|
SCREW CORT 3.5 X 48MM LP AR-8835-48
|
Facility
|
IP
|
$603.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6105629
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$307.29 |
| Max. Negotiated Rate |
$576.95 |
| Rate for Payer: Aetna Commercial |
$564.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$539.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$332.37
|
| Rate for Payer: Cash Price |
$180.90
|
| Rate for Payer: Cigna Commercial |
$576.95
|
| Rate for Payer: Health EOS Commercial |
$558.14
|
| Rate for Payer: HFN Commercial |
$576.95
|
| Rate for Payer: Multiplan Commercial |
$501.70
|
| Rate for Payer: Preferred Network Access Commercial |
$576.95
|
| Rate for Payer: Quartz Beloit One Network |
$307.29
|
| Rate for Payer: Quartz Commercial |
$376.27
|
| Rate for Payer: WEA Trust Commercial |
$344.92
|
| Rate for Payer: WPS Commercial |
$464.49
|
|
|
SCREW CORT 3.5 X 48MM LP AR-8835-48
|
Facility
|
OP
|
$603.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6105629
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$175.59 |
| Max. Negotiated Rate |
$576.95 |
| Rate for Payer: Aetna Commercial |
$564.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$539.32
|
| Rate for Payer: Aetna Managed Medicare |
$175.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$407.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$313.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$301.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$332.37
|
| Rate for Payer: Cash Price |
$180.90
|
| Rate for Payer: Cigna Commercial |
$576.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$350.95
|
| Rate for Payer: Health EOS Commercial |
$558.14
|
| Rate for Payer: HFN Commercial |
$576.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$470.34
|
| Rate for Payer: Multiplan Commercial |
$501.70
|
| Rate for Payer: NAPHCARE Commercial |
$376.27
|
| Rate for Payer: Preferred Network Access Commercial |
$576.95
|
| Rate for Payer: Quartz Beloit One Network |
$307.29
|
| Rate for Payer: Quartz Commercial |
$407.63
|
| Rate for Payer: Quartz Medicare Advantage |
$376.27
|
| Rate for Payer: The Alliance Commercial |
$313.56
|
| Rate for Payer: WEA Trust Commercial |
$344.92
|
| Rate for Payer: WPS Commercial |
$464.49
|
|
|
SCREW CORT 3.5 X 50 204.850
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966902
|
|
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 50 204.850
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966902
|
|
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 50MM LP AR-8835-50
|
Facility
|
IP
|
$652.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5416039
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$332.26 |
| Max. Negotiated Rate |
$623.83 |
| Rate for Payer: Aetna Commercial |
$610.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$583.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$359.38
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cigna Commercial |
$623.83
|
| Rate for Payer: Health EOS Commercial |
$603.49
|
| Rate for Payer: HFN Commercial |
$623.83
|
| Rate for Payer: Multiplan Commercial |
$542.46
|
| Rate for Payer: Preferred Network Access Commercial |
$623.83
|
| Rate for Payer: Quartz Beloit One Network |
$332.26
|
| Rate for Payer: Quartz Commercial |
$406.85
|
| Rate for Payer: WEA Trust Commercial |
$372.94
|
| Rate for Payer: WPS Commercial |
$502.24
|
|
|
SCREW CORT 3.5 X 50MM LP AR-8835-50
|
Facility
|
OP
|
$652.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5416039
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$189.86 |
| Max. Negotiated Rate |
$623.83 |
| Rate for Payer: Aetna Commercial |
$610.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$583.15
|
| Rate for Payer: Aetna Managed Medicare |
$189.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$440.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$339.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$325.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$359.38
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cigna Commercial |
$623.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$379.46
|
| Rate for Payer: Health EOS Commercial |
$603.49
|
| Rate for Payer: HFN Commercial |
$623.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$508.56
|
| Rate for Payer: Multiplan Commercial |
$542.46
|
| Rate for Payer: NAPHCARE Commercial |
$406.85
|
| Rate for Payer: Preferred Network Access Commercial |
$623.83
|
| Rate for Payer: Quartz Beloit One Network |
$332.26
|
| Rate for Payer: Quartz Commercial |
$440.75
|
| Rate for Payer: Quartz Medicare Advantage |
$406.85
|
| Rate for Payer: The Alliance Commercial |
$339.04
|
| Rate for Payer: WEA Trust Commercial |
$372.94
|
| Rate for Payer: WPS Commercial |
$502.24
|
|
|
SCREW-CORT 3.5 X 55 204.855
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966904
|
|
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 55 204.855
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966904
|
|
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 55MM LP AR-8835-55
|
Facility
|
IP
|
$652.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5416040
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$332.26 |
| Max. Negotiated Rate |
$623.83 |
| Rate for Payer: Aetna Commercial |
$610.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$583.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$359.38
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cigna Commercial |
$623.83
|
| Rate for Payer: Health EOS Commercial |
$603.49
|
| Rate for Payer: HFN Commercial |
$623.83
|
| Rate for Payer: Multiplan Commercial |
$542.46
|
| Rate for Payer: Preferred Network Access Commercial |
$623.83
|
| Rate for Payer: Quartz Beloit One Network |
$332.26
|
| Rate for Payer: Quartz Commercial |
$406.85
|
| Rate for Payer: WEA Trust Commercial |
$372.94
|
| Rate for Payer: WPS Commercial |
$502.24
|
|
|
SCREW CORT 3.5 X 55MM LP AR-8835-55
|
Facility
|
OP
|
$652.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5416040
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$189.86 |
| Max. Negotiated Rate |
$623.83 |
| Rate for Payer: Aetna Commercial |
$610.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$583.15
|
| Rate for Payer: Aetna Managed Medicare |
$189.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$440.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$339.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$325.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$359.38
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cigna Commercial |
$623.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$379.46
|
| Rate for Payer: Health EOS Commercial |
$603.49
|
| Rate for Payer: HFN Commercial |
$623.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$508.56
|
| Rate for Payer: Multiplan Commercial |
$542.46
|
| Rate for Payer: NAPHCARE Commercial |
$406.85
|
| Rate for Payer: Preferred Network Access Commercial |
$623.83
|
| Rate for Payer: Quartz Beloit One Network |
$332.26
|
| Rate for Payer: Quartz Commercial |
$440.75
|
| Rate for Payer: Quartz Medicare Advantage |
$406.85
|
| Rate for Payer: The Alliance Commercial |
$339.04
|
| Rate for Payer: WEA Trust Commercial |
$372.94
|
| Rate for Payer: WPS Commercial |
$502.24
|
|
|
SCREW CORT 3.5 X 55MM ST 661455
|
Facility
|
OP
|
$760.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5458971
|
|
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 55MM ST 661455
|
Facility
|
IP
|
$760.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5458971
|
|
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 56MM LOW PROFILE 02.206.256
|
Facility
|
OP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3937361
|
|
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 56MM LOW PROFILE 02.206.256
|
Facility
|
IP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3937361
|
|
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 60 204.860
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415207
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$113.57 |
| Max. Negotiated Rate |
$373.15 |
| Rate for Payer: Aetna Commercial |
$365.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$348.82
|
| Rate for Payer: Aetna Managed Medicare |
$113.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$263.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$202.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$194.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$214.97
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cigna Commercial |
$373.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$226.98
|
| Rate for Payer: Health EOS Commercial |
$360.98
|
| Rate for Payer: HFN Commercial |
$373.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$304.20
|
| Rate for Payer: Multiplan Commercial |
$324.48
|
| Rate for Payer: NAPHCARE Commercial |
$243.36
|
| Rate for Payer: Preferred Network Access Commercial |
$373.15
|
| Rate for Payer: Quartz Beloit One Network |
$198.74
|
| Rate for Payer: Quartz Commercial |
$263.64
|
| Rate for Payer: Quartz Medicare Advantage |
$243.36
|
| Rate for Payer: The Alliance Commercial |
$202.80
|
| Rate for Payer: WEA Trust Commercial |
$223.08
|
| Rate for Payer: WPS Commercial |
$300.42
|
|
|
SCREW-CORT 3.5 X 60 204.860
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415207
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.74 |
| Max. Negotiated Rate |
$373.15 |
| Rate for Payer: Aetna Commercial |
$365.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$348.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$214.97
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cigna Commercial |
$373.15
|
| Rate for Payer: Health EOS Commercial |
$360.98
|
| Rate for Payer: HFN Commercial |
$373.15
|
| Rate for Payer: Multiplan Commercial |
$324.48
|
| Rate for Payer: Preferred Network Access Commercial |
$373.15
|
| Rate for Payer: Quartz Beloit One Network |
$198.74
|
| Rate for Payer: Quartz Commercial |
$243.36
|
| Rate for Payer: WEA Trust Commercial |
$223.08
|
| Rate for Payer: WPS Commercial |
$300.42
|
|
|
SCREW CORT 3.5 X 60MM LOW PROFILE 02.206.260
|
Facility
|
OP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3937351
|
|
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 60MM LOW PROFILE 02.206.260
|
Facility
|
IP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3937351
|
|
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 65 204.865
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966906
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.64 |
| Max. Negotiated Rate |
$113.86 |
| Rate for Payer: Aetna Commercial |
$111.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$106.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.59
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: Cigna Commercial |
$113.86
|
| Rate for Payer: Health EOS Commercial |
$110.15
|
| Rate for Payer: HFN Commercial |
$113.86
|
| Rate for Payer: Multiplan Commercial |
$99.01
|
| Rate for Payer: Preferred Network Access Commercial |
$113.86
|
| Rate for Payer: Quartz Beloit One Network |
$60.64
|
| Rate for Payer: Quartz Commercial |
$74.26
|
| Rate for Payer: WEA Trust Commercial |
$68.07
|
| Rate for Payer: WPS Commercial |
$91.67
|
|
|
SCREW-CORT 3.5 X 65 204.865
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966906
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$34.65 |
| Max. Negotiated Rate |
$113.86 |
| Rate for Payer: Aetna Commercial |
$111.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$106.43
|
| Rate for Payer: Aetna Managed Medicare |
$34.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$80.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$61.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$59.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.59
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: Cigna Commercial |
$113.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$69.26
|
| Rate for Payer: Health EOS Commercial |
$110.15
|
| Rate for Payer: HFN Commercial |
$113.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$92.82
|
| Rate for Payer: Multiplan Commercial |
$99.01
|
| Rate for Payer: NAPHCARE Commercial |
$74.26
|
| Rate for Payer: Preferred Network Access Commercial |
$113.86
|
| Rate for Payer: Quartz Beloit One Network |
$60.64
|
| Rate for Payer: Quartz Commercial |
$80.44
|
| Rate for Payer: Quartz Medicare Advantage |
$74.26
|
| Rate for Payer: The Alliance Commercial |
$61.88
|
| Rate for Payer: WEA Trust Commercial |
$68.07
|
| Rate for Payer: WPS Commercial |
$91.67
|
|
|
SCREW-CORT 3.5 X 80 204.880
|
Facility
|
IP
|
$413.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5264686
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$210.46 |
| Max. Negotiated Rate |
$395.16 |
| Rate for Payer: Aetna Commercial |
$386.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$369.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$227.65
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: Cigna Commercial |
$395.16
|
| Rate for Payer: Health EOS Commercial |
$382.27
|
| Rate for Payer: HFN Commercial |
$395.16
|
| Rate for Payer: Multiplan Commercial |
$343.62
|
| Rate for Payer: Preferred Network Access Commercial |
$395.16
|
| Rate for Payer: Quartz Beloit One Network |
$210.46
|
| Rate for Payer: Quartz Commercial |
$257.71
|
| Rate for Payer: WEA Trust Commercial |
$236.24
|
| Rate for Payer: WPS Commercial |
$318.13
|
|
|
SCREW-CORT 3.5 X 80 204.880
|
Facility
|
OP
|
$413.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5264686
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$120.27 |
| Max. Negotiated Rate |
$395.16 |
| Rate for Payer: Aetna Commercial |
$386.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$369.39
|
| Rate for Payer: Aetna Managed Medicare |
$120.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$279.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$214.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$206.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$227.65
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: Cigna Commercial |
$395.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$240.37
|
| Rate for Payer: Health EOS Commercial |
$382.27
|
| Rate for Payer: HFN Commercial |
$395.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$322.14
|
| Rate for Payer: Multiplan Commercial |
$343.62
|
| Rate for Payer: NAPHCARE Commercial |
$257.71
|
| Rate for Payer: Preferred Network Access Commercial |
$395.16
|
| Rate for Payer: Quartz Beloit One Network |
$210.46
|
| Rate for Payer: Quartz Commercial |
$279.19
|
| Rate for Payer: Quartz Medicare Advantage |
$257.71
|
| Rate for Payer: The Alliance Commercial |
$214.76
|
| Rate for Payer: WEA Trust Commercial |
$236.24
|
| Rate for Payer: WPS Commercial |
$318.13
|
|
|
SCREW CORT 3.5 X 8MM LP AR-8835-08
|
Facility
|
IP
|
$652.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5306832
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$332.26 |
| Max. Negotiated Rate |
$623.83 |
| Rate for Payer: Aetna Commercial |
$610.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$583.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$359.38
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cigna Commercial |
$623.83
|
| Rate for Payer: Health EOS Commercial |
$603.49
|
| Rate for Payer: HFN Commercial |
$623.83
|
| Rate for Payer: Multiplan Commercial |
$542.46
|
| Rate for Payer: Preferred Network Access Commercial |
$623.83
|
| Rate for Payer: Quartz Beloit One Network |
$332.26
|
| Rate for Payer: Quartz Commercial |
$406.85
|
| Rate for Payer: WEA Trust Commercial |
$372.94
|
| Rate for Payer: WPS Commercial |
$502.24
|
|
|
SCREW CORT 3.5 X 8MM LP AR-8835-08
|
Facility
|
OP
|
$652.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5306832
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$189.86 |
| Max. Negotiated Rate |
$623.83 |
| Rate for Payer: Aetna Commercial |
$610.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$583.15
|
| Rate for Payer: Aetna Managed Medicare |
$189.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$440.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$339.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$325.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$359.38
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cigna Commercial |
$623.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$379.46
|
| Rate for Payer: Health EOS Commercial |
$603.49
|
| Rate for Payer: HFN Commercial |
$623.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$508.56
|
| Rate for Payer: Multiplan Commercial |
$542.46
|
| Rate for Payer: NAPHCARE Commercial |
$406.85
|
| Rate for Payer: Preferred Network Access Commercial |
$623.83
|
| Rate for Payer: Quartz Beloit One Network |
$332.26
|
| Rate for Payer: Quartz Commercial |
$440.75
|
| Rate for Payer: Quartz Medicare Advantage |
$406.85
|
| Rate for Payer: The Alliance Commercial |
$339.04
|
| Rate for Payer: WEA Trust Commercial |
$372.94
|
| Rate for Payer: WPS Commercial |
$502.24
|
|
|
SCREW-CORT 4.5 X 14 214.014
|
Facility
|
OP
|
$279.00
|
|
| Hospital Charge Code |
2967296
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.24 |
| Max. Negotiated Rate |
$266.95 |
| Rate for Payer: Aetna Commercial |
$261.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$249.54
|
| Rate for Payer: Aetna Managed Medicare |
$81.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$188.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$145.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$139.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$153.78
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna Commercial |
$266.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$162.38
|
| Rate for Payer: Health EOS Commercial |
$258.24
|
| Rate for Payer: HFN Commercial |
$266.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$217.62
|
| Rate for Payer: Multiplan Commercial |
$232.13
|
| Rate for Payer: NAPHCARE Commercial |
$174.10
|
| Rate for Payer: Preferred Network Access Commercial |
$266.95
|
| Rate for Payer: Quartz Beloit One Network |
$142.18
|
| Rate for Payer: Quartz Commercial |
$188.60
|
| Rate for Payer: Quartz Medicare Advantage |
$174.10
|
| Rate for Payer: The Alliance Commercial |
$145.08
|
| Rate for Payer: WEA Trust Commercial |
$159.59
|
| Rate for Payer: WPS Commercial |
$214.91
|
|
