|
SCREW CANN LDA 2.4 X 44 TIGER 200-24-044
|
Facility
|
OP
|
$2,059.00
|
|
| Hospital Charge Code |
3782778
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$599.58 |
| Max. Negotiated Rate |
$1,970.05 |
| Rate for Payer: Aetna Commercial |
$1,927.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,841.57
|
| Rate for Payer: Aetna Managed Medicare |
$599.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,391.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,070.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,027.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,134.92
|
| Rate for Payer: Cash Price |
$617.70
|
| Rate for Payer: Cigna Commercial |
$1,970.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,198.34
|
| Rate for Payer: Health EOS Commercial |
$1,905.81
|
| Rate for Payer: HFN Commercial |
$1,970.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,606.02
|
| Rate for Payer: Multiplan Commercial |
$1,713.09
|
| Rate for Payer: NAPHCARE Commercial |
$1,284.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,970.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,049.27
|
| Rate for Payer: Quartz Commercial |
$1,391.88
|
| Rate for Payer: Quartz Medicare Advantage |
$1,284.82
|
| Rate for Payer: The Alliance Commercial |
$1,070.68
|
| Rate for Payer: WEA Trust Commercial |
$1,177.75
|
| Rate for Payer: WPS Commercial |
$1,586.05
|
|
|
SCREW CANN LDA 2.4 X 46 TIGER 200-24-046
|
Facility
|
OP
|
$2,139.00
|
|
| Hospital Charge Code |
3782779
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$622.88 |
| Max. Negotiated Rate |
$2,046.60 |
| Rate for Payer: Aetna Commercial |
$2,002.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,913.12
|
| Rate for Payer: Aetna Managed Medicare |
$622.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,445.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,112.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,067.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,179.02
|
| Rate for Payer: Cash Price |
$641.70
|
| Rate for Payer: Cigna Commercial |
$2,046.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,244.90
|
| Rate for Payer: Health EOS Commercial |
$1,979.86
|
| Rate for Payer: HFN Commercial |
$2,046.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,668.42
|
| Rate for Payer: Multiplan Commercial |
$1,779.65
|
| Rate for Payer: NAPHCARE Commercial |
$1,334.74
|
| Rate for Payer: Preferred Network Access Commercial |
$2,046.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,090.03
|
| Rate for Payer: Quartz Commercial |
$1,445.96
|
| Rate for Payer: Quartz Medicare Advantage |
$1,334.74
|
| Rate for Payer: The Alliance Commercial |
$1,112.28
|
| Rate for Payer: WEA Trust Commercial |
$1,223.51
|
| Rate for Payer: WPS Commercial |
$1,647.67
|
|
|
SCREW CANN LDA 2.4 X 46 TIGER 200-24-046
|
Facility
|
IP
|
$2,139.00
|
|
| Hospital Charge Code |
3782779
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,090.03 |
| Max. Negotiated Rate |
$2,046.60 |
| Rate for Payer: Aetna Commercial |
$2,002.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,913.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,179.02
|
| Rate for Payer: Cash Price |
$641.70
|
| Rate for Payer: Cigna Commercial |
$2,046.60
|
| Rate for Payer: Health EOS Commercial |
$1,979.86
|
| Rate for Payer: HFN Commercial |
$2,046.60
|
| Rate for Payer: Multiplan Commercial |
$1,779.65
|
| Rate for Payer: Preferred Network Access Commercial |
$2,046.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,090.03
|
| Rate for Payer: Quartz Commercial |
$1,334.74
|
| Rate for Payer: WEA Trust Commercial |
$1,223.51
|
| Rate for Payer: WPS Commercial |
$1,647.67
|
|
|
SCREW CANN LDA 2.4 X 48 TIGER 200-24-048
|
Facility
|
OP
|
$2,059.00
|
|
| Hospital Charge Code |
3782780
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$599.58 |
| Max. Negotiated Rate |
$1,970.05 |
| Rate for Payer: Aetna Commercial |
$1,927.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,841.57
|
| Rate for Payer: Aetna Managed Medicare |
$599.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,391.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,070.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,027.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,134.92
|
| Rate for Payer: Cash Price |
$617.70
|
| Rate for Payer: Cigna Commercial |
$1,970.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,198.34
|
| Rate for Payer: Health EOS Commercial |
$1,905.81
|
| Rate for Payer: HFN Commercial |
$1,970.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,606.02
|
| Rate for Payer: Multiplan Commercial |
$1,713.09
|
| Rate for Payer: NAPHCARE Commercial |
$1,284.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,970.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,049.27
|
| Rate for Payer: Quartz Commercial |
$1,391.88
|
| Rate for Payer: Quartz Medicare Advantage |
$1,284.82
|
| Rate for Payer: The Alliance Commercial |
$1,070.68
|
| Rate for Payer: WEA Trust Commercial |
$1,177.75
|
| Rate for Payer: WPS Commercial |
$1,586.05
|
|
|
SCREW CANN LDA 2.4 X 48 TIGER 200-24-048
|
Facility
|
IP
|
$2,059.00
|
|
| Hospital Charge Code |
3782780
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,049.27 |
| Max. Negotiated Rate |
$1,970.05 |
| Rate for Payer: Aetna Commercial |
$1,927.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,841.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,134.92
|
| Rate for Payer: Cash Price |
$617.70
|
| Rate for Payer: Cigna Commercial |
$1,970.05
|
| Rate for Payer: Health EOS Commercial |
$1,905.81
|
| Rate for Payer: HFN Commercial |
$1,970.05
|
| Rate for Payer: Multiplan Commercial |
$1,713.09
|
| Rate for Payer: Preferred Network Access Commercial |
$1,970.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,049.27
|
| Rate for Payer: Quartz Commercial |
$1,284.82
|
| Rate for Payer: WEA Trust Commercial |
$1,177.75
|
| Rate for Payer: WPS Commercial |
$1,586.05
|
|
|
SCREW CANN LOCK 3.7 X 16MM 02.240.016
|
Facility
|
OP
|
$2,953.00
|
|
| Hospital Charge Code |
3072507
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$859.91 |
| Max. Negotiated Rate |
$2,825.43 |
| Rate for Payer: Aetna Commercial |
$2,764.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,641.16
|
| Rate for Payer: Aetna Managed Medicare |
$859.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,996.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,535.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,474.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,627.69
|
| Rate for Payer: Cash Price |
$885.90
|
| Rate for Payer: Cigna Commercial |
$2,825.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,718.65
|
| Rate for Payer: Health EOS Commercial |
$2,733.30
|
| Rate for Payer: HFN Commercial |
$2,825.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,303.34
|
| Rate for Payer: Multiplan Commercial |
$2,456.90
|
| Rate for Payer: NAPHCARE Commercial |
$1,842.67
|
| Rate for Payer: Preferred Network Access Commercial |
$2,825.43
|
| Rate for Payer: Quartz Beloit One Network |
$1,504.85
|
| Rate for Payer: Quartz Commercial |
$1,996.23
|
| Rate for Payer: Quartz Medicare Advantage |
$1,842.67
|
| Rate for Payer: The Alliance Commercial |
$1,535.56
|
| Rate for Payer: WEA Trust Commercial |
$1,689.12
|
| Rate for Payer: WPS Commercial |
$2,274.70
|
|
|
SCREW CANN LOCK 3.7 X 16MM 02.240.016
|
Facility
|
IP
|
$2,953.00
|
|
| Hospital Charge Code |
3072507
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,504.85 |
| Max. Negotiated Rate |
$2,825.43 |
| Rate for Payer: Aetna Commercial |
$2,764.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,641.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,627.69
|
| Rate for Payer: Cash Price |
$885.90
|
| Rate for Payer: Cigna Commercial |
$2,825.43
|
| Rate for Payer: Health EOS Commercial |
$2,733.30
|
| Rate for Payer: HFN Commercial |
$2,825.43
|
| Rate for Payer: Multiplan Commercial |
$2,456.90
|
| Rate for Payer: Preferred Network Access Commercial |
$2,825.43
|
| Rate for Payer: Quartz Beloit One Network |
$1,504.85
|
| Rate for Payer: Quartz Commercial |
$1,842.67
|
| Rate for Payer: WEA Trust Commercial |
$1,689.12
|
| Rate for Payer: WPS Commercial |
$2,274.70
|
|
|
SCREW CANN LOCK 3.7 X 24MM 02.240.024
|
Facility
|
IP
|
$2,752.00
|
|
| Hospital Charge Code |
3072509
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,402.42 |
| Max. Negotiated Rate |
$2,633.11 |
| Rate for Payer: Aetna Commercial |
$2,575.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,461.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,516.90
|
| Rate for Payer: Cash Price |
$825.60
|
| Rate for Payer: Cigna Commercial |
$2,633.11
|
| Rate for Payer: Health EOS Commercial |
$2,547.25
|
| Rate for Payer: HFN Commercial |
$2,633.11
|
| Rate for Payer: Multiplan Commercial |
$2,289.66
|
| Rate for Payer: Preferred Network Access Commercial |
$2,633.11
|
| Rate for Payer: Quartz Beloit One Network |
$1,402.42
|
| Rate for Payer: Quartz Commercial |
$1,717.25
|
| Rate for Payer: WEA Trust Commercial |
$1,574.14
|
| Rate for Payer: WPS Commercial |
$2,119.87
|
|
|
SCREW CANN LOCK 3.7 X 24MM 02.240.024
|
Facility
|
OP
|
$2,752.00
|
|
| Hospital Charge Code |
3072509
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$801.38 |
| Max. Negotiated Rate |
$2,633.11 |
| Rate for Payer: Aetna Commercial |
$2,575.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,461.39
|
| Rate for Payer: Aetna Managed Medicare |
$801.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,860.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,431.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,373.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,516.90
|
| Rate for Payer: Cash Price |
$825.60
|
| Rate for Payer: Cigna Commercial |
$2,633.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,601.66
|
| Rate for Payer: Health EOS Commercial |
$2,547.25
|
| Rate for Payer: HFN Commercial |
$2,633.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,146.56
|
| Rate for Payer: Multiplan Commercial |
$2,289.66
|
| Rate for Payer: NAPHCARE Commercial |
$1,717.25
|
| Rate for Payer: Preferred Network Access Commercial |
$2,633.11
|
| Rate for Payer: Quartz Beloit One Network |
$1,402.42
|
| Rate for Payer: Quartz Commercial |
$1,860.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,717.25
|
| Rate for Payer: The Alliance Commercial |
$1,431.04
|
| Rate for Payer: WEA Trust Commercial |
$1,574.14
|
| Rate for Payer: WPS Commercial |
$2,119.87
|
|
|
SCREW CANN LOCK 3.7 X 28MM 02.240.028
|
Facility
|
OP
|
$2,752.00
|
|
| Hospital Charge Code |
3072472
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$801.38 |
| Max. Negotiated Rate |
$2,633.11 |
| Rate for Payer: Aetna Commercial |
$2,575.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,461.39
|
| Rate for Payer: Aetna Managed Medicare |
$801.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,860.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,431.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,373.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,516.90
|
| Rate for Payer: Cash Price |
$825.60
|
| Rate for Payer: Cigna Commercial |
$2,633.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,601.66
|
| Rate for Payer: Health EOS Commercial |
$2,547.25
|
| Rate for Payer: HFN Commercial |
$2,633.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,146.56
|
| Rate for Payer: Multiplan Commercial |
$2,289.66
|
| Rate for Payer: NAPHCARE Commercial |
$1,717.25
|
| Rate for Payer: Preferred Network Access Commercial |
$2,633.11
|
| Rate for Payer: Quartz Beloit One Network |
$1,402.42
|
| Rate for Payer: Quartz Commercial |
$1,860.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,717.25
|
| Rate for Payer: The Alliance Commercial |
$1,431.04
|
| Rate for Payer: WEA Trust Commercial |
$1,574.14
|
| Rate for Payer: WPS Commercial |
$2,119.87
|
|
|
SCREW CANN LOCK 3.7 X 28MM 02.240.028
|
Facility
|
IP
|
$2,752.00
|
|
| Hospital Charge Code |
3072472
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,402.42 |
| Max. Negotiated Rate |
$2,633.11 |
| Rate for Payer: Aetna Commercial |
$2,575.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,461.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,516.90
|
| Rate for Payer: Cash Price |
$825.60
|
| Rate for Payer: Cigna Commercial |
$2,633.11
|
| Rate for Payer: Health EOS Commercial |
$2,547.25
|
| Rate for Payer: HFN Commercial |
$2,633.11
|
| Rate for Payer: Multiplan Commercial |
$2,289.66
|
| Rate for Payer: Preferred Network Access Commercial |
$2,633.11
|
| Rate for Payer: Quartz Beloit One Network |
$1,402.42
|
| Rate for Payer: Quartz Commercial |
$1,717.25
|
| Rate for Payer: WEA Trust Commercial |
$1,574.14
|
| Rate for Payer: WPS Commercial |
$2,119.87
|
|
|
SCREW CANN LOCK 3.7 X 30MM 02.240.030
|
Facility
|
OP
|
$2,752.00
|
|
| Hospital Charge Code |
2966502
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$801.38 |
| Max. Negotiated Rate |
$2,633.11 |
| Rate for Payer: Aetna Commercial |
$2,575.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,461.39
|
| Rate for Payer: Aetna Managed Medicare |
$801.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,860.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,431.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,373.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,516.90
|
| Rate for Payer: Cash Price |
$825.60
|
| Rate for Payer: Cigna Commercial |
$2,633.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,601.66
|
| Rate for Payer: Health EOS Commercial |
$2,547.25
|
| Rate for Payer: HFN Commercial |
$2,633.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,146.56
|
| Rate for Payer: Multiplan Commercial |
$2,289.66
|
| Rate for Payer: NAPHCARE Commercial |
$1,717.25
|
| Rate for Payer: Preferred Network Access Commercial |
$2,633.11
|
| Rate for Payer: Quartz Beloit One Network |
$1,402.42
|
| Rate for Payer: Quartz Commercial |
$1,860.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,717.25
|
| Rate for Payer: The Alliance Commercial |
$1,431.04
|
| Rate for Payer: WEA Trust Commercial |
$1,574.14
|
| Rate for Payer: WPS Commercial |
$2,119.87
|
|
|
SCREW CANN LOCK 3.7 X 30MM 02.240.030
|
Facility
|
IP
|
$2,752.00
|
|
| Hospital Charge Code |
2966502
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,402.42 |
| Max. Negotiated Rate |
$2,633.11 |
| Rate for Payer: Aetna Commercial |
$2,575.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,461.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,516.90
|
| Rate for Payer: Cash Price |
$825.60
|
| Rate for Payer: Cigna Commercial |
$2,633.11
|
| Rate for Payer: Health EOS Commercial |
$2,547.25
|
| Rate for Payer: HFN Commercial |
$2,633.11
|
| Rate for Payer: Multiplan Commercial |
$2,289.66
|
| Rate for Payer: Preferred Network Access Commercial |
$2,633.11
|
| Rate for Payer: Quartz Beloit One Network |
$1,402.42
|
| Rate for Payer: Quartz Commercial |
$1,717.25
|
| Rate for Payer: WEA Trust Commercial |
$1,574.14
|
| Rate for Payer: WPS Commercial |
$2,119.87
|
|
|
SCREW CANN LOCK 3.7 X 32MM 02.240.032
|
Facility
|
IP
|
$2,752.00
|
|
| Hospital Charge Code |
2966503
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,402.42 |
| Max. Negotiated Rate |
$2,633.11 |
| Rate for Payer: Aetna Commercial |
$2,575.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,461.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,516.90
|
| Rate for Payer: Cash Price |
$825.60
|
| Rate for Payer: Cigna Commercial |
$2,633.11
|
| Rate for Payer: Health EOS Commercial |
$2,547.25
|
| Rate for Payer: HFN Commercial |
$2,633.11
|
| Rate for Payer: Multiplan Commercial |
$2,289.66
|
| Rate for Payer: Preferred Network Access Commercial |
$2,633.11
|
| Rate for Payer: Quartz Beloit One Network |
$1,402.42
|
| Rate for Payer: Quartz Commercial |
$1,717.25
|
| Rate for Payer: WEA Trust Commercial |
$1,574.14
|
| Rate for Payer: WPS Commercial |
$2,119.87
|
|
|
SCREW CANN LOCK 3.7 X 32MM 02.240.032
|
Facility
|
OP
|
$2,752.00
|
|
| Hospital Charge Code |
2966503
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$801.38 |
| Max. Negotiated Rate |
$2,633.11 |
| Rate for Payer: Aetna Commercial |
$2,575.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,461.39
|
| Rate for Payer: Aetna Managed Medicare |
$801.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,860.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,431.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,373.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,516.90
|
| Rate for Payer: Cash Price |
$825.60
|
| Rate for Payer: Cigna Commercial |
$2,633.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,601.66
|
| Rate for Payer: Health EOS Commercial |
$2,547.25
|
| Rate for Payer: HFN Commercial |
$2,633.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,146.56
|
| Rate for Payer: Multiplan Commercial |
$2,289.66
|
| Rate for Payer: NAPHCARE Commercial |
$1,717.25
|
| Rate for Payer: Preferred Network Access Commercial |
$2,633.11
|
| Rate for Payer: Quartz Beloit One Network |
$1,402.42
|
| Rate for Payer: Quartz Commercial |
$1,860.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,717.25
|
| Rate for Payer: The Alliance Commercial |
$1,431.04
|
| Rate for Payer: WEA Trust Commercial |
$1,574.14
|
| Rate for Payer: WPS Commercial |
$2,119.87
|
|
|
SCREW CANN LOCK 3.7 X 34MM 02.240.034
|
Facility
|
OP
|
$2,752.00
|
|
| Hospital Charge Code |
3072473
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$801.38 |
| Max. Negotiated Rate |
$2,633.11 |
| Rate for Payer: Aetna Commercial |
$2,575.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,461.39
|
| Rate for Payer: Aetna Managed Medicare |
$801.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,860.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,431.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,373.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,516.90
|
| Rate for Payer: Cash Price |
$825.60
|
| Rate for Payer: Cigna Commercial |
$2,633.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,601.66
|
| Rate for Payer: Health EOS Commercial |
$2,547.25
|
| Rate for Payer: HFN Commercial |
$2,633.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,146.56
|
| Rate for Payer: Multiplan Commercial |
$2,289.66
|
| Rate for Payer: NAPHCARE Commercial |
$1,717.25
|
| Rate for Payer: Preferred Network Access Commercial |
$2,633.11
|
| Rate for Payer: Quartz Beloit One Network |
$1,402.42
|
| Rate for Payer: Quartz Commercial |
$1,860.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,717.25
|
| Rate for Payer: The Alliance Commercial |
$1,431.04
|
| Rate for Payer: WEA Trust Commercial |
$1,574.14
|
| Rate for Payer: WPS Commercial |
$2,119.87
|
|
|
SCREW CANN LOCK 3.7 X 34MM 02.240.034
|
Facility
|
IP
|
$2,752.00
|
|
| Hospital Charge Code |
3072473
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,402.42 |
| Max. Negotiated Rate |
$2,633.11 |
| Rate for Payer: Aetna Commercial |
$2,575.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,461.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,516.90
|
| Rate for Payer: Cash Price |
$825.60
|
| Rate for Payer: Cigna Commercial |
$2,633.11
|
| Rate for Payer: Health EOS Commercial |
$2,547.25
|
| Rate for Payer: HFN Commercial |
$2,633.11
|
| Rate for Payer: Multiplan Commercial |
$2,289.66
|
| Rate for Payer: Preferred Network Access Commercial |
$2,633.11
|
| Rate for Payer: Quartz Beloit One Network |
$1,402.42
|
| Rate for Payer: Quartz Commercial |
$1,717.25
|
| Rate for Payer: WEA Trust Commercial |
$1,574.14
|
| Rate for Payer: WPS Commercial |
$2,119.87
|
|
|
SCREW CANN LOCK 3.7 X 36MM 02.240.036
|
Facility
|
IP
|
$2,752.00
|
|
| Hospital Charge Code |
3072510
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,402.42 |
| Max. Negotiated Rate |
$2,633.11 |
| Rate for Payer: Aetna Commercial |
$2,575.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,461.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,516.90
|
| Rate for Payer: Cash Price |
$825.60
|
| Rate for Payer: Cigna Commercial |
$2,633.11
|
| Rate for Payer: Health EOS Commercial |
$2,547.25
|
| Rate for Payer: HFN Commercial |
$2,633.11
|
| Rate for Payer: Multiplan Commercial |
$2,289.66
|
| Rate for Payer: Preferred Network Access Commercial |
$2,633.11
|
| Rate for Payer: Quartz Beloit One Network |
$1,402.42
|
| Rate for Payer: Quartz Commercial |
$1,717.25
|
| Rate for Payer: WEA Trust Commercial |
$1,574.14
|
| Rate for Payer: WPS Commercial |
$2,119.87
|
|
|
SCREW CANN LOCK 3.7 X 36MM 02.240.036
|
Facility
|
OP
|
$2,752.00
|
|
| Hospital Charge Code |
3072510
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$801.38 |
| Max. Negotiated Rate |
$2,633.11 |
| Rate for Payer: Aetna Commercial |
$2,575.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,461.39
|
| Rate for Payer: Aetna Managed Medicare |
$801.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,860.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,431.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,373.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,516.90
|
| Rate for Payer: Cash Price |
$825.60
|
| Rate for Payer: Cigna Commercial |
$2,633.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,601.66
|
| Rate for Payer: Health EOS Commercial |
$2,547.25
|
| Rate for Payer: HFN Commercial |
$2,633.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,146.56
|
| Rate for Payer: Multiplan Commercial |
$2,289.66
|
| Rate for Payer: NAPHCARE Commercial |
$1,717.25
|
| Rate for Payer: Preferred Network Access Commercial |
$2,633.11
|
| Rate for Payer: Quartz Beloit One Network |
$1,402.42
|
| Rate for Payer: Quartz Commercial |
$1,860.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,717.25
|
| Rate for Payer: The Alliance Commercial |
$1,431.04
|
| Rate for Payer: WEA Trust Commercial |
$1,574.14
|
| Rate for Payer: WPS Commercial |
$2,119.87
|
|
|
SCREW CANN LOCK 3.7 X 38MM 02.240.038
|
Facility
|
IP
|
$2,953.00
|
|
| Hospital Charge Code |
2966504
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,504.85 |
| Max. Negotiated Rate |
$2,825.43 |
| Rate for Payer: Aetna Commercial |
$2,764.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,641.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,627.69
|
| Rate for Payer: Cash Price |
$885.90
|
| Rate for Payer: Cigna Commercial |
$2,825.43
|
| Rate for Payer: Health EOS Commercial |
$2,733.30
|
| Rate for Payer: HFN Commercial |
$2,825.43
|
| Rate for Payer: Multiplan Commercial |
$2,456.90
|
| Rate for Payer: Preferred Network Access Commercial |
$2,825.43
|
| Rate for Payer: Quartz Beloit One Network |
$1,504.85
|
| Rate for Payer: Quartz Commercial |
$1,842.67
|
| Rate for Payer: WEA Trust Commercial |
$1,689.12
|
| Rate for Payer: WPS Commercial |
$2,274.70
|
|
|
SCREW CANN LOCK 3.7 X 38MM 02.240.038
|
Facility
|
OP
|
$2,953.00
|
|
| Hospital Charge Code |
2966504
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$859.91 |
| Max. Negotiated Rate |
$2,825.43 |
| Rate for Payer: Aetna Commercial |
$2,764.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,641.16
|
| Rate for Payer: Aetna Managed Medicare |
$859.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,996.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,535.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,474.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,627.69
|
| Rate for Payer: Cash Price |
$885.90
|
| Rate for Payer: Cigna Commercial |
$2,825.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,718.65
|
| Rate for Payer: Health EOS Commercial |
$2,733.30
|
| Rate for Payer: HFN Commercial |
$2,825.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,303.34
|
| Rate for Payer: Multiplan Commercial |
$2,456.90
|
| Rate for Payer: NAPHCARE Commercial |
$1,842.67
|
| Rate for Payer: Preferred Network Access Commercial |
$2,825.43
|
| Rate for Payer: Quartz Beloit One Network |
$1,504.85
|
| Rate for Payer: Quartz Commercial |
$1,996.23
|
| Rate for Payer: Quartz Medicare Advantage |
$1,842.67
|
| Rate for Payer: The Alliance Commercial |
$1,535.56
|
| Rate for Payer: WEA Trust Commercial |
$1,689.12
|
| Rate for Payer: WPS Commercial |
$2,274.70
|
|
|
SCREW CANN LOCK 3.7 X 40MM 02.240.040
|
Facility
|
IP
|
$2,752.00
|
|
| Hospital Charge Code |
2966505
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,402.42 |
| Max. Negotiated Rate |
$2,633.11 |
| Rate for Payer: Aetna Commercial |
$2,575.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,461.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,516.90
|
| Rate for Payer: Cash Price |
$825.60
|
| Rate for Payer: Cigna Commercial |
$2,633.11
|
| Rate for Payer: Health EOS Commercial |
$2,547.25
|
| Rate for Payer: HFN Commercial |
$2,633.11
|
| Rate for Payer: Multiplan Commercial |
$2,289.66
|
| Rate for Payer: Preferred Network Access Commercial |
$2,633.11
|
| Rate for Payer: Quartz Beloit One Network |
$1,402.42
|
| Rate for Payer: Quartz Commercial |
$1,717.25
|
| Rate for Payer: WEA Trust Commercial |
$1,574.14
|
| Rate for Payer: WPS Commercial |
$2,119.87
|
|
|
SCREW CANN LOCK 3.7 X 40MM 02.240.040
|
Facility
|
OP
|
$2,752.00
|
|
| Hospital Charge Code |
2966505
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$801.38 |
| Max. Negotiated Rate |
$2,633.11 |
| Rate for Payer: Aetna Commercial |
$2,575.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,461.39
|
| Rate for Payer: Aetna Managed Medicare |
$801.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,860.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,431.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,373.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,516.90
|
| Rate for Payer: Cash Price |
$825.60
|
| Rate for Payer: Cigna Commercial |
$2,633.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,601.66
|
| Rate for Payer: Health EOS Commercial |
$2,547.25
|
| Rate for Payer: HFN Commercial |
$2,633.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,146.56
|
| Rate for Payer: Multiplan Commercial |
$2,289.66
|
| Rate for Payer: NAPHCARE Commercial |
$1,717.25
|
| Rate for Payer: Preferred Network Access Commercial |
$2,633.11
|
| Rate for Payer: Quartz Beloit One Network |
$1,402.42
|
| Rate for Payer: Quartz Commercial |
$1,860.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,717.25
|
| Rate for Payer: The Alliance Commercial |
$1,431.04
|
| Rate for Payer: WEA Trust Commercial |
$1,574.14
|
| Rate for Payer: WPS Commercial |
$2,119.87
|
|
|
SCREW CANN LOCK 3.7 X 42MM 02.240.042
|
Facility
|
OP
|
$2,752.00
|
|
| Hospital Charge Code |
2966506
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$801.38 |
| Max. Negotiated Rate |
$2,633.11 |
| Rate for Payer: Aetna Commercial |
$2,575.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,461.39
|
| Rate for Payer: Aetna Managed Medicare |
$801.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,860.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,431.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,373.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,516.90
|
| Rate for Payer: Cash Price |
$825.60
|
| Rate for Payer: Cigna Commercial |
$2,633.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,601.66
|
| Rate for Payer: Health EOS Commercial |
$2,547.25
|
| Rate for Payer: HFN Commercial |
$2,633.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,146.56
|
| Rate for Payer: Multiplan Commercial |
$2,289.66
|
| Rate for Payer: NAPHCARE Commercial |
$1,717.25
|
| Rate for Payer: Preferred Network Access Commercial |
$2,633.11
|
| Rate for Payer: Quartz Beloit One Network |
$1,402.42
|
| Rate for Payer: Quartz Commercial |
$1,860.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,717.25
|
| Rate for Payer: The Alliance Commercial |
$1,431.04
|
| Rate for Payer: WEA Trust Commercial |
$1,574.14
|
| Rate for Payer: WPS Commercial |
$2,119.87
|
|
|
SCREW CANN LOCK 3.7 X 42MM 02.240.042
|
Facility
|
IP
|
$2,752.00
|
|
| Hospital Charge Code |
2966506
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,402.42 |
| Max. Negotiated Rate |
$2,633.11 |
| Rate for Payer: Aetna Commercial |
$2,575.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,461.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,516.90
|
| Rate for Payer: Cash Price |
$825.60
|
| Rate for Payer: Cigna Commercial |
$2,633.11
|
| Rate for Payer: Health EOS Commercial |
$2,547.25
|
| Rate for Payer: HFN Commercial |
$2,633.11
|
| Rate for Payer: Multiplan Commercial |
$2,289.66
|
| Rate for Payer: Preferred Network Access Commercial |
$2,633.11
|
| Rate for Payer: Quartz Beloit One Network |
$1,402.42
|
| Rate for Payer: Quartz Commercial |
$1,717.25
|
| Rate for Payer: WEA Trust Commercial |
$1,574.14
|
| Rate for Payer: WPS Commercial |
$2,119.87
|
|
