|
SCREW CORT 3.5 X 56MM LOW PROFILE 02.206.256
|
Facility
|
OP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3937361
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$145.32 |
| Max. Negotiated Rate |
$2,076.00 |
| Rate for Payer: Aetna Commercial |
$467.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$446.34
|
| Rate for Payer: Aetna Managed Medicare |
$145.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$337.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$259.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$249.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$275.07
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna Commercial |
$477.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$290.43
|
| Rate for Payer: Health EOS Commercial |
$461.91
|
| Rate for Payer: HFN Commercial |
$477.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$389.25
|
| Rate for Payer: Multiplan Commercial |
$415.20
|
| Rate for Payer: NAPHCARE Commercial |
$311.40
|
| Rate for Payer: Preferred Network Access Commercial |
$477.48
|
| Rate for Payer: Quartz Beloit One Network |
$254.31
|
| Rate for Payer: Quartz Commercial |
$337.35
|
| Rate for Payer: Quartz Medicare Advantage |
$311.40
|
| Rate for Payer: The Alliance Commercial |
$2,076.00
|
| Rate for Payer: WEA Trust Commercial |
$285.45
|
| Rate for Payer: WPS Commercial |
$384.42
|
|
|
SCREW-CORT 3.5 X 60 204.860
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415207
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$191.10 |
| Max. Negotiated Rate |
$358.80 |
| Rate for Payer: Aetna Commercial |
$351.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$335.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$206.70
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cigna Commercial |
$358.80
|
| Rate for Payer: Health EOS Commercial |
$347.10
|
| Rate for Payer: HFN Commercial |
$358.80
|
| Rate for Payer: Multiplan Commercial |
$312.00
|
| Rate for Payer: NAPHCARE Commercial |
$234.00
|
| Rate for Payer: Preferred Network Access Commercial |
$358.80
|
| Rate for Payer: Quartz Beloit One Network |
$191.10
|
| Rate for Payer: Quartz Commercial |
$234.00
|
| Rate for Payer: WEA Trust Commercial |
$214.50
|
| Rate for Payer: WPS Commercial |
$288.87
|
|
|
SCREW-CORT 3.5 X 60 204.860
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415207
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$1,560.00 |
| Rate for Payer: Aetna Commercial |
$351.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$335.40
|
| Rate for Payer: Aetna Managed Medicare |
$109.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$253.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$195.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$187.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$206.70
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cigna Commercial |
$358.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$218.24
|
| Rate for Payer: Health EOS Commercial |
$347.10
|
| Rate for Payer: HFN Commercial |
$358.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$292.50
|
| Rate for Payer: Multiplan Commercial |
$312.00
|
| Rate for Payer: NAPHCARE Commercial |
$234.00
|
| Rate for Payer: Preferred Network Access Commercial |
$358.80
|
| Rate for Payer: Quartz Beloit One Network |
$191.10
|
| Rate for Payer: Quartz Commercial |
$253.50
|
| Rate for Payer: Quartz Medicare Advantage |
$234.00
|
| Rate for Payer: The Alliance Commercial |
$1,560.00
|
| Rate for Payer: WEA Trust Commercial |
$214.50
|
| Rate for Payer: WPS Commercial |
$288.87
|
|
|
SCREW CORT 3.5 X 60MM LOW PROFILE 02.206.260
|
Facility
|
OP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3937351
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$145.32 |
| Max. Negotiated Rate |
$2,076.00 |
| Rate for Payer: Aetna Commercial |
$467.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$446.34
|
| Rate for Payer: Aetna Managed Medicare |
$145.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$337.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$259.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$249.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$275.07
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna Commercial |
$477.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$290.43
|
| Rate for Payer: Health EOS Commercial |
$461.91
|
| Rate for Payer: HFN Commercial |
$477.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$389.25
|
| Rate for Payer: Multiplan Commercial |
$415.20
|
| Rate for Payer: NAPHCARE Commercial |
$311.40
|
| Rate for Payer: Preferred Network Access Commercial |
$477.48
|
| Rate for Payer: Quartz Beloit One Network |
$254.31
|
| Rate for Payer: Quartz Commercial |
$337.35
|
| Rate for Payer: Quartz Medicare Advantage |
$311.40
|
| Rate for Payer: The Alliance Commercial |
$2,076.00
|
| Rate for Payer: WEA Trust Commercial |
$285.45
|
| Rate for Payer: WPS Commercial |
$384.42
|
|
|
SCREW CORT 3.5 X 60MM LOW PROFILE 02.206.260
|
Facility
|
IP
|
$519.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3937351
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$254.31 |
| Max. Negotiated Rate |
$477.48 |
| Rate for Payer: Aetna Commercial |
$467.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$446.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$275.07
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna Commercial |
$477.48
|
| Rate for Payer: Health EOS Commercial |
$461.91
|
| Rate for Payer: HFN Commercial |
$477.48
|
| Rate for Payer: Multiplan Commercial |
$415.20
|
| Rate for Payer: NAPHCARE Commercial |
$311.40
|
| Rate for Payer: Preferred Network Access Commercial |
$477.48
|
| Rate for Payer: Quartz Beloit One Network |
$254.31
|
| Rate for Payer: Quartz Commercial |
$311.40
|
| Rate for Payer: WEA Trust Commercial |
$285.45
|
| Rate for Payer: WPS Commercial |
$384.42
|
|
|
SCREW-CORT 3.5 X 65 204.865
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966906
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$58.31 |
| Max. Negotiated Rate |
$109.48 |
| Rate for Payer: Aetna Commercial |
$107.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$102.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.07
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: Cigna Commercial |
$109.48
|
| Rate for Payer: Health EOS Commercial |
$105.91
|
| Rate for Payer: HFN Commercial |
$109.48
|
| Rate for Payer: Multiplan Commercial |
$95.20
|
| Rate for Payer: NAPHCARE Commercial |
$71.40
|
| Rate for Payer: Preferred Network Access Commercial |
$109.48
|
| Rate for Payer: Quartz Beloit One Network |
$58.31
|
| Rate for Payer: Quartz Commercial |
$71.40
|
| Rate for Payer: WEA Trust Commercial |
$65.45
|
| Rate for Payer: WPS Commercial |
$88.14
|
|
|
SCREW-CORT 3.5 X 65 204.865
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966906
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$33.32 |
| Max. Negotiated Rate |
$476.00 |
| Rate for Payer: Aetna Commercial |
$107.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$102.34
|
| Rate for Payer: Aetna Managed Medicare |
$33.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$77.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$59.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$57.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.07
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: Cigna Commercial |
$109.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66.59
|
| Rate for Payer: Health EOS Commercial |
$105.91
|
| Rate for Payer: HFN Commercial |
$109.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$89.25
|
| Rate for Payer: Multiplan Commercial |
$95.20
|
| Rate for Payer: NAPHCARE Commercial |
$71.40
|
| Rate for Payer: Preferred Network Access Commercial |
$109.48
|
| Rate for Payer: Quartz Beloit One Network |
$58.31
|
| Rate for Payer: Quartz Commercial |
$77.35
|
| Rate for Payer: Quartz Medicare Advantage |
$71.40
|
| Rate for Payer: The Alliance Commercial |
$476.00
|
| Rate for Payer: WEA Trust Commercial |
$65.45
|
| Rate for Payer: WPS Commercial |
$88.14
|
|
|
SCREW-CORT 3.5 X 80 204.880
|
Facility
|
IP
|
$413.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5264686
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$202.37 |
| Max. Negotiated Rate |
$379.96 |
| Rate for Payer: Aetna Commercial |
$371.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$355.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$218.89
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: Cigna Commercial |
$379.96
|
| Rate for Payer: Health EOS Commercial |
$367.57
|
| Rate for Payer: HFN Commercial |
$379.96
|
| Rate for Payer: Multiplan Commercial |
$330.40
|
| Rate for Payer: NAPHCARE Commercial |
$247.80
|
| Rate for Payer: Preferred Network Access Commercial |
$379.96
|
| Rate for Payer: Quartz Beloit One Network |
$202.37
|
| Rate for Payer: Quartz Commercial |
$247.80
|
| Rate for Payer: WEA Trust Commercial |
$227.15
|
| Rate for Payer: WPS Commercial |
$305.91
|
|
|
SCREW-CORT 3.5 X 80 204.880
|
Facility
|
OP
|
$413.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5264686
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$115.64 |
| Max. Negotiated Rate |
$1,652.00 |
| Rate for Payer: Aetna Commercial |
$371.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$355.18
|
| Rate for Payer: Aetna Managed Medicare |
$115.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$268.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$206.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$198.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$218.89
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: Cigna Commercial |
$379.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$231.11
|
| Rate for Payer: Health EOS Commercial |
$367.57
|
| Rate for Payer: HFN Commercial |
$379.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$309.75
|
| Rate for Payer: Multiplan Commercial |
$330.40
|
| Rate for Payer: NAPHCARE Commercial |
$247.80
|
| Rate for Payer: Preferred Network Access Commercial |
$379.96
|
| Rate for Payer: Quartz Beloit One Network |
$202.37
|
| Rate for Payer: Quartz Commercial |
$268.45
|
| Rate for Payer: Quartz Medicare Advantage |
$247.80
|
| Rate for Payer: The Alliance Commercial |
$1,652.00
|
| Rate for Payer: WEA Trust Commercial |
$227.15
|
| Rate for Payer: WPS Commercial |
$305.91
|
|
|
SCREW CORT 3.5 X 8MM LP AR-8835-08
|
Facility
|
IP
|
$652.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5306832
|
|
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 CORT 3.5 X 8MM LP AR-8835-08
|
Facility
|
OP
|
$652.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5306832
|
|
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-CORT 4.5 X 14 214.014
|
Facility
|
OP
|
$279.00
|
|
| Hospital Charge Code |
2967296
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$78.12 |
| Max. Negotiated Rate |
$1,116.00 |
| Rate for Payer: Aetna Commercial |
$251.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$239.94
|
| Rate for Payer: Aetna Managed Medicare |
$78.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$181.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$139.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$133.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$147.87
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna Commercial |
$256.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$156.13
|
| Rate for Payer: Health EOS Commercial |
$248.31
|
| Rate for Payer: HFN Commercial |
$256.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$209.25
|
| Rate for Payer: Multiplan Commercial |
$223.20
|
| Rate for Payer: NAPHCARE Commercial |
$167.40
|
| Rate for Payer: Preferred Network Access Commercial |
$256.68
|
| Rate for Payer: Quartz Beloit One Network |
$136.71
|
| Rate for Payer: Quartz Commercial |
$181.35
|
| Rate for Payer: Quartz Medicare Advantage |
$167.40
|
| Rate for Payer: The Alliance Commercial |
$1,116.00
|
| Rate for Payer: WEA Trust Commercial |
$153.45
|
| Rate for Payer: WPS Commercial |
$206.66
|
|
|
SCREW-CORT 4.5 X 14 214.014
|
Facility
|
IP
|
$279.00
|
|
| Hospital Charge Code |
2967296
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$136.71 |
| Max. Negotiated Rate |
$256.68 |
| Rate for Payer: Aetna Commercial |
$251.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$239.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$147.87
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna Commercial |
$256.68
|
| Rate for Payer: Health EOS Commercial |
$248.31
|
| Rate for Payer: HFN Commercial |
$256.68
|
| Rate for Payer: Multiplan Commercial |
$223.20
|
| Rate for Payer: NAPHCARE Commercial |
$167.40
|
| Rate for Payer: Preferred Network Access Commercial |
$256.68
|
| Rate for Payer: Quartz Beloit One Network |
$136.71
|
| Rate for Payer: Quartz Commercial |
$167.40
|
| Rate for Payer: WEA Trust Commercial |
$153.45
|
| Rate for Payer: WPS Commercial |
$206.66
|
|
|
SCREW CORT 4.5 X 14 214.814
|
Facility
|
IP
|
$484.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966920
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$237.16 |
| Max. Negotiated Rate |
$445.28 |
| Rate for Payer: Aetna Commercial |
$435.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$416.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$256.52
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$445.28
|
| Rate for Payer: Health EOS Commercial |
$430.76
|
| Rate for Payer: HFN Commercial |
$445.28
|
| Rate for Payer: Multiplan Commercial |
$387.20
|
| Rate for Payer: NAPHCARE Commercial |
$290.40
|
| Rate for Payer: Preferred Network Access Commercial |
$445.28
|
| Rate for Payer: Quartz Beloit One Network |
$237.16
|
| Rate for Payer: Quartz Commercial |
$290.40
|
| Rate for Payer: WEA Trust Commercial |
$266.20
|
| Rate for Payer: WPS Commercial |
$358.50
|
|
|
SCREW CORT 4.5 X 14 214.814
|
Facility
|
OP
|
$484.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966920
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$135.52 |
| Max. Negotiated Rate |
$1,936.00 |
| Rate for Payer: Aetna Commercial |
$435.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$416.24
|
| Rate for Payer: Aetna Managed Medicare |
$135.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$314.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$242.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$232.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$256.52
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$445.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$270.85
|
| Rate for Payer: Health EOS Commercial |
$430.76
|
| Rate for Payer: HFN Commercial |
$445.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$363.00
|
| Rate for Payer: Multiplan Commercial |
$387.20
|
| Rate for Payer: NAPHCARE Commercial |
$290.40
|
| Rate for Payer: Preferred Network Access Commercial |
$445.28
|
| Rate for Payer: Quartz Beloit One Network |
$237.16
|
| Rate for Payer: Quartz Commercial |
$314.60
|
| Rate for Payer: Quartz Medicare Advantage |
$290.40
|
| Rate for Payer: The Alliance Commercial |
$1,936.00
|
| Rate for Payer: WEA Trust Commercial |
$266.20
|
| Rate for Payer: WPS Commercial |
$358.50
|
|
|
SCREW CORT 4.5 X 14MM SELF-TAP 661714
|
Facility
|
IP
|
$796.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5146616
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$390.04 |
| Max. Negotiated Rate |
$732.32 |
| Rate for Payer: Aetna Commercial |
$716.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$684.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$421.88
|
| Rate for Payer: Cash Price |
$238.80
|
| Rate for Payer: Cigna Commercial |
$732.32
|
| Rate for Payer: Health EOS Commercial |
$708.44
|
| Rate for Payer: HFN Commercial |
$732.32
|
| Rate for Payer: Multiplan Commercial |
$636.80
|
| Rate for Payer: NAPHCARE Commercial |
$477.60
|
| Rate for Payer: Preferred Network Access Commercial |
$732.32
|
| Rate for Payer: Quartz Beloit One Network |
$390.04
|
| Rate for Payer: Quartz Commercial |
$477.60
|
| Rate for Payer: WEA Trust Commercial |
$437.80
|
| Rate for Payer: WPS Commercial |
$589.60
|
|
|
SCREW CORT 4.5 X 14MM SELF-TAP 661714
|
Facility
|
OP
|
$796.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5146616
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$222.88 |
| Max. Negotiated Rate |
$3,184.00 |
| Rate for Payer: Aetna Commercial |
$716.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$684.56
|
| Rate for Payer: Aetna Managed Medicare |
$222.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$517.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$398.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$382.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$421.88
|
| Rate for Payer: Cash Price |
$238.80
|
| Rate for Payer: Cigna Commercial |
$732.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$445.44
|
| Rate for Payer: Health EOS Commercial |
$708.44
|
| Rate for Payer: HFN Commercial |
$732.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$597.00
|
| Rate for Payer: Multiplan Commercial |
$636.80
|
| Rate for Payer: NAPHCARE Commercial |
$477.60
|
| Rate for Payer: Preferred Network Access Commercial |
$732.32
|
| Rate for Payer: Quartz Beloit One Network |
$390.04
|
| Rate for Payer: Quartz Commercial |
$517.40
|
| Rate for Payer: Quartz Medicare Advantage |
$477.60
|
| Rate for Payer: The Alliance Commercial |
$3,184.00
|
| Rate for Payer: WEA Trust Commercial |
$437.80
|
| Rate for Payer: WPS Commercial |
$589.60
|
|
|
SCREW-CORT 4.5 X 16 214.016
|
Facility
|
OP
|
$279.00
|
|
| Hospital Charge Code |
2967297
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$78.12 |
| Max. Negotiated Rate |
$1,116.00 |
| Rate for Payer: Aetna Commercial |
$251.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$239.94
|
| Rate for Payer: Aetna Managed Medicare |
$78.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$181.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$139.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$133.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$147.87
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna Commercial |
$256.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$156.13
|
| Rate for Payer: Health EOS Commercial |
$248.31
|
| Rate for Payer: HFN Commercial |
$256.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$209.25
|
| Rate for Payer: Multiplan Commercial |
$223.20
|
| Rate for Payer: NAPHCARE Commercial |
$167.40
|
| Rate for Payer: Preferred Network Access Commercial |
$256.68
|
| Rate for Payer: Quartz Beloit One Network |
$136.71
|
| Rate for Payer: Quartz Commercial |
$181.35
|
| Rate for Payer: Quartz Medicare Advantage |
$167.40
|
| Rate for Payer: The Alliance Commercial |
$1,116.00
|
| Rate for Payer: WEA Trust Commercial |
$153.45
|
| Rate for Payer: WPS Commercial |
$206.66
|
|
|
SCREW-CORT 4.5 X 16 214.016
|
Facility
|
IP
|
$279.00
|
|
| Hospital Charge Code |
2967297
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$136.71 |
| Max. Negotiated Rate |
$256.68 |
| Rate for Payer: Aetna Commercial |
$251.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$239.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$147.87
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna Commercial |
$256.68
|
| Rate for Payer: Health EOS Commercial |
$248.31
|
| Rate for Payer: HFN Commercial |
$256.68
|
| Rate for Payer: Multiplan Commercial |
$223.20
|
| Rate for Payer: NAPHCARE Commercial |
$167.40
|
| Rate for Payer: Preferred Network Access Commercial |
$256.68
|
| Rate for Payer: Quartz Beloit One Network |
$136.71
|
| Rate for Payer: Quartz Commercial |
$167.40
|
| Rate for Payer: WEA Trust Commercial |
$153.45
|
| Rate for Payer: WPS Commercial |
$206.66
|
|
|
SCREW CORT 4.5 X 20MM 340620
|
Facility
|
OP
|
$464.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5106940
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$129.92 |
| Max. Negotiated Rate |
$1,856.00 |
| Rate for Payer: Aetna Commercial |
$417.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$399.04
|
| Rate for Payer: Aetna Managed Medicare |
$129.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$301.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$232.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$222.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$245.92
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cigna Commercial |
$426.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$259.65
|
| Rate for Payer: Health EOS Commercial |
$412.96
|
| Rate for Payer: HFN Commercial |
$426.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$348.00
|
| Rate for Payer: Multiplan Commercial |
$371.20
|
| Rate for Payer: NAPHCARE Commercial |
$278.40
|
| Rate for Payer: Preferred Network Access Commercial |
$426.88
|
| Rate for Payer: Quartz Beloit One Network |
$227.36
|
| Rate for Payer: Quartz Commercial |
$301.60
|
| Rate for Payer: Quartz Medicare Advantage |
$278.40
|
| Rate for Payer: The Alliance Commercial |
$1,856.00
|
| Rate for Payer: WEA Trust Commercial |
$255.20
|
| Rate for Payer: WPS Commercial |
$343.68
|
|
|
SCREW CORT 4.5 X 20MM 340620
|
Facility
|
IP
|
$464.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5106940
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$227.36 |
| Max. Negotiated Rate |
$426.88 |
| Rate for Payer: Aetna Commercial |
$417.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$399.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$245.92
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cigna Commercial |
$426.88
|
| Rate for Payer: Health EOS Commercial |
$412.96
|
| Rate for Payer: HFN Commercial |
$426.88
|
| Rate for Payer: Multiplan Commercial |
$371.20
|
| Rate for Payer: NAPHCARE Commercial |
$278.40
|
| Rate for Payer: Preferred Network Access Commercial |
$426.88
|
| Rate for Payer: Quartz Beloit One Network |
$227.36
|
| Rate for Payer: Quartz Commercial |
$278.40
|
| Rate for Payer: WEA Trust Commercial |
$255.20
|
| Rate for Payer: WPS Commercial |
$343.68
|
|
|
SCREW-CORT 4.5 X 24 214.024
|
Facility
|
OP
|
$279.00
|
|
| Hospital Charge Code |
2967298
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$78.12 |
| Max. Negotiated Rate |
$1,116.00 |
| Rate for Payer: Aetna Commercial |
$251.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$239.94
|
| Rate for Payer: Aetna Managed Medicare |
$78.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$181.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$139.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$133.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$147.87
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna Commercial |
$256.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$156.13
|
| Rate for Payer: Health EOS Commercial |
$248.31
|
| Rate for Payer: HFN Commercial |
$256.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$209.25
|
| Rate for Payer: Multiplan Commercial |
$223.20
|
| Rate for Payer: NAPHCARE Commercial |
$167.40
|
| Rate for Payer: Preferred Network Access Commercial |
$256.68
|
| Rate for Payer: Quartz Beloit One Network |
$136.71
|
| Rate for Payer: Quartz Commercial |
$181.35
|
| Rate for Payer: Quartz Medicare Advantage |
$167.40
|
| Rate for Payer: The Alliance Commercial |
$1,116.00
|
| Rate for Payer: WEA Trust Commercial |
$153.45
|
| Rate for Payer: WPS Commercial |
$206.66
|
|
|
SCREW-CORT 4.5 X 24 214.024
|
Facility
|
IP
|
$279.00
|
|
| Hospital Charge Code |
2967298
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$136.71 |
| Max. Negotiated Rate |
$256.68 |
| Rate for Payer: Aetna Commercial |
$251.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$239.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$147.87
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna Commercial |
$256.68
|
| Rate for Payer: Health EOS Commercial |
$248.31
|
| Rate for Payer: HFN Commercial |
$256.68
|
| Rate for Payer: Multiplan Commercial |
$223.20
|
| Rate for Payer: NAPHCARE Commercial |
$167.40
|
| Rate for Payer: Preferred Network Access Commercial |
$256.68
|
| Rate for Payer: Quartz Beloit One Network |
$136.71
|
| Rate for Payer: Quartz Commercial |
$167.40
|
| Rate for Payer: WEA Trust Commercial |
$153.45
|
| Rate for Payer: WPS Commercial |
$206.66
|
|
|
SCREW CORT 4.5 X 24MM SELF-TAP 661724
|
Facility
|
OP
|
$828.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6175224
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$231.84 |
| Max. Negotiated Rate |
$3,312.00 |
| Rate for Payer: Aetna Commercial |
$745.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$712.08
|
| Rate for Payer: Aetna Managed Medicare |
$231.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$538.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$414.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$397.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$438.84
|
| Rate for Payer: Cash Price |
$248.40
|
| Rate for Payer: Cigna Commercial |
$761.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$463.35
|
| Rate for Payer: Health EOS Commercial |
$736.92
|
| Rate for Payer: HFN Commercial |
$761.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$621.00
|
| Rate for Payer: Multiplan Commercial |
$662.40
|
| Rate for Payer: NAPHCARE Commercial |
$496.80
|
| Rate for Payer: Preferred Network Access Commercial |
$761.76
|
| Rate for Payer: Quartz Beloit One Network |
$405.72
|
| Rate for Payer: Quartz Commercial |
$538.20
|
| Rate for Payer: Quartz Medicare Advantage |
$496.80
|
| Rate for Payer: The Alliance Commercial |
$3,312.00
|
| Rate for Payer: WEA Trust Commercial |
$455.40
|
| Rate for Payer: WPS Commercial |
$613.30
|
|
|
SCREW CORT 4.5 X 24MM SELF-TAP 661724
|
Facility
|
IP
|
$828.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6175224
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$405.72 |
| Max. Negotiated Rate |
$761.76 |
| Rate for Payer: Aetna Commercial |
$745.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$712.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$438.84
|
| Rate for Payer: Cash Price |
$248.40
|
| Rate for Payer: Cigna Commercial |
$761.76
|
| Rate for Payer: Health EOS Commercial |
$736.92
|
| Rate for Payer: HFN Commercial |
$761.76
|
| Rate for Payer: Multiplan Commercial |
$662.40
|
| Rate for Payer: NAPHCARE Commercial |
$496.80
|
| Rate for Payer: Preferred Network Access Commercial |
$761.76
|
| Rate for Payer: Quartz Beloit One Network |
$405.72
|
| Rate for Payer: Quartz Commercial |
$496.80
|
| Rate for Payer: WEA Trust Commercial |
$455.40
|
| Rate for Payer: WPS Commercial |
$613.30
|
|
