|
SCREW-CANN 2.4 X 10 319-2410
|
Facility
|
IP
|
$2,303.00
|
|
| Hospital Charge Code |
2965472
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,128.47 |
| Max. Negotiated Rate |
$2,118.76 |
| Rate for Payer: Aetna Commercial |
$2,072.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,980.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,220.59
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cigna Commercial |
$2,118.76
|
| Rate for Payer: Health EOS Commercial |
$2,049.67
|
| Rate for Payer: HFN Commercial |
$2,118.76
|
| Rate for Payer: Multiplan Commercial |
$1,842.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,381.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,118.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,128.47
|
| Rate for Payer: Quartz Commercial |
$1,381.80
|
| Rate for Payer: WEA Trust Commercial |
$1,266.65
|
| Rate for Payer: WPS Commercial |
$1,705.83
|
|
|
SCREW-CANN 2.4 X 10 319-2410
|
Facility
|
OP
|
$2,303.00
|
|
| Hospital Charge Code |
2965472
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$644.84 |
| Max. Negotiated Rate |
$9,212.00 |
| Rate for Payer: Aetna Commercial |
$2,072.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,980.58
|
| Rate for Payer: Aetna Managed Medicare |
$644.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,496.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,151.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,105.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,220.59
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cigna Commercial |
$2,118.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,288.76
|
| Rate for Payer: Health EOS Commercial |
$2,049.67
|
| Rate for Payer: HFN Commercial |
$2,118.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,727.25
|
| Rate for Payer: Multiplan Commercial |
$1,842.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,381.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,118.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,128.47
|
| Rate for Payer: Quartz Commercial |
$1,496.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,381.80
|
| Rate for Payer: The Alliance Commercial |
$9,212.00
|
| Rate for Payer: WEA Trust Commercial |
$1,266.65
|
| Rate for Payer: WPS Commercial |
$1,705.83
|
|
|
SCREW CANN 2.4 X 10 TIGER 200-24-010
|
Facility
|
OP
|
$2,059.00
|
|
| Hospital Charge Code |
3782767
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$576.52 |
| Max. Negotiated Rate |
$8,236.00 |
| Rate for Payer: Aetna Commercial |
$1,853.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,770.74
|
| Rate for Payer: Aetna Managed Medicare |
$576.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,338.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,029.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$988.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,091.27
|
| Rate for Payer: Cash Price |
$617.70
|
| Rate for Payer: Cigna Commercial |
$1,894.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,152.22
|
| Rate for Payer: Health EOS Commercial |
$1,832.51
|
| Rate for Payer: HFN Commercial |
$1,894.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,544.25
|
| Rate for Payer: Multiplan Commercial |
$1,647.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,235.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,894.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,008.91
|
| Rate for Payer: Quartz Commercial |
$1,338.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,235.40
|
| Rate for Payer: The Alliance Commercial |
$8,236.00
|
| Rate for Payer: WEA Trust Commercial |
$1,132.45
|
| Rate for Payer: WPS Commercial |
$1,525.10
|
|
|
SCREW CANN 2.4 X 10 TIGER 200-24-010
|
Facility
|
IP
|
$2,059.00
|
|
| Hospital Charge Code |
3782767
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,008.91 |
| Max. Negotiated Rate |
$1,894.28 |
| Rate for Payer: Aetna Commercial |
$1,853.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,770.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,091.27
|
| Rate for Payer: Cash Price |
$617.70
|
| Rate for Payer: Cigna Commercial |
$1,894.28
|
| Rate for Payer: Health EOS Commercial |
$1,832.51
|
| Rate for Payer: HFN Commercial |
$1,894.28
|
| Rate for Payer: Multiplan Commercial |
$1,647.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,235.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,894.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,008.91
|
| Rate for Payer: Quartz Commercial |
$1,235.40
|
| Rate for Payer: WEA Trust Commercial |
$1,132.45
|
| Rate for Payer: WPS Commercial |
$1,525.10
|
|
|
SCREW-CANN 2.4 X 12 319-2412
|
Facility
|
OP
|
$2,303.00
|
|
| Hospital Charge Code |
2965473
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$644.84 |
| Max. Negotiated Rate |
$9,212.00 |
| Rate for Payer: Aetna Commercial |
$2,072.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,980.58
|
| Rate for Payer: Aetna Managed Medicare |
$644.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,496.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,151.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,105.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,220.59
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cigna Commercial |
$2,118.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,288.76
|
| Rate for Payer: Health EOS Commercial |
$2,049.67
|
| Rate for Payer: HFN Commercial |
$2,118.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,727.25
|
| Rate for Payer: Multiplan Commercial |
$1,842.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,381.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,118.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,128.47
|
| Rate for Payer: Quartz Commercial |
$1,496.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,381.80
|
| Rate for Payer: The Alliance Commercial |
$9,212.00
|
| Rate for Payer: WEA Trust Commercial |
$1,266.65
|
| Rate for Payer: WPS Commercial |
$1,705.83
|
|
|
SCREW-CANN 2.4 X 12 319-2412
|
Facility
|
IP
|
$2,303.00
|
|
| Hospital Charge Code |
2965473
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,128.47 |
| Max. Negotiated Rate |
$2,118.76 |
| Rate for Payer: Aetna Commercial |
$2,072.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,980.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,220.59
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cigna Commercial |
$2,118.76
|
| Rate for Payer: Health EOS Commercial |
$2,049.67
|
| Rate for Payer: HFN Commercial |
$2,118.76
|
| Rate for Payer: Multiplan Commercial |
$1,842.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,381.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,118.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,128.47
|
| Rate for Payer: Quartz Commercial |
$1,381.80
|
| Rate for Payer: WEA Trust Commercial |
$1,266.65
|
| Rate for Payer: WPS Commercial |
$1,705.83
|
|
|
SCREW CANN 2.4 X 12 TIGER 200-24-012
|
Facility
|
IP
|
$2,059.00
|
|
| Hospital Charge Code |
3782768
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,008.91 |
| Max. Negotiated Rate |
$1,894.28 |
| Rate for Payer: Aetna Commercial |
$1,853.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,770.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,091.27
|
| Rate for Payer: Cash Price |
$617.70
|
| Rate for Payer: Cigna Commercial |
$1,894.28
|
| Rate for Payer: Health EOS Commercial |
$1,832.51
|
| Rate for Payer: HFN Commercial |
$1,894.28
|
| Rate for Payer: Multiplan Commercial |
$1,647.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,235.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,894.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,008.91
|
| Rate for Payer: Quartz Commercial |
$1,235.40
|
| Rate for Payer: WEA Trust Commercial |
$1,132.45
|
| Rate for Payer: WPS Commercial |
$1,525.10
|
|
|
SCREW CANN 2.4 X 12 TIGER 200-24-012
|
Facility
|
OP
|
$2,059.00
|
|
| Hospital Charge Code |
3782768
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$576.52 |
| Max. Negotiated Rate |
$8,236.00 |
| Rate for Payer: Aetna Commercial |
$1,853.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,770.74
|
| Rate for Payer: Aetna Managed Medicare |
$576.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,338.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,029.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$988.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,091.27
|
| Rate for Payer: Cash Price |
$617.70
|
| Rate for Payer: Cigna Commercial |
$1,894.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,152.22
|
| Rate for Payer: Health EOS Commercial |
$1,832.51
|
| Rate for Payer: HFN Commercial |
$1,894.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,544.25
|
| Rate for Payer: Multiplan Commercial |
$1,647.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,235.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,894.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,008.91
|
| Rate for Payer: Quartz Commercial |
$1,338.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,235.40
|
| Rate for Payer: The Alliance Commercial |
$8,236.00
|
| Rate for Payer: WEA Trust Commercial |
$1,132.45
|
| Rate for Payer: WPS Commercial |
$1,525.10
|
|
|
SCREW-CANN 2.4 X 14 319-2414
|
Facility
|
OP
|
$2,303.00
|
|
| Hospital Charge Code |
2965475
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$644.84 |
| Max. Negotiated Rate |
$9,212.00 |
| Rate for Payer: Aetna Commercial |
$2,072.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,980.58
|
| Rate for Payer: Aetna Managed Medicare |
$644.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,496.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,151.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,105.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,220.59
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cigna Commercial |
$2,118.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,288.76
|
| Rate for Payer: Health EOS Commercial |
$2,049.67
|
| Rate for Payer: HFN Commercial |
$2,118.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,727.25
|
| Rate for Payer: Multiplan Commercial |
$1,842.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,381.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,118.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,128.47
|
| Rate for Payer: Quartz Commercial |
$1,496.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,381.80
|
| Rate for Payer: The Alliance Commercial |
$9,212.00
|
| Rate for Payer: WEA Trust Commercial |
$1,266.65
|
| Rate for Payer: WPS Commercial |
$1,705.83
|
|
|
SCREW-CANN 2.4 X 14 319-2414
|
Facility
|
IP
|
$2,303.00
|
|
| Hospital Charge Code |
2965475
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,128.47 |
| Max. Negotiated Rate |
$2,118.76 |
| Rate for Payer: Aetna Commercial |
$2,072.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,980.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,220.59
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cigna Commercial |
$2,118.76
|
| Rate for Payer: Health EOS Commercial |
$2,049.67
|
| Rate for Payer: HFN Commercial |
$2,118.76
|
| Rate for Payer: Multiplan Commercial |
$1,842.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,381.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,118.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,128.47
|
| Rate for Payer: Quartz Commercial |
$1,381.80
|
| Rate for Payer: WEA Trust Commercial |
$1,266.65
|
| Rate for Payer: WPS Commercial |
$1,705.83
|
|
|
SCREW CANN 2.4 X 14MM PT LP TI AR-8724-14PT
|
Facility
|
OP
|
$2,213.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415096
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$619.64 |
| Max. Negotiated Rate |
$8,852.00 |
| Rate for Payer: Aetna Commercial |
$1,991.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,903.18
|
| Rate for Payer: Aetna Managed Medicare |
$619.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,438.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,106.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,062.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,172.89
|
| Rate for Payer: Cash Price |
$663.90
|
| Rate for Payer: Cigna Commercial |
$2,035.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,238.39
|
| Rate for Payer: Health EOS Commercial |
$1,969.57
|
| Rate for Payer: HFN Commercial |
$2,035.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,659.75
|
| Rate for Payer: Multiplan Commercial |
$1,770.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,327.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,035.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,084.37
|
| Rate for Payer: Quartz Commercial |
$1,438.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,327.80
|
| Rate for Payer: The Alliance Commercial |
$8,852.00
|
| Rate for Payer: WEA Trust Commercial |
$1,217.15
|
| Rate for Payer: WPS Commercial |
$1,639.17
|
|
|
SCREW CANN 2.4 X 14MM PT LP TI AR-8724-14PT
|
Facility
|
IP
|
$2,213.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415096
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,084.37 |
| Max. Negotiated Rate |
$2,035.96 |
| Rate for Payer: Aetna Commercial |
$1,991.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,903.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,172.89
|
| Rate for Payer: Cash Price |
$663.90
|
| Rate for Payer: Cigna Commercial |
$2,035.96
|
| Rate for Payer: Health EOS Commercial |
$1,969.57
|
| Rate for Payer: HFN Commercial |
$2,035.96
|
| Rate for Payer: Multiplan Commercial |
$1,770.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,327.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,035.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,084.37
|
| Rate for Payer: Quartz Commercial |
$1,327.80
|
| Rate for Payer: WEA Trust Commercial |
$1,217.15
|
| Rate for Payer: WPS Commercial |
$1,639.17
|
|
|
SCREW CANN 2.4 X 14 TIGER 200-24-014
|
Facility
|
OP
|
$2,139.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3267474
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$598.92 |
| Max. Negotiated Rate |
$8,556.00 |
| Rate for Payer: Aetna Commercial |
$1,925.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,839.54
|
| Rate for Payer: Aetna Managed Medicare |
$598.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,390.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,069.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,026.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,133.67
|
| Rate for Payer: Cash Price |
$641.70
|
| Rate for Payer: Cigna Commercial |
$1,967.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,196.98
|
| Rate for Payer: Health EOS Commercial |
$1,903.71
|
| Rate for Payer: HFN Commercial |
$1,967.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,604.25
|
| Rate for Payer: Multiplan Commercial |
$1,711.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,283.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,967.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,048.11
|
| Rate for Payer: Quartz Commercial |
$1,390.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,283.40
|
| Rate for Payer: The Alliance Commercial |
$8,556.00
|
| Rate for Payer: WEA Trust Commercial |
$1,176.45
|
| Rate for Payer: WPS Commercial |
$1,584.36
|
|
|
SCREW CANN 2.4 X 14 TIGER 200-24-014
|
Facility
|
IP
|
$2,139.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3267474
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,048.11 |
| Max. Negotiated Rate |
$1,967.88 |
| Rate for Payer: Aetna Commercial |
$1,925.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,839.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,133.67
|
| Rate for Payer: Cash Price |
$641.70
|
| Rate for Payer: Cigna Commercial |
$1,967.88
|
| Rate for Payer: Health EOS Commercial |
$1,903.71
|
| Rate for Payer: HFN Commercial |
$1,967.88
|
| Rate for Payer: Multiplan Commercial |
$1,711.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,283.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,967.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,048.11
|
| Rate for Payer: Quartz Commercial |
$1,283.40
|
| Rate for Payer: WEA Trust Commercial |
$1,176.45
|
| Rate for Payer: WPS Commercial |
$1,584.36
|
|
|
SCREW-CANN 2.4 X 16 319-2416
|
Facility
|
IP
|
$2,303.00
|
|
| Hospital Charge Code |
2965477
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,128.47 |
| Max. Negotiated Rate |
$2,118.76 |
| Rate for Payer: Aetna Commercial |
$2,072.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,980.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,220.59
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cigna Commercial |
$2,118.76
|
| Rate for Payer: Health EOS Commercial |
$2,049.67
|
| Rate for Payer: HFN Commercial |
$2,118.76
|
| Rate for Payer: Multiplan Commercial |
$1,842.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,381.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,118.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,128.47
|
| Rate for Payer: Quartz Commercial |
$1,381.80
|
| Rate for Payer: WEA Trust Commercial |
$1,266.65
|
| Rate for Payer: WPS Commercial |
$1,705.83
|
|
|
SCREW-CANN 2.4 X 16 319-2416
|
Facility
|
OP
|
$2,303.00
|
|
| Hospital Charge Code |
2965477
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$644.84 |
| Max. Negotiated Rate |
$9,212.00 |
| Rate for Payer: Aetna Commercial |
$2,072.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,980.58
|
| Rate for Payer: Aetna Managed Medicare |
$644.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,496.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,151.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,105.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,220.59
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cigna Commercial |
$2,118.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,288.76
|
| Rate for Payer: Health EOS Commercial |
$2,049.67
|
| Rate for Payer: HFN Commercial |
$2,118.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,727.25
|
| Rate for Payer: Multiplan Commercial |
$1,842.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,381.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,118.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,128.47
|
| Rate for Payer: Quartz Commercial |
$1,496.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,381.80
|
| Rate for Payer: The Alliance Commercial |
$9,212.00
|
| Rate for Payer: WEA Trust Commercial |
$1,266.65
|
| Rate for Payer: WPS Commercial |
$1,705.83
|
|
|
SCREW CANN 2.4 X 16 TIGER 200-24-016
|
Facility
|
OP
|
$2,139.00
|
|
| Hospital Charge Code |
3072568
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$598.92 |
| Max. Negotiated Rate |
$8,556.00 |
| Rate for Payer: Aetna Commercial |
$1,925.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,839.54
|
| Rate for Payer: Aetna Managed Medicare |
$598.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,390.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,069.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,026.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,133.67
|
| Rate for Payer: Cash Price |
$641.70
|
| Rate for Payer: Cigna Commercial |
$1,967.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,196.98
|
| Rate for Payer: Health EOS Commercial |
$1,903.71
|
| Rate for Payer: HFN Commercial |
$1,967.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,604.25
|
| Rate for Payer: Multiplan Commercial |
$1,711.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,283.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,967.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,048.11
|
| Rate for Payer: Quartz Commercial |
$1,390.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,283.40
|
| Rate for Payer: The Alliance Commercial |
$8,556.00
|
| Rate for Payer: WEA Trust Commercial |
$1,176.45
|
| Rate for Payer: WPS Commercial |
$1,584.36
|
|
|
SCREW CANN 2.4 X 16 TIGER 200-24-016
|
Facility
|
IP
|
$2,139.00
|
|
| Hospital Charge Code |
3072568
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,048.11 |
| Max. Negotiated Rate |
$1,967.88 |
| Rate for Payer: Aetna Commercial |
$1,925.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,839.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,133.67
|
| Rate for Payer: Cash Price |
$641.70
|
| Rate for Payer: Cigna Commercial |
$1,967.88
|
| Rate for Payer: Health EOS Commercial |
$1,903.71
|
| Rate for Payer: HFN Commercial |
$1,967.88
|
| Rate for Payer: Multiplan Commercial |
$1,711.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,283.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,967.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,048.11
|
| Rate for Payer: Quartz Commercial |
$1,283.40
|
| Rate for Payer: WEA Trust Commercial |
$1,176.45
|
| Rate for Payer: WPS Commercial |
$1,584.36
|
|
|
SCREW-CANN 2.4 X 18 319-2418
|
Facility
|
OP
|
$2,303.00
|
|
| Hospital Charge Code |
2965479
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$644.84 |
| Max. Negotiated Rate |
$9,212.00 |
| Rate for Payer: Aetna Commercial |
$2,072.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,980.58
|
| Rate for Payer: Aetna Managed Medicare |
$644.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,496.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,151.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,105.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,220.59
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cigna Commercial |
$2,118.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,288.76
|
| Rate for Payer: Health EOS Commercial |
$2,049.67
|
| Rate for Payer: HFN Commercial |
$2,118.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,727.25
|
| Rate for Payer: Multiplan Commercial |
$1,842.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,381.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,118.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,128.47
|
| Rate for Payer: Quartz Commercial |
$1,496.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,381.80
|
| Rate for Payer: The Alliance Commercial |
$9,212.00
|
| Rate for Payer: WEA Trust Commercial |
$1,266.65
|
| Rate for Payer: WPS Commercial |
$1,705.83
|
|
|
SCREW-CANN 2.4 X 18 319-2418
|
Facility
|
IP
|
$2,303.00
|
|
| Hospital Charge Code |
2965479
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,128.47 |
| Max. Negotiated Rate |
$2,118.76 |
| Rate for Payer: Aetna Commercial |
$2,072.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,980.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,220.59
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cigna Commercial |
$2,118.76
|
| Rate for Payer: Health EOS Commercial |
$2,049.67
|
| Rate for Payer: HFN Commercial |
$2,118.76
|
| Rate for Payer: Multiplan Commercial |
$1,842.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,381.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,118.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,128.47
|
| Rate for Payer: Quartz Commercial |
$1,381.80
|
| Rate for Payer: WEA Trust Commercial |
$1,266.65
|
| Rate for Payer: WPS Commercial |
$1,705.83
|
|
|
SCREW CANN 2.4 X 18 TIGER 200-24-018
|
Facility
|
OP
|
$2,139.00
|
|
| Hospital Charge Code |
3333541
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$598.92 |
| Max. Negotiated Rate |
$8,556.00 |
| Rate for Payer: Aetna Commercial |
$1,925.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,839.54
|
| Rate for Payer: Aetna Managed Medicare |
$598.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,390.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,069.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,026.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,133.67
|
| Rate for Payer: Cash Price |
$641.70
|
| Rate for Payer: Cigna Commercial |
$1,967.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,196.98
|
| Rate for Payer: Health EOS Commercial |
$1,903.71
|
| Rate for Payer: HFN Commercial |
$1,967.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,604.25
|
| Rate for Payer: Multiplan Commercial |
$1,711.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,283.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,967.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,048.11
|
| Rate for Payer: Quartz Commercial |
$1,390.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,283.40
|
| Rate for Payer: The Alliance Commercial |
$8,556.00
|
| Rate for Payer: WEA Trust Commercial |
$1,176.45
|
| Rate for Payer: WPS Commercial |
$1,584.36
|
|
|
SCREW CANN 2.4 X 18 TIGER 200-24-018
|
Facility
|
IP
|
$2,139.00
|
|
| Hospital Charge Code |
3333541
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,048.11 |
| Max. Negotiated Rate |
$1,967.88 |
| Rate for Payer: Aetna Commercial |
$1,925.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,839.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,133.67
|
| Rate for Payer: Cash Price |
$641.70
|
| Rate for Payer: Cigna Commercial |
$1,967.88
|
| Rate for Payer: Health EOS Commercial |
$1,903.71
|
| Rate for Payer: HFN Commercial |
$1,967.88
|
| Rate for Payer: Multiplan Commercial |
$1,711.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,283.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,967.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,048.11
|
| Rate for Payer: Quartz Commercial |
$1,283.40
|
| Rate for Payer: WEA Trust Commercial |
$1,176.45
|
| Rate for Payer: WPS Commercial |
$1,584.36
|
|
|
SCREW-CANN 2.4 X 20 319-2420
|
Facility
|
OP
|
$2,303.00
|
|
| Hospital Charge Code |
2965481
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$644.84 |
| Max. Negotiated Rate |
$9,212.00 |
| Rate for Payer: Aetna Commercial |
$2,072.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,980.58
|
| Rate for Payer: Aetna Managed Medicare |
$644.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,496.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,151.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,105.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,220.59
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cigna Commercial |
$2,118.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,288.76
|
| Rate for Payer: Health EOS Commercial |
$2,049.67
|
| Rate for Payer: HFN Commercial |
$2,118.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,727.25
|
| Rate for Payer: Multiplan Commercial |
$1,842.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,381.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,118.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,128.47
|
| Rate for Payer: Quartz Commercial |
$1,496.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,381.80
|
| Rate for Payer: The Alliance Commercial |
$9,212.00
|
| Rate for Payer: WEA Trust Commercial |
$1,266.65
|
| Rate for Payer: WPS Commercial |
$1,705.83
|
|
|
SCREW-CANN 2.4 X 20 319-2420
|
Facility
|
IP
|
$2,303.00
|
|
| Hospital Charge Code |
2965481
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,128.47 |
| Max. Negotiated Rate |
$2,118.76 |
| Rate for Payer: Aetna Commercial |
$2,072.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,980.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,220.59
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cigna Commercial |
$2,118.76
|
| Rate for Payer: Health EOS Commercial |
$2,049.67
|
| Rate for Payer: HFN Commercial |
$2,118.76
|
| Rate for Payer: Multiplan Commercial |
$1,842.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,381.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,118.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,128.47
|
| Rate for Payer: Quartz Commercial |
$1,381.80
|
| Rate for Payer: WEA Trust Commercial |
$1,266.65
|
| Rate for Payer: WPS Commercial |
$1,705.83
|
|
|
SCREW CANN 2.4 X 20 PART THREAD LP TI AR-8724-20
|
Facility
|
OP
|
$2,213.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415810
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$619.64 |
| Max. Negotiated Rate |
$8,852.00 |
| Rate for Payer: Aetna Commercial |
$1,991.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,903.18
|
| Rate for Payer: Aetna Managed Medicare |
$619.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,438.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,106.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,062.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,172.89
|
| Rate for Payer: Cash Price |
$663.90
|
| Rate for Payer: Cigna Commercial |
$2,035.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,238.39
|
| Rate for Payer: Health EOS Commercial |
$1,969.57
|
| Rate for Payer: HFN Commercial |
$2,035.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,659.75
|
| Rate for Payer: Multiplan Commercial |
$1,770.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,327.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,035.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,084.37
|
| Rate for Payer: Quartz Commercial |
$1,438.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,327.80
|
| Rate for Payer: The Alliance Commercial |
$8,852.00
|
| Rate for Payer: WEA Trust Commercial |
$1,217.15
|
| Rate for Payer: WPS Commercial |
$1,639.17
|
|
