|
SCREW CANN 3.75 X 36MM FULLY THREAD AR-7000-36FT
|
Facility
|
OP
|
$2,926.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4124778
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$819.28 |
| Max. Negotiated Rate |
$11,704.00 |
| Rate for Payer: Aetna Commercial |
$2,633.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,516.36
|
| Rate for Payer: Aetna Managed Medicare |
$819.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,901.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,463.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,404.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,550.78
|
| Rate for Payer: Cash Price |
$877.80
|
| Rate for Payer: Cigna Commercial |
$2,691.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,637.39
|
| Rate for Payer: Health EOS Commercial |
$2,604.14
|
| Rate for Payer: HFN Commercial |
$2,691.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,194.50
|
| Rate for Payer: Multiplan Commercial |
$2,340.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,755.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,691.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,433.74
|
| Rate for Payer: Quartz Commercial |
$1,901.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,755.60
|
| Rate for Payer: The Alliance Commercial |
$11,704.00
|
| Rate for Payer: WEA Trust Commercial |
$1,609.30
|
| Rate for Payer: WPS Commercial |
$2,167.29
|
|
|
SCREW CANN 3.75 X 36MM FULLY THREAD AR-7000-36FT
|
Facility
|
IP
|
$2,926.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4124778
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,433.74 |
| Max. Negotiated Rate |
$2,691.92 |
| Rate for Payer: Aetna Commercial |
$2,633.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,516.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,550.78
|
| Rate for Payer: Cash Price |
$877.80
|
| Rate for Payer: Cigna Commercial |
$2,691.92
|
| Rate for Payer: Health EOS Commercial |
$2,604.14
|
| Rate for Payer: HFN Commercial |
$2,691.92
|
| Rate for Payer: Multiplan Commercial |
$2,340.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,755.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,691.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,433.74
|
| Rate for Payer: Quartz Commercial |
$1,755.60
|
| Rate for Payer: WEA Trust Commercial |
$1,609.30
|
| Rate for Payer: WPS Commercial |
$2,167.29
|
|
|
SCREW CANN 3.75 X 36MM PARTIAL THREAD AR-7000-36
|
Facility
|
IP
|
$2,046.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508887
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,002.54 |
| Max. Negotiated Rate |
$1,882.32 |
| Rate for Payer: Aetna Commercial |
$1,841.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,759.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,084.38
|
| Rate for Payer: Cash Price |
$613.80
|
| Rate for Payer: Cigna Commercial |
$1,882.32
|
| Rate for Payer: Health EOS Commercial |
$1,820.94
|
| Rate for Payer: HFN Commercial |
$1,882.32
|
| Rate for Payer: Multiplan Commercial |
$1,636.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,227.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,882.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,002.54
|
| Rate for Payer: Quartz Commercial |
$1,227.60
|
| Rate for Payer: WEA Trust Commercial |
$1,125.30
|
| Rate for Payer: WPS Commercial |
$1,515.47
|
|
|
SCREW CANN 3.75 X 36MM PARTIAL THREAD AR-7000-36
|
Facility
|
OP
|
$2,046.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508887
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$572.88 |
| Max. Negotiated Rate |
$8,184.00 |
| Rate for Payer: Aetna Commercial |
$1,841.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,759.56
|
| Rate for Payer: Aetna Managed Medicare |
$572.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,329.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,023.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$982.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,084.38
|
| Rate for Payer: Cash Price |
$613.80
|
| Rate for Payer: Cigna Commercial |
$1,882.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,144.94
|
| Rate for Payer: Health EOS Commercial |
$1,820.94
|
| Rate for Payer: HFN Commercial |
$1,882.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,534.50
|
| Rate for Payer: Multiplan Commercial |
$1,636.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,227.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,882.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,002.54
|
| Rate for Payer: Quartz Commercial |
$1,329.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,227.60
|
| Rate for Payer: The Alliance Commercial |
$8,184.00
|
| Rate for Payer: WEA Trust Commercial |
$1,125.30
|
| Rate for Payer: WPS Commercial |
$1,515.47
|
|
|
SCREW-CANN 4.0 X 10 207.610
|
Facility
|
IP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967128
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$918.75 |
| Max. Negotiated Rate |
$1,725.00 |
| Rate for Payer: Aetna Commercial |
$1,687.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,612.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$993.75
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,725.00
|
| Rate for Payer: Health EOS Commercial |
$1,668.75
|
| Rate for Payer: HFN Commercial |
$1,725.00
|
| Rate for Payer: Multiplan Commercial |
$1,500.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,125.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,725.00
|
| Rate for Payer: Quartz Beloit One Network |
$918.75
|
| Rate for Payer: Quartz Commercial |
$1,125.00
|
| Rate for Payer: WEA Trust Commercial |
$1,031.25
|
| Rate for Payer: WPS Commercial |
$1,388.81
|
|
|
SCREW-CANN 4.0 X 10 207.610
|
Facility
|
OP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967128
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$7,500.00 |
| Rate for Payer: Aetna Commercial |
$1,687.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,612.50
|
| Rate for Payer: Aetna Managed Medicare |
$525.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,218.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$937.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$993.75
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,725.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,049.25
|
| Rate for Payer: Health EOS Commercial |
$1,668.75
|
| Rate for Payer: HFN Commercial |
$1,725.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,406.25
|
| Rate for Payer: Multiplan Commercial |
$1,500.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,125.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,725.00
|
| Rate for Payer: Quartz Beloit One Network |
$918.75
|
| Rate for Payer: Quartz Commercial |
$1,218.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,125.00
|
| Rate for Payer: The Alliance Commercial |
$7,500.00
|
| Rate for Payer: WEA Trust Commercial |
$1,031.25
|
| Rate for Payer: WPS Commercial |
$1,388.81
|
|
|
SCREW-CANN 4.0 X 12 207.612
|
Facility
|
OP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967129
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$7,500.00 |
| Rate for Payer: Aetna Commercial |
$1,687.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,612.50
|
| Rate for Payer: Aetna Managed Medicare |
$525.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,218.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$937.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$993.75
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,725.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,049.25
|
| Rate for Payer: Health EOS Commercial |
$1,668.75
|
| Rate for Payer: HFN Commercial |
$1,725.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,406.25
|
| Rate for Payer: Multiplan Commercial |
$1,500.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,125.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,725.00
|
| Rate for Payer: Quartz Beloit One Network |
$918.75
|
| Rate for Payer: Quartz Commercial |
$1,218.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,125.00
|
| Rate for Payer: The Alliance Commercial |
$7,500.00
|
| Rate for Payer: WEA Trust Commercial |
$1,031.25
|
| Rate for Payer: WPS Commercial |
$1,388.81
|
|
|
SCREW-CANN 4.0 X 12 207.612
|
Facility
|
IP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967129
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$918.75 |
| Max. Negotiated Rate |
$1,725.00 |
| Rate for Payer: Aetna Commercial |
$1,687.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,612.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$993.75
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,725.00
|
| Rate for Payer: Health EOS Commercial |
$1,668.75
|
| Rate for Payer: HFN Commercial |
$1,725.00
|
| Rate for Payer: Multiplan Commercial |
$1,500.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,125.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,725.00
|
| Rate for Payer: Quartz Beloit One Network |
$918.75
|
| Rate for Payer: Quartz Commercial |
$1,125.00
|
| Rate for Payer: WEA Trust Commercial |
$1,031.25
|
| Rate for Payer: WPS Commercial |
$1,388.81
|
|
|
SCREW-CANN 4.0 X 14 207.614
|
Facility
|
IP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$918.75 |
| Max. Negotiated Rate |
$1,725.00 |
| Rate for Payer: Aetna Commercial |
$1,687.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,612.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$993.75
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,725.00
|
| Rate for Payer: Health EOS Commercial |
$1,668.75
|
| Rate for Payer: HFN Commercial |
$1,725.00
|
| Rate for Payer: Multiplan Commercial |
$1,500.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,125.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,725.00
|
| Rate for Payer: Quartz Beloit One Network |
$918.75
|
| Rate for Payer: Quartz Commercial |
$1,125.00
|
| Rate for Payer: WEA Trust Commercial |
$1,031.25
|
| Rate for Payer: WPS Commercial |
$1,388.81
|
|
|
SCREW-CANN 4.0 X 14 207.614
|
Facility
|
OP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$7,500.00 |
| Rate for Payer: Aetna Commercial |
$1,687.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,612.50
|
| Rate for Payer: Aetna Managed Medicare |
$525.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,218.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$937.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$993.75
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,725.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,049.25
|
| Rate for Payer: Health EOS Commercial |
$1,668.75
|
| Rate for Payer: HFN Commercial |
$1,725.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,406.25
|
| Rate for Payer: Multiplan Commercial |
$1,500.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,125.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,725.00
|
| Rate for Payer: Quartz Beloit One Network |
$918.75
|
| Rate for Payer: Quartz Commercial |
$1,218.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,125.00
|
| Rate for Payer: The Alliance Commercial |
$7,500.00
|
| Rate for Payer: WEA Trust Commercial |
$1,031.25
|
| Rate for Payer: WPS Commercial |
$1,388.81
|
|
|
SCREW-CANN 4.0 X 16 207.616
|
Facility
|
OP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967131
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$7,500.00 |
| Rate for Payer: Aetna Commercial |
$1,687.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,612.50
|
| Rate for Payer: Aetna Managed Medicare |
$525.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,218.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$937.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$993.75
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,725.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,049.25
|
| Rate for Payer: Health EOS Commercial |
$1,668.75
|
| Rate for Payer: HFN Commercial |
$1,725.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,406.25
|
| Rate for Payer: Multiplan Commercial |
$1,500.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,125.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,725.00
|
| Rate for Payer: Quartz Beloit One Network |
$918.75
|
| Rate for Payer: Quartz Commercial |
$1,218.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,125.00
|
| Rate for Payer: The Alliance Commercial |
$7,500.00
|
| Rate for Payer: WEA Trust Commercial |
$1,031.25
|
| Rate for Payer: WPS Commercial |
$1,388.81
|
|
|
SCREW-CANN 4.0 X 16 207.616
|
Facility
|
IP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967131
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$918.75 |
| Max. Negotiated Rate |
$1,725.00 |
| Rate for Payer: Aetna Commercial |
$1,687.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,612.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$993.75
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,725.00
|
| Rate for Payer: Health EOS Commercial |
$1,668.75
|
| Rate for Payer: HFN Commercial |
$1,725.00
|
| Rate for Payer: Multiplan Commercial |
$1,500.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,125.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,725.00
|
| Rate for Payer: Quartz Beloit One Network |
$918.75
|
| Rate for Payer: Quartz Commercial |
$1,125.00
|
| Rate for Payer: WEA Trust Commercial |
$1,031.25
|
| Rate for Payer: WPS Commercial |
$1,388.81
|
|
|
SCREW-CANN 4.0 X 16 207.716
|
Facility
|
IP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967132
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$918.75 |
| Max. Negotiated Rate |
$1,725.00 |
| Rate for Payer: Aetna Commercial |
$1,687.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,612.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$993.75
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,725.00
|
| Rate for Payer: Health EOS Commercial |
$1,668.75
|
| Rate for Payer: HFN Commercial |
$1,725.00
|
| Rate for Payer: Multiplan Commercial |
$1,500.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,125.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,725.00
|
| Rate for Payer: Quartz Beloit One Network |
$918.75
|
| Rate for Payer: Quartz Commercial |
$1,125.00
|
| Rate for Payer: WEA Trust Commercial |
$1,031.25
|
| Rate for Payer: WPS Commercial |
$1,388.81
|
|
|
SCREW-CANN 4.0 X 16 207.716
|
Facility
|
OP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967132
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$7,500.00 |
| Rate for Payer: Aetna Commercial |
$1,687.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,612.50
|
| Rate for Payer: Aetna Managed Medicare |
$525.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,218.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$937.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$993.75
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,725.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,049.25
|
| Rate for Payer: Health EOS Commercial |
$1,668.75
|
| Rate for Payer: HFN Commercial |
$1,725.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,406.25
|
| Rate for Payer: Multiplan Commercial |
$1,500.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,125.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,725.00
|
| Rate for Payer: Quartz Beloit One Network |
$918.75
|
| Rate for Payer: Quartz Commercial |
$1,218.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,125.00
|
| Rate for Payer: The Alliance Commercial |
$7,500.00
|
| Rate for Payer: WEA Trust Commercial |
$1,031.25
|
| Rate for Payer: WPS Commercial |
$1,388.81
|
|
|
SCREW CANN 4.0 X 16MM TRILLIANT 200-40-016
|
Facility
|
OP
|
$1,997.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599586
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$559.16 |
| Max. Negotiated Rate |
$7,988.00 |
| Rate for Payer: Aetna Commercial |
$1,797.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,717.42
|
| Rate for Payer: Aetna Managed Medicare |
$559.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,298.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$998.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$958.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,058.41
|
| Rate for Payer: Cash Price |
$599.10
|
| Rate for Payer: Cigna Commercial |
$1,837.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,117.52
|
| Rate for Payer: Health EOS Commercial |
$1,777.33
|
| Rate for Payer: HFN Commercial |
$1,837.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,497.75
|
| Rate for Payer: Multiplan Commercial |
$1,597.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,198.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,837.24
|
| Rate for Payer: Quartz Beloit One Network |
$978.53
|
| Rate for Payer: Quartz Commercial |
$1,298.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,198.20
|
| Rate for Payer: The Alliance Commercial |
$7,988.00
|
| Rate for Payer: WEA Trust Commercial |
$1,098.35
|
| Rate for Payer: WPS Commercial |
$1,479.18
|
|
|
SCREW CANN 4.0 X 16MM TRILLIANT 200-40-016
|
Facility
|
IP
|
$1,997.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599586
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$978.53 |
| Max. Negotiated Rate |
$1,837.24 |
| Rate for Payer: Aetna Commercial |
$1,797.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,717.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,058.41
|
| Rate for Payer: Cash Price |
$599.10
|
| Rate for Payer: Cigna Commercial |
$1,837.24
|
| Rate for Payer: Health EOS Commercial |
$1,777.33
|
| Rate for Payer: HFN Commercial |
$1,837.24
|
| Rate for Payer: Multiplan Commercial |
$1,597.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,198.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,837.24
|
| Rate for Payer: Quartz Beloit One Network |
$978.53
|
| Rate for Payer: Quartz Commercial |
$1,198.20
|
| Rate for Payer: WEA Trust Commercial |
$1,098.35
|
| Rate for Payer: WPS Commercial |
$1,479.18
|
|
|
SCREW-CANN 4.0 X 18 207.618
|
Facility
|
IP
|
$1,947.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967133
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$954.03 |
| Max. Negotiated Rate |
$1,791.24 |
| Rate for Payer: Aetna Commercial |
$1,752.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,674.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,031.91
|
| Rate for Payer: Cash Price |
$584.10
|
| Rate for Payer: Cigna Commercial |
$1,791.24
|
| Rate for Payer: Health EOS Commercial |
$1,732.83
|
| Rate for Payer: HFN Commercial |
$1,791.24
|
| Rate for Payer: Multiplan Commercial |
$1,557.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,168.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,791.24
|
| Rate for Payer: Quartz Beloit One Network |
$954.03
|
| Rate for Payer: Quartz Commercial |
$1,168.20
|
| Rate for Payer: WEA Trust Commercial |
$1,070.85
|
| Rate for Payer: WPS Commercial |
$1,442.14
|
|
|
SCREW-CANN 4.0 X 18 207.618
|
Facility
|
OP
|
$1,947.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967133
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$545.16 |
| Max. Negotiated Rate |
$7,788.00 |
| Rate for Payer: Aetna Commercial |
$1,752.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,674.42
|
| Rate for Payer: Aetna Managed Medicare |
$545.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,265.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$973.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$934.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,031.91
|
| Rate for Payer: Cash Price |
$584.10
|
| Rate for Payer: Cigna Commercial |
$1,791.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,089.54
|
| Rate for Payer: Health EOS Commercial |
$1,732.83
|
| Rate for Payer: HFN Commercial |
$1,791.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,460.25
|
| Rate for Payer: Multiplan Commercial |
$1,557.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,168.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,791.24
|
| Rate for Payer: Quartz Beloit One Network |
$954.03
|
| Rate for Payer: Quartz Commercial |
$1,265.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,168.20
|
| Rate for Payer: The Alliance Commercial |
$7,788.00
|
| Rate for Payer: WEA Trust Commercial |
$1,070.85
|
| Rate for Payer: WPS Commercial |
$1,442.14
|
|
|
SCREW-CANN 4.0 X 18 207.718
|
Facility
|
OP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967134
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$7,500.00 |
| Rate for Payer: Aetna Commercial |
$1,687.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,612.50
|
| Rate for Payer: Aetna Managed Medicare |
$525.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,218.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$937.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$993.75
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,725.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,049.25
|
| Rate for Payer: Health EOS Commercial |
$1,668.75
|
| Rate for Payer: HFN Commercial |
$1,725.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,406.25
|
| Rate for Payer: Multiplan Commercial |
$1,500.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,125.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,725.00
|
| Rate for Payer: Quartz Beloit One Network |
$918.75
|
| Rate for Payer: Quartz Commercial |
$1,218.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,125.00
|
| Rate for Payer: The Alliance Commercial |
$7,500.00
|
| Rate for Payer: WEA Trust Commercial |
$1,031.25
|
| Rate for Payer: WPS Commercial |
$1,388.81
|
|
|
SCREW-CANN 4.0 X 18 207.718
|
Facility
|
IP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967134
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$918.75 |
| Max. Negotiated Rate |
$1,725.00 |
| Rate for Payer: Aetna Commercial |
$1,687.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,612.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$993.75
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,725.00
|
| Rate for Payer: Health EOS Commercial |
$1,668.75
|
| Rate for Payer: HFN Commercial |
$1,725.00
|
| Rate for Payer: Multiplan Commercial |
$1,500.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,125.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,725.00
|
| Rate for Payer: Quartz Beloit One Network |
$918.75
|
| Rate for Payer: Quartz Commercial |
$1,125.00
|
| Rate for Payer: WEA Trust Commercial |
$1,031.25
|
| Rate for Payer: WPS Commercial |
$1,388.81
|
|
|
SCREW-CANN 4.0 X 20 207.620
|
Facility
|
OP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967135
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$7,500.00 |
| Rate for Payer: Aetna Commercial |
$1,687.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,612.50
|
| Rate for Payer: Aetna Managed Medicare |
$525.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,218.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$937.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$993.75
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,725.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,049.25
|
| Rate for Payer: Health EOS Commercial |
$1,668.75
|
| Rate for Payer: HFN Commercial |
$1,725.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,406.25
|
| Rate for Payer: Multiplan Commercial |
$1,500.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,125.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,725.00
|
| Rate for Payer: Quartz Beloit One Network |
$918.75
|
| Rate for Payer: Quartz Commercial |
$1,218.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,125.00
|
| Rate for Payer: The Alliance Commercial |
$7,500.00
|
| Rate for Payer: WEA Trust Commercial |
$1,031.25
|
| Rate for Payer: WPS Commercial |
$1,388.81
|
|
|
SCREW-CANN 4.0 X 20 207.620
|
Facility
|
IP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967135
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$918.75 |
| Max. Negotiated Rate |
$1,725.00 |
| Rate for Payer: Aetna Commercial |
$1,687.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,612.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$993.75
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,725.00
|
| Rate for Payer: Health EOS Commercial |
$1,668.75
|
| Rate for Payer: HFN Commercial |
$1,725.00
|
| Rate for Payer: Multiplan Commercial |
$1,500.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,125.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,725.00
|
| Rate for Payer: Quartz Beloit One Network |
$918.75
|
| Rate for Payer: Quartz Commercial |
$1,125.00
|
| Rate for Payer: WEA Trust Commercial |
$1,031.25
|
| Rate for Payer: WPS Commercial |
$1,388.81
|
|
|
SCREW-CANN 4.0 X 20 207.720
|
Facility
|
OP
|
$1,947.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967136
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$545.16 |
| Max. Negotiated Rate |
$7,788.00 |
| Rate for Payer: Aetna Commercial |
$1,752.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,674.42
|
| Rate for Payer: Aetna Managed Medicare |
$545.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,265.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$973.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$934.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,031.91
|
| Rate for Payer: Cash Price |
$584.10
|
| Rate for Payer: Cigna Commercial |
$1,791.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,089.54
|
| Rate for Payer: Health EOS Commercial |
$1,732.83
|
| Rate for Payer: HFN Commercial |
$1,791.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,460.25
|
| Rate for Payer: Multiplan Commercial |
$1,557.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,168.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,791.24
|
| Rate for Payer: Quartz Beloit One Network |
$954.03
|
| Rate for Payer: Quartz Commercial |
$1,265.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,168.20
|
| Rate for Payer: The Alliance Commercial |
$7,788.00
|
| Rate for Payer: WEA Trust Commercial |
$1,070.85
|
| Rate for Payer: WPS Commercial |
$1,442.14
|
|
|
SCREW-CANN 4.0 X 20 207.720
|
Facility
|
IP
|
$1,947.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967136
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$954.03 |
| Max. Negotiated Rate |
$1,791.24 |
| Rate for Payer: Aetna Commercial |
$1,752.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,674.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,031.91
|
| Rate for Payer: Cash Price |
$584.10
|
| Rate for Payer: Cigna Commercial |
$1,791.24
|
| Rate for Payer: Health EOS Commercial |
$1,732.83
|
| Rate for Payer: HFN Commercial |
$1,791.24
|
| Rate for Payer: Multiplan Commercial |
$1,557.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,168.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,791.24
|
| Rate for Payer: Quartz Beloit One Network |
$954.03
|
| Rate for Payer: Quartz Commercial |
$1,168.20
|
| Rate for Payer: WEA Trust Commercial |
$1,070.85
|
| Rate for Payer: WPS Commercial |
$1,442.14
|
|
|
SCREW-CANN 4.0 X 22 207.622
|
Facility
|
OP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967137
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$7,500.00 |
| Rate for Payer: Aetna Commercial |
$1,687.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,612.50
|
| Rate for Payer: Aetna Managed Medicare |
$525.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,218.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$937.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$993.75
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,725.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,049.25
|
| Rate for Payer: Health EOS Commercial |
$1,668.75
|
| Rate for Payer: HFN Commercial |
$1,725.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,406.25
|
| Rate for Payer: Multiplan Commercial |
$1,500.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,125.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,725.00
|
| Rate for Payer: Quartz Beloit One Network |
$918.75
|
| Rate for Payer: Quartz Commercial |
$1,218.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,125.00
|
| Rate for Payer: The Alliance Commercial |
$7,500.00
|
| Rate for Payer: WEA Trust Commercial |
$1,031.25
|
| Rate for Payer: WPS Commercial |
$1,388.81
|
|
