|
SCREW CORT 4.5 X 58MM 340658
|
Facility
|
OP
|
$464.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3805541
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$135.12 |
| Max. Negotiated Rate |
$443.96 |
| Rate for Payer: Aetna Commercial |
$434.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$415.00
|
| Rate for Payer: Aetna Managed Medicare |
$135.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$313.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$241.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$231.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$255.76
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cigna Commercial |
$443.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$270.05
|
| Rate for Payer: Health EOS Commercial |
$429.48
|
| Rate for Payer: HFN Commercial |
$443.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$361.92
|
| Rate for Payer: Multiplan Commercial |
$386.05
|
| Rate for Payer: NAPHCARE Commercial |
$289.54
|
| Rate for Payer: Preferred Network Access Commercial |
$443.96
|
| Rate for Payer: Quartz Beloit One Network |
$236.45
|
| Rate for Payer: Quartz Commercial |
$313.66
|
| Rate for Payer: Quartz Medicare Advantage |
$289.54
|
| Rate for Payer: The Alliance Commercial |
$241.28
|
| Rate for Payer: WEA Trust Commercial |
$265.41
|
| Rate for Payer: WPS Commercial |
$357.42
|
|
|
SCREW CORT 4.5 X 58MM 340658
|
Facility
|
IP
|
$464.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3805541
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$236.45 |
| Max. Negotiated Rate |
$443.96 |
| Rate for Payer: Aetna Commercial |
$434.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$415.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$255.76
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cigna Commercial |
$443.96
|
| Rate for Payer: Health EOS Commercial |
$429.48
|
| Rate for Payer: HFN Commercial |
$443.96
|
| Rate for Payer: Multiplan Commercial |
$386.05
|
| Rate for Payer: Preferred Network Access Commercial |
$443.96
|
| Rate for Payer: Quartz Beloit One Network |
$236.45
|
| Rate for Payer: Quartz Commercial |
$289.54
|
| Rate for Payer: WEA Trust Commercial |
$265.41
|
| Rate for Payer: WPS Commercial |
$357.42
|
|
|
SCREW CORT 4.5 X 60 214.860
|
Facility
|
IP
|
$466.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966943
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$237.47 |
| Max. Negotiated Rate |
$445.87 |
| Rate for Payer: Aetna Commercial |
$436.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$416.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$256.86
|
| Rate for Payer: Cash Price |
$139.80
|
| Rate for Payer: Cigna Commercial |
$445.87
|
| Rate for Payer: Health EOS Commercial |
$431.33
|
| Rate for Payer: HFN Commercial |
$445.87
|
| Rate for Payer: Multiplan Commercial |
$387.71
|
| Rate for Payer: Preferred Network Access Commercial |
$445.87
|
| Rate for Payer: Quartz Beloit One Network |
$237.47
|
| Rate for Payer: Quartz Commercial |
$290.78
|
| Rate for Payer: WEA Trust Commercial |
$266.55
|
| Rate for Payer: WPS Commercial |
$358.96
|
|
|
SCREW CORT 4.5 X 60 214.860
|
Facility
|
OP
|
$466.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966943
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$135.70 |
| Max. Negotiated Rate |
$445.87 |
| Rate for Payer: Aetna Commercial |
$436.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$416.79
|
| Rate for Payer: Aetna Managed Medicare |
$135.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$315.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$242.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$232.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$256.86
|
| Rate for Payer: Cash Price |
$139.80
|
| Rate for Payer: Cigna Commercial |
$445.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$271.21
|
| Rate for Payer: Health EOS Commercial |
$431.33
|
| Rate for Payer: HFN Commercial |
$445.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$363.48
|
| Rate for Payer: Multiplan Commercial |
$387.71
|
| Rate for Payer: NAPHCARE Commercial |
$290.78
|
| Rate for Payer: Preferred Network Access Commercial |
$445.87
|
| Rate for Payer: Quartz Beloit One Network |
$237.47
|
| Rate for Payer: Quartz Commercial |
$315.02
|
| Rate for Payer: Quartz Medicare Advantage |
$290.78
|
| Rate for Payer: The Alliance Commercial |
$242.32
|
| Rate for Payer: WEA Trust Commercial |
$266.55
|
| Rate for Payer: WPS Commercial |
$358.96
|
|
|
SCREW CORT 4.5 X 62 214.862
|
Facility
|
OP
|
$484.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966944
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.94 |
| Max. Negotiated Rate |
$463.09 |
| Rate for Payer: Aetna Commercial |
$453.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$432.89
|
| Rate for Payer: Aetna Managed Medicare |
$140.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$327.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$251.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$241.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$266.78
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$463.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$281.69
|
| Rate for Payer: Health EOS Commercial |
$447.99
|
| Rate for Payer: HFN Commercial |
$463.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$377.52
|
| Rate for Payer: Multiplan Commercial |
$402.69
|
| Rate for Payer: NAPHCARE Commercial |
$302.02
|
| Rate for Payer: Preferred Network Access Commercial |
$463.09
|
| Rate for Payer: Quartz Beloit One Network |
$246.65
|
| Rate for Payer: Quartz Commercial |
$327.18
|
| Rate for Payer: Quartz Medicare Advantage |
$302.02
|
| Rate for Payer: The Alliance Commercial |
$251.68
|
| Rate for Payer: WEA Trust Commercial |
$276.85
|
| Rate for Payer: WPS Commercial |
$372.83
|
|
|
SCREW CORT 4.5 X 62 214.862
|
Facility
|
IP
|
$484.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966944
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$246.65 |
| Max. Negotiated Rate |
$463.09 |
| Rate for Payer: Aetna Commercial |
$453.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$432.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$266.78
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$463.09
|
| Rate for Payer: Health EOS Commercial |
$447.99
|
| Rate for Payer: HFN Commercial |
$463.09
|
| Rate for Payer: Multiplan Commercial |
$402.69
|
| Rate for Payer: Preferred Network Access Commercial |
$463.09
|
| Rate for Payer: Quartz Beloit One Network |
$246.65
|
| Rate for Payer: Quartz Commercial |
$302.02
|
| Rate for Payer: WEA Trust Commercial |
$276.85
|
| Rate for Payer: WPS Commercial |
$372.83
|
|
|
SCREW CORT 4.5 X 64 214.864
|
Facility
|
IP
|
$466.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966945
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$237.47 |
| Max. Negotiated Rate |
$445.87 |
| Rate for Payer: Aetna Commercial |
$436.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$416.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$256.86
|
| Rate for Payer: Cash Price |
$139.80
|
| Rate for Payer: Cigna Commercial |
$445.87
|
| Rate for Payer: Health EOS Commercial |
$431.33
|
| Rate for Payer: HFN Commercial |
$445.87
|
| Rate for Payer: Multiplan Commercial |
$387.71
|
| Rate for Payer: Preferred Network Access Commercial |
$445.87
|
| Rate for Payer: Quartz Beloit One Network |
$237.47
|
| Rate for Payer: Quartz Commercial |
$290.78
|
| Rate for Payer: WEA Trust Commercial |
$266.55
|
| Rate for Payer: WPS Commercial |
$358.96
|
|
|
SCREW CORT 4.5 X 64 214.864
|
Facility
|
OP
|
$466.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966945
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$135.70 |
| Max. Negotiated Rate |
$445.87 |
| Rate for Payer: Aetna Commercial |
$436.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$416.79
|
| Rate for Payer: Aetna Managed Medicare |
$135.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$315.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$242.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$232.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$256.86
|
| Rate for Payer: Cash Price |
$139.80
|
| Rate for Payer: Cigna Commercial |
$445.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$271.21
|
| Rate for Payer: Health EOS Commercial |
$431.33
|
| Rate for Payer: HFN Commercial |
$445.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$363.48
|
| Rate for Payer: Multiplan Commercial |
$387.71
|
| Rate for Payer: NAPHCARE Commercial |
$290.78
|
| Rate for Payer: Preferred Network Access Commercial |
$445.87
|
| Rate for Payer: Quartz Beloit One Network |
$237.47
|
| Rate for Payer: Quartz Commercial |
$315.02
|
| Rate for Payer: Quartz Medicare Advantage |
$290.78
|
| Rate for Payer: The Alliance Commercial |
$242.32
|
| Rate for Payer: WEA Trust Commercial |
$266.55
|
| Rate for Payer: WPS Commercial |
$358.96
|
|
|
SCREW CORT 4.5 X 66 214.866
|
Facility
|
OP
|
$466.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966946
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$135.70 |
| Max. Negotiated Rate |
$445.87 |
| Rate for Payer: Aetna Commercial |
$436.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$416.79
|
| Rate for Payer: Aetna Managed Medicare |
$135.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$315.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$242.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$232.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$256.86
|
| Rate for Payer: Cash Price |
$139.80
|
| Rate for Payer: Cigna Commercial |
$445.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$271.21
|
| Rate for Payer: Health EOS Commercial |
$431.33
|
| Rate for Payer: HFN Commercial |
$445.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$363.48
|
| Rate for Payer: Multiplan Commercial |
$387.71
|
| Rate for Payer: NAPHCARE Commercial |
$290.78
|
| Rate for Payer: Preferred Network Access Commercial |
$445.87
|
| Rate for Payer: Quartz Beloit One Network |
$237.47
|
| Rate for Payer: Quartz Commercial |
$315.02
|
| Rate for Payer: Quartz Medicare Advantage |
$290.78
|
| Rate for Payer: The Alliance Commercial |
$242.32
|
| Rate for Payer: WEA Trust Commercial |
$266.55
|
| Rate for Payer: WPS Commercial |
$358.96
|
|
|
SCREW CORT 4.5 X 66 214.866
|
Facility
|
IP
|
$466.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966946
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$237.47 |
| Max. Negotiated Rate |
$445.87 |
| Rate for Payer: Aetna Commercial |
$436.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$416.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$256.86
|
| Rate for Payer: Cash Price |
$139.80
|
| Rate for Payer: Cigna Commercial |
$445.87
|
| Rate for Payer: Health EOS Commercial |
$431.33
|
| Rate for Payer: HFN Commercial |
$445.87
|
| Rate for Payer: Multiplan Commercial |
$387.71
|
| Rate for Payer: Preferred Network Access Commercial |
$445.87
|
| Rate for Payer: Quartz Beloit One Network |
$237.47
|
| Rate for Payer: Quartz Commercial |
$290.78
|
| Rate for Payer: WEA Trust Commercial |
$266.55
|
| Rate for Payer: WPS Commercial |
$358.96
|
|
|
SCREW CORT 4.5 X 68 214.868
|
Facility
|
OP
|
$466.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966947
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$135.70 |
| Max. Negotiated Rate |
$445.87 |
| Rate for Payer: Aetna Commercial |
$436.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$416.79
|
| Rate for Payer: Aetna Managed Medicare |
$135.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$315.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$242.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$232.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$256.86
|
| Rate for Payer: Cash Price |
$139.80
|
| Rate for Payer: Cigna Commercial |
$445.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$271.21
|
| Rate for Payer: Health EOS Commercial |
$431.33
|
| Rate for Payer: HFN Commercial |
$445.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$363.48
|
| Rate for Payer: Multiplan Commercial |
$387.71
|
| Rate for Payer: NAPHCARE Commercial |
$290.78
|
| Rate for Payer: Preferred Network Access Commercial |
$445.87
|
| Rate for Payer: Quartz Beloit One Network |
$237.47
|
| Rate for Payer: Quartz Commercial |
$315.02
|
| Rate for Payer: Quartz Medicare Advantage |
$290.78
|
| Rate for Payer: The Alliance Commercial |
$242.32
|
| Rate for Payer: WEA Trust Commercial |
$266.55
|
| Rate for Payer: WPS Commercial |
$358.96
|
|
|
SCREW CORT 4.5 X 68 214.868
|
Facility
|
IP
|
$466.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966947
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$237.47 |
| Max. Negotiated Rate |
$445.87 |
| Rate for Payer: Aetna Commercial |
$436.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$416.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$256.86
|
| Rate for Payer: Cash Price |
$139.80
|
| Rate for Payer: Cigna Commercial |
$445.87
|
| Rate for Payer: Health EOS Commercial |
$431.33
|
| Rate for Payer: HFN Commercial |
$445.87
|
| Rate for Payer: Multiplan Commercial |
$387.71
|
| Rate for Payer: Preferred Network Access Commercial |
$445.87
|
| Rate for Payer: Quartz Beloit One Network |
$237.47
|
| Rate for Payer: Quartz Commercial |
$290.78
|
| Rate for Payer: WEA Trust Commercial |
$266.55
|
| Rate for Payer: WPS Commercial |
$358.96
|
|
|
SCREW CORT 4.5 X 70 214.870
|
Facility
|
OP
|
$484.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966948
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.94 |
| Max. Negotiated Rate |
$463.09 |
| Rate for Payer: Aetna Commercial |
$453.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$432.89
|
| Rate for Payer: Aetna Managed Medicare |
$140.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$327.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$251.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$241.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$266.78
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$463.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$281.69
|
| Rate for Payer: Health EOS Commercial |
$447.99
|
| Rate for Payer: HFN Commercial |
$463.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$377.52
|
| Rate for Payer: Multiplan Commercial |
$402.69
|
| Rate for Payer: NAPHCARE Commercial |
$302.02
|
| Rate for Payer: Preferred Network Access Commercial |
$463.09
|
| Rate for Payer: Quartz Beloit One Network |
$246.65
|
| Rate for Payer: Quartz Commercial |
$327.18
|
| Rate for Payer: Quartz Medicare Advantage |
$302.02
|
| Rate for Payer: The Alliance Commercial |
$251.68
|
| Rate for Payer: WEA Trust Commercial |
$276.85
|
| Rate for Payer: WPS Commercial |
$372.83
|
|
|
SCREW CORT 4.5 X 70 214.870
|
Facility
|
IP
|
$484.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966948
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$246.65 |
| Max. Negotiated Rate |
$463.09 |
| Rate for Payer: Aetna Commercial |
$453.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$432.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$266.78
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$463.09
|
| Rate for Payer: Health EOS Commercial |
$447.99
|
| Rate for Payer: HFN Commercial |
$463.09
|
| Rate for Payer: Multiplan Commercial |
$402.69
|
| Rate for Payer: Preferred Network Access Commercial |
$463.09
|
| Rate for Payer: Quartz Beloit One Network |
$246.65
|
| Rate for Payer: Quartz Commercial |
$302.02
|
| Rate for Payer: WEA Trust Commercial |
$276.85
|
| Rate for Payer: WPS Commercial |
$372.83
|
|
|
SCREW CORT 4.5 X 70MM 340670
|
Facility
|
OP
|
$464.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5106945
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$135.12 |
| Max. Negotiated Rate |
$443.96 |
| Rate for Payer: Aetna Commercial |
$434.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$415.00
|
| Rate for Payer: Aetna Managed Medicare |
$135.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$313.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$241.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$231.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$255.76
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cigna Commercial |
$443.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$270.05
|
| Rate for Payer: Health EOS Commercial |
$429.48
|
| Rate for Payer: HFN Commercial |
$443.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$361.92
|
| Rate for Payer: Multiplan Commercial |
$386.05
|
| Rate for Payer: NAPHCARE Commercial |
$289.54
|
| Rate for Payer: Preferred Network Access Commercial |
$443.96
|
| Rate for Payer: Quartz Beloit One Network |
$236.45
|
| Rate for Payer: Quartz Commercial |
$313.66
|
| Rate for Payer: Quartz Medicare Advantage |
$289.54
|
| Rate for Payer: The Alliance Commercial |
$241.28
|
| Rate for Payer: WEA Trust Commercial |
$265.41
|
| Rate for Payer: WPS Commercial |
$357.42
|
|
|
SCREW CORT 4.5 X 70MM 340670
|
Facility
|
IP
|
$464.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5106945
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$236.45 |
| Max. Negotiated Rate |
$443.96 |
| Rate for Payer: Aetna Commercial |
$434.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$415.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$255.76
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cigna Commercial |
$443.96
|
| Rate for Payer: Health EOS Commercial |
$429.48
|
| Rate for Payer: HFN Commercial |
$443.96
|
| Rate for Payer: Multiplan Commercial |
$386.05
|
| Rate for Payer: Preferred Network Access Commercial |
$443.96
|
| Rate for Payer: Quartz Beloit One Network |
$236.45
|
| Rate for Payer: Quartz Commercial |
$289.54
|
| Rate for Payer: WEA Trust Commercial |
$265.41
|
| Rate for Payer: WPS Commercial |
$357.42
|
|
|
SCREW CORT 4.5 X 72 214.872
|
Facility
|
OP
|
$373.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459391
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$108.62 |
| Max. Negotiated Rate |
$356.89 |
| Rate for Payer: Aetna Commercial |
$349.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$333.61
|
| Rate for Payer: Aetna Managed Medicare |
$108.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$252.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$193.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$186.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$205.60
|
| Rate for Payer: Cash Price |
$111.90
|
| Rate for Payer: Cigna Commercial |
$356.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$217.09
|
| Rate for Payer: Health EOS Commercial |
$345.25
|
| Rate for Payer: HFN Commercial |
$356.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$290.94
|
| Rate for Payer: Multiplan Commercial |
$310.34
|
| Rate for Payer: NAPHCARE Commercial |
$232.75
|
| Rate for Payer: Preferred Network Access Commercial |
$356.89
|
| Rate for Payer: Quartz Beloit One Network |
$190.08
|
| Rate for Payer: Quartz Commercial |
$252.15
|
| Rate for Payer: Quartz Medicare Advantage |
$232.75
|
| Rate for Payer: The Alliance Commercial |
$193.96
|
| Rate for Payer: WEA Trust Commercial |
$213.36
|
| Rate for Payer: WPS Commercial |
$287.32
|
|
|
SCREW CORT 4.5 X 72 214.872
|
Facility
|
IP
|
$373.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459391
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$190.08 |
| Max. Negotiated Rate |
$356.89 |
| Rate for Payer: Aetna Commercial |
$349.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$333.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$205.60
|
| Rate for Payer: Cash Price |
$111.90
|
| Rate for Payer: Cigna Commercial |
$356.89
|
| Rate for Payer: Health EOS Commercial |
$345.25
|
| Rate for Payer: HFN Commercial |
$356.89
|
| Rate for Payer: Multiplan Commercial |
$310.34
|
| Rate for Payer: Preferred Network Access Commercial |
$356.89
|
| Rate for Payer: Quartz Beloit One Network |
$190.08
|
| Rate for Payer: Quartz Commercial |
$232.75
|
| Rate for Payer: WEA Trust Commercial |
$213.36
|
| Rate for Payer: WPS Commercial |
$287.32
|
|
|
SCREW CORT 4.5 X 76 214.876
|
Facility
|
IP
|
$602.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459393
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$306.78 |
| Max. Negotiated Rate |
$575.99 |
| Rate for Payer: Aetna Commercial |
$563.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$538.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$331.82
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cigna Commercial |
$575.99
|
| Rate for Payer: Health EOS Commercial |
$557.21
|
| Rate for Payer: HFN Commercial |
$575.99
|
| Rate for Payer: Multiplan Commercial |
$500.86
|
| Rate for Payer: Preferred Network Access Commercial |
$575.99
|
| Rate for Payer: Quartz Beloit One Network |
$306.78
|
| Rate for Payer: Quartz Commercial |
$375.65
|
| Rate for Payer: WEA Trust Commercial |
$344.34
|
| Rate for Payer: WPS Commercial |
$463.72
|
|
|
SCREW CORT 4.5 X 76 214.876
|
Facility
|
OP
|
$602.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459393
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$175.30 |
| Max. Negotiated Rate |
$575.99 |
| Rate for Payer: Aetna Commercial |
$563.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$538.43
|
| Rate for Payer: Aetna Managed Medicare |
$175.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$406.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$313.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$300.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$331.82
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cigna Commercial |
$575.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$350.36
|
| Rate for Payer: Health EOS Commercial |
$557.21
|
| Rate for Payer: HFN Commercial |
$575.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$469.56
|
| Rate for Payer: Multiplan Commercial |
$500.86
|
| Rate for Payer: NAPHCARE Commercial |
$375.65
|
| Rate for Payer: Preferred Network Access Commercial |
$575.99
|
| Rate for Payer: Quartz Beloit One Network |
$306.78
|
| Rate for Payer: Quartz Commercial |
$406.95
|
| Rate for Payer: Quartz Medicare Advantage |
$375.65
|
| Rate for Payer: The Alliance Commercial |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$344.34
|
| Rate for Payer: WPS Commercial |
$463.72
|
|
|
SCREW CORT 4.5 X 80 214.880
|
Facility
|
OP
|
$602.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459394
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$175.30 |
| Max. Negotiated Rate |
$575.99 |
| Rate for Payer: Aetna Commercial |
$563.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$538.43
|
| Rate for Payer: Aetna Managed Medicare |
$175.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$406.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$313.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$300.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$331.82
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cigna Commercial |
$575.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$350.36
|
| Rate for Payer: Health EOS Commercial |
$557.21
|
| Rate for Payer: HFN Commercial |
$575.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$469.56
|
| Rate for Payer: Multiplan Commercial |
$500.86
|
| Rate for Payer: NAPHCARE Commercial |
$375.65
|
| Rate for Payer: Preferred Network Access Commercial |
$575.99
|
| Rate for Payer: Quartz Beloit One Network |
$306.78
|
| Rate for Payer: Quartz Commercial |
$406.95
|
| Rate for Payer: Quartz Medicare Advantage |
$375.65
|
| Rate for Payer: The Alliance Commercial |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$344.34
|
| Rate for Payer: WPS Commercial |
$463.72
|
|
|
SCREW CORT 4.5 X 80 214.880
|
Facility
|
IP
|
$602.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459394
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$306.78 |
| Max. Negotiated Rate |
$575.99 |
| Rate for Payer: Aetna Commercial |
$563.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$538.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$331.82
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cigna Commercial |
$575.99
|
| Rate for Payer: Health EOS Commercial |
$557.21
|
| Rate for Payer: HFN Commercial |
$575.99
|
| Rate for Payer: Multiplan Commercial |
$500.86
|
| Rate for Payer: Preferred Network Access Commercial |
$575.99
|
| Rate for Payer: Quartz Beloit One Network |
$306.78
|
| Rate for Payer: Quartz Commercial |
$375.65
|
| Rate for Payer: WEA Trust Commercial |
$344.34
|
| Rate for Payer: WPS Commercial |
$463.72
|
|
|
SCREW CORT 4.5 X 80MM SELF-TAP 661780
|
Facility
|
OP
|
$796.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5458800
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$231.80 |
| Max. Negotiated Rate |
$761.61 |
| Rate for Payer: Aetna Commercial |
$745.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$711.94
|
| Rate for Payer: Aetna Managed Medicare |
$231.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$538.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$413.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$397.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$438.76
|
| Rate for Payer: Cash Price |
$238.80
|
| Rate for Payer: Cigna Commercial |
$761.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$463.27
|
| Rate for Payer: Health EOS Commercial |
$736.78
|
| Rate for Payer: HFN Commercial |
$761.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$620.88
|
| Rate for Payer: Multiplan Commercial |
$662.27
|
| Rate for Payer: NAPHCARE Commercial |
$496.70
|
| Rate for Payer: Preferred Network Access Commercial |
$761.61
|
| Rate for Payer: Quartz Beloit One Network |
$405.64
|
| Rate for Payer: Quartz Commercial |
$538.10
|
| Rate for Payer: Quartz Medicare Advantage |
$496.70
|
| Rate for Payer: The Alliance Commercial |
$413.92
|
| Rate for Payer: WEA Trust Commercial |
$455.31
|
| Rate for Payer: WPS Commercial |
$613.16
|
|
|
SCREW CORT 4.5 X 80MM SELF-TAP 661780
|
Facility
|
IP
|
$796.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5458800
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$405.64 |
| Max. Negotiated Rate |
$761.61 |
| Rate for Payer: Aetna Commercial |
$745.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$711.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$438.76
|
| Rate for Payer: Cash Price |
$238.80
|
| Rate for Payer: Cigna Commercial |
$761.61
|
| Rate for Payer: Health EOS Commercial |
$736.78
|
| Rate for Payer: HFN Commercial |
$761.61
|
| Rate for Payer: Multiplan Commercial |
$662.27
|
| Rate for Payer: Preferred Network Access Commercial |
$761.61
|
| Rate for Payer: Quartz Beloit One Network |
$405.64
|
| Rate for Payer: Quartz Commercial |
$496.70
|
| Rate for Payer: WEA Trust Commercial |
$455.31
|
| Rate for Payer: WPS Commercial |
$613.16
|
|
|
SCREW CORTEX 1.3MM X 10MM 02.130.010
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5206663
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$232.96 |
| Max. Negotiated Rate |
$765.44 |
| Rate for Payer: Aetna Commercial |
$748.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$715.52
|
| Rate for Payer: Aetna Managed Medicare |
$232.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$540.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$416.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$399.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$440.96
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cigna Commercial |
$765.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$465.60
|
| Rate for Payer: Health EOS Commercial |
$740.48
|
| Rate for Payer: HFN Commercial |
$765.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$624.00
|
| Rate for Payer: Multiplan Commercial |
$665.60
|
| Rate for Payer: NAPHCARE Commercial |
$499.20
|
| Rate for Payer: Preferred Network Access Commercial |
$765.44
|
| Rate for Payer: Quartz Beloit One Network |
$407.68
|
| Rate for Payer: Quartz Commercial |
$540.80
|
| Rate for Payer: Quartz Medicare Advantage |
$499.20
|
| Rate for Payer: The Alliance Commercial |
$416.00
|
| Rate for Payer: WEA Trust Commercial |
$457.60
|
| Rate for Payer: WPS Commercial |
$616.24
|
|
