|
SCREW CANN 4.0 X 50MM SHORT THREAD LP AR-8840C-50
|
Facility
|
OP
|
$2,196.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5416055
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$614.88 |
| Max. Negotiated Rate |
$8,784.00 |
| Rate for Payer: Aetna Commercial |
$1,976.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,888.56
|
| Rate for Payer: Aetna Managed Medicare |
$614.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,427.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,098.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,054.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,163.88
|
| Rate for Payer: Cash Price |
$658.80
|
| Rate for Payer: Cigna Commercial |
$2,020.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,228.88
|
| Rate for Payer: Health EOS Commercial |
$1,954.44
|
| Rate for Payer: HFN Commercial |
$2,020.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,647.00
|
| Rate for Payer: Multiplan Commercial |
$1,756.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,317.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,020.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,076.04
|
| Rate for Payer: Quartz Commercial |
$1,427.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,317.60
|
| Rate for Payer: The Alliance Commercial |
$8,784.00
|
| Rate for Payer: WEA Trust Commercial |
$1,207.80
|
| Rate for Payer: WPS Commercial |
$1,626.58
|
|
|
SCREW CANN 4.0 X 50MM SHORT THREAD LP AR-8840C-50
|
Facility
|
IP
|
$2,196.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5416055
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,076.04 |
| Max. Negotiated Rate |
$2,020.32 |
| Rate for Payer: Aetna Commercial |
$1,976.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,888.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,163.88
|
| Rate for Payer: Cash Price |
$658.80
|
| Rate for Payer: Cigna Commercial |
$2,020.32
|
| Rate for Payer: Health EOS Commercial |
$1,954.44
|
| Rate for Payer: HFN Commercial |
$2,020.32
|
| Rate for Payer: Multiplan Commercial |
$1,756.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,317.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,020.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,076.04
|
| Rate for Payer: Quartz Commercial |
$1,317.60
|
| Rate for Payer: WEA Trust Commercial |
$1,207.80
|
| Rate for Payer: WPS Commercial |
$1,626.58
|
|
|
SCREW CANN 4.0 X 55MM LONG THREAD LP AR-8840CL-55
|
Facility
|
OP
|
$2,209.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5591386
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$618.52 |
| Max. Negotiated Rate |
$8,836.00 |
| Rate for Payer: Aetna Commercial |
$1,988.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,899.74
|
| Rate for Payer: Aetna Managed Medicare |
$618.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,435.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,104.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,060.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,170.77
|
| Rate for Payer: Cash Price |
$662.70
|
| Rate for Payer: Cigna Commercial |
$2,032.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,236.16
|
| Rate for Payer: Health EOS Commercial |
$1,966.01
|
| Rate for Payer: HFN Commercial |
$2,032.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,656.75
|
| Rate for Payer: Multiplan Commercial |
$1,767.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,325.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,032.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,082.41
|
| Rate for Payer: Quartz Commercial |
$1,435.85
|
| Rate for Payer: Quartz Medicare Advantage |
$1,325.40
|
| Rate for Payer: The Alliance Commercial |
$8,836.00
|
| Rate for Payer: WEA Trust Commercial |
$1,214.95
|
| Rate for Payer: WPS Commercial |
$1,636.21
|
|
|
SCREW CANN 4.0 X 55MM LONG THREAD LP AR-8840CL-55
|
Facility
|
IP
|
$2,209.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5591386
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,082.41 |
| Max. Negotiated Rate |
$2,032.28 |
| Rate for Payer: Aetna Commercial |
$1,988.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,899.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,170.77
|
| Rate for Payer: Cash Price |
$662.70
|
| Rate for Payer: Cigna Commercial |
$2,032.28
|
| Rate for Payer: Health EOS Commercial |
$1,966.01
|
| Rate for Payer: HFN Commercial |
$2,032.28
|
| Rate for Payer: Multiplan Commercial |
$1,767.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,325.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,032.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,082.41
|
| Rate for Payer: Quartz Commercial |
$1,325.40
|
| Rate for Payer: WEA Trust Commercial |
$1,214.95
|
| Rate for Payer: WPS Commercial |
$1,636.21
|
|
|
SCREW CANN 4.0 X 55MM SHORT THREAD LP AR-8840C-55
|
Facility
|
OP
|
$2,196.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5416056
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$614.88 |
| Max. Negotiated Rate |
$8,784.00 |
| Rate for Payer: Aetna Commercial |
$1,976.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,888.56
|
| Rate for Payer: Aetna Managed Medicare |
$614.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,427.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,098.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,054.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,163.88
|
| Rate for Payer: Cash Price |
$658.80
|
| Rate for Payer: Cigna Commercial |
$2,020.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,228.88
|
| Rate for Payer: Health EOS Commercial |
$1,954.44
|
| Rate for Payer: HFN Commercial |
$2,020.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,647.00
|
| Rate for Payer: Multiplan Commercial |
$1,756.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,317.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,020.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,076.04
|
| Rate for Payer: Quartz Commercial |
$1,427.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,317.60
|
| Rate for Payer: The Alliance Commercial |
$8,784.00
|
| Rate for Payer: WEA Trust Commercial |
$1,207.80
|
| Rate for Payer: WPS Commercial |
$1,626.58
|
|
|
SCREW CANN 4.0 X 55MM SHORT THREAD LP AR-8840C-55
|
Facility
|
IP
|
$2,196.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5416056
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,076.04 |
| Max. Negotiated Rate |
$2,020.32 |
| Rate for Payer: Aetna Commercial |
$1,976.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,888.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,163.88
|
| Rate for Payer: Cash Price |
$658.80
|
| Rate for Payer: Cigna Commercial |
$2,020.32
|
| Rate for Payer: Health EOS Commercial |
$1,954.44
|
| Rate for Payer: HFN Commercial |
$2,020.32
|
| Rate for Payer: Multiplan Commercial |
$1,756.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,317.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,020.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,076.04
|
| Rate for Payer: Quartz Commercial |
$1,317.60
|
| Rate for Payer: WEA Trust Commercial |
$1,207.80
|
| Rate for Payer: WPS Commercial |
$1,626.58
|
|
|
SCREW CANN 4.0 X 60MM LONG THREAD LP AR-8840CL-60
|
Facility
|
OP
|
$2,031.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6173857
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$568.68 |
| Max. Negotiated Rate |
$8,124.00 |
| Rate for Payer: Aetna Commercial |
$1,827.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,746.66
|
| Rate for Payer: Aetna Managed Medicare |
$568.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,320.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,015.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$974.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,076.43
|
| Rate for Payer: Cash Price |
$609.30
|
| Rate for Payer: Cigna Commercial |
$1,868.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,136.55
|
| Rate for Payer: Health EOS Commercial |
$1,807.59
|
| Rate for Payer: HFN Commercial |
$1,868.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,523.25
|
| Rate for Payer: Multiplan Commercial |
$1,624.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,218.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,868.52
|
| Rate for Payer: Quartz Beloit One Network |
$995.19
|
| Rate for Payer: Quartz Commercial |
$1,320.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,218.60
|
| Rate for Payer: The Alliance Commercial |
$8,124.00
|
| Rate for Payer: WEA Trust Commercial |
$1,117.05
|
| Rate for Payer: WPS Commercial |
$1,504.36
|
|
|
SCREW CANN 4.0 X 60MM LONG THREAD LP AR-8840CL-60
|
Facility
|
IP
|
$2,031.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6173857
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$995.19 |
| Max. Negotiated Rate |
$1,868.52 |
| Rate for Payer: Aetna Commercial |
$1,827.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,746.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,076.43
|
| Rate for Payer: Cash Price |
$609.30
|
| Rate for Payer: Cigna Commercial |
$1,868.52
|
| Rate for Payer: Health EOS Commercial |
$1,807.59
|
| Rate for Payer: HFN Commercial |
$1,868.52
|
| Rate for Payer: Multiplan Commercial |
$1,624.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,218.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,868.52
|
| Rate for Payer: Quartz Beloit One Network |
$995.19
|
| Rate for Payer: Quartz Commercial |
$1,218.60
|
| Rate for Payer: WEA Trust Commercial |
$1,117.05
|
| Rate for Payer: WPS Commercial |
$1,504.36
|
|
|
SCREW CANN 4.0 X 60MM SHORT THREAD LP AR-8840C-60
|
Facility
|
IP
|
$2,196.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5416057
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,076.04 |
| Max. Negotiated Rate |
$2,020.32 |
| Rate for Payer: Aetna Commercial |
$1,976.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,888.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,163.88
|
| Rate for Payer: Cash Price |
$658.80
|
| Rate for Payer: Cigna Commercial |
$2,020.32
|
| Rate for Payer: Health EOS Commercial |
$1,954.44
|
| Rate for Payer: HFN Commercial |
$2,020.32
|
| Rate for Payer: Multiplan Commercial |
$1,756.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,317.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,020.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,076.04
|
| Rate for Payer: Quartz Commercial |
$1,317.60
|
| Rate for Payer: WEA Trust Commercial |
$1,207.80
|
| Rate for Payer: WPS Commercial |
$1,626.58
|
|
|
SCREW CANN 4.0 X 60MM SHORT THREAD LP AR-8840C-60
|
Facility
|
OP
|
$2,196.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5416057
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$614.88 |
| Max. Negotiated Rate |
$8,784.00 |
| Rate for Payer: Aetna Commercial |
$1,976.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,888.56
|
| Rate for Payer: Aetna Managed Medicare |
$614.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,427.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,098.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,054.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,163.88
|
| Rate for Payer: Cash Price |
$658.80
|
| Rate for Payer: Cigna Commercial |
$2,020.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,228.88
|
| Rate for Payer: Health EOS Commercial |
$1,954.44
|
| Rate for Payer: HFN Commercial |
$2,020.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,647.00
|
| Rate for Payer: Multiplan Commercial |
$1,756.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,317.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,020.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,076.04
|
| Rate for Payer: Quartz Commercial |
$1,427.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,317.60
|
| Rate for Payer: The Alliance Commercial |
$8,784.00
|
| Rate for Payer: WEA Trust Commercial |
$1,207.80
|
| Rate for Payer: WPS Commercial |
$1,626.58
|
|
|
SCREW CANN 4.0 X 70MM PARTIAL THREAD STRYKER 604670
|
Facility
|
OP
|
$1,811.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6185027
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$507.08 |
| Max. Negotiated Rate |
$7,244.00 |
| Rate for Payer: Aetna Commercial |
$1,629.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,557.46
|
| Rate for Payer: Aetna Managed Medicare |
$507.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,177.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$905.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$869.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$959.83
|
| Rate for Payer: Cash Price |
$543.30
|
| Rate for Payer: Cigna Commercial |
$1,666.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,013.44
|
| Rate for Payer: Health EOS Commercial |
$1,611.79
|
| Rate for Payer: HFN Commercial |
$1,666.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,358.25
|
| Rate for Payer: Multiplan Commercial |
$1,448.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,086.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,666.12
|
| Rate for Payer: Quartz Beloit One Network |
$887.39
|
| Rate for Payer: Quartz Commercial |
$1,177.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,086.60
|
| Rate for Payer: The Alliance Commercial |
$7,244.00
|
| Rate for Payer: WEA Trust Commercial |
$996.05
|
| Rate for Payer: WPS Commercial |
$1,341.41
|
|
|
SCREW CANN 4.0 X 70MM PARTIAL THREAD STRYKER 604670
|
Facility
|
IP
|
$1,811.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6185027
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$887.39 |
| Max. Negotiated Rate |
$1,666.12 |
| Rate for Payer: Aetna Commercial |
$1,629.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,557.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$959.83
|
| Rate for Payer: Cash Price |
$543.30
|
| Rate for Payer: Cigna Commercial |
$1,666.12
|
| Rate for Payer: Health EOS Commercial |
$1,611.79
|
| Rate for Payer: HFN Commercial |
$1,666.12
|
| Rate for Payer: Multiplan Commercial |
$1,448.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,086.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,666.12
|
| Rate for Payer: Quartz Beloit One Network |
$887.39
|
| Rate for Payer: Quartz Commercial |
$1,086.60
|
| Rate for Payer: WEA Trust Commercial |
$996.05
|
| Rate for Payer: WPS Commercial |
$1,341.41
|
|
|
SCREW-CANN 4.5 X 20 214.520
|
Facility
|
IP
|
$1,875.00
|
|
| Hospital Charge Code |
2967167
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$918.75 |
| Max. Negotiated Rate |
$1,725.00 |
| Rate for Payer: Aetna Commercial |
$1,687.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,612.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$993.75
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,725.00
|
| Rate for Payer: Health EOS Commercial |
$1,668.75
|
| Rate for Payer: HFN Commercial |
$1,725.00
|
| Rate for Payer: Multiplan Commercial |
$1,500.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,125.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,725.00
|
| Rate for Payer: Quartz Beloit One Network |
$918.75
|
| Rate for Payer: Quartz Commercial |
$1,125.00
|
| Rate for Payer: WEA Trust Commercial |
$1,031.25
|
| Rate for Payer: WPS Commercial |
$1,388.81
|
|
|
SCREW-CANN 4.5 X 20 214.520
|
Facility
|
OP
|
$1,875.00
|
|
| Hospital Charge Code |
2967167
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$7,500.00 |
| Rate for Payer: Aetna Commercial |
$1,687.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,612.50
|
| Rate for Payer: Aetna Managed Medicare |
$525.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,218.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$937.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$993.75
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,725.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,049.25
|
| Rate for Payer: Health EOS Commercial |
$1,668.75
|
| Rate for Payer: HFN Commercial |
$1,725.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,406.25
|
| Rate for Payer: Multiplan Commercial |
$1,500.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,125.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,725.00
|
| Rate for Payer: Quartz Beloit One Network |
$918.75
|
| Rate for Payer: Quartz Commercial |
$1,218.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,125.00
|
| Rate for Payer: The Alliance Commercial |
$7,500.00
|
| Rate for Payer: WEA Trust Commercial |
$1,031.25
|
| Rate for Payer: WPS Commercial |
$1,388.81
|
|
|
SCREW-CANN 4.5 X 20 214.720
|
Facility
|
OP
|
$1,875.00
|
|
| Hospital Charge Code |
2967168
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$7,500.00 |
| Rate for Payer: Aetna Commercial |
$1,687.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,612.50
|
| Rate for Payer: Aetna Managed Medicare |
$525.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,218.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$937.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$993.75
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,725.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,049.25
|
| Rate for Payer: Health EOS Commercial |
$1,668.75
|
| Rate for Payer: HFN Commercial |
$1,725.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,406.25
|
| Rate for Payer: Multiplan Commercial |
$1,500.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,125.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,725.00
|
| Rate for Payer: Quartz Beloit One Network |
$918.75
|
| Rate for Payer: Quartz Commercial |
$1,218.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,125.00
|
| Rate for Payer: The Alliance Commercial |
$7,500.00
|
| Rate for Payer: WEA Trust Commercial |
$1,031.25
|
| Rate for Payer: WPS Commercial |
$1,388.81
|
|
|
SCREW-CANN 4.5 X 20 214.720
|
Facility
|
IP
|
$1,875.00
|
|
| Hospital Charge Code |
2967168
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$918.75 |
| Max. Negotiated Rate |
$1,725.00 |
| Rate for Payer: Aetna Commercial |
$1,687.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,612.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$993.75
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,725.00
|
| Rate for Payer: Health EOS Commercial |
$1,668.75
|
| Rate for Payer: HFN Commercial |
$1,725.00
|
| Rate for Payer: Multiplan Commercial |
$1,500.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,125.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,725.00
|
| Rate for Payer: Quartz Beloit One Network |
$918.75
|
| Rate for Payer: Quartz Commercial |
$1,125.00
|
| Rate for Payer: WEA Trust Commercial |
$1,031.25
|
| Rate for Payer: WPS Commercial |
$1,388.81
|
|
|
SCREW-CANN 4.5 X 22 214.522
|
Facility
|
IP
|
$1,875.00
|
|
| Hospital Charge Code |
2967169
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$918.75 |
| Max. Negotiated Rate |
$1,725.00 |
| Rate for Payer: Aetna Commercial |
$1,687.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,612.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$993.75
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,725.00
|
| Rate for Payer: Health EOS Commercial |
$1,668.75
|
| Rate for Payer: HFN Commercial |
$1,725.00
|
| Rate for Payer: Multiplan Commercial |
$1,500.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,125.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,725.00
|
| Rate for Payer: Quartz Beloit One Network |
$918.75
|
| Rate for Payer: Quartz Commercial |
$1,125.00
|
| Rate for Payer: WEA Trust Commercial |
$1,031.25
|
| Rate for Payer: WPS Commercial |
$1,388.81
|
|
|
SCREW-CANN 4.5 X 22 214.522
|
Facility
|
OP
|
$1,875.00
|
|
| Hospital Charge Code |
2967169
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$7,500.00 |
| Rate for Payer: Aetna Commercial |
$1,687.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,612.50
|
| Rate for Payer: Aetna Managed Medicare |
$525.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,218.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$937.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$993.75
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,725.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,049.25
|
| Rate for Payer: Health EOS Commercial |
$1,668.75
|
| Rate for Payer: HFN Commercial |
$1,725.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,406.25
|
| Rate for Payer: Multiplan Commercial |
$1,500.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,125.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,725.00
|
| Rate for Payer: Quartz Beloit One Network |
$918.75
|
| Rate for Payer: Quartz Commercial |
$1,218.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,125.00
|
| Rate for Payer: The Alliance Commercial |
$7,500.00
|
| Rate for Payer: WEA Trust Commercial |
$1,031.25
|
| Rate for Payer: WPS Commercial |
$1,388.81
|
|
|
SCREW-CANN 4.5 X 22 214.722
|
Facility
|
IP
|
$1,875.00
|
|
| Hospital Charge Code |
2967170
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$918.75 |
| Max. Negotiated Rate |
$1,725.00 |
| Rate for Payer: Aetna Commercial |
$1,687.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,612.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$993.75
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,725.00
|
| Rate for Payer: Health EOS Commercial |
$1,668.75
|
| Rate for Payer: HFN Commercial |
$1,725.00
|
| Rate for Payer: Multiplan Commercial |
$1,500.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,125.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,725.00
|
| Rate for Payer: Quartz Beloit One Network |
$918.75
|
| Rate for Payer: Quartz Commercial |
$1,125.00
|
| Rate for Payer: WEA Trust Commercial |
$1,031.25
|
| Rate for Payer: WPS Commercial |
$1,388.81
|
|
|
SCREW-CANN 4.5 X 22 214.722
|
Facility
|
OP
|
$1,875.00
|
|
| Hospital Charge Code |
2967170
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$7,500.00 |
| Rate for Payer: Aetna Commercial |
$1,687.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,612.50
|
| Rate for Payer: Aetna Managed Medicare |
$525.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,218.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$937.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$993.75
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,725.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,049.25
|
| Rate for Payer: Health EOS Commercial |
$1,668.75
|
| Rate for Payer: HFN Commercial |
$1,725.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,406.25
|
| Rate for Payer: Multiplan Commercial |
$1,500.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,125.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,725.00
|
| Rate for Payer: Quartz Beloit One Network |
$918.75
|
| Rate for Payer: Quartz Commercial |
$1,218.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,125.00
|
| Rate for Payer: The Alliance Commercial |
$7,500.00
|
| Rate for Payer: WEA Trust Commercial |
$1,031.25
|
| Rate for Payer: WPS Commercial |
$1,388.81
|
|
|
SCREW-CANN 4.5 X 24 214.524
|
Facility
|
IP
|
$1,875.00
|
|
| Hospital Charge Code |
2967171
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$918.75 |
| Max. Negotiated Rate |
$1,725.00 |
| Rate for Payer: Aetna Commercial |
$1,687.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,612.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$993.75
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,725.00
|
| Rate for Payer: Health EOS Commercial |
$1,668.75
|
| Rate for Payer: HFN Commercial |
$1,725.00
|
| Rate for Payer: Multiplan Commercial |
$1,500.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,125.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,725.00
|
| Rate for Payer: Quartz Beloit One Network |
$918.75
|
| Rate for Payer: Quartz Commercial |
$1,125.00
|
| Rate for Payer: WEA Trust Commercial |
$1,031.25
|
| Rate for Payer: WPS Commercial |
$1,388.81
|
|
|
SCREW-CANN 4.5 X 24 214.524
|
Facility
|
OP
|
$1,875.00
|
|
| Hospital Charge Code |
2967171
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$7,500.00 |
| Rate for Payer: Aetna Commercial |
$1,687.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,612.50
|
| Rate for Payer: Aetna Managed Medicare |
$525.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,218.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$937.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$993.75
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,725.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,049.25
|
| Rate for Payer: Health EOS Commercial |
$1,668.75
|
| Rate for Payer: HFN Commercial |
$1,725.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,406.25
|
| Rate for Payer: Multiplan Commercial |
$1,500.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,125.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,725.00
|
| Rate for Payer: Quartz Beloit One Network |
$918.75
|
| Rate for Payer: Quartz Commercial |
$1,218.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,125.00
|
| Rate for Payer: The Alliance Commercial |
$7,500.00
|
| Rate for Payer: WEA Trust Commercial |
$1,031.25
|
| Rate for Payer: WPS Commercial |
$1,388.81
|
|
|
SCREW-CANN 4.5 X 24 214.724
|
Facility
|
IP
|
$1,875.00
|
|
| Hospital Charge Code |
2967172
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$918.75 |
| Max. Negotiated Rate |
$1,725.00 |
| Rate for Payer: Aetna Commercial |
$1,687.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,612.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$993.75
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,725.00
|
| Rate for Payer: Health EOS Commercial |
$1,668.75
|
| Rate for Payer: HFN Commercial |
$1,725.00
|
| Rate for Payer: Multiplan Commercial |
$1,500.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,125.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,725.00
|
| Rate for Payer: Quartz Beloit One Network |
$918.75
|
| Rate for Payer: Quartz Commercial |
$1,125.00
|
| Rate for Payer: WEA Trust Commercial |
$1,031.25
|
| Rate for Payer: WPS Commercial |
$1,388.81
|
|
|
SCREW-CANN 4.5 X 24 214.724
|
Facility
|
OP
|
$1,875.00
|
|
| Hospital Charge Code |
2967172
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$7,500.00 |
| Rate for Payer: Aetna Commercial |
$1,687.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,612.50
|
| Rate for Payer: Aetna Managed Medicare |
$525.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,218.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$937.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$993.75
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,725.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,049.25
|
| Rate for Payer: Health EOS Commercial |
$1,668.75
|
| Rate for Payer: HFN Commercial |
$1,725.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,406.25
|
| Rate for Payer: Multiplan Commercial |
$1,500.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,125.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,725.00
|
| Rate for Payer: Quartz Beloit One Network |
$918.75
|
| Rate for Payer: Quartz Commercial |
$1,218.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,125.00
|
| Rate for Payer: The Alliance Commercial |
$7,500.00
|
| Rate for Payer: WEA Trust Commercial |
$1,031.25
|
| Rate for Payer: WPS Commercial |
$1,388.81
|
|
|
SCREW-CANN 4.5 X 26 214.526
|
Facility
|
OP
|
$1,875.00
|
|
| Hospital Charge Code |
2967173
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$7,500.00 |
| Rate for Payer: Aetna Commercial |
$1,687.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,612.50
|
| Rate for Payer: Aetna Managed Medicare |
$525.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,218.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$937.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$993.75
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,725.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,049.25
|
| Rate for Payer: Health EOS Commercial |
$1,668.75
|
| Rate for Payer: HFN Commercial |
$1,725.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,406.25
|
| Rate for Payer: Multiplan Commercial |
$1,500.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,125.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,725.00
|
| Rate for Payer: Quartz Beloit One Network |
$918.75
|
| Rate for Payer: Quartz Commercial |
$1,218.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,125.00
|
| Rate for Payer: The Alliance Commercial |
$7,500.00
|
| Rate for Payer: WEA Trust Commercial |
$1,031.25
|
| Rate for Payer: WPS Commercial |
$1,388.81
|
|
