|
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 |
$619.19 |
| Max. Negotiated Rate |
$1,162.56 |
| Rate for Payer: Aetna Commercial |
$1,137.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,086.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$669.74
|
| Rate for Payer: Cash Price |
$364.52
|
| Rate for Payer: Cigna Commercial |
$1,162.56
|
| Rate for Payer: Health EOS Commercial |
$1,124.65
|
| Rate for Payer: HFN Commercial |
$1,162.56
|
| Rate for Payer: Multiplan Commercial |
$1,010.92
|
| Rate for Payer: Preferred Network Access Commercial |
$1,162.56
|
| Rate for Payer: Quartz Beloit One Network |
$619.19
|
| Rate for Payer: Quartz Commercial |
$758.19
|
| Rate for Payer: WEA Trust Commercial |
$695.01
|
| Rate for Payer: WPS Commercial |
$935.95
|
|
|
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 |
$353.82 |
| Max. Negotiated Rate |
$1,162.56 |
| Rate for Payer: Aetna Commercial |
$1,137.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,086.74
|
| Rate for Payer: Aetna Managed Medicare |
$353.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$821.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$631.83
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$606.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$669.74
|
| Rate for Payer: Cash Price |
$364.52
|
| Rate for Payer: Cigna Commercial |
$1,162.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$707.16
|
| Rate for Payer: Health EOS Commercial |
$1,124.65
|
| Rate for Payer: HFN Commercial |
$1,162.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$947.74
|
| Rate for Payer: Multiplan Commercial |
$1,010.92
|
| Rate for Payer: NAPHCARE Commercial |
$758.19
|
| Rate for Payer: Preferred Network Access Commercial |
$1,162.56
|
| Rate for Payer: Quartz Beloit One Network |
$619.19
|
| Rate for Payer: Quartz Commercial |
$821.37
|
| Rate for Payer: Quartz Medicare Advantage |
$758.19
|
| Rate for Payer: The Alliance Commercial |
$631.83
|
| Rate for Payer: WEA Trust Commercial |
$695.01
|
| Rate for Payer: WPS Commercial |
$935.95
|
|
|
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 |
$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 16MM 656416
|
Facility
|
OP
|
$1,315.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6173724
|
|
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 18MM 656418
|
Facility
|
IP
|
$1,315.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6172079
|
|
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 18MM 656418
|
Facility
|
OP
|
$1,315.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6172079
|
|
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 20MM 656420
|
Facility
|
IP
|
$1,270.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6037664
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.19 |
| Max. Negotiated Rate |
$1,215.14 |
| Rate for Payer: Aetna Commercial |
$1,188.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,135.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$700.02
|
| Rate for Payer: Cash Price |
$381.00
|
| Rate for Payer: Cigna Commercial |
$1,215.14
|
| Rate for Payer: Health EOS Commercial |
$1,175.51
|
| Rate for Payer: HFN Commercial |
$1,215.14
|
| Rate for Payer: Multiplan Commercial |
$1,056.64
|
| Rate for Payer: Preferred Network Access Commercial |
$1,215.14
|
| Rate for Payer: Quartz Beloit One Network |
$647.19
|
| Rate for Payer: Quartz Commercial |
$792.48
|
| Rate for Payer: WEA Trust Commercial |
$726.44
|
| Rate for Payer: WPS Commercial |
$978.28
|
|
|
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 |
$369.82 |
| Max. Negotiated Rate |
$1,215.14 |
| Rate for Payer: Aetna Commercial |
$1,188.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,135.89
|
| Rate for Payer: Aetna Managed Medicare |
$369.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$858.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$660.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$633.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$700.02
|
| Rate for Payer: Cash Price |
$381.00
|
| Rate for Payer: Cigna Commercial |
$1,215.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$739.14
|
| Rate for Payer: Health EOS Commercial |
$1,175.51
|
| Rate for Payer: HFN Commercial |
$1,215.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$990.60
|
| Rate for Payer: Multiplan Commercial |
$1,056.64
|
| Rate for Payer: NAPHCARE Commercial |
$792.48
|
| Rate for Payer: Preferred Network Access Commercial |
$1,215.14
|
| Rate for Payer: Quartz Beloit One Network |
$647.19
|
| Rate for Payer: Quartz Commercial |
$858.52
|
| Rate for Payer: Quartz Medicare Advantage |
$792.48
|
| Rate for Payer: The Alliance Commercial |
$660.40
|
| Rate for Payer: WEA Trust Commercial |
$726.44
|
| Rate for Payer: WPS Commercial |
$978.28
|
|
|
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 |
$647.19 |
| Max. Negotiated Rate |
$1,215.14 |
| Rate for Payer: Aetna Commercial |
$1,188.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,135.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$700.02
|
| Rate for Payer: Cash Price |
$381.00
|
| Rate for Payer: Cigna Commercial |
$1,215.14
|
| Rate for Payer: Health EOS Commercial |
$1,175.51
|
| Rate for Payer: HFN Commercial |
$1,215.14
|
| Rate for Payer: Multiplan Commercial |
$1,056.64
|
| Rate for Payer: Preferred Network Access Commercial |
$1,215.14
|
| Rate for Payer: Quartz Beloit One Network |
$647.19
|
| Rate for Payer: Quartz Commercial |
$792.48
|
| Rate for Payer: WEA Trust Commercial |
$726.44
|
| Rate for Payer: WPS Commercial |
$978.28
|
|
|
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 |
$369.82 |
| Max. Negotiated Rate |
$1,215.14 |
| Rate for Payer: Aetna Commercial |
$1,188.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,135.89
|
| Rate for Payer: Aetna Managed Medicare |
$369.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$858.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$660.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$633.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$700.02
|
| Rate for Payer: Cash Price |
$381.00
|
| Rate for Payer: Cigna Commercial |
$1,215.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$739.14
|
| Rate for Payer: Health EOS Commercial |
$1,175.51
|
| Rate for Payer: HFN Commercial |
$1,215.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$990.60
|
| Rate for Payer: Multiplan Commercial |
$1,056.64
|
| Rate for Payer: NAPHCARE Commercial |
$792.48
|
| Rate for Payer: Preferred Network Access Commercial |
$1,215.14
|
| Rate for Payer: Quartz Beloit One Network |
$647.19
|
| Rate for Payer: Quartz Commercial |
$858.52
|
| Rate for Payer: Quartz Medicare Advantage |
$792.48
|
| Rate for Payer: The Alliance Commercial |
$660.40
|
| Rate for Payer: WEA Trust Commercial |
$726.44
|
| Rate for Payer: WPS Commercial |
$978.28
|
|
|
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 |
$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 26MM 656426
|
Facility
|
OP
|
$1,315.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6171783
|
|
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 36MM 656436
|
Facility
|
OP
|
$1,321.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685717
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$384.68 |
| Max. Negotiated Rate |
$1,263.93 |
| Rate for Payer: Aetna Commercial |
$1,236.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,181.50
|
| Rate for Payer: Aetna Managed Medicare |
$384.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$893.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$686.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$659.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$728.14
|
| Rate for Payer: Cash Price |
$396.30
|
| Rate for Payer: Cigna Commercial |
$1,263.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$768.82
|
| Rate for Payer: Health EOS Commercial |
$1,222.72
|
| Rate for Payer: HFN Commercial |
$1,263.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,030.38
|
| Rate for Payer: Multiplan Commercial |
$1,099.07
|
| Rate for Payer: NAPHCARE Commercial |
$824.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,263.93
|
| Rate for Payer: Quartz Beloit One Network |
$673.18
|
| Rate for Payer: Quartz Commercial |
$893.00
|
| Rate for Payer: Quartz Medicare Advantage |
$824.30
|
| Rate for Payer: The Alliance Commercial |
$686.92
|
| Rate for Payer: WEA Trust Commercial |
$755.61
|
| Rate for Payer: WPS Commercial |
$1,017.57
|
|
|
SCREW VARIAX 2 MINI 2.7MM X 36MM 656436
|
Facility
|
IP
|
$1,321.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685717
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$673.18 |
| Max. Negotiated Rate |
$1,263.93 |
| Rate for Payer: Aetna Commercial |
$1,236.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,181.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$728.14
|
| Rate for Payer: Cash Price |
$396.30
|
| Rate for Payer: Cigna Commercial |
$1,263.93
|
| Rate for Payer: Health EOS Commercial |
$1,222.72
|
| Rate for Payer: HFN Commercial |
$1,263.93
|
| Rate for Payer: Multiplan Commercial |
$1,099.07
|
| Rate for Payer: Preferred Network Access Commercial |
$1,263.93
|
| Rate for Payer: Quartz Beloit One Network |
$673.18
|
| Rate for Payer: Quartz Commercial |
$824.30
|
| Rate for Payer: WEA Trust Commercial |
$755.61
|
| Rate for Payer: WPS Commercial |
$1,017.57
|
|
|
SCREW VARIAX 2 MINI 2.7MM X 38MM 656438
|
Facility
|
IP
|
$1,321.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685718
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$673.18 |
| Max. Negotiated Rate |
$1,263.93 |
| Rate for Payer: Aetna Commercial |
$1,236.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,181.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$728.14
|
| Rate for Payer: Cash Price |
$396.30
|
| Rate for Payer: Cigna Commercial |
$1,263.93
|
| Rate for Payer: Health EOS Commercial |
$1,222.72
|
| Rate for Payer: HFN Commercial |
$1,263.93
|
| Rate for Payer: Multiplan Commercial |
$1,099.07
|
| Rate for Payer: Preferred Network Access Commercial |
$1,263.93
|
| Rate for Payer: Quartz Beloit One Network |
$673.18
|
| Rate for Payer: Quartz Commercial |
$824.30
|
| Rate for Payer: WEA Trust Commercial |
$755.61
|
| Rate for Payer: WPS Commercial |
$1,017.57
|
|
|
SCREW VARIAX 2 MINI 2.7MM X 38MM 656438
|
Facility
|
OP
|
$1,321.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685718
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$384.68 |
| Max. Negotiated Rate |
$1,263.93 |
| Rate for Payer: Aetna Commercial |
$1,236.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,181.50
|
| Rate for Payer: Aetna Managed Medicare |
$384.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$893.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$686.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$659.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$728.14
|
| Rate for Payer: Cash Price |
$396.30
|
| Rate for Payer: Cigna Commercial |
$1,263.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$768.82
|
| Rate for Payer: Health EOS Commercial |
$1,222.72
|
| Rate for Payer: HFN Commercial |
$1,263.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,030.38
|
| Rate for Payer: Multiplan Commercial |
$1,099.07
|
| Rate for Payer: NAPHCARE Commercial |
$824.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,263.93
|
| Rate for Payer: Quartz Beloit One Network |
$673.18
|
| Rate for Payer: Quartz Commercial |
$893.00
|
| Rate for Payer: Quartz Medicare Advantage |
$824.30
|
| Rate for Payer: The Alliance Commercial |
$686.92
|
| Rate for Payer: WEA Trust Commercial |
$755.61
|
| Rate for Payer: WPS Commercial |
$1,017.57
|
|
|
SCREW VARIAX 2 MINI 2.7MM X 40MM 656440
|
Facility
|
IP
|
$1,321.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685719
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$673.18 |
| Max. Negotiated Rate |
$1,263.93 |
| Rate for Payer: Aetna Commercial |
$1,236.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,181.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$728.14
|
| Rate for Payer: Cash Price |
$396.30
|
| Rate for Payer: Cigna Commercial |
$1,263.93
|
| Rate for Payer: Health EOS Commercial |
$1,222.72
|
| Rate for Payer: HFN Commercial |
$1,263.93
|
| Rate for Payer: Multiplan Commercial |
$1,099.07
|
| Rate for Payer: Preferred Network Access Commercial |
$1,263.93
|
| Rate for Payer: Quartz Beloit One Network |
$673.18
|
| Rate for Payer: Quartz Commercial |
$824.30
|
| Rate for Payer: WEA Trust Commercial |
$755.61
|
| Rate for Payer: WPS Commercial |
$1,017.57
|
|
|
SCREW VARIAX 2 MINI 2.7MM X 40MM 656440
|
Facility
|
OP
|
$1,321.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685719
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$384.68 |
| Max. Negotiated Rate |
$1,263.93 |
| Rate for Payer: Aetna Commercial |
$1,236.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,181.50
|
| Rate for Payer: Aetna Managed Medicare |
$384.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$893.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$686.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$659.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$728.14
|
| Rate for Payer: Cash Price |
$396.30
|
| Rate for Payer: Cigna Commercial |
$1,263.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$768.82
|
| Rate for Payer: Health EOS Commercial |
$1,222.72
|
| Rate for Payer: HFN Commercial |
$1,263.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,030.38
|
| Rate for Payer: Multiplan Commercial |
$1,099.07
|
| Rate for Payer: NAPHCARE Commercial |
$824.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,263.93
|
| Rate for Payer: Quartz Beloit One Network |
$673.18
|
| Rate for Payer: Quartz Commercial |
$893.00
|
| Rate for Payer: Quartz Medicare Advantage |
$824.30
|
| Rate for Payer: The Alliance Commercial |
$686.92
|
| Rate for Payer: WEA Trust Commercial |
$755.61
|
| Rate for Payer: WPS Commercial |
$1,017.57
|
|
|
SCREW VARIAX 2 MINI 2.7MM X 42MM 656442
|
Facility
|
IP
|
$1,321.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685720
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$673.18 |
| Max. Negotiated Rate |
$1,263.93 |
| Rate for Payer: Aetna Commercial |
$1,236.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,181.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$728.14
|
| Rate for Payer: Cash Price |
$396.30
|
| Rate for Payer: Cigna Commercial |
$1,263.93
|
| Rate for Payer: Health EOS Commercial |
$1,222.72
|
| Rate for Payer: HFN Commercial |
$1,263.93
|
| Rate for Payer: Multiplan Commercial |
$1,099.07
|
| Rate for Payer: Preferred Network Access Commercial |
$1,263.93
|
| Rate for Payer: Quartz Beloit One Network |
$673.18
|
| Rate for Payer: Quartz Commercial |
$824.30
|
| Rate for Payer: WEA Trust Commercial |
$755.61
|
| Rate for Payer: WPS Commercial |
$1,017.57
|
|
|
SCREW VARIAX 2 MINI 2.7MM X 42MM 656442
|
Facility
|
OP
|
$1,321.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685720
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$384.68 |
| Max. Negotiated Rate |
$1,263.93 |
| Rate for Payer: Aetna Commercial |
$1,236.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,181.50
|
| Rate for Payer: Aetna Managed Medicare |
$384.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$893.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$686.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$659.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$728.14
|
| Rate for Payer: Cash Price |
$396.30
|
| Rate for Payer: Cigna Commercial |
$1,263.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$768.82
|
| Rate for Payer: Health EOS Commercial |
$1,222.72
|
| Rate for Payer: HFN Commercial |
$1,263.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,030.38
|
| Rate for Payer: Multiplan Commercial |
$1,099.07
|
| Rate for Payer: NAPHCARE Commercial |
$824.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,263.93
|
| Rate for Payer: Quartz Beloit One Network |
$673.18
|
| Rate for Payer: Quartz Commercial |
$893.00
|
| Rate for Payer: Quartz Medicare Advantage |
$824.30
|
| Rate for Payer: The Alliance Commercial |
$686.92
|
| Rate for Payer: WEA Trust Commercial |
$755.61
|
| Rate for Payer: WPS Commercial |
$1,017.57
|
|
|
SCREW VARIAX 2 MINI 2.7MM X 46MM 656446
|
Facility
|
IP
|
$1,321.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685721
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$673.18 |
| Max. Negotiated Rate |
$1,263.93 |
| Rate for Payer: Aetna Commercial |
$1,236.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,181.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$728.14
|
| Rate for Payer: Cash Price |
$396.30
|
| Rate for Payer: Cigna Commercial |
$1,263.93
|
| Rate for Payer: Health EOS Commercial |
$1,222.72
|
| Rate for Payer: HFN Commercial |
$1,263.93
|
| Rate for Payer: Multiplan Commercial |
$1,099.07
|
| Rate for Payer: Preferred Network Access Commercial |
$1,263.93
|
| Rate for Payer: Quartz Beloit One Network |
$673.18
|
| Rate for Payer: Quartz Commercial |
$824.30
|
| Rate for Payer: WEA Trust Commercial |
$755.61
|
| Rate for Payer: WPS Commercial |
$1,017.57
|
|
|
SCREW VARIAX 2 MINI 2.7MM X 46MM 656446
|
Facility
|
OP
|
$1,321.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685721
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$384.68 |
| Max. Negotiated Rate |
$1,263.93 |
| Rate for Payer: Aetna Commercial |
$1,236.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,181.50
|
| Rate for Payer: Aetna Managed Medicare |
$384.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$893.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$686.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$659.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$728.14
|
| Rate for Payer: Cash Price |
$396.30
|
| Rate for Payer: Cigna Commercial |
$1,263.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$768.82
|
| Rate for Payer: Health EOS Commercial |
$1,222.72
|
| Rate for Payer: HFN Commercial |
$1,263.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,030.38
|
| Rate for Payer: Multiplan Commercial |
$1,099.07
|
| Rate for Payer: NAPHCARE Commercial |
$824.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,263.93
|
| Rate for Payer: Quartz Beloit One Network |
$673.18
|
| Rate for Payer: Quartz Commercial |
$893.00
|
| Rate for Payer: Quartz Medicare Advantage |
$824.30
|
| Rate for Payer: The Alliance Commercial |
$686.92
|
| Rate for Payer: WEA Trust Commercial |
$755.61
|
| Rate for Payer: WPS Commercial |
$1,017.57
|
|
|
SCREW VARIAX 2 MINI 2.7MM X 48MM 656448
|
Facility
|
IP
|
$1,321.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685722
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$673.18 |
| Max. Negotiated Rate |
$1,263.93 |
| Rate for Payer: Aetna Commercial |
$1,236.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,181.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$728.14
|
| Rate for Payer: Cash Price |
$396.30
|
| Rate for Payer: Cigna Commercial |
$1,263.93
|
| Rate for Payer: Health EOS Commercial |
$1,222.72
|
| Rate for Payer: HFN Commercial |
$1,263.93
|
| Rate for Payer: Multiplan Commercial |
$1,099.07
|
| Rate for Payer: Preferred Network Access Commercial |
$1,263.93
|
| Rate for Payer: Quartz Beloit One Network |
$673.18
|
| Rate for Payer: Quartz Commercial |
$824.30
|
| Rate for Payer: WEA Trust Commercial |
$755.61
|
| Rate for Payer: WPS Commercial |
$1,017.57
|
|
|
SCREW VARIAX 2 MINI 2.7MM X 48MM 656448
|
Facility
|
OP
|
$1,321.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685722
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$384.68 |
| Max. Negotiated Rate |
$1,263.93 |
| Rate for Payer: Aetna Commercial |
$1,236.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,181.50
|
| Rate for Payer: Aetna Managed Medicare |
$384.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$893.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$686.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$659.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$728.14
|
| Rate for Payer: Cash Price |
$396.30
|
| Rate for Payer: Cigna Commercial |
$1,263.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$768.82
|
| Rate for Payer: Health EOS Commercial |
$1,222.72
|
| Rate for Payer: HFN Commercial |
$1,263.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,030.38
|
| Rate for Payer: Multiplan Commercial |
$1,099.07
|
| Rate for Payer: NAPHCARE Commercial |
$824.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,263.93
|
| Rate for Payer: Quartz Beloit One Network |
$673.18
|
| Rate for Payer: Quartz Commercial |
$893.00
|
| Rate for Payer: Quartz Medicare Advantage |
$824.30
|
| Rate for Payer: The Alliance Commercial |
$686.92
|
| Rate for Payer: WEA Trust Commercial |
$755.61
|
| Rate for Payer: WPS Commercial |
$1,017.57
|
|
|
SCREW/WASHER 2.7MM DIA X 10MM L TI STERILE 285210SND
|
Facility
|
IP
|
$4,266.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5617661
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,173.95 |
| Max. Negotiated Rate |
$4,081.71 |
| Rate for Payer: Aetna Commercial |
$3,992.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,815.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,351.42
|
| Rate for Payer: Cash Price |
$1,279.80
|
| Rate for Payer: Cigna Commercial |
$4,081.71
|
| Rate for Payer: Health EOS Commercial |
$3,948.61
|
| Rate for Payer: HFN Commercial |
$4,081.71
|
| Rate for Payer: Multiplan Commercial |
$3,549.31
|
| Rate for Payer: Preferred Network Access Commercial |
$4,081.71
|
| Rate for Payer: Quartz Beloit One Network |
$2,173.95
|
| Rate for Payer: Quartz Commercial |
$2,661.98
|
| Rate for Payer: WEA Trust Commercial |
$2,440.15
|
| Rate for Payer: WPS Commercial |
$3,286.10
|
|
