|
SCREW LOCK 5.0 X 30 FULLY THREAD 1896-5030S
|
Facility
|
IP
|
$1,882.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508988
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$959.07 |
| Max. Negotiated Rate |
$1,800.70 |
| Rate for Payer: Aetna Commercial |
$1,761.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,683.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,037.36
|
| Rate for Payer: Cash Price |
$564.60
|
| Rate for Payer: Cigna Commercial |
$1,800.70
|
| Rate for Payer: Health EOS Commercial |
$1,741.98
|
| Rate for Payer: HFN Commercial |
$1,800.70
|
| Rate for Payer: Multiplan Commercial |
$1,565.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,800.70
|
| Rate for Payer: Quartz Beloit One Network |
$959.07
|
| Rate for Payer: Quartz Commercial |
$1,174.37
|
| Rate for Payer: WEA Trust Commercial |
$1,076.50
|
| Rate for Payer: WPS Commercial |
$1,449.70
|
|
|
SCREW LOCK 5.0 X 30MM SELF-TAP 661130
|
Facility
|
OP
|
$2,005.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5458794
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$583.86 |
| Max. Negotiated Rate |
$1,918.38 |
| Rate for Payer: Aetna Commercial |
$1,876.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,793.27
|
| Rate for Payer: Aetna Managed Medicare |
$583.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,355.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,042.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,000.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,105.16
|
| Rate for Payer: Cash Price |
$601.50
|
| Rate for Payer: Cigna Commercial |
$1,918.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,166.91
|
| Rate for Payer: Health EOS Commercial |
$1,855.83
|
| Rate for Payer: HFN Commercial |
$1,918.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,563.90
|
| Rate for Payer: Multiplan Commercial |
$1,668.16
|
| Rate for Payer: NAPHCARE Commercial |
$1,251.12
|
| Rate for Payer: Preferred Network Access Commercial |
$1,918.38
|
| Rate for Payer: Quartz Beloit One Network |
$1,021.75
|
| Rate for Payer: Quartz Commercial |
$1,355.38
|
| Rate for Payer: Quartz Medicare Advantage |
$1,251.12
|
| Rate for Payer: The Alliance Commercial |
$1,042.60
|
| Rate for Payer: WEA Trust Commercial |
$1,146.86
|
| Rate for Payer: WPS Commercial |
$1,544.45
|
|
|
SCREW LOCK 5.0 X 30MM SELF-TAP 661130
|
Facility
|
IP
|
$2,005.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5458794
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,021.75 |
| Max. Negotiated Rate |
$1,918.38 |
| Rate for Payer: Aetna Commercial |
$1,876.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,793.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,105.16
|
| Rate for Payer: Cash Price |
$601.50
|
| Rate for Payer: Cigna Commercial |
$1,918.38
|
| Rate for Payer: Health EOS Commercial |
$1,855.83
|
| Rate for Payer: HFN Commercial |
$1,918.38
|
| Rate for Payer: Multiplan Commercial |
$1,668.16
|
| Rate for Payer: Preferred Network Access Commercial |
$1,918.38
|
| Rate for Payer: Quartz Beloit One Network |
$1,021.75
|
| Rate for Payer: Quartz Commercial |
$1,251.12
|
| Rate for Payer: WEA Trust Commercial |
$1,146.86
|
| Rate for Payer: WPS Commercial |
$1,544.45
|
|
|
SCREW LOCK 5.0 X 30MM TI 04.005.520S
|
Facility
|
IP
|
$2,318.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4595012
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,181.25 |
| Max. Negotiated Rate |
$2,217.86 |
| Rate for Payer: Aetna Commercial |
$2,169.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,073.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,277.68
|
| Rate for Payer: Cash Price |
$695.40
|
| Rate for Payer: Cigna Commercial |
$2,217.86
|
| Rate for Payer: Health EOS Commercial |
$2,145.54
|
| Rate for Payer: HFN Commercial |
$2,217.86
|
| Rate for Payer: Multiplan Commercial |
$1,928.58
|
| Rate for Payer: Preferred Network Access Commercial |
$2,217.86
|
| Rate for Payer: Quartz Beloit One Network |
$1,181.25
|
| Rate for Payer: Quartz Commercial |
$1,446.43
|
| Rate for Payer: WEA Trust Commercial |
$1,325.90
|
| Rate for Payer: WPS Commercial |
$1,785.56
|
|
|
SCREW LOCK 5.0 X 30MM TI 04.005.520S
|
Facility
|
OP
|
$2,318.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4595012
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$675.00 |
| Max. Negotiated Rate |
$2,217.86 |
| Rate for Payer: Aetna Commercial |
$2,169.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,073.22
|
| Rate for Payer: Aetna Managed Medicare |
$675.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,566.97
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,205.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,157.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,277.68
|
| Rate for Payer: Cash Price |
$695.40
|
| Rate for Payer: Cigna Commercial |
$2,217.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,349.08
|
| Rate for Payer: Health EOS Commercial |
$2,145.54
|
| Rate for Payer: HFN Commercial |
$2,217.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,808.04
|
| Rate for Payer: Multiplan Commercial |
$1,928.58
|
| Rate for Payer: NAPHCARE Commercial |
$1,446.43
|
| Rate for Payer: Preferred Network Access Commercial |
$2,217.86
|
| Rate for Payer: Quartz Beloit One Network |
$1,181.25
|
| Rate for Payer: Quartz Commercial |
$1,566.97
|
| Rate for Payer: Quartz Medicare Advantage |
$1,446.43
|
| Rate for Payer: The Alliance Commercial |
$1,205.36
|
| Rate for Payer: WEA Trust Commercial |
$1,325.90
|
| Rate for Payer: WPS Commercial |
$1,785.56
|
|
|
SCREW LOCK 5.0 X 30MM XL25 IM NAIL TI 04.045.030S
|
Facility
|
OP
|
$2,717.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6202983
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$791.19 |
| Max. Negotiated Rate |
$2,599.63 |
| Rate for Payer: Aetna Commercial |
$2,543.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,430.08
|
| Rate for Payer: Aetna Managed Medicare |
$791.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,836.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,412.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,356.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,497.61
|
| Rate for Payer: Cash Price |
$815.10
|
| Rate for Payer: Cigna Commercial |
$2,599.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,581.29
|
| Rate for Payer: Health EOS Commercial |
$2,514.86
|
| Rate for Payer: HFN Commercial |
$2,599.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,119.26
|
| Rate for Payer: Multiplan Commercial |
$2,260.54
|
| Rate for Payer: NAPHCARE Commercial |
$1,695.41
|
| Rate for Payer: Preferred Network Access Commercial |
$2,599.63
|
| Rate for Payer: Quartz Beloit One Network |
$1,384.58
|
| Rate for Payer: Quartz Commercial |
$1,836.69
|
| Rate for Payer: Quartz Medicare Advantage |
$1,695.41
|
| Rate for Payer: The Alliance Commercial |
$1,412.84
|
| Rate for Payer: WEA Trust Commercial |
$1,554.12
|
| Rate for Payer: WPS Commercial |
$2,092.91
|
|
|
SCREW LOCK 5.0 X 30MM XL25 IM NAIL TI 04.045.030S
|
Facility
|
IP
|
$2,717.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6202983
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,384.58 |
| Max. Negotiated Rate |
$2,599.63 |
| Rate for Payer: Aetna Commercial |
$2,543.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,430.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,497.61
|
| Rate for Payer: Cash Price |
$815.10
|
| Rate for Payer: Cigna Commercial |
$2,599.63
|
| Rate for Payer: Health EOS Commercial |
$2,514.86
|
| Rate for Payer: HFN Commercial |
$2,599.63
|
| Rate for Payer: Multiplan Commercial |
$2,260.54
|
| Rate for Payer: Preferred Network Access Commercial |
$2,599.63
|
| Rate for Payer: Quartz Beloit One Network |
$1,384.58
|
| Rate for Payer: Quartz Commercial |
$1,695.41
|
| Rate for Payer: WEA Trust Commercial |
$1,554.12
|
| Rate for Payer: WPS Commercial |
$2,092.91
|
|
|
SCREW-LOCK 5.0 X 30 TFN 458.930
|
Facility
|
IP
|
$2,724.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966963
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,388.15 |
| Max. Negotiated Rate |
$2,606.32 |
| Rate for Payer: Aetna Commercial |
$2,549.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,436.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,501.47
|
| Rate for Payer: Cash Price |
$817.20
|
| Rate for Payer: Cigna Commercial |
$2,606.32
|
| Rate for Payer: Health EOS Commercial |
$2,521.33
|
| Rate for Payer: HFN Commercial |
$2,606.32
|
| Rate for Payer: Multiplan Commercial |
$2,266.37
|
| Rate for Payer: Preferred Network Access Commercial |
$2,606.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,388.15
|
| Rate for Payer: Quartz Commercial |
$1,699.78
|
| Rate for Payer: WEA Trust Commercial |
$1,558.13
|
| Rate for Payer: WPS Commercial |
$2,098.30
|
|
|
SCREW-LOCK 5.0 X 30 TFN 458.930
|
Facility
|
OP
|
$2,724.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966963
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$793.23 |
| Max. Negotiated Rate |
$2,606.32 |
| Rate for Payer: Aetna Commercial |
$2,549.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,436.35
|
| Rate for Payer: Aetna Managed Medicare |
$793.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,841.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,416.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,359.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,501.47
|
| Rate for Payer: Cash Price |
$817.20
|
| Rate for Payer: Cigna Commercial |
$2,606.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,585.37
|
| Rate for Payer: Health EOS Commercial |
$2,521.33
|
| Rate for Payer: HFN Commercial |
$2,606.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,124.72
|
| Rate for Payer: Multiplan Commercial |
$2,266.37
|
| Rate for Payer: NAPHCARE Commercial |
$1,699.78
|
| Rate for Payer: Preferred Network Access Commercial |
$2,606.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,388.15
|
| Rate for Payer: Quartz Commercial |
$1,841.42
|
| Rate for Payer: Quartz Medicare Advantage |
$1,699.78
|
| Rate for Payer: The Alliance Commercial |
$1,416.48
|
| Rate for Payer: WEA Trust Commercial |
$1,558.13
|
| Rate for Payer: WPS Commercial |
$2,098.30
|
|
|
SCREW LOCK 5.0 X 32 212.210
|
Facility
|
IP
|
$1,917.00
|
|
| Hospital Charge Code |
2966964
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$976.90 |
| Max. Negotiated Rate |
$1,834.19 |
| Rate for Payer: Aetna Commercial |
$1,794.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,714.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,056.65
|
| Rate for Payer: Cash Price |
$575.10
|
| Rate for Payer: Cigna Commercial |
$1,834.19
|
| Rate for Payer: Health EOS Commercial |
$1,774.38
|
| Rate for Payer: HFN Commercial |
$1,834.19
|
| Rate for Payer: Multiplan Commercial |
$1,594.94
|
| Rate for Payer: Preferred Network Access Commercial |
$1,834.19
|
| Rate for Payer: Quartz Beloit One Network |
$976.90
|
| Rate for Payer: Quartz Commercial |
$1,196.21
|
| Rate for Payer: WEA Trust Commercial |
$1,096.52
|
| Rate for Payer: WPS Commercial |
$1,476.67
|
|
|
SCREW LOCK 5.0 X 32 212.210
|
Facility
|
OP
|
$1,917.00
|
|
| Hospital Charge Code |
2966964
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$558.23 |
| Max. Negotiated Rate |
$1,834.19 |
| Rate for Payer: Aetna Commercial |
$1,794.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,714.56
|
| Rate for Payer: Aetna Managed Medicare |
$558.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,295.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$996.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$956.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,056.65
|
| Rate for Payer: Cash Price |
$575.10
|
| Rate for Payer: Cigna Commercial |
$1,834.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,115.69
|
| Rate for Payer: Health EOS Commercial |
$1,774.38
|
| Rate for Payer: HFN Commercial |
$1,834.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,495.26
|
| Rate for Payer: Multiplan Commercial |
$1,594.94
|
| Rate for Payer: NAPHCARE Commercial |
$1,196.21
|
| Rate for Payer: Preferred Network Access Commercial |
$1,834.19
|
| Rate for Payer: Quartz Beloit One Network |
$976.90
|
| Rate for Payer: Quartz Commercial |
$1,295.89
|
| Rate for Payer: Quartz Medicare Advantage |
$1,196.21
|
| Rate for Payer: The Alliance Commercial |
$996.84
|
| Rate for Payer: WEA Trust Commercial |
$1,096.52
|
| Rate for Payer: WPS Commercial |
$1,476.67
|
|
|
SCREW LOCK 5.0 X 32.5 FULLY THREAD 1896-5032S
|
Facility
|
OP
|
$1,957.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508989
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$569.88 |
| Max. Negotiated Rate |
$1,872.46 |
| Rate for Payer: Aetna Commercial |
$1,831.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,750.34
|
| Rate for Payer: Aetna Managed Medicare |
$569.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,322.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,017.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$976.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,078.70
|
| Rate for Payer: Cash Price |
$587.10
|
| Rate for Payer: Cigna Commercial |
$1,872.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,138.97
|
| Rate for Payer: Health EOS Commercial |
$1,811.40
|
| Rate for Payer: HFN Commercial |
$1,872.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,526.46
|
| Rate for Payer: Multiplan Commercial |
$1,628.22
|
| Rate for Payer: NAPHCARE Commercial |
$1,221.17
|
| Rate for Payer: Preferred Network Access Commercial |
$1,872.46
|
| Rate for Payer: Quartz Beloit One Network |
$997.29
|
| Rate for Payer: Quartz Commercial |
$1,322.93
|
| Rate for Payer: Quartz Medicare Advantage |
$1,221.17
|
| Rate for Payer: The Alliance Commercial |
$1,017.64
|
| Rate for Payer: WEA Trust Commercial |
$1,119.40
|
| Rate for Payer: WPS Commercial |
$1,507.48
|
|
|
SCREW LOCK 5.0 X 32.5 FULLY THREAD 1896-5032S
|
Facility
|
IP
|
$1,957.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508989
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$997.29 |
| Max. Negotiated Rate |
$1,872.46 |
| Rate for Payer: Aetna Commercial |
$1,831.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,750.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,078.70
|
| Rate for Payer: Cash Price |
$587.10
|
| Rate for Payer: Cigna Commercial |
$1,872.46
|
| Rate for Payer: Health EOS Commercial |
$1,811.40
|
| Rate for Payer: HFN Commercial |
$1,872.46
|
| Rate for Payer: Multiplan Commercial |
$1,628.22
|
| Rate for Payer: Preferred Network Access Commercial |
$1,872.46
|
| Rate for Payer: Quartz Beloit One Network |
$997.29
|
| Rate for Payer: Quartz Commercial |
$1,221.17
|
| Rate for Payer: WEA Trust Commercial |
$1,119.40
|
| Rate for Payer: WPS Commercial |
$1,507.48
|
|
|
SCREW LOCK 5.0 X 32MM TI 04.005.522S
|
Facility
|
OP
|
$3,058.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966536
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$890.49 |
| Max. Negotiated Rate |
$2,925.89 |
| Rate for Payer: Aetna Commercial |
$2,862.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,735.08
|
| Rate for Payer: Aetna Managed Medicare |
$890.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,067.21
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,590.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,526.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,685.57
|
| Rate for Payer: Cash Price |
$917.40
|
| Rate for Payer: Cigna Commercial |
$2,925.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,779.76
|
| Rate for Payer: Health EOS Commercial |
$2,830.48
|
| Rate for Payer: HFN Commercial |
$2,925.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,385.24
|
| Rate for Payer: Multiplan Commercial |
$2,544.26
|
| Rate for Payer: NAPHCARE Commercial |
$1,908.19
|
| Rate for Payer: Preferred Network Access Commercial |
$2,925.89
|
| Rate for Payer: Quartz Beloit One Network |
$1,558.36
|
| Rate for Payer: Quartz Commercial |
$2,067.21
|
| Rate for Payer: Quartz Medicare Advantage |
$1,908.19
|
| Rate for Payer: The Alliance Commercial |
$1,590.16
|
| Rate for Payer: WEA Trust Commercial |
$1,749.18
|
| Rate for Payer: WPS Commercial |
$2,355.58
|
|
|
SCREW LOCK 5.0 X 32MM TI 04.005.522S
|
Facility
|
IP
|
$3,058.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966536
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,558.36 |
| Max. Negotiated Rate |
$2,925.89 |
| Rate for Payer: Aetna Commercial |
$2,862.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,735.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,685.57
|
| Rate for Payer: Cash Price |
$917.40
|
| Rate for Payer: Cigna Commercial |
$2,925.89
|
| Rate for Payer: Health EOS Commercial |
$2,830.48
|
| Rate for Payer: HFN Commercial |
$2,925.89
|
| Rate for Payer: Multiplan Commercial |
$2,544.26
|
| Rate for Payer: Preferred Network Access Commercial |
$2,925.89
|
| Rate for Payer: Quartz Beloit One Network |
$1,558.36
|
| Rate for Payer: Quartz Commercial |
$1,908.19
|
| Rate for Payer: WEA Trust Commercial |
$1,749.18
|
| Rate for Payer: WPS Commercial |
$2,355.58
|
|
|
SCREW LOCK 5.0 X 32MM XL25 IM NAIL TI 04.045.032S
|
Facility
|
OP
|
$2,332.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6175603
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$679.08 |
| Max. Negotiated Rate |
$2,231.26 |
| Rate for Payer: Aetna Commercial |
$2,182.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,085.74
|
| Rate for Payer: Aetna Managed Medicare |
$679.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,576.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,212.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,164.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,285.40
|
| Rate for Payer: Cash Price |
$699.60
|
| Rate for Payer: Cigna Commercial |
$2,231.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,357.22
|
| Rate for Payer: Health EOS Commercial |
$2,158.50
|
| Rate for Payer: HFN Commercial |
$2,231.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,818.96
|
| Rate for Payer: Multiplan Commercial |
$1,940.22
|
| Rate for Payer: NAPHCARE Commercial |
$1,455.17
|
| Rate for Payer: Preferred Network Access Commercial |
$2,231.26
|
| Rate for Payer: Quartz Beloit One Network |
$1,188.39
|
| Rate for Payer: Quartz Commercial |
$1,576.43
|
| Rate for Payer: Quartz Medicare Advantage |
$1,455.17
|
| Rate for Payer: The Alliance Commercial |
$1,212.64
|
| Rate for Payer: WEA Trust Commercial |
$1,333.90
|
| Rate for Payer: WPS Commercial |
$1,796.34
|
|
|
SCREW LOCK 5.0 X 32MM XL25 IM NAIL TI 04.045.032S
|
Facility
|
IP
|
$2,332.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6175603
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,188.39 |
| Max. Negotiated Rate |
$2,231.26 |
| Rate for Payer: Aetna Commercial |
$2,182.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,085.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,285.40
|
| Rate for Payer: Cash Price |
$699.60
|
| Rate for Payer: Cigna Commercial |
$2,231.26
|
| Rate for Payer: Health EOS Commercial |
$2,158.50
|
| Rate for Payer: HFN Commercial |
$2,231.26
|
| Rate for Payer: Multiplan Commercial |
$1,940.22
|
| Rate for Payer: Preferred Network Access Commercial |
$2,231.26
|
| Rate for Payer: Quartz Beloit One Network |
$1,188.39
|
| Rate for Payer: Quartz Commercial |
$1,455.17
|
| Rate for Payer: WEA Trust Commercial |
$1,333.90
|
| Rate for Payer: WPS Commercial |
$1,796.34
|
|
|
SCREW-LOCK 5.0 X 32 TFN 458.932
|
Facility
|
OP
|
$2,724.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966965
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$793.23 |
| Max. Negotiated Rate |
$2,606.32 |
| Rate for Payer: Aetna Commercial |
$2,549.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,436.35
|
| Rate for Payer: Aetna Managed Medicare |
$793.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,841.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,416.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,359.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,501.47
|
| Rate for Payer: Cash Price |
$817.20
|
| Rate for Payer: Cigna Commercial |
$2,606.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,585.37
|
| Rate for Payer: Health EOS Commercial |
$2,521.33
|
| Rate for Payer: HFN Commercial |
$2,606.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,124.72
|
| Rate for Payer: Multiplan Commercial |
$2,266.37
|
| Rate for Payer: NAPHCARE Commercial |
$1,699.78
|
| Rate for Payer: Preferred Network Access Commercial |
$2,606.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,388.15
|
| Rate for Payer: Quartz Commercial |
$1,841.42
|
| Rate for Payer: Quartz Medicare Advantage |
$1,699.78
|
| Rate for Payer: The Alliance Commercial |
$1,416.48
|
| Rate for Payer: WEA Trust Commercial |
$1,558.13
|
| Rate for Payer: WPS Commercial |
$2,098.30
|
|
|
SCREW-LOCK 5.0 X 32 TFN 458.932
|
Facility
|
IP
|
$2,724.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966965
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,388.15 |
| Max. Negotiated Rate |
$2,606.32 |
| Rate for Payer: Aetna Commercial |
$2,549.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,436.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,501.47
|
| Rate for Payer: Cash Price |
$817.20
|
| Rate for Payer: Cigna Commercial |
$2,606.32
|
| Rate for Payer: Health EOS Commercial |
$2,521.33
|
| Rate for Payer: HFN Commercial |
$2,606.32
|
| Rate for Payer: Multiplan Commercial |
$2,266.37
|
| Rate for Payer: Preferred Network Access Commercial |
$2,606.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,388.15
|
| Rate for Payer: Quartz Commercial |
$1,699.78
|
| Rate for Payer: WEA Trust Commercial |
$1,558.13
|
| Rate for Payer: WPS Commercial |
$2,098.30
|
|
|
SCREW LOCK 5.0 X 32 VA 02.231.232
|
Facility
|
OP
|
$2,648.00
|
|
| Hospital Charge Code |
3072542
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$771.10 |
| Max. Negotiated Rate |
$2,533.61 |
| Rate for Payer: Aetna Commercial |
$2,478.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,368.37
|
| Rate for Payer: Aetna Managed Medicare |
$771.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,790.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,376.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,321.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,459.58
|
| Rate for Payer: Cash Price |
$794.40
|
| Rate for Payer: Cigna Commercial |
$2,533.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,541.14
|
| Rate for Payer: Health EOS Commercial |
$2,450.99
|
| Rate for Payer: HFN Commercial |
$2,533.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,065.44
|
| Rate for Payer: Multiplan Commercial |
$2,203.14
|
| Rate for Payer: NAPHCARE Commercial |
$1,652.35
|
| Rate for Payer: Preferred Network Access Commercial |
$2,533.61
|
| Rate for Payer: Quartz Beloit One Network |
$1,349.42
|
| Rate for Payer: Quartz Commercial |
$1,790.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,652.35
|
| Rate for Payer: The Alliance Commercial |
$1,376.96
|
| Rate for Payer: WEA Trust Commercial |
$1,514.66
|
| Rate for Payer: WPS Commercial |
$2,039.75
|
|
|
SCREW LOCK 5.0 X 32 VA 02.231.232
|
Facility
|
IP
|
$2,648.00
|
|
| Hospital Charge Code |
3072542
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,349.42 |
| Max. Negotiated Rate |
$2,533.61 |
| Rate for Payer: Aetna Commercial |
$2,478.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,368.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,459.58
|
| Rate for Payer: Cash Price |
$794.40
|
| Rate for Payer: Cigna Commercial |
$2,533.61
|
| Rate for Payer: Health EOS Commercial |
$2,450.99
|
| Rate for Payer: HFN Commercial |
$2,533.61
|
| Rate for Payer: Multiplan Commercial |
$2,203.14
|
| Rate for Payer: Preferred Network Access Commercial |
$2,533.61
|
| Rate for Payer: Quartz Beloit One Network |
$1,349.42
|
| Rate for Payer: Quartz Commercial |
$1,652.35
|
| Rate for Payer: WEA Trust Commercial |
$1,514.66
|
| Rate for Payer: WPS Commercial |
$2,039.75
|
|
|
SCREW-LOCK 5.0X34 212.211
|
Facility
|
IP
|
$1,917.00
|
|
| Hospital Charge Code |
2966966
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$976.90 |
| Max. Negotiated Rate |
$1,834.19 |
| Rate for Payer: Aetna Commercial |
$1,794.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,714.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,056.65
|
| Rate for Payer: Cash Price |
$575.10
|
| Rate for Payer: Cigna Commercial |
$1,834.19
|
| Rate for Payer: Health EOS Commercial |
$1,774.38
|
| Rate for Payer: HFN Commercial |
$1,834.19
|
| Rate for Payer: Multiplan Commercial |
$1,594.94
|
| Rate for Payer: Preferred Network Access Commercial |
$1,834.19
|
| Rate for Payer: Quartz Beloit One Network |
$976.90
|
| Rate for Payer: Quartz Commercial |
$1,196.21
|
| Rate for Payer: WEA Trust Commercial |
$1,096.52
|
| Rate for Payer: WPS Commercial |
$1,476.67
|
|
|
SCREW-LOCK 5.0X34 212.211
|
Facility
|
OP
|
$1,917.00
|
|
| Hospital Charge Code |
2966966
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$558.23 |
| Max. Negotiated Rate |
$1,834.19 |
| Rate for Payer: Aetna Commercial |
$1,794.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,714.56
|
| Rate for Payer: Aetna Managed Medicare |
$558.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,295.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$996.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$956.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,056.65
|
| Rate for Payer: Cash Price |
$575.10
|
| Rate for Payer: Cigna Commercial |
$1,834.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,115.69
|
| Rate for Payer: Health EOS Commercial |
$1,774.38
|
| Rate for Payer: HFN Commercial |
$1,834.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,495.26
|
| Rate for Payer: Multiplan Commercial |
$1,594.94
|
| Rate for Payer: NAPHCARE Commercial |
$1,196.21
|
| Rate for Payer: Preferred Network Access Commercial |
$1,834.19
|
| Rate for Payer: Quartz Beloit One Network |
$976.90
|
| Rate for Payer: Quartz Commercial |
$1,295.89
|
| Rate for Payer: Quartz Medicare Advantage |
$1,196.21
|
| Rate for Payer: The Alliance Commercial |
$996.84
|
| Rate for Payer: WEA Trust Commercial |
$1,096.52
|
| Rate for Payer: WPS Commercial |
$1,476.67
|
|
|
SCREW LOCK 5.0 X 34MM TI 04.005.524S
|
Facility
|
IP
|
$3,058.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966526
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,558.36 |
| Max. Negotiated Rate |
$2,925.89 |
| Rate for Payer: Aetna Commercial |
$2,862.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,735.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,685.57
|
| Rate for Payer: Cash Price |
$917.40
|
| Rate for Payer: Cigna Commercial |
$2,925.89
|
| Rate for Payer: Health EOS Commercial |
$2,830.48
|
| Rate for Payer: HFN Commercial |
$2,925.89
|
| Rate for Payer: Multiplan Commercial |
$2,544.26
|
| Rate for Payer: Preferred Network Access Commercial |
$2,925.89
|
| Rate for Payer: Quartz Beloit One Network |
$1,558.36
|
| Rate for Payer: Quartz Commercial |
$1,908.19
|
| Rate for Payer: WEA Trust Commercial |
$1,749.18
|
| Rate for Payer: WPS Commercial |
$2,355.58
|
|
|
SCREW LOCK 5.0 X 34MM TI 04.005.524S
|
Facility
|
OP
|
$3,058.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966526
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$890.49 |
| Max. Negotiated Rate |
$2,925.89 |
| Rate for Payer: Aetna Commercial |
$2,862.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,735.08
|
| Rate for Payer: Aetna Managed Medicare |
$890.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,067.21
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,590.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,526.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,685.57
|
| Rate for Payer: Cash Price |
$917.40
|
| Rate for Payer: Cigna Commercial |
$2,925.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,779.76
|
| Rate for Payer: Health EOS Commercial |
$2,830.48
|
| Rate for Payer: HFN Commercial |
$2,925.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,385.24
|
| Rate for Payer: Multiplan Commercial |
$2,544.26
|
| Rate for Payer: NAPHCARE Commercial |
$1,908.19
|
| Rate for Payer: Preferred Network Access Commercial |
$2,925.89
|
| Rate for Payer: Quartz Beloit One Network |
$1,558.36
|
| Rate for Payer: Quartz Commercial |
$2,067.21
|
| Rate for Payer: Quartz Medicare Advantage |
$1,908.19
|
| Rate for Payer: The Alliance Commercial |
$1,590.16
|
| Rate for Payer: WEA Trust Commercial |
$1,749.18
|
| Rate for Payer: WPS Commercial |
$2,355.58
|
|
