|
SCREW GRIDLOCK 2.4 X 22 301-24-022
|
Facility
|
IP
|
$1,383.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5456743
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$677.67 |
| Max. Negotiated Rate |
$1,272.36 |
| Rate for Payer: Aetna Commercial |
$1,244.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,189.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$732.99
|
| Rate for Payer: Cash Price |
$414.90
|
| Rate for Payer: Cigna Commercial |
$1,272.36
|
| Rate for Payer: Health EOS Commercial |
$1,230.87
|
| Rate for Payer: HFN Commercial |
$1,272.36
|
| Rate for Payer: Multiplan Commercial |
$1,106.40
|
| Rate for Payer: NAPHCARE Commercial |
$829.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,272.36
|
| Rate for Payer: Quartz Beloit One Network |
$677.67
|
| Rate for Payer: Quartz Commercial |
$829.80
|
| Rate for Payer: WEA Trust Commercial |
$760.65
|
| Rate for Payer: WPS Commercial |
$1,024.39
|
|
|
SCREW GRIDLOCK 2.4 X 22 301-24-022
|
Facility
|
OP
|
$1,383.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5456743
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$387.24 |
| Max. Negotiated Rate |
$5,532.00 |
| Rate for Payer: Aetna Commercial |
$1,244.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,189.38
|
| Rate for Payer: Aetna Managed Medicare |
$387.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$898.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$691.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$663.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$732.99
|
| Rate for Payer: Cash Price |
$414.90
|
| Rate for Payer: Cigna Commercial |
$1,272.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$773.93
|
| Rate for Payer: Health EOS Commercial |
$1,230.87
|
| Rate for Payer: HFN Commercial |
$1,272.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,037.25
|
| Rate for Payer: Multiplan Commercial |
$1,106.40
|
| Rate for Payer: NAPHCARE Commercial |
$829.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,272.36
|
| Rate for Payer: Quartz Beloit One Network |
$677.67
|
| Rate for Payer: Quartz Commercial |
$898.95
|
| Rate for Payer: Quartz Medicare Advantage |
$829.80
|
| Rate for Payer: The Alliance Commercial |
$5,532.00
|
| Rate for Payer: WEA Trust Commercial |
$760.65
|
| Rate for Payer: WPS Commercial |
$1,024.39
|
|
|
SCREW GRIDLOCK 2.4 X 24 301-24-024
|
Facility
|
OP
|
$1,330.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415999
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$372.40 |
| Max. Negotiated Rate |
$5,320.00 |
| Rate for Payer: Aetna Commercial |
$1,197.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,143.80
|
| Rate for Payer: Aetna Managed Medicare |
$372.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$864.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$665.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$638.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$704.90
|
| Rate for Payer: Cash Price |
$399.00
|
| Rate for Payer: Cigna Commercial |
$1,223.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$744.27
|
| Rate for Payer: Health EOS Commercial |
$1,183.70
|
| Rate for Payer: HFN Commercial |
$1,223.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$997.50
|
| Rate for Payer: Multiplan Commercial |
$1,064.00
|
| Rate for Payer: NAPHCARE Commercial |
$798.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,223.60
|
| Rate for Payer: Quartz Beloit One Network |
$651.70
|
| Rate for Payer: Quartz Commercial |
$864.50
|
| Rate for Payer: Quartz Medicare Advantage |
$798.00
|
| Rate for Payer: The Alliance Commercial |
$5,320.00
|
| Rate for Payer: WEA Trust Commercial |
$731.50
|
| Rate for Payer: WPS Commercial |
$985.13
|
|
|
SCREW GRIDLOCK 2.4 X 24 301-24-024
|
Facility
|
IP
|
$1,330.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415999
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$651.70 |
| Max. Negotiated Rate |
$1,223.60 |
| Rate for Payer: Aetna Commercial |
$1,197.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,143.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$704.90
|
| Rate for Payer: Cash Price |
$399.00
|
| Rate for Payer: Cigna Commercial |
$1,223.60
|
| Rate for Payer: Health EOS Commercial |
$1,183.70
|
| Rate for Payer: HFN Commercial |
$1,223.60
|
| Rate for Payer: Multiplan Commercial |
$1,064.00
|
| Rate for Payer: NAPHCARE Commercial |
$798.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,223.60
|
| Rate for Payer: Quartz Beloit One Network |
$651.70
|
| Rate for Payer: Quartz Commercial |
$798.00
|
| Rate for Payer: WEA Trust Commercial |
$731.50
|
| Rate for Payer: WPS Commercial |
$985.13
|
|
|
SCREW GRIDLOCK LOCK 2.4 X 10MM 302-24-010
|
Facility
|
IP
|
$2,394.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5240667
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,173.06 |
| Max. Negotiated Rate |
$2,202.48 |
| Rate for Payer: Aetna Commercial |
$2,154.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,058.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,268.82
|
| Rate for Payer: Cash Price |
$718.20
|
| Rate for Payer: Cigna Commercial |
$2,202.48
|
| Rate for Payer: Health EOS Commercial |
$2,130.66
|
| Rate for Payer: HFN Commercial |
$2,202.48
|
| Rate for Payer: Multiplan Commercial |
$1,915.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,436.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,202.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,173.06
|
| Rate for Payer: Quartz Commercial |
$1,436.40
|
| Rate for Payer: WEA Trust Commercial |
$1,316.70
|
| Rate for Payer: WPS Commercial |
$1,773.24
|
|
|
SCREW GRIDLOCK LOCK 2.4 X 10MM 302-24-010
|
Facility
|
OP
|
$2,394.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5240667
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$670.32 |
| Max. Negotiated Rate |
$9,576.00 |
| Rate for Payer: Aetna Commercial |
$2,154.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,058.84
|
| Rate for Payer: Aetna Managed Medicare |
$670.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,556.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,197.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,149.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,268.82
|
| Rate for Payer: Cash Price |
$718.20
|
| Rate for Payer: Cigna Commercial |
$2,202.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,339.68
|
| Rate for Payer: Health EOS Commercial |
$2,130.66
|
| Rate for Payer: HFN Commercial |
$2,202.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,795.50
|
| Rate for Payer: Multiplan Commercial |
$1,915.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,436.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,202.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,173.06
|
| Rate for Payer: Quartz Commercial |
$1,556.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,436.40
|
| Rate for Payer: The Alliance Commercial |
$9,576.00
|
| Rate for Payer: WEA Trust Commercial |
$1,316.70
|
| Rate for Payer: WPS Commercial |
$1,773.24
|
|
|
SCREW GRIDLOCK LOCK 2.4 X 12MM 302-24-012
|
Facility
|
OP
|
$2,394.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5248607
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$670.32 |
| Max. Negotiated Rate |
$9,576.00 |
| Rate for Payer: Aetna Commercial |
$2,154.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,058.84
|
| Rate for Payer: Aetna Managed Medicare |
$670.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,556.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,197.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,149.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,268.82
|
| Rate for Payer: Cash Price |
$718.20
|
| Rate for Payer: Cigna Commercial |
$2,202.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,339.68
|
| Rate for Payer: Health EOS Commercial |
$2,130.66
|
| Rate for Payer: HFN Commercial |
$2,202.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,795.50
|
| Rate for Payer: Multiplan Commercial |
$1,915.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,436.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,202.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,173.06
|
| Rate for Payer: Quartz Commercial |
$1,556.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,436.40
|
| Rate for Payer: The Alliance Commercial |
$9,576.00
|
| Rate for Payer: WEA Trust Commercial |
$1,316.70
|
| Rate for Payer: WPS Commercial |
$1,773.24
|
|
|
SCREW GRIDLOCK LOCK 2.4 X 12MM 302-24-012
|
Facility
|
IP
|
$2,394.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5248607
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,173.06 |
| Max. Negotiated Rate |
$2,202.48 |
| Rate for Payer: Aetna Commercial |
$2,154.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,058.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,268.82
|
| Rate for Payer: Cash Price |
$718.20
|
| Rate for Payer: Cigna Commercial |
$2,202.48
|
| Rate for Payer: Health EOS Commercial |
$2,130.66
|
| Rate for Payer: HFN Commercial |
$2,202.48
|
| Rate for Payer: Multiplan Commercial |
$1,915.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,436.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,202.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,173.06
|
| Rate for Payer: Quartz Commercial |
$1,436.40
|
| Rate for Payer: WEA Trust Commercial |
$1,316.70
|
| Rate for Payer: WPS Commercial |
$1,773.24
|
|
|
SCREW GRIDLOCK LOCK 2.4 X 14MM 302-24-014
|
Facility
|
IP
|
$2,394.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5611546
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,173.06 |
| Max. Negotiated Rate |
$2,202.48 |
| Rate for Payer: Aetna Commercial |
$2,154.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,058.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,268.82
|
| Rate for Payer: Cash Price |
$718.20
|
| Rate for Payer: Cigna Commercial |
$2,202.48
|
| Rate for Payer: Health EOS Commercial |
$2,130.66
|
| Rate for Payer: HFN Commercial |
$2,202.48
|
| Rate for Payer: Multiplan Commercial |
$1,915.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,436.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,202.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,173.06
|
| Rate for Payer: Quartz Commercial |
$1,436.40
|
| Rate for Payer: WEA Trust Commercial |
$1,316.70
|
| Rate for Payer: WPS Commercial |
$1,773.24
|
|
|
SCREW GRIDLOCK LOCK 2.4 X 14MM 302-24-014
|
Facility
|
OP
|
$2,394.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5611546
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$670.32 |
| Max. Negotiated Rate |
$9,576.00 |
| Rate for Payer: Aetna Commercial |
$2,154.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,058.84
|
| Rate for Payer: Aetna Managed Medicare |
$670.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,556.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,197.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,149.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,268.82
|
| Rate for Payer: Cash Price |
$718.20
|
| Rate for Payer: Cigna Commercial |
$2,202.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,339.68
|
| Rate for Payer: Health EOS Commercial |
$2,130.66
|
| Rate for Payer: HFN Commercial |
$2,202.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,795.50
|
| Rate for Payer: Multiplan Commercial |
$1,915.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,436.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,202.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,173.06
|
| Rate for Payer: Quartz Commercial |
$1,556.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,436.40
|
| Rate for Payer: The Alliance Commercial |
$9,576.00
|
| Rate for Payer: WEA Trust Commercial |
$1,316.70
|
| Rate for Payer: WPS Commercial |
$1,773.24
|
|
|
SCREW GRIDLOCK LOCK 2.4 X 16MM 302-24-016
|
Facility
|
OP
|
$2,394.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5611545
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$670.32 |
| Max. Negotiated Rate |
$9,576.00 |
| Rate for Payer: Aetna Commercial |
$2,154.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,058.84
|
| Rate for Payer: Aetna Managed Medicare |
$670.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,556.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,197.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,149.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,268.82
|
| Rate for Payer: Cash Price |
$718.20
|
| Rate for Payer: Cigna Commercial |
$2,202.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,339.68
|
| Rate for Payer: Health EOS Commercial |
$2,130.66
|
| Rate for Payer: HFN Commercial |
$2,202.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,795.50
|
| Rate for Payer: Multiplan Commercial |
$1,915.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,436.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,202.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,173.06
|
| Rate for Payer: Quartz Commercial |
$1,556.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,436.40
|
| Rate for Payer: The Alliance Commercial |
$9,576.00
|
| Rate for Payer: WEA Trust Commercial |
$1,316.70
|
| Rate for Payer: WPS Commercial |
$1,773.24
|
|
|
SCREW GRIDLOCK LOCK 2.4 X 16MM 302-24-016
|
Facility
|
IP
|
$2,394.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5611545
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,173.06 |
| Max. Negotiated Rate |
$2,202.48 |
| Rate for Payer: Aetna Commercial |
$2,154.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,058.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,268.82
|
| Rate for Payer: Cash Price |
$718.20
|
| Rate for Payer: Cigna Commercial |
$2,202.48
|
| Rate for Payer: Health EOS Commercial |
$2,130.66
|
| Rate for Payer: HFN Commercial |
$2,202.48
|
| Rate for Payer: Multiplan Commercial |
$1,915.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,436.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,202.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,173.06
|
| Rate for Payer: Quartz Commercial |
$1,436.40
|
| Rate for Payer: WEA Trust Commercial |
$1,316.70
|
| Rate for Payer: WPS Commercial |
$1,773.24
|
|
|
SCREW GRIDLOCK LOCK 2.4 X 18MM 302-24-018
|
Facility
|
IP
|
$2,394.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5456744
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,173.06 |
| Max. Negotiated Rate |
$2,202.48 |
| Rate for Payer: Aetna Commercial |
$2,154.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,058.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,268.82
|
| Rate for Payer: Cash Price |
$718.20
|
| Rate for Payer: Cigna Commercial |
$2,202.48
|
| Rate for Payer: Health EOS Commercial |
$2,130.66
|
| Rate for Payer: HFN Commercial |
$2,202.48
|
| Rate for Payer: Multiplan Commercial |
$1,915.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,436.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,202.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,173.06
|
| Rate for Payer: Quartz Commercial |
$1,436.40
|
| Rate for Payer: WEA Trust Commercial |
$1,316.70
|
| Rate for Payer: WPS Commercial |
$1,773.24
|
|
|
SCREW GRIDLOCK LOCK 2.4 X 18MM 302-24-018
|
Facility
|
OP
|
$2,394.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5456744
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$670.32 |
| Max. Negotiated Rate |
$9,576.00 |
| Rate for Payer: Aetna Commercial |
$2,154.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,058.84
|
| Rate for Payer: Aetna Managed Medicare |
$670.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,556.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,197.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,149.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,268.82
|
| Rate for Payer: Cash Price |
$718.20
|
| Rate for Payer: Cigna Commercial |
$2,202.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,339.68
|
| Rate for Payer: Health EOS Commercial |
$2,130.66
|
| Rate for Payer: HFN Commercial |
$2,202.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,795.50
|
| Rate for Payer: Multiplan Commercial |
$1,915.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,436.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,202.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,173.06
|
| Rate for Payer: Quartz Commercial |
$1,556.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,436.40
|
| Rate for Payer: The Alliance Commercial |
$9,576.00
|
| Rate for Payer: WEA Trust Commercial |
$1,316.70
|
| Rate for Payer: WPS Commercial |
$1,773.24
|
|
|
SCREW GRIDLOCK LOCK 2.4 X 20MM 302-24-020
|
Facility
|
IP
|
$2,394.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5416000
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,173.06 |
| Max. Negotiated Rate |
$2,202.48 |
| Rate for Payer: Aetna Commercial |
$2,154.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,058.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,268.82
|
| Rate for Payer: Cash Price |
$718.20
|
| Rate for Payer: Cigna Commercial |
$2,202.48
|
| Rate for Payer: Health EOS Commercial |
$2,130.66
|
| Rate for Payer: HFN Commercial |
$2,202.48
|
| Rate for Payer: Multiplan Commercial |
$1,915.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,436.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,202.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,173.06
|
| Rate for Payer: Quartz Commercial |
$1,436.40
|
| Rate for Payer: WEA Trust Commercial |
$1,316.70
|
| Rate for Payer: WPS Commercial |
$1,773.24
|
|
|
SCREW GRIDLOCK LOCK 2.4 X 20MM 302-24-020
|
Facility
|
OP
|
$2,394.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5416000
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$670.32 |
| Max. Negotiated Rate |
$9,576.00 |
| Rate for Payer: Aetna Commercial |
$2,154.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,058.84
|
| Rate for Payer: Aetna Managed Medicare |
$670.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,556.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,197.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,149.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,268.82
|
| Rate for Payer: Cash Price |
$718.20
|
| Rate for Payer: Cigna Commercial |
$2,202.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,339.68
|
| Rate for Payer: Health EOS Commercial |
$2,130.66
|
| Rate for Payer: HFN Commercial |
$2,202.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,795.50
|
| Rate for Payer: Multiplan Commercial |
$1,915.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,436.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,202.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,173.06
|
| Rate for Payer: Quartz Commercial |
$1,556.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,436.40
|
| Rate for Payer: The Alliance Commercial |
$9,576.00
|
| Rate for Payer: WEA Trust Commercial |
$1,316.70
|
| Rate for Payer: WPS Commercial |
$1,773.24
|
|
|
SCREW GRIDLOCK LOCK 2.4 X 22MM 302-24-022
|
Facility
|
IP
|
$2,585.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5416001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,266.65 |
| Max. Negotiated Rate |
$2,378.20 |
| Rate for Payer: Aetna Commercial |
$2,326.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,223.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,370.05
|
| Rate for Payer: Cash Price |
$775.50
|
| Rate for Payer: Cigna Commercial |
$2,378.20
|
| Rate for Payer: Health EOS Commercial |
$2,300.65
|
| Rate for Payer: HFN Commercial |
$2,378.20
|
| Rate for Payer: Multiplan Commercial |
$2,068.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,551.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,378.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,266.65
|
| Rate for Payer: Quartz Commercial |
$1,551.00
|
| Rate for Payer: WEA Trust Commercial |
$1,421.75
|
| Rate for Payer: WPS Commercial |
$1,914.71
|
|
|
SCREW GRIDLOCK LOCK 2.4 X 22MM 302-24-022
|
Facility
|
OP
|
$2,585.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5416001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$723.80 |
| Max. Negotiated Rate |
$10,340.00 |
| Rate for Payer: Aetna Commercial |
$2,326.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,223.10
|
| Rate for Payer: Aetna Managed Medicare |
$723.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,680.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,292.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,240.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,370.05
|
| Rate for Payer: Cash Price |
$775.50
|
| Rate for Payer: Cigna Commercial |
$2,378.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,446.57
|
| Rate for Payer: Health EOS Commercial |
$2,300.65
|
| Rate for Payer: HFN Commercial |
$2,378.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,938.75
|
| Rate for Payer: Multiplan Commercial |
$2,068.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,551.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,378.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,266.65
|
| Rate for Payer: Quartz Commercial |
$1,680.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,551.00
|
| Rate for Payer: The Alliance Commercial |
$10,340.00
|
| Rate for Payer: WEA Trust Commercial |
$1,421.75
|
| Rate for Payer: WPS Commercial |
$1,914.71
|
|
|
SCREW GRIDLOCK LOCK 2.4 X 24MM 302-24-024
|
Facility
|
OP
|
$2,394.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5496816
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$670.32 |
| Max. Negotiated Rate |
$9,576.00 |
| Rate for Payer: Aetna Commercial |
$2,154.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,058.84
|
| Rate for Payer: Aetna Managed Medicare |
$670.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,556.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,197.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,149.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,268.82
|
| Rate for Payer: Cash Price |
$718.20
|
| Rate for Payer: Cigna Commercial |
$2,202.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,339.68
|
| Rate for Payer: Health EOS Commercial |
$2,130.66
|
| Rate for Payer: HFN Commercial |
$2,202.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,795.50
|
| Rate for Payer: Multiplan Commercial |
$1,915.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,436.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,202.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,173.06
|
| Rate for Payer: Quartz Commercial |
$1,556.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,436.40
|
| Rate for Payer: The Alliance Commercial |
$9,576.00
|
| Rate for Payer: WEA Trust Commercial |
$1,316.70
|
| Rate for Payer: WPS Commercial |
$1,773.24
|
|
|
SCREW GRIDLOCK LOCK 2.4 X 24MM 302-24-024
|
Facility
|
IP
|
$2,394.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5496816
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,173.06 |
| Max. Negotiated Rate |
$2,202.48 |
| Rate for Payer: Aetna Commercial |
$2,154.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,058.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,268.82
|
| Rate for Payer: Cash Price |
$718.20
|
| Rate for Payer: Cigna Commercial |
$2,202.48
|
| Rate for Payer: Health EOS Commercial |
$2,130.66
|
| Rate for Payer: HFN Commercial |
$2,202.48
|
| Rate for Payer: Multiplan Commercial |
$1,915.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,436.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,202.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,173.06
|
| Rate for Payer: Quartz Commercial |
$1,436.40
|
| Rate for Payer: WEA Trust Commercial |
$1,316.70
|
| Rate for Payer: WPS Commercial |
$1,773.24
|
|
|
SCREW HEADED 2.0 X 12 DART-FIRE COMPRESSION D1N20012S
|
Facility
|
IP
|
$3,868.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6182383
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,895.32 |
| Max. Negotiated Rate |
$3,558.56 |
| Rate for Payer: Aetna Commercial |
$3,481.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,326.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,050.04
|
| Rate for Payer: Cash Price |
$1,160.40
|
| Rate for Payer: Cigna Commercial |
$3,558.56
|
| Rate for Payer: Health EOS Commercial |
$3,442.52
|
| Rate for Payer: HFN Commercial |
$3,558.56
|
| Rate for Payer: Multiplan Commercial |
$3,094.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,320.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,558.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,895.32
|
| Rate for Payer: Quartz Commercial |
$2,320.80
|
| Rate for Payer: WEA Trust Commercial |
$2,127.40
|
| Rate for Payer: WPS Commercial |
$2,865.03
|
|
|
SCREW HEADED 2.0 X 12 DART-FIRE COMPRESSION D1N20012S
|
Facility
|
OP
|
$3,868.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6182383
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,083.04 |
| Max. Negotiated Rate |
$15,472.00 |
| Rate for Payer: Aetna Commercial |
$3,481.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,326.48
|
| Rate for Payer: Aetna Managed Medicare |
$1,083.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,514.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,934.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,856.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,050.04
|
| Rate for Payer: Cash Price |
$1,160.40
|
| Rate for Payer: Cigna Commercial |
$3,558.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,164.53
|
| Rate for Payer: Health EOS Commercial |
$3,442.52
|
| Rate for Payer: HFN Commercial |
$3,558.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,901.00
|
| Rate for Payer: Multiplan Commercial |
$3,094.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,320.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,558.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,895.32
|
| Rate for Payer: Quartz Commercial |
$2,514.20
|
| Rate for Payer: Quartz Medicare Advantage |
$2,320.80
|
| Rate for Payer: The Alliance Commercial |
$15,472.00
|
| Rate for Payer: WEA Trust Commercial |
$2,127.40
|
| Rate for Payer: WPS Commercial |
$2,865.03
|
|
|
SCREW HEADED 2.5 X 10MM IC2510
|
Facility
|
OP
|
$2,102.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5861645
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$588.56 |
| Max. Negotiated Rate |
$8,408.00 |
| Rate for Payer: Aetna Commercial |
$1,891.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,807.72
|
| Rate for Payer: Aetna Managed Medicare |
$588.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,366.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,051.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,008.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,114.06
|
| Rate for Payer: Cash Price |
$630.60
|
| Rate for Payer: Cigna Commercial |
$1,933.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,176.28
|
| Rate for Payer: Health EOS Commercial |
$1,870.78
|
| Rate for Payer: HFN Commercial |
$1,933.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,576.50
|
| Rate for Payer: Multiplan Commercial |
$1,681.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,261.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,933.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,029.98
|
| Rate for Payer: Quartz Commercial |
$1,366.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,261.20
|
| Rate for Payer: The Alliance Commercial |
$8,408.00
|
| Rate for Payer: WEA Trust Commercial |
$1,156.10
|
| Rate for Payer: WPS Commercial |
$1,556.95
|
|
|
SCREW HEADED 2.5 X 10MM IC2510
|
Facility
|
IP
|
$2,102.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5861645
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,029.98 |
| Max. Negotiated Rate |
$1,933.84 |
| Rate for Payer: Aetna Commercial |
$1,891.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,807.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,114.06
|
| Rate for Payer: Cash Price |
$630.60
|
| Rate for Payer: Cigna Commercial |
$1,933.84
|
| Rate for Payer: Health EOS Commercial |
$1,870.78
|
| Rate for Payer: HFN Commercial |
$1,933.84
|
| Rate for Payer: Multiplan Commercial |
$1,681.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,261.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,933.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,029.98
|
| Rate for Payer: Quartz Commercial |
$1,261.20
|
| Rate for Payer: WEA Trust Commercial |
$1,156.10
|
| Rate for Payer: WPS Commercial |
$1,556.95
|
|
|
SCREW HEADED 2.5 X 12MM IC2512
|
Facility
|
OP
|
$2,102.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5729903
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$588.56 |
| Max. Negotiated Rate |
$8,408.00 |
| Rate for Payer: Aetna Commercial |
$1,891.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,807.72
|
| Rate for Payer: Aetna Managed Medicare |
$588.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,366.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,051.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,008.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,114.06
|
| Rate for Payer: Cash Price |
$630.60
|
| Rate for Payer: Cigna Commercial |
$1,933.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,176.28
|
| Rate for Payer: Health EOS Commercial |
$1,870.78
|
| Rate for Payer: HFN Commercial |
$1,933.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,576.50
|
| Rate for Payer: Multiplan Commercial |
$1,681.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,261.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,933.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,029.98
|
| Rate for Payer: Quartz Commercial |
$1,366.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,261.20
|
| Rate for Payer: The Alliance Commercial |
$8,408.00
|
| Rate for Payer: WEA Trust Commercial |
$1,156.10
|
| Rate for Payer: WPS Commercial |
$1,556.95
|
|
