|
SCREW LOCK IMN 5.0 X 37.5MM 2360-5037S
|
Facility
|
OP
|
$2,599.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5797678
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$756.83 |
| Max. Negotiated Rate |
$2,486.72 |
| Rate for Payer: Aetna Commercial |
$2,432.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,324.55
|
| Rate for Payer: Aetna Managed Medicare |
$756.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,756.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,351.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,297.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,432.57
|
| Rate for Payer: Cash Price |
$779.70
|
| Rate for Payer: Cigna Commercial |
$2,486.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,512.62
|
| Rate for Payer: Health EOS Commercial |
$2,405.63
|
| Rate for Payer: HFN Commercial |
$2,486.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,027.22
|
| Rate for Payer: Multiplan Commercial |
$2,162.37
|
| Rate for Payer: NAPHCARE Commercial |
$1,621.78
|
| Rate for Payer: Preferred Network Access Commercial |
$2,486.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,324.45
|
| Rate for Payer: Quartz Commercial |
$1,756.92
|
| Rate for Payer: Quartz Medicare Advantage |
$1,621.78
|
| Rate for Payer: The Alliance Commercial |
$1,351.48
|
| Rate for Payer: WEA Trust Commercial |
$1,486.63
|
| Rate for Payer: WPS Commercial |
$2,002.01
|
|
|
SCREW LOCK IMN 5.0 X 37.5MM 2360-5037S
|
Facility
|
IP
|
$2,599.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5797678
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,324.45 |
| Max. Negotiated Rate |
$2,486.72 |
| Rate for Payer: Aetna Commercial |
$2,432.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,324.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,432.57
|
| Rate for Payer: Cash Price |
$779.70
|
| Rate for Payer: Cigna Commercial |
$2,486.72
|
| Rate for Payer: Health EOS Commercial |
$2,405.63
|
| Rate for Payer: HFN Commercial |
$2,486.72
|
| Rate for Payer: Multiplan Commercial |
$2,162.37
|
| Rate for Payer: Preferred Network Access Commercial |
$2,486.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,324.45
|
| Rate for Payer: Quartz Commercial |
$1,621.78
|
| Rate for Payer: WEA Trust Commercial |
$1,486.63
|
| Rate for Payer: WPS Commercial |
$2,002.01
|
|
|
SCREW LOCK IMN 5.0 X 37.5MM 2361-5037S
|
Facility
|
OP
|
$2,676.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6201032
|
|
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 37.5MM 2361-5037S
|
Facility
|
IP
|
$2,676.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6201032
|
|
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 40MM 2360-5040S
|
Facility
|
OP
|
$2,703.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599791
|
|
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 40MM 2360-5040S
|
Facility
|
IP
|
$2,703.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599791
|
|
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 42.5MM 2360-5042S
|
Facility
|
IP
|
$2,703.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599789
|
|
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 42.5MM 2360-5042S
|
Facility
|
OP
|
$2,703.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599789
|
|
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 42.5MM 2361-5042S
|
Facility
|
OP
|
$2,676.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6177991
|
|
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 42.5MM 2361-5042S
|
Facility
|
IP
|
$2,676.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6177991
|
|
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 45MM 2361-5045S
|
Facility
|
OP
|
$2,676.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6201030
|
|
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 45MM 2361-5045S
|
Facility
|
IP
|
$2,676.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6201030
|
|
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 47.5MM 2360-5047S
|
Facility
|
IP
|
$3,756.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599792
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,914.06 |
| Max. Negotiated Rate |
$3,593.74 |
| Rate for Payer: Aetna Commercial |
$3,515.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,359.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,070.31
|
| Rate for Payer: Cash Price |
$1,126.80
|
| Rate for Payer: Cigna Commercial |
$3,593.74
|
| Rate for Payer: Health EOS Commercial |
$3,476.55
|
| Rate for Payer: HFN Commercial |
$3,593.74
|
| Rate for Payer: Multiplan Commercial |
$3,124.99
|
| Rate for Payer: Preferred Network Access Commercial |
$3,593.74
|
| Rate for Payer: Quartz Beloit One Network |
$1,914.06
|
| Rate for Payer: Quartz Commercial |
$2,343.74
|
| Rate for Payer: WEA Trust Commercial |
$2,148.43
|
| Rate for Payer: WPS Commercial |
$2,893.25
|
|
|
SCREW LOCK IMN 5.0 X 47.5MM 2360-5047S
|
Facility
|
OP
|
$3,756.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599792
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,093.75 |
| Max. Negotiated Rate |
$3,593.74 |
| Rate for Payer: Aetna Commercial |
$3,515.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,359.37
|
| Rate for Payer: Aetna Managed Medicare |
$1,093.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,539.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,953.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,875.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,070.31
|
| Rate for Payer: Cash Price |
$1,126.80
|
| Rate for Payer: Cigna Commercial |
$3,593.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,185.99
|
| Rate for Payer: Health EOS Commercial |
$3,476.55
|
| Rate for Payer: HFN Commercial |
$3,593.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,929.68
|
| Rate for Payer: Multiplan Commercial |
$3,124.99
|
| Rate for Payer: NAPHCARE Commercial |
$2,343.74
|
| Rate for Payer: Preferred Network Access Commercial |
$3,593.74
|
| Rate for Payer: Quartz Beloit One Network |
$1,914.06
|
| Rate for Payer: Quartz Commercial |
$2,539.06
|
| Rate for Payer: Quartz Medicare Advantage |
$2,343.74
|
| Rate for Payer: The Alliance Commercial |
$1,953.12
|
| Rate for Payer: WEA Trust Commercial |
$2,148.43
|
| Rate for Payer: WPS Commercial |
$2,893.25
|
|
|
SCREW LOCK IMN 5.0 X 50MM 2360-5050S
|
Facility
|
IP
|
$2,062.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6151667
|
|
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 50MM 2360-5050S
|
Facility
|
OP
|
$2,062.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6151667
|
|
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 52.5MM 2360-5052S
|
Facility
|
IP
|
$2,599.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5797677
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,324.45 |
| Max. Negotiated Rate |
$2,486.72 |
| Rate for Payer: Aetna Commercial |
$2,432.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,324.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,432.57
|
| Rate for Payer: Cash Price |
$779.70
|
| Rate for Payer: Cigna Commercial |
$2,486.72
|
| Rate for Payer: Health EOS Commercial |
$2,405.63
|
| Rate for Payer: HFN Commercial |
$2,486.72
|
| Rate for Payer: Multiplan Commercial |
$2,162.37
|
| Rate for Payer: Preferred Network Access Commercial |
$2,486.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,324.45
|
| Rate for Payer: Quartz Commercial |
$1,621.78
|
| Rate for Payer: WEA Trust Commercial |
$1,486.63
|
| Rate for Payer: WPS Commercial |
$2,002.01
|
|
|
SCREW LOCK IMN 5.0 X 52.5MM 2360-5052S
|
Facility
|
OP
|
$2,599.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5797677
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$756.83 |
| Max. Negotiated Rate |
$2,486.72 |
| Rate for Payer: Aetna Commercial |
$2,432.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,324.55
|
| Rate for Payer: Aetna Managed Medicare |
$756.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,756.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,351.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,297.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,432.57
|
| Rate for Payer: Cash Price |
$779.70
|
| Rate for Payer: Cigna Commercial |
$2,486.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,512.62
|
| Rate for Payer: Health EOS Commercial |
$2,405.63
|
| Rate for Payer: HFN Commercial |
$2,486.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,027.22
|
| Rate for Payer: Multiplan Commercial |
$2,162.37
|
| Rate for Payer: NAPHCARE Commercial |
$1,621.78
|
| Rate for Payer: Preferred Network Access Commercial |
$2,486.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,324.45
|
| Rate for Payer: Quartz Commercial |
$1,756.92
|
| Rate for Payer: Quartz Medicare Advantage |
$1,621.78
|
| Rate for Payer: The Alliance Commercial |
$1,351.48
|
| Rate for Payer: WEA Trust Commercial |
$1,486.63
|
| Rate for Payer: WPS Commercial |
$2,002.01
|
|
|
SCREW LOCK IMN 5.0 X 60MM 2360-5060S
|
Facility
|
OP
|
$2,599.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685870
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$756.83 |
| Max. Negotiated Rate |
$2,486.72 |
| Rate for Payer: Aetna Commercial |
$2,432.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,324.55
|
| Rate for Payer: Aetna Managed Medicare |
$756.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,756.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,351.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,297.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,432.57
|
| Rate for Payer: Cash Price |
$779.70
|
| Rate for Payer: Cigna Commercial |
$2,486.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,512.62
|
| Rate for Payer: Health EOS Commercial |
$2,405.63
|
| Rate for Payer: HFN Commercial |
$2,486.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,027.22
|
| Rate for Payer: Multiplan Commercial |
$2,162.37
|
| Rate for Payer: NAPHCARE Commercial |
$1,621.78
|
| Rate for Payer: Preferred Network Access Commercial |
$2,486.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,324.45
|
| Rate for Payer: Quartz Commercial |
$1,756.92
|
| Rate for Payer: Quartz Medicare Advantage |
$1,621.78
|
| Rate for Payer: The Alliance Commercial |
$1,351.48
|
| Rate for Payer: WEA Trust Commercial |
$1,486.63
|
| Rate for Payer: WPS Commercial |
$2,002.01
|
|
|
SCREW LOCK IMN 5.0 X 60MM 2360-5060S
|
Facility
|
IP
|
$2,599.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685870
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,324.45 |
| Max. Negotiated Rate |
$2,486.72 |
| Rate for Payer: Aetna Commercial |
$2,432.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,324.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,432.57
|
| Rate for Payer: Cash Price |
$779.70
|
| Rate for Payer: Cigna Commercial |
$2,486.72
|
| Rate for Payer: Health EOS Commercial |
$2,405.63
|
| Rate for Payer: HFN Commercial |
$2,486.72
|
| Rate for Payer: Multiplan Commercial |
$2,162.37
|
| Rate for Payer: Preferred Network Access Commercial |
$2,486.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,324.45
|
| Rate for Payer: Quartz Commercial |
$1,621.78
|
| Rate for Payer: WEA Trust Commercial |
$1,486.63
|
| Rate for Payer: WPS Commercial |
$2,002.01
|
|
|
SCREW LOCK IMN 5.0 X 60MM 2361-5060S
|
Facility
|
OP
|
$2,676.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6173012
|
|
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 60MM 2361-5060S
|
Facility
|
IP
|
$2,676.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6173012
|
|
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 65MM 2360-5065S
|
Facility
|
IP
|
$2,703.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599793
|
|
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 65MM 2360-5065S
|
Facility
|
OP
|
$2,703.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599793
|
|
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 65MM 2361-5065S
|
Facility
|
OP
|
$2,676.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6177992
|
|
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
|
|
