|
SCREW LOCK 4.0 X 26MM TI STARDRIVE 04.005.416
|
Facility
|
OP
|
$2,679.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966517
|
|
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 28 FULLY THREAD 1896-4028S
|
Facility
|
IP
|
$1,285.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6246233
|
|
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 28 FULLY THREAD 1896-4028S
|
Facility
|
OP
|
$1,285.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6246233
|
|
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 28MM ST 661028
|
Facility
|
OP
|
$2,589.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5458915
|
|
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 28MM ST 661028
|
Facility
|
IP
|
$2,589.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5458915
|
|
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 28MM TI STARDRIVE 04.005.418S
|
Facility
|
IP
|
$1,968.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3313461
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,002.89 |
| Max. Negotiated Rate |
$1,882.98 |
| Rate for Payer: Aetna Commercial |
$1,842.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,760.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,084.76
|
| Rate for Payer: Cash Price |
$590.40
|
| Rate for Payer: Cigna Commercial |
$1,882.98
|
| Rate for Payer: Health EOS Commercial |
$1,821.58
|
| Rate for Payer: HFN Commercial |
$1,882.98
|
| Rate for Payer: Multiplan Commercial |
$1,637.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,882.98
|
| Rate for Payer: Quartz Beloit One Network |
$1,002.89
|
| Rate for Payer: Quartz Commercial |
$1,228.03
|
| Rate for Payer: WEA Trust Commercial |
$1,125.70
|
| Rate for Payer: WPS Commercial |
$1,515.95
|
|
|
SCREW LOCK 4.0 X 28MM TI STARDRIVE 04.005.418S
|
Facility
|
OP
|
$1,968.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3313461
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$573.08 |
| Max. Negotiated Rate |
$1,882.98 |
| Rate for Payer: Aetna Commercial |
$1,842.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,760.18
|
| Rate for Payer: Aetna Managed Medicare |
$573.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,330.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,023.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$982.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,084.76
|
| Rate for Payer: Cash Price |
$590.40
|
| Rate for Payer: Cigna Commercial |
$1,882.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,145.38
|
| Rate for Payer: Health EOS Commercial |
$1,821.58
|
| Rate for Payer: HFN Commercial |
$1,882.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,535.04
|
| Rate for Payer: Multiplan Commercial |
$1,637.38
|
| Rate for Payer: NAPHCARE Commercial |
$1,228.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,882.98
|
| Rate for Payer: Quartz Beloit One Network |
$1,002.89
|
| Rate for Payer: Quartz Commercial |
$1,330.37
|
| Rate for Payer: Quartz Medicare Advantage |
$1,228.03
|
| Rate for Payer: The Alliance Commercial |
$1,023.36
|
| Rate for Payer: WEA Trust Commercial |
$1,125.70
|
| Rate for Payer: WPS Commercial |
$1,515.95
|
|
|
SCREW-LOCK 4.0 X 30 222.585
|
Facility
|
OP
|
$591.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966911
|
|
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 30 222.585
|
Facility
|
IP
|
$591.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966911
|
|
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 30 FULLY THREAD 1896-4030S
|
Facility
|
OP
|
$1,337.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6207007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$389.33 |
| Max. Negotiated Rate |
$1,279.24 |
| Rate for Payer: Aetna Commercial |
$1,251.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,195.81
|
| Rate for Payer: Aetna Managed Medicare |
$389.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$903.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$695.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$667.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$736.95
|
| Rate for Payer: Cash Price |
$401.10
|
| Rate for Payer: Cigna Commercial |
$1,279.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$778.13
|
| Rate for Payer: Health EOS Commercial |
$1,237.53
|
| Rate for Payer: HFN Commercial |
$1,279.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,042.86
|
| Rate for Payer: Multiplan Commercial |
$1,112.38
|
| Rate for Payer: NAPHCARE Commercial |
$834.29
|
| Rate for Payer: Preferred Network Access Commercial |
$1,279.24
|
| Rate for Payer: Quartz Beloit One Network |
$681.34
|
| Rate for Payer: Quartz Commercial |
$903.81
|
| Rate for Payer: Quartz Medicare Advantage |
$834.29
|
| Rate for Payer: The Alliance Commercial |
$695.24
|
| Rate for Payer: WEA Trust Commercial |
$764.76
|
| Rate for Payer: WPS Commercial |
$1,029.89
|
|
|
SCREW LOCK 4.0 X 30 FULLY THREAD 1896-4030S
|
Facility
|
IP
|
$1,337.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6207007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$681.34 |
| Max. Negotiated Rate |
$1,279.24 |
| Rate for Payer: Aetna Commercial |
$1,251.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,195.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$736.95
|
| Rate for Payer: Cash Price |
$401.10
|
| Rate for Payer: Cigna Commercial |
$1,279.24
|
| Rate for Payer: Health EOS Commercial |
$1,237.53
|
| Rate for Payer: HFN Commercial |
$1,279.24
|
| Rate for Payer: Multiplan Commercial |
$1,112.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,279.24
|
| Rate for Payer: Quartz Beloit One Network |
$681.34
|
| Rate for Payer: Quartz Commercial |
$834.29
|
| Rate for Payer: WEA Trust Commercial |
$764.76
|
| Rate for Payer: WPS Commercial |
$1,029.89
|
|
|
SCREW LOCK 4.0 X 30MM ST 661030
|
Facility
|
IP
|
$2,489.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5458917
|
|
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 30MM ST 661030
|
Facility
|
OP
|
$2,489.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5458917
|
|
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 30MM TI STARDRIVE 04.005.420S
|
Facility
|
OP
|
$1,968.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3869341
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$573.08 |
| Max. Negotiated Rate |
$1,882.98 |
| Rate for Payer: Aetna Commercial |
$1,842.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,760.18
|
| Rate for Payer: Aetna Managed Medicare |
$573.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,330.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,023.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$982.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,084.76
|
| Rate for Payer: Cash Price |
$590.40
|
| Rate for Payer: Cigna Commercial |
$1,882.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,145.38
|
| Rate for Payer: Health EOS Commercial |
$1,821.58
|
| Rate for Payer: HFN Commercial |
$1,882.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,535.04
|
| Rate for Payer: Multiplan Commercial |
$1,637.38
|
| Rate for Payer: NAPHCARE Commercial |
$1,228.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,882.98
|
| Rate for Payer: Quartz Beloit One Network |
$1,002.89
|
| Rate for Payer: Quartz Commercial |
$1,330.37
|
| Rate for Payer: Quartz Medicare Advantage |
$1,228.03
|
| Rate for Payer: The Alliance Commercial |
$1,023.36
|
| Rate for Payer: WEA Trust Commercial |
$1,125.70
|
| Rate for Payer: WPS Commercial |
$1,515.95
|
|
|
SCREW LOCK 4.0 X 30MM TI STARDRIVE 04.005.420S
|
Facility
|
IP
|
$1,968.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3869341
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,002.89 |
| Max. Negotiated Rate |
$1,882.98 |
| Rate for Payer: Aetna Commercial |
$1,842.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,760.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,084.76
|
| Rate for Payer: Cash Price |
$590.40
|
| Rate for Payer: Cigna Commercial |
$1,882.98
|
| Rate for Payer: Health EOS Commercial |
$1,821.58
|
| Rate for Payer: HFN Commercial |
$1,882.98
|
| Rate for Payer: Multiplan Commercial |
$1,637.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,882.98
|
| Rate for Payer: Quartz Beloit One Network |
$1,002.89
|
| Rate for Payer: Quartz Commercial |
$1,228.03
|
| Rate for Payer: WEA Trust Commercial |
$1,125.70
|
| Rate for Payer: WPS Commercial |
$1,515.95
|
|
|
SCREW LOCK 4.0 X 32 FULLY THREAD 1896-4032S
|
Facility
|
OP
|
$1,337.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6207008
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$389.33 |
| Max. Negotiated Rate |
$1,279.24 |
| Rate for Payer: Aetna Commercial |
$1,251.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,195.81
|
| Rate for Payer: Aetna Managed Medicare |
$389.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$903.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$695.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$667.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$736.95
|
| Rate for Payer: Cash Price |
$401.10
|
| Rate for Payer: Cigna Commercial |
$1,279.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$778.13
|
| Rate for Payer: Health EOS Commercial |
$1,237.53
|
| Rate for Payer: HFN Commercial |
$1,279.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,042.86
|
| Rate for Payer: Multiplan Commercial |
$1,112.38
|
| Rate for Payer: NAPHCARE Commercial |
$834.29
|
| Rate for Payer: Preferred Network Access Commercial |
$1,279.24
|
| Rate for Payer: Quartz Beloit One Network |
$681.34
|
| Rate for Payer: Quartz Commercial |
$903.81
|
| Rate for Payer: Quartz Medicare Advantage |
$834.29
|
| Rate for Payer: The Alliance Commercial |
$695.24
|
| Rate for Payer: WEA Trust Commercial |
$764.76
|
| Rate for Payer: WPS Commercial |
$1,029.89
|
|
|
SCREW LOCK 4.0 X 32 FULLY THREAD 1896-4032S
|
Facility
|
IP
|
$1,337.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6207008
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$681.34 |
| Max. Negotiated Rate |
$1,279.24 |
| Rate for Payer: Aetna Commercial |
$1,251.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,195.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$736.95
|
| Rate for Payer: Cash Price |
$401.10
|
| Rate for Payer: Cigna Commercial |
$1,279.24
|
| Rate for Payer: Health EOS Commercial |
$1,237.53
|
| Rate for Payer: HFN Commercial |
$1,279.24
|
| Rate for Payer: Multiplan Commercial |
$1,112.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,279.24
|
| Rate for Payer: Quartz Beloit One Network |
$681.34
|
| Rate for Payer: Quartz Commercial |
$834.29
|
| Rate for Payer: WEA Trust Commercial |
$764.76
|
| Rate for Payer: WPS Commercial |
$1,029.89
|
|
|
SCREW LOCK 4.0 X 32MM ST 661032
|
Facility
|
OP
|
$2,589.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5520854
|
|
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 32MM ST 661032
|
Facility
|
IP
|
$2,589.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5520854
|
|
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 32MM TI STARDRIVE 04.005.422
|
Facility
|
IP
|
$1,968.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4074603
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,002.89 |
| Max. Negotiated Rate |
$1,882.98 |
| Rate for Payer: Aetna Commercial |
$1,842.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,760.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,084.76
|
| Rate for Payer: Cash Price |
$590.40
|
| Rate for Payer: Cigna Commercial |
$1,882.98
|
| Rate for Payer: Health EOS Commercial |
$1,821.58
|
| Rate for Payer: HFN Commercial |
$1,882.98
|
| Rate for Payer: Multiplan Commercial |
$1,637.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,882.98
|
| Rate for Payer: Quartz Beloit One Network |
$1,002.89
|
| Rate for Payer: Quartz Commercial |
$1,228.03
|
| Rate for Payer: WEA Trust Commercial |
$1,125.70
|
| Rate for Payer: WPS Commercial |
$1,515.95
|
|
|
SCREW LOCK 4.0 X 32MM TI STARDRIVE 04.005.422
|
Facility
|
OP
|
$1,968.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4074603
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$573.08 |
| Max. Negotiated Rate |
$1,882.98 |
| Rate for Payer: Aetna Commercial |
$1,842.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,760.18
|
| Rate for Payer: Aetna Managed Medicare |
$573.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,330.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,023.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$982.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,084.76
|
| Rate for Payer: Cash Price |
$590.40
|
| Rate for Payer: Cigna Commercial |
$1,882.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,145.38
|
| Rate for Payer: Health EOS Commercial |
$1,821.58
|
| Rate for Payer: HFN Commercial |
$1,882.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,535.04
|
| Rate for Payer: Multiplan Commercial |
$1,637.38
|
| Rate for Payer: NAPHCARE Commercial |
$1,228.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,882.98
|
| Rate for Payer: Quartz Beloit One Network |
$1,002.89
|
| Rate for Payer: Quartz Commercial |
$1,330.37
|
| Rate for Payer: Quartz Medicare Advantage |
$1,228.03
|
| Rate for Payer: The Alliance Commercial |
$1,023.36
|
| Rate for Payer: WEA Trust Commercial |
$1,125.70
|
| Rate for Payer: WPS Commercial |
$1,515.95
|
|
|
SCREW-LOCK 4.0 X 34 222.586
|
Facility
|
IP
|
$591.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966912
|
|
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 34 222.586
|
Facility
|
OP
|
$591.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966912
|
|
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 34MM TI STARDRIVE 04.005.424
|
Facility
|
OP
|
$2,945.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966515
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$857.58 |
| Max. Negotiated Rate |
$2,817.78 |
| Rate for Payer: Aetna Commercial |
$2,756.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,634.01
|
| Rate for Payer: Aetna Managed Medicare |
$857.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,990.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,531.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,470.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,623.28
|
| Rate for Payer: Cash Price |
$883.50
|
| Rate for Payer: Cigna Commercial |
$2,817.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,713.99
|
| Rate for Payer: Health EOS Commercial |
$2,725.89
|
| Rate for Payer: HFN Commercial |
$2,817.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,297.10
|
| Rate for Payer: Multiplan Commercial |
$2,450.24
|
| Rate for Payer: NAPHCARE Commercial |
$1,837.68
|
| Rate for Payer: Preferred Network Access Commercial |
$2,817.78
|
| Rate for Payer: Quartz Beloit One Network |
$1,500.77
|
| Rate for Payer: Quartz Commercial |
$1,990.82
|
| Rate for Payer: Quartz Medicare Advantage |
$1,837.68
|
| Rate for Payer: The Alliance Commercial |
$1,531.40
|
| Rate for Payer: WEA Trust Commercial |
$1,684.54
|
| Rate for Payer: WPS Commercial |
$2,268.53
|
|
|
SCREW LOCK 4.0 X 34MM TI STARDRIVE 04.005.424
|
Facility
|
IP
|
$2,945.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966515
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.77 |
| Max. Negotiated Rate |
$2,817.78 |
| Rate for Payer: Aetna Commercial |
$2,756.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,634.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,623.28
|
| Rate for Payer: Cash Price |
$883.50
|
| Rate for Payer: Cigna Commercial |
$2,817.78
|
| Rate for Payer: Health EOS Commercial |
$2,725.89
|
| Rate for Payer: HFN Commercial |
$2,817.78
|
| Rate for Payer: Multiplan Commercial |
$2,450.24
|
| Rate for Payer: Preferred Network Access Commercial |
$2,817.78
|
| Rate for Payer: Quartz Beloit One Network |
$1,500.77
|
| Rate for Payer: Quartz Commercial |
$1,837.68
|
| Rate for Payer: WEA Trust Commercial |
$1,684.54
|
| Rate for Payer: WPS Commercial |
$2,268.53
|
|
