|
COUNTERSINK CANN 4.0MM AO FITTING 705260
|
Facility
OP
|
$3,376.00
|
|
| Hospital Charge Code |
5729731
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$945.28 |
| Max. Negotiated Rate |
$13,504.00 |
| Rate for Payer: Aetna Commercial |
$3,038.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,903.36
|
| Rate for Payer: Aetna Managed Medicare |
$945.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,194.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,688.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,620.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,789.28
|
| Rate for Payer: Cash Price |
$1,012.80
|
| Rate for Payer: Cigna Commercial |
$3,105.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,889.21
|
| Rate for Payer: Health EOS Commercial |
$3,004.64
|
| Rate for Payer: HFN Commercial |
$3,105.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,532.00
|
| Rate for Payer: Multiplan Commercial |
$2,700.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,025.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,105.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,654.24
|
| Rate for Payer: Quartz Commercial |
$2,194.40
|
| Rate for Payer: Quartz Medicare Advantage |
$2,025.60
|
| Rate for Payer: The Alliance Commercial |
$13,504.00
|
| Rate for Payer: WEA Trust Commercial |
$1,856.80
|
| Rate for Payer: WPS Commercial |
$2,500.60
|
|
|
COUNTERSINK CANN 4.0MM AO FITTING 705260
|
Facility
IP
|
$3,376.00
|
|
| Hospital Charge Code |
5729731
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,654.24 |
| Max. Negotiated Rate |
$3,105.92 |
| Rate for Payer: Aetna Commercial |
$3,038.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,789.28
|
| Rate for Payer: Cash Price |
$1,012.80
|
| Rate for Payer: Cigna Commercial |
$3,105.92
|
| Rate for Payer: Health EOS Commercial |
$3,004.64
|
| Rate for Payer: HFN Commercial |
$3,105.92
|
| Rate for Payer: Multiplan Commercial |
$2,700.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,025.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,105.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,654.24
|
| Rate for Payer: Quartz Commercial |
$2,025.60
|
| Rate for Payer: WEA Trust Commercial |
$1,856.80
|
| Rate for Payer: WPS Commercial |
$2,500.60
|
|
|
COUNTERSINK CANN 5.0MM AO FITTING 705261
|
Facility
IP
|
$3,498.00
|
|
| Hospital Charge Code |
5611677
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,714.02 |
| Max. Negotiated Rate |
$3,218.16 |
| Rate for Payer: Aetna Commercial |
$3,148.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,853.94
|
| Rate for Payer: Cash Price |
$1,049.40
|
| Rate for Payer: Cigna Commercial |
$3,218.16
|
| Rate for Payer: Health EOS Commercial |
$3,113.22
|
| Rate for Payer: HFN Commercial |
$3,218.16
|
| Rate for Payer: Multiplan Commercial |
$2,798.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,098.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,218.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,714.02
|
| Rate for Payer: Quartz Commercial |
$2,098.80
|
| Rate for Payer: WEA Trust Commercial |
$1,923.90
|
| Rate for Payer: WPS Commercial |
$2,590.97
|
|
|
COUNTERSINK CANN 5.0MM AO FITTING 705261
|
Facility
OP
|
$3,498.00
|
|
| Hospital Charge Code |
5611677
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$979.44 |
| Max. Negotiated Rate |
$13,992.00 |
| Rate for Payer: Aetna Commercial |
$3,148.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,008.28
|
| Rate for Payer: Aetna Managed Medicare |
$979.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,273.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,749.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,679.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,853.94
|
| Rate for Payer: Cash Price |
$1,049.40
|
| Rate for Payer: Cigna Commercial |
$3,218.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,957.48
|
| Rate for Payer: Health EOS Commercial |
$3,113.22
|
| Rate for Payer: HFN Commercial |
$3,218.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,623.50
|
| Rate for Payer: Multiplan Commercial |
$2,798.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,098.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,218.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,714.02
|
| Rate for Payer: Quartz Commercial |
$2,273.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2,098.80
|
| Rate for Payer: The Alliance Commercial |
$13,992.00
|
| Rate for Payer: WEA Trust Commercial |
$1,923.90
|
| Rate for Payer: WPS Commercial |
$2,590.97
|
|
|
COUNTERSINK CANN 7.0MM AO FITTING 705262
|
Facility
IP
|
$3,566.00
|
|
| Hospital Charge Code |
5641642
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,747.34 |
| Max. Negotiated Rate |
$3,280.72 |
| Rate for Payer: Aetna Commercial |
$3,209.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,889.98
|
| Rate for Payer: Cash Price |
$1,069.80
|
| Rate for Payer: Cigna Commercial |
$3,280.72
|
| Rate for Payer: Health EOS Commercial |
$3,173.74
|
| Rate for Payer: HFN Commercial |
$3,280.72
|
| Rate for Payer: Multiplan Commercial |
$2,852.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,139.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,280.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,747.34
|
| Rate for Payer: Quartz Commercial |
$2,139.60
|
| Rate for Payer: WEA Trust Commercial |
$1,961.30
|
| Rate for Payer: WPS Commercial |
$2,641.34
|
|
|
COUNTERSINK CANN 7.0MM AO FITTING 705262
|
Facility
OP
|
$3,566.00
|
|
| Hospital Charge Code |
5641642
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$998.48 |
| Max. Negotiated Rate |
$14,264.00 |
| Rate for Payer: Aetna Commercial |
$3,209.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,066.76
|
| Rate for Payer: Aetna Managed Medicare |
$998.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,317.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,783.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,711.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,889.98
|
| Rate for Payer: Cash Price |
$1,069.80
|
| Rate for Payer: Cigna Commercial |
$3,280.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,995.53
|
| Rate for Payer: Health EOS Commercial |
$3,173.74
|
| Rate for Payer: HFN Commercial |
$3,280.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,674.50
|
| Rate for Payer: Multiplan Commercial |
$2,852.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,139.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,280.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,747.34
|
| Rate for Payer: Quartz Commercial |
$2,317.90
|
| Rate for Payer: Quartz Medicare Advantage |
$2,139.60
|
| Rate for Payer: The Alliance Commercial |
$14,264.00
|
| Rate for Payer: WEA Trust Commercial |
$1,961.30
|
| Rate for Payer: WPS Commercial |
$2,641.34
|
|
|
COUNTERSINK CANN FOR 6.5MM/7.3MM CANN SCREWS 310.78
|
Facility
IP
|
$5,325.00
|
|
| Hospital Charge Code |
4067880
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,609.25 |
| Max. Negotiated Rate |
$4,899.00 |
| Rate for Payer: Aetna Commercial |
$4,792.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,822.25
|
| Rate for Payer: Cash Price |
$1,597.50
|
| Rate for Payer: Cigna Commercial |
$4,899.00
|
| Rate for Payer: Health EOS Commercial |
$4,739.25
|
| Rate for Payer: HFN Commercial |
$4,899.00
|
| Rate for Payer: Multiplan Commercial |
$4,260.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,195.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,899.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,609.25
|
| Rate for Payer: Quartz Commercial |
$3,195.00
|
| Rate for Payer: WEA Trust Commercial |
$2,928.75
|
| Rate for Payer: WPS Commercial |
$3,944.23
|
|
|
COUNTERSINK CANN FOR 6.5MM/7.3MM CANN SCREWS 310.78
|
Facility
OP
|
$5,325.00
|
|
| Hospital Charge Code |
4067880
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,491.00 |
| Max. Negotiated Rate |
$21,300.00 |
| Rate for Payer: Aetna Commercial |
$4,792.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,579.50
|
| Rate for Payer: Aetna Managed Medicare |
$1,491.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,461.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,662.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,556.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,822.25
|
| Rate for Payer: Cash Price |
$1,597.50
|
| Rate for Payer: Cigna Commercial |
$4,899.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,979.87
|
| Rate for Payer: Health EOS Commercial |
$4,739.25
|
| Rate for Payer: HFN Commercial |
$4,899.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,993.75
|
| Rate for Payer: Multiplan Commercial |
$4,260.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,195.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,899.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,609.25
|
| Rate for Payer: Quartz Commercial |
$3,461.25
|
| Rate for Payer: Quartz Medicare Advantage |
$3,195.00
|
| Rate for Payer: The Alliance Commercial |
$21,300.00
|
| Rate for Payer: WEA Trust Commercial |
$2,928.75
|
| Rate for Payer: WPS Commercial |
$3,944.23
|
|
|
COUNTERSINK FOR 4.3MM HEADLESS CANN SCREW AR-8610CS-43
|
Facility
OP
|
$2,330.00
|
|
| Hospital Charge Code |
5603792
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$652.40 |
| Max. Negotiated Rate |
$9,320.00 |
| Rate for Payer: Aetna Commercial |
$2,097.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,003.80
|
| Rate for Payer: Aetna Managed Medicare |
$652.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,514.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,165.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,118.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,234.90
|
| Rate for Payer: Cash Price |
$699.00
|
| Rate for Payer: Cigna Commercial |
$2,143.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,303.87
|
| Rate for Payer: Health EOS Commercial |
$2,073.70
|
| Rate for Payer: HFN Commercial |
$2,143.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,747.50
|
| Rate for Payer: Multiplan Commercial |
$1,864.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,398.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,143.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,141.70
|
| Rate for Payer: Quartz Commercial |
$1,514.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,398.00
|
| Rate for Payer: The Alliance Commercial |
$9,320.00
|
| Rate for Payer: WEA Trust Commercial |
$1,281.50
|
| Rate for Payer: WPS Commercial |
$1,725.83
|
|
|
COUNTERSINK FOR 4.3MM HEADLESS CANN SCREW AR-8610CS-43
|
Facility
IP
|
$2,330.00
|
|
| Hospital Charge Code |
5603792
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,141.70 |
| Max. Negotiated Rate |
$2,143.60 |
| Rate for Payer: Aetna Commercial |
$2,097.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,234.90
|
| Rate for Payer: Cash Price |
$699.00
|
| Rate for Payer: Cigna Commercial |
$2,143.60
|
| Rate for Payer: Health EOS Commercial |
$2,073.70
|
| Rate for Payer: HFN Commercial |
$2,143.60
|
| Rate for Payer: Multiplan Commercial |
$1,864.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,398.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,143.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,141.70
|
| Rate for Payer: Quartz Commercial |
$1,398.00
|
| Rate for Payer: WEA Trust Commercial |
$1,281.50
|
| Rate for Payer: WPS Commercial |
$1,725.83
|
|
|
COUNTERSINK FOR 6.5MM HEADLESS CANN SCREW AR-8610CS-65
|
Facility
OP
|
$2,330.00
|
|
| Hospital Charge Code |
5603793
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$652.40 |
| Max. Negotiated Rate |
$9,320.00 |
| Rate for Payer: Aetna Commercial |
$2,097.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,003.80
|
| Rate for Payer: Aetna Managed Medicare |
$652.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,514.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,165.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,118.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,234.90
|
| Rate for Payer: Cash Price |
$699.00
|
| Rate for Payer: Cigna Commercial |
$2,143.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,303.87
|
| Rate for Payer: Health EOS Commercial |
$2,073.70
|
| Rate for Payer: HFN Commercial |
$2,143.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,747.50
|
| Rate for Payer: Multiplan Commercial |
$1,864.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,398.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,143.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,141.70
|
| Rate for Payer: Quartz Commercial |
$1,514.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,398.00
|
| Rate for Payer: The Alliance Commercial |
$9,320.00
|
| Rate for Payer: WEA Trust Commercial |
$1,281.50
|
| Rate for Payer: WPS Commercial |
$1,725.83
|
|
|
COUNTERSINK FOR 6.5MM HEADLESS CANN SCREW AR-8610CS-65
|
Facility
IP
|
$2,330.00
|
|
| Hospital Charge Code |
5603793
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,141.70 |
| Max. Negotiated Rate |
$2,143.60 |
| Rate for Payer: Aetna Commercial |
$2,097.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,234.90
|
| Rate for Payer: Cash Price |
$699.00
|
| Rate for Payer: Cigna Commercial |
$2,143.60
|
| Rate for Payer: Health EOS Commercial |
$2,073.70
|
| Rate for Payer: HFN Commercial |
$2,143.60
|
| Rate for Payer: Multiplan Commercial |
$1,864.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,398.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,143.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,141.70
|
| Rate for Payer: Quartz Commercial |
$1,398.00
|
| Rate for Payer: WEA Trust Commercial |
$1,281.50
|
| Rate for Payer: WPS Commercial |
$1,725.83
|
|
|
COUPLING HOFFMAN 3 LARGE GREEN/GREEN 4922-1-010
|
Facility
IP
|
$4,084.00
|
|
| Hospital Charge Code |
5685707
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,001.16 |
| Max. Negotiated Rate |
$3,757.28 |
| Rate for Payer: Aetna Commercial |
$3,675.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,164.52
|
| Rate for Payer: Cash Price |
$1,225.20
|
| Rate for Payer: Cigna Commercial |
$3,757.28
|
| Rate for Payer: Health EOS Commercial |
$3,634.76
|
| Rate for Payer: HFN Commercial |
$3,757.28
|
| Rate for Payer: Multiplan Commercial |
$3,267.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,450.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,757.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,001.16
|
| Rate for Payer: Quartz Commercial |
$2,450.40
|
| Rate for Payer: WEA Trust Commercial |
$2,246.20
|
| Rate for Payer: WPS Commercial |
$3,025.02
|
|
|
COUPLING HOFFMAN 3 LARGE GREEN/GREEN 4922-1-010
|
Facility
OP
|
$4,084.00
|
|
| Hospital Charge Code |
5685707
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,143.52 |
| Max. Negotiated Rate |
$16,336.00 |
| Rate for Payer: Aetna Commercial |
$3,675.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,512.24
|
| Rate for Payer: Aetna Managed Medicare |
$1,143.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,654.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,042.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,960.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,164.52
|
| Rate for Payer: Cash Price |
$1,225.20
|
| Rate for Payer: Cigna Commercial |
$3,757.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,285.41
|
| Rate for Payer: Health EOS Commercial |
$3,634.76
|
| Rate for Payer: HFN Commercial |
$3,757.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,063.00
|
| Rate for Payer: Multiplan Commercial |
$3,267.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,450.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,757.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,001.16
|
| Rate for Payer: Quartz Commercial |
$2,654.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2,450.40
|
| Rate for Payer: The Alliance Commercial |
$16,336.00
|
| Rate for Payer: WEA Trust Commercial |
$2,246.20
|
| Rate for Payer: WPS Commercial |
$3,025.02
|
|
|
COUPLING HOFFMAN 3 LARGE GREEN/SILVER (INVERTED) 4922-1-030
|
Facility
OP
|
$4,084.00
|
|
| Hospital Charge Code |
5685708
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,143.52 |
| Max. Negotiated Rate |
$16,336.00 |
| Rate for Payer: Aetna Commercial |
$3,675.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,512.24
|
| Rate for Payer: Aetna Managed Medicare |
$1,143.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,654.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,042.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,960.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,164.52
|
| Rate for Payer: Cash Price |
$1,225.20
|
| Rate for Payer: Cigna Commercial |
$3,757.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,285.41
|
| Rate for Payer: Health EOS Commercial |
$3,634.76
|
| Rate for Payer: HFN Commercial |
$3,757.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,063.00
|
| Rate for Payer: Multiplan Commercial |
$3,267.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,450.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,757.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,001.16
|
| Rate for Payer: Quartz Commercial |
$2,654.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2,450.40
|
| Rate for Payer: The Alliance Commercial |
$16,336.00
|
| Rate for Payer: WEA Trust Commercial |
$2,246.20
|
| Rate for Payer: WPS Commercial |
$3,025.02
|
|
|
COUPLING HOFFMAN 3 LARGE GREEN/SILVER (INVERTED) 4922-1-030
|
Facility
IP
|
$4,084.00
|
|
| Hospital Charge Code |
5685708
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,001.16 |
| Max. Negotiated Rate |
$3,757.28 |
| Rate for Payer: Aetna Commercial |
$3,675.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,164.52
|
| Rate for Payer: Cash Price |
$1,225.20
|
| Rate for Payer: Cigna Commercial |
$3,757.28
|
| Rate for Payer: Health EOS Commercial |
$3,634.76
|
| Rate for Payer: HFN Commercial |
$3,757.28
|
| Rate for Payer: Multiplan Commercial |
$3,267.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,450.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,757.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,001.16
|
| Rate for Payer: Quartz Commercial |
$2,450.40
|
| Rate for Payer: WEA Trust Commercial |
$2,246.20
|
| Rate for Payer: WPS Commercial |
$3,025.02
|
|
|
COUPLING PIN-TO-ROD 1.65 - 2.0/3.0MM 4960-1-020
|
Facility
OP
|
$4,669.00
|
|
| Hospital Charge Code |
5349471
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,307.32 |
| Max. Negotiated Rate |
$18,676.00 |
| Rate for Payer: Aetna Commercial |
$4,202.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,015.34
|
| Rate for Payer: Aetna Managed Medicare |
$1,307.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,034.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,334.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,241.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,474.57
|
| Rate for Payer: Cash Price |
$1,400.70
|
| Rate for Payer: Cigna Commercial |
$4,295.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,612.77
|
| Rate for Payer: Health EOS Commercial |
$4,155.41
|
| Rate for Payer: HFN Commercial |
$4,295.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,501.75
|
| Rate for Payer: Multiplan Commercial |
$3,735.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,801.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,295.48
|
| Rate for Payer: Quartz Beloit One Network |
$2,287.81
|
| Rate for Payer: Quartz Commercial |
$3,034.85
|
| Rate for Payer: Quartz Medicare Advantage |
$2,801.40
|
| Rate for Payer: The Alliance Commercial |
$18,676.00
|
| Rate for Payer: WEA Trust Commercial |
$2,567.95
|
| Rate for Payer: WPS Commercial |
$3,458.33
|
|
|
COUPLING PIN-TO-ROD 1.65 - 2.0/3.0MM 4960-1-020
|
Facility
IP
|
$4,669.00
|
|
| Hospital Charge Code |
5349471
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,287.81 |
| Max. Negotiated Rate |
$4,295.48 |
| Rate for Payer: Aetna Commercial |
$4,202.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,474.57
|
| Rate for Payer: Cash Price |
$1,400.70
|
| Rate for Payer: Cigna Commercial |
$4,295.48
|
| Rate for Payer: Health EOS Commercial |
$4,155.41
|
| Rate for Payer: HFN Commercial |
$4,295.48
|
| Rate for Payer: Multiplan Commercial |
$3,735.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,801.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,295.48
|
| Rate for Payer: Quartz Beloit One Network |
$2,287.81
|
| Rate for Payer: Quartz Commercial |
$2,801.40
|
| Rate for Payer: WEA Trust Commercial |
$2,567.95
|
| Rate for Payer: WPS Commercial |
$3,458.33
|
|
|
COUPLING ROD-TO-ROD 3.0/3.0MM 4960-1-010
|
Facility
IP
|
$4,579.00
|
|
| Hospital Charge Code |
5349470
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,243.71 |
| Max. Negotiated Rate |
$4,212.68 |
| Rate for Payer: Aetna Commercial |
$4,121.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,426.87
|
| Rate for Payer: Cash Price |
$1,373.70
|
| Rate for Payer: Cigna Commercial |
$4,212.68
|
| Rate for Payer: Health EOS Commercial |
$4,075.31
|
| Rate for Payer: HFN Commercial |
$4,212.68
|
| Rate for Payer: Multiplan Commercial |
$3,663.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,747.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,212.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,243.71
|
| Rate for Payer: Quartz Commercial |
$2,747.40
|
| Rate for Payer: WEA Trust Commercial |
$2,518.45
|
| Rate for Payer: WPS Commercial |
$3,391.67
|
|
|
COUPLING ROD-TO-ROD 3.0/3.0MM 4960-1-010
|
Facility
OP
|
$4,579.00
|
|
| Hospital Charge Code |
5349470
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,282.12 |
| Max. Negotiated Rate |
$18,316.00 |
| Rate for Payer: Aetna Commercial |
$4,121.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,937.94
|
| Rate for Payer: Aetna Managed Medicare |
$1,282.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,976.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,289.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,197.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,426.87
|
| Rate for Payer: Cash Price |
$1,373.70
|
| Rate for Payer: Cigna Commercial |
$4,212.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,562.41
|
| Rate for Payer: Health EOS Commercial |
$4,075.31
|
| Rate for Payer: HFN Commercial |
$4,212.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,434.25
|
| Rate for Payer: Multiplan Commercial |
$3,663.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,747.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,212.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,243.71
|
| Rate for Payer: Quartz Commercial |
$2,976.35
|
| Rate for Payer: Quartz Medicare Advantage |
$2,747.40
|
| Rate for Payer: The Alliance Commercial |
$18,316.00
|
| Rate for Payer: WEA Trust Commercial |
$2,518.45
|
| Rate for Payer: WPS Commercial |
$3,391.67
|
|
|
COUPLING ROD-TO-ROD 5.0/3.0MM 4960-1-060
|
Facility
OP
|
$3,806.00
|
|
| Hospital Charge Code |
6170222
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,065.68 |
| Max. Negotiated Rate |
$15,224.00 |
| Rate for Payer: Aetna Commercial |
$3,425.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,273.16
|
| Rate for Payer: Aetna Managed Medicare |
$1,065.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,473.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,903.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,826.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,017.18
|
| Rate for Payer: Cash Price |
$1,141.80
|
| Rate for Payer: Cigna Commercial |
$3,501.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,129.84
|
| Rate for Payer: Health EOS Commercial |
$3,387.34
|
| Rate for Payer: HFN Commercial |
$3,501.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,854.50
|
| Rate for Payer: Multiplan Commercial |
$3,044.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,283.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,501.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,864.94
|
| Rate for Payer: Quartz Commercial |
$2,473.90
|
| Rate for Payer: Quartz Medicare Advantage |
$2,283.60
|
| Rate for Payer: The Alliance Commercial |
$15,224.00
|
| Rate for Payer: WEA Trust Commercial |
$2,093.30
|
| Rate for Payer: WPS Commercial |
$2,819.10
|
|
|
COUPLING ROD-TO-ROD 5.0/3.0MM 4960-1-060
|
Facility
IP
|
$3,806.00
|
|
| Hospital Charge Code |
6170222
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,864.94 |
| Max. Negotiated Rate |
$3,501.52 |
| Rate for Payer: Aetna Commercial |
$3,425.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,017.18
|
| Rate for Payer: Cash Price |
$1,141.80
|
| Rate for Payer: Cigna Commercial |
$3,501.52
|
| Rate for Payer: Health EOS Commercial |
$3,387.34
|
| Rate for Payer: HFN Commercial |
$3,501.52
|
| Rate for Payer: Multiplan Commercial |
$3,044.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,283.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,501.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,864.94
|
| Rate for Payer: Quartz Commercial |
$2,283.60
|
| Rate for Payer: WEA Trust Commercial |
$2,093.30
|
| Rate for Payer: WPS Commercial |
$2,819.10
|
|
|
COVERALL HOODED W/BOOTS 2XL 45095
|
Facility
IP
|
$265.00
|
|
| Hospital Charge Code |
4347543
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$129.85 |
| Max. Negotiated Rate |
$243.80 |
| Rate for Payer: Aetna Commercial |
$238.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$140.45
|
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Cigna Commercial |
$243.80
|
| Rate for Payer: Health EOS Commercial |
$235.85
|
| Rate for Payer: HFN Commercial |
$243.80
|
| Rate for Payer: Multiplan Commercial |
$212.00
|
| Rate for Payer: NAPHCARE Commercial |
$159.00
|
| Rate for Payer: Preferred Network Access Commercial |
$243.80
|
| Rate for Payer: Quartz Beloit One Network |
$129.85
|
| Rate for Payer: Quartz Commercial |
$159.00
|
| Rate for Payer: WEA Trust Commercial |
$145.75
|
| Rate for Payer: WPS Commercial |
$196.29
|
|
|
COVERALL HOODED W/BOOTS 2XL 45095
|
Facility
OP
|
$265.00
|
|
| Hospital Charge Code |
4347543
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$74.20 |
| Max. Negotiated Rate |
$1,060.00 |
| Rate for Payer: Aetna Commercial |
$238.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$227.90
|
| Rate for Payer: Aetna Managed Medicare |
$74.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$172.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$132.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$127.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$140.45
|
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Cigna Commercial |
$243.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$148.29
|
| Rate for Payer: Health EOS Commercial |
$235.85
|
| Rate for Payer: HFN Commercial |
$243.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$198.75
|
| Rate for Payer: Multiplan Commercial |
$212.00
|
| Rate for Payer: NAPHCARE Commercial |
$159.00
|
| Rate for Payer: Preferred Network Access Commercial |
$243.80
|
| Rate for Payer: Quartz Beloit One Network |
$129.85
|
| Rate for Payer: Quartz Commercial |
$172.25
|
| Rate for Payer: Quartz Medicare Advantage |
$159.00
|
| Rate for Payer: The Alliance Commercial |
$1,060.00
|
| Rate for Payer: WEA Trust Commercial |
$145.75
|
| Rate for Payer: WPS Commercial |
$196.29
|
|
|
COVERALL HOODED W/BOOTS XL45094
|
Facility
IP
|
$265.00
|
|
| Hospital Charge Code |
4347542
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$129.85 |
| Max. Negotiated Rate |
$243.80 |
| Rate for Payer: Aetna Commercial |
$238.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$140.45
|
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Cigna Commercial |
$243.80
|
| Rate for Payer: Health EOS Commercial |
$235.85
|
| Rate for Payer: HFN Commercial |
$243.80
|
| Rate for Payer: Multiplan Commercial |
$212.00
|
| Rate for Payer: NAPHCARE Commercial |
$159.00
|
| Rate for Payer: Preferred Network Access Commercial |
$243.80
|
| Rate for Payer: Quartz Beloit One Network |
$129.85
|
| Rate for Payer: Quartz Commercial |
$159.00
|
| Rate for Payer: WEA Trust Commercial |
$145.75
|
| Rate for Payer: WPS Commercial |
$196.29
|
|
