|
SCREW LOCK 4.5 X 18MM LP TI AR-8545L-18
|
Facility
|
OP
|
$2,596.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5603787
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$726.88 |
| Max. Negotiated Rate |
$10,384.00 |
| Rate for Payer: Aetna Commercial |
$2,336.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,232.56
|
| Rate for Payer: Aetna Managed Medicare |
$726.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,687.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,298.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,246.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,375.88
|
| Rate for Payer: Cash Price |
$778.80
|
| Rate for Payer: Cigna Commercial |
$2,388.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,452.72
|
| Rate for Payer: Health EOS Commercial |
$2,310.44
|
| Rate for Payer: HFN Commercial |
$2,388.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,947.00
|
| Rate for Payer: Multiplan Commercial |
$2,076.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,557.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,388.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,272.04
|
| Rate for Payer: Quartz Commercial |
$1,687.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,557.60
|
| Rate for Payer: The Alliance Commercial |
$10,384.00
|
| Rate for Payer: WEA Trust Commercial |
$1,427.80
|
| Rate for Payer: WPS Commercial |
$1,922.86
|
|
|
SCREW LOCK 4.5 X 18MM LP TI AR-8545L-18
|
Facility
|
IP
|
$2,596.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5603787
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,272.04 |
| Max. Negotiated Rate |
$2,388.32 |
| Rate for Payer: Aetna Commercial |
$2,336.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,232.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,375.88
|
| Rate for Payer: Cash Price |
$778.80
|
| Rate for Payer: Cigna Commercial |
$2,388.32
|
| Rate for Payer: Health EOS Commercial |
$2,310.44
|
| Rate for Payer: HFN Commercial |
$2,388.32
|
| Rate for Payer: Multiplan Commercial |
$2,076.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,557.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,388.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,272.04
|
| Rate for Payer: Quartz Commercial |
$1,557.60
|
| Rate for Payer: WEA Trust Commercial |
$1,427.80
|
| Rate for Payer: WPS Commercial |
$1,922.86
|
|
|
SCREW LOCK 4.5 X 20MM LP TI AR-8545L-20
|
Facility
|
OP
|
$2,496.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5803658
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$698.88 |
| Max. Negotiated Rate |
$9,984.00 |
| Rate for Payer: Aetna Commercial |
$2,246.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,146.56
|
| Rate for Payer: Aetna Managed Medicare |
$698.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,622.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,248.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,198.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,322.88
|
| Rate for Payer: Cash Price |
$748.80
|
| Rate for Payer: Cigna Commercial |
$2,296.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,396.76
|
| Rate for Payer: Health EOS Commercial |
$2,221.44
|
| Rate for Payer: HFN Commercial |
$2,296.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,872.00
|
| Rate for Payer: Multiplan Commercial |
$1,996.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,497.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,296.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,223.04
|
| Rate for Payer: Quartz Commercial |
$1,622.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,497.60
|
| Rate for Payer: The Alliance Commercial |
$9,984.00
|
| Rate for Payer: WEA Trust Commercial |
$1,372.80
|
| Rate for Payer: WPS Commercial |
$1,848.79
|
|
|
SCREW LOCK 4.5 X 20MM LP TI AR-8545L-20
|
Facility
|
IP
|
$2,496.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5803658
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,223.04 |
| Max. Negotiated Rate |
$2,296.32 |
| Rate for Payer: Aetna Commercial |
$2,246.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,146.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,322.88
|
| Rate for Payer: Cash Price |
$748.80
|
| Rate for Payer: Cigna Commercial |
$2,296.32
|
| Rate for Payer: Health EOS Commercial |
$2,221.44
|
| Rate for Payer: HFN Commercial |
$2,296.32
|
| Rate for Payer: Multiplan Commercial |
$1,996.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,497.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,296.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,223.04
|
| Rate for Payer: Quartz Commercial |
$1,497.60
|
| Rate for Payer: WEA Trust Commercial |
$1,372.80
|
| Rate for Payer: WPS Commercial |
$1,848.79
|
|
|
SCREW LOCK 4.5 X 22MM LP TI AR-8545L-22
|
Facility
|
IP
|
$2,496.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5803659
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,223.04 |
| Max. Negotiated Rate |
$2,296.32 |
| Rate for Payer: Aetna Commercial |
$2,246.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,146.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,322.88
|
| Rate for Payer: Cash Price |
$748.80
|
| Rate for Payer: Cigna Commercial |
$2,296.32
|
| Rate for Payer: Health EOS Commercial |
$2,221.44
|
| Rate for Payer: HFN Commercial |
$2,296.32
|
| Rate for Payer: Multiplan Commercial |
$1,996.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,497.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,296.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,223.04
|
| Rate for Payer: Quartz Commercial |
$1,497.60
|
| Rate for Payer: WEA Trust Commercial |
$1,372.80
|
| Rate for Payer: WPS Commercial |
$1,848.79
|
|
|
SCREW LOCK 4.5 X 22MM LP TI AR-8545L-22
|
Facility
|
OP
|
$2,496.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5803659
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$698.88 |
| Max. Negotiated Rate |
$9,984.00 |
| Rate for Payer: Aetna Commercial |
$2,246.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,146.56
|
| Rate for Payer: Aetna Managed Medicare |
$698.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,622.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,248.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,198.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,322.88
|
| Rate for Payer: Cash Price |
$748.80
|
| Rate for Payer: Cigna Commercial |
$2,296.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,396.76
|
| Rate for Payer: Health EOS Commercial |
$2,221.44
|
| Rate for Payer: HFN Commercial |
$2,296.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,872.00
|
| Rate for Payer: Multiplan Commercial |
$1,996.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,497.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,296.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,223.04
|
| Rate for Payer: Quartz Commercial |
$1,622.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,497.60
|
| Rate for Payer: The Alliance Commercial |
$9,984.00
|
| Rate for Payer: WEA Trust Commercial |
$1,372.80
|
| Rate for Payer: WPS Commercial |
$1,848.79
|
|
|
SCREW LOCK 4.5 X 24MM LP TI AR-8545L-24
|
Facility
|
IP
|
$2,596.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5603788
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,272.04 |
| Max. Negotiated Rate |
$2,388.32 |
| Rate for Payer: Aetna Commercial |
$2,336.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,232.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,375.88
|
| Rate for Payer: Cash Price |
$778.80
|
| Rate for Payer: Cigna Commercial |
$2,388.32
|
| Rate for Payer: Health EOS Commercial |
$2,310.44
|
| Rate for Payer: HFN Commercial |
$2,388.32
|
| Rate for Payer: Multiplan Commercial |
$2,076.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,557.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,388.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,272.04
|
| Rate for Payer: Quartz Commercial |
$1,557.60
|
| Rate for Payer: WEA Trust Commercial |
$1,427.80
|
| Rate for Payer: WPS Commercial |
$1,922.86
|
|
|
SCREW LOCK 4.5 X 24MM LP TI AR-8545L-24
|
Facility
|
OP
|
$2,596.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5603788
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$726.88 |
| Max. Negotiated Rate |
$10,384.00 |
| Rate for Payer: Aetna Commercial |
$2,336.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,232.56
|
| Rate for Payer: Aetna Managed Medicare |
$726.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,687.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,298.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,246.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,375.88
|
| Rate for Payer: Cash Price |
$778.80
|
| Rate for Payer: Cigna Commercial |
$2,388.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,452.72
|
| Rate for Payer: Health EOS Commercial |
$2,310.44
|
| Rate for Payer: HFN Commercial |
$2,388.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,947.00
|
| Rate for Payer: Multiplan Commercial |
$2,076.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,557.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,388.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,272.04
|
| Rate for Payer: Quartz Commercial |
$1,687.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,557.60
|
| Rate for Payer: The Alliance Commercial |
$10,384.00
|
| Rate for Payer: WEA Trust Commercial |
$1,427.80
|
| Rate for Payer: WPS Commercial |
$1,922.86
|
|
|
SCREW LOCK 4.5 X 26MM LP TI AR-8545L-26
|
Facility
|
IP
|
$2,496.00
|
|
|
Service Code
|
HCPCS C1715
|
| Hospital Charge Code |
5803660
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,223.04 |
| Max. Negotiated Rate |
$2,296.32 |
| Rate for Payer: Aetna Commercial |
$2,246.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,146.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,322.88
|
| Rate for Payer: Cash Price |
$748.80
|
| Rate for Payer: Cigna Commercial |
$2,296.32
|
| Rate for Payer: Health EOS Commercial |
$2,221.44
|
| Rate for Payer: HFN Commercial |
$2,296.32
|
| Rate for Payer: Multiplan Commercial |
$1,996.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,497.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,296.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,223.04
|
| Rate for Payer: Quartz Commercial |
$1,497.60
|
| Rate for Payer: WEA Trust Commercial |
$1,372.80
|
| Rate for Payer: WPS Commercial |
$1,848.79
|
|
|
SCREW LOCK 4.5 X 26MM LP TI AR-8545L-26
|
Facility
|
OP
|
$2,496.00
|
|
|
Service Code
|
HCPCS C1715
|
| Hospital Charge Code |
5803660
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$698.88 |
| Max. Negotiated Rate |
$9,984.00 |
| Rate for Payer: Aetna Commercial |
$2,246.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,146.56
|
| Rate for Payer: Aetna Managed Medicare |
$698.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,622.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,248.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,198.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,322.88
|
| Rate for Payer: Cash Price |
$748.80
|
| Rate for Payer: Cigna Commercial |
$2,296.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,396.76
|
| Rate for Payer: Health EOS Commercial |
$2,221.44
|
| Rate for Payer: HFN Commercial |
$2,296.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,872.00
|
| Rate for Payer: Multiplan Commercial |
$1,996.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,497.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,296.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,223.04
|
| Rate for Payer: Quartz Commercial |
$1,622.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,497.60
|
| Rate for Payer: The Alliance Commercial |
$9,984.00
|
| Rate for Payer: WEA Trust Commercial |
$1,372.80
|
| Rate for Payer: WPS Commercial |
$1,848.79
|
|
|
SCREW LOCK 4.5 X 28MM LP TI AR-8545L-28
|
Facility
|
OP
|
$2,596.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5603789
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$726.88 |
| Max. Negotiated Rate |
$10,384.00 |
| Rate for Payer: Aetna Commercial |
$2,336.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,232.56
|
| Rate for Payer: Aetna Managed Medicare |
$726.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,687.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,298.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,246.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,375.88
|
| Rate for Payer: Cash Price |
$778.80
|
| Rate for Payer: Cigna Commercial |
$2,388.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,452.72
|
| Rate for Payer: Health EOS Commercial |
$2,310.44
|
| Rate for Payer: HFN Commercial |
$2,388.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,947.00
|
| Rate for Payer: Multiplan Commercial |
$2,076.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,557.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,388.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,272.04
|
| Rate for Payer: Quartz Commercial |
$1,687.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,557.60
|
| Rate for Payer: The Alliance Commercial |
$10,384.00
|
| Rate for Payer: WEA Trust Commercial |
$1,427.80
|
| Rate for Payer: WPS Commercial |
$1,922.86
|
|
|
SCREW LOCK 4.5 X 28MM LP TI AR-8545L-28
|
Facility
|
IP
|
$2,596.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5603789
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,272.04 |
| Max. Negotiated Rate |
$2,388.32 |
| Rate for Payer: Aetna Commercial |
$2,336.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,232.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,375.88
|
| Rate for Payer: Cash Price |
$778.80
|
| Rate for Payer: Cigna Commercial |
$2,388.32
|
| Rate for Payer: Health EOS Commercial |
$2,310.44
|
| Rate for Payer: HFN Commercial |
$2,388.32
|
| Rate for Payer: Multiplan Commercial |
$2,076.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,557.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,388.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,272.04
|
| Rate for Payer: Quartz Commercial |
$1,557.60
|
| Rate for Payer: WEA Trust Commercial |
$1,427.80
|
| Rate for Payer: WPS Commercial |
$1,922.86
|
|
|
SCREW LOCK 4.5 X 30MM LP TI AR-8545L-30
|
Facility
|
IP
|
$2,496.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5803661
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,223.04 |
| Max. Negotiated Rate |
$2,296.32 |
| Rate for Payer: Aetna Commercial |
$2,246.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,146.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,322.88
|
| Rate for Payer: Cash Price |
$748.80
|
| Rate for Payer: Cigna Commercial |
$2,296.32
|
| Rate for Payer: Health EOS Commercial |
$2,221.44
|
| Rate for Payer: HFN Commercial |
$2,296.32
|
| Rate for Payer: Multiplan Commercial |
$1,996.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,497.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,296.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,223.04
|
| Rate for Payer: Quartz Commercial |
$1,497.60
|
| Rate for Payer: WEA Trust Commercial |
$1,372.80
|
| Rate for Payer: WPS Commercial |
$1,848.79
|
|
|
SCREW LOCK 4.5 X 30MM LP TI AR-8545L-30
|
Facility
|
OP
|
$2,496.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5803661
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$698.88 |
| Max. Negotiated Rate |
$9,984.00 |
| Rate for Payer: Aetna Commercial |
$2,246.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,146.56
|
| Rate for Payer: Aetna Managed Medicare |
$698.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,622.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,248.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,198.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,322.88
|
| Rate for Payer: Cash Price |
$748.80
|
| Rate for Payer: Cigna Commercial |
$2,296.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,396.76
|
| Rate for Payer: Health EOS Commercial |
$2,221.44
|
| Rate for Payer: HFN Commercial |
$2,296.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,872.00
|
| Rate for Payer: Multiplan Commercial |
$1,996.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,497.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,296.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,223.04
|
| Rate for Payer: Quartz Commercial |
$1,622.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,497.60
|
| Rate for Payer: The Alliance Commercial |
$9,984.00
|
| Rate for Payer: WEA Trust Commercial |
$1,372.80
|
| Rate for Payer: WPS Commercial |
$1,848.79
|
|
|
SCREW LOCK 4.5 X 32MM LP TI AR-8545L-32
|
Facility
|
IP
|
$2,496.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5803662
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,223.04 |
| Max. Negotiated Rate |
$2,296.32 |
| Rate for Payer: Aetna Commercial |
$2,246.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,146.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,322.88
|
| Rate for Payer: Cash Price |
$748.80
|
| Rate for Payer: Cigna Commercial |
$2,296.32
|
| Rate for Payer: Health EOS Commercial |
$2,221.44
|
| Rate for Payer: HFN Commercial |
$2,296.32
|
| Rate for Payer: Multiplan Commercial |
$1,996.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,497.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,296.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,223.04
|
| Rate for Payer: Quartz Commercial |
$1,497.60
|
| Rate for Payer: WEA Trust Commercial |
$1,372.80
|
| Rate for Payer: WPS Commercial |
$1,848.79
|
|
|
SCREW LOCK 4.5 X 32MM LP TI AR-8545L-32
|
Facility
|
OP
|
$2,496.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5803662
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$698.88 |
| Max. Negotiated Rate |
$9,984.00 |
| Rate for Payer: Aetna Commercial |
$2,246.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,146.56
|
| Rate for Payer: Aetna Managed Medicare |
$698.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,622.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,248.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,198.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,322.88
|
| Rate for Payer: Cash Price |
$748.80
|
| Rate for Payer: Cigna Commercial |
$2,296.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,396.76
|
| Rate for Payer: Health EOS Commercial |
$2,221.44
|
| Rate for Payer: HFN Commercial |
$2,296.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,872.00
|
| Rate for Payer: Multiplan Commercial |
$1,996.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,497.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,296.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,223.04
|
| Rate for Payer: Quartz Commercial |
$1,622.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,497.60
|
| Rate for Payer: The Alliance Commercial |
$9,984.00
|
| Rate for Payer: WEA Trust Commercial |
$1,372.80
|
| Rate for Payer: WPS Commercial |
$1,848.79
|
|
|
SCREW LOCK 4.5 X 34MM LP TI AR-8545L-34
|
Facility
|
IP
|
$2,496.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5803663
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,223.04 |
| Max. Negotiated Rate |
$2,296.32 |
| Rate for Payer: Aetna Commercial |
$2,246.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,146.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,322.88
|
| Rate for Payer: Cash Price |
$748.80
|
| Rate for Payer: Cigna Commercial |
$2,296.32
|
| Rate for Payer: Health EOS Commercial |
$2,221.44
|
| Rate for Payer: HFN Commercial |
$2,296.32
|
| Rate for Payer: Multiplan Commercial |
$1,996.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,497.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,296.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,223.04
|
| Rate for Payer: Quartz Commercial |
$1,497.60
|
| Rate for Payer: WEA Trust Commercial |
$1,372.80
|
| Rate for Payer: WPS Commercial |
$1,848.79
|
|
|
SCREW LOCK 4.5 X 34MM LP TI AR-8545L-34
|
Facility
|
OP
|
$2,496.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5803663
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$698.88 |
| Max. Negotiated Rate |
$9,984.00 |
| Rate for Payer: Aetna Commercial |
$2,246.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,146.56
|
| Rate for Payer: Aetna Managed Medicare |
$698.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,622.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,248.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,198.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,322.88
|
| Rate for Payer: Cash Price |
$748.80
|
| Rate for Payer: Cigna Commercial |
$2,296.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,396.76
|
| Rate for Payer: Health EOS Commercial |
$2,221.44
|
| Rate for Payer: HFN Commercial |
$2,296.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,872.00
|
| Rate for Payer: Multiplan Commercial |
$1,996.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,497.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,296.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,223.04
|
| Rate for Payer: Quartz Commercial |
$1,622.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,497.60
|
| Rate for Payer: The Alliance Commercial |
$9,984.00
|
| Rate for Payer: WEA Trust Commercial |
$1,372.80
|
| Rate for Payer: WPS Commercial |
$1,848.79
|
|
|
SCREW LOCK 4.5 X 36MM LP TI AR-8545L-36
|
Facility
|
OP
|
$2,596.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5603790
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$726.88 |
| Max. Negotiated Rate |
$10,384.00 |
| Rate for Payer: Aetna Commercial |
$2,336.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,232.56
|
| Rate for Payer: Aetna Managed Medicare |
$726.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,687.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,298.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,246.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,375.88
|
| Rate for Payer: Cash Price |
$778.80
|
| Rate for Payer: Cigna Commercial |
$2,388.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,452.72
|
| Rate for Payer: Health EOS Commercial |
$2,310.44
|
| Rate for Payer: HFN Commercial |
$2,388.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,947.00
|
| Rate for Payer: Multiplan Commercial |
$2,076.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,557.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,388.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,272.04
|
| Rate for Payer: Quartz Commercial |
$1,687.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,557.60
|
| Rate for Payer: The Alliance Commercial |
$10,384.00
|
| Rate for Payer: WEA Trust Commercial |
$1,427.80
|
| Rate for Payer: WPS Commercial |
$1,922.86
|
|
|
SCREW LOCK 4.5 X 36MM LP TI AR-8545L-36
|
Facility
|
IP
|
$2,596.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5603790
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,272.04 |
| Max. Negotiated Rate |
$2,388.32 |
| Rate for Payer: Aetna Commercial |
$2,336.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,232.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,375.88
|
| Rate for Payer: Cash Price |
$778.80
|
| Rate for Payer: Cigna Commercial |
$2,388.32
|
| Rate for Payer: Health EOS Commercial |
$2,310.44
|
| Rate for Payer: HFN Commercial |
$2,388.32
|
| Rate for Payer: Multiplan Commercial |
$2,076.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,557.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,388.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,272.04
|
| Rate for Payer: Quartz Commercial |
$1,557.60
|
| Rate for Payer: WEA Trust Commercial |
$1,427.80
|
| Rate for Payer: WPS Commercial |
$1,922.86
|
|
|
SCREW LOCK 4.5 X 38MM LP TI AR-8545L-38
|
Facility
|
OP
|
$2,496.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5803664
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$698.88 |
| Max. Negotiated Rate |
$9,984.00 |
| Rate for Payer: Aetna Commercial |
$2,246.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,146.56
|
| Rate for Payer: Aetna Managed Medicare |
$698.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,622.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,248.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,198.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,322.88
|
| Rate for Payer: Cash Price |
$748.80
|
| Rate for Payer: Cigna Commercial |
$2,296.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,396.76
|
| Rate for Payer: Health EOS Commercial |
$2,221.44
|
| Rate for Payer: HFN Commercial |
$2,296.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,872.00
|
| Rate for Payer: Multiplan Commercial |
$1,996.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,497.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,296.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,223.04
|
| Rate for Payer: Quartz Commercial |
$1,622.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,497.60
|
| Rate for Payer: The Alliance Commercial |
$9,984.00
|
| Rate for Payer: WEA Trust Commercial |
$1,372.80
|
| Rate for Payer: WPS Commercial |
$1,848.79
|
|
|
SCREW LOCK 4.5 X 38MM LP TI AR-8545L-38
|
Facility
|
IP
|
$2,496.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5803664
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,223.04 |
| Max. Negotiated Rate |
$2,296.32 |
| Rate for Payer: Aetna Commercial |
$2,246.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,146.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,322.88
|
| Rate for Payer: Cash Price |
$748.80
|
| Rate for Payer: Cigna Commercial |
$2,296.32
|
| Rate for Payer: Health EOS Commercial |
$2,221.44
|
| Rate for Payer: HFN Commercial |
$2,296.32
|
| Rate for Payer: Multiplan Commercial |
$1,996.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,497.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,296.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,223.04
|
| Rate for Payer: Quartz Commercial |
$1,497.60
|
| Rate for Payer: WEA Trust Commercial |
$1,372.80
|
| Rate for Payer: WPS Commercial |
$1,848.79
|
|
|
SCREW LOCK 4.5 X 40MM LP TI AR-8545L-40
|
Facility
|
OP
|
$2,496.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5803665
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$698.88 |
| Max. Negotiated Rate |
$9,984.00 |
| Rate for Payer: Aetna Commercial |
$2,246.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,146.56
|
| Rate for Payer: Aetna Managed Medicare |
$698.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,622.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,248.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,198.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,322.88
|
| Rate for Payer: Cash Price |
$748.80
|
| Rate for Payer: Cigna Commercial |
$2,296.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,396.76
|
| Rate for Payer: Health EOS Commercial |
$2,221.44
|
| Rate for Payer: HFN Commercial |
$2,296.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,872.00
|
| Rate for Payer: Multiplan Commercial |
$1,996.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,497.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,296.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,223.04
|
| Rate for Payer: Quartz Commercial |
$1,622.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,497.60
|
| Rate for Payer: The Alliance Commercial |
$9,984.00
|
| Rate for Payer: WEA Trust Commercial |
$1,372.80
|
| Rate for Payer: WPS Commercial |
$1,848.79
|
|
|
SCREW LOCK 4.5 X 40MM LP TI AR-8545L-40
|
Facility
|
IP
|
$2,496.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5803665
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,223.04 |
| Max. Negotiated Rate |
$2,296.32 |
| Rate for Payer: Aetna Commercial |
$2,246.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,146.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,322.88
|
| Rate for Payer: Cash Price |
$748.80
|
| Rate for Payer: Cigna Commercial |
$2,296.32
|
| Rate for Payer: Health EOS Commercial |
$2,221.44
|
| Rate for Payer: HFN Commercial |
$2,296.32
|
| Rate for Payer: Multiplan Commercial |
$1,996.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,497.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,296.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,223.04
|
| Rate for Payer: Quartz Commercial |
$1,497.60
|
| Rate for Payer: WEA Trust Commercial |
$1,372.80
|
| Rate for Payer: WPS Commercial |
$1,848.79
|
|
|
SCREW LOCK 4.5 X 42MM LP TI AR-8545L-42
|
Facility
|
OP
|
$2,496.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5803666
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$698.88 |
| Max. Negotiated Rate |
$9,984.00 |
| Rate for Payer: Aetna Commercial |
$2,246.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,146.56
|
| Rate for Payer: Aetna Managed Medicare |
$698.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,622.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,248.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,198.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,322.88
|
| Rate for Payer: Cash Price |
$748.80
|
| Rate for Payer: Cigna Commercial |
$2,296.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,396.76
|
| Rate for Payer: Health EOS Commercial |
$2,221.44
|
| Rate for Payer: HFN Commercial |
$2,296.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,872.00
|
| Rate for Payer: Multiplan Commercial |
$1,996.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,497.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,296.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,223.04
|
| Rate for Payer: Quartz Commercial |
$1,622.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,497.60
|
| Rate for Payer: The Alliance Commercial |
$9,984.00
|
| Rate for Payer: WEA Trust Commercial |
$1,372.80
|
| Rate for Payer: WPS Commercial |
$1,848.79
|
|
