|
SCREW-LOCK 3.5 X 38 212.116
|
Facility
|
IP
|
$692.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966897
|
|
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 40 212.117
|
Facility
|
OP
|
$716.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966899
|
|
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 40 212.117
|
Facility
|
IP
|
$716.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966899
|
|
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 42 212.118
|
Facility
|
OP
|
$1,462.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6174914
|
|
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 42 212.118
|
Facility
|
IP
|
$1,462.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6174914
|
|
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 42.5MM MFT-021-35-425
|
Facility
|
IP
|
$3,283.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4028657
|
|
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 42.5MM MFT-021-35-425
|
Facility
|
OP
|
$3,283.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4028657
|
|
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 44 212.134
|
Facility
|
OP
|
$1,462.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6174858
|
|
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 44 212.134
|
Facility
|
IP
|
$1,462.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6174858
|
|
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 45 212.119
|
Facility
|
IP
|
$692.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966901
|
|
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 45 212.119
|
Facility
|
OP
|
$692.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966901
|
|
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 48MM 212.120
|
Facility
|
IP
|
$1,408.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5803719
|
|
Hospital Revenue Code
|
289
|
| Min. Negotiated Rate |
$717.52 |
| Max. Negotiated Rate |
$1,347.17 |
| Rate for Payer: Aetna Commercial |
$1,317.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,259.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$776.09
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Cigna Commercial |
$1,347.17
|
| Rate for Payer: Health EOS Commercial |
$1,303.24
|
| Rate for Payer: HFN Commercial |
$1,347.17
|
| Rate for Payer: Multiplan Commercial |
$1,171.46
|
| Rate for Payer: Preferred Network Access Commercial |
$1,347.17
|
| Rate for Payer: Quartz Beloit One Network |
$717.52
|
| Rate for Payer: Quartz Commercial |
$878.59
|
| Rate for Payer: WEA Trust Commercial |
$805.38
|
| Rate for Payer: WPS Commercial |
$1,084.58
|
|
|
SCREW LOCK 3.5 X 48MM 212.120
|
Facility
|
OP
|
$1,408.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5803719
|
|
Hospital Revenue Code
|
289
|
| Min. Negotiated Rate |
$410.01 |
| Max. Negotiated Rate |
$1,347.17 |
| Rate for Payer: Aetna Commercial |
$1,317.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,259.32
|
| Rate for Payer: Aetna Managed Medicare |
$410.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$951.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$732.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$702.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$776.09
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Cigna Commercial |
$1,347.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$819.46
|
| Rate for Payer: Health EOS Commercial |
$1,303.24
|
| Rate for Payer: HFN Commercial |
$1,347.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,098.24
|
| Rate for Payer: Multiplan Commercial |
$1,171.46
|
| Rate for Payer: NAPHCARE Commercial |
$878.59
|
| Rate for Payer: Preferred Network Access Commercial |
$1,347.17
|
| Rate for Payer: Quartz Beloit One Network |
$717.52
|
| Rate for Payer: Quartz Commercial |
$951.81
|
| Rate for Payer: Quartz Medicare Advantage |
$878.59
|
| Rate for Payer: The Alliance Commercial |
$732.16
|
| Rate for Payer: United Healthcare PPO |
$1,098.24
|
| Rate for Payer: WEA Trust Commercial |
$805.38
|
| Rate for Payer: WPS Commercial |
$1,084.58
|
|
|
SCREW LOCK 3.5 X 50 212.121
|
Facility
|
IP
|
$692.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966903
|
|
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 50 212.121
|
Facility
|
OP
|
$692.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966903
|
|
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 52MM 212.122
|
Facility
|
OP
|
$1,408.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5803720
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$410.01 |
| Max. Negotiated Rate |
$1,347.17 |
| Rate for Payer: Aetna Commercial |
$1,317.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,259.32
|
| Rate for Payer: Aetna Managed Medicare |
$410.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$951.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$732.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$702.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$776.09
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Cigna Commercial |
$1,347.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$819.46
|
| Rate for Payer: Health EOS Commercial |
$1,303.24
|
| Rate for Payer: HFN Commercial |
$1,347.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,098.24
|
| Rate for Payer: Multiplan Commercial |
$1,171.46
|
| Rate for Payer: NAPHCARE Commercial |
$878.59
|
| Rate for Payer: Preferred Network Access Commercial |
$1,347.17
|
| Rate for Payer: Quartz Beloit One Network |
$717.52
|
| Rate for Payer: Quartz Commercial |
$951.81
|
| Rate for Payer: Quartz Medicare Advantage |
$878.59
|
| Rate for Payer: The Alliance Commercial |
$732.16
|
| Rate for Payer: WEA Trust Commercial |
$805.38
|
| Rate for Payer: WPS Commercial |
$1,084.58
|
|
|
SCREW LOCK 3.5 X 52MM 212.122
|
Facility
|
IP
|
$1,408.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5803720
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$717.52 |
| Max. Negotiated Rate |
$1,347.17 |
| Rate for Payer: Aetna Commercial |
$1,317.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,259.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$776.09
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Cigna Commercial |
$1,347.17
|
| Rate for Payer: Health EOS Commercial |
$1,303.24
|
| Rate for Payer: HFN Commercial |
$1,347.17
|
| Rate for Payer: Multiplan Commercial |
$1,171.46
|
| Rate for Payer: Preferred Network Access Commercial |
$1,347.17
|
| Rate for Payer: Quartz Beloit One Network |
$717.52
|
| Rate for Payer: Quartz Commercial |
$878.59
|
| Rate for Payer: WEA Trust Commercial |
$805.38
|
| Rate for Payer: WPS Commercial |
$1,084.58
|
|
|
SCREW LOCK 3.5 X 55 212.123
|
Facility
|
OP
|
$692.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966905
|
|
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 55 212.123
|
Facility
|
IP
|
$692.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966905
|
|
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 60 212.124
|
Facility
|
OP
|
$692.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966907
|
|
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 60 212.124
|
Facility
|
IP
|
$692.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966907
|
|
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 3Di 3.5 X 20MM ORTHOLOC 58803520
|
Facility
|
OP
|
$2,743.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6185017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$798.76 |
| Max. Negotiated Rate |
$2,624.50 |
| Rate for Payer: Aetna Commercial |
$2,567.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,453.34
|
| Rate for Payer: Aetna Managed Medicare |
$798.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,854.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,426.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,369.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,511.94
|
| Rate for Payer: Cash Price |
$822.90
|
| Rate for Payer: Cigna Commercial |
$2,624.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,596.43
|
| Rate for Payer: Health EOS Commercial |
$2,538.92
|
| Rate for Payer: HFN Commercial |
$2,624.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,139.54
|
| Rate for Payer: Multiplan Commercial |
$2,282.18
|
| Rate for Payer: NAPHCARE Commercial |
$1,711.63
|
| Rate for Payer: Preferred Network Access Commercial |
$2,624.50
|
| Rate for Payer: Quartz Beloit One Network |
$1,397.83
|
| Rate for Payer: Quartz Commercial |
$1,854.27
|
| Rate for Payer: Quartz Medicare Advantage |
$1,711.63
|
| Rate for Payer: The Alliance Commercial |
$1,426.36
|
| Rate for Payer: WEA Trust Commercial |
$1,569.00
|
| Rate for Payer: WPS Commercial |
$2,112.93
|
|
|
SCREW LOCK 3Di 3.5 X 20MM ORTHOLOC 58803520
|
Facility
|
IP
|
$2,743.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6185017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,397.83 |
| Max. Negotiated Rate |
$2,624.50 |
| Rate for Payer: Aetna Commercial |
$2,567.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,453.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,511.94
|
| Rate for Payer: Cash Price |
$822.90
|
| Rate for Payer: Cigna Commercial |
$2,624.50
|
| Rate for Payer: Health EOS Commercial |
$2,538.92
|
| Rate for Payer: HFN Commercial |
$2,624.50
|
| Rate for Payer: Multiplan Commercial |
$2,282.18
|
| Rate for Payer: Preferred Network Access Commercial |
$2,624.50
|
| Rate for Payer: Quartz Beloit One Network |
$1,397.83
|
| Rate for Payer: Quartz Commercial |
$1,711.63
|
| Rate for Payer: WEA Trust Commercial |
$1,569.00
|
| Rate for Payer: WPS Commercial |
$2,112.93
|
|
|
SCREW LOCK 3Di 3.5 X 22MM ORTHOLOC 58803522
|
Facility
|
OP
|
$2,743.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6182938
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$798.76 |
| Max. Negotiated Rate |
$2,624.50 |
| Rate for Payer: Aetna Commercial |
$2,567.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,453.34
|
| Rate for Payer: Aetna Managed Medicare |
$798.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,854.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,426.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,369.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,511.94
|
| Rate for Payer: Cash Price |
$822.90
|
| Rate for Payer: Cigna Commercial |
$2,624.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,596.43
|
| Rate for Payer: Health EOS Commercial |
$2,538.92
|
| Rate for Payer: HFN Commercial |
$2,624.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,139.54
|
| Rate for Payer: Multiplan Commercial |
$2,282.18
|
| Rate for Payer: NAPHCARE Commercial |
$1,711.63
|
| Rate for Payer: Preferred Network Access Commercial |
$2,624.50
|
| Rate for Payer: Quartz Beloit One Network |
$1,397.83
|
| Rate for Payer: Quartz Commercial |
$1,854.27
|
| Rate for Payer: Quartz Medicare Advantage |
$1,711.63
|
| Rate for Payer: The Alliance Commercial |
$1,426.36
|
| Rate for Payer: WEA Trust Commercial |
$1,569.00
|
| Rate for Payer: WPS Commercial |
$2,112.93
|
|
|
SCREW LOCK 3Di 3.5 X 22MM ORTHOLOC 58803522
|
Facility
|
IP
|
$2,743.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6182938
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,397.83 |
| Max. Negotiated Rate |
$2,624.50 |
| Rate for Payer: Aetna Commercial |
$2,567.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,453.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,511.94
|
| Rate for Payer: Cash Price |
$822.90
|
| Rate for Payer: Cigna Commercial |
$2,624.50
|
| Rate for Payer: Health EOS Commercial |
$2,538.92
|
| Rate for Payer: HFN Commercial |
$2,624.50
|
| Rate for Payer: Multiplan Commercial |
$2,282.18
|
| Rate for Payer: Preferred Network Access Commercial |
$2,624.50
|
| Rate for Payer: Quartz Beloit One Network |
$1,397.83
|
| Rate for Payer: Quartz Commercial |
$1,711.63
|
| Rate for Payer: WEA Trust Commercial |
$1,569.00
|
| Rate for Payer: WPS Commercial |
$2,112.93
|
|
