|
PLATE ACUTIE STERNUM WIRE STW-1104
|
Facility
|
IP
|
$4,593.00
|
|
| Hospital Charge Code |
2964166
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,250.57 |
| Max. Negotiated Rate |
$4,225.56 |
| Rate for Payer: Aetna Commercial |
$4,133.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,949.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,434.29
|
| Rate for Payer: Cash Price |
$1,377.90
|
| Rate for Payer: Cigna Commercial |
$4,225.56
|
| Rate for Payer: Health EOS Commercial |
$4,087.77
|
| Rate for Payer: HFN Commercial |
$4,225.56
|
| Rate for Payer: Multiplan Commercial |
$3,674.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,755.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,225.56
|
| Rate for Payer: Quartz Beloit One Network |
$2,250.57
|
| Rate for Payer: Quartz Commercial |
$2,755.80
|
| Rate for Payer: WEA Trust Commercial |
$2,526.15
|
| Rate for Payer: WPS Commercial |
$3,402.04
|
|
|
PLATE ACUTIE STERNUM WIRE STW-1104
|
Facility
|
OP
|
$4,593.00
|
|
| Hospital Charge Code |
2964166
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,286.04 |
| Max. Negotiated Rate |
$18,372.00 |
| Rate for Payer: Aetna Commercial |
$4,133.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,949.98
|
| Rate for Payer: Aetna Managed Medicare |
$1,286.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,985.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,296.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,204.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,434.29
|
| Rate for Payer: Cash Price |
$1,377.90
|
| Rate for Payer: Cigna Commercial |
$4,225.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,570.24
|
| Rate for Payer: Health EOS Commercial |
$4,087.77
|
| Rate for Payer: HFN Commercial |
$4,225.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,444.75
|
| Rate for Payer: Multiplan Commercial |
$3,674.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,755.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,225.56
|
| Rate for Payer: Quartz Beloit One Network |
$2,250.57
|
| Rate for Payer: Quartz Commercial |
$2,985.45
|
| Rate for Payer: Quartz Medicare Advantage |
$2,755.80
|
| Rate for Payer: The Alliance Commercial |
$18,372.00
|
| Rate for Payer: WEA Trust Commercial |
$2,526.15
|
| Rate for Payer: WPS Commercial |
$3,402.04
|
|
|
PLATE AMBI 120DEG 4HL 91-5968
|
Facility
|
OP
|
$5,753.00
|
|
| Hospital Charge Code |
2966015
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,610.84 |
| Max. Negotiated Rate |
$23,012.00 |
| Rate for Payer: Aetna Commercial |
$5,177.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,947.58
|
| Rate for Payer: Aetna Managed Medicare |
$1,610.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,739.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,876.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,761.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,049.09
|
| Rate for Payer: Cash Price |
$1,725.90
|
| Rate for Payer: Cigna Commercial |
$5,292.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,219.38
|
| Rate for Payer: Health EOS Commercial |
$5,120.17
|
| Rate for Payer: HFN Commercial |
$5,292.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,314.75
|
| Rate for Payer: Multiplan Commercial |
$4,602.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,451.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,292.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,818.97
|
| Rate for Payer: Quartz Commercial |
$3,739.45
|
| Rate for Payer: Quartz Medicare Advantage |
$3,451.80
|
| Rate for Payer: The Alliance Commercial |
$23,012.00
|
| Rate for Payer: WEA Trust Commercial |
$3,164.15
|
| Rate for Payer: WPS Commercial |
$4,261.25
|
|
|
PLATE AMBI 120DEG 4HL 91-5968
|
Facility
|
IP
|
$5,753.00
|
|
| Hospital Charge Code |
2966015
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,818.97 |
| Max. Negotiated Rate |
$5,292.76 |
| Rate for Payer: Aetna Commercial |
$5,177.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,947.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,049.09
|
| Rate for Payer: Cash Price |
$1,725.90
|
| Rate for Payer: Cigna Commercial |
$5,292.76
|
| Rate for Payer: Health EOS Commercial |
$5,120.17
|
| Rate for Payer: HFN Commercial |
$5,292.76
|
| Rate for Payer: Multiplan Commercial |
$4,602.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,451.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,292.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,818.97
|
| Rate for Payer: Quartz Commercial |
$3,451.80
|
| Rate for Payer: WEA Trust Commercial |
$3,164.15
|
| Rate for Payer: WPS Commercial |
$4,261.25
|
|
|
PLATE AMBI 125DEG 4HL 91-4543
|
Facility
|
IP
|
$5,753.00
|
|
| Hospital Charge Code |
2966016
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,818.97 |
| Max. Negotiated Rate |
$5,292.76 |
| Rate for Payer: Aetna Commercial |
$5,177.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,947.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,049.09
|
| Rate for Payer: Cash Price |
$1,725.90
|
| Rate for Payer: Cigna Commercial |
$5,292.76
|
| Rate for Payer: Health EOS Commercial |
$5,120.17
|
| Rate for Payer: HFN Commercial |
$5,292.76
|
| Rate for Payer: Multiplan Commercial |
$4,602.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,451.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,292.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,818.97
|
| Rate for Payer: Quartz Commercial |
$3,451.80
|
| Rate for Payer: WEA Trust Commercial |
$3,164.15
|
| Rate for Payer: WPS Commercial |
$4,261.25
|
|
|
PLATE AMBI 125DEG 4HL 91-4543
|
Facility
|
OP
|
$5,753.00
|
|
| Hospital Charge Code |
2966016
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,610.84 |
| Max. Negotiated Rate |
$23,012.00 |
| Rate for Payer: Aetna Commercial |
$5,177.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,947.58
|
| Rate for Payer: Aetna Managed Medicare |
$1,610.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,739.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,876.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,761.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,049.09
|
| Rate for Payer: Cash Price |
$1,725.90
|
| Rate for Payer: Cigna Commercial |
$5,292.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,219.38
|
| Rate for Payer: Health EOS Commercial |
$5,120.17
|
| Rate for Payer: HFN Commercial |
$5,292.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,314.75
|
| Rate for Payer: Multiplan Commercial |
$4,602.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,451.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,292.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,818.97
|
| Rate for Payer: Quartz Commercial |
$3,739.45
|
| Rate for Payer: Quartz Medicare Advantage |
$3,451.80
|
| Rate for Payer: The Alliance Commercial |
$23,012.00
|
| Rate for Payer: WEA Trust Commercial |
$3,164.15
|
| Rate for Payer: WPS Commercial |
$4,261.25
|
|
|
PLATE AMBI 130DEG 3HL 124125
|
Facility
|
OP
|
$3,707.00
|
|
| Hospital Charge Code |
2966017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,037.96 |
| Max. Negotiated Rate |
$14,828.00 |
| Rate for Payer: Aetna Commercial |
$3,336.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,188.02
|
| Rate for Payer: Aetna Managed Medicare |
$1,037.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,409.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,853.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,779.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,964.71
|
| Rate for Payer: Cash Price |
$1,112.10
|
| Rate for Payer: Cigna Commercial |
$3,410.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,074.44
|
| Rate for Payer: Health EOS Commercial |
$3,299.23
|
| Rate for Payer: HFN Commercial |
$3,410.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,780.25
|
| Rate for Payer: Multiplan Commercial |
$2,965.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,224.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,410.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,816.43
|
| Rate for Payer: Quartz Commercial |
$2,409.55
|
| Rate for Payer: Quartz Medicare Advantage |
$2,224.20
|
| Rate for Payer: The Alliance Commercial |
$14,828.00
|
| Rate for Payer: WEA Trust Commercial |
$2,038.85
|
| Rate for Payer: WPS Commercial |
$2,745.77
|
|
|
PLATE AMBI 130DEG 3HL 124125
|
Facility
|
IP
|
$3,707.00
|
|
| Hospital Charge Code |
2966017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,816.43 |
| Max. Negotiated Rate |
$3,410.44 |
| Rate for Payer: Aetna Commercial |
$3,336.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,188.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,964.71
|
| Rate for Payer: Cash Price |
$1,112.10
|
| Rate for Payer: Cigna Commercial |
$3,410.44
|
| Rate for Payer: Health EOS Commercial |
$3,299.23
|
| Rate for Payer: HFN Commercial |
$3,410.44
|
| Rate for Payer: Multiplan Commercial |
$2,965.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,224.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,410.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,816.43
|
| Rate for Payer: Quartz Commercial |
$2,224.20
|
| Rate for Payer: WEA Trust Commercial |
$2,038.85
|
| Rate for Payer: WPS Commercial |
$2,745.77
|
|
|
PLATE AMBI 130DEG 4HL 124130
|
Facility
|
IP
|
$3,707.00
|
|
| Hospital Charge Code |
2966018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,816.43 |
| Max. Negotiated Rate |
$3,410.44 |
| Rate for Payer: Aetna Commercial |
$3,336.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,188.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,964.71
|
| Rate for Payer: Cash Price |
$1,112.10
|
| Rate for Payer: Cigna Commercial |
$3,410.44
|
| Rate for Payer: Health EOS Commercial |
$3,299.23
|
| Rate for Payer: HFN Commercial |
$3,410.44
|
| Rate for Payer: Multiplan Commercial |
$2,965.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,224.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,410.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,816.43
|
| Rate for Payer: Quartz Commercial |
$2,224.20
|
| Rate for Payer: WEA Trust Commercial |
$2,038.85
|
| Rate for Payer: WPS Commercial |
$2,745.77
|
|
|
PLATE AMBI 130DEG 4HL 124130
|
Facility
|
OP
|
$3,707.00
|
|
| Hospital Charge Code |
2966018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,037.96 |
| Max. Negotiated Rate |
$14,828.00 |
| Rate for Payer: Aetna Commercial |
$3,336.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,188.02
|
| Rate for Payer: Aetna Managed Medicare |
$1,037.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,409.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,853.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,779.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,964.71
|
| Rate for Payer: Cash Price |
$1,112.10
|
| Rate for Payer: Cigna Commercial |
$3,410.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,074.44
|
| Rate for Payer: Health EOS Commercial |
$3,299.23
|
| Rate for Payer: HFN Commercial |
$3,410.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,780.25
|
| Rate for Payer: Multiplan Commercial |
$2,965.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,224.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,410.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,816.43
|
| Rate for Payer: Quartz Commercial |
$2,409.55
|
| Rate for Payer: Quartz Medicare Advantage |
$2,224.20
|
| Rate for Payer: The Alliance Commercial |
$14,828.00
|
| Rate for Payer: WEA Trust Commercial |
$2,038.85
|
| Rate for Payer: WPS Commercial |
$2,745.77
|
|
|
PLATE AMBI 130DEG 5HL 124135
|
Facility
|
OP
|
$4,064.00
|
|
| Hospital Charge Code |
2966019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,137.92 |
| Max. Negotiated Rate |
$16,256.00 |
| Rate for Payer: Aetna Commercial |
$3,657.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,495.04
|
| Rate for Payer: Aetna Managed Medicare |
$1,137.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,641.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,032.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,950.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,153.92
|
| Rate for Payer: Cash Price |
$1,219.20
|
| Rate for Payer: Cigna Commercial |
$3,738.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,274.21
|
| Rate for Payer: Health EOS Commercial |
$3,616.96
|
| Rate for Payer: HFN Commercial |
$3,738.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,048.00
|
| Rate for Payer: Multiplan Commercial |
$3,251.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,438.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,738.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,991.36
|
| Rate for Payer: Quartz Commercial |
$2,641.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2,438.40
|
| Rate for Payer: The Alliance Commercial |
$16,256.00
|
| Rate for Payer: WEA Trust Commercial |
$2,235.20
|
| Rate for Payer: WPS Commercial |
$3,010.20
|
|
|
PLATE AMBI 130DEG 5HL 124135
|
Facility
|
IP
|
$4,064.00
|
|
| Hospital Charge Code |
2966019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,991.36 |
| Max. Negotiated Rate |
$3,738.88 |
| Rate for Payer: Aetna Commercial |
$3,657.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,495.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,153.92
|
| Rate for Payer: Cash Price |
$1,219.20
|
| Rate for Payer: Cigna Commercial |
$3,738.88
|
| Rate for Payer: Health EOS Commercial |
$3,616.96
|
| Rate for Payer: HFN Commercial |
$3,738.88
|
| Rate for Payer: Multiplan Commercial |
$3,251.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,438.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,738.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,991.36
|
| Rate for Payer: Quartz Commercial |
$2,438.40
|
| Rate for Payer: WEA Trust Commercial |
$2,235.20
|
| Rate for Payer: WPS Commercial |
$3,010.20
|
|
|
PLATE AMBI 130DEG 6HL 124140
|
Facility
|
OP
|
$4,064.00
|
|
| Hospital Charge Code |
2966020
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,137.92 |
| Max. Negotiated Rate |
$16,256.00 |
| Rate for Payer: Aetna Commercial |
$3,657.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,495.04
|
| Rate for Payer: Aetna Managed Medicare |
$1,137.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,641.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,032.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,950.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,153.92
|
| Rate for Payer: Cash Price |
$1,219.20
|
| Rate for Payer: Cigna Commercial |
$3,738.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,274.21
|
| Rate for Payer: Health EOS Commercial |
$3,616.96
|
| Rate for Payer: HFN Commercial |
$3,738.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,048.00
|
| Rate for Payer: Multiplan Commercial |
$3,251.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,438.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,738.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,991.36
|
| Rate for Payer: Quartz Commercial |
$2,641.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2,438.40
|
| Rate for Payer: The Alliance Commercial |
$16,256.00
|
| Rate for Payer: WEA Trust Commercial |
$2,235.20
|
| Rate for Payer: WPS Commercial |
$3,010.20
|
|
|
PLATE AMBI 130DEG 6HL 124140
|
Facility
|
IP
|
$4,064.00
|
|
| Hospital Charge Code |
2966020
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,991.36 |
| Max. Negotiated Rate |
$3,738.88 |
| Rate for Payer: Aetna Commercial |
$3,657.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,495.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,153.92
|
| Rate for Payer: Cash Price |
$1,219.20
|
| Rate for Payer: Cigna Commercial |
$3,738.88
|
| Rate for Payer: Health EOS Commercial |
$3,616.96
|
| Rate for Payer: HFN Commercial |
$3,738.88
|
| Rate for Payer: Multiplan Commercial |
$3,251.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,438.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,738.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,991.36
|
| Rate for Payer: Quartz Commercial |
$2,438.40
|
| Rate for Payer: WEA Trust Commercial |
$2,235.20
|
| Rate for Payer: WPS Commercial |
$3,010.20
|
|
|
PLATE AMBI 130DEG 8HL 124145
|
Facility
|
IP
|
$3,747.00
|
|
| Hospital Charge Code |
2966030
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,836.03 |
| Max. Negotiated Rate |
$3,447.24 |
| Rate for Payer: Aetna Commercial |
$3,372.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,222.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,985.91
|
| Rate for Payer: Cash Price |
$1,124.10
|
| Rate for Payer: Cigna Commercial |
$3,447.24
|
| Rate for Payer: Health EOS Commercial |
$3,334.83
|
| Rate for Payer: HFN Commercial |
$3,447.24
|
| Rate for Payer: Multiplan Commercial |
$2,997.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,248.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,447.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,836.03
|
| Rate for Payer: Quartz Commercial |
$2,248.20
|
| Rate for Payer: WEA Trust Commercial |
$2,060.85
|
| Rate for Payer: WPS Commercial |
$2,775.40
|
|
|
PLATE AMBI 130DEG 8HL 124145
|
Facility
|
OP
|
$3,747.00
|
|
| Hospital Charge Code |
2966030
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,049.16 |
| Max. Negotiated Rate |
$14,988.00 |
| Rate for Payer: Aetna Commercial |
$3,372.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,222.42
|
| Rate for Payer: Aetna Managed Medicare |
$1,049.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,435.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,873.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,798.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,985.91
|
| Rate for Payer: Cash Price |
$1,124.10
|
| Rate for Payer: Cigna Commercial |
$3,447.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,096.82
|
| Rate for Payer: Health EOS Commercial |
$3,334.83
|
| Rate for Payer: HFN Commercial |
$3,447.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,810.25
|
| Rate for Payer: Multiplan Commercial |
$2,997.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,248.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,447.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,836.03
|
| Rate for Payer: Quartz Commercial |
$2,435.55
|
| Rate for Payer: Quartz Medicare Advantage |
$2,248.20
|
| Rate for Payer: The Alliance Commercial |
$14,988.00
|
| Rate for Payer: WEA Trust Commercial |
$2,060.85
|
| Rate for Payer: WPS Commercial |
$2,775.40
|
|
|
PLATE AMBI 135DEG 10HL 124151
|
Facility
|
IP
|
$5,753.00
|
|
| Hospital Charge Code |
2966031
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,818.97 |
| Max. Negotiated Rate |
$5,292.76 |
| Rate for Payer: Aetna Commercial |
$5,177.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,947.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,049.09
|
| Rate for Payer: Cash Price |
$1,725.90
|
| Rate for Payer: Cigna Commercial |
$5,292.76
|
| Rate for Payer: Health EOS Commercial |
$5,120.17
|
| Rate for Payer: HFN Commercial |
$5,292.76
|
| Rate for Payer: Multiplan Commercial |
$4,602.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,451.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,292.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,818.97
|
| Rate for Payer: Quartz Commercial |
$3,451.80
|
| Rate for Payer: WEA Trust Commercial |
$3,164.15
|
| Rate for Payer: WPS Commercial |
$4,261.25
|
|
|
PLATE AMBI 135DEG 10HL 124151
|
Facility
|
OP
|
$5,753.00
|
|
| Hospital Charge Code |
2966031
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,610.84 |
| Max. Negotiated Rate |
$23,012.00 |
| Rate for Payer: Aetna Commercial |
$5,177.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,947.58
|
| Rate for Payer: Aetna Managed Medicare |
$1,610.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,739.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,876.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,761.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,049.09
|
| Rate for Payer: Cash Price |
$1,725.90
|
| Rate for Payer: Cigna Commercial |
$5,292.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,219.38
|
| Rate for Payer: Health EOS Commercial |
$5,120.17
|
| Rate for Payer: HFN Commercial |
$5,292.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,314.75
|
| Rate for Payer: Multiplan Commercial |
$4,602.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,451.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,292.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,818.97
|
| Rate for Payer: Quartz Commercial |
$3,739.45
|
| Rate for Payer: Quartz Medicare Advantage |
$3,451.80
|
| Rate for Payer: The Alliance Commercial |
$23,012.00
|
| Rate for Payer: WEA Trust Commercial |
$3,164.15
|
| Rate for Payer: WPS Commercial |
$4,261.25
|
|
|
PLATE AMBI 135DEG 2HL 124121
|
Facility
|
OP
|
$7,922.00
|
|
| Hospital Charge Code |
4494005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,218.16 |
| Max. Negotiated Rate |
$31,688.00 |
| Rate for Payer: Aetna Commercial |
$7,129.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,812.92
|
| Rate for Payer: Aetna Managed Medicare |
$2,218.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,149.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,961.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,802.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,198.66
|
| Rate for Payer: Cash Price |
$2,376.60
|
| Rate for Payer: Cigna Commercial |
$7,288.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,433.15
|
| Rate for Payer: Health EOS Commercial |
$7,050.58
|
| Rate for Payer: HFN Commercial |
$7,288.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,941.50
|
| Rate for Payer: Multiplan Commercial |
$6,337.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,753.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,288.24
|
| Rate for Payer: Quartz Beloit One Network |
$3,881.78
|
| Rate for Payer: Quartz Commercial |
$5,149.30
|
| Rate for Payer: Quartz Medicare Advantage |
$4,753.20
|
| Rate for Payer: The Alliance Commercial |
$31,688.00
|
| Rate for Payer: WEA Trust Commercial |
$4,357.10
|
| Rate for Payer: WPS Commercial |
$5,867.83
|
|
|
PLATE AMBI 135DEG 2HL 124121
|
Facility
|
IP
|
$7,922.00
|
|
| Hospital Charge Code |
4494005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,881.78 |
| Max. Negotiated Rate |
$7,288.24 |
| Rate for Payer: Aetna Commercial |
$7,129.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,812.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,198.66
|
| Rate for Payer: Cash Price |
$2,376.60
|
| Rate for Payer: Cigna Commercial |
$7,288.24
|
| Rate for Payer: Health EOS Commercial |
$7,050.58
|
| Rate for Payer: HFN Commercial |
$7,288.24
|
| Rate for Payer: Multiplan Commercial |
$6,337.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,753.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,288.24
|
| Rate for Payer: Quartz Beloit One Network |
$3,881.78
|
| Rate for Payer: Quartz Commercial |
$4,753.20
|
| Rate for Payer: WEA Trust Commercial |
$4,357.10
|
| Rate for Payer: WPS Commercial |
$5,867.83
|
|
|
PLATE AMBI 135DEG 3HL 124126
|
Facility
|
IP
|
$3,707.00
|
|
| Hospital Charge Code |
2966021
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,816.43 |
| Max. Negotiated Rate |
$3,410.44 |
| Rate for Payer: Aetna Commercial |
$3,336.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,188.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,964.71
|
| Rate for Payer: Cash Price |
$1,112.10
|
| Rate for Payer: Cigna Commercial |
$3,410.44
|
| Rate for Payer: Health EOS Commercial |
$3,299.23
|
| Rate for Payer: HFN Commercial |
$3,410.44
|
| Rate for Payer: Multiplan Commercial |
$2,965.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,224.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,410.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,816.43
|
| Rate for Payer: Quartz Commercial |
$2,224.20
|
| Rate for Payer: WEA Trust Commercial |
$2,038.85
|
| Rate for Payer: WPS Commercial |
$2,745.77
|
|
|
PLATE AMBI 135DEG 3HL 124126
|
Facility
|
OP
|
$3,707.00
|
|
| Hospital Charge Code |
2966021
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,037.96 |
| Max. Negotiated Rate |
$14,828.00 |
| Rate for Payer: Aetna Commercial |
$3,336.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,188.02
|
| Rate for Payer: Aetna Managed Medicare |
$1,037.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,409.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,853.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,779.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,964.71
|
| Rate for Payer: Cash Price |
$1,112.10
|
| Rate for Payer: Cigna Commercial |
$3,410.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,074.44
|
| Rate for Payer: Health EOS Commercial |
$3,299.23
|
| Rate for Payer: HFN Commercial |
$3,410.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,780.25
|
| Rate for Payer: Multiplan Commercial |
$2,965.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,224.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,410.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,816.43
|
| Rate for Payer: Quartz Commercial |
$2,409.55
|
| Rate for Payer: Quartz Medicare Advantage |
$2,224.20
|
| Rate for Payer: The Alliance Commercial |
$14,828.00
|
| Rate for Payer: WEA Trust Commercial |
$2,038.85
|
| Rate for Payer: WPS Commercial |
$2,745.77
|
|
|
PLATE AMBI 135DEG 4HL 124131
|
Facility
|
IP
|
$3,707.00
|
|
| Hospital Charge Code |
2966022
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,816.43 |
| Max. Negotiated Rate |
$3,410.44 |
| Rate for Payer: Aetna Commercial |
$3,336.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,188.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,964.71
|
| Rate for Payer: Cash Price |
$1,112.10
|
| Rate for Payer: Cigna Commercial |
$3,410.44
|
| Rate for Payer: Health EOS Commercial |
$3,299.23
|
| Rate for Payer: HFN Commercial |
$3,410.44
|
| Rate for Payer: Multiplan Commercial |
$2,965.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,224.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,410.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,816.43
|
| Rate for Payer: Quartz Commercial |
$2,224.20
|
| Rate for Payer: WEA Trust Commercial |
$2,038.85
|
| Rate for Payer: WPS Commercial |
$2,745.77
|
|
|
PLATE AMBI 135DEG 4HL 124131
|
Facility
|
OP
|
$3,707.00
|
|
| Hospital Charge Code |
2966022
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,037.96 |
| Max. Negotiated Rate |
$14,828.00 |
| Rate for Payer: Aetna Commercial |
$3,336.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,188.02
|
| Rate for Payer: Aetna Managed Medicare |
$1,037.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,409.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,853.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,779.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,964.71
|
| Rate for Payer: Cash Price |
$1,112.10
|
| Rate for Payer: Cigna Commercial |
$3,410.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,074.44
|
| Rate for Payer: Health EOS Commercial |
$3,299.23
|
| Rate for Payer: HFN Commercial |
$3,410.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,780.25
|
| Rate for Payer: Multiplan Commercial |
$2,965.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,224.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,410.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,816.43
|
| Rate for Payer: Quartz Commercial |
$2,409.55
|
| Rate for Payer: Quartz Medicare Advantage |
$2,224.20
|
| Rate for Payer: The Alliance Commercial |
$14,828.00
|
| Rate for Payer: WEA Trust Commercial |
$2,038.85
|
| Rate for Payer: WPS Commercial |
$2,745.77
|
|
|
PLATE AMBI 135DEG 5HL 124136
|
Facility
|
IP
|
$3,967.00
|
|
| Hospital Charge Code |
2966023
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,943.83 |
| Max. Negotiated Rate |
$3,649.64 |
| Rate for Payer: Aetna Commercial |
$3,570.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,411.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,102.51
|
| Rate for Payer: Cash Price |
$1,190.10
|
| Rate for Payer: Cigna Commercial |
$3,649.64
|
| Rate for Payer: Health EOS Commercial |
$3,530.63
|
| Rate for Payer: HFN Commercial |
$3,649.64
|
| Rate for Payer: Multiplan Commercial |
$3,173.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,380.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,649.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,943.83
|
| Rate for Payer: Quartz Commercial |
$2,380.20
|
| Rate for Payer: WEA Trust Commercial |
$2,181.85
|
| Rate for Payer: WPS Commercial |
$2,938.36
|
|
