|
SCREW-LOCK 2.4 X 28 412.828
|
Facility
|
OP
|
$709.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966823
|
|
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 28MM 04.210.128
|
Facility
|
IP
|
$2,027.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966824
|
|
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 28MM 04.210.128
|
Facility
|
OP
|
$2,027.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966824
|
|
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 28 STARDRIVE 02.210.128
|
Facility
|
OP
|
$1,430.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6001633
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$400.40 |
| Max. Negotiated Rate |
$5,720.00 |
| Rate for Payer: Aetna Commercial |
$1,287.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,229.80
|
| Rate for Payer: Aetna Managed Medicare |
$400.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$929.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$715.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$686.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$757.90
|
| Rate for Payer: Cash Price |
$429.00
|
| Rate for Payer: Cigna Commercial |
$1,315.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$800.23
|
| Rate for Payer: Health EOS Commercial |
$1,272.70
|
| Rate for Payer: HFN Commercial |
$1,315.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,072.50
|
| Rate for Payer: Multiplan Commercial |
$1,144.00
|
| Rate for Payer: NAPHCARE Commercial |
$858.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,315.60
|
| Rate for Payer: Quartz Beloit One Network |
$700.70
|
| Rate for Payer: Quartz Commercial |
$929.50
|
| Rate for Payer: Quartz Medicare Advantage |
$858.00
|
| Rate for Payer: The Alliance Commercial |
$5,720.00
|
| Rate for Payer: WEA Trust Commercial |
$786.50
|
| Rate for Payer: WPS Commercial |
$1,059.20
|
|
|
SCREW LOCK 2.4 X 28 STARDRIVE 02.210.128
|
Facility
|
IP
|
$1,430.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6001633
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$700.70 |
| Max. Negotiated Rate |
$1,315.60 |
| Rate for Payer: Aetna Commercial |
$1,287.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,229.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$757.90
|
| Rate for Payer: Cash Price |
$429.00
|
| Rate for Payer: Cigna Commercial |
$1,315.60
|
| Rate for Payer: Health EOS Commercial |
$1,272.70
|
| Rate for Payer: HFN Commercial |
$1,315.60
|
| Rate for Payer: Multiplan Commercial |
$1,144.00
|
| Rate for Payer: NAPHCARE Commercial |
$858.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,315.60
|
| Rate for Payer: Quartz Beloit One Network |
$700.70
|
| Rate for Payer: Quartz Commercial |
$858.00
|
| Rate for Payer: WEA Trust Commercial |
$786.50
|
| Rate for Payer: WPS Commercial |
$1,059.20
|
|
|
SCREW-LOCK 2.4 X 30 412.830
|
Facility
|
IP
|
$709.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966826
|
|
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 30 412.830
|
Facility
|
OP
|
$709.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966826
|
|
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 30MM 04.210.130
|
Facility
|
OP
|
$2,027.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966827
|
|
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 30MM 04.210.130
|
Facility
|
IP
|
$2,027.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966827
|
|
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 6 412.806
|
Facility
|
IP
|
$709.00
|
|
| Hospital Charge Code |
2966829
|
|
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 6 412.806
|
Facility
|
OP
|
$709.00
|
|
| Hospital Charge Code |
2966829
|
|
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 8 412.808
|
Facility
|
OP
|
$709.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966831
|
|
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 8 412.808
|
Facility
|
IP
|
$709.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966831
|
|
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 8MM 04.210.108
|
Facility
|
OP
|
$2,027.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966832
|
|
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 8MM 04.210.108
|
Facility
|
IP
|
$2,027.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966832
|
|
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 2.7MM X 10MM 657010
|
Facility
|
OP
|
$2,105.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6167817
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$589.40 |
| Max. Negotiated Rate |
$8,420.00 |
| Rate for Payer: Aetna Commercial |
$1,894.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,810.30
|
| Rate for Payer: Aetna Managed Medicare |
$589.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,368.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,052.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,010.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,115.65
|
| Rate for Payer: Cash Price |
$631.50
|
| Rate for Payer: Cigna Commercial |
$1,936.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,177.96
|
| Rate for Payer: Health EOS Commercial |
$1,873.45
|
| Rate for Payer: HFN Commercial |
$1,936.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,578.75
|
| Rate for Payer: Multiplan Commercial |
$1,684.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,263.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,936.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,031.45
|
| Rate for Payer: Quartz Commercial |
$1,368.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,263.00
|
| Rate for Payer: The Alliance Commercial |
$8,420.00
|
| Rate for Payer: WEA Trust Commercial |
$1,157.75
|
| Rate for Payer: WPS Commercial |
$1,559.17
|
|
|
SCREW LOCK 2.7MM X 10MM 657010
|
Facility
|
IP
|
$2,105.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6167817
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,031.45 |
| Max. Negotiated Rate |
$1,936.60 |
| Rate for Payer: Aetna Commercial |
$1,894.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,810.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,115.65
|
| Rate for Payer: Cash Price |
$631.50
|
| Rate for Payer: Cigna Commercial |
$1,936.60
|
| Rate for Payer: Health EOS Commercial |
$1,873.45
|
| Rate for Payer: HFN Commercial |
$1,936.60
|
| Rate for Payer: Multiplan Commercial |
$1,684.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,263.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,936.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,031.45
|
| Rate for Payer: Quartz Commercial |
$1,263.00
|
| Rate for Payer: WEA Trust Commercial |
$1,157.75
|
| Rate for Payer: WPS Commercial |
$1,559.17
|
|
|
SCREW LOCK 2.7MM X 12MM 657012
|
Facility
|
IP
|
$2,105.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6167818
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,031.45 |
| Max. Negotiated Rate |
$1,936.60 |
| Rate for Payer: Aetna Commercial |
$1,894.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,810.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,115.65
|
| Rate for Payer: Cash Price |
$631.50
|
| Rate for Payer: Cigna Commercial |
$1,936.60
|
| Rate for Payer: Health EOS Commercial |
$1,873.45
|
| Rate for Payer: HFN Commercial |
$1,936.60
|
| Rate for Payer: Multiplan Commercial |
$1,684.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,263.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,936.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,031.45
|
| Rate for Payer: Quartz Commercial |
$1,263.00
|
| Rate for Payer: WEA Trust Commercial |
$1,157.75
|
| Rate for Payer: WPS Commercial |
$1,559.17
|
|
|
SCREW LOCK 2.7MM X 12MM 657012
|
Facility
|
OP
|
$2,105.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6167818
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$589.40 |
| Max. Negotiated Rate |
$8,420.00 |
| Rate for Payer: Aetna Commercial |
$1,894.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,810.30
|
| Rate for Payer: Aetna Managed Medicare |
$589.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,368.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,052.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,010.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,115.65
|
| Rate for Payer: Cash Price |
$631.50
|
| Rate for Payer: Cigna Commercial |
$1,936.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,177.96
|
| Rate for Payer: Health EOS Commercial |
$1,873.45
|
| Rate for Payer: HFN Commercial |
$1,936.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,578.75
|
| Rate for Payer: Multiplan Commercial |
$1,684.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,263.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,936.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,031.45
|
| Rate for Payer: Quartz Commercial |
$1,368.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,263.00
|
| Rate for Payer: The Alliance Commercial |
$8,420.00
|
| Rate for Payer: WEA Trust Commercial |
$1,157.75
|
| Rate for Payer: WPS Commercial |
$1,559.17
|
|
|
SCREW LOCK 2.7MM X 14MM 657014
|
Facility
|
OP
|
$2,105.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6169643
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$589.40 |
| Max. Negotiated Rate |
$8,420.00 |
| Rate for Payer: Aetna Commercial |
$1,894.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,810.30
|
| Rate for Payer: Aetna Managed Medicare |
$589.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,368.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,052.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,010.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,115.65
|
| Rate for Payer: Cash Price |
$631.50
|
| Rate for Payer: Cigna Commercial |
$1,936.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,177.96
|
| Rate for Payer: Health EOS Commercial |
$1,873.45
|
| Rate for Payer: HFN Commercial |
$1,936.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,578.75
|
| Rate for Payer: Multiplan Commercial |
$1,684.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,263.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,936.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,031.45
|
| Rate for Payer: Quartz Commercial |
$1,368.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,263.00
|
| Rate for Payer: The Alliance Commercial |
$8,420.00
|
| Rate for Payer: WEA Trust Commercial |
$1,157.75
|
| Rate for Payer: WPS Commercial |
$1,559.17
|
|
|
SCREW LOCK 2.7MM X 14MM 657014
|
Facility
|
IP
|
$2,105.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6169643
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,031.45 |
| Max. Negotiated Rate |
$1,936.60 |
| Rate for Payer: Aetna Commercial |
$1,894.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,810.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,115.65
|
| Rate for Payer: Cash Price |
$631.50
|
| Rate for Payer: Cigna Commercial |
$1,936.60
|
| Rate for Payer: Health EOS Commercial |
$1,873.45
|
| Rate for Payer: HFN Commercial |
$1,936.60
|
| Rate for Payer: Multiplan Commercial |
$1,684.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,263.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,936.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,031.45
|
| Rate for Payer: Quartz Commercial |
$1,263.00
|
| Rate for Payer: WEA Trust Commercial |
$1,157.75
|
| Rate for Payer: WPS Commercial |
$1,559.17
|
|
|
SCREW LOCK 2.7MM X 16MM 657016
|
Facility
|
OP
|
$2,190.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599690
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$613.20 |
| Max. Negotiated Rate |
$8,760.00 |
| Rate for Payer: Aetna Commercial |
$1,971.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,883.40
|
| Rate for Payer: Aetna Managed Medicare |
$613.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,423.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,095.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,051.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,160.70
|
| Rate for Payer: Cash Price |
$657.00
|
| Rate for Payer: Cigna Commercial |
$2,014.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,225.52
|
| Rate for Payer: Health EOS Commercial |
$1,949.10
|
| Rate for Payer: HFN Commercial |
$2,014.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,642.50
|
| Rate for Payer: Multiplan Commercial |
$1,752.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,314.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,014.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,073.10
|
| Rate for Payer: Quartz Commercial |
$1,423.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,314.00
|
| Rate for Payer: The Alliance Commercial |
$8,760.00
|
| Rate for Payer: WEA Trust Commercial |
$1,204.50
|
| Rate for Payer: WPS Commercial |
$1,622.13
|
|
|
SCREW LOCK 2.7MM X 16MM 657016
|
Facility
|
IP
|
$2,190.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599690
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,073.10 |
| Max. Negotiated Rate |
$2,014.80 |
| Rate for Payer: Aetna Commercial |
$1,971.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,883.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,160.70
|
| Rate for Payer: Cash Price |
$657.00
|
| Rate for Payer: Cigna Commercial |
$2,014.80
|
| Rate for Payer: Health EOS Commercial |
$1,949.10
|
| Rate for Payer: HFN Commercial |
$2,014.80
|
| Rate for Payer: Multiplan Commercial |
$1,752.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,314.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,014.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,073.10
|
| Rate for Payer: Quartz Commercial |
$1,314.00
|
| Rate for Payer: WEA Trust Commercial |
$1,204.50
|
| Rate for Payer: WPS Commercial |
$1,622.13
|
|
|
SCREW LOCK 2.7 X 10MM 02.211.008
|
Facility
|
IP
|
$1,546.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5617630
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$757.54 |
| Max. Negotiated Rate |
$1,422.32 |
| Rate for Payer: Aetna Commercial |
$1,391.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,329.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$819.38
|
| Rate for Payer: Cash Price |
$463.80
|
| Rate for Payer: Cigna Commercial |
$1,422.32
|
| Rate for Payer: Health EOS Commercial |
$1,375.94
|
| Rate for Payer: HFN Commercial |
$1,422.32
|
| Rate for Payer: Multiplan Commercial |
$1,236.80
|
| Rate for Payer: NAPHCARE Commercial |
$927.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,422.32
|
| Rate for Payer: Quartz Beloit One Network |
$757.54
|
| Rate for Payer: Quartz Commercial |
$927.60
|
| Rate for Payer: WEA Trust Commercial |
$850.30
|
| Rate for Payer: WPS Commercial |
$1,145.12
|
|
|
SCREW LOCK 2.7 X 10MM 02.211.008
|
Facility
|
OP
|
$1,546.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5617630
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$432.88 |
| Max. Negotiated Rate |
$6,184.00 |
| Rate for Payer: Aetna Commercial |
$1,391.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,329.56
|
| Rate for Payer: Aetna Managed Medicare |
$432.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,004.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$773.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$742.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$819.38
|
| Rate for Payer: Cash Price |
$463.80
|
| Rate for Payer: Cigna Commercial |
$1,422.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$865.14
|
| Rate for Payer: Health EOS Commercial |
$1,375.94
|
| Rate for Payer: HFN Commercial |
$1,422.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,159.50
|
| Rate for Payer: Multiplan Commercial |
$1,236.80
|
| Rate for Payer: NAPHCARE Commercial |
$927.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,422.32
|
| Rate for Payer: Quartz Beloit One Network |
$757.54
|
| Rate for Payer: Quartz Commercial |
$1,004.90
|
| Rate for Payer: Quartz Medicare Advantage |
$927.60
|
| Rate for Payer: The Alliance Commercial |
$6,184.00
|
| Rate for Payer: WEA Trust Commercial |
$850.30
|
| Rate for Payer: WPS Commercial |
$1,145.12
|
|
