|
SCREW CANN LOCK 3.7 X 44MM 02.240.044
|
Facility
|
IP
|
$2,752.00
|
|
| Hospital Charge Code |
2966507
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,402.42 |
| Max. Negotiated Rate |
$2,633.11 |
| Rate for Payer: Aetna Commercial |
$2,575.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,461.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,516.90
|
| Rate for Payer: Cash Price |
$825.60
|
| Rate for Payer: Cigna Commercial |
$2,633.11
|
| Rate for Payer: Health EOS Commercial |
$2,547.25
|
| Rate for Payer: HFN Commercial |
$2,633.11
|
| Rate for Payer: Multiplan Commercial |
$2,289.66
|
| Rate for Payer: Preferred Network Access Commercial |
$2,633.11
|
| Rate for Payer: Quartz Beloit One Network |
$1,402.42
|
| Rate for Payer: Quartz Commercial |
$1,717.25
|
| Rate for Payer: WEA Trust Commercial |
$1,574.14
|
| Rate for Payer: WPS Commercial |
$2,119.87
|
|
|
SCREW CANN LOCK 3.7 X 44MM 02.240.044
|
Facility
|
OP
|
$2,752.00
|
|
| Hospital Charge Code |
2966507
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$801.38 |
| Max. Negotiated Rate |
$2,633.11 |
| Rate for Payer: Aetna Commercial |
$2,575.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,461.39
|
| Rate for Payer: Aetna Managed Medicare |
$801.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,860.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,431.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,373.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,516.90
|
| Rate for Payer: Cash Price |
$825.60
|
| Rate for Payer: Cigna Commercial |
$2,633.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,601.66
|
| Rate for Payer: Health EOS Commercial |
$2,547.25
|
| Rate for Payer: HFN Commercial |
$2,633.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,146.56
|
| Rate for Payer: Multiplan Commercial |
$2,289.66
|
| Rate for Payer: NAPHCARE Commercial |
$1,717.25
|
| Rate for Payer: Preferred Network Access Commercial |
$2,633.11
|
| Rate for Payer: Quartz Beloit One Network |
$1,402.42
|
| Rate for Payer: Quartz Commercial |
$1,860.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,717.25
|
| Rate for Payer: The Alliance Commercial |
$1,431.04
|
| Rate for Payer: WEA Trust Commercial |
$1,574.14
|
| Rate for Payer: WPS Commercial |
$2,119.87
|
|
|
SCREW CANN LOCK 3.7 X 46MM 02.240.046
|
Facility
|
OP
|
$2,752.00
|
|
| Hospital Charge Code |
2966508
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$801.38 |
| Max. Negotiated Rate |
$2,633.11 |
| Rate for Payer: Aetna Commercial |
$2,575.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,461.39
|
| Rate for Payer: Aetna Managed Medicare |
$801.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,860.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,431.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,373.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,516.90
|
| Rate for Payer: Cash Price |
$825.60
|
| Rate for Payer: Cigna Commercial |
$2,633.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,601.66
|
| Rate for Payer: Health EOS Commercial |
$2,547.25
|
| Rate for Payer: HFN Commercial |
$2,633.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,146.56
|
| Rate for Payer: Multiplan Commercial |
$2,289.66
|
| Rate for Payer: NAPHCARE Commercial |
$1,717.25
|
| Rate for Payer: Preferred Network Access Commercial |
$2,633.11
|
| Rate for Payer: Quartz Beloit One Network |
$1,402.42
|
| Rate for Payer: Quartz Commercial |
$1,860.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,717.25
|
| Rate for Payer: The Alliance Commercial |
$1,431.04
|
| Rate for Payer: WEA Trust Commercial |
$1,574.14
|
| Rate for Payer: WPS Commercial |
$2,119.87
|
|
|
SCREW CANN LOCK 3.7 X 46MM 02.240.046
|
Facility
|
IP
|
$2,752.00
|
|
| Hospital Charge Code |
2966508
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,402.42 |
| Max. Negotiated Rate |
$2,633.11 |
| Rate for Payer: Aetna Commercial |
$2,575.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,461.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,516.90
|
| Rate for Payer: Cash Price |
$825.60
|
| Rate for Payer: Cigna Commercial |
$2,633.11
|
| Rate for Payer: Health EOS Commercial |
$2,547.25
|
| Rate for Payer: HFN Commercial |
$2,633.11
|
| Rate for Payer: Multiplan Commercial |
$2,289.66
|
| Rate for Payer: Preferred Network Access Commercial |
$2,633.11
|
| Rate for Payer: Quartz Beloit One Network |
$1,402.42
|
| Rate for Payer: Quartz Commercial |
$1,717.25
|
| Rate for Payer: WEA Trust Commercial |
$1,574.14
|
| Rate for Payer: WPS Commercial |
$2,119.87
|
|
|
SCREW CANN LOCK 3.7 X 48MM 02.240.048
|
Facility
|
OP
|
$2,752.00
|
|
| Hospital Charge Code |
2966509
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$801.38 |
| Max. Negotiated Rate |
$2,633.11 |
| Rate for Payer: Aetna Commercial |
$2,575.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,461.39
|
| Rate for Payer: Aetna Managed Medicare |
$801.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,860.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,431.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,373.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,516.90
|
| Rate for Payer: Cash Price |
$825.60
|
| Rate for Payer: Cigna Commercial |
$2,633.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,601.66
|
| Rate for Payer: Health EOS Commercial |
$2,547.25
|
| Rate for Payer: HFN Commercial |
$2,633.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,146.56
|
| Rate for Payer: Multiplan Commercial |
$2,289.66
|
| Rate for Payer: NAPHCARE Commercial |
$1,717.25
|
| Rate for Payer: Preferred Network Access Commercial |
$2,633.11
|
| Rate for Payer: Quartz Beloit One Network |
$1,402.42
|
| Rate for Payer: Quartz Commercial |
$1,860.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,717.25
|
| Rate for Payer: The Alliance Commercial |
$1,431.04
|
| Rate for Payer: WEA Trust Commercial |
$1,574.14
|
| Rate for Payer: WPS Commercial |
$2,119.87
|
|
|
SCREW CANN LOCK 3.7 X 48MM 02.240.048
|
Facility
|
IP
|
$2,752.00
|
|
| Hospital Charge Code |
2966509
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,402.42 |
| Max. Negotiated Rate |
$2,633.11 |
| Rate for Payer: Aetna Commercial |
$2,575.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,461.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,516.90
|
| Rate for Payer: Cash Price |
$825.60
|
| Rate for Payer: Cigna Commercial |
$2,633.11
|
| Rate for Payer: Health EOS Commercial |
$2,547.25
|
| Rate for Payer: HFN Commercial |
$2,633.11
|
| Rate for Payer: Multiplan Commercial |
$2,289.66
|
| Rate for Payer: Preferred Network Access Commercial |
$2,633.11
|
| Rate for Payer: Quartz Beloit One Network |
$1,402.42
|
| Rate for Payer: Quartz Commercial |
$1,717.25
|
| Rate for Payer: WEA Trust Commercial |
$1,574.14
|
| Rate for Payer: WPS Commercial |
$2,119.87
|
|
|
SCREW CANN LOCK 3.7 X 50MM 02.240.050
|
Facility
|
IP
|
$2,953.00
|
|
| Hospital Charge Code |
2966510
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,504.85 |
| Max. Negotiated Rate |
$2,825.43 |
| Rate for Payer: Aetna Commercial |
$2,764.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,641.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,627.69
|
| Rate for Payer: Cash Price |
$885.90
|
| Rate for Payer: Cigna Commercial |
$2,825.43
|
| Rate for Payer: Health EOS Commercial |
$2,733.30
|
| Rate for Payer: HFN Commercial |
$2,825.43
|
| Rate for Payer: Multiplan Commercial |
$2,456.90
|
| Rate for Payer: Preferred Network Access Commercial |
$2,825.43
|
| Rate for Payer: Quartz Beloit One Network |
$1,504.85
|
| Rate for Payer: Quartz Commercial |
$1,842.67
|
| Rate for Payer: WEA Trust Commercial |
$1,689.12
|
| Rate for Payer: WPS Commercial |
$2,274.70
|
|
|
SCREW CANN LOCK 3.7 X 50MM 02.240.050
|
Facility
|
OP
|
$2,953.00
|
|
| Hospital Charge Code |
2966510
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$859.91 |
| Max. Negotiated Rate |
$2,825.43 |
| Rate for Payer: Aetna Commercial |
$2,764.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,641.16
|
| Rate for Payer: Aetna Managed Medicare |
$859.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,996.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,535.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,474.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,627.69
|
| Rate for Payer: Cash Price |
$885.90
|
| Rate for Payer: Cigna Commercial |
$2,825.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,718.65
|
| Rate for Payer: Health EOS Commercial |
$2,733.30
|
| Rate for Payer: HFN Commercial |
$2,825.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,303.34
|
| Rate for Payer: Multiplan Commercial |
$2,456.90
|
| Rate for Payer: NAPHCARE Commercial |
$1,842.67
|
| Rate for Payer: Preferred Network Access Commercial |
$2,825.43
|
| Rate for Payer: Quartz Beloit One Network |
$1,504.85
|
| Rate for Payer: Quartz Commercial |
$1,996.23
|
| Rate for Payer: Quartz Medicare Advantage |
$1,842.67
|
| Rate for Payer: The Alliance Commercial |
$1,535.56
|
| Rate for Payer: WEA Trust Commercial |
$1,689.12
|
| Rate for Payer: WPS Commercial |
$2,274.70
|
|
|
SCREW CANN LOCK 3.7 X 54MM 02.240.054
|
Facility
|
OP
|
$2,953.00
|
|
| Hospital Charge Code |
2966511
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$859.91 |
| Max. Negotiated Rate |
$2,825.43 |
| Rate for Payer: Aetna Commercial |
$2,764.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,641.16
|
| Rate for Payer: Aetna Managed Medicare |
$859.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,996.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,535.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,474.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,627.69
|
| Rate for Payer: Cash Price |
$885.90
|
| Rate for Payer: Cigna Commercial |
$2,825.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,718.65
|
| Rate for Payer: Health EOS Commercial |
$2,733.30
|
| Rate for Payer: HFN Commercial |
$2,825.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,303.34
|
| Rate for Payer: Multiplan Commercial |
$2,456.90
|
| Rate for Payer: NAPHCARE Commercial |
$1,842.67
|
| Rate for Payer: Preferred Network Access Commercial |
$2,825.43
|
| Rate for Payer: Quartz Beloit One Network |
$1,504.85
|
| Rate for Payer: Quartz Commercial |
$1,996.23
|
| Rate for Payer: Quartz Medicare Advantage |
$1,842.67
|
| Rate for Payer: The Alliance Commercial |
$1,535.56
|
| Rate for Payer: WEA Trust Commercial |
$1,689.12
|
| Rate for Payer: WPS Commercial |
$2,274.70
|
|
|
SCREW CANN LOCK 3.7 X 54MM 02.240.054
|
Facility
|
IP
|
$2,953.00
|
|
| Hospital Charge Code |
2966511
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,504.85 |
| Max. Negotiated Rate |
$2,825.43 |
| Rate for Payer: Aetna Commercial |
$2,764.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,641.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,627.69
|
| Rate for Payer: Cash Price |
$885.90
|
| Rate for Payer: Cigna Commercial |
$2,825.43
|
| Rate for Payer: Health EOS Commercial |
$2,733.30
|
| Rate for Payer: HFN Commercial |
$2,825.43
|
| Rate for Payer: Multiplan Commercial |
$2,456.90
|
| Rate for Payer: Preferred Network Access Commercial |
$2,825.43
|
| Rate for Payer: Quartz Beloit One Network |
$1,504.85
|
| Rate for Payer: Quartz Commercial |
$1,842.67
|
| Rate for Payer: WEA Trust Commercial |
$1,689.12
|
| Rate for Payer: WPS Commercial |
$2,274.70
|
|
|
SCREW CANN LOCK VA 5.0 X 45 02.231.645
|
Facility
|
IP
|
$2,877.00
|
|
| Hospital Charge Code |
3072543
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,466.12 |
| Max. Negotiated Rate |
$2,752.71 |
| Rate for Payer: Aetna Commercial |
$2,692.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,573.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,585.80
|
| Rate for Payer: Cash Price |
$863.10
|
| Rate for Payer: Cigna Commercial |
$2,752.71
|
| Rate for Payer: Health EOS Commercial |
$2,662.95
|
| Rate for Payer: HFN Commercial |
$2,752.71
|
| Rate for Payer: Multiplan Commercial |
$2,393.66
|
| Rate for Payer: Preferred Network Access Commercial |
$2,752.71
|
| Rate for Payer: Quartz Beloit One Network |
$1,466.12
|
| Rate for Payer: Quartz Commercial |
$1,795.25
|
| Rate for Payer: WEA Trust Commercial |
$1,645.64
|
| Rate for Payer: WPS Commercial |
$2,216.15
|
|
|
SCREW CANN LOCK VA 5.0 X 45 02.231.645
|
Facility
|
OP
|
$2,877.00
|
|
| Hospital Charge Code |
3072543
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$837.78 |
| Max. Negotiated Rate |
$2,752.71 |
| Rate for Payer: Aetna Commercial |
$2,692.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,573.19
|
| Rate for Payer: Aetna Managed Medicare |
$837.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,944.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,496.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,436.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,585.80
|
| Rate for Payer: Cash Price |
$863.10
|
| Rate for Payer: Cigna Commercial |
$2,752.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,674.41
|
| Rate for Payer: Health EOS Commercial |
$2,662.95
|
| Rate for Payer: HFN Commercial |
$2,752.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,244.06
|
| Rate for Payer: Multiplan Commercial |
$2,393.66
|
| Rate for Payer: NAPHCARE Commercial |
$1,795.25
|
| Rate for Payer: Preferred Network Access Commercial |
$2,752.71
|
| Rate for Payer: Quartz Beloit One Network |
$1,466.12
|
| Rate for Payer: Quartz Commercial |
$1,944.85
|
| Rate for Payer: Quartz Medicare Advantage |
$1,795.25
|
| Rate for Payer: The Alliance Commercial |
$1,496.04
|
| Rate for Payer: WEA Trust Commercial |
$1,645.64
|
| Rate for Payer: WPS Commercial |
$2,216.15
|
|
|
SCREW CANN LOCK VA 5.0 X 80 02.231.680
|
Facility
|
OP
|
$2,263.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3181496
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$658.99 |
| Max. Negotiated Rate |
$2,165.24 |
| Rate for Payer: Aetna Commercial |
$2,118.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,024.03
|
| Rate for Payer: Aetna Managed Medicare |
$658.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,529.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,176.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,129.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,247.37
|
| Rate for Payer: Cash Price |
$678.90
|
| Rate for Payer: Cigna Commercial |
$2,165.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,317.07
|
| Rate for Payer: Health EOS Commercial |
$2,094.63
|
| Rate for Payer: HFN Commercial |
$2,165.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,765.14
|
| Rate for Payer: Multiplan Commercial |
$1,882.82
|
| Rate for Payer: NAPHCARE Commercial |
$1,412.11
|
| Rate for Payer: Preferred Network Access Commercial |
$2,165.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,153.22
|
| Rate for Payer: Quartz Commercial |
$1,529.79
|
| Rate for Payer: Quartz Medicare Advantage |
$1,412.11
|
| Rate for Payer: The Alliance Commercial |
$1,176.76
|
| Rate for Payer: WEA Trust Commercial |
$1,294.44
|
| Rate for Payer: WPS Commercial |
$1,743.19
|
|
|
SCREW CANN LOCK VA 5.0 X 80 02.231.680
|
Facility
|
IP
|
$2,263.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3181496
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,153.22 |
| Max. Negotiated Rate |
$2,165.24 |
| Rate for Payer: Aetna Commercial |
$2,118.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,024.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,247.37
|
| Rate for Payer: Cash Price |
$678.90
|
| Rate for Payer: Cigna Commercial |
$2,165.24
|
| Rate for Payer: Health EOS Commercial |
$2,094.63
|
| Rate for Payer: HFN Commercial |
$2,165.24
|
| Rate for Payer: Multiplan Commercial |
$1,882.82
|
| Rate for Payer: Preferred Network Access Commercial |
$2,165.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,153.22
|
| Rate for Payer: Quartz Commercial |
$1,412.11
|
| Rate for Payer: WEA Trust Commercial |
$1,294.44
|
| Rate for Payer: WPS Commercial |
$1,743.19
|
|
|
SCREW CANN LOCK VA 5.0 X 85 02.231.685
|
Facility
|
OP
|
$2,301.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5286727
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$670.05 |
| Max. Negotiated Rate |
$2,201.60 |
| Rate for Payer: Aetna Commercial |
$2,153.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,058.01
|
| Rate for Payer: Aetna Managed Medicare |
$670.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,555.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,196.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,148.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,268.31
|
| Rate for Payer: Cash Price |
$690.30
|
| Rate for Payer: Cigna Commercial |
$2,201.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,339.18
|
| Rate for Payer: Health EOS Commercial |
$2,129.81
|
| Rate for Payer: HFN Commercial |
$2,201.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,794.78
|
| Rate for Payer: Multiplan Commercial |
$1,914.43
|
| Rate for Payer: NAPHCARE Commercial |
$1,435.82
|
| Rate for Payer: Preferred Network Access Commercial |
$2,201.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,172.59
|
| Rate for Payer: Quartz Commercial |
$1,555.48
|
| Rate for Payer: Quartz Medicare Advantage |
$1,435.82
|
| Rate for Payer: The Alliance Commercial |
$1,196.52
|
| Rate for Payer: WEA Trust Commercial |
$1,316.17
|
| Rate for Payer: WPS Commercial |
$1,772.46
|
|
|
SCREW CANN LOCK VA 5.0 X 85 02.231.685
|
Facility
|
IP
|
$2,301.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5286727
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,172.59 |
| Max. Negotiated Rate |
$2,201.60 |
| Rate for Payer: Aetna Commercial |
$2,153.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,058.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,268.31
|
| Rate for Payer: Cash Price |
$690.30
|
| Rate for Payer: Cigna Commercial |
$2,201.60
|
| Rate for Payer: Health EOS Commercial |
$2,129.81
|
| Rate for Payer: HFN Commercial |
$2,201.60
|
| Rate for Payer: Multiplan Commercial |
$1,914.43
|
| Rate for Payer: Preferred Network Access Commercial |
$2,201.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,172.59
|
| Rate for Payer: Quartz Commercial |
$1,435.82
|
| Rate for Payer: WEA Trust Commercial |
$1,316.17
|
| Rate for Payer: WPS Commercial |
$1,772.46
|
|
|
SCREW CANN LOCK VA 5.0 X 90 02.231.690
|
Facility
|
OP
|
$2,176.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6167935
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$633.65 |
| Max. Negotiated Rate |
$2,082.00 |
| Rate for Payer: Aetna Commercial |
$2,036.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,946.21
|
| Rate for Payer: Aetna Managed Medicare |
$633.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,470.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,131.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,086.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,199.41
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Cigna Commercial |
$2,082.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,266.43
|
| Rate for Payer: Health EOS Commercial |
$2,014.11
|
| Rate for Payer: HFN Commercial |
$2,082.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,697.28
|
| Rate for Payer: Multiplan Commercial |
$1,810.43
|
| Rate for Payer: NAPHCARE Commercial |
$1,357.82
|
| Rate for Payer: Preferred Network Access Commercial |
$2,082.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,108.89
|
| Rate for Payer: Quartz Commercial |
$1,470.98
|
| Rate for Payer: Quartz Medicare Advantage |
$1,357.82
|
| Rate for Payer: The Alliance Commercial |
$1,131.52
|
| Rate for Payer: WEA Trust Commercial |
$1,244.67
|
| Rate for Payer: WPS Commercial |
$1,676.17
|
|
|
SCREW CANN LOCK VA 5.0 X 90 02.231.690
|
Facility
|
IP
|
$2,176.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6167935
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,108.89 |
| Max. Negotiated Rate |
$2,082.00 |
| Rate for Payer: Aetna Commercial |
$2,036.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,946.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,199.41
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Cigna Commercial |
$2,082.00
|
| Rate for Payer: Health EOS Commercial |
$2,014.11
|
| Rate for Payer: HFN Commercial |
$2,082.00
|
| Rate for Payer: Multiplan Commercial |
$1,810.43
|
| Rate for Payer: Preferred Network Access Commercial |
$2,082.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,108.89
|
| Rate for Payer: Quartz Commercial |
$1,357.82
|
| Rate for Payer: WEA Trust Commercial |
$1,244.67
|
| Rate for Payer: WPS Commercial |
$1,676.17
|
|
|
SCREW CANN LP PARTIAL THREAD AR-8933-26PT
|
Facility
|
IP
|
$1,597.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459665
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$813.83 |
| Max. Negotiated Rate |
$1,528.01 |
| Rate for Payer: Aetna Commercial |
$1,494.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,428.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$880.27
|
| Rate for Payer: Cash Price |
$479.10
|
| Rate for Payer: Cigna Commercial |
$1,528.01
|
| Rate for Payer: Health EOS Commercial |
$1,478.18
|
| Rate for Payer: HFN Commercial |
$1,528.01
|
| Rate for Payer: Multiplan Commercial |
$1,328.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,528.01
|
| Rate for Payer: Quartz Beloit One Network |
$813.83
|
| Rate for Payer: Quartz Commercial |
$996.53
|
| Rate for Payer: WEA Trust Commercial |
$913.48
|
| Rate for Payer: WPS Commercial |
$1,230.17
|
|
|
SCREW CANN LP PARTIAL THREAD AR-8933-26PT
|
Facility
|
OP
|
$1,597.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459665
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$465.05 |
| Max. Negotiated Rate |
$1,528.01 |
| Rate for Payer: Aetna Commercial |
$1,494.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,428.36
|
| Rate for Payer: Aetna Managed Medicare |
$465.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,079.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$830.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$797.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$880.27
|
| Rate for Payer: Cash Price |
$479.10
|
| Rate for Payer: Cigna Commercial |
$1,528.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$929.45
|
| Rate for Payer: Health EOS Commercial |
$1,478.18
|
| Rate for Payer: HFN Commercial |
$1,528.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,245.66
|
| Rate for Payer: Multiplan Commercial |
$1,328.70
|
| Rate for Payer: NAPHCARE Commercial |
$996.53
|
| Rate for Payer: Preferred Network Access Commercial |
$1,528.01
|
| Rate for Payer: Quartz Beloit One Network |
$813.83
|
| Rate for Payer: Quartz Commercial |
$1,079.57
|
| Rate for Payer: Quartz Medicare Advantage |
$996.53
|
| Rate for Payer: The Alliance Commercial |
$830.44
|
| Rate for Payer: WEA Trust Commercial |
$913.48
|
| Rate for Payer: WPS Commercial |
$1,230.17
|
|
|
SCREW CANN MINI 3.0 X 16MM HEADED IC3016
|
Facility
|
IP
|
$2,021.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6175596
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,029.90 |
| Max. Negotiated Rate |
$1,933.69 |
| Rate for Payer: Aetna Commercial |
$1,891.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,807.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,113.98
|
| Rate for Payer: Cash Price |
$606.30
|
| Rate for Payer: Cigna Commercial |
$1,933.69
|
| Rate for Payer: Health EOS Commercial |
$1,870.64
|
| Rate for Payer: HFN Commercial |
$1,933.69
|
| Rate for Payer: Multiplan Commercial |
$1,681.47
|
| Rate for Payer: Preferred Network Access Commercial |
$1,933.69
|
| Rate for Payer: Quartz Beloit One Network |
$1,029.90
|
| Rate for Payer: Quartz Commercial |
$1,261.10
|
| Rate for Payer: WEA Trust Commercial |
$1,156.01
|
| Rate for Payer: WPS Commercial |
$1,556.78
|
|
|
SCREW CANN MINI 3.0 X 16MM HEADED IC3016
|
Facility
|
OP
|
$2,021.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6175596
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$588.52 |
| Max. Negotiated Rate |
$1,933.69 |
| Rate for Payer: Aetna Commercial |
$1,891.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,807.58
|
| Rate for Payer: Aetna Managed Medicare |
$588.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,366.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,050.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,008.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,113.98
|
| Rate for Payer: Cash Price |
$606.30
|
| Rate for Payer: Cigna Commercial |
$1,933.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,176.22
|
| Rate for Payer: Health EOS Commercial |
$1,870.64
|
| Rate for Payer: HFN Commercial |
$1,933.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,576.38
|
| Rate for Payer: Multiplan Commercial |
$1,681.47
|
| Rate for Payer: NAPHCARE Commercial |
$1,261.10
|
| Rate for Payer: Preferred Network Access Commercial |
$1,933.69
|
| Rate for Payer: Quartz Beloit One Network |
$1,029.90
|
| Rate for Payer: Quartz Commercial |
$1,366.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,261.10
|
| Rate for Payer: The Alliance Commercial |
$1,050.92
|
| Rate for Payer: WEA Trust Commercial |
$1,156.01
|
| Rate for Payer: WPS Commercial |
$1,556.78
|
|
|
SCREW CANN MINI 3.0 X 18MM HEADED IC3018
|
Facility
|
IP
|
$2,021.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6175597
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,029.90 |
| Max. Negotiated Rate |
$1,933.69 |
| Rate for Payer: Aetna Commercial |
$1,891.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,807.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,113.98
|
| Rate for Payer: Cash Price |
$606.30
|
| Rate for Payer: Cigna Commercial |
$1,933.69
|
| Rate for Payer: Health EOS Commercial |
$1,870.64
|
| Rate for Payer: HFN Commercial |
$1,933.69
|
| Rate for Payer: Multiplan Commercial |
$1,681.47
|
| Rate for Payer: Preferred Network Access Commercial |
$1,933.69
|
| Rate for Payer: Quartz Beloit One Network |
$1,029.90
|
| Rate for Payer: Quartz Commercial |
$1,261.10
|
| Rate for Payer: WEA Trust Commercial |
$1,156.01
|
| Rate for Payer: WPS Commercial |
$1,556.78
|
|
|
SCREW CANN MINI 3.0 X 18MM HEADED IC3018
|
Facility
|
OP
|
$2,021.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6175597
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$588.52 |
| Max. Negotiated Rate |
$1,933.69 |
| Rate for Payer: Aetna Commercial |
$1,891.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,807.58
|
| Rate for Payer: Aetna Managed Medicare |
$588.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,366.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,050.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,008.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,113.98
|
| Rate for Payer: Cash Price |
$606.30
|
| Rate for Payer: Cigna Commercial |
$1,933.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,176.22
|
| Rate for Payer: Health EOS Commercial |
$1,870.64
|
| Rate for Payer: HFN Commercial |
$1,933.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,576.38
|
| Rate for Payer: Multiplan Commercial |
$1,681.47
|
| Rate for Payer: NAPHCARE Commercial |
$1,261.10
|
| Rate for Payer: Preferred Network Access Commercial |
$1,933.69
|
| Rate for Payer: Quartz Beloit One Network |
$1,029.90
|
| Rate for Payer: Quartz Commercial |
$1,366.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,261.10
|
| Rate for Payer: The Alliance Commercial |
$1,050.92
|
| Rate for Payer: WEA Trust Commercial |
$1,156.01
|
| Rate for Payer: WPS Commercial |
$1,556.78
|
|
|
SCREW CANN MINI 3.0 X 22MM HEADED IC3022
|
Facility
|
OP
|
$2,186.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599634
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$636.56 |
| Max. Negotiated Rate |
$2,091.56 |
| Rate for Payer: Aetna Commercial |
$2,046.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,955.16
|
| Rate for Payer: Aetna Managed Medicare |
$636.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,477.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,136.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,091.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,204.92
|
| Rate for Payer: Cash Price |
$655.80
|
| Rate for Payer: Cigna Commercial |
$2,091.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,272.25
|
| Rate for Payer: Health EOS Commercial |
$2,023.36
|
| Rate for Payer: HFN Commercial |
$2,091.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,705.08
|
| Rate for Payer: Multiplan Commercial |
$1,818.75
|
| Rate for Payer: NAPHCARE Commercial |
$1,364.06
|
| Rate for Payer: Preferred Network Access Commercial |
$2,091.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,113.99
|
| Rate for Payer: Quartz Commercial |
$1,477.74
|
| Rate for Payer: Quartz Medicare Advantage |
$1,364.06
|
| Rate for Payer: The Alliance Commercial |
$1,136.72
|
| Rate for Payer: WEA Trust Commercial |
$1,250.39
|
| Rate for Payer: WPS Commercial |
$1,683.88
|
|
