|
ZZZ***SCREW-CORT 3.5 X 12 204.012*** OBSOLETE *** USE 204.812
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967277
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.79 |
| Max. Negotiated Rate |
$177.96 |
| Rate for Payer: Aetna Commercial |
$174.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$166.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$102.52
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$177.96
|
| Rate for Payer: Health EOS Commercial |
$172.16
|
| Rate for Payer: HFN Commercial |
$177.96
|
| Rate for Payer: Multiplan Commercial |
$154.75
|
| Rate for Payer: Preferred Network Access Commercial |
$177.96
|
| Rate for Payer: Quartz Beloit One Network |
$94.79
|
| Rate for Payer: Quartz Commercial |
$116.06
|
| Rate for Payer: WEA Trust Commercial |
$106.39
|
| Rate for Payer: WPS Commercial |
$143.28
|
|
|
ZZZ***SCREW-CORT 3.5 X 14 204.014*** OBSOLETE *** USE 204.814
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967278
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.79 |
| Max. Negotiated Rate |
$177.96 |
| Rate for Payer: Aetna Commercial |
$174.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$166.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$102.52
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$177.96
|
| Rate for Payer: Health EOS Commercial |
$172.16
|
| Rate for Payer: HFN Commercial |
$177.96
|
| Rate for Payer: Multiplan Commercial |
$154.75
|
| Rate for Payer: Preferred Network Access Commercial |
$177.96
|
| Rate for Payer: Quartz Beloit One Network |
$94.79
|
| Rate for Payer: Quartz Commercial |
$116.06
|
| Rate for Payer: WEA Trust Commercial |
$106.39
|
| Rate for Payer: WPS Commercial |
$143.28
|
|
|
ZZZ***SCREW-CORT 3.5 X 14 204.014*** OBSOLETE *** USE 204.814
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967278
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$54.16 |
| Max. Negotiated Rate |
$177.96 |
| Rate for Payer: Aetna Commercial |
$174.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$166.36
|
| Rate for Payer: Aetna Managed Medicare |
$54.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$125.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$96.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$92.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$102.52
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$177.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$108.25
|
| Rate for Payer: Health EOS Commercial |
$172.16
|
| Rate for Payer: HFN Commercial |
$177.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$145.08
|
| Rate for Payer: Multiplan Commercial |
$154.75
|
| Rate for Payer: NAPHCARE Commercial |
$116.06
|
| Rate for Payer: Preferred Network Access Commercial |
$177.96
|
| Rate for Payer: Quartz Beloit One Network |
$94.79
|
| Rate for Payer: Quartz Commercial |
$125.74
|
| Rate for Payer: Quartz Medicare Advantage |
$116.06
|
| Rate for Payer: The Alliance Commercial |
$96.72
|
| Rate for Payer: WEA Trust Commercial |
$106.39
|
| Rate for Payer: WPS Commercial |
$143.28
|
|
|
ZZZ***SCREW-CORT 3.5 X 16 204.016*** OBSOLETE *** USE 204.816
|
Facility
|
IP
|
$179.00
|
|
| Hospital Charge Code |
2967279
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$91.22 |
| Max. Negotiated Rate |
$171.27 |
| Rate for Payer: Aetna Commercial |
$167.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.66
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cigna Commercial |
$171.27
|
| Rate for Payer: Health EOS Commercial |
$165.68
|
| Rate for Payer: HFN Commercial |
$171.27
|
| Rate for Payer: Multiplan Commercial |
$148.93
|
| Rate for Payer: Preferred Network Access Commercial |
$171.27
|
| Rate for Payer: Quartz Beloit One Network |
$91.22
|
| Rate for Payer: Quartz Commercial |
$111.70
|
| Rate for Payer: WEA Trust Commercial |
$102.39
|
| Rate for Payer: WPS Commercial |
$137.88
|
|
|
ZZZ***SCREW-CORT 3.5 X 16 204.016*** OBSOLETE *** USE 204.816
|
Facility
|
OP
|
$179.00
|
|
| Hospital Charge Code |
2967279
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.12 |
| Max. Negotiated Rate |
$171.27 |
| Rate for Payer: Aetna Commercial |
$167.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.10
|
| Rate for Payer: Aetna Managed Medicare |
$52.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$121.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$93.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$89.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.66
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cigna Commercial |
$171.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$104.18
|
| Rate for Payer: Health EOS Commercial |
$165.68
|
| Rate for Payer: HFN Commercial |
$171.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$139.62
|
| Rate for Payer: Multiplan Commercial |
$148.93
|
| Rate for Payer: NAPHCARE Commercial |
$111.70
|
| Rate for Payer: Preferred Network Access Commercial |
$171.27
|
| Rate for Payer: Quartz Beloit One Network |
$91.22
|
| Rate for Payer: Quartz Commercial |
$121.00
|
| Rate for Payer: Quartz Medicare Advantage |
$111.70
|
| Rate for Payer: The Alliance Commercial |
$93.08
|
| Rate for Payer: WEA Trust Commercial |
$102.39
|
| Rate for Payer: WPS Commercial |
$137.88
|
|
|
ZZZ***SCREW-CORT 3.5 X 18 204.018*** OBSOLETE *** USE 204.818
|
Facility
|
OP
|
$179.00
|
|
| Hospital Charge Code |
2967280
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.12 |
| Max. Negotiated Rate |
$171.27 |
| Rate for Payer: Aetna Commercial |
$167.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.10
|
| Rate for Payer: Aetna Managed Medicare |
$52.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$121.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$93.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$89.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.66
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cigna Commercial |
$171.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$104.18
|
| Rate for Payer: Health EOS Commercial |
$165.68
|
| Rate for Payer: HFN Commercial |
$171.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$139.62
|
| Rate for Payer: Multiplan Commercial |
$148.93
|
| Rate for Payer: NAPHCARE Commercial |
$111.70
|
| Rate for Payer: Preferred Network Access Commercial |
$171.27
|
| Rate for Payer: Quartz Beloit One Network |
$91.22
|
| Rate for Payer: Quartz Commercial |
$121.00
|
| Rate for Payer: Quartz Medicare Advantage |
$111.70
|
| Rate for Payer: The Alliance Commercial |
$93.08
|
| Rate for Payer: WEA Trust Commercial |
$102.39
|
| Rate for Payer: WPS Commercial |
$137.88
|
|
|
ZZZ***SCREW-CORT 3.5 X 18 204.018*** OBSOLETE *** USE 204.818
|
Facility
|
IP
|
$179.00
|
|
| Hospital Charge Code |
2967280
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$91.22 |
| Max. Negotiated Rate |
$171.27 |
| Rate for Payer: Aetna Commercial |
$167.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.66
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cigna Commercial |
$171.27
|
| Rate for Payer: Health EOS Commercial |
$165.68
|
| Rate for Payer: HFN Commercial |
$171.27
|
| Rate for Payer: Multiplan Commercial |
$148.93
|
| Rate for Payer: Preferred Network Access Commercial |
$171.27
|
| Rate for Payer: Quartz Beloit One Network |
$91.22
|
| Rate for Payer: Quartz Commercial |
$111.70
|
| Rate for Payer: WEA Trust Commercial |
$102.39
|
| Rate for Payer: WPS Commercial |
$137.88
|
|
|
ZZZ***SCREW-CORT 3.5 X 20 204.020*** OBSOLETE *** USE 204.820
|
Facility
|
OP
|
$179.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967282
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.12 |
| Max. Negotiated Rate |
$171.27 |
| Rate for Payer: Aetna Commercial |
$167.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.10
|
| Rate for Payer: Aetna Managed Medicare |
$52.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$121.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$93.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$89.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.66
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cigna Commercial |
$171.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$104.18
|
| Rate for Payer: Health EOS Commercial |
$165.68
|
| Rate for Payer: HFN Commercial |
$171.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$139.62
|
| Rate for Payer: Multiplan Commercial |
$148.93
|
| Rate for Payer: NAPHCARE Commercial |
$111.70
|
| Rate for Payer: Preferred Network Access Commercial |
$171.27
|
| Rate for Payer: Quartz Beloit One Network |
$91.22
|
| Rate for Payer: Quartz Commercial |
$121.00
|
| Rate for Payer: Quartz Medicare Advantage |
$111.70
|
| Rate for Payer: The Alliance Commercial |
$93.08
|
| Rate for Payer: WEA Trust Commercial |
$102.39
|
| Rate for Payer: WPS Commercial |
$137.88
|
|
|
ZZZ***SCREW-CORT 3.5 X 20 204.020*** OBSOLETE *** USE 204.820
|
Facility
|
IP
|
$179.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967282
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$91.22 |
| Max. Negotiated Rate |
$171.27 |
| Rate for Payer: Aetna Commercial |
$167.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.66
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cigna Commercial |
$171.27
|
| Rate for Payer: Health EOS Commercial |
$165.68
|
| Rate for Payer: HFN Commercial |
$171.27
|
| Rate for Payer: Multiplan Commercial |
$148.93
|
| Rate for Payer: Preferred Network Access Commercial |
$171.27
|
| Rate for Payer: Quartz Beloit One Network |
$91.22
|
| Rate for Payer: Quartz Commercial |
$111.70
|
| Rate for Payer: WEA Trust Commercial |
$102.39
|
| Rate for Payer: WPS Commercial |
$137.88
|
|
|
ZZZ***SCREW-CORT 3.5 X 20 204.220***OBSOLETE***
|
Facility
|
OP
|
$179.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967283
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.12 |
| Max. Negotiated Rate |
$171.27 |
| Rate for Payer: Aetna Commercial |
$167.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.10
|
| Rate for Payer: Aetna Managed Medicare |
$52.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$121.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$93.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$89.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.66
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cigna Commercial |
$171.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$104.18
|
| Rate for Payer: Health EOS Commercial |
$165.68
|
| Rate for Payer: HFN Commercial |
$171.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$139.62
|
| Rate for Payer: Multiplan Commercial |
$148.93
|
| Rate for Payer: NAPHCARE Commercial |
$111.70
|
| Rate for Payer: Preferred Network Access Commercial |
$171.27
|
| Rate for Payer: Quartz Beloit One Network |
$91.22
|
| Rate for Payer: Quartz Commercial |
$121.00
|
| Rate for Payer: Quartz Medicare Advantage |
$111.70
|
| Rate for Payer: The Alliance Commercial |
$93.08
|
| Rate for Payer: WEA Trust Commercial |
$102.39
|
| Rate for Payer: WPS Commercial |
$137.88
|
|
|
ZZZ***SCREW-CORT 3.5 X 20 204.220***OBSOLETE***
|
Facility
|
IP
|
$179.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967283
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$91.22 |
| Max. Negotiated Rate |
$171.27 |
| Rate for Payer: Aetna Commercial |
$167.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.66
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cigna Commercial |
$171.27
|
| Rate for Payer: Health EOS Commercial |
$165.68
|
| Rate for Payer: HFN Commercial |
$171.27
|
| Rate for Payer: Multiplan Commercial |
$148.93
|
| Rate for Payer: Preferred Network Access Commercial |
$171.27
|
| Rate for Payer: Quartz Beloit One Network |
$91.22
|
| Rate for Payer: Quartz Commercial |
$111.70
|
| Rate for Payer: WEA Trust Commercial |
$102.39
|
| Rate for Payer: WPS Commercial |
$137.88
|
|
|
ZZZ***SCREW-CORT 3.5 X 22 204.022*** OBSOLETE *** USE 204.822
|
Facility
|
OP
|
$179.00
|
|
| Hospital Charge Code |
3031077
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.12 |
| Max. Negotiated Rate |
$171.27 |
| Rate for Payer: Aetna Commercial |
$167.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.10
|
| Rate for Payer: Aetna Managed Medicare |
$52.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$121.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$93.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$89.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.66
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cigna Commercial |
$171.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$104.18
|
| Rate for Payer: Health EOS Commercial |
$165.68
|
| Rate for Payer: HFN Commercial |
$171.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$139.62
|
| Rate for Payer: Multiplan Commercial |
$148.93
|
| Rate for Payer: NAPHCARE Commercial |
$111.70
|
| Rate for Payer: Preferred Network Access Commercial |
$171.27
|
| Rate for Payer: Quartz Beloit One Network |
$91.22
|
| Rate for Payer: Quartz Commercial |
$121.00
|
| Rate for Payer: Quartz Medicare Advantage |
$111.70
|
| Rate for Payer: The Alliance Commercial |
$93.08
|
| Rate for Payer: WEA Trust Commercial |
$102.39
|
| Rate for Payer: WPS Commercial |
$137.88
|
|
|
ZZZ***SCREW-CORT 3.5 X 22 204.022*** OBSOLETE *** USE 204.822
|
Facility
|
IP
|
$179.00
|
|
| Hospital Charge Code |
3031077
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$91.22 |
| Max. Negotiated Rate |
$171.27 |
| Rate for Payer: Aetna Commercial |
$167.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.66
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cigna Commercial |
$171.27
|
| Rate for Payer: Health EOS Commercial |
$165.68
|
| Rate for Payer: HFN Commercial |
$171.27
|
| Rate for Payer: Multiplan Commercial |
$148.93
|
| Rate for Payer: Preferred Network Access Commercial |
$171.27
|
| Rate for Payer: Quartz Beloit One Network |
$91.22
|
| Rate for Payer: Quartz Commercial |
$111.70
|
| Rate for Payer: WEA Trust Commercial |
$102.39
|
| Rate for Payer: WPS Commercial |
$137.88
|
|
|
ZZZ***SCREW-CORT 3.5 X 24 204.024*** OBSOLETE *** USE 204.824
|
Facility
|
OP
|
$179.00
|
|
| Hospital Charge Code |
2967284
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.12 |
| Max. Negotiated Rate |
$171.27 |
| Rate for Payer: Aetna Commercial |
$167.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.10
|
| Rate for Payer: Aetna Managed Medicare |
$52.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$121.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$93.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$89.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.66
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cigna Commercial |
$171.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$104.18
|
| Rate for Payer: Health EOS Commercial |
$165.68
|
| Rate for Payer: HFN Commercial |
$171.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$139.62
|
| Rate for Payer: Multiplan Commercial |
$148.93
|
| Rate for Payer: NAPHCARE Commercial |
$111.70
|
| Rate for Payer: Preferred Network Access Commercial |
$171.27
|
| Rate for Payer: Quartz Beloit One Network |
$91.22
|
| Rate for Payer: Quartz Commercial |
$121.00
|
| Rate for Payer: Quartz Medicare Advantage |
$111.70
|
| Rate for Payer: The Alliance Commercial |
$93.08
|
| Rate for Payer: WEA Trust Commercial |
$102.39
|
| Rate for Payer: WPS Commercial |
$137.88
|
|
|
ZZZ***SCREW-CORT 3.5 X 24 204.024*** OBSOLETE *** USE 204.824
|
Facility
|
IP
|
$179.00
|
|
| Hospital Charge Code |
2967284
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$91.22 |
| Max. Negotiated Rate |
$171.27 |
| Rate for Payer: Aetna Commercial |
$167.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.66
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cigna Commercial |
$171.27
|
| Rate for Payer: Health EOS Commercial |
$165.68
|
| Rate for Payer: HFN Commercial |
$171.27
|
| Rate for Payer: Multiplan Commercial |
$148.93
|
| Rate for Payer: Preferred Network Access Commercial |
$171.27
|
| Rate for Payer: Quartz Beloit One Network |
$91.22
|
| Rate for Payer: Quartz Commercial |
$111.70
|
| Rate for Payer: WEA Trust Commercial |
$102.39
|
| Rate for Payer: WPS Commercial |
$137.88
|
|
|
ZZZ***SCREW-CORT 3.5 X 26 204.026*** OBSOLETE *** USE 204.826
|
Facility
|
OP
|
$179.00
|
|
| Hospital Charge Code |
2967285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.12 |
| Max. Negotiated Rate |
$171.27 |
| Rate for Payer: Aetna Commercial |
$167.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.10
|
| Rate for Payer: Aetna Managed Medicare |
$52.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$121.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$93.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$89.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.66
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cigna Commercial |
$171.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$104.18
|
| Rate for Payer: Health EOS Commercial |
$165.68
|
| Rate for Payer: HFN Commercial |
$171.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$139.62
|
| Rate for Payer: Multiplan Commercial |
$148.93
|
| Rate for Payer: NAPHCARE Commercial |
$111.70
|
| Rate for Payer: Preferred Network Access Commercial |
$171.27
|
| Rate for Payer: Quartz Beloit One Network |
$91.22
|
| Rate for Payer: Quartz Commercial |
$121.00
|
| Rate for Payer: Quartz Medicare Advantage |
$111.70
|
| Rate for Payer: The Alliance Commercial |
$93.08
|
| Rate for Payer: WEA Trust Commercial |
$102.39
|
| Rate for Payer: WPS Commercial |
$137.88
|
|
|
ZZZ***SCREW-CORT 3.5 X 26 204.026*** OBSOLETE *** USE 204.826
|
Facility
|
IP
|
$179.00
|
|
| Hospital Charge Code |
2967285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$91.22 |
| Max. Negotiated Rate |
$171.27 |
| Rate for Payer: Aetna Commercial |
$167.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.66
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cigna Commercial |
$171.27
|
| Rate for Payer: Health EOS Commercial |
$165.68
|
| Rate for Payer: HFN Commercial |
$171.27
|
| Rate for Payer: Multiplan Commercial |
$148.93
|
| Rate for Payer: Preferred Network Access Commercial |
$171.27
|
| Rate for Payer: Quartz Beloit One Network |
$91.22
|
| Rate for Payer: Quartz Commercial |
$111.70
|
| Rate for Payer: WEA Trust Commercial |
$102.39
|
| Rate for Payer: WPS Commercial |
$137.88
|
|
|
ZZZ***SCREW-CORT 3.5 X 28 204.028*** OBSOLETE *** USE 204.828
|
Facility
|
OP
|
$179.00
|
|
| Hospital Charge Code |
2967286
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.12 |
| Max. Negotiated Rate |
$171.27 |
| Rate for Payer: Aetna Commercial |
$167.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.10
|
| Rate for Payer: Aetna Managed Medicare |
$52.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$121.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$93.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$89.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.66
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cigna Commercial |
$171.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$104.18
|
| Rate for Payer: Health EOS Commercial |
$165.68
|
| Rate for Payer: HFN Commercial |
$171.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$139.62
|
| Rate for Payer: Multiplan Commercial |
$148.93
|
| Rate for Payer: NAPHCARE Commercial |
$111.70
|
| Rate for Payer: Preferred Network Access Commercial |
$171.27
|
| Rate for Payer: Quartz Beloit One Network |
$91.22
|
| Rate for Payer: Quartz Commercial |
$121.00
|
| Rate for Payer: Quartz Medicare Advantage |
$111.70
|
| Rate for Payer: The Alliance Commercial |
$93.08
|
| Rate for Payer: WEA Trust Commercial |
$102.39
|
| Rate for Payer: WPS Commercial |
$137.88
|
|
|
ZZZ***SCREW-CORT 3.5 X 28 204.028*** OBSOLETE *** USE 204.828
|
Facility
|
IP
|
$179.00
|
|
| Hospital Charge Code |
2967286
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$91.22 |
| Max. Negotiated Rate |
$171.27 |
| Rate for Payer: Aetna Commercial |
$167.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.66
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cigna Commercial |
$171.27
|
| Rate for Payer: Health EOS Commercial |
$165.68
|
| Rate for Payer: HFN Commercial |
$171.27
|
| Rate for Payer: Multiplan Commercial |
$148.93
|
| Rate for Payer: Preferred Network Access Commercial |
$171.27
|
| Rate for Payer: Quartz Beloit One Network |
$91.22
|
| Rate for Payer: Quartz Commercial |
$111.70
|
| Rate for Payer: WEA Trust Commercial |
$102.39
|
| Rate for Payer: WPS Commercial |
$137.88
|
|
|
ZZZ***SCREW-CORT 3.5 X 30 204.030*** OBSOLETE *** USE 204.830
|
Facility
|
OP
|
$179.00
|
|
| Hospital Charge Code |
2967287
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.12 |
| Max. Negotiated Rate |
$171.27 |
| Rate for Payer: Aetna Commercial |
$167.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.10
|
| Rate for Payer: Aetna Managed Medicare |
$52.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$121.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$93.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$89.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.66
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cigna Commercial |
$171.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$104.18
|
| Rate for Payer: Health EOS Commercial |
$165.68
|
| Rate for Payer: HFN Commercial |
$171.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$139.62
|
| Rate for Payer: Multiplan Commercial |
$148.93
|
| Rate for Payer: NAPHCARE Commercial |
$111.70
|
| Rate for Payer: Preferred Network Access Commercial |
$171.27
|
| Rate for Payer: Quartz Beloit One Network |
$91.22
|
| Rate for Payer: Quartz Commercial |
$121.00
|
| Rate for Payer: Quartz Medicare Advantage |
$111.70
|
| Rate for Payer: The Alliance Commercial |
$93.08
|
| Rate for Payer: WEA Trust Commercial |
$102.39
|
| Rate for Payer: WPS Commercial |
$137.88
|
|
|
ZZZ***SCREW-CORT 3.5 X 30 204.030*** OBSOLETE *** USE 204.830
|
Facility
|
IP
|
$179.00
|
|
| Hospital Charge Code |
2967287
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$91.22 |
| Max. Negotiated Rate |
$171.27 |
| Rate for Payer: Aetna Commercial |
$167.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.66
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cigna Commercial |
$171.27
|
| Rate for Payer: Health EOS Commercial |
$165.68
|
| Rate for Payer: HFN Commercial |
$171.27
|
| Rate for Payer: Multiplan Commercial |
$148.93
|
| Rate for Payer: Preferred Network Access Commercial |
$171.27
|
| Rate for Payer: Quartz Beloit One Network |
$91.22
|
| Rate for Payer: Quartz Commercial |
$111.70
|
| Rate for Payer: WEA Trust Commercial |
$102.39
|
| Rate for Payer: WPS Commercial |
$137.88
|
|
|
ZZZ***SCREW-CORT 3.5 X 32 204.032*** OBSOLETE *** USE 204.832
|
Facility
|
IP
|
$179.00
|
|
| Hospital Charge Code |
2967288
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$91.22 |
| Max. Negotiated Rate |
$171.27 |
| Rate for Payer: Aetna Commercial |
$167.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.66
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cigna Commercial |
$171.27
|
| Rate for Payer: Health EOS Commercial |
$165.68
|
| Rate for Payer: HFN Commercial |
$171.27
|
| Rate for Payer: Multiplan Commercial |
$148.93
|
| Rate for Payer: Preferred Network Access Commercial |
$171.27
|
| Rate for Payer: Quartz Beloit One Network |
$91.22
|
| Rate for Payer: Quartz Commercial |
$111.70
|
| Rate for Payer: WEA Trust Commercial |
$102.39
|
| Rate for Payer: WPS Commercial |
$137.88
|
|
|
ZZZ***SCREW-CORT 3.5 X 32 204.032*** OBSOLETE *** USE 204.832
|
Facility
|
OP
|
$179.00
|
|
| Hospital Charge Code |
2967288
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.12 |
| Max. Negotiated Rate |
$171.27 |
| Rate for Payer: Aetna Commercial |
$167.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.10
|
| Rate for Payer: Aetna Managed Medicare |
$52.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$121.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$93.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$89.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.66
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cigna Commercial |
$171.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$104.18
|
| Rate for Payer: Health EOS Commercial |
$165.68
|
| Rate for Payer: HFN Commercial |
$171.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$139.62
|
| Rate for Payer: Multiplan Commercial |
$148.93
|
| Rate for Payer: NAPHCARE Commercial |
$111.70
|
| Rate for Payer: Preferred Network Access Commercial |
$171.27
|
| Rate for Payer: Quartz Beloit One Network |
$91.22
|
| Rate for Payer: Quartz Commercial |
$121.00
|
| Rate for Payer: Quartz Medicare Advantage |
$111.70
|
| Rate for Payer: The Alliance Commercial |
$93.08
|
| Rate for Payer: WEA Trust Commercial |
$102.39
|
| Rate for Payer: WPS Commercial |
$137.88
|
|
|
ZZZ***SCREW-CORT 3.5 X 34 204.034*** OBSOLETE *** USE 204.834
|
Facility
|
OP
|
$179.00
|
|
| Hospital Charge Code |
2967289
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.12 |
| Max. Negotiated Rate |
$171.27 |
| Rate for Payer: Aetna Commercial |
$167.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.10
|
| Rate for Payer: Aetna Managed Medicare |
$52.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$121.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$93.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$89.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.66
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cigna Commercial |
$171.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$104.18
|
| Rate for Payer: Health EOS Commercial |
$165.68
|
| Rate for Payer: HFN Commercial |
$171.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$139.62
|
| Rate for Payer: Multiplan Commercial |
$148.93
|
| Rate for Payer: NAPHCARE Commercial |
$111.70
|
| Rate for Payer: Preferred Network Access Commercial |
$171.27
|
| Rate for Payer: Quartz Beloit One Network |
$91.22
|
| Rate for Payer: Quartz Commercial |
$121.00
|
| Rate for Payer: Quartz Medicare Advantage |
$111.70
|
| Rate for Payer: The Alliance Commercial |
$93.08
|
| Rate for Payer: WEA Trust Commercial |
$102.39
|
| Rate for Payer: WPS Commercial |
$137.88
|
|
|
ZZZ***SCREW-CORT 3.5 X 34 204.034*** OBSOLETE *** USE 204.834
|
Facility
|
IP
|
$179.00
|
|
| Hospital Charge Code |
2967289
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$91.22 |
| Max. Negotiated Rate |
$171.27 |
| Rate for Payer: Aetna Commercial |
$167.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.66
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cigna Commercial |
$171.27
|
| Rate for Payer: Health EOS Commercial |
$165.68
|
| Rate for Payer: HFN Commercial |
$171.27
|
| Rate for Payer: Multiplan Commercial |
$148.93
|
| Rate for Payer: Preferred Network Access Commercial |
$171.27
|
| Rate for Payer: Quartz Beloit One Network |
$91.22
|
| Rate for Payer: Quartz Commercial |
$111.70
|
| Rate for Payer: WEA Trust Commercial |
$102.39
|
| Rate for Payer: WPS Commercial |
$137.88
|
|
