|
SCREW-CANN 7.3 X 80 02.207.280
|
Facility
|
OP
|
$3,060.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967239
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$891.07 |
| Max. Negotiated Rate |
$2,927.81 |
| Rate for Payer: Aetna Commercial |
$2,864.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,736.86
|
| Rate for Payer: Aetna Managed Medicare |
$891.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,068.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,591.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,527.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,686.67
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Cigna Commercial |
$2,927.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,780.92
|
| Rate for Payer: Health EOS Commercial |
$2,832.34
|
| Rate for Payer: HFN Commercial |
$2,927.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,386.80
|
| Rate for Payer: Multiplan Commercial |
$2,545.92
|
| Rate for Payer: NAPHCARE Commercial |
$1,909.44
|
| Rate for Payer: Preferred Network Access Commercial |
$2,927.81
|
| Rate for Payer: Quartz Beloit One Network |
$1,559.38
|
| Rate for Payer: Quartz Commercial |
$2,068.56
|
| Rate for Payer: Quartz Medicare Advantage |
$1,909.44
|
| Rate for Payer: The Alliance Commercial |
$1,591.20
|
| Rate for Payer: WEA Trust Commercial |
$1,750.32
|
| Rate for Payer: WPS Commercial |
$2,357.12
|
|
|
SCREW-CANN 7.3 X 80 02.207.480
|
Facility
|
OP
|
$3,060.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967229
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$891.07 |
| Max. Negotiated Rate |
$2,927.81 |
| Rate for Payer: Aetna Commercial |
$2,864.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,736.86
|
| Rate for Payer: Aetna Managed Medicare |
$891.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,068.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,591.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,527.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,686.67
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Cigna Commercial |
$2,927.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,780.92
|
| Rate for Payer: Health EOS Commercial |
$2,832.34
|
| Rate for Payer: HFN Commercial |
$2,927.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,386.80
|
| Rate for Payer: Multiplan Commercial |
$2,545.92
|
| Rate for Payer: NAPHCARE Commercial |
$1,909.44
|
| Rate for Payer: Preferred Network Access Commercial |
$2,927.81
|
| Rate for Payer: Quartz Beloit One Network |
$1,559.38
|
| Rate for Payer: Quartz Commercial |
$2,068.56
|
| Rate for Payer: Quartz Medicare Advantage |
$1,909.44
|
| Rate for Payer: The Alliance Commercial |
$1,591.20
|
| Rate for Payer: WEA Trust Commercial |
$1,750.32
|
| Rate for Payer: WPS Commercial |
$2,357.12
|
|
|
SCREW-CANN 7.3 X 80 02.207.480
|
Facility
|
IP
|
$3,060.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967229
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,559.38 |
| Max. Negotiated Rate |
$2,927.81 |
| Rate for Payer: Aetna Commercial |
$2,864.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,736.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,686.67
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Cigna Commercial |
$2,927.81
|
| Rate for Payer: Health EOS Commercial |
$2,832.34
|
| Rate for Payer: HFN Commercial |
$2,927.81
|
| Rate for Payer: Multiplan Commercial |
$2,545.92
|
| Rate for Payer: Preferred Network Access Commercial |
$2,927.81
|
| Rate for Payer: Quartz Beloit One Network |
$1,559.38
|
| Rate for Payer: Quartz Commercial |
$1,909.44
|
| Rate for Payer: WEA Trust Commercial |
$1,750.32
|
| Rate for Payer: WPS Commercial |
$2,357.12
|
|
|
SCREW-CANN 7.3 X 85 02.207.085
|
Facility
|
IP
|
$1,233.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967020
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$628.34 |
| Max. Negotiated Rate |
$1,179.73 |
| Rate for Payer: Aetna Commercial |
$1,154.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,102.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$679.63
|
| Rate for Payer: Cash Price |
$369.90
|
| Rate for Payer: Cigna Commercial |
$1,179.73
|
| Rate for Payer: Health EOS Commercial |
$1,141.26
|
| Rate for Payer: HFN Commercial |
$1,179.73
|
| Rate for Payer: Multiplan Commercial |
$1,025.86
|
| Rate for Payer: Preferred Network Access Commercial |
$1,179.73
|
| Rate for Payer: Quartz Beloit One Network |
$628.34
|
| Rate for Payer: Quartz Commercial |
$769.39
|
| Rate for Payer: WEA Trust Commercial |
$705.28
|
| Rate for Payer: WPS Commercial |
$949.78
|
|
|
SCREW-CANN 7.3 X 85 02.207.085
|
Facility
|
OP
|
$1,233.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967020
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$359.05 |
| Max. Negotiated Rate |
$1,179.73 |
| Rate for Payer: Aetna Commercial |
$1,154.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,102.80
|
| Rate for Payer: Aetna Managed Medicare |
$359.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$833.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$641.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$615.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$679.63
|
| Rate for Payer: Cash Price |
$369.90
|
| Rate for Payer: Cigna Commercial |
$1,179.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$717.61
|
| Rate for Payer: Health EOS Commercial |
$1,141.26
|
| Rate for Payer: HFN Commercial |
$1,179.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$961.74
|
| Rate for Payer: Multiplan Commercial |
$1,025.86
|
| Rate for Payer: NAPHCARE Commercial |
$769.39
|
| Rate for Payer: Preferred Network Access Commercial |
$1,179.73
|
| Rate for Payer: Quartz Beloit One Network |
$628.34
|
| Rate for Payer: Quartz Commercial |
$833.51
|
| Rate for Payer: Quartz Medicare Advantage |
$769.39
|
| Rate for Payer: The Alliance Commercial |
$641.16
|
| Rate for Payer: WEA Trust Commercial |
$705.28
|
| Rate for Payer: WPS Commercial |
$949.78
|
|
|
SCREW-CANN 7.3 X 85 02.207.285
|
Facility
|
IP
|
$3,060.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967240
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,559.38 |
| Max. Negotiated Rate |
$2,927.81 |
| Rate for Payer: Aetna Commercial |
$2,864.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,736.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,686.67
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Cigna Commercial |
$2,927.81
|
| Rate for Payer: Health EOS Commercial |
$2,832.34
|
| Rate for Payer: HFN Commercial |
$2,927.81
|
| Rate for Payer: Multiplan Commercial |
$2,545.92
|
| Rate for Payer: Preferred Network Access Commercial |
$2,927.81
|
| Rate for Payer: Quartz Beloit One Network |
$1,559.38
|
| Rate for Payer: Quartz Commercial |
$1,909.44
|
| Rate for Payer: WEA Trust Commercial |
$1,750.32
|
| Rate for Payer: WPS Commercial |
$2,357.12
|
|
|
SCREW-CANN 7.3 X 85 02.207.285
|
Facility
|
OP
|
$3,060.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967240
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$891.07 |
| Max. Negotiated Rate |
$2,927.81 |
| Rate for Payer: Aetna Commercial |
$2,864.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,736.86
|
| Rate for Payer: Aetna Managed Medicare |
$891.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,068.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,591.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,527.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,686.67
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Cigna Commercial |
$2,927.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,780.92
|
| Rate for Payer: Health EOS Commercial |
$2,832.34
|
| Rate for Payer: HFN Commercial |
$2,927.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,386.80
|
| Rate for Payer: Multiplan Commercial |
$2,545.92
|
| Rate for Payer: NAPHCARE Commercial |
$1,909.44
|
| Rate for Payer: Preferred Network Access Commercial |
$2,927.81
|
| Rate for Payer: Quartz Beloit One Network |
$1,559.38
|
| Rate for Payer: Quartz Commercial |
$2,068.56
|
| Rate for Payer: Quartz Medicare Advantage |
$1,909.44
|
| Rate for Payer: The Alliance Commercial |
$1,591.20
|
| Rate for Payer: WEA Trust Commercial |
$1,750.32
|
| Rate for Payer: WPS Commercial |
$2,357.12
|
|
|
SCREW-CANN 7.3 X 85 02.207.485
|
Facility
|
IP
|
$3,060.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967230
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,559.38 |
| Max. Negotiated Rate |
$2,927.81 |
| Rate for Payer: Aetna Commercial |
$2,864.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,736.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,686.67
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Cigna Commercial |
$2,927.81
|
| Rate for Payer: Health EOS Commercial |
$2,832.34
|
| Rate for Payer: HFN Commercial |
$2,927.81
|
| Rate for Payer: Multiplan Commercial |
$2,545.92
|
| Rate for Payer: Preferred Network Access Commercial |
$2,927.81
|
| Rate for Payer: Quartz Beloit One Network |
$1,559.38
|
| Rate for Payer: Quartz Commercial |
$1,909.44
|
| Rate for Payer: WEA Trust Commercial |
$1,750.32
|
| Rate for Payer: WPS Commercial |
$2,357.12
|
|
|
SCREW-CANN 7.3 X 85 02.207.485
|
Facility
|
OP
|
$3,060.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967230
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$891.07 |
| Max. Negotiated Rate |
$2,927.81 |
| Rate for Payer: Aetna Commercial |
$2,864.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,736.86
|
| Rate for Payer: Aetna Managed Medicare |
$891.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,068.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,591.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,527.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,686.67
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Cigna Commercial |
$2,927.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,780.92
|
| Rate for Payer: Health EOS Commercial |
$2,832.34
|
| Rate for Payer: HFN Commercial |
$2,927.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,386.80
|
| Rate for Payer: Multiplan Commercial |
$2,545.92
|
| Rate for Payer: NAPHCARE Commercial |
$1,909.44
|
| Rate for Payer: Preferred Network Access Commercial |
$2,927.81
|
| Rate for Payer: Quartz Beloit One Network |
$1,559.38
|
| Rate for Payer: Quartz Commercial |
$2,068.56
|
| Rate for Payer: Quartz Medicare Advantage |
$1,909.44
|
| Rate for Payer: The Alliance Commercial |
$1,591.20
|
| Rate for Payer: WEA Trust Commercial |
$1,750.32
|
| Rate for Payer: WPS Commercial |
$2,357.12
|
|
|
SCREW-CANN 7.3 X 90 02.207.090
|
Facility
|
OP
|
$1,233.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967021
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$359.05 |
| Max. Negotiated Rate |
$1,179.73 |
| Rate for Payer: Aetna Commercial |
$1,154.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,102.80
|
| Rate for Payer: Aetna Managed Medicare |
$359.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$833.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$641.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$615.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$679.63
|
| Rate for Payer: Cash Price |
$369.90
|
| Rate for Payer: Cigna Commercial |
$1,179.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$717.61
|
| Rate for Payer: Health EOS Commercial |
$1,141.26
|
| Rate for Payer: HFN Commercial |
$1,179.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$961.74
|
| Rate for Payer: Multiplan Commercial |
$1,025.86
|
| Rate for Payer: NAPHCARE Commercial |
$769.39
|
| Rate for Payer: Preferred Network Access Commercial |
$1,179.73
|
| Rate for Payer: Quartz Beloit One Network |
$628.34
|
| Rate for Payer: Quartz Commercial |
$833.51
|
| Rate for Payer: Quartz Medicare Advantage |
$769.39
|
| Rate for Payer: The Alliance Commercial |
$641.16
|
| Rate for Payer: WEA Trust Commercial |
$705.28
|
| Rate for Payer: WPS Commercial |
$949.78
|
|
|
SCREW-CANN 7.3 X 90 02.207.090
|
Facility
|
IP
|
$1,233.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967021
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$628.34 |
| Max. Negotiated Rate |
$1,179.73 |
| Rate for Payer: Aetna Commercial |
$1,154.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,102.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$679.63
|
| Rate for Payer: Cash Price |
$369.90
|
| Rate for Payer: Cigna Commercial |
$1,179.73
|
| Rate for Payer: Health EOS Commercial |
$1,141.26
|
| Rate for Payer: HFN Commercial |
$1,179.73
|
| Rate for Payer: Multiplan Commercial |
$1,025.86
|
| Rate for Payer: Preferred Network Access Commercial |
$1,179.73
|
| Rate for Payer: Quartz Beloit One Network |
$628.34
|
| Rate for Payer: Quartz Commercial |
$769.39
|
| Rate for Payer: WEA Trust Commercial |
$705.28
|
| Rate for Payer: WPS Commercial |
$949.78
|
|
|
SCREW-CANN 7.3 X 90 02.207.290
|
Facility
|
OP
|
$3,060.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967241
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$891.07 |
| Max. Negotiated Rate |
$2,927.81 |
| Rate for Payer: Aetna Commercial |
$2,864.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,736.86
|
| Rate for Payer: Aetna Managed Medicare |
$891.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,068.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,591.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,527.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,686.67
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Cigna Commercial |
$2,927.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,780.92
|
| Rate for Payer: Health EOS Commercial |
$2,832.34
|
| Rate for Payer: HFN Commercial |
$2,927.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,386.80
|
| Rate for Payer: Multiplan Commercial |
$2,545.92
|
| Rate for Payer: NAPHCARE Commercial |
$1,909.44
|
| Rate for Payer: Preferred Network Access Commercial |
$2,927.81
|
| Rate for Payer: Quartz Beloit One Network |
$1,559.38
|
| Rate for Payer: Quartz Commercial |
$2,068.56
|
| Rate for Payer: Quartz Medicare Advantage |
$1,909.44
|
| Rate for Payer: The Alliance Commercial |
$1,591.20
|
| Rate for Payer: WEA Trust Commercial |
$1,750.32
|
| Rate for Payer: WPS Commercial |
$2,357.12
|
|
|
SCREW-CANN 7.3 X 90 02.207.290
|
Facility
|
IP
|
$3,060.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967241
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,559.38 |
| Max. Negotiated Rate |
$2,927.81 |
| Rate for Payer: Aetna Commercial |
$2,864.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,736.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,686.67
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Cigna Commercial |
$2,927.81
|
| Rate for Payer: Health EOS Commercial |
$2,832.34
|
| Rate for Payer: HFN Commercial |
$2,927.81
|
| Rate for Payer: Multiplan Commercial |
$2,545.92
|
| Rate for Payer: Preferred Network Access Commercial |
$2,927.81
|
| Rate for Payer: Quartz Beloit One Network |
$1,559.38
|
| Rate for Payer: Quartz Commercial |
$1,909.44
|
| Rate for Payer: WEA Trust Commercial |
$1,750.32
|
| Rate for Payer: WPS Commercial |
$2,357.12
|
|
|
SCREW-CANN 7.3 X 90 02.207.490
|
Facility
|
OP
|
$3,060.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967231
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$891.07 |
| Max. Negotiated Rate |
$2,927.81 |
| Rate for Payer: Aetna Commercial |
$2,864.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,736.86
|
| Rate for Payer: Aetna Managed Medicare |
$891.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,068.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,591.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,527.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,686.67
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Cigna Commercial |
$2,927.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,780.92
|
| Rate for Payer: Health EOS Commercial |
$2,832.34
|
| Rate for Payer: HFN Commercial |
$2,927.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,386.80
|
| Rate for Payer: Multiplan Commercial |
$2,545.92
|
| Rate for Payer: NAPHCARE Commercial |
$1,909.44
|
| Rate for Payer: Preferred Network Access Commercial |
$2,927.81
|
| Rate for Payer: Quartz Beloit One Network |
$1,559.38
|
| Rate for Payer: Quartz Commercial |
$2,068.56
|
| Rate for Payer: Quartz Medicare Advantage |
$1,909.44
|
| Rate for Payer: The Alliance Commercial |
$1,591.20
|
| Rate for Payer: WEA Trust Commercial |
$1,750.32
|
| Rate for Payer: WPS Commercial |
$2,357.12
|
|
|
SCREW-CANN 7.3 X 90 02.207.490
|
Facility
|
IP
|
$3,060.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967231
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,559.38 |
| Max. Negotiated Rate |
$2,927.81 |
| Rate for Payer: Aetna Commercial |
$2,864.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,736.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,686.67
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Cigna Commercial |
$2,927.81
|
| Rate for Payer: Health EOS Commercial |
$2,832.34
|
| Rate for Payer: HFN Commercial |
$2,927.81
|
| Rate for Payer: Multiplan Commercial |
$2,545.92
|
| Rate for Payer: Preferred Network Access Commercial |
$2,927.81
|
| Rate for Payer: Quartz Beloit One Network |
$1,559.38
|
| Rate for Payer: Quartz Commercial |
$1,909.44
|
| Rate for Payer: WEA Trust Commercial |
$1,750.32
|
| Rate for Payer: WPS Commercial |
$2,357.12
|
|
|
SCREW-CANN 7.3 X 95 02.207.095
|
Facility
|
IP
|
$1,233.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967022
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$628.34 |
| Max. Negotiated Rate |
$1,179.73 |
| Rate for Payer: Aetna Commercial |
$1,154.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,102.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$679.63
|
| Rate for Payer: Cash Price |
$369.90
|
| Rate for Payer: Cigna Commercial |
$1,179.73
|
| Rate for Payer: Health EOS Commercial |
$1,141.26
|
| Rate for Payer: HFN Commercial |
$1,179.73
|
| Rate for Payer: Multiplan Commercial |
$1,025.86
|
| Rate for Payer: Preferred Network Access Commercial |
$1,179.73
|
| Rate for Payer: Quartz Beloit One Network |
$628.34
|
| Rate for Payer: Quartz Commercial |
$769.39
|
| Rate for Payer: WEA Trust Commercial |
$705.28
|
| Rate for Payer: WPS Commercial |
$949.78
|
|
|
SCREW-CANN 7.3 X 95 02.207.095
|
Facility
|
OP
|
$1,233.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967022
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$359.05 |
| Max. Negotiated Rate |
$1,179.73 |
| Rate for Payer: Aetna Commercial |
$1,154.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,102.80
|
| Rate for Payer: Aetna Managed Medicare |
$359.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$833.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$641.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$615.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$679.63
|
| Rate for Payer: Cash Price |
$369.90
|
| Rate for Payer: Cigna Commercial |
$1,179.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$717.61
|
| Rate for Payer: Health EOS Commercial |
$1,141.26
|
| Rate for Payer: HFN Commercial |
$1,179.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$961.74
|
| Rate for Payer: Multiplan Commercial |
$1,025.86
|
| Rate for Payer: NAPHCARE Commercial |
$769.39
|
| Rate for Payer: Preferred Network Access Commercial |
$1,179.73
|
| Rate for Payer: Quartz Beloit One Network |
$628.34
|
| Rate for Payer: Quartz Commercial |
$833.51
|
| Rate for Payer: Quartz Medicare Advantage |
$769.39
|
| Rate for Payer: The Alliance Commercial |
$641.16
|
| Rate for Payer: WEA Trust Commercial |
$705.28
|
| Rate for Payer: WPS Commercial |
$949.78
|
|
|
SCREW-CANN 7.3 X 95 02.207.295
|
Facility
|
OP
|
$3,060.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967242
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$891.07 |
| Max. Negotiated Rate |
$2,927.81 |
| Rate for Payer: Aetna Commercial |
$2,864.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,736.86
|
| Rate for Payer: Aetna Managed Medicare |
$891.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,068.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,591.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,527.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,686.67
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Cigna Commercial |
$2,927.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,780.92
|
| Rate for Payer: Health EOS Commercial |
$2,832.34
|
| Rate for Payer: HFN Commercial |
$2,927.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,386.80
|
| Rate for Payer: Multiplan Commercial |
$2,545.92
|
| Rate for Payer: NAPHCARE Commercial |
$1,909.44
|
| Rate for Payer: Preferred Network Access Commercial |
$2,927.81
|
| Rate for Payer: Quartz Beloit One Network |
$1,559.38
|
| Rate for Payer: Quartz Commercial |
$2,068.56
|
| Rate for Payer: Quartz Medicare Advantage |
$1,909.44
|
| Rate for Payer: The Alliance Commercial |
$1,591.20
|
| Rate for Payer: WEA Trust Commercial |
$1,750.32
|
| Rate for Payer: WPS Commercial |
$2,357.12
|
|
|
SCREW-CANN 7.3 X 95 02.207.295
|
Facility
|
IP
|
$3,060.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967242
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,559.38 |
| Max. Negotiated Rate |
$2,927.81 |
| Rate for Payer: Aetna Commercial |
$2,864.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,736.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,686.67
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Cigna Commercial |
$2,927.81
|
| Rate for Payer: Health EOS Commercial |
$2,832.34
|
| Rate for Payer: HFN Commercial |
$2,927.81
|
| Rate for Payer: Multiplan Commercial |
$2,545.92
|
| Rate for Payer: Preferred Network Access Commercial |
$2,927.81
|
| Rate for Payer: Quartz Beloit One Network |
$1,559.38
|
| Rate for Payer: Quartz Commercial |
$1,909.44
|
| Rate for Payer: WEA Trust Commercial |
$1,750.32
|
| Rate for Payer: WPS Commercial |
$2,357.12
|
|
|
SCREW-CANN 7.3 X 95 02.207.495
|
Facility
|
IP
|
$3,060.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967232
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,559.38 |
| Max. Negotiated Rate |
$2,927.81 |
| Rate for Payer: Aetna Commercial |
$2,864.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,736.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,686.67
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Cigna Commercial |
$2,927.81
|
| Rate for Payer: Health EOS Commercial |
$2,832.34
|
| Rate for Payer: HFN Commercial |
$2,927.81
|
| Rate for Payer: Multiplan Commercial |
$2,545.92
|
| Rate for Payer: Preferred Network Access Commercial |
$2,927.81
|
| Rate for Payer: Quartz Beloit One Network |
$1,559.38
|
| Rate for Payer: Quartz Commercial |
$1,909.44
|
| Rate for Payer: WEA Trust Commercial |
$1,750.32
|
| Rate for Payer: WPS Commercial |
$2,357.12
|
|
|
SCREW-CANN 7.3 X 95 02.207.495
|
Facility
|
OP
|
$3,060.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967232
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$891.07 |
| Max. Negotiated Rate |
$2,927.81 |
| Rate for Payer: Aetna Commercial |
$2,864.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,736.86
|
| Rate for Payer: Aetna Managed Medicare |
$891.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,068.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,591.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,527.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,686.67
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Cigna Commercial |
$2,927.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,780.92
|
| Rate for Payer: Health EOS Commercial |
$2,832.34
|
| Rate for Payer: HFN Commercial |
$2,927.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,386.80
|
| Rate for Payer: Multiplan Commercial |
$2,545.92
|
| Rate for Payer: NAPHCARE Commercial |
$1,909.44
|
| Rate for Payer: Preferred Network Access Commercial |
$2,927.81
|
| Rate for Payer: Quartz Beloit One Network |
$1,559.38
|
| Rate for Payer: Quartz Commercial |
$2,068.56
|
| Rate for Payer: Quartz Medicare Advantage |
$1,909.44
|
| Rate for Payer: The Alliance Commercial |
$1,591.20
|
| Rate for Payer: WEA Trust Commercial |
$1,750.32
|
| Rate for Payer: WPS Commercial |
$2,357.12
|
|
|
SCREW-CANN AMBI 6.5 X 100MM 121640
|
Facility
|
IP
|
$2,674.00
|
|
| Hospital Charge Code |
2965992
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,362.67 |
| Max. Negotiated Rate |
$2,558.48 |
| Rate for Payer: Aetna Commercial |
$2,502.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,391.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,473.91
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cigna Commercial |
$2,558.48
|
| Rate for Payer: Health EOS Commercial |
$2,475.05
|
| Rate for Payer: HFN Commercial |
$2,558.48
|
| Rate for Payer: Multiplan Commercial |
$2,224.77
|
| Rate for Payer: Preferred Network Access Commercial |
$2,558.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,362.67
|
| Rate for Payer: Quartz Commercial |
$1,668.58
|
| Rate for Payer: WEA Trust Commercial |
$1,529.53
|
| Rate for Payer: WPS Commercial |
$2,059.78
|
|
|
SCREW-CANN AMBI 6.5 X 100MM 121640
|
Facility
|
OP
|
$2,674.00
|
|
| Hospital Charge Code |
2965992
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$778.67 |
| Max. Negotiated Rate |
$2,558.48 |
| Rate for Payer: Aetna Commercial |
$2,502.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,391.63
|
| Rate for Payer: Aetna Managed Medicare |
$778.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,807.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,390.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,334.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,473.91
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cigna Commercial |
$2,558.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,556.27
|
| Rate for Payer: Health EOS Commercial |
$2,475.05
|
| Rate for Payer: HFN Commercial |
$2,558.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,085.72
|
| Rate for Payer: Multiplan Commercial |
$2,224.77
|
| Rate for Payer: NAPHCARE Commercial |
$1,668.58
|
| Rate for Payer: Preferred Network Access Commercial |
$2,558.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,362.67
|
| Rate for Payer: Quartz Commercial |
$1,807.62
|
| Rate for Payer: Quartz Medicare Advantage |
$1,668.58
|
| Rate for Payer: The Alliance Commercial |
$1,390.48
|
| Rate for Payer: WEA Trust Commercial |
$1,529.53
|
| Rate for Payer: WPS Commercial |
$2,059.78
|
|
|
SCREW-CANN AMBI 6.5 X 105MM 121641
|
Facility
|
OP
|
$2,674.00
|
|
| Hospital Charge Code |
2965993
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$778.67 |
| Max. Negotiated Rate |
$2,558.48 |
| Rate for Payer: Aetna Commercial |
$2,502.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,391.63
|
| Rate for Payer: Aetna Managed Medicare |
$778.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,807.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,390.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,334.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,473.91
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cigna Commercial |
$2,558.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,556.27
|
| Rate for Payer: Health EOS Commercial |
$2,475.05
|
| Rate for Payer: HFN Commercial |
$2,558.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,085.72
|
| Rate for Payer: Multiplan Commercial |
$2,224.77
|
| Rate for Payer: NAPHCARE Commercial |
$1,668.58
|
| Rate for Payer: Preferred Network Access Commercial |
$2,558.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,362.67
|
| Rate for Payer: Quartz Commercial |
$1,807.62
|
| Rate for Payer: Quartz Medicare Advantage |
$1,668.58
|
| Rate for Payer: The Alliance Commercial |
$1,390.48
|
| Rate for Payer: WEA Trust Commercial |
$1,529.53
|
| Rate for Payer: WPS Commercial |
$2,059.78
|
|
|
SCREW-CANN AMBI 6.5 X 105MM 121641
|
Facility
|
IP
|
$2,674.00
|
|
| Hospital Charge Code |
2965993
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,362.67 |
| Max. Negotiated Rate |
$2,558.48 |
| Rate for Payer: Aetna Commercial |
$2,502.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,391.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,473.91
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cigna Commercial |
$2,558.48
|
| Rate for Payer: Health EOS Commercial |
$2,475.05
|
| Rate for Payer: HFN Commercial |
$2,558.48
|
| Rate for Payer: Multiplan Commercial |
$2,224.77
|
| Rate for Payer: Preferred Network Access Commercial |
$2,558.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,362.67
|
| Rate for Payer: Quartz Commercial |
$1,668.58
|
| Rate for Payer: WEA Trust Commercial |
$1,529.53
|
| Rate for Payer: WPS Commercial |
$2,059.78
|
|
