|
SCREW NON-LOCK 3.5MM X 20MM 657420
|
Facility
|
IP
|
$1,430.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599685
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$700.70 |
| Max. Negotiated Rate |
$1,315.60 |
| Rate for Payer: Aetna Commercial |
$1,287.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,229.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$757.90
|
| Rate for Payer: Cash Price |
$429.00
|
| Rate for Payer: Cigna Commercial |
$1,315.60
|
| Rate for Payer: Health EOS Commercial |
$1,272.70
|
| Rate for Payer: HFN Commercial |
$1,315.60
|
| Rate for Payer: Multiplan Commercial |
$1,144.00
|
| Rate for Payer: NAPHCARE Commercial |
$858.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,315.60
|
| Rate for Payer: Quartz Beloit One Network |
$700.70
|
| Rate for Payer: Quartz Commercial |
$858.00
|
| Rate for Payer: WEA Trust Commercial |
$786.50
|
| Rate for Payer: WPS Commercial |
$1,059.20
|
|
|
SCREW NON-LOCK 3.5MM X 20MM 657420
|
Facility
|
OP
|
$1,430.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599685
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$400.40 |
| Max. Negotiated Rate |
$5,720.00 |
| Rate for Payer: Aetna Commercial |
$1,287.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,229.80
|
| Rate for Payer: Aetna Managed Medicare |
$400.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$929.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$715.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$686.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$757.90
|
| Rate for Payer: Cash Price |
$429.00
|
| Rate for Payer: Cigna Commercial |
$1,315.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$800.23
|
| Rate for Payer: Health EOS Commercial |
$1,272.70
|
| Rate for Payer: HFN Commercial |
$1,315.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,072.50
|
| Rate for Payer: Multiplan Commercial |
$1,144.00
|
| Rate for Payer: NAPHCARE Commercial |
$858.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,315.60
|
| Rate for Payer: Quartz Beloit One Network |
$700.70
|
| Rate for Payer: Quartz Commercial |
$929.50
|
| Rate for Payer: Quartz Medicare Advantage |
$858.00
|
| Rate for Payer: The Alliance Commercial |
$5,720.00
|
| Rate for Payer: WEA Trust Commercial |
$786.50
|
| Rate for Payer: WPS Commercial |
$1,059.20
|
|
|
SCREW NON-LOCK 3.5MM X 22MM 657422
|
Facility
|
IP
|
$1,430.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5547413
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$700.70 |
| Max. Negotiated Rate |
$1,315.60 |
| Rate for Payer: Aetna Commercial |
$1,287.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,229.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$757.90
|
| Rate for Payer: Cash Price |
$429.00
|
| Rate for Payer: Cigna Commercial |
$1,315.60
|
| Rate for Payer: Health EOS Commercial |
$1,272.70
|
| Rate for Payer: HFN Commercial |
$1,315.60
|
| Rate for Payer: Multiplan Commercial |
$1,144.00
|
| Rate for Payer: NAPHCARE Commercial |
$858.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,315.60
|
| Rate for Payer: Quartz Beloit One Network |
$700.70
|
| Rate for Payer: Quartz Commercial |
$858.00
|
| Rate for Payer: WEA Trust Commercial |
$786.50
|
| Rate for Payer: WPS Commercial |
$1,059.20
|
|
|
SCREW NON-LOCK 3.5MM X 22MM 657422
|
Facility
|
OP
|
$1,430.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5547413
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$400.40 |
| Max. Negotiated Rate |
$5,720.00 |
| Rate for Payer: Aetna Commercial |
$1,287.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,229.80
|
| Rate for Payer: Aetna Managed Medicare |
$400.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$929.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$715.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$686.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$757.90
|
| Rate for Payer: Cash Price |
$429.00
|
| Rate for Payer: Cigna Commercial |
$1,315.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$800.23
|
| Rate for Payer: Health EOS Commercial |
$1,272.70
|
| Rate for Payer: HFN Commercial |
$1,315.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,072.50
|
| Rate for Payer: Multiplan Commercial |
$1,144.00
|
| Rate for Payer: NAPHCARE Commercial |
$858.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,315.60
|
| Rate for Payer: Quartz Beloit One Network |
$700.70
|
| Rate for Payer: Quartz Commercial |
$929.50
|
| Rate for Payer: Quartz Medicare Advantage |
$858.00
|
| Rate for Payer: The Alliance Commercial |
$5,720.00
|
| Rate for Payer: WEA Trust Commercial |
$786.50
|
| Rate for Payer: WPS Commercial |
$1,059.20
|
|
|
SCREW NON-LOCK 3.5MM X 24MM 657424
|
Facility
|
IP
|
$1,430.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599686
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$700.70 |
| Max. Negotiated Rate |
$1,315.60 |
| Rate for Payer: Aetna Commercial |
$1,287.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,229.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$757.90
|
| Rate for Payer: Cash Price |
$429.00
|
| Rate for Payer: Cigna Commercial |
$1,315.60
|
| Rate for Payer: Health EOS Commercial |
$1,272.70
|
| Rate for Payer: HFN Commercial |
$1,315.60
|
| Rate for Payer: Multiplan Commercial |
$1,144.00
|
| Rate for Payer: NAPHCARE Commercial |
$858.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,315.60
|
| Rate for Payer: Quartz Beloit One Network |
$700.70
|
| Rate for Payer: Quartz Commercial |
$858.00
|
| Rate for Payer: WEA Trust Commercial |
$786.50
|
| Rate for Payer: WPS Commercial |
$1,059.20
|
|
|
SCREW NON-LOCK 3.5MM X 24MM 657424
|
Facility
|
OP
|
$1,430.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599686
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$400.40 |
| Max. Negotiated Rate |
$5,720.00 |
| Rate for Payer: Aetna Commercial |
$1,287.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,229.80
|
| Rate for Payer: Aetna Managed Medicare |
$400.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$929.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$715.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$686.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$757.90
|
| Rate for Payer: Cash Price |
$429.00
|
| Rate for Payer: Cigna Commercial |
$1,315.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$800.23
|
| Rate for Payer: Health EOS Commercial |
$1,272.70
|
| Rate for Payer: HFN Commercial |
$1,315.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,072.50
|
| Rate for Payer: Multiplan Commercial |
$1,144.00
|
| Rate for Payer: NAPHCARE Commercial |
$858.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,315.60
|
| Rate for Payer: Quartz Beloit One Network |
$700.70
|
| Rate for Payer: Quartz Commercial |
$929.50
|
| Rate for Payer: Quartz Medicare Advantage |
$858.00
|
| Rate for Payer: The Alliance Commercial |
$5,720.00
|
| Rate for Payer: WEA Trust Commercial |
$786.50
|
| Rate for Payer: WPS Commercial |
$1,059.20
|
|
|
SCREW NON-LOCK 3.5MM X 26MM 657426
|
Facility
|
IP
|
$1,430.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599687
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$700.70 |
| Max. Negotiated Rate |
$1,315.60 |
| Rate for Payer: Aetna Commercial |
$1,287.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,229.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$757.90
|
| Rate for Payer: Cash Price |
$429.00
|
| Rate for Payer: Cigna Commercial |
$1,315.60
|
| Rate for Payer: Health EOS Commercial |
$1,272.70
|
| Rate for Payer: HFN Commercial |
$1,315.60
|
| Rate for Payer: Multiplan Commercial |
$1,144.00
|
| Rate for Payer: NAPHCARE Commercial |
$858.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,315.60
|
| Rate for Payer: Quartz Beloit One Network |
$700.70
|
| Rate for Payer: Quartz Commercial |
$858.00
|
| Rate for Payer: WEA Trust Commercial |
$786.50
|
| Rate for Payer: WPS Commercial |
$1,059.20
|
|
|
SCREW NON-LOCK 3.5MM X 26MM 657426
|
Facility
|
OP
|
$1,430.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599687
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$400.40 |
| Max. Negotiated Rate |
$5,720.00 |
| Rate for Payer: Aetna Commercial |
$1,287.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,229.80
|
| Rate for Payer: Aetna Managed Medicare |
$400.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$929.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$715.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$686.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$757.90
|
| Rate for Payer: Cash Price |
$429.00
|
| Rate for Payer: Cigna Commercial |
$1,315.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$800.23
|
| Rate for Payer: Health EOS Commercial |
$1,272.70
|
| Rate for Payer: HFN Commercial |
$1,315.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,072.50
|
| Rate for Payer: Multiplan Commercial |
$1,144.00
|
| Rate for Payer: NAPHCARE Commercial |
$858.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,315.60
|
| Rate for Payer: Quartz Beloit One Network |
$700.70
|
| Rate for Payer: Quartz Commercial |
$929.50
|
| Rate for Payer: Quartz Medicare Advantage |
$858.00
|
| Rate for Payer: The Alliance Commercial |
$5,720.00
|
| Rate for Payer: WEA Trust Commercial |
$786.50
|
| Rate for Payer: WPS Commercial |
$1,059.20
|
|
|
SCREW NON-LOCK 3.5MM X 28MM 657428
|
Facility
|
IP
|
$1,430.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599688
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$700.70 |
| Max. Negotiated Rate |
$1,315.60 |
| Rate for Payer: Aetna Commercial |
$1,287.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,229.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$757.90
|
| Rate for Payer: Cash Price |
$429.00
|
| Rate for Payer: Cigna Commercial |
$1,315.60
|
| Rate for Payer: Health EOS Commercial |
$1,272.70
|
| Rate for Payer: HFN Commercial |
$1,315.60
|
| Rate for Payer: Multiplan Commercial |
$1,144.00
|
| Rate for Payer: NAPHCARE Commercial |
$858.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,315.60
|
| Rate for Payer: Quartz Beloit One Network |
$700.70
|
| Rate for Payer: Quartz Commercial |
$858.00
|
| Rate for Payer: WEA Trust Commercial |
$786.50
|
| Rate for Payer: WPS Commercial |
$1,059.20
|
|
|
SCREW NON-LOCK 3.5MM X 28MM 657428
|
Facility
|
OP
|
$1,430.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599688
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$400.40 |
| Max. Negotiated Rate |
$5,720.00 |
| Rate for Payer: Aetna Commercial |
$1,287.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,229.80
|
| Rate for Payer: Aetna Managed Medicare |
$400.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$929.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$715.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$686.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$757.90
|
| Rate for Payer: Cash Price |
$429.00
|
| Rate for Payer: Cigna Commercial |
$1,315.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$800.23
|
| Rate for Payer: Health EOS Commercial |
$1,272.70
|
| Rate for Payer: HFN Commercial |
$1,315.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,072.50
|
| Rate for Payer: Multiplan Commercial |
$1,144.00
|
| Rate for Payer: NAPHCARE Commercial |
$858.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,315.60
|
| Rate for Payer: Quartz Beloit One Network |
$700.70
|
| Rate for Payer: Quartz Commercial |
$929.50
|
| Rate for Payer: Quartz Medicare Advantage |
$858.00
|
| Rate for Payer: The Alliance Commercial |
$5,720.00
|
| Rate for Payer: WEA Trust Commercial |
$786.50
|
| Rate for Payer: WPS Commercial |
$1,059.20
|
|
|
SCREW NON-LOCK 3.5MM X 30MM 657430
|
Facility
|
IP
|
$1,430.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5603670
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$700.70 |
| Max. Negotiated Rate |
$1,315.60 |
| Rate for Payer: Aetna Commercial |
$1,287.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,229.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$757.90
|
| Rate for Payer: Cash Price |
$429.00
|
| Rate for Payer: Cigna Commercial |
$1,315.60
|
| Rate for Payer: Health EOS Commercial |
$1,272.70
|
| Rate for Payer: HFN Commercial |
$1,315.60
|
| Rate for Payer: Multiplan Commercial |
$1,144.00
|
| Rate for Payer: NAPHCARE Commercial |
$858.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,315.60
|
| Rate for Payer: Quartz Beloit One Network |
$700.70
|
| Rate for Payer: Quartz Commercial |
$858.00
|
| Rate for Payer: WEA Trust Commercial |
$786.50
|
| Rate for Payer: WPS Commercial |
$1,059.20
|
|
|
SCREW NON-LOCK 3.5MM X 30MM 657430
|
Facility
|
OP
|
$1,430.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5603670
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$400.40 |
| Max. Negotiated Rate |
$5,720.00 |
| Rate for Payer: Aetna Commercial |
$1,287.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,229.80
|
| Rate for Payer: Aetna Managed Medicare |
$400.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$929.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$715.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$686.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$757.90
|
| Rate for Payer: Cash Price |
$429.00
|
| Rate for Payer: Cigna Commercial |
$1,315.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$800.23
|
| Rate for Payer: Health EOS Commercial |
$1,272.70
|
| Rate for Payer: HFN Commercial |
$1,315.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,072.50
|
| Rate for Payer: Multiplan Commercial |
$1,144.00
|
| Rate for Payer: NAPHCARE Commercial |
$858.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,315.60
|
| Rate for Payer: Quartz Beloit One Network |
$700.70
|
| Rate for Payer: Quartz Commercial |
$929.50
|
| Rate for Payer: Quartz Medicare Advantage |
$858.00
|
| Rate for Payer: The Alliance Commercial |
$5,720.00
|
| Rate for Payer: WEA Trust Commercial |
$786.50
|
| Rate for Payer: WPS Commercial |
$1,059.20
|
|
|
SCREW NON-LOCK 3.5MM X 32MM 657432
|
Facility
|
OP
|
$1,373.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6172080
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$384.44 |
| Max. Negotiated Rate |
$5,492.00 |
| Rate for Payer: Aetna Commercial |
$1,235.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,180.78
|
| Rate for Payer: Aetna Managed Medicare |
$384.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$892.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$686.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$659.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$727.69
|
| Rate for Payer: Cash Price |
$411.90
|
| Rate for Payer: Cigna Commercial |
$1,263.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$768.33
|
| Rate for Payer: Health EOS Commercial |
$1,221.97
|
| Rate for Payer: HFN Commercial |
$1,263.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,029.75
|
| Rate for Payer: Multiplan Commercial |
$1,098.40
|
| Rate for Payer: NAPHCARE Commercial |
$823.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,263.16
|
| Rate for Payer: Quartz Beloit One Network |
$672.77
|
| Rate for Payer: Quartz Commercial |
$892.45
|
| Rate for Payer: Quartz Medicare Advantage |
$823.80
|
| Rate for Payer: The Alliance Commercial |
$5,492.00
|
| Rate for Payer: WEA Trust Commercial |
$755.15
|
| Rate for Payer: WPS Commercial |
$1,016.98
|
|
|
SCREW NON-LOCK 3.5MM X 32MM 657432
|
Facility
|
IP
|
$1,373.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6172080
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$672.77 |
| Max. Negotiated Rate |
$1,263.16 |
| Rate for Payer: Aetna Commercial |
$1,235.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,180.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$727.69
|
| Rate for Payer: Cash Price |
$411.90
|
| Rate for Payer: Cigna Commercial |
$1,263.16
|
| Rate for Payer: Health EOS Commercial |
$1,221.97
|
| Rate for Payer: HFN Commercial |
$1,263.16
|
| Rate for Payer: Multiplan Commercial |
$1,098.40
|
| Rate for Payer: NAPHCARE Commercial |
$823.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,263.16
|
| Rate for Payer: Quartz Beloit One Network |
$672.77
|
| Rate for Payer: Quartz Commercial |
$823.80
|
| Rate for Payer: WEA Trust Commercial |
$755.15
|
| Rate for Payer: WPS Commercial |
$1,016.98
|
|
|
SCREW NON-LOCK 3.5MM X 34MM 657434
|
Facility
|
OP
|
$1,320.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6185029
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$369.60 |
| Max. Negotiated Rate |
$5,280.00 |
| Rate for Payer: Aetna Commercial |
$1,188.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,135.20
|
| Rate for Payer: Aetna Managed Medicare |
$369.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$858.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$660.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$633.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$699.60
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cigna Commercial |
$1,214.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$738.67
|
| Rate for Payer: Health EOS Commercial |
$1,174.80
|
| Rate for Payer: HFN Commercial |
$1,214.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$990.00
|
| Rate for Payer: Multiplan Commercial |
$1,056.00
|
| Rate for Payer: NAPHCARE Commercial |
$792.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,214.40
|
| Rate for Payer: Quartz Beloit One Network |
$646.80
|
| Rate for Payer: Quartz Commercial |
$858.00
|
| Rate for Payer: Quartz Medicare Advantage |
$792.00
|
| Rate for Payer: The Alliance Commercial |
$5,280.00
|
| Rate for Payer: WEA Trust Commercial |
$726.00
|
| Rate for Payer: WPS Commercial |
$977.72
|
|
|
SCREW NON-LOCK 3.5MM X 34MM 657434
|
Facility
|
IP
|
$1,320.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6185029
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$646.80 |
| Max. Negotiated Rate |
$1,214.40 |
| Rate for Payer: Aetna Commercial |
$1,188.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,135.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$699.60
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cigna Commercial |
$1,214.40
|
| Rate for Payer: Health EOS Commercial |
$1,174.80
|
| Rate for Payer: HFN Commercial |
$1,214.40
|
| Rate for Payer: Multiplan Commercial |
$1,056.00
|
| Rate for Payer: NAPHCARE Commercial |
$792.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,214.40
|
| Rate for Payer: Quartz Beloit One Network |
$646.80
|
| Rate for Payer: Quartz Commercial |
$792.00
|
| Rate for Payer: WEA Trust Commercial |
$726.00
|
| Rate for Payer: WPS Commercial |
$977.72
|
|
|
SCREW NON-LOCK 3.5MM X 42MM 657442
|
Facility
|
OP
|
$1,373.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6171784
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$384.44 |
| Max. Negotiated Rate |
$5,492.00 |
| Rate for Payer: Aetna Commercial |
$1,235.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,180.78
|
| Rate for Payer: Aetna Managed Medicare |
$384.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$892.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$686.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$659.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$727.69
|
| Rate for Payer: Cash Price |
$411.90
|
| Rate for Payer: Cigna Commercial |
$1,263.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$768.33
|
| Rate for Payer: Health EOS Commercial |
$1,221.97
|
| Rate for Payer: HFN Commercial |
$1,263.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,029.75
|
| Rate for Payer: Multiplan Commercial |
$1,098.40
|
| Rate for Payer: NAPHCARE Commercial |
$823.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,263.16
|
| Rate for Payer: Quartz Beloit One Network |
$672.77
|
| Rate for Payer: Quartz Commercial |
$892.45
|
| Rate for Payer: Quartz Medicare Advantage |
$823.80
|
| Rate for Payer: The Alliance Commercial |
$5,492.00
|
| Rate for Payer: WEA Trust Commercial |
$755.15
|
| Rate for Payer: WPS Commercial |
$1,016.98
|
|
|
SCREW NON-LOCK 3.5MM X 42MM 657442
|
Facility
|
IP
|
$1,373.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6171784
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$672.77 |
| Max. Negotiated Rate |
$1,263.16 |
| Rate for Payer: Aetna Commercial |
$1,235.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,180.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$727.69
|
| Rate for Payer: Cash Price |
$411.90
|
| Rate for Payer: Cigna Commercial |
$1,263.16
|
| Rate for Payer: Health EOS Commercial |
$1,221.97
|
| Rate for Payer: HFN Commercial |
$1,263.16
|
| Rate for Payer: Multiplan Commercial |
$1,098.40
|
| Rate for Payer: NAPHCARE Commercial |
$823.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,263.16
|
| Rate for Payer: Quartz Beloit One Network |
$672.77
|
| Rate for Payer: Quartz Commercial |
$823.80
|
| Rate for Payer: WEA Trust Commercial |
$755.15
|
| Rate for Payer: WPS Commercial |
$1,016.98
|
|
|
SCREW NON-LOCK 3.5MM X 55MM 657455
|
Facility
|
IP
|
$1,430.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599689
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$700.70 |
| Max. Negotiated Rate |
$1,315.60 |
| Rate for Payer: Aetna Commercial |
$1,287.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,229.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$757.90
|
| Rate for Payer: Cash Price |
$429.00
|
| Rate for Payer: Cigna Commercial |
$1,315.60
|
| Rate for Payer: Health EOS Commercial |
$1,272.70
|
| Rate for Payer: HFN Commercial |
$1,315.60
|
| Rate for Payer: Multiplan Commercial |
$1,144.00
|
| Rate for Payer: NAPHCARE Commercial |
$858.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,315.60
|
| Rate for Payer: Quartz Beloit One Network |
$700.70
|
| Rate for Payer: Quartz Commercial |
$858.00
|
| Rate for Payer: WEA Trust Commercial |
$786.50
|
| Rate for Payer: WPS Commercial |
$1,059.20
|
|
|
SCREW NON-LOCK 3.5MM X 55MM 657455
|
Facility
|
OP
|
$1,430.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599689
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$400.40 |
| Max. Negotiated Rate |
$5,720.00 |
| Rate for Payer: Aetna Commercial |
$1,287.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,229.80
|
| Rate for Payer: Aetna Managed Medicare |
$400.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$929.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$715.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$686.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$757.90
|
| Rate for Payer: Cash Price |
$429.00
|
| Rate for Payer: Cigna Commercial |
$1,315.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$800.23
|
| Rate for Payer: Health EOS Commercial |
$1,272.70
|
| Rate for Payer: HFN Commercial |
$1,315.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,072.50
|
| Rate for Payer: Multiplan Commercial |
$1,144.00
|
| Rate for Payer: NAPHCARE Commercial |
$858.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,315.60
|
| Rate for Payer: Quartz Beloit One Network |
$700.70
|
| Rate for Payer: Quartz Commercial |
$929.50
|
| Rate for Payer: Quartz Medicare Advantage |
$858.00
|
| Rate for Payer: The Alliance Commercial |
$5,720.00
|
| Rate for Payer: WEA Trust Commercial |
$786.50
|
| Rate for Payer: WPS Commercial |
$1,059.20
|
|
|
SCREW NON-LOCK 3.5 X 16MM MFT-011-35-16
|
Facility
|
IP
|
$3,283.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4028658
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,608.67 |
| Max. Negotiated Rate |
$3,020.36 |
| Rate for Payer: Aetna Commercial |
$2,954.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,823.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,739.99
|
| Rate for Payer: Cash Price |
$984.90
|
| Rate for Payer: Cigna Commercial |
$3,020.36
|
| Rate for Payer: Health EOS Commercial |
$2,921.87
|
| Rate for Payer: HFN Commercial |
$3,020.36
|
| Rate for Payer: Multiplan Commercial |
$2,626.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,969.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,020.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,608.67
|
| Rate for Payer: Quartz Commercial |
$1,969.80
|
| Rate for Payer: WEA Trust Commercial |
$1,805.65
|
| Rate for Payer: WPS Commercial |
$2,431.72
|
|
|
SCREW NON-LOCK 3.5 X 16MM MFT-011-35-16
|
Facility
|
OP
|
$3,283.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4028658
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$919.24 |
| Max. Negotiated Rate |
$13,132.00 |
| Rate for Payer: Aetna Commercial |
$2,954.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,823.38
|
| Rate for Payer: Aetna Managed Medicare |
$919.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,133.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,641.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,575.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,739.99
|
| Rate for Payer: Cash Price |
$984.90
|
| Rate for Payer: Cigna Commercial |
$3,020.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,837.17
|
| Rate for Payer: Health EOS Commercial |
$2,921.87
|
| Rate for Payer: HFN Commercial |
$3,020.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,462.25
|
| Rate for Payer: Multiplan Commercial |
$2,626.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,969.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,020.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,608.67
|
| Rate for Payer: Quartz Commercial |
$2,133.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,969.80
|
| Rate for Payer: The Alliance Commercial |
$13,132.00
|
| Rate for Payer: WEA Trust Commercial |
$1,805.65
|
| Rate for Payer: WPS Commercial |
$2,431.72
|
|
|
SCREW NON-LOCK 3.5 X 26MM MFT-011-35-26
|
Facility
|
OP
|
$3,283.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5787649
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$919.24 |
| Max. Negotiated Rate |
$13,132.00 |
| Rate for Payer: Aetna Commercial |
$2,954.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,823.38
|
| Rate for Payer: Aetna Managed Medicare |
$919.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,133.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,641.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,575.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,739.99
|
| Rate for Payer: Cash Price |
$984.90
|
| Rate for Payer: Cigna Commercial |
$3,020.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,837.17
|
| Rate for Payer: Health EOS Commercial |
$2,921.87
|
| Rate for Payer: HFN Commercial |
$3,020.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,462.25
|
| Rate for Payer: Multiplan Commercial |
$2,626.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,969.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,020.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,608.67
|
| Rate for Payer: Quartz Commercial |
$2,133.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,969.80
|
| Rate for Payer: The Alliance Commercial |
$13,132.00
|
| Rate for Payer: WEA Trust Commercial |
$1,805.65
|
| Rate for Payer: WPS Commercial |
$2,431.72
|
|
|
SCREW NON-LOCK 3.5 X 26MM MFT-011-35-26
|
Facility
|
IP
|
$3,283.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5787649
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,608.67 |
| Max. Negotiated Rate |
$3,020.36 |
| Rate for Payer: Aetna Commercial |
$2,954.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,823.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,739.99
|
| Rate for Payer: Cash Price |
$984.90
|
| Rate for Payer: Cigna Commercial |
$3,020.36
|
| Rate for Payer: Health EOS Commercial |
$2,921.87
|
| Rate for Payer: HFN Commercial |
$3,020.36
|
| Rate for Payer: Multiplan Commercial |
$2,626.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,969.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,020.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,608.67
|
| Rate for Payer: Quartz Commercial |
$1,969.80
|
| Rate for Payer: WEA Trust Commercial |
$1,805.65
|
| Rate for Payer: WPS Commercial |
$2,431.72
|
|
|
SCREW NON-LOCK 3.5 X 30MM MFT-011-35-30
|
Facility
|
OP
|
$3,283.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5729847
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$919.24 |
| Max. Negotiated Rate |
$13,132.00 |
| Rate for Payer: Aetna Commercial |
$2,954.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,823.38
|
| Rate for Payer: Aetna Managed Medicare |
$919.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,133.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,641.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,575.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,739.99
|
| Rate for Payer: Cash Price |
$984.90
|
| Rate for Payer: Cigna Commercial |
$3,020.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,837.17
|
| Rate for Payer: Health EOS Commercial |
$2,921.87
|
| Rate for Payer: HFN Commercial |
$3,020.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,462.25
|
| Rate for Payer: Multiplan Commercial |
$2,626.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,969.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,020.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,608.67
|
| Rate for Payer: Quartz Commercial |
$2,133.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,969.80
|
| Rate for Payer: The Alliance Commercial |
$13,132.00
|
| Rate for Payer: WEA Trust Commercial |
$1,805.65
|
| Rate for Payer: WPS Commercial |
$2,431.72
|
|
