|
SCREW NON-LOCK 2.4 X 10MM 656110
|
Facility
|
IP
|
$1,321.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685849
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$673.18 |
| Max. Negotiated Rate |
$1,263.93 |
| Rate for Payer: Aetna Commercial |
$1,236.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,181.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$728.14
|
| Rate for Payer: Cash Price |
$396.30
|
| Rate for Payer: Cigna Commercial |
$1,263.93
|
| Rate for Payer: Health EOS Commercial |
$1,222.72
|
| Rate for Payer: HFN Commercial |
$1,263.93
|
| Rate for Payer: Multiplan Commercial |
$1,099.07
|
| Rate for Payer: Preferred Network Access Commercial |
$1,263.93
|
| Rate for Payer: Quartz Beloit One Network |
$673.18
|
| Rate for Payer: Quartz Commercial |
$824.30
|
| Rate for Payer: WEA Trust Commercial |
$755.61
|
| Rate for Payer: WPS Commercial |
$1,017.57
|
|
|
SCREW NON-LOCK 2.4 X 10MM 656110
|
Facility
|
OP
|
$1,321.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685849
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$384.68 |
| Max. Negotiated Rate |
$1,263.93 |
| Rate for Payer: Aetna Commercial |
$1,236.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,181.50
|
| Rate for Payer: Aetna Managed Medicare |
$384.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$893.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$686.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$659.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$728.14
|
| Rate for Payer: Cash Price |
$396.30
|
| Rate for Payer: Cigna Commercial |
$1,263.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$768.82
|
| Rate for Payer: Health EOS Commercial |
$1,222.72
|
| Rate for Payer: HFN Commercial |
$1,263.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,030.38
|
| Rate for Payer: Multiplan Commercial |
$1,099.07
|
| Rate for Payer: NAPHCARE Commercial |
$824.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,263.93
|
| Rate for Payer: Quartz Beloit One Network |
$673.18
|
| Rate for Payer: Quartz Commercial |
$893.00
|
| Rate for Payer: Quartz Medicare Advantage |
$824.30
|
| Rate for Payer: The Alliance Commercial |
$686.92
|
| Rate for Payer: WEA Trust Commercial |
$755.61
|
| Rate for Payer: WPS Commercial |
$1,017.57
|
|
|
SCREW NON-LOCK 2.4 X 12MM 656112
|
Facility
|
IP
|
$1,321.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685850
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$673.18 |
| Max. Negotiated Rate |
$1,263.93 |
| Rate for Payer: Aetna Commercial |
$1,236.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,181.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$728.14
|
| Rate for Payer: Cash Price |
$396.30
|
| Rate for Payer: Cigna Commercial |
$1,263.93
|
| Rate for Payer: Health EOS Commercial |
$1,222.72
|
| Rate for Payer: HFN Commercial |
$1,263.93
|
| Rate for Payer: Multiplan Commercial |
$1,099.07
|
| Rate for Payer: Preferred Network Access Commercial |
$1,263.93
|
| Rate for Payer: Quartz Beloit One Network |
$673.18
|
| Rate for Payer: Quartz Commercial |
$824.30
|
| Rate for Payer: WEA Trust Commercial |
$755.61
|
| Rate for Payer: WPS Commercial |
$1,017.57
|
|
|
SCREW NON-LOCK 2.4 X 12MM 656112
|
Facility
|
OP
|
$1,321.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685850
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$384.68 |
| Max. Negotiated Rate |
$1,263.93 |
| Rate for Payer: Aetna Commercial |
$1,236.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,181.50
|
| Rate for Payer: Aetna Managed Medicare |
$384.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$893.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$686.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$659.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$728.14
|
| Rate for Payer: Cash Price |
$396.30
|
| Rate for Payer: Cigna Commercial |
$1,263.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$768.82
|
| Rate for Payer: Health EOS Commercial |
$1,222.72
|
| Rate for Payer: HFN Commercial |
$1,263.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,030.38
|
| Rate for Payer: Multiplan Commercial |
$1,099.07
|
| Rate for Payer: NAPHCARE Commercial |
$824.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,263.93
|
| Rate for Payer: Quartz Beloit One Network |
$673.18
|
| Rate for Payer: Quartz Commercial |
$893.00
|
| Rate for Payer: Quartz Medicare Advantage |
$824.30
|
| Rate for Payer: The Alliance Commercial |
$686.92
|
| Rate for Payer: WEA Trust Commercial |
$755.61
|
| Rate for Payer: WPS Commercial |
$1,017.57
|
|
|
SCREW NON-LOCK 2.4 X 12MM TI 5201024012
|
Facility
|
IP
|
$4,116.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6149643
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,097.51 |
| Max. Negotiated Rate |
$3,938.19 |
| Rate for Payer: Aetna Commercial |
$3,852.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,681.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,268.74
|
| Rate for Payer: Cash Price |
$1,234.80
|
| Rate for Payer: Cigna Commercial |
$3,938.19
|
| Rate for Payer: Health EOS Commercial |
$3,809.77
|
| Rate for Payer: HFN Commercial |
$3,938.19
|
| Rate for Payer: Multiplan Commercial |
$3,424.51
|
| Rate for Payer: Preferred Network Access Commercial |
$3,938.19
|
| Rate for Payer: Quartz Beloit One Network |
$2,097.51
|
| Rate for Payer: Quartz Commercial |
$2,568.38
|
| Rate for Payer: WEA Trust Commercial |
$2,354.35
|
| Rate for Payer: WPS Commercial |
$3,170.55
|
|
|
SCREW NON-LOCK 2.4 X 12MM TI 5201024012
|
Facility
|
OP
|
$4,116.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6149643
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,198.58 |
| Max. Negotiated Rate |
$3,938.19 |
| Rate for Payer: Aetna Commercial |
$3,852.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,681.35
|
| Rate for Payer: Aetna Managed Medicare |
$1,198.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,782.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,140.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,054.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,268.74
|
| Rate for Payer: Cash Price |
$1,234.80
|
| Rate for Payer: Cigna Commercial |
$3,938.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,395.51
|
| Rate for Payer: Health EOS Commercial |
$3,809.77
|
| Rate for Payer: HFN Commercial |
$3,938.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,210.48
|
| Rate for Payer: Multiplan Commercial |
$3,424.51
|
| Rate for Payer: NAPHCARE Commercial |
$2,568.38
|
| Rate for Payer: Preferred Network Access Commercial |
$3,938.19
|
| Rate for Payer: Quartz Beloit One Network |
$2,097.51
|
| Rate for Payer: Quartz Commercial |
$2,782.42
|
| Rate for Payer: Quartz Medicare Advantage |
$2,568.38
|
| Rate for Payer: The Alliance Commercial |
$2,140.32
|
| Rate for Payer: WEA Trust Commercial |
$2,354.35
|
| Rate for Payer: WPS Commercial |
$3,170.55
|
|
|
SCREW NON-LOCK 2.4 X 12MM TI 5201124012
|
Facility
|
IP
|
$2,179.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6149644
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,110.42 |
| Max. Negotiated Rate |
$2,084.87 |
| Rate for Payer: Aetna Commercial |
$2,039.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,948.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,201.06
|
| Rate for Payer: Cash Price |
$653.70
|
| Rate for Payer: Cigna Commercial |
$2,084.87
|
| Rate for Payer: Health EOS Commercial |
$2,016.88
|
| Rate for Payer: HFN Commercial |
$2,084.87
|
| Rate for Payer: Multiplan Commercial |
$1,812.93
|
| Rate for Payer: Preferred Network Access Commercial |
$2,084.87
|
| Rate for Payer: Quartz Beloit One Network |
$1,110.42
|
| Rate for Payer: Quartz Commercial |
$1,359.70
|
| Rate for Payer: WEA Trust Commercial |
$1,246.39
|
| Rate for Payer: WPS Commercial |
$1,678.48
|
|
|
SCREW NON-LOCK 2.4 X 12MM TI 5201124012
|
Facility
|
OP
|
$2,179.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6149644
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$634.52 |
| Max. Negotiated Rate |
$2,084.87 |
| Rate for Payer: Aetna Commercial |
$2,039.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,948.90
|
| Rate for Payer: Aetna Managed Medicare |
$634.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,473.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,133.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,087.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,201.06
|
| Rate for Payer: Cash Price |
$653.70
|
| Rate for Payer: Cigna Commercial |
$2,084.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,268.18
|
| Rate for Payer: Health EOS Commercial |
$2,016.88
|
| Rate for Payer: HFN Commercial |
$2,084.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,699.62
|
| Rate for Payer: Multiplan Commercial |
$1,812.93
|
| Rate for Payer: NAPHCARE Commercial |
$1,359.70
|
| Rate for Payer: Preferred Network Access Commercial |
$2,084.87
|
| Rate for Payer: Quartz Beloit One Network |
$1,110.42
|
| Rate for Payer: Quartz Commercial |
$1,473.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,359.70
|
| Rate for Payer: The Alliance Commercial |
$1,133.08
|
| Rate for Payer: WEA Trust Commercial |
$1,246.39
|
| Rate for Payer: WPS Commercial |
$1,678.48
|
|
|
SCREW NON-LOCK 2.4 X 14MM 656114
|
Facility
|
OP
|
$1,321.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5458928
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$384.68 |
| Max. Negotiated Rate |
$1,263.93 |
| Rate for Payer: Aetna Commercial |
$1,236.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,181.50
|
| Rate for Payer: Aetna Managed Medicare |
$384.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$893.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$686.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$659.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$728.14
|
| Rate for Payer: Cash Price |
$396.30
|
| Rate for Payer: Cigna Commercial |
$1,263.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$768.82
|
| Rate for Payer: Health EOS Commercial |
$1,222.72
|
| Rate for Payer: HFN Commercial |
$1,263.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,030.38
|
| Rate for Payer: Multiplan Commercial |
$1,099.07
|
| Rate for Payer: NAPHCARE Commercial |
$824.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,263.93
|
| Rate for Payer: Quartz Beloit One Network |
$673.18
|
| Rate for Payer: Quartz Commercial |
$893.00
|
| Rate for Payer: Quartz Medicare Advantage |
$824.30
|
| Rate for Payer: The Alliance Commercial |
$686.92
|
| Rate for Payer: WEA Trust Commercial |
$755.61
|
| Rate for Payer: WPS Commercial |
$1,017.57
|
|
|
SCREW NON-LOCK 2.4 X 14MM 656114
|
Facility
|
IP
|
$1,321.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5458928
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$673.18 |
| Max. Negotiated Rate |
$1,263.93 |
| Rate for Payer: Aetna Commercial |
$1,236.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,181.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$728.14
|
| Rate for Payer: Cash Price |
$396.30
|
| Rate for Payer: Cigna Commercial |
$1,263.93
|
| Rate for Payer: Health EOS Commercial |
$1,222.72
|
| Rate for Payer: HFN Commercial |
$1,263.93
|
| Rate for Payer: Multiplan Commercial |
$1,099.07
|
| Rate for Payer: Preferred Network Access Commercial |
$1,263.93
|
| Rate for Payer: Quartz Beloit One Network |
$673.18
|
| Rate for Payer: Quartz Commercial |
$824.30
|
| Rate for Payer: WEA Trust Commercial |
$755.61
|
| Rate for Payer: WPS Commercial |
$1,017.57
|
|
|
SCREW NON-LOCK 2.4 X 14MM TI 5201124014
|
Facility
|
IP
|
$2,179.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6149645
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,110.42 |
| Max. Negotiated Rate |
$2,084.87 |
| Rate for Payer: Aetna Commercial |
$2,039.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,948.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,201.06
|
| Rate for Payer: Cash Price |
$653.70
|
| Rate for Payer: Cigna Commercial |
$2,084.87
|
| Rate for Payer: Health EOS Commercial |
$2,016.88
|
| Rate for Payer: HFN Commercial |
$2,084.87
|
| Rate for Payer: Multiplan Commercial |
$1,812.93
|
| Rate for Payer: Preferred Network Access Commercial |
$2,084.87
|
| Rate for Payer: Quartz Beloit One Network |
$1,110.42
|
| Rate for Payer: Quartz Commercial |
$1,359.70
|
| Rate for Payer: WEA Trust Commercial |
$1,246.39
|
| Rate for Payer: WPS Commercial |
$1,678.48
|
|
|
SCREW NON-LOCK 2.4 X 14MM TI 5201124014
|
Facility
|
OP
|
$2,179.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6149645
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$634.52 |
| Max. Negotiated Rate |
$2,084.87 |
| Rate for Payer: Aetna Commercial |
$2,039.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,948.90
|
| Rate for Payer: Aetna Managed Medicare |
$634.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,473.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,133.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,087.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,201.06
|
| Rate for Payer: Cash Price |
$653.70
|
| Rate for Payer: Cigna Commercial |
$2,084.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,268.18
|
| Rate for Payer: Health EOS Commercial |
$2,016.88
|
| Rate for Payer: HFN Commercial |
$2,084.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,699.62
|
| Rate for Payer: Multiplan Commercial |
$1,812.93
|
| Rate for Payer: NAPHCARE Commercial |
$1,359.70
|
| Rate for Payer: Preferred Network Access Commercial |
$2,084.87
|
| Rate for Payer: Quartz Beloit One Network |
$1,110.42
|
| Rate for Payer: Quartz Commercial |
$1,473.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,359.70
|
| Rate for Payer: The Alliance Commercial |
$1,133.08
|
| Rate for Payer: WEA Trust Commercial |
$1,246.39
|
| Rate for Payer: WPS Commercial |
$1,678.48
|
|
|
SCREW NON-LOCK 2.4 X 16MM 656116
|
Facility
|
OP
|
$1,321.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5611548
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$384.68 |
| Max. Negotiated Rate |
$1,263.93 |
| Rate for Payer: Aetna Commercial |
$1,236.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,181.50
|
| Rate for Payer: Aetna Managed Medicare |
$384.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$893.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$686.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$659.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$728.14
|
| Rate for Payer: Cash Price |
$396.30
|
| Rate for Payer: Cigna Commercial |
$1,263.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$768.82
|
| Rate for Payer: Health EOS Commercial |
$1,222.72
|
| Rate for Payer: HFN Commercial |
$1,263.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,030.38
|
| Rate for Payer: Multiplan Commercial |
$1,099.07
|
| Rate for Payer: NAPHCARE Commercial |
$824.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,263.93
|
| Rate for Payer: Quartz Beloit One Network |
$673.18
|
| Rate for Payer: Quartz Commercial |
$893.00
|
| Rate for Payer: Quartz Medicare Advantage |
$824.30
|
| Rate for Payer: The Alliance Commercial |
$686.92
|
| Rate for Payer: WEA Trust Commercial |
$755.61
|
| Rate for Payer: WPS Commercial |
$1,017.57
|
|
|
SCREW NON-LOCK 2.4 X 16MM 656116
|
Facility
|
IP
|
$1,321.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5611548
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$673.18 |
| Max. Negotiated Rate |
$1,263.93 |
| Rate for Payer: Aetna Commercial |
$1,236.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,181.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$728.14
|
| Rate for Payer: Cash Price |
$396.30
|
| Rate for Payer: Cigna Commercial |
$1,263.93
|
| Rate for Payer: Health EOS Commercial |
$1,222.72
|
| Rate for Payer: HFN Commercial |
$1,263.93
|
| Rate for Payer: Multiplan Commercial |
$1,099.07
|
| Rate for Payer: Preferred Network Access Commercial |
$1,263.93
|
| Rate for Payer: Quartz Beloit One Network |
$673.18
|
| Rate for Payer: Quartz Commercial |
$824.30
|
| Rate for Payer: WEA Trust Commercial |
$755.61
|
| Rate for Payer: WPS Commercial |
$1,017.57
|
|
|
SCREW NON-LOCK 2.4 X 22MM 656122
|
Facility
|
IP
|
$1,321.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5809965
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$673.18 |
| Max. Negotiated Rate |
$1,263.93 |
| Rate for Payer: Aetna Commercial |
$1,236.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,181.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$728.14
|
| Rate for Payer: Cash Price |
$396.30
|
| Rate for Payer: Cigna Commercial |
$1,263.93
|
| Rate for Payer: Health EOS Commercial |
$1,222.72
|
| Rate for Payer: HFN Commercial |
$1,263.93
|
| Rate for Payer: Multiplan Commercial |
$1,099.07
|
| Rate for Payer: Preferred Network Access Commercial |
$1,263.93
|
| Rate for Payer: Quartz Beloit One Network |
$673.18
|
| Rate for Payer: Quartz Commercial |
$824.30
|
| Rate for Payer: WEA Trust Commercial |
$755.61
|
| Rate for Payer: WPS Commercial |
$1,017.57
|
|
|
SCREW NON-LOCK 2.4 X 22MM 656122
|
Facility
|
OP
|
$1,321.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5809965
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$384.68 |
| Max. Negotiated Rate |
$1,263.93 |
| Rate for Payer: Aetna Commercial |
$1,236.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,181.50
|
| Rate for Payer: Aetna Managed Medicare |
$384.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$893.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$686.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$659.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$728.14
|
| Rate for Payer: Cash Price |
$396.30
|
| Rate for Payer: Cigna Commercial |
$1,263.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$768.82
|
| Rate for Payer: Health EOS Commercial |
$1,222.72
|
| Rate for Payer: HFN Commercial |
$1,263.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,030.38
|
| Rate for Payer: Multiplan Commercial |
$1,099.07
|
| Rate for Payer: NAPHCARE Commercial |
$824.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,263.93
|
| Rate for Payer: Quartz Beloit One Network |
$673.18
|
| Rate for Payer: Quartz Commercial |
$893.00
|
| Rate for Payer: Quartz Medicare Advantage |
$824.30
|
| Rate for Payer: The Alliance Commercial |
$686.92
|
| Rate for Payer: WEA Trust Commercial |
$755.61
|
| Rate for Payer: WPS Commercial |
$1,017.57
|
|
|
SCREW NON-LOCK 2.4 X 22MM TI 5201124022
|
Facility
|
OP
|
$2,179.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5957649
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$634.52 |
| Max. Negotiated Rate |
$2,084.87 |
| Rate for Payer: Aetna Commercial |
$2,039.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,948.90
|
| Rate for Payer: Aetna Managed Medicare |
$634.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,473.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,133.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,087.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,201.06
|
| Rate for Payer: Cash Price |
$653.70
|
| Rate for Payer: Cigna Commercial |
$2,084.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,268.18
|
| Rate for Payer: Health EOS Commercial |
$2,016.88
|
| Rate for Payer: HFN Commercial |
$2,084.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,699.62
|
| Rate for Payer: Multiplan Commercial |
$1,812.93
|
| Rate for Payer: NAPHCARE Commercial |
$1,359.70
|
| Rate for Payer: Preferred Network Access Commercial |
$2,084.87
|
| Rate for Payer: Quartz Beloit One Network |
$1,110.42
|
| Rate for Payer: Quartz Commercial |
$1,473.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,359.70
|
| Rate for Payer: The Alliance Commercial |
$1,133.08
|
| Rate for Payer: WEA Trust Commercial |
$1,246.39
|
| Rate for Payer: WPS Commercial |
$1,678.48
|
|
|
SCREW NON-LOCK 2.4 X 22MM TI 5201124022
|
Facility
|
IP
|
$2,179.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5957649
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,110.42 |
| Max. Negotiated Rate |
$2,084.87 |
| Rate for Payer: Aetna Commercial |
$2,039.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,948.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,201.06
|
| Rate for Payer: Cash Price |
$653.70
|
| Rate for Payer: Cigna Commercial |
$2,084.87
|
| Rate for Payer: Health EOS Commercial |
$2,016.88
|
| Rate for Payer: HFN Commercial |
$2,084.87
|
| Rate for Payer: Multiplan Commercial |
$1,812.93
|
| Rate for Payer: Preferred Network Access Commercial |
$2,084.87
|
| Rate for Payer: Quartz Beloit One Network |
$1,110.42
|
| Rate for Payer: Quartz Commercial |
$1,359.70
|
| Rate for Payer: WEA Trust Commercial |
$1,246.39
|
| Rate for Payer: WPS Commercial |
$1,678.48
|
|
|
SCREW NON-LOCK 2.7MM X 10MM 657110
|
Facility
|
IP
|
$1,322.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5458929
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$673.69 |
| Max. Negotiated Rate |
$1,264.89 |
| Rate for Payer: Aetna Commercial |
$1,237.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,182.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$728.69
|
| Rate for Payer: Cash Price |
$396.60
|
| Rate for Payer: Cigna Commercial |
$1,264.89
|
| Rate for Payer: Health EOS Commercial |
$1,223.64
|
| Rate for Payer: HFN Commercial |
$1,264.89
|
| Rate for Payer: Multiplan Commercial |
$1,099.90
|
| Rate for Payer: Preferred Network Access Commercial |
$1,264.89
|
| Rate for Payer: Quartz Beloit One Network |
$673.69
|
| Rate for Payer: Quartz Commercial |
$824.93
|
| Rate for Payer: WEA Trust Commercial |
$756.18
|
| Rate for Payer: WPS Commercial |
$1,018.34
|
|
|
SCREW NON-LOCK 2.7MM X 10MM 657110
|
Facility
|
OP
|
$1,322.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5458929
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$384.97 |
| Max. Negotiated Rate |
$1,264.89 |
| Rate for Payer: Aetna Commercial |
$1,237.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,182.40
|
| Rate for Payer: Aetna Managed Medicare |
$384.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$893.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$687.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$659.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$728.69
|
| Rate for Payer: Cash Price |
$396.60
|
| Rate for Payer: Cigna Commercial |
$1,264.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$769.40
|
| Rate for Payer: Health EOS Commercial |
$1,223.64
|
| Rate for Payer: HFN Commercial |
$1,264.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,031.16
|
| Rate for Payer: Multiplan Commercial |
$1,099.90
|
| Rate for Payer: NAPHCARE Commercial |
$824.93
|
| Rate for Payer: Preferred Network Access Commercial |
$1,264.89
|
| Rate for Payer: Quartz Beloit One Network |
$673.69
|
| Rate for Payer: Quartz Commercial |
$893.67
|
| Rate for Payer: Quartz Medicare Advantage |
$824.93
|
| Rate for Payer: The Alliance Commercial |
$687.44
|
| Rate for Payer: WEA Trust Commercial |
$756.18
|
| Rate for Payer: WPS Commercial |
$1,018.34
|
|
|
SCREW NON-LOCK 2.7MM X 12MM 657112
|
Facility
|
IP
|
$1,375.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415588
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$700.70 |
| Max. Negotiated Rate |
$1,315.60 |
| Rate for Payer: Aetna Commercial |
$1,287.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,229.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$757.90
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$1,315.60
|
| Rate for Payer: Health EOS Commercial |
$1,272.70
|
| Rate for Payer: HFN Commercial |
$1,315.60
|
| Rate for Payer: Multiplan Commercial |
$1,144.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,315.60
|
| Rate for Payer: Quartz Beloit One Network |
$700.70
|
| Rate for Payer: Quartz Commercial |
$858.00
|
| Rate for Payer: WEA Trust Commercial |
$786.50
|
| Rate for Payer: WPS Commercial |
$1,059.16
|
|
|
SCREW NON-LOCK 2.7MM X 12MM 657112
|
Facility
|
OP
|
$1,375.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415588
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$400.40 |
| Max. Negotiated Rate |
$1,315.60 |
| Rate for Payer: Aetna Commercial |
$1,287.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,229.80
|
| Rate for Payer: Aetna Managed Medicare |
$400.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$929.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$715.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$686.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$757.90
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$1,315.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$800.25
|
| Rate for Payer: Health EOS Commercial |
$1,272.70
|
| Rate for Payer: HFN Commercial |
$1,315.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,072.50
|
| Rate for Payer: Multiplan Commercial |
$1,144.00
|
| Rate for Payer: NAPHCARE Commercial |
$858.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,315.60
|
| Rate for Payer: Quartz Beloit One Network |
$700.70
|
| Rate for Payer: Quartz Commercial |
$929.50
|
| Rate for Payer: Quartz Medicare Advantage |
$858.00
|
| Rate for Payer: The Alliance Commercial |
$715.00
|
| Rate for Payer: WEA Trust Commercial |
$786.50
|
| Rate for Payer: WPS Commercial |
$1,059.16
|
|
|
SCREW NON-LOCK 2.7MM X 14MM 657114
|
Facility
|
OP
|
$1,375.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415589
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$400.40 |
| Max. Negotiated Rate |
$1,315.60 |
| Rate for Payer: Aetna Commercial |
$1,287.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,229.80
|
| Rate for Payer: Aetna Managed Medicare |
$400.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$929.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$715.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$686.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$757.90
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$1,315.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$800.25
|
| Rate for Payer: Health EOS Commercial |
$1,272.70
|
| Rate for Payer: HFN Commercial |
$1,315.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,072.50
|
| Rate for Payer: Multiplan Commercial |
$1,144.00
|
| Rate for Payer: NAPHCARE Commercial |
$858.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,315.60
|
| Rate for Payer: Quartz Beloit One Network |
$700.70
|
| Rate for Payer: Quartz Commercial |
$929.50
|
| Rate for Payer: Quartz Medicare Advantage |
$858.00
|
| Rate for Payer: The Alliance Commercial |
$715.00
|
| Rate for Payer: WEA Trust Commercial |
$786.50
|
| Rate for Payer: WPS Commercial |
$1,059.16
|
|
|
SCREW NON-LOCK 2.7MM X 14MM 657114
|
Facility
|
IP
|
$1,375.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415589
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$700.70 |
| Max. Negotiated Rate |
$1,315.60 |
| Rate for Payer: Aetna Commercial |
$1,287.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,229.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$757.90
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$1,315.60
|
| Rate for Payer: Health EOS Commercial |
$1,272.70
|
| Rate for Payer: HFN Commercial |
$1,315.60
|
| Rate for Payer: Multiplan Commercial |
$1,144.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,315.60
|
| Rate for Payer: Quartz Beloit One Network |
$700.70
|
| Rate for Payer: Quartz Commercial |
$858.00
|
| Rate for Payer: WEA Trust Commercial |
$786.50
|
| Rate for Payer: WPS Commercial |
$1,059.16
|
|
|
SCREW NON-LOCK 2.7MM X 16MM 657116
|
Facility
|
OP
|
$1,374.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415590
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$400.11 |
| Max. Negotiated Rate |
$1,314.64 |
| Rate for Payer: Aetna Commercial |
$1,286.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,228.91
|
| Rate for Payer: Aetna Managed Medicare |
$400.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$928.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$714.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$685.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$757.35
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Cigna Commercial |
$1,314.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$799.67
|
| Rate for Payer: Health EOS Commercial |
$1,271.77
|
| Rate for Payer: HFN Commercial |
$1,314.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,071.72
|
| Rate for Payer: Multiplan Commercial |
$1,143.17
|
| Rate for Payer: NAPHCARE Commercial |
$857.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,314.64
|
| Rate for Payer: Quartz Beloit One Network |
$700.19
|
| Rate for Payer: Quartz Commercial |
$928.82
|
| Rate for Payer: Quartz Medicare Advantage |
$857.38
|
| Rate for Payer: The Alliance Commercial |
$714.48
|
| Rate for Payer: WEA Trust Commercial |
$785.93
|
| Rate for Payer: WPS Commercial |
$1,058.39
|
|
