|
SCREW LOCK 3.5MM X 30MM T10 657330
|
Facility
|
OP
|
$3,364.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5861714
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$979.60 |
| Max. Negotiated Rate |
$3,218.68 |
| Rate for Payer: Aetna Commercial |
$3,148.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,008.76
|
| Rate for Payer: Aetna Managed Medicare |
$979.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,274.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,749.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,679.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,854.24
|
| Rate for Payer: Cash Price |
$1,009.20
|
| Rate for Payer: Cigna Commercial |
$3,218.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,957.85
|
| Rate for Payer: Health EOS Commercial |
$3,113.72
|
| Rate for Payer: HFN Commercial |
$3,218.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,623.92
|
| Rate for Payer: Multiplan Commercial |
$2,798.85
|
| Rate for Payer: NAPHCARE Commercial |
$2,099.14
|
| Rate for Payer: Preferred Network Access Commercial |
$3,218.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,714.29
|
| Rate for Payer: Quartz Commercial |
$2,274.06
|
| Rate for Payer: Quartz Medicare Advantage |
$2,099.14
|
| Rate for Payer: The Alliance Commercial |
$1,749.28
|
| Rate for Payer: WEA Trust Commercial |
$1,924.21
|
| Rate for Payer: WPS Commercial |
$2,591.29
|
|
|
SCREW LOCK 3.5MM X 30MM T10 657330
|
Facility
|
IP
|
$3,364.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5861714
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,714.29 |
| Max. Negotiated Rate |
$3,218.68 |
| Rate for Payer: Aetna Commercial |
$3,148.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,008.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,854.24
|
| Rate for Payer: Cash Price |
$1,009.20
|
| Rate for Payer: Cigna Commercial |
$3,218.68
|
| Rate for Payer: Health EOS Commercial |
$3,113.72
|
| Rate for Payer: HFN Commercial |
$3,218.68
|
| Rate for Payer: Multiplan Commercial |
$2,798.85
|
| Rate for Payer: Preferred Network Access Commercial |
$3,218.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,714.29
|
| Rate for Payer: Quartz Commercial |
$2,099.14
|
| Rate for Payer: WEA Trust Commercial |
$1,924.21
|
| Rate for Payer: WPS Commercial |
$2,591.29
|
|
|
SCREW-LOCK 3.5 X 10 212.101
|
Facility
|
IP
|
$692.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966872
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$352.64 |
| Max. Negotiated Rate |
$662.11 |
| Rate for Payer: Aetna Commercial |
$647.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$618.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$381.43
|
| Rate for Payer: Cash Price |
$207.60
|
| Rate for Payer: Cigna Commercial |
$662.11
|
| Rate for Payer: Health EOS Commercial |
$640.52
|
| Rate for Payer: HFN Commercial |
$662.11
|
| Rate for Payer: Multiplan Commercial |
$575.74
|
| Rate for Payer: Preferred Network Access Commercial |
$662.11
|
| Rate for Payer: Quartz Beloit One Network |
$352.64
|
| Rate for Payer: Quartz Commercial |
$431.81
|
| Rate for Payer: WEA Trust Commercial |
$395.82
|
| Rate for Payer: WPS Commercial |
$533.05
|
|
|
SCREW-LOCK 3.5 X 10 212.101
|
Facility
|
OP
|
$692.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966872
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$201.51 |
| Max. Negotiated Rate |
$662.11 |
| Rate for Payer: Aetna Commercial |
$647.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$618.92
|
| Rate for Payer: Aetna Managed Medicare |
$201.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$467.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$359.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$345.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$381.43
|
| Rate for Payer: Cash Price |
$207.60
|
| Rate for Payer: Cigna Commercial |
$662.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$402.74
|
| Rate for Payer: Health EOS Commercial |
$640.52
|
| Rate for Payer: HFN Commercial |
$662.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$539.76
|
| Rate for Payer: Multiplan Commercial |
$575.74
|
| Rate for Payer: NAPHCARE Commercial |
$431.81
|
| Rate for Payer: Preferred Network Access Commercial |
$662.11
|
| Rate for Payer: Quartz Beloit One Network |
$352.64
|
| Rate for Payer: Quartz Commercial |
$467.79
|
| Rate for Payer: Quartz Medicare Advantage |
$431.81
|
| Rate for Payer: The Alliance Commercial |
$359.84
|
| Rate for Payer: WEA Trust Commercial |
$395.82
|
| Rate for Payer: WPS Commercial |
$533.05
|
|
|
SCREW LOCK 3.5 X 10MM MFT-021-35-10
|
Facility
|
OP
|
$3,283.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4066509
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$956.01 |
| Max. Negotiated Rate |
$3,141.17 |
| Rate for Payer: Aetna Commercial |
$3,072.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,936.32
|
| Rate for Payer: Aetna Managed Medicare |
$956.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,219.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,707.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,638.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,809.59
|
| Rate for Payer: Cash Price |
$984.90
|
| Rate for Payer: Cigna Commercial |
$3,141.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,910.71
|
| Rate for Payer: Health EOS Commercial |
$3,038.74
|
| Rate for Payer: HFN Commercial |
$3,141.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,560.74
|
| Rate for Payer: Multiplan Commercial |
$2,731.46
|
| Rate for Payer: NAPHCARE Commercial |
$2,048.59
|
| Rate for Payer: Preferred Network Access Commercial |
$3,141.17
|
| Rate for Payer: Quartz Beloit One Network |
$1,673.02
|
| Rate for Payer: Quartz Commercial |
$2,219.31
|
| Rate for Payer: Quartz Medicare Advantage |
$2,048.59
|
| Rate for Payer: The Alliance Commercial |
$1,707.16
|
| Rate for Payer: WEA Trust Commercial |
$1,877.88
|
| Rate for Payer: WPS Commercial |
$2,528.89
|
|
|
SCREW LOCK 3.5 X 10MM MFT-021-35-10
|
Facility
|
IP
|
$3,283.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4066509
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,673.02 |
| Max. Negotiated Rate |
$3,141.17 |
| Rate for Payer: Aetna Commercial |
$3,072.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,936.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,809.59
|
| Rate for Payer: Cash Price |
$984.90
|
| Rate for Payer: Cigna Commercial |
$3,141.17
|
| Rate for Payer: Health EOS Commercial |
$3,038.74
|
| Rate for Payer: HFN Commercial |
$3,141.17
|
| Rate for Payer: Multiplan Commercial |
$2,731.46
|
| Rate for Payer: Preferred Network Access Commercial |
$3,141.17
|
| Rate for Payer: Quartz Beloit One Network |
$1,673.02
|
| Rate for Payer: Quartz Commercial |
$2,048.59
|
| Rate for Payer: WEA Trust Commercial |
$1,877.88
|
| Rate for Payer: WPS Commercial |
$2,528.89
|
|
|
SCREW LOCK 3.5 X 10MM SS LP AR-8835L-10
|
Facility
|
IP
|
$1,374.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6244181
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$700.19 |
| Max. Negotiated Rate |
$1,314.64 |
| Rate for Payer: Aetna Commercial |
$1,286.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,228.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$757.35
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Cigna Commercial |
$1,314.64
|
| Rate for Payer: Health EOS Commercial |
$1,271.77
|
| Rate for Payer: HFN Commercial |
$1,314.64
|
| Rate for Payer: Multiplan Commercial |
$1,143.17
|
| Rate for Payer: Preferred Network Access Commercial |
$1,314.64
|
| Rate for Payer: Quartz Beloit One Network |
$700.19
|
| Rate for Payer: Quartz Commercial |
$857.38
|
| Rate for Payer: WEA Trust Commercial |
$785.93
|
| Rate for Payer: WPS Commercial |
$1,058.39
|
|
|
SCREW LOCK 3.5 X 10MM SS LP AR-8835L-10
|
Facility
|
OP
|
$1,374.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6244181
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$400.11 |
| Max. Negotiated Rate |
$1,314.64 |
| Rate for Payer: Aetna Commercial |
$1,286.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,228.91
|
| Rate for Payer: Aetna Managed Medicare |
$400.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$928.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$714.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$685.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$757.35
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Cigna Commercial |
$1,314.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$799.67
|
| Rate for Payer: Health EOS Commercial |
$1,271.77
|
| Rate for Payer: HFN Commercial |
$1,314.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,071.72
|
| Rate for Payer: Multiplan Commercial |
$1,143.17
|
| Rate for Payer: NAPHCARE Commercial |
$857.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,314.64
|
| Rate for Payer: Quartz Beloit One Network |
$700.19
|
| Rate for Payer: Quartz Commercial |
$928.82
|
| Rate for Payer: Quartz Medicare Advantage |
$857.38
|
| Rate for Payer: The Alliance Commercial |
$714.48
|
| Rate for Payer: WEA Trust Commercial |
$785.93
|
| Rate for Payer: WPS Commercial |
$1,058.39
|
|
|
SCREW-LOCK 3.5 X 12 212.102
|
Facility
|
OP
|
$692.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966874
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$201.51 |
| Max. Negotiated Rate |
$662.11 |
| Rate for Payer: Aetna Commercial |
$647.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$618.92
|
| Rate for Payer: Aetna Managed Medicare |
$201.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$467.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$359.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$345.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$381.43
|
| Rate for Payer: Cash Price |
$207.60
|
| Rate for Payer: Cigna Commercial |
$662.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$402.74
|
| Rate for Payer: Health EOS Commercial |
$640.52
|
| Rate for Payer: HFN Commercial |
$662.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$539.76
|
| Rate for Payer: Multiplan Commercial |
$575.74
|
| Rate for Payer: NAPHCARE Commercial |
$431.81
|
| Rate for Payer: Preferred Network Access Commercial |
$662.11
|
| Rate for Payer: Quartz Beloit One Network |
$352.64
|
| Rate for Payer: Quartz Commercial |
$467.79
|
| Rate for Payer: Quartz Medicare Advantage |
$431.81
|
| Rate for Payer: The Alliance Commercial |
$359.84
|
| Rate for Payer: WEA Trust Commercial |
$395.82
|
| Rate for Payer: WPS Commercial |
$533.05
|
|
|
SCREW-LOCK 3.5 X 12 212.102
|
Facility
|
IP
|
$692.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966874
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$352.64 |
| Max. Negotiated Rate |
$662.11 |
| Rate for Payer: Aetna Commercial |
$647.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$618.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$381.43
|
| Rate for Payer: Cash Price |
$207.60
|
| Rate for Payer: Cigna Commercial |
$662.11
|
| Rate for Payer: Health EOS Commercial |
$640.52
|
| Rate for Payer: HFN Commercial |
$662.11
|
| Rate for Payer: Multiplan Commercial |
$575.74
|
| Rate for Payer: Preferred Network Access Commercial |
$662.11
|
| Rate for Payer: Quartz Beloit One Network |
$352.64
|
| Rate for Payer: Quartz Commercial |
$431.81
|
| Rate for Payer: WEA Trust Commercial |
$395.82
|
| Rate for Payer: WPS Commercial |
$533.05
|
|
|
SCREW LOCK 3.5 X 12MM LP TI AR-8935L-12
|
Facility
|
OP
|
$1,997.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5384978
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$581.53 |
| Max. Negotiated Rate |
$1,910.73 |
| Rate for Payer: Aetna Commercial |
$1,869.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,786.12
|
| Rate for Payer: Aetna Managed Medicare |
$581.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,349.97
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,038.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$996.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,100.75
|
| Rate for Payer: Cash Price |
$599.10
|
| Rate for Payer: Cigna Commercial |
$1,910.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,162.25
|
| Rate for Payer: Health EOS Commercial |
$1,848.42
|
| Rate for Payer: HFN Commercial |
$1,910.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,557.66
|
| Rate for Payer: Multiplan Commercial |
$1,661.50
|
| Rate for Payer: NAPHCARE Commercial |
$1,246.13
|
| Rate for Payer: Preferred Network Access Commercial |
$1,910.73
|
| Rate for Payer: Quartz Beloit One Network |
$1,017.67
|
| Rate for Payer: Quartz Commercial |
$1,349.97
|
| Rate for Payer: Quartz Medicare Advantage |
$1,246.13
|
| Rate for Payer: The Alliance Commercial |
$1,038.44
|
| Rate for Payer: WEA Trust Commercial |
$1,142.28
|
| Rate for Payer: WPS Commercial |
$1,538.29
|
|
|
SCREW LOCK 3.5 X 12MM LP TI AR-8935L-12
|
Facility
|
IP
|
$1,997.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5384978
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,017.67 |
| Max. Negotiated Rate |
$1,910.73 |
| Rate for Payer: Aetna Commercial |
$1,869.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,786.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,100.75
|
| Rate for Payer: Cash Price |
$599.10
|
| Rate for Payer: Cigna Commercial |
$1,910.73
|
| Rate for Payer: Health EOS Commercial |
$1,848.42
|
| Rate for Payer: HFN Commercial |
$1,910.73
|
| Rate for Payer: Multiplan Commercial |
$1,661.50
|
| Rate for Payer: Preferred Network Access Commercial |
$1,910.73
|
| Rate for Payer: Quartz Beloit One Network |
$1,017.67
|
| Rate for Payer: Quartz Commercial |
$1,246.13
|
| Rate for Payer: WEA Trust Commercial |
$1,142.28
|
| Rate for Payer: WPS Commercial |
$1,538.29
|
|
|
SCREW LOCK 3.5 X 12MM MFT-021-35-12
|
Facility
|
OP
|
$3,283.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4066510
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$956.01 |
| Max. Negotiated Rate |
$3,141.17 |
| Rate for Payer: Aetna Commercial |
$3,072.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,936.32
|
| Rate for Payer: Aetna Managed Medicare |
$956.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,219.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,707.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,638.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,809.59
|
| Rate for Payer: Cash Price |
$984.90
|
| Rate for Payer: Cigna Commercial |
$3,141.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,910.71
|
| Rate for Payer: Health EOS Commercial |
$3,038.74
|
| Rate for Payer: HFN Commercial |
$3,141.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,560.74
|
| Rate for Payer: Multiplan Commercial |
$2,731.46
|
| Rate for Payer: NAPHCARE Commercial |
$2,048.59
|
| Rate for Payer: Preferred Network Access Commercial |
$3,141.17
|
| Rate for Payer: Quartz Beloit One Network |
$1,673.02
|
| Rate for Payer: Quartz Commercial |
$2,219.31
|
| Rate for Payer: Quartz Medicare Advantage |
$2,048.59
|
| Rate for Payer: The Alliance Commercial |
$1,707.16
|
| Rate for Payer: WEA Trust Commercial |
$1,877.88
|
| Rate for Payer: WPS Commercial |
$2,528.89
|
|
|
SCREW LOCK 3.5 X 12MM MFT-021-35-12
|
Facility
|
IP
|
$3,283.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4066510
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$1,673.02 |
| Max. Negotiated Rate |
$3,141.17 |
| Rate for Payer: Aetna Commercial |
$3,072.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,936.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,809.59
|
| Rate for Payer: Cash Price |
$984.90
|
| Rate for Payer: Cigna Commercial |
$3,141.17
|
| Rate for Payer: Health EOS Commercial |
$3,038.74
|
| Rate for Payer: HFN Commercial |
$3,141.17
|
| Rate for Payer: Multiplan Commercial |
$2,731.46
|
| Rate for Payer: Preferred Network Access Commercial |
$3,141.17
|
| Rate for Payer: Quartz Beloit One Network |
$1,673.02
|
| Rate for Payer: Quartz Commercial |
$2,048.59
|
| Rate for Payer: WEA Trust Commercial |
$1,877.88
|
| Rate for Payer: WPS Commercial |
$2,528.89
|
|
|
SCREW LOCK 3.5 X 12MM SS LP AR-8835L-12
|
Facility
|
IP
|
$1,531.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508981
|
|
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 3.5 X 12MM SS LP AR-8835L-12
|
Facility
|
OP
|
$1,531.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508981
|
|
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 3.5 X 14 212.103
|
Facility
|
IP
|
$716.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966876
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$364.87 |
| Max. Negotiated Rate |
$685.07 |
| Rate for Payer: Aetna Commercial |
$670.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$640.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$394.66
|
| Rate for Payer: Cash Price |
$214.80
|
| Rate for Payer: Cigna Commercial |
$685.07
|
| Rate for Payer: Health EOS Commercial |
$662.73
|
| Rate for Payer: HFN Commercial |
$685.07
|
| Rate for Payer: Multiplan Commercial |
$595.71
|
| Rate for Payer: Preferred Network Access Commercial |
$685.07
|
| Rate for Payer: Quartz Beloit One Network |
$364.87
|
| Rate for Payer: Quartz Commercial |
$446.78
|
| Rate for Payer: WEA Trust Commercial |
$409.55
|
| Rate for Payer: WPS Commercial |
$551.53
|
|
|
SCREW LOCK 3.5 X 14 212.103
|
Facility
|
OP
|
$716.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966876
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$208.50 |
| Max. Negotiated Rate |
$685.07 |
| Rate for Payer: Aetna Commercial |
$670.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$640.39
|
| Rate for Payer: Aetna Managed Medicare |
$208.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$484.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$372.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$357.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$394.66
|
| Rate for Payer: Cash Price |
$214.80
|
| Rate for Payer: Cigna Commercial |
$685.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$416.71
|
| Rate for Payer: Health EOS Commercial |
$662.73
|
| Rate for Payer: HFN Commercial |
$685.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$558.48
|
| Rate for Payer: Multiplan Commercial |
$595.71
|
| Rate for Payer: NAPHCARE Commercial |
$446.78
|
| Rate for Payer: Preferred Network Access Commercial |
$685.07
|
| Rate for Payer: Quartz Beloit One Network |
$364.87
|
| Rate for Payer: Quartz Commercial |
$484.02
|
| Rate for Payer: Quartz Medicare Advantage |
$446.78
|
| Rate for Payer: The Alliance Commercial |
$372.32
|
| Rate for Payer: WEA Trust Commercial |
$409.55
|
| Rate for Payer: WPS Commercial |
$551.53
|
|
|
SCREW LOCK 3.5 X 14MM LP AR-8835L-14
|
Facility
|
OP
|
$1,531.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415027
|
|
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 3.5 X 14MM LP AR-8835L-14
|
Facility
|
IP
|
$1,531.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415027
|
|
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 3.5 X 14MM LP TI AR-8935L-14
|
Facility
|
IP
|
$1,997.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414667
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,017.67 |
| Max. Negotiated Rate |
$1,910.73 |
| Rate for Payer: Aetna Commercial |
$1,869.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,786.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,100.75
|
| Rate for Payer: Cash Price |
$599.10
|
| Rate for Payer: Cigna Commercial |
$1,910.73
|
| Rate for Payer: Health EOS Commercial |
$1,848.42
|
| Rate for Payer: HFN Commercial |
$1,910.73
|
| Rate for Payer: Multiplan Commercial |
$1,661.50
|
| Rate for Payer: Preferred Network Access Commercial |
$1,910.73
|
| Rate for Payer: Quartz Beloit One Network |
$1,017.67
|
| Rate for Payer: Quartz Commercial |
$1,246.13
|
| Rate for Payer: WEA Trust Commercial |
$1,142.28
|
| Rate for Payer: WPS Commercial |
$1,538.29
|
|
|
SCREW LOCK 3.5 X 14MM LP TI AR-8935L-14
|
Facility
|
OP
|
$1,997.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414667
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$581.53 |
| Max. Negotiated Rate |
$1,910.73 |
| Rate for Payer: Aetna Commercial |
$1,869.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,786.12
|
| Rate for Payer: Aetna Managed Medicare |
$581.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,349.97
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,038.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$996.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,100.75
|
| Rate for Payer: Cash Price |
$599.10
|
| Rate for Payer: Cigna Commercial |
$1,910.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,162.25
|
| Rate for Payer: Health EOS Commercial |
$1,848.42
|
| Rate for Payer: HFN Commercial |
$1,910.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,557.66
|
| Rate for Payer: Multiplan Commercial |
$1,661.50
|
| Rate for Payer: NAPHCARE Commercial |
$1,246.13
|
| Rate for Payer: Preferred Network Access Commercial |
$1,910.73
|
| Rate for Payer: Quartz Beloit One Network |
$1,017.67
|
| Rate for Payer: Quartz Commercial |
$1,349.97
|
| Rate for Payer: Quartz Medicare Advantage |
$1,246.13
|
| Rate for Payer: The Alliance Commercial |
$1,038.44
|
| Rate for Payer: WEA Trust Commercial |
$1,142.28
|
| Rate for Payer: WPS Commercial |
$1,538.29
|
|
|
SCREW-LOCK 3.5 X 16 212.104
|
Facility
|
IP
|
$716.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966878
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$364.87 |
| Max. Negotiated Rate |
$685.07 |
| Rate for Payer: Aetna Commercial |
$670.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$640.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$394.66
|
| Rate for Payer: Cash Price |
$214.80
|
| Rate for Payer: Cigna Commercial |
$685.07
|
| Rate for Payer: Health EOS Commercial |
$662.73
|
| Rate for Payer: HFN Commercial |
$685.07
|
| Rate for Payer: Multiplan Commercial |
$595.71
|
| Rate for Payer: Preferred Network Access Commercial |
$685.07
|
| Rate for Payer: Quartz Beloit One Network |
$364.87
|
| Rate for Payer: Quartz Commercial |
$446.78
|
| Rate for Payer: WEA Trust Commercial |
$409.55
|
| Rate for Payer: WPS Commercial |
$551.53
|
|
|
SCREW-LOCK 3.5 X 16 212.104
|
Facility
|
OP
|
$716.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966878
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$208.50 |
| Max. Negotiated Rate |
$685.07 |
| Rate for Payer: Aetna Commercial |
$670.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$640.39
|
| Rate for Payer: Aetna Managed Medicare |
$208.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$484.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$372.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$357.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$394.66
|
| Rate for Payer: Cash Price |
$214.80
|
| Rate for Payer: Cigna Commercial |
$685.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$416.71
|
| Rate for Payer: Health EOS Commercial |
$662.73
|
| Rate for Payer: HFN Commercial |
$685.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$558.48
|
| Rate for Payer: Multiplan Commercial |
$595.71
|
| Rate for Payer: NAPHCARE Commercial |
$446.78
|
| Rate for Payer: Preferred Network Access Commercial |
$685.07
|
| Rate for Payer: Quartz Beloit One Network |
$364.87
|
| Rate for Payer: Quartz Commercial |
$484.02
|
| Rate for Payer: Quartz Medicare Advantage |
$446.78
|
| Rate for Payer: The Alliance Commercial |
$372.32
|
| Rate for Payer: WEA Trust Commercial |
$409.55
|
| Rate for Payer: WPS Commercial |
$551.53
|
|
|
SCREW LOCK 3.5 X 16MM LP AR-8835L-16
|
Facility
|
OP
|
$1,531.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4317090
|
|
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
|
|
