|
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
|
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 2.4x20MM 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 2.4X24 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
|
|
|
SCREW 2.4x26 CORTEX SLF TAP 201.776
|
Facility
|
IP
|
$1,077.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966462
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$527.73 |
| Max. Negotiated Rate |
$990.84 |
| Rate for Payer: Aetna Commercial |
$969.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$926.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$570.81
|
| Rate for Payer: Cash Price |
$323.10
|
| Rate for Payer: Cigna Commercial |
$990.84
|
| Rate for Payer: Health EOS Commercial |
$958.53
|
| Rate for Payer: HFN Commercial |
$990.84
|
| Rate for Payer: Multiplan Commercial |
$861.60
|
| Rate for Payer: NAPHCARE Commercial |
$646.20
|
| Rate for Payer: Preferred Network Access Commercial |
$990.84
|
| Rate for Payer: Quartz Beloit One Network |
$527.73
|
| Rate for Payer: Quartz Commercial |
$646.20
|
| Rate for Payer: WEA Trust Commercial |
$592.35
|
| Rate for Payer: WPS Commercial |
$797.73
|
|
|
SCREW 2.4x26 CORTEX SLF TAP 201.776
|
Facility
|
OP
|
$1,077.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966462
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$301.56 |
| Max. Negotiated Rate |
$4,308.00 |
| Rate for Payer: Aetna Commercial |
$969.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$926.22
|
| Rate for Payer: Aetna Managed Medicare |
$301.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$700.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$538.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$516.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$570.81
|
| Rate for Payer: Cash Price |
$323.10
|
| Rate for Payer: Cigna Commercial |
$990.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$602.69
|
| Rate for Payer: Health EOS Commercial |
$958.53
|
| Rate for Payer: HFN Commercial |
$990.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$807.75
|
| Rate for Payer: Multiplan Commercial |
$861.60
|
| Rate for Payer: NAPHCARE Commercial |
$646.20
|
| Rate for Payer: Preferred Network Access Commercial |
$990.84
|
| Rate for Payer: Quartz Beloit One Network |
$527.73
|
| Rate for Payer: Quartz Commercial |
$700.05
|
| Rate for Payer: Quartz Medicare Advantage |
$646.20
|
| Rate for Payer: The Alliance Commercial |
$4,308.00
|
| Rate for Payer: WEA Trust Commercial |
$592.35
|
| Rate for Payer: WPS Commercial |
$797.73
|
|
|
SCREW 2.4x28 CORTEX SLF-TAP 201.778
|
Facility
|
IP
|
$1,040.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966464
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$509.60 |
| Max. Negotiated Rate |
$956.80 |
| Rate for Payer: Aetna Commercial |
$936.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$894.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$551.20
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Cigna Commercial |
$956.80
|
| Rate for Payer: Health EOS Commercial |
$925.60
|
| Rate for Payer: HFN Commercial |
$956.80
|
| Rate for Payer: Multiplan Commercial |
$832.00
|
| Rate for Payer: NAPHCARE Commercial |
$624.00
|
| Rate for Payer: Preferred Network Access Commercial |
$956.80
|
| Rate for Payer: Quartz Beloit One Network |
$509.60
|
| Rate for Payer: Quartz Commercial |
$624.00
|
| Rate for Payer: WEA Trust Commercial |
$572.00
|
| Rate for Payer: WPS Commercial |
$770.33
|
|
|
SCREW 2.4x28 CORTEX SLF-TAP 201.778
|
Facility
|
OP
|
$1,040.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966464
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$291.20 |
| Max. Negotiated Rate |
$4,160.00 |
| Rate for Payer: Aetna Commercial |
$936.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$894.40
|
| Rate for Payer: Aetna Managed Medicare |
$291.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$676.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$520.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$499.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$551.20
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Cigna Commercial |
$956.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$581.98
|
| Rate for Payer: Health EOS Commercial |
$925.60
|
| Rate for Payer: HFN Commercial |
$956.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$832.00
|
| Rate for Payer: NAPHCARE Commercial |
$624.00
|
| Rate for Payer: Preferred Network Access Commercial |
$956.80
|
| Rate for Payer: Quartz Beloit One Network |
$509.60
|
| Rate for Payer: Quartz Commercial |
$676.00
|
| Rate for Payer: Quartz Medicare Advantage |
$624.00
|
| Rate for Payer: The Alliance Commercial |
$4,160.00
|
| Rate for Payer: WEA Trust Commercial |
$572.00
|
| Rate for Payer: WPS Commercial |
$770.33
|
|
|
SCREW 2.5 X 20MM TI SV20
|
Facility
|
IP
|
$5,270.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5583410
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,582.30 |
| Max. Negotiated Rate |
$4,848.40 |
| Rate for Payer: Aetna Commercial |
$4,743.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,532.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,793.10
|
| Rate for Payer: Cash Price |
$1,581.00
|
| Rate for Payer: Cigna Commercial |
$4,848.40
|
| Rate for Payer: Health EOS Commercial |
$4,690.30
|
| Rate for Payer: HFN Commercial |
$4,848.40
|
| Rate for Payer: Multiplan Commercial |
$4,216.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,162.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,848.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,582.30
|
| Rate for Payer: Quartz Commercial |
$3,162.00
|
| Rate for Payer: WEA Trust Commercial |
$2,898.50
|
| Rate for Payer: WPS Commercial |
$3,903.49
|
|
|
SCREW 2.5 X 20MM TI SV20
|
Facility
|
OP
|
$5,270.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5583410
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,475.60 |
| Max. Negotiated Rate |
$21,080.00 |
| Rate for Payer: Aetna Commercial |
$4,743.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,532.20
|
| Rate for Payer: Aetna Managed Medicare |
$1,475.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,425.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,635.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,529.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,793.10
|
| Rate for Payer: Cash Price |
$1,581.00
|
| Rate for Payer: Cigna Commercial |
$4,848.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,949.09
|
| Rate for Payer: Health EOS Commercial |
$4,690.30
|
| Rate for Payer: HFN Commercial |
$4,848.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,952.50
|
| Rate for Payer: Multiplan Commercial |
$4,216.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,162.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,848.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,582.30
|
| Rate for Payer: Quartz Commercial |
$3,425.50
|
| Rate for Payer: Quartz Medicare Advantage |
$3,162.00
|
| Rate for Payer: The Alliance Commercial |
$21,080.00
|
| Rate for Payer: WEA Trust Commercial |
$2,898.50
|
| Rate for Payer: WPS Commercial |
$3,903.49
|
|
|
SCREW 2.7 X 14MM LOCKING
|
Facility
|
OP
|
$2,670.00
|
|
| Hospital Charge Code |
2964739
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$747.60 |
| Max. Negotiated Rate |
$10,680.00 |
| Rate for Payer: Aetna Commercial |
$2,403.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,296.20
|
| Rate for Payer: Aetna Managed Medicare |
$747.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,735.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,335.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,281.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,415.10
|
| Rate for Payer: Cash Price |
$801.00
|
| Rate for Payer: Cigna Commercial |
$2,456.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,494.13
|
| Rate for Payer: Health EOS Commercial |
$2,376.30
|
| Rate for Payer: HFN Commercial |
$2,456.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,002.50
|
| Rate for Payer: Multiplan Commercial |
$2,136.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,602.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,456.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,308.30
|
| Rate for Payer: Quartz Commercial |
$1,735.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,602.00
|
| Rate for Payer: The Alliance Commercial |
$10,680.00
|
| Rate for Payer: WEA Trust Commercial |
$1,468.50
|
| Rate for Payer: WPS Commercial |
$1,977.67
|
|
|
SCREW 2.7 X 14MM LOCKING
|
Facility
|
IP
|
$2,670.00
|
|
| Hospital Charge Code |
2964739
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,308.30 |
| Max. Negotiated Rate |
$2,456.40 |
| Rate for Payer: Aetna Commercial |
$2,403.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,296.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,415.10
|
| Rate for Payer: Cash Price |
$801.00
|
| Rate for Payer: Cigna Commercial |
$2,456.40
|
| Rate for Payer: Health EOS Commercial |
$2,376.30
|
| Rate for Payer: HFN Commercial |
$2,456.40
|
| Rate for Payer: Multiplan Commercial |
$2,136.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,602.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,456.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,308.30
|
| Rate for Payer: Quartz Commercial |
$1,602.00
|
| Rate for Payer: WEA Trust Commercial |
$1,468.50
|
| Rate for Payer: WPS Commercial |
$1,977.67
|
|
|
SCREW 2.7 X 16MM LOCKING
|
Facility
|
IP
|
$2,670.00
|
|
| Hospital Charge Code |
2964740
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,308.30 |
| Max. Negotiated Rate |
$2,456.40 |
| Rate for Payer: Aetna Commercial |
$2,403.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,296.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,415.10
|
| Rate for Payer: Cash Price |
$801.00
|
| Rate for Payer: Cigna Commercial |
$2,456.40
|
| Rate for Payer: Health EOS Commercial |
$2,376.30
|
| Rate for Payer: HFN Commercial |
$2,456.40
|
| Rate for Payer: Multiplan Commercial |
$2,136.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,602.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,456.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,308.30
|
| Rate for Payer: Quartz Commercial |
$1,602.00
|
| Rate for Payer: WEA Trust Commercial |
$1,468.50
|
| Rate for Payer: WPS Commercial |
$1,977.67
|
|
|
SCREW 2.7 X 16MM LOCKING
|
Facility
|
OP
|
$2,670.00
|
|
| Hospital Charge Code |
2964740
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$747.60 |
| Max. Negotiated Rate |
$10,680.00 |
| Rate for Payer: Aetna Commercial |
$2,403.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,296.20
|
| Rate for Payer: Aetna Managed Medicare |
$747.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,735.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,335.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,281.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,415.10
|
| Rate for Payer: Cash Price |
$801.00
|
| Rate for Payer: Cigna Commercial |
$2,456.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,494.13
|
| Rate for Payer: Health EOS Commercial |
$2,376.30
|
| Rate for Payer: HFN Commercial |
$2,456.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,002.50
|
| Rate for Payer: Multiplan Commercial |
$2,136.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,602.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,456.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,308.30
|
| Rate for Payer: Quartz Commercial |
$1,735.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,602.00
|
| Rate for Payer: The Alliance Commercial |
$10,680.00
|
| Rate for Payer: WEA Trust Commercial |
$1,468.50
|
| Rate for Payer: WPS Commercial |
$1,977.67
|
|
|
SCREW 2.7 X 16MM STD.
|
Facility
|
OP
|
$1,754.00
|
|
| Hospital Charge Code |
2964741
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$491.12 |
| Max. Negotiated Rate |
$7,016.00 |
| Rate for Payer: Aetna Commercial |
$1,578.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,508.44
|
| Rate for Payer: Aetna Managed Medicare |
$491.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,140.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$877.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$841.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$929.62
|
| Rate for Payer: Cash Price |
$526.20
|
| Rate for Payer: Cigna Commercial |
$1,613.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$981.54
|
| Rate for Payer: Health EOS Commercial |
$1,561.06
|
| Rate for Payer: HFN Commercial |
$1,613.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,315.50
|
| Rate for Payer: Multiplan Commercial |
$1,403.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,052.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,613.68
|
| Rate for Payer: Quartz Beloit One Network |
$859.46
|
| Rate for Payer: Quartz Commercial |
$1,140.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,052.40
|
| Rate for Payer: The Alliance Commercial |
$7,016.00
|
| Rate for Payer: WEA Trust Commercial |
$964.70
|
| Rate for Payer: WPS Commercial |
$1,299.19
|
|
|
SCREW 2.7 X 16MM STD.
|
Facility
|
IP
|
$1,754.00
|
|
| Hospital Charge Code |
2964741
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$859.46 |
| Max. Negotiated Rate |
$1,613.68 |
| Rate for Payer: Aetna Commercial |
$1,578.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,508.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$929.62
|
| Rate for Payer: Cash Price |
$526.20
|
| Rate for Payer: Cigna Commercial |
$1,613.68
|
| Rate for Payer: Health EOS Commercial |
$1,561.06
|
| Rate for Payer: HFN Commercial |
$1,613.68
|
| Rate for Payer: Multiplan Commercial |
$1,403.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,052.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,613.68
|
| Rate for Payer: Quartz Beloit One Network |
$859.46
|
| Rate for Payer: Quartz Commercial |
$1,052.40
|
| Rate for Payer: WEA Trust Commercial |
$964.70
|
| Rate for Payer: WPS Commercial |
$1,299.19
|
|
|
SCREW 2.7x22 THREADED STEPPED
|
Facility
|
OP
|
$2,347.00
|
|
| Hospital Charge Code |
2966485
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$657.16 |
| Max. Negotiated Rate |
$9,388.00 |
| Rate for Payer: Aetna Commercial |
$2,112.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,018.42
|
| Rate for Payer: Aetna Managed Medicare |
$657.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,525.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,173.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,126.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,243.91
|
| Rate for Payer: Cash Price |
$704.10
|
| Rate for Payer: Cigna Commercial |
$2,159.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,313.38
|
| Rate for Payer: Health EOS Commercial |
$2,088.83
|
| Rate for Payer: HFN Commercial |
$2,159.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,760.25
|
| Rate for Payer: Multiplan Commercial |
$1,877.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,408.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,159.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,150.03
|
| Rate for Payer: Quartz Commercial |
$1,525.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,408.20
|
| Rate for Payer: The Alliance Commercial |
$9,388.00
|
| Rate for Payer: WEA Trust Commercial |
$1,290.85
|
| Rate for Payer: WPS Commercial |
$1,738.42
|
|
|
SCREW 2.7x22 THREADED STEPPED
|
Facility
|
IP
|
$2,347.00
|
|
| Hospital Charge Code |
2966485
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,150.03 |
| Max. Negotiated Rate |
$2,159.24 |
| Rate for Payer: Aetna Commercial |
$2,112.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,018.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,243.91
|
| Rate for Payer: Cash Price |
$704.10
|
| Rate for Payer: Cigna Commercial |
$2,159.24
|
| Rate for Payer: Health EOS Commercial |
$2,088.83
|
| Rate for Payer: HFN Commercial |
$2,159.24
|
| Rate for Payer: Multiplan Commercial |
$1,877.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,408.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,159.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,150.03
|
| Rate for Payer: Quartz Commercial |
$1,408.20
|
| Rate for Payer: WEA Trust Commercial |
$1,290.85
|
| Rate for Payer: WPS Commercial |
$1,738.42
|
|
|
SCREW 2.7 X 24MM LOW PRO ORTHOLOC SYSTEM 58812724
|
Facility
|
OP
|
$1,751.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6200968
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$490.28 |
| Max. Negotiated Rate |
$7,004.00 |
| Rate for Payer: Aetna Commercial |
$1,575.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,505.86
|
| Rate for Payer: Aetna Managed Medicare |
$490.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,138.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$875.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$840.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$928.03
|
| Rate for Payer: Cash Price |
$525.30
|
| Rate for Payer: Cigna Commercial |
$1,610.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$979.86
|
| Rate for Payer: Health EOS Commercial |
$1,558.39
|
| Rate for Payer: HFN Commercial |
$1,610.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,313.25
|
| Rate for Payer: Multiplan Commercial |
$1,400.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,050.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,610.92
|
| Rate for Payer: Quartz Beloit One Network |
$857.99
|
| Rate for Payer: Quartz Commercial |
$1,138.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,050.60
|
| Rate for Payer: The Alliance Commercial |
$7,004.00
|
| Rate for Payer: WEA Trust Commercial |
$963.05
|
| Rate for Payer: WPS Commercial |
$1,296.97
|
|
|
SCREW 2.7 X 24MM LOW PRO ORTHOLOC SYSTEM 58812724
|
Facility
|
IP
|
$1,751.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6200968
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$857.99 |
| Max. Negotiated Rate |
$1,610.92 |
| Rate for Payer: Aetna Commercial |
$1,575.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,505.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$928.03
|
| Rate for Payer: Cash Price |
$525.30
|
| Rate for Payer: Cigna Commercial |
$1,610.92
|
| Rate for Payer: Health EOS Commercial |
$1,558.39
|
| Rate for Payer: HFN Commercial |
$1,610.92
|
| Rate for Payer: Multiplan Commercial |
$1,400.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,050.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,610.92
|
| Rate for Payer: Quartz Beloit One Network |
$857.99
|
| Rate for Payer: Quartz Commercial |
$1,050.60
|
| Rate for Payer: WEA Trust Commercial |
$963.05
|
| Rate for Payer: WPS Commercial |
$1,296.97
|
|
|
SCREW 2.7 X 24MM STD.
|
Facility
|
OP
|
$1,754.00
|
|
| Hospital Charge Code |
2964742
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$491.12 |
| Max. Negotiated Rate |
$7,016.00 |
| Rate for Payer: Aetna Commercial |
$1,578.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,508.44
|
| Rate for Payer: Aetna Managed Medicare |
$491.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,140.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$877.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$841.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$929.62
|
| Rate for Payer: Cash Price |
$526.20
|
| Rate for Payer: Cigna Commercial |
$1,613.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$981.54
|
| Rate for Payer: Health EOS Commercial |
$1,561.06
|
| Rate for Payer: HFN Commercial |
$1,613.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,315.50
|
| Rate for Payer: Multiplan Commercial |
$1,403.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,052.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,613.68
|
| Rate for Payer: Quartz Beloit One Network |
$859.46
|
| Rate for Payer: Quartz Commercial |
$1,140.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,052.40
|
| Rate for Payer: The Alliance Commercial |
$7,016.00
|
| Rate for Payer: WEA Trust Commercial |
$964.70
|
| Rate for Payer: WPS Commercial |
$1,299.19
|
|
|
SCREW 2.7 X 24MM STD.
|
Facility
|
IP
|
$1,754.00
|
|
| Hospital Charge Code |
2964742
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$859.46 |
| Max. Negotiated Rate |
$1,613.68 |
| Rate for Payer: Aetna Commercial |
$1,578.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,508.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$929.62
|
| Rate for Payer: Cash Price |
$526.20
|
| Rate for Payer: Cigna Commercial |
$1,613.68
|
| Rate for Payer: Health EOS Commercial |
$1,561.06
|
| Rate for Payer: HFN Commercial |
$1,613.68
|
| Rate for Payer: Multiplan Commercial |
$1,403.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,052.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,613.68
|
| Rate for Payer: Quartz Beloit One Network |
$859.46
|
| Rate for Payer: Quartz Commercial |
$1,052.40
|
| Rate for Payer: WEA Trust Commercial |
$964.70
|
| Rate for Payer: WPS Commercial |
$1,299.19
|
|
