|
SCREW-CANN 3.0 X 29 202.629
|
Facility
|
OP
|
$2,121.00
|
|
| Hospital Charge Code |
2967113
|
|
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 29 202.629
|
Facility
|
IP
|
$2,121.00
|
|
| Hospital Charge Code |
2967113
|
|
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 29 202.729
|
Facility
|
OP
|
$2,121.00
|
|
| Hospital Charge Code |
2967114
|
|
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 29 202.729
|
Facility
|
IP
|
$2,121.00
|
|
| Hospital Charge Code |
2967114
|
|
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 30 202.630
|
Facility
|
IP
|
$2,121.00
|
|
| Hospital Charge Code |
2967115
|
|
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 30 202.630
|
Facility
|
OP
|
$2,121.00
|
|
| Hospital Charge Code |
2967115
|
|
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 30 202.730
|
Facility
|
OP
|
$2,121.00
|
|
| Hospital Charge Code |
2967116
|
|
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 30 202.730
|
Facility
|
IP
|
$2,121.00
|
|
| Hospital Charge Code |
2967116
|
|
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 30 TIGER 200-30-030
|
Facility
|
OP
|
$2,059.00
|
|
| Hospital Charge Code |
3784156
|
|
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 30 TIGER 200-30-030
|
Facility
|
IP
|
$2,059.00
|
|
| Hospital Charge Code |
3784156
|
|
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 32 202.632
|
Facility
|
IP
|
$2,121.00
|
|
| Hospital Charge Code |
2967117
|
|
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 32 202.632
|
Facility
|
OP
|
$2,121.00
|
|
| Hospital Charge Code |
2967117
|
|
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 32 202.732
|
Facility
|
IP
|
$2,202.00
|
|
| Hospital Charge Code |
2967118
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,122.14 |
| Max. Negotiated Rate |
$2,106.87 |
| Rate for Payer: Aetna Commercial |
$2,061.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,969.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,213.74
|
| Rate for Payer: Cash Price |
$660.60
|
| Rate for Payer: Cigna Commercial |
$2,106.87
|
| Rate for Payer: Health EOS Commercial |
$2,038.17
|
| Rate for Payer: HFN Commercial |
$2,106.87
|
| Rate for Payer: Multiplan Commercial |
$1,832.06
|
| Rate for Payer: Preferred Network Access Commercial |
$2,106.87
|
| Rate for Payer: Quartz Beloit One Network |
$1,122.14
|
| Rate for Payer: Quartz Commercial |
$1,374.05
|
| Rate for Payer: WEA Trust Commercial |
$1,259.54
|
| Rate for Payer: WPS Commercial |
$1,696.20
|
|
|
SCREW-CANN 3.0 X 32 202.732
|
Facility
|
OP
|
$2,202.00
|
|
| Hospital Charge Code |
2967118
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$641.22 |
| Max. Negotiated Rate |
$2,106.87 |
| Rate for Payer: Aetna Commercial |
$2,061.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,969.47
|
| Rate for Payer: Aetna Managed Medicare |
$641.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,488.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,145.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,099.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,213.74
|
| Rate for Payer: Cash Price |
$660.60
|
| Rate for Payer: Cigna Commercial |
$2,106.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,281.56
|
| Rate for Payer: Health EOS Commercial |
$2,038.17
|
| Rate for Payer: HFN Commercial |
$2,106.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,717.56
|
| Rate for Payer: Multiplan Commercial |
$1,832.06
|
| Rate for Payer: NAPHCARE Commercial |
$1,374.05
|
| Rate for Payer: Preferred Network Access Commercial |
$2,106.87
|
| Rate for Payer: Quartz Beloit One Network |
$1,122.14
|
| Rate for Payer: Quartz Commercial |
$1,488.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,374.05
|
| Rate for Payer: The Alliance Commercial |
$1,145.04
|
| Rate for Payer: WEA Trust Commercial |
$1,259.54
|
| Rate for Payer: WPS Commercial |
$1,696.20
|
|
|
SCREW CANN 3.0 X 32 TIGER 200-30-032
|
Facility
|
OP
|
$2,059.00
|
|
| Hospital Charge Code |
3784157
|
|
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 32 TIGER 200-30-032
|
Facility
|
IP
|
$2,059.00
|
|
| Hospital Charge Code |
3784157
|
|
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 34 202.634
|
Facility
|
IP
|
$2,121.00
|
|
| Hospital Charge Code |
2967119
|
|
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 34 202.634
|
Facility
|
OP
|
$2,121.00
|
|
| Hospital Charge Code |
2967119
|
|
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 3.0X34 202.734
|
Facility
|
IP
|
$2,121.00
|
|
| Hospital Charge Code |
2990557
|
|
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 3.0X34 202.734
|
Facility
|
OP
|
$2,121.00
|
|
| Hospital Charge Code |
2990557
|
|
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 34 TIGER 200-30-034
|
Facility
|
IP
|
$2,059.00
|
|
| Hospital Charge Code |
3784158
|
|
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 34 TIGER 200-30-034
|
Facility
|
OP
|
$2,059.00
|
|
| Hospital Charge Code |
3784158
|
|
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 36 202.636
|
Facility
|
OP
|
$2,121.00
|
|
| Hospital Charge Code |
2967120
|
|
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 36 202.636
|
Facility
|
IP
|
$2,121.00
|
|
| Hospital Charge Code |
2967120
|
|
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 36 202.736
|
Facility
|
IP
|
$2,121.00
|
|
| Hospital Charge Code |
2967121
|
|
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
|
|
