|
SCREW MINI CANN 2.5 X 30 HEADLESS IH2530
|
Facility
|
IP
|
$2,570.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6173855
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,259.30 |
| Max. Negotiated Rate |
$2,364.40 |
| Rate for Payer: Aetna Commercial |
$2,313.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,210.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,362.10
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cigna Commercial |
$2,364.40
|
| Rate for Payer: Health EOS Commercial |
$2,287.30
|
| Rate for Payer: HFN Commercial |
$2,364.40
|
| Rate for Payer: Multiplan Commercial |
$2,056.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,542.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,364.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,259.30
|
| Rate for Payer: Quartz Commercial |
$1,542.00
|
| Rate for Payer: WEA Trust Commercial |
$1,413.50
|
| Rate for Payer: WPS Commercial |
$1,903.60
|
|
|
SCREW MINI CANN 3.0 X 14MM HEADLESS IH3014
|
Facility
|
OP
|
$2,471.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6232161
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$691.88 |
| Max. Negotiated Rate |
$9,884.00 |
| Rate for Payer: Aetna Commercial |
$2,223.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,125.06
|
| Rate for Payer: Aetna Managed Medicare |
$691.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,606.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,235.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,186.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,309.63
|
| Rate for Payer: Cash Price |
$741.30
|
| Rate for Payer: Cigna Commercial |
$2,273.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,382.77
|
| Rate for Payer: Health EOS Commercial |
$2,199.19
|
| Rate for Payer: HFN Commercial |
$2,273.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,853.25
|
| Rate for Payer: Multiplan Commercial |
$1,976.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,482.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,273.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,210.79
|
| Rate for Payer: Quartz Commercial |
$1,606.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,482.60
|
| Rate for Payer: The Alliance Commercial |
$9,884.00
|
| Rate for Payer: WEA Trust Commercial |
$1,359.05
|
| Rate for Payer: WPS Commercial |
$1,830.27
|
|
|
SCREW MINI CANN 3.0 X 14MM HEADLESS IH3014
|
Facility
|
IP
|
$2,471.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6232161
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,210.79 |
| Max. Negotiated Rate |
$2,273.32 |
| Rate for Payer: Aetna Commercial |
$2,223.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,125.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,309.63
|
| Rate for Payer: Cash Price |
$741.30
|
| Rate for Payer: Cigna Commercial |
$2,273.32
|
| Rate for Payer: Health EOS Commercial |
$2,199.19
|
| Rate for Payer: HFN Commercial |
$2,273.32
|
| Rate for Payer: Multiplan Commercial |
$1,976.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,482.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,273.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,210.79
|
| Rate for Payer: Quartz Commercial |
$1,482.60
|
| Rate for Payer: WEA Trust Commercial |
$1,359.05
|
| Rate for Payer: WPS Commercial |
$1,830.27
|
|
|
SCREW MINI CANN 3.0 X 16MM HEADLESS IH3016
|
Facility
|
IP
|
$2,471.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6232162
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,210.79 |
| Max. Negotiated Rate |
$2,273.32 |
| Rate for Payer: Aetna Commercial |
$2,223.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,125.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,309.63
|
| Rate for Payer: Cash Price |
$741.30
|
| Rate for Payer: Cigna Commercial |
$2,273.32
|
| Rate for Payer: Health EOS Commercial |
$2,199.19
|
| Rate for Payer: HFN Commercial |
$2,273.32
|
| Rate for Payer: Multiplan Commercial |
$1,976.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,482.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,273.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,210.79
|
| Rate for Payer: Quartz Commercial |
$1,482.60
|
| Rate for Payer: WEA Trust Commercial |
$1,359.05
|
| Rate for Payer: WPS Commercial |
$1,830.27
|
|
|
SCREW MINI CANN 3.0 X 16MM HEADLESS IH3016
|
Facility
|
OP
|
$2,471.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6232162
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$691.88 |
| Max. Negotiated Rate |
$9,884.00 |
| Rate for Payer: Aetna Commercial |
$2,223.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,125.06
|
| Rate for Payer: Aetna Managed Medicare |
$691.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,606.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,235.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,186.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,309.63
|
| Rate for Payer: Cash Price |
$741.30
|
| Rate for Payer: Cigna Commercial |
$2,273.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,382.77
|
| Rate for Payer: Health EOS Commercial |
$2,199.19
|
| Rate for Payer: HFN Commercial |
$2,273.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,853.25
|
| Rate for Payer: Multiplan Commercial |
$1,976.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,482.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,273.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,210.79
|
| Rate for Payer: Quartz Commercial |
$1,606.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,482.60
|
| Rate for Payer: The Alliance Commercial |
$9,884.00
|
| Rate for Payer: WEA Trust Commercial |
$1,359.05
|
| Rate for Payer: WPS Commercial |
$1,830.27
|
|
|
SCREW MINI CANN 3.0 X 20MM HEADLESS IH3020
|
Facility
|
OP
|
$2,927.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5831689
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$819.56 |
| Max. Negotiated Rate |
$11,708.00 |
| Rate for Payer: Aetna Commercial |
$2,634.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,517.22
|
| Rate for Payer: Aetna Managed Medicare |
$819.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,902.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,463.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,404.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,551.31
|
| Rate for Payer: Cash Price |
$878.10
|
| Rate for Payer: Cigna Commercial |
$2,692.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,637.95
|
| Rate for Payer: Health EOS Commercial |
$2,605.03
|
| Rate for Payer: HFN Commercial |
$2,692.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,195.25
|
| Rate for Payer: Multiplan Commercial |
$2,341.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,756.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,692.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,434.23
|
| Rate for Payer: Quartz Commercial |
$1,902.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,756.20
|
| Rate for Payer: The Alliance Commercial |
$11,708.00
|
| Rate for Payer: WEA Trust Commercial |
$1,609.85
|
| Rate for Payer: WPS Commercial |
$2,168.03
|
|
|
SCREW MINI CANN 3.0 X 20MM HEADLESS IH3020
|
Facility
|
IP
|
$2,927.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5831689
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,434.23 |
| Max. Negotiated Rate |
$2,692.84 |
| Rate for Payer: Aetna Commercial |
$2,634.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,517.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,551.31
|
| Rate for Payer: Cash Price |
$878.10
|
| Rate for Payer: Cigna Commercial |
$2,692.84
|
| Rate for Payer: Health EOS Commercial |
$2,605.03
|
| Rate for Payer: HFN Commercial |
$2,692.84
|
| Rate for Payer: Multiplan Commercial |
$2,341.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,756.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,692.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,434.23
|
| Rate for Payer: Quartz Commercial |
$1,756.20
|
| Rate for Payer: WEA Trust Commercial |
$1,609.85
|
| Rate for Payer: WPS Commercial |
$2,168.03
|
|
|
SCREW MINI CANN 3.0 X 22MM HEADLESS IH3022
|
Facility
|
IP
|
$2,814.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6049657
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,378.86 |
| Max. Negotiated Rate |
$2,588.88 |
| Rate for Payer: Aetna Commercial |
$2,532.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,420.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,491.42
|
| Rate for Payer: Cash Price |
$844.20
|
| Rate for Payer: Cigna Commercial |
$2,588.88
|
| Rate for Payer: Health EOS Commercial |
$2,504.46
|
| Rate for Payer: HFN Commercial |
$2,588.88
|
| Rate for Payer: Multiplan Commercial |
$2,251.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,688.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,588.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,378.86
|
| Rate for Payer: Quartz Commercial |
$1,688.40
|
| Rate for Payer: WEA Trust Commercial |
$1,547.70
|
| Rate for Payer: WPS Commercial |
$2,084.33
|
|
|
SCREW MINI CANN 3.0 X 22MM HEADLESS IH3022
|
Facility
|
OP
|
$2,814.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6049657
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$787.92 |
| Max. Negotiated Rate |
$11,256.00 |
| Rate for Payer: Aetna Commercial |
$2,532.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,420.04
|
| Rate for Payer: Aetna Managed Medicare |
$787.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,829.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,407.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,350.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,491.42
|
| Rate for Payer: Cash Price |
$844.20
|
| Rate for Payer: Cigna Commercial |
$2,588.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,574.71
|
| Rate for Payer: Health EOS Commercial |
$2,504.46
|
| Rate for Payer: HFN Commercial |
$2,588.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,110.50
|
| Rate for Payer: Multiplan Commercial |
$2,251.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,688.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,588.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,378.86
|
| Rate for Payer: Quartz Commercial |
$1,829.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,688.40
|
| Rate for Payer: The Alliance Commercial |
$11,256.00
|
| Rate for Payer: WEA Trust Commercial |
$1,547.70
|
| Rate for Payer: WPS Commercial |
$2,084.33
|
|
|
SCREW MINI CANN 3.0 X 24MM HEADLESS IH3024
|
Facility
|
OP
|
$2,927.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5659623
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$819.56 |
| Max. Negotiated Rate |
$11,708.00 |
| Rate for Payer: Aetna Commercial |
$2,634.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,517.22
|
| Rate for Payer: Aetna Managed Medicare |
$819.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,902.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,463.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,404.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,551.31
|
| Rate for Payer: Cash Price |
$878.10
|
| Rate for Payer: Cigna Commercial |
$2,692.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,637.95
|
| Rate for Payer: Health EOS Commercial |
$2,605.03
|
| Rate for Payer: HFN Commercial |
$2,692.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,195.25
|
| Rate for Payer: Multiplan Commercial |
$2,341.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,756.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,692.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,434.23
|
| Rate for Payer: Quartz Commercial |
$1,902.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,756.20
|
| Rate for Payer: The Alliance Commercial |
$11,708.00
|
| Rate for Payer: WEA Trust Commercial |
$1,609.85
|
| Rate for Payer: WPS Commercial |
$2,168.03
|
|
|
SCREW MINI CANN 3.0 X 24MM HEADLESS IH3024
|
Facility
|
IP
|
$2,927.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5659623
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,434.23 |
| Max. Negotiated Rate |
$2,692.84 |
| Rate for Payer: Aetna Commercial |
$2,634.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,517.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,551.31
|
| Rate for Payer: Cash Price |
$878.10
|
| Rate for Payer: Cigna Commercial |
$2,692.84
|
| Rate for Payer: Health EOS Commercial |
$2,605.03
|
| Rate for Payer: HFN Commercial |
$2,692.84
|
| Rate for Payer: Multiplan Commercial |
$2,341.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,756.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,692.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,434.23
|
| Rate for Payer: Quartz Commercial |
$1,756.20
|
| Rate for Payer: WEA Trust Commercial |
$1,609.85
|
| Rate for Payer: WPS Commercial |
$2,168.03
|
|
|
SCREW NEXFIX SNAP-OFF MODEL 2 NSO-2012
|
Facility
|
OP
|
$2,147.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6181254
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$601.16 |
| Max. Negotiated Rate |
$8,588.00 |
| Rate for Payer: Aetna Commercial |
$1,932.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,846.42
|
| Rate for Payer: Aetna Managed Medicare |
$601.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,395.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,073.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,030.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,137.91
|
| Rate for Payer: Cash Price |
$644.10
|
| Rate for Payer: Cigna Commercial |
$1,975.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,201.46
|
| Rate for Payer: Health EOS Commercial |
$1,910.83
|
| Rate for Payer: HFN Commercial |
$1,975.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,610.25
|
| Rate for Payer: Multiplan Commercial |
$1,717.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,288.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,975.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,052.03
|
| Rate for Payer: Quartz Commercial |
$1,395.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,288.20
|
| Rate for Payer: The Alliance Commercial |
$8,588.00
|
| Rate for Payer: WEA Trust Commercial |
$1,180.85
|
| Rate for Payer: WPS Commercial |
$1,590.28
|
|
|
SCREW NEXFIX SNAP-OFF MODEL 2 NSO-2012
|
Facility
|
IP
|
$2,147.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6181254
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,052.03 |
| Max. Negotiated Rate |
$1,975.24 |
| Rate for Payer: Aetna Commercial |
$1,932.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,846.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,137.91
|
| Rate for Payer: Cash Price |
$644.10
|
| Rate for Payer: Cigna Commercial |
$1,975.24
|
| Rate for Payer: Health EOS Commercial |
$1,910.83
|
| Rate for Payer: HFN Commercial |
$1,975.24
|
| Rate for Payer: Multiplan Commercial |
$1,717.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,288.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,975.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,052.03
|
| Rate for Payer: Quartz Commercial |
$1,288.20
|
| Rate for Payer: WEA Trust Commercial |
$1,180.85
|
| Rate for Payer: WPS Commercial |
$1,590.28
|
|
|
SCREW NON-LOCK 1.7 X 10MM 662610
|
Facility
|
OP
|
$1,268.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6170223
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$355.04 |
| Max. Negotiated Rate |
$5,072.00 |
| Rate for Payer: Aetna Commercial |
$1,141.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,090.48
|
| Rate for Payer: Aetna Managed Medicare |
$355.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$824.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$634.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$608.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$672.04
|
| Rate for Payer: Cash Price |
$380.40
|
| Rate for Payer: Cigna Commercial |
$1,166.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$709.57
|
| Rate for Payer: Health EOS Commercial |
$1,128.52
|
| Rate for Payer: HFN Commercial |
$1,166.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$951.00
|
| Rate for Payer: Multiplan Commercial |
$1,014.40
|
| Rate for Payer: NAPHCARE Commercial |
$760.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,166.56
|
| Rate for Payer: Quartz Beloit One Network |
$621.32
|
| Rate for Payer: Quartz Commercial |
$824.20
|
| Rate for Payer: Quartz Medicare Advantage |
$760.80
|
| Rate for Payer: The Alliance Commercial |
$5,072.00
|
| Rate for Payer: WEA Trust Commercial |
$697.40
|
| Rate for Payer: WPS Commercial |
$939.21
|
|
|
SCREW NON-LOCK 1.7 X 10MM 662610
|
Facility
|
IP
|
$1,268.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6170223
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$621.32 |
| Max. Negotiated Rate |
$1,166.56 |
| Rate for Payer: Aetna Commercial |
$1,141.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,090.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$672.04
|
| Rate for Payer: Cash Price |
$380.40
|
| Rate for Payer: Cigna Commercial |
$1,166.56
|
| Rate for Payer: Health EOS Commercial |
$1,128.52
|
| Rate for Payer: HFN Commercial |
$1,166.56
|
| Rate for Payer: Multiplan Commercial |
$1,014.40
|
| Rate for Payer: NAPHCARE Commercial |
$760.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,166.56
|
| Rate for Payer: Quartz Beloit One Network |
$621.32
|
| Rate for Payer: Quartz Commercial |
$760.80
|
| Rate for Payer: WEA Trust Commercial |
$697.40
|
| Rate for Payer: WPS Commercial |
$939.21
|
|
|
SCREW NON-LOCK 1.7 X 13MM 662613
|
Facility
|
IP
|
$1,268.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6170225
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$621.32 |
| Max. Negotiated Rate |
$1,166.56 |
| Rate for Payer: Aetna Commercial |
$1,141.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,090.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$672.04
|
| Rate for Payer: Cash Price |
$380.40
|
| Rate for Payer: Cigna Commercial |
$1,166.56
|
| Rate for Payer: Health EOS Commercial |
$1,128.52
|
| Rate for Payer: HFN Commercial |
$1,166.56
|
| Rate for Payer: Multiplan Commercial |
$1,014.40
|
| Rate for Payer: NAPHCARE Commercial |
$760.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,166.56
|
| Rate for Payer: Quartz Beloit One Network |
$621.32
|
| Rate for Payer: Quartz Commercial |
$760.80
|
| Rate for Payer: WEA Trust Commercial |
$697.40
|
| Rate for Payer: WPS Commercial |
$939.21
|
|
|
SCREW NON-LOCK 1.7 X 13MM 662613
|
Facility
|
OP
|
$1,268.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6170225
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$355.04 |
| Max. Negotiated Rate |
$5,072.00 |
| Rate for Payer: Aetna Commercial |
$1,141.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,090.48
|
| Rate for Payer: Aetna Managed Medicare |
$355.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$824.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$634.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$608.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$672.04
|
| Rate for Payer: Cash Price |
$380.40
|
| Rate for Payer: Cigna Commercial |
$1,166.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$709.57
|
| Rate for Payer: Health EOS Commercial |
$1,128.52
|
| Rate for Payer: HFN Commercial |
$1,166.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$951.00
|
| Rate for Payer: Multiplan Commercial |
$1,014.40
|
| Rate for Payer: NAPHCARE Commercial |
$760.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,166.56
|
| Rate for Payer: Quartz Beloit One Network |
$621.32
|
| Rate for Payer: Quartz Commercial |
$824.20
|
| Rate for Payer: Quartz Medicare Advantage |
$760.80
|
| Rate for Payer: The Alliance Commercial |
$5,072.00
|
| Rate for Payer: WEA Trust Commercial |
$697.40
|
| Rate for Payer: WPS Commercial |
$939.21
|
|
|
SCREW NON-LOCK 1.7 X 9MM 662609
|
Facility
|
IP
|
$1,268.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6170224
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$621.32 |
| Max. Negotiated Rate |
$1,166.56 |
| Rate for Payer: Aetna Commercial |
$1,141.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,090.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$672.04
|
| Rate for Payer: Cash Price |
$380.40
|
| Rate for Payer: Cigna Commercial |
$1,166.56
|
| Rate for Payer: Health EOS Commercial |
$1,128.52
|
| Rate for Payer: HFN Commercial |
$1,166.56
|
| Rate for Payer: Multiplan Commercial |
$1,014.40
|
| Rate for Payer: NAPHCARE Commercial |
$760.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,166.56
|
| Rate for Payer: Quartz Beloit One Network |
$621.32
|
| Rate for Payer: Quartz Commercial |
$760.80
|
| Rate for Payer: WEA Trust Commercial |
$697.40
|
| Rate for Payer: WPS Commercial |
$939.21
|
|
|
SCREW NON-LOCK 1.7 X 9MM 662609
|
Facility
|
OP
|
$1,268.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6170224
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$355.04 |
| Max. Negotiated Rate |
$5,072.00 |
| Rate for Payer: Aetna Commercial |
$1,141.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,090.48
|
| Rate for Payer: Aetna Managed Medicare |
$355.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$824.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$634.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$608.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$672.04
|
| Rate for Payer: Cash Price |
$380.40
|
| Rate for Payer: Cigna Commercial |
$1,166.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$709.57
|
| Rate for Payer: Health EOS Commercial |
$1,128.52
|
| Rate for Payer: HFN Commercial |
$1,166.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$951.00
|
| Rate for Payer: Multiplan Commercial |
$1,014.40
|
| Rate for Payer: NAPHCARE Commercial |
$760.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,166.56
|
| Rate for Payer: Quartz Beloit One Network |
$621.32
|
| Rate for Payer: Quartz Commercial |
$824.20
|
| Rate for Payer: Quartz Medicare Advantage |
$760.80
|
| Rate for Payer: The Alliance Commercial |
$5,072.00
|
| Rate for Payer: WEA Trust Commercial |
$697.40
|
| Rate for Payer: WPS Commercial |
$939.21
|
|
|
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 |
$369.88 |
| Max. Negotiated Rate |
$5,284.00 |
| Rate for Payer: Aetna Commercial |
$1,188.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,136.06
|
| Rate for Payer: Aetna Managed Medicare |
$369.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$858.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$660.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$634.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$700.13
|
| Rate for Payer: Cash Price |
$396.30
|
| Rate for Payer: Cigna Commercial |
$1,215.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$739.23
|
| Rate for Payer: Health EOS Commercial |
$1,175.69
|
| Rate for Payer: HFN Commercial |
$1,215.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$990.75
|
| Rate for Payer: Multiplan Commercial |
$1,056.80
|
| Rate for Payer: NAPHCARE Commercial |
$792.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,215.32
|
| Rate for Payer: Quartz Beloit One Network |
$647.29
|
| Rate for Payer: Quartz Commercial |
$858.65
|
| Rate for Payer: Quartz Medicare Advantage |
$792.60
|
| Rate for Payer: The Alliance Commercial |
$5,284.00
|
| Rate for Payer: WEA Trust Commercial |
$726.55
|
| Rate for Payer: WPS Commercial |
$978.46
|
|
|
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 |
$647.29 |
| Max. Negotiated Rate |
$1,215.32 |
| Rate for Payer: Aetna Commercial |
$1,188.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,136.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$700.13
|
| Rate for Payer: Cash Price |
$396.30
|
| Rate for Payer: Cigna Commercial |
$1,215.32
|
| Rate for Payer: Health EOS Commercial |
$1,175.69
|
| Rate for Payer: HFN Commercial |
$1,215.32
|
| Rate for Payer: Multiplan Commercial |
$1,056.80
|
| Rate for Payer: NAPHCARE Commercial |
$792.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,215.32
|
| Rate for Payer: Quartz Beloit One Network |
$647.29
|
| Rate for Payer: Quartz Commercial |
$792.60
|
| Rate for Payer: WEA Trust Commercial |
$726.55
|
| Rate for Payer: WPS Commercial |
$978.46
|
|
|
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 |
$369.88 |
| Max. Negotiated Rate |
$5,284.00 |
| Rate for Payer: Aetna Commercial |
$1,188.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,136.06
|
| Rate for Payer: Aetna Managed Medicare |
$369.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$858.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$660.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$634.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$700.13
|
| Rate for Payer: Cash Price |
$396.30
|
| Rate for Payer: Cigna Commercial |
$1,215.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$739.23
|
| Rate for Payer: Health EOS Commercial |
$1,175.69
|
| Rate for Payer: HFN Commercial |
$1,215.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$990.75
|
| Rate for Payer: Multiplan Commercial |
$1,056.80
|
| Rate for Payer: NAPHCARE Commercial |
$792.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,215.32
|
| Rate for Payer: Quartz Beloit One Network |
$647.29
|
| Rate for Payer: Quartz Commercial |
$858.65
|
| Rate for Payer: Quartz Medicare Advantage |
$792.60
|
| Rate for Payer: The Alliance Commercial |
$5,284.00
|
| Rate for Payer: WEA Trust Commercial |
$726.55
|
| Rate for Payer: WPS Commercial |
$978.46
|
|
|
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 |
$647.29 |
| Max. Negotiated Rate |
$1,215.32 |
| Rate for Payer: Aetna Commercial |
$1,188.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,136.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$700.13
|
| Rate for Payer: Cash Price |
$396.30
|
| Rate for Payer: Cigna Commercial |
$1,215.32
|
| Rate for Payer: Health EOS Commercial |
$1,175.69
|
| Rate for Payer: HFN Commercial |
$1,215.32
|
| Rate for Payer: Multiplan Commercial |
$1,056.80
|
| Rate for Payer: NAPHCARE Commercial |
$792.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,215.32
|
| Rate for Payer: Quartz Beloit One Network |
$647.29
|
| Rate for Payer: Quartz Commercial |
$792.60
|
| Rate for Payer: WEA Trust Commercial |
$726.55
|
| Rate for Payer: WPS Commercial |
$978.46
|
|
|
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 |
$2,016.84 |
| Max. Negotiated Rate |
$3,786.72 |
| Rate for Payer: Aetna Commercial |
$3,704.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,539.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,181.48
|
| Rate for Payer: Cash Price |
$1,234.80
|
| Rate for Payer: Cigna Commercial |
$3,786.72
|
| Rate for Payer: Health EOS Commercial |
$3,663.24
|
| Rate for Payer: HFN Commercial |
$3,786.72
|
| Rate for Payer: Multiplan Commercial |
$3,292.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,469.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,786.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,016.84
|
| Rate for Payer: Quartz Commercial |
$2,469.60
|
| Rate for Payer: WEA Trust Commercial |
$2,263.80
|
| Rate for Payer: WPS Commercial |
$3,048.72
|
|
|
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 |
$1,152.48 |
| Max. Negotiated Rate |
$16,464.00 |
| Rate for Payer: Aetna Commercial |
$3,704.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,539.76
|
| Rate for Payer: Aetna Managed Medicare |
$1,152.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,675.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,058.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,975.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,181.48
|
| Rate for Payer: Cash Price |
$1,234.80
|
| Rate for Payer: Cigna Commercial |
$3,786.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,303.31
|
| Rate for Payer: Health EOS Commercial |
$3,663.24
|
| Rate for Payer: HFN Commercial |
$3,786.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,087.00
|
| Rate for Payer: Multiplan Commercial |
$3,292.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,469.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,786.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,016.84
|
| Rate for Payer: Quartz Commercial |
$2,675.40
|
| Rate for Payer: Quartz Medicare Advantage |
$2,469.60
|
| Rate for Payer: The Alliance Commercial |
$16,464.00
|
| Rate for Payer: WEA Trust Commercial |
$2,263.80
|
| Rate for Payer: WPS Commercial |
$3,048.72
|
|
