|
SCREW-CANN AMBI 6.5 X 55MM 121631
|
Facility
|
OP
|
$2,674.00
|
|
| Hospital Charge Code |
2965999
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$748.72 |
| Max. Negotiated Rate |
$10,696.00 |
| Rate for Payer: Aetna Commercial |
$2,406.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,299.64
|
| Rate for Payer: Aetna Managed Medicare |
$748.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,738.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,337.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,283.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,417.22
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cigna Commercial |
$2,460.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,496.37
|
| Rate for Payer: Health EOS Commercial |
$2,379.86
|
| Rate for Payer: HFN Commercial |
$2,460.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,005.50
|
| Rate for Payer: Multiplan Commercial |
$2,139.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,604.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,460.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,310.26
|
| Rate for Payer: Quartz Commercial |
$1,738.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,604.40
|
| Rate for Payer: The Alliance Commercial |
$10,696.00
|
| Rate for Payer: WEA Trust Commercial |
$1,470.70
|
| Rate for Payer: WPS Commercial |
$1,980.63
|
|
|
SCREW-CANN AMBI 6.5 X 60MM 121632
|
Facility
|
OP
|
$2,674.00
|
|
| Hospital Charge Code |
2966000
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$748.72 |
| Max. Negotiated Rate |
$10,696.00 |
| Rate for Payer: Aetna Commercial |
$2,406.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,299.64
|
| Rate for Payer: Aetna Managed Medicare |
$748.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,738.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,337.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,283.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,417.22
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cigna Commercial |
$2,460.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,496.37
|
| Rate for Payer: Health EOS Commercial |
$2,379.86
|
| Rate for Payer: HFN Commercial |
$2,460.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,005.50
|
| Rate for Payer: Multiplan Commercial |
$2,139.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,604.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,460.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,310.26
|
| Rate for Payer: Quartz Commercial |
$1,738.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,604.40
|
| Rate for Payer: The Alliance Commercial |
$10,696.00
|
| Rate for Payer: WEA Trust Commercial |
$1,470.70
|
| Rate for Payer: WPS Commercial |
$1,980.63
|
|
|
SCREW-CANN AMBI 6.5 X 60MM 121632
|
Facility
|
IP
|
$2,674.00
|
|
| Hospital Charge Code |
2966000
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,310.26 |
| Max. Negotiated Rate |
$2,460.08 |
| Rate for Payer: Aetna Commercial |
$2,406.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,299.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,417.22
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cigna Commercial |
$2,460.08
|
| Rate for Payer: Health EOS Commercial |
$2,379.86
|
| Rate for Payer: HFN Commercial |
$2,460.08
|
| Rate for Payer: Multiplan Commercial |
$2,139.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,604.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,460.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,310.26
|
| Rate for Payer: Quartz Commercial |
$1,604.40
|
| Rate for Payer: WEA Trust Commercial |
$1,470.70
|
| Rate for Payer: WPS Commercial |
$1,980.63
|
|
|
SCREW-CANN AMBI 6.5 X 65MM 121633
|
Facility
|
IP
|
$2,674.00
|
|
| Hospital Charge Code |
2966001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,310.26 |
| Max. Negotiated Rate |
$2,460.08 |
| Rate for Payer: Aetna Commercial |
$2,406.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,299.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,417.22
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cigna Commercial |
$2,460.08
|
| Rate for Payer: Health EOS Commercial |
$2,379.86
|
| Rate for Payer: HFN Commercial |
$2,460.08
|
| Rate for Payer: Multiplan Commercial |
$2,139.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,604.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,460.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,310.26
|
| Rate for Payer: Quartz Commercial |
$1,604.40
|
| Rate for Payer: WEA Trust Commercial |
$1,470.70
|
| Rate for Payer: WPS Commercial |
$1,980.63
|
|
|
SCREW-CANN AMBI 6.5 X 65MM 121633
|
Facility
|
OP
|
$2,674.00
|
|
| Hospital Charge Code |
2966001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$748.72 |
| Max. Negotiated Rate |
$10,696.00 |
| Rate for Payer: Aetna Commercial |
$2,406.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,299.64
|
| Rate for Payer: Aetna Managed Medicare |
$748.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,738.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,337.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,283.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,417.22
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cigna Commercial |
$2,460.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,496.37
|
| Rate for Payer: Health EOS Commercial |
$2,379.86
|
| Rate for Payer: HFN Commercial |
$2,460.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,005.50
|
| Rate for Payer: Multiplan Commercial |
$2,139.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,604.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,460.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,310.26
|
| Rate for Payer: Quartz Commercial |
$1,738.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,604.40
|
| Rate for Payer: The Alliance Commercial |
$10,696.00
|
| Rate for Payer: WEA Trust Commercial |
$1,470.70
|
| Rate for Payer: WPS Commercial |
$1,980.63
|
|
|
SCREW-CANN AMBI 6.5 X 70MM 121634
|
Facility
|
IP
|
$2,674.00
|
|
| Hospital Charge Code |
2966002
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,310.26 |
| Max. Negotiated Rate |
$2,460.08 |
| Rate for Payer: Aetna Commercial |
$2,406.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,299.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,417.22
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cigna Commercial |
$2,460.08
|
| Rate for Payer: Health EOS Commercial |
$2,379.86
|
| Rate for Payer: HFN Commercial |
$2,460.08
|
| Rate for Payer: Multiplan Commercial |
$2,139.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,604.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,460.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,310.26
|
| Rate for Payer: Quartz Commercial |
$1,604.40
|
| Rate for Payer: WEA Trust Commercial |
$1,470.70
|
| Rate for Payer: WPS Commercial |
$1,980.63
|
|
|
SCREW-CANN AMBI 6.5 X 70MM 121634
|
Facility
|
OP
|
$2,674.00
|
|
| Hospital Charge Code |
2966002
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$748.72 |
| Max. Negotiated Rate |
$10,696.00 |
| Rate for Payer: Aetna Commercial |
$2,406.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,299.64
|
| Rate for Payer: Aetna Managed Medicare |
$748.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,738.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,337.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,283.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,417.22
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cigna Commercial |
$2,460.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,496.37
|
| Rate for Payer: Health EOS Commercial |
$2,379.86
|
| Rate for Payer: HFN Commercial |
$2,460.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,005.50
|
| Rate for Payer: Multiplan Commercial |
$2,139.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,604.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,460.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,310.26
|
| Rate for Payer: Quartz Commercial |
$1,738.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,604.40
|
| Rate for Payer: The Alliance Commercial |
$10,696.00
|
| Rate for Payer: WEA Trust Commercial |
$1,470.70
|
| Rate for Payer: WPS Commercial |
$1,980.63
|
|
|
SCREW-CANN AMBI 6.5 X 75MM 121635
|
Facility
|
IP
|
$2,674.00
|
|
| Hospital Charge Code |
2966003
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,310.26 |
| Max. Negotiated Rate |
$2,460.08 |
| Rate for Payer: Aetna Commercial |
$2,406.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,299.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,417.22
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cigna Commercial |
$2,460.08
|
| Rate for Payer: Health EOS Commercial |
$2,379.86
|
| Rate for Payer: HFN Commercial |
$2,460.08
|
| Rate for Payer: Multiplan Commercial |
$2,139.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,604.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,460.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,310.26
|
| Rate for Payer: Quartz Commercial |
$1,604.40
|
| Rate for Payer: WEA Trust Commercial |
$1,470.70
|
| Rate for Payer: WPS Commercial |
$1,980.63
|
|
|
SCREW-CANN AMBI 6.5 X 75MM 121635
|
Facility
|
OP
|
$2,674.00
|
|
| Hospital Charge Code |
2966003
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$748.72 |
| Max. Negotiated Rate |
$10,696.00 |
| Rate for Payer: Aetna Commercial |
$2,406.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,299.64
|
| Rate for Payer: Aetna Managed Medicare |
$748.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,738.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,337.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,283.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,417.22
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cigna Commercial |
$2,460.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,496.37
|
| Rate for Payer: Health EOS Commercial |
$2,379.86
|
| Rate for Payer: HFN Commercial |
$2,460.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,005.50
|
| Rate for Payer: Multiplan Commercial |
$2,139.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,604.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,460.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,310.26
|
| Rate for Payer: Quartz Commercial |
$1,738.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,604.40
|
| Rate for Payer: The Alliance Commercial |
$10,696.00
|
| Rate for Payer: WEA Trust Commercial |
$1,470.70
|
| Rate for Payer: WPS Commercial |
$1,980.63
|
|
|
SCREW-CANN AMBI 6.5 X 80MM 121636
|
Facility
|
OP
|
$2,674.00
|
|
| Hospital Charge Code |
2966004
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$748.72 |
| Max. Negotiated Rate |
$10,696.00 |
| Rate for Payer: Aetna Commercial |
$2,406.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,299.64
|
| Rate for Payer: Aetna Managed Medicare |
$748.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,738.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,337.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,283.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,417.22
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cigna Commercial |
$2,460.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,496.37
|
| Rate for Payer: Health EOS Commercial |
$2,379.86
|
| Rate for Payer: HFN Commercial |
$2,460.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,005.50
|
| Rate for Payer: Multiplan Commercial |
$2,139.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,604.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,460.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,310.26
|
| Rate for Payer: Quartz Commercial |
$1,738.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,604.40
|
| Rate for Payer: The Alliance Commercial |
$10,696.00
|
| Rate for Payer: WEA Trust Commercial |
$1,470.70
|
| Rate for Payer: WPS Commercial |
$1,980.63
|
|
|
SCREW-CANN AMBI 6.5 X 80MM 121636
|
Facility
|
IP
|
$2,674.00
|
|
| Hospital Charge Code |
2966004
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,310.26 |
| Max. Negotiated Rate |
$2,460.08 |
| Rate for Payer: Aetna Commercial |
$2,406.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,299.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,417.22
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cigna Commercial |
$2,460.08
|
| Rate for Payer: Health EOS Commercial |
$2,379.86
|
| Rate for Payer: HFN Commercial |
$2,460.08
|
| Rate for Payer: Multiplan Commercial |
$2,139.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,604.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,460.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,310.26
|
| Rate for Payer: Quartz Commercial |
$1,604.40
|
| Rate for Payer: WEA Trust Commercial |
$1,470.70
|
| Rate for Payer: WPS Commercial |
$1,980.63
|
|
|
SCREW-CANN AMBI 6.5 X 85MM 121637
|
Facility
|
IP
|
$2,674.00
|
|
| Hospital Charge Code |
2966007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,310.26 |
| Max. Negotiated Rate |
$2,460.08 |
| Rate for Payer: Aetna Commercial |
$2,406.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,299.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,417.22
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cigna Commercial |
$2,460.08
|
| Rate for Payer: Health EOS Commercial |
$2,379.86
|
| Rate for Payer: HFN Commercial |
$2,460.08
|
| Rate for Payer: Multiplan Commercial |
$2,139.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,604.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,460.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,310.26
|
| Rate for Payer: Quartz Commercial |
$1,604.40
|
| Rate for Payer: WEA Trust Commercial |
$1,470.70
|
| Rate for Payer: WPS Commercial |
$1,980.63
|
|
|
SCREW-CANN AMBI 6.5 X 85MM 121637
|
Facility
|
OP
|
$2,674.00
|
|
| Hospital Charge Code |
2966007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$748.72 |
| Max. Negotiated Rate |
$10,696.00 |
| Rate for Payer: Aetna Commercial |
$2,406.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,299.64
|
| Rate for Payer: Aetna Managed Medicare |
$748.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,738.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,337.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,283.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,417.22
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cigna Commercial |
$2,460.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,496.37
|
| Rate for Payer: Health EOS Commercial |
$2,379.86
|
| Rate for Payer: HFN Commercial |
$2,460.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,005.50
|
| Rate for Payer: Multiplan Commercial |
$2,139.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,604.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,460.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,310.26
|
| Rate for Payer: Quartz Commercial |
$1,738.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,604.40
|
| Rate for Payer: The Alliance Commercial |
$10,696.00
|
| Rate for Payer: WEA Trust Commercial |
$1,470.70
|
| Rate for Payer: WPS Commercial |
$1,980.63
|
|
|
SCREW-CANN AMBI 6.5 X 90MM 121638
|
Facility
|
IP
|
$2,674.00
|
|
| Hospital Charge Code |
2966005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,310.26 |
| Max. Negotiated Rate |
$2,460.08 |
| Rate for Payer: Aetna Commercial |
$2,406.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,299.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,417.22
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cigna Commercial |
$2,460.08
|
| Rate for Payer: Health EOS Commercial |
$2,379.86
|
| Rate for Payer: HFN Commercial |
$2,460.08
|
| Rate for Payer: Multiplan Commercial |
$2,139.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,604.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,460.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,310.26
|
| Rate for Payer: Quartz Commercial |
$1,604.40
|
| Rate for Payer: WEA Trust Commercial |
$1,470.70
|
| Rate for Payer: WPS Commercial |
$1,980.63
|
|
|
SCREW-CANN AMBI 6.5 X 90MM 121638
|
Facility
|
OP
|
$2,674.00
|
|
| Hospital Charge Code |
2966005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$748.72 |
| Max. Negotiated Rate |
$10,696.00 |
| Rate for Payer: Aetna Commercial |
$2,406.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,299.64
|
| Rate for Payer: Aetna Managed Medicare |
$748.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,738.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,337.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,283.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,417.22
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cigna Commercial |
$2,460.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,496.37
|
| Rate for Payer: Health EOS Commercial |
$2,379.86
|
| Rate for Payer: HFN Commercial |
$2,460.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,005.50
|
| Rate for Payer: Multiplan Commercial |
$2,139.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,604.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,460.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,310.26
|
| Rate for Payer: Quartz Commercial |
$1,738.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,604.40
|
| Rate for Payer: The Alliance Commercial |
$10,696.00
|
| Rate for Payer: WEA Trust Commercial |
$1,470.70
|
| Rate for Payer: WPS Commercial |
$1,980.63
|
|
|
SCREW-CANN AMBI 6.5 X 95MM 121639
|
Facility
|
IP
|
$2,674.00
|
|
| Hospital Charge Code |
2966006
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,310.26 |
| Max. Negotiated Rate |
$2,460.08 |
| Rate for Payer: Aetna Commercial |
$2,406.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,299.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,417.22
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cigna Commercial |
$2,460.08
|
| Rate for Payer: Health EOS Commercial |
$2,379.86
|
| Rate for Payer: HFN Commercial |
$2,460.08
|
| Rate for Payer: Multiplan Commercial |
$2,139.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,604.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,460.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,310.26
|
| Rate for Payer: Quartz Commercial |
$1,604.40
|
| Rate for Payer: WEA Trust Commercial |
$1,470.70
|
| Rate for Payer: WPS Commercial |
$1,980.63
|
|
|
SCREW-CANN AMBI 6.5 X 95MM 121639
|
Facility
|
OP
|
$2,674.00
|
|
| Hospital Charge Code |
2966006
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$748.72 |
| Max. Negotiated Rate |
$10,696.00 |
| Rate for Payer: Aetna Commercial |
$2,406.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,299.64
|
| Rate for Payer: Aetna Managed Medicare |
$748.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,738.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,337.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,283.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,417.22
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cigna Commercial |
$2,460.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,496.37
|
| Rate for Payer: Health EOS Commercial |
$2,379.86
|
| Rate for Payer: HFN Commercial |
$2,460.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,005.50
|
| Rate for Payer: Multiplan Commercial |
$2,139.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,604.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,460.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,310.26
|
| Rate for Payer: Quartz Commercial |
$1,738.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,604.40
|
| Rate for Payer: The Alliance Commercial |
$10,696.00
|
| Rate for Payer: WEA Trust Commercial |
$1,470.70
|
| Rate for Payer: WPS Commercial |
$1,980.63
|
|
|
SCREW CANN ASNIS III SS 8 X 120MM 326720
|
Facility
|
OP
|
$2,308.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6201054
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$646.24 |
| Max. Negotiated Rate |
$9,232.00 |
| Rate for Payer: Aetna Commercial |
$2,077.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,984.88
|
| Rate for Payer: Aetna Managed Medicare |
$646.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,500.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,154.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,107.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,223.24
|
| Rate for Payer: Cash Price |
$692.40
|
| Rate for Payer: Cigna Commercial |
$2,123.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,291.56
|
| Rate for Payer: Health EOS Commercial |
$2,054.12
|
| Rate for Payer: HFN Commercial |
$2,123.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,731.00
|
| Rate for Payer: Multiplan Commercial |
$1,846.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,384.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,123.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,130.92
|
| Rate for Payer: Quartz Commercial |
$1,500.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,384.80
|
| Rate for Payer: The Alliance Commercial |
$9,232.00
|
| Rate for Payer: WEA Trust Commercial |
$1,269.40
|
| Rate for Payer: WPS Commercial |
$1,709.54
|
|
|
SCREW CANN ASNIS III SS 8 X 120MM 326720
|
Facility
|
IP
|
$2,308.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6201054
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,130.92 |
| Max. Negotiated Rate |
$2,123.36 |
| Rate for Payer: Aetna Commercial |
$2,077.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,984.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,223.24
|
| Rate for Payer: Cash Price |
$692.40
|
| Rate for Payer: Cigna Commercial |
$2,123.36
|
| Rate for Payer: Health EOS Commercial |
$2,054.12
|
| Rate for Payer: HFN Commercial |
$2,123.36
|
| Rate for Payer: Multiplan Commercial |
$1,846.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,384.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,123.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,130.92
|
| Rate for Payer: Quartz Commercial |
$1,384.80
|
| Rate for Payer: WEA Trust Commercial |
$1,269.40
|
| Rate for Payer: WPS Commercial |
$1,709.54
|
|
|
SCREW CANN COMPRESSION 3.5 X 16MM TI CS16A
|
Facility
|
OP
|
$2,570.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6174857
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$719.60 |
| Max. Negotiated Rate |
$10,280.00 |
| Rate for Payer: Aetna Commercial |
$2,313.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,210.20
|
| Rate for Payer: Aetna Managed Medicare |
$719.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,670.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,285.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,233.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,362.10
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cigna Commercial |
$2,364.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,438.17
|
| Rate for Payer: Health EOS Commercial |
$2,287.30
|
| Rate for Payer: HFN Commercial |
$2,364.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,927.50
|
| Rate for Payer: Multiplan Commercial |
$2,056.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,542.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,364.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,259.30
|
| Rate for Payer: Quartz Commercial |
$1,670.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,542.00
|
| Rate for Payer: The Alliance Commercial |
$10,280.00
|
| Rate for Payer: WEA Trust Commercial |
$1,413.50
|
| Rate for Payer: WPS Commercial |
$1,903.60
|
|
|
SCREW CANN COMPRESSION 3.5 X 16MM TI CS16A
|
Facility
|
IP
|
$2,570.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6174857
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,259.30 |
| Max. Negotiated Rate |
$2,364.40 |
| Rate for Payer: Aetna Commercial |
$2,313.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,210.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,362.10
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cigna Commercial |
$2,364.40
|
| Rate for Payer: Health EOS Commercial |
$2,287.30
|
| Rate for Payer: HFN Commercial |
$2,364.40
|
| Rate for Payer: Multiplan Commercial |
$2,056.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,542.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,364.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,259.30
|
| Rate for Payer: Quartz Commercial |
$1,542.00
|
| Rate for Payer: WEA Trust Commercial |
$1,413.50
|
| Rate for Payer: WPS Commercial |
$1,903.60
|
|
|
SCREW CANN CONICAL 3.7 X 34MM 02.240.234
|
Facility
|
IP
|
$2,414.00
|
|
| Hospital Charge Code |
3072614
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,182.86 |
| Max. Negotiated Rate |
$2,220.88 |
| Rate for Payer: Aetna Commercial |
$2,172.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,076.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,279.42
|
| Rate for Payer: Cash Price |
$724.20
|
| Rate for Payer: Cigna Commercial |
$2,220.88
|
| Rate for Payer: Health EOS Commercial |
$2,148.46
|
| Rate for Payer: HFN Commercial |
$2,220.88
|
| Rate for Payer: Multiplan Commercial |
$1,931.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,448.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,220.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,182.86
|
| Rate for Payer: Quartz Commercial |
$1,448.40
|
| Rate for Payer: WEA Trust Commercial |
$1,327.70
|
| Rate for Payer: WPS Commercial |
$1,788.05
|
|
|
SCREW CANN CONICAL 3.7 X 34MM 02.240.234
|
Facility
|
OP
|
$2,414.00
|
|
| Hospital Charge Code |
3072614
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$675.92 |
| Max. Negotiated Rate |
$9,656.00 |
| Rate for Payer: Aetna Commercial |
$2,172.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,076.04
|
| Rate for Payer: Aetna Managed Medicare |
$675.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,569.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,207.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,158.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,279.42
|
| Rate for Payer: Cash Price |
$724.20
|
| Rate for Payer: Cigna Commercial |
$2,220.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,350.87
|
| Rate for Payer: Health EOS Commercial |
$2,148.46
|
| Rate for Payer: HFN Commercial |
$2,220.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,810.50
|
| Rate for Payer: Multiplan Commercial |
$1,931.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,448.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,220.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,182.86
|
| Rate for Payer: Quartz Commercial |
$1,569.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,448.40
|
| Rate for Payer: The Alliance Commercial |
$9,656.00
|
| Rate for Payer: WEA Trust Commercial |
$1,327.70
|
| Rate for Payer: WPS Commercial |
$1,788.05
|
|
|
SCREW CANN CONICAL 3.7 X 36MM 02.240.236
|
Facility
|
OP
|
$2,414.00
|
|
| Hospital Charge Code |
3072603
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$675.92 |
| Max. Negotiated Rate |
$9,656.00 |
| Rate for Payer: Aetna Commercial |
$2,172.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,076.04
|
| Rate for Payer: Aetna Managed Medicare |
$675.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,569.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,207.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,158.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,279.42
|
| Rate for Payer: Cash Price |
$724.20
|
| Rate for Payer: Cigna Commercial |
$2,220.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,350.87
|
| Rate for Payer: Health EOS Commercial |
$2,148.46
|
| Rate for Payer: HFN Commercial |
$2,220.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,810.50
|
| Rate for Payer: Multiplan Commercial |
$1,931.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,448.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,220.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,182.86
|
| Rate for Payer: Quartz Commercial |
$1,569.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,448.40
|
| Rate for Payer: The Alliance Commercial |
$9,656.00
|
| Rate for Payer: WEA Trust Commercial |
$1,327.70
|
| Rate for Payer: WPS Commercial |
$1,788.05
|
|
|
SCREW CANN CONICAL 3.7 X 36MM 02.240.236
|
Facility
|
IP
|
$2,414.00
|
|
| Hospital Charge Code |
3072603
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,182.86 |
| Max. Negotiated Rate |
$2,220.88 |
| Rate for Payer: Aetna Commercial |
$2,172.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,076.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,279.42
|
| Rate for Payer: Cash Price |
$724.20
|
| Rate for Payer: Cigna Commercial |
$2,220.88
|
| Rate for Payer: Health EOS Commercial |
$2,148.46
|
| Rate for Payer: HFN Commercial |
$2,220.88
|
| Rate for Payer: Multiplan Commercial |
$1,931.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,448.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,220.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,182.86
|
| Rate for Payer: Quartz Commercial |
$1,448.40
|
| Rate for Payer: WEA Trust Commercial |
$1,327.70
|
| Rate for Payer: WPS Commercial |
$1,788.05
|
|
