|
SCREW LOCK 3.5 X 28MM LP AR-8835L-28
|
Facility
|
IP
|
$1,531.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5496982
|
|
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 28MM LP AR-8835L-28
|
Facility
|
OP
|
$1,531.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5496982
|
|
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 30 212.111
|
Facility
|
OP
|
$692.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966892
|
|
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 30 212.111
|
Facility
|
IP
|
$692.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966892
|
|
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 30MM LP AR-8835L-30
|
Facility
|
OP
|
$1,531.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5496983
|
|
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 30MM LP AR-8835L-30
|
Facility
|
IP
|
$1,531.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5496983
|
|
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 30MM MFT-021-35-30
|
Facility
|
IP
|
$3,283.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5729848
|
|
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 30MM MFT-021-35-30
|
Facility
|
OP
|
$3,283.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5729848
|
|
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 32 212.112
|
Facility
|
IP
|
$692.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966893
|
|
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 32 212.112
|
Facility
|
OP
|
$692.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966893
|
|
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 32.5MM MFT-021-35-325
|
Facility
|
OP
|
$3,283.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5787658
|
|
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 32.5MM MFT-021-35-325
|
Facility
|
IP
|
$3,283.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5787658
|
|
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 32MM LP AR-8835L-32
|
Facility
|
IP
|
$1,361.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6185046
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$693.57 |
| Max. Negotiated Rate |
$1,302.20 |
| Rate for Payer: Aetna Commercial |
$1,273.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,217.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$750.18
|
| Rate for Payer: Cash Price |
$408.30
|
| Rate for Payer: Cigna Commercial |
$1,302.20
|
| Rate for Payer: Health EOS Commercial |
$1,259.74
|
| Rate for Payer: HFN Commercial |
$1,302.20
|
| Rate for Payer: Multiplan Commercial |
$1,132.35
|
| Rate for Payer: Preferred Network Access Commercial |
$1,302.20
|
| Rate for Payer: Quartz Beloit One Network |
$693.57
|
| Rate for Payer: Quartz Commercial |
$849.26
|
| Rate for Payer: WEA Trust Commercial |
$778.49
|
| Rate for Payer: WPS Commercial |
$1,048.38
|
|
|
SCREW LOCK 3.5 X 32MM LP AR-8835L-32
|
Facility
|
OP
|
$1,361.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6185046
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$396.32 |
| Max. Negotiated Rate |
$1,302.20 |
| Rate for Payer: Aetna Commercial |
$1,273.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,217.28
|
| Rate for Payer: Aetna Managed Medicare |
$396.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$920.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$707.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$679.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$750.18
|
| Rate for Payer: Cash Price |
$408.30
|
| Rate for Payer: Cigna Commercial |
$1,302.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$792.10
|
| Rate for Payer: Health EOS Commercial |
$1,259.74
|
| Rate for Payer: HFN Commercial |
$1,302.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,061.58
|
| Rate for Payer: Multiplan Commercial |
$1,132.35
|
| Rate for Payer: NAPHCARE Commercial |
$849.26
|
| Rate for Payer: Preferred Network Access Commercial |
$1,302.20
|
| Rate for Payer: Quartz Beloit One Network |
$693.57
|
| Rate for Payer: Quartz Commercial |
$920.04
|
| Rate for Payer: Quartz Medicare Advantage |
$849.26
|
| Rate for Payer: The Alliance Commercial |
$707.72
|
| Rate for Payer: WEA Trust Commercial |
$778.49
|
| Rate for Payer: WPS Commercial |
$1,048.38
|
|
|
SCREW LOCK 3.5 X 34 212.113
|
Facility
|
OP
|
$692.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966895
|
|
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 34 212.113
|
Facility
|
IP
|
$692.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966895
|
|
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 34MM LP AR-8835L-34
|
Facility
|
IP
|
$1,472.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5861649
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$750.13 |
| Max. Negotiated Rate |
$1,408.41 |
| Rate for Payer: Aetna Commercial |
$1,377.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,316.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$811.37
|
| Rate for Payer: Cash Price |
$441.60
|
| Rate for Payer: Cigna Commercial |
$1,408.41
|
| Rate for Payer: Health EOS Commercial |
$1,362.48
|
| Rate for Payer: HFN Commercial |
$1,408.41
|
| Rate for Payer: Multiplan Commercial |
$1,224.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,408.41
|
| Rate for Payer: Quartz Beloit One Network |
$750.13
|
| Rate for Payer: Quartz Commercial |
$918.53
|
| Rate for Payer: WEA Trust Commercial |
$841.98
|
| Rate for Payer: WPS Commercial |
$1,133.88
|
|
|
SCREW LOCK 3.5 X 34MM LP AR-8835L-34
|
Facility
|
OP
|
$1,472.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5861649
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$428.65 |
| Max. Negotiated Rate |
$1,408.41 |
| Rate for Payer: Aetna Commercial |
$1,377.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,316.56
|
| Rate for Payer: Aetna Managed Medicare |
$428.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$995.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$765.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$734.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$811.37
|
| Rate for Payer: Cash Price |
$441.60
|
| Rate for Payer: Cigna Commercial |
$1,408.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$856.70
|
| Rate for Payer: Health EOS Commercial |
$1,362.48
|
| Rate for Payer: HFN Commercial |
$1,408.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,148.16
|
| Rate for Payer: Multiplan Commercial |
$1,224.70
|
| Rate for Payer: NAPHCARE Commercial |
$918.53
|
| Rate for Payer: Preferred Network Access Commercial |
$1,408.41
|
| Rate for Payer: Quartz Beloit One Network |
$750.13
|
| Rate for Payer: Quartz Commercial |
$995.07
|
| Rate for Payer: Quartz Medicare Advantage |
$918.53
|
| Rate for Payer: The Alliance Commercial |
$765.44
|
| Rate for Payer: WEA Trust Commercial |
$841.98
|
| Rate for Payer: WPS Commercial |
$1,133.88
|
|
|
SCREW-LOCK 3.5 X 35 212.114
|
Facility
|
IP
|
$1,462.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6174911
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$745.04 |
| Max. Negotiated Rate |
$1,398.84 |
| Rate for Payer: Aetna Commercial |
$1,368.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,307.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$805.85
|
| Rate for Payer: Cash Price |
$438.60
|
| Rate for Payer: Cigna Commercial |
$1,398.84
|
| Rate for Payer: Health EOS Commercial |
$1,353.23
|
| Rate for Payer: HFN Commercial |
$1,398.84
|
| Rate for Payer: Multiplan Commercial |
$1,216.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,398.84
|
| Rate for Payer: Quartz Beloit One Network |
$745.04
|
| Rate for Payer: Quartz Commercial |
$912.29
|
| Rate for Payer: WEA Trust Commercial |
$836.26
|
| Rate for Payer: WPS Commercial |
$1,126.18
|
|
|
SCREW-LOCK 3.5 X 35 212.114
|
Facility
|
OP
|
$1,462.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6174911
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$425.73 |
| Max. Negotiated Rate |
$1,398.84 |
| Rate for Payer: Aetna Commercial |
$1,368.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,307.61
|
| Rate for Payer: Aetna Managed Medicare |
$425.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$988.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$760.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$729.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$805.85
|
| Rate for Payer: Cash Price |
$438.60
|
| Rate for Payer: Cigna Commercial |
$1,398.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$850.88
|
| Rate for Payer: Health EOS Commercial |
$1,353.23
|
| Rate for Payer: HFN Commercial |
$1,398.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,140.36
|
| Rate for Payer: Multiplan Commercial |
$1,216.38
|
| Rate for Payer: NAPHCARE Commercial |
$912.29
|
| Rate for Payer: Preferred Network Access Commercial |
$1,398.84
|
| Rate for Payer: Quartz Beloit One Network |
$745.04
|
| Rate for Payer: Quartz Commercial |
$988.31
|
| Rate for Payer: Quartz Medicare Advantage |
$912.29
|
| Rate for Payer: The Alliance Commercial |
$760.24
|
| Rate for Payer: WEA Trust Commercial |
$836.26
|
| Rate for Payer: WPS Commercial |
$1,126.18
|
|
|
SCREW LOCK 3.5 X 35MM MFT-021-35-35
|
Facility
|
IP
|
$3,283.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5729849
|
|
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 35MM MFT-021-35-35
|
Facility
|
OP
|
$3,283.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5729849
|
|
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 36 212.115
|
Facility
|
OP
|
$716.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966896
|
|
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 36 212.115
|
Facility
|
IP
|
$716.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966896
|
|
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 38 212.116
|
Facility
|
OP
|
$692.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966897
|
|
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
|
|
