|
SCREW SCHANZ 5.0 X 170 BLUNT POINT 294.55
|
Facility
|
IP
|
$999.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494321
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$489.51 |
| Max. Negotiated Rate |
$919.08 |
| Rate for Payer: Aetna Commercial |
$899.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$859.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$529.47
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Cigna Commercial |
$919.08
|
| Rate for Payer: Health EOS Commercial |
$889.11
|
| Rate for Payer: HFN Commercial |
$919.08
|
| Rate for Payer: Multiplan Commercial |
$799.20
|
| Rate for Payer: NAPHCARE Commercial |
$599.40
|
| Rate for Payer: Preferred Network Access Commercial |
$919.08
|
| Rate for Payer: Quartz Beloit One Network |
$489.51
|
| Rate for Payer: Quartz Commercial |
$599.40
|
| Rate for Payer: WEA Trust Commercial |
$549.45
|
| Rate for Payer: WPS Commercial |
$739.96
|
|
|
SCREW SCHANZ 5.0 X 170 BLUNT POINT 294.55
|
Facility
|
OP
|
$999.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494321
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$279.72 |
| Max. Negotiated Rate |
$3,996.00 |
| Rate for Payer: Aetna Commercial |
$899.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$859.14
|
| Rate for Payer: Aetna Managed Medicare |
$279.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$649.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$499.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$479.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$529.47
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Cigna Commercial |
$919.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$559.04
|
| Rate for Payer: Health EOS Commercial |
$889.11
|
| Rate for Payer: HFN Commercial |
$919.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$749.25
|
| Rate for Payer: Multiplan Commercial |
$799.20
|
| Rate for Payer: NAPHCARE Commercial |
$599.40
|
| Rate for Payer: Preferred Network Access Commercial |
$919.08
|
| Rate for Payer: Quartz Beloit One Network |
$489.51
|
| Rate for Payer: Quartz Commercial |
$649.35
|
| Rate for Payer: Quartz Medicare Advantage |
$599.40
|
| Rate for Payer: The Alliance Commercial |
$3,996.00
|
| Rate for Payer: WEA Trust Commercial |
$549.45
|
| Rate for Payer: WPS Commercial |
$739.96
|
|
|
SCREW SCHANZ 5.0 X 200 80MM THREAD SELF DRILLING SS 294.786
|
Facility
|
IP
|
$2,621.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966565
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,284.29 |
| Max. Negotiated Rate |
$2,411.32 |
| Rate for Payer: Aetna Commercial |
$2,358.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,254.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,389.13
|
| Rate for Payer: Cash Price |
$786.30
|
| Rate for Payer: Cigna Commercial |
$2,411.32
|
| Rate for Payer: Health EOS Commercial |
$2,332.69
|
| Rate for Payer: HFN Commercial |
$2,411.32
|
| Rate for Payer: Multiplan Commercial |
$2,096.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,572.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,411.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,284.29
|
| Rate for Payer: Quartz Commercial |
$1,572.60
|
| Rate for Payer: WEA Trust Commercial |
$1,441.55
|
| Rate for Payer: WPS Commercial |
$1,941.37
|
|
|
SCREW SCHANZ 5.0 X 200 80MM THREAD SELF DRILLING SS 294.786
|
Facility
|
OP
|
$2,621.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966565
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$733.88 |
| Max. Negotiated Rate |
$10,484.00 |
| Rate for Payer: Aetna Commercial |
$2,358.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,254.06
|
| Rate for Payer: Aetna Managed Medicare |
$733.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,703.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,310.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,258.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,389.13
|
| Rate for Payer: Cash Price |
$786.30
|
| Rate for Payer: Cigna Commercial |
$2,411.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,466.71
|
| Rate for Payer: Health EOS Commercial |
$2,332.69
|
| Rate for Payer: HFN Commercial |
$2,411.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,965.75
|
| Rate for Payer: Multiplan Commercial |
$2,096.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,572.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,411.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,284.29
|
| Rate for Payer: Quartz Commercial |
$1,703.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,572.60
|
| Rate for Payer: The Alliance Commercial |
$10,484.00
|
| Rate for Payer: WEA Trust Commercial |
$1,441.55
|
| Rate for Payer: WPS Commercial |
$1,941.37
|
|
|
SCREW SCHANZ 5.0 X 200 BLUNT POINT 294.56
|
Facility
|
IP
|
$1,190.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5106697
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$583.10 |
| Max. Negotiated Rate |
$1,094.80 |
| Rate for Payer: Aetna Commercial |
$1,071.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,023.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$630.70
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cigna Commercial |
$1,094.80
|
| Rate for Payer: Health EOS Commercial |
$1,059.10
|
| Rate for Payer: HFN Commercial |
$1,094.80
|
| Rate for Payer: Multiplan Commercial |
$952.00
|
| Rate for Payer: NAPHCARE Commercial |
$714.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,094.80
|
| Rate for Payer: Quartz Beloit One Network |
$583.10
|
| Rate for Payer: Quartz Commercial |
$714.00
|
| Rate for Payer: WEA Trust Commercial |
$654.50
|
| Rate for Payer: WPS Commercial |
$881.43
|
|
|
SCREW SCHANZ 5.0 X 200 BLUNT POINT 294.56
|
Facility
|
OP
|
$1,190.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5106697
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$333.20 |
| Max. Negotiated Rate |
$4,760.00 |
| Rate for Payer: Aetna Commercial |
$1,071.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,023.40
|
| Rate for Payer: Aetna Managed Medicare |
$333.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$773.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$595.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$571.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$630.70
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cigna Commercial |
$1,094.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$665.92
|
| Rate for Payer: Health EOS Commercial |
$1,059.10
|
| Rate for Payer: HFN Commercial |
$1,094.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$892.50
|
| Rate for Payer: Multiplan Commercial |
$952.00
|
| Rate for Payer: NAPHCARE Commercial |
$714.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,094.80
|
| Rate for Payer: Quartz Beloit One Network |
$583.10
|
| Rate for Payer: Quartz Commercial |
$773.50
|
| Rate for Payer: Quartz Medicare Advantage |
$714.00
|
| Rate for Payer: The Alliance Commercial |
$4,760.00
|
| Rate for Payer: WEA Trust Commercial |
$654.50
|
| Rate for Payer: WPS Commercial |
$881.43
|
|
|
SCREW SCHANZ 6.0 X 160 294.67
|
Facility
|
IP
|
$887.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5264608
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$434.63 |
| Max. Negotiated Rate |
$816.04 |
| Rate for Payer: Aetna Commercial |
$798.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$762.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$470.11
|
| Rate for Payer: Cash Price |
$266.10
|
| Rate for Payer: Cigna Commercial |
$816.04
|
| Rate for Payer: Health EOS Commercial |
$789.43
|
| Rate for Payer: HFN Commercial |
$816.04
|
| Rate for Payer: Multiplan Commercial |
$709.60
|
| Rate for Payer: NAPHCARE Commercial |
$532.20
|
| Rate for Payer: Preferred Network Access Commercial |
$816.04
|
| Rate for Payer: Quartz Beloit One Network |
$434.63
|
| Rate for Payer: Quartz Commercial |
$532.20
|
| Rate for Payer: WEA Trust Commercial |
$487.85
|
| Rate for Payer: WPS Commercial |
$657.00
|
|
|
SCREW SCHANZ 6.0 X 160 294.67
|
Facility
|
OP
|
$887.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5264608
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$248.36 |
| Max. Negotiated Rate |
$3,548.00 |
| Rate for Payer: Aetna Commercial |
$798.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$762.82
|
| Rate for Payer: Aetna Managed Medicare |
$248.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$576.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$443.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$425.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$470.11
|
| Rate for Payer: Cash Price |
$266.10
|
| Rate for Payer: Cigna Commercial |
$816.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$496.37
|
| Rate for Payer: Health EOS Commercial |
$789.43
|
| Rate for Payer: HFN Commercial |
$816.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$665.25
|
| Rate for Payer: Multiplan Commercial |
$709.60
|
| Rate for Payer: NAPHCARE Commercial |
$532.20
|
| Rate for Payer: Preferred Network Access Commercial |
$816.04
|
| Rate for Payer: Quartz Beloit One Network |
$434.63
|
| Rate for Payer: Quartz Commercial |
$576.55
|
| Rate for Payer: Quartz Medicare Advantage |
$532.20
|
| Rate for Payer: The Alliance Commercial |
$3,548.00
|
| Rate for Payer: WEA Trust Commercial |
$487.85
|
| Rate for Payer: WPS Commercial |
$657.00
|
|
|
SCREW SLEEVE 3.5M LOCK 323.053
|
Facility
|
OP
|
$1,938.00
|
|
| Hospital Charge Code |
2967024
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$542.64 |
| Max. Negotiated Rate |
$7,752.00 |
| Rate for Payer: Aetna Commercial |
$1,744.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,666.68
|
| Rate for Payer: Aetna Managed Medicare |
$542.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,259.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$969.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$930.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,027.14
|
| Rate for Payer: Cash Price |
$581.40
|
| Rate for Payer: Cigna Commercial |
$1,782.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,084.50
|
| Rate for Payer: Health EOS Commercial |
$1,724.82
|
| Rate for Payer: HFN Commercial |
$1,782.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,453.50
|
| Rate for Payer: Multiplan Commercial |
$1,550.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,162.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,782.96
|
| Rate for Payer: Quartz Beloit One Network |
$949.62
|
| Rate for Payer: Quartz Commercial |
$1,259.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,162.80
|
| Rate for Payer: The Alliance Commercial |
$7,752.00
|
| Rate for Payer: WEA Trust Commercial |
$1,065.90
|
| Rate for Payer: WPS Commercial |
$1,435.48
|
|
|
SCREW SLEEVE 3.5M LOCK 323.053
|
Facility
|
IP
|
$1,938.00
|
|
| Hospital Charge Code |
2967024
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$949.62 |
| Max. Negotiated Rate |
$1,782.96 |
| Rate for Payer: Aetna Commercial |
$1,744.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,666.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,027.14
|
| Rate for Payer: Cash Price |
$581.40
|
| Rate for Payer: Cigna Commercial |
$1,782.96
|
| Rate for Payer: Health EOS Commercial |
$1,724.82
|
| Rate for Payer: HFN Commercial |
$1,782.96
|
| Rate for Payer: Multiplan Commercial |
$1,550.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,162.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,782.96
|
| Rate for Payer: Quartz Beloit One Network |
$949.62
|
| Rate for Payer: Quartz Commercial |
$1,162.80
|
| Rate for Payer: WEA Trust Commercial |
$1,065.90
|
| Rate for Payer: WPS Commercial |
$1,435.48
|
|
|
SCREW SNAP-OFF 2.0 X 11MM CHARLOTTE F & A 45110001
|
Facility
|
OP
|
$2,532.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6220216
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$708.96 |
| Max. Negotiated Rate |
$10,128.00 |
| Rate for Payer: Aetna Commercial |
$2,278.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,177.52
|
| Rate for Payer: Aetna Managed Medicare |
$708.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,645.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,266.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,215.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,341.96
|
| Rate for Payer: Cash Price |
$759.60
|
| Rate for Payer: Cigna Commercial |
$2,329.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,416.91
|
| Rate for Payer: Health EOS Commercial |
$2,253.48
|
| Rate for Payer: HFN Commercial |
$2,329.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,899.00
|
| Rate for Payer: Multiplan Commercial |
$2,025.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,519.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,329.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,240.68
|
| Rate for Payer: Quartz Commercial |
$1,645.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,519.20
|
| Rate for Payer: The Alliance Commercial |
$10,128.00
|
| Rate for Payer: WEA Trust Commercial |
$1,392.60
|
| Rate for Payer: WPS Commercial |
$1,875.45
|
|
|
SCREW SNAP-OFF 2.0 X 11MM CHARLOTTE F & A 45110001
|
Facility
|
IP
|
$2,532.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6220216
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,240.68 |
| Max. Negotiated Rate |
$2,329.44 |
| Rate for Payer: Aetna Commercial |
$2,278.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,177.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,341.96
|
| Rate for Payer: Cash Price |
$759.60
|
| Rate for Payer: Cigna Commercial |
$2,329.44
|
| Rate for Payer: Health EOS Commercial |
$2,253.48
|
| Rate for Payer: HFN Commercial |
$2,329.44
|
| Rate for Payer: Multiplan Commercial |
$2,025.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,519.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,329.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,240.68
|
| Rate for Payer: Quartz Commercial |
$1,519.20
|
| Rate for Payer: WEA Trust Commercial |
$1,392.60
|
| Rate for Payer: WPS Commercial |
$1,875.45
|
|
|
SCREW SNAP OFF 2.0 X 11 WS11
|
Facility
|
IP
|
$4,264.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685738
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,089.36 |
| Max. Negotiated Rate |
$3,922.88 |
| Rate for Payer: Aetna Commercial |
$3,837.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,667.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,259.92
|
| Rate for Payer: Cash Price |
$1,279.20
|
| Rate for Payer: Cigna Commercial |
$3,922.88
|
| Rate for Payer: Health EOS Commercial |
$3,794.96
|
| Rate for Payer: HFN Commercial |
$3,922.88
|
| Rate for Payer: Multiplan Commercial |
$3,411.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,558.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,922.88
|
| Rate for Payer: Quartz Beloit One Network |
$2,089.36
|
| Rate for Payer: Quartz Commercial |
$2,558.40
|
| Rate for Payer: WEA Trust Commercial |
$2,345.20
|
| Rate for Payer: WPS Commercial |
$3,158.34
|
|
|
SCREW SNAP OFF 2.0 X 11 WS11
|
Facility
|
OP
|
$4,264.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685738
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,193.92 |
| Max. Negotiated Rate |
$17,056.00 |
| Rate for Payer: Aetna Commercial |
$3,837.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,667.04
|
| Rate for Payer: Aetna Managed Medicare |
$1,193.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,771.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,132.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,046.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,259.92
|
| Rate for Payer: Cash Price |
$1,279.20
|
| Rate for Payer: Cigna Commercial |
$3,922.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,386.13
|
| Rate for Payer: Health EOS Commercial |
$3,794.96
|
| Rate for Payer: HFN Commercial |
$3,922.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,198.00
|
| Rate for Payer: Multiplan Commercial |
$3,411.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,558.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,922.88
|
| Rate for Payer: Quartz Beloit One Network |
$2,089.36
|
| Rate for Payer: Quartz Commercial |
$2,771.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2,558.40
|
| Rate for Payer: The Alliance Commercial |
$17,056.00
|
| Rate for Payer: WEA Trust Commercial |
$2,345.20
|
| Rate for Payer: WPS Commercial |
$3,158.34
|
|
|
SCREW SNAP-OFF 2.0 X 12MM CHARLOTTE F & A 45110002
|
Facility
|
IP
|
$2,563.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6199054
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,255.87 |
| Max. Negotiated Rate |
$2,357.96 |
| Rate for Payer: Aetna Commercial |
$2,306.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,204.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,358.39
|
| Rate for Payer: Cash Price |
$768.90
|
| Rate for Payer: Cigna Commercial |
$2,357.96
|
| Rate for Payer: Health EOS Commercial |
$2,281.07
|
| Rate for Payer: HFN Commercial |
$2,357.96
|
| Rate for Payer: Multiplan Commercial |
$2,050.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,537.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,357.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,255.87
|
| Rate for Payer: Quartz Commercial |
$1,537.80
|
| Rate for Payer: WEA Trust Commercial |
$1,409.65
|
| Rate for Payer: WPS Commercial |
$1,898.41
|
|
|
SCREW SNAP-OFF 2.0 X 12MM CHARLOTTE F & A 45110002
|
Facility
|
OP
|
$2,563.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6199054
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$717.64 |
| Max. Negotiated Rate |
$10,252.00 |
| Rate for Payer: Aetna Commercial |
$2,306.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,204.18
|
| Rate for Payer: Aetna Managed Medicare |
$717.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,665.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,281.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,230.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,358.39
|
| Rate for Payer: Cash Price |
$768.90
|
| Rate for Payer: Cigna Commercial |
$2,357.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,434.25
|
| Rate for Payer: Health EOS Commercial |
$2,281.07
|
| Rate for Payer: HFN Commercial |
$2,357.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,922.25
|
| Rate for Payer: Multiplan Commercial |
$2,050.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,537.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,357.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,255.87
|
| Rate for Payer: Quartz Commercial |
$1,665.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,537.80
|
| Rate for Payer: The Alliance Commercial |
$10,252.00
|
| Rate for Payer: WEA Trust Commercial |
$1,409.65
|
| Rate for Payer: WPS Commercial |
$1,898.41
|
|
|
SCREW SNAP OFF 2.0 X 12 WS12
|
Facility
|
OP
|
$5,270.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5583417
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,475.60 |
| Max. Negotiated Rate |
$21,080.00 |
| Rate for Payer: Aetna Commercial |
$4,743.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,532.20
|
| Rate for Payer: Aetna Managed Medicare |
$1,475.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,425.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,635.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,529.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,793.10
|
| Rate for Payer: Cash Price |
$1,581.00
|
| Rate for Payer: Cigna Commercial |
$4,848.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,949.09
|
| Rate for Payer: Health EOS Commercial |
$4,690.30
|
| Rate for Payer: HFN Commercial |
$4,848.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,952.50
|
| Rate for Payer: Multiplan Commercial |
$4,216.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,162.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,848.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,582.30
|
| Rate for Payer: Quartz Commercial |
$3,425.50
|
| Rate for Payer: Quartz Medicare Advantage |
$3,162.00
|
| Rate for Payer: The Alliance Commercial |
$21,080.00
|
| Rate for Payer: WEA Trust Commercial |
$2,898.50
|
| Rate for Payer: WPS Commercial |
$3,903.49
|
|
|
SCREW SNAP OFF 2.0 X 12 WS12
|
Facility
|
IP
|
$5,270.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5583417
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,582.30 |
| Max. Negotiated Rate |
$4,848.40 |
| Rate for Payer: Aetna Commercial |
$4,743.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,532.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,793.10
|
| Rate for Payer: Cash Price |
$1,581.00
|
| Rate for Payer: Cigna Commercial |
$4,848.40
|
| Rate for Payer: Health EOS Commercial |
$4,690.30
|
| Rate for Payer: HFN Commercial |
$4,848.40
|
| Rate for Payer: Multiplan Commercial |
$4,216.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,162.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,848.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,582.30
|
| Rate for Payer: Quartz Commercial |
$3,162.00
|
| Rate for Payer: WEA Trust Commercial |
$2,898.50
|
| Rate for Payer: WPS Commercial |
$3,903.49
|
|
|
SCREW SNAP-OFF 2.0 X 13MM CHARLOTTE F & A 45112013
|
Facility
|
IP
|
$2,563.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6199055
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,255.87 |
| Max. Negotiated Rate |
$2,357.96 |
| Rate for Payer: Aetna Commercial |
$2,306.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,204.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,358.39
|
| Rate for Payer: Cash Price |
$768.90
|
| Rate for Payer: Cigna Commercial |
$2,357.96
|
| Rate for Payer: Health EOS Commercial |
$2,281.07
|
| Rate for Payer: HFN Commercial |
$2,357.96
|
| Rate for Payer: Multiplan Commercial |
$2,050.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,537.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,357.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,255.87
|
| Rate for Payer: Quartz Commercial |
$1,537.80
|
| Rate for Payer: WEA Trust Commercial |
$1,409.65
|
| Rate for Payer: WPS Commercial |
$1,898.41
|
|
|
SCREW SNAP-OFF 2.0 X 13MM CHARLOTTE F & A 45112013
|
Facility
|
OP
|
$2,563.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6199055
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$717.64 |
| Max. Negotiated Rate |
$10,252.00 |
| Rate for Payer: Aetna Commercial |
$2,306.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,204.18
|
| Rate for Payer: Aetna Managed Medicare |
$717.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,665.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,281.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,230.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,358.39
|
| Rate for Payer: Cash Price |
$768.90
|
| Rate for Payer: Cigna Commercial |
$2,357.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,434.25
|
| Rate for Payer: Health EOS Commercial |
$2,281.07
|
| Rate for Payer: HFN Commercial |
$2,357.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,922.25
|
| Rate for Payer: Multiplan Commercial |
$2,050.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,537.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,357.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,255.87
|
| Rate for Payer: Quartz Commercial |
$1,665.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,537.80
|
| Rate for Payer: The Alliance Commercial |
$10,252.00
|
| Rate for Payer: WEA Trust Commercial |
$1,409.65
|
| Rate for Payer: WPS Commercial |
$1,898.41
|
|
|
SCREW SNAP OFF 2.0 X 13 WS13
|
Facility
|
IP
|
$4,264.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685739
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,089.36 |
| Max. Negotiated Rate |
$3,922.88 |
| Rate for Payer: Aetna Commercial |
$3,837.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,667.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,259.92
|
| Rate for Payer: Cash Price |
$1,279.20
|
| Rate for Payer: Cigna Commercial |
$3,922.88
|
| Rate for Payer: Health EOS Commercial |
$3,794.96
|
| Rate for Payer: HFN Commercial |
$3,922.88
|
| Rate for Payer: Multiplan Commercial |
$3,411.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,558.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,922.88
|
| Rate for Payer: Quartz Beloit One Network |
$2,089.36
|
| Rate for Payer: Quartz Commercial |
$2,558.40
|
| Rate for Payer: WEA Trust Commercial |
$2,345.20
|
| Rate for Payer: WPS Commercial |
$3,158.34
|
|
|
SCREW SNAP OFF 2.0 X 13 WS13
|
Facility
|
OP
|
$4,264.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685739
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,193.92 |
| Max. Negotiated Rate |
$17,056.00 |
| Rate for Payer: Aetna Commercial |
$3,837.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,667.04
|
| Rate for Payer: Aetna Managed Medicare |
$1,193.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,771.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,132.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,046.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,259.92
|
| Rate for Payer: Cash Price |
$1,279.20
|
| Rate for Payer: Cigna Commercial |
$3,922.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,386.13
|
| Rate for Payer: Health EOS Commercial |
$3,794.96
|
| Rate for Payer: HFN Commercial |
$3,922.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,198.00
|
| Rate for Payer: Multiplan Commercial |
$3,411.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,558.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,922.88
|
| Rate for Payer: Quartz Beloit One Network |
$2,089.36
|
| Rate for Payer: Quartz Commercial |
$2,771.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2,558.40
|
| Rate for Payer: The Alliance Commercial |
$17,056.00
|
| Rate for Payer: WEA Trust Commercial |
$2,345.20
|
| Rate for Payer: WPS Commercial |
$3,158.34
|
|
|
SCREW SNAP-OFF 2.0 X 14MM CHARLOTTE F & A 45110003
|
Facility
|
IP
|
$2,563.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6217044
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,255.87 |
| Max. Negotiated Rate |
$2,357.96 |
| Rate for Payer: Aetna Commercial |
$2,306.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,204.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,358.39
|
| Rate for Payer: Cash Price |
$768.90
|
| Rate for Payer: Cigna Commercial |
$2,357.96
|
| Rate for Payer: Health EOS Commercial |
$2,281.07
|
| Rate for Payer: HFN Commercial |
$2,357.96
|
| Rate for Payer: Multiplan Commercial |
$2,050.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,537.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,357.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,255.87
|
| Rate for Payer: Quartz Commercial |
$1,537.80
|
| Rate for Payer: WEA Trust Commercial |
$1,409.65
|
| Rate for Payer: WPS Commercial |
$1,898.41
|
|
|
SCREW SNAP-OFF 2.0 X 14MM CHARLOTTE F & A 45110003
|
Facility
|
OP
|
$2,563.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6217044
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$717.64 |
| Max. Negotiated Rate |
$10,252.00 |
| Rate for Payer: Aetna Commercial |
$2,306.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,204.18
|
| Rate for Payer: Aetna Managed Medicare |
$717.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,665.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,281.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,230.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,358.39
|
| Rate for Payer: Cash Price |
$768.90
|
| Rate for Payer: Cigna Commercial |
$2,357.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,434.25
|
| Rate for Payer: Health EOS Commercial |
$2,281.07
|
| Rate for Payer: HFN Commercial |
$2,357.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,922.25
|
| Rate for Payer: Multiplan Commercial |
$2,050.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,537.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,357.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,255.87
|
| Rate for Payer: Quartz Commercial |
$1,665.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,537.80
|
| Rate for Payer: The Alliance Commercial |
$10,252.00
|
| Rate for Payer: WEA Trust Commercial |
$1,409.65
|
| Rate for Payer: WPS Commercial |
$1,898.41
|
|
|
SCREW SNAP OFF 2.0 X 14 WS14
|
Facility
|
OP
|
$5,270.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5583418
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,475.60 |
| Max. Negotiated Rate |
$21,080.00 |
| Rate for Payer: Aetna Commercial |
$4,743.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,532.20
|
| Rate for Payer: Aetna Managed Medicare |
$1,475.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,425.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,635.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,529.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,793.10
|
| Rate for Payer: Cash Price |
$1,581.00
|
| Rate for Payer: Cigna Commercial |
$4,848.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,949.09
|
| Rate for Payer: Health EOS Commercial |
$4,690.30
|
| Rate for Payer: HFN Commercial |
$4,848.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,952.50
|
| Rate for Payer: Multiplan Commercial |
$4,216.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,162.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,848.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,582.30
|
| Rate for Payer: Quartz Commercial |
$3,425.50
|
| Rate for Payer: Quartz Medicare Advantage |
$3,162.00
|
| Rate for Payer: The Alliance Commercial |
$21,080.00
|
| Rate for Payer: WEA Trust Commercial |
$2,898.50
|
| Rate for Payer: WPS Commercial |
$3,903.49
|
|
