|
SCREW LOCK 4.0 X 38MM ST 661038
|
Facility
|
IP
|
$2,589.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5458919
|
|
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 38MM ST 661038
|
Facility
|
OP
|
$2,589.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5458919
|
|
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 38MM TI STARDRIVE 04.005.428
|
Facility
|
IP
|
$1,968.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4509054
|
|
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 38MM TI STARDRIVE 04.005.428
|
Facility
|
OP
|
$1,968.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4509054
|
|
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 40MM ST 661040
|
Facility
|
IP
|
$2,589.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5458920
|
|
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 40MM ST 661040
|
Facility
|
OP
|
$2,589.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5458920
|
|
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 42 222.588
|
Facility
|
OP
|
$591.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966914
|
|
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 42 222.588
|
Facility
|
IP
|
$591.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966914
|
|
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 42MM ST 661042
|
Facility
|
IP
|
$2,589.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599551
|
|
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 42MM ST 661042
|
Facility
|
OP
|
$2,589.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599551
|
|
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 44MM ST 661044
|
Facility
|
IP
|
$2,589.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5520855
|
|
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 44MM ST 661044
|
Facility
|
OP
|
$2,589.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5520855
|
|
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 46 222.589
|
Facility
|
IP
|
$591.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966915
|
|
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 46 222.589
|
Facility
|
OP
|
$591.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966915
|
|
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 46MM ST 661046
|
Facility
|
OP
|
$2,589.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5520856
|
|
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 46MM ST 661046
|
Facility
|
IP
|
$2,589.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5520856
|
|
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 48MM ST 661048
|
Facility
|
IP
|
$2,589.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5458964
|
|
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 48MM ST 661048
|
Facility
|
OP
|
$2,589.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5458964
|
|
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 50 222.590
|
Facility
|
IP
|
$591.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966916
|
|
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 50 222.590
|
Facility
|
OP
|
$591.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966916
|
|
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 50MM ST 661050
|
Facility
|
IP
|
$2,589.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5458963
|
|
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 50MM ST 661050
|
Facility
|
OP
|
$2,589.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5458963
|
|
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 54 222.591
|
Facility
|
IP
|
$591.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966917
|
|
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 54 222.591
|
Facility
|
OP
|
$591.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966917
|
|
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 55MM ST 661055
|
Facility
|
IP
|
$2,589.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5458965
|
|
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
|
|
