|
SCREW LOCKING VA 3.5MM X 20MM 02.127.120
|
Facility
|
OP
|
$1,878.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6234158
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$546.87 |
| Max. Negotiated Rate |
$1,796.87 |
| Rate for Payer: Aetna Commercial |
$1,757.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,679.68
|
| Rate for Payer: Aetna Managed Medicare |
$546.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,269.53
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$976.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$937.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,035.15
|
| Rate for Payer: Cash Price |
$563.40
|
| Rate for Payer: Cigna Commercial |
$1,796.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,093.00
|
| Rate for Payer: Health EOS Commercial |
$1,738.28
|
| Rate for Payer: HFN Commercial |
$1,796.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,464.84
|
| Rate for Payer: Multiplan Commercial |
$1,562.50
|
| Rate for Payer: NAPHCARE Commercial |
$1,171.87
|
| Rate for Payer: Preferred Network Access Commercial |
$1,796.87
|
| Rate for Payer: Quartz Beloit One Network |
$957.03
|
| Rate for Payer: Quartz Commercial |
$1,269.53
|
| Rate for Payer: Quartz Medicare Advantage |
$1,171.87
|
| Rate for Payer: The Alliance Commercial |
$976.56
|
| Rate for Payer: WEA Trust Commercial |
$1,074.22
|
| Rate for Payer: WPS Commercial |
$1,446.62
|
|
|
SCREW LOCKING VA 3.5MM X 24MM 02.127.124
|
Facility
|
IP
|
$1,775.00
|
|
| Hospital Charge Code |
4028669
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$904.54 |
| Max. Negotiated Rate |
$1,698.32 |
| Rate for Payer: Aetna Commercial |
$1,661.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,587.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$978.38
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$1,698.32
|
| Rate for Payer: Health EOS Commercial |
$1,642.94
|
| Rate for Payer: HFN Commercial |
$1,698.32
|
| Rate for Payer: Multiplan Commercial |
$1,476.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,698.32
|
| Rate for Payer: Quartz Beloit One Network |
$904.54
|
| Rate for Payer: Quartz Commercial |
$1,107.60
|
| Rate for Payer: WEA Trust Commercial |
$1,015.30
|
| Rate for Payer: WPS Commercial |
$1,367.28
|
|
|
SCREW LOCKING VA 3.5MM X 24MM 02.127.124
|
Facility
|
OP
|
$1,775.00
|
|
| Hospital Charge Code |
4028669
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$516.88 |
| Max. Negotiated Rate |
$1,698.32 |
| Rate for Payer: Aetna Commercial |
$1,661.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,587.56
|
| Rate for Payer: Aetna Managed Medicare |
$516.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,199.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$923.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$886.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$978.38
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$1,698.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,033.05
|
| Rate for Payer: Health EOS Commercial |
$1,642.94
|
| Rate for Payer: HFN Commercial |
$1,698.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,384.50
|
| Rate for Payer: Multiplan Commercial |
$1,476.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,107.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,698.32
|
| Rate for Payer: Quartz Beloit One Network |
$904.54
|
| Rate for Payer: Quartz Commercial |
$1,199.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,107.60
|
| Rate for Payer: The Alliance Commercial |
$923.00
|
| Rate for Payer: WEA Trust Commercial |
$1,015.30
|
| Rate for Payer: WPS Commercial |
$1,367.28
|
|
|
SCREW LOCKING VA 3.5MM X 26MM 02.127.126
|
Facility
|
OP
|
$1,775.00
|
|
| Hospital Charge Code |
4028670
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$516.88 |
| Max. Negotiated Rate |
$1,698.32 |
| Rate for Payer: Aetna Commercial |
$1,661.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,587.56
|
| Rate for Payer: Aetna Managed Medicare |
$516.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,199.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$923.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$886.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$978.38
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$1,698.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,033.05
|
| Rate for Payer: Health EOS Commercial |
$1,642.94
|
| Rate for Payer: HFN Commercial |
$1,698.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,384.50
|
| Rate for Payer: Multiplan Commercial |
$1,476.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,107.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,698.32
|
| Rate for Payer: Quartz Beloit One Network |
$904.54
|
| Rate for Payer: Quartz Commercial |
$1,199.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,107.60
|
| Rate for Payer: The Alliance Commercial |
$923.00
|
| Rate for Payer: WEA Trust Commercial |
$1,015.30
|
| Rate for Payer: WPS Commercial |
$1,367.28
|
|
|
SCREW LOCKING VA 3.5MM X 26MM 02.127.126
|
Facility
|
IP
|
$1,775.00
|
|
| Hospital Charge Code |
4028670
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$904.54 |
| Max. Negotiated Rate |
$1,698.32 |
| Rate for Payer: Aetna Commercial |
$1,661.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,587.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$978.38
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$1,698.32
|
| Rate for Payer: Health EOS Commercial |
$1,642.94
|
| Rate for Payer: HFN Commercial |
$1,698.32
|
| Rate for Payer: Multiplan Commercial |
$1,476.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,698.32
|
| Rate for Payer: Quartz Beloit One Network |
$904.54
|
| Rate for Payer: Quartz Commercial |
$1,107.60
|
| Rate for Payer: WEA Trust Commercial |
$1,015.30
|
| Rate for Payer: WPS Commercial |
$1,367.28
|
|
|
SCREW LOCKING VA 3.5MM X 28MM 02.127.128
|
Facility
|
IP
|
$1,775.00
|
|
| Hospital Charge Code |
3265472
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$904.54 |
| Max. Negotiated Rate |
$1,698.32 |
| Rate for Payer: Aetna Commercial |
$1,661.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,587.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$978.38
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$1,698.32
|
| Rate for Payer: Health EOS Commercial |
$1,642.94
|
| Rate for Payer: HFN Commercial |
$1,698.32
|
| Rate for Payer: Multiplan Commercial |
$1,476.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,698.32
|
| Rate for Payer: Quartz Beloit One Network |
$904.54
|
| Rate for Payer: Quartz Commercial |
$1,107.60
|
| Rate for Payer: WEA Trust Commercial |
$1,015.30
|
| Rate for Payer: WPS Commercial |
$1,367.28
|
|
|
SCREW LOCKING VA 3.5MM X 28MM 02.127.128
|
Facility
|
OP
|
$1,775.00
|
|
| Hospital Charge Code |
3265472
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$516.88 |
| Max. Negotiated Rate |
$1,698.32 |
| Rate for Payer: Aetna Commercial |
$1,661.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,587.56
|
| Rate for Payer: Aetna Managed Medicare |
$516.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,199.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$923.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$886.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$978.38
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$1,698.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,033.05
|
| Rate for Payer: Health EOS Commercial |
$1,642.94
|
| Rate for Payer: HFN Commercial |
$1,698.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,384.50
|
| Rate for Payer: Multiplan Commercial |
$1,476.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,107.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,698.32
|
| Rate for Payer: Quartz Beloit One Network |
$904.54
|
| Rate for Payer: Quartz Commercial |
$1,199.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,107.60
|
| Rate for Payer: The Alliance Commercial |
$923.00
|
| Rate for Payer: WEA Trust Commercial |
$1,015.30
|
| Rate for Payer: WPS Commercial |
$1,367.28
|
|
|
SCREW LOCKING VA 3.5MM X 30MM 02.127.130
|
Facility
|
IP
|
$1,775.00
|
|
| Hospital Charge Code |
3265473
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$904.54 |
| Max. Negotiated Rate |
$1,698.32 |
| Rate for Payer: Aetna Commercial |
$1,661.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,587.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$978.38
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$1,698.32
|
| Rate for Payer: Health EOS Commercial |
$1,642.94
|
| Rate for Payer: HFN Commercial |
$1,698.32
|
| Rate for Payer: Multiplan Commercial |
$1,476.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,698.32
|
| Rate for Payer: Quartz Beloit One Network |
$904.54
|
| Rate for Payer: Quartz Commercial |
$1,107.60
|
| Rate for Payer: WEA Trust Commercial |
$1,015.30
|
| Rate for Payer: WPS Commercial |
$1,367.28
|
|
|
SCREW LOCKING VA 3.5MM X 30MM 02.127.130
|
Facility
|
OP
|
$1,775.00
|
|
| Hospital Charge Code |
3265473
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$516.88 |
| Max. Negotiated Rate |
$1,698.32 |
| Rate for Payer: Aetna Commercial |
$1,661.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,587.56
|
| Rate for Payer: Aetna Managed Medicare |
$516.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,199.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$923.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$886.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$978.38
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$1,698.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,033.05
|
| Rate for Payer: Health EOS Commercial |
$1,642.94
|
| Rate for Payer: HFN Commercial |
$1,698.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,384.50
|
| Rate for Payer: Multiplan Commercial |
$1,476.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,107.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,698.32
|
| Rate for Payer: Quartz Beloit One Network |
$904.54
|
| Rate for Payer: Quartz Commercial |
$1,199.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,107.60
|
| Rate for Payer: The Alliance Commercial |
$923.00
|
| Rate for Payer: WEA Trust Commercial |
$1,015.30
|
| Rate for Payer: WPS Commercial |
$1,367.28
|
|
|
SCREW LOCKING VA 3.5MM X 32MM 02.127.132
|
Facility
|
IP
|
$1,775.00
|
|
| Hospital Charge Code |
4268747
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$904.54 |
| Max. Negotiated Rate |
$1,698.32 |
| Rate for Payer: Aetna Commercial |
$1,661.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,587.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$978.38
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$1,698.32
|
| Rate for Payer: Health EOS Commercial |
$1,642.94
|
| Rate for Payer: HFN Commercial |
$1,698.32
|
| Rate for Payer: Multiplan Commercial |
$1,476.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,698.32
|
| Rate for Payer: Quartz Beloit One Network |
$904.54
|
| Rate for Payer: Quartz Commercial |
$1,107.60
|
| Rate for Payer: WEA Trust Commercial |
$1,015.30
|
| Rate for Payer: WPS Commercial |
$1,367.28
|
|
|
SCREW LOCKING VA 3.5MM X 32MM 02.127.132
|
Facility
|
OP
|
$1,775.00
|
|
| Hospital Charge Code |
4268747
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$516.88 |
| Max. Negotiated Rate |
$1,698.32 |
| Rate for Payer: Aetna Commercial |
$1,661.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,587.56
|
| Rate for Payer: Aetna Managed Medicare |
$516.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,199.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$923.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$886.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$978.38
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$1,698.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,033.05
|
| Rate for Payer: Health EOS Commercial |
$1,642.94
|
| Rate for Payer: HFN Commercial |
$1,698.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,384.50
|
| Rate for Payer: Multiplan Commercial |
$1,476.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,107.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,698.32
|
| Rate for Payer: Quartz Beloit One Network |
$904.54
|
| Rate for Payer: Quartz Commercial |
$1,199.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,107.60
|
| Rate for Payer: The Alliance Commercial |
$923.00
|
| Rate for Payer: WEA Trust Commercial |
$1,015.30
|
| Rate for Payer: WPS Commercial |
$1,367.28
|
|
|
SCREW LOCKING VA 3.5MM X 34MM 02.127.134
|
Facility
|
IP
|
$1,775.00
|
|
| Hospital Charge Code |
3265474
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$904.54 |
| Max. Negotiated Rate |
$1,698.32 |
| Rate for Payer: Aetna Commercial |
$1,661.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,587.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$978.38
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$1,698.32
|
| Rate for Payer: Health EOS Commercial |
$1,642.94
|
| Rate for Payer: HFN Commercial |
$1,698.32
|
| Rate for Payer: Multiplan Commercial |
$1,476.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,698.32
|
| Rate for Payer: Quartz Beloit One Network |
$904.54
|
| Rate for Payer: Quartz Commercial |
$1,107.60
|
| Rate for Payer: WEA Trust Commercial |
$1,015.30
|
| Rate for Payer: WPS Commercial |
$1,367.28
|
|
|
SCREW LOCKING VA 3.5MM X 34MM 02.127.134
|
Facility
|
OP
|
$1,775.00
|
|
| Hospital Charge Code |
3265474
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$516.88 |
| Max. Negotiated Rate |
$1,698.32 |
| Rate for Payer: Aetna Commercial |
$1,661.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,587.56
|
| Rate for Payer: Aetna Managed Medicare |
$516.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,199.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$923.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$886.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$978.38
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$1,698.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,033.05
|
| Rate for Payer: Health EOS Commercial |
$1,642.94
|
| Rate for Payer: HFN Commercial |
$1,698.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,384.50
|
| Rate for Payer: Multiplan Commercial |
$1,476.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,107.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,698.32
|
| Rate for Payer: Quartz Beloit One Network |
$904.54
|
| Rate for Payer: Quartz Commercial |
$1,199.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,107.60
|
| Rate for Payer: The Alliance Commercial |
$923.00
|
| Rate for Payer: WEA Trust Commercial |
$1,015.30
|
| Rate for Payer: WPS Commercial |
$1,367.28
|
|
|
SCREW LOCKING VA 3.5MM X 40MM 02.127.140
|
Facility
|
IP
|
$1,878.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6234159
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$957.03 |
| Max. Negotiated Rate |
$1,796.87 |
| Rate for Payer: Aetna Commercial |
$1,757.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,679.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,035.15
|
| Rate for Payer: Cash Price |
$563.40
|
| Rate for Payer: Cigna Commercial |
$1,796.87
|
| Rate for Payer: Health EOS Commercial |
$1,738.28
|
| Rate for Payer: HFN Commercial |
$1,796.87
|
| Rate for Payer: Multiplan Commercial |
$1,562.50
|
| Rate for Payer: Preferred Network Access Commercial |
$1,796.87
|
| Rate for Payer: Quartz Beloit One Network |
$957.03
|
| Rate for Payer: Quartz Commercial |
$1,171.87
|
| Rate for Payer: WEA Trust Commercial |
$1,074.22
|
| Rate for Payer: WPS Commercial |
$1,446.62
|
|
|
SCREW LOCKING VA 3.5MM X 40MM 02.127.140
|
Facility
|
OP
|
$1,878.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6234159
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$546.87 |
| Max. Negotiated Rate |
$1,796.87 |
| Rate for Payer: Aetna Commercial |
$1,757.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,679.68
|
| Rate for Payer: Aetna Managed Medicare |
$546.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,269.53
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$976.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$937.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,035.15
|
| Rate for Payer: Cash Price |
$563.40
|
| Rate for Payer: Cigna Commercial |
$1,796.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,093.00
|
| Rate for Payer: Health EOS Commercial |
$1,738.28
|
| Rate for Payer: HFN Commercial |
$1,796.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,464.84
|
| Rate for Payer: Multiplan Commercial |
$1,562.50
|
| Rate for Payer: NAPHCARE Commercial |
$1,171.87
|
| Rate for Payer: Preferred Network Access Commercial |
$1,796.87
|
| Rate for Payer: Quartz Beloit One Network |
$957.03
|
| Rate for Payer: Quartz Commercial |
$1,269.53
|
| Rate for Payer: Quartz Medicare Advantage |
$1,171.87
|
| Rate for Payer: The Alliance Commercial |
$976.56
|
| Rate for Payer: WEA Trust Commercial |
$1,074.22
|
| Rate for Payer: WPS Commercial |
$1,446.62
|
|
|
SCREW LOCKING VA 3.5MM X 42MM 02.127.142
|
Facility
|
IP
|
$1,878.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6234160
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$957.03 |
| Max. Negotiated Rate |
$1,796.87 |
| Rate for Payer: Aetna Commercial |
$1,757.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,679.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,035.15
|
| Rate for Payer: Cash Price |
$563.40
|
| Rate for Payer: Cigna Commercial |
$1,796.87
|
| Rate for Payer: Health EOS Commercial |
$1,738.28
|
| Rate for Payer: HFN Commercial |
$1,796.87
|
| Rate for Payer: Multiplan Commercial |
$1,562.50
|
| Rate for Payer: Preferred Network Access Commercial |
$1,796.87
|
| Rate for Payer: Quartz Beloit One Network |
$957.03
|
| Rate for Payer: Quartz Commercial |
$1,171.87
|
| Rate for Payer: WEA Trust Commercial |
$1,074.22
|
| Rate for Payer: WPS Commercial |
$1,446.62
|
|
|
SCREW LOCKING VA 3.5MM X 42MM 02.127.142
|
Facility
|
OP
|
$1,878.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6234160
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$546.87 |
| Max. Negotiated Rate |
$1,796.87 |
| Rate for Payer: Aetna Commercial |
$1,757.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,679.68
|
| Rate for Payer: Aetna Managed Medicare |
$546.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,269.53
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$976.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$937.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,035.15
|
| Rate for Payer: Cash Price |
$563.40
|
| Rate for Payer: Cigna Commercial |
$1,796.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,093.00
|
| Rate for Payer: Health EOS Commercial |
$1,738.28
|
| Rate for Payer: HFN Commercial |
$1,796.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,464.84
|
| Rate for Payer: Multiplan Commercial |
$1,562.50
|
| Rate for Payer: NAPHCARE Commercial |
$1,171.87
|
| Rate for Payer: Preferred Network Access Commercial |
$1,796.87
|
| Rate for Payer: Quartz Beloit One Network |
$957.03
|
| Rate for Payer: Quartz Commercial |
$1,269.53
|
| Rate for Payer: Quartz Medicare Advantage |
$1,171.87
|
| Rate for Payer: The Alliance Commercial |
$976.56
|
| Rate for Payer: WEA Trust Commercial |
$1,074.22
|
| Rate for Payer: WPS Commercial |
$1,446.62
|
|
|
SCREW LOCKING VA 3.5MM X 44MM 02.127.144
|
Facility
|
IP
|
$1,775.00
|
|
| Hospital Charge Code |
5074827
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$904.54 |
| Max. Negotiated Rate |
$1,698.32 |
| Rate for Payer: Aetna Commercial |
$1,661.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,587.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$978.38
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$1,698.32
|
| Rate for Payer: Health EOS Commercial |
$1,642.94
|
| Rate for Payer: HFN Commercial |
$1,698.32
|
| Rate for Payer: Multiplan Commercial |
$1,476.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,698.32
|
| Rate for Payer: Quartz Beloit One Network |
$904.54
|
| Rate for Payer: Quartz Commercial |
$1,107.60
|
| Rate for Payer: WEA Trust Commercial |
$1,015.30
|
| Rate for Payer: WPS Commercial |
$1,367.28
|
|
|
SCREW LOCKING VA 3.5MM X 44MM 02.127.144
|
Facility
|
OP
|
$1,775.00
|
|
| Hospital Charge Code |
5074827
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$516.88 |
| Max. Negotiated Rate |
$1,698.32 |
| Rate for Payer: Aetna Commercial |
$1,661.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,587.56
|
| Rate for Payer: Aetna Managed Medicare |
$516.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,199.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$923.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$886.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$978.38
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$1,698.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,033.05
|
| Rate for Payer: Health EOS Commercial |
$1,642.94
|
| Rate for Payer: HFN Commercial |
$1,698.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,384.50
|
| Rate for Payer: Multiplan Commercial |
$1,476.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,107.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,698.32
|
| Rate for Payer: Quartz Beloit One Network |
$904.54
|
| Rate for Payer: Quartz Commercial |
$1,199.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,107.60
|
| Rate for Payer: The Alliance Commercial |
$923.00
|
| Rate for Payer: WEA Trust Commercial |
$1,015.30
|
| Rate for Payer: WPS Commercial |
$1,367.28
|
|
|
SCREW LOCKING VA 3.5MM X 46MM 02.127.146
|
Facility
|
IP
|
$1,775.00
|
|
| Hospital Charge Code |
5074828
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$904.54 |
| Max. Negotiated Rate |
$1,698.32 |
| Rate for Payer: Aetna Commercial |
$1,661.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,587.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$978.38
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$1,698.32
|
| Rate for Payer: Health EOS Commercial |
$1,642.94
|
| Rate for Payer: HFN Commercial |
$1,698.32
|
| Rate for Payer: Multiplan Commercial |
$1,476.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,698.32
|
| Rate for Payer: Quartz Beloit One Network |
$904.54
|
| Rate for Payer: Quartz Commercial |
$1,107.60
|
| Rate for Payer: WEA Trust Commercial |
$1,015.30
|
| Rate for Payer: WPS Commercial |
$1,367.28
|
|
|
SCREW LOCKING VA 3.5MM X 46MM 02.127.146
|
Facility
|
OP
|
$1,775.00
|
|
| Hospital Charge Code |
5074828
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$516.88 |
| Max. Negotiated Rate |
$1,698.32 |
| Rate for Payer: Aetna Commercial |
$1,661.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,587.56
|
| Rate for Payer: Aetna Managed Medicare |
$516.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,199.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$923.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$886.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$978.38
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$1,698.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,033.05
|
| Rate for Payer: Health EOS Commercial |
$1,642.94
|
| Rate for Payer: HFN Commercial |
$1,698.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,384.50
|
| Rate for Payer: Multiplan Commercial |
$1,476.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,107.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,698.32
|
| Rate for Payer: Quartz Beloit One Network |
$904.54
|
| Rate for Payer: Quartz Commercial |
$1,199.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,107.60
|
| Rate for Payer: The Alliance Commercial |
$923.00
|
| Rate for Payer: WEA Trust Commercial |
$1,015.30
|
| Rate for Payer: WPS Commercial |
$1,367.28
|
|
|
SCREW LOCKING VA 3.5MM X 50MM 02.127.150
|
Facility
|
OP
|
$1,775.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6001649
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$516.88 |
| Max. Negotiated Rate |
$1,698.32 |
| Rate for Payer: Aetna Commercial |
$1,661.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,587.56
|
| Rate for Payer: Aetna Managed Medicare |
$516.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,199.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$923.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$886.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$978.38
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$1,698.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,033.05
|
| Rate for Payer: Health EOS Commercial |
$1,642.94
|
| Rate for Payer: HFN Commercial |
$1,698.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,384.50
|
| Rate for Payer: Multiplan Commercial |
$1,476.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,107.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,698.32
|
| Rate for Payer: Quartz Beloit One Network |
$904.54
|
| Rate for Payer: Quartz Commercial |
$1,199.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,107.60
|
| Rate for Payer: The Alliance Commercial |
$923.00
|
| Rate for Payer: WEA Trust Commercial |
$1,015.30
|
| Rate for Payer: WPS Commercial |
$1,367.28
|
|
|
SCREW LOCKING VA 3.5MM X 50MM 02.127.150
|
Facility
|
IP
|
$1,775.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6001649
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$904.54 |
| Max. Negotiated Rate |
$1,698.32 |
| Rate for Payer: Aetna Commercial |
$1,661.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,587.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$978.38
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$1,698.32
|
| Rate for Payer: Health EOS Commercial |
$1,642.94
|
| Rate for Payer: HFN Commercial |
$1,698.32
|
| Rate for Payer: Multiplan Commercial |
$1,476.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,698.32
|
| Rate for Payer: Quartz Beloit One Network |
$904.54
|
| Rate for Payer: Quartz Commercial |
$1,107.60
|
| Rate for Payer: WEA Trust Commercial |
$1,015.30
|
| Rate for Payer: WPS Commercial |
$1,367.28
|
|
|
SCREW LOCKING VA 3.5MM X 54MM 02.127.154
|
Facility
|
IP
|
$1,775.00
|
|
| Hospital Charge Code |
5106924
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$904.54 |
| Max. Negotiated Rate |
$1,698.32 |
| Rate for Payer: Aetna Commercial |
$1,661.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,587.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$978.38
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$1,698.32
|
| Rate for Payer: Health EOS Commercial |
$1,642.94
|
| Rate for Payer: HFN Commercial |
$1,698.32
|
| Rate for Payer: Multiplan Commercial |
$1,476.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,698.32
|
| Rate for Payer: Quartz Beloit One Network |
$904.54
|
| Rate for Payer: Quartz Commercial |
$1,107.60
|
| Rate for Payer: WEA Trust Commercial |
$1,015.30
|
| Rate for Payer: WPS Commercial |
$1,367.28
|
|
|
SCREW LOCKING VA 3.5MM X 54MM 02.127.154
|
Facility
|
OP
|
$1,775.00
|
|
| Hospital Charge Code |
5106924
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$516.88 |
| Max. Negotiated Rate |
$1,698.32 |
| Rate for Payer: Aetna Commercial |
$1,661.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,587.56
|
| Rate for Payer: Aetna Managed Medicare |
$516.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,199.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$923.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$886.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$978.38
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$1,698.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,033.05
|
| Rate for Payer: Health EOS Commercial |
$1,642.94
|
| Rate for Payer: HFN Commercial |
$1,698.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,384.50
|
| Rate for Payer: Multiplan Commercial |
$1,476.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,107.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,698.32
|
| Rate for Payer: Quartz Beloit One Network |
$904.54
|
| Rate for Payer: Quartz Commercial |
$1,199.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,107.60
|
| Rate for Payer: The Alliance Commercial |
$923.00
|
| Rate for Payer: WEA Trust Commercial |
$1,015.30
|
| Rate for Payer: WPS Commercial |
$1,367.28
|
|
