|
SCREW METAPHYSEAL 2.7 X 36MM 02.118.536
|
Facility
|
IP
|
$817.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5583218
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$400.33 |
| Max. Negotiated Rate |
$751.64 |
| Rate for Payer: Aetna Commercial |
$735.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$702.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$433.01
|
| Rate for Payer: Cash Price |
$245.10
|
| Rate for Payer: Cigna Commercial |
$751.64
|
| Rate for Payer: Health EOS Commercial |
$727.13
|
| Rate for Payer: HFN Commercial |
$751.64
|
| Rate for Payer: Multiplan Commercial |
$653.60
|
| Rate for Payer: NAPHCARE Commercial |
$490.20
|
| Rate for Payer: Preferred Network Access Commercial |
$751.64
|
| Rate for Payer: Quartz Beloit One Network |
$400.33
|
| Rate for Payer: Quartz Commercial |
$490.20
|
| Rate for Payer: WEA Trust Commercial |
$449.35
|
| Rate for Payer: WPS Commercial |
$605.15
|
|
|
SCREW METAPHYSEAL 2.7 X 36MM 02.118.536
|
Facility
|
OP
|
$817.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5583218
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$228.76 |
| Max. Negotiated Rate |
$3,268.00 |
| Rate for Payer: Aetna Commercial |
$735.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$702.62
|
| Rate for Payer: Aetna Managed Medicare |
$228.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$531.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$408.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$392.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$433.01
|
| Rate for Payer: Cash Price |
$245.10
|
| Rate for Payer: Cigna Commercial |
$751.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$457.19
|
| Rate for Payer: Health EOS Commercial |
$727.13
|
| Rate for Payer: HFN Commercial |
$751.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$612.75
|
| Rate for Payer: Multiplan Commercial |
$653.60
|
| Rate for Payer: NAPHCARE Commercial |
$490.20
|
| Rate for Payer: Preferred Network Access Commercial |
$751.64
|
| Rate for Payer: Quartz Beloit One Network |
$400.33
|
| Rate for Payer: Quartz Commercial |
$531.05
|
| Rate for Payer: Quartz Medicare Advantage |
$490.20
|
| Rate for Payer: The Alliance Commercial |
$3,268.00
|
| Rate for Payer: WEA Trust Commercial |
$449.35
|
| Rate for Payer: WPS Commercial |
$605.15
|
|
|
SCREW METAPHYSEAL 2.7 X 38MM 02.118.538
|
Facility
|
OP
|
$817.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4268744
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$228.76 |
| Max. Negotiated Rate |
$3,268.00 |
| Rate for Payer: Aetna Commercial |
$735.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$702.62
|
| Rate for Payer: Aetna Managed Medicare |
$228.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$531.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$408.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$392.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$433.01
|
| Rate for Payer: Cash Price |
$245.10
|
| Rate for Payer: Cigna Commercial |
$751.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$457.19
|
| Rate for Payer: Health EOS Commercial |
$727.13
|
| Rate for Payer: HFN Commercial |
$751.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$612.75
|
| Rate for Payer: Multiplan Commercial |
$653.60
|
| Rate for Payer: NAPHCARE Commercial |
$490.20
|
| Rate for Payer: Preferred Network Access Commercial |
$751.64
|
| Rate for Payer: Quartz Beloit One Network |
$400.33
|
| Rate for Payer: Quartz Commercial |
$531.05
|
| Rate for Payer: Quartz Medicare Advantage |
$490.20
|
| Rate for Payer: The Alliance Commercial |
$3,268.00
|
| Rate for Payer: WEA Trust Commercial |
$449.35
|
| Rate for Payer: WPS Commercial |
$605.15
|
|
|
SCREW METAPHYSEAL 2.7 X 38MM 02.118.538
|
Facility
|
IP
|
$817.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4268744
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$400.33 |
| Max. Negotiated Rate |
$751.64 |
| Rate for Payer: Aetna Commercial |
$735.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$702.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$433.01
|
| Rate for Payer: Cash Price |
$245.10
|
| Rate for Payer: Cigna Commercial |
$751.64
|
| Rate for Payer: Health EOS Commercial |
$727.13
|
| Rate for Payer: HFN Commercial |
$751.64
|
| Rate for Payer: Multiplan Commercial |
$653.60
|
| Rate for Payer: NAPHCARE Commercial |
$490.20
|
| Rate for Payer: Preferred Network Access Commercial |
$751.64
|
| Rate for Payer: Quartz Beloit One Network |
$400.33
|
| Rate for Payer: Quartz Commercial |
$490.20
|
| Rate for Payer: WEA Trust Commercial |
$449.35
|
| Rate for Payer: WPS Commercial |
$605.15
|
|
|
SCREW METAPHYSEAL 2.7 X 40MM 02.118.540
|
Facility
|
OP
|
$817.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5106759
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$228.76 |
| Max. Negotiated Rate |
$3,268.00 |
| Rate for Payer: Aetna Commercial |
$735.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$702.62
|
| Rate for Payer: Aetna Managed Medicare |
$228.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$531.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$408.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$392.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$433.01
|
| Rate for Payer: Cash Price |
$245.10
|
| Rate for Payer: Cigna Commercial |
$751.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$457.19
|
| Rate for Payer: Health EOS Commercial |
$727.13
|
| Rate for Payer: HFN Commercial |
$751.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$612.75
|
| Rate for Payer: Multiplan Commercial |
$653.60
|
| Rate for Payer: NAPHCARE Commercial |
$490.20
|
| Rate for Payer: Preferred Network Access Commercial |
$751.64
|
| Rate for Payer: Quartz Beloit One Network |
$400.33
|
| Rate for Payer: Quartz Commercial |
$531.05
|
| Rate for Payer: Quartz Medicare Advantage |
$490.20
|
| Rate for Payer: The Alliance Commercial |
$3,268.00
|
| Rate for Payer: WEA Trust Commercial |
$449.35
|
| Rate for Payer: WPS Commercial |
$605.15
|
|
|
SCREW METAPHYSEAL 2.7 X 40MM 02.118.540
|
Facility
|
IP
|
$817.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5106759
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$400.33 |
| Max. Negotiated Rate |
$751.64 |
| Rate for Payer: Aetna Commercial |
$735.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$702.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$433.01
|
| Rate for Payer: Cash Price |
$245.10
|
| Rate for Payer: Cigna Commercial |
$751.64
|
| Rate for Payer: Health EOS Commercial |
$727.13
|
| Rate for Payer: HFN Commercial |
$751.64
|
| Rate for Payer: Multiplan Commercial |
$653.60
|
| Rate for Payer: NAPHCARE Commercial |
$490.20
|
| Rate for Payer: Preferred Network Access Commercial |
$751.64
|
| Rate for Payer: Quartz Beloit One Network |
$400.33
|
| Rate for Payer: Quartz Commercial |
$490.20
|
| Rate for Payer: WEA Trust Commercial |
$449.35
|
| Rate for Payer: WPS Commercial |
$605.15
|
|
|
SCREW METAPHYSEAL 2.7 X 42MM 02.118.542
|
Facility
|
OP
|
$817.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4317094
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$228.76 |
| Max. Negotiated Rate |
$3,268.00 |
| Rate for Payer: Aetna Commercial |
$735.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$702.62
|
| Rate for Payer: Aetna Managed Medicare |
$228.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$531.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$408.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$392.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$433.01
|
| Rate for Payer: Cash Price |
$245.10
|
| Rate for Payer: Cigna Commercial |
$751.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$457.19
|
| Rate for Payer: Health EOS Commercial |
$727.13
|
| Rate for Payer: HFN Commercial |
$751.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$612.75
|
| Rate for Payer: Multiplan Commercial |
$653.60
|
| Rate for Payer: NAPHCARE Commercial |
$490.20
|
| Rate for Payer: Preferred Network Access Commercial |
$751.64
|
| Rate for Payer: Quartz Beloit One Network |
$400.33
|
| Rate for Payer: Quartz Commercial |
$531.05
|
| Rate for Payer: Quartz Medicare Advantage |
$490.20
|
| Rate for Payer: The Alliance Commercial |
$3,268.00
|
| Rate for Payer: WEA Trust Commercial |
$449.35
|
| Rate for Payer: WPS Commercial |
$605.15
|
|
|
SCREW METAPHYSEAL 2.7 X 42MM 02.118.542
|
Facility
|
IP
|
$817.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4317094
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$400.33 |
| Max. Negotiated Rate |
$751.64 |
| Rate for Payer: Aetna Commercial |
$735.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$702.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$433.01
|
| Rate for Payer: Cash Price |
$245.10
|
| Rate for Payer: Cigna Commercial |
$751.64
|
| Rate for Payer: Health EOS Commercial |
$727.13
|
| Rate for Payer: HFN Commercial |
$751.64
|
| Rate for Payer: Multiplan Commercial |
$653.60
|
| Rate for Payer: NAPHCARE Commercial |
$490.20
|
| Rate for Payer: Preferred Network Access Commercial |
$751.64
|
| Rate for Payer: Quartz Beloit One Network |
$400.33
|
| Rate for Payer: Quartz Commercial |
$490.20
|
| Rate for Payer: WEA Trust Commercial |
$449.35
|
| Rate for Payer: WPS Commercial |
$605.15
|
|
|
SCREW METAPHYSEAL 2.7 X 44MM 02.118.544
|
Facility
|
IP
|
$817.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4317098
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$400.33 |
| Max. Negotiated Rate |
$751.64 |
| Rate for Payer: Aetna Commercial |
$735.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$702.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$433.01
|
| Rate for Payer: Cash Price |
$245.10
|
| Rate for Payer: Cigna Commercial |
$751.64
|
| Rate for Payer: Health EOS Commercial |
$727.13
|
| Rate for Payer: HFN Commercial |
$751.64
|
| Rate for Payer: Multiplan Commercial |
$653.60
|
| Rate for Payer: NAPHCARE Commercial |
$490.20
|
| Rate for Payer: Preferred Network Access Commercial |
$751.64
|
| Rate for Payer: Quartz Beloit One Network |
$400.33
|
| Rate for Payer: Quartz Commercial |
$490.20
|
| Rate for Payer: WEA Trust Commercial |
$449.35
|
| Rate for Payer: WPS Commercial |
$605.15
|
|
|
SCREW METAPHYSEAL 2.7 X 44MM 02.118.544
|
Facility
|
OP
|
$817.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4317098
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$228.76 |
| Max. Negotiated Rate |
$3,268.00 |
| Rate for Payer: Aetna Commercial |
$735.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$702.62
|
| Rate for Payer: Aetna Managed Medicare |
$228.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$531.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$408.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$392.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$433.01
|
| Rate for Payer: Cash Price |
$245.10
|
| Rate for Payer: Cigna Commercial |
$751.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$457.19
|
| Rate for Payer: Health EOS Commercial |
$727.13
|
| Rate for Payer: HFN Commercial |
$751.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$612.75
|
| Rate for Payer: Multiplan Commercial |
$653.60
|
| Rate for Payer: NAPHCARE Commercial |
$490.20
|
| Rate for Payer: Preferred Network Access Commercial |
$751.64
|
| Rate for Payer: Quartz Beloit One Network |
$400.33
|
| Rate for Payer: Quartz Commercial |
$531.05
|
| Rate for Payer: Quartz Medicare Advantage |
$490.20
|
| Rate for Payer: The Alliance Commercial |
$3,268.00
|
| Rate for Payer: WEA Trust Commercial |
$449.35
|
| Rate for Payer: WPS Commercial |
$605.15
|
|
|
SCREW METAPHYSEAL 2.7 X 46MM 02.118.546
|
Facility
|
IP
|
$817.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4317095
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$400.33 |
| Max. Negotiated Rate |
$751.64 |
| Rate for Payer: Aetna Commercial |
$735.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$702.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$433.01
|
| Rate for Payer: Cash Price |
$245.10
|
| Rate for Payer: Cigna Commercial |
$751.64
|
| Rate for Payer: Health EOS Commercial |
$727.13
|
| Rate for Payer: HFN Commercial |
$751.64
|
| Rate for Payer: Multiplan Commercial |
$653.60
|
| Rate for Payer: NAPHCARE Commercial |
$490.20
|
| Rate for Payer: Preferred Network Access Commercial |
$751.64
|
| Rate for Payer: Quartz Beloit One Network |
$400.33
|
| Rate for Payer: Quartz Commercial |
$490.20
|
| Rate for Payer: WEA Trust Commercial |
$449.35
|
| Rate for Payer: WPS Commercial |
$605.15
|
|
|
SCREW METAPHYSEAL 2.7 X 46MM 02.118.546
|
Facility
|
OP
|
$817.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4317095
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$228.76 |
| Max. Negotiated Rate |
$3,268.00 |
| Rate for Payer: Aetna Commercial |
$735.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$702.62
|
| Rate for Payer: Aetna Managed Medicare |
$228.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$531.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$408.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$392.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$433.01
|
| Rate for Payer: Cash Price |
$245.10
|
| Rate for Payer: Cigna Commercial |
$751.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$457.19
|
| Rate for Payer: Health EOS Commercial |
$727.13
|
| Rate for Payer: HFN Commercial |
$751.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$612.75
|
| Rate for Payer: Multiplan Commercial |
$653.60
|
| Rate for Payer: NAPHCARE Commercial |
$490.20
|
| Rate for Payer: Preferred Network Access Commercial |
$751.64
|
| Rate for Payer: Quartz Beloit One Network |
$400.33
|
| Rate for Payer: Quartz Commercial |
$531.05
|
| Rate for Payer: Quartz Medicare Advantage |
$490.20
|
| Rate for Payer: The Alliance Commercial |
$3,268.00
|
| Rate for Payer: WEA Trust Commercial |
$449.35
|
| Rate for Payer: WPS Commercial |
$605.15
|
|
|
SCREW METAPHYSEAL 2.7 X 48MM 02.118.548
|
Facility
|
OP
|
$817.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5106910
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$228.76 |
| Max. Negotiated Rate |
$3,268.00 |
| Rate for Payer: Aetna Commercial |
$735.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$702.62
|
| Rate for Payer: Aetna Managed Medicare |
$228.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$531.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$408.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$392.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$433.01
|
| Rate for Payer: Cash Price |
$245.10
|
| Rate for Payer: Cigna Commercial |
$751.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$457.19
|
| Rate for Payer: Health EOS Commercial |
$727.13
|
| Rate for Payer: HFN Commercial |
$751.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$612.75
|
| Rate for Payer: Multiplan Commercial |
$653.60
|
| Rate for Payer: NAPHCARE Commercial |
$490.20
|
| Rate for Payer: Preferred Network Access Commercial |
$751.64
|
| Rate for Payer: Quartz Beloit One Network |
$400.33
|
| Rate for Payer: Quartz Commercial |
$531.05
|
| Rate for Payer: Quartz Medicare Advantage |
$490.20
|
| Rate for Payer: The Alliance Commercial |
$3,268.00
|
| Rate for Payer: WEA Trust Commercial |
$449.35
|
| Rate for Payer: WPS Commercial |
$605.15
|
|
|
SCREW METAPHYSEAL 2.7 X 48MM 02.118.548
|
Facility
|
IP
|
$817.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5106910
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$400.33 |
| Max. Negotiated Rate |
$751.64 |
| Rate for Payer: Aetna Commercial |
$735.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$702.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$433.01
|
| Rate for Payer: Cash Price |
$245.10
|
| Rate for Payer: Cigna Commercial |
$751.64
|
| Rate for Payer: Health EOS Commercial |
$727.13
|
| Rate for Payer: HFN Commercial |
$751.64
|
| Rate for Payer: Multiplan Commercial |
$653.60
|
| Rate for Payer: NAPHCARE Commercial |
$490.20
|
| Rate for Payer: Preferred Network Access Commercial |
$751.64
|
| Rate for Payer: Quartz Beloit One Network |
$400.33
|
| Rate for Payer: Quartz Commercial |
$490.20
|
| Rate for Payer: WEA Trust Commercial |
$449.35
|
| Rate for Payer: WPS Commercial |
$605.15
|
|
|
SCREW METAPHYSEAL 2.7 X 50MM 02.118.550
|
Facility
|
OP
|
$817.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4317096
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$228.76 |
| Max. Negotiated Rate |
$3,268.00 |
| Rate for Payer: Aetna Commercial |
$735.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$702.62
|
| Rate for Payer: Aetna Managed Medicare |
$228.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$531.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$408.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$392.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$433.01
|
| Rate for Payer: Cash Price |
$245.10
|
| Rate for Payer: Cigna Commercial |
$751.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$457.19
|
| Rate for Payer: Health EOS Commercial |
$727.13
|
| Rate for Payer: HFN Commercial |
$751.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$612.75
|
| Rate for Payer: Multiplan Commercial |
$653.60
|
| Rate for Payer: NAPHCARE Commercial |
$490.20
|
| Rate for Payer: Preferred Network Access Commercial |
$751.64
|
| Rate for Payer: Quartz Beloit One Network |
$400.33
|
| Rate for Payer: Quartz Commercial |
$531.05
|
| Rate for Payer: Quartz Medicare Advantage |
$490.20
|
| Rate for Payer: The Alliance Commercial |
$3,268.00
|
| Rate for Payer: WEA Trust Commercial |
$449.35
|
| Rate for Payer: WPS Commercial |
$605.15
|
|
|
SCREW METAPHYSEAL 2.7 X 50MM 02.118.550
|
Facility
|
IP
|
$817.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4317096
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$400.33 |
| Max. Negotiated Rate |
$751.64 |
| Rate for Payer: Aetna Commercial |
$735.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$702.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$433.01
|
| Rate for Payer: Cash Price |
$245.10
|
| Rate for Payer: Cigna Commercial |
$751.64
|
| Rate for Payer: Health EOS Commercial |
$727.13
|
| Rate for Payer: HFN Commercial |
$751.64
|
| Rate for Payer: Multiplan Commercial |
$653.60
|
| Rate for Payer: NAPHCARE Commercial |
$490.20
|
| Rate for Payer: Preferred Network Access Commercial |
$751.64
|
| Rate for Payer: Quartz Beloit One Network |
$400.33
|
| Rate for Payer: Quartz Commercial |
$490.20
|
| Rate for Payer: WEA Trust Commercial |
$449.35
|
| Rate for Payer: WPS Commercial |
$605.15
|
|
|
SCREW METAPHYSEAL 2.7 X 52MM 02.118.552
|
Facility
|
OP
|
$817.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5248647
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$228.76 |
| Max. Negotiated Rate |
$3,268.00 |
| Rate for Payer: Aetna Commercial |
$735.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$702.62
|
| Rate for Payer: Aetna Managed Medicare |
$228.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$531.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$408.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$392.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$433.01
|
| Rate for Payer: Cash Price |
$245.10
|
| Rate for Payer: Cigna Commercial |
$751.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$457.19
|
| Rate for Payer: Health EOS Commercial |
$727.13
|
| Rate for Payer: HFN Commercial |
$751.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$612.75
|
| Rate for Payer: Multiplan Commercial |
$653.60
|
| Rate for Payer: NAPHCARE Commercial |
$490.20
|
| Rate for Payer: Preferred Network Access Commercial |
$751.64
|
| Rate for Payer: Quartz Beloit One Network |
$400.33
|
| Rate for Payer: Quartz Commercial |
$531.05
|
| Rate for Payer: Quartz Medicare Advantage |
$490.20
|
| Rate for Payer: The Alliance Commercial |
$3,268.00
|
| Rate for Payer: WEA Trust Commercial |
$449.35
|
| Rate for Payer: WPS Commercial |
$605.15
|
|
|
SCREW METAPHYSEAL 2.7 X 52MM 02.118.552
|
Facility
|
IP
|
$817.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5248647
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$400.33 |
| Max. Negotiated Rate |
$751.64 |
| Rate for Payer: Aetna Commercial |
$735.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$702.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$433.01
|
| Rate for Payer: Cash Price |
$245.10
|
| Rate for Payer: Cigna Commercial |
$751.64
|
| Rate for Payer: Health EOS Commercial |
$727.13
|
| Rate for Payer: HFN Commercial |
$751.64
|
| Rate for Payer: Multiplan Commercial |
$653.60
|
| Rate for Payer: NAPHCARE Commercial |
$490.20
|
| Rate for Payer: Preferred Network Access Commercial |
$751.64
|
| Rate for Payer: Quartz Beloit One Network |
$400.33
|
| Rate for Payer: Quartz Commercial |
$490.20
|
| Rate for Payer: WEA Trust Commercial |
$449.35
|
| Rate for Payer: WPS Commercial |
$605.15
|
|
|
SCREW METAPHYSEAL 2.7 X 70MM 02.118.570
|
Facility
|
IP
|
$817.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3265485
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$400.33 |
| Max. Negotiated Rate |
$751.64 |
| Rate for Payer: Aetna Commercial |
$735.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$702.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$433.01
|
| Rate for Payer: Cash Price |
$245.10
|
| Rate for Payer: Cigna Commercial |
$751.64
|
| Rate for Payer: Health EOS Commercial |
$727.13
|
| Rate for Payer: HFN Commercial |
$751.64
|
| Rate for Payer: Multiplan Commercial |
$653.60
|
| Rate for Payer: NAPHCARE Commercial |
$490.20
|
| Rate for Payer: Preferred Network Access Commercial |
$751.64
|
| Rate for Payer: Quartz Beloit One Network |
$400.33
|
| Rate for Payer: Quartz Commercial |
$490.20
|
| Rate for Payer: WEA Trust Commercial |
$449.35
|
| Rate for Payer: WPS Commercial |
$605.15
|
|
|
SCREW METAPHYSEAL 2.7 X 70MM 02.118.570
|
Facility
|
OP
|
$817.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3265485
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$228.76 |
| Max. Negotiated Rate |
$3,268.00 |
| Rate for Payer: Aetna Commercial |
$735.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$702.62
|
| Rate for Payer: Aetna Managed Medicare |
$228.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$531.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$408.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$392.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$433.01
|
| Rate for Payer: Cash Price |
$245.10
|
| Rate for Payer: Cigna Commercial |
$751.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$457.19
|
| Rate for Payer: Health EOS Commercial |
$727.13
|
| Rate for Payer: HFN Commercial |
$751.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$612.75
|
| Rate for Payer: Multiplan Commercial |
$653.60
|
| Rate for Payer: NAPHCARE Commercial |
$490.20
|
| Rate for Payer: Preferred Network Access Commercial |
$751.64
|
| Rate for Payer: Quartz Beloit One Network |
$400.33
|
| Rate for Payer: Quartz Commercial |
$531.05
|
| Rate for Payer: Quartz Medicare Advantage |
$490.20
|
| Rate for Payer: The Alliance Commercial |
$3,268.00
|
| Rate for Payer: WEA Trust Commercial |
$449.35
|
| Rate for Payer: WPS Commercial |
$605.15
|
|
|
SCREW MICRO CANN 2.0 X 15 6MM THREAD LENGTH ASNIS TI 40-20115
|
Facility
|
IP
|
$1,845.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6171703
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$904.05 |
| Max. Negotiated Rate |
$1,697.40 |
| Rate for Payer: Aetna Commercial |
$1,660.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,586.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$977.85
|
| Rate for Payer: Cash Price |
$553.50
|
| Rate for Payer: Cigna Commercial |
$1,697.40
|
| Rate for Payer: Health EOS Commercial |
$1,642.05
|
| Rate for Payer: HFN Commercial |
$1,697.40
|
| Rate for Payer: Multiplan Commercial |
$1,476.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,107.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,697.40
|
| Rate for Payer: Quartz Beloit One Network |
$904.05
|
| Rate for Payer: Quartz Commercial |
$1,107.00
|
| Rate for Payer: WEA Trust Commercial |
$1,014.75
|
| Rate for Payer: WPS Commercial |
$1,366.59
|
|
|
SCREW MICRO CANN 2.0 X 15 6MM THREAD LENGTH ASNIS TI 40-20115
|
Facility
|
OP
|
$1,845.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6171703
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$516.60 |
| Max. Negotiated Rate |
$7,380.00 |
| Rate for Payer: Aetna Commercial |
$1,660.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,586.70
|
| Rate for Payer: Aetna Managed Medicare |
$516.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,199.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$922.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$885.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$977.85
|
| Rate for Payer: Cash Price |
$553.50
|
| Rate for Payer: Cigna Commercial |
$1,697.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,032.46
|
| Rate for Payer: Health EOS Commercial |
$1,642.05
|
| Rate for Payer: HFN Commercial |
$1,697.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,383.75
|
| Rate for Payer: Multiplan Commercial |
$1,476.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,107.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,697.40
|
| Rate for Payer: Quartz Beloit One Network |
$904.05
|
| Rate for Payer: Quartz Commercial |
$1,199.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,107.00
|
| Rate for Payer: The Alliance Commercial |
$7,380.00
|
| Rate for Payer: WEA Trust Commercial |
$1,014.75
|
| Rate for Payer: WPS Commercial |
$1,366.59
|
|
|
SCREW MICRO CANN 2.0 X 16 7MM THREAD LENGTH ASNIS TI 40-20116
|
Facility
|
OP
|
$1,845.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6171704
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$516.60 |
| Max. Negotiated Rate |
$7,380.00 |
| Rate for Payer: Aetna Commercial |
$1,660.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,586.70
|
| Rate for Payer: Aetna Managed Medicare |
$516.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,199.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$922.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$885.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$977.85
|
| Rate for Payer: Cash Price |
$553.50
|
| Rate for Payer: Cigna Commercial |
$1,697.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,032.46
|
| Rate for Payer: Health EOS Commercial |
$1,642.05
|
| Rate for Payer: HFN Commercial |
$1,697.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,383.75
|
| Rate for Payer: Multiplan Commercial |
$1,476.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,107.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,697.40
|
| Rate for Payer: Quartz Beloit One Network |
$904.05
|
| Rate for Payer: Quartz Commercial |
$1,199.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,107.00
|
| Rate for Payer: The Alliance Commercial |
$7,380.00
|
| Rate for Payer: WEA Trust Commercial |
$1,014.75
|
| Rate for Payer: WPS Commercial |
$1,366.59
|
|
|
SCREW MICRO CANN 2.0 X 16 7MM THREAD LENGTH ASNIS TI 40-20116
|
Facility
|
IP
|
$1,845.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6171704
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$904.05 |
| Max. Negotiated Rate |
$1,697.40 |
| Rate for Payer: Aetna Commercial |
$1,660.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,586.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$977.85
|
| Rate for Payer: Cash Price |
$553.50
|
| Rate for Payer: Cigna Commercial |
$1,697.40
|
| Rate for Payer: Health EOS Commercial |
$1,642.05
|
| Rate for Payer: HFN Commercial |
$1,697.40
|
| Rate for Payer: Multiplan Commercial |
$1,476.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,107.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,697.40
|
| Rate for Payer: Quartz Beloit One Network |
$904.05
|
| Rate for Payer: Quartz Commercial |
$1,107.00
|
| Rate for Payer: WEA Trust Commercial |
$1,014.75
|
| Rate for Payer: WPS Commercial |
$1,366.59
|
|
|
SCREW MICRO CANN 2.0 X 24MM X 6MM THREAD ASNIS 40-20124
|
Facility
|
IP
|
$2,102.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767635
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,029.98 |
| Max. Negotiated Rate |
$1,933.84 |
| Rate for Payer: Aetna Commercial |
$1,891.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,807.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,114.06
|
| Rate for Payer: Cash Price |
$630.60
|
| Rate for Payer: Cigna Commercial |
$1,933.84
|
| Rate for Payer: Health EOS Commercial |
$1,870.78
|
| Rate for Payer: HFN Commercial |
$1,933.84
|
| Rate for Payer: Multiplan Commercial |
$1,681.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,261.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,933.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,029.98
|
| Rate for Payer: Quartz Commercial |
$1,261.20
|
| Rate for Payer: WEA Trust Commercial |
$1,156.10
|
| Rate for Payer: WPS Commercial |
$1,556.95
|
|
