|
SCREW-AMBI 4.5 X 36 7112-9236
|
Facility
|
OP
|
$345.00
|
|
| Hospital Charge Code |
2965985
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$100.46 |
| Max. Negotiated Rate |
$330.10 |
| Rate for Payer: Aetna Commercial |
$322.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$308.57
|
| Rate for Payer: Aetna Managed Medicare |
$100.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$233.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$179.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$172.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$190.16
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$330.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$200.79
|
| Rate for Payer: Health EOS Commercial |
$319.33
|
| Rate for Payer: HFN Commercial |
$330.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$269.10
|
| Rate for Payer: Multiplan Commercial |
$287.04
|
| Rate for Payer: NAPHCARE Commercial |
$215.28
|
| Rate for Payer: Preferred Network Access Commercial |
$330.10
|
| Rate for Payer: Quartz Beloit One Network |
$175.81
|
| Rate for Payer: Quartz Commercial |
$233.22
|
| Rate for Payer: Quartz Medicare Advantage |
$215.28
|
| Rate for Payer: The Alliance Commercial |
$179.40
|
| Rate for Payer: WEA Trust Commercial |
$197.34
|
| Rate for Payer: WPS Commercial |
$265.75
|
|
|
SCREW-AMBI 4.5 X 36 7112-9236
|
Facility
|
IP
|
$345.00
|
|
| Hospital Charge Code |
2965985
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$175.81 |
| Max. Negotiated Rate |
$330.10 |
| Rate for Payer: Aetna Commercial |
$322.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$308.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$190.16
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$330.10
|
| Rate for Payer: Health EOS Commercial |
$319.33
|
| Rate for Payer: HFN Commercial |
$330.10
|
| Rate for Payer: Multiplan Commercial |
$287.04
|
| Rate for Payer: Preferred Network Access Commercial |
$330.10
|
| Rate for Payer: Quartz Beloit One Network |
$175.81
|
| Rate for Payer: Quartz Commercial |
$215.28
|
| Rate for Payer: WEA Trust Commercial |
$197.34
|
| Rate for Payer: WPS Commercial |
$265.75
|
|
|
SCREW-AMBI 4.5 X 38 7112-9238
|
Facility
|
IP
|
$345.00
|
|
| Hospital Charge Code |
2965986
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$175.81 |
| Max. Negotiated Rate |
$330.10 |
| Rate for Payer: Aetna Commercial |
$322.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$308.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$190.16
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$330.10
|
| Rate for Payer: Health EOS Commercial |
$319.33
|
| Rate for Payer: HFN Commercial |
$330.10
|
| Rate for Payer: Multiplan Commercial |
$287.04
|
| Rate for Payer: Preferred Network Access Commercial |
$330.10
|
| Rate for Payer: Quartz Beloit One Network |
$175.81
|
| Rate for Payer: Quartz Commercial |
$215.28
|
| Rate for Payer: WEA Trust Commercial |
$197.34
|
| Rate for Payer: WPS Commercial |
$265.75
|
|
|
SCREW-AMBI 4.5 X 38 7112-9238
|
Facility
|
OP
|
$345.00
|
|
| Hospital Charge Code |
2965986
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$100.46 |
| Max. Negotiated Rate |
$330.10 |
| Rate for Payer: Aetna Commercial |
$322.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$308.57
|
| Rate for Payer: Aetna Managed Medicare |
$100.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$233.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$179.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$172.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$190.16
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$330.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$200.79
|
| Rate for Payer: Health EOS Commercial |
$319.33
|
| Rate for Payer: HFN Commercial |
$330.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$269.10
|
| Rate for Payer: Multiplan Commercial |
$287.04
|
| Rate for Payer: NAPHCARE Commercial |
$215.28
|
| Rate for Payer: Preferred Network Access Commercial |
$330.10
|
| Rate for Payer: Quartz Beloit One Network |
$175.81
|
| Rate for Payer: Quartz Commercial |
$233.22
|
| Rate for Payer: Quartz Medicare Advantage |
$215.28
|
| Rate for Payer: The Alliance Commercial |
$179.40
|
| Rate for Payer: WEA Trust Commercial |
$197.34
|
| Rate for Payer: WPS Commercial |
$265.75
|
|
|
SCREW-AMBI 4.5 X 40 7112-9240
|
Facility
|
IP
|
$345.00
|
|
| Hospital Charge Code |
2965987
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$175.81 |
| Max. Negotiated Rate |
$330.10 |
| Rate for Payer: Aetna Commercial |
$322.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$308.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$190.16
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$330.10
|
| Rate for Payer: Health EOS Commercial |
$319.33
|
| Rate for Payer: HFN Commercial |
$330.10
|
| Rate for Payer: Multiplan Commercial |
$287.04
|
| Rate for Payer: Preferred Network Access Commercial |
$330.10
|
| Rate for Payer: Quartz Beloit One Network |
$175.81
|
| Rate for Payer: Quartz Commercial |
$215.28
|
| Rate for Payer: WEA Trust Commercial |
$197.34
|
| Rate for Payer: WPS Commercial |
$265.75
|
|
|
SCREW-AMBI 4.5 X 40 7112-9240
|
Facility
|
OP
|
$345.00
|
|
| Hospital Charge Code |
2965987
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$100.46 |
| Max. Negotiated Rate |
$330.10 |
| Rate for Payer: Aetna Commercial |
$322.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$308.57
|
| Rate for Payer: Aetna Managed Medicare |
$100.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$233.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$179.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$172.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$190.16
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$330.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$200.79
|
| Rate for Payer: Health EOS Commercial |
$319.33
|
| Rate for Payer: HFN Commercial |
$330.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$269.10
|
| Rate for Payer: Multiplan Commercial |
$287.04
|
| Rate for Payer: NAPHCARE Commercial |
$215.28
|
| Rate for Payer: Preferred Network Access Commercial |
$330.10
|
| Rate for Payer: Quartz Beloit One Network |
$175.81
|
| Rate for Payer: Quartz Commercial |
$233.22
|
| Rate for Payer: Quartz Medicare Advantage |
$215.28
|
| Rate for Payer: The Alliance Commercial |
$179.40
|
| Rate for Payer: WEA Trust Commercial |
$197.34
|
| Rate for Payer: WPS Commercial |
$265.75
|
|
|
SCREW-AMBI 4.5 X 42 7112-9242
|
Facility
|
IP
|
$345.00
|
|
| Hospital Charge Code |
2965988
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$175.81 |
| Max. Negotiated Rate |
$330.10 |
| Rate for Payer: Aetna Commercial |
$322.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$308.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$190.16
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$330.10
|
| Rate for Payer: Health EOS Commercial |
$319.33
|
| Rate for Payer: HFN Commercial |
$330.10
|
| Rate for Payer: Multiplan Commercial |
$287.04
|
| Rate for Payer: Preferred Network Access Commercial |
$330.10
|
| Rate for Payer: Quartz Beloit One Network |
$175.81
|
| Rate for Payer: Quartz Commercial |
$215.28
|
| Rate for Payer: WEA Trust Commercial |
$197.34
|
| Rate for Payer: WPS Commercial |
$265.75
|
|
|
SCREW-AMBI 4.5 X 42 7112-9242
|
Facility
|
OP
|
$345.00
|
|
| Hospital Charge Code |
2965988
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$100.46 |
| Max. Negotiated Rate |
$330.10 |
| Rate for Payer: Aetna Commercial |
$322.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$308.57
|
| Rate for Payer: Aetna Managed Medicare |
$100.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$233.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$179.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$172.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$190.16
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$330.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$200.79
|
| Rate for Payer: Health EOS Commercial |
$319.33
|
| Rate for Payer: HFN Commercial |
$330.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$269.10
|
| Rate for Payer: Multiplan Commercial |
$287.04
|
| Rate for Payer: NAPHCARE Commercial |
$215.28
|
| Rate for Payer: Preferred Network Access Commercial |
$330.10
|
| Rate for Payer: Quartz Beloit One Network |
$175.81
|
| Rate for Payer: Quartz Commercial |
$233.22
|
| Rate for Payer: Quartz Medicare Advantage |
$215.28
|
| Rate for Payer: The Alliance Commercial |
$179.40
|
| Rate for Payer: WEA Trust Commercial |
$197.34
|
| Rate for Payer: WPS Commercial |
$265.75
|
|
|
SCREW-AMBI 4.5 X 44 7112-9244
|
Facility
|
IP
|
$345.00
|
|
| Hospital Charge Code |
2965989
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$175.81 |
| Max. Negotiated Rate |
$330.10 |
| Rate for Payer: Aetna Commercial |
$322.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$308.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$190.16
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$330.10
|
| Rate for Payer: Health EOS Commercial |
$319.33
|
| Rate for Payer: HFN Commercial |
$330.10
|
| Rate for Payer: Multiplan Commercial |
$287.04
|
| Rate for Payer: Preferred Network Access Commercial |
$330.10
|
| Rate for Payer: Quartz Beloit One Network |
$175.81
|
| Rate for Payer: Quartz Commercial |
$215.28
|
| Rate for Payer: WEA Trust Commercial |
$197.34
|
| Rate for Payer: WPS Commercial |
$265.75
|
|
|
SCREW-AMBI 4.5 X 44 7112-9244
|
Facility
|
OP
|
$345.00
|
|
| Hospital Charge Code |
2965989
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$100.46 |
| Max. Negotiated Rate |
$330.10 |
| Rate for Payer: Aetna Commercial |
$322.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$308.57
|
| Rate for Payer: Aetna Managed Medicare |
$100.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$233.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$179.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$172.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$190.16
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$330.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$200.79
|
| Rate for Payer: Health EOS Commercial |
$319.33
|
| Rate for Payer: HFN Commercial |
$330.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$269.10
|
| Rate for Payer: Multiplan Commercial |
$287.04
|
| Rate for Payer: NAPHCARE Commercial |
$215.28
|
| Rate for Payer: Preferred Network Access Commercial |
$330.10
|
| Rate for Payer: Quartz Beloit One Network |
$175.81
|
| Rate for Payer: Quartz Commercial |
$233.22
|
| Rate for Payer: Quartz Medicare Advantage |
$215.28
|
| Rate for Payer: The Alliance Commercial |
$179.40
|
| Rate for Payer: WEA Trust Commercial |
$197.34
|
| Rate for Payer: WPS Commercial |
$265.75
|
|
|
SCREW-AMBI 4.5 X 46 7112-9246
|
Facility
|
IP
|
$345.00
|
|
| Hospital Charge Code |
2965990
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$175.81 |
| Max. Negotiated Rate |
$330.10 |
| Rate for Payer: Aetna Commercial |
$322.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$308.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$190.16
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$330.10
|
| Rate for Payer: Health EOS Commercial |
$319.33
|
| Rate for Payer: HFN Commercial |
$330.10
|
| Rate for Payer: Multiplan Commercial |
$287.04
|
| Rate for Payer: Preferred Network Access Commercial |
$330.10
|
| Rate for Payer: Quartz Beloit One Network |
$175.81
|
| Rate for Payer: Quartz Commercial |
$215.28
|
| Rate for Payer: WEA Trust Commercial |
$197.34
|
| Rate for Payer: WPS Commercial |
$265.75
|
|
|
SCREW-AMBI 4.5 X 46 7112-9246
|
Facility
|
OP
|
$345.00
|
|
| Hospital Charge Code |
2965990
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$100.46 |
| Max. Negotiated Rate |
$330.10 |
| Rate for Payer: Aetna Commercial |
$322.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$308.57
|
| Rate for Payer: Aetna Managed Medicare |
$100.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$233.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$179.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$172.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$190.16
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$330.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$200.79
|
| Rate for Payer: Health EOS Commercial |
$319.33
|
| Rate for Payer: HFN Commercial |
$330.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$269.10
|
| Rate for Payer: Multiplan Commercial |
$287.04
|
| Rate for Payer: NAPHCARE Commercial |
$215.28
|
| Rate for Payer: Preferred Network Access Commercial |
$330.10
|
| Rate for Payer: Quartz Beloit One Network |
$175.81
|
| Rate for Payer: Quartz Commercial |
$233.22
|
| Rate for Payer: Quartz Medicare Advantage |
$215.28
|
| Rate for Payer: The Alliance Commercial |
$179.40
|
| Rate for Payer: WEA Trust Commercial |
$197.34
|
| Rate for Payer: WPS Commercial |
$265.75
|
|
|
SCREW-AMBI 4.5 X 48 7112-9248
|
Facility
|
OP
|
$345.00
|
|
| Hospital Charge Code |
2965991
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$100.46 |
| Max. Negotiated Rate |
$330.10 |
| Rate for Payer: Aetna Commercial |
$322.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$308.57
|
| Rate for Payer: Aetna Managed Medicare |
$100.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$233.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$179.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$172.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$190.16
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$330.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$200.79
|
| Rate for Payer: Health EOS Commercial |
$319.33
|
| Rate for Payer: HFN Commercial |
$330.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$269.10
|
| Rate for Payer: Multiplan Commercial |
$287.04
|
| Rate for Payer: NAPHCARE Commercial |
$215.28
|
| Rate for Payer: Preferred Network Access Commercial |
$330.10
|
| Rate for Payer: Quartz Beloit One Network |
$175.81
|
| Rate for Payer: Quartz Commercial |
$233.22
|
| Rate for Payer: Quartz Medicare Advantage |
$215.28
|
| Rate for Payer: The Alliance Commercial |
$179.40
|
| Rate for Payer: WEA Trust Commercial |
$197.34
|
| Rate for Payer: WPS Commercial |
$265.75
|
|
|
SCREW-AMBI 4.5 X 48 7112-9248
|
Facility
|
IP
|
$345.00
|
|
| Hospital Charge Code |
2965991
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$175.81 |
| Max. Negotiated Rate |
$330.10 |
| Rate for Payer: Aetna Commercial |
$322.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$308.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$190.16
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$330.10
|
| Rate for Payer: Health EOS Commercial |
$319.33
|
| Rate for Payer: HFN Commercial |
$330.10
|
| Rate for Payer: Multiplan Commercial |
$287.04
|
| Rate for Payer: Preferred Network Access Commercial |
$330.10
|
| Rate for Payer: Quartz Beloit One Network |
$175.81
|
| Rate for Payer: Quartz Commercial |
$215.28
|
| Rate for Payer: WEA Trust Commercial |
$197.34
|
| Rate for Payer: WPS Commercial |
$265.75
|
|
|
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 |
$767.89 |
| Max. Negotiated Rate |
$2,523.08 |
| Rate for Payer: Aetna Commercial |
$2,468.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,358.53
|
| Rate for Payer: Aetna Managed Medicare |
$767.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,782.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,371.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,316.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,453.51
|
| Rate for Payer: Cash Price |
$791.10
|
| Rate for Payer: Cigna Commercial |
$2,523.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,534.73
|
| Rate for Payer: Health EOS Commercial |
$2,440.81
|
| Rate for Payer: HFN Commercial |
$2,523.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,056.86
|
| Rate for Payer: Multiplan Commercial |
$2,193.98
|
| Rate for Payer: NAPHCARE Commercial |
$1,645.49
|
| Rate for Payer: Preferred Network Access Commercial |
$2,523.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,343.82
|
| Rate for Payer: Quartz Commercial |
$1,782.61
|
| Rate for Payer: Quartz Medicare Advantage |
$1,645.49
|
| Rate for Payer: The Alliance Commercial |
$1,371.24
|
| Rate for Payer: WEA Trust Commercial |
$1,508.36
|
| Rate for Payer: WPS Commercial |
$2,031.28
|
|
|
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 |
$1,343.82 |
| Max. Negotiated Rate |
$2,523.08 |
| Rate for Payer: Aetna Commercial |
$2,468.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,358.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,453.51
|
| Rate for Payer: Cash Price |
$791.10
|
| Rate for Payer: Cigna Commercial |
$2,523.08
|
| Rate for Payer: Health EOS Commercial |
$2,440.81
|
| Rate for Payer: HFN Commercial |
$2,523.08
|
| Rate for Payer: Multiplan Commercial |
$2,193.98
|
| Rate for Payer: Preferred Network Access Commercial |
$2,523.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,343.82
|
| Rate for Payer: Quartz Commercial |
$1,645.49
|
| Rate for Payer: WEA Trust Commercial |
$1,508.36
|
| Rate for Payer: WPS Commercial |
$2,031.28
|
|
|
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 |
$871.27 |
| Max. Negotiated Rate |
$2,862.75 |
| Rate for Payer: Aetna Commercial |
$2,800.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,676.04
|
| Rate for Payer: Aetna Managed Medicare |
$871.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,022.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,555.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,493.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,649.19
|
| Rate for Payer: Cash Price |
$897.60
|
| Rate for Payer: Cigna Commercial |
$2,862.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,741.34
|
| Rate for Payer: Health EOS Commercial |
$2,769.40
|
| Rate for Payer: HFN Commercial |
$2,862.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,333.76
|
| Rate for Payer: Multiplan Commercial |
$2,489.34
|
| Rate for Payer: NAPHCARE Commercial |
$1,867.01
|
| Rate for Payer: Preferred Network Access Commercial |
$2,862.75
|
| Rate for Payer: Quartz Beloit One Network |
$1,524.72
|
| Rate for Payer: Quartz Commercial |
$2,022.59
|
| Rate for Payer: Quartz Medicare Advantage |
$1,867.01
|
| Rate for Payer: The Alliance Commercial |
$1,555.84
|
| Rate for Payer: WEA Trust Commercial |
$1,711.42
|
| Rate for Payer: WPS Commercial |
$2,304.74
|
|
|
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 |
$1,524.72 |
| Max. Negotiated Rate |
$2,862.75 |
| Rate for Payer: Aetna Commercial |
$2,800.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,676.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,649.19
|
| Rate for Payer: Cash Price |
$897.60
|
| Rate for Payer: Cigna Commercial |
$2,862.75
|
| Rate for Payer: Health EOS Commercial |
$2,769.40
|
| Rate for Payer: HFN Commercial |
$2,862.75
|
| Rate for Payer: Multiplan Commercial |
$2,489.34
|
| Rate for Payer: Preferred Network Access Commercial |
$2,862.75
|
| Rate for Payer: Quartz Beloit One Network |
$1,524.72
|
| Rate for Payer: Quartz Commercial |
$1,867.01
|
| Rate for Payer: WEA Trust Commercial |
$1,711.42
|
| Rate for Payer: WPS Commercial |
$2,304.74
|
|
|
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 |
$1,524.72 |
| Max. Negotiated Rate |
$2,862.75 |
| Rate for Payer: Aetna Commercial |
$2,800.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,676.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,649.19
|
| Rate for Payer: Cash Price |
$897.60
|
| Rate for Payer: Cigna Commercial |
$2,862.75
|
| Rate for Payer: Health EOS Commercial |
$2,769.40
|
| Rate for Payer: HFN Commercial |
$2,862.75
|
| Rate for Payer: Multiplan Commercial |
$2,489.34
|
| Rate for Payer: Preferred Network Access Commercial |
$2,862.75
|
| Rate for Payer: Quartz Beloit One Network |
$1,524.72
|
| Rate for Payer: Quartz Commercial |
$1,867.01
|
| Rate for Payer: WEA Trust Commercial |
$1,711.42
|
| Rate for Payer: WPS Commercial |
$2,304.74
|
|
|
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 |
$871.27 |
| Max. Negotiated Rate |
$2,862.75 |
| Rate for Payer: Aetna Commercial |
$2,800.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,676.04
|
| Rate for Payer: Aetna Managed Medicare |
$871.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,022.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,555.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,493.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,649.19
|
| Rate for Payer: Cash Price |
$897.60
|
| Rate for Payer: Cigna Commercial |
$2,862.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,741.34
|
| Rate for Payer: Health EOS Commercial |
$2,769.40
|
| Rate for Payer: HFN Commercial |
$2,862.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,333.76
|
| Rate for Payer: Multiplan Commercial |
$2,489.34
|
| Rate for Payer: NAPHCARE Commercial |
$1,867.01
|
| Rate for Payer: Preferred Network Access Commercial |
$2,862.75
|
| Rate for Payer: Quartz Beloit One Network |
$1,524.72
|
| Rate for Payer: Quartz Commercial |
$2,022.59
|
| Rate for Payer: Quartz Medicare Advantage |
$1,867.01
|
| Rate for Payer: The Alliance Commercial |
$1,555.84
|
| Rate for Payer: WEA Trust Commercial |
$1,711.42
|
| Rate for Payer: WPS Commercial |
$2,304.74
|
|
|
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 |
$871.27 |
| Max. Negotiated Rate |
$2,862.75 |
| Rate for Payer: Aetna Commercial |
$2,800.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,676.04
|
| Rate for Payer: Aetna Managed Medicare |
$871.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,022.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,555.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,493.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,649.19
|
| Rate for Payer: Cash Price |
$897.60
|
| Rate for Payer: Cigna Commercial |
$2,862.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,741.34
|
| Rate for Payer: Health EOS Commercial |
$2,769.40
|
| Rate for Payer: HFN Commercial |
$2,862.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,333.76
|
| Rate for Payer: Multiplan Commercial |
$2,489.34
|
| Rate for Payer: NAPHCARE Commercial |
$1,867.01
|
| Rate for Payer: Preferred Network Access Commercial |
$2,862.75
|
| Rate for Payer: Quartz Beloit One Network |
$1,524.72
|
| Rate for Payer: Quartz Commercial |
$2,022.59
|
| Rate for Payer: Quartz Medicare Advantage |
$1,867.01
|
| Rate for Payer: The Alliance Commercial |
$1,555.84
|
| Rate for Payer: WEA Trust Commercial |
$1,711.42
|
| Rate for Payer: WPS Commercial |
$2,304.74
|
|
|
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 |
$1,524.72 |
| Max. Negotiated Rate |
$2,862.75 |
| Rate for Payer: Aetna Commercial |
$2,800.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,676.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,649.19
|
| Rate for Payer: Cash Price |
$897.60
|
| Rate for Payer: Cigna Commercial |
$2,862.75
|
| Rate for Payer: Health EOS Commercial |
$2,769.40
|
| Rate for Payer: HFN Commercial |
$2,862.75
|
| Rate for Payer: Multiplan Commercial |
$2,489.34
|
| Rate for Payer: Preferred Network Access Commercial |
$2,862.75
|
| Rate for Payer: Quartz Beloit One Network |
$1,524.72
|
| Rate for Payer: Quartz Commercial |
$1,867.01
|
| Rate for Payer: WEA Trust Commercial |
$1,711.42
|
| Rate for Payer: WPS Commercial |
$2,304.74
|
|
|
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 |
$1,524.72 |
| Max. Negotiated Rate |
$2,862.75 |
| Rate for Payer: Aetna Commercial |
$2,800.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,676.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,649.19
|
| Rate for Payer: Cash Price |
$897.60
|
| Rate for Payer: Cigna Commercial |
$2,862.75
|
| Rate for Payer: Health EOS Commercial |
$2,769.40
|
| Rate for Payer: HFN Commercial |
$2,862.75
|
| Rate for Payer: Multiplan Commercial |
$2,489.34
|
| Rate for Payer: Preferred Network Access Commercial |
$2,862.75
|
| Rate for Payer: Quartz Beloit One Network |
$1,524.72
|
| Rate for Payer: Quartz Commercial |
$1,867.01
|
| Rate for Payer: WEA Trust Commercial |
$1,711.42
|
| Rate for Payer: WPS Commercial |
$2,304.74
|
|
|
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 |
$871.27 |
| Max. Negotiated Rate |
$2,862.75 |
| Rate for Payer: Aetna Commercial |
$2,800.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,676.04
|
| Rate for Payer: Aetna Managed Medicare |
$871.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,022.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,555.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,493.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,649.19
|
| Rate for Payer: Cash Price |
$897.60
|
| Rate for Payer: Cigna Commercial |
$2,862.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,741.34
|
| Rate for Payer: Health EOS Commercial |
$2,769.40
|
| Rate for Payer: HFN Commercial |
$2,862.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,333.76
|
| Rate for Payer: Multiplan Commercial |
$2,489.34
|
| Rate for Payer: NAPHCARE Commercial |
$1,867.01
|
| Rate for Payer: Preferred Network Access Commercial |
$2,862.75
|
| Rate for Payer: Quartz Beloit One Network |
$1,524.72
|
| Rate for Payer: Quartz Commercial |
$2,022.59
|
| Rate for Payer: Quartz Medicare Advantage |
$1,867.01
|
| Rate for Payer: The Alliance Commercial |
$1,555.84
|
| Rate for Payer: WEA Trust Commercial |
$1,711.42
|
| Rate for Payer: WPS Commercial |
$2,304.74
|
|
|
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 |
$767.89 |
| Max. Negotiated Rate |
$2,523.08 |
| Rate for Payer: Aetna Commercial |
$2,468.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,358.53
|
| Rate for Payer: Aetna Managed Medicare |
$767.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,782.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,371.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,316.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,453.51
|
| Rate for Payer: Cash Price |
$791.10
|
| Rate for Payer: Cigna Commercial |
$2,523.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,534.73
|
| Rate for Payer: Health EOS Commercial |
$2,440.81
|
| Rate for Payer: HFN Commercial |
$2,523.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,056.86
|
| Rate for Payer: Multiplan Commercial |
$2,193.98
|
| Rate for Payer: NAPHCARE Commercial |
$1,645.49
|
| Rate for Payer: Preferred Network Access Commercial |
$2,523.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,343.82
|
| Rate for Payer: Quartz Commercial |
$1,782.61
|
| Rate for Payer: Quartz Medicare Advantage |
$1,645.49
|
| Rate for Payer: The Alliance Commercial |
$1,371.24
|
| Rate for Payer: WEA Trust Commercial |
$1,508.36
|
| Rate for Payer: WPS Commercial |
$2,031.28
|
|
