|
SCREW LOCK 2.7MM X 12MM 657012
|
Facility
|
IP
|
$2,105.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6167818
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,031.45 |
| Max. Negotiated Rate |
$1,936.60 |
| Rate for Payer: Aetna Commercial |
$1,894.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,810.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,115.65
|
| Rate for Payer: Cash Price |
$631.50
|
| Rate for Payer: Cigna Commercial |
$1,936.60
|
| Rate for Payer: Health EOS Commercial |
$1,873.45
|
| Rate for Payer: HFN Commercial |
$1,936.60
|
| Rate for Payer: Multiplan Commercial |
$1,684.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,263.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,936.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,031.45
|
| Rate for Payer: Quartz Commercial |
$1,263.00
|
| Rate for Payer: WEA Trust Commercial |
$1,157.75
|
| Rate for Payer: WPS Commercial |
$1,559.17
|
|
|
SCREW LOCK 2.7MM X 14MM 657014
|
Facility
|
IP
|
$2,105.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6169643
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,031.45 |
| Max. Negotiated Rate |
$1,936.60 |
| Rate for Payer: Aetna Commercial |
$1,894.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,810.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,115.65
|
| Rate for Payer: Cash Price |
$631.50
|
| Rate for Payer: Cigna Commercial |
$1,936.60
|
| Rate for Payer: Health EOS Commercial |
$1,873.45
|
| Rate for Payer: HFN Commercial |
$1,936.60
|
| Rate for Payer: Multiplan Commercial |
$1,684.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,263.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,936.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,031.45
|
| Rate for Payer: Quartz Commercial |
$1,263.00
|
| Rate for Payer: WEA Trust Commercial |
$1,157.75
|
| Rate for Payer: WPS Commercial |
$1,559.17
|
|
|
SCREW LOCK 2.7MM X 14MM 657014
|
Facility
|
OP
|
$2,105.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6169643
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$589.40 |
| Max. Negotiated Rate |
$8,420.00 |
| Rate for Payer: Aetna Commercial |
$1,894.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,810.30
|
| Rate for Payer: Aetna Managed Medicare |
$589.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,368.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,052.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,010.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,115.65
|
| Rate for Payer: Cash Price |
$631.50
|
| Rate for Payer: Cigna Commercial |
$1,936.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,177.96
|
| Rate for Payer: Health EOS Commercial |
$1,873.45
|
| Rate for Payer: HFN Commercial |
$1,936.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,578.75
|
| Rate for Payer: Multiplan Commercial |
$1,684.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,263.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,936.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,031.45
|
| Rate for Payer: Quartz Commercial |
$1,368.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,263.00
|
| Rate for Payer: The Alliance Commercial |
$8,420.00
|
| Rate for Payer: WEA Trust Commercial |
$1,157.75
|
| Rate for Payer: WPS Commercial |
$1,559.17
|
|
|
SCREW LOCK 2.7MM X 16MM 657016
|
Facility
|
IP
|
$2,190.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599690
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,073.10 |
| Max. Negotiated Rate |
$2,014.80 |
| Rate for Payer: Aetna Commercial |
$1,971.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,883.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,160.70
|
| Rate for Payer: Cash Price |
$657.00
|
| Rate for Payer: Cigna Commercial |
$2,014.80
|
| Rate for Payer: Health EOS Commercial |
$1,949.10
|
| Rate for Payer: HFN Commercial |
$2,014.80
|
| Rate for Payer: Multiplan Commercial |
$1,752.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,314.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,014.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,073.10
|
| Rate for Payer: Quartz Commercial |
$1,314.00
|
| Rate for Payer: WEA Trust Commercial |
$1,204.50
|
| Rate for Payer: WPS Commercial |
$1,622.13
|
|
|
SCREW LOCK 2.7MM X 16MM 657016
|
Facility
|
OP
|
$2,190.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599690
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$613.20 |
| Max. Negotiated Rate |
$8,760.00 |
| Rate for Payer: Aetna Commercial |
$1,971.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,883.40
|
| Rate for Payer: Aetna Managed Medicare |
$613.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,423.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,095.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,051.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,160.70
|
| Rate for Payer: Cash Price |
$657.00
|
| Rate for Payer: Cigna Commercial |
$2,014.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,225.52
|
| Rate for Payer: Health EOS Commercial |
$1,949.10
|
| Rate for Payer: HFN Commercial |
$2,014.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,642.50
|
| Rate for Payer: Multiplan Commercial |
$1,752.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,314.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,014.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,073.10
|
| Rate for Payer: Quartz Commercial |
$1,423.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,314.00
|
| Rate for Payer: The Alliance Commercial |
$8,760.00
|
| Rate for Payer: WEA Trust Commercial |
$1,204.50
|
| Rate for Payer: WPS Commercial |
$1,622.13
|
|
|
SCREW LOCK 2.7 X 10MM 02.211.008
|
Facility
|
OP
|
$1,546.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5617630
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$432.88 |
| Max. Negotiated Rate |
$6,184.00 |
| Rate for Payer: Aetna Commercial |
$1,391.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,329.56
|
| Rate for Payer: Aetna Managed Medicare |
$432.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,004.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$773.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$742.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$819.38
|
| Rate for Payer: Cash Price |
$463.80
|
| Rate for Payer: Cigna Commercial |
$1,422.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$865.14
|
| Rate for Payer: Health EOS Commercial |
$1,375.94
|
| Rate for Payer: HFN Commercial |
$1,422.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,159.50
|
| Rate for Payer: Multiplan Commercial |
$1,236.80
|
| Rate for Payer: NAPHCARE Commercial |
$927.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,422.32
|
| Rate for Payer: Quartz Beloit One Network |
$757.54
|
| Rate for Payer: Quartz Commercial |
$1,004.90
|
| Rate for Payer: Quartz Medicare Advantage |
$927.60
|
| Rate for Payer: The Alliance Commercial |
$6,184.00
|
| Rate for Payer: WEA Trust Commercial |
$850.30
|
| Rate for Payer: WPS Commercial |
$1,145.12
|
|
|
SCREW LOCK 2.7 X 10MM 02.211.008
|
Facility
|
IP
|
$1,546.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5617630
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$757.54 |
| Max. Negotiated Rate |
$1,422.32 |
| Rate for Payer: Aetna Commercial |
$1,391.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,329.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$819.38
|
| Rate for Payer: Cash Price |
$463.80
|
| Rate for Payer: Cigna Commercial |
$1,422.32
|
| Rate for Payer: Health EOS Commercial |
$1,375.94
|
| Rate for Payer: HFN Commercial |
$1,422.32
|
| Rate for Payer: Multiplan Commercial |
$1,236.80
|
| Rate for Payer: NAPHCARE Commercial |
$927.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,422.32
|
| Rate for Payer: Quartz Beloit One Network |
$757.54
|
| Rate for Payer: Quartz Commercial |
$927.60
|
| Rate for Payer: WEA Trust Commercial |
$850.30
|
| Rate for Payer: WPS Commercial |
$1,145.12
|
|
|
SCREW LOCK 2.7 X 10MM 02.211.010
|
Facility
|
IP
|
$2,107.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966474
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,032.43 |
| Max. Negotiated Rate |
$1,938.44 |
| Rate for Payer: Aetna Commercial |
$1,896.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,812.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,116.71
|
| Rate for Payer: Cash Price |
$632.10
|
| Rate for Payer: Cigna Commercial |
$1,938.44
|
| Rate for Payer: Health EOS Commercial |
$1,875.23
|
| Rate for Payer: HFN Commercial |
$1,938.44
|
| Rate for Payer: Multiplan Commercial |
$1,685.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,264.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,938.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,032.43
|
| Rate for Payer: Quartz Commercial |
$1,264.20
|
| Rate for Payer: WEA Trust Commercial |
$1,158.85
|
| Rate for Payer: WPS Commercial |
$1,560.65
|
|
|
SCREW LOCK 2.7 X 10MM 02.211.010
|
Facility
|
OP
|
$2,107.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966474
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$589.96 |
| Max. Negotiated Rate |
$8,428.00 |
| Rate for Payer: Aetna Commercial |
$1,896.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,812.02
|
| Rate for Payer: Aetna Managed Medicare |
$589.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,369.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,053.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,011.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,116.71
|
| Rate for Payer: Cash Price |
$632.10
|
| Rate for Payer: Cigna Commercial |
$1,938.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,179.08
|
| Rate for Payer: Health EOS Commercial |
$1,875.23
|
| Rate for Payer: HFN Commercial |
$1,938.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,580.25
|
| Rate for Payer: Multiplan Commercial |
$1,685.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,264.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,938.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,032.43
|
| Rate for Payer: Quartz Commercial |
$1,369.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,264.20
|
| Rate for Payer: The Alliance Commercial |
$8,428.00
|
| Rate for Payer: WEA Trust Commercial |
$1,158.85
|
| Rate for Payer: WPS Commercial |
$1,560.65
|
|
|
SCREW LOCK 2.7 X 10MM SS LP AR-8827L-10
|
Facility
|
IP
|
$1,531.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5349253
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$750.19 |
| Max. Negotiated Rate |
$1,408.52 |
| Rate for Payer: Aetna Commercial |
$1,377.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,316.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$811.43
|
| Rate for Payer: Cash Price |
$459.30
|
| Rate for Payer: Cigna Commercial |
$1,408.52
|
| Rate for Payer: Health EOS Commercial |
$1,362.59
|
| Rate for Payer: HFN Commercial |
$1,408.52
|
| Rate for Payer: Multiplan Commercial |
$1,224.80
|
| Rate for Payer: NAPHCARE Commercial |
$918.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,408.52
|
| Rate for Payer: Quartz Beloit One Network |
$750.19
|
| Rate for Payer: Quartz Commercial |
$918.60
|
| Rate for Payer: WEA Trust Commercial |
$842.05
|
| Rate for Payer: WPS Commercial |
$1,134.01
|
|
|
SCREW LOCK 2.7 X 10MM SS LP AR-8827L-10
|
Facility
|
OP
|
$1,531.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5349253
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$428.68 |
| Max. Negotiated Rate |
$6,124.00 |
| Rate for Payer: Aetna Commercial |
$1,377.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,316.66
|
| Rate for Payer: Aetna Managed Medicare |
$428.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$995.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$765.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$734.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$811.43
|
| Rate for Payer: Cash Price |
$459.30
|
| Rate for Payer: Cigna Commercial |
$1,408.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$856.75
|
| Rate for Payer: Health EOS Commercial |
$1,362.59
|
| Rate for Payer: HFN Commercial |
$1,408.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,148.25
|
| Rate for Payer: Multiplan Commercial |
$1,224.80
|
| Rate for Payer: NAPHCARE Commercial |
$918.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,408.52
|
| Rate for Payer: Quartz Beloit One Network |
$750.19
|
| Rate for Payer: Quartz Commercial |
$995.15
|
| Rate for Payer: Quartz Medicare Advantage |
$918.60
|
| Rate for Payer: The Alliance Commercial |
$6,124.00
|
| Rate for Payer: WEA Trust Commercial |
$842.05
|
| Rate for Payer: WPS Commercial |
$1,134.01
|
|
|
SCREW LOCK 2.7 X 10 ST 202.210
|
Facility
|
IP
|
$1,700.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966476
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$833.00 |
| Max. Negotiated Rate |
$1,564.00 |
| Rate for Payer: Aetna Commercial |
$1,530.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,462.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$901.00
|
| Rate for Payer: Cash Price |
$510.00
|
| Rate for Payer: Cigna Commercial |
$1,564.00
|
| Rate for Payer: Health EOS Commercial |
$1,513.00
|
| Rate for Payer: HFN Commercial |
$1,564.00
|
| Rate for Payer: Multiplan Commercial |
$1,360.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,020.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,564.00
|
| Rate for Payer: Quartz Beloit One Network |
$833.00
|
| Rate for Payer: Quartz Commercial |
$1,020.00
|
| Rate for Payer: WEA Trust Commercial |
$935.00
|
| Rate for Payer: WPS Commercial |
$1,259.19
|
|
|
SCREW LOCK 2.7 X 10 ST 202.210
|
Facility
|
OP
|
$1,700.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966476
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$476.00 |
| Max. Negotiated Rate |
$6,800.00 |
| Rate for Payer: Aetna Commercial |
$1,530.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,462.00
|
| Rate for Payer: Aetna Managed Medicare |
$476.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,105.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$850.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$816.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$901.00
|
| Rate for Payer: Cash Price |
$510.00
|
| Rate for Payer: Cigna Commercial |
$1,564.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$951.32
|
| Rate for Payer: Health EOS Commercial |
$1,513.00
|
| Rate for Payer: HFN Commercial |
$1,564.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,275.00
|
| Rate for Payer: Multiplan Commercial |
$1,360.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,020.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,564.00
|
| Rate for Payer: Quartz Beloit One Network |
$833.00
|
| Rate for Payer: Quartz Commercial |
$1,105.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,020.00
|
| Rate for Payer: The Alliance Commercial |
$6,800.00
|
| Rate for Payer: WEA Trust Commercial |
$935.00
|
| Rate for Payer: WPS Commercial |
$1,259.19
|
|
|
SCREW LOCK 2.7 X 11 ST 202.211
|
Facility
|
OP
|
$1,340.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4519761
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$375.20 |
| Max. Negotiated Rate |
$5,360.00 |
| Rate for Payer: Aetna Commercial |
$1,206.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,152.40
|
| Rate for Payer: Aetna Managed Medicare |
$375.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$871.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$670.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$643.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$710.20
|
| Rate for Payer: Cash Price |
$402.00
|
| Rate for Payer: Cigna Commercial |
$1,232.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$749.86
|
| Rate for Payer: Health EOS Commercial |
$1,192.60
|
| Rate for Payer: HFN Commercial |
$1,232.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,005.00
|
| Rate for Payer: Multiplan Commercial |
$1,072.00
|
| Rate for Payer: NAPHCARE Commercial |
$804.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,232.80
|
| Rate for Payer: Quartz Beloit One Network |
$656.60
|
| Rate for Payer: Quartz Commercial |
$871.00
|
| Rate for Payer: Quartz Medicare Advantage |
$804.00
|
| Rate for Payer: The Alliance Commercial |
$5,360.00
|
| Rate for Payer: WEA Trust Commercial |
$737.00
|
| Rate for Payer: WPS Commercial |
$992.54
|
|
|
SCREW LOCK 2.7 X 11 ST 202.211
|
Facility
|
IP
|
$1,340.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4519761
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$656.60 |
| Max. Negotiated Rate |
$1,232.80 |
| Rate for Payer: Aetna Commercial |
$1,206.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,152.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$710.20
|
| Rate for Payer: Cash Price |
$402.00
|
| Rate for Payer: Cigna Commercial |
$1,232.80
|
| Rate for Payer: Health EOS Commercial |
$1,192.60
|
| Rate for Payer: HFN Commercial |
$1,232.80
|
| Rate for Payer: Multiplan Commercial |
$1,072.00
|
| Rate for Payer: NAPHCARE Commercial |
$804.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,232.80
|
| Rate for Payer: Quartz Beloit One Network |
$656.60
|
| Rate for Payer: Quartz Commercial |
$804.00
|
| Rate for Payer: WEA Trust Commercial |
$737.00
|
| Rate for Payer: WPS Commercial |
$992.54
|
|
|
SCREW LOCK 2.7 X 12MM 02.211.012
|
Facility
|
OP
|
$2,188.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966478
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.64 |
| Max. Negotiated Rate |
$8,752.00 |
| Rate for Payer: Aetna Commercial |
$1,969.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,881.68
|
| Rate for Payer: Aetna Managed Medicare |
$612.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,422.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,094.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,050.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,159.64
|
| Rate for Payer: Cash Price |
$656.40
|
| Rate for Payer: Cigna Commercial |
$2,012.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,224.40
|
| Rate for Payer: Health EOS Commercial |
$1,947.32
|
| Rate for Payer: HFN Commercial |
$2,012.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,641.00
|
| Rate for Payer: Multiplan Commercial |
$1,750.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,312.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,012.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,072.12
|
| Rate for Payer: Quartz Commercial |
$1,422.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,312.80
|
| Rate for Payer: The Alliance Commercial |
$8,752.00
|
| Rate for Payer: WEA Trust Commercial |
$1,203.40
|
| Rate for Payer: WPS Commercial |
$1,620.65
|
|
|
SCREW LOCK 2.7 X 12MM 02.211.012
|
Facility
|
IP
|
$2,188.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966478
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,072.12 |
| Max. Negotiated Rate |
$2,012.96 |
| Rate for Payer: Aetna Commercial |
$1,969.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,881.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,159.64
|
| Rate for Payer: Cash Price |
$656.40
|
| Rate for Payer: Cigna Commercial |
$2,012.96
|
| Rate for Payer: Health EOS Commercial |
$1,947.32
|
| Rate for Payer: HFN Commercial |
$2,012.96
|
| Rate for Payer: Multiplan Commercial |
$1,750.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,312.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,012.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,072.12
|
| Rate for Payer: Quartz Commercial |
$1,312.80
|
| Rate for Payer: WEA Trust Commercial |
$1,203.40
|
| Rate for Payer: WPS Commercial |
$1,620.65
|
|
|
SCREW LOCK 2.7 X 12MM SS LP AR-8827L-12
|
Facility
|
OP
|
$1,531.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5306831
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$428.68 |
| Max. Negotiated Rate |
$6,124.00 |
| Rate for Payer: Aetna Commercial |
$1,377.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,316.66
|
| Rate for Payer: Aetna Managed Medicare |
$428.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$995.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$765.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$734.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$811.43
|
| Rate for Payer: Cash Price |
$459.30
|
| Rate for Payer: Cigna Commercial |
$1,408.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$856.75
|
| Rate for Payer: Health EOS Commercial |
$1,362.59
|
| Rate for Payer: HFN Commercial |
$1,408.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,148.25
|
| Rate for Payer: Multiplan Commercial |
$1,224.80
|
| Rate for Payer: NAPHCARE Commercial |
$918.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,408.52
|
| Rate for Payer: Quartz Beloit One Network |
$750.19
|
| Rate for Payer: Quartz Commercial |
$995.15
|
| Rate for Payer: Quartz Medicare Advantage |
$918.60
|
| Rate for Payer: The Alliance Commercial |
$6,124.00
|
| Rate for Payer: WEA Trust Commercial |
$842.05
|
| Rate for Payer: WPS Commercial |
$1,134.01
|
|
|
SCREW LOCK 2.7 X 12MM SS LP AR-8827L-12
|
Facility
|
IP
|
$1,531.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5306831
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$750.19 |
| Max. Negotiated Rate |
$1,408.52 |
| Rate for Payer: Aetna Commercial |
$1,377.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,316.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$811.43
|
| Rate for Payer: Cash Price |
$459.30
|
| Rate for Payer: Cigna Commercial |
$1,408.52
|
| Rate for Payer: Health EOS Commercial |
$1,362.59
|
| Rate for Payer: HFN Commercial |
$1,408.52
|
| Rate for Payer: Multiplan Commercial |
$1,224.80
|
| Rate for Payer: NAPHCARE Commercial |
$918.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,408.52
|
| Rate for Payer: Quartz Beloit One Network |
$750.19
|
| Rate for Payer: Quartz Commercial |
$918.60
|
| Rate for Payer: WEA Trust Commercial |
$842.05
|
| Rate for Payer: WPS Commercial |
$1,134.01
|
|
|
SCREW LOCK 2.7 X 12 ST 202.212
|
Facility
|
OP
|
$1,766.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966468
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$494.48 |
| Max. Negotiated Rate |
$7,064.00 |
| Rate for Payer: Aetna Commercial |
$1,589.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,518.76
|
| Rate for Payer: Aetna Managed Medicare |
$494.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,147.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$883.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$847.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$935.98
|
| Rate for Payer: Cash Price |
$529.80
|
| Rate for Payer: Cigna Commercial |
$1,624.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$988.25
|
| Rate for Payer: Health EOS Commercial |
$1,571.74
|
| Rate for Payer: HFN Commercial |
$1,624.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,324.50
|
| Rate for Payer: Multiplan Commercial |
$1,412.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,059.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,624.72
|
| Rate for Payer: Quartz Beloit One Network |
$865.34
|
| Rate for Payer: Quartz Commercial |
$1,147.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,059.60
|
| Rate for Payer: The Alliance Commercial |
$7,064.00
|
| Rate for Payer: WEA Trust Commercial |
$971.30
|
| Rate for Payer: WPS Commercial |
$1,308.08
|
|
|
SCREW LOCK 2.7 X 12 ST 202.212
|
Facility
|
IP
|
$1,766.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966468
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$865.34 |
| Max. Negotiated Rate |
$1,624.72 |
| Rate for Payer: Aetna Commercial |
$1,589.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,518.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$935.98
|
| Rate for Payer: Cash Price |
$529.80
|
| Rate for Payer: Cigna Commercial |
$1,624.72
|
| Rate for Payer: Health EOS Commercial |
$1,571.74
|
| Rate for Payer: HFN Commercial |
$1,624.72
|
| Rate for Payer: Multiplan Commercial |
$1,412.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,059.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,624.72
|
| Rate for Payer: Quartz Beloit One Network |
$865.34
|
| Rate for Payer: Quartz Commercial |
$1,059.60
|
| Rate for Payer: WEA Trust Commercial |
$971.30
|
| Rate for Payer: WPS Commercial |
$1,308.08
|
|
|
SCREW LOCK 2.7 X 13 ST 202.213
|
Facility
|
OP
|
$1,340.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414733
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$375.20 |
| Max. Negotiated Rate |
$5,360.00 |
| Rate for Payer: Aetna Commercial |
$1,206.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,152.40
|
| Rate for Payer: Aetna Managed Medicare |
$375.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$871.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$670.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$643.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$710.20
|
| Rate for Payer: Cash Price |
$402.00
|
| Rate for Payer: Cigna Commercial |
$1,232.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$749.86
|
| Rate for Payer: Health EOS Commercial |
$1,192.60
|
| Rate for Payer: HFN Commercial |
$1,232.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,005.00
|
| Rate for Payer: Multiplan Commercial |
$1,072.00
|
| Rate for Payer: NAPHCARE Commercial |
$804.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,232.80
|
| Rate for Payer: Quartz Beloit One Network |
$656.60
|
| Rate for Payer: Quartz Commercial |
$871.00
|
| Rate for Payer: Quartz Medicare Advantage |
$804.00
|
| Rate for Payer: The Alliance Commercial |
$5,360.00
|
| Rate for Payer: WEA Trust Commercial |
$737.00
|
| Rate for Payer: WPS Commercial |
$992.54
|
|
|
SCREW LOCK 2.7 X 13 ST 202.213
|
Facility
|
IP
|
$1,340.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414733
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$656.60 |
| Max. Negotiated Rate |
$1,232.80 |
| Rate for Payer: Aetna Commercial |
$1,206.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,152.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$710.20
|
| Rate for Payer: Cash Price |
$402.00
|
| Rate for Payer: Cigna Commercial |
$1,232.80
|
| Rate for Payer: Health EOS Commercial |
$1,192.60
|
| Rate for Payer: HFN Commercial |
$1,232.80
|
| Rate for Payer: Multiplan Commercial |
$1,072.00
|
| Rate for Payer: NAPHCARE Commercial |
$804.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,232.80
|
| Rate for Payer: Quartz Beloit One Network |
$656.60
|
| Rate for Payer: Quartz Commercial |
$804.00
|
| Rate for Payer: WEA Trust Commercial |
$737.00
|
| Rate for Payer: WPS Commercial |
$992.54
|
|
|
SCREW LOCK 2.7 X 14MM 02.211.014
|
Facility
|
IP
|
$2,039.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966479
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$999.11 |
| Max. Negotiated Rate |
$1,875.88 |
| Rate for Payer: Aetna Commercial |
$1,835.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,753.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,080.67
|
| Rate for Payer: Cash Price |
$611.70
|
| Rate for Payer: Cigna Commercial |
$1,875.88
|
| Rate for Payer: Health EOS Commercial |
$1,814.71
|
| Rate for Payer: HFN Commercial |
$1,875.88
|
| Rate for Payer: Multiplan Commercial |
$1,631.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,223.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,875.88
|
| Rate for Payer: Quartz Beloit One Network |
$999.11
|
| Rate for Payer: Quartz Commercial |
$1,223.40
|
| Rate for Payer: WEA Trust Commercial |
$1,121.45
|
| Rate for Payer: WPS Commercial |
$1,510.29
|
|
|
SCREW LOCK 2.7 X 14MM 02.211.014
|
Facility
|
OP
|
$2,039.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966479
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$570.92 |
| Max. Negotiated Rate |
$8,156.00 |
| Rate for Payer: Aetna Commercial |
$1,835.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,753.54
|
| Rate for Payer: Aetna Managed Medicare |
$570.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,325.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,019.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$978.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,080.67
|
| Rate for Payer: Cash Price |
$611.70
|
| Rate for Payer: Cigna Commercial |
$1,875.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,141.02
|
| Rate for Payer: Health EOS Commercial |
$1,814.71
|
| Rate for Payer: HFN Commercial |
$1,875.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,529.25
|
| Rate for Payer: Multiplan Commercial |
$1,631.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,223.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,875.88
|
| Rate for Payer: Quartz Beloit One Network |
$999.11
|
| Rate for Payer: Quartz Commercial |
$1,325.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,223.40
|
| Rate for Payer: The Alliance Commercial |
$8,156.00
|
| Rate for Payer: WEA Trust Commercial |
$1,121.45
|
| Rate for Payer: WPS Commercial |
$1,510.29
|
|
