|
SCREW CORT 3.5 X 26 204.826
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966887
|
|
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 26 204.826
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966887
|
|
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 26 ACUMED 30-0264
|
Facility
|
IP
|
$1,644.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4595311
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$805.56 |
| Max. Negotiated Rate |
$1,512.48 |
| Rate for Payer: Aetna Commercial |
$1,479.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,413.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$871.32
|
| Rate for Payer: Cash Price |
$493.20
|
| Rate for Payer: Cigna Commercial |
$1,512.48
|
| Rate for Payer: Health EOS Commercial |
$1,463.16
|
| Rate for Payer: HFN Commercial |
$1,512.48
|
| Rate for Payer: Multiplan Commercial |
$1,315.20
|
| Rate for Payer: NAPHCARE Commercial |
$986.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,512.48
|
| Rate for Payer: Quartz Beloit One Network |
$805.56
|
| Rate for Payer: Quartz Commercial |
$986.40
|
| Rate for Payer: WEA Trust Commercial |
$904.20
|
| Rate for Payer: WPS Commercial |
$1,217.71
|
|
|
SCREW CORT 3.5 X 26 ACUMED 30-0264
|
Facility
|
OP
|
$1,644.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4595311
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$460.32 |
| Max. Negotiated Rate |
$6,576.00 |
| Rate for Payer: Aetna Commercial |
$1,479.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,413.84
|
| Rate for Payer: Aetna Managed Medicare |
$460.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,068.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$822.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$789.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$871.32
|
| Rate for Payer: Cash Price |
$493.20
|
| Rate for Payer: Cigna Commercial |
$1,512.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$919.98
|
| Rate for Payer: Health EOS Commercial |
$1,463.16
|
| Rate for Payer: HFN Commercial |
$1,512.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,233.00
|
| Rate for Payer: Multiplan Commercial |
$1,315.20
|
| Rate for Payer: NAPHCARE Commercial |
$986.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,512.48
|
| Rate for Payer: Quartz Beloit One Network |
$805.56
|
| Rate for Payer: Quartz Commercial |
$1,068.60
|
| Rate for Payer: Quartz Medicare Advantage |
$986.40
|
| Rate for Payer: The Alliance Commercial |
$6,576.00
|
| Rate for Payer: WEA Trust Commercial |
$904.20
|
| Rate for Payer: WPS Commercial |
$1,217.71
|
|
|
SCREW CORT 3.5 X 26MM 338626
|
Facility
|
OP
|
$414.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3901360
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$115.92 |
| Max. Negotiated Rate |
$1,656.00 |
| Rate for Payer: Aetna Commercial |
$372.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$356.04
|
| Rate for Payer: Aetna Managed Medicare |
$115.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$269.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$207.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$198.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$219.42
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cigna Commercial |
$380.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$231.67
|
| Rate for Payer: Health EOS Commercial |
$368.46
|
| Rate for Payer: HFN Commercial |
$380.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$310.50
|
| Rate for Payer: Multiplan Commercial |
$331.20
|
| Rate for Payer: NAPHCARE Commercial |
$248.40
|
| Rate for Payer: Preferred Network Access Commercial |
$380.88
|
| Rate for Payer: Quartz Beloit One Network |
$202.86
|
| Rate for Payer: Quartz Commercial |
$269.10
|
| Rate for Payer: Quartz Medicare Advantage |
$248.40
|
| Rate for Payer: The Alliance Commercial |
$1,656.00
|
| Rate for Payer: WEA Trust Commercial |
$227.70
|
| Rate for Payer: WPS Commercial |
$306.65
|
|
|
SCREW CORT 3.5 X 26MM 338626
|
Facility
|
IP
|
$414.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3901360
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$202.86 |
| Max. Negotiated Rate |
$380.88 |
| Rate for Payer: Aetna Commercial |
$372.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$356.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$219.42
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cigna Commercial |
$380.88
|
| Rate for Payer: Health EOS Commercial |
$368.46
|
| Rate for Payer: HFN Commercial |
$380.88
|
| Rate for Payer: Multiplan Commercial |
$331.20
|
| Rate for Payer: NAPHCARE Commercial |
$248.40
|
| Rate for Payer: Preferred Network Access Commercial |
$380.88
|
| Rate for Payer: Quartz Beloit One Network |
$202.86
|
| Rate for Payer: Quartz Commercial |
$248.40
|
| Rate for Payer: WEA Trust Commercial |
$227.70
|
| Rate for Payer: WPS Commercial |
$306.65
|
|
|
SCREW CORT 3.5 X 26MM LP 02.206.226
|
Facility
|
OP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4317100
|
|
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 26MM LP 02.206.226
|
Facility
|
IP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4317100
|
|
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 26MM LP AR-8835-26
|
Facility
|
OP
|
$627.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5611681
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$175.56 |
| Max. Negotiated Rate |
$2,508.00 |
| Rate for Payer: Aetna Commercial |
$564.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$539.22
|
| Rate for Payer: Aetna Managed Medicare |
$175.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$407.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$313.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$300.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$332.31
|
| Rate for Payer: Cash Price |
$188.10
|
| Rate for Payer: Cigna Commercial |
$576.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$350.87
|
| Rate for Payer: Health EOS Commercial |
$558.03
|
| Rate for Payer: HFN Commercial |
$576.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$470.25
|
| Rate for Payer: Multiplan Commercial |
$501.60
|
| Rate for Payer: NAPHCARE Commercial |
$376.20
|
| Rate for Payer: Preferred Network Access Commercial |
$576.84
|
| Rate for Payer: Quartz Beloit One Network |
$307.23
|
| Rate for Payer: Quartz Commercial |
$407.55
|
| Rate for Payer: Quartz Medicare Advantage |
$376.20
|
| Rate for Payer: The Alliance Commercial |
$2,508.00
|
| Rate for Payer: WEA Trust Commercial |
$344.85
|
| Rate for Payer: WPS Commercial |
$464.42
|
|
|
SCREW CORT 3.5 X 26MM LP AR-8835-26
|
Facility
|
IP
|
$627.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5611681
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$307.23 |
| Max. Negotiated Rate |
$576.84 |
| Rate for Payer: Aetna Commercial |
$564.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$539.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$332.31
|
| Rate for Payer: Cash Price |
$188.10
|
| Rate for Payer: Cigna Commercial |
$576.84
|
| Rate for Payer: Health EOS Commercial |
$558.03
|
| Rate for Payer: HFN Commercial |
$576.84
|
| Rate for Payer: Multiplan Commercial |
$501.60
|
| Rate for Payer: NAPHCARE Commercial |
$376.20
|
| Rate for Payer: Preferred Network Access Commercial |
$576.84
|
| Rate for Payer: Quartz Beloit One Network |
$307.23
|
| Rate for Payer: Quartz Commercial |
$376.20
|
| Rate for Payer: WEA Trust Commercial |
$344.85
|
| Rate for Payer: WPS Commercial |
$464.42
|
|
|
SCREW CORT 3.5 X 26MM ST 661426
|
Facility
|
OP
|
$760.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5520858
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$212.80 |
| Max. Negotiated Rate |
$3,040.00 |
| Rate for Payer: Aetna Commercial |
$684.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$653.60
|
| Rate for Payer: Aetna Managed Medicare |
$212.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$494.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$380.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$364.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$402.80
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cigna Commercial |
$699.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$425.30
|
| Rate for Payer: Health EOS Commercial |
$676.40
|
| Rate for Payer: HFN Commercial |
$699.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$570.00
|
| Rate for Payer: Multiplan Commercial |
$608.00
|
| Rate for Payer: NAPHCARE Commercial |
$456.00
|
| Rate for Payer: Preferred Network Access Commercial |
$699.20
|
| Rate for Payer: Quartz Beloit One Network |
$372.40
|
| Rate for Payer: Quartz Commercial |
$494.00
|
| Rate for Payer: Quartz Medicare Advantage |
$456.00
|
| Rate for Payer: The Alliance Commercial |
$3,040.00
|
| Rate for Payer: WEA Trust Commercial |
$418.00
|
| Rate for Payer: WPS Commercial |
$562.93
|
|
|
SCREW CORT 3.5 X 26MM ST 661426
|
Facility
|
IP
|
$760.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5520858
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$372.40 |
| Max. Negotiated Rate |
$699.20 |
| Rate for Payer: Aetna Commercial |
$684.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$653.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$402.80
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cigna Commercial |
$699.20
|
| Rate for Payer: Health EOS Commercial |
$676.40
|
| Rate for Payer: HFN Commercial |
$699.20
|
| Rate for Payer: Multiplan Commercial |
$608.00
|
| Rate for Payer: NAPHCARE Commercial |
$456.00
|
| Rate for Payer: Preferred Network Access Commercial |
$699.20
|
| Rate for Payer: Quartz Beloit One Network |
$372.40
|
| Rate for Payer: Quartz Commercial |
$456.00
|
| Rate for Payer: WEA Trust Commercial |
$418.00
|
| Rate for Payer: WPS Commercial |
$562.93
|
|
|
SCREW CORT 3.5 X 26 STARDRIVE 02.200.026
|
Facility
|
IP
|
$412.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6174859
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$201.88 |
| Max. Negotiated Rate |
$379.04 |
| Rate for Payer: Aetna Commercial |
$370.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$354.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$218.36
|
| Rate for Payer: Cash Price |
$123.60
|
| Rate for Payer: Cigna Commercial |
$379.04
|
| Rate for Payer: Health EOS Commercial |
$366.68
|
| Rate for Payer: HFN Commercial |
$379.04
|
| Rate for Payer: Multiplan Commercial |
$329.60
|
| Rate for Payer: NAPHCARE Commercial |
$247.20
|
| Rate for Payer: Preferred Network Access Commercial |
$379.04
|
| Rate for Payer: Quartz Beloit One Network |
$201.88
|
| Rate for Payer: Quartz Commercial |
$247.20
|
| Rate for Payer: WEA Trust Commercial |
$226.60
|
| Rate for Payer: WPS Commercial |
$305.17
|
|
|
SCREW CORT 3.5 X 26 STARDRIVE 02.200.026
|
Facility
|
OP
|
$412.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6174859
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$115.36 |
| Max. Negotiated Rate |
$1,648.00 |
| Rate for Payer: Aetna Commercial |
$370.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$354.32
|
| Rate for Payer: Aetna Managed Medicare |
$115.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$267.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$206.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$197.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$218.36
|
| Rate for Payer: Cash Price |
$123.60
|
| Rate for Payer: Cigna Commercial |
$379.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$230.56
|
| Rate for Payer: Health EOS Commercial |
$366.68
|
| Rate for Payer: HFN Commercial |
$379.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$309.00
|
| Rate for Payer: Multiplan Commercial |
$329.60
|
| Rate for Payer: NAPHCARE Commercial |
$247.20
|
| Rate for Payer: Preferred Network Access Commercial |
$379.04
|
| Rate for Payer: Quartz Beloit One Network |
$201.88
|
| Rate for Payer: Quartz Commercial |
$267.80
|
| Rate for Payer: Quartz Medicare Advantage |
$247.20
|
| Rate for Payer: The Alliance Commercial |
$1,648.00
|
| Rate for Payer: WEA Trust Commercial |
$226.60
|
| Rate for Payer: WPS Commercial |
$305.17
|
|
|
SCREW-CORT 3.5 X 28 204.228
|
Facility
|
IP
|
$113.00
|
|
| Hospital Charge Code |
2966865
|
|
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 28 204.228
|
Facility
|
OP
|
$113.00
|
|
| Hospital Charge Code |
2966865
|
|
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 28 204.828
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966889
|
|
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 28 204.828
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966889
|
|
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 28MM 338628
|
Facility
|
OP
|
$414.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3983339
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$115.92 |
| Max. Negotiated Rate |
$1,656.00 |
| Rate for Payer: Aetna Commercial |
$372.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$356.04
|
| Rate for Payer: Aetna Managed Medicare |
$115.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$269.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$207.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$198.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$219.42
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cigna Commercial |
$380.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$231.67
|
| Rate for Payer: Health EOS Commercial |
$368.46
|
| Rate for Payer: HFN Commercial |
$380.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$310.50
|
| Rate for Payer: Multiplan Commercial |
$331.20
|
| Rate for Payer: NAPHCARE Commercial |
$248.40
|
| Rate for Payer: Preferred Network Access Commercial |
$380.88
|
| Rate for Payer: Quartz Beloit One Network |
$202.86
|
| Rate for Payer: Quartz Commercial |
$269.10
|
| Rate for Payer: Quartz Medicare Advantage |
$248.40
|
| Rate for Payer: The Alliance Commercial |
$1,656.00
|
| Rate for Payer: WEA Trust Commercial |
$227.70
|
| Rate for Payer: WPS Commercial |
$306.65
|
|
|
SCREW CORT 3.5 X 28MM 338628
|
Facility
|
IP
|
$414.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3983339
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$202.86 |
| Max. Negotiated Rate |
$380.88 |
| Rate for Payer: Aetna Commercial |
$372.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$356.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$219.42
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cigna Commercial |
$380.88
|
| Rate for Payer: Health EOS Commercial |
$368.46
|
| Rate for Payer: HFN Commercial |
$380.88
|
| Rate for Payer: Multiplan Commercial |
$331.20
|
| Rate for Payer: NAPHCARE Commercial |
$248.40
|
| Rate for Payer: Preferred Network Access Commercial |
$380.88
|
| Rate for Payer: Quartz Beloit One Network |
$202.86
|
| Rate for Payer: Quartz Commercial |
$248.40
|
| Rate for Payer: WEA Trust Commercial |
$227.70
|
| Rate for Payer: WPS Commercial |
$306.65
|
|
|
SCREW CORT 3.5 X 28MM LP AR-8835-28
|
Facility
|
OP
|
$627.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5787661
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$175.56 |
| Max. Negotiated Rate |
$2,508.00 |
| Rate for Payer: Aetna Commercial |
$564.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$539.22
|
| Rate for Payer: Aetna Managed Medicare |
$175.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$407.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$313.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$300.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$332.31
|
| Rate for Payer: Cash Price |
$188.10
|
| Rate for Payer: Cigna Commercial |
$576.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$350.87
|
| Rate for Payer: Health EOS Commercial |
$558.03
|
| Rate for Payer: HFN Commercial |
$576.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$470.25
|
| Rate for Payer: Multiplan Commercial |
$501.60
|
| Rate for Payer: NAPHCARE Commercial |
$376.20
|
| Rate for Payer: Preferred Network Access Commercial |
$576.84
|
| Rate for Payer: Quartz Beloit One Network |
$307.23
|
| Rate for Payer: Quartz Commercial |
$407.55
|
| Rate for Payer: Quartz Medicare Advantage |
$376.20
|
| Rate for Payer: The Alliance Commercial |
$2,508.00
|
| Rate for Payer: WEA Trust Commercial |
$344.85
|
| Rate for Payer: WPS Commercial |
$464.42
|
|
|
SCREW CORT 3.5 X 28MM LP AR-8835-28
|
Facility
|
IP
|
$627.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5787661
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$307.23 |
| Max. Negotiated Rate |
$576.84 |
| Rate for Payer: Aetna Commercial |
$564.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$539.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$332.31
|
| Rate for Payer: Cash Price |
$188.10
|
| Rate for Payer: Cigna Commercial |
$576.84
|
| Rate for Payer: Health EOS Commercial |
$558.03
|
| Rate for Payer: HFN Commercial |
$576.84
|
| Rate for Payer: Multiplan Commercial |
$501.60
|
| Rate for Payer: NAPHCARE Commercial |
$376.20
|
| Rate for Payer: Preferred Network Access Commercial |
$576.84
|
| Rate for Payer: Quartz Beloit One Network |
$307.23
|
| Rate for Payer: Quartz Commercial |
$376.20
|
| Rate for Payer: WEA Trust Commercial |
$344.85
|
| Rate for Payer: WPS Commercial |
$464.42
|
|
|
SCREW CORT 3.5 X 28MM ST 661428
|
Facility
|
IP
|
$731.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5627652
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$358.19 |
| Max. Negotiated Rate |
$672.52 |
| Rate for Payer: Aetna Commercial |
$657.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$628.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$387.43
|
| Rate for Payer: Cash Price |
$219.30
|
| Rate for Payer: Cigna Commercial |
$672.52
|
| Rate for Payer: Health EOS Commercial |
$650.59
|
| Rate for Payer: HFN Commercial |
$672.52
|
| Rate for Payer: Multiplan Commercial |
$584.80
|
| Rate for Payer: NAPHCARE Commercial |
$438.60
|
| Rate for Payer: Preferred Network Access Commercial |
$672.52
|
| Rate for Payer: Quartz Beloit One Network |
$358.19
|
| Rate for Payer: Quartz Commercial |
$438.60
|
| Rate for Payer: WEA Trust Commercial |
$402.05
|
| Rate for Payer: WPS Commercial |
$541.45
|
|
|
SCREW CORT 3.5 X 28MM ST 661428
|
Facility
|
OP
|
$731.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5627652
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$204.68 |
| Max. Negotiated Rate |
$2,924.00 |
| Rate for Payer: Aetna Commercial |
$657.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$628.66
|
| Rate for Payer: Aetna Managed Medicare |
$204.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$475.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$365.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$350.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$387.43
|
| Rate for Payer: Cash Price |
$219.30
|
| Rate for Payer: Cigna Commercial |
$672.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$409.07
|
| Rate for Payer: Health EOS Commercial |
$650.59
|
| Rate for Payer: HFN Commercial |
$672.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$548.25
|
| Rate for Payer: Multiplan Commercial |
$584.80
|
| Rate for Payer: NAPHCARE Commercial |
$438.60
|
| Rate for Payer: Preferred Network Access Commercial |
$672.52
|
| Rate for Payer: Quartz Beloit One Network |
$358.19
|
| Rate for Payer: Quartz Commercial |
$475.15
|
| Rate for Payer: Quartz Medicare Advantage |
$438.60
|
| Rate for Payer: The Alliance Commercial |
$2,924.00
|
| Rate for Payer: WEA Trust Commercial |
$402.05
|
| Rate for Payer: WPS Commercial |
$541.45
|
|
|
SCREW CORT 3.5 X 28 STARDRIVE 02.200.028
|
Facility
|
IP
|
$412.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6174860
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$201.88 |
| Max. Negotiated Rate |
$379.04 |
| Rate for Payer: Aetna Commercial |
$370.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$354.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$218.36
|
| Rate for Payer: Cash Price |
$123.60
|
| Rate for Payer: Cigna Commercial |
$379.04
|
| Rate for Payer: Health EOS Commercial |
$366.68
|
| Rate for Payer: HFN Commercial |
$379.04
|
| Rate for Payer: Multiplan Commercial |
$329.60
|
| Rate for Payer: NAPHCARE Commercial |
$247.20
|
| Rate for Payer: Preferred Network Access Commercial |
$379.04
|
| Rate for Payer: Quartz Beloit One Network |
$201.88
|
| Rate for Payer: Quartz Commercial |
$247.20
|
| Rate for Payer: WEA Trust Commercial |
$226.60
|
| Rate for Payer: WPS Commercial |
$305.17
|
|
