|
SCREW-CANN 7.3 X 50 02.207.250
|
Facility
|
OP
|
$3,060.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967233
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$856.80 |
| Max. Negotiated Rate |
$12,240.00 |
| Rate for Payer: Aetna Commercial |
$2,754.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,631.60
|
| Rate for Payer: Aetna Managed Medicare |
$856.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,989.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,530.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,468.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,621.80
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Cigna Commercial |
$2,815.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,712.38
|
| Rate for Payer: Health EOS Commercial |
$2,723.40
|
| Rate for Payer: HFN Commercial |
$2,815.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,295.00
|
| Rate for Payer: Multiplan Commercial |
$2,448.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,836.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,815.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,499.40
|
| Rate for Payer: Quartz Commercial |
$1,989.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,836.00
|
| Rate for Payer: The Alliance Commercial |
$12,240.00
|
| Rate for Payer: WEA Trust Commercial |
$1,683.00
|
| Rate for Payer: WPS Commercial |
$2,266.54
|
|
|
SCREW-CANN 7.3 X 50 02.207.250
|
Facility
|
IP
|
$3,060.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967233
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,499.40 |
| Max. Negotiated Rate |
$2,815.20 |
| Rate for Payer: Aetna Commercial |
$2,754.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,631.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,621.80
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Cigna Commercial |
$2,815.20
|
| Rate for Payer: Health EOS Commercial |
$2,723.40
|
| Rate for Payer: HFN Commercial |
$2,815.20
|
| Rate for Payer: Multiplan Commercial |
$2,448.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,836.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,815.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,499.40
|
| Rate for Payer: Quartz Commercial |
$1,836.00
|
| Rate for Payer: WEA Trust Commercial |
$1,683.00
|
| Rate for Payer: WPS Commercial |
$2,266.54
|
|
|
SCREW-CANN 7.3 X 50 02.207.450
|
Facility
|
OP
|
$3,060.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967223
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$856.80 |
| Max. Negotiated Rate |
$12,240.00 |
| Rate for Payer: Aetna Commercial |
$2,754.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,631.60
|
| Rate for Payer: Aetna Managed Medicare |
$856.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,989.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,530.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,468.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,621.80
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Cigna Commercial |
$2,815.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,712.38
|
| Rate for Payer: Health EOS Commercial |
$2,723.40
|
| Rate for Payer: HFN Commercial |
$2,815.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,295.00
|
| Rate for Payer: Multiplan Commercial |
$2,448.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,836.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,815.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,499.40
|
| Rate for Payer: Quartz Commercial |
$1,989.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,836.00
|
| Rate for Payer: The Alliance Commercial |
$12,240.00
|
| Rate for Payer: WEA Trust Commercial |
$1,683.00
|
| Rate for Payer: WPS Commercial |
$2,266.54
|
|
|
SCREW-CANN 7.3 X 50 02.207.450
|
Facility
|
IP
|
$3,060.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967223
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,499.40 |
| Max. Negotiated Rate |
$2,815.20 |
| Rate for Payer: Aetna Commercial |
$2,754.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,631.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,621.80
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Cigna Commercial |
$2,815.20
|
| Rate for Payer: Health EOS Commercial |
$2,723.40
|
| Rate for Payer: HFN Commercial |
$2,815.20
|
| Rate for Payer: Multiplan Commercial |
$2,448.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,836.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,815.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,499.40
|
| Rate for Payer: Quartz Commercial |
$1,836.00
|
| Rate for Payer: WEA Trust Commercial |
$1,683.00
|
| Rate for Payer: WPS Commercial |
$2,266.54
|
|
|
SCREW-CANN 7.3 X 55 02.207.055
|
Facility
|
OP
|
$1,233.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967014
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$345.24 |
| Max. Negotiated Rate |
$4,932.00 |
| Rate for Payer: Aetna Commercial |
$1,109.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,060.38
|
| Rate for Payer: Aetna Managed Medicare |
$345.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$801.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$616.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$591.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$653.49
|
| Rate for Payer: Cash Price |
$369.90
|
| Rate for Payer: Cigna Commercial |
$1,134.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$689.99
|
| Rate for Payer: Health EOS Commercial |
$1,097.37
|
| Rate for Payer: HFN Commercial |
$1,134.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$924.75
|
| Rate for Payer: Multiplan Commercial |
$986.40
|
| Rate for Payer: NAPHCARE Commercial |
$739.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,134.36
|
| Rate for Payer: Quartz Beloit One Network |
$604.17
|
| Rate for Payer: Quartz Commercial |
$801.45
|
| Rate for Payer: Quartz Medicare Advantage |
$739.80
|
| Rate for Payer: The Alliance Commercial |
$4,932.00
|
| Rate for Payer: WEA Trust Commercial |
$678.15
|
| Rate for Payer: WPS Commercial |
$913.28
|
|
|
SCREW-CANN 7.3 X 55 02.207.055
|
Facility
|
IP
|
$1,233.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967014
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$604.17 |
| Max. Negotiated Rate |
$1,134.36 |
| Rate for Payer: Aetna Commercial |
$1,109.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,060.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$653.49
|
| Rate for Payer: Cash Price |
$369.90
|
| Rate for Payer: Cigna Commercial |
$1,134.36
|
| Rate for Payer: Health EOS Commercial |
$1,097.37
|
| Rate for Payer: HFN Commercial |
$1,134.36
|
| Rate for Payer: Multiplan Commercial |
$986.40
|
| Rate for Payer: NAPHCARE Commercial |
$739.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,134.36
|
| Rate for Payer: Quartz Beloit One Network |
$604.17
|
| Rate for Payer: Quartz Commercial |
$739.80
|
| Rate for Payer: WEA Trust Commercial |
$678.15
|
| Rate for Payer: WPS Commercial |
$913.28
|
|
|
SCREW-CANN 7.3 X 55 02.207.255
|
Facility
|
OP
|
$3,060.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967234
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$856.80 |
| Max. Negotiated Rate |
$12,240.00 |
| Rate for Payer: Aetna Commercial |
$2,754.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,631.60
|
| Rate for Payer: Aetna Managed Medicare |
$856.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,989.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,530.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,468.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,621.80
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Cigna Commercial |
$2,815.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,712.38
|
| Rate for Payer: Health EOS Commercial |
$2,723.40
|
| Rate for Payer: HFN Commercial |
$2,815.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,295.00
|
| Rate for Payer: Multiplan Commercial |
$2,448.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,836.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,815.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,499.40
|
| Rate for Payer: Quartz Commercial |
$1,989.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,836.00
|
| Rate for Payer: The Alliance Commercial |
$12,240.00
|
| Rate for Payer: WEA Trust Commercial |
$1,683.00
|
| Rate for Payer: WPS Commercial |
$2,266.54
|
|
|
SCREW-CANN 7.3 X 55 02.207.255
|
Facility
|
IP
|
$3,060.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967234
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,499.40 |
| Max. Negotiated Rate |
$2,815.20 |
| Rate for Payer: Aetna Commercial |
$2,754.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,631.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,621.80
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Cigna Commercial |
$2,815.20
|
| Rate for Payer: Health EOS Commercial |
$2,723.40
|
| Rate for Payer: HFN Commercial |
$2,815.20
|
| Rate for Payer: Multiplan Commercial |
$2,448.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,836.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,815.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,499.40
|
| Rate for Payer: Quartz Commercial |
$1,836.00
|
| Rate for Payer: WEA Trust Commercial |
$1,683.00
|
| Rate for Payer: WPS Commercial |
$2,266.54
|
|
|
SCREW-CANN 7.3 X 55 02.207.455
|
Facility
|
OP
|
$3,060.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967224
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$856.80 |
| Max. Negotiated Rate |
$12,240.00 |
| Rate for Payer: Aetna Commercial |
$2,754.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,631.60
|
| Rate for Payer: Aetna Managed Medicare |
$856.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,989.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,530.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,468.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,621.80
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Cigna Commercial |
$2,815.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,712.38
|
| Rate for Payer: Health EOS Commercial |
$2,723.40
|
| Rate for Payer: HFN Commercial |
$2,815.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,295.00
|
| Rate for Payer: Multiplan Commercial |
$2,448.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,836.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,815.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,499.40
|
| Rate for Payer: Quartz Commercial |
$1,989.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,836.00
|
| Rate for Payer: The Alliance Commercial |
$12,240.00
|
| Rate for Payer: WEA Trust Commercial |
$1,683.00
|
| Rate for Payer: WPS Commercial |
$2,266.54
|
|
|
SCREW-CANN 7.3 X 55 02.207.455
|
Facility
|
IP
|
$3,060.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967224
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,499.40 |
| Max. Negotiated Rate |
$2,815.20 |
| Rate for Payer: Aetna Commercial |
$2,754.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,631.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,621.80
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Cigna Commercial |
$2,815.20
|
| Rate for Payer: Health EOS Commercial |
$2,723.40
|
| Rate for Payer: HFN Commercial |
$2,815.20
|
| Rate for Payer: Multiplan Commercial |
$2,448.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,836.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,815.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,499.40
|
| Rate for Payer: Quartz Commercial |
$1,836.00
|
| Rate for Payer: WEA Trust Commercial |
$1,683.00
|
| Rate for Payer: WPS Commercial |
$2,266.54
|
|
|
SCREW-CANN 7.3 X 60 02.207.060
|
Facility
|
OP
|
$1,233.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967015
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$345.24 |
| Max. Negotiated Rate |
$4,932.00 |
| Rate for Payer: Aetna Commercial |
$1,109.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,060.38
|
| Rate for Payer: Aetna Managed Medicare |
$345.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$801.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$616.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$591.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$653.49
|
| Rate for Payer: Cash Price |
$369.90
|
| Rate for Payer: Cigna Commercial |
$1,134.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$689.99
|
| Rate for Payer: Health EOS Commercial |
$1,097.37
|
| Rate for Payer: HFN Commercial |
$1,134.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$924.75
|
| Rate for Payer: Multiplan Commercial |
$986.40
|
| Rate for Payer: NAPHCARE Commercial |
$739.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,134.36
|
| Rate for Payer: Quartz Beloit One Network |
$604.17
|
| Rate for Payer: Quartz Commercial |
$801.45
|
| Rate for Payer: Quartz Medicare Advantage |
$739.80
|
| Rate for Payer: The Alliance Commercial |
$4,932.00
|
| Rate for Payer: WEA Trust Commercial |
$678.15
|
| Rate for Payer: WPS Commercial |
$913.28
|
|
|
SCREW-CANN 7.3 X 60 02.207.060
|
Facility
|
IP
|
$1,233.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967015
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$604.17 |
| Max. Negotiated Rate |
$1,134.36 |
| Rate for Payer: Aetna Commercial |
$1,109.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,060.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$653.49
|
| Rate for Payer: Cash Price |
$369.90
|
| Rate for Payer: Cigna Commercial |
$1,134.36
|
| Rate for Payer: Health EOS Commercial |
$1,097.37
|
| Rate for Payer: HFN Commercial |
$1,134.36
|
| Rate for Payer: Multiplan Commercial |
$986.40
|
| Rate for Payer: NAPHCARE Commercial |
$739.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,134.36
|
| Rate for Payer: Quartz Beloit One Network |
$604.17
|
| Rate for Payer: Quartz Commercial |
$739.80
|
| Rate for Payer: WEA Trust Commercial |
$678.15
|
| Rate for Payer: WPS Commercial |
$913.28
|
|
|
SCREW-CANN 7.3 X 60 02.207.260
|
Facility
|
OP
|
$3,060.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967235
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$856.80 |
| Max. Negotiated Rate |
$12,240.00 |
| Rate for Payer: Aetna Commercial |
$2,754.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,631.60
|
| Rate for Payer: Aetna Managed Medicare |
$856.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,989.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,530.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,468.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,621.80
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Cigna Commercial |
$2,815.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,712.38
|
| Rate for Payer: Health EOS Commercial |
$2,723.40
|
| Rate for Payer: HFN Commercial |
$2,815.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,295.00
|
| Rate for Payer: Multiplan Commercial |
$2,448.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,836.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,815.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,499.40
|
| Rate for Payer: Quartz Commercial |
$1,989.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,836.00
|
| Rate for Payer: The Alliance Commercial |
$12,240.00
|
| Rate for Payer: WEA Trust Commercial |
$1,683.00
|
| Rate for Payer: WPS Commercial |
$2,266.54
|
|
|
SCREW-CANN 7.3 X 60 02.207.260
|
Facility
|
IP
|
$3,060.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967235
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,499.40 |
| Max. Negotiated Rate |
$2,815.20 |
| Rate for Payer: Aetna Commercial |
$2,754.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,631.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,621.80
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Cigna Commercial |
$2,815.20
|
| Rate for Payer: Health EOS Commercial |
$2,723.40
|
| Rate for Payer: HFN Commercial |
$2,815.20
|
| Rate for Payer: Multiplan Commercial |
$2,448.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,836.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,815.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,499.40
|
| Rate for Payer: Quartz Commercial |
$1,836.00
|
| Rate for Payer: WEA Trust Commercial |
$1,683.00
|
| Rate for Payer: WPS Commercial |
$2,266.54
|
|
|
SCREW-CANN 7.3 X 60 02.207.460
|
Facility
|
OP
|
$3,060.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967225
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$856.80 |
| Max. Negotiated Rate |
$12,240.00 |
| Rate for Payer: Aetna Commercial |
$2,754.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,631.60
|
| Rate for Payer: Aetna Managed Medicare |
$856.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,989.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,530.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,468.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,621.80
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Cigna Commercial |
$2,815.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,712.38
|
| Rate for Payer: Health EOS Commercial |
$2,723.40
|
| Rate for Payer: HFN Commercial |
$2,815.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,295.00
|
| Rate for Payer: Multiplan Commercial |
$2,448.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,836.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,815.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,499.40
|
| Rate for Payer: Quartz Commercial |
$1,989.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,836.00
|
| Rate for Payer: The Alliance Commercial |
$12,240.00
|
| Rate for Payer: WEA Trust Commercial |
$1,683.00
|
| Rate for Payer: WPS Commercial |
$2,266.54
|
|
|
SCREW-CANN 7.3 X 60 02.207.460
|
Facility
|
IP
|
$3,060.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967225
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,499.40 |
| Max. Negotiated Rate |
$2,815.20 |
| Rate for Payer: Aetna Commercial |
$2,754.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,631.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,621.80
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Cigna Commercial |
$2,815.20
|
| Rate for Payer: Health EOS Commercial |
$2,723.40
|
| Rate for Payer: HFN Commercial |
$2,815.20
|
| Rate for Payer: Multiplan Commercial |
$2,448.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,836.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,815.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,499.40
|
| Rate for Payer: Quartz Commercial |
$1,836.00
|
| Rate for Payer: WEA Trust Commercial |
$1,683.00
|
| Rate for Payer: WPS Commercial |
$2,266.54
|
|
|
SCREW-CANN 7.3 X 65 02.207.065
|
Facility
|
OP
|
$1,233.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967016
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$345.24 |
| Max. Negotiated Rate |
$4,932.00 |
| Rate for Payer: Aetna Commercial |
$1,109.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,060.38
|
| Rate for Payer: Aetna Managed Medicare |
$345.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$801.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$616.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$591.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$653.49
|
| Rate for Payer: Cash Price |
$369.90
|
| Rate for Payer: Cigna Commercial |
$1,134.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$689.99
|
| Rate for Payer: Health EOS Commercial |
$1,097.37
|
| Rate for Payer: HFN Commercial |
$1,134.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$924.75
|
| Rate for Payer: Multiplan Commercial |
$986.40
|
| Rate for Payer: NAPHCARE Commercial |
$739.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,134.36
|
| Rate for Payer: Quartz Beloit One Network |
$604.17
|
| Rate for Payer: Quartz Commercial |
$801.45
|
| Rate for Payer: Quartz Medicare Advantage |
$739.80
|
| Rate for Payer: The Alliance Commercial |
$4,932.00
|
| Rate for Payer: WEA Trust Commercial |
$678.15
|
| Rate for Payer: WPS Commercial |
$913.28
|
|
|
SCREW-CANN 7.3 X 65 02.207.065
|
Facility
|
IP
|
$1,233.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967016
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$604.17 |
| Max. Negotiated Rate |
$1,134.36 |
| Rate for Payer: Aetna Commercial |
$1,109.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,060.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$653.49
|
| Rate for Payer: Cash Price |
$369.90
|
| Rate for Payer: Cigna Commercial |
$1,134.36
|
| Rate for Payer: Health EOS Commercial |
$1,097.37
|
| Rate for Payer: HFN Commercial |
$1,134.36
|
| Rate for Payer: Multiplan Commercial |
$986.40
|
| Rate for Payer: NAPHCARE Commercial |
$739.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,134.36
|
| Rate for Payer: Quartz Beloit One Network |
$604.17
|
| Rate for Payer: Quartz Commercial |
$739.80
|
| Rate for Payer: WEA Trust Commercial |
$678.15
|
| Rate for Payer: WPS Commercial |
$913.28
|
|
|
SCREW-CANN 7.3 X 65 02.207.265
|
Facility
|
OP
|
$3,060.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967236
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$856.80 |
| Max. Negotiated Rate |
$12,240.00 |
| Rate for Payer: Aetna Commercial |
$2,754.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,631.60
|
| Rate for Payer: Aetna Managed Medicare |
$856.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,989.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,530.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,468.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,621.80
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Cigna Commercial |
$2,815.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,712.38
|
| Rate for Payer: Health EOS Commercial |
$2,723.40
|
| Rate for Payer: HFN Commercial |
$2,815.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,295.00
|
| Rate for Payer: Multiplan Commercial |
$2,448.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,836.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,815.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,499.40
|
| Rate for Payer: Quartz Commercial |
$1,989.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,836.00
|
| Rate for Payer: The Alliance Commercial |
$12,240.00
|
| Rate for Payer: WEA Trust Commercial |
$1,683.00
|
| Rate for Payer: WPS Commercial |
$2,266.54
|
|
|
SCREW-CANN 7.3 X 65 02.207.265
|
Facility
|
IP
|
$3,060.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967236
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,499.40 |
| Max. Negotiated Rate |
$2,815.20 |
| Rate for Payer: Aetna Commercial |
$2,754.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,631.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,621.80
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Cigna Commercial |
$2,815.20
|
| Rate for Payer: Health EOS Commercial |
$2,723.40
|
| Rate for Payer: HFN Commercial |
$2,815.20
|
| Rate for Payer: Multiplan Commercial |
$2,448.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,836.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,815.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,499.40
|
| Rate for Payer: Quartz Commercial |
$1,836.00
|
| Rate for Payer: WEA Trust Commercial |
$1,683.00
|
| Rate for Payer: WPS Commercial |
$2,266.54
|
|
|
SCREW-CANN 7.3 X 65 02.207.465
|
Facility
|
IP
|
$3,060.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967226
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,499.40 |
| Max. Negotiated Rate |
$2,815.20 |
| Rate for Payer: Aetna Commercial |
$2,754.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,631.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,621.80
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Cigna Commercial |
$2,815.20
|
| Rate for Payer: Health EOS Commercial |
$2,723.40
|
| Rate for Payer: HFN Commercial |
$2,815.20
|
| Rate for Payer: Multiplan Commercial |
$2,448.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,836.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,815.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,499.40
|
| Rate for Payer: Quartz Commercial |
$1,836.00
|
| Rate for Payer: WEA Trust Commercial |
$1,683.00
|
| Rate for Payer: WPS Commercial |
$2,266.54
|
|
|
SCREW-CANN 7.3 X 65 02.207.465
|
Facility
|
OP
|
$3,060.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967226
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$856.80 |
| Max. Negotiated Rate |
$12,240.00 |
| Rate for Payer: Aetna Commercial |
$2,754.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,631.60
|
| Rate for Payer: Aetna Managed Medicare |
$856.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,989.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,530.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,468.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,621.80
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Cigna Commercial |
$2,815.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,712.38
|
| Rate for Payer: Health EOS Commercial |
$2,723.40
|
| Rate for Payer: HFN Commercial |
$2,815.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,295.00
|
| Rate for Payer: Multiplan Commercial |
$2,448.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,836.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,815.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,499.40
|
| Rate for Payer: Quartz Commercial |
$1,989.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,836.00
|
| Rate for Payer: The Alliance Commercial |
$12,240.00
|
| Rate for Payer: WEA Trust Commercial |
$1,683.00
|
| Rate for Payer: WPS Commercial |
$2,266.54
|
|
|
SCREW-CANN 7.3 X 70 02.207.070
|
Facility
|
OP
|
$1,233.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$345.24 |
| Max. Negotiated Rate |
$4,932.00 |
| Rate for Payer: Aetna Commercial |
$1,109.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,060.38
|
| Rate for Payer: Aetna Managed Medicare |
$345.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$801.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$616.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$591.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$653.49
|
| Rate for Payer: Cash Price |
$369.90
|
| Rate for Payer: Cigna Commercial |
$1,134.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$689.99
|
| Rate for Payer: Health EOS Commercial |
$1,097.37
|
| Rate for Payer: HFN Commercial |
$1,134.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$924.75
|
| Rate for Payer: Multiplan Commercial |
$986.40
|
| Rate for Payer: NAPHCARE Commercial |
$739.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,134.36
|
| Rate for Payer: Quartz Beloit One Network |
$604.17
|
| Rate for Payer: Quartz Commercial |
$801.45
|
| Rate for Payer: Quartz Medicare Advantage |
$739.80
|
| Rate for Payer: The Alliance Commercial |
$4,932.00
|
| Rate for Payer: WEA Trust Commercial |
$678.15
|
| Rate for Payer: WPS Commercial |
$913.28
|
|
|
SCREW-CANN 7.3 X 70 02.207.070
|
Facility
|
IP
|
$1,233.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$604.17 |
| Max. Negotiated Rate |
$1,134.36 |
| Rate for Payer: Aetna Commercial |
$1,109.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,060.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$653.49
|
| Rate for Payer: Cash Price |
$369.90
|
| Rate for Payer: Cigna Commercial |
$1,134.36
|
| Rate for Payer: Health EOS Commercial |
$1,097.37
|
| Rate for Payer: HFN Commercial |
$1,134.36
|
| Rate for Payer: Multiplan Commercial |
$986.40
|
| Rate for Payer: NAPHCARE Commercial |
$739.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,134.36
|
| Rate for Payer: Quartz Beloit One Network |
$604.17
|
| Rate for Payer: Quartz Commercial |
$739.80
|
| Rate for Payer: WEA Trust Commercial |
$678.15
|
| Rate for Payer: WPS Commercial |
$913.28
|
|
|
SCREW-CANN 7.3 X 70 02.207.270
|
Facility
|
OP
|
$3,060.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967237
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$856.80 |
| Max. Negotiated Rate |
$12,240.00 |
| Rate for Payer: Aetna Commercial |
$2,754.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,631.60
|
| Rate for Payer: Aetna Managed Medicare |
$856.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,989.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,530.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,468.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,621.80
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Cigna Commercial |
$2,815.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,712.38
|
| Rate for Payer: Health EOS Commercial |
$2,723.40
|
| Rate for Payer: HFN Commercial |
$2,815.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,295.00
|
| Rate for Payer: Multiplan Commercial |
$2,448.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,836.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,815.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,499.40
|
| Rate for Payer: Quartz Commercial |
$1,989.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,836.00
|
| Rate for Payer: The Alliance Commercial |
$12,240.00
|
| Rate for Payer: WEA Trust Commercial |
$1,683.00
|
| Rate for Payer: WPS Commercial |
$2,266.54
|
|
