|
SCREW CANN 7.3MM X 120MM X 32MM THREAD 209.920
|
Facility
|
IP
|
$2,954.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4067871
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,447.46 |
| Max. Negotiated Rate |
$2,717.68 |
| Rate for Payer: Aetna Commercial |
$2,658.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,540.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,565.62
|
| Rate for Payer: Cash Price |
$886.20
|
| Rate for Payer: Cigna Commercial |
$2,717.68
|
| Rate for Payer: Health EOS Commercial |
$2,629.06
|
| Rate for Payer: HFN Commercial |
$2,717.68
|
| Rate for Payer: Multiplan Commercial |
$2,363.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,772.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,717.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,447.46
|
| Rate for Payer: Quartz Commercial |
$1,772.40
|
| Rate for Payer: WEA Trust Commercial |
$1,624.70
|
| Rate for Payer: WPS Commercial |
$2,188.03
|
|
|
SCREW CANN 7.3MM X 120MM X 32MM THREAD 209.920
|
Facility
|
OP
|
$2,954.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4067871
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$827.12 |
| Max. Negotiated Rate |
$11,816.00 |
| Rate for Payer: Aetna Commercial |
$2,658.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,540.44
|
| Rate for Payer: Aetna Managed Medicare |
$827.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,920.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,477.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,417.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,565.62
|
| Rate for Payer: Cash Price |
$886.20
|
| Rate for Payer: Cigna Commercial |
$2,717.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,653.06
|
| Rate for Payer: Health EOS Commercial |
$2,629.06
|
| Rate for Payer: HFN Commercial |
$2,717.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,215.50
|
| Rate for Payer: Multiplan Commercial |
$2,363.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,772.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,717.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,447.46
|
| Rate for Payer: Quartz Commercial |
$1,920.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,772.40
|
| Rate for Payer: The Alliance Commercial |
$11,816.00
|
| Rate for Payer: WEA Trust Commercial |
$1,624.70
|
| Rate for Payer: WPS Commercial |
$2,188.03
|
|
|
SCREW CANN 7.3MM X 125MM X 16MM THREAD 208.925
|
Facility
|
IP
|
$2,954.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4066489
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,447.46 |
| Max. Negotiated Rate |
$2,717.68 |
| Rate for Payer: Aetna Commercial |
$2,658.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,540.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,565.62
|
| Rate for Payer: Cash Price |
$886.20
|
| Rate for Payer: Cigna Commercial |
$2,717.68
|
| Rate for Payer: Health EOS Commercial |
$2,629.06
|
| Rate for Payer: HFN Commercial |
$2,717.68
|
| Rate for Payer: Multiplan Commercial |
$2,363.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,772.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,717.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,447.46
|
| Rate for Payer: Quartz Commercial |
$1,772.40
|
| Rate for Payer: WEA Trust Commercial |
$1,624.70
|
| Rate for Payer: WPS Commercial |
$2,188.03
|
|
|
SCREW CANN 7.3MM X 125MM X 16MM THREAD 208.925
|
Facility
|
OP
|
$2,954.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4066489
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$827.12 |
| Max. Negotiated Rate |
$11,816.00 |
| Rate for Payer: Aetna Commercial |
$2,658.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,540.44
|
| Rate for Payer: Aetna Managed Medicare |
$827.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,920.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,477.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,417.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,565.62
|
| Rate for Payer: Cash Price |
$886.20
|
| Rate for Payer: Cigna Commercial |
$2,717.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,653.06
|
| Rate for Payer: Health EOS Commercial |
$2,629.06
|
| Rate for Payer: HFN Commercial |
$2,717.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,215.50
|
| Rate for Payer: Multiplan Commercial |
$2,363.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,772.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,717.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,447.46
|
| Rate for Payer: Quartz Commercial |
$1,920.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,772.40
|
| Rate for Payer: The Alliance Commercial |
$11,816.00
|
| Rate for Payer: WEA Trust Commercial |
$1,624.70
|
| Rate for Payer: WPS Commercial |
$2,188.03
|
|
|
SCREW CANN 7.3MM X 125MM X 32MM THREAD 209.925
|
Facility
|
IP
|
$2,954.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4067872
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,447.46 |
| Max. Negotiated Rate |
$2,717.68 |
| Rate for Payer: Aetna Commercial |
$2,658.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,540.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,565.62
|
| Rate for Payer: Cash Price |
$886.20
|
| Rate for Payer: Cigna Commercial |
$2,717.68
|
| Rate for Payer: Health EOS Commercial |
$2,629.06
|
| Rate for Payer: HFN Commercial |
$2,717.68
|
| Rate for Payer: Multiplan Commercial |
$2,363.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,772.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,717.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,447.46
|
| Rate for Payer: Quartz Commercial |
$1,772.40
|
| Rate for Payer: WEA Trust Commercial |
$1,624.70
|
| Rate for Payer: WPS Commercial |
$2,188.03
|
|
|
SCREW CANN 7.3MM X 125MM X 32MM THREAD 209.925
|
Facility
|
OP
|
$2,954.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4067872
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$827.12 |
| Max. Negotiated Rate |
$11,816.00 |
| Rate for Payer: Aetna Commercial |
$2,658.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,540.44
|
| Rate for Payer: Aetna Managed Medicare |
$827.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,920.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,477.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,417.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,565.62
|
| Rate for Payer: Cash Price |
$886.20
|
| Rate for Payer: Cigna Commercial |
$2,717.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,653.06
|
| Rate for Payer: Health EOS Commercial |
$2,629.06
|
| Rate for Payer: HFN Commercial |
$2,717.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,215.50
|
| Rate for Payer: Multiplan Commercial |
$2,363.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,772.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,717.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,447.46
|
| Rate for Payer: Quartz Commercial |
$1,920.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,772.40
|
| Rate for Payer: The Alliance Commercial |
$11,816.00
|
| Rate for Payer: WEA Trust Commercial |
$1,624.70
|
| Rate for Payer: WPS Commercial |
$2,188.03
|
|
|
SCREW CANN 7.3MM X 130MM X 16MM THREAD 208.930
|
Facility
|
OP
|
$2,954.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4066490
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$827.12 |
| Max. Negotiated Rate |
$11,816.00 |
| Rate for Payer: Aetna Commercial |
$2,658.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,540.44
|
| Rate for Payer: Aetna Managed Medicare |
$827.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,920.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,477.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,417.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,565.62
|
| Rate for Payer: Cash Price |
$886.20
|
| Rate for Payer: Cigna Commercial |
$2,717.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,653.06
|
| Rate for Payer: Health EOS Commercial |
$2,629.06
|
| Rate for Payer: HFN Commercial |
$2,717.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,215.50
|
| Rate for Payer: Multiplan Commercial |
$2,363.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,772.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,717.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,447.46
|
| Rate for Payer: Quartz Commercial |
$1,920.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,772.40
|
| Rate for Payer: The Alliance Commercial |
$11,816.00
|
| Rate for Payer: WEA Trust Commercial |
$1,624.70
|
| Rate for Payer: WPS Commercial |
$2,188.03
|
|
|
SCREW CANN 7.3MM X 130MM X 16MM THREAD 208.930
|
Facility
|
IP
|
$2,954.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4066490
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,447.46 |
| Max. Negotiated Rate |
$2,717.68 |
| Rate for Payer: Aetna Commercial |
$2,658.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,540.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,565.62
|
| Rate for Payer: Cash Price |
$886.20
|
| Rate for Payer: Cigna Commercial |
$2,717.68
|
| Rate for Payer: Health EOS Commercial |
$2,629.06
|
| Rate for Payer: HFN Commercial |
$2,717.68
|
| Rate for Payer: Multiplan Commercial |
$2,363.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,772.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,717.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,447.46
|
| Rate for Payer: Quartz Commercial |
$1,772.40
|
| Rate for Payer: WEA Trust Commercial |
$1,624.70
|
| Rate for Payer: WPS Commercial |
$2,188.03
|
|
|
SCREW CANN 7.3MM X 130MM X 32MM THREAD 209.930
|
Facility
|
OP
|
$2,954.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4067873
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$827.12 |
| Max. Negotiated Rate |
$11,816.00 |
| Rate for Payer: Aetna Commercial |
$2,658.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,540.44
|
| Rate for Payer: Aetna Managed Medicare |
$827.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,920.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,477.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,417.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,565.62
|
| Rate for Payer: Cash Price |
$886.20
|
| Rate for Payer: Cigna Commercial |
$2,717.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,653.06
|
| Rate for Payer: Health EOS Commercial |
$2,629.06
|
| Rate for Payer: HFN Commercial |
$2,717.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,215.50
|
| Rate for Payer: Multiplan Commercial |
$2,363.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,772.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,717.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,447.46
|
| Rate for Payer: Quartz Commercial |
$1,920.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,772.40
|
| Rate for Payer: The Alliance Commercial |
$11,816.00
|
| Rate for Payer: WEA Trust Commercial |
$1,624.70
|
| Rate for Payer: WPS Commercial |
$2,188.03
|
|
|
SCREW CANN 7.3MM X 130MM X 32MM THREAD 209.930
|
Facility
|
IP
|
$2,954.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4067873
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,447.46 |
| Max. Negotiated Rate |
$2,717.68 |
| Rate for Payer: Aetna Commercial |
$2,658.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,540.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,565.62
|
| Rate for Payer: Cash Price |
$886.20
|
| Rate for Payer: Cigna Commercial |
$2,717.68
|
| Rate for Payer: Health EOS Commercial |
$2,629.06
|
| Rate for Payer: HFN Commercial |
$2,717.68
|
| Rate for Payer: Multiplan Commercial |
$2,363.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,772.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,717.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,447.46
|
| Rate for Payer: Quartz Commercial |
$1,772.40
|
| Rate for Payer: WEA Trust Commercial |
$1,624.70
|
| Rate for Payer: WPS Commercial |
$2,188.03
|
|
|
SCREW CANN 7.3MM X 135MM X 16MM THREAD 208.935
|
Facility
|
IP
|
$2,954.00
|
|
| Hospital Charge Code |
4066491
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,447.46 |
| Max. Negotiated Rate |
$2,717.68 |
| Rate for Payer: Aetna Commercial |
$2,658.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,540.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,565.62
|
| Rate for Payer: Cash Price |
$886.20
|
| Rate for Payer: Cigna Commercial |
$2,717.68
|
| Rate for Payer: Health EOS Commercial |
$2,629.06
|
| Rate for Payer: HFN Commercial |
$2,717.68
|
| Rate for Payer: Multiplan Commercial |
$2,363.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,772.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,717.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,447.46
|
| Rate for Payer: Quartz Commercial |
$1,772.40
|
| Rate for Payer: WEA Trust Commercial |
$1,624.70
|
| Rate for Payer: WPS Commercial |
$2,188.03
|
|
|
SCREW CANN 7.3MM X 135MM X 16MM THREAD 208.935
|
Facility
|
OP
|
$2,954.00
|
|
| Hospital Charge Code |
4066491
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$827.12 |
| Max. Negotiated Rate |
$11,816.00 |
| Rate for Payer: Aetna Commercial |
$2,658.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,540.44
|
| Rate for Payer: Aetna Managed Medicare |
$827.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,920.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,477.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,417.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,565.62
|
| Rate for Payer: Cash Price |
$886.20
|
| Rate for Payer: Cigna Commercial |
$2,717.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,653.06
|
| Rate for Payer: Health EOS Commercial |
$2,629.06
|
| Rate for Payer: HFN Commercial |
$2,717.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,215.50
|
| Rate for Payer: Multiplan Commercial |
$2,363.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,772.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,717.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,447.46
|
| Rate for Payer: Quartz Commercial |
$1,920.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,772.40
|
| Rate for Payer: The Alliance Commercial |
$11,816.00
|
| Rate for Payer: WEA Trust Commercial |
$1,624.70
|
| Rate for Payer: WPS Commercial |
$2,188.03
|
|
|
SCREW CANN 7.3MM X 135MM X 32MM THREAD 209.935
|
Facility
|
OP
|
$2,954.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4067874
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$827.12 |
| Max. Negotiated Rate |
$11,816.00 |
| Rate for Payer: Aetna Commercial |
$2,658.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,540.44
|
| Rate for Payer: Aetna Managed Medicare |
$827.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,920.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,477.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,417.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,565.62
|
| Rate for Payer: Cash Price |
$886.20
|
| Rate for Payer: Cigna Commercial |
$2,717.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,653.06
|
| Rate for Payer: Health EOS Commercial |
$2,629.06
|
| Rate for Payer: HFN Commercial |
$2,717.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,215.50
|
| Rate for Payer: Multiplan Commercial |
$2,363.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,772.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,717.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,447.46
|
| Rate for Payer: Quartz Commercial |
$1,920.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,772.40
|
| Rate for Payer: The Alliance Commercial |
$11,816.00
|
| Rate for Payer: WEA Trust Commercial |
$1,624.70
|
| Rate for Payer: WPS Commercial |
$2,188.03
|
|
|
SCREW CANN 7.3MM X 135MM X 32MM THREAD 209.935
|
Facility
|
IP
|
$2,954.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4067874
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,447.46 |
| Max. Negotiated Rate |
$2,717.68 |
| Rate for Payer: Aetna Commercial |
$2,658.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,540.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,565.62
|
| Rate for Payer: Cash Price |
$886.20
|
| Rate for Payer: Cigna Commercial |
$2,717.68
|
| Rate for Payer: Health EOS Commercial |
$2,629.06
|
| Rate for Payer: HFN Commercial |
$2,717.68
|
| Rate for Payer: Multiplan Commercial |
$2,363.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,772.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,717.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,447.46
|
| Rate for Payer: Quartz Commercial |
$1,772.40
|
| Rate for Payer: WEA Trust Commercial |
$1,624.70
|
| Rate for Payer: WPS Commercial |
$2,188.03
|
|
|
SCREW CANN 7.3MM X 140MM X 16MM THREAD 208.940
|
Facility
|
IP
|
$2,354.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4066492
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,153.46 |
| Max. Negotiated Rate |
$2,165.68 |
| Rate for Payer: Aetna Commercial |
$2,118.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,024.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,247.62
|
| Rate for Payer: Cash Price |
$706.20
|
| Rate for Payer: Cigna Commercial |
$2,165.68
|
| Rate for Payer: Health EOS Commercial |
$2,095.06
|
| Rate for Payer: HFN Commercial |
$2,165.68
|
| Rate for Payer: Multiplan Commercial |
$1,883.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,412.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,165.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,153.46
|
| Rate for Payer: Quartz Commercial |
$1,412.40
|
| Rate for Payer: WEA Trust Commercial |
$1,294.70
|
| Rate for Payer: WPS Commercial |
$1,743.61
|
|
|
SCREW CANN 7.3MM X 140MM X 16MM THREAD 208.940
|
Facility
|
OP
|
$2,354.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4066492
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$659.12 |
| Max. Negotiated Rate |
$9,416.00 |
| Rate for Payer: Aetna Commercial |
$2,118.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,024.44
|
| Rate for Payer: Aetna Managed Medicare |
$659.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,530.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,177.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,129.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,247.62
|
| Rate for Payer: Cash Price |
$706.20
|
| Rate for Payer: Cigna Commercial |
$2,165.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,317.30
|
| Rate for Payer: Health EOS Commercial |
$2,095.06
|
| Rate for Payer: HFN Commercial |
$2,165.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,765.50
|
| Rate for Payer: Multiplan Commercial |
$1,883.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,412.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,165.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,153.46
|
| Rate for Payer: Quartz Commercial |
$1,530.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,412.40
|
| Rate for Payer: The Alliance Commercial |
$9,416.00
|
| Rate for Payer: WEA Trust Commercial |
$1,294.70
|
| Rate for Payer: WPS Commercial |
$1,743.61
|
|
|
SCREW CANN 7.3MM X 140MM X 32MM THREAD 209.940
|
Facility
|
IP
|
$2,954.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4067875
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,447.46 |
| Max. Negotiated Rate |
$2,717.68 |
| Rate for Payer: Aetna Commercial |
$2,658.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,540.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,565.62
|
| Rate for Payer: Cash Price |
$886.20
|
| Rate for Payer: Cigna Commercial |
$2,717.68
|
| Rate for Payer: Health EOS Commercial |
$2,629.06
|
| Rate for Payer: HFN Commercial |
$2,717.68
|
| Rate for Payer: Multiplan Commercial |
$2,363.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,772.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,717.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,447.46
|
| Rate for Payer: Quartz Commercial |
$1,772.40
|
| Rate for Payer: WEA Trust Commercial |
$1,624.70
|
| Rate for Payer: WPS Commercial |
$2,188.03
|
|
|
SCREW CANN 7.3MM X 140MM X 32MM THREAD 209.940
|
Facility
|
OP
|
$2,954.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4067875
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$827.12 |
| Max. Negotiated Rate |
$11,816.00 |
| Rate for Payer: Aetna Commercial |
$2,658.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,540.44
|
| Rate for Payer: Aetna Managed Medicare |
$827.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,920.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,477.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,417.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,565.62
|
| Rate for Payer: Cash Price |
$886.20
|
| Rate for Payer: Cigna Commercial |
$2,717.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,653.06
|
| Rate for Payer: Health EOS Commercial |
$2,629.06
|
| Rate for Payer: HFN Commercial |
$2,717.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,215.50
|
| Rate for Payer: Multiplan Commercial |
$2,363.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,772.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,717.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,447.46
|
| Rate for Payer: Quartz Commercial |
$1,920.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,772.40
|
| Rate for Payer: The Alliance Commercial |
$11,816.00
|
| Rate for Payer: WEA Trust Commercial |
$1,624.70
|
| Rate for Payer: WPS Commercial |
$2,188.03
|
|
|
SCREW CANN 7.3MM X 145MM X 16MM THREAD 208.945
|
Facility
|
IP
|
$2,954.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4066493
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,447.46 |
| Max. Negotiated Rate |
$2,717.68 |
| Rate for Payer: Aetna Commercial |
$2,658.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,540.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,565.62
|
| Rate for Payer: Cash Price |
$886.20
|
| Rate for Payer: Cigna Commercial |
$2,717.68
|
| Rate for Payer: Health EOS Commercial |
$2,629.06
|
| Rate for Payer: HFN Commercial |
$2,717.68
|
| Rate for Payer: Multiplan Commercial |
$2,363.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,772.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,717.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,447.46
|
| Rate for Payer: Quartz Commercial |
$1,772.40
|
| Rate for Payer: WEA Trust Commercial |
$1,624.70
|
| Rate for Payer: WPS Commercial |
$2,188.03
|
|
|
SCREW CANN 7.3MM X 145MM X 16MM THREAD 208.945
|
Facility
|
OP
|
$2,954.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4066493
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$827.12 |
| Max. Negotiated Rate |
$11,816.00 |
| Rate for Payer: Aetna Commercial |
$2,658.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,540.44
|
| Rate for Payer: Aetna Managed Medicare |
$827.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,920.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,477.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,417.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,565.62
|
| Rate for Payer: Cash Price |
$886.20
|
| Rate for Payer: Cigna Commercial |
$2,717.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,653.06
|
| Rate for Payer: Health EOS Commercial |
$2,629.06
|
| Rate for Payer: HFN Commercial |
$2,717.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,215.50
|
| Rate for Payer: Multiplan Commercial |
$2,363.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,772.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,717.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,447.46
|
| Rate for Payer: Quartz Commercial |
$1,920.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,772.40
|
| Rate for Payer: The Alliance Commercial |
$11,816.00
|
| Rate for Payer: WEA Trust Commercial |
$1,624.70
|
| Rate for Payer: WPS Commercial |
$2,188.03
|
|
|
SCREW CANN 7.3MM X 145MM X 32MM THREAD 209.945
|
Facility
|
IP
|
$2,954.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4067876
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,447.46 |
| Max. Negotiated Rate |
$2,717.68 |
| Rate for Payer: Aetna Commercial |
$2,658.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,540.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,565.62
|
| Rate for Payer: Cash Price |
$886.20
|
| Rate for Payer: Cigna Commercial |
$2,717.68
|
| Rate for Payer: Health EOS Commercial |
$2,629.06
|
| Rate for Payer: HFN Commercial |
$2,717.68
|
| Rate for Payer: Multiplan Commercial |
$2,363.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,772.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,717.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,447.46
|
| Rate for Payer: Quartz Commercial |
$1,772.40
|
| Rate for Payer: WEA Trust Commercial |
$1,624.70
|
| Rate for Payer: WPS Commercial |
$2,188.03
|
|
|
SCREW CANN 7.3MM X 145MM X 32MM THREAD 209.945
|
Facility
|
OP
|
$2,954.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4067876
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$827.12 |
| Max. Negotiated Rate |
$11,816.00 |
| Rate for Payer: Aetna Commercial |
$2,658.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,540.44
|
| Rate for Payer: Aetna Managed Medicare |
$827.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,920.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,477.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,417.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,565.62
|
| Rate for Payer: Cash Price |
$886.20
|
| Rate for Payer: Cigna Commercial |
$2,717.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,653.06
|
| Rate for Payer: Health EOS Commercial |
$2,629.06
|
| Rate for Payer: HFN Commercial |
$2,717.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,215.50
|
| Rate for Payer: Multiplan Commercial |
$2,363.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,772.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,717.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,447.46
|
| Rate for Payer: Quartz Commercial |
$1,920.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,772.40
|
| Rate for Payer: The Alliance Commercial |
$11,816.00
|
| Rate for Payer: WEA Trust Commercial |
$1,624.70
|
| Rate for Payer: WPS Commercial |
$2,188.03
|
|
|
SCREW CANN 7.3MM X 150MM X 16MM THREAD 208.950
|
Facility
|
OP
|
$2,954.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4066494
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$827.12 |
| Max. Negotiated Rate |
$11,816.00 |
| Rate for Payer: Aetna Commercial |
$2,658.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,540.44
|
| Rate for Payer: Aetna Managed Medicare |
$827.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,920.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,477.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,417.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,565.62
|
| Rate for Payer: Cash Price |
$886.20
|
| Rate for Payer: Cigna Commercial |
$2,717.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,653.06
|
| Rate for Payer: Health EOS Commercial |
$2,629.06
|
| Rate for Payer: HFN Commercial |
$2,717.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,215.50
|
| Rate for Payer: Multiplan Commercial |
$2,363.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,772.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,717.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,447.46
|
| Rate for Payer: Quartz Commercial |
$1,920.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,772.40
|
| Rate for Payer: The Alliance Commercial |
$11,816.00
|
| Rate for Payer: WEA Trust Commercial |
$1,624.70
|
| Rate for Payer: WPS Commercial |
$2,188.03
|
|
|
SCREW CANN 7.3MM X 150MM X 16MM THREAD 208.950
|
Facility
|
IP
|
$2,954.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4066494
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,447.46 |
| Max. Negotiated Rate |
$2,717.68 |
| Rate for Payer: Aetna Commercial |
$2,658.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,540.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,565.62
|
| Rate for Payer: Cash Price |
$886.20
|
| Rate for Payer: Cigna Commercial |
$2,717.68
|
| Rate for Payer: Health EOS Commercial |
$2,629.06
|
| Rate for Payer: HFN Commercial |
$2,717.68
|
| Rate for Payer: Multiplan Commercial |
$2,363.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,772.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,717.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,447.46
|
| Rate for Payer: Quartz Commercial |
$1,772.40
|
| Rate for Payer: WEA Trust Commercial |
$1,624.70
|
| Rate for Payer: WPS Commercial |
$2,188.03
|
|
|
SCREW CANN 7.3MM X 150MM X 32MM THREAD 209.950
|
Facility
|
OP
|
$2,954.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4067877
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$827.12 |
| Max. Negotiated Rate |
$11,816.00 |
| Rate for Payer: Aetna Commercial |
$2,658.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,540.44
|
| Rate for Payer: Aetna Managed Medicare |
$827.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,920.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,477.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,417.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,565.62
|
| Rate for Payer: Cash Price |
$886.20
|
| Rate for Payer: Cigna Commercial |
$2,717.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,653.06
|
| Rate for Payer: Health EOS Commercial |
$2,629.06
|
| Rate for Payer: HFN Commercial |
$2,717.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,215.50
|
| Rate for Payer: Multiplan Commercial |
$2,363.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,772.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,717.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,447.46
|
| Rate for Payer: Quartz Commercial |
$1,920.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,772.40
|
| Rate for Payer: The Alliance Commercial |
$11,816.00
|
| Rate for Payer: WEA Trust Commercial |
$1,624.70
|
| Rate for Payer: WPS Commercial |
$2,188.03
|
|
