|
SCREW-LOCK 5.0X48 212.218
|
Facility
|
IP
|
$1,917.00
|
|
| Hospital Charge Code |
2966983
|
|
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 48MM TI 04.005.538S
|
Facility
|
IP
|
$2,318.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3937346
|
|
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 48MM TI 04.005.538S
|
Facility
|
OP
|
$2,318.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3937346
|
|
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 48 TFN 458.948
|
Facility
|
IP
|
$2,724.00
|
|
| Hospital Charge Code |
2966984
|
|
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 48 TFN 458.948
|
Facility
|
OP
|
$2,724.00
|
|
| Hospital Charge Code |
2966984
|
|
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 48 VA 02.231.248
|
Facility
|
IP
|
$2,342.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3181490
|
|
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 48 VA 02.231.248
|
Facility
|
OP
|
$2,342.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3181490
|
|
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 50 212.219
|
Facility
|
OP
|
$1,917.00
|
|
| Hospital Charge Code |
2966986
|
|
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 50 212.219
|
Facility
|
IP
|
$1,917.00
|
|
| Hospital Charge Code |
2966986
|
|
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 50 FULL THREAD 1896-5050S
|
Facility
|
IP
|
$2,661.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3072609
|
|
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 5.0 X 50 FULL THREAD 1896-5050S
|
Facility
|
OP
|
$2,661.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3072609
|
|
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 50MM TI 04.005.540S
|
Facility
|
OP
|
$2,318.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4268745
|
|
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 50MM TI 04.005.540S
|
Facility
|
IP
|
$2,318.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4268745
|
|
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 50MM XL25 IM NAIL TI 04.045.050S
|
Facility
|
IP
|
$2,826.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6175476
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,384.74 |
| Max. Negotiated Rate |
$2,599.92 |
| Rate for Payer: Aetna Commercial |
$2,543.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,430.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,497.78
|
| Rate for Payer: Cash Price |
$847.80
|
| Rate for Payer: Cigna Commercial |
$2,599.92
|
| Rate for Payer: Health EOS Commercial |
$2,515.14
|
| Rate for Payer: HFN Commercial |
$2,599.92
|
| Rate for Payer: Multiplan Commercial |
$2,260.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,695.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,599.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,384.74
|
| Rate for Payer: Quartz Commercial |
$1,695.60
|
| Rate for Payer: WEA Trust Commercial |
$1,554.30
|
| Rate for Payer: WPS Commercial |
$2,093.22
|
|
|
SCREW LOCK 5.0 X 50MM XL25 IM NAIL TI 04.045.050S
|
Facility
|
OP
|
$2,826.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6175476
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$791.28 |
| Max. Negotiated Rate |
$11,304.00 |
| Rate for Payer: Aetna Commercial |
$2,543.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,430.36
|
| Rate for Payer: Aetna Managed Medicare |
$791.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,836.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,413.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,356.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,497.78
|
| Rate for Payer: Cash Price |
$847.80
|
| Rate for Payer: Cigna Commercial |
$2,599.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,581.43
|
| Rate for Payer: Health EOS Commercial |
$2,515.14
|
| Rate for Payer: HFN Commercial |
$2,599.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,119.50
|
| Rate for Payer: Multiplan Commercial |
$2,260.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,695.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,599.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,384.74
|
| Rate for Payer: Quartz Commercial |
$1,836.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,695.60
|
| Rate for Payer: The Alliance Commercial |
$11,304.00
|
| Rate for Payer: WEA Trust Commercial |
$1,554.30
|
| Rate for Payer: WPS Commercial |
$2,093.22
|
|
|
SCREW-LOCK 5.0 X 50 TFN 458.950
|
Facility
|
IP
|
$2,724.00
|
|
| Hospital Charge Code |
2966987
|
|
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 50 TFN 458.950
|
Facility
|
OP
|
$2,724.00
|
|
| Hospital Charge Code |
2966987
|
|
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 50 VA 02.231.250
|
Facility
|
OP
|
$2,255.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5348980
|
|
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 50 VA 02.231.250
|
Facility
|
IP
|
$2,255.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5348980
|
|
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 52.5 FULL THREAD 1896-5052S
|
Facility
|
OP
|
$2,564.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4099053
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$717.92 |
| Max. Negotiated Rate |
$10,256.00 |
| Rate for Payer: Aetna Commercial |
$2,307.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,205.04
|
| Rate for Payer: Aetna Managed Medicare |
$717.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,666.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,282.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,230.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,358.92
|
| Rate for Payer: Cash Price |
$769.20
|
| Rate for Payer: Cigna Commercial |
$2,358.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,434.81
|
| Rate for Payer: Health EOS Commercial |
$2,281.96
|
| Rate for Payer: HFN Commercial |
$2,358.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,923.00
|
| Rate for Payer: Multiplan Commercial |
$2,051.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,538.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,358.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,256.36
|
| Rate for Payer: Quartz Commercial |
$1,666.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,538.40
|
| Rate for Payer: The Alliance Commercial |
$10,256.00
|
| Rate for Payer: WEA Trust Commercial |
$1,410.20
|
| Rate for Payer: WPS Commercial |
$1,899.15
|
|
|
SCREW LOCK 5.0 X 52.5 FULL THREAD 1896-5052S
|
Facility
|
IP
|
$2,564.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4099053
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,256.36 |
| Max. Negotiated Rate |
$2,358.88 |
| Rate for Payer: Aetna Commercial |
$2,307.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,205.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,358.92
|
| Rate for Payer: Cash Price |
$769.20
|
| Rate for Payer: Cigna Commercial |
$2,358.88
|
| Rate for Payer: Health EOS Commercial |
$2,281.96
|
| Rate for Payer: HFN Commercial |
$2,358.88
|
| Rate for Payer: Multiplan Commercial |
$2,051.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,538.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,358.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,256.36
|
| Rate for Payer: Quartz Commercial |
$1,538.40
|
| Rate for Payer: WEA Trust Commercial |
$1,410.20
|
| Rate for Payer: WPS Commercial |
$1,899.15
|
|
|
SCREW LOCK 5.0 X 52MM TI 04.005.542S
|
Facility
|
IP
|
$2,728.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2969460
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,336.72 |
| Max. Negotiated Rate |
$2,509.76 |
| Rate for Payer: Aetna Commercial |
$2,455.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,346.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,445.84
|
| Rate for Payer: Cash Price |
$818.40
|
| Rate for Payer: Cigna Commercial |
$2,509.76
|
| Rate for Payer: Health EOS Commercial |
$2,427.92
|
| Rate for Payer: HFN Commercial |
$2,509.76
|
| Rate for Payer: Multiplan Commercial |
$2,182.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,636.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,509.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,336.72
|
| Rate for Payer: Quartz Commercial |
$1,636.80
|
| Rate for Payer: WEA Trust Commercial |
$1,500.40
|
| Rate for Payer: WPS Commercial |
$2,020.63
|
|
|
SCREW LOCK 5.0 X 52MM TI 04.005.542S
|
Facility
|
OP
|
$2,728.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2969460
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$763.84 |
| Max. Negotiated Rate |
$10,912.00 |
| Rate for Payer: Aetna Commercial |
$2,455.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,346.08
|
| Rate for Payer: Aetna Managed Medicare |
$763.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,773.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,364.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,309.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,445.84
|
| Rate for Payer: Cash Price |
$818.40
|
| Rate for Payer: Cigna Commercial |
$2,509.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,526.59
|
| Rate for Payer: Health EOS Commercial |
$2,427.92
|
| Rate for Payer: HFN Commercial |
$2,509.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,046.00
|
| Rate for Payer: Multiplan Commercial |
$2,182.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,636.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,509.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,336.72
|
| Rate for Payer: Quartz Commercial |
$1,773.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,636.80
|
| Rate for Payer: The Alliance Commercial |
$10,912.00
|
| Rate for Payer: WEA Trust Commercial |
$1,500.40
|
| Rate for Payer: WPS Commercial |
$2,020.63
|
|
|
SCREW LOCK 5.0 X 52MM XL25 IM NAIL TI 04.045.052S
|
Facility
|
IP
|
$2,612.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6246189
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,279.97 |
| Max. Negotiated Rate |
$2,403.21 |
| Rate for Payer: Aetna Commercial |
$2,350.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,246.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,384.46
|
| Rate for Payer: Cash Price |
$783.65
|
| Rate for Payer: Cigna Commercial |
$2,403.21
|
| Rate for Payer: Health EOS Commercial |
$2,324.84
|
| Rate for Payer: HFN Commercial |
$2,403.21
|
| Rate for Payer: Multiplan Commercial |
$2,089.74
|
| Rate for Payer: NAPHCARE Commercial |
$1,567.31
|
| Rate for Payer: Preferred Network Access Commercial |
$2,403.21
|
| Rate for Payer: Quartz Beloit One Network |
$1,279.97
|
| Rate for Payer: Quartz Commercial |
$1,567.31
|
| Rate for Payer: WEA Trust Commercial |
$1,436.70
|
| Rate for Payer: WPS Commercial |
$1,934.84
|
|
|
SCREW LOCK 5.0 X 52MM XL25 IM NAIL TI 04.045.052S
|
Facility
|
OP
|
$2,612.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6246189
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$731.41 |
| Max. Negotiated Rate |
$10,448.72 |
| Rate for Payer: Aetna Commercial |
$2,350.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,246.47
|
| Rate for Payer: Aetna Managed Medicare |
$731.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,697.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,306.09
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,253.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,384.46
|
| Rate for Payer: Cash Price |
$783.65
|
| Rate for Payer: Cigna Commercial |
$2,403.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,461.78
|
| Rate for Payer: Health EOS Commercial |
$2,324.84
|
| Rate for Payer: HFN Commercial |
$2,403.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,959.14
|
| Rate for Payer: Multiplan Commercial |
$2,089.74
|
| Rate for Payer: NAPHCARE Commercial |
$1,567.31
|
| Rate for Payer: Preferred Network Access Commercial |
$2,403.21
|
| Rate for Payer: Quartz Beloit One Network |
$1,279.97
|
| Rate for Payer: Quartz Commercial |
$1,697.92
|
| Rate for Payer: Quartz Medicare Advantage |
$1,567.31
|
| Rate for Payer: The Alliance Commercial |
$10,448.72
|
| Rate for Payer: WEA Trust Commercial |
$1,436.70
|
| Rate for Payer: WPS Commercial |
$1,934.84
|
|
