|
SCREW 1.5x13 TI SF TAP CORTEX
|
Facility
|
IP
|
$971.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966410
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$494.82 |
| Max. Negotiated Rate |
$929.05 |
| Rate for Payer: Aetna Commercial |
$908.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$868.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$535.22
|
| Rate for Payer: Cash Price |
$291.30
|
| Rate for Payer: Cigna Commercial |
$929.05
|
| Rate for Payer: Health EOS Commercial |
$898.76
|
| Rate for Payer: HFN Commercial |
$929.05
|
| Rate for Payer: Multiplan Commercial |
$807.87
|
| Rate for Payer: Preferred Network Access Commercial |
$929.05
|
| Rate for Payer: Quartz Beloit One Network |
$494.82
|
| Rate for Payer: Quartz Commercial |
$605.90
|
| Rate for Payer: WEA Trust Commercial |
$555.41
|
| Rate for Payer: WPS Commercial |
$747.96
|
|
|
SCREW 1.5x18MM LOCKING 02.214.018
|
Facility
|
IP
|
$2,335.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508909
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,189.92 |
| Max. Negotiated Rate |
$2,234.13 |
| Rate for Payer: Aetna Commercial |
$2,185.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,088.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,287.05
|
| Rate for Payer: Cash Price |
$700.50
|
| Rate for Payer: Cigna Commercial |
$2,234.13
|
| Rate for Payer: Health EOS Commercial |
$2,161.28
|
| Rate for Payer: HFN Commercial |
$2,234.13
|
| Rate for Payer: Multiplan Commercial |
$1,942.72
|
| Rate for Payer: Preferred Network Access Commercial |
$2,234.13
|
| Rate for Payer: Quartz Beloit One Network |
$1,189.92
|
| Rate for Payer: Quartz Commercial |
$1,457.04
|
| Rate for Payer: WEA Trust Commercial |
$1,335.62
|
| Rate for Payer: WPS Commercial |
$1,798.65
|
|
|
SCREW 1.5x18MM LOCKING 02.214.018
|
Facility
|
OP
|
$2,335.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508909
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$679.95 |
| Max. Negotiated Rate |
$2,234.13 |
| Rate for Payer: Aetna Commercial |
$2,185.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,088.42
|
| Rate for Payer: Aetna Managed Medicare |
$679.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,578.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,214.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,165.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,287.05
|
| Rate for Payer: Cash Price |
$700.50
|
| Rate for Payer: Cigna Commercial |
$2,234.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,358.97
|
| Rate for Payer: Health EOS Commercial |
$2,161.28
|
| Rate for Payer: HFN Commercial |
$2,234.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,821.30
|
| Rate for Payer: Multiplan Commercial |
$1,942.72
|
| Rate for Payer: NAPHCARE Commercial |
$1,457.04
|
| Rate for Payer: Preferred Network Access Commercial |
$2,234.13
|
| Rate for Payer: Quartz Beloit One Network |
$1,189.92
|
| Rate for Payer: Quartz Commercial |
$1,578.46
|
| Rate for Payer: Quartz Medicare Advantage |
$1,457.04
|
| Rate for Payer: The Alliance Commercial |
$1,214.20
|
| Rate for Payer: WEA Trust Commercial |
$1,335.62
|
| Rate for Payer: WPS Commercial |
$1,798.65
|
|
|
SCREW 1.5x20MM LOCKING 02.214.020
|
Facility
|
OP
|
$2,335.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508910
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$679.95 |
| Max. Negotiated Rate |
$2,234.13 |
| Rate for Payer: Aetna Commercial |
$2,185.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,088.42
|
| Rate for Payer: Aetna Managed Medicare |
$679.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,578.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,214.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,165.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,287.05
|
| Rate for Payer: Cash Price |
$700.50
|
| Rate for Payer: Cigna Commercial |
$2,234.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,358.97
|
| Rate for Payer: Health EOS Commercial |
$2,161.28
|
| Rate for Payer: HFN Commercial |
$2,234.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,821.30
|
| Rate for Payer: Multiplan Commercial |
$1,942.72
|
| Rate for Payer: NAPHCARE Commercial |
$1,457.04
|
| Rate for Payer: Preferred Network Access Commercial |
$2,234.13
|
| Rate for Payer: Quartz Beloit One Network |
$1,189.92
|
| Rate for Payer: Quartz Commercial |
$1,578.46
|
| Rate for Payer: Quartz Medicare Advantage |
$1,457.04
|
| Rate for Payer: The Alliance Commercial |
$1,214.20
|
| Rate for Payer: WEA Trust Commercial |
$1,335.62
|
| Rate for Payer: WPS Commercial |
$1,798.65
|
|
|
SCREW 1.5x20MM LOCKING 02.214.020
|
Facility
|
IP
|
$2,335.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508910
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,189.92 |
| Max. Negotiated Rate |
$2,234.13 |
| Rate for Payer: Aetna Commercial |
$2,185.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,088.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,287.05
|
| Rate for Payer: Cash Price |
$700.50
|
| Rate for Payer: Cigna Commercial |
$2,234.13
|
| Rate for Payer: Health EOS Commercial |
$2,161.28
|
| Rate for Payer: HFN Commercial |
$2,234.13
|
| Rate for Payer: Multiplan Commercial |
$1,942.72
|
| Rate for Payer: Preferred Network Access Commercial |
$2,234.13
|
| Rate for Payer: Quartz Beloit One Network |
$1,189.92
|
| Rate for Payer: Quartz Commercial |
$1,457.04
|
| Rate for Payer: WEA Trust Commercial |
$1,335.62
|
| Rate for Payer: WPS Commercial |
$1,798.65
|
|
|
SCREW 1.5x22MM LOCKING 02.214.022
|
Facility
|
IP
|
$2,335.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508911
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,189.92 |
| Max. Negotiated Rate |
$2,234.13 |
| Rate for Payer: Aetna Commercial |
$2,185.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,088.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,287.05
|
| Rate for Payer: Cash Price |
$700.50
|
| Rate for Payer: Cigna Commercial |
$2,234.13
|
| Rate for Payer: Health EOS Commercial |
$2,161.28
|
| Rate for Payer: HFN Commercial |
$2,234.13
|
| Rate for Payer: Multiplan Commercial |
$1,942.72
|
| Rate for Payer: Preferred Network Access Commercial |
$2,234.13
|
| Rate for Payer: Quartz Beloit One Network |
$1,189.92
|
| Rate for Payer: Quartz Commercial |
$1,457.04
|
| Rate for Payer: WEA Trust Commercial |
$1,335.62
|
| Rate for Payer: WPS Commercial |
$1,798.65
|
|
|
SCREW 1.5x22MM LOCKING 02.214.022
|
Facility
|
OP
|
$2,335.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508911
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$679.95 |
| Max. Negotiated Rate |
$2,234.13 |
| Rate for Payer: Aetna Commercial |
$2,185.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,088.42
|
| Rate for Payer: Aetna Managed Medicare |
$679.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,578.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,214.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,165.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,287.05
|
| Rate for Payer: Cash Price |
$700.50
|
| Rate for Payer: Cigna Commercial |
$2,234.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,358.97
|
| Rate for Payer: Health EOS Commercial |
$2,161.28
|
| Rate for Payer: HFN Commercial |
$2,234.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,821.30
|
| Rate for Payer: Multiplan Commercial |
$1,942.72
|
| Rate for Payer: NAPHCARE Commercial |
$1,457.04
|
| Rate for Payer: Preferred Network Access Commercial |
$2,234.13
|
| Rate for Payer: Quartz Beloit One Network |
$1,189.92
|
| Rate for Payer: Quartz Commercial |
$1,578.46
|
| Rate for Payer: Quartz Medicare Advantage |
$1,457.04
|
| Rate for Payer: The Alliance Commercial |
$1,214.20
|
| Rate for Payer: WEA Trust Commercial |
$1,335.62
|
| Rate for Payer: WPS Commercial |
$1,798.65
|
|
|
SCREW 1.5x24MM LOCKING 02.214.024
|
Facility
|
OP
|
$2,335.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4519462
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$679.95 |
| Max. Negotiated Rate |
$2,234.13 |
| Rate for Payer: Aetna Commercial |
$2,185.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,088.42
|
| Rate for Payer: Aetna Managed Medicare |
$679.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,578.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,214.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,165.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,287.05
|
| Rate for Payer: Cash Price |
$700.50
|
| Rate for Payer: Cigna Commercial |
$2,234.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,358.97
|
| Rate for Payer: Health EOS Commercial |
$2,161.28
|
| Rate for Payer: HFN Commercial |
$2,234.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,821.30
|
| Rate for Payer: Multiplan Commercial |
$1,942.72
|
| Rate for Payer: NAPHCARE Commercial |
$1,457.04
|
| Rate for Payer: Preferred Network Access Commercial |
$2,234.13
|
| Rate for Payer: Quartz Beloit One Network |
$1,189.92
|
| Rate for Payer: Quartz Commercial |
$1,578.46
|
| Rate for Payer: Quartz Medicare Advantage |
$1,457.04
|
| Rate for Payer: The Alliance Commercial |
$1,214.20
|
| Rate for Payer: WEA Trust Commercial |
$1,335.62
|
| Rate for Payer: WPS Commercial |
$1,798.65
|
|
|
SCREW 1.5x24MM LOCKING 02.214.024
|
Facility
|
IP
|
$2,335.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4519462
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,189.92 |
| Max. Negotiated Rate |
$2,234.13 |
| Rate for Payer: Aetna Commercial |
$2,185.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,088.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,287.05
|
| Rate for Payer: Cash Price |
$700.50
|
| Rate for Payer: Cigna Commercial |
$2,234.13
|
| Rate for Payer: Health EOS Commercial |
$2,161.28
|
| Rate for Payer: HFN Commercial |
$2,234.13
|
| Rate for Payer: Multiplan Commercial |
$1,942.72
|
| Rate for Payer: Preferred Network Access Commercial |
$2,234.13
|
| Rate for Payer: Quartz Beloit One Network |
$1,189.92
|
| Rate for Payer: Quartz Commercial |
$1,457.04
|
| Rate for Payer: WEA Trust Commercial |
$1,335.62
|
| Rate for Payer: WPS Commercial |
$1,798.65
|
|
|
SCREW 1.5x6MM LOCKING SYNTHES 02.214.006
|
Facility
|
OP
|
$2,335.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508905
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$679.95 |
| Max. Negotiated Rate |
$2,234.13 |
| Rate for Payer: Aetna Commercial |
$2,185.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,088.42
|
| Rate for Payer: Aetna Managed Medicare |
$679.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,578.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,214.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,165.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,287.05
|
| Rate for Payer: Cash Price |
$700.50
|
| Rate for Payer: Cigna Commercial |
$2,234.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,358.97
|
| Rate for Payer: Health EOS Commercial |
$2,161.28
|
| Rate for Payer: HFN Commercial |
$2,234.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,821.30
|
| Rate for Payer: Multiplan Commercial |
$1,942.72
|
| Rate for Payer: NAPHCARE Commercial |
$1,457.04
|
| Rate for Payer: Preferred Network Access Commercial |
$2,234.13
|
| Rate for Payer: Quartz Beloit One Network |
$1,189.92
|
| Rate for Payer: Quartz Commercial |
$1,578.46
|
| Rate for Payer: Quartz Medicare Advantage |
$1,457.04
|
| Rate for Payer: The Alliance Commercial |
$1,214.20
|
| Rate for Payer: WEA Trust Commercial |
$1,335.62
|
| Rate for Payer: WPS Commercial |
$1,798.65
|
|
|
SCREW 1.5x6MM LOCKING SYNTHES 02.214.006
|
Facility
|
IP
|
$2,335.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508905
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,189.92 |
| Max. Negotiated Rate |
$2,234.13 |
| Rate for Payer: Aetna Commercial |
$2,185.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,088.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,287.05
|
| Rate for Payer: Cash Price |
$700.50
|
| Rate for Payer: Cigna Commercial |
$2,234.13
|
| Rate for Payer: Health EOS Commercial |
$2,161.28
|
| Rate for Payer: HFN Commercial |
$2,234.13
|
| Rate for Payer: Multiplan Commercial |
$1,942.72
|
| Rate for Payer: Preferred Network Access Commercial |
$2,234.13
|
| Rate for Payer: Quartz Beloit One Network |
$1,189.92
|
| Rate for Payer: Quartz Commercial |
$1,457.04
|
| Rate for Payer: WEA Trust Commercial |
$1,335.62
|
| Rate for Payer: WPS Commercial |
$1,798.65
|
|
|
SCREW 1.5x7MM LOCKING SYNTHES 02.214.007
|
Facility
|
IP
|
$2,335.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508906
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,189.92 |
| Max. Negotiated Rate |
$2,234.13 |
| Rate for Payer: Aetna Commercial |
$2,185.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,088.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,287.05
|
| Rate for Payer: Cash Price |
$700.50
|
| Rate for Payer: Cigna Commercial |
$2,234.13
|
| Rate for Payer: Health EOS Commercial |
$2,161.28
|
| Rate for Payer: HFN Commercial |
$2,234.13
|
| Rate for Payer: Multiplan Commercial |
$1,942.72
|
| Rate for Payer: Preferred Network Access Commercial |
$2,234.13
|
| Rate for Payer: Quartz Beloit One Network |
$1,189.92
|
| Rate for Payer: Quartz Commercial |
$1,457.04
|
| Rate for Payer: WEA Trust Commercial |
$1,335.62
|
| Rate for Payer: WPS Commercial |
$1,798.65
|
|
|
SCREW 1.5x7MM LOCKING SYNTHES 02.214.007
|
Facility
|
OP
|
$2,335.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508906
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$679.95 |
| Max. Negotiated Rate |
$2,234.13 |
| Rate for Payer: Aetna Commercial |
$2,185.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,088.42
|
| Rate for Payer: Aetna Managed Medicare |
$679.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,578.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,214.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,165.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,287.05
|
| Rate for Payer: Cash Price |
$700.50
|
| Rate for Payer: Cigna Commercial |
$2,234.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,358.97
|
| Rate for Payer: Health EOS Commercial |
$2,161.28
|
| Rate for Payer: HFN Commercial |
$2,234.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,821.30
|
| Rate for Payer: Multiplan Commercial |
$1,942.72
|
| Rate for Payer: NAPHCARE Commercial |
$1,457.04
|
| Rate for Payer: Preferred Network Access Commercial |
$2,234.13
|
| Rate for Payer: Quartz Beloit One Network |
$1,189.92
|
| Rate for Payer: Quartz Commercial |
$1,578.46
|
| Rate for Payer: Quartz Medicare Advantage |
$1,457.04
|
| Rate for Payer: The Alliance Commercial |
$1,214.20
|
| Rate for Payer: WEA Trust Commercial |
$1,335.62
|
| Rate for Payer: WPS Commercial |
$1,798.65
|
|
|
SCREW 1.5x8MM CORTEX SELF 400.808.96
|
Facility
|
OP
|
$1,032.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966420
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$300.52 |
| Max. Negotiated Rate |
$987.42 |
| Rate for Payer: Aetna Commercial |
$965.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$923.02
|
| Rate for Payer: Aetna Managed Medicare |
$300.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$697.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$536.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$515.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$568.84
|
| Rate for Payer: Cash Price |
$309.60
|
| Rate for Payer: Cigna Commercial |
$987.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$600.62
|
| Rate for Payer: Health EOS Commercial |
$955.22
|
| Rate for Payer: HFN Commercial |
$987.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$804.96
|
| Rate for Payer: Multiplan Commercial |
$858.62
|
| Rate for Payer: NAPHCARE Commercial |
$643.97
|
| Rate for Payer: Preferred Network Access Commercial |
$987.42
|
| Rate for Payer: Quartz Beloit One Network |
$525.91
|
| Rate for Payer: Quartz Commercial |
$697.63
|
| Rate for Payer: Quartz Medicare Advantage |
$643.97
|
| Rate for Payer: The Alliance Commercial |
$536.64
|
| Rate for Payer: WEA Trust Commercial |
$590.30
|
| Rate for Payer: WPS Commercial |
$794.95
|
|
|
SCREW 1.5x8MM CORTEX SELF 400.808.96
|
Facility
|
IP
|
$1,032.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966420
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$525.91 |
| Max. Negotiated Rate |
$987.42 |
| Rate for Payer: Aetna Commercial |
$965.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$923.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$568.84
|
| Rate for Payer: Cash Price |
$309.60
|
| Rate for Payer: Cigna Commercial |
$987.42
|
| Rate for Payer: Health EOS Commercial |
$955.22
|
| Rate for Payer: HFN Commercial |
$987.42
|
| Rate for Payer: Multiplan Commercial |
$858.62
|
| Rate for Payer: Preferred Network Access Commercial |
$987.42
|
| Rate for Payer: Quartz Beloit One Network |
$525.91
|
| Rate for Payer: Quartz Commercial |
$643.97
|
| Rate for Payer: WEA Trust Commercial |
$590.30
|
| Rate for Payer: WPS Commercial |
$794.95
|
|
|
SCREW 2.0x12 LCK SF TAP TI
|
Facility
|
OP
|
$1,823.00
|
|
| Hospital Charge Code |
2966429
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$530.86 |
| Max. Negotiated Rate |
$1,744.25 |
| Rate for Payer: Aetna Commercial |
$1,706.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,630.49
|
| Rate for Payer: Aetna Managed Medicare |
$530.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,232.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$947.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$910.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,004.84
|
| Rate for Payer: Cash Price |
$546.90
|
| Rate for Payer: Cigna Commercial |
$1,744.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,060.99
|
| Rate for Payer: Health EOS Commercial |
$1,687.37
|
| Rate for Payer: HFN Commercial |
$1,744.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,421.94
|
| Rate for Payer: Multiplan Commercial |
$1,516.74
|
| Rate for Payer: NAPHCARE Commercial |
$1,137.55
|
| Rate for Payer: Preferred Network Access Commercial |
$1,744.25
|
| Rate for Payer: Quartz Beloit One Network |
$929.00
|
| Rate for Payer: Quartz Commercial |
$1,232.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,137.55
|
| Rate for Payer: The Alliance Commercial |
$947.96
|
| Rate for Payer: WEA Trust Commercial |
$1,042.76
|
| Rate for Payer: WPS Commercial |
$1,404.26
|
|
|
SCREW 2.0x12 LCK SF TAP TI
|
Facility
|
IP
|
$1,823.00
|
|
| Hospital Charge Code |
2966429
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$1,744.25 |
| Rate for Payer: Aetna Commercial |
$1,706.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,630.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,004.84
|
| Rate for Payer: Cash Price |
$546.90
|
| Rate for Payer: Cigna Commercial |
$1,744.25
|
| Rate for Payer: Health EOS Commercial |
$1,687.37
|
| Rate for Payer: HFN Commercial |
$1,744.25
|
| Rate for Payer: Multiplan Commercial |
$1,516.74
|
| Rate for Payer: Preferred Network Access Commercial |
$1,744.25
|
| Rate for Payer: Quartz Beloit One Network |
$929.00
|
| Rate for Payer: Quartz Commercial |
$1,137.55
|
| Rate for Payer: WEA Trust Commercial |
$1,042.76
|
| Rate for Payer: WPS Commercial |
$1,404.26
|
|
|
SCREW 2.0x22 CANN 319-2022
|
Facility
|
OP
|
$2,303.00
|
|
| Hospital Charge Code |
2975072
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$670.63 |
| Max. Negotiated Rate |
$2,203.51 |
| Rate for Payer: Aetna Commercial |
$2,155.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,059.80
|
| Rate for Payer: Aetna Managed Medicare |
$670.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,556.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,197.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,149.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,269.41
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cigna Commercial |
$2,203.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,340.35
|
| Rate for Payer: Health EOS Commercial |
$2,131.66
|
| Rate for Payer: HFN Commercial |
$2,203.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,796.34
|
| Rate for Payer: Multiplan Commercial |
$1,916.10
|
| Rate for Payer: NAPHCARE Commercial |
$1,437.07
|
| Rate for Payer: Preferred Network Access Commercial |
$2,203.51
|
| Rate for Payer: Quartz Beloit One Network |
$1,173.61
|
| Rate for Payer: Quartz Commercial |
$1,556.83
|
| Rate for Payer: Quartz Medicare Advantage |
$1,437.07
|
| Rate for Payer: The Alliance Commercial |
$1,197.56
|
| Rate for Payer: WEA Trust Commercial |
$1,317.32
|
| Rate for Payer: WPS Commercial |
$1,774.00
|
|
|
SCREW 2.0x22 CANN 319-2022
|
Facility
|
IP
|
$2,303.00
|
|
| Hospital Charge Code |
2975072
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,173.61 |
| Max. Negotiated Rate |
$2,203.51 |
| Rate for Payer: Aetna Commercial |
$2,155.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,059.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,269.41
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cigna Commercial |
$2,203.51
|
| Rate for Payer: Health EOS Commercial |
$2,131.66
|
| Rate for Payer: HFN Commercial |
$2,203.51
|
| Rate for Payer: Multiplan Commercial |
$1,916.10
|
| Rate for Payer: Preferred Network Access Commercial |
$2,203.51
|
| Rate for Payer: Quartz Beloit One Network |
$1,173.61
|
| Rate for Payer: Quartz Commercial |
$1,437.07
|
| Rate for Payer: WEA Trust Commercial |
$1,317.32
|
| Rate for Payer: WPS Commercial |
$1,774.00
|
|
|
SCREW 2.0x6 CANN 319-2006
|
Facility
|
OP
|
$2,303.00
|
|
| Hospital Charge Code |
2975071
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$670.63 |
| Max. Negotiated Rate |
$2,203.51 |
| Rate for Payer: Aetna Commercial |
$2,155.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,059.80
|
| Rate for Payer: Aetna Managed Medicare |
$670.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,556.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,197.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,149.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,269.41
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cigna Commercial |
$2,203.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,340.35
|
| Rate for Payer: Health EOS Commercial |
$2,131.66
|
| Rate for Payer: HFN Commercial |
$2,203.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,796.34
|
| Rate for Payer: Multiplan Commercial |
$1,916.10
|
| Rate for Payer: NAPHCARE Commercial |
$1,437.07
|
| Rate for Payer: Preferred Network Access Commercial |
$2,203.51
|
| Rate for Payer: Quartz Beloit One Network |
$1,173.61
|
| Rate for Payer: Quartz Commercial |
$1,556.83
|
| Rate for Payer: Quartz Medicare Advantage |
$1,437.07
|
| Rate for Payer: The Alliance Commercial |
$1,197.56
|
| Rate for Payer: WEA Trust Commercial |
$1,317.32
|
| Rate for Payer: WPS Commercial |
$1,774.00
|
|
|
SCREW 2.0x6 CANN 319-2006
|
Facility
|
IP
|
$2,303.00
|
|
| Hospital Charge Code |
2975071
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,173.61 |
| Max. Negotiated Rate |
$2,203.51 |
| Rate for Payer: Aetna Commercial |
$2,155.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,059.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,269.41
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cigna Commercial |
$2,203.51
|
| Rate for Payer: Health EOS Commercial |
$2,131.66
|
| Rate for Payer: HFN Commercial |
$2,203.51
|
| Rate for Payer: Multiplan Commercial |
$1,916.10
|
| Rate for Payer: Preferred Network Access Commercial |
$2,203.51
|
| Rate for Payer: Quartz Beloit One Network |
$1,173.61
|
| Rate for Payer: Quartz Commercial |
$1,437.07
|
| Rate for Payer: WEA Trust Commercial |
$1,317.32
|
| Rate for Payer: WPS Commercial |
$1,774.00
|
|
|
SCREW 2.0x7 KLS MARTIN
|
Facility
|
OP
|
$988.00
|
|
| Hospital Charge Code |
2965253
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$287.71 |
| Max. Negotiated Rate |
$945.32 |
| Rate for Payer: Aetna Commercial |
$924.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$883.67
|
| Rate for Payer: Aetna Managed Medicare |
$287.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$667.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$513.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$493.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$544.59
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cigna Commercial |
$945.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$575.02
|
| Rate for Payer: Health EOS Commercial |
$914.49
|
| Rate for Payer: HFN Commercial |
$945.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$770.64
|
| Rate for Payer: Multiplan Commercial |
$822.02
|
| Rate for Payer: NAPHCARE Commercial |
$616.51
|
| Rate for Payer: Preferred Network Access Commercial |
$945.32
|
| Rate for Payer: Quartz Beloit One Network |
$503.48
|
| Rate for Payer: Quartz Commercial |
$667.89
|
| Rate for Payer: Quartz Medicare Advantage |
$616.51
|
| Rate for Payer: The Alliance Commercial |
$513.76
|
| Rate for Payer: WEA Trust Commercial |
$565.14
|
| Rate for Payer: WPS Commercial |
$761.06
|
|
|
SCREW 2.0x7 KLS MARTIN
|
Facility
|
IP
|
$988.00
|
|
| Hospital Charge Code |
2965253
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$503.48 |
| Max. Negotiated Rate |
$945.32 |
| Rate for Payer: Aetna Commercial |
$924.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$883.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$544.59
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cigna Commercial |
$945.32
|
| Rate for Payer: Health EOS Commercial |
$914.49
|
| Rate for Payer: HFN Commercial |
$945.32
|
| Rate for Payer: Multiplan Commercial |
$822.02
|
| Rate for Payer: Preferred Network Access Commercial |
$945.32
|
| Rate for Payer: Quartz Beloit One Network |
$503.48
|
| Rate for Payer: Quartz Commercial |
$616.51
|
| Rate for Payer: WEA Trust Commercial |
$565.14
|
| Rate for Payer: WPS Commercial |
$761.06
|
|
|
SCREW 2.0x9 KLS MARTIN
|
Facility
|
OP
|
$915.00
|
|
| Hospital Charge Code |
2965254
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.45 |
| Max. Negotiated Rate |
$875.47 |
| Rate for Payer: Aetna Commercial |
$856.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$818.38
|
| Rate for Payer: Aetna Managed Medicare |
$266.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$618.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$475.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$456.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$504.35
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cigna Commercial |
$875.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$532.53
|
| Rate for Payer: Health EOS Commercial |
$846.92
|
| Rate for Payer: HFN Commercial |
$875.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$713.70
|
| Rate for Payer: Multiplan Commercial |
$761.28
|
| Rate for Payer: NAPHCARE Commercial |
$570.96
|
| Rate for Payer: Preferred Network Access Commercial |
$875.47
|
| Rate for Payer: Quartz Beloit One Network |
$466.28
|
| Rate for Payer: Quartz Commercial |
$618.54
|
| Rate for Payer: Quartz Medicare Advantage |
$570.96
|
| Rate for Payer: The Alliance Commercial |
$475.80
|
| Rate for Payer: WEA Trust Commercial |
$523.38
|
| Rate for Payer: WPS Commercial |
$704.82
|
|
|
SCREW 2.0x9 KLS MARTIN
|
Facility
|
IP
|
$915.00
|
|
| Hospital Charge Code |
2965254
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$466.28 |
| Max. Negotiated Rate |
$875.47 |
| Rate for Payer: Aetna Commercial |
$856.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$818.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$504.35
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cigna Commercial |
$875.47
|
| Rate for Payer: Health EOS Commercial |
$846.92
|
| Rate for Payer: HFN Commercial |
$875.47
|
| Rate for Payer: Multiplan Commercial |
$761.28
|
| Rate for Payer: Preferred Network Access Commercial |
$875.47
|
| Rate for Payer: Quartz Beloit One Network |
$466.28
|
| Rate for Payer: Quartz Commercial |
$570.96
|
| Rate for Payer: WEA Trust Commercial |
$523.38
|
| Rate for Payer: WPS Commercial |
$704.82
|
|
