|
SCOPE NANONEEDLE 125MM AR-3210-0043
|
Facility
|
OP
|
$3,724.00
|
|
| Hospital Charge Code |
6234120
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,042.72 |
| Max. Negotiated Rate |
$14,896.00 |
| Rate for Payer: Aetna Commercial |
$3,351.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,202.64
|
| Rate for Payer: Aetna Managed Medicare |
$1,042.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,420.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,862.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,787.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,973.72
|
| Rate for Payer: Cash Price |
$1,117.20
|
| Rate for Payer: Cigna Commercial |
$3,426.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,083.95
|
| Rate for Payer: Health EOS Commercial |
$3,314.36
|
| Rate for Payer: HFN Commercial |
$3,426.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,793.00
|
| Rate for Payer: Multiplan Commercial |
$2,979.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,234.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,426.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,824.76
|
| Rate for Payer: Quartz Commercial |
$2,420.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2,234.40
|
| Rate for Payer: The Alliance Commercial |
$14,896.00
|
| Rate for Payer: WEA Trust Commercial |
$2,048.20
|
| Rate for Payer: WPS Commercial |
$2,758.37
|
|
|
SCOPE NANONEEDLE 125MM AR-3210-0043
|
Facility
|
IP
|
$3,724.00
|
|
| Hospital Charge Code |
6234120
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,824.76 |
| Max. Negotiated Rate |
$3,426.08 |
| Rate for Payer: Aetna Commercial |
$3,351.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,202.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,973.72
|
| Rate for Payer: Cash Price |
$1,117.20
|
| Rate for Payer: Cigna Commercial |
$3,426.08
|
| Rate for Payer: Health EOS Commercial |
$3,314.36
|
| Rate for Payer: HFN Commercial |
$3,426.08
|
| Rate for Payer: Multiplan Commercial |
$2,979.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,234.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,426.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,824.76
|
| Rate for Payer: Quartz Commercial |
$2,234.40
|
| Rate for Payer: WEA Trust Commercial |
$2,048.20
|
| Rate for Payer: WPS Commercial |
$2,758.37
|
|
|
SCOPE SANI DISPOSABLE ANOSCOPE 82420
|
Facility
|
IP
|
$38.00
|
|
| Hospital Charge Code |
2963326
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$18.62 |
| Max. Negotiated Rate |
$34.96 |
| Rate for Payer: Aetna Commercial |
$34.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$32.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$20.14
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$34.96
|
| Rate for Payer: Health EOS Commercial |
$33.82
|
| Rate for Payer: HFN Commercial |
$34.96
|
| Rate for Payer: Multiplan Commercial |
$30.40
|
| Rate for Payer: NAPHCARE Commercial |
$22.80
|
| Rate for Payer: Preferred Network Access Commercial |
$34.96
|
| Rate for Payer: Quartz Beloit One Network |
$18.62
|
| Rate for Payer: Quartz Commercial |
$22.80
|
| Rate for Payer: WEA Trust Commercial |
$20.90
|
| Rate for Payer: WPS Commercial |
$28.15
|
|
|
SCOPE SANI DISPOSABLE ANOSCOPE 82420
|
Facility
|
OP
|
$38.00
|
|
| Hospital Charge Code |
2963326
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$10.64 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: Aetna Commercial |
$34.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$32.68
|
| Rate for Payer: Aetna Managed Medicare |
$10.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$24.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$20.14
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$34.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21.26
|
| Rate for Payer: Health EOS Commercial |
$33.82
|
| Rate for Payer: HFN Commercial |
$34.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28.50
|
| Rate for Payer: Multiplan Commercial |
$30.40
|
| Rate for Payer: NAPHCARE Commercial |
$22.80
|
| Rate for Payer: Preferred Network Access Commercial |
$34.96
|
| Rate for Payer: Quartz Beloit One Network |
$18.62
|
| Rate for Payer: Quartz Commercial |
$24.70
|
| Rate for Payer: Quartz Medicare Advantage |
$22.80
|
| Rate for Payer: The Alliance Commercial |
$152.00
|
| Rate for Payer: WEA Trust Commercial |
$20.90
|
| Rate for Payer: WPS Commercial |
$28.15
|
|
|
SCORING TEMPLATES
|
Facility
|
IP
|
$1,592.00
|
|
| Hospital Charge Code |
2972352
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$780.08 |
| Max. Negotiated Rate |
$1,464.64 |
| Rate for Payer: Aetna Commercial |
$1,432.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,369.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$843.76
|
| Rate for Payer: Cash Price |
$477.60
|
| Rate for Payer: Cigna Commercial |
$1,464.64
|
| Rate for Payer: Health EOS Commercial |
$1,416.88
|
| Rate for Payer: HFN Commercial |
$1,464.64
|
| Rate for Payer: Multiplan Commercial |
$1,273.60
|
| Rate for Payer: NAPHCARE Commercial |
$955.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,464.64
|
| Rate for Payer: Quartz Beloit One Network |
$780.08
|
| Rate for Payer: Quartz Commercial |
$955.20
|
| Rate for Payer: WEA Trust Commercial |
$875.60
|
| Rate for Payer: WPS Commercial |
$1,179.19
|
|
|
SCORING TEMPLATES
|
Facility
|
OP
|
$1,592.00
|
|
| Hospital Charge Code |
2972352
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$445.76 |
| Max. Negotiated Rate |
$6,368.00 |
| Rate for Payer: Aetna Commercial |
$1,432.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,369.12
|
| Rate for Payer: Aetna Managed Medicare |
$445.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,034.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$796.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$764.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$843.76
|
| Rate for Payer: Cash Price |
$477.60
|
| Rate for Payer: Cigna Commercial |
$1,464.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$890.88
|
| Rate for Payer: Health EOS Commercial |
$1,416.88
|
| Rate for Payer: HFN Commercial |
$1,464.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,194.00
|
| Rate for Payer: Multiplan Commercial |
$1,273.60
|
| Rate for Payer: NAPHCARE Commercial |
$955.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,464.64
|
| Rate for Payer: Quartz Beloit One Network |
$780.08
|
| Rate for Payer: Quartz Commercial |
$1,034.80
|
| Rate for Payer: Quartz Medicare Advantage |
$955.20
|
| Rate for Payer: The Alliance Commercial |
$6,368.00
|
| Rate for Payer: WEA Trust Commercial |
$875.60
|
| Rate for Payer: WPS Commercial |
$1,179.19
|
|
|
Screen - Pulmonary Function Test Charge
|
Facility
|
OP
|
$434.00
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
3006992
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$154.39 |
| Max. Negotiated Rate |
$617.56 |
| Rate for Payer: Aetna Commercial |
$390.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$373.24
|
| Rate for Payer: Aetna Managed Medicare |
$154.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$282.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$217.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$208.32
|
| Rate for Payer: Anthem Medicare Advantage |
$154.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$230.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$154.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$154.39
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cigna Commercial |
$399.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$154.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$242.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$154.39
|
| Rate for Payer: Health EOS Commercial |
$386.26
|
| Rate for Payer: HFN Commercial |
$399.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$574.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$154.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$154.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$154.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$154.39
|
| Rate for Payer: Multiplan Commercial |
$347.20
|
| Rate for Payer: NAPHCARE Commercial |
$231.58
|
| Rate for Payer: Preferred Network Access Commercial |
$399.28
|
| Rate for Payer: Quartz Beloit One Network |
$212.66
|
| Rate for Payer: Quartz Commercial |
$282.10
|
| Rate for Payer: Quartz Medicare Advantage |
$154.39
|
| Rate for Payer: The Alliance Commercial |
$617.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$154.39
|
| Rate for Payer: United Healthcare PPO |
$325.50
|
| Rate for Payer: WEA Trust Commercial |
$238.70
|
| Rate for Payer: Wellcare Medicare |
$154.39
|
| Rate for Payer: WPS Commercial |
$321.46
|
|
|
Screen - Pulmonary Function Test Charge
|
Facility
|
IP
|
$434.00
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
3006992
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$212.66 |
| Max. Negotiated Rate |
$399.28 |
| Rate for Payer: Aetna Commercial |
$390.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$373.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$230.02
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cigna Commercial |
$399.28
|
| Rate for Payer: Health EOS Commercial |
$386.26
|
| Rate for Payer: HFN Commercial |
$399.28
|
| Rate for Payer: Multiplan Commercial |
$347.20
|
| Rate for Payer: NAPHCARE Commercial |
$260.40
|
| Rate for Payer: Preferred Network Access Commercial |
$399.28
|
| Rate for Payer: Quartz Beloit One Network |
$212.66
|
| Rate for Payer: Quartz Commercial |
$260.40
|
| Rate for Payer: WEA Trust Commercial |
$238.70
|
| Rate for Payer: WPS Commercial |
$321.46
|
|
|
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 |
$386.40 |
| Max. Negotiated Rate |
$5,520.00 |
| Rate for Payer: Aetna Commercial |
$1,242.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,186.80
|
| Rate for Payer: Aetna Managed Medicare |
$386.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$897.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$690.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$662.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$731.40
|
| Rate for Payer: Cash Price |
$414.00
|
| Rate for Payer: Cigna Commercial |
$1,269.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$772.25
|
| Rate for Payer: Health EOS Commercial |
$1,228.20
|
| Rate for Payer: HFN Commercial |
$1,269.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,035.00
|
| Rate for Payer: Multiplan Commercial |
$1,104.00
|
| Rate for Payer: NAPHCARE Commercial |
$828.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,269.60
|
| Rate for Payer: Quartz Beloit One Network |
$676.20
|
| Rate for Payer: Quartz Commercial |
$897.00
|
| Rate for Payer: Quartz Medicare Advantage |
$828.00
|
| Rate for Payer: The Alliance Commercial |
$5,520.00
|
| Rate for Payer: WEA Trust Commercial |
$759.00
|
| Rate for Payer: WPS Commercial |
$1,022.17
|
|
|
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 |
$676.20 |
| Max. Negotiated Rate |
$1,269.60 |
| Rate for Payer: Aetna Commercial |
$1,242.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,186.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$731.40
|
| Rate for Payer: Cash Price |
$414.00
|
| Rate for Payer: Cigna Commercial |
$1,269.60
|
| Rate for Payer: Health EOS Commercial |
$1,228.20
|
| Rate for Payer: HFN Commercial |
$1,269.60
|
| Rate for Payer: Multiplan Commercial |
$1,104.00
|
| Rate for Payer: NAPHCARE Commercial |
$828.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,269.60
|
| Rate for Payer: Quartz Beloit One Network |
$676.20
|
| Rate for Payer: Quartz Commercial |
$828.00
|
| Rate for Payer: WEA Trust Commercial |
$759.00
|
| Rate for Payer: WPS Commercial |
$1,022.17
|
|
|
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 |
$903.84 |
| Max. Negotiated Rate |
$12,912.00 |
| Rate for Payer: Aetna Commercial |
$2,905.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,776.08
|
| Rate for Payer: Aetna Managed Medicare |
$903.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,098.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,614.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,549.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,710.84
|
| Rate for Payer: Cash Price |
$968.40
|
| Rate for Payer: Cigna Commercial |
$2,969.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,806.39
|
| Rate for Payer: Health EOS Commercial |
$2,872.92
|
| Rate for Payer: HFN Commercial |
$2,969.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,421.00
|
| Rate for Payer: Multiplan Commercial |
$2,582.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,936.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,969.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,581.72
|
| Rate for Payer: Quartz Commercial |
$2,098.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,936.80
|
| Rate for Payer: The Alliance Commercial |
$12,912.00
|
| Rate for Payer: WEA Trust Commercial |
$1,775.40
|
| Rate for Payer: WPS Commercial |
$2,390.98
|
|
|
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 |
$1,581.72 |
| Max. Negotiated Rate |
$2,969.76 |
| Rate for Payer: Aetna Commercial |
$2,905.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,776.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,710.84
|
| Rate for Payer: Cash Price |
$968.40
|
| Rate for Payer: Cigna Commercial |
$2,969.76
|
| Rate for Payer: Health EOS Commercial |
$2,872.92
|
| Rate for Payer: HFN Commercial |
$2,969.76
|
| Rate for Payer: Multiplan Commercial |
$2,582.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,936.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,969.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,581.72
|
| Rate for Payer: Quartz Commercial |
$1,936.80
|
| Rate for Payer: WEA Trust Commercial |
$1,775.40
|
| Rate for Payer: WPS Commercial |
$2,390.98
|
|
|
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 |
$712.46 |
| Max. Negotiated Rate |
$1,337.68 |
| Rate for Payer: Aetna Commercial |
$1,308.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,250.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$770.62
|
| Rate for Payer: Cash Price |
$436.20
|
| Rate for Payer: Cigna Commercial |
$1,337.68
|
| Rate for Payer: Health EOS Commercial |
$1,294.06
|
| Rate for Payer: HFN Commercial |
$1,337.68
|
| Rate for Payer: Multiplan Commercial |
$1,163.20
|
| Rate for Payer: NAPHCARE Commercial |
$872.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,337.68
|
| Rate for Payer: Quartz Beloit One Network |
$712.46
|
| Rate for Payer: Quartz Commercial |
$872.40
|
| Rate for Payer: WEA Trust Commercial |
$799.70
|
| Rate for Payer: WPS Commercial |
$1,076.98
|
|
|
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 |
$407.12 |
| Max. Negotiated Rate |
$5,816.00 |
| Rate for Payer: Aetna Commercial |
$1,308.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,250.44
|
| Rate for Payer: Aetna Managed Medicare |
$407.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$945.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$727.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$697.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$770.62
|
| Rate for Payer: Cash Price |
$436.20
|
| Rate for Payer: Cigna Commercial |
$1,337.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$813.66
|
| Rate for Payer: Health EOS Commercial |
$1,294.06
|
| Rate for Payer: HFN Commercial |
$1,337.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,090.50
|
| Rate for Payer: Multiplan Commercial |
$1,163.20
|
| Rate for Payer: NAPHCARE Commercial |
$872.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,337.68
|
| Rate for Payer: Quartz Beloit One Network |
$712.46
|
| Rate for Payer: Quartz Commercial |
$945.10
|
| Rate for Payer: Quartz Medicare Advantage |
$872.40
|
| Rate for Payer: The Alliance Commercial |
$5,816.00
|
| Rate for Payer: WEA Trust Commercial |
$799.70
|
| Rate for Payer: WPS Commercial |
$1,076.98
|
|
|
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 |
$298.48 |
| Max. Negotiated Rate |
$4,264.00 |
| Rate for Payer: Aetna Commercial |
$959.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$916.76
|
| Rate for Payer: Aetna Managed Medicare |
$298.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$692.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$533.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$511.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$564.98
|
| Rate for Payer: Cash Price |
$319.80
|
| Rate for Payer: Cigna Commercial |
$980.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$596.53
|
| Rate for Payer: Health EOS Commercial |
$948.74
|
| Rate for Payer: HFN Commercial |
$980.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$799.50
|
| Rate for Payer: Multiplan Commercial |
$852.80
|
| Rate for Payer: NAPHCARE Commercial |
$639.60
|
| Rate for Payer: Preferred Network Access Commercial |
$980.72
|
| Rate for Payer: Quartz Beloit One Network |
$522.34
|
| Rate for Payer: Quartz Commercial |
$692.90
|
| Rate for Payer: Quartz Medicare Advantage |
$639.60
|
| Rate for Payer: The Alliance Commercial |
$4,264.00
|
| Rate for Payer: WEA Trust Commercial |
$586.30
|
| Rate for Payer: WPS Commercial |
$789.59
|
|
|
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 |
$522.34 |
| Max. Negotiated Rate |
$980.72 |
| Rate for Payer: Aetna Commercial |
$959.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$916.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$564.98
|
| Rate for Payer: Cash Price |
$319.80
|
| Rate for Payer: Cigna Commercial |
$980.72
|
| Rate for Payer: Health EOS Commercial |
$948.74
|
| Rate for Payer: HFN Commercial |
$980.72
|
| Rate for Payer: Multiplan Commercial |
$852.80
|
| Rate for Payer: NAPHCARE Commercial |
$639.60
|
| Rate for Payer: Preferred Network Access Commercial |
$980.72
|
| Rate for Payer: Quartz Beloit One Network |
$522.34
|
| Rate for Payer: Quartz Commercial |
$639.60
|
| Rate for Payer: WEA Trust Commercial |
$586.30
|
| Rate for Payer: WPS Commercial |
$789.59
|
|
|
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 |
$903.84 |
| Max. Negotiated Rate |
$12,912.00 |
| Rate for Payer: Aetna Commercial |
$2,905.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,776.08
|
| Rate for Payer: Aetna Managed Medicare |
$903.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,098.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,614.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,549.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,710.84
|
| Rate for Payer: Cash Price |
$968.40
|
| Rate for Payer: Cigna Commercial |
$2,969.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,806.39
|
| Rate for Payer: Health EOS Commercial |
$2,872.92
|
| Rate for Payer: HFN Commercial |
$2,969.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,421.00
|
| Rate for Payer: Multiplan Commercial |
$2,582.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,936.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,969.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,581.72
|
| Rate for Payer: Quartz Commercial |
$2,098.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,936.80
|
| Rate for Payer: The Alliance Commercial |
$12,912.00
|
| Rate for Payer: WEA Trust Commercial |
$1,775.40
|
| Rate for Payer: WPS Commercial |
$2,390.98
|
|
|
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 |
$1,581.72 |
| Max. Negotiated Rate |
$2,969.76 |
| Rate for Payer: Aetna Commercial |
$2,905.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,776.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,710.84
|
| Rate for Payer: Cash Price |
$968.40
|
| Rate for Payer: Cigna Commercial |
$2,969.76
|
| Rate for Payer: Health EOS Commercial |
$2,872.92
|
| Rate for Payer: HFN Commercial |
$2,969.76
|
| Rate for Payer: Multiplan Commercial |
$2,582.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,936.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,969.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,581.72
|
| Rate for Payer: Quartz Commercial |
$1,936.80
|
| Rate for Payer: WEA Trust Commercial |
$1,775.40
|
| Rate for Payer: WPS Commercial |
$2,390.98
|
|
|
SCREW 1.5x13 TI SF TAP CORTEX
|
Facility
|
IP
|
$971.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966410
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$475.79 |
| Max. Negotiated Rate |
$893.32 |
| Rate for Payer: Aetna Commercial |
$873.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$835.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$514.63
|
| Rate for Payer: Cash Price |
$291.30
|
| Rate for Payer: Cigna Commercial |
$893.32
|
| Rate for Payer: Health EOS Commercial |
$864.19
|
| Rate for Payer: HFN Commercial |
$893.32
|
| Rate for Payer: Multiplan Commercial |
$776.80
|
| Rate for Payer: NAPHCARE Commercial |
$582.60
|
| Rate for Payer: Preferred Network Access Commercial |
$893.32
|
| Rate for Payer: Quartz Beloit One Network |
$475.79
|
| Rate for Payer: Quartz Commercial |
$582.60
|
| Rate for Payer: WEA Trust Commercial |
$534.05
|
| Rate for Payer: WPS Commercial |
$719.22
|
|
|
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 |
$271.88 |
| Max. Negotiated Rate |
$3,884.00 |
| Rate for Payer: Aetna Commercial |
$873.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$835.06
|
| Rate for Payer: Aetna Managed Medicare |
$271.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$631.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$485.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$466.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$514.63
|
| Rate for Payer: Cash Price |
$291.30
|
| Rate for Payer: Cigna Commercial |
$893.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$543.37
|
| Rate for Payer: Health EOS Commercial |
$864.19
|
| Rate for Payer: HFN Commercial |
$893.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$728.25
|
| Rate for Payer: Multiplan Commercial |
$776.80
|
| Rate for Payer: NAPHCARE Commercial |
$582.60
|
| Rate for Payer: Preferred Network Access Commercial |
$893.32
|
| Rate for Payer: Quartz Beloit One Network |
$475.79
|
| Rate for Payer: Quartz Commercial |
$631.15
|
| Rate for Payer: Quartz Medicare Advantage |
$582.60
|
| Rate for Payer: The Alliance Commercial |
$3,884.00
|
| Rate for Payer: WEA Trust Commercial |
$534.05
|
| Rate for Payer: WPS Commercial |
$719.22
|
|
|
SCREW 1.5x18MM LOCKING 02.214.018
|
Facility
|
OP
|
$2,335.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508909
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$653.80 |
| Max. Negotiated Rate |
$9,340.00 |
| Rate for Payer: Aetna Commercial |
$2,101.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,008.10
|
| Rate for Payer: Aetna Managed Medicare |
$653.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,517.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,167.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,120.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,237.55
|
| Rate for Payer: Cash Price |
$700.50
|
| Rate for Payer: Cigna Commercial |
$2,148.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,306.67
|
| Rate for Payer: Health EOS Commercial |
$2,078.15
|
| Rate for Payer: HFN Commercial |
$2,148.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,751.25
|
| Rate for Payer: Multiplan Commercial |
$1,868.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,401.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,148.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,144.15
|
| Rate for Payer: Quartz Commercial |
$1,517.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,401.00
|
| Rate for Payer: The Alliance Commercial |
$9,340.00
|
| Rate for Payer: WEA Trust Commercial |
$1,284.25
|
| Rate for Payer: WPS Commercial |
$1,729.53
|
|
|
SCREW 1.5x18MM LOCKING 02.214.018
|
Facility
|
IP
|
$2,335.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508909
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,144.15 |
| Max. Negotiated Rate |
$2,148.20 |
| Rate for Payer: Aetna Commercial |
$2,101.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,008.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,237.55
|
| Rate for Payer: Cash Price |
$700.50
|
| Rate for Payer: Cigna Commercial |
$2,148.20
|
| Rate for Payer: Health EOS Commercial |
$2,078.15
|
| Rate for Payer: HFN Commercial |
$2,148.20
|
| Rate for Payer: Multiplan Commercial |
$1,868.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,401.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,148.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,144.15
|
| Rate for Payer: Quartz Commercial |
$1,401.00
|
| Rate for Payer: WEA Trust Commercial |
$1,284.25
|
| Rate for Payer: WPS Commercial |
$1,729.53
|
|
|
SCREW 1.5x20MM LOCKING 02.214.020
|
Facility
|
OP
|
$2,335.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508910
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$653.80 |
| Max. Negotiated Rate |
$9,340.00 |
| Rate for Payer: Aetna Commercial |
$2,101.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,008.10
|
| Rate for Payer: Aetna Managed Medicare |
$653.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,517.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,167.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,120.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,237.55
|
| Rate for Payer: Cash Price |
$700.50
|
| Rate for Payer: Cigna Commercial |
$2,148.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,306.67
|
| Rate for Payer: Health EOS Commercial |
$2,078.15
|
| Rate for Payer: HFN Commercial |
$2,148.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,751.25
|
| Rate for Payer: Multiplan Commercial |
$1,868.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,401.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,148.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,144.15
|
| Rate for Payer: Quartz Commercial |
$1,517.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,401.00
|
| Rate for Payer: The Alliance Commercial |
$9,340.00
|
| Rate for Payer: WEA Trust Commercial |
$1,284.25
|
| Rate for Payer: WPS Commercial |
$1,729.53
|
|
|
SCREW 1.5x20MM LOCKING 02.214.020
|
Facility
|
IP
|
$2,335.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508910
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,144.15 |
| Max. Negotiated Rate |
$2,148.20 |
| Rate for Payer: Aetna Commercial |
$2,101.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,008.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,237.55
|
| Rate for Payer: Cash Price |
$700.50
|
| Rate for Payer: Cigna Commercial |
$2,148.20
|
| Rate for Payer: Health EOS Commercial |
$2,078.15
|
| Rate for Payer: HFN Commercial |
$2,148.20
|
| Rate for Payer: Multiplan Commercial |
$1,868.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,401.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,148.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,144.15
|
| Rate for Payer: Quartz Commercial |
$1,401.00
|
| Rate for Payer: WEA Trust Commercial |
$1,284.25
|
| Rate for Payer: WPS Commercial |
$1,729.53
|
|
|
SCREW 1.5x22MM LOCKING 02.214.022
|
Facility
|
IP
|
$2,335.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508911
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,144.15 |
| Max. Negotiated Rate |
$2,148.20 |
| Rate for Payer: Aetna Commercial |
$2,101.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,008.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,237.55
|
| Rate for Payer: Cash Price |
$700.50
|
| Rate for Payer: Cigna Commercial |
$2,148.20
|
| Rate for Payer: Health EOS Commercial |
$2,078.15
|
| Rate for Payer: HFN Commercial |
$2,148.20
|
| Rate for Payer: Multiplan Commercial |
$1,868.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,401.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,148.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,144.15
|
| Rate for Payer: Quartz Commercial |
$1,401.00
|
| Rate for Payer: WEA Trust Commercial |
$1,284.25
|
| Rate for Payer: WPS Commercial |
$1,729.53
|
|
