|
SCREW 3.5 X 12 CORT 30-0257
|
Facility
|
IP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494363
|
|
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 12 LOCK 30-0234
|
Facility
|
IP
|
$2,386.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3529508
|
|
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 12 LOCK 30-0234
|
Facility
|
OP
|
$2,386.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3529508
|
|
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 12 LOCKING COL-3120
|
Facility
|
IP
|
$1,281.00
|
|
| Hospital Charge Code |
2964156
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$627.69 |
| Max. Negotiated Rate |
$1,178.52 |
| Rate for Payer: Aetna Commercial |
$1,152.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,101.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$678.93
|
| Rate for Payer: Cash Price |
$384.30
|
| Rate for Payer: Cigna Commercial |
$1,178.52
|
| Rate for Payer: Health EOS Commercial |
$1,140.09
|
| Rate for Payer: HFN Commercial |
$1,178.52
|
| Rate for Payer: Multiplan Commercial |
$1,024.80
|
| Rate for Payer: NAPHCARE Commercial |
$768.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,178.52
|
| Rate for Payer: Quartz Beloit One Network |
$627.69
|
| Rate for Payer: Quartz Commercial |
$768.60
|
| Rate for Payer: WEA Trust Commercial |
$704.55
|
| Rate for Payer: WPS Commercial |
$948.84
|
|
|
SCREW 3.5 X 12 LOCKING COL-3120
|
Facility
|
OP
|
$1,281.00
|
|
| Hospital Charge Code |
2964156
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$358.68 |
| Max. Negotiated Rate |
$5,124.00 |
| Rate for Payer: Aetna Commercial |
$1,152.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,101.66
|
| Rate for Payer: Aetna Managed Medicare |
$358.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$832.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$640.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$614.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$678.93
|
| Rate for Payer: Cash Price |
$384.30
|
| Rate for Payer: Cigna Commercial |
$1,178.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$716.85
|
| Rate for Payer: Health EOS Commercial |
$1,140.09
|
| Rate for Payer: HFN Commercial |
$1,178.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$960.75
|
| Rate for Payer: Multiplan Commercial |
$1,024.80
|
| Rate for Payer: NAPHCARE Commercial |
$768.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,178.52
|
| Rate for Payer: Quartz Beloit One Network |
$627.69
|
| Rate for Payer: Quartz Commercial |
$832.65
|
| Rate for Payer: Quartz Medicare Advantage |
$768.60
|
| Rate for Payer: The Alliance Commercial |
$5,124.00
|
| Rate for Payer: WEA Trust Commercial |
$704.55
|
| Rate for Payer: WPS Commercial |
$948.84
|
|
|
SCREW 3.5x12 TI SF TAP CORTEX
|
Facility
|
OP
|
$523.00
|
|
| Hospital Charge Code |
2966496
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$146.44 |
| Max. Negotiated Rate |
$2,092.00 |
| Rate for Payer: Aetna Commercial |
$470.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$449.78
|
| Rate for Payer: Aetna Managed Medicare |
$146.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$339.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$261.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$251.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$277.19
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cigna Commercial |
$481.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$292.67
|
| Rate for Payer: Health EOS Commercial |
$465.47
|
| Rate for Payer: HFN Commercial |
$481.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$392.25
|
| Rate for Payer: Multiplan Commercial |
$418.40
|
| Rate for Payer: NAPHCARE Commercial |
$313.80
|
| Rate for Payer: Preferred Network Access Commercial |
$481.16
|
| Rate for Payer: Quartz Beloit One Network |
$256.27
|
| Rate for Payer: Quartz Commercial |
$339.95
|
| Rate for Payer: Quartz Medicare Advantage |
$313.80
|
| Rate for Payer: The Alliance Commercial |
$2,092.00
|
| Rate for Payer: WEA Trust Commercial |
$287.65
|
| Rate for Payer: WPS Commercial |
$387.39
|
|
|
SCREW 3.5x12 TI SF TAP CORTEX
|
Facility
|
IP
|
$523.00
|
|
| Hospital Charge Code |
2966496
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$256.27 |
| Max. Negotiated Rate |
$481.16 |
| Rate for Payer: Aetna Commercial |
$470.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$449.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$277.19
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cigna Commercial |
$481.16
|
| Rate for Payer: Health EOS Commercial |
$465.47
|
| Rate for Payer: HFN Commercial |
$481.16
|
| Rate for Payer: Multiplan Commercial |
$418.40
|
| Rate for Payer: NAPHCARE Commercial |
$313.80
|
| Rate for Payer: Preferred Network Access Commercial |
$481.16
|
| Rate for Payer: Quartz Beloit One Network |
$256.27
|
| Rate for Payer: Quartz Commercial |
$313.80
|
| Rate for Payer: WEA Trust Commercial |
$287.65
|
| Rate for Payer: WPS Commercial |
$387.39
|
|
|
SCREW 3.5 X 14 CORT 30-0258
|
Facility
|
IP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494164
|
|
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 14 CORT 30-0258
|
Facility
|
OP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494164
|
|
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 14 LOCK 30-0235
|
Facility
|
OP
|
$2,386.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494364
|
|
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 14 LOCK 30-0235
|
Facility
|
IP
|
$2,386.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494364
|
|
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 14MM CORT C0-3140
|
Facility
|
IP
|
$1,135.00
|
|
| Hospital Charge Code |
2964160
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$556.15 |
| Max. Negotiated Rate |
$1,044.20 |
| Rate for Payer: Aetna Commercial |
$1,021.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$976.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$601.55
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cigna Commercial |
$1,044.20
|
| Rate for Payer: Health EOS Commercial |
$1,010.15
|
| Rate for Payer: HFN Commercial |
$1,044.20
|
| Rate for Payer: Multiplan Commercial |
$908.00
|
| Rate for Payer: NAPHCARE Commercial |
$681.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,044.20
|
| Rate for Payer: Quartz Beloit One Network |
$556.15
|
| Rate for Payer: Quartz Commercial |
$681.00
|
| Rate for Payer: WEA Trust Commercial |
$624.25
|
| Rate for Payer: WPS Commercial |
$840.69
|
|
|
SCREW 3.5 X 14MM CORT C0-3140
|
Facility
|
OP
|
$1,135.00
|
|
| Hospital Charge Code |
2964160
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$317.80 |
| Max. Negotiated Rate |
$4,540.00 |
| Rate for Payer: Aetna Commercial |
$1,021.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$976.10
|
| Rate for Payer: Aetna Managed Medicare |
$317.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$737.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$567.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$544.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$601.55
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cigna Commercial |
$1,044.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$635.15
|
| Rate for Payer: Health EOS Commercial |
$1,010.15
|
| Rate for Payer: HFN Commercial |
$1,044.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$851.25
|
| Rate for Payer: Multiplan Commercial |
$908.00
|
| Rate for Payer: NAPHCARE Commercial |
$681.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,044.20
|
| Rate for Payer: Quartz Beloit One Network |
$556.15
|
| Rate for Payer: Quartz Commercial |
$737.75
|
| Rate for Payer: Quartz Medicare Advantage |
$681.00
|
| Rate for Payer: The Alliance Commercial |
$4,540.00
|
| Rate for Payer: WEA Trust Commercial |
$624.25
|
| Rate for Payer: WPS Commercial |
$840.69
|
|
|
SCREW 3.5x14 TI SF TAP CORTEX
|
Facility
|
OP
|
$523.00
|
|
| Hospital Charge Code |
2966497
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$146.44 |
| Max. Negotiated Rate |
$2,092.00 |
| Rate for Payer: Aetna Commercial |
$470.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$449.78
|
| Rate for Payer: Aetna Managed Medicare |
$146.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$339.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$261.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$251.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$277.19
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cigna Commercial |
$481.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$292.67
|
| Rate for Payer: Health EOS Commercial |
$465.47
|
| Rate for Payer: HFN Commercial |
$481.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$392.25
|
| Rate for Payer: Multiplan Commercial |
$418.40
|
| Rate for Payer: NAPHCARE Commercial |
$313.80
|
| Rate for Payer: Preferred Network Access Commercial |
$481.16
|
| Rate for Payer: Quartz Beloit One Network |
$256.27
|
| Rate for Payer: Quartz Commercial |
$339.95
|
| Rate for Payer: Quartz Medicare Advantage |
$313.80
|
| Rate for Payer: The Alliance Commercial |
$2,092.00
|
| Rate for Payer: WEA Trust Commercial |
$287.65
|
| Rate for Payer: WPS Commercial |
$387.39
|
|
|
SCREW 3.5x14 TI SF TAP CORTEX
|
Facility
|
IP
|
$523.00
|
|
| Hospital Charge Code |
2966497
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$256.27 |
| Max. Negotiated Rate |
$481.16 |
| Rate for Payer: Aetna Commercial |
$470.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$449.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$277.19
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cigna Commercial |
$481.16
|
| Rate for Payer: Health EOS Commercial |
$465.47
|
| Rate for Payer: HFN Commercial |
$481.16
|
| Rate for Payer: Multiplan Commercial |
$418.40
|
| Rate for Payer: NAPHCARE Commercial |
$313.80
|
| Rate for Payer: Preferred Network Access Commercial |
$481.16
|
| Rate for Payer: Quartz Beloit One Network |
$256.27
|
| Rate for Payer: Quartz Commercial |
$313.80
|
| Rate for Payer: WEA Trust Commercial |
$287.65
|
| Rate for Payer: WPS Commercial |
$387.39
|
|
|
SCREW 3.5 X 16 CORT 30-0259
|
Facility
|
OP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494163
|
|
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 16 CORT 30-0259
|
Facility
|
IP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494163
|
|
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 16 LOCK 30-0236
|
Facility
|
OP
|
$2,386.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4594905
|
|
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 16 LOCK 30-0236
|
Facility
|
IP
|
$2,386.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4594905
|
|
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 3.5x16 LOCK CORTICAL
|
Facility
|
OP
|
$1,724.00
|
|
| Hospital Charge Code |
2964161
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$482.72 |
| Max. Negotiated Rate |
$6,896.00 |
| Rate for Payer: Aetna Commercial |
$1,551.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,482.64
|
| Rate for Payer: Aetna Managed Medicare |
$482.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,120.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$862.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$827.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$913.72
|
| Rate for Payer: Cash Price |
$517.20
|
| Rate for Payer: Cigna Commercial |
$1,586.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$964.75
|
| Rate for Payer: Health EOS Commercial |
$1,534.36
|
| Rate for Payer: HFN Commercial |
$1,586.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,293.00
|
| Rate for Payer: Multiplan Commercial |
$1,379.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,034.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,586.08
|
| Rate for Payer: Quartz Beloit One Network |
$844.76
|
| Rate for Payer: Quartz Commercial |
$1,120.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,034.40
|
| Rate for Payer: The Alliance Commercial |
$6,896.00
|
| Rate for Payer: WEA Trust Commercial |
$948.20
|
| Rate for Payer: WPS Commercial |
$1,276.97
|
|
|
SCREW 3.5x16 LOCK CORTICAL
|
Facility
|
IP
|
$1,724.00
|
|
| Hospital Charge Code |
2964161
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$844.76 |
| Max. Negotiated Rate |
$1,586.08 |
| Rate for Payer: Aetna Commercial |
$1,551.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,482.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$913.72
|
| Rate for Payer: Cash Price |
$517.20
|
| Rate for Payer: Cigna Commercial |
$1,586.08
|
| Rate for Payer: Health EOS Commercial |
$1,534.36
|
| Rate for Payer: HFN Commercial |
$1,586.08
|
| Rate for Payer: Multiplan Commercial |
$1,379.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,034.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,586.08
|
| Rate for Payer: Quartz Beloit One Network |
$844.76
|
| Rate for Payer: Quartz Commercial |
$1,034.40
|
| Rate for Payer: WEA Trust Commercial |
$948.20
|
| Rate for Payer: WPS Commercial |
$1,276.97
|
|
|
SCREW 3.5 X 18 LOCK 30-0237
|
Facility
|
IP
|
$2,298.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4595270
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,126.02 |
| Max. Negotiated Rate |
$2,114.16 |
| Rate for Payer: Aetna Commercial |
$2,068.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,976.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,217.94
|
| Rate for Payer: Cash Price |
$689.40
|
| Rate for Payer: Cigna Commercial |
$2,114.16
|
| Rate for Payer: Health EOS Commercial |
$2,045.22
|
| Rate for Payer: HFN Commercial |
$2,114.16
|
| Rate for Payer: Multiplan Commercial |
$1,838.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,378.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,114.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,126.02
|
| Rate for Payer: Quartz Commercial |
$1,378.80
|
| Rate for Payer: WEA Trust Commercial |
$1,263.90
|
| Rate for Payer: WPS Commercial |
$1,702.13
|
|
|
SCREW 3.5 X 18 LOCK 30-0237
|
Facility
|
OP
|
$2,298.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4595270
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$643.44 |
| Max. Negotiated Rate |
$9,192.00 |
| Rate for Payer: Aetna Commercial |
$2,068.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,976.28
|
| Rate for Payer: Aetna Managed Medicare |
$643.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,493.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,149.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,103.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,217.94
|
| Rate for Payer: Cash Price |
$689.40
|
| Rate for Payer: Cigna Commercial |
$2,114.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,285.96
|
| Rate for Payer: Health EOS Commercial |
$2,045.22
|
| Rate for Payer: HFN Commercial |
$2,114.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,723.50
|
| Rate for Payer: Multiplan Commercial |
$1,838.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,378.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,114.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,126.02
|
| Rate for Payer: Quartz Commercial |
$1,493.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,378.80
|
| Rate for Payer: The Alliance Commercial |
$9,192.00
|
| Rate for Payer: WEA Trust Commercial |
$1,263.90
|
| Rate for Payer: WPS Commercial |
$1,702.13
|
|
|
SCREW 3.5 X 18MM TI CS18A
|
Facility
|
IP
|
$5,270.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5583412
|
|
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 3.5 X 18MM TI CS18A
|
Facility
|
OP
|
$5,270.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5583412
|
|
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
|
|
