|
SCREW LOCK 5.0 X 80 VA 02.231.280
|
Facility
|
IP
|
$2,342.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494422
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,193.48 |
| Max. Negotiated Rate |
$2,240.83 |
| Rate for Payer: Aetna Commercial |
$2,192.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,094.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,290.91
|
| Rate for Payer: Cash Price |
$702.60
|
| Rate for Payer: Cigna Commercial |
$2,240.83
|
| Rate for Payer: Health EOS Commercial |
$2,167.76
|
| Rate for Payer: HFN Commercial |
$2,240.83
|
| Rate for Payer: Multiplan Commercial |
$1,948.54
|
| Rate for Payer: Preferred Network Access Commercial |
$2,240.83
|
| Rate for Payer: Quartz Beloit One Network |
$1,193.48
|
| Rate for Payer: Quartz Commercial |
$1,461.41
|
| Rate for Payer: WEA Trust Commercial |
$1,339.62
|
| Rate for Payer: WPS Commercial |
$1,804.04
|
|
|
SCREW LOCK 5.0 X 80 VA 02.231.280
|
Facility
|
OP
|
$2,342.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494422
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$681.99 |
| Max. Negotiated Rate |
$2,240.83 |
| Rate for Payer: Aetna Commercial |
$2,192.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,094.68
|
| Rate for Payer: Aetna Managed Medicare |
$681.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,583.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,217.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,169.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,290.91
|
| Rate for Payer: Cash Price |
$702.60
|
| Rate for Payer: Cigna Commercial |
$2,240.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,363.04
|
| Rate for Payer: Health EOS Commercial |
$2,167.76
|
| Rate for Payer: HFN Commercial |
$2,240.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,826.76
|
| Rate for Payer: Multiplan Commercial |
$1,948.54
|
| Rate for Payer: NAPHCARE Commercial |
$1,461.41
|
| Rate for Payer: Preferred Network Access Commercial |
$2,240.83
|
| Rate for Payer: Quartz Beloit One Network |
$1,193.48
|
| Rate for Payer: Quartz Commercial |
$1,583.19
|
| Rate for Payer: Quartz Medicare Advantage |
$1,461.41
|
| Rate for Payer: The Alliance Commercial |
$1,217.84
|
| Rate for Payer: WEA Trust Commercial |
$1,339.62
|
| Rate for Payer: WPS Commercial |
$1,804.04
|
|
|
SCREW LOCK 5.0 X 84MM XL25 IM NAIL TI 04.045.084S
|
Facility
|
IP
|
$2,612.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6246186
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,331.17 |
| Max. Negotiated Rate |
$2,499.33 |
| Rate for Payer: Aetna Commercial |
$2,445.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,336.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,439.83
|
| Rate for Payer: Cash Price |
$783.65
|
| Rate for Payer: Cigna Commercial |
$2,499.33
|
| Rate for Payer: Health EOS Commercial |
$2,417.83
|
| Rate for Payer: HFN Commercial |
$2,499.33
|
| Rate for Payer: Multiplan Commercial |
$2,173.33
|
| Rate for Payer: Preferred Network Access Commercial |
$2,499.33
|
| Rate for Payer: Quartz Beloit One Network |
$1,331.17
|
| Rate for Payer: Quartz Commercial |
$1,630.00
|
| Rate for Payer: WEA Trust Commercial |
$1,494.17
|
| Rate for Payer: WPS Commercial |
$2,012.16
|
|
|
SCREW LOCK 5.0 X 84MM XL25 IM NAIL TI 04.045.084S
|
Facility
|
OP
|
$2,612.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6246186
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$760.67 |
| Max. Negotiated Rate |
$2,499.33 |
| Rate for Payer: Aetna Commercial |
$2,445.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,336.33
|
| Rate for Payer: Aetna Managed Medicare |
$760.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,765.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,358.33
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,304.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,439.83
|
| Rate for Payer: Cash Price |
$783.65
|
| Rate for Payer: Cigna Commercial |
$2,499.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,520.29
|
| Rate for Payer: Health EOS Commercial |
$2,417.83
|
| Rate for Payer: HFN Commercial |
$2,499.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,037.50
|
| Rate for Payer: Multiplan Commercial |
$2,173.33
|
| Rate for Payer: NAPHCARE Commercial |
$1,630.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,499.33
|
| Rate for Payer: Quartz Beloit One Network |
$1,331.17
|
| Rate for Payer: Quartz Commercial |
$1,765.83
|
| Rate for Payer: Quartz Medicare Advantage |
$1,630.00
|
| Rate for Payer: The Alliance Commercial |
$1,358.33
|
| Rate for Payer: WEA Trust Commercial |
$1,494.17
|
| Rate for Payer: WPS Commercial |
$2,012.16
|
|
|
SCREW-LOCK 5.0X85 212.226
|
Facility
|
OP
|
$1,917.00
|
|
| Hospital Charge Code |
2967007
|
|
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 5.0X85 212.226
|
Facility
|
IP
|
$1,917.00
|
|
| Hospital Charge Code |
2967007
|
|
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 85 FULL THREAD 1896-5085S
|
Facility
|
IP
|
$1,882.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508995
|
|
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 85 FULL THREAD 1896-5085S
|
Facility
|
OP
|
$1,882.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508995
|
|
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 85MM TI 04.005.575S
|
Facility
|
OP
|
$2,232.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4467412
|
|
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 85MM TI 04.005.575S
|
Facility
|
IP
|
$2,232.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4467412
|
|
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 85 TFN 458.985
|
Facility
|
IP
|
$2,724.00
|
|
| Hospital Charge Code |
2967008
|
|
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 85 TFN 458.985
|
Facility
|
OP
|
$2,724.00
|
|
| Hospital Charge Code |
2967008
|
|
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 85 VA 02.231.285
|
Facility
|
OP
|
$2,255.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5286726
|
|
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 85 VA 02.231.285
|
Facility
|
IP
|
$2,255.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5286726
|
|
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 86MM XL25 IM NAIL TI 04.045.086S
|
Facility
|
OP
|
$2,612.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6246185
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$760.67 |
| Max. Negotiated Rate |
$2,499.33 |
| Rate for Payer: Aetna Commercial |
$2,445.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,336.33
|
| Rate for Payer: Aetna Managed Medicare |
$760.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,765.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,358.33
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,304.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,439.83
|
| Rate for Payer: Cash Price |
$783.65
|
| Rate for Payer: Cigna Commercial |
$2,499.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,520.29
|
| Rate for Payer: Health EOS Commercial |
$2,417.83
|
| Rate for Payer: HFN Commercial |
$2,499.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,037.50
|
| Rate for Payer: Multiplan Commercial |
$2,173.33
|
| Rate for Payer: NAPHCARE Commercial |
$1,630.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,499.33
|
| Rate for Payer: Quartz Beloit One Network |
$1,331.17
|
| Rate for Payer: Quartz Commercial |
$1,765.83
|
| Rate for Payer: Quartz Medicare Advantage |
$1,630.00
|
| Rate for Payer: The Alliance Commercial |
$1,358.33
|
| Rate for Payer: WEA Trust Commercial |
$1,494.17
|
| Rate for Payer: WPS Commercial |
$2,012.16
|
|
|
SCREW LOCK 5.0 X 86MM XL25 IM NAIL TI 04.045.086S
|
Facility
|
IP
|
$2,612.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6246185
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,331.17 |
| Max. Negotiated Rate |
$2,499.33 |
| Rate for Payer: Aetna Commercial |
$2,445.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,336.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,439.83
|
| Rate for Payer: Cash Price |
$783.65
|
| Rate for Payer: Cigna Commercial |
$2,499.33
|
| Rate for Payer: Health EOS Commercial |
$2,417.83
|
| Rate for Payer: HFN Commercial |
$2,499.33
|
| Rate for Payer: Multiplan Commercial |
$2,173.33
|
| Rate for Payer: Preferred Network Access Commercial |
$2,499.33
|
| Rate for Payer: Quartz Beloit One Network |
$1,331.17
|
| Rate for Payer: Quartz Commercial |
$1,630.00
|
| Rate for Payer: WEA Trust Commercial |
$1,494.17
|
| Rate for Payer: WPS Commercial |
$2,012.16
|
|
|
SCREW-LOCK 5.0X90 212.227
|
Facility
|
IP
|
$1,917.00
|
|
| Hospital Charge Code |
2967010
|
|
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 5.0X90 212.227
|
Facility
|
OP
|
$1,917.00
|
|
| Hospital Charge Code |
2967010
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$558.23 |
| Max. Negotiated Rate |
$1,834.19 |
| Rate for Payer: Aetna Commercial |
$1,794.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,714.56
|
| Rate for Payer: Aetna Managed Medicare |
$558.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,295.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$996.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$956.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,056.65
|
| Rate for Payer: Cash Price |
$575.10
|
| Rate for Payer: Cigna Commercial |
$1,834.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,115.69
|
| Rate for Payer: Health EOS Commercial |
$1,774.38
|
| Rate for Payer: HFN Commercial |
$1,834.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,495.26
|
| Rate for Payer: Multiplan Commercial |
$1,594.94
|
| Rate for Payer: NAPHCARE Commercial |
$1,196.21
|
| Rate for Payer: Preferred Network Access Commercial |
$1,834.19
|
| Rate for Payer: Quartz Beloit One Network |
$976.90
|
| Rate for Payer: Quartz Commercial |
$1,295.89
|
| Rate for Payer: Quartz Medicare Advantage |
$1,196.21
|
| Rate for Payer: The Alliance Commercial |
$996.84
|
| Rate for Payer: WEA Trust Commercial |
$1,096.52
|
| Rate for Payer: WPS Commercial |
$1,476.67
|
|
|
SCREW LOCK 5.0 X 90 FULL THREAD 1896-5090S
|
Facility
|
OP
|
$1,882.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508996
|
|
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 90 FULL THREAD 1896-5090S
|
Facility
|
IP
|
$1,882.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508996
|
|
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 90MM SELF-TAP 661190
|
Facility
|
IP
|
$2,005.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5146614
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,021.75 |
| Max. Negotiated Rate |
$1,918.38 |
| Rate for Payer: Aetna Commercial |
$1,876.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,793.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,105.16
|
| Rate for Payer: Cash Price |
$601.50
|
| Rate for Payer: Cigna Commercial |
$1,918.38
|
| Rate for Payer: Health EOS Commercial |
$1,855.83
|
| Rate for Payer: HFN Commercial |
$1,918.38
|
| Rate for Payer: Multiplan Commercial |
$1,668.16
|
| Rate for Payer: Preferred Network Access Commercial |
$1,918.38
|
| Rate for Payer: Quartz Beloit One Network |
$1,021.75
|
| Rate for Payer: Quartz Commercial |
$1,251.12
|
| Rate for Payer: WEA Trust Commercial |
$1,146.86
|
| Rate for Payer: WPS Commercial |
$1,544.45
|
|
|
SCREW LOCK 5.0 X 90MM SELF-TAP 661190
|
Facility
|
OP
|
$2,005.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5146614
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$583.86 |
| Max. Negotiated Rate |
$1,918.38 |
| Rate for Payer: Aetna Commercial |
$1,876.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,793.27
|
| Rate for Payer: Aetna Managed Medicare |
$583.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,355.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,042.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,000.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,105.16
|
| Rate for Payer: Cash Price |
$601.50
|
| Rate for Payer: Cigna Commercial |
$1,918.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,166.91
|
| Rate for Payer: Health EOS Commercial |
$1,855.83
|
| Rate for Payer: HFN Commercial |
$1,918.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,563.90
|
| Rate for Payer: Multiplan Commercial |
$1,668.16
|
| Rate for Payer: NAPHCARE Commercial |
$1,251.12
|
| Rate for Payer: Preferred Network Access Commercial |
$1,918.38
|
| Rate for Payer: Quartz Beloit One Network |
$1,021.75
|
| Rate for Payer: Quartz Commercial |
$1,355.38
|
| Rate for Payer: Quartz Medicare Advantage |
$1,251.12
|
| Rate for Payer: The Alliance Commercial |
$1,042.60
|
| Rate for Payer: WEA Trust Commercial |
$1,146.86
|
| Rate for Payer: WPS Commercial |
$1,544.45
|
|
|
SCREW-LOCK 5.0 X 90 TFN 458.990
|
Facility
|
IP
|
$2,724.00
|
|
| Hospital Charge Code |
2967011
|
|
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 90 TFN 458.990
|
Facility
|
OP
|
$2,724.00
|
|
| Hospital Charge Code |
2967011
|
|
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 90 VA 02.231.290
|
Facility
|
IP
|
$2,342.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4778612
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,193.48 |
| Max. Negotiated Rate |
$2,240.83 |
| Rate for Payer: Aetna Commercial |
$2,192.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,094.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,290.91
|
| Rate for Payer: Cash Price |
$702.60
|
| Rate for Payer: Cigna Commercial |
$2,240.83
|
| Rate for Payer: Health EOS Commercial |
$2,167.76
|
| Rate for Payer: HFN Commercial |
$2,240.83
|
| Rate for Payer: Multiplan Commercial |
$1,948.54
|
| Rate for Payer: Preferred Network Access Commercial |
$2,240.83
|
| Rate for Payer: Quartz Beloit One Network |
$1,193.48
|
| Rate for Payer: Quartz Commercial |
$1,461.41
|
| Rate for Payer: WEA Trust Commercial |
$1,339.62
|
| Rate for Payer: WPS Commercial |
$1,804.04
|
|
