|
SCREW-LOCK 5.0 X 68 TFN 458.968
|
Facility
|
IP
|
$2,724.00
|
|
| Hospital Charge Code |
2966998
|
|
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 68 TFN 458.968
|
Facility
|
OP
|
$2,724.00
|
|
| Hospital Charge Code |
2966998
|
|
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 5.0X70 212.223
|
Facility
|
OP
|
$1,917.00
|
|
| Hospital Charge Code |
2967000
|
|
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 5.0X70 212.223
|
Facility
|
IP
|
$1,917.00
|
|
| Hospital Charge Code |
2967000
|
|
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 70 FULLY THREAD 1896-5070S
|
Facility
|
IP
|
$1,882.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508993
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$922.18 |
| Max. Negotiated Rate |
$1,731.44 |
| Rate for Payer: Aetna Commercial |
$1,693.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,618.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$997.46
|
| Rate for Payer: Cash Price |
$564.60
|
| Rate for Payer: Cigna Commercial |
$1,731.44
|
| Rate for Payer: Health EOS Commercial |
$1,674.98
|
| Rate for Payer: HFN Commercial |
$1,731.44
|
| Rate for Payer: Multiplan Commercial |
$1,505.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,129.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,731.44
|
| Rate for Payer: Quartz Beloit One Network |
$922.18
|
| Rate for Payer: Quartz Commercial |
$1,129.20
|
| Rate for Payer: WEA Trust Commercial |
$1,035.10
|
| Rate for Payer: WPS Commercial |
$1,394.00
|
|
|
SCREW LOCK 5.0 X 70 FULLY THREAD 1896-5070S
|
Facility
|
OP
|
$1,882.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508993
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$526.96 |
| Max. Negotiated Rate |
$7,528.00 |
| Rate for Payer: Aetna Commercial |
$1,693.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,618.52
|
| Rate for Payer: Aetna Managed Medicare |
$526.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,223.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$941.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$903.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$997.46
|
| Rate for Payer: Cash Price |
$564.60
|
| Rate for Payer: Cigna Commercial |
$1,731.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,053.17
|
| Rate for Payer: Health EOS Commercial |
$1,674.98
|
| Rate for Payer: HFN Commercial |
$1,731.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,411.50
|
| Rate for Payer: Multiplan Commercial |
$1,505.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,129.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,731.44
|
| Rate for Payer: Quartz Beloit One Network |
$922.18
|
| Rate for Payer: Quartz Commercial |
$1,223.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,129.20
|
| Rate for Payer: The Alliance Commercial |
$7,528.00
|
| Rate for Payer: WEA Trust Commercial |
$1,035.10
|
| Rate for Payer: WPS Commercial |
$1,394.00
|
|
|
SCREW LOCK 5.0 X 70MM TI 04.005.560S
|
Facility
|
OP
|
$2,232.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3961329
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$624.96 |
| Max. Negotiated Rate |
$8,928.00 |
| Rate for Payer: Aetna Commercial |
$2,008.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,919.52
|
| Rate for Payer: Aetna Managed Medicare |
$624.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,450.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,116.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,071.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,182.96
|
| Rate for Payer: Cash Price |
$669.60
|
| Rate for Payer: Cigna Commercial |
$2,053.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,249.03
|
| Rate for Payer: Health EOS Commercial |
$1,986.48
|
| Rate for Payer: HFN Commercial |
$2,053.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,674.00
|
| Rate for Payer: Multiplan Commercial |
$1,785.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,339.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,053.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,093.68
|
| Rate for Payer: Quartz Commercial |
$1,450.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,339.20
|
| Rate for Payer: The Alliance Commercial |
$8,928.00
|
| Rate for Payer: WEA Trust Commercial |
$1,227.60
|
| Rate for Payer: WPS Commercial |
$1,653.24
|
|
|
SCREW LOCK 5.0 X 70MM TI 04.005.560S
|
Facility
|
IP
|
$2,232.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3961329
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,093.68 |
| Max. Negotiated Rate |
$2,053.44 |
| Rate for Payer: Aetna Commercial |
$2,008.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,919.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,182.96
|
| Rate for Payer: Cash Price |
$669.60
|
| Rate for Payer: Cigna Commercial |
$2,053.44
|
| Rate for Payer: Health EOS Commercial |
$1,986.48
|
| Rate for Payer: HFN Commercial |
$2,053.44
|
| Rate for Payer: Multiplan Commercial |
$1,785.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,339.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,053.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,093.68
|
| Rate for Payer: Quartz Commercial |
$1,339.20
|
| Rate for Payer: WEA Trust Commercial |
$1,227.60
|
| Rate for Payer: WPS Commercial |
$1,653.24
|
|
|
SCREW LOCK 5.0 X 70 VA 02.231.270
|
Facility
|
OP
|
$2,342.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4778611
|
|
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 70 VA 02.231.270
|
Facility
|
IP
|
$2,342.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4778611
|
|
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 72MM XL25 IM NAIL TI 04.045.072S
|
Facility
|
OP
|
$2,717.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6202969
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$760.76 |
| Max. Negotiated Rate |
$10,868.00 |
| Rate for Payer: Aetna Commercial |
$2,445.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,336.62
|
| Rate for Payer: Aetna Managed Medicare |
$760.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,766.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,358.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,304.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,440.01
|
| Rate for Payer: Cash Price |
$815.10
|
| Rate for Payer: Cigna Commercial |
$2,499.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,520.43
|
| Rate for Payer: Health EOS Commercial |
$2,418.13
|
| Rate for Payer: HFN Commercial |
$2,499.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,037.75
|
| Rate for Payer: Multiplan Commercial |
$2,173.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,630.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,499.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,331.33
|
| Rate for Payer: Quartz Commercial |
$1,766.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,630.20
|
| Rate for Payer: The Alliance Commercial |
$10,868.00
|
| Rate for Payer: WEA Trust Commercial |
$1,494.35
|
| Rate for Payer: WPS Commercial |
$2,012.48
|
|
|
SCREW LOCK 5.0 X 72MM XL25 IM NAIL TI 04.045.072S
|
Facility
|
IP
|
$2,717.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6202969
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,331.33 |
| Max. Negotiated Rate |
$2,499.64 |
| Rate for Payer: Aetna Commercial |
$2,445.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,336.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,440.01
|
| Rate for Payer: Cash Price |
$815.10
|
| Rate for Payer: Cigna Commercial |
$2,499.64
|
| Rate for Payer: Health EOS Commercial |
$2,418.13
|
| Rate for Payer: HFN Commercial |
$2,499.64
|
| Rate for Payer: Multiplan Commercial |
$2,173.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,630.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,499.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,331.33
|
| Rate for Payer: Quartz Commercial |
$1,630.20
|
| Rate for Payer: WEA Trust Commercial |
$1,494.35
|
| Rate for Payer: WPS Commercial |
$2,012.48
|
|
|
SCREW-LOCK 5.0 X 72 TFN 458.972
|
Facility
|
OP
|
$2,724.00
|
|
| Hospital Charge Code |
2967001
|
|
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 72 TFN 458.972
|
Facility
|
IP
|
$2,724.00
|
|
| Hospital Charge Code |
2967001
|
|
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 74MM TI 04.005.564S
|
Facility
|
IP
|
$2,232.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508963
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,093.68 |
| Max. Negotiated Rate |
$2,053.44 |
| Rate for Payer: Aetna Commercial |
$2,008.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,919.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,182.96
|
| Rate for Payer: Cash Price |
$669.60
|
| Rate for Payer: Cigna Commercial |
$2,053.44
|
| Rate for Payer: Health EOS Commercial |
$1,986.48
|
| Rate for Payer: HFN Commercial |
$2,053.44
|
| Rate for Payer: Multiplan Commercial |
$1,785.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,339.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,053.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,093.68
|
| Rate for Payer: Quartz Commercial |
$1,339.20
|
| Rate for Payer: WEA Trust Commercial |
$1,227.60
|
| Rate for Payer: WPS Commercial |
$1,653.24
|
|
|
SCREW LOCK 5.0 X 74MM TI 04.005.564S
|
Facility
|
OP
|
$2,232.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508963
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$624.96 |
| Max. Negotiated Rate |
$8,928.00 |
| Rate for Payer: Aetna Commercial |
$2,008.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,919.52
|
| Rate for Payer: Aetna Managed Medicare |
$624.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,450.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,116.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,071.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,182.96
|
| Rate for Payer: Cash Price |
$669.60
|
| Rate for Payer: Cigna Commercial |
$2,053.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,249.03
|
| Rate for Payer: Health EOS Commercial |
$1,986.48
|
| Rate for Payer: HFN Commercial |
$2,053.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,674.00
|
| Rate for Payer: Multiplan Commercial |
$1,785.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,339.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,053.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,093.68
|
| Rate for Payer: Quartz Commercial |
$1,450.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,339.20
|
| Rate for Payer: The Alliance Commercial |
$8,928.00
|
| Rate for Payer: WEA Trust Commercial |
$1,227.60
|
| Rate for Payer: WPS Commercial |
$1,653.24
|
|
|
SCREW-LOCK 5.0X75 212.224
|
Facility
|
OP
|
$1,917.00
|
|
| Hospital Charge Code |
2967002
|
|
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 5.0X75 212.224
|
Facility
|
IP
|
$1,917.00
|
|
| Hospital Charge Code |
2967002
|
|
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 75 FULL THREAD 1896-5075S
|
Facility
|
IP
|
$2,661.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3072612
|
|
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 75 FULL THREAD 1896-5075S
|
Facility
|
OP
|
$2,661.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3072612
|
|
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 75MM SELF-TAP 661175
|
Facility
|
OP
|
$2,005.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5146613
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$561.40 |
| Max. Negotiated Rate |
$8,020.00 |
| Rate for Payer: Aetna Commercial |
$1,804.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,724.30
|
| Rate for Payer: Aetna Managed Medicare |
$561.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,303.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,002.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$962.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,062.65
|
| Rate for Payer: Cash Price |
$601.50
|
| Rate for Payer: Cigna Commercial |
$1,844.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,122.00
|
| Rate for Payer: Health EOS Commercial |
$1,784.45
|
| Rate for Payer: HFN Commercial |
$1,844.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,503.75
|
| Rate for Payer: Multiplan Commercial |
$1,604.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,203.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,844.60
|
| Rate for Payer: Quartz Beloit One Network |
$982.45
|
| Rate for Payer: Quartz Commercial |
$1,303.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,203.00
|
| Rate for Payer: The Alliance Commercial |
$8,020.00
|
| Rate for Payer: WEA Trust Commercial |
$1,102.75
|
| Rate for Payer: WPS Commercial |
$1,485.10
|
|
|
SCREW LOCK 5.0 X 75MM SELF-TAP 661175
|
Facility
|
IP
|
$2,005.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5146613
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$982.45 |
| Max. Negotiated Rate |
$1,844.60 |
| Rate for Payer: Aetna Commercial |
$1,804.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,724.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,062.65
|
| Rate for Payer: Cash Price |
$601.50
|
| Rate for Payer: Cigna Commercial |
$1,844.60
|
| Rate for Payer: Health EOS Commercial |
$1,784.45
|
| Rate for Payer: HFN Commercial |
$1,844.60
|
| Rate for Payer: Multiplan Commercial |
$1,604.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,203.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,844.60
|
| Rate for Payer: Quartz Beloit One Network |
$982.45
|
| Rate for Payer: Quartz Commercial |
$1,203.00
|
| Rate for Payer: WEA Trust Commercial |
$1,102.75
|
| Rate for Payer: WPS Commercial |
$1,485.10
|
|
|
SCREW LOCK 5.0 X 75 VA 02.231.275
|
Facility
|
OP
|
$2,342.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5179331
|
|
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 75 VA 02.231.275
|
Facility
|
IP
|
$2,342.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5179331
|
|
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 76MM TI LOCK IM NAIL 04.005.566S
|
Facility
|
IP
|
$2,012.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415834
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$985.88 |
| Max. Negotiated Rate |
$1,851.04 |
| Rate for Payer: Aetna Commercial |
$1,810.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,730.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,066.36
|
| Rate for Payer: Cash Price |
$603.60
|
| Rate for Payer: Cigna Commercial |
$1,851.04
|
| Rate for Payer: Health EOS Commercial |
$1,790.68
|
| Rate for Payer: HFN Commercial |
$1,851.04
|
| Rate for Payer: Multiplan Commercial |
$1,609.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,207.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,851.04
|
| Rate for Payer: Quartz Beloit One Network |
$985.88
|
| Rate for Payer: Quartz Commercial |
$1,207.20
|
| Rate for Payer: WEA Trust Commercial |
$1,106.60
|
| Rate for Payer: WPS Commercial |
$1,490.29
|
|
