|
SCREW-CANN 3.0 X 14 202.614
|
Facility
|
OP
|
$2,121.00
|
|
| Hospital Charge Code |
2967091
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$617.64 |
| Max. Negotiated Rate |
$2,029.37 |
| Rate for Payer: Aetna Commercial |
$1,985.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,897.02
|
| Rate for Payer: Aetna Managed Medicare |
$617.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,433.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,102.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,058.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,169.10
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cigna Commercial |
$2,029.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,234.42
|
| Rate for Payer: Health EOS Commercial |
$1,963.20
|
| Rate for Payer: HFN Commercial |
$2,029.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,654.38
|
| Rate for Payer: Multiplan Commercial |
$1,764.67
|
| Rate for Payer: NAPHCARE Commercial |
$1,323.50
|
| Rate for Payer: Preferred Network Access Commercial |
$2,029.37
|
| Rate for Payer: Quartz Beloit One Network |
$1,080.86
|
| Rate for Payer: Quartz Commercial |
$1,433.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,323.50
|
| Rate for Payer: The Alliance Commercial |
$1,102.92
|
| Rate for Payer: WEA Trust Commercial |
$1,213.21
|
| Rate for Payer: WPS Commercial |
$1,633.81
|
|
|
SCREW-CANN 3.0 X 14 202.714
|
Facility
|
OP
|
$2,121.00
|
|
| Hospital Charge Code |
2967092
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$617.64 |
| Max. Negotiated Rate |
$2,029.37 |
| Rate for Payer: Aetna Commercial |
$1,985.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,897.02
|
| Rate for Payer: Aetna Managed Medicare |
$617.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,433.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,102.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,058.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,169.10
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cigna Commercial |
$2,029.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,234.42
|
| Rate for Payer: Health EOS Commercial |
$1,963.20
|
| Rate for Payer: HFN Commercial |
$2,029.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,654.38
|
| Rate for Payer: Multiplan Commercial |
$1,764.67
|
| Rate for Payer: NAPHCARE Commercial |
$1,323.50
|
| Rate for Payer: Preferred Network Access Commercial |
$2,029.37
|
| Rate for Payer: Quartz Beloit One Network |
$1,080.86
|
| Rate for Payer: Quartz Commercial |
$1,433.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,323.50
|
| Rate for Payer: The Alliance Commercial |
$1,102.92
|
| Rate for Payer: WEA Trust Commercial |
$1,213.21
|
| Rate for Payer: WPS Commercial |
$1,633.81
|
|
|
SCREW-CANN 3.0 X 14 202.714
|
Facility
|
IP
|
$2,121.00
|
|
| Hospital Charge Code |
2967092
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,080.86 |
| Max. Negotiated Rate |
$2,029.37 |
| Rate for Payer: Aetna Commercial |
$1,985.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,897.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,169.10
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cigna Commercial |
$2,029.37
|
| Rate for Payer: Health EOS Commercial |
$1,963.20
|
| Rate for Payer: HFN Commercial |
$2,029.37
|
| Rate for Payer: Multiplan Commercial |
$1,764.67
|
| Rate for Payer: Preferred Network Access Commercial |
$2,029.37
|
| Rate for Payer: Quartz Beloit One Network |
$1,080.86
|
| Rate for Payer: Quartz Commercial |
$1,323.50
|
| Rate for Payer: WEA Trust Commercial |
$1,213.21
|
| Rate for Payer: WPS Commercial |
$1,633.81
|
|
|
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 |
$1,049.27 |
| 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 3.0 X 14 TIGER 200-30-014
|
Facility
|
OP
|
$2,059.00
|
|
| Hospital Charge Code |
3784150
|
|
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 3.0 X 15 202.615
|
Facility
|
IP
|
$2,121.00
|
|
| Hospital Charge Code |
2967093
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,080.86 |
| Max. Negotiated Rate |
$2,029.37 |
| Rate for Payer: Aetna Commercial |
$1,985.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,897.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,169.10
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cigna Commercial |
$2,029.37
|
| Rate for Payer: Health EOS Commercial |
$1,963.20
|
| Rate for Payer: HFN Commercial |
$2,029.37
|
| Rate for Payer: Multiplan Commercial |
$1,764.67
|
| Rate for Payer: Preferred Network Access Commercial |
$2,029.37
|
| Rate for Payer: Quartz Beloit One Network |
$1,080.86
|
| Rate for Payer: Quartz Commercial |
$1,323.50
|
| Rate for Payer: WEA Trust Commercial |
$1,213.21
|
| Rate for Payer: WPS Commercial |
$1,633.81
|
|
|
SCREW-CANN 3.0 X 15 202.615
|
Facility
|
OP
|
$2,121.00
|
|
| Hospital Charge Code |
2967093
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$617.64 |
| Max. Negotiated Rate |
$2,029.37 |
| Rate for Payer: Aetna Commercial |
$1,985.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,897.02
|
| Rate for Payer: Aetna Managed Medicare |
$617.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,433.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,102.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,058.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,169.10
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cigna Commercial |
$2,029.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,234.42
|
| Rate for Payer: Health EOS Commercial |
$1,963.20
|
| Rate for Payer: HFN Commercial |
$2,029.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,654.38
|
| Rate for Payer: Multiplan Commercial |
$1,764.67
|
| Rate for Payer: NAPHCARE Commercial |
$1,323.50
|
| Rate for Payer: Preferred Network Access Commercial |
$2,029.37
|
| Rate for Payer: Quartz Beloit One Network |
$1,080.86
|
| Rate for Payer: Quartz Commercial |
$1,433.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,323.50
|
| Rate for Payer: The Alliance Commercial |
$1,102.92
|
| Rate for Payer: WEA Trust Commercial |
$1,213.21
|
| Rate for Payer: WPS Commercial |
$1,633.81
|
|
|
SCREW-CANN 3.0X15 202.715
|
Facility
|
IP
|
$2,121.00
|
|
| Hospital Charge Code |
2990549
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,080.86 |
| Max. Negotiated Rate |
$2,029.37 |
| Rate for Payer: Aetna Commercial |
$1,985.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,897.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,169.10
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cigna Commercial |
$2,029.37
|
| Rate for Payer: Health EOS Commercial |
$1,963.20
|
| Rate for Payer: HFN Commercial |
$2,029.37
|
| Rate for Payer: Multiplan Commercial |
$1,764.67
|
| Rate for Payer: Preferred Network Access Commercial |
$2,029.37
|
| Rate for Payer: Quartz Beloit One Network |
$1,080.86
|
| Rate for Payer: Quartz Commercial |
$1,323.50
|
| Rate for Payer: WEA Trust Commercial |
$1,213.21
|
| Rate for Payer: WPS Commercial |
$1,633.81
|
|
|
SCREW-CANN 3.0X15 202.715
|
Facility
|
OP
|
$2,121.00
|
|
| Hospital Charge Code |
2990549
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$617.64 |
| Max. Negotiated Rate |
$2,029.37 |
| Rate for Payer: Aetna Commercial |
$1,985.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,897.02
|
| Rate for Payer: Aetna Managed Medicare |
$617.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,433.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,102.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,058.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,169.10
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cigna Commercial |
$2,029.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,234.42
|
| Rate for Payer: Health EOS Commercial |
$1,963.20
|
| Rate for Payer: HFN Commercial |
$2,029.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,654.38
|
| Rate for Payer: Multiplan Commercial |
$1,764.67
|
| Rate for Payer: NAPHCARE Commercial |
$1,323.50
|
| Rate for Payer: Preferred Network Access Commercial |
$2,029.37
|
| Rate for Payer: Quartz Beloit One Network |
$1,080.86
|
| Rate for Payer: Quartz Commercial |
$1,433.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,323.50
|
| Rate for Payer: The Alliance Commercial |
$1,102.92
|
| Rate for Payer: WEA Trust Commercial |
$1,213.21
|
| Rate for Payer: WPS Commercial |
$1,633.81
|
|
|
SCREW-CANN 3.0 X 16 202.616
|
Facility
|
IP
|
$2,121.00
|
|
| Hospital Charge Code |
2967094
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,080.86 |
| Max. Negotiated Rate |
$2,029.37 |
| Rate for Payer: Aetna Commercial |
$1,985.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,897.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,169.10
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cigna Commercial |
$2,029.37
|
| Rate for Payer: Health EOS Commercial |
$1,963.20
|
| Rate for Payer: HFN Commercial |
$2,029.37
|
| Rate for Payer: Multiplan Commercial |
$1,764.67
|
| Rate for Payer: Preferred Network Access Commercial |
$2,029.37
|
| Rate for Payer: Quartz Beloit One Network |
$1,080.86
|
| Rate for Payer: Quartz Commercial |
$1,323.50
|
| Rate for Payer: WEA Trust Commercial |
$1,213.21
|
| Rate for Payer: WPS Commercial |
$1,633.81
|
|
|
SCREW-CANN 3.0 X 16 202.616
|
Facility
|
OP
|
$2,121.00
|
|
| Hospital Charge Code |
2967094
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$617.64 |
| Max. Negotiated Rate |
$2,029.37 |
| Rate for Payer: Aetna Commercial |
$1,985.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,897.02
|
| Rate for Payer: Aetna Managed Medicare |
$617.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,433.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,102.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,058.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,169.10
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cigna Commercial |
$2,029.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,234.42
|
| Rate for Payer: Health EOS Commercial |
$1,963.20
|
| Rate for Payer: HFN Commercial |
$2,029.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,654.38
|
| Rate for Payer: Multiplan Commercial |
$1,764.67
|
| Rate for Payer: NAPHCARE Commercial |
$1,323.50
|
| Rate for Payer: Preferred Network Access Commercial |
$2,029.37
|
| Rate for Payer: Quartz Beloit One Network |
$1,080.86
|
| Rate for Payer: Quartz Commercial |
$1,433.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,323.50
|
| Rate for Payer: The Alliance Commercial |
$1,102.92
|
| Rate for Payer: WEA Trust Commercial |
$1,213.21
|
| Rate for Payer: WPS Commercial |
$1,633.81
|
|
|
SCREW-CANN 3.0 X 16 202.716
|
Facility
|
IP
|
$2,121.00
|
|
| Hospital Charge Code |
2967095
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,080.86 |
| Max. Negotiated Rate |
$2,029.37 |
| Rate for Payer: Aetna Commercial |
$1,985.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,897.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,169.10
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cigna Commercial |
$2,029.37
|
| Rate for Payer: Health EOS Commercial |
$1,963.20
|
| Rate for Payer: HFN Commercial |
$2,029.37
|
| Rate for Payer: Multiplan Commercial |
$1,764.67
|
| Rate for Payer: Preferred Network Access Commercial |
$2,029.37
|
| Rate for Payer: Quartz Beloit One Network |
$1,080.86
|
| Rate for Payer: Quartz Commercial |
$1,323.50
|
| Rate for Payer: WEA Trust Commercial |
$1,213.21
|
| Rate for Payer: WPS Commercial |
$1,633.81
|
|
|
SCREW-CANN 3.0 X 16 202.716
|
Facility
|
OP
|
$2,121.00
|
|
| Hospital Charge Code |
2967095
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$617.64 |
| Max. Negotiated Rate |
$2,029.37 |
| Rate for Payer: Aetna Commercial |
$1,985.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,897.02
|
| Rate for Payer: Aetna Managed Medicare |
$617.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,433.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,102.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,058.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,169.10
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cigna Commercial |
$2,029.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,234.42
|
| Rate for Payer: Health EOS Commercial |
$1,963.20
|
| Rate for Payer: HFN Commercial |
$2,029.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,654.38
|
| Rate for Payer: Multiplan Commercial |
$1,764.67
|
| Rate for Payer: NAPHCARE Commercial |
$1,323.50
|
| Rate for Payer: Preferred Network Access Commercial |
$2,029.37
|
| Rate for Payer: Quartz Beloit One Network |
$1,080.86
|
| Rate for Payer: Quartz Commercial |
$1,433.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,323.50
|
| Rate for Payer: The Alliance Commercial |
$1,102.92
|
| Rate for Payer: WEA Trust Commercial |
$1,213.21
|
| Rate for Payer: WPS Commercial |
$1,633.81
|
|
|
SCREW CANN 3.0 X 16 TIGER 200-30-016
|
Facility
|
OP
|
$2,059.00
|
|
| Hospital Charge Code |
3333543
|
|
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 3.0 X 16 TIGER 200-30-016
|
Facility
|
IP
|
$2,059.00
|
|
| Hospital Charge Code |
3333543
|
|
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 3.0 X 17 202.617
|
Facility
|
OP
|
$2,121.00
|
|
| Hospital Charge Code |
2967096
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$617.64 |
| Max. Negotiated Rate |
$2,029.37 |
| Rate for Payer: Aetna Commercial |
$1,985.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,897.02
|
| Rate for Payer: Aetna Managed Medicare |
$617.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,433.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,102.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,058.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,169.10
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cigna Commercial |
$2,029.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,234.42
|
| Rate for Payer: Health EOS Commercial |
$1,963.20
|
| Rate for Payer: HFN Commercial |
$2,029.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,654.38
|
| Rate for Payer: Multiplan Commercial |
$1,764.67
|
| Rate for Payer: NAPHCARE Commercial |
$1,323.50
|
| Rate for Payer: Preferred Network Access Commercial |
$2,029.37
|
| Rate for Payer: Quartz Beloit One Network |
$1,080.86
|
| Rate for Payer: Quartz Commercial |
$1,433.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,323.50
|
| Rate for Payer: The Alliance Commercial |
$1,102.92
|
| Rate for Payer: WEA Trust Commercial |
$1,213.21
|
| Rate for Payer: WPS Commercial |
$1,633.81
|
|
|
SCREW-CANN 3.0 X 17 202.617
|
Facility
|
IP
|
$2,121.00
|
|
| Hospital Charge Code |
2967096
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,080.86 |
| Max. Negotiated Rate |
$2,029.37 |
| Rate for Payer: Aetna Commercial |
$1,985.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,897.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,169.10
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cigna Commercial |
$2,029.37
|
| Rate for Payer: Health EOS Commercial |
$1,963.20
|
| Rate for Payer: HFN Commercial |
$2,029.37
|
| Rate for Payer: Multiplan Commercial |
$1,764.67
|
| Rate for Payer: Preferred Network Access Commercial |
$2,029.37
|
| Rate for Payer: Quartz Beloit One Network |
$1,080.86
|
| Rate for Payer: Quartz Commercial |
$1,323.50
|
| Rate for Payer: WEA Trust Commercial |
$1,213.21
|
| Rate for Payer: WPS Commercial |
$1,633.81
|
|
|
SCREW-CANN 3.0X17 202.717
|
Facility
|
IP
|
$2,121.00
|
|
| Hospital Charge Code |
2990550
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,080.86 |
| Max. Negotiated Rate |
$2,029.37 |
| Rate for Payer: Aetna Commercial |
$1,985.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,897.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,169.10
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cigna Commercial |
$2,029.37
|
| Rate for Payer: Health EOS Commercial |
$1,963.20
|
| Rate for Payer: HFN Commercial |
$2,029.37
|
| Rate for Payer: Multiplan Commercial |
$1,764.67
|
| Rate for Payer: Preferred Network Access Commercial |
$2,029.37
|
| Rate for Payer: Quartz Beloit One Network |
$1,080.86
|
| Rate for Payer: Quartz Commercial |
$1,323.50
|
| Rate for Payer: WEA Trust Commercial |
$1,213.21
|
| Rate for Payer: WPS Commercial |
$1,633.81
|
|
|
SCREW-CANN 3.0X17 202.717
|
Facility
|
OP
|
$2,121.00
|
|
| Hospital Charge Code |
2990550
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$617.64 |
| Max. Negotiated Rate |
$2,029.37 |
| Rate for Payer: Aetna Commercial |
$1,985.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,897.02
|
| Rate for Payer: Aetna Managed Medicare |
$617.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,433.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,102.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,058.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,169.10
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cigna Commercial |
$2,029.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,234.42
|
| Rate for Payer: Health EOS Commercial |
$1,963.20
|
| Rate for Payer: HFN Commercial |
$2,029.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,654.38
|
| Rate for Payer: Multiplan Commercial |
$1,764.67
|
| Rate for Payer: NAPHCARE Commercial |
$1,323.50
|
| Rate for Payer: Preferred Network Access Commercial |
$2,029.37
|
| Rate for Payer: Quartz Beloit One Network |
$1,080.86
|
| Rate for Payer: Quartz Commercial |
$1,433.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,323.50
|
| Rate for Payer: The Alliance Commercial |
$1,102.92
|
| Rate for Payer: WEA Trust Commercial |
$1,213.21
|
| Rate for Payer: WPS Commercial |
$1,633.81
|
|
|
SCREW-CANN 3.0 X 18 202.618
|
Facility
|
OP
|
$2,121.00
|
|
| Hospital Charge Code |
2967097
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$617.64 |
| Max. Negotiated Rate |
$2,029.37 |
| Rate for Payer: Aetna Commercial |
$1,985.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,897.02
|
| Rate for Payer: Aetna Managed Medicare |
$617.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,433.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,102.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,058.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,169.10
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cigna Commercial |
$2,029.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,234.42
|
| Rate for Payer: Health EOS Commercial |
$1,963.20
|
| Rate for Payer: HFN Commercial |
$2,029.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,654.38
|
| Rate for Payer: Multiplan Commercial |
$1,764.67
|
| Rate for Payer: NAPHCARE Commercial |
$1,323.50
|
| Rate for Payer: Preferred Network Access Commercial |
$2,029.37
|
| Rate for Payer: Quartz Beloit One Network |
$1,080.86
|
| Rate for Payer: Quartz Commercial |
$1,433.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,323.50
|
| Rate for Payer: The Alliance Commercial |
$1,102.92
|
| Rate for Payer: WEA Trust Commercial |
$1,213.21
|
| Rate for Payer: WPS Commercial |
$1,633.81
|
|
|
SCREW-CANN 3.0 X 18 202.618
|
Facility
|
IP
|
$2,121.00
|
|
| Hospital Charge Code |
2967097
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,080.86 |
| Max. Negotiated Rate |
$2,029.37 |
| Rate for Payer: Aetna Commercial |
$1,985.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,897.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,169.10
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cigna Commercial |
$2,029.37
|
| Rate for Payer: Health EOS Commercial |
$1,963.20
|
| Rate for Payer: HFN Commercial |
$2,029.37
|
| Rate for Payer: Multiplan Commercial |
$1,764.67
|
| Rate for Payer: Preferred Network Access Commercial |
$2,029.37
|
| Rate for Payer: Quartz Beloit One Network |
$1,080.86
|
| Rate for Payer: Quartz Commercial |
$1,323.50
|
| Rate for Payer: WEA Trust Commercial |
$1,213.21
|
| Rate for Payer: WPS Commercial |
$1,633.81
|
|
|
SCREW-CANN 3.0X18 202.718
|
Facility
|
IP
|
$2,121.00
|
|
| Hospital Charge Code |
2990551
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,080.86 |
| Max. Negotiated Rate |
$2,029.37 |
| Rate for Payer: Aetna Commercial |
$1,985.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,897.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,169.10
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cigna Commercial |
$2,029.37
|
| Rate for Payer: Health EOS Commercial |
$1,963.20
|
| Rate for Payer: HFN Commercial |
$2,029.37
|
| Rate for Payer: Multiplan Commercial |
$1,764.67
|
| Rate for Payer: Preferred Network Access Commercial |
$2,029.37
|
| Rate for Payer: Quartz Beloit One Network |
$1,080.86
|
| Rate for Payer: Quartz Commercial |
$1,323.50
|
| Rate for Payer: WEA Trust Commercial |
$1,213.21
|
| Rate for Payer: WPS Commercial |
$1,633.81
|
|
|
SCREW-CANN 3.0X18 202.718
|
Facility
|
OP
|
$2,121.00
|
|
| Hospital Charge Code |
2990551
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$617.64 |
| Max. Negotiated Rate |
$2,029.37 |
| Rate for Payer: Aetna Commercial |
$1,985.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,897.02
|
| Rate for Payer: Aetna Managed Medicare |
$617.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,433.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,102.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,058.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,169.10
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cigna Commercial |
$2,029.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,234.42
|
| Rate for Payer: Health EOS Commercial |
$1,963.20
|
| Rate for Payer: HFN Commercial |
$2,029.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,654.38
|
| Rate for Payer: Multiplan Commercial |
$1,764.67
|
| Rate for Payer: NAPHCARE Commercial |
$1,323.50
|
| Rate for Payer: Preferred Network Access Commercial |
$2,029.37
|
| Rate for Payer: Quartz Beloit One Network |
$1,080.86
|
| Rate for Payer: Quartz Commercial |
$1,433.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,323.50
|
| Rate for Payer: The Alliance Commercial |
$1,102.92
|
| Rate for Payer: WEA Trust Commercial |
$1,213.21
|
| Rate for Payer: WPS Commercial |
$1,633.81
|
|
|
SCREW CANN 3.0 X 18 TIGER 200-30-018
|
Facility
|
OP
|
$2,059.00
|
|
| Hospital Charge Code |
3784151
|
|
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 3.0 X 18 TIGER 200-30-018
|
Facility
|
IP
|
$2,059.00
|
|
| Hospital Charge Code |
3784151
|
|
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
|
|
