|
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 |
$1,067.71 |
| Max. Negotiated Rate |
$2,004.68 |
| Rate for Payer: Aetna Commercial |
$1,961.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,873.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,154.87
|
| Rate for Payer: Cash Price |
$653.70
|
| Rate for Payer: Cigna Commercial |
$2,004.68
|
| Rate for Payer: Health EOS Commercial |
$1,939.31
|
| Rate for Payer: HFN Commercial |
$2,004.68
|
| Rate for Payer: Multiplan Commercial |
$1,743.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,307.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,004.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,067.71
|
| Rate for Payer: Quartz Commercial |
$1,307.40
|
| Rate for Payer: WEA Trust Commercial |
$1,198.45
|
| Rate for Payer: WPS Commercial |
$1,613.99
|
|
|
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 |
$610.12 |
| Max. Negotiated Rate |
$8,716.00 |
| Rate for Payer: Aetna Commercial |
$1,961.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,873.94
|
| Rate for Payer: Aetna Managed Medicare |
$610.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,416.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,089.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,045.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,154.87
|
| Rate for Payer: Cash Price |
$653.70
|
| Rate for Payer: Cigna Commercial |
$2,004.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,219.37
|
| Rate for Payer: Health EOS Commercial |
$1,939.31
|
| Rate for Payer: HFN Commercial |
$2,004.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,634.25
|
| Rate for Payer: Multiplan Commercial |
$1,743.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,307.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,004.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,067.71
|
| Rate for Payer: Quartz Commercial |
$1,416.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,307.40
|
| Rate for Payer: The Alliance Commercial |
$8,716.00
|
| Rate for Payer: WEA Trust Commercial |
$1,198.45
|
| Rate for Payer: WPS Commercial |
$1,613.99
|
|
|
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 |
$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 14MM 656114
|
Facility
|
IP
|
$1,321.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5458928
|
|
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 14MM TI 5201124014
|
Facility
|
IP
|
$2,179.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6149645
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,067.71 |
| Max. Negotiated Rate |
$2,004.68 |
| Rate for Payer: Aetna Commercial |
$1,961.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,873.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,154.87
|
| Rate for Payer: Cash Price |
$653.70
|
| Rate for Payer: Cigna Commercial |
$2,004.68
|
| Rate for Payer: Health EOS Commercial |
$1,939.31
|
| Rate for Payer: HFN Commercial |
$2,004.68
|
| Rate for Payer: Multiplan Commercial |
$1,743.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,307.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,004.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,067.71
|
| Rate for Payer: Quartz Commercial |
$1,307.40
|
| Rate for Payer: WEA Trust Commercial |
$1,198.45
|
| Rate for Payer: WPS Commercial |
$1,613.99
|
|
|
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 |
$610.12 |
| Max. Negotiated Rate |
$8,716.00 |
| Rate for Payer: Aetna Commercial |
$1,961.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,873.94
|
| Rate for Payer: Aetna Managed Medicare |
$610.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,416.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,089.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,045.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,154.87
|
| Rate for Payer: Cash Price |
$653.70
|
| Rate for Payer: Cigna Commercial |
$2,004.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,219.37
|
| Rate for Payer: Health EOS Commercial |
$1,939.31
|
| Rate for Payer: HFN Commercial |
$2,004.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,634.25
|
| Rate for Payer: Multiplan Commercial |
$1,743.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,307.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,004.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,067.71
|
| Rate for Payer: Quartz Commercial |
$1,416.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,307.40
|
| Rate for Payer: The Alliance Commercial |
$8,716.00
|
| Rate for Payer: WEA Trust Commercial |
$1,198.45
|
| Rate for Payer: WPS Commercial |
$1,613.99
|
|
|
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 |
$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 16MM 656116
|
Facility
|
OP
|
$1,321.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5611548
|
|
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 22MM 656122
|
Facility
|
IP
|
$1,321.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5809965
|
|
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 22MM 656122
|
Facility
|
OP
|
$1,321.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5809965
|
|
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 22MM TI 5201124022
|
Facility
|
IP
|
$2,179.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5957649
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,067.71 |
| Max. Negotiated Rate |
$2,004.68 |
| Rate for Payer: Aetna Commercial |
$1,961.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,873.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,154.87
|
| Rate for Payer: Cash Price |
$653.70
|
| Rate for Payer: Cigna Commercial |
$2,004.68
|
| Rate for Payer: Health EOS Commercial |
$1,939.31
|
| Rate for Payer: HFN Commercial |
$2,004.68
|
| Rate for Payer: Multiplan Commercial |
$1,743.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,307.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,004.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,067.71
|
| Rate for Payer: Quartz Commercial |
$1,307.40
|
| Rate for Payer: WEA Trust Commercial |
$1,198.45
|
| Rate for Payer: WPS Commercial |
$1,613.99
|
|
|
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 |
$610.12 |
| Max. Negotiated Rate |
$8,716.00 |
| Rate for Payer: Aetna Commercial |
$1,961.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,873.94
|
| Rate for Payer: Aetna Managed Medicare |
$610.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,416.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,089.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,045.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,154.87
|
| Rate for Payer: Cash Price |
$653.70
|
| Rate for Payer: Cigna Commercial |
$2,004.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,219.37
|
| Rate for Payer: Health EOS Commercial |
$1,939.31
|
| Rate for Payer: HFN Commercial |
$2,004.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,634.25
|
| Rate for Payer: Multiplan Commercial |
$1,743.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,307.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,004.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,067.71
|
| Rate for Payer: Quartz Commercial |
$1,416.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,307.40
|
| Rate for Payer: The Alliance Commercial |
$8,716.00
|
| Rate for Payer: WEA Trust Commercial |
$1,198.45
|
| Rate for Payer: WPS Commercial |
$1,613.99
|
|
|
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 |
$647.78 |
| Max. Negotiated Rate |
$1,216.24 |
| Rate for Payer: Aetna Commercial |
$1,189.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,136.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$700.66
|
| Rate for Payer: Cash Price |
$396.60
|
| Rate for Payer: Cigna Commercial |
$1,216.24
|
| Rate for Payer: Health EOS Commercial |
$1,176.58
|
| Rate for Payer: HFN Commercial |
$1,216.24
|
| Rate for Payer: Multiplan Commercial |
$1,057.60
|
| Rate for Payer: NAPHCARE Commercial |
$793.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,216.24
|
| Rate for Payer: Quartz Beloit One Network |
$647.78
|
| Rate for Payer: Quartz Commercial |
$793.20
|
| Rate for Payer: WEA Trust Commercial |
$727.10
|
| Rate for Payer: WPS Commercial |
$979.21
|
|
|
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 |
$370.16 |
| Max. Negotiated Rate |
$5,288.00 |
| Rate for Payer: Aetna Commercial |
$1,189.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,136.92
|
| Rate for Payer: Aetna Managed Medicare |
$370.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$859.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$661.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$634.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$700.66
|
| Rate for Payer: Cash Price |
$396.60
|
| Rate for Payer: Cigna Commercial |
$1,216.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$739.79
|
| Rate for Payer: Health EOS Commercial |
$1,176.58
|
| Rate for Payer: HFN Commercial |
$1,216.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$991.50
|
| Rate for Payer: Multiplan Commercial |
$1,057.60
|
| Rate for Payer: NAPHCARE Commercial |
$793.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,216.24
|
| Rate for Payer: Quartz Beloit One Network |
$647.78
|
| Rate for Payer: Quartz Commercial |
$859.30
|
| Rate for Payer: Quartz Medicare Advantage |
$793.20
|
| Rate for Payer: The Alliance Commercial |
$5,288.00
|
| Rate for Payer: WEA Trust Commercial |
$727.10
|
| Rate for Payer: WPS Commercial |
$979.21
|
|
|
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 |
$385.00 |
| Max. Negotiated Rate |
$5,500.00 |
| Rate for Payer: Aetna Commercial |
$1,237.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,182.50
|
| Rate for Payer: Aetna Managed Medicare |
$385.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$893.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$687.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$660.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$728.75
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$1,265.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$769.45
|
| Rate for Payer: Health EOS Commercial |
$1,223.75
|
| Rate for Payer: HFN Commercial |
$1,265.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,031.25
|
| Rate for Payer: Multiplan Commercial |
$1,100.00
|
| Rate for Payer: NAPHCARE Commercial |
$825.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,265.00
|
| Rate for Payer: Quartz Beloit One Network |
$673.75
|
| Rate for Payer: Quartz Commercial |
$893.75
|
| Rate for Payer: Quartz Medicare Advantage |
$825.00
|
| Rate for Payer: The Alliance Commercial |
$5,500.00
|
| Rate for Payer: WEA Trust Commercial |
$756.25
|
| Rate for Payer: WPS Commercial |
$1,018.46
|
|
|
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 |
$673.75 |
| Max. Negotiated Rate |
$1,265.00 |
| Rate for Payer: Aetna Commercial |
$1,237.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,182.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$728.75
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$1,265.00
|
| Rate for Payer: Health EOS Commercial |
$1,223.75
|
| Rate for Payer: HFN Commercial |
$1,265.00
|
| Rate for Payer: Multiplan Commercial |
$1,100.00
|
| Rate for Payer: NAPHCARE Commercial |
$825.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,265.00
|
| Rate for Payer: Quartz Beloit One Network |
$673.75
|
| Rate for Payer: Quartz Commercial |
$825.00
|
| Rate for Payer: WEA Trust Commercial |
$756.25
|
| Rate for Payer: WPS Commercial |
$1,018.46
|
|
|
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 |
$673.75 |
| Max. Negotiated Rate |
$1,265.00 |
| Rate for Payer: Aetna Commercial |
$1,237.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,182.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$728.75
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$1,265.00
|
| Rate for Payer: Health EOS Commercial |
$1,223.75
|
| Rate for Payer: HFN Commercial |
$1,265.00
|
| Rate for Payer: Multiplan Commercial |
$1,100.00
|
| Rate for Payer: NAPHCARE Commercial |
$825.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,265.00
|
| Rate for Payer: Quartz Beloit One Network |
$673.75
|
| Rate for Payer: Quartz Commercial |
$825.00
|
| Rate for Payer: WEA Trust Commercial |
$756.25
|
| Rate for Payer: WPS Commercial |
$1,018.46
|
|
|
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 |
$385.00 |
| Max. Negotiated Rate |
$5,500.00 |
| Rate for Payer: Aetna Commercial |
$1,237.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,182.50
|
| Rate for Payer: Aetna Managed Medicare |
$385.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$893.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$687.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$660.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$728.75
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$1,265.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$769.45
|
| Rate for Payer: Health EOS Commercial |
$1,223.75
|
| Rate for Payer: HFN Commercial |
$1,265.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,031.25
|
| Rate for Payer: Multiplan Commercial |
$1,100.00
|
| Rate for Payer: NAPHCARE Commercial |
$825.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,265.00
|
| Rate for Payer: Quartz Beloit One Network |
$673.75
|
| Rate for Payer: Quartz Commercial |
$893.75
|
| Rate for Payer: Quartz Medicare Advantage |
$825.00
|
| Rate for Payer: The Alliance Commercial |
$5,500.00
|
| Rate for Payer: WEA Trust Commercial |
$756.25
|
| Rate for Payer: WPS Commercial |
$1,018.46
|
|
|
SCREW NON-LOCK 2.7MM X 16MM 657116
|
Facility
|
IP
|
$1,374.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415590
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$673.26 |
| Max. Negotiated Rate |
$1,264.08 |
| Rate for Payer: Aetna Commercial |
$1,236.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,181.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$728.22
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Cigna Commercial |
$1,264.08
|
| Rate for Payer: Health EOS Commercial |
$1,222.86
|
| Rate for Payer: HFN Commercial |
$1,264.08
|
| Rate for Payer: Multiplan Commercial |
$1,099.20
|
| Rate for Payer: NAPHCARE Commercial |
$824.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,264.08
|
| Rate for Payer: Quartz Beloit One Network |
$673.26
|
| Rate for Payer: Quartz Commercial |
$824.40
|
| Rate for Payer: WEA Trust Commercial |
$755.70
|
| Rate for Payer: WPS Commercial |
$1,017.72
|
|
|
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 |
$384.72 |
| Max. Negotiated Rate |
$5,496.00 |
| Rate for Payer: Aetna Commercial |
$1,236.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,181.64
|
| Rate for Payer: Aetna Managed Medicare |
$384.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$893.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$687.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$659.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$728.22
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Cigna Commercial |
$1,264.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$768.89
|
| Rate for Payer: Health EOS Commercial |
$1,222.86
|
| Rate for Payer: HFN Commercial |
$1,264.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,030.50
|
| Rate for Payer: Multiplan Commercial |
$1,099.20
|
| Rate for Payer: NAPHCARE Commercial |
$824.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,264.08
|
| Rate for Payer: Quartz Beloit One Network |
$673.26
|
| Rate for Payer: Quartz Commercial |
$893.10
|
| Rate for Payer: Quartz Medicare Advantage |
$824.40
|
| Rate for Payer: The Alliance Commercial |
$5,496.00
|
| Rate for Payer: WEA Trust Commercial |
$755.70
|
| Rate for Payer: WPS Commercial |
$1,017.72
|
|
|
SCREW NON-LOCK 2.7MM X 18MM 657118
|
Facility
|
IP
|
$1,322.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415591
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.78 |
| Max. Negotiated Rate |
$1,216.24 |
| Rate for Payer: Aetna Commercial |
$1,189.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,136.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$700.66
|
| Rate for Payer: Cash Price |
$396.60
|
| Rate for Payer: Cigna Commercial |
$1,216.24
|
| Rate for Payer: Health EOS Commercial |
$1,176.58
|
| Rate for Payer: HFN Commercial |
$1,216.24
|
| Rate for Payer: Multiplan Commercial |
$1,057.60
|
| Rate for Payer: NAPHCARE Commercial |
$793.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,216.24
|
| Rate for Payer: Quartz Beloit One Network |
$647.78
|
| Rate for Payer: Quartz Commercial |
$793.20
|
| Rate for Payer: WEA Trust Commercial |
$727.10
|
| Rate for Payer: WPS Commercial |
$979.21
|
|
|
SCREW NON-LOCK 2.7MM X 18MM 657118
|
Facility
|
OP
|
$1,322.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415591
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$370.16 |
| Max. Negotiated Rate |
$5,288.00 |
| Rate for Payer: Aetna Commercial |
$1,189.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,136.92
|
| Rate for Payer: Aetna Managed Medicare |
$370.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$859.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$661.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$634.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$700.66
|
| Rate for Payer: Cash Price |
$396.60
|
| Rate for Payer: Cigna Commercial |
$1,216.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$739.79
|
| Rate for Payer: Health EOS Commercial |
$1,176.58
|
| Rate for Payer: HFN Commercial |
$1,216.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$991.50
|
| Rate for Payer: Multiplan Commercial |
$1,057.60
|
| Rate for Payer: NAPHCARE Commercial |
$793.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,216.24
|
| Rate for Payer: Quartz Beloit One Network |
$647.78
|
| Rate for Payer: Quartz Commercial |
$859.30
|
| Rate for Payer: Quartz Medicare Advantage |
$793.20
|
| Rate for Payer: The Alliance Commercial |
$5,288.00
|
| Rate for Payer: WEA Trust Commercial |
$727.10
|
| Rate for Payer: WPS Commercial |
$979.21
|
|
|
SCREW NON-LOCK 2.7MM X 22MM 657122
|
Facility
|
OP
|
$1,322.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6151691
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$370.16 |
| Max. Negotiated Rate |
$5,288.00 |
| Rate for Payer: Aetna Commercial |
$1,189.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,136.92
|
| Rate for Payer: Aetna Managed Medicare |
$370.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$859.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$661.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$634.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$700.66
|
| Rate for Payer: Cash Price |
$396.60
|
| Rate for Payer: Cigna Commercial |
$1,216.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$739.79
|
| Rate for Payer: Health EOS Commercial |
$1,176.58
|
| Rate for Payer: HFN Commercial |
$1,216.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$991.50
|
| Rate for Payer: Multiplan Commercial |
$1,057.60
|
| Rate for Payer: NAPHCARE Commercial |
$793.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,216.24
|
| Rate for Payer: Quartz Beloit One Network |
$647.78
|
| Rate for Payer: Quartz Commercial |
$859.30
|
| Rate for Payer: Quartz Medicare Advantage |
$793.20
|
| Rate for Payer: The Alliance Commercial |
$5,288.00
|
| Rate for Payer: WEA Trust Commercial |
$727.10
|
| Rate for Payer: WPS Commercial |
$979.21
|
|
|
SCREW NON-LOCK 2.7MM X 22MM 657122
|
Facility
|
IP
|
$1,322.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6151691
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.78 |
| Max. Negotiated Rate |
$1,216.24 |
| Rate for Payer: Aetna Commercial |
$1,189.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,136.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$700.66
|
| Rate for Payer: Cash Price |
$396.60
|
| Rate for Payer: Cigna Commercial |
$1,216.24
|
| Rate for Payer: Health EOS Commercial |
$1,176.58
|
| Rate for Payer: HFN Commercial |
$1,216.24
|
| Rate for Payer: Multiplan Commercial |
$1,057.60
|
| Rate for Payer: NAPHCARE Commercial |
$793.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,216.24
|
| Rate for Payer: Quartz Beloit One Network |
$647.78
|
| Rate for Payer: Quartz Commercial |
$793.20
|
| Rate for Payer: WEA Trust Commercial |
$727.10
|
| Rate for Payer: WPS Commercial |
$979.21
|
|
|
SCREW NON-LOCK 3.5MM X 12MM 657412
|
Facility
|
OP
|
$1,430.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5603669
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$400.40 |
| Max. Negotiated Rate |
$5,720.00 |
| 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 |
$429.00
|
| Rate for Payer: Cigna Commercial |
$1,315.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$800.23
|
| 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 |
$5,720.00
|
| Rate for Payer: WEA Trust Commercial |
$786.50
|
| Rate for Payer: WPS Commercial |
$1,059.20
|
|
