|
SCREW-LOCK 2.4 X 24MM 04.210.124
|
Facility
|
OP
|
$2,106.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966818
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$613.27 |
| Max. Negotiated Rate |
$2,015.02 |
| Rate for Payer: Aetna Commercial |
$1,971.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,883.61
|
| Rate for Payer: Aetna Managed Medicare |
$613.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,423.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,095.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,051.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,160.83
|
| Rate for Payer: Cash Price |
$631.80
|
| Rate for Payer: Cigna Commercial |
$2,015.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,225.69
|
| Rate for Payer: Health EOS Commercial |
$1,949.31
|
| Rate for Payer: HFN Commercial |
$2,015.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,642.68
|
| Rate for Payer: Multiplan Commercial |
$1,752.19
|
| Rate for Payer: NAPHCARE Commercial |
$1,314.14
|
| Rate for Payer: Preferred Network Access Commercial |
$2,015.02
|
| Rate for Payer: Quartz Beloit One Network |
$1,073.22
|
| Rate for Payer: Quartz Commercial |
$1,423.66
|
| Rate for Payer: Quartz Medicare Advantage |
$1,314.14
|
| Rate for Payer: The Alliance Commercial |
$1,095.12
|
| Rate for Payer: WEA Trust Commercial |
$1,204.63
|
| Rate for Payer: WPS Commercial |
$1,622.25
|
|
|
SCREW-LOCK 2.4 X 24MM 04.210.124
|
Facility
|
IP
|
$2,106.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966818
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,073.22 |
| Max. Negotiated Rate |
$2,015.02 |
| Rate for Payer: Aetna Commercial |
$1,971.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,883.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,160.83
|
| Rate for Payer: Cash Price |
$631.80
|
| Rate for Payer: Cigna Commercial |
$2,015.02
|
| Rate for Payer: Health EOS Commercial |
$1,949.31
|
| Rate for Payer: HFN Commercial |
$2,015.02
|
| Rate for Payer: Multiplan Commercial |
$1,752.19
|
| Rate for Payer: Preferred Network Access Commercial |
$2,015.02
|
| Rate for Payer: Quartz Beloit One Network |
$1,073.22
|
| Rate for Payer: Quartz Commercial |
$1,314.14
|
| Rate for Payer: WEA Trust Commercial |
$1,204.63
|
| Rate for Payer: WPS Commercial |
$1,622.25
|
|
|
SCREW LOCK 2.4 X 24MM 212.824
|
Facility
|
OP
|
$1,750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966461
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$509.60 |
| Max. Negotiated Rate |
$1,674.40 |
| Rate for Payer: Aetna Commercial |
$1,638.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,565.20
|
| Rate for Payer: Aetna Managed Medicare |
$509.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,183.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$910.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$873.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$964.60
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$1,674.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,018.50
|
| Rate for Payer: Health EOS Commercial |
$1,619.80
|
| Rate for Payer: HFN Commercial |
$1,674.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,365.00
|
| Rate for Payer: Multiplan Commercial |
$1,456.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,092.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,674.40
|
| Rate for Payer: Quartz Beloit One Network |
$891.80
|
| Rate for Payer: Quartz Commercial |
$1,183.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,092.00
|
| Rate for Payer: The Alliance Commercial |
$910.00
|
| Rate for Payer: WEA Trust Commercial |
$1,001.00
|
| Rate for Payer: WPS Commercial |
$1,348.03
|
|
|
SCREW LOCK 2.4 X 24MM 212.824
|
Facility
|
IP
|
$1,750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966461
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$891.80 |
| Max. Negotiated Rate |
$1,674.40 |
| Rate for Payer: Aetna Commercial |
$1,638.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,565.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$964.60
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$1,674.40
|
| Rate for Payer: Health EOS Commercial |
$1,619.80
|
| Rate for Payer: HFN Commercial |
$1,674.40
|
| Rate for Payer: Multiplan Commercial |
$1,456.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,674.40
|
| Rate for Payer: Quartz Beloit One Network |
$891.80
|
| Rate for Payer: Quartz Commercial |
$1,092.00
|
| Rate for Payer: WEA Trust Commercial |
$1,001.00
|
| Rate for Payer: WPS Commercial |
$1,348.03
|
|
|
SCREW LOCK 2.4 X 24 STARDRIVE 02.210.124
|
Facility
|
IP
|
$2,027.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966575
|
|
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 24 STARDRIVE 02.210.124
|
Facility
|
OP
|
$2,027.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966575
|
|
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 26 412.826
|
Facility
|
IP
|
$709.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966820
|
|
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 26 412.826
|
Facility
|
OP
|
$709.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966820
|
|
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 26MM 04.210.126
|
Facility
|
OP
|
$2,027.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966821
|
|
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 26MM 04.210.126
|
Facility
|
IP
|
$2,027.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966821
|
|
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 26 STARDRIVE 02.210.126
|
Facility
|
IP
|
$2,027.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966463
|
|
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 26 STARDRIVE 02.210.126
|
Facility
|
OP
|
$2,027.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966463
|
|
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 28 412.828
|
Facility
|
OP
|
$709.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966823
|
|
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 28 412.828
|
Facility
|
IP
|
$709.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966823
|
|
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 28MM 04.210.128
|
Facility
|
IP
|
$2,027.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966824
|
|
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 28MM 04.210.128
|
Facility
|
OP
|
$2,027.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966824
|
|
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 28 STARDRIVE 02.210.128
|
Facility
|
OP
|
$1,430.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6001633
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$416.42 |
| Max. Negotiated Rate |
$1,368.22 |
| Rate for Payer: Aetna Commercial |
$1,338.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,278.99
|
| Rate for Payer: Aetna Managed Medicare |
$416.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$966.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$743.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$713.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$788.22
|
| Rate for Payer: Cash Price |
$429.00
|
| Rate for Payer: Cigna Commercial |
$1,368.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$832.26
|
| Rate for Payer: Health EOS Commercial |
$1,323.61
|
| Rate for Payer: HFN Commercial |
$1,368.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,115.40
|
| Rate for Payer: Multiplan Commercial |
$1,189.76
|
| Rate for Payer: NAPHCARE Commercial |
$892.32
|
| Rate for Payer: Preferred Network Access Commercial |
$1,368.22
|
| Rate for Payer: Quartz Beloit One Network |
$728.73
|
| Rate for Payer: Quartz Commercial |
$966.68
|
| Rate for Payer: Quartz Medicare Advantage |
$892.32
|
| Rate for Payer: The Alliance Commercial |
$743.60
|
| Rate for Payer: WEA Trust Commercial |
$817.96
|
| Rate for Payer: WPS Commercial |
$1,101.53
|
|
|
SCREW LOCK 2.4 X 28 STARDRIVE 02.210.128
|
Facility
|
IP
|
$1,430.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6001633
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$728.73 |
| Max. Negotiated Rate |
$1,368.22 |
| Rate for Payer: Aetna Commercial |
$1,338.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,278.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$788.22
|
| Rate for Payer: Cash Price |
$429.00
|
| Rate for Payer: Cigna Commercial |
$1,368.22
|
| Rate for Payer: Health EOS Commercial |
$1,323.61
|
| Rate for Payer: HFN Commercial |
$1,368.22
|
| Rate for Payer: Multiplan Commercial |
$1,189.76
|
| Rate for Payer: Preferred Network Access Commercial |
$1,368.22
|
| Rate for Payer: Quartz Beloit One Network |
$728.73
|
| Rate for Payer: Quartz Commercial |
$892.32
|
| Rate for Payer: WEA Trust Commercial |
$817.96
|
| Rate for Payer: WPS Commercial |
$1,101.53
|
|
|
SCREW-LOCK 2.4 X 30 412.830
|
Facility
|
OP
|
$709.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966826
|
|
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 30 412.830
|
Facility
|
IP
|
$709.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966826
|
|
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 30MM 04.210.130
|
Facility
|
IP
|
$2,027.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966827
|
|
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 30MM 04.210.130
|
Facility
|
OP
|
$2,027.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966827
|
|
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 6 412.806
|
Facility
|
OP
|
$709.00
|
|
| Hospital Charge Code |
2966829
|
|
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 6 412.806
|
Facility
|
IP
|
$709.00
|
|
| Hospital Charge Code |
2966829
|
|
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 8 412.808
|
Facility
|
IP
|
$709.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966831
|
|
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
|
|
