|
SCREW CORT 2.4 X 24MM LP TI AR-8916CX24-24
|
Facility
|
OP
|
$1,354.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414676
|
|
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 26 401.776
|
Facility
|
OP
|
$497.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966819
|
|
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 26 401.776
|
Facility
|
IP
|
$497.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966819
|
|
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 26MM LP TI AR-8916CX24-26
|
Facility
|
IP
|
$1,464.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414677
|
|
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 26MM LP TI AR-8916CX24-26
|
Facility
|
OP
|
$1,464.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414677
|
|
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 28 401.778
|
Facility
|
IP
|
$1,184.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966822
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$580.16 |
| Max. Negotiated Rate |
$1,089.28 |
| Rate for Payer: Aetna Commercial |
$1,065.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,018.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$627.52
|
| Rate for Payer: Cash Price |
$355.20
|
| Rate for Payer: Cigna Commercial |
$1,089.28
|
| Rate for Payer: Health EOS Commercial |
$1,053.76
|
| Rate for Payer: HFN Commercial |
$1,089.28
|
| Rate for Payer: Multiplan Commercial |
$947.20
|
| Rate for Payer: NAPHCARE Commercial |
$710.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,089.28
|
| Rate for Payer: Quartz Beloit One Network |
$580.16
|
| Rate for Payer: Quartz Commercial |
$710.40
|
| Rate for Payer: WEA Trust Commercial |
$651.20
|
| Rate for Payer: WPS Commercial |
$876.99
|
|
|
SCREW-CORT 2.4 X 28 401.778
|
Facility
|
OP
|
$1,184.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966822
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$331.52 |
| Max. Negotiated Rate |
$4,736.00 |
| Rate for Payer: Aetna Commercial |
$1,065.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,018.24
|
| Rate for Payer: Aetna Managed Medicare |
$331.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$769.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$592.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$568.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$627.52
|
| Rate for Payer: Cash Price |
$355.20
|
| Rate for Payer: Cigna Commercial |
$1,089.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$662.57
|
| Rate for Payer: Health EOS Commercial |
$1,053.76
|
| Rate for Payer: HFN Commercial |
$1,089.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$888.00
|
| Rate for Payer: Multiplan Commercial |
$947.20
|
| Rate for Payer: NAPHCARE Commercial |
$710.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,089.28
|
| Rate for Payer: Quartz Beloit One Network |
$580.16
|
| Rate for Payer: Quartz Commercial |
$769.60
|
| Rate for Payer: Quartz Medicare Advantage |
$710.40
|
| Rate for Payer: The Alliance Commercial |
$4,736.00
|
| Rate for Payer: WEA Trust Commercial |
$651.20
|
| Rate for Payer: WPS Commercial |
$876.99
|
|
|
SCREW CORT 2.4 X 28MM LP TI AR-8916CX24-28
|
Facility
|
OP
|
$1,464.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414678
|
|
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 28MM LP TI AR-8916CX24-28
|
Facility
|
IP
|
$1,464.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414678
|
|
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 30 401.780
|
Facility
|
IP
|
$478.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966825
|
|
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 30 401.780
|
Facility
|
OP
|
$478.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966825
|
|
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 30MM LP TI AR-8916CX24-30
|
Facility
|
OP
|
$1,464.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414679
|
|
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 30MM LP TI AR-8916CX24-30
|
Facility
|
IP
|
$1,464.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414679
|
|
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 30 STARDRIVE 201.780
|
Facility
|
IP
|
$1,077.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966465
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$527.73 |
| Max. Negotiated Rate |
$990.84 |
| Rate for Payer: Aetna Commercial |
$969.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$926.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$570.81
|
| Rate for Payer: Cash Price |
$323.10
|
| Rate for Payer: Cigna Commercial |
$990.84
|
| Rate for Payer: Health EOS Commercial |
$958.53
|
| Rate for Payer: HFN Commercial |
$990.84
|
| Rate for Payer: Multiplan Commercial |
$861.60
|
| Rate for Payer: NAPHCARE Commercial |
$646.20
|
| Rate for Payer: Preferred Network Access Commercial |
$990.84
|
| Rate for Payer: Quartz Beloit One Network |
$527.73
|
| Rate for Payer: Quartz Commercial |
$646.20
|
| Rate for Payer: WEA Trust Commercial |
$592.35
|
| Rate for Payer: WPS Commercial |
$797.73
|
|
|
SCREW CORT 2.4 X 30 STARDRIVE 201.780
|
Facility
|
OP
|
$1,077.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966465
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$301.56 |
| Max. Negotiated Rate |
$4,308.00 |
| Rate for Payer: Aetna Commercial |
$969.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$926.22
|
| Rate for Payer: Aetna Managed Medicare |
$301.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$700.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$538.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$516.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$570.81
|
| Rate for Payer: Cash Price |
$323.10
|
| Rate for Payer: Cigna Commercial |
$990.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$602.69
|
| Rate for Payer: Health EOS Commercial |
$958.53
|
| Rate for Payer: HFN Commercial |
$990.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$807.75
|
| Rate for Payer: Multiplan Commercial |
$861.60
|
| Rate for Payer: NAPHCARE Commercial |
$646.20
|
| Rate for Payer: Preferred Network Access Commercial |
$990.84
|
| Rate for Payer: Quartz Beloit One Network |
$527.73
|
| Rate for Payer: Quartz Commercial |
$700.05
|
| Rate for Payer: Quartz Medicare Advantage |
$646.20
|
| Rate for Payer: The Alliance Commercial |
$4,308.00
|
| Rate for Payer: WEA Trust Commercial |
$592.35
|
| Rate for Payer: WPS Commercial |
$797.73
|
|
|
SCREW CORT 2.4 X 32MM LP TI AR-8916CX24-32
|
Facility
|
OP
|
$1,464.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414675
|
|
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 32MM LP TI AR-8916CX24-32
|
Facility
|
IP
|
$1,464.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414675
|
|
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 34MM LP TI AR-8916CX24-34
|
Facility
|
OP
|
$1,464.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414680
|
|
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 34MM LP TI AR-8916CX24-34
|
Facility
|
IP
|
$1,464.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414680
|
|
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 6 401.756
|
Facility
|
IP
|
$478.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966828
|
|
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 6 401.756
|
Facility
|
OP
|
$478.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966828
|
|
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 8 401.758
|
Facility
|
IP
|
$478.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966830
|
|
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 8 401.758
|
Facility
|
OP
|
$478.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966830
|
|
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 8MM STARDRIVE 201.758
|
Facility
|
IP
|
$1,040.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966466
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$509.60 |
| Max. Negotiated Rate |
$956.80 |
| Rate for Payer: Aetna Commercial |
$936.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$894.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$551.20
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Cigna Commercial |
$956.80
|
| Rate for Payer: Health EOS Commercial |
$925.60
|
| Rate for Payer: HFN Commercial |
$956.80
|
| Rate for Payer: Multiplan Commercial |
$832.00
|
| Rate for Payer: NAPHCARE Commercial |
$624.00
|
| Rate for Payer: Preferred Network Access Commercial |
$956.80
|
| Rate for Payer: Quartz Beloit One Network |
$509.60
|
| Rate for Payer: Quartz Commercial |
$624.00
|
| Rate for Payer: WEA Trust Commercial |
$572.00
|
| Rate for Payer: WPS Commercial |
$770.33
|
|
|
SCREW CORT 2.4 X 8MM STARDRIVE 201.758
|
Facility
|
OP
|
$1,040.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966466
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$291.20 |
| Max. Negotiated Rate |
$4,160.00 |
| Rate for Payer: Aetna Commercial |
$936.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$894.40
|
| Rate for Payer: Aetna Managed Medicare |
$291.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$676.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$520.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$499.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$551.20
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Cigna Commercial |
$956.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$581.98
|
| Rate for Payer: Health EOS Commercial |
$925.60
|
| Rate for Payer: HFN Commercial |
$956.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$832.00
|
| Rate for Payer: NAPHCARE Commercial |
$624.00
|
| Rate for Payer: Preferred Network Access Commercial |
$956.80
|
| Rate for Payer: Quartz Beloit One Network |
$509.60
|
| Rate for Payer: Quartz Commercial |
$676.00
|
| Rate for Payer: Quartz Medicare Advantage |
$624.00
|
| Rate for Payer: The Alliance Commercial |
$4,160.00
|
| Rate for Payer: WEA Trust Commercial |
$572.00
|
| Rate for Payer: WPS Commercial |
$770.33
|
|
