|
SCREW NON-LOCK 3.5MM X 32MM 657432
|
Facility
|
IP
|
$1,373.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6172080
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$699.68 |
| Max. Negotiated Rate |
$1,313.69 |
| Rate for Payer: Aetna Commercial |
$1,285.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,228.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$756.80
|
| Rate for Payer: Cash Price |
$411.90
|
| Rate for Payer: Cigna Commercial |
$1,313.69
|
| Rate for Payer: Health EOS Commercial |
$1,270.85
|
| Rate for Payer: HFN Commercial |
$1,313.69
|
| Rate for Payer: Multiplan Commercial |
$1,142.34
|
| Rate for Payer: Preferred Network Access Commercial |
$1,313.69
|
| Rate for Payer: Quartz Beloit One Network |
$699.68
|
| Rate for Payer: Quartz Commercial |
$856.75
|
| Rate for Payer: WEA Trust Commercial |
$785.36
|
| Rate for Payer: WPS Commercial |
$1,057.62
|
|
|
SCREW NON-LOCK 3.5MM X 32MM 657432
|
Facility
|
OP
|
$1,373.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6172080
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$399.82 |
| Max. Negotiated Rate |
$1,313.69 |
| Rate for Payer: Aetna Commercial |
$1,285.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,228.01
|
| Rate for Payer: Aetna Managed Medicare |
$399.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$928.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$713.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$685.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$756.80
|
| Rate for Payer: Cash Price |
$411.90
|
| Rate for Payer: Cigna Commercial |
$1,313.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$799.09
|
| Rate for Payer: Health EOS Commercial |
$1,270.85
|
| Rate for Payer: HFN Commercial |
$1,313.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,070.94
|
| Rate for Payer: Multiplan Commercial |
$1,142.34
|
| Rate for Payer: NAPHCARE Commercial |
$856.75
|
| Rate for Payer: Preferred Network Access Commercial |
$1,313.69
|
| Rate for Payer: Quartz Beloit One Network |
$699.68
|
| Rate for Payer: Quartz Commercial |
$928.15
|
| Rate for Payer: Quartz Medicare Advantage |
$856.75
|
| Rate for Payer: The Alliance Commercial |
$713.96
|
| Rate for Payer: WEA Trust Commercial |
$785.36
|
| Rate for Payer: WPS Commercial |
$1,057.62
|
|
|
SCREW NON-LOCK 3.5MM X 34MM 657434
|
Facility
|
IP
|
$1,320.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6185029
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$672.67 |
| Max. Negotiated Rate |
$1,262.98 |
| Rate for Payer: Aetna Commercial |
$1,235.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,180.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$727.58
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cigna Commercial |
$1,262.98
|
| Rate for Payer: Health EOS Commercial |
$1,221.79
|
| Rate for Payer: HFN Commercial |
$1,262.98
|
| Rate for Payer: Multiplan Commercial |
$1,098.24
|
| Rate for Payer: Preferred Network Access Commercial |
$1,262.98
|
| Rate for Payer: Quartz Beloit One Network |
$672.67
|
| Rate for Payer: Quartz Commercial |
$823.68
|
| Rate for Payer: WEA Trust Commercial |
$755.04
|
| Rate for Payer: WPS Commercial |
$1,016.80
|
|
|
SCREW NON-LOCK 3.5MM X 34MM 657434
|
Facility
|
OP
|
$1,320.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6185029
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$384.38 |
| Max. Negotiated Rate |
$1,262.98 |
| Rate for Payer: Aetna Commercial |
$1,235.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,180.61
|
| Rate for Payer: Aetna Managed Medicare |
$384.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$892.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$686.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$658.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$727.58
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cigna Commercial |
$1,262.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$768.24
|
| Rate for Payer: Health EOS Commercial |
$1,221.79
|
| Rate for Payer: HFN Commercial |
$1,262.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,029.60
|
| Rate for Payer: Multiplan Commercial |
$1,098.24
|
| Rate for Payer: NAPHCARE Commercial |
$823.68
|
| Rate for Payer: Preferred Network Access Commercial |
$1,262.98
|
| Rate for Payer: Quartz Beloit One Network |
$672.67
|
| Rate for Payer: Quartz Commercial |
$892.32
|
| Rate for Payer: Quartz Medicare Advantage |
$823.68
|
| Rate for Payer: The Alliance Commercial |
$686.40
|
| Rate for Payer: WEA Trust Commercial |
$755.04
|
| Rate for Payer: WPS Commercial |
$1,016.80
|
|
|
SCREW NON-LOCK 3.5MM X 42MM 657442
|
Facility
|
OP
|
$1,373.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6171784
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$399.82 |
| Max. Negotiated Rate |
$1,313.69 |
| Rate for Payer: Aetna Commercial |
$1,285.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,228.01
|
| Rate for Payer: Aetna Managed Medicare |
$399.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$928.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$713.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$685.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$756.80
|
| Rate for Payer: Cash Price |
$411.90
|
| Rate for Payer: Cigna Commercial |
$1,313.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$799.09
|
| Rate for Payer: Health EOS Commercial |
$1,270.85
|
| Rate for Payer: HFN Commercial |
$1,313.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,070.94
|
| Rate for Payer: Multiplan Commercial |
$1,142.34
|
| Rate for Payer: NAPHCARE Commercial |
$856.75
|
| Rate for Payer: Preferred Network Access Commercial |
$1,313.69
|
| Rate for Payer: Quartz Beloit One Network |
$699.68
|
| Rate for Payer: Quartz Commercial |
$928.15
|
| Rate for Payer: Quartz Medicare Advantage |
$856.75
|
| Rate for Payer: The Alliance Commercial |
$713.96
|
| Rate for Payer: WEA Trust Commercial |
$785.36
|
| Rate for Payer: WPS Commercial |
$1,057.62
|
|
|
SCREW NON-LOCK 3.5MM X 42MM 657442
|
Facility
|
IP
|
$1,373.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6171784
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$699.68 |
| Max. Negotiated Rate |
$1,313.69 |
| Rate for Payer: Aetna Commercial |
$1,285.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,228.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$756.80
|
| Rate for Payer: Cash Price |
$411.90
|
| Rate for Payer: Cigna Commercial |
$1,313.69
|
| Rate for Payer: Health EOS Commercial |
$1,270.85
|
| Rate for Payer: HFN Commercial |
$1,313.69
|
| Rate for Payer: Multiplan Commercial |
$1,142.34
|
| Rate for Payer: Preferred Network Access Commercial |
$1,313.69
|
| Rate for Payer: Quartz Beloit One Network |
$699.68
|
| Rate for Payer: Quartz Commercial |
$856.75
|
| Rate for Payer: WEA Trust Commercial |
$785.36
|
| Rate for Payer: WPS Commercial |
$1,057.62
|
|
|
SCREW NON-LOCK 3.5MM X 55MM 657455
|
Facility
|
OP
|
$1,430.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599689
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$416.42 |
| Max. Negotiated Rate |
$1,368.22 |
| Rate for Payer: Aetna Commercial |
$1,338.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,278.99
|
| Rate for Payer: Aetna Managed Medicare |
$416.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$966.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$743.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$713.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$788.22
|
| Rate for Payer: Cash Price |
$429.00
|
| Rate for Payer: Cigna Commercial |
$1,368.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$832.26
|
| Rate for Payer: Health EOS Commercial |
$1,323.61
|
| Rate for Payer: HFN Commercial |
$1,368.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,115.40
|
| Rate for Payer: Multiplan Commercial |
$1,189.76
|
| Rate for Payer: NAPHCARE Commercial |
$892.32
|
| Rate for Payer: Preferred Network Access Commercial |
$1,368.22
|
| Rate for Payer: Quartz Beloit One Network |
$728.73
|
| Rate for Payer: Quartz Commercial |
$966.68
|
| Rate for Payer: Quartz Medicare Advantage |
$892.32
|
| Rate for Payer: The Alliance Commercial |
$743.60
|
| Rate for Payer: WEA Trust Commercial |
$817.96
|
| Rate for Payer: WPS Commercial |
$1,101.53
|
|
|
SCREW NON-LOCK 3.5MM X 55MM 657455
|
Facility
|
IP
|
$1,430.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599689
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$728.73 |
| Max. Negotiated Rate |
$1,368.22 |
| Rate for Payer: Aetna Commercial |
$1,338.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,278.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$788.22
|
| Rate for Payer: Cash Price |
$429.00
|
| Rate for Payer: Cigna Commercial |
$1,368.22
|
| Rate for Payer: Health EOS Commercial |
$1,323.61
|
| Rate for Payer: HFN Commercial |
$1,368.22
|
| Rate for Payer: Multiplan Commercial |
$1,189.76
|
| Rate for Payer: Preferred Network Access Commercial |
$1,368.22
|
| Rate for Payer: Quartz Beloit One Network |
$728.73
|
| Rate for Payer: Quartz Commercial |
$892.32
|
| Rate for Payer: WEA Trust Commercial |
$817.96
|
| Rate for Payer: WPS Commercial |
$1,101.53
|
|
|
SCREW NON-LOCK 3.5 X 16MM MFT-011-35-16
|
Facility
|
OP
|
$3,283.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4028658
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$956.01 |
| Max. Negotiated Rate |
$3,141.17 |
| Rate for Payer: Aetna Commercial |
$3,072.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,936.32
|
| Rate for Payer: Aetna Managed Medicare |
$956.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,219.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,707.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,638.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,809.59
|
| Rate for Payer: Cash Price |
$984.90
|
| Rate for Payer: Cigna Commercial |
$3,141.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,910.71
|
| Rate for Payer: Health EOS Commercial |
$3,038.74
|
| Rate for Payer: HFN Commercial |
$3,141.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,560.74
|
| Rate for Payer: Multiplan Commercial |
$2,731.46
|
| Rate for Payer: NAPHCARE Commercial |
$2,048.59
|
| Rate for Payer: Preferred Network Access Commercial |
$3,141.17
|
| Rate for Payer: Quartz Beloit One Network |
$1,673.02
|
| Rate for Payer: Quartz Commercial |
$2,219.31
|
| Rate for Payer: Quartz Medicare Advantage |
$2,048.59
|
| Rate for Payer: The Alliance Commercial |
$1,707.16
|
| Rate for Payer: WEA Trust Commercial |
$1,877.88
|
| Rate for Payer: WPS Commercial |
$2,528.89
|
|
|
SCREW NON-LOCK 3.5 X 16MM MFT-011-35-16
|
Facility
|
IP
|
$3,283.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4028658
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,673.02 |
| Max. Negotiated Rate |
$3,141.17 |
| Rate for Payer: Aetna Commercial |
$3,072.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,936.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,809.59
|
| Rate for Payer: Cash Price |
$984.90
|
| Rate for Payer: Cigna Commercial |
$3,141.17
|
| Rate for Payer: Health EOS Commercial |
$3,038.74
|
| Rate for Payer: HFN Commercial |
$3,141.17
|
| Rate for Payer: Multiplan Commercial |
$2,731.46
|
| Rate for Payer: Preferred Network Access Commercial |
$3,141.17
|
| Rate for Payer: Quartz Beloit One Network |
$1,673.02
|
| Rate for Payer: Quartz Commercial |
$2,048.59
|
| Rate for Payer: WEA Trust Commercial |
$1,877.88
|
| Rate for Payer: WPS Commercial |
$2,528.89
|
|
|
SCREW NON-LOCK 3.5 X 26MM MFT-011-35-26
|
Facility
|
IP
|
$3,283.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5787649
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,673.02 |
| Max. Negotiated Rate |
$3,141.17 |
| Rate for Payer: Aetna Commercial |
$3,072.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,936.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,809.59
|
| Rate for Payer: Cash Price |
$984.90
|
| Rate for Payer: Cigna Commercial |
$3,141.17
|
| Rate for Payer: Health EOS Commercial |
$3,038.74
|
| Rate for Payer: HFN Commercial |
$3,141.17
|
| Rate for Payer: Multiplan Commercial |
$2,731.46
|
| Rate for Payer: Preferred Network Access Commercial |
$3,141.17
|
| Rate for Payer: Quartz Beloit One Network |
$1,673.02
|
| Rate for Payer: Quartz Commercial |
$2,048.59
|
| Rate for Payer: WEA Trust Commercial |
$1,877.88
|
| Rate for Payer: WPS Commercial |
$2,528.89
|
|
|
SCREW NON-LOCK 3.5 X 26MM MFT-011-35-26
|
Facility
|
OP
|
$3,283.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5787649
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$956.01 |
| Max. Negotiated Rate |
$3,141.17 |
| Rate for Payer: Aetna Commercial |
$3,072.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,936.32
|
| Rate for Payer: Aetna Managed Medicare |
$956.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,219.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,707.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,638.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,809.59
|
| Rate for Payer: Cash Price |
$984.90
|
| Rate for Payer: Cigna Commercial |
$3,141.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,910.71
|
| Rate for Payer: Health EOS Commercial |
$3,038.74
|
| Rate for Payer: HFN Commercial |
$3,141.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,560.74
|
| Rate for Payer: Multiplan Commercial |
$2,731.46
|
| Rate for Payer: NAPHCARE Commercial |
$2,048.59
|
| Rate for Payer: Preferred Network Access Commercial |
$3,141.17
|
| Rate for Payer: Quartz Beloit One Network |
$1,673.02
|
| Rate for Payer: Quartz Commercial |
$2,219.31
|
| Rate for Payer: Quartz Medicare Advantage |
$2,048.59
|
| Rate for Payer: The Alliance Commercial |
$1,707.16
|
| Rate for Payer: WEA Trust Commercial |
$1,877.88
|
| Rate for Payer: WPS Commercial |
$2,528.89
|
|
|
SCREW NON-LOCK 3.5 X 30MM MFT-011-35-30
|
Facility
|
OP
|
$3,283.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5729847
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$956.01 |
| Max. Negotiated Rate |
$3,141.17 |
| Rate for Payer: Aetna Commercial |
$3,072.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,936.32
|
| Rate for Payer: Aetna Managed Medicare |
$956.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,219.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,707.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,638.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,809.59
|
| Rate for Payer: Cash Price |
$984.90
|
| Rate for Payer: Cigna Commercial |
$3,141.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,910.71
|
| Rate for Payer: Health EOS Commercial |
$3,038.74
|
| Rate for Payer: HFN Commercial |
$3,141.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,560.74
|
| Rate for Payer: Multiplan Commercial |
$2,731.46
|
| Rate for Payer: NAPHCARE Commercial |
$2,048.59
|
| Rate for Payer: Preferred Network Access Commercial |
$3,141.17
|
| Rate for Payer: Quartz Beloit One Network |
$1,673.02
|
| Rate for Payer: Quartz Commercial |
$2,219.31
|
| Rate for Payer: Quartz Medicare Advantage |
$2,048.59
|
| Rate for Payer: The Alliance Commercial |
$1,707.16
|
| Rate for Payer: WEA Trust Commercial |
$1,877.88
|
| Rate for Payer: WPS Commercial |
$2,528.89
|
|
|
SCREW NON-LOCK 3.5 X 30MM MFT-011-35-30
|
Facility
|
IP
|
$3,283.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5729847
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,673.02 |
| Max. Negotiated Rate |
$3,141.17 |
| Rate for Payer: Aetna Commercial |
$3,072.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,936.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,809.59
|
| Rate for Payer: Cash Price |
$984.90
|
| Rate for Payer: Cigna Commercial |
$3,141.17
|
| Rate for Payer: Health EOS Commercial |
$3,038.74
|
| Rate for Payer: HFN Commercial |
$3,141.17
|
| Rate for Payer: Multiplan Commercial |
$2,731.46
|
| Rate for Payer: Preferred Network Access Commercial |
$3,141.17
|
| Rate for Payer: Quartz Beloit One Network |
$1,673.02
|
| Rate for Payer: Quartz Commercial |
$2,048.59
|
| Rate for Payer: WEA Trust Commercial |
$1,877.88
|
| Rate for Payer: WPS Commercial |
$2,528.89
|
|
|
SCREW NON-LOCK 3.5 X 32.5MM MFT-011-35-325
|
Facility
|
OP
|
$3,283.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5729851
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$956.01 |
| Max. Negotiated Rate |
$3,141.17 |
| Rate for Payer: Aetna Commercial |
$3,072.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,936.32
|
| Rate for Payer: Aetna Managed Medicare |
$956.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,219.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,707.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,638.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,809.59
|
| Rate for Payer: Cash Price |
$984.90
|
| Rate for Payer: Cigna Commercial |
$3,141.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,910.71
|
| Rate for Payer: Health EOS Commercial |
$3,038.74
|
| Rate for Payer: HFN Commercial |
$3,141.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,560.74
|
| Rate for Payer: Multiplan Commercial |
$2,731.46
|
| Rate for Payer: NAPHCARE Commercial |
$2,048.59
|
| Rate for Payer: Preferred Network Access Commercial |
$3,141.17
|
| Rate for Payer: Quartz Beloit One Network |
$1,673.02
|
| Rate for Payer: Quartz Commercial |
$2,219.31
|
| Rate for Payer: Quartz Medicare Advantage |
$2,048.59
|
| Rate for Payer: The Alliance Commercial |
$1,707.16
|
| Rate for Payer: WEA Trust Commercial |
$1,877.88
|
| Rate for Payer: WPS Commercial |
$2,528.89
|
|
|
SCREW NON-LOCK 3.5 X 32.5MM MFT-011-35-325
|
Facility
|
IP
|
$3,283.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5729851
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,673.02 |
| Max. Negotiated Rate |
$3,141.17 |
| Rate for Payer: Aetna Commercial |
$3,072.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,936.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,809.59
|
| Rate for Payer: Cash Price |
$984.90
|
| Rate for Payer: Cigna Commercial |
$3,141.17
|
| Rate for Payer: Health EOS Commercial |
$3,038.74
|
| Rate for Payer: HFN Commercial |
$3,141.17
|
| Rate for Payer: Multiplan Commercial |
$2,731.46
|
| Rate for Payer: Preferred Network Access Commercial |
$3,141.17
|
| Rate for Payer: Quartz Beloit One Network |
$1,673.02
|
| Rate for Payer: Quartz Commercial |
$2,048.59
|
| Rate for Payer: WEA Trust Commercial |
$1,877.88
|
| Rate for Payer: WPS Commercial |
$2,528.89
|
|
|
SCREW NON-LOCK 4.0 X 30 TORNIER ZPFTS30
|
Facility
|
IP
|
$1,281.00
|
|
| Hospital Charge Code |
2967361
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$652.80 |
| Max. Negotiated Rate |
$1,225.66 |
| Rate for Payer: Aetna Commercial |
$1,199.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,145.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$706.09
|
| Rate for Payer: Cash Price |
$384.30
|
| Rate for Payer: Cigna Commercial |
$1,225.66
|
| Rate for Payer: Health EOS Commercial |
$1,185.69
|
| Rate for Payer: HFN Commercial |
$1,225.66
|
| Rate for Payer: Multiplan Commercial |
$1,065.79
|
| Rate for Payer: Preferred Network Access Commercial |
$1,225.66
|
| Rate for Payer: Quartz Beloit One Network |
$652.80
|
| Rate for Payer: Quartz Commercial |
$799.34
|
| Rate for Payer: WEA Trust Commercial |
$732.73
|
| Rate for Payer: WPS Commercial |
$986.75
|
|
|
SCREW NON-LOCK 4.0 X 30 TORNIER ZPFTS30
|
Facility
|
OP
|
$1,281.00
|
|
| Hospital Charge Code |
2967361
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$373.03 |
| Max. Negotiated Rate |
$1,225.66 |
| Rate for Payer: Aetna Commercial |
$1,199.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,145.73
|
| Rate for Payer: Aetna Managed Medicare |
$373.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$865.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$666.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$639.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$706.09
|
| Rate for Payer: Cash Price |
$384.30
|
| Rate for Payer: Cigna Commercial |
$1,225.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$745.54
|
| Rate for Payer: Health EOS Commercial |
$1,185.69
|
| Rate for Payer: HFN Commercial |
$1,225.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$999.18
|
| Rate for Payer: Multiplan Commercial |
$1,065.79
|
| Rate for Payer: NAPHCARE Commercial |
$799.34
|
| Rate for Payer: Preferred Network Access Commercial |
$1,225.66
|
| Rate for Payer: Quartz Beloit One Network |
$652.80
|
| Rate for Payer: Quartz Commercial |
$865.96
|
| Rate for Payer: Quartz Medicare Advantage |
$799.34
|
| Rate for Payer: The Alliance Commercial |
$666.12
|
| Rate for Payer: WEA Trust Commercial |
$732.73
|
| Rate for Payer: WPS Commercial |
$986.75
|
|
|
SCREW NON-LOCK 4.0 X 32 TORNIER ZPFTS32
|
Facility
|
OP
|
$1,281.00
|
|
| Hospital Charge Code |
2967362
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$373.03 |
| Max. Negotiated Rate |
$1,225.66 |
| Rate for Payer: Aetna Commercial |
$1,199.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,145.73
|
| Rate for Payer: Aetna Managed Medicare |
$373.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$865.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$666.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$639.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$706.09
|
| Rate for Payer: Cash Price |
$384.30
|
| Rate for Payer: Cigna Commercial |
$1,225.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$745.54
|
| Rate for Payer: Health EOS Commercial |
$1,185.69
|
| Rate for Payer: HFN Commercial |
$1,225.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$999.18
|
| Rate for Payer: Multiplan Commercial |
$1,065.79
|
| Rate for Payer: NAPHCARE Commercial |
$799.34
|
| Rate for Payer: Preferred Network Access Commercial |
$1,225.66
|
| Rate for Payer: Quartz Beloit One Network |
$652.80
|
| Rate for Payer: Quartz Commercial |
$865.96
|
| Rate for Payer: Quartz Medicare Advantage |
$799.34
|
| Rate for Payer: The Alliance Commercial |
$666.12
|
| Rate for Payer: WEA Trust Commercial |
$732.73
|
| Rate for Payer: WPS Commercial |
$986.75
|
|
|
SCREW NON-LOCK 4.0 X 32 TORNIER ZPFTS32
|
Facility
|
IP
|
$1,281.00
|
|
| Hospital Charge Code |
2967362
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$652.80 |
| Max. Negotiated Rate |
$1,225.66 |
| Rate for Payer: Aetna Commercial |
$1,199.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,145.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$706.09
|
| Rate for Payer: Cash Price |
$384.30
|
| Rate for Payer: Cigna Commercial |
$1,225.66
|
| Rate for Payer: Health EOS Commercial |
$1,185.69
|
| Rate for Payer: HFN Commercial |
$1,225.66
|
| Rate for Payer: Multiplan Commercial |
$1,065.79
|
| Rate for Payer: Preferred Network Access Commercial |
$1,225.66
|
| Rate for Payer: Quartz Beloit One Network |
$652.80
|
| Rate for Payer: Quartz Commercial |
$799.34
|
| Rate for Payer: WEA Trust Commercial |
$732.73
|
| Rate for Payer: WPS Commercial |
$986.75
|
|
|
SCREW NON-LOCK 4.0 X 34 TORNIER ZPFTS34
|
Facility
|
OP
|
$1,281.00
|
|
| Hospital Charge Code |
2967364
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$373.03 |
| Max. Negotiated Rate |
$1,225.66 |
| Rate for Payer: Aetna Commercial |
$1,199.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,145.73
|
| Rate for Payer: Aetna Managed Medicare |
$373.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$865.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$666.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$639.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$706.09
|
| Rate for Payer: Cash Price |
$384.30
|
| Rate for Payer: Cigna Commercial |
$1,225.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$745.54
|
| Rate for Payer: Health EOS Commercial |
$1,185.69
|
| Rate for Payer: HFN Commercial |
$1,225.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$999.18
|
| Rate for Payer: Multiplan Commercial |
$1,065.79
|
| Rate for Payer: NAPHCARE Commercial |
$799.34
|
| Rate for Payer: Preferred Network Access Commercial |
$1,225.66
|
| Rate for Payer: Quartz Beloit One Network |
$652.80
|
| Rate for Payer: Quartz Commercial |
$865.96
|
| Rate for Payer: Quartz Medicare Advantage |
$799.34
|
| Rate for Payer: The Alliance Commercial |
$666.12
|
| Rate for Payer: WEA Trust Commercial |
$732.73
|
| Rate for Payer: WPS Commercial |
$986.75
|
|
|
SCREW NON-LOCK 4.0 X 34 TORNIER ZPFTS34
|
Facility
|
IP
|
$1,281.00
|
|
| Hospital Charge Code |
2967364
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$652.80 |
| Max. Negotiated Rate |
$1,225.66 |
| Rate for Payer: Aetna Commercial |
$1,199.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,145.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$706.09
|
| Rate for Payer: Cash Price |
$384.30
|
| Rate for Payer: Cigna Commercial |
$1,225.66
|
| Rate for Payer: Health EOS Commercial |
$1,185.69
|
| Rate for Payer: HFN Commercial |
$1,225.66
|
| Rate for Payer: Multiplan Commercial |
$1,065.79
|
| Rate for Payer: Preferred Network Access Commercial |
$1,225.66
|
| Rate for Payer: Quartz Beloit One Network |
$652.80
|
| Rate for Payer: Quartz Commercial |
$799.34
|
| Rate for Payer: WEA Trust Commercial |
$732.73
|
| Rate for Payer: WPS Commercial |
$986.75
|
|
|
SCREW NONLOCK 4.5 X 22MM LP TI AR-8545-22
|
Facility
|
OP
|
$1,152.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5803652
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$335.46 |
| Max. Negotiated Rate |
$1,102.23 |
| Rate for Payer: Aetna Commercial |
$1,078.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,030.35
|
| Rate for Payer: Aetna Managed Medicare |
$335.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$778.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$599.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$575.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$634.98
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Cigna Commercial |
$1,102.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$670.46
|
| Rate for Payer: Health EOS Commercial |
$1,066.29
|
| Rate for Payer: HFN Commercial |
$1,102.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$898.56
|
| Rate for Payer: Multiplan Commercial |
$958.46
|
| Rate for Payer: NAPHCARE Commercial |
$718.85
|
| Rate for Payer: Preferred Network Access Commercial |
$1,102.23
|
| Rate for Payer: Quartz Beloit One Network |
$587.06
|
| Rate for Payer: Quartz Commercial |
$778.75
|
| Rate for Payer: Quartz Medicare Advantage |
$718.85
|
| Rate for Payer: The Alliance Commercial |
$599.04
|
| Rate for Payer: WEA Trust Commercial |
$658.94
|
| Rate for Payer: WPS Commercial |
$887.39
|
|
|
SCREW NONLOCK 4.5 X 22MM LP TI AR-8545-22
|
Facility
|
IP
|
$1,152.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5803652
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$587.06 |
| Max. Negotiated Rate |
$1,102.23 |
| Rate for Payer: Aetna Commercial |
$1,078.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,030.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$634.98
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Cigna Commercial |
$1,102.23
|
| Rate for Payer: Health EOS Commercial |
$1,066.29
|
| Rate for Payer: HFN Commercial |
$1,102.23
|
| Rate for Payer: Multiplan Commercial |
$958.46
|
| Rate for Payer: Preferred Network Access Commercial |
$1,102.23
|
| Rate for Payer: Quartz Beloit One Network |
$587.06
|
| Rate for Payer: Quartz Commercial |
$718.85
|
| Rate for Payer: WEA Trust Commercial |
$658.94
|
| Rate for Payer: WPS Commercial |
$887.39
|
|
|
SCREW NONLOCK 4.5 X 24MM LP TI AR-8545-24
|
Facility
|
IP
|
$1,152.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5803653
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$587.06 |
| Max. Negotiated Rate |
$1,102.23 |
| Rate for Payer: Aetna Commercial |
$1,078.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,030.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$634.98
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Cigna Commercial |
$1,102.23
|
| Rate for Payer: Health EOS Commercial |
$1,066.29
|
| Rate for Payer: HFN Commercial |
$1,102.23
|
| Rate for Payer: Multiplan Commercial |
$958.46
|
| Rate for Payer: Preferred Network Access Commercial |
$1,102.23
|
| Rate for Payer: Quartz Beloit One Network |
$587.06
|
| Rate for Payer: Quartz Commercial |
$718.85
|
| Rate for Payer: WEA Trust Commercial |
$658.94
|
| Rate for Payer: WPS Commercial |
$887.39
|
|
