|
SCREW CORT 2.0MM X 10MM SELF TAPPING 201.810
|
Facility
|
OP
|
$610.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508573
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$170.80 |
| Max. Negotiated Rate |
$2,440.00 |
| Rate for Payer: Aetna Commercial |
$549.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$524.60
|
| Rate for Payer: Aetna Managed Medicare |
$170.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$396.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$305.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$292.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$323.30
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$561.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$341.36
|
| Rate for Payer: Health EOS Commercial |
$542.90
|
| Rate for Payer: HFN Commercial |
$561.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$457.50
|
| Rate for Payer: Multiplan Commercial |
$488.00
|
| Rate for Payer: NAPHCARE Commercial |
$366.00
|
| Rate for Payer: Preferred Network Access Commercial |
$561.20
|
| Rate for Payer: Quartz Beloit One Network |
$298.90
|
| Rate for Payer: Quartz Commercial |
$396.50
|
| Rate for Payer: Quartz Medicare Advantage |
$366.00
|
| Rate for Payer: The Alliance Commercial |
$2,440.00
|
| Rate for Payer: WEA Trust Commercial |
$335.50
|
| Rate for Payer: WPS Commercial |
$451.83
|
|
|
SCREW CORT 2.0MM X 10MM SELF TAPPING 201.810
|
Facility
|
IP
|
$610.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508573
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$298.90 |
| Max. Negotiated Rate |
$561.20 |
| Rate for Payer: Aetna Commercial |
$549.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$524.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$323.30
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$561.20
|
| Rate for Payer: Health EOS Commercial |
$542.90
|
| Rate for Payer: HFN Commercial |
$561.20
|
| Rate for Payer: Multiplan Commercial |
$488.00
|
| Rate for Payer: NAPHCARE Commercial |
$366.00
|
| Rate for Payer: Preferred Network Access Commercial |
$561.20
|
| Rate for Payer: Quartz Beloit One Network |
$298.90
|
| Rate for Payer: Quartz Commercial |
$366.00
|
| Rate for Payer: WEA Trust Commercial |
$335.50
|
| Rate for Payer: WPS Commercial |
$451.83
|
|
|
SCREW CORT 2.0MM X 11MM SELF TAPPING 201.811
|
Facility
|
IP
|
$588.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508574
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$288.12 |
| Max. Negotiated Rate |
$540.96 |
| Rate for Payer: Aetna Commercial |
$529.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$505.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$311.64
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cigna Commercial |
$540.96
|
| Rate for Payer: Health EOS Commercial |
$523.32
|
| Rate for Payer: HFN Commercial |
$540.96
|
| Rate for Payer: Multiplan Commercial |
$470.40
|
| Rate for Payer: NAPHCARE Commercial |
$352.80
|
| Rate for Payer: Preferred Network Access Commercial |
$540.96
|
| Rate for Payer: Quartz Beloit One Network |
$288.12
|
| Rate for Payer: Quartz Commercial |
$352.80
|
| Rate for Payer: WEA Trust Commercial |
$323.40
|
| Rate for Payer: WPS Commercial |
$435.53
|
|
|
SCREW CORT 2.0MM X 11MM SELF TAPPING 201.811
|
Facility
|
OP
|
$588.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508574
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$164.64 |
| Max. Negotiated Rate |
$2,352.00 |
| Rate for Payer: Aetna Commercial |
$529.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$505.68
|
| Rate for Payer: Aetna Managed Medicare |
$164.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$382.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$294.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$282.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$311.64
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cigna Commercial |
$540.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$329.04
|
| Rate for Payer: Health EOS Commercial |
$523.32
|
| Rate for Payer: HFN Commercial |
$540.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$441.00
|
| Rate for Payer: Multiplan Commercial |
$470.40
|
| Rate for Payer: NAPHCARE Commercial |
$352.80
|
| Rate for Payer: Preferred Network Access Commercial |
$540.96
|
| Rate for Payer: Quartz Beloit One Network |
$288.12
|
| Rate for Payer: Quartz Commercial |
$382.20
|
| Rate for Payer: Quartz Medicare Advantage |
$352.80
|
| Rate for Payer: The Alliance Commercial |
$2,352.00
|
| Rate for Payer: WEA Trust Commercial |
$323.40
|
| Rate for Payer: WPS Commercial |
$435.53
|
|
|
SCREW CORT 2.0MM X 12MM SELF TAPPING 201.812
|
Facility
|
IP
|
$588.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508575
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$288.12 |
| Max. Negotiated Rate |
$540.96 |
| Rate for Payer: Aetna Commercial |
$529.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$505.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$311.64
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cigna Commercial |
$540.96
|
| Rate for Payer: Health EOS Commercial |
$523.32
|
| Rate for Payer: HFN Commercial |
$540.96
|
| Rate for Payer: Multiplan Commercial |
$470.40
|
| Rate for Payer: NAPHCARE Commercial |
$352.80
|
| Rate for Payer: Preferred Network Access Commercial |
$540.96
|
| Rate for Payer: Quartz Beloit One Network |
$288.12
|
| Rate for Payer: Quartz Commercial |
$352.80
|
| Rate for Payer: WEA Trust Commercial |
$323.40
|
| Rate for Payer: WPS Commercial |
$435.53
|
|
|
SCREW CORT 2.0MM X 12MM SELF TAPPING 201.812
|
Facility
|
OP
|
$588.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508575
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$164.64 |
| Max. Negotiated Rate |
$2,352.00 |
| Rate for Payer: Aetna Commercial |
$529.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$505.68
|
| Rate for Payer: Aetna Managed Medicare |
$164.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$382.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$294.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$282.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$311.64
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cigna Commercial |
$540.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$329.04
|
| Rate for Payer: Health EOS Commercial |
$523.32
|
| Rate for Payer: HFN Commercial |
$540.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$441.00
|
| Rate for Payer: Multiplan Commercial |
$470.40
|
| Rate for Payer: NAPHCARE Commercial |
$352.80
|
| Rate for Payer: Preferred Network Access Commercial |
$540.96
|
| Rate for Payer: Quartz Beloit One Network |
$288.12
|
| Rate for Payer: Quartz Commercial |
$382.20
|
| Rate for Payer: Quartz Medicare Advantage |
$352.80
|
| Rate for Payer: The Alliance Commercial |
$2,352.00
|
| Rate for Payer: WEA Trust Commercial |
$323.40
|
| Rate for Payer: WPS Commercial |
$435.53
|
|
|
SCREW CORT 2.0MM X 13MM SELF TAPPING 201.813
|
Facility
|
IP
|
$588.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508576
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$288.12 |
| Max. Negotiated Rate |
$540.96 |
| Rate for Payer: Aetna Commercial |
$529.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$505.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$311.64
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cigna Commercial |
$540.96
|
| Rate for Payer: Health EOS Commercial |
$523.32
|
| Rate for Payer: HFN Commercial |
$540.96
|
| Rate for Payer: Multiplan Commercial |
$470.40
|
| Rate for Payer: NAPHCARE Commercial |
$352.80
|
| Rate for Payer: Preferred Network Access Commercial |
$540.96
|
| Rate for Payer: Quartz Beloit One Network |
$288.12
|
| Rate for Payer: Quartz Commercial |
$352.80
|
| Rate for Payer: WEA Trust Commercial |
$323.40
|
| Rate for Payer: WPS Commercial |
$435.53
|
|
|
SCREW CORT 2.0MM X 13MM SELF TAPPING 201.813
|
Facility
|
OP
|
$588.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508576
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$164.64 |
| Max. Negotiated Rate |
$2,352.00 |
| Rate for Payer: Aetna Commercial |
$529.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$505.68
|
| Rate for Payer: Aetna Managed Medicare |
$164.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$382.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$294.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$282.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$311.64
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cigna Commercial |
$540.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$329.04
|
| Rate for Payer: Health EOS Commercial |
$523.32
|
| Rate for Payer: HFN Commercial |
$540.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$441.00
|
| Rate for Payer: Multiplan Commercial |
$470.40
|
| Rate for Payer: NAPHCARE Commercial |
$352.80
|
| Rate for Payer: Preferred Network Access Commercial |
$540.96
|
| Rate for Payer: Quartz Beloit One Network |
$288.12
|
| Rate for Payer: Quartz Commercial |
$382.20
|
| Rate for Payer: Quartz Medicare Advantage |
$352.80
|
| Rate for Payer: The Alliance Commercial |
$2,352.00
|
| Rate for Payer: WEA Trust Commercial |
$323.40
|
| Rate for Payer: WPS Commercial |
$435.53
|
|
|
SCREW CORT 2.0MM X 14MM SELF TAPPING 201.814
|
Facility
|
OP
|
$588.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508859
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$164.64 |
| Max. Negotiated Rate |
$2,352.00 |
| Rate for Payer: Aetna Commercial |
$529.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$505.68
|
| Rate for Payer: Aetna Managed Medicare |
$164.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$382.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$294.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$282.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$311.64
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cigna Commercial |
$540.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$329.04
|
| Rate for Payer: Health EOS Commercial |
$523.32
|
| Rate for Payer: HFN Commercial |
$540.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$441.00
|
| Rate for Payer: Multiplan Commercial |
$470.40
|
| Rate for Payer: NAPHCARE Commercial |
$352.80
|
| Rate for Payer: Preferred Network Access Commercial |
$540.96
|
| Rate for Payer: Quartz Beloit One Network |
$288.12
|
| Rate for Payer: Quartz Commercial |
$382.20
|
| Rate for Payer: Quartz Medicare Advantage |
$352.80
|
| Rate for Payer: The Alliance Commercial |
$2,352.00
|
| Rate for Payer: WEA Trust Commercial |
$323.40
|
| Rate for Payer: WPS Commercial |
$435.53
|
|
|
SCREW CORT 2.0MM X 14MM SELF TAPPING 201.814
|
Facility
|
IP
|
$588.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508859
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$288.12 |
| Max. Negotiated Rate |
$540.96 |
| Rate for Payer: Aetna Commercial |
$529.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$505.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$311.64
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cigna Commercial |
$540.96
|
| Rate for Payer: Health EOS Commercial |
$523.32
|
| Rate for Payer: HFN Commercial |
$540.96
|
| Rate for Payer: Multiplan Commercial |
$470.40
|
| Rate for Payer: NAPHCARE Commercial |
$352.80
|
| Rate for Payer: Preferred Network Access Commercial |
$540.96
|
| Rate for Payer: Quartz Beloit One Network |
$288.12
|
| Rate for Payer: Quartz Commercial |
$352.80
|
| Rate for Payer: WEA Trust Commercial |
$323.40
|
| Rate for Payer: WPS Commercial |
$435.53
|
|
|
SCREW CORT 2.0MM X 16MM SELF TAPPING 201.816
|
Facility
|
OP
|
$588.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508860
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$164.64 |
| Max. Negotiated Rate |
$2,352.00 |
| Rate for Payer: Aetna Commercial |
$529.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$505.68
|
| Rate for Payer: Aetna Managed Medicare |
$164.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$382.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$294.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$282.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$311.64
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cigna Commercial |
$540.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$329.04
|
| Rate for Payer: Health EOS Commercial |
$523.32
|
| Rate for Payer: HFN Commercial |
$540.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$441.00
|
| Rate for Payer: Multiplan Commercial |
$470.40
|
| Rate for Payer: NAPHCARE Commercial |
$352.80
|
| Rate for Payer: Preferred Network Access Commercial |
$540.96
|
| Rate for Payer: Quartz Beloit One Network |
$288.12
|
| Rate for Payer: Quartz Commercial |
$382.20
|
| Rate for Payer: Quartz Medicare Advantage |
$352.80
|
| Rate for Payer: The Alliance Commercial |
$2,352.00
|
| Rate for Payer: WEA Trust Commercial |
$323.40
|
| Rate for Payer: WPS Commercial |
$435.53
|
|
|
SCREW CORT 2.0MM X 16MM SELF TAPPING 201.816
|
Facility
|
IP
|
$588.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508860
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$288.12 |
| Max. Negotiated Rate |
$540.96 |
| Rate for Payer: Aetna Commercial |
$529.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$505.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$311.64
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cigna Commercial |
$540.96
|
| Rate for Payer: Health EOS Commercial |
$523.32
|
| Rate for Payer: HFN Commercial |
$540.96
|
| Rate for Payer: Multiplan Commercial |
$470.40
|
| Rate for Payer: NAPHCARE Commercial |
$352.80
|
| Rate for Payer: Preferred Network Access Commercial |
$540.96
|
| Rate for Payer: Quartz Beloit One Network |
$288.12
|
| Rate for Payer: Quartz Commercial |
$352.80
|
| Rate for Payer: WEA Trust Commercial |
$323.40
|
| Rate for Payer: WPS Commercial |
$435.53
|
|
|
SCREW CORT 2.0MM X 18MM SELF TAPPING 201.818
|
Facility
|
IP
|
$588.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508577
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$288.12 |
| Max. Negotiated Rate |
$540.96 |
| Rate for Payer: Aetna Commercial |
$529.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$505.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$311.64
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cigna Commercial |
$540.96
|
| Rate for Payer: Health EOS Commercial |
$523.32
|
| Rate for Payer: HFN Commercial |
$540.96
|
| Rate for Payer: Multiplan Commercial |
$470.40
|
| Rate for Payer: NAPHCARE Commercial |
$352.80
|
| Rate for Payer: Preferred Network Access Commercial |
$540.96
|
| Rate for Payer: Quartz Beloit One Network |
$288.12
|
| Rate for Payer: Quartz Commercial |
$352.80
|
| Rate for Payer: WEA Trust Commercial |
$323.40
|
| Rate for Payer: WPS Commercial |
$435.53
|
|
|
SCREW CORT 2.0MM X 18MM SELF TAPPING 201.818
|
Facility
|
OP
|
$588.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508577
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$164.64 |
| Max. Negotiated Rate |
$2,352.00 |
| Rate for Payer: Aetna Commercial |
$529.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$505.68
|
| Rate for Payer: Aetna Managed Medicare |
$164.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$382.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$294.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$282.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$311.64
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cigna Commercial |
$540.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$329.04
|
| Rate for Payer: Health EOS Commercial |
$523.32
|
| Rate for Payer: HFN Commercial |
$540.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$441.00
|
| Rate for Payer: Multiplan Commercial |
$470.40
|
| Rate for Payer: NAPHCARE Commercial |
$352.80
|
| Rate for Payer: Preferred Network Access Commercial |
$540.96
|
| Rate for Payer: Quartz Beloit One Network |
$288.12
|
| Rate for Payer: Quartz Commercial |
$382.20
|
| Rate for Payer: Quartz Medicare Advantage |
$352.80
|
| Rate for Payer: The Alliance Commercial |
$2,352.00
|
| Rate for Payer: WEA Trust Commercial |
$323.40
|
| Rate for Payer: WPS Commercial |
$435.53
|
|
|
SCREW CORT 2.0MM X 20MM SELF TAPPING 201.820
|
Facility
|
IP
|
$588.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508578
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$288.12 |
| Max. Negotiated Rate |
$540.96 |
| Rate for Payer: Aetna Commercial |
$529.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$505.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$311.64
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cigna Commercial |
$540.96
|
| Rate for Payer: Health EOS Commercial |
$523.32
|
| Rate for Payer: HFN Commercial |
$540.96
|
| Rate for Payer: Multiplan Commercial |
$470.40
|
| Rate for Payer: NAPHCARE Commercial |
$352.80
|
| Rate for Payer: Preferred Network Access Commercial |
$540.96
|
| Rate for Payer: Quartz Beloit One Network |
$288.12
|
| Rate for Payer: Quartz Commercial |
$352.80
|
| Rate for Payer: WEA Trust Commercial |
$323.40
|
| Rate for Payer: WPS Commercial |
$435.53
|
|
|
SCREW CORT 2.0MM X 20MM SELF TAPPING 201.820
|
Facility
|
OP
|
$588.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508578
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$164.64 |
| Max. Negotiated Rate |
$2,352.00 |
| Rate for Payer: Aetna Commercial |
$529.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$505.68
|
| Rate for Payer: Aetna Managed Medicare |
$164.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$382.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$294.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$282.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$311.64
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cigna Commercial |
$540.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$329.04
|
| Rate for Payer: Health EOS Commercial |
$523.32
|
| Rate for Payer: HFN Commercial |
$540.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$441.00
|
| Rate for Payer: Multiplan Commercial |
$470.40
|
| Rate for Payer: NAPHCARE Commercial |
$352.80
|
| Rate for Payer: Preferred Network Access Commercial |
$540.96
|
| Rate for Payer: Quartz Beloit One Network |
$288.12
|
| Rate for Payer: Quartz Commercial |
$382.20
|
| Rate for Payer: Quartz Medicare Advantage |
$352.80
|
| Rate for Payer: The Alliance Commercial |
$2,352.00
|
| Rate for Payer: WEA Trust Commercial |
$323.40
|
| Rate for Payer: WPS Commercial |
$435.53
|
|
|
SCREW CORT 2.0MM X 22MM SELF TAPPING 201.822
|
Facility
|
OP
|
$588.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508579
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$164.64 |
| Max. Negotiated Rate |
$2,352.00 |
| Rate for Payer: Aetna Commercial |
$529.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$505.68
|
| Rate for Payer: Aetna Managed Medicare |
$164.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$382.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$294.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$282.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$311.64
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cigna Commercial |
$540.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$329.04
|
| Rate for Payer: Health EOS Commercial |
$523.32
|
| Rate for Payer: HFN Commercial |
$540.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$441.00
|
| Rate for Payer: Multiplan Commercial |
$470.40
|
| Rate for Payer: NAPHCARE Commercial |
$352.80
|
| Rate for Payer: Preferred Network Access Commercial |
$540.96
|
| Rate for Payer: Quartz Beloit One Network |
$288.12
|
| Rate for Payer: Quartz Commercial |
$382.20
|
| Rate for Payer: Quartz Medicare Advantage |
$352.80
|
| Rate for Payer: The Alliance Commercial |
$2,352.00
|
| Rate for Payer: WEA Trust Commercial |
$323.40
|
| Rate for Payer: WPS Commercial |
$435.53
|
|
|
SCREW CORT 2.0MM X 22MM SELF TAPPING 201.822
|
Facility
|
IP
|
$588.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508579
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$288.12 |
| Max. Negotiated Rate |
$540.96 |
| Rate for Payer: Aetna Commercial |
$529.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$505.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$311.64
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cigna Commercial |
$540.96
|
| Rate for Payer: Health EOS Commercial |
$523.32
|
| Rate for Payer: HFN Commercial |
$540.96
|
| Rate for Payer: Multiplan Commercial |
$470.40
|
| Rate for Payer: NAPHCARE Commercial |
$352.80
|
| Rate for Payer: Preferred Network Access Commercial |
$540.96
|
| Rate for Payer: Quartz Beloit One Network |
$288.12
|
| Rate for Payer: Quartz Commercial |
$352.80
|
| Rate for Payer: WEA Trust Commercial |
$323.40
|
| Rate for Payer: WPS Commercial |
$435.53
|
|
|
SCREW CORT 2.0MM X 24MM SELF TAPPING 201.824
|
Facility
|
IP
|
$588.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508580
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$288.12 |
| Max. Negotiated Rate |
$540.96 |
| Rate for Payer: Aetna Commercial |
$529.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$505.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$311.64
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cigna Commercial |
$540.96
|
| Rate for Payer: Health EOS Commercial |
$523.32
|
| Rate for Payer: HFN Commercial |
$540.96
|
| Rate for Payer: Multiplan Commercial |
$470.40
|
| Rate for Payer: NAPHCARE Commercial |
$352.80
|
| Rate for Payer: Preferred Network Access Commercial |
$540.96
|
| Rate for Payer: Quartz Beloit One Network |
$288.12
|
| Rate for Payer: Quartz Commercial |
$352.80
|
| Rate for Payer: WEA Trust Commercial |
$323.40
|
| Rate for Payer: WPS Commercial |
$435.53
|
|
|
SCREW CORT 2.0MM X 24MM SELF TAPPING 201.824
|
Facility
|
OP
|
$588.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508580
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$164.64 |
| Max. Negotiated Rate |
$2,352.00 |
| Rate for Payer: Aetna Commercial |
$529.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$505.68
|
| Rate for Payer: Aetna Managed Medicare |
$164.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$382.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$294.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$282.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$311.64
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cigna Commercial |
$540.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$329.04
|
| Rate for Payer: Health EOS Commercial |
$523.32
|
| Rate for Payer: HFN Commercial |
$540.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$441.00
|
| Rate for Payer: Multiplan Commercial |
$470.40
|
| Rate for Payer: NAPHCARE Commercial |
$352.80
|
| Rate for Payer: Preferred Network Access Commercial |
$540.96
|
| Rate for Payer: Quartz Beloit One Network |
$288.12
|
| Rate for Payer: Quartz Commercial |
$382.20
|
| Rate for Payer: Quartz Medicare Advantage |
$352.80
|
| Rate for Payer: The Alliance Commercial |
$2,352.00
|
| Rate for Payer: WEA Trust Commercial |
$323.40
|
| Rate for Payer: WPS Commercial |
$435.53
|
|
|
SCREW CORT 2.0MM X 26MM SELF TAPPING 201.826
|
Facility
|
IP
|
$588.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508581
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$288.12 |
| Max. Negotiated Rate |
$540.96 |
| Rate for Payer: Aetna Commercial |
$529.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$505.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$311.64
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cigna Commercial |
$540.96
|
| Rate for Payer: Health EOS Commercial |
$523.32
|
| Rate for Payer: HFN Commercial |
$540.96
|
| Rate for Payer: Multiplan Commercial |
$470.40
|
| Rate for Payer: NAPHCARE Commercial |
$352.80
|
| Rate for Payer: Preferred Network Access Commercial |
$540.96
|
| Rate for Payer: Quartz Beloit One Network |
$288.12
|
| Rate for Payer: Quartz Commercial |
$352.80
|
| Rate for Payer: WEA Trust Commercial |
$323.40
|
| Rate for Payer: WPS Commercial |
$435.53
|
|
|
SCREW CORT 2.0MM X 26MM SELF TAPPING 201.826
|
Facility
|
OP
|
$588.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508581
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$164.64 |
| Max. Negotiated Rate |
$2,352.00 |
| Rate for Payer: Aetna Commercial |
$529.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$505.68
|
| Rate for Payer: Aetna Managed Medicare |
$164.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$382.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$294.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$282.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$311.64
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cigna Commercial |
$540.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$329.04
|
| Rate for Payer: Health EOS Commercial |
$523.32
|
| Rate for Payer: HFN Commercial |
$540.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$441.00
|
| Rate for Payer: Multiplan Commercial |
$470.40
|
| Rate for Payer: NAPHCARE Commercial |
$352.80
|
| Rate for Payer: Preferred Network Access Commercial |
$540.96
|
| Rate for Payer: Quartz Beloit One Network |
$288.12
|
| Rate for Payer: Quartz Commercial |
$382.20
|
| Rate for Payer: Quartz Medicare Advantage |
$352.80
|
| Rate for Payer: The Alliance Commercial |
$2,352.00
|
| Rate for Payer: WEA Trust Commercial |
$323.40
|
| Rate for Payer: WPS Commercial |
$435.53
|
|
|
SCREW CORT 2.0MM X 28MM SELF TAPPING 201.828
|
Facility
|
OP
|
$588.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508582
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$164.64 |
| Max. Negotiated Rate |
$2,352.00 |
| Rate for Payer: Aetna Commercial |
$529.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$505.68
|
| Rate for Payer: Aetna Managed Medicare |
$164.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$382.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$294.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$282.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$311.64
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cigna Commercial |
$540.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$329.04
|
| Rate for Payer: Health EOS Commercial |
$523.32
|
| Rate for Payer: HFN Commercial |
$540.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$441.00
|
| Rate for Payer: Multiplan Commercial |
$470.40
|
| Rate for Payer: NAPHCARE Commercial |
$352.80
|
| Rate for Payer: Preferred Network Access Commercial |
$540.96
|
| Rate for Payer: Quartz Beloit One Network |
$288.12
|
| Rate for Payer: Quartz Commercial |
$382.20
|
| Rate for Payer: Quartz Medicare Advantage |
$352.80
|
| Rate for Payer: The Alliance Commercial |
$2,352.00
|
| Rate for Payer: WEA Trust Commercial |
$323.40
|
| Rate for Payer: WPS Commercial |
$435.53
|
|
|
SCREW CORT 2.0MM X 28MM SELF TAPPING 201.828
|
Facility
|
IP
|
$588.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508582
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$288.12 |
| Max. Negotiated Rate |
$540.96 |
| Rate for Payer: Aetna Commercial |
$529.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$505.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$311.64
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cigna Commercial |
$540.96
|
| Rate for Payer: Health EOS Commercial |
$523.32
|
| Rate for Payer: HFN Commercial |
$540.96
|
| Rate for Payer: Multiplan Commercial |
$470.40
|
| Rate for Payer: NAPHCARE Commercial |
$352.80
|
| Rate for Payer: Preferred Network Access Commercial |
$540.96
|
| Rate for Payer: Quartz Beloit One Network |
$288.12
|
| Rate for Payer: Quartz Commercial |
$352.80
|
| Rate for Payer: WEA Trust Commercial |
$323.40
|
| Rate for Payer: WPS Commercial |
$435.53
|
|
|
SCREW CORT 2.0MM X 30MM SELF TAPPING 201.830
|
Facility
|
OP
|
$588.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508584
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$164.64 |
| Max. Negotiated Rate |
$2,352.00 |
| Rate for Payer: Aetna Commercial |
$529.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$505.68
|
| Rate for Payer: Aetna Managed Medicare |
$164.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$382.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$294.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$282.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$311.64
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cigna Commercial |
$540.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$329.04
|
| Rate for Payer: Health EOS Commercial |
$523.32
|
| Rate for Payer: HFN Commercial |
$540.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$441.00
|
| Rate for Payer: Multiplan Commercial |
$470.40
|
| Rate for Payer: NAPHCARE Commercial |
$352.80
|
| Rate for Payer: Preferred Network Access Commercial |
$540.96
|
| Rate for Payer: Quartz Beloit One Network |
$288.12
|
| Rate for Payer: Quartz Commercial |
$382.20
|
| Rate for Payer: Quartz Medicare Advantage |
$352.80
|
| Rate for Payer: The Alliance Commercial |
$2,352.00
|
| Rate for Payer: WEA Trust Commercial |
$323.40
|
| Rate for Payer: WPS Commercial |
$435.53
|
|
