|
SCREW-CANN 4.5 X 44 214.744
|
Facility
|
IP
|
$1,947.00
|
|
| Hospital Charge Code |
2967192
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$992.19 |
| Max. Negotiated Rate |
$1,862.89 |
| Rate for Payer: Aetna Commercial |
$1,822.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,741.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,073.19
|
| Rate for Payer: Cash Price |
$584.10
|
| Rate for Payer: Cigna Commercial |
$1,862.89
|
| Rate for Payer: Health EOS Commercial |
$1,802.14
|
| Rate for Payer: HFN Commercial |
$1,862.89
|
| Rate for Payer: Multiplan Commercial |
$1,619.90
|
| Rate for Payer: Preferred Network Access Commercial |
$1,862.89
|
| Rate for Payer: Quartz Beloit One Network |
$992.19
|
| Rate for Payer: Quartz Commercial |
$1,214.93
|
| Rate for Payer: WEA Trust Commercial |
$1,113.68
|
| Rate for Payer: WPS Commercial |
$1,499.77
|
|
|
SCREW-CANN 4.5 X 44 214.744
|
Facility
|
OP
|
$1,947.00
|
|
| Hospital Charge Code |
2967192
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$566.97 |
| Max. Negotiated Rate |
$1,862.89 |
| Rate for Payer: Aetna Commercial |
$1,822.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,741.40
|
| Rate for Payer: Aetna Managed Medicare |
$566.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,316.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,012.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$971.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,073.19
|
| Rate for Payer: Cash Price |
$584.10
|
| Rate for Payer: Cigna Commercial |
$1,862.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,133.15
|
| Rate for Payer: Health EOS Commercial |
$1,802.14
|
| Rate for Payer: HFN Commercial |
$1,862.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,518.66
|
| Rate for Payer: Multiplan Commercial |
$1,619.90
|
| Rate for Payer: NAPHCARE Commercial |
$1,214.93
|
| Rate for Payer: Preferred Network Access Commercial |
$1,862.89
|
| Rate for Payer: Quartz Beloit One Network |
$992.19
|
| Rate for Payer: Quartz Commercial |
$1,316.17
|
| Rate for Payer: Quartz Medicare Advantage |
$1,214.93
|
| Rate for Payer: The Alliance Commercial |
$1,012.44
|
| Rate for Payer: WEA Trust Commercial |
$1,113.68
|
| Rate for Payer: WPS Commercial |
$1,499.77
|
|
|
SCREW-CANN 4.5 X 46 214.546
|
Facility
|
OP
|
$1,875.00
|
|
| Hospital Charge Code |
2967193
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$546.00 |
| Max. Negotiated Rate |
$1,794.00 |
| Rate for Payer: Aetna Commercial |
$1,755.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,677.00
|
| Rate for Payer: Aetna Managed Medicare |
$546.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,267.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$975.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$936.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,033.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,794.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,091.25
|
| Rate for Payer: Health EOS Commercial |
$1,735.50
|
| Rate for Payer: HFN Commercial |
$1,794.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,462.50
|
| Rate for Payer: Multiplan Commercial |
$1,560.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,170.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,794.00
|
| Rate for Payer: Quartz Beloit One Network |
$955.50
|
| Rate for Payer: Quartz Commercial |
$1,267.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,170.00
|
| Rate for Payer: The Alliance Commercial |
$975.00
|
| Rate for Payer: WEA Trust Commercial |
$1,072.50
|
| Rate for Payer: WPS Commercial |
$1,444.31
|
|
|
SCREW-CANN 4.5 X 46 214.546
|
Facility
|
IP
|
$1,875.00
|
|
| Hospital Charge Code |
2967193
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$955.50 |
| Max. Negotiated Rate |
$1,794.00 |
| Rate for Payer: Aetna Commercial |
$1,755.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,677.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,033.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,794.00
|
| Rate for Payer: Health EOS Commercial |
$1,735.50
|
| Rate for Payer: HFN Commercial |
$1,794.00
|
| Rate for Payer: Multiplan Commercial |
$1,560.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,794.00
|
| Rate for Payer: Quartz Beloit One Network |
$955.50
|
| Rate for Payer: Quartz Commercial |
$1,170.00
|
| Rate for Payer: WEA Trust Commercial |
$1,072.50
|
| Rate for Payer: WPS Commercial |
$1,444.31
|
|
|
SCREW-CANN 4.5 X 46 214.746
|
Facility
|
OP
|
$1,875.00
|
|
| Hospital Charge Code |
2967194
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$546.00 |
| Max. Negotiated Rate |
$1,794.00 |
| Rate for Payer: Aetna Commercial |
$1,755.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,677.00
|
| Rate for Payer: Aetna Managed Medicare |
$546.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,267.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$975.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$936.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,033.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,794.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,091.25
|
| Rate for Payer: Health EOS Commercial |
$1,735.50
|
| Rate for Payer: HFN Commercial |
$1,794.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,462.50
|
| Rate for Payer: Multiplan Commercial |
$1,560.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,170.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,794.00
|
| Rate for Payer: Quartz Beloit One Network |
$955.50
|
| Rate for Payer: Quartz Commercial |
$1,267.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,170.00
|
| Rate for Payer: The Alliance Commercial |
$975.00
|
| Rate for Payer: WEA Trust Commercial |
$1,072.50
|
| Rate for Payer: WPS Commercial |
$1,444.31
|
|
|
SCREW-CANN 4.5 X 46 214.746
|
Facility
|
IP
|
$1,875.00
|
|
| Hospital Charge Code |
2967194
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$955.50 |
| Max. Negotiated Rate |
$1,794.00 |
| Rate for Payer: Aetna Commercial |
$1,755.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,677.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,033.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,794.00
|
| Rate for Payer: Health EOS Commercial |
$1,735.50
|
| Rate for Payer: HFN Commercial |
$1,794.00
|
| Rate for Payer: Multiplan Commercial |
$1,560.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,794.00
|
| Rate for Payer: Quartz Beloit One Network |
$955.50
|
| Rate for Payer: Quartz Commercial |
$1,170.00
|
| Rate for Payer: WEA Trust Commercial |
$1,072.50
|
| Rate for Payer: WPS Commercial |
$1,444.31
|
|
|
SCREW-CANN 4.5 X 48 214.548
|
Facility
|
IP
|
$1,947.00
|
|
| Hospital Charge Code |
2967195
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$992.19 |
| Max. Negotiated Rate |
$1,862.89 |
| Rate for Payer: Aetna Commercial |
$1,822.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,741.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,073.19
|
| Rate for Payer: Cash Price |
$584.10
|
| Rate for Payer: Cigna Commercial |
$1,862.89
|
| Rate for Payer: Health EOS Commercial |
$1,802.14
|
| Rate for Payer: HFN Commercial |
$1,862.89
|
| Rate for Payer: Multiplan Commercial |
$1,619.90
|
| Rate for Payer: Preferred Network Access Commercial |
$1,862.89
|
| Rate for Payer: Quartz Beloit One Network |
$992.19
|
| Rate for Payer: Quartz Commercial |
$1,214.93
|
| Rate for Payer: WEA Trust Commercial |
$1,113.68
|
| Rate for Payer: WPS Commercial |
$1,499.77
|
|
|
SCREW-CANN 4.5 X 48 214.548
|
Facility
|
OP
|
$1,947.00
|
|
| Hospital Charge Code |
2967195
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$566.97 |
| Max. Negotiated Rate |
$1,862.89 |
| Rate for Payer: Aetna Commercial |
$1,822.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,741.40
|
| Rate for Payer: Aetna Managed Medicare |
$566.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,316.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,012.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$971.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,073.19
|
| Rate for Payer: Cash Price |
$584.10
|
| Rate for Payer: Cigna Commercial |
$1,862.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,133.15
|
| Rate for Payer: Health EOS Commercial |
$1,802.14
|
| Rate for Payer: HFN Commercial |
$1,862.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,518.66
|
| Rate for Payer: Multiplan Commercial |
$1,619.90
|
| Rate for Payer: NAPHCARE Commercial |
$1,214.93
|
| Rate for Payer: Preferred Network Access Commercial |
$1,862.89
|
| Rate for Payer: Quartz Beloit One Network |
$992.19
|
| Rate for Payer: Quartz Commercial |
$1,316.17
|
| Rate for Payer: Quartz Medicare Advantage |
$1,214.93
|
| Rate for Payer: The Alliance Commercial |
$1,012.44
|
| Rate for Payer: WEA Trust Commercial |
$1,113.68
|
| Rate for Payer: WPS Commercial |
$1,499.77
|
|
|
SCREW-CANN 4.5 X 48 214.748
|
Facility
|
IP
|
$1,947.00
|
|
| Hospital Charge Code |
2967196
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$992.19 |
| Max. Negotiated Rate |
$1,862.89 |
| Rate for Payer: Aetna Commercial |
$1,822.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,741.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,073.19
|
| Rate for Payer: Cash Price |
$584.10
|
| Rate for Payer: Cigna Commercial |
$1,862.89
|
| Rate for Payer: Health EOS Commercial |
$1,802.14
|
| Rate for Payer: HFN Commercial |
$1,862.89
|
| Rate for Payer: Multiplan Commercial |
$1,619.90
|
| Rate for Payer: Preferred Network Access Commercial |
$1,862.89
|
| Rate for Payer: Quartz Beloit One Network |
$992.19
|
| Rate for Payer: Quartz Commercial |
$1,214.93
|
| Rate for Payer: WEA Trust Commercial |
$1,113.68
|
| Rate for Payer: WPS Commercial |
$1,499.77
|
|
|
SCREW-CANN 4.5 X 48 214.748
|
Facility
|
OP
|
$1,947.00
|
|
| Hospital Charge Code |
2967196
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$566.97 |
| Max. Negotiated Rate |
$1,862.89 |
| Rate for Payer: Aetna Commercial |
$1,822.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,741.40
|
| Rate for Payer: Aetna Managed Medicare |
$566.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,316.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,012.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$971.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,073.19
|
| Rate for Payer: Cash Price |
$584.10
|
| Rate for Payer: Cigna Commercial |
$1,862.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,133.15
|
| Rate for Payer: Health EOS Commercial |
$1,802.14
|
| Rate for Payer: HFN Commercial |
$1,862.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,518.66
|
| Rate for Payer: Multiplan Commercial |
$1,619.90
|
| Rate for Payer: NAPHCARE Commercial |
$1,214.93
|
| Rate for Payer: Preferred Network Access Commercial |
$1,862.89
|
| Rate for Payer: Quartz Beloit One Network |
$992.19
|
| Rate for Payer: Quartz Commercial |
$1,316.17
|
| Rate for Payer: Quartz Medicare Advantage |
$1,214.93
|
| Rate for Payer: The Alliance Commercial |
$1,012.44
|
| Rate for Payer: WEA Trust Commercial |
$1,113.68
|
| Rate for Payer: WPS Commercial |
$1,499.77
|
|
|
SCREW-CANN 4.5 X 50 214.550
|
Facility
|
IP
|
$1,947.00
|
|
| Hospital Charge Code |
2967197
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$992.19 |
| Max. Negotiated Rate |
$1,862.89 |
| Rate for Payer: Aetna Commercial |
$1,822.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,741.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,073.19
|
| Rate for Payer: Cash Price |
$584.10
|
| Rate for Payer: Cigna Commercial |
$1,862.89
|
| Rate for Payer: Health EOS Commercial |
$1,802.14
|
| Rate for Payer: HFN Commercial |
$1,862.89
|
| Rate for Payer: Multiplan Commercial |
$1,619.90
|
| Rate for Payer: Preferred Network Access Commercial |
$1,862.89
|
| Rate for Payer: Quartz Beloit One Network |
$992.19
|
| Rate for Payer: Quartz Commercial |
$1,214.93
|
| Rate for Payer: WEA Trust Commercial |
$1,113.68
|
| Rate for Payer: WPS Commercial |
$1,499.77
|
|
|
SCREW-CANN 4.5 X 50 214.550
|
Facility
|
OP
|
$1,947.00
|
|
| Hospital Charge Code |
2967197
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$566.97 |
| Max. Negotiated Rate |
$1,862.89 |
| Rate for Payer: Aetna Commercial |
$1,822.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,741.40
|
| Rate for Payer: Aetna Managed Medicare |
$566.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,316.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,012.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$971.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,073.19
|
| Rate for Payer: Cash Price |
$584.10
|
| Rate for Payer: Cigna Commercial |
$1,862.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,133.15
|
| Rate for Payer: Health EOS Commercial |
$1,802.14
|
| Rate for Payer: HFN Commercial |
$1,862.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,518.66
|
| Rate for Payer: Multiplan Commercial |
$1,619.90
|
| Rate for Payer: NAPHCARE Commercial |
$1,214.93
|
| Rate for Payer: Preferred Network Access Commercial |
$1,862.89
|
| Rate for Payer: Quartz Beloit One Network |
$992.19
|
| Rate for Payer: Quartz Commercial |
$1,316.17
|
| Rate for Payer: Quartz Medicare Advantage |
$1,214.93
|
| Rate for Payer: The Alliance Commercial |
$1,012.44
|
| Rate for Payer: WEA Trust Commercial |
$1,113.68
|
| Rate for Payer: WPS Commercial |
$1,499.77
|
|
|
SCREW-CANN 4.5 X 50 214.750
|
Facility
|
OP
|
$1,947.00
|
|
| Hospital Charge Code |
2967198
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$566.97 |
| Max. Negotiated Rate |
$1,862.89 |
| Rate for Payer: Aetna Commercial |
$1,822.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,741.40
|
| Rate for Payer: Aetna Managed Medicare |
$566.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,316.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,012.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$971.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,073.19
|
| Rate for Payer: Cash Price |
$584.10
|
| Rate for Payer: Cigna Commercial |
$1,862.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,133.15
|
| Rate for Payer: Health EOS Commercial |
$1,802.14
|
| Rate for Payer: HFN Commercial |
$1,862.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,518.66
|
| Rate for Payer: Multiplan Commercial |
$1,619.90
|
| Rate for Payer: NAPHCARE Commercial |
$1,214.93
|
| Rate for Payer: Preferred Network Access Commercial |
$1,862.89
|
| Rate for Payer: Quartz Beloit One Network |
$992.19
|
| Rate for Payer: Quartz Commercial |
$1,316.17
|
| Rate for Payer: Quartz Medicare Advantage |
$1,214.93
|
| Rate for Payer: The Alliance Commercial |
$1,012.44
|
| Rate for Payer: WEA Trust Commercial |
$1,113.68
|
| Rate for Payer: WPS Commercial |
$1,499.77
|
|
|
SCREW-CANN 4.5 X 50 214.750
|
Facility
|
IP
|
$1,947.00
|
|
| Hospital Charge Code |
2967198
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$992.19 |
| Max. Negotiated Rate |
$1,862.89 |
| Rate for Payer: Aetna Commercial |
$1,822.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,741.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,073.19
|
| Rate for Payer: Cash Price |
$584.10
|
| Rate for Payer: Cigna Commercial |
$1,862.89
|
| Rate for Payer: Health EOS Commercial |
$1,802.14
|
| Rate for Payer: HFN Commercial |
$1,862.89
|
| Rate for Payer: Multiplan Commercial |
$1,619.90
|
| Rate for Payer: Preferred Network Access Commercial |
$1,862.89
|
| Rate for Payer: Quartz Beloit One Network |
$992.19
|
| Rate for Payer: Quartz Commercial |
$1,214.93
|
| Rate for Payer: WEA Trust Commercial |
$1,113.68
|
| Rate for Payer: WPS Commercial |
$1,499.77
|
|
|
SCREW-CANN 4.5 X 52 214.552
|
Facility
|
OP
|
$1,875.00
|
|
| Hospital Charge Code |
2967199
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$546.00 |
| Max. Negotiated Rate |
$1,794.00 |
| Rate for Payer: Aetna Commercial |
$1,755.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,677.00
|
| Rate for Payer: Aetna Managed Medicare |
$546.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,267.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$975.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$936.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,033.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,794.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,091.25
|
| Rate for Payer: Health EOS Commercial |
$1,735.50
|
| Rate for Payer: HFN Commercial |
$1,794.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,462.50
|
| Rate for Payer: Multiplan Commercial |
$1,560.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,170.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,794.00
|
| Rate for Payer: Quartz Beloit One Network |
$955.50
|
| Rate for Payer: Quartz Commercial |
$1,267.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,170.00
|
| Rate for Payer: The Alliance Commercial |
$975.00
|
| Rate for Payer: WEA Trust Commercial |
$1,072.50
|
| Rate for Payer: WPS Commercial |
$1,444.31
|
|
|
SCREW-CANN 4.5 X 52 214.552
|
Facility
|
IP
|
$1,875.00
|
|
| Hospital Charge Code |
2967199
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$955.50 |
| Max. Negotiated Rate |
$1,794.00 |
| Rate for Payer: Aetna Commercial |
$1,755.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,677.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,033.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,794.00
|
| Rate for Payer: Health EOS Commercial |
$1,735.50
|
| Rate for Payer: HFN Commercial |
$1,794.00
|
| Rate for Payer: Multiplan Commercial |
$1,560.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,794.00
|
| Rate for Payer: Quartz Beloit One Network |
$955.50
|
| Rate for Payer: Quartz Commercial |
$1,170.00
|
| Rate for Payer: WEA Trust Commercial |
$1,072.50
|
| Rate for Payer: WPS Commercial |
$1,444.31
|
|
|
SCREW-CANN 4.5 X 52 214.752
|
Facility
|
OP
|
$1,875.00
|
|
| Hospital Charge Code |
2967200
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$546.00 |
| Max. Negotiated Rate |
$1,794.00 |
| Rate for Payer: Aetna Commercial |
$1,755.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,677.00
|
| Rate for Payer: Aetna Managed Medicare |
$546.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,267.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$975.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$936.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,033.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,794.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,091.25
|
| Rate for Payer: Health EOS Commercial |
$1,735.50
|
| Rate for Payer: HFN Commercial |
$1,794.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,462.50
|
| Rate for Payer: Multiplan Commercial |
$1,560.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,170.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,794.00
|
| Rate for Payer: Quartz Beloit One Network |
$955.50
|
| Rate for Payer: Quartz Commercial |
$1,267.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,170.00
|
| Rate for Payer: The Alliance Commercial |
$975.00
|
| Rate for Payer: WEA Trust Commercial |
$1,072.50
|
| Rate for Payer: WPS Commercial |
$1,444.31
|
|
|
SCREW-CANN 4.5 X 52 214.752
|
Facility
|
IP
|
$1,875.00
|
|
| Hospital Charge Code |
2967200
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$955.50 |
| Max. Negotiated Rate |
$1,794.00 |
| Rate for Payer: Aetna Commercial |
$1,755.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,677.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,033.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,794.00
|
| Rate for Payer: Health EOS Commercial |
$1,735.50
|
| Rate for Payer: HFN Commercial |
$1,794.00
|
| Rate for Payer: Multiplan Commercial |
$1,560.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,794.00
|
| Rate for Payer: Quartz Beloit One Network |
$955.50
|
| Rate for Payer: Quartz Commercial |
$1,170.00
|
| Rate for Payer: WEA Trust Commercial |
$1,072.50
|
| Rate for Payer: WPS Commercial |
$1,444.31
|
|
|
SCREW-CANN 4.5 X 54 214.554
|
Facility
|
IP
|
$1,875.00
|
|
| Hospital Charge Code |
2967201
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$955.50 |
| Max. Negotiated Rate |
$1,794.00 |
| Rate for Payer: Aetna Commercial |
$1,755.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,677.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,033.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,794.00
|
| Rate for Payer: Health EOS Commercial |
$1,735.50
|
| Rate for Payer: HFN Commercial |
$1,794.00
|
| Rate for Payer: Multiplan Commercial |
$1,560.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,794.00
|
| Rate for Payer: Quartz Beloit One Network |
$955.50
|
| Rate for Payer: Quartz Commercial |
$1,170.00
|
| Rate for Payer: WEA Trust Commercial |
$1,072.50
|
| Rate for Payer: WPS Commercial |
$1,444.31
|
|
|
SCREW-CANN 4.5 X 54 214.554
|
Facility
|
OP
|
$1,875.00
|
|
| Hospital Charge Code |
2967201
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$546.00 |
| Max. Negotiated Rate |
$1,794.00 |
| Rate for Payer: Aetna Commercial |
$1,755.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,677.00
|
| Rate for Payer: Aetna Managed Medicare |
$546.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,267.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$975.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$936.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,033.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,794.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,091.25
|
| Rate for Payer: Health EOS Commercial |
$1,735.50
|
| Rate for Payer: HFN Commercial |
$1,794.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,462.50
|
| Rate for Payer: Multiplan Commercial |
$1,560.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,170.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,794.00
|
| Rate for Payer: Quartz Beloit One Network |
$955.50
|
| Rate for Payer: Quartz Commercial |
$1,267.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,170.00
|
| Rate for Payer: The Alliance Commercial |
$975.00
|
| Rate for Payer: WEA Trust Commercial |
$1,072.50
|
| Rate for Payer: WPS Commercial |
$1,444.31
|
|
|
SCREW-CANN 4.5 X 54 214.754
|
Facility
|
IP
|
$1,875.00
|
|
| Hospital Charge Code |
2967202
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$955.50 |
| Max. Negotiated Rate |
$1,794.00 |
| Rate for Payer: Aetna Commercial |
$1,755.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,677.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,033.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,794.00
|
| Rate for Payer: Health EOS Commercial |
$1,735.50
|
| Rate for Payer: HFN Commercial |
$1,794.00
|
| Rate for Payer: Multiplan Commercial |
$1,560.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,794.00
|
| Rate for Payer: Quartz Beloit One Network |
$955.50
|
| Rate for Payer: Quartz Commercial |
$1,170.00
|
| Rate for Payer: WEA Trust Commercial |
$1,072.50
|
| Rate for Payer: WPS Commercial |
$1,444.31
|
|
|
SCREW-CANN 4.5 X 54 214.754
|
Facility
|
OP
|
$1,875.00
|
|
| Hospital Charge Code |
2967202
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$546.00 |
| Max. Negotiated Rate |
$1,794.00 |
| Rate for Payer: Aetna Commercial |
$1,755.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,677.00
|
| Rate for Payer: Aetna Managed Medicare |
$546.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,267.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$975.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$936.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,033.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,794.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,091.25
|
| Rate for Payer: Health EOS Commercial |
$1,735.50
|
| Rate for Payer: HFN Commercial |
$1,794.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,462.50
|
| Rate for Payer: Multiplan Commercial |
$1,560.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,170.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,794.00
|
| Rate for Payer: Quartz Beloit One Network |
$955.50
|
| Rate for Payer: Quartz Commercial |
$1,267.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,170.00
|
| Rate for Payer: The Alliance Commercial |
$975.00
|
| Rate for Payer: WEA Trust Commercial |
$1,072.50
|
| Rate for Payer: WPS Commercial |
$1,444.31
|
|
|
SCREW-CANN 4.5 X 56 214.556
|
Facility
|
OP
|
$1,875.00
|
|
| Hospital Charge Code |
2967203
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$546.00 |
| Max. Negotiated Rate |
$1,794.00 |
| Rate for Payer: Aetna Commercial |
$1,755.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,677.00
|
| Rate for Payer: Aetna Managed Medicare |
$546.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,267.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$975.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$936.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,033.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,794.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,091.25
|
| Rate for Payer: Health EOS Commercial |
$1,735.50
|
| Rate for Payer: HFN Commercial |
$1,794.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,462.50
|
| Rate for Payer: Multiplan Commercial |
$1,560.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,170.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,794.00
|
| Rate for Payer: Quartz Beloit One Network |
$955.50
|
| Rate for Payer: Quartz Commercial |
$1,267.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,170.00
|
| Rate for Payer: The Alliance Commercial |
$975.00
|
| Rate for Payer: WEA Trust Commercial |
$1,072.50
|
| Rate for Payer: WPS Commercial |
$1,444.31
|
|
|
SCREW-CANN 4.5 X 56 214.556
|
Facility
|
IP
|
$1,875.00
|
|
| Hospital Charge Code |
2967203
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$955.50 |
| Max. Negotiated Rate |
$1,794.00 |
| Rate for Payer: Aetna Commercial |
$1,755.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,677.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,033.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,794.00
|
| Rate for Payer: Health EOS Commercial |
$1,735.50
|
| Rate for Payer: HFN Commercial |
$1,794.00
|
| Rate for Payer: Multiplan Commercial |
$1,560.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,794.00
|
| Rate for Payer: Quartz Beloit One Network |
$955.50
|
| Rate for Payer: Quartz Commercial |
$1,170.00
|
| Rate for Payer: WEA Trust Commercial |
$1,072.50
|
| Rate for Payer: WPS Commercial |
$1,444.31
|
|
|
SCREW-CANN 4.5 X 56 214.756
|
Facility
|
OP
|
$1,875.00
|
|
| Hospital Charge Code |
2967204
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$546.00 |
| Max. Negotiated Rate |
$1,794.00 |
| Rate for Payer: Aetna Commercial |
$1,755.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,677.00
|
| Rate for Payer: Aetna Managed Medicare |
$546.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,267.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$975.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$936.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,033.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,794.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,091.25
|
| Rate for Payer: Health EOS Commercial |
$1,735.50
|
| Rate for Payer: HFN Commercial |
$1,794.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,462.50
|
| Rate for Payer: Multiplan Commercial |
$1,560.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,170.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,794.00
|
| Rate for Payer: Quartz Beloit One Network |
$955.50
|
| Rate for Payer: Quartz Commercial |
$1,267.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,170.00
|
| Rate for Payer: The Alliance Commercial |
$975.00
|
| Rate for Payer: WEA Trust Commercial |
$1,072.50
|
| Rate for Payer: WPS Commercial |
$1,444.31
|
|
