|
SCREW LOCK 5.0 X 38MM TI 04.005.528S
|
Facility
|
OP
|
$2,834.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966537
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$825.26 |
| Max. Negotiated Rate |
$2,711.57 |
| Rate for Payer: Aetna Commercial |
$2,652.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,534.73
|
| Rate for Payer: Aetna Managed Medicare |
$825.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,915.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,473.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,414.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,562.10
|
| Rate for Payer: Cash Price |
$850.20
|
| Rate for Payer: Cigna Commercial |
$2,711.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,649.39
|
| Rate for Payer: Health EOS Commercial |
$2,623.15
|
| Rate for Payer: HFN Commercial |
$2,711.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,210.52
|
| Rate for Payer: Multiplan Commercial |
$2,357.89
|
| Rate for Payer: NAPHCARE Commercial |
$1,768.42
|
| Rate for Payer: Preferred Network Access Commercial |
$2,711.57
|
| Rate for Payer: Quartz Beloit One Network |
$1,444.21
|
| Rate for Payer: Quartz Commercial |
$1,915.78
|
| Rate for Payer: Quartz Medicare Advantage |
$1,768.42
|
| Rate for Payer: The Alliance Commercial |
$1,473.68
|
| Rate for Payer: WEA Trust Commercial |
$1,621.05
|
| Rate for Payer: WPS Commercial |
$2,183.03
|
|
|
SCREW LOCK 5.0 X 38MM XL25 IM NAIL TI 04.045.038S
|
Facility
|
OP
|
$2,721.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6182647
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$792.36 |
| Max. Negotiated Rate |
$2,603.45 |
| Rate for Payer: Aetna Commercial |
$2,546.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,433.66
|
| Rate for Payer: Aetna Managed Medicare |
$792.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,839.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,414.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,358.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,499.82
|
| Rate for Payer: Cash Price |
$816.30
|
| Rate for Payer: Cigna Commercial |
$2,603.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,583.62
|
| Rate for Payer: Health EOS Commercial |
$2,518.56
|
| Rate for Payer: HFN Commercial |
$2,603.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,122.38
|
| Rate for Payer: Multiplan Commercial |
$2,263.87
|
| Rate for Payer: NAPHCARE Commercial |
$1,697.90
|
| Rate for Payer: Preferred Network Access Commercial |
$2,603.45
|
| Rate for Payer: Quartz Beloit One Network |
$1,386.62
|
| Rate for Payer: Quartz Commercial |
$1,839.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,697.90
|
| Rate for Payer: The Alliance Commercial |
$1,414.92
|
| Rate for Payer: WEA Trust Commercial |
$1,556.41
|
| Rate for Payer: WPS Commercial |
$2,095.99
|
|
|
SCREW LOCK 5.0 X 38MM XL25 IM NAIL TI 04.045.038S
|
Facility
|
IP
|
$2,721.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6182647
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,386.62 |
| Max. Negotiated Rate |
$2,603.45 |
| Rate for Payer: Aetna Commercial |
$2,546.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,433.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,499.82
|
| Rate for Payer: Cash Price |
$816.30
|
| Rate for Payer: Cigna Commercial |
$2,603.45
|
| Rate for Payer: Health EOS Commercial |
$2,518.56
|
| Rate for Payer: HFN Commercial |
$2,603.45
|
| Rate for Payer: Multiplan Commercial |
$2,263.87
|
| Rate for Payer: Preferred Network Access Commercial |
$2,603.45
|
| Rate for Payer: Quartz Beloit One Network |
$1,386.62
|
| Rate for Payer: Quartz Commercial |
$1,697.90
|
| Rate for Payer: WEA Trust Commercial |
$1,556.41
|
| Rate for Payer: WPS Commercial |
$2,095.99
|
|
|
SCREW-LOCK 5.0 X 38 TFN 458.938
|
Facility
|
IP
|
$2,724.00
|
|
| Hospital Charge Code |
2966972
|
|
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 38 TFN 458.938
|
Facility
|
OP
|
$2,724.00
|
|
| Hospital Charge Code |
2966972
|
|
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 38 VA 02.231.238
|
Facility
|
IP
|
$2,255.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494426
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,149.15 |
| Max. Negotiated Rate |
$2,157.58 |
| Rate for Payer: Aetna Commercial |
$2,110.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,016.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,242.96
|
| Rate for Payer: Cash Price |
$676.50
|
| Rate for Payer: Cigna Commercial |
$2,157.58
|
| Rate for Payer: Health EOS Commercial |
$2,087.23
|
| Rate for Payer: HFN Commercial |
$2,157.58
|
| Rate for Payer: Multiplan Commercial |
$1,876.16
|
| Rate for Payer: Preferred Network Access Commercial |
$2,157.58
|
| Rate for Payer: Quartz Beloit One Network |
$1,149.15
|
| Rate for Payer: Quartz Commercial |
$1,407.12
|
| Rate for Payer: WEA Trust Commercial |
$1,289.86
|
| Rate for Payer: WPS Commercial |
$1,737.03
|
|
|
SCREW LOCK 5.0 X 38 VA 02.231.238
|
Facility
|
OP
|
$2,255.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494426
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$656.66 |
| Max. Negotiated Rate |
$2,157.58 |
| Rate for Payer: Aetna Commercial |
$2,110.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,016.87
|
| Rate for Payer: Aetna Managed Medicare |
$656.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,524.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,172.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,125.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,242.96
|
| Rate for Payer: Cash Price |
$676.50
|
| Rate for Payer: Cigna Commercial |
$2,157.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,312.41
|
| Rate for Payer: Health EOS Commercial |
$2,087.23
|
| Rate for Payer: HFN Commercial |
$2,157.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,758.90
|
| Rate for Payer: Multiplan Commercial |
$1,876.16
|
| Rate for Payer: NAPHCARE Commercial |
$1,407.12
|
| Rate for Payer: Preferred Network Access Commercial |
$2,157.58
|
| Rate for Payer: Quartz Beloit One Network |
$1,149.15
|
| Rate for Payer: Quartz Commercial |
$1,524.38
|
| Rate for Payer: Quartz Medicare Advantage |
$1,407.12
|
| Rate for Payer: The Alliance Commercial |
$1,172.60
|
| Rate for Payer: WEA Trust Commercial |
$1,289.86
|
| Rate for Payer: WPS Commercial |
$1,737.03
|
|
|
SCREW-LOCK 5.0X40 212.214
|
Facility
|
IP
|
$1,917.00
|
|
| Hospital Charge Code |
2966974
|
|
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 5.0X40 212.214
|
Facility
|
OP
|
$1,917.00
|
|
| Hospital Charge Code |
2966974
|
|
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 40 FULLY THREAD 1896-5040S
|
Facility
|
IP
|
$2,661.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3605503
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,356.05 |
| Max. Negotiated Rate |
$2,546.04 |
| Rate for Payer: Aetna Commercial |
$2,490.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,380.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,466.74
|
| Rate for Payer: Cash Price |
$798.30
|
| Rate for Payer: Cigna Commercial |
$2,546.04
|
| Rate for Payer: Health EOS Commercial |
$2,463.02
|
| Rate for Payer: HFN Commercial |
$2,546.04
|
| Rate for Payer: Multiplan Commercial |
$2,213.95
|
| Rate for Payer: Preferred Network Access Commercial |
$2,546.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,356.05
|
| Rate for Payer: Quartz Commercial |
$1,660.46
|
| Rate for Payer: WEA Trust Commercial |
$1,522.09
|
| Rate for Payer: WPS Commercial |
$2,049.77
|
|
|
SCREW LOCK 5.0 X 40 FULLY THREAD 1896-5040S
|
Facility
|
OP
|
$2,661.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3605503
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$774.88 |
| Max. Negotiated Rate |
$2,546.04 |
| Rate for Payer: Aetna Commercial |
$2,490.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,380.00
|
| Rate for Payer: Aetna Managed Medicare |
$774.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,798.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,383.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,328.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,466.74
|
| Rate for Payer: Cash Price |
$798.30
|
| Rate for Payer: Cigna Commercial |
$2,546.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,548.70
|
| Rate for Payer: Health EOS Commercial |
$2,463.02
|
| Rate for Payer: HFN Commercial |
$2,546.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,075.58
|
| Rate for Payer: Multiplan Commercial |
$2,213.95
|
| Rate for Payer: NAPHCARE Commercial |
$1,660.46
|
| Rate for Payer: Preferred Network Access Commercial |
$2,546.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,356.05
|
| Rate for Payer: Quartz Commercial |
$1,798.84
|
| Rate for Payer: Quartz Medicare Advantage |
$1,660.46
|
| Rate for Payer: The Alliance Commercial |
$1,383.72
|
| Rate for Payer: WEA Trust Commercial |
$1,522.09
|
| Rate for Payer: WPS Commercial |
$2,049.77
|
|
|
SCREW LOCK 5.0 X 40MM ST T25 STARDRIVE 412.214S
|
Facility
|
OP
|
$1,906.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6178983
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$555.03 |
| Max. Negotiated Rate |
$1,823.66 |
| Rate for Payer: Aetna Commercial |
$1,784.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,704.73
|
| Rate for Payer: Aetna Managed Medicare |
$555.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,288.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$991.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$951.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,050.59
|
| Rate for Payer: Cash Price |
$571.80
|
| Rate for Payer: Cigna Commercial |
$1,823.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,109.29
|
| Rate for Payer: Health EOS Commercial |
$1,764.19
|
| Rate for Payer: HFN Commercial |
$1,823.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,486.68
|
| Rate for Payer: Multiplan Commercial |
$1,585.79
|
| Rate for Payer: NAPHCARE Commercial |
$1,189.34
|
| Rate for Payer: Preferred Network Access Commercial |
$1,823.66
|
| Rate for Payer: Quartz Beloit One Network |
$971.30
|
| Rate for Payer: Quartz Commercial |
$1,288.46
|
| Rate for Payer: Quartz Medicare Advantage |
$1,189.34
|
| Rate for Payer: The Alliance Commercial |
$991.12
|
| Rate for Payer: WEA Trust Commercial |
$1,090.23
|
| Rate for Payer: WPS Commercial |
$1,468.19
|
|
|
SCREW LOCK 5.0 X 40MM ST T25 STARDRIVE 412.214S
|
Facility
|
IP
|
$1,906.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6178983
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$971.30 |
| Max. Negotiated Rate |
$1,823.66 |
| Rate for Payer: Aetna Commercial |
$1,784.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,704.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,050.59
|
| Rate for Payer: Cash Price |
$571.80
|
| Rate for Payer: Cigna Commercial |
$1,823.66
|
| Rate for Payer: Health EOS Commercial |
$1,764.19
|
| Rate for Payer: HFN Commercial |
$1,823.66
|
| Rate for Payer: Multiplan Commercial |
$1,585.79
|
| Rate for Payer: Preferred Network Access Commercial |
$1,823.66
|
| Rate for Payer: Quartz Beloit One Network |
$971.30
|
| Rate for Payer: Quartz Commercial |
$1,189.34
|
| Rate for Payer: WEA Trust Commercial |
$1,090.23
|
| Rate for Payer: WPS Commercial |
$1,468.19
|
|
|
SCREW LOCK 5.0 X 40MM TI 04.005.530S
|
Facility
|
OP
|
$2,834.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966530
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$825.26 |
| Max. Negotiated Rate |
$2,711.57 |
| Rate for Payer: Aetna Commercial |
$2,652.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,534.73
|
| Rate for Payer: Aetna Managed Medicare |
$825.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,915.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,473.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,414.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,562.10
|
| Rate for Payer: Cash Price |
$850.20
|
| Rate for Payer: Cigna Commercial |
$2,711.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,649.39
|
| Rate for Payer: Health EOS Commercial |
$2,623.15
|
| Rate for Payer: HFN Commercial |
$2,711.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,210.52
|
| Rate for Payer: Multiplan Commercial |
$2,357.89
|
| Rate for Payer: NAPHCARE Commercial |
$1,768.42
|
| Rate for Payer: Preferred Network Access Commercial |
$2,711.57
|
| Rate for Payer: Quartz Beloit One Network |
$1,444.21
|
| Rate for Payer: Quartz Commercial |
$1,915.78
|
| Rate for Payer: Quartz Medicare Advantage |
$1,768.42
|
| Rate for Payer: The Alliance Commercial |
$1,473.68
|
| Rate for Payer: WEA Trust Commercial |
$1,621.05
|
| Rate for Payer: WPS Commercial |
$2,183.03
|
|
|
SCREW LOCK 5.0 X 40MM TI 04.005.530S
|
Facility
|
IP
|
$2,834.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966530
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.21 |
| Max. Negotiated Rate |
$2,711.57 |
| Rate for Payer: Aetna Commercial |
$2,652.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,534.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,562.10
|
| Rate for Payer: Cash Price |
$850.20
|
| Rate for Payer: Cigna Commercial |
$2,711.57
|
| Rate for Payer: Health EOS Commercial |
$2,623.15
|
| Rate for Payer: HFN Commercial |
$2,711.57
|
| Rate for Payer: Multiplan Commercial |
$2,357.89
|
| Rate for Payer: Preferred Network Access Commercial |
$2,711.57
|
| Rate for Payer: Quartz Beloit One Network |
$1,444.21
|
| Rate for Payer: Quartz Commercial |
$1,768.42
|
| Rate for Payer: WEA Trust Commercial |
$1,621.05
|
| Rate for Payer: WPS Commercial |
$2,183.03
|
|
|
SCREW LOCK 5.0 X 40MM XL25 IM NAIL TI 04.045.040S
|
Facility
|
IP
|
$2,826.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6175475
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,440.13 |
| Max. Negotiated Rate |
$2,703.92 |
| Rate for Payer: Aetna Commercial |
$2,645.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,527.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,557.69
|
| Rate for Payer: Cash Price |
$847.80
|
| Rate for Payer: Cigna Commercial |
$2,703.92
|
| Rate for Payer: Health EOS Commercial |
$2,615.75
|
| Rate for Payer: HFN Commercial |
$2,703.92
|
| Rate for Payer: Multiplan Commercial |
$2,351.23
|
| Rate for Payer: Preferred Network Access Commercial |
$2,703.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,440.13
|
| Rate for Payer: Quartz Commercial |
$1,763.42
|
| Rate for Payer: WEA Trust Commercial |
$1,616.47
|
| Rate for Payer: WPS Commercial |
$2,176.87
|
|
|
SCREW LOCK 5.0 X 40MM XL25 IM NAIL TI 04.045.040S
|
Facility
|
OP
|
$2,826.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6175475
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$822.93 |
| Max. Negotiated Rate |
$2,703.92 |
| Rate for Payer: Aetna Commercial |
$2,645.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,527.57
|
| Rate for Payer: Aetna Managed Medicare |
$822.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,910.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,469.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,410.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,557.69
|
| Rate for Payer: Cash Price |
$847.80
|
| Rate for Payer: Cigna Commercial |
$2,703.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,644.73
|
| Rate for Payer: Health EOS Commercial |
$2,615.75
|
| Rate for Payer: HFN Commercial |
$2,703.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,204.28
|
| Rate for Payer: Multiplan Commercial |
$2,351.23
|
| Rate for Payer: NAPHCARE Commercial |
$1,763.42
|
| Rate for Payer: Preferred Network Access Commercial |
$2,703.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,440.13
|
| Rate for Payer: Quartz Commercial |
$1,910.38
|
| Rate for Payer: Quartz Medicare Advantage |
$1,763.42
|
| Rate for Payer: The Alliance Commercial |
$1,469.52
|
| Rate for Payer: WEA Trust Commercial |
$1,616.47
|
| Rate for Payer: WPS Commercial |
$2,176.87
|
|
|
SCREW-LOCK 5.0 X 40 TFN 458.940
|
Facility
|
OP
|
$2,724.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966975
|
|
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 40 TFN 458.940
|
Facility
|
IP
|
$2,724.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966975
|
|
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 40 VA 02.231.240
|
Facility
|
OP
|
$2,255.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494425
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$656.66 |
| Max. Negotiated Rate |
$2,157.58 |
| Rate for Payer: Aetna Commercial |
$2,110.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,016.87
|
| Rate for Payer: Aetna Managed Medicare |
$656.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,524.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,172.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,125.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,242.96
|
| Rate for Payer: Cash Price |
$676.50
|
| Rate for Payer: Cigna Commercial |
$2,157.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,312.41
|
| Rate for Payer: Health EOS Commercial |
$2,087.23
|
| Rate for Payer: HFN Commercial |
$2,157.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,758.90
|
| Rate for Payer: Multiplan Commercial |
$1,876.16
|
| Rate for Payer: NAPHCARE Commercial |
$1,407.12
|
| Rate for Payer: Preferred Network Access Commercial |
$2,157.58
|
| Rate for Payer: Quartz Beloit One Network |
$1,149.15
|
| Rate for Payer: Quartz Commercial |
$1,524.38
|
| Rate for Payer: Quartz Medicare Advantage |
$1,407.12
|
| Rate for Payer: The Alliance Commercial |
$1,172.60
|
| Rate for Payer: WEA Trust Commercial |
$1,289.86
|
| Rate for Payer: WPS Commercial |
$1,737.03
|
|
|
SCREW LOCK 5.0 X 40 VA 02.231.240
|
Facility
|
IP
|
$2,255.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494425
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,149.15 |
| Max. Negotiated Rate |
$2,157.58 |
| Rate for Payer: Aetna Commercial |
$2,110.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,016.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,242.96
|
| Rate for Payer: Cash Price |
$676.50
|
| Rate for Payer: Cigna Commercial |
$2,157.58
|
| Rate for Payer: Health EOS Commercial |
$2,087.23
|
| Rate for Payer: HFN Commercial |
$2,157.58
|
| Rate for Payer: Multiplan Commercial |
$1,876.16
|
| Rate for Payer: Preferred Network Access Commercial |
$2,157.58
|
| Rate for Payer: Quartz Beloit One Network |
$1,149.15
|
| Rate for Payer: Quartz Commercial |
$1,407.12
|
| Rate for Payer: WEA Trust Commercial |
$1,289.86
|
| Rate for Payer: WPS Commercial |
$1,737.03
|
|
|
SCREW-LOCK 5.0X42 212.215
|
Facility
|
OP
|
$1,917.00
|
|
| Hospital Charge Code |
2966976
|
|
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 5.0X42 212.215
|
Facility
|
IP
|
$1,917.00
|
|
| Hospital Charge Code |
2966976
|
|
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 42.5 FULLY THEAD 1896-5042S
|
Facility
|
OP
|
$2,661.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4252225
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$774.88 |
| Max. Negotiated Rate |
$2,546.04 |
| Rate for Payer: Aetna Commercial |
$2,490.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,380.00
|
| Rate for Payer: Aetna Managed Medicare |
$774.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,798.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,383.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,328.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,466.74
|
| Rate for Payer: Cash Price |
$798.30
|
| Rate for Payer: Cigna Commercial |
$2,546.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,548.70
|
| Rate for Payer: Health EOS Commercial |
$2,463.02
|
| Rate for Payer: HFN Commercial |
$2,546.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,075.58
|
| Rate for Payer: Multiplan Commercial |
$2,213.95
|
| Rate for Payer: NAPHCARE Commercial |
$1,660.46
|
| Rate for Payer: Preferred Network Access Commercial |
$2,546.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,356.05
|
| Rate for Payer: Quartz Commercial |
$1,798.84
|
| Rate for Payer: Quartz Medicare Advantage |
$1,660.46
|
| Rate for Payer: The Alliance Commercial |
$1,383.72
|
| Rate for Payer: WEA Trust Commercial |
$1,522.09
|
| Rate for Payer: WPS Commercial |
$2,049.77
|
|
|
SCREW LOCK 5.0 X 42.5 FULLY THEAD 1896-5042S
|
Facility
|
IP
|
$2,661.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4252225
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,356.05 |
| Max. Negotiated Rate |
$2,546.04 |
| Rate for Payer: Aetna Commercial |
$2,490.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,380.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,466.74
|
| Rate for Payer: Cash Price |
$798.30
|
| Rate for Payer: Cigna Commercial |
$2,546.04
|
| Rate for Payer: Health EOS Commercial |
$2,463.02
|
| Rate for Payer: HFN Commercial |
$2,546.04
|
| Rate for Payer: Multiplan Commercial |
$2,213.95
|
| Rate for Payer: Preferred Network Access Commercial |
$2,546.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,356.05
|
| Rate for Payer: Quartz Commercial |
$1,660.46
|
| Rate for Payer: WEA Trust Commercial |
$1,522.09
|
| Rate for Payer: WPS Commercial |
$2,049.77
|
|
