|
SCREW-CANN AMBI 6.5 X 85MM 121637
|
Facility
|
OP
|
$2,674.00
|
|
| Hospital Charge Code |
2966007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$778.67 |
| Max. Negotiated Rate |
$2,558.48 |
| Rate for Payer: Aetna Commercial |
$2,502.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,391.63
|
| Rate for Payer: Aetna Managed Medicare |
$778.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,807.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,390.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,334.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,473.91
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cigna Commercial |
$2,558.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,556.27
|
| Rate for Payer: Health EOS Commercial |
$2,475.05
|
| Rate for Payer: HFN Commercial |
$2,558.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,085.72
|
| Rate for Payer: Multiplan Commercial |
$2,224.77
|
| Rate for Payer: NAPHCARE Commercial |
$1,668.58
|
| Rate for Payer: Preferred Network Access Commercial |
$2,558.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,362.67
|
| Rate for Payer: Quartz Commercial |
$1,807.62
|
| Rate for Payer: Quartz Medicare Advantage |
$1,668.58
|
| Rate for Payer: The Alliance Commercial |
$1,390.48
|
| Rate for Payer: WEA Trust Commercial |
$1,529.53
|
| Rate for Payer: WPS Commercial |
$2,059.78
|
|
|
SCREW-CANN AMBI 6.5 X 90MM 121638
|
Facility
|
OP
|
$2,674.00
|
|
| Hospital Charge Code |
2966005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$778.67 |
| Max. Negotiated Rate |
$2,558.48 |
| Rate for Payer: Aetna Commercial |
$2,502.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,391.63
|
| Rate for Payer: Aetna Managed Medicare |
$778.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,807.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,390.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,334.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,473.91
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cigna Commercial |
$2,558.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,556.27
|
| Rate for Payer: Health EOS Commercial |
$2,475.05
|
| Rate for Payer: HFN Commercial |
$2,558.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,085.72
|
| Rate for Payer: Multiplan Commercial |
$2,224.77
|
| Rate for Payer: NAPHCARE Commercial |
$1,668.58
|
| Rate for Payer: Preferred Network Access Commercial |
$2,558.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,362.67
|
| Rate for Payer: Quartz Commercial |
$1,807.62
|
| Rate for Payer: Quartz Medicare Advantage |
$1,668.58
|
| Rate for Payer: The Alliance Commercial |
$1,390.48
|
| Rate for Payer: WEA Trust Commercial |
$1,529.53
|
| Rate for Payer: WPS Commercial |
$2,059.78
|
|
|
SCREW-CANN AMBI 6.5 X 90MM 121638
|
Facility
|
IP
|
$2,674.00
|
|
| Hospital Charge Code |
2966005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,362.67 |
| Max. Negotiated Rate |
$2,558.48 |
| Rate for Payer: Aetna Commercial |
$2,502.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,391.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,473.91
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cigna Commercial |
$2,558.48
|
| Rate for Payer: Health EOS Commercial |
$2,475.05
|
| Rate for Payer: HFN Commercial |
$2,558.48
|
| Rate for Payer: Multiplan Commercial |
$2,224.77
|
| Rate for Payer: Preferred Network Access Commercial |
$2,558.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,362.67
|
| Rate for Payer: Quartz Commercial |
$1,668.58
|
| Rate for Payer: WEA Trust Commercial |
$1,529.53
|
| Rate for Payer: WPS Commercial |
$2,059.78
|
|
|
SCREW-CANN AMBI 6.5 X 95MM 121639
|
Facility
|
IP
|
$2,674.00
|
|
| Hospital Charge Code |
2966006
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,362.67 |
| Max. Negotiated Rate |
$2,558.48 |
| Rate for Payer: Aetna Commercial |
$2,502.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,391.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,473.91
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cigna Commercial |
$2,558.48
|
| Rate for Payer: Health EOS Commercial |
$2,475.05
|
| Rate for Payer: HFN Commercial |
$2,558.48
|
| Rate for Payer: Multiplan Commercial |
$2,224.77
|
| Rate for Payer: Preferred Network Access Commercial |
$2,558.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,362.67
|
| Rate for Payer: Quartz Commercial |
$1,668.58
|
| Rate for Payer: WEA Trust Commercial |
$1,529.53
|
| Rate for Payer: WPS Commercial |
$2,059.78
|
|
|
SCREW-CANN AMBI 6.5 X 95MM 121639
|
Facility
|
OP
|
$2,674.00
|
|
| Hospital Charge Code |
2966006
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$778.67 |
| Max. Negotiated Rate |
$2,558.48 |
| Rate for Payer: Aetna Commercial |
$2,502.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,391.63
|
| Rate for Payer: Aetna Managed Medicare |
$778.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,807.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,390.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,334.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,473.91
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cigna Commercial |
$2,558.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,556.27
|
| Rate for Payer: Health EOS Commercial |
$2,475.05
|
| Rate for Payer: HFN Commercial |
$2,558.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,085.72
|
| Rate for Payer: Multiplan Commercial |
$2,224.77
|
| Rate for Payer: NAPHCARE Commercial |
$1,668.58
|
| Rate for Payer: Preferred Network Access Commercial |
$2,558.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,362.67
|
| Rate for Payer: Quartz Commercial |
$1,807.62
|
| Rate for Payer: Quartz Medicare Advantage |
$1,668.58
|
| Rate for Payer: The Alliance Commercial |
$1,390.48
|
| Rate for Payer: WEA Trust Commercial |
$1,529.53
|
| Rate for Payer: WPS Commercial |
$2,059.78
|
|
|
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 |
$1,176.16 |
| Max. Negotiated Rate |
$2,208.29 |
| Rate for Payer: Aetna Commercial |
$2,160.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,064.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,272.17
|
| Rate for Payer: Cash Price |
$692.40
|
| Rate for Payer: Cigna Commercial |
$2,208.29
|
| Rate for Payer: Health EOS Commercial |
$2,136.28
|
| Rate for Payer: HFN Commercial |
$2,208.29
|
| Rate for Payer: Multiplan Commercial |
$1,920.26
|
| Rate for Payer: Preferred Network Access Commercial |
$2,208.29
|
| Rate for Payer: Quartz Beloit One Network |
$1,176.16
|
| Rate for Payer: Quartz Commercial |
$1,440.19
|
| Rate for Payer: WEA Trust Commercial |
$1,320.18
|
| Rate for Payer: WPS Commercial |
$1,777.85
|
|
|
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 |
$672.09 |
| Max. Negotiated Rate |
$2,208.29 |
| Rate for Payer: Aetna Commercial |
$2,160.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,064.28
|
| Rate for Payer: Aetna Managed Medicare |
$672.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,560.21
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,200.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,152.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,272.17
|
| Rate for Payer: Cash Price |
$692.40
|
| Rate for Payer: Cigna Commercial |
$2,208.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,343.26
|
| Rate for Payer: Health EOS Commercial |
$2,136.28
|
| Rate for Payer: HFN Commercial |
$2,208.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,800.24
|
| Rate for Payer: Multiplan Commercial |
$1,920.26
|
| Rate for Payer: NAPHCARE Commercial |
$1,440.19
|
| Rate for Payer: Preferred Network Access Commercial |
$2,208.29
|
| Rate for Payer: Quartz Beloit One Network |
$1,176.16
|
| Rate for Payer: Quartz Commercial |
$1,560.21
|
| Rate for Payer: Quartz Medicare Advantage |
$1,440.19
|
| Rate for Payer: The Alliance Commercial |
$1,200.16
|
| Rate for Payer: WEA Trust Commercial |
$1,320.18
|
| Rate for Payer: WPS Commercial |
$1,777.85
|
|
|
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 |
$748.38 |
| Max. Negotiated Rate |
$2,458.98 |
| Rate for Payer: Aetna Commercial |
$2,405.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,298.61
|
| Rate for Payer: Aetna Managed Medicare |
$748.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,737.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,336.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,282.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,416.58
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cigna Commercial |
$2,458.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,495.74
|
| Rate for Payer: Health EOS Commercial |
$2,378.79
|
| Rate for Payer: HFN Commercial |
$2,458.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,004.60
|
| Rate for Payer: Multiplan Commercial |
$2,138.24
|
| Rate for Payer: NAPHCARE Commercial |
$1,603.68
|
| Rate for Payer: Preferred Network Access Commercial |
$2,458.98
|
| Rate for Payer: Quartz Beloit One Network |
$1,309.67
|
| Rate for Payer: Quartz Commercial |
$1,737.32
|
| Rate for Payer: Quartz Medicare Advantage |
$1,603.68
|
| Rate for Payer: The Alliance Commercial |
$1,336.40
|
| Rate for Payer: WEA Trust Commercial |
$1,470.04
|
| Rate for Payer: WPS Commercial |
$1,979.67
|
|
|
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 |
$1,309.67 |
| Max. Negotiated Rate |
$2,458.98 |
| Rate for Payer: Aetna Commercial |
$2,405.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,298.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,416.58
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cigna Commercial |
$2,458.98
|
| Rate for Payer: Health EOS Commercial |
$2,378.79
|
| Rate for Payer: HFN Commercial |
$2,458.98
|
| Rate for Payer: Multiplan Commercial |
$2,138.24
|
| Rate for Payer: Preferred Network Access Commercial |
$2,458.98
|
| Rate for Payer: Quartz Beloit One Network |
$1,309.67
|
| Rate for Payer: Quartz Commercial |
$1,603.68
|
| Rate for Payer: WEA Trust Commercial |
$1,470.04
|
| Rate for Payer: WPS Commercial |
$1,979.67
|
|
|
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 |
$702.96 |
| Max. Negotiated Rate |
$2,309.72 |
| Rate for Payer: Aetna Commercial |
$2,259.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,159.08
|
| Rate for Payer: Aetna Managed Medicare |
$702.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,631.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,255.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,205.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,330.60
|
| Rate for Payer: Cash Price |
$724.20
|
| Rate for Payer: Cigna Commercial |
$2,309.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,404.95
|
| Rate for Payer: Health EOS Commercial |
$2,234.40
|
| Rate for Payer: HFN Commercial |
$2,309.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,882.92
|
| Rate for Payer: Multiplan Commercial |
$2,008.45
|
| Rate for Payer: NAPHCARE Commercial |
$1,506.34
|
| Rate for Payer: Preferred Network Access Commercial |
$2,309.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,230.17
|
| Rate for Payer: Quartz Commercial |
$1,631.86
|
| Rate for Payer: Quartz Medicare Advantage |
$1,506.34
|
| Rate for Payer: The Alliance Commercial |
$1,255.28
|
| Rate for Payer: WEA Trust Commercial |
$1,380.81
|
| Rate for Payer: WPS Commercial |
$1,859.50
|
|
|
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 |
$1,230.17 |
| Max. Negotiated Rate |
$2,309.72 |
| Rate for Payer: Aetna Commercial |
$2,259.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,159.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,330.60
|
| Rate for Payer: Cash Price |
$724.20
|
| Rate for Payer: Cigna Commercial |
$2,309.72
|
| Rate for Payer: Health EOS Commercial |
$2,234.40
|
| Rate for Payer: HFN Commercial |
$2,309.72
|
| Rate for Payer: Multiplan Commercial |
$2,008.45
|
| Rate for Payer: Preferred Network Access Commercial |
$2,309.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,230.17
|
| Rate for Payer: Quartz Commercial |
$1,506.34
|
| Rate for Payer: WEA Trust Commercial |
$1,380.81
|
| Rate for Payer: WPS Commercial |
$1,859.50
|
|
|
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 |
$1,230.17 |
| Max. Negotiated Rate |
$2,309.72 |
| Rate for Payer: Aetna Commercial |
$2,259.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,159.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,330.60
|
| Rate for Payer: Cash Price |
$724.20
|
| Rate for Payer: Cigna Commercial |
$2,309.72
|
| Rate for Payer: Health EOS Commercial |
$2,234.40
|
| Rate for Payer: HFN Commercial |
$2,309.72
|
| Rate for Payer: Multiplan Commercial |
$2,008.45
|
| Rate for Payer: Preferred Network Access Commercial |
$2,309.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,230.17
|
| Rate for Payer: Quartz Commercial |
$1,506.34
|
| Rate for Payer: WEA Trust Commercial |
$1,380.81
|
| Rate for Payer: WPS Commercial |
$1,859.50
|
|
|
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 |
$702.96 |
| Max. Negotiated Rate |
$2,309.72 |
| Rate for Payer: Aetna Commercial |
$2,259.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,159.08
|
| Rate for Payer: Aetna Managed Medicare |
$702.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,631.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,255.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,205.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,330.60
|
| Rate for Payer: Cash Price |
$724.20
|
| Rate for Payer: Cigna Commercial |
$2,309.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,404.95
|
| Rate for Payer: Health EOS Commercial |
$2,234.40
|
| Rate for Payer: HFN Commercial |
$2,309.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,882.92
|
| Rate for Payer: Multiplan Commercial |
$2,008.45
|
| Rate for Payer: NAPHCARE Commercial |
$1,506.34
|
| Rate for Payer: Preferred Network Access Commercial |
$2,309.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,230.17
|
| Rate for Payer: Quartz Commercial |
$1,631.86
|
| Rate for Payer: Quartz Medicare Advantage |
$1,506.34
|
| Rate for Payer: The Alliance Commercial |
$1,255.28
|
| Rate for Payer: WEA Trust Commercial |
$1,380.81
|
| Rate for Payer: WPS Commercial |
$1,859.50
|
|
|
SCREW CANN CONICAL 3.7 X 40MM 02.240.240
|
Facility
|
OP
|
$2,414.00
|
|
| Hospital Charge Code |
3072604
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$702.96 |
| Max. Negotiated Rate |
$2,309.72 |
| Rate for Payer: Aetna Commercial |
$2,259.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,159.08
|
| Rate for Payer: Aetna Managed Medicare |
$702.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,631.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,255.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,205.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,330.60
|
| Rate for Payer: Cash Price |
$724.20
|
| Rate for Payer: Cigna Commercial |
$2,309.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,404.95
|
| Rate for Payer: Health EOS Commercial |
$2,234.40
|
| Rate for Payer: HFN Commercial |
$2,309.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,882.92
|
| Rate for Payer: Multiplan Commercial |
$2,008.45
|
| Rate for Payer: NAPHCARE Commercial |
$1,506.34
|
| Rate for Payer: Preferred Network Access Commercial |
$2,309.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,230.17
|
| Rate for Payer: Quartz Commercial |
$1,631.86
|
| Rate for Payer: Quartz Medicare Advantage |
$1,506.34
|
| Rate for Payer: The Alliance Commercial |
$1,255.28
|
| Rate for Payer: WEA Trust Commercial |
$1,380.81
|
| Rate for Payer: WPS Commercial |
$1,859.50
|
|
|
SCREW CANN CONICAL 3.7 X 40MM 02.240.240
|
Facility
|
IP
|
$2,414.00
|
|
| Hospital Charge Code |
3072604
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,230.17 |
| Max. Negotiated Rate |
$2,309.72 |
| Rate for Payer: Aetna Commercial |
$2,259.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,159.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,330.60
|
| Rate for Payer: Cash Price |
$724.20
|
| Rate for Payer: Cigna Commercial |
$2,309.72
|
| Rate for Payer: Health EOS Commercial |
$2,234.40
|
| Rate for Payer: HFN Commercial |
$2,309.72
|
| Rate for Payer: Multiplan Commercial |
$2,008.45
|
| Rate for Payer: Preferred Network Access Commercial |
$2,309.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,230.17
|
| Rate for Payer: Quartz Commercial |
$1,506.34
|
| Rate for Payer: WEA Trust Commercial |
$1,380.81
|
| Rate for Payer: WPS Commercial |
$1,859.50
|
|
|
SCREW CANN CONICAL 3.7 X 44MM 02.240.244
|
Facility
|
IP
|
$2,414.00
|
|
| Hospital Charge Code |
3072605
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,230.17 |
| Max. Negotiated Rate |
$2,309.72 |
| Rate for Payer: Aetna Commercial |
$2,259.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,159.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,330.60
|
| Rate for Payer: Cash Price |
$724.20
|
| Rate for Payer: Cigna Commercial |
$2,309.72
|
| Rate for Payer: Health EOS Commercial |
$2,234.40
|
| Rate for Payer: HFN Commercial |
$2,309.72
|
| Rate for Payer: Multiplan Commercial |
$2,008.45
|
| Rate for Payer: Preferred Network Access Commercial |
$2,309.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,230.17
|
| Rate for Payer: Quartz Commercial |
$1,506.34
|
| Rate for Payer: WEA Trust Commercial |
$1,380.81
|
| Rate for Payer: WPS Commercial |
$1,859.50
|
|
|
SCREW CANN CONICAL 3.7 X 44MM 02.240.244
|
Facility
|
OP
|
$2,414.00
|
|
| Hospital Charge Code |
3072605
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$702.96 |
| Max. Negotiated Rate |
$2,309.72 |
| Rate for Payer: Aetna Commercial |
$2,259.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,159.08
|
| Rate for Payer: Aetna Managed Medicare |
$702.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,631.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,255.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,205.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,330.60
|
| Rate for Payer: Cash Price |
$724.20
|
| Rate for Payer: Cigna Commercial |
$2,309.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,404.95
|
| Rate for Payer: Health EOS Commercial |
$2,234.40
|
| Rate for Payer: HFN Commercial |
$2,309.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,882.92
|
| Rate for Payer: Multiplan Commercial |
$2,008.45
|
| Rate for Payer: NAPHCARE Commercial |
$1,506.34
|
| Rate for Payer: Preferred Network Access Commercial |
$2,309.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,230.17
|
| Rate for Payer: Quartz Commercial |
$1,631.86
|
| Rate for Payer: Quartz Medicare Advantage |
$1,506.34
|
| Rate for Payer: The Alliance Commercial |
$1,255.28
|
| Rate for Payer: WEA Trust Commercial |
$1,380.81
|
| Rate for Payer: WPS Commercial |
$1,859.50
|
|
|
SCREW CANN HEADLESS COMPRESSION 2.0 X 22MM ST TI 04.333.022
|
Facility
|
IP
|
$4,101.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6228136
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,089.87 |
| Max. Negotiated Rate |
$3,923.84 |
| Rate for Payer: Aetna Commercial |
$3,838.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,667.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,260.47
|
| Rate for Payer: Cash Price |
$1,230.30
|
| Rate for Payer: Cigna Commercial |
$3,923.84
|
| Rate for Payer: Health EOS Commercial |
$3,795.89
|
| Rate for Payer: HFN Commercial |
$3,923.84
|
| Rate for Payer: Multiplan Commercial |
$3,412.03
|
| Rate for Payer: Preferred Network Access Commercial |
$3,923.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,089.87
|
| Rate for Payer: Quartz Commercial |
$2,559.02
|
| Rate for Payer: WEA Trust Commercial |
$2,345.77
|
| Rate for Payer: WPS Commercial |
$3,159.00
|
|
|
SCREW CANN HEADLESS COMPRESSION 2.0 X 22MM ST TI 04.333.022
|
Facility
|
OP
|
$4,101.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6228136
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,194.21 |
| Max. Negotiated Rate |
$3,923.84 |
| Rate for Payer: Aetna Commercial |
$3,838.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,667.93
|
| Rate for Payer: Aetna Managed Medicare |
$1,194.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,772.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,132.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,047.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,260.47
|
| Rate for Payer: Cash Price |
$1,230.30
|
| Rate for Payer: Cigna Commercial |
$3,923.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,386.78
|
| Rate for Payer: Health EOS Commercial |
$3,795.89
|
| Rate for Payer: HFN Commercial |
$3,923.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,198.78
|
| Rate for Payer: Multiplan Commercial |
$3,412.03
|
| Rate for Payer: NAPHCARE Commercial |
$2,559.02
|
| Rate for Payer: Preferred Network Access Commercial |
$3,923.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,089.87
|
| Rate for Payer: Quartz Commercial |
$2,772.28
|
| Rate for Payer: Quartz Medicare Advantage |
$2,559.02
|
| Rate for Payer: The Alliance Commercial |
$2,132.52
|
| Rate for Payer: WEA Trust Commercial |
$2,345.77
|
| Rate for Payer: WPS Commercial |
$3,159.00
|
|
|
SCREW CANN LDA 2.0 X 26 TIGER 200-20-026
|
Facility
|
IP
|
$2,289.00
|
|
| Hospital Charge Code |
3782756
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,166.47 |
| Max. Negotiated Rate |
$2,190.12 |
| Rate for Payer: Aetna Commercial |
$2,142.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,047.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,261.70
|
| Rate for Payer: Cash Price |
$686.70
|
| Rate for Payer: Cigna Commercial |
$2,190.12
|
| Rate for Payer: Health EOS Commercial |
$2,118.70
|
| Rate for Payer: HFN Commercial |
$2,190.12
|
| Rate for Payer: Multiplan Commercial |
$1,904.45
|
| Rate for Payer: Preferred Network Access Commercial |
$2,190.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,166.47
|
| Rate for Payer: Quartz Commercial |
$1,428.34
|
| Rate for Payer: WEA Trust Commercial |
$1,309.31
|
| Rate for Payer: WPS Commercial |
$1,763.22
|
|
|
SCREW CANN LDA 2.0 X 26 TIGER 200-20-026
|
Facility
|
OP
|
$2,289.00
|
|
| Hospital Charge Code |
3782756
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$666.56 |
| Max. Negotiated Rate |
$2,190.12 |
| Rate for Payer: Aetna Commercial |
$2,142.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,047.28
|
| Rate for Payer: Aetna Managed Medicare |
$666.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,547.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,190.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,142.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,261.70
|
| Rate for Payer: Cash Price |
$686.70
|
| Rate for Payer: Cigna Commercial |
$2,190.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,332.20
|
| Rate for Payer: Health EOS Commercial |
$2,118.70
|
| Rate for Payer: HFN Commercial |
$2,190.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,785.42
|
| Rate for Payer: Multiplan Commercial |
$1,904.45
|
| Rate for Payer: NAPHCARE Commercial |
$1,428.34
|
| Rate for Payer: Preferred Network Access Commercial |
$2,190.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,166.47
|
| Rate for Payer: Quartz Commercial |
$1,547.36
|
| Rate for Payer: Quartz Medicare Advantage |
$1,428.34
|
| Rate for Payer: The Alliance Commercial |
$1,190.28
|
| Rate for Payer: WEA Trust Commercial |
$1,309.31
|
| Rate for Payer: WPS Commercial |
$1,763.22
|
|
|
SCREW CANN LDA 2.0 X 28 TIGER 200-20-028
|
Facility
|
OP
|
$2,289.00
|
|
| Hospital Charge Code |
3782757
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$666.56 |
| Max. Negotiated Rate |
$2,190.12 |
| Rate for Payer: Aetna Commercial |
$2,142.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,047.28
|
| Rate for Payer: Aetna Managed Medicare |
$666.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,547.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,190.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,142.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,261.70
|
| Rate for Payer: Cash Price |
$686.70
|
| Rate for Payer: Cigna Commercial |
$2,190.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,332.20
|
| Rate for Payer: Health EOS Commercial |
$2,118.70
|
| Rate for Payer: HFN Commercial |
$2,190.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,785.42
|
| Rate for Payer: Multiplan Commercial |
$1,904.45
|
| Rate for Payer: NAPHCARE Commercial |
$1,428.34
|
| Rate for Payer: Preferred Network Access Commercial |
$2,190.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,166.47
|
| Rate for Payer: Quartz Commercial |
$1,547.36
|
| Rate for Payer: Quartz Medicare Advantage |
$1,428.34
|
| Rate for Payer: The Alliance Commercial |
$1,190.28
|
| Rate for Payer: WEA Trust Commercial |
$1,309.31
|
| Rate for Payer: WPS Commercial |
$1,763.22
|
|
|
SCREW CANN LDA 2.0 X 28 TIGER 200-20-028
|
Facility
|
IP
|
$2,289.00
|
|
| Hospital Charge Code |
3782757
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,166.47 |
| Max. Negotiated Rate |
$2,190.12 |
| Rate for Payer: Aetna Commercial |
$2,142.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,047.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,261.70
|
| Rate for Payer: Cash Price |
$686.70
|
| Rate for Payer: Cigna Commercial |
$2,190.12
|
| Rate for Payer: Health EOS Commercial |
$2,118.70
|
| Rate for Payer: HFN Commercial |
$2,190.12
|
| Rate for Payer: Multiplan Commercial |
$1,904.45
|
| Rate for Payer: Preferred Network Access Commercial |
$2,190.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,166.47
|
| Rate for Payer: Quartz Commercial |
$1,428.34
|
| Rate for Payer: WEA Trust Commercial |
$1,309.31
|
| Rate for Payer: WPS Commercial |
$1,763.22
|
|
|
SCREW CANN LDA 2.0 X 30 TIGER 200-20-030
|
Facility
|
IP
|
$2,289.00
|
|
| Hospital Charge Code |
3782758
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,166.47 |
| Max. Negotiated Rate |
$2,190.12 |
| Rate for Payer: Aetna Commercial |
$2,142.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,047.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,261.70
|
| Rate for Payer: Cash Price |
$686.70
|
| Rate for Payer: Cigna Commercial |
$2,190.12
|
| Rate for Payer: Health EOS Commercial |
$2,118.70
|
| Rate for Payer: HFN Commercial |
$2,190.12
|
| Rate for Payer: Multiplan Commercial |
$1,904.45
|
| Rate for Payer: Preferred Network Access Commercial |
$2,190.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,166.47
|
| Rate for Payer: Quartz Commercial |
$1,428.34
|
| Rate for Payer: WEA Trust Commercial |
$1,309.31
|
| Rate for Payer: WPS Commercial |
$1,763.22
|
|
|
SCREW CANN LDA 2.0 X 30 TIGER 200-20-030
|
Facility
|
OP
|
$2,289.00
|
|
| Hospital Charge Code |
3782758
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$666.56 |
| Max. Negotiated Rate |
$2,190.12 |
| Rate for Payer: Aetna Commercial |
$2,142.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,047.28
|
| Rate for Payer: Aetna Managed Medicare |
$666.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,547.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,190.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,142.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,261.70
|
| Rate for Payer: Cash Price |
$686.70
|
| Rate for Payer: Cigna Commercial |
$2,190.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,332.20
|
| Rate for Payer: Health EOS Commercial |
$2,118.70
|
| Rate for Payer: HFN Commercial |
$2,190.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,785.42
|
| Rate for Payer: Multiplan Commercial |
$1,904.45
|
| Rate for Payer: NAPHCARE Commercial |
$1,428.34
|
| Rate for Payer: Preferred Network Access Commercial |
$2,190.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,166.47
|
| Rate for Payer: Quartz Commercial |
$1,547.36
|
| Rate for Payer: Quartz Medicare Advantage |
$1,428.34
|
| Rate for Payer: The Alliance Commercial |
$1,190.28
|
| Rate for Payer: WEA Trust Commercial |
$1,309.31
|
| Rate for Payer: WPS Commercial |
$1,763.22
|
|
