|
SCREW VAL 4.5 X 80MM OPTILINK ST TI 42.231.280
|
Facility
|
IP
|
$1,903.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6201050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$969.77 |
| Max. Negotiated Rate |
$1,820.79 |
| Rate for Payer: Aetna Commercial |
$1,781.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,702.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,048.93
|
| Rate for Payer: Cash Price |
$570.90
|
| Rate for Payer: Cigna Commercial |
$1,820.79
|
| Rate for Payer: Health EOS Commercial |
$1,761.42
|
| Rate for Payer: HFN Commercial |
$1,820.79
|
| Rate for Payer: Multiplan Commercial |
$1,583.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,820.79
|
| Rate for Payer: Quartz Beloit One Network |
$969.77
|
| Rate for Payer: Quartz Commercial |
$1,187.47
|
| Rate for Payer: WEA Trust Commercial |
$1,088.52
|
| Rate for Payer: WPS Commercial |
$1,465.88
|
|
|
SCREW VAL KREULOCK 3.0 X 10MM TI AR-8933VCL-10
|
Facility
|
IP
|
$2,816.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6244272
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,435.39 |
| Max. Negotiated Rate |
$2,695.02 |
| Rate for Payer: Aetna Commercial |
$2,636.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,519.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,552.57
|
| Rate for Payer: Cash Price |
$845.01
|
| Rate for Payer: Cigna Commercial |
$2,695.02
|
| Rate for Payer: Health EOS Commercial |
$2,607.14
|
| Rate for Payer: HFN Commercial |
$2,695.02
|
| Rate for Payer: Multiplan Commercial |
$2,343.49
|
| Rate for Payer: Preferred Network Access Commercial |
$2,695.02
|
| Rate for Payer: Quartz Beloit One Network |
$1,435.39
|
| Rate for Payer: Quartz Commercial |
$1,757.62
|
| Rate for Payer: WEA Trust Commercial |
$1,611.15
|
| Rate for Payer: WPS Commercial |
$2,169.70
|
|
|
SCREW VAL KREULOCK 3.0 X 10MM TI AR-8933VCL-10
|
Facility
|
OP
|
$2,816.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6244272
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$820.22 |
| Max. Negotiated Rate |
$2,695.02 |
| Rate for Payer: Aetna Commercial |
$2,636.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,519.26
|
| Rate for Payer: Aetna Managed Medicare |
$820.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,904.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,464.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,406.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,552.57
|
| Rate for Payer: Cash Price |
$845.01
|
| Rate for Payer: Cigna Commercial |
$2,695.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,639.32
|
| Rate for Payer: Health EOS Commercial |
$2,607.14
|
| Rate for Payer: HFN Commercial |
$2,695.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,197.03
|
| Rate for Payer: Multiplan Commercial |
$2,343.49
|
| Rate for Payer: NAPHCARE Commercial |
$1,757.62
|
| Rate for Payer: Preferred Network Access Commercial |
$2,695.02
|
| Rate for Payer: Quartz Beloit One Network |
$1,435.39
|
| Rate for Payer: Quartz Commercial |
$1,904.09
|
| Rate for Payer: Quartz Medicare Advantage |
$1,757.62
|
| Rate for Payer: The Alliance Commercial |
$1,464.68
|
| Rate for Payer: WEA Trust Commercial |
$1,611.15
|
| Rate for Payer: WPS Commercial |
$2,169.70
|
|
|
SCREW VAL KREULOCK 3.0 X 12MM TI AR-8933VCL-12
|
Facility
|
OP
|
$2,816.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6244273
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$820.22 |
| Max. Negotiated Rate |
$2,695.02 |
| Rate for Payer: Aetna Commercial |
$2,636.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,519.26
|
| Rate for Payer: Aetna Managed Medicare |
$820.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,904.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,464.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,406.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,552.57
|
| Rate for Payer: Cash Price |
$845.01
|
| Rate for Payer: Cigna Commercial |
$2,695.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,639.32
|
| Rate for Payer: Health EOS Commercial |
$2,607.14
|
| Rate for Payer: HFN Commercial |
$2,695.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,197.03
|
| Rate for Payer: Multiplan Commercial |
$2,343.49
|
| Rate for Payer: NAPHCARE Commercial |
$1,757.62
|
| Rate for Payer: Preferred Network Access Commercial |
$2,695.02
|
| Rate for Payer: Quartz Beloit One Network |
$1,435.39
|
| Rate for Payer: Quartz Commercial |
$1,904.09
|
| Rate for Payer: Quartz Medicare Advantage |
$1,757.62
|
| Rate for Payer: The Alliance Commercial |
$1,464.68
|
| Rate for Payer: WEA Trust Commercial |
$1,611.15
|
| Rate for Payer: WPS Commercial |
$2,169.70
|
|
|
SCREW VAL KREULOCK 3.0 X 12MM TI AR-8933VCL-12
|
Facility
|
IP
|
$2,816.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6244273
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,435.39 |
| Max. Negotiated Rate |
$2,695.02 |
| Rate for Payer: Aetna Commercial |
$2,636.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,519.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,552.57
|
| Rate for Payer: Cash Price |
$845.01
|
| Rate for Payer: Cigna Commercial |
$2,695.02
|
| Rate for Payer: Health EOS Commercial |
$2,607.14
|
| Rate for Payer: HFN Commercial |
$2,695.02
|
| Rate for Payer: Multiplan Commercial |
$2,343.49
|
| Rate for Payer: Preferred Network Access Commercial |
$2,695.02
|
| Rate for Payer: Quartz Beloit One Network |
$1,435.39
|
| Rate for Payer: Quartz Commercial |
$1,757.62
|
| Rate for Payer: WEA Trust Commercial |
$1,611.15
|
| Rate for Payer: WPS Commercial |
$2,169.70
|
|
|
SCREW VAL KREULOCK 3.0 X 14MM TI AR-8933VCL-14
|
Facility
|
OP
|
$2,816.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6244274
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$820.22 |
| Max. Negotiated Rate |
$2,695.02 |
| Rate for Payer: Aetna Commercial |
$2,636.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,519.26
|
| Rate for Payer: Aetna Managed Medicare |
$820.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,904.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,464.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,406.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,552.57
|
| Rate for Payer: Cash Price |
$845.01
|
| Rate for Payer: Cigna Commercial |
$2,695.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,639.32
|
| Rate for Payer: Health EOS Commercial |
$2,607.14
|
| Rate for Payer: HFN Commercial |
$2,695.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,197.03
|
| Rate for Payer: Multiplan Commercial |
$2,343.49
|
| Rate for Payer: NAPHCARE Commercial |
$1,757.62
|
| Rate for Payer: Preferred Network Access Commercial |
$2,695.02
|
| Rate for Payer: Quartz Beloit One Network |
$1,435.39
|
| Rate for Payer: Quartz Commercial |
$1,904.09
|
| Rate for Payer: Quartz Medicare Advantage |
$1,757.62
|
| Rate for Payer: The Alliance Commercial |
$1,464.68
|
| Rate for Payer: WEA Trust Commercial |
$1,611.15
|
| Rate for Payer: WPS Commercial |
$2,169.70
|
|
|
SCREW VAL KREULOCK 3.0 X 14MM TI AR-8933VCL-14
|
Facility
|
IP
|
$2,816.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6244274
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,435.39 |
| Max. Negotiated Rate |
$2,695.02 |
| Rate for Payer: Aetna Commercial |
$2,636.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,519.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,552.57
|
| Rate for Payer: Cash Price |
$845.01
|
| Rate for Payer: Cigna Commercial |
$2,695.02
|
| Rate for Payer: Health EOS Commercial |
$2,607.14
|
| Rate for Payer: HFN Commercial |
$2,695.02
|
| Rate for Payer: Multiplan Commercial |
$2,343.49
|
| Rate for Payer: Preferred Network Access Commercial |
$2,695.02
|
| Rate for Payer: Quartz Beloit One Network |
$1,435.39
|
| Rate for Payer: Quartz Commercial |
$1,757.62
|
| Rate for Payer: WEA Trust Commercial |
$1,611.15
|
| Rate for Payer: WPS Commercial |
$2,169.70
|
|
|
SCREW VARIAX 2 MINI 2.4MM X 10MM 656010
|
Facility
|
IP
|
$1,889.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685846
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$962.63 |
| Max. Negotiated Rate |
$1,807.40 |
| Rate for Payer: Aetna Commercial |
$1,768.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,689.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,041.22
|
| Rate for Payer: Cash Price |
$566.70
|
| Rate for Payer: Cigna Commercial |
$1,807.40
|
| Rate for Payer: Health EOS Commercial |
$1,748.46
|
| Rate for Payer: HFN Commercial |
$1,807.40
|
| Rate for Payer: Multiplan Commercial |
$1,571.65
|
| Rate for Payer: Preferred Network Access Commercial |
$1,807.40
|
| Rate for Payer: Quartz Beloit One Network |
$962.63
|
| Rate for Payer: Quartz Commercial |
$1,178.74
|
| Rate for Payer: WEA Trust Commercial |
$1,080.51
|
| Rate for Payer: WPS Commercial |
$1,455.10
|
|
|
SCREW VARIAX 2 MINI 2.4MM X 10MM 656010
|
Facility
|
OP
|
$1,889.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685846
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$550.08 |
| Max. Negotiated Rate |
$1,807.40 |
| Rate for Payer: Aetna Commercial |
$1,768.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,689.52
|
| Rate for Payer: Aetna Managed Medicare |
$550.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,276.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$982.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$942.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,041.22
|
| Rate for Payer: Cash Price |
$566.70
|
| Rate for Payer: Cigna Commercial |
$1,807.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,099.40
|
| Rate for Payer: Health EOS Commercial |
$1,748.46
|
| Rate for Payer: HFN Commercial |
$1,807.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,473.42
|
| Rate for Payer: Multiplan Commercial |
$1,571.65
|
| Rate for Payer: NAPHCARE Commercial |
$1,178.74
|
| Rate for Payer: Preferred Network Access Commercial |
$1,807.40
|
| Rate for Payer: Quartz Beloit One Network |
$962.63
|
| Rate for Payer: Quartz Commercial |
$1,276.96
|
| Rate for Payer: Quartz Medicare Advantage |
$1,178.74
|
| Rate for Payer: The Alliance Commercial |
$982.28
|
| Rate for Payer: WEA Trust Commercial |
$1,080.51
|
| Rate for Payer: WPS Commercial |
$1,455.10
|
|
|
SCREW VARIAX 2 MINI 2.4MM X 12MM 656012
|
Facility
|
OP
|
$1,889.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685847
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$550.08 |
| Max. Negotiated Rate |
$1,807.40 |
| Rate for Payer: Aetna Commercial |
$1,768.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,689.52
|
| Rate for Payer: Aetna Managed Medicare |
$550.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,276.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$982.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$942.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,041.22
|
| Rate for Payer: Cash Price |
$566.70
|
| Rate for Payer: Cigna Commercial |
$1,807.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,099.40
|
| Rate for Payer: Health EOS Commercial |
$1,748.46
|
| Rate for Payer: HFN Commercial |
$1,807.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,473.42
|
| Rate for Payer: Multiplan Commercial |
$1,571.65
|
| Rate for Payer: NAPHCARE Commercial |
$1,178.74
|
| Rate for Payer: Preferred Network Access Commercial |
$1,807.40
|
| Rate for Payer: Quartz Beloit One Network |
$962.63
|
| Rate for Payer: Quartz Commercial |
$1,276.96
|
| Rate for Payer: Quartz Medicare Advantage |
$1,178.74
|
| Rate for Payer: The Alliance Commercial |
$982.28
|
| Rate for Payer: WEA Trust Commercial |
$1,080.51
|
| Rate for Payer: WPS Commercial |
$1,455.10
|
|
|
SCREW VARIAX 2 MINI 2.4MM X 12MM 656012
|
Facility
|
IP
|
$1,889.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685847
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$962.63 |
| Max. Negotiated Rate |
$1,807.40 |
| Rate for Payer: Aetna Commercial |
$1,768.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,689.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,041.22
|
| Rate for Payer: Cash Price |
$566.70
|
| Rate for Payer: Cigna Commercial |
$1,807.40
|
| Rate for Payer: Health EOS Commercial |
$1,748.46
|
| Rate for Payer: HFN Commercial |
$1,807.40
|
| Rate for Payer: Multiplan Commercial |
$1,571.65
|
| Rate for Payer: Preferred Network Access Commercial |
$1,807.40
|
| Rate for Payer: Quartz Beloit One Network |
$962.63
|
| Rate for Payer: Quartz Commercial |
$1,178.74
|
| Rate for Payer: WEA Trust Commercial |
$1,080.51
|
| Rate for Payer: WPS Commercial |
$1,455.10
|
|
|
SCREW VARIAX 2 MINI 2.4MM X 14MM 656014
|
Facility
|
OP
|
$1,888.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685848
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$549.79 |
| Max. Negotiated Rate |
$1,806.44 |
| Rate for Payer: Aetna Commercial |
$1,767.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,688.63
|
| Rate for Payer: Aetna Managed Medicare |
$549.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,276.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$981.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$942.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,040.67
|
| Rate for Payer: Cash Price |
$566.40
|
| Rate for Payer: Cigna Commercial |
$1,806.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,098.82
|
| Rate for Payer: Health EOS Commercial |
$1,747.53
|
| Rate for Payer: HFN Commercial |
$1,806.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,472.64
|
| Rate for Payer: Multiplan Commercial |
$1,570.82
|
| Rate for Payer: NAPHCARE Commercial |
$1,178.11
|
| Rate for Payer: Preferred Network Access Commercial |
$1,806.44
|
| Rate for Payer: Quartz Beloit One Network |
$962.12
|
| Rate for Payer: Quartz Commercial |
$1,276.29
|
| Rate for Payer: Quartz Medicare Advantage |
$1,178.11
|
| Rate for Payer: The Alliance Commercial |
$981.76
|
| Rate for Payer: WEA Trust Commercial |
$1,079.94
|
| Rate for Payer: WPS Commercial |
$1,454.33
|
|
|
SCREW VARIAX 2 MINI 2.4MM X 14MM 656014
|
Facility
|
IP
|
$1,888.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685848
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$962.12 |
| Max. Negotiated Rate |
$1,806.44 |
| Rate for Payer: Aetna Commercial |
$1,767.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,688.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,040.67
|
| Rate for Payer: Cash Price |
$566.40
|
| Rate for Payer: Cigna Commercial |
$1,806.44
|
| Rate for Payer: Health EOS Commercial |
$1,747.53
|
| Rate for Payer: HFN Commercial |
$1,806.44
|
| Rate for Payer: Multiplan Commercial |
$1,570.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,806.44
|
| Rate for Payer: Quartz Beloit One Network |
$962.12
|
| Rate for Payer: Quartz Commercial |
$1,178.11
|
| Rate for Payer: WEA Trust Commercial |
$1,079.94
|
| Rate for Payer: WPS Commercial |
$1,454.33
|
|
|
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 |
$962.63 |
| Max. Negotiated Rate |
$1,807.40 |
| Rate for Payer: Aetna Commercial |
$1,768.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,689.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,041.22
|
| Rate for Payer: Cash Price |
$566.70
|
| Rate for Payer: Cigna Commercial |
$1,807.40
|
| Rate for Payer: Health EOS Commercial |
$1,748.46
|
| Rate for Payer: HFN Commercial |
$1,807.40
|
| Rate for Payer: Multiplan Commercial |
$1,571.65
|
| Rate for Payer: Preferred Network Access Commercial |
$1,807.40
|
| Rate for Payer: Quartz Beloit One Network |
$962.63
|
| Rate for Payer: Quartz Commercial |
$1,178.74
|
| Rate for Payer: WEA Trust Commercial |
$1,080.51
|
| Rate for Payer: WPS Commercial |
$1,455.10
|
|
|
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 |
$550.08 |
| Max. Negotiated Rate |
$1,807.40 |
| Rate for Payer: Aetna Commercial |
$1,768.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,689.52
|
| Rate for Payer: Aetna Managed Medicare |
$550.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,276.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$982.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$942.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,041.22
|
| Rate for Payer: Cash Price |
$566.70
|
| Rate for Payer: Cigna Commercial |
$1,807.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,099.40
|
| Rate for Payer: Health EOS Commercial |
$1,748.46
|
| Rate for Payer: HFN Commercial |
$1,807.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,473.42
|
| Rate for Payer: Multiplan Commercial |
$1,571.65
|
| Rate for Payer: NAPHCARE Commercial |
$1,178.74
|
| Rate for Payer: Preferred Network Access Commercial |
$1,807.40
|
| Rate for Payer: Quartz Beloit One Network |
$962.63
|
| Rate for Payer: Quartz Commercial |
$1,276.96
|
| Rate for Payer: Quartz Medicare Advantage |
$1,178.74
|
| Rate for Payer: The Alliance Commercial |
$982.28
|
| Rate for Payer: WEA Trust Commercial |
$1,080.51
|
| Rate for Payer: WPS Commercial |
$1,455.10
|
|
|
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 |
$959.58 |
| Max. Negotiated Rate |
$1,801.65 |
| Rate for Payer: Aetna Commercial |
$1,762.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,684.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,037.91
|
| Rate for Payer: Cash Price |
$564.90
|
| Rate for Payer: Cigna Commercial |
$1,801.65
|
| Rate for Payer: Health EOS Commercial |
$1,742.90
|
| Rate for Payer: HFN Commercial |
$1,801.65
|
| Rate for Payer: Multiplan Commercial |
$1,566.66
|
| Rate for Payer: Preferred Network Access Commercial |
$1,801.65
|
| Rate for Payer: Quartz Beloit One Network |
$959.58
|
| Rate for Payer: Quartz Commercial |
$1,174.99
|
| Rate for Payer: WEA Trust Commercial |
$1,077.08
|
| Rate for Payer: WPS Commercial |
$1,450.47
|
|
|
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 |
$548.33 |
| Max. Negotiated Rate |
$1,801.65 |
| Rate for Payer: Aetna Commercial |
$1,762.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,684.16
|
| Rate for Payer: Aetna Managed Medicare |
$548.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,272.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$979.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$939.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,037.91
|
| Rate for Payer: Cash Price |
$564.90
|
| Rate for Payer: Cigna Commercial |
$1,801.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,095.91
|
| Rate for Payer: Health EOS Commercial |
$1,742.90
|
| Rate for Payer: HFN Commercial |
$1,801.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,468.74
|
| Rate for Payer: Multiplan Commercial |
$1,566.66
|
| Rate for Payer: NAPHCARE Commercial |
$1,174.99
|
| Rate for Payer: Preferred Network Access Commercial |
$1,801.65
|
| Rate for Payer: Quartz Beloit One Network |
$959.58
|
| Rate for Payer: Quartz Commercial |
$1,272.91
|
| Rate for Payer: Quartz Medicare Advantage |
$1,174.99
|
| Rate for Payer: The Alliance Commercial |
$979.16
|
| Rate for Payer: WEA Trust Commercial |
$1,077.08
|
| Rate for Payer: WPS Commercial |
$1,450.47
|
|
|
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 |
$962.63 |
| Max. Negotiated Rate |
$1,807.40 |
| Rate for Payer: Aetna Commercial |
$1,768.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,689.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,041.22
|
| Rate for Payer: Cash Price |
$566.70
|
| Rate for Payer: Cigna Commercial |
$1,807.40
|
| Rate for Payer: Health EOS Commercial |
$1,748.46
|
| Rate for Payer: HFN Commercial |
$1,807.40
|
| Rate for Payer: Multiplan Commercial |
$1,571.65
|
| Rate for Payer: Preferred Network Access Commercial |
$1,807.40
|
| Rate for Payer: Quartz Beloit One Network |
$962.63
|
| Rate for Payer: Quartz Commercial |
$1,178.74
|
| Rate for Payer: WEA Trust Commercial |
$1,080.51
|
| Rate for Payer: WPS Commercial |
$1,455.10
|
|
|
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 |
$550.08 |
| Max. Negotiated Rate |
$1,807.40 |
| Rate for Payer: Aetna Commercial |
$1,768.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,689.52
|
| Rate for Payer: Aetna Managed Medicare |
$550.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,276.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$982.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$942.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,041.22
|
| Rate for Payer: Cash Price |
$566.70
|
| Rate for Payer: Cigna Commercial |
$1,807.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,099.40
|
| Rate for Payer: Health EOS Commercial |
$1,748.46
|
| Rate for Payer: HFN Commercial |
$1,807.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,473.42
|
| Rate for Payer: Multiplan Commercial |
$1,571.65
|
| Rate for Payer: NAPHCARE Commercial |
$1,178.74
|
| Rate for Payer: Preferred Network Access Commercial |
$1,807.40
|
| Rate for Payer: Quartz Beloit One Network |
$962.63
|
| Rate for Payer: Quartz Commercial |
$1,276.96
|
| Rate for Payer: Quartz Medicare Advantage |
$1,178.74
|
| Rate for Payer: The Alliance Commercial |
$982.28
|
| Rate for Payer: WEA Trust Commercial |
$1,080.51
|
| Rate for Payer: WPS Commercial |
$1,455.10
|
|
|
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 |
$550.08 |
| Max. Negotiated Rate |
$1,807.40 |
| Rate for Payer: Aetna Commercial |
$1,768.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,689.52
|
| Rate for Payer: Aetna Managed Medicare |
$550.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,276.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$982.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$942.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,041.22
|
| Rate for Payer: Cash Price |
$566.70
|
| Rate for Payer: Cigna Commercial |
$1,807.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,099.40
|
| Rate for Payer: Health EOS Commercial |
$1,748.46
|
| Rate for Payer: HFN Commercial |
$1,807.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,473.42
|
| Rate for Payer: Multiplan Commercial |
$1,571.65
|
| Rate for Payer: NAPHCARE Commercial |
$1,178.74
|
| Rate for Payer: Preferred Network Access Commercial |
$1,807.40
|
| Rate for Payer: Quartz Beloit One Network |
$962.63
|
| Rate for Payer: Quartz Commercial |
$1,276.96
|
| Rate for Payer: Quartz Medicare Advantage |
$1,178.74
|
| Rate for Payer: The Alliance Commercial |
$982.28
|
| Rate for Payer: WEA Trust Commercial |
$1,080.51
|
| Rate for Payer: WPS Commercial |
$1,455.10
|
|
|
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 |
$962.63 |
| Max. Negotiated Rate |
$1,807.40 |
| Rate for Payer: Aetna Commercial |
$1,768.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,689.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,041.22
|
| Rate for Payer: Cash Price |
$566.70
|
| Rate for Payer: Cigna Commercial |
$1,807.40
|
| Rate for Payer: Health EOS Commercial |
$1,748.46
|
| Rate for Payer: HFN Commercial |
$1,807.40
|
| Rate for Payer: Multiplan Commercial |
$1,571.65
|
| Rate for Payer: Preferred Network Access Commercial |
$1,807.40
|
| Rate for Payer: Quartz Beloit One Network |
$962.63
|
| Rate for Payer: Quartz Commercial |
$1,178.74
|
| Rate for Payer: WEA Trust Commercial |
$1,080.51
|
| Rate for Payer: WPS Commercial |
$1,455.10
|
|
|
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 |
$382.93 |
| Max. Negotiated Rate |
$1,258.19 |
| Rate for Payer: Aetna Commercial |
$1,230.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,176.14
|
| Rate for Payer: Aetna Managed Medicare |
$382.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$888.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$683.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$656.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$724.83
|
| Rate for Payer: Cash Price |
$394.50
|
| Rate for Payer: Cigna Commercial |
$1,258.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$765.33
|
| Rate for Payer: Health EOS Commercial |
$1,217.16
|
| Rate for Payer: HFN Commercial |
$1,258.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,025.70
|
| Rate for Payer: Multiplan Commercial |
$1,094.08
|
| Rate for Payer: NAPHCARE Commercial |
$820.56
|
| Rate for Payer: Preferred Network Access Commercial |
$1,258.19
|
| Rate for Payer: Quartz Beloit One Network |
$670.12
|
| Rate for Payer: Quartz Commercial |
$888.94
|
| Rate for Payer: Quartz Medicare Advantage |
$820.56
|
| Rate for Payer: The Alliance Commercial |
$683.80
|
| Rate for Payer: WEA Trust Commercial |
$752.18
|
| Rate for Payer: WPS Commercial |
$1,012.94
|
|
|
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 |
$670.12 |
| Max. Negotiated Rate |
$1,258.19 |
| Rate for Payer: Aetna Commercial |
$1,230.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,176.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$724.83
|
| Rate for Payer: Cash Price |
$394.50
|
| Rate for Payer: Cigna Commercial |
$1,258.19
|
| Rate for Payer: Health EOS Commercial |
$1,217.16
|
| Rate for Payer: HFN Commercial |
$1,258.19
|
| Rate for Payer: Multiplan Commercial |
$1,094.08
|
| Rate for Payer: Preferred Network Access Commercial |
$1,258.19
|
| Rate for Payer: Quartz Beloit One Network |
$670.12
|
| Rate for Payer: Quartz Commercial |
$820.56
|
| Rate for Payer: WEA Trust Commercial |
$752.18
|
| Rate for Payer: WPS Commercial |
$1,012.94
|
|
|
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 |
$670.12 |
| Max. Negotiated Rate |
$1,258.19 |
| Rate for Payer: Aetna Commercial |
$1,230.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,176.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$724.83
|
| Rate for Payer: Cash Price |
$394.50
|
| Rate for Payer: Cigna Commercial |
$1,258.19
|
| Rate for Payer: Health EOS Commercial |
$1,217.16
|
| Rate for Payer: HFN Commercial |
$1,258.19
|
| Rate for Payer: Multiplan Commercial |
$1,094.08
|
| Rate for Payer: Preferred Network Access Commercial |
$1,258.19
|
| Rate for Payer: Quartz Beloit One Network |
$670.12
|
| Rate for Payer: Quartz Commercial |
$820.56
|
| Rate for Payer: WEA Trust Commercial |
$752.18
|
| Rate for Payer: WPS Commercial |
$1,012.94
|
|
|
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 |
$382.93 |
| Max. Negotiated Rate |
$1,258.19 |
| Rate for Payer: Aetna Commercial |
$1,230.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,176.14
|
| Rate for Payer: Aetna Managed Medicare |
$382.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$888.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$683.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$656.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$724.83
|
| Rate for Payer: Cash Price |
$394.50
|
| Rate for Payer: Cigna Commercial |
$1,258.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$765.33
|
| Rate for Payer: Health EOS Commercial |
$1,217.16
|
| Rate for Payer: HFN Commercial |
$1,258.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,025.70
|
| Rate for Payer: Multiplan Commercial |
$1,094.08
|
| Rate for Payer: NAPHCARE Commercial |
$820.56
|
| Rate for Payer: Preferred Network Access Commercial |
$1,258.19
|
| Rate for Payer: Quartz Beloit One Network |
$670.12
|
| Rate for Payer: Quartz Commercial |
$888.94
|
| Rate for Payer: Quartz Medicare Advantage |
$820.56
|
| Rate for Payer: The Alliance Commercial |
$683.80
|
| Rate for Payer: WEA Trust Commercial |
$752.18
|
| Rate for Payer: WPS Commercial |
$1,012.94
|
|
