|
SCREW HEADLESS 2.0 X 26 317-2026
|
Facility
|
OP
|
$3,287.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2965468
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$920.36 |
| Max. Negotiated Rate |
$13,148.00 |
| Rate for Payer: Aetna Commercial |
$2,958.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,826.82
|
| Rate for Payer: Aetna Managed Medicare |
$920.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,136.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,643.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,577.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,742.11
|
| Rate for Payer: Cash Price |
$986.10
|
| Rate for Payer: Cigna Commercial |
$3,024.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,839.41
|
| Rate for Payer: Health EOS Commercial |
$2,925.43
|
| Rate for Payer: HFN Commercial |
$3,024.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,465.25
|
| Rate for Payer: Multiplan Commercial |
$2,629.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,972.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,024.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,610.63
|
| Rate for Payer: Quartz Commercial |
$2,136.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,972.20
|
| Rate for Payer: The Alliance Commercial |
$13,148.00
|
| Rate for Payer: WEA Trust Commercial |
$1,807.85
|
| Rate for Payer: WPS Commercial |
$2,434.68
|
|
|
SCREW HEADLESS 2.0 X 26 317-2026
|
Facility
|
IP
|
$3,287.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2965468
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,610.63 |
| Max. Negotiated Rate |
$3,024.04 |
| Rate for Payer: Aetna Commercial |
$2,958.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,826.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,742.11
|
| Rate for Payer: Cash Price |
$986.10
|
| Rate for Payer: Cigna Commercial |
$3,024.04
|
| Rate for Payer: Health EOS Commercial |
$2,925.43
|
| Rate for Payer: HFN Commercial |
$3,024.04
|
| Rate for Payer: Multiplan Commercial |
$2,629.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,972.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,024.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,610.63
|
| Rate for Payer: Quartz Commercial |
$1,972.20
|
| Rate for Payer: WEA Trust Commercial |
$1,807.85
|
| Rate for Payer: WPS Commercial |
$2,434.68
|
|
|
SCREW HEADLESS 2.0 X 28 317-2028
|
Facility
|
OP
|
$3,287.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2965469
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$920.36 |
| Max. Negotiated Rate |
$13,148.00 |
| Rate for Payer: Aetna Commercial |
$2,958.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,826.82
|
| Rate for Payer: Aetna Managed Medicare |
$920.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,136.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,643.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,577.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,742.11
|
| Rate for Payer: Cash Price |
$986.10
|
| Rate for Payer: Cigna Commercial |
$3,024.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,839.41
|
| Rate for Payer: Health EOS Commercial |
$2,925.43
|
| Rate for Payer: HFN Commercial |
$3,024.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,465.25
|
| Rate for Payer: Multiplan Commercial |
$2,629.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,972.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,024.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,610.63
|
| Rate for Payer: Quartz Commercial |
$2,136.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,972.20
|
| Rate for Payer: The Alliance Commercial |
$13,148.00
|
| Rate for Payer: WEA Trust Commercial |
$1,807.85
|
| Rate for Payer: WPS Commercial |
$2,434.68
|
|
|
SCREW HEADLESS 2.0 X 28 317-2028
|
Facility
|
IP
|
$3,287.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2965469
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,610.63 |
| Max. Negotiated Rate |
$3,024.04 |
| Rate for Payer: Aetna Commercial |
$2,958.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,826.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,742.11
|
| Rate for Payer: Cash Price |
$986.10
|
| Rate for Payer: Cigna Commercial |
$3,024.04
|
| Rate for Payer: Health EOS Commercial |
$2,925.43
|
| Rate for Payer: HFN Commercial |
$3,024.04
|
| Rate for Payer: Multiplan Commercial |
$2,629.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,972.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,024.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,610.63
|
| Rate for Payer: Quartz Commercial |
$1,972.20
|
| Rate for Payer: WEA Trust Commercial |
$1,807.85
|
| Rate for Payer: WPS Commercial |
$2,434.68
|
|
|
SCREW HEADLESS 2.0 X 30 317-2030
|
Facility
|
IP
|
$3,287.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2965470
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,610.63 |
| Max. Negotiated Rate |
$3,024.04 |
| Rate for Payer: Aetna Commercial |
$2,958.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,826.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,742.11
|
| Rate for Payer: Cash Price |
$986.10
|
| Rate for Payer: Cigna Commercial |
$3,024.04
|
| Rate for Payer: Health EOS Commercial |
$2,925.43
|
| Rate for Payer: HFN Commercial |
$3,024.04
|
| Rate for Payer: Multiplan Commercial |
$2,629.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,972.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,024.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,610.63
|
| Rate for Payer: Quartz Commercial |
$1,972.20
|
| Rate for Payer: WEA Trust Commercial |
$1,807.85
|
| Rate for Payer: WPS Commercial |
$2,434.68
|
|
|
SCREW HEADLESS 2.0 X 30 317-2030
|
Facility
|
OP
|
$3,287.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2965470
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$920.36 |
| Max. Negotiated Rate |
$13,148.00 |
| Rate for Payer: Aetna Commercial |
$2,958.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,826.82
|
| Rate for Payer: Aetna Managed Medicare |
$920.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,136.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,643.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,577.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,742.11
|
| Rate for Payer: Cash Price |
$986.10
|
| Rate for Payer: Cigna Commercial |
$3,024.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,839.41
|
| Rate for Payer: Health EOS Commercial |
$2,925.43
|
| Rate for Payer: HFN Commercial |
$3,024.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,465.25
|
| Rate for Payer: Multiplan Commercial |
$2,629.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,972.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,024.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,610.63
|
| Rate for Payer: Quartz Commercial |
$2,136.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,972.20
|
| Rate for Payer: The Alliance Commercial |
$13,148.00
|
| Rate for Payer: WEA Trust Commercial |
$1,807.85
|
| Rate for Payer: WPS Commercial |
$2,434.68
|
|
|
SCREW HEADLESS 2.0 X 40 317-2040
|
Facility
|
OP
|
$3,888.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5810081
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,088.64 |
| Max. Negotiated Rate |
$15,552.00 |
| Rate for Payer: Aetna Commercial |
$3,499.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,343.68
|
| Rate for Payer: Aetna Managed Medicare |
$1,088.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,527.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,944.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,866.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,060.64
|
| Rate for Payer: Cash Price |
$1,166.40
|
| Rate for Payer: Cigna Commercial |
$3,576.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,175.72
|
| Rate for Payer: Health EOS Commercial |
$3,460.32
|
| Rate for Payer: HFN Commercial |
$3,576.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,916.00
|
| Rate for Payer: Multiplan Commercial |
$3,110.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,332.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,576.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,905.12
|
| Rate for Payer: Quartz Commercial |
$2,527.20
|
| Rate for Payer: Quartz Medicare Advantage |
$2,332.80
|
| Rate for Payer: The Alliance Commercial |
$15,552.00
|
| Rate for Payer: WEA Trust Commercial |
$2,138.40
|
| Rate for Payer: WPS Commercial |
$2,879.84
|
|
|
SCREW HEADLESS 2.0 X 40 317-2040
|
Facility
|
IP
|
$3,888.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5810081
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,905.12 |
| Max. Negotiated Rate |
$3,576.96 |
| Rate for Payer: Aetna Commercial |
$3,499.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,343.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,060.64
|
| Rate for Payer: Cash Price |
$1,166.40
|
| Rate for Payer: Cigna Commercial |
$3,576.96
|
| Rate for Payer: Health EOS Commercial |
$3,460.32
|
| Rate for Payer: HFN Commercial |
$3,576.96
|
| Rate for Payer: Multiplan Commercial |
$3,110.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,332.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,576.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,905.12
|
| Rate for Payer: Quartz Commercial |
$2,332.80
|
| Rate for Payer: WEA Trust Commercial |
$2,138.40
|
| Rate for Payer: WPS Commercial |
$2,879.84
|
|
|
SCREW HEADLESS 2.0 X 42 317-2042
|
Facility
|
OP
|
$3,888.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5810082
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,088.64 |
| Max. Negotiated Rate |
$15,552.00 |
| Rate for Payer: Aetna Commercial |
$3,499.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,343.68
|
| Rate for Payer: Aetna Managed Medicare |
$1,088.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,527.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,944.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,866.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,060.64
|
| Rate for Payer: Cash Price |
$1,166.40
|
| Rate for Payer: Cigna Commercial |
$3,576.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,175.72
|
| Rate for Payer: Health EOS Commercial |
$3,460.32
|
| Rate for Payer: HFN Commercial |
$3,576.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,916.00
|
| Rate for Payer: Multiplan Commercial |
$3,110.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,332.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,576.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,905.12
|
| Rate for Payer: Quartz Commercial |
$2,527.20
|
| Rate for Payer: Quartz Medicare Advantage |
$2,332.80
|
| Rate for Payer: The Alliance Commercial |
$15,552.00
|
| Rate for Payer: WEA Trust Commercial |
$2,138.40
|
| Rate for Payer: WPS Commercial |
$2,879.84
|
|
|
SCREW HEADLESS 2.0 X 42 317-2042
|
Facility
|
IP
|
$3,888.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5810082
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,905.12 |
| Max. Negotiated Rate |
$3,576.96 |
| Rate for Payer: Aetna Commercial |
$3,499.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,343.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,060.64
|
| Rate for Payer: Cash Price |
$1,166.40
|
| Rate for Payer: Cigna Commercial |
$3,576.96
|
| Rate for Payer: Health EOS Commercial |
$3,460.32
|
| Rate for Payer: HFN Commercial |
$3,576.96
|
| Rate for Payer: Multiplan Commercial |
$3,110.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,332.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,576.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,905.12
|
| Rate for Payer: Quartz Commercial |
$2,332.80
|
| Rate for Payer: WEA Trust Commercial |
$2,138.40
|
| Rate for Payer: WPS Commercial |
$2,879.84
|
|
|
SCREW HEADLESS 2.4 X 12 317-2412
|
Facility
|
IP
|
$3,287.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2965474
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,610.63 |
| Max. Negotiated Rate |
$3,024.04 |
| Rate for Payer: Aetna Commercial |
$2,958.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,826.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,742.11
|
| Rate for Payer: Cash Price |
$986.10
|
| Rate for Payer: Cigna Commercial |
$3,024.04
|
| Rate for Payer: Health EOS Commercial |
$2,925.43
|
| Rate for Payer: HFN Commercial |
$3,024.04
|
| Rate for Payer: Multiplan Commercial |
$2,629.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,972.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,024.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,610.63
|
| Rate for Payer: Quartz Commercial |
$1,972.20
|
| Rate for Payer: WEA Trust Commercial |
$1,807.85
|
| Rate for Payer: WPS Commercial |
$2,434.68
|
|
|
SCREW HEADLESS 2.4 X 12 317-2412
|
Facility
|
OP
|
$3,287.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2965474
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$920.36 |
| Max. Negotiated Rate |
$13,148.00 |
| Rate for Payer: Aetna Commercial |
$2,958.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,826.82
|
| Rate for Payer: Aetna Managed Medicare |
$920.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,136.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,643.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,577.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,742.11
|
| Rate for Payer: Cash Price |
$986.10
|
| Rate for Payer: Cigna Commercial |
$3,024.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,839.41
|
| Rate for Payer: Health EOS Commercial |
$2,925.43
|
| Rate for Payer: HFN Commercial |
$3,024.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,465.25
|
| Rate for Payer: Multiplan Commercial |
$2,629.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,972.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,024.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,610.63
|
| Rate for Payer: Quartz Commercial |
$2,136.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,972.20
|
| Rate for Payer: The Alliance Commercial |
$13,148.00
|
| Rate for Payer: WEA Trust Commercial |
$1,807.85
|
| Rate for Payer: WPS Commercial |
$2,434.68
|
|
|
SCREW HEADLESS 2.4 X 14 317-2414
|
Facility
|
IP
|
$3,287.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2965476
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,610.63 |
| Max. Negotiated Rate |
$3,024.04 |
| Rate for Payer: Aetna Commercial |
$2,958.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,826.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,742.11
|
| Rate for Payer: Cash Price |
$986.10
|
| Rate for Payer: Cigna Commercial |
$3,024.04
|
| Rate for Payer: Health EOS Commercial |
$2,925.43
|
| Rate for Payer: HFN Commercial |
$3,024.04
|
| Rate for Payer: Multiplan Commercial |
$2,629.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,972.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,024.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,610.63
|
| Rate for Payer: Quartz Commercial |
$1,972.20
|
| Rate for Payer: WEA Trust Commercial |
$1,807.85
|
| Rate for Payer: WPS Commercial |
$2,434.68
|
|
|
SCREW HEADLESS 2.4 X 14 317-2414
|
Facility
|
OP
|
$3,287.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2965476
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$920.36 |
| Max. Negotiated Rate |
$13,148.00 |
| Rate for Payer: Aetna Commercial |
$2,958.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,826.82
|
| Rate for Payer: Aetna Managed Medicare |
$920.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,136.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,643.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,577.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,742.11
|
| Rate for Payer: Cash Price |
$986.10
|
| Rate for Payer: Cigna Commercial |
$3,024.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,839.41
|
| Rate for Payer: Health EOS Commercial |
$2,925.43
|
| Rate for Payer: HFN Commercial |
$3,024.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,465.25
|
| Rate for Payer: Multiplan Commercial |
$2,629.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,972.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,024.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,610.63
|
| Rate for Payer: Quartz Commercial |
$2,136.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,972.20
|
| Rate for Payer: The Alliance Commercial |
$13,148.00
|
| Rate for Payer: WEA Trust Commercial |
$1,807.85
|
| Rate for Payer: WPS Commercial |
$2,434.68
|
|
|
SCREW HEADLESS 2.4 X 16 317-2416
|
Facility
|
OP
|
$3,287.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2965478
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$920.36 |
| Max. Negotiated Rate |
$13,148.00 |
| Rate for Payer: Aetna Commercial |
$2,958.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,826.82
|
| Rate for Payer: Aetna Managed Medicare |
$920.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,136.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,643.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,577.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,742.11
|
| Rate for Payer: Cash Price |
$986.10
|
| Rate for Payer: Cigna Commercial |
$3,024.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,839.41
|
| Rate for Payer: Health EOS Commercial |
$2,925.43
|
| Rate for Payer: HFN Commercial |
$3,024.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,465.25
|
| Rate for Payer: Multiplan Commercial |
$2,629.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,972.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,024.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,610.63
|
| Rate for Payer: Quartz Commercial |
$2,136.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,972.20
|
| Rate for Payer: The Alliance Commercial |
$13,148.00
|
| Rate for Payer: WEA Trust Commercial |
$1,807.85
|
| Rate for Payer: WPS Commercial |
$2,434.68
|
|
|
SCREW HEADLESS 2.4 X 16 317-2416
|
Facility
|
IP
|
$3,287.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2965478
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,610.63 |
| Max. Negotiated Rate |
$3,024.04 |
| Rate for Payer: Aetna Commercial |
$2,958.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,826.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,742.11
|
| Rate for Payer: Cash Price |
$986.10
|
| Rate for Payer: Cigna Commercial |
$3,024.04
|
| Rate for Payer: Health EOS Commercial |
$2,925.43
|
| Rate for Payer: HFN Commercial |
$3,024.04
|
| Rate for Payer: Multiplan Commercial |
$2,629.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,972.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,024.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,610.63
|
| Rate for Payer: Quartz Commercial |
$1,972.20
|
| Rate for Payer: WEA Trust Commercial |
$1,807.85
|
| Rate for Payer: WPS Commercial |
$2,434.68
|
|
|
SCREW HEADLESS 2.4 X 18 317-2418
|
Facility
|
OP
|
$3,287.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2965480
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$920.36 |
| Max. Negotiated Rate |
$13,148.00 |
| Rate for Payer: Aetna Commercial |
$2,958.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,826.82
|
| Rate for Payer: Aetna Managed Medicare |
$920.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,136.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,643.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,577.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,742.11
|
| Rate for Payer: Cash Price |
$986.10
|
| Rate for Payer: Cigna Commercial |
$3,024.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,839.41
|
| Rate for Payer: Health EOS Commercial |
$2,925.43
|
| Rate for Payer: HFN Commercial |
$3,024.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,465.25
|
| Rate for Payer: Multiplan Commercial |
$2,629.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,972.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,024.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,610.63
|
| Rate for Payer: Quartz Commercial |
$2,136.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,972.20
|
| Rate for Payer: The Alliance Commercial |
$13,148.00
|
| Rate for Payer: WEA Trust Commercial |
$1,807.85
|
| Rate for Payer: WPS Commercial |
$2,434.68
|
|
|
SCREW HEADLESS 2.4 X 18 317-2418
|
Facility
|
IP
|
$3,287.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2965480
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,610.63 |
| Max. Negotiated Rate |
$3,024.04 |
| Rate for Payer: Aetna Commercial |
$2,958.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,826.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,742.11
|
| Rate for Payer: Cash Price |
$986.10
|
| Rate for Payer: Cigna Commercial |
$3,024.04
|
| Rate for Payer: Health EOS Commercial |
$2,925.43
|
| Rate for Payer: HFN Commercial |
$3,024.04
|
| Rate for Payer: Multiplan Commercial |
$2,629.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,972.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,024.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,610.63
|
| Rate for Payer: Quartz Commercial |
$1,972.20
|
| Rate for Payer: WEA Trust Commercial |
$1,807.85
|
| Rate for Payer: WPS Commercial |
$2,434.68
|
|
|
SCREW HEADLESS 2.4 X 20 317-2420
|
Facility
|
IP
|
$3,287.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2965482
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,610.63 |
| Max. Negotiated Rate |
$3,024.04 |
| Rate for Payer: Aetna Commercial |
$2,958.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,826.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,742.11
|
| Rate for Payer: Cash Price |
$986.10
|
| Rate for Payer: Cigna Commercial |
$3,024.04
|
| Rate for Payer: Health EOS Commercial |
$2,925.43
|
| Rate for Payer: HFN Commercial |
$3,024.04
|
| Rate for Payer: Multiplan Commercial |
$2,629.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,972.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,024.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,610.63
|
| Rate for Payer: Quartz Commercial |
$1,972.20
|
| Rate for Payer: WEA Trust Commercial |
$1,807.85
|
| Rate for Payer: WPS Commercial |
$2,434.68
|
|
|
SCREW HEADLESS 2.4 X 20 317-2420
|
Facility
|
OP
|
$3,287.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2965482
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$920.36 |
| Max. Negotiated Rate |
$13,148.00 |
| Rate for Payer: Aetna Commercial |
$2,958.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,826.82
|
| Rate for Payer: Aetna Managed Medicare |
$920.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,136.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,643.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,577.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,742.11
|
| Rate for Payer: Cash Price |
$986.10
|
| Rate for Payer: Cigna Commercial |
$3,024.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,839.41
|
| Rate for Payer: Health EOS Commercial |
$2,925.43
|
| Rate for Payer: HFN Commercial |
$3,024.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,465.25
|
| Rate for Payer: Multiplan Commercial |
$2,629.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,972.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,024.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,610.63
|
| Rate for Payer: Quartz Commercial |
$2,136.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,972.20
|
| Rate for Payer: The Alliance Commercial |
$13,148.00
|
| Rate for Payer: WEA Trust Commercial |
$1,807.85
|
| Rate for Payer: WPS Commercial |
$2,434.68
|
|
|
SCREW HEADLESS 2.4 X 22 317-2422
|
Facility
|
IP
|
$3,287.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2965484
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,610.63 |
| Max. Negotiated Rate |
$3,024.04 |
| Rate for Payer: Aetna Commercial |
$2,958.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,826.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,742.11
|
| Rate for Payer: Cash Price |
$986.10
|
| Rate for Payer: Cigna Commercial |
$3,024.04
|
| Rate for Payer: Health EOS Commercial |
$2,925.43
|
| Rate for Payer: HFN Commercial |
$3,024.04
|
| Rate for Payer: Multiplan Commercial |
$2,629.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,972.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,024.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,610.63
|
| Rate for Payer: Quartz Commercial |
$1,972.20
|
| Rate for Payer: WEA Trust Commercial |
$1,807.85
|
| Rate for Payer: WPS Commercial |
$2,434.68
|
|
|
SCREW HEADLESS 2.4 X 22 317-2422
|
Facility
|
OP
|
$3,287.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2965484
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$920.36 |
| Max. Negotiated Rate |
$13,148.00 |
| Rate for Payer: Aetna Commercial |
$2,958.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,826.82
|
| Rate for Payer: Aetna Managed Medicare |
$920.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,136.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,643.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,577.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,742.11
|
| Rate for Payer: Cash Price |
$986.10
|
| Rate for Payer: Cigna Commercial |
$3,024.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,839.41
|
| Rate for Payer: Health EOS Commercial |
$2,925.43
|
| Rate for Payer: HFN Commercial |
$3,024.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,465.25
|
| Rate for Payer: Multiplan Commercial |
$2,629.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,972.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,024.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,610.63
|
| Rate for Payer: Quartz Commercial |
$2,136.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,972.20
|
| Rate for Payer: The Alliance Commercial |
$13,148.00
|
| Rate for Payer: WEA Trust Commercial |
$1,807.85
|
| Rate for Payer: WPS Commercial |
$2,434.68
|
|
|
SCREW HEADLESS 2.4 X 24 317-2424
|
Facility
|
IP
|
$3,287.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2965486
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,610.63 |
| Max. Negotiated Rate |
$3,024.04 |
| Rate for Payer: Aetna Commercial |
$2,958.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,826.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,742.11
|
| Rate for Payer: Cash Price |
$986.10
|
| Rate for Payer: Cigna Commercial |
$3,024.04
|
| Rate for Payer: Health EOS Commercial |
$2,925.43
|
| Rate for Payer: HFN Commercial |
$3,024.04
|
| Rate for Payer: Multiplan Commercial |
$2,629.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,972.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,024.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,610.63
|
| Rate for Payer: Quartz Commercial |
$1,972.20
|
| Rate for Payer: WEA Trust Commercial |
$1,807.85
|
| Rate for Payer: WPS Commercial |
$2,434.68
|
|
|
SCREW HEADLESS 2.4 X 24 317-2424
|
Facility
|
OP
|
$3,287.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2965486
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$920.36 |
| Max. Negotiated Rate |
$13,148.00 |
| Rate for Payer: Aetna Commercial |
$2,958.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,826.82
|
| Rate for Payer: Aetna Managed Medicare |
$920.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,136.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,643.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,577.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,742.11
|
| Rate for Payer: Cash Price |
$986.10
|
| Rate for Payer: Cigna Commercial |
$3,024.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,839.41
|
| Rate for Payer: Health EOS Commercial |
$2,925.43
|
| Rate for Payer: HFN Commercial |
$3,024.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,465.25
|
| Rate for Payer: Multiplan Commercial |
$2,629.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,972.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,024.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,610.63
|
| Rate for Payer: Quartz Commercial |
$2,136.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,972.20
|
| Rate for Payer: The Alliance Commercial |
$13,148.00
|
| Rate for Payer: WEA Trust Commercial |
$1,807.85
|
| Rate for Payer: WPS Commercial |
$2,434.68
|
|
|
SCREW HEADLESS 2.4 X 26 317-2426
|
Facility
|
OP
|
$3,287.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2965488
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$920.36 |
| Max. Negotiated Rate |
$13,148.00 |
| Rate for Payer: Aetna Commercial |
$2,958.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,826.82
|
| Rate for Payer: Aetna Managed Medicare |
$920.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,136.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,643.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,577.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,742.11
|
| Rate for Payer: Cash Price |
$986.10
|
| Rate for Payer: Cigna Commercial |
$3,024.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,839.41
|
| Rate for Payer: Health EOS Commercial |
$2,925.43
|
| Rate for Payer: HFN Commercial |
$3,024.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,465.25
|
| Rate for Payer: Multiplan Commercial |
$2,629.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,972.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,024.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,610.63
|
| Rate for Payer: Quartz Commercial |
$2,136.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,972.20
|
| Rate for Payer: The Alliance Commercial |
$13,148.00
|
| Rate for Payer: WEA Trust Commercial |
$1,807.85
|
| Rate for Payer: WPS Commercial |
$2,434.68
|
|
