|
SCREW-LOCK 5.0 X 56 TFN 458.956
|
Facility
|
OP
|
$2,724.00
|
|
| Hospital Charge Code |
2966991
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$793.23 |
| Max. Negotiated Rate |
$2,606.32 |
| Rate for Payer: Aetna Commercial |
$2,549.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,436.35
|
| Rate for Payer: Aetna Managed Medicare |
$793.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,841.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,416.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,359.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,501.47
|
| Rate for Payer: Cash Price |
$817.20
|
| Rate for Payer: Cigna Commercial |
$2,606.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,585.37
|
| Rate for Payer: Health EOS Commercial |
$2,521.33
|
| Rate for Payer: HFN Commercial |
$2,606.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,124.72
|
| Rate for Payer: Multiplan Commercial |
$2,266.37
|
| Rate for Payer: NAPHCARE Commercial |
$1,699.78
|
| Rate for Payer: Preferred Network Access Commercial |
$2,606.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,388.15
|
| Rate for Payer: Quartz Commercial |
$1,841.42
|
| Rate for Payer: Quartz Medicare Advantage |
$1,699.78
|
| Rate for Payer: The Alliance Commercial |
$1,416.48
|
| Rate for Payer: WEA Trust Commercial |
$1,558.13
|
| Rate for Payer: WPS Commercial |
$2,098.30
|
|
|
SCREW LOCK 5.0 X 57.5 FULLY THREAD 1896-5057S
|
Facility
|
IP
|
$1,882.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508990
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$959.07 |
| Max. Negotiated Rate |
$1,800.70 |
| Rate for Payer: Aetna Commercial |
$1,761.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,683.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,037.36
|
| Rate for Payer: Cash Price |
$564.60
|
| Rate for Payer: Cigna Commercial |
$1,800.70
|
| Rate for Payer: Health EOS Commercial |
$1,741.98
|
| Rate for Payer: HFN Commercial |
$1,800.70
|
| Rate for Payer: Multiplan Commercial |
$1,565.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,800.70
|
| Rate for Payer: Quartz Beloit One Network |
$959.07
|
| Rate for Payer: Quartz Commercial |
$1,174.37
|
| Rate for Payer: WEA Trust Commercial |
$1,076.50
|
| Rate for Payer: WPS Commercial |
$1,449.70
|
|
|
SCREW LOCK 5.0 X 57.5 FULLY THREAD 1896-5057S
|
Facility
|
OP
|
$1,882.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508990
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$548.04 |
| Max. Negotiated Rate |
$1,800.70 |
| Rate for Payer: Aetna Commercial |
$1,761.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,683.26
|
| Rate for Payer: Aetna Managed Medicare |
$548.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,272.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$978.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$939.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,037.36
|
| Rate for Payer: Cash Price |
$564.60
|
| Rate for Payer: Cigna Commercial |
$1,800.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,095.32
|
| Rate for Payer: Health EOS Commercial |
$1,741.98
|
| Rate for Payer: HFN Commercial |
$1,800.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,467.96
|
| Rate for Payer: Multiplan Commercial |
$1,565.82
|
| Rate for Payer: NAPHCARE Commercial |
$1,174.37
|
| Rate for Payer: Preferred Network Access Commercial |
$1,800.70
|
| Rate for Payer: Quartz Beloit One Network |
$959.07
|
| Rate for Payer: Quartz Commercial |
$1,272.23
|
| Rate for Payer: Quartz Medicare Advantage |
$1,174.37
|
| Rate for Payer: The Alliance Commercial |
$978.64
|
| Rate for Payer: WEA Trust Commercial |
$1,076.50
|
| Rate for Payer: WPS Commercial |
$1,449.70
|
|
|
SCREW LOCK 5.0 X 58MM TI 04.005.548S
|
Facility
|
IP
|
$2,232.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4074604
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,137.43 |
| Max. Negotiated Rate |
$2,135.58 |
| Rate for Payer: Aetna Commercial |
$2,089.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,996.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,230.28
|
| Rate for Payer: Cash Price |
$669.60
|
| Rate for Payer: Cigna Commercial |
$2,135.58
|
| Rate for Payer: Health EOS Commercial |
$2,065.94
|
| Rate for Payer: HFN Commercial |
$2,135.58
|
| Rate for Payer: Multiplan Commercial |
$1,857.02
|
| Rate for Payer: Preferred Network Access Commercial |
$2,135.58
|
| Rate for Payer: Quartz Beloit One Network |
$1,137.43
|
| Rate for Payer: Quartz Commercial |
$1,392.77
|
| Rate for Payer: WEA Trust Commercial |
$1,276.70
|
| Rate for Payer: WPS Commercial |
$1,719.31
|
|
|
SCREW LOCK 5.0 X 58MM TI 04.005.548S
|
Facility
|
OP
|
$2,232.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4074604
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$649.96 |
| Max. Negotiated Rate |
$2,135.58 |
| Rate for Payer: Aetna Commercial |
$2,089.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,996.30
|
| Rate for Payer: Aetna Managed Medicare |
$649.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,508.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,160.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,114.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,230.28
|
| Rate for Payer: Cash Price |
$669.60
|
| Rate for Payer: Cigna Commercial |
$2,135.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,299.02
|
| Rate for Payer: Health EOS Commercial |
$2,065.94
|
| Rate for Payer: HFN Commercial |
$2,135.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,740.96
|
| Rate for Payer: Multiplan Commercial |
$1,857.02
|
| Rate for Payer: NAPHCARE Commercial |
$1,392.77
|
| Rate for Payer: Preferred Network Access Commercial |
$2,135.58
|
| Rate for Payer: Quartz Beloit One Network |
$1,137.43
|
| Rate for Payer: Quartz Commercial |
$1,508.83
|
| Rate for Payer: Quartz Medicare Advantage |
$1,392.77
|
| Rate for Payer: The Alliance Commercial |
$1,160.64
|
| Rate for Payer: WEA Trust Commercial |
$1,276.70
|
| Rate for Payer: WPS Commercial |
$1,719.31
|
|
|
SCREW LOCK 5.0 X 58MM XL25 IM NAIL TI 04.045.058S
|
Facility
|
IP
|
$2,717.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6202971
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,384.58 |
| Max. Negotiated Rate |
$2,599.63 |
| Rate for Payer: Aetna Commercial |
$2,543.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,430.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,497.61
|
| Rate for Payer: Cash Price |
$815.10
|
| Rate for Payer: Cigna Commercial |
$2,599.63
|
| Rate for Payer: Health EOS Commercial |
$2,514.86
|
| Rate for Payer: HFN Commercial |
$2,599.63
|
| Rate for Payer: Multiplan Commercial |
$2,260.54
|
| Rate for Payer: Preferred Network Access Commercial |
$2,599.63
|
| Rate for Payer: Quartz Beloit One Network |
$1,384.58
|
| Rate for Payer: Quartz Commercial |
$1,695.41
|
| Rate for Payer: WEA Trust Commercial |
$1,554.12
|
| Rate for Payer: WPS Commercial |
$2,092.91
|
|
|
SCREW LOCK 5.0 X 58MM XL25 IM NAIL TI 04.045.058S
|
Facility
|
OP
|
$2,717.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6202971
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$791.19 |
| Max. Negotiated Rate |
$2,599.63 |
| Rate for Payer: Aetna Commercial |
$2,543.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,430.08
|
| Rate for Payer: Aetna Managed Medicare |
$791.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,836.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,412.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,356.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,497.61
|
| Rate for Payer: Cash Price |
$815.10
|
| Rate for Payer: Cigna Commercial |
$2,599.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,581.29
|
| Rate for Payer: Health EOS Commercial |
$2,514.86
|
| Rate for Payer: HFN Commercial |
$2,599.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,119.26
|
| Rate for Payer: Multiplan Commercial |
$2,260.54
|
| Rate for Payer: NAPHCARE Commercial |
$1,695.41
|
| Rate for Payer: Preferred Network Access Commercial |
$2,599.63
|
| Rate for Payer: Quartz Beloit One Network |
$1,384.58
|
| Rate for Payer: Quartz Commercial |
$1,836.69
|
| Rate for Payer: Quartz Medicare Advantage |
$1,695.41
|
| Rate for Payer: The Alliance Commercial |
$1,412.84
|
| Rate for Payer: WEA Trust Commercial |
$1,554.12
|
| Rate for Payer: WPS Commercial |
$2,092.91
|
|
|
SCREW-LOCK 5.0 X 58 TFN 458.958
|
Facility
|
OP
|
$2,724.00
|
|
| Hospital Charge Code |
2966992
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$793.23 |
| Max. Negotiated Rate |
$2,606.32 |
| Rate for Payer: Aetna Commercial |
$2,549.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,436.35
|
| Rate for Payer: Aetna Managed Medicare |
$793.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,841.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,416.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,359.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,501.47
|
| Rate for Payer: Cash Price |
$817.20
|
| Rate for Payer: Cigna Commercial |
$2,606.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,585.37
|
| Rate for Payer: Health EOS Commercial |
$2,521.33
|
| Rate for Payer: HFN Commercial |
$2,606.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,124.72
|
| Rate for Payer: Multiplan Commercial |
$2,266.37
|
| Rate for Payer: NAPHCARE Commercial |
$1,699.78
|
| Rate for Payer: Preferred Network Access Commercial |
$2,606.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,388.15
|
| Rate for Payer: Quartz Commercial |
$1,841.42
|
| Rate for Payer: Quartz Medicare Advantage |
$1,699.78
|
| Rate for Payer: The Alliance Commercial |
$1,416.48
|
| Rate for Payer: WEA Trust Commercial |
$1,558.13
|
| Rate for Payer: WPS Commercial |
$2,098.30
|
|
|
SCREW-LOCK 5.0 X 58 TFN 458.958
|
Facility
|
IP
|
$2,724.00
|
|
| Hospital Charge Code |
2966992
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,388.15 |
| Max. Negotiated Rate |
$2,606.32 |
| Rate for Payer: Aetna Commercial |
$2,549.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,436.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,501.47
|
| Rate for Payer: Cash Price |
$817.20
|
| Rate for Payer: Cigna Commercial |
$2,606.32
|
| Rate for Payer: Health EOS Commercial |
$2,521.33
|
| Rate for Payer: HFN Commercial |
$2,606.32
|
| Rate for Payer: Multiplan Commercial |
$2,266.37
|
| Rate for Payer: Preferred Network Access Commercial |
$2,606.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,388.15
|
| Rate for Payer: Quartz Commercial |
$1,699.78
|
| Rate for Payer: WEA Trust Commercial |
$1,558.13
|
| Rate for Payer: WPS Commercial |
$2,098.30
|
|
|
SCREW-LOCK 5.0X60 212.221
|
Facility
|
OP
|
$1,917.00
|
|
| Hospital Charge Code |
2966994
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$558.23 |
| Max. Negotiated Rate |
$1,834.19 |
| Rate for Payer: Aetna Commercial |
$1,794.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,714.56
|
| Rate for Payer: Aetna Managed Medicare |
$558.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,295.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$996.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$956.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,056.65
|
| Rate for Payer: Cash Price |
$575.10
|
| Rate for Payer: Cigna Commercial |
$1,834.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,115.69
|
| Rate for Payer: Health EOS Commercial |
$1,774.38
|
| Rate for Payer: HFN Commercial |
$1,834.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,495.26
|
| Rate for Payer: Multiplan Commercial |
$1,594.94
|
| Rate for Payer: NAPHCARE Commercial |
$1,196.21
|
| Rate for Payer: Preferred Network Access Commercial |
$1,834.19
|
| Rate for Payer: Quartz Beloit One Network |
$976.90
|
| Rate for Payer: Quartz Commercial |
$1,295.89
|
| Rate for Payer: Quartz Medicare Advantage |
$1,196.21
|
| Rate for Payer: The Alliance Commercial |
$996.84
|
| Rate for Payer: WEA Trust Commercial |
$1,096.52
|
| Rate for Payer: WPS Commercial |
$1,476.67
|
|
|
SCREW-LOCK 5.0X60 212.221
|
Facility
|
IP
|
$1,917.00
|
|
| Hospital Charge Code |
2966994
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$976.90 |
| Max. Negotiated Rate |
$1,834.19 |
| Rate for Payer: Aetna Commercial |
$1,794.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,714.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,056.65
|
| Rate for Payer: Cash Price |
$575.10
|
| Rate for Payer: Cigna Commercial |
$1,834.19
|
| Rate for Payer: Health EOS Commercial |
$1,774.38
|
| Rate for Payer: HFN Commercial |
$1,834.19
|
| Rate for Payer: Multiplan Commercial |
$1,594.94
|
| Rate for Payer: Preferred Network Access Commercial |
$1,834.19
|
| Rate for Payer: Quartz Beloit One Network |
$976.90
|
| Rate for Payer: Quartz Commercial |
$1,196.21
|
| Rate for Payer: WEA Trust Commercial |
$1,096.52
|
| Rate for Payer: WPS Commercial |
$1,476.67
|
|
|
SCREW LOCK 5.0 X 60 FULLY THREAD 1896-5060S
|
Facility
|
OP
|
$1,882.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508991
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$548.04 |
| Max. Negotiated Rate |
$1,800.70 |
| Rate for Payer: Aetna Commercial |
$1,761.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,683.26
|
| Rate for Payer: Aetna Managed Medicare |
$548.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,272.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$978.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$939.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,037.36
|
| Rate for Payer: Cash Price |
$564.60
|
| Rate for Payer: Cigna Commercial |
$1,800.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,095.32
|
| Rate for Payer: Health EOS Commercial |
$1,741.98
|
| Rate for Payer: HFN Commercial |
$1,800.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,467.96
|
| Rate for Payer: Multiplan Commercial |
$1,565.82
|
| Rate for Payer: NAPHCARE Commercial |
$1,174.37
|
| Rate for Payer: Preferred Network Access Commercial |
$1,800.70
|
| Rate for Payer: Quartz Beloit One Network |
$959.07
|
| Rate for Payer: Quartz Commercial |
$1,272.23
|
| Rate for Payer: Quartz Medicare Advantage |
$1,174.37
|
| Rate for Payer: The Alliance Commercial |
$978.64
|
| Rate for Payer: WEA Trust Commercial |
$1,076.50
|
| Rate for Payer: WPS Commercial |
$1,449.70
|
|
|
SCREW LOCK 5.0 X 60 FULLY THREAD 1896-5060S
|
Facility
|
IP
|
$1,882.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508991
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$959.07 |
| Max. Negotiated Rate |
$1,800.70 |
| Rate for Payer: Aetna Commercial |
$1,761.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,683.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,037.36
|
| Rate for Payer: Cash Price |
$564.60
|
| Rate for Payer: Cigna Commercial |
$1,800.70
|
| Rate for Payer: Health EOS Commercial |
$1,741.98
|
| Rate for Payer: HFN Commercial |
$1,800.70
|
| Rate for Payer: Multiplan Commercial |
$1,565.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,800.70
|
| Rate for Payer: Quartz Beloit One Network |
$959.07
|
| Rate for Payer: Quartz Commercial |
$1,174.37
|
| Rate for Payer: WEA Trust Commercial |
$1,076.50
|
| Rate for Payer: WPS Commercial |
$1,449.70
|
|
|
SCREW-LOCK 5.0 X 60 TFN 458.960
|
Facility
|
IP
|
$2,724.00
|
|
| Hospital Charge Code |
2966995
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,388.15 |
| Max. Negotiated Rate |
$2,606.32 |
| Rate for Payer: Aetna Commercial |
$2,549.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,436.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,501.47
|
| Rate for Payer: Cash Price |
$817.20
|
| Rate for Payer: Cigna Commercial |
$2,606.32
|
| Rate for Payer: Health EOS Commercial |
$2,521.33
|
| Rate for Payer: HFN Commercial |
$2,606.32
|
| Rate for Payer: Multiplan Commercial |
$2,266.37
|
| Rate for Payer: Preferred Network Access Commercial |
$2,606.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,388.15
|
| Rate for Payer: Quartz Commercial |
$1,699.78
|
| Rate for Payer: WEA Trust Commercial |
$1,558.13
|
| Rate for Payer: WPS Commercial |
$2,098.30
|
|
|
SCREW-LOCK 5.0 X 60 TFN 458.960
|
Facility
|
OP
|
$2,724.00
|
|
| Hospital Charge Code |
2966995
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$793.23 |
| Max. Negotiated Rate |
$2,606.32 |
| Rate for Payer: Aetna Commercial |
$2,549.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,436.35
|
| Rate for Payer: Aetna Managed Medicare |
$793.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,841.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,416.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,359.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,501.47
|
| Rate for Payer: Cash Price |
$817.20
|
| Rate for Payer: Cigna Commercial |
$2,606.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,585.37
|
| Rate for Payer: Health EOS Commercial |
$2,521.33
|
| Rate for Payer: HFN Commercial |
$2,606.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,124.72
|
| Rate for Payer: Multiplan Commercial |
$2,266.37
|
| Rate for Payer: NAPHCARE Commercial |
$1,699.78
|
| Rate for Payer: Preferred Network Access Commercial |
$2,606.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,388.15
|
| Rate for Payer: Quartz Commercial |
$1,841.42
|
| Rate for Payer: Quartz Medicare Advantage |
$1,699.78
|
| Rate for Payer: The Alliance Commercial |
$1,416.48
|
| Rate for Payer: WEA Trust Commercial |
$1,558.13
|
| Rate for Payer: WPS Commercial |
$2,098.30
|
|
|
SCREW LOCK 5.0 X 60 VA 02.231.260
|
Facility
|
OP
|
$2,255.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494423
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$656.66 |
| Max. Negotiated Rate |
$2,157.58 |
| Rate for Payer: Aetna Commercial |
$2,110.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,016.87
|
| Rate for Payer: Aetna Managed Medicare |
$656.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,524.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,172.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,125.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,242.96
|
| Rate for Payer: Cash Price |
$676.50
|
| Rate for Payer: Cigna Commercial |
$2,157.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,312.41
|
| Rate for Payer: Health EOS Commercial |
$2,087.23
|
| Rate for Payer: HFN Commercial |
$2,157.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,758.90
|
| Rate for Payer: Multiplan Commercial |
$1,876.16
|
| Rate for Payer: NAPHCARE Commercial |
$1,407.12
|
| Rate for Payer: Preferred Network Access Commercial |
$2,157.58
|
| Rate for Payer: Quartz Beloit One Network |
$1,149.15
|
| Rate for Payer: Quartz Commercial |
$1,524.38
|
| Rate for Payer: Quartz Medicare Advantage |
$1,407.12
|
| Rate for Payer: The Alliance Commercial |
$1,172.60
|
| Rate for Payer: WEA Trust Commercial |
$1,289.86
|
| Rate for Payer: WPS Commercial |
$1,737.03
|
|
|
SCREW LOCK 5.0 X 60 VA 02.231.260
|
Facility
|
IP
|
$2,255.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494423
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,149.15 |
| Max. Negotiated Rate |
$2,157.58 |
| Rate for Payer: Aetna Commercial |
$2,110.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,016.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,242.96
|
| Rate for Payer: Cash Price |
$676.50
|
| Rate for Payer: Cigna Commercial |
$2,157.58
|
| Rate for Payer: Health EOS Commercial |
$2,087.23
|
| Rate for Payer: HFN Commercial |
$2,157.58
|
| Rate for Payer: Multiplan Commercial |
$1,876.16
|
| Rate for Payer: Preferred Network Access Commercial |
$2,157.58
|
| Rate for Payer: Quartz Beloit One Network |
$1,149.15
|
| Rate for Payer: Quartz Commercial |
$1,407.12
|
| Rate for Payer: WEA Trust Commercial |
$1,289.86
|
| Rate for Payer: WPS Commercial |
$1,737.03
|
|
|
SCREW LOCK 5.0 X 62MM TI 04.005.552S
|
Facility
|
OP
|
$2,232.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4520291
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$649.96 |
| Max. Negotiated Rate |
$2,135.58 |
| Rate for Payer: Aetna Commercial |
$2,089.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,996.30
|
| Rate for Payer: Aetna Managed Medicare |
$649.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,508.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,160.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,114.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,230.28
|
| Rate for Payer: Cash Price |
$669.60
|
| Rate for Payer: Cigna Commercial |
$2,135.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,299.02
|
| Rate for Payer: Health EOS Commercial |
$2,065.94
|
| Rate for Payer: HFN Commercial |
$2,135.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,740.96
|
| Rate for Payer: Multiplan Commercial |
$1,857.02
|
| Rate for Payer: NAPHCARE Commercial |
$1,392.77
|
| Rate for Payer: Preferred Network Access Commercial |
$2,135.58
|
| Rate for Payer: Quartz Beloit One Network |
$1,137.43
|
| Rate for Payer: Quartz Commercial |
$1,508.83
|
| Rate for Payer: Quartz Medicare Advantage |
$1,392.77
|
| Rate for Payer: The Alliance Commercial |
$1,160.64
|
| Rate for Payer: WEA Trust Commercial |
$1,276.70
|
| Rate for Payer: WPS Commercial |
$1,719.31
|
|
|
SCREW LOCK 5.0 X 62MM TI 04.005.552S
|
Facility
|
IP
|
$2,232.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4520291
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,137.43 |
| Max. Negotiated Rate |
$2,135.58 |
| Rate for Payer: Aetna Commercial |
$2,089.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,996.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,230.28
|
| Rate for Payer: Cash Price |
$669.60
|
| Rate for Payer: Cigna Commercial |
$2,135.58
|
| Rate for Payer: Health EOS Commercial |
$2,065.94
|
| Rate for Payer: HFN Commercial |
$2,135.58
|
| Rate for Payer: Multiplan Commercial |
$1,857.02
|
| Rate for Payer: Preferred Network Access Commercial |
$2,135.58
|
| Rate for Payer: Quartz Beloit One Network |
$1,137.43
|
| Rate for Payer: Quartz Commercial |
$1,392.77
|
| Rate for Payer: WEA Trust Commercial |
$1,276.70
|
| Rate for Payer: WPS Commercial |
$1,719.31
|
|
|
SCREW LOCK 5.0 X 64MM TI 04.005.554S
|
Facility
|
OP
|
$2,012.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415198
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$585.89 |
| Max. Negotiated Rate |
$1,925.08 |
| Rate for Payer: Aetna Commercial |
$1,883.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,799.53
|
| Rate for Payer: Aetna Managed Medicare |
$585.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,360.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,046.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,004.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,109.01
|
| Rate for Payer: Cash Price |
$603.60
|
| Rate for Payer: Cigna Commercial |
$1,925.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,170.98
|
| Rate for Payer: Health EOS Commercial |
$1,862.31
|
| Rate for Payer: HFN Commercial |
$1,925.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,569.36
|
| Rate for Payer: Multiplan Commercial |
$1,673.98
|
| Rate for Payer: NAPHCARE Commercial |
$1,255.49
|
| Rate for Payer: Preferred Network Access Commercial |
$1,925.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,025.32
|
| Rate for Payer: Quartz Commercial |
$1,360.11
|
| Rate for Payer: Quartz Medicare Advantage |
$1,255.49
|
| Rate for Payer: The Alliance Commercial |
$1,046.24
|
| Rate for Payer: WEA Trust Commercial |
$1,150.86
|
| Rate for Payer: WPS Commercial |
$1,549.84
|
|
|
SCREW LOCK 5.0 X 64MM TI 04.005.554S
|
Facility
|
IP
|
$2,012.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415198
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,025.32 |
| Max. Negotiated Rate |
$1,925.08 |
| Rate for Payer: Aetna Commercial |
$1,883.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,799.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,109.01
|
| Rate for Payer: Cash Price |
$603.60
|
| Rate for Payer: Cigna Commercial |
$1,925.08
|
| Rate for Payer: Health EOS Commercial |
$1,862.31
|
| Rate for Payer: HFN Commercial |
$1,925.08
|
| Rate for Payer: Multiplan Commercial |
$1,673.98
|
| Rate for Payer: Preferred Network Access Commercial |
$1,925.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,025.32
|
| Rate for Payer: Quartz Commercial |
$1,255.49
|
| Rate for Payer: WEA Trust Commercial |
$1,150.86
|
| Rate for Payer: WPS Commercial |
$1,549.84
|
|
|
SCREW-LOCK 5.0 X 64 TFN 458.964
|
Facility
|
IP
|
$2,724.00
|
|
| Hospital Charge Code |
2966996
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,388.15 |
| Max. Negotiated Rate |
$2,606.32 |
| Rate for Payer: Aetna Commercial |
$2,549.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,436.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,501.47
|
| Rate for Payer: Cash Price |
$817.20
|
| Rate for Payer: Cigna Commercial |
$2,606.32
|
| Rate for Payer: Health EOS Commercial |
$2,521.33
|
| Rate for Payer: HFN Commercial |
$2,606.32
|
| Rate for Payer: Multiplan Commercial |
$2,266.37
|
| Rate for Payer: Preferred Network Access Commercial |
$2,606.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,388.15
|
| Rate for Payer: Quartz Commercial |
$1,699.78
|
| Rate for Payer: WEA Trust Commercial |
$1,558.13
|
| Rate for Payer: WPS Commercial |
$2,098.30
|
|
|
SCREW-LOCK 5.0 X 64 TFN 458.964
|
Facility
|
OP
|
$2,724.00
|
|
| Hospital Charge Code |
2966996
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$793.23 |
| Max. Negotiated Rate |
$2,606.32 |
| Rate for Payer: Aetna Commercial |
$2,549.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,436.35
|
| Rate for Payer: Aetna Managed Medicare |
$793.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,841.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,416.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,359.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,501.47
|
| Rate for Payer: Cash Price |
$817.20
|
| Rate for Payer: Cigna Commercial |
$2,606.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,585.37
|
| Rate for Payer: Health EOS Commercial |
$2,521.33
|
| Rate for Payer: HFN Commercial |
$2,606.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,124.72
|
| Rate for Payer: Multiplan Commercial |
$2,266.37
|
| Rate for Payer: NAPHCARE Commercial |
$1,699.78
|
| Rate for Payer: Preferred Network Access Commercial |
$2,606.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,388.15
|
| Rate for Payer: Quartz Commercial |
$1,841.42
|
| Rate for Payer: Quartz Medicare Advantage |
$1,699.78
|
| Rate for Payer: The Alliance Commercial |
$1,416.48
|
| Rate for Payer: WEA Trust Commercial |
$1,558.13
|
| Rate for Payer: WPS Commercial |
$2,098.30
|
|
|
SCREW-LOCK 5.0X65 212.222
|
Facility
|
IP
|
$1,917.00
|
|
| Hospital Charge Code |
2966997
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$976.90 |
| Max. Negotiated Rate |
$1,834.19 |
| Rate for Payer: Aetna Commercial |
$1,794.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,714.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,056.65
|
| Rate for Payer: Cash Price |
$575.10
|
| Rate for Payer: Cigna Commercial |
$1,834.19
|
| Rate for Payer: Health EOS Commercial |
$1,774.38
|
| Rate for Payer: HFN Commercial |
$1,834.19
|
| Rate for Payer: Multiplan Commercial |
$1,594.94
|
| Rate for Payer: Preferred Network Access Commercial |
$1,834.19
|
| Rate for Payer: Quartz Beloit One Network |
$976.90
|
| Rate for Payer: Quartz Commercial |
$1,196.21
|
| Rate for Payer: WEA Trust Commercial |
$1,096.52
|
| Rate for Payer: WPS Commercial |
$1,476.67
|
|
|
SCREW-LOCK 5.0X65 212.222
|
Facility
|
OP
|
$1,917.00
|
|
| Hospital Charge Code |
2966997
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$558.23 |
| Max. Negotiated Rate |
$1,834.19 |
| Rate for Payer: Aetna Commercial |
$1,794.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,714.56
|
| Rate for Payer: Aetna Managed Medicare |
$558.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,295.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$996.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$956.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,056.65
|
| Rate for Payer: Cash Price |
$575.10
|
| Rate for Payer: Cigna Commercial |
$1,834.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,115.69
|
| Rate for Payer: Health EOS Commercial |
$1,774.38
|
| Rate for Payer: HFN Commercial |
$1,834.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,495.26
|
| Rate for Payer: Multiplan Commercial |
$1,594.94
|
| Rate for Payer: NAPHCARE Commercial |
$1,196.21
|
| Rate for Payer: Preferred Network Access Commercial |
$1,834.19
|
| Rate for Payer: Quartz Beloit One Network |
$976.90
|
| Rate for Payer: Quartz Commercial |
$1,295.89
|
| Rate for Payer: Quartz Medicare Advantage |
$1,196.21
|
| Rate for Payer: The Alliance Commercial |
$996.84
|
| Rate for Payer: WEA Trust Commercial |
$1,096.52
|
| Rate for Payer: WPS Commercial |
$1,476.67
|
|
