|
SCREW LOCK IMN 5.0 X 65MM 2361-5065S
|
Facility
|
IP
|
$2,676.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6177992
|
|
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 I/M NAIL TI 4.0 X 40MM 04.005.430S
|
Facility
|
OP
|
$2,945.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966518
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$857.58 |
| Max. Negotiated Rate |
$2,817.78 |
| Rate for Payer: Aetna Commercial |
$2,756.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,634.01
|
| Rate for Payer: Aetna Managed Medicare |
$857.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,990.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,531.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,470.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,623.28
|
| Rate for Payer: Cash Price |
$883.50
|
| Rate for Payer: Cigna Commercial |
$2,817.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,713.99
|
| Rate for Payer: Health EOS Commercial |
$2,725.89
|
| Rate for Payer: HFN Commercial |
$2,817.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,297.10
|
| Rate for Payer: Multiplan Commercial |
$2,450.24
|
| Rate for Payer: NAPHCARE Commercial |
$1,837.68
|
| Rate for Payer: Preferred Network Access Commercial |
$2,817.78
|
| Rate for Payer: Quartz Beloit One Network |
$1,500.77
|
| Rate for Payer: Quartz Commercial |
$1,990.82
|
| Rate for Payer: Quartz Medicare Advantage |
$1,837.68
|
| Rate for Payer: The Alliance Commercial |
$1,531.40
|
| Rate for Payer: WEA Trust Commercial |
$1,684.54
|
| Rate for Payer: WPS Commercial |
$2,268.53
|
|
|
SCREW LOCK I/M NAIL TI 4.0 X 40MM 04.005.430S
|
Facility
|
IP
|
$2,945.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966518
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.77 |
| Max. Negotiated Rate |
$2,817.78 |
| Rate for Payer: Aetna Commercial |
$2,756.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,634.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,623.28
|
| Rate for Payer: Cash Price |
$883.50
|
| Rate for Payer: Cigna Commercial |
$2,817.78
|
| Rate for Payer: Health EOS Commercial |
$2,725.89
|
| Rate for Payer: HFN Commercial |
$2,817.78
|
| Rate for Payer: Multiplan Commercial |
$2,450.24
|
| Rate for Payer: Preferred Network Access Commercial |
$2,817.78
|
| Rate for Payer: Quartz Beloit One Network |
$1,500.77
|
| Rate for Payer: Quartz Commercial |
$1,837.68
|
| Rate for Payer: WEA Trust Commercial |
$1,684.54
|
| Rate for Payer: WPS Commercial |
$2,268.53
|
|
|
SCREW LOCK I/M NAIL TI 4.0 X 44MM 04.005.434S
|
Facility
|
IP
|
$1,968.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3444842
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,002.89 |
| Max. Negotiated Rate |
$1,882.98 |
| Rate for Payer: Aetna Commercial |
$1,842.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,760.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,084.76
|
| Rate for Payer: Cash Price |
$590.40
|
| Rate for Payer: Cigna Commercial |
$1,882.98
|
| Rate for Payer: Health EOS Commercial |
$1,821.58
|
| Rate for Payer: HFN Commercial |
$1,882.98
|
| Rate for Payer: Multiplan Commercial |
$1,637.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,882.98
|
| Rate for Payer: Quartz Beloit One Network |
$1,002.89
|
| Rate for Payer: Quartz Commercial |
$1,228.03
|
| Rate for Payer: WEA Trust Commercial |
$1,125.70
|
| Rate for Payer: WPS Commercial |
$1,515.95
|
|
|
SCREW LOCK I/M NAIL TI 4.0 X 44MM 04.005.434S
|
Facility
|
OP
|
$1,968.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3444842
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$573.08 |
| Max. Negotiated Rate |
$1,882.98 |
| Rate for Payer: Aetna Commercial |
$1,842.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,760.18
|
| Rate for Payer: Aetna Managed Medicare |
$573.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,330.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,023.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$982.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,084.76
|
| Rate for Payer: Cash Price |
$590.40
|
| Rate for Payer: Cigna Commercial |
$1,882.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,145.38
|
| Rate for Payer: Health EOS Commercial |
$1,821.58
|
| Rate for Payer: HFN Commercial |
$1,882.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,535.04
|
| Rate for Payer: Multiplan Commercial |
$1,637.38
|
| Rate for Payer: NAPHCARE Commercial |
$1,228.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,882.98
|
| Rate for Payer: Quartz Beloit One Network |
$1,002.89
|
| Rate for Payer: Quartz Commercial |
$1,330.37
|
| Rate for Payer: Quartz Medicare Advantage |
$1,228.03
|
| Rate for Payer: The Alliance Commercial |
$1,023.36
|
| Rate for Payer: WEA Trust Commercial |
$1,125.70
|
| Rate for Payer: WPS Commercial |
$1,515.95
|
|
|
SCREW LOCK I/M NAIL TI 4.0 X 48MM 04.005.438S
|
Facility
|
OP
|
$1,968.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4519017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$573.08 |
| Max. Negotiated Rate |
$1,882.98 |
| Rate for Payer: Aetna Commercial |
$1,842.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,760.18
|
| Rate for Payer: Aetna Managed Medicare |
$573.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,330.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,023.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$982.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,084.76
|
| Rate for Payer: Cash Price |
$590.40
|
| Rate for Payer: Cigna Commercial |
$1,882.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,145.38
|
| Rate for Payer: Health EOS Commercial |
$1,821.58
|
| Rate for Payer: HFN Commercial |
$1,882.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,535.04
|
| Rate for Payer: Multiplan Commercial |
$1,637.38
|
| Rate for Payer: NAPHCARE Commercial |
$1,228.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,882.98
|
| Rate for Payer: Quartz Beloit One Network |
$1,002.89
|
| Rate for Payer: Quartz Commercial |
$1,330.37
|
| Rate for Payer: Quartz Medicare Advantage |
$1,228.03
|
| Rate for Payer: The Alliance Commercial |
$1,023.36
|
| Rate for Payer: WEA Trust Commercial |
$1,125.70
|
| Rate for Payer: WPS Commercial |
$1,515.95
|
|
|
SCREW LOCK I/M NAIL TI 4.0 X 48MM 04.005.438S
|
Facility
|
IP
|
$1,968.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4519017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,002.89 |
| Max. Negotiated Rate |
$1,882.98 |
| Rate for Payer: Aetna Commercial |
$1,842.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,760.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,084.76
|
| Rate for Payer: Cash Price |
$590.40
|
| Rate for Payer: Cigna Commercial |
$1,882.98
|
| Rate for Payer: Health EOS Commercial |
$1,821.58
|
| Rate for Payer: HFN Commercial |
$1,882.98
|
| Rate for Payer: Multiplan Commercial |
$1,637.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,882.98
|
| Rate for Payer: Quartz Beloit One Network |
$1,002.89
|
| Rate for Payer: Quartz Commercial |
$1,228.03
|
| Rate for Payer: WEA Trust Commercial |
$1,125.70
|
| Rate for Payer: WPS Commercial |
$1,515.95
|
|
|
SCREW LOCK I/M NAIL TI 4.0 X 50MM 04.005.440S
|
Facility
|
IP
|
$1,968.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4640803
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,002.89 |
| Max. Negotiated Rate |
$1,882.98 |
| Rate for Payer: Aetna Commercial |
$1,842.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,760.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,084.76
|
| Rate for Payer: Cash Price |
$590.40
|
| Rate for Payer: Cigna Commercial |
$1,882.98
|
| Rate for Payer: Health EOS Commercial |
$1,821.58
|
| Rate for Payer: HFN Commercial |
$1,882.98
|
| Rate for Payer: Multiplan Commercial |
$1,637.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,882.98
|
| Rate for Payer: Quartz Beloit One Network |
$1,002.89
|
| Rate for Payer: Quartz Commercial |
$1,228.03
|
| Rate for Payer: WEA Trust Commercial |
$1,125.70
|
| Rate for Payer: WPS Commercial |
$1,515.95
|
|
|
SCREW LOCK I/M NAIL TI 4.0 X 50MM 04.005.440S
|
Facility
|
OP
|
$1,968.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4640803
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$573.08 |
| Max. Negotiated Rate |
$1,882.98 |
| Rate for Payer: Aetna Commercial |
$1,842.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,760.18
|
| Rate for Payer: Aetna Managed Medicare |
$573.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,330.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,023.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$982.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,084.76
|
| Rate for Payer: Cash Price |
$590.40
|
| Rate for Payer: Cigna Commercial |
$1,882.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,145.38
|
| Rate for Payer: Health EOS Commercial |
$1,821.58
|
| Rate for Payer: HFN Commercial |
$1,882.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,535.04
|
| Rate for Payer: Multiplan Commercial |
$1,637.38
|
| Rate for Payer: NAPHCARE Commercial |
$1,228.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,882.98
|
| Rate for Payer: Quartz Beloit One Network |
$1,002.89
|
| Rate for Payer: Quartz Commercial |
$1,330.37
|
| Rate for Payer: Quartz Medicare Advantage |
$1,228.03
|
| Rate for Payer: The Alliance Commercial |
$1,023.36
|
| Rate for Payer: WEA Trust Commercial |
$1,125.70
|
| Rate for Payer: WPS Commercial |
$1,515.95
|
|
|
SCREW LOCKING 2.4 X 10 MS-2410L
|
Facility
|
IP
|
$1,958.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5520865
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$997.80 |
| Max. Negotiated Rate |
$1,873.41 |
| Rate for Payer: Aetna Commercial |
$1,832.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,751.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,079.25
|
| Rate for Payer: Cash Price |
$587.40
|
| Rate for Payer: Cigna Commercial |
$1,873.41
|
| Rate for Payer: Health EOS Commercial |
$1,812.32
|
| Rate for Payer: HFN Commercial |
$1,873.41
|
| Rate for Payer: Multiplan Commercial |
$1,629.06
|
| Rate for Payer: Preferred Network Access Commercial |
$1,873.41
|
| Rate for Payer: Quartz Beloit One Network |
$997.80
|
| Rate for Payer: Quartz Commercial |
$1,221.79
|
| Rate for Payer: WEA Trust Commercial |
$1,119.98
|
| Rate for Payer: WPS Commercial |
$1,508.25
|
|
|
SCREW LOCKING 2.4 X 10 MS-2410L
|
Facility
|
OP
|
$1,958.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5520865
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$570.17 |
| Max. Negotiated Rate |
$1,873.41 |
| Rate for Payer: Aetna Commercial |
$1,832.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,751.24
|
| Rate for Payer: Aetna Managed Medicare |
$570.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,323.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,018.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$977.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,079.25
|
| Rate for Payer: Cash Price |
$587.40
|
| Rate for Payer: Cigna Commercial |
$1,873.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,139.56
|
| Rate for Payer: Health EOS Commercial |
$1,812.32
|
| Rate for Payer: HFN Commercial |
$1,873.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,527.24
|
| Rate for Payer: Multiplan Commercial |
$1,629.06
|
| Rate for Payer: NAPHCARE Commercial |
$1,221.79
|
| Rate for Payer: Preferred Network Access Commercial |
$1,873.41
|
| Rate for Payer: Quartz Beloit One Network |
$997.80
|
| Rate for Payer: Quartz Commercial |
$1,323.61
|
| Rate for Payer: Quartz Medicare Advantage |
$1,221.79
|
| Rate for Payer: The Alliance Commercial |
$1,018.16
|
| Rate for Payer: WEA Trust Commercial |
$1,119.98
|
| Rate for Payer: WPS Commercial |
$1,508.25
|
|
|
SCREW LOCKING 2.4 X 12 MS-2412L
|
Facility
|
OP
|
$1,957.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5264781
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$569.88 |
| Max. Negotiated Rate |
$1,872.46 |
| Rate for Payer: Aetna Commercial |
$1,831.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,750.34
|
| Rate for Payer: Aetna Managed Medicare |
$569.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,322.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,017.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$976.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,078.70
|
| Rate for Payer: Cash Price |
$587.10
|
| Rate for Payer: Cigna Commercial |
$1,872.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,138.97
|
| Rate for Payer: Health EOS Commercial |
$1,811.40
|
| Rate for Payer: HFN Commercial |
$1,872.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,526.46
|
| Rate for Payer: Multiplan Commercial |
$1,628.22
|
| Rate for Payer: NAPHCARE Commercial |
$1,221.17
|
| Rate for Payer: Preferred Network Access Commercial |
$1,872.46
|
| Rate for Payer: Quartz Beloit One Network |
$997.29
|
| Rate for Payer: Quartz Commercial |
$1,322.93
|
| Rate for Payer: Quartz Medicare Advantage |
$1,221.17
|
| Rate for Payer: The Alliance Commercial |
$1,017.64
|
| Rate for Payer: WEA Trust Commercial |
$1,119.40
|
| Rate for Payer: WPS Commercial |
$1,507.48
|
|
|
SCREW LOCKING 2.4 X 12 MS-2412L
|
Facility
|
IP
|
$1,957.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5264781
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$997.29 |
| Max. Negotiated Rate |
$1,872.46 |
| Rate for Payer: Aetna Commercial |
$1,831.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,750.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,078.70
|
| Rate for Payer: Cash Price |
$587.10
|
| Rate for Payer: Cigna Commercial |
$1,872.46
|
| Rate for Payer: Health EOS Commercial |
$1,811.40
|
| Rate for Payer: HFN Commercial |
$1,872.46
|
| Rate for Payer: Multiplan Commercial |
$1,628.22
|
| Rate for Payer: Preferred Network Access Commercial |
$1,872.46
|
| Rate for Payer: Quartz Beloit One Network |
$997.29
|
| Rate for Payer: Quartz Commercial |
$1,221.17
|
| Rate for Payer: WEA Trust Commercial |
$1,119.40
|
| Rate for Payer: WPS Commercial |
$1,507.48
|
|
|
SCREW LOCKING 2.4 X 8 MS-2408L
|
Facility
|
OP
|
$1,293.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6170098
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$376.52 |
| Max. Negotiated Rate |
$1,237.14 |
| Rate for Payer: Aetna Commercial |
$1,210.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,156.46
|
| Rate for Payer: Aetna Managed Medicare |
$376.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$874.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$672.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$645.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$712.70
|
| Rate for Payer: Cash Price |
$387.90
|
| Rate for Payer: Cigna Commercial |
$1,237.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$752.53
|
| Rate for Payer: Health EOS Commercial |
$1,196.80
|
| Rate for Payer: HFN Commercial |
$1,237.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,008.54
|
| Rate for Payer: Multiplan Commercial |
$1,075.78
|
| Rate for Payer: NAPHCARE Commercial |
$806.83
|
| Rate for Payer: Preferred Network Access Commercial |
$1,237.14
|
| Rate for Payer: Quartz Beloit One Network |
$658.91
|
| Rate for Payer: Quartz Commercial |
$874.07
|
| Rate for Payer: Quartz Medicare Advantage |
$806.83
|
| Rate for Payer: The Alliance Commercial |
$672.36
|
| Rate for Payer: WEA Trust Commercial |
$739.60
|
| Rate for Payer: WPS Commercial |
$996.00
|
|
|
SCREW LOCKING 2.4 X 8 MS-2408L
|
Facility
|
IP
|
$1,293.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6170098
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$658.91 |
| Max. Negotiated Rate |
$1,237.14 |
| Rate for Payer: Aetna Commercial |
$1,210.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,156.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$712.70
|
| Rate for Payer: Cash Price |
$387.90
|
| Rate for Payer: Cigna Commercial |
$1,237.14
|
| Rate for Payer: Health EOS Commercial |
$1,196.80
|
| Rate for Payer: HFN Commercial |
$1,237.14
|
| Rate for Payer: Multiplan Commercial |
$1,075.78
|
| Rate for Payer: Preferred Network Access Commercial |
$1,237.14
|
| Rate for Payer: Quartz Beloit One Network |
$658.91
|
| Rate for Payer: Quartz Commercial |
$806.83
|
| Rate for Payer: WEA Trust Commercial |
$739.60
|
| Rate for Payer: WPS Commercial |
$996.00
|
|
|
SCREW LOCKING 2.7 X 10MM 656310
|
Facility
|
IP
|
$1,883.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6173721
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$959.58 |
| Max. Negotiated Rate |
$1,801.65 |
| Rate for Payer: Aetna Commercial |
$1,762.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,684.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,037.91
|
| Rate for Payer: Cash Price |
$564.90
|
| Rate for Payer: Cigna Commercial |
$1,801.65
|
| Rate for Payer: Health EOS Commercial |
$1,742.90
|
| Rate for Payer: HFN Commercial |
$1,801.65
|
| Rate for Payer: Multiplan Commercial |
$1,566.66
|
| Rate for Payer: Preferred Network Access Commercial |
$1,801.65
|
| Rate for Payer: Quartz Beloit One Network |
$959.58
|
| Rate for Payer: Quartz Commercial |
$1,174.99
|
| Rate for Payer: WEA Trust Commercial |
$1,077.08
|
| Rate for Payer: WPS Commercial |
$1,450.47
|
|
|
SCREW LOCKING 2.7 X 10MM 656310
|
Facility
|
OP
|
$1,883.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6173721
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$548.33 |
| Max. Negotiated Rate |
$1,801.65 |
| Rate for Payer: Aetna Commercial |
$1,762.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,684.16
|
| Rate for Payer: Aetna Managed Medicare |
$548.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,272.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$979.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$939.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,037.91
|
| Rate for Payer: Cash Price |
$564.90
|
| Rate for Payer: Cigna Commercial |
$1,801.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,095.91
|
| Rate for Payer: Health EOS Commercial |
$1,742.90
|
| Rate for Payer: HFN Commercial |
$1,801.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,468.74
|
| Rate for Payer: Multiplan Commercial |
$1,566.66
|
| Rate for Payer: NAPHCARE Commercial |
$1,174.99
|
| Rate for Payer: Preferred Network Access Commercial |
$1,801.65
|
| Rate for Payer: Quartz Beloit One Network |
$959.58
|
| Rate for Payer: Quartz Commercial |
$1,272.91
|
| Rate for Payer: Quartz Medicare Advantage |
$1,174.99
|
| Rate for Payer: The Alliance Commercial |
$979.16
|
| Rate for Payer: WEA Trust Commercial |
$1,077.08
|
| Rate for Payer: WPS Commercial |
$1,450.47
|
|
|
SCREW LOCKING 2.7 X 12MM 656312
|
Facility
|
IP
|
$1,889.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5563674
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$962.63 |
| Max. Negotiated Rate |
$1,807.40 |
| Rate for Payer: Aetna Commercial |
$1,768.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,689.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,041.22
|
| Rate for Payer: Cash Price |
$566.70
|
| Rate for Payer: Cigna Commercial |
$1,807.40
|
| Rate for Payer: Health EOS Commercial |
$1,748.46
|
| Rate for Payer: HFN Commercial |
$1,807.40
|
| Rate for Payer: Multiplan Commercial |
$1,571.65
|
| Rate for Payer: Preferred Network Access Commercial |
$1,807.40
|
| Rate for Payer: Quartz Beloit One Network |
$962.63
|
| Rate for Payer: Quartz Commercial |
$1,178.74
|
| Rate for Payer: WEA Trust Commercial |
$1,080.51
|
| Rate for Payer: WPS Commercial |
$1,455.10
|
|
|
SCREW LOCKING 2.7 X 12MM 656312
|
Facility
|
OP
|
$1,889.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5563674
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$550.08 |
| Max. Negotiated Rate |
$1,807.40 |
| Rate for Payer: Aetna Commercial |
$1,768.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,689.52
|
| Rate for Payer: Aetna Managed Medicare |
$550.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,276.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$982.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$942.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,041.22
|
| Rate for Payer: Cash Price |
$566.70
|
| Rate for Payer: Cigna Commercial |
$1,807.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,099.40
|
| Rate for Payer: Health EOS Commercial |
$1,748.46
|
| Rate for Payer: HFN Commercial |
$1,807.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,473.42
|
| Rate for Payer: Multiplan Commercial |
$1,571.65
|
| Rate for Payer: NAPHCARE Commercial |
$1,178.74
|
| Rate for Payer: Preferred Network Access Commercial |
$1,807.40
|
| Rate for Payer: Quartz Beloit One Network |
$962.63
|
| Rate for Payer: Quartz Commercial |
$1,276.96
|
| Rate for Payer: Quartz Medicare Advantage |
$1,178.74
|
| Rate for Payer: The Alliance Commercial |
$982.28
|
| Rate for Payer: WEA Trust Commercial |
$1,080.51
|
| Rate for Payer: WPS Commercial |
$1,455.10
|
|
|
SCREW LOCKING 2.7 X 14MM 656314
|
Facility
|
OP
|
$1,889.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5563675
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$550.08 |
| Max. Negotiated Rate |
$1,807.40 |
| Rate for Payer: Aetna Commercial |
$1,768.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,689.52
|
| Rate for Payer: Aetna Managed Medicare |
$550.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,276.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$982.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$942.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,041.22
|
| Rate for Payer: Cash Price |
$566.70
|
| Rate for Payer: Cigna Commercial |
$1,807.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,099.40
|
| Rate for Payer: Health EOS Commercial |
$1,748.46
|
| Rate for Payer: HFN Commercial |
$1,807.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,473.42
|
| Rate for Payer: Multiplan Commercial |
$1,571.65
|
| Rate for Payer: NAPHCARE Commercial |
$1,178.74
|
| Rate for Payer: Preferred Network Access Commercial |
$1,807.40
|
| Rate for Payer: Quartz Beloit One Network |
$962.63
|
| Rate for Payer: Quartz Commercial |
$1,276.96
|
| Rate for Payer: Quartz Medicare Advantage |
$1,178.74
|
| Rate for Payer: The Alliance Commercial |
$982.28
|
| Rate for Payer: WEA Trust Commercial |
$1,080.51
|
| Rate for Payer: WPS Commercial |
$1,455.10
|
|
|
SCREW LOCKING 2.7 X 14MM 656314
|
Facility
|
IP
|
$1,889.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5563675
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$962.63 |
| Max. Negotiated Rate |
$1,807.40 |
| Rate for Payer: Aetna Commercial |
$1,768.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,689.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,041.22
|
| Rate for Payer: Cash Price |
$566.70
|
| Rate for Payer: Cigna Commercial |
$1,807.40
|
| Rate for Payer: Health EOS Commercial |
$1,748.46
|
| Rate for Payer: HFN Commercial |
$1,807.40
|
| Rate for Payer: Multiplan Commercial |
$1,571.65
|
| Rate for Payer: Preferred Network Access Commercial |
$1,807.40
|
| Rate for Payer: Quartz Beloit One Network |
$962.63
|
| Rate for Payer: Quartz Commercial |
$1,178.74
|
| Rate for Payer: WEA Trust Commercial |
$1,080.51
|
| Rate for Payer: WPS Commercial |
$1,455.10
|
|
|
SCREW LOCKING 2.7 X 16MM 656316
|
Facility
|
OP
|
$1,889.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5563678
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$550.08 |
| Max. Negotiated Rate |
$1,807.40 |
| Rate for Payer: Aetna Commercial |
$1,768.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,689.52
|
| Rate for Payer: Aetna Managed Medicare |
$550.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,276.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$982.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$942.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,041.22
|
| Rate for Payer: Cash Price |
$566.70
|
| Rate for Payer: Cigna Commercial |
$1,807.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,099.40
|
| Rate for Payer: Health EOS Commercial |
$1,748.46
|
| Rate for Payer: HFN Commercial |
$1,807.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,473.42
|
| Rate for Payer: Multiplan Commercial |
$1,571.65
|
| Rate for Payer: NAPHCARE Commercial |
$1,178.74
|
| Rate for Payer: Preferred Network Access Commercial |
$1,807.40
|
| Rate for Payer: Quartz Beloit One Network |
$962.63
|
| Rate for Payer: Quartz Commercial |
$1,276.96
|
| Rate for Payer: Quartz Medicare Advantage |
$1,178.74
|
| Rate for Payer: The Alliance Commercial |
$982.28
|
| Rate for Payer: WEA Trust Commercial |
$1,080.51
|
| Rate for Payer: WPS Commercial |
$1,455.10
|
|
|
SCREW LOCKING 2.7 X 16MM 656316
|
Facility
|
IP
|
$1,889.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5563678
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$962.63 |
| Max. Negotiated Rate |
$1,807.40 |
| Rate for Payer: Aetna Commercial |
$1,768.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,689.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,041.22
|
| Rate for Payer: Cash Price |
$566.70
|
| Rate for Payer: Cigna Commercial |
$1,807.40
|
| Rate for Payer: Health EOS Commercial |
$1,748.46
|
| Rate for Payer: HFN Commercial |
$1,807.40
|
| Rate for Payer: Multiplan Commercial |
$1,571.65
|
| Rate for Payer: Preferred Network Access Commercial |
$1,807.40
|
| Rate for Payer: Quartz Beloit One Network |
$962.63
|
| Rate for Payer: Quartz Commercial |
$1,178.74
|
| Rate for Payer: WEA Trust Commercial |
$1,080.51
|
| Rate for Payer: WPS Commercial |
$1,455.10
|
|
|
SCREW LOCKING 2.7 X 18MM 656318
|
Facility
|
OP
|
$1,889.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5563676
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$550.08 |
| Max. Negotiated Rate |
$1,807.40 |
| Rate for Payer: Aetna Commercial |
$1,768.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,689.52
|
| Rate for Payer: Aetna Managed Medicare |
$550.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,276.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$982.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$942.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,041.22
|
| Rate for Payer: Cash Price |
$566.70
|
| Rate for Payer: Cigna Commercial |
$1,807.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,099.40
|
| Rate for Payer: Health EOS Commercial |
$1,748.46
|
| Rate for Payer: HFN Commercial |
$1,807.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,473.42
|
| Rate for Payer: Multiplan Commercial |
$1,571.65
|
| Rate for Payer: NAPHCARE Commercial |
$1,178.74
|
| Rate for Payer: Preferred Network Access Commercial |
$1,807.40
|
| Rate for Payer: Quartz Beloit One Network |
$962.63
|
| Rate for Payer: Quartz Commercial |
$1,276.96
|
| Rate for Payer: Quartz Medicare Advantage |
$1,178.74
|
| Rate for Payer: The Alliance Commercial |
$982.28
|
| Rate for Payer: WEA Trust Commercial |
$1,080.51
|
| Rate for Payer: WPS Commercial |
$1,455.10
|
|
|
SCREW LOCKING 2.7 X 18MM 656318
|
Facility
|
IP
|
$1,889.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5563676
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$962.63 |
| Max. Negotiated Rate |
$1,807.40 |
| Rate for Payer: Aetna Commercial |
$1,768.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,689.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,041.22
|
| Rate for Payer: Cash Price |
$566.70
|
| Rate for Payer: Cigna Commercial |
$1,807.40
|
| Rate for Payer: Health EOS Commercial |
$1,748.46
|
| Rate for Payer: HFN Commercial |
$1,807.40
|
| Rate for Payer: Multiplan Commercial |
$1,571.65
|
| Rate for Payer: Preferred Network Access Commercial |
$1,807.40
|
| Rate for Payer: Quartz Beloit One Network |
$962.63
|
| Rate for Payer: Quartz Commercial |
$1,178.74
|
| Rate for Payer: WEA Trust Commercial |
$1,080.51
|
| Rate for Payer: WPS Commercial |
$1,455.10
|
|
