|
SCREW LOCK 3.5MM X 10MM T10 657310
|
Facility
|
IP
|
$2,024.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6185028
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$991.76 |
| Max. Negotiated Rate |
$1,862.08 |
| Rate for Payer: Aetna Commercial |
$1,821.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,740.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,072.72
|
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Cigna Commercial |
$1,862.08
|
| Rate for Payer: Health EOS Commercial |
$1,801.36
|
| Rate for Payer: HFN Commercial |
$1,862.08
|
| Rate for Payer: Multiplan Commercial |
$1,619.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,214.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,862.08
|
| Rate for Payer: Quartz Beloit One Network |
$991.76
|
| Rate for Payer: Quartz Commercial |
$1,214.40
|
| Rate for Payer: WEA Trust Commercial |
$1,113.20
|
| Rate for Payer: WPS Commercial |
$1,499.18
|
|
|
SCREW LOCK 3.5MM X 12MM T10 657312
|
Facility
|
OP
|
$2,190.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599677
|
|
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 3.5MM X 12MM T10 657312
|
Facility
|
IP
|
$2,190.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599677
|
|
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 3.5MM X 14MM T10 657314
|
Facility
|
IP
|
$2,190.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5547414
|
|
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 3.5MM X 14MM T10 657314
|
Facility
|
OP
|
$2,190.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5547414
|
|
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 3.5MM X 16MM T10 657316
|
Facility
|
IP
|
$2,190.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5547415
|
|
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 3.5MM X 16MM T10 657316
|
Facility
|
OP
|
$2,190.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5547415
|
|
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 3.5MM X 18MM T10 657318
|
Facility
|
OP
|
$2,190.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5583324
|
|
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 3.5MM X 18MM T10 657318
|
Facility
|
IP
|
$2,190.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5583324
|
|
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 3.5MM X 20MM T10 657320
|
Facility
|
OP
|
$2,190.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5547416
|
|
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 3.5MM X 20MM T10 657320
|
Facility
|
IP
|
$2,190.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5547416
|
|
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 3.5MM X 22MM T10 657322
|
Facility
|
IP
|
$2,190.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599678
|
|
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 3.5MM X 22MM T10 657322
|
Facility
|
OP
|
$2,190.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599678
|
|
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 3.5MM X 24MM T10 657324
|
Facility
|
OP
|
$2,190.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5547418
|
|
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 3.5MM X 24MM T10 657324
|
Facility
|
IP
|
$2,190.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5547418
|
|
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 3.5MM X 26MM T10 657326
|
Facility
|
OP
|
$2,190.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599679
|
|
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 3.5MM X 26MM T10 657326
|
Facility
|
IP
|
$2,190.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599679
|
|
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 3.5MM X 28MM T10 657328
|
Facility
|
IP
|
$2,190.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5583325
|
|
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 3.5MM X 28MM T10 657328
|
Facility
|
OP
|
$2,190.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5583325
|
|
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 3.5MM X 30MM T10 657330
|
Facility
|
IP
|
$3,364.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5861714
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,648.36 |
| Max. Negotiated Rate |
$3,094.88 |
| Rate for Payer: Aetna Commercial |
$3,027.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,893.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,782.92
|
| Rate for Payer: Cash Price |
$1,009.20
|
| Rate for Payer: Cigna Commercial |
$3,094.88
|
| Rate for Payer: Health EOS Commercial |
$2,993.96
|
| Rate for Payer: HFN Commercial |
$3,094.88
|
| Rate for Payer: Multiplan Commercial |
$2,691.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,018.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,094.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,648.36
|
| Rate for Payer: Quartz Commercial |
$2,018.40
|
| Rate for Payer: WEA Trust Commercial |
$1,850.20
|
| Rate for Payer: WPS Commercial |
$2,491.71
|
|
|
SCREW LOCK 3.5MM X 30MM T10 657330
|
Facility
|
OP
|
$3,364.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5861714
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$941.92 |
| Max. Negotiated Rate |
$13,456.00 |
| Rate for Payer: Aetna Commercial |
$3,027.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,893.04
|
| Rate for Payer: Aetna Managed Medicare |
$941.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,186.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,682.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,614.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,782.92
|
| Rate for Payer: Cash Price |
$1,009.20
|
| Rate for Payer: Cigna Commercial |
$3,094.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,882.49
|
| Rate for Payer: Health EOS Commercial |
$2,993.96
|
| Rate for Payer: HFN Commercial |
$3,094.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,523.00
|
| Rate for Payer: Multiplan Commercial |
$2,691.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,018.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,094.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,648.36
|
| Rate for Payer: Quartz Commercial |
$2,186.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2,018.40
|
| Rate for Payer: The Alliance Commercial |
$13,456.00
|
| Rate for Payer: WEA Trust Commercial |
$1,850.20
|
| Rate for Payer: WPS Commercial |
$2,491.71
|
|
|
SCREW-LOCK 3.5 X 10 212.101
|
Facility
|
OP
|
$692.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966872
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$193.76 |
| Max. Negotiated Rate |
$2,768.00 |
| Rate for Payer: Aetna Commercial |
$622.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$595.12
|
| Rate for Payer: Aetna Managed Medicare |
$193.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$449.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$346.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$332.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$366.76
|
| Rate for Payer: Cash Price |
$207.60
|
| Rate for Payer: Cigna Commercial |
$636.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$387.24
|
| Rate for Payer: Health EOS Commercial |
$615.88
|
| Rate for Payer: HFN Commercial |
$636.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$519.00
|
| Rate for Payer: Multiplan Commercial |
$553.60
|
| Rate for Payer: NAPHCARE Commercial |
$415.20
|
| Rate for Payer: Preferred Network Access Commercial |
$636.64
|
| Rate for Payer: Quartz Beloit One Network |
$339.08
|
| Rate for Payer: Quartz Commercial |
$449.80
|
| Rate for Payer: Quartz Medicare Advantage |
$415.20
|
| Rate for Payer: The Alliance Commercial |
$2,768.00
|
| Rate for Payer: WEA Trust Commercial |
$380.60
|
| Rate for Payer: WPS Commercial |
$512.56
|
|
|
SCREW-LOCK 3.5 X 10 212.101
|
Facility
|
IP
|
$692.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966872
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.08 |
| Max. Negotiated Rate |
$636.64 |
| Rate for Payer: Aetna Commercial |
$622.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$595.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$366.76
|
| Rate for Payer: Cash Price |
$207.60
|
| Rate for Payer: Cigna Commercial |
$636.64
|
| Rate for Payer: Health EOS Commercial |
$615.88
|
| Rate for Payer: HFN Commercial |
$636.64
|
| Rate for Payer: Multiplan Commercial |
$553.60
|
| Rate for Payer: NAPHCARE Commercial |
$415.20
|
| Rate for Payer: Preferred Network Access Commercial |
$636.64
|
| Rate for Payer: Quartz Beloit One Network |
$339.08
|
| Rate for Payer: Quartz Commercial |
$415.20
|
| Rate for Payer: WEA Trust Commercial |
$380.60
|
| Rate for Payer: WPS Commercial |
$512.56
|
|
|
SCREW LOCK 3.5 X 10MM MFT-021-35-10
|
Facility
|
OP
|
$3,283.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4066509
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$919.24 |
| Max. Negotiated Rate |
$13,132.00 |
| Rate for Payer: Aetna Commercial |
$2,954.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,823.38
|
| Rate for Payer: Aetna Managed Medicare |
$919.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,133.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,641.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,575.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,739.99
|
| Rate for Payer: Cash Price |
$984.90
|
| Rate for Payer: Cigna Commercial |
$3,020.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,837.17
|
| Rate for Payer: Health EOS Commercial |
$2,921.87
|
| Rate for Payer: HFN Commercial |
$3,020.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,462.25
|
| Rate for Payer: Multiplan Commercial |
$2,626.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,969.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,020.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,608.67
|
| Rate for Payer: Quartz Commercial |
$2,133.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,969.80
|
| Rate for Payer: The Alliance Commercial |
$13,132.00
|
| Rate for Payer: WEA Trust Commercial |
$1,805.65
|
| Rate for Payer: WPS Commercial |
$2,431.72
|
|
|
SCREW LOCK 3.5 X 10MM MFT-021-35-10
|
Facility
|
IP
|
$3,283.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4066509
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,608.67 |
| Max. Negotiated Rate |
$3,020.36 |
| Rate for Payer: Aetna Commercial |
$2,954.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,823.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,739.99
|
| Rate for Payer: Cash Price |
$984.90
|
| Rate for Payer: Cigna Commercial |
$3,020.36
|
| Rate for Payer: Health EOS Commercial |
$2,921.87
|
| Rate for Payer: HFN Commercial |
$3,020.36
|
| Rate for Payer: Multiplan Commercial |
$2,626.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,969.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,020.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,608.67
|
| Rate for Payer: Quartz Commercial |
$1,969.80
|
| Rate for Payer: WEA Trust Commercial |
$1,805.65
|
| Rate for Payer: WPS Commercial |
$2,431.72
|
|
