|
SCREW CORT 4.5 X 42MM SELF-TAP 661742
|
Facility
|
IP
|
$828.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5146617
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$421.95 |
| Max. Negotiated Rate |
$792.23 |
| Rate for Payer: Aetna Commercial |
$775.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$740.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$456.39
|
| Rate for Payer: Cash Price |
$248.40
|
| Rate for Payer: Cigna Commercial |
$792.23
|
| Rate for Payer: Health EOS Commercial |
$766.40
|
| Rate for Payer: HFN Commercial |
$792.23
|
| Rate for Payer: Multiplan Commercial |
$688.90
|
| Rate for Payer: Preferred Network Access Commercial |
$792.23
|
| Rate for Payer: Quartz Beloit One Network |
$421.95
|
| Rate for Payer: Quartz Commercial |
$516.67
|
| Rate for Payer: WEA Trust Commercial |
$473.62
|
| Rate for Payer: WPS Commercial |
$637.81
|
|
|
SCREW CORT 4.5 X 42MM SELF-TAP 661742
|
Facility
|
OP
|
$828.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5146617
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$241.11 |
| Max. Negotiated Rate |
$792.23 |
| Rate for Payer: Aetna Commercial |
$775.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$740.56
|
| Rate for Payer: Aetna Managed Medicare |
$241.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$559.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$430.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$413.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$456.39
|
| Rate for Payer: Cash Price |
$248.40
|
| Rate for Payer: Cigna Commercial |
$792.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$481.90
|
| Rate for Payer: Health EOS Commercial |
$766.40
|
| Rate for Payer: HFN Commercial |
$792.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$645.84
|
| Rate for Payer: Multiplan Commercial |
$688.90
|
| Rate for Payer: NAPHCARE Commercial |
$516.67
|
| Rate for Payer: Preferred Network Access Commercial |
$792.23
|
| Rate for Payer: Quartz Beloit One Network |
$421.95
|
| Rate for Payer: Quartz Commercial |
$559.73
|
| Rate for Payer: Quartz Medicare Advantage |
$516.67
|
| Rate for Payer: The Alliance Commercial |
$430.56
|
| Rate for Payer: WEA Trust Commercial |
$473.62
|
| Rate for Payer: WPS Commercial |
$637.81
|
|
|
SCREW-CORT 4.5 X 44 214.044***DISC
|
Facility
|
IP
|
$279.00
|
|
| Hospital Charge Code |
2967308
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$142.18 |
| Max. Negotiated Rate |
$266.95 |
| Rate for Payer: Aetna Commercial |
$261.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$249.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$153.78
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna Commercial |
$266.95
|
| Rate for Payer: Health EOS Commercial |
$258.24
|
| Rate for Payer: HFN Commercial |
$266.95
|
| Rate for Payer: Multiplan Commercial |
$232.13
|
| Rate for Payer: Preferred Network Access Commercial |
$266.95
|
| Rate for Payer: Quartz Beloit One Network |
$142.18
|
| Rate for Payer: Quartz Commercial |
$174.10
|
| Rate for Payer: WEA Trust Commercial |
$159.59
|
| Rate for Payer: WPS Commercial |
$214.91
|
|
|
SCREW-CORT 4.5 X 44 214.044***DISC
|
Facility
|
OP
|
$279.00
|
|
| Hospital Charge Code |
2967308
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.24 |
| Max. Negotiated Rate |
$266.95 |
| Rate for Payer: Aetna Commercial |
$261.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$249.54
|
| Rate for Payer: Aetna Managed Medicare |
$81.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$188.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$145.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$139.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$153.78
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna Commercial |
$266.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$162.38
|
| Rate for Payer: Health EOS Commercial |
$258.24
|
| Rate for Payer: HFN Commercial |
$266.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$217.62
|
| Rate for Payer: Multiplan Commercial |
$232.13
|
| Rate for Payer: NAPHCARE Commercial |
$174.10
|
| Rate for Payer: Preferred Network Access Commercial |
$266.95
|
| Rate for Payer: Quartz Beloit One Network |
$142.18
|
| Rate for Payer: Quartz Commercial |
$188.60
|
| Rate for Payer: Quartz Medicare Advantage |
$174.10
|
| Rate for Payer: The Alliance Commercial |
$145.08
|
| Rate for Payer: WEA Trust Commercial |
$159.59
|
| Rate for Payer: WPS Commercial |
$214.91
|
|
|
SCREW CORT 4.5 X 44 214.844
|
Facility
|
IP
|
$484.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966935
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$246.65 |
| Max. Negotiated Rate |
$463.09 |
| Rate for Payer: Aetna Commercial |
$453.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$432.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$266.78
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$463.09
|
| Rate for Payer: Health EOS Commercial |
$447.99
|
| Rate for Payer: HFN Commercial |
$463.09
|
| Rate for Payer: Multiplan Commercial |
$402.69
|
| Rate for Payer: Preferred Network Access Commercial |
$463.09
|
| Rate for Payer: Quartz Beloit One Network |
$246.65
|
| Rate for Payer: Quartz Commercial |
$302.02
|
| Rate for Payer: WEA Trust Commercial |
$276.85
|
| Rate for Payer: WPS Commercial |
$372.83
|
|
|
SCREW CORT 4.5 X 44 214.844
|
Facility
|
OP
|
$484.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966935
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.94 |
| Max. Negotiated Rate |
$463.09 |
| Rate for Payer: Aetna Commercial |
$453.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$432.89
|
| Rate for Payer: Aetna Managed Medicare |
$140.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$327.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$251.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$241.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$266.78
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$463.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$281.69
|
| Rate for Payer: Health EOS Commercial |
$447.99
|
| Rate for Payer: HFN Commercial |
$463.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$377.52
|
| Rate for Payer: Multiplan Commercial |
$402.69
|
| Rate for Payer: NAPHCARE Commercial |
$302.02
|
| Rate for Payer: Preferred Network Access Commercial |
$463.09
|
| Rate for Payer: Quartz Beloit One Network |
$246.65
|
| Rate for Payer: Quartz Commercial |
$327.18
|
| Rate for Payer: Quartz Medicare Advantage |
$302.02
|
| Rate for Payer: The Alliance Commercial |
$251.68
|
| Rate for Payer: WEA Trust Commercial |
$276.85
|
| Rate for Payer: WPS Commercial |
$372.83
|
|
|
SCREW CORT 4.5 X 44MM 340644
|
Facility
|
OP
|
$464.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5106941
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$135.12 |
| Max. Negotiated Rate |
$443.96 |
| Rate for Payer: Aetna Commercial |
$434.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$415.00
|
| Rate for Payer: Aetna Managed Medicare |
$135.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$313.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$241.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$231.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$255.76
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cigna Commercial |
$443.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$270.05
|
| Rate for Payer: Health EOS Commercial |
$429.48
|
| Rate for Payer: HFN Commercial |
$443.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$361.92
|
| Rate for Payer: Multiplan Commercial |
$386.05
|
| Rate for Payer: NAPHCARE Commercial |
$289.54
|
| Rate for Payer: Preferred Network Access Commercial |
$443.96
|
| Rate for Payer: Quartz Beloit One Network |
$236.45
|
| Rate for Payer: Quartz Commercial |
$313.66
|
| Rate for Payer: Quartz Medicare Advantage |
$289.54
|
| Rate for Payer: The Alliance Commercial |
$241.28
|
| Rate for Payer: WEA Trust Commercial |
$265.41
|
| Rate for Payer: WPS Commercial |
$357.42
|
|
|
SCREW CORT 4.5 X 44MM 340644
|
Facility
|
IP
|
$464.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5106941
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$236.45 |
| Max. Negotiated Rate |
$443.96 |
| Rate for Payer: Aetna Commercial |
$434.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$415.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$255.76
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cigna Commercial |
$443.96
|
| Rate for Payer: Health EOS Commercial |
$429.48
|
| Rate for Payer: HFN Commercial |
$443.96
|
| Rate for Payer: Multiplan Commercial |
$386.05
|
| Rate for Payer: Preferred Network Access Commercial |
$443.96
|
| Rate for Payer: Quartz Beloit One Network |
$236.45
|
| Rate for Payer: Quartz Commercial |
$289.54
|
| Rate for Payer: WEA Trust Commercial |
$265.41
|
| Rate for Payer: WPS Commercial |
$357.42
|
|
|
SCREW CORT 4.5 X 44MM SELF-TAP 661744
|
Facility
|
IP
|
$828.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6175232
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$421.95 |
| Max. Negotiated Rate |
$792.23 |
| Rate for Payer: Aetna Commercial |
$775.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$740.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$456.39
|
| Rate for Payer: Cash Price |
$248.40
|
| Rate for Payer: Cigna Commercial |
$792.23
|
| Rate for Payer: Health EOS Commercial |
$766.40
|
| Rate for Payer: HFN Commercial |
$792.23
|
| Rate for Payer: Multiplan Commercial |
$688.90
|
| Rate for Payer: Preferred Network Access Commercial |
$792.23
|
| Rate for Payer: Quartz Beloit One Network |
$421.95
|
| Rate for Payer: Quartz Commercial |
$516.67
|
| Rate for Payer: WEA Trust Commercial |
$473.62
|
| Rate for Payer: WPS Commercial |
$637.81
|
|
|
SCREW CORT 4.5 X 44MM SELF-TAP 661744
|
Facility
|
OP
|
$828.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6175232
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$241.11 |
| Max. Negotiated Rate |
$792.23 |
| Rate for Payer: Aetna Commercial |
$775.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$740.56
|
| Rate for Payer: Aetna Managed Medicare |
$241.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$559.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$430.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$413.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$456.39
|
| Rate for Payer: Cash Price |
$248.40
|
| Rate for Payer: Cigna Commercial |
$792.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$481.90
|
| Rate for Payer: Health EOS Commercial |
$766.40
|
| Rate for Payer: HFN Commercial |
$792.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$645.84
|
| Rate for Payer: Multiplan Commercial |
$688.90
|
| Rate for Payer: NAPHCARE Commercial |
$516.67
|
| Rate for Payer: Preferred Network Access Commercial |
$792.23
|
| Rate for Payer: Quartz Beloit One Network |
$421.95
|
| Rate for Payer: Quartz Commercial |
$559.73
|
| Rate for Payer: Quartz Medicare Advantage |
$516.67
|
| Rate for Payer: The Alliance Commercial |
$430.56
|
| Rate for Payer: WEA Trust Commercial |
$473.62
|
| Rate for Payer: WPS Commercial |
$637.81
|
|
|
SCREW-CORT 4.5 X 46 214.046
|
Facility
|
OP
|
$279.00
|
|
| Hospital Charge Code |
2967309
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.24 |
| Max. Negotiated Rate |
$266.95 |
| Rate for Payer: Aetna Commercial |
$261.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$249.54
|
| Rate for Payer: Aetna Managed Medicare |
$81.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$188.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$145.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$139.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$153.78
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna Commercial |
$266.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$162.38
|
| Rate for Payer: Health EOS Commercial |
$258.24
|
| Rate for Payer: HFN Commercial |
$266.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$217.62
|
| Rate for Payer: Multiplan Commercial |
$232.13
|
| Rate for Payer: NAPHCARE Commercial |
$174.10
|
| Rate for Payer: Preferred Network Access Commercial |
$266.95
|
| Rate for Payer: Quartz Beloit One Network |
$142.18
|
| Rate for Payer: Quartz Commercial |
$188.60
|
| Rate for Payer: Quartz Medicare Advantage |
$174.10
|
| Rate for Payer: The Alliance Commercial |
$145.08
|
| Rate for Payer: WEA Trust Commercial |
$159.59
|
| Rate for Payer: WPS Commercial |
$214.91
|
|
|
SCREW-CORT 4.5 X 46 214.046
|
Facility
|
IP
|
$279.00
|
|
| Hospital Charge Code |
2967309
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$142.18 |
| Max. Negotiated Rate |
$266.95 |
| Rate for Payer: Aetna Commercial |
$261.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$249.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$153.78
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna Commercial |
$266.95
|
| Rate for Payer: Health EOS Commercial |
$258.24
|
| Rate for Payer: HFN Commercial |
$266.95
|
| Rate for Payer: Multiplan Commercial |
$232.13
|
| Rate for Payer: Preferred Network Access Commercial |
$266.95
|
| Rate for Payer: Quartz Beloit One Network |
$142.18
|
| Rate for Payer: Quartz Commercial |
$174.10
|
| Rate for Payer: WEA Trust Commercial |
$159.59
|
| Rate for Payer: WPS Commercial |
$214.91
|
|
|
SCREW CORT 4.5 X 46 214.846
|
Facility
|
OP
|
$484.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966936
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.94 |
| Max. Negotiated Rate |
$463.09 |
| Rate for Payer: Aetna Commercial |
$453.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$432.89
|
| Rate for Payer: Aetna Managed Medicare |
$140.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$327.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$251.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$241.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$266.78
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$463.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$281.69
|
| Rate for Payer: Health EOS Commercial |
$447.99
|
| Rate for Payer: HFN Commercial |
$463.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$377.52
|
| Rate for Payer: Multiplan Commercial |
$402.69
|
| Rate for Payer: NAPHCARE Commercial |
$302.02
|
| Rate for Payer: Preferred Network Access Commercial |
$463.09
|
| Rate for Payer: Quartz Beloit One Network |
$246.65
|
| Rate for Payer: Quartz Commercial |
$327.18
|
| Rate for Payer: Quartz Medicare Advantage |
$302.02
|
| Rate for Payer: The Alliance Commercial |
$251.68
|
| Rate for Payer: WEA Trust Commercial |
$276.85
|
| Rate for Payer: WPS Commercial |
$372.83
|
|
|
SCREW CORT 4.5 X 46 214.846
|
Facility
|
IP
|
$484.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966936
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$246.65 |
| Max. Negotiated Rate |
$463.09 |
| Rate for Payer: Aetna Commercial |
$453.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$432.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$266.78
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$463.09
|
| Rate for Payer: Health EOS Commercial |
$447.99
|
| Rate for Payer: HFN Commercial |
$463.09
|
| Rate for Payer: Multiplan Commercial |
$402.69
|
| Rate for Payer: Preferred Network Access Commercial |
$463.09
|
| Rate for Payer: Quartz Beloit One Network |
$246.65
|
| Rate for Payer: Quartz Commercial |
$302.02
|
| Rate for Payer: WEA Trust Commercial |
$276.85
|
| Rate for Payer: WPS Commercial |
$372.83
|
|
|
SCREW CORT 4.5 X 46MM 340646
|
Facility
|
IP
|
$464.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5106944
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$236.45 |
| Max. Negotiated Rate |
$443.96 |
| Rate for Payer: Aetna Commercial |
$434.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$415.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$255.76
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cigna Commercial |
$443.96
|
| Rate for Payer: Health EOS Commercial |
$429.48
|
| Rate for Payer: HFN Commercial |
$443.96
|
| Rate for Payer: Multiplan Commercial |
$386.05
|
| Rate for Payer: Preferred Network Access Commercial |
$443.96
|
| Rate for Payer: Quartz Beloit One Network |
$236.45
|
| Rate for Payer: Quartz Commercial |
$289.54
|
| Rate for Payer: WEA Trust Commercial |
$265.41
|
| Rate for Payer: WPS Commercial |
$357.42
|
|
|
SCREW CORT 4.5 X 46MM 340646
|
Facility
|
OP
|
$464.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5106944
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$135.12 |
| Max. Negotiated Rate |
$443.96 |
| Rate for Payer: Aetna Commercial |
$434.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$415.00
|
| Rate for Payer: Aetna Managed Medicare |
$135.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$313.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$241.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$231.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$255.76
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cigna Commercial |
$443.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$270.05
|
| Rate for Payer: Health EOS Commercial |
$429.48
|
| Rate for Payer: HFN Commercial |
$443.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$361.92
|
| Rate for Payer: Multiplan Commercial |
$386.05
|
| Rate for Payer: NAPHCARE Commercial |
$289.54
|
| Rate for Payer: Preferred Network Access Commercial |
$443.96
|
| Rate for Payer: Quartz Beloit One Network |
$236.45
|
| Rate for Payer: Quartz Commercial |
$313.66
|
| Rate for Payer: Quartz Medicare Advantage |
$289.54
|
| Rate for Payer: The Alliance Commercial |
$241.28
|
| Rate for Payer: WEA Trust Commercial |
$265.41
|
| Rate for Payer: WPS Commercial |
$357.42
|
|
|
SCREW CORT 4.5 X 46MM SELF-TAP 661746
|
Facility
|
OP
|
$828.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5146618
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$241.11 |
| Max. Negotiated Rate |
$792.23 |
| Rate for Payer: Aetna Commercial |
$775.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$740.56
|
| Rate for Payer: Aetna Managed Medicare |
$241.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$559.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$430.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$413.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$456.39
|
| Rate for Payer: Cash Price |
$248.40
|
| Rate for Payer: Cigna Commercial |
$792.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$481.90
|
| Rate for Payer: Health EOS Commercial |
$766.40
|
| Rate for Payer: HFN Commercial |
$792.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$645.84
|
| Rate for Payer: Multiplan Commercial |
$688.90
|
| Rate for Payer: NAPHCARE Commercial |
$516.67
|
| Rate for Payer: Preferred Network Access Commercial |
$792.23
|
| Rate for Payer: Quartz Beloit One Network |
$421.95
|
| Rate for Payer: Quartz Commercial |
$559.73
|
| Rate for Payer: Quartz Medicare Advantage |
$516.67
|
| Rate for Payer: The Alliance Commercial |
$430.56
|
| Rate for Payer: WEA Trust Commercial |
$473.62
|
| Rate for Payer: WPS Commercial |
$637.81
|
|
|
SCREW CORT 4.5 X 46MM SELF-TAP 661746
|
Facility
|
IP
|
$828.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5146618
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$421.95 |
| Max. Negotiated Rate |
$792.23 |
| Rate for Payer: Aetna Commercial |
$775.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$740.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$456.39
|
| Rate for Payer: Cash Price |
$248.40
|
| Rate for Payer: Cigna Commercial |
$792.23
|
| Rate for Payer: Health EOS Commercial |
$766.40
|
| Rate for Payer: HFN Commercial |
$792.23
|
| Rate for Payer: Multiplan Commercial |
$688.90
|
| Rate for Payer: Preferred Network Access Commercial |
$792.23
|
| Rate for Payer: Quartz Beloit One Network |
$421.95
|
| Rate for Payer: Quartz Commercial |
$516.67
|
| Rate for Payer: WEA Trust Commercial |
$473.62
|
| Rate for Payer: WPS Commercial |
$637.81
|
|
|
SCREW-CORT 4.5 X 48 214.048
|
Facility
|
IP
|
$279.00
|
|
| Hospital Charge Code |
2967310
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$142.18 |
| Max. Negotiated Rate |
$266.95 |
| Rate for Payer: Aetna Commercial |
$261.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$249.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$153.78
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna Commercial |
$266.95
|
| Rate for Payer: Health EOS Commercial |
$258.24
|
| Rate for Payer: HFN Commercial |
$266.95
|
| Rate for Payer: Multiplan Commercial |
$232.13
|
| Rate for Payer: Preferred Network Access Commercial |
$266.95
|
| Rate for Payer: Quartz Beloit One Network |
$142.18
|
| Rate for Payer: Quartz Commercial |
$174.10
|
| Rate for Payer: WEA Trust Commercial |
$159.59
|
| Rate for Payer: WPS Commercial |
$214.91
|
|
|
SCREW-CORT 4.5 X 48 214.048
|
Facility
|
OP
|
$279.00
|
|
| Hospital Charge Code |
2967310
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.24 |
| Max. Negotiated Rate |
$266.95 |
| Rate for Payer: Aetna Commercial |
$261.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$249.54
|
| Rate for Payer: Aetna Managed Medicare |
$81.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$188.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$145.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$139.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$153.78
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna Commercial |
$266.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$162.38
|
| Rate for Payer: Health EOS Commercial |
$258.24
|
| Rate for Payer: HFN Commercial |
$266.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$217.62
|
| Rate for Payer: Multiplan Commercial |
$232.13
|
| Rate for Payer: NAPHCARE Commercial |
$174.10
|
| Rate for Payer: Preferred Network Access Commercial |
$266.95
|
| Rate for Payer: Quartz Beloit One Network |
$142.18
|
| Rate for Payer: Quartz Commercial |
$188.60
|
| Rate for Payer: Quartz Medicare Advantage |
$174.10
|
| Rate for Payer: The Alliance Commercial |
$145.08
|
| Rate for Payer: WEA Trust Commercial |
$159.59
|
| Rate for Payer: WPS Commercial |
$214.91
|
|
|
SCREW CORT 4.5 X 48 214.848
|
Facility
|
OP
|
$466.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966937
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$135.70 |
| Max. Negotiated Rate |
$445.87 |
| Rate for Payer: Aetna Commercial |
$436.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$416.79
|
| Rate for Payer: Aetna Managed Medicare |
$135.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$315.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$242.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$232.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$256.86
|
| Rate for Payer: Cash Price |
$139.80
|
| Rate for Payer: Cigna Commercial |
$445.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$271.21
|
| Rate for Payer: Health EOS Commercial |
$431.33
|
| Rate for Payer: HFN Commercial |
$445.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$363.48
|
| Rate for Payer: Multiplan Commercial |
$387.71
|
| Rate for Payer: NAPHCARE Commercial |
$290.78
|
| Rate for Payer: Preferred Network Access Commercial |
$445.87
|
| Rate for Payer: Quartz Beloit One Network |
$237.47
|
| Rate for Payer: Quartz Commercial |
$315.02
|
| Rate for Payer: Quartz Medicare Advantage |
$290.78
|
| Rate for Payer: The Alliance Commercial |
$242.32
|
| Rate for Payer: WEA Trust Commercial |
$266.55
|
| Rate for Payer: WPS Commercial |
$358.96
|
|
|
SCREW CORT 4.5 X 48 214.848
|
Facility
|
IP
|
$466.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966937
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$237.47 |
| Max. Negotiated Rate |
$445.87 |
| Rate for Payer: Aetna Commercial |
$436.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$416.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$256.86
|
| Rate for Payer: Cash Price |
$139.80
|
| Rate for Payer: Cigna Commercial |
$445.87
|
| Rate for Payer: Health EOS Commercial |
$431.33
|
| Rate for Payer: HFN Commercial |
$445.87
|
| Rate for Payer: Multiplan Commercial |
$387.71
|
| Rate for Payer: Preferred Network Access Commercial |
$445.87
|
| Rate for Payer: Quartz Beloit One Network |
$237.47
|
| Rate for Payer: Quartz Commercial |
$290.78
|
| Rate for Payer: WEA Trust Commercial |
$266.55
|
| Rate for Payer: WPS Commercial |
$358.96
|
|
|
SCREW-CORT 4.5 X 50 214.050
|
Facility
|
OP
|
$279.00
|
|
| Hospital Charge Code |
2967311
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.24 |
| Max. Negotiated Rate |
$266.95 |
| Rate for Payer: Aetna Commercial |
$261.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$249.54
|
| Rate for Payer: Aetna Managed Medicare |
$81.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$188.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$145.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$139.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$153.78
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna Commercial |
$266.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$162.38
|
| Rate for Payer: Health EOS Commercial |
$258.24
|
| Rate for Payer: HFN Commercial |
$266.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$217.62
|
| Rate for Payer: Multiplan Commercial |
$232.13
|
| Rate for Payer: NAPHCARE Commercial |
$174.10
|
| Rate for Payer: Preferred Network Access Commercial |
$266.95
|
| Rate for Payer: Quartz Beloit One Network |
$142.18
|
| Rate for Payer: Quartz Commercial |
$188.60
|
| Rate for Payer: Quartz Medicare Advantage |
$174.10
|
| Rate for Payer: The Alliance Commercial |
$145.08
|
| Rate for Payer: WEA Trust Commercial |
$159.59
|
| Rate for Payer: WPS Commercial |
$214.91
|
|
|
SCREW-CORT 4.5 X 50 214.050
|
Facility
|
IP
|
$279.00
|
|
| Hospital Charge Code |
2967311
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$142.18 |
| Max. Negotiated Rate |
$266.95 |
| Rate for Payer: Aetna Commercial |
$261.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$249.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$153.78
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna Commercial |
$266.95
|
| Rate for Payer: Health EOS Commercial |
$258.24
|
| Rate for Payer: HFN Commercial |
$266.95
|
| Rate for Payer: Multiplan Commercial |
$232.13
|
| Rate for Payer: Preferred Network Access Commercial |
$266.95
|
| Rate for Payer: Quartz Beloit One Network |
$142.18
|
| Rate for Payer: Quartz Commercial |
$174.10
|
| Rate for Payer: WEA Trust Commercial |
$159.59
|
| Rate for Payer: WPS Commercial |
$214.91
|
|
|
SCREW CORT 4.5 X 50 214.850
|
Facility
|
IP
|
$484.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966938
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$246.65 |
| Max. Negotiated Rate |
$463.09 |
| Rate for Payer: Aetna Commercial |
$453.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$432.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$266.78
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$463.09
|
| Rate for Payer: Health EOS Commercial |
$447.99
|
| Rate for Payer: HFN Commercial |
$463.09
|
| Rate for Payer: Multiplan Commercial |
$402.69
|
| Rate for Payer: Preferred Network Access Commercial |
$463.09
|
| Rate for Payer: Quartz Beloit One Network |
$246.65
|
| Rate for Payer: Quartz Commercial |
$302.02
|
| Rate for Payer: WEA Trust Commercial |
$276.85
|
| Rate for Payer: WPS Commercial |
$372.83
|
|
