|
SCREW LOCK VA 3.5 X 18MM TI AR-8735L-18
|
Facility
|
OP
|
$1,255.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6175179
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$351.40 |
| Max. Negotiated Rate |
$5,020.00 |
| Rate for Payer: Aetna Commercial |
$1,129.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,079.30
|
| Rate for Payer: Aetna Managed Medicare |
$351.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$815.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$627.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$602.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$665.15
|
| Rate for Payer: Cash Price |
$376.50
|
| Rate for Payer: Cigna Commercial |
$1,154.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$702.30
|
| Rate for Payer: Health EOS Commercial |
$1,116.95
|
| Rate for Payer: HFN Commercial |
$1,154.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$941.25
|
| Rate for Payer: Multiplan Commercial |
$1,004.00
|
| Rate for Payer: NAPHCARE Commercial |
$753.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,154.60
|
| Rate for Payer: Quartz Beloit One Network |
$614.95
|
| Rate for Payer: Quartz Commercial |
$815.75
|
| Rate for Payer: Quartz Medicare Advantage |
$753.00
|
| Rate for Payer: The Alliance Commercial |
$5,020.00
|
| Rate for Payer: WEA Trust Commercial |
$690.25
|
| Rate for Payer: WPS Commercial |
$929.58
|
|
|
SCREW MALL 4.5 X 25 215.025
|
Facility
|
IP
|
$262.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967317
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$128.38 |
| Max. Negotiated Rate |
$241.04 |
| Rate for Payer: Aetna Commercial |
$235.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$225.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$138.86
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$241.04
|
| Rate for Payer: Health EOS Commercial |
$233.18
|
| Rate for Payer: HFN Commercial |
$241.04
|
| Rate for Payer: Multiplan Commercial |
$209.60
|
| Rate for Payer: NAPHCARE Commercial |
$157.20
|
| Rate for Payer: Preferred Network Access Commercial |
$241.04
|
| Rate for Payer: Quartz Beloit One Network |
$128.38
|
| Rate for Payer: Quartz Commercial |
$157.20
|
| Rate for Payer: WEA Trust Commercial |
$144.10
|
| Rate for Payer: WPS Commercial |
$194.06
|
|
|
SCREW MALL 4.5 X 25 215.025
|
Facility
|
OP
|
$262.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967317
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$73.36 |
| Max. Negotiated Rate |
$1,048.00 |
| Rate for Payer: Aetna Commercial |
$235.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$225.32
|
| Rate for Payer: Aetna Managed Medicare |
$73.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$170.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$131.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$125.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$138.86
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$241.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$146.62
|
| Rate for Payer: Health EOS Commercial |
$233.18
|
| Rate for Payer: HFN Commercial |
$241.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$196.50
|
| Rate for Payer: Multiplan Commercial |
$209.60
|
| Rate for Payer: NAPHCARE Commercial |
$157.20
|
| Rate for Payer: Preferred Network Access Commercial |
$241.04
|
| Rate for Payer: Quartz Beloit One Network |
$128.38
|
| Rate for Payer: Quartz Commercial |
$170.30
|
| Rate for Payer: Quartz Medicare Advantage |
$157.20
|
| Rate for Payer: The Alliance Commercial |
$1,048.00
|
| Rate for Payer: WEA Trust Commercial |
$144.10
|
| Rate for Payer: WPS Commercial |
$194.06
|
|
|
SCREW MALL 4.5 X 30 215.030
|
Facility
|
OP
|
$262.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967318
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$73.36 |
| Max. Negotiated Rate |
$1,048.00 |
| Rate for Payer: Aetna Commercial |
$235.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$225.32
|
| Rate for Payer: Aetna Managed Medicare |
$73.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$170.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$131.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$125.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$138.86
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$241.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$146.62
|
| Rate for Payer: Health EOS Commercial |
$233.18
|
| Rate for Payer: HFN Commercial |
$241.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$196.50
|
| Rate for Payer: Multiplan Commercial |
$209.60
|
| Rate for Payer: NAPHCARE Commercial |
$157.20
|
| Rate for Payer: Preferred Network Access Commercial |
$241.04
|
| Rate for Payer: Quartz Beloit One Network |
$128.38
|
| Rate for Payer: Quartz Commercial |
$170.30
|
| Rate for Payer: Quartz Medicare Advantage |
$157.20
|
| Rate for Payer: The Alliance Commercial |
$1,048.00
|
| Rate for Payer: WEA Trust Commercial |
$144.10
|
| Rate for Payer: WPS Commercial |
$194.06
|
|
|
SCREW MALL 4.5 X 30 215.030
|
Facility
|
IP
|
$262.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967318
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$128.38 |
| Max. Negotiated Rate |
$241.04 |
| Rate for Payer: Aetna Commercial |
$235.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$225.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$138.86
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$241.04
|
| Rate for Payer: Health EOS Commercial |
$233.18
|
| Rate for Payer: HFN Commercial |
$241.04
|
| Rate for Payer: Multiplan Commercial |
$209.60
|
| Rate for Payer: NAPHCARE Commercial |
$157.20
|
| Rate for Payer: Preferred Network Access Commercial |
$241.04
|
| Rate for Payer: Quartz Beloit One Network |
$128.38
|
| Rate for Payer: Quartz Commercial |
$157.20
|
| Rate for Payer: WEA Trust Commercial |
$144.10
|
| Rate for Payer: WPS Commercial |
$194.06
|
|
|
SCREW MALL 4.5 X 35 215.035
|
Facility
|
OP
|
$262.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967319
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$73.36 |
| Max. Negotiated Rate |
$1,048.00 |
| Rate for Payer: Aetna Commercial |
$235.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$225.32
|
| Rate for Payer: Aetna Managed Medicare |
$73.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$170.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$131.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$125.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$138.86
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$241.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$146.62
|
| Rate for Payer: Health EOS Commercial |
$233.18
|
| Rate for Payer: HFN Commercial |
$241.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$196.50
|
| Rate for Payer: Multiplan Commercial |
$209.60
|
| Rate for Payer: NAPHCARE Commercial |
$157.20
|
| Rate for Payer: Preferred Network Access Commercial |
$241.04
|
| Rate for Payer: Quartz Beloit One Network |
$128.38
|
| Rate for Payer: Quartz Commercial |
$170.30
|
| Rate for Payer: Quartz Medicare Advantage |
$157.20
|
| Rate for Payer: The Alliance Commercial |
$1,048.00
|
| Rate for Payer: WEA Trust Commercial |
$144.10
|
| Rate for Payer: WPS Commercial |
$194.06
|
|
|
SCREW MALL 4.5 X 35 215.035
|
Facility
|
IP
|
$262.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967319
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$128.38 |
| Max. Negotiated Rate |
$241.04 |
| Rate for Payer: Aetna Commercial |
$235.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$225.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$138.86
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$241.04
|
| Rate for Payer: Health EOS Commercial |
$233.18
|
| Rate for Payer: HFN Commercial |
$241.04
|
| Rate for Payer: Multiplan Commercial |
$209.60
|
| Rate for Payer: NAPHCARE Commercial |
$157.20
|
| Rate for Payer: Preferred Network Access Commercial |
$241.04
|
| Rate for Payer: Quartz Beloit One Network |
$128.38
|
| Rate for Payer: Quartz Commercial |
$157.20
|
| Rate for Payer: WEA Trust Commercial |
$144.10
|
| Rate for Payer: WPS Commercial |
$194.06
|
|
|
SCREW MALL 4.5 X 40 215.040
|
Facility
|
OP
|
$262.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967320
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$73.36 |
| Max. Negotiated Rate |
$1,048.00 |
| Rate for Payer: Aetna Commercial |
$235.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$225.32
|
| Rate for Payer: Aetna Managed Medicare |
$73.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$170.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$131.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$125.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$138.86
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$241.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$146.62
|
| Rate for Payer: Health EOS Commercial |
$233.18
|
| Rate for Payer: HFN Commercial |
$241.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$196.50
|
| Rate for Payer: Multiplan Commercial |
$209.60
|
| Rate for Payer: NAPHCARE Commercial |
$157.20
|
| Rate for Payer: Preferred Network Access Commercial |
$241.04
|
| Rate for Payer: Quartz Beloit One Network |
$128.38
|
| Rate for Payer: Quartz Commercial |
$170.30
|
| Rate for Payer: Quartz Medicare Advantage |
$157.20
|
| Rate for Payer: The Alliance Commercial |
$1,048.00
|
| Rate for Payer: WEA Trust Commercial |
$144.10
|
| Rate for Payer: WPS Commercial |
$194.06
|
|
|
SCREW MALL 4.5 X 40 215.040
|
Facility
|
IP
|
$262.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967320
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$128.38 |
| Max. Negotiated Rate |
$241.04 |
| Rate for Payer: Aetna Commercial |
$235.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$225.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$138.86
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$241.04
|
| Rate for Payer: Health EOS Commercial |
$233.18
|
| Rate for Payer: HFN Commercial |
$241.04
|
| Rate for Payer: Multiplan Commercial |
$209.60
|
| Rate for Payer: NAPHCARE Commercial |
$157.20
|
| Rate for Payer: Preferred Network Access Commercial |
$241.04
|
| Rate for Payer: Quartz Beloit One Network |
$128.38
|
| Rate for Payer: Quartz Commercial |
$157.20
|
| Rate for Payer: WEA Trust Commercial |
$144.10
|
| Rate for Payer: WPS Commercial |
$194.06
|
|
|
SCREW MALL 4.5 X 45 215.045
|
Facility
|
IP
|
$262.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967321
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$128.38 |
| Max. Negotiated Rate |
$241.04 |
| Rate for Payer: Aetna Commercial |
$235.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$225.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$138.86
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$241.04
|
| Rate for Payer: Health EOS Commercial |
$233.18
|
| Rate for Payer: HFN Commercial |
$241.04
|
| Rate for Payer: Multiplan Commercial |
$209.60
|
| Rate for Payer: NAPHCARE Commercial |
$157.20
|
| Rate for Payer: Preferred Network Access Commercial |
$241.04
|
| Rate for Payer: Quartz Beloit One Network |
$128.38
|
| Rate for Payer: Quartz Commercial |
$157.20
|
| Rate for Payer: WEA Trust Commercial |
$144.10
|
| Rate for Payer: WPS Commercial |
$194.06
|
|
|
SCREW MALL 4.5 X 45 215.045
|
Facility
|
OP
|
$262.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967321
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$73.36 |
| Max. Negotiated Rate |
$1,048.00 |
| Rate for Payer: Aetna Commercial |
$235.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$225.32
|
| Rate for Payer: Aetna Managed Medicare |
$73.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$170.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$131.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$125.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$138.86
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$241.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$146.62
|
| Rate for Payer: Health EOS Commercial |
$233.18
|
| Rate for Payer: HFN Commercial |
$241.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$196.50
|
| Rate for Payer: Multiplan Commercial |
$209.60
|
| Rate for Payer: NAPHCARE Commercial |
$157.20
|
| Rate for Payer: Preferred Network Access Commercial |
$241.04
|
| Rate for Payer: Quartz Beloit One Network |
$128.38
|
| Rate for Payer: Quartz Commercial |
$170.30
|
| Rate for Payer: Quartz Medicare Advantage |
$157.20
|
| Rate for Payer: The Alliance Commercial |
$1,048.00
|
| Rate for Payer: WEA Trust Commercial |
$144.10
|
| Rate for Payer: WPS Commercial |
$194.06
|
|
|
SCREW MALL 4.5 X 50 215.050
|
Facility
|
IP
|
$262.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967322
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$128.38 |
| Max. Negotiated Rate |
$241.04 |
| Rate for Payer: Aetna Commercial |
$235.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$225.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$138.86
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$241.04
|
| Rate for Payer: Health EOS Commercial |
$233.18
|
| Rate for Payer: HFN Commercial |
$241.04
|
| Rate for Payer: Multiplan Commercial |
$209.60
|
| Rate for Payer: NAPHCARE Commercial |
$157.20
|
| Rate for Payer: Preferred Network Access Commercial |
$241.04
|
| Rate for Payer: Quartz Beloit One Network |
$128.38
|
| Rate for Payer: Quartz Commercial |
$157.20
|
| Rate for Payer: WEA Trust Commercial |
$144.10
|
| Rate for Payer: WPS Commercial |
$194.06
|
|
|
SCREW MALL 4.5 X 50 215.050
|
Facility
|
OP
|
$262.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967322
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$73.36 |
| Max. Negotiated Rate |
$1,048.00 |
| Rate for Payer: Aetna Commercial |
$235.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$225.32
|
| Rate for Payer: Aetna Managed Medicare |
$73.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$170.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$131.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$125.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$138.86
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$241.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$146.62
|
| Rate for Payer: Health EOS Commercial |
$233.18
|
| Rate for Payer: HFN Commercial |
$241.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$196.50
|
| Rate for Payer: Multiplan Commercial |
$209.60
|
| Rate for Payer: NAPHCARE Commercial |
$157.20
|
| Rate for Payer: Preferred Network Access Commercial |
$241.04
|
| Rate for Payer: Quartz Beloit One Network |
$128.38
|
| Rate for Payer: Quartz Commercial |
$170.30
|
| Rate for Payer: Quartz Medicare Advantage |
$157.20
|
| Rate for Payer: The Alliance Commercial |
$1,048.00
|
| Rate for Payer: WEA Trust Commercial |
$144.10
|
| Rate for Payer: WPS Commercial |
$194.06
|
|
|
SCREW MALL 4.5 X 55 215.055
|
Facility
|
IP
|
$262.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967323
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$128.38 |
| Max. Negotiated Rate |
$241.04 |
| Rate for Payer: Aetna Commercial |
$235.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$225.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$138.86
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$241.04
|
| Rate for Payer: Health EOS Commercial |
$233.18
|
| Rate for Payer: HFN Commercial |
$241.04
|
| Rate for Payer: Multiplan Commercial |
$209.60
|
| Rate for Payer: NAPHCARE Commercial |
$157.20
|
| Rate for Payer: Preferred Network Access Commercial |
$241.04
|
| Rate for Payer: Quartz Beloit One Network |
$128.38
|
| Rate for Payer: Quartz Commercial |
$157.20
|
| Rate for Payer: WEA Trust Commercial |
$144.10
|
| Rate for Payer: WPS Commercial |
$194.06
|
|
|
SCREW MALL 4.5 X 55 215.055
|
Facility
|
OP
|
$262.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967323
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$73.36 |
| Max. Negotiated Rate |
$1,048.00 |
| Rate for Payer: Aetna Commercial |
$235.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$225.32
|
| Rate for Payer: Aetna Managed Medicare |
$73.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$170.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$131.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$125.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$138.86
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$241.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$146.62
|
| Rate for Payer: Health EOS Commercial |
$233.18
|
| Rate for Payer: HFN Commercial |
$241.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$196.50
|
| Rate for Payer: Multiplan Commercial |
$209.60
|
| Rate for Payer: NAPHCARE Commercial |
$157.20
|
| Rate for Payer: Preferred Network Access Commercial |
$241.04
|
| Rate for Payer: Quartz Beloit One Network |
$128.38
|
| Rate for Payer: Quartz Commercial |
$170.30
|
| Rate for Payer: Quartz Medicare Advantage |
$157.20
|
| Rate for Payer: The Alliance Commercial |
$1,048.00
|
| Rate for Payer: WEA Trust Commercial |
$144.10
|
| Rate for Payer: WPS Commercial |
$194.06
|
|
|
SCREW MALL 4.5 X 60 215.060
|
Facility
|
OP
|
$262.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967324
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$73.36 |
| Max. Negotiated Rate |
$1,048.00 |
| Rate for Payer: Aetna Commercial |
$235.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$225.32
|
| Rate for Payer: Aetna Managed Medicare |
$73.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$170.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$131.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$125.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$138.86
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$241.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$146.62
|
| Rate for Payer: Health EOS Commercial |
$233.18
|
| Rate for Payer: HFN Commercial |
$241.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$196.50
|
| Rate for Payer: Multiplan Commercial |
$209.60
|
| Rate for Payer: NAPHCARE Commercial |
$157.20
|
| Rate for Payer: Preferred Network Access Commercial |
$241.04
|
| Rate for Payer: Quartz Beloit One Network |
$128.38
|
| Rate for Payer: Quartz Commercial |
$170.30
|
| Rate for Payer: Quartz Medicare Advantage |
$157.20
|
| Rate for Payer: The Alliance Commercial |
$1,048.00
|
| Rate for Payer: WEA Trust Commercial |
$144.10
|
| Rate for Payer: WPS Commercial |
$194.06
|
|
|
SCREW MALL 4.5 X 60 215.060
|
Facility
|
IP
|
$262.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967324
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$128.38 |
| Max. Negotiated Rate |
$241.04 |
| Rate for Payer: Aetna Commercial |
$235.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$225.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$138.86
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$241.04
|
| Rate for Payer: Health EOS Commercial |
$233.18
|
| Rate for Payer: HFN Commercial |
$241.04
|
| Rate for Payer: Multiplan Commercial |
$209.60
|
| Rate for Payer: NAPHCARE Commercial |
$157.20
|
| Rate for Payer: Preferred Network Access Commercial |
$241.04
|
| Rate for Payer: Quartz Beloit One Network |
$128.38
|
| Rate for Payer: Quartz Commercial |
$157.20
|
| Rate for Payer: WEA Trust Commercial |
$144.10
|
| Rate for Payer: WPS Commercial |
$194.06
|
|
|
SCREW MALL 4.5 X 65 215.065
|
Facility
|
IP
|
$262.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967325
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$128.38 |
| Max. Negotiated Rate |
$241.04 |
| Rate for Payer: Aetna Commercial |
$235.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$225.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$138.86
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$241.04
|
| Rate for Payer: Health EOS Commercial |
$233.18
|
| Rate for Payer: HFN Commercial |
$241.04
|
| Rate for Payer: Multiplan Commercial |
$209.60
|
| Rate for Payer: NAPHCARE Commercial |
$157.20
|
| Rate for Payer: Preferred Network Access Commercial |
$241.04
|
| Rate for Payer: Quartz Beloit One Network |
$128.38
|
| Rate for Payer: Quartz Commercial |
$157.20
|
| Rate for Payer: WEA Trust Commercial |
$144.10
|
| Rate for Payer: WPS Commercial |
$194.06
|
|
|
SCREW MALL 4.5 X 65 215.065
|
Facility
|
OP
|
$262.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967325
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$73.36 |
| Max. Negotiated Rate |
$1,048.00 |
| Rate for Payer: Aetna Commercial |
$235.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$225.32
|
| Rate for Payer: Aetna Managed Medicare |
$73.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$170.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$131.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$125.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$138.86
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$241.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$146.62
|
| Rate for Payer: Health EOS Commercial |
$233.18
|
| Rate for Payer: HFN Commercial |
$241.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$196.50
|
| Rate for Payer: Multiplan Commercial |
$209.60
|
| Rate for Payer: NAPHCARE Commercial |
$157.20
|
| Rate for Payer: Preferred Network Access Commercial |
$241.04
|
| Rate for Payer: Quartz Beloit One Network |
$128.38
|
| Rate for Payer: Quartz Commercial |
$170.30
|
| Rate for Payer: Quartz Medicare Advantage |
$157.20
|
| Rate for Payer: The Alliance Commercial |
$1,048.00
|
| Rate for Payer: WEA Trust Commercial |
$144.10
|
| Rate for Payer: WPS Commercial |
$194.06
|
|
|
SCREW MALL 4.5 X 70 215.070
|
Facility
|
OP
|
$262.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967326
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$73.36 |
| Max. Negotiated Rate |
$1,048.00 |
| Rate for Payer: Aetna Commercial |
$235.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$225.32
|
| Rate for Payer: Aetna Managed Medicare |
$73.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$170.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$131.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$125.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$138.86
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$241.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$146.62
|
| Rate for Payer: Health EOS Commercial |
$233.18
|
| Rate for Payer: HFN Commercial |
$241.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$196.50
|
| Rate for Payer: Multiplan Commercial |
$209.60
|
| Rate for Payer: NAPHCARE Commercial |
$157.20
|
| Rate for Payer: Preferred Network Access Commercial |
$241.04
|
| Rate for Payer: Quartz Beloit One Network |
$128.38
|
| Rate for Payer: Quartz Commercial |
$170.30
|
| Rate for Payer: Quartz Medicare Advantage |
$157.20
|
| Rate for Payer: The Alliance Commercial |
$1,048.00
|
| Rate for Payer: WEA Trust Commercial |
$144.10
|
| Rate for Payer: WPS Commercial |
$194.06
|
|
|
SCREW MALL 4.5 X 70 215.070
|
Facility
|
IP
|
$262.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967326
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$128.38 |
| Max. Negotiated Rate |
$241.04 |
| Rate for Payer: Aetna Commercial |
$235.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$225.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$138.86
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$241.04
|
| Rate for Payer: Health EOS Commercial |
$233.18
|
| Rate for Payer: HFN Commercial |
$241.04
|
| Rate for Payer: Multiplan Commercial |
$209.60
|
| Rate for Payer: NAPHCARE Commercial |
$157.20
|
| Rate for Payer: Preferred Network Access Commercial |
$241.04
|
| Rate for Payer: Quartz Beloit One Network |
$128.38
|
| Rate for Payer: Quartz Commercial |
$157.20
|
| Rate for Payer: WEA Trust Commercial |
$144.10
|
| Rate for Payer: WPS Commercial |
$194.06
|
|
|
SCREW MATRIX EMERGENCY MANDIBLE 2.7 X 6MM 04.503.466.01
|
Facility
|
IP
|
$2,202.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5831669
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,078.98 |
| Max. Negotiated Rate |
$2,025.84 |
| Rate for Payer: Aetna Commercial |
$1,981.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,893.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,167.06
|
| Rate for Payer: Cash Price |
$660.60
|
| Rate for Payer: Cigna Commercial |
$2,025.84
|
| Rate for Payer: Health EOS Commercial |
$1,959.78
|
| Rate for Payer: HFN Commercial |
$2,025.84
|
| Rate for Payer: Multiplan Commercial |
$1,761.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,321.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,025.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,078.98
|
| Rate for Payer: Quartz Commercial |
$1,321.20
|
| Rate for Payer: WEA Trust Commercial |
$1,211.10
|
| Rate for Payer: WPS Commercial |
$1,631.02
|
|
|
SCREW MATRIX EMERGENCY MANDIBLE 2.7 X 6MM 04.503.466.01
|
Facility
|
OP
|
$2,202.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5831669
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$616.56 |
| Max. Negotiated Rate |
$8,808.00 |
| Rate for Payer: Aetna Commercial |
$1,981.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,893.72
|
| Rate for Payer: Aetna Managed Medicare |
$616.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,431.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,101.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,056.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,167.06
|
| Rate for Payer: Cash Price |
$660.60
|
| Rate for Payer: Cigna Commercial |
$2,025.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,232.24
|
| Rate for Payer: Health EOS Commercial |
$1,959.78
|
| Rate for Payer: HFN Commercial |
$2,025.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,651.50
|
| Rate for Payer: Multiplan Commercial |
$1,761.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,321.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,025.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,078.98
|
| Rate for Payer: Quartz Commercial |
$1,431.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,321.20
|
| Rate for Payer: The Alliance Commercial |
$8,808.00
|
| Rate for Payer: WEA Trust Commercial |
$1,211.10
|
| Rate for Payer: WPS Commercial |
$1,631.02
|
|
|
SCREW MATRIX EMERGENCY MIDFACE 4MM 04.503.234.01
|
Facility
|
IP
|
$884.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5349486
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$433.16 |
| Max. Negotiated Rate |
$813.28 |
| Rate for Payer: Aetna Commercial |
$795.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$760.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$468.52
|
| Rate for Payer: Cash Price |
$265.20
|
| Rate for Payer: Cigna Commercial |
$813.28
|
| Rate for Payer: Health EOS Commercial |
$786.76
|
| Rate for Payer: HFN Commercial |
$813.28
|
| Rate for Payer: Multiplan Commercial |
$707.20
|
| Rate for Payer: NAPHCARE Commercial |
$530.40
|
| Rate for Payer: Preferred Network Access Commercial |
$813.28
|
| Rate for Payer: Quartz Beloit One Network |
$433.16
|
| Rate for Payer: Quartz Commercial |
$530.40
|
| Rate for Payer: WEA Trust Commercial |
$486.20
|
| Rate for Payer: WPS Commercial |
$654.78
|
|
|
SCREW MATRIX EMERGENCY MIDFACE 4MM 04.503.234.01
|
Facility
|
OP
|
$884.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5349486
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$247.52 |
| Max. Negotiated Rate |
$3,536.00 |
| Rate for Payer: Aetna Commercial |
$795.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$760.24
|
| Rate for Payer: Aetna Managed Medicare |
$247.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$574.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$442.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$424.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$468.52
|
| Rate for Payer: Cash Price |
$265.20
|
| Rate for Payer: Cigna Commercial |
$813.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$494.69
|
| Rate for Payer: Health EOS Commercial |
$786.76
|
| Rate for Payer: HFN Commercial |
$813.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$663.00
|
| Rate for Payer: Multiplan Commercial |
$707.20
|
| Rate for Payer: NAPHCARE Commercial |
$530.40
|
| Rate for Payer: Preferred Network Access Commercial |
$813.28
|
| Rate for Payer: Quartz Beloit One Network |
$433.16
|
| Rate for Payer: Quartz Commercial |
$574.60
|
| Rate for Payer: Quartz Medicare Advantage |
$530.40
|
| Rate for Payer: The Alliance Commercial |
$3,536.00
|
| Rate for Payer: WEA Trust Commercial |
$486.20
|
| Rate for Payer: WPS Commercial |
$654.78
|
|
