|
SCREW LOCK 5.0 X 42 VA 02.231.242
|
Facility
|
OP
|
$2,342.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3333536
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$655.76 |
| Max. Negotiated Rate |
$9,368.00 |
| Rate for Payer: Aetna Commercial |
$2,107.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,014.12
|
| Rate for Payer: Aetna Managed Medicare |
$655.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,522.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,171.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,124.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,241.26
|
| Rate for Payer: Cash Price |
$702.60
|
| Rate for Payer: Cigna Commercial |
$2,154.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,310.58
|
| Rate for Payer: Health EOS Commercial |
$2,084.38
|
| Rate for Payer: HFN Commercial |
$2,154.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,756.50
|
| Rate for Payer: Multiplan Commercial |
$1,873.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,405.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,154.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,147.58
|
| Rate for Payer: Quartz Commercial |
$1,522.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,405.20
|
| Rate for Payer: The Alliance Commercial |
$9,368.00
|
| Rate for Payer: WEA Trust Commercial |
$1,288.10
|
| Rate for Payer: WPS Commercial |
$1,734.72
|
|
|
SCREW LOCK 5.0 X 42 VA 02.231.242
|
Facility
|
IP
|
$2,342.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3333536
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,147.58 |
| Max. Negotiated Rate |
$2,154.64 |
| Rate for Payer: Aetna Commercial |
$2,107.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,014.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,241.26
|
| Rate for Payer: Cash Price |
$702.60
|
| Rate for Payer: Cigna Commercial |
$2,154.64
|
| Rate for Payer: Health EOS Commercial |
$2,084.38
|
| Rate for Payer: HFN Commercial |
$2,154.64
|
| Rate for Payer: Multiplan Commercial |
$1,873.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,405.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,154.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,147.58
|
| Rate for Payer: Quartz Commercial |
$1,405.20
|
| Rate for Payer: WEA Trust Commercial |
$1,288.10
|
| Rate for Payer: WPS Commercial |
$1,734.72
|
|
|
SCREW-LOCK 5.0X44 212.216
|
Facility
|
IP
|
$1,917.00
|
|
| Hospital Charge Code |
2966978
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$939.33 |
| Max. Negotiated Rate |
$1,763.64 |
| Rate for Payer: Aetna Commercial |
$1,725.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,648.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,016.01
|
| Rate for Payer: Cash Price |
$575.10
|
| Rate for Payer: Cigna Commercial |
$1,763.64
|
| Rate for Payer: Health EOS Commercial |
$1,706.13
|
| Rate for Payer: HFN Commercial |
$1,763.64
|
| Rate for Payer: Multiplan Commercial |
$1,533.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,150.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,763.64
|
| Rate for Payer: Quartz Beloit One Network |
$939.33
|
| Rate for Payer: Quartz Commercial |
$1,150.20
|
| Rate for Payer: WEA Trust Commercial |
$1,054.35
|
| Rate for Payer: WPS Commercial |
$1,419.92
|
|
|
SCREW-LOCK 5.0X44 212.216
|
Facility
|
OP
|
$1,917.00
|
|
| Hospital Charge Code |
2966978
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$536.76 |
| Max. Negotiated Rate |
$7,668.00 |
| Rate for Payer: Aetna Commercial |
$1,725.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,648.62
|
| Rate for Payer: Aetna Managed Medicare |
$536.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,246.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$958.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$920.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,016.01
|
| Rate for Payer: Cash Price |
$575.10
|
| Rate for Payer: Cigna Commercial |
$1,763.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,072.75
|
| Rate for Payer: Health EOS Commercial |
$1,706.13
|
| Rate for Payer: HFN Commercial |
$1,763.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,437.75
|
| Rate for Payer: Multiplan Commercial |
$1,533.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,150.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,763.64
|
| Rate for Payer: Quartz Beloit One Network |
$939.33
|
| Rate for Payer: Quartz Commercial |
$1,246.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,150.20
|
| Rate for Payer: The Alliance Commercial |
$7,668.00
|
| Rate for Payer: WEA Trust Commercial |
$1,054.35
|
| Rate for Payer: WPS Commercial |
$1,419.92
|
|
|
SCREW LOCK 5.0 X 44MM TI 04.005.534S
|
Facility
|
OP
|
$2,318.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3937344
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$649.04 |
| Max. Negotiated Rate |
$9,272.00 |
| Rate for Payer: Aetna Commercial |
$2,086.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,993.48
|
| Rate for Payer: Aetna Managed Medicare |
$649.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,506.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,159.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,112.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,228.54
|
| Rate for Payer: Cash Price |
$695.40
|
| Rate for Payer: Cigna Commercial |
$2,132.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,297.15
|
| Rate for Payer: Health EOS Commercial |
$2,063.02
|
| Rate for Payer: HFN Commercial |
$2,132.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,738.50
|
| Rate for Payer: Multiplan Commercial |
$1,854.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,390.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,132.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,135.82
|
| Rate for Payer: Quartz Commercial |
$1,506.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,390.80
|
| Rate for Payer: The Alliance Commercial |
$9,272.00
|
| Rate for Payer: WEA Trust Commercial |
$1,274.90
|
| Rate for Payer: WPS Commercial |
$1,716.94
|
|
|
SCREW LOCK 5.0 X 44MM TI 04.005.534S
|
Facility
|
IP
|
$2,318.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3937344
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,135.82 |
| Max. Negotiated Rate |
$2,132.56 |
| Rate for Payer: Aetna Commercial |
$2,086.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,993.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,228.54
|
| Rate for Payer: Cash Price |
$695.40
|
| Rate for Payer: Cigna Commercial |
$2,132.56
|
| Rate for Payer: Health EOS Commercial |
$2,063.02
|
| Rate for Payer: HFN Commercial |
$2,132.56
|
| Rate for Payer: Multiplan Commercial |
$1,854.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,390.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,132.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,135.82
|
| Rate for Payer: Quartz Commercial |
$1,390.80
|
| Rate for Payer: WEA Trust Commercial |
$1,274.90
|
| Rate for Payer: WPS Commercial |
$1,716.94
|
|
|
SCREW-LOCK 5.0 X 44 TFN 458.944
|
Facility
|
IP
|
$2,724.00
|
|
| Hospital Charge Code |
2966979
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,334.76 |
| Max. Negotiated Rate |
$2,506.08 |
| Rate for Payer: Aetna Commercial |
$2,451.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,342.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,443.72
|
| Rate for Payer: Cash Price |
$817.20
|
| Rate for Payer: Cigna Commercial |
$2,506.08
|
| Rate for Payer: Health EOS Commercial |
$2,424.36
|
| Rate for Payer: HFN Commercial |
$2,506.08
|
| Rate for Payer: Multiplan Commercial |
$2,179.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,634.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,506.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,334.76
|
| Rate for Payer: Quartz Commercial |
$1,634.40
|
| Rate for Payer: WEA Trust Commercial |
$1,498.20
|
| Rate for Payer: WPS Commercial |
$2,017.67
|
|
|
SCREW-LOCK 5.0 X 44 TFN 458.944
|
Facility
|
OP
|
$2,724.00
|
|
| Hospital Charge Code |
2966979
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$762.72 |
| Max. Negotiated Rate |
$10,896.00 |
| Rate for Payer: Aetna Commercial |
$2,451.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,342.64
|
| Rate for Payer: Aetna Managed Medicare |
$762.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,770.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,362.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,307.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,443.72
|
| Rate for Payer: Cash Price |
$817.20
|
| Rate for Payer: Cigna Commercial |
$2,506.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,524.35
|
| Rate for Payer: Health EOS Commercial |
$2,424.36
|
| Rate for Payer: HFN Commercial |
$2,506.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,043.00
|
| Rate for Payer: Multiplan Commercial |
$2,179.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,634.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,506.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,334.76
|
| Rate for Payer: Quartz Commercial |
$1,770.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,634.40
|
| Rate for Payer: The Alliance Commercial |
$10,896.00
|
| Rate for Payer: WEA Trust Commercial |
$1,498.20
|
| Rate for Payer: WPS Commercial |
$2,017.67
|
|
|
SCREW LOCK 5.0 X 44 VA 02.231.244
|
Facility
|
IP
|
$2,342.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5179332
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,147.58 |
| Max. Negotiated Rate |
$2,154.64 |
| Rate for Payer: Aetna Commercial |
$2,107.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,014.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,241.26
|
| Rate for Payer: Cash Price |
$702.60
|
| Rate for Payer: Cigna Commercial |
$2,154.64
|
| Rate for Payer: Health EOS Commercial |
$2,084.38
|
| Rate for Payer: HFN Commercial |
$2,154.64
|
| Rate for Payer: Multiplan Commercial |
$1,873.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,405.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,154.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,147.58
|
| Rate for Payer: Quartz Commercial |
$1,405.20
|
| Rate for Payer: WEA Trust Commercial |
$1,288.10
|
| Rate for Payer: WPS Commercial |
$1,734.72
|
|
|
SCREW LOCK 5.0 X 44 VA 02.231.244
|
Facility
|
OP
|
$2,342.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5179332
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$655.76 |
| Max. Negotiated Rate |
$9,368.00 |
| Rate for Payer: Aetna Commercial |
$2,107.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,014.12
|
| Rate for Payer: Aetna Managed Medicare |
$655.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,522.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,171.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,124.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,241.26
|
| Rate for Payer: Cash Price |
$702.60
|
| Rate for Payer: Cigna Commercial |
$2,154.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,310.58
|
| Rate for Payer: Health EOS Commercial |
$2,084.38
|
| Rate for Payer: HFN Commercial |
$2,154.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,756.50
|
| Rate for Payer: Multiplan Commercial |
$1,873.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,405.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,154.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,147.58
|
| Rate for Payer: Quartz Commercial |
$1,522.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,405.20
|
| Rate for Payer: The Alliance Commercial |
$9,368.00
|
| Rate for Payer: WEA Trust Commercial |
$1,288.10
|
| Rate for Payer: WPS Commercial |
$1,734.72
|
|
|
SCREW LOCK 5.0 X 45 FULLY THREAD 1896-5045S
|
Facility
|
OP
|
$2,661.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3605504
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$745.08 |
| Max. Negotiated Rate |
$10,644.00 |
| Rate for Payer: Aetna Commercial |
$2,394.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,288.46
|
| Rate for Payer: Aetna Managed Medicare |
$745.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,729.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,330.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,277.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,410.33
|
| Rate for Payer: Cash Price |
$798.30
|
| Rate for Payer: Cigna Commercial |
$2,448.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,489.10
|
| Rate for Payer: Health EOS Commercial |
$2,368.29
|
| Rate for Payer: HFN Commercial |
$2,448.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,995.75
|
| Rate for Payer: Multiplan Commercial |
$2,128.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,596.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,448.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,303.89
|
| Rate for Payer: Quartz Commercial |
$1,729.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,596.60
|
| Rate for Payer: The Alliance Commercial |
$10,644.00
|
| Rate for Payer: WEA Trust Commercial |
$1,463.55
|
| Rate for Payer: WPS Commercial |
$1,971.00
|
|
|
SCREW LOCK 5.0 X 45 FULLY THREAD 1896-5045S
|
Facility
|
IP
|
$2,661.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3605504
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,303.89 |
| Max. Negotiated Rate |
$2,448.12 |
| Rate for Payer: Aetna Commercial |
$2,394.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,288.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,410.33
|
| Rate for Payer: Cash Price |
$798.30
|
| Rate for Payer: Cigna Commercial |
$2,448.12
|
| Rate for Payer: Health EOS Commercial |
$2,368.29
|
| Rate for Payer: HFN Commercial |
$2,448.12
|
| Rate for Payer: Multiplan Commercial |
$2,128.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,596.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,448.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,303.89
|
| Rate for Payer: Quartz Commercial |
$1,596.60
|
| Rate for Payer: WEA Trust Commercial |
$1,463.55
|
| Rate for Payer: WPS Commercial |
$1,971.00
|
|
|
SCREW-LOCK 5.0X46 212.217
|
Facility
|
OP
|
$1,917.00
|
|
| Hospital Charge Code |
2966981
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$536.76 |
| Max. Negotiated Rate |
$7,668.00 |
| Rate for Payer: Aetna Commercial |
$1,725.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,648.62
|
| Rate for Payer: Aetna Managed Medicare |
$536.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,246.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$958.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$920.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,016.01
|
| Rate for Payer: Cash Price |
$575.10
|
| Rate for Payer: Cigna Commercial |
$1,763.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,072.75
|
| Rate for Payer: Health EOS Commercial |
$1,706.13
|
| Rate for Payer: HFN Commercial |
$1,763.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,437.75
|
| Rate for Payer: Multiplan Commercial |
$1,533.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,150.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,763.64
|
| Rate for Payer: Quartz Beloit One Network |
$939.33
|
| Rate for Payer: Quartz Commercial |
$1,246.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,150.20
|
| Rate for Payer: The Alliance Commercial |
$7,668.00
|
| Rate for Payer: WEA Trust Commercial |
$1,054.35
|
| Rate for Payer: WPS Commercial |
$1,419.92
|
|
|
SCREW-LOCK 5.0X46 212.217
|
Facility
|
IP
|
$1,917.00
|
|
| Hospital Charge Code |
2966981
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$939.33 |
| Max. Negotiated Rate |
$1,763.64 |
| Rate for Payer: Aetna Commercial |
$1,725.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,648.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,016.01
|
| Rate for Payer: Cash Price |
$575.10
|
| Rate for Payer: Cigna Commercial |
$1,763.64
|
| Rate for Payer: Health EOS Commercial |
$1,706.13
|
| Rate for Payer: HFN Commercial |
$1,763.64
|
| Rate for Payer: Multiplan Commercial |
$1,533.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,150.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,763.64
|
| Rate for Payer: Quartz Beloit One Network |
$939.33
|
| Rate for Payer: Quartz Commercial |
$1,150.20
|
| Rate for Payer: WEA Trust Commercial |
$1,054.35
|
| Rate for Payer: WPS Commercial |
$1,419.92
|
|
|
SCREW LOCK 5.0 X 46MM TI 04.005.536S
|
Facility
|
OP
|
$2,318.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4858863
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$649.04 |
| Max. Negotiated Rate |
$9,272.00 |
| Rate for Payer: Aetna Commercial |
$2,086.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,993.48
|
| Rate for Payer: Aetna Managed Medicare |
$649.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,506.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,159.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,112.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,228.54
|
| Rate for Payer: Cash Price |
$695.40
|
| Rate for Payer: Cigna Commercial |
$2,132.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,297.15
|
| Rate for Payer: Health EOS Commercial |
$2,063.02
|
| Rate for Payer: HFN Commercial |
$2,132.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,738.50
|
| Rate for Payer: Multiplan Commercial |
$1,854.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,390.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,132.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,135.82
|
| Rate for Payer: Quartz Commercial |
$1,506.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,390.80
|
| Rate for Payer: The Alliance Commercial |
$9,272.00
|
| Rate for Payer: WEA Trust Commercial |
$1,274.90
|
| Rate for Payer: WPS Commercial |
$1,716.94
|
|
|
SCREW LOCK 5.0 X 46MM TI 04.005.536S
|
Facility
|
IP
|
$2,318.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4858863
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,135.82 |
| Max. Negotiated Rate |
$2,132.56 |
| Rate for Payer: Aetna Commercial |
$2,086.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,993.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,228.54
|
| Rate for Payer: Cash Price |
$695.40
|
| Rate for Payer: Cigna Commercial |
$2,132.56
|
| Rate for Payer: Health EOS Commercial |
$2,063.02
|
| Rate for Payer: HFN Commercial |
$2,132.56
|
| Rate for Payer: Multiplan Commercial |
$1,854.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,390.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,132.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,135.82
|
| Rate for Payer: Quartz Commercial |
$1,390.80
|
| Rate for Payer: WEA Trust Commercial |
$1,274.90
|
| Rate for Payer: WPS Commercial |
$1,716.94
|
|
|
SCREW LOCK 5.0 X 46MM XL25 IM NAIL TI 04.045.046S
|
Facility
|
IP
|
$2,721.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6182645
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,333.29 |
| Max. Negotiated Rate |
$2,503.32 |
| Rate for Payer: Aetna Commercial |
$2,448.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,340.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,442.13
|
| Rate for Payer: Cash Price |
$816.30
|
| Rate for Payer: Cigna Commercial |
$2,503.32
|
| Rate for Payer: Health EOS Commercial |
$2,421.69
|
| Rate for Payer: HFN Commercial |
$2,503.32
|
| Rate for Payer: Multiplan Commercial |
$2,176.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,632.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,503.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,333.29
|
| Rate for Payer: Quartz Commercial |
$1,632.60
|
| Rate for Payer: WEA Trust Commercial |
$1,496.55
|
| Rate for Payer: WPS Commercial |
$2,015.44
|
|
|
SCREW LOCK 5.0 X 46MM XL25 IM NAIL TI 04.045.046S
|
Facility
|
OP
|
$2,721.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6182645
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$761.88 |
| Max. Negotiated Rate |
$10,884.00 |
| Rate for Payer: Aetna Commercial |
$2,448.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,340.06
|
| Rate for Payer: Aetna Managed Medicare |
$761.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,768.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,360.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,306.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,442.13
|
| Rate for Payer: Cash Price |
$816.30
|
| Rate for Payer: Cigna Commercial |
$2,503.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,522.67
|
| Rate for Payer: Health EOS Commercial |
$2,421.69
|
| Rate for Payer: HFN Commercial |
$2,503.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,040.75
|
| Rate for Payer: Multiplan Commercial |
$2,176.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,632.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,503.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,333.29
|
| Rate for Payer: Quartz Commercial |
$1,768.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,632.60
|
| Rate for Payer: The Alliance Commercial |
$10,884.00
|
| Rate for Payer: WEA Trust Commercial |
$1,496.55
|
| Rate for Payer: WPS Commercial |
$2,015.44
|
|
|
SCREW-LOCK 5.0 X 46 TFN 458.946
|
Facility
|
IP
|
$2,724.00
|
|
| Hospital Charge Code |
2966982
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,334.76 |
| Max. Negotiated Rate |
$2,506.08 |
| Rate for Payer: Aetna Commercial |
$2,451.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,342.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,443.72
|
| Rate for Payer: Cash Price |
$817.20
|
| Rate for Payer: Cigna Commercial |
$2,506.08
|
| Rate for Payer: Health EOS Commercial |
$2,424.36
|
| Rate for Payer: HFN Commercial |
$2,506.08
|
| Rate for Payer: Multiplan Commercial |
$2,179.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,634.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,506.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,334.76
|
| Rate for Payer: Quartz Commercial |
$1,634.40
|
| Rate for Payer: WEA Trust Commercial |
$1,498.20
|
| Rate for Payer: WPS Commercial |
$2,017.67
|
|
|
SCREW-LOCK 5.0 X 46 TFN 458.946
|
Facility
|
OP
|
$2,724.00
|
|
| Hospital Charge Code |
2966982
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$762.72 |
| Max. Negotiated Rate |
$10,896.00 |
| Rate for Payer: Aetna Commercial |
$2,451.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,342.64
|
| Rate for Payer: Aetna Managed Medicare |
$762.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,770.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,362.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,307.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,443.72
|
| Rate for Payer: Cash Price |
$817.20
|
| Rate for Payer: Cigna Commercial |
$2,506.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,524.35
|
| Rate for Payer: Health EOS Commercial |
$2,424.36
|
| Rate for Payer: HFN Commercial |
$2,506.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,043.00
|
| Rate for Payer: Multiplan Commercial |
$2,179.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,634.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,506.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,334.76
|
| Rate for Payer: Quartz Commercial |
$1,770.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,634.40
|
| Rate for Payer: The Alliance Commercial |
$10,896.00
|
| Rate for Payer: WEA Trust Commercial |
$1,498.20
|
| Rate for Payer: WPS Commercial |
$2,017.67
|
|
|
SCREW LOCK 5.0 X 46 VA 02.231.246
|
Facility
|
IP
|
$2,255.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5306729
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,104.95 |
| Max. Negotiated Rate |
$2,074.60 |
| Rate for Payer: Aetna Commercial |
$2,029.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,939.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,195.15
|
| Rate for Payer: Cash Price |
$676.50
|
| Rate for Payer: Cigna Commercial |
$2,074.60
|
| Rate for Payer: Health EOS Commercial |
$2,006.95
|
| Rate for Payer: HFN Commercial |
$2,074.60
|
| Rate for Payer: Multiplan Commercial |
$1,804.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,353.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,074.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,104.95
|
| Rate for Payer: Quartz Commercial |
$1,353.00
|
| Rate for Payer: WEA Trust Commercial |
$1,240.25
|
| Rate for Payer: WPS Commercial |
$1,670.28
|
|
|
SCREW LOCK 5.0 X 46 VA 02.231.246
|
Facility
|
OP
|
$2,255.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5306729
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$631.40 |
| Max. Negotiated Rate |
$9,020.00 |
| Rate for Payer: Aetna Commercial |
$2,029.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,939.30
|
| Rate for Payer: Aetna Managed Medicare |
$631.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,465.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,127.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,082.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,195.15
|
| Rate for Payer: Cash Price |
$676.50
|
| Rate for Payer: Cigna Commercial |
$2,074.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,261.90
|
| Rate for Payer: Health EOS Commercial |
$2,006.95
|
| Rate for Payer: HFN Commercial |
$2,074.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,691.25
|
| Rate for Payer: Multiplan Commercial |
$1,804.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,353.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,074.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,104.95
|
| Rate for Payer: Quartz Commercial |
$1,465.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,353.00
|
| Rate for Payer: The Alliance Commercial |
$9,020.00
|
| Rate for Payer: WEA Trust Commercial |
$1,240.25
|
| Rate for Payer: WPS Commercial |
$1,670.28
|
|
|
SCREW LOCK 5.0 X 47.5 FULLY THEAD 1896-5047S
|
Facility
|
OP
|
$2,661.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4263456
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$745.08 |
| Max. Negotiated Rate |
$10,644.00 |
| Rate for Payer: Aetna Commercial |
$2,394.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,288.46
|
| Rate for Payer: Aetna Managed Medicare |
$745.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,729.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,330.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,277.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,410.33
|
| Rate for Payer: Cash Price |
$798.30
|
| Rate for Payer: Cigna Commercial |
$2,448.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,489.10
|
| Rate for Payer: Health EOS Commercial |
$2,368.29
|
| Rate for Payer: HFN Commercial |
$2,448.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,995.75
|
| Rate for Payer: Multiplan Commercial |
$2,128.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,596.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,448.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,303.89
|
| Rate for Payer: Quartz Commercial |
$1,729.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,596.60
|
| Rate for Payer: The Alliance Commercial |
$10,644.00
|
| Rate for Payer: WEA Trust Commercial |
$1,463.55
|
| Rate for Payer: WPS Commercial |
$1,971.00
|
|
|
SCREW LOCK 5.0 X 47.5 FULLY THEAD 1896-5047S
|
Facility
|
IP
|
$2,661.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4263456
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,303.89 |
| Max. Negotiated Rate |
$2,448.12 |
| Rate for Payer: Aetna Commercial |
$2,394.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,288.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,410.33
|
| Rate for Payer: Cash Price |
$798.30
|
| Rate for Payer: Cigna Commercial |
$2,448.12
|
| Rate for Payer: Health EOS Commercial |
$2,368.29
|
| Rate for Payer: HFN Commercial |
$2,448.12
|
| Rate for Payer: Multiplan Commercial |
$2,128.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,596.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,448.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,303.89
|
| Rate for Payer: Quartz Commercial |
$1,596.60
|
| Rate for Payer: WEA Trust Commercial |
$1,463.55
|
| Rate for Payer: WPS Commercial |
$1,971.00
|
|
|
SCREW-LOCK 5.0X48 212.218
|
Facility
|
OP
|
$1,917.00
|
|
| Hospital Charge Code |
2966983
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$536.76 |
| Max. Negotiated Rate |
$7,668.00 |
| Rate for Payer: Aetna Commercial |
$1,725.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,648.62
|
| Rate for Payer: Aetna Managed Medicare |
$536.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,246.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$958.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$920.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,016.01
|
| Rate for Payer: Cash Price |
$575.10
|
| Rate for Payer: Cigna Commercial |
$1,763.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,072.75
|
| Rate for Payer: Health EOS Commercial |
$1,706.13
|
| Rate for Payer: HFN Commercial |
$1,763.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,437.75
|
| Rate for Payer: Multiplan Commercial |
$1,533.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,150.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,763.64
|
| Rate for Payer: Quartz Beloit One Network |
$939.33
|
| Rate for Payer: Quartz Commercial |
$1,246.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,150.20
|
| Rate for Payer: The Alliance Commercial |
$7,668.00
|
| Rate for Payer: WEA Trust Commercial |
$1,054.35
|
| Rate for Payer: WPS Commercial |
$1,419.92
|
|
