|
SCREW 2.7 X 28MM LOW PRO ORTHOLOC SYSTEM 58812728
|
Facility
|
OP
|
$1,751.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6200969
|
|
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 28MM LOW PRO ORTHOLOC SYSTEM 58812728
|
Facility
|
IP
|
$1,751.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6200969
|
|
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 2.7x30 THREADED STEPPED
|
Facility
|
OP
|
$2,347.00
|
|
| Hospital Charge Code |
2966486
|
|
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 2.7x30 THREADED STEPPED
|
Facility
|
IP
|
$2,347.00
|
|
| Hospital Charge Code |
2966486
|
|
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 3.0 DART-FIRE D1N35022S
|
Facility
|
IP
|
$3,403.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5547329
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,667.47 |
| Max. Negotiated Rate |
$3,130.76 |
| Rate for Payer: Aetna Commercial |
$3,062.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,926.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,803.59
|
| Rate for Payer: Cash Price |
$1,020.90
|
| Rate for Payer: Cigna Commercial |
$3,130.76
|
| Rate for Payer: Health EOS Commercial |
$3,028.67
|
| Rate for Payer: HFN Commercial |
$3,130.76
|
| Rate for Payer: Multiplan Commercial |
$2,722.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,041.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,130.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,667.47
|
| Rate for Payer: Quartz Commercial |
$2,041.80
|
| Rate for Payer: WEA Trust Commercial |
$1,871.65
|
| Rate for Payer: WPS Commercial |
$2,520.60
|
|
|
SCREW 3.0 DART-FIRE D1N35022S
|
Facility
|
OP
|
$3,403.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5547329
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$952.84 |
| Max. Negotiated Rate |
$13,612.00 |
| Rate for Payer: Aetna Commercial |
$3,062.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,926.58
|
| Rate for Payer: Aetna Managed Medicare |
$952.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,211.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,701.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,633.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,803.59
|
| Rate for Payer: Cash Price |
$1,020.90
|
| Rate for Payer: Cigna Commercial |
$3,130.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,904.32
|
| Rate for Payer: Health EOS Commercial |
$3,028.67
|
| Rate for Payer: HFN Commercial |
$3,130.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,552.25
|
| Rate for Payer: Multiplan Commercial |
$2,722.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,041.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,130.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,667.47
|
| Rate for Payer: Quartz Commercial |
$2,211.95
|
| Rate for Payer: Quartz Medicare Advantage |
$2,041.80
|
| Rate for Payer: The Alliance Commercial |
$13,612.00
|
| Rate for Payer: WEA Trust Commercial |
$1,871.65
|
| Rate for Payer: WPS Commercial |
$2,520.60
|
|
|
SCREW 3.0x23 HEADLESS COMPRESS
|
Facility
|
OP
|
$4,269.00
|
|
| Hospital Charge Code |
2966491
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,195.32 |
| Max. Negotiated Rate |
$17,076.00 |
| Rate for Payer: Aetna Commercial |
$3,842.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,671.34
|
| Rate for Payer: Aetna Managed Medicare |
$1,195.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,774.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,134.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,049.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,262.57
|
| Rate for Payer: Cash Price |
$1,280.70
|
| Rate for Payer: Cigna Commercial |
$3,927.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,388.93
|
| Rate for Payer: Health EOS Commercial |
$3,799.41
|
| Rate for Payer: HFN Commercial |
$3,927.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,201.75
|
| Rate for Payer: Multiplan Commercial |
$3,415.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,561.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,927.48
|
| Rate for Payer: Quartz Beloit One Network |
$2,091.81
|
| Rate for Payer: Quartz Commercial |
$2,774.85
|
| Rate for Payer: Quartz Medicare Advantage |
$2,561.40
|
| Rate for Payer: The Alliance Commercial |
$17,076.00
|
| Rate for Payer: WEA Trust Commercial |
$2,347.95
|
| Rate for Payer: WPS Commercial |
$3,162.05
|
|
|
SCREW 3.0x23 HEADLESS COMPRESS
|
Facility
|
IP
|
$4,269.00
|
|
| Hospital Charge Code |
2966491
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,091.81 |
| Max. Negotiated Rate |
$3,927.48 |
| Rate for Payer: Aetna Commercial |
$3,842.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,671.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,262.57
|
| Rate for Payer: Cash Price |
$1,280.70
|
| Rate for Payer: Cigna Commercial |
$3,927.48
|
| Rate for Payer: Health EOS Commercial |
$3,799.41
|
| Rate for Payer: HFN Commercial |
$3,927.48
|
| Rate for Payer: Multiplan Commercial |
$3,415.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,561.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,927.48
|
| Rate for Payer: Quartz Beloit One Network |
$2,091.81
|
| Rate for Payer: Quartz Commercial |
$2,561.40
|
| Rate for Payer: WEA Trust Commercial |
$2,347.95
|
| Rate for Payer: WPS Commercial |
$3,162.05
|
|
|
SCREW 3.0x25 HEADLESS COMPRESS
|
Facility
|
OP
|
$4,269.00
|
|
| Hospital Charge Code |
2966492
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,195.32 |
| Max. Negotiated Rate |
$17,076.00 |
| Rate for Payer: Aetna Commercial |
$3,842.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,671.34
|
| Rate for Payer: Aetna Managed Medicare |
$1,195.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,774.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,134.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,049.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,262.57
|
| Rate for Payer: Cash Price |
$1,280.70
|
| Rate for Payer: Cigna Commercial |
$3,927.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,388.93
|
| Rate for Payer: Health EOS Commercial |
$3,799.41
|
| Rate for Payer: HFN Commercial |
$3,927.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,201.75
|
| Rate for Payer: Multiplan Commercial |
$3,415.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,561.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,927.48
|
| Rate for Payer: Quartz Beloit One Network |
$2,091.81
|
| Rate for Payer: Quartz Commercial |
$2,774.85
|
| Rate for Payer: Quartz Medicare Advantage |
$2,561.40
|
| Rate for Payer: The Alliance Commercial |
$17,076.00
|
| Rate for Payer: WEA Trust Commercial |
$2,347.95
|
| Rate for Payer: WPS Commercial |
$3,162.05
|
|
|
SCREW 3.0x25 HEADLESS COMPRESS
|
Facility
|
IP
|
$4,269.00
|
|
| Hospital Charge Code |
2966492
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,091.81 |
| Max. Negotiated Rate |
$3,927.48 |
| Rate for Payer: Aetna Commercial |
$3,842.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,671.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,262.57
|
| Rate for Payer: Cash Price |
$1,280.70
|
| Rate for Payer: Cigna Commercial |
$3,927.48
|
| Rate for Payer: Health EOS Commercial |
$3,799.41
|
| Rate for Payer: HFN Commercial |
$3,927.48
|
| Rate for Payer: Multiplan Commercial |
$3,415.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,561.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,927.48
|
| Rate for Payer: Quartz Beloit One Network |
$2,091.81
|
| Rate for Payer: Quartz Commercial |
$2,561.40
|
| Rate for Payer: WEA Trust Commercial |
$2,347.95
|
| Rate for Payer: WPS Commercial |
$3,162.05
|
|
|
SCREW 3.0x28 HEADLESS COMPRESS
|
Facility
|
IP
|
$4,269.00
|
|
| Hospital Charge Code |
2966493
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,091.81 |
| Max. Negotiated Rate |
$3,927.48 |
| Rate for Payer: Aetna Commercial |
$3,842.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,671.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,262.57
|
| Rate for Payer: Cash Price |
$1,280.70
|
| Rate for Payer: Cigna Commercial |
$3,927.48
|
| Rate for Payer: Health EOS Commercial |
$3,799.41
|
| Rate for Payer: HFN Commercial |
$3,927.48
|
| Rate for Payer: Multiplan Commercial |
$3,415.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,561.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,927.48
|
| Rate for Payer: Quartz Beloit One Network |
$2,091.81
|
| Rate for Payer: Quartz Commercial |
$2,561.40
|
| Rate for Payer: WEA Trust Commercial |
$2,347.95
|
| Rate for Payer: WPS Commercial |
$3,162.05
|
|
|
SCREW 3.0x28 HEADLESS COMPRESS
|
Facility
|
OP
|
$4,269.00
|
|
| Hospital Charge Code |
2966493
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,195.32 |
| Max. Negotiated Rate |
$17,076.00 |
| Rate for Payer: Aetna Commercial |
$3,842.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,671.34
|
| Rate for Payer: Aetna Managed Medicare |
$1,195.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,774.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,134.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,049.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,262.57
|
| Rate for Payer: Cash Price |
$1,280.70
|
| Rate for Payer: Cigna Commercial |
$3,927.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,388.93
|
| Rate for Payer: Health EOS Commercial |
$3,799.41
|
| Rate for Payer: HFN Commercial |
$3,927.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,201.75
|
| Rate for Payer: Multiplan Commercial |
$3,415.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,561.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,927.48
|
| Rate for Payer: Quartz Beloit One Network |
$2,091.81
|
| Rate for Payer: Quartz Commercial |
$2,774.85
|
| Rate for Payer: Quartz Medicare Advantage |
$2,561.40
|
| Rate for Payer: The Alliance Commercial |
$17,076.00
|
| Rate for Payer: WEA Trust Commercial |
$2,347.95
|
| Rate for Payer: WPS Commercial |
$3,162.05
|
|
|
SCREW 3.0X30 HEADLESS COMPRESS
|
Facility
|
OP
|
$4,066.00
|
|
| Hospital Charge Code |
2966494
|
|
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 3.0X30 HEADLESS COMPRESS
|
Facility
|
IP
|
$4,066.00
|
|
| Hospital Charge Code |
2966494
|
|
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 3.5 X 10 CORT 30-0256
|
Facility
|
IP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4595317
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$836.92 |
| Max. Negotiated Rate |
$1,571.36 |
| Rate for Payer: Aetna Commercial |
$1,537.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,468.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$905.24
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,571.36
|
| Rate for Payer: Health EOS Commercial |
$1,520.12
|
| Rate for Payer: HFN Commercial |
$1,571.36
|
| Rate for Payer: Multiplan Commercial |
$1,366.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,024.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,571.36
|
| Rate for Payer: Quartz Beloit One Network |
$836.92
|
| Rate for Payer: Quartz Commercial |
$1,024.80
|
| Rate for Payer: WEA Trust Commercial |
$939.40
|
| Rate for Payer: WPS Commercial |
$1,265.12
|
|
|
SCREW 3.5 X 10 CORT 30-0256
|
Facility
|
OP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4595317
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$478.24 |
| Max. Negotiated Rate |
$6,832.00 |
| Rate for Payer: Aetna Commercial |
$1,537.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,468.88
|
| Rate for Payer: Aetna Managed Medicare |
$478.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,110.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$854.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$819.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$905.24
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,571.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$955.80
|
| Rate for Payer: Health EOS Commercial |
$1,520.12
|
| Rate for Payer: HFN Commercial |
$1,571.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,281.00
|
| Rate for Payer: Multiplan Commercial |
$1,366.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,024.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,571.36
|
| Rate for Payer: Quartz Beloit One Network |
$836.92
|
| Rate for Payer: Quartz Commercial |
$1,110.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,024.80
|
| Rate for Payer: The Alliance Commercial |
$6,832.00
|
| Rate for Payer: WEA Trust Commercial |
$939.40
|
| Rate for Payer: WPS Commercial |
$1,265.12
|
|
|
SCREW 3.5 X 10 LOCK 30-0233
|
Facility
|
OP
|
$2,386.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3297466
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$668.08 |
| Max. Negotiated Rate |
$9,544.00 |
| Rate for Payer: Aetna Commercial |
$2,147.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,051.96
|
| Rate for Payer: Aetna Managed Medicare |
$668.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,550.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,193.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,145.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,264.58
|
| Rate for Payer: Cash Price |
$715.80
|
| Rate for Payer: Cigna Commercial |
$2,195.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,335.21
|
| Rate for Payer: Health EOS Commercial |
$2,123.54
|
| Rate for Payer: HFN Commercial |
$2,195.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,789.50
|
| Rate for Payer: Multiplan Commercial |
$1,908.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,431.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,195.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,169.14
|
| Rate for Payer: Quartz Commercial |
$1,550.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,431.60
|
| Rate for Payer: The Alliance Commercial |
$9,544.00
|
| Rate for Payer: WEA Trust Commercial |
$1,312.30
|
| Rate for Payer: WPS Commercial |
$1,767.31
|
|
|
SCREW 3.5 X 10 LOCK 30-0233
|
Facility
|
IP
|
$2,386.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3297466
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,169.14 |
| Max. Negotiated Rate |
$2,195.12 |
| Rate for Payer: Aetna Commercial |
$2,147.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,051.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,264.58
|
| Rate for Payer: Cash Price |
$715.80
|
| Rate for Payer: Cigna Commercial |
$2,195.12
|
| Rate for Payer: Health EOS Commercial |
$2,123.54
|
| Rate for Payer: HFN Commercial |
$2,195.12
|
| Rate for Payer: Multiplan Commercial |
$1,908.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,431.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,195.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,169.14
|
| Rate for Payer: Quartz Commercial |
$1,431.60
|
| Rate for Payer: WEA Trust Commercial |
$1,312.30
|
| Rate for Payer: WPS Commercial |
$1,767.31
|
|
|
SCREW 3.5 X 10 LOCKING
|
Facility
|
IP
|
$1,777.00
|
|
| Hospital Charge Code |
2967392
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$870.73 |
| Max. Negotiated Rate |
$1,634.84 |
| Rate for Payer: Aetna Commercial |
$1,599.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,528.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$941.81
|
| Rate for Payer: Cash Price |
$533.10
|
| Rate for Payer: Cigna Commercial |
$1,634.84
|
| Rate for Payer: Health EOS Commercial |
$1,581.53
|
| Rate for Payer: HFN Commercial |
$1,634.84
|
| Rate for Payer: Multiplan Commercial |
$1,421.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,066.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,634.84
|
| Rate for Payer: Quartz Beloit One Network |
$870.73
|
| Rate for Payer: Quartz Commercial |
$1,066.20
|
| Rate for Payer: WEA Trust Commercial |
$977.35
|
| Rate for Payer: WPS Commercial |
$1,316.22
|
|
|
SCREW 3.5 X 10 LOCKING
|
Facility
|
OP
|
$1,777.00
|
|
| Hospital Charge Code |
2967392
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$497.56 |
| Max. Negotiated Rate |
$7,108.00 |
| Rate for Payer: Aetna Commercial |
$1,599.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,528.22
|
| Rate for Payer: Aetna Managed Medicare |
$497.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,155.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$888.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$852.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$941.81
|
| Rate for Payer: Cash Price |
$533.10
|
| Rate for Payer: Cigna Commercial |
$1,634.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$994.41
|
| Rate for Payer: Health EOS Commercial |
$1,581.53
|
| Rate for Payer: HFN Commercial |
$1,634.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,332.75
|
| Rate for Payer: Multiplan Commercial |
$1,421.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,066.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,634.84
|
| Rate for Payer: Quartz Beloit One Network |
$870.73
|
| Rate for Payer: Quartz Commercial |
$1,155.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,066.20
|
| Rate for Payer: The Alliance Commercial |
$7,108.00
|
| Rate for Payer: WEA Trust Commercial |
$977.35
|
| Rate for Payer: WPS Commercial |
$1,316.22
|
|
|
SCREW 3.5 X 10 NON-LOCKING C0-3100
|
Facility
|
OP
|
$1,611.00
|
|
| Hospital Charge Code |
2964158
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$451.08 |
| Max. Negotiated Rate |
$6,444.00 |
| Rate for Payer: Aetna Commercial |
$1,449.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,385.46
|
| Rate for Payer: Aetna Managed Medicare |
$451.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,047.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$805.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$773.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$853.83
|
| Rate for Payer: Cash Price |
$483.30
|
| Rate for Payer: Cigna Commercial |
$1,482.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$901.52
|
| Rate for Payer: Health EOS Commercial |
$1,433.79
|
| Rate for Payer: HFN Commercial |
$1,482.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,208.25
|
| Rate for Payer: Multiplan Commercial |
$1,288.80
|
| Rate for Payer: NAPHCARE Commercial |
$966.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,482.12
|
| Rate for Payer: Quartz Beloit One Network |
$789.39
|
| Rate for Payer: Quartz Commercial |
$1,047.15
|
| Rate for Payer: Quartz Medicare Advantage |
$966.60
|
| Rate for Payer: The Alliance Commercial |
$6,444.00
|
| Rate for Payer: WEA Trust Commercial |
$886.05
|
| Rate for Payer: WPS Commercial |
$1,193.27
|
|
|
SCREW 3.5 X 10 NON-LOCKING C0-3100
|
Facility
|
IP
|
$1,611.00
|
|
| Hospital Charge Code |
2964158
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$789.39 |
| Max. Negotiated Rate |
$1,482.12 |
| Rate for Payer: Aetna Commercial |
$1,449.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,385.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$853.83
|
| Rate for Payer: Cash Price |
$483.30
|
| Rate for Payer: Cigna Commercial |
$1,482.12
|
| Rate for Payer: Health EOS Commercial |
$1,433.79
|
| Rate for Payer: HFN Commercial |
$1,482.12
|
| Rate for Payer: Multiplan Commercial |
$1,288.80
|
| Rate for Payer: NAPHCARE Commercial |
$966.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,482.12
|
| Rate for Payer: Quartz Beloit One Network |
$789.39
|
| Rate for Payer: Quartz Commercial |
$966.60
|
| Rate for Payer: WEA Trust Commercial |
$886.05
|
| Rate for Payer: WPS Commercial |
$1,193.27
|
|
|
SCREW 3.5 X 12 C0-3120
|
Facility
|
OP
|
$1,099.00
|
|
| Hospital Charge Code |
2964159
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$307.72 |
| Max. Negotiated Rate |
$4,396.00 |
| Rate for Payer: Aetna Commercial |
$989.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$945.14
|
| Rate for Payer: Aetna Managed Medicare |
$307.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$714.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$549.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$527.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$582.47
|
| Rate for Payer: Cash Price |
$329.70
|
| Rate for Payer: Cigna Commercial |
$1,011.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$615.00
|
| Rate for Payer: Health EOS Commercial |
$978.11
|
| Rate for Payer: HFN Commercial |
$1,011.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$824.25
|
| Rate for Payer: Multiplan Commercial |
$879.20
|
| Rate for Payer: NAPHCARE Commercial |
$659.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,011.08
|
| Rate for Payer: Quartz Beloit One Network |
$538.51
|
| Rate for Payer: Quartz Commercial |
$714.35
|
| Rate for Payer: Quartz Medicare Advantage |
$659.40
|
| Rate for Payer: The Alliance Commercial |
$4,396.00
|
| Rate for Payer: WEA Trust Commercial |
$604.45
|
| Rate for Payer: WPS Commercial |
$814.03
|
|
|
SCREW 3.5 X 12 C0-3120
|
Facility
|
IP
|
$1,099.00
|
|
| Hospital Charge Code |
2964159
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$538.51 |
| Max. Negotiated Rate |
$1,011.08 |
| Rate for Payer: Aetna Commercial |
$989.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$945.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$582.47
|
| Rate for Payer: Cash Price |
$329.70
|
| Rate for Payer: Cigna Commercial |
$1,011.08
|
| Rate for Payer: Health EOS Commercial |
$978.11
|
| Rate for Payer: HFN Commercial |
$1,011.08
|
| Rate for Payer: Multiplan Commercial |
$879.20
|
| Rate for Payer: NAPHCARE Commercial |
$659.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,011.08
|
| Rate for Payer: Quartz Beloit One Network |
$538.51
|
| Rate for Payer: Quartz Commercial |
$659.40
|
| Rate for Payer: WEA Trust Commercial |
$604.45
|
| Rate for Payer: WPS Commercial |
$814.03
|
|
|
SCREW 3.5 X 12 CORT 30-0257
|
Facility
|
OP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494363
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$478.24 |
| Max. Negotiated Rate |
$6,832.00 |
| Rate for Payer: Aetna Commercial |
$1,537.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,468.88
|
| Rate for Payer: Aetna Managed Medicare |
$478.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,110.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$854.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$819.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$905.24
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,571.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$955.80
|
| Rate for Payer: Health EOS Commercial |
$1,520.12
|
| Rate for Payer: HFN Commercial |
$1,571.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,281.00
|
| Rate for Payer: Multiplan Commercial |
$1,366.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,024.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,571.36
|
| Rate for Payer: Quartz Beloit One Network |
$836.92
|
| Rate for Payer: Quartz Commercial |
$1,110.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,024.80
|
| Rate for Payer: The Alliance Commercial |
$6,832.00
|
| Rate for Payer: WEA Trust Commercial |
$939.40
|
| Rate for Payer: WPS Commercial |
$1,265.12
|
|
