|
SCREW LOCK 2.0 X 18MM TI 5201120018
|
Facility
|
OP
|
$2,179.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5957647
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.12 |
| Max. Negotiated Rate |
$8,716.00 |
| Rate for Payer: Aetna Commercial |
$1,961.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,873.94
|
| Rate for Payer: Aetna Managed Medicare |
$610.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,416.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,089.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,045.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,154.87
|
| Rate for Payer: Cash Price |
$653.70
|
| Rate for Payer: Cigna Commercial |
$2,004.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,219.37
|
| Rate for Payer: Health EOS Commercial |
$1,939.31
|
| Rate for Payer: HFN Commercial |
$2,004.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,634.25
|
| Rate for Payer: Multiplan Commercial |
$1,743.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,307.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,004.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,067.71
|
| Rate for Payer: Quartz Commercial |
$1,416.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,307.40
|
| Rate for Payer: The Alliance Commercial |
$8,716.00
|
| Rate for Payer: WEA Trust Commercial |
$1,198.45
|
| Rate for Payer: WPS Commercial |
$1,613.99
|
|
|
SCREW LOCK 2.0 X 18MM TI 5201120018
|
Facility
|
IP
|
$2,179.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5957647
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,067.71 |
| Max. Negotiated Rate |
$2,004.68 |
| Rate for Payer: Aetna Commercial |
$1,961.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,873.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,154.87
|
| Rate for Payer: Cash Price |
$653.70
|
| Rate for Payer: Cigna Commercial |
$2,004.68
|
| Rate for Payer: Health EOS Commercial |
$1,939.31
|
| Rate for Payer: HFN Commercial |
$2,004.68
|
| Rate for Payer: Multiplan Commercial |
$1,743.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,307.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,004.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,067.71
|
| Rate for Payer: Quartz Commercial |
$1,307.40
|
| Rate for Payer: WEA Trust Commercial |
$1,198.45
|
| Rate for Payer: WPS Commercial |
$1,613.99
|
|
|
SCREW LOCK 2.0 X 20MM TI 5201120020
|
Facility
|
OP
|
$2,179.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5957648
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.12 |
| Max. Negotiated Rate |
$8,716.00 |
| Rate for Payer: Aetna Commercial |
$1,961.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,873.94
|
| Rate for Payer: Aetna Managed Medicare |
$610.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,416.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,089.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,045.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,154.87
|
| Rate for Payer: Cash Price |
$653.70
|
| Rate for Payer: Cigna Commercial |
$2,004.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,219.37
|
| Rate for Payer: Health EOS Commercial |
$1,939.31
|
| Rate for Payer: HFN Commercial |
$2,004.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,634.25
|
| Rate for Payer: Multiplan Commercial |
$1,743.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,307.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,004.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,067.71
|
| Rate for Payer: Quartz Commercial |
$1,416.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,307.40
|
| Rate for Payer: The Alliance Commercial |
$8,716.00
|
| Rate for Payer: WEA Trust Commercial |
$1,198.45
|
| Rate for Payer: WPS Commercial |
$1,613.99
|
|
|
SCREW LOCK 2.0 X 20MM TI 5201120020
|
Facility
|
IP
|
$2,179.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5957648
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,067.71 |
| Max. Negotiated Rate |
$2,004.68 |
| Rate for Payer: Aetna Commercial |
$1,961.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,873.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,154.87
|
| Rate for Payer: Cash Price |
$653.70
|
| Rate for Payer: Cigna Commercial |
$2,004.68
|
| Rate for Payer: Health EOS Commercial |
$1,939.31
|
| Rate for Payer: HFN Commercial |
$2,004.68
|
| Rate for Payer: Multiplan Commercial |
$1,743.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,307.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,004.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,067.71
|
| Rate for Payer: Quartz Commercial |
$1,307.40
|
| Rate for Payer: WEA Trust Commercial |
$1,198.45
|
| Rate for Payer: WPS Commercial |
$1,613.99
|
|
|
SCREW-LOCK 2.4 X 10 412.810
|
Facility
|
IP
|
$709.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966796
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$347.41 |
| Max. Negotiated Rate |
$652.28 |
| Rate for Payer: Aetna Commercial |
$638.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$609.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$375.77
|
| Rate for Payer: Cash Price |
$212.70
|
| Rate for Payer: Cigna Commercial |
$652.28
|
| Rate for Payer: Health EOS Commercial |
$631.01
|
| Rate for Payer: HFN Commercial |
$652.28
|
| Rate for Payer: Multiplan Commercial |
$567.20
|
| Rate for Payer: NAPHCARE Commercial |
$425.40
|
| Rate for Payer: Preferred Network Access Commercial |
$652.28
|
| Rate for Payer: Quartz Beloit One Network |
$347.41
|
| Rate for Payer: Quartz Commercial |
$425.40
|
| Rate for Payer: WEA Trust Commercial |
$389.95
|
| Rate for Payer: WPS Commercial |
$525.16
|
|
|
SCREW-LOCK 2.4 X 10 412.810
|
Facility
|
OP
|
$709.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966796
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.52 |
| Max. Negotiated Rate |
$2,836.00 |
| Rate for Payer: Aetna Commercial |
$638.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$609.74
|
| Rate for Payer: Aetna Managed Medicare |
$198.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$460.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$354.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$340.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$375.77
|
| Rate for Payer: Cash Price |
$212.70
|
| Rate for Payer: Cigna Commercial |
$652.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$396.76
|
| Rate for Payer: Health EOS Commercial |
$631.01
|
| Rate for Payer: HFN Commercial |
$652.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$531.75
|
| Rate for Payer: Multiplan Commercial |
$567.20
|
| Rate for Payer: NAPHCARE Commercial |
$425.40
|
| Rate for Payer: Preferred Network Access Commercial |
$652.28
|
| Rate for Payer: Quartz Beloit One Network |
$347.41
|
| Rate for Payer: Quartz Commercial |
$460.85
|
| Rate for Payer: Quartz Medicare Advantage |
$425.40
|
| Rate for Payer: The Alliance Commercial |
$2,836.00
|
| Rate for Payer: WEA Trust Commercial |
$389.95
|
| Rate for Payer: WPS Commercial |
$525.16
|
|
|
SCREW-LOCK 2.4 X 10MM 04.210.110
|
Facility
|
OP
|
$2,027.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966797
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$567.56 |
| Max. Negotiated Rate |
$8,108.00 |
| Rate for Payer: Aetna Commercial |
$1,824.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,743.22
|
| Rate for Payer: Aetna Managed Medicare |
$567.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,317.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,013.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$972.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,074.31
|
| Rate for Payer: Cash Price |
$608.10
|
| Rate for Payer: Cigna Commercial |
$1,864.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,134.31
|
| Rate for Payer: Health EOS Commercial |
$1,804.03
|
| Rate for Payer: HFN Commercial |
$1,864.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,520.25
|
| Rate for Payer: Multiplan Commercial |
$1,621.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,216.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,864.84
|
| Rate for Payer: Quartz Beloit One Network |
$993.23
|
| Rate for Payer: Quartz Commercial |
$1,317.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,216.20
|
| Rate for Payer: The Alliance Commercial |
$8,108.00
|
| Rate for Payer: WEA Trust Commercial |
$1,114.85
|
| Rate for Payer: WPS Commercial |
$1,501.40
|
|
|
SCREW-LOCK 2.4 X 10MM 04.210.110
|
Facility
|
IP
|
$2,027.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966797
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$993.23 |
| Max. Negotiated Rate |
$1,864.84 |
| Rate for Payer: Aetna Commercial |
$1,824.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,743.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,074.31
|
| Rate for Payer: Cash Price |
$608.10
|
| Rate for Payer: Cigna Commercial |
$1,864.84
|
| Rate for Payer: Health EOS Commercial |
$1,804.03
|
| Rate for Payer: HFN Commercial |
$1,864.84
|
| Rate for Payer: Multiplan Commercial |
$1,621.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,216.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,864.84
|
| Rate for Payer: Quartz Beloit One Network |
$993.23
|
| Rate for Payer: Quartz Commercial |
$1,216.20
|
| Rate for Payer: WEA Trust Commercial |
$1,114.85
|
| Rate for Payer: WPS Commercial |
$1,501.40
|
|
|
SCREW LOCK 2.4 X 10MM 212.810
|
Facility
|
OP
|
$1,644.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966438
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$460.32 |
| Max. Negotiated Rate |
$6,576.00 |
| Rate for Payer: Aetna Commercial |
$1,479.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,413.84
|
| Rate for Payer: Aetna Managed Medicare |
$460.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,068.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$822.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$789.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$871.32
|
| Rate for Payer: Cash Price |
$493.20
|
| Rate for Payer: Cigna Commercial |
$1,512.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$919.98
|
| Rate for Payer: Health EOS Commercial |
$1,463.16
|
| Rate for Payer: HFN Commercial |
$1,512.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,233.00
|
| Rate for Payer: Multiplan Commercial |
$1,315.20
|
| Rate for Payer: NAPHCARE Commercial |
$986.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,512.48
|
| Rate for Payer: Quartz Beloit One Network |
$805.56
|
| Rate for Payer: Quartz Commercial |
$1,068.60
|
| Rate for Payer: Quartz Medicare Advantage |
$986.40
|
| Rate for Payer: The Alliance Commercial |
$6,576.00
|
| Rate for Payer: WEA Trust Commercial |
$904.20
|
| Rate for Payer: WPS Commercial |
$1,217.71
|
|
|
SCREW LOCK 2.4 X 10MM 212.810
|
Facility
|
IP
|
$1,644.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966438
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$805.56 |
| Max. Negotiated Rate |
$1,512.48 |
| Rate for Payer: Aetna Commercial |
$1,479.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,413.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$871.32
|
| Rate for Payer: Cash Price |
$493.20
|
| Rate for Payer: Cigna Commercial |
$1,512.48
|
| Rate for Payer: Health EOS Commercial |
$1,463.16
|
| Rate for Payer: HFN Commercial |
$1,512.48
|
| Rate for Payer: Multiplan Commercial |
$1,315.20
|
| Rate for Payer: NAPHCARE Commercial |
$986.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,512.48
|
| Rate for Payer: Quartz Beloit One Network |
$805.56
|
| Rate for Payer: Quartz Commercial |
$986.40
|
| Rate for Payer: WEA Trust Commercial |
$904.20
|
| Rate for Payer: WPS Commercial |
$1,217.71
|
|
|
SCREW LOCK 2.4 X 10MM TI 5201024010
|
Facility
|
OP
|
$4,116.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6149642
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,152.48 |
| Max. Negotiated Rate |
$16,464.00 |
| Rate for Payer: Aetna Commercial |
$3,704.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,539.76
|
| Rate for Payer: Aetna Managed Medicare |
$1,152.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,675.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,058.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,975.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,181.48
|
| Rate for Payer: Cash Price |
$1,234.80
|
| Rate for Payer: Cigna Commercial |
$3,786.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,303.31
|
| Rate for Payer: Health EOS Commercial |
$3,663.24
|
| Rate for Payer: HFN Commercial |
$3,786.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,087.00
|
| Rate for Payer: Multiplan Commercial |
$3,292.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,469.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,786.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,016.84
|
| Rate for Payer: Quartz Commercial |
$2,675.40
|
| Rate for Payer: Quartz Medicare Advantage |
$2,469.60
|
| Rate for Payer: The Alliance Commercial |
$16,464.00
|
| Rate for Payer: WEA Trust Commercial |
$2,263.80
|
| Rate for Payer: WPS Commercial |
$3,048.72
|
|
|
SCREW LOCK 2.4 X 10MM TI 5201024010
|
Facility
|
IP
|
$4,116.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6149642
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,016.84 |
| Max. Negotiated Rate |
$3,786.72 |
| Rate for Payer: Aetna Commercial |
$3,704.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,539.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,181.48
|
| Rate for Payer: Cash Price |
$1,234.80
|
| Rate for Payer: Cigna Commercial |
$3,786.72
|
| Rate for Payer: Health EOS Commercial |
$3,663.24
|
| Rate for Payer: HFN Commercial |
$3,786.72
|
| Rate for Payer: Multiplan Commercial |
$3,292.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,469.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,786.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,016.84
|
| Rate for Payer: Quartz Commercial |
$2,469.60
|
| Rate for Payer: WEA Trust Commercial |
$2,263.80
|
| Rate for Payer: WPS Commercial |
$3,048.72
|
|
|
SCREW-LOCK 2.4 X 12 412.812
|
Facility
|
OP
|
$709.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966799
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.52 |
| Max. Negotiated Rate |
$2,836.00 |
| Rate for Payer: Aetna Commercial |
$638.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$609.74
|
| Rate for Payer: Aetna Managed Medicare |
$198.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$460.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$354.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$340.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$375.77
|
| Rate for Payer: Cash Price |
$212.70
|
| Rate for Payer: Cigna Commercial |
$652.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$396.76
|
| Rate for Payer: Health EOS Commercial |
$631.01
|
| Rate for Payer: HFN Commercial |
$652.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$531.75
|
| Rate for Payer: Multiplan Commercial |
$567.20
|
| Rate for Payer: NAPHCARE Commercial |
$425.40
|
| Rate for Payer: Preferred Network Access Commercial |
$652.28
|
| Rate for Payer: Quartz Beloit One Network |
$347.41
|
| Rate for Payer: Quartz Commercial |
$460.85
|
| Rate for Payer: Quartz Medicare Advantage |
$425.40
|
| Rate for Payer: The Alliance Commercial |
$2,836.00
|
| Rate for Payer: WEA Trust Commercial |
$389.95
|
| Rate for Payer: WPS Commercial |
$525.16
|
|
|
SCREW-LOCK 2.4 X 12 412.812
|
Facility
|
IP
|
$709.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966799
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$347.41 |
| Max. Negotiated Rate |
$652.28 |
| Rate for Payer: Aetna Commercial |
$638.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$609.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$375.77
|
| Rate for Payer: Cash Price |
$212.70
|
| Rate for Payer: Cigna Commercial |
$652.28
|
| Rate for Payer: Health EOS Commercial |
$631.01
|
| Rate for Payer: HFN Commercial |
$652.28
|
| Rate for Payer: Multiplan Commercial |
$567.20
|
| Rate for Payer: NAPHCARE Commercial |
$425.40
|
| Rate for Payer: Preferred Network Access Commercial |
$652.28
|
| Rate for Payer: Quartz Beloit One Network |
$347.41
|
| Rate for Payer: Quartz Commercial |
$425.40
|
| Rate for Payer: WEA Trust Commercial |
$389.95
|
| Rate for Payer: WPS Commercial |
$525.16
|
|
|
SCREW-LOCK 2.4 X 12MM 04.210.112
|
Facility
|
IP
|
$2,027.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966800
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$993.23 |
| Max. Negotiated Rate |
$1,864.84 |
| Rate for Payer: Aetna Commercial |
$1,824.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,743.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,074.31
|
| Rate for Payer: Cash Price |
$608.10
|
| Rate for Payer: Cigna Commercial |
$1,864.84
|
| Rate for Payer: Health EOS Commercial |
$1,804.03
|
| Rate for Payer: HFN Commercial |
$1,864.84
|
| Rate for Payer: Multiplan Commercial |
$1,621.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,216.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,864.84
|
| Rate for Payer: Quartz Beloit One Network |
$993.23
|
| Rate for Payer: Quartz Commercial |
$1,216.20
|
| Rate for Payer: WEA Trust Commercial |
$1,114.85
|
| Rate for Payer: WPS Commercial |
$1,501.40
|
|
|
SCREW-LOCK 2.4 X 12MM 04.210.112
|
Facility
|
OP
|
$2,027.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966800
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$567.56 |
| Max. Negotiated Rate |
$8,108.00 |
| Rate for Payer: Aetna Commercial |
$1,824.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,743.22
|
| Rate for Payer: Aetna Managed Medicare |
$567.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,317.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,013.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$972.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,074.31
|
| Rate for Payer: Cash Price |
$608.10
|
| Rate for Payer: Cigna Commercial |
$1,864.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,134.31
|
| Rate for Payer: Health EOS Commercial |
$1,804.03
|
| Rate for Payer: HFN Commercial |
$1,864.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,520.25
|
| Rate for Payer: Multiplan Commercial |
$1,621.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,216.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,864.84
|
| Rate for Payer: Quartz Beloit One Network |
$993.23
|
| Rate for Payer: Quartz Commercial |
$1,317.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,216.20
|
| Rate for Payer: The Alliance Commercial |
$8,108.00
|
| Rate for Payer: WEA Trust Commercial |
$1,114.85
|
| Rate for Payer: WPS Commercial |
$1,501.40
|
|
|
SCREW LOCK 2.4 X 12MM 212.812
|
Facility
|
IP
|
$1,644.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966439
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$805.56 |
| Max. Negotiated Rate |
$1,512.48 |
| Rate for Payer: Aetna Commercial |
$1,479.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,413.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$871.32
|
| Rate for Payer: Cash Price |
$493.20
|
| Rate for Payer: Cigna Commercial |
$1,512.48
|
| Rate for Payer: Health EOS Commercial |
$1,463.16
|
| Rate for Payer: HFN Commercial |
$1,512.48
|
| Rate for Payer: Multiplan Commercial |
$1,315.20
|
| Rate for Payer: NAPHCARE Commercial |
$986.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,512.48
|
| Rate for Payer: Quartz Beloit One Network |
$805.56
|
| Rate for Payer: Quartz Commercial |
$986.40
|
| Rate for Payer: WEA Trust Commercial |
$904.20
|
| Rate for Payer: WPS Commercial |
$1,217.71
|
|
|
SCREW LOCK 2.4 X 12MM 212.812
|
Facility
|
OP
|
$1,644.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966439
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$460.32 |
| Max. Negotiated Rate |
$6,576.00 |
| Rate for Payer: Aetna Commercial |
$1,479.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,413.84
|
| Rate for Payer: Aetna Managed Medicare |
$460.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,068.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$822.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$789.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$871.32
|
| Rate for Payer: Cash Price |
$493.20
|
| Rate for Payer: Cigna Commercial |
$1,512.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$919.98
|
| Rate for Payer: Health EOS Commercial |
$1,463.16
|
| Rate for Payer: HFN Commercial |
$1,512.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,233.00
|
| Rate for Payer: Multiplan Commercial |
$1,315.20
|
| Rate for Payer: NAPHCARE Commercial |
$986.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,512.48
|
| Rate for Payer: Quartz Beloit One Network |
$805.56
|
| Rate for Payer: Quartz Commercial |
$1,068.60
|
| Rate for Payer: Quartz Medicare Advantage |
$986.40
|
| Rate for Payer: The Alliance Commercial |
$6,576.00
|
| Rate for Payer: WEA Trust Commercial |
$904.20
|
| Rate for Payer: WPS Commercial |
$1,217.71
|
|
|
SCREW LOCK 2.4 X 12 STARDRIVE 02.210.112
|
Facility
|
OP
|
$1,889.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966447
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$528.92 |
| Max. Negotiated Rate |
$7,556.00 |
| Rate for Payer: Aetna Commercial |
$1,700.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,624.54
|
| Rate for Payer: Aetna Managed Medicare |
$528.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,227.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$944.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$906.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,001.17
|
| Rate for Payer: Cash Price |
$566.70
|
| Rate for Payer: Cigna Commercial |
$1,737.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,057.08
|
| Rate for Payer: Health EOS Commercial |
$1,681.21
|
| Rate for Payer: HFN Commercial |
$1,737.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,416.75
|
| Rate for Payer: Multiplan Commercial |
$1,511.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,133.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,737.88
|
| Rate for Payer: Quartz Beloit One Network |
$925.61
|
| Rate for Payer: Quartz Commercial |
$1,227.85
|
| Rate for Payer: Quartz Medicare Advantage |
$1,133.40
|
| Rate for Payer: The Alliance Commercial |
$7,556.00
|
| Rate for Payer: WEA Trust Commercial |
$1,038.95
|
| Rate for Payer: WPS Commercial |
$1,399.18
|
|
|
SCREW LOCK 2.4 X 12 STARDRIVE 02.210.112
|
Facility
|
IP
|
$1,889.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966447
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$925.61 |
| Max. Negotiated Rate |
$1,737.88 |
| Rate for Payer: Aetna Commercial |
$1,700.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,624.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,001.17
|
| Rate for Payer: Cash Price |
$566.70
|
| Rate for Payer: Cigna Commercial |
$1,737.88
|
| Rate for Payer: Health EOS Commercial |
$1,681.21
|
| Rate for Payer: HFN Commercial |
$1,737.88
|
| Rate for Payer: Multiplan Commercial |
$1,511.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,133.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,737.88
|
| Rate for Payer: Quartz Beloit One Network |
$925.61
|
| Rate for Payer: Quartz Commercial |
$1,133.40
|
| Rate for Payer: WEA Trust Commercial |
$1,038.95
|
| Rate for Payer: WPS Commercial |
$1,399.18
|
|
|
SCREW-LOCK 2.4 X 14 412.814
|
Facility
|
IP
|
$709.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966802
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$347.41 |
| Max. Negotiated Rate |
$652.28 |
| Rate for Payer: Aetna Commercial |
$638.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$609.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$375.77
|
| Rate for Payer: Cash Price |
$212.70
|
| Rate for Payer: Cigna Commercial |
$652.28
|
| Rate for Payer: Health EOS Commercial |
$631.01
|
| Rate for Payer: HFN Commercial |
$652.28
|
| Rate for Payer: Multiplan Commercial |
$567.20
|
| Rate for Payer: NAPHCARE Commercial |
$425.40
|
| Rate for Payer: Preferred Network Access Commercial |
$652.28
|
| Rate for Payer: Quartz Beloit One Network |
$347.41
|
| Rate for Payer: Quartz Commercial |
$425.40
|
| Rate for Payer: WEA Trust Commercial |
$389.95
|
| Rate for Payer: WPS Commercial |
$525.16
|
|
|
SCREW-LOCK 2.4 X 14 412.814
|
Facility
|
OP
|
$709.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966802
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.52 |
| Max. Negotiated Rate |
$2,836.00 |
| Rate for Payer: Aetna Commercial |
$638.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$609.74
|
| Rate for Payer: Aetna Managed Medicare |
$198.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$460.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$354.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$340.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$375.77
|
| Rate for Payer: Cash Price |
$212.70
|
| Rate for Payer: Cigna Commercial |
$652.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$396.76
|
| Rate for Payer: Health EOS Commercial |
$631.01
|
| Rate for Payer: HFN Commercial |
$652.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$531.75
|
| Rate for Payer: Multiplan Commercial |
$567.20
|
| Rate for Payer: NAPHCARE Commercial |
$425.40
|
| Rate for Payer: Preferred Network Access Commercial |
$652.28
|
| Rate for Payer: Quartz Beloit One Network |
$347.41
|
| Rate for Payer: Quartz Commercial |
$460.85
|
| Rate for Payer: Quartz Medicare Advantage |
$425.40
|
| Rate for Payer: The Alliance Commercial |
$2,836.00
|
| Rate for Payer: WEA Trust Commercial |
$389.95
|
| Rate for Payer: WPS Commercial |
$525.16
|
|
|
SCREW-LOCK 2.4 X 14MM 04.210.114
|
Facility
|
IP
|
$2,106.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966803
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,031.94 |
| Max. Negotiated Rate |
$1,937.52 |
| Rate for Payer: Aetna Commercial |
$1,895.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,811.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,116.18
|
| Rate for Payer: Cash Price |
$631.80
|
| Rate for Payer: Cigna Commercial |
$1,937.52
|
| Rate for Payer: Health EOS Commercial |
$1,874.34
|
| Rate for Payer: HFN Commercial |
$1,937.52
|
| Rate for Payer: Multiplan Commercial |
$1,684.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,263.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,937.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,031.94
|
| Rate for Payer: Quartz Commercial |
$1,263.60
|
| Rate for Payer: WEA Trust Commercial |
$1,158.30
|
| Rate for Payer: WPS Commercial |
$1,559.91
|
|
|
SCREW-LOCK 2.4 X 14MM 04.210.114
|
Facility
|
OP
|
$2,106.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966803
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$589.68 |
| Max. Negotiated Rate |
$8,424.00 |
| Rate for Payer: Aetna Commercial |
$1,895.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,811.16
|
| Rate for Payer: Aetna Managed Medicare |
$589.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,368.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,053.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,010.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,116.18
|
| Rate for Payer: Cash Price |
$631.80
|
| Rate for Payer: Cigna Commercial |
$1,937.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,178.52
|
| Rate for Payer: Health EOS Commercial |
$1,874.34
|
| Rate for Payer: HFN Commercial |
$1,937.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,579.50
|
| Rate for Payer: Multiplan Commercial |
$1,684.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,263.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,937.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,031.94
|
| Rate for Payer: Quartz Commercial |
$1,368.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,263.60
|
| Rate for Payer: The Alliance Commercial |
$8,424.00
|
| Rate for Payer: WEA Trust Commercial |
$1,158.30
|
| Rate for Payer: WPS Commercial |
$1,559.91
|
|
|
SCREW LOCK 2.4 X 14MM 212.814
|
Facility
|
IP
|
$1,897.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966441
|
|
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
|
|
