|
ROD CARBON FIBER 11.0MM X 100MM 394.80
|
Facility
|
IP
|
$3,132.00
|
|
| Hospital Charge Code |
2966393
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,534.68 |
| Max. Negotiated Rate |
$2,881.44 |
| Rate for Payer: Aetna Commercial |
$2,818.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,693.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,659.96
|
| Rate for Payer: Cash Price |
$939.60
|
| Rate for Payer: Cigna Commercial |
$2,881.44
|
| Rate for Payer: Health EOS Commercial |
$2,787.48
|
| Rate for Payer: HFN Commercial |
$2,881.44
|
| Rate for Payer: Multiplan Commercial |
$2,505.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,879.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,881.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,534.68
|
| Rate for Payer: Quartz Commercial |
$1,879.20
|
| Rate for Payer: WEA Trust Commercial |
$1,722.60
|
| Rate for Payer: WPS Commercial |
$2,319.87
|
|
|
ROD CARBON FIBER 11.0MM X 100MM 394.80
|
Facility
|
OP
|
$3,132.00
|
|
| Hospital Charge Code |
2966393
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$876.96 |
| Max. Negotiated Rate |
$12,528.00 |
| Rate for Payer: Aetna Commercial |
$2,818.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,693.52
|
| Rate for Payer: Aetna Managed Medicare |
$876.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,035.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,566.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,503.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,659.96
|
| Rate for Payer: Cash Price |
$939.60
|
| Rate for Payer: Cigna Commercial |
$2,881.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,752.67
|
| Rate for Payer: Health EOS Commercial |
$2,787.48
|
| Rate for Payer: HFN Commercial |
$2,881.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,349.00
|
| Rate for Payer: Multiplan Commercial |
$2,505.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,879.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,881.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,534.68
|
| Rate for Payer: Quartz Commercial |
$2,035.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,879.20
|
| Rate for Payer: The Alliance Commercial |
$12,528.00
|
| Rate for Payer: WEA Trust Commercial |
$1,722.60
|
| Rate for Payer: WPS Commercial |
$2,319.87
|
|
|
ROD CARBON FIBER 11.0MM X 150MM 394.82
|
Facility
|
OP
|
$1,950.00
|
|
| Hospital Charge Code |
2966388
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$546.00 |
| Max. Negotiated Rate |
$7,800.00 |
| Rate for Payer: Aetna Commercial |
$1,755.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,677.00
|
| Rate for Payer: Aetna Managed Medicare |
$546.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,267.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$975.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$936.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,033.50
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cigna Commercial |
$1,794.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,091.22
|
| Rate for Payer: Health EOS Commercial |
$1,735.50
|
| Rate for Payer: HFN Commercial |
$1,794.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,462.50
|
| Rate for Payer: Multiplan Commercial |
$1,560.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,170.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,794.00
|
| Rate for Payer: Quartz Beloit One Network |
$955.50
|
| Rate for Payer: Quartz Commercial |
$1,267.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,170.00
|
| Rate for Payer: The Alliance Commercial |
$7,800.00
|
| Rate for Payer: WEA Trust Commercial |
$1,072.50
|
| Rate for Payer: WPS Commercial |
$1,444.36
|
|
|
ROD CARBON FIBER 11.0MM X 150MM 394.82
|
Facility
|
IP
|
$1,950.00
|
|
| Hospital Charge Code |
2966388
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$955.50 |
| Max. Negotiated Rate |
$1,794.00 |
| Rate for Payer: Aetna Commercial |
$1,755.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,677.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,033.50
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cigna Commercial |
$1,794.00
|
| Rate for Payer: Health EOS Commercial |
$1,735.50
|
| Rate for Payer: HFN Commercial |
$1,794.00
|
| Rate for Payer: Multiplan Commercial |
$1,560.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,170.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,794.00
|
| Rate for Payer: Quartz Beloit One Network |
$955.50
|
| Rate for Payer: Quartz Commercial |
$1,170.00
|
| Rate for Payer: WEA Trust Commercial |
$1,072.50
|
| Rate for Payer: WPS Commercial |
$1,444.36
|
|
|
ROD CARBON FIBER 11.0MM X 200MM 394.83
|
Facility
|
OP
|
$3,017.00
|
|
| Hospital Charge Code |
2966389
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$844.76 |
| Max. Negotiated Rate |
$12,068.00 |
| Rate for Payer: Aetna Commercial |
$2,715.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,594.62
|
| Rate for Payer: Aetna Managed Medicare |
$844.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,961.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,508.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,448.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,599.01
|
| Rate for Payer: Cash Price |
$905.10
|
| Rate for Payer: Cigna Commercial |
$2,775.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,688.31
|
| Rate for Payer: Health EOS Commercial |
$2,685.13
|
| Rate for Payer: HFN Commercial |
$2,775.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,262.75
|
| Rate for Payer: Multiplan Commercial |
$2,413.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,810.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,775.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,478.33
|
| Rate for Payer: Quartz Commercial |
$1,961.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,810.20
|
| Rate for Payer: The Alliance Commercial |
$12,068.00
|
| Rate for Payer: WEA Trust Commercial |
$1,659.35
|
| Rate for Payer: WPS Commercial |
$2,234.69
|
|
|
ROD CARBON FIBER 11.0MM X 200MM 394.83
|
Facility
|
IP
|
$3,017.00
|
|
| Hospital Charge Code |
2966389
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,478.33 |
| Max. Negotiated Rate |
$2,775.64 |
| Rate for Payer: Aetna Commercial |
$2,715.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,594.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,599.01
|
| Rate for Payer: Cash Price |
$905.10
|
| Rate for Payer: Cigna Commercial |
$2,775.64
|
| Rate for Payer: Health EOS Commercial |
$2,685.13
|
| Rate for Payer: HFN Commercial |
$2,775.64
|
| Rate for Payer: Multiplan Commercial |
$2,413.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,810.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,775.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,478.33
|
| Rate for Payer: Quartz Commercial |
$1,810.20
|
| Rate for Payer: WEA Trust Commercial |
$1,659.35
|
| Rate for Payer: WPS Commercial |
$2,234.69
|
|
|
ROD CARBON FIBER 11.0MM X 250MM 394.84
|
Facility
|
OP
|
$2,293.00
|
|
| Hospital Charge Code |
3133483
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$642.04 |
| Max. Negotiated Rate |
$9,172.00 |
| Rate for Payer: Aetna Commercial |
$2,063.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,971.98
|
| Rate for Payer: Aetna Managed Medicare |
$642.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,490.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,146.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,100.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,215.29
|
| Rate for Payer: Cash Price |
$687.90
|
| Rate for Payer: Cigna Commercial |
$2,109.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,283.16
|
| Rate for Payer: Health EOS Commercial |
$2,040.77
|
| Rate for Payer: HFN Commercial |
$2,109.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,719.75
|
| Rate for Payer: Multiplan Commercial |
$1,834.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,375.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,109.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,123.57
|
| Rate for Payer: Quartz Commercial |
$1,490.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,375.80
|
| Rate for Payer: The Alliance Commercial |
$9,172.00
|
| Rate for Payer: WEA Trust Commercial |
$1,261.15
|
| Rate for Payer: WPS Commercial |
$1,698.43
|
|
|
ROD CARBON FIBER 11.0MM X 250MM 394.84
|
Facility
|
IP
|
$2,293.00
|
|
| Hospital Charge Code |
3133483
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,123.57 |
| Max. Negotiated Rate |
$2,109.56 |
| Rate for Payer: Aetna Commercial |
$2,063.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,971.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,215.29
|
| Rate for Payer: Cash Price |
$687.90
|
| Rate for Payer: Cigna Commercial |
$2,109.56
|
| Rate for Payer: Health EOS Commercial |
$2,040.77
|
| Rate for Payer: HFN Commercial |
$2,109.56
|
| Rate for Payer: Multiplan Commercial |
$1,834.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,375.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,109.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,123.57
|
| Rate for Payer: Quartz Commercial |
$1,375.80
|
| Rate for Payer: WEA Trust Commercial |
$1,261.15
|
| Rate for Payer: WPS Commercial |
$1,698.43
|
|
|
ROD CARBON FIBER 11.0MM X 300MM 394.85
|
Facility
|
IP
|
$3,356.00
|
|
| Hospital Charge Code |
2966390
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,644.44 |
| Max. Negotiated Rate |
$3,087.52 |
| Rate for Payer: Aetna Commercial |
$3,020.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,886.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,778.68
|
| Rate for Payer: Cash Price |
$1,006.80
|
| Rate for Payer: Cigna Commercial |
$3,087.52
|
| Rate for Payer: Health EOS Commercial |
$2,986.84
|
| Rate for Payer: HFN Commercial |
$3,087.52
|
| Rate for Payer: Multiplan Commercial |
$2,684.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,013.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,087.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,644.44
|
| Rate for Payer: Quartz Commercial |
$2,013.60
|
| Rate for Payer: WEA Trust Commercial |
$1,845.80
|
| Rate for Payer: WPS Commercial |
$2,485.79
|
|
|
ROD CARBON FIBER 11.0MM X 300MM 394.85
|
Facility
|
OP
|
$3,356.00
|
|
| Hospital Charge Code |
2966390
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$939.68 |
| Max. Negotiated Rate |
$13,424.00 |
| Rate for Payer: Aetna Commercial |
$3,020.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,886.16
|
| Rate for Payer: Aetna Managed Medicare |
$939.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,181.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,678.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,610.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,778.68
|
| Rate for Payer: Cash Price |
$1,006.80
|
| Rate for Payer: Cigna Commercial |
$3,087.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,878.02
|
| Rate for Payer: Health EOS Commercial |
$2,986.84
|
| Rate for Payer: HFN Commercial |
$3,087.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,517.00
|
| Rate for Payer: Multiplan Commercial |
$2,684.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,013.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,087.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,644.44
|
| Rate for Payer: Quartz Commercial |
$2,181.40
|
| Rate for Payer: Quartz Medicare Advantage |
$2,013.60
|
| Rate for Payer: The Alliance Commercial |
$13,424.00
|
| Rate for Payer: WEA Trust Commercial |
$1,845.80
|
| Rate for Payer: WPS Commercial |
$2,485.79
|
|
|
ROD CARBON FIBER 11.0MM X 350MM 394.86
|
Facility
|
IP
|
$3,356.00
|
|
| Hospital Charge Code |
2966391
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,644.44 |
| Max. Negotiated Rate |
$3,087.52 |
| Rate for Payer: Aetna Commercial |
$3,020.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,886.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,778.68
|
| Rate for Payer: Cash Price |
$1,006.80
|
| Rate for Payer: Cigna Commercial |
$3,087.52
|
| Rate for Payer: Health EOS Commercial |
$2,986.84
|
| Rate for Payer: HFN Commercial |
$3,087.52
|
| Rate for Payer: Multiplan Commercial |
$2,684.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,013.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,087.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,644.44
|
| Rate for Payer: Quartz Commercial |
$2,013.60
|
| Rate for Payer: WEA Trust Commercial |
$1,845.80
|
| Rate for Payer: WPS Commercial |
$2,485.79
|
|
|
ROD CARBON FIBER 11.0MM X 350MM 394.86
|
Facility
|
OP
|
$3,356.00
|
|
| Hospital Charge Code |
2966391
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$939.68 |
| Max. Negotiated Rate |
$13,424.00 |
| Rate for Payer: Aetna Commercial |
$3,020.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,886.16
|
| Rate for Payer: Aetna Managed Medicare |
$939.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,181.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,678.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,610.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,778.68
|
| Rate for Payer: Cash Price |
$1,006.80
|
| Rate for Payer: Cigna Commercial |
$3,087.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,878.02
|
| Rate for Payer: Health EOS Commercial |
$2,986.84
|
| Rate for Payer: HFN Commercial |
$3,087.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,517.00
|
| Rate for Payer: Multiplan Commercial |
$2,684.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,013.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,087.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,644.44
|
| Rate for Payer: Quartz Commercial |
$2,181.40
|
| Rate for Payer: Quartz Medicare Advantage |
$2,013.60
|
| Rate for Payer: The Alliance Commercial |
$13,424.00
|
| Rate for Payer: WEA Trust Commercial |
$1,845.80
|
| Rate for Payer: WPS Commercial |
$2,485.79
|
|
|
ROD CARBON FIBER 11.0MM X 400MM 394.87
|
Facility
|
OP
|
$3,837.00
|
|
| Hospital Charge Code |
2966392
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,074.36 |
| Max. Negotiated Rate |
$15,348.00 |
| Rate for Payer: Aetna Commercial |
$3,453.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,299.82
|
| Rate for Payer: Aetna Managed Medicare |
$1,074.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,494.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,918.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,841.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,033.61
|
| Rate for Payer: Cash Price |
$1,151.10
|
| Rate for Payer: Cigna Commercial |
$3,530.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,147.19
|
| Rate for Payer: Health EOS Commercial |
$3,414.93
|
| Rate for Payer: HFN Commercial |
$3,530.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,877.75
|
| Rate for Payer: Multiplan Commercial |
$3,069.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,302.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,530.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,880.13
|
| Rate for Payer: Quartz Commercial |
$2,494.05
|
| Rate for Payer: Quartz Medicare Advantage |
$2,302.20
|
| Rate for Payer: The Alliance Commercial |
$15,348.00
|
| Rate for Payer: WEA Trust Commercial |
$2,110.35
|
| Rate for Payer: WPS Commercial |
$2,842.07
|
|
|
ROD CARBON FIBER 11.0MM X 400MM 394.87
|
Facility
|
IP
|
$3,837.00
|
|
| Hospital Charge Code |
2966392
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,880.13 |
| Max. Negotiated Rate |
$3,530.04 |
| Rate for Payer: Aetna Commercial |
$3,453.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,299.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,033.61
|
| Rate for Payer: Cash Price |
$1,151.10
|
| Rate for Payer: Cigna Commercial |
$3,530.04
|
| Rate for Payer: Health EOS Commercial |
$3,414.93
|
| Rate for Payer: HFN Commercial |
$3,530.04
|
| Rate for Payer: Multiplan Commercial |
$3,069.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,302.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,530.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,880.13
|
| Rate for Payer: Quartz Commercial |
$2,302.20
|
| Rate for Payer: WEA Trust Commercial |
$2,110.35
|
| Rate for Payer: WPS Commercial |
$2,842.07
|
|
|
ROD CARBON FIBER 11.0MM X 500MM 394.89
|
Facility
|
OP
|
$2,584.00
|
|
| Hospital Charge Code |
4208664
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$723.52 |
| Max. Negotiated Rate |
$10,336.00 |
| Rate for Payer: Aetna Commercial |
$2,325.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,222.24
|
| Rate for Payer: Aetna Managed Medicare |
$723.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,679.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,292.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,240.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,369.52
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cigna Commercial |
$2,377.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,446.01
|
| Rate for Payer: Health EOS Commercial |
$2,299.76
|
| Rate for Payer: HFN Commercial |
$2,377.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,938.00
|
| Rate for Payer: Multiplan Commercial |
$2,067.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,550.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,377.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,266.16
|
| Rate for Payer: Quartz Commercial |
$1,679.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,550.40
|
| Rate for Payer: The Alliance Commercial |
$10,336.00
|
| Rate for Payer: WEA Trust Commercial |
$1,421.20
|
| Rate for Payer: WPS Commercial |
$1,913.97
|
|
|
ROD CARBON FIBER 11.0MM X 500MM 394.89
|
Facility
|
IP
|
$2,584.00
|
|
| Hospital Charge Code |
4208664
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,266.16 |
| Max. Negotiated Rate |
$2,377.28 |
| Rate for Payer: Aetna Commercial |
$2,325.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,222.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,369.52
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cigna Commercial |
$2,377.28
|
| Rate for Payer: Health EOS Commercial |
$2,299.76
|
| Rate for Payer: HFN Commercial |
$2,377.28
|
| Rate for Payer: Multiplan Commercial |
$2,067.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,550.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,377.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,266.16
|
| Rate for Payer: Quartz Commercial |
$1,550.40
|
| Rate for Payer: WEA Trust Commercial |
$1,421.20
|
| Rate for Payer: WPS Commercial |
$1,913.97
|
|
|
ROD CARBON FIBER 11.0 X 650 394.92
|
Facility
|
OP
|
$3,413.00
|
|
| Hospital Charge Code |
4155809
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$955.64 |
| Max. Negotiated Rate |
$13,652.00 |
| Rate for Payer: Aetna Commercial |
$3,071.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,935.18
|
| Rate for Payer: Aetna Managed Medicare |
$955.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,218.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,706.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,638.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,808.89
|
| Rate for Payer: Cash Price |
$1,023.90
|
| Rate for Payer: Cigna Commercial |
$3,139.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,909.91
|
| Rate for Payer: Health EOS Commercial |
$3,037.57
|
| Rate for Payer: HFN Commercial |
$3,139.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,559.75
|
| Rate for Payer: Multiplan Commercial |
$2,730.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,047.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,139.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,672.37
|
| Rate for Payer: Quartz Commercial |
$2,218.45
|
| Rate for Payer: Quartz Medicare Advantage |
$2,047.80
|
| Rate for Payer: The Alliance Commercial |
$13,652.00
|
| Rate for Payer: WEA Trust Commercial |
$1,877.15
|
| Rate for Payer: WPS Commercial |
$2,528.01
|
|
|
ROD CARBON FIBER 11.0 X 650 394.92
|
Facility
|
IP
|
$3,413.00
|
|
| Hospital Charge Code |
4155809
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,672.37 |
| Max. Negotiated Rate |
$3,139.96 |
| Rate for Payer: Aetna Commercial |
$3,071.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,935.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,808.89
|
| Rate for Payer: Cash Price |
$1,023.90
|
| Rate for Payer: Cigna Commercial |
$3,139.96
|
| Rate for Payer: Health EOS Commercial |
$3,037.57
|
| Rate for Payer: HFN Commercial |
$3,139.96
|
| Rate for Payer: Multiplan Commercial |
$2,730.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,047.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,139.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,672.37
|
| Rate for Payer: Quartz Commercial |
$2,047.80
|
| Rate for Payer: WEA Trust Commercial |
$1,877.15
|
| Rate for Payer: WPS Commercial |
$2,528.01
|
|
|
ROD CARBON FIBER 8.0 X 200 395.782
|
Facility
|
OP
|
$2,191.00
|
|
| Hospital Charge Code |
2966394
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$613.48 |
| Max. Negotiated Rate |
$8,764.00 |
| Rate for Payer: Aetna Commercial |
$1,971.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,884.26
|
| Rate for Payer: Aetna Managed Medicare |
$613.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,424.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,095.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,051.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,161.23
|
| Rate for Payer: Cash Price |
$657.30
|
| Rate for Payer: Cigna Commercial |
$2,015.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,226.08
|
| Rate for Payer: Health EOS Commercial |
$1,949.99
|
| Rate for Payer: HFN Commercial |
$2,015.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,643.25
|
| Rate for Payer: Multiplan Commercial |
$1,752.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,314.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,015.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,073.59
|
| Rate for Payer: Quartz Commercial |
$1,424.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,314.60
|
| Rate for Payer: The Alliance Commercial |
$8,764.00
|
| Rate for Payer: WEA Trust Commercial |
$1,205.05
|
| Rate for Payer: WPS Commercial |
$1,622.87
|
|
|
ROD CARBON FIBER 8.0 X 200 395.782
|
Facility
|
IP
|
$2,191.00
|
|
| Hospital Charge Code |
2966394
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,073.59 |
| Max. Negotiated Rate |
$2,015.72 |
| Rate for Payer: Aetna Commercial |
$1,971.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,884.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,161.23
|
| Rate for Payer: Cash Price |
$657.30
|
| Rate for Payer: Cigna Commercial |
$2,015.72
|
| Rate for Payer: Health EOS Commercial |
$1,949.99
|
| Rate for Payer: HFN Commercial |
$2,015.72
|
| Rate for Payer: Multiplan Commercial |
$1,752.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,314.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,015.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,073.59
|
| Rate for Payer: Quartz Commercial |
$1,314.60
|
| Rate for Payer: WEA Trust Commercial |
$1,205.05
|
| Rate for Payer: WPS Commercial |
$1,622.87
|
|
|
ROD CARBON FIBER 8.0 X 220 395.784
|
Facility
|
IP
|
$2,029.00
|
|
| Hospital Charge Code |
2966395
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$994.21 |
| Max. Negotiated Rate |
$1,866.68 |
| Rate for Payer: Aetna Commercial |
$1,826.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,744.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,075.37
|
| Rate for Payer: Cash Price |
$608.70
|
| Rate for Payer: Cigna Commercial |
$1,866.68
|
| Rate for Payer: Health EOS Commercial |
$1,805.81
|
| Rate for Payer: HFN Commercial |
$1,866.68
|
| Rate for Payer: Multiplan Commercial |
$1,623.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,217.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,866.68
|
| Rate for Payer: Quartz Beloit One Network |
$994.21
|
| Rate for Payer: Quartz Commercial |
$1,217.40
|
| Rate for Payer: WEA Trust Commercial |
$1,115.95
|
| Rate for Payer: WPS Commercial |
$1,502.88
|
|
|
ROD CARBON FIBER 8.0 X 220 395.784
|
Facility
|
OP
|
$2,029.00
|
|
| Hospital Charge Code |
2966395
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$568.12 |
| Max. Negotiated Rate |
$8,116.00 |
| Rate for Payer: Aetna Commercial |
$1,826.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,744.94
|
| Rate for Payer: Aetna Managed Medicare |
$568.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,318.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,014.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$973.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,075.37
|
| Rate for Payer: Cash Price |
$608.70
|
| Rate for Payer: Cigna Commercial |
$1,866.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,135.43
|
| Rate for Payer: Health EOS Commercial |
$1,805.81
|
| Rate for Payer: HFN Commercial |
$1,866.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,521.75
|
| Rate for Payer: Multiplan Commercial |
$1,623.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,217.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,866.68
|
| Rate for Payer: Quartz Beloit One Network |
$994.21
|
| Rate for Payer: Quartz Commercial |
$1,318.85
|
| Rate for Payer: Quartz Medicare Advantage |
$1,217.40
|
| Rate for Payer: The Alliance Commercial |
$8,116.00
|
| Rate for Payer: WEA Trust Commercial |
$1,115.95
|
| Rate for Payer: WPS Commercial |
$1,502.88
|
|
|
ROD HOFFMANN 3 VECTRAN 11MM X 350MM 4922-8-350
|
Facility
|
IP
|
$2,844.00
|
|
| Hospital Charge Code |
5685714
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,393.56 |
| Max. Negotiated Rate |
$2,616.48 |
| Rate for Payer: Aetna Commercial |
$2,559.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,445.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,507.32
|
| Rate for Payer: Cash Price |
$853.20
|
| Rate for Payer: Cigna Commercial |
$2,616.48
|
| Rate for Payer: Health EOS Commercial |
$2,531.16
|
| Rate for Payer: HFN Commercial |
$2,616.48
|
| Rate for Payer: Multiplan Commercial |
$2,275.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,706.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,616.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,393.56
|
| Rate for Payer: Quartz Commercial |
$1,706.40
|
| Rate for Payer: WEA Trust Commercial |
$1,564.20
|
| Rate for Payer: WPS Commercial |
$2,106.55
|
|
|
ROD HOFFMANN 3 VECTRAN 11MM X 350MM 4922-8-350
|
Facility
|
OP
|
$2,844.00
|
|
| Hospital Charge Code |
5685714
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$796.32 |
| Max. Negotiated Rate |
$11,376.00 |
| Rate for Payer: Aetna Commercial |
$2,559.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,445.84
|
| Rate for Payer: Aetna Managed Medicare |
$796.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,848.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,422.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,365.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,507.32
|
| Rate for Payer: Cash Price |
$853.20
|
| Rate for Payer: Cigna Commercial |
$2,616.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,591.50
|
| Rate for Payer: Health EOS Commercial |
$2,531.16
|
| Rate for Payer: HFN Commercial |
$2,616.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,133.00
|
| Rate for Payer: Multiplan Commercial |
$2,275.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,706.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,616.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,393.56
|
| Rate for Payer: Quartz Commercial |
$1,848.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,706.40
|
| Rate for Payer: The Alliance Commercial |
$11,376.00
|
| Rate for Payer: WEA Trust Commercial |
$1,564.20
|
| Rate for Payer: WPS Commercial |
$2,106.55
|
|
|
ROD HOFFMANN 3 VECTRAN 11MM X 400MM 4922-8-400
|
Facility
|
OP
|
$3,254.00
|
|
| Hospital Charge Code |
5685715
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$911.12 |
| Max. Negotiated Rate |
$13,016.00 |
| Rate for Payer: Aetna Commercial |
$2,928.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,798.44
|
| Rate for Payer: Aetna Managed Medicare |
$911.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,115.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,627.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,561.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,724.62
|
| Rate for Payer: Cash Price |
$976.20
|
| Rate for Payer: Cigna Commercial |
$2,993.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,820.94
|
| Rate for Payer: Health EOS Commercial |
$2,896.06
|
| Rate for Payer: HFN Commercial |
$2,993.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,440.50
|
| Rate for Payer: Multiplan Commercial |
$2,603.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,952.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,993.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,594.46
|
| Rate for Payer: Quartz Commercial |
$2,115.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,952.40
|
| Rate for Payer: The Alliance Commercial |
$13,016.00
|
| Rate for Payer: WEA Trust Commercial |
$1,789.70
|
| Rate for Payer: WPS Commercial |
$2,410.24
|
|
