|
SCREW CORT 3.5 X 34MM LP AR-8835-34
|
Facility
|
IP
|
$652.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5563351
|
|
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 34MM LP AR-8835-34
|
Facility
|
OP
|
$652.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5563351
|
|
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 34MM ST 661434
|
Facility
|
IP
|
$760.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5458967
|
|
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 34MM ST 661434
|
Facility
|
OP
|
$760.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5458967
|
|
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 35MM LP AR-8835-35
|
Facility
|
IP
|
$652.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5563352
|
|
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 35MM LP AR-8835-35
|
Facility
|
OP
|
$652.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5563352
|
|
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 36 204.236
|
Facility
|
OP
|
$113.00
|
|
| Hospital Charge Code |
2966869
|
|
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 36 204.236
|
Facility
|
IP
|
$113.00
|
|
| Hospital Charge Code |
2966869
|
|
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 36 204.836
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2990956
|
|
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 36 204.836
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2990956
|
|
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 36MM LP AR-8835-36
|
Facility
|
OP
|
$652.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5603584
|
|
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 36MM LP AR-8835-36
|
Facility
|
IP
|
$652.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5603584
|
|
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 36MM ST 661436
|
Facility
|
OP
|
$731.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5627654
|
|
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 36MM ST 661436
|
Facility
|
IP
|
$731.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5627654
|
|
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 38 204.238
|
Facility
|
OP
|
$113.00
|
|
| Hospital Charge Code |
2966870
|
|
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 38 204.238
|
Facility
|
IP
|
$113.00
|
|
| Hospital Charge Code |
2966870
|
|
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 38 204.838
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2990957
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$33.32 |
| Max. Negotiated Rate |
$476.00 |
| Rate for Payer: Aetna Commercial |
$107.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$102.34
|
| Rate for Payer: Aetna Managed Medicare |
$33.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$77.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$59.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$57.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.07
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: Cigna Commercial |
$109.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66.59
|
| Rate for Payer: Health EOS Commercial |
$105.91
|
| Rate for Payer: HFN Commercial |
$109.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$89.25
|
| Rate for Payer: Multiplan Commercial |
$95.20
|
| Rate for Payer: NAPHCARE Commercial |
$71.40
|
| Rate for Payer: Preferred Network Access Commercial |
$109.48
|
| Rate for Payer: Quartz Beloit One Network |
$58.31
|
| Rate for Payer: Quartz Commercial |
$77.35
|
| Rate for Payer: Quartz Medicare Advantage |
$71.40
|
| Rate for Payer: The Alliance Commercial |
$476.00
|
| Rate for Payer: WEA Trust Commercial |
$65.45
|
| Rate for Payer: WPS Commercial |
$88.14
|
|
|
SCREW-CORT 3.5 X 38 204.838
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2990957
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$58.31 |
| Max. Negotiated Rate |
$109.48 |
| Rate for Payer: Aetna Commercial |
$107.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$102.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.07
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: Cigna Commercial |
$109.48
|
| Rate for Payer: Health EOS Commercial |
$105.91
|
| Rate for Payer: HFN Commercial |
$109.48
|
| Rate for Payer: Multiplan Commercial |
$95.20
|
| Rate for Payer: NAPHCARE Commercial |
$71.40
|
| Rate for Payer: Preferred Network Access Commercial |
$109.48
|
| Rate for Payer: Quartz Beloit One Network |
$58.31
|
| Rate for Payer: Quartz Commercial |
$71.40
|
| Rate for Payer: WEA Trust Commercial |
$65.45
|
| Rate for Payer: WPS Commercial |
$88.14
|
|
|
SCREW CORT 3.5 X 38MM LP 02.206.238
|
Facility
|
IP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4317102
|
|
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 38MM LP 02.206.238
|
Facility
|
OP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4317102
|
|
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 38MM LP AR-8835-38
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6182542
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$284.20 |
| Max. Negotiated Rate |
$533.60 |
| Rate for Payer: Aetna Commercial |
$522.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$498.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$307.40
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$533.60
|
| Rate for Payer: Health EOS Commercial |
$516.20
|
| Rate for Payer: HFN Commercial |
$533.60
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: NAPHCARE Commercial |
$348.00
|
| Rate for Payer: Preferred Network Access Commercial |
$533.60
|
| Rate for Payer: Quartz Beloit One Network |
$284.20
|
| Rate for Payer: Quartz Commercial |
$348.00
|
| Rate for Payer: WEA Trust Commercial |
$319.00
|
| Rate for Payer: WPS Commercial |
$429.61
|
|
|
SCREW CORT 3.5 X 38MM LP AR-8835-38
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6182542
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$162.40 |
| Max. Negotiated Rate |
$2,320.00 |
| Rate for Payer: Aetna Commercial |
$522.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$498.80
|
| Rate for Payer: Aetna Managed Medicare |
$162.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$377.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$290.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$278.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$307.40
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$533.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$324.57
|
| Rate for Payer: Health EOS Commercial |
$516.20
|
| Rate for Payer: HFN Commercial |
$533.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$435.00
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: NAPHCARE Commercial |
$348.00
|
| Rate for Payer: Preferred Network Access Commercial |
$533.60
|
| Rate for Payer: Quartz Beloit One Network |
$284.20
|
| Rate for Payer: Quartz Commercial |
$377.00
|
| Rate for Payer: Quartz Medicare Advantage |
$348.00
|
| Rate for Payer: The Alliance Commercial |
$2,320.00
|
| Rate for Payer: WEA Trust Commercial |
$319.00
|
| Rate for Payer: WPS Commercial |
$429.61
|
|
|
SCREW-CORT 3.5 X 40 204.840
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966898
|
|
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 40 204.840
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966898
|
|
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 40MM LP AR-8835-40
|
Facility
|
OP
|
$603.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5977644
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.84 |
| Max. Negotiated Rate |
$2,412.00 |
| Rate for Payer: Aetna Commercial |
$542.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$518.58
|
| Rate for Payer: Aetna Managed Medicare |
$168.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$391.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$301.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$289.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$319.59
|
| Rate for Payer: Cash Price |
$180.90
|
| Rate for Payer: Cigna Commercial |
$554.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$337.44
|
| Rate for Payer: Health EOS Commercial |
$536.67
|
| Rate for Payer: HFN Commercial |
$554.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$452.25
|
| Rate for Payer: Multiplan Commercial |
$482.40
|
| Rate for Payer: NAPHCARE Commercial |
$361.80
|
| Rate for Payer: Preferred Network Access Commercial |
$554.76
|
| Rate for Payer: Quartz Beloit One Network |
$295.47
|
| Rate for Payer: Quartz Commercial |
$391.95
|
| Rate for Payer: Quartz Medicare Advantage |
$361.80
|
| Rate for Payer: The Alliance Commercial |
$2,412.00
|
| Rate for Payer: WEA Trust Commercial |
$331.65
|
| Rate for Payer: WPS Commercial |
$446.64
|
|
