|
SCREW-LOCK 5.0X80 212.225
|
Facility
|
IP
|
$1,917.00
|
|
| Hospital Charge Code |
2967005
|
|
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 5.0X80 212.225
|
Facility
|
OP
|
$1,917.00
|
|
| Hospital Charge Code |
2967005
|
|
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 80 FULL THREAD 1896-5080S
|
Facility
|
OP
|
$1,882.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508994
|
|
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 80 FULL THREAD 1896-5080S
|
Facility
|
IP
|
$1,882.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508994
|
|
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 80MM SELF-TAP 661180
|
Facility
|
IP
|
$2,005.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5458797
|
|
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 80MM SELF-TAP 661180
|
Facility
|
OP
|
$2,005.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5458797
|
|
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 80MM TI 04.005.570S
|
Facility
|
OP
|
$2,232.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4640723
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$624.96 |
| Max. Negotiated Rate |
$8,928.00 |
| Rate for Payer: Aetna Commercial |
$2,008.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,919.52
|
| Rate for Payer: Aetna Managed Medicare |
$624.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,450.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,116.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,071.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,182.96
|
| Rate for Payer: Cash Price |
$669.60
|
| Rate for Payer: Cigna Commercial |
$2,053.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,249.03
|
| Rate for Payer: Health EOS Commercial |
$1,986.48
|
| Rate for Payer: HFN Commercial |
$2,053.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,674.00
|
| Rate for Payer: Multiplan Commercial |
$1,785.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,339.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,053.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,093.68
|
| Rate for Payer: Quartz Commercial |
$1,450.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,339.20
|
| Rate for Payer: The Alliance Commercial |
$8,928.00
|
| Rate for Payer: WEA Trust Commercial |
$1,227.60
|
| Rate for Payer: WPS Commercial |
$1,653.24
|
|
|
SCREW LOCK 5.0 X 80MM TI 04.005.570S
|
Facility
|
IP
|
$2,232.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4640723
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,093.68 |
| Max. Negotiated Rate |
$2,053.44 |
| Rate for Payer: Aetna Commercial |
$2,008.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,919.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,182.96
|
| Rate for Payer: Cash Price |
$669.60
|
| Rate for Payer: Cigna Commercial |
$2,053.44
|
| Rate for Payer: Health EOS Commercial |
$1,986.48
|
| Rate for Payer: HFN Commercial |
$2,053.44
|
| Rate for Payer: Multiplan Commercial |
$1,785.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,339.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,053.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,093.68
|
| Rate for Payer: Quartz Commercial |
$1,339.20
|
| Rate for Payer: WEA Trust Commercial |
$1,227.60
|
| Rate for Payer: WPS Commercial |
$1,653.24
|
|
|
SCREW LOCK 5.0 X 80MM XL25 IM NAIL TI 04.045.080S
|
Facility
|
OP
|
$2,826.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6175477
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$791.28 |
| Max. Negotiated Rate |
$11,304.00 |
| Rate for Payer: Aetna Commercial |
$2,543.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,430.36
|
| Rate for Payer: Aetna Managed Medicare |
$791.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,836.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,413.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,356.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,497.78
|
| Rate for Payer: Cash Price |
$847.80
|
| Rate for Payer: Cigna Commercial |
$2,599.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,581.43
|
| Rate for Payer: Health EOS Commercial |
$2,515.14
|
| Rate for Payer: HFN Commercial |
$2,599.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,119.50
|
| Rate for Payer: Multiplan Commercial |
$2,260.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,695.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,599.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,384.74
|
| Rate for Payer: Quartz Commercial |
$1,836.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,695.60
|
| Rate for Payer: The Alliance Commercial |
$11,304.00
|
| Rate for Payer: WEA Trust Commercial |
$1,554.30
|
| Rate for Payer: WPS Commercial |
$2,093.22
|
|
|
SCREW LOCK 5.0 X 80MM XL25 IM NAIL TI 04.045.080S
|
Facility
|
IP
|
$2,826.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6175477
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,384.74 |
| Max. Negotiated Rate |
$2,599.92 |
| Rate for Payer: Aetna Commercial |
$2,543.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,430.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,497.78
|
| Rate for Payer: Cash Price |
$847.80
|
| Rate for Payer: Cigna Commercial |
$2,599.92
|
| Rate for Payer: Health EOS Commercial |
$2,515.14
|
| Rate for Payer: HFN Commercial |
$2,599.92
|
| Rate for Payer: Multiplan Commercial |
$2,260.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,695.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,599.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,384.74
|
| Rate for Payer: Quartz Commercial |
$1,695.60
|
| Rate for Payer: WEA Trust Commercial |
$1,554.30
|
| Rate for Payer: WPS Commercial |
$2,093.22
|
|
|
SCREW-LOCK 5.0 X 80 TFN 458.980
|
Facility
|
OP
|
$2,724.00
|
|
| Hospital Charge Code |
2967006
|
|
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 80 TFN 458.980
|
Facility
|
IP
|
$2,724.00
|
|
| Hospital Charge Code |
2967006
|
|
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 80 VA 02.231.280
|
Facility
|
OP
|
$2,342.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494422
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$655.76 |
| Max. Negotiated Rate |
$9,368.00 |
| Rate for Payer: Aetna Commercial |
$2,107.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,014.12
|
| Rate for Payer: Aetna Managed Medicare |
$655.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,522.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,171.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,124.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,241.26
|
| Rate for Payer: Cash Price |
$702.60
|
| Rate for Payer: Cigna Commercial |
$2,154.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,310.58
|
| Rate for Payer: Health EOS Commercial |
$2,084.38
|
| Rate for Payer: HFN Commercial |
$2,154.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,756.50
|
| Rate for Payer: Multiplan Commercial |
$1,873.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,405.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,154.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,147.58
|
| Rate for Payer: Quartz Commercial |
$1,522.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,405.20
|
| Rate for Payer: The Alliance Commercial |
$9,368.00
|
| Rate for Payer: WEA Trust Commercial |
$1,288.10
|
| Rate for Payer: WPS Commercial |
$1,734.72
|
|
|
SCREW LOCK 5.0 X 80 VA 02.231.280
|
Facility
|
IP
|
$2,342.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494422
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,147.58 |
| Max. Negotiated Rate |
$2,154.64 |
| Rate for Payer: Aetna Commercial |
$2,107.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,014.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,241.26
|
| Rate for Payer: Cash Price |
$702.60
|
| Rate for Payer: Cigna Commercial |
$2,154.64
|
| Rate for Payer: Health EOS Commercial |
$2,084.38
|
| Rate for Payer: HFN Commercial |
$2,154.64
|
| Rate for Payer: Multiplan Commercial |
$1,873.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,405.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,154.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,147.58
|
| Rate for Payer: Quartz Commercial |
$1,405.20
|
| Rate for Payer: WEA Trust Commercial |
$1,288.10
|
| Rate for Payer: WPS Commercial |
$1,734.72
|
|
|
SCREW LOCK 5.0 X 84MM XL25 IM NAIL TI 04.045.084S
|
Facility
|
IP
|
$2,612.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6246186
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,279.97 |
| Max. Negotiated Rate |
$2,403.21 |
| Rate for Payer: Aetna Commercial |
$2,350.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,246.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,384.46
|
| Rate for Payer: Cash Price |
$783.65
|
| Rate for Payer: Cigna Commercial |
$2,403.21
|
| Rate for Payer: Health EOS Commercial |
$2,324.84
|
| Rate for Payer: HFN Commercial |
$2,403.21
|
| Rate for Payer: Multiplan Commercial |
$2,089.74
|
| Rate for Payer: NAPHCARE Commercial |
$1,567.31
|
| Rate for Payer: Preferred Network Access Commercial |
$2,403.21
|
| Rate for Payer: Quartz Beloit One Network |
$1,279.97
|
| Rate for Payer: Quartz Commercial |
$1,567.31
|
| Rate for Payer: WEA Trust Commercial |
$1,436.70
|
| Rate for Payer: WPS Commercial |
$1,934.84
|
|
|
SCREW LOCK 5.0 X 84MM XL25 IM NAIL TI 04.045.084S
|
Facility
|
OP
|
$2,612.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6246186
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$731.41 |
| Max. Negotiated Rate |
$10,448.72 |
| Rate for Payer: Aetna Commercial |
$2,350.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,246.47
|
| Rate for Payer: Aetna Managed Medicare |
$731.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,697.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,306.09
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,253.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,384.46
|
| Rate for Payer: Cash Price |
$783.65
|
| Rate for Payer: Cigna Commercial |
$2,403.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,461.78
|
| Rate for Payer: Health EOS Commercial |
$2,324.84
|
| Rate for Payer: HFN Commercial |
$2,403.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,959.14
|
| Rate for Payer: Multiplan Commercial |
$2,089.74
|
| Rate for Payer: NAPHCARE Commercial |
$1,567.31
|
| Rate for Payer: Preferred Network Access Commercial |
$2,403.21
|
| Rate for Payer: Quartz Beloit One Network |
$1,279.97
|
| Rate for Payer: Quartz Commercial |
$1,697.92
|
| Rate for Payer: Quartz Medicare Advantage |
$1,567.31
|
| Rate for Payer: The Alliance Commercial |
$10,448.72
|
| Rate for Payer: WEA Trust Commercial |
$1,436.70
|
| Rate for Payer: WPS Commercial |
$1,934.84
|
|
|
SCREW-LOCK 5.0X85 212.226
|
Facility
|
IP
|
$1,917.00
|
|
| Hospital Charge Code |
2967007
|
|
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 5.0X85 212.226
|
Facility
|
OP
|
$1,917.00
|
|
| Hospital Charge Code |
2967007
|
|
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 85 FULL THREAD 1896-5085S
|
Facility
|
OP
|
$1,882.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508995
|
|
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 85 FULL THREAD 1896-5085S
|
Facility
|
IP
|
$1,882.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508995
|
|
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 85MM TI 04.005.575S
|
Facility
|
OP
|
$2,232.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4467412
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$624.96 |
| Max. Negotiated Rate |
$8,928.00 |
| Rate for Payer: Aetna Commercial |
$2,008.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,919.52
|
| Rate for Payer: Aetna Managed Medicare |
$624.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,450.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,116.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,071.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,182.96
|
| Rate for Payer: Cash Price |
$669.60
|
| Rate for Payer: Cigna Commercial |
$2,053.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,249.03
|
| Rate for Payer: Health EOS Commercial |
$1,986.48
|
| Rate for Payer: HFN Commercial |
$2,053.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,674.00
|
| Rate for Payer: Multiplan Commercial |
$1,785.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,339.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,053.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,093.68
|
| Rate for Payer: Quartz Commercial |
$1,450.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,339.20
|
| Rate for Payer: The Alliance Commercial |
$8,928.00
|
| Rate for Payer: WEA Trust Commercial |
$1,227.60
|
| Rate for Payer: WPS Commercial |
$1,653.24
|
|
|
SCREW LOCK 5.0 X 85MM TI 04.005.575S
|
Facility
|
IP
|
$2,232.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4467412
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,093.68 |
| Max. Negotiated Rate |
$2,053.44 |
| Rate for Payer: Aetna Commercial |
$2,008.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,919.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,182.96
|
| Rate for Payer: Cash Price |
$669.60
|
| Rate for Payer: Cigna Commercial |
$2,053.44
|
| Rate for Payer: Health EOS Commercial |
$1,986.48
|
| Rate for Payer: HFN Commercial |
$2,053.44
|
| Rate for Payer: Multiplan Commercial |
$1,785.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,339.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,053.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,093.68
|
| Rate for Payer: Quartz Commercial |
$1,339.20
|
| Rate for Payer: WEA Trust Commercial |
$1,227.60
|
| Rate for Payer: WPS Commercial |
$1,653.24
|
|
|
SCREW-LOCK 5.0 X 85 TFN 458.985
|
Facility
|
IP
|
$2,724.00
|
|
| Hospital Charge Code |
2967008
|
|
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 85 TFN 458.985
|
Facility
|
OP
|
$2,724.00
|
|
| Hospital Charge Code |
2967008
|
|
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 85 VA 02.231.285
|
Facility
|
IP
|
$2,255.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5286726
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,104.95 |
| Max. Negotiated Rate |
$2,074.60 |
| Rate for Payer: Aetna Commercial |
$2,029.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,939.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,195.15
|
| Rate for Payer: Cash Price |
$676.50
|
| Rate for Payer: Cigna Commercial |
$2,074.60
|
| Rate for Payer: Health EOS Commercial |
$2,006.95
|
| Rate for Payer: HFN Commercial |
$2,074.60
|
| Rate for Payer: Multiplan Commercial |
$1,804.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,353.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,074.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,104.95
|
| Rate for Payer: Quartz Commercial |
$1,353.00
|
| Rate for Payer: WEA Trust Commercial |
$1,240.25
|
| Rate for Payer: WPS Commercial |
$1,670.28
|
|
