|
SCREW 2.3 X 18 LOCK CO-T2318
|
Facility
|
OP
|
$1,647.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967390
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$461.16 |
| Max. Negotiated Rate |
$6,588.00 |
| Rate for Payer: Aetna Commercial |
$1,482.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,416.42
|
| Rate for Payer: Aetna Managed Medicare |
$461.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,070.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$823.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$790.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$872.91
|
| Rate for Payer: Cash Price |
$494.10
|
| Rate for Payer: Cigna Commercial |
$1,515.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$921.66
|
| Rate for Payer: Health EOS Commercial |
$1,465.83
|
| Rate for Payer: HFN Commercial |
$1,515.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,235.25
|
| Rate for Payer: Multiplan Commercial |
$1,317.60
|
| Rate for Payer: NAPHCARE Commercial |
$988.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,515.24
|
| Rate for Payer: Quartz Beloit One Network |
$807.03
|
| Rate for Payer: Quartz Commercial |
$1,070.55
|
| Rate for Payer: Quartz Medicare Advantage |
$988.20
|
| Rate for Payer: The Alliance Commercial |
$6,588.00
|
| Rate for Payer: WEA Trust Commercial |
$905.85
|
| Rate for Payer: WPS Commercial |
$1,219.93
|
|
|
SCREW 2.3 X 20 C0-2320
|
Facility
|
IP
|
$1,429.00
|
|
| Hospital Charge Code |
2964153
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$700.21 |
| Max. Negotiated Rate |
$1,314.68 |
| Rate for Payer: Aetna Commercial |
$1,286.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,228.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$757.37
|
| Rate for Payer: Cash Price |
$428.70
|
| Rate for Payer: Cigna Commercial |
$1,314.68
|
| Rate for Payer: Health EOS Commercial |
$1,271.81
|
| Rate for Payer: HFN Commercial |
$1,314.68
|
| Rate for Payer: Multiplan Commercial |
$1,143.20
|
| Rate for Payer: NAPHCARE Commercial |
$857.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,314.68
|
| Rate for Payer: Quartz Beloit One Network |
$700.21
|
| Rate for Payer: Quartz Commercial |
$857.40
|
| Rate for Payer: WEA Trust Commercial |
$785.95
|
| Rate for Payer: WPS Commercial |
$1,058.46
|
|
|
SCREW 2.3 X 20 C0-2320
|
Facility
|
OP
|
$1,429.00
|
|
| Hospital Charge Code |
2964153
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$400.12 |
| Max. Negotiated Rate |
$5,716.00 |
| Rate for Payer: Aetna Commercial |
$1,286.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,228.94
|
| Rate for Payer: Aetna Managed Medicare |
$400.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$928.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$714.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$685.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$757.37
|
| Rate for Payer: Cash Price |
$428.70
|
| Rate for Payer: Cigna Commercial |
$1,314.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$799.67
|
| Rate for Payer: Health EOS Commercial |
$1,271.81
|
| Rate for Payer: HFN Commercial |
$1,314.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,071.75
|
| Rate for Payer: Multiplan Commercial |
$1,143.20
|
| Rate for Payer: NAPHCARE Commercial |
$857.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,314.68
|
| Rate for Payer: Quartz Beloit One Network |
$700.21
|
| Rate for Payer: Quartz Commercial |
$928.85
|
| Rate for Payer: Quartz Medicare Advantage |
$857.40
|
| Rate for Payer: The Alliance Commercial |
$5,716.00
|
| Rate for Payer: WEA Trust Commercial |
$785.95
|
| Rate for Payer: WPS Commercial |
$1,058.46
|
|
|
SCREW 2.3 X 20 LOCK CO-T2320
|
Facility
|
OP
|
$1,725.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3487506
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$483.00 |
| Max. Negotiated Rate |
$6,900.00 |
| Rate for Payer: Aetna Commercial |
$1,552.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,483.50
|
| Rate for Payer: Aetna Managed Medicare |
$483.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,121.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$862.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$828.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$914.25
|
| Rate for Payer: Cash Price |
$517.50
|
| Rate for Payer: Cigna Commercial |
$1,587.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$965.31
|
| Rate for Payer: Health EOS Commercial |
$1,535.25
|
| Rate for Payer: HFN Commercial |
$1,587.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,293.75
|
| Rate for Payer: Multiplan Commercial |
$1,380.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,035.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,587.00
|
| Rate for Payer: Quartz Beloit One Network |
$845.25
|
| Rate for Payer: Quartz Commercial |
$1,121.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,035.00
|
| Rate for Payer: The Alliance Commercial |
$6,900.00
|
| Rate for Payer: WEA Trust Commercial |
$948.75
|
| Rate for Payer: WPS Commercial |
$1,277.71
|
|
|
SCREW 2.3 X 20 LOCK CO-T2320
|
Facility
|
IP
|
$1,725.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3487506
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$845.25 |
| Max. Negotiated Rate |
$1,587.00 |
| Rate for Payer: Aetna Commercial |
$1,552.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,483.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$914.25
|
| Rate for Payer: Cash Price |
$517.50
|
| Rate for Payer: Cigna Commercial |
$1,587.00
|
| Rate for Payer: Health EOS Commercial |
$1,535.25
|
| Rate for Payer: HFN Commercial |
$1,587.00
|
| Rate for Payer: Multiplan Commercial |
$1,380.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,035.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,587.00
|
| Rate for Payer: Quartz Beloit One Network |
$845.25
|
| Rate for Payer: Quartz Commercial |
$1,035.00
|
| Rate for Payer: WEA Trust Commercial |
$948.75
|
| Rate for Payer: WPS Commercial |
$1,277.71
|
|
|
SCREW 2.3 X 22 LOCK CO-T2322
|
Facility
|
IP
|
$1,725.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4520326
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$845.25 |
| Max. Negotiated Rate |
$1,587.00 |
| Rate for Payer: Aetna Commercial |
$1,552.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,483.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$914.25
|
| Rate for Payer: Cash Price |
$517.50
|
| Rate for Payer: Cigna Commercial |
$1,587.00
|
| Rate for Payer: Health EOS Commercial |
$1,535.25
|
| Rate for Payer: HFN Commercial |
$1,587.00
|
| Rate for Payer: Multiplan Commercial |
$1,380.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,035.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,587.00
|
| Rate for Payer: Quartz Beloit One Network |
$845.25
|
| Rate for Payer: Quartz Commercial |
$1,035.00
|
| Rate for Payer: WEA Trust Commercial |
$948.75
|
| Rate for Payer: WPS Commercial |
$1,277.71
|
|
|
SCREW 2.3 X 22 LOCK CO-T2322
|
Facility
|
OP
|
$1,725.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4520326
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$483.00 |
| Max. Negotiated Rate |
$6,900.00 |
| Rate for Payer: Aetna Commercial |
$1,552.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,483.50
|
| Rate for Payer: Aetna Managed Medicare |
$483.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,121.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$862.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$828.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$914.25
|
| Rate for Payer: Cash Price |
$517.50
|
| Rate for Payer: Cigna Commercial |
$1,587.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$965.31
|
| Rate for Payer: Health EOS Commercial |
$1,535.25
|
| Rate for Payer: HFN Commercial |
$1,587.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,293.75
|
| Rate for Payer: Multiplan Commercial |
$1,380.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,035.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,587.00
|
| Rate for Payer: Quartz Beloit One Network |
$845.25
|
| Rate for Payer: Quartz Commercial |
$1,121.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,035.00
|
| Rate for Payer: The Alliance Commercial |
$6,900.00
|
| Rate for Payer: WEA Trust Commercial |
$948.75
|
| Rate for Payer: WPS Commercial |
$1,277.71
|
|
|
SCREW 2.3 X 24 LOCL CO-T2324
|
Facility
|
IP
|
$2,137.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3381507
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,047.13 |
| Max. Negotiated Rate |
$1,966.04 |
| Rate for Payer: Aetna Commercial |
$1,923.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,837.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,132.61
|
| Rate for Payer: Cash Price |
$641.10
|
| Rate for Payer: Cigna Commercial |
$1,966.04
|
| Rate for Payer: Health EOS Commercial |
$1,901.93
|
| Rate for Payer: HFN Commercial |
$1,966.04
|
| Rate for Payer: Multiplan Commercial |
$1,709.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,282.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,966.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,047.13
|
| Rate for Payer: Quartz Commercial |
$1,282.20
|
| Rate for Payer: WEA Trust Commercial |
$1,175.35
|
| Rate for Payer: WPS Commercial |
$1,582.88
|
|
|
SCREW 2.3 X 24 LOCL CO-T2324
|
Facility
|
OP
|
$2,137.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3381507
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$598.36 |
| Max. Negotiated Rate |
$8,548.00 |
| Rate for Payer: Aetna Commercial |
$1,923.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,837.82
|
| Rate for Payer: Aetna Managed Medicare |
$598.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,389.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,068.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,025.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,132.61
|
| Rate for Payer: Cash Price |
$641.10
|
| Rate for Payer: Cigna Commercial |
$1,966.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,195.87
|
| Rate for Payer: Health EOS Commercial |
$1,901.93
|
| Rate for Payer: HFN Commercial |
$1,966.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,602.75
|
| Rate for Payer: Multiplan Commercial |
$1,709.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,282.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,966.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,047.13
|
| Rate for Payer: Quartz Commercial |
$1,389.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,282.20
|
| Rate for Payer: The Alliance Commercial |
$8,548.00
|
| Rate for Payer: WEA Trust Commercial |
$1,175.35
|
| Rate for Payer: WPS Commercial |
$1,582.88
|
|
|
SCREW 2.3 X 26 LOCK CO-T2326
|
Facility
|
OP
|
$1,661.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5264943
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$465.08 |
| Max. Negotiated Rate |
$6,644.00 |
| Rate for Payer: Aetna Commercial |
$1,494.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,428.46
|
| Rate for Payer: Aetna Managed Medicare |
$465.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,079.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$830.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$797.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$880.33
|
| Rate for Payer: Cash Price |
$498.30
|
| Rate for Payer: Cigna Commercial |
$1,528.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$929.50
|
| Rate for Payer: Health EOS Commercial |
$1,478.29
|
| Rate for Payer: HFN Commercial |
$1,528.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,245.75
|
| Rate for Payer: Multiplan Commercial |
$1,328.80
|
| Rate for Payer: NAPHCARE Commercial |
$996.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,528.12
|
| Rate for Payer: Quartz Beloit One Network |
$813.89
|
| Rate for Payer: Quartz Commercial |
$1,079.65
|
| Rate for Payer: Quartz Medicare Advantage |
$996.60
|
| Rate for Payer: The Alliance Commercial |
$6,644.00
|
| Rate for Payer: WEA Trust Commercial |
$913.55
|
| Rate for Payer: WPS Commercial |
$1,230.30
|
|
|
SCREW 2.3 X 26 LOCK CO-T2326
|
Facility
|
IP
|
$1,661.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5264943
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$813.89 |
| Max. Negotiated Rate |
$1,528.12 |
| Rate for Payer: Aetna Commercial |
$1,494.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,428.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$880.33
|
| Rate for Payer: Cash Price |
$498.30
|
| Rate for Payer: Cigna Commercial |
$1,528.12
|
| Rate for Payer: Health EOS Commercial |
$1,478.29
|
| Rate for Payer: HFN Commercial |
$1,528.12
|
| Rate for Payer: Multiplan Commercial |
$1,328.80
|
| Rate for Payer: NAPHCARE Commercial |
$996.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,528.12
|
| Rate for Payer: Quartz Beloit One Network |
$813.89
|
| Rate for Payer: Quartz Commercial |
$996.60
|
| Rate for Payer: WEA Trust Commercial |
$913.55
|
| Rate for Payer: WPS Commercial |
$1,230.30
|
|
|
SCREW 2.3x5mm
|
Facility
|
OP
|
$1,172.00
|
|
| Hospital Charge Code |
2965257
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$328.16 |
| Max. Negotiated Rate |
$4,688.00 |
| Rate for Payer: Aetna Commercial |
$1,054.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,007.92
|
| Rate for Payer: Aetna Managed Medicare |
$328.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$761.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$562.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$621.16
|
| Rate for Payer: Cash Price |
$351.60
|
| Rate for Payer: Cigna Commercial |
$1,078.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$655.85
|
| Rate for Payer: Health EOS Commercial |
$1,043.08
|
| Rate for Payer: HFN Commercial |
$1,078.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$879.00
|
| Rate for Payer: Multiplan Commercial |
$937.60
|
| Rate for Payer: NAPHCARE Commercial |
$703.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,078.24
|
| Rate for Payer: Quartz Beloit One Network |
$574.28
|
| Rate for Payer: Quartz Commercial |
$761.80
|
| Rate for Payer: Quartz Medicare Advantage |
$703.20
|
| Rate for Payer: The Alliance Commercial |
$4,688.00
|
| Rate for Payer: WEA Trust Commercial |
$644.60
|
| Rate for Payer: WPS Commercial |
$868.10
|
|
|
SCREW 2.3x5mm
|
Facility
|
IP
|
$1,172.00
|
|
| Hospital Charge Code |
2965257
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$574.28 |
| Max. Negotiated Rate |
$1,078.24 |
| Rate for Payer: Aetna Commercial |
$1,054.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,007.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$621.16
|
| Rate for Payer: Cash Price |
$351.60
|
| Rate for Payer: Cigna Commercial |
$1,078.24
|
| Rate for Payer: Health EOS Commercial |
$1,043.08
|
| Rate for Payer: HFN Commercial |
$1,078.24
|
| Rate for Payer: Multiplan Commercial |
$937.60
|
| Rate for Payer: NAPHCARE Commercial |
$703.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,078.24
|
| Rate for Payer: Quartz Beloit One Network |
$574.28
|
| Rate for Payer: Quartz Commercial |
$703.20
|
| Rate for Payer: WEA Trust Commercial |
$644.60
|
| Rate for Payer: WPS Commercial |
$868.10
|
|
|
SCREW 2.3x7 KLS MARTIN
|
Facility
|
OP
|
$1,172.00
|
|
| Hospital Charge Code |
2965258
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$328.16 |
| Max. Negotiated Rate |
$4,688.00 |
| Rate for Payer: Aetna Commercial |
$1,054.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,007.92
|
| Rate for Payer: Aetna Managed Medicare |
$328.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$761.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$562.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$621.16
|
| Rate for Payer: Cash Price |
$351.60
|
| Rate for Payer: Cigna Commercial |
$1,078.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$655.85
|
| Rate for Payer: Health EOS Commercial |
$1,043.08
|
| Rate for Payer: HFN Commercial |
$1,078.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$879.00
|
| Rate for Payer: Multiplan Commercial |
$937.60
|
| Rate for Payer: NAPHCARE Commercial |
$703.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,078.24
|
| Rate for Payer: Quartz Beloit One Network |
$574.28
|
| Rate for Payer: Quartz Commercial |
$761.80
|
| Rate for Payer: Quartz Medicare Advantage |
$703.20
|
| Rate for Payer: The Alliance Commercial |
$4,688.00
|
| Rate for Payer: WEA Trust Commercial |
$644.60
|
| Rate for Payer: WPS Commercial |
$868.10
|
|
|
SCREW 2.3x7 KLS MARTIN
|
Facility
|
IP
|
$1,172.00
|
|
| Hospital Charge Code |
2965258
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$574.28 |
| Max. Negotiated Rate |
$1,078.24 |
| Rate for Payer: Aetna Commercial |
$1,054.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,007.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$621.16
|
| Rate for Payer: Cash Price |
$351.60
|
| Rate for Payer: Cigna Commercial |
$1,078.24
|
| Rate for Payer: Health EOS Commercial |
$1,043.08
|
| Rate for Payer: HFN Commercial |
$1,078.24
|
| Rate for Payer: Multiplan Commercial |
$937.60
|
| Rate for Payer: NAPHCARE Commercial |
$703.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,078.24
|
| Rate for Payer: Quartz Beloit One Network |
$574.28
|
| Rate for Payer: Quartz Commercial |
$703.20
|
| Rate for Payer: WEA Trust Commercial |
$644.60
|
| Rate for Payer: WPS Commercial |
$868.10
|
|
|
SCREW 2.4x10 LOCKING 02.210.110
|
Facility
|
OP
|
$2,196.00
|
|
| Hospital Charge Code |
2990963
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$614.88 |
| Max. Negotiated Rate |
$8,784.00 |
| Rate for Payer: Aetna Commercial |
$1,976.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,888.56
|
| Rate for Payer: Aetna Managed Medicare |
$614.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,427.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,098.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,054.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,163.88
|
| Rate for Payer: Cash Price |
$658.80
|
| Rate for Payer: Cigna Commercial |
$2,020.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,228.88
|
| Rate for Payer: Health EOS Commercial |
$1,954.44
|
| Rate for Payer: HFN Commercial |
$2,020.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,647.00
|
| Rate for Payer: Multiplan Commercial |
$1,756.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,317.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,020.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,076.04
|
| Rate for Payer: Quartz Commercial |
$1,427.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,317.60
|
| Rate for Payer: The Alliance Commercial |
$8,784.00
|
| Rate for Payer: WEA Trust Commercial |
$1,207.80
|
| Rate for Payer: WPS Commercial |
$1,626.58
|
|
|
SCREW 2.4x10 LOCKING 02.210.110
|
Facility
|
IP
|
$2,196.00
|
|
| Hospital Charge Code |
2990963
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,076.04 |
| Max. Negotiated Rate |
$2,020.32 |
| Rate for Payer: Aetna Commercial |
$1,976.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,888.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,163.88
|
| Rate for Payer: Cash Price |
$658.80
|
| Rate for Payer: Cigna Commercial |
$2,020.32
|
| Rate for Payer: Health EOS Commercial |
$1,954.44
|
| Rate for Payer: HFN Commercial |
$2,020.32
|
| Rate for Payer: Multiplan Commercial |
$1,756.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,317.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,020.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,076.04
|
| Rate for Payer: Quartz Commercial |
$1,317.60
|
| Rate for Payer: WEA Trust Commercial |
$1,207.80
|
| Rate for Payer: WPS Commercial |
$1,626.58
|
|
|
SCREW 2.4 X 16 HEADLESS 02.226.216
|
Facility
|
IP
|
$4,066.00
|
|
| Hospital Charge Code |
2966449
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,992.34 |
| Max. Negotiated Rate |
$3,740.72 |
| Rate for Payer: Aetna Commercial |
$3,659.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,496.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,154.98
|
| Rate for Payer: Cash Price |
$1,219.80
|
| Rate for Payer: Cigna Commercial |
$3,740.72
|
| Rate for Payer: Health EOS Commercial |
$3,618.74
|
| Rate for Payer: HFN Commercial |
$3,740.72
|
| Rate for Payer: Multiplan Commercial |
$3,252.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,439.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,740.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,992.34
|
| Rate for Payer: Quartz Commercial |
$2,439.60
|
| Rate for Payer: WEA Trust Commercial |
$2,236.30
|
| Rate for Payer: WPS Commercial |
$3,011.69
|
|
|
SCREW 2.4 X 16 HEADLESS 02.226.216
|
Facility
|
OP
|
$4,066.00
|
|
| Hospital Charge Code |
2966449
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,138.48 |
| Max. Negotiated Rate |
$16,264.00 |
| Rate for Payer: Aetna Commercial |
$3,659.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,496.76
|
| Rate for Payer: Aetna Managed Medicare |
$1,138.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,642.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,033.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,951.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,154.98
|
| Rate for Payer: Cash Price |
$1,219.80
|
| Rate for Payer: Cigna Commercial |
$3,740.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,275.33
|
| Rate for Payer: Health EOS Commercial |
$3,618.74
|
| Rate for Payer: HFN Commercial |
$3,740.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,049.50
|
| Rate for Payer: Multiplan Commercial |
$3,252.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,439.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,740.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,992.34
|
| Rate for Payer: Quartz Commercial |
$2,642.90
|
| Rate for Payer: Quartz Medicare Advantage |
$2,439.60
|
| Rate for Payer: The Alliance Commercial |
$16,264.00
|
| Rate for Payer: WEA Trust Commercial |
$2,236.30
|
| Rate for Payer: WPS Commercial |
$3,011.69
|
|
|
SCREW 2.4x18 HEADLESS
|
Facility
|
OP
|
$4,066.00
|
|
| Hospital Charge Code |
2966450
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,138.48 |
| Max. Negotiated Rate |
$16,264.00 |
| Rate for Payer: Aetna Commercial |
$3,659.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,496.76
|
| Rate for Payer: Aetna Managed Medicare |
$1,138.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,642.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,033.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,951.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,154.98
|
| Rate for Payer: Cash Price |
$1,219.80
|
| Rate for Payer: Cigna Commercial |
$3,740.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,275.33
|
| Rate for Payer: Health EOS Commercial |
$3,618.74
|
| Rate for Payer: HFN Commercial |
$3,740.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,049.50
|
| Rate for Payer: Multiplan Commercial |
$3,252.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,439.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,740.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,992.34
|
| Rate for Payer: Quartz Commercial |
$2,642.90
|
| Rate for Payer: Quartz Medicare Advantage |
$2,439.60
|
| Rate for Payer: The Alliance Commercial |
$16,264.00
|
| Rate for Payer: WEA Trust Commercial |
$2,236.30
|
| Rate for Payer: WPS Commercial |
$3,011.69
|
|
|
SCREW 2.4x18 HEADLESS
|
Facility
|
IP
|
$4,066.00
|
|
| Hospital Charge Code |
2966450
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,992.34 |
| Max. Negotiated Rate |
$3,740.72 |
| Rate for Payer: Aetna Commercial |
$3,659.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,496.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,154.98
|
| Rate for Payer: Cash Price |
$1,219.80
|
| Rate for Payer: Cigna Commercial |
$3,740.72
|
| Rate for Payer: Health EOS Commercial |
$3,618.74
|
| Rate for Payer: HFN Commercial |
$3,740.72
|
| Rate for Payer: Multiplan Commercial |
$3,252.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,439.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,740.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,992.34
|
| Rate for Payer: Quartz Commercial |
$2,439.60
|
| Rate for Payer: WEA Trust Commercial |
$2,236.30
|
| Rate for Payer: WPS Commercial |
$3,011.69
|
|
|
SCREW 2.4x20MM COMPRESSION
|
Facility
|
IP
|
$4,428.00
|
|
| Hospital Charge Code |
2966456
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,169.72 |
| Max. Negotiated Rate |
$4,073.76 |
| Rate for Payer: Aetna Commercial |
$3,985.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,808.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,346.84
|
| Rate for Payer: Cash Price |
$1,328.40
|
| Rate for Payer: Cigna Commercial |
$4,073.76
|
| Rate for Payer: Health EOS Commercial |
$3,940.92
|
| Rate for Payer: HFN Commercial |
$4,073.76
|
| Rate for Payer: Multiplan Commercial |
$3,542.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,656.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,073.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,169.72
|
| Rate for Payer: Quartz Commercial |
$2,656.80
|
| Rate for Payer: WEA Trust Commercial |
$2,435.40
|
| Rate for Payer: WPS Commercial |
$3,279.82
|
|
|
SCREW 2.4x20MM COMPRESSION
|
Facility
|
OP
|
$4,428.00
|
|
| Hospital Charge Code |
2966456
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,239.84 |
| Max. Negotiated Rate |
$17,712.00 |
| Rate for Payer: Aetna Commercial |
$3,985.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,808.08
|
| Rate for Payer: Aetna Managed Medicare |
$1,239.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,878.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,214.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,125.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,346.84
|
| Rate for Payer: Cash Price |
$1,328.40
|
| Rate for Payer: Cigna Commercial |
$4,073.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,477.91
|
| Rate for Payer: Health EOS Commercial |
$3,940.92
|
| Rate for Payer: HFN Commercial |
$4,073.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,321.00
|
| Rate for Payer: Multiplan Commercial |
$3,542.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,656.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,073.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,169.72
|
| Rate for Payer: Quartz Commercial |
$2,878.20
|
| Rate for Payer: Quartz Medicare Advantage |
$2,656.80
|
| Rate for Payer: The Alliance Commercial |
$17,712.00
|
| Rate for Payer: WEA Trust Commercial |
$2,435.40
|
| Rate for Payer: WPS Commercial |
$3,279.82
|
|
|
SCREW 2.4X24 CORTEX 201.774
|
Facility
|
IP
|
$999.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966460
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$489.51 |
| Max. Negotiated Rate |
$919.08 |
| Rate for Payer: Aetna Commercial |
$899.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$859.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$529.47
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Cigna Commercial |
$919.08
|
| Rate for Payer: Health EOS Commercial |
$889.11
|
| Rate for Payer: HFN Commercial |
$919.08
|
| Rate for Payer: Multiplan Commercial |
$799.20
|
| Rate for Payer: NAPHCARE Commercial |
$599.40
|
| Rate for Payer: Preferred Network Access Commercial |
$919.08
|
| Rate for Payer: Quartz Beloit One Network |
$489.51
|
| Rate for Payer: Quartz Commercial |
$599.40
|
| Rate for Payer: WEA Trust Commercial |
$549.45
|
| Rate for Payer: WPS Commercial |
$739.96
|
|
|
SCREW 2.4X24 CORTEX 201.774
|
Facility
|
OP
|
$999.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966460
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$279.72 |
| Max. Negotiated Rate |
$3,996.00 |
| Rate for Payer: Aetna Commercial |
$899.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$859.14
|
| Rate for Payer: Aetna Managed Medicare |
$279.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$649.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$499.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$479.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$529.47
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Cigna Commercial |
$919.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$559.04
|
| Rate for Payer: Health EOS Commercial |
$889.11
|
| Rate for Payer: HFN Commercial |
$919.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$749.25
|
| Rate for Payer: Multiplan Commercial |
$799.20
|
| Rate for Payer: NAPHCARE Commercial |
$599.40
|
| Rate for Payer: Preferred Network Access Commercial |
$919.08
|
| Rate for Payer: Quartz Beloit One Network |
$489.51
|
| Rate for Payer: Quartz Commercial |
$649.35
|
| Rate for Payer: Quartz Medicare Advantage |
$599.40
|
| Rate for Payer: The Alliance Commercial |
$3,996.00
|
| Rate for Payer: WEA Trust Commercial |
$549.45
|
| Rate for Payer: WPS Commercial |
$739.96
|
|
