|
SCREW-AMBI 4.5 X 42 7112-9242
|
Facility
|
OP
|
$345.00
|
|
| Hospital Charge Code |
2965988
|
|
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-AMBI 4.5 X 42 7112-9242
|
Facility
|
IP
|
$345.00
|
|
| Hospital Charge Code |
2965988
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$169.05 |
| Max. Negotiated Rate |
$317.40 |
| Rate for Payer: Aetna Commercial |
$310.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$296.70
|
| 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: Health EOS Commercial |
$307.05
|
| Rate for Payer: HFN Commercial |
$317.40
|
| 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 |
$207.00
|
| Rate for Payer: WEA Trust Commercial |
$189.75
|
| Rate for Payer: WPS Commercial |
$255.54
|
|
|
SCREW-AMBI 4.5 X 44 7112-9244
|
Facility
|
OP
|
$345.00
|
|
| Hospital Charge Code |
2965989
|
|
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-AMBI 4.5 X 44 7112-9244
|
Facility
|
IP
|
$345.00
|
|
| Hospital Charge Code |
2965989
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$169.05 |
| Max. Negotiated Rate |
$317.40 |
| Rate for Payer: Aetna Commercial |
$310.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$296.70
|
| 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: Health EOS Commercial |
$307.05
|
| Rate for Payer: HFN Commercial |
$317.40
|
| 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 |
$207.00
|
| Rate for Payer: WEA Trust Commercial |
$189.75
|
| Rate for Payer: WPS Commercial |
$255.54
|
|
|
SCREW-AMBI 4.5 X 46 7112-9246
|
Facility
|
OP
|
$345.00
|
|
| Hospital Charge Code |
2965990
|
|
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-AMBI 4.5 X 46 7112-9246
|
Facility
|
IP
|
$345.00
|
|
| Hospital Charge Code |
2965990
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$169.05 |
| Max. Negotiated Rate |
$317.40 |
| Rate for Payer: Aetna Commercial |
$310.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$296.70
|
| 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: Health EOS Commercial |
$307.05
|
| Rate for Payer: HFN Commercial |
$317.40
|
| 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 |
$207.00
|
| Rate for Payer: WEA Trust Commercial |
$189.75
|
| Rate for Payer: WPS Commercial |
$255.54
|
|
|
SCREW-AMBI 4.5 X 48 7112-9248
|
Facility
|
IP
|
$345.00
|
|
| Hospital Charge Code |
2965991
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$169.05 |
| Max. Negotiated Rate |
$317.40 |
| Rate for Payer: Aetna Commercial |
$310.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$296.70
|
| 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: Health EOS Commercial |
$307.05
|
| Rate for Payer: HFN Commercial |
$317.40
|
| 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 |
$207.00
|
| Rate for Payer: WEA Trust Commercial |
$189.75
|
| Rate for Payer: WPS Commercial |
$255.54
|
|
|
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
|
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 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 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
|
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 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 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
|
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 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 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 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 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
|
|
