|
SCREW 4.5X22 214.822
|
Facility
|
OP
|
$466.00
|
|
| Hospital Charge Code |
2966924
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$130.48 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$419.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$400.76
|
| Rate for Payer: Aetna Managed Medicare |
$130.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$302.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$233.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$223.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$246.98
|
| Rate for Payer: Cash Price |
$139.80
|
| Rate for Payer: Cigna Commercial |
$428.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$260.77
|
| Rate for Payer: Health EOS Commercial |
$414.74
|
| Rate for Payer: HFN Commercial |
$428.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$349.50
|
| Rate for Payer: Multiplan Commercial |
$372.80
|
| Rate for Payer: NAPHCARE Commercial |
$279.60
|
| Rate for Payer: Preferred Network Access Commercial |
$428.72
|
| Rate for Payer: Quartz Beloit One Network |
$228.34
|
| Rate for Payer: Quartz Commercial |
$302.90
|
| Rate for Payer: Quartz Medicare Advantage |
$279.60
|
| Rate for Payer: The Alliance Commercial |
$1,864.00
|
| Rate for Payer: WEA Trust Commercial |
$256.30
|
| Rate for Payer: WPS Commercial |
$345.17
|
|
|
SCREW 4.5X22 214.822
|
Facility
|
IP
|
$466.00
|
|
| Hospital Charge Code |
2966924
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$228.34 |
| Max. Negotiated Rate |
$428.72 |
| Rate for Payer: Aetna Commercial |
$419.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$400.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$246.98
|
| Rate for Payer: Cash Price |
$139.80
|
| Rate for Payer: Cigna Commercial |
$428.72
|
| Rate for Payer: Health EOS Commercial |
$414.74
|
| Rate for Payer: HFN Commercial |
$428.72
|
| Rate for Payer: Multiplan Commercial |
$372.80
|
| Rate for Payer: NAPHCARE Commercial |
$279.60
|
| Rate for Payer: Preferred Network Access Commercial |
$428.72
|
| Rate for Payer: Quartz Beloit One Network |
$228.34
|
| Rate for Payer: Quartz Commercial |
$279.60
|
| Rate for Payer: WEA Trust Commercial |
$256.30
|
| Rate for Payer: WPS Commercial |
$345.17
|
|
|
SCREW 4.5X24 214.824
|
Facility
|
IP
|
$484.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966925
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$237.16 |
| Max. Negotiated Rate |
$445.28 |
| Rate for Payer: Aetna Commercial |
$435.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$416.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$256.52
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$445.28
|
| Rate for Payer: Health EOS Commercial |
$430.76
|
| Rate for Payer: HFN Commercial |
$445.28
|
| Rate for Payer: Multiplan Commercial |
$387.20
|
| Rate for Payer: NAPHCARE Commercial |
$290.40
|
| Rate for Payer: Preferred Network Access Commercial |
$445.28
|
| Rate for Payer: Quartz Beloit One Network |
$237.16
|
| Rate for Payer: Quartz Commercial |
$290.40
|
| Rate for Payer: WEA Trust Commercial |
$266.20
|
| Rate for Payer: WPS Commercial |
$358.50
|
|
|
SCREW 4.5X24 214.824
|
Facility
|
OP
|
$484.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966925
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$135.52 |
| Max. Negotiated Rate |
$1,936.00 |
| Rate for Payer: Aetna Commercial |
$435.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$416.24
|
| Rate for Payer: Aetna Managed Medicare |
$135.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$314.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$242.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$232.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$256.52
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$445.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$270.85
|
| Rate for Payer: Health EOS Commercial |
$430.76
|
| Rate for Payer: HFN Commercial |
$445.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$363.00
|
| Rate for Payer: Multiplan Commercial |
$387.20
|
| Rate for Payer: NAPHCARE Commercial |
$290.40
|
| Rate for Payer: Preferred Network Access Commercial |
$445.28
|
| Rate for Payer: Quartz Beloit One Network |
$237.16
|
| Rate for Payer: Quartz Commercial |
$314.60
|
| Rate for Payer: Quartz Medicare Advantage |
$290.40
|
| Rate for Payer: The Alliance Commercial |
$1,936.00
|
| Rate for Payer: WEA Trust Commercial |
$266.20
|
| Rate for Payer: WPS Commercial |
$358.50
|
|
|
SCREW 4.5X26 214.826
|
Facility
|
IP
|
$466.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966926
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$228.34 |
| Max. Negotiated Rate |
$428.72 |
| Rate for Payer: Aetna Commercial |
$419.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$400.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$246.98
|
| Rate for Payer: Cash Price |
$139.80
|
| Rate for Payer: Cigna Commercial |
$428.72
|
| Rate for Payer: Health EOS Commercial |
$414.74
|
| Rate for Payer: HFN Commercial |
$428.72
|
| Rate for Payer: Multiplan Commercial |
$372.80
|
| Rate for Payer: NAPHCARE Commercial |
$279.60
|
| Rate for Payer: Preferred Network Access Commercial |
$428.72
|
| Rate for Payer: Quartz Beloit One Network |
$228.34
|
| Rate for Payer: Quartz Commercial |
$279.60
|
| Rate for Payer: WEA Trust Commercial |
$256.30
|
| Rate for Payer: WPS Commercial |
$345.17
|
|
|
SCREW 4.5X26 214.826
|
Facility
|
OP
|
$466.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966926
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$130.48 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$419.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$400.76
|
| Rate for Payer: Aetna Managed Medicare |
$130.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$302.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$233.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$223.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$246.98
|
| Rate for Payer: Cash Price |
$139.80
|
| Rate for Payer: Cigna Commercial |
$428.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$260.77
|
| Rate for Payer: Health EOS Commercial |
$414.74
|
| Rate for Payer: HFN Commercial |
$428.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$349.50
|
| Rate for Payer: Multiplan Commercial |
$372.80
|
| Rate for Payer: NAPHCARE Commercial |
$279.60
|
| Rate for Payer: Preferred Network Access Commercial |
$428.72
|
| Rate for Payer: Quartz Beloit One Network |
$228.34
|
| Rate for Payer: Quartz Commercial |
$302.90
|
| Rate for Payer: Quartz Medicare Advantage |
$279.60
|
| Rate for Payer: The Alliance Commercial |
$1,864.00
|
| Rate for Payer: WEA Trust Commercial |
$256.30
|
| Rate for Payer: WPS Commercial |
$345.17
|
|
|
SCREW 4.5x38 MULTILOC
|
Facility
|
OP
|
$3,651.00
|
|
| Hospital Charge Code |
2966521
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,022.28 |
| Max. Negotiated Rate |
$14,604.00 |
| Rate for Payer: Aetna Commercial |
$3,285.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,139.86
|
| Rate for Payer: Aetna Managed Medicare |
$1,022.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,373.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,825.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,752.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,935.03
|
| Rate for Payer: Cash Price |
$1,095.30
|
| Rate for Payer: Cigna Commercial |
$3,358.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,043.10
|
| Rate for Payer: Health EOS Commercial |
$3,249.39
|
| Rate for Payer: HFN Commercial |
$3,358.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,738.25
|
| Rate for Payer: Multiplan Commercial |
$2,920.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,190.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,358.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,788.99
|
| Rate for Payer: Quartz Commercial |
$2,373.15
|
| Rate for Payer: Quartz Medicare Advantage |
$2,190.60
|
| Rate for Payer: The Alliance Commercial |
$14,604.00
|
| Rate for Payer: WEA Trust Commercial |
$2,008.05
|
| Rate for Payer: WPS Commercial |
$2,704.30
|
|
|
SCREW 4.5x38 MULTILOC
|
Facility
|
IP
|
$3,651.00
|
|
| Hospital Charge Code |
2966521
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,788.99 |
| Max. Negotiated Rate |
$3,358.92 |
| Rate for Payer: Aetna Commercial |
$3,285.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,139.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,935.03
|
| Rate for Payer: Cash Price |
$1,095.30
|
| Rate for Payer: Cigna Commercial |
$3,358.92
|
| Rate for Payer: Health EOS Commercial |
$3,249.39
|
| Rate for Payer: HFN Commercial |
$3,358.92
|
| Rate for Payer: Multiplan Commercial |
$2,920.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,190.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,358.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,788.99
|
| Rate for Payer: Quartz Commercial |
$2,190.60
|
| Rate for Payer: WEA Trust Commercial |
$2,008.05
|
| Rate for Payer: WPS Commercial |
$2,704.30
|
|
|
SCREW 4.5x40 MULTILOC
|
Facility
|
IP
|
$3,651.00
|
|
| Hospital Charge Code |
2966522
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,788.99 |
| Max. Negotiated Rate |
$3,358.92 |
| Rate for Payer: Aetna Commercial |
$3,285.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,139.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,935.03
|
| Rate for Payer: Cash Price |
$1,095.30
|
| Rate for Payer: Cigna Commercial |
$3,358.92
|
| Rate for Payer: Health EOS Commercial |
$3,249.39
|
| Rate for Payer: HFN Commercial |
$3,358.92
|
| Rate for Payer: Multiplan Commercial |
$2,920.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,190.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,358.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,788.99
|
| Rate for Payer: Quartz Commercial |
$2,190.60
|
| Rate for Payer: WEA Trust Commercial |
$2,008.05
|
| Rate for Payer: WPS Commercial |
$2,704.30
|
|
|
SCREW 4.5x40 MULTILOC
|
Facility
|
OP
|
$3,651.00
|
|
| Hospital Charge Code |
2966522
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,022.28 |
| Max. Negotiated Rate |
$14,604.00 |
| Rate for Payer: Aetna Commercial |
$3,285.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,139.86
|
| Rate for Payer: Aetna Managed Medicare |
$1,022.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,373.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,825.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,752.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,935.03
|
| Rate for Payer: Cash Price |
$1,095.30
|
| Rate for Payer: Cigna Commercial |
$3,358.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,043.10
|
| Rate for Payer: Health EOS Commercial |
$3,249.39
|
| Rate for Payer: HFN Commercial |
$3,358.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,738.25
|
| Rate for Payer: Multiplan Commercial |
$2,920.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,190.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,358.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,788.99
|
| Rate for Payer: Quartz Commercial |
$2,373.15
|
| Rate for Payer: Quartz Medicare Advantage |
$2,190.60
|
| Rate for Payer: The Alliance Commercial |
$14,604.00
|
| Rate for Payer: WEA Trust Commercial |
$2,008.05
|
| Rate for Payer: WPS Commercial |
$2,704.30
|
|
|
SCREW 4.O CANNULATED SPIDER
|
Facility
|
IP
|
$3,008.00
|
|
| Hospital Charge Code |
2965018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,473.92 |
| Max. Negotiated Rate |
$2,767.36 |
| Rate for Payer: Aetna Commercial |
$2,707.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,586.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,594.24
|
| Rate for Payer: Cash Price |
$902.40
|
| Rate for Payer: Cigna Commercial |
$2,767.36
|
| Rate for Payer: Health EOS Commercial |
$2,677.12
|
| Rate for Payer: HFN Commercial |
$2,767.36
|
| Rate for Payer: Multiplan Commercial |
$2,406.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,804.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,767.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,473.92
|
| Rate for Payer: Quartz Commercial |
$1,804.80
|
| Rate for Payer: WEA Trust Commercial |
$1,654.40
|
| Rate for Payer: WPS Commercial |
$2,228.03
|
|
|
SCREW 4.O CANNULATED SPIDER
|
Facility
|
OP
|
$3,008.00
|
|
| Hospital Charge Code |
2965018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$842.24 |
| Max. Negotiated Rate |
$12,032.00 |
| Rate for Payer: Aetna Commercial |
$2,707.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,586.88
|
| Rate for Payer: Aetna Managed Medicare |
$842.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,955.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,504.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,443.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,594.24
|
| Rate for Payer: Cash Price |
$902.40
|
| Rate for Payer: Cigna Commercial |
$2,767.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,683.28
|
| Rate for Payer: Health EOS Commercial |
$2,677.12
|
| Rate for Payer: HFN Commercial |
$2,767.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,256.00
|
| Rate for Payer: Multiplan Commercial |
$2,406.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,804.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,767.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,473.92
|
| Rate for Payer: Quartz Commercial |
$1,955.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,804.80
|
| Rate for Payer: The Alliance Commercial |
$12,032.00
|
| Rate for Payer: WEA Trust Commercial |
$1,654.40
|
| Rate for Payer: WPS Commercial |
$2,228.03
|
|
|
SCREW 5.0x10MM PERIPROSTHETIC
|
Facility
|
IP
|
$2,630.00
|
|
| Hospital Charge Code |
2966523
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,288.70 |
| Max. Negotiated Rate |
$2,419.60 |
| Rate for Payer: Aetna Commercial |
$2,367.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,261.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,393.90
|
| Rate for Payer: Cash Price |
$789.00
|
| Rate for Payer: Cigna Commercial |
$2,419.60
|
| Rate for Payer: Health EOS Commercial |
$2,340.70
|
| Rate for Payer: HFN Commercial |
$2,419.60
|
| Rate for Payer: Multiplan Commercial |
$2,104.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,578.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,419.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,288.70
|
| Rate for Payer: Quartz Commercial |
$1,578.00
|
| Rate for Payer: WEA Trust Commercial |
$1,446.50
|
| Rate for Payer: WPS Commercial |
$1,948.04
|
|
|
SCREW 5.0x10MM PERIPROSTHETIC
|
Facility
|
OP
|
$2,630.00
|
|
| Hospital Charge Code |
2966523
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$736.40 |
| Max. Negotiated Rate |
$10,520.00 |
| Rate for Payer: Aetna Commercial |
$2,367.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,261.80
|
| Rate for Payer: Aetna Managed Medicare |
$736.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,709.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,315.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,262.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,393.90
|
| Rate for Payer: Cash Price |
$789.00
|
| Rate for Payer: Cigna Commercial |
$2,419.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,471.75
|
| Rate for Payer: Health EOS Commercial |
$2,340.70
|
| Rate for Payer: HFN Commercial |
$2,419.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,972.50
|
| Rate for Payer: Multiplan Commercial |
$2,104.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,578.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,419.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,288.70
|
| Rate for Payer: Quartz Commercial |
$1,709.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,578.00
|
| Rate for Payer: The Alliance Commercial |
$10,520.00
|
| Rate for Payer: WEA Trust Commercial |
$1,446.50
|
| Rate for Payer: WPS Commercial |
$1,948.04
|
|
|
SCREW 5.0 X 26 CANCELLOUS 71755026
|
Facility
|
IP
|
$2,260.00
|
|
| Hospital Charge Code |
2966036
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,107.40 |
| Max. Negotiated Rate |
$2,079.20 |
| Rate for Payer: Aetna Commercial |
$2,034.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,943.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,197.80
|
| Rate for Payer: Cash Price |
$678.00
|
| Rate for Payer: Cigna Commercial |
$2,079.20
|
| Rate for Payer: Health EOS Commercial |
$2,011.40
|
| Rate for Payer: HFN Commercial |
$2,079.20
|
| Rate for Payer: Multiplan Commercial |
$1,808.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,356.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,079.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,107.40
|
| Rate for Payer: Quartz Commercial |
$1,356.00
|
| Rate for Payer: WEA Trust Commercial |
$1,243.00
|
| Rate for Payer: WPS Commercial |
$1,673.98
|
|
|
SCREW 5.0 X 26 CANCELLOUS 71755026
|
Facility
|
OP
|
$2,260.00
|
|
| Hospital Charge Code |
2966036
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$632.80 |
| Max. Negotiated Rate |
$9,040.00 |
| Rate for Payer: Aetna Commercial |
$2,034.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,943.60
|
| Rate for Payer: Aetna Managed Medicare |
$632.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,469.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,130.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,084.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,197.80
|
| Rate for Payer: Cash Price |
$678.00
|
| Rate for Payer: Cigna Commercial |
$2,079.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,264.70
|
| Rate for Payer: Health EOS Commercial |
$2,011.40
|
| Rate for Payer: HFN Commercial |
$2,079.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,695.00
|
| Rate for Payer: Multiplan Commercial |
$1,808.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,356.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,079.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,107.40
|
| Rate for Payer: Quartz Commercial |
$1,469.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,356.00
|
| Rate for Payer: The Alliance Commercial |
$9,040.00
|
| Rate for Payer: WEA Trust Commercial |
$1,243.00
|
| Rate for Payer: WPS Commercial |
$1,673.98
|
|
|
SCREW 5.0x36 ANGULAR STABLE LK
|
Facility
|
IP
|
$2,751.00
|
|
| Hospital Charge Code |
2966527
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,347.99 |
| Max. Negotiated Rate |
$2,530.92 |
| Rate for Payer: Aetna Commercial |
$2,475.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,365.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,458.03
|
| Rate for Payer: Cash Price |
$825.30
|
| Rate for Payer: Cigna Commercial |
$2,530.92
|
| Rate for Payer: Health EOS Commercial |
$2,448.39
|
| Rate for Payer: HFN Commercial |
$2,530.92
|
| Rate for Payer: Multiplan Commercial |
$2,200.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,650.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,530.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,347.99
|
| Rate for Payer: Quartz Commercial |
$1,650.60
|
| Rate for Payer: WEA Trust Commercial |
$1,513.05
|
| Rate for Payer: WPS Commercial |
$2,037.67
|
|
|
SCREW 5.0x36 ANGULAR STABLE LK
|
Facility
|
OP
|
$2,751.00
|
|
| Hospital Charge Code |
2966527
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$770.28 |
| Max. Negotiated Rate |
$11,004.00 |
| Rate for Payer: Aetna Commercial |
$2,475.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,365.86
|
| Rate for Payer: Aetna Managed Medicare |
$770.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,788.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,375.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,320.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,458.03
|
| Rate for Payer: Cash Price |
$825.30
|
| Rate for Payer: Cigna Commercial |
$2,530.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,539.46
|
| Rate for Payer: Health EOS Commercial |
$2,448.39
|
| Rate for Payer: HFN Commercial |
$2,530.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,063.25
|
| Rate for Payer: Multiplan Commercial |
$2,200.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,650.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,530.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,347.99
|
| Rate for Payer: Quartz Commercial |
$1,788.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,650.60
|
| Rate for Payer: The Alliance Commercial |
$11,004.00
|
| Rate for Payer: WEA Trust Commercial |
$1,513.05
|
| Rate for Payer: WPS Commercial |
$2,037.67
|
|
|
SCREW 5.0x38 TI ANGULAR STABLE
|
Facility
|
OP
|
$2,751.00
|
|
| Hospital Charge Code |
2966529
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$770.28 |
| Max. Negotiated Rate |
$11,004.00 |
| Rate for Payer: Aetna Commercial |
$2,475.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,365.86
|
| Rate for Payer: Aetna Managed Medicare |
$770.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,788.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,375.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,320.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,458.03
|
| Rate for Payer: Cash Price |
$825.30
|
| Rate for Payer: Cigna Commercial |
$2,530.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,539.46
|
| Rate for Payer: Health EOS Commercial |
$2,448.39
|
| Rate for Payer: HFN Commercial |
$2,530.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,063.25
|
| Rate for Payer: Multiplan Commercial |
$2,200.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,650.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,530.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,347.99
|
| Rate for Payer: Quartz Commercial |
$1,788.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,650.60
|
| Rate for Payer: The Alliance Commercial |
$11,004.00
|
| Rate for Payer: WEA Trust Commercial |
$1,513.05
|
| Rate for Payer: WPS Commercial |
$2,037.67
|
|
|
SCREW 5.0x38 TI ANGULAR STABLE
|
Facility
|
IP
|
$2,751.00
|
|
| Hospital Charge Code |
2966529
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,347.99 |
| Max. Negotiated Rate |
$2,530.92 |
| Rate for Payer: Aetna Commercial |
$2,475.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,365.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,458.03
|
| Rate for Payer: Cash Price |
$825.30
|
| Rate for Payer: Cigna Commercial |
$2,530.92
|
| Rate for Payer: Health EOS Commercial |
$2,448.39
|
| Rate for Payer: HFN Commercial |
$2,530.92
|
| Rate for Payer: Multiplan Commercial |
$2,200.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,650.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,530.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,347.99
|
| Rate for Payer: Quartz Commercial |
$1,650.60
|
| Rate for Payer: WEA Trust Commercial |
$1,513.05
|
| Rate for Payer: WPS Commercial |
$2,037.67
|
|
|
SCREW 5.0x44 ANGULAR STABLE LK
|
Facility
|
OP
|
$2,852.00
|
|
| Hospital Charge Code |
2966531
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$798.56 |
| Max. Negotiated Rate |
$11,408.00 |
| Rate for Payer: Aetna Commercial |
$2,566.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,452.72
|
| Rate for Payer: Aetna Managed Medicare |
$798.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,853.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,426.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,368.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,511.56
|
| Rate for Payer: Cash Price |
$855.60
|
| Rate for Payer: Cigna Commercial |
$2,623.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,595.98
|
| Rate for Payer: Health EOS Commercial |
$2,538.28
|
| Rate for Payer: HFN Commercial |
$2,623.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,139.00
|
| Rate for Payer: Multiplan Commercial |
$2,281.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,711.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,623.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,397.48
|
| Rate for Payer: Quartz Commercial |
$1,853.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,711.20
|
| Rate for Payer: The Alliance Commercial |
$11,408.00
|
| Rate for Payer: WEA Trust Commercial |
$1,568.60
|
| Rate for Payer: WPS Commercial |
$2,112.48
|
|
|
SCREW 5.0x44 ANGULAR STABLE LK
|
Facility
|
IP
|
$2,852.00
|
|
| Hospital Charge Code |
2966531
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,397.48 |
| Max. Negotiated Rate |
$2,623.84 |
| Rate for Payer: Aetna Commercial |
$2,566.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,452.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,511.56
|
| Rate for Payer: Cash Price |
$855.60
|
| Rate for Payer: Cigna Commercial |
$2,623.84
|
| Rate for Payer: Health EOS Commercial |
$2,538.28
|
| Rate for Payer: HFN Commercial |
$2,623.84
|
| Rate for Payer: Multiplan Commercial |
$2,281.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,711.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,623.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,397.48
|
| Rate for Payer: Quartz Commercial |
$1,711.20
|
| Rate for Payer: WEA Trust Commercial |
$1,568.60
|
| Rate for Payer: WPS Commercial |
$2,112.48
|
|
|
SCREW 5.0x48 ANGULAR STABLE LK
|
Facility
|
OP
|
$2,751.00
|
|
| Hospital Charge Code |
2966532
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$770.28 |
| Max. Negotiated Rate |
$11,004.00 |
| Rate for Payer: Aetna Commercial |
$2,475.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,365.86
|
| Rate for Payer: Aetna Managed Medicare |
$770.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,788.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,375.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,320.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,458.03
|
| Rate for Payer: Cash Price |
$825.30
|
| Rate for Payer: Cigna Commercial |
$2,530.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,539.46
|
| Rate for Payer: Health EOS Commercial |
$2,448.39
|
| Rate for Payer: HFN Commercial |
$2,530.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,063.25
|
| Rate for Payer: Multiplan Commercial |
$2,200.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,650.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,530.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,347.99
|
| Rate for Payer: Quartz Commercial |
$1,788.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,650.60
|
| Rate for Payer: The Alliance Commercial |
$11,004.00
|
| Rate for Payer: WEA Trust Commercial |
$1,513.05
|
| Rate for Payer: WPS Commercial |
$2,037.67
|
|
|
SCREW 5.0x48 ANGULAR STABLE LK
|
Facility
|
IP
|
$2,751.00
|
|
| Hospital Charge Code |
2966532
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,347.99 |
| Max. Negotiated Rate |
$2,530.92 |
| Rate for Payer: Aetna Commercial |
$2,475.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,365.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,458.03
|
| Rate for Payer: Cash Price |
$825.30
|
| Rate for Payer: Cigna Commercial |
$2,530.92
|
| Rate for Payer: Health EOS Commercial |
$2,448.39
|
| Rate for Payer: HFN Commercial |
$2,530.92
|
| Rate for Payer: Multiplan Commercial |
$2,200.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,650.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,530.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,347.99
|
| Rate for Payer: Quartz Commercial |
$1,650.60
|
| Rate for Payer: WEA Trust Commercial |
$1,513.05
|
| Rate for Payer: WPS Commercial |
$2,037.67
|
|
|
SCREW 5.0x65MM CORE LOCKING
|
Facility
|
OP
|
$3,007.00
|
|
| Hospital Charge Code |
2966533
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$841.96 |
| Max. Negotiated Rate |
$12,028.00 |
| Rate for Payer: Aetna Commercial |
$2,706.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,586.02
|
| Rate for Payer: Aetna Managed Medicare |
$841.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,954.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,503.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,443.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,593.71
|
| Rate for Payer: Cash Price |
$902.10
|
| Rate for Payer: Cigna Commercial |
$2,766.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,682.72
|
| Rate for Payer: Health EOS Commercial |
$2,676.23
|
| Rate for Payer: HFN Commercial |
$2,766.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,255.25
|
| Rate for Payer: Multiplan Commercial |
$2,405.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,804.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,766.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,473.43
|
| Rate for Payer: Quartz Commercial |
$1,954.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,804.20
|
| Rate for Payer: The Alliance Commercial |
$12,028.00
|
| Rate for Payer: WEA Trust Commercial |
$1,653.85
|
| Rate for Payer: WPS Commercial |
$2,227.28
|
|
