|
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
|
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 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 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
|
|
|
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 26 214.026
|
Facility
|
IP
|
$279.00
|
|
| Hospital Charge Code |
2967299
|
|
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 26 214.026
|
Facility
|
OP
|
$279.00
|
|
| Hospital Charge Code |
2967299
|
|
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 26MM 340626
|
Facility
|
IP
|
$464.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6198984
|
|
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 26MM 340626
|
Facility
|
OP
|
$464.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6198984
|
|
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 26MM SELF-TAP 661726
|
Facility
|
IP
|
$828.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6175225
|
|
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
|
|
|
SCREW CORT 4.5 X 26MM SELF-TAP 661726
|
Facility
|
OP
|
$828.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6175225
|
|
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 28 214.028
|
Facility
|
IP
|
$279.00
|
|
| Hospital Charge Code |
2967300
|
|
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 28 214.028
|
Facility
|
OP
|
$279.00
|
|
| Hospital Charge Code |
2967300
|
|
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 28 214.828
|
Facility
|
IP
|
$466.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966927
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$228.34 |
| Max. Negotiated Rate |
$428.72 |
| Rate for Payer: Aetna Commercial |
$419.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$400.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$246.98
|
| Rate for Payer: Cash Price |
$139.80
|
| Rate for Payer: Cigna Commercial |
$428.72
|
| Rate for Payer: Health EOS Commercial |
$414.74
|
| Rate for Payer: HFN Commercial |
$428.72
|
| Rate for Payer: Multiplan Commercial |
$372.80
|
| Rate for Payer: NAPHCARE Commercial |
$279.60
|
| Rate for Payer: Preferred Network Access Commercial |
$428.72
|
| Rate for Payer: Quartz Beloit One Network |
$228.34
|
| Rate for Payer: Quartz Commercial |
$279.60
|
| Rate for Payer: WEA Trust Commercial |
$256.30
|
| Rate for Payer: WPS Commercial |
$345.17
|
|
|
SCREW CORT 4.5 X 28 214.828
|
Facility
|
OP
|
$466.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966927
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$130.48 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$419.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$400.76
|
| Rate for Payer: Aetna Managed Medicare |
$130.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$302.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$233.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$223.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$246.98
|
| Rate for Payer: Cash Price |
$139.80
|
| Rate for Payer: Cigna Commercial |
$428.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$260.77
|
| Rate for Payer: Health EOS Commercial |
$414.74
|
| Rate for Payer: HFN Commercial |
$428.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$349.50
|
| Rate for Payer: Multiplan Commercial |
$372.80
|
| Rate for Payer: NAPHCARE Commercial |
$279.60
|
| Rate for Payer: Preferred Network Access Commercial |
$428.72
|
| Rate for Payer: Quartz Beloit One Network |
$228.34
|
| Rate for Payer: Quartz Commercial |
$302.90
|
| Rate for Payer: Quartz Medicare Advantage |
$279.60
|
| Rate for Payer: The Alliance Commercial |
$1,864.00
|
| Rate for Payer: WEA Trust Commercial |
$256.30
|
| Rate for Payer: WPS Commercial |
$345.17
|
|
|
SCREW CORT 4.5 X 28MM 340628
|
Facility
|
OP
|
$464.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6198985
|
|
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 28MM 340628
|
Facility
|
IP
|
$464.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6198985
|
|
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 28MM SELF-TAP 661728
|
Facility
|
IP
|
$828.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6175226
|
|
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
|
|
|
SCREW CORT 4.5 X 28MM SELF-TAP 661728
|
Facility
|
OP
|
$828.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6175226
|
|
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 30 214.030
|
Facility
|
OP
|
$279.00
|
|
| Hospital Charge Code |
2967301
|
|
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 30 214.030
|
Facility
|
IP
|
$279.00
|
|
| Hospital Charge Code |
2967301
|
|
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 30 214.830
|
Facility
|
OP
|
$466.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966928
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$130.48 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$419.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$400.76
|
| Rate for Payer: Aetna Managed Medicare |
$130.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$302.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$233.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$223.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$246.98
|
| Rate for Payer: Cash Price |
$139.80
|
| Rate for Payer: Cigna Commercial |
$428.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$260.77
|
| Rate for Payer: Health EOS Commercial |
$414.74
|
| Rate for Payer: HFN Commercial |
$428.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$349.50
|
| Rate for Payer: Multiplan Commercial |
$372.80
|
| Rate for Payer: NAPHCARE Commercial |
$279.60
|
| Rate for Payer: Preferred Network Access Commercial |
$428.72
|
| Rate for Payer: Quartz Beloit One Network |
$228.34
|
| Rate for Payer: Quartz Commercial |
$302.90
|
| Rate for Payer: Quartz Medicare Advantage |
$279.60
|
| Rate for Payer: The Alliance Commercial |
$1,864.00
|
| Rate for Payer: WEA Trust Commercial |
$256.30
|
| Rate for Payer: WPS Commercial |
$345.17
|
|
|
SCREW CORT 4.5 X 30 214.830
|
Facility
|
IP
|
$466.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966928
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$228.34 |
| Max. Negotiated Rate |
$428.72 |
| Rate for Payer: Aetna Commercial |
$419.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$400.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$246.98
|
| Rate for Payer: Cash Price |
$139.80
|
| Rate for Payer: Cigna Commercial |
$428.72
|
| Rate for Payer: Health EOS Commercial |
$414.74
|
| Rate for Payer: HFN Commercial |
$428.72
|
| Rate for Payer: Multiplan Commercial |
$372.80
|
| Rate for Payer: NAPHCARE Commercial |
$279.60
|
| Rate for Payer: Preferred Network Access Commercial |
$428.72
|
| Rate for Payer: Quartz Beloit One Network |
$228.34
|
| Rate for Payer: Quartz Commercial |
$279.60
|
| Rate for Payer: WEA Trust Commercial |
$256.30
|
| Rate for Payer: WPS Commercial |
$345.17
|
|
