|
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 |
$1,343.82 |
| 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 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 |
$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 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 |
$1,343.82 |
| 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 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 |
$753.04 |
| Max. Negotiated Rate |
$2,474.28 |
| Rate for Payer: Aetna Commercial |
$2,420.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,312.92
|
| Rate for Payer: Aetna Managed Medicare |
$753.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,748.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,344.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,290.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,425.40
|
| Rate for Payer: Cash Price |
$775.80
|
| Rate for Payer: Cigna Commercial |
$2,474.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,505.05
|
| Rate for Payer: Health EOS Commercial |
$2,393.60
|
| Rate for Payer: HFN Commercial |
$2,474.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,017.08
|
| Rate for Payer: Multiplan Commercial |
$2,151.55
|
| Rate for Payer: NAPHCARE Commercial |
$1,613.66
|
| Rate for Payer: Preferred Network Access Commercial |
$2,474.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,317.83
|
| Rate for Payer: Quartz Commercial |
$1,748.14
|
| Rate for Payer: Quartz Medicare Advantage |
$1,613.66
|
| Rate for Payer: The Alliance Commercial |
$1,344.72
|
| Rate for Payer: WEA Trust Commercial |
$1,479.19
|
| Rate for Payer: WPS Commercial |
$1,992.00
|
|
|
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 |
$1,317.83 |
| Max. Negotiated Rate |
$2,474.28 |
| Rate for Payer: Aetna Commercial |
$2,420.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,312.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,425.40
|
| Rate for Payer: Cash Price |
$775.80
|
| Rate for Payer: Cigna Commercial |
$2,474.28
|
| Rate for Payer: Health EOS Commercial |
$2,393.60
|
| Rate for Payer: HFN Commercial |
$2,474.28
|
| Rate for Payer: Multiplan Commercial |
$2,151.55
|
| Rate for Payer: Preferred Network Access Commercial |
$2,474.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,317.83
|
| Rate for Payer: Quartz Commercial |
$1,613.66
|
| Rate for Payer: WEA Trust Commercial |
$1,479.19
|
| Rate for Payer: WPS Commercial |
$1,992.00
|
|
|
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 |
$663.64 |
| Max. Negotiated Rate |
$2,180.55 |
| Rate for Payer: Aetna Commercial |
$2,133.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,038.34
|
| Rate for Payer: Aetna Managed Medicare |
$663.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,540.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,185.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,137.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,256.18
|
| Rate for Payer: Cash Price |
$683.70
|
| Rate for Payer: Cigna Commercial |
$2,180.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,326.38
|
| Rate for Payer: Health EOS Commercial |
$2,109.44
|
| Rate for Payer: HFN Commercial |
$2,180.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,777.62
|
| Rate for Payer: Multiplan Commercial |
$1,896.13
|
| Rate for Payer: NAPHCARE Commercial |
$1,422.10
|
| Rate for Payer: Preferred Network Access Commercial |
$2,180.55
|
| Rate for Payer: Quartz Beloit One Network |
$1,161.38
|
| Rate for Payer: Quartz Commercial |
$1,540.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,422.10
|
| Rate for Payer: The Alliance Commercial |
$1,185.08
|
| Rate for Payer: WEA Trust Commercial |
$1,303.59
|
| Rate for Payer: WPS Commercial |
$1,755.51
|
|
|
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 |
$1,161.38 |
| Max. Negotiated Rate |
$2,180.55 |
| Rate for Payer: Aetna Commercial |
$2,133.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,038.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,256.18
|
| Rate for Payer: Cash Price |
$683.70
|
| Rate for Payer: Cigna Commercial |
$2,180.55
|
| Rate for Payer: Health EOS Commercial |
$2,109.44
|
| Rate for Payer: HFN Commercial |
$2,180.55
|
| Rate for Payer: Multiplan Commercial |
$1,896.13
|
| Rate for Payer: Preferred Network Access Commercial |
$2,180.55
|
| Rate for Payer: Quartz Beloit One Network |
$1,161.38
|
| Rate for Payer: Quartz Commercial |
$1,422.10
|
| Rate for Payer: WEA Trust Commercial |
$1,303.59
|
| Rate for Payer: WPS Commercial |
$1,755.51
|
|
|
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 |
$663.64 |
| Max. Negotiated Rate |
$2,180.55 |
| Rate for Payer: Aetna Commercial |
$2,133.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,038.34
|
| Rate for Payer: Aetna Managed Medicare |
$663.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,540.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,185.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,137.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,256.18
|
| Rate for Payer: Cash Price |
$683.70
|
| Rate for Payer: Cigna Commercial |
$2,180.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,326.38
|
| Rate for Payer: Health EOS Commercial |
$2,109.44
|
| Rate for Payer: HFN Commercial |
$2,180.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,777.62
|
| Rate for Payer: Multiplan Commercial |
$1,896.13
|
| Rate for Payer: NAPHCARE Commercial |
$1,422.10
|
| Rate for Payer: Preferred Network Access Commercial |
$2,180.55
|
| Rate for Payer: Quartz Beloit One Network |
$1,161.38
|
| Rate for Payer: Quartz Commercial |
$1,540.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,422.10
|
| Rate for Payer: The Alliance Commercial |
$1,185.08
|
| Rate for Payer: WEA Trust Commercial |
$1,303.59
|
| Rate for Payer: WPS Commercial |
$1,755.51
|
|
|
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 |
$1,161.38 |
| Max. Negotiated Rate |
$2,180.55 |
| Rate for Payer: Aetna Commercial |
$2,133.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,038.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,256.18
|
| Rate for Payer: Cash Price |
$683.70
|
| Rate for Payer: Cigna Commercial |
$2,180.55
|
| Rate for Payer: Health EOS Commercial |
$2,109.44
|
| Rate for Payer: HFN Commercial |
$2,180.55
|
| Rate for Payer: Multiplan Commercial |
$1,896.13
|
| Rate for Payer: Preferred Network Access Commercial |
$2,180.55
|
| Rate for Payer: Quartz Beloit One Network |
$1,161.38
|
| Rate for Payer: Quartz Commercial |
$1,422.10
|
| Rate for Payer: WEA Trust Commercial |
$1,303.59
|
| Rate for Payer: WPS Commercial |
$1,755.51
|
|
|
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 |
$709.07 |
| Max. Negotiated Rate |
$2,329.81 |
| Rate for Payer: Aetna Commercial |
$2,279.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,177.86
|
| Rate for Payer: Aetna Managed Medicare |
$709.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,646.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,266.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,215.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,342.17
|
| Rate for Payer: Cash Price |
$730.50
|
| Rate for Payer: Cigna Commercial |
$2,329.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,417.17
|
| Rate for Payer: Health EOS Commercial |
$2,253.84
|
| Rate for Payer: HFN Commercial |
$2,329.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,899.30
|
| Rate for Payer: Multiplan Commercial |
$2,025.92
|
| Rate for Payer: NAPHCARE Commercial |
$1,519.44
|
| Rate for Payer: Preferred Network Access Commercial |
$2,329.81
|
| Rate for Payer: Quartz Beloit One Network |
$1,240.88
|
| Rate for Payer: Quartz Commercial |
$1,646.06
|
| Rate for Payer: Quartz Medicare Advantage |
$1,519.44
|
| Rate for Payer: The Alliance Commercial |
$1,266.20
|
| Rate for Payer: WEA Trust Commercial |
$1,392.82
|
| Rate for Payer: WPS Commercial |
$1,875.68
|
|
|
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 |
$1,240.88 |
| Max. Negotiated Rate |
$2,329.81 |
| Rate for Payer: Aetna Commercial |
$2,279.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,177.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,342.17
|
| Rate for Payer: Cash Price |
$730.50
|
| Rate for Payer: Cigna Commercial |
$2,329.81
|
| Rate for Payer: Health EOS Commercial |
$2,253.84
|
| Rate for Payer: HFN Commercial |
$2,329.81
|
| Rate for Payer: Multiplan Commercial |
$2,025.92
|
| Rate for Payer: Preferred Network Access Commercial |
$2,329.81
|
| Rate for Payer: Quartz Beloit One Network |
$1,240.88
|
| Rate for Payer: Quartz Commercial |
$1,519.44
|
| Rate for Payer: WEA Trust Commercial |
$1,392.82
|
| Rate for Payer: WPS Commercial |
$1,875.68
|
|
|
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 |
$649.96 |
| Max. Negotiated Rate |
$2,135.58 |
| Rate for Payer: Aetna Commercial |
$2,089.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,996.30
|
| Rate for Payer: Aetna Managed Medicare |
$649.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,508.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,160.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,114.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,230.28
|
| Rate for Payer: Cash Price |
$669.60
|
| Rate for Payer: Cigna Commercial |
$2,135.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,299.02
|
| Rate for Payer: Health EOS Commercial |
$2,065.94
|
| Rate for Payer: HFN Commercial |
$2,135.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,740.96
|
| Rate for Payer: Multiplan Commercial |
$1,857.02
|
| Rate for Payer: NAPHCARE Commercial |
$1,392.77
|
| Rate for Payer: Preferred Network Access Commercial |
$2,135.58
|
| Rate for Payer: Quartz Beloit One Network |
$1,137.43
|
| Rate for Payer: Quartz Commercial |
$1,508.83
|
| Rate for Payer: Quartz Medicare Advantage |
$1,392.77
|
| Rate for Payer: The Alliance Commercial |
$1,160.64
|
| Rate for Payer: WEA Trust Commercial |
$1,276.70
|
| Rate for Payer: WPS Commercial |
$1,719.31
|
|
|
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 |
$1,137.43 |
| Max. Negotiated Rate |
$2,135.58 |
| Rate for Payer: Aetna Commercial |
$2,089.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,996.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,230.28
|
| Rate for Payer: Cash Price |
$669.60
|
| Rate for Payer: Cigna Commercial |
$2,135.58
|
| Rate for Payer: Health EOS Commercial |
$2,065.94
|
| Rate for Payer: HFN Commercial |
$2,135.58
|
| Rate for Payer: Multiplan Commercial |
$1,857.02
|
| Rate for Payer: Preferred Network Access Commercial |
$2,135.58
|
| Rate for Payer: Quartz Beloit One Network |
$1,137.43
|
| Rate for Payer: Quartz Commercial |
$1,392.77
|
| Rate for Payer: WEA Trust Commercial |
$1,276.70
|
| Rate for Payer: WPS Commercial |
$1,719.31
|
|
|
SCREW ANCHORAGE NON-LOCK 3MMX26MM FT T8 BLUE PLSS3026
|
Facility
|
OP
|
$2,586.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5265001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$753.04 |
| Max. Negotiated Rate |
$2,474.28 |
| Rate for Payer: Aetna Commercial |
$2,420.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,312.92
|
| Rate for Payer: Aetna Managed Medicare |
$753.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,748.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,344.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,290.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,425.40
|
| Rate for Payer: Cash Price |
$775.80
|
| Rate for Payer: Cigna Commercial |
$2,474.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,505.05
|
| Rate for Payer: Health EOS Commercial |
$2,393.60
|
| Rate for Payer: HFN Commercial |
$2,474.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,017.08
|
| Rate for Payer: Multiplan Commercial |
$2,151.55
|
| Rate for Payer: NAPHCARE Commercial |
$1,613.66
|
| Rate for Payer: Preferred Network Access Commercial |
$2,474.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,317.83
|
| Rate for Payer: Quartz Commercial |
$1,748.14
|
| Rate for Payer: Quartz Medicare Advantage |
$1,613.66
|
| Rate for Payer: The Alliance Commercial |
$1,344.72
|
| Rate for Payer: WEA Trust Commercial |
$1,479.19
|
| Rate for Payer: WPS Commercial |
$1,992.00
|
|
|
SCREW ANCHORAGE NON-LOCK 3MMX26MM FT T8 BLUE PLSS3026
|
Facility
|
IP
|
$2,586.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5265001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,317.83 |
| Max. Negotiated Rate |
$2,474.28 |
| Rate for Payer: Aetna Commercial |
$2,420.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,312.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,425.40
|
| Rate for Payer: Cash Price |
$775.80
|
| Rate for Payer: Cigna Commercial |
$2,474.28
|
| Rate for Payer: Health EOS Commercial |
$2,393.60
|
| Rate for Payer: HFN Commercial |
$2,474.28
|
| Rate for Payer: Multiplan Commercial |
$2,151.55
|
| Rate for Payer: Preferred Network Access Commercial |
$2,474.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,317.83
|
| Rate for Payer: Quartz Commercial |
$1,613.66
|
| Rate for Payer: WEA Trust Commercial |
$1,479.19
|
| Rate for Payer: WPS Commercial |
$1,992.00
|
|
|
SCREW ANCHORAGE NON-LOCK 3MMX30MM FT T8 BLUE PLSS3030
|
Facility
|
IP
|
$2,232.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5831731
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,137.43 |
| Max. Negotiated Rate |
$2,135.58 |
| Rate for Payer: Aetna Commercial |
$2,089.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,996.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,230.28
|
| Rate for Payer: Cash Price |
$669.60
|
| Rate for Payer: Cigna Commercial |
$2,135.58
|
| Rate for Payer: Health EOS Commercial |
$2,065.94
|
| Rate for Payer: HFN Commercial |
$2,135.58
|
| Rate for Payer: Multiplan Commercial |
$1,857.02
|
| Rate for Payer: Preferred Network Access Commercial |
$2,135.58
|
| Rate for Payer: Quartz Beloit One Network |
$1,137.43
|
| Rate for Payer: Quartz Commercial |
$1,392.77
|
| Rate for Payer: WEA Trust Commercial |
$1,276.70
|
| Rate for Payer: WPS Commercial |
$1,719.31
|
|
|
SCREW ANCHORAGE NON-LOCK 3MMX30MM FT T8 BLUE PLSS3030
|
Facility
|
OP
|
$2,232.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5831731
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$649.96 |
| Max. Negotiated Rate |
$2,135.58 |
| Rate for Payer: Aetna Commercial |
$2,089.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,996.30
|
| Rate for Payer: Aetna Managed Medicare |
$649.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,508.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,160.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,114.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,230.28
|
| Rate for Payer: Cash Price |
$669.60
|
| Rate for Payer: Cigna Commercial |
$2,135.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,299.02
|
| Rate for Payer: Health EOS Commercial |
$2,065.94
|
| Rate for Payer: HFN Commercial |
$2,135.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,740.96
|
| Rate for Payer: Multiplan Commercial |
$1,857.02
|
| Rate for Payer: NAPHCARE Commercial |
$1,392.77
|
| Rate for Payer: Preferred Network Access Commercial |
$2,135.58
|
| Rate for Payer: Quartz Beloit One Network |
$1,137.43
|
| Rate for Payer: Quartz Commercial |
$1,508.83
|
| Rate for Payer: Quartz Medicare Advantage |
$1,392.77
|
| Rate for Payer: The Alliance Commercial |
$1,160.64
|
| Rate for Payer: WEA Trust Commercial |
$1,276.70
|
| Rate for Payer: WPS Commercial |
$1,719.31
|
|
|
SCREW ART SURF LOCK 5950-90
|
Facility
|
IP
|
$1,641.00
|
|
| Hospital Charge Code |
2967809
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$836.25 |
| Max. Negotiated Rate |
$1,570.11 |
| Rate for Payer: Aetna Commercial |
$1,535.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,467.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$904.52
|
| Rate for Payer: Cash Price |
$492.30
|
| Rate for Payer: Cigna Commercial |
$1,570.11
|
| Rate for Payer: Health EOS Commercial |
$1,518.91
|
| Rate for Payer: HFN Commercial |
$1,570.11
|
| Rate for Payer: Multiplan Commercial |
$1,365.31
|
| Rate for Payer: Preferred Network Access Commercial |
$1,570.11
|
| Rate for Payer: Quartz Beloit One Network |
$836.25
|
| Rate for Payer: Quartz Commercial |
$1,023.98
|
| Rate for Payer: WEA Trust Commercial |
$938.65
|
| Rate for Payer: WPS Commercial |
$1,264.06
|
|
|
SCREW ART SURF LOCK 5950-90
|
Facility
|
OP
|
$1,641.00
|
|
| Hospital Charge Code |
2967809
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$477.86 |
| Max. Negotiated Rate |
$1,570.11 |
| Rate for Payer: Aetna Commercial |
$1,535.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,467.71
|
| Rate for Payer: Aetna Managed Medicare |
$477.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,109.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$853.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$819.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$904.52
|
| Rate for Payer: Cash Price |
$492.30
|
| Rate for Payer: Cigna Commercial |
$1,570.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$955.06
|
| Rate for Payer: Health EOS Commercial |
$1,518.91
|
| Rate for Payer: HFN Commercial |
$1,570.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,279.98
|
| Rate for Payer: Multiplan Commercial |
$1,365.31
|
| Rate for Payer: NAPHCARE Commercial |
$1,023.98
|
| Rate for Payer: Preferred Network Access Commercial |
$1,570.11
|
| Rate for Payer: Quartz Beloit One Network |
$836.25
|
| Rate for Payer: Quartz Commercial |
$1,109.32
|
| Rate for Payer: Quartz Medicare Advantage |
$1,023.98
|
| Rate for Payer: The Alliance Commercial |
$853.32
|
| Rate for Payer: WEA Trust Commercial |
$938.65
|
| Rate for Payer: WPS Commercial |
$1,264.06
|
|
|
SCREW BIO-COMPOSITE 2.7 X 20MM AR-5025B-20
|
Facility
|
IP
|
$3,922.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6220124
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,998.65 |
| Max. Negotiated Rate |
$3,752.57 |
| Rate for Payer: Aetna Commercial |
$3,670.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,507.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,161.81
|
| Rate for Payer: Cash Price |
$1,176.60
|
| Rate for Payer: Cigna Commercial |
$3,752.57
|
| Rate for Payer: Health EOS Commercial |
$3,630.20
|
| Rate for Payer: HFN Commercial |
$3,752.57
|
| Rate for Payer: Multiplan Commercial |
$3,263.10
|
| Rate for Payer: Preferred Network Access Commercial |
$3,752.57
|
| Rate for Payer: Quartz Beloit One Network |
$1,998.65
|
| Rate for Payer: Quartz Commercial |
$2,447.33
|
| Rate for Payer: WEA Trust Commercial |
$2,243.38
|
| Rate for Payer: WPS Commercial |
$3,021.12
|
|
|
SCREW BIO-COMPOSITE 2.7 X 20MM AR-5025B-20
|
Facility
|
OP
|
$3,922.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6220124
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,142.09 |
| Max. Negotiated Rate |
$3,752.57 |
| Rate for Payer: Aetna Commercial |
$3,670.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,507.84
|
| Rate for Payer: Aetna Managed Medicare |
$1,142.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,651.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,039.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,957.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,161.81
|
| Rate for Payer: Cash Price |
$1,176.60
|
| Rate for Payer: Cigna Commercial |
$3,752.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,282.60
|
| Rate for Payer: Health EOS Commercial |
$3,630.20
|
| Rate for Payer: HFN Commercial |
$3,752.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,059.16
|
| Rate for Payer: Multiplan Commercial |
$3,263.10
|
| Rate for Payer: NAPHCARE Commercial |
$2,447.33
|
| Rate for Payer: Preferred Network Access Commercial |
$3,752.57
|
| Rate for Payer: Quartz Beloit One Network |
$1,998.65
|
| Rate for Payer: Quartz Commercial |
$2,651.27
|
| Rate for Payer: Quartz Medicare Advantage |
$2,447.33
|
| Rate for Payer: The Alliance Commercial |
$2,039.44
|
| Rate for Payer: WEA Trust Commercial |
$2,243.38
|
| Rate for Payer: WPS Commercial |
$3,021.12
|
|
|
SCREW BIO-COMPOSITE 3 X 16MM AR-5025B-16
|
Facility
|
OP
|
$4,335.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5885645
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,262.35 |
| Max. Negotiated Rate |
$4,147.73 |
| Rate for Payer: Aetna Commercial |
$4,057.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,877.22
|
| Rate for Payer: Aetna Managed Medicare |
$1,262.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,930.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,254.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,164.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,389.45
|
| Rate for Payer: Cash Price |
$1,300.50
|
| Rate for Payer: Cigna Commercial |
$4,147.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,522.97
|
| Rate for Payer: Health EOS Commercial |
$4,012.48
|
| Rate for Payer: HFN Commercial |
$4,147.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,381.30
|
| Rate for Payer: Multiplan Commercial |
$3,606.72
|
| Rate for Payer: NAPHCARE Commercial |
$2,705.04
|
| Rate for Payer: Preferred Network Access Commercial |
$4,147.73
|
| Rate for Payer: Quartz Beloit One Network |
$2,209.12
|
| Rate for Payer: Quartz Commercial |
$2,930.46
|
| Rate for Payer: Quartz Medicare Advantage |
$2,705.04
|
| Rate for Payer: The Alliance Commercial |
$2,254.20
|
| Rate for Payer: WEA Trust Commercial |
$2,479.62
|
| Rate for Payer: WPS Commercial |
$3,339.25
|
|
|
SCREW BIO-COMPOSITE 3 X 16MM AR-5025B-16
|
Facility
|
IP
|
$4,335.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5885645
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,209.12 |
| Max. Negotiated Rate |
$4,147.73 |
| Rate for Payer: Aetna Commercial |
$4,057.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,877.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,389.45
|
| Rate for Payer: Cash Price |
$1,300.50
|
| Rate for Payer: Cigna Commercial |
$4,147.73
|
| Rate for Payer: Health EOS Commercial |
$4,012.48
|
| Rate for Payer: HFN Commercial |
$4,147.73
|
| Rate for Payer: Multiplan Commercial |
$3,606.72
|
| Rate for Payer: Preferred Network Access Commercial |
$4,147.73
|
| Rate for Payer: Quartz Beloit One Network |
$2,209.12
|
| Rate for Payer: Quartz Commercial |
$2,705.04
|
| Rate for Payer: WEA Trust Commercial |
$2,479.62
|
| Rate for Payer: WPS Commercial |
$3,339.25
|
|
|
SCREW BIO-COMPOSITE 3 X 18MM AR-5025B-18
|
Facility
|
OP
|
$4,335.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5885646
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,262.35 |
| Max. Negotiated Rate |
$4,147.73 |
| Rate for Payer: Aetna Commercial |
$4,057.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,877.22
|
| Rate for Payer: Aetna Managed Medicare |
$1,262.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,930.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,254.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,164.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,389.45
|
| Rate for Payer: Cash Price |
$1,300.50
|
| Rate for Payer: Cigna Commercial |
$4,147.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,522.97
|
| Rate for Payer: Health EOS Commercial |
$4,012.48
|
| Rate for Payer: HFN Commercial |
$4,147.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,381.30
|
| Rate for Payer: Multiplan Commercial |
$3,606.72
|
| Rate for Payer: NAPHCARE Commercial |
$2,705.04
|
| Rate for Payer: Preferred Network Access Commercial |
$4,147.73
|
| Rate for Payer: Quartz Beloit One Network |
$2,209.12
|
| Rate for Payer: Quartz Commercial |
$2,930.46
|
| Rate for Payer: Quartz Medicare Advantage |
$2,705.04
|
| Rate for Payer: The Alliance Commercial |
$2,254.20
|
| Rate for Payer: WEA Trust Commercial |
$2,479.62
|
| Rate for Payer: WPS Commercial |
$3,339.25
|
|
|
SCREW BIO-COMPOSITE 3 X 18MM AR-5025B-18
|
Facility
|
IP
|
$4,335.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5885646
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,209.12 |
| Max. Negotiated Rate |
$4,147.73 |
| Rate for Payer: Aetna Commercial |
$4,057.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,877.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,389.45
|
| Rate for Payer: Cash Price |
$1,300.50
|
| Rate for Payer: Cigna Commercial |
$4,147.73
|
| Rate for Payer: Health EOS Commercial |
$4,012.48
|
| Rate for Payer: HFN Commercial |
$4,147.73
|
| Rate for Payer: Multiplan Commercial |
$3,606.72
|
| Rate for Payer: Preferred Network Access Commercial |
$4,147.73
|
| Rate for Payer: Quartz Beloit One Network |
$2,209.12
|
| Rate for Payer: Quartz Commercial |
$2,705.04
|
| Rate for Payer: WEA Trust Commercial |
$2,479.62
|
| Rate for Payer: WPS Commercial |
$3,339.25
|
|
