|
SCREW-AMBI 4.5 X 48 7112-9248
|
Facility
|
OP
|
$345.00
|
|
| Hospital Charge Code |
2965991
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$96.60 |
| Max. Negotiated Rate |
$1,380.00 |
| Rate for Payer: Aetna Commercial |
$310.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$296.70
|
| Rate for Payer: Aetna Managed Medicare |
$96.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$224.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$172.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$165.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$182.85
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$317.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$193.06
|
| Rate for Payer: Health EOS Commercial |
$307.05
|
| Rate for Payer: HFN Commercial |
$317.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$258.75
|
| Rate for Payer: Multiplan Commercial |
$276.00
|
| Rate for Payer: NAPHCARE Commercial |
$207.00
|
| Rate for Payer: Preferred Network Access Commercial |
$317.40
|
| Rate for Payer: Quartz Beloit One Network |
$169.05
|
| Rate for Payer: Quartz Commercial |
$224.25
|
| Rate for Payer: Quartz Medicare Advantage |
$207.00
|
| Rate for Payer: The Alliance Commercial |
$1,380.00
|
| Rate for Payer: WEA Trust Commercial |
$189.75
|
| Rate for Payer: WPS Commercial |
$255.54
|
|
|
SCREW ANCHORAGE LOCK 3.5MMX14MM FT T8 YELLOW PLSL3514
|
Facility
|
IP
|
$2,637.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5895719
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,292.13 |
| Max. Negotiated Rate |
$2,426.04 |
| Rate for Payer: Aetna Commercial |
$2,373.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,267.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,397.61
|
| Rate for Payer: Cash Price |
$791.10
|
| Rate for Payer: Cigna Commercial |
$2,426.04
|
| Rate for Payer: Health EOS Commercial |
$2,346.93
|
| Rate for Payer: HFN Commercial |
$2,426.04
|
| Rate for Payer: Multiplan Commercial |
$2,109.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,582.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,426.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,292.13
|
| Rate for Payer: Quartz Commercial |
$1,582.20
|
| Rate for Payer: WEA Trust Commercial |
$1,450.35
|
| Rate for Payer: WPS Commercial |
$1,953.23
|
|
|
SCREW ANCHORAGE LOCK 3.5MMX14MM FT T8 YELLOW PLSL3514
|
Facility
|
OP
|
$2,637.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5895719
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$738.36 |
| Max. Negotiated Rate |
$10,548.00 |
| Rate for Payer: Aetna Commercial |
$2,373.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,267.82
|
| Rate for Payer: Aetna Managed Medicare |
$738.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,714.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,318.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,265.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,397.61
|
| Rate for Payer: Cash Price |
$791.10
|
| Rate for Payer: Cigna Commercial |
$2,426.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,475.67
|
| Rate for Payer: Health EOS Commercial |
$2,346.93
|
| Rate for Payer: HFN Commercial |
$2,426.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,977.75
|
| Rate for Payer: Multiplan Commercial |
$2,109.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,582.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,426.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,292.13
|
| Rate for Payer: Quartz Commercial |
$1,714.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,582.20
|
| Rate for Payer: The Alliance Commercial |
$10,548.00
|
| Rate for Payer: WEA Trust Commercial |
$1,450.35
|
| Rate for Payer: WPS Commercial |
$1,953.23
|
|
|
SCREW ANCHORAGE LOCK 3MMX10MM FT T8 BLUE PLSL3010
|
Facility
|
IP
|
$2,992.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5591284
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,466.08 |
| Max. Negotiated Rate |
$2,752.64 |
| Rate for Payer: Aetna Commercial |
$2,692.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,573.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,585.76
|
| Rate for Payer: Cash Price |
$897.60
|
| Rate for Payer: Cigna Commercial |
$2,752.64
|
| Rate for Payer: Health EOS Commercial |
$2,662.88
|
| Rate for Payer: HFN Commercial |
$2,752.64
|
| Rate for Payer: Multiplan Commercial |
$2,393.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,795.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,752.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,466.08
|
| Rate for Payer: Quartz Commercial |
$1,795.20
|
| Rate for Payer: WEA Trust Commercial |
$1,645.60
|
| Rate for Payer: WPS Commercial |
$2,216.17
|
|
|
SCREW ANCHORAGE LOCK 3MMX10MM FT T8 BLUE PLSL3010
|
Facility
|
OP
|
$2,992.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5591284
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$837.76 |
| Max. Negotiated Rate |
$11,968.00 |
| Rate for Payer: Aetna Commercial |
$2,692.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,573.12
|
| Rate for Payer: Aetna Managed Medicare |
$837.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,944.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,496.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,436.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,585.76
|
| Rate for Payer: Cash Price |
$897.60
|
| Rate for Payer: Cigna Commercial |
$2,752.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,674.32
|
| Rate for Payer: Health EOS Commercial |
$2,662.88
|
| Rate for Payer: HFN Commercial |
$2,752.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,244.00
|
| Rate for Payer: Multiplan Commercial |
$2,393.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,795.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,752.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,466.08
|
| Rate for Payer: Quartz Commercial |
$1,944.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,795.20
|
| Rate for Payer: The Alliance Commercial |
$11,968.00
|
| Rate for Payer: WEA Trust Commercial |
$1,645.60
|
| Rate for Payer: WPS Commercial |
$2,216.17
|
|
|
SCREW ANCHORAGE LOCK 3MMX12MM FT T8 BLUE PLSL3012
|
Facility
|
OP
|
$2,992.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5591285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$837.76 |
| Max. Negotiated Rate |
$11,968.00 |
| Rate for Payer: Aetna Commercial |
$2,692.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,573.12
|
| Rate for Payer: Aetna Managed Medicare |
$837.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,944.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,496.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,436.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,585.76
|
| Rate for Payer: Cash Price |
$897.60
|
| Rate for Payer: Cigna Commercial |
$2,752.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,674.32
|
| Rate for Payer: Health EOS Commercial |
$2,662.88
|
| Rate for Payer: HFN Commercial |
$2,752.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,244.00
|
| Rate for Payer: Multiplan Commercial |
$2,393.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,795.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,752.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,466.08
|
| Rate for Payer: Quartz Commercial |
$1,944.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,795.20
|
| Rate for Payer: The Alliance Commercial |
$11,968.00
|
| Rate for Payer: WEA Trust Commercial |
$1,645.60
|
| Rate for Payer: WPS Commercial |
$2,216.17
|
|
|
SCREW ANCHORAGE LOCK 3MMX12MM FT T8 BLUE PLSL3012
|
Facility
|
IP
|
$2,992.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5591285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,466.08 |
| Max. Negotiated Rate |
$2,752.64 |
| Rate for Payer: Aetna Commercial |
$2,692.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,573.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,585.76
|
| Rate for Payer: Cash Price |
$897.60
|
| Rate for Payer: Cigna Commercial |
$2,752.64
|
| Rate for Payer: Health EOS Commercial |
$2,662.88
|
| Rate for Payer: HFN Commercial |
$2,752.64
|
| Rate for Payer: Multiplan Commercial |
$2,393.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,795.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,752.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,466.08
|
| Rate for Payer: Quartz Commercial |
$1,795.20
|
| Rate for Payer: WEA Trust Commercial |
$1,645.60
|
| Rate for Payer: WPS Commercial |
$2,216.17
|
|
|
SCREW ANCHORAGE LOCK 3MMX14MM FT T8 BLUE PLSL3014
|
Facility
|
IP
|
$2,992.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5264999
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,466.08 |
| Max. Negotiated Rate |
$2,752.64 |
| Rate for Payer: Aetna Commercial |
$2,692.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,573.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,585.76
|
| Rate for Payer: Cash Price |
$897.60
|
| Rate for Payer: Cigna Commercial |
$2,752.64
|
| Rate for Payer: Health EOS Commercial |
$2,662.88
|
| Rate for Payer: HFN Commercial |
$2,752.64
|
| Rate for Payer: Multiplan Commercial |
$2,393.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,795.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,752.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,466.08
|
| Rate for Payer: Quartz Commercial |
$1,795.20
|
| Rate for Payer: WEA Trust Commercial |
$1,645.60
|
| Rate for Payer: WPS Commercial |
$2,216.17
|
|
|
SCREW ANCHORAGE LOCK 3MMX14MM FT T8 BLUE PLSL3014
|
Facility
|
OP
|
$2,992.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5264999
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$837.76 |
| Max. Negotiated Rate |
$11,968.00 |
| Rate for Payer: Aetna Commercial |
$2,692.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,573.12
|
| Rate for Payer: Aetna Managed Medicare |
$837.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,944.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,496.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,436.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,585.76
|
| Rate for Payer: Cash Price |
$897.60
|
| Rate for Payer: Cigna Commercial |
$2,752.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,674.32
|
| Rate for Payer: Health EOS Commercial |
$2,662.88
|
| Rate for Payer: HFN Commercial |
$2,752.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,244.00
|
| Rate for Payer: Multiplan Commercial |
$2,393.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,795.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,752.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,466.08
|
| Rate for Payer: Quartz Commercial |
$1,944.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,795.20
|
| Rate for Payer: The Alliance Commercial |
$11,968.00
|
| Rate for Payer: WEA Trust Commercial |
$1,645.60
|
| Rate for Payer: WPS Commercial |
$2,216.17
|
|
|
SCREW ANCHORAGE LOCK 3MMX16MM FT T8 BLUE PLSL3016
|
Facility
|
OP
|
$2,992.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5265000
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$837.76 |
| Max. Negotiated Rate |
$11,968.00 |
| Rate for Payer: Aetna Commercial |
$2,692.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,573.12
|
| Rate for Payer: Aetna Managed Medicare |
$837.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,944.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,496.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,436.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,585.76
|
| Rate for Payer: Cash Price |
$897.60
|
| Rate for Payer: Cigna Commercial |
$2,752.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,674.32
|
| Rate for Payer: Health EOS Commercial |
$2,662.88
|
| Rate for Payer: HFN Commercial |
$2,752.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,244.00
|
| Rate for Payer: Multiplan Commercial |
$2,393.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,795.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,752.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,466.08
|
| Rate for Payer: Quartz Commercial |
$1,944.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,795.20
|
| Rate for Payer: The Alliance Commercial |
$11,968.00
|
| Rate for Payer: WEA Trust Commercial |
$1,645.60
|
| Rate for Payer: WPS Commercial |
$2,216.17
|
|
|
SCREW ANCHORAGE LOCK 3MMX16MM FT T8 BLUE PLSL3016
|
Facility
|
IP
|
$2,992.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5265000
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,466.08 |
| Max. Negotiated Rate |
$2,752.64 |
| Rate for Payer: Aetna Commercial |
$2,692.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,573.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,585.76
|
| Rate for Payer: Cash Price |
$897.60
|
| Rate for Payer: Cigna Commercial |
$2,752.64
|
| Rate for Payer: Health EOS Commercial |
$2,662.88
|
| Rate for Payer: HFN Commercial |
$2,752.64
|
| Rate for Payer: Multiplan Commercial |
$2,393.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,795.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,752.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,466.08
|
| Rate for Payer: Quartz Commercial |
$1,795.20
|
| Rate for Payer: WEA Trust Commercial |
$1,645.60
|
| Rate for Payer: WPS Commercial |
$2,216.17
|
|
|
SCREW ANCHORAGE LOCK 3MMX18MM FT T8 BLUE PLSL3018
|
Facility
|
OP
|
$2,637.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5617696
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$738.36 |
| Max. Negotiated Rate |
$10,548.00 |
| Rate for Payer: Aetna Commercial |
$2,373.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,267.82
|
| Rate for Payer: Aetna Managed Medicare |
$738.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,714.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,318.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,265.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,397.61
|
| Rate for Payer: Cash Price |
$791.10
|
| Rate for Payer: Cigna Commercial |
$2,426.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,475.67
|
| Rate for Payer: Health EOS Commercial |
$2,346.93
|
| Rate for Payer: HFN Commercial |
$2,426.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,977.75
|
| Rate for Payer: Multiplan Commercial |
$2,109.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,582.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,426.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,292.13
|
| Rate for Payer: Quartz Commercial |
$1,714.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,582.20
|
| Rate for Payer: The Alliance Commercial |
$10,548.00
|
| Rate for Payer: WEA Trust Commercial |
$1,450.35
|
| Rate for Payer: WPS Commercial |
$1,953.23
|
|
|
SCREW ANCHORAGE LOCK 3MMX18MM FT T8 BLUE PLSL3018
|
Facility
|
IP
|
$2,637.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5617696
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,292.13 |
| Max. Negotiated Rate |
$2,426.04 |
| Rate for Payer: Aetna Commercial |
$2,373.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,267.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,397.61
|
| Rate for Payer: Cash Price |
$791.10
|
| Rate for Payer: Cigna Commercial |
$2,426.04
|
| Rate for Payer: Health EOS Commercial |
$2,346.93
|
| Rate for Payer: HFN Commercial |
$2,426.04
|
| Rate for Payer: Multiplan Commercial |
$2,109.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,582.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,426.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,292.13
|
| Rate for Payer: Quartz Commercial |
$1,582.20
|
| Rate for Payer: WEA Trust Commercial |
$1,450.35
|
| Rate for Payer: WPS Commercial |
$1,953.23
|
|
|
SCREW ANCHORAGE LOCK 3MMX20MM FT T8 BLUE PLSL3020
|
Facility
|
OP
|
$2,637.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5617697
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$738.36 |
| Max. Negotiated Rate |
$10,548.00 |
| Rate for Payer: Aetna Commercial |
$2,373.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,267.82
|
| Rate for Payer: Aetna Managed Medicare |
$738.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,714.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,318.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,265.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,397.61
|
| Rate for Payer: Cash Price |
$791.10
|
| Rate for Payer: Cigna Commercial |
$2,426.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,475.67
|
| Rate for Payer: Health EOS Commercial |
$2,346.93
|
| Rate for Payer: HFN Commercial |
$2,426.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,977.75
|
| Rate for Payer: Multiplan Commercial |
$2,109.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,582.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,426.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,292.13
|
| Rate for Payer: Quartz Commercial |
$1,714.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,582.20
|
| Rate for Payer: The Alliance Commercial |
$10,548.00
|
| Rate for Payer: WEA Trust Commercial |
$1,450.35
|
| Rate for Payer: WPS Commercial |
$1,953.23
|
|
|
SCREW ANCHORAGE LOCK 3MMX20MM FT T8 BLUE PLSL3020
|
Facility
|
IP
|
$2,637.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5617697
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,292.13 |
| Max. Negotiated Rate |
$2,426.04 |
| Rate for Payer: Aetna Commercial |
$2,373.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,267.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,397.61
|
| Rate for Payer: Cash Price |
$791.10
|
| Rate for Payer: Cigna Commercial |
$2,426.04
|
| Rate for Payer: Health EOS Commercial |
$2,346.93
|
| Rate for Payer: HFN Commercial |
$2,426.04
|
| Rate for Payer: Multiplan Commercial |
$2,109.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,582.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,426.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,292.13
|
| Rate for Payer: Quartz Commercial |
$1,582.20
|
| Rate for Payer: WEA Trust Commercial |
$1,450.35
|
| Rate for Payer: WPS Commercial |
$1,953.23
|
|
|
SCREW ANCHORAGE NON-LOCK 3MMX14MM FT T8 BLUE PLSS3014
|
Facility
|
OP
|
$2,586.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5591286
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$724.08 |
| Max. Negotiated Rate |
$10,344.00 |
| Rate for Payer: Aetna Commercial |
$2,327.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,223.96
|
| Rate for Payer: Aetna Managed Medicare |
$724.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,680.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,293.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,241.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,370.58
|
| Rate for Payer: Cash Price |
$775.80
|
| Rate for Payer: Cigna Commercial |
$2,379.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,447.13
|
| Rate for Payer: Health EOS Commercial |
$2,301.54
|
| Rate for Payer: HFN Commercial |
$2,379.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,939.50
|
| Rate for Payer: Multiplan Commercial |
$2,068.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,551.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,379.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,267.14
|
| Rate for Payer: Quartz Commercial |
$1,680.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,551.60
|
| Rate for Payer: The Alliance Commercial |
$10,344.00
|
| Rate for Payer: WEA Trust Commercial |
$1,422.30
|
| Rate for Payer: WPS Commercial |
$1,915.45
|
|
|
SCREW ANCHORAGE NON-LOCK 3MMX14MM FT T8 BLUE PLSS3014
|
Facility
|
IP
|
$2,586.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5591286
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,267.14 |
| Max. Negotiated Rate |
$2,379.12 |
| Rate for Payer: Aetna Commercial |
$2,327.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,223.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,370.58
|
| Rate for Payer: Cash Price |
$775.80
|
| Rate for Payer: Cigna Commercial |
$2,379.12
|
| Rate for Payer: Health EOS Commercial |
$2,301.54
|
| Rate for Payer: HFN Commercial |
$2,379.12
|
| Rate for Payer: Multiplan Commercial |
$2,068.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,551.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,379.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,267.14
|
| Rate for Payer: Quartz Commercial |
$1,551.60
|
| Rate for Payer: WEA Trust Commercial |
$1,422.30
|
| Rate for Payer: WPS Commercial |
$1,915.45
|
|
|
SCREW ANCHORAGE NON-LOCK 3MMX16MM FT T8 BLUE PLSS3016
|
Facility
|
IP
|
$2,279.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5617699
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,116.71 |
| Max. Negotiated Rate |
$2,096.68 |
| Rate for Payer: Aetna Commercial |
$2,051.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,959.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,207.87
|
| Rate for Payer: Cash Price |
$683.70
|
| Rate for Payer: Cigna Commercial |
$2,096.68
|
| Rate for Payer: Health EOS Commercial |
$2,028.31
|
| Rate for Payer: HFN Commercial |
$2,096.68
|
| Rate for Payer: Multiplan Commercial |
$1,823.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,367.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,096.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,116.71
|
| Rate for Payer: Quartz Commercial |
$1,367.40
|
| Rate for Payer: WEA Trust Commercial |
$1,253.45
|
| Rate for Payer: WPS Commercial |
$1,688.06
|
|
|
SCREW ANCHORAGE NON-LOCK 3MMX16MM FT T8 BLUE PLSS3016
|
Facility
|
OP
|
$2,279.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5617699
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.12 |
| Max. Negotiated Rate |
$9,116.00 |
| Rate for Payer: Aetna Commercial |
$2,051.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,959.94
|
| Rate for Payer: Aetna Managed Medicare |
$638.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,481.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,139.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,093.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,207.87
|
| Rate for Payer: Cash Price |
$683.70
|
| Rate for Payer: Cigna Commercial |
$2,096.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,275.33
|
| Rate for Payer: Health EOS Commercial |
$2,028.31
|
| Rate for Payer: HFN Commercial |
$2,096.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,709.25
|
| Rate for Payer: Multiplan Commercial |
$1,823.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,367.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,096.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,116.71
|
| Rate for Payer: Quartz Commercial |
$1,481.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,367.40
|
| Rate for Payer: The Alliance Commercial |
$9,116.00
|
| Rate for Payer: WEA Trust Commercial |
$1,253.45
|
| Rate for Payer: WPS Commercial |
$1,688.06
|
|
|
SCREW ANCHORAGE NON-LOCK 3MMX18MM FT T8 BLUE PLSS3018
|
Facility
|
IP
|
$2,279.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685828
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,116.71 |
| Max. Negotiated Rate |
$2,096.68 |
| Rate for Payer: Aetna Commercial |
$2,051.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,959.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,207.87
|
| Rate for Payer: Cash Price |
$683.70
|
| Rate for Payer: Cigna Commercial |
$2,096.68
|
| Rate for Payer: Health EOS Commercial |
$2,028.31
|
| Rate for Payer: HFN Commercial |
$2,096.68
|
| Rate for Payer: Multiplan Commercial |
$1,823.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,367.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,096.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,116.71
|
| Rate for Payer: Quartz Commercial |
$1,367.40
|
| Rate for Payer: WEA Trust Commercial |
$1,253.45
|
| Rate for Payer: WPS Commercial |
$1,688.06
|
|
|
SCREW ANCHORAGE NON-LOCK 3MMX18MM FT T8 BLUE PLSS3018
|
Facility
|
OP
|
$2,279.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685828
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.12 |
| Max. Negotiated Rate |
$9,116.00 |
| Rate for Payer: Aetna Commercial |
$2,051.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,959.94
|
| Rate for Payer: Aetna Managed Medicare |
$638.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,481.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,139.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,093.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,207.87
|
| Rate for Payer: Cash Price |
$683.70
|
| Rate for Payer: Cigna Commercial |
$2,096.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,275.33
|
| Rate for Payer: Health EOS Commercial |
$2,028.31
|
| Rate for Payer: HFN Commercial |
$2,096.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,709.25
|
| Rate for Payer: Multiplan Commercial |
$1,823.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,367.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,096.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,116.71
|
| Rate for Payer: Quartz Commercial |
$1,481.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,367.40
|
| Rate for Payer: The Alliance Commercial |
$9,116.00
|
| Rate for Payer: WEA Trust Commercial |
$1,253.45
|
| Rate for Payer: WPS Commercial |
$1,688.06
|
|
|
SCREW ANCHORAGE NON-LOCK 3MMX20MM FT T8 BLUE PLSS3020
|
Facility
|
IP
|
$2,435.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5611634
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,193.15 |
| Max. Negotiated Rate |
$2,240.20 |
| Rate for Payer: Aetna Commercial |
$2,191.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,094.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,290.55
|
| Rate for Payer: Cash Price |
$730.50
|
| Rate for Payer: Cigna Commercial |
$2,240.20
|
| Rate for Payer: Health EOS Commercial |
$2,167.15
|
| Rate for Payer: HFN Commercial |
$2,240.20
|
| Rate for Payer: Multiplan Commercial |
$1,948.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,461.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,240.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,193.15
|
| Rate for Payer: Quartz Commercial |
$1,461.00
|
| Rate for Payer: WEA Trust Commercial |
$1,339.25
|
| Rate for Payer: WPS Commercial |
$1,803.60
|
|
|
SCREW ANCHORAGE NON-LOCK 3MMX20MM FT T8 BLUE PLSS3020
|
Facility
|
OP
|
$2,435.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5611634
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$681.80 |
| Max. Negotiated Rate |
$9,740.00 |
| Rate for Payer: Aetna Commercial |
$2,191.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,094.10
|
| Rate for Payer: Aetna Managed Medicare |
$681.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,582.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,217.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,168.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,290.55
|
| Rate for Payer: Cash Price |
$730.50
|
| Rate for Payer: Cigna Commercial |
$2,240.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,362.63
|
| Rate for Payer: Health EOS Commercial |
$2,167.15
|
| Rate for Payer: HFN Commercial |
$2,240.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,826.25
|
| Rate for Payer: Multiplan Commercial |
$1,948.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,461.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,240.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,193.15
|
| Rate for Payer: Quartz Commercial |
$1,582.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,461.00
|
| Rate for Payer: The Alliance Commercial |
$9,740.00
|
| Rate for Payer: WEA Trust Commercial |
$1,339.25
|
| Rate for Payer: WPS Commercial |
$1,803.60
|
|
|
SCREW ANCHORAGE NON-LOCK 3MMX22MM FT T8 BLUE PLSS3022
|
Facility
|
IP
|
$2,232.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5729729
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,093.68 |
| Max. Negotiated Rate |
$2,053.44 |
| Rate for Payer: Aetna Commercial |
$2,008.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,919.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,182.96
|
| Rate for Payer: Cash Price |
$669.60
|
| Rate for Payer: Cigna Commercial |
$2,053.44
|
| Rate for Payer: Health EOS Commercial |
$1,986.48
|
| Rate for Payer: HFN Commercial |
$2,053.44
|
| Rate for Payer: Multiplan Commercial |
$1,785.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,339.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,053.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,093.68
|
| Rate for Payer: Quartz Commercial |
$1,339.20
|
| Rate for Payer: WEA Trust Commercial |
$1,227.60
|
| Rate for Payer: WPS Commercial |
$1,653.24
|
|
|
SCREW ANCHORAGE NON-LOCK 3MMX22MM FT T8 BLUE PLSS3022
|
Facility
|
OP
|
$2,232.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5729729
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$624.96 |
| Max. Negotiated Rate |
$8,928.00 |
| Rate for Payer: Aetna Commercial |
$2,008.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,919.52
|
| Rate for Payer: Aetna Managed Medicare |
$624.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,450.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,116.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,071.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,182.96
|
| Rate for Payer: Cash Price |
$669.60
|
| Rate for Payer: Cigna Commercial |
$2,053.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,249.03
|
| Rate for Payer: Health EOS Commercial |
$1,986.48
|
| Rate for Payer: HFN Commercial |
$2,053.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,674.00
|
| Rate for Payer: Multiplan Commercial |
$1,785.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,339.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,053.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,093.68
|
| Rate for Payer: Quartz Commercial |
$1,450.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,339.20
|
| Rate for Payer: The Alliance Commercial |
$8,928.00
|
| Rate for Payer: WEA Trust Commercial |
$1,227.60
|
| Rate for Payer: WPS Commercial |
$1,653.24
|
|
