|
SCREW LOCK IMN 5.0 X 42.5MM 2360-5042S
|
Facility
|
IP
|
$2,703.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599789
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,324.47 |
| Max. Negotiated Rate |
$2,486.76 |
| Rate for Payer: Aetna Commercial |
$2,432.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,324.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,432.59
|
| Rate for Payer: Cash Price |
$810.90
|
| Rate for Payer: Cigna Commercial |
$2,486.76
|
| Rate for Payer: Health EOS Commercial |
$2,405.67
|
| Rate for Payer: HFN Commercial |
$2,486.76
|
| Rate for Payer: Multiplan Commercial |
$2,162.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,621.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,486.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,324.47
|
| Rate for Payer: Quartz Commercial |
$1,621.80
|
| Rate for Payer: WEA Trust Commercial |
$1,486.65
|
| Rate for Payer: WPS Commercial |
$2,002.11
|
|
|
SCREW LOCK IMN 5.0 X 42.5MM 2360-5042S
|
Facility
|
OP
|
$2,703.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599789
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$756.84 |
| Max. Negotiated Rate |
$10,812.00 |
| Rate for Payer: Aetna Commercial |
$2,432.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,324.58
|
| Rate for Payer: Aetna Managed Medicare |
$756.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,756.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,351.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,297.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,432.59
|
| Rate for Payer: Cash Price |
$810.90
|
| Rate for Payer: Cigna Commercial |
$2,486.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,512.60
|
| Rate for Payer: Health EOS Commercial |
$2,405.67
|
| Rate for Payer: HFN Commercial |
$2,486.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,027.25
|
| Rate for Payer: Multiplan Commercial |
$2,162.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,621.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,486.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,324.47
|
| Rate for Payer: Quartz Commercial |
$1,756.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,621.80
|
| Rate for Payer: The Alliance Commercial |
$10,812.00
|
| Rate for Payer: WEA Trust Commercial |
$1,486.65
|
| Rate for Payer: WPS Commercial |
$2,002.11
|
|
|
SCREW LOCK IMN 5.0 X 42.5MM 2361-5042S
|
Facility
|
OP
|
$2,676.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6177991
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$749.28 |
| Max. Negotiated Rate |
$10,704.00 |
| Rate for Payer: Aetna Commercial |
$2,408.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,301.36
|
| Rate for Payer: Aetna Managed Medicare |
$749.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,739.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,338.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,284.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,418.28
|
| Rate for Payer: Cash Price |
$802.80
|
| Rate for Payer: Cigna Commercial |
$2,461.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,497.49
|
| Rate for Payer: Health EOS Commercial |
$2,381.64
|
| Rate for Payer: HFN Commercial |
$2,461.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,007.00
|
| Rate for Payer: Multiplan Commercial |
$2,140.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,605.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,461.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,311.24
|
| Rate for Payer: Quartz Commercial |
$1,739.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,605.60
|
| Rate for Payer: The Alliance Commercial |
$10,704.00
|
| Rate for Payer: WEA Trust Commercial |
$1,471.80
|
| Rate for Payer: WPS Commercial |
$1,982.11
|
|
|
SCREW LOCK IMN 5.0 X 42.5MM 2361-5042S
|
Facility
|
IP
|
$2,676.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6177991
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,311.24 |
| Max. Negotiated Rate |
$2,461.92 |
| Rate for Payer: Aetna Commercial |
$2,408.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,301.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,418.28
|
| Rate for Payer: Cash Price |
$802.80
|
| Rate for Payer: Cigna Commercial |
$2,461.92
|
| Rate for Payer: Health EOS Commercial |
$2,381.64
|
| Rate for Payer: HFN Commercial |
$2,461.92
|
| Rate for Payer: Multiplan Commercial |
$2,140.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,605.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,461.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,311.24
|
| Rate for Payer: Quartz Commercial |
$1,605.60
|
| Rate for Payer: WEA Trust Commercial |
$1,471.80
|
| Rate for Payer: WPS Commercial |
$1,982.11
|
|
|
SCREW LOCK IMN 5.0 X 45MM 2361-5045S
|
Facility
|
OP
|
$2,676.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6201030
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$749.28 |
| Max. Negotiated Rate |
$10,704.00 |
| Rate for Payer: Aetna Commercial |
$2,408.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,301.36
|
| Rate for Payer: Aetna Managed Medicare |
$749.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,739.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,338.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,284.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,418.28
|
| Rate for Payer: Cash Price |
$802.80
|
| Rate for Payer: Cigna Commercial |
$2,461.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,497.49
|
| Rate for Payer: Health EOS Commercial |
$2,381.64
|
| Rate for Payer: HFN Commercial |
$2,461.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,007.00
|
| Rate for Payer: Multiplan Commercial |
$2,140.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,605.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,461.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,311.24
|
| Rate for Payer: Quartz Commercial |
$1,739.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,605.60
|
| Rate for Payer: The Alliance Commercial |
$10,704.00
|
| Rate for Payer: WEA Trust Commercial |
$1,471.80
|
| Rate for Payer: WPS Commercial |
$1,982.11
|
|
|
SCREW LOCK IMN 5.0 X 45MM 2361-5045S
|
Facility
|
IP
|
$2,676.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6201030
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,311.24 |
| Max. Negotiated Rate |
$2,461.92 |
| Rate for Payer: Aetna Commercial |
$2,408.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,301.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,418.28
|
| Rate for Payer: Cash Price |
$802.80
|
| Rate for Payer: Cigna Commercial |
$2,461.92
|
| Rate for Payer: Health EOS Commercial |
$2,381.64
|
| Rate for Payer: HFN Commercial |
$2,461.92
|
| Rate for Payer: Multiplan Commercial |
$2,140.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,605.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,461.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,311.24
|
| Rate for Payer: Quartz Commercial |
$1,605.60
|
| Rate for Payer: WEA Trust Commercial |
$1,471.80
|
| Rate for Payer: WPS Commercial |
$1,982.11
|
|
|
SCREW LOCK IMN 5.0 X 47.5MM 2360-5047S
|
Facility
|
OP
|
$3,756.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599792
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,051.68 |
| Max. Negotiated Rate |
$15,024.00 |
| Rate for Payer: Aetna Commercial |
$3,380.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,230.16
|
| Rate for Payer: Aetna Managed Medicare |
$1,051.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,441.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,878.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,802.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,990.68
|
| Rate for Payer: Cash Price |
$1,126.80
|
| Rate for Payer: Cigna Commercial |
$3,455.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,101.86
|
| Rate for Payer: Health EOS Commercial |
$3,342.84
|
| Rate for Payer: HFN Commercial |
$3,455.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,817.00
|
| Rate for Payer: Multiplan Commercial |
$3,004.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,253.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,455.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,840.44
|
| Rate for Payer: Quartz Commercial |
$2,441.40
|
| Rate for Payer: Quartz Medicare Advantage |
$2,253.60
|
| Rate for Payer: The Alliance Commercial |
$15,024.00
|
| Rate for Payer: WEA Trust Commercial |
$2,065.80
|
| Rate for Payer: WPS Commercial |
$2,782.07
|
|
|
SCREW LOCK IMN 5.0 X 47.5MM 2360-5047S
|
Facility
|
IP
|
$3,756.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599792
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,840.44 |
| Max. Negotiated Rate |
$3,455.52 |
| Rate for Payer: Aetna Commercial |
$3,380.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,230.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,990.68
|
| Rate for Payer: Cash Price |
$1,126.80
|
| Rate for Payer: Cigna Commercial |
$3,455.52
|
| Rate for Payer: Health EOS Commercial |
$3,342.84
|
| Rate for Payer: HFN Commercial |
$3,455.52
|
| Rate for Payer: Multiplan Commercial |
$3,004.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,253.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,455.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,840.44
|
| Rate for Payer: Quartz Commercial |
$2,253.60
|
| Rate for Payer: WEA Trust Commercial |
$2,065.80
|
| Rate for Payer: WPS Commercial |
$2,782.07
|
|
|
SCREW LOCK IMN 5.0 X 50MM 2360-5050S
|
Facility
|
IP
|
$2,062.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6151667
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,010.38 |
| Max. Negotiated Rate |
$1,897.04 |
| Rate for Payer: Aetna Commercial |
$1,855.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,773.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,092.86
|
| Rate for Payer: Cash Price |
$618.60
|
| Rate for Payer: Cigna Commercial |
$1,897.04
|
| Rate for Payer: Health EOS Commercial |
$1,835.18
|
| Rate for Payer: HFN Commercial |
$1,897.04
|
| Rate for Payer: Multiplan Commercial |
$1,649.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,237.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,897.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,010.38
|
| Rate for Payer: Quartz Commercial |
$1,237.20
|
| Rate for Payer: WEA Trust Commercial |
$1,134.10
|
| Rate for Payer: WPS Commercial |
$1,527.32
|
|
|
SCREW LOCK IMN 5.0 X 50MM 2360-5050S
|
Facility
|
OP
|
$2,062.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6151667
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$577.36 |
| Max. Negotiated Rate |
$8,248.00 |
| Rate for Payer: Aetna Commercial |
$1,855.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,773.32
|
| Rate for Payer: Aetna Managed Medicare |
$577.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,340.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,031.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$989.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,092.86
|
| Rate for Payer: Cash Price |
$618.60
|
| Rate for Payer: Cigna Commercial |
$1,897.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,153.90
|
| Rate for Payer: Health EOS Commercial |
$1,835.18
|
| Rate for Payer: HFN Commercial |
$1,897.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,546.50
|
| Rate for Payer: Multiplan Commercial |
$1,649.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,237.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,897.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,010.38
|
| Rate for Payer: Quartz Commercial |
$1,340.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,237.20
|
| Rate for Payer: The Alliance Commercial |
$8,248.00
|
| Rate for Payer: WEA Trust Commercial |
$1,134.10
|
| Rate for Payer: WPS Commercial |
$1,527.32
|
|
|
SCREW LOCK IMN 5.0 X 52.5MM 2360-5052S
|
Facility
|
OP
|
$2,599.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5797677
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$727.72 |
| Max. Negotiated Rate |
$10,396.00 |
| Rate for Payer: Aetna Commercial |
$2,339.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,235.14
|
| Rate for Payer: Aetna Managed Medicare |
$727.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,689.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,299.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,247.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,377.47
|
| Rate for Payer: Cash Price |
$779.70
|
| Rate for Payer: Cigna Commercial |
$2,391.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,454.40
|
| Rate for Payer: Health EOS Commercial |
$2,313.11
|
| Rate for Payer: HFN Commercial |
$2,391.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,949.25
|
| Rate for Payer: Multiplan Commercial |
$2,079.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,559.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,391.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,273.51
|
| Rate for Payer: Quartz Commercial |
$1,689.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,559.40
|
| Rate for Payer: The Alliance Commercial |
$10,396.00
|
| Rate for Payer: WEA Trust Commercial |
$1,429.45
|
| Rate for Payer: WPS Commercial |
$1,925.08
|
|
|
SCREW LOCK IMN 5.0 X 52.5MM 2360-5052S
|
Facility
|
IP
|
$2,599.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5797677
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,273.51 |
| Max. Negotiated Rate |
$2,391.08 |
| Rate for Payer: Aetna Commercial |
$2,339.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,235.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,377.47
|
| Rate for Payer: Cash Price |
$779.70
|
| Rate for Payer: Cigna Commercial |
$2,391.08
|
| Rate for Payer: Health EOS Commercial |
$2,313.11
|
| Rate for Payer: HFN Commercial |
$2,391.08
|
| Rate for Payer: Multiplan Commercial |
$2,079.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,559.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,391.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,273.51
|
| Rate for Payer: Quartz Commercial |
$1,559.40
|
| Rate for Payer: WEA Trust Commercial |
$1,429.45
|
| Rate for Payer: WPS Commercial |
$1,925.08
|
|
|
SCREW LOCK IMN 5.0 X 60MM 2360-5060S
|
Facility
|
OP
|
$2,599.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685870
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$727.72 |
| Max. Negotiated Rate |
$10,396.00 |
| Rate for Payer: Aetna Commercial |
$2,339.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,235.14
|
| Rate for Payer: Aetna Managed Medicare |
$727.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,689.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,299.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,247.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,377.47
|
| Rate for Payer: Cash Price |
$779.70
|
| Rate for Payer: Cigna Commercial |
$2,391.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,454.40
|
| Rate for Payer: Health EOS Commercial |
$2,313.11
|
| Rate for Payer: HFN Commercial |
$2,391.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,949.25
|
| Rate for Payer: Multiplan Commercial |
$2,079.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,559.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,391.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,273.51
|
| Rate for Payer: Quartz Commercial |
$1,689.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,559.40
|
| Rate for Payer: The Alliance Commercial |
$10,396.00
|
| Rate for Payer: WEA Trust Commercial |
$1,429.45
|
| Rate for Payer: WPS Commercial |
$1,925.08
|
|
|
SCREW LOCK IMN 5.0 X 60MM 2360-5060S
|
Facility
|
IP
|
$2,599.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685870
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,273.51 |
| Max. Negotiated Rate |
$2,391.08 |
| Rate for Payer: Aetna Commercial |
$2,339.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,235.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,377.47
|
| Rate for Payer: Cash Price |
$779.70
|
| Rate for Payer: Cigna Commercial |
$2,391.08
|
| Rate for Payer: Health EOS Commercial |
$2,313.11
|
| Rate for Payer: HFN Commercial |
$2,391.08
|
| Rate for Payer: Multiplan Commercial |
$2,079.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,559.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,391.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,273.51
|
| Rate for Payer: Quartz Commercial |
$1,559.40
|
| Rate for Payer: WEA Trust Commercial |
$1,429.45
|
| Rate for Payer: WPS Commercial |
$1,925.08
|
|
|
SCREW LOCK IMN 5.0 X 60MM 2361-5060S
|
Facility
|
OP
|
$2,676.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6173012
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$749.28 |
| Max. Negotiated Rate |
$10,704.00 |
| Rate for Payer: Aetna Commercial |
$2,408.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,301.36
|
| Rate for Payer: Aetna Managed Medicare |
$749.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,739.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,338.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,284.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,418.28
|
| Rate for Payer: Cash Price |
$802.80
|
| Rate for Payer: Cigna Commercial |
$2,461.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,497.49
|
| Rate for Payer: Health EOS Commercial |
$2,381.64
|
| Rate for Payer: HFN Commercial |
$2,461.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,007.00
|
| Rate for Payer: Multiplan Commercial |
$2,140.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,605.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,461.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,311.24
|
| Rate for Payer: Quartz Commercial |
$1,739.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,605.60
|
| Rate for Payer: The Alliance Commercial |
$10,704.00
|
| Rate for Payer: WEA Trust Commercial |
$1,471.80
|
| Rate for Payer: WPS Commercial |
$1,982.11
|
|
|
SCREW LOCK IMN 5.0 X 60MM 2361-5060S
|
Facility
|
IP
|
$2,676.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6173012
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,311.24 |
| Max. Negotiated Rate |
$2,461.92 |
| Rate for Payer: Aetna Commercial |
$2,408.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,301.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,418.28
|
| Rate for Payer: Cash Price |
$802.80
|
| Rate for Payer: Cigna Commercial |
$2,461.92
|
| Rate for Payer: Health EOS Commercial |
$2,381.64
|
| Rate for Payer: HFN Commercial |
$2,461.92
|
| Rate for Payer: Multiplan Commercial |
$2,140.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,605.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,461.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,311.24
|
| Rate for Payer: Quartz Commercial |
$1,605.60
|
| Rate for Payer: WEA Trust Commercial |
$1,471.80
|
| Rate for Payer: WPS Commercial |
$1,982.11
|
|
|
SCREW LOCK IMN 5.0 X 65MM 2360-5065S
|
Facility
|
OP
|
$2,703.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599793
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$756.84 |
| Max. Negotiated Rate |
$10,812.00 |
| Rate for Payer: Aetna Commercial |
$2,432.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,324.58
|
| Rate for Payer: Aetna Managed Medicare |
$756.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,756.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,351.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,297.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,432.59
|
| Rate for Payer: Cash Price |
$810.90
|
| Rate for Payer: Cigna Commercial |
$2,486.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,512.60
|
| Rate for Payer: Health EOS Commercial |
$2,405.67
|
| Rate for Payer: HFN Commercial |
$2,486.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,027.25
|
| Rate for Payer: Multiplan Commercial |
$2,162.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,621.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,486.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,324.47
|
| Rate for Payer: Quartz Commercial |
$1,756.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,621.80
|
| Rate for Payer: The Alliance Commercial |
$10,812.00
|
| Rate for Payer: WEA Trust Commercial |
$1,486.65
|
| Rate for Payer: WPS Commercial |
$2,002.11
|
|
|
SCREW LOCK IMN 5.0 X 65MM 2360-5065S
|
Facility
|
IP
|
$2,703.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599793
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,324.47 |
| Max. Negotiated Rate |
$2,486.76 |
| Rate for Payer: Aetna Commercial |
$2,432.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,324.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,432.59
|
| Rate for Payer: Cash Price |
$810.90
|
| Rate for Payer: Cigna Commercial |
$2,486.76
|
| Rate for Payer: Health EOS Commercial |
$2,405.67
|
| Rate for Payer: HFN Commercial |
$2,486.76
|
| Rate for Payer: Multiplan Commercial |
$2,162.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,621.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,486.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,324.47
|
| Rate for Payer: Quartz Commercial |
$1,621.80
|
| Rate for Payer: WEA Trust Commercial |
$1,486.65
|
| Rate for Payer: WPS Commercial |
$2,002.11
|
|
|
SCREW LOCK IMN 5.0 X 65MM 2361-5065S
|
Facility
|
IP
|
$2,676.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6177992
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,311.24 |
| Max. Negotiated Rate |
$2,461.92 |
| Rate for Payer: Aetna Commercial |
$2,408.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,301.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,418.28
|
| Rate for Payer: Cash Price |
$802.80
|
| Rate for Payer: Cigna Commercial |
$2,461.92
|
| Rate for Payer: Health EOS Commercial |
$2,381.64
|
| Rate for Payer: HFN Commercial |
$2,461.92
|
| Rate for Payer: Multiplan Commercial |
$2,140.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,605.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,461.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,311.24
|
| Rate for Payer: Quartz Commercial |
$1,605.60
|
| Rate for Payer: WEA Trust Commercial |
$1,471.80
|
| Rate for Payer: WPS Commercial |
$1,982.11
|
|
|
SCREW LOCK IMN 5.0 X 65MM 2361-5065S
|
Facility
|
OP
|
$2,676.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6177992
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$749.28 |
| Max. Negotiated Rate |
$10,704.00 |
| Rate for Payer: Aetna Commercial |
$2,408.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,301.36
|
| Rate for Payer: Aetna Managed Medicare |
$749.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,739.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,338.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,284.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,418.28
|
| Rate for Payer: Cash Price |
$802.80
|
| Rate for Payer: Cigna Commercial |
$2,461.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,497.49
|
| Rate for Payer: Health EOS Commercial |
$2,381.64
|
| Rate for Payer: HFN Commercial |
$2,461.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,007.00
|
| Rate for Payer: Multiplan Commercial |
$2,140.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,605.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,461.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,311.24
|
| Rate for Payer: Quartz Commercial |
$1,739.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,605.60
|
| Rate for Payer: The Alliance Commercial |
$10,704.00
|
| Rate for Payer: WEA Trust Commercial |
$1,471.80
|
| Rate for Payer: WPS Commercial |
$1,982.11
|
|
|
SCREW LOCK I/M NAIL TI 4.0 X 40MM 04.005.430S
|
Facility
|
OP
|
$2,945.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966518
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$824.60 |
| Max. Negotiated Rate |
$11,780.00 |
| Rate for Payer: Aetna Commercial |
$2,650.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,532.70
|
| Rate for Payer: Aetna Managed Medicare |
$824.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,914.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,472.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,413.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,560.85
|
| Rate for Payer: Cash Price |
$883.50
|
| Rate for Payer: Cigna Commercial |
$2,709.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,648.02
|
| Rate for Payer: Health EOS Commercial |
$2,621.05
|
| Rate for Payer: HFN Commercial |
$2,709.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,208.75
|
| Rate for Payer: Multiplan Commercial |
$2,356.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,767.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,709.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,443.05
|
| Rate for Payer: Quartz Commercial |
$1,914.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,767.00
|
| Rate for Payer: The Alliance Commercial |
$11,780.00
|
| Rate for Payer: WEA Trust Commercial |
$1,619.75
|
| Rate for Payer: WPS Commercial |
$2,181.36
|
|
|
SCREW LOCK I/M NAIL TI 4.0 X 40MM 04.005.430S
|
Facility
|
IP
|
$2,945.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966518
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,443.05 |
| Max. Negotiated Rate |
$2,709.40 |
| Rate for Payer: Aetna Commercial |
$2,650.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,532.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,560.85
|
| Rate for Payer: Cash Price |
$883.50
|
| Rate for Payer: Cigna Commercial |
$2,709.40
|
| Rate for Payer: Health EOS Commercial |
$2,621.05
|
| Rate for Payer: HFN Commercial |
$2,709.40
|
| Rate for Payer: Multiplan Commercial |
$2,356.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,767.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,709.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,443.05
|
| Rate for Payer: Quartz Commercial |
$1,767.00
|
| Rate for Payer: WEA Trust Commercial |
$1,619.75
|
| Rate for Payer: WPS Commercial |
$2,181.36
|
|
|
SCREW LOCK I/M NAIL TI 4.0 X 44MM 04.005.434S
|
Facility
|
IP
|
$1,968.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3444842
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$964.32 |
| Max. Negotiated Rate |
$1,810.56 |
| Rate for Payer: Aetna Commercial |
$1,771.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,692.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,043.04
|
| Rate for Payer: Cash Price |
$590.40
|
| Rate for Payer: Cigna Commercial |
$1,810.56
|
| Rate for Payer: Health EOS Commercial |
$1,751.52
|
| Rate for Payer: HFN Commercial |
$1,810.56
|
| Rate for Payer: Multiplan Commercial |
$1,574.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,180.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,810.56
|
| Rate for Payer: Quartz Beloit One Network |
$964.32
|
| Rate for Payer: Quartz Commercial |
$1,180.80
|
| Rate for Payer: WEA Trust Commercial |
$1,082.40
|
| Rate for Payer: WPS Commercial |
$1,457.70
|
|
|
SCREW LOCK I/M NAIL TI 4.0 X 44MM 04.005.434S
|
Facility
|
OP
|
$1,968.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3444842
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$551.04 |
| Max. Negotiated Rate |
$7,872.00 |
| Rate for Payer: Aetna Commercial |
$1,771.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,692.48
|
| Rate for Payer: Aetna Managed Medicare |
$551.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,279.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$984.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$944.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,043.04
|
| Rate for Payer: Cash Price |
$590.40
|
| Rate for Payer: Cigna Commercial |
$1,810.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,101.29
|
| Rate for Payer: Health EOS Commercial |
$1,751.52
|
| Rate for Payer: HFN Commercial |
$1,810.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,476.00
|
| Rate for Payer: Multiplan Commercial |
$1,574.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,180.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,810.56
|
| Rate for Payer: Quartz Beloit One Network |
$964.32
|
| Rate for Payer: Quartz Commercial |
$1,279.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,180.80
|
| Rate for Payer: The Alliance Commercial |
$7,872.00
|
| Rate for Payer: WEA Trust Commercial |
$1,082.40
|
| Rate for Payer: WPS Commercial |
$1,457.70
|
|
|
SCREW LOCK I/M NAIL TI 4.0 X 48MM 04.005.438S
|
Facility
|
IP
|
$1,968.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4519017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$964.32 |
| Max. Negotiated Rate |
$1,810.56 |
| Rate for Payer: Aetna Commercial |
$1,771.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,692.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,043.04
|
| Rate for Payer: Cash Price |
$590.40
|
| Rate for Payer: Cigna Commercial |
$1,810.56
|
| Rate for Payer: Health EOS Commercial |
$1,751.52
|
| Rate for Payer: HFN Commercial |
$1,810.56
|
| Rate for Payer: Multiplan Commercial |
$1,574.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,180.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,810.56
|
| Rate for Payer: Quartz Beloit One Network |
$964.32
|
| Rate for Payer: Quartz Commercial |
$1,180.80
|
| Rate for Payer: WEA Trust Commercial |
$1,082.40
|
| Rate for Payer: WPS Commercial |
$1,457.70
|
|
