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 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
|
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
|
|
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 45 FULL THREAD 206.045
|
Facility
|
IP
|
$171.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
2967051
|
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 45 FULL THREAD 206.045
|
Facility
|
OP
|
$171.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
2967051
|
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 45 PART THREAD 207.045
|
Facility
|
OP
|
$218.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
2967052
|
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 45 PART THREAD 207.045
|
Facility
|
IP
|
$218.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
2967052
|
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 48 LP AR-8840-48
|
Facility
|
IP
|
$603.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
6171772
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$295.47 |
Max. Negotiated Rate |
$554.76 |
Rate for Payer: Aetna Commercial |
$542.70
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$518.58
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$319.59
|
Rate for Payer: Cash Price |
$180.90
|
Rate for Payer: Cigna Commercial |
$554.76
|
Rate for Payer: Health EOS Commercial |
$536.67
|
Rate for Payer: HFN Commercial |
$554.76
|
Rate for Payer: Multiplan Commercial |
$482.40
|
Rate for Payer: NAPHCARE Commercial |
$361.80
|
Rate for Payer: Preferred Network Access Commercial |
$554.76
|
Rate for Payer: Quartz Beloit One Network |
$295.47
|
Rate for Payer: Quartz Commercial |
$361.80
|
Rate for Payer: WEA Trust Commercial |
$331.65
|
Rate for Payer: WPS Commercial |
$446.64
|
|
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 |
$168.84 |
Max. Negotiated Rate |
$2,412.00 |
Rate for Payer: Aetna Commercial |
$542.70
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$518.58
|
Rate for Payer: Aetna Managed Medicare |
$168.84
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$391.95
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$301.50
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$289.44
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$319.59
|
Rate for Payer: Cash Price |
$180.90
|
Rate for Payer: Cigna Commercial |
$554.76
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$337.44
|
Rate for Payer: Health EOS Commercial |
$536.67
|
Rate for Payer: HFN Commercial |
$554.76
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$452.25
|
Rate for Payer: Multiplan Commercial |
$482.40
|
Rate for Payer: NAPHCARE Commercial |
$361.80
|
Rate for Payer: Preferred Network Access Commercial |
$554.76
|
Rate for Payer: Quartz Beloit One Network |
$295.47
|
Rate for Payer: Quartz Commercial |
$391.95
|
Rate for Payer: Quartz Medicare Advantage |
$361.80
|
Rate for Payer: The Alliance Commercial |
$2,412.00
|
Rate for Payer: WEA Trust Commercial |
$331.65
|
Rate for Payer: WPS Commercial |
$446.64
|
|
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 |
$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 50 FULL THREAD 206.050
|
Facility
|
IP
|
$178.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
2967053
|
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 50 PART THREAD 207.050
|
Facility
|
IP
|
$210.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
2967054
|
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 50 PART THREAD 207.050
|
Facility
|
OP
|
$210.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
2967054
|
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 55 FULL THREAD 206.055
|
Facility
|
IP
|
$496.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
4494437
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$243.04 |
Max. Negotiated Rate |
$456.32 |
Rate for Payer: Aetna Commercial |
$446.40
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$426.56
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$262.88
|
Rate for Payer: Cash Price |
$148.80
|
Rate for Payer: Cigna Commercial |
$456.32
|
Rate for Payer: Health EOS Commercial |
$441.44
|
Rate for Payer: HFN Commercial |
$456.32
|
Rate for Payer: Multiplan Commercial |
$396.80
|
Rate for Payer: NAPHCARE Commercial |
$297.60
|
Rate for Payer: Preferred Network Access Commercial |
$456.32
|
Rate for Payer: Quartz Beloit One Network |
$243.04
|
Rate for Payer: Quartz Commercial |
$297.60
|
Rate for Payer: WEA Trust Commercial |
$272.80
|
Rate for Payer: WPS Commercial |
$367.39
|
|
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 |
$138.88 |
Max. Negotiated Rate |
$1,984.00 |
Rate for Payer: Aetna Commercial |
$446.40
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$426.56
|
Rate for Payer: Aetna Managed Medicare |
$138.88
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$322.40
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$248.00
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$238.08
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$262.88
|
Rate for Payer: Cash Price |
$148.80
|
Rate for Payer: Cigna Commercial |
$456.32
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$277.56
|
Rate for Payer: Health EOS Commercial |
$441.44
|
Rate for Payer: HFN Commercial |
$456.32
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$372.00
|
Rate for Payer: Multiplan Commercial |
$396.80
|
Rate for Payer: NAPHCARE Commercial |
$297.60
|
Rate for Payer: Preferred Network Access Commercial |
$456.32
|
Rate for Payer: Quartz Beloit One Network |
$243.04
|
Rate for Payer: Quartz Commercial |
$322.40
|
Rate for Payer: Quartz Medicare Advantage |
$297.60
|
Rate for Payer: The Alliance Commercial |
$1,984.00
|
Rate for Payer: WEA Trust Commercial |
$272.80
|
Rate for Payer: WPS Commercial |
$367.39
|
|
SCREW CANC 4.0 X 60 FULL THREAD 206.060
|
Facility
|
IP
|
$496.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
4494438
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$243.04 |
Max. Negotiated Rate |
$456.32 |
Rate for Payer: Aetna Commercial |
$446.40
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$426.56
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$262.88
|
Rate for Payer: Cash Price |
$148.80
|
Rate for Payer: Cigna Commercial |
$456.32
|
Rate for Payer: Health EOS Commercial |
$441.44
|
Rate for Payer: HFN Commercial |
$456.32
|
Rate for Payer: Multiplan Commercial |
$396.80
|
Rate for Payer: NAPHCARE Commercial |
$297.60
|
Rate for Payer: Preferred Network Access Commercial |
$456.32
|
Rate for Payer: Quartz Beloit One Network |
$243.04
|
Rate for Payer: Quartz Commercial |
$297.60
|
Rate for Payer: WEA Trust Commercial |
$272.80
|
Rate for Payer: WPS Commercial |
$367.39
|
|
SCREW CANC 4.0 X 60 FULL THREAD 206.060
|
Facility
|
OP
|
$496.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
4494438
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$138.88 |
Max. Negotiated Rate |
$1,984.00 |
Rate for Payer: Aetna Commercial |
$446.40
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$426.56
|
Rate for Payer: Aetna Managed Medicare |
$138.88
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$322.40
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$248.00
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$238.08
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$262.88
|
Rate for Payer: Cash Price |
$148.80
|
Rate for Payer: Cigna Commercial |
$456.32
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$277.56
|
Rate for Payer: Health EOS Commercial |
$441.44
|
Rate for Payer: HFN Commercial |
$456.32
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$372.00
|
Rate for Payer: Multiplan Commercial |
$396.80
|
Rate for Payer: NAPHCARE Commercial |
$297.60
|
Rate for Payer: Preferred Network Access Commercial |
$456.32
|
Rate for Payer: Quartz Beloit One Network |
$243.04
|
Rate for Payer: Quartz Commercial |
$322.40
|
Rate for Payer: Quartz Medicare Advantage |
$297.60
|
Rate for Payer: The Alliance Commercial |
$1,984.00
|
Rate for Payer: WEA Trust Commercial |
$272.80
|
Rate for Payer: WPS Commercial |
$367.39
|
|
SCREW CANC 4.0 X 80 FULL THREAD 206.080
|
Facility
|
IP
|
$423.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
5264967
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$207.27 |
Max. Negotiated Rate |
$389.16 |
Rate for Payer: Aetna Commercial |
$380.70
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$363.78
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$224.19
|
Rate for Payer: Cash Price |
$126.90
|
Rate for Payer: Cigna Commercial |
$389.16
|
Rate for Payer: Health EOS Commercial |
$376.47
|
Rate for Payer: HFN Commercial |
$389.16
|
Rate for Payer: Multiplan Commercial |
$338.40
|
Rate for Payer: NAPHCARE Commercial |
$253.80
|
Rate for Payer: Preferred Network Access Commercial |
$389.16
|
Rate for Payer: Quartz Beloit One Network |
$207.27
|
Rate for Payer: Quartz Commercial |
$253.80
|
Rate for Payer: WEA Trust Commercial |
$232.65
|
Rate for Payer: WPS Commercial |
$313.32
|
|
SCREW CANC 4.0 X 80 FULL THREAD 206.080
|
Facility
|
OP
|
$423.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
5264967
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$118.44 |
Max. Negotiated Rate |
$1,692.00 |
Rate for Payer: Aetna Commercial |
$380.70
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$363.78
|
Rate for Payer: Aetna Managed Medicare |
$118.44
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$274.95
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$211.50
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$203.04
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$224.19
|
Rate for Payer: Cash Price |
$126.90
|
Rate for Payer: Cigna Commercial |
$389.16
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$236.71
|
Rate for Payer: Health EOS Commercial |
$376.47
|
Rate for Payer: HFN Commercial |
$389.16
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$317.25
|
Rate for Payer: Multiplan Commercial |
$338.40
|
Rate for Payer: NAPHCARE Commercial |
$253.80
|
Rate for Payer: Preferred Network Access Commercial |
$389.16
|
Rate for Payer: Quartz Beloit One Network |
$207.27
|
Rate for Payer: Quartz Commercial |
$274.95
|
Rate for Payer: Quartz Medicare Advantage |
$253.80
|
Rate for Payer: The Alliance Commercial |
$1,692.00
|
Rate for Payer: WEA Trust Commercial |
$232.65
|
Rate for Payer: WPS Commercial |
$313.32
|
|
SCREW CANC 5.5 X 60MM LP TI AR-8555-60
|
Facility
|
OP
|
$1,198.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
5603791
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$335.44 |
Max. Negotiated Rate |
$4,792.00 |
Rate for Payer: Aetna Commercial |
$1,078.20
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,030.28
|
Rate for Payer: Aetna Managed Medicare |
$335.44
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$778.70
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$599.00
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$575.04
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$634.94
|
Rate for Payer: Cash Price |
$359.40
|
Rate for Payer: Cigna Commercial |
$1,102.16
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$670.40
|
Rate for Payer: Health EOS Commercial |
$1,066.22
|
Rate for Payer: HFN Commercial |
$1,102.16
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$898.50
|
Rate for Payer: Multiplan Commercial |
$958.40
|
Rate for Payer: NAPHCARE Commercial |
$718.80
|
Rate for Payer: Preferred Network Access Commercial |
$1,102.16
|
Rate for Payer: Quartz Beloit One Network |
$587.02
|
Rate for Payer: Quartz Commercial |
$778.70
|
Rate for Payer: Quartz Medicare Advantage |
$718.80
|
Rate for Payer: The Alliance Commercial |
$4,792.00
|
Rate for Payer: WEA Trust Commercial |
$658.90
|
Rate for Payer: WPS Commercial |
$887.36
|
|
SCREW CANC 5.5 X 60MM LP TI AR-8555-60
|
Facility
|
IP
|
$1,198.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
5603791
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$587.02 |
Max. Negotiated Rate |
$1,102.16 |
Rate for Payer: Aetna Commercial |
$1,078.20
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,030.28
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$634.94
|
Rate for Payer: Cash Price |
$359.40
|
Rate for Payer: Cigna Commercial |
$1,102.16
|
Rate for Payer: Health EOS Commercial |
$1,066.22
|
Rate for Payer: HFN Commercial |
$1,102.16
|
Rate for Payer: Multiplan Commercial |
$958.40
|
Rate for Payer: NAPHCARE Commercial |
$718.80
|
Rate for Payer: Preferred Network Access Commercial |
$1,102.16
|
Rate for Payer: Quartz Beloit One Network |
$587.02
|
Rate for Payer: Quartz Commercial |
$718.80
|
Rate for Payer: WEA Trust Commercial |
$658.90
|
Rate for Payer: WPS Commercial |
$887.36
|
|