|
SCREW-CANN 5.0 X 50 02.205.050
|
Facility
|
IP
|
$827.00
|
|
| Hospital Charge Code |
2966985
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$405.23 |
| Max. Negotiated Rate |
$760.84 |
| Rate for Payer: Aetna Commercial |
$744.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$711.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$438.31
|
| Rate for Payer: Cash Price |
$248.10
|
| Rate for Payer: Cigna Commercial |
$760.84
|
| Rate for Payer: Health EOS Commercial |
$736.03
|
| Rate for Payer: HFN Commercial |
$760.84
|
| Rate for Payer: Multiplan Commercial |
$661.60
|
| Rate for Payer: NAPHCARE Commercial |
$496.20
|
| Rate for Payer: Preferred Network Access Commercial |
$760.84
|
| Rate for Payer: Quartz Beloit One Network |
$405.23
|
| Rate for Payer: Quartz Commercial |
$496.20
|
| Rate for Payer: WEA Trust Commercial |
$454.85
|
| Rate for Payer: WPS Commercial |
$612.56
|
|
|
SCREW-CANN 5.0 X 50 02.205.050
|
Facility
|
OP
|
$827.00
|
|
| Hospital Charge Code |
2966985
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$231.56 |
| Max. Negotiated Rate |
$3,308.00 |
| Rate for Payer: Aetna Commercial |
$744.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$711.22
|
| Rate for Payer: Aetna Managed Medicare |
$231.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$537.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$413.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$396.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$438.31
|
| Rate for Payer: Cash Price |
$248.10
|
| Rate for Payer: Cigna Commercial |
$760.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$462.79
|
| Rate for Payer: Health EOS Commercial |
$736.03
|
| Rate for Payer: HFN Commercial |
$760.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$620.25
|
| Rate for Payer: Multiplan Commercial |
$661.60
|
| Rate for Payer: NAPHCARE Commercial |
$496.20
|
| Rate for Payer: Preferred Network Access Commercial |
$760.84
|
| Rate for Payer: Quartz Beloit One Network |
$405.23
|
| Rate for Payer: Quartz Commercial |
$537.55
|
| Rate for Payer: Quartz Medicare Advantage |
$496.20
|
| Rate for Payer: The Alliance Commercial |
$3,308.00
|
| Rate for Payer: WEA Trust Commercial |
$454.85
|
| Rate for Payer: WPS Commercial |
$612.56
|
|
|
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 |
$990.78 |
| Max. Negotiated Rate |
$1,860.24 |
| Rate for Payer: Aetna Commercial |
$1,819.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,738.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,071.66
|
| Rate for Payer: Cash Price |
$606.60
|
| Rate for Payer: Cigna Commercial |
$1,860.24
|
| Rate for Payer: Health EOS Commercial |
$1,799.58
|
| Rate for Payer: HFN Commercial |
$1,860.24
|
| Rate for Payer: Multiplan Commercial |
$1,617.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,213.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,860.24
|
| Rate for Payer: Quartz Beloit One Network |
$990.78
|
| Rate for Payer: Quartz Commercial |
$1,213.20
|
| Rate for Payer: WEA Trust Commercial |
$1,112.10
|
| Rate for Payer: WPS Commercial |
$1,497.70
|
|
|
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 |
$566.16 |
| Max. Negotiated Rate |
$8,088.00 |
| Rate for Payer: Aetna Commercial |
$1,819.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,738.92
|
| Rate for Payer: Aetna Managed Medicare |
$566.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,314.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,011.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$970.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,071.66
|
| Rate for Payer: Cash Price |
$606.60
|
| Rate for Payer: Cigna Commercial |
$1,860.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,131.51
|
| Rate for Payer: Health EOS Commercial |
$1,799.58
|
| Rate for Payer: HFN Commercial |
$1,860.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,516.50
|
| Rate for Payer: Multiplan Commercial |
$1,617.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,213.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,860.24
|
| Rate for Payer: Quartz Beloit One Network |
$990.78
|
| Rate for Payer: Quartz Commercial |
$1,314.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,213.20
|
| Rate for Payer: The Alliance Commercial |
$8,088.00
|
| Rate for Payer: WEA Trust Commercial |
$1,112.10
|
| Rate for Payer: WPS Commercial |
$1,497.70
|
|
|
SCREW-CANN 5.0 X 55 02.205.055
|
Facility
|
IP
|
$827.00
|
|
| Hospital Charge Code |
2966989
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$405.23 |
| Max. Negotiated Rate |
$760.84 |
| Rate for Payer: Aetna Commercial |
$744.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$711.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$438.31
|
| Rate for Payer: Cash Price |
$248.10
|
| Rate for Payer: Cigna Commercial |
$760.84
|
| Rate for Payer: Health EOS Commercial |
$736.03
|
| Rate for Payer: HFN Commercial |
$760.84
|
| Rate for Payer: Multiplan Commercial |
$661.60
|
| Rate for Payer: NAPHCARE Commercial |
$496.20
|
| Rate for Payer: Preferred Network Access Commercial |
$760.84
|
| Rate for Payer: Quartz Beloit One Network |
$405.23
|
| Rate for Payer: Quartz Commercial |
$496.20
|
| Rate for Payer: WEA Trust Commercial |
$454.85
|
| Rate for Payer: WPS Commercial |
$612.56
|
|
|
SCREW-CANN 5.0 X 55 02.205.055
|
Facility
|
OP
|
$827.00
|
|
| Hospital Charge Code |
2966989
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$231.56 |
| Max. Negotiated Rate |
$3,308.00 |
| Rate for Payer: Aetna Commercial |
$744.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$711.22
|
| Rate for Payer: Aetna Managed Medicare |
$231.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$537.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$413.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$396.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$438.31
|
| Rate for Payer: Cash Price |
$248.10
|
| Rate for Payer: Cigna Commercial |
$760.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$462.79
|
| Rate for Payer: Health EOS Commercial |
$736.03
|
| Rate for Payer: HFN Commercial |
$760.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$620.25
|
| Rate for Payer: Multiplan Commercial |
$661.60
|
| Rate for Payer: NAPHCARE Commercial |
$496.20
|
| Rate for Payer: Preferred Network Access Commercial |
$760.84
|
| Rate for Payer: Quartz Beloit One Network |
$405.23
|
| Rate for Payer: Quartz Commercial |
$537.55
|
| Rate for Payer: Quartz Medicare Advantage |
$496.20
|
| Rate for Payer: The Alliance Commercial |
$3,308.00
|
| Rate for Payer: WEA Trust Commercial |
$454.85
|
| Rate for Payer: WPS Commercial |
$612.56
|
|
|
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 |
$566.16 |
| Max. Negotiated Rate |
$8,088.00 |
| Rate for Payer: Aetna Commercial |
$1,819.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,738.92
|
| Rate for Payer: Aetna Managed Medicare |
$566.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,314.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,011.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$970.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,071.66
|
| Rate for Payer: Cash Price |
$606.60
|
| Rate for Payer: Cigna Commercial |
$1,860.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,131.51
|
| Rate for Payer: Health EOS Commercial |
$1,799.58
|
| Rate for Payer: HFN Commercial |
$1,860.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,516.50
|
| Rate for Payer: Multiplan Commercial |
$1,617.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,213.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,860.24
|
| Rate for Payer: Quartz Beloit One Network |
$990.78
|
| Rate for Payer: Quartz Commercial |
$1,314.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,213.20
|
| Rate for Payer: The Alliance Commercial |
$8,088.00
|
| Rate for Payer: WEA Trust Commercial |
$1,112.10
|
| Rate for Payer: WPS Commercial |
$1,497.70
|
|
|
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 |
$990.78 |
| Max. Negotiated Rate |
$1,860.24 |
| Rate for Payer: Aetna Commercial |
$1,819.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,738.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,071.66
|
| Rate for Payer: Cash Price |
$606.60
|
| Rate for Payer: Cigna Commercial |
$1,860.24
|
| Rate for Payer: Health EOS Commercial |
$1,799.58
|
| Rate for Payer: HFN Commercial |
$1,860.24
|
| Rate for Payer: Multiplan Commercial |
$1,617.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,213.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,860.24
|
| Rate for Payer: Quartz Beloit One Network |
$990.78
|
| Rate for Payer: Quartz Commercial |
$1,213.20
|
| Rate for Payer: WEA Trust Commercial |
$1,112.10
|
| Rate for Payer: WPS Commercial |
$1,497.70
|
|
|
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 |
$990.78 |
| Max. Negotiated Rate |
$1,860.24 |
| Rate for Payer: Aetna Commercial |
$1,819.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,738.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,071.66
|
| Rate for Payer: Cash Price |
$606.60
|
| Rate for Payer: Cigna Commercial |
$1,860.24
|
| Rate for Payer: Health EOS Commercial |
$1,799.58
|
| Rate for Payer: HFN Commercial |
$1,860.24
|
| Rate for Payer: Multiplan Commercial |
$1,617.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,213.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,860.24
|
| Rate for Payer: Quartz Beloit One Network |
$990.78
|
| Rate for Payer: Quartz Commercial |
$1,213.20
|
| Rate for Payer: WEA Trust Commercial |
$1,112.10
|
| Rate for Payer: WPS Commercial |
$1,497.70
|
|
|
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 |
$566.16 |
| Max. Negotiated Rate |
$8,088.00 |
| Rate for Payer: Aetna Commercial |
$1,819.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,738.92
|
| Rate for Payer: Aetna Managed Medicare |
$566.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,314.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,011.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$970.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,071.66
|
| Rate for Payer: Cash Price |
$606.60
|
| Rate for Payer: Cigna Commercial |
$1,860.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,131.51
|
| Rate for Payer: Health EOS Commercial |
$1,799.58
|
| Rate for Payer: HFN Commercial |
$1,860.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,516.50
|
| Rate for Payer: Multiplan Commercial |
$1,617.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,213.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,860.24
|
| Rate for Payer: Quartz Beloit One Network |
$990.78
|
| Rate for Payer: Quartz Commercial |
$1,314.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,213.20
|
| Rate for Payer: The Alliance Commercial |
$8,088.00
|
| Rate for Payer: WEA Trust Commercial |
$1,112.10
|
| Rate for Payer: WPS Commercial |
$1,497.70
|
|
|
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 |
$608.72 |
| Max. Negotiated Rate |
$8,696.00 |
| Rate for Payer: Aetna Commercial |
$1,956.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,869.64
|
| Rate for Payer: Aetna Managed Medicare |
$608.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,413.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,087.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,043.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,152.22
|
| Rate for Payer: Cash Price |
$652.20
|
| Rate for Payer: Cigna Commercial |
$2,000.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,216.57
|
| Rate for Payer: Health EOS Commercial |
$1,934.86
|
| Rate for Payer: HFN Commercial |
$2,000.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,630.50
|
| Rate for Payer: Multiplan Commercial |
$1,739.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,304.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,000.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,065.26
|
| Rate for Payer: Quartz Commercial |
$1,413.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,304.40
|
| Rate for Payer: The Alliance Commercial |
$8,696.00
|
| Rate for Payer: WEA Trust Commercial |
$1,195.70
|
| Rate for Payer: WPS Commercial |
$1,610.28
|
|
|
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 |
$1,065.26 |
| Max. Negotiated Rate |
$2,000.08 |
| Rate for Payer: Aetna Commercial |
$1,956.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,869.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,152.22
|
| Rate for Payer: Cash Price |
$652.20
|
| Rate for Payer: Cigna Commercial |
$2,000.08
|
| Rate for Payer: Health EOS Commercial |
$1,934.86
|
| Rate for Payer: HFN Commercial |
$2,000.08
|
| Rate for Payer: Multiplan Commercial |
$1,739.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,304.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,000.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,065.26
|
| Rate for Payer: Quartz Commercial |
$1,304.40
|
| Rate for Payer: WEA Trust Commercial |
$1,195.70
|
| Rate for Payer: WPS Commercial |
$1,610.28
|
|
|
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 |
$990.78 |
| Max. Negotiated Rate |
$1,860.24 |
| Rate for Payer: Aetna Commercial |
$1,819.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,738.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,071.66
|
| Rate for Payer: Cash Price |
$606.60
|
| Rate for Payer: Cigna Commercial |
$1,860.24
|
| Rate for Payer: Health EOS Commercial |
$1,799.58
|
| Rate for Payer: HFN Commercial |
$1,860.24
|
| Rate for Payer: Multiplan Commercial |
$1,617.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,213.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,860.24
|
| Rate for Payer: Quartz Beloit One Network |
$990.78
|
| Rate for Payer: Quartz Commercial |
$1,213.20
|
| Rate for Payer: WEA Trust Commercial |
$1,112.10
|
| Rate for Payer: WPS Commercial |
$1,497.70
|
|
|
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 |
$566.16 |
| Max. Negotiated Rate |
$8,088.00 |
| Rate for Payer: Aetna Commercial |
$1,819.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,738.92
|
| Rate for Payer: Aetna Managed Medicare |
$566.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,314.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,011.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$970.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,071.66
|
| Rate for Payer: Cash Price |
$606.60
|
| Rate for Payer: Cigna Commercial |
$1,860.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,131.51
|
| Rate for Payer: Health EOS Commercial |
$1,799.58
|
| Rate for Payer: HFN Commercial |
$1,860.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,516.50
|
| Rate for Payer: Multiplan Commercial |
$1,617.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,213.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,860.24
|
| Rate for Payer: Quartz Beloit One Network |
$990.78
|
| Rate for Payer: Quartz Commercial |
$1,314.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,213.20
|
| Rate for Payer: The Alliance Commercial |
$8,088.00
|
| Rate for Payer: WEA Trust Commercial |
$1,112.10
|
| Rate for Payer: WPS Commercial |
$1,497.70
|
|
|
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 |
$908.95 |
| Max. Negotiated Rate |
$1,706.60 |
| Rate for Payer: Aetna Commercial |
$1,669.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,595.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$983.15
|
| Rate for Payer: Cash Price |
$556.50
|
| Rate for Payer: Cigna Commercial |
$1,706.60
|
| Rate for Payer: Health EOS Commercial |
$1,650.95
|
| Rate for Payer: HFN Commercial |
$1,706.60
|
| Rate for Payer: Multiplan Commercial |
$1,484.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,113.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,706.60
|
| Rate for Payer: Quartz Beloit One Network |
$908.95
|
| Rate for Payer: Quartz Commercial |
$1,113.00
|
| Rate for Payer: WEA Trust Commercial |
$1,020.25
|
| Rate for Payer: WPS Commercial |
$1,374.00
|
|
|
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 |
$519.40 |
| Max. Negotiated Rate |
$7,420.00 |
| Rate for Payer: Aetna Commercial |
$1,669.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,595.30
|
| Rate for Payer: Aetna Managed Medicare |
$519.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,205.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$927.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$890.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$983.15
|
| Rate for Payer: Cash Price |
$556.50
|
| Rate for Payer: Cigna Commercial |
$1,706.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,038.06
|
| Rate for Payer: Health EOS Commercial |
$1,650.95
|
| Rate for Payer: HFN Commercial |
$1,706.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,391.25
|
| Rate for Payer: Multiplan Commercial |
$1,484.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,113.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,706.60
|
| Rate for Payer: Quartz Beloit One Network |
$908.95
|
| Rate for Payer: Quartz Commercial |
$1,205.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,113.00
|
| Rate for Payer: The Alliance Commercial |
$7,420.00
|
| Rate for Payer: WEA Trust Commercial |
$1,020.25
|
| Rate for Payer: WPS Commercial |
$1,374.00
|
|
|
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 |
$566.16 |
| Max. Negotiated Rate |
$8,088.00 |
| Rate for Payer: Aetna Commercial |
$1,819.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,738.92
|
| Rate for Payer: Aetna Managed Medicare |
$566.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,314.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,011.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$970.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,071.66
|
| Rate for Payer: Cash Price |
$606.60
|
| Rate for Payer: Cigna Commercial |
$1,860.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,131.51
|
| Rate for Payer: Health EOS Commercial |
$1,799.58
|
| Rate for Payer: HFN Commercial |
$1,860.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,516.50
|
| Rate for Payer: Multiplan Commercial |
$1,617.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,213.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,860.24
|
| Rate for Payer: Quartz Beloit One Network |
$990.78
|
| Rate for Payer: Quartz Commercial |
$1,314.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,213.20
|
| Rate for Payer: The Alliance Commercial |
$8,088.00
|
| Rate for Payer: WEA Trust Commercial |
$1,112.10
|
| Rate for Payer: WPS Commercial |
$1,497.70
|
|
|
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 |
$990.78 |
| Max. Negotiated Rate |
$1,860.24 |
| Rate for Payer: Aetna Commercial |
$1,819.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,738.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,071.66
|
| Rate for Payer: Cash Price |
$606.60
|
| Rate for Payer: Cigna Commercial |
$1,860.24
|
| Rate for Payer: Health EOS Commercial |
$1,799.58
|
| Rate for Payer: HFN Commercial |
$1,860.24
|
| Rate for Payer: Multiplan Commercial |
$1,617.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,213.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,860.24
|
| Rate for Payer: Quartz Beloit One Network |
$990.78
|
| Rate for Payer: Quartz Commercial |
$1,213.20
|
| Rate for Payer: WEA Trust Commercial |
$1,112.10
|
| Rate for Payer: WPS Commercial |
$1,497.70
|
|
|
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 |
$1,065.26 |
| Max. Negotiated Rate |
$2,000.08 |
| Rate for Payer: Aetna Commercial |
$1,956.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,869.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,152.22
|
| Rate for Payer: Cash Price |
$652.20
|
| Rate for Payer: Cigna Commercial |
$2,000.08
|
| Rate for Payer: Health EOS Commercial |
$1,934.86
|
| Rate for Payer: HFN Commercial |
$2,000.08
|
| Rate for Payer: Multiplan Commercial |
$1,739.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,304.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,000.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,065.26
|
| Rate for Payer: Quartz Commercial |
$1,304.40
|
| Rate for Payer: WEA Trust Commercial |
$1,195.70
|
| Rate for Payer: WPS Commercial |
$1,610.28
|
|
|
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 |
$608.72 |
| Max. Negotiated Rate |
$8,696.00 |
| Rate for Payer: Aetna Commercial |
$1,956.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,869.64
|
| Rate for Payer: Aetna Managed Medicare |
$608.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,413.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,087.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,043.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,152.22
|
| Rate for Payer: Cash Price |
$652.20
|
| Rate for Payer: Cigna Commercial |
$2,000.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,216.57
|
| Rate for Payer: Health EOS Commercial |
$1,934.86
|
| Rate for Payer: HFN Commercial |
$2,000.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,630.50
|
| Rate for Payer: Multiplan Commercial |
$1,739.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,304.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,000.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,065.26
|
| Rate for Payer: Quartz Commercial |
$1,413.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,304.40
|
| Rate for Payer: The Alliance Commercial |
$8,696.00
|
| Rate for Payer: WEA Trust Commercial |
$1,195.70
|
| Rate for Payer: WPS Commercial |
$1,610.28
|
|
|
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 |
$1,029.00 |
| Max. Negotiated Rate |
$1,932.00 |
| Rate for Payer: Aetna Commercial |
$1,890.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,806.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,113.00
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Cigna Commercial |
$1,932.00
|
| Rate for Payer: Health EOS Commercial |
$1,869.00
|
| Rate for Payer: HFN Commercial |
$1,932.00
|
| Rate for Payer: Multiplan Commercial |
$1,680.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,260.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,932.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,029.00
|
| Rate for Payer: Quartz Commercial |
$1,260.00
|
| Rate for Payer: WEA Trust Commercial |
$1,155.00
|
| Rate for Payer: WPS Commercial |
$1,555.47
|
|
|
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 |
$588.00 |
| Max. Negotiated Rate |
$8,400.00 |
| Rate for Payer: Aetna Commercial |
$1,890.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,806.00
|
| Rate for Payer: Aetna Managed Medicare |
$588.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,365.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,050.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,008.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,113.00
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Cigna Commercial |
$1,932.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,175.16
|
| Rate for Payer: Health EOS Commercial |
$1,869.00
|
| Rate for Payer: HFN Commercial |
$1,932.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,575.00
|
| Rate for Payer: Multiplan Commercial |
$1,680.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,260.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,932.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,029.00
|
| Rate for Payer: Quartz Commercial |
$1,365.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,260.00
|
| Rate for Payer: The Alliance Commercial |
$8,400.00
|
| Rate for Payer: WEA Trust Commercial |
$1,155.00
|
| Rate for Payer: WPS Commercial |
$1,555.47
|
|
|
SCREW-CANN 5.0 X 80 02.205.080
|
Facility
|
OP
|
$827.00
|
|
| Hospital Charge Code |
2967004
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$231.56 |
| Max. Negotiated Rate |
$3,308.00 |
| Rate for Payer: Aetna Commercial |
$744.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$711.22
|
| Rate for Payer: Aetna Managed Medicare |
$231.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$537.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$413.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$396.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$438.31
|
| Rate for Payer: Cash Price |
$248.10
|
| Rate for Payer: Cigna Commercial |
$760.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$462.79
|
| Rate for Payer: Health EOS Commercial |
$736.03
|
| Rate for Payer: HFN Commercial |
$760.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$620.25
|
| Rate for Payer: Multiplan Commercial |
$661.60
|
| Rate for Payer: NAPHCARE Commercial |
$496.20
|
| Rate for Payer: Preferred Network Access Commercial |
$760.84
|
| Rate for Payer: Quartz Beloit One Network |
$405.23
|
| Rate for Payer: Quartz Commercial |
$537.55
|
| Rate for Payer: Quartz Medicare Advantage |
$496.20
|
| Rate for Payer: The Alliance Commercial |
$3,308.00
|
| Rate for Payer: WEA Trust Commercial |
$454.85
|
| Rate for Payer: WPS Commercial |
$612.56
|
|
|
SCREW-CANN 5.0 X 80 02.205.080
|
Facility
|
IP
|
$827.00
|
|
| Hospital Charge Code |
2967004
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$405.23 |
| Max. Negotiated Rate |
$760.84 |
| Rate for Payer: Aetna Commercial |
$744.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$711.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$438.31
|
| Rate for Payer: Cash Price |
$248.10
|
| Rate for Payer: Cigna Commercial |
$760.84
|
| Rate for Payer: Health EOS Commercial |
$736.03
|
| Rate for Payer: HFN Commercial |
$760.84
|
| Rate for Payer: Multiplan Commercial |
$661.60
|
| Rate for Payer: NAPHCARE Commercial |
$496.20
|
| Rate for Payer: Preferred Network Access Commercial |
$760.84
|
| Rate for Payer: Quartz Beloit One Network |
$405.23
|
| Rate for Payer: Quartz Commercial |
$496.20
|
| Rate for Payer: WEA Trust Commercial |
$454.85
|
| Rate for Payer: WPS Commercial |
$612.56
|
|
|
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 |
$566.16 |
| Max. Negotiated Rate |
$8,088.00 |
| Rate for Payer: Aetna Commercial |
$1,819.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,738.92
|
| Rate for Payer: Aetna Managed Medicare |
$566.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,314.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,011.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$970.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,071.66
|
| Rate for Payer: Cash Price |
$606.60
|
| Rate for Payer: Cigna Commercial |
$1,860.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,131.51
|
| Rate for Payer: Health EOS Commercial |
$1,799.58
|
| Rate for Payer: HFN Commercial |
$1,860.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,516.50
|
| Rate for Payer: Multiplan Commercial |
$1,617.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,213.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,860.24
|
| Rate for Payer: Quartz Beloit One Network |
$990.78
|
| Rate for Payer: Quartz Commercial |
$1,314.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,213.20
|
| Rate for Payer: The Alliance Commercial |
$8,088.00
|
| Rate for Payer: WEA Trust Commercial |
$1,112.10
|
| Rate for Payer: WPS Commercial |
$1,497.70
|
|
