|
SCREW 3.5 X 28 LOCK 30-0242
|
Facility
|
OP
|
$2,298.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494170
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$643.44 |
| Max. Negotiated Rate |
$9,192.00 |
| Rate for Payer: Aetna Commercial |
$2,068.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,976.28
|
| Rate for Payer: Aetna Managed Medicare |
$643.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,493.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,149.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,103.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,217.94
|
| Rate for Payer: Cash Price |
$689.40
|
| Rate for Payer: Cigna Commercial |
$2,114.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,285.96
|
| Rate for Payer: Health EOS Commercial |
$2,045.22
|
| Rate for Payer: HFN Commercial |
$2,114.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,723.50
|
| Rate for Payer: Multiplan Commercial |
$1,838.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,378.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,114.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,126.02
|
| Rate for Payer: Quartz Commercial |
$1,493.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,378.80
|
| Rate for Payer: The Alliance Commercial |
$9,192.00
|
| Rate for Payer: WEA Trust Commercial |
$1,263.90
|
| Rate for Payer: WPS Commercial |
$1,702.13
|
|
|
SCREW 3.5 X 30 LOCKING
|
Facility
|
OP
|
$1,728.00
|
|
| Hospital Charge Code |
2966495
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$483.84 |
| Max. Negotiated Rate |
$6,912.00 |
| Rate for Payer: Aetna Commercial |
$1,555.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,486.08
|
| Rate for Payer: Aetna Managed Medicare |
$483.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,123.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$864.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$829.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$915.84
|
| Rate for Payer: Cash Price |
$518.40
|
| Rate for Payer: Cigna Commercial |
$1,589.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$966.99
|
| Rate for Payer: Health EOS Commercial |
$1,537.92
|
| Rate for Payer: HFN Commercial |
$1,589.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,296.00
|
| Rate for Payer: Multiplan Commercial |
$1,382.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,036.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,589.76
|
| Rate for Payer: Quartz Beloit One Network |
$846.72
|
| Rate for Payer: Quartz Commercial |
$1,123.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,036.80
|
| Rate for Payer: The Alliance Commercial |
$6,912.00
|
| Rate for Payer: WEA Trust Commercial |
$950.40
|
| Rate for Payer: WPS Commercial |
$1,279.93
|
|
|
SCREW 3.5 X 30 LOCKING
|
Facility
|
IP
|
$1,728.00
|
|
| Hospital Charge Code |
2966495
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$846.72 |
| Max. Negotiated Rate |
$1,589.76 |
| Rate for Payer: Aetna Commercial |
$1,555.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,486.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$915.84
|
| Rate for Payer: Cash Price |
$518.40
|
| Rate for Payer: Cigna Commercial |
$1,589.76
|
| Rate for Payer: Health EOS Commercial |
$1,537.92
|
| Rate for Payer: HFN Commercial |
$1,589.76
|
| Rate for Payer: Multiplan Commercial |
$1,382.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,036.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,589.76
|
| Rate for Payer: Quartz Beloit One Network |
$846.72
|
| Rate for Payer: Quartz Commercial |
$1,036.80
|
| Rate for Payer: WEA Trust Commercial |
$950.40
|
| Rate for Payer: WPS Commercial |
$1,279.93
|
|
|
SCREW 3.5x32 LOCKING 213.032
|
Facility
|
IP
|
$2,002.00
|
|
| Hospital Charge Code |
2966499
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$980.98 |
| Max. Negotiated Rate |
$1,841.84 |
| Rate for Payer: Aetna Commercial |
$1,801.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,721.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,061.06
|
| Rate for Payer: Cash Price |
$600.60
|
| Rate for Payer: Cigna Commercial |
$1,841.84
|
| Rate for Payer: Health EOS Commercial |
$1,781.78
|
| Rate for Payer: HFN Commercial |
$1,841.84
|
| Rate for Payer: Multiplan Commercial |
$1,601.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,201.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,841.84
|
| Rate for Payer: Quartz Beloit One Network |
$980.98
|
| Rate for Payer: Quartz Commercial |
$1,201.20
|
| Rate for Payer: WEA Trust Commercial |
$1,101.10
|
| Rate for Payer: WPS Commercial |
$1,482.88
|
|
|
SCREW 3.5x32 LOCKING 213.032
|
Facility
|
OP
|
$2,002.00
|
|
| Hospital Charge Code |
2966499
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$560.56 |
| Max. Negotiated Rate |
$8,008.00 |
| Rate for Payer: Aetna Commercial |
$1,801.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,721.72
|
| Rate for Payer: Aetna Managed Medicare |
$560.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,301.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,001.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$960.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,061.06
|
| Rate for Payer: Cash Price |
$600.60
|
| Rate for Payer: Cigna Commercial |
$1,841.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,120.32
|
| Rate for Payer: Health EOS Commercial |
$1,781.78
|
| Rate for Payer: HFN Commercial |
$1,841.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,501.50
|
| Rate for Payer: Multiplan Commercial |
$1,601.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,201.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,841.84
|
| Rate for Payer: Quartz Beloit One Network |
$980.98
|
| Rate for Payer: Quartz Commercial |
$1,301.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,201.20
|
| Rate for Payer: The Alliance Commercial |
$8,008.00
|
| Rate for Payer: WEA Trust Commercial |
$1,101.10
|
| Rate for Payer: WPS Commercial |
$1,482.88
|
|
|
SCREW 3.5X34 LOCKING
|
Facility
|
OP
|
$2,002.00
|
|
| Hospital Charge Code |
2966500
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$560.56 |
| Max. Negotiated Rate |
$8,008.00 |
| Rate for Payer: Aetna Commercial |
$1,801.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,721.72
|
| Rate for Payer: Aetna Managed Medicare |
$560.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,301.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,001.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$960.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,061.06
|
| Rate for Payer: Cash Price |
$600.60
|
| Rate for Payer: Cigna Commercial |
$1,841.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,120.32
|
| Rate for Payer: Health EOS Commercial |
$1,781.78
|
| Rate for Payer: HFN Commercial |
$1,841.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,501.50
|
| Rate for Payer: Multiplan Commercial |
$1,601.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,201.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,841.84
|
| Rate for Payer: Quartz Beloit One Network |
$980.98
|
| Rate for Payer: Quartz Commercial |
$1,301.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,201.20
|
| Rate for Payer: The Alliance Commercial |
$8,008.00
|
| Rate for Payer: WEA Trust Commercial |
$1,101.10
|
| Rate for Payer: WPS Commercial |
$1,482.88
|
|
|
SCREW 3.5X34 LOCKING
|
Facility
|
IP
|
$2,002.00
|
|
| Hospital Charge Code |
2966500
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$980.98 |
| Max. Negotiated Rate |
$1,841.84 |
| Rate for Payer: Aetna Commercial |
$1,801.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,721.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,061.06
|
| Rate for Payer: Cash Price |
$600.60
|
| Rate for Payer: Cigna Commercial |
$1,841.84
|
| Rate for Payer: Health EOS Commercial |
$1,781.78
|
| Rate for Payer: HFN Commercial |
$1,841.84
|
| Rate for Payer: Multiplan Commercial |
$1,601.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,201.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,841.84
|
| Rate for Payer: Quartz Beloit One Network |
$980.98
|
| Rate for Payer: Quartz Commercial |
$1,201.20
|
| Rate for Payer: WEA Trust Commercial |
$1,101.10
|
| Rate for Payer: WPS Commercial |
$1,482.88
|
|
|
SCREW 3.5x36 LOCKING 213.036
|
Facility
|
IP
|
$2,002.00
|
|
| Hospital Charge Code |
2966501
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$980.98 |
| Max. Negotiated Rate |
$1,841.84 |
| Rate for Payer: Aetna Commercial |
$1,801.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,721.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,061.06
|
| Rate for Payer: Cash Price |
$600.60
|
| Rate for Payer: Cigna Commercial |
$1,841.84
|
| Rate for Payer: Health EOS Commercial |
$1,781.78
|
| Rate for Payer: HFN Commercial |
$1,841.84
|
| Rate for Payer: Multiplan Commercial |
$1,601.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,201.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,841.84
|
| Rate for Payer: Quartz Beloit One Network |
$980.98
|
| Rate for Payer: Quartz Commercial |
$1,201.20
|
| Rate for Payer: WEA Trust Commercial |
$1,101.10
|
| Rate for Payer: WPS Commercial |
$1,482.88
|
|
|
SCREW 3.5x36 LOCKING 213.036
|
Facility
|
OP
|
$2,002.00
|
|
| Hospital Charge Code |
2966501
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$560.56 |
| Max. Negotiated Rate |
$8,008.00 |
| Rate for Payer: Aetna Commercial |
$1,801.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,721.72
|
| Rate for Payer: Aetna Managed Medicare |
$560.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,301.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,001.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$960.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,061.06
|
| Rate for Payer: Cash Price |
$600.60
|
| Rate for Payer: Cigna Commercial |
$1,841.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,120.32
|
| Rate for Payer: Health EOS Commercial |
$1,781.78
|
| Rate for Payer: HFN Commercial |
$1,841.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,501.50
|
| Rate for Payer: Multiplan Commercial |
$1,601.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,201.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,841.84
|
| Rate for Payer: Quartz Beloit One Network |
$980.98
|
| Rate for Payer: Quartz Commercial |
$1,301.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,201.20
|
| Rate for Payer: The Alliance Commercial |
$8,008.00
|
| Rate for Payer: WEA Trust Commercial |
$1,101.10
|
| Rate for Payer: WPS Commercial |
$1,482.88
|
|
|
SCREW 3.5 X 40 LOCK 30-0248
|
Facility
|
IP
|
$2,298.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4595312
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,126.02 |
| Max. Negotiated Rate |
$2,114.16 |
| Rate for Payer: Aetna Commercial |
$2,068.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,976.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,217.94
|
| Rate for Payer: Cash Price |
$689.40
|
| Rate for Payer: Cigna Commercial |
$2,114.16
|
| Rate for Payer: Health EOS Commercial |
$2,045.22
|
| Rate for Payer: HFN Commercial |
$2,114.16
|
| Rate for Payer: Multiplan Commercial |
$1,838.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,378.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,114.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,126.02
|
| Rate for Payer: Quartz Commercial |
$1,378.80
|
| Rate for Payer: WEA Trust Commercial |
$1,263.90
|
| Rate for Payer: WPS Commercial |
$1,702.13
|
|
|
SCREW 3.5 X 40 LOCK 30-0248
|
Facility
|
OP
|
$2,298.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4595312
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$643.44 |
| Max. Negotiated Rate |
$9,192.00 |
| Rate for Payer: Aetna Commercial |
$2,068.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,976.28
|
| Rate for Payer: Aetna Managed Medicare |
$643.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,493.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,149.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,103.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,217.94
|
| Rate for Payer: Cash Price |
$689.40
|
| Rate for Payer: Cigna Commercial |
$2,114.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,285.96
|
| Rate for Payer: Health EOS Commercial |
$2,045.22
|
| Rate for Payer: HFN Commercial |
$2,114.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,723.50
|
| Rate for Payer: Multiplan Commercial |
$1,838.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,378.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,114.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,126.02
|
| Rate for Payer: Quartz Commercial |
$1,493.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,378.80
|
| Rate for Payer: The Alliance Commercial |
$9,192.00
|
| Rate for Payer: WEA Trust Commercial |
$1,263.90
|
| Rate for Payer: WPS Commercial |
$1,702.13
|
|
|
SCREW 4.0 CANNULATED 44MM
|
Facility
|
OP
|
$2,747.00
|
|
| Hospital Charge Code |
2965016
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$769.16 |
| Max. Negotiated Rate |
$10,988.00 |
| Rate for Payer: Aetna Commercial |
$2,472.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,362.42
|
| Rate for Payer: Aetna Managed Medicare |
$769.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,785.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,373.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,318.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,455.91
|
| Rate for Payer: Cash Price |
$824.10
|
| Rate for Payer: Cigna Commercial |
$2,527.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,537.22
|
| Rate for Payer: Health EOS Commercial |
$2,444.83
|
| Rate for Payer: HFN Commercial |
$2,527.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,060.25
|
| Rate for Payer: Multiplan Commercial |
$2,197.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,648.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,527.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,346.03
|
| Rate for Payer: Quartz Commercial |
$1,785.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,648.20
|
| Rate for Payer: The Alliance Commercial |
$10,988.00
|
| Rate for Payer: WEA Trust Commercial |
$1,510.85
|
| Rate for Payer: WPS Commercial |
$2,034.70
|
|
|
SCREW 4.0 CANNULATED 44MM
|
Facility
|
IP
|
$2,747.00
|
|
| Hospital Charge Code |
2965016
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,346.03 |
| Max. Negotiated Rate |
$2,527.24 |
| Rate for Payer: Aetna Commercial |
$2,472.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,362.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,455.91
|
| Rate for Payer: Cash Price |
$824.10
|
| Rate for Payer: Cigna Commercial |
$2,527.24
|
| Rate for Payer: Health EOS Commercial |
$2,444.83
|
| Rate for Payer: HFN Commercial |
$2,527.24
|
| Rate for Payer: Multiplan Commercial |
$2,197.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,648.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,527.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,346.03
|
| Rate for Payer: Quartz Commercial |
$1,648.20
|
| Rate for Payer: WEA Trust Commercial |
$1,510.85
|
| Rate for Payer: WPS Commercial |
$2,034.70
|
|
|
SCREW 4.0x18 TITANIUM CANCELLO
|
Facility
|
IP
|
$472.00
|
|
| Hospital Charge Code |
2966514
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$231.28 |
| Max. Negotiated Rate |
$434.24 |
| Rate for Payer: Aetna Commercial |
$424.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$405.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$250.16
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cigna Commercial |
$434.24
|
| Rate for Payer: Health EOS Commercial |
$420.08
|
| Rate for Payer: HFN Commercial |
$434.24
|
| Rate for Payer: Multiplan Commercial |
$377.60
|
| Rate for Payer: NAPHCARE Commercial |
$283.20
|
| Rate for Payer: Preferred Network Access Commercial |
$434.24
|
| Rate for Payer: Quartz Beloit One Network |
$231.28
|
| Rate for Payer: Quartz Commercial |
$283.20
|
| Rate for Payer: WEA Trust Commercial |
$259.60
|
| Rate for Payer: WPS Commercial |
$349.61
|
|
|
SCREW 4.0x18 TITANIUM CANCELLO
|
Facility
|
OP
|
$472.00
|
|
| Hospital Charge Code |
2966514
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$132.16 |
| Max. Negotiated Rate |
$1,888.00 |
| Rate for Payer: Aetna Commercial |
$424.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$405.92
|
| Rate for Payer: Aetna Managed Medicare |
$132.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$306.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$236.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$226.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$250.16
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cigna Commercial |
$434.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$264.13
|
| Rate for Payer: Health EOS Commercial |
$420.08
|
| Rate for Payer: HFN Commercial |
$434.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$354.00
|
| Rate for Payer: Multiplan Commercial |
$377.60
|
| Rate for Payer: NAPHCARE Commercial |
$283.20
|
| Rate for Payer: Preferred Network Access Commercial |
$434.24
|
| Rate for Payer: Quartz Beloit One Network |
$231.28
|
| Rate for Payer: Quartz Commercial |
$306.80
|
| Rate for Payer: Quartz Medicare Advantage |
$283.20
|
| Rate for Payer: The Alliance Commercial |
$1,888.00
|
| Rate for Payer: WEA Trust Commercial |
$259.60
|
| Rate for Payer: WPS Commercial |
$349.61
|
|
|
SCREW 4.0 X 20 CORTICAL
|
Facility
|
IP
|
$2,340.00
|
|
| Hospital Charge Code |
2966035
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,146.60 |
| Max. Negotiated Rate |
$2,152.80 |
| Rate for Payer: Aetna Commercial |
$2,106.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,012.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,240.20
|
| Rate for Payer: Cash Price |
$702.00
|
| Rate for Payer: Cigna Commercial |
$2,152.80
|
| Rate for Payer: Health EOS Commercial |
$2,082.60
|
| Rate for Payer: HFN Commercial |
$2,152.80
|
| Rate for Payer: Multiplan Commercial |
$1,872.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,404.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,152.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,146.60
|
| Rate for Payer: Quartz Commercial |
$1,404.00
|
| Rate for Payer: WEA Trust Commercial |
$1,287.00
|
| Rate for Payer: WPS Commercial |
$1,733.24
|
|
|
SCREW 4.0 X 20 CORTICAL
|
Facility
|
OP
|
$2,340.00
|
|
| Hospital Charge Code |
2966035
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$655.20 |
| Max. Negotiated Rate |
$9,360.00 |
| Rate for Payer: Aetna Commercial |
$2,106.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,012.40
|
| Rate for Payer: Aetna Managed Medicare |
$655.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,521.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,170.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,123.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,240.20
|
| Rate for Payer: Cash Price |
$702.00
|
| Rate for Payer: Cigna Commercial |
$2,152.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,309.46
|
| Rate for Payer: Health EOS Commercial |
$2,082.60
|
| Rate for Payer: HFN Commercial |
$2,152.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,755.00
|
| Rate for Payer: Multiplan Commercial |
$1,872.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,404.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,152.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,146.60
|
| Rate for Payer: Quartz Commercial |
$1,521.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,404.00
|
| Rate for Payer: The Alliance Commercial |
$9,360.00
|
| Rate for Payer: WEA Trust Commercial |
$1,287.00
|
| Rate for Payer: WPS Commercial |
$1,733.24
|
|
|
SCREW 4.0x34 LOCKING TORNIER
|
Facility
|
IP
|
$1,373.00
|
|
| Hospital Charge Code |
2967363
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$672.77 |
| Max. Negotiated Rate |
$1,263.16 |
| Rate for Payer: Aetna Commercial |
$1,235.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,180.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$727.69
|
| Rate for Payer: Cash Price |
$411.90
|
| Rate for Payer: Cigna Commercial |
$1,263.16
|
| Rate for Payer: Health EOS Commercial |
$1,221.97
|
| Rate for Payer: HFN Commercial |
$1,263.16
|
| Rate for Payer: Multiplan Commercial |
$1,098.40
|
| Rate for Payer: NAPHCARE Commercial |
$823.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,263.16
|
| Rate for Payer: Quartz Beloit One Network |
$672.77
|
| Rate for Payer: Quartz Commercial |
$823.80
|
| Rate for Payer: WEA Trust Commercial |
$755.15
|
| Rate for Payer: WPS Commercial |
$1,016.98
|
|
|
SCREW 4.0x34 LOCKING TORNIER
|
Facility
|
OP
|
$1,373.00
|
|
| Hospital Charge Code |
2967363
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$384.44 |
| Max. Negotiated Rate |
$5,492.00 |
| Rate for Payer: Aetna Commercial |
$1,235.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,180.78
|
| Rate for Payer: Aetna Managed Medicare |
$384.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$892.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$686.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$659.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$727.69
|
| Rate for Payer: Cash Price |
$411.90
|
| Rate for Payer: Cigna Commercial |
$1,263.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$768.33
|
| Rate for Payer: Health EOS Commercial |
$1,221.97
|
| Rate for Payer: HFN Commercial |
$1,263.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,029.75
|
| Rate for Payer: Multiplan Commercial |
$1,098.40
|
| Rate for Payer: NAPHCARE Commercial |
$823.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,263.16
|
| Rate for Payer: Quartz Beloit One Network |
$672.77
|
| Rate for Payer: Quartz Commercial |
$892.45
|
| Rate for Payer: Quartz Medicare Advantage |
$823.80
|
| Rate for Payer: The Alliance Commercial |
$5,492.00
|
| Rate for Payer: WEA Trust Commercial |
$755.15
|
| Rate for Payer: WPS Commercial |
$1,016.98
|
|
|
SCREW 4.0 X 38MM LONG THREAD LP AR-8840PL-38
|
Facility
|
IP
|
$652.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5416058
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$319.48 |
| Max. Negotiated Rate |
$599.84 |
| Rate for Payer: Aetna Commercial |
$586.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$560.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$345.56
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cigna Commercial |
$599.84
|
| Rate for Payer: Health EOS Commercial |
$580.28
|
| Rate for Payer: HFN Commercial |
$599.84
|
| Rate for Payer: Multiplan Commercial |
$521.60
|
| Rate for Payer: NAPHCARE Commercial |
$391.20
|
| Rate for Payer: Preferred Network Access Commercial |
$599.84
|
| Rate for Payer: Quartz Beloit One Network |
$319.48
|
| Rate for Payer: Quartz Commercial |
$391.20
|
| Rate for Payer: WEA Trust Commercial |
$358.60
|
| Rate for Payer: WPS Commercial |
$482.94
|
|
|
SCREW 4.0 X 38MM LONG THREAD LP AR-8840PL-38
|
Facility
|
OP
|
$652.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5416058
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$182.56 |
| Max. Negotiated Rate |
$2,608.00 |
| Rate for Payer: Aetna Commercial |
$586.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$560.72
|
| Rate for Payer: Aetna Managed Medicare |
$182.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$423.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$326.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$312.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$345.56
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cigna Commercial |
$599.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$364.86
|
| Rate for Payer: Health EOS Commercial |
$580.28
|
| Rate for Payer: HFN Commercial |
$599.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$489.00
|
| Rate for Payer: Multiplan Commercial |
$521.60
|
| Rate for Payer: NAPHCARE Commercial |
$391.20
|
| Rate for Payer: Preferred Network Access Commercial |
$599.84
|
| Rate for Payer: Quartz Beloit One Network |
$319.48
|
| Rate for Payer: Quartz Commercial |
$423.80
|
| Rate for Payer: Quartz Medicare Advantage |
$391.20
|
| Rate for Payer: The Alliance Commercial |
$2,608.00
|
| Rate for Payer: WEA Trust Commercial |
$358.60
|
| Rate for Payer: WPS Commercial |
$482.94
|
|
|
SCREW 4.0 X 40MM CANN TRILLIANT 200-40-040
|
Facility
|
IP
|
$2,289.00
|
|
| Hospital Charge Code |
4595750
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,121.61 |
| Max. Negotiated Rate |
$2,105.88 |
| Rate for Payer: Aetna Commercial |
$2,060.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,968.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,213.17
|
| Rate for Payer: Cash Price |
$686.70
|
| Rate for Payer: Cigna Commercial |
$2,105.88
|
| Rate for Payer: Health EOS Commercial |
$2,037.21
|
| Rate for Payer: HFN Commercial |
$2,105.88
|
| Rate for Payer: Multiplan Commercial |
$1,831.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,373.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,105.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,121.61
|
| Rate for Payer: Quartz Commercial |
$1,373.40
|
| Rate for Payer: WEA Trust Commercial |
$1,258.95
|
| Rate for Payer: WPS Commercial |
$1,695.46
|
|
|
SCREW 4.0 X 40MM CANN TRILLIANT 200-40-040
|
Facility
|
OP
|
$2,289.00
|
|
| Hospital Charge Code |
4595750
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$640.92 |
| Max. Negotiated Rate |
$9,156.00 |
| Rate for Payer: Aetna Commercial |
$2,060.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,968.54
|
| Rate for Payer: Aetna Managed Medicare |
$640.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,487.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,144.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,098.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,213.17
|
| Rate for Payer: Cash Price |
$686.70
|
| Rate for Payer: Cigna Commercial |
$2,105.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,280.92
|
| Rate for Payer: Health EOS Commercial |
$2,037.21
|
| Rate for Payer: HFN Commercial |
$2,105.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,716.75
|
| Rate for Payer: Multiplan Commercial |
$1,831.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,373.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,105.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,121.61
|
| Rate for Payer: Quartz Commercial |
$1,487.85
|
| Rate for Payer: Quartz Medicare Advantage |
$1,373.40
|
| Rate for Payer: The Alliance Commercial |
$9,156.00
|
| Rate for Payer: WEA Trust Commercial |
$1,258.95
|
| Rate for Payer: WPS Commercial |
$1,695.46
|
|
|
SCREW 4.0x42 CANNULATED
|
Facility
|
IP
|
$1,922.00
|
|
| Hospital Charge Code |
2965017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$941.78 |
| Max. Negotiated Rate |
$1,768.24 |
| Rate for Payer: Aetna Commercial |
$1,729.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,652.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,018.66
|
| Rate for Payer: Cash Price |
$576.60
|
| Rate for Payer: Cigna Commercial |
$1,768.24
|
| Rate for Payer: Health EOS Commercial |
$1,710.58
|
| Rate for Payer: HFN Commercial |
$1,768.24
|
| Rate for Payer: Multiplan Commercial |
$1,537.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,153.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,768.24
|
| Rate for Payer: Quartz Beloit One Network |
$941.78
|
| Rate for Payer: Quartz Commercial |
$1,153.20
|
| Rate for Payer: WEA Trust Commercial |
$1,057.10
|
| Rate for Payer: WPS Commercial |
$1,423.63
|
|
|
SCREW 4.0x42 CANNULATED
|
Facility
|
OP
|
$1,922.00
|
|
| Hospital Charge Code |
2965017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$538.16 |
| Max. Negotiated Rate |
$7,688.00 |
| Rate for Payer: Aetna Commercial |
$1,729.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,652.92
|
| Rate for Payer: Aetna Managed Medicare |
$538.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,249.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$961.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$922.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,018.66
|
| Rate for Payer: Cash Price |
$576.60
|
| Rate for Payer: Cigna Commercial |
$1,768.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,075.55
|
| Rate for Payer: Health EOS Commercial |
$1,710.58
|
| Rate for Payer: HFN Commercial |
$1,768.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,441.50
|
| Rate for Payer: Multiplan Commercial |
$1,537.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,153.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,768.24
|
| Rate for Payer: Quartz Beloit One Network |
$941.78
|
| Rate for Payer: Quartz Commercial |
$1,249.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,153.20
|
| Rate for Payer: The Alliance Commercial |
$7,688.00
|
| Rate for Payer: WEA Trust Commercial |
$1,057.10
|
| Rate for Payer: WPS Commercial |
$1,423.63
|
|
