|
SCREW-CANN 5.0 X 40 02.205.240
|
Facility
|
IP
|
$2,022.00
|
|
| Hospital Charge Code |
2967213
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,030.41 |
| Max. Negotiated Rate |
$1,934.65 |
| Rate for Payer: Aetna Commercial |
$1,892.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,808.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,114.53
|
| Rate for Payer: Cash Price |
$606.60
|
| Rate for Payer: Cigna Commercial |
$1,934.65
|
| Rate for Payer: Health EOS Commercial |
$1,871.56
|
| Rate for Payer: HFN Commercial |
$1,934.65
|
| Rate for Payer: Multiplan Commercial |
$1,682.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,934.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,030.41
|
| Rate for Payer: Quartz Commercial |
$1,261.73
|
| Rate for Payer: WEA Trust Commercial |
$1,156.58
|
| Rate for Payer: WPS Commercial |
$1,557.55
|
|
|
SCREW-CANN 5.0 X 40 02.205.240
|
Facility
|
OP
|
$2,022.00
|
|
| Hospital Charge Code |
2967213
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$588.81 |
| Max. Negotiated Rate |
$1,934.65 |
| Rate for Payer: Aetna Commercial |
$1,892.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,808.48
|
| Rate for Payer: Aetna Managed Medicare |
$588.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,366.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,051.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,009.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,114.53
|
| Rate for Payer: Cash Price |
$606.60
|
| Rate for Payer: Cigna Commercial |
$1,934.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,176.80
|
| Rate for Payer: Health EOS Commercial |
$1,871.56
|
| Rate for Payer: HFN Commercial |
$1,934.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,577.16
|
| Rate for Payer: Multiplan Commercial |
$1,682.30
|
| Rate for Payer: NAPHCARE Commercial |
$1,261.73
|
| Rate for Payer: Preferred Network Access Commercial |
$1,934.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,030.41
|
| Rate for Payer: Quartz Commercial |
$1,366.87
|
| Rate for Payer: Quartz Medicare Advantage |
$1,261.73
|
| Rate for Payer: The Alliance Commercial |
$1,051.44
|
| Rate for Payer: WEA Trust Commercial |
$1,156.58
|
| Rate for Payer: WPS Commercial |
$1,557.55
|
|
|
SCREW-CANN 5.0 X 45 02.205.045
|
Facility
|
IP
|
$827.00
|
|
| Hospital Charge Code |
2966980
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$421.44 |
| Max. Negotiated Rate |
$791.27 |
| Rate for Payer: Aetna Commercial |
$774.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$739.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$455.84
|
| Rate for Payer: Cash Price |
$248.10
|
| Rate for Payer: Cigna Commercial |
$791.27
|
| Rate for Payer: Health EOS Commercial |
$765.47
|
| Rate for Payer: HFN Commercial |
$791.27
|
| Rate for Payer: Multiplan Commercial |
$688.06
|
| Rate for Payer: Preferred Network Access Commercial |
$791.27
|
| Rate for Payer: Quartz Beloit One Network |
$421.44
|
| Rate for Payer: Quartz Commercial |
$516.05
|
| Rate for Payer: WEA Trust Commercial |
$473.04
|
| Rate for Payer: WPS Commercial |
$637.04
|
|
|
SCREW-CANN 5.0 X 45 02.205.045
|
Facility
|
OP
|
$827.00
|
|
| Hospital Charge Code |
2966980
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$240.82 |
| Max. Negotiated Rate |
$791.27 |
| Rate for Payer: Aetna Commercial |
$774.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$739.67
|
| Rate for Payer: Aetna Managed Medicare |
$240.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$559.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$430.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$412.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$455.84
|
| Rate for Payer: Cash Price |
$248.10
|
| Rate for Payer: Cigna Commercial |
$791.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$481.31
|
| Rate for Payer: Health EOS Commercial |
$765.47
|
| Rate for Payer: HFN Commercial |
$791.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$645.06
|
| Rate for Payer: Multiplan Commercial |
$688.06
|
| Rate for Payer: NAPHCARE Commercial |
$516.05
|
| Rate for Payer: Preferred Network Access Commercial |
$791.27
|
| Rate for Payer: Quartz Beloit One Network |
$421.44
|
| Rate for Payer: Quartz Commercial |
$559.05
|
| Rate for Payer: Quartz Medicare Advantage |
$516.05
|
| Rate for Payer: The Alliance Commercial |
$430.04
|
| Rate for Payer: WEA Trust Commercial |
$473.04
|
| Rate for Payer: WPS Commercial |
$637.04
|
|
|
SCREW-CANN 5.0 X 45 02.205.245
|
Facility
|
IP
|
$2,022.00
|
|
| Hospital Charge Code |
2967214
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,030.41 |
| Max. Negotiated Rate |
$1,934.65 |
| Rate for Payer: Aetna Commercial |
$1,892.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,808.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,114.53
|
| Rate for Payer: Cash Price |
$606.60
|
| Rate for Payer: Cigna Commercial |
$1,934.65
|
| Rate for Payer: Health EOS Commercial |
$1,871.56
|
| Rate for Payer: HFN Commercial |
$1,934.65
|
| Rate for Payer: Multiplan Commercial |
$1,682.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,934.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,030.41
|
| Rate for Payer: Quartz Commercial |
$1,261.73
|
| Rate for Payer: WEA Trust Commercial |
$1,156.58
|
| Rate for Payer: WPS Commercial |
$1,557.55
|
|
|
SCREW-CANN 5.0 X 45 02.205.245
|
Facility
|
OP
|
$2,022.00
|
|
| Hospital Charge Code |
2967214
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$588.81 |
| Max. Negotiated Rate |
$1,934.65 |
| Rate for Payer: Aetna Commercial |
$1,892.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,808.48
|
| Rate for Payer: Aetna Managed Medicare |
$588.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,366.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,051.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,009.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,114.53
|
| Rate for Payer: Cash Price |
$606.60
|
| Rate for Payer: Cigna Commercial |
$1,934.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,176.80
|
| Rate for Payer: Health EOS Commercial |
$1,871.56
|
| Rate for Payer: HFN Commercial |
$1,934.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,577.16
|
| Rate for Payer: Multiplan Commercial |
$1,682.30
|
| Rate for Payer: NAPHCARE Commercial |
$1,261.73
|
| Rate for Payer: Preferred Network Access Commercial |
$1,934.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,030.41
|
| Rate for Payer: Quartz Commercial |
$1,366.87
|
| Rate for Payer: Quartz Medicare Advantage |
$1,261.73
|
| Rate for Payer: The Alliance Commercial |
$1,051.44
|
| Rate for Payer: WEA Trust Commercial |
$1,156.58
|
| Rate for Payer: WPS Commercial |
$1,557.55
|
|
|
SCREW-CANN 5.0 X 50 02.205.050
|
Facility
|
OP
|
$827.00
|
|
| Hospital Charge Code |
2966985
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$240.82 |
| Max. Negotiated Rate |
$791.27 |
| Rate for Payer: Aetna Commercial |
$774.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$739.67
|
| Rate for Payer: Aetna Managed Medicare |
$240.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$559.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$430.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$412.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$455.84
|
| Rate for Payer: Cash Price |
$248.10
|
| Rate for Payer: Cigna Commercial |
$791.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$481.31
|
| Rate for Payer: Health EOS Commercial |
$765.47
|
| Rate for Payer: HFN Commercial |
$791.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$645.06
|
| Rate for Payer: Multiplan Commercial |
$688.06
|
| Rate for Payer: NAPHCARE Commercial |
$516.05
|
| Rate for Payer: Preferred Network Access Commercial |
$791.27
|
| Rate for Payer: Quartz Beloit One Network |
$421.44
|
| Rate for Payer: Quartz Commercial |
$559.05
|
| Rate for Payer: Quartz Medicare Advantage |
$516.05
|
| Rate for Payer: The Alliance Commercial |
$430.04
|
| Rate for Payer: WEA Trust Commercial |
$473.04
|
| Rate for Payer: WPS Commercial |
$637.04
|
|
|
SCREW-CANN 5.0 X 50 02.205.050
|
Facility
|
IP
|
$827.00
|
|
| Hospital Charge Code |
2966985
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$421.44 |
| Max. Negotiated Rate |
$791.27 |
| Rate for Payer: Aetna Commercial |
$774.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$739.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$455.84
|
| Rate for Payer: Cash Price |
$248.10
|
| Rate for Payer: Cigna Commercial |
$791.27
|
| Rate for Payer: Health EOS Commercial |
$765.47
|
| Rate for Payer: HFN Commercial |
$791.27
|
| Rate for Payer: Multiplan Commercial |
$688.06
|
| Rate for Payer: Preferred Network Access Commercial |
$791.27
|
| Rate for Payer: Quartz Beloit One Network |
$421.44
|
| Rate for Payer: Quartz Commercial |
$516.05
|
| Rate for Payer: WEA Trust Commercial |
$473.04
|
| Rate for Payer: WPS Commercial |
$637.04
|
|
|
SCREW-CANN 5.0 X 50 02.205.250
|
Facility
|
OP
|
$2,022.00
|
|
| Hospital Charge Code |
2990952
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$588.81 |
| Max. Negotiated Rate |
$1,934.65 |
| Rate for Payer: Aetna Commercial |
$1,892.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,808.48
|
| Rate for Payer: Aetna Managed Medicare |
$588.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,366.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,051.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,009.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,114.53
|
| Rate for Payer: Cash Price |
$606.60
|
| Rate for Payer: Cigna Commercial |
$1,934.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,176.80
|
| Rate for Payer: Health EOS Commercial |
$1,871.56
|
| Rate for Payer: HFN Commercial |
$1,934.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,577.16
|
| Rate for Payer: Multiplan Commercial |
$1,682.30
|
| Rate for Payer: NAPHCARE Commercial |
$1,261.73
|
| Rate for Payer: Preferred Network Access Commercial |
$1,934.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,030.41
|
| Rate for Payer: Quartz Commercial |
$1,366.87
|
| Rate for Payer: Quartz Medicare Advantage |
$1,261.73
|
| Rate for Payer: The Alliance Commercial |
$1,051.44
|
| Rate for Payer: WEA Trust Commercial |
$1,156.58
|
| Rate for Payer: WPS Commercial |
$1,557.55
|
|
|
SCREW-CANN 5.0 X 50 02.205.250
|
Facility
|
IP
|
$2,022.00
|
|
| Hospital Charge Code |
2990952
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,030.41 |
| Max. Negotiated Rate |
$1,934.65 |
| Rate for Payer: Aetna Commercial |
$1,892.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,808.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,114.53
|
| Rate for Payer: Cash Price |
$606.60
|
| Rate for Payer: Cigna Commercial |
$1,934.65
|
| Rate for Payer: Health EOS Commercial |
$1,871.56
|
| Rate for Payer: HFN Commercial |
$1,934.65
|
| Rate for Payer: Multiplan Commercial |
$1,682.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,934.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,030.41
|
| Rate for Payer: Quartz Commercial |
$1,261.73
|
| Rate for Payer: WEA Trust Commercial |
$1,156.58
|
| Rate for Payer: WPS Commercial |
$1,557.55
|
|
|
SCREW-CANN 5.0 X 55 02.205.055
|
Facility
|
OP
|
$827.00
|
|
| Hospital Charge Code |
2966989
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$240.82 |
| Max. Negotiated Rate |
$791.27 |
| Rate for Payer: Aetna Commercial |
$774.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$739.67
|
| Rate for Payer: Aetna Managed Medicare |
$240.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$559.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$430.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$412.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$455.84
|
| Rate for Payer: Cash Price |
$248.10
|
| Rate for Payer: Cigna Commercial |
$791.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$481.31
|
| Rate for Payer: Health EOS Commercial |
$765.47
|
| Rate for Payer: HFN Commercial |
$791.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$645.06
|
| Rate for Payer: Multiplan Commercial |
$688.06
|
| Rate for Payer: NAPHCARE Commercial |
$516.05
|
| Rate for Payer: Preferred Network Access Commercial |
$791.27
|
| Rate for Payer: Quartz Beloit One Network |
$421.44
|
| Rate for Payer: Quartz Commercial |
$559.05
|
| Rate for Payer: Quartz Medicare Advantage |
$516.05
|
| Rate for Payer: The Alliance Commercial |
$430.04
|
| Rate for Payer: WEA Trust Commercial |
$473.04
|
| Rate for Payer: WPS Commercial |
$637.04
|
|
|
SCREW-CANN 5.0 X 55 02.205.055
|
Facility
|
IP
|
$827.00
|
|
| Hospital Charge Code |
2966989
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$421.44 |
| Max. Negotiated Rate |
$791.27 |
| Rate for Payer: Aetna Commercial |
$774.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$739.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$455.84
|
| Rate for Payer: Cash Price |
$248.10
|
| Rate for Payer: Cigna Commercial |
$791.27
|
| Rate for Payer: Health EOS Commercial |
$765.47
|
| Rate for Payer: HFN Commercial |
$791.27
|
| Rate for Payer: Multiplan Commercial |
$688.06
|
| Rate for Payer: Preferred Network Access Commercial |
$791.27
|
| Rate for Payer: Quartz Beloit One Network |
$421.44
|
| Rate for Payer: Quartz Commercial |
$516.05
|
| Rate for Payer: WEA Trust Commercial |
$473.04
|
| Rate for Payer: WPS Commercial |
$637.04
|
|
|
SCREW-CANN 5.0 X 55 02.205.255
|
Facility
|
IP
|
$2,022.00
|
|
| Hospital Charge Code |
2990953
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,030.41 |
| Max. Negotiated Rate |
$1,934.65 |
| Rate for Payer: Aetna Commercial |
$1,892.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,808.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,114.53
|
| Rate for Payer: Cash Price |
$606.60
|
| Rate for Payer: Cigna Commercial |
$1,934.65
|
| Rate for Payer: Health EOS Commercial |
$1,871.56
|
| Rate for Payer: HFN Commercial |
$1,934.65
|
| Rate for Payer: Multiplan Commercial |
$1,682.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,934.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,030.41
|
| Rate for Payer: Quartz Commercial |
$1,261.73
|
| Rate for Payer: WEA Trust Commercial |
$1,156.58
|
| Rate for Payer: WPS Commercial |
$1,557.55
|
|
|
SCREW-CANN 5.0 X 55 02.205.255
|
Facility
|
OP
|
$2,022.00
|
|
| Hospital Charge Code |
2990953
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$588.81 |
| Max. Negotiated Rate |
$1,934.65 |
| Rate for Payer: Aetna Commercial |
$1,892.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,808.48
|
| Rate for Payer: Aetna Managed Medicare |
$588.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,366.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,051.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,009.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,114.53
|
| Rate for Payer: Cash Price |
$606.60
|
| Rate for Payer: Cigna Commercial |
$1,934.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,176.80
|
| Rate for Payer: Health EOS Commercial |
$1,871.56
|
| Rate for Payer: HFN Commercial |
$1,934.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,577.16
|
| Rate for Payer: Multiplan Commercial |
$1,682.30
|
| Rate for Payer: NAPHCARE Commercial |
$1,261.73
|
| Rate for Payer: Preferred Network Access Commercial |
$1,934.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,030.41
|
| Rate for Payer: Quartz Commercial |
$1,366.87
|
| Rate for Payer: Quartz Medicare Advantage |
$1,261.73
|
| Rate for Payer: The Alliance Commercial |
$1,051.44
|
| Rate for Payer: WEA Trust Commercial |
$1,156.58
|
| Rate for Payer: WPS Commercial |
$1,557.55
|
|
|
SCREW-CANN 5.0 X 60 02.205.260
|
Facility
|
IP
|
$2,022.00
|
|
| Hospital Charge Code |
2967215
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,030.41 |
| Max. Negotiated Rate |
$1,934.65 |
| Rate for Payer: Aetna Commercial |
$1,892.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,808.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,114.53
|
| Rate for Payer: Cash Price |
$606.60
|
| Rate for Payer: Cigna Commercial |
$1,934.65
|
| Rate for Payer: Health EOS Commercial |
$1,871.56
|
| Rate for Payer: HFN Commercial |
$1,934.65
|
| Rate for Payer: Multiplan Commercial |
$1,682.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,934.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,030.41
|
| Rate for Payer: Quartz Commercial |
$1,261.73
|
| Rate for Payer: WEA Trust Commercial |
$1,156.58
|
| Rate for Payer: WPS Commercial |
$1,557.55
|
|
|
SCREW-CANN 5.0 X 60 02.205.260
|
Facility
|
OP
|
$2,022.00
|
|
| Hospital Charge Code |
2967215
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$588.81 |
| Max. Negotiated Rate |
$1,934.65 |
| Rate for Payer: Aetna Commercial |
$1,892.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,808.48
|
| Rate for Payer: Aetna Managed Medicare |
$588.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,366.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,051.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,009.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,114.53
|
| Rate for Payer: Cash Price |
$606.60
|
| Rate for Payer: Cigna Commercial |
$1,934.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,176.80
|
| Rate for Payer: Health EOS Commercial |
$1,871.56
|
| Rate for Payer: HFN Commercial |
$1,934.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,577.16
|
| Rate for Payer: Multiplan Commercial |
$1,682.30
|
| Rate for Payer: NAPHCARE Commercial |
$1,261.73
|
| Rate for Payer: Preferred Network Access Commercial |
$1,934.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,030.41
|
| Rate for Payer: Quartz Commercial |
$1,366.87
|
| Rate for Payer: Quartz Medicare Advantage |
$1,261.73
|
| Rate for Payer: The Alliance Commercial |
$1,051.44
|
| Rate for Payer: WEA Trust Commercial |
$1,156.58
|
| Rate for Payer: WPS Commercial |
$1,557.55
|
|
|
SCREW CANN 5.0 X 60MM PART THREAD TI ASNIS III 601660
|
Facility
|
IP
|
$2,174.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5582934
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,107.87 |
| Max. Negotiated Rate |
$2,080.08 |
| Rate for Payer: Aetna Commercial |
$2,034.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,944.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,198.31
|
| Rate for Payer: Cash Price |
$652.20
|
| Rate for Payer: Cigna Commercial |
$2,080.08
|
| Rate for Payer: Health EOS Commercial |
$2,012.25
|
| Rate for Payer: HFN Commercial |
$2,080.08
|
| Rate for Payer: Multiplan Commercial |
$1,808.77
|
| Rate for Payer: Preferred Network Access Commercial |
$2,080.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,107.87
|
| Rate for Payer: Quartz Commercial |
$1,356.58
|
| Rate for Payer: WEA Trust Commercial |
$1,243.53
|
| Rate for Payer: WPS Commercial |
$1,674.63
|
|
|
SCREW CANN 5.0 X 60MM PART THREAD TI ASNIS III 601660
|
Facility
|
OP
|
$2,174.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5582934
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$633.07 |
| Max. Negotiated Rate |
$2,080.08 |
| Rate for Payer: Aetna Commercial |
$2,034.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,944.43
|
| Rate for Payer: Aetna Managed Medicare |
$633.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,469.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,130.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,085.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,198.31
|
| Rate for Payer: Cash Price |
$652.20
|
| Rate for Payer: Cigna Commercial |
$2,080.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,265.27
|
| Rate for Payer: Health EOS Commercial |
$2,012.25
|
| Rate for Payer: HFN Commercial |
$2,080.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,695.72
|
| Rate for Payer: Multiplan Commercial |
$1,808.77
|
| Rate for Payer: NAPHCARE Commercial |
$1,356.58
|
| Rate for Payer: Preferred Network Access Commercial |
$2,080.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,107.87
|
| Rate for Payer: Quartz Commercial |
$1,469.62
|
| Rate for Payer: Quartz Medicare Advantage |
$1,356.58
|
| Rate for Payer: The Alliance Commercial |
$1,130.48
|
| Rate for Payer: WEA Trust Commercial |
$1,243.53
|
| Rate for Payer: WPS Commercial |
$1,674.63
|
|
|
SCREW-CANN 5.0 X 65 02.205.265
|
Facility
|
OP
|
$2,022.00
|
|
| Hospital Charge Code |
2967216
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$588.81 |
| Max. Negotiated Rate |
$1,934.65 |
| Rate for Payer: Aetna Commercial |
$1,892.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,808.48
|
| Rate for Payer: Aetna Managed Medicare |
$588.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,366.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,051.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,009.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,114.53
|
| Rate for Payer: Cash Price |
$606.60
|
| Rate for Payer: Cigna Commercial |
$1,934.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,176.80
|
| Rate for Payer: Health EOS Commercial |
$1,871.56
|
| Rate for Payer: HFN Commercial |
$1,934.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,577.16
|
| Rate for Payer: Multiplan Commercial |
$1,682.30
|
| Rate for Payer: NAPHCARE Commercial |
$1,261.73
|
| Rate for Payer: Preferred Network Access Commercial |
$1,934.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,030.41
|
| Rate for Payer: Quartz Commercial |
$1,366.87
|
| Rate for Payer: Quartz Medicare Advantage |
$1,261.73
|
| Rate for Payer: The Alliance Commercial |
$1,051.44
|
| Rate for Payer: WEA Trust Commercial |
$1,156.58
|
| Rate for Payer: WPS Commercial |
$1,557.55
|
|
|
SCREW-CANN 5.0 X 65 02.205.265
|
Facility
|
IP
|
$2,022.00
|
|
| Hospital Charge Code |
2967216
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,030.41 |
| Max. Negotiated Rate |
$1,934.65 |
| Rate for Payer: Aetna Commercial |
$1,892.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,808.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,114.53
|
| Rate for Payer: Cash Price |
$606.60
|
| Rate for Payer: Cigna Commercial |
$1,934.65
|
| Rate for Payer: Health EOS Commercial |
$1,871.56
|
| Rate for Payer: HFN Commercial |
$1,934.65
|
| Rate for Payer: Multiplan Commercial |
$1,682.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,934.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,030.41
|
| Rate for Payer: Quartz Commercial |
$1,261.73
|
| Rate for Payer: WEA Trust Commercial |
$1,156.58
|
| Rate for Payer: WPS Commercial |
$1,557.55
|
|
|
SCREW CANN 5.0 X 65MM PART THREAD TI ASNIS III 601665
|
Facility
|
OP
|
$1,855.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5582935
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$540.18 |
| Max. Negotiated Rate |
$1,774.86 |
| Rate for Payer: Aetna Commercial |
$1,736.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,659.11
|
| Rate for Payer: Aetna Managed Medicare |
$540.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,253.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$964.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$926.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,022.48
|
| Rate for Payer: Cash Price |
$556.50
|
| Rate for Payer: Cigna Commercial |
$1,774.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,079.61
|
| Rate for Payer: Health EOS Commercial |
$1,716.99
|
| Rate for Payer: HFN Commercial |
$1,774.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,446.90
|
| Rate for Payer: Multiplan Commercial |
$1,543.36
|
| Rate for Payer: NAPHCARE Commercial |
$1,157.52
|
| Rate for Payer: Preferred Network Access Commercial |
$1,774.86
|
| Rate for Payer: Quartz Beloit One Network |
$945.31
|
| Rate for Payer: Quartz Commercial |
$1,253.98
|
| Rate for Payer: Quartz Medicare Advantage |
$1,157.52
|
| Rate for Payer: The Alliance Commercial |
$964.60
|
| Rate for Payer: WEA Trust Commercial |
$1,061.06
|
| Rate for Payer: WPS Commercial |
$1,428.91
|
|
|
SCREW CANN 5.0 X 65MM PART THREAD TI ASNIS III 601665
|
Facility
|
IP
|
$1,855.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5582935
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$945.31 |
| Max. Negotiated Rate |
$1,774.86 |
| Rate for Payer: Aetna Commercial |
$1,736.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,659.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,022.48
|
| Rate for Payer: Cash Price |
$556.50
|
| Rate for Payer: Cigna Commercial |
$1,774.86
|
| Rate for Payer: Health EOS Commercial |
$1,716.99
|
| Rate for Payer: HFN Commercial |
$1,774.86
|
| Rate for Payer: Multiplan Commercial |
$1,543.36
|
| Rate for Payer: Preferred Network Access Commercial |
$1,774.86
|
| Rate for Payer: Quartz Beloit One Network |
$945.31
|
| Rate for Payer: Quartz Commercial |
$1,157.52
|
| Rate for Payer: WEA Trust Commercial |
$1,061.06
|
| Rate for Payer: WPS Commercial |
$1,428.91
|
|
|
SCREW-CANN 5.0 X 70 02.205.270
|
Facility
|
OP
|
$2,022.00
|
|
| Hospital Charge Code |
2967217
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$588.81 |
| Max. Negotiated Rate |
$1,934.65 |
| Rate for Payer: Aetna Commercial |
$1,892.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,808.48
|
| Rate for Payer: Aetna Managed Medicare |
$588.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,366.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,051.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,009.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,114.53
|
| Rate for Payer: Cash Price |
$606.60
|
| Rate for Payer: Cigna Commercial |
$1,934.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,176.80
|
| Rate for Payer: Health EOS Commercial |
$1,871.56
|
| Rate for Payer: HFN Commercial |
$1,934.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,577.16
|
| Rate for Payer: Multiplan Commercial |
$1,682.30
|
| Rate for Payer: NAPHCARE Commercial |
$1,261.73
|
| Rate for Payer: Preferred Network Access Commercial |
$1,934.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,030.41
|
| Rate for Payer: Quartz Commercial |
$1,366.87
|
| Rate for Payer: Quartz Medicare Advantage |
$1,261.73
|
| Rate for Payer: The Alliance Commercial |
$1,051.44
|
| Rate for Payer: WEA Trust Commercial |
$1,156.58
|
| Rate for Payer: WPS Commercial |
$1,557.55
|
|
|
SCREW-CANN 5.0 X 70 02.205.270
|
Facility
|
IP
|
$2,022.00
|
|
| Hospital Charge Code |
2967217
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,030.41 |
| Max. Negotiated Rate |
$1,934.65 |
| Rate for Payer: Aetna Commercial |
$1,892.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,808.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,114.53
|
| Rate for Payer: Cash Price |
$606.60
|
| Rate for Payer: Cigna Commercial |
$1,934.65
|
| Rate for Payer: Health EOS Commercial |
$1,871.56
|
| Rate for Payer: HFN Commercial |
$1,934.65
|
| Rate for Payer: Multiplan Commercial |
$1,682.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,934.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,030.41
|
| Rate for Payer: Quartz Commercial |
$1,261.73
|
| Rate for Payer: WEA Trust Commercial |
$1,156.58
|
| Rate for Payer: WPS Commercial |
$1,557.55
|
|
|
SCREW CANN 5.0 X 70MM PART THREAD TI ASNIS III 601670
|
Facility
|
OP
|
$2,174.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5582936
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$633.07 |
| Max. Negotiated Rate |
$2,080.08 |
| Rate for Payer: Aetna Commercial |
$2,034.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,944.43
|
| Rate for Payer: Aetna Managed Medicare |
$633.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,469.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,130.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,085.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,198.31
|
| Rate for Payer: Cash Price |
$652.20
|
| Rate for Payer: Cigna Commercial |
$2,080.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,265.27
|
| Rate for Payer: Health EOS Commercial |
$2,012.25
|
| Rate for Payer: HFN Commercial |
$2,080.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,695.72
|
| Rate for Payer: Multiplan Commercial |
$1,808.77
|
| Rate for Payer: NAPHCARE Commercial |
$1,356.58
|
| Rate for Payer: Preferred Network Access Commercial |
$2,080.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,107.87
|
| Rate for Payer: Quartz Commercial |
$1,469.62
|
| Rate for Payer: Quartz Medicare Advantage |
$1,356.58
|
| Rate for Payer: The Alliance Commercial |
$1,130.48
|
| Rate for Payer: WEA Trust Commercial |
$1,243.53
|
| Rate for Payer: WPS Commercial |
$1,674.63
|
|
