|
SCREW CORT 3.5 X 14MM LP TI AR-8935-14
|
Facility
|
IP
|
$958.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414665
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$469.42 |
| Max. Negotiated Rate |
$881.36 |
| Rate for Payer: Aetna Commercial |
$862.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$823.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$507.74
|
| Rate for Payer: Cash Price |
$287.40
|
| Rate for Payer: Cigna Commercial |
$881.36
|
| Rate for Payer: Health EOS Commercial |
$852.62
|
| Rate for Payer: HFN Commercial |
$881.36
|
| Rate for Payer: Multiplan Commercial |
$766.40
|
| Rate for Payer: NAPHCARE Commercial |
$574.80
|
| Rate for Payer: Preferred Network Access Commercial |
$881.36
|
| Rate for Payer: Quartz Beloit One Network |
$469.42
|
| Rate for Payer: Quartz Commercial |
$574.80
|
| Rate for Payer: WEA Trust Commercial |
$526.90
|
| Rate for Payer: WPS Commercial |
$709.59
|
|
|
SCREW CORT 3.5 X 14MM STAR DRIVE 02.206.214
|
Facility
|
IP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3444848
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$254.31 |
| Max. Negotiated Rate |
$477.48 |
| Rate for Payer: Aetna Commercial |
$467.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$446.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$275.07
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna Commercial |
$477.48
|
| Rate for Payer: Health EOS Commercial |
$461.91
|
| Rate for Payer: HFN Commercial |
$477.48
|
| Rate for Payer: Multiplan Commercial |
$415.20
|
| Rate for Payer: NAPHCARE Commercial |
$311.40
|
| Rate for Payer: Preferred Network Access Commercial |
$477.48
|
| Rate for Payer: Quartz Beloit One Network |
$254.31
|
| Rate for Payer: Quartz Commercial |
$311.40
|
| Rate for Payer: WEA Trust Commercial |
$285.45
|
| Rate for Payer: WPS Commercial |
$384.42
|
|
|
SCREW CORT 3.5 X 14MM STAR DRIVE 02.206.214
|
Facility
|
OP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3444848
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$145.32 |
| Max. Negotiated Rate |
$2,076.00 |
| Rate for Payer: Aetna Commercial |
$467.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$446.34
|
| Rate for Payer: Aetna Managed Medicare |
$145.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$337.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$259.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$249.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$275.07
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna Commercial |
$477.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$290.43
|
| Rate for Payer: Health EOS Commercial |
$461.91
|
| Rate for Payer: HFN Commercial |
$477.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$389.25
|
| Rate for Payer: Multiplan Commercial |
$415.20
|
| Rate for Payer: NAPHCARE Commercial |
$311.40
|
| Rate for Payer: Preferred Network Access Commercial |
$477.48
|
| Rate for Payer: Quartz Beloit One Network |
$254.31
|
| Rate for Payer: Quartz Commercial |
$337.35
|
| Rate for Payer: Quartz Medicare Advantage |
$311.40
|
| Rate for Payer: The Alliance Commercial |
$2,076.00
|
| Rate for Payer: WEA Trust Commercial |
$285.45
|
| Rate for Payer: WPS Commercial |
$384.42
|
|
|
SCREW CORT 3.5 X 14MM TI AR-8735-14
|
Facility
|
IP
|
$886.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599753
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$434.14 |
| Max. Negotiated Rate |
$815.12 |
| Rate for Payer: Aetna Commercial |
$797.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$761.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$469.58
|
| Rate for Payer: Cash Price |
$265.80
|
| Rate for Payer: Cigna Commercial |
$815.12
|
| Rate for Payer: Health EOS Commercial |
$788.54
|
| Rate for Payer: HFN Commercial |
$815.12
|
| Rate for Payer: Multiplan Commercial |
$708.80
|
| Rate for Payer: NAPHCARE Commercial |
$531.60
|
| Rate for Payer: Preferred Network Access Commercial |
$815.12
|
| Rate for Payer: Quartz Beloit One Network |
$434.14
|
| Rate for Payer: Quartz Commercial |
$531.60
|
| Rate for Payer: WEA Trust Commercial |
$487.30
|
| Rate for Payer: WPS Commercial |
$656.26
|
|
|
SCREW CORT 3.5 X 14MM TI AR-8735-14
|
Facility
|
OP
|
$886.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599753
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$248.08 |
| Max. Negotiated Rate |
$3,544.00 |
| Rate for Payer: Aetna Commercial |
$797.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$761.96
|
| Rate for Payer: Aetna Managed Medicare |
$248.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$575.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$443.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$425.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$469.58
|
| Rate for Payer: Cash Price |
$265.80
|
| Rate for Payer: Cigna Commercial |
$815.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$495.81
|
| Rate for Payer: Health EOS Commercial |
$788.54
|
| Rate for Payer: HFN Commercial |
$815.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$664.50
|
| Rate for Payer: Multiplan Commercial |
$708.80
|
| Rate for Payer: NAPHCARE Commercial |
$531.60
|
| Rate for Payer: Preferred Network Access Commercial |
$815.12
|
| Rate for Payer: Quartz Beloit One Network |
$434.14
|
| Rate for Payer: Quartz Commercial |
$575.90
|
| Rate for Payer: Quartz Medicare Advantage |
$531.60
|
| Rate for Payer: The Alliance Commercial |
$3,544.00
|
| Rate for Payer: WEA Trust Commercial |
$487.30
|
| Rate for Payer: WPS Commercial |
$656.26
|
|
|
SCREW CORT 3.5 X 14 STARDRIVE 02.200.014
|
Facility
|
OP
|
$404.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4047411
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$113.12 |
| Max. Negotiated Rate |
$1,616.00 |
| Rate for Payer: Aetna Commercial |
$363.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$347.44
|
| Rate for Payer: Aetna Managed Medicare |
$113.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$262.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$202.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$193.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$214.12
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cigna Commercial |
$371.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$226.08
|
| Rate for Payer: Health EOS Commercial |
$359.56
|
| Rate for Payer: HFN Commercial |
$371.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$303.00
|
| Rate for Payer: Multiplan Commercial |
$323.20
|
| Rate for Payer: NAPHCARE Commercial |
$242.40
|
| Rate for Payer: Preferred Network Access Commercial |
$371.68
|
| Rate for Payer: Quartz Beloit One Network |
$197.96
|
| Rate for Payer: Quartz Commercial |
$262.60
|
| Rate for Payer: Quartz Medicare Advantage |
$242.40
|
| Rate for Payer: The Alliance Commercial |
$1,616.00
|
| Rate for Payer: WEA Trust Commercial |
$222.20
|
| Rate for Payer: WPS Commercial |
$299.24
|
|
|
SCREW CORT 3.5 X 14 STARDRIVE 02.200.014
|
Facility
|
IP
|
$404.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4047411
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$197.96 |
| Max. Negotiated Rate |
$371.68 |
| Rate for Payer: Aetna Commercial |
$363.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$347.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$214.12
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cigna Commercial |
$371.68
|
| Rate for Payer: Health EOS Commercial |
$359.56
|
| Rate for Payer: HFN Commercial |
$371.68
|
| Rate for Payer: Multiplan Commercial |
$323.20
|
| Rate for Payer: NAPHCARE Commercial |
$242.40
|
| Rate for Payer: Preferred Network Access Commercial |
$371.68
|
| Rate for Payer: Quartz Beloit One Network |
$197.96
|
| Rate for Payer: Quartz Commercial |
$242.40
|
| Rate for Payer: WEA Trust Commercial |
$222.20
|
| Rate for Payer: WPS Commercial |
$299.24
|
|
|
SCREW-CORT 3.5 X 16 204.216
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966861
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$55.37 |
| Max. Negotiated Rate |
$103.96 |
| Rate for Payer: Aetna Commercial |
$101.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$97.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$59.89
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cigna Commercial |
$103.96
|
| Rate for Payer: Health EOS Commercial |
$100.57
|
| Rate for Payer: HFN Commercial |
$103.96
|
| Rate for Payer: Multiplan Commercial |
$90.40
|
| Rate for Payer: NAPHCARE Commercial |
$67.80
|
| Rate for Payer: Preferred Network Access Commercial |
$103.96
|
| Rate for Payer: Quartz Beloit One Network |
$55.37
|
| Rate for Payer: Quartz Commercial |
$67.80
|
| Rate for Payer: WEA Trust Commercial |
$62.15
|
| Rate for Payer: WPS Commercial |
$83.70
|
|
|
SCREW-CORT 3.5 X 16 204.216
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966861
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$31.64 |
| Max. Negotiated Rate |
$452.00 |
| Rate for Payer: Aetna Commercial |
$101.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$97.18
|
| Rate for Payer: Aetna Managed Medicare |
$31.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$73.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$56.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$54.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$59.89
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cigna Commercial |
$103.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$63.23
|
| Rate for Payer: Health EOS Commercial |
$100.57
|
| Rate for Payer: HFN Commercial |
$103.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$84.75
|
| Rate for Payer: Multiplan Commercial |
$90.40
|
| Rate for Payer: NAPHCARE Commercial |
$67.80
|
| Rate for Payer: Preferred Network Access Commercial |
$103.96
|
| Rate for Payer: Quartz Beloit One Network |
$55.37
|
| Rate for Payer: Quartz Commercial |
$73.45
|
| Rate for Payer: Quartz Medicare Advantage |
$67.80
|
| Rate for Payer: The Alliance Commercial |
$452.00
|
| Rate for Payer: WEA Trust Commercial |
$62.15
|
| Rate for Payer: WPS Commercial |
$83.70
|
|
|
SCREW CORT 3.5 X 16 204.816
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966877
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$34.72 |
| Max. Negotiated Rate |
$496.00 |
| Rate for Payer: Aetna Commercial |
$111.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$106.64
|
| Rate for Payer: Aetna Managed Medicare |
$34.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$80.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$62.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$59.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.72
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cigna Commercial |
$114.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$69.39
|
| Rate for Payer: Health EOS Commercial |
$110.36
|
| Rate for Payer: HFN Commercial |
$114.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$93.00
|
| Rate for Payer: Multiplan Commercial |
$99.20
|
| Rate for Payer: NAPHCARE Commercial |
$74.40
|
| Rate for Payer: Preferred Network Access Commercial |
$114.08
|
| Rate for Payer: Quartz Beloit One Network |
$60.76
|
| Rate for Payer: Quartz Commercial |
$80.60
|
| Rate for Payer: Quartz Medicare Advantage |
$74.40
|
| Rate for Payer: The Alliance Commercial |
$496.00
|
| Rate for Payer: WEA Trust Commercial |
$68.20
|
| Rate for Payer: WPS Commercial |
$91.85
|
|
|
SCREW CORT 3.5 X 16 204.816
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966877
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.76 |
| Max. Negotiated Rate |
$114.08 |
| Rate for Payer: Aetna Commercial |
$111.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$106.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.72
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cigna Commercial |
$114.08
|
| Rate for Payer: Health EOS Commercial |
$110.36
|
| Rate for Payer: HFN Commercial |
$114.08
|
| Rate for Payer: Multiplan Commercial |
$99.20
|
| Rate for Payer: NAPHCARE Commercial |
$74.40
|
| Rate for Payer: Preferred Network Access Commercial |
$114.08
|
| Rate for Payer: Quartz Beloit One Network |
$60.76
|
| Rate for Payer: Quartz Commercial |
$74.40
|
| Rate for Payer: WEA Trust Commercial |
$68.20
|
| Rate for Payer: WPS Commercial |
$91.85
|
|
|
SCREW CORT 3.5 X 16MM LP AR-8835-16
|
Facility
|
OP
|
$652.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5306833
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$182.56 |
| Max. Negotiated Rate |
$2,608.00 |
| Rate for Payer: Aetna Commercial |
$586.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$560.72
|
| Rate for Payer: Aetna Managed Medicare |
$182.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$423.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$326.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$312.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$345.56
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cigna Commercial |
$599.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$364.86
|
| Rate for Payer: Health EOS Commercial |
$580.28
|
| Rate for Payer: HFN Commercial |
$599.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$489.00
|
| Rate for Payer: Multiplan Commercial |
$521.60
|
| Rate for Payer: NAPHCARE Commercial |
$391.20
|
| Rate for Payer: Preferred Network Access Commercial |
$599.84
|
| Rate for Payer: Quartz Beloit One Network |
$319.48
|
| Rate for Payer: Quartz Commercial |
$423.80
|
| Rate for Payer: Quartz Medicare Advantage |
$391.20
|
| Rate for Payer: The Alliance Commercial |
$2,608.00
|
| Rate for Payer: WEA Trust Commercial |
$358.60
|
| Rate for Payer: WPS Commercial |
$482.94
|
|
|
SCREW CORT 3.5 X 16MM LP AR-8835-16
|
Facility
|
IP
|
$652.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5306833
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$319.48 |
| Max. Negotiated Rate |
$599.84 |
| Rate for Payer: Aetna Commercial |
$586.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$560.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$345.56
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cigna Commercial |
$599.84
|
| Rate for Payer: Health EOS Commercial |
$580.28
|
| Rate for Payer: HFN Commercial |
$599.84
|
| Rate for Payer: Multiplan Commercial |
$521.60
|
| Rate for Payer: NAPHCARE Commercial |
$391.20
|
| Rate for Payer: Preferred Network Access Commercial |
$599.84
|
| Rate for Payer: Quartz Beloit One Network |
$319.48
|
| Rate for Payer: Quartz Commercial |
$391.20
|
| Rate for Payer: WEA Trust Commercial |
$358.60
|
| Rate for Payer: WPS Commercial |
$482.94
|
|
|
SCREW CORT 3.5 X 16MM LP TI AR-8935-16
|
Facility
|
IP
|
$921.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414666
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$451.29 |
| Max. Negotiated Rate |
$847.32 |
| Rate for Payer: Aetna Commercial |
$828.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$792.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$488.13
|
| Rate for Payer: Cash Price |
$276.30
|
| Rate for Payer: Cigna Commercial |
$847.32
|
| Rate for Payer: Health EOS Commercial |
$819.69
|
| Rate for Payer: HFN Commercial |
$847.32
|
| Rate for Payer: Multiplan Commercial |
$736.80
|
| Rate for Payer: NAPHCARE Commercial |
$552.60
|
| Rate for Payer: Preferred Network Access Commercial |
$847.32
|
| Rate for Payer: Quartz Beloit One Network |
$451.29
|
| Rate for Payer: Quartz Commercial |
$552.60
|
| Rate for Payer: WEA Trust Commercial |
$506.55
|
| Rate for Payer: WPS Commercial |
$682.18
|
|
|
SCREW CORT 3.5 X 16MM LP TI AR-8935-16
|
Facility
|
OP
|
$921.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414666
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$257.88 |
| Max. Negotiated Rate |
$3,684.00 |
| Rate for Payer: Aetna Commercial |
$828.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$792.06
|
| Rate for Payer: Aetna Managed Medicare |
$257.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$598.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$460.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$442.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$488.13
|
| Rate for Payer: Cash Price |
$276.30
|
| Rate for Payer: Cigna Commercial |
$847.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$515.39
|
| Rate for Payer: Health EOS Commercial |
$819.69
|
| Rate for Payer: HFN Commercial |
$847.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$690.75
|
| Rate for Payer: Multiplan Commercial |
$736.80
|
| Rate for Payer: NAPHCARE Commercial |
$552.60
|
| Rate for Payer: Preferred Network Access Commercial |
$847.32
|
| Rate for Payer: Quartz Beloit One Network |
$451.29
|
| Rate for Payer: Quartz Commercial |
$598.65
|
| Rate for Payer: Quartz Medicare Advantage |
$552.60
|
| Rate for Payer: The Alliance Commercial |
$3,684.00
|
| Rate for Payer: WEA Trust Commercial |
$506.55
|
| Rate for Payer: WPS Commercial |
$682.18
|
|
|
SCREW CORT 3.5 X 16MM TI AR-8735-16
|
Facility
|
OP
|
$886.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5659670
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$248.08 |
| Max. Negotiated Rate |
$3,544.00 |
| Rate for Payer: Aetna Commercial |
$797.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$761.96
|
| Rate for Payer: Aetna Managed Medicare |
$248.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$575.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$443.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$425.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$469.58
|
| Rate for Payer: Cash Price |
$265.80
|
| Rate for Payer: Cigna Commercial |
$815.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$495.81
|
| Rate for Payer: Health EOS Commercial |
$788.54
|
| Rate for Payer: HFN Commercial |
$815.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$664.50
|
| Rate for Payer: Multiplan Commercial |
$708.80
|
| Rate for Payer: NAPHCARE Commercial |
$531.60
|
| Rate for Payer: Preferred Network Access Commercial |
$815.12
|
| Rate for Payer: Quartz Beloit One Network |
$434.14
|
| Rate for Payer: Quartz Commercial |
$575.90
|
| Rate for Payer: Quartz Medicare Advantage |
$531.60
|
| Rate for Payer: The Alliance Commercial |
$3,544.00
|
| Rate for Payer: WEA Trust Commercial |
$487.30
|
| Rate for Payer: WPS Commercial |
$656.26
|
|
|
SCREW CORT 3.5 X 16MM TI AR-8735-16
|
Facility
|
IP
|
$886.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5659670
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$434.14 |
| Max. Negotiated Rate |
$815.12 |
| Rate for Payer: Aetna Commercial |
$797.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$761.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$469.58
|
| Rate for Payer: Cash Price |
$265.80
|
| Rate for Payer: Cigna Commercial |
$815.12
|
| Rate for Payer: Health EOS Commercial |
$788.54
|
| Rate for Payer: HFN Commercial |
$815.12
|
| Rate for Payer: Multiplan Commercial |
$708.80
|
| Rate for Payer: NAPHCARE Commercial |
$531.60
|
| Rate for Payer: Preferred Network Access Commercial |
$815.12
|
| Rate for Payer: Quartz Beloit One Network |
$434.14
|
| Rate for Payer: Quartz Commercial |
$531.60
|
| Rate for Payer: WEA Trust Commercial |
$487.30
|
| Rate for Payer: WPS Commercial |
$656.26
|
|
|
SCREW CORT 3.5 X 16 STARDRIVE 02.200.016
|
Facility
|
OP
|
$404.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4040820
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$113.12 |
| Max. Negotiated Rate |
$1,616.00 |
| Rate for Payer: Aetna Commercial |
$363.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$347.44
|
| Rate for Payer: Aetna Managed Medicare |
$113.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$262.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$202.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$193.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$214.12
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cigna Commercial |
$371.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$226.08
|
| Rate for Payer: Health EOS Commercial |
$359.56
|
| Rate for Payer: HFN Commercial |
$371.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$303.00
|
| Rate for Payer: Multiplan Commercial |
$323.20
|
| Rate for Payer: NAPHCARE Commercial |
$242.40
|
| Rate for Payer: Preferred Network Access Commercial |
$371.68
|
| Rate for Payer: Quartz Beloit One Network |
$197.96
|
| Rate for Payer: Quartz Commercial |
$262.60
|
| Rate for Payer: Quartz Medicare Advantage |
$242.40
|
| Rate for Payer: The Alliance Commercial |
$1,616.00
|
| Rate for Payer: WEA Trust Commercial |
$222.20
|
| Rate for Payer: WPS Commercial |
$299.24
|
|
|
SCREW CORT 3.5 X 16 STARDRIVE 02.200.016
|
Facility
|
IP
|
$404.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4040820
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$197.96 |
| Max. Negotiated Rate |
$371.68 |
| Rate for Payer: Aetna Commercial |
$363.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$347.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$214.12
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cigna Commercial |
$371.68
|
| Rate for Payer: Health EOS Commercial |
$359.56
|
| Rate for Payer: HFN Commercial |
$371.68
|
| Rate for Payer: Multiplan Commercial |
$323.20
|
| Rate for Payer: NAPHCARE Commercial |
$242.40
|
| Rate for Payer: Preferred Network Access Commercial |
$371.68
|
| Rate for Payer: Quartz Beloit One Network |
$197.96
|
| Rate for Payer: Quartz Commercial |
$242.40
|
| Rate for Payer: WEA Trust Commercial |
$222.20
|
| Rate for Payer: WPS Commercial |
$299.24
|
|
|
SCREW-CORT 3.5 X 18 204.218
|
Facility
|
OP
|
$179.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967281
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$50.12 |
| Max. Negotiated Rate |
$716.00 |
| Rate for Payer: Aetna Commercial |
$161.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$153.94
|
| Rate for Payer: Aetna Managed Medicare |
$50.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$116.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$89.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$85.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$94.87
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cigna Commercial |
$164.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$100.17
|
| Rate for Payer: Health EOS Commercial |
$159.31
|
| Rate for Payer: HFN Commercial |
$164.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$134.25
|
| Rate for Payer: Multiplan Commercial |
$143.20
|
| Rate for Payer: NAPHCARE Commercial |
$107.40
|
| Rate for Payer: Preferred Network Access Commercial |
$164.68
|
| Rate for Payer: Quartz Beloit One Network |
$87.71
|
| Rate for Payer: Quartz Commercial |
$116.35
|
| Rate for Payer: Quartz Medicare Advantage |
$107.40
|
| Rate for Payer: The Alliance Commercial |
$716.00
|
| Rate for Payer: WEA Trust Commercial |
$98.45
|
| Rate for Payer: WPS Commercial |
$132.59
|
|
|
SCREW-CORT 3.5 X 18 204.218
|
Facility
|
IP
|
$179.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967281
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$87.71 |
| Max. Negotiated Rate |
$164.68 |
| Rate for Payer: Aetna Commercial |
$161.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$153.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$94.87
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cigna Commercial |
$164.68
|
| Rate for Payer: Health EOS Commercial |
$159.31
|
| Rate for Payer: HFN Commercial |
$164.68
|
| Rate for Payer: Multiplan Commercial |
$143.20
|
| Rate for Payer: NAPHCARE Commercial |
$107.40
|
| Rate for Payer: Preferred Network Access Commercial |
$164.68
|
| Rate for Payer: Quartz Beloit One Network |
$87.71
|
| Rate for Payer: Quartz Commercial |
$107.40
|
| Rate for Payer: WEA Trust Commercial |
$98.45
|
| Rate for Payer: WPS Commercial |
$132.59
|
|
|
SCREW CORT 3.5 X 18 204.818
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966879
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.76 |
| Max. Negotiated Rate |
$114.08 |
| Rate for Payer: Aetna Commercial |
$111.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$106.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.72
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cigna Commercial |
$114.08
|
| Rate for Payer: Health EOS Commercial |
$110.36
|
| Rate for Payer: HFN Commercial |
$114.08
|
| Rate for Payer: Multiplan Commercial |
$99.20
|
| Rate for Payer: NAPHCARE Commercial |
$74.40
|
| Rate for Payer: Preferred Network Access Commercial |
$114.08
|
| Rate for Payer: Quartz Beloit One Network |
$60.76
|
| Rate for Payer: Quartz Commercial |
$74.40
|
| Rate for Payer: WEA Trust Commercial |
$68.20
|
| Rate for Payer: WPS Commercial |
$91.85
|
|
|
SCREW CORT 3.5 X 18 204.818
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966879
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$34.72 |
| Max. Negotiated Rate |
$496.00 |
| Rate for Payer: Aetna Commercial |
$111.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$106.64
|
| Rate for Payer: Aetna Managed Medicare |
$34.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$80.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$62.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$59.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.72
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cigna Commercial |
$114.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$69.39
|
| Rate for Payer: Health EOS Commercial |
$110.36
|
| Rate for Payer: HFN Commercial |
$114.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$93.00
|
| Rate for Payer: Multiplan Commercial |
$99.20
|
| Rate for Payer: NAPHCARE Commercial |
$74.40
|
| Rate for Payer: Preferred Network Access Commercial |
$114.08
|
| Rate for Payer: Quartz Beloit One Network |
$60.76
|
| Rate for Payer: Quartz Commercial |
$80.60
|
| Rate for Payer: Quartz Medicare Advantage |
$74.40
|
| Rate for Payer: The Alliance Commercial |
$496.00
|
| Rate for Payer: WEA Trust Commercial |
$68.20
|
| Rate for Payer: WPS Commercial |
$91.85
|
|
|
SCREW CORT 3.5 X 18 LOW PROFILE 02.206.218
|
Facility
|
IP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3984838
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$254.31 |
| Max. Negotiated Rate |
$477.48 |
| Rate for Payer: Aetna Commercial |
$467.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$446.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$275.07
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna Commercial |
$477.48
|
| Rate for Payer: Health EOS Commercial |
$461.91
|
| Rate for Payer: HFN Commercial |
$477.48
|
| Rate for Payer: Multiplan Commercial |
$415.20
|
| Rate for Payer: NAPHCARE Commercial |
$311.40
|
| Rate for Payer: Preferred Network Access Commercial |
$477.48
|
| Rate for Payer: Quartz Beloit One Network |
$254.31
|
| Rate for Payer: Quartz Commercial |
$311.40
|
| Rate for Payer: WEA Trust Commercial |
$285.45
|
| Rate for Payer: WPS Commercial |
$384.42
|
|
|
SCREW CORT 3.5 X 18 LOW PROFILE 02.206.218
|
Facility
|
OP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3984838
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$145.32 |
| Max. Negotiated Rate |
$2,076.00 |
| Rate for Payer: Aetna Commercial |
$467.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$446.34
|
| Rate for Payer: Aetna Managed Medicare |
$145.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$337.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$259.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$249.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$275.07
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna Commercial |
$477.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$290.43
|
| Rate for Payer: Health EOS Commercial |
$461.91
|
| Rate for Payer: HFN Commercial |
$477.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$389.25
|
| Rate for Payer: Multiplan Commercial |
$415.20
|
| Rate for Payer: NAPHCARE Commercial |
$311.40
|
| Rate for Payer: Preferred Network Access Commercial |
$477.48
|
| Rate for Payer: Quartz Beloit One Network |
$254.31
|
| Rate for Payer: Quartz Commercial |
$337.35
|
| Rate for Payer: Quartz Medicare Advantage |
$311.40
|
| Rate for Payer: The Alliance Commercial |
$2,076.00
|
| Rate for Payer: WEA Trust Commercial |
$285.45
|
| Rate for Payer: WPS Commercial |
$384.42
|
|
