|
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 |
$1,499.40 |
| 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 85 02.207.485
|
Facility
|
IP
|
$3,060.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967230
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,499.40 |
| 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 85 02.207.485
|
Facility
|
OP
|
$3,060.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967230
|
|
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 90 02.207.090
|
Facility
|
OP
|
$1,233.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967021
|
|
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 90 02.207.090
|
Facility
|
IP
|
$1,233.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967021
|
|
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 90 02.207.290
|
Facility
|
OP
|
$3,060.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967241
|
|
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 90 02.207.290
|
Facility
|
IP
|
$3,060.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967241
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,499.40 |
| 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 90 02.207.490
|
Facility
|
OP
|
$3,060.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967231
|
|
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 90 02.207.490
|
Facility
|
IP
|
$3,060.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967231
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,499.40 |
| 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 95 02.207.095
|
Facility
|
OP
|
$1,233.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967022
|
|
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 95 02.207.095
|
Facility
|
IP
|
$1,233.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967022
|
|
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 95 02.207.295
|
Facility
|
IP
|
$3,060.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967242
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,499.40 |
| 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 95 02.207.295
|
Facility
|
OP
|
$3,060.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967242
|
|
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 95 02.207.495
|
Facility
|
OP
|
$3,060.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967232
|
|
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 95 02.207.495
|
Facility
|
IP
|
$3,060.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967232
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,499.40 |
| 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 AMBI 6.5 X 100MM 121640
|
Facility
|
OP
|
$2,674.00
|
|
| Hospital Charge Code |
2965992
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$748.72 |
| Max. Negotiated Rate |
$10,696.00 |
| Rate for Payer: Aetna Commercial |
$2,406.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,299.64
|
| Rate for Payer: Aetna Managed Medicare |
$748.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,738.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,337.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,283.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,417.22
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cigna Commercial |
$2,460.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,496.37
|
| Rate for Payer: Health EOS Commercial |
$2,379.86
|
| Rate for Payer: HFN Commercial |
$2,460.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,005.50
|
| Rate for Payer: Multiplan Commercial |
$2,139.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,604.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,460.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,310.26
|
| Rate for Payer: Quartz Commercial |
$1,738.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,604.40
|
| Rate for Payer: The Alliance Commercial |
$10,696.00
|
| Rate for Payer: WEA Trust Commercial |
$1,470.70
|
| Rate for Payer: WPS Commercial |
$1,980.63
|
|
|
SCREW-CANN AMBI 6.5 X 100MM 121640
|
Facility
|
IP
|
$2,674.00
|
|
| Hospital Charge Code |
2965992
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,310.26 |
| Max. Negotiated Rate |
$2,460.08 |
| Rate for Payer: Aetna Commercial |
$2,406.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,299.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,417.22
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cigna Commercial |
$2,460.08
|
| Rate for Payer: Health EOS Commercial |
$2,379.86
|
| Rate for Payer: HFN Commercial |
$2,460.08
|
| Rate for Payer: Multiplan Commercial |
$2,139.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,604.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,460.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,310.26
|
| Rate for Payer: Quartz Commercial |
$1,604.40
|
| Rate for Payer: WEA Trust Commercial |
$1,470.70
|
| Rate for Payer: WPS Commercial |
$1,980.63
|
|
|
SCREW-CANN AMBI 6.5 X 105MM 121641
|
Facility
|
OP
|
$2,674.00
|
|
| Hospital Charge Code |
2965993
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$748.72 |
| Max. Negotiated Rate |
$10,696.00 |
| Rate for Payer: Aetna Commercial |
$2,406.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,299.64
|
| Rate for Payer: Aetna Managed Medicare |
$748.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,738.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,337.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,283.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,417.22
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cigna Commercial |
$2,460.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,496.37
|
| Rate for Payer: Health EOS Commercial |
$2,379.86
|
| Rate for Payer: HFN Commercial |
$2,460.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,005.50
|
| Rate for Payer: Multiplan Commercial |
$2,139.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,604.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,460.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,310.26
|
| Rate for Payer: Quartz Commercial |
$1,738.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,604.40
|
| Rate for Payer: The Alliance Commercial |
$10,696.00
|
| Rate for Payer: WEA Trust Commercial |
$1,470.70
|
| Rate for Payer: WPS Commercial |
$1,980.63
|
|
|
SCREW-CANN AMBI 6.5 X 105MM 121641
|
Facility
|
IP
|
$2,674.00
|
|
| Hospital Charge Code |
2965993
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,310.26 |
| Max. Negotiated Rate |
$2,460.08 |
| Rate for Payer: Aetna Commercial |
$2,406.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,299.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,417.22
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cigna Commercial |
$2,460.08
|
| Rate for Payer: Health EOS Commercial |
$2,379.86
|
| Rate for Payer: HFN Commercial |
$2,460.08
|
| Rate for Payer: Multiplan Commercial |
$2,139.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,604.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,460.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,310.26
|
| Rate for Payer: Quartz Commercial |
$1,604.40
|
| Rate for Payer: WEA Trust Commercial |
$1,470.70
|
| Rate for Payer: WPS Commercial |
$1,980.63
|
|
|
SCREW CANN AMBI 6.5 X 110MM 121642
|
Facility
|
OP
|
$2,674.00
|
|
| Hospital Charge Code |
2965994
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$748.72 |
| Max. Negotiated Rate |
$10,696.00 |
| Rate for Payer: Aetna Commercial |
$2,406.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,299.64
|
| Rate for Payer: Aetna Managed Medicare |
$748.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,738.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,337.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,283.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,417.22
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cigna Commercial |
$2,460.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,496.37
|
| Rate for Payer: Health EOS Commercial |
$2,379.86
|
| Rate for Payer: HFN Commercial |
$2,460.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,005.50
|
| Rate for Payer: Multiplan Commercial |
$2,139.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,604.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,460.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,310.26
|
| Rate for Payer: Quartz Commercial |
$1,738.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,604.40
|
| Rate for Payer: The Alliance Commercial |
$10,696.00
|
| Rate for Payer: WEA Trust Commercial |
$1,470.70
|
| Rate for Payer: WPS Commercial |
$1,980.63
|
|
|
SCREW CANN AMBI 6.5 X 110MM 121642
|
Facility
|
IP
|
$2,674.00
|
|
| Hospital Charge Code |
2965994
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,310.26 |
| Max. Negotiated Rate |
$2,460.08 |
| Rate for Payer: Aetna Commercial |
$2,406.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,299.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,417.22
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cigna Commercial |
$2,460.08
|
| Rate for Payer: Health EOS Commercial |
$2,379.86
|
| Rate for Payer: HFN Commercial |
$2,460.08
|
| Rate for Payer: Multiplan Commercial |
$2,139.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,604.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,460.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,310.26
|
| Rate for Payer: Quartz Commercial |
$1,604.40
|
| Rate for Payer: WEA Trust Commercial |
$1,470.70
|
| Rate for Payer: WPS Commercial |
$1,980.63
|
|
|
SCREW-CANN AMBI 6.5 X 30MM 121626
|
Facility
|
OP
|
$2,674.00
|
|
| Hospital Charge Code |
2966038
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$748.72 |
| Max. Negotiated Rate |
$10,696.00 |
| Rate for Payer: Aetna Commercial |
$2,406.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,299.64
|
| Rate for Payer: Aetna Managed Medicare |
$748.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,738.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,337.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,283.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,417.22
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cigna Commercial |
$2,460.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,496.37
|
| Rate for Payer: Health EOS Commercial |
$2,379.86
|
| Rate for Payer: HFN Commercial |
$2,460.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,005.50
|
| Rate for Payer: Multiplan Commercial |
$2,139.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,604.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,460.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,310.26
|
| Rate for Payer: Quartz Commercial |
$1,738.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,604.40
|
| Rate for Payer: The Alliance Commercial |
$10,696.00
|
| Rate for Payer: WEA Trust Commercial |
$1,470.70
|
| Rate for Payer: WPS Commercial |
$1,980.63
|
|
|
SCREW-CANN AMBI 6.5 X 30MM 121626
|
Facility
|
IP
|
$2,674.00
|
|
| Hospital Charge Code |
2966038
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,310.26 |
| Max. Negotiated Rate |
$2,460.08 |
| Rate for Payer: Aetna Commercial |
$2,406.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,299.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,417.22
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cigna Commercial |
$2,460.08
|
| Rate for Payer: Health EOS Commercial |
$2,379.86
|
| Rate for Payer: HFN Commercial |
$2,460.08
|
| Rate for Payer: Multiplan Commercial |
$2,139.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,604.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,460.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,310.26
|
| Rate for Payer: Quartz Commercial |
$1,604.40
|
| Rate for Payer: WEA Trust Commercial |
$1,470.70
|
| Rate for Payer: WPS Commercial |
$1,980.63
|
|
|
SCREW-CANN AMBI 6.5 X 35MM 121627
|
Facility
|
IP
|
$2,674.00
|
|
| Hospital Charge Code |
2965995
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,310.26 |
| Max. Negotiated Rate |
$2,460.08 |
| Rate for Payer: Aetna Commercial |
$2,406.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,299.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,417.22
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cigna Commercial |
$2,460.08
|
| Rate for Payer: Health EOS Commercial |
$2,379.86
|
| Rate for Payer: HFN Commercial |
$2,460.08
|
| Rate for Payer: Multiplan Commercial |
$2,139.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,604.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,460.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,310.26
|
| Rate for Payer: Quartz Commercial |
$1,604.40
|
| Rate for Payer: WEA Trust Commercial |
$1,470.70
|
| Rate for Payer: WPS Commercial |
$1,980.63
|
|
|
SCREW-CANN AMBI 6.5 X 35MM 121627
|
Facility
|
OP
|
$2,674.00
|
|
| Hospital Charge Code |
2965995
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$748.72 |
| Max. Negotiated Rate |
$10,696.00 |
| Rate for Payer: Aetna Commercial |
$2,406.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,299.64
|
| Rate for Payer: Aetna Managed Medicare |
$748.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,738.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,337.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,283.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,417.22
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cigna Commercial |
$2,460.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,496.37
|
| Rate for Payer: Health EOS Commercial |
$2,379.86
|
| Rate for Payer: HFN Commercial |
$2,460.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,005.50
|
| Rate for Payer: Multiplan Commercial |
$2,139.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,604.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,460.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,310.26
|
| Rate for Payer: Quartz Commercial |
$1,738.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,604.40
|
| Rate for Payer: The Alliance Commercial |
$10,696.00
|
| Rate for Payer: WEA Trust Commercial |
$1,470.70
|
| Rate for Payer: WPS Commercial |
$1,980.63
|
|
