|
SCREW LOCK VA 2.4 X 22MM TI AR-8724V-22
|
Facility
|
OP
|
$1,864.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5384970
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$542.80 |
| Max. Negotiated Rate |
$1,783.48 |
| Rate for Payer: Aetna Commercial |
$1,744.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,667.16
|
| Rate for Payer: Aetna Managed Medicare |
$542.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,260.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$969.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$930.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,027.44
|
| Rate for Payer: Cash Price |
$559.20
|
| Rate for Payer: Cigna Commercial |
$1,783.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,084.85
|
| Rate for Payer: Health EOS Commercial |
$1,725.32
|
| Rate for Payer: HFN Commercial |
$1,783.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,453.92
|
| Rate for Payer: Multiplan Commercial |
$1,550.85
|
| Rate for Payer: NAPHCARE Commercial |
$1,163.14
|
| Rate for Payer: Preferred Network Access Commercial |
$1,783.48
|
| Rate for Payer: Quartz Beloit One Network |
$949.89
|
| Rate for Payer: Quartz Commercial |
$1,260.06
|
| Rate for Payer: Quartz Medicare Advantage |
$1,163.14
|
| Rate for Payer: The Alliance Commercial |
$969.28
|
| Rate for Payer: WEA Trust Commercial |
$1,066.21
|
| Rate for Payer: WPS Commercial |
$1,435.84
|
|
|
SCREW LOCK VA 2.4 X 22MM TI AR-8724V-22
|
Facility
|
IP
|
$1,864.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5384970
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$949.89 |
| Max. Negotiated Rate |
$1,783.48 |
| Rate for Payer: Aetna Commercial |
$1,744.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,667.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,027.44
|
| Rate for Payer: Cash Price |
$559.20
|
| Rate for Payer: Cigna Commercial |
$1,783.48
|
| Rate for Payer: Health EOS Commercial |
$1,725.32
|
| Rate for Payer: HFN Commercial |
$1,783.48
|
| Rate for Payer: Multiplan Commercial |
$1,550.85
|
| Rate for Payer: Preferred Network Access Commercial |
$1,783.48
|
| Rate for Payer: Quartz Beloit One Network |
$949.89
|
| Rate for Payer: Quartz Commercial |
$1,163.14
|
| Rate for Payer: WEA Trust Commercial |
$1,066.21
|
| Rate for Payer: WPS Commercial |
$1,435.84
|
|
|
SCREW LOCK VA 2.4 X 26MM TI AR-8724V-26
|
Facility
|
OP
|
$1,864.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5384973
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$542.80 |
| Max. Negotiated Rate |
$1,783.48 |
| Rate for Payer: Aetna Commercial |
$1,744.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,667.16
|
| Rate for Payer: Aetna Managed Medicare |
$542.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,260.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$969.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$930.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,027.44
|
| Rate for Payer: Cash Price |
$559.20
|
| Rate for Payer: Cigna Commercial |
$1,783.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,084.85
|
| Rate for Payer: Health EOS Commercial |
$1,725.32
|
| Rate for Payer: HFN Commercial |
$1,783.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,453.92
|
| Rate for Payer: Multiplan Commercial |
$1,550.85
|
| Rate for Payer: NAPHCARE Commercial |
$1,163.14
|
| Rate for Payer: Preferred Network Access Commercial |
$1,783.48
|
| Rate for Payer: Quartz Beloit One Network |
$949.89
|
| Rate for Payer: Quartz Commercial |
$1,260.06
|
| Rate for Payer: Quartz Medicare Advantage |
$1,163.14
|
| Rate for Payer: The Alliance Commercial |
$969.28
|
| Rate for Payer: WEA Trust Commercial |
$1,066.21
|
| Rate for Payer: WPS Commercial |
$1,435.84
|
|
|
SCREW LOCK VA 2.4 X 26MM TI AR-8724V-26
|
Facility
|
IP
|
$1,864.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5384973
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$949.89 |
| Max. Negotiated Rate |
$1,783.48 |
| Rate for Payer: Aetna Commercial |
$1,744.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,667.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,027.44
|
| Rate for Payer: Cash Price |
$559.20
|
| Rate for Payer: Cigna Commercial |
$1,783.48
|
| Rate for Payer: Health EOS Commercial |
$1,725.32
|
| Rate for Payer: HFN Commercial |
$1,783.48
|
| Rate for Payer: Multiplan Commercial |
$1,550.85
|
| Rate for Payer: Preferred Network Access Commercial |
$1,783.48
|
| Rate for Payer: Quartz Beloit One Network |
$949.89
|
| Rate for Payer: Quartz Commercial |
$1,163.14
|
| Rate for Payer: WEA Trust Commercial |
$1,066.21
|
| Rate for Payer: WPS Commercial |
$1,435.84
|
|
|
SCREW LOCK VA 2.4 X 8MM TI AR-8724V-08
|
Facility
|
IP
|
$1,864.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5597610
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$949.89 |
| Max. Negotiated Rate |
$1,783.48 |
| Rate for Payer: Aetna Commercial |
$1,744.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,667.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,027.44
|
| Rate for Payer: Cash Price |
$559.20
|
| Rate for Payer: Cigna Commercial |
$1,783.48
|
| Rate for Payer: Health EOS Commercial |
$1,725.32
|
| Rate for Payer: HFN Commercial |
$1,783.48
|
| Rate for Payer: Multiplan Commercial |
$1,550.85
|
| Rate for Payer: Preferred Network Access Commercial |
$1,783.48
|
| Rate for Payer: Quartz Beloit One Network |
$949.89
|
| Rate for Payer: Quartz Commercial |
$1,163.14
|
| Rate for Payer: WEA Trust Commercial |
$1,066.21
|
| Rate for Payer: WPS Commercial |
$1,435.84
|
|
|
SCREW LOCK VA 2.4 X 8MM TI AR-8724V-08
|
Facility
|
OP
|
$1,864.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5597610
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$542.80 |
| Max. Negotiated Rate |
$1,783.48 |
| Rate for Payer: Aetna Commercial |
$1,744.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,667.16
|
| Rate for Payer: Aetna Managed Medicare |
$542.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,260.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$969.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$930.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,027.44
|
| Rate for Payer: Cash Price |
$559.20
|
| Rate for Payer: Cigna Commercial |
$1,783.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,084.85
|
| Rate for Payer: Health EOS Commercial |
$1,725.32
|
| Rate for Payer: HFN Commercial |
$1,783.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,453.92
|
| Rate for Payer: Multiplan Commercial |
$1,550.85
|
| Rate for Payer: NAPHCARE Commercial |
$1,163.14
|
| Rate for Payer: Preferred Network Access Commercial |
$1,783.48
|
| Rate for Payer: Quartz Beloit One Network |
$949.89
|
| Rate for Payer: Quartz Commercial |
$1,260.06
|
| Rate for Payer: Quartz Medicare Advantage |
$1,163.14
|
| Rate for Payer: The Alliance Commercial |
$969.28
|
| Rate for Payer: WEA Trust Commercial |
$1,066.21
|
| Rate for Payer: WPS Commercial |
$1,435.84
|
|
|
SCREW LOCK VA 3.5 X 12MM TI AR-8735L-12
|
Facility
|
IP
|
$1,255.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599751
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$639.55 |
| Max. Negotiated Rate |
$1,200.78 |
| Rate for Payer: Aetna Commercial |
$1,174.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,122.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$691.76
|
| Rate for Payer: Cash Price |
$376.50
|
| Rate for Payer: Cigna Commercial |
$1,200.78
|
| Rate for Payer: Health EOS Commercial |
$1,161.63
|
| Rate for Payer: HFN Commercial |
$1,200.78
|
| Rate for Payer: Multiplan Commercial |
$1,044.16
|
| Rate for Payer: Preferred Network Access Commercial |
$1,200.78
|
| Rate for Payer: Quartz Beloit One Network |
$639.55
|
| Rate for Payer: Quartz Commercial |
$783.12
|
| Rate for Payer: WEA Trust Commercial |
$717.86
|
| Rate for Payer: WPS Commercial |
$966.73
|
|
|
SCREW LOCK VA 3.5 X 12MM TI AR-8735L-12
|
Facility
|
OP
|
$1,255.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599751
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$365.46 |
| Max. Negotiated Rate |
$1,200.78 |
| Rate for Payer: Aetna Commercial |
$1,174.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,122.47
|
| Rate for Payer: Aetna Managed Medicare |
$365.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$848.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$652.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$626.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$691.76
|
| Rate for Payer: Cash Price |
$376.50
|
| Rate for Payer: Cigna Commercial |
$1,200.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$730.41
|
| Rate for Payer: Health EOS Commercial |
$1,161.63
|
| Rate for Payer: HFN Commercial |
$1,200.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$978.90
|
| Rate for Payer: Multiplan Commercial |
$1,044.16
|
| Rate for Payer: NAPHCARE Commercial |
$783.12
|
| Rate for Payer: Preferred Network Access Commercial |
$1,200.78
|
| Rate for Payer: Quartz Beloit One Network |
$639.55
|
| Rate for Payer: Quartz Commercial |
$848.38
|
| Rate for Payer: Quartz Medicare Advantage |
$783.12
|
| Rate for Payer: The Alliance Commercial |
$652.60
|
| Rate for Payer: WEA Trust Commercial |
$717.86
|
| Rate for Payer: WPS Commercial |
$966.73
|
|
|
SCREW LOCK VA 3.5 X 14MM TI AR-8735L-14
|
Facility
|
OP
|
$1,255.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599752
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$365.46 |
| Max. Negotiated Rate |
$1,200.78 |
| Rate for Payer: Aetna Commercial |
$1,174.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,122.47
|
| Rate for Payer: Aetna Managed Medicare |
$365.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$848.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$652.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$626.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$691.76
|
| Rate for Payer: Cash Price |
$376.50
|
| Rate for Payer: Cigna Commercial |
$1,200.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$730.41
|
| Rate for Payer: Health EOS Commercial |
$1,161.63
|
| Rate for Payer: HFN Commercial |
$1,200.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$978.90
|
| Rate for Payer: Multiplan Commercial |
$1,044.16
|
| Rate for Payer: NAPHCARE Commercial |
$783.12
|
| Rate for Payer: Preferred Network Access Commercial |
$1,200.78
|
| Rate for Payer: Quartz Beloit One Network |
$639.55
|
| Rate for Payer: Quartz Commercial |
$848.38
|
| Rate for Payer: Quartz Medicare Advantage |
$783.12
|
| Rate for Payer: The Alliance Commercial |
$652.60
|
| Rate for Payer: WEA Trust Commercial |
$717.86
|
| Rate for Payer: WPS Commercial |
$966.73
|
|
|
SCREW LOCK VA 3.5 X 14MM TI AR-8735L-14
|
Facility
|
IP
|
$1,255.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599752
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$639.55 |
| Max. Negotiated Rate |
$1,200.78 |
| Rate for Payer: Aetna Commercial |
$1,174.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,122.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$691.76
|
| Rate for Payer: Cash Price |
$376.50
|
| Rate for Payer: Cigna Commercial |
$1,200.78
|
| Rate for Payer: Health EOS Commercial |
$1,161.63
|
| Rate for Payer: HFN Commercial |
$1,200.78
|
| Rate for Payer: Multiplan Commercial |
$1,044.16
|
| Rate for Payer: Preferred Network Access Commercial |
$1,200.78
|
| Rate for Payer: Quartz Beloit One Network |
$639.55
|
| Rate for Payer: Quartz Commercial |
$783.12
|
| Rate for Payer: WEA Trust Commercial |
$717.86
|
| Rate for Payer: WPS Commercial |
$966.73
|
|
|
SCREW LOCK VA 3.5 X 16MM TI AR-8735L-16
|
Facility
|
OP
|
$1,255.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6175178
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$365.46 |
| Max. Negotiated Rate |
$1,200.78 |
| Rate for Payer: Aetna Commercial |
$1,174.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,122.47
|
| Rate for Payer: Aetna Managed Medicare |
$365.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$848.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$652.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$626.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$691.76
|
| Rate for Payer: Cash Price |
$376.50
|
| Rate for Payer: Cigna Commercial |
$1,200.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$730.41
|
| Rate for Payer: Health EOS Commercial |
$1,161.63
|
| Rate for Payer: HFN Commercial |
$1,200.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$978.90
|
| Rate for Payer: Multiplan Commercial |
$1,044.16
|
| Rate for Payer: NAPHCARE Commercial |
$783.12
|
| Rate for Payer: Preferred Network Access Commercial |
$1,200.78
|
| Rate for Payer: Quartz Beloit One Network |
$639.55
|
| Rate for Payer: Quartz Commercial |
$848.38
|
| Rate for Payer: Quartz Medicare Advantage |
$783.12
|
| Rate for Payer: The Alliance Commercial |
$652.60
|
| Rate for Payer: WEA Trust Commercial |
$717.86
|
| Rate for Payer: WPS Commercial |
$966.73
|
|
|
SCREW LOCK VA 3.5 X 16MM TI AR-8735L-16
|
Facility
|
IP
|
$1,255.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6175178
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$639.55 |
| Max. Negotiated Rate |
$1,200.78 |
| Rate for Payer: Aetna Commercial |
$1,174.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,122.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$691.76
|
| Rate for Payer: Cash Price |
$376.50
|
| Rate for Payer: Cigna Commercial |
$1,200.78
|
| Rate for Payer: Health EOS Commercial |
$1,161.63
|
| Rate for Payer: HFN Commercial |
$1,200.78
|
| Rate for Payer: Multiplan Commercial |
$1,044.16
|
| Rate for Payer: Preferred Network Access Commercial |
$1,200.78
|
| Rate for Payer: Quartz Beloit One Network |
$639.55
|
| Rate for Payer: Quartz Commercial |
$783.12
|
| Rate for Payer: WEA Trust Commercial |
$717.86
|
| Rate for Payer: WPS Commercial |
$966.73
|
|
|
SCREW LOCK VA 3.5 X 18MM TI AR-8735L-18
|
Facility
|
OP
|
$1,255.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6175179
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$365.46 |
| Max. Negotiated Rate |
$1,200.78 |
| Rate for Payer: Aetna Commercial |
$1,174.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,122.47
|
| Rate for Payer: Aetna Managed Medicare |
$365.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$848.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$652.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$626.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$691.76
|
| Rate for Payer: Cash Price |
$376.50
|
| Rate for Payer: Cigna Commercial |
$1,200.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$730.41
|
| Rate for Payer: Health EOS Commercial |
$1,161.63
|
| Rate for Payer: HFN Commercial |
$1,200.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$978.90
|
| Rate for Payer: Multiplan Commercial |
$1,044.16
|
| Rate for Payer: NAPHCARE Commercial |
$783.12
|
| Rate for Payer: Preferred Network Access Commercial |
$1,200.78
|
| Rate for Payer: Quartz Beloit One Network |
$639.55
|
| Rate for Payer: Quartz Commercial |
$848.38
|
| Rate for Payer: Quartz Medicare Advantage |
$783.12
|
| Rate for Payer: The Alliance Commercial |
$652.60
|
| Rate for Payer: WEA Trust Commercial |
$717.86
|
| Rate for Payer: WPS Commercial |
$966.73
|
|
|
SCREW LOCK VA 3.5 X 18MM TI AR-8735L-18
|
Facility
|
IP
|
$1,255.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6175179
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$639.55 |
| Max. Negotiated Rate |
$1,200.78 |
| Rate for Payer: Aetna Commercial |
$1,174.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,122.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$691.76
|
| Rate for Payer: Cash Price |
$376.50
|
| Rate for Payer: Cigna Commercial |
$1,200.78
|
| Rate for Payer: Health EOS Commercial |
$1,161.63
|
| Rate for Payer: HFN Commercial |
$1,200.78
|
| Rate for Payer: Multiplan Commercial |
$1,044.16
|
| Rate for Payer: Preferred Network Access Commercial |
$1,200.78
|
| Rate for Payer: Quartz Beloit One Network |
$639.55
|
| Rate for Payer: Quartz Commercial |
$783.12
|
| Rate for Payer: WEA Trust Commercial |
$717.86
|
| Rate for Payer: WPS Commercial |
$966.73
|
|
|
SCREW MALL 4.5 X 25 215.025
|
Facility
|
IP
|
$262.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967317
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$133.52 |
| Max. Negotiated Rate |
$250.68 |
| Rate for Payer: Aetna Commercial |
$245.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$234.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$144.41
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$250.68
|
| Rate for Payer: Health EOS Commercial |
$242.51
|
| Rate for Payer: HFN Commercial |
$250.68
|
| Rate for Payer: Multiplan Commercial |
$217.98
|
| Rate for Payer: Preferred Network Access Commercial |
$250.68
|
| Rate for Payer: Quartz Beloit One Network |
$133.52
|
| Rate for Payer: Quartz Commercial |
$163.49
|
| Rate for Payer: WEA Trust Commercial |
$149.86
|
| Rate for Payer: WPS Commercial |
$201.82
|
|
|
SCREW MALL 4.5 X 25 215.025
|
Facility
|
OP
|
$262.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967317
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$76.29 |
| Max. Negotiated Rate |
$250.68 |
| Rate for Payer: Aetna Commercial |
$245.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$234.33
|
| Rate for Payer: Aetna Managed Medicare |
$76.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$177.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$136.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$130.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$144.41
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$250.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$152.48
|
| Rate for Payer: Health EOS Commercial |
$242.51
|
| Rate for Payer: HFN Commercial |
$250.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$204.36
|
| Rate for Payer: Multiplan Commercial |
$217.98
|
| Rate for Payer: NAPHCARE Commercial |
$163.49
|
| Rate for Payer: Preferred Network Access Commercial |
$250.68
|
| Rate for Payer: Quartz Beloit One Network |
$133.52
|
| Rate for Payer: Quartz Commercial |
$177.11
|
| Rate for Payer: Quartz Medicare Advantage |
$163.49
|
| Rate for Payer: The Alliance Commercial |
$136.24
|
| Rate for Payer: WEA Trust Commercial |
$149.86
|
| Rate for Payer: WPS Commercial |
$201.82
|
|
|
SCREW MALL 4.5 X 30 215.030
|
Facility
|
OP
|
$262.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967318
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$76.29 |
| Max. Negotiated Rate |
$250.68 |
| Rate for Payer: Aetna Commercial |
$245.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$234.33
|
| Rate for Payer: Aetna Managed Medicare |
$76.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$177.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$136.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$130.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$144.41
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$250.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$152.48
|
| Rate for Payer: Health EOS Commercial |
$242.51
|
| Rate for Payer: HFN Commercial |
$250.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$204.36
|
| Rate for Payer: Multiplan Commercial |
$217.98
|
| Rate for Payer: NAPHCARE Commercial |
$163.49
|
| Rate for Payer: Preferred Network Access Commercial |
$250.68
|
| Rate for Payer: Quartz Beloit One Network |
$133.52
|
| Rate for Payer: Quartz Commercial |
$177.11
|
| Rate for Payer: Quartz Medicare Advantage |
$163.49
|
| Rate for Payer: The Alliance Commercial |
$136.24
|
| Rate for Payer: WEA Trust Commercial |
$149.86
|
| Rate for Payer: WPS Commercial |
$201.82
|
|
|
SCREW MALL 4.5 X 30 215.030
|
Facility
|
IP
|
$262.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967318
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$133.52 |
| Max. Negotiated Rate |
$250.68 |
| Rate for Payer: Aetna Commercial |
$245.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$234.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$144.41
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$250.68
|
| Rate for Payer: Health EOS Commercial |
$242.51
|
| Rate for Payer: HFN Commercial |
$250.68
|
| Rate for Payer: Multiplan Commercial |
$217.98
|
| Rate for Payer: Preferred Network Access Commercial |
$250.68
|
| Rate for Payer: Quartz Beloit One Network |
$133.52
|
| Rate for Payer: Quartz Commercial |
$163.49
|
| Rate for Payer: WEA Trust Commercial |
$149.86
|
| Rate for Payer: WPS Commercial |
$201.82
|
|
|
SCREW MALL 4.5 X 35 215.035
|
Facility
|
OP
|
$262.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967319
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$76.29 |
| Max. Negotiated Rate |
$250.68 |
| Rate for Payer: Aetna Commercial |
$245.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$234.33
|
| Rate for Payer: Aetna Managed Medicare |
$76.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$177.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$136.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$130.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$144.41
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$250.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$152.48
|
| Rate for Payer: Health EOS Commercial |
$242.51
|
| Rate for Payer: HFN Commercial |
$250.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$204.36
|
| Rate for Payer: Multiplan Commercial |
$217.98
|
| Rate for Payer: NAPHCARE Commercial |
$163.49
|
| Rate for Payer: Preferred Network Access Commercial |
$250.68
|
| Rate for Payer: Quartz Beloit One Network |
$133.52
|
| Rate for Payer: Quartz Commercial |
$177.11
|
| Rate for Payer: Quartz Medicare Advantage |
$163.49
|
| Rate for Payer: The Alliance Commercial |
$136.24
|
| Rate for Payer: WEA Trust Commercial |
$149.86
|
| Rate for Payer: WPS Commercial |
$201.82
|
|
|
SCREW MALL 4.5 X 35 215.035
|
Facility
|
IP
|
$262.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967319
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$133.52 |
| Max. Negotiated Rate |
$250.68 |
| Rate for Payer: Aetna Commercial |
$245.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$234.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$144.41
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$250.68
|
| Rate for Payer: Health EOS Commercial |
$242.51
|
| Rate for Payer: HFN Commercial |
$250.68
|
| Rate for Payer: Multiplan Commercial |
$217.98
|
| Rate for Payer: Preferred Network Access Commercial |
$250.68
|
| Rate for Payer: Quartz Beloit One Network |
$133.52
|
| Rate for Payer: Quartz Commercial |
$163.49
|
| Rate for Payer: WEA Trust Commercial |
$149.86
|
| Rate for Payer: WPS Commercial |
$201.82
|
|
|
SCREW MALL 4.5 X 40 215.040
|
Facility
|
IP
|
$262.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967320
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$133.52 |
| Max. Negotiated Rate |
$250.68 |
| Rate for Payer: Aetna Commercial |
$245.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$234.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$144.41
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$250.68
|
| Rate for Payer: Health EOS Commercial |
$242.51
|
| Rate for Payer: HFN Commercial |
$250.68
|
| Rate for Payer: Multiplan Commercial |
$217.98
|
| Rate for Payer: Preferred Network Access Commercial |
$250.68
|
| Rate for Payer: Quartz Beloit One Network |
$133.52
|
| Rate for Payer: Quartz Commercial |
$163.49
|
| Rate for Payer: WEA Trust Commercial |
$149.86
|
| Rate for Payer: WPS Commercial |
$201.82
|
|
|
SCREW MALL 4.5 X 40 215.040
|
Facility
|
OP
|
$262.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967320
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$76.29 |
| Max. Negotiated Rate |
$250.68 |
| Rate for Payer: Aetna Commercial |
$245.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$234.33
|
| Rate for Payer: Aetna Managed Medicare |
$76.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$177.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$136.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$130.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$144.41
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$250.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$152.48
|
| Rate for Payer: Health EOS Commercial |
$242.51
|
| Rate for Payer: HFN Commercial |
$250.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$204.36
|
| Rate for Payer: Multiplan Commercial |
$217.98
|
| Rate for Payer: NAPHCARE Commercial |
$163.49
|
| Rate for Payer: Preferred Network Access Commercial |
$250.68
|
| Rate for Payer: Quartz Beloit One Network |
$133.52
|
| Rate for Payer: Quartz Commercial |
$177.11
|
| Rate for Payer: Quartz Medicare Advantage |
$163.49
|
| Rate for Payer: The Alliance Commercial |
$136.24
|
| Rate for Payer: WEA Trust Commercial |
$149.86
|
| Rate for Payer: WPS Commercial |
$201.82
|
|
|
SCREW MALL 4.5 X 45 215.045
|
Facility
|
IP
|
$262.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967321
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$133.52 |
| Max. Negotiated Rate |
$250.68 |
| Rate for Payer: Aetna Commercial |
$245.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$234.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$144.41
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$250.68
|
| Rate for Payer: Health EOS Commercial |
$242.51
|
| Rate for Payer: HFN Commercial |
$250.68
|
| Rate for Payer: Multiplan Commercial |
$217.98
|
| Rate for Payer: Preferred Network Access Commercial |
$250.68
|
| Rate for Payer: Quartz Beloit One Network |
$133.52
|
| Rate for Payer: Quartz Commercial |
$163.49
|
| Rate for Payer: WEA Trust Commercial |
$149.86
|
| Rate for Payer: WPS Commercial |
$201.82
|
|
|
SCREW MALL 4.5 X 45 215.045
|
Facility
|
OP
|
$262.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967321
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$76.29 |
| Max. Negotiated Rate |
$250.68 |
| Rate for Payer: Aetna Commercial |
$245.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$234.33
|
| Rate for Payer: Aetna Managed Medicare |
$76.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$177.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$136.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$130.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$144.41
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$250.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$152.48
|
| Rate for Payer: Health EOS Commercial |
$242.51
|
| Rate for Payer: HFN Commercial |
$250.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$204.36
|
| Rate for Payer: Multiplan Commercial |
$217.98
|
| Rate for Payer: NAPHCARE Commercial |
$163.49
|
| Rate for Payer: Preferred Network Access Commercial |
$250.68
|
| Rate for Payer: Quartz Beloit One Network |
$133.52
|
| Rate for Payer: Quartz Commercial |
$177.11
|
| Rate for Payer: Quartz Medicare Advantage |
$163.49
|
| Rate for Payer: The Alliance Commercial |
$136.24
|
| Rate for Payer: WEA Trust Commercial |
$149.86
|
| Rate for Payer: WPS Commercial |
$201.82
|
|
|
SCREW MALL 4.5 X 50 215.050
|
Facility
|
OP
|
$262.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967322
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$76.29 |
| Max. Negotiated Rate |
$250.68 |
| Rate for Payer: Aetna Commercial |
$245.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$234.33
|
| Rate for Payer: Aetna Managed Medicare |
$76.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$177.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$136.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$130.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$144.41
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$250.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$152.48
|
| Rate for Payer: Health EOS Commercial |
$242.51
|
| Rate for Payer: HFN Commercial |
$250.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$204.36
|
| Rate for Payer: Multiplan Commercial |
$217.98
|
| Rate for Payer: NAPHCARE Commercial |
$163.49
|
| Rate for Payer: Preferred Network Access Commercial |
$250.68
|
| Rate for Payer: Quartz Beloit One Network |
$133.52
|
| Rate for Payer: Quartz Commercial |
$177.11
|
| Rate for Payer: Quartz Medicare Advantage |
$163.49
|
| Rate for Payer: The Alliance Commercial |
$136.24
|
| Rate for Payer: WEA Trust Commercial |
$149.86
|
| Rate for Payer: WPS Commercial |
$201.82
|
|
