|
SCREW CORT 2.7 X 14 STARDRIVE 202.874
|
Facility
|
IP
|
$790.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966469
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$387.10 |
| Max. Negotiated Rate |
$726.80 |
| Rate for Payer: Aetna Commercial |
$711.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$679.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$418.70
|
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cigna Commercial |
$726.80
|
| Rate for Payer: Health EOS Commercial |
$703.10
|
| Rate for Payer: HFN Commercial |
$726.80
|
| Rate for Payer: Multiplan Commercial |
$632.00
|
| Rate for Payer: NAPHCARE Commercial |
$474.00
|
| Rate for Payer: Preferred Network Access Commercial |
$726.80
|
| Rate for Payer: Quartz Beloit One Network |
$387.10
|
| Rate for Payer: Quartz Commercial |
$474.00
|
| Rate for Payer: WEA Trust Commercial |
$434.50
|
| Rate for Payer: WPS Commercial |
$585.15
|
|
|
SCREW-CORT 2.7 X 16 202.016
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967265
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$65.17 |
| Max. Negotiated Rate |
$122.36 |
| Rate for Payer: Aetna Commercial |
$119.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$114.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$70.49
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cigna Commercial |
$122.36
|
| Rate for Payer: Health EOS Commercial |
$118.37
|
| Rate for Payer: HFN Commercial |
$122.36
|
| Rate for Payer: Multiplan Commercial |
$106.40
|
| Rate for Payer: NAPHCARE Commercial |
$79.80
|
| Rate for Payer: Preferred Network Access Commercial |
$122.36
|
| Rate for Payer: Quartz Beloit One Network |
$65.17
|
| Rate for Payer: Quartz Commercial |
$79.80
|
| Rate for Payer: WEA Trust Commercial |
$73.15
|
| Rate for Payer: WPS Commercial |
$98.51
|
|
|
SCREW-CORT 2.7 X 16 202.016
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967265
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$37.24 |
| Max. Negotiated Rate |
$532.00 |
| Rate for Payer: Aetna Commercial |
$119.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$114.38
|
| Rate for Payer: Aetna Managed Medicare |
$37.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$86.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$66.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$63.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$70.49
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cigna Commercial |
$122.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$74.43
|
| Rate for Payer: Health EOS Commercial |
$118.37
|
| Rate for Payer: HFN Commercial |
$122.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$99.75
|
| Rate for Payer: Multiplan Commercial |
$106.40
|
| Rate for Payer: NAPHCARE Commercial |
$79.80
|
| Rate for Payer: Preferred Network Access Commercial |
$122.36
|
| Rate for Payer: Quartz Beloit One Network |
$65.17
|
| Rate for Payer: Quartz Commercial |
$86.45
|
| Rate for Payer: Quartz Medicare Advantage |
$79.80
|
| Rate for Payer: The Alliance Commercial |
$532.00
|
| Rate for Payer: WEA Trust Commercial |
$73.15
|
| Rate for Payer: WPS Commercial |
$98.51
|
|
|
SCREW CORT 2.7 X 16 202.816
|
Facility
|
IP
|
$123.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966839
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.27 |
| Max. Negotiated Rate |
$113.16 |
| Rate for Payer: Aetna Commercial |
$110.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$105.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.19
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna Commercial |
$113.16
|
| Rate for Payer: Health EOS Commercial |
$109.47
|
| Rate for Payer: HFN Commercial |
$113.16
|
| Rate for Payer: Multiplan Commercial |
$98.40
|
| Rate for Payer: NAPHCARE Commercial |
$73.80
|
| Rate for Payer: Preferred Network Access Commercial |
$113.16
|
| Rate for Payer: Quartz Beloit One Network |
$60.27
|
| Rate for Payer: Quartz Commercial |
$73.80
|
| Rate for Payer: WEA Trust Commercial |
$67.65
|
| Rate for Payer: WPS Commercial |
$91.11
|
|
|
SCREW CORT 2.7 X 16 202.816
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966839
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$34.44 |
| Max. Negotiated Rate |
$492.00 |
| Rate for Payer: Aetna Commercial |
$110.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$105.78
|
| Rate for Payer: Aetna Managed Medicare |
$34.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$79.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$61.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$59.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.19
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna Commercial |
$113.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$68.83
|
| Rate for Payer: Health EOS Commercial |
$109.47
|
| Rate for Payer: HFN Commercial |
$113.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$92.25
|
| Rate for Payer: Multiplan Commercial |
$98.40
|
| Rate for Payer: NAPHCARE Commercial |
$73.80
|
| Rate for Payer: Preferred Network Access Commercial |
$113.16
|
| Rate for Payer: Quartz Beloit One Network |
$60.27
|
| Rate for Payer: Quartz Commercial |
$79.95
|
| Rate for Payer: Quartz Medicare Advantage |
$73.80
|
| Rate for Payer: The Alliance Commercial |
$492.00
|
| Rate for Payer: WEA Trust Commercial |
$67.65
|
| Rate for Payer: WPS Commercial |
$91.11
|
|
|
SCREW-CORT 2.7 X 16 402.876
|
Facility
|
IP
|
$355.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2990954
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$173.95 |
| Max. Negotiated Rate |
$326.60 |
| Rate for Payer: Aetna Commercial |
$319.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$305.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$188.15
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cigna Commercial |
$326.60
|
| Rate for Payer: Health EOS Commercial |
$315.95
|
| Rate for Payer: HFN Commercial |
$326.60
|
| Rate for Payer: Multiplan Commercial |
$284.00
|
| Rate for Payer: NAPHCARE Commercial |
$213.00
|
| Rate for Payer: Preferred Network Access Commercial |
$326.60
|
| Rate for Payer: Quartz Beloit One Network |
$173.95
|
| Rate for Payer: Quartz Commercial |
$213.00
|
| Rate for Payer: WEA Trust Commercial |
$195.25
|
| Rate for Payer: WPS Commercial |
$262.95
|
|
|
SCREW-CORT 2.7 X 16 402.876
|
Facility
|
OP
|
$355.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2990954
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$99.40 |
| Max. Negotiated Rate |
$1,420.00 |
| Rate for Payer: Aetna Commercial |
$319.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$305.30
|
| Rate for Payer: Aetna Managed Medicare |
$99.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$230.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$177.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$170.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$188.15
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cigna Commercial |
$326.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$198.66
|
| Rate for Payer: Health EOS Commercial |
$315.95
|
| Rate for Payer: HFN Commercial |
$326.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$266.25
|
| Rate for Payer: Multiplan Commercial |
$284.00
|
| Rate for Payer: NAPHCARE Commercial |
$213.00
|
| Rate for Payer: Preferred Network Access Commercial |
$326.60
|
| Rate for Payer: Quartz Beloit One Network |
$173.95
|
| Rate for Payer: Quartz Commercial |
$230.75
|
| Rate for Payer: Quartz Medicare Advantage |
$213.00
|
| Rate for Payer: The Alliance Commercial |
$1,420.00
|
| Rate for Payer: WEA Trust Commercial |
$195.25
|
| Rate for Payer: WPS Commercial |
$262.95
|
|
|
SCREW CORT 2.7 X 16 LO-PRO AR-8827-16
|
Facility
|
OP
|
$839.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5520831
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$234.92 |
| Max. Negotiated Rate |
$3,356.00 |
| Rate for Payer: Aetna Commercial |
$755.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$721.54
|
| Rate for Payer: Aetna Managed Medicare |
$234.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$545.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$419.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$402.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$444.67
|
| Rate for Payer: Cash Price |
$251.70
|
| Rate for Payer: Cigna Commercial |
$771.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$469.50
|
| Rate for Payer: Health EOS Commercial |
$746.71
|
| Rate for Payer: HFN Commercial |
$771.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$629.25
|
| Rate for Payer: Multiplan Commercial |
$671.20
|
| Rate for Payer: NAPHCARE Commercial |
$503.40
|
| Rate for Payer: Preferred Network Access Commercial |
$771.88
|
| Rate for Payer: Quartz Beloit One Network |
$411.11
|
| Rate for Payer: Quartz Commercial |
$545.35
|
| Rate for Payer: Quartz Medicare Advantage |
$503.40
|
| Rate for Payer: The Alliance Commercial |
$3,356.00
|
| Rate for Payer: WEA Trust Commercial |
$461.45
|
| Rate for Payer: WPS Commercial |
$621.45
|
|
|
SCREW CORT 2.7 X 16 LO-PRO AR-8827-16
|
Facility
|
IP
|
$839.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5520831
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$411.11 |
| Max. Negotiated Rate |
$771.88 |
| Rate for Payer: Aetna Commercial |
$755.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$721.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$444.67
|
| Rate for Payer: Cash Price |
$251.70
|
| Rate for Payer: Cigna Commercial |
$771.88
|
| Rate for Payer: Health EOS Commercial |
$746.71
|
| Rate for Payer: HFN Commercial |
$771.88
|
| Rate for Payer: Multiplan Commercial |
$671.20
|
| Rate for Payer: NAPHCARE Commercial |
$503.40
|
| Rate for Payer: Preferred Network Access Commercial |
$771.88
|
| Rate for Payer: Quartz Beloit One Network |
$411.11
|
| Rate for Payer: Quartz Commercial |
$503.40
|
| Rate for Payer: WEA Trust Commercial |
$461.45
|
| Rate for Payer: WPS Commercial |
$621.45
|
|
|
SCREW CORT 2.7 X 16MM COLINK AFX LOW-PRO P72 ST016
|
Facility
|
OP
|
$1,932.00
|
|
|
Service Code
|
HCPCS C1714
|
| Hospital Charge Code |
6172085
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$540.96 |
| Max. Negotiated Rate |
$7,728.00 |
| Rate for Payer: Aetna Commercial |
$1,738.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,661.52
|
| Rate for Payer: Aetna Managed Medicare |
$540.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,255.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$966.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$927.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,023.96
|
| Rate for Payer: Cash Price |
$579.60
|
| Rate for Payer: Cigna Commercial |
$1,777.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,081.15
|
| Rate for Payer: Health EOS Commercial |
$1,719.48
|
| Rate for Payer: HFN Commercial |
$1,777.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,449.00
|
| Rate for Payer: Multiplan Commercial |
$1,545.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,159.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,777.44
|
| Rate for Payer: Quartz Beloit One Network |
$946.68
|
| Rate for Payer: Quartz Commercial |
$1,255.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,159.20
|
| Rate for Payer: The Alliance Commercial |
$7,728.00
|
| Rate for Payer: WEA Trust Commercial |
$1,062.60
|
| Rate for Payer: WPS Commercial |
$1,431.03
|
|
|
SCREW CORT 2.7 X 16MM COLINK AFX LOW-PRO P72 ST016
|
Facility
|
IP
|
$1,932.00
|
|
|
Service Code
|
HCPCS C1714
|
| Hospital Charge Code |
6172085
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$946.68 |
| Max. Negotiated Rate |
$1,777.44 |
| Rate for Payer: Aetna Commercial |
$1,738.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,661.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,023.96
|
| Rate for Payer: Cash Price |
$579.60
|
| Rate for Payer: Cigna Commercial |
$1,777.44
|
| Rate for Payer: Health EOS Commercial |
$1,719.48
|
| Rate for Payer: HFN Commercial |
$1,777.44
|
| Rate for Payer: Multiplan Commercial |
$1,545.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,159.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,777.44
|
| Rate for Payer: Quartz Beloit One Network |
$946.68
|
| Rate for Payer: Quartz Commercial |
$1,159.20
|
| Rate for Payer: WEA Trust Commercial |
$1,062.60
|
| Rate for Payer: WPS Commercial |
$1,431.03
|
|
|
SCREW CORT 2.7 X 16 STARDRIVE 202.876
|
Facility
|
IP
|
$790.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966470
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$387.10 |
| Max. Negotiated Rate |
$726.80 |
| Rate for Payer: Aetna Commercial |
$711.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$679.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$418.70
|
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cigna Commercial |
$726.80
|
| Rate for Payer: Health EOS Commercial |
$703.10
|
| Rate for Payer: HFN Commercial |
$726.80
|
| Rate for Payer: Multiplan Commercial |
$632.00
|
| Rate for Payer: NAPHCARE Commercial |
$474.00
|
| Rate for Payer: Preferred Network Access Commercial |
$726.80
|
| Rate for Payer: Quartz Beloit One Network |
$387.10
|
| Rate for Payer: Quartz Commercial |
$474.00
|
| Rate for Payer: WEA Trust Commercial |
$434.50
|
| Rate for Payer: WPS Commercial |
$585.15
|
|
|
SCREW CORT 2.7 X 16 STARDRIVE 202.876
|
Facility
|
OP
|
$790.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966470
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$221.20 |
| Max. Negotiated Rate |
$3,160.00 |
| Rate for Payer: Aetna Commercial |
$711.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$679.40
|
| Rate for Payer: Aetna Managed Medicare |
$221.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$513.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$395.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$379.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$418.70
|
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cigna Commercial |
$726.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$442.08
|
| Rate for Payer: Health EOS Commercial |
$703.10
|
| Rate for Payer: HFN Commercial |
$726.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$592.50
|
| Rate for Payer: Multiplan Commercial |
$632.00
|
| Rate for Payer: NAPHCARE Commercial |
$474.00
|
| Rate for Payer: Preferred Network Access Commercial |
$726.80
|
| Rate for Payer: Quartz Beloit One Network |
$387.10
|
| Rate for Payer: Quartz Commercial |
$513.50
|
| Rate for Payer: Quartz Medicare Advantage |
$474.00
|
| Rate for Payer: The Alliance Commercial |
$3,160.00
|
| Rate for Payer: WEA Trust Commercial |
$434.50
|
| Rate for Payer: WPS Commercial |
$585.15
|
|
|
SCREW-CORT 2.7 X 18 202.018
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967266
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$37.24 |
| Max. Negotiated Rate |
$532.00 |
| Rate for Payer: Aetna Commercial |
$119.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$114.38
|
| Rate for Payer: Aetna Managed Medicare |
$37.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$86.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$66.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$63.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$70.49
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cigna Commercial |
$122.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$74.43
|
| Rate for Payer: Health EOS Commercial |
$118.37
|
| Rate for Payer: HFN Commercial |
$122.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$99.75
|
| Rate for Payer: Multiplan Commercial |
$106.40
|
| Rate for Payer: NAPHCARE Commercial |
$79.80
|
| Rate for Payer: Preferred Network Access Commercial |
$122.36
|
| Rate for Payer: Quartz Beloit One Network |
$65.17
|
| Rate for Payer: Quartz Commercial |
$86.45
|
| Rate for Payer: Quartz Medicare Advantage |
$79.80
|
| Rate for Payer: The Alliance Commercial |
$532.00
|
| Rate for Payer: WEA Trust Commercial |
$73.15
|
| Rate for Payer: WPS Commercial |
$98.51
|
|
|
SCREW-CORT 2.7 X 18 202.018
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967266
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$65.17 |
| Max. Negotiated Rate |
$122.36 |
| Rate for Payer: Aetna Commercial |
$119.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$114.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$70.49
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cigna Commercial |
$122.36
|
| Rate for Payer: Health EOS Commercial |
$118.37
|
| Rate for Payer: HFN Commercial |
$122.36
|
| Rate for Payer: Multiplan Commercial |
$106.40
|
| Rate for Payer: NAPHCARE Commercial |
$79.80
|
| Rate for Payer: Preferred Network Access Commercial |
$122.36
|
| Rate for Payer: Quartz Beloit One Network |
$65.17
|
| Rate for Payer: Quartz Commercial |
$79.80
|
| Rate for Payer: WEA Trust Commercial |
$73.15
|
| Rate for Payer: WPS Commercial |
$98.51
|
|
|
SCREW CORT 2.7 X 18 202.818
|
Facility
|
IP
|
$123.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966840
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.27 |
| Max. Negotiated Rate |
$113.16 |
| Rate for Payer: Aetna Commercial |
$110.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$105.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.19
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna Commercial |
$113.16
|
| Rate for Payer: Health EOS Commercial |
$109.47
|
| Rate for Payer: HFN Commercial |
$113.16
|
| Rate for Payer: Multiplan Commercial |
$98.40
|
| Rate for Payer: NAPHCARE Commercial |
$73.80
|
| Rate for Payer: Preferred Network Access Commercial |
$113.16
|
| Rate for Payer: Quartz Beloit One Network |
$60.27
|
| Rate for Payer: Quartz Commercial |
$73.80
|
| Rate for Payer: WEA Trust Commercial |
$67.65
|
| Rate for Payer: WPS Commercial |
$91.11
|
|
|
SCREW CORT 2.7 X 18 202.818
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966840
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$34.44 |
| Max. Negotiated Rate |
$492.00 |
| Rate for Payer: Aetna Commercial |
$110.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$105.78
|
| Rate for Payer: Aetna Managed Medicare |
$34.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$79.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$61.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$59.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.19
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna Commercial |
$113.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$68.83
|
| Rate for Payer: Health EOS Commercial |
$109.47
|
| Rate for Payer: HFN Commercial |
$113.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$92.25
|
| Rate for Payer: Multiplan Commercial |
$98.40
|
| Rate for Payer: NAPHCARE Commercial |
$73.80
|
| Rate for Payer: Preferred Network Access Commercial |
$113.16
|
| Rate for Payer: Quartz Beloit One Network |
$60.27
|
| Rate for Payer: Quartz Commercial |
$79.95
|
| Rate for Payer: Quartz Medicare Advantage |
$73.80
|
| Rate for Payer: The Alliance Commercial |
$492.00
|
| Rate for Payer: WEA Trust Commercial |
$67.65
|
| Rate for Payer: WPS Commercial |
$91.11
|
|
|
SCREW-CORT 2.7 X 18 402.878
|
Facility
|
OP
|
$342.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966841
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$95.76 |
| Max. Negotiated Rate |
$1,368.00 |
| Rate for Payer: Aetna Commercial |
$307.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$294.12
|
| Rate for Payer: Aetna Managed Medicare |
$95.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$222.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$171.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$164.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$181.26
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cigna Commercial |
$314.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$191.38
|
| Rate for Payer: Health EOS Commercial |
$304.38
|
| Rate for Payer: HFN Commercial |
$314.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$256.50
|
| Rate for Payer: Multiplan Commercial |
$273.60
|
| Rate for Payer: NAPHCARE Commercial |
$205.20
|
| Rate for Payer: Preferred Network Access Commercial |
$314.64
|
| Rate for Payer: Quartz Beloit One Network |
$167.58
|
| Rate for Payer: Quartz Commercial |
$222.30
|
| Rate for Payer: Quartz Medicare Advantage |
$205.20
|
| Rate for Payer: The Alliance Commercial |
$1,368.00
|
| Rate for Payer: WEA Trust Commercial |
$188.10
|
| Rate for Payer: WPS Commercial |
$253.32
|
|
|
SCREW-CORT 2.7 X 18 402.878
|
Facility
|
IP
|
$342.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966841
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$167.58 |
| Max. Negotiated Rate |
$314.64 |
| Rate for Payer: Aetna Commercial |
$307.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$294.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$181.26
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cigna Commercial |
$314.64
|
| Rate for Payer: Health EOS Commercial |
$304.38
|
| Rate for Payer: HFN Commercial |
$314.64
|
| Rate for Payer: Multiplan Commercial |
$273.60
|
| Rate for Payer: NAPHCARE Commercial |
$205.20
|
| Rate for Payer: Preferred Network Access Commercial |
$314.64
|
| Rate for Payer: Quartz Beloit One Network |
$167.58
|
| Rate for Payer: Quartz Commercial |
$205.20
|
| Rate for Payer: WEA Trust Commercial |
$188.10
|
| Rate for Payer: WPS Commercial |
$253.32
|
|
|
SCREW CORT 2.7 X 18 LO-PRO AR-8827-18
|
Facility
|
IP
|
$839.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5563350
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$411.11 |
| Max. Negotiated Rate |
$771.88 |
| Rate for Payer: Aetna Commercial |
$755.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$721.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$444.67
|
| Rate for Payer: Cash Price |
$251.70
|
| Rate for Payer: Cigna Commercial |
$771.88
|
| Rate for Payer: Health EOS Commercial |
$746.71
|
| Rate for Payer: HFN Commercial |
$771.88
|
| Rate for Payer: Multiplan Commercial |
$671.20
|
| Rate for Payer: NAPHCARE Commercial |
$503.40
|
| Rate for Payer: Preferred Network Access Commercial |
$771.88
|
| Rate for Payer: Quartz Beloit One Network |
$411.11
|
| Rate for Payer: Quartz Commercial |
$503.40
|
| Rate for Payer: WEA Trust Commercial |
$461.45
|
| Rate for Payer: WPS Commercial |
$621.45
|
|
|
SCREW CORT 2.7 X 18 LO-PRO AR-8827-18
|
Facility
|
OP
|
$839.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5563350
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$234.92 |
| Max. Negotiated Rate |
$3,356.00 |
| Rate for Payer: Aetna Commercial |
$755.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$721.54
|
| Rate for Payer: Aetna Managed Medicare |
$234.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$545.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$419.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$402.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$444.67
|
| Rate for Payer: Cash Price |
$251.70
|
| Rate for Payer: Cigna Commercial |
$771.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$469.50
|
| Rate for Payer: Health EOS Commercial |
$746.71
|
| Rate for Payer: HFN Commercial |
$771.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$629.25
|
| Rate for Payer: Multiplan Commercial |
$671.20
|
| Rate for Payer: NAPHCARE Commercial |
$503.40
|
| Rate for Payer: Preferred Network Access Commercial |
$771.88
|
| Rate for Payer: Quartz Beloit One Network |
$411.11
|
| Rate for Payer: Quartz Commercial |
$545.35
|
| Rate for Payer: Quartz Medicare Advantage |
$503.40
|
| Rate for Payer: The Alliance Commercial |
$3,356.00
|
| Rate for Payer: WEA Trust Commercial |
$461.45
|
| Rate for Payer: WPS Commercial |
$621.45
|
|
|
SCREW CORT 2.7 X 18 STARDRIVE 202.878
|
Facility
|
IP
|
$790.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3529516
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$387.10 |
| Max. Negotiated Rate |
$726.80 |
| Rate for Payer: Aetna Commercial |
$711.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$679.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$418.70
|
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cigna Commercial |
$726.80
|
| Rate for Payer: Health EOS Commercial |
$703.10
|
| Rate for Payer: HFN Commercial |
$726.80
|
| Rate for Payer: Multiplan Commercial |
$632.00
|
| Rate for Payer: NAPHCARE Commercial |
$474.00
|
| Rate for Payer: Preferred Network Access Commercial |
$726.80
|
| Rate for Payer: Quartz Beloit One Network |
$387.10
|
| Rate for Payer: Quartz Commercial |
$474.00
|
| Rate for Payer: WEA Trust Commercial |
$434.50
|
| Rate for Payer: WPS Commercial |
$585.15
|
|
|
SCREW CORT 2.7 X 18 STARDRIVE 202.878
|
Facility
|
OP
|
$790.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3529516
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$221.20 |
| Max. Negotiated Rate |
$3,160.00 |
| Rate for Payer: Aetna Commercial |
$711.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$679.40
|
| Rate for Payer: Aetna Managed Medicare |
$221.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$513.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$395.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$379.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$418.70
|
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cigna Commercial |
$726.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$442.08
|
| Rate for Payer: Health EOS Commercial |
$703.10
|
| Rate for Payer: HFN Commercial |
$726.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$592.50
|
| Rate for Payer: Multiplan Commercial |
$632.00
|
| Rate for Payer: NAPHCARE Commercial |
$474.00
|
| Rate for Payer: Preferred Network Access Commercial |
$726.80
|
| Rate for Payer: Quartz Beloit One Network |
$387.10
|
| Rate for Payer: Quartz Commercial |
$513.50
|
| Rate for Payer: Quartz Medicare Advantage |
$474.00
|
| Rate for Payer: The Alliance Commercial |
$3,160.00
|
| Rate for Payer: WEA Trust Commercial |
$434.50
|
| Rate for Payer: WPS Commercial |
$585.15
|
|
|
SCREW-CORT 2.7 X 20 202.020
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967267
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$37.24 |
| Max. Negotiated Rate |
$532.00 |
| Rate for Payer: Aetna Commercial |
$119.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$114.38
|
| Rate for Payer: Aetna Managed Medicare |
$37.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$86.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$66.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$63.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$70.49
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cigna Commercial |
$122.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$74.43
|
| Rate for Payer: Health EOS Commercial |
$118.37
|
| Rate for Payer: HFN Commercial |
$122.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$99.75
|
| Rate for Payer: Multiplan Commercial |
$106.40
|
| Rate for Payer: NAPHCARE Commercial |
$79.80
|
| Rate for Payer: Preferred Network Access Commercial |
$122.36
|
| Rate for Payer: Quartz Beloit One Network |
$65.17
|
| Rate for Payer: Quartz Commercial |
$86.45
|
| Rate for Payer: Quartz Medicare Advantage |
$79.80
|
| Rate for Payer: The Alliance Commercial |
$532.00
|
| Rate for Payer: WEA Trust Commercial |
$73.15
|
| Rate for Payer: WPS Commercial |
$98.51
|
|
|
SCREW-CORT 2.7 X 20 202.020
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967267
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$65.17 |
| Max. Negotiated Rate |
$122.36 |
| Rate for Payer: Aetna Commercial |
$119.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$114.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$70.49
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cigna Commercial |
$122.36
|
| Rate for Payer: Health EOS Commercial |
$118.37
|
| Rate for Payer: HFN Commercial |
$122.36
|
| Rate for Payer: Multiplan Commercial |
$106.40
|
| Rate for Payer: NAPHCARE Commercial |
$79.80
|
| Rate for Payer: Preferred Network Access Commercial |
$122.36
|
| Rate for Payer: Quartz Beloit One Network |
$65.17
|
| Rate for Payer: Quartz Commercial |
$79.80
|
| Rate for Payer: WEA Trust Commercial |
$73.15
|
| Rate for Payer: WPS Commercial |
$98.51
|
|
