|
SCREW LOCK 4.0 X 28MM TI STARDRIVE 04.005.418S
|
Facility
|
OP
|
$1,968.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3313461
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$551.04 |
| Max. Negotiated Rate |
$7,872.00 |
| Rate for Payer: Aetna Commercial |
$1,771.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,692.48
|
| Rate for Payer: Aetna Managed Medicare |
$551.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,279.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$984.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$944.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,043.04
|
| Rate for Payer: Cash Price |
$590.40
|
| Rate for Payer: Cigna Commercial |
$1,810.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,101.29
|
| Rate for Payer: Health EOS Commercial |
$1,751.52
|
| Rate for Payer: HFN Commercial |
$1,810.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,476.00
|
| Rate for Payer: Multiplan Commercial |
$1,574.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,180.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,810.56
|
| Rate for Payer: Quartz Beloit One Network |
$964.32
|
| Rate for Payer: Quartz Commercial |
$1,279.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,180.80
|
| Rate for Payer: The Alliance Commercial |
$7,872.00
|
| Rate for Payer: WEA Trust Commercial |
$1,082.40
|
| Rate for Payer: WPS Commercial |
$1,457.70
|
|
|
SCREW-LOCK 4.0 X 30 222.585
|
Facility
|
IP
|
$591.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966911
|
|
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 30 222.585
|
Facility
|
OP
|
$591.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966911
|
|
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
|
|
|
SCREW LOCK 4.0 X 30 FULLY THREAD 1896-4030S
|
Facility
|
IP
|
$1,337.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6207007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$655.13 |
| Max. Negotiated Rate |
$1,230.04 |
| Rate for Payer: Aetna Commercial |
$1,203.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,149.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$708.61
|
| Rate for Payer: Cash Price |
$401.10
|
| Rate for Payer: Cigna Commercial |
$1,230.04
|
| Rate for Payer: Health EOS Commercial |
$1,189.93
|
| Rate for Payer: HFN Commercial |
$1,230.04
|
| Rate for Payer: Multiplan Commercial |
$1,069.60
|
| Rate for Payer: NAPHCARE Commercial |
$802.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,230.04
|
| Rate for Payer: Quartz Beloit One Network |
$655.13
|
| Rate for Payer: Quartz Commercial |
$802.20
|
| Rate for Payer: WEA Trust Commercial |
$735.35
|
| Rate for Payer: WPS Commercial |
$990.32
|
|
|
SCREW LOCK 4.0 X 30 FULLY THREAD 1896-4030S
|
Facility
|
OP
|
$1,337.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6207007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$374.36 |
| Max. Negotiated Rate |
$5,348.00 |
| Rate for Payer: Aetna Commercial |
$1,203.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,149.82
|
| Rate for Payer: Aetna Managed Medicare |
$374.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$869.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$668.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$641.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$708.61
|
| Rate for Payer: Cash Price |
$401.10
|
| Rate for Payer: Cigna Commercial |
$1,230.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$748.19
|
| Rate for Payer: Health EOS Commercial |
$1,189.93
|
| Rate for Payer: HFN Commercial |
$1,230.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,002.75
|
| Rate for Payer: Multiplan Commercial |
$1,069.60
|
| Rate for Payer: NAPHCARE Commercial |
$802.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,230.04
|
| Rate for Payer: Quartz Beloit One Network |
$655.13
|
| Rate for Payer: Quartz Commercial |
$869.05
|
| Rate for Payer: Quartz Medicare Advantage |
$802.20
|
| Rate for Payer: The Alliance Commercial |
$5,348.00
|
| Rate for Payer: WEA Trust Commercial |
$735.35
|
| Rate for Payer: WPS Commercial |
$990.32
|
|
|
SCREW LOCK 4.0 X 30MM ST 661030
|
Facility
|
IP
|
$2,489.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5458917
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,219.61 |
| Max. Negotiated Rate |
$2,289.88 |
| Rate for Payer: Aetna Commercial |
$2,240.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,140.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,319.17
|
| Rate for Payer: Cash Price |
$746.70
|
| Rate for Payer: Cigna Commercial |
$2,289.88
|
| Rate for Payer: Health EOS Commercial |
$2,215.21
|
| Rate for Payer: HFN Commercial |
$2,289.88
|
| Rate for Payer: Multiplan Commercial |
$1,991.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,493.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,289.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,219.61
|
| Rate for Payer: Quartz Commercial |
$1,493.40
|
| Rate for Payer: WEA Trust Commercial |
$1,368.95
|
| Rate for Payer: WPS Commercial |
$1,843.60
|
|
|
SCREW LOCK 4.0 X 30MM ST 661030
|
Facility
|
OP
|
$2,489.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5458917
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$696.92 |
| Max. Negotiated Rate |
$9,956.00 |
| Rate for Payer: Aetna Commercial |
$2,240.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,140.54
|
| Rate for Payer: Aetna Managed Medicare |
$696.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,617.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,244.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,194.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,319.17
|
| Rate for Payer: Cash Price |
$746.70
|
| Rate for Payer: Cigna Commercial |
$2,289.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,392.84
|
| Rate for Payer: Health EOS Commercial |
$2,215.21
|
| Rate for Payer: HFN Commercial |
$2,289.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,866.75
|
| Rate for Payer: Multiplan Commercial |
$1,991.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,493.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,289.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,219.61
|
| Rate for Payer: Quartz Commercial |
$1,617.85
|
| Rate for Payer: Quartz Medicare Advantage |
$1,493.40
|
| Rate for Payer: The Alliance Commercial |
$9,956.00
|
| Rate for Payer: WEA Trust Commercial |
$1,368.95
|
| Rate for Payer: WPS Commercial |
$1,843.60
|
|
|
SCREW LOCK 4.0 X 30MM TI STARDRIVE 04.005.420S
|
Facility
|
IP
|
$1,968.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3869341
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$964.32 |
| Max. Negotiated Rate |
$1,810.56 |
| Rate for Payer: Aetna Commercial |
$1,771.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,692.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,043.04
|
| Rate for Payer: Cash Price |
$590.40
|
| Rate for Payer: Cigna Commercial |
$1,810.56
|
| Rate for Payer: Health EOS Commercial |
$1,751.52
|
| Rate for Payer: HFN Commercial |
$1,810.56
|
| Rate for Payer: Multiplan Commercial |
$1,574.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,180.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,810.56
|
| Rate for Payer: Quartz Beloit One Network |
$964.32
|
| Rate for Payer: Quartz Commercial |
$1,180.80
|
| Rate for Payer: WEA Trust Commercial |
$1,082.40
|
| Rate for Payer: WPS Commercial |
$1,457.70
|
|
|
SCREW LOCK 4.0 X 30MM TI STARDRIVE 04.005.420S
|
Facility
|
OP
|
$1,968.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3869341
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$551.04 |
| Max. Negotiated Rate |
$7,872.00 |
| Rate for Payer: Aetna Commercial |
$1,771.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,692.48
|
| Rate for Payer: Aetna Managed Medicare |
$551.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,279.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$984.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$944.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,043.04
|
| Rate for Payer: Cash Price |
$590.40
|
| Rate for Payer: Cigna Commercial |
$1,810.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,101.29
|
| Rate for Payer: Health EOS Commercial |
$1,751.52
|
| Rate for Payer: HFN Commercial |
$1,810.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,476.00
|
| Rate for Payer: Multiplan Commercial |
$1,574.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,180.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,810.56
|
| Rate for Payer: Quartz Beloit One Network |
$964.32
|
| Rate for Payer: Quartz Commercial |
$1,279.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,180.80
|
| Rate for Payer: The Alliance Commercial |
$7,872.00
|
| Rate for Payer: WEA Trust Commercial |
$1,082.40
|
| Rate for Payer: WPS Commercial |
$1,457.70
|
|
|
SCREW LOCK 4.0 X 32 FULLY THREAD 1896-4032S
|
Facility
|
IP
|
$1,337.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6207008
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$655.13 |
| Max. Negotiated Rate |
$1,230.04 |
| Rate for Payer: Aetna Commercial |
$1,203.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,149.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$708.61
|
| Rate for Payer: Cash Price |
$401.10
|
| Rate for Payer: Cigna Commercial |
$1,230.04
|
| Rate for Payer: Health EOS Commercial |
$1,189.93
|
| Rate for Payer: HFN Commercial |
$1,230.04
|
| Rate for Payer: Multiplan Commercial |
$1,069.60
|
| Rate for Payer: NAPHCARE Commercial |
$802.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,230.04
|
| Rate for Payer: Quartz Beloit One Network |
$655.13
|
| Rate for Payer: Quartz Commercial |
$802.20
|
| Rate for Payer: WEA Trust Commercial |
$735.35
|
| Rate for Payer: WPS Commercial |
$990.32
|
|
|
SCREW LOCK 4.0 X 32 FULLY THREAD 1896-4032S
|
Facility
|
OP
|
$1,337.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6207008
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$374.36 |
| Max. Negotiated Rate |
$5,348.00 |
| Rate for Payer: Aetna Commercial |
$1,203.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,149.82
|
| Rate for Payer: Aetna Managed Medicare |
$374.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$869.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$668.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$641.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$708.61
|
| Rate for Payer: Cash Price |
$401.10
|
| Rate for Payer: Cigna Commercial |
$1,230.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$748.19
|
| Rate for Payer: Health EOS Commercial |
$1,189.93
|
| Rate for Payer: HFN Commercial |
$1,230.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,002.75
|
| Rate for Payer: Multiplan Commercial |
$1,069.60
|
| Rate for Payer: NAPHCARE Commercial |
$802.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,230.04
|
| Rate for Payer: Quartz Beloit One Network |
$655.13
|
| Rate for Payer: Quartz Commercial |
$869.05
|
| Rate for Payer: Quartz Medicare Advantage |
$802.20
|
| Rate for Payer: The Alliance Commercial |
$5,348.00
|
| Rate for Payer: WEA Trust Commercial |
$735.35
|
| Rate for Payer: WPS Commercial |
$990.32
|
|
|
SCREW LOCK 4.0 X 32MM ST 661032
|
Facility
|
OP
|
$2,589.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5520854
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$724.92 |
| Max. Negotiated Rate |
$10,356.00 |
| Rate for Payer: Aetna Commercial |
$2,330.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,226.54
|
| Rate for Payer: Aetna Managed Medicare |
$724.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,682.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,294.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,242.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,372.17
|
| Rate for Payer: Cash Price |
$776.70
|
| Rate for Payer: Cigna Commercial |
$2,381.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,448.80
|
| Rate for Payer: Health EOS Commercial |
$2,304.21
|
| Rate for Payer: HFN Commercial |
$2,381.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,941.75
|
| Rate for Payer: Multiplan Commercial |
$2,071.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,553.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,381.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,268.61
|
| Rate for Payer: Quartz Commercial |
$1,682.85
|
| Rate for Payer: Quartz Medicare Advantage |
$1,553.40
|
| Rate for Payer: The Alliance Commercial |
$10,356.00
|
| Rate for Payer: WEA Trust Commercial |
$1,423.95
|
| Rate for Payer: WPS Commercial |
$1,917.67
|
|
|
SCREW LOCK 4.0 X 32MM ST 661032
|
Facility
|
IP
|
$2,589.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5520854
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,268.61 |
| Max. Negotiated Rate |
$2,381.88 |
| Rate for Payer: Aetna Commercial |
$2,330.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,226.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,372.17
|
| Rate for Payer: Cash Price |
$776.70
|
| Rate for Payer: Cigna Commercial |
$2,381.88
|
| Rate for Payer: Health EOS Commercial |
$2,304.21
|
| Rate for Payer: HFN Commercial |
$2,381.88
|
| Rate for Payer: Multiplan Commercial |
$2,071.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,553.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,381.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,268.61
|
| Rate for Payer: Quartz Commercial |
$1,553.40
|
| Rate for Payer: WEA Trust Commercial |
$1,423.95
|
| Rate for Payer: WPS Commercial |
$1,917.67
|
|
|
SCREW LOCK 4.0 X 32MM TI STARDRIVE 04.005.422
|
Facility
|
OP
|
$1,968.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4074603
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$551.04 |
| Max. Negotiated Rate |
$7,872.00 |
| Rate for Payer: Aetna Commercial |
$1,771.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,692.48
|
| Rate for Payer: Aetna Managed Medicare |
$551.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,279.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$984.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$944.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,043.04
|
| Rate for Payer: Cash Price |
$590.40
|
| Rate for Payer: Cigna Commercial |
$1,810.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,101.29
|
| Rate for Payer: Health EOS Commercial |
$1,751.52
|
| Rate for Payer: HFN Commercial |
$1,810.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,476.00
|
| Rate for Payer: Multiplan Commercial |
$1,574.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,180.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,810.56
|
| Rate for Payer: Quartz Beloit One Network |
$964.32
|
| Rate for Payer: Quartz Commercial |
$1,279.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,180.80
|
| Rate for Payer: The Alliance Commercial |
$7,872.00
|
| Rate for Payer: WEA Trust Commercial |
$1,082.40
|
| Rate for Payer: WPS Commercial |
$1,457.70
|
|
|
SCREW LOCK 4.0 X 32MM TI STARDRIVE 04.005.422
|
Facility
|
IP
|
$1,968.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4074603
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$964.32 |
| Max. Negotiated Rate |
$1,810.56 |
| Rate for Payer: Aetna Commercial |
$1,771.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,692.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,043.04
|
| Rate for Payer: Cash Price |
$590.40
|
| Rate for Payer: Cigna Commercial |
$1,810.56
|
| Rate for Payer: Health EOS Commercial |
$1,751.52
|
| Rate for Payer: HFN Commercial |
$1,810.56
|
| Rate for Payer: Multiplan Commercial |
$1,574.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,180.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,810.56
|
| Rate for Payer: Quartz Beloit One Network |
$964.32
|
| Rate for Payer: Quartz Commercial |
$1,180.80
|
| Rate for Payer: WEA Trust Commercial |
$1,082.40
|
| Rate for Payer: WPS Commercial |
$1,457.70
|
|
|
SCREW-LOCK 4.0 X 34 222.586
|
Facility
|
OP
|
$591.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966912
|
|
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
|
|
|
SCREW-LOCK 4.0 X 34 222.586
|
Facility
|
IP
|
$591.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966912
|
|
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 34MM TI STARDRIVE 04.005.424
|
Facility
|
IP
|
$2,945.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966515
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,443.05 |
| Max. Negotiated Rate |
$2,709.40 |
| Rate for Payer: Aetna Commercial |
$2,650.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,532.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,560.85
|
| Rate for Payer: Cash Price |
$883.50
|
| Rate for Payer: Cigna Commercial |
$2,709.40
|
| Rate for Payer: Health EOS Commercial |
$2,621.05
|
| Rate for Payer: HFN Commercial |
$2,709.40
|
| Rate for Payer: Multiplan Commercial |
$2,356.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,767.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,709.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,443.05
|
| Rate for Payer: Quartz Commercial |
$1,767.00
|
| Rate for Payer: WEA Trust Commercial |
$1,619.75
|
| Rate for Payer: WPS Commercial |
$2,181.36
|
|
|
SCREW LOCK 4.0 X 34MM TI STARDRIVE 04.005.424
|
Facility
|
OP
|
$2,945.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966515
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$824.60 |
| Max. Negotiated Rate |
$11,780.00 |
| Rate for Payer: Aetna Commercial |
$2,650.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,532.70
|
| Rate for Payer: Aetna Managed Medicare |
$824.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,914.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,472.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,413.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,560.85
|
| Rate for Payer: Cash Price |
$883.50
|
| Rate for Payer: Cigna Commercial |
$2,709.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,648.02
|
| Rate for Payer: Health EOS Commercial |
$2,621.05
|
| Rate for Payer: HFN Commercial |
$2,709.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,208.75
|
| Rate for Payer: Multiplan Commercial |
$2,356.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,767.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,709.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,443.05
|
| Rate for Payer: Quartz Commercial |
$1,914.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,767.00
|
| Rate for Payer: The Alliance Commercial |
$11,780.00
|
| Rate for Payer: WEA Trust Commercial |
$1,619.75
|
| Rate for Payer: WPS Commercial |
$2,181.36
|
|
|
SCREW LOCK 4.0 X 36MM ST 661036
|
Facility
|
IP
|
$2,589.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5458918
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,268.61 |
| Max. Negotiated Rate |
$2,381.88 |
| Rate for Payer: Aetna Commercial |
$2,330.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,226.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,372.17
|
| Rate for Payer: Cash Price |
$776.70
|
| Rate for Payer: Cigna Commercial |
$2,381.88
|
| Rate for Payer: Health EOS Commercial |
$2,304.21
|
| Rate for Payer: HFN Commercial |
$2,381.88
|
| Rate for Payer: Multiplan Commercial |
$2,071.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,553.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,381.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,268.61
|
| Rate for Payer: Quartz Commercial |
$1,553.40
|
| Rate for Payer: WEA Trust Commercial |
$1,423.95
|
| Rate for Payer: WPS Commercial |
$1,917.67
|
|
|
SCREW LOCK 4.0 X 36MM ST 661036
|
Facility
|
OP
|
$2,589.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5458918
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$724.92 |
| Max. Negotiated Rate |
$10,356.00 |
| Rate for Payer: Aetna Commercial |
$2,330.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,226.54
|
| Rate for Payer: Aetna Managed Medicare |
$724.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,682.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,294.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,242.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,372.17
|
| Rate for Payer: Cash Price |
$776.70
|
| Rate for Payer: Cigna Commercial |
$2,381.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,448.80
|
| Rate for Payer: Health EOS Commercial |
$2,304.21
|
| Rate for Payer: HFN Commercial |
$2,381.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,941.75
|
| Rate for Payer: Multiplan Commercial |
$2,071.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,553.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,381.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,268.61
|
| Rate for Payer: Quartz Commercial |
$1,682.85
|
| Rate for Payer: Quartz Medicare Advantage |
$1,553.40
|
| Rate for Payer: The Alliance Commercial |
$10,356.00
|
| Rate for Payer: WEA Trust Commercial |
$1,423.95
|
| Rate for Payer: WPS Commercial |
$1,917.67
|
|
|
SCREW LOCK 4.0 X 36MM TI STARDRIVE 04.005.426S
|
Facility
|
IP
|
$1,968.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3444843
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$964.32 |
| Max. Negotiated Rate |
$1,810.56 |
| Rate for Payer: Aetna Commercial |
$1,771.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,692.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,043.04
|
| Rate for Payer: Cash Price |
$590.40
|
| Rate for Payer: Cigna Commercial |
$1,810.56
|
| Rate for Payer: Health EOS Commercial |
$1,751.52
|
| Rate for Payer: HFN Commercial |
$1,810.56
|
| Rate for Payer: Multiplan Commercial |
$1,574.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,180.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,810.56
|
| Rate for Payer: Quartz Beloit One Network |
$964.32
|
| Rate for Payer: Quartz Commercial |
$1,180.80
|
| Rate for Payer: WEA Trust Commercial |
$1,082.40
|
| Rate for Payer: WPS Commercial |
$1,457.70
|
|
|
SCREW LOCK 4.0 X 36MM TI STARDRIVE 04.005.426S
|
Facility
|
OP
|
$1,968.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3444843
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$551.04 |
| Max. Negotiated Rate |
$7,872.00 |
| Rate for Payer: Aetna Commercial |
$1,771.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,692.48
|
| Rate for Payer: Aetna Managed Medicare |
$551.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,279.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$984.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$944.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,043.04
|
| Rate for Payer: Cash Price |
$590.40
|
| Rate for Payer: Cigna Commercial |
$1,810.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,101.29
|
| Rate for Payer: Health EOS Commercial |
$1,751.52
|
| Rate for Payer: HFN Commercial |
$1,810.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,476.00
|
| Rate for Payer: Multiplan Commercial |
$1,574.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,180.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,810.56
|
| Rate for Payer: Quartz Beloit One Network |
$964.32
|
| Rate for Payer: Quartz Commercial |
$1,279.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,180.80
|
| Rate for Payer: The Alliance Commercial |
$7,872.00
|
| Rate for Payer: WEA Trust Commercial |
$1,082.40
|
| Rate for Payer: WPS Commercial |
$1,457.70
|
|
|
SCREW-LOCK 4.0 X 38 222.587
|
Facility
|
IP
|
$591.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966913
|
|
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 38 222.587
|
Facility
|
OP
|
$591.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966913
|
|
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
|
|
