|
SCREW-CORT 4.5 X 38 214.038
|
Facility
|
OP
|
$279.00
|
|
| Hospital Charge Code |
2967305
|
|
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 38 214.838
|
Facility
|
OP
|
$484.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966932
|
|
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 38 214.838
|
Facility
|
IP
|
$484.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966932
|
|
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 38MM 340638
|
Facility
|
OP
|
$464.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3805539
|
|
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 38MM 340638
|
Facility
|
IP
|
$464.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3805539
|
|
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 38MM SELF-TAP 661738
|
Facility
|
IP
|
$828.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6175230
|
|
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 38MM SELF-TAP 661738
|
Facility
|
OP
|
$828.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6175230
|
|
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 40 214.040***DISC
|
Facility
|
IP
|
$279.00
|
|
| Hospital Charge Code |
2967306
|
|
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 40 214.040***DISC
|
Facility
|
OP
|
$279.00
|
|
| Hospital Charge Code |
2967306
|
|
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 40 214.840
|
Facility
|
IP
|
$466.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2964939
|
|
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 40 214.840
|
Facility
|
OP
|
$466.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2964939
|
|
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 40MM SELF-TAP 661740
|
Facility
|
OP
|
$828.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6175231
|
|
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 40MM SELF-TAP 661740
|
Facility
|
IP
|
$828.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6175231
|
|
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 42 214.042***DISC
|
Facility
|
IP
|
$279.00
|
|
| Hospital Charge Code |
2967307
|
|
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 42 214.042***DISC
|
Facility
|
OP
|
$279.00
|
|
| Hospital Charge Code |
2967307
|
|
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 42 214.842
|
Facility
|
OP
|
$466.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966934
|
|
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 42 214.842
|
Facility
|
IP
|
$466.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966934
|
|
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 42MM 340642
|
Facility
|
IP
|
$464.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6184982
|
|
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 42MM 340642
|
Facility
|
OP
|
$464.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6184982
|
|
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 42MM SELF-TAP 661742
|
Facility
|
IP
|
$828.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5146617
|
|
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 42MM SELF-TAP 661742
|
Facility
|
OP
|
$828.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5146617
|
|
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 44 214.044***DISC
|
Facility
|
IP
|
$279.00
|
|
| Hospital Charge Code |
2967308
|
|
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 44 214.044***DISC
|
Facility
|
OP
|
$279.00
|
|
| Hospital Charge Code |
2967308
|
|
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 44 214.844
|
Facility
|
OP
|
$484.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966935
|
|
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 44 214.844
|
Facility
|
IP
|
$484.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966935
|
|
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
|
|
