|
COUNTERSINK CANN 5.0MM AO FITTING 705261
|
Facility
|
OP
|
$3,498.00
|
|
| Hospital Charge Code |
5611677
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,018.62 |
| Max. Negotiated Rate |
$3,346.89 |
| Rate for Payer: Aetna Commercial |
$3,274.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,128.61
|
| Rate for Payer: Aetna Managed Medicare |
$1,018.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,364.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,818.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,746.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,928.10
|
| Rate for Payer: Cash Price |
$1,049.40
|
| Rate for Payer: Cigna Commercial |
$3,346.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,035.84
|
| Rate for Payer: Health EOS Commercial |
$3,237.75
|
| Rate for Payer: HFN Commercial |
$3,346.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,728.44
|
| Rate for Payer: Multiplan Commercial |
$2,910.34
|
| Rate for Payer: NAPHCARE Commercial |
$2,182.75
|
| Rate for Payer: Preferred Network Access Commercial |
$3,346.89
|
| Rate for Payer: Quartz Beloit One Network |
$1,782.58
|
| Rate for Payer: Quartz Commercial |
$2,364.65
|
| Rate for Payer: Quartz Medicare Advantage |
$2,182.75
|
| Rate for Payer: The Alliance Commercial |
$1,818.96
|
| Rate for Payer: WEA Trust Commercial |
$2,000.86
|
| Rate for Payer: WPS Commercial |
$2,694.51
|
|
|
COUNTERSINK CANN 5.0MM AO FITTING 705261
|
Facility
|
IP
|
$3,498.00
|
|
| Hospital Charge Code |
5611677
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,782.58 |
| Max. Negotiated Rate |
$3,346.89 |
| Rate for Payer: Aetna Commercial |
$3,274.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,128.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,928.10
|
| Rate for Payer: Cash Price |
$1,049.40
|
| Rate for Payer: Cigna Commercial |
$3,346.89
|
| Rate for Payer: Health EOS Commercial |
$3,237.75
|
| Rate for Payer: HFN Commercial |
$3,346.89
|
| Rate for Payer: Multiplan Commercial |
$2,910.34
|
| Rate for Payer: Preferred Network Access Commercial |
$3,346.89
|
| Rate for Payer: Quartz Beloit One Network |
$1,782.58
|
| Rate for Payer: Quartz Commercial |
$2,182.75
|
| Rate for Payer: WEA Trust Commercial |
$2,000.86
|
| Rate for Payer: WPS Commercial |
$2,694.51
|
|
|
COUNTERSINK CANN 7.0MM AO FITTING 705262
|
Facility
|
OP
|
$3,566.00
|
|
| Hospital Charge Code |
5641642
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,038.42 |
| Max. Negotiated Rate |
$3,411.95 |
| Rate for Payer: Aetna Commercial |
$3,337.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,189.43
|
| Rate for Payer: Aetna Managed Medicare |
$1,038.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,410.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,854.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,780.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,965.58
|
| Rate for Payer: Cash Price |
$1,069.80
|
| Rate for Payer: Cigna Commercial |
$3,411.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,075.41
|
| Rate for Payer: Health EOS Commercial |
$3,300.69
|
| Rate for Payer: HFN Commercial |
$3,411.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,781.48
|
| Rate for Payer: Multiplan Commercial |
$2,966.91
|
| Rate for Payer: NAPHCARE Commercial |
$2,225.18
|
| Rate for Payer: Preferred Network Access Commercial |
$3,411.95
|
| Rate for Payer: Quartz Beloit One Network |
$1,817.23
|
| Rate for Payer: Quartz Commercial |
$2,410.62
|
| Rate for Payer: Quartz Medicare Advantage |
$2,225.18
|
| Rate for Payer: The Alliance Commercial |
$1,854.32
|
| Rate for Payer: WEA Trust Commercial |
$2,039.75
|
| Rate for Payer: WPS Commercial |
$2,746.89
|
|
|
COUNTERSINK CANN 7.0MM AO FITTING 705262
|
Facility
|
IP
|
$3,566.00
|
|
| Hospital Charge Code |
5641642
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,817.23 |
| Max. Negotiated Rate |
$3,411.95 |
| Rate for Payer: Aetna Commercial |
$3,337.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,189.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,965.58
|
| Rate for Payer: Cash Price |
$1,069.80
|
| Rate for Payer: Cigna Commercial |
$3,411.95
|
| Rate for Payer: Health EOS Commercial |
$3,300.69
|
| Rate for Payer: HFN Commercial |
$3,411.95
|
| Rate for Payer: Multiplan Commercial |
$2,966.91
|
| Rate for Payer: Preferred Network Access Commercial |
$3,411.95
|
| Rate for Payer: Quartz Beloit One Network |
$1,817.23
|
| Rate for Payer: Quartz Commercial |
$2,225.18
|
| Rate for Payer: WEA Trust Commercial |
$2,039.75
|
| Rate for Payer: WPS Commercial |
$2,746.89
|
|
|
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 |
$2,713.62 |
| Max. Negotiated Rate |
$5,094.96 |
| Rate for Payer: Aetna Commercial |
$4,984.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,762.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,935.14
|
| Rate for Payer: Cash Price |
$1,597.50
|
| Rate for Payer: Cigna Commercial |
$5,094.96
|
| Rate for Payer: Health EOS Commercial |
$4,928.82
|
| Rate for Payer: HFN Commercial |
$5,094.96
|
| Rate for Payer: Multiplan Commercial |
$4,430.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,094.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,713.62
|
| Rate for Payer: Quartz Commercial |
$3,322.80
|
| Rate for Payer: WEA Trust Commercial |
$3,045.90
|
| Rate for Payer: WPS Commercial |
$4,101.85
|
|
|
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 |
$1,550.64 |
| Max. Negotiated Rate |
$5,094.96 |
| Rate for Payer: Aetna Commercial |
$4,984.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,762.68
|
| Rate for Payer: Aetna Managed Medicare |
$1,550.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,599.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,769.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,658.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,935.14
|
| Rate for Payer: Cash Price |
$1,597.50
|
| Rate for Payer: Cigna Commercial |
$5,094.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,099.15
|
| Rate for Payer: Health EOS Commercial |
$4,928.82
|
| Rate for Payer: HFN Commercial |
$5,094.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,153.50
|
| Rate for Payer: Multiplan Commercial |
$4,430.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,322.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,094.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,713.62
|
| Rate for Payer: Quartz Commercial |
$3,599.70
|
| Rate for Payer: Quartz Medicare Advantage |
$3,322.80
|
| Rate for Payer: The Alliance Commercial |
$2,769.00
|
| Rate for Payer: WEA Trust Commercial |
$3,045.90
|
| Rate for Payer: WPS Commercial |
$4,101.85
|
|
|
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 |
$678.50 |
| Max. Negotiated Rate |
$2,229.34 |
| Rate for Payer: Aetna Commercial |
$2,180.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,083.95
|
| Rate for Payer: Aetna Managed Medicare |
$678.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,575.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,211.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,163.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,284.30
|
| Rate for Payer: Cash Price |
$699.00
|
| Rate for Payer: Cigna Commercial |
$2,229.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,356.06
|
| Rate for Payer: Health EOS Commercial |
$2,156.65
|
| Rate for Payer: HFN Commercial |
$2,229.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,817.40
|
| Rate for Payer: Multiplan Commercial |
$1,938.56
|
| Rate for Payer: NAPHCARE Commercial |
$1,453.92
|
| Rate for Payer: Preferred Network Access Commercial |
$2,229.34
|
| Rate for Payer: Quartz Beloit One Network |
$1,187.37
|
| Rate for Payer: Quartz Commercial |
$1,575.08
|
| Rate for Payer: Quartz Medicare Advantage |
$1,453.92
|
| Rate for Payer: The Alliance Commercial |
$1,211.60
|
| Rate for Payer: WEA Trust Commercial |
$1,332.76
|
| Rate for Payer: WPS Commercial |
$1,794.80
|
|
|
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 |
$1,187.37 |
| Max. Negotiated Rate |
$2,229.34 |
| Rate for Payer: Aetna Commercial |
$2,180.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,083.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,284.30
|
| Rate for Payer: Cash Price |
$699.00
|
| Rate for Payer: Cigna Commercial |
$2,229.34
|
| Rate for Payer: Health EOS Commercial |
$2,156.65
|
| Rate for Payer: HFN Commercial |
$2,229.34
|
| Rate for Payer: Multiplan Commercial |
$1,938.56
|
| Rate for Payer: Preferred Network Access Commercial |
$2,229.34
|
| Rate for Payer: Quartz Beloit One Network |
$1,187.37
|
| Rate for Payer: Quartz Commercial |
$1,453.92
|
| Rate for Payer: WEA Trust Commercial |
$1,332.76
|
| Rate for Payer: WPS Commercial |
$1,794.80
|
|
|
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 |
$678.50 |
| Max. Negotiated Rate |
$2,229.34 |
| Rate for Payer: Aetna Commercial |
$2,180.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,083.95
|
| Rate for Payer: Aetna Managed Medicare |
$678.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,575.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,211.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,163.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,284.30
|
| Rate for Payer: Cash Price |
$699.00
|
| Rate for Payer: Cigna Commercial |
$2,229.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,356.06
|
| Rate for Payer: Health EOS Commercial |
$2,156.65
|
| Rate for Payer: HFN Commercial |
$2,229.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,817.40
|
| Rate for Payer: Multiplan Commercial |
$1,938.56
|
| Rate for Payer: NAPHCARE Commercial |
$1,453.92
|
| Rate for Payer: Preferred Network Access Commercial |
$2,229.34
|
| Rate for Payer: Quartz Beloit One Network |
$1,187.37
|
| Rate for Payer: Quartz Commercial |
$1,575.08
|
| Rate for Payer: Quartz Medicare Advantage |
$1,453.92
|
| Rate for Payer: The Alliance Commercial |
$1,211.60
|
| Rate for Payer: WEA Trust Commercial |
$1,332.76
|
| Rate for Payer: WPS Commercial |
$1,794.80
|
|
|
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 |
$1,187.37 |
| Max. Negotiated Rate |
$2,229.34 |
| Rate for Payer: Aetna Commercial |
$2,180.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,083.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,284.30
|
| Rate for Payer: Cash Price |
$699.00
|
| Rate for Payer: Cigna Commercial |
$2,229.34
|
| Rate for Payer: Health EOS Commercial |
$2,156.65
|
| Rate for Payer: HFN Commercial |
$2,229.34
|
| Rate for Payer: Multiplan Commercial |
$1,938.56
|
| Rate for Payer: Preferred Network Access Commercial |
$2,229.34
|
| Rate for Payer: Quartz Beloit One Network |
$1,187.37
|
| Rate for Payer: Quartz Commercial |
$1,453.92
|
| Rate for Payer: WEA Trust Commercial |
$1,332.76
|
| Rate for Payer: WPS Commercial |
$1,794.80
|
|
|
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 |
$1,189.26 |
| Max. Negotiated Rate |
$3,907.57 |
| Rate for Payer: Aetna Commercial |
$3,822.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,652.73
|
| Rate for Payer: Aetna Managed Medicare |
$1,189.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,760.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,123.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,038.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,251.10
|
| Rate for Payer: Cash Price |
$1,225.20
|
| Rate for Payer: Cigna Commercial |
$3,907.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,376.89
|
| Rate for Payer: Health EOS Commercial |
$3,780.15
|
| Rate for Payer: HFN Commercial |
$3,907.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,185.52
|
| Rate for Payer: Multiplan Commercial |
$3,397.89
|
| Rate for Payer: NAPHCARE Commercial |
$2,548.42
|
| Rate for Payer: Preferred Network Access Commercial |
$3,907.57
|
| Rate for Payer: Quartz Beloit One Network |
$2,081.21
|
| Rate for Payer: Quartz Commercial |
$2,760.78
|
| Rate for Payer: Quartz Medicare Advantage |
$2,548.42
|
| Rate for Payer: The Alliance Commercial |
$2,123.68
|
| Rate for Payer: WEA Trust Commercial |
$2,336.05
|
| Rate for Payer: WPS Commercial |
$3,145.91
|
|
|
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 |
$2,081.21 |
| Max. Negotiated Rate |
$3,907.57 |
| Rate for Payer: Aetna Commercial |
$3,822.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,652.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,251.10
|
| Rate for Payer: Cash Price |
$1,225.20
|
| Rate for Payer: Cigna Commercial |
$3,907.57
|
| Rate for Payer: Health EOS Commercial |
$3,780.15
|
| Rate for Payer: HFN Commercial |
$3,907.57
|
| Rate for Payer: Multiplan Commercial |
$3,397.89
|
| Rate for Payer: Preferred Network Access Commercial |
$3,907.57
|
| Rate for Payer: Quartz Beloit One Network |
$2,081.21
|
| Rate for Payer: Quartz Commercial |
$2,548.42
|
| Rate for Payer: WEA Trust Commercial |
$2,336.05
|
| Rate for Payer: WPS Commercial |
$3,145.91
|
|
|
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 |
$1,189.26 |
| Max. Negotiated Rate |
$3,907.57 |
| Rate for Payer: Aetna Commercial |
$3,822.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,652.73
|
| Rate for Payer: Aetna Managed Medicare |
$1,189.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,760.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,123.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,038.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,251.10
|
| Rate for Payer: Cash Price |
$1,225.20
|
| Rate for Payer: Cigna Commercial |
$3,907.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,376.89
|
| Rate for Payer: Health EOS Commercial |
$3,780.15
|
| Rate for Payer: HFN Commercial |
$3,907.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,185.52
|
| Rate for Payer: Multiplan Commercial |
$3,397.89
|
| Rate for Payer: NAPHCARE Commercial |
$2,548.42
|
| Rate for Payer: Preferred Network Access Commercial |
$3,907.57
|
| Rate for Payer: Quartz Beloit One Network |
$2,081.21
|
| Rate for Payer: Quartz Commercial |
$2,760.78
|
| Rate for Payer: Quartz Medicare Advantage |
$2,548.42
|
| Rate for Payer: The Alliance Commercial |
$2,123.68
|
| Rate for Payer: WEA Trust Commercial |
$2,336.05
|
| Rate for Payer: WPS Commercial |
$3,145.91
|
|
|
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 |
$2,081.21 |
| Max. Negotiated Rate |
$3,907.57 |
| Rate for Payer: Aetna Commercial |
$3,822.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,652.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,251.10
|
| Rate for Payer: Cash Price |
$1,225.20
|
| Rate for Payer: Cigna Commercial |
$3,907.57
|
| Rate for Payer: Health EOS Commercial |
$3,780.15
|
| Rate for Payer: HFN Commercial |
$3,907.57
|
| Rate for Payer: Multiplan Commercial |
$3,397.89
|
| Rate for Payer: Preferred Network Access Commercial |
$3,907.57
|
| Rate for Payer: Quartz Beloit One Network |
$2,081.21
|
| Rate for Payer: Quartz Commercial |
$2,548.42
|
| Rate for Payer: WEA Trust Commercial |
$2,336.05
|
| Rate for Payer: WPS Commercial |
$3,145.91
|
|
|
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 |
$1,359.61 |
| Max. Negotiated Rate |
$4,467.30 |
| Rate for Payer: Aetna Commercial |
$4,370.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,175.95
|
| Rate for Payer: Aetna Managed Medicare |
$1,359.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,156.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,427.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,330.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,573.55
|
| Rate for Payer: Cash Price |
$1,400.70
|
| Rate for Payer: Cigna Commercial |
$4,467.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,717.36
|
| Rate for Payer: Health EOS Commercial |
$4,321.63
|
| Rate for Payer: HFN Commercial |
$4,467.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,641.82
|
| Rate for Payer: Multiplan Commercial |
$3,884.61
|
| Rate for Payer: NAPHCARE Commercial |
$2,913.46
|
| Rate for Payer: Preferred Network Access Commercial |
$4,467.30
|
| Rate for Payer: Quartz Beloit One Network |
$2,379.32
|
| Rate for Payer: Quartz Commercial |
$3,156.24
|
| Rate for Payer: Quartz Medicare Advantage |
$2,913.46
|
| Rate for Payer: The Alliance Commercial |
$2,427.88
|
| Rate for Payer: WEA Trust Commercial |
$2,670.67
|
| Rate for Payer: WPS Commercial |
$3,596.53
|
|
|
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 |
$2,379.32 |
| Max. Negotiated Rate |
$4,467.30 |
| Rate for Payer: Aetna Commercial |
$4,370.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,175.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,573.55
|
| Rate for Payer: Cash Price |
$1,400.70
|
| Rate for Payer: Cigna Commercial |
$4,467.30
|
| Rate for Payer: Health EOS Commercial |
$4,321.63
|
| Rate for Payer: HFN Commercial |
$4,467.30
|
| Rate for Payer: Multiplan Commercial |
$3,884.61
|
| Rate for Payer: Preferred Network Access Commercial |
$4,467.30
|
| Rate for Payer: Quartz Beloit One Network |
$2,379.32
|
| Rate for Payer: Quartz Commercial |
$2,913.46
|
| Rate for Payer: WEA Trust Commercial |
$2,670.67
|
| Rate for Payer: WPS Commercial |
$3,596.53
|
|
|
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 |
$2,333.46 |
| Max. Negotiated Rate |
$4,381.19 |
| Rate for Payer: Aetna Commercial |
$4,285.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,095.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,523.94
|
| Rate for Payer: Cash Price |
$1,373.70
|
| Rate for Payer: Cigna Commercial |
$4,381.19
|
| Rate for Payer: Health EOS Commercial |
$4,238.32
|
| Rate for Payer: HFN Commercial |
$4,381.19
|
| Rate for Payer: Multiplan Commercial |
$3,809.73
|
| Rate for Payer: Preferred Network Access Commercial |
$4,381.19
|
| Rate for Payer: Quartz Beloit One Network |
$2,333.46
|
| Rate for Payer: Quartz Commercial |
$2,857.30
|
| Rate for Payer: WEA Trust Commercial |
$2,619.19
|
| Rate for Payer: WPS Commercial |
$3,527.20
|
|
|
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 |
$1,333.40 |
| Max. Negotiated Rate |
$4,381.19 |
| Rate for Payer: Aetna Commercial |
$4,285.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,095.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,333.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,095.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,381.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,285.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,523.94
|
| Rate for Payer: Cash Price |
$1,373.70
|
| Rate for Payer: Cigna Commercial |
$4,381.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,664.98
|
| Rate for Payer: Health EOS Commercial |
$4,238.32
|
| Rate for Payer: HFN Commercial |
$4,381.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,571.62
|
| Rate for Payer: Multiplan Commercial |
$3,809.73
|
| Rate for Payer: NAPHCARE Commercial |
$2,857.30
|
| Rate for Payer: Preferred Network Access Commercial |
$4,381.19
|
| Rate for Payer: Quartz Beloit One Network |
$2,333.46
|
| Rate for Payer: Quartz Commercial |
$3,095.40
|
| Rate for Payer: Quartz Medicare Advantage |
$2,857.30
|
| Rate for Payer: The Alliance Commercial |
$2,381.08
|
| Rate for Payer: WEA Trust Commercial |
$2,619.19
|
| Rate for Payer: WPS Commercial |
$3,527.20
|
|
|
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 |
$1,939.54 |
| Max. Negotiated Rate |
$3,641.58 |
| Rate for Payer: Aetna Commercial |
$3,562.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,404.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,097.87
|
| Rate for Payer: Cash Price |
$1,141.80
|
| Rate for Payer: Cigna Commercial |
$3,641.58
|
| Rate for Payer: Health EOS Commercial |
$3,522.83
|
| Rate for Payer: HFN Commercial |
$3,641.58
|
| Rate for Payer: Multiplan Commercial |
$3,166.59
|
| Rate for Payer: Preferred Network Access Commercial |
$3,641.58
|
| Rate for Payer: Quartz Beloit One Network |
$1,939.54
|
| Rate for Payer: Quartz Commercial |
$2,374.94
|
| Rate for Payer: WEA Trust Commercial |
$2,177.03
|
| Rate for Payer: WPS Commercial |
$2,931.76
|
|
|
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 |
$1,108.31 |
| Max. Negotiated Rate |
$3,641.58 |
| Rate for Payer: Aetna Commercial |
$3,562.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,404.09
|
| Rate for Payer: Aetna Managed Medicare |
$1,108.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,572.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,979.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,899.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,097.87
|
| Rate for Payer: Cash Price |
$1,141.80
|
| Rate for Payer: Cigna Commercial |
$3,641.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,215.09
|
| Rate for Payer: Health EOS Commercial |
$3,522.83
|
| Rate for Payer: HFN Commercial |
$3,641.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,968.68
|
| Rate for Payer: Multiplan Commercial |
$3,166.59
|
| Rate for Payer: NAPHCARE Commercial |
$2,374.94
|
| Rate for Payer: Preferred Network Access Commercial |
$3,641.58
|
| Rate for Payer: Quartz Beloit One Network |
$1,939.54
|
| Rate for Payer: Quartz Commercial |
$2,572.86
|
| Rate for Payer: Quartz Medicare Advantage |
$2,374.94
|
| Rate for Payer: The Alliance Commercial |
$1,979.12
|
| Rate for Payer: WEA Trust Commercial |
$2,177.03
|
| Rate for Payer: WPS Commercial |
$2,931.76
|
|
|
COVERALL HOODED W/BOOTS 2XL 45095
|
Facility
|
OP
|
$265.00
|
|
| Hospital Charge Code |
4347543
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$77.17 |
| Max. Negotiated Rate |
$253.55 |
| Rate for Payer: Aetna Commercial |
$248.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.02
|
| Rate for Payer: Aetna Managed Medicare |
$77.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$179.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$137.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$132.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.07
|
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Cigna Commercial |
$253.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$154.23
|
| Rate for Payer: Health EOS Commercial |
$245.28
|
| Rate for Payer: HFN Commercial |
$253.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$206.70
|
| Rate for Payer: Multiplan Commercial |
$220.48
|
| Rate for Payer: NAPHCARE Commercial |
$165.36
|
| Rate for Payer: Preferred Network Access Commercial |
$253.55
|
| Rate for Payer: Quartz Beloit One Network |
$135.04
|
| Rate for Payer: Quartz Commercial |
$179.14
|
| Rate for Payer: Quartz Medicare Advantage |
$165.36
|
| Rate for Payer: The Alliance Commercial |
$137.80
|
| Rate for Payer: WEA Trust Commercial |
$151.58
|
| Rate for Payer: WPS Commercial |
$204.13
|
|
|
COVERALL HOODED W/BOOTS 2XL 45095
|
Facility
|
IP
|
$265.00
|
|
| Hospital Charge Code |
4347543
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.04 |
| Max. Negotiated Rate |
$253.55 |
| Rate for Payer: Aetna Commercial |
$248.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.07
|
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Cigna Commercial |
$253.55
|
| Rate for Payer: Health EOS Commercial |
$245.28
|
| Rate for Payer: HFN Commercial |
$253.55
|
| Rate for Payer: Multiplan Commercial |
$220.48
|
| Rate for Payer: Preferred Network Access Commercial |
$253.55
|
| Rate for Payer: Quartz Beloit One Network |
$135.04
|
| Rate for Payer: Quartz Commercial |
$165.36
|
| Rate for Payer: WEA Trust Commercial |
$151.58
|
| Rate for Payer: WPS Commercial |
$204.13
|
|
|
COVERALL HOODED W/BOOTS XL45094
|
Facility
|
OP
|
$265.00
|
|
| Hospital Charge Code |
4347542
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$77.17 |
| Max. Negotiated Rate |
$253.55 |
| Rate for Payer: Aetna Commercial |
$248.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.02
|
| Rate for Payer: Aetna Managed Medicare |
$77.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$179.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$137.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$132.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.07
|
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Cigna Commercial |
$253.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$154.23
|
| Rate for Payer: Health EOS Commercial |
$245.28
|
| Rate for Payer: HFN Commercial |
$253.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$206.70
|
| Rate for Payer: Multiplan Commercial |
$220.48
|
| Rate for Payer: NAPHCARE Commercial |
$165.36
|
| Rate for Payer: Preferred Network Access Commercial |
$253.55
|
| Rate for Payer: Quartz Beloit One Network |
$135.04
|
| Rate for Payer: Quartz Commercial |
$179.14
|
| Rate for Payer: Quartz Medicare Advantage |
$165.36
|
| Rate for Payer: The Alliance Commercial |
$137.80
|
| Rate for Payer: WEA Trust Commercial |
$151.58
|
| Rate for Payer: WPS Commercial |
$204.13
|
|
|
COVERALL HOODED W/BOOTS XL45094
|
Facility
|
IP
|
$265.00
|
|
| Hospital Charge Code |
4347542
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.04 |
| Max. Negotiated Rate |
$253.55 |
| Rate for Payer: Aetna Commercial |
$248.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.07
|
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Cigna Commercial |
$253.55
|
| Rate for Payer: Health EOS Commercial |
$245.28
|
| Rate for Payer: HFN Commercial |
$253.55
|
| Rate for Payer: Multiplan Commercial |
$220.48
|
| Rate for Payer: Preferred Network Access Commercial |
$253.55
|
| Rate for Payer: Quartz Beloit One Network |
$135.04
|
| Rate for Payer: Quartz Commercial |
$165.36
|
| Rate for Payer: WEA Trust Commercial |
$151.58
|
| Rate for Payer: WPS Commercial |
$204.13
|
|
|
COVERALL TYVEK 2 XL 76827
|
Facility
|
OP
|
$212.00
|
|
| Hospital Charge Code |
4494607
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$61.73 |
| Max. Negotiated Rate |
$202.84 |
| Rate for Payer: Aetna Commercial |
$198.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$189.61
|
| Rate for Payer: Aetna Managed Medicare |
$61.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$143.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$110.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$105.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$116.85
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cigna Commercial |
$202.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$123.38
|
| Rate for Payer: Health EOS Commercial |
$196.23
|
| Rate for Payer: HFN Commercial |
$202.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$165.36
|
| Rate for Payer: Multiplan Commercial |
$176.38
|
| Rate for Payer: NAPHCARE Commercial |
$132.29
|
| Rate for Payer: Preferred Network Access Commercial |
$202.84
|
| Rate for Payer: Quartz Beloit One Network |
$108.04
|
| Rate for Payer: Quartz Commercial |
$143.31
|
| Rate for Payer: Quartz Medicare Advantage |
$132.29
|
| Rate for Payer: The Alliance Commercial |
$110.24
|
| Rate for Payer: WEA Trust Commercial |
$121.26
|
| Rate for Payer: WPS Commercial |
$163.30
|
|
