|
SCREW CANN 7.3MM X 95MM X 32MM THREAD 209.895
|
Facility
|
OP
|
$2,954.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2969338
|
|
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 7.3 X 30 02.207.030
|
Facility
|
IP
|
$3,623.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966538
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,775.27 |
| Max. Negotiated Rate |
$3,333.16 |
| Rate for Payer: Aetna Commercial |
$3,260.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,115.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,920.19
|
| Rate for Payer: Cash Price |
$1,086.90
|
| Rate for Payer: Cigna Commercial |
$3,333.16
|
| Rate for Payer: Health EOS Commercial |
$3,224.47
|
| Rate for Payer: HFN Commercial |
$3,333.16
|
| Rate for Payer: Multiplan Commercial |
$2,898.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,173.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,333.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,775.27
|
| Rate for Payer: Quartz Commercial |
$2,173.80
|
| Rate for Payer: WEA Trust Commercial |
$1,992.65
|
| Rate for Payer: WPS Commercial |
$2,683.56
|
|
|
SCREW-CANN 7.3 X 30 02.207.030
|
Facility
|
OP
|
$3,623.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966538
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,014.44 |
| Max. Negotiated Rate |
$14,492.00 |
| Rate for Payer: Aetna Commercial |
$3,260.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,115.78
|
| Rate for Payer: Aetna Managed Medicare |
$1,014.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,354.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,811.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,739.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,920.19
|
| Rate for Payer: Cash Price |
$1,086.90
|
| Rate for Payer: Cigna Commercial |
$3,333.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,027.43
|
| Rate for Payer: Health EOS Commercial |
$3,224.47
|
| Rate for Payer: HFN Commercial |
$3,333.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,717.25
|
| Rate for Payer: Multiplan Commercial |
$2,898.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,173.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,333.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,775.27
|
| Rate for Payer: Quartz Commercial |
$2,354.95
|
| Rate for Payer: Quartz Medicare Advantage |
$2,173.80
|
| Rate for Payer: The Alliance Commercial |
$14,492.00
|
| Rate for Payer: WEA Trust Commercial |
$1,992.65
|
| Rate for Payer: WPS Commercial |
$2,683.56
|
|
|
SCREW-CANN 7.3 X 45 02.207.045
|
Facility
|
IP
|
$3,623.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966540
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,775.27 |
| Max. Negotiated Rate |
$3,333.16 |
| Rate for Payer: Aetna Commercial |
$3,260.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,115.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,920.19
|
| Rate for Payer: Cash Price |
$1,086.90
|
| Rate for Payer: Cigna Commercial |
$3,333.16
|
| Rate for Payer: Health EOS Commercial |
$3,224.47
|
| Rate for Payer: HFN Commercial |
$3,333.16
|
| Rate for Payer: Multiplan Commercial |
$2,898.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,173.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,333.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,775.27
|
| Rate for Payer: Quartz Commercial |
$2,173.80
|
| Rate for Payer: WEA Trust Commercial |
$1,992.65
|
| Rate for Payer: WPS Commercial |
$2,683.56
|
|
|
SCREW-CANN 7.3 X 45 02.207.045
|
Facility
|
OP
|
$3,623.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966540
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,014.44 |
| Max. Negotiated Rate |
$14,492.00 |
| Rate for Payer: Aetna Commercial |
$3,260.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,115.78
|
| Rate for Payer: Aetna Managed Medicare |
$1,014.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,354.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,811.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,739.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,920.19
|
| Rate for Payer: Cash Price |
$1,086.90
|
| Rate for Payer: Cigna Commercial |
$3,333.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,027.43
|
| Rate for Payer: Health EOS Commercial |
$3,224.47
|
| Rate for Payer: HFN Commercial |
$3,333.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,717.25
|
| Rate for Payer: Multiplan Commercial |
$2,898.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,173.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,333.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,775.27
|
| Rate for Payer: Quartz Commercial |
$2,354.95
|
| Rate for Payer: Quartz Medicare Advantage |
$2,173.80
|
| Rate for Payer: The Alliance Commercial |
$14,492.00
|
| Rate for Payer: WEA Trust Commercial |
$1,992.65
|
| Rate for Payer: WPS Commercial |
$2,683.56
|
|
|
SCREW-CANN 7.3 X 50 02.207.050
|
Facility
|
OP
|
$1,233.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967013
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$345.24 |
| Max. Negotiated Rate |
$4,932.00 |
| Rate for Payer: Aetna Commercial |
$1,109.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,060.38
|
| Rate for Payer: Aetna Managed Medicare |
$345.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$801.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$616.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$591.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$653.49
|
| Rate for Payer: Cash Price |
$369.90
|
| Rate for Payer: Cigna Commercial |
$1,134.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$689.99
|
| Rate for Payer: Health EOS Commercial |
$1,097.37
|
| Rate for Payer: HFN Commercial |
$1,134.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$924.75
|
| Rate for Payer: Multiplan Commercial |
$986.40
|
| Rate for Payer: NAPHCARE Commercial |
$739.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,134.36
|
| Rate for Payer: Quartz Beloit One Network |
$604.17
|
| Rate for Payer: Quartz Commercial |
$801.45
|
| Rate for Payer: Quartz Medicare Advantage |
$739.80
|
| Rate for Payer: The Alliance Commercial |
$4,932.00
|
| Rate for Payer: WEA Trust Commercial |
$678.15
|
| Rate for Payer: WPS Commercial |
$913.28
|
|
|
SCREW-CANN 7.3 X 50 02.207.050
|
Facility
|
IP
|
$1,233.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967013
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$604.17 |
| Max. Negotiated Rate |
$1,134.36 |
| Rate for Payer: Aetna Commercial |
$1,109.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,060.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$653.49
|
| Rate for Payer: Cash Price |
$369.90
|
| Rate for Payer: Cigna Commercial |
$1,134.36
|
| Rate for Payer: Health EOS Commercial |
$1,097.37
|
| Rate for Payer: HFN Commercial |
$1,134.36
|
| Rate for Payer: Multiplan Commercial |
$986.40
|
| Rate for Payer: NAPHCARE Commercial |
$739.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,134.36
|
| Rate for Payer: Quartz Beloit One Network |
$604.17
|
| Rate for Payer: Quartz Commercial |
$739.80
|
| Rate for Payer: WEA Trust Commercial |
$678.15
|
| Rate for Payer: WPS Commercial |
$913.28
|
|
|
SCREW-CANN 7.3 X 50 02.207.250
|
Facility
|
IP
|
$3,060.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967233
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,499.40 |
| Max. Negotiated Rate |
$2,815.20 |
| Rate for Payer: Aetna Commercial |
$2,754.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,631.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,621.80
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Cigna Commercial |
$2,815.20
|
| Rate for Payer: Health EOS Commercial |
$2,723.40
|
| Rate for Payer: HFN Commercial |
$2,815.20
|
| Rate for Payer: Multiplan Commercial |
$2,448.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,836.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,815.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,499.40
|
| Rate for Payer: Quartz Commercial |
$1,836.00
|
| Rate for Payer: WEA Trust Commercial |
$1,683.00
|
| Rate for Payer: WPS Commercial |
$2,266.54
|
|
|
SCREW-CANN 7.3 X 50 02.207.250
|
Facility
|
OP
|
$3,060.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967233
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$856.80 |
| Max. Negotiated Rate |
$12,240.00 |
| Rate for Payer: Aetna Commercial |
$2,754.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,631.60
|
| Rate for Payer: Aetna Managed Medicare |
$856.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,989.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,530.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,468.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,621.80
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Cigna Commercial |
$2,815.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,712.38
|
| Rate for Payer: Health EOS Commercial |
$2,723.40
|
| Rate for Payer: HFN Commercial |
$2,815.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,295.00
|
| Rate for Payer: Multiplan Commercial |
$2,448.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,836.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,815.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,499.40
|
| Rate for Payer: Quartz Commercial |
$1,989.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,836.00
|
| Rate for Payer: The Alliance Commercial |
$12,240.00
|
| Rate for Payer: WEA Trust Commercial |
$1,683.00
|
| Rate for Payer: WPS Commercial |
$2,266.54
|
|
|
SCREW-CANN 7.3 X 50 02.207.450
|
Facility
|
IP
|
$3,060.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967223
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,499.40 |
| Max. Negotiated Rate |
$2,815.20 |
| Rate for Payer: Aetna Commercial |
$2,754.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,631.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,621.80
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Cigna Commercial |
$2,815.20
|
| Rate for Payer: Health EOS Commercial |
$2,723.40
|
| Rate for Payer: HFN Commercial |
$2,815.20
|
| Rate for Payer: Multiplan Commercial |
$2,448.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,836.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,815.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,499.40
|
| Rate for Payer: Quartz Commercial |
$1,836.00
|
| Rate for Payer: WEA Trust Commercial |
$1,683.00
|
| Rate for Payer: WPS Commercial |
$2,266.54
|
|
|
SCREW-CANN 7.3 X 50 02.207.450
|
Facility
|
OP
|
$3,060.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967223
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$856.80 |
| Max. Negotiated Rate |
$12,240.00 |
| Rate for Payer: Aetna Commercial |
$2,754.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,631.60
|
| Rate for Payer: Aetna Managed Medicare |
$856.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,989.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,530.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,468.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,621.80
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Cigna Commercial |
$2,815.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,712.38
|
| Rate for Payer: Health EOS Commercial |
$2,723.40
|
| Rate for Payer: HFN Commercial |
$2,815.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,295.00
|
| Rate for Payer: Multiplan Commercial |
$2,448.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,836.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,815.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,499.40
|
| Rate for Payer: Quartz Commercial |
$1,989.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,836.00
|
| Rate for Payer: The Alliance Commercial |
$12,240.00
|
| Rate for Payer: WEA Trust Commercial |
$1,683.00
|
| Rate for Payer: WPS Commercial |
$2,266.54
|
|
|
SCREW-CANN 7.3 X 55 02.207.055
|
Facility
|
IP
|
$1,233.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967014
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$604.17 |
| Max. Negotiated Rate |
$1,134.36 |
| Rate for Payer: Aetna Commercial |
$1,109.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,060.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$653.49
|
| Rate for Payer: Cash Price |
$369.90
|
| Rate for Payer: Cigna Commercial |
$1,134.36
|
| Rate for Payer: Health EOS Commercial |
$1,097.37
|
| Rate for Payer: HFN Commercial |
$1,134.36
|
| Rate for Payer: Multiplan Commercial |
$986.40
|
| Rate for Payer: NAPHCARE Commercial |
$739.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,134.36
|
| Rate for Payer: Quartz Beloit One Network |
$604.17
|
| Rate for Payer: Quartz Commercial |
$739.80
|
| Rate for Payer: WEA Trust Commercial |
$678.15
|
| Rate for Payer: WPS Commercial |
$913.28
|
|
|
SCREW-CANN 7.3 X 55 02.207.055
|
Facility
|
OP
|
$1,233.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967014
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$345.24 |
| Max. Negotiated Rate |
$4,932.00 |
| Rate for Payer: Aetna Commercial |
$1,109.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,060.38
|
| Rate for Payer: Aetna Managed Medicare |
$345.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$801.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$616.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$591.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$653.49
|
| Rate for Payer: Cash Price |
$369.90
|
| Rate for Payer: Cigna Commercial |
$1,134.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$689.99
|
| Rate for Payer: Health EOS Commercial |
$1,097.37
|
| Rate for Payer: HFN Commercial |
$1,134.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$924.75
|
| Rate for Payer: Multiplan Commercial |
$986.40
|
| Rate for Payer: NAPHCARE Commercial |
$739.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,134.36
|
| Rate for Payer: Quartz Beloit One Network |
$604.17
|
| Rate for Payer: Quartz Commercial |
$801.45
|
| Rate for Payer: Quartz Medicare Advantage |
$739.80
|
| Rate for Payer: The Alliance Commercial |
$4,932.00
|
| Rate for Payer: WEA Trust Commercial |
$678.15
|
| Rate for Payer: WPS Commercial |
$913.28
|
|
|
SCREW-CANN 7.3 X 55 02.207.255
|
Facility
|
OP
|
$3,060.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967234
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$856.80 |
| Max. Negotiated Rate |
$12,240.00 |
| Rate for Payer: Aetna Commercial |
$2,754.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,631.60
|
| Rate for Payer: Aetna Managed Medicare |
$856.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,989.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,530.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,468.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,621.80
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Cigna Commercial |
$2,815.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,712.38
|
| Rate for Payer: Health EOS Commercial |
$2,723.40
|
| Rate for Payer: HFN Commercial |
$2,815.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,295.00
|
| Rate for Payer: Multiplan Commercial |
$2,448.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,836.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,815.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,499.40
|
| Rate for Payer: Quartz Commercial |
$1,989.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,836.00
|
| Rate for Payer: The Alliance Commercial |
$12,240.00
|
| Rate for Payer: WEA Trust Commercial |
$1,683.00
|
| Rate for Payer: WPS Commercial |
$2,266.54
|
|
|
SCREW-CANN 7.3 X 55 02.207.255
|
Facility
|
IP
|
$3,060.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967234
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,499.40 |
| Max. Negotiated Rate |
$2,815.20 |
| Rate for Payer: Aetna Commercial |
$2,754.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,631.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,621.80
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Cigna Commercial |
$2,815.20
|
| Rate for Payer: Health EOS Commercial |
$2,723.40
|
| Rate for Payer: HFN Commercial |
$2,815.20
|
| Rate for Payer: Multiplan Commercial |
$2,448.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,836.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,815.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,499.40
|
| Rate for Payer: Quartz Commercial |
$1,836.00
|
| Rate for Payer: WEA Trust Commercial |
$1,683.00
|
| Rate for Payer: WPS Commercial |
$2,266.54
|
|
|
SCREW-CANN 7.3 X 55 02.207.455
|
Facility
|
IP
|
$3,060.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967224
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,499.40 |
| Max. Negotiated Rate |
$2,815.20 |
| Rate for Payer: Aetna Commercial |
$2,754.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,631.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,621.80
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Cigna Commercial |
$2,815.20
|
| Rate for Payer: Health EOS Commercial |
$2,723.40
|
| Rate for Payer: HFN Commercial |
$2,815.20
|
| Rate for Payer: Multiplan Commercial |
$2,448.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,836.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,815.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,499.40
|
| Rate for Payer: Quartz Commercial |
$1,836.00
|
| Rate for Payer: WEA Trust Commercial |
$1,683.00
|
| Rate for Payer: WPS Commercial |
$2,266.54
|
|
|
SCREW-CANN 7.3 X 55 02.207.455
|
Facility
|
OP
|
$3,060.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967224
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$856.80 |
| Max. Negotiated Rate |
$12,240.00 |
| Rate for Payer: Aetna Commercial |
$2,754.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,631.60
|
| Rate for Payer: Aetna Managed Medicare |
$856.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,989.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,530.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,468.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,621.80
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Cigna Commercial |
$2,815.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,712.38
|
| Rate for Payer: Health EOS Commercial |
$2,723.40
|
| Rate for Payer: HFN Commercial |
$2,815.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,295.00
|
| Rate for Payer: Multiplan Commercial |
$2,448.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,836.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,815.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,499.40
|
| Rate for Payer: Quartz Commercial |
$1,989.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,836.00
|
| Rate for Payer: The Alliance Commercial |
$12,240.00
|
| Rate for Payer: WEA Trust Commercial |
$1,683.00
|
| Rate for Payer: WPS Commercial |
$2,266.54
|
|
|
SCREW-CANN 7.3 X 60 02.207.060
|
Facility
|
IP
|
$1,233.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967015
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$604.17 |
| Max. Negotiated Rate |
$1,134.36 |
| Rate for Payer: Aetna Commercial |
$1,109.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,060.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$653.49
|
| Rate for Payer: Cash Price |
$369.90
|
| Rate for Payer: Cigna Commercial |
$1,134.36
|
| Rate for Payer: Health EOS Commercial |
$1,097.37
|
| Rate for Payer: HFN Commercial |
$1,134.36
|
| Rate for Payer: Multiplan Commercial |
$986.40
|
| Rate for Payer: NAPHCARE Commercial |
$739.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,134.36
|
| Rate for Payer: Quartz Beloit One Network |
$604.17
|
| Rate for Payer: Quartz Commercial |
$739.80
|
| Rate for Payer: WEA Trust Commercial |
$678.15
|
| Rate for Payer: WPS Commercial |
$913.28
|
|
|
SCREW-CANN 7.3 X 60 02.207.060
|
Facility
|
OP
|
$1,233.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967015
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$345.24 |
| Max. Negotiated Rate |
$4,932.00 |
| Rate for Payer: Aetna Commercial |
$1,109.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,060.38
|
| Rate for Payer: Aetna Managed Medicare |
$345.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$801.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$616.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$591.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$653.49
|
| Rate for Payer: Cash Price |
$369.90
|
| Rate for Payer: Cigna Commercial |
$1,134.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$689.99
|
| Rate for Payer: Health EOS Commercial |
$1,097.37
|
| Rate for Payer: HFN Commercial |
$1,134.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$924.75
|
| Rate for Payer: Multiplan Commercial |
$986.40
|
| Rate for Payer: NAPHCARE Commercial |
$739.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,134.36
|
| Rate for Payer: Quartz Beloit One Network |
$604.17
|
| Rate for Payer: Quartz Commercial |
$801.45
|
| Rate for Payer: Quartz Medicare Advantage |
$739.80
|
| Rate for Payer: The Alliance Commercial |
$4,932.00
|
| Rate for Payer: WEA Trust Commercial |
$678.15
|
| Rate for Payer: WPS Commercial |
$913.28
|
|
|
SCREW-CANN 7.3 X 60 02.207.260
|
Facility
|
OP
|
$3,060.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967235
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$856.80 |
| Max. Negotiated Rate |
$12,240.00 |
| Rate for Payer: Aetna Commercial |
$2,754.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,631.60
|
| Rate for Payer: Aetna Managed Medicare |
$856.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,989.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,530.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,468.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,621.80
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Cigna Commercial |
$2,815.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,712.38
|
| Rate for Payer: Health EOS Commercial |
$2,723.40
|
| Rate for Payer: HFN Commercial |
$2,815.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,295.00
|
| Rate for Payer: Multiplan Commercial |
$2,448.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,836.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,815.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,499.40
|
| Rate for Payer: Quartz Commercial |
$1,989.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,836.00
|
| Rate for Payer: The Alliance Commercial |
$12,240.00
|
| Rate for Payer: WEA Trust Commercial |
$1,683.00
|
| Rate for Payer: WPS Commercial |
$2,266.54
|
|
|
SCREW-CANN 7.3 X 60 02.207.260
|
Facility
|
IP
|
$3,060.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967235
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,499.40 |
| Max. Negotiated Rate |
$2,815.20 |
| Rate for Payer: Aetna Commercial |
$2,754.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,631.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,621.80
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Cigna Commercial |
$2,815.20
|
| Rate for Payer: Health EOS Commercial |
$2,723.40
|
| Rate for Payer: HFN Commercial |
$2,815.20
|
| Rate for Payer: Multiplan Commercial |
$2,448.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,836.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,815.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,499.40
|
| Rate for Payer: Quartz Commercial |
$1,836.00
|
| Rate for Payer: WEA Trust Commercial |
$1,683.00
|
| Rate for Payer: WPS Commercial |
$2,266.54
|
|
|
SCREW-CANN 7.3 X 60 02.207.460
|
Facility
|
IP
|
$3,060.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967225
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,499.40 |
| Max. Negotiated Rate |
$2,815.20 |
| Rate for Payer: Aetna Commercial |
$2,754.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,631.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,621.80
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Cigna Commercial |
$2,815.20
|
| Rate for Payer: Health EOS Commercial |
$2,723.40
|
| Rate for Payer: HFN Commercial |
$2,815.20
|
| Rate for Payer: Multiplan Commercial |
$2,448.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,836.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,815.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,499.40
|
| Rate for Payer: Quartz Commercial |
$1,836.00
|
| Rate for Payer: WEA Trust Commercial |
$1,683.00
|
| Rate for Payer: WPS Commercial |
$2,266.54
|
|
|
SCREW-CANN 7.3 X 60 02.207.460
|
Facility
|
OP
|
$3,060.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967225
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$856.80 |
| Max. Negotiated Rate |
$12,240.00 |
| Rate for Payer: Aetna Commercial |
$2,754.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,631.60
|
| Rate for Payer: Aetna Managed Medicare |
$856.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,989.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,530.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,468.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,621.80
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Cigna Commercial |
$2,815.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,712.38
|
| Rate for Payer: Health EOS Commercial |
$2,723.40
|
| Rate for Payer: HFN Commercial |
$2,815.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,295.00
|
| Rate for Payer: Multiplan Commercial |
$2,448.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,836.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,815.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,499.40
|
| Rate for Payer: Quartz Commercial |
$1,989.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,836.00
|
| Rate for Payer: The Alliance Commercial |
$12,240.00
|
| Rate for Payer: WEA Trust Commercial |
$1,683.00
|
| Rate for Payer: WPS Commercial |
$2,266.54
|
|
|
SCREW-CANN 7.3 X 65 02.207.065
|
Facility
|
OP
|
$1,233.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967016
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$345.24 |
| Max. Negotiated Rate |
$4,932.00 |
| Rate for Payer: Aetna Commercial |
$1,109.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,060.38
|
| Rate for Payer: Aetna Managed Medicare |
$345.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$801.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$616.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$591.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$653.49
|
| Rate for Payer: Cash Price |
$369.90
|
| Rate for Payer: Cigna Commercial |
$1,134.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$689.99
|
| Rate for Payer: Health EOS Commercial |
$1,097.37
|
| Rate for Payer: HFN Commercial |
$1,134.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$924.75
|
| Rate for Payer: Multiplan Commercial |
$986.40
|
| Rate for Payer: NAPHCARE Commercial |
$739.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,134.36
|
| Rate for Payer: Quartz Beloit One Network |
$604.17
|
| Rate for Payer: Quartz Commercial |
$801.45
|
| Rate for Payer: Quartz Medicare Advantage |
$739.80
|
| Rate for Payer: The Alliance Commercial |
$4,932.00
|
| Rate for Payer: WEA Trust Commercial |
$678.15
|
| Rate for Payer: WPS Commercial |
$913.28
|
|
|
SCREW-CANN 7.3 X 65 02.207.065
|
Facility
|
IP
|
$1,233.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967016
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$604.17 |
| Max. Negotiated Rate |
$1,134.36 |
| Rate for Payer: Aetna Commercial |
$1,109.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,060.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$653.49
|
| Rate for Payer: Cash Price |
$369.90
|
| Rate for Payer: Cigna Commercial |
$1,134.36
|
| Rate for Payer: Health EOS Commercial |
$1,097.37
|
| Rate for Payer: HFN Commercial |
$1,134.36
|
| Rate for Payer: Multiplan Commercial |
$986.40
|
| Rate for Payer: NAPHCARE Commercial |
$739.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,134.36
|
| Rate for Payer: Quartz Beloit One Network |
$604.17
|
| Rate for Payer: Quartz Commercial |
$739.80
|
| Rate for Payer: WEA Trust Commercial |
$678.15
|
| Rate for Payer: WPS Commercial |
$913.28
|
|
