|
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 |
$130.48 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$419.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$400.76
|
| Rate for Payer: Aetna Managed Medicare |
$130.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$302.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$233.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$223.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$246.98
|
| Rate for Payer: Cash Price |
$139.80
|
| Rate for Payer: Cigna Commercial |
$428.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$260.77
|
| Rate for Payer: Health EOS Commercial |
$414.74
|
| Rate for Payer: HFN Commercial |
$428.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$349.50
|
| Rate for Payer: Multiplan Commercial |
$372.80
|
| Rate for Payer: NAPHCARE Commercial |
$279.60
|
| Rate for Payer: Preferred Network Access Commercial |
$428.72
|
| Rate for Payer: Quartz Beloit One Network |
$228.34
|
| Rate for Payer: Quartz Commercial |
$302.90
|
| Rate for Payer: Quartz Medicare Advantage |
$279.60
|
| Rate for Payer: The Alliance Commercial |
$1,864.00
|
| Rate for Payer: WEA Trust Commercial |
$256.30
|
| Rate for Payer: WPS Commercial |
$345.17
|
|
|
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 |
$228.34 |
| Max. Negotiated Rate |
$428.72 |
| Rate for Payer: Aetna Commercial |
$419.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$400.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$246.98
|
| Rate for Payer: Cash Price |
$139.80
|
| Rate for Payer: Cigna Commercial |
$428.72
|
| Rate for Payer: Health EOS Commercial |
$414.74
|
| Rate for Payer: HFN Commercial |
$428.72
|
| Rate for Payer: Multiplan Commercial |
$372.80
|
| Rate for Payer: NAPHCARE Commercial |
$279.60
|
| Rate for Payer: Preferred Network Access Commercial |
$428.72
|
| Rate for Payer: Quartz Beloit One Network |
$228.34
|
| Rate for Payer: Quartz Commercial |
$279.60
|
| Rate for Payer: WEA Trust Commercial |
$256.30
|
| Rate for Payer: WPS Commercial |
$345.17
|
|
|
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 |
$130.48 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$419.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$400.76
|
| Rate for Payer: Aetna Managed Medicare |
$130.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$302.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$233.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$223.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$246.98
|
| Rate for Payer: Cash Price |
$139.80
|
| Rate for Payer: Cigna Commercial |
$428.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$260.77
|
| Rate for Payer: Health EOS Commercial |
$414.74
|
| Rate for Payer: HFN Commercial |
$428.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$349.50
|
| Rate for Payer: Multiplan Commercial |
$372.80
|
| Rate for Payer: NAPHCARE Commercial |
$279.60
|
| Rate for Payer: Preferred Network Access Commercial |
$428.72
|
| Rate for Payer: Quartz Beloit One Network |
$228.34
|
| Rate for Payer: Quartz Commercial |
$302.90
|
| Rate for Payer: Quartz Medicare Advantage |
$279.60
|
| Rate for Payer: The Alliance Commercial |
$1,864.00
|
| Rate for Payer: WEA Trust Commercial |
$256.30
|
| Rate for Payer: WPS Commercial |
$345.17
|
|
|
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 |
$228.34 |
| Max. Negotiated Rate |
$428.72 |
| Rate for Payer: Aetna Commercial |
$419.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$400.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$246.98
|
| Rate for Payer: Cash Price |
$139.80
|
| Rate for Payer: Cigna Commercial |
$428.72
|
| Rate for Payer: Health EOS Commercial |
$414.74
|
| Rate for Payer: HFN Commercial |
$428.72
|
| Rate for Payer: Multiplan Commercial |
$372.80
|
| Rate for Payer: NAPHCARE Commercial |
$279.60
|
| Rate for Payer: Preferred Network Access Commercial |
$428.72
|
| Rate for Payer: Quartz Beloit One Network |
$228.34
|
| Rate for Payer: Quartz Commercial |
$279.60
|
| Rate for Payer: WEA Trust Commercial |
$256.30
|
| Rate for Payer: WPS Commercial |
$345.17
|
|
|
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 |
$228.34 |
| Max. Negotiated Rate |
$428.72 |
| Rate for Payer: Aetna Commercial |
$419.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$400.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$246.98
|
| Rate for Payer: Cash Price |
$139.80
|
| Rate for Payer: Cigna Commercial |
$428.72
|
| Rate for Payer: Health EOS Commercial |
$414.74
|
| Rate for Payer: HFN Commercial |
$428.72
|
| Rate for Payer: Multiplan Commercial |
$372.80
|
| Rate for Payer: NAPHCARE Commercial |
$279.60
|
| Rate for Payer: Preferred Network Access Commercial |
$428.72
|
| Rate for Payer: Quartz Beloit One Network |
$228.34
|
| Rate for Payer: Quartz Commercial |
$279.60
|
| Rate for Payer: WEA Trust Commercial |
$256.30
|
| Rate for Payer: WPS Commercial |
$345.17
|
|
|
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 |
$130.48 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$419.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$400.76
|
| Rate for Payer: Aetna Managed Medicare |
$130.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$302.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$233.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$223.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$246.98
|
| Rate for Payer: Cash Price |
$139.80
|
| Rate for Payer: Cigna Commercial |
$428.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$260.77
|
| Rate for Payer: Health EOS Commercial |
$414.74
|
| Rate for Payer: HFN Commercial |
$428.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$349.50
|
| Rate for Payer: Multiplan Commercial |
$372.80
|
| Rate for Payer: NAPHCARE Commercial |
$279.60
|
| Rate for Payer: Preferred Network Access Commercial |
$428.72
|
| Rate for Payer: Quartz Beloit One Network |
$228.34
|
| Rate for Payer: Quartz Commercial |
$302.90
|
| Rate for Payer: Quartz Medicare Advantage |
$279.60
|
| Rate for Payer: The Alliance Commercial |
$1,864.00
|
| Rate for Payer: WEA Trust Commercial |
$256.30
|
| Rate for Payer: WPS Commercial |
$345.17
|
|
|
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 |
$237.16 |
| Max. Negotiated Rate |
$445.28 |
| Rate for Payer: Aetna Commercial |
$435.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$416.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$256.52
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$445.28
|
| Rate for Payer: Health EOS Commercial |
$430.76
|
| Rate for Payer: HFN Commercial |
$445.28
|
| Rate for Payer: Multiplan Commercial |
$387.20
|
| Rate for Payer: NAPHCARE Commercial |
$290.40
|
| Rate for Payer: Preferred Network Access Commercial |
$445.28
|
| Rate for Payer: Quartz Beloit One Network |
$237.16
|
| Rate for Payer: Quartz Commercial |
$290.40
|
| Rate for Payer: WEA Trust Commercial |
$266.20
|
| Rate for Payer: WPS Commercial |
$358.50
|
|
|
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 |
$135.52 |
| Max. Negotiated Rate |
$1,936.00 |
| Rate for Payer: Aetna Commercial |
$435.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$416.24
|
| Rate for Payer: Aetna Managed Medicare |
$135.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$314.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$242.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$232.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$256.52
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$445.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$270.85
|
| Rate for Payer: Health EOS Commercial |
$430.76
|
| Rate for Payer: HFN Commercial |
$445.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$363.00
|
| Rate for Payer: Multiplan Commercial |
$387.20
|
| Rate for Payer: NAPHCARE Commercial |
$290.40
|
| Rate for Payer: Preferred Network Access Commercial |
$445.28
|
| Rate for Payer: Quartz Beloit One Network |
$237.16
|
| Rate for Payer: Quartz Commercial |
$314.60
|
| Rate for Payer: Quartz Medicare Advantage |
$290.40
|
| Rate for Payer: The Alliance Commercial |
$1,936.00
|
| Rate for Payer: WEA Trust Commercial |
$266.20
|
| Rate for Payer: WPS Commercial |
$358.50
|
|
|
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 |
$227.36 |
| Max. Negotiated Rate |
$426.88 |
| Rate for Payer: Aetna Commercial |
$417.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$399.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$245.92
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cigna Commercial |
$426.88
|
| Rate for Payer: Health EOS Commercial |
$412.96
|
| Rate for Payer: HFN Commercial |
$426.88
|
| Rate for Payer: Multiplan Commercial |
$371.20
|
| Rate for Payer: NAPHCARE Commercial |
$278.40
|
| Rate for Payer: Preferred Network Access Commercial |
$426.88
|
| Rate for Payer: Quartz Beloit One Network |
$227.36
|
| Rate for Payer: Quartz Commercial |
$278.40
|
| Rate for Payer: WEA Trust Commercial |
$255.20
|
| Rate for Payer: WPS Commercial |
$343.68
|
|
|
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 |
$129.92 |
| Max. Negotiated Rate |
$1,856.00 |
| Rate for Payer: Aetna Commercial |
$417.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$399.04
|
| Rate for Payer: Aetna Managed Medicare |
$129.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$301.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$232.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$222.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$245.92
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cigna Commercial |
$426.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$259.65
|
| Rate for Payer: Health EOS Commercial |
$412.96
|
| Rate for Payer: HFN Commercial |
$426.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$348.00
|
| Rate for Payer: Multiplan Commercial |
$371.20
|
| Rate for Payer: NAPHCARE Commercial |
$278.40
|
| Rate for Payer: Preferred Network Access Commercial |
$426.88
|
| Rate for Payer: Quartz Beloit One Network |
$227.36
|
| Rate for Payer: Quartz Commercial |
$301.60
|
| Rate for Payer: Quartz Medicare Advantage |
$278.40
|
| Rate for Payer: The Alliance Commercial |
$1,856.00
|
| Rate for Payer: WEA Trust Commercial |
$255.20
|
| Rate for Payer: WPS Commercial |
$343.68
|
|
|
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 |
$104.44 |
| Max. Negotiated Rate |
$1,492.00 |
| Rate for Payer: Aetna Commercial |
$335.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$320.78
|
| Rate for Payer: Aetna Managed Medicare |
$104.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$242.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$186.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$179.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$197.69
|
| Rate for Payer: Cash Price |
$111.90
|
| Rate for Payer: Cigna Commercial |
$343.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$208.73
|
| Rate for Payer: Health EOS Commercial |
$331.97
|
| Rate for Payer: HFN Commercial |
$343.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$279.75
|
| Rate for Payer: Multiplan Commercial |
$298.40
|
| Rate for Payer: NAPHCARE Commercial |
$223.80
|
| Rate for Payer: Preferred Network Access Commercial |
$343.16
|
| Rate for Payer: Quartz Beloit One Network |
$182.77
|
| Rate for Payer: Quartz Commercial |
$242.45
|
| Rate for Payer: Quartz Medicare Advantage |
$223.80
|
| Rate for Payer: The Alliance Commercial |
$1,492.00
|
| Rate for Payer: WEA Trust Commercial |
$205.15
|
| Rate for Payer: WPS Commercial |
$276.28
|
|
|
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 |
$182.77 |
| Max. Negotiated Rate |
$343.16 |
| Rate for Payer: Aetna Commercial |
$335.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$320.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$197.69
|
| Rate for Payer: Cash Price |
$111.90
|
| Rate for Payer: Cigna Commercial |
$343.16
|
| Rate for Payer: Health EOS Commercial |
$331.97
|
| Rate for Payer: HFN Commercial |
$343.16
|
| Rate for Payer: Multiplan Commercial |
$298.40
|
| Rate for Payer: NAPHCARE Commercial |
$223.80
|
| Rate for Payer: Preferred Network Access Commercial |
$343.16
|
| Rate for Payer: Quartz Beloit One Network |
$182.77
|
| Rate for Payer: Quartz Commercial |
$223.80
|
| Rate for Payer: WEA Trust Commercial |
$205.15
|
| Rate for Payer: WPS Commercial |
$276.28
|
|
|
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 |
$294.98 |
| Max. Negotiated Rate |
$553.84 |
| Rate for Payer: Aetna Commercial |
$541.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$517.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$319.06
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cigna Commercial |
$553.84
|
| Rate for Payer: Health EOS Commercial |
$535.78
|
| Rate for Payer: HFN Commercial |
$553.84
|
| Rate for Payer: Multiplan Commercial |
$481.60
|
| Rate for Payer: NAPHCARE Commercial |
$361.20
|
| Rate for Payer: Preferred Network Access Commercial |
$553.84
|
| Rate for Payer: Quartz Beloit One Network |
$294.98
|
| Rate for Payer: Quartz Commercial |
$361.20
|
| Rate for Payer: WEA Trust Commercial |
$331.10
|
| Rate for Payer: WPS Commercial |
$445.90
|
|
|
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 |
$168.56 |
| Max. Negotiated Rate |
$2,408.00 |
| Rate for Payer: Aetna Commercial |
$541.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$517.72
|
| Rate for Payer: Aetna Managed Medicare |
$168.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$391.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$301.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$288.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$319.06
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cigna Commercial |
$553.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$336.88
|
| Rate for Payer: Health EOS Commercial |
$535.78
|
| Rate for Payer: HFN Commercial |
$553.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$451.50
|
| Rate for Payer: Multiplan Commercial |
$481.60
|
| Rate for Payer: NAPHCARE Commercial |
$361.20
|
| Rate for Payer: Preferred Network Access Commercial |
$553.84
|
| Rate for Payer: Quartz Beloit One Network |
$294.98
|
| Rate for Payer: Quartz Commercial |
$391.30
|
| Rate for Payer: Quartz Medicare Advantage |
$361.20
|
| Rate for Payer: The Alliance Commercial |
$2,408.00
|
| Rate for Payer: WEA Trust Commercial |
$331.10
|
| Rate for Payer: WPS Commercial |
$445.90
|
|
|
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 |
$294.98 |
| Max. Negotiated Rate |
$553.84 |
| Rate for Payer: Aetna Commercial |
$541.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$517.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$319.06
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cigna Commercial |
$553.84
|
| Rate for Payer: Health EOS Commercial |
$535.78
|
| Rate for Payer: HFN Commercial |
$553.84
|
| Rate for Payer: Multiplan Commercial |
$481.60
|
| Rate for Payer: NAPHCARE Commercial |
$361.20
|
| Rate for Payer: Preferred Network Access Commercial |
$553.84
|
| Rate for Payer: Quartz Beloit One Network |
$294.98
|
| Rate for Payer: Quartz Commercial |
$361.20
|
| Rate for Payer: WEA Trust Commercial |
$331.10
|
| Rate for Payer: WPS Commercial |
$445.90
|
|
|
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 |
$168.56 |
| Max. Negotiated Rate |
$2,408.00 |
| Rate for Payer: Aetna Commercial |
$541.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$517.72
|
| Rate for Payer: Aetna Managed Medicare |
$168.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$391.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$301.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$288.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$319.06
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cigna Commercial |
$553.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$336.88
|
| Rate for Payer: Health EOS Commercial |
$535.78
|
| Rate for Payer: HFN Commercial |
$553.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$451.50
|
| Rate for Payer: Multiplan Commercial |
$481.60
|
| Rate for Payer: NAPHCARE Commercial |
$361.20
|
| Rate for Payer: Preferred Network Access Commercial |
$553.84
|
| Rate for Payer: Quartz Beloit One Network |
$294.98
|
| Rate for Payer: Quartz Commercial |
$391.30
|
| Rate for Payer: Quartz Medicare Advantage |
$361.20
|
| Rate for Payer: The Alliance Commercial |
$2,408.00
|
| Rate for Payer: WEA Trust Commercial |
$331.10
|
| Rate for Payer: WPS Commercial |
$445.90
|
|
|
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 |
$390.04 |
| Max. Negotiated Rate |
$732.32 |
| Rate for Payer: Aetna Commercial |
$716.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$684.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$421.88
|
| Rate for Payer: Cash Price |
$238.80
|
| Rate for Payer: Cigna Commercial |
$732.32
|
| Rate for Payer: Health EOS Commercial |
$708.44
|
| Rate for Payer: HFN Commercial |
$732.32
|
| Rate for Payer: Multiplan Commercial |
$636.80
|
| Rate for Payer: NAPHCARE Commercial |
$477.60
|
| Rate for Payer: Preferred Network Access Commercial |
$732.32
|
| Rate for Payer: Quartz Beloit One Network |
$390.04
|
| Rate for Payer: Quartz Commercial |
$477.60
|
| Rate for Payer: WEA Trust Commercial |
$437.80
|
| Rate for Payer: WPS Commercial |
$589.60
|
|
|
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 |
$222.88 |
| Max. Negotiated Rate |
$3,184.00 |
| Rate for Payer: Aetna Commercial |
$716.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$684.56
|
| Rate for Payer: Aetna Managed Medicare |
$222.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$517.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$398.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$382.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$421.88
|
| Rate for Payer: Cash Price |
$238.80
|
| Rate for Payer: Cigna Commercial |
$732.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$445.44
|
| Rate for Payer: Health EOS Commercial |
$708.44
|
| Rate for Payer: HFN Commercial |
$732.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$597.00
|
| Rate for Payer: Multiplan Commercial |
$636.80
|
| Rate for Payer: NAPHCARE Commercial |
$477.60
|
| Rate for Payer: Preferred Network Access Commercial |
$732.32
|
| Rate for Payer: Quartz Beloit One Network |
$390.04
|
| Rate for Payer: Quartz Commercial |
$517.40
|
| Rate for Payer: Quartz Medicare Advantage |
$477.60
|
| Rate for Payer: The Alliance Commercial |
$3,184.00
|
| Rate for Payer: WEA Trust Commercial |
$437.80
|
| Rate for Payer: WPS Commercial |
$589.60
|
|
|
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 |
$224.00 |
| Max. Negotiated Rate |
$3,200.00 |
| Rate for Payer: Aetna Commercial |
$720.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$688.00
|
| Rate for Payer: Aetna Managed Medicare |
$224.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$520.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$400.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$384.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$424.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cigna Commercial |
$736.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$447.68
|
| Rate for Payer: Health EOS Commercial |
$712.00
|
| Rate for Payer: HFN Commercial |
$736.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$600.00
|
| Rate for Payer: Multiplan Commercial |
$640.00
|
| Rate for Payer: NAPHCARE Commercial |
$480.00
|
| Rate for Payer: Preferred Network Access Commercial |
$736.00
|
| Rate for Payer: Quartz Beloit One Network |
$392.00
|
| Rate for Payer: Quartz Commercial |
$520.00
|
| Rate for Payer: Quartz Medicare Advantage |
$480.00
|
| Rate for Payer: The Alliance Commercial |
$3,200.00
|
| Rate for Payer: WEA Trust Commercial |
$440.00
|
| Rate for Payer: WPS Commercial |
$592.56
|
|
|
SCREW CORTEX 1.3MM X 10MM 02.130.010
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5206663
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$392.00 |
| Max. Negotiated Rate |
$736.00 |
| Rate for Payer: Aetna Commercial |
$720.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$688.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$424.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cigna Commercial |
$736.00
|
| Rate for Payer: Health EOS Commercial |
$712.00
|
| Rate for Payer: HFN Commercial |
$736.00
|
| Rate for Payer: Multiplan Commercial |
$640.00
|
| Rate for Payer: NAPHCARE Commercial |
$480.00
|
| Rate for Payer: Preferred Network Access Commercial |
$736.00
|
| Rate for Payer: Quartz Beloit One Network |
$392.00
|
| Rate for Payer: Quartz Commercial |
$480.00
|
| Rate for Payer: WEA Trust Commercial |
$440.00
|
| Rate for Payer: WPS Commercial |
$592.56
|
|
|
SCREW CORTEX 1.3MM X 12MM 02.130.012
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5206667
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$392.00 |
| Max. Negotiated Rate |
$736.00 |
| Rate for Payer: Aetna Commercial |
$720.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$688.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$424.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cigna Commercial |
$736.00
|
| Rate for Payer: Health EOS Commercial |
$712.00
|
| Rate for Payer: HFN Commercial |
$736.00
|
| Rate for Payer: Multiplan Commercial |
$640.00
|
| Rate for Payer: NAPHCARE Commercial |
$480.00
|
| Rate for Payer: Preferred Network Access Commercial |
$736.00
|
| Rate for Payer: Quartz Beloit One Network |
$392.00
|
| Rate for Payer: Quartz Commercial |
$480.00
|
| Rate for Payer: WEA Trust Commercial |
$440.00
|
| Rate for Payer: WPS Commercial |
$592.56
|
|
|
SCREW CORTEX 1.3MM X 12MM 02.130.012
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5206667
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.00 |
| Max. Negotiated Rate |
$3,200.00 |
| Rate for Payer: Aetna Commercial |
$720.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$688.00
|
| Rate for Payer: Aetna Managed Medicare |
$224.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$520.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$400.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$384.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$424.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cigna Commercial |
$736.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$447.68
|
| Rate for Payer: Health EOS Commercial |
$712.00
|
| Rate for Payer: HFN Commercial |
$736.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$600.00
|
| Rate for Payer: Multiplan Commercial |
$640.00
|
| Rate for Payer: NAPHCARE Commercial |
$480.00
|
| Rate for Payer: Preferred Network Access Commercial |
$736.00
|
| Rate for Payer: Quartz Beloit One Network |
$392.00
|
| Rate for Payer: Quartz Commercial |
$520.00
|
| Rate for Payer: Quartz Medicare Advantage |
$480.00
|
| Rate for Payer: The Alliance Commercial |
$3,200.00
|
| Rate for Payer: WEA Trust Commercial |
$440.00
|
| Rate for Payer: WPS Commercial |
$592.56
|
|
|
SCREW CORTEX 1.3MM X 14MM 02.130.014
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5206664
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.00 |
| Max. Negotiated Rate |
$3,200.00 |
| Rate for Payer: Aetna Commercial |
$720.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$688.00
|
| Rate for Payer: Aetna Managed Medicare |
$224.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$520.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$400.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$384.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$424.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cigna Commercial |
$736.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$447.68
|
| Rate for Payer: Health EOS Commercial |
$712.00
|
| Rate for Payer: HFN Commercial |
$736.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$600.00
|
| Rate for Payer: Multiplan Commercial |
$640.00
|
| Rate for Payer: NAPHCARE Commercial |
$480.00
|
| Rate for Payer: Preferred Network Access Commercial |
$736.00
|
| Rate for Payer: Quartz Beloit One Network |
$392.00
|
| Rate for Payer: Quartz Commercial |
$520.00
|
| Rate for Payer: Quartz Medicare Advantage |
$480.00
|
| Rate for Payer: The Alliance Commercial |
$3,200.00
|
| Rate for Payer: WEA Trust Commercial |
$440.00
|
| Rate for Payer: WPS Commercial |
$592.56
|
|
|
SCREW CORTEX 1.3MM X 14MM 02.130.014
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5206664
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$392.00 |
| Max. Negotiated Rate |
$736.00 |
| Rate for Payer: Aetna Commercial |
$720.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$688.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$424.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cigna Commercial |
$736.00
|
| Rate for Payer: Health EOS Commercial |
$712.00
|
| Rate for Payer: HFN Commercial |
$736.00
|
| Rate for Payer: Multiplan Commercial |
$640.00
|
| Rate for Payer: NAPHCARE Commercial |
$480.00
|
| Rate for Payer: Preferred Network Access Commercial |
$736.00
|
| Rate for Payer: Quartz Beloit One Network |
$392.00
|
| Rate for Payer: Quartz Commercial |
$480.00
|
| Rate for Payer: WEA Trust Commercial |
$440.00
|
| Rate for Payer: WPS Commercial |
$592.56
|
|
|
SCREW CORTEX 1.3MM X 16MM 02.130.016
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5206665
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$392.00 |
| Max. Negotiated Rate |
$736.00 |
| Rate for Payer: Aetna Commercial |
$720.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$688.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$424.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cigna Commercial |
$736.00
|
| Rate for Payer: Health EOS Commercial |
$712.00
|
| Rate for Payer: HFN Commercial |
$736.00
|
| Rate for Payer: Multiplan Commercial |
$640.00
|
| Rate for Payer: NAPHCARE Commercial |
$480.00
|
| Rate for Payer: Preferred Network Access Commercial |
$736.00
|
| Rate for Payer: Quartz Beloit One Network |
$392.00
|
| Rate for Payer: Quartz Commercial |
$480.00
|
| Rate for Payer: WEA Trust Commercial |
$440.00
|
| Rate for Payer: WPS Commercial |
$592.56
|
|
