|
SCREW NON-LOCK 3.5 X 30MM MFT-011-35-30
|
Facility
|
IP
|
$3,283.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5729847
|
|
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 32.5MM MFT-011-35-325
|
Facility
|
IP
|
$3,283.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5729851
|
|
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 32.5MM MFT-011-35-325
|
Facility
|
OP
|
$3,283.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5729851
|
|
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 4.0 X 30 TORNIER ZPFTS30
|
Facility
|
OP
|
$1,281.00
|
|
| Hospital Charge Code |
2967361
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$358.68 |
| Max. Negotiated Rate |
$5,124.00 |
| Rate for Payer: Aetna Commercial |
$1,152.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,101.66
|
| Rate for Payer: Aetna Managed Medicare |
$358.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$832.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$640.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$614.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$678.93
|
| Rate for Payer: Cash Price |
$384.30
|
| Rate for Payer: Cigna Commercial |
$1,178.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$716.85
|
| Rate for Payer: Health EOS Commercial |
$1,140.09
|
| Rate for Payer: HFN Commercial |
$1,178.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$960.75
|
| Rate for Payer: Multiplan Commercial |
$1,024.80
|
| Rate for Payer: NAPHCARE Commercial |
$768.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,178.52
|
| Rate for Payer: Quartz Beloit One Network |
$627.69
|
| Rate for Payer: Quartz Commercial |
$832.65
|
| Rate for Payer: Quartz Medicare Advantage |
$768.60
|
| Rate for Payer: The Alliance Commercial |
$5,124.00
|
| Rate for Payer: WEA Trust Commercial |
$704.55
|
| Rate for Payer: WPS Commercial |
$948.84
|
|
|
SCREW NON-LOCK 4.0 X 30 TORNIER ZPFTS30
|
Facility
|
IP
|
$1,281.00
|
|
| Hospital Charge Code |
2967361
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$627.69 |
| Max. Negotiated Rate |
$1,178.52 |
| Rate for Payer: Aetna Commercial |
$1,152.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,101.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$678.93
|
| Rate for Payer: Cash Price |
$384.30
|
| Rate for Payer: Cigna Commercial |
$1,178.52
|
| Rate for Payer: Health EOS Commercial |
$1,140.09
|
| Rate for Payer: HFN Commercial |
$1,178.52
|
| Rate for Payer: Multiplan Commercial |
$1,024.80
|
| Rate for Payer: NAPHCARE Commercial |
$768.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,178.52
|
| Rate for Payer: Quartz Beloit One Network |
$627.69
|
| Rate for Payer: Quartz Commercial |
$768.60
|
| Rate for Payer: WEA Trust Commercial |
$704.55
|
| Rate for Payer: WPS Commercial |
$948.84
|
|
|
SCREW NON-LOCK 4.0 X 32 TORNIER ZPFTS32
|
Facility
|
IP
|
$1,281.00
|
|
| Hospital Charge Code |
2967362
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$627.69 |
| Max. Negotiated Rate |
$1,178.52 |
| Rate for Payer: Aetna Commercial |
$1,152.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,101.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$678.93
|
| Rate for Payer: Cash Price |
$384.30
|
| Rate for Payer: Cigna Commercial |
$1,178.52
|
| Rate for Payer: Health EOS Commercial |
$1,140.09
|
| Rate for Payer: HFN Commercial |
$1,178.52
|
| Rate for Payer: Multiplan Commercial |
$1,024.80
|
| Rate for Payer: NAPHCARE Commercial |
$768.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,178.52
|
| Rate for Payer: Quartz Beloit One Network |
$627.69
|
| Rate for Payer: Quartz Commercial |
$768.60
|
| Rate for Payer: WEA Trust Commercial |
$704.55
|
| Rate for Payer: WPS Commercial |
$948.84
|
|
|
SCREW NON-LOCK 4.0 X 32 TORNIER ZPFTS32
|
Facility
|
OP
|
$1,281.00
|
|
| Hospital Charge Code |
2967362
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$358.68 |
| Max. Negotiated Rate |
$5,124.00 |
| Rate for Payer: Aetna Commercial |
$1,152.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,101.66
|
| Rate for Payer: Aetna Managed Medicare |
$358.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$832.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$640.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$614.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$678.93
|
| Rate for Payer: Cash Price |
$384.30
|
| Rate for Payer: Cigna Commercial |
$1,178.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$716.85
|
| Rate for Payer: Health EOS Commercial |
$1,140.09
|
| Rate for Payer: HFN Commercial |
$1,178.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$960.75
|
| Rate for Payer: Multiplan Commercial |
$1,024.80
|
| Rate for Payer: NAPHCARE Commercial |
$768.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,178.52
|
| Rate for Payer: Quartz Beloit One Network |
$627.69
|
| Rate for Payer: Quartz Commercial |
$832.65
|
| Rate for Payer: Quartz Medicare Advantage |
$768.60
|
| Rate for Payer: The Alliance Commercial |
$5,124.00
|
| Rate for Payer: WEA Trust Commercial |
$704.55
|
| Rate for Payer: WPS Commercial |
$948.84
|
|
|
SCREW NON-LOCK 4.0 X 34 TORNIER ZPFTS34
|
Facility
|
OP
|
$1,281.00
|
|
| Hospital Charge Code |
2967364
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$358.68 |
| Max. Negotiated Rate |
$5,124.00 |
| Rate for Payer: Aetna Commercial |
$1,152.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,101.66
|
| Rate for Payer: Aetna Managed Medicare |
$358.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$832.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$640.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$614.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$678.93
|
| Rate for Payer: Cash Price |
$384.30
|
| Rate for Payer: Cigna Commercial |
$1,178.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$716.85
|
| Rate for Payer: Health EOS Commercial |
$1,140.09
|
| Rate for Payer: HFN Commercial |
$1,178.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$960.75
|
| Rate for Payer: Multiplan Commercial |
$1,024.80
|
| Rate for Payer: NAPHCARE Commercial |
$768.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,178.52
|
| Rate for Payer: Quartz Beloit One Network |
$627.69
|
| Rate for Payer: Quartz Commercial |
$832.65
|
| Rate for Payer: Quartz Medicare Advantage |
$768.60
|
| Rate for Payer: The Alliance Commercial |
$5,124.00
|
| Rate for Payer: WEA Trust Commercial |
$704.55
|
| Rate for Payer: WPS Commercial |
$948.84
|
|
|
SCREW NON-LOCK 4.0 X 34 TORNIER ZPFTS34
|
Facility
|
IP
|
$1,281.00
|
|
| Hospital Charge Code |
2967364
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$627.69 |
| Max. Negotiated Rate |
$1,178.52 |
| Rate for Payer: Aetna Commercial |
$1,152.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,101.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$678.93
|
| Rate for Payer: Cash Price |
$384.30
|
| Rate for Payer: Cigna Commercial |
$1,178.52
|
| Rate for Payer: Health EOS Commercial |
$1,140.09
|
| Rate for Payer: HFN Commercial |
$1,178.52
|
| Rate for Payer: Multiplan Commercial |
$1,024.80
|
| Rate for Payer: NAPHCARE Commercial |
$768.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,178.52
|
| Rate for Payer: Quartz Beloit One Network |
$627.69
|
| Rate for Payer: Quartz Commercial |
$768.60
|
| Rate for Payer: WEA Trust Commercial |
$704.55
|
| Rate for Payer: WPS Commercial |
$948.84
|
|
|
SCREW NONLOCK 4.5 X 22MM LP TI AR-8545-22
|
Facility
|
OP
|
$1,152.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5803652
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$322.56 |
| Max. Negotiated Rate |
$4,608.00 |
| Rate for Payer: Aetna Commercial |
$1,036.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$990.72
|
| Rate for Payer: Aetna Managed Medicare |
$322.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$748.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$576.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$552.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$610.56
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Cigna Commercial |
$1,059.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$644.66
|
| Rate for Payer: Health EOS Commercial |
$1,025.28
|
| Rate for Payer: HFN Commercial |
$1,059.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$864.00
|
| Rate for Payer: Multiplan Commercial |
$921.60
|
| Rate for Payer: NAPHCARE Commercial |
$691.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,059.84
|
| Rate for Payer: Quartz Beloit One Network |
$564.48
|
| Rate for Payer: Quartz Commercial |
$748.80
|
| Rate for Payer: Quartz Medicare Advantage |
$691.20
|
| Rate for Payer: The Alliance Commercial |
$4,608.00
|
| Rate for Payer: WEA Trust Commercial |
$633.60
|
| Rate for Payer: WPS Commercial |
$853.29
|
|
|
SCREW NONLOCK 4.5 X 22MM LP TI AR-8545-22
|
Facility
|
IP
|
$1,152.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5803652
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$564.48 |
| Max. Negotiated Rate |
$1,059.84 |
| Rate for Payer: Aetna Commercial |
$1,036.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$990.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$610.56
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Cigna Commercial |
$1,059.84
|
| Rate for Payer: Health EOS Commercial |
$1,025.28
|
| Rate for Payer: HFN Commercial |
$1,059.84
|
| Rate for Payer: Multiplan Commercial |
$921.60
|
| Rate for Payer: NAPHCARE Commercial |
$691.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,059.84
|
| Rate for Payer: Quartz Beloit One Network |
$564.48
|
| Rate for Payer: Quartz Commercial |
$691.20
|
| Rate for Payer: WEA Trust Commercial |
$633.60
|
| Rate for Payer: WPS Commercial |
$853.29
|
|
|
SCREW NONLOCK 4.5 X 24MM LP TI AR-8545-24
|
Facility
|
IP
|
$1,152.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5803653
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$564.48 |
| Max. Negotiated Rate |
$1,059.84 |
| Rate for Payer: Aetna Commercial |
$1,036.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$990.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$610.56
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Cigna Commercial |
$1,059.84
|
| Rate for Payer: Health EOS Commercial |
$1,025.28
|
| Rate for Payer: HFN Commercial |
$1,059.84
|
| Rate for Payer: Multiplan Commercial |
$921.60
|
| Rate for Payer: NAPHCARE Commercial |
$691.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,059.84
|
| Rate for Payer: Quartz Beloit One Network |
$564.48
|
| Rate for Payer: Quartz Commercial |
$691.20
|
| Rate for Payer: WEA Trust Commercial |
$633.60
|
| Rate for Payer: WPS Commercial |
$853.29
|
|
|
SCREW NONLOCK 4.5 X 24MM LP TI AR-8545-24
|
Facility
|
OP
|
$1,152.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5803653
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$322.56 |
| Max. Negotiated Rate |
$4,608.00 |
| Rate for Payer: Aetna Commercial |
$1,036.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$990.72
|
| Rate for Payer: Aetna Managed Medicare |
$322.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$748.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$576.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$552.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$610.56
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Cigna Commercial |
$1,059.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$644.66
|
| Rate for Payer: Health EOS Commercial |
$1,025.28
|
| Rate for Payer: HFN Commercial |
$1,059.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$864.00
|
| Rate for Payer: Multiplan Commercial |
$921.60
|
| Rate for Payer: NAPHCARE Commercial |
$691.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,059.84
|
| Rate for Payer: Quartz Beloit One Network |
$564.48
|
| Rate for Payer: Quartz Commercial |
$748.80
|
| Rate for Payer: Quartz Medicare Advantage |
$691.20
|
| Rate for Payer: The Alliance Commercial |
$4,608.00
|
| Rate for Payer: WEA Trust Commercial |
$633.60
|
| Rate for Payer: WPS Commercial |
$853.29
|
|
|
SCREW NONLOCK 4.5 X 26MM LP TI AR-8545-26
|
Facility
|
IP
|
$1,198.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5603786
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$587.02 |
| Max. Negotiated Rate |
$1,102.16 |
| Rate for Payer: Aetna Commercial |
$1,078.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,030.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$634.94
|
| Rate for Payer: Cash Price |
$359.40
|
| Rate for Payer: Cigna Commercial |
$1,102.16
|
| Rate for Payer: Health EOS Commercial |
$1,066.22
|
| Rate for Payer: HFN Commercial |
$1,102.16
|
| Rate for Payer: Multiplan Commercial |
$958.40
|
| Rate for Payer: NAPHCARE Commercial |
$718.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,102.16
|
| Rate for Payer: Quartz Beloit One Network |
$587.02
|
| Rate for Payer: Quartz Commercial |
$718.80
|
| Rate for Payer: WEA Trust Commercial |
$658.90
|
| Rate for Payer: WPS Commercial |
$887.36
|
|
|
SCREW NONLOCK 4.5 X 26MM LP TI AR-8545-26
|
Facility
|
OP
|
$1,198.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5603786
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$335.44 |
| Max. Negotiated Rate |
$4,792.00 |
| Rate for Payer: Aetna Commercial |
$1,078.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,030.28
|
| Rate for Payer: Aetna Managed Medicare |
$335.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$778.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$599.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$575.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$634.94
|
| Rate for Payer: Cash Price |
$359.40
|
| Rate for Payer: Cigna Commercial |
$1,102.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$670.40
|
| Rate for Payer: Health EOS Commercial |
$1,066.22
|
| Rate for Payer: HFN Commercial |
$1,102.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$898.50
|
| Rate for Payer: Multiplan Commercial |
$958.40
|
| Rate for Payer: NAPHCARE Commercial |
$718.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,102.16
|
| Rate for Payer: Quartz Beloit One Network |
$587.02
|
| Rate for Payer: Quartz Commercial |
$778.70
|
| Rate for Payer: Quartz Medicare Advantage |
$718.80
|
| Rate for Payer: The Alliance Commercial |
$4,792.00
|
| Rate for Payer: WEA Trust Commercial |
$658.90
|
| Rate for Payer: WPS Commercial |
$887.36
|
|
|
SCREW NONLOCK 4.5 X 28MM LP TI AR-8545-28
|
Facility
|
OP
|
$1,152.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5803654
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$322.56 |
| Max. Negotiated Rate |
$4,608.00 |
| Rate for Payer: Aetna Commercial |
$1,036.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$990.72
|
| Rate for Payer: Aetna Managed Medicare |
$322.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$748.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$576.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$552.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$610.56
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Cigna Commercial |
$1,059.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$644.66
|
| Rate for Payer: Health EOS Commercial |
$1,025.28
|
| Rate for Payer: HFN Commercial |
$1,059.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$864.00
|
| Rate for Payer: Multiplan Commercial |
$921.60
|
| Rate for Payer: NAPHCARE Commercial |
$691.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,059.84
|
| Rate for Payer: Quartz Beloit One Network |
$564.48
|
| Rate for Payer: Quartz Commercial |
$748.80
|
| Rate for Payer: Quartz Medicare Advantage |
$691.20
|
| Rate for Payer: The Alliance Commercial |
$4,608.00
|
| Rate for Payer: WEA Trust Commercial |
$633.60
|
| Rate for Payer: WPS Commercial |
$853.29
|
|
|
SCREW NONLOCK 4.5 X 28MM LP TI AR-8545-28
|
Facility
|
IP
|
$1,152.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5803654
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$564.48 |
| Max. Negotiated Rate |
$1,059.84 |
| Rate for Payer: Aetna Commercial |
$1,036.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$990.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$610.56
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Cigna Commercial |
$1,059.84
|
| Rate for Payer: Health EOS Commercial |
$1,025.28
|
| Rate for Payer: HFN Commercial |
$1,059.84
|
| Rate for Payer: Multiplan Commercial |
$921.60
|
| Rate for Payer: NAPHCARE Commercial |
$691.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,059.84
|
| Rate for Payer: Quartz Beloit One Network |
$564.48
|
| Rate for Payer: Quartz Commercial |
$691.20
|
| Rate for Payer: WEA Trust Commercial |
$633.60
|
| Rate for Payer: WPS Commercial |
$853.29
|
|
|
SCREW NONLOCK 4.5 X 30MM LP TI AR-8545-30
|
Facility
|
OP
|
$1,152.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5803655
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$322.56 |
| Max. Negotiated Rate |
$4,608.00 |
| Rate for Payer: Aetna Commercial |
$1,036.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$990.72
|
| Rate for Payer: Aetna Managed Medicare |
$322.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$748.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$576.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$552.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$610.56
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Cigna Commercial |
$1,059.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$644.66
|
| Rate for Payer: Health EOS Commercial |
$1,025.28
|
| Rate for Payer: HFN Commercial |
$1,059.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$864.00
|
| Rate for Payer: Multiplan Commercial |
$921.60
|
| Rate for Payer: NAPHCARE Commercial |
$691.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,059.84
|
| Rate for Payer: Quartz Beloit One Network |
$564.48
|
| Rate for Payer: Quartz Commercial |
$748.80
|
| Rate for Payer: Quartz Medicare Advantage |
$691.20
|
| Rate for Payer: The Alliance Commercial |
$4,608.00
|
| Rate for Payer: WEA Trust Commercial |
$633.60
|
| Rate for Payer: WPS Commercial |
$853.29
|
|
|
SCREW NONLOCK 4.5 X 30MM LP TI AR-8545-30
|
Facility
|
IP
|
$1,152.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5803655
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$564.48 |
| Max. Negotiated Rate |
$1,059.84 |
| Rate for Payer: Aetna Commercial |
$1,036.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$990.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$610.56
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Cigna Commercial |
$1,059.84
|
| Rate for Payer: Health EOS Commercial |
$1,025.28
|
| Rate for Payer: HFN Commercial |
$1,059.84
|
| Rate for Payer: Multiplan Commercial |
$921.60
|
| Rate for Payer: NAPHCARE Commercial |
$691.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,059.84
|
| Rate for Payer: Quartz Beloit One Network |
$564.48
|
| Rate for Payer: Quartz Commercial |
$691.20
|
| Rate for Payer: WEA Trust Commercial |
$633.60
|
| Rate for Payer: WPS Commercial |
$853.29
|
|
|
SCREW NONLOCK 4.5 X 32MM LP TI AR-8545-32
|
Facility
|
OP
|
$1,152.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5803656
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$322.56 |
| Max. Negotiated Rate |
$4,608.00 |
| Rate for Payer: Aetna Commercial |
$1,036.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$990.72
|
| Rate for Payer: Aetna Managed Medicare |
$322.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$748.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$576.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$552.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$610.56
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Cigna Commercial |
$1,059.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$644.66
|
| Rate for Payer: Health EOS Commercial |
$1,025.28
|
| Rate for Payer: HFN Commercial |
$1,059.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$864.00
|
| Rate for Payer: Multiplan Commercial |
$921.60
|
| Rate for Payer: NAPHCARE Commercial |
$691.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,059.84
|
| Rate for Payer: Quartz Beloit One Network |
$564.48
|
| Rate for Payer: Quartz Commercial |
$748.80
|
| Rate for Payer: Quartz Medicare Advantage |
$691.20
|
| Rate for Payer: The Alliance Commercial |
$4,608.00
|
| Rate for Payer: WEA Trust Commercial |
$633.60
|
| Rate for Payer: WPS Commercial |
$853.29
|
|
|
SCREW NONLOCK 4.5 X 32MM LP TI AR-8545-32
|
Facility
|
IP
|
$1,152.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5803656
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$564.48 |
| Max. Negotiated Rate |
$1,059.84 |
| Rate for Payer: Aetna Commercial |
$1,036.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$990.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$610.56
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Cigna Commercial |
$1,059.84
|
| Rate for Payer: Health EOS Commercial |
$1,025.28
|
| Rate for Payer: HFN Commercial |
$1,059.84
|
| Rate for Payer: Multiplan Commercial |
$921.60
|
| Rate for Payer: NAPHCARE Commercial |
$691.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,059.84
|
| Rate for Payer: Quartz Beloit One Network |
$564.48
|
| Rate for Payer: Quartz Commercial |
$691.20
|
| Rate for Payer: WEA Trust Commercial |
$633.60
|
| Rate for Payer: WPS Commercial |
$853.29
|
|
|
SCREW NONLOCK 4.5 X 85MM LP TI AR-8545-85
|
Facility
|
IP
|
$1,152.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5803657
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$564.48 |
| Max. Negotiated Rate |
$1,059.84 |
| Rate for Payer: Aetna Commercial |
$1,036.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$990.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$610.56
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Cigna Commercial |
$1,059.84
|
| Rate for Payer: Health EOS Commercial |
$1,025.28
|
| Rate for Payer: HFN Commercial |
$1,059.84
|
| Rate for Payer: Multiplan Commercial |
$921.60
|
| Rate for Payer: NAPHCARE Commercial |
$691.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,059.84
|
| Rate for Payer: Quartz Beloit One Network |
$564.48
|
| Rate for Payer: Quartz Commercial |
$691.20
|
| Rate for Payer: WEA Trust Commercial |
$633.60
|
| Rate for Payer: WPS Commercial |
$853.29
|
|
|
SCREW NONLOCK 4.5 X 85MM LP TI AR-8545-85
|
Facility
|
OP
|
$1,152.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5803657
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$322.56 |
| Max. Negotiated Rate |
$4,608.00 |
| Rate for Payer: Aetna Commercial |
$1,036.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$990.72
|
| Rate for Payer: Aetna Managed Medicare |
$322.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$748.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$576.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$552.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$610.56
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Cigna Commercial |
$1,059.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$644.66
|
| Rate for Payer: Health EOS Commercial |
$1,025.28
|
| Rate for Payer: HFN Commercial |
$1,059.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$864.00
|
| Rate for Payer: Multiplan Commercial |
$921.60
|
| Rate for Payer: NAPHCARE Commercial |
$691.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,059.84
|
| Rate for Payer: Quartz Beloit One Network |
$564.48
|
| Rate for Payer: Quartz Commercial |
$748.80
|
| Rate for Payer: Quartz Medicare Advantage |
$691.20
|
| Rate for Payer: The Alliance Commercial |
$4,608.00
|
| Rate for Payer: WEA Trust Commercial |
$633.60
|
| Rate for Payer: WPS Commercial |
$853.29
|
|
|
SCREW NUT 5.0 222.578
|
Facility
|
IP
|
$676.00
|
|
| Hospital Charge Code |
2967023
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$331.24 |
| Max. Negotiated Rate |
$621.92 |
| Rate for Payer: Aetna Commercial |
$608.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$581.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$358.28
|
| Rate for Payer: Cash Price |
$202.80
|
| Rate for Payer: Cigna Commercial |
$621.92
|
| Rate for Payer: Health EOS Commercial |
$601.64
|
| Rate for Payer: HFN Commercial |
$621.92
|
| Rate for Payer: Multiplan Commercial |
$540.80
|
| Rate for Payer: NAPHCARE Commercial |
$405.60
|
| Rate for Payer: Preferred Network Access Commercial |
$621.92
|
| Rate for Payer: Quartz Beloit One Network |
$331.24
|
| Rate for Payer: Quartz Commercial |
$405.60
|
| Rate for Payer: WEA Trust Commercial |
$371.80
|
| Rate for Payer: WPS Commercial |
$500.71
|
|
|
SCREW NUT 5.0 222.578
|
Facility
|
OP
|
$676.00
|
|
| Hospital Charge Code |
2967023
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$189.28 |
| Max. Negotiated Rate |
$2,704.00 |
| Rate for Payer: Aetna Commercial |
$608.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$581.36
|
| Rate for Payer: Aetna Managed Medicare |
$189.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$439.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$338.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$324.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$358.28
|
| Rate for Payer: Cash Price |
$202.80
|
| Rate for Payer: Cigna Commercial |
$621.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$378.29
|
| Rate for Payer: Health EOS Commercial |
$601.64
|
| Rate for Payer: HFN Commercial |
$621.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$507.00
|
| Rate for Payer: Multiplan Commercial |
$540.80
|
| Rate for Payer: NAPHCARE Commercial |
$405.60
|
| Rate for Payer: Preferred Network Access Commercial |
$621.92
|
| Rate for Payer: Quartz Beloit One Network |
$331.24
|
| Rate for Payer: Quartz Commercial |
$439.40
|
| Rate for Payer: Quartz Medicare Advantage |
$405.60
|
| Rate for Payer: The Alliance Commercial |
$2,704.00
|
| Rate for Payer: WEA Trust Commercial |
$371.80
|
| Rate for Payer: WPS Commercial |
$500.71
|
|
