|
SCREW VARIAX 2 MINI 2.4MM X 16MM 656016
|
Facility
|
IP
|
$1,889.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5809963
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$925.61 |
| Max. Negotiated Rate |
$1,737.88 |
| Rate for Payer: Aetna Commercial |
$1,700.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,624.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,001.17
|
| Rate for Payer: Cash Price |
$566.70
|
| Rate for Payer: Cigna Commercial |
$1,737.88
|
| Rate for Payer: Health EOS Commercial |
$1,681.21
|
| Rate for Payer: HFN Commercial |
$1,737.88
|
| Rate for Payer: Multiplan Commercial |
$1,511.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,133.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,737.88
|
| Rate for Payer: Quartz Beloit One Network |
$925.61
|
| Rate for Payer: Quartz Commercial |
$1,133.40
|
| Rate for Payer: WEA Trust Commercial |
$1,038.95
|
| Rate for Payer: WPS Commercial |
$1,399.18
|
|
|
SCREW VARIAX 2 MINI 2.4MM X 16MM 656016
|
Facility
|
OP
|
$1,889.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5809963
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$528.92 |
| Max. Negotiated Rate |
$7,556.00 |
| Rate for Payer: Aetna Commercial |
$1,700.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,624.54
|
| Rate for Payer: Aetna Managed Medicare |
$528.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,227.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$944.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$906.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,001.17
|
| Rate for Payer: Cash Price |
$566.70
|
| Rate for Payer: Cigna Commercial |
$1,737.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,057.08
|
| Rate for Payer: Health EOS Commercial |
$1,681.21
|
| Rate for Payer: HFN Commercial |
$1,737.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,416.75
|
| Rate for Payer: Multiplan Commercial |
$1,511.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,133.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,737.88
|
| Rate for Payer: Quartz Beloit One Network |
$925.61
|
| Rate for Payer: Quartz Commercial |
$1,227.85
|
| Rate for Payer: Quartz Medicare Advantage |
$1,133.40
|
| Rate for Payer: The Alliance Commercial |
$7,556.00
|
| Rate for Payer: WEA Trust Commercial |
$1,038.95
|
| Rate for Payer: WPS Commercial |
$1,399.18
|
|
|
SCREW VARIAX 2 MINI 2.4MM X 18MM 656018
|
Facility
|
IP
|
$1,883.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6171788
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$922.67 |
| Max. Negotiated Rate |
$1,732.36 |
| Rate for Payer: Aetna Commercial |
$1,694.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,619.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$997.99
|
| Rate for Payer: Cash Price |
$564.90
|
| Rate for Payer: Cigna Commercial |
$1,732.36
|
| Rate for Payer: Health EOS Commercial |
$1,675.87
|
| Rate for Payer: HFN Commercial |
$1,732.36
|
| Rate for Payer: Multiplan Commercial |
$1,506.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,129.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,732.36
|
| Rate for Payer: Quartz Beloit One Network |
$922.67
|
| Rate for Payer: Quartz Commercial |
$1,129.80
|
| Rate for Payer: WEA Trust Commercial |
$1,035.65
|
| Rate for Payer: WPS Commercial |
$1,394.74
|
|
|
SCREW VARIAX 2 MINI 2.4MM X 18MM 656018
|
Facility
|
OP
|
$1,883.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6171788
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$527.24 |
| Max. Negotiated Rate |
$7,532.00 |
| Rate for Payer: Aetna Commercial |
$1,694.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,619.38
|
| Rate for Payer: Aetna Managed Medicare |
$527.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,223.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$941.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$903.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$997.99
|
| Rate for Payer: Cash Price |
$564.90
|
| Rate for Payer: Cigna Commercial |
$1,732.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,053.73
|
| Rate for Payer: Health EOS Commercial |
$1,675.87
|
| Rate for Payer: HFN Commercial |
$1,732.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,412.25
|
| Rate for Payer: Multiplan Commercial |
$1,506.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,129.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,732.36
|
| Rate for Payer: Quartz Beloit One Network |
$922.67
|
| Rate for Payer: Quartz Commercial |
$1,223.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,129.80
|
| Rate for Payer: The Alliance Commercial |
$7,532.00
|
| Rate for Payer: WEA Trust Commercial |
$1,035.65
|
| Rate for Payer: WPS Commercial |
$1,394.74
|
|
|
SCREW VARIAX 2 MINI 2.4MM X 20MM 656020
|
Facility
|
IP
|
$1,889.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685851
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$925.61 |
| Max. Negotiated Rate |
$1,737.88 |
| Rate for Payer: Aetna Commercial |
$1,700.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,624.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,001.17
|
| Rate for Payer: Cash Price |
$566.70
|
| Rate for Payer: Cigna Commercial |
$1,737.88
|
| Rate for Payer: Health EOS Commercial |
$1,681.21
|
| Rate for Payer: HFN Commercial |
$1,737.88
|
| Rate for Payer: Multiplan Commercial |
$1,511.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,133.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,737.88
|
| Rate for Payer: Quartz Beloit One Network |
$925.61
|
| Rate for Payer: Quartz Commercial |
$1,133.40
|
| Rate for Payer: WEA Trust Commercial |
$1,038.95
|
| Rate for Payer: WPS Commercial |
$1,399.18
|
|
|
SCREW VARIAX 2 MINI 2.4MM X 20MM 656020
|
Facility
|
OP
|
$1,889.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685851
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$528.92 |
| Max. Negotiated Rate |
$7,556.00 |
| Rate for Payer: Aetna Commercial |
$1,700.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,624.54
|
| Rate for Payer: Aetna Managed Medicare |
$528.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,227.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$944.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$906.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,001.17
|
| Rate for Payer: Cash Price |
$566.70
|
| Rate for Payer: Cigna Commercial |
$1,737.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,057.08
|
| Rate for Payer: Health EOS Commercial |
$1,681.21
|
| Rate for Payer: HFN Commercial |
$1,737.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,416.75
|
| Rate for Payer: Multiplan Commercial |
$1,511.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,133.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,737.88
|
| Rate for Payer: Quartz Beloit One Network |
$925.61
|
| Rate for Payer: Quartz Commercial |
$1,227.85
|
| Rate for Payer: Quartz Medicare Advantage |
$1,133.40
|
| Rate for Payer: The Alliance Commercial |
$7,556.00
|
| Rate for Payer: WEA Trust Commercial |
$1,038.95
|
| Rate for Payer: WPS Commercial |
$1,399.18
|
|
|
SCREW VARIAX 2 MINI 2.4MM X 22MM 656022
|
Facility
|
IP
|
$1,889.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5809964
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$925.61 |
| Max. Negotiated Rate |
$1,737.88 |
| Rate for Payer: Aetna Commercial |
$1,700.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,624.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,001.17
|
| Rate for Payer: Cash Price |
$566.70
|
| Rate for Payer: Cigna Commercial |
$1,737.88
|
| Rate for Payer: Health EOS Commercial |
$1,681.21
|
| Rate for Payer: HFN Commercial |
$1,737.88
|
| Rate for Payer: Multiplan Commercial |
$1,511.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,133.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,737.88
|
| Rate for Payer: Quartz Beloit One Network |
$925.61
|
| Rate for Payer: Quartz Commercial |
$1,133.40
|
| Rate for Payer: WEA Trust Commercial |
$1,038.95
|
| Rate for Payer: WPS Commercial |
$1,399.18
|
|
|
SCREW VARIAX 2 MINI 2.4MM X 22MM 656022
|
Facility
|
OP
|
$1,889.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5809964
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$528.92 |
| Max. Negotiated Rate |
$7,556.00 |
| Rate for Payer: Aetna Commercial |
$1,700.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,624.54
|
| Rate for Payer: Aetna Managed Medicare |
$528.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,227.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$944.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$906.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,001.17
|
| Rate for Payer: Cash Price |
$566.70
|
| Rate for Payer: Cigna Commercial |
$1,737.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,057.08
|
| Rate for Payer: Health EOS Commercial |
$1,681.21
|
| Rate for Payer: HFN Commercial |
$1,737.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,416.75
|
| Rate for Payer: Multiplan Commercial |
$1,511.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,133.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,737.88
|
| Rate for Payer: Quartz Beloit One Network |
$925.61
|
| Rate for Payer: Quartz Commercial |
$1,227.85
|
| Rate for Payer: Quartz Medicare Advantage |
$1,133.40
|
| Rate for Payer: The Alliance Commercial |
$7,556.00
|
| Rate for Payer: WEA Trust Commercial |
$1,038.95
|
| Rate for Payer: WPS Commercial |
$1,399.18
|
|
|
SCREW VARIAX 2 MINI 2.7MM X 10MM 656410
|
Facility
|
OP
|
$1,315.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6173722
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$368.20 |
| Max. Negotiated Rate |
$5,260.00 |
| Rate for Payer: Aetna Commercial |
$1,183.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,130.90
|
| Rate for Payer: Aetna Managed Medicare |
$368.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$854.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$657.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$631.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$696.95
|
| Rate for Payer: Cash Price |
$394.50
|
| Rate for Payer: Cigna Commercial |
$1,209.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$735.87
|
| Rate for Payer: Health EOS Commercial |
$1,170.35
|
| Rate for Payer: HFN Commercial |
$1,209.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$986.25
|
| Rate for Payer: Multiplan Commercial |
$1,052.00
|
| Rate for Payer: NAPHCARE Commercial |
$789.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,209.80
|
| Rate for Payer: Quartz Beloit One Network |
$644.35
|
| Rate for Payer: Quartz Commercial |
$854.75
|
| Rate for Payer: Quartz Medicare Advantage |
$789.00
|
| Rate for Payer: The Alliance Commercial |
$5,260.00
|
| Rate for Payer: WEA Trust Commercial |
$723.25
|
| Rate for Payer: WPS Commercial |
$974.02
|
|
|
SCREW VARIAX 2 MINI 2.7MM X 10MM 656410
|
Facility
|
IP
|
$1,315.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6173722
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$644.35 |
| Max. Negotiated Rate |
$1,209.80 |
| Rate for Payer: Aetna Commercial |
$1,183.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,130.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$696.95
|
| Rate for Payer: Cash Price |
$394.50
|
| Rate for Payer: Cigna Commercial |
$1,209.80
|
| Rate for Payer: Health EOS Commercial |
$1,170.35
|
| Rate for Payer: HFN Commercial |
$1,209.80
|
| Rate for Payer: Multiplan Commercial |
$1,052.00
|
| Rate for Payer: NAPHCARE Commercial |
$789.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,209.80
|
| Rate for Payer: Quartz Beloit One Network |
$644.35
|
| Rate for Payer: Quartz Commercial |
$789.00
|
| Rate for Payer: WEA Trust Commercial |
$723.25
|
| Rate for Payer: WPS Commercial |
$974.02
|
|
|
SCREW VARIAX 2 MINI 2.7MM X 12MM 656412
|
Facility
|
OP
|
$1,315.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6173723
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$368.20 |
| Max. Negotiated Rate |
$5,260.00 |
| Rate for Payer: Aetna Commercial |
$1,183.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,130.90
|
| Rate for Payer: Aetna Managed Medicare |
$368.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$854.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$657.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$631.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$696.95
|
| Rate for Payer: Cash Price |
$394.50
|
| Rate for Payer: Cigna Commercial |
$1,209.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$735.87
|
| Rate for Payer: Health EOS Commercial |
$1,170.35
|
| Rate for Payer: HFN Commercial |
$1,209.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$986.25
|
| Rate for Payer: Multiplan Commercial |
$1,052.00
|
| Rate for Payer: NAPHCARE Commercial |
$789.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,209.80
|
| Rate for Payer: Quartz Beloit One Network |
$644.35
|
| Rate for Payer: Quartz Commercial |
$854.75
|
| Rate for Payer: Quartz Medicare Advantage |
$789.00
|
| Rate for Payer: The Alliance Commercial |
$5,260.00
|
| Rate for Payer: WEA Trust Commercial |
$723.25
|
| Rate for Payer: WPS Commercial |
$974.02
|
|
|
SCREW VARIAX 2 MINI 2.7MM X 12MM 656412
|
Facility
|
IP
|
$1,315.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6173723
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$644.35 |
| Max. Negotiated Rate |
$1,209.80 |
| Rate for Payer: Aetna Commercial |
$1,183.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,130.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$696.95
|
| Rate for Payer: Cash Price |
$394.50
|
| Rate for Payer: Cigna Commercial |
$1,209.80
|
| Rate for Payer: Health EOS Commercial |
$1,170.35
|
| Rate for Payer: HFN Commercial |
$1,209.80
|
| Rate for Payer: Multiplan Commercial |
$1,052.00
|
| Rate for Payer: NAPHCARE Commercial |
$789.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,209.80
|
| Rate for Payer: Quartz Beloit One Network |
$644.35
|
| Rate for Payer: Quartz Commercial |
$789.00
|
| Rate for Payer: WEA Trust Commercial |
$723.25
|
| Rate for Payer: WPS Commercial |
$974.02
|
|
|
SCREW VARIAX 2 MINI 2.7MM X 14MM 656414
|
Facility
|
IP
|
$1,215.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6252125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$595.37 |
| Max. Negotiated Rate |
$1,117.85 |
| Rate for Payer: Aetna Commercial |
$1,093.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,044.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$643.98
|
| Rate for Payer: Cash Price |
$364.52
|
| Rate for Payer: Cigna Commercial |
$1,117.85
|
| Rate for Payer: Health EOS Commercial |
$1,081.39
|
| Rate for Payer: HFN Commercial |
$1,117.85
|
| Rate for Payer: Multiplan Commercial |
$972.04
|
| Rate for Payer: NAPHCARE Commercial |
$729.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,117.85
|
| Rate for Payer: Quartz Beloit One Network |
$595.37
|
| Rate for Payer: Quartz Commercial |
$729.03
|
| Rate for Payer: WEA Trust Commercial |
$668.28
|
| Rate for Payer: WPS Commercial |
$899.99
|
|
|
SCREW VARIAX 2 MINI 2.7MM X 14MM 656414
|
Facility
|
OP
|
$1,215.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6252125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$340.21 |
| Max. Negotiated Rate |
$4,860.20 |
| Rate for Payer: Aetna Commercial |
$1,093.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,044.94
|
| Rate for Payer: Aetna Managed Medicare |
$340.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$789.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$607.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$583.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$643.98
|
| Rate for Payer: Cash Price |
$364.52
|
| Rate for Payer: Cigna Commercial |
$1,117.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$679.94
|
| Rate for Payer: Health EOS Commercial |
$1,081.39
|
| Rate for Payer: HFN Commercial |
$1,117.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$911.29
|
| Rate for Payer: Multiplan Commercial |
$972.04
|
| Rate for Payer: NAPHCARE Commercial |
$729.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,117.85
|
| Rate for Payer: Quartz Beloit One Network |
$595.37
|
| Rate for Payer: Quartz Commercial |
$789.78
|
| Rate for Payer: Quartz Medicare Advantage |
$729.03
|
| Rate for Payer: The Alliance Commercial |
$4,860.20
|
| Rate for Payer: WEA Trust Commercial |
$668.28
|
| Rate for Payer: WPS Commercial |
$899.99
|
|
|
SCREW VARIAX 2 MINI 2.7MM X 16MM 656416
|
Facility
|
IP
|
$1,315.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6173724
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$644.35 |
| Max. Negotiated Rate |
$1,209.80 |
| Rate for Payer: Aetna Commercial |
$1,183.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,130.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$696.95
|
| Rate for Payer: Cash Price |
$394.50
|
| Rate for Payer: Cigna Commercial |
$1,209.80
|
| Rate for Payer: Health EOS Commercial |
$1,170.35
|
| Rate for Payer: HFN Commercial |
$1,209.80
|
| Rate for Payer: Multiplan Commercial |
$1,052.00
|
| Rate for Payer: NAPHCARE Commercial |
$789.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,209.80
|
| Rate for Payer: Quartz Beloit One Network |
$644.35
|
| Rate for Payer: Quartz Commercial |
$789.00
|
| Rate for Payer: WEA Trust Commercial |
$723.25
|
| Rate for Payer: WPS Commercial |
$974.02
|
|
|
SCREW VARIAX 2 MINI 2.7MM X 16MM 656416
|
Facility
|
OP
|
$1,315.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6173724
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$368.20 |
| Max. Negotiated Rate |
$5,260.00 |
| Rate for Payer: Aetna Commercial |
$1,183.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,130.90
|
| Rate for Payer: Aetna Managed Medicare |
$368.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$854.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$657.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$631.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$696.95
|
| Rate for Payer: Cash Price |
$394.50
|
| Rate for Payer: Cigna Commercial |
$1,209.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$735.87
|
| Rate for Payer: Health EOS Commercial |
$1,170.35
|
| Rate for Payer: HFN Commercial |
$1,209.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$986.25
|
| Rate for Payer: Multiplan Commercial |
$1,052.00
|
| Rate for Payer: NAPHCARE Commercial |
$789.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,209.80
|
| Rate for Payer: Quartz Beloit One Network |
$644.35
|
| Rate for Payer: Quartz Commercial |
$854.75
|
| Rate for Payer: Quartz Medicare Advantage |
$789.00
|
| Rate for Payer: The Alliance Commercial |
$5,260.00
|
| Rate for Payer: WEA Trust Commercial |
$723.25
|
| Rate for Payer: WPS Commercial |
$974.02
|
|
|
SCREW VARIAX 2 MINI 2.7MM X 18MM 656418
|
Facility
|
IP
|
$1,315.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6172079
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$644.35 |
| Max. Negotiated Rate |
$1,209.80 |
| Rate for Payer: Aetna Commercial |
$1,183.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,130.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$696.95
|
| Rate for Payer: Cash Price |
$394.50
|
| Rate for Payer: Cigna Commercial |
$1,209.80
|
| Rate for Payer: Health EOS Commercial |
$1,170.35
|
| Rate for Payer: HFN Commercial |
$1,209.80
|
| Rate for Payer: Multiplan Commercial |
$1,052.00
|
| Rate for Payer: NAPHCARE Commercial |
$789.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,209.80
|
| Rate for Payer: Quartz Beloit One Network |
$644.35
|
| Rate for Payer: Quartz Commercial |
$789.00
|
| Rate for Payer: WEA Trust Commercial |
$723.25
|
| Rate for Payer: WPS Commercial |
$974.02
|
|
|
SCREW VARIAX 2 MINI 2.7MM X 18MM 656418
|
Facility
|
OP
|
$1,315.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6172079
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$368.20 |
| Max. Negotiated Rate |
$5,260.00 |
| Rate for Payer: Aetna Commercial |
$1,183.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,130.90
|
| Rate for Payer: Aetna Managed Medicare |
$368.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$854.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$657.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$631.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$696.95
|
| Rate for Payer: Cash Price |
$394.50
|
| Rate for Payer: Cigna Commercial |
$1,209.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$735.87
|
| Rate for Payer: Health EOS Commercial |
$1,170.35
|
| Rate for Payer: HFN Commercial |
$1,209.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$986.25
|
| Rate for Payer: Multiplan Commercial |
$1,052.00
|
| Rate for Payer: NAPHCARE Commercial |
$789.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,209.80
|
| Rate for Payer: Quartz Beloit One Network |
$644.35
|
| Rate for Payer: Quartz Commercial |
$854.75
|
| Rate for Payer: Quartz Medicare Advantage |
$789.00
|
| Rate for Payer: The Alliance Commercial |
$5,260.00
|
| Rate for Payer: WEA Trust Commercial |
$723.25
|
| Rate for Payer: WPS Commercial |
$974.02
|
|
|
SCREW VARIAX 2 MINI 2.7MM X 20MM 656420
|
Facility
|
IP
|
$1,270.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6037664
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$622.30 |
| Max. Negotiated Rate |
$1,168.40 |
| Rate for Payer: Aetna Commercial |
$1,143.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,092.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$673.10
|
| Rate for Payer: Cash Price |
$381.00
|
| Rate for Payer: Cigna Commercial |
$1,168.40
|
| Rate for Payer: Health EOS Commercial |
$1,130.30
|
| Rate for Payer: HFN Commercial |
$1,168.40
|
| Rate for Payer: Multiplan Commercial |
$1,016.00
|
| Rate for Payer: NAPHCARE Commercial |
$762.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,168.40
|
| Rate for Payer: Quartz Beloit One Network |
$622.30
|
| Rate for Payer: Quartz Commercial |
$762.00
|
| Rate for Payer: WEA Trust Commercial |
$698.50
|
| Rate for Payer: WPS Commercial |
$940.69
|
|
|
SCREW VARIAX 2 MINI 2.7MM X 20MM 656420
|
Facility
|
OP
|
$1,270.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6037664
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$355.60 |
| Max. Negotiated Rate |
$5,080.00 |
| Rate for Payer: Aetna Commercial |
$1,143.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,092.20
|
| Rate for Payer: Aetna Managed Medicare |
$355.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$825.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$635.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$609.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$673.10
|
| Rate for Payer: Cash Price |
$381.00
|
| Rate for Payer: Cigna Commercial |
$1,168.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$710.69
|
| Rate for Payer: Health EOS Commercial |
$1,130.30
|
| Rate for Payer: HFN Commercial |
$1,168.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$952.50
|
| Rate for Payer: Multiplan Commercial |
$1,016.00
|
| Rate for Payer: NAPHCARE Commercial |
$762.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,168.40
|
| Rate for Payer: Quartz Beloit One Network |
$622.30
|
| Rate for Payer: Quartz Commercial |
$825.50
|
| Rate for Payer: Quartz Medicare Advantage |
$762.00
|
| Rate for Payer: The Alliance Commercial |
$5,080.00
|
| Rate for Payer: WEA Trust Commercial |
$698.50
|
| Rate for Payer: WPS Commercial |
$940.69
|
|
|
SCREW VARIAX 2 MINI 2.7MM X 22MM 656422
|
Facility
|
IP
|
$1,270.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6037665
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$622.30 |
| Max. Negotiated Rate |
$1,168.40 |
| Rate for Payer: Aetna Commercial |
$1,143.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,092.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$673.10
|
| Rate for Payer: Cash Price |
$381.00
|
| Rate for Payer: Cigna Commercial |
$1,168.40
|
| Rate for Payer: Health EOS Commercial |
$1,130.30
|
| Rate for Payer: HFN Commercial |
$1,168.40
|
| Rate for Payer: Multiplan Commercial |
$1,016.00
|
| Rate for Payer: NAPHCARE Commercial |
$762.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,168.40
|
| Rate for Payer: Quartz Beloit One Network |
$622.30
|
| Rate for Payer: Quartz Commercial |
$762.00
|
| Rate for Payer: WEA Trust Commercial |
$698.50
|
| Rate for Payer: WPS Commercial |
$940.69
|
|
|
SCREW VARIAX 2 MINI 2.7MM X 22MM 656422
|
Facility
|
OP
|
$1,270.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6037665
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$355.60 |
| Max. Negotiated Rate |
$5,080.00 |
| Rate for Payer: Aetna Commercial |
$1,143.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,092.20
|
| Rate for Payer: Aetna Managed Medicare |
$355.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$825.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$635.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$609.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$673.10
|
| Rate for Payer: Cash Price |
$381.00
|
| Rate for Payer: Cigna Commercial |
$1,168.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$710.69
|
| Rate for Payer: Health EOS Commercial |
$1,130.30
|
| Rate for Payer: HFN Commercial |
$1,168.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$952.50
|
| Rate for Payer: Multiplan Commercial |
$1,016.00
|
| Rate for Payer: NAPHCARE Commercial |
$762.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,168.40
|
| Rate for Payer: Quartz Beloit One Network |
$622.30
|
| Rate for Payer: Quartz Commercial |
$825.50
|
| Rate for Payer: Quartz Medicare Advantage |
$762.00
|
| Rate for Payer: The Alliance Commercial |
$5,080.00
|
| Rate for Payer: WEA Trust Commercial |
$698.50
|
| Rate for Payer: WPS Commercial |
$940.69
|
|
|
SCREW VARIAX 2 MINI 2.7MM X 26MM 656426
|
Facility
|
IP
|
$1,315.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6171783
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$644.35 |
| Max. Negotiated Rate |
$1,209.80 |
| Rate for Payer: Aetna Commercial |
$1,183.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,130.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$696.95
|
| Rate for Payer: Cash Price |
$394.50
|
| Rate for Payer: Cigna Commercial |
$1,209.80
|
| Rate for Payer: Health EOS Commercial |
$1,170.35
|
| Rate for Payer: HFN Commercial |
$1,209.80
|
| Rate for Payer: Multiplan Commercial |
$1,052.00
|
| Rate for Payer: NAPHCARE Commercial |
$789.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,209.80
|
| Rate for Payer: Quartz Beloit One Network |
$644.35
|
| Rate for Payer: Quartz Commercial |
$789.00
|
| Rate for Payer: WEA Trust Commercial |
$723.25
|
| Rate for Payer: WPS Commercial |
$974.02
|
|
|
SCREW VARIAX 2 MINI 2.7MM X 26MM 656426
|
Facility
|
OP
|
$1,315.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6171783
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$368.20 |
| Max. Negotiated Rate |
$5,260.00 |
| Rate for Payer: Aetna Commercial |
$1,183.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,130.90
|
| Rate for Payer: Aetna Managed Medicare |
$368.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$854.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$657.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$631.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$696.95
|
| Rate for Payer: Cash Price |
$394.50
|
| Rate for Payer: Cigna Commercial |
$1,209.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$735.87
|
| Rate for Payer: Health EOS Commercial |
$1,170.35
|
| Rate for Payer: HFN Commercial |
$1,209.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$986.25
|
| Rate for Payer: Multiplan Commercial |
$1,052.00
|
| Rate for Payer: NAPHCARE Commercial |
$789.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,209.80
|
| Rate for Payer: Quartz Beloit One Network |
$644.35
|
| Rate for Payer: Quartz Commercial |
$854.75
|
| Rate for Payer: Quartz Medicare Advantage |
$789.00
|
| Rate for Payer: The Alliance Commercial |
$5,260.00
|
| Rate for Payer: WEA Trust Commercial |
$723.25
|
| Rate for Payer: WPS Commercial |
$974.02
|
|
|
SCREW VARIAX 2 MINI 2.7MM X 36MM 656436
|
Facility
|
OP
|
$1,321.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685717
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$369.88 |
| Max. Negotiated Rate |
$5,284.00 |
| Rate for Payer: Aetna Commercial |
$1,188.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,136.06
|
| Rate for Payer: Aetna Managed Medicare |
$369.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$858.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$660.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$634.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$700.13
|
| Rate for Payer: Cash Price |
$396.30
|
| Rate for Payer: Cigna Commercial |
$1,215.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$739.23
|
| Rate for Payer: Health EOS Commercial |
$1,175.69
|
| Rate for Payer: HFN Commercial |
$1,215.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$990.75
|
| Rate for Payer: Multiplan Commercial |
$1,056.80
|
| Rate for Payer: NAPHCARE Commercial |
$792.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,215.32
|
| Rate for Payer: Quartz Beloit One Network |
$647.29
|
| Rate for Payer: Quartz Commercial |
$858.65
|
| Rate for Payer: Quartz Medicare Advantage |
$792.60
|
| Rate for Payer: The Alliance Commercial |
$5,284.00
|
| Rate for Payer: WEA Trust Commercial |
$726.55
|
| Rate for Payer: WPS Commercial |
$978.46
|
|
