|
SCREW-CANN 4.5 X 56 214.756
|
Facility
|
IP
|
$1,875.00
|
|
| Hospital Charge Code |
2967204
|
|
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 60 214.560
|
Facility
|
OP
|
$1,875.00
|
|
| Hospital Charge Code |
2967205
|
|
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 60 214.560
|
Facility
|
IP
|
$1,875.00
|
|
| Hospital Charge Code |
2967205
|
|
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 60 214.760
|
Facility
|
OP
|
$1,947.00
|
|
| Hospital Charge Code |
2967206
|
|
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 60 214.760
|
Facility
|
IP
|
$1,947.00
|
|
| Hospital Charge Code |
2967206
|
|
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 64 214.564
|
Facility
|
IP
|
$1,875.00
|
|
| Hospital Charge Code |
2967207
|
|
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 64 214.564
|
Facility
|
OP
|
$1,875.00
|
|
| Hospital Charge Code |
2967207
|
|
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 64 214.764
|
Facility
|
IP
|
$1,875.00
|
|
| Hospital Charge Code |
2967208
|
|
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 64 214.764
|
Facility
|
OP
|
$1,875.00
|
|
| Hospital Charge Code |
2967208
|
|
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 68 214.568
|
Facility
|
IP
|
$1,875.00
|
|
| Hospital Charge Code |
2967209
|
|
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 68 214.568
|
Facility
|
OP
|
$1,875.00
|
|
| Hospital Charge Code |
2967209
|
|
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 68 214.768
|
Facility
|
OP
|
$1,875.00
|
|
| Hospital Charge Code |
2967210
|
|
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 68 214.768
|
Facility
|
IP
|
$1,875.00
|
|
| Hospital Charge Code |
2967210
|
|
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 72 214.572
|
Facility
|
OP
|
$1,875.00
|
|
| Hospital Charge Code |
2967211
|
|
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 72 214.572
|
Facility
|
IP
|
$1,875.00
|
|
| Hospital Charge Code |
2967211
|
|
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 72 214.772
|
Facility
|
IP
|
$1,875.00
|
|
| Hospital Charge Code |
2967212
|
|
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 72 214.772
|
Facility
|
OP
|
$1,875.00
|
|
| Hospital Charge Code |
2967212
|
|
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 5.0 X 25 02.205.025
|
Facility
|
IP
|
$827.00
|
|
| Hospital Charge Code |
2966957
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$421.44 |
| Max. Negotiated Rate |
$791.27 |
| Rate for Payer: Aetna Commercial |
$774.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$739.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$455.84
|
| Rate for Payer: Cash Price |
$248.10
|
| Rate for Payer: Cigna Commercial |
$791.27
|
| Rate for Payer: Health EOS Commercial |
$765.47
|
| Rate for Payer: HFN Commercial |
$791.27
|
| Rate for Payer: Multiplan Commercial |
$688.06
|
| Rate for Payer: Preferred Network Access Commercial |
$791.27
|
| Rate for Payer: Quartz Beloit One Network |
$421.44
|
| Rate for Payer: Quartz Commercial |
$516.05
|
| Rate for Payer: WEA Trust Commercial |
$473.04
|
| Rate for Payer: WPS Commercial |
$637.04
|
|
|
SCREW-CANN 5.0 X 25 02.205.025
|
Facility
|
OP
|
$827.00
|
|
| Hospital Charge Code |
2966957
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$240.82 |
| Max. Negotiated Rate |
$791.27 |
| Rate for Payer: Aetna Commercial |
$774.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$739.67
|
| Rate for Payer: Aetna Managed Medicare |
$240.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$559.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$430.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$412.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$455.84
|
| Rate for Payer: Cash Price |
$248.10
|
| Rate for Payer: Cigna Commercial |
$791.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$481.31
|
| Rate for Payer: Health EOS Commercial |
$765.47
|
| Rate for Payer: HFN Commercial |
$791.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$645.06
|
| Rate for Payer: Multiplan Commercial |
$688.06
|
| Rate for Payer: NAPHCARE Commercial |
$516.05
|
| Rate for Payer: Preferred Network Access Commercial |
$791.27
|
| Rate for Payer: Quartz Beloit One Network |
$421.44
|
| Rate for Payer: Quartz Commercial |
$559.05
|
| Rate for Payer: Quartz Medicare Advantage |
$516.05
|
| Rate for Payer: The Alliance Commercial |
$430.04
|
| Rate for Payer: WEA Trust Commercial |
$473.04
|
| Rate for Payer: WPS Commercial |
$637.04
|
|
|
SCREW-CANN 5.0 X 30 02.205.030
|
Facility
|
IP
|
$2,303.00
|
|
| Hospital Charge Code |
2966961
|
|
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 5.0 X 30 02.205.030
|
Facility
|
OP
|
$2,303.00
|
|
| Hospital Charge Code |
2966961
|
|
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 5.0 X 35 02.205.035
|
Facility
|
IP
|
$827.00
|
|
| Hospital Charge Code |
2966968
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$421.44 |
| Max. Negotiated Rate |
$791.27 |
| Rate for Payer: Aetna Commercial |
$774.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$739.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$455.84
|
| Rate for Payer: Cash Price |
$248.10
|
| Rate for Payer: Cigna Commercial |
$791.27
|
| Rate for Payer: Health EOS Commercial |
$765.47
|
| Rate for Payer: HFN Commercial |
$791.27
|
| Rate for Payer: Multiplan Commercial |
$688.06
|
| Rate for Payer: Preferred Network Access Commercial |
$791.27
|
| Rate for Payer: Quartz Beloit One Network |
$421.44
|
| Rate for Payer: Quartz Commercial |
$516.05
|
| Rate for Payer: WEA Trust Commercial |
$473.04
|
| Rate for Payer: WPS Commercial |
$637.04
|
|
|
SCREW-CANN 5.0 X 35 02.205.035
|
Facility
|
OP
|
$827.00
|
|
| Hospital Charge Code |
2966968
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$240.82 |
| Max. Negotiated Rate |
$791.27 |
| Rate for Payer: Aetna Commercial |
$774.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$739.67
|
| Rate for Payer: Aetna Managed Medicare |
$240.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$559.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$430.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$412.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$455.84
|
| Rate for Payer: Cash Price |
$248.10
|
| Rate for Payer: Cigna Commercial |
$791.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$481.31
|
| Rate for Payer: Health EOS Commercial |
$765.47
|
| Rate for Payer: HFN Commercial |
$791.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$645.06
|
| Rate for Payer: Multiplan Commercial |
$688.06
|
| Rate for Payer: NAPHCARE Commercial |
$516.05
|
| Rate for Payer: Preferred Network Access Commercial |
$791.27
|
| Rate for Payer: Quartz Beloit One Network |
$421.44
|
| Rate for Payer: Quartz Commercial |
$559.05
|
| Rate for Payer: Quartz Medicare Advantage |
$516.05
|
| Rate for Payer: The Alliance Commercial |
$430.04
|
| Rate for Payer: WEA Trust Commercial |
$473.04
|
| Rate for Payer: WPS Commercial |
$637.04
|
|
|
SCREW-CANN 5.0 X 40 02.205.040
|
Facility
|
OP
|
$827.00
|
|
| Hospital Charge Code |
2966973
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$240.82 |
| Max. Negotiated Rate |
$791.27 |
| Rate for Payer: Aetna Commercial |
$774.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$739.67
|
| Rate for Payer: Aetna Managed Medicare |
$240.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$559.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$430.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$412.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$455.84
|
| Rate for Payer: Cash Price |
$248.10
|
| Rate for Payer: Cigna Commercial |
$791.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$481.31
|
| Rate for Payer: Health EOS Commercial |
$765.47
|
| Rate for Payer: HFN Commercial |
$791.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$645.06
|
| Rate for Payer: Multiplan Commercial |
$688.06
|
| Rate for Payer: NAPHCARE Commercial |
$516.05
|
| Rate for Payer: Preferred Network Access Commercial |
$791.27
|
| Rate for Payer: Quartz Beloit One Network |
$421.44
|
| Rate for Payer: Quartz Commercial |
$559.05
|
| Rate for Payer: Quartz Medicare Advantage |
$516.05
|
| Rate for Payer: The Alliance Commercial |
$430.04
|
| Rate for Payer: WEA Trust Commercial |
$473.04
|
| Rate for Payer: WPS Commercial |
$637.04
|
|
|
SCREW-CANN 5.0 X 40 02.205.040
|
Facility
|
IP
|
$827.00
|
|
| Hospital Charge Code |
2966973
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$421.44 |
| Max. Negotiated Rate |
$791.27 |
| Rate for Payer: Aetna Commercial |
$774.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$739.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$455.84
|
| Rate for Payer: Cash Price |
$248.10
|
| Rate for Payer: Cigna Commercial |
$791.27
|
| Rate for Payer: Health EOS Commercial |
$765.47
|
| Rate for Payer: HFN Commercial |
$791.27
|
| Rate for Payer: Multiplan Commercial |
$688.06
|
| Rate for Payer: Preferred Network Access Commercial |
$791.27
|
| Rate for Payer: Quartz Beloit One Network |
$421.44
|
| Rate for Payer: Quartz Commercial |
$516.05
|
| Rate for Payer: WEA Trust Commercial |
$473.04
|
| Rate for Payer: WPS Commercial |
$637.04
|
|
