|
SCREW CANC 4.0 X 26 FULL THREAD 206.026
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967041
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$83.79 |
| Max. Negotiated Rate |
$157.32 |
| Rate for Payer: Aetna Commercial |
$153.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$147.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$90.63
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cigna Commercial |
$157.32
|
| Rate for Payer: Health EOS Commercial |
$152.19
|
| Rate for Payer: HFN Commercial |
$157.32
|
| Rate for Payer: Multiplan Commercial |
$136.80
|
| Rate for Payer: NAPHCARE Commercial |
$102.60
|
| Rate for Payer: Preferred Network Access Commercial |
$157.32
|
| Rate for Payer: Quartz Beloit One Network |
$83.79
|
| Rate for Payer: Quartz Commercial |
$102.60
|
| Rate for Payer: WEA Trust Commercial |
$94.05
|
| Rate for Payer: WPS Commercial |
$126.66
|
|
|
SCREW CANC 4.0 X 26 PART THREAD 207.026
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967042
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$106.82 |
| Max. Negotiated Rate |
$200.56 |
| Rate for Payer: Aetna Commercial |
$196.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$187.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.54
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cigna Commercial |
$200.56
|
| Rate for Payer: Health EOS Commercial |
$194.02
|
| Rate for Payer: HFN Commercial |
$200.56
|
| Rate for Payer: Multiplan Commercial |
$174.40
|
| Rate for Payer: NAPHCARE Commercial |
$130.80
|
| Rate for Payer: Preferred Network Access Commercial |
$200.56
|
| Rate for Payer: Quartz Beloit One Network |
$106.82
|
| Rate for Payer: Quartz Commercial |
$130.80
|
| Rate for Payer: WEA Trust Commercial |
$119.90
|
| Rate for Payer: WPS Commercial |
$161.47
|
|
|
SCREW CANC 4.0 X 26 PART THREAD 207.026
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967042
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$61.04 |
| Max. Negotiated Rate |
$872.00 |
| Rate for Payer: Aetna Commercial |
$196.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$187.48
|
| Rate for Payer: Aetna Managed Medicare |
$61.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$141.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$109.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$104.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.54
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cigna Commercial |
$200.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$121.99
|
| Rate for Payer: Health EOS Commercial |
$194.02
|
| Rate for Payer: HFN Commercial |
$200.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$163.50
|
| Rate for Payer: Multiplan Commercial |
$174.40
|
| Rate for Payer: NAPHCARE Commercial |
$130.80
|
| Rate for Payer: Preferred Network Access Commercial |
$200.56
|
| Rate for Payer: Quartz Beloit One Network |
$106.82
|
| Rate for Payer: Quartz Commercial |
$141.70
|
| Rate for Payer: Quartz Medicare Advantage |
$130.80
|
| Rate for Payer: The Alliance Commercial |
$872.00
|
| Rate for Payer: WEA Trust Commercial |
$119.90
|
| Rate for Payer: WPS Commercial |
$161.47
|
|
|
SCREW CANC 4.0 X 28 FULL THREAD 206.028
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$83.79 |
| Max. Negotiated Rate |
$157.32 |
| Rate for Payer: Aetna Commercial |
$153.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$147.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$90.63
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cigna Commercial |
$157.32
|
| Rate for Payer: Health EOS Commercial |
$152.19
|
| Rate for Payer: HFN Commercial |
$157.32
|
| Rate for Payer: Multiplan Commercial |
$136.80
|
| Rate for Payer: NAPHCARE Commercial |
$102.60
|
| Rate for Payer: Preferred Network Access Commercial |
$157.32
|
| Rate for Payer: Quartz Beloit One Network |
$83.79
|
| Rate for Payer: Quartz Commercial |
$102.60
|
| Rate for Payer: WEA Trust Commercial |
$94.05
|
| Rate for Payer: WPS Commercial |
$126.66
|
|
|
SCREW CANC 4.0 X 28 FULL THREAD 206.028
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$47.88 |
| Max. Negotiated Rate |
$684.00 |
| Rate for Payer: Aetna Commercial |
$153.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$147.06
|
| Rate for Payer: Aetna Managed Medicare |
$47.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$111.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$85.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$82.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$90.63
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cigna Commercial |
$157.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$95.69
|
| Rate for Payer: Health EOS Commercial |
$152.19
|
| Rate for Payer: HFN Commercial |
$157.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$128.25
|
| Rate for Payer: Multiplan Commercial |
$136.80
|
| Rate for Payer: NAPHCARE Commercial |
$102.60
|
| Rate for Payer: Preferred Network Access Commercial |
$157.32
|
| Rate for Payer: Quartz Beloit One Network |
$83.79
|
| Rate for Payer: Quartz Commercial |
$111.15
|
| Rate for Payer: Quartz Medicare Advantage |
$102.60
|
| Rate for Payer: The Alliance Commercial |
$684.00
|
| Rate for Payer: WEA Trust Commercial |
$94.05
|
| Rate for Payer: WPS Commercial |
$126.66
|
|
|
SCREW CANC 4.0 X 28MM ORTHOLOC FULL THREAD 58934028
|
Facility
|
OP
|
$1,751.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6206995
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$490.28 |
| Max. Negotiated Rate |
$7,004.00 |
| Rate for Payer: Aetna Commercial |
$1,575.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,505.86
|
| Rate for Payer: Aetna Managed Medicare |
$490.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,138.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$875.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$840.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$928.03
|
| Rate for Payer: Cash Price |
$525.30
|
| Rate for Payer: Cigna Commercial |
$1,610.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$979.86
|
| Rate for Payer: Health EOS Commercial |
$1,558.39
|
| Rate for Payer: HFN Commercial |
$1,610.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,313.25
|
| Rate for Payer: Multiplan Commercial |
$1,400.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,050.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,610.92
|
| Rate for Payer: Quartz Beloit One Network |
$857.99
|
| Rate for Payer: Quartz Commercial |
$1,138.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,050.60
|
| Rate for Payer: The Alliance Commercial |
$7,004.00
|
| Rate for Payer: WEA Trust Commercial |
$963.05
|
| Rate for Payer: WPS Commercial |
$1,296.97
|
|
|
SCREW CANC 4.0 X 28MM ORTHOLOC FULL THREAD 58934028
|
Facility
|
IP
|
$1,751.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6206995
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$857.99 |
| Max. Negotiated Rate |
$1,610.92 |
| Rate for Payer: Aetna Commercial |
$1,575.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,505.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$928.03
|
| Rate for Payer: Cash Price |
$525.30
|
| Rate for Payer: Cigna Commercial |
$1,610.92
|
| Rate for Payer: Health EOS Commercial |
$1,558.39
|
| Rate for Payer: HFN Commercial |
$1,610.92
|
| Rate for Payer: Multiplan Commercial |
$1,400.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,050.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,610.92
|
| Rate for Payer: Quartz Beloit One Network |
$857.99
|
| Rate for Payer: Quartz Commercial |
$1,050.60
|
| Rate for Payer: WEA Trust Commercial |
$963.05
|
| Rate for Payer: WPS Commercial |
$1,296.97
|
|
|
SCREW CANC 4.0 X 28 PART THREAD 207.028
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967044
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$102.90 |
| Max. Negotiated Rate |
$193.20 |
| Rate for Payer: Aetna Commercial |
$189.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$180.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$111.30
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$193.20
|
| Rate for Payer: Health EOS Commercial |
$186.90
|
| Rate for Payer: HFN Commercial |
$193.20
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: NAPHCARE Commercial |
$126.00
|
| Rate for Payer: Preferred Network Access Commercial |
$193.20
|
| Rate for Payer: Quartz Beloit One Network |
$102.90
|
| Rate for Payer: Quartz Commercial |
$126.00
|
| Rate for Payer: WEA Trust Commercial |
$115.50
|
| Rate for Payer: WPS Commercial |
$155.55
|
|
|
SCREW CANC 4.0 X 28 PART THREAD 207.028
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967044
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna Commercial |
$189.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$180.60
|
| Rate for Payer: Aetna Managed Medicare |
$58.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$136.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$105.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$100.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$111.30
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$193.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$117.52
|
| Rate for Payer: Health EOS Commercial |
$186.90
|
| Rate for Payer: HFN Commercial |
$193.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$157.50
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: NAPHCARE Commercial |
$126.00
|
| Rate for Payer: Preferred Network Access Commercial |
$193.20
|
| Rate for Payer: Quartz Beloit One Network |
$102.90
|
| Rate for Payer: Quartz Commercial |
$136.50
|
| Rate for Payer: Quartz Medicare Advantage |
$126.00
|
| Rate for Payer: The Alliance Commercial |
$840.00
|
| Rate for Payer: WEA Trust Commercial |
$115.50
|
| Rate for Payer: WPS Commercial |
$155.55
|
|
|
SCREW CANC 4.0 X 30 FULL THREAD 206.030
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967045
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$83.79 |
| Max. Negotiated Rate |
$157.32 |
| Rate for Payer: Aetna Commercial |
$153.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$147.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$90.63
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cigna Commercial |
$157.32
|
| Rate for Payer: Health EOS Commercial |
$152.19
|
| Rate for Payer: HFN Commercial |
$157.32
|
| Rate for Payer: Multiplan Commercial |
$136.80
|
| Rate for Payer: NAPHCARE Commercial |
$102.60
|
| Rate for Payer: Preferred Network Access Commercial |
$157.32
|
| Rate for Payer: Quartz Beloit One Network |
$83.79
|
| Rate for Payer: Quartz Commercial |
$102.60
|
| Rate for Payer: WEA Trust Commercial |
$94.05
|
| Rate for Payer: WPS Commercial |
$126.66
|
|
|
SCREW CANC 4.0 X 30 FULL THREAD 206.030
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967045
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$47.88 |
| Max. Negotiated Rate |
$684.00 |
| Rate for Payer: Aetna Commercial |
$153.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$147.06
|
| Rate for Payer: Aetna Managed Medicare |
$47.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$111.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$85.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$82.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$90.63
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cigna Commercial |
$157.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$95.69
|
| Rate for Payer: Health EOS Commercial |
$152.19
|
| Rate for Payer: HFN Commercial |
$157.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$128.25
|
| Rate for Payer: Multiplan Commercial |
$136.80
|
| Rate for Payer: NAPHCARE Commercial |
$102.60
|
| Rate for Payer: Preferred Network Access Commercial |
$157.32
|
| Rate for Payer: Quartz Beloit One Network |
$83.79
|
| Rate for Payer: Quartz Commercial |
$111.15
|
| Rate for Payer: Quartz Medicare Advantage |
$102.60
|
| Rate for Payer: The Alliance Commercial |
$684.00
|
| Rate for Payer: WEA Trust Commercial |
$94.05
|
| Rate for Payer: WPS Commercial |
$126.66
|
|
|
SCREW CANC 4.0 X 30 PART THREAD 207.030
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967046
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$102.90 |
| Max. Negotiated Rate |
$193.20 |
| Rate for Payer: Aetna Commercial |
$189.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$180.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$111.30
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$193.20
|
| Rate for Payer: Health EOS Commercial |
$186.90
|
| Rate for Payer: HFN Commercial |
$193.20
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: NAPHCARE Commercial |
$126.00
|
| Rate for Payer: Preferred Network Access Commercial |
$193.20
|
| Rate for Payer: Quartz Beloit One Network |
$102.90
|
| Rate for Payer: Quartz Commercial |
$126.00
|
| Rate for Payer: WEA Trust Commercial |
$115.50
|
| Rate for Payer: WPS Commercial |
$155.55
|
|
|
SCREW CANC 4.0 X 30 PART THREAD 207.030
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967046
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna Commercial |
$189.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$180.60
|
| Rate for Payer: Aetna Managed Medicare |
$58.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$136.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$105.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$100.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$111.30
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$193.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$117.52
|
| Rate for Payer: Health EOS Commercial |
$186.90
|
| Rate for Payer: HFN Commercial |
$193.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$157.50
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: NAPHCARE Commercial |
$126.00
|
| Rate for Payer: Preferred Network Access Commercial |
$193.20
|
| Rate for Payer: Quartz Beloit One Network |
$102.90
|
| Rate for Payer: Quartz Commercial |
$136.50
|
| Rate for Payer: Quartz Medicare Advantage |
$126.00
|
| Rate for Payer: The Alliance Commercial |
$840.00
|
| Rate for Payer: WEA Trust Commercial |
$115.50
|
| Rate for Payer: WPS Commercial |
$155.55
|
|
|
SCREW CANC 4.0 X 35 FULL THREAD 206.035
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967047
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$87.22 |
| Max. Negotiated Rate |
$163.76 |
| Rate for Payer: Aetna Commercial |
$160.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$153.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$94.34
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cigna Commercial |
$163.76
|
| Rate for Payer: Health EOS Commercial |
$158.42
|
| Rate for Payer: HFN Commercial |
$163.76
|
| Rate for Payer: Multiplan Commercial |
$142.40
|
| Rate for Payer: NAPHCARE Commercial |
$106.80
|
| Rate for Payer: Preferred Network Access Commercial |
$163.76
|
| Rate for Payer: Quartz Beloit One Network |
$87.22
|
| Rate for Payer: Quartz Commercial |
$106.80
|
| Rate for Payer: WEA Trust Commercial |
$97.90
|
| Rate for Payer: WPS Commercial |
$131.84
|
|
|
SCREW CANC 4.0 X 35 FULL THREAD 206.035
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967047
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$49.84 |
| Max. Negotiated Rate |
$712.00 |
| Rate for Payer: Aetna Commercial |
$160.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$153.08
|
| Rate for Payer: Aetna Managed Medicare |
$49.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$115.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$89.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$85.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$94.34
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cigna Commercial |
$163.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$99.61
|
| Rate for Payer: Health EOS Commercial |
$158.42
|
| Rate for Payer: HFN Commercial |
$163.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$133.50
|
| Rate for Payer: Multiplan Commercial |
$142.40
|
| Rate for Payer: NAPHCARE Commercial |
$106.80
|
| Rate for Payer: Preferred Network Access Commercial |
$163.76
|
| Rate for Payer: Quartz Beloit One Network |
$87.22
|
| Rate for Payer: Quartz Commercial |
$115.70
|
| Rate for Payer: Quartz Medicare Advantage |
$106.80
|
| Rate for Payer: The Alliance Commercial |
$712.00
|
| Rate for Payer: WEA Trust Commercial |
$97.90
|
| Rate for Payer: WPS Commercial |
$131.84
|
|
|
SCREW CANC 4.0 X 35 PART THREAD 207.035
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967048
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$102.90 |
| Max. Negotiated Rate |
$193.20 |
| Rate for Payer: Aetna Commercial |
$189.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$180.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$111.30
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$193.20
|
| Rate for Payer: Health EOS Commercial |
$186.90
|
| Rate for Payer: HFN Commercial |
$193.20
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: NAPHCARE Commercial |
$126.00
|
| Rate for Payer: Preferred Network Access Commercial |
$193.20
|
| Rate for Payer: Quartz Beloit One Network |
$102.90
|
| Rate for Payer: Quartz Commercial |
$126.00
|
| Rate for Payer: WEA Trust Commercial |
$115.50
|
| Rate for Payer: WPS Commercial |
$155.55
|
|
|
SCREW CANC 4.0 X 35 PART THREAD 207.035
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967048
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna Commercial |
$189.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$180.60
|
| Rate for Payer: Aetna Managed Medicare |
$58.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$136.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$105.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$100.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$111.30
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$193.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$117.52
|
| Rate for Payer: Health EOS Commercial |
$186.90
|
| Rate for Payer: HFN Commercial |
$193.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$157.50
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: NAPHCARE Commercial |
$126.00
|
| Rate for Payer: Preferred Network Access Commercial |
$193.20
|
| Rate for Payer: Quartz Beloit One Network |
$102.90
|
| Rate for Payer: Quartz Commercial |
$136.50
|
| Rate for Payer: Quartz Medicare Advantage |
$126.00
|
| Rate for Payer: The Alliance Commercial |
$840.00
|
| Rate for Payer: WEA Trust Commercial |
$115.50
|
| Rate for Payer: WPS Commercial |
$155.55
|
|
|
SCREW CANC 4.0 X 36 LP AR-8840-36
|
Facility
|
IP
|
$652.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5496984
|
|
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 CANC 4.0 X 36 LP AR-8840-36
|
Facility
|
OP
|
$652.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5496984
|
|
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 CANC 4.0 X 38 LP AR-8840-38
|
Facility
|
IP
|
$585.71
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6244121
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$287.00 |
| Max. Negotiated Rate |
$538.85 |
| Rate for Payer: Aetna Commercial |
$527.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$503.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$310.43
|
| Rate for Payer: Cash Price |
$175.71
|
| Rate for Payer: Cigna Commercial |
$538.85
|
| Rate for Payer: Health EOS Commercial |
$521.28
|
| Rate for Payer: HFN Commercial |
$538.85
|
| Rate for Payer: Multiplan Commercial |
$468.57
|
| Rate for Payer: NAPHCARE Commercial |
$351.43
|
| Rate for Payer: Preferred Network Access Commercial |
$538.85
|
| Rate for Payer: Quartz Beloit One Network |
$287.00
|
| Rate for Payer: Quartz Commercial |
$351.43
|
| Rate for Payer: WEA Trust Commercial |
$322.14
|
| Rate for Payer: WPS Commercial |
$433.84
|
|
|
SCREW CANC 4.0 X 38 LP AR-8840-38
|
Facility
|
OP
|
$585.71
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6244121
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$164.00 |
| Max. Negotiated Rate |
$2,342.84 |
| Rate for Payer: Aetna Commercial |
$527.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$503.71
|
| Rate for Payer: Aetna Managed Medicare |
$164.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$380.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$292.86
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$281.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$310.43
|
| Rate for Payer: Cash Price |
$175.71
|
| Rate for Payer: Cigna Commercial |
$538.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$327.76
|
| Rate for Payer: Health EOS Commercial |
$521.28
|
| Rate for Payer: HFN Commercial |
$538.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$439.28
|
| Rate for Payer: Multiplan Commercial |
$468.57
|
| Rate for Payer: NAPHCARE Commercial |
$351.43
|
| Rate for Payer: Preferred Network Access Commercial |
$538.85
|
| Rate for Payer: Quartz Beloit One Network |
$287.00
|
| Rate for Payer: Quartz Commercial |
$380.71
|
| Rate for Payer: Quartz Medicare Advantage |
$351.43
|
| Rate for Payer: The Alliance Commercial |
$2,342.84
|
| Rate for Payer: WEA Trust Commercial |
$322.14
|
| Rate for Payer: WPS Commercial |
$433.84
|
|
|
SCREW CANC 4.0 X 40 FULL THREAD 206.040
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967049
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$83.79 |
| Max. Negotiated Rate |
$157.32 |
| Rate for Payer: Aetna Commercial |
$153.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$147.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$90.63
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cigna Commercial |
$157.32
|
| Rate for Payer: Health EOS Commercial |
$152.19
|
| Rate for Payer: HFN Commercial |
$157.32
|
| Rate for Payer: Multiplan Commercial |
$136.80
|
| Rate for Payer: NAPHCARE Commercial |
$102.60
|
| Rate for Payer: Preferred Network Access Commercial |
$157.32
|
| Rate for Payer: Quartz Beloit One Network |
$83.79
|
| Rate for Payer: Quartz Commercial |
$102.60
|
| Rate for Payer: WEA Trust Commercial |
$94.05
|
| Rate for Payer: WPS Commercial |
$126.66
|
|
|
SCREW CANC 4.0 X 40 FULL THREAD 206.040
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967049
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$47.88 |
| Max. Negotiated Rate |
$684.00 |
| Rate for Payer: Aetna Commercial |
$153.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$147.06
|
| Rate for Payer: Aetna Managed Medicare |
$47.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$111.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$85.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$82.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$90.63
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cigna Commercial |
$157.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$95.69
|
| Rate for Payer: Health EOS Commercial |
$152.19
|
| Rate for Payer: HFN Commercial |
$157.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$128.25
|
| Rate for Payer: Multiplan Commercial |
$136.80
|
| Rate for Payer: NAPHCARE Commercial |
$102.60
|
| Rate for Payer: Preferred Network Access Commercial |
$157.32
|
| Rate for Payer: Quartz Beloit One Network |
$83.79
|
| Rate for Payer: Quartz Commercial |
$111.15
|
| Rate for Payer: Quartz Medicare Advantage |
$102.60
|
| Rate for Payer: The Alliance Commercial |
$684.00
|
| Rate for Payer: WEA Trust Commercial |
$94.05
|
| Rate for Payer: WPS Commercial |
$126.66
|
|
|
SCREW CANC 4.0 X 40 PART THREAD 207.040
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna Commercial |
$189.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$180.60
|
| Rate for Payer: Aetna Managed Medicare |
$58.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$136.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$105.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$100.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$111.30
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$193.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$117.52
|
| Rate for Payer: Health EOS Commercial |
$186.90
|
| Rate for Payer: HFN Commercial |
$193.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$157.50
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: NAPHCARE Commercial |
$126.00
|
| Rate for Payer: Preferred Network Access Commercial |
$193.20
|
| Rate for Payer: Quartz Beloit One Network |
$102.90
|
| Rate for Payer: Quartz Commercial |
$136.50
|
| Rate for Payer: Quartz Medicare Advantage |
$126.00
|
| Rate for Payer: The Alliance Commercial |
$840.00
|
| Rate for Payer: WEA Trust Commercial |
$115.50
|
| Rate for Payer: WPS Commercial |
$155.55
|
|
|
SCREW CANC 4.0 X 40 PART THREAD 207.040
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$102.90 |
| Max. Negotiated Rate |
$193.20 |
| Rate for Payer: Aetna Commercial |
$189.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$180.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$111.30
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$193.20
|
| Rate for Payer: Health EOS Commercial |
$186.90
|
| Rate for Payer: HFN Commercial |
$193.20
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: NAPHCARE Commercial |
$126.00
|
| Rate for Payer: Preferred Network Access Commercial |
$193.20
|
| Rate for Payer: Quartz Beloit One Network |
$102.90
|
| Rate for Payer: Quartz Commercial |
$126.00
|
| Rate for Payer: WEA Trust Commercial |
$115.50
|
| Rate for Payer: WPS Commercial |
$155.55
|
|
