|
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 |
$1,447.46 |
| Max. Negotiated Rate |
$2,717.68 |
| Rate for Payer: Aetna Commercial |
$2,658.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,540.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,565.62
|
| Rate for Payer: Cash Price |
$886.20
|
| Rate for Payer: Cigna Commercial |
$2,717.68
|
| Rate for Payer: Health EOS Commercial |
$2,629.06
|
| Rate for Payer: HFN Commercial |
$2,717.68
|
| Rate for Payer: Multiplan Commercial |
$2,363.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,772.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,717.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,447.46
|
| Rate for Payer: Quartz Commercial |
$1,772.40
|
| Rate for Payer: WEA Trust Commercial |
$1,624.70
|
| Rate for Payer: WPS Commercial |
$2,188.03
|
|
|
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 |
$827.12 |
| Max. Negotiated Rate |
$11,816.00 |
| Rate for Payer: Aetna Commercial |
$2,658.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,540.44
|
| Rate for Payer: Aetna Managed Medicare |
$827.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,920.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,477.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,417.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,565.62
|
| Rate for Payer: Cash Price |
$886.20
|
| Rate for Payer: Cigna Commercial |
$2,717.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,653.06
|
| Rate for Payer: Health EOS Commercial |
$2,629.06
|
| Rate for Payer: HFN Commercial |
$2,717.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,215.50
|
| Rate for Payer: Multiplan Commercial |
$2,363.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,772.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,717.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,447.46
|
| Rate for Payer: Quartz Commercial |
$1,920.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,772.40
|
| Rate for Payer: The Alliance Commercial |
$11,816.00
|
| Rate for Payer: WEA Trust Commercial |
$1,624.70
|
| Rate for Payer: WPS Commercial |
$2,188.03
|
|
|
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 |
$1,447.46 |
| Max. Negotiated Rate |
$2,717.68 |
| Rate for Payer: Aetna Commercial |
$2,658.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,540.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,565.62
|
| Rate for Payer: Cash Price |
$886.20
|
| Rate for Payer: Cigna Commercial |
$2,717.68
|
| Rate for Payer: Health EOS Commercial |
$2,629.06
|
| Rate for Payer: HFN Commercial |
$2,717.68
|
| Rate for Payer: Multiplan Commercial |
$2,363.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,772.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,717.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,447.46
|
| Rate for Payer: Quartz Commercial |
$1,772.40
|
| Rate for Payer: WEA Trust Commercial |
$1,624.70
|
| Rate for Payer: WPS Commercial |
$2,188.03
|
|
|
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 |
$827.12 |
| Max. Negotiated Rate |
$11,816.00 |
| Rate for Payer: Aetna Commercial |
$2,658.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,540.44
|
| Rate for Payer: Aetna Managed Medicare |
$827.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,920.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,477.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,417.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,565.62
|
| Rate for Payer: Cash Price |
$886.20
|
| Rate for Payer: Cigna Commercial |
$2,717.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,653.06
|
| Rate for Payer: Health EOS Commercial |
$2,629.06
|
| Rate for Payer: HFN Commercial |
$2,717.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,215.50
|
| Rate for Payer: Multiplan Commercial |
$2,363.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,772.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,717.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,447.46
|
| Rate for Payer: Quartz Commercial |
$1,920.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,772.40
|
| Rate for Payer: The Alliance Commercial |
$11,816.00
|
| Rate for Payer: WEA Trust Commercial |
$1,624.70
|
| Rate for Payer: WPS Commercial |
$2,188.03
|
|
|
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 |
$1,447.46 |
| Max. Negotiated Rate |
$2,717.68 |
| Rate for Payer: Aetna Commercial |
$2,658.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,540.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,565.62
|
| Rate for Payer: Cash Price |
$886.20
|
| Rate for Payer: Cigna Commercial |
$2,717.68
|
| Rate for Payer: Health EOS Commercial |
$2,629.06
|
| Rate for Payer: HFN Commercial |
$2,717.68
|
| Rate for Payer: Multiplan Commercial |
$2,363.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,772.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,717.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,447.46
|
| Rate for Payer: Quartz Commercial |
$1,772.40
|
| Rate for Payer: WEA Trust Commercial |
$1,624.70
|
| Rate for Payer: WPS Commercial |
$2,188.03
|
|
|
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 |
$827.12 |
| Max. Negotiated Rate |
$11,816.00 |
| Rate for Payer: Aetna Commercial |
$2,658.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,540.44
|
| Rate for Payer: Aetna Managed Medicare |
$827.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,920.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,477.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,417.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,565.62
|
| Rate for Payer: Cash Price |
$886.20
|
| Rate for Payer: Cigna Commercial |
$2,717.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,653.06
|
| Rate for Payer: Health EOS Commercial |
$2,629.06
|
| Rate for Payer: HFN Commercial |
$2,717.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,215.50
|
| Rate for Payer: Multiplan Commercial |
$2,363.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,772.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,717.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,447.46
|
| Rate for Payer: Quartz Commercial |
$1,920.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,772.40
|
| Rate for Payer: The Alliance Commercial |
$11,816.00
|
| Rate for Payer: WEA Trust Commercial |
$1,624.70
|
| Rate for Payer: WPS Commercial |
$2,188.03
|
|
|
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 |
$1,447.46 |
| Max. Negotiated Rate |
$2,717.68 |
| Rate for Payer: Aetna Commercial |
$2,658.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,540.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,565.62
|
| Rate for Payer: Cash Price |
$886.20
|
| Rate for Payer: Cigna Commercial |
$2,717.68
|
| Rate for Payer: Health EOS Commercial |
$2,629.06
|
| Rate for Payer: HFN Commercial |
$2,717.68
|
| Rate for Payer: Multiplan Commercial |
$2,363.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,772.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,717.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,447.46
|
| Rate for Payer: Quartz Commercial |
$1,772.40
|
| Rate for Payer: WEA Trust Commercial |
$1,624.70
|
| Rate for Payer: WPS Commercial |
$2,188.03
|
|
|
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 |
$827.12 |
| Max. Negotiated Rate |
$11,816.00 |
| Rate for Payer: Aetna Commercial |
$2,658.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,540.44
|
| Rate for Payer: Aetna Managed Medicare |
$827.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,920.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,477.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,417.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,565.62
|
| Rate for Payer: Cash Price |
$886.20
|
| Rate for Payer: Cigna Commercial |
$2,717.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,653.06
|
| Rate for Payer: Health EOS Commercial |
$2,629.06
|
| Rate for Payer: HFN Commercial |
$2,717.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,215.50
|
| Rate for Payer: Multiplan Commercial |
$2,363.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,772.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,717.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,447.46
|
| Rate for Payer: Quartz Commercial |
$1,920.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,772.40
|
| Rate for Payer: The Alliance Commercial |
$11,816.00
|
| Rate for Payer: WEA Trust Commercial |
$1,624.70
|
| Rate for Payer: WPS Commercial |
$2,188.03
|
|
|
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 |
$1,447.46 |
| Max. Negotiated Rate |
$2,717.68 |
| Rate for Payer: Aetna Commercial |
$2,658.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,540.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,565.62
|
| Rate for Payer: Cash Price |
$886.20
|
| Rate for Payer: Cigna Commercial |
$2,717.68
|
| Rate for Payer: Health EOS Commercial |
$2,629.06
|
| Rate for Payer: HFN Commercial |
$2,717.68
|
| Rate for Payer: Multiplan Commercial |
$2,363.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,772.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,717.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,447.46
|
| Rate for Payer: Quartz Commercial |
$1,772.40
|
| Rate for Payer: WEA Trust Commercial |
$1,624.70
|
| Rate for Payer: WPS Commercial |
$2,188.03
|
|
|
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 |
$827.12 |
| Max. Negotiated Rate |
$11,816.00 |
| Rate for Payer: Aetna Commercial |
$2,658.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,540.44
|
| Rate for Payer: Aetna Managed Medicare |
$827.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,920.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,477.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,417.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,565.62
|
| Rate for Payer: Cash Price |
$886.20
|
| Rate for Payer: Cigna Commercial |
$2,717.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,653.06
|
| Rate for Payer: Health EOS Commercial |
$2,629.06
|
| Rate for Payer: HFN Commercial |
$2,717.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,215.50
|
| Rate for Payer: Multiplan Commercial |
$2,363.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,772.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,717.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,447.46
|
| Rate for Payer: Quartz Commercial |
$1,920.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,772.40
|
| Rate for Payer: The Alliance Commercial |
$11,816.00
|
| Rate for Payer: WEA Trust Commercial |
$1,624.70
|
| Rate for Payer: WPS Commercial |
$2,188.03
|
|
|
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 |
$1,502.83 |
| Max. Negotiated Rate |
$2,821.64 |
| Rate for Payer: Aetna Commercial |
$2,760.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,637.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,625.51
|
| Rate for Payer: Cash Price |
$920.10
|
| Rate for Payer: Cigna Commercial |
$2,821.64
|
| Rate for Payer: Health EOS Commercial |
$2,729.63
|
| Rate for Payer: HFN Commercial |
$2,821.64
|
| Rate for Payer: Multiplan Commercial |
$2,453.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,840.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,821.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,502.83
|
| Rate for Payer: Quartz Commercial |
$1,840.20
|
| Rate for Payer: WEA Trust Commercial |
$1,686.85
|
| Rate for Payer: WPS Commercial |
$2,271.73
|
|
|
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 |
$858.76 |
| Max. Negotiated Rate |
$12,268.00 |
| Rate for Payer: Aetna Commercial |
$2,760.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,637.62
|
| Rate for Payer: Aetna Managed Medicare |
$858.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,993.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,533.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,472.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,625.51
|
| Rate for Payer: Cash Price |
$920.10
|
| Rate for Payer: Cigna Commercial |
$2,821.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,716.29
|
| Rate for Payer: Health EOS Commercial |
$2,729.63
|
| Rate for Payer: HFN Commercial |
$2,821.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,300.25
|
| Rate for Payer: Multiplan Commercial |
$2,453.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,840.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,821.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,502.83
|
| Rate for Payer: Quartz Commercial |
$1,993.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,840.20
|
| Rate for Payer: The Alliance Commercial |
$12,268.00
|
| Rate for Payer: WEA Trust Commercial |
$1,686.85
|
| Rate for Payer: WPS Commercial |
$2,271.73
|
|
|
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 |
$1,502.83 |
| Max. Negotiated Rate |
$2,821.64 |
| Rate for Payer: Aetna Commercial |
$2,760.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,637.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,625.51
|
| Rate for Payer: Cash Price |
$920.10
|
| Rate for Payer: Cigna Commercial |
$2,821.64
|
| Rate for Payer: Health EOS Commercial |
$2,729.63
|
| Rate for Payer: HFN Commercial |
$2,821.64
|
| Rate for Payer: Multiplan Commercial |
$2,453.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,840.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,821.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,502.83
|
| Rate for Payer: Quartz Commercial |
$1,840.20
|
| Rate for Payer: WEA Trust Commercial |
$1,686.85
|
| Rate for Payer: WPS Commercial |
$2,271.73
|
|
|
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 |
$858.76 |
| Max. Negotiated Rate |
$12,268.00 |
| Rate for Payer: Aetna Commercial |
$2,760.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,637.62
|
| Rate for Payer: Aetna Managed Medicare |
$858.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,993.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,533.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,472.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,625.51
|
| Rate for Payer: Cash Price |
$920.10
|
| Rate for Payer: Cigna Commercial |
$2,821.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,716.29
|
| Rate for Payer: Health EOS Commercial |
$2,729.63
|
| Rate for Payer: HFN Commercial |
$2,821.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,300.25
|
| Rate for Payer: Multiplan Commercial |
$2,453.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,840.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,821.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,502.83
|
| Rate for Payer: Quartz Commercial |
$1,993.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,840.20
|
| Rate for Payer: The Alliance Commercial |
$12,268.00
|
| Rate for Payer: WEA Trust Commercial |
$1,686.85
|
| Rate for Payer: WPS Commercial |
$2,271.73
|
|
|
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 |
$1,502.83 |
| Max. Negotiated Rate |
$2,821.64 |
| Rate for Payer: Aetna Commercial |
$2,760.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,637.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,625.51
|
| Rate for Payer: Cash Price |
$920.10
|
| Rate for Payer: Cigna Commercial |
$2,821.64
|
| Rate for Payer: Health EOS Commercial |
$2,729.63
|
| Rate for Payer: HFN Commercial |
$2,821.64
|
| Rate for Payer: Multiplan Commercial |
$2,453.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,840.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,821.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,502.83
|
| Rate for Payer: Quartz Commercial |
$1,840.20
|
| Rate for Payer: WEA Trust Commercial |
$1,686.85
|
| Rate for Payer: WPS Commercial |
$2,271.73
|
|
|
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 |
$858.76 |
| Max. Negotiated Rate |
$12,268.00 |
| Rate for Payer: Aetna Commercial |
$2,760.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,637.62
|
| Rate for Payer: Aetna Managed Medicare |
$858.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,993.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,533.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,472.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,625.51
|
| Rate for Payer: Cash Price |
$920.10
|
| Rate for Payer: Cigna Commercial |
$2,821.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,716.29
|
| Rate for Payer: Health EOS Commercial |
$2,729.63
|
| Rate for Payer: HFN Commercial |
$2,821.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,300.25
|
| Rate for Payer: Multiplan Commercial |
$2,453.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,840.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,821.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,502.83
|
| Rate for Payer: Quartz Commercial |
$1,993.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,840.20
|
| Rate for Payer: The Alliance Commercial |
$12,268.00
|
| Rate for Payer: WEA Trust Commercial |
$1,686.85
|
| Rate for Payer: WPS Commercial |
$2,271.73
|
|
|
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 |
$827.12 |
| Max. Negotiated Rate |
$11,816.00 |
| Rate for Payer: Aetna Commercial |
$2,658.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,540.44
|
| Rate for Payer: Aetna Managed Medicare |
$827.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,920.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,477.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,417.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,565.62
|
| Rate for Payer: Cash Price |
$886.20
|
| Rate for Payer: Cigna Commercial |
$2,717.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,653.06
|
| Rate for Payer: Health EOS Commercial |
$2,629.06
|
| Rate for Payer: HFN Commercial |
$2,717.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,215.50
|
| Rate for Payer: Multiplan Commercial |
$2,363.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,772.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,717.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,447.46
|
| Rate for Payer: Quartz Commercial |
$1,920.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,772.40
|
| Rate for Payer: The Alliance Commercial |
$11,816.00
|
| Rate for Payer: WEA Trust Commercial |
$1,624.70
|
| Rate for Payer: WPS Commercial |
$2,188.03
|
|
|
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 |
$1,447.46 |
| Max. Negotiated Rate |
$2,717.68 |
| Rate for Payer: Aetna Commercial |
$2,658.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,540.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,565.62
|
| Rate for Payer: Cash Price |
$886.20
|
| Rate for Payer: Cigna Commercial |
$2,717.68
|
| Rate for Payer: Health EOS Commercial |
$2,629.06
|
| Rate for Payer: HFN Commercial |
$2,717.68
|
| Rate for Payer: Multiplan Commercial |
$2,363.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,772.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,717.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,447.46
|
| Rate for Payer: Quartz Commercial |
$1,772.40
|
| Rate for Payer: WEA Trust Commercial |
$1,624.70
|
| Rate for Payer: WPS Commercial |
$2,188.03
|
|
|
SCREW CANN 6.5MM X 90MM X 16MM THREAD 208.413
|
Facility
|
IP
|
$2,954.00
|
|
| Hospital Charge Code |
4065101
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,447.46 |
| Max. Negotiated Rate |
$2,717.68 |
| Rate for Payer: Aetna Commercial |
$2,658.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,540.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,565.62
|
| Rate for Payer: Cash Price |
$886.20
|
| Rate for Payer: Cigna Commercial |
$2,717.68
|
| Rate for Payer: Health EOS Commercial |
$2,629.06
|
| Rate for Payer: HFN Commercial |
$2,717.68
|
| Rate for Payer: Multiplan Commercial |
$2,363.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,772.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,717.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,447.46
|
| Rate for Payer: Quartz Commercial |
$1,772.40
|
| Rate for Payer: WEA Trust Commercial |
$1,624.70
|
| Rate for Payer: WPS Commercial |
$2,188.03
|
|
|
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 |
$827.12 |
| Max. Negotiated Rate |
$11,816.00 |
| Rate for Payer: Aetna Commercial |
$2,658.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,540.44
|
| Rate for Payer: Aetna Managed Medicare |
$827.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,920.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,477.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,417.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,565.62
|
| Rate for Payer: Cash Price |
$886.20
|
| Rate for Payer: Cigna Commercial |
$2,717.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,653.06
|
| Rate for Payer: Health EOS Commercial |
$2,629.06
|
| Rate for Payer: HFN Commercial |
$2,717.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,215.50
|
| Rate for Payer: Multiplan Commercial |
$2,363.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,772.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,717.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,447.46
|
| Rate for Payer: Quartz Commercial |
$1,920.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,772.40
|
| Rate for Payer: The Alliance Commercial |
$11,816.00
|
| Rate for Payer: WEA Trust Commercial |
$1,624.70
|
| Rate for Payer: WPS Commercial |
$2,188.03
|
|
|
SCREW CANN 6.5MM X 90MM X 32 THREAD 208.440
|
Facility
|
IP
|
$3,067.00
|
|
| Hospital Charge Code |
4066457
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,502.83 |
| Max. Negotiated Rate |
$2,821.64 |
| Rate for Payer: Aetna Commercial |
$2,760.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,637.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,625.51
|
| Rate for Payer: Cash Price |
$920.10
|
| Rate for Payer: Cigna Commercial |
$2,821.64
|
| Rate for Payer: Health EOS Commercial |
$2,729.63
|
| Rate for Payer: HFN Commercial |
$2,821.64
|
| Rate for Payer: Multiplan Commercial |
$2,453.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,840.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,821.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,502.83
|
| Rate for Payer: Quartz Commercial |
$1,840.20
|
| Rate for Payer: WEA Trust Commercial |
$1,686.85
|
| Rate for Payer: WPS Commercial |
$2,271.73
|
|
|
SCREW CANN 6.5MM X 90MM X 32 THREAD 208.440
|
Facility
|
OP
|
$3,067.00
|
|
| Hospital Charge Code |
4066457
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$858.76 |
| Max. Negotiated Rate |
$12,268.00 |
| Rate for Payer: Aetna Commercial |
$2,760.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,637.62
|
| Rate for Payer: Aetna Managed Medicare |
$858.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,993.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,533.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,472.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,625.51
|
| Rate for Payer: Cash Price |
$920.10
|
| Rate for Payer: Cigna Commercial |
$2,821.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,716.29
|
| Rate for Payer: Health EOS Commercial |
$2,729.63
|
| Rate for Payer: HFN Commercial |
$2,821.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,300.25
|
| Rate for Payer: Multiplan Commercial |
$2,453.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,840.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,821.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,502.83
|
| Rate for Payer: Quartz Commercial |
$1,993.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,840.20
|
| Rate for Payer: The Alliance Commercial |
$12,268.00
|
| Rate for Payer: WEA Trust Commercial |
$1,686.85
|
| Rate for Payer: WPS Commercial |
$2,271.73
|
|
|
SCREW CANN 6.5MM X 95MM X 16MM THREAD 208.414
|
Facility
|
OP
|
$2,954.00
|
|
| Hospital Charge Code |
4046088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$827.12 |
| Max. Negotiated Rate |
$11,816.00 |
| Rate for Payer: Aetna Commercial |
$2,658.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,540.44
|
| Rate for Payer: Aetna Managed Medicare |
$827.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,920.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,477.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,417.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,565.62
|
| Rate for Payer: Cash Price |
$886.20
|
| Rate for Payer: Cigna Commercial |
$2,717.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,653.06
|
| Rate for Payer: Health EOS Commercial |
$2,629.06
|
| Rate for Payer: HFN Commercial |
$2,717.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,215.50
|
| Rate for Payer: Multiplan Commercial |
$2,363.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,772.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,717.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,447.46
|
| Rate for Payer: Quartz Commercial |
$1,920.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,772.40
|
| Rate for Payer: The Alliance Commercial |
$11,816.00
|
| Rate for Payer: WEA Trust Commercial |
$1,624.70
|
| Rate for Payer: WPS Commercial |
$2,188.03
|
|
|
SCREW CANN 6.5MM X 95MM X 16MM THREAD 208.414
|
Facility
|
IP
|
$2,954.00
|
|
| Hospital Charge Code |
4046088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,447.46 |
| Max. Negotiated Rate |
$2,717.68 |
| Rate for Payer: Aetna Commercial |
$2,658.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,540.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,565.62
|
| Rate for Payer: Cash Price |
$886.20
|
| Rate for Payer: Cigna Commercial |
$2,717.68
|
| Rate for Payer: Health EOS Commercial |
$2,629.06
|
| Rate for Payer: HFN Commercial |
$2,717.68
|
| Rate for Payer: Multiplan Commercial |
$2,363.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,772.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,717.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,447.46
|
| Rate for Payer: Quartz Commercial |
$1,772.40
|
| Rate for Payer: WEA Trust Commercial |
$1,624.70
|
| Rate for Payer: WPS Commercial |
$2,188.03
|
|
|
SCREW CANN 6.5MM X 95MM X 32 THREAD 208.441
|
Facility
|
IP
|
$2,954.00
|
|
| Hospital Charge Code |
4066458
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,447.46 |
| Max. Negotiated Rate |
$2,717.68 |
| Rate for Payer: Aetna Commercial |
$2,658.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,540.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,565.62
|
| Rate for Payer: Cash Price |
$886.20
|
| Rate for Payer: Cigna Commercial |
$2,717.68
|
| Rate for Payer: Health EOS Commercial |
$2,629.06
|
| Rate for Payer: HFN Commercial |
$2,717.68
|
| Rate for Payer: Multiplan Commercial |
$2,363.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,772.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,717.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,447.46
|
| Rate for Payer: Quartz Commercial |
$1,772.40
|
| Rate for Payer: WEA Trust Commercial |
$1,624.70
|
| Rate for Payer: WPS Commercial |
$2,188.03
|
|
