|
SCREW LOCK LG HD 3.5 X 38MM ORTHOLOC 58803538
|
Facility
|
IP
|
$3,496.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6171779
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,781.56 |
| Max. Negotiated Rate |
$3,344.97 |
| Rate for Payer: Aetna Commercial |
$3,272.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,126.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,927.00
|
| Rate for Payer: Cash Price |
$1,048.80
|
| Rate for Payer: Cigna Commercial |
$3,344.97
|
| Rate for Payer: Health EOS Commercial |
$3,235.90
|
| Rate for Payer: HFN Commercial |
$3,344.97
|
| Rate for Payer: Multiplan Commercial |
$2,908.67
|
| Rate for Payer: Preferred Network Access Commercial |
$3,344.97
|
| Rate for Payer: Quartz Beloit One Network |
$1,781.56
|
| Rate for Payer: Quartz Commercial |
$2,181.50
|
| Rate for Payer: WEA Trust Commercial |
$1,999.71
|
| Rate for Payer: WPS Commercial |
$2,692.97
|
|
|
SCREW LOCK LG HD 3.5 X 38MM ORTHOLOC 58803538
|
Facility
|
OP
|
$3,496.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6171779
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,018.04 |
| Max. Negotiated Rate |
$3,344.97 |
| Rate for Payer: Aetna Commercial |
$3,272.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,126.82
|
| Rate for Payer: Aetna Managed Medicare |
$1,018.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,363.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,817.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,745.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,927.00
|
| Rate for Payer: Cash Price |
$1,048.80
|
| Rate for Payer: Cigna Commercial |
$3,344.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,034.67
|
| Rate for Payer: Health EOS Commercial |
$3,235.90
|
| Rate for Payer: HFN Commercial |
$3,344.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,726.88
|
| Rate for Payer: Multiplan Commercial |
$2,908.67
|
| Rate for Payer: NAPHCARE Commercial |
$2,181.50
|
| Rate for Payer: Preferred Network Access Commercial |
$3,344.97
|
| Rate for Payer: Quartz Beloit One Network |
$1,781.56
|
| Rate for Payer: Quartz Commercial |
$2,363.30
|
| Rate for Payer: Quartz Medicare Advantage |
$2,181.50
|
| Rate for Payer: The Alliance Commercial |
$1,817.92
|
| Rate for Payer: WEA Trust Commercial |
$1,999.71
|
| Rate for Payer: WPS Commercial |
$2,692.97
|
|
|
SCREW LOCK LG HD 3.5 X 46MM ORTHOLOC 58803546
|
Facility
|
IP
|
$2,743.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6228139
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,397.83 |
| Max. Negotiated Rate |
$2,624.50 |
| Rate for Payer: Aetna Commercial |
$2,567.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,453.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,511.94
|
| Rate for Payer: Cash Price |
$822.90
|
| Rate for Payer: Cigna Commercial |
$2,624.50
|
| Rate for Payer: Health EOS Commercial |
$2,538.92
|
| Rate for Payer: HFN Commercial |
$2,624.50
|
| Rate for Payer: Multiplan Commercial |
$2,282.18
|
| Rate for Payer: Preferred Network Access Commercial |
$2,624.50
|
| Rate for Payer: Quartz Beloit One Network |
$1,397.83
|
| Rate for Payer: Quartz Commercial |
$1,711.63
|
| Rate for Payer: WEA Trust Commercial |
$1,569.00
|
| Rate for Payer: WPS Commercial |
$2,112.93
|
|
|
SCREW LOCK LG HD 3.5 X 46MM ORTHOLOC 58803546
|
Facility
|
OP
|
$2,743.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6228139
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$798.76 |
| Max. Negotiated Rate |
$2,624.50 |
| Rate for Payer: Aetna Commercial |
$2,567.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,453.34
|
| Rate for Payer: Aetna Managed Medicare |
$798.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,854.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,426.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,369.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,511.94
|
| Rate for Payer: Cash Price |
$822.90
|
| Rate for Payer: Cigna Commercial |
$2,624.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,596.43
|
| Rate for Payer: Health EOS Commercial |
$2,538.92
|
| Rate for Payer: HFN Commercial |
$2,624.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,139.54
|
| Rate for Payer: Multiplan Commercial |
$2,282.18
|
| Rate for Payer: NAPHCARE Commercial |
$1,711.63
|
| Rate for Payer: Preferred Network Access Commercial |
$2,624.50
|
| Rate for Payer: Quartz Beloit One Network |
$1,397.83
|
| Rate for Payer: Quartz Commercial |
$1,854.27
|
| Rate for Payer: Quartz Medicare Advantage |
$1,711.63
|
| Rate for Payer: The Alliance Commercial |
$1,426.36
|
| Rate for Payer: WEA Trust Commercial |
$1,569.00
|
| Rate for Payer: WPS Commercial |
$2,112.93
|
|
|
SCREW LOCK LG HD 3.5 X 50MM ORTHOLOC 58803550
|
Facility
|
IP
|
$2,743.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6228140
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,397.83 |
| Max. Negotiated Rate |
$2,624.50 |
| Rate for Payer: Aetna Commercial |
$2,567.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,453.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,511.94
|
| Rate for Payer: Cash Price |
$822.90
|
| Rate for Payer: Cigna Commercial |
$2,624.50
|
| Rate for Payer: Health EOS Commercial |
$2,538.92
|
| Rate for Payer: HFN Commercial |
$2,624.50
|
| Rate for Payer: Multiplan Commercial |
$2,282.18
|
| Rate for Payer: Preferred Network Access Commercial |
$2,624.50
|
| Rate for Payer: Quartz Beloit One Network |
$1,397.83
|
| Rate for Payer: Quartz Commercial |
$1,711.63
|
| Rate for Payer: WEA Trust Commercial |
$1,569.00
|
| Rate for Payer: WPS Commercial |
$2,112.93
|
|
|
SCREW LOCK LG HD 3.5 X 50MM ORTHOLOC 58803550
|
Facility
|
OP
|
$2,743.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6228140
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$798.76 |
| Max. Negotiated Rate |
$2,624.50 |
| Rate for Payer: Aetna Commercial |
$2,567.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,453.34
|
| Rate for Payer: Aetna Managed Medicare |
$798.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,854.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,426.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,369.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,511.94
|
| Rate for Payer: Cash Price |
$822.90
|
| Rate for Payer: Cigna Commercial |
$2,624.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,596.43
|
| Rate for Payer: Health EOS Commercial |
$2,538.92
|
| Rate for Payer: HFN Commercial |
$2,624.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,139.54
|
| Rate for Payer: Multiplan Commercial |
$2,282.18
|
| Rate for Payer: NAPHCARE Commercial |
$1,711.63
|
| Rate for Payer: Preferred Network Access Commercial |
$2,624.50
|
| Rate for Payer: Quartz Beloit One Network |
$1,397.83
|
| Rate for Payer: Quartz Commercial |
$1,854.27
|
| Rate for Payer: Quartz Medicare Advantage |
$1,711.63
|
| Rate for Payer: The Alliance Commercial |
$1,426.36
|
| Rate for Payer: WEA Trust Commercial |
$1,569.00
|
| Rate for Payer: WPS Commercial |
$2,112.93
|
|
|
SCREW LOCK LP 3.5 X 10MM BRONZE ORTHOLOC 58813510
|
Facility
|
OP
|
$1,751.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6211039
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$509.89 |
| Max. Negotiated Rate |
$1,675.36 |
| Rate for Payer: Aetna Commercial |
$1,638.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,566.09
|
| Rate for Payer: Aetna Managed Medicare |
$509.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,183.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$910.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$874.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$965.15
|
| Rate for Payer: Cash Price |
$525.30
|
| Rate for Payer: Cigna Commercial |
$1,675.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,019.08
|
| Rate for Payer: Health EOS Commercial |
$1,620.73
|
| Rate for Payer: HFN Commercial |
$1,675.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,365.78
|
| Rate for Payer: Multiplan Commercial |
$1,456.83
|
| Rate for Payer: NAPHCARE Commercial |
$1,092.62
|
| Rate for Payer: Preferred Network Access Commercial |
$1,675.36
|
| Rate for Payer: Quartz Beloit One Network |
$892.31
|
| Rate for Payer: Quartz Commercial |
$1,183.68
|
| Rate for Payer: Quartz Medicare Advantage |
$1,092.62
|
| Rate for Payer: The Alliance Commercial |
$910.52
|
| Rate for Payer: WEA Trust Commercial |
$1,001.57
|
| Rate for Payer: WPS Commercial |
$1,348.80
|
|
|
SCREW LOCK LP 3.5 X 10MM BRONZE ORTHOLOC 58813510
|
Facility
|
IP
|
$1,751.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6211039
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$892.31 |
| Max. Negotiated Rate |
$1,675.36 |
| Rate for Payer: Aetna Commercial |
$1,638.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,566.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$965.15
|
| Rate for Payer: Cash Price |
$525.30
|
| Rate for Payer: Cigna Commercial |
$1,675.36
|
| Rate for Payer: Health EOS Commercial |
$1,620.73
|
| Rate for Payer: HFN Commercial |
$1,675.36
|
| Rate for Payer: Multiplan Commercial |
$1,456.83
|
| Rate for Payer: Preferred Network Access Commercial |
$1,675.36
|
| Rate for Payer: Quartz Beloit One Network |
$892.31
|
| Rate for Payer: Quartz Commercial |
$1,092.62
|
| Rate for Payer: WEA Trust Commercial |
$1,001.57
|
| Rate for Payer: WPS Commercial |
$1,348.80
|
|
|
SCREW LOCK LP 3.5 X 12MM BRONZE ORTHOLOC 58813512
|
Facility
|
IP
|
$1,792.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5729837
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$913.20 |
| Max. Negotiated Rate |
$1,714.59 |
| Rate for Payer: Aetna Commercial |
$1,677.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,602.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$987.75
|
| Rate for Payer: Cash Price |
$537.60
|
| Rate for Payer: Cigna Commercial |
$1,714.59
|
| Rate for Payer: Health EOS Commercial |
$1,658.68
|
| Rate for Payer: HFN Commercial |
$1,714.59
|
| Rate for Payer: Multiplan Commercial |
$1,490.94
|
| Rate for Payer: Preferred Network Access Commercial |
$1,714.59
|
| Rate for Payer: Quartz Beloit One Network |
$913.20
|
| Rate for Payer: Quartz Commercial |
$1,118.21
|
| Rate for Payer: WEA Trust Commercial |
$1,025.02
|
| Rate for Payer: WPS Commercial |
$1,380.38
|
|
|
SCREW LOCK LP 3.5 X 12MM BRONZE ORTHOLOC 58813512
|
Facility
|
OP
|
$1,792.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5729837
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$521.83 |
| Max. Negotiated Rate |
$1,714.59 |
| Rate for Payer: Aetna Commercial |
$1,677.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,602.76
|
| Rate for Payer: Aetna Managed Medicare |
$521.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,211.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$931.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$894.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$987.75
|
| Rate for Payer: Cash Price |
$537.60
|
| Rate for Payer: Cigna Commercial |
$1,714.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,042.94
|
| Rate for Payer: Health EOS Commercial |
$1,658.68
|
| Rate for Payer: HFN Commercial |
$1,714.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,397.76
|
| Rate for Payer: Multiplan Commercial |
$1,490.94
|
| Rate for Payer: NAPHCARE Commercial |
$1,118.21
|
| Rate for Payer: Preferred Network Access Commercial |
$1,714.59
|
| Rate for Payer: Quartz Beloit One Network |
$913.20
|
| Rate for Payer: Quartz Commercial |
$1,211.39
|
| Rate for Payer: Quartz Medicare Advantage |
$1,118.21
|
| Rate for Payer: The Alliance Commercial |
$931.84
|
| Rate for Payer: WEA Trust Commercial |
$1,025.02
|
| Rate for Payer: WPS Commercial |
$1,380.38
|
|
|
SCREW LOCK LP 3.5 X 14MM BRONZE ORTHOLOC 58813514
|
Facility
|
OP
|
$1,792.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5729838
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$521.83 |
| Max. Negotiated Rate |
$1,714.59 |
| Rate for Payer: Aetna Commercial |
$1,677.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,602.76
|
| Rate for Payer: Aetna Managed Medicare |
$521.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,211.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$931.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$894.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$987.75
|
| Rate for Payer: Cash Price |
$537.60
|
| Rate for Payer: Cigna Commercial |
$1,714.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,042.94
|
| Rate for Payer: Health EOS Commercial |
$1,658.68
|
| Rate for Payer: HFN Commercial |
$1,714.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,397.76
|
| Rate for Payer: Multiplan Commercial |
$1,490.94
|
| Rate for Payer: NAPHCARE Commercial |
$1,118.21
|
| Rate for Payer: Preferred Network Access Commercial |
$1,714.59
|
| Rate for Payer: Quartz Beloit One Network |
$913.20
|
| Rate for Payer: Quartz Commercial |
$1,211.39
|
| Rate for Payer: Quartz Medicare Advantage |
$1,118.21
|
| Rate for Payer: The Alliance Commercial |
$931.84
|
| Rate for Payer: WEA Trust Commercial |
$1,025.02
|
| Rate for Payer: WPS Commercial |
$1,380.38
|
|
|
SCREW LOCK LP 3.5 X 14MM BRONZE ORTHOLOC 58813514
|
Facility
|
IP
|
$1,792.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5729838
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$913.20 |
| Max. Negotiated Rate |
$1,714.59 |
| Rate for Payer: Aetna Commercial |
$1,677.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,602.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$987.75
|
| Rate for Payer: Cash Price |
$537.60
|
| Rate for Payer: Cigna Commercial |
$1,714.59
|
| Rate for Payer: Health EOS Commercial |
$1,658.68
|
| Rate for Payer: HFN Commercial |
$1,714.59
|
| Rate for Payer: Multiplan Commercial |
$1,490.94
|
| Rate for Payer: Preferred Network Access Commercial |
$1,714.59
|
| Rate for Payer: Quartz Beloit One Network |
$913.20
|
| Rate for Payer: Quartz Commercial |
$1,118.21
|
| Rate for Payer: WEA Trust Commercial |
$1,025.02
|
| Rate for Payer: WPS Commercial |
$1,380.38
|
|
|
SCREW LOCK LP 3.5 X 16MM BRONZE ORTHOLOC 58813516
|
Facility
|
IP
|
$1,792.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459799
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$913.20 |
| Max. Negotiated Rate |
$1,714.59 |
| Rate for Payer: Aetna Commercial |
$1,677.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,602.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$987.75
|
| Rate for Payer: Cash Price |
$537.60
|
| Rate for Payer: Cigna Commercial |
$1,714.59
|
| Rate for Payer: Health EOS Commercial |
$1,658.68
|
| Rate for Payer: HFN Commercial |
$1,714.59
|
| Rate for Payer: Multiplan Commercial |
$1,490.94
|
| Rate for Payer: Preferred Network Access Commercial |
$1,714.59
|
| Rate for Payer: Quartz Beloit One Network |
$913.20
|
| Rate for Payer: Quartz Commercial |
$1,118.21
|
| Rate for Payer: WEA Trust Commercial |
$1,025.02
|
| Rate for Payer: WPS Commercial |
$1,380.38
|
|
|
SCREW LOCK LP 3.5 X 16MM BRONZE ORTHOLOC 58813516
|
Facility
|
OP
|
$1,792.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459799
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$521.83 |
| Max. Negotiated Rate |
$1,714.59 |
| Rate for Payer: Aetna Commercial |
$1,677.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,602.76
|
| Rate for Payer: Aetna Managed Medicare |
$521.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,211.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$931.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$894.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$987.75
|
| Rate for Payer: Cash Price |
$537.60
|
| Rate for Payer: Cigna Commercial |
$1,714.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,042.94
|
| Rate for Payer: Health EOS Commercial |
$1,658.68
|
| Rate for Payer: HFN Commercial |
$1,714.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,397.76
|
| Rate for Payer: Multiplan Commercial |
$1,490.94
|
| Rate for Payer: NAPHCARE Commercial |
$1,118.21
|
| Rate for Payer: Preferred Network Access Commercial |
$1,714.59
|
| Rate for Payer: Quartz Beloit One Network |
$913.20
|
| Rate for Payer: Quartz Commercial |
$1,211.39
|
| Rate for Payer: Quartz Medicare Advantage |
$1,118.21
|
| Rate for Payer: The Alliance Commercial |
$931.84
|
| Rate for Payer: WEA Trust Commercial |
$1,025.02
|
| Rate for Payer: WPS Commercial |
$1,380.38
|
|
|
SCREW LOCK LP 3.5 X 18MM BRONZE ORTHOLOC 58813518
|
Facility
|
OP
|
$1,751.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6228132
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$509.89 |
| Max. Negotiated Rate |
$1,675.36 |
| Rate for Payer: Aetna Commercial |
$1,638.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,566.09
|
| Rate for Payer: Aetna Managed Medicare |
$509.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,183.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$910.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$874.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$965.15
|
| Rate for Payer: Cash Price |
$525.30
|
| Rate for Payer: Cigna Commercial |
$1,675.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,019.08
|
| Rate for Payer: Health EOS Commercial |
$1,620.73
|
| Rate for Payer: HFN Commercial |
$1,675.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,365.78
|
| Rate for Payer: Multiplan Commercial |
$1,456.83
|
| Rate for Payer: NAPHCARE Commercial |
$1,092.62
|
| Rate for Payer: Preferred Network Access Commercial |
$1,675.36
|
| Rate for Payer: Quartz Beloit One Network |
$892.31
|
| Rate for Payer: Quartz Commercial |
$1,183.68
|
| Rate for Payer: Quartz Medicare Advantage |
$1,092.62
|
| Rate for Payer: The Alliance Commercial |
$910.52
|
| Rate for Payer: WEA Trust Commercial |
$1,001.57
|
| Rate for Payer: WPS Commercial |
$1,348.80
|
|
|
SCREW LOCK LP 3.5 X 18MM BRONZE ORTHOLOC 58813518
|
Facility
|
IP
|
$1,751.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6228132
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$892.31 |
| Max. Negotiated Rate |
$1,675.36 |
| Rate for Payer: Aetna Commercial |
$1,638.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,566.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$965.15
|
| Rate for Payer: Cash Price |
$525.30
|
| Rate for Payer: Cigna Commercial |
$1,675.36
|
| Rate for Payer: Health EOS Commercial |
$1,620.73
|
| Rate for Payer: HFN Commercial |
$1,675.36
|
| Rate for Payer: Multiplan Commercial |
$1,456.83
|
| Rate for Payer: Preferred Network Access Commercial |
$1,675.36
|
| Rate for Payer: Quartz Beloit One Network |
$892.31
|
| Rate for Payer: Quartz Commercial |
$1,092.62
|
| Rate for Payer: WEA Trust Commercial |
$1,001.57
|
| Rate for Payer: WPS Commercial |
$1,348.80
|
|
|
SCREW LOCK LP 3.5 X 20MM ORTHOLOC 58813520
|
Facility
|
OP
|
$1,751.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6185021
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$509.89 |
| Max. Negotiated Rate |
$1,675.36 |
| Rate for Payer: Aetna Commercial |
$1,638.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,566.09
|
| Rate for Payer: Aetna Managed Medicare |
$509.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,183.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$910.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$874.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$965.15
|
| Rate for Payer: Cash Price |
$525.30
|
| Rate for Payer: Cigna Commercial |
$1,675.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,019.08
|
| Rate for Payer: Health EOS Commercial |
$1,620.73
|
| Rate for Payer: HFN Commercial |
$1,675.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,365.78
|
| Rate for Payer: Multiplan Commercial |
$1,456.83
|
| Rate for Payer: NAPHCARE Commercial |
$1,092.62
|
| Rate for Payer: Preferred Network Access Commercial |
$1,675.36
|
| Rate for Payer: Quartz Beloit One Network |
$892.31
|
| Rate for Payer: Quartz Commercial |
$1,183.68
|
| Rate for Payer: Quartz Medicare Advantage |
$1,092.62
|
| Rate for Payer: The Alliance Commercial |
$910.52
|
| Rate for Payer: WEA Trust Commercial |
$1,001.57
|
| Rate for Payer: WPS Commercial |
$1,348.80
|
|
|
SCREW LOCK LP 3.5 X 20MM ORTHOLOC 58813520
|
Facility
|
IP
|
$1,751.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6185021
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$892.31 |
| Max. Negotiated Rate |
$1,675.36 |
| Rate for Payer: Aetna Commercial |
$1,638.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,566.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$965.15
|
| Rate for Payer: Cash Price |
$525.30
|
| Rate for Payer: Cigna Commercial |
$1,675.36
|
| Rate for Payer: Health EOS Commercial |
$1,620.73
|
| Rate for Payer: HFN Commercial |
$1,675.36
|
| Rate for Payer: Multiplan Commercial |
$1,456.83
|
| Rate for Payer: Preferred Network Access Commercial |
$1,675.36
|
| Rate for Payer: Quartz Beloit One Network |
$892.31
|
| Rate for Payer: Quartz Commercial |
$1,092.62
|
| Rate for Payer: WEA Trust Commercial |
$1,001.57
|
| Rate for Payer: WPS Commercial |
$1,348.80
|
|
|
SCREW LOCK LP 3.5 X 26MM ORTHOLOC 58813526
|
Facility
|
IP
|
$1,751.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6206973
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$892.31 |
| Max. Negotiated Rate |
$1,675.36 |
| Rate for Payer: Aetna Commercial |
$1,638.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,566.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$965.15
|
| Rate for Payer: Cash Price |
$525.30
|
| Rate for Payer: Cigna Commercial |
$1,675.36
|
| Rate for Payer: Health EOS Commercial |
$1,620.73
|
| Rate for Payer: HFN Commercial |
$1,675.36
|
| Rate for Payer: Multiplan Commercial |
$1,456.83
|
| Rate for Payer: Preferred Network Access Commercial |
$1,675.36
|
| Rate for Payer: Quartz Beloit One Network |
$892.31
|
| Rate for Payer: Quartz Commercial |
$1,092.62
|
| Rate for Payer: WEA Trust Commercial |
$1,001.57
|
| Rate for Payer: WPS Commercial |
$1,348.80
|
|
|
SCREW LOCK LP 3.5 X 26MM ORTHOLOC 58813526
|
Facility
|
OP
|
$1,751.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6206973
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$509.89 |
| Max. Negotiated Rate |
$1,675.36 |
| Rate for Payer: Aetna Commercial |
$1,638.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,566.09
|
| Rate for Payer: Aetna Managed Medicare |
$509.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,183.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$910.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$874.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$965.15
|
| Rate for Payer: Cash Price |
$525.30
|
| Rate for Payer: Cigna Commercial |
$1,675.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,019.08
|
| Rate for Payer: Health EOS Commercial |
$1,620.73
|
| Rate for Payer: HFN Commercial |
$1,675.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,365.78
|
| Rate for Payer: Multiplan Commercial |
$1,456.83
|
| Rate for Payer: NAPHCARE Commercial |
$1,092.62
|
| Rate for Payer: Preferred Network Access Commercial |
$1,675.36
|
| Rate for Payer: Quartz Beloit One Network |
$892.31
|
| Rate for Payer: Quartz Commercial |
$1,183.68
|
| Rate for Payer: Quartz Medicare Advantage |
$1,092.62
|
| Rate for Payer: The Alliance Commercial |
$910.52
|
| Rate for Payer: WEA Trust Commercial |
$1,001.57
|
| Rate for Payer: WPS Commercial |
$1,348.80
|
|
|
SCREW LOCK LP 3.5 X 28MM BRONZE ORTHOLOC 58813528
|
Facility
|
OP
|
$1,751.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6228133
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$509.89 |
| Max. Negotiated Rate |
$1,675.36 |
| Rate for Payer: Aetna Commercial |
$1,638.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,566.09
|
| Rate for Payer: Aetna Managed Medicare |
$509.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,183.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$910.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$874.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$965.15
|
| Rate for Payer: Cash Price |
$525.30
|
| Rate for Payer: Cigna Commercial |
$1,675.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,019.08
|
| Rate for Payer: Health EOS Commercial |
$1,620.73
|
| Rate for Payer: HFN Commercial |
$1,675.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,365.78
|
| Rate for Payer: Multiplan Commercial |
$1,456.83
|
| Rate for Payer: NAPHCARE Commercial |
$1,092.62
|
| Rate for Payer: Preferred Network Access Commercial |
$1,675.36
|
| Rate for Payer: Quartz Beloit One Network |
$892.31
|
| Rate for Payer: Quartz Commercial |
$1,183.68
|
| Rate for Payer: Quartz Medicare Advantage |
$1,092.62
|
| Rate for Payer: The Alliance Commercial |
$910.52
|
| Rate for Payer: WEA Trust Commercial |
$1,001.57
|
| Rate for Payer: WPS Commercial |
$1,348.80
|
|
|
SCREW LOCK LP 3.5 X 28MM BRONZE ORTHOLOC 58813528
|
Facility
|
IP
|
$1,751.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6228133
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$892.31 |
| Max. Negotiated Rate |
$1,675.36 |
| Rate for Payer: Aetna Commercial |
$1,638.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,566.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$965.15
|
| Rate for Payer: Cash Price |
$525.30
|
| Rate for Payer: Cigna Commercial |
$1,675.36
|
| Rate for Payer: Health EOS Commercial |
$1,620.73
|
| Rate for Payer: HFN Commercial |
$1,675.36
|
| Rate for Payer: Multiplan Commercial |
$1,456.83
|
| Rate for Payer: Preferred Network Access Commercial |
$1,675.36
|
| Rate for Payer: Quartz Beloit One Network |
$892.31
|
| Rate for Payer: Quartz Commercial |
$1,092.62
|
| Rate for Payer: WEA Trust Commercial |
$1,001.57
|
| Rate for Payer: WPS Commercial |
$1,348.80
|
|
|
SCREW LOCK LP 3.5 X 30MM BRONZE ORTHOLOC 58813530
|
Facility
|
OP
|
$2,234.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6171780
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.54 |
| Max. Negotiated Rate |
$2,137.49 |
| Rate for Payer: Aetna Commercial |
$2,091.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,998.09
|
| Rate for Payer: Aetna Managed Medicare |
$650.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,510.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,161.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,115.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,231.38
|
| Rate for Payer: Cash Price |
$670.20
|
| Rate for Payer: Cigna Commercial |
$2,137.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,300.19
|
| Rate for Payer: Health EOS Commercial |
$2,067.79
|
| Rate for Payer: HFN Commercial |
$2,137.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,742.52
|
| Rate for Payer: Multiplan Commercial |
$1,858.69
|
| Rate for Payer: NAPHCARE Commercial |
$1,394.02
|
| Rate for Payer: Preferred Network Access Commercial |
$2,137.49
|
| Rate for Payer: Quartz Beloit One Network |
$1,138.45
|
| Rate for Payer: Quartz Commercial |
$1,510.18
|
| Rate for Payer: Quartz Medicare Advantage |
$1,394.02
|
| Rate for Payer: The Alliance Commercial |
$1,161.68
|
| Rate for Payer: WEA Trust Commercial |
$1,277.85
|
| Rate for Payer: WPS Commercial |
$1,720.85
|
|
|
SCREW LOCK LP 3.5 X 30MM BRONZE ORTHOLOC 58813530
|
Facility
|
IP
|
$2,234.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6171780
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,138.45 |
| Max. Negotiated Rate |
$2,137.49 |
| Rate for Payer: Aetna Commercial |
$2,091.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,998.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,231.38
|
| Rate for Payer: Cash Price |
$670.20
|
| Rate for Payer: Cigna Commercial |
$2,137.49
|
| Rate for Payer: Health EOS Commercial |
$2,067.79
|
| Rate for Payer: HFN Commercial |
$2,137.49
|
| Rate for Payer: Multiplan Commercial |
$1,858.69
|
| Rate for Payer: Preferred Network Access Commercial |
$2,137.49
|
| Rate for Payer: Quartz Beloit One Network |
$1,138.45
|
| Rate for Payer: Quartz Commercial |
$1,394.02
|
| Rate for Payer: WEA Trust Commercial |
$1,277.85
|
| Rate for Payer: WPS Commercial |
$1,720.85
|
|
|
SCREW LOCK LP 3.5 X 48MM BRONZE ORTHOLOC 58813548
|
Facility
|
OP
|
$1,751.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6228142
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$509.89 |
| Max. Negotiated Rate |
$1,675.36 |
| Rate for Payer: Aetna Commercial |
$1,638.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,566.09
|
| Rate for Payer: Aetna Managed Medicare |
$509.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,183.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$910.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$874.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$965.15
|
| Rate for Payer: Cash Price |
$525.30
|
| Rate for Payer: Cigna Commercial |
$1,675.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,019.08
|
| Rate for Payer: Health EOS Commercial |
$1,620.73
|
| Rate for Payer: HFN Commercial |
$1,675.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,365.78
|
| Rate for Payer: Multiplan Commercial |
$1,456.83
|
| Rate for Payer: NAPHCARE Commercial |
$1,092.62
|
| Rate for Payer: Preferred Network Access Commercial |
$1,675.36
|
| Rate for Payer: Quartz Beloit One Network |
$892.31
|
| Rate for Payer: Quartz Commercial |
$1,183.68
|
| Rate for Payer: Quartz Medicare Advantage |
$1,092.62
|
| Rate for Payer: The Alliance Commercial |
$910.52
|
| Rate for Payer: WEA Trust Commercial |
$1,001.57
|
| Rate for Payer: WPS Commercial |
$1,348.80
|
|
