|
SCREW LOCK 2.0MM X 12MM STARDRIVE 201.882
|
Facility
|
IP
|
$1,759.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966431
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$896.39 |
| Max. Negotiated Rate |
$1,683.01 |
| Rate for Payer: Aetna Commercial |
$1,646.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,573.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$969.56
|
| Rate for Payer: Cash Price |
$527.70
|
| Rate for Payer: Cigna Commercial |
$1,683.01
|
| Rate for Payer: Health EOS Commercial |
$1,628.13
|
| Rate for Payer: HFN Commercial |
$1,683.01
|
| Rate for Payer: Multiplan Commercial |
$1,463.49
|
| Rate for Payer: Preferred Network Access Commercial |
$1,683.01
|
| Rate for Payer: Quartz Beloit One Network |
$896.39
|
| Rate for Payer: Quartz Commercial |
$1,097.62
|
| Rate for Payer: WEA Trust Commercial |
$1,006.15
|
| Rate for Payer: WPS Commercial |
$1,354.96
|
|
|
SCREW LOCK 2.0MM X 14MM STARDRIVE 201.884
|
Facility
|
IP
|
$1,759.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966432
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$896.39 |
| Max. Negotiated Rate |
$1,683.01 |
| Rate for Payer: Aetna Commercial |
$1,646.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,573.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$969.56
|
| Rate for Payer: Cash Price |
$527.70
|
| Rate for Payer: Cigna Commercial |
$1,683.01
|
| Rate for Payer: Health EOS Commercial |
$1,628.13
|
| Rate for Payer: HFN Commercial |
$1,683.01
|
| Rate for Payer: Multiplan Commercial |
$1,463.49
|
| Rate for Payer: Preferred Network Access Commercial |
$1,683.01
|
| Rate for Payer: Quartz Beloit One Network |
$896.39
|
| Rate for Payer: Quartz Commercial |
$1,097.62
|
| Rate for Payer: WEA Trust Commercial |
$1,006.15
|
| Rate for Payer: WPS Commercial |
$1,354.96
|
|
|
SCREW LOCK 2.0MM X 14MM STARDRIVE 201.884
|
Facility
|
OP
|
$1,759.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966432
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$512.22 |
| Max. Negotiated Rate |
$1,683.01 |
| Rate for Payer: Aetna Commercial |
$1,646.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,573.25
|
| Rate for Payer: Aetna Managed Medicare |
$512.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,189.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$914.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$878.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$969.56
|
| Rate for Payer: Cash Price |
$527.70
|
| Rate for Payer: Cigna Commercial |
$1,683.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,023.74
|
| Rate for Payer: Health EOS Commercial |
$1,628.13
|
| Rate for Payer: HFN Commercial |
$1,683.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,372.02
|
| Rate for Payer: Multiplan Commercial |
$1,463.49
|
| Rate for Payer: NAPHCARE Commercial |
$1,097.62
|
| Rate for Payer: Preferred Network Access Commercial |
$1,683.01
|
| Rate for Payer: Quartz Beloit One Network |
$896.39
|
| Rate for Payer: Quartz Commercial |
$1,189.08
|
| Rate for Payer: Quartz Medicare Advantage |
$1,097.62
|
| Rate for Payer: The Alliance Commercial |
$914.68
|
| Rate for Payer: WEA Trust Commercial |
$1,006.15
|
| Rate for Payer: WPS Commercial |
$1,354.96
|
|
|
SCREW LOCK 2.0MM X 16MM STARDRIVE 201.886
|
Facility
|
IP
|
$1,759.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966434
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$896.39 |
| Max. Negotiated Rate |
$1,683.01 |
| Rate for Payer: Aetna Commercial |
$1,646.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,573.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$969.56
|
| Rate for Payer: Cash Price |
$527.70
|
| Rate for Payer: Cigna Commercial |
$1,683.01
|
| Rate for Payer: Health EOS Commercial |
$1,628.13
|
| Rate for Payer: HFN Commercial |
$1,683.01
|
| Rate for Payer: Multiplan Commercial |
$1,463.49
|
| Rate for Payer: Preferred Network Access Commercial |
$1,683.01
|
| Rate for Payer: Quartz Beloit One Network |
$896.39
|
| Rate for Payer: Quartz Commercial |
$1,097.62
|
| Rate for Payer: WEA Trust Commercial |
$1,006.15
|
| Rate for Payer: WPS Commercial |
$1,354.96
|
|
|
SCREW LOCK 2.0MM X 16MM STARDRIVE 201.886
|
Facility
|
OP
|
$1,759.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966434
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$512.22 |
| Max. Negotiated Rate |
$1,683.01 |
| Rate for Payer: Aetna Commercial |
$1,646.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,573.25
|
| Rate for Payer: Aetna Managed Medicare |
$512.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,189.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$914.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$878.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$969.56
|
| Rate for Payer: Cash Price |
$527.70
|
| Rate for Payer: Cigna Commercial |
$1,683.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,023.74
|
| Rate for Payer: Health EOS Commercial |
$1,628.13
|
| Rate for Payer: HFN Commercial |
$1,683.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,372.02
|
| Rate for Payer: Multiplan Commercial |
$1,463.49
|
| Rate for Payer: NAPHCARE Commercial |
$1,097.62
|
| Rate for Payer: Preferred Network Access Commercial |
$1,683.01
|
| Rate for Payer: Quartz Beloit One Network |
$896.39
|
| Rate for Payer: Quartz Commercial |
$1,189.08
|
| Rate for Payer: Quartz Medicare Advantage |
$1,097.62
|
| Rate for Payer: The Alliance Commercial |
$914.68
|
| Rate for Payer: WEA Trust Commercial |
$1,006.15
|
| Rate for Payer: WPS Commercial |
$1,354.96
|
|
|
SCREW LOCK 2.0MM X 18MM STARDRIVE 201.888
|
Facility
|
IP
|
$1,897.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966436
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$966.71 |
| Max. Negotiated Rate |
$1,815.05 |
| Rate for Payer: Aetna Commercial |
$1,775.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,696.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,045.63
|
| Rate for Payer: Cash Price |
$569.10
|
| Rate for Payer: Cigna Commercial |
$1,815.05
|
| Rate for Payer: Health EOS Commercial |
$1,755.86
|
| Rate for Payer: HFN Commercial |
$1,815.05
|
| Rate for Payer: Multiplan Commercial |
$1,578.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,815.05
|
| Rate for Payer: Quartz Beloit One Network |
$966.71
|
| Rate for Payer: Quartz Commercial |
$1,183.73
|
| Rate for Payer: WEA Trust Commercial |
$1,085.08
|
| Rate for Payer: WPS Commercial |
$1,461.26
|
|
|
SCREW LOCK 2.0MM X 18MM STARDRIVE 201.888
|
Facility
|
OP
|
$1,897.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966436
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$552.41 |
| Max. Negotiated Rate |
$1,815.05 |
| Rate for Payer: Aetna Commercial |
$1,775.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,696.68
|
| Rate for Payer: Aetna Managed Medicare |
$552.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,282.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$986.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$946.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,045.63
|
| Rate for Payer: Cash Price |
$569.10
|
| Rate for Payer: Cigna Commercial |
$1,815.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,104.05
|
| Rate for Payer: Health EOS Commercial |
$1,755.86
|
| Rate for Payer: HFN Commercial |
$1,815.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,479.66
|
| Rate for Payer: Multiplan Commercial |
$1,578.30
|
| Rate for Payer: NAPHCARE Commercial |
$1,183.73
|
| Rate for Payer: Preferred Network Access Commercial |
$1,815.05
|
| Rate for Payer: Quartz Beloit One Network |
$966.71
|
| Rate for Payer: Quartz Commercial |
$1,282.37
|
| Rate for Payer: Quartz Medicare Advantage |
$1,183.73
|
| Rate for Payer: The Alliance Commercial |
$986.44
|
| Rate for Payer: WEA Trust Commercial |
$1,085.08
|
| Rate for Payer: WPS Commercial |
$1,461.26
|
|
|
SCREW LOCK 2.0MM X 20MM STARDRIVE 201.890
|
Facility
|
IP
|
$1,291.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414988
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$657.89 |
| Max. Negotiated Rate |
$1,235.23 |
| Rate for Payer: Aetna Commercial |
$1,208.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,154.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$711.60
|
| Rate for Payer: Cash Price |
$387.30
|
| Rate for Payer: Cigna Commercial |
$1,235.23
|
| Rate for Payer: Health EOS Commercial |
$1,194.95
|
| Rate for Payer: HFN Commercial |
$1,235.23
|
| Rate for Payer: Multiplan Commercial |
$1,074.11
|
| Rate for Payer: Preferred Network Access Commercial |
$1,235.23
|
| Rate for Payer: Quartz Beloit One Network |
$657.89
|
| Rate for Payer: Quartz Commercial |
$805.58
|
| Rate for Payer: WEA Trust Commercial |
$738.45
|
| Rate for Payer: WPS Commercial |
$994.46
|
|
|
SCREW LOCK 2.0MM X 20MM STARDRIVE 201.890
|
Facility
|
OP
|
$1,291.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414988
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$375.94 |
| Max. Negotiated Rate |
$1,235.23 |
| Rate for Payer: Aetna Commercial |
$1,208.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,154.67
|
| Rate for Payer: Aetna Managed Medicare |
$375.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$872.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$671.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$644.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$711.60
|
| Rate for Payer: Cash Price |
$387.30
|
| Rate for Payer: Cigna Commercial |
$1,235.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$751.36
|
| Rate for Payer: Health EOS Commercial |
$1,194.95
|
| Rate for Payer: HFN Commercial |
$1,235.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,006.98
|
| Rate for Payer: Multiplan Commercial |
$1,074.11
|
| Rate for Payer: NAPHCARE Commercial |
$805.58
|
| Rate for Payer: Preferred Network Access Commercial |
$1,235.23
|
| Rate for Payer: Quartz Beloit One Network |
$657.89
|
| Rate for Payer: Quartz Commercial |
$872.72
|
| Rate for Payer: Quartz Medicare Advantage |
$805.58
|
| Rate for Payer: The Alliance Commercial |
$671.32
|
| Rate for Payer: WEA Trust Commercial |
$738.45
|
| Rate for Payer: WPS Commercial |
$994.46
|
|
|
SCREW LOCK 2.0 X 10 401.880
|
Facility
|
OP
|
$1,823.00
|
|
| Hospital Charge Code |
2966427
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$530.86 |
| Max. Negotiated Rate |
$1,744.25 |
| Rate for Payer: Aetna Commercial |
$1,706.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,630.49
|
| Rate for Payer: Aetna Managed Medicare |
$530.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,232.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$947.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$910.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,004.84
|
| Rate for Payer: Cash Price |
$546.90
|
| Rate for Payer: Cigna Commercial |
$1,744.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,060.99
|
| Rate for Payer: Health EOS Commercial |
$1,687.37
|
| Rate for Payer: HFN Commercial |
$1,744.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,421.94
|
| Rate for Payer: Multiplan Commercial |
$1,516.74
|
| Rate for Payer: NAPHCARE Commercial |
$1,137.55
|
| Rate for Payer: Preferred Network Access Commercial |
$1,744.25
|
| Rate for Payer: Quartz Beloit One Network |
$929.00
|
| Rate for Payer: Quartz Commercial |
$1,232.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,137.55
|
| Rate for Payer: The Alliance Commercial |
$947.96
|
| Rate for Payer: WEA Trust Commercial |
$1,042.76
|
| Rate for Payer: WPS Commercial |
$1,404.26
|
|
|
SCREW LOCK 2.0 X 10 401.880
|
Facility
|
IP
|
$1,823.00
|
|
| Hospital Charge Code |
2966427
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$1,744.25 |
| Rate for Payer: Aetna Commercial |
$1,706.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,630.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,004.84
|
| Rate for Payer: Cash Price |
$546.90
|
| Rate for Payer: Cigna Commercial |
$1,744.25
|
| Rate for Payer: Health EOS Commercial |
$1,687.37
|
| Rate for Payer: HFN Commercial |
$1,744.25
|
| Rate for Payer: Multiplan Commercial |
$1,516.74
|
| Rate for Payer: Preferred Network Access Commercial |
$1,744.25
|
| Rate for Payer: Quartz Beloit One Network |
$929.00
|
| Rate for Payer: Quartz Commercial |
$1,137.55
|
| Rate for Payer: WEA Trust Commercial |
$1,042.76
|
| Rate for Payer: WPS Commercial |
$1,404.26
|
|
|
SCREW LOCK 2.0 X 10MM TI 5201020010
|
Facility
|
IP
|
$3,630.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6172200
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,849.85 |
| Max. Negotiated Rate |
$3,473.18 |
| Rate for Payer: Aetna Commercial |
$3,397.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,246.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,000.86
|
| Rate for Payer: Cash Price |
$1,089.00
|
| Rate for Payer: Cigna Commercial |
$3,473.18
|
| Rate for Payer: Health EOS Commercial |
$3,359.93
|
| Rate for Payer: HFN Commercial |
$3,473.18
|
| Rate for Payer: Multiplan Commercial |
$3,020.16
|
| Rate for Payer: Preferred Network Access Commercial |
$3,473.18
|
| Rate for Payer: Quartz Beloit One Network |
$1,849.85
|
| Rate for Payer: Quartz Commercial |
$2,265.12
|
| Rate for Payer: WEA Trust Commercial |
$2,076.36
|
| Rate for Payer: WPS Commercial |
$2,796.19
|
|
|
SCREW LOCK 2.0 X 10MM TI 5201020010
|
Facility
|
OP
|
$3,630.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6172200
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,057.06 |
| Max. Negotiated Rate |
$3,473.18 |
| Rate for Payer: Aetna Commercial |
$3,397.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,246.67
|
| Rate for Payer: Aetna Managed Medicare |
$1,057.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,453.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,887.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,812.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,000.86
|
| Rate for Payer: Cash Price |
$1,089.00
|
| Rate for Payer: Cigna Commercial |
$3,473.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,112.66
|
| Rate for Payer: Health EOS Commercial |
$3,359.93
|
| Rate for Payer: HFN Commercial |
$3,473.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,831.40
|
| Rate for Payer: Multiplan Commercial |
$3,020.16
|
| Rate for Payer: NAPHCARE Commercial |
$2,265.12
|
| Rate for Payer: Preferred Network Access Commercial |
$3,473.18
|
| Rate for Payer: Quartz Beloit One Network |
$1,849.85
|
| Rate for Payer: Quartz Commercial |
$2,453.88
|
| Rate for Payer: Quartz Medicare Advantage |
$2,265.12
|
| Rate for Payer: The Alliance Commercial |
$1,887.60
|
| Rate for Payer: WEA Trust Commercial |
$2,076.36
|
| Rate for Payer: WPS Commercial |
$2,796.19
|
|
|
SCREW LOCK 2.0 X 18MM TI 5201120018
|
Facility
|
IP
|
$2,179.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5957647
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,110.42 |
| Max. Negotiated Rate |
$2,084.87 |
| Rate for Payer: Aetna Commercial |
$2,039.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,948.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,201.06
|
| Rate for Payer: Cash Price |
$653.70
|
| Rate for Payer: Cigna Commercial |
$2,084.87
|
| Rate for Payer: Health EOS Commercial |
$2,016.88
|
| Rate for Payer: HFN Commercial |
$2,084.87
|
| Rate for Payer: Multiplan Commercial |
$1,812.93
|
| Rate for Payer: Preferred Network Access Commercial |
$2,084.87
|
| Rate for Payer: Quartz Beloit One Network |
$1,110.42
|
| Rate for Payer: Quartz Commercial |
$1,359.70
|
| Rate for Payer: WEA Trust Commercial |
$1,246.39
|
| Rate for Payer: WPS Commercial |
$1,678.48
|
|
|
SCREW LOCK 2.0 X 18MM TI 5201120018
|
Facility
|
OP
|
$2,179.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5957647
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$634.52 |
| Max. Negotiated Rate |
$2,084.87 |
| Rate for Payer: Aetna Commercial |
$2,039.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,948.90
|
| Rate for Payer: Aetna Managed Medicare |
$634.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,473.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,133.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,087.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,201.06
|
| Rate for Payer: Cash Price |
$653.70
|
| Rate for Payer: Cigna Commercial |
$2,084.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,268.18
|
| Rate for Payer: Health EOS Commercial |
$2,016.88
|
| Rate for Payer: HFN Commercial |
$2,084.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,699.62
|
| Rate for Payer: Multiplan Commercial |
$1,812.93
|
| Rate for Payer: NAPHCARE Commercial |
$1,359.70
|
| Rate for Payer: Preferred Network Access Commercial |
$2,084.87
|
| Rate for Payer: Quartz Beloit One Network |
$1,110.42
|
| Rate for Payer: Quartz Commercial |
$1,473.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,359.70
|
| Rate for Payer: The Alliance Commercial |
$1,133.08
|
| Rate for Payer: WEA Trust Commercial |
$1,246.39
|
| Rate for Payer: WPS Commercial |
$1,678.48
|
|
|
SCREW LOCK 2.0 X 20MM TI 5201120020
|
Facility
|
OP
|
$2,179.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5957648
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$634.52 |
| Max. Negotiated Rate |
$2,084.87 |
| Rate for Payer: Aetna Commercial |
$2,039.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,948.90
|
| Rate for Payer: Aetna Managed Medicare |
$634.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,473.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,133.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,087.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,201.06
|
| Rate for Payer: Cash Price |
$653.70
|
| Rate for Payer: Cigna Commercial |
$2,084.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,268.18
|
| Rate for Payer: Health EOS Commercial |
$2,016.88
|
| Rate for Payer: HFN Commercial |
$2,084.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,699.62
|
| Rate for Payer: Multiplan Commercial |
$1,812.93
|
| Rate for Payer: NAPHCARE Commercial |
$1,359.70
|
| Rate for Payer: Preferred Network Access Commercial |
$2,084.87
|
| Rate for Payer: Quartz Beloit One Network |
$1,110.42
|
| Rate for Payer: Quartz Commercial |
$1,473.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,359.70
|
| Rate for Payer: The Alliance Commercial |
$1,133.08
|
| Rate for Payer: WEA Trust Commercial |
$1,246.39
|
| Rate for Payer: WPS Commercial |
$1,678.48
|
|
|
SCREW LOCK 2.0 X 20MM TI 5201120020
|
Facility
|
IP
|
$2,179.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5957648
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,110.42 |
| Max. Negotiated Rate |
$2,084.87 |
| Rate for Payer: Aetna Commercial |
$2,039.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,948.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,201.06
|
| Rate for Payer: Cash Price |
$653.70
|
| Rate for Payer: Cigna Commercial |
$2,084.87
|
| Rate for Payer: Health EOS Commercial |
$2,016.88
|
| Rate for Payer: HFN Commercial |
$2,084.87
|
| Rate for Payer: Multiplan Commercial |
$1,812.93
|
| Rate for Payer: Preferred Network Access Commercial |
$2,084.87
|
| Rate for Payer: Quartz Beloit One Network |
$1,110.42
|
| Rate for Payer: Quartz Commercial |
$1,359.70
|
| Rate for Payer: WEA Trust Commercial |
$1,246.39
|
| Rate for Payer: WPS Commercial |
$1,678.48
|
|
|
SCREW-LOCK 2.4 X 10 412.810
|
Facility
|
IP
|
$709.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966796
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$361.31 |
| Max. Negotiated Rate |
$678.37 |
| Rate for Payer: Aetna Commercial |
$663.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$634.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$390.80
|
| Rate for Payer: Cash Price |
$212.70
|
| Rate for Payer: Cigna Commercial |
$678.37
|
| Rate for Payer: Health EOS Commercial |
$656.25
|
| Rate for Payer: HFN Commercial |
$678.37
|
| Rate for Payer: Multiplan Commercial |
$589.89
|
| Rate for Payer: Preferred Network Access Commercial |
$678.37
|
| Rate for Payer: Quartz Beloit One Network |
$361.31
|
| Rate for Payer: Quartz Commercial |
$442.42
|
| Rate for Payer: WEA Trust Commercial |
$405.55
|
| Rate for Payer: WPS Commercial |
$546.14
|
|
|
SCREW-LOCK 2.4 X 10 412.810
|
Facility
|
OP
|
$709.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966796
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$206.46 |
| Max. Negotiated Rate |
$678.37 |
| Rate for Payer: Aetna Commercial |
$663.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$634.13
|
| Rate for Payer: Aetna Managed Medicare |
$206.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$479.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$368.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$353.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$390.80
|
| Rate for Payer: Cash Price |
$212.70
|
| Rate for Payer: Cigna Commercial |
$678.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$412.64
|
| Rate for Payer: Health EOS Commercial |
$656.25
|
| Rate for Payer: HFN Commercial |
$678.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$553.02
|
| Rate for Payer: Multiplan Commercial |
$589.89
|
| Rate for Payer: NAPHCARE Commercial |
$442.42
|
| Rate for Payer: Preferred Network Access Commercial |
$678.37
|
| Rate for Payer: Quartz Beloit One Network |
$361.31
|
| Rate for Payer: Quartz Commercial |
$479.28
|
| Rate for Payer: Quartz Medicare Advantage |
$442.42
|
| Rate for Payer: The Alliance Commercial |
$368.68
|
| Rate for Payer: WEA Trust Commercial |
$405.55
|
| Rate for Payer: WPS Commercial |
$546.14
|
|
|
SCREW-LOCK 2.4 X 10MM 04.210.110
|
Facility
|
IP
|
$2,027.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966797
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,032.96 |
| Max. Negotiated Rate |
$1,939.43 |
| Rate for Payer: Aetna Commercial |
$1,897.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,812.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,117.28
|
| Rate for Payer: Cash Price |
$608.10
|
| Rate for Payer: Cigna Commercial |
$1,939.43
|
| Rate for Payer: Health EOS Commercial |
$1,876.19
|
| Rate for Payer: HFN Commercial |
$1,939.43
|
| Rate for Payer: Multiplan Commercial |
$1,686.46
|
| Rate for Payer: Preferred Network Access Commercial |
$1,939.43
|
| Rate for Payer: Quartz Beloit One Network |
$1,032.96
|
| Rate for Payer: Quartz Commercial |
$1,264.85
|
| Rate for Payer: WEA Trust Commercial |
$1,159.44
|
| Rate for Payer: WPS Commercial |
$1,561.40
|
|
|
SCREW-LOCK 2.4 X 10MM 04.210.110
|
Facility
|
OP
|
$2,027.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966797
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$590.26 |
| Max. Negotiated Rate |
$1,939.43 |
| Rate for Payer: Aetna Commercial |
$1,897.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,812.95
|
| Rate for Payer: Aetna Managed Medicare |
$590.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,370.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,054.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,011.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,117.28
|
| Rate for Payer: Cash Price |
$608.10
|
| Rate for Payer: Cigna Commercial |
$1,939.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,179.71
|
| Rate for Payer: Health EOS Commercial |
$1,876.19
|
| Rate for Payer: HFN Commercial |
$1,939.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,581.06
|
| Rate for Payer: Multiplan Commercial |
$1,686.46
|
| Rate for Payer: NAPHCARE Commercial |
$1,264.85
|
| Rate for Payer: Preferred Network Access Commercial |
$1,939.43
|
| Rate for Payer: Quartz Beloit One Network |
$1,032.96
|
| Rate for Payer: Quartz Commercial |
$1,370.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,264.85
|
| Rate for Payer: The Alliance Commercial |
$1,054.04
|
| Rate for Payer: WEA Trust Commercial |
$1,159.44
|
| Rate for Payer: WPS Commercial |
$1,561.40
|
|
|
SCREW LOCK 2.4 X 10MM 212.810
|
Facility
|
OP
|
$1,644.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966438
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$478.73 |
| Max. Negotiated Rate |
$1,572.98 |
| Rate for Payer: Aetna Commercial |
$1,538.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,470.39
|
| Rate for Payer: Aetna Managed Medicare |
$478.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,111.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$854.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$820.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$906.17
|
| Rate for Payer: Cash Price |
$493.20
|
| Rate for Payer: Cigna Commercial |
$1,572.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$956.81
|
| Rate for Payer: Health EOS Commercial |
$1,521.69
|
| Rate for Payer: HFN Commercial |
$1,572.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,282.32
|
| Rate for Payer: Multiplan Commercial |
$1,367.81
|
| Rate for Payer: NAPHCARE Commercial |
$1,025.86
|
| Rate for Payer: Preferred Network Access Commercial |
$1,572.98
|
| Rate for Payer: Quartz Beloit One Network |
$837.78
|
| Rate for Payer: Quartz Commercial |
$1,111.34
|
| Rate for Payer: Quartz Medicare Advantage |
$1,025.86
|
| Rate for Payer: The Alliance Commercial |
$854.88
|
| Rate for Payer: WEA Trust Commercial |
$940.37
|
| Rate for Payer: WPS Commercial |
$1,266.37
|
|
|
SCREW LOCK 2.4 X 10MM 212.810
|
Facility
|
IP
|
$1,644.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966438
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$837.78 |
| Max. Negotiated Rate |
$1,572.98 |
| Rate for Payer: Aetna Commercial |
$1,538.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,470.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$906.17
|
| Rate for Payer: Cash Price |
$493.20
|
| Rate for Payer: Cigna Commercial |
$1,572.98
|
| Rate for Payer: Health EOS Commercial |
$1,521.69
|
| Rate for Payer: HFN Commercial |
$1,572.98
|
| Rate for Payer: Multiplan Commercial |
$1,367.81
|
| Rate for Payer: Preferred Network Access Commercial |
$1,572.98
|
| Rate for Payer: Quartz Beloit One Network |
$837.78
|
| Rate for Payer: Quartz Commercial |
$1,025.86
|
| Rate for Payer: WEA Trust Commercial |
$940.37
|
| Rate for Payer: WPS Commercial |
$1,266.37
|
|
|
SCREW LOCK 2.4 X 10MM TI 5201024010
|
Facility
|
IP
|
$4,116.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6149642
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,097.51 |
| Max. Negotiated Rate |
$3,938.19 |
| Rate for Payer: Aetna Commercial |
$3,852.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,681.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,268.74
|
| Rate for Payer: Cash Price |
$1,234.80
|
| Rate for Payer: Cigna Commercial |
$3,938.19
|
| Rate for Payer: Health EOS Commercial |
$3,809.77
|
| Rate for Payer: HFN Commercial |
$3,938.19
|
| Rate for Payer: Multiplan Commercial |
$3,424.51
|
| Rate for Payer: Preferred Network Access Commercial |
$3,938.19
|
| Rate for Payer: Quartz Beloit One Network |
$2,097.51
|
| Rate for Payer: Quartz Commercial |
$2,568.38
|
| Rate for Payer: WEA Trust Commercial |
$2,354.35
|
| Rate for Payer: WPS Commercial |
$3,170.55
|
|
|
SCREW LOCK 2.4 X 10MM TI 5201024010
|
Facility
|
OP
|
$4,116.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6149642
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,198.58 |
| Max. Negotiated Rate |
$3,938.19 |
| Rate for Payer: Aetna Commercial |
$3,852.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,681.35
|
| Rate for Payer: Aetna Managed Medicare |
$1,198.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,782.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,140.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,054.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,268.74
|
| Rate for Payer: Cash Price |
$1,234.80
|
| Rate for Payer: Cigna Commercial |
$3,938.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,395.51
|
| Rate for Payer: Health EOS Commercial |
$3,809.77
|
| Rate for Payer: HFN Commercial |
$3,938.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,210.48
|
| Rate for Payer: Multiplan Commercial |
$3,424.51
|
| Rate for Payer: NAPHCARE Commercial |
$2,568.38
|
| Rate for Payer: Preferred Network Access Commercial |
$3,938.19
|
| Rate for Payer: Quartz Beloit One Network |
$2,097.51
|
| Rate for Payer: Quartz Commercial |
$2,782.42
|
| Rate for Payer: Quartz Medicare Advantage |
$2,568.38
|
| Rate for Payer: The Alliance Commercial |
$2,140.32
|
| Rate for Payer: WEA Trust Commercial |
$2,354.35
|
| Rate for Payer: WPS Commercial |
$3,170.55
|
|
