|
SCREW CORT 2.4MM X 12MM SELF TAPPING 201.642
|
Facility
|
IP
|
$1,245.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494557
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.05 |
| Max. Negotiated Rate |
$1,145.40 |
| Rate for Payer: Aetna Commercial |
$1,120.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,070.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$659.85
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Cigna Commercial |
$1,145.40
|
| Rate for Payer: Health EOS Commercial |
$1,108.05
|
| Rate for Payer: HFN Commercial |
$1,145.40
|
| Rate for Payer: Multiplan Commercial |
$996.00
|
| Rate for Payer: NAPHCARE Commercial |
$747.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,145.40
|
| Rate for Payer: Quartz Beloit One Network |
$610.05
|
| Rate for Payer: Quartz Commercial |
$747.00
|
| Rate for Payer: WEA Trust Commercial |
$684.75
|
| Rate for Payer: WPS Commercial |
$922.17
|
|
|
SCREW CORT 2.4MM X 12MM SELF TAPPING 201.642
|
Facility
|
OP
|
$1,245.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494557
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$348.60 |
| Max. Negotiated Rate |
$4,980.00 |
| Rate for Payer: Aetna Commercial |
$1,120.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,070.70
|
| Rate for Payer: Aetna Managed Medicare |
$348.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$809.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$622.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$597.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$659.85
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Cigna Commercial |
$1,145.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$696.70
|
| Rate for Payer: Health EOS Commercial |
$1,108.05
|
| Rate for Payer: HFN Commercial |
$1,145.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$933.75
|
| Rate for Payer: Multiplan Commercial |
$996.00
|
| Rate for Payer: NAPHCARE Commercial |
$747.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,145.40
|
| Rate for Payer: Quartz Beloit One Network |
$610.05
|
| Rate for Payer: Quartz Commercial |
$809.25
|
| Rate for Payer: Quartz Medicare Advantage |
$747.00
|
| Rate for Payer: The Alliance Commercial |
$4,980.00
|
| Rate for Payer: WEA Trust Commercial |
$684.75
|
| Rate for Payer: WPS Commercial |
$922.17
|
|
|
SCREW CORT 2.4MM X 13MM SELF TAPPING 201.643
|
Facility
|
IP
|
$1,245.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494558
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.05 |
| Max. Negotiated Rate |
$1,145.40 |
| Rate for Payer: Aetna Commercial |
$1,120.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,070.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$659.85
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Cigna Commercial |
$1,145.40
|
| Rate for Payer: Health EOS Commercial |
$1,108.05
|
| Rate for Payer: HFN Commercial |
$1,145.40
|
| Rate for Payer: Multiplan Commercial |
$996.00
|
| Rate for Payer: NAPHCARE Commercial |
$747.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,145.40
|
| Rate for Payer: Quartz Beloit One Network |
$610.05
|
| Rate for Payer: Quartz Commercial |
$747.00
|
| Rate for Payer: WEA Trust Commercial |
$684.75
|
| Rate for Payer: WPS Commercial |
$922.17
|
|
|
SCREW CORT 2.4MM X 13MM SELF TAPPING 201.643
|
Facility
|
OP
|
$1,245.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494558
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$348.60 |
| Max. Negotiated Rate |
$4,980.00 |
| Rate for Payer: Aetna Commercial |
$1,120.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,070.70
|
| Rate for Payer: Aetna Managed Medicare |
$348.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$809.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$622.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$597.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$659.85
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Cigna Commercial |
$1,145.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$696.70
|
| Rate for Payer: Health EOS Commercial |
$1,108.05
|
| Rate for Payer: HFN Commercial |
$1,145.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$933.75
|
| Rate for Payer: Multiplan Commercial |
$996.00
|
| Rate for Payer: NAPHCARE Commercial |
$747.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,145.40
|
| Rate for Payer: Quartz Beloit One Network |
$610.05
|
| Rate for Payer: Quartz Commercial |
$809.25
|
| Rate for Payer: Quartz Medicare Advantage |
$747.00
|
| Rate for Payer: The Alliance Commercial |
$4,980.00
|
| Rate for Payer: WEA Trust Commercial |
$684.75
|
| Rate for Payer: WPS Commercial |
$922.17
|
|
|
SCREW CORT 2.4MM X 14MM SELF TAPPING 201.644
|
Facility
|
IP
|
$1,245.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494559
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.05 |
| Max. Negotiated Rate |
$1,145.40 |
| Rate for Payer: Aetna Commercial |
$1,120.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,070.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$659.85
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Cigna Commercial |
$1,145.40
|
| Rate for Payer: Health EOS Commercial |
$1,108.05
|
| Rate for Payer: HFN Commercial |
$1,145.40
|
| Rate for Payer: Multiplan Commercial |
$996.00
|
| Rate for Payer: NAPHCARE Commercial |
$747.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,145.40
|
| Rate for Payer: Quartz Beloit One Network |
$610.05
|
| Rate for Payer: Quartz Commercial |
$747.00
|
| Rate for Payer: WEA Trust Commercial |
$684.75
|
| Rate for Payer: WPS Commercial |
$922.17
|
|
|
SCREW CORT 2.4MM X 14MM SELF TAPPING 201.644
|
Facility
|
OP
|
$1,245.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494559
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$348.60 |
| Max. Negotiated Rate |
$4,980.00 |
| Rate for Payer: Aetna Commercial |
$1,120.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,070.70
|
| Rate for Payer: Aetna Managed Medicare |
$348.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$809.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$622.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$597.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$659.85
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Cigna Commercial |
$1,145.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$696.70
|
| Rate for Payer: Health EOS Commercial |
$1,108.05
|
| Rate for Payer: HFN Commercial |
$1,145.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$933.75
|
| Rate for Payer: Multiplan Commercial |
$996.00
|
| Rate for Payer: NAPHCARE Commercial |
$747.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,145.40
|
| Rate for Payer: Quartz Beloit One Network |
$610.05
|
| Rate for Payer: Quartz Commercial |
$809.25
|
| Rate for Payer: Quartz Medicare Advantage |
$747.00
|
| Rate for Payer: The Alliance Commercial |
$4,980.00
|
| Rate for Payer: WEA Trust Commercial |
$684.75
|
| Rate for Payer: WPS Commercial |
$922.17
|
|
|
SCREW CORT 2.4MM X 16MM SELF TAPPING 201.646
|
Facility
|
IP
|
$1,245.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494560
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.05 |
| Max. Negotiated Rate |
$1,145.40 |
| Rate for Payer: Aetna Commercial |
$1,120.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,070.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$659.85
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Cigna Commercial |
$1,145.40
|
| Rate for Payer: Health EOS Commercial |
$1,108.05
|
| Rate for Payer: HFN Commercial |
$1,145.40
|
| Rate for Payer: Multiplan Commercial |
$996.00
|
| Rate for Payer: NAPHCARE Commercial |
$747.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,145.40
|
| Rate for Payer: Quartz Beloit One Network |
$610.05
|
| Rate for Payer: Quartz Commercial |
$747.00
|
| Rate for Payer: WEA Trust Commercial |
$684.75
|
| Rate for Payer: WPS Commercial |
$922.17
|
|
|
SCREW CORT 2.4MM X 16MM SELF TAPPING 201.646
|
Facility
|
OP
|
$1,245.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494560
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$348.60 |
| Max. Negotiated Rate |
$4,980.00 |
| Rate for Payer: Aetna Commercial |
$1,120.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,070.70
|
| Rate for Payer: Aetna Managed Medicare |
$348.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$809.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$622.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$597.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$659.85
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Cigna Commercial |
$1,145.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$696.70
|
| Rate for Payer: Health EOS Commercial |
$1,108.05
|
| Rate for Payer: HFN Commercial |
$1,145.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$933.75
|
| Rate for Payer: Multiplan Commercial |
$996.00
|
| Rate for Payer: NAPHCARE Commercial |
$747.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,145.40
|
| Rate for Payer: Quartz Beloit One Network |
$610.05
|
| Rate for Payer: Quartz Commercial |
$809.25
|
| Rate for Payer: Quartz Medicare Advantage |
$747.00
|
| Rate for Payer: The Alliance Commercial |
$4,980.00
|
| Rate for Payer: WEA Trust Commercial |
$684.75
|
| Rate for Payer: WPS Commercial |
$922.17
|
|
|
SCREW CORT 2.4MM X 18MM SELF TAPPING 201.648
|
Facility
|
IP
|
$1,245.00
|
|
| Hospital Charge Code |
4494561
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.05 |
| Max. Negotiated Rate |
$1,145.40 |
| Rate for Payer: Aetna Commercial |
$1,120.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,070.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$659.85
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Cigna Commercial |
$1,145.40
|
| Rate for Payer: Health EOS Commercial |
$1,108.05
|
| Rate for Payer: HFN Commercial |
$1,145.40
|
| Rate for Payer: Multiplan Commercial |
$996.00
|
| Rate for Payer: NAPHCARE Commercial |
$747.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,145.40
|
| Rate for Payer: Quartz Beloit One Network |
$610.05
|
| Rate for Payer: Quartz Commercial |
$747.00
|
| Rate for Payer: WEA Trust Commercial |
$684.75
|
| Rate for Payer: WPS Commercial |
$922.17
|
|
|
SCREW CORT 2.4MM X 18MM SELF TAPPING 201.648
|
Facility
|
OP
|
$1,245.00
|
|
| Hospital Charge Code |
4494561
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$348.60 |
| Max. Negotiated Rate |
$4,980.00 |
| Rate for Payer: Aetna Commercial |
$1,120.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,070.70
|
| Rate for Payer: Aetna Managed Medicare |
$348.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$809.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$622.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$597.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$659.85
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Cigna Commercial |
$1,145.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$696.70
|
| Rate for Payer: Health EOS Commercial |
$1,108.05
|
| Rate for Payer: HFN Commercial |
$1,145.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$933.75
|
| Rate for Payer: Multiplan Commercial |
$996.00
|
| Rate for Payer: NAPHCARE Commercial |
$747.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,145.40
|
| Rate for Payer: Quartz Beloit One Network |
$610.05
|
| Rate for Payer: Quartz Commercial |
$809.25
|
| Rate for Payer: Quartz Medicare Advantage |
$747.00
|
| Rate for Payer: The Alliance Commercial |
$4,980.00
|
| Rate for Payer: WEA Trust Commercial |
$684.75
|
| Rate for Payer: WPS Commercial |
$922.17
|
|
|
SCREW CORT 2.4MM X 20MM SELF TAPPING 201.650
|
Facility
|
IP
|
$1,293.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494562
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$633.57 |
| Max. Negotiated Rate |
$1,189.56 |
| Rate for Payer: Aetna Commercial |
$1,163.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,111.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$685.29
|
| Rate for Payer: Cash Price |
$387.90
|
| Rate for Payer: Cigna Commercial |
$1,189.56
|
| Rate for Payer: Health EOS Commercial |
$1,150.77
|
| Rate for Payer: HFN Commercial |
$1,189.56
|
| Rate for Payer: Multiplan Commercial |
$1,034.40
|
| Rate for Payer: NAPHCARE Commercial |
$775.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,189.56
|
| Rate for Payer: Quartz Beloit One Network |
$633.57
|
| Rate for Payer: Quartz Commercial |
$775.80
|
| Rate for Payer: WEA Trust Commercial |
$711.15
|
| Rate for Payer: WPS Commercial |
$957.73
|
|
|
SCREW CORT 2.4MM X 20MM SELF TAPPING 201.650
|
Facility
|
OP
|
$1,293.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494562
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$362.04 |
| Max. Negotiated Rate |
$5,172.00 |
| Rate for Payer: Aetna Commercial |
$1,163.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,111.98
|
| Rate for Payer: Aetna Managed Medicare |
$362.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$840.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$646.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$620.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$685.29
|
| Rate for Payer: Cash Price |
$387.90
|
| Rate for Payer: Cigna Commercial |
$1,189.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$723.56
|
| Rate for Payer: Health EOS Commercial |
$1,150.77
|
| Rate for Payer: HFN Commercial |
$1,189.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$969.75
|
| Rate for Payer: Multiplan Commercial |
$1,034.40
|
| Rate for Payer: NAPHCARE Commercial |
$775.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,189.56
|
| Rate for Payer: Quartz Beloit One Network |
$633.57
|
| Rate for Payer: Quartz Commercial |
$840.45
|
| Rate for Payer: Quartz Medicare Advantage |
$775.80
|
| Rate for Payer: The Alliance Commercial |
$5,172.00
|
| Rate for Payer: WEA Trust Commercial |
$711.15
|
| Rate for Payer: WPS Commercial |
$957.73
|
|
|
SCREW CORT 2.4MM X 22MM SELF TAPPING 201.652
|
Facility
|
OP
|
$1,245.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494563
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$348.60 |
| Max. Negotiated Rate |
$4,980.00 |
| Rate for Payer: Aetna Commercial |
$1,120.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,070.70
|
| Rate for Payer: Aetna Managed Medicare |
$348.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$809.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$622.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$597.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$659.85
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Cigna Commercial |
$1,145.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$696.70
|
| Rate for Payer: Health EOS Commercial |
$1,108.05
|
| Rate for Payer: HFN Commercial |
$1,145.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$933.75
|
| Rate for Payer: Multiplan Commercial |
$996.00
|
| Rate for Payer: NAPHCARE Commercial |
$747.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,145.40
|
| Rate for Payer: Quartz Beloit One Network |
$610.05
|
| Rate for Payer: Quartz Commercial |
$809.25
|
| Rate for Payer: Quartz Medicare Advantage |
$747.00
|
| Rate for Payer: The Alliance Commercial |
$4,980.00
|
| Rate for Payer: WEA Trust Commercial |
$684.75
|
| Rate for Payer: WPS Commercial |
$922.17
|
|
|
SCREW CORT 2.4MM X 22MM SELF TAPPING 201.652
|
Facility
|
IP
|
$1,245.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494563
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.05 |
| Max. Negotiated Rate |
$1,145.40 |
| Rate for Payer: Aetna Commercial |
$1,120.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,070.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$659.85
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Cigna Commercial |
$1,145.40
|
| Rate for Payer: Health EOS Commercial |
$1,108.05
|
| Rate for Payer: HFN Commercial |
$1,145.40
|
| Rate for Payer: Multiplan Commercial |
$996.00
|
| Rate for Payer: NAPHCARE Commercial |
$747.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,145.40
|
| Rate for Payer: Quartz Beloit One Network |
$610.05
|
| Rate for Payer: Quartz Commercial |
$747.00
|
| Rate for Payer: WEA Trust Commercial |
$684.75
|
| Rate for Payer: WPS Commercial |
$922.17
|
|
|
SCREW CORT 2.4MM X 24MM SELF TAPPING 201.654
|
Facility
|
IP
|
$1,293.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494564
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$633.57 |
| Max. Negotiated Rate |
$1,189.56 |
| Rate for Payer: Aetna Commercial |
$1,163.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,111.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$685.29
|
| Rate for Payer: Cash Price |
$387.90
|
| Rate for Payer: Cigna Commercial |
$1,189.56
|
| Rate for Payer: Health EOS Commercial |
$1,150.77
|
| Rate for Payer: HFN Commercial |
$1,189.56
|
| Rate for Payer: Multiplan Commercial |
$1,034.40
|
| Rate for Payer: NAPHCARE Commercial |
$775.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,189.56
|
| Rate for Payer: Quartz Beloit One Network |
$633.57
|
| Rate for Payer: Quartz Commercial |
$775.80
|
| Rate for Payer: WEA Trust Commercial |
$711.15
|
| Rate for Payer: WPS Commercial |
$957.73
|
|
|
SCREW CORT 2.4MM X 24MM SELF TAPPING 201.654
|
Facility
|
OP
|
$1,293.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494564
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$362.04 |
| Max. Negotiated Rate |
$5,172.00 |
| Rate for Payer: Aetna Commercial |
$1,163.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,111.98
|
| Rate for Payer: Aetna Managed Medicare |
$362.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$840.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$646.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$620.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$685.29
|
| Rate for Payer: Cash Price |
$387.90
|
| Rate for Payer: Cigna Commercial |
$1,189.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$723.56
|
| Rate for Payer: Health EOS Commercial |
$1,150.77
|
| Rate for Payer: HFN Commercial |
$1,189.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$969.75
|
| Rate for Payer: Multiplan Commercial |
$1,034.40
|
| Rate for Payer: NAPHCARE Commercial |
$775.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,189.56
|
| Rate for Payer: Quartz Beloit One Network |
$633.57
|
| Rate for Payer: Quartz Commercial |
$840.45
|
| Rate for Payer: Quartz Medicare Advantage |
$775.80
|
| Rate for Payer: The Alliance Commercial |
$5,172.00
|
| Rate for Payer: WEA Trust Commercial |
$711.15
|
| Rate for Payer: WPS Commercial |
$957.73
|
|
|
SCREW CORT 2.4MM X 26MM SELF TAPPING 201.656
|
Facility
|
IP
|
$1,293.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494565
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$633.57 |
| Max. Negotiated Rate |
$1,189.56 |
| Rate for Payer: Aetna Commercial |
$1,163.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,111.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$685.29
|
| Rate for Payer: Cash Price |
$387.90
|
| Rate for Payer: Cigna Commercial |
$1,189.56
|
| Rate for Payer: Health EOS Commercial |
$1,150.77
|
| Rate for Payer: HFN Commercial |
$1,189.56
|
| Rate for Payer: Multiplan Commercial |
$1,034.40
|
| Rate for Payer: NAPHCARE Commercial |
$775.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,189.56
|
| Rate for Payer: Quartz Beloit One Network |
$633.57
|
| Rate for Payer: Quartz Commercial |
$775.80
|
| Rate for Payer: WEA Trust Commercial |
$711.15
|
| Rate for Payer: WPS Commercial |
$957.73
|
|
|
SCREW CORT 2.4MM X 26MM SELF TAPPING 201.656
|
Facility
|
OP
|
$1,293.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494565
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$362.04 |
| Max. Negotiated Rate |
$5,172.00 |
| Rate for Payer: Aetna Commercial |
$1,163.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,111.98
|
| Rate for Payer: Aetna Managed Medicare |
$362.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$840.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$646.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$620.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$685.29
|
| Rate for Payer: Cash Price |
$387.90
|
| Rate for Payer: Cigna Commercial |
$1,189.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$723.56
|
| Rate for Payer: Health EOS Commercial |
$1,150.77
|
| Rate for Payer: HFN Commercial |
$1,189.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$969.75
|
| Rate for Payer: Multiplan Commercial |
$1,034.40
|
| Rate for Payer: NAPHCARE Commercial |
$775.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,189.56
|
| Rate for Payer: Quartz Beloit One Network |
$633.57
|
| Rate for Payer: Quartz Commercial |
$840.45
|
| Rate for Payer: Quartz Medicare Advantage |
$775.80
|
| Rate for Payer: The Alliance Commercial |
$5,172.00
|
| Rate for Payer: WEA Trust Commercial |
$711.15
|
| Rate for Payer: WPS Commercial |
$957.73
|
|
|
SCREW CORT 2.4MM X 28MM SELF TAPPING 201.658
|
Facility
|
OP
|
$773.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494566
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$216.44 |
| Max. Negotiated Rate |
$3,092.00 |
| Rate for Payer: Aetna Commercial |
$695.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$664.78
|
| Rate for Payer: Aetna Managed Medicare |
$216.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$502.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$386.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$371.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$409.69
|
| Rate for Payer: Cash Price |
$231.90
|
| Rate for Payer: Cigna Commercial |
$711.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$432.57
|
| Rate for Payer: Health EOS Commercial |
$687.97
|
| Rate for Payer: HFN Commercial |
$711.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$579.75
|
| Rate for Payer: Multiplan Commercial |
$618.40
|
| Rate for Payer: NAPHCARE Commercial |
$463.80
|
| Rate for Payer: Preferred Network Access Commercial |
$711.16
|
| Rate for Payer: Quartz Beloit One Network |
$378.77
|
| Rate for Payer: Quartz Commercial |
$502.45
|
| Rate for Payer: Quartz Medicare Advantage |
$463.80
|
| Rate for Payer: The Alliance Commercial |
$3,092.00
|
| Rate for Payer: WEA Trust Commercial |
$425.15
|
| Rate for Payer: WPS Commercial |
$572.56
|
|
|
SCREW CORT 2.4MM X 28MM SELF TAPPING 201.658
|
Facility
|
IP
|
$773.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494566
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$378.77 |
| Max. Negotiated Rate |
$711.16 |
| Rate for Payer: Aetna Commercial |
$695.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$664.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$409.69
|
| Rate for Payer: Cash Price |
$231.90
|
| Rate for Payer: Cigna Commercial |
$711.16
|
| Rate for Payer: Health EOS Commercial |
$687.97
|
| Rate for Payer: HFN Commercial |
$711.16
|
| Rate for Payer: Multiplan Commercial |
$618.40
|
| Rate for Payer: NAPHCARE Commercial |
$463.80
|
| Rate for Payer: Preferred Network Access Commercial |
$711.16
|
| Rate for Payer: Quartz Beloit One Network |
$378.77
|
| Rate for Payer: Quartz Commercial |
$463.80
|
| Rate for Payer: WEA Trust Commercial |
$425.15
|
| Rate for Payer: WPS Commercial |
$572.56
|
|
|
SCREW CORT 2.4MM X 30MM SELF TAPPING 201.660
|
Facility
|
IP
|
$1,245.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494567
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.05 |
| Max. Negotiated Rate |
$1,145.40 |
| Rate for Payer: Aetna Commercial |
$1,120.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,070.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$659.85
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Cigna Commercial |
$1,145.40
|
| Rate for Payer: Health EOS Commercial |
$1,108.05
|
| Rate for Payer: HFN Commercial |
$1,145.40
|
| Rate for Payer: Multiplan Commercial |
$996.00
|
| Rate for Payer: NAPHCARE Commercial |
$747.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,145.40
|
| Rate for Payer: Quartz Beloit One Network |
$610.05
|
| Rate for Payer: Quartz Commercial |
$747.00
|
| Rate for Payer: WEA Trust Commercial |
$684.75
|
| Rate for Payer: WPS Commercial |
$922.17
|
|
|
SCREW CORT 2.4MM X 30MM SELF TAPPING 201.660
|
Facility
|
OP
|
$1,245.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494567
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$348.60 |
| Max. Negotiated Rate |
$4,980.00 |
| Rate for Payer: Aetna Commercial |
$1,120.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,070.70
|
| Rate for Payer: Aetna Managed Medicare |
$348.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$809.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$622.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$597.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$659.85
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Cigna Commercial |
$1,145.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$696.70
|
| Rate for Payer: Health EOS Commercial |
$1,108.05
|
| Rate for Payer: HFN Commercial |
$1,145.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$933.75
|
| Rate for Payer: Multiplan Commercial |
$996.00
|
| Rate for Payer: NAPHCARE Commercial |
$747.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,145.40
|
| Rate for Payer: Quartz Beloit One Network |
$610.05
|
| Rate for Payer: Quartz Commercial |
$809.25
|
| Rate for Payer: Quartz Medicare Advantage |
$747.00
|
| Rate for Payer: The Alliance Commercial |
$4,980.00
|
| Rate for Payer: WEA Trust Commercial |
$684.75
|
| Rate for Payer: WPS Commercial |
$922.17
|
|
|
SCREW CORT 2.4MM X 32MM SELF TAPPING 201.662
|
Facility
|
OP
|
$1,245.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494568
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$348.60 |
| Max. Negotiated Rate |
$4,980.00 |
| Rate for Payer: Aetna Commercial |
$1,120.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,070.70
|
| Rate for Payer: Aetna Managed Medicare |
$348.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$809.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$622.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$597.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$659.85
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Cigna Commercial |
$1,145.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$696.70
|
| Rate for Payer: Health EOS Commercial |
$1,108.05
|
| Rate for Payer: HFN Commercial |
$1,145.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$933.75
|
| Rate for Payer: Multiplan Commercial |
$996.00
|
| Rate for Payer: NAPHCARE Commercial |
$747.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,145.40
|
| Rate for Payer: Quartz Beloit One Network |
$610.05
|
| Rate for Payer: Quartz Commercial |
$809.25
|
| Rate for Payer: Quartz Medicare Advantage |
$747.00
|
| Rate for Payer: The Alliance Commercial |
$4,980.00
|
| Rate for Payer: WEA Trust Commercial |
$684.75
|
| Rate for Payer: WPS Commercial |
$922.17
|
|
|
SCREW CORT 2.4MM X 32MM SELF TAPPING 201.662
|
Facility
|
IP
|
$1,245.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494568
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.05 |
| Max. Negotiated Rate |
$1,145.40 |
| Rate for Payer: Aetna Commercial |
$1,120.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,070.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$659.85
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Cigna Commercial |
$1,145.40
|
| Rate for Payer: Health EOS Commercial |
$1,108.05
|
| Rate for Payer: HFN Commercial |
$1,145.40
|
| Rate for Payer: Multiplan Commercial |
$996.00
|
| Rate for Payer: NAPHCARE Commercial |
$747.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,145.40
|
| Rate for Payer: Quartz Beloit One Network |
$610.05
|
| Rate for Payer: Quartz Commercial |
$747.00
|
| Rate for Payer: WEA Trust Commercial |
$684.75
|
| Rate for Payer: WPS Commercial |
$922.17
|
|
|
SCREW CORT 2.4MM X 6MM SELF TAPPING 201.636
|
Facility
|
IP
|
$1,245.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494550
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.05 |
| Max. Negotiated Rate |
$1,145.40 |
| Rate for Payer: Aetna Commercial |
$1,120.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,070.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$659.85
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Cigna Commercial |
$1,145.40
|
| Rate for Payer: Health EOS Commercial |
$1,108.05
|
| Rate for Payer: HFN Commercial |
$1,145.40
|
| Rate for Payer: Multiplan Commercial |
$996.00
|
| Rate for Payer: NAPHCARE Commercial |
$747.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,145.40
|
| Rate for Payer: Quartz Beloit One Network |
$610.05
|
| Rate for Payer: Quartz Commercial |
$747.00
|
| Rate for Payer: WEA Trust Commercial |
$684.75
|
| Rate for Payer: WPS Commercial |
$922.17
|
|
