|
SCREW LOCK LG HD 3.5 X 18MM ORTHOLOC 58803518
|
Facility
|
IP
|
$3,369.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5895661
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,650.81 |
| Max. Negotiated Rate |
$3,099.48 |
| Rate for Payer: Aetna Commercial |
$3,032.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,897.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,785.57
|
| Rate for Payer: Cash Price |
$1,010.70
|
| Rate for Payer: Cigna Commercial |
$3,099.48
|
| Rate for Payer: Health EOS Commercial |
$2,998.41
|
| Rate for Payer: HFN Commercial |
$3,099.48
|
| Rate for Payer: Multiplan Commercial |
$2,695.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,021.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,099.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,650.81
|
| Rate for Payer: Quartz Commercial |
$2,021.40
|
| Rate for Payer: WEA Trust Commercial |
$1,852.95
|
| Rate for Payer: WPS Commercial |
$2,495.42
|
|
|
SCREW LOCK LG HD 3.5 X 18MM ORTHOLOC 58803518
|
Facility
|
OP
|
$3,369.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5895661
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$943.32 |
| Max. Negotiated Rate |
$13,476.00 |
| Rate for Payer: Aetna Commercial |
$3,032.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,897.34
|
| Rate for Payer: Aetna Managed Medicare |
$943.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,189.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,684.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,617.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,785.57
|
| Rate for Payer: Cash Price |
$1,010.70
|
| Rate for Payer: Cigna Commercial |
$3,099.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,885.29
|
| Rate for Payer: Health EOS Commercial |
$2,998.41
|
| Rate for Payer: HFN Commercial |
$3,099.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,526.75
|
| Rate for Payer: Multiplan Commercial |
$2,695.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,021.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,099.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,650.81
|
| Rate for Payer: Quartz Commercial |
$2,189.85
|
| Rate for Payer: Quartz Medicare Advantage |
$2,021.40
|
| Rate for Payer: The Alliance Commercial |
$13,476.00
|
| Rate for Payer: WEA Trust Commercial |
$1,852.95
|
| Rate for Payer: WPS Commercial |
$2,495.42
|
|
|
SCREW LOCK LG HD 3.5 X 24MM ORTHOLOC 58803524
|
Facility
|
OP
|
$2,853.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6175188
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$798.84 |
| Max. Negotiated Rate |
$11,412.00 |
| Rate for Payer: Aetna Commercial |
$2,567.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,453.58
|
| Rate for Payer: Aetna Managed Medicare |
$798.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,854.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,426.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,369.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,512.09
|
| Rate for Payer: Cash Price |
$855.90
|
| Rate for Payer: Cigna Commercial |
$2,624.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,596.54
|
| Rate for Payer: Health EOS Commercial |
$2,539.17
|
| Rate for Payer: HFN Commercial |
$2,624.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,139.75
|
| Rate for Payer: Multiplan Commercial |
$2,282.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,711.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,624.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,397.97
|
| Rate for Payer: Quartz Commercial |
$1,854.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,711.80
|
| Rate for Payer: The Alliance Commercial |
$11,412.00
|
| Rate for Payer: WEA Trust Commercial |
$1,569.15
|
| Rate for Payer: WPS Commercial |
$2,113.22
|
|
|
SCREW LOCK LG HD 3.5 X 24MM ORTHOLOC 58803524
|
Facility
|
IP
|
$2,853.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6175188
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,397.97 |
| Max. Negotiated Rate |
$2,624.76 |
| Rate for Payer: Aetna Commercial |
$2,567.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,453.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,512.09
|
| Rate for Payer: Cash Price |
$855.90
|
| Rate for Payer: Cigna Commercial |
$2,624.76
|
| Rate for Payer: Health EOS Commercial |
$2,539.17
|
| Rate for Payer: HFN Commercial |
$2,624.76
|
| Rate for Payer: Multiplan Commercial |
$2,282.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,711.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,624.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,397.97
|
| Rate for Payer: Quartz Commercial |
$1,711.80
|
| Rate for Payer: WEA Trust Commercial |
$1,569.15
|
| Rate for Payer: WPS Commercial |
$2,113.22
|
|
|
SCREW LOCK LG HD 3.5 X 30MM ORTHOLOC 58803530
|
Facility
|
OP
|
$3,496.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6171778
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$978.88 |
| Max. Negotiated Rate |
$13,984.00 |
| Rate for Payer: Aetna Commercial |
$3,146.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,006.56
|
| Rate for Payer: Aetna Managed Medicare |
$978.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,272.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,748.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,678.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,852.88
|
| Rate for Payer: Cash Price |
$1,048.80
|
| Rate for Payer: Cigna Commercial |
$3,216.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,956.36
|
| Rate for Payer: Health EOS Commercial |
$3,111.44
|
| Rate for Payer: HFN Commercial |
$3,216.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,622.00
|
| Rate for Payer: Multiplan Commercial |
$2,796.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,097.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,216.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,713.04
|
| Rate for Payer: Quartz Commercial |
$2,272.40
|
| Rate for Payer: Quartz Medicare Advantage |
$2,097.60
|
| Rate for Payer: The Alliance Commercial |
$13,984.00
|
| Rate for Payer: WEA Trust Commercial |
$1,922.80
|
| Rate for Payer: WPS Commercial |
$2,589.49
|
|
|
SCREW LOCK LG HD 3.5 X 30MM ORTHOLOC 58803530
|
Facility
|
IP
|
$3,496.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6171778
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,713.04 |
| Max. Negotiated Rate |
$3,216.32 |
| Rate for Payer: Aetna Commercial |
$3,146.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,006.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,852.88
|
| Rate for Payer: Cash Price |
$1,048.80
|
| Rate for Payer: Cigna Commercial |
$3,216.32
|
| Rate for Payer: Health EOS Commercial |
$3,111.44
|
| Rate for Payer: HFN Commercial |
$3,216.32
|
| Rate for Payer: Multiplan Commercial |
$2,796.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,097.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,216.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,713.04
|
| Rate for Payer: Quartz Commercial |
$2,097.60
|
| Rate for Payer: WEA Trust Commercial |
$1,922.80
|
| Rate for Payer: WPS Commercial |
$2,589.49
|
|
|
SCREW LOCK LG HD 3.5 X 32MM ORTHOLOC 58803532
|
Facility
|
OP
|
$1,751.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6185018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$490.28 |
| Max. Negotiated Rate |
$7,004.00 |
| Rate for Payer: Aetna Commercial |
$1,575.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,505.86
|
| Rate for Payer: Aetna Managed Medicare |
$490.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,138.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$875.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$840.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$928.03
|
| Rate for Payer: Cash Price |
$525.30
|
| Rate for Payer: Cigna Commercial |
$1,610.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$979.86
|
| Rate for Payer: Health EOS Commercial |
$1,558.39
|
| Rate for Payer: HFN Commercial |
$1,610.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,313.25
|
| Rate for Payer: Multiplan Commercial |
$1,400.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,050.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,610.92
|
| Rate for Payer: Quartz Beloit One Network |
$857.99
|
| Rate for Payer: Quartz Commercial |
$1,138.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,050.60
|
| Rate for Payer: The Alliance Commercial |
$7,004.00
|
| Rate for Payer: WEA Trust Commercial |
$963.05
|
| Rate for Payer: WPS Commercial |
$1,296.97
|
|
|
SCREW LOCK LG HD 3.5 X 32MM ORTHOLOC 58803532
|
Facility
|
IP
|
$1,751.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6185018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$857.99 |
| Max. Negotiated Rate |
$1,610.92 |
| Rate for Payer: Aetna Commercial |
$1,575.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,505.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$928.03
|
| Rate for Payer: Cash Price |
$525.30
|
| Rate for Payer: Cigna Commercial |
$1,610.92
|
| Rate for Payer: Health EOS Commercial |
$1,558.39
|
| Rate for Payer: HFN Commercial |
$1,610.92
|
| Rate for Payer: Multiplan Commercial |
$1,400.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,050.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,610.92
|
| Rate for Payer: Quartz Beloit One Network |
$857.99
|
| Rate for Payer: Quartz Commercial |
$1,050.60
|
| Rate for Payer: WEA Trust Commercial |
$963.05
|
| Rate for Payer: WPS Commercial |
$1,296.97
|
|
|
SCREW LOCK LG HD 3.5 X 34MM ORTHOLOC 58803534
|
Facility
|
OP
|
$1,751.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6185019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$490.28 |
| Max. Negotiated Rate |
$7,004.00 |
| Rate for Payer: Aetna Commercial |
$1,575.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,505.86
|
| Rate for Payer: Aetna Managed Medicare |
$490.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,138.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$875.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$840.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$928.03
|
| Rate for Payer: Cash Price |
$525.30
|
| Rate for Payer: Cigna Commercial |
$1,610.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$979.86
|
| Rate for Payer: Health EOS Commercial |
$1,558.39
|
| Rate for Payer: HFN Commercial |
$1,610.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,313.25
|
| Rate for Payer: Multiplan Commercial |
$1,400.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,050.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,610.92
|
| Rate for Payer: Quartz Beloit One Network |
$857.99
|
| Rate for Payer: Quartz Commercial |
$1,138.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,050.60
|
| Rate for Payer: The Alliance Commercial |
$7,004.00
|
| Rate for Payer: WEA Trust Commercial |
$963.05
|
| Rate for Payer: WPS Commercial |
$1,296.97
|
|
|
SCREW LOCK LG HD 3.5 X 34MM ORTHOLOC 58803534
|
Facility
|
IP
|
$1,751.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6185019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$857.99 |
| Max. Negotiated Rate |
$1,610.92 |
| Rate for Payer: Aetna Commercial |
$1,575.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,505.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$928.03
|
| Rate for Payer: Cash Price |
$525.30
|
| Rate for Payer: Cigna Commercial |
$1,610.92
|
| Rate for Payer: Health EOS Commercial |
$1,558.39
|
| Rate for Payer: HFN Commercial |
$1,610.92
|
| Rate for Payer: Multiplan Commercial |
$1,400.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,050.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,610.92
|
| Rate for Payer: Quartz Beloit One Network |
$857.99
|
| Rate for Payer: Quartz Commercial |
$1,050.60
|
| Rate for Payer: WEA Trust Commercial |
$963.05
|
| Rate for Payer: WPS Commercial |
$1,296.97
|
|
|
SCREW LOCK LG HD 3.5 X 36MM ORTHOLOC 58803536
|
Facility
|
OP
|
$1,751.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6185020
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$490.28 |
| Max. Negotiated Rate |
$7,004.00 |
| Rate for Payer: Aetna Commercial |
$1,575.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,505.86
|
| Rate for Payer: Aetna Managed Medicare |
$490.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,138.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$875.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$840.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$928.03
|
| Rate for Payer: Cash Price |
$525.30
|
| Rate for Payer: Cigna Commercial |
$1,610.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$979.86
|
| Rate for Payer: Health EOS Commercial |
$1,558.39
|
| Rate for Payer: HFN Commercial |
$1,610.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,313.25
|
| Rate for Payer: Multiplan Commercial |
$1,400.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,050.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,610.92
|
| Rate for Payer: Quartz Beloit One Network |
$857.99
|
| Rate for Payer: Quartz Commercial |
$1,138.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,050.60
|
| Rate for Payer: The Alliance Commercial |
$7,004.00
|
| Rate for Payer: WEA Trust Commercial |
$963.05
|
| Rate for Payer: WPS Commercial |
$1,296.97
|
|
|
SCREW LOCK LG HD 3.5 X 36MM ORTHOLOC 58803536
|
Facility
|
IP
|
$1,751.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6185020
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$857.99 |
| Max. Negotiated Rate |
$1,610.92 |
| Rate for Payer: Aetna Commercial |
$1,575.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,505.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$928.03
|
| Rate for Payer: Cash Price |
$525.30
|
| Rate for Payer: Cigna Commercial |
$1,610.92
|
| Rate for Payer: Health EOS Commercial |
$1,558.39
|
| Rate for Payer: HFN Commercial |
$1,610.92
|
| Rate for Payer: Multiplan Commercial |
$1,400.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,050.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,610.92
|
| Rate for Payer: Quartz Beloit One Network |
$857.99
|
| Rate for Payer: Quartz Commercial |
$1,050.60
|
| Rate for Payer: WEA Trust Commercial |
$963.05
|
| Rate for Payer: WPS Commercial |
$1,296.97
|
|
|
SCREW LOCK LG HD 3.5 X 38MM ORTHOLOC 58803538
|
Facility
|
IP
|
$3,496.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6171779
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,713.04 |
| Max. Negotiated Rate |
$3,216.32 |
| Rate for Payer: Aetna Commercial |
$3,146.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,006.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,852.88
|
| Rate for Payer: Cash Price |
$1,048.80
|
| Rate for Payer: Cigna Commercial |
$3,216.32
|
| Rate for Payer: Health EOS Commercial |
$3,111.44
|
| Rate for Payer: HFN Commercial |
$3,216.32
|
| Rate for Payer: Multiplan Commercial |
$2,796.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,097.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,216.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,713.04
|
| Rate for Payer: Quartz Commercial |
$2,097.60
|
| Rate for Payer: WEA Trust Commercial |
$1,922.80
|
| Rate for Payer: WPS Commercial |
$2,589.49
|
|
|
SCREW LOCK LG HD 3.5 X 38MM ORTHOLOC 58803538
|
Facility
|
OP
|
$3,496.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6171779
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$978.88 |
| Max. Negotiated Rate |
$13,984.00 |
| Rate for Payer: Aetna Commercial |
$3,146.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,006.56
|
| Rate for Payer: Aetna Managed Medicare |
$978.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,272.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,748.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,678.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,852.88
|
| Rate for Payer: Cash Price |
$1,048.80
|
| Rate for Payer: Cigna Commercial |
$3,216.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,956.36
|
| Rate for Payer: Health EOS Commercial |
$3,111.44
|
| Rate for Payer: HFN Commercial |
$3,216.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,622.00
|
| Rate for Payer: Multiplan Commercial |
$2,796.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,097.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,216.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,713.04
|
| Rate for Payer: Quartz Commercial |
$2,272.40
|
| Rate for Payer: Quartz Medicare Advantage |
$2,097.60
|
| Rate for Payer: The Alliance Commercial |
$13,984.00
|
| Rate for Payer: WEA Trust Commercial |
$1,922.80
|
| Rate for Payer: WPS Commercial |
$2,589.49
|
|
|
SCREW LOCK LG HD 3.5 X 46MM ORTHOLOC 58803546
|
Facility
|
OP
|
$2,743.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6228139
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$768.04 |
| Max. Negotiated Rate |
$10,972.00 |
| Rate for Payer: Aetna Commercial |
$2,468.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,358.98
|
| Rate for Payer: Aetna Managed Medicare |
$768.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,782.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,371.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,316.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,453.79
|
| Rate for Payer: Cash Price |
$822.90
|
| Rate for Payer: Cigna Commercial |
$2,523.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,534.98
|
| Rate for Payer: Health EOS Commercial |
$2,441.27
|
| Rate for Payer: HFN Commercial |
$2,523.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,057.25
|
| Rate for Payer: Multiplan Commercial |
$2,194.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,645.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,523.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,344.07
|
| Rate for Payer: Quartz Commercial |
$1,782.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,645.80
|
| Rate for Payer: The Alliance Commercial |
$10,972.00
|
| Rate for Payer: WEA Trust Commercial |
$1,508.65
|
| Rate for Payer: WPS Commercial |
$2,031.74
|
|
|
SCREW LOCK LG HD 3.5 X 46MM ORTHOLOC 58803546
|
Facility
|
IP
|
$2,743.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6228139
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,344.07 |
| Max. Negotiated Rate |
$2,523.56 |
| Rate for Payer: Aetna Commercial |
$2,468.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,358.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,453.79
|
| Rate for Payer: Cash Price |
$822.90
|
| Rate for Payer: Cigna Commercial |
$2,523.56
|
| Rate for Payer: Health EOS Commercial |
$2,441.27
|
| Rate for Payer: HFN Commercial |
$2,523.56
|
| Rate for Payer: Multiplan Commercial |
$2,194.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,645.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,523.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,344.07
|
| Rate for Payer: Quartz Commercial |
$1,645.80
|
| Rate for Payer: WEA Trust Commercial |
$1,508.65
|
| Rate for Payer: WPS Commercial |
$2,031.74
|
|
|
SCREW LOCK LG HD 3.5 X 50MM ORTHOLOC 58803550
|
Facility
|
IP
|
$2,743.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6228140
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,344.07 |
| Max. Negotiated Rate |
$2,523.56 |
| Rate for Payer: Aetna Commercial |
$2,468.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,358.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,453.79
|
| Rate for Payer: Cash Price |
$822.90
|
| Rate for Payer: Cigna Commercial |
$2,523.56
|
| Rate for Payer: Health EOS Commercial |
$2,441.27
|
| Rate for Payer: HFN Commercial |
$2,523.56
|
| Rate for Payer: Multiplan Commercial |
$2,194.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,645.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,523.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,344.07
|
| Rate for Payer: Quartz Commercial |
$1,645.80
|
| Rate for Payer: WEA Trust Commercial |
$1,508.65
|
| Rate for Payer: WPS Commercial |
$2,031.74
|
|
|
SCREW LOCK LG HD 3.5 X 50MM ORTHOLOC 58803550
|
Facility
|
OP
|
$2,743.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6228140
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$768.04 |
| Max. Negotiated Rate |
$10,972.00 |
| Rate for Payer: Aetna Commercial |
$2,468.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,358.98
|
| Rate for Payer: Aetna Managed Medicare |
$768.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,782.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,371.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,316.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,453.79
|
| Rate for Payer: Cash Price |
$822.90
|
| Rate for Payer: Cigna Commercial |
$2,523.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,534.98
|
| Rate for Payer: Health EOS Commercial |
$2,441.27
|
| Rate for Payer: HFN Commercial |
$2,523.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,057.25
|
| Rate for Payer: Multiplan Commercial |
$2,194.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,645.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,523.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,344.07
|
| Rate for Payer: Quartz Commercial |
$1,782.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,645.80
|
| Rate for Payer: The Alliance Commercial |
$10,972.00
|
| Rate for Payer: WEA Trust Commercial |
$1,508.65
|
| Rate for Payer: WPS Commercial |
$2,031.74
|
|
|
SCREW LOCK LP 3.5 X 10MM BRONZE ORTHOLOC 58813510
|
Facility
|
OP
|
$1,751.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6211039
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$490.28 |
| Max. Negotiated Rate |
$7,004.00 |
| Rate for Payer: Aetna Commercial |
$1,575.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,505.86
|
| Rate for Payer: Aetna Managed Medicare |
$490.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,138.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$875.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$840.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$928.03
|
| Rate for Payer: Cash Price |
$525.30
|
| Rate for Payer: Cigna Commercial |
$1,610.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$979.86
|
| Rate for Payer: Health EOS Commercial |
$1,558.39
|
| Rate for Payer: HFN Commercial |
$1,610.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,313.25
|
| Rate for Payer: Multiplan Commercial |
$1,400.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,050.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,610.92
|
| Rate for Payer: Quartz Beloit One Network |
$857.99
|
| Rate for Payer: Quartz Commercial |
$1,138.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,050.60
|
| Rate for Payer: The Alliance Commercial |
$7,004.00
|
| Rate for Payer: WEA Trust Commercial |
$963.05
|
| Rate for Payer: WPS Commercial |
$1,296.97
|
|
|
SCREW LOCK LP 3.5 X 10MM BRONZE ORTHOLOC 58813510
|
Facility
|
IP
|
$1,751.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6211039
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$857.99 |
| Max. Negotiated Rate |
$1,610.92 |
| Rate for Payer: Aetna Commercial |
$1,575.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,505.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$928.03
|
| Rate for Payer: Cash Price |
$525.30
|
| Rate for Payer: Cigna Commercial |
$1,610.92
|
| Rate for Payer: Health EOS Commercial |
$1,558.39
|
| Rate for Payer: HFN Commercial |
$1,610.92
|
| Rate for Payer: Multiplan Commercial |
$1,400.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,050.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,610.92
|
| Rate for Payer: Quartz Beloit One Network |
$857.99
|
| Rate for Payer: Quartz Commercial |
$1,050.60
|
| Rate for Payer: WEA Trust Commercial |
$963.05
|
| Rate for Payer: WPS Commercial |
$1,296.97
|
|
|
SCREW LOCK LP 3.5 X 12MM BRONZE ORTHOLOC 58813512
|
Facility
|
IP
|
$1,792.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5729837
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$878.08 |
| Max. Negotiated Rate |
$1,648.64 |
| Rate for Payer: Aetna Commercial |
$1,612.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,541.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$949.76
|
| Rate for Payer: Cash Price |
$537.60
|
| Rate for Payer: Cigna Commercial |
$1,648.64
|
| Rate for Payer: Health EOS Commercial |
$1,594.88
|
| Rate for Payer: HFN Commercial |
$1,648.64
|
| Rate for Payer: Multiplan Commercial |
$1,433.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,075.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,648.64
|
| Rate for Payer: Quartz Beloit One Network |
$878.08
|
| Rate for Payer: Quartz Commercial |
$1,075.20
|
| Rate for Payer: WEA Trust Commercial |
$985.60
|
| Rate for Payer: WPS Commercial |
$1,327.33
|
|
|
SCREW LOCK LP 3.5 X 12MM BRONZE ORTHOLOC 58813512
|
Facility
|
OP
|
$1,792.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5729837
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$501.76 |
| Max. Negotiated Rate |
$7,168.00 |
| Rate for Payer: Aetna Commercial |
$1,612.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,541.12
|
| Rate for Payer: Aetna Managed Medicare |
$501.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,164.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$896.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$860.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$949.76
|
| Rate for Payer: Cash Price |
$537.60
|
| Rate for Payer: Cigna Commercial |
$1,648.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,002.80
|
| Rate for Payer: Health EOS Commercial |
$1,594.88
|
| Rate for Payer: HFN Commercial |
$1,648.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,344.00
|
| Rate for Payer: Multiplan Commercial |
$1,433.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,075.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,648.64
|
| Rate for Payer: Quartz Beloit One Network |
$878.08
|
| Rate for Payer: Quartz Commercial |
$1,164.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,075.20
|
| Rate for Payer: The Alliance Commercial |
$7,168.00
|
| Rate for Payer: WEA Trust Commercial |
$985.60
|
| Rate for Payer: WPS Commercial |
$1,327.33
|
|
|
SCREW LOCK LP 3.5 X 14MM BRONZE ORTHOLOC 58813514
|
Facility
|
IP
|
$1,792.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5729838
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$878.08 |
| Max. Negotiated Rate |
$1,648.64 |
| Rate for Payer: Aetna Commercial |
$1,612.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,541.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$949.76
|
| Rate for Payer: Cash Price |
$537.60
|
| Rate for Payer: Cigna Commercial |
$1,648.64
|
| Rate for Payer: Health EOS Commercial |
$1,594.88
|
| Rate for Payer: HFN Commercial |
$1,648.64
|
| Rate for Payer: Multiplan Commercial |
$1,433.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,075.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,648.64
|
| Rate for Payer: Quartz Beloit One Network |
$878.08
|
| Rate for Payer: Quartz Commercial |
$1,075.20
|
| Rate for Payer: WEA Trust Commercial |
$985.60
|
| Rate for Payer: WPS Commercial |
$1,327.33
|
|
|
SCREW LOCK LP 3.5 X 14MM BRONZE ORTHOLOC 58813514
|
Facility
|
OP
|
$1,792.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5729838
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$501.76 |
| Max. Negotiated Rate |
$7,168.00 |
| Rate for Payer: Aetna Commercial |
$1,612.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,541.12
|
| Rate for Payer: Aetna Managed Medicare |
$501.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,164.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$896.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$860.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$949.76
|
| Rate for Payer: Cash Price |
$537.60
|
| Rate for Payer: Cigna Commercial |
$1,648.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,002.80
|
| Rate for Payer: Health EOS Commercial |
$1,594.88
|
| Rate for Payer: HFN Commercial |
$1,648.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,344.00
|
| Rate for Payer: Multiplan Commercial |
$1,433.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,075.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,648.64
|
| Rate for Payer: Quartz Beloit One Network |
$878.08
|
| Rate for Payer: Quartz Commercial |
$1,164.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,075.20
|
| Rate for Payer: The Alliance Commercial |
$7,168.00
|
| Rate for Payer: WEA Trust Commercial |
$985.60
|
| Rate for Payer: WPS Commercial |
$1,327.33
|
|
|
SCREW LOCK LP 3.5 X 16MM BRONZE ORTHOLOC 58813516
|
Facility
|
IP
|
$1,792.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459799
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$878.08 |
| Max. Negotiated Rate |
$1,648.64 |
| Rate for Payer: Aetna Commercial |
$1,612.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,541.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$949.76
|
| Rate for Payer: Cash Price |
$537.60
|
| Rate for Payer: Cigna Commercial |
$1,648.64
|
| Rate for Payer: Health EOS Commercial |
$1,594.88
|
| Rate for Payer: HFN Commercial |
$1,648.64
|
| Rate for Payer: Multiplan Commercial |
$1,433.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,075.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,648.64
|
| Rate for Payer: Quartz Beloit One Network |
$878.08
|
| Rate for Payer: Quartz Commercial |
$1,075.20
|
| Rate for Payer: WEA Trust Commercial |
$985.60
|
| Rate for Payer: WPS Commercial |
$1,327.33
|
|
