|
SCREW-CANN 2.0 X 10 319-2010
|
Facility
|
IP
|
$2,303.00
|
|
| Hospital Charge Code |
2965454
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,173.61 |
| Max. Negotiated Rate |
$2,203.51 |
| Rate for Payer: Aetna Commercial |
$2,155.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,059.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,269.41
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cigna Commercial |
$2,203.51
|
| Rate for Payer: Health EOS Commercial |
$2,131.66
|
| Rate for Payer: HFN Commercial |
$2,203.51
|
| Rate for Payer: Multiplan Commercial |
$1,916.10
|
| Rate for Payer: Preferred Network Access Commercial |
$2,203.51
|
| Rate for Payer: Quartz Beloit One Network |
$1,173.61
|
| Rate for Payer: Quartz Commercial |
$1,437.07
|
| Rate for Payer: WEA Trust Commercial |
$1,317.32
|
| Rate for Payer: WPS Commercial |
$1,774.00
|
|
|
SCREW CANN 2.0 X 10 TIGER 200-20-010
|
Facility
|
IP
|
$2,059.00
|
|
| Hospital Charge Code |
3782752
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,049.27 |
| Max. Negotiated Rate |
$1,970.05 |
| Rate for Payer: Aetna Commercial |
$1,927.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,841.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,134.92
|
| Rate for Payer: Cash Price |
$617.70
|
| Rate for Payer: Cigna Commercial |
$1,970.05
|
| Rate for Payer: Health EOS Commercial |
$1,905.81
|
| Rate for Payer: HFN Commercial |
$1,970.05
|
| Rate for Payer: Multiplan Commercial |
$1,713.09
|
| Rate for Payer: Preferred Network Access Commercial |
$1,970.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,049.27
|
| Rate for Payer: Quartz Commercial |
$1,284.82
|
| Rate for Payer: WEA Trust Commercial |
$1,177.75
|
| Rate for Payer: WPS Commercial |
$1,586.05
|
|
|
SCREW CANN 2.0 X 10 TIGER 200-20-010
|
Facility
|
OP
|
$2,059.00
|
|
| Hospital Charge Code |
3782752
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$599.58 |
| Max. Negotiated Rate |
$1,970.05 |
| Rate for Payer: Aetna Commercial |
$1,927.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,841.57
|
| Rate for Payer: Aetna Managed Medicare |
$599.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,391.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,070.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,027.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,134.92
|
| Rate for Payer: Cash Price |
$617.70
|
| Rate for Payer: Cigna Commercial |
$1,970.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,198.34
|
| Rate for Payer: Health EOS Commercial |
$1,905.81
|
| Rate for Payer: HFN Commercial |
$1,970.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,606.02
|
| Rate for Payer: Multiplan Commercial |
$1,713.09
|
| Rate for Payer: NAPHCARE Commercial |
$1,284.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,970.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,049.27
|
| Rate for Payer: Quartz Commercial |
$1,391.88
|
| Rate for Payer: Quartz Medicare Advantage |
$1,284.82
|
| Rate for Payer: The Alliance Commercial |
$1,070.68
|
| Rate for Payer: WEA Trust Commercial |
$1,177.75
|
| Rate for Payer: WPS Commercial |
$1,586.05
|
|
|
SCREW-CANN 2.0 X 12 319-2012
|
Facility
|
IP
|
$2,303.00
|
|
| Hospital Charge Code |
2965455
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,173.61 |
| Max. Negotiated Rate |
$2,203.51 |
| Rate for Payer: Aetna Commercial |
$2,155.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,059.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,269.41
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cigna Commercial |
$2,203.51
|
| Rate for Payer: Health EOS Commercial |
$2,131.66
|
| Rate for Payer: HFN Commercial |
$2,203.51
|
| Rate for Payer: Multiplan Commercial |
$1,916.10
|
| Rate for Payer: Preferred Network Access Commercial |
$2,203.51
|
| Rate for Payer: Quartz Beloit One Network |
$1,173.61
|
| Rate for Payer: Quartz Commercial |
$1,437.07
|
| Rate for Payer: WEA Trust Commercial |
$1,317.32
|
| Rate for Payer: WPS Commercial |
$1,774.00
|
|
|
SCREW-CANN 2.0 X 12 319-2012
|
Facility
|
OP
|
$2,303.00
|
|
| Hospital Charge Code |
2965455
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$670.63 |
| Max. Negotiated Rate |
$2,203.51 |
| Rate for Payer: Aetna Commercial |
$2,155.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,059.80
|
| Rate for Payer: Aetna Managed Medicare |
$670.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,556.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,197.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,149.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,269.41
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cigna Commercial |
$2,203.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,340.35
|
| Rate for Payer: Health EOS Commercial |
$2,131.66
|
| Rate for Payer: HFN Commercial |
$2,203.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,796.34
|
| Rate for Payer: Multiplan Commercial |
$1,916.10
|
| Rate for Payer: NAPHCARE Commercial |
$1,437.07
|
| Rate for Payer: Preferred Network Access Commercial |
$2,203.51
|
| Rate for Payer: Quartz Beloit One Network |
$1,173.61
|
| Rate for Payer: Quartz Commercial |
$1,556.83
|
| Rate for Payer: Quartz Medicare Advantage |
$1,437.07
|
| Rate for Payer: The Alliance Commercial |
$1,197.56
|
| Rate for Payer: WEA Trust Commercial |
$1,317.32
|
| Rate for Payer: WPS Commercial |
$1,774.00
|
|
|
SCREW CANN 2.0 X 12 TIGER 200-20-012
|
Facility
|
IP
|
$2,139.00
|
|
| Hospital Charge Code |
3487501
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,090.03 |
| Max. Negotiated Rate |
$2,046.60 |
| Rate for Payer: Aetna Commercial |
$2,002.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,913.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,179.02
|
| Rate for Payer: Cash Price |
$641.70
|
| Rate for Payer: Cigna Commercial |
$2,046.60
|
| Rate for Payer: Health EOS Commercial |
$1,979.86
|
| Rate for Payer: HFN Commercial |
$2,046.60
|
| Rate for Payer: Multiplan Commercial |
$1,779.65
|
| Rate for Payer: Preferred Network Access Commercial |
$2,046.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,090.03
|
| Rate for Payer: Quartz Commercial |
$1,334.74
|
| Rate for Payer: WEA Trust Commercial |
$1,223.51
|
| Rate for Payer: WPS Commercial |
$1,647.67
|
|
|
SCREW CANN 2.0 X 12 TIGER 200-20-012
|
Facility
|
OP
|
$2,139.00
|
|
| Hospital Charge Code |
3487501
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$622.88 |
| Max. Negotiated Rate |
$2,046.60 |
| Rate for Payer: Aetna Commercial |
$2,002.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,913.12
|
| Rate for Payer: Aetna Managed Medicare |
$622.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,445.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,112.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,067.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,179.02
|
| Rate for Payer: Cash Price |
$641.70
|
| Rate for Payer: Cigna Commercial |
$2,046.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,244.90
|
| Rate for Payer: Health EOS Commercial |
$1,979.86
|
| Rate for Payer: HFN Commercial |
$2,046.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,668.42
|
| Rate for Payer: Multiplan Commercial |
$1,779.65
|
| Rate for Payer: NAPHCARE Commercial |
$1,334.74
|
| Rate for Payer: Preferred Network Access Commercial |
$2,046.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,090.03
|
| Rate for Payer: Quartz Commercial |
$1,445.96
|
| Rate for Payer: Quartz Medicare Advantage |
$1,334.74
|
| Rate for Payer: The Alliance Commercial |
$1,112.28
|
| Rate for Payer: WEA Trust Commercial |
$1,223.51
|
| Rate for Payer: WPS Commercial |
$1,647.67
|
|
|
SCREW-CANN 2.0 X 14 319-2014
|
Facility
|
IP
|
$2,303.00
|
|
| Hospital Charge Code |
2965457
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,173.61 |
| Max. Negotiated Rate |
$2,203.51 |
| Rate for Payer: Aetna Commercial |
$2,155.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,059.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,269.41
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cigna Commercial |
$2,203.51
|
| Rate for Payer: Health EOS Commercial |
$2,131.66
|
| Rate for Payer: HFN Commercial |
$2,203.51
|
| Rate for Payer: Multiplan Commercial |
$1,916.10
|
| Rate for Payer: Preferred Network Access Commercial |
$2,203.51
|
| Rate for Payer: Quartz Beloit One Network |
$1,173.61
|
| Rate for Payer: Quartz Commercial |
$1,437.07
|
| Rate for Payer: WEA Trust Commercial |
$1,317.32
|
| Rate for Payer: WPS Commercial |
$1,774.00
|
|
|
SCREW-CANN 2.0 X 14 319-2014
|
Facility
|
OP
|
$2,303.00
|
|
| Hospital Charge Code |
2965457
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$670.63 |
| Max. Negotiated Rate |
$2,203.51 |
| Rate for Payer: Aetna Commercial |
$2,155.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,059.80
|
| Rate for Payer: Aetna Managed Medicare |
$670.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,556.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,197.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,149.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,269.41
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cigna Commercial |
$2,203.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,340.35
|
| Rate for Payer: Health EOS Commercial |
$2,131.66
|
| Rate for Payer: HFN Commercial |
$2,203.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,796.34
|
| Rate for Payer: Multiplan Commercial |
$1,916.10
|
| Rate for Payer: NAPHCARE Commercial |
$1,437.07
|
| Rate for Payer: Preferred Network Access Commercial |
$2,203.51
|
| Rate for Payer: Quartz Beloit One Network |
$1,173.61
|
| Rate for Payer: Quartz Commercial |
$1,556.83
|
| Rate for Payer: Quartz Medicare Advantage |
$1,437.07
|
| Rate for Payer: The Alliance Commercial |
$1,197.56
|
| Rate for Payer: WEA Trust Commercial |
$1,317.32
|
| Rate for Payer: WPS Commercial |
$1,774.00
|
|
|
SCREW CANN 2.0 X 14 TIGER 200-20-014
|
Facility
|
IP
|
$2,139.00
|
|
| Hospital Charge Code |
3072566
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,090.03 |
| Max. Negotiated Rate |
$2,046.60 |
| Rate for Payer: Aetna Commercial |
$2,002.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,913.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,179.02
|
| Rate for Payer: Cash Price |
$641.70
|
| Rate for Payer: Cigna Commercial |
$2,046.60
|
| Rate for Payer: Health EOS Commercial |
$1,979.86
|
| Rate for Payer: HFN Commercial |
$2,046.60
|
| Rate for Payer: Multiplan Commercial |
$1,779.65
|
| Rate for Payer: Preferred Network Access Commercial |
$2,046.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,090.03
|
| Rate for Payer: Quartz Commercial |
$1,334.74
|
| Rate for Payer: WEA Trust Commercial |
$1,223.51
|
| Rate for Payer: WPS Commercial |
$1,647.67
|
|
|
SCREW CANN 2.0 X 14 TIGER 200-20-014
|
Facility
|
OP
|
$2,139.00
|
|
| Hospital Charge Code |
3072566
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$622.88 |
| Max. Negotiated Rate |
$2,046.60 |
| Rate for Payer: Aetna Commercial |
$2,002.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,913.12
|
| Rate for Payer: Aetna Managed Medicare |
$622.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,445.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,112.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,067.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,179.02
|
| Rate for Payer: Cash Price |
$641.70
|
| Rate for Payer: Cigna Commercial |
$2,046.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,244.90
|
| Rate for Payer: Health EOS Commercial |
$1,979.86
|
| Rate for Payer: HFN Commercial |
$2,046.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,668.42
|
| Rate for Payer: Multiplan Commercial |
$1,779.65
|
| Rate for Payer: NAPHCARE Commercial |
$1,334.74
|
| Rate for Payer: Preferred Network Access Commercial |
$2,046.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,090.03
|
| Rate for Payer: Quartz Commercial |
$1,445.96
|
| Rate for Payer: Quartz Medicare Advantage |
$1,334.74
|
| Rate for Payer: The Alliance Commercial |
$1,112.28
|
| Rate for Payer: WEA Trust Commercial |
$1,223.51
|
| Rate for Payer: WPS Commercial |
$1,647.67
|
|
|
SCREW-CANN 2.0 X 16 319-2016
|
Facility
|
OP
|
$2,303.00
|
|
| Hospital Charge Code |
2965459
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$670.63 |
| Max. Negotiated Rate |
$2,203.51 |
| Rate for Payer: Aetna Commercial |
$2,155.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,059.80
|
| Rate for Payer: Aetna Managed Medicare |
$670.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,556.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,197.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,149.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,269.41
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cigna Commercial |
$2,203.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,340.35
|
| Rate for Payer: Health EOS Commercial |
$2,131.66
|
| Rate for Payer: HFN Commercial |
$2,203.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,796.34
|
| Rate for Payer: Multiplan Commercial |
$1,916.10
|
| Rate for Payer: NAPHCARE Commercial |
$1,437.07
|
| Rate for Payer: Preferred Network Access Commercial |
$2,203.51
|
| Rate for Payer: Quartz Beloit One Network |
$1,173.61
|
| Rate for Payer: Quartz Commercial |
$1,556.83
|
| Rate for Payer: Quartz Medicare Advantage |
$1,437.07
|
| Rate for Payer: The Alliance Commercial |
$1,197.56
|
| Rate for Payer: WEA Trust Commercial |
$1,317.32
|
| Rate for Payer: WPS Commercial |
$1,774.00
|
|
|
SCREW-CANN 2.0 X 16 319-2016
|
Facility
|
IP
|
$2,303.00
|
|
| Hospital Charge Code |
2965459
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,173.61 |
| Max. Negotiated Rate |
$2,203.51 |
| Rate for Payer: Aetna Commercial |
$2,155.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,059.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,269.41
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cigna Commercial |
$2,203.51
|
| Rate for Payer: Health EOS Commercial |
$2,131.66
|
| Rate for Payer: HFN Commercial |
$2,203.51
|
| Rate for Payer: Multiplan Commercial |
$1,916.10
|
| Rate for Payer: Preferred Network Access Commercial |
$2,203.51
|
| Rate for Payer: Quartz Beloit One Network |
$1,173.61
|
| Rate for Payer: Quartz Commercial |
$1,437.07
|
| Rate for Payer: WEA Trust Commercial |
$1,317.32
|
| Rate for Payer: WPS Commercial |
$1,774.00
|
|
|
SCREW CANN 2.0 X 16 TIGER 200-20-016
|
Facility
|
IP
|
$2,059.00
|
|
| Hospital Charge Code |
3072567
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,049.27 |
| Max. Negotiated Rate |
$1,970.05 |
| Rate for Payer: Aetna Commercial |
$1,927.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,841.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,134.92
|
| Rate for Payer: Cash Price |
$617.70
|
| Rate for Payer: Cigna Commercial |
$1,970.05
|
| Rate for Payer: Health EOS Commercial |
$1,905.81
|
| Rate for Payer: HFN Commercial |
$1,970.05
|
| Rate for Payer: Multiplan Commercial |
$1,713.09
|
| Rate for Payer: Preferred Network Access Commercial |
$1,970.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,049.27
|
| Rate for Payer: Quartz Commercial |
$1,284.82
|
| Rate for Payer: WEA Trust Commercial |
$1,177.75
|
| Rate for Payer: WPS Commercial |
$1,586.05
|
|
|
SCREW CANN 2.0 X 16 TIGER 200-20-016
|
Facility
|
OP
|
$2,059.00
|
|
| Hospital Charge Code |
3072567
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$599.58 |
| Max. Negotiated Rate |
$1,970.05 |
| Rate for Payer: Aetna Commercial |
$1,927.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,841.57
|
| Rate for Payer: Aetna Managed Medicare |
$599.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,391.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,070.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,027.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,134.92
|
| Rate for Payer: Cash Price |
$617.70
|
| Rate for Payer: Cigna Commercial |
$1,970.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,198.34
|
| Rate for Payer: Health EOS Commercial |
$1,905.81
|
| Rate for Payer: HFN Commercial |
$1,970.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,606.02
|
| Rate for Payer: Multiplan Commercial |
$1,713.09
|
| Rate for Payer: NAPHCARE Commercial |
$1,284.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,970.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,049.27
|
| Rate for Payer: Quartz Commercial |
$1,391.88
|
| Rate for Payer: Quartz Medicare Advantage |
$1,284.82
|
| Rate for Payer: The Alliance Commercial |
$1,070.68
|
| Rate for Payer: WEA Trust Commercial |
$1,177.75
|
| Rate for Payer: WPS Commercial |
$1,586.05
|
|
|
SCREW-CANN 2.0 X 18 319-2018
|
Facility
|
OP
|
$2,303.00
|
|
| Hospital Charge Code |
2965461
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$670.63 |
| Max. Negotiated Rate |
$2,203.51 |
| Rate for Payer: Aetna Commercial |
$2,155.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,059.80
|
| Rate for Payer: Aetna Managed Medicare |
$670.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,556.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,197.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,149.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,269.41
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cigna Commercial |
$2,203.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,340.35
|
| Rate for Payer: Health EOS Commercial |
$2,131.66
|
| Rate for Payer: HFN Commercial |
$2,203.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,796.34
|
| Rate for Payer: Multiplan Commercial |
$1,916.10
|
| Rate for Payer: NAPHCARE Commercial |
$1,437.07
|
| Rate for Payer: Preferred Network Access Commercial |
$2,203.51
|
| Rate for Payer: Quartz Beloit One Network |
$1,173.61
|
| Rate for Payer: Quartz Commercial |
$1,556.83
|
| Rate for Payer: Quartz Medicare Advantage |
$1,437.07
|
| Rate for Payer: The Alliance Commercial |
$1,197.56
|
| Rate for Payer: WEA Trust Commercial |
$1,317.32
|
| Rate for Payer: WPS Commercial |
$1,774.00
|
|
|
SCREW-CANN 2.0 X 18 319-2018
|
Facility
|
IP
|
$2,303.00
|
|
| Hospital Charge Code |
2965461
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,173.61 |
| Max. Negotiated Rate |
$2,203.51 |
| Rate for Payer: Aetna Commercial |
$2,155.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,059.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,269.41
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cigna Commercial |
$2,203.51
|
| Rate for Payer: Health EOS Commercial |
$2,131.66
|
| Rate for Payer: HFN Commercial |
$2,203.51
|
| Rate for Payer: Multiplan Commercial |
$1,916.10
|
| Rate for Payer: Preferred Network Access Commercial |
$2,203.51
|
| Rate for Payer: Quartz Beloit One Network |
$1,173.61
|
| Rate for Payer: Quartz Commercial |
$1,437.07
|
| Rate for Payer: WEA Trust Commercial |
$1,317.32
|
| Rate for Payer: WPS Commercial |
$1,774.00
|
|
|
SCREW CANN 2.0 X 18 TIGER 200-20-018
|
Facility
|
IP
|
$2,139.00
|
|
| Hospital Charge Code |
3487502
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,090.03 |
| Max. Negotiated Rate |
$2,046.60 |
| Rate for Payer: Aetna Commercial |
$2,002.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,913.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,179.02
|
| Rate for Payer: Cash Price |
$641.70
|
| Rate for Payer: Cigna Commercial |
$2,046.60
|
| Rate for Payer: Health EOS Commercial |
$1,979.86
|
| Rate for Payer: HFN Commercial |
$2,046.60
|
| Rate for Payer: Multiplan Commercial |
$1,779.65
|
| Rate for Payer: Preferred Network Access Commercial |
$2,046.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,090.03
|
| Rate for Payer: Quartz Commercial |
$1,334.74
|
| Rate for Payer: WEA Trust Commercial |
$1,223.51
|
| Rate for Payer: WPS Commercial |
$1,647.67
|
|
|
SCREW CANN 2.0 X 18 TIGER 200-20-018
|
Facility
|
OP
|
$2,139.00
|
|
| Hospital Charge Code |
3487502
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$622.88 |
| Max. Negotiated Rate |
$2,046.60 |
| Rate for Payer: Aetna Commercial |
$2,002.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,913.12
|
| Rate for Payer: Aetna Managed Medicare |
$622.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,445.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,112.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,067.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,179.02
|
| Rate for Payer: Cash Price |
$641.70
|
| Rate for Payer: Cigna Commercial |
$2,046.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,244.90
|
| Rate for Payer: Health EOS Commercial |
$1,979.86
|
| Rate for Payer: HFN Commercial |
$2,046.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,668.42
|
| Rate for Payer: Multiplan Commercial |
$1,779.65
|
| Rate for Payer: NAPHCARE Commercial |
$1,334.74
|
| Rate for Payer: Preferred Network Access Commercial |
$2,046.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,090.03
|
| Rate for Payer: Quartz Commercial |
$1,445.96
|
| Rate for Payer: Quartz Medicare Advantage |
$1,334.74
|
| Rate for Payer: The Alliance Commercial |
$1,112.28
|
| Rate for Payer: WEA Trust Commercial |
$1,223.51
|
| Rate for Payer: WPS Commercial |
$1,647.67
|
|
|
SCREW-CANN 2.0 X 20 319-2020
|
Facility
|
OP
|
$2,303.00
|
|
| Hospital Charge Code |
2965463
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$670.63 |
| Max. Negotiated Rate |
$2,203.51 |
| Rate for Payer: Aetna Commercial |
$2,155.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,059.80
|
| Rate for Payer: Aetna Managed Medicare |
$670.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,556.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,197.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,149.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,269.41
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cigna Commercial |
$2,203.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,340.35
|
| Rate for Payer: Health EOS Commercial |
$2,131.66
|
| Rate for Payer: HFN Commercial |
$2,203.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,796.34
|
| Rate for Payer: Multiplan Commercial |
$1,916.10
|
| Rate for Payer: NAPHCARE Commercial |
$1,437.07
|
| Rate for Payer: Preferred Network Access Commercial |
$2,203.51
|
| Rate for Payer: Quartz Beloit One Network |
$1,173.61
|
| Rate for Payer: Quartz Commercial |
$1,556.83
|
| Rate for Payer: Quartz Medicare Advantage |
$1,437.07
|
| Rate for Payer: The Alliance Commercial |
$1,197.56
|
| Rate for Payer: WEA Trust Commercial |
$1,317.32
|
| Rate for Payer: WPS Commercial |
$1,774.00
|
|
|
SCREW-CANN 2.0 X 20 319-2020
|
Facility
|
IP
|
$2,303.00
|
|
| Hospital Charge Code |
2965463
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,173.61 |
| Max. Negotiated Rate |
$2,203.51 |
| Rate for Payer: Aetna Commercial |
$2,155.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,059.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,269.41
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cigna Commercial |
$2,203.51
|
| Rate for Payer: Health EOS Commercial |
$2,131.66
|
| Rate for Payer: HFN Commercial |
$2,203.51
|
| Rate for Payer: Multiplan Commercial |
$1,916.10
|
| Rate for Payer: Preferred Network Access Commercial |
$2,203.51
|
| Rate for Payer: Quartz Beloit One Network |
$1,173.61
|
| Rate for Payer: Quartz Commercial |
$1,437.07
|
| Rate for Payer: WEA Trust Commercial |
$1,317.32
|
| Rate for Payer: WPS Commercial |
$1,774.00
|
|
|
SCREW CANN 2.0 X 20 TIGER 200-20-020
|
Facility
|
OP
|
$2,059.00
|
|
| Hospital Charge Code |
3782753
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$599.58 |
| Max. Negotiated Rate |
$1,970.05 |
| Rate for Payer: Aetna Commercial |
$1,927.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,841.57
|
| Rate for Payer: Aetna Managed Medicare |
$599.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,391.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,070.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,027.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,134.92
|
| Rate for Payer: Cash Price |
$617.70
|
| Rate for Payer: Cigna Commercial |
$1,970.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,198.34
|
| Rate for Payer: Health EOS Commercial |
$1,905.81
|
| Rate for Payer: HFN Commercial |
$1,970.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,606.02
|
| Rate for Payer: Multiplan Commercial |
$1,713.09
|
| Rate for Payer: NAPHCARE Commercial |
$1,284.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,970.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,049.27
|
| Rate for Payer: Quartz Commercial |
$1,391.88
|
| Rate for Payer: Quartz Medicare Advantage |
$1,284.82
|
| Rate for Payer: The Alliance Commercial |
$1,070.68
|
| Rate for Payer: WEA Trust Commercial |
$1,177.75
|
| Rate for Payer: WPS Commercial |
$1,586.05
|
|
|
SCREW CANN 2.0 X 20 TIGER 200-20-020
|
Facility
|
IP
|
$2,059.00
|
|
| Hospital Charge Code |
3782753
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,049.27 |
| Max. Negotiated Rate |
$1,970.05 |
| Rate for Payer: Aetna Commercial |
$1,927.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,841.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,134.92
|
| Rate for Payer: Cash Price |
$617.70
|
| Rate for Payer: Cigna Commercial |
$1,970.05
|
| Rate for Payer: Health EOS Commercial |
$1,905.81
|
| Rate for Payer: HFN Commercial |
$1,970.05
|
| Rate for Payer: Multiplan Commercial |
$1,713.09
|
| Rate for Payer: Preferred Network Access Commercial |
$1,970.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,049.27
|
| Rate for Payer: Quartz Commercial |
$1,284.82
|
| Rate for Payer: WEA Trust Commercial |
$1,177.75
|
| Rate for Payer: WPS Commercial |
$1,586.05
|
|
|
SCREW CANN 2.0 X 22 TIGER 200-20-022
|
Facility
|
OP
|
$2,059.00
|
|
| Hospital Charge Code |
3782754
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$599.58 |
| Max. Negotiated Rate |
$1,970.05 |
| Rate for Payer: Aetna Commercial |
$1,927.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,841.57
|
| Rate for Payer: Aetna Managed Medicare |
$599.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,391.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,070.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,027.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,134.92
|
| Rate for Payer: Cash Price |
$617.70
|
| Rate for Payer: Cigna Commercial |
$1,970.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,198.34
|
| Rate for Payer: Health EOS Commercial |
$1,905.81
|
| Rate for Payer: HFN Commercial |
$1,970.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,606.02
|
| Rate for Payer: Multiplan Commercial |
$1,713.09
|
| Rate for Payer: NAPHCARE Commercial |
$1,284.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,970.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,049.27
|
| Rate for Payer: Quartz Commercial |
$1,391.88
|
| Rate for Payer: Quartz Medicare Advantage |
$1,284.82
|
| Rate for Payer: The Alliance Commercial |
$1,070.68
|
| Rate for Payer: WEA Trust Commercial |
$1,177.75
|
| Rate for Payer: WPS Commercial |
$1,586.05
|
|
|
SCREW CANN 2.0 X 22 TIGER 200-20-022
|
Facility
|
IP
|
$2,059.00
|
|
| Hospital Charge Code |
3782754
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,049.27 |
| Max. Negotiated Rate |
$1,970.05 |
| Rate for Payer: Aetna Commercial |
$1,927.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,841.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,134.92
|
| Rate for Payer: Cash Price |
$617.70
|
| Rate for Payer: Cigna Commercial |
$1,970.05
|
| Rate for Payer: Health EOS Commercial |
$1,905.81
|
| Rate for Payer: HFN Commercial |
$1,970.05
|
| Rate for Payer: Multiplan Commercial |
$1,713.09
|
| Rate for Payer: Preferred Network Access Commercial |
$1,970.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,049.27
|
| Rate for Payer: Quartz Commercial |
$1,284.82
|
| Rate for Payer: WEA Trust Commercial |
$1,177.75
|
| Rate for Payer: WPS Commercial |
$1,586.05
|
|
