|
SCREW CANN 6.5MM X 55MM X 32 THREAD 208.433
|
Facility
|
OP
|
$2,954.00
|
|
| Hospital Charge Code |
4066450
|
|
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 55MM X 32 THREAD 208.433
|
Facility
|
IP
|
$2,954.00
|
|
| Hospital Charge Code |
4066450
|
|
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 60MM X 16MM THREAD 208.407
|
Facility
|
IP
|
$2,954.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4065096
|
|
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 60MM X 16MM THREAD 208.407
|
Facility
|
OP
|
$2,954.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4065096
|
|
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 60MM X 32 THREAD 208.434
|
Facility
|
OP
|
$2,954.00
|
|
| Hospital Charge Code |
4066451
|
|
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 60MM X 32 THREAD 208.434
|
Facility
|
IP
|
$2,954.00
|
|
| Hospital Charge Code |
4066451
|
|
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 65MM X 32 THREAD 208.435
|
Facility
|
IP
|
$2,954.00
|
|
| Hospital Charge Code |
4066452
|
|
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 65MM X 32 THREAD 208.435
|
Facility
|
OP
|
$2,954.00
|
|
| Hospital Charge Code |
4066452
|
|
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 70MM X 16MM 208.409
|
Facility
|
IP
|
$2,954.00
|
|
| Hospital Charge Code |
4065098
|
|
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 70MM X 16MM 208.409
|
Facility
|
OP
|
$2,954.00
|
|
| Hospital Charge Code |
4065098
|
|
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 70MM X 32MM THREAD 208.436
|
Facility
|
OP
|
$2,954.00
|
|
| Hospital Charge Code |
3365519
|
|
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 70MM X 32MM THREAD 208.436
|
Facility
|
IP
|
$2,954.00
|
|
| Hospital Charge Code |
3365519
|
|
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 75MM X 16MM 208.410
|
Facility
|
OP
|
$2,954.00
|
|
| Hospital Charge Code |
4065100
|
|
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 75MM X 16MM 208.410
|
Facility
|
IP
|
$2,954.00
|
|
| Hospital Charge Code |
4065100
|
|
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 75MM X 32MM THREAD 208.437
|
Facility
|
OP
|
$2,954.00
|
|
| Hospital Charge Code |
4066454
|
|
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 75MM X 32MM THREAD 208.437
|
Facility
|
IP
|
$2,954.00
|
|
| Hospital Charge Code |
4066454
|
|
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 80MM X 16MM THREAD 208.411
|
Facility
|
IP
|
$3,067.00
|
|
| Hospital Charge Code |
3267490
|
|
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 80MM X 16MM THREAD 208.411
|
Facility
|
OP
|
$3,067.00
|
|
| Hospital Charge Code |
3267490
|
|
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 80MM X 32 THREAD 208.438
|
Facility
|
OP
|
$3,067.00
|
|
| Hospital Charge Code |
4066455
|
|
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 80MM X 32 THREAD 208.438
|
Facility
|
IP
|
$3,067.00
|
|
| Hospital Charge Code |
4066455
|
|
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 85MM X 16MM THREAD 208.412
|
Facility
|
IP
|
$3,067.00
|
|
| Hospital Charge Code |
3267491
|
|
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 85MM X 16MM THREAD 208.412
|
Facility
|
OP
|
$3,067.00
|
|
| Hospital Charge Code |
3267491
|
|
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 85MM X 32 THREAD 208.439
|
Facility
|
IP
|
$2,954.00
|
|
| Hospital Charge Code |
4066456
|
|
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 85MM X 32 THREAD 208.439
|
Facility
|
OP
|
$2,954.00
|
|
| Hospital Charge Code |
4066456
|
|
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 90MM X 16MM THREAD 208.413
|
Facility
|
OP
|
$2,954.00
|
|
| Hospital Charge Code |
4065101
|
|
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
|
|
