|
SCREW METAPHYSEAL 2.7 X 28MM 02.118.528
|
Facility
|
OP
|
$1,546.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5106758
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$432.88 |
| Max. Negotiated Rate |
$6,184.00 |
| Rate for Payer: Aetna Commercial |
$1,391.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,329.56
|
| Rate for Payer: Aetna Managed Medicare |
$432.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,004.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$773.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$742.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$819.38
|
| Rate for Payer: Cash Price |
$463.80
|
| Rate for Payer: Cigna Commercial |
$1,422.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$865.14
|
| Rate for Payer: Health EOS Commercial |
$1,375.94
|
| Rate for Payer: HFN Commercial |
$1,422.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,159.50
|
| Rate for Payer: Multiplan Commercial |
$1,236.80
|
| Rate for Payer: NAPHCARE Commercial |
$927.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,422.32
|
| Rate for Payer: Quartz Beloit One Network |
$757.54
|
| Rate for Payer: Quartz Commercial |
$1,004.90
|
| Rate for Payer: Quartz Medicare Advantage |
$927.60
|
| Rate for Payer: The Alliance Commercial |
$6,184.00
|
| Rate for Payer: WEA Trust Commercial |
$850.30
|
| Rate for Payer: WPS Commercial |
$1,145.12
|
|
|
SCREW METAPHYSEAL 2.7 X 30MM 02.118.530
|
Facility
|
OP
|
$817.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5178932
|
|
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 30MM 02.118.530
|
Facility
|
IP
|
$817.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5178932
|
|
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 32MM 02.118.532
|
Facility
|
IP
|
$817.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5178930
|
|
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 32MM 02.118.532
|
Facility
|
OP
|
$817.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5178930
|
|
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 34MM 02.118.534
|
Facility
|
OP
|
$817.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5178931
|
|
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 34MM 02.118.534
|
Facility
|
IP
|
$817.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5178931
|
|
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
|
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
|
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 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 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 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 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
|
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 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 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 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 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 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 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
|
|
