|
SCREW CANN 4.0 X 70MM PARTIAL THREAD STRYKER 604670
|
Facility
|
IP
|
$1,811.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6185027
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$922.89 |
| Max. Negotiated Rate |
$1,732.76 |
| Rate for Payer: Aetna Commercial |
$1,695.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,619.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$998.22
|
| Rate for Payer: Cash Price |
$543.30
|
| Rate for Payer: Cigna Commercial |
$1,732.76
|
| Rate for Payer: Health EOS Commercial |
$1,676.26
|
| Rate for Payer: HFN Commercial |
$1,732.76
|
| Rate for Payer: Multiplan Commercial |
$1,506.75
|
| Rate for Payer: Preferred Network Access Commercial |
$1,732.76
|
| Rate for Payer: Quartz Beloit One Network |
$922.89
|
| Rate for Payer: Quartz Commercial |
$1,130.06
|
| Rate for Payer: WEA Trust Commercial |
$1,035.89
|
| Rate for Payer: WPS Commercial |
$1,395.01
|
|
|
SCREW CANN 4.0 X 70MM PARTIAL THREAD STRYKER 604670
|
Facility
|
OP
|
$1,811.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6185027
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$527.36 |
| Max. Negotiated Rate |
$1,732.76 |
| Rate for Payer: Aetna Commercial |
$1,695.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,619.76
|
| Rate for Payer: Aetna Managed Medicare |
$527.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,224.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$941.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$904.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$998.22
|
| Rate for Payer: Cash Price |
$543.30
|
| Rate for Payer: Cigna Commercial |
$1,732.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,054.00
|
| Rate for Payer: Health EOS Commercial |
$1,676.26
|
| Rate for Payer: HFN Commercial |
$1,732.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,412.58
|
| Rate for Payer: Multiplan Commercial |
$1,506.75
|
| Rate for Payer: NAPHCARE Commercial |
$1,130.06
|
| Rate for Payer: Preferred Network Access Commercial |
$1,732.76
|
| Rate for Payer: Quartz Beloit One Network |
$922.89
|
| Rate for Payer: Quartz Commercial |
$1,224.24
|
| Rate for Payer: Quartz Medicare Advantage |
$1,130.06
|
| Rate for Payer: The Alliance Commercial |
$941.72
|
| Rate for Payer: WEA Trust Commercial |
$1,035.89
|
| Rate for Payer: WPS Commercial |
$1,395.01
|
|
|
SCREW-CANN 4.5 X 20 214.520
|
Facility
|
IP
|
$1,875.00
|
|
| Hospital Charge Code |
2967167
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$955.50 |
| Max. Negotiated Rate |
$1,794.00 |
| Rate for Payer: Aetna Commercial |
$1,755.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,677.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,033.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,794.00
|
| Rate for Payer: Health EOS Commercial |
$1,735.50
|
| Rate for Payer: HFN Commercial |
$1,794.00
|
| Rate for Payer: Multiplan Commercial |
$1,560.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,794.00
|
| Rate for Payer: Quartz Beloit One Network |
$955.50
|
| Rate for Payer: Quartz Commercial |
$1,170.00
|
| Rate for Payer: WEA Trust Commercial |
$1,072.50
|
| Rate for Payer: WPS Commercial |
$1,444.31
|
|
|
SCREW-CANN 4.5 X 20 214.520
|
Facility
|
OP
|
$1,875.00
|
|
| Hospital Charge Code |
2967167
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$546.00 |
| Max. Negotiated Rate |
$1,794.00 |
| Rate for Payer: Aetna Commercial |
$1,755.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,677.00
|
| Rate for Payer: Aetna Managed Medicare |
$546.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,267.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$975.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$936.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,033.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,794.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,091.25
|
| Rate for Payer: Health EOS Commercial |
$1,735.50
|
| Rate for Payer: HFN Commercial |
$1,794.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,462.50
|
| Rate for Payer: Multiplan Commercial |
$1,560.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,170.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,794.00
|
| Rate for Payer: Quartz Beloit One Network |
$955.50
|
| Rate for Payer: Quartz Commercial |
$1,267.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,170.00
|
| Rate for Payer: The Alliance Commercial |
$975.00
|
| Rate for Payer: WEA Trust Commercial |
$1,072.50
|
| Rate for Payer: WPS Commercial |
$1,444.31
|
|
|
SCREW-CANN 4.5 X 20 214.720
|
Facility
|
OP
|
$1,875.00
|
|
| Hospital Charge Code |
2967168
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$546.00 |
| Max. Negotiated Rate |
$1,794.00 |
| Rate for Payer: Aetna Commercial |
$1,755.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,677.00
|
| Rate for Payer: Aetna Managed Medicare |
$546.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,267.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$975.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$936.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,033.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,794.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,091.25
|
| Rate for Payer: Health EOS Commercial |
$1,735.50
|
| Rate for Payer: HFN Commercial |
$1,794.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,462.50
|
| Rate for Payer: Multiplan Commercial |
$1,560.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,170.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,794.00
|
| Rate for Payer: Quartz Beloit One Network |
$955.50
|
| Rate for Payer: Quartz Commercial |
$1,267.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,170.00
|
| Rate for Payer: The Alliance Commercial |
$975.00
|
| Rate for Payer: WEA Trust Commercial |
$1,072.50
|
| Rate for Payer: WPS Commercial |
$1,444.31
|
|
|
SCREW-CANN 4.5 X 20 214.720
|
Facility
|
IP
|
$1,875.00
|
|
| Hospital Charge Code |
2967168
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$955.50 |
| Max. Negotiated Rate |
$1,794.00 |
| Rate for Payer: Aetna Commercial |
$1,755.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,677.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,033.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,794.00
|
| Rate for Payer: Health EOS Commercial |
$1,735.50
|
| Rate for Payer: HFN Commercial |
$1,794.00
|
| Rate for Payer: Multiplan Commercial |
$1,560.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,794.00
|
| Rate for Payer: Quartz Beloit One Network |
$955.50
|
| Rate for Payer: Quartz Commercial |
$1,170.00
|
| Rate for Payer: WEA Trust Commercial |
$1,072.50
|
| Rate for Payer: WPS Commercial |
$1,444.31
|
|
|
SCREW-CANN 4.5 X 22 214.522
|
Facility
|
OP
|
$1,875.00
|
|
| Hospital Charge Code |
2967169
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$546.00 |
| Max. Negotiated Rate |
$1,794.00 |
| Rate for Payer: Aetna Commercial |
$1,755.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,677.00
|
| Rate for Payer: Aetna Managed Medicare |
$546.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,267.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$975.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$936.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,033.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,794.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,091.25
|
| Rate for Payer: Health EOS Commercial |
$1,735.50
|
| Rate for Payer: HFN Commercial |
$1,794.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,462.50
|
| Rate for Payer: Multiplan Commercial |
$1,560.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,170.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,794.00
|
| Rate for Payer: Quartz Beloit One Network |
$955.50
|
| Rate for Payer: Quartz Commercial |
$1,267.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,170.00
|
| Rate for Payer: The Alliance Commercial |
$975.00
|
| Rate for Payer: WEA Trust Commercial |
$1,072.50
|
| Rate for Payer: WPS Commercial |
$1,444.31
|
|
|
SCREW-CANN 4.5 X 22 214.522
|
Facility
|
IP
|
$1,875.00
|
|
| Hospital Charge Code |
2967169
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$955.50 |
| Max. Negotiated Rate |
$1,794.00 |
| Rate for Payer: Aetna Commercial |
$1,755.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,677.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,033.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,794.00
|
| Rate for Payer: Health EOS Commercial |
$1,735.50
|
| Rate for Payer: HFN Commercial |
$1,794.00
|
| Rate for Payer: Multiplan Commercial |
$1,560.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,794.00
|
| Rate for Payer: Quartz Beloit One Network |
$955.50
|
| Rate for Payer: Quartz Commercial |
$1,170.00
|
| Rate for Payer: WEA Trust Commercial |
$1,072.50
|
| Rate for Payer: WPS Commercial |
$1,444.31
|
|
|
SCREW-CANN 4.5 X 22 214.722
|
Facility
|
IP
|
$1,875.00
|
|
| Hospital Charge Code |
2967170
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$955.50 |
| Max. Negotiated Rate |
$1,794.00 |
| Rate for Payer: Aetna Commercial |
$1,755.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,677.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,033.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,794.00
|
| Rate for Payer: Health EOS Commercial |
$1,735.50
|
| Rate for Payer: HFN Commercial |
$1,794.00
|
| Rate for Payer: Multiplan Commercial |
$1,560.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,794.00
|
| Rate for Payer: Quartz Beloit One Network |
$955.50
|
| Rate for Payer: Quartz Commercial |
$1,170.00
|
| Rate for Payer: WEA Trust Commercial |
$1,072.50
|
| Rate for Payer: WPS Commercial |
$1,444.31
|
|
|
SCREW-CANN 4.5 X 22 214.722
|
Facility
|
OP
|
$1,875.00
|
|
| Hospital Charge Code |
2967170
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$546.00 |
| Max. Negotiated Rate |
$1,794.00 |
| Rate for Payer: Aetna Commercial |
$1,755.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,677.00
|
| Rate for Payer: Aetna Managed Medicare |
$546.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,267.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$975.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$936.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,033.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,794.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,091.25
|
| Rate for Payer: Health EOS Commercial |
$1,735.50
|
| Rate for Payer: HFN Commercial |
$1,794.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,462.50
|
| Rate for Payer: Multiplan Commercial |
$1,560.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,170.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,794.00
|
| Rate for Payer: Quartz Beloit One Network |
$955.50
|
| Rate for Payer: Quartz Commercial |
$1,267.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,170.00
|
| Rate for Payer: The Alliance Commercial |
$975.00
|
| Rate for Payer: WEA Trust Commercial |
$1,072.50
|
| Rate for Payer: WPS Commercial |
$1,444.31
|
|
|
SCREW-CANN 4.5 X 24 214.524
|
Facility
|
IP
|
$1,875.00
|
|
| Hospital Charge Code |
2967171
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$955.50 |
| Max. Negotiated Rate |
$1,794.00 |
| Rate for Payer: Aetna Commercial |
$1,755.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,677.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,033.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,794.00
|
| Rate for Payer: Health EOS Commercial |
$1,735.50
|
| Rate for Payer: HFN Commercial |
$1,794.00
|
| Rate for Payer: Multiplan Commercial |
$1,560.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,794.00
|
| Rate for Payer: Quartz Beloit One Network |
$955.50
|
| Rate for Payer: Quartz Commercial |
$1,170.00
|
| Rate for Payer: WEA Trust Commercial |
$1,072.50
|
| Rate for Payer: WPS Commercial |
$1,444.31
|
|
|
SCREW-CANN 4.5 X 24 214.524
|
Facility
|
OP
|
$1,875.00
|
|
| Hospital Charge Code |
2967171
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$546.00 |
| Max. Negotiated Rate |
$1,794.00 |
| Rate for Payer: Aetna Commercial |
$1,755.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,677.00
|
| Rate for Payer: Aetna Managed Medicare |
$546.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,267.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$975.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$936.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,033.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,794.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,091.25
|
| Rate for Payer: Health EOS Commercial |
$1,735.50
|
| Rate for Payer: HFN Commercial |
$1,794.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,462.50
|
| Rate for Payer: Multiplan Commercial |
$1,560.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,170.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,794.00
|
| Rate for Payer: Quartz Beloit One Network |
$955.50
|
| Rate for Payer: Quartz Commercial |
$1,267.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,170.00
|
| Rate for Payer: The Alliance Commercial |
$975.00
|
| Rate for Payer: WEA Trust Commercial |
$1,072.50
|
| Rate for Payer: WPS Commercial |
$1,444.31
|
|
|
SCREW-CANN 4.5 X 24 214.724
|
Facility
|
IP
|
$1,875.00
|
|
| Hospital Charge Code |
2967172
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$955.50 |
| Max. Negotiated Rate |
$1,794.00 |
| Rate for Payer: Aetna Commercial |
$1,755.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,677.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,033.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,794.00
|
| Rate for Payer: Health EOS Commercial |
$1,735.50
|
| Rate for Payer: HFN Commercial |
$1,794.00
|
| Rate for Payer: Multiplan Commercial |
$1,560.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,794.00
|
| Rate for Payer: Quartz Beloit One Network |
$955.50
|
| Rate for Payer: Quartz Commercial |
$1,170.00
|
| Rate for Payer: WEA Trust Commercial |
$1,072.50
|
| Rate for Payer: WPS Commercial |
$1,444.31
|
|
|
SCREW-CANN 4.5 X 24 214.724
|
Facility
|
OP
|
$1,875.00
|
|
| Hospital Charge Code |
2967172
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$546.00 |
| Max. Negotiated Rate |
$1,794.00 |
| Rate for Payer: Aetna Commercial |
$1,755.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,677.00
|
| Rate for Payer: Aetna Managed Medicare |
$546.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,267.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$975.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$936.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,033.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,794.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,091.25
|
| Rate for Payer: Health EOS Commercial |
$1,735.50
|
| Rate for Payer: HFN Commercial |
$1,794.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,462.50
|
| Rate for Payer: Multiplan Commercial |
$1,560.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,170.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,794.00
|
| Rate for Payer: Quartz Beloit One Network |
$955.50
|
| Rate for Payer: Quartz Commercial |
$1,267.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,170.00
|
| Rate for Payer: The Alliance Commercial |
$975.00
|
| Rate for Payer: WEA Trust Commercial |
$1,072.50
|
| Rate for Payer: WPS Commercial |
$1,444.31
|
|
|
SCREW-CANN 4.5 X 26 214.526
|
Facility
|
IP
|
$1,875.00
|
|
| Hospital Charge Code |
2967173
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$955.50 |
| Max. Negotiated Rate |
$1,794.00 |
| Rate for Payer: Aetna Commercial |
$1,755.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,677.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,033.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,794.00
|
| Rate for Payer: Health EOS Commercial |
$1,735.50
|
| Rate for Payer: HFN Commercial |
$1,794.00
|
| Rate for Payer: Multiplan Commercial |
$1,560.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,794.00
|
| Rate for Payer: Quartz Beloit One Network |
$955.50
|
| Rate for Payer: Quartz Commercial |
$1,170.00
|
| Rate for Payer: WEA Trust Commercial |
$1,072.50
|
| Rate for Payer: WPS Commercial |
$1,444.31
|
|
|
SCREW-CANN 4.5 X 26 214.526
|
Facility
|
OP
|
$1,875.00
|
|
| Hospital Charge Code |
2967173
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$546.00 |
| Max. Negotiated Rate |
$1,794.00 |
| Rate for Payer: Aetna Commercial |
$1,755.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,677.00
|
| Rate for Payer: Aetna Managed Medicare |
$546.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,267.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$975.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$936.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,033.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,794.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,091.25
|
| Rate for Payer: Health EOS Commercial |
$1,735.50
|
| Rate for Payer: HFN Commercial |
$1,794.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,462.50
|
| Rate for Payer: Multiplan Commercial |
$1,560.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,170.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,794.00
|
| Rate for Payer: Quartz Beloit One Network |
$955.50
|
| Rate for Payer: Quartz Commercial |
$1,267.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,170.00
|
| Rate for Payer: The Alliance Commercial |
$975.00
|
| Rate for Payer: WEA Trust Commercial |
$1,072.50
|
| Rate for Payer: WPS Commercial |
$1,444.31
|
|
|
SCREW-CANN 4.5 X 26 214.726
|
Facility
|
IP
|
$1,875.00
|
|
| Hospital Charge Code |
2967174
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$955.50 |
| Max. Negotiated Rate |
$1,794.00 |
| Rate for Payer: Aetna Commercial |
$1,755.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,677.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,033.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,794.00
|
| Rate for Payer: Health EOS Commercial |
$1,735.50
|
| Rate for Payer: HFN Commercial |
$1,794.00
|
| Rate for Payer: Multiplan Commercial |
$1,560.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,794.00
|
| Rate for Payer: Quartz Beloit One Network |
$955.50
|
| Rate for Payer: Quartz Commercial |
$1,170.00
|
| Rate for Payer: WEA Trust Commercial |
$1,072.50
|
| Rate for Payer: WPS Commercial |
$1,444.31
|
|
|
SCREW-CANN 4.5 X 26 214.726
|
Facility
|
OP
|
$1,875.00
|
|
| Hospital Charge Code |
2967174
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$546.00 |
| Max. Negotiated Rate |
$1,794.00 |
| Rate for Payer: Aetna Commercial |
$1,755.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,677.00
|
| Rate for Payer: Aetna Managed Medicare |
$546.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,267.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$975.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$936.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,033.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,794.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,091.25
|
| Rate for Payer: Health EOS Commercial |
$1,735.50
|
| Rate for Payer: HFN Commercial |
$1,794.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,462.50
|
| Rate for Payer: Multiplan Commercial |
$1,560.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,170.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,794.00
|
| Rate for Payer: Quartz Beloit One Network |
$955.50
|
| Rate for Payer: Quartz Commercial |
$1,267.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,170.00
|
| Rate for Payer: The Alliance Commercial |
$975.00
|
| Rate for Payer: WEA Trust Commercial |
$1,072.50
|
| Rate for Payer: WPS Commercial |
$1,444.31
|
|
|
SCREW-CANN 4.5 X 28 214.528
|
Facility
|
IP
|
$1,875.00
|
|
| Hospital Charge Code |
2967175
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$955.50 |
| Max. Negotiated Rate |
$1,794.00 |
| Rate for Payer: Aetna Commercial |
$1,755.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,677.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,033.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,794.00
|
| Rate for Payer: Health EOS Commercial |
$1,735.50
|
| Rate for Payer: HFN Commercial |
$1,794.00
|
| Rate for Payer: Multiplan Commercial |
$1,560.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,794.00
|
| Rate for Payer: Quartz Beloit One Network |
$955.50
|
| Rate for Payer: Quartz Commercial |
$1,170.00
|
| Rate for Payer: WEA Trust Commercial |
$1,072.50
|
| Rate for Payer: WPS Commercial |
$1,444.31
|
|
|
SCREW-CANN 4.5 X 28 214.528
|
Facility
|
OP
|
$1,875.00
|
|
| Hospital Charge Code |
2967175
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$546.00 |
| Max. Negotiated Rate |
$1,794.00 |
| Rate for Payer: Aetna Commercial |
$1,755.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,677.00
|
| Rate for Payer: Aetna Managed Medicare |
$546.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,267.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$975.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$936.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,033.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,794.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,091.25
|
| Rate for Payer: Health EOS Commercial |
$1,735.50
|
| Rate for Payer: HFN Commercial |
$1,794.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,462.50
|
| Rate for Payer: Multiplan Commercial |
$1,560.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,170.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,794.00
|
| Rate for Payer: Quartz Beloit One Network |
$955.50
|
| Rate for Payer: Quartz Commercial |
$1,267.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,170.00
|
| Rate for Payer: The Alliance Commercial |
$975.00
|
| Rate for Payer: WEA Trust Commercial |
$1,072.50
|
| Rate for Payer: WPS Commercial |
$1,444.31
|
|
|
SCREW-CANN 4.5 X 28 214.728
|
Facility
|
IP
|
$1,875.00
|
|
| Hospital Charge Code |
2967176
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$955.50 |
| Max. Negotiated Rate |
$1,794.00 |
| Rate for Payer: Aetna Commercial |
$1,755.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,677.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,033.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,794.00
|
| Rate for Payer: Health EOS Commercial |
$1,735.50
|
| Rate for Payer: HFN Commercial |
$1,794.00
|
| Rate for Payer: Multiplan Commercial |
$1,560.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,794.00
|
| Rate for Payer: Quartz Beloit One Network |
$955.50
|
| Rate for Payer: Quartz Commercial |
$1,170.00
|
| Rate for Payer: WEA Trust Commercial |
$1,072.50
|
| Rate for Payer: WPS Commercial |
$1,444.31
|
|
|
SCREW-CANN 4.5 X 28 214.728
|
Facility
|
OP
|
$1,875.00
|
|
| Hospital Charge Code |
2967176
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$546.00 |
| Max. Negotiated Rate |
$1,794.00 |
| Rate for Payer: Aetna Commercial |
$1,755.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,677.00
|
| Rate for Payer: Aetna Managed Medicare |
$546.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,267.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$975.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$936.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,033.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,794.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,091.25
|
| Rate for Payer: Health EOS Commercial |
$1,735.50
|
| Rate for Payer: HFN Commercial |
$1,794.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,462.50
|
| Rate for Payer: Multiplan Commercial |
$1,560.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,170.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,794.00
|
| Rate for Payer: Quartz Beloit One Network |
$955.50
|
| Rate for Payer: Quartz Commercial |
$1,267.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,170.00
|
| Rate for Payer: The Alliance Commercial |
$975.00
|
| Rate for Payer: WEA Trust Commercial |
$1,072.50
|
| Rate for Payer: WPS Commercial |
$1,444.31
|
|
|
SCREW-CANN 4.5 X 30 214.530
|
Facility
|
IP
|
$1,875.00
|
|
| Hospital Charge Code |
2967177
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$955.50 |
| Max. Negotiated Rate |
$1,794.00 |
| Rate for Payer: Aetna Commercial |
$1,755.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,677.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,033.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,794.00
|
| Rate for Payer: Health EOS Commercial |
$1,735.50
|
| Rate for Payer: HFN Commercial |
$1,794.00
|
| Rate for Payer: Multiplan Commercial |
$1,560.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,794.00
|
| Rate for Payer: Quartz Beloit One Network |
$955.50
|
| Rate for Payer: Quartz Commercial |
$1,170.00
|
| Rate for Payer: WEA Trust Commercial |
$1,072.50
|
| Rate for Payer: WPS Commercial |
$1,444.31
|
|
|
SCREW-CANN 4.5 X 30 214.530
|
Facility
|
OP
|
$1,875.00
|
|
| Hospital Charge Code |
2967177
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$546.00 |
| Max. Negotiated Rate |
$1,794.00 |
| Rate for Payer: Aetna Commercial |
$1,755.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,677.00
|
| Rate for Payer: Aetna Managed Medicare |
$546.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,267.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$975.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$936.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,033.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,794.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,091.25
|
| Rate for Payer: Health EOS Commercial |
$1,735.50
|
| Rate for Payer: HFN Commercial |
$1,794.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,462.50
|
| Rate for Payer: Multiplan Commercial |
$1,560.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,170.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,794.00
|
| Rate for Payer: Quartz Beloit One Network |
$955.50
|
| Rate for Payer: Quartz Commercial |
$1,267.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,170.00
|
| Rate for Payer: The Alliance Commercial |
$975.00
|
| Rate for Payer: WEA Trust Commercial |
$1,072.50
|
| Rate for Payer: WPS Commercial |
$1,444.31
|
|
|
SCREW-CANN 4.5 X 30 214.730
|
Facility
|
IP
|
$1,875.00
|
|
| Hospital Charge Code |
2967178
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$955.50 |
| Max. Negotiated Rate |
$1,794.00 |
| Rate for Payer: Aetna Commercial |
$1,755.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,677.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,033.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,794.00
|
| Rate for Payer: Health EOS Commercial |
$1,735.50
|
| Rate for Payer: HFN Commercial |
$1,794.00
|
| Rate for Payer: Multiplan Commercial |
$1,560.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,794.00
|
| Rate for Payer: Quartz Beloit One Network |
$955.50
|
| Rate for Payer: Quartz Commercial |
$1,170.00
|
| Rate for Payer: WEA Trust Commercial |
$1,072.50
|
| Rate for Payer: WPS Commercial |
$1,444.31
|
|
