|
SCREW LOCK 3.5 X 42.5MM MFT-021-35-425
|
Facility
|
OP
|
$3,283.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4028657
|
|
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 44 212.134
|
Facility
|
OP
|
$1,462.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6174858
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$409.36 |
| Max. Negotiated Rate |
$5,848.00 |
| Rate for Payer: Aetna Commercial |
$1,315.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,257.32
|
| Rate for Payer: Aetna Managed Medicare |
$409.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$950.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$731.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$701.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$774.86
|
| Rate for Payer: Cash Price |
$438.60
|
| Rate for Payer: Cigna Commercial |
$1,345.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$818.14
|
| Rate for Payer: Health EOS Commercial |
$1,301.18
|
| Rate for Payer: HFN Commercial |
$1,345.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,096.50
|
| Rate for Payer: Multiplan Commercial |
$1,169.60
|
| Rate for Payer: NAPHCARE Commercial |
$877.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,345.04
|
| Rate for Payer: Quartz Beloit One Network |
$716.38
|
| Rate for Payer: Quartz Commercial |
$950.30
|
| Rate for Payer: Quartz Medicare Advantage |
$877.20
|
| Rate for Payer: The Alliance Commercial |
$5,848.00
|
| Rate for Payer: WEA Trust Commercial |
$804.10
|
| Rate for Payer: WPS Commercial |
$1,082.90
|
|
|
SCREW LOCK 3.5 X 44 212.134
|
Facility
|
IP
|
$1,462.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6174858
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$716.38 |
| Max. Negotiated Rate |
$1,345.04 |
| Rate for Payer: Aetna Commercial |
$1,315.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,257.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$774.86
|
| Rate for Payer: Cash Price |
$438.60
|
| Rate for Payer: Cigna Commercial |
$1,345.04
|
| Rate for Payer: Health EOS Commercial |
$1,301.18
|
| Rate for Payer: HFN Commercial |
$1,345.04
|
| Rate for Payer: Multiplan Commercial |
$1,169.60
|
| Rate for Payer: NAPHCARE Commercial |
$877.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,345.04
|
| Rate for Payer: Quartz Beloit One Network |
$716.38
|
| Rate for Payer: Quartz Commercial |
$877.20
|
| Rate for Payer: WEA Trust Commercial |
$804.10
|
| Rate for Payer: WPS Commercial |
$1,082.90
|
|
|
SCREW-LOCK 3.5 X 45 212.119
|
Facility
|
IP
|
$692.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966901
|
|
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 45 212.119
|
Facility
|
OP
|
$692.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966901
|
|
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 48MM 212.120
|
Facility
|
OP
|
$1,408.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5803719
|
|
Hospital Revenue Code
|
289
|
| Min. Negotiated Rate |
$394.24 |
| Max. Negotiated Rate |
$5,632.00 |
| Rate for Payer: Aetna Commercial |
$1,267.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,210.88
|
| Rate for Payer: Aetna Managed Medicare |
$394.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$915.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$704.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$675.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$746.24
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Cigna Commercial |
$1,295.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$787.92
|
| Rate for Payer: Health EOS Commercial |
$1,253.12
|
| Rate for Payer: HFN Commercial |
$1,295.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,056.00
|
| Rate for Payer: Multiplan Commercial |
$1,126.40
|
| Rate for Payer: NAPHCARE Commercial |
$844.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,295.36
|
| Rate for Payer: Quartz Beloit One Network |
$689.92
|
| Rate for Payer: Quartz Commercial |
$915.20
|
| Rate for Payer: Quartz Medicare Advantage |
$844.80
|
| Rate for Payer: The Alliance Commercial |
$5,632.00
|
| Rate for Payer: United Healthcare PPO |
$1,056.00
|
| Rate for Payer: WEA Trust Commercial |
$774.40
|
| Rate for Payer: WPS Commercial |
$1,042.91
|
|
|
SCREW LOCK 3.5 X 48MM 212.120
|
Facility
|
IP
|
$1,408.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5803719
|
|
Hospital Revenue Code
|
289
|
| Min. Negotiated Rate |
$689.92 |
| Max. Negotiated Rate |
$1,295.36 |
| Rate for Payer: Aetna Commercial |
$1,267.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,210.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$746.24
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Cigna Commercial |
$1,295.36
|
| Rate for Payer: Health EOS Commercial |
$1,253.12
|
| Rate for Payer: HFN Commercial |
$1,295.36
|
| Rate for Payer: Multiplan Commercial |
$1,126.40
|
| Rate for Payer: NAPHCARE Commercial |
$844.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,295.36
|
| Rate for Payer: Quartz Beloit One Network |
$689.92
|
| Rate for Payer: Quartz Commercial |
$844.80
|
| Rate for Payer: WEA Trust Commercial |
$774.40
|
| Rate for Payer: WPS Commercial |
$1,042.91
|
|
|
SCREW LOCK 3.5 X 50 212.121
|
Facility
|
IP
|
$692.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966903
|
|
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 50 212.121
|
Facility
|
OP
|
$692.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966903
|
|
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 52MM 212.122
|
Facility
|
OP
|
$1,408.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5803720
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$394.24 |
| Max. Negotiated Rate |
$5,632.00 |
| Rate for Payer: Aetna Commercial |
$1,267.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,210.88
|
| Rate for Payer: Aetna Managed Medicare |
$394.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$915.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$704.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$675.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$746.24
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Cigna Commercial |
$1,295.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$787.92
|
| Rate for Payer: Health EOS Commercial |
$1,253.12
|
| Rate for Payer: HFN Commercial |
$1,295.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,056.00
|
| Rate for Payer: Multiplan Commercial |
$1,126.40
|
| Rate for Payer: NAPHCARE Commercial |
$844.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,295.36
|
| Rate for Payer: Quartz Beloit One Network |
$689.92
|
| Rate for Payer: Quartz Commercial |
$915.20
|
| Rate for Payer: Quartz Medicare Advantage |
$844.80
|
| Rate for Payer: The Alliance Commercial |
$5,632.00
|
| Rate for Payer: WEA Trust Commercial |
$774.40
|
| Rate for Payer: WPS Commercial |
$1,042.91
|
|
|
SCREW LOCK 3.5 X 52MM 212.122
|
Facility
|
IP
|
$1,408.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5803720
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$689.92 |
| Max. Negotiated Rate |
$1,295.36 |
| Rate for Payer: Aetna Commercial |
$1,267.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,210.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$746.24
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Cigna Commercial |
$1,295.36
|
| Rate for Payer: Health EOS Commercial |
$1,253.12
|
| Rate for Payer: HFN Commercial |
$1,295.36
|
| Rate for Payer: Multiplan Commercial |
$1,126.40
|
| Rate for Payer: NAPHCARE Commercial |
$844.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,295.36
|
| Rate for Payer: Quartz Beloit One Network |
$689.92
|
| Rate for Payer: Quartz Commercial |
$844.80
|
| Rate for Payer: WEA Trust Commercial |
$774.40
|
| Rate for Payer: WPS Commercial |
$1,042.91
|
|
|
SCREW LOCK 3.5 X 55 212.123
|
Facility
|
IP
|
$692.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966905
|
|
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 55 212.123
|
Facility
|
OP
|
$692.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966905
|
|
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 60 212.124
|
Facility
|
OP
|
$692.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966907
|
|
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 60 212.124
|
Facility
|
IP
|
$692.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966907
|
|
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 3Di 3.5 X 20MM ORTHOLOC 58803520
|
Facility
|
IP
|
$2,743.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6185017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,344.07 |
| Max. Negotiated Rate |
$2,523.56 |
| Rate for Payer: Aetna Commercial |
$2,468.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,358.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,453.79
|
| Rate for Payer: Cash Price |
$822.90
|
| Rate for Payer: Cigna Commercial |
$2,523.56
|
| Rate for Payer: Health EOS Commercial |
$2,441.27
|
| Rate for Payer: HFN Commercial |
$2,523.56
|
| Rate for Payer: Multiplan Commercial |
$2,194.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,645.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,523.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,344.07
|
| Rate for Payer: Quartz Commercial |
$1,645.80
|
| Rate for Payer: WEA Trust Commercial |
$1,508.65
|
| Rate for Payer: WPS Commercial |
$2,031.74
|
|
|
SCREW LOCK 3Di 3.5 X 20MM ORTHOLOC 58803520
|
Facility
|
OP
|
$2,743.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6185017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$768.04 |
| Max. Negotiated Rate |
$10,972.00 |
| Rate for Payer: Aetna Commercial |
$2,468.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,358.98
|
| Rate for Payer: Aetna Managed Medicare |
$768.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,782.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,371.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,316.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,453.79
|
| Rate for Payer: Cash Price |
$822.90
|
| Rate for Payer: Cigna Commercial |
$2,523.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,534.98
|
| Rate for Payer: Health EOS Commercial |
$2,441.27
|
| Rate for Payer: HFN Commercial |
$2,523.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,057.25
|
| Rate for Payer: Multiplan Commercial |
$2,194.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,645.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,523.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,344.07
|
| Rate for Payer: Quartz Commercial |
$1,782.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,645.80
|
| Rate for Payer: The Alliance Commercial |
$10,972.00
|
| Rate for Payer: WEA Trust Commercial |
$1,508.65
|
| Rate for Payer: WPS Commercial |
$2,031.74
|
|
|
SCREW LOCK 3Di 3.5 X 22MM ORTHOLOC 58803522
|
Facility
|
IP
|
$2,743.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6182938
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,344.07 |
| Max. Negotiated Rate |
$2,523.56 |
| Rate for Payer: Aetna Commercial |
$2,468.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,358.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,453.79
|
| Rate for Payer: Cash Price |
$822.90
|
| Rate for Payer: Cigna Commercial |
$2,523.56
|
| Rate for Payer: Health EOS Commercial |
$2,441.27
|
| Rate for Payer: HFN Commercial |
$2,523.56
|
| Rate for Payer: Multiplan Commercial |
$2,194.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,645.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,523.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,344.07
|
| Rate for Payer: Quartz Commercial |
$1,645.80
|
| Rate for Payer: WEA Trust Commercial |
$1,508.65
|
| Rate for Payer: WPS Commercial |
$2,031.74
|
|
|
SCREW LOCK 3Di 3.5 X 22MM ORTHOLOC 58803522
|
Facility
|
OP
|
$2,743.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6182938
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$768.04 |
| Max. Negotiated Rate |
$10,972.00 |
| Rate for Payer: Aetna Commercial |
$2,468.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,358.98
|
| Rate for Payer: Aetna Managed Medicare |
$768.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,782.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,371.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,316.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,453.79
|
| Rate for Payer: Cash Price |
$822.90
|
| Rate for Payer: Cigna Commercial |
$2,523.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,534.98
|
| Rate for Payer: Health EOS Commercial |
$2,441.27
|
| Rate for Payer: HFN Commercial |
$2,523.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,057.25
|
| Rate for Payer: Multiplan Commercial |
$2,194.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,645.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,523.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,344.07
|
| Rate for Payer: Quartz Commercial |
$1,782.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,645.80
|
| Rate for Payer: The Alliance Commercial |
$10,972.00
|
| Rate for Payer: WEA Trust Commercial |
$1,508.65
|
| Rate for Payer: WPS Commercial |
$2,031.74
|
|
|
SCREW LOCK 3Di 3.5 X 26MM ORTHOLOC 58803526
|
Facility
|
OP
|
$2,743.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6182939
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$768.04 |
| Max. Negotiated Rate |
$10,972.00 |
| Rate for Payer: Aetna Commercial |
$2,468.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,358.98
|
| Rate for Payer: Aetna Managed Medicare |
$768.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,782.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,371.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,316.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,453.79
|
| Rate for Payer: Cash Price |
$822.90
|
| Rate for Payer: Cigna Commercial |
$2,523.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,534.98
|
| Rate for Payer: Health EOS Commercial |
$2,441.27
|
| Rate for Payer: HFN Commercial |
$2,523.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,057.25
|
| Rate for Payer: Multiplan Commercial |
$2,194.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,645.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,523.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,344.07
|
| Rate for Payer: Quartz Commercial |
$1,782.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,645.80
|
| Rate for Payer: The Alliance Commercial |
$10,972.00
|
| Rate for Payer: WEA Trust Commercial |
$1,508.65
|
| Rate for Payer: WPS Commercial |
$2,031.74
|
|
|
SCREW LOCK 3Di 3.5 X 26MM ORTHOLOC 58803526
|
Facility
|
IP
|
$2,743.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6182939
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,344.07 |
| Max. Negotiated Rate |
$2,523.56 |
| Rate for Payer: Aetna Commercial |
$2,468.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,358.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,453.79
|
| Rate for Payer: Cash Price |
$822.90
|
| Rate for Payer: Cigna Commercial |
$2,523.56
|
| Rate for Payer: Health EOS Commercial |
$2,441.27
|
| Rate for Payer: HFN Commercial |
$2,523.56
|
| Rate for Payer: Multiplan Commercial |
$2,194.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,645.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,523.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,344.07
|
| Rate for Payer: Quartz Commercial |
$1,645.80
|
| Rate for Payer: WEA Trust Commercial |
$1,508.65
|
| Rate for Payer: WPS Commercial |
$2,031.74
|
|
|
SCREW LOCK 3Di 3.5 X 28MM ORTHOLOC 58803528
|
Facility
|
OP
|
$2,743.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6182940
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$768.04 |
| Max. Negotiated Rate |
$10,972.00 |
| Rate for Payer: Aetna Commercial |
$2,468.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,358.98
|
| Rate for Payer: Aetna Managed Medicare |
$768.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,782.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,371.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,316.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,453.79
|
| Rate for Payer: Cash Price |
$822.90
|
| Rate for Payer: Cigna Commercial |
$2,523.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,534.98
|
| Rate for Payer: Health EOS Commercial |
$2,441.27
|
| Rate for Payer: HFN Commercial |
$2,523.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,057.25
|
| Rate for Payer: Multiplan Commercial |
$2,194.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,645.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,523.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,344.07
|
| Rate for Payer: Quartz Commercial |
$1,782.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,645.80
|
| Rate for Payer: The Alliance Commercial |
$10,972.00
|
| Rate for Payer: WEA Trust Commercial |
$1,508.65
|
| Rate for Payer: WPS Commercial |
$2,031.74
|
|
|
SCREW LOCK 3Di 3.5 X 28MM ORTHOLOC 58803528
|
Facility
|
IP
|
$2,743.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6182940
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,344.07 |
| Max. Negotiated Rate |
$2,523.56 |
| Rate for Payer: Aetna Commercial |
$2,468.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,358.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,453.79
|
| Rate for Payer: Cash Price |
$822.90
|
| Rate for Payer: Cigna Commercial |
$2,523.56
|
| Rate for Payer: Health EOS Commercial |
$2,441.27
|
| Rate for Payer: HFN Commercial |
$2,523.56
|
| Rate for Payer: Multiplan Commercial |
$2,194.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,645.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,523.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,344.07
|
| Rate for Payer: Quartz Commercial |
$1,645.80
|
| Rate for Payer: WEA Trust Commercial |
$1,508.65
|
| Rate for Payer: WPS Commercial |
$2,031.74
|
|
|
SCREW-LOCK 4.0 X 14 222.580
|
Facility
|
IP
|
$591.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966908
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$289.59 |
| Max. Negotiated Rate |
$543.72 |
| Rate for Payer: Aetna Commercial |
$531.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$508.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$313.23
|
| Rate for Payer: Cash Price |
$177.30
|
| Rate for Payer: Cigna Commercial |
$543.72
|
| Rate for Payer: Health EOS Commercial |
$525.99
|
| Rate for Payer: HFN Commercial |
$543.72
|
| Rate for Payer: Multiplan Commercial |
$472.80
|
| Rate for Payer: NAPHCARE Commercial |
$354.60
|
| Rate for Payer: Preferred Network Access Commercial |
$543.72
|
| Rate for Payer: Quartz Beloit One Network |
$289.59
|
| Rate for Payer: Quartz Commercial |
$354.60
|
| Rate for Payer: WEA Trust Commercial |
$325.05
|
| Rate for Payer: WPS Commercial |
$437.75
|
|
|
SCREW-LOCK 4.0 X 14 222.580
|
Facility
|
OP
|
$591.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966908
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$165.48 |
| Max. Negotiated Rate |
$2,364.00 |
| Rate for Payer: Aetna Commercial |
$531.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$508.26
|
| Rate for Payer: Aetna Managed Medicare |
$165.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$384.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$295.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$283.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$313.23
|
| Rate for Payer: Cash Price |
$177.30
|
| Rate for Payer: Cigna Commercial |
$543.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$330.72
|
| Rate for Payer: Health EOS Commercial |
$525.99
|
| Rate for Payer: HFN Commercial |
$543.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$443.25
|
| Rate for Payer: Multiplan Commercial |
$472.80
|
| Rate for Payer: NAPHCARE Commercial |
$354.60
|
| Rate for Payer: Preferred Network Access Commercial |
$543.72
|
| Rate for Payer: Quartz Beloit One Network |
$289.59
|
| Rate for Payer: Quartz Commercial |
$384.15
|
| Rate for Payer: Quartz Medicare Advantage |
$354.60
|
| Rate for Payer: The Alliance Commercial |
$2,364.00
|
| Rate for Payer: WEA Trust Commercial |
$325.05
|
| Rate for Payer: WPS Commercial |
$437.75
|
|
