|
SCREW LOCK 4.0 X 36MM ST 661036
|
Facility
|
OP
|
$2,589.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5458918
|
|
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 36MM ST 661036
|
Facility
|
IP
|
$2,589.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5458918
|
|
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 36MM TI STARDRIVE 04.005.426S
|
Facility
|
OP
|
$1,968.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3444843
|
|
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 36MM TI STARDRIVE 04.005.426S
|
Facility
|
IP
|
$1,968.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3444843
|
|
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 38 222.587
|
Facility
|
OP
|
$591.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966913
|
|
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 38 222.587
|
Facility
|
IP
|
$591.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966913
|
|
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 38MM ST 661038
|
Facility
|
IP
|
$2,589.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5458919
|
|
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 38MM ST 661038
|
Facility
|
OP
|
$2,589.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5458919
|
|
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 38MM TI STARDRIVE 04.005.428
|
Facility
|
OP
|
$1,968.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4509054
|
|
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 38MM TI STARDRIVE 04.005.428
|
Facility
|
IP
|
$1,968.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4509054
|
|
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 40MM ST 661040
|
Facility
|
IP
|
$2,589.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5458920
|
|
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 40MM ST 661040
|
Facility
|
OP
|
$2,589.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5458920
|
|
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 42 222.588
|
Facility
|
IP
|
$591.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966914
|
|
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 42 222.588
|
Facility
|
OP
|
$591.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966914
|
|
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 42MM ST 661042
|
Facility
|
OP
|
$2,589.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599551
|
|
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 42MM ST 661042
|
Facility
|
IP
|
$2,589.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599551
|
|
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 44MM ST 661044
|
Facility
|
OP
|
$2,589.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5520855
|
|
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 44MM ST 661044
|
Facility
|
IP
|
$2,589.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5520855
|
|
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 46 222.589
|
Facility
|
IP
|
$591.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966915
|
|
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 46 222.589
|
Facility
|
OP
|
$591.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966915
|
|
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 46MM ST 661046
|
Facility
|
OP
|
$2,589.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5520856
|
|
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 46MM ST 661046
|
Facility
|
IP
|
$2,589.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5520856
|
|
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 48MM ST 661048
|
Facility
|
IP
|
$2,589.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5458964
|
|
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 48MM ST 661048
|
Facility
|
OP
|
$2,589.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5458964
|
|
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 50 222.590
|
Facility
|
OP
|
$591.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966916
|
|
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
|
|
