|
SCREW LOCK 1.5 X 13MM 02.214.013
|
Facility
|
IP
|
$1,812.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966412
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$887.88 |
| Max. Negotiated Rate |
$1,667.04 |
| Rate for Payer: Aetna Commercial |
$1,630.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,558.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$960.36
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cigna Commercial |
$1,667.04
|
| Rate for Payer: Health EOS Commercial |
$1,612.68
|
| Rate for Payer: HFN Commercial |
$1,667.04
|
| Rate for Payer: Multiplan Commercial |
$1,449.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,087.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,667.04
|
| Rate for Payer: Quartz Beloit One Network |
$887.88
|
| Rate for Payer: Quartz Commercial |
$1,087.20
|
| Rate for Payer: WEA Trust Commercial |
$996.60
|
| Rate for Payer: WPS Commercial |
$1,342.15
|
|
|
SCREW LOCK 1.5 X 14MM 02.214.014
|
Facility
|
IP
|
$1,812.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966414
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$887.88 |
| Max. Negotiated Rate |
$1,667.04 |
| Rate for Payer: Aetna Commercial |
$1,630.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,558.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$960.36
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cigna Commercial |
$1,667.04
|
| Rate for Payer: Health EOS Commercial |
$1,612.68
|
| Rate for Payer: HFN Commercial |
$1,667.04
|
| Rate for Payer: Multiplan Commercial |
$1,449.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,087.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,667.04
|
| Rate for Payer: Quartz Beloit One Network |
$887.88
|
| Rate for Payer: Quartz Commercial |
$1,087.20
|
| Rate for Payer: WEA Trust Commercial |
$996.60
|
| Rate for Payer: WPS Commercial |
$1,342.15
|
|
|
SCREW LOCK 1.5 X 14MM 02.214.014
|
Facility
|
OP
|
$1,812.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966414
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$507.36 |
| Max. Negotiated Rate |
$7,248.00 |
| Rate for Payer: Aetna Commercial |
$1,630.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,558.32
|
| Rate for Payer: Aetna Managed Medicare |
$507.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,177.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$906.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$869.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$960.36
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cigna Commercial |
$1,667.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,014.00
|
| Rate for Payer: Health EOS Commercial |
$1,612.68
|
| Rate for Payer: HFN Commercial |
$1,667.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,359.00
|
| Rate for Payer: Multiplan Commercial |
$1,449.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,087.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,667.04
|
| Rate for Payer: Quartz Beloit One Network |
$887.88
|
| Rate for Payer: Quartz Commercial |
$1,177.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,087.20
|
| Rate for Payer: The Alliance Commercial |
$7,248.00
|
| Rate for Payer: WEA Trust Commercial |
$996.60
|
| Rate for Payer: WPS Commercial |
$1,342.15
|
|
|
SCREW LOCK 1.5 X 16MM 02.214.016
|
Facility
|
IP
|
$1,826.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966417
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$894.74 |
| Max. Negotiated Rate |
$1,679.92 |
| Rate for Payer: Aetna Commercial |
$1,643.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,570.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$967.78
|
| Rate for Payer: Cash Price |
$547.80
|
| Rate for Payer: Cigna Commercial |
$1,679.92
|
| Rate for Payer: Health EOS Commercial |
$1,625.14
|
| Rate for Payer: HFN Commercial |
$1,679.92
|
| Rate for Payer: Multiplan Commercial |
$1,460.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,095.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,679.92
|
| Rate for Payer: Quartz Beloit One Network |
$894.74
|
| Rate for Payer: Quartz Commercial |
$1,095.60
|
| Rate for Payer: WEA Trust Commercial |
$1,004.30
|
| Rate for Payer: WPS Commercial |
$1,352.52
|
|
|
SCREW LOCK 1.5 X 16MM 02.214.016
|
Facility
|
OP
|
$1,826.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966417
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$511.28 |
| Max. Negotiated Rate |
$7,304.00 |
| Rate for Payer: Aetna Commercial |
$1,643.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,570.36
|
| Rate for Payer: Aetna Managed Medicare |
$511.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,186.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$913.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$876.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$967.78
|
| Rate for Payer: Cash Price |
$547.80
|
| Rate for Payer: Cigna Commercial |
$1,679.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,021.83
|
| Rate for Payer: Health EOS Commercial |
$1,625.14
|
| Rate for Payer: HFN Commercial |
$1,679.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,369.50
|
| Rate for Payer: Multiplan Commercial |
$1,460.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,095.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,679.92
|
| Rate for Payer: Quartz Beloit One Network |
$894.74
|
| Rate for Payer: Quartz Commercial |
$1,186.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,095.60
|
| Rate for Payer: The Alliance Commercial |
$7,304.00
|
| Rate for Payer: WEA Trust Commercial |
$1,004.30
|
| Rate for Payer: WPS Commercial |
$1,352.52
|
|
|
SCREW LOCK 1.5 X 8MM 02.214.008
|
Facility
|
IP
|
$1,678.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966421
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$822.22 |
| Max. Negotiated Rate |
$1,543.76 |
| Rate for Payer: Aetna Commercial |
$1,510.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,443.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$889.34
|
| Rate for Payer: Cash Price |
$503.40
|
| Rate for Payer: Cigna Commercial |
$1,543.76
|
| Rate for Payer: Health EOS Commercial |
$1,493.42
|
| Rate for Payer: HFN Commercial |
$1,543.76
|
| Rate for Payer: Multiplan Commercial |
$1,342.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,006.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,543.76
|
| Rate for Payer: Quartz Beloit One Network |
$822.22
|
| Rate for Payer: Quartz Commercial |
$1,006.80
|
| Rate for Payer: WEA Trust Commercial |
$922.90
|
| Rate for Payer: WPS Commercial |
$1,242.89
|
|
|
SCREW LOCK 1.5 X 8MM 02.214.008
|
Facility
|
OP
|
$1,678.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966421
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$469.84 |
| Max. Negotiated Rate |
$6,712.00 |
| Rate for Payer: Aetna Commercial |
$1,510.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,443.08
|
| Rate for Payer: Aetna Managed Medicare |
$469.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,090.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$839.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$805.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$889.34
|
| Rate for Payer: Cash Price |
$503.40
|
| Rate for Payer: Cigna Commercial |
$1,543.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$939.01
|
| Rate for Payer: Health EOS Commercial |
$1,493.42
|
| Rate for Payer: HFN Commercial |
$1,543.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,258.50
|
| Rate for Payer: Multiplan Commercial |
$1,342.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,006.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,543.76
|
| Rate for Payer: Quartz Beloit One Network |
$822.22
|
| Rate for Payer: Quartz Commercial |
$1,090.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,006.80
|
| Rate for Payer: The Alliance Commercial |
$6,712.00
|
| Rate for Payer: WEA Trust Commercial |
$922.90
|
| Rate for Payer: WPS Commercial |
$1,242.89
|
|
|
SCREW LOCK 1.5 X 9MM 02.214.009
|
Facility
|
OP
|
$1,678.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966424
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$469.84 |
| Max. Negotiated Rate |
$6,712.00 |
| Rate for Payer: Aetna Commercial |
$1,510.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,443.08
|
| Rate for Payer: Aetna Managed Medicare |
$469.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,090.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$839.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$805.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$889.34
|
| Rate for Payer: Cash Price |
$503.40
|
| Rate for Payer: Cigna Commercial |
$1,543.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$939.01
|
| Rate for Payer: Health EOS Commercial |
$1,493.42
|
| Rate for Payer: HFN Commercial |
$1,543.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,258.50
|
| Rate for Payer: Multiplan Commercial |
$1,342.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,006.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,543.76
|
| Rate for Payer: Quartz Beloit One Network |
$822.22
|
| Rate for Payer: Quartz Commercial |
$1,090.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,006.80
|
| Rate for Payer: The Alliance Commercial |
$6,712.00
|
| Rate for Payer: WEA Trust Commercial |
$922.90
|
| Rate for Payer: WPS Commercial |
$1,242.89
|
|
|
SCREW LOCK 1.5 X 9MM 02.214.009
|
Facility
|
IP
|
$1,678.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966424
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$822.22 |
| Max. Negotiated Rate |
$1,543.76 |
| Rate for Payer: Aetna Commercial |
$1,510.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,443.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$889.34
|
| Rate for Payer: Cash Price |
$503.40
|
| Rate for Payer: Cigna Commercial |
$1,543.76
|
| Rate for Payer: Health EOS Commercial |
$1,493.42
|
| Rate for Payer: HFN Commercial |
$1,543.76
|
| Rate for Payer: Multiplan Commercial |
$1,342.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,006.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,543.76
|
| Rate for Payer: Quartz Beloit One Network |
$822.22
|
| Rate for Payer: Quartz Commercial |
$1,006.80
|
| Rate for Payer: WEA Trust Commercial |
$922.90
|
| Rate for Payer: WPS Commercial |
$1,242.89
|
|
|
SCREW LOCK 2.0MM X 10MM STARDRIVE 201.880
|
Facility
|
OP
|
$1,759.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966426
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$492.52 |
| Max. Negotiated Rate |
$7,036.00 |
| Rate for Payer: Aetna Commercial |
$1,583.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,512.74
|
| Rate for Payer: Aetna Managed Medicare |
$492.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,143.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$879.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$844.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$932.27
|
| Rate for Payer: Cash Price |
$527.70
|
| Rate for Payer: Cigna Commercial |
$1,618.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$984.34
|
| Rate for Payer: Health EOS Commercial |
$1,565.51
|
| Rate for Payer: HFN Commercial |
$1,618.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,319.25
|
| Rate for Payer: Multiplan Commercial |
$1,407.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,055.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,618.28
|
| Rate for Payer: Quartz Beloit One Network |
$861.91
|
| Rate for Payer: Quartz Commercial |
$1,143.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,055.40
|
| Rate for Payer: The Alliance Commercial |
$7,036.00
|
| Rate for Payer: WEA Trust Commercial |
$967.45
|
| Rate for Payer: WPS Commercial |
$1,302.89
|
|
|
SCREW LOCK 2.0MM X 10MM STARDRIVE 201.880
|
Facility
|
IP
|
$1,759.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966426
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$861.91 |
| Max. Negotiated Rate |
$1,618.28 |
| Rate for Payer: Aetna Commercial |
$1,583.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,512.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$932.27
|
| Rate for Payer: Cash Price |
$527.70
|
| Rate for Payer: Cigna Commercial |
$1,618.28
|
| Rate for Payer: Health EOS Commercial |
$1,565.51
|
| Rate for Payer: HFN Commercial |
$1,618.28
|
| Rate for Payer: Multiplan Commercial |
$1,407.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,055.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,618.28
|
| Rate for Payer: Quartz Beloit One Network |
$861.91
|
| Rate for Payer: Quartz Commercial |
$1,055.40
|
| Rate for Payer: WEA Trust Commercial |
$967.45
|
| Rate for Payer: WPS Commercial |
$1,302.89
|
|
|
SCREW LOCK 2.0MM X 12MM STARDRIVE 201.882
|
Facility
|
IP
|
$1,759.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966431
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$861.91 |
| Max. Negotiated Rate |
$1,618.28 |
| Rate for Payer: Aetna Commercial |
$1,583.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,512.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$932.27
|
| Rate for Payer: Cash Price |
$527.70
|
| Rate for Payer: Cigna Commercial |
$1,618.28
|
| Rate for Payer: Health EOS Commercial |
$1,565.51
|
| Rate for Payer: HFN Commercial |
$1,618.28
|
| Rate for Payer: Multiplan Commercial |
$1,407.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,055.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,618.28
|
| Rate for Payer: Quartz Beloit One Network |
$861.91
|
| Rate for Payer: Quartz Commercial |
$1,055.40
|
| Rate for Payer: WEA Trust Commercial |
$967.45
|
| Rate for Payer: WPS Commercial |
$1,302.89
|
|
|
SCREW LOCK 2.0MM X 12MM STARDRIVE 201.882
|
Facility
|
OP
|
$1,759.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966431
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$492.52 |
| Max. Negotiated Rate |
$7,036.00 |
| Rate for Payer: Aetna Commercial |
$1,583.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,512.74
|
| Rate for Payer: Aetna Managed Medicare |
$492.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,143.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$879.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$844.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$932.27
|
| Rate for Payer: Cash Price |
$527.70
|
| Rate for Payer: Cigna Commercial |
$1,618.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$984.34
|
| Rate for Payer: Health EOS Commercial |
$1,565.51
|
| Rate for Payer: HFN Commercial |
$1,618.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,319.25
|
| Rate for Payer: Multiplan Commercial |
$1,407.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,055.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,618.28
|
| Rate for Payer: Quartz Beloit One Network |
$861.91
|
| Rate for Payer: Quartz Commercial |
$1,143.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,055.40
|
| Rate for Payer: The Alliance Commercial |
$7,036.00
|
| Rate for Payer: WEA Trust Commercial |
$967.45
|
| Rate for Payer: WPS Commercial |
$1,302.89
|
|
|
SCREW LOCK 2.0MM X 14MM STARDRIVE 201.884
|
Facility
|
OP
|
$1,759.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966432
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$492.52 |
| Max. Negotiated Rate |
$7,036.00 |
| Rate for Payer: Aetna Commercial |
$1,583.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,512.74
|
| Rate for Payer: Aetna Managed Medicare |
$492.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,143.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$879.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$844.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$932.27
|
| Rate for Payer: Cash Price |
$527.70
|
| Rate for Payer: Cigna Commercial |
$1,618.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$984.34
|
| Rate for Payer: Health EOS Commercial |
$1,565.51
|
| Rate for Payer: HFN Commercial |
$1,618.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,319.25
|
| Rate for Payer: Multiplan Commercial |
$1,407.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,055.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,618.28
|
| Rate for Payer: Quartz Beloit One Network |
$861.91
|
| Rate for Payer: Quartz Commercial |
$1,143.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,055.40
|
| Rate for Payer: The Alliance Commercial |
$7,036.00
|
| Rate for Payer: WEA Trust Commercial |
$967.45
|
| Rate for Payer: WPS Commercial |
$1,302.89
|
|
|
SCREW LOCK 2.0MM X 14MM STARDRIVE 201.884
|
Facility
|
IP
|
$1,759.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966432
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$861.91 |
| Max. Negotiated Rate |
$1,618.28 |
| Rate for Payer: Aetna Commercial |
$1,583.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,512.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$932.27
|
| Rate for Payer: Cash Price |
$527.70
|
| Rate for Payer: Cigna Commercial |
$1,618.28
|
| Rate for Payer: Health EOS Commercial |
$1,565.51
|
| Rate for Payer: HFN Commercial |
$1,618.28
|
| Rate for Payer: Multiplan Commercial |
$1,407.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,055.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,618.28
|
| Rate for Payer: Quartz Beloit One Network |
$861.91
|
| Rate for Payer: Quartz Commercial |
$1,055.40
|
| Rate for Payer: WEA Trust Commercial |
$967.45
|
| Rate for Payer: WPS Commercial |
$1,302.89
|
|
|
SCREW LOCK 2.0MM X 16MM STARDRIVE 201.886
|
Facility
|
OP
|
$1,759.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966434
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$492.52 |
| Max. Negotiated Rate |
$7,036.00 |
| Rate for Payer: Aetna Commercial |
$1,583.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,512.74
|
| Rate for Payer: Aetna Managed Medicare |
$492.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,143.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$879.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$844.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$932.27
|
| Rate for Payer: Cash Price |
$527.70
|
| Rate for Payer: Cigna Commercial |
$1,618.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$984.34
|
| Rate for Payer: Health EOS Commercial |
$1,565.51
|
| Rate for Payer: HFN Commercial |
$1,618.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,319.25
|
| Rate for Payer: Multiplan Commercial |
$1,407.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,055.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,618.28
|
| Rate for Payer: Quartz Beloit One Network |
$861.91
|
| Rate for Payer: Quartz Commercial |
$1,143.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,055.40
|
| Rate for Payer: The Alliance Commercial |
$7,036.00
|
| Rate for Payer: WEA Trust Commercial |
$967.45
|
| Rate for Payer: WPS Commercial |
$1,302.89
|
|
|
SCREW LOCK 2.0MM X 16MM STARDRIVE 201.886
|
Facility
|
IP
|
$1,759.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966434
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$861.91 |
| Max. Negotiated Rate |
$1,618.28 |
| Rate for Payer: Aetna Commercial |
$1,583.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,512.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$932.27
|
| Rate for Payer: Cash Price |
$527.70
|
| Rate for Payer: Cigna Commercial |
$1,618.28
|
| Rate for Payer: Health EOS Commercial |
$1,565.51
|
| Rate for Payer: HFN Commercial |
$1,618.28
|
| Rate for Payer: Multiplan Commercial |
$1,407.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,055.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,618.28
|
| Rate for Payer: Quartz Beloit One Network |
$861.91
|
| Rate for Payer: Quartz Commercial |
$1,055.40
|
| Rate for Payer: WEA Trust Commercial |
$967.45
|
| Rate for Payer: WPS Commercial |
$1,302.89
|
|
|
SCREW LOCK 2.0MM X 18MM STARDRIVE 201.888
|
Facility
|
OP
|
$1,897.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966436
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$531.16 |
| Max. Negotiated Rate |
$7,588.00 |
| Rate for Payer: Aetna Commercial |
$1,707.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,631.42
|
| Rate for Payer: Aetna Managed Medicare |
$531.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,233.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$948.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$910.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,005.41
|
| Rate for Payer: Cash Price |
$569.10
|
| Rate for Payer: Cigna Commercial |
$1,745.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,061.56
|
| Rate for Payer: Health EOS Commercial |
$1,688.33
|
| Rate for Payer: HFN Commercial |
$1,745.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,422.75
|
| Rate for Payer: Multiplan Commercial |
$1,517.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,138.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,745.24
|
| Rate for Payer: Quartz Beloit One Network |
$929.53
|
| Rate for Payer: Quartz Commercial |
$1,233.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,138.20
|
| Rate for Payer: The Alliance Commercial |
$7,588.00
|
| Rate for Payer: WEA Trust Commercial |
$1,043.35
|
| Rate for Payer: WPS Commercial |
$1,405.11
|
|
|
SCREW LOCK 2.0MM X 18MM STARDRIVE 201.888
|
Facility
|
IP
|
$1,897.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966436
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$929.53 |
| Max. Negotiated Rate |
$1,745.24 |
| Rate for Payer: Aetna Commercial |
$1,707.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,631.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,005.41
|
| Rate for Payer: Cash Price |
$569.10
|
| Rate for Payer: Cigna Commercial |
$1,745.24
|
| Rate for Payer: Health EOS Commercial |
$1,688.33
|
| Rate for Payer: HFN Commercial |
$1,745.24
|
| Rate for Payer: Multiplan Commercial |
$1,517.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,138.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,745.24
|
| Rate for Payer: Quartz Beloit One Network |
$929.53
|
| Rate for Payer: Quartz Commercial |
$1,138.20
|
| Rate for Payer: WEA Trust Commercial |
$1,043.35
|
| Rate for Payer: WPS Commercial |
$1,405.11
|
|
|
SCREW LOCK 2.0MM X 20MM STARDRIVE 201.890
|
Facility
|
OP
|
$1,291.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414988
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$361.48 |
| Max. Negotiated Rate |
$5,164.00 |
| Rate for Payer: Aetna Commercial |
$1,161.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,110.26
|
| Rate for Payer: Aetna Managed Medicare |
$361.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$839.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$645.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$619.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$684.23
|
| Rate for Payer: Cash Price |
$387.30
|
| Rate for Payer: Cigna Commercial |
$1,187.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$722.44
|
| Rate for Payer: Health EOS Commercial |
$1,148.99
|
| Rate for Payer: HFN Commercial |
$1,187.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$968.25
|
| Rate for Payer: Multiplan Commercial |
$1,032.80
|
| Rate for Payer: NAPHCARE Commercial |
$774.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,187.72
|
| Rate for Payer: Quartz Beloit One Network |
$632.59
|
| Rate for Payer: Quartz Commercial |
$839.15
|
| Rate for Payer: Quartz Medicare Advantage |
$774.60
|
| Rate for Payer: The Alliance Commercial |
$5,164.00
|
| Rate for Payer: WEA Trust Commercial |
$710.05
|
| Rate for Payer: WPS Commercial |
$956.24
|
|
|
SCREW LOCK 2.0MM X 20MM STARDRIVE 201.890
|
Facility
|
IP
|
$1,291.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414988
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$632.59 |
| Max. Negotiated Rate |
$1,187.72 |
| Rate for Payer: Aetna Commercial |
$1,161.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,110.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$684.23
|
| Rate for Payer: Cash Price |
$387.30
|
| Rate for Payer: Cigna Commercial |
$1,187.72
|
| Rate for Payer: Health EOS Commercial |
$1,148.99
|
| Rate for Payer: HFN Commercial |
$1,187.72
|
| Rate for Payer: Multiplan Commercial |
$1,032.80
|
| Rate for Payer: NAPHCARE Commercial |
$774.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,187.72
|
| Rate for Payer: Quartz Beloit One Network |
$632.59
|
| Rate for Payer: Quartz Commercial |
$774.60
|
| Rate for Payer: WEA Trust Commercial |
$710.05
|
| Rate for Payer: WPS Commercial |
$956.24
|
|
|
SCREW LOCK 2.0 X 10 401.880
|
Facility
|
IP
|
$1,823.00
|
|
| Hospital Charge Code |
2966427
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$893.27 |
| Max. Negotiated Rate |
$1,677.16 |
| Rate for Payer: Aetna Commercial |
$1,640.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,567.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$966.19
|
| Rate for Payer: Cash Price |
$546.90
|
| Rate for Payer: Cigna Commercial |
$1,677.16
|
| Rate for Payer: Health EOS Commercial |
$1,622.47
|
| Rate for Payer: HFN Commercial |
$1,677.16
|
| Rate for Payer: Multiplan Commercial |
$1,458.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,093.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,677.16
|
| Rate for Payer: Quartz Beloit One Network |
$893.27
|
| Rate for Payer: Quartz Commercial |
$1,093.80
|
| Rate for Payer: WEA Trust Commercial |
$1,002.65
|
| Rate for Payer: WPS Commercial |
$1,350.30
|
|
|
SCREW LOCK 2.0 X 10 401.880
|
Facility
|
OP
|
$1,823.00
|
|
| Hospital Charge Code |
2966427
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$510.44 |
| Max. Negotiated Rate |
$7,292.00 |
| Rate for Payer: Aetna Commercial |
$1,640.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,567.78
|
| Rate for Payer: Aetna Managed Medicare |
$510.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,184.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$911.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$875.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$966.19
|
| Rate for Payer: Cash Price |
$546.90
|
| Rate for Payer: Cigna Commercial |
$1,677.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,020.15
|
| Rate for Payer: Health EOS Commercial |
$1,622.47
|
| Rate for Payer: HFN Commercial |
$1,677.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,367.25
|
| Rate for Payer: Multiplan Commercial |
$1,458.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,093.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,677.16
|
| Rate for Payer: Quartz Beloit One Network |
$893.27
|
| Rate for Payer: Quartz Commercial |
$1,184.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,093.80
|
| Rate for Payer: The Alliance Commercial |
$7,292.00
|
| Rate for Payer: WEA Trust Commercial |
$1,002.65
|
| Rate for Payer: WPS Commercial |
$1,350.30
|
|
|
SCREW LOCK 2.0 X 10MM TI 5201020010
|
Facility
|
IP
|
$3,630.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6172200
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,778.70 |
| Max. Negotiated Rate |
$3,339.60 |
| Rate for Payer: Aetna Commercial |
$3,267.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,121.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,923.90
|
| Rate for Payer: Cash Price |
$1,089.00
|
| Rate for Payer: Cigna Commercial |
$3,339.60
|
| Rate for Payer: Health EOS Commercial |
$3,230.70
|
| Rate for Payer: HFN Commercial |
$3,339.60
|
| Rate for Payer: Multiplan Commercial |
$2,904.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,178.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,339.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,778.70
|
| Rate for Payer: Quartz Commercial |
$2,178.00
|
| Rate for Payer: WEA Trust Commercial |
$1,996.50
|
| Rate for Payer: WPS Commercial |
$2,688.74
|
|
|
SCREW LOCK 2.0 X 10MM TI 5201020010
|
Facility
|
OP
|
$3,630.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6172200
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,016.40 |
| Max. Negotiated Rate |
$14,520.00 |
| Rate for Payer: Aetna Commercial |
$3,267.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,121.80
|
| Rate for Payer: Aetna Managed Medicare |
$1,016.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,359.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,815.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,742.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,923.90
|
| Rate for Payer: Cash Price |
$1,089.00
|
| Rate for Payer: Cigna Commercial |
$3,339.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,031.35
|
| Rate for Payer: Health EOS Commercial |
$3,230.70
|
| Rate for Payer: HFN Commercial |
$3,339.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,722.50
|
| Rate for Payer: Multiplan Commercial |
$2,904.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,178.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,339.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,778.70
|
| Rate for Payer: Quartz Commercial |
$2,359.50
|
| Rate for Payer: Quartz Medicare Advantage |
$2,178.00
|
| Rate for Payer: The Alliance Commercial |
$14,520.00
|
| Rate for Payer: WEA Trust Commercial |
$1,996.50
|
| Rate for Payer: WPS Commercial |
$2,688.74
|
|
