|
SCREW-CANN 4.0 X 32 207.732
|
Facility
|
IP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967148
|
|
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 32 207.732
|
Facility
|
OP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967148
|
|
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 32MM LONG THREAD LP AR-8840CL-32
|
Facility
|
IP
|
$2,196.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415065
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,076.04 |
| Max. Negotiated Rate |
$2,020.32 |
| Rate for Payer: Aetna Commercial |
$1,976.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,888.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,163.88
|
| Rate for Payer: Cash Price |
$658.80
|
| Rate for Payer: Cigna Commercial |
$2,020.32
|
| Rate for Payer: Health EOS Commercial |
$1,954.44
|
| Rate for Payer: HFN Commercial |
$2,020.32
|
| Rate for Payer: Multiplan Commercial |
$1,756.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,317.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,020.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,076.04
|
| Rate for Payer: Quartz Commercial |
$1,317.60
|
| Rate for Payer: WEA Trust Commercial |
$1,207.80
|
| Rate for Payer: WPS Commercial |
$1,626.58
|
|
|
SCREW CANN 4.0 X 32MM LONG THREAD LP AR-8840CL-32
|
Facility
|
OP
|
$2,196.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415065
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$614.88 |
| Max. Negotiated Rate |
$8,784.00 |
| Rate for Payer: Aetna Commercial |
$1,976.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,888.56
|
| Rate for Payer: Aetna Managed Medicare |
$614.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,427.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,098.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,054.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,163.88
|
| Rate for Payer: Cash Price |
$658.80
|
| Rate for Payer: Cigna Commercial |
$2,020.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,228.88
|
| Rate for Payer: Health EOS Commercial |
$1,954.44
|
| Rate for Payer: HFN Commercial |
$2,020.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,647.00
|
| Rate for Payer: Multiplan Commercial |
$1,756.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,317.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,020.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,076.04
|
| Rate for Payer: Quartz Commercial |
$1,427.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,317.60
|
| Rate for Payer: The Alliance Commercial |
$8,784.00
|
| Rate for Payer: WEA Trust Commercial |
$1,207.80
|
| Rate for Payer: WPS Commercial |
$1,626.58
|
|
|
SCREW-CANN 4.0 X 34 207.634
|
Facility
|
OP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967149
|
|
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 34 207.634
|
Facility
|
IP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967149
|
|
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 34 207.734
|
Facility
|
OP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967150
|
|
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 34 207.734
|
Facility
|
IP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967150
|
|
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 34MM LONG THREAD LP AR-8840CL-34
|
Facility
|
IP
|
$2,196.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5496987
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,076.04 |
| Max. Negotiated Rate |
$2,020.32 |
| Rate for Payer: Aetna Commercial |
$1,976.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,888.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,163.88
|
| Rate for Payer: Cash Price |
$658.80
|
| Rate for Payer: Cigna Commercial |
$2,020.32
|
| Rate for Payer: Health EOS Commercial |
$1,954.44
|
| Rate for Payer: HFN Commercial |
$2,020.32
|
| Rate for Payer: Multiplan Commercial |
$1,756.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,317.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,020.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,076.04
|
| Rate for Payer: Quartz Commercial |
$1,317.60
|
| Rate for Payer: WEA Trust Commercial |
$1,207.80
|
| Rate for Payer: WPS Commercial |
$1,626.58
|
|
|
SCREW CANN 4.0 X 34MM LONG THREAD LP AR-8840CL-34
|
Facility
|
OP
|
$2,196.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5496987
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$614.88 |
| Max. Negotiated Rate |
$8,784.00 |
| Rate for Payer: Aetna Commercial |
$1,976.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,888.56
|
| Rate for Payer: Aetna Managed Medicare |
$614.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,427.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,098.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,054.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,163.88
|
| Rate for Payer: Cash Price |
$658.80
|
| Rate for Payer: Cigna Commercial |
$2,020.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,228.88
|
| Rate for Payer: Health EOS Commercial |
$1,954.44
|
| Rate for Payer: HFN Commercial |
$2,020.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,647.00
|
| Rate for Payer: Multiplan Commercial |
$1,756.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,317.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,020.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,076.04
|
| Rate for Payer: Quartz Commercial |
$1,427.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,317.60
|
| Rate for Payer: The Alliance Commercial |
$8,784.00
|
| Rate for Payer: WEA Trust Commercial |
$1,207.80
|
| Rate for Payer: WPS Commercial |
$1,626.58
|
|
|
SCREW CANN 4.0 X 34MM PART THREAD ASNIS III 604634
|
Facility
|
OP
|
$1,811.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6199013
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$507.08 |
| Max. Negotiated Rate |
$7,244.00 |
| Rate for Payer: Aetna Commercial |
$1,629.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,557.46
|
| Rate for Payer: Aetna Managed Medicare |
$507.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,177.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$905.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$869.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$959.83
|
| Rate for Payer: Cash Price |
$543.30
|
| Rate for Payer: Cigna Commercial |
$1,666.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,013.44
|
| Rate for Payer: Health EOS Commercial |
$1,611.79
|
| Rate for Payer: HFN Commercial |
$1,666.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,358.25
|
| Rate for Payer: Multiplan Commercial |
$1,448.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,086.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,666.12
|
| Rate for Payer: Quartz Beloit One Network |
$887.39
|
| Rate for Payer: Quartz Commercial |
$1,177.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,086.60
|
| Rate for Payer: The Alliance Commercial |
$7,244.00
|
| Rate for Payer: WEA Trust Commercial |
$996.05
|
| Rate for Payer: WPS Commercial |
$1,341.41
|
|
|
SCREW CANN 4.0 X 34MM PART THREAD ASNIS III 604634
|
Facility
|
IP
|
$1,811.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6199013
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$887.39 |
| Max. Negotiated Rate |
$1,666.12 |
| Rate for Payer: Aetna Commercial |
$1,629.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,557.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$959.83
|
| Rate for Payer: Cash Price |
$543.30
|
| Rate for Payer: Cigna Commercial |
$1,666.12
|
| Rate for Payer: Health EOS Commercial |
$1,611.79
|
| Rate for Payer: HFN Commercial |
$1,666.12
|
| Rate for Payer: Multiplan Commercial |
$1,448.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,086.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,666.12
|
| Rate for Payer: Quartz Beloit One Network |
$887.39
|
| Rate for Payer: Quartz Commercial |
$1,086.60
|
| Rate for Payer: WEA Trust Commercial |
$996.05
|
| Rate for Payer: WPS Commercial |
$1,341.41
|
|
|
SCREW-CANN 4.0 X 36 207.636
|
Facility
|
OP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967151
|
|
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 36 207.636
|
Facility
|
IP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967151
|
|
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 36 207.736
|
Facility
|
OP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967152
|
|
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 36 207.736
|
Facility
|
IP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967152
|
|
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 36MM LONG THREAD LP AR-8840CL-36
|
Facility
|
IP
|
$2,196.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415066
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,076.04 |
| Max. Negotiated Rate |
$2,020.32 |
| Rate for Payer: Aetna Commercial |
$1,976.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,888.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,163.88
|
| Rate for Payer: Cash Price |
$658.80
|
| Rate for Payer: Cigna Commercial |
$2,020.32
|
| Rate for Payer: Health EOS Commercial |
$1,954.44
|
| Rate for Payer: HFN Commercial |
$2,020.32
|
| Rate for Payer: Multiplan Commercial |
$1,756.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,317.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,020.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,076.04
|
| Rate for Payer: Quartz Commercial |
$1,317.60
|
| Rate for Payer: WEA Trust Commercial |
$1,207.80
|
| Rate for Payer: WPS Commercial |
$1,626.58
|
|
|
SCREW CANN 4.0 X 36MM LONG THREAD LP AR-8840CL-36
|
Facility
|
OP
|
$2,196.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415066
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$614.88 |
| Max. Negotiated Rate |
$8,784.00 |
| Rate for Payer: Aetna Commercial |
$1,976.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,888.56
|
| Rate for Payer: Aetna Managed Medicare |
$614.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,427.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,098.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,054.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,163.88
|
| Rate for Payer: Cash Price |
$658.80
|
| Rate for Payer: Cigna Commercial |
$2,020.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,228.88
|
| Rate for Payer: Health EOS Commercial |
$1,954.44
|
| Rate for Payer: HFN Commercial |
$2,020.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,647.00
|
| Rate for Payer: Multiplan Commercial |
$1,756.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,317.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,020.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,076.04
|
| Rate for Payer: Quartz Commercial |
$1,427.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,317.60
|
| Rate for Payer: The Alliance Commercial |
$8,784.00
|
| Rate for Payer: WEA Trust Commercial |
$1,207.80
|
| Rate for Payer: WPS Commercial |
$1,626.58
|
|
|
SCREW CANN 4.0 X 36MM SHORT THREAD LP AR-8840C-36
|
Facility
|
IP
|
$2,112.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5627641
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,034.88 |
| Max. Negotiated Rate |
$1,943.04 |
| Rate for Payer: Aetna Commercial |
$1,900.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,816.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,119.36
|
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Cigna Commercial |
$1,943.04
|
| Rate for Payer: Health EOS Commercial |
$1,879.68
|
| Rate for Payer: HFN Commercial |
$1,943.04
|
| Rate for Payer: Multiplan Commercial |
$1,689.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,267.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,943.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,034.88
|
| Rate for Payer: Quartz Commercial |
$1,267.20
|
| Rate for Payer: WEA Trust Commercial |
$1,161.60
|
| Rate for Payer: WPS Commercial |
$1,564.36
|
|
|
SCREW CANN 4.0 X 36MM SHORT THREAD LP AR-8840C-36
|
Facility
|
OP
|
$2,112.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5627641
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$591.36 |
| Max. Negotiated Rate |
$8,448.00 |
| Rate for Payer: Aetna Commercial |
$1,900.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,816.32
|
| Rate for Payer: Aetna Managed Medicare |
$591.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,372.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,056.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,013.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,119.36
|
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Cigna Commercial |
$1,943.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,181.88
|
| Rate for Payer: Health EOS Commercial |
$1,879.68
|
| Rate for Payer: HFN Commercial |
$1,943.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,584.00
|
| Rate for Payer: Multiplan Commercial |
$1,689.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,267.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,943.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,034.88
|
| Rate for Payer: Quartz Commercial |
$1,372.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,267.20
|
| Rate for Payer: The Alliance Commercial |
$8,448.00
|
| Rate for Payer: WEA Trust Commercial |
$1,161.60
|
| Rate for Payer: WPS Commercial |
$1,564.36
|
|
|
SCREW CANN 4.0 X 38 207.638
|
Facility
|
OP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967153
|
|
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 38 207.638
|
Facility
|
IP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967153
|
|
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 38 207.738
|
Facility
|
OP
|
$1,947.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967154
|
|
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 38 207.738
|
Facility
|
IP
|
$1,947.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967154
|
|
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 38MM LONG THREAD LP AR-8840CL-38
|
Facility
|
OP
|
$2,112.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5627637
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$591.36 |
| Max. Negotiated Rate |
$8,448.00 |
| Rate for Payer: Aetna Commercial |
$1,900.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,816.32
|
| Rate for Payer: Aetna Managed Medicare |
$591.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,372.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,056.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,013.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,119.36
|
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Cigna Commercial |
$1,943.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,181.88
|
| Rate for Payer: Health EOS Commercial |
$1,879.68
|
| Rate for Payer: HFN Commercial |
$1,943.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,584.00
|
| Rate for Payer: Multiplan Commercial |
$1,689.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,267.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,943.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,034.88
|
| Rate for Payer: Quartz Commercial |
$1,372.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,267.20
|
| Rate for Payer: The Alliance Commercial |
$8,448.00
|
| Rate for Payer: WEA Trust Commercial |
$1,161.60
|
| Rate for Payer: WPS Commercial |
$1,564.36
|
|
