8956-12
|
Facility
|
IP
|
$1,464.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5286717
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$717.36 |
| Max. Negotiated Rate |
$1,346.88 |
| Rate for Payer: Aetna Commercial |
$1,317.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,259.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$775.92
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cigna Commercial |
$1,346.88
|
| Rate for Payer: Health EOS Commercial |
$1,302.96
|
| Rate for Payer: HFN Commercial |
$1,346.88
|
| Rate for Payer: Multiplan Commercial |
$1,171.20
|
| Rate for Payer: NAPHCARE Commercial |
$878.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,346.88
|
| Rate for Payer: Quartz Beloit One Network |
$717.36
|
| Rate for Payer: Quartz Commercial |
$878.40
|
| Rate for Payer: WEA Trust Commercial |
$805.20
|
| Rate for Payer: WPS Commercial |
$1,084.38
|
|
|
SCREW CORT 2.4 X 12MM AR-8956-12
|
Facility
|
OP
|
$1,464.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5286717
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$409.92 |
| Max. Negotiated Rate |
$5,856.00 |
| Rate for Payer: Aetna Commercial |
$1,317.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,259.04
|
| Rate for Payer: Aetna Managed Medicare |
$409.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$951.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$732.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$702.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$775.92
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cigna Commercial |
$1,346.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$819.25
|
| Rate for Payer: Health EOS Commercial |
$1,302.96
|
| Rate for Payer: HFN Commercial |
$1,346.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,098.00
|
| Rate for Payer: Multiplan Commercial |
$1,171.20
|
| Rate for Payer: NAPHCARE Commercial |
$878.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,346.88
|
| Rate for Payer: Quartz Beloit One Network |
$717.36
|
| Rate for Payer: Quartz Commercial |
$951.60
|
| Rate for Payer: Quartz Medicare Advantage |
$878.40
|
| Rate for Payer: The Alliance Commercial |
$5,856.00
|
| Rate for Payer: WEA Trust Commercial |
$805.20
|
| Rate for Payer: WPS Commercial |
$1,084.38
|
|
|
SCREW CORT 2.4 X 12MM LP TI AR-8724-12
|
Facility
|
IP
|
$1,463.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5200623
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$716.87 |
| Max. Negotiated Rate |
$1,345.96 |
| Rate for Payer: Aetna Commercial |
$1,316.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,258.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$775.39
|
| Rate for Payer: Cash Price |
$438.90
|
| Rate for Payer: Cigna Commercial |
$1,345.96
|
| Rate for Payer: Health EOS Commercial |
$1,302.07
|
| Rate for Payer: HFN Commercial |
$1,345.96
|
| Rate for Payer: Multiplan Commercial |
$1,170.40
|
| Rate for Payer: NAPHCARE Commercial |
$877.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,345.96
|
| Rate for Payer: Quartz Beloit One Network |
$716.87
|
| Rate for Payer: Quartz Commercial |
$877.80
|
| Rate for Payer: WEA Trust Commercial |
$804.65
|
| Rate for Payer: WPS Commercial |
$1,083.64
|
|
|
SCREW CORT 2.4 X 12MM LP TI AR-8724-12
|
Facility
|
OP
|
$1,463.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5200623
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$409.64 |
| Max. Negotiated Rate |
$5,852.00 |
| Rate for Payer: Aetna Commercial |
$1,316.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,258.18
|
| Rate for Payer: Aetna Managed Medicare |
$409.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$950.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$731.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$702.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$775.39
|
| Rate for Payer: Cash Price |
$438.90
|
| Rate for Payer: Cigna Commercial |
$1,345.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$818.69
|
| Rate for Payer: Health EOS Commercial |
$1,302.07
|
| Rate for Payer: HFN Commercial |
$1,345.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,097.25
|
| Rate for Payer: Multiplan Commercial |
$1,170.40
|
| Rate for Payer: NAPHCARE Commercial |
$877.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,345.96
|
| Rate for Payer: Quartz Beloit One Network |
$716.87
|
| Rate for Payer: Quartz Commercial |
$950.95
|
| Rate for Payer: Quartz Medicare Advantage |
$877.80
|
| Rate for Payer: The Alliance Commercial |
$5,852.00
|
| Rate for Payer: WEA Trust Commercial |
$804.65
|
| Rate for Payer: WPS Commercial |
$1,083.64
|
|
|
SCREW-CORT 2.4 X 14 401.764
|
Facility
|
IP
|
$478.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966801
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$234.22 |
| Max. Negotiated Rate |
$439.76 |
| Rate for Payer: Aetna Commercial |
$430.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$411.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$253.34
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cigna Commercial |
$439.76
|
| Rate for Payer: Health EOS Commercial |
$425.42
|
| Rate for Payer: HFN Commercial |
$439.76
|
| Rate for Payer: Multiplan Commercial |
$382.40
|
| Rate for Payer: NAPHCARE Commercial |
$286.80
|
| Rate for Payer: Preferred Network Access Commercial |
$439.76
|
| Rate for Payer: Quartz Beloit One Network |
$234.22
|
| Rate for Payer: Quartz Commercial |
$286.80
|
| Rate for Payer: WEA Trust Commercial |
$262.90
|
| Rate for Payer: WPS Commercial |
$354.05
|
|
|
SCREW-CORT 2.4 X 14 401.764
|
Facility
|
OP
|
$478.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966801
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$133.84 |
| Max. Negotiated Rate |
$1,912.00 |
| Rate for Payer: Aetna Commercial |
$430.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$411.08
|
| Rate for Payer: Aetna Managed Medicare |
$133.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$310.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$239.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$229.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$253.34
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cigna Commercial |
$439.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$267.49
|
| Rate for Payer: Health EOS Commercial |
$425.42
|
| Rate for Payer: HFN Commercial |
$439.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$358.50
|
| Rate for Payer: Multiplan Commercial |
$382.40
|
| Rate for Payer: NAPHCARE Commercial |
$286.80
|
| Rate for Payer: Preferred Network Access Commercial |
$439.76
|
| Rate for Payer: Quartz Beloit One Network |
$234.22
|
| Rate for Payer: Quartz Commercial |
$310.70
|
| Rate for Payer: Quartz Medicare Advantage |
$286.80
|
| Rate for Payer: The Alliance Commercial |
$1,912.00
|
| Rate for Payer: WEA Trust Commercial |
$262.90
|
| Rate for Payer: WPS Commercial |
$354.05
|
|
|
SCREW-CORT 2.4 X 16 401.766
|
Facility
|
IP
|
$478.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966804
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$234.22 |
| Max. Negotiated Rate |
$439.76 |
| Rate for Payer: Aetna Commercial |
$430.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$411.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$253.34
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cigna Commercial |
$439.76
|
| Rate for Payer: Health EOS Commercial |
$425.42
|
| Rate for Payer: HFN Commercial |
$439.76
|
| Rate for Payer: Multiplan Commercial |
$382.40
|
| Rate for Payer: NAPHCARE Commercial |
$286.80
|
| Rate for Payer: Preferred Network Access Commercial |
$439.76
|
| Rate for Payer: Quartz Beloit One Network |
$234.22
|
| Rate for Payer: Quartz Commercial |
$286.80
|
| Rate for Payer: WEA Trust Commercial |
$262.90
|
| Rate for Payer: WPS Commercial |
$354.05
|
|
|
SCREW-CORT 2.4 X 16 401.766
|
Facility
|
OP
|
$478.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966804
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$133.84 |
| Max. Negotiated Rate |
$1,912.00 |
| Rate for Payer: Aetna Commercial |
$430.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$411.08
|
| Rate for Payer: Aetna Managed Medicare |
$133.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$310.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$239.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$229.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$253.34
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cigna Commercial |
$439.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$267.49
|
| Rate for Payer: Health EOS Commercial |
$425.42
|
| Rate for Payer: HFN Commercial |
$439.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$358.50
|
| Rate for Payer: Multiplan Commercial |
$382.40
|
| Rate for Payer: NAPHCARE Commercial |
$286.80
|
| Rate for Payer: Preferred Network Access Commercial |
$439.76
|
| Rate for Payer: Quartz Beloit One Network |
$234.22
|
| Rate for Payer: Quartz Commercial |
$310.70
|
| Rate for Payer: Quartz Medicare Advantage |
$286.80
|
| Rate for Payer: The Alliance Commercial |
$1,912.00
|
| Rate for Payer: WEA Trust Commercial |
$262.90
|
| Rate for Payer: WPS Commercial |
$354.05
|
|
|
SCREW CORT 2.4 X 16MM LP TI AR-8916CX24-16
|
Facility
|
OP
|
$1,354.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6165905
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$379.12 |
| Max. Negotiated Rate |
$5,416.00 |
| Rate for Payer: Aetna Commercial |
$1,218.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,164.44
|
| Rate for Payer: Aetna Managed Medicare |
$379.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$880.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$677.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$649.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$717.62
|
| Rate for Payer: Cash Price |
$406.20
|
| Rate for Payer: Cigna Commercial |
$1,245.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$757.70
|
| Rate for Payer: Health EOS Commercial |
$1,205.06
|
| Rate for Payer: HFN Commercial |
$1,245.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,015.50
|
| Rate for Payer: Multiplan Commercial |
$1,083.20
|
| Rate for Payer: NAPHCARE Commercial |
$812.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,245.68
|
| Rate for Payer: Quartz Beloit One Network |
$663.46
|
| Rate for Payer: Quartz Commercial |
$880.10
|
| Rate for Payer: Quartz Medicare Advantage |
$812.40
|
| Rate for Payer: The Alliance Commercial |
$5,416.00
|
| Rate for Payer: WEA Trust Commercial |
$744.70
|
| Rate for Payer: WPS Commercial |
$1,002.91
|
|
|
SCREW CORT 2.4 X 16MM LP TI AR-8916CX24-16
|
Facility
|
IP
|
$1,354.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6165905
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$663.46 |
| Max. Negotiated Rate |
$1,245.68 |
| Rate for Payer: Aetna Commercial |
$1,218.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,164.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$717.62
|
| Rate for Payer: Cash Price |
$406.20
|
| Rate for Payer: Cigna Commercial |
$1,245.68
|
| Rate for Payer: Health EOS Commercial |
$1,205.06
|
| Rate for Payer: HFN Commercial |
$1,245.68
|
| Rate for Payer: Multiplan Commercial |
$1,083.20
|
| Rate for Payer: NAPHCARE Commercial |
$812.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,245.68
|
| Rate for Payer: Quartz Beloit One Network |
$663.46
|
| Rate for Payer: Quartz Commercial |
$812.40
|
| Rate for Payer: WEA Trust Commercial |
$744.70
|
| Rate for Payer: WPS Commercial |
$1,002.91
|
|
