|
SCREW-LOCK 4.0 X 50 222.590
|
Facility
|
IP
|
$591.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966916
|
|
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 50MM ST 661050
|
Facility
|
IP
|
$2,589.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5458963
|
|
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 50MM ST 661050
|
Facility
|
OP
|
$2,589.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5458963
|
|
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 54 222.591
|
Facility
|
OP
|
$591.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966917
|
|
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 54 222.591
|
Facility
|
IP
|
$591.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966917
|
|
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 55MM ST 661055
|
Facility
|
IP
|
$2,589.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5458965
|
|
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 55MM ST 661055
|
Facility
|
OP
|
$2,589.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5458965
|
|
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 58 222.592
|
Facility
|
IP
|
$591.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966918
|
|
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 58 222.592
|
Facility
|
OP
|
$591.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966918
|
|
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 60MM ST 661060
|
Facility
|
OP
|
$2,589.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5520857
|
|
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 60MM ST 661060
|
Facility
|
IP
|
$2,589.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5520857
|
|
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 62 222.593
|
Facility
|
IP
|
$591.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966919
|
|
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 62 222.593
|
Facility
|
OP
|
$591.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966919
|
|
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 4.5 X 18MM LP TI AR-8545L-18
|
Facility
|
OP
|
$2,596.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5603787
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$755.96 |
| Max. Negotiated Rate |
$2,483.85 |
| Rate for Payer: Aetna Commercial |
$2,429.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,321.86
|
| Rate for Payer: Aetna Managed Medicare |
$755.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,754.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,349.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,295.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,430.92
|
| Rate for Payer: Cash Price |
$778.80
|
| Rate for Payer: Cigna Commercial |
$2,483.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,510.87
|
| Rate for Payer: Health EOS Commercial |
$2,402.86
|
| Rate for Payer: HFN Commercial |
$2,483.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,024.88
|
| Rate for Payer: Multiplan Commercial |
$2,159.87
|
| Rate for Payer: NAPHCARE Commercial |
$1,619.90
|
| Rate for Payer: Preferred Network Access Commercial |
$2,483.85
|
| Rate for Payer: Quartz Beloit One Network |
$1,322.92
|
| Rate for Payer: Quartz Commercial |
$1,754.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,619.90
|
| Rate for Payer: The Alliance Commercial |
$1,349.92
|
| Rate for Payer: WEA Trust Commercial |
$1,484.91
|
| Rate for Payer: WPS Commercial |
$1,999.70
|
|
|
SCREW LOCK 4.5 X 18MM LP TI AR-8545L-18
|
Facility
|
IP
|
$2,596.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5603787
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,322.92 |
| Max. Negotiated Rate |
$2,483.85 |
| Rate for Payer: Aetna Commercial |
$2,429.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,321.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,430.92
|
| Rate for Payer: Cash Price |
$778.80
|
| Rate for Payer: Cigna Commercial |
$2,483.85
|
| Rate for Payer: Health EOS Commercial |
$2,402.86
|
| Rate for Payer: HFN Commercial |
$2,483.85
|
| Rate for Payer: Multiplan Commercial |
$2,159.87
|
| Rate for Payer: Preferred Network Access Commercial |
$2,483.85
|
| Rate for Payer: Quartz Beloit One Network |
$1,322.92
|
| Rate for Payer: Quartz Commercial |
$1,619.90
|
| Rate for Payer: WEA Trust Commercial |
$1,484.91
|
| Rate for Payer: WPS Commercial |
$1,999.70
|
|
|
SCREW LOCK 4.5 X 20MM LP TI AR-8545L-20
|
Facility
|
IP
|
$2,496.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5803658
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,271.96 |
| Max. Negotiated Rate |
$2,388.17 |
| Rate for Payer: Aetna Commercial |
$2,336.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,232.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,375.80
|
| Rate for Payer: Cash Price |
$748.80
|
| Rate for Payer: Cigna Commercial |
$2,388.17
|
| Rate for Payer: Health EOS Commercial |
$2,310.30
|
| Rate for Payer: HFN Commercial |
$2,388.17
|
| Rate for Payer: Multiplan Commercial |
$2,076.67
|
| Rate for Payer: Preferred Network Access Commercial |
$2,388.17
|
| Rate for Payer: Quartz Beloit One Network |
$1,271.96
|
| Rate for Payer: Quartz Commercial |
$1,557.50
|
| Rate for Payer: WEA Trust Commercial |
$1,427.71
|
| Rate for Payer: WPS Commercial |
$1,922.67
|
|
|
SCREW LOCK 4.5 X 20MM LP TI AR-8545L-20
|
Facility
|
OP
|
$2,496.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5803658
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$726.84 |
| Max. Negotiated Rate |
$2,388.17 |
| Rate for Payer: Aetna Commercial |
$2,336.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,232.42
|
| Rate for Payer: Aetna Managed Medicare |
$726.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,687.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,297.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,246.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,375.80
|
| Rate for Payer: Cash Price |
$748.80
|
| Rate for Payer: Cigna Commercial |
$2,388.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,452.67
|
| Rate for Payer: Health EOS Commercial |
$2,310.30
|
| Rate for Payer: HFN Commercial |
$2,388.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,946.88
|
| Rate for Payer: Multiplan Commercial |
$2,076.67
|
| Rate for Payer: NAPHCARE Commercial |
$1,557.50
|
| Rate for Payer: Preferred Network Access Commercial |
$2,388.17
|
| Rate for Payer: Quartz Beloit One Network |
$1,271.96
|
| Rate for Payer: Quartz Commercial |
$1,687.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,557.50
|
| Rate for Payer: The Alliance Commercial |
$1,297.92
|
| Rate for Payer: WEA Trust Commercial |
$1,427.71
|
| Rate for Payer: WPS Commercial |
$1,922.67
|
|
|
SCREW LOCK 4.5 X 22MM LP TI AR-8545L-22
|
Facility
|
OP
|
$2,496.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5803659
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$726.84 |
| Max. Negotiated Rate |
$2,388.17 |
| Rate for Payer: Aetna Commercial |
$2,336.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,232.42
|
| Rate for Payer: Aetna Managed Medicare |
$726.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,687.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,297.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,246.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,375.80
|
| Rate for Payer: Cash Price |
$748.80
|
| Rate for Payer: Cigna Commercial |
$2,388.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,452.67
|
| Rate for Payer: Health EOS Commercial |
$2,310.30
|
| Rate for Payer: HFN Commercial |
$2,388.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,946.88
|
| Rate for Payer: Multiplan Commercial |
$2,076.67
|
| Rate for Payer: NAPHCARE Commercial |
$1,557.50
|
| Rate for Payer: Preferred Network Access Commercial |
$2,388.17
|
| Rate for Payer: Quartz Beloit One Network |
$1,271.96
|
| Rate for Payer: Quartz Commercial |
$1,687.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,557.50
|
| Rate for Payer: The Alliance Commercial |
$1,297.92
|
| Rate for Payer: WEA Trust Commercial |
$1,427.71
|
| Rate for Payer: WPS Commercial |
$1,922.67
|
|
|
SCREW LOCK 4.5 X 22MM LP TI AR-8545L-22
|
Facility
|
IP
|
$2,496.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5803659
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,271.96 |
| Max. Negotiated Rate |
$2,388.17 |
| Rate for Payer: Aetna Commercial |
$2,336.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,232.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,375.80
|
| Rate for Payer: Cash Price |
$748.80
|
| Rate for Payer: Cigna Commercial |
$2,388.17
|
| Rate for Payer: Health EOS Commercial |
$2,310.30
|
| Rate for Payer: HFN Commercial |
$2,388.17
|
| Rate for Payer: Multiplan Commercial |
$2,076.67
|
| Rate for Payer: Preferred Network Access Commercial |
$2,388.17
|
| Rate for Payer: Quartz Beloit One Network |
$1,271.96
|
| Rate for Payer: Quartz Commercial |
$1,557.50
|
| Rate for Payer: WEA Trust Commercial |
$1,427.71
|
| Rate for Payer: WPS Commercial |
$1,922.67
|
|
|
SCREW LOCK 4.5 X 24MM LP TI AR-8545L-24
|
Facility
|
IP
|
$2,596.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5603788
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,322.92 |
| Max. Negotiated Rate |
$2,483.85 |
| Rate for Payer: Aetna Commercial |
$2,429.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,321.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,430.92
|
| Rate for Payer: Cash Price |
$778.80
|
| Rate for Payer: Cigna Commercial |
$2,483.85
|
| Rate for Payer: Health EOS Commercial |
$2,402.86
|
| Rate for Payer: HFN Commercial |
$2,483.85
|
| Rate for Payer: Multiplan Commercial |
$2,159.87
|
| Rate for Payer: Preferred Network Access Commercial |
$2,483.85
|
| Rate for Payer: Quartz Beloit One Network |
$1,322.92
|
| Rate for Payer: Quartz Commercial |
$1,619.90
|
| Rate for Payer: WEA Trust Commercial |
$1,484.91
|
| Rate for Payer: WPS Commercial |
$1,999.70
|
|
|
SCREW LOCK 4.5 X 24MM LP TI AR-8545L-24
|
Facility
|
OP
|
$2,596.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5603788
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$755.96 |
| Max. Negotiated Rate |
$2,483.85 |
| Rate for Payer: Aetna Commercial |
$2,429.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,321.86
|
| Rate for Payer: Aetna Managed Medicare |
$755.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,754.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,349.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,295.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,430.92
|
| Rate for Payer: Cash Price |
$778.80
|
| Rate for Payer: Cigna Commercial |
$2,483.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,510.87
|
| Rate for Payer: Health EOS Commercial |
$2,402.86
|
| Rate for Payer: HFN Commercial |
$2,483.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,024.88
|
| Rate for Payer: Multiplan Commercial |
$2,159.87
|
| Rate for Payer: NAPHCARE Commercial |
$1,619.90
|
| Rate for Payer: Preferred Network Access Commercial |
$2,483.85
|
| Rate for Payer: Quartz Beloit One Network |
$1,322.92
|
| Rate for Payer: Quartz Commercial |
$1,754.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,619.90
|
| Rate for Payer: The Alliance Commercial |
$1,349.92
|
| Rate for Payer: WEA Trust Commercial |
$1,484.91
|
| Rate for Payer: WPS Commercial |
$1,999.70
|
|
|
SCREW LOCK 4.5 X 26MM LP TI AR-8545L-26
|
Facility
|
IP
|
$2,496.00
|
|
|
Service Code
|
HCPCS C1715
|
| Hospital Charge Code |
5803660
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,271.96 |
| Max. Negotiated Rate |
$2,388.17 |
| Rate for Payer: Aetna Commercial |
$2,336.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,232.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,375.80
|
| Rate for Payer: Cash Price |
$748.80
|
| Rate for Payer: Cigna Commercial |
$2,388.17
|
| Rate for Payer: Health EOS Commercial |
$2,310.30
|
| Rate for Payer: HFN Commercial |
$2,388.17
|
| Rate for Payer: Multiplan Commercial |
$2,076.67
|
| Rate for Payer: Preferred Network Access Commercial |
$2,388.17
|
| Rate for Payer: Quartz Beloit One Network |
$1,271.96
|
| Rate for Payer: Quartz Commercial |
$1,557.50
|
| Rate for Payer: WEA Trust Commercial |
$1,427.71
|
| Rate for Payer: WPS Commercial |
$1,922.67
|
|
|
SCREW LOCK 4.5 X 26MM LP TI AR-8545L-26
|
Facility
|
OP
|
$2,496.00
|
|
|
Service Code
|
HCPCS C1715
|
| Hospital Charge Code |
5803660
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$726.84 |
| Max. Negotiated Rate |
$2,388.17 |
| Rate for Payer: Aetna Commercial |
$2,336.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,232.42
|
| Rate for Payer: Aetna Managed Medicare |
$726.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,687.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,297.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,246.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,375.80
|
| Rate for Payer: Cash Price |
$748.80
|
| Rate for Payer: Cigna Commercial |
$2,388.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,452.67
|
| Rate for Payer: Health EOS Commercial |
$2,310.30
|
| Rate for Payer: HFN Commercial |
$2,388.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,946.88
|
| Rate for Payer: Multiplan Commercial |
$2,076.67
|
| Rate for Payer: NAPHCARE Commercial |
$1,557.50
|
| Rate for Payer: Preferred Network Access Commercial |
$2,388.17
|
| Rate for Payer: Quartz Beloit One Network |
$1,271.96
|
| Rate for Payer: Quartz Commercial |
$1,687.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,557.50
|
| Rate for Payer: The Alliance Commercial |
$1,297.92
|
| Rate for Payer: WEA Trust Commercial |
$1,427.71
|
| Rate for Payer: WPS Commercial |
$1,922.67
|
|
|
SCREW LOCK 4.5 X 28MM LP TI AR-8545L-28
|
Facility
|
OP
|
$2,596.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5603789
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$755.96 |
| Max. Negotiated Rate |
$2,483.85 |
| Rate for Payer: Aetna Commercial |
$2,429.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,321.86
|
| Rate for Payer: Aetna Managed Medicare |
$755.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,754.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,349.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,295.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,430.92
|
| Rate for Payer: Cash Price |
$778.80
|
| Rate for Payer: Cigna Commercial |
$2,483.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,510.87
|
| Rate for Payer: Health EOS Commercial |
$2,402.86
|
| Rate for Payer: HFN Commercial |
$2,483.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,024.88
|
| Rate for Payer: Multiplan Commercial |
$2,159.87
|
| Rate for Payer: NAPHCARE Commercial |
$1,619.90
|
| Rate for Payer: Preferred Network Access Commercial |
$2,483.85
|
| Rate for Payer: Quartz Beloit One Network |
$1,322.92
|
| Rate for Payer: Quartz Commercial |
$1,754.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,619.90
|
| Rate for Payer: The Alliance Commercial |
$1,349.92
|
| Rate for Payer: WEA Trust Commercial |
$1,484.91
|
| Rate for Payer: WPS Commercial |
$1,999.70
|
|
|
SCREW LOCK 4.5 X 28MM LP TI AR-8545L-28
|
Facility
|
IP
|
$2,596.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5603789
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,322.92 |
| Max. Negotiated Rate |
$2,483.85 |
| Rate for Payer: Aetna Commercial |
$2,429.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,321.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,430.92
|
| Rate for Payer: Cash Price |
$778.80
|
| Rate for Payer: Cigna Commercial |
$2,483.85
|
| Rate for Payer: Health EOS Commercial |
$2,402.86
|
| Rate for Payer: HFN Commercial |
$2,483.85
|
| Rate for Payer: Multiplan Commercial |
$2,159.87
|
| Rate for Payer: Preferred Network Access Commercial |
$2,483.85
|
| Rate for Payer: Quartz Beloit One Network |
$1,322.92
|
| Rate for Payer: Quartz Commercial |
$1,619.90
|
| Rate for Payer: WEA Trust Commercial |
$1,484.91
|
| Rate for Payer: WPS Commercial |
$1,999.70
|
|
