|
SCREW LOCKING VA 3.5MM X 56MM 02.127.156
|
Facility
|
OP
|
$1,775.00
|
|
| Hospital Charge Code |
5456986
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$516.88 |
| Max. Negotiated Rate |
$1,698.32 |
| Rate for Payer: Aetna Commercial |
$1,661.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,587.56
|
| Rate for Payer: Aetna Managed Medicare |
$516.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,199.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$923.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$886.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$978.38
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$1,698.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,033.05
|
| Rate for Payer: Health EOS Commercial |
$1,642.94
|
| Rate for Payer: HFN Commercial |
$1,698.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,384.50
|
| Rate for Payer: Multiplan Commercial |
$1,476.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,107.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,698.32
|
| Rate for Payer: Quartz Beloit One Network |
$904.54
|
| Rate for Payer: Quartz Commercial |
$1,199.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,107.60
|
| Rate for Payer: The Alliance Commercial |
$923.00
|
| Rate for Payer: WEA Trust Commercial |
$1,015.30
|
| Rate for Payer: WPS Commercial |
$1,367.28
|
|
|
SCREW LOCKING VA 3.5MM X 56MM 02.127.156
|
Facility
|
IP
|
$1,775.00
|
|
| Hospital Charge Code |
5456986
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$904.54 |
| Max. Negotiated Rate |
$1,698.32 |
| Rate for Payer: Aetna Commercial |
$1,661.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,587.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$978.38
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$1,698.32
|
| Rate for Payer: Health EOS Commercial |
$1,642.94
|
| Rate for Payer: HFN Commercial |
$1,698.32
|
| Rate for Payer: Multiplan Commercial |
$1,476.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,698.32
|
| Rate for Payer: Quartz Beloit One Network |
$904.54
|
| Rate for Payer: Quartz Commercial |
$1,107.60
|
| Rate for Payer: WEA Trust Commercial |
$1,015.30
|
| Rate for Payer: WPS Commercial |
$1,367.28
|
|
|
SCREW LOCKING VA 3.5MM X 60MM 02.127.160
|
Facility
|
IP
|
$1,775.00
|
|
| Hospital Charge Code |
5456985
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$904.54 |
| Max. Negotiated Rate |
$1,698.32 |
| Rate for Payer: Aetna Commercial |
$1,661.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,587.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$978.38
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$1,698.32
|
| Rate for Payer: Health EOS Commercial |
$1,642.94
|
| Rate for Payer: HFN Commercial |
$1,698.32
|
| Rate for Payer: Multiplan Commercial |
$1,476.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,698.32
|
| Rate for Payer: Quartz Beloit One Network |
$904.54
|
| Rate for Payer: Quartz Commercial |
$1,107.60
|
| Rate for Payer: WEA Trust Commercial |
$1,015.30
|
| Rate for Payer: WPS Commercial |
$1,367.28
|
|
|
SCREW LOCKING VA 3.5MM X 60MM 02.127.160
|
Facility
|
OP
|
$1,775.00
|
|
| Hospital Charge Code |
5456985
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$516.88 |
| Max. Negotiated Rate |
$1,698.32 |
| Rate for Payer: Aetna Commercial |
$1,661.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,587.56
|
| Rate for Payer: Aetna Managed Medicare |
$516.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,199.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$923.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$886.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$978.38
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$1,698.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,033.05
|
| Rate for Payer: Health EOS Commercial |
$1,642.94
|
| Rate for Payer: HFN Commercial |
$1,698.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,384.50
|
| Rate for Payer: Multiplan Commercial |
$1,476.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,107.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,698.32
|
| Rate for Payer: Quartz Beloit One Network |
$904.54
|
| Rate for Payer: Quartz Commercial |
$1,199.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,107.60
|
| Rate for Payer: The Alliance Commercial |
$923.00
|
| Rate for Payer: WEA Trust Commercial |
$1,015.30
|
| Rate for Payer: WPS Commercial |
$1,367.28
|
|
|
SCREW LOCKING VA 3.5MM X 70MM 02.127.170
|
Facility
|
IP
|
$1,775.00
|
|
| Hospital Charge Code |
4268748
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$904.54 |
| Max. Negotiated Rate |
$1,698.32 |
| Rate for Payer: Aetna Commercial |
$1,661.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,587.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$978.38
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$1,698.32
|
| Rate for Payer: Health EOS Commercial |
$1,642.94
|
| Rate for Payer: HFN Commercial |
$1,698.32
|
| Rate for Payer: Multiplan Commercial |
$1,476.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,698.32
|
| Rate for Payer: Quartz Beloit One Network |
$904.54
|
| Rate for Payer: Quartz Commercial |
$1,107.60
|
| Rate for Payer: WEA Trust Commercial |
$1,015.30
|
| Rate for Payer: WPS Commercial |
$1,367.28
|
|
|
SCREW LOCKING VA 3.5MM X 70MM 02.127.170
|
Facility
|
OP
|
$1,775.00
|
|
| Hospital Charge Code |
4268748
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$516.88 |
| Max. Negotiated Rate |
$1,698.32 |
| Rate for Payer: Aetna Commercial |
$1,661.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,587.56
|
| Rate for Payer: Aetna Managed Medicare |
$516.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,199.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$923.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$886.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$978.38
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$1,698.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,033.05
|
| Rate for Payer: Health EOS Commercial |
$1,642.94
|
| Rate for Payer: HFN Commercial |
$1,698.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,384.50
|
| Rate for Payer: Multiplan Commercial |
$1,476.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,107.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,698.32
|
| Rate for Payer: Quartz Beloit One Network |
$904.54
|
| Rate for Payer: Quartz Commercial |
$1,199.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,107.60
|
| Rate for Payer: The Alliance Commercial |
$923.00
|
| Rate for Payer: WEA Trust Commercial |
$1,015.30
|
| Rate for Payer: WPS Commercial |
$1,367.28
|
|
|
SCREW LOCKING VA 3.5MM X 75MM 02.127.175
|
Facility
|
IP
|
$2,803.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4462800
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,428.41 |
| Max. Negotiated Rate |
$2,681.91 |
| Rate for Payer: Aetna Commercial |
$2,623.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,507.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,545.01
|
| Rate for Payer: Cash Price |
$840.90
|
| Rate for Payer: Cigna Commercial |
$2,681.91
|
| Rate for Payer: Health EOS Commercial |
$2,594.46
|
| Rate for Payer: HFN Commercial |
$2,681.91
|
| Rate for Payer: Multiplan Commercial |
$2,332.10
|
| Rate for Payer: Preferred Network Access Commercial |
$2,681.91
|
| Rate for Payer: Quartz Beloit One Network |
$1,428.41
|
| Rate for Payer: Quartz Commercial |
$1,749.07
|
| Rate for Payer: WEA Trust Commercial |
$1,603.32
|
| Rate for Payer: WPS Commercial |
$2,159.15
|
|
|
SCREW LOCKING VA 3.5MM X 75MM 02.127.175
|
Facility
|
OP
|
$2,803.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4462800
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$816.23 |
| Max. Negotiated Rate |
$2,681.91 |
| Rate for Payer: Aetna Commercial |
$2,623.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,507.00
|
| Rate for Payer: Aetna Managed Medicare |
$816.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,894.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,457.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,399.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,545.01
|
| Rate for Payer: Cash Price |
$840.90
|
| Rate for Payer: Cigna Commercial |
$2,681.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,631.35
|
| Rate for Payer: Health EOS Commercial |
$2,594.46
|
| Rate for Payer: HFN Commercial |
$2,681.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,186.34
|
| Rate for Payer: Multiplan Commercial |
$2,332.10
|
| Rate for Payer: NAPHCARE Commercial |
$1,749.07
|
| Rate for Payer: Preferred Network Access Commercial |
$2,681.91
|
| Rate for Payer: Quartz Beloit One Network |
$1,428.41
|
| Rate for Payer: Quartz Commercial |
$1,894.83
|
| Rate for Payer: Quartz Medicare Advantage |
$1,749.07
|
| Rate for Payer: The Alliance Commercial |
$1,457.56
|
| Rate for Payer: WEA Trust Commercial |
$1,603.32
|
| Rate for Payer: WPS Commercial |
$2,159.15
|
|
|
SCREW LOCKING VA 3.5MM X 80MM 02.127.180
|
Facility
|
OP
|
$1,775.00
|
|
| Hospital Charge Code |
5306642
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$516.88 |
| Max. Negotiated Rate |
$1,698.32 |
| Rate for Payer: Aetna Commercial |
$1,661.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,587.56
|
| Rate for Payer: Aetna Managed Medicare |
$516.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,199.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$923.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$886.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$978.38
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$1,698.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,033.05
|
| Rate for Payer: Health EOS Commercial |
$1,642.94
|
| Rate for Payer: HFN Commercial |
$1,698.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,384.50
|
| Rate for Payer: Multiplan Commercial |
$1,476.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,107.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,698.32
|
| Rate for Payer: Quartz Beloit One Network |
$904.54
|
| Rate for Payer: Quartz Commercial |
$1,199.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,107.60
|
| Rate for Payer: The Alliance Commercial |
$923.00
|
| Rate for Payer: WEA Trust Commercial |
$1,015.30
|
| Rate for Payer: WPS Commercial |
$1,367.28
|
|
|
SCREW LOCKING VA 3.5MM X 80MM 02.127.180
|
Facility
|
IP
|
$1,775.00
|
|
| Hospital Charge Code |
5306642
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$904.54 |
| Max. Negotiated Rate |
$1,698.32 |
| Rate for Payer: Aetna Commercial |
$1,661.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,587.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$978.38
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$1,698.32
|
| Rate for Payer: Health EOS Commercial |
$1,642.94
|
| Rate for Payer: HFN Commercial |
$1,698.32
|
| Rate for Payer: Multiplan Commercial |
$1,476.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,698.32
|
| Rate for Payer: Quartz Beloit One Network |
$904.54
|
| Rate for Payer: Quartz Commercial |
$1,107.60
|
| Rate for Payer: WEA Trust Commercial |
$1,015.30
|
| Rate for Payer: WPS Commercial |
$1,367.28
|
|
|
SCREW LOCKING VA 3.5MM X 85MM 02.127.185
|
Facility
|
IP
|
$1,775.00
|
|
| Hospital Charge Code |
5306643
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$904.54 |
| Max. Negotiated Rate |
$1,698.32 |
| Rate for Payer: Aetna Commercial |
$1,661.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,587.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$978.38
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$1,698.32
|
| Rate for Payer: Health EOS Commercial |
$1,642.94
|
| Rate for Payer: HFN Commercial |
$1,698.32
|
| Rate for Payer: Multiplan Commercial |
$1,476.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,698.32
|
| Rate for Payer: Quartz Beloit One Network |
$904.54
|
| Rate for Payer: Quartz Commercial |
$1,107.60
|
| Rate for Payer: WEA Trust Commercial |
$1,015.30
|
| Rate for Payer: WPS Commercial |
$1,367.28
|
|
|
SCREW LOCKING VA 3.5MM X 85MM 02.127.185
|
Facility
|
OP
|
$1,775.00
|
|
| Hospital Charge Code |
5306643
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$516.88 |
| Max. Negotiated Rate |
$1,698.32 |
| Rate for Payer: Aetna Commercial |
$1,661.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,587.56
|
| Rate for Payer: Aetna Managed Medicare |
$516.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,199.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$923.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$886.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$978.38
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$1,698.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,033.05
|
| Rate for Payer: Health EOS Commercial |
$1,642.94
|
| Rate for Payer: HFN Commercial |
$1,698.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,384.50
|
| Rate for Payer: Multiplan Commercial |
$1,476.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,107.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,698.32
|
| Rate for Payer: Quartz Beloit One Network |
$904.54
|
| Rate for Payer: Quartz Commercial |
$1,199.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,107.60
|
| Rate for Payer: The Alliance Commercial |
$923.00
|
| Rate for Payer: WEA Trust Commercial |
$1,015.30
|
| Rate for Payer: WPS Commercial |
$1,367.28
|
|
|
SCREW LOCKING VA 3.5MM X 90MM 02.127.190
|
Facility
|
OP
|
$1,775.00
|
|
| Hospital Charge Code |
5074830
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$516.88 |
| Max. Negotiated Rate |
$1,698.32 |
| Rate for Payer: Aetna Commercial |
$1,661.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,587.56
|
| Rate for Payer: Aetna Managed Medicare |
$516.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,199.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$923.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$886.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$978.38
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$1,698.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,033.05
|
| Rate for Payer: Health EOS Commercial |
$1,642.94
|
| Rate for Payer: HFN Commercial |
$1,698.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,384.50
|
| Rate for Payer: Multiplan Commercial |
$1,476.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,107.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,698.32
|
| Rate for Payer: Quartz Beloit One Network |
$904.54
|
| Rate for Payer: Quartz Commercial |
$1,199.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,107.60
|
| Rate for Payer: The Alliance Commercial |
$923.00
|
| Rate for Payer: WEA Trust Commercial |
$1,015.30
|
| Rate for Payer: WPS Commercial |
$1,367.28
|
|
|
SCREW LOCKING VA 3.5MM X 90MM 02.127.190
|
Facility
|
IP
|
$1,775.00
|
|
| Hospital Charge Code |
5074830
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$904.54 |
| Max. Negotiated Rate |
$1,698.32 |
| Rate for Payer: Aetna Commercial |
$1,661.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,587.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$978.38
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$1,698.32
|
| Rate for Payer: Health EOS Commercial |
$1,642.94
|
| Rate for Payer: HFN Commercial |
$1,698.32
|
| Rate for Payer: Multiplan Commercial |
$1,476.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,698.32
|
| Rate for Payer: Quartz Beloit One Network |
$904.54
|
| Rate for Payer: Quartz Commercial |
$1,107.60
|
| Rate for Payer: WEA Trust Commercial |
$1,015.30
|
| Rate for Payer: WPS Commercial |
$1,367.28
|
|
|
SCREW LOCK LG HD 2.7 X 10MM ORTHOLOC 58802710
|
Facility
|
OP
|
$2,823.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5729832
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$822.06 |
| Max. Negotiated Rate |
$2,701.05 |
| Rate for Payer: Aetna Commercial |
$2,642.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,524.89
|
| Rate for Payer: Aetna Managed Medicare |
$822.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,908.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,467.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,409.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,556.04
|
| Rate for Payer: Cash Price |
$846.90
|
| Rate for Payer: Cigna Commercial |
$2,701.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,642.99
|
| Rate for Payer: Health EOS Commercial |
$2,612.97
|
| Rate for Payer: HFN Commercial |
$2,701.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,201.94
|
| Rate for Payer: Multiplan Commercial |
$2,348.74
|
| Rate for Payer: NAPHCARE Commercial |
$1,761.55
|
| Rate for Payer: Preferred Network Access Commercial |
$2,701.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,438.60
|
| Rate for Payer: Quartz Commercial |
$1,908.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,761.55
|
| Rate for Payer: The Alliance Commercial |
$1,467.96
|
| Rate for Payer: WEA Trust Commercial |
$1,614.76
|
| Rate for Payer: WPS Commercial |
$2,174.56
|
|
|
SCREW LOCK LG HD 2.7 X 10MM ORTHOLOC 58802710
|
Facility
|
IP
|
$2,823.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5729832
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,438.60 |
| Max. Negotiated Rate |
$2,701.05 |
| Rate for Payer: Aetna Commercial |
$2,642.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,524.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,556.04
|
| Rate for Payer: Cash Price |
$846.90
|
| Rate for Payer: Cigna Commercial |
$2,701.05
|
| Rate for Payer: Health EOS Commercial |
$2,612.97
|
| Rate for Payer: HFN Commercial |
$2,701.05
|
| Rate for Payer: Multiplan Commercial |
$2,348.74
|
| Rate for Payer: Preferred Network Access Commercial |
$2,701.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,438.60
|
| Rate for Payer: Quartz Commercial |
$1,761.55
|
| Rate for Payer: WEA Trust Commercial |
$1,614.76
|
| Rate for Payer: WPS Commercial |
$2,174.56
|
|
|
SCREW LOCK LG HD 2.7 X 12MM ORTHOLOC 58802712
|
Facility
|
OP
|
$2,823.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5729833
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$822.06 |
| Max. Negotiated Rate |
$2,701.05 |
| Rate for Payer: Aetna Commercial |
$2,642.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,524.89
|
| Rate for Payer: Aetna Managed Medicare |
$822.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,908.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,467.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,409.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,556.04
|
| Rate for Payer: Cash Price |
$846.90
|
| Rate for Payer: Cigna Commercial |
$2,701.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,642.99
|
| Rate for Payer: Health EOS Commercial |
$2,612.97
|
| Rate for Payer: HFN Commercial |
$2,701.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,201.94
|
| Rate for Payer: Multiplan Commercial |
$2,348.74
|
| Rate for Payer: NAPHCARE Commercial |
$1,761.55
|
| Rate for Payer: Preferred Network Access Commercial |
$2,701.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,438.60
|
| Rate for Payer: Quartz Commercial |
$1,908.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,761.55
|
| Rate for Payer: The Alliance Commercial |
$1,467.96
|
| Rate for Payer: WEA Trust Commercial |
$1,614.76
|
| Rate for Payer: WPS Commercial |
$2,174.56
|
|
|
SCREW LOCK LG HD 2.7 X 12MM ORTHOLOC 58802712
|
Facility
|
IP
|
$2,823.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5729833
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,438.60 |
| Max. Negotiated Rate |
$2,701.05 |
| Rate for Payer: Aetna Commercial |
$2,642.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,524.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,556.04
|
| Rate for Payer: Cash Price |
$846.90
|
| Rate for Payer: Cigna Commercial |
$2,701.05
|
| Rate for Payer: Health EOS Commercial |
$2,612.97
|
| Rate for Payer: HFN Commercial |
$2,701.05
|
| Rate for Payer: Multiplan Commercial |
$2,348.74
|
| Rate for Payer: Preferred Network Access Commercial |
$2,701.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,438.60
|
| Rate for Payer: Quartz Commercial |
$1,761.55
|
| Rate for Payer: WEA Trust Commercial |
$1,614.76
|
| Rate for Payer: WPS Commercial |
$2,174.56
|
|
|
SCREW LOCK LG HD 2.7 X 14MM ORTHOLOC 58802714
|
Facility
|
OP
|
$2,823.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415907
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$822.06 |
| Max. Negotiated Rate |
$2,701.05 |
| Rate for Payer: Aetna Commercial |
$2,642.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,524.89
|
| Rate for Payer: Aetna Managed Medicare |
$822.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,908.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,467.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,409.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,556.04
|
| Rate for Payer: Cash Price |
$846.90
|
| Rate for Payer: Cigna Commercial |
$2,701.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,642.99
|
| Rate for Payer: Health EOS Commercial |
$2,612.97
|
| Rate for Payer: HFN Commercial |
$2,701.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,201.94
|
| Rate for Payer: Multiplan Commercial |
$2,348.74
|
| Rate for Payer: NAPHCARE Commercial |
$1,761.55
|
| Rate for Payer: Preferred Network Access Commercial |
$2,701.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,438.60
|
| Rate for Payer: Quartz Commercial |
$1,908.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,761.55
|
| Rate for Payer: The Alliance Commercial |
$1,467.96
|
| Rate for Payer: WEA Trust Commercial |
$1,614.76
|
| Rate for Payer: WPS Commercial |
$2,174.56
|
|
|
SCREW LOCK LG HD 2.7 X 14MM ORTHOLOC 58802714
|
Facility
|
IP
|
$2,823.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415907
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,438.60 |
| Max. Negotiated Rate |
$2,701.05 |
| Rate for Payer: Aetna Commercial |
$2,642.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,524.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,556.04
|
| Rate for Payer: Cash Price |
$846.90
|
| Rate for Payer: Cigna Commercial |
$2,701.05
|
| Rate for Payer: Health EOS Commercial |
$2,612.97
|
| Rate for Payer: HFN Commercial |
$2,701.05
|
| Rate for Payer: Multiplan Commercial |
$2,348.74
|
| Rate for Payer: Preferred Network Access Commercial |
$2,701.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,438.60
|
| Rate for Payer: Quartz Commercial |
$1,761.55
|
| Rate for Payer: WEA Trust Commercial |
$1,614.76
|
| Rate for Payer: WPS Commercial |
$2,174.56
|
|
|
SCREW LOCK LG HD 2.7 X 16MM ORTHOLOC 58802716
|
Facility
|
OP
|
$2,823.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5458983
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$822.06 |
| Max. Negotiated Rate |
$2,701.05 |
| Rate for Payer: Aetna Commercial |
$2,642.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,524.89
|
| Rate for Payer: Aetna Managed Medicare |
$822.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,908.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,467.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,409.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,556.04
|
| Rate for Payer: Cash Price |
$846.90
|
| Rate for Payer: Cigna Commercial |
$2,701.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,642.99
|
| Rate for Payer: Health EOS Commercial |
$2,612.97
|
| Rate for Payer: HFN Commercial |
$2,701.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,201.94
|
| Rate for Payer: Multiplan Commercial |
$2,348.74
|
| Rate for Payer: NAPHCARE Commercial |
$1,761.55
|
| Rate for Payer: Preferred Network Access Commercial |
$2,701.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,438.60
|
| Rate for Payer: Quartz Commercial |
$1,908.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,761.55
|
| Rate for Payer: The Alliance Commercial |
$1,467.96
|
| Rate for Payer: WEA Trust Commercial |
$1,614.76
|
| Rate for Payer: WPS Commercial |
$2,174.56
|
|
|
SCREW LOCK LG HD 2.7 X 16MM ORTHOLOC 58802716
|
Facility
|
IP
|
$2,823.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5458983
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,438.60 |
| Max. Negotiated Rate |
$2,701.05 |
| Rate for Payer: Aetna Commercial |
$2,642.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,524.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,556.04
|
| Rate for Payer: Cash Price |
$846.90
|
| Rate for Payer: Cigna Commercial |
$2,701.05
|
| Rate for Payer: Health EOS Commercial |
$2,612.97
|
| Rate for Payer: HFN Commercial |
$2,701.05
|
| Rate for Payer: Multiplan Commercial |
$2,348.74
|
| Rate for Payer: Preferred Network Access Commercial |
$2,701.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,438.60
|
| Rate for Payer: Quartz Commercial |
$1,761.55
|
| Rate for Payer: WEA Trust Commercial |
$1,614.76
|
| Rate for Payer: WPS Commercial |
$2,174.56
|
|
|
SCREW LOCK LG HD 2.7 X 18MM ORTHOLOC 58802718
|
Facility
|
IP
|
$2,823.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415908
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,438.60 |
| Max. Negotiated Rate |
$2,701.05 |
| Rate for Payer: Aetna Commercial |
$2,642.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,524.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,556.04
|
| Rate for Payer: Cash Price |
$846.90
|
| Rate for Payer: Cigna Commercial |
$2,701.05
|
| Rate for Payer: Health EOS Commercial |
$2,612.97
|
| Rate for Payer: HFN Commercial |
$2,701.05
|
| Rate for Payer: Multiplan Commercial |
$2,348.74
|
| Rate for Payer: Preferred Network Access Commercial |
$2,701.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,438.60
|
| Rate for Payer: Quartz Commercial |
$1,761.55
|
| Rate for Payer: WEA Trust Commercial |
$1,614.76
|
| Rate for Payer: WPS Commercial |
$2,174.56
|
|
|
SCREW LOCK LG HD 2.7 X 18MM ORTHOLOC 58802718
|
Facility
|
OP
|
$2,823.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415908
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$822.06 |
| Max. Negotiated Rate |
$2,701.05 |
| Rate for Payer: Aetna Commercial |
$2,642.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,524.89
|
| Rate for Payer: Aetna Managed Medicare |
$822.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,908.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,467.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,409.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,556.04
|
| Rate for Payer: Cash Price |
$846.90
|
| Rate for Payer: Cigna Commercial |
$2,701.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,642.99
|
| Rate for Payer: Health EOS Commercial |
$2,612.97
|
| Rate for Payer: HFN Commercial |
$2,701.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,201.94
|
| Rate for Payer: Multiplan Commercial |
$2,348.74
|
| Rate for Payer: NAPHCARE Commercial |
$1,761.55
|
| Rate for Payer: Preferred Network Access Commercial |
$2,701.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,438.60
|
| Rate for Payer: Quartz Commercial |
$1,908.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,761.55
|
| Rate for Payer: The Alliance Commercial |
$1,467.96
|
| Rate for Payer: WEA Trust Commercial |
$1,614.76
|
| Rate for Payer: WPS Commercial |
$2,174.56
|
|
|
SCREW LOCK LG HD 2.7 X 20MM ORTHOLOC 58802720
|
Facility
|
IP
|
$2,823.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459796
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,438.60 |
| Max. Negotiated Rate |
$2,701.05 |
| Rate for Payer: Aetna Commercial |
$2,642.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,524.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,556.04
|
| Rate for Payer: Cash Price |
$846.90
|
| Rate for Payer: Cigna Commercial |
$2,701.05
|
| Rate for Payer: Health EOS Commercial |
$2,612.97
|
| Rate for Payer: HFN Commercial |
$2,701.05
|
| Rate for Payer: Multiplan Commercial |
$2,348.74
|
| Rate for Payer: Preferred Network Access Commercial |
$2,701.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,438.60
|
| Rate for Payer: Quartz Commercial |
$1,761.55
|
| Rate for Payer: WEA Trust Commercial |
$1,614.76
|
| Rate for Payer: WPS Commercial |
$2,174.56
|
|
