|
SCREW CAGE MEDIUM 35MM AR-9301-02
|
Facility
|
OP
|
$17,653.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5603586
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,942.84 |
| Max. Negotiated Rate |
$70,612.00 |
| Rate for Payer: Aetna Commercial |
$15,887.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,181.58
|
| Rate for Payer: Aetna Managed Medicare |
$4,942.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,474.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,826.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,473.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,356.09
|
| Rate for Payer: Cash Price |
$5,295.90
|
| Rate for Payer: Cigna Commercial |
$16,240.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,878.62
|
| Rate for Payer: Health EOS Commercial |
$15,711.17
|
| Rate for Payer: HFN Commercial |
$16,240.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,239.75
|
| Rate for Payer: Multiplan Commercial |
$14,122.40
|
| Rate for Payer: NAPHCARE Commercial |
$10,591.80
|
| Rate for Payer: Preferred Network Access Commercial |
$16,240.76
|
| Rate for Payer: Quartz Beloit One Network |
$8,649.97
|
| Rate for Payer: Quartz Commercial |
$11,474.45
|
| Rate for Payer: Quartz Medicare Advantage |
$10,591.80
|
| Rate for Payer: The Alliance Commercial |
$70,612.00
|
| Rate for Payer: WEA Trust Commercial |
$9,709.15
|
| Rate for Payer: WPS Commercial |
$13,075.58
|
|
|
SCREW CAGE MEDIUM 35MM AR-9301-02
|
Facility
|
IP
|
$17,653.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5603586
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,649.97 |
| Max. Negotiated Rate |
$16,240.76 |
| Rate for Payer: Aetna Commercial |
$15,887.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,181.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,356.09
|
| Rate for Payer: Cash Price |
$5,295.90
|
| Rate for Payer: Cigna Commercial |
$16,240.76
|
| Rate for Payer: Health EOS Commercial |
$15,711.17
|
| Rate for Payer: HFN Commercial |
$16,240.76
|
| Rate for Payer: Multiplan Commercial |
$14,122.40
|
| Rate for Payer: NAPHCARE Commercial |
$10,591.80
|
| Rate for Payer: Preferred Network Access Commercial |
$16,240.76
|
| Rate for Payer: Quartz Beloit One Network |
$8,649.97
|
| Rate for Payer: Quartz Commercial |
$10,591.80
|
| Rate for Payer: WEA Trust Commercial |
$9,709.15
|
| Rate for Payer: WPS Commercial |
$13,075.58
|
|
|
SCREW CANC 3.0 X 12MM SS FT AR-8830-12
|
Facility
|
OP
|
$799.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508982
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$223.72 |
| Max. Negotiated Rate |
$3,196.00 |
| Rate for Payer: Aetna Commercial |
$719.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$687.14
|
| Rate for Payer: Aetna Managed Medicare |
$223.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$519.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$399.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$383.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$423.47
|
| Rate for Payer: Cash Price |
$239.70
|
| Rate for Payer: Cigna Commercial |
$735.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$447.12
|
| Rate for Payer: Health EOS Commercial |
$711.11
|
| Rate for Payer: HFN Commercial |
$735.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$599.25
|
| Rate for Payer: Multiplan Commercial |
$639.20
|
| Rate for Payer: NAPHCARE Commercial |
$479.40
|
| Rate for Payer: Preferred Network Access Commercial |
$735.08
|
| Rate for Payer: Quartz Beloit One Network |
$391.51
|
| Rate for Payer: Quartz Commercial |
$519.35
|
| Rate for Payer: Quartz Medicare Advantage |
$479.40
|
| Rate for Payer: The Alliance Commercial |
$3,196.00
|
| Rate for Payer: WEA Trust Commercial |
$439.45
|
| Rate for Payer: WPS Commercial |
$591.82
|
|
|
SCREW CANC 3.0 X 12MM SS FT AR-8830-12
|
Facility
|
IP
|
$799.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508982
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$391.51 |
| Max. Negotiated Rate |
$735.08 |
| Rate for Payer: Aetna Commercial |
$719.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$687.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$423.47
|
| Rate for Payer: Cash Price |
$239.70
|
| Rate for Payer: Cigna Commercial |
$735.08
|
| Rate for Payer: Health EOS Commercial |
$711.11
|
| Rate for Payer: HFN Commercial |
$735.08
|
| Rate for Payer: Multiplan Commercial |
$639.20
|
| Rate for Payer: NAPHCARE Commercial |
$479.40
|
| Rate for Payer: Preferred Network Access Commercial |
$735.08
|
| Rate for Payer: Quartz Beloit One Network |
$391.51
|
| Rate for Payer: Quartz Commercial |
$479.40
|
| Rate for Payer: WEA Trust Commercial |
$439.45
|
| Rate for Payer: WPS Commercial |
$591.82
|
|
|
SCREW CANC 3.0 X 14MM SS FT AR-8830-14
|
Facility
|
IP
|
$799.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508983
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$391.51 |
| Max. Negotiated Rate |
$735.08 |
| Rate for Payer: Aetna Commercial |
$719.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$687.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$423.47
|
| Rate for Payer: Cash Price |
$239.70
|
| Rate for Payer: Cigna Commercial |
$735.08
|
| Rate for Payer: Health EOS Commercial |
$711.11
|
| Rate for Payer: HFN Commercial |
$735.08
|
| Rate for Payer: Multiplan Commercial |
$639.20
|
| Rate for Payer: NAPHCARE Commercial |
$479.40
|
| Rate for Payer: Preferred Network Access Commercial |
$735.08
|
| Rate for Payer: Quartz Beloit One Network |
$391.51
|
| Rate for Payer: Quartz Commercial |
$479.40
|
| Rate for Payer: WEA Trust Commercial |
$439.45
|
| Rate for Payer: WPS Commercial |
$591.82
|
|
|
SCREW CANC 3.0 X 14MM SS FT AR-8830-14
|
Facility
|
OP
|
$799.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508983
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$223.72 |
| Max. Negotiated Rate |
$3,196.00 |
| Rate for Payer: Aetna Commercial |
$719.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$687.14
|
| Rate for Payer: Aetna Managed Medicare |
$223.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$519.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$399.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$383.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$423.47
|
| Rate for Payer: Cash Price |
$239.70
|
| Rate for Payer: Cigna Commercial |
$735.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$447.12
|
| Rate for Payer: Health EOS Commercial |
$711.11
|
| Rate for Payer: HFN Commercial |
$735.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$599.25
|
| Rate for Payer: Multiplan Commercial |
$639.20
|
| Rate for Payer: NAPHCARE Commercial |
$479.40
|
| Rate for Payer: Preferred Network Access Commercial |
$735.08
|
| Rate for Payer: Quartz Beloit One Network |
$391.51
|
| Rate for Payer: Quartz Commercial |
$519.35
|
| Rate for Payer: Quartz Medicare Advantage |
$479.40
|
| Rate for Payer: The Alliance Commercial |
$3,196.00
|
| Rate for Payer: WEA Trust Commercial |
$439.45
|
| Rate for Payer: WPS Commercial |
$591.82
|
|
|
SCREW CANC 3.0 X 16MM SS FT AR-8830-16
|
Facility
|
IP
|
$799.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4509008
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$391.51 |
| Max. Negotiated Rate |
$735.08 |
| Rate for Payer: Aetna Commercial |
$719.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$687.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$423.47
|
| Rate for Payer: Cash Price |
$239.70
|
| Rate for Payer: Cigna Commercial |
$735.08
|
| Rate for Payer: Health EOS Commercial |
$711.11
|
| Rate for Payer: HFN Commercial |
$735.08
|
| Rate for Payer: Multiplan Commercial |
$639.20
|
| Rate for Payer: NAPHCARE Commercial |
$479.40
|
| Rate for Payer: Preferred Network Access Commercial |
$735.08
|
| Rate for Payer: Quartz Beloit One Network |
$391.51
|
| Rate for Payer: Quartz Commercial |
$479.40
|
| Rate for Payer: WEA Trust Commercial |
$439.45
|
| Rate for Payer: WPS Commercial |
$591.82
|
|
|
SCREW CANC 3.0 X 16MM SS FT AR-8830-16
|
Facility
|
OP
|
$799.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4509008
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$223.72 |
| Max. Negotiated Rate |
$3,196.00 |
| Rate for Payer: Aetna Commercial |
$719.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$687.14
|
| Rate for Payer: Aetna Managed Medicare |
$223.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$519.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$399.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$383.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$423.47
|
| Rate for Payer: Cash Price |
$239.70
|
| Rate for Payer: Cigna Commercial |
$735.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$447.12
|
| Rate for Payer: Health EOS Commercial |
$711.11
|
| Rate for Payer: HFN Commercial |
$735.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$599.25
|
| Rate for Payer: Multiplan Commercial |
$639.20
|
| Rate for Payer: NAPHCARE Commercial |
$479.40
|
| Rate for Payer: Preferred Network Access Commercial |
$735.08
|
| Rate for Payer: Quartz Beloit One Network |
$391.51
|
| Rate for Payer: Quartz Commercial |
$519.35
|
| Rate for Payer: Quartz Medicare Advantage |
$479.40
|
| Rate for Payer: The Alliance Commercial |
$3,196.00
|
| Rate for Payer: WEA Trust Commercial |
$439.45
|
| Rate for Payer: WPS Commercial |
$591.82
|
|
|
SCREW CANC 3.0 X 18MM SS FT AR-8830-18
|
Facility
|
IP
|
$738.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6153644
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$361.62 |
| Max. Negotiated Rate |
$678.96 |
| Rate for Payer: Aetna Commercial |
$664.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$634.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$391.14
|
| Rate for Payer: Cash Price |
$221.40
|
| Rate for Payer: Cigna Commercial |
$678.96
|
| Rate for Payer: Health EOS Commercial |
$656.82
|
| Rate for Payer: HFN Commercial |
$678.96
|
| Rate for Payer: Multiplan Commercial |
$590.40
|
| Rate for Payer: NAPHCARE Commercial |
$442.80
|
| Rate for Payer: Preferred Network Access Commercial |
$678.96
|
| Rate for Payer: Quartz Beloit One Network |
$361.62
|
| Rate for Payer: Quartz Commercial |
$442.80
|
| Rate for Payer: WEA Trust Commercial |
$405.90
|
| Rate for Payer: WPS Commercial |
$546.64
|
|
|
SCREW CANC 3.0 X 18MM SS FT AR-8830-18
|
Facility
|
OP
|
$738.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6153644
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$206.64 |
| Max. Negotiated Rate |
$2,952.00 |
| Rate for Payer: Aetna Commercial |
$664.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$634.68
|
| Rate for Payer: Aetna Managed Medicare |
$206.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$479.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$369.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$354.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$391.14
|
| Rate for Payer: Cash Price |
$221.40
|
| Rate for Payer: Cigna Commercial |
$678.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$412.98
|
| Rate for Payer: Health EOS Commercial |
$656.82
|
| Rate for Payer: HFN Commercial |
$678.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$553.50
|
| Rate for Payer: Multiplan Commercial |
$590.40
|
| Rate for Payer: NAPHCARE Commercial |
$442.80
|
| Rate for Payer: Preferred Network Access Commercial |
$678.96
|
| Rate for Payer: Quartz Beloit One Network |
$361.62
|
| Rate for Payer: Quartz Commercial |
$479.70
|
| Rate for Payer: Quartz Medicare Advantage |
$442.80
|
| Rate for Payer: The Alliance Commercial |
$2,952.00
|
| Rate for Payer: WEA Trust Commercial |
$405.90
|
| Rate for Payer: WPS Commercial |
$546.64
|
|
|
SCREW CANC 3.0 X 30MM SS FT AR-8830-30
|
Facility
|
OP
|
$627.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5861648
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$175.56 |
| Max. Negotiated Rate |
$2,508.00 |
| Rate for Payer: Aetna Commercial |
$564.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$539.22
|
| Rate for Payer: Aetna Managed Medicare |
$175.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$407.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$313.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$300.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$332.31
|
| Rate for Payer: Cash Price |
$188.10
|
| Rate for Payer: Cigna Commercial |
$576.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$350.87
|
| Rate for Payer: Health EOS Commercial |
$558.03
|
| Rate for Payer: HFN Commercial |
$576.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$470.25
|
| Rate for Payer: Multiplan Commercial |
$501.60
|
| Rate for Payer: NAPHCARE Commercial |
$376.20
|
| Rate for Payer: Preferred Network Access Commercial |
$576.84
|
| Rate for Payer: Quartz Beloit One Network |
$307.23
|
| Rate for Payer: Quartz Commercial |
$407.55
|
| Rate for Payer: Quartz Medicare Advantage |
$376.20
|
| Rate for Payer: The Alliance Commercial |
$2,508.00
|
| Rate for Payer: WEA Trust Commercial |
$344.85
|
| Rate for Payer: WPS Commercial |
$464.42
|
|
|
SCREW CANC 3.0 X 30MM SS FT AR-8830-30
|
Facility
|
IP
|
$627.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5861648
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$307.23 |
| Max. Negotiated Rate |
$576.84 |
| Rate for Payer: Aetna Commercial |
$564.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$539.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$332.31
|
| Rate for Payer: Cash Price |
$188.10
|
| Rate for Payer: Cigna Commercial |
$576.84
|
| Rate for Payer: Health EOS Commercial |
$558.03
|
| Rate for Payer: HFN Commercial |
$576.84
|
| Rate for Payer: Multiplan Commercial |
$501.60
|
| Rate for Payer: NAPHCARE Commercial |
$376.20
|
| Rate for Payer: Preferred Network Access Commercial |
$576.84
|
| Rate for Payer: Quartz Beloit One Network |
$307.23
|
| Rate for Payer: Quartz Commercial |
$376.20
|
| Rate for Payer: WEA Trust Commercial |
$344.85
|
| Rate for Payer: WPS Commercial |
$464.42
|
|
|
SCREW CANC 4.0 X 10 FULL THREAD 206.010
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967025
|
|
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 10 FULL THREAD 206.010
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967025
|
|
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 10 PART THREAD 207.010
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967026
|
|
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 10 PART THREAD 207.010
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967026
|
|
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 12 FULL THREAD 206.012
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967027
|
|
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 12 FULL THREAD 206.012
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967027
|
|
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 12 LP AR-8840-12
|
Facility
|
IP
|
$627.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5627648
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$307.23 |
| Max. Negotiated Rate |
$576.84 |
| Rate for Payer: Aetna Commercial |
$564.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$539.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$332.31
|
| Rate for Payer: Cash Price |
$188.10
|
| Rate for Payer: Cigna Commercial |
$576.84
|
| Rate for Payer: Health EOS Commercial |
$558.03
|
| Rate for Payer: HFN Commercial |
$576.84
|
| Rate for Payer: Multiplan Commercial |
$501.60
|
| Rate for Payer: NAPHCARE Commercial |
$376.20
|
| Rate for Payer: Preferred Network Access Commercial |
$576.84
|
| Rate for Payer: Quartz Beloit One Network |
$307.23
|
| Rate for Payer: Quartz Commercial |
$376.20
|
| Rate for Payer: WEA Trust Commercial |
$344.85
|
| Rate for Payer: WPS Commercial |
$464.42
|
|
|
SCREW CANC 4.0 X 12 LP AR-8840-12
|
Facility
|
OP
|
$627.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5627648
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$175.56 |
| Max. Negotiated Rate |
$2,508.00 |
| Rate for Payer: Aetna Commercial |
$564.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$539.22
|
| Rate for Payer: Aetna Managed Medicare |
$175.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$407.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$313.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$300.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$332.31
|
| Rate for Payer: Cash Price |
$188.10
|
| Rate for Payer: Cigna Commercial |
$576.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$350.87
|
| Rate for Payer: Health EOS Commercial |
$558.03
|
| Rate for Payer: HFN Commercial |
$576.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$470.25
|
| Rate for Payer: Multiplan Commercial |
$501.60
|
| Rate for Payer: NAPHCARE Commercial |
$376.20
|
| Rate for Payer: Preferred Network Access Commercial |
$576.84
|
| Rate for Payer: Quartz Beloit One Network |
$307.23
|
| Rate for Payer: Quartz Commercial |
$407.55
|
| Rate for Payer: Quartz Medicare Advantage |
$376.20
|
| Rate for Payer: The Alliance Commercial |
$2,508.00
|
| Rate for Payer: WEA Trust Commercial |
$344.85
|
| Rate for Payer: WPS Commercial |
$464.42
|
|
|
SCREW CANC 4.0 X 12 PART THREAD 207.012
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967028
|
|
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 12 PART THREAD 207.012
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967028
|
|
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 14 FULL THREAD 206.014
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967029
|
|
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 14 FULL THREAD 206.014
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967029
|
|
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 14 LP AR-8840-14
|
Facility
|
IP
|
$652.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415205
|
|
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
|
|
