|
SCREW-LOCK 2.4 X 8 412.808
|
Facility
|
OP
|
$709.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966831
|
|
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 8MM 04.210.108
|
Facility
|
IP
|
$2,027.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966832
|
|
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 8MM 04.210.108
|
Facility
|
OP
|
$2,027.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966832
|
|
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 2.7MM X 10MM 657010
|
Facility
|
IP
|
$2,105.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6167817
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,072.71 |
| Max. Negotiated Rate |
$2,014.06 |
| Rate for Payer: Aetna Commercial |
$1,970.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,882.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,160.28
|
| Rate for Payer: Cash Price |
$631.50
|
| Rate for Payer: Cigna Commercial |
$2,014.06
|
| Rate for Payer: Health EOS Commercial |
$1,948.39
|
| Rate for Payer: HFN Commercial |
$2,014.06
|
| Rate for Payer: Multiplan Commercial |
$1,751.36
|
| Rate for Payer: Preferred Network Access Commercial |
$2,014.06
|
| Rate for Payer: Quartz Beloit One Network |
$1,072.71
|
| Rate for Payer: Quartz Commercial |
$1,313.52
|
| Rate for Payer: WEA Trust Commercial |
$1,204.06
|
| Rate for Payer: WPS Commercial |
$1,621.48
|
|
|
SCREW LOCK 2.7MM X 10MM 657010
|
Facility
|
OP
|
$2,105.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6167817
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.98 |
| Max. Negotiated Rate |
$2,014.06 |
| Rate for Payer: Aetna Commercial |
$1,970.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,882.71
|
| Rate for Payer: Aetna Managed Medicare |
$612.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,422.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,094.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,050.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,160.28
|
| Rate for Payer: Cash Price |
$631.50
|
| Rate for Payer: Cigna Commercial |
$2,014.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,225.11
|
| Rate for Payer: Health EOS Commercial |
$1,948.39
|
| Rate for Payer: HFN Commercial |
$2,014.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,641.90
|
| Rate for Payer: Multiplan Commercial |
$1,751.36
|
| Rate for Payer: NAPHCARE Commercial |
$1,313.52
|
| Rate for Payer: Preferred Network Access Commercial |
$2,014.06
|
| Rate for Payer: Quartz Beloit One Network |
$1,072.71
|
| Rate for Payer: Quartz Commercial |
$1,422.98
|
| Rate for Payer: Quartz Medicare Advantage |
$1,313.52
|
| Rate for Payer: The Alliance Commercial |
$1,094.60
|
| Rate for Payer: WEA Trust Commercial |
$1,204.06
|
| Rate for Payer: WPS Commercial |
$1,621.48
|
|
|
SCREW LOCK 2.7MM X 12MM 657012
|
Facility
|
IP
|
$2,105.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6167818
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,072.71 |
| Max. Negotiated Rate |
$2,014.06 |
| Rate for Payer: Aetna Commercial |
$1,970.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,882.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,160.28
|
| Rate for Payer: Cash Price |
$631.50
|
| Rate for Payer: Cigna Commercial |
$2,014.06
|
| Rate for Payer: Health EOS Commercial |
$1,948.39
|
| Rate for Payer: HFN Commercial |
$2,014.06
|
| Rate for Payer: Multiplan Commercial |
$1,751.36
|
| Rate for Payer: Preferred Network Access Commercial |
$2,014.06
|
| Rate for Payer: Quartz Beloit One Network |
$1,072.71
|
| Rate for Payer: Quartz Commercial |
$1,313.52
|
| Rate for Payer: WEA Trust Commercial |
$1,204.06
|
| Rate for Payer: WPS Commercial |
$1,621.48
|
|
|
SCREW LOCK 2.7MM X 12MM 657012
|
Facility
|
OP
|
$2,105.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6167818
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.98 |
| Max. Negotiated Rate |
$2,014.06 |
| Rate for Payer: Aetna Commercial |
$1,970.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,882.71
|
| Rate for Payer: Aetna Managed Medicare |
$612.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,422.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,094.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,050.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,160.28
|
| Rate for Payer: Cash Price |
$631.50
|
| Rate for Payer: Cigna Commercial |
$2,014.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,225.11
|
| Rate for Payer: Health EOS Commercial |
$1,948.39
|
| Rate for Payer: HFN Commercial |
$2,014.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,641.90
|
| Rate for Payer: Multiplan Commercial |
$1,751.36
|
| Rate for Payer: NAPHCARE Commercial |
$1,313.52
|
| Rate for Payer: Preferred Network Access Commercial |
$2,014.06
|
| Rate for Payer: Quartz Beloit One Network |
$1,072.71
|
| Rate for Payer: Quartz Commercial |
$1,422.98
|
| Rate for Payer: Quartz Medicare Advantage |
$1,313.52
|
| Rate for Payer: The Alliance Commercial |
$1,094.60
|
| Rate for Payer: WEA Trust Commercial |
$1,204.06
|
| Rate for Payer: WPS Commercial |
$1,621.48
|
|
|
SCREW LOCK 2.7MM X 14MM 657014
|
Facility
|
OP
|
$2,105.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6169643
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.98 |
| Max. Negotiated Rate |
$2,014.06 |
| Rate for Payer: Aetna Commercial |
$1,970.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,882.71
|
| Rate for Payer: Aetna Managed Medicare |
$612.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,422.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,094.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,050.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,160.28
|
| Rate for Payer: Cash Price |
$631.50
|
| Rate for Payer: Cigna Commercial |
$2,014.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,225.11
|
| Rate for Payer: Health EOS Commercial |
$1,948.39
|
| Rate for Payer: HFN Commercial |
$2,014.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,641.90
|
| Rate for Payer: Multiplan Commercial |
$1,751.36
|
| Rate for Payer: NAPHCARE Commercial |
$1,313.52
|
| Rate for Payer: Preferred Network Access Commercial |
$2,014.06
|
| Rate for Payer: Quartz Beloit One Network |
$1,072.71
|
| Rate for Payer: Quartz Commercial |
$1,422.98
|
| Rate for Payer: Quartz Medicare Advantage |
$1,313.52
|
| Rate for Payer: The Alliance Commercial |
$1,094.60
|
| Rate for Payer: WEA Trust Commercial |
$1,204.06
|
| Rate for Payer: WPS Commercial |
$1,621.48
|
|
|
SCREW LOCK 2.7MM X 14MM 657014
|
Facility
|
IP
|
$2,105.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6169643
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,072.71 |
| Max. Negotiated Rate |
$2,014.06 |
| Rate for Payer: Aetna Commercial |
$1,970.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,882.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,160.28
|
| Rate for Payer: Cash Price |
$631.50
|
| Rate for Payer: Cigna Commercial |
$2,014.06
|
| Rate for Payer: Health EOS Commercial |
$1,948.39
|
| Rate for Payer: HFN Commercial |
$2,014.06
|
| Rate for Payer: Multiplan Commercial |
$1,751.36
|
| Rate for Payer: Preferred Network Access Commercial |
$2,014.06
|
| Rate for Payer: Quartz Beloit One Network |
$1,072.71
|
| Rate for Payer: Quartz Commercial |
$1,313.52
|
| Rate for Payer: WEA Trust Commercial |
$1,204.06
|
| Rate for Payer: WPS Commercial |
$1,621.48
|
|
|
SCREW LOCK 2.7MM X 16MM 657016
|
Facility
|
IP
|
$2,190.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599690
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,116.02 |
| Max. Negotiated Rate |
$2,095.39 |
| Rate for Payer: Aetna Commercial |
$2,049.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,958.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,207.13
|
| Rate for Payer: Cash Price |
$657.00
|
| Rate for Payer: Cigna Commercial |
$2,095.39
|
| Rate for Payer: Health EOS Commercial |
$2,027.06
|
| Rate for Payer: HFN Commercial |
$2,095.39
|
| Rate for Payer: Multiplan Commercial |
$1,822.08
|
| Rate for Payer: Preferred Network Access Commercial |
$2,095.39
|
| Rate for Payer: Quartz Beloit One Network |
$1,116.02
|
| Rate for Payer: Quartz Commercial |
$1,366.56
|
| Rate for Payer: WEA Trust Commercial |
$1,252.68
|
| Rate for Payer: WPS Commercial |
$1,686.96
|
|
|
SCREW LOCK 2.7MM X 16MM 657016
|
Facility
|
OP
|
$2,190.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599690
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$637.73 |
| Max. Negotiated Rate |
$2,095.39 |
| Rate for Payer: Aetna Commercial |
$2,049.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,958.74
|
| Rate for Payer: Aetna Managed Medicare |
$637.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,480.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,138.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,093.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,207.13
|
| Rate for Payer: Cash Price |
$657.00
|
| Rate for Payer: Cigna Commercial |
$2,095.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,274.58
|
| Rate for Payer: Health EOS Commercial |
$2,027.06
|
| Rate for Payer: HFN Commercial |
$2,095.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,708.20
|
| Rate for Payer: Multiplan Commercial |
$1,822.08
|
| Rate for Payer: NAPHCARE Commercial |
$1,366.56
|
| Rate for Payer: Preferred Network Access Commercial |
$2,095.39
|
| Rate for Payer: Quartz Beloit One Network |
$1,116.02
|
| Rate for Payer: Quartz Commercial |
$1,480.44
|
| Rate for Payer: Quartz Medicare Advantage |
$1,366.56
|
| Rate for Payer: The Alliance Commercial |
$1,138.80
|
| Rate for Payer: WEA Trust Commercial |
$1,252.68
|
| Rate for Payer: WPS Commercial |
$1,686.96
|
|
|
SCREW LOCK 2.7 X 10MM 02.211.008
|
Facility
|
IP
|
$1,546.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5617630
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$787.84 |
| Max. Negotiated Rate |
$1,479.21 |
| Rate for Payer: Aetna Commercial |
$1,447.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,382.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$852.16
|
| Rate for Payer: Cash Price |
$463.80
|
| Rate for Payer: Cigna Commercial |
$1,479.21
|
| Rate for Payer: Health EOS Commercial |
$1,430.98
|
| Rate for Payer: HFN Commercial |
$1,479.21
|
| Rate for Payer: Multiplan Commercial |
$1,286.27
|
| Rate for Payer: Preferred Network Access Commercial |
$1,479.21
|
| Rate for Payer: Quartz Beloit One Network |
$787.84
|
| Rate for Payer: Quartz Commercial |
$964.70
|
| Rate for Payer: WEA Trust Commercial |
$884.31
|
| Rate for Payer: WPS Commercial |
$1,190.88
|
|
|
SCREW LOCK 2.7 X 10MM 02.211.008
|
Facility
|
OP
|
$1,546.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5617630
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$450.20 |
| Max. Negotiated Rate |
$1,479.21 |
| Rate for Payer: Aetna Commercial |
$1,447.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,382.74
|
| Rate for Payer: Aetna Managed Medicare |
$450.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,045.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$803.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$771.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$852.16
|
| Rate for Payer: Cash Price |
$463.80
|
| Rate for Payer: Cigna Commercial |
$1,479.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$899.77
|
| Rate for Payer: Health EOS Commercial |
$1,430.98
|
| Rate for Payer: HFN Commercial |
$1,479.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,205.88
|
| Rate for Payer: Multiplan Commercial |
$1,286.27
|
| Rate for Payer: NAPHCARE Commercial |
$964.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,479.21
|
| Rate for Payer: Quartz Beloit One Network |
$787.84
|
| Rate for Payer: Quartz Commercial |
$1,045.10
|
| Rate for Payer: Quartz Medicare Advantage |
$964.70
|
| Rate for Payer: The Alliance Commercial |
$803.92
|
| Rate for Payer: WEA Trust Commercial |
$884.31
|
| Rate for Payer: WPS Commercial |
$1,190.88
|
|
|
SCREW LOCK 2.7 X 10MM 02.211.010
|
Facility
|
IP
|
$2,107.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966474
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,073.73 |
| Max. Negotiated Rate |
$2,015.98 |
| Rate for Payer: Aetna Commercial |
$1,972.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,884.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,161.38
|
| Rate for Payer: Cash Price |
$632.10
|
| Rate for Payer: Cigna Commercial |
$2,015.98
|
| Rate for Payer: Health EOS Commercial |
$1,950.24
|
| Rate for Payer: HFN Commercial |
$2,015.98
|
| Rate for Payer: Multiplan Commercial |
$1,753.02
|
| Rate for Payer: Preferred Network Access Commercial |
$2,015.98
|
| Rate for Payer: Quartz Beloit One Network |
$1,073.73
|
| Rate for Payer: Quartz Commercial |
$1,314.77
|
| Rate for Payer: WEA Trust Commercial |
$1,205.20
|
| Rate for Payer: WPS Commercial |
$1,623.02
|
|
|
SCREW LOCK 2.7 X 10MM 02.211.010
|
Facility
|
OP
|
$2,107.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966474
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$613.56 |
| Max. Negotiated Rate |
$2,015.98 |
| Rate for Payer: Aetna Commercial |
$1,972.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,884.50
|
| Rate for Payer: Aetna Managed Medicare |
$613.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,424.33
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,095.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,051.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,161.38
|
| Rate for Payer: Cash Price |
$632.10
|
| Rate for Payer: Cigna Commercial |
$2,015.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,226.27
|
| Rate for Payer: Health EOS Commercial |
$1,950.24
|
| Rate for Payer: HFN Commercial |
$2,015.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,643.46
|
| Rate for Payer: Multiplan Commercial |
$1,753.02
|
| Rate for Payer: NAPHCARE Commercial |
$1,314.77
|
| Rate for Payer: Preferred Network Access Commercial |
$2,015.98
|
| Rate for Payer: Quartz Beloit One Network |
$1,073.73
|
| Rate for Payer: Quartz Commercial |
$1,424.33
|
| Rate for Payer: Quartz Medicare Advantage |
$1,314.77
|
| Rate for Payer: The Alliance Commercial |
$1,095.64
|
| Rate for Payer: WEA Trust Commercial |
$1,205.20
|
| Rate for Payer: WPS Commercial |
$1,623.02
|
|
|
SCREW LOCK 2.7 X 10MM SS LP AR-8827L-10
|
Facility
|
OP
|
$1,531.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5349253
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$445.83 |
| Max. Negotiated Rate |
$1,464.86 |
| Rate for Payer: Aetna Commercial |
$1,433.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,369.33
|
| Rate for Payer: Aetna Managed Medicare |
$445.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,034.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$796.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$764.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$843.89
|
| Rate for Payer: Cash Price |
$459.30
|
| Rate for Payer: Cigna Commercial |
$1,464.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$891.04
|
| Rate for Payer: Health EOS Commercial |
$1,417.09
|
| Rate for Payer: HFN Commercial |
$1,464.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,194.18
|
| Rate for Payer: Multiplan Commercial |
$1,273.79
|
| Rate for Payer: NAPHCARE Commercial |
$955.34
|
| Rate for Payer: Preferred Network Access Commercial |
$1,464.86
|
| Rate for Payer: Quartz Beloit One Network |
$780.20
|
| Rate for Payer: Quartz Commercial |
$1,034.96
|
| Rate for Payer: Quartz Medicare Advantage |
$955.34
|
| Rate for Payer: The Alliance Commercial |
$796.12
|
| Rate for Payer: WEA Trust Commercial |
$875.73
|
| Rate for Payer: WPS Commercial |
$1,179.33
|
|
|
SCREW LOCK 2.7 X 10MM SS LP AR-8827L-10
|
Facility
|
IP
|
$1,531.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5349253
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.20 |
| Max. Negotiated Rate |
$1,464.86 |
| Rate for Payer: Aetna Commercial |
$1,433.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,369.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$843.89
|
| Rate for Payer: Cash Price |
$459.30
|
| Rate for Payer: Cigna Commercial |
$1,464.86
|
| Rate for Payer: Health EOS Commercial |
$1,417.09
|
| Rate for Payer: HFN Commercial |
$1,464.86
|
| Rate for Payer: Multiplan Commercial |
$1,273.79
|
| Rate for Payer: Preferred Network Access Commercial |
$1,464.86
|
| Rate for Payer: Quartz Beloit One Network |
$780.20
|
| Rate for Payer: Quartz Commercial |
$955.34
|
| Rate for Payer: WEA Trust Commercial |
$875.73
|
| Rate for Payer: WPS Commercial |
$1,179.33
|
|
|
SCREW LOCK 2.7 X 10 ST 202.210
|
Facility
|
IP
|
$1,700.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966476
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$866.32 |
| Max. Negotiated Rate |
$1,626.56 |
| Rate for Payer: Aetna Commercial |
$1,591.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,520.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$937.04
|
| Rate for Payer: Cash Price |
$510.00
|
| Rate for Payer: Cigna Commercial |
$1,626.56
|
| Rate for Payer: Health EOS Commercial |
$1,573.52
|
| Rate for Payer: HFN Commercial |
$1,626.56
|
| Rate for Payer: Multiplan Commercial |
$1,414.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,626.56
|
| Rate for Payer: Quartz Beloit One Network |
$866.32
|
| Rate for Payer: Quartz Commercial |
$1,060.80
|
| Rate for Payer: WEA Trust Commercial |
$972.40
|
| Rate for Payer: WPS Commercial |
$1,309.51
|
|
|
SCREW LOCK 2.7 X 10 ST 202.210
|
Facility
|
OP
|
$1,700.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966476
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$495.04 |
| Max. Negotiated Rate |
$1,626.56 |
| Rate for Payer: Aetna Commercial |
$1,591.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,520.48
|
| Rate for Payer: Aetna Managed Medicare |
$495.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,149.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$884.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$848.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$937.04
|
| Rate for Payer: Cash Price |
$510.00
|
| Rate for Payer: Cigna Commercial |
$1,626.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$989.40
|
| Rate for Payer: Health EOS Commercial |
$1,573.52
|
| Rate for Payer: HFN Commercial |
$1,626.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,326.00
|
| Rate for Payer: Multiplan Commercial |
$1,414.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,060.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,626.56
|
| Rate for Payer: Quartz Beloit One Network |
$866.32
|
| Rate for Payer: Quartz Commercial |
$1,149.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,060.80
|
| Rate for Payer: The Alliance Commercial |
$884.00
|
| Rate for Payer: WEA Trust Commercial |
$972.40
|
| Rate for Payer: WPS Commercial |
$1,309.51
|
|
|
SCREW LOCK 2.7 X 11 ST 202.211
|
Facility
|
IP
|
$1,340.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4519761
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$682.86 |
| Max. Negotiated Rate |
$1,282.11 |
| Rate for Payer: Aetna Commercial |
$1,254.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,198.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$738.61
|
| Rate for Payer: Cash Price |
$402.00
|
| Rate for Payer: Cigna Commercial |
$1,282.11
|
| Rate for Payer: Health EOS Commercial |
$1,240.30
|
| Rate for Payer: HFN Commercial |
$1,282.11
|
| Rate for Payer: Multiplan Commercial |
$1,114.88
|
| Rate for Payer: Preferred Network Access Commercial |
$1,282.11
|
| Rate for Payer: Quartz Beloit One Network |
$682.86
|
| Rate for Payer: Quartz Commercial |
$836.16
|
| Rate for Payer: WEA Trust Commercial |
$766.48
|
| Rate for Payer: WPS Commercial |
$1,032.20
|
|
|
SCREW LOCK 2.7 X 11 ST 202.211
|
Facility
|
OP
|
$1,340.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4519761
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$390.21 |
| Max. Negotiated Rate |
$1,282.11 |
| Rate for Payer: Aetna Commercial |
$1,254.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,198.50
|
| Rate for Payer: Aetna Managed Medicare |
$390.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$905.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$696.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$668.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$738.61
|
| Rate for Payer: Cash Price |
$402.00
|
| Rate for Payer: Cigna Commercial |
$1,282.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$779.88
|
| Rate for Payer: Health EOS Commercial |
$1,240.30
|
| Rate for Payer: HFN Commercial |
$1,282.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,045.20
|
| Rate for Payer: Multiplan Commercial |
$1,114.88
|
| Rate for Payer: NAPHCARE Commercial |
$836.16
|
| Rate for Payer: Preferred Network Access Commercial |
$1,282.11
|
| Rate for Payer: Quartz Beloit One Network |
$682.86
|
| Rate for Payer: Quartz Commercial |
$905.84
|
| Rate for Payer: Quartz Medicare Advantage |
$836.16
|
| Rate for Payer: The Alliance Commercial |
$696.80
|
| Rate for Payer: WEA Trust Commercial |
$766.48
|
| Rate for Payer: WPS Commercial |
$1,032.20
|
|
|
SCREW LOCK 2.7 X 12MM 02.211.012
|
Facility
|
OP
|
$2,188.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966478
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$637.15 |
| Max. Negotiated Rate |
$2,093.48 |
| Rate for Payer: Aetna Commercial |
$2,047.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,956.95
|
| Rate for Payer: Aetna Managed Medicare |
$637.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,479.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,137.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,092.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,206.03
|
| Rate for Payer: Cash Price |
$656.40
|
| Rate for Payer: Cigna Commercial |
$2,093.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,273.42
|
| Rate for Payer: Health EOS Commercial |
$2,025.21
|
| Rate for Payer: HFN Commercial |
$2,093.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,706.64
|
| Rate for Payer: Multiplan Commercial |
$1,820.42
|
| Rate for Payer: NAPHCARE Commercial |
$1,365.31
|
| Rate for Payer: Preferred Network Access Commercial |
$2,093.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,115.00
|
| Rate for Payer: Quartz Commercial |
$1,479.09
|
| Rate for Payer: Quartz Medicare Advantage |
$1,365.31
|
| Rate for Payer: The Alliance Commercial |
$1,137.76
|
| Rate for Payer: WEA Trust Commercial |
$1,251.54
|
| Rate for Payer: WPS Commercial |
$1,685.42
|
|
|
SCREW LOCK 2.7 X 12MM 02.211.012
|
Facility
|
IP
|
$2,188.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966478
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,115.00 |
| Max. Negotiated Rate |
$2,093.48 |
| Rate for Payer: Aetna Commercial |
$2,047.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,956.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,206.03
|
| Rate for Payer: Cash Price |
$656.40
|
| Rate for Payer: Cigna Commercial |
$2,093.48
|
| Rate for Payer: Health EOS Commercial |
$2,025.21
|
| Rate for Payer: HFN Commercial |
$2,093.48
|
| Rate for Payer: Multiplan Commercial |
$1,820.42
|
| Rate for Payer: Preferred Network Access Commercial |
$2,093.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,115.00
|
| Rate for Payer: Quartz Commercial |
$1,365.31
|
| Rate for Payer: WEA Trust Commercial |
$1,251.54
|
| Rate for Payer: WPS Commercial |
$1,685.42
|
|
|
SCREW LOCK 2.7 X 12MM SS LP AR-8827L-12
|
Facility
|
OP
|
$1,531.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5306831
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$445.83 |
| Max. Negotiated Rate |
$1,464.86 |
| Rate for Payer: Aetna Commercial |
$1,433.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,369.33
|
| Rate for Payer: Aetna Managed Medicare |
$445.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,034.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$796.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$764.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$843.89
|
| Rate for Payer: Cash Price |
$459.30
|
| Rate for Payer: Cigna Commercial |
$1,464.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$891.04
|
| Rate for Payer: Health EOS Commercial |
$1,417.09
|
| Rate for Payer: HFN Commercial |
$1,464.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,194.18
|
| Rate for Payer: Multiplan Commercial |
$1,273.79
|
| Rate for Payer: NAPHCARE Commercial |
$955.34
|
| Rate for Payer: Preferred Network Access Commercial |
$1,464.86
|
| Rate for Payer: Quartz Beloit One Network |
$780.20
|
| Rate for Payer: Quartz Commercial |
$1,034.96
|
| Rate for Payer: Quartz Medicare Advantage |
$955.34
|
| Rate for Payer: The Alliance Commercial |
$796.12
|
| Rate for Payer: WEA Trust Commercial |
$875.73
|
| Rate for Payer: WPS Commercial |
$1,179.33
|
|
|
SCREW LOCK 2.7 X 12MM SS LP AR-8827L-12
|
Facility
|
IP
|
$1,531.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5306831
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.20 |
| Max. Negotiated Rate |
$1,464.86 |
| Rate for Payer: Aetna Commercial |
$1,433.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,369.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$843.89
|
| Rate for Payer: Cash Price |
$459.30
|
| Rate for Payer: Cigna Commercial |
$1,464.86
|
| Rate for Payer: Health EOS Commercial |
$1,417.09
|
| Rate for Payer: HFN Commercial |
$1,464.86
|
| Rate for Payer: Multiplan Commercial |
$1,273.79
|
| Rate for Payer: Preferred Network Access Commercial |
$1,464.86
|
| Rate for Payer: Quartz Beloit One Network |
$780.20
|
| Rate for Payer: Quartz Commercial |
$955.34
|
| Rate for Payer: WEA Trust Commercial |
$875.73
|
| Rate for Payer: WPS Commercial |
$1,179.33
|
|
