|
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 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
|
|
|
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 |
$1,182.86 |
| 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 40MM 02.240.240
|
Facility
|
OP
|
$2,414.00
|
|
| Hospital Charge Code |
3072604
|
|
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 44MM 02.240.244
|
Facility
|
IP
|
$2,414.00
|
|
| Hospital Charge Code |
3072605
|
|
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 44MM 02.240.244
|
Facility
|
OP
|
$2,414.00
|
|
| Hospital Charge Code |
3072605
|
|
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 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 |
$1,148.28 |
| Max. Negotiated Rate |
$16,404.00 |
| Rate for Payer: Aetna Commercial |
$3,690.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,526.86
|
| Rate for Payer: Aetna Managed Medicare |
$1,148.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,665.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,050.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,968.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,173.53
|
| Rate for Payer: Cash Price |
$1,230.30
|
| Rate for Payer: Cigna Commercial |
$3,772.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,294.92
|
| Rate for Payer: Health EOS Commercial |
$3,649.89
|
| Rate for Payer: HFN Commercial |
$3,772.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,075.75
|
| Rate for Payer: Multiplan Commercial |
$3,280.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,460.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,772.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,009.49
|
| Rate for Payer: Quartz Commercial |
$2,665.65
|
| Rate for Payer: Quartz Medicare Advantage |
$2,460.60
|
| Rate for Payer: The Alliance Commercial |
$16,404.00
|
| Rate for Payer: WEA Trust Commercial |
$2,255.55
|
| Rate for Payer: WPS Commercial |
$3,037.61
|
|
|
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 |
$2,009.49 |
| Max. Negotiated Rate |
$3,772.92 |
| Rate for Payer: Aetna Commercial |
$3,690.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,526.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,173.53
|
| Rate for Payer: Cash Price |
$1,230.30
|
| Rate for Payer: Cigna Commercial |
$3,772.92
|
| Rate for Payer: Health EOS Commercial |
$3,649.89
|
| Rate for Payer: HFN Commercial |
$3,772.92
|
| Rate for Payer: Multiplan Commercial |
$3,280.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,460.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,772.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,009.49
|
| Rate for Payer: Quartz Commercial |
$2,460.60
|
| Rate for Payer: WEA Trust Commercial |
$2,255.55
|
| Rate for Payer: WPS Commercial |
$3,037.61
|
|
|
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 |
$640.92 |
| Max. Negotiated Rate |
$9,156.00 |
| Rate for Payer: Aetna Commercial |
$2,060.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,968.54
|
| Rate for Payer: Aetna Managed Medicare |
$640.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,487.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,144.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,098.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,213.17
|
| Rate for Payer: Cash Price |
$686.70
|
| Rate for Payer: Cigna Commercial |
$2,105.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,280.92
|
| Rate for Payer: Health EOS Commercial |
$2,037.21
|
| Rate for Payer: HFN Commercial |
$2,105.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,716.75
|
| Rate for Payer: Multiplan Commercial |
$1,831.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,373.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,105.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,121.61
|
| Rate for Payer: Quartz Commercial |
$1,487.85
|
| Rate for Payer: Quartz Medicare Advantage |
$1,373.40
|
| Rate for Payer: The Alliance Commercial |
$9,156.00
|
| Rate for Payer: WEA Trust Commercial |
$1,258.95
|
| Rate for Payer: WPS Commercial |
$1,695.46
|
|
|
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 |
$1,121.61 |
| Max. Negotiated Rate |
$2,105.88 |
| Rate for Payer: Aetna Commercial |
$2,060.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,968.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,213.17
|
| Rate for Payer: Cash Price |
$686.70
|
| Rate for Payer: Cigna Commercial |
$2,105.88
|
| Rate for Payer: Health EOS Commercial |
$2,037.21
|
| Rate for Payer: HFN Commercial |
$2,105.88
|
| Rate for Payer: Multiplan Commercial |
$1,831.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,373.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,105.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,121.61
|
| Rate for Payer: Quartz Commercial |
$1,373.40
|
| Rate for Payer: WEA Trust Commercial |
$1,258.95
|
| Rate for Payer: WPS Commercial |
$1,695.46
|
|
|
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 |
$1,121.61 |
| Max. Negotiated Rate |
$2,105.88 |
| Rate for Payer: Aetna Commercial |
$2,060.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,968.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,213.17
|
| Rate for Payer: Cash Price |
$686.70
|
| Rate for Payer: Cigna Commercial |
$2,105.88
|
| Rate for Payer: Health EOS Commercial |
$2,037.21
|
| Rate for Payer: HFN Commercial |
$2,105.88
|
| Rate for Payer: Multiplan Commercial |
$1,831.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,373.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,105.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,121.61
|
| Rate for Payer: Quartz Commercial |
$1,373.40
|
| Rate for Payer: WEA Trust Commercial |
$1,258.95
|
| Rate for Payer: WPS Commercial |
$1,695.46
|
|
|
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 |
$640.92 |
| Max. Negotiated Rate |
$9,156.00 |
| Rate for Payer: Aetna Commercial |
$2,060.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,968.54
|
| Rate for Payer: Aetna Managed Medicare |
$640.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,487.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,144.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,098.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,213.17
|
| Rate for Payer: Cash Price |
$686.70
|
| Rate for Payer: Cigna Commercial |
$2,105.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,280.92
|
| Rate for Payer: Health EOS Commercial |
$2,037.21
|
| Rate for Payer: HFN Commercial |
$2,105.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,716.75
|
| Rate for Payer: Multiplan Commercial |
$1,831.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,373.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,105.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,121.61
|
| Rate for Payer: Quartz Commercial |
$1,487.85
|
| Rate for Payer: Quartz Medicare Advantage |
$1,373.40
|
| Rate for Payer: The Alliance Commercial |
$9,156.00
|
| Rate for Payer: WEA Trust Commercial |
$1,258.95
|
| Rate for Payer: WPS Commercial |
$1,695.46
|
|
|
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 |
$1,121.61 |
| Max. Negotiated Rate |
$2,105.88 |
| Rate for Payer: Aetna Commercial |
$2,060.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,968.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,213.17
|
| Rate for Payer: Cash Price |
$686.70
|
| Rate for Payer: Cigna Commercial |
$2,105.88
|
| Rate for Payer: Health EOS Commercial |
$2,037.21
|
| Rate for Payer: HFN Commercial |
$2,105.88
|
| Rate for Payer: Multiplan Commercial |
$1,831.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,373.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,105.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,121.61
|
| Rate for Payer: Quartz Commercial |
$1,373.40
|
| Rate for Payer: WEA Trust Commercial |
$1,258.95
|
| Rate for Payer: WPS Commercial |
$1,695.46
|
|
|
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 |
$640.92 |
| Max. Negotiated Rate |
$9,156.00 |
| Rate for Payer: Aetna Commercial |
$2,060.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,968.54
|
| Rate for Payer: Aetna Managed Medicare |
$640.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,487.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,144.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,098.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,213.17
|
| Rate for Payer: Cash Price |
$686.70
|
| Rate for Payer: Cigna Commercial |
$2,105.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,280.92
|
| Rate for Payer: Health EOS Commercial |
$2,037.21
|
| Rate for Payer: HFN Commercial |
$2,105.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,716.75
|
| Rate for Payer: Multiplan Commercial |
$1,831.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,373.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,105.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,121.61
|
| Rate for Payer: Quartz Commercial |
$1,487.85
|
| Rate for Payer: Quartz Medicare Advantage |
$1,373.40
|
| Rate for Payer: The Alliance Commercial |
$9,156.00
|
| Rate for Payer: WEA Trust Commercial |
$1,258.95
|
| Rate for Payer: WPS Commercial |
$1,695.46
|
|
|
SCREW CANN LDA 2.0 X 32 TIGER 200-20-032
|
Facility
|
IP
|
$2,289.00
|
|
| Hospital Charge Code |
3782759
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,121.61 |
| Max. Negotiated Rate |
$2,105.88 |
| Rate for Payer: Aetna Commercial |
$2,060.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,968.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,213.17
|
| Rate for Payer: Cash Price |
$686.70
|
| Rate for Payer: Cigna Commercial |
$2,105.88
|
| Rate for Payer: Health EOS Commercial |
$2,037.21
|
| Rate for Payer: HFN Commercial |
$2,105.88
|
| Rate for Payer: Multiplan Commercial |
$1,831.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,373.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,105.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,121.61
|
| Rate for Payer: Quartz Commercial |
$1,373.40
|
| Rate for Payer: WEA Trust Commercial |
$1,258.95
|
| Rate for Payer: WPS Commercial |
$1,695.46
|
|
|
SCREW CANN LDA 2.0 X 32 TIGER 200-20-032
|
Facility
|
OP
|
$2,289.00
|
|
| Hospital Charge Code |
3782759
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$640.92 |
| Max. Negotiated Rate |
$9,156.00 |
| Rate for Payer: Aetna Commercial |
$2,060.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,968.54
|
| Rate for Payer: Aetna Managed Medicare |
$640.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,487.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,144.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,098.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,213.17
|
| Rate for Payer: Cash Price |
$686.70
|
| Rate for Payer: Cigna Commercial |
$2,105.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,280.92
|
| Rate for Payer: Health EOS Commercial |
$2,037.21
|
| Rate for Payer: HFN Commercial |
$2,105.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,716.75
|
| Rate for Payer: Multiplan Commercial |
$1,831.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,373.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,105.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,121.61
|
| Rate for Payer: Quartz Commercial |
$1,487.85
|
| Rate for Payer: Quartz Medicare Advantage |
$1,373.40
|
| Rate for Payer: The Alliance Commercial |
$9,156.00
|
| Rate for Payer: WEA Trust Commercial |
$1,258.95
|
| Rate for Payer: WPS Commercial |
$1,695.46
|
|
|
SCREW CANN LDA 2.0 X 34 TIGER 200-20-034
|
Facility
|
IP
|
$2,289.00
|
|
| Hospital Charge Code |
3782760
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,121.61 |
| Max. Negotiated Rate |
$2,105.88 |
| Rate for Payer: Aetna Commercial |
$2,060.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,968.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,213.17
|
| Rate for Payer: Cash Price |
$686.70
|
| Rate for Payer: Cigna Commercial |
$2,105.88
|
| Rate for Payer: Health EOS Commercial |
$2,037.21
|
| Rate for Payer: HFN Commercial |
$2,105.88
|
| Rate for Payer: Multiplan Commercial |
$1,831.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,373.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,105.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,121.61
|
| Rate for Payer: Quartz Commercial |
$1,373.40
|
| Rate for Payer: WEA Trust Commercial |
$1,258.95
|
| Rate for Payer: WPS Commercial |
$1,695.46
|
|
|
SCREW CANN LDA 2.0 X 34 TIGER 200-20-034
|
Facility
|
OP
|
$2,289.00
|
|
| Hospital Charge Code |
3782760
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$640.92 |
| Max. Negotiated Rate |
$9,156.00 |
| Rate for Payer: Aetna Commercial |
$2,060.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,968.54
|
| Rate for Payer: Aetna Managed Medicare |
$640.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,487.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,144.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,098.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,213.17
|
| Rate for Payer: Cash Price |
$686.70
|
| Rate for Payer: Cigna Commercial |
$2,105.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,280.92
|
| Rate for Payer: Health EOS Commercial |
$2,037.21
|
| Rate for Payer: HFN Commercial |
$2,105.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,716.75
|
| Rate for Payer: Multiplan Commercial |
$1,831.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,373.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,105.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,121.61
|
| Rate for Payer: Quartz Commercial |
$1,487.85
|
| Rate for Payer: Quartz Medicare Advantage |
$1,373.40
|
| Rate for Payer: The Alliance Commercial |
$9,156.00
|
| Rate for Payer: WEA Trust Commercial |
$1,258.95
|
| Rate for Payer: WPS Commercial |
$1,695.46
|
|
|
SCREW CANN LDA 2.0 X 36 TIGER 200-20-036
|
Facility
|
IP
|
$2,289.00
|
|
| Hospital Charge Code |
3782761
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,121.61 |
| Max. Negotiated Rate |
$2,105.88 |
| Rate for Payer: Aetna Commercial |
$2,060.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,968.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,213.17
|
| Rate for Payer: Cash Price |
$686.70
|
| Rate for Payer: Cigna Commercial |
$2,105.88
|
| Rate for Payer: Health EOS Commercial |
$2,037.21
|
| Rate for Payer: HFN Commercial |
$2,105.88
|
| Rate for Payer: Multiplan Commercial |
$1,831.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,373.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,105.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,121.61
|
| Rate for Payer: Quartz Commercial |
$1,373.40
|
| Rate for Payer: WEA Trust Commercial |
$1,258.95
|
| Rate for Payer: WPS Commercial |
$1,695.46
|
|
|
SCREW CANN LDA 2.0 X 36 TIGER 200-20-036
|
Facility
|
OP
|
$2,289.00
|
|
| Hospital Charge Code |
3782761
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$640.92 |
| Max. Negotiated Rate |
$9,156.00 |
| Rate for Payer: Aetna Commercial |
$2,060.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,968.54
|
| Rate for Payer: Aetna Managed Medicare |
$640.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,487.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,144.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,098.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,213.17
|
| Rate for Payer: Cash Price |
$686.70
|
| Rate for Payer: Cigna Commercial |
$2,105.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,280.92
|
| Rate for Payer: Health EOS Commercial |
$2,037.21
|
| Rate for Payer: HFN Commercial |
$2,105.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,716.75
|
| Rate for Payer: Multiplan Commercial |
$1,831.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,373.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,105.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,121.61
|
| Rate for Payer: Quartz Commercial |
$1,487.85
|
| Rate for Payer: Quartz Medicare Advantage |
$1,373.40
|
| Rate for Payer: The Alliance Commercial |
$9,156.00
|
| Rate for Payer: WEA Trust Commercial |
$1,258.95
|
| Rate for Payer: WPS Commercial |
$1,695.46
|
|
