|
SCREW CORT 2.7 X 20 202.820
|
Facility
|
IP
|
$123.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966842
|
|
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 20 202.820
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966842
|
|
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 20 402.880
|
Facility
|
OP
|
$342.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966843
|
|
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 20 402.880
|
Facility
|
IP
|
$342.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966843
|
|
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 20 LO-PRO AR-8827-20
|
Facility
|
OP
|
$839.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415087
|
|
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 20 LO-PRO AR-8827-20
|
Facility
|
IP
|
$839.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415087
|
|
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 20 STARDRIVE 202.880
|
Facility
|
IP
|
$579.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4047410
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$283.71 |
| Max. Negotiated Rate |
$532.68 |
| Rate for Payer: Aetna Commercial |
$521.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$497.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$306.87
|
| Rate for Payer: Cash Price |
$173.70
|
| Rate for Payer: Cigna Commercial |
$532.68
|
| Rate for Payer: Health EOS Commercial |
$515.31
|
| Rate for Payer: HFN Commercial |
$532.68
|
| Rate for Payer: Multiplan Commercial |
$463.20
|
| Rate for Payer: NAPHCARE Commercial |
$347.40
|
| Rate for Payer: Preferred Network Access Commercial |
$532.68
|
| Rate for Payer: Quartz Beloit One Network |
$283.71
|
| Rate for Payer: Quartz Commercial |
$347.40
|
| Rate for Payer: WEA Trust Commercial |
$318.45
|
| Rate for Payer: WPS Commercial |
$428.87
|
|
|
SCREW CORT 2.7 X 20 STARDRIVE 202.880
|
Facility
|
OP
|
$579.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4047410
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$162.12 |
| Max. Negotiated Rate |
$2,316.00 |
| Rate for Payer: Aetna Commercial |
$521.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$497.94
|
| Rate for Payer: Aetna Managed Medicare |
$162.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$376.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$289.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$277.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$306.87
|
| Rate for Payer: Cash Price |
$173.70
|
| Rate for Payer: Cigna Commercial |
$532.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$324.01
|
| Rate for Payer: Health EOS Commercial |
$515.31
|
| Rate for Payer: HFN Commercial |
$532.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$434.25
|
| Rate for Payer: Multiplan Commercial |
$463.20
|
| Rate for Payer: NAPHCARE Commercial |
$347.40
|
| Rate for Payer: Preferred Network Access Commercial |
$532.68
|
| Rate for Payer: Quartz Beloit One Network |
$283.71
|
| Rate for Payer: Quartz Commercial |
$376.35
|
| Rate for Payer: Quartz Medicare Advantage |
$347.40
|
| Rate for Payer: The Alliance Commercial |
$2,316.00
|
| Rate for Payer: WEA Trust Commercial |
$318.45
|
| Rate for Payer: WPS Commercial |
$428.87
|
|
|
SCREW-CORT 2.7 X 22 202.022
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967268
|
|
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 22 202.022
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967268
|
|
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 22 202.822
|
Facility
|
IP
|
$123.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966844
|
|
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 22 202.822
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966844
|
|
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 22 402.882
|
Facility
|
OP
|
$342.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966845
|
|
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 22 402.882
|
Facility
|
IP
|
$342.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966845
|
|
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 22 LO-PRO AR-8827-22
|
Facility
|
IP
|
$839.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5591382
|
|
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 22 LO-PRO AR-8827-22
|
Facility
|
OP
|
$839.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5591382
|
|
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 22 STARDRIVE 202.882
|
Facility
|
IP
|
$579.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4520593
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$283.71 |
| Max. Negotiated Rate |
$532.68 |
| Rate for Payer: Aetna Commercial |
$521.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$497.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$306.87
|
| Rate for Payer: Cash Price |
$173.70
|
| Rate for Payer: Cigna Commercial |
$532.68
|
| Rate for Payer: Health EOS Commercial |
$515.31
|
| Rate for Payer: HFN Commercial |
$532.68
|
| Rate for Payer: Multiplan Commercial |
$463.20
|
| Rate for Payer: NAPHCARE Commercial |
$347.40
|
| Rate for Payer: Preferred Network Access Commercial |
$532.68
|
| Rate for Payer: Quartz Beloit One Network |
$283.71
|
| Rate for Payer: Quartz Commercial |
$347.40
|
| Rate for Payer: WEA Trust Commercial |
$318.45
|
| Rate for Payer: WPS Commercial |
$428.87
|
|
|
SCREW CORT 2.7 X 22 STARDRIVE 202.882
|
Facility
|
OP
|
$579.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4520593
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$162.12 |
| Max. Negotiated Rate |
$2,316.00 |
| Rate for Payer: Aetna Commercial |
$521.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$497.94
|
| Rate for Payer: Aetna Managed Medicare |
$162.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$376.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$289.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$277.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$306.87
|
| Rate for Payer: Cash Price |
$173.70
|
| Rate for Payer: Cigna Commercial |
$532.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$324.01
|
| Rate for Payer: Health EOS Commercial |
$515.31
|
| Rate for Payer: HFN Commercial |
$532.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$434.25
|
| Rate for Payer: Multiplan Commercial |
$463.20
|
| Rate for Payer: NAPHCARE Commercial |
$347.40
|
| Rate for Payer: Preferred Network Access Commercial |
$532.68
|
| Rate for Payer: Quartz Beloit One Network |
$283.71
|
| Rate for Payer: Quartz Commercial |
$376.35
|
| Rate for Payer: Quartz Medicare Advantage |
$347.40
|
| Rate for Payer: The Alliance Commercial |
$2,316.00
|
| Rate for Payer: WEA Trust Commercial |
$318.45
|
| Rate for Payer: WPS Commercial |
$428.87
|
|
|
SCREW-CORT 2.7 X 24 202.024
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967269
|
|
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 24 202.024
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967269
|
|
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 24 202.824
|
Facility
|
IP
|
$123.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966846
|
|
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 24 202.824
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966846
|
|
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 24 402.884
|
Facility
|
OP
|
$342.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966847
|
|
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 24 402.884
|
Facility
|
IP
|
$342.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966847
|
|
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 24 LO-PRO AR-8827-24
|
Facility
|
IP
|
$839.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5454697
|
|
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
|
|
