|
SCREW LOCK 2.7 X 26 ST 202.226
|
Facility
|
IP
|
$572.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4520523
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$280.28 |
| Max. Negotiated Rate |
$526.24 |
| Rate for Payer: Aetna Commercial |
$514.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$491.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$303.16
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Cigna Commercial |
$526.24
|
| Rate for Payer: Health EOS Commercial |
$509.08
|
| Rate for Payer: HFN Commercial |
$526.24
|
| Rate for Payer: Multiplan Commercial |
$457.60
|
| Rate for Payer: NAPHCARE Commercial |
$343.20
|
| Rate for Payer: Preferred Network Access Commercial |
$526.24
|
| Rate for Payer: Quartz Beloit One Network |
$280.28
|
| Rate for Payer: Quartz Commercial |
$343.20
|
| Rate for Payer: WEA Trust Commercial |
$314.60
|
| Rate for Payer: WPS Commercial |
$423.68
|
|
|
SCREW LOCK 2.7 X 26 ST 202.226
|
Facility
|
OP
|
$572.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4520523
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$160.16 |
| Max. Negotiated Rate |
$2,288.00 |
| Rate for Payer: Aetna Commercial |
$514.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$491.92
|
| Rate for Payer: Aetna Managed Medicare |
$160.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$371.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$286.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$274.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$303.16
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Cigna Commercial |
$526.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$320.09
|
| Rate for Payer: Health EOS Commercial |
$509.08
|
| Rate for Payer: HFN Commercial |
$526.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$429.00
|
| Rate for Payer: Multiplan Commercial |
$457.60
|
| Rate for Payer: NAPHCARE Commercial |
$343.20
|
| Rate for Payer: Preferred Network Access Commercial |
$526.24
|
| Rate for Payer: Quartz Beloit One Network |
$280.28
|
| Rate for Payer: Quartz Commercial |
$371.80
|
| Rate for Payer: Quartz Medicare Advantage |
$343.20
|
| Rate for Payer: The Alliance Commercial |
$2,288.00
|
| Rate for Payer: WEA Trust Commercial |
$314.60
|
| Rate for Payer: WPS Commercial |
$423.68
|
|
|
SCREW LOCK 2.7 X 28MM 02.211.028
|
Facility
|
IP
|
$1,608.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3265465
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$787.92 |
| Max. Negotiated Rate |
$1,479.36 |
| Rate for Payer: Aetna Commercial |
$1,447.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,382.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$852.24
|
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Cigna Commercial |
$1,479.36
|
| Rate for Payer: Health EOS Commercial |
$1,431.12
|
| Rate for Payer: HFN Commercial |
$1,479.36
|
| Rate for Payer: Multiplan Commercial |
$1,286.40
|
| Rate for Payer: NAPHCARE Commercial |
$964.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,479.36
|
| Rate for Payer: Quartz Beloit One Network |
$787.92
|
| Rate for Payer: Quartz Commercial |
$964.80
|
| Rate for Payer: WEA Trust Commercial |
$884.40
|
| Rate for Payer: WPS Commercial |
$1,191.05
|
|
|
SCREW LOCK 2.7 X 28MM 02.211.028
|
Facility
|
OP
|
$1,608.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3265465
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$450.24 |
| Max. Negotiated Rate |
$6,432.00 |
| Rate for Payer: Aetna Commercial |
$1,447.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,382.88
|
| Rate for Payer: Aetna Managed Medicare |
$450.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,045.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$804.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$771.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$852.24
|
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Cigna Commercial |
$1,479.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$899.84
|
| Rate for Payer: Health EOS Commercial |
$1,431.12
|
| Rate for Payer: HFN Commercial |
$1,479.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,206.00
|
| Rate for Payer: Multiplan Commercial |
$1,286.40
|
| Rate for Payer: NAPHCARE Commercial |
$964.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,479.36
|
| Rate for Payer: Quartz Beloit One Network |
$787.92
|
| Rate for Payer: Quartz Commercial |
$1,045.20
|
| Rate for Payer: Quartz Medicare Advantage |
$964.80
|
| Rate for Payer: The Alliance Commercial |
$6,432.00
|
| Rate for Payer: WEA Trust Commercial |
$884.40
|
| Rate for Payer: WPS Commercial |
$1,191.05
|
|
|
SCREW LOCK 2.7 X 28 ST 202.228
|
Facility
|
OP
|
$1,976.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966473
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$553.28 |
| Max. Negotiated Rate |
$7,904.00 |
| Rate for Payer: Aetna Commercial |
$1,778.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,699.36
|
| Rate for Payer: Aetna Managed Medicare |
$553.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,284.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$988.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$948.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,047.28
|
| Rate for Payer: Cash Price |
$592.80
|
| Rate for Payer: Cigna Commercial |
$1,817.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,105.77
|
| Rate for Payer: Health EOS Commercial |
$1,758.64
|
| Rate for Payer: HFN Commercial |
$1,817.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,482.00
|
| Rate for Payer: Multiplan Commercial |
$1,580.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,185.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,817.92
|
| Rate for Payer: Quartz Beloit One Network |
$968.24
|
| Rate for Payer: Quartz Commercial |
$1,284.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,185.60
|
| Rate for Payer: The Alliance Commercial |
$7,904.00
|
| Rate for Payer: WEA Trust Commercial |
$1,086.80
|
| Rate for Payer: WPS Commercial |
$1,463.62
|
|
|
SCREW LOCK 2.7 X 28 ST 202.228
|
Facility
|
IP
|
$1,976.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966473
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$968.24 |
| Max. Negotiated Rate |
$1,817.92 |
| Rate for Payer: Aetna Commercial |
$1,778.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,699.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,047.28
|
| Rate for Payer: Cash Price |
$592.80
|
| Rate for Payer: Cigna Commercial |
$1,817.92
|
| Rate for Payer: Health EOS Commercial |
$1,758.64
|
| Rate for Payer: HFN Commercial |
$1,817.92
|
| Rate for Payer: Multiplan Commercial |
$1,580.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,185.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,817.92
|
| Rate for Payer: Quartz Beloit One Network |
$968.24
|
| Rate for Payer: Quartz Commercial |
$1,185.60
|
| Rate for Payer: WEA Trust Commercial |
$1,086.80
|
| Rate for Payer: WPS Commercial |
$1,463.62
|
|
|
SCREW LOCK 2.7 X 30MM 02.211.030
|
Facility
|
OP
|
$1,546.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3265466
|
|
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
|
|
|
SCREW LOCK 2.7 X 30MM 02.211.030
|
Facility
|
IP
|
$1,546.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3265466
|
|
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 30 ST 202.230
|
Facility
|
OP
|
$1,976.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2969337
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$553.28 |
| Max. Negotiated Rate |
$7,904.00 |
| Rate for Payer: Aetna Commercial |
$1,778.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,699.36
|
| Rate for Payer: Aetna Managed Medicare |
$553.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,284.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$988.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$948.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,047.28
|
| Rate for Payer: Cash Price |
$592.80
|
| Rate for Payer: Cigna Commercial |
$1,817.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,105.77
|
| Rate for Payer: Health EOS Commercial |
$1,758.64
|
| Rate for Payer: HFN Commercial |
$1,817.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,482.00
|
| Rate for Payer: Multiplan Commercial |
$1,580.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,185.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,817.92
|
| Rate for Payer: Quartz Beloit One Network |
$968.24
|
| Rate for Payer: Quartz Commercial |
$1,284.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,185.60
|
| Rate for Payer: The Alliance Commercial |
$7,904.00
|
| Rate for Payer: WEA Trust Commercial |
$1,086.80
|
| Rate for Payer: WPS Commercial |
$1,463.62
|
|
|
SCREW LOCK 2.7 X 30 ST 202.230
|
Facility
|
IP
|
$1,976.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2969337
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$968.24 |
| Max. Negotiated Rate |
$1,817.92 |
| Rate for Payer: Aetna Commercial |
$1,778.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,699.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,047.28
|
| Rate for Payer: Cash Price |
$592.80
|
| Rate for Payer: Cigna Commercial |
$1,817.92
|
| Rate for Payer: Health EOS Commercial |
$1,758.64
|
| Rate for Payer: HFN Commercial |
$1,817.92
|
| Rate for Payer: Multiplan Commercial |
$1,580.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,185.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,817.92
|
| Rate for Payer: Quartz Beloit One Network |
$968.24
|
| Rate for Payer: Quartz Commercial |
$1,185.60
|
| Rate for Payer: WEA Trust Commercial |
$1,086.80
|
| Rate for Payer: WPS Commercial |
$1,463.62
|
|
|
SCREW LOCK 2.7 X 32MM 02.211.032
|
Facility
|
IP
|
$1,608.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3265467
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$787.92 |
| Max. Negotiated Rate |
$1,479.36 |
| Rate for Payer: Aetna Commercial |
$1,447.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,382.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$852.24
|
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Cigna Commercial |
$1,479.36
|
| Rate for Payer: Health EOS Commercial |
$1,431.12
|
| Rate for Payer: HFN Commercial |
$1,479.36
|
| Rate for Payer: Multiplan Commercial |
$1,286.40
|
| Rate for Payer: NAPHCARE Commercial |
$964.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,479.36
|
| Rate for Payer: Quartz Beloit One Network |
$787.92
|
| Rate for Payer: Quartz Commercial |
$964.80
|
| Rate for Payer: WEA Trust Commercial |
$884.40
|
| Rate for Payer: WPS Commercial |
$1,191.05
|
|
|
SCREW LOCK 2.7 X 32MM 02.211.032
|
Facility
|
OP
|
$1,608.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3265467
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$450.24 |
| Max. Negotiated Rate |
$6,432.00 |
| Rate for Payer: Aetna Commercial |
$1,447.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,382.88
|
| Rate for Payer: Aetna Managed Medicare |
$450.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,045.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$804.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$771.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$852.24
|
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Cigna Commercial |
$1,479.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$899.84
|
| Rate for Payer: Health EOS Commercial |
$1,431.12
|
| Rate for Payer: HFN Commercial |
$1,479.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,206.00
|
| Rate for Payer: Multiplan Commercial |
$1,286.40
|
| Rate for Payer: NAPHCARE Commercial |
$964.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,479.36
|
| Rate for Payer: Quartz Beloit One Network |
$787.92
|
| Rate for Payer: Quartz Commercial |
$1,045.20
|
| Rate for Payer: Quartz Medicare Advantage |
$964.80
|
| Rate for Payer: The Alliance Commercial |
$6,432.00
|
| Rate for Payer: WEA Trust Commercial |
$884.40
|
| Rate for Payer: WPS Commercial |
$1,191.05
|
|
|
SCREW LOCK 2.7 X 34MM 02.211.034
|
Facility
|
IP
|
$1,546.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3265489
|
|
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 34MM 02.211.034
|
Facility
|
OP
|
$1,546.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3265489
|
|
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
|
|
|
SCREW LOCK 2.7 X 36MM 02.211.036
|
Facility
|
OP
|
$1,546.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3265469
|
|
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
|
|
|
SCREW LOCK 2.7 X 36MM 02.211.036
|
Facility
|
IP
|
$1,546.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3265469
|
|
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 38MM 02.211.038
|
Facility
|
OP
|
$1,608.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3265470
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$450.24 |
| Max. Negotiated Rate |
$6,432.00 |
| Rate for Payer: Aetna Commercial |
$1,447.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,382.88
|
| Rate for Payer: Aetna Managed Medicare |
$450.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,045.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$804.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$771.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$852.24
|
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Cigna Commercial |
$1,479.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$899.84
|
| Rate for Payer: Health EOS Commercial |
$1,431.12
|
| Rate for Payer: HFN Commercial |
$1,479.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,206.00
|
| Rate for Payer: Multiplan Commercial |
$1,286.40
|
| Rate for Payer: NAPHCARE Commercial |
$964.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,479.36
|
| Rate for Payer: Quartz Beloit One Network |
$787.92
|
| Rate for Payer: Quartz Commercial |
$1,045.20
|
| Rate for Payer: Quartz Medicare Advantage |
$964.80
|
| Rate for Payer: The Alliance Commercial |
$6,432.00
|
| Rate for Payer: WEA Trust Commercial |
$884.40
|
| Rate for Payer: WPS Commercial |
$1,191.05
|
|
|
SCREW LOCK 2.7 X 38MM 02.211.038
|
Facility
|
IP
|
$1,608.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3265470
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$787.92 |
| Max. Negotiated Rate |
$1,479.36 |
| Rate for Payer: Aetna Commercial |
$1,447.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,382.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$852.24
|
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Cigna Commercial |
$1,479.36
|
| Rate for Payer: Health EOS Commercial |
$1,431.12
|
| Rate for Payer: HFN Commercial |
$1,479.36
|
| Rate for Payer: Multiplan Commercial |
$1,286.40
|
| Rate for Payer: NAPHCARE Commercial |
$964.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,479.36
|
| Rate for Payer: Quartz Beloit One Network |
$787.92
|
| Rate for Payer: Quartz Commercial |
$964.80
|
| Rate for Payer: WEA Trust Commercial |
$884.40
|
| Rate for Payer: WPS Commercial |
$1,191.05
|
|
|
SCREW LOCK 2.7 X 40MM 02.211.040
|
Facility
|
OP
|
$1,608.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3127491
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$450.24 |
| Max. Negotiated Rate |
$6,432.00 |
| Rate for Payer: Aetna Commercial |
$1,447.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,382.88
|
| Rate for Payer: Aetna Managed Medicare |
$450.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,045.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$804.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$771.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$852.24
|
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Cigna Commercial |
$1,479.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$899.84
|
| Rate for Payer: Health EOS Commercial |
$1,431.12
|
| Rate for Payer: HFN Commercial |
$1,479.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,206.00
|
| Rate for Payer: Multiplan Commercial |
$1,286.40
|
| Rate for Payer: NAPHCARE Commercial |
$964.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,479.36
|
| Rate for Payer: Quartz Beloit One Network |
$787.92
|
| Rate for Payer: Quartz Commercial |
$1,045.20
|
| Rate for Payer: Quartz Medicare Advantage |
$964.80
|
| Rate for Payer: The Alliance Commercial |
$6,432.00
|
| Rate for Payer: WEA Trust Commercial |
$884.40
|
| Rate for Payer: WPS Commercial |
$1,191.05
|
|
|
SCREW LOCK 2.7 X 40MM 02.211.040
|
Facility
|
IP
|
$1,608.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3127491
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$787.92 |
| Max. Negotiated Rate |
$1,479.36 |
| Rate for Payer: Aetna Commercial |
$1,447.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,382.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$852.24
|
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Cigna Commercial |
$1,479.36
|
| Rate for Payer: Health EOS Commercial |
$1,431.12
|
| Rate for Payer: HFN Commercial |
$1,479.36
|
| Rate for Payer: Multiplan Commercial |
$1,286.40
|
| Rate for Payer: NAPHCARE Commercial |
$964.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,479.36
|
| Rate for Payer: Quartz Beloit One Network |
$787.92
|
| Rate for Payer: Quartz Commercial |
$964.80
|
| Rate for Payer: WEA Trust Commercial |
$884.40
|
| Rate for Payer: WPS Commercial |
$1,191.05
|
|
|
SCREW LOCK 2.7 X 40 ST 202.240
|
Facility
|
IP
|
$1,846.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966488
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$904.54 |
| Max. Negotiated Rate |
$1,698.32 |
| Rate for Payer: Aetna Commercial |
$1,661.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,587.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$978.38
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Cigna Commercial |
$1,698.32
|
| Rate for Payer: Health EOS Commercial |
$1,642.94
|
| Rate for Payer: HFN Commercial |
$1,698.32
|
| Rate for Payer: Multiplan Commercial |
$1,476.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,107.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,698.32
|
| Rate for Payer: Quartz Beloit One Network |
$904.54
|
| Rate for Payer: Quartz Commercial |
$1,107.60
|
| Rate for Payer: WEA Trust Commercial |
$1,015.30
|
| Rate for Payer: WPS Commercial |
$1,367.33
|
|
|
SCREW LOCK 2.7 X 40 ST 202.240
|
Facility
|
OP
|
$1,846.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966488
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$516.88 |
| Max. Negotiated Rate |
$7,384.00 |
| Rate for Payer: Aetna Commercial |
$1,661.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,587.56
|
| Rate for Payer: Aetna Managed Medicare |
$516.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,199.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$923.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$886.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$978.38
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Cigna Commercial |
$1,698.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,033.02
|
| Rate for Payer: Health EOS Commercial |
$1,642.94
|
| Rate for Payer: HFN Commercial |
$1,698.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,384.50
|
| Rate for Payer: Multiplan Commercial |
$1,476.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,107.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,698.32
|
| Rate for Payer: Quartz Beloit One Network |
$904.54
|
| Rate for Payer: Quartz Commercial |
$1,199.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,107.60
|
| Rate for Payer: The Alliance Commercial |
$7,384.00
|
| Rate for Payer: WEA Trust Commercial |
$1,015.30
|
| Rate for Payer: WPS Commercial |
$1,367.33
|
|
|
SCREW LOCK 2.7 X 42MM 02.211.042
|
Facility
|
OP
|
$1,546.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3265471
|
|
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
|
|
|
SCREW LOCK 2.7 X 42MM 02.211.042
|
Facility
|
IP
|
$1,546.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3265471
|
|
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 44MM 02.211.044
|
Facility
|
IP
|
$1,608.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4028663
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$787.92 |
| Max. Negotiated Rate |
$1,479.36 |
| Rate for Payer: Aetna Commercial |
$1,447.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,382.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$852.24
|
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Cigna Commercial |
$1,479.36
|
| Rate for Payer: Health EOS Commercial |
$1,431.12
|
| Rate for Payer: HFN Commercial |
$1,479.36
|
| Rate for Payer: Multiplan Commercial |
$1,286.40
|
| Rate for Payer: NAPHCARE Commercial |
$964.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,479.36
|
| Rate for Payer: Quartz Beloit One Network |
$787.92
|
| Rate for Payer: Quartz Commercial |
$964.80
|
| Rate for Payer: WEA Trust Commercial |
$884.40
|
| Rate for Payer: WPS Commercial |
$1,191.05
|
|
