|
SCREW CANN 3.0 X 26 TIGER 200-30-026
|
Facility
|
OP
|
$2,059.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3784153
|
|
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 26 TIGER 200-30-026
|
Facility
|
IP
|
$2,059.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3784153
|
|
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 X2 7 202.627
|
Facility
|
OP
|
$2,121.00
|
|
| Hospital Charge Code |
2967110
|
|
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 X2 7 202.627
|
Facility
|
IP
|
$2,121.00
|
|
| Hospital Charge Code |
2967110
|
|
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 3.0X27 202.727
|
Facility
|
OP
|
$2,121.00
|
|
| Hospital Charge Code |
2990556
|
|
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 3.0X27 202.727
|
Facility
|
IP
|
$2,121.00
|
|
| Hospital Charge Code |
2990556
|
|
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 28 202.628
|
Facility
|
OP
|
$2,121.00
|
|
| Hospital Charge Code |
2967111
|
|
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 28 202.628
|
Facility
|
IP
|
$2,121.00
|
|
| Hospital Charge Code |
2967111
|
|
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 28 202.728
|
Facility
|
IP
|
$2,121.00
|
|
| Hospital Charge Code |
2967112
|
|
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 28 202.728
|
Facility
|
OP
|
$2,121.00
|
|
| Hospital Charge Code |
2967112
|
|
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 28 TIGER 200-30-028
|
Facility
|
IP
|
$2,059.00
|
|
| Hospital Charge Code |
3784154
|
|
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 28 TIGER 200-30-028
|
Facility
|
OP
|
$2,059.00
|
|
| Hospital Charge Code |
3784154
|
|
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 29 202.629
|
Facility
|
IP
|
$2,121.00
|
|
| Hospital Charge Code |
2967113
|
|
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 29 202.629
|
Facility
|
OP
|
$2,121.00
|
|
| Hospital Charge Code |
2967113
|
|
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 29 202.729
|
Facility
|
IP
|
$2,121.00
|
|
| Hospital Charge Code |
2967114
|
|
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 29 202.729
|
Facility
|
OP
|
$2,121.00
|
|
| Hospital Charge Code |
2967114
|
|
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 30 202.630
|
Facility
|
IP
|
$2,121.00
|
|
| Hospital Charge Code |
2967115
|
|
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 30 202.630
|
Facility
|
OP
|
$2,121.00
|
|
| Hospital Charge Code |
2967115
|
|
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 30 202.730
|
Facility
|
OP
|
$2,121.00
|
|
| Hospital Charge Code |
2967116
|
|
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 30 202.730
|
Facility
|
IP
|
$2,121.00
|
|
| Hospital Charge Code |
2967116
|
|
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 30 TIGER 200-30-030
|
Facility
|
IP
|
$2,059.00
|
|
| Hospital Charge Code |
3784156
|
|
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 30 TIGER 200-30-030
|
Facility
|
OP
|
$2,059.00
|
|
| Hospital Charge Code |
3784156
|
|
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 32 202.632
|
Facility
|
OP
|
$2,121.00
|
|
| Hospital Charge Code |
2967117
|
|
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 32 202.632
|
Facility
|
IP
|
$2,121.00
|
|
| Hospital Charge Code |
2967117
|
|
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 32 202.732
|
Facility
|
IP
|
$2,202.00
|
|
| Hospital Charge Code |
2967118
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,078.98 |
| Max. Negotiated Rate |
$2,025.84 |
| Rate for Payer: Aetna Commercial |
$1,981.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,893.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,167.06
|
| Rate for Payer: Cash Price |
$660.60
|
| Rate for Payer: Cigna Commercial |
$2,025.84
|
| Rate for Payer: Health EOS Commercial |
$1,959.78
|
| Rate for Payer: HFN Commercial |
$2,025.84
|
| Rate for Payer: Multiplan Commercial |
$1,761.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,321.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,025.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,078.98
|
| Rate for Payer: Quartz Commercial |
$1,321.20
|
| Rate for Payer: WEA Trust Commercial |
$1,211.10
|
| Rate for Payer: WPS Commercial |
$1,631.02
|
|
