|
SCREW LOCK 4.5 X 42MM LP TI AR-8545L-42
|
Facility
|
IP
|
$2,496.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5803666
|
|
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 44MM LP TI AR-8545L-44
|
Facility
|
IP
|
$2,496.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5803667
|
|
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 44MM LP TI AR-8545L-44
|
Facility
|
OP
|
$2,496.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5803667
|
|
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 5.0 X 100 FULL THREAD 1896-5100S
|
Facility
|
IP
|
$1,882.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508997
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$922.18 |
| Max. Negotiated Rate |
$1,731.44 |
| Rate for Payer: Aetna Commercial |
$1,693.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,618.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$997.46
|
| Rate for Payer: Cash Price |
$564.60
|
| Rate for Payer: Cigna Commercial |
$1,731.44
|
| Rate for Payer: Health EOS Commercial |
$1,674.98
|
| Rate for Payer: HFN Commercial |
$1,731.44
|
| Rate for Payer: Multiplan Commercial |
$1,505.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,129.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,731.44
|
| Rate for Payer: Quartz Beloit One Network |
$922.18
|
| Rate for Payer: Quartz Commercial |
$1,129.20
|
| Rate for Payer: WEA Trust Commercial |
$1,035.10
|
| Rate for Payer: WPS Commercial |
$1,394.00
|
|
|
SCREW LOCK 5.0 X 100 FULL THREAD 1896-5100S
|
Facility
|
OP
|
$1,882.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508997
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$526.96 |
| Max. Negotiated Rate |
$7,528.00 |
| Rate for Payer: Aetna Commercial |
$1,693.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,618.52
|
| Rate for Payer: Aetna Managed Medicare |
$526.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,223.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$941.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$903.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$997.46
|
| Rate for Payer: Cash Price |
$564.60
|
| Rate for Payer: Cigna Commercial |
$1,731.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,053.17
|
| Rate for Payer: Health EOS Commercial |
$1,674.98
|
| Rate for Payer: HFN Commercial |
$1,731.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,411.50
|
| Rate for Payer: Multiplan Commercial |
$1,505.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,129.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,731.44
|
| Rate for Payer: Quartz Beloit One Network |
$922.18
|
| Rate for Payer: Quartz Commercial |
$1,223.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,129.20
|
| Rate for Payer: The Alliance Commercial |
$7,528.00
|
| Rate for Payer: WEA Trust Commercial |
$1,035.10
|
| Rate for Payer: WPS Commercial |
$1,394.00
|
|
|
SCREW-LOCK 5.0 X 100 TFN 458.999
|
Facility
|
IP
|
$2,724.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966950
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,334.76 |
| Max. Negotiated Rate |
$2,506.08 |
| Rate for Payer: Aetna Commercial |
$2,451.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,342.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,443.72
|
| Rate for Payer: Cash Price |
$817.20
|
| Rate for Payer: Cigna Commercial |
$2,506.08
|
| Rate for Payer: Health EOS Commercial |
$2,424.36
|
| Rate for Payer: HFN Commercial |
$2,506.08
|
| Rate for Payer: Multiplan Commercial |
$2,179.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,634.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,506.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,334.76
|
| Rate for Payer: Quartz Commercial |
$1,634.40
|
| Rate for Payer: WEA Trust Commercial |
$1,498.20
|
| Rate for Payer: WPS Commercial |
$2,017.67
|
|
|
SCREW-LOCK 5.0 X 100 TFN 458.999
|
Facility
|
OP
|
$2,724.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966950
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$762.72 |
| Max. Negotiated Rate |
$10,896.00 |
| Rate for Payer: Aetna Commercial |
$2,451.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,342.64
|
| Rate for Payer: Aetna Managed Medicare |
$762.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,770.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,362.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,307.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,443.72
|
| Rate for Payer: Cash Price |
$817.20
|
| Rate for Payer: Cigna Commercial |
$2,506.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,524.35
|
| Rate for Payer: Health EOS Commercial |
$2,424.36
|
| Rate for Payer: HFN Commercial |
$2,506.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,043.00
|
| Rate for Payer: Multiplan Commercial |
$2,179.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,634.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,506.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,334.76
|
| Rate for Payer: Quartz Commercial |
$1,770.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,634.40
|
| Rate for Payer: The Alliance Commercial |
$10,896.00
|
| Rate for Payer: WEA Trust Commercial |
$1,498.20
|
| Rate for Payer: WPS Commercial |
$2,017.67
|
|
|
SCREW LOCK 5.0 X 105 FULL THREAD 1896-5105S
|
Facility
|
OP
|
$1,882.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508998
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$526.96 |
| Max. Negotiated Rate |
$7,528.00 |
| Rate for Payer: Aetna Commercial |
$1,693.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,618.52
|
| Rate for Payer: Aetna Managed Medicare |
$526.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,223.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$941.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$903.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$997.46
|
| Rate for Payer: Cash Price |
$564.60
|
| Rate for Payer: Cigna Commercial |
$1,731.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,053.17
|
| Rate for Payer: Health EOS Commercial |
$1,674.98
|
| Rate for Payer: HFN Commercial |
$1,731.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,411.50
|
| Rate for Payer: Multiplan Commercial |
$1,505.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,129.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,731.44
|
| Rate for Payer: Quartz Beloit One Network |
$922.18
|
| Rate for Payer: Quartz Commercial |
$1,223.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,129.20
|
| Rate for Payer: The Alliance Commercial |
$7,528.00
|
| Rate for Payer: WEA Trust Commercial |
$1,035.10
|
| Rate for Payer: WPS Commercial |
$1,394.00
|
|
|
SCREW LOCK 5.0 X 105 FULL THREAD 1896-5105S
|
Facility
|
IP
|
$1,882.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508998
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$922.18 |
| Max. Negotiated Rate |
$1,731.44 |
| Rate for Payer: Aetna Commercial |
$1,693.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,618.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$997.46
|
| Rate for Payer: Cash Price |
$564.60
|
| Rate for Payer: Cigna Commercial |
$1,731.44
|
| Rate for Payer: Health EOS Commercial |
$1,674.98
|
| Rate for Payer: HFN Commercial |
$1,731.44
|
| Rate for Payer: Multiplan Commercial |
$1,505.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,129.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,731.44
|
| Rate for Payer: Quartz Beloit One Network |
$922.18
|
| Rate for Payer: Quartz Commercial |
$1,129.20
|
| Rate for Payer: WEA Trust Commercial |
$1,035.10
|
| Rate for Payer: WPS Commercial |
$1,394.00
|
|
|
SCREW LOCK 5.0 X 10MM PERI 02.231.010
|
Facility
|
IP
|
$2,333.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5799778
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,143.17 |
| Max. Negotiated Rate |
$2,146.36 |
| Rate for Payer: Aetna Commercial |
$2,099.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,006.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,236.49
|
| Rate for Payer: Cash Price |
$699.90
|
| Rate for Payer: Cigna Commercial |
$2,146.36
|
| Rate for Payer: Health EOS Commercial |
$2,076.37
|
| Rate for Payer: HFN Commercial |
$2,146.36
|
| Rate for Payer: Multiplan Commercial |
$1,866.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,399.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,146.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,143.17
|
| Rate for Payer: Quartz Commercial |
$1,399.80
|
| Rate for Payer: WEA Trust Commercial |
$1,283.15
|
| Rate for Payer: WPS Commercial |
$1,728.05
|
|
|
SCREW LOCK 5.0 X 10MM PERI 02.231.010
|
Facility
|
OP
|
$2,333.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5799778
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$653.24 |
| Max. Negotiated Rate |
$9,332.00 |
| Rate for Payer: Aetna Commercial |
$2,099.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,006.38
|
| Rate for Payer: Aetna Managed Medicare |
$653.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,516.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,166.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,119.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,236.49
|
| Rate for Payer: Cash Price |
$699.90
|
| Rate for Payer: Cigna Commercial |
$2,146.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,305.55
|
| Rate for Payer: Health EOS Commercial |
$2,076.37
|
| Rate for Payer: HFN Commercial |
$2,146.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,749.75
|
| Rate for Payer: Multiplan Commercial |
$1,866.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,399.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,146.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,143.17
|
| Rate for Payer: Quartz Commercial |
$1,516.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,399.80
|
| Rate for Payer: The Alliance Commercial |
$9,332.00
|
| Rate for Payer: WEA Trust Commercial |
$1,283.15
|
| Rate for Payer: WPS Commercial |
$1,728.05
|
|
|
SCREW LOCK 5.0 X 110 FULL THREAD 1896-5110S
|
Facility
|
IP
|
$1,882.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508999
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$922.18 |
| Max. Negotiated Rate |
$1,731.44 |
| Rate for Payer: Aetna Commercial |
$1,693.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,618.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$997.46
|
| Rate for Payer: Cash Price |
$564.60
|
| Rate for Payer: Cigna Commercial |
$1,731.44
|
| Rate for Payer: Health EOS Commercial |
$1,674.98
|
| Rate for Payer: HFN Commercial |
$1,731.44
|
| Rate for Payer: Multiplan Commercial |
$1,505.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,129.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,731.44
|
| Rate for Payer: Quartz Beloit One Network |
$922.18
|
| Rate for Payer: Quartz Commercial |
$1,129.20
|
| Rate for Payer: WEA Trust Commercial |
$1,035.10
|
| Rate for Payer: WPS Commercial |
$1,394.00
|
|
|
SCREW LOCK 5.0 X 110 FULL THREAD 1896-5110S
|
Facility
|
OP
|
$1,882.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508999
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$526.96 |
| Max. Negotiated Rate |
$7,528.00 |
| Rate for Payer: Aetna Commercial |
$1,693.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,618.52
|
| Rate for Payer: Aetna Managed Medicare |
$526.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,223.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$941.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$903.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$997.46
|
| Rate for Payer: Cash Price |
$564.60
|
| Rate for Payer: Cigna Commercial |
$1,731.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,053.17
|
| Rate for Payer: Health EOS Commercial |
$1,674.98
|
| Rate for Payer: HFN Commercial |
$1,731.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,411.50
|
| Rate for Payer: Multiplan Commercial |
$1,505.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,129.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,731.44
|
| Rate for Payer: Quartz Beloit One Network |
$922.18
|
| Rate for Payer: Quartz Commercial |
$1,223.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,129.20
|
| Rate for Payer: The Alliance Commercial |
$7,528.00
|
| Rate for Payer: WEA Trust Commercial |
$1,035.10
|
| Rate for Payer: WPS Commercial |
$1,394.00
|
|
|
SCREW LOCK 5.0 X 115 FULL THREAD 1896-5115S
|
Facility
|
OP
|
$1,882.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4509000
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$526.96 |
| Max. Negotiated Rate |
$7,528.00 |
| Rate for Payer: Aetna Commercial |
$1,693.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,618.52
|
| Rate for Payer: Aetna Managed Medicare |
$526.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,223.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$941.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$903.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$997.46
|
| Rate for Payer: Cash Price |
$564.60
|
| Rate for Payer: Cigna Commercial |
$1,731.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,053.17
|
| Rate for Payer: Health EOS Commercial |
$1,674.98
|
| Rate for Payer: HFN Commercial |
$1,731.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,411.50
|
| Rate for Payer: Multiplan Commercial |
$1,505.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,129.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,731.44
|
| Rate for Payer: Quartz Beloit One Network |
$922.18
|
| Rate for Payer: Quartz Commercial |
$1,223.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,129.20
|
| Rate for Payer: The Alliance Commercial |
$7,528.00
|
| Rate for Payer: WEA Trust Commercial |
$1,035.10
|
| Rate for Payer: WPS Commercial |
$1,394.00
|
|
|
SCREW LOCK 5.0 X 115 FULL THREAD 1896-5115S
|
Facility
|
IP
|
$1,882.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4509000
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$922.18 |
| Max. Negotiated Rate |
$1,731.44 |
| Rate for Payer: Aetna Commercial |
$1,693.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,618.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$997.46
|
| Rate for Payer: Cash Price |
$564.60
|
| Rate for Payer: Cigna Commercial |
$1,731.44
|
| Rate for Payer: Health EOS Commercial |
$1,674.98
|
| Rate for Payer: HFN Commercial |
$1,731.44
|
| Rate for Payer: Multiplan Commercial |
$1,505.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,129.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,731.44
|
| Rate for Payer: Quartz Beloit One Network |
$922.18
|
| Rate for Payer: Quartz Commercial |
$1,129.20
|
| Rate for Payer: WEA Trust Commercial |
$1,035.10
|
| Rate for Payer: WPS Commercial |
$1,394.00
|
|
|
SCREW LOCK 5.0 X 120 FULL THREAD 1896-5120S
|
Facility
|
OP
|
$1,882.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4509001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$526.96 |
| Max. Negotiated Rate |
$7,528.00 |
| Rate for Payer: Aetna Commercial |
$1,693.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,618.52
|
| Rate for Payer: Aetna Managed Medicare |
$526.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,223.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$941.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$903.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$997.46
|
| Rate for Payer: Cash Price |
$564.60
|
| Rate for Payer: Cigna Commercial |
$1,731.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,053.17
|
| Rate for Payer: Health EOS Commercial |
$1,674.98
|
| Rate for Payer: HFN Commercial |
$1,731.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,411.50
|
| Rate for Payer: Multiplan Commercial |
$1,505.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,129.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,731.44
|
| Rate for Payer: Quartz Beloit One Network |
$922.18
|
| Rate for Payer: Quartz Commercial |
$1,223.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,129.20
|
| Rate for Payer: The Alliance Commercial |
$7,528.00
|
| Rate for Payer: WEA Trust Commercial |
$1,035.10
|
| Rate for Payer: WPS Commercial |
$1,394.00
|
|
|
SCREW LOCK 5.0 X 120 FULL THREAD 1896-5120S
|
Facility
|
IP
|
$1,882.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4509001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$922.18 |
| Max. Negotiated Rate |
$1,731.44 |
| Rate for Payer: Aetna Commercial |
$1,693.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,618.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$997.46
|
| Rate for Payer: Cash Price |
$564.60
|
| Rate for Payer: Cigna Commercial |
$1,731.44
|
| Rate for Payer: Health EOS Commercial |
$1,674.98
|
| Rate for Payer: HFN Commercial |
$1,731.44
|
| Rate for Payer: Multiplan Commercial |
$1,505.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,129.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,731.44
|
| Rate for Payer: Quartz Beloit One Network |
$922.18
|
| Rate for Payer: Quartz Commercial |
$1,129.20
|
| Rate for Payer: WEA Trust Commercial |
$1,035.10
|
| Rate for Payer: WPS Commercial |
$1,394.00
|
|
|
SCREW-LOCK 5.0X14 212.201
|
Facility
|
IP
|
$1,917.00
|
|
| Hospital Charge Code |
2966951
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$939.33 |
| Max. Negotiated Rate |
$1,763.64 |
| Rate for Payer: Aetna Commercial |
$1,725.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,648.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,016.01
|
| Rate for Payer: Cash Price |
$575.10
|
| Rate for Payer: Cigna Commercial |
$1,763.64
|
| Rate for Payer: Health EOS Commercial |
$1,706.13
|
| Rate for Payer: HFN Commercial |
$1,763.64
|
| Rate for Payer: Multiplan Commercial |
$1,533.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,150.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,763.64
|
| Rate for Payer: Quartz Beloit One Network |
$939.33
|
| Rate for Payer: Quartz Commercial |
$1,150.20
|
| Rate for Payer: WEA Trust Commercial |
$1,054.35
|
| Rate for Payer: WPS Commercial |
$1,419.92
|
|
|
SCREW-LOCK 5.0X14 212.201
|
Facility
|
OP
|
$1,917.00
|
|
| Hospital Charge Code |
2966951
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$536.76 |
| Max. Negotiated Rate |
$7,668.00 |
| Rate for Payer: Aetna Commercial |
$1,725.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,648.62
|
| Rate for Payer: Aetna Managed Medicare |
$536.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,246.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$958.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$920.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,016.01
|
| Rate for Payer: Cash Price |
$575.10
|
| Rate for Payer: Cigna Commercial |
$1,763.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,072.75
|
| Rate for Payer: Health EOS Commercial |
$1,706.13
|
| Rate for Payer: HFN Commercial |
$1,763.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,437.75
|
| Rate for Payer: Multiplan Commercial |
$1,533.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,150.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,763.64
|
| Rate for Payer: Quartz Beloit One Network |
$939.33
|
| Rate for Payer: Quartz Commercial |
$1,246.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,150.20
|
| Rate for Payer: The Alliance Commercial |
$7,668.00
|
| Rate for Payer: WEA Trust Commercial |
$1,054.35
|
| Rate for Payer: WPS Commercial |
$1,419.92
|
|
|
SCREW LOCK 5.0 X 14MM PERI
|
Facility
|
OP
|
$3,466.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3072539
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$970.48 |
| Max. Negotiated Rate |
$13,864.00 |
| Rate for Payer: Aetna Commercial |
$3,119.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,980.76
|
| Rate for Payer: Aetna Managed Medicare |
$970.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,252.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,733.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,663.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,836.98
|
| Rate for Payer: Cash Price |
$1,039.80
|
| Rate for Payer: Cigna Commercial |
$3,188.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,939.57
|
| Rate for Payer: Health EOS Commercial |
$3,084.74
|
| Rate for Payer: HFN Commercial |
$3,188.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,599.50
|
| Rate for Payer: Multiplan Commercial |
$2,772.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,079.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,188.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,698.34
|
| Rate for Payer: Quartz Commercial |
$2,252.90
|
| Rate for Payer: Quartz Medicare Advantage |
$2,079.60
|
| Rate for Payer: The Alliance Commercial |
$13,864.00
|
| Rate for Payer: WEA Trust Commercial |
$1,906.30
|
| Rate for Payer: WPS Commercial |
$2,567.27
|
|
|
SCREW LOCK 5.0 X 14MM PERI
|
Facility
|
IP
|
$3,466.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3072539
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,698.34 |
| Max. Negotiated Rate |
$3,188.72 |
| Rate for Payer: Aetna Commercial |
$3,119.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,980.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,836.98
|
| Rate for Payer: Cash Price |
$1,039.80
|
| Rate for Payer: Cigna Commercial |
$3,188.72
|
| Rate for Payer: Health EOS Commercial |
$3,084.74
|
| Rate for Payer: HFN Commercial |
$3,188.72
|
| Rate for Payer: Multiplan Commercial |
$2,772.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,079.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,188.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,698.34
|
| Rate for Payer: Quartz Commercial |
$2,079.60
|
| Rate for Payer: WEA Trust Commercial |
$1,906.30
|
| Rate for Payer: WPS Commercial |
$2,567.27
|
|
|
SCREW LOCK 5.0 X 14MM SELF-TAP 661114
|
Facility
|
OP
|
$2,005.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5458792
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$561.40 |
| Max. Negotiated Rate |
$8,020.00 |
| Rate for Payer: Aetna Commercial |
$1,804.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,724.30
|
| Rate for Payer: Aetna Managed Medicare |
$561.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,303.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,002.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$962.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,062.65
|
| Rate for Payer: Cash Price |
$601.50
|
| Rate for Payer: Cigna Commercial |
$1,844.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,122.00
|
| Rate for Payer: Health EOS Commercial |
$1,784.45
|
| Rate for Payer: HFN Commercial |
$1,844.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,503.75
|
| Rate for Payer: Multiplan Commercial |
$1,604.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,203.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,844.60
|
| Rate for Payer: Quartz Beloit One Network |
$982.45
|
| Rate for Payer: Quartz Commercial |
$1,303.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,203.00
|
| Rate for Payer: The Alliance Commercial |
$8,020.00
|
| Rate for Payer: WEA Trust Commercial |
$1,102.75
|
| Rate for Payer: WPS Commercial |
$1,485.10
|
|
|
SCREW LOCK 5.0 X 14MM SELF-TAP 661114
|
Facility
|
IP
|
$2,005.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5458792
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$982.45 |
| Max. Negotiated Rate |
$1,844.60 |
| Rate for Payer: Aetna Commercial |
$1,804.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,724.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,062.65
|
| Rate for Payer: Cash Price |
$601.50
|
| Rate for Payer: Cigna Commercial |
$1,844.60
|
| Rate for Payer: Health EOS Commercial |
$1,784.45
|
| Rate for Payer: HFN Commercial |
$1,844.60
|
| Rate for Payer: Multiplan Commercial |
$1,604.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,203.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,844.60
|
| Rate for Payer: Quartz Beloit One Network |
$982.45
|
| Rate for Payer: Quartz Commercial |
$1,203.00
|
| Rate for Payer: WEA Trust Commercial |
$1,102.75
|
| Rate for Payer: WPS Commercial |
$1,485.10
|
|
|
SCREW LOCK 5.0 X 14 VA 02.231.214
|
Facility
|
OP
|
$2,085.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5799779
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$583.80 |
| Max. Negotiated Rate |
$8,340.00 |
| Rate for Payer: Aetna Commercial |
$1,876.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,793.10
|
| Rate for Payer: Aetna Managed Medicare |
$583.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,355.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,042.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,000.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,105.05
|
| Rate for Payer: Cash Price |
$625.50
|
| Rate for Payer: Cigna Commercial |
$1,918.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,166.77
|
| Rate for Payer: Health EOS Commercial |
$1,855.65
|
| Rate for Payer: HFN Commercial |
$1,918.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,563.75
|
| Rate for Payer: Multiplan Commercial |
$1,668.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,251.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,918.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,021.65
|
| Rate for Payer: Quartz Commercial |
$1,355.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,251.00
|
| Rate for Payer: The Alliance Commercial |
$8,340.00
|
| Rate for Payer: WEA Trust Commercial |
$1,146.75
|
| Rate for Payer: WPS Commercial |
$1,544.36
|
|
|
SCREW LOCK 5.0 X 14 VA 02.231.214
|
Facility
|
IP
|
$2,085.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5799779
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,021.65 |
| Max. Negotiated Rate |
$1,918.20 |
| Rate for Payer: Aetna Commercial |
$1,876.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,793.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,105.05
|
| Rate for Payer: Cash Price |
$625.50
|
| Rate for Payer: Cigna Commercial |
$1,918.20
|
| Rate for Payer: Health EOS Commercial |
$1,855.65
|
| Rate for Payer: HFN Commercial |
$1,918.20
|
| Rate for Payer: Multiplan Commercial |
$1,668.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,251.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,918.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,021.65
|
| Rate for Payer: Quartz Commercial |
$1,251.00
|
| Rate for Payer: WEA Trust Commercial |
$1,146.75
|
| Rate for Payer: WPS Commercial |
$1,544.36
|
|
