|
Scleroderma Antibody (Scl 70)
|
Facility
|
IP
|
$244.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
2942854
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$124.34 |
| Max. Negotiated Rate |
$233.46 |
| Rate for Payer: Aetna Commercial |
$228.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$218.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$134.49
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cigna Commercial |
$233.46
|
| Rate for Payer: Health EOS Commercial |
$225.85
|
| Rate for Payer: HFN Commercial |
$233.46
|
| Rate for Payer: Multiplan Commercial |
$203.01
|
| Rate for Payer: Preferred Network Access Commercial |
$233.46
|
| Rate for Payer: Quartz Beloit One Network |
$124.34
|
| Rate for Payer: Quartz Commercial |
$152.26
|
| Rate for Payer: WEA Trust Commercial |
$139.57
|
| Rate for Payer: WPS Commercial |
$187.95
|
|
|
Scleroderma Antibody (Scl 70)
|
Professional
|
Both
|
$244.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
2942854
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.65 |
| Max. Negotiated Rate |
$241.07 |
| Rate for Payer: Aetna Commercial |
$241.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$218.23
|
| Rate for Payer: Aetna Managed Medicare |
$18.65
|
| Rate for Payer: Anthem Medicare Advantage |
$18.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.65
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cigna Commercial |
$241.07
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$126.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.65
|
| Rate for Payer: Health EOS Commercial |
$230.92
|
| Rate for Payer: HFN Commercial |
$241.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$65.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.65
|
| Rate for Payer: Multiplan Commercial |
$203.01
|
| Rate for Payer: NAPHCARE Commercial |
$27.97
|
| Rate for Payer: Preferred Network Access Commercial |
$241.07
|
| Rate for Payer: Quartz Beloit One Network |
$111.65
|
| Rate for Payer: Quartz Commercial |
$144.64
|
| Rate for Payer: Quartz Medicare Advantage |
$18.65
|
| Rate for Payer: The Alliance Commercial |
$73.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.65
|
| Rate for Payer: WEA Trust Commercial |
$139.57
|
| Rate for Payer: WPS Commercial |
$82.05
|
|
|
SCLEROTHERAPY
|
Facility
|
OP
|
$888.00
|
|
| Hospital Charge Code |
2960563
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$258.59 |
| Max. Negotiated Rate |
$849.64 |
| Rate for Payer: Aetna Commercial |
$831.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$794.23
|
| Rate for Payer: Aetna Managed Medicare |
$258.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$600.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$461.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$443.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$489.47
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cigna Commercial |
$849.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$516.82
|
| Rate for Payer: Health EOS Commercial |
$821.93
|
| Rate for Payer: HFN Commercial |
$849.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$692.64
|
| Rate for Payer: Multiplan Commercial |
$738.82
|
| Rate for Payer: NAPHCARE Commercial |
$554.11
|
| Rate for Payer: Preferred Network Access Commercial |
$849.64
|
| Rate for Payer: Quartz Beloit One Network |
$452.52
|
| Rate for Payer: Quartz Commercial |
$600.29
|
| Rate for Payer: Quartz Medicare Advantage |
$554.11
|
| Rate for Payer: The Alliance Commercial |
$461.76
|
| Rate for Payer: WEA Trust Commercial |
$507.94
|
| Rate for Payer: WPS Commercial |
$684.03
|
|
|
SCLEROTHERAPY
|
Facility
|
IP
|
$888.00
|
|
| Hospital Charge Code |
2960563
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$452.52 |
| Max. Negotiated Rate |
$849.64 |
| Rate for Payer: Aetna Commercial |
$831.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$794.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$489.47
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cigna Commercial |
$849.64
|
| Rate for Payer: Health EOS Commercial |
$821.93
|
| Rate for Payer: HFN Commercial |
$849.64
|
| Rate for Payer: Multiplan Commercial |
$738.82
|
| Rate for Payer: Preferred Network Access Commercial |
$849.64
|
| Rate for Payer: Quartz Beloit One Network |
$452.52
|
| Rate for Payer: Quartz Commercial |
$554.11
|
| Rate for Payer: WEA Trust Commercial |
$507.94
|
| Rate for Payer: WPS Commercial |
$684.03
|
|
|
SCOPE NANONEEDLE 125MM AR-3210-0043
|
Facility
|
IP
|
$3,724.00
|
|
| Hospital Charge Code |
6234120
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,897.75 |
| Max. Negotiated Rate |
$3,563.12 |
| Rate for Payer: Aetna Commercial |
$3,485.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,330.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,052.67
|
| Rate for Payer: Cash Price |
$1,117.20
|
| Rate for Payer: Cigna Commercial |
$3,563.12
|
| Rate for Payer: Health EOS Commercial |
$3,446.93
|
| Rate for Payer: HFN Commercial |
$3,563.12
|
| Rate for Payer: Multiplan Commercial |
$3,098.37
|
| Rate for Payer: Preferred Network Access Commercial |
$3,563.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,897.75
|
| Rate for Payer: Quartz Commercial |
$2,323.78
|
| Rate for Payer: WEA Trust Commercial |
$2,130.13
|
| Rate for Payer: WPS Commercial |
$2,868.60
|
|
|
SCOPE NANONEEDLE 125MM AR-3210-0043
|
Facility
|
OP
|
$3,724.00
|
|
| Hospital Charge Code |
6234120
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,084.43 |
| Max. Negotiated Rate |
$3,563.12 |
| Rate for Payer: Aetna Commercial |
$3,485.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,330.75
|
| Rate for Payer: Aetna Managed Medicare |
$1,084.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,517.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,936.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,859.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,052.67
|
| Rate for Payer: Cash Price |
$1,117.20
|
| Rate for Payer: Cigna Commercial |
$3,563.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,167.37
|
| Rate for Payer: Health EOS Commercial |
$3,446.93
|
| Rate for Payer: HFN Commercial |
$3,563.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,904.72
|
| Rate for Payer: Multiplan Commercial |
$3,098.37
|
| Rate for Payer: NAPHCARE Commercial |
$2,323.78
|
| Rate for Payer: Preferred Network Access Commercial |
$3,563.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,897.75
|
| Rate for Payer: Quartz Commercial |
$2,517.42
|
| Rate for Payer: Quartz Medicare Advantage |
$2,323.78
|
| Rate for Payer: The Alliance Commercial |
$1,936.48
|
| Rate for Payer: WEA Trust Commercial |
$2,130.13
|
| Rate for Payer: WPS Commercial |
$2,868.60
|
|
|
SCOPE SANI DISPOSABLE ANOSCOPE 82420
|
Facility
|
IP
|
$38.00
|
|
| Hospital Charge Code |
2963326
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$19.36 |
| Max. Negotiated Rate |
$36.36 |
| Rate for Payer: Aetna Commercial |
$35.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$33.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$20.95
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$36.36
|
| Rate for Payer: Health EOS Commercial |
$35.17
|
| Rate for Payer: HFN Commercial |
$36.36
|
| Rate for Payer: Multiplan Commercial |
$31.62
|
| Rate for Payer: Preferred Network Access Commercial |
$36.36
|
| Rate for Payer: Quartz Beloit One Network |
$19.36
|
| Rate for Payer: Quartz Commercial |
$23.71
|
| Rate for Payer: WEA Trust Commercial |
$21.74
|
| Rate for Payer: WPS Commercial |
$29.27
|
|
|
SCOPE SANI DISPOSABLE ANOSCOPE 82420
|
Facility
|
OP
|
$38.00
|
|
| Hospital Charge Code |
2963326
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$11.07 |
| Max. Negotiated Rate |
$36.36 |
| Rate for Payer: Aetna Commercial |
$35.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$33.99
|
| Rate for Payer: Aetna Managed Medicare |
$11.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$20.95
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$36.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22.12
|
| Rate for Payer: Health EOS Commercial |
$35.17
|
| Rate for Payer: HFN Commercial |
$36.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29.64
|
| Rate for Payer: Multiplan Commercial |
$31.62
|
| Rate for Payer: NAPHCARE Commercial |
$23.71
|
| Rate for Payer: Preferred Network Access Commercial |
$36.36
|
| Rate for Payer: Quartz Beloit One Network |
$19.36
|
| Rate for Payer: Quartz Commercial |
$25.69
|
| Rate for Payer: Quartz Medicare Advantage |
$23.71
|
| Rate for Payer: The Alliance Commercial |
$19.76
|
| Rate for Payer: WEA Trust Commercial |
$21.74
|
| Rate for Payer: WPS Commercial |
$29.27
|
|
|
SCORING TEMPLATES
|
Facility
|
OP
|
$1,592.00
|
|
| Hospital Charge Code |
2972352
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$463.59 |
| Max. Negotiated Rate |
$1,523.23 |
| Rate for Payer: Aetna Commercial |
$1,490.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,423.88
|
| Rate for Payer: Aetna Managed Medicare |
$463.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,076.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$827.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$794.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$877.51
|
| Rate for Payer: Cash Price |
$477.60
|
| Rate for Payer: Cigna Commercial |
$1,523.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$926.54
|
| Rate for Payer: Health EOS Commercial |
$1,473.56
|
| Rate for Payer: HFN Commercial |
$1,523.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,241.76
|
| Rate for Payer: Multiplan Commercial |
$1,324.54
|
| Rate for Payer: NAPHCARE Commercial |
$993.41
|
| Rate for Payer: Preferred Network Access Commercial |
$1,523.23
|
| Rate for Payer: Quartz Beloit One Network |
$811.28
|
| Rate for Payer: Quartz Commercial |
$1,076.19
|
| Rate for Payer: Quartz Medicare Advantage |
$993.41
|
| Rate for Payer: The Alliance Commercial |
$827.84
|
| Rate for Payer: WEA Trust Commercial |
$910.62
|
| Rate for Payer: WPS Commercial |
$1,226.32
|
|
|
SCORING TEMPLATES
|
Facility
|
IP
|
$1,592.00
|
|
| Hospital Charge Code |
2972352
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$811.28 |
| Max. Negotiated Rate |
$1,523.23 |
| Rate for Payer: Aetna Commercial |
$1,490.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,423.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$877.51
|
| Rate for Payer: Cash Price |
$477.60
|
| Rate for Payer: Cigna Commercial |
$1,523.23
|
| Rate for Payer: Health EOS Commercial |
$1,473.56
|
| Rate for Payer: HFN Commercial |
$1,523.23
|
| Rate for Payer: Multiplan Commercial |
$1,324.54
|
| Rate for Payer: Preferred Network Access Commercial |
$1,523.23
|
| Rate for Payer: Quartz Beloit One Network |
$811.28
|
| Rate for Payer: Quartz Commercial |
$993.41
|
| Rate for Payer: WEA Trust Commercial |
$910.62
|
| Rate for Payer: WPS Commercial |
$1,226.32
|
|
|
SCREENING COLORECTAL SERVICES
|
Facility
|
OP
|
$552.95
|
|
|
Service Code
|
EAPG 00149
|
| Min. Negotiated Rate |
$531.68 |
| Max. Negotiated Rate |
$552.95 |
| Rate for Payer: Anthem Medicaid |
$531.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$531.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$531.68
|
| Rate for Payer: Dean Health Medicaid |
$531.68
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$531.68
|
| Rate for Payer: Managed Health Services Medicaid |
$552.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$531.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$531.68
|
| Rate for Payer: United Healthcare Medicaid |
$531.68
|
|
|
SCREENING FOR BEHAVIORAL CHANGE OR RISK ASSESSMENT
|
Facility
|
OP
|
$36.69
|
|
|
Service Code
|
EAPG 00324
|
| Min. Negotiated Rate |
$35.28 |
| Max. Negotiated Rate |
$36.69 |
| Rate for Payer: Anthem Medicaid |
$35.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$35.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$35.28
|
| Rate for Payer: Dean Health Medicaid |
$35.28
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$35.28
|
| Rate for Payer: Managed Health Services Medicaid |
$36.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.28
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$35.28
|
| Rate for Payer: United Healthcare Medicaid |
$35.28
|
|
|
Screen - Pulmonary Function Test Charge
|
Facility
|
IP
|
$434.00
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
3006992
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$221.17 |
| Max. Negotiated Rate |
$415.25 |
| Rate for Payer: Aetna Commercial |
$406.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$388.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$239.22
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cigna Commercial |
$415.25
|
| Rate for Payer: Health EOS Commercial |
$401.71
|
| Rate for Payer: HFN Commercial |
$415.25
|
| Rate for Payer: Multiplan Commercial |
$361.09
|
| Rate for Payer: Preferred Network Access Commercial |
$415.25
|
| Rate for Payer: Quartz Beloit One Network |
$221.17
|
| Rate for Payer: Quartz Commercial |
$270.82
|
| Rate for Payer: WEA Trust Commercial |
$248.25
|
| Rate for Payer: WPS Commercial |
$334.31
|
|
|
Screen - Pulmonary Function Test Charge
|
Facility
|
OP
|
$434.00
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
3006992
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$216.65 |
| Max. Negotiated Rate |
$908.96 |
| Rate for Payer: Aetna Commercial |
$406.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$388.17
|
| Rate for Payer: Aetna Managed Medicare |
$227.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$293.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$225.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$216.65
|
| Rate for Payer: Anthem Medicare Advantage |
$227.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$239.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$227.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$227.24
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cigna Commercial |
$415.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$227.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$252.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$227.24
|
| Rate for Payer: Health EOS Commercial |
$401.71
|
| Rate for Payer: HFN Commercial |
$415.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$227.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$227.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$227.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$227.24
|
| Rate for Payer: Multiplan Commercial |
$361.09
|
| Rate for Payer: NAPHCARE Commercial |
$340.86
|
| Rate for Payer: Preferred Network Access Commercial |
$415.25
|
| Rate for Payer: Quartz Beloit One Network |
$221.17
|
| Rate for Payer: Quartz Commercial |
$293.38
|
| Rate for Payer: Quartz Medicare Advantage |
$227.24
|
| Rate for Payer: The Alliance Commercial |
$908.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.24
|
| Rate for Payer: United Healthcare PPO |
$338.52
|
| Rate for Payer: WEA Trust Commercial |
$248.25
|
| Rate for Payer: Wellcare Medicare |
$227.24
|
| Rate for Payer: WPS Commercial |
$334.31
|
|
|
SCREW 1.0x10MM 400.530
|
Facility
|
IP
|
$1,380.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966397
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$703.25 |
| Max. Negotiated Rate |
$1,320.38 |
| Rate for Payer: Aetna Commercial |
$1,291.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,234.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$760.66
|
| Rate for Payer: Cash Price |
$414.00
|
| Rate for Payer: Cigna Commercial |
$1,320.38
|
| Rate for Payer: Health EOS Commercial |
$1,277.33
|
| Rate for Payer: HFN Commercial |
$1,320.38
|
| Rate for Payer: Multiplan Commercial |
$1,148.16
|
| Rate for Payer: Preferred Network Access Commercial |
$1,320.38
|
| Rate for Payer: Quartz Beloit One Network |
$703.25
|
| Rate for Payer: Quartz Commercial |
$861.12
|
| Rate for Payer: WEA Trust Commercial |
$789.36
|
| Rate for Payer: WPS Commercial |
$1,063.01
|
|
|
SCREW 1.0x10MM 400.530
|
Facility
|
OP
|
$1,380.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966397
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$401.86 |
| Max. Negotiated Rate |
$1,320.38 |
| Rate for Payer: Aetna Commercial |
$1,291.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,234.27
|
| Rate for Payer: Aetna Managed Medicare |
$401.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$932.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$717.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$688.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$760.66
|
| Rate for Payer: Cash Price |
$414.00
|
| Rate for Payer: Cigna Commercial |
$1,320.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$803.16
|
| Rate for Payer: Health EOS Commercial |
$1,277.33
|
| Rate for Payer: HFN Commercial |
$1,320.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,076.40
|
| Rate for Payer: Multiplan Commercial |
$1,148.16
|
| Rate for Payer: NAPHCARE Commercial |
$861.12
|
| Rate for Payer: Preferred Network Access Commercial |
$1,320.38
|
| Rate for Payer: Quartz Beloit One Network |
$703.25
|
| Rate for Payer: Quartz Commercial |
$932.88
|
| Rate for Payer: Quartz Medicare Advantage |
$861.12
|
| Rate for Payer: The Alliance Commercial |
$717.60
|
| Rate for Payer: WEA Trust Commercial |
$789.36
|
| Rate for Payer: WPS Commercial |
$1,063.01
|
|
|
SCREW 1.5x10 HEADLESS COMPRESS
|
Facility
|
IP
|
$3,228.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966402
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,644.99 |
| Max. Negotiated Rate |
$3,088.55 |
| Rate for Payer: Aetna Commercial |
$3,021.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,887.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,779.27
|
| Rate for Payer: Cash Price |
$968.40
|
| Rate for Payer: Cigna Commercial |
$3,088.55
|
| Rate for Payer: Health EOS Commercial |
$2,987.84
|
| Rate for Payer: HFN Commercial |
$3,088.55
|
| Rate for Payer: Multiplan Commercial |
$2,685.70
|
| Rate for Payer: Preferred Network Access Commercial |
$3,088.55
|
| Rate for Payer: Quartz Beloit One Network |
$1,644.99
|
| Rate for Payer: Quartz Commercial |
$2,014.27
|
| Rate for Payer: WEA Trust Commercial |
$1,846.42
|
| Rate for Payer: WPS Commercial |
$2,486.53
|
|
|
SCREW 1.5x10 HEADLESS COMPRESS
|
Facility
|
OP
|
$3,228.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966402
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$939.99 |
| Max. Negotiated Rate |
$3,088.55 |
| Rate for Payer: Aetna Commercial |
$3,021.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,887.12
|
| Rate for Payer: Aetna Managed Medicare |
$939.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,182.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,678.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,611.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,779.27
|
| Rate for Payer: Cash Price |
$968.40
|
| Rate for Payer: Cigna Commercial |
$3,088.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,878.70
|
| Rate for Payer: Health EOS Commercial |
$2,987.84
|
| Rate for Payer: HFN Commercial |
$3,088.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,517.84
|
| Rate for Payer: Multiplan Commercial |
$2,685.70
|
| Rate for Payer: NAPHCARE Commercial |
$2,014.27
|
| Rate for Payer: Preferred Network Access Commercial |
$3,088.55
|
| Rate for Payer: Quartz Beloit One Network |
$1,644.99
|
| Rate for Payer: Quartz Commercial |
$2,182.13
|
| Rate for Payer: Quartz Medicare Advantage |
$2,014.27
|
| Rate for Payer: The Alliance Commercial |
$1,678.56
|
| Rate for Payer: WEA Trust Commercial |
$1,846.42
|
| Rate for Payer: WPS Commercial |
$2,486.53
|
|
|
SCREW 1.5x10MM CORTEX SELF 400.810.96
|
Facility
|
IP
|
$1,454.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966404
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$740.96 |
| Max. Negotiated Rate |
$1,391.19 |
| Rate for Payer: Aetna Commercial |
$1,360.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,300.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$801.44
|
| Rate for Payer: Cash Price |
$436.20
|
| Rate for Payer: Cigna Commercial |
$1,391.19
|
| Rate for Payer: Health EOS Commercial |
$1,345.82
|
| Rate for Payer: HFN Commercial |
$1,391.19
|
| Rate for Payer: Multiplan Commercial |
$1,209.73
|
| Rate for Payer: Preferred Network Access Commercial |
$1,391.19
|
| Rate for Payer: Quartz Beloit One Network |
$740.96
|
| Rate for Payer: Quartz Commercial |
$907.30
|
| Rate for Payer: WEA Trust Commercial |
$831.69
|
| Rate for Payer: WPS Commercial |
$1,120.02
|
|
|
SCREW 1.5x10MM CORTEX SELF 400.810.96
|
Facility
|
OP
|
$1,454.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966404
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$423.40 |
| Max. Negotiated Rate |
$1,391.19 |
| Rate for Payer: Aetna Commercial |
$1,360.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,300.46
|
| Rate for Payer: Aetna Managed Medicare |
$423.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$982.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$756.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$725.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$801.44
|
| Rate for Payer: Cash Price |
$436.20
|
| Rate for Payer: Cigna Commercial |
$1,391.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$846.23
|
| Rate for Payer: Health EOS Commercial |
$1,345.82
|
| Rate for Payer: HFN Commercial |
$1,391.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,134.12
|
| Rate for Payer: Multiplan Commercial |
$1,209.73
|
| Rate for Payer: NAPHCARE Commercial |
$907.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,391.19
|
| Rate for Payer: Quartz Beloit One Network |
$740.96
|
| Rate for Payer: Quartz Commercial |
$982.90
|
| Rate for Payer: Quartz Medicare Advantage |
$907.30
|
| Rate for Payer: The Alliance Commercial |
$756.08
|
| Rate for Payer: WEA Trust Commercial |
$831.69
|
| Rate for Payer: WPS Commercial |
$1,120.02
|
|
|
SCREW 1.5x11MM CORTEX SELF 400.811.96
|
Facility
|
IP
|
$1,066.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966405
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$543.23 |
| Max. Negotiated Rate |
$1,019.95 |
| Rate for Payer: Aetna Commercial |
$997.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$953.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$587.58
|
| Rate for Payer: Cash Price |
$319.80
|
| Rate for Payer: Cigna Commercial |
$1,019.95
|
| Rate for Payer: Health EOS Commercial |
$986.69
|
| Rate for Payer: HFN Commercial |
$1,019.95
|
| Rate for Payer: Multiplan Commercial |
$886.91
|
| Rate for Payer: Preferred Network Access Commercial |
$1,019.95
|
| Rate for Payer: Quartz Beloit One Network |
$543.23
|
| Rate for Payer: Quartz Commercial |
$665.18
|
| Rate for Payer: WEA Trust Commercial |
$609.75
|
| Rate for Payer: WPS Commercial |
$821.14
|
|
|
SCREW 1.5x11MM CORTEX SELF 400.811.96
|
Facility
|
OP
|
$1,066.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966405
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$310.42 |
| Max. Negotiated Rate |
$1,019.95 |
| Rate for Payer: Aetna Commercial |
$997.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$953.43
|
| Rate for Payer: Aetna Managed Medicare |
$310.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$720.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$554.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$532.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$587.58
|
| Rate for Payer: Cash Price |
$319.80
|
| Rate for Payer: Cigna Commercial |
$1,019.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$620.41
|
| Rate for Payer: Health EOS Commercial |
$986.69
|
| Rate for Payer: HFN Commercial |
$1,019.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$831.48
|
| Rate for Payer: Multiplan Commercial |
$886.91
|
| Rate for Payer: NAPHCARE Commercial |
$665.18
|
| Rate for Payer: Preferred Network Access Commercial |
$1,019.95
|
| Rate for Payer: Quartz Beloit One Network |
$543.23
|
| Rate for Payer: Quartz Commercial |
$720.62
|
| Rate for Payer: Quartz Medicare Advantage |
$665.18
|
| Rate for Payer: The Alliance Commercial |
$554.32
|
| Rate for Payer: WEA Trust Commercial |
$609.75
|
| Rate for Payer: WPS Commercial |
$821.14
|
|
|
SCREW 1.5x12 HEADLESS COMPRESS
|
Facility
|
IP
|
$3,228.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966408
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,644.99 |
| Max. Negotiated Rate |
$3,088.55 |
| Rate for Payer: Aetna Commercial |
$3,021.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,887.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,779.27
|
| Rate for Payer: Cash Price |
$968.40
|
| Rate for Payer: Cigna Commercial |
$3,088.55
|
| Rate for Payer: Health EOS Commercial |
$2,987.84
|
| Rate for Payer: HFN Commercial |
$3,088.55
|
| Rate for Payer: Multiplan Commercial |
$2,685.70
|
| Rate for Payer: Preferred Network Access Commercial |
$3,088.55
|
| Rate for Payer: Quartz Beloit One Network |
$1,644.99
|
| Rate for Payer: Quartz Commercial |
$2,014.27
|
| Rate for Payer: WEA Trust Commercial |
$1,846.42
|
| Rate for Payer: WPS Commercial |
$2,486.53
|
|
|
SCREW 1.5x12 HEADLESS COMPRESS
|
Facility
|
OP
|
$3,228.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966408
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$939.99 |
| Max. Negotiated Rate |
$3,088.55 |
| Rate for Payer: Aetna Commercial |
$3,021.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,887.12
|
| Rate for Payer: Aetna Managed Medicare |
$939.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,182.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,678.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,611.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,779.27
|
| Rate for Payer: Cash Price |
$968.40
|
| Rate for Payer: Cigna Commercial |
$3,088.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,878.70
|
| Rate for Payer: Health EOS Commercial |
$2,987.84
|
| Rate for Payer: HFN Commercial |
$3,088.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,517.84
|
| Rate for Payer: Multiplan Commercial |
$2,685.70
|
| Rate for Payer: NAPHCARE Commercial |
$2,014.27
|
| Rate for Payer: Preferred Network Access Commercial |
$3,088.55
|
| Rate for Payer: Quartz Beloit One Network |
$1,644.99
|
| Rate for Payer: Quartz Commercial |
$2,182.13
|
| Rate for Payer: Quartz Medicare Advantage |
$2,014.27
|
| Rate for Payer: The Alliance Commercial |
$1,678.56
|
| Rate for Payer: WEA Trust Commercial |
$1,846.42
|
| Rate for Payer: WPS Commercial |
$2,486.53
|
|
|
SCREW 1.5x13 TI SF TAP CORTEX
|
Facility
|
OP
|
$971.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966410
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$282.76 |
| Max. Negotiated Rate |
$929.05 |
| Rate for Payer: Aetna Commercial |
$908.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$868.46
|
| Rate for Payer: Aetna Managed Medicare |
$282.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$656.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$504.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$484.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$535.22
|
| Rate for Payer: Cash Price |
$291.30
|
| Rate for Payer: Cigna Commercial |
$929.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$565.12
|
| Rate for Payer: Health EOS Commercial |
$898.76
|
| Rate for Payer: HFN Commercial |
$929.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$757.38
|
| Rate for Payer: Multiplan Commercial |
$807.87
|
| Rate for Payer: NAPHCARE Commercial |
$605.90
|
| Rate for Payer: Preferred Network Access Commercial |
$929.05
|
| Rate for Payer: Quartz Beloit One Network |
$494.82
|
| Rate for Payer: Quartz Commercial |
$656.40
|
| Rate for Payer: Quartz Medicare Advantage |
$605.90
|
| Rate for Payer: The Alliance Commercial |
$504.92
|
| Rate for Payer: WEA Trust Commercial |
$555.41
|
| Rate for Payer: WPS Commercial |
$747.96
|
|
