|
SCREW CANN LOCK 3.7 X 32MM 02.240.032
|
Facility
|
OP
|
$2,752.00
|
|
| Hospital Charge Code |
2966503
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$770.56 |
| Max. Negotiated Rate |
$11,008.00 |
| Rate for Payer: Aetna Commercial |
$2,476.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,366.72
|
| Rate for Payer: Aetna Managed Medicare |
$770.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,788.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,376.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,320.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,458.56
|
| Rate for Payer: Cash Price |
$825.60
|
| Rate for Payer: Cigna Commercial |
$2,531.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,540.02
|
| Rate for Payer: Health EOS Commercial |
$2,449.28
|
| Rate for Payer: HFN Commercial |
$2,531.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,064.00
|
| Rate for Payer: Multiplan Commercial |
$2,201.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,651.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,531.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,348.48
|
| Rate for Payer: Quartz Commercial |
$1,788.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,651.20
|
| Rate for Payer: The Alliance Commercial |
$11,008.00
|
| Rate for Payer: WEA Trust Commercial |
$1,513.60
|
| Rate for Payer: WPS Commercial |
$2,038.41
|
|
|
SCREW CANN LOCK 3.7 X 32MM 02.240.032
|
Facility
|
IP
|
$2,752.00
|
|
| Hospital Charge Code |
2966503
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,348.48 |
| Max. Negotiated Rate |
$2,531.84 |
| Rate for Payer: Aetna Commercial |
$2,476.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,366.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,458.56
|
| Rate for Payer: Cash Price |
$825.60
|
| Rate for Payer: Cigna Commercial |
$2,531.84
|
| Rate for Payer: Health EOS Commercial |
$2,449.28
|
| Rate for Payer: HFN Commercial |
$2,531.84
|
| Rate for Payer: Multiplan Commercial |
$2,201.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,651.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,531.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,348.48
|
| Rate for Payer: Quartz Commercial |
$1,651.20
|
| Rate for Payer: WEA Trust Commercial |
$1,513.60
|
| Rate for Payer: WPS Commercial |
$2,038.41
|
|
|
SCREW CANN LOCK 3.7 X 34MM 02.240.034
|
Facility
|
OP
|
$2,752.00
|
|
| Hospital Charge Code |
3072473
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$770.56 |
| Max. Negotiated Rate |
$11,008.00 |
| Rate for Payer: Aetna Commercial |
$2,476.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,366.72
|
| Rate for Payer: Aetna Managed Medicare |
$770.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,788.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,376.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,320.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,458.56
|
| Rate for Payer: Cash Price |
$825.60
|
| Rate for Payer: Cigna Commercial |
$2,531.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,540.02
|
| Rate for Payer: Health EOS Commercial |
$2,449.28
|
| Rate for Payer: HFN Commercial |
$2,531.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,064.00
|
| Rate for Payer: Multiplan Commercial |
$2,201.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,651.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,531.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,348.48
|
| Rate for Payer: Quartz Commercial |
$1,788.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,651.20
|
| Rate for Payer: The Alliance Commercial |
$11,008.00
|
| Rate for Payer: WEA Trust Commercial |
$1,513.60
|
| Rate for Payer: WPS Commercial |
$2,038.41
|
|
|
SCREW CANN LOCK 3.7 X 34MM 02.240.034
|
Facility
|
IP
|
$2,752.00
|
|
| Hospital Charge Code |
3072473
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,348.48 |
| Max. Negotiated Rate |
$2,531.84 |
| Rate for Payer: Aetna Commercial |
$2,476.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,366.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,458.56
|
| Rate for Payer: Cash Price |
$825.60
|
| Rate for Payer: Cigna Commercial |
$2,531.84
|
| Rate for Payer: Health EOS Commercial |
$2,449.28
|
| Rate for Payer: HFN Commercial |
$2,531.84
|
| Rate for Payer: Multiplan Commercial |
$2,201.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,651.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,531.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,348.48
|
| Rate for Payer: Quartz Commercial |
$1,651.20
|
| Rate for Payer: WEA Trust Commercial |
$1,513.60
|
| Rate for Payer: WPS Commercial |
$2,038.41
|
|
|
SCREW CANN LOCK 3.7 X 36MM 02.240.036
|
Facility
|
IP
|
$2,752.00
|
|
| Hospital Charge Code |
3072510
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,348.48 |
| Max. Negotiated Rate |
$2,531.84 |
| Rate for Payer: Aetna Commercial |
$2,476.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,366.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,458.56
|
| Rate for Payer: Cash Price |
$825.60
|
| Rate for Payer: Cigna Commercial |
$2,531.84
|
| Rate for Payer: Health EOS Commercial |
$2,449.28
|
| Rate for Payer: HFN Commercial |
$2,531.84
|
| Rate for Payer: Multiplan Commercial |
$2,201.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,651.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,531.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,348.48
|
| Rate for Payer: Quartz Commercial |
$1,651.20
|
| Rate for Payer: WEA Trust Commercial |
$1,513.60
|
| Rate for Payer: WPS Commercial |
$2,038.41
|
|
|
SCREW CANN LOCK 3.7 X 36MM 02.240.036
|
Facility
|
OP
|
$2,752.00
|
|
| Hospital Charge Code |
3072510
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$770.56 |
| Max. Negotiated Rate |
$11,008.00 |
| Rate for Payer: Aetna Commercial |
$2,476.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,366.72
|
| Rate for Payer: Aetna Managed Medicare |
$770.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,788.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,376.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,320.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,458.56
|
| Rate for Payer: Cash Price |
$825.60
|
| Rate for Payer: Cigna Commercial |
$2,531.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,540.02
|
| Rate for Payer: Health EOS Commercial |
$2,449.28
|
| Rate for Payer: HFN Commercial |
$2,531.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,064.00
|
| Rate for Payer: Multiplan Commercial |
$2,201.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,651.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,531.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,348.48
|
| Rate for Payer: Quartz Commercial |
$1,788.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,651.20
|
| Rate for Payer: The Alliance Commercial |
$11,008.00
|
| Rate for Payer: WEA Trust Commercial |
$1,513.60
|
| Rate for Payer: WPS Commercial |
$2,038.41
|
|
|
SCREW CANN LOCK 3.7 X 38MM 02.240.038
|
Facility
|
OP
|
$2,953.00
|
|
| Hospital Charge Code |
2966504
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$826.84 |
| Max. Negotiated Rate |
$11,812.00 |
| Rate for Payer: Aetna Commercial |
$2,657.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,539.58
|
| Rate for Payer: Aetna Managed Medicare |
$826.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,919.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,476.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,417.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,565.09
|
| Rate for Payer: Cash Price |
$885.90
|
| Rate for Payer: Cigna Commercial |
$2,716.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,652.50
|
| Rate for Payer: Health EOS Commercial |
$2,628.17
|
| Rate for Payer: HFN Commercial |
$2,716.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,214.75
|
| Rate for Payer: Multiplan Commercial |
$2,362.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,771.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,716.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,446.97
|
| Rate for Payer: Quartz Commercial |
$1,919.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,771.80
|
| Rate for Payer: The Alliance Commercial |
$11,812.00
|
| Rate for Payer: WEA Trust Commercial |
$1,624.15
|
| Rate for Payer: WPS Commercial |
$2,187.29
|
|
|
SCREW CANN LOCK 3.7 X 38MM 02.240.038
|
Facility
|
IP
|
$2,953.00
|
|
| Hospital Charge Code |
2966504
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,446.97 |
| Max. Negotiated Rate |
$2,716.76 |
| Rate for Payer: Aetna Commercial |
$2,657.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,539.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,565.09
|
| Rate for Payer: Cash Price |
$885.90
|
| Rate for Payer: Cigna Commercial |
$2,716.76
|
| Rate for Payer: Health EOS Commercial |
$2,628.17
|
| Rate for Payer: HFN Commercial |
$2,716.76
|
| Rate for Payer: Multiplan Commercial |
$2,362.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,771.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,716.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,446.97
|
| Rate for Payer: Quartz Commercial |
$1,771.80
|
| Rate for Payer: WEA Trust Commercial |
$1,624.15
|
| Rate for Payer: WPS Commercial |
$2,187.29
|
|
|
SCREW CANN LOCK 3.7 X 40MM 02.240.040
|
Facility
|
IP
|
$2,752.00
|
|
| Hospital Charge Code |
2966505
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,348.48 |
| Max. Negotiated Rate |
$2,531.84 |
| Rate for Payer: Aetna Commercial |
$2,476.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,366.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,458.56
|
| Rate for Payer: Cash Price |
$825.60
|
| Rate for Payer: Cigna Commercial |
$2,531.84
|
| Rate for Payer: Health EOS Commercial |
$2,449.28
|
| Rate for Payer: HFN Commercial |
$2,531.84
|
| Rate for Payer: Multiplan Commercial |
$2,201.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,651.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,531.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,348.48
|
| Rate for Payer: Quartz Commercial |
$1,651.20
|
| Rate for Payer: WEA Trust Commercial |
$1,513.60
|
| Rate for Payer: WPS Commercial |
$2,038.41
|
|
|
SCREW CANN LOCK 3.7 X 40MM 02.240.040
|
Facility
|
OP
|
$2,752.00
|
|
| Hospital Charge Code |
2966505
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$770.56 |
| Max. Negotiated Rate |
$11,008.00 |
| Rate for Payer: Aetna Commercial |
$2,476.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,366.72
|
| Rate for Payer: Aetna Managed Medicare |
$770.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,788.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,376.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,320.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,458.56
|
| Rate for Payer: Cash Price |
$825.60
|
| Rate for Payer: Cigna Commercial |
$2,531.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,540.02
|
| Rate for Payer: Health EOS Commercial |
$2,449.28
|
| Rate for Payer: HFN Commercial |
$2,531.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,064.00
|
| Rate for Payer: Multiplan Commercial |
$2,201.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,651.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,531.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,348.48
|
| Rate for Payer: Quartz Commercial |
$1,788.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,651.20
|
| Rate for Payer: The Alliance Commercial |
$11,008.00
|
| Rate for Payer: WEA Trust Commercial |
$1,513.60
|
| Rate for Payer: WPS Commercial |
$2,038.41
|
|
|
SCREW CANN LOCK 3.7 X 42MM 02.240.042
|
Facility
|
IP
|
$2,752.00
|
|
| Hospital Charge Code |
2966506
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,348.48 |
| Max. Negotiated Rate |
$2,531.84 |
| Rate for Payer: Aetna Commercial |
$2,476.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,366.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,458.56
|
| Rate for Payer: Cash Price |
$825.60
|
| Rate for Payer: Cigna Commercial |
$2,531.84
|
| Rate for Payer: Health EOS Commercial |
$2,449.28
|
| Rate for Payer: HFN Commercial |
$2,531.84
|
| Rate for Payer: Multiplan Commercial |
$2,201.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,651.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,531.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,348.48
|
| Rate for Payer: Quartz Commercial |
$1,651.20
|
| Rate for Payer: WEA Trust Commercial |
$1,513.60
|
| Rate for Payer: WPS Commercial |
$2,038.41
|
|
|
SCREW CANN LOCK 3.7 X 42MM 02.240.042
|
Facility
|
OP
|
$2,752.00
|
|
| Hospital Charge Code |
2966506
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$770.56 |
| Max. Negotiated Rate |
$11,008.00 |
| Rate for Payer: Aetna Commercial |
$2,476.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,366.72
|
| Rate for Payer: Aetna Managed Medicare |
$770.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,788.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,376.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,320.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,458.56
|
| Rate for Payer: Cash Price |
$825.60
|
| Rate for Payer: Cigna Commercial |
$2,531.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,540.02
|
| Rate for Payer: Health EOS Commercial |
$2,449.28
|
| Rate for Payer: HFN Commercial |
$2,531.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,064.00
|
| Rate for Payer: Multiplan Commercial |
$2,201.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,651.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,531.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,348.48
|
| Rate for Payer: Quartz Commercial |
$1,788.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,651.20
|
| Rate for Payer: The Alliance Commercial |
$11,008.00
|
| Rate for Payer: WEA Trust Commercial |
$1,513.60
|
| Rate for Payer: WPS Commercial |
$2,038.41
|
|
|
SCREW CANN LOCK 3.7 X 44MM 02.240.044
|
Facility
|
OP
|
$2,752.00
|
|
| Hospital Charge Code |
2966507
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$770.56 |
| Max. Negotiated Rate |
$11,008.00 |
| Rate for Payer: Aetna Commercial |
$2,476.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,366.72
|
| Rate for Payer: Aetna Managed Medicare |
$770.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,788.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,376.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,320.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,458.56
|
| Rate for Payer: Cash Price |
$825.60
|
| Rate for Payer: Cigna Commercial |
$2,531.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,540.02
|
| Rate for Payer: Health EOS Commercial |
$2,449.28
|
| Rate for Payer: HFN Commercial |
$2,531.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,064.00
|
| Rate for Payer: Multiplan Commercial |
$2,201.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,651.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,531.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,348.48
|
| Rate for Payer: Quartz Commercial |
$1,788.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,651.20
|
| Rate for Payer: The Alliance Commercial |
$11,008.00
|
| Rate for Payer: WEA Trust Commercial |
$1,513.60
|
| Rate for Payer: WPS Commercial |
$2,038.41
|
|
|
SCREW CANN LOCK 3.7 X 44MM 02.240.044
|
Facility
|
IP
|
$2,752.00
|
|
| Hospital Charge Code |
2966507
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,348.48 |
| Max. Negotiated Rate |
$2,531.84 |
| Rate for Payer: Aetna Commercial |
$2,476.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,366.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,458.56
|
| Rate for Payer: Cash Price |
$825.60
|
| Rate for Payer: Cigna Commercial |
$2,531.84
|
| Rate for Payer: Health EOS Commercial |
$2,449.28
|
| Rate for Payer: HFN Commercial |
$2,531.84
|
| Rate for Payer: Multiplan Commercial |
$2,201.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,651.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,531.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,348.48
|
| Rate for Payer: Quartz Commercial |
$1,651.20
|
| Rate for Payer: WEA Trust Commercial |
$1,513.60
|
| Rate for Payer: WPS Commercial |
$2,038.41
|
|
|
SCREW CANN LOCK 3.7 X 46MM 02.240.046
|
Facility
|
IP
|
$2,752.00
|
|
| Hospital Charge Code |
2966508
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,348.48 |
| Max. Negotiated Rate |
$2,531.84 |
| Rate for Payer: Aetna Commercial |
$2,476.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,366.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,458.56
|
| Rate for Payer: Cash Price |
$825.60
|
| Rate for Payer: Cigna Commercial |
$2,531.84
|
| Rate for Payer: Health EOS Commercial |
$2,449.28
|
| Rate for Payer: HFN Commercial |
$2,531.84
|
| Rate for Payer: Multiplan Commercial |
$2,201.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,651.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,531.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,348.48
|
| Rate for Payer: Quartz Commercial |
$1,651.20
|
| Rate for Payer: WEA Trust Commercial |
$1,513.60
|
| Rate for Payer: WPS Commercial |
$2,038.41
|
|
|
SCREW CANN LOCK 3.7 X 46MM 02.240.046
|
Facility
|
OP
|
$2,752.00
|
|
| Hospital Charge Code |
2966508
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$770.56 |
| Max. Negotiated Rate |
$11,008.00 |
| Rate for Payer: Aetna Commercial |
$2,476.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,366.72
|
| Rate for Payer: Aetna Managed Medicare |
$770.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,788.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,376.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,320.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,458.56
|
| Rate for Payer: Cash Price |
$825.60
|
| Rate for Payer: Cigna Commercial |
$2,531.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,540.02
|
| Rate for Payer: Health EOS Commercial |
$2,449.28
|
| Rate for Payer: HFN Commercial |
$2,531.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,064.00
|
| Rate for Payer: Multiplan Commercial |
$2,201.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,651.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,531.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,348.48
|
| Rate for Payer: Quartz Commercial |
$1,788.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,651.20
|
| Rate for Payer: The Alliance Commercial |
$11,008.00
|
| Rate for Payer: WEA Trust Commercial |
$1,513.60
|
| Rate for Payer: WPS Commercial |
$2,038.41
|
|
|
SCREW CANN LOCK 3.7 X 48MM 02.240.048
|
Facility
|
IP
|
$2,752.00
|
|
| Hospital Charge Code |
2966509
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,348.48 |
| Max. Negotiated Rate |
$2,531.84 |
| Rate for Payer: Aetna Commercial |
$2,476.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,366.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,458.56
|
| Rate for Payer: Cash Price |
$825.60
|
| Rate for Payer: Cigna Commercial |
$2,531.84
|
| Rate for Payer: Health EOS Commercial |
$2,449.28
|
| Rate for Payer: HFN Commercial |
$2,531.84
|
| Rate for Payer: Multiplan Commercial |
$2,201.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,651.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,531.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,348.48
|
| Rate for Payer: Quartz Commercial |
$1,651.20
|
| Rate for Payer: WEA Trust Commercial |
$1,513.60
|
| Rate for Payer: WPS Commercial |
$2,038.41
|
|
|
SCREW CANN LOCK 3.7 X 48MM 02.240.048
|
Facility
|
OP
|
$2,752.00
|
|
| Hospital Charge Code |
2966509
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$770.56 |
| Max. Negotiated Rate |
$11,008.00 |
| Rate for Payer: Aetna Commercial |
$2,476.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,366.72
|
| Rate for Payer: Aetna Managed Medicare |
$770.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,788.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,376.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,320.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,458.56
|
| Rate for Payer: Cash Price |
$825.60
|
| Rate for Payer: Cigna Commercial |
$2,531.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,540.02
|
| Rate for Payer: Health EOS Commercial |
$2,449.28
|
| Rate for Payer: HFN Commercial |
$2,531.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,064.00
|
| Rate for Payer: Multiplan Commercial |
$2,201.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,651.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,531.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,348.48
|
| Rate for Payer: Quartz Commercial |
$1,788.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,651.20
|
| Rate for Payer: The Alliance Commercial |
$11,008.00
|
| Rate for Payer: WEA Trust Commercial |
$1,513.60
|
| Rate for Payer: WPS Commercial |
$2,038.41
|
|
|
SCREW CANN LOCK 3.7 X 50MM 02.240.050
|
Facility
|
OP
|
$2,953.00
|
|
| Hospital Charge Code |
2966510
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$826.84 |
| Max. Negotiated Rate |
$11,812.00 |
| Rate for Payer: Aetna Commercial |
$2,657.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,539.58
|
| Rate for Payer: Aetna Managed Medicare |
$826.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,919.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,476.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,417.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,565.09
|
| Rate for Payer: Cash Price |
$885.90
|
| Rate for Payer: Cigna Commercial |
$2,716.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,652.50
|
| Rate for Payer: Health EOS Commercial |
$2,628.17
|
| Rate for Payer: HFN Commercial |
$2,716.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,214.75
|
| Rate for Payer: Multiplan Commercial |
$2,362.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,771.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,716.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,446.97
|
| Rate for Payer: Quartz Commercial |
$1,919.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,771.80
|
| Rate for Payer: The Alliance Commercial |
$11,812.00
|
| Rate for Payer: WEA Trust Commercial |
$1,624.15
|
| Rate for Payer: WPS Commercial |
$2,187.29
|
|
|
SCREW CANN LOCK 3.7 X 50MM 02.240.050
|
Facility
|
IP
|
$2,953.00
|
|
| Hospital Charge Code |
2966510
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,446.97 |
| Max. Negotiated Rate |
$2,716.76 |
| Rate for Payer: Aetna Commercial |
$2,657.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,539.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,565.09
|
| Rate for Payer: Cash Price |
$885.90
|
| Rate for Payer: Cigna Commercial |
$2,716.76
|
| Rate for Payer: Health EOS Commercial |
$2,628.17
|
| Rate for Payer: HFN Commercial |
$2,716.76
|
| Rate for Payer: Multiplan Commercial |
$2,362.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,771.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,716.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,446.97
|
| Rate for Payer: Quartz Commercial |
$1,771.80
|
| Rate for Payer: WEA Trust Commercial |
$1,624.15
|
| Rate for Payer: WPS Commercial |
$2,187.29
|
|
|
SCREW CANN LOCK 3.7 X 54MM 02.240.054
|
Facility
|
OP
|
$2,953.00
|
|
| Hospital Charge Code |
2966511
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$826.84 |
| Max. Negotiated Rate |
$11,812.00 |
| Rate for Payer: Aetna Commercial |
$2,657.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,539.58
|
| Rate for Payer: Aetna Managed Medicare |
$826.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,919.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,476.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,417.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,565.09
|
| Rate for Payer: Cash Price |
$885.90
|
| Rate for Payer: Cigna Commercial |
$2,716.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,652.50
|
| Rate for Payer: Health EOS Commercial |
$2,628.17
|
| Rate for Payer: HFN Commercial |
$2,716.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,214.75
|
| Rate for Payer: Multiplan Commercial |
$2,362.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,771.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,716.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,446.97
|
| Rate for Payer: Quartz Commercial |
$1,919.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,771.80
|
| Rate for Payer: The Alliance Commercial |
$11,812.00
|
| Rate for Payer: WEA Trust Commercial |
$1,624.15
|
| Rate for Payer: WPS Commercial |
$2,187.29
|
|
|
SCREW CANN LOCK 3.7 X 54MM 02.240.054
|
Facility
|
IP
|
$2,953.00
|
|
| Hospital Charge Code |
2966511
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,446.97 |
| Max. Negotiated Rate |
$2,716.76 |
| Rate for Payer: Aetna Commercial |
$2,657.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,539.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,565.09
|
| Rate for Payer: Cash Price |
$885.90
|
| Rate for Payer: Cigna Commercial |
$2,716.76
|
| Rate for Payer: Health EOS Commercial |
$2,628.17
|
| Rate for Payer: HFN Commercial |
$2,716.76
|
| Rate for Payer: Multiplan Commercial |
$2,362.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,771.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,716.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,446.97
|
| Rate for Payer: Quartz Commercial |
$1,771.80
|
| Rate for Payer: WEA Trust Commercial |
$1,624.15
|
| Rate for Payer: WPS Commercial |
$2,187.29
|
|
|
SCREW CANN LOCK VA 5.0 X 45 02.231.645
|
Facility
|
IP
|
$2,877.00
|
|
| Hospital Charge Code |
3072543
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,409.73 |
| Max. Negotiated Rate |
$2,646.84 |
| Rate for Payer: Aetna Commercial |
$2,589.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,474.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,524.81
|
| Rate for Payer: Cash Price |
$863.10
|
| Rate for Payer: Cigna Commercial |
$2,646.84
|
| Rate for Payer: Health EOS Commercial |
$2,560.53
|
| Rate for Payer: HFN Commercial |
$2,646.84
|
| Rate for Payer: Multiplan Commercial |
$2,301.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,726.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,646.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,409.73
|
| Rate for Payer: Quartz Commercial |
$1,726.20
|
| Rate for Payer: WEA Trust Commercial |
$1,582.35
|
| Rate for Payer: WPS Commercial |
$2,130.99
|
|
|
SCREW CANN LOCK VA 5.0 X 45 02.231.645
|
Facility
|
OP
|
$2,877.00
|
|
| Hospital Charge Code |
3072543
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$805.56 |
| Max. Negotiated Rate |
$11,508.00 |
| Rate for Payer: Aetna Commercial |
$2,589.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,474.22
|
| Rate for Payer: Aetna Managed Medicare |
$805.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,870.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,438.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,380.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,524.81
|
| Rate for Payer: Cash Price |
$863.10
|
| Rate for Payer: Cigna Commercial |
$2,646.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,609.97
|
| Rate for Payer: Health EOS Commercial |
$2,560.53
|
| Rate for Payer: HFN Commercial |
$2,646.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,157.75
|
| Rate for Payer: Multiplan Commercial |
$2,301.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,726.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,646.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,409.73
|
| Rate for Payer: Quartz Commercial |
$1,870.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,726.20
|
| Rate for Payer: The Alliance Commercial |
$11,508.00
|
| Rate for Payer: WEA Trust Commercial |
$1,582.35
|
| Rate for Payer: WPS Commercial |
$2,130.99
|
|
|
SCREW CANN LOCK VA 5.0 X 80 02.231.680
|
Facility
|
OP
|
$2,263.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3181496
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$633.64 |
| Max. Negotiated Rate |
$9,052.00 |
| Rate for Payer: Aetna Commercial |
$2,036.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,946.18
|
| Rate for Payer: Aetna Managed Medicare |
$633.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,470.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,131.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,086.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,199.39
|
| Rate for Payer: Cash Price |
$678.90
|
| Rate for Payer: Cigna Commercial |
$2,081.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,266.37
|
| Rate for Payer: Health EOS Commercial |
$2,014.07
|
| Rate for Payer: HFN Commercial |
$2,081.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,697.25
|
| Rate for Payer: Multiplan Commercial |
$1,810.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,357.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,081.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,108.87
|
| Rate for Payer: Quartz Commercial |
$1,470.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,357.80
|
| Rate for Payer: The Alliance Commercial |
$9,052.00
|
| Rate for Payer: WEA Trust Commercial |
$1,244.65
|
| Rate for Payer: WPS Commercial |
$1,676.20
|
|
