|
SCREW CORT 3.5 X 24MM ST 661424
|
Facility
|
OP
|
$760.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5458921
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$221.31 |
| Max. Negotiated Rate |
$727.17 |
| Rate for Payer: Aetna Commercial |
$711.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$679.74
|
| Rate for Payer: Aetna Managed Medicare |
$221.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$513.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$395.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$379.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$418.91
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cigna Commercial |
$727.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$442.32
|
| Rate for Payer: Health EOS Commercial |
$703.46
|
| Rate for Payer: HFN Commercial |
$727.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$592.80
|
| Rate for Payer: Multiplan Commercial |
$632.32
|
| Rate for Payer: NAPHCARE Commercial |
$474.24
|
| Rate for Payer: Preferred Network Access Commercial |
$727.17
|
| Rate for Payer: Quartz Beloit One Network |
$387.30
|
| Rate for Payer: Quartz Commercial |
$513.76
|
| Rate for Payer: Quartz Medicare Advantage |
$474.24
|
| Rate for Payer: The Alliance Commercial |
$395.20
|
| Rate for Payer: WEA Trust Commercial |
$434.72
|
| Rate for Payer: WPS Commercial |
$585.43
|
|
|
SCREW CORT 3.5 X 24MM ST 661424
|
Facility
|
IP
|
$760.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5458921
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$387.30 |
| Max. Negotiated Rate |
$727.17 |
| Rate for Payer: Aetna Commercial |
$711.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$679.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$418.91
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cigna Commercial |
$727.17
|
| Rate for Payer: Health EOS Commercial |
$703.46
|
| Rate for Payer: HFN Commercial |
$727.17
|
| Rate for Payer: Multiplan Commercial |
$632.32
|
| Rate for Payer: Preferred Network Access Commercial |
$727.17
|
| Rate for Payer: Quartz Beloit One Network |
$387.30
|
| Rate for Payer: Quartz Commercial |
$474.24
|
| Rate for Payer: WEA Trust Commercial |
$434.72
|
| Rate for Payer: WPS Commercial |
$585.43
|
|
|
SCREW CORT 3.5 X 24 STARDRIVE 02.200.024
|
Facility
|
OP
|
$404.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4047412
|
|
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 24 STARDRIVE 02.200.024
|
Facility
|
IP
|
$404.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4047412
|
|
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 26 204.226
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966864
|
|
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 26 204.226
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966864
|
|
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 26 204.826
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966887
|
|
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 26 204.826
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966887
|
|
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 26 ACUMED 30-0264
|
Facility
|
IP
|
$1,644.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4595311
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$837.78 |
| Max. Negotiated Rate |
$1,572.98 |
| Rate for Payer: Aetna Commercial |
$1,538.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,470.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$906.17
|
| Rate for Payer: Cash Price |
$493.20
|
| Rate for Payer: Cigna Commercial |
$1,572.98
|
| Rate for Payer: Health EOS Commercial |
$1,521.69
|
| Rate for Payer: HFN Commercial |
$1,572.98
|
| Rate for Payer: Multiplan Commercial |
$1,367.81
|
| Rate for Payer: Preferred Network Access Commercial |
$1,572.98
|
| Rate for Payer: Quartz Beloit One Network |
$837.78
|
| Rate for Payer: Quartz Commercial |
$1,025.86
|
| Rate for Payer: WEA Trust Commercial |
$940.37
|
| Rate for Payer: WPS Commercial |
$1,266.37
|
|
|
SCREW CORT 3.5 X 26 ACUMED 30-0264
|
Facility
|
OP
|
$1,644.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4595311
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$478.73 |
| Max. Negotiated Rate |
$1,572.98 |
| Rate for Payer: Aetna Commercial |
$1,538.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,470.39
|
| Rate for Payer: Aetna Managed Medicare |
$478.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,111.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$854.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$820.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$906.17
|
| Rate for Payer: Cash Price |
$493.20
|
| Rate for Payer: Cigna Commercial |
$1,572.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$956.81
|
| Rate for Payer: Health EOS Commercial |
$1,521.69
|
| Rate for Payer: HFN Commercial |
$1,572.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,282.32
|
| Rate for Payer: Multiplan Commercial |
$1,367.81
|
| Rate for Payer: NAPHCARE Commercial |
$1,025.86
|
| Rate for Payer: Preferred Network Access Commercial |
$1,572.98
|
| Rate for Payer: Quartz Beloit One Network |
$837.78
|
| Rate for Payer: Quartz Commercial |
$1,111.34
|
| Rate for Payer: Quartz Medicare Advantage |
$1,025.86
|
| Rate for Payer: The Alliance Commercial |
$854.88
|
| Rate for Payer: WEA Trust Commercial |
$940.37
|
| Rate for Payer: WPS Commercial |
$1,266.37
|
|
|
SCREW CORT 3.5 X 26MM 338626
|
Facility
|
IP
|
$414.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3901360
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$210.97 |
| Max. Negotiated Rate |
$396.12 |
| Rate for Payer: Aetna Commercial |
$387.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$370.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$228.20
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cigna Commercial |
$396.12
|
| Rate for Payer: Health EOS Commercial |
$383.20
|
| Rate for Payer: HFN Commercial |
$396.12
|
| Rate for Payer: Multiplan Commercial |
$344.45
|
| Rate for Payer: Preferred Network Access Commercial |
$396.12
|
| Rate for Payer: Quartz Beloit One Network |
$210.97
|
| Rate for Payer: Quartz Commercial |
$258.34
|
| Rate for Payer: WEA Trust Commercial |
$236.81
|
| Rate for Payer: WPS Commercial |
$318.90
|
|
|
SCREW CORT 3.5 X 26MM 338626
|
Facility
|
OP
|
$414.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3901360
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$120.56 |
| Max. Negotiated Rate |
$396.12 |
| Rate for Payer: Aetna Commercial |
$387.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$370.28
|
| Rate for Payer: Aetna Managed Medicare |
$120.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$279.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$215.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$206.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$228.20
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cigna Commercial |
$396.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$240.95
|
| Rate for Payer: Health EOS Commercial |
$383.20
|
| Rate for Payer: HFN Commercial |
$396.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$322.92
|
| Rate for Payer: Multiplan Commercial |
$344.45
|
| Rate for Payer: NAPHCARE Commercial |
$258.34
|
| Rate for Payer: Preferred Network Access Commercial |
$396.12
|
| Rate for Payer: Quartz Beloit One Network |
$210.97
|
| Rate for Payer: Quartz Commercial |
$279.86
|
| Rate for Payer: Quartz Medicare Advantage |
$258.34
|
| Rate for Payer: The Alliance Commercial |
$215.28
|
| Rate for Payer: WEA Trust Commercial |
$236.81
|
| Rate for Payer: WPS Commercial |
$318.90
|
|
|
SCREW CORT 3.5 X 26MM LP 02.206.226
|
Facility
|
OP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4317100
|
|
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 26MM LP 02.206.226
|
Facility
|
IP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4317100
|
|
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 26MM LP AR-8835-26
|
Facility
|
OP
|
$627.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5611681
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$182.58 |
| Max. Negotiated Rate |
$599.91 |
| Rate for Payer: Aetna Commercial |
$586.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$560.79
|
| Rate for Payer: Aetna Managed Medicare |
$182.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$423.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$326.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$313.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$345.60
|
| Rate for Payer: Cash Price |
$188.10
|
| Rate for Payer: Cigna Commercial |
$599.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$364.91
|
| Rate for Payer: Health EOS Commercial |
$580.35
|
| Rate for Payer: HFN Commercial |
$599.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$489.06
|
| Rate for Payer: Multiplan Commercial |
$521.66
|
| Rate for Payer: NAPHCARE Commercial |
$391.25
|
| Rate for Payer: Preferred Network Access Commercial |
$599.91
|
| Rate for Payer: Quartz Beloit One Network |
$319.52
|
| Rate for Payer: Quartz Commercial |
$423.85
|
| Rate for Payer: Quartz Medicare Advantage |
$391.25
|
| Rate for Payer: The Alliance Commercial |
$326.04
|
| Rate for Payer: WEA Trust Commercial |
$358.64
|
| Rate for Payer: WPS Commercial |
$482.98
|
|
|
SCREW CORT 3.5 X 26MM LP AR-8835-26
|
Facility
|
IP
|
$627.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5611681
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$319.52 |
| Max. Negotiated Rate |
$599.91 |
| Rate for Payer: Aetna Commercial |
$586.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$560.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$345.60
|
| Rate for Payer: Cash Price |
$188.10
|
| Rate for Payer: Cigna Commercial |
$599.91
|
| Rate for Payer: Health EOS Commercial |
$580.35
|
| Rate for Payer: HFN Commercial |
$599.91
|
| Rate for Payer: Multiplan Commercial |
$521.66
|
| Rate for Payer: Preferred Network Access Commercial |
$599.91
|
| Rate for Payer: Quartz Beloit One Network |
$319.52
|
| Rate for Payer: Quartz Commercial |
$391.25
|
| Rate for Payer: WEA Trust Commercial |
$358.64
|
| Rate for Payer: WPS Commercial |
$482.98
|
|
|
SCREW CORT 3.5 X 26MM ST 661426
|
Facility
|
IP
|
$760.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5520858
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$387.30 |
| Max. Negotiated Rate |
$727.17 |
| Rate for Payer: Aetna Commercial |
$711.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$679.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$418.91
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cigna Commercial |
$727.17
|
| Rate for Payer: Health EOS Commercial |
$703.46
|
| Rate for Payer: HFN Commercial |
$727.17
|
| Rate for Payer: Multiplan Commercial |
$632.32
|
| Rate for Payer: Preferred Network Access Commercial |
$727.17
|
| Rate for Payer: Quartz Beloit One Network |
$387.30
|
| Rate for Payer: Quartz Commercial |
$474.24
|
| Rate for Payer: WEA Trust Commercial |
$434.72
|
| Rate for Payer: WPS Commercial |
$585.43
|
|
|
SCREW CORT 3.5 X 26MM ST 661426
|
Facility
|
OP
|
$760.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5520858
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$221.31 |
| Max. Negotiated Rate |
$727.17 |
| Rate for Payer: Aetna Commercial |
$711.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$679.74
|
| Rate for Payer: Aetna Managed Medicare |
$221.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$513.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$395.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$379.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$418.91
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cigna Commercial |
$727.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$442.32
|
| Rate for Payer: Health EOS Commercial |
$703.46
|
| Rate for Payer: HFN Commercial |
$727.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$592.80
|
| Rate for Payer: Multiplan Commercial |
$632.32
|
| Rate for Payer: NAPHCARE Commercial |
$474.24
|
| Rate for Payer: Preferred Network Access Commercial |
$727.17
|
| Rate for Payer: Quartz Beloit One Network |
$387.30
|
| Rate for Payer: Quartz Commercial |
$513.76
|
| Rate for Payer: Quartz Medicare Advantage |
$474.24
|
| Rate for Payer: The Alliance Commercial |
$395.20
|
| Rate for Payer: WEA Trust Commercial |
$434.72
|
| Rate for Payer: WPS Commercial |
$585.43
|
|
|
SCREW CORT 3.5 X 26 STARDRIVE 02.200.026
|
Facility
|
IP
|
$412.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6174859
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$209.96 |
| Max. Negotiated Rate |
$394.20 |
| Rate for Payer: Aetna Commercial |
$385.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$368.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$227.09
|
| Rate for Payer: Cash Price |
$123.60
|
| Rate for Payer: Cigna Commercial |
$394.20
|
| Rate for Payer: Health EOS Commercial |
$381.35
|
| Rate for Payer: HFN Commercial |
$394.20
|
| Rate for Payer: Multiplan Commercial |
$342.78
|
| Rate for Payer: Preferred Network Access Commercial |
$394.20
|
| Rate for Payer: Quartz Beloit One Network |
$209.96
|
| Rate for Payer: Quartz Commercial |
$257.09
|
| Rate for Payer: WEA Trust Commercial |
$235.66
|
| Rate for Payer: WPS Commercial |
$317.36
|
|
|
SCREW CORT 3.5 X 26 STARDRIVE 02.200.026
|
Facility
|
OP
|
$412.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6174859
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$119.97 |
| Max. Negotiated Rate |
$394.20 |
| Rate for Payer: Aetna Commercial |
$385.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$368.49
|
| Rate for Payer: Aetna Managed Medicare |
$119.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$278.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$214.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$205.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$227.09
|
| Rate for Payer: Cash Price |
$123.60
|
| Rate for Payer: Cigna Commercial |
$394.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$239.78
|
| Rate for Payer: Health EOS Commercial |
$381.35
|
| Rate for Payer: HFN Commercial |
$394.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$321.36
|
| Rate for Payer: Multiplan Commercial |
$342.78
|
| Rate for Payer: NAPHCARE Commercial |
$257.09
|
| Rate for Payer: Preferred Network Access Commercial |
$394.20
|
| Rate for Payer: Quartz Beloit One Network |
$209.96
|
| Rate for Payer: Quartz Commercial |
$278.51
|
| Rate for Payer: Quartz Medicare Advantage |
$257.09
|
| Rate for Payer: The Alliance Commercial |
$214.24
|
| Rate for Payer: WEA Trust Commercial |
$235.66
|
| Rate for Payer: WPS Commercial |
$317.36
|
|
|
SCREW-CORT 3.5 X 28 204.228
|
Facility
|
IP
|
$113.00
|
|
| Hospital Charge Code |
2966865
|
|
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 28 204.228
|
Facility
|
OP
|
$113.00
|
|
| Hospital Charge Code |
2966865
|
|
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 28 204.828
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966889
|
|
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 28 204.828
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966889
|
|
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 28MM 338628
|
Facility
|
OP
|
$414.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3983339
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$120.56 |
| Max. Negotiated Rate |
$396.12 |
| Rate for Payer: Aetna Commercial |
$387.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$370.28
|
| Rate for Payer: Aetna Managed Medicare |
$120.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$279.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$215.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$206.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$228.20
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cigna Commercial |
$396.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$240.95
|
| Rate for Payer: Health EOS Commercial |
$383.20
|
| Rate for Payer: HFN Commercial |
$396.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$322.92
|
| Rate for Payer: Multiplan Commercial |
$344.45
|
| Rate for Payer: NAPHCARE Commercial |
$258.34
|
| Rate for Payer: Preferred Network Access Commercial |
$396.12
|
| Rate for Payer: Quartz Beloit One Network |
$210.97
|
| Rate for Payer: Quartz Commercial |
$279.86
|
| Rate for Payer: Quartz Medicare Advantage |
$258.34
|
| Rate for Payer: The Alliance Commercial |
$215.28
|
| Rate for Payer: WEA Trust Commercial |
$236.81
|
| Rate for Payer: WPS Commercial |
$318.90
|
|
