|
SCREW CANN 5.0 X 70MM PART THREAD TI ASNIS III 601670
|
Facility
|
IP
|
$2,174.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5582936
|
|
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 75 CONICAL 02.205.275
|
Facility
|
OP
|
$2,100.00
|
|
| Hospital Charge Code |
2967218
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$611.52 |
| Max. Negotiated Rate |
$2,009.28 |
| Rate for Payer: Aetna Commercial |
$1,965.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,878.24
|
| Rate for Payer: Aetna Managed Medicare |
$611.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,419.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,092.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,048.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,157.52
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Cigna Commercial |
$2,009.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,222.20
|
| Rate for Payer: Health EOS Commercial |
$1,943.76
|
| Rate for Payer: HFN Commercial |
$2,009.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,638.00
|
| Rate for Payer: Multiplan Commercial |
$1,747.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,310.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,009.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,070.16
|
| Rate for Payer: Quartz Commercial |
$1,419.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,310.40
|
| Rate for Payer: The Alliance Commercial |
$1,092.00
|
| Rate for Payer: WEA Trust Commercial |
$1,201.20
|
| Rate for Payer: WPS Commercial |
$1,617.63
|
|
|
SCREW CANN 5.0 X 75 CONICAL 02.205.275
|
Facility
|
IP
|
$2,100.00
|
|
| Hospital Charge Code |
2967218
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,070.16 |
| Max. Negotiated Rate |
$2,009.28 |
| Rate for Payer: Aetna Commercial |
$1,965.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,878.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,157.52
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Cigna Commercial |
$2,009.28
|
| Rate for Payer: Health EOS Commercial |
$1,943.76
|
| Rate for Payer: HFN Commercial |
$2,009.28
|
| Rate for Payer: Multiplan Commercial |
$1,747.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,009.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,070.16
|
| Rate for Payer: Quartz Commercial |
$1,310.40
|
| Rate for Payer: WEA Trust Commercial |
$1,201.20
|
| Rate for Payer: WPS Commercial |
$1,617.63
|
|
|
SCREW-CANN 5.0 X 80 02.205.080
|
Facility
|
OP
|
$827.00
|
|
| Hospital Charge Code |
2967004
|
|
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 80 02.205.080
|
Facility
|
IP
|
$827.00
|
|
| Hospital Charge Code |
2967004
|
|
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 80 02.205.280
|
Facility
|
OP
|
$2,022.00
|
|
| Hospital Charge Code |
2967219
|
|
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 80 02.205.280
|
Facility
|
IP
|
$2,022.00
|
|
| Hospital Charge Code |
2967219
|
|
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 85 02.205.285
|
Facility
|
IP
|
$2,022.00
|
|
| Hospital Charge Code |
2967220
|
|
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 85 02.205.285
|
Facility
|
OP
|
$2,022.00
|
|
| Hospital Charge Code |
2967220
|
|
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 90 02.205.090
|
Facility
|
OP
|
$827.00
|
|
| Hospital Charge Code |
2967009
|
|
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 90 02.205.090
|
Facility
|
IP
|
$827.00
|
|
| Hospital Charge Code |
2967009
|
|
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 90 02.205.290
|
Facility
|
OP
|
$2,022.00
|
|
| Hospital Charge Code |
2967221
|
|
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 90 02.205.290
|
Facility
|
IP
|
$2,022.00
|
|
| Hospital Charge Code |
2967221
|
|
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 95 02.205.295
|
Facility
|
IP
|
$2,022.00
|
|
| Hospital Charge Code |
2967222
|
|
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 95 02.205.295
|
Facility
|
OP
|
$2,022.00
|
|
| Hospital Charge Code |
2967222
|
|
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 6.5MM X 100MM X 16MM THREAD 208.415
|
Facility
|
IP
|
$3,067.00
|
|
| Hospital Charge Code |
4065102
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,562.94 |
| Max. Negotiated Rate |
$2,934.51 |
| Rate for Payer: Aetna Commercial |
$2,870.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,743.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,690.53
|
| Rate for Payer: Cash Price |
$920.10
|
| Rate for Payer: Cigna Commercial |
$2,934.51
|
| Rate for Payer: Health EOS Commercial |
$2,838.82
|
| Rate for Payer: HFN Commercial |
$2,934.51
|
| Rate for Payer: Multiplan Commercial |
$2,551.74
|
| Rate for Payer: Preferred Network Access Commercial |
$2,934.51
|
| Rate for Payer: Quartz Beloit One Network |
$1,562.94
|
| Rate for Payer: Quartz Commercial |
$1,913.81
|
| Rate for Payer: WEA Trust Commercial |
$1,754.32
|
| Rate for Payer: WPS Commercial |
$2,362.51
|
|
|
SCREW CANN 6.5MM X 100MM X 16MM THREAD 208.415
|
Facility
|
OP
|
$3,067.00
|
|
| Hospital Charge Code |
4065102
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$893.11 |
| Max. Negotiated Rate |
$2,934.51 |
| Rate for Payer: Aetna Commercial |
$2,870.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,743.12
|
| Rate for Payer: Aetna Managed Medicare |
$893.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,073.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,594.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,531.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,690.53
|
| Rate for Payer: Cash Price |
$920.10
|
| Rate for Payer: Cigna Commercial |
$2,934.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,784.99
|
| Rate for Payer: Health EOS Commercial |
$2,838.82
|
| Rate for Payer: HFN Commercial |
$2,934.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,392.26
|
| Rate for Payer: Multiplan Commercial |
$2,551.74
|
| Rate for Payer: NAPHCARE Commercial |
$1,913.81
|
| Rate for Payer: Preferred Network Access Commercial |
$2,934.51
|
| Rate for Payer: Quartz Beloit One Network |
$1,562.94
|
| Rate for Payer: Quartz Commercial |
$2,073.29
|
| Rate for Payer: Quartz Medicare Advantage |
$1,913.81
|
| Rate for Payer: The Alliance Commercial |
$1,594.84
|
| Rate for Payer: WEA Trust Commercial |
$1,754.32
|
| Rate for Payer: WPS Commercial |
$2,362.51
|
|
|
SCREW CANN 6.5MM X 100MM X 32 THREAD 208.442
|
Facility
|
OP
|
$3,067.00
|
|
| Hospital Charge Code |
4066460
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$893.11 |
| Max. Negotiated Rate |
$2,934.51 |
| Rate for Payer: Aetna Commercial |
$2,870.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,743.12
|
| Rate for Payer: Aetna Managed Medicare |
$893.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,073.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,594.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,531.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,690.53
|
| Rate for Payer: Cash Price |
$920.10
|
| Rate for Payer: Cigna Commercial |
$2,934.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,784.99
|
| Rate for Payer: Health EOS Commercial |
$2,838.82
|
| Rate for Payer: HFN Commercial |
$2,934.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,392.26
|
| Rate for Payer: Multiplan Commercial |
$2,551.74
|
| Rate for Payer: NAPHCARE Commercial |
$1,913.81
|
| Rate for Payer: Preferred Network Access Commercial |
$2,934.51
|
| Rate for Payer: Quartz Beloit One Network |
$1,562.94
|
| Rate for Payer: Quartz Commercial |
$2,073.29
|
| Rate for Payer: Quartz Medicare Advantage |
$1,913.81
|
| Rate for Payer: The Alliance Commercial |
$1,594.84
|
| Rate for Payer: WEA Trust Commercial |
$1,754.32
|
| Rate for Payer: WPS Commercial |
$2,362.51
|
|
|
SCREW CANN 6.5MM X 100MM X 32 THREAD 208.442
|
Facility
|
IP
|
$3,067.00
|
|
| Hospital Charge Code |
4066460
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,562.94 |
| Max. Negotiated Rate |
$2,934.51 |
| Rate for Payer: Aetna Commercial |
$2,870.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,743.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,690.53
|
| Rate for Payer: Cash Price |
$920.10
|
| Rate for Payer: Cigna Commercial |
$2,934.51
|
| Rate for Payer: Health EOS Commercial |
$2,838.82
|
| Rate for Payer: HFN Commercial |
$2,934.51
|
| Rate for Payer: Multiplan Commercial |
$2,551.74
|
| Rate for Payer: Preferred Network Access Commercial |
$2,934.51
|
| Rate for Payer: Quartz Beloit One Network |
$1,562.94
|
| Rate for Payer: Quartz Commercial |
$1,913.81
|
| Rate for Payer: WEA Trust Commercial |
$1,754.32
|
| Rate for Payer: WPS Commercial |
$2,362.51
|
|
|
SCREW CANN 6.5MM X 105MM X 16MM THREAD 208.416
|
Facility
|
IP
|
$2,954.00
|
|
| Hospital Charge Code |
4065103
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,505.36 |
| Max. Negotiated Rate |
$2,826.39 |
| Rate for Payer: Aetna Commercial |
$2,764.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,642.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,628.24
|
| Rate for Payer: Cash Price |
$886.20
|
| Rate for Payer: Cigna Commercial |
$2,826.39
|
| Rate for Payer: Health EOS Commercial |
$2,734.22
|
| Rate for Payer: HFN Commercial |
$2,826.39
|
| Rate for Payer: Multiplan Commercial |
$2,457.73
|
| Rate for Payer: Preferred Network Access Commercial |
$2,826.39
|
| Rate for Payer: Quartz Beloit One Network |
$1,505.36
|
| Rate for Payer: Quartz Commercial |
$1,843.30
|
| Rate for Payer: WEA Trust Commercial |
$1,689.69
|
| Rate for Payer: WPS Commercial |
$2,275.47
|
|
|
SCREW CANN 6.5MM X 105MM X 16MM THREAD 208.416
|
Facility
|
OP
|
$2,954.00
|
|
| Hospital Charge Code |
4065103
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$860.20 |
| Max. Negotiated Rate |
$2,826.39 |
| Rate for Payer: Aetna Commercial |
$2,764.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,642.06
|
| Rate for Payer: Aetna Managed Medicare |
$860.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,996.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,536.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,474.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,628.24
|
| Rate for Payer: Cash Price |
$886.20
|
| Rate for Payer: Cigna Commercial |
$2,826.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,719.23
|
| Rate for Payer: Health EOS Commercial |
$2,734.22
|
| Rate for Payer: HFN Commercial |
$2,826.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,304.12
|
| Rate for Payer: Multiplan Commercial |
$2,457.73
|
| Rate for Payer: NAPHCARE Commercial |
$1,843.30
|
| Rate for Payer: Preferred Network Access Commercial |
$2,826.39
|
| Rate for Payer: Quartz Beloit One Network |
$1,505.36
|
| Rate for Payer: Quartz Commercial |
$1,996.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,843.30
|
| Rate for Payer: The Alliance Commercial |
$1,536.08
|
| Rate for Payer: WEA Trust Commercial |
$1,689.69
|
| Rate for Payer: WPS Commercial |
$2,275.47
|
|
|
SCREW CANN 6.5MM X 105MM X 32 THREAD 208.443
|
Facility
|
OP
|
$2,954.00
|
|
| Hospital Charge Code |
4066461
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$860.20 |
| Max. Negotiated Rate |
$2,826.39 |
| Rate for Payer: Aetna Commercial |
$2,764.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,642.06
|
| Rate for Payer: Aetna Managed Medicare |
$860.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,996.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,536.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,474.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,628.24
|
| Rate for Payer: Cash Price |
$886.20
|
| Rate for Payer: Cigna Commercial |
$2,826.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,719.23
|
| Rate for Payer: Health EOS Commercial |
$2,734.22
|
| Rate for Payer: HFN Commercial |
$2,826.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,304.12
|
| Rate for Payer: Multiplan Commercial |
$2,457.73
|
| Rate for Payer: NAPHCARE Commercial |
$1,843.30
|
| Rate for Payer: Preferred Network Access Commercial |
$2,826.39
|
| Rate for Payer: Quartz Beloit One Network |
$1,505.36
|
| Rate for Payer: Quartz Commercial |
$1,996.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,843.30
|
| Rate for Payer: The Alliance Commercial |
$1,536.08
|
| Rate for Payer: WEA Trust Commercial |
$1,689.69
|
| Rate for Payer: WPS Commercial |
$2,275.47
|
|
|
SCREW CANN 6.5MM X 105MM X 32 THREAD 208.443
|
Facility
|
IP
|
$2,954.00
|
|
| Hospital Charge Code |
4066461
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,505.36 |
| Max. Negotiated Rate |
$2,826.39 |
| Rate for Payer: Aetna Commercial |
$2,764.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,642.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,628.24
|
| Rate for Payer: Cash Price |
$886.20
|
| Rate for Payer: Cigna Commercial |
$2,826.39
|
| Rate for Payer: Health EOS Commercial |
$2,734.22
|
| Rate for Payer: HFN Commercial |
$2,826.39
|
| Rate for Payer: Multiplan Commercial |
$2,457.73
|
| Rate for Payer: Preferred Network Access Commercial |
$2,826.39
|
| Rate for Payer: Quartz Beloit One Network |
$1,505.36
|
| Rate for Payer: Quartz Commercial |
$1,843.30
|
| Rate for Payer: WEA Trust Commercial |
$1,689.69
|
| Rate for Payer: WPS Commercial |
$2,275.47
|
|
|
SCREW CANN 6.5MM X 110MM X 16MM THREAD 208.417
|
Facility
|
OP
|
$2,954.00
|
|
| Hospital Charge Code |
4065104
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$860.20 |
| Max. Negotiated Rate |
$2,826.39 |
| Rate for Payer: Aetna Commercial |
$2,764.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,642.06
|
| Rate for Payer: Aetna Managed Medicare |
$860.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,996.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,536.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,474.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,628.24
|
| Rate for Payer: Cash Price |
$886.20
|
| Rate for Payer: Cigna Commercial |
$2,826.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,719.23
|
| Rate for Payer: Health EOS Commercial |
$2,734.22
|
| Rate for Payer: HFN Commercial |
$2,826.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,304.12
|
| Rate for Payer: Multiplan Commercial |
$2,457.73
|
| Rate for Payer: NAPHCARE Commercial |
$1,843.30
|
| Rate for Payer: Preferred Network Access Commercial |
$2,826.39
|
| Rate for Payer: Quartz Beloit One Network |
$1,505.36
|
| Rate for Payer: Quartz Commercial |
$1,996.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,843.30
|
| Rate for Payer: The Alliance Commercial |
$1,536.08
|
| Rate for Payer: WEA Trust Commercial |
$1,689.69
|
| Rate for Payer: WPS Commercial |
$2,275.47
|
|
|
SCREW CANN 6.5MM X 110MM X 16MM THREAD 208.417
|
Facility
|
IP
|
$2,954.00
|
|
| Hospital Charge Code |
4065104
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,505.36 |
| Max. Negotiated Rate |
$2,826.39 |
| Rate for Payer: Aetna Commercial |
$2,764.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,642.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,628.24
|
| Rate for Payer: Cash Price |
$886.20
|
| Rate for Payer: Cigna Commercial |
$2,826.39
|
| Rate for Payer: Health EOS Commercial |
$2,734.22
|
| Rate for Payer: HFN Commercial |
$2,826.39
|
| Rate for Payer: Multiplan Commercial |
$2,457.73
|
| Rate for Payer: Preferred Network Access Commercial |
$2,826.39
|
| Rate for Payer: Quartz Beloit One Network |
$1,505.36
|
| Rate for Payer: Quartz Commercial |
$1,843.30
|
| Rate for Payer: WEA Trust Commercial |
$1,689.69
|
| Rate for Payer: WPS Commercial |
$2,275.47
|
|
