|
SCREW-CANN 3.0 X 10 202.610
|
Facility
|
OP
|
$2,121.00
|
|
| Hospital Charge Code |
2967087
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$593.88 |
| Max. Negotiated Rate |
$8,484.00 |
| Rate for Payer: Aetna Commercial |
$1,908.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,824.06
|
| Rate for Payer: Aetna Managed Medicare |
$593.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,378.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,060.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,018.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,124.13
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cigna Commercial |
$1,951.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,186.91
|
| Rate for Payer: Health EOS Commercial |
$1,887.69
|
| Rate for Payer: HFN Commercial |
$1,951.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,590.75
|
| Rate for Payer: Multiplan Commercial |
$1,696.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,272.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,951.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,039.29
|
| Rate for Payer: Quartz Commercial |
$1,378.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,272.60
|
| Rate for Payer: The Alliance Commercial |
$8,484.00
|
| Rate for Payer: WEA Trust Commercial |
$1,166.55
|
| Rate for Payer: WPS Commercial |
$1,571.02
|
|
|
SCREW CANN 3.0 X 10 TIGER 200-30-010
|
Facility
|
IP
|
$2,059.00
|
|
| Hospital Charge Code |
3784148
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,008.91 |
| Max. Negotiated Rate |
$1,894.28 |
| Rate for Payer: Aetna Commercial |
$1,853.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,770.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,091.27
|
| Rate for Payer: Cash Price |
$617.70
|
| Rate for Payer: Cigna Commercial |
$1,894.28
|
| Rate for Payer: Health EOS Commercial |
$1,832.51
|
| Rate for Payer: HFN Commercial |
$1,894.28
|
| Rate for Payer: Multiplan Commercial |
$1,647.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,235.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,894.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,008.91
|
| Rate for Payer: Quartz Commercial |
$1,235.40
|
| Rate for Payer: WEA Trust Commercial |
$1,132.45
|
| Rate for Payer: WPS Commercial |
$1,525.10
|
|
|
SCREW CANN 3.0 X 10 TIGER 200-30-010
|
Facility
|
OP
|
$2,059.00
|
|
| Hospital Charge Code |
3784148
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$576.52 |
| Max. Negotiated Rate |
$8,236.00 |
| Rate for Payer: Aetna Commercial |
$1,853.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,770.74
|
| Rate for Payer: Aetna Managed Medicare |
$576.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,338.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,029.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$988.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,091.27
|
| Rate for Payer: Cash Price |
$617.70
|
| Rate for Payer: Cigna Commercial |
$1,894.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,152.22
|
| Rate for Payer: Health EOS Commercial |
$1,832.51
|
| Rate for Payer: HFN Commercial |
$1,894.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,544.25
|
| Rate for Payer: Multiplan Commercial |
$1,647.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,235.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,894.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,008.91
|
| Rate for Payer: Quartz Commercial |
$1,338.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,235.40
|
| Rate for Payer: The Alliance Commercial |
$8,236.00
|
| Rate for Payer: WEA Trust Commercial |
$1,132.45
|
| Rate for Payer: WPS Commercial |
$1,525.10
|
|
|
SCREW-CANN 3.0 X 11 202.611
|
Facility
|
IP
|
$2,121.00
|
|
| Hospital Charge Code |
2967088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,039.29 |
| Max. Negotiated Rate |
$1,951.32 |
| Rate for Payer: Aetna Commercial |
$1,908.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,824.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,124.13
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cigna Commercial |
$1,951.32
|
| Rate for Payer: Health EOS Commercial |
$1,887.69
|
| Rate for Payer: HFN Commercial |
$1,951.32
|
| Rate for Payer: Multiplan Commercial |
$1,696.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,272.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,951.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,039.29
|
| Rate for Payer: Quartz Commercial |
$1,272.60
|
| Rate for Payer: WEA Trust Commercial |
$1,166.55
|
| Rate for Payer: WPS Commercial |
$1,571.02
|
|
|
SCREW-CANN 3.0 X 11 202.611
|
Facility
|
OP
|
$2,121.00
|
|
| Hospital Charge Code |
2967088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$593.88 |
| Max. Negotiated Rate |
$8,484.00 |
| Rate for Payer: Aetna Commercial |
$1,908.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,824.06
|
| Rate for Payer: Aetna Managed Medicare |
$593.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,378.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,060.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,018.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,124.13
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cigna Commercial |
$1,951.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,186.91
|
| Rate for Payer: Health EOS Commercial |
$1,887.69
|
| Rate for Payer: HFN Commercial |
$1,951.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,590.75
|
| Rate for Payer: Multiplan Commercial |
$1,696.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,272.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,951.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,039.29
|
| Rate for Payer: Quartz Commercial |
$1,378.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,272.60
|
| Rate for Payer: The Alliance Commercial |
$8,484.00
|
| Rate for Payer: WEA Trust Commercial |
$1,166.55
|
| Rate for Payer: WPS Commercial |
$1,571.02
|
|
|
SCREW-CANN 3.0 X 12 202.612
|
Facility
|
OP
|
$2,121.00
|
|
| Hospital Charge Code |
2967089
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$593.88 |
| Max. Negotiated Rate |
$8,484.00 |
| Rate for Payer: Aetna Commercial |
$1,908.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,824.06
|
| Rate for Payer: Aetna Managed Medicare |
$593.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,378.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,060.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,018.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,124.13
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cigna Commercial |
$1,951.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,186.91
|
| Rate for Payer: Health EOS Commercial |
$1,887.69
|
| Rate for Payer: HFN Commercial |
$1,951.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,590.75
|
| Rate for Payer: Multiplan Commercial |
$1,696.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,272.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,951.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,039.29
|
| Rate for Payer: Quartz Commercial |
$1,378.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,272.60
|
| Rate for Payer: The Alliance Commercial |
$8,484.00
|
| Rate for Payer: WEA Trust Commercial |
$1,166.55
|
| Rate for Payer: WPS Commercial |
$1,571.02
|
|
|
SCREW-CANN 3.0 X 12 202.612
|
Facility
|
IP
|
$2,121.00
|
|
| Hospital Charge Code |
2967089
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,039.29 |
| Max. Negotiated Rate |
$1,951.32 |
| Rate for Payer: Aetna Commercial |
$1,908.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,824.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,124.13
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cigna Commercial |
$1,951.32
|
| Rate for Payer: Health EOS Commercial |
$1,887.69
|
| Rate for Payer: HFN Commercial |
$1,951.32
|
| Rate for Payer: Multiplan Commercial |
$1,696.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,272.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,951.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,039.29
|
| Rate for Payer: Quartz Commercial |
$1,272.60
|
| Rate for Payer: WEA Trust Commercial |
$1,166.55
|
| Rate for Payer: WPS Commercial |
$1,571.02
|
|
|
SCREW CANN 3.0 X 12 TIGER 200-30-012
|
Facility
|
IP
|
$2,059.00
|
|
| Hospital Charge Code |
3784149
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,008.91 |
| Max. Negotiated Rate |
$1,894.28 |
| Rate for Payer: Aetna Commercial |
$1,853.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,770.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,091.27
|
| Rate for Payer: Cash Price |
$617.70
|
| Rate for Payer: Cigna Commercial |
$1,894.28
|
| Rate for Payer: Health EOS Commercial |
$1,832.51
|
| Rate for Payer: HFN Commercial |
$1,894.28
|
| Rate for Payer: Multiplan Commercial |
$1,647.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,235.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,894.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,008.91
|
| Rate for Payer: Quartz Commercial |
$1,235.40
|
| Rate for Payer: WEA Trust Commercial |
$1,132.45
|
| Rate for Payer: WPS Commercial |
$1,525.10
|
|
|
SCREW CANN 3.0 X 12 TIGER 200-30-012
|
Facility
|
OP
|
$2,059.00
|
|
| Hospital Charge Code |
3784149
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$576.52 |
| Max. Negotiated Rate |
$8,236.00 |
| Rate for Payer: Aetna Commercial |
$1,853.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,770.74
|
| Rate for Payer: Aetna Managed Medicare |
$576.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,338.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,029.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$988.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,091.27
|
| Rate for Payer: Cash Price |
$617.70
|
| Rate for Payer: Cigna Commercial |
$1,894.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,152.22
|
| Rate for Payer: Health EOS Commercial |
$1,832.51
|
| Rate for Payer: HFN Commercial |
$1,894.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,544.25
|
| Rate for Payer: Multiplan Commercial |
$1,647.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,235.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,894.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,008.91
|
| Rate for Payer: Quartz Commercial |
$1,338.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,235.40
|
| Rate for Payer: The Alliance Commercial |
$8,236.00
|
| Rate for Payer: WEA Trust Commercial |
$1,132.45
|
| Rate for Payer: WPS Commercial |
$1,525.10
|
|
|
SCREW-CANN 3.0 X 13 202.613
|
Facility
|
OP
|
$2,121.00
|
|
| Hospital Charge Code |
2967090
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$593.88 |
| Max. Negotiated Rate |
$8,484.00 |
| Rate for Payer: Aetna Commercial |
$1,908.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,824.06
|
| Rate for Payer: Aetna Managed Medicare |
$593.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,378.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,060.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,018.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,124.13
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cigna Commercial |
$1,951.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,186.91
|
| Rate for Payer: Health EOS Commercial |
$1,887.69
|
| Rate for Payer: HFN Commercial |
$1,951.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,590.75
|
| Rate for Payer: Multiplan Commercial |
$1,696.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,272.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,951.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,039.29
|
| Rate for Payer: Quartz Commercial |
$1,378.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,272.60
|
| Rate for Payer: The Alliance Commercial |
$8,484.00
|
| Rate for Payer: WEA Trust Commercial |
$1,166.55
|
| Rate for Payer: WPS Commercial |
$1,571.02
|
|
|
SCREW-CANN 3.0 X 13 202.613
|
Facility
|
IP
|
$2,121.00
|
|
| Hospital Charge Code |
2967090
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,039.29 |
| Max. Negotiated Rate |
$1,951.32 |
| Rate for Payer: Aetna Commercial |
$1,908.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,824.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,124.13
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cigna Commercial |
$1,951.32
|
| Rate for Payer: Health EOS Commercial |
$1,887.69
|
| Rate for Payer: HFN Commercial |
$1,951.32
|
| Rate for Payer: Multiplan Commercial |
$1,696.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,272.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,951.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,039.29
|
| Rate for Payer: Quartz Commercial |
$1,272.60
|
| Rate for Payer: WEA Trust Commercial |
$1,166.55
|
| Rate for Payer: WPS Commercial |
$1,571.02
|
|
|
SCREW-CANN 3.0 X 14 202.614
|
Facility
|
IP
|
$2,121.00
|
|
| Hospital Charge Code |
2967091
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,039.29 |
| Max. Negotiated Rate |
$1,951.32 |
| Rate for Payer: Aetna Commercial |
$1,908.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,824.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,124.13
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cigna Commercial |
$1,951.32
|
| Rate for Payer: Health EOS Commercial |
$1,887.69
|
| Rate for Payer: HFN Commercial |
$1,951.32
|
| Rate for Payer: Multiplan Commercial |
$1,696.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,272.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,951.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,039.29
|
| Rate for Payer: Quartz Commercial |
$1,272.60
|
| Rate for Payer: WEA Trust Commercial |
$1,166.55
|
| Rate for Payer: WPS Commercial |
$1,571.02
|
|
|
SCREW-CANN 3.0 X 14 202.614
|
Facility
|
OP
|
$2,121.00
|
|
| Hospital Charge Code |
2967091
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$593.88 |
| Max. Negotiated Rate |
$8,484.00 |
| Rate for Payer: Aetna Commercial |
$1,908.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,824.06
|
| Rate for Payer: Aetna Managed Medicare |
$593.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,378.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,060.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,018.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,124.13
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cigna Commercial |
$1,951.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,186.91
|
| Rate for Payer: Health EOS Commercial |
$1,887.69
|
| Rate for Payer: HFN Commercial |
$1,951.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,590.75
|
| Rate for Payer: Multiplan Commercial |
$1,696.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,272.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,951.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,039.29
|
| Rate for Payer: Quartz Commercial |
$1,378.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,272.60
|
| Rate for Payer: The Alliance Commercial |
$8,484.00
|
| Rate for Payer: WEA Trust Commercial |
$1,166.55
|
| Rate for Payer: WPS Commercial |
$1,571.02
|
|
|
SCREW-CANN 3.0 X 14 202.714
|
Facility
|
IP
|
$2,121.00
|
|
| Hospital Charge Code |
2967092
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,039.29 |
| Max. Negotiated Rate |
$1,951.32 |
| Rate for Payer: Aetna Commercial |
$1,908.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,824.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,124.13
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cigna Commercial |
$1,951.32
|
| Rate for Payer: Health EOS Commercial |
$1,887.69
|
| Rate for Payer: HFN Commercial |
$1,951.32
|
| Rate for Payer: Multiplan Commercial |
$1,696.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,272.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,951.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,039.29
|
| Rate for Payer: Quartz Commercial |
$1,272.60
|
| Rate for Payer: WEA Trust Commercial |
$1,166.55
|
| Rate for Payer: WPS Commercial |
$1,571.02
|
|
|
SCREW-CANN 3.0 X 14 202.714
|
Facility
|
OP
|
$2,121.00
|
|
| Hospital Charge Code |
2967092
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$593.88 |
| Max. Negotiated Rate |
$8,484.00 |
| Rate for Payer: Aetna Commercial |
$1,908.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,824.06
|
| Rate for Payer: Aetna Managed Medicare |
$593.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,378.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,060.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,018.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,124.13
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cigna Commercial |
$1,951.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,186.91
|
| Rate for Payer: Health EOS Commercial |
$1,887.69
|
| Rate for Payer: HFN Commercial |
$1,951.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,590.75
|
| Rate for Payer: Multiplan Commercial |
$1,696.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,272.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,951.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,039.29
|
| Rate for Payer: Quartz Commercial |
$1,378.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,272.60
|
| Rate for Payer: The Alliance Commercial |
$8,484.00
|
| Rate for Payer: WEA Trust Commercial |
$1,166.55
|
| Rate for Payer: WPS Commercial |
$1,571.02
|
|
|
SCREW CANN 3.0 X 14 TIGER 200-30-014
|
Facility
|
OP
|
$2,059.00
|
|
| Hospital Charge Code |
3784150
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$576.52 |
| Max. Negotiated Rate |
$8,236.00 |
| Rate for Payer: Aetna Commercial |
$1,853.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,770.74
|
| Rate for Payer: Aetna Managed Medicare |
$576.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,338.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,029.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$988.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,091.27
|
| Rate for Payer: Cash Price |
$617.70
|
| Rate for Payer: Cigna Commercial |
$1,894.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,152.22
|
| Rate for Payer: Health EOS Commercial |
$1,832.51
|
| Rate for Payer: HFN Commercial |
$1,894.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,544.25
|
| Rate for Payer: Multiplan Commercial |
$1,647.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,235.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,894.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,008.91
|
| Rate for Payer: Quartz Commercial |
$1,338.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,235.40
|
| Rate for Payer: The Alliance Commercial |
$8,236.00
|
| Rate for Payer: WEA Trust Commercial |
$1,132.45
|
| Rate for Payer: WPS Commercial |
$1,525.10
|
|
|
SCREW CANN 3.0 X 14 TIGER 200-30-014
|
Facility
|
IP
|
$2,059.00
|
|
| Hospital Charge Code |
3784150
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,008.91 |
| Max. Negotiated Rate |
$1,894.28 |
| Rate for Payer: Aetna Commercial |
$1,853.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,770.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,091.27
|
| Rate for Payer: Cash Price |
$617.70
|
| Rate for Payer: Cigna Commercial |
$1,894.28
|
| Rate for Payer: Health EOS Commercial |
$1,832.51
|
| Rate for Payer: HFN Commercial |
$1,894.28
|
| Rate for Payer: Multiplan Commercial |
$1,647.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,235.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,894.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,008.91
|
| Rate for Payer: Quartz Commercial |
$1,235.40
|
| Rate for Payer: WEA Trust Commercial |
$1,132.45
|
| Rate for Payer: WPS Commercial |
$1,525.10
|
|
|
SCREW-CANN 3.0 X 15 202.615
|
Facility
|
OP
|
$2,121.00
|
|
| Hospital Charge Code |
2967093
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$593.88 |
| Max. Negotiated Rate |
$8,484.00 |
| Rate for Payer: Aetna Commercial |
$1,908.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,824.06
|
| Rate for Payer: Aetna Managed Medicare |
$593.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,378.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,060.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,018.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,124.13
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cigna Commercial |
$1,951.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,186.91
|
| Rate for Payer: Health EOS Commercial |
$1,887.69
|
| Rate for Payer: HFN Commercial |
$1,951.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,590.75
|
| Rate for Payer: Multiplan Commercial |
$1,696.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,272.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,951.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,039.29
|
| Rate for Payer: Quartz Commercial |
$1,378.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,272.60
|
| Rate for Payer: The Alliance Commercial |
$8,484.00
|
| Rate for Payer: WEA Trust Commercial |
$1,166.55
|
| Rate for Payer: WPS Commercial |
$1,571.02
|
|
|
SCREW-CANN 3.0 X 15 202.615
|
Facility
|
IP
|
$2,121.00
|
|
| Hospital Charge Code |
2967093
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,039.29 |
| Max. Negotiated Rate |
$1,951.32 |
| Rate for Payer: Aetna Commercial |
$1,908.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,824.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,124.13
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cigna Commercial |
$1,951.32
|
| Rate for Payer: Health EOS Commercial |
$1,887.69
|
| Rate for Payer: HFN Commercial |
$1,951.32
|
| Rate for Payer: Multiplan Commercial |
$1,696.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,272.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,951.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,039.29
|
| Rate for Payer: Quartz Commercial |
$1,272.60
|
| Rate for Payer: WEA Trust Commercial |
$1,166.55
|
| Rate for Payer: WPS Commercial |
$1,571.02
|
|
|
SCREW-CANN 3.0X15 202.715
|
Facility
|
OP
|
$2,121.00
|
|
| Hospital Charge Code |
2990549
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$593.88 |
| Max. Negotiated Rate |
$8,484.00 |
| Rate for Payer: Aetna Commercial |
$1,908.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,824.06
|
| Rate for Payer: Aetna Managed Medicare |
$593.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,378.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,060.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,018.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,124.13
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cigna Commercial |
$1,951.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,186.91
|
| Rate for Payer: Health EOS Commercial |
$1,887.69
|
| Rate for Payer: HFN Commercial |
$1,951.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,590.75
|
| Rate for Payer: Multiplan Commercial |
$1,696.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,272.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,951.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,039.29
|
| Rate for Payer: Quartz Commercial |
$1,378.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,272.60
|
| Rate for Payer: The Alliance Commercial |
$8,484.00
|
| Rate for Payer: WEA Trust Commercial |
$1,166.55
|
| Rate for Payer: WPS Commercial |
$1,571.02
|
|
|
SCREW-CANN 3.0X15 202.715
|
Facility
|
IP
|
$2,121.00
|
|
| Hospital Charge Code |
2990549
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,039.29 |
| Max. Negotiated Rate |
$1,951.32 |
| Rate for Payer: Aetna Commercial |
$1,908.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,824.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,124.13
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cigna Commercial |
$1,951.32
|
| Rate for Payer: Health EOS Commercial |
$1,887.69
|
| Rate for Payer: HFN Commercial |
$1,951.32
|
| Rate for Payer: Multiplan Commercial |
$1,696.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,272.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,951.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,039.29
|
| Rate for Payer: Quartz Commercial |
$1,272.60
|
| Rate for Payer: WEA Trust Commercial |
$1,166.55
|
| Rate for Payer: WPS Commercial |
$1,571.02
|
|
|
SCREW-CANN 3.0 X 16 202.616
|
Facility
|
IP
|
$2,121.00
|
|
| Hospital Charge Code |
2967094
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,039.29 |
| Max. Negotiated Rate |
$1,951.32 |
| Rate for Payer: Aetna Commercial |
$1,908.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,824.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,124.13
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cigna Commercial |
$1,951.32
|
| Rate for Payer: Health EOS Commercial |
$1,887.69
|
| Rate for Payer: HFN Commercial |
$1,951.32
|
| Rate for Payer: Multiplan Commercial |
$1,696.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,272.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,951.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,039.29
|
| Rate for Payer: Quartz Commercial |
$1,272.60
|
| Rate for Payer: WEA Trust Commercial |
$1,166.55
|
| Rate for Payer: WPS Commercial |
$1,571.02
|
|
|
SCREW-CANN 3.0 X 16 202.616
|
Facility
|
OP
|
$2,121.00
|
|
| Hospital Charge Code |
2967094
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$593.88 |
| Max. Negotiated Rate |
$8,484.00 |
| Rate for Payer: Aetna Commercial |
$1,908.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,824.06
|
| Rate for Payer: Aetna Managed Medicare |
$593.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,378.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,060.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,018.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,124.13
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cigna Commercial |
$1,951.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,186.91
|
| Rate for Payer: Health EOS Commercial |
$1,887.69
|
| Rate for Payer: HFN Commercial |
$1,951.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,590.75
|
| Rate for Payer: Multiplan Commercial |
$1,696.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,272.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,951.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,039.29
|
| Rate for Payer: Quartz Commercial |
$1,378.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,272.60
|
| Rate for Payer: The Alliance Commercial |
$8,484.00
|
| Rate for Payer: WEA Trust Commercial |
$1,166.55
|
| Rate for Payer: WPS Commercial |
$1,571.02
|
|
|
SCREW-CANN 3.0 X 16 202.716
|
Facility
|
IP
|
$2,121.00
|
|
| Hospital Charge Code |
2967095
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,039.29 |
| Max. Negotiated Rate |
$1,951.32 |
| Rate for Payer: Aetna Commercial |
$1,908.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,824.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,124.13
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cigna Commercial |
$1,951.32
|
| Rate for Payer: Health EOS Commercial |
$1,887.69
|
| Rate for Payer: HFN Commercial |
$1,951.32
|
| Rate for Payer: Multiplan Commercial |
$1,696.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,272.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,951.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,039.29
|
| Rate for Payer: Quartz Commercial |
$1,272.60
|
| Rate for Payer: WEA Trust Commercial |
$1,166.55
|
| Rate for Payer: WPS Commercial |
$1,571.02
|
|
|
SCREW-CANN 3.0 X 16 202.716
|
Facility
|
OP
|
$2,121.00
|
|
| Hospital Charge Code |
2967095
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$593.88 |
| Max. Negotiated Rate |
$8,484.00 |
| Rate for Payer: Aetna Commercial |
$1,908.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,824.06
|
| Rate for Payer: Aetna Managed Medicare |
$593.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,378.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,060.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,018.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,124.13
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cigna Commercial |
$1,951.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,186.91
|
| Rate for Payer: Health EOS Commercial |
$1,887.69
|
| Rate for Payer: HFN Commercial |
$1,951.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,590.75
|
| Rate for Payer: Multiplan Commercial |
$1,696.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,272.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,951.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,039.29
|
| Rate for Payer: Quartz Commercial |
$1,378.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,272.60
|
| Rate for Payer: The Alliance Commercial |
$8,484.00
|
| Rate for Payer: WEA Trust Commercial |
$1,166.55
|
| Rate for Payer: WPS Commercial |
$1,571.02
|
|
