|
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 |
$107.02 |
| Max. Negotiated Rate |
$200.93 |
| Rate for Payer: Aetna Commercial |
$196.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$187.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.75
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$200.93
|
| Rate for Payer: Health EOS Commercial |
$194.38
|
| Rate for Payer: HFN Commercial |
$200.93
|
| Rate for Payer: Multiplan Commercial |
$174.72
|
| Rate for Payer: Preferred Network Access Commercial |
$200.93
|
| Rate for Payer: Quartz Beloit One Network |
$107.02
|
| Rate for Payer: Quartz Commercial |
$131.04
|
| Rate for Payer: WEA Trust Commercial |
$120.12
|
| Rate for Payer: WPS Commercial |
$161.76
|
|
|
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 |
$90.71 |
| Max. Negotiated Rate |
$170.31 |
| Rate for Payer: Aetna Commercial |
$166.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$159.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.11
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cigna Commercial |
$170.31
|
| Rate for Payer: Health EOS Commercial |
$164.76
|
| Rate for Payer: HFN Commercial |
$170.31
|
| Rate for Payer: Multiplan Commercial |
$148.10
|
| Rate for Payer: Preferred Network Access Commercial |
$170.31
|
| Rate for Payer: Quartz Beloit One Network |
$90.71
|
| Rate for Payer: Quartz Commercial |
$111.07
|
| Rate for Payer: WEA Trust Commercial |
$101.82
|
| Rate for Payer: WPS Commercial |
$137.11
|
|
|
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 |
$51.83 |
| Max. Negotiated Rate |
$170.31 |
| Rate for Payer: Aetna Commercial |
$166.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$159.20
|
| Rate for Payer: Aetna Managed Medicare |
$51.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$120.33
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$92.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$88.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.11
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cigna Commercial |
$170.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$103.60
|
| Rate for Payer: Health EOS Commercial |
$164.76
|
| Rate for Payer: HFN Commercial |
$170.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$138.84
|
| Rate for Payer: Multiplan Commercial |
$148.10
|
| Rate for Payer: NAPHCARE Commercial |
$111.07
|
| Rate for Payer: Preferred Network Access Commercial |
$170.31
|
| Rate for Payer: Quartz Beloit One Network |
$90.71
|
| Rate for Payer: Quartz Commercial |
$120.33
|
| Rate for Payer: Quartz Medicare Advantage |
$111.07
|
| Rate for Payer: The Alliance Commercial |
$92.56
|
| Rate for Payer: WEA Trust Commercial |
$101.82
|
| Rate for Payer: WPS Commercial |
$137.11
|
|
|
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 |
$61.15 |
| Max. Negotiated Rate |
$200.93 |
| Rate for Payer: Aetna Commercial |
$196.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$187.82
|
| Rate for Payer: Aetna Managed Medicare |
$61.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$141.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$109.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$104.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.75
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$200.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$122.22
|
| Rate for Payer: Health EOS Commercial |
$194.38
|
| Rate for Payer: HFN Commercial |
$200.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$163.80
|
| Rate for Payer: Multiplan Commercial |
$174.72
|
| Rate for Payer: NAPHCARE Commercial |
$131.04
|
| Rate for Payer: Preferred Network Access Commercial |
$200.93
|
| Rate for Payer: Quartz Beloit One Network |
$107.02
|
| Rate for Payer: Quartz Commercial |
$141.96
|
| Rate for Payer: Quartz Medicare Advantage |
$131.04
|
| Rate for Payer: The Alliance Commercial |
$109.20
|
| Rate for Payer: WEA Trust Commercial |
$120.12
|
| Rate for Payer: WPS Commercial |
$161.76
|
|
|
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 |
$107.02 |
| Max. Negotiated Rate |
$200.93 |
| Rate for Payer: Aetna Commercial |
$196.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$187.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.75
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$200.93
|
| Rate for Payer: Health EOS Commercial |
$194.38
|
| Rate for Payer: HFN Commercial |
$200.93
|
| Rate for Payer: Multiplan Commercial |
$174.72
|
| Rate for Payer: Preferred Network Access Commercial |
$200.93
|
| Rate for Payer: Quartz Beloit One Network |
$107.02
|
| Rate for Payer: Quartz Commercial |
$131.04
|
| Rate for Payer: WEA Trust Commercial |
$120.12
|
| Rate for Payer: WPS Commercial |
$161.76
|
|
|
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 |
$332.26 |
| Max. Negotiated Rate |
$623.83 |
| Rate for Payer: Aetna Commercial |
$610.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$583.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$359.38
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cigna Commercial |
$623.83
|
| Rate for Payer: Health EOS Commercial |
$603.49
|
| Rate for Payer: HFN Commercial |
$623.83
|
| Rate for Payer: Multiplan Commercial |
$542.46
|
| Rate for Payer: Preferred Network Access Commercial |
$623.83
|
| Rate for Payer: Quartz Beloit One Network |
$332.26
|
| Rate for Payer: Quartz Commercial |
$406.85
|
| Rate for Payer: WEA Trust Commercial |
$372.94
|
| Rate for Payer: WPS Commercial |
$502.24
|
|
|
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 |
$189.86 |
| Max. Negotiated Rate |
$623.83 |
| Rate for Payer: Aetna Commercial |
$610.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$583.15
|
| Rate for Payer: Aetna Managed Medicare |
$189.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$440.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$339.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$325.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$359.38
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cigna Commercial |
$623.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$379.46
|
| Rate for Payer: Health EOS Commercial |
$603.49
|
| Rate for Payer: HFN Commercial |
$623.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$508.56
|
| Rate for Payer: Multiplan Commercial |
$542.46
|
| Rate for Payer: NAPHCARE Commercial |
$406.85
|
| Rate for Payer: Preferred Network Access Commercial |
$623.83
|
| Rate for Payer: Quartz Beloit One Network |
$332.26
|
| Rate for Payer: Quartz Commercial |
$440.75
|
| Rate for Payer: Quartz Medicare Advantage |
$406.85
|
| Rate for Payer: The Alliance Commercial |
$339.04
|
| Rate for Payer: WEA Trust Commercial |
$372.94
|
| Rate for Payer: WPS Commercial |
$502.24
|
|
|
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 |
$170.56 |
| Max. Negotiated Rate |
$560.41 |
| Rate for Payer: Aetna Commercial |
$548.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$523.86
|
| Rate for Payer: Aetna Managed Medicare |
$170.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$395.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$304.57
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$292.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$322.84
|
| Rate for Payer: Cash Price |
$175.71
|
| Rate for Payer: Cigna Commercial |
$560.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$340.88
|
| Rate for Payer: Health EOS Commercial |
$542.13
|
| Rate for Payer: HFN Commercial |
$560.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$456.85
|
| Rate for Payer: Multiplan Commercial |
$487.31
|
| Rate for Payer: NAPHCARE Commercial |
$365.48
|
| Rate for Payer: Preferred Network Access Commercial |
$560.41
|
| Rate for Payer: Quartz Beloit One Network |
$298.48
|
| Rate for Payer: Quartz Commercial |
$395.94
|
| Rate for Payer: Quartz Medicare Advantage |
$365.48
|
| Rate for Payer: The Alliance Commercial |
$304.57
|
| Rate for Payer: WEA Trust Commercial |
$335.03
|
| Rate for Payer: WPS Commercial |
$451.17
|
|
|
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 |
$298.48 |
| Max. Negotiated Rate |
$560.41 |
| Rate for Payer: Aetna Commercial |
$548.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$523.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$322.84
|
| Rate for Payer: Cash Price |
$175.71
|
| Rate for Payer: Cigna Commercial |
$560.41
|
| Rate for Payer: Health EOS Commercial |
$542.13
|
| Rate for Payer: HFN Commercial |
$560.41
|
| Rate for Payer: Multiplan Commercial |
$487.31
|
| Rate for Payer: Preferred Network Access Commercial |
$560.41
|
| Rate for Payer: Quartz Beloit One Network |
$298.48
|
| Rate for Payer: Quartz Commercial |
$365.48
|
| Rate for Payer: WEA Trust Commercial |
$335.03
|
| Rate for Payer: WPS Commercial |
$451.17
|
|
|
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 |
$87.14 |
| Max. Negotiated Rate |
$163.61 |
| Rate for Payer: Aetna Commercial |
$160.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$152.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$94.26
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cigna Commercial |
$163.61
|
| Rate for Payer: Health EOS Commercial |
$158.28
|
| Rate for Payer: HFN Commercial |
$163.61
|
| Rate for Payer: Multiplan Commercial |
$142.27
|
| Rate for Payer: Preferred Network Access Commercial |
$163.61
|
| Rate for Payer: Quartz Beloit One Network |
$87.14
|
| Rate for Payer: Quartz Commercial |
$106.70
|
| Rate for Payer: WEA Trust Commercial |
$97.81
|
| Rate for Payer: WPS Commercial |
$131.72
|
|
|
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 |
$49.80 |
| Max. Negotiated Rate |
$163.61 |
| Rate for Payer: Aetna Commercial |
$160.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$152.94
|
| Rate for Payer: Aetna Managed Medicare |
$49.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$115.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$88.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$85.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$94.26
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cigna Commercial |
$163.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$99.52
|
| Rate for Payer: Health EOS Commercial |
$158.28
|
| Rate for Payer: HFN Commercial |
$163.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$133.38
|
| Rate for Payer: Multiplan Commercial |
$142.27
|
| Rate for Payer: NAPHCARE Commercial |
$106.70
|
| Rate for Payer: Preferred Network Access Commercial |
$163.61
|
| Rate for Payer: Quartz Beloit One Network |
$87.14
|
| Rate for Payer: Quartz Commercial |
$115.60
|
| Rate for Payer: Quartz Medicare Advantage |
$106.70
|
| Rate for Payer: The Alliance Commercial |
$88.92
|
| Rate for Payer: WEA Trust Commercial |
$97.81
|
| Rate for Payer: WPS Commercial |
$131.72
|
|
|
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 |
$61.15 |
| Max. Negotiated Rate |
$200.93 |
| Rate for Payer: Aetna Commercial |
$196.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$187.82
|
| Rate for Payer: Aetna Managed Medicare |
$61.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$141.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$109.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$104.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.75
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$200.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$122.22
|
| Rate for Payer: Health EOS Commercial |
$194.38
|
| Rate for Payer: HFN Commercial |
$200.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$163.80
|
| Rate for Payer: Multiplan Commercial |
$174.72
|
| Rate for Payer: NAPHCARE Commercial |
$131.04
|
| Rate for Payer: Preferred Network Access Commercial |
$200.93
|
| Rate for Payer: Quartz Beloit One Network |
$107.02
|
| Rate for Payer: Quartz Commercial |
$141.96
|
| Rate for Payer: Quartz Medicare Advantage |
$131.04
|
| Rate for Payer: The Alliance Commercial |
$109.20
|
| Rate for Payer: WEA Trust Commercial |
$120.12
|
| Rate for Payer: WPS Commercial |
$161.76
|
|
|
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 |
$107.02 |
| Max. Negotiated Rate |
$200.93 |
| Rate for Payer: Aetna Commercial |
$196.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$187.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.75
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$200.93
|
| Rate for Payer: Health EOS Commercial |
$194.38
|
| Rate for Payer: HFN Commercial |
$200.93
|
| Rate for Payer: Multiplan Commercial |
$174.72
|
| Rate for Payer: Preferred Network Access Commercial |
$200.93
|
| Rate for Payer: Quartz Beloit One Network |
$107.02
|
| Rate for Payer: Quartz Commercial |
$131.04
|
| Rate for Payer: WEA Trust Commercial |
$120.12
|
| Rate for Payer: WPS Commercial |
$161.76
|
|
|
SCREW CANC 4.0 X 45 FULL THREAD 206.045
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967051
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$87.14 |
| Max. Negotiated Rate |
$163.61 |
| Rate for Payer: Aetna Commercial |
$160.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$152.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$94.26
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cigna Commercial |
$163.61
|
| Rate for Payer: Health EOS Commercial |
$158.28
|
| Rate for Payer: HFN Commercial |
$163.61
|
| Rate for Payer: Multiplan Commercial |
$142.27
|
| Rate for Payer: Preferred Network Access Commercial |
$163.61
|
| Rate for Payer: Quartz Beloit One Network |
$87.14
|
| Rate for Payer: Quartz Commercial |
$106.70
|
| Rate for Payer: WEA Trust Commercial |
$97.81
|
| Rate for Payer: WPS Commercial |
$131.72
|
|
|
SCREW CANC 4.0 X 45 FULL THREAD 206.045
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967051
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$49.80 |
| Max. Negotiated Rate |
$163.61 |
| Rate for Payer: Aetna Commercial |
$160.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$152.94
|
| Rate for Payer: Aetna Managed Medicare |
$49.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$115.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$88.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$85.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$94.26
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cigna Commercial |
$163.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$99.52
|
| Rate for Payer: Health EOS Commercial |
$158.28
|
| Rate for Payer: HFN Commercial |
$163.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$133.38
|
| Rate for Payer: Multiplan Commercial |
$142.27
|
| Rate for Payer: NAPHCARE Commercial |
$106.70
|
| Rate for Payer: Preferred Network Access Commercial |
$163.61
|
| Rate for Payer: Quartz Beloit One Network |
$87.14
|
| Rate for Payer: Quartz Commercial |
$115.60
|
| Rate for Payer: Quartz Medicare Advantage |
$106.70
|
| Rate for Payer: The Alliance Commercial |
$88.92
|
| Rate for Payer: WEA Trust Commercial |
$97.81
|
| Rate for Payer: WPS Commercial |
$131.72
|
|
|
SCREW CANC 4.0 X 45 PART THREAD 207.045
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$111.09 |
| Max. Negotiated Rate |
$208.58 |
| Rate for Payer: Aetna Commercial |
$204.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$194.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$120.16
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cigna Commercial |
$208.58
|
| Rate for Payer: Health EOS Commercial |
$201.78
|
| Rate for Payer: HFN Commercial |
$208.58
|
| Rate for Payer: Multiplan Commercial |
$181.38
|
| Rate for Payer: Preferred Network Access Commercial |
$208.58
|
| Rate for Payer: Quartz Beloit One Network |
$111.09
|
| Rate for Payer: Quartz Commercial |
$136.03
|
| Rate for Payer: WEA Trust Commercial |
$124.70
|
| Rate for Payer: WPS Commercial |
$167.93
|
|
|
SCREW CANC 4.0 X 45 PART THREAD 207.045
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$63.48 |
| Max. Negotiated Rate |
$208.58 |
| Rate for Payer: Aetna Commercial |
$204.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$194.98
|
| Rate for Payer: Aetna Managed Medicare |
$63.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$147.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$113.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$108.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$120.16
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cigna Commercial |
$208.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$126.88
|
| Rate for Payer: Health EOS Commercial |
$201.78
|
| Rate for Payer: HFN Commercial |
$208.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$170.04
|
| Rate for Payer: Multiplan Commercial |
$181.38
|
| Rate for Payer: NAPHCARE Commercial |
$136.03
|
| Rate for Payer: Preferred Network Access Commercial |
$208.58
|
| Rate for Payer: Quartz Beloit One Network |
$111.09
|
| Rate for Payer: Quartz Commercial |
$147.37
|
| Rate for Payer: Quartz Medicare Advantage |
$136.03
|
| Rate for Payer: The Alliance Commercial |
$113.36
|
| Rate for Payer: WEA Trust Commercial |
$124.70
|
| Rate for Payer: WPS Commercial |
$167.93
|
|
|
SCREW CANC 4.0 X 48 LP AR-8840-48
|
Facility
|
IP
|
$603.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6171772
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$307.29 |
| Max. Negotiated Rate |
$576.95 |
| Rate for Payer: Aetna Commercial |
$564.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$539.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$332.37
|
| Rate for Payer: Cash Price |
$180.90
|
| Rate for Payer: Cigna Commercial |
$576.95
|
| Rate for Payer: Health EOS Commercial |
$558.14
|
| Rate for Payer: HFN Commercial |
$576.95
|
| Rate for Payer: Multiplan Commercial |
$501.70
|
| Rate for Payer: Preferred Network Access Commercial |
$576.95
|
| Rate for Payer: Quartz Beloit One Network |
$307.29
|
| Rate for Payer: Quartz Commercial |
$376.27
|
| Rate for Payer: WEA Trust Commercial |
$344.92
|
| Rate for Payer: WPS Commercial |
$464.49
|
|
|
SCREW CANC 4.0 X 48 LP AR-8840-48
|
Facility
|
OP
|
$603.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6171772
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$175.59 |
| Max. Negotiated Rate |
$576.95 |
| Rate for Payer: Aetna Commercial |
$564.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$539.32
|
| Rate for Payer: Aetna Managed Medicare |
$175.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$407.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$313.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$301.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$332.37
|
| Rate for Payer: Cash Price |
$180.90
|
| Rate for Payer: Cigna Commercial |
$576.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$350.95
|
| Rate for Payer: Health EOS Commercial |
$558.14
|
| Rate for Payer: HFN Commercial |
$576.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$470.34
|
| Rate for Payer: Multiplan Commercial |
$501.70
|
| Rate for Payer: NAPHCARE Commercial |
$376.27
|
| Rate for Payer: Preferred Network Access Commercial |
$576.95
|
| Rate for Payer: Quartz Beloit One Network |
$307.29
|
| Rate for Payer: Quartz Commercial |
$407.63
|
| Rate for Payer: Quartz Medicare Advantage |
$376.27
|
| Rate for Payer: The Alliance Commercial |
$313.56
|
| Rate for Payer: WEA Trust Commercial |
$344.92
|
| Rate for Payer: WPS Commercial |
$464.49
|
|
|
SCREW CANC 4.0 X 50 FULL THREAD 206.050
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967053
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$90.71 |
| Max. Negotiated Rate |
$170.31 |
| Rate for Payer: Aetna Commercial |
$166.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$159.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.11
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cigna Commercial |
$170.31
|
| Rate for Payer: Health EOS Commercial |
$164.76
|
| Rate for Payer: HFN Commercial |
$170.31
|
| Rate for Payer: Multiplan Commercial |
$148.10
|
| Rate for Payer: Preferred Network Access Commercial |
$170.31
|
| Rate for Payer: Quartz Beloit One Network |
$90.71
|
| Rate for Payer: Quartz Commercial |
$111.07
|
| Rate for Payer: WEA Trust Commercial |
$101.82
|
| Rate for Payer: WPS Commercial |
$137.11
|
|
|
SCREW CANC 4.0 X 50 FULL THREAD 206.050
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967053
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$51.83 |
| Max. Negotiated Rate |
$170.31 |
| Rate for Payer: Aetna Commercial |
$166.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$159.20
|
| Rate for Payer: Aetna Managed Medicare |
$51.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$120.33
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$92.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$88.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.11
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cigna Commercial |
$170.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$103.60
|
| Rate for Payer: Health EOS Commercial |
$164.76
|
| Rate for Payer: HFN Commercial |
$170.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$138.84
|
| Rate for Payer: Multiplan Commercial |
$148.10
|
| Rate for Payer: NAPHCARE Commercial |
$111.07
|
| Rate for Payer: Preferred Network Access Commercial |
$170.31
|
| Rate for Payer: Quartz Beloit One Network |
$90.71
|
| Rate for Payer: Quartz Commercial |
$120.33
|
| Rate for Payer: Quartz Medicare Advantage |
$111.07
|
| Rate for Payer: The Alliance Commercial |
$92.56
|
| Rate for Payer: WEA Trust Commercial |
$101.82
|
| Rate for Payer: WPS Commercial |
$137.11
|
|
|
SCREW CANC 4.0 X 50 PART THREAD 207.050
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967054
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$61.15 |
| Max. Negotiated Rate |
$200.93 |
| Rate for Payer: Aetna Commercial |
$196.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$187.82
|
| Rate for Payer: Aetna Managed Medicare |
$61.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$141.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$109.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$104.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.75
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$200.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$122.22
|
| Rate for Payer: Health EOS Commercial |
$194.38
|
| Rate for Payer: HFN Commercial |
$200.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$163.80
|
| Rate for Payer: Multiplan Commercial |
$174.72
|
| Rate for Payer: NAPHCARE Commercial |
$131.04
|
| Rate for Payer: Preferred Network Access Commercial |
$200.93
|
| Rate for Payer: Quartz Beloit One Network |
$107.02
|
| Rate for Payer: Quartz Commercial |
$141.96
|
| Rate for Payer: Quartz Medicare Advantage |
$131.04
|
| Rate for Payer: The Alliance Commercial |
$109.20
|
| Rate for Payer: WEA Trust Commercial |
$120.12
|
| Rate for Payer: WPS Commercial |
$161.76
|
|
|
SCREW CANC 4.0 X 50 PART THREAD 207.050
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967054
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$107.02 |
| Max. Negotiated Rate |
$200.93 |
| Rate for Payer: Aetna Commercial |
$196.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$187.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.75
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$200.93
|
| Rate for Payer: Health EOS Commercial |
$194.38
|
| Rate for Payer: HFN Commercial |
$200.93
|
| Rate for Payer: Multiplan Commercial |
$174.72
|
| Rate for Payer: Preferred Network Access Commercial |
$200.93
|
| Rate for Payer: Quartz Beloit One Network |
$107.02
|
| Rate for Payer: Quartz Commercial |
$131.04
|
| Rate for Payer: WEA Trust Commercial |
$120.12
|
| Rate for Payer: WPS Commercial |
$161.76
|
|
|
SCREW CANC 4.0 X 55 FULL THREAD 206.055
|
Facility
|
IP
|
$496.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494437
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$252.76 |
| Max. Negotiated Rate |
$474.57 |
| Rate for Payer: Aetna Commercial |
$464.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$443.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$273.40
|
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Cigna Commercial |
$474.57
|
| Rate for Payer: Health EOS Commercial |
$459.10
|
| Rate for Payer: HFN Commercial |
$474.57
|
| Rate for Payer: Multiplan Commercial |
$412.67
|
| Rate for Payer: Preferred Network Access Commercial |
$474.57
|
| Rate for Payer: Quartz Beloit One Network |
$252.76
|
| Rate for Payer: Quartz Commercial |
$309.50
|
| Rate for Payer: WEA Trust Commercial |
$283.71
|
| Rate for Payer: WPS Commercial |
$382.07
|
|
|
SCREW CANC 4.0 X 55 FULL THREAD 206.055
|
Facility
|
OP
|
$496.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494437
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$144.44 |
| Max. Negotiated Rate |
$474.57 |
| Rate for Payer: Aetna Commercial |
$464.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$443.62
|
| Rate for Payer: Aetna Managed Medicare |
$144.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$335.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$257.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$247.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$273.40
|
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Cigna Commercial |
$474.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$288.67
|
| Rate for Payer: Health EOS Commercial |
$459.10
|
| Rate for Payer: HFN Commercial |
$474.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$386.88
|
| Rate for Payer: Multiplan Commercial |
$412.67
|
| Rate for Payer: NAPHCARE Commercial |
$309.50
|
| Rate for Payer: Preferred Network Access Commercial |
$474.57
|
| Rate for Payer: Quartz Beloit One Network |
$252.76
|
| Rate for Payer: Quartz Commercial |
$335.30
|
| Rate for Payer: Quartz Medicare Advantage |
$309.50
|
| Rate for Payer: The Alliance Commercial |
$257.92
|
| Rate for Payer: WEA Trust Commercial |
$283.71
|
| Rate for Payer: WPS Commercial |
$382.07
|
|
