|
SCREW LOCK 2.4 X 18 STARDRIVE 02.210.118
|
Facility
|
OP
|
$2,027.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966452
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$567.56 |
| Max. Negotiated Rate |
$8,108.00 |
| Rate for Payer: Aetna Commercial |
$1,824.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,743.22
|
| Rate for Payer: Aetna Managed Medicare |
$567.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,317.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,013.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$972.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,074.31
|
| Rate for Payer: Cash Price |
$608.10
|
| Rate for Payer: Cigna Commercial |
$1,864.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,134.31
|
| Rate for Payer: Health EOS Commercial |
$1,804.03
|
| Rate for Payer: HFN Commercial |
$1,864.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,520.25
|
| Rate for Payer: Multiplan Commercial |
$1,621.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,216.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,864.84
|
| Rate for Payer: Quartz Beloit One Network |
$993.23
|
| Rate for Payer: Quartz Commercial |
$1,317.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,216.20
|
| Rate for Payer: The Alliance Commercial |
$8,108.00
|
| Rate for Payer: WEA Trust Commercial |
$1,114.85
|
| Rate for Payer: WPS Commercial |
$1,501.40
|
|
|
SCREW-LOCK 2.4 X 20 412.820
|
Facility
|
OP
|
$709.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966811
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.52 |
| Max. Negotiated Rate |
$2,836.00 |
| Rate for Payer: Aetna Commercial |
$638.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$609.74
|
| Rate for Payer: Aetna Managed Medicare |
$198.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$460.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$354.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$340.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$375.77
|
| Rate for Payer: Cash Price |
$212.70
|
| Rate for Payer: Cigna Commercial |
$652.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$396.76
|
| Rate for Payer: Health EOS Commercial |
$631.01
|
| Rate for Payer: HFN Commercial |
$652.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$531.75
|
| Rate for Payer: Multiplan Commercial |
$567.20
|
| Rate for Payer: NAPHCARE Commercial |
$425.40
|
| Rate for Payer: Preferred Network Access Commercial |
$652.28
|
| Rate for Payer: Quartz Beloit One Network |
$347.41
|
| Rate for Payer: Quartz Commercial |
$460.85
|
| Rate for Payer: Quartz Medicare Advantage |
$425.40
|
| Rate for Payer: The Alliance Commercial |
$2,836.00
|
| Rate for Payer: WEA Trust Commercial |
$389.95
|
| Rate for Payer: WPS Commercial |
$525.16
|
|
|
SCREW-LOCK 2.4 X 20 412.820
|
Facility
|
IP
|
$709.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966811
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$347.41 |
| Max. Negotiated Rate |
$652.28 |
| Rate for Payer: Aetna Commercial |
$638.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$609.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$375.77
|
| Rate for Payer: Cash Price |
$212.70
|
| Rate for Payer: Cigna Commercial |
$652.28
|
| Rate for Payer: Health EOS Commercial |
$631.01
|
| Rate for Payer: HFN Commercial |
$652.28
|
| Rate for Payer: Multiplan Commercial |
$567.20
|
| Rate for Payer: NAPHCARE Commercial |
$425.40
|
| Rate for Payer: Preferred Network Access Commercial |
$652.28
|
| Rate for Payer: Quartz Beloit One Network |
$347.41
|
| Rate for Payer: Quartz Commercial |
$425.40
|
| Rate for Payer: WEA Trust Commercial |
$389.95
|
| Rate for Payer: WPS Commercial |
$525.16
|
|
|
SCREW-LOCK 2.4 X 20MM 04.210.120
|
Facility
|
OP
|
$2,106.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966812
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$589.68 |
| Max. Negotiated Rate |
$8,424.00 |
| Rate for Payer: Aetna Commercial |
$1,895.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,811.16
|
| Rate for Payer: Aetna Managed Medicare |
$589.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,368.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,053.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,010.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,116.18
|
| Rate for Payer: Cash Price |
$631.80
|
| Rate for Payer: Cigna Commercial |
$1,937.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,178.52
|
| Rate for Payer: Health EOS Commercial |
$1,874.34
|
| Rate for Payer: HFN Commercial |
$1,937.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,579.50
|
| Rate for Payer: Multiplan Commercial |
$1,684.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,263.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,937.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,031.94
|
| Rate for Payer: Quartz Commercial |
$1,368.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,263.60
|
| Rate for Payer: The Alliance Commercial |
$8,424.00
|
| Rate for Payer: WEA Trust Commercial |
$1,158.30
|
| Rate for Payer: WPS Commercial |
$1,559.91
|
|
|
SCREW-LOCK 2.4 X 20MM 04.210.120
|
Facility
|
IP
|
$2,106.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966812
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,031.94 |
| Max. Negotiated Rate |
$1,937.52 |
| Rate for Payer: Aetna Commercial |
$1,895.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,811.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,116.18
|
| Rate for Payer: Cash Price |
$631.80
|
| Rate for Payer: Cigna Commercial |
$1,937.52
|
| Rate for Payer: Health EOS Commercial |
$1,874.34
|
| Rate for Payer: HFN Commercial |
$1,937.52
|
| Rate for Payer: Multiplan Commercial |
$1,684.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,263.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,937.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,031.94
|
| Rate for Payer: Quartz Commercial |
$1,263.60
|
| Rate for Payer: WEA Trust Commercial |
$1,158.30
|
| Rate for Payer: WPS Commercial |
$1,559.91
|
|
|
SCREW LOCK 2.4 X 20MM 212.820
|
Facility
|
OP
|
$1,750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966454
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$490.00 |
| Max. Negotiated Rate |
$7,000.00 |
| Rate for Payer: Aetna Commercial |
$1,575.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,505.00
|
| Rate for Payer: Aetna Managed Medicare |
$490.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,137.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$875.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$840.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$927.50
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$1,610.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$979.30
|
| Rate for Payer: Health EOS Commercial |
$1,557.50
|
| Rate for Payer: HFN Commercial |
$1,610.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,312.50
|
| Rate for Payer: Multiplan Commercial |
$1,400.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,050.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,610.00
|
| Rate for Payer: Quartz Beloit One Network |
$857.50
|
| Rate for Payer: Quartz Commercial |
$1,137.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,050.00
|
| Rate for Payer: The Alliance Commercial |
$7,000.00
|
| Rate for Payer: WEA Trust Commercial |
$962.50
|
| Rate for Payer: WPS Commercial |
$1,296.22
|
|
|
SCREW LOCK 2.4 X 20MM 212.820
|
Facility
|
IP
|
$1,750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966454
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$857.50 |
| Max. Negotiated Rate |
$1,610.00 |
| Rate for Payer: Aetna Commercial |
$1,575.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,505.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$927.50
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$1,610.00
|
| Rate for Payer: Health EOS Commercial |
$1,557.50
|
| Rate for Payer: HFN Commercial |
$1,610.00
|
| Rate for Payer: Multiplan Commercial |
$1,400.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,050.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,610.00
|
| Rate for Payer: Quartz Beloit One Network |
$857.50
|
| Rate for Payer: Quartz Commercial |
$1,050.00
|
| Rate for Payer: WEA Trust Commercial |
$962.50
|
| Rate for Payer: WPS Commercial |
$1,296.22
|
|
|
SCREW LOCK 2.4 X 20 STARDRIVE 02.210.120
|
Facility
|
OP
|
$1,961.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966455
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$549.08 |
| Max. Negotiated Rate |
$7,844.00 |
| Rate for Payer: Aetna Commercial |
$1,764.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,686.46
|
| Rate for Payer: Aetna Managed Medicare |
$549.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,274.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$980.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$941.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,039.33
|
| Rate for Payer: Cash Price |
$588.30
|
| Rate for Payer: Cigna Commercial |
$1,804.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,097.38
|
| Rate for Payer: Health EOS Commercial |
$1,745.29
|
| Rate for Payer: HFN Commercial |
$1,804.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,470.75
|
| Rate for Payer: Multiplan Commercial |
$1,568.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,176.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,804.12
|
| Rate for Payer: Quartz Beloit One Network |
$960.89
|
| Rate for Payer: Quartz Commercial |
$1,274.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,176.60
|
| Rate for Payer: The Alliance Commercial |
$7,844.00
|
| Rate for Payer: WEA Trust Commercial |
$1,078.55
|
| Rate for Payer: WPS Commercial |
$1,452.51
|
|
|
SCREW LOCK 2.4 X 20 STARDRIVE 02.210.120
|
Facility
|
IP
|
$1,961.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966455
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$960.89 |
| Max. Negotiated Rate |
$1,804.12 |
| Rate for Payer: Aetna Commercial |
$1,764.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,686.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,039.33
|
| Rate for Payer: Cash Price |
$588.30
|
| Rate for Payer: Cigna Commercial |
$1,804.12
|
| Rate for Payer: Health EOS Commercial |
$1,745.29
|
| Rate for Payer: HFN Commercial |
$1,804.12
|
| Rate for Payer: Multiplan Commercial |
$1,568.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,176.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,804.12
|
| Rate for Payer: Quartz Beloit One Network |
$960.89
|
| Rate for Payer: Quartz Commercial |
$1,176.60
|
| Rate for Payer: WEA Trust Commercial |
$1,078.55
|
| Rate for Payer: WPS Commercial |
$1,452.51
|
|
|
SCREW-LOCK 2.4 X 22 412.822
|
Facility
|
OP
|
$709.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966814
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.52 |
| Max. Negotiated Rate |
$2,836.00 |
| Rate for Payer: Aetna Commercial |
$638.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$609.74
|
| Rate for Payer: Aetna Managed Medicare |
$198.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$460.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$354.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$340.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$375.77
|
| Rate for Payer: Cash Price |
$212.70
|
| Rate for Payer: Cigna Commercial |
$652.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$396.76
|
| Rate for Payer: Health EOS Commercial |
$631.01
|
| Rate for Payer: HFN Commercial |
$652.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$531.75
|
| Rate for Payer: Multiplan Commercial |
$567.20
|
| Rate for Payer: NAPHCARE Commercial |
$425.40
|
| Rate for Payer: Preferred Network Access Commercial |
$652.28
|
| Rate for Payer: Quartz Beloit One Network |
$347.41
|
| Rate for Payer: Quartz Commercial |
$460.85
|
| Rate for Payer: Quartz Medicare Advantage |
$425.40
|
| Rate for Payer: The Alliance Commercial |
$2,836.00
|
| Rate for Payer: WEA Trust Commercial |
$389.95
|
| Rate for Payer: WPS Commercial |
$525.16
|
|
|
SCREW-LOCK 2.4 X 22 412.822
|
Facility
|
IP
|
$709.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966814
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$347.41 |
| Max. Negotiated Rate |
$652.28 |
| Rate for Payer: Aetna Commercial |
$638.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$609.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$375.77
|
| Rate for Payer: Cash Price |
$212.70
|
| Rate for Payer: Cigna Commercial |
$652.28
|
| Rate for Payer: Health EOS Commercial |
$631.01
|
| Rate for Payer: HFN Commercial |
$652.28
|
| Rate for Payer: Multiplan Commercial |
$567.20
|
| Rate for Payer: NAPHCARE Commercial |
$425.40
|
| Rate for Payer: Preferred Network Access Commercial |
$652.28
|
| Rate for Payer: Quartz Beloit One Network |
$347.41
|
| Rate for Payer: Quartz Commercial |
$425.40
|
| Rate for Payer: WEA Trust Commercial |
$389.95
|
| Rate for Payer: WPS Commercial |
$525.16
|
|
|
SCREW-LOCK 2.4 X 22MM 04.210.122
|
Facility
|
OP
|
$2,106.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966815
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$589.68 |
| Max. Negotiated Rate |
$8,424.00 |
| Rate for Payer: Aetna Commercial |
$1,895.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,811.16
|
| Rate for Payer: Aetna Managed Medicare |
$589.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,368.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,053.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,010.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,116.18
|
| Rate for Payer: Cash Price |
$631.80
|
| Rate for Payer: Cigna Commercial |
$1,937.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,178.52
|
| Rate for Payer: Health EOS Commercial |
$1,874.34
|
| Rate for Payer: HFN Commercial |
$1,937.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,579.50
|
| Rate for Payer: Multiplan Commercial |
$1,684.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,263.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,937.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,031.94
|
| Rate for Payer: Quartz Commercial |
$1,368.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,263.60
|
| Rate for Payer: The Alliance Commercial |
$8,424.00
|
| Rate for Payer: WEA Trust Commercial |
$1,158.30
|
| Rate for Payer: WPS Commercial |
$1,559.91
|
|
|
SCREW-LOCK 2.4 X 22MM 04.210.122
|
Facility
|
IP
|
$2,106.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966815
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,031.94 |
| Max. Negotiated Rate |
$1,937.52 |
| Rate for Payer: Aetna Commercial |
$1,895.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,811.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,116.18
|
| Rate for Payer: Cash Price |
$631.80
|
| Rate for Payer: Cigna Commercial |
$1,937.52
|
| Rate for Payer: Health EOS Commercial |
$1,874.34
|
| Rate for Payer: HFN Commercial |
$1,937.52
|
| Rate for Payer: Multiplan Commercial |
$1,684.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,263.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,937.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,031.94
|
| Rate for Payer: Quartz Commercial |
$1,263.60
|
| Rate for Payer: WEA Trust Commercial |
$1,158.30
|
| Rate for Payer: WPS Commercial |
$1,559.91
|
|
|
SCREW LOCK 2.4 X 22MM 212.822
|
Facility
|
IP
|
$1,750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966458
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$857.50 |
| Max. Negotiated Rate |
$1,610.00 |
| Rate for Payer: Aetna Commercial |
$1,575.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,505.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$927.50
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$1,610.00
|
| Rate for Payer: Health EOS Commercial |
$1,557.50
|
| Rate for Payer: HFN Commercial |
$1,610.00
|
| Rate for Payer: Multiplan Commercial |
$1,400.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,050.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,610.00
|
| Rate for Payer: Quartz Beloit One Network |
$857.50
|
| Rate for Payer: Quartz Commercial |
$1,050.00
|
| Rate for Payer: WEA Trust Commercial |
$962.50
|
| Rate for Payer: WPS Commercial |
$1,296.22
|
|
|
SCREW LOCK 2.4 X 22MM 212.822
|
Facility
|
OP
|
$1,750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966458
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$490.00 |
| Max. Negotiated Rate |
$7,000.00 |
| Rate for Payer: Aetna Commercial |
$1,575.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,505.00
|
| Rate for Payer: Aetna Managed Medicare |
$490.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,137.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$875.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$840.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$927.50
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$1,610.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$979.30
|
| Rate for Payer: Health EOS Commercial |
$1,557.50
|
| Rate for Payer: HFN Commercial |
$1,610.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,312.50
|
| Rate for Payer: Multiplan Commercial |
$1,400.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,050.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,610.00
|
| Rate for Payer: Quartz Beloit One Network |
$857.50
|
| Rate for Payer: Quartz Commercial |
$1,137.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,050.00
|
| Rate for Payer: The Alliance Commercial |
$7,000.00
|
| Rate for Payer: WEA Trust Commercial |
$962.50
|
| Rate for Payer: WPS Commercial |
$1,296.22
|
|
|
SCREW LOCK 2.4 X 22 STARDRIVE 02.210.122
|
Facility
|
OP
|
$1,961.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966459
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$549.08 |
| Max. Negotiated Rate |
$7,844.00 |
| Rate for Payer: Aetna Commercial |
$1,764.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,686.46
|
| Rate for Payer: Aetna Managed Medicare |
$549.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,274.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$980.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$941.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,039.33
|
| Rate for Payer: Cash Price |
$588.30
|
| Rate for Payer: Cigna Commercial |
$1,804.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,097.38
|
| Rate for Payer: Health EOS Commercial |
$1,745.29
|
| Rate for Payer: HFN Commercial |
$1,804.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,470.75
|
| Rate for Payer: Multiplan Commercial |
$1,568.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,176.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,804.12
|
| Rate for Payer: Quartz Beloit One Network |
$960.89
|
| Rate for Payer: Quartz Commercial |
$1,274.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,176.60
|
| Rate for Payer: The Alliance Commercial |
$7,844.00
|
| Rate for Payer: WEA Trust Commercial |
$1,078.55
|
| Rate for Payer: WPS Commercial |
$1,452.51
|
|
|
SCREW LOCK 2.4 X 22 STARDRIVE 02.210.122
|
Facility
|
IP
|
$1,961.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966459
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$960.89 |
| Max. Negotiated Rate |
$1,804.12 |
| Rate for Payer: Aetna Commercial |
$1,764.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,686.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,039.33
|
| Rate for Payer: Cash Price |
$588.30
|
| Rate for Payer: Cigna Commercial |
$1,804.12
|
| Rate for Payer: Health EOS Commercial |
$1,745.29
|
| Rate for Payer: HFN Commercial |
$1,804.12
|
| Rate for Payer: Multiplan Commercial |
$1,568.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,176.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,804.12
|
| Rate for Payer: Quartz Beloit One Network |
$960.89
|
| Rate for Payer: Quartz Commercial |
$1,176.60
|
| Rate for Payer: WEA Trust Commercial |
$1,078.55
|
| Rate for Payer: WPS Commercial |
$1,452.51
|
|
|
SCREW-LOCK 2.4 X 24 412.824
|
Facility
|
OP
|
$709.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966817
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.52 |
| Max. Negotiated Rate |
$2,836.00 |
| Rate for Payer: Aetna Commercial |
$638.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$609.74
|
| Rate for Payer: Aetna Managed Medicare |
$198.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$460.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$354.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$340.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$375.77
|
| Rate for Payer: Cash Price |
$212.70
|
| Rate for Payer: Cigna Commercial |
$652.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$396.76
|
| Rate for Payer: Health EOS Commercial |
$631.01
|
| Rate for Payer: HFN Commercial |
$652.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$531.75
|
| Rate for Payer: Multiplan Commercial |
$567.20
|
| Rate for Payer: NAPHCARE Commercial |
$425.40
|
| Rate for Payer: Preferred Network Access Commercial |
$652.28
|
| Rate for Payer: Quartz Beloit One Network |
$347.41
|
| Rate for Payer: Quartz Commercial |
$460.85
|
| Rate for Payer: Quartz Medicare Advantage |
$425.40
|
| Rate for Payer: The Alliance Commercial |
$2,836.00
|
| Rate for Payer: WEA Trust Commercial |
$389.95
|
| Rate for Payer: WPS Commercial |
$525.16
|
|
|
SCREW-LOCK 2.4 X 24 412.824
|
Facility
|
IP
|
$709.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966817
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$347.41 |
| Max. Negotiated Rate |
$652.28 |
| Rate for Payer: Aetna Commercial |
$638.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$609.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$375.77
|
| Rate for Payer: Cash Price |
$212.70
|
| Rate for Payer: Cigna Commercial |
$652.28
|
| Rate for Payer: Health EOS Commercial |
$631.01
|
| Rate for Payer: HFN Commercial |
$652.28
|
| Rate for Payer: Multiplan Commercial |
$567.20
|
| Rate for Payer: NAPHCARE Commercial |
$425.40
|
| Rate for Payer: Preferred Network Access Commercial |
$652.28
|
| Rate for Payer: Quartz Beloit One Network |
$347.41
|
| Rate for Payer: Quartz Commercial |
$425.40
|
| Rate for Payer: WEA Trust Commercial |
$389.95
|
| Rate for Payer: WPS Commercial |
$525.16
|
|
|
SCREW-LOCK 2.4 X 24MM 04.210.124
|
Facility
|
IP
|
$2,106.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966818
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,031.94 |
| Max. Negotiated Rate |
$1,937.52 |
| Rate for Payer: Aetna Commercial |
$1,895.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,811.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,116.18
|
| Rate for Payer: Cash Price |
$631.80
|
| Rate for Payer: Cigna Commercial |
$1,937.52
|
| Rate for Payer: Health EOS Commercial |
$1,874.34
|
| Rate for Payer: HFN Commercial |
$1,937.52
|
| Rate for Payer: Multiplan Commercial |
$1,684.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,263.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,937.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,031.94
|
| Rate for Payer: Quartz Commercial |
$1,263.60
|
| Rate for Payer: WEA Trust Commercial |
$1,158.30
|
| Rate for Payer: WPS Commercial |
$1,559.91
|
|
|
SCREW-LOCK 2.4 X 24MM 04.210.124
|
Facility
|
OP
|
$2,106.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966818
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$589.68 |
| Max. Negotiated Rate |
$8,424.00 |
| Rate for Payer: Aetna Commercial |
$1,895.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,811.16
|
| Rate for Payer: Aetna Managed Medicare |
$589.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,368.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,053.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,010.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,116.18
|
| Rate for Payer: Cash Price |
$631.80
|
| Rate for Payer: Cigna Commercial |
$1,937.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,178.52
|
| Rate for Payer: Health EOS Commercial |
$1,874.34
|
| Rate for Payer: HFN Commercial |
$1,937.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,579.50
|
| Rate for Payer: Multiplan Commercial |
$1,684.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,263.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,937.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,031.94
|
| Rate for Payer: Quartz Commercial |
$1,368.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,263.60
|
| Rate for Payer: The Alliance Commercial |
$8,424.00
|
| Rate for Payer: WEA Trust Commercial |
$1,158.30
|
| Rate for Payer: WPS Commercial |
$1,559.91
|
|
|
SCREW LOCK 2.4 X 24MM 212.824
|
Facility
|
IP
|
$1,750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966461
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$857.50 |
| Max. Negotiated Rate |
$1,610.00 |
| Rate for Payer: Aetna Commercial |
$1,575.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,505.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$927.50
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$1,610.00
|
| Rate for Payer: Health EOS Commercial |
$1,557.50
|
| Rate for Payer: HFN Commercial |
$1,610.00
|
| Rate for Payer: Multiplan Commercial |
$1,400.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,050.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,610.00
|
| Rate for Payer: Quartz Beloit One Network |
$857.50
|
| Rate for Payer: Quartz Commercial |
$1,050.00
|
| Rate for Payer: WEA Trust Commercial |
$962.50
|
| Rate for Payer: WPS Commercial |
$1,296.22
|
|
|
SCREW LOCK 2.4 X 24MM 212.824
|
Facility
|
OP
|
$1,750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966461
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$490.00 |
| Max. Negotiated Rate |
$7,000.00 |
| Rate for Payer: Aetna Commercial |
$1,575.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,505.00
|
| Rate for Payer: Aetna Managed Medicare |
$490.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,137.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$875.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$840.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$927.50
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$1,610.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$979.30
|
| Rate for Payer: Health EOS Commercial |
$1,557.50
|
| Rate for Payer: HFN Commercial |
$1,610.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,312.50
|
| Rate for Payer: Multiplan Commercial |
$1,400.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,050.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,610.00
|
| Rate for Payer: Quartz Beloit One Network |
$857.50
|
| Rate for Payer: Quartz Commercial |
$1,137.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,050.00
|
| Rate for Payer: The Alliance Commercial |
$7,000.00
|
| Rate for Payer: WEA Trust Commercial |
$962.50
|
| Rate for Payer: WPS Commercial |
$1,296.22
|
|
|
SCREW LOCK 2.4 X 24 STARDRIVE 02.210.124
|
Facility
|
OP
|
$2,027.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966575
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$567.56 |
| Max. Negotiated Rate |
$8,108.00 |
| Rate for Payer: Aetna Commercial |
$1,824.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,743.22
|
| Rate for Payer: Aetna Managed Medicare |
$567.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,317.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,013.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$972.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,074.31
|
| Rate for Payer: Cash Price |
$608.10
|
| Rate for Payer: Cigna Commercial |
$1,864.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,134.31
|
| Rate for Payer: Health EOS Commercial |
$1,804.03
|
| Rate for Payer: HFN Commercial |
$1,864.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,520.25
|
| Rate for Payer: Multiplan Commercial |
$1,621.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,216.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,864.84
|
| Rate for Payer: Quartz Beloit One Network |
$993.23
|
| Rate for Payer: Quartz Commercial |
$1,317.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,216.20
|
| Rate for Payer: The Alliance Commercial |
$8,108.00
|
| Rate for Payer: WEA Trust Commercial |
$1,114.85
|
| Rate for Payer: WPS Commercial |
$1,501.40
|
|
|
SCREW LOCK 2.4 X 24 STARDRIVE 02.210.124
|
Facility
|
IP
|
$2,027.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966575
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$993.23 |
| Max. Negotiated Rate |
$1,864.84 |
| Rate for Payer: Aetna Commercial |
$1,824.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,743.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,074.31
|
| Rate for Payer: Cash Price |
$608.10
|
| Rate for Payer: Cigna Commercial |
$1,864.84
|
| Rate for Payer: Health EOS Commercial |
$1,804.03
|
| Rate for Payer: HFN Commercial |
$1,864.84
|
| Rate for Payer: Multiplan Commercial |
$1,621.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,216.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,864.84
|
| Rate for Payer: Quartz Beloit One Network |
$993.23
|
| Rate for Payer: Quartz Commercial |
$1,216.20
|
| Rate for Payer: WEA Trust Commercial |
$1,114.85
|
| Rate for Payer: WPS Commercial |
$1,501.40
|
|
