|
SCREW-LOCK 3.5 X 18 212.105
|
Facility
|
IP
|
$716.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966880
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$350.84 |
| Max. Negotiated Rate |
$658.72 |
| Rate for Payer: Aetna Commercial |
$644.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$615.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$379.48
|
| Rate for Payer: Cash Price |
$214.80
|
| Rate for Payer: Cigna Commercial |
$658.72
|
| Rate for Payer: Health EOS Commercial |
$637.24
|
| Rate for Payer: HFN Commercial |
$658.72
|
| Rate for Payer: Multiplan Commercial |
$572.80
|
| Rate for Payer: NAPHCARE Commercial |
$429.60
|
| Rate for Payer: Preferred Network Access Commercial |
$658.72
|
| Rate for Payer: Quartz Beloit One Network |
$350.84
|
| Rate for Payer: Quartz Commercial |
$429.60
|
| Rate for Payer: WEA Trust Commercial |
$393.80
|
| Rate for Payer: WPS Commercial |
$530.34
|
|
|
SCREW LOCK 3.5 X 18MM LP AR-8835L-18
|
Facility
|
IP
|
$1,531.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4317091
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$750.19 |
| Max. Negotiated Rate |
$1,408.52 |
| Rate for Payer: Aetna Commercial |
$1,377.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,316.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$811.43
|
| Rate for Payer: Cash Price |
$459.30
|
| Rate for Payer: Cigna Commercial |
$1,408.52
|
| Rate for Payer: Health EOS Commercial |
$1,362.59
|
| Rate for Payer: HFN Commercial |
$1,408.52
|
| Rate for Payer: Multiplan Commercial |
$1,224.80
|
| Rate for Payer: NAPHCARE Commercial |
$918.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,408.52
|
| Rate for Payer: Quartz Beloit One Network |
$750.19
|
| Rate for Payer: Quartz Commercial |
$918.60
|
| Rate for Payer: WEA Trust Commercial |
$842.05
|
| Rate for Payer: WPS Commercial |
$1,134.01
|
|
|
SCREW LOCK 3.5 X 18MM LP AR-8835L-18
|
Facility
|
OP
|
$1,531.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4317091
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$428.68 |
| Max. Negotiated Rate |
$6,124.00 |
| Rate for Payer: Aetna Commercial |
$1,377.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,316.66
|
| Rate for Payer: Aetna Managed Medicare |
$428.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$995.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$765.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$734.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$811.43
|
| Rate for Payer: Cash Price |
$459.30
|
| Rate for Payer: Cigna Commercial |
$1,408.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$856.75
|
| Rate for Payer: Health EOS Commercial |
$1,362.59
|
| Rate for Payer: HFN Commercial |
$1,408.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,148.25
|
| Rate for Payer: Multiplan Commercial |
$1,224.80
|
| Rate for Payer: NAPHCARE Commercial |
$918.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,408.52
|
| Rate for Payer: Quartz Beloit One Network |
$750.19
|
| Rate for Payer: Quartz Commercial |
$995.15
|
| Rate for Payer: Quartz Medicare Advantage |
$918.60
|
| Rate for Payer: The Alliance Commercial |
$6,124.00
|
| Rate for Payer: WEA Trust Commercial |
$842.05
|
| Rate for Payer: WPS Commercial |
$1,134.01
|
|
|
SCREW-LOCK 3.5 X 20 212.106
|
Facility
|
IP
|
$716.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966882
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$350.84 |
| Max. Negotiated Rate |
$658.72 |
| Rate for Payer: Aetna Commercial |
$644.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$615.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$379.48
|
| Rate for Payer: Cash Price |
$214.80
|
| Rate for Payer: Cigna Commercial |
$658.72
|
| Rate for Payer: Health EOS Commercial |
$637.24
|
| Rate for Payer: HFN Commercial |
$658.72
|
| Rate for Payer: Multiplan Commercial |
$572.80
|
| Rate for Payer: NAPHCARE Commercial |
$429.60
|
| Rate for Payer: Preferred Network Access Commercial |
$658.72
|
| Rate for Payer: Quartz Beloit One Network |
$350.84
|
| Rate for Payer: Quartz Commercial |
$429.60
|
| Rate for Payer: WEA Trust Commercial |
$393.80
|
| Rate for Payer: WPS Commercial |
$530.34
|
|
|
SCREW-LOCK 3.5 X 20 212.106
|
Facility
|
OP
|
$716.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966882
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$200.48 |
| Max. Negotiated Rate |
$2,864.00 |
| Rate for Payer: Aetna Commercial |
$644.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$615.76
|
| Rate for Payer: Aetna Managed Medicare |
$200.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$465.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$358.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$343.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$379.48
|
| Rate for Payer: Cash Price |
$214.80
|
| Rate for Payer: Cigna Commercial |
$658.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$400.67
|
| Rate for Payer: Health EOS Commercial |
$637.24
|
| Rate for Payer: HFN Commercial |
$658.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$537.00
|
| Rate for Payer: Multiplan Commercial |
$572.80
|
| Rate for Payer: NAPHCARE Commercial |
$429.60
|
| Rate for Payer: Preferred Network Access Commercial |
$658.72
|
| Rate for Payer: Quartz Beloit One Network |
$350.84
|
| Rate for Payer: Quartz Commercial |
$465.40
|
| Rate for Payer: Quartz Medicare Advantage |
$429.60
|
| Rate for Payer: The Alliance Commercial |
$2,864.00
|
| Rate for Payer: WEA Trust Commercial |
$393.80
|
| Rate for Payer: WPS Commercial |
$530.34
|
|
|
SCREW LOCK 3.5 X 20MM LP AR-8835L-20
|
Facility
|
IP
|
$1,531.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4317092
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$750.19 |
| Max. Negotiated Rate |
$1,408.52 |
| Rate for Payer: Aetna Commercial |
$1,377.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,316.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$811.43
|
| Rate for Payer: Cash Price |
$459.30
|
| Rate for Payer: Cigna Commercial |
$1,408.52
|
| Rate for Payer: Health EOS Commercial |
$1,362.59
|
| Rate for Payer: HFN Commercial |
$1,408.52
|
| Rate for Payer: Multiplan Commercial |
$1,224.80
|
| Rate for Payer: NAPHCARE Commercial |
$918.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,408.52
|
| Rate for Payer: Quartz Beloit One Network |
$750.19
|
| Rate for Payer: Quartz Commercial |
$918.60
|
| Rate for Payer: WEA Trust Commercial |
$842.05
|
| Rate for Payer: WPS Commercial |
$1,134.01
|
|
|
SCREW LOCK 3.5 X 20MM LP AR-8835L-20
|
Facility
|
OP
|
$1,531.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4317092
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$428.68 |
| Max. Negotiated Rate |
$6,124.00 |
| Rate for Payer: Aetna Commercial |
$1,377.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,316.66
|
| Rate for Payer: Aetna Managed Medicare |
$428.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$995.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$765.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$734.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$811.43
|
| Rate for Payer: Cash Price |
$459.30
|
| Rate for Payer: Cigna Commercial |
$1,408.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$856.75
|
| Rate for Payer: Health EOS Commercial |
$1,362.59
|
| Rate for Payer: HFN Commercial |
$1,408.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,148.25
|
| Rate for Payer: Multiplan Commercial |
$1,224.80
|
| Rate for Payer: NAPHCARE Commercial |
$918.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,408.52
|
| Rate for Payer: Quartz Beloit One Network |
$750.19
|
| Rate for Payer: Quartz Commercial |
$995.15
|
| Rate for Payer: Quartz Medicare Advantage |
$918.60
|
| Rate for Payer: The Alliance Commercial |
$6,124.00
|
| Rate for Payer: WEA Trust Commercial |
$842.05
|
| Rate for Payer: WPS Commercial |
$1,134.01
|
|
|
SCREW LOCK 3.5 X 20MM MFT-021-35-20
|
Facility
|
IP
|
$3,283.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4028655
|
|
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
|
|
|
SCREW LOCK 3.5 X 20MM MFT-021-35-20
|
Facility
|
OP
|
$3,283.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4028655
|
|
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 22 212.107
|
Facility
|
OP
|
$692.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966884
|
|
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 22 212.107
|
Facility
|
IP
|
$692.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966884
|
|
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 22MM LP AR-8835L-22
|
Facility
|
IP
|
$1,361.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6178273
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$666.89 |
| Max. Negotiated Rate |
$1,252.12 |
| Rate for Payer: Aetna Commercial |
$1,224.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,170.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$721.33
|
| Rate for Payer: Cash Price |
$408.30
|
| Rate for Payer: Cigna Commercial |
$1,252.12
|
| Rate for Payer: Health EOS Commercial |
$1,211.29
|
| Rate for Payer: HFN Commercial |
$1,252.12
|
| Rate for Payer: Multiplan Commercial |
$1,088.80
|
| Rate for Payer: NAPHCARE Commercial |
$816.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,252.12
|
| Rate for Payer: Quartz Beloit One Network |
$666.89
|
| Rate for Payer: Quartz Commercial |
$816.60
|
| Rate for Payer: WEA Trust Commercial |
$748.55
|
| Rate for Payer: WPS Commercial |
$1,008.09
|
|
|
SCREW LOCK 3.5 X 22MM LP AR-8835L-22
|
Facility
|
OP
|
$1,361.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6178273
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$381.08 |
| Max. Negotiated Rate |
$5,444.00 |
| Rate for Payer: Aetna Commercial |
$1,224.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,170.46
|
| Rate for Payer: Aetna Managed Medicare |
$381.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$884.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$680.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$653.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$721.33
|
| Rate for Payer: Cash Price |
$408.30
|
| Rate for Payer: Cigna Commercial |
$1,252.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$761.62
|
| Rate for Payer: Health EOS Commercial |
$1,211.29
|
| Rate for Payer: HFN Commercial |
$1,252.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,020.75
|
| Rate for Payer: Multiplan Commercial |
$1,088.80
|
| Rate for Payer: NAPHCARE Commercial |
$816.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,252.12
|
| Rate for Payer: Quartz Beloit One Network |
$666.89
|
| Rate for Payer: Quartz Commercial |
$884.65
|
| Rate for Payer: Quartz Medicare Advantage |
$816.60
|
| Rate for Payer: The Alliance Commercial |
$5,444.00
|
| Rate for Payer: WEA Trust Commercial |
$748.55
|
| Rate for Payer: WPS Commercial |
$1,008.09
|
|
|
SCREW-LOCK 3.5 X 24 212.108
|
Facility
|
OP
|
$692.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966886
|
|
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 24 212.108
|
Facility
|
IP
|
$692.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966886
|
|
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 26 212.109
|
Facility
|
IP
|
$716.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966888
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$350.84 |
| Max. Negotiated Rate |
$658.72 |
| Rate for Payer: Aetna Commercial |
$644.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$615.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$379.48
|
| Rate for Payer: Cash Price |
$214.80
|
| Rate for Payer: Cigna Commercial |
$658.72
|
| Rate for Payer: Health EOS Commercial |
$637.24
|
| Rate for Payer: HFN Commercial |
$658.72
|
| Rate for Payer: Multiplan Commercial |
$572.80
|
| Rate for Payer: NAPHCARE Commercial |
$429.60
|
| Rate for Payer: Preferred Network Access Commercial |
$658.72
|
| Rate for Payer: Quartz Beloit One Network |
$350.84
|
| Rate for Payer: Quartz Commercial |
$429.60
|
| Rate for Payer: WEA Trust Commercial |
$393.80
|
| Rate for Payer: WPS Commercial |
$530.34
|
|
|
SCREW-LOCK 3.5 X 26 212.109
|
Facility
|
OP
|
$716.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966888
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$200.48 |
| Max. Negotiated Rate |
$2,864.00 |
| Rate for Payer: Aetna Commercial |
$644.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$615.76
|
| Rate for Payer: Aetna Managed Medicare |
$200.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$465.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$358.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$343.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$379.48
|
| Rate for Payer: Cash Price |
$214.80
|
| Rate for Payer: Cigna Commercial |
$658.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$400.67
|
| Rate for Payer: Health EOS Commercial |
$637.24
|
| Rate for Payer: HFN Commercial |
$658.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$537.00
|
| Rate for Payer: Multiplan Commercial |
$572.80
|
| Rate for Payer: NAPHCARE Commercial |
$429.60
|
| Rate for Payer: Preferred Network Access Commercial |
$658.72
|
| Rate for Payer: Quartz Beloit One Network |
$350.84
|
| Rate for Payer: Quartz Commercial |
$465.40
|
| Rate for Payer: Quartz Medicare Advantage |
$429.60
|
| Rate for Payer: The Alliance Commercial |
$2,864.00
|
| Rate for Payer: WEA Trust Commercial |
$393.80
|
| Rate for Payer: WPS Commercial |
$530.34
|
|
|
SCREW LOCK 3.5 X 28 212.110
|
Facility
|
OP
|
$692.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966890
|
|
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 28 212.110
|
Facility
|
IP
|
$692.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966890
|
|
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 28MM LP AR-8835L-28
|
Facility
|
OP
|
$1,531.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5496982
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$428.68 |
| Max. Negotiated Rate |
$6,124.00 |
| Rate for Payer: Aetna Commercial |
$1,377.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,316.66
|
| Rate for Payer: Aetna Managed Medicare |
$428.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$995.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$765.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$734.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$811.43
|
| Rate for Payer: Cash Price |
$459.30
|
| Rate for Payer: Cigna Commercial |
$1,408.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$856.75
|
| Rate for Payer: Health EOS Commercial |
$1,362.59
|
| Rate for Payer: HFN Commercial |
$1,408.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,148.25
|
| Rate for Payer: Multiplan Commercial |
$1,224.80
|
| Rate for Payer: NAPHCARE Commercial |
$918.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,408.52
|
| Rate for Payer: Quartz Beloit One Network |
$750.19
|
| Rate for Payer: Quartz Commercial |
$995.15
|
| Rate for Payer: Quartz Medicare Advantage |
$918.60
|
| Rate for Payer: The Alliance Commercial |
$6,124.00
|
| Rate for Payer: WEA Trust Commercial |
$842.05
|
| Rate for Payer: WPS Commercial |
$1,134.01
|
|
|
SCREW LOCK 3.5 X 28MM LP AR-8835L-28
|
Facility
|
IP
|
$1,531.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5496982
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$750.19 |
| Max. Negotiated Rate |
$1,408.52 |
| Rate for Payer: Aetna Commercial |
$1,377.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,316.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$811.43
|
| Rate for Payer: Cash Price |
$459.30
|
| Rate for Payer: Cigna Commercial |
$1,408.52
|
| Rate for Payer: Health EOS Commercial |
$1,362.59
|
| Rate for Payer: HFN Commercial |
$1,408.52
|
| Rate for Payer: Multiplan Commercial |
$1,224.80
|
| Rate for Payer: NAPHCARE Commercial |
$918.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,408.52
|
| Rate for Payer: Quartz Beloit One Network |
$750.19
|
| Rate for Payer: Quartz Commercial |
$918.60
|
| Rate for Payer: WEA Trust Commercial |
$842.05
|
| Rate for Payer: WPS Commercial |
$1,134.01
|
|
|
SCREW-LOCK 3.5 X 30 212.111
|
Facility
|
IP
|
$692.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966892
|
|
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 30 212.111
|
Facility
|
OP
|
$692.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966892
|
|
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 30MM LP AR-8835L-30
|
Facility
|
IP
|
$1,531.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5496983
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$750.19 |
| Max. Negotiated Rate |
$1,408.52 |
| Rate for Payer: Aetna Commercial |
$1,377.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,316.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$811.43
|
| Rate for Payer: Cash Price |
$459.30
|
| Rate for Payer: Cigna Commercial |
$1,408.52
|
| Rate for Payer: Health EOS Commercial |
$1,362.59
|
| Rate for Payer: HFN Commercial |
$1,408.52
|
| Rate for Payer: Multiplan Commercial |
$1,224.80
|
| Rate for Payer: NAPHCARE Commercial |
$918.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,408.52
|
| Rate for Payer: Quartz Beloit One Network |
$750.19
|
| Rate for Payer: Quartz Commercial |
$918.60
|
| Rate for Payer: WEA Trust Commercial |
$842.05
|
| Rate for Payer: WPS Commercial |
$1,134.01
|
|
|
SCREW LOCK 3.5 X 30MM LP AR-8835L-30
|
Facility
|
OP
|
$1,531.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5496983
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$428.68 |
| Max. Negotiated Rate |
$6,124.00 |
| Rate for Payer: Aetna Commercial |
$1,377.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,316.66
|
| Rate for Payer: Aetna Managed Medicare |
$428.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$995.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$765.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$734.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$811.43
|
| Rate for Payer: Cash Price |
$459.30
|
| Rate for Payer: Cigna Commercial |
$1,408.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$856.75
|
| Rate for Payer: Health EOS Commercial |
$1,362.59
|
| Rate for Payer: HFN Commercial |
$1,408.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,148.25
|
| Rate for Payer: Multiplan Commercial |
$1,224.80
|
| Rate for Payer: NAPHCARE Commercial |
$918.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,408.52
|
| Rate for Payer: Quartz Beloit One Network |
$750.19
|
| Rate for Payer: Quartz Commercial |
$995.15
|
| Rate for Payer: Quartz Medicare Advantage |
$918.60
|
| Rate for Payer: The Alliance Commercial |
$6,124.00
|
| Rate for Payer: WEA Trust Commercial |
$842.05
|
| Rate for Payer: WPS Commercial |
$1,134.01
|
|
