|
SCREW MATRIX MIDFACE 5MM SELF-DRILLING TI 04.503.225.01
|
Facility
|
OP
|
$884.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5264662
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$257.42 |
| Max. Negotiated Rate |
$845.81 |
| Rate for Payer: Aetna Commercial |
$827.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$790.65
|
| Rate for Payer: Aetna Managed Medicare |
$257.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$597.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$459.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$441.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$487.26
|
| Rate for Payer: Cash Price |
$265.20
|
| Rate for Payer: Cigna Commercial |
$845.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$514.49
|
| Rate for Payer: Health EOS Commercial |
$818.23
|
| Rate for Payer: HFN Commercial |
$845.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$689.52
|
| Rate for Payer: Multiplan Commercial |
$735.49
|
| Rate for Payer: NAPHCARE Commercial |
$551.62
|
| Rate for Payer: Preferred Network Access Commercial |
$845.81
|
| Rate for Payer: Quartz Beloit One Network |
$450.49
|
| Rate for Payer: Quartz Commercial |
$597.58
|
| Rate for Payer: Quartz Medicare Advantage |
$551.62
|
| Rate for Payer: The Alliance Commercial |
$459.68
|
| Rate for Payer: WEA Trust Commercial |
$505.65
|
| Rate for Payer: WPS Commercial |
$680.95
|
|
|
SCREW MATRIX MIDFACE 5MM SELF-DRILLING TI 04.503.225.01
|
Facility
|
IP
|
$884.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5264662
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$450.49 |
| Max. Negotiated Rate |
$845.81 |
| Rate for Payer: Aetna Commercial |
$827.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$790.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$487.26
|
| Rate for Payer: Cash Price |
$265.20
|
| Rate for Payer: Cigna Commercial |
$845.81
|
| Rate for Payer: Health EOS Commercial |
$818.23
|
| Rate for Payer: HFN Commercial |
$845.81
|
| Rate for Payer: Multiplan Commercial |
$735.49
|
| Rate for Payer: Preferred Network Access Commercial |
$845.81
|
| Rate for Payer: Quartz Beloit One Network |
$450.49
|
| Rate for Payer: Quartz Commercial |
$551.62
|
| Rate for Payer: WEA Trust Commercial |
$505.65
|
| Rate for Payer: WPS Commercial |
$680.95
|
|
|
SCREW MATRIX MIDFACE 5MM SELF-DRILLING TI 04.503.228.01
|
Facility
|
IP
|
$2,118.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6226129
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,079.33 |
| Max. Negotiated Rate |
$2,026.50 |
| Rate for Payer: Aetna Commercial |
$1,982.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,894.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,167.44
|
| Rate for Payer: Cash Price |
$635.40
|
| Rate for Payer: Cigna Commercial |
$2,026.50
|
| Rate for Payer: Health EOS Commercial |
$1,960.42
|
| Rate for Payer: HFN Commercial |
$2,026.50
|
| Rate for Payer: Multiplan Commercial |
$1,762.18
|
| Rate for Payer: Preferred Network Access Commercial |
$2,026.50
|
| Rate for Payer: Quartz Beloit One Network |
$1,079.33
|
| Rate for Payer: Quartz Commercial |
$1,321.63
|
| Rate for Payer: WEA Trust Commercial |
$1,211.50
|
| Rate for Payer: WPS Commercial |
$1,631.50
|
|
|
SCREW MATRIX MIDFACE 5MM SELF-DRILLING TI 04.503.228.01
|
Facility
|
OP
|
$2,118.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6226129
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$616.76 |
| Max. Negotiated Rate |
$2,026.50 |
| Rate for Payer: Aetna Commercial |
$1,982.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,894.34
|
| Rate for Payer: Aetna Managed Medicare |
$616.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,431.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,101.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,057.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,167.44
|
| Rate for Payer: Cash Price |
$635.40
|
| Rate for Payer: Cigna Commercial |
$2,026.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,232.68
|
| Rate for Payer: Health EOS Commercial |
$1,960.42
|
| Rate for Payer: HFN Commercial |
$2,026.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,652.04
|
| Rate for Payer: Multiplan Commercial |
$1,762.18
|
| Rate for Payer: NAPHCARE Commercial |
$1,321.63
|
| Rate for Payer: Preferred Network Access Commercial |
$2,026.50
|
| Rate for Payer: Quartz Beloit One Network |
$1,079.33
|
| Rate for Payer: Quartz Commercial |
$1,431.77
|
| Rate for Payer: Quartz Medicare Advantage |
$1,321.63
|
| Rate for Payer: The Alliance Commercial |
$1,101.36
|
| Rate for Payer: WEA Trust Commercial |
$1,211.50
|
| Rate for Payer: WPS Commercial |
$1,631.50
|
|
|
SCREW MATRIX MIDFACE 5MM SELF-TAPPING TI 04.503.205.05
|
Facility
|
IP
|
$858.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5306829
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$437.24 |
| Max. Negotiated Rate |
$820.93 |
| Rate for Payer: Aetna Commercial |
$803.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$767.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$472.93
|
| Rate for Payer: Cash Price |
$257.40
|
| Rate for Payer: Cigna Commercial |
$820.93
|
| Rate for Payer: Health EOS Commercial |
$794.16
|
| Rate for Payer: HFN Commercial |
$820.93
|
| Rate for Payer: Multiplan Commercial |
$713.86
|
| Rate for Payer: Preferred Network Access Commercial |
$820.93
|
| Rate for Payer: Quartz Beloit One Network |
$437.24
|
| Rate for Payer: Quartz Commercial |
$535.39
|
| Rate for Payer: WEA Trust Commercial |
$490.78
|
| Rate for Payer: WPS Commercial |
$660.92
|
|
|
SCREW MATRIX MIDFACE 5MM SELF-TAPPING TI 04.503.205.05
|
Facility
|
OP
|
$858.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5306829
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$249.85 |
| Max. Negotiated Rate |
$820.93 |
| Rate for Payer: Aetna Commercial |
$803.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$767.40
|
| Rate for Payer: Aetna Managed Medicare |
$249.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$580.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$446.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$428.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$472.93
|
| Rate for Payer: Cash Price |
$257.40
|
| Rate for Payer: Cigna Commercial |
$820.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$499.36
|
| Rate for Payer: Health EOS Commercial |
$794.16
|
| Rate for Payer: HFN Commercial |
$820.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$669.24
|
| Rate for Payer: Multiplan Commercial |
$713.86
|
| Rate for Payer: NAPHCARE Commercial |
$535.39
|
| Rate for Payer: Preferred Network Access Commercial |
$820.93
|
| Rate for Payer: Quartz Beloit One Network |
$437.24
|
| Rate for Payer: Quartz Commercial |
$580.01
|
| Rate for Payer: Quartz Medicare Advantage |
$535.39
|
| Rate for Payer: The Alliance Commercial |
$446.16
|
| Rate for Payer: WEA Trust Commercial |
$490.78
|
| Rate for Payer: WPS Commercial |
$660.92
|
|
|
SCREW MATRIX MIDFACE 6MM SELF-DRILLING TI 04.503.226.01
|
Facility
|
OP
|
$884.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5190793
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$257.42 |
| Max. Negotiated Rate |
$845.81 |
| Rate for Payer: Aetna Commercial |
$827.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$790.65
|
| Rate for Payer: Aetna Managed Medicare |
$257.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$597.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$459.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$441.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$487.26
|
| Rate for Payer: Cash Price |
$265.20
|
| Rate for Payer: Cigna Commercial |
$845.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$514.49
|
| Rate for Payer: Health EOS Commercial |
$818.23
|
| Rate for Payer: HFN Commercial |
$845.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$689.52
|
| Rate for Payer: Multiplan Commercial |
$735.49
|
| Rate for Payer: NAPHCARE Commercial |
$551.62
|
| Rate for Payer: Preferred Network Access Commercial |
$845.81
|
| Rate for Payer: Quartz Beloit One Network |
$450.49
|
| Rate for Payer: Quartz Commercial |
$597.58
|
| Rate for Payer: Quartz Medicare Advantage |
$551.62
|
| Rate for Payer: The Alliance Commercial |
$459.68
|
| Rate for Payer: WEA Trust Commercial |
$505.65
|
| Rate for Payer: WPS Commercial |
$680.95
|
|
|
SCREW MATRIX MIDFACE 6MM SELF-DRILLING TI 04.503.226.01
|
Facility
|
IP
|
$884.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5190793
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$450.49 |
| Max. Negotiated Rate |
$845.81 |
| Rate for Payer: Aetna Commercial |
$827.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$790.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$487.26
|
| Rate for Payer: Cash Price |
$265.20
|
| Rate for Payer: Cigna Commercial |
$845.81
|
| Rate for Payer: Health EOS Commercial |
$818.23
|
| Rate for Payer: HFN Commercial |
$845.81
|
| Rate for Payer: Multiplan Commercial |
$735.49
|
| Rate for Payer: Preferred Network Access Commercial |
$845.81
|
| Rate for Payer: Quartz Beloit One Network |
$450.49
|
| Rate for Payer: Quartz Commercial |
$551.62
|
| Rate for Payer: WEA Trust Commercial |
$505.65
|
| Rate for Payer: WPS Commercial |
$680.95
|
|
|
SCREW MATRIX MIDFACE EMERGENCY TI 5MM 04.503.235.01
|
Facility
|
OP
|
$884.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5349234
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$257.42 |
| Max. Negotiated Rate |
$845.81 |
| Rate for Payer: Aetna Commercial |
$827.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$790.65
|
| Rate for Payer: Aetna Managed Medicare |
$257.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$597.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$459.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$441.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$487.26
|
| Rate for Payer: Cash Price |
$265.20
|
| Rate for Payer: Cigna Commercial |
$845.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$514.49
|
| Rate for Payer: Health EOS Commercial |
$818.23
|
| Rate for Payer: HFN Commercial |
$845.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$689.52
|
| Rate for Payer: Multiplan Commercial |
$735.49
|
| Rate for Payer: NAPHCARE Commercial |
$551.62
|
| Rate for Payer: Preferred Network Access Commercial |
$845.81
|
| Rate for Payer: Quartz Beloit One Network |
$450.49
|
| Rate for Payer: Quartz Commercial |
$597.58
|
| Rate for Payer: Quartz Medicare Advantage |
$551.62
|
| Rate for Payer: The Alliance Commercial |
$459.68
|
| Rate for Payer: WEA Trust Commercial |
$505.65
|
| Rate for Payer: WPS Commercial |
$680.95
|
|
|
SCREW MATRIX MIDFACE EMERGENCY TI 5MM 04.503.235.01
|
Facility
|
IP
|
$884.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5349234
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$450.49 |
| Max. Negotiated Rate |
$845.81 |
| Rate for Payer: Aetna Commercial |
$827.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$790.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$487.26
|
| Rate for Payer: Cash Price |
$265.20
|
| Rate for Payer: Cigna Commercial |
$845.81
|
| Rate for Payer: Health EOS Commercial |
$818.23
|
| Rate for Payer: HFN Commercial |
$845.81
|
| Rate for Payer: Multiplan Commercial |
$735.49
|
| Rate for Payer: Preferred Network Access Commercial |
$845.81
|
| Rate for Payer: Quartz Beloit One Network |
$450.49
|
| Rate for Payer: Quartz Commercial |
$551.62
|
| Rate for Payer: WEA Trust Commercial |
$505.65
|
| Rate for Payer: WPS Commercial |
$680.95
|
|
|
SCREW MATRIX WAVE MMF 1.85 X 6MM 04.503.824.01
|
Facility
|
IP
|
$2,086.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5831678
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,063.03 |
| Max. Negotiated Rate |
$1,995.88 |
| Rate for Payer: Aetna Commercial |
$1,952.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,865.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,149.80
|
| Rate for Payer: Cash Price |
$625.80
|
| Rate for Payer: Cigna Commercial |
$1,995.88
|
| Rate for Payer: Health EOS Commercial |
$1,930.80
|
| Rate for Payer: HFN Commercial |
$1,995.88
|
| Rate for Payer: Multiplan Commercial |
$1,735.55
|
| Rate for Payer: Preferred Network Access Commercial |
$1,995.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,063.03
|
| Rate for Payer: Quartz Commercial |
$1,301.66
|
| Rate for Payer: WEA Trust Commercial |
$1,193.19
|
| Rate for Payer: WPS Commercial |
$1,606.85
|
|
|
SCREW MATRIX WAVE MMF 1.85 X 6MM 04.503.824.01
|
Facility
|
OP
|
$2,086.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5831678
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$607.44 |
| Max. Negotiated Rate |
$1,995.88 |
| Rate for Payer: Aetna Commercial |
$1,952.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,865.72
|
| Rate for Payer: Aetna Managed Medicare |
$607.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,410.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,084.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,041.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,149.80
|
| Rate for Payer: Cash Price |
$625.80
|
| Rate for Payer: Cigna Commercial |
$1,995.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,214.05
|
| Rate for Payer: Health EOS Commercial |
$1,930.80
|
| Rate for Payer: HFN Commercial |
$1,995.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,627.08
|
| Rate for Payer: Multiplan Commercial |
$1,735.55
|
| Rate for Payer: NAPHCARE Commercial |
$1,301.66
|
| Rate for Payer: Preferred Network Access Commercial |
$1,995.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,063.03
|
| Rate for Payer: Quartz Commercial |
$1,410.14
|
| Rate for Payer: Quartz Medicare Advantage |
$1,301.66
|
| Rate for Payer: The Alliance Commercial |
$1,084.72
|
| Rate for Payer: WEA Trust Commercial |
$1,193.19
|
| Rate for Payer: WPS Commercial |
$1,606.85
|
|
|
SCREW MATRIX WAVE MMF 1.85 X 8MM 04.503.825.01
|
Facility
|
OP
|
$2,105.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6001632
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.98 |
| Max. Negotiated Rate |
$2,014.06 |
| Rate for Payer: Aetna Commercial |
$1,970.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,882.71
|
| Rate for Payer: Aetna Managed Medicare |
$612.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,422.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,094.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,050.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,160.28
|
| Rate for Payer: Cash Price |
$631.50
|
| Rate for Payer: Cigna Commercial |
$2,014.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,225.11
|
| Rate for Payer: Health EOS Commercial |
$1,948.39
|
| Rate for Payer: HFN Commercial |
$2,014.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,641.90
|
| Rate for Payer: Multiplan Commercial |
$1,751.36
|
| Rate for Payer: NAPHCARE Commercial |
$1,313.52
|
| Rate for Payer: Preferred Network Access Commercial |
$2,014.06
|
| Rate for Payer: Quartz Beloit One Network |
$1,072.71
|
| Rate for Payer: Quartz Commercial |
$1,422.98
|
| Rate for Payer: Quartz Medicare Advantage |
$1,313.52
|
| Rate for Payer: The Alliance Commercial |
$1,094.60
|
| Rate for Payer: WEA Trust Commercial |
$1,204.06
|
| Rate for Payer: WPS Commercial |
$1,621.48
|
|
|
SCREW MATRIX WAVE MMF 1.85 X 8MM 04.503.825.01
|
Facility
|
IP
|
$2,105.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6001632
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,072.71 |
| Max. Negotiated Rate |
$2,014.06 |
| Rate for Payer: Aetna Commercial |
$1,970.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,882.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,160.28
|
| Rate for Payer: Cash Price |
$631.50
|
| Rate for Payer: Cigna Commercial |
$2,014.06
|
| Rate for Payer: Health EOS Commercial |
$1,948.39
|
| Rate for Payer: HFN Commercial |
$2,014.06
|
| Rate for Payer: Multiplan Commercial |
$1,751.36
|
| Rate for Payer: Preferred Network Access Commercial |
$2,014.06
|
| Rate for Payer: Quartz Beloit One Network |
$1,072.71
|
| Rate for Payer: Quartz Commercial |
$1,313.52
|
| Rate for Payer: WEA Trust Commercial |
$1,204.06
|
| Rate for Payer: WPS Commercial |
$1,621.48
|
|
|
SCREW METAPHYSEAL 2.7 X 12MM 02.118.512
|
Facility
|
OP
|
$786.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3697492
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$228.88 |
| Max. Negotiated Rate |
$752.04 |
| Rate for Payer: Aetna Commercial |
$735.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$703.00
|
| Rate for Payer: Aetna Managed Medicare |
$228.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$531.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$408.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$392.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$433.24
|
| Rate for Payer: Cash Price |
$235.80
|
| Rate for Payer: Cigna Commercial |
$752.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$457.45
|
| Rate for Payer: Health EOS Commercial |
$727.52
|
| Rate for Payer: HFN Commercial |
$752.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$613.08
|
| Rate for Payer: Multiplan Commercial |
$653.95
|
| Rate for Payer: NAPHCARE Commercial |
$490.46
|
| Rate for Payer: Preferred Network Access Commercial |
$752.04
|
| Rate for Payer: Quartz Beloit One Network |
$400.55
|
| Rate for Payer: Quartz Commercial |
$531.34
|
| Rate for Payer: Quartz Medicare Advantage |
$490.46
|
| Rate for Payer: The Alliance Commercial |
$408.72
|
| Rate for Payer: WEA Trust Commercial |
$449.59
|
| Rate for Payer: WPS Commercial |
$605.46
|
|
|
SCREW METAPHYSEAL 2.7 X 12MM 02.118.512
|
Facility
|
IP
|
$786.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3697492
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$400.55 |
| Max. Negotiated Rate |
$752.04 |
| Rate for Payer: Aetna Commercial |
$735.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$703.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$433.24
|
| Rate for Payer: Cash Price |
$235.80
|
| Rate for Payer: Cigna Commercial |
$752.04
|
| Rate for Payer: Health EOS Commercial |
$727.52
|
| Rate for Payer: HFN Commercial |
$752.04
|
| Rate for Payer: Multiplan Commercial |
$653.95
|
| Rate for Payer: Preferred Network Access Commercial |
$752.04
|
| Rate for Payer: Quartz Beloit One Network |
$400.55
|
| Rate for Payer: Quartz Commercial |
$490.46
|
| Rate for Payer: WEA Trust Commercial |
$449.59
|
| Rate for Payer: WPS Commercial |
$605.46
|
|
|
SCREW METAPHYSEAL 2.7 X 14MM 02.118.514
|
Facility
|
IP
|
$817.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4208673
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$416.34 |
| Max. Negotiated Rate |
$781.71 |
| Rate for Payer: Aetna Commercial |
$764.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$730.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$450.33
|
| Rate for Payer: Cash Price |
$245.10
|
| Rate for Payer: Cigna Commercial |
$781.71
|
| Rate for Payer: Health EOS Commercial |
$756.22
|
| Rate for Payer: HFN Commercial |
$781.71
|
| Rate for Payer: Multiplan Commercial |
$679.74
|
| Rate for Payer: Preferred Network Access Commercial |
$781.71
|
| Rate for Payer: Quartz Beloit One Network |
$416.34
|
| Rate for Payer: Quartz Commercial |
$509.81
|
| Rate for Payer: WEA Trust Commercial |
$467.32
|
| Rate for Payer: WPS Commercial |
$629.34
|
|
|
SCREW METAPHYSEAL 2.7 X 14MM 02.118.514
|
Facility
|
OP
|
$817.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4208673
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$237.91 |
| Max. Negotiated Rate |
$781.71 |
| Rate for Payer: Aetna Commercial |
$764.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$730.72
|
| Rate for Payer: Aetna Managed Medicare |
$237.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$552.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$424.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$407.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$450.33
|
| Rate for Payer: Cash Price |
$245.10
|
| Rate for Payer: Cigna Commercial |
$781.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$475.49
|
| Rate for Payer: Health EOS Commercial |
$756.22
|
| Rate for Payer: HFN Commercial |
$781.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$637.26
|
| Rate for Payer: Multiplan Commercial |
$679.74
|
| Rate for Payer: NAPHCARE Commercial |
$509.81
|
| Rate for Payer: Preferred Network Access Commercial |
$781.71
|
| Rate for Payer: Quartz Beloit One Network |
$416.34
|
| Rate for Payer: Quartz Commercial |
$552.29
|
| Rate for Payer: Quartz Medicare Advantage |
$509.81
|
| Rate for Payer: The Alliance Commercial |
$424.84
|
| Rate for Payer: WEA Trust Commercial |
$467.32
|
| Rate for Payer: WPS Commercial |
$629.34
|
|
|
SCREW METAPHYSEAL 2.7 X 16MM 02.118.516
|
Facility
|
IP
|
$817.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3697495
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$416.34 |
| Max. Negotiated Rate |
$781.71 |
| Rate for Payer: Aetna Commercial |
$764.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$730.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$450.33
|
| Rate for Payer: Cash Price |
$245.10
|
| Rate for Payer: Cigna Commercial |
$781.71
|
| Rate for Payer: Health EOS Commercial |
$756.22
|
| Rate for Payer: HFN Commercial |
$781.71
|
| Rate for Payer: Multiplan Commercial |
$679.74
|
| Rate for Payer: Preferred Network Access Commercial |
$781.71
|
| Rate for Payer: Quartz Beloit One Network |
$416.34
|
| Rate for Payer: Quartz Commercial |
$509.81
|
| Rate for Payer: WEA Trust Commercial |
$467.32
|
| Rate for Payer: WPS Commercial |
$629.34
|
|
|
SCREW METAPHYSEAL 2.7 X 16MM 02.118.516
|
Facility
|
OP
|
$817.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3697495
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$237.91 |
| Max. Negotiated Rate |
$781.71 |
| Rate for Payer: Aetna Commercial |
$764.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$730.72
|
| Rate for Payer: Aetna Managed Medicare |
$237.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$552.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$424.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$407.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$450.33
|
| Rate for Payer: Cash Price |
$245.10
|
| Rate for Payer: Cigna Commercial |
$781.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$475.49
|
| Rate for Payer: Health EOS Commercial |
$756.22
|
| Rate for Payer: HFN Commercial |
$781.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$637.26
|
| Rate for Payer: Multiplan Commercial |
$679.74
|
| Rate for Payer: NAPHCARE Commercial |
$509.81
|
| Rate for Payer: Preferred Network Access Commercial |
$781.71
|
| Rate for Payer: Quartz Beloit One Network |
$416.34
|
| Rate for Payer: Quartz Commercial |
$552.29
|
| Rate for Payer: Quartz Medicare Advantage |
$509.81
|
| Rate for Payer: The Alliance Commercial |
$424.84
|
| Rate for Payer: WEA Trust Commercial |
$467.32
|
| Rate for Payer: WPS Commercial |
$629.34
|
|
|
SCREW METAPHYSEAL 2.7 X 18MM 02.118.518
|
Facility
|
OP
|
$817.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3937349
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$237.91 |
| Max. Negotiated Rate |
$781.71 |
| Rate for Payer: Aetna Commercial |
$764.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$730.72
|
| Rate for Payer: Aetna Managed Medicare |
$237.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$552.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$424.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$407.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$450.33
|
| Rate for Payer: Cash Price |
$245.10
|
| Rate for Payer: Cigna Commercial |
$781.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$475.49
|
| Rate for Payer: Health EOS Commercial |
$756.22
|
| Rate for Payer: HFN Commercial |
$781.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$637.26
|
| Rate for Payer: Multiplan Commercial |
$679.74
|
| Rate for Payer: NAPHCARE Commercial |
$509.81
|
| Rate for Payer: Preferred Network Access Commercial |
$781.71
|
| Rate for Payer: Quartz Beloit One Network |
$416.34
|
| Rate for Payer: Quartz Commercial |
$552.29
|
| Rate for Payer: Quartz Medicare Advantage |
$509.81
|
| Rate for Payer: The Alliance Commercial |
$424.84
|
| Rate for Payer: WEA Trust Commercial |
$467.32
|
| Rate for Payer: WPS Commercial |
$629.34
|
|
|
SCREW METAPHYSEAL 2.7 X 18MM 02.118.518
|
Facility
|
IP
|
$817.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3937349
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$416.34 |
| Max. Negotiated Rate |
$781.71 |
| Rate for Payer: Aetna Commercial |
$764.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$730.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$450.33
|
| Rate for Payer: Cash Price |
$245.10
|
| Rate for Payer: Cigna Commercial |
$781.71
|
| Rate for Payer: Health EOS Commercial |
$756.22
|
| Rate for Payer: HFN Commercial |
$781.71
|
| Rate for Payer: Multiplan Commercial |
$679.74
|
| Rate for Payer: Preferred Network Access Commercial |
$781.71
|
| Rate for Payer: Quartz Beloit One Network |
$416.34
|
| Rate for Payer: Quartz Commercial |
$509.81
|
| Rate for Payer: WEA Trust Commercial |
$467.32
|
| Rate for Payer: WPS Commercial |
$629.34
|
|
|
SCREW METAPHYSEAL 2.7 X 20MM 02.118.520
|
Facility
|
IP
|
$817.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3937354
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$416.34 |
| Max. Negotiated Rate |
$781.71 |
| Rate for Payer: Aetna Commercial |
$764.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$730.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$450.33
|
| Rate for Payer: Cash Price |
$245.10
|
| Rate for Payer: Cigna Commercial |
$781.71
|
| Rate for Payer: Health EOS Commercial |
$756.22
|
| Rate for Payer: HFN Commercial |
$781.71
|
| Rate for Payer: Multiplan Commercial |
$679.74
|
| Rate for Payer: Preferred Network Access Commercial |
$781.71
|
| Rate for Payer: Quartz Beloit One Network |
$416.34
|
| Rate for Payer: Quartz Commercial |
$509.81
|
| Rate for Payer: WEA Trust Commercial |
$467.32
|
| Rate for Payer: WPS Commercial |
$629.34
|
|
|
SCREW METAPHYSEAL 2.7 X 20MM 02.118.520
|
Facility
|
OP
|
$817.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3937354
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$237.91 |
| Max. Negotiated Rate |
$781.71 |
| Rate for Payer: Aetna Commercial |
$764.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$730.72
|
| Rate for Payer: Aetna Managed Medicare |
$237.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$552.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$424.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$407.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$450.33
|
| Rate for Payer: Cash Price |
$245.10
|
| Rate for Payer: Cigna Commercial |
$781.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$475.49
|
| Rate for Payer: Health EOS Commercial |
$756.22
|
| Rate for Payer: HFN Commercial |
$781.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$637.26
|
| Rate for Payer: Multiplan Commercial |
$679.74
|
| Rate for Payer: NAPHCARE Commercial |
$509.81
|
| Rate for Payer: Preferred Network Access Commercial |
$781.71
|
| Rate for Payer: Quartz Beloit One Network |
$416.34
|
| Rate for Payer: Quartz Commercial |
$552.29
|
| Rate for Payer: Quartz Medicare Advantage |
$509.81
|
| Rate for Payer: The Alliance Commercial |
$424.84
|
| Rate for Payer: WEA Trust Commercial |
$467.32
|
| Rate for Payer: WPS Commercial |
$629.34
|
|
|
SCREW METAPHYSEAL 2.7 X 22MM 02.118.522
|
Facility
|
OP
|
$817.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3937360
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$237.91 |
| Max. Negotiated Rate |
$781.71 |
| Rate for Payer: Aetna Commercial |
$764.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$730.72
|
| Rate for Payer: Aetna Managed Medicare |
$237.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$552.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$424.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$407.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$450.33
|
| Rate for Payer: Cash Price |
$245.10
|
| Rate for Payer: Cigna Commercial |
$781.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$475.49
|
| Rate for Payer: Health EOS Commercial |
$756.22
|
| Rate for Payer: HFN Commercial |
$781.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$637.26
|
| Rate for Payer: Multiplan Commercial |
$679.74
|
| Rate for Payer: NAPHCARE Commercial |
$509.81
|
| Rate for Payer: Preferred Network Access Commercial |
$781.71
|
| Rate for Payer: Quartz Beloit One Network |
$416.34
|
| Rate for Payer: Quartz Commercial |
$552.29
|
| Rate for Payer: Quartz Medicare Advantage |
$509.81
|
| Rate for Payer: The Alliance Commercial |
$424.84
|
| Rate for Payer: WEA Trust Commercial |
$467.32
|
| Rate for Payer: WPS Commercial |
$629.34
|
|
