|
SCREW LOCK 3Di 3.5 X 26MM ORTHOLOC 58803526
|
Facility
|
IP
|
$2,743.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6182939
|
|
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 26MM ORTHOLOC 58803526
|
Facility
|
OP
|
$2,743.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6182939
|
|
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 28MM ORTHOLOC 58803528
|
Facility
|
IP
|
$2,743.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6182940
|
|
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 28MM ORTHOLOC 58803528
|
Facility
|
OP
|
$2,743.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6182940
|
|
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 4.0 X 14 222.580
|
Facility
|
OP
|
$591.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966908
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$172.10 |
| Max. Negotiated Rate |
$565.47 |
| Rate for Payer: Aetna Commercial |
$553.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$528.59
|
| Rate for Payer: Aetna Managed Medicare |
$172.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$399.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$307.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$295.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$325.76
|
| Rate for Payer: Cash Price |
$177.30
|
| Rate for Payer: Cigna Commercial |
$565.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$343.96
|
| Rate for Payer: Health EOS Commercial |
$547.03
|
| Rate for Payer: HFN Commercial |
$565.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$460.98
|
| Rate for Payer: Multiplan Commercial |
$491.71
|
| Rate for Payer: NAPHCARE Commercial |
$368.78
|
| Rate for Payer: Preferred Network Access Commercial |
$565.47
|
| Rate for Payer: Quartz Beloit One Network |
$301.17
|
| Rate for Payer: Quartz Commercial |
$399.52
|
| Rate for Payer: Quartz Medicare Advantage |
$368.78
|
| Rate for Payer: The Alliance Commercial |
$307.32
|
| Rate for Payer: WEA Trust Commercial |
$338.05
|
| Rate for Payer: WPS Commercial |
$455.25
|
|
|
SCREW-LOCK 4.0 X 14 222.580
|
Facility
|
IP
|
$591.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966908
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$301.17 |
| Max. Negotiated Rate |
$565.47 |
| Rate for Payer: Aetna Commercial |
$553.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$528.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$325.76
|
| Rate for Payer: Cash Price |
$177.30
|
| Rate for Payer: Cigna Commercial |
$565.47
|
| Rate for Payer: Health EOS Commercial |
$547.03
|
| Rate for Payer: HFN Commercial |
$565.47
|
| Rate for Payer: Multiplan Commercial |
$491.71
|
| Rate for Payer: Preferred Network Access Commercial |
$565.47
|
| Rate for Payer: Quartz Beloit One Network |
$301.17
|
| Rate for Payer: Quartz Commercial |
$368.78
|
| Rate for Payer: WEA Trust Commercial |
$338.05
|
| Rate for Payer: WPS Commercial |
$455.25
|
|
|
SCREW LOCK 4.0 X 14MM ST 661014
|
Facility
|
OP
|
$2,589.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5458912
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$753.92 |
| Max. Negotiated Rate |
$2,477.16 |
| Rate for Payer: Aetna Commercial |
$2,423.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,315.60
|
| Rate for Payer: Aetna Managed Medicare |
$753.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,750.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,346.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,292.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,427.06
|
| Rate for Payer: Cash Price |
$776.70
|
| Rate for Payer: Cigna Commercial |
$2,477.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,506.80
|
| Rate for Payer: Health EOS Commercial |
$2,396.38
|
| Rate for Payer: HFN Commercial |
$2,477.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,019.42
|
| Rate for Payer: Multiplan Commercial |
$2,154.05
|
| Rate for Payer: NAPHCARE Commercial |
$1,615.54
|
| Rate for Payer: Preferred Network Access Commercial |
$2,477.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,319.35
|
| Rate for Payer: Quartz Commercial |
$1,750.16
|
| Rate for Payer: Quartz Medicare Advantage |
$1,615.54
|
| Rate for Payer: The Alliance Commercial |
$1,346.28
|
| Rate for Payer: WEA Trust Commercial |
$1,480.91
|
| Rate for Payer: WPS Commercial |
$1,994.31
|
|
|
SCREW LOCK 4.0 X 14MM ST 661014
|
Facility
|
IP
|
$2,589.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5458912
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,319.35 |
| Max. Negotiated Rate |
$2,477.16 |
| Rate for Payer: Aetna Commercial |
$2,423.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,315.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,427.06
|
| Rate for Payer: Cash Price |
$776.70
|
| Rate for Payer: Cigna Commercial |
$2,477.16
|
| Rate for Payer: Health EOS Commercial |
$2,396.38
|
| Rate for Payer: HFN Commercial |
$2,477.16
|
| Rate for Payer: Multiplan Commercial |
$2,154.05
|
| Rate for Payer: Preferred Network Access Commercial |
$2,477.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,319.35
|
| Rate for Payer: Quartz Commercial |
$1,615.54
|
| Rate for Payer: WEA Trust Commercial |
$1,480.91
|
| Rate for Payer: WPS Commercial |
$1,994.31
|
|
|
SCREW LOCK 4.0 X 16MM ST 661016
|
Facility
|
OP
|
$2,489.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5627650
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$724.80 |
| Max. Negotiated Rate |
$2,381.48 |
| Rate for Payer: Aetna Commercial |
$2,329.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,226.16
|
| Rate for Payer: Aetna Managed Medicare |
$724.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,682.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,294.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,242.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,371.94
|
| Rate for Payer: Cash Price |
$746.70
|
| Rate for Payer: Cigna Commercial |
$2,381.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,448.60
|
| Rate for Payer: Health EOS Commercial |
$2,303.82
|
| Rate for Payer: HFN Commercial |
$2,381.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,941.42
|
| Rate for Payer: Multiplan Commercial |
$2,070.85
|
| Rate for Payer: NAPHCARE Commercial |
$1,553.14
|
| Rate for Payer: Preferred Network Access Commercial |
$2,381.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,268.39
|
| Rate for Payer: Quartz Commercial |
$1,682.56
|
| Rate for Payer: Quartz Medicare Advantage |
$1,553.14
|
| Rate for Payer: The Alliance Commercial |
$1,294.28
|
| Rate for Payer: WEA Trust Commercial |
$1,423.71
|
| Rate for Payer: WPS Commercial |
$1,917.28
|
|
|
SCREW LOCK 4.0 X 16MM ST 661016
|
Facility
|
IP
|
$2,489.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5627650
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,268.39 |
| Max. Negotiated Rate |
$2,381.48 |
| Rate for Payer: Aetna Commercial |
$2,329.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,226.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,371.94
|
| Rate for Payer: Cash Price |
$746.70
|
| Rate for Payer: Cigna Commercial |
$2,381.48
|
| Rate for Payer: Health EOS Commercial |
$2,303.82
|
| Rate for Payer: HFN Commercial |
$2,381.48
|
| Rate for Payer: Multiplan Commercial |
$2,070.85
|
| Rate for Payer: Preferred Network Access Commercial |
$2,381.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,268.39
|
| Rate for Payer: Quartz Commercial |
$1,553.14
|
| Rate for Payer: WEA Trust Commercial |
$1,423.71
|
| Rate for Payer: WPS Commercial |
$1,917.28
|
|
|
SCREW-LOCK 4.0 X 18 222.582
|
Facility
|
IP
|
$591.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966909
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$301.17 |
| Max. Negotiated Rate |
$565.47 |
| Rate for Payer: Aetna Commercial |
$553.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$528.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$325.76
|
| Rate for Payer: Cash Price |
$177.30
|
| Rate for Payer: Cigna Commercial |
$565.47
|
| Rate for Payer: Health EOS Commercial |
$547.03
|
| Rate for Payer: HFN Commercial |
$565.47
|
| Rate for Payer: Multiplan Commercial |
$491.71
|
| Rate for Payer: Preferred Network Access Commercial |
$565.47
|
| Rate for Payer: Quartz Beloit One Network |
$301.17
|
| Rate for Payer: Quartz Commercial |
$368.78
|
| Rate for Payer: WEA Trust Commercial |
$338.05
|
| Rate for Payer: WPS Commercial |
$455.25
|
|
|
SCREW-LOCK 4.0 X 18 222.582
|
Facility
|
OP
|
$591.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966909
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$172.10 |
| Max. Negotiated Rate |
$565.47 |
| Rate for Payer: Aetna Commercial |
$553.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$528.59
|
| Rate for Payer: Aetna Managed Medicare |
$172.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$399.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$307.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$295.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$325.76
|
| Rate for Payer: Cash Price |
$177.30
|
| Rate for Payer: Cigna Commercial |
$565.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$343.96
|
| Rate for Payer: Health EOS Commercial |
$547.03
|
| Rate for Payer: HFN Commercial |
$565.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$460.98
|
| Rate for Payer: Multiplan Commercial |
$491.71
|
| Rate for Payer: NAPHCARE Commercial |
$368.78
|
| Rate for Payer: Preferred Network Access Commercial |
$565.47
|
| Rate for Payer: Quartz Beloit One Network |
$301.17
|
| Rate for Payer: Quartz Commercial |
$399.52
|
| Rate for Payer: Quartz Medicare Advantage |
$368.78
|
| Rate for Payer: The Alliance Commercial |
$307.32
|
| Rate for Payer: WEA Trust Commercial |
$338.05
|
| Rate for Payer: WPS Commercial |
$455.25
|
|
|
SCREW LOCK 4.0 X 18MM ST 661018
|
Facility
|
IP
|
$2,489.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5627651
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,268.39 |
| Max. Negotiated Rate |
$2,381.48 |
| Rate for Payer: Aetna Commercial |
$2,329.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,226.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,371.94
|
| Rate for Payer: Cash Price |
$746.70
|
| Rate for Payer: Cigna Commercial |
$2,381.48
|
| Rate for Payer: Health EOS Commercial |
$2,303.82
|
| Rate for Payer: HFN Commercial |
$2,381.48
|
| Rate for Payer: Multiplan Commercial |
$2,070.85
|
| Rate for Payer: Preferred Network Access Commercial |
$2,381.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,268.39
|
| Rate for Payer: Quartz Commercial |
$1,553.14
|
| Rate for Payer: WEA Trust Commercial |
$1,423.71
|
| Rate for Payer: WPS Commercial |
$1,917.28
|
|
|
SCREW LOCK 4.0 X 18MM ST 661018
|
Facility
|
OP
|
$2,489.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5627651
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$724.80 |
| Max. Negotiated Rate |
$2,381.48 |
| Rate for Payer: Aetna Commercial |
$2,329.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,226.16
|
| Rate for Payer: Aetna Managed Medicare |
$724.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,682.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,294.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,242.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,371.94
|
| Rate for Payer: Cash Price |
$746.70
|
| Rate for Payer: Cigna Commercial |
$2,381.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,448.60
|
| Rate for Payer: Health EOS Commercial |
$2,303.82
|
| Rate for Payer: HFN Commercial |
$2,381.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,941.42
|
| Rate for Payer: Multiplan Commercial |
$2,070.85
|
| Rate for Payer: NAPHCARE Commercial |
$1,553.14
|
| Rate for Payer: Preferred Network Access Commercial |
$2,381.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,268.39
|
| Rate for Payer: Quartz Commercial |
$1,682.56
|
| Rate for Payer: Quartz Medicare Advantage |
$1,553.14
|
| Rate for Payer: The Alliance Commercial |
$1,294.28
|
| Rate for Payer: WEA Trust Commercial |
$1,423.71
|
| Rate for Payer: WPS Commercial |
$1,917.28
|
|
|
SCREW LOCK 4.0 X 24MM ST 661024
|
Facility
|
OP
|
$2,589.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5458913
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$753.92 |
| Max. Negotiated Rate |
$2,477.16 |
| Rate for Payer: Aetna Commercial |
$2,423.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,315.60
|
| Rate for Payer: Aetna Managed Medicare |
$753.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,750.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,346.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,292.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,427.06
|
| Rate for Payer: Cash Price |
$776.70
|
| Rate for Payer: Cigna Commercial |
$2,477.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,506.80
|
| Rate for Payer: Health EOS Commercial |
$2,396.38
|
| Rate for Payer: HFN Commercial |
$2,477.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,019.42
|
| Rate for Payer: Multiplan Commercial |
$2,154.05
|
| Rate for Payer: NAPHCARE Commercial |
$1,615.54
|
| Rate for Payer: Preferred Network Access Commercial |
$2,477.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,319.35
|
| Rate for Payer: Quartz Commercial |
$1,750.16
|
| Rate for Payer: Quartz Medicare Advantage |
$1,615.54
|
| Rate for Payer: The Alliance Commercial |
$1,346.28
|
| Rate for Payer: WEA Trust Commercial |
$1,480.91
|
| Rate for Payer: WPS Commercial |
$1,994.31
|
|
|
SCREW LOCK 4.0 X 24MM ST 661024
|
Facility
|
IP
|
$2,589.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5458913
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,319.35 |
| Max. Negotiated Rate |
$2,477.16 |
| Rate for Payer: Aetna Commercial |
$2,423.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,315.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,427.06
|
| Rate for Payer: Cash Price |
$776.70
|
| Rate for Payer: Cigna Commercial |
$2,477.16
|
| Rate for Payer: Health EOS Commercial |
$2,396.38
|
| Rate for Payer: HFN Commercial |
$2,477.16
|
| Rate for Payer: Multiplan Commercial |
$2,154.05
|
| Rate for Payer: Preferred Network Access Commercial |
$2,477.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,319.35
|
| Rate for Payer: Quartz Commercial |
$1,615.54
|
| Rate for Payer: WEA Trust Commercial |
$1,480.91
|
| Rate for Payer: WPS Commercial |
$1,994.31
|
|
|
SCREW LOCK 4.0 X 24MM TI STARDRIVE 04.005.414S
|
Facility
|
IP
|
$2,679.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966516
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,365.22 |
| Max. Negotiated Rate |
$2,563.27 |
| Rate for Payer: Aetna Commercial |
$2,507.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,396.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,476.66
|
| Rate for Payer: Cash Price |
$803.70
|
| Rate for Payer: Cigna Commercial |
$2,563.27
|
| Rate for Payer: Health EOS Commercial |
$2,479.68
|
| Rate for Payer: HFN Commercial |
$2,563.27
|
| Rate for Payer: Multiplan Commercial |
$2,228.93
|
| Rate for Payer: Preferred Network Access Commercial |
$2,563.27
|
| Rate for Payer: Quartz Beloit One Network |
$1,365.22
|
| Rate for Payer: Quartz Commercial |
$1,671.70
|
| Rate for Payer: WEA Trust Commercial |
$1,532.39
|
| Rate for Payer: WPS Commercial |
$2,063.63
|
|
|
SCREW LOCK 4.0 X 24MM TI STARDRIVE 04.005.414S
|
Facility
|
OP
|
$2,679.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966516
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.12 |
| Max. Negotiated Rate |
$2,563.27 |
| Rate for Payer: Aetna Commercial |
$2,507.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,396.10
|
| Rate for Payer: Aetna Managed Medicare |
$780.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,811.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,393.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,337.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,476.66
|
| Rate for Payer: Cash Price |
$803.70
|
| Rate for Payer: Cigna Commercial |
$2,563.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,559.18
|
| Rate for Payer: Health EOS Commercial |
$2,479.68
|
| Rate for Payer: HFN Commercial |
$2,563.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,089.62
|
| Rate for Payer: Multiplan Commercial |
$2,228.93
|
| Rate for Payer: NAPHCARE Commercial |
$1,671.70
|
| Rate for Payer: Preferred Network Access Commercial |
$2,563.27
|
| Rate for Payer: Quartz Beloit One Network |
$1,365.22
|
| Rate for Payer: Quartz Commercial |
$1,811.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,671.70
|
| Rate for Payer: The Alliance Commercial |
$1,393.08
|
| Rate for Payer: WEA Trust Commercial |
$1,532.39
|
| Rate for Payer: WPS Commercial |
$2,063.63
|
|
|
SCREW-LOCK 4.0 X 26 222.584
|
Facility
|
IP
|
$591.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966910
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$301.17 |
| Max. Negotiated Rate |
$565.47 |
| Rate for Payer: Aetna Commercial |
$553.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$528.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$325.76
|
| Rate for Payer: Cash Price |
$177.30
|
| Rate for Payer: Cigna Commercial |
$565.47
|
| Rate for Payer: Health EOS Commercial |
$547.03
|
| Rate for Payer: HFN Commercial |
$565.47
|
| Rate for Payer: Multiplan Commercial |
$491.71
|
| Rate for Payer: Preferred Network Access Commercial |
$565.47
|
| Rate for Payer: Quartz Beloit One Network |
$301.17
|
| Rate for Payer: Quartz Commercial |
$368.78
|
| Rate for Payer: WEA Trust Commercial |
$338.05
|
| Rate for Payer: WPS Commercial |
$455.25
|
|
|
SCREW-LOCK 4.0 X 26 222.584
|
Facility
|
OP
|
$591.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966910
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$172.10 |
| Max. Negotiated Rate |
$565.47 |
| Rate for Payer: Aetna Commercial |
$553.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$528.59
|
| Rate for Payer: Aetna Managed Medicare |
$172.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$399.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$307.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$295.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$325.76
|
| Rate for Payer: Cash Price |
$177.30
|
| Rate for Payer: Cigna Commercial |
$565.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$343.96
|
| Rate for Payer: Health EOS Commercial |
$547.03
|
| Rate for Payer: HFN Commercial |
$565.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$460.98
|
| Rate for Payer: Multiplan Commercial |
$491.71
|
| Rate for Payer: NAPHCARE Commercial |
$368.78
|
| Rate for Payer: Preferred Network Access Commercial |
$565.47
|
| Rate for Payer: Quartz Beloit One Network |
$301.17
|
| Rate for Payer: Quartz Commercial |
$399.52
|
| Rate for Payer: Quartz Medicare Advantage |
$368.78
|
| Rate for Payer: The Alliance Commercial |
$307.32
|
| Rate for Payer: WEA Trust Commercial |
$338.05
|
| Rate for Payer: WPS Commercial |
$455.25
|
|
|
SCREW LOCK 4.0 X 26 FULLY THREAD 1896-4026S
|
Facility
|
IP
|
$1,285.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6246232
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$655.25 |
| Max. Negotiated Rate |
$1,230.26 |
| Rate for Payer: Aetna Commercial |
$1,203.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,150.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$708.74
|
| Rate for Payer: Cash Price |
$385.74
|
| Rate for Payer: Cigna Commercial |
$1,230.26
|
| Rate for Payer: Health EOS Commercial |
$1,190.15
|
| Rate for Payer: HFN Commercial |
$1,230.26
|
| Rate for Payer: Multiplan Commercial |
$1,069.79
|
| Rate for Payer: Preferred Network Access Commercial |
$1,230.26
|
| Rate for Payer: Quartz Beloit One Network |
$655.25
|
| Rate for Payer: Quartz Commercial |
$802.35
|
| Rate for Payer: WEA Trust Commercial |
$735.48
|
| Rate for Payer: WPS Commercial |
$990.46
|
|
|
SCREW LOCK 4.0 X 26 FULLY THREAD 1896-4026S
|
Facility
|
OP
|
$1,285.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6246232
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$374.43 |
| Max. Negotiated Rate |
$1,230.26 |
| Rate for Payer: Aetna Commercial |
$1,203.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,150.03
|
| Rate for Payer: Aetna Managed Medicare |
$374.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$869.21
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$668.62
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$641.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$708.74
|
| Rate for Payer: Cash Price |
$385.74
|
| Rate for Payer: Cigna Commercial |
$1,230.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$748.34
|
| Rate for Payer: Health EOS Commercial |
$1,190.15
|
| Rate for Payer: HFN Commercial |
$1,230.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,002.93
|
| Rate for Payer: Multiplan Commercial |
$1,069.79
|
| Rate for Payer: NAPHCARE Commercial |
$802.35
|
| Rate for Payer: Preferred Network Access Commercial |
$1,230.26
|
| Rate for Payer: Quartz Beloit One Network |
$655.25
|
| Rate for Payer: Quartz Commercial |
$869.21
|
| Rate for Payer: Quartz Medicare Advantage |
$802.35
|
| Rate for Payer: The Alliance Commercial |
$668.62
|
| Rate for Payer: WEA Trust Commercial |
$735.48
|
| Rate for Payer: WPS Commercial |
$990.46
|
|
|
SCREW LOCK 4.0 X 26MM ST 661026
|
Facility
|
OP
|
$2,589.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5458914
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$753.92 |
| Max. Negotiated Rate |
$2,477.16 |
| Rate for Payer: Aetna Commercial |
$2,423.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,315.60
|
| Rate for Payer: Aetna Managed Medicare |
$753.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,750.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,346.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,292.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,427.06
|
| Rate for Payer: Cash Price |
$776.70
|
| Rate for Payer: Cigna Commercial |
$2,477.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,506.80
|
| Rate for Payer: Health EOS Commercial |
$2,396.38
|
| Rate for Payer: HFN Commercial |
$2,477.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,019.42
|
| Rate for Payer: Multiplan Commercial |
$2,154.05
|
| Rate for Payer: NAPHCARE Commercial |
$1,615.54
|
| Rate for Payer: Preferred Network Access Commercial |
$2,477.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,319.35
|
| Rate for Payer: Quartz Commercial |
$1,750.16
|
| Rate for Payer: Quartz Medicare Advantage |
$1,615.54
|
| Rate for Payer: The Alliance Commercial |
$1,346.28
|
| Rate for Payer: WEA Trust Commercial |
$1,480.91
|
| Rate for Payer: WPS Commercial |
$1,994.31
|
|
|
SCREW LOCK 4.0 X 26MM ST 661026
|
Facility
|
IP
|
$2,589.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5458914
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,319.35 |
| Max. Negotiated Rate |
$2,477.16 |
| Rate for Payer: Aetna Commercial |
$2,423.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,315.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,427.06
|
| Rate for Payer: Cash Price |
$776.70
|
| Rate for Payer: Cigna Commercial |
$2,477.16
|
| Rate for Payer: Health EOS Commercial |
$2,396.38
|
| Rate for Payer: HFN Commercial |
$2,477.16
|
| Rate for Payer: Multiplan Commercial |
$2,154.05
|
| Rate for Payer: Preferred Network Access Commercial |
$2,477.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,319.35
|
| Rate for Payer: Quartz Commercial |
$1,615.54
|
| Rate for Payer: WEA Trust Commercial |
$1,480.91
|
| Rate for Payer: WPS Commercial |
$1,994.31
|
|
|
SCREW LOCK 4.0 X 26MM TI STARDRIVE 04.005.416
|
Facility
|
IP
|
$2,679.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966517
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,365.22 |
| Max. Negotiated Rate |
$2,563.27 |
| Rate for Payer: Aetna Commercial |
$2,507.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,396.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,476.66
|
| Rate for Payer: Cash Price |
$803.70
|
| Rate for Payer: Cigna Commercial |
$2,563.27
|
| Rate for Payer: Health EOS Commercial |
$2,479.68
|
| Rate for Payer: HFN Commercial |
$2,563.27
|
| Rate for Payer: Multiplan Commercial |
$2,228.93
|
| Rate for Payer: Preferred Network Access Commercial |
$2,563.27
|
| Rate for Payer: Quartz Beloit One Network |
$1,365.22
|
| Rate for Payer: Quartz Commercial |
$1,671.70
|
| Rate for Payer: WEA Trust Commercial |
$1,532.39
|
| Rate for Payer: WPS Commercial |
$2,063.63
|
|
