|
SCREW HEADED 4.0MM X 36MM D1N40036S
|
Facility
|
IP
|
$2,241.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6200970
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,142.01 |
| Max. Negotiated Rate |
$2,144.19 |
| Rate for Payer: Aetna Commercial |
$2,097.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,004.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,235.24
|
| Rate for Payer: Cash Price |
$672.30
|
| Rate for Payer: Cigna Commercial |
$2,144.19
|
| Rate for Payer: Health EOS Commercial |
$2,074.27
|
| Rate for Payer: HFN Commercial |
$2,144.19
|
| Rate for Payer: Multiplan Commercial |
$1,864.51
|
| Rate for Payer: Preferred Network Access Commercial |
$2,144.19
|
| Rate for Payer: Quartz Beloit One Network |
$1,142.01
|
| Rate for Payer: Quartz Commercial |
$1,398.38
|
| Rate for Payer: WEA Trust Commercial |
$1,281.85
|
| Rate for Payer: WPS Commercial |
$1,726.24
|
|
|
SCREW HEADED 4.0MM X 52MM D1N40052S
|
Facility
|
OP
|
$2,241.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6178986
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$652.58 |
| Max. Negotiated Rate |
$2,144.19 |
| Rate for Payer: Aetna Commercial |
$2,097.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,004.35
|
| Rate for Payer: Aetna Managed Medicare |
$652.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,514.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,165.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,118.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,235.24
|
| Rate for Payer: Cash Price |
$672.30
|
| Rate for Payer: Cigna Commercial |
$2,144.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,304.26
|
| Rate for Payer: Health EOS Commercial |
$2,074.27
|
| Rate for Payer: HFN Commercial |
$2,144.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,747.98
|
| Rate for Payer: Multiplan Commercial |
$1,864.51
|
| Rate for Payer: NAPHCARE Commercial |
$1,398.38
|
| Rate for Payer: Preferred Network Access Commercial |
$2,144.19
|
| Rate for Payer: Quartz Beloit One Network |
$1,142.01
|
| Rate for Payer: Quartz Commercial |
$1,514.92
|
| Rate for Payer: Quartz Medicare Advantage |
$1,398.38
|
| Rate for Payer: The Alliance Commercial |
$1,165.32
|
| Rate for Payer: WEA Trust Commercial |
$1,281.85
|
| Rate for Payer: WPS Commercial |
$1,726.24
|
|
|
SCREW HEADED 4.0MM X 52MM D1N40052S
|
Facility
|
IP
|
$2,241.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6178986
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,142.01 |
| Max. Negotiated Rate |
$2,144.19 |
| Rate for Payer: Aetna Commercial |
$2,097.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,004.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,235.24
|
| Rate for Payer: Cash Price |
$672.30
|
| Rate for Payer: Cigna Commercial |
$2,144.19
|
| Rate for Payer: Health EOS Commercial |
$2,074.27
|
| Rate for Payer: HFN Commercial |
$2,144.19
|
| Rate for Payer: Multiplan Commercial |
$1,864.51
|
| Rate for Payer: Preferred Network Access Commercial |
$2,144.19
|
| Rate for Payer: Quartz Beloit One Network |
$1,142.01
|
| Rate for Payer: Quartz Commercial |
$1,398.38
|
| Rate for Payer: WEA Trust Commercial |
$1,281.85
|
| Rate for Payer: WPS Commercial |
$1,726.24
|
|
|
SCREW HEADED 4.0MM X 60MM D1N40060S
|
Facility
|
OP
|
$2,331.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6173853
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$678.79 |
| Max. Negotiated Rate |
$2,230.30 |
| Rate for Payer: Aetna Commercial |
$2,181.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,084.85
|
| Rate for Payer: Aetna Managed Medicare |
$678.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,575.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,212.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,163.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,284.85
|
| Rate for Payer: Cash Price |
$699.30
|
| Rate for Payer: Cigna Commercial |
$2,230.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,356.64
|
| Rate for Payer: Health EOS Commercial |
$2,157.57
|
| Rate for Payer: HFN Commercial |
$2,230.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,818.18
|
| Rate for Payer: Multiplan Commercial |
$1,939.39
|
| Rate for Payer: NAPHCARE Commercial |
$1,454.54
|
| Rate for Payer: Preferred Network Access Commercial |
$2,230.30
|
| Rate for Payer: Quartz Beloit One Network |
$1,187.88
|
| Rate for Payer: Quartz Commercial |
$1,575.76
|
| Rate for Payer: Quartz Medicare Advantage |
$1,454.54
|
| Rate for Payer: The Alliance Commercial |
$1,212.12
|
| Rate for Payer: WEA Trust Commercial |
$1,333.33
|
| Rate for Payer: WPS Commercial |
$1,795.57
|
|
|
SCREW HEADED 4.0MM X 60MM D1N40060S
|
Facility
|
IP
|
$2,331.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6173853
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,187.88 |
| Max. Negotiated Rate |
$2,230.30 |
| Rate for Payer: Aetna Commercial |
$2,181.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,084.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,284.85
|
| Rate for Payer: Cash Price |
$699.30
|
| Rate for Payer: Cigna Commercial |
$2,230.30
|
| Rate for Payer: Health EOS Commercial |
$2,157.57
|
| Rate for Payer: HFN Commercial |
$2,230.30
|
| Rate for Payer: Multiplan Commercial |
$1,939.39
|
| Rate for Payer: Preferred Network Access Commercial |
$2,230.30
|
| Rate for Payer: Quartz Beloit One Network |
$1,187.88
|
| Rate for Payer: Quartz Commercial |
$1,454.54
|
| Rate for Payer: WEA Trust Commercial |
$1,333.33
|
| Rate for Payer: WPS Commercial |
$1,795.57
|
|
|
SCREW HEADED 4.0 X 38MM IC4038
|
Facility
|
IP
|
$1,790.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6211042
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$912.18 |
| Max. Negotiated Rate |
$1,712.67 |
| Rate for Payer: Aetna Commercial |
$1,675.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,600.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$986.65
|
| Rate for Payer: Cash Price |
$537.00
|
| Rate for Payer: Cigna Commercial |
$1,712.67
|
| Rate for Payer: Health EOS Commercial |
$1,656.82
|
| Rate for Payer: HFN Commercial |
$1,712.67
|
| Rate for Payer: Multiplan Commercial |
$1,489.28
|
| Rate for Payer: Preferred Network Access Commercial |
$1,712.67
|
| Rate for Payer: Quartz Beloit One Network |
$912.18
|
| Rate for Payer: Quartz Commercial |
$1,116.96
|
| Rate for Payer: WEA Trust Commercial |
$1,023.88
|
| Rate for Payer: WPS Commercial |
$1,378.84
|
|
|
SCREW HEADED 4.0 X 38MM IC4038
|
Facility
|
OP
|
$1,790.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6211042
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$521.25 |
| Max. Negotiated Rate |
$1,712.67 |
| Rate for Payer: Aetna Commercial |
$1,675.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,600.98
|
| Rate for Payer: Aetna Managed Medicare |
$521.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,210.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$930.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$893.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$986.65
|
| Rate for Payer: Cash Price |
$537.00
|
| Rate for Payer: Cigna Commercial |
$1,712.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,041.78
|
| Rate for Payer: Health EOS Commercial |
$1,656.82
|
| Rate for Payer: HFN Commercial |
$1,712.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,396.20
|
| Rate for Payer: Multiplan Commercial |
$1,489.28
|
| Rate for Payer: NAPHCARE Commercial |
$1,116.96
|
| Rate for Payer: Preferred Network Access Commercial |
$1,712.67
|
| Rate for Payer: Quartz Beloit One Network |
$912.18
|
| Rate for Payer: Quartz Commercial |
$1,210.04
|
| Rate for Payer: Quartz Medicare Advantage |
$1,116.96
|
| Rate for Payer: The Alliance Commercial |
$930.80
|
| Rate for Payer: WEA Trust Commercial |
$1,023.88
|
| Rate for Payer: WPS Commercial |
$1,378.84
|
|
|
SCREW HEADED 4.0 X 40MM IC4040
|
Facility
|
IP
|
$1,790.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6211043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$912.18 |
| Max. Negotiated Rate |
$1,712.67 |
| Rate for Payer: Aetna Commercial |
$1,675.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,600.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$986.65
|
| Rate for Payer: Cash Price |
$537.00
|
| Rate for Payer: Cigna Commercial |
$1,712.67
|
| Rate for Payer: Health EOS Commercial |
$1,656.82
|
| Rate for Payer: HFN Commercial |
$1,712.67
|
| Rate for Payer: Multiplan Commercial |
$1,489.28
|
| Rate for Payer: Preferred Network Access Commercial |
$1,712.67
|
| Rate for Payer: Quartz Beloit One Network |
$912.18
|
| Rate for Payer: Quartz Commercial |
$1,116.96
|
| Rate for Payer: WEA Trust Commercial |
$1,023.88
|
| Rate for Payer: WPS Commercial |
$1,378.84
|
|
|
SCREW HEADED 4.0 X 40MM IC4040
|
Facility
|
OP
|
$1,790.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6211043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$521.25 |
| Max. Negotiated Rate |
$1,712.67 |
| Rate for Payer: Aetna Commercial |
$1,675.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,600.98
|
| Rate for Payer: Aetna Managed Medicare |
$521.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,210.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$930.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$893.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$986.65
|
| Rate for Payer: Cash Price |
$537.00
|
| Rate for Payer: Cigna Commercial |
$1,712.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,041.78
|
| Rate for Payer: Health EOS Commercial |
$1,656.82
|
| Rate for Payer: HFN Commercial |
$1,712.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,396.20
|
| Rate for Payer: Multiplan Commercial |
$1,489.28
|
| Rate for Payer: NAPHCARE Commercial |
$1,116.96
|
| Rate for Payer: Preferred Network Access Commercial |
$1,712.67
|
| Rate for Payer: Quartz Beloit One Network |
$912.18
|
| Rate for Payer: Quartz Commercial |
$1,210.04
|
| Rate for Payer: Quartz Medicare Advantage |
$1,116.96
|
| Rate for Payer: The Alliance Commercial |
$930.80
|
| Rate for Payer: WEA Trust Commercial |
$1,023.88
|
| Rate for Payer: WPS Commercial |
$1,378.84
|
|
|
SCREW HEADED 4.0 X 46MM IC4046
|
Facility
|
OP
|
$1,790.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6220181
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$521.25 |
| Max. Negotiated Rate |
$1,712.67 |
| Rate for Payer: Aetna Commercial |
$1,675.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,600.98
|
| Rate for Payer: Aetna Managed Medicare |
$521.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,210.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$930.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$893.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$986.65
|
| Rate for Payer: Cash Price |
$537.00
|
| Rate for Payer: Cigna Commercial |
$1,712.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,041.78
|
| Rate for Payer: Health EOS Commercial |
$1,656.82
|
| Rate for Payer: HFN Commercial |
$1,712.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,396.20
|
| Rate for Payer: Multiplan Commercial |
$1,489.28
|
| Rate for Payer: NAPHCARE Commercial |
$1,116.96
|
| Rate for Payer: Preferred Network Access Commercial |
$1,712.67
|
| Rate for Payer: Quartz Beloit One Network |
$912.18
|
| Rate for Payer: Quartz Commercial |
$1,210.04
|
| Rate for Payer: Quartz Medicare Advantage |
$1,116.96
|
| Rate for Payer: The Alliance Commercial |
$930.80
|
| Rate for Payer: WEA Trust Commercial |
$1,023.88
|
| Rate for Payer: WPS Commercial |
$1,378.84
|
|
|
SCREW HEADED 4.0 X 46MM IC4046
|
Facility
|
IP
|
$1,790.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6220181
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$912.18 |
| Max. Negotiated Rate |
$1,712.67 |
| Rate for Payer: Aetna Commercial |
$1,675.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,600.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$986.65
|
| Rate for Payer: Cash Price |
$537.00
|
| Rate for Payer: Cigna Commercial |
$1,712.67
|
| Rate for Payer: Health EOS Commercial |
$1,656.82
|
| Rate for Payer: HFN Commercial |
$1,712.67
|
| Rate for Payer: Multiplan Commercial |
$1,489.28
|
| Rate for Payer: Preferred Network Access Commercial |
$1,712.67
|
| Rate for Payer: Quartz Beloit One Network |
$912.18
|
| Rate for Payer: Quartz Commercial |
$1,116.96
|
| Rate for Payer: WEA Trust Commercial |
$1,023.88
|
| Rate for Payer: WPS Commercial |
$1,378.84
|
|
|
SCREW HEADED 4.0 X 48MM IC4048
|
Facility
|
IP
|
$1,790.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6220182
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$912.18 |
| Max. Negotiated Rate |
$1,712.67 |
| Rate for Payer: Aetna Commercial |
$1,675.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,600.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$986.65
|
| Rate for Payer: Cash Price |
$537.00
|
| Rate for Payer: Cigna Commercial |
$1,712.67
|
| Rate for Payer: Health EOS Commercial |
$1,656.82
|
| Rate for Payer: HFN Commercial |
$1,712.67
|
| Rate for Payer: Multiplan Commercial |
$1,489.28
|
| Rate for Payer: Preferred Network Access Commercial |
$1,712.67
|
| Rate for Payer: Quartz Beloit One Network |
$912.18
|
| Rate for Payer: Quartz Commercial |
$1,116.96
|
| Rate for Payer: WEA Trust Commercial |
$1,023.88
|
| Rate for Payer: WPS Commercial |
$1,378.84
|
|
|
SCREW HEADED 4.0 X 48MM IC4048
|
Facility
|
OP
|
$1,790.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6220182
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$521.25 |
| Max. Negotiated Rate |
$1,712.67 |
| Rate for Payer: Aetna Commercial |
$1,675.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,600.98
|
| Rate for Payer: Aetna Managed Medicare |
$521.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,210.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$930.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$893.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$986.65
|
| Rate for Payer: Cash Price |
$537.00
|
| Rate for Payer: Cigna Commercial |
$1,712.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,041.78
|
| Rate for Payer: Health EOS Commercial |
$1,656.82
|
| Rate for Payer: HFN Commercial |
$1,712.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,396.20
|
| Rate for Payer: Multiplan Commercial |
$1,489.28
|
| Rate for Payer: NAPHCARE Commercial |
$1,116.96
|
| Rate for Payer: Preferred Network Access Commercial |
$1,712.67
|
| Rate for Payer: Quartz Beloit One Network |
$912.18
|
| Rate for Payer: Quartz Commercial |
$1,210.04
|
| Rate for Payer: Quartz Medicare Advantage |
$1,116.96
|
| Rate for Payer: The Alliance Commercial |
$930.80
|
| Rate for Payer: WEA Trust Commercial |
$1,023.88
|
| Rate for Payer: WPS Commercial |
$1,378.84
|
|
|
SCREW HEADED M/G UNI 48MM 5791-41
|
Facility
|
IP
|
$2,839.00
|
|
| Hospital Charge Code |
2990959
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,446.75 |
| Max. Negotiated Rate |
$2,716.36 |
| Rate for Payer: Aetna Commercial |
$2,657.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,539.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,564.86
|
| Rate for Payer: Cash Price |
$851.70
|
| Rate for Payer: Cigna Commercial |
$2,716.36
|
| Rate for Payer: Health EOS Commercial |
$2,627.78
|
| Rate for Payer: HFN Commercial |
$2,716.36
|
| Rate for Payer: Multiplan Commercial |
$2,362.05
|
| Rate for Payer: Preferred Network Access Commercial |
$2,716.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,446.75
|
| Rate for Payer: Quartz Commercial |
$1,771.54
|
| Rate for Payer: WEA Trust Commercial |
$1,623.91
|
| Rate for Payer: WPS Commercial |
$2,186.88
|
|
|
SCREW HEADED M/G UNI 48MM 5791-41
|
Facility
|
OP
|
$2,839.00
|
|
| Hospital Charge Code |
2990959
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$826.72 |
| Max. Negotiated Rate |
$2,716.36 |
| Rate for Payer: Aetna Commercial |
$2,657.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,539.20
|
| Rate for Payer: Aetna Managed Medicare |
$826.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,919.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,476.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,417.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,564.86
|
| Rate for Payer: Cash Price |
$851.70
|
| Rate for Payer: Cigna Commercial |
$2,716.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,652.30
|
| Rate for Payer: Health EOS Commercial |
$2,627.78
|
| Rate for Payer: HFN Commercial |
$2,716.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,214.42
|
| Rate for Payer: Multiplan Commercial |
$2,362.05
|
| Rate for Payer: NAPHCARE Commercial |
$1,771.54
|
| Rate for Payer: Preferred Network Access Commercial |
$2,716.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,446.75
|
| Rate for Payer: Quartz Commercial |
$1,919.16
|
| Rate for Payer: Quartz Medicare Advantage |
$1,771.54
|
| Rate for Payer: The Alliance Commercial |
$1,476.28
|
| Rate for Payer: WEA Trust Commercial |
$1,623.91
|
| Rate for Payer: WPS Commercial |
$2,186.88
|
|
|
SCREW HEADED ZUK 33MM 00-5791-044-00
|
Facility
|
IP
|
$280.00
|
|
| Hospital Charge Code |
2965840
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$142.69 |
| Max. Negotiated Rate |
$267.90 |
| Rate for Payer: Aetna Commercial |
$262.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$250.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$154.34
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cigna Commercial |
$267.90
|
| Rate for Payer: Health EOS Commercial |
$259.17
|
| Rate for Payer: HFN Commercial |
$267.90
|
| Rate for Payer: Multiplan Commercial |
$232.96
|
| Rate for Payer: Preferred Network Access Commercial |
$267.90
|
| Rate for Payer: Quartz Beloit One Network |
$142.69
|
| Rate for Payer: Quartz Commercial |
$174.72
|
| Rate for Payer: WEA Trust Commercial |
$160.16
|
| Rate for Payer: WPS Commercial |
$215.68
|
|
|
SCREW HEADED ZUK 33MM 00-5791-044-00
|
Facility
|
OP
|
$280.00
|
|
| Hospital Charge Code |
2965840
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.54 |
| Max. Negotiated Rate |
$267.90 |
| Rate for Payer: Aetna Commercial |
$262.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$250.43
|
| Rate for Payer: Aetna Managed Medicare |
$81.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$189.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$145.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$139.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$154.34
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cigna Commercial |
$267.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$162.96
|
| Rate for Payer: Health EOS Commercial |
$259.17
|
| Rate for Payer: HFN Commercial |
$267.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$218.40
|
| Rate for Payer: Multiplan Commercial |
$232.96
|
| Rate for Payer: NAPHCARE Commercial |
$174.72
|
| Rate for Payer: Preferred Network Access Commercial |
$267.90
|
| Rate for Payer: Quartz Beloit One Network |
$142.69
|
| Rate for Payer: Quartz Commercial |
$189.28
|
| Rate for Payer: Quartz Medicare Advantage |
$174.72
|
| Rate for Payer: The Alliance Commercial |
$145.60
|
| Rate for Payer: WEA Trust Commercial |
$160.16
|
| Rate for Payer: WPS Commercial |
$215.68
|
|
|
SCREW HEADLESS 2.0 X 12 317-2012
|
Facility
|
IP
|
$3,287.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2965456
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,675.06 |
| Max. Negotiated Rate |
$3,145.00 |
| Rate for Payer: Aetna Commercial |
$3,076.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,939.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,811.79
|
| Rate for Payer: Cash Price |
$986.10
|
| Rate for Payer: Cigna Commercial |
$3,145.00
|
| Rate for Payer: Health EOS Commercial |
$3,042.45
|
| Rate for Payer: HFN Commercial |
$3,145.00
|
| Rate for Payer: Multiplan Commercial |
$2,734.78
|
| Rate for Payer: Preferred Network Access Commercial |
$3,145.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,675.06
|
| Rate for Payer: Quartz Commercial |
$2,051.09
|
| Rate for Payer: WEA Trust Commercial |
$1,880.16
|
| Rate for Payer: WPS Commercial |
$2,531.98
|
|
|
SCREW HEADLESS 2.0 X 12 317-2012
|
Facility
|
OP
|
$3,287.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2965456
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$957.17 |
| Max. Negotiated Rate |
$3,145.00 |
| Rate for Payer: Aetna Commercial |
$3,076.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,939.89
|
| Rate for Payer: Aetna Managed Medicare |
$957.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,222.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,709.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,640.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,811.79
|
| Rate for Payer: Cash Price |
$986.10
|
| Rate for Payer: Cigna Commercial |
$3,145.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,913.03
|
| Rate for Payer: Health EOS Commercial |
$3,042.45
|
| Rate for Payer: HFN Commercial |
$3,145.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,563.86
|
| Rate for Payer: Multiplan Commercial |
$2,734.78
|
| Rate for Payer: NAPHCARE Commercial |
$2,051.09
|
| Rate for Payer: Preferred Network Access Commercial |
$3,145.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,675.06
|
| Rate for Payer: Quartz Commercial |
$2,222.01
|
| Rate for Payer: Quartz Medicare Advantage |
$2,051.09
|
| Rate for Payer: The Alliance Commercial |
$1,709.24
|
| Rate for Payer: WEA Trust Commercial |
$1,880.16
|
| Rate for Payer: WPS Commercial |
$2,531.98
|
|
|
SCREW HEADLESS 2.0 X 14 317-2014
|
Facility
|
IP
|
$3,287.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2965458
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,675.06 |
| Max. Negotiated Rate |
$3,145.00 |
| Rate for Payer: Aetna Commercial |
$3,076.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,939.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,811.79
|
| Rate for Payer: Cash Price |
$986.10
|
| Rate for Payer: Cigna Commercial |
$3,145.00
|
| Rate for Payer: Health EOS Commercial |
$3,042.45
|
| Rate for Payer: HFN Commercial |
$3,145.00
|
| Rate for Payer: Multiplan Commercial |
$2,734.78
|
| Rate for Payer: Preferred Network Access Commercial |
$3,145.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,675.06
|
| Rate for Payer: Quartz Commercial |
$2,051.09
|
| Rate for Payer: WEA Trust Commercial |
$1,880.16
|
| Rate for Payer: WPS Commercial |
$2,531.98
|
|
|
SCREW HEADLESS 2.0 X 14 317-2014
|
Facility
|
OP
|
$3,287.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2965458
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$957.17 |
| Max. Negotiated Rate |
$3,145.00 |
| Rate for Payer: Aetna Commercial |
$3,076.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,939.89
|
| Rate for Payer: Aetna Managed Medicare |
$957.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,222.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,709.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,640.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,811.79
|
| Rate for Payer: Cash Price |
$986.10
|
| Rate for Payer: Cigna Commercial |
$3,145.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,913.03
|
| Rate for Payer: Health EOS Commercial |
$3,042.45
|
| Rate for Payer: HFN Commercial |
$3,145.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,563.86
|
| Rate for Payer: Multiplan Commercial |
$2,734.78
|
| Rate for Payer: NAPHCARE Commercial |
$2,051.09
|
| Rate for Payer: Preferred Network Access Commercial |
$3,145.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,675.06
|
| Rate for Payer: Quartz Commercial |
$2,222.01
|
| Rate for Payer: Quartz Medicare Advantage |
$2,051.09
|
| Rate for Payer: The Alliance Commercial |
$1,709.24
|
| Rate for Payer: WEA Trust Commercial |
$1,880.16
|
| Rate for Payer: WPS Commercial |
$2,531.98
|
|
|
SCREW HEADLESS 2.0 X 16 317-2016
|
Facility
|
IP
|
$3,287.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2965460
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,675.06 |
| Max. Negotiated Rate |
$3,145.00 |
| Rate for Payer: Aetna Commercial |
$3,076.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,939.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,811.79
|
| Rate for Payer: Cash Price |
$986.10
|
| Rate for Payer: Cigna Commercial |
$3,145.00
|
| Rate for Payer: Health EOS Commercial |
$3,042.45
|
| Rate for Payer: HFN Commercial |
$3,145.00
|
| Rate for Payer: Multiplan Commercial |
$2,734.78
|
| Rate for Payer: Preferred Network Access Commercial |
$3,145.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,675.06
|
| Rate for Payer: Quartz Commercial |
$2,051.09
|
| Rate for Payer: WEA Trust Commercial |
$1,880.16
|
| Rate for Payer: WPS Commercial |
$2,531.98
|
|
|
SCREW HEADLESS 2.0 X 16 317-2016
|
Facility
|
OP
|
$3,287.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2965460
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$957.17 |
| Max. Negotiated Rate |
$3,145.00 |
| Rate for Payer: Aetna Commercial |
$3,076.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,939.89
|
| Rate for Payer: Aetna Managed Medicare |
$957.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,222.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,709.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,640.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,811.79
|
| Rate for Payer: Cash Price |
$986.10
|
| Rate for Payer: Cigna Commercial |
$3,145.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,913.03
|
| Rate for Payer: Health EOS Commercial |
$3,042.45
|
| Rate for Payer: HFN Commercial |
$3,145.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,563.86
|
| Rate for Payer: Multiplan Commercial |
$2,734.78
|
| Rate for Payer: NAPHCARE Commercial |
$2,051.09
|
| Rate for Payer: Preferred Network Access Commercial |
$3,145.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,675.06
|
| Rate for Payer: Quartz Commercial |
$2,222.01
|
| Rate for Payer: Quartz Medicare Advantage |
$2,051.09
|
| Rate for Payer: The Alliance Commercial |
$1,709.24
|
| Rate for Payer: WEA Trust Commercial |
$1,880.16
|
| Rate for Payer: WPS Commercial |
$2,531.98
|
|
|
SCREW HEADLESS 2.0 X 18 317-2018
|
Facility
|
OP
|
$3,287.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2965462
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$957.17 |
| Max. Negotiated Rate |
$3,145.00 |
| Rate for Payer: Aetna Commercial |
$3,076.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,939.89
|
| Rate for Payer: Aetna Managed Medicare |
$957.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,222.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,709.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,640.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,811.79
|
| Rate for Payer: Cash Price |
$986.10
|
| Rate for Payer: Cigna Commercial |
$3,145.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,913.03
|
| Rate for Payer: Health EOS Commercial |
$3,042.45
|
| Rate for Payer: HFN Commercial |
$3,145.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,563.86
|
| Rate for Payer: Multiplan Commercial |
$2,734.78
|
| Rate for Payer: NAPHCARE Commercial |
$2,051.09
|
| Rate for Payer: Preferred Network Access Commercial |
$3,145.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,675.06
|
| Rate for Payer: Quartz Commercial |
$2,222.01
|
| Rate for Payer: Quartz Medicare Advantage |
$2,051.09
|
| Rate for Payer: The Alliance Commercial |
$1,709.24
|
| Rate for Payer: WEA Trust Commercial |
$1,880.16
|
| Rate for Payer: WPS Commercial |
$2,531.98
|
|
|
SCREW HEADLESS 2.0 X 18 317-2018
|
Facility
|
IP
|
$3,287.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2965462
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,675.06 |
| Max. Negotiated Rate |
$3,145.00 |
| Rate for Payer: Aetna Commercial |
$3,076.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,939.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,811.79
|
| Rate for Payer: Cash Price |
$986.10
|
| Rate for Payer: Cigna Commercial |
$3,145.00
|
| Rate for Payer: Health EOS Commercial |
$3,042.45
|
| Rate for Payer: HFN Commercial |
$3,145.00
|
| Rate for Payer: Multiplan Commercial |
$2,734.78
|
| Rate for Payer: Preferred Network Access Commercial |
$3,145.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,675.06
|
| Rate for Payer: Quartz Commercial |
$2,051.09
|
| Rate for Payer: WEA Trust Commercial |
$1,880.16
|
| Rate for Payer: WPS Commercial |
$2,531.98
|
|
