|
SCREW LOCK 5.0 X 90 VA 02.231.290
|
Facility
|
OP
|
$2,342.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4778612
|
|
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 95 FULL THREAD 1896-5095S
|
Facility
|
IP
|
$2,219.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4518611
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,130.80 |
| Max. Negotiated Rate |
$2,123.14 |
| Rate for Payer: Aetna Commercial |
$2,076.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,984.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,223.11
|
| Rate for Payer: Cash Price |
$665.70
|
| Rate for Payer: Cigna Commercial |
$2,123.14
|
| Rate for Payer: Health EOS Commercial |
$2,053.91
|
| Rate for Payer: HFN Commercial |
$2,123.14
|
| Rate for Payer: Multiplan Commercial |
$1,846.21
|
| Rate for Payer: Preferred Network Access Commercial |
$2,123.14
|
| Rate for Payer: Quartz Beloit One Network |
$1,130.80
|
| Rate for Payer: Quartz Commercial |
$1,384.66
|
| Rate for Payer: WEA Trust Commercial |
$1,269.27
|
| Rate for Payer: WPS Commercial |
$1,709.30
|
|
|
SCREW LOCK 5.0 X 95 FULL THREAD 1896-5095S
|
Facility
|
OP
|
$2,219.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4518611
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$646.17 |
| Max. Negotiated Rate |
$2,123.14 |
| Rate for Payer: Aetna Commercial |
$2,076.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,984.67
|
| Rate for Payer: Aetna Managed Medicare |
$646.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,500.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,153.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,107.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,223.11
|
| Rate for Payer: Cash Price |
$665.70
|
| Rate for Payer: Cigna Commercial |
$2,123.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,291.46
|
| Rate for Payer: Health EOS Commercial |
$2,053.91
|
| Rate for Payer: HFN Commercial |
$2,123.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,730.82
|
| Rate for Payer: Multiplan Commercial |
$1,846.21
|
| Rate for Payer: NAPHCARE Commercial |
$1,384.66
|
| Rate for Payer: Preferred Network Access Commercial |
$2,123.14
|
| Rate for Payer: Quartz Beloit One Network |
$1,130.80
|
| Rate for Payer: Quartz Commercial |
$1,500.04
|
| Rate for Payer: Quartz Medicare Advantage |
$1,384.66
|
| Rate for Payer: The Alliance Commercial |
$1,153.88
|
| Rate for Payer: WEA Trust Commercial |
$1,269.27
|
| Rate for Payer: WPS Commercial |
$1,709.30
|
|
|
SCREW LOCK 5.0 X 95MM SELF-TAP 661195
|
Facility
|
OP
|
$2,005.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5458798
|
|
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 95MM SELF-TAP 661195
|
Facility
|
IP
|
$2,005.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5458798
|
|
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 95 TFN 458.995
|
Facility
|
IP
|
$2,724.00
|
|
| Hospital Charge Code |
2967012
|
|
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 95 TFN 458.995
|
Facility
|
OP
|
$2,724.00
|
|
| Hospital Charge Code |
2967012
|
|
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 CANN 3.7 X 26
|
Facility
|
OP
|
$2,752.00
|
|
| Hospital Charge Code |
3072613
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$801.38 |
| Max. Negotiated Rate |
$2,633.11 |
| Rate for Payer: Aetna Commercial |
$2,575.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,461.39
|
| Rate for Payer: Aetna Managed Medicare |
$801.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,860.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,431.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,373.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,516.90
|
| Rate for Payer: Cash Price |
$825.60
|
| Rate for Payer: Cigna Commercial |
$2,633.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,601.66
|
| Rate for Payer: Health EOS Commercial |
$2,547.25
|
| Rate for Payer: HFN Commercial |
$2,633.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,146.56
|
| Rate for Payer: Multiplan Commercial |
$2,289.66
|
| Rate for Payer: NAPHCARE Commercial |
$1,717.25
|
| Rate for Payer: Preferred Network Access Commercial |
$2,633.11
|
| Rate for Payer: Quartz Beloit One Network |
$1,402.42
|
| Rate for Payer: Quartz Commercial |
$1,860.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,717.25
|
| Rate for Payer: The Alliance Commercial |
$1,431.04
|
| Rate for Payer: WEA Trust Commercial |
$1,574.14
|
| Rate for Payer: WPS Commercial |
$2,119.87
|
|
|
SCREW LOCK CANN 3.7 X 26
|
Facility
|
IP
|
$2,752.00
|
|
| Hospital Charge Code |
3072613
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,402.42 |
| Max. Negotiated Rate |
$2,633.11 |
| Rate for Payer: Aetna Commercial |
$2,575.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,461.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,516.90
|
| Rate for Payer: Cash Price |
$825.60
|
| Rate for Payer: Cigna Commercial |
$2,633.11
|
| Rate for Payer: Health EOS Commercial |
$2,547.25
|
| Rate for Payer: HFN Commercial |
$2,633.11
|
| Rate for Payer: Multiplan Commercial |
$2,289.66
|
| Rate for Payer: Preferred Network Access Commercial |
$2,633.11
|
| Rate for Payer: Quartz Beloit One Network |
$1,402.42
|
| Rate for Payer: Quartz Commercial |
$1,717.25
|
| Rate for Payer: WEA Trust Commercial |
$1,574.14
|
| Rate for Payer: WPS Commercial |
$2,119.87
|
|
|
SCREW LOCK CANN 5.0 X 60 02.205.060
|
Facility
|
OP
|
$827.00
|
|
| Hospital Charge Code |
2966993
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$240.82 |
| Max. Negotiated Rate |
$791.27 |
| Rate for Payer: Aetna Commercial |
$774.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$739.67
|
| Rate for Payer: Aetna Managed Medicare |
$240.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$559.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$430.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$412.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$455.84
|
| Rate for Payer: Cash Price |
$248.10
|
| Rate for Payer: Cigna Commercial |
$791.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$481.31
|
| Rate for Payer: Health EOS Commercial |
$765.47
|
| Rate for Payer: HFN Commercial |
$791.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$645.06
|
| Rate for Payer: Multiplan Commercial |
$688.06
|
| Rate for Payer: NAPHCARE Commercial |
$516.05
|
| Rate for Payer: Preferred Network Access Commercial |
$791.27
|
| Rate for Payer: Quartz Beloit One Network |
$421.44
|
| Rate for Payer: Quartz Commercial |
$559.05
|
| Rate for Payer: Quartz Medicare Advantage |
$516.05
|
| Rate for Payer: The Alliance Commercial |
$430.04
|
| Rate for Payer: WEA Trust Commercial |
$473.04
|
| Rate for Payer: WPS Commercial |
$637.04
|
|
|
SCREW LOCK CANN 5.0 X 60 02.205.060
|
Facility
|
IP
|
$827.00
|
|
| Hospital Charge Code |
2966993
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$421.44 |
| Max. Negotiated Rate |
$791.27 |
| Rate for Payer: Aetna Commercial |
$774.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$739.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$455.84
|
| Rate for Payer: Cash Price |
$248.10
|
| Rate for Payer: Cigna Commercial |
$791.27
|
| Rate for Payer: Health EOS Commercial |
$765.47
|
| Rate for Payer: HFN Commercial |
$791.27
|
| Rate for Payer: Multiplan Commercial |
$688.06
|
| Rate for Payer: Preferred Network Access Commercial |
$791.27
|
| Rate for Payer: Quartz Beloit One Network |
$421.44
|
| Rate for Payer: Quartz Commercial |
$516.05
|
| Rate for Payer: WEA Trust Commercial |
$473.04
|
| Rate for Payer: WPS Commercial |
$637.04
|
|
|
SCREW LOCK CANN 5.0 X 65MM 02.205.065
|
Facility
|
OP
|
$827.00
|
|
| Hospital Charge Code |
3613520
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$240.82 |
| Max. Negotiated Rate |
$791.27 |
| Rate for Payer: Aetna Commercial |
$774.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$739.67
|
| Rate for Payer: Aetna Managed Medicare |
$240.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$559.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$430.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$412.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$455.84
|
| Rate for Payer: Cash Price |
$248.10
|
| Rate for Payer: Cigna Commercial |
$791.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$481.31
|
| Rate for Payer: Health EOS Commercial |
$765.47
|
| Rate for Payer: HFN Commercial |
$791.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$645.06
|
| Rate for Payer: Multiplan Commercial |
$688.06
|
| Rate for Payer: NAPHCARE Commercial |
$516.05
|
| Rate for Payer: Preferred Network Access Commercial |
$791.27
|
| Rate for Payer: Quartz Beloit One Network |
$421.44
|
| Rate for Payer: Quartz Commercial |
$559.05
|
| Rate for Payer: Quartz Medicare Advantage |
$516.05
|
| Rate for Payer: The Alliance Commercial |
$430.04
|
| Rate for Payer: WEA Trust Commercial |
$473.04
|
| Rate for Payer: WPS Commercial |
$637.04
|
|
|
SCREW LOCK CANN 5.0 X 65MM 02.205.065
|
Facility
|
IP
|
$827.00
|
|
| Hospital Charge Code |
3613520
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$421.44 |
| Max. Negotiated Rate |
$791.27 |
| Rate for Payer: Aetna Commercial |
$774.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$739.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$455.84
|
| Rate for Payer: Cash Price |
$248.10
|
| Rate for Payer: Cigna Commercial |
$791.27
|
| Rate for Payer: Health EOS Commercial |
$765.47
|
| Rate for Payer: HFN Commercial |
$791.27
|
| Rate for Payer: Multiplan Commercial |
$688.06
|
| Rate for Payer: Preferred Network Access Commercial |
$791.27
|
| Rate for Payer: Quartz Beloit One Network |
$421.44
|
| Rate for Payer: Quartz Commercial |
$516.05
|
| Rate for Payer: WEA Trust Commercial |
$473.04
|
| Rate for Payer: WPS Commercial |
$637.04
|
|
|
SCREW LOCK CANN 5.0 X 70 02.205.070
|
Facility
|
OP
|
$827.00
|
|
| Hospital Charge Code |
2966999
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$240.82 |
| Max. Negotiated Rate |
$791.27 |
| Rate for Payer: Aetna Commercial |
$774.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$739.67
|
| Rate for Payer: Aetna Managed Medicare |
$240.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$559.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$430.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$412.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$455.84
|
| Rate for Payer: Cash Price |
$248.10
|
| Rate for Payer: Cigna Commercial |
$791.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$481.31
|
| Rate for Payer: Health EOS Commercial |
$765.47
|
| Rate for Payer: HFN Commercial |
$791.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$645.06
|
| Rate for Payer: Multiplan Commercial |
$688.06
|
| Rate for Payer: NAPHCARE Commercial |
$516.05
|
| Rate for Payer: Preferred Network Access Commercial |
$791.27
|
| Rate for Payer: Quartz Beloit One Network |
$421.44
|
| Rate for Payer: Quartz Commercial |
$559.05
|
| Rate for Payer: Quartz Medicare Advantage |
$516.05
|
| Rate for Payer: The Alliance Commercial |
$430.04
|
| Rate for Payer: WEA Trust Commercial |
$473.04
|
| Rate for Payer: WPS Commercial |
$637.04
|
|
|
SCREW LOCK CANN 5.0 X 70 02.205.070
|
Facility
|
IP
|
$827.00
|
|
| Hospital Charge Code |
2966999
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$421.44 |
| Max. Negotiated Rate |
$791.27 |
| Rate for Payer: Aetna Commercial |
$774.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$739.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$455.84
|
| Rate for Payer: Cash Price |
$248.10
|
| Rate for Payer: Cigna Commercial |
$791.27
|
| Rate for Payer: Health EOS Commercial |
$765.47
|
| Rate for Payer: HFN Commercial |
$791.27
|
| Rate for Payer: Multiplan Commercial |
$688.06
|
| Rate for Payer: Preferred Network Access Commercial |
$791.27
|
| Rate for Payer: Quartz Beloit One Network |
$421.44
|
| Rate for Payer: Quartz Commercial |
$516.05
|
| Rate for Payer: WEA Trust Commercial |
$473.04
|
| Rate for Payer: WPS Commercial |
$637.04
|
|
|
SCREW LOCK CORT VA 2.4 X 18MM TI AR-8916VNC-18
|
Facility
|
IP
|
$1,864.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5456671
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$949.89 |
| Max. Negotiated Rate |
$1,783.48 |
| Rate for Payer: Aetna Commercial |
$1,744.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,667.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,027.44
|
| Rate for Payer: Cash Price |
$559.20
|
| Rate for Payer: Cigna Commercial |
$1,783.48
|
| Rate for Payer: Health EOS Commercial |
$1,725.32
|
| Rate for Payer: HFN Commercial |
$1,783.48
|
| Rate for Payer: Multiplan Commercial |
$1,550.85
|
| Rate for Payer: Preferred Network Access Commercial |
$1,783.48
|
| Rate for Payer: Quartz Beloit One Network |
$949.89
|
| Rate for Payer: Quartz Commercial |
$1,163.14
|
| Rate for Payer: WEA Trust Commercial |
$1,066.21
|
| Rate for Payer: WPS Commercial |
$1,435.84
|
|
|
SCREW LOCK CORT VA 2.4 X 18MM TI AR-8916VNC-18
|
Facility
|
OP
|
$1,864.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5456671
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$542.80 |
| Max. Negotiated Rate |
$1,783.48 |
| Rate for Payer: Aetna Commercial |
$1,744.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,667.16
|
| Rate for Payer: Aetna Managed Medicare |
$542.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,260.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$969.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$930.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,027.44
|
| Rate for Payer: Cash Price |
$559.20
|
| Rate for Payer: Cigna Commercial |
$1,783.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,084.85
|
| Rate for Payer: Health EOS Commercial |
$1,725.32
|
| Rate for Payer: HFN Commercial |
$1,783.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,453.92
|
| Rate for Payer: Multiplan Commercial |
$1,550.85
|
| Rate for Payer: NAPHCARE Commercial |
$1,163.14
|
| Rate for Payer: Preferred Network Access Commercial |
$1,783.48
|
| Rate for Payer: Quartz Beloit One Network |
$949.89
|
| Rate for Payer: Quartz Commercial |
$1,260.06
|
| Rate for Payer: Quartz Medicare Advantage |
$1,163.14
|
| Rate for Payer: The Alliance Commercial |
$969.28
|
| Rate for Payer: WEA Trust Commercial |
$1,066.21
|
| Rate for Payer: WPS Commercial |
$1,435.84
|
|
|
SCREW LOCK IMN 5.0 X 25MM 2360-5025S
|
Facility
|
IP
|
$2,062.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6201045
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,050.80 |
| Max. Negotiated Rate |
$1,972.92 |
| Rate for Payer: Aetna Commercial |
$1,930.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,844.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,136.57
|
| Rate for Payer: Cash Price |
$618.60
|
| Rate for Payer: Cigna Commercial |
$1,972.92
|
| Rate for Payer: Health EOS Commercial |
$1,908.59
|
| Rate for Payer: HFN Commercial |
$1,972.92
|
| Rate for Payer: Multiplan Commercial |
$1,715.58
|
| Rate for Payer: Preferred Network Access Commercial |
$1,972.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,050.80
|
| Rate for Payer: Quartz Commercial |
$1,286.69
|
| Rate for Payer: WEA Trust Commercial |
$1,179.46
|
| Rate for Payer: WPS Commercial |
$1,588.36
|
|
|
SCREW LOCK IMN 5.0 X 25MM 2360-5025S
|
Facility
|
OP
|
$2,062.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6201045
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$600.45 |
| Max. Negotiated Rate |
$1,972.92 |
| Rate for Payer: Aetna Commercial |
$1,930.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,844.25
|
| Rate for Payer: Aetna Managed Medicare |
$600.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,393.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,072.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,029.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,136.57
|
| Rate for Payer: Cash Price |
$618.60
|
| Rate for Payer: Cigna Commercial |
$1,972.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,200.08
|
| Rate for Payer: Health EOS Commercial |
$1,908.59
|
| Rate for Payer: HFN Commercial |
$1,972.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,608.36
|
| Rate for Payer: Multiplan Commercial |
$1,715.58
|
| Rate for Payer: NAPHCARE Commercial |
$1,286.69
|
| Rate for Payer: Preferred Network Access Commercial |
$1,972.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,050.80
|
| Rate for Payer: Quartz Commercial |
$1,393.91
|
| Rate for Payer: Quartz Medicare Advantage |
$1,286.69
|
| Rate for Payer: The Alliance Commercial |
$1,072.24
|
| Rate for Payer: WEA Trust Commercial |
$1,179.46
|
| Rate for Payer: WPS Commercial |
$1,588.36
|
|
|
SCREW LOCK IMN 5.0 X 32.5MM 2361-5032S
|
Facility
|
IP
|
$2,676.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6177990
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,363.69 |
| Max. Negotiated Rate |
$2,560.40 |
| Rate for Payer: Aetna Commercial |
$2,504.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,393.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,475.01
|
| Rate for Payer: Cash Price |
$802.80
|
| Rate for Payer: Cigna Commercial |
$2,560.40
|
| Rate for Payer: Health EOS Commercial |
$2,476.91
|
| Rate for Payer: HFN Commercial |
$2,560.40
|
| Rate for Payer: Multiplan Commercial |
$2,226.43
|
| Rate for Payer: Preferred Network Access Commercial |
$2,560.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,363.69
|
| Rate for Payer: Quartz Commercial |
$1,669.82
|
| Rate for Payer: WEA Trust Commercial |
$1,530.67
|
| Rate for Payer: WPS Commercial |
$2,061.32
|
|
|
SCREW LOCK IMN 5.0 X 32.5MM 2361-5032S
|
Facility
|
OP
|
$2,676.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6177990
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$779.25 |
| Max. Negotiated Rate |
$2,560.40 |
| Rate for Payer: Aetna Commercial |
$2,504.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,393.41
|
| Rate for Payer: Aetna Managed Medicare |
$779.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,808.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,391.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,335.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,475.01
|
| Rate for Payer: Cash Price |
$802.80
|
| Rate for Payer: Cigna Commercial |
$2,560.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,557.43
|
| Rate for Payer: Health EOS Commercial |
$2,476.91
|
| Rate for Payer: HFN Commercial |
$2,560.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,087.28
|
| Rate for Payer: Multiplan Commercial |
$2,226.43
|
| Rate for Payer: NAPHCARE Commercial |
$1,669.82
|
| Rate for Payer: Preferred Network Access Commercial |
$2,560.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,363.69
|
| Rate for Payer: Quartz Commercial |
$1,808.98
|
| Rate for Payer: Quartz Medicare Advantage |
$1,669.82
|
| Rate for Payer: The Alliance Commercial |
$1,391.52
|
| Rate for Payer: WEA Trust Commercial |
$1,530.67
|
| Rate for Payer: WPS Commercial |
$2,061.32
|
|
|
SCREW LOCK IMN 5.0 X 35MM 2360-5035S
|
Facility
|
IP
|
$2,703.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599790
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,377.45 |
| Max. Negotiated Rate |
$2,586.23 |
| Rate for Payer: Aetna Commercial |
$2,530.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,417.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,489.89
|
| Rate for Payer: Cash Price |
$810.90
|
| Rate for Payer: Cigna Commercial |
$2,586.23
|
| Rate for Payer: Health EOS Commercial |
$2,501.90
|
| Rate for Payer: HFN Commercial |
$2,586.23
|
| Rate for Payer: Multiplan Commercial |
$2,248.90
|
| Rate for Payer: Preferred Network Access Commercial |
$2,586.23
|
| Rate for Payer: Quartz Beloit One Network |
$1,377.45
|
| Rate for Payer: Quartz Commercial |
$1,686.67
|
| Rate for Payer: WEA Trust Commercial |
$1,546.12
|
| Rate for Payer: WPS Commercial |
$2,082.12
|
|
|
SCREW LOCK IMN 5.0 X 35MM 2360-5035S
|
Facility
|
OP
|
$2,703.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599790
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$787.11 |
| Max. Negotiated Rate |
$2,586.23 |
| Rate for Payer: Aetna Commercial |
$2,530.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,417.56
|
| Rate for Payer: Aetna Managed Medicare |
$787.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,827.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,405.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,349.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,489.89
|
| Rate for Payer: Cash Price |
$810.90
|
| Rate for Payer: Cigna Commercial |
$2,586.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,573.15
|
| Rate for Payer: Health EOS Commercial |
$2,501.90
|
| Rate for Payer: HFN Commercial |
$2,586.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,108.34
|
| Rate for Payer: Multiplan Commercial |
$2,248.90
|
| Rate for Payer: NAPHCARE Commercial |
$1,686.67
|
| Rate for Payer: Preferred Network Access Commercial |
$2,586.23
|
| Rate for Payer: Quartz Beloit One Network |
$1,377.45
|
| Rate for Payer: Quartz Commercial |
$1,827.23
|
| Rate for Payer: Quartz Medicare Advantage |
$1,686.67
|
| Rate for Payer: The Alliance Commercial |
$1,405.56
|
| Rate for Payer: WEA Trust Commercial |
$1,546.12
|
| Rate for Payer: WPS Commercial |
$2,082.12
|
|
|
SCREW LOCK IMN 5.0 X 35MM 2361-5035S
|
Facility
|
OP
|
$2,676.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6201031
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$779.25 |
| Max. Negotiated Rate |
$2,560.40 |
| Rate for Payer: Aetna Commercial |
$2,504.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,393.41
|
| Rate for Payer: Aetna Managed Medicare |
$779.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,808.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,391.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,335.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,475.01
|
| Rate for Payer: Cash Price |
$802.80
|
| Rate for Payer: Cigna Commercial |
$2,560.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,557.43
|
| Rate for Payer: Health EOS Commercial |
$2,476.91
|
| Rate for Payer: HFN Commercial |
$2,560.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,087.28
|
| Rate for Payer: Multiplan Commercial |
$2,226.43
|
| Rate for Payer: NAPHCARE Commercial |
$1,669.82
|
| Rate for Payer: Preferred Network Access Commercial |
$2,560.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,363.69
|
| Rate for Payer: Quartz Commercial |
$1,808.98
|
| Rate for Payer: Quartz Medicare Advantage |
$1,669.82
|
| Rate for Payer: The Alliance Commercial |
$1,391.52
|
| Rate for Payer: WEA Trust Commercial |
$1,530.67
|
| Rate for Payer: WPS Commercial |
$2,061.32
|
|
|
SCREW LOCK IMN 5.0 X 35MM 2361-5035S
|
Facility
|
IP
|
$2,676.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6201031
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,363.69 |
| Max. Negotiated Rate |
$2,560.40 |
| Rate for Payer: Aetna Commercial |
$2,504.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,393.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,475.01
|
| Rate for Payer: Cash Price |
$802.80
|
| Rate for Payer: Cigna Commercial |
$2,560.40
|
| Rate for Payer: Health EOS Commercial |
$2,476.91
|
| Rate for Payer: HFN Commercial |
$2,560.40
|
| Rate for Payer: Multiplan Commercial |
$2,226.43
|
| Rate for Payer: Preferred Network Access Commercial |
$2,560.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,363.69
|
| Rate for Payer: Quartz Commercial |
$1,669.82
|
| Rate for Payer: WEA Trust Commercial |
$1,530.67
|
| Rate for Payer: WPS Commercial |
$2,061.32
|
|
