|
SCREW-CANN 4.5 X 22 214.722
|
Facility
|
IP
|
$1,875.00
|
|
| Hospital Charge Code |
2967170
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$918.75 |
| Max. Negotiated Rate |
$1,725.00 |
| Rate for Payer: Aetna Commercial |
$1,687.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,612.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$993.75
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,725.00
|
| Rate for Payer: Health EOS Commercial |
$1,668.75
|
| Rate for Payer: HFN Commercial |
$1,725.00
|
| Rate for Payer: Multiplan Commercial |
$1,500.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,125.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,725.00
|
| Rate for Payer: Quartz Beloit One Network |
$918.75
|
| Rate for Payer: Quartz Commercial |
$1,125.00
|
| Rate for Payer: WEA Trust Commercial |
$1,031.25
|
| Rate for Payer: WPS Commercial |
$1,388.81
|
|
|
SCREW-CANN 4.5 X 22 214.722
|
Facility
|
OP
|
$1,875.00
|
|
| Hospital Charge Code |
2967170
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$7,500.00 |
| Rate for Payer: Aetna Commercial |
$1,687.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,612.50
|
| Rate for Payer: Aetna Managed Medicare |
$525.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,218.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$937.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$993.75
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,725.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,049.25
|
| Rate for Payer: Health EOS Commercial |
$1,668.75
|
| Rate for Payer: HFN Commercial |
$1,725.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,406.25
|
| Rate for Payer: Multiplan Commercial |
$1,500.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,125.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,725.00
|
| Rate for Payer: Quartz Beloit One Network |
$918.75
|
| Rate for Payer: Quartz Commercial |
$1,218.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,125.00
|
| Rate for Payer: The Alliance Commercial |
$7,500.00
|
| Rate for Payer: WEA Trust Commercial |
$1,031.25
|
| Rate for Payer: WPS Commercial |
$1,388.81
|
|
|
SCREW-CANN 4.5 X 24 214.524
|
Facility
|
OP
|
$1,875.00
|
|
| Hospital Charge Code |
2967171
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$7,500.00 |
| Rate for Payer: Aetna Commercial |
$1,687.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,612.50
|
| Rate for Payer: Aetna Managed Medicare |
$525.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,218.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$937.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$993.75
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,725.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,049.25
|
| Rate for Payer: Health EOS Commercial |
$1,668.75
|
| Rate for Payer: HFN Commercial |
$1,725.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,406.25
|
| Rate for Payer: Multiplan Commercial |
$1,500.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,125.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,725.00
|
| Rate for Payer: Quartz Beloit One Network |
$918.75
|
| Rate for Payer: Quartz Commercial |
$1,218.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,125.00
|
| Rate for Payer: The Alliance Commercial |
$7,500.00
|
| Rate for Payer: WEA Trust Commercial |
$1,031.25
|
| Rate for Payer: WPS Commercial |
$1,388.81
|
|
|
SCREW-CANN 4.5 X 24 214.524
|
Facility
|
IP
|
$1,875.00
|
|
| Hospital Charge Code |
2967171
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$918.75 |
| Max. Negotiated Rate |
$1,725.00 |
| Rate for Payer: Aetna Commercial |
$1,687.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,612.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$993.75
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,725.00
|
| Rate for Payer: Health EOS Commercial |
$1,668.75
|
| Rate for Payer: HFN Commercial |
$1,725.00
|
| Rate for Payer: Multiplan Commercial |
$1,500.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,125.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,725.00
|
| Rate for Payer: Quartz Beloit One Network |
$918.75
|
| Rate for Payer: Quartz Commercial |
$1,125.00
|
| Rate for Payer: WEA Trust Commercial |
$1,031.25
|
| Rate for Payer: WPS Commercial |
$1,388.81
|
|
|
SCREW-CANN 4.5 X 24 214.724
|
Facility
|
OP
|
$1,875.00
|
|
| Hospital Charge Code |
2967172
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$7,500.00 |
| Rate for Payer: Aetna Commercial |
$1,687.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,612.50
|
| Rate for Payer: Aetna Managed Medicare |
$525.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,218.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$937.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$993.75
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,725.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,049.25
|
| Rate for Payer: Health EOS Commercial |
$1,668.75
|
| Rate for Payer: HFN Commercial |
$1,725.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,406.25
|
| Rate for Payer: Multiplan Commercial |
$1,500.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,125.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,725.00
|
| Rate for Payer: Quartz Beloit One Network |
$918.75
|
| Rate for Payer: Quartz Commercial |
$1,218.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,125.00
|
| Rate for Payer: The Alliance Commercial |
$7,500.00
|
| Rate for Payer: WEA Trust Commercial |
$1,031.25
|
| Rate for Payer: WPS Commercial |
$1,388.81
|
|
|
SCREW-CANN 4.5 X 24 214.724
|
Facility
|
IP
|
$1,875.00
|
|
| Hospital Charge Code |
2967172
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$918.75 |
| Max. Negotiated Rate |
$1,725.00 |
| Rate for Payer: Aetna Commercial |
$1,687.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,612.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$993.75
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,725.00
|
| Rate for Payer: Health EOS Commercial |
$1,668.75
|
| Rate for Payer: HFN Commercial |
$1,725.00
|
| Rate for Payer: Multiplan Commercial |
$1,500.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,125.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,725.00
|
| Rate for Payer: Quartz Beloit One Network |
$918.75
|
| Rate for Payer: Quartz Commercial |
$1,125.00
|
| Rate for Payer: WEA Trust Commercial |
$1,031.25
|
| Rate for Payer: WPS Commercial |
$1,388.81
|
|
|
SCREW-CANN 4.5 X 26 214.526
|
Facility
|
OP
|
$1,875.00
|
|
| Hospital Charge Code |
2967173
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$7,500.00 |
| Rate for Payer: Aetna Commercial |
$1,687.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,612.50
|
| Rate for Payer: Aetna Managed Medicare |
$525.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,218.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$937.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$993.75
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,725.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,049.25
|
| Rate for Payer: Health EOS Commercial |
$1,668.75
|
| Rate for Payer: HFN Commercial |
$1,725.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,406.25
|
| Rate for Payer: Multiplan Commercial |
$1,500.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,125.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,725.00
|
| Rate for Payer: Quartz Beloit One Network |
$918.75
|
| Rate for Payer: Quartz Commercial |
$1,218.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,125.00
|
| Rate for Payer: The Alliance Commercial |
$7,500.00
|
| Rate for Payer: WEA Trust Commercial |
$1,031.25
|
| Rate for Payer: WPS Commercial |
$1,388.81
|
|
|
SCREW-CANN 4.5 X 26 214.526
|
Facility
|
IP
|
$1,875.00
|
|
| Hospital Charge Code |
2967173
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$918.75 |
| Max. Negotiated Rate |
$1,725.00 |
| Rate for Payer: Aetna Commercial |
$1,687.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,612.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$993.75
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,725.00
|
| Rate for Payer: Health EOS Commercial |
$1,668.75
|
| Rate for Payer: HFN Commercial |
$1,725.00
|
| Rate for Payer: Multiplan Commercial |
$1,500.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,125.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,725.00
|
| Rate for Payer: Quartz Beloit One Network |
$918.75
|
| Rate for Payer: Quartz Commercial |
$1,125.00
|
| Rate for Payer: WEA Trust Commercial |
$1,031.25
|
| Rate for Payer: WPS Commercial |
$1,388.81
|
|
|
SCREW-CANN 4.5 X 26 214.726
|
Facility
|
OP
|
$1,875.00
|
|
| Hospital Charge Code |
2967174
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$7,500.00 |
| Rate for Payer: Aetna Commercial |
$1,687.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,612.50
|
| Rate for Payer: Aetna Managed Medicare |
$525.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,218.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$937.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$993.75
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,725.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,049.25
|
| Rate for Payer: Health EOS Commercial |
$1,668.75
|
| Rate for Payer: HFN Commercial |
$1,725.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,406.25
|
| Rate for Payer: Multiplan Commercial |
$1,500.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,125.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,725.00
|
| Rate for Payer: Quartz Beloit One Network |
$918.75
|
| Rate for Payer: Quartz Commercial |
$1,218.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,125.00
|
| Rate for Payer: The Alliance Commercial |
$7,500.00
|
| Rate for Payer: WEA Trust Commercial |
$1,031.25
|
| Rate for Payer: WPS Commercial |
$1,388.81
|
|
|
SCREW-CANN 4.5 X 26 214.726
|
Facility
|
IP
|
$1,875.00
|
|
| Hospital Charge Code |
2967174
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$918.75 |
| Max. Negotiated Rate |
$1,725.00 |
| Rate for Payer: Aetna Commercial |
$1,687.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,612.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$993.75
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,725.00
|
| Rate for Payer: Health EOS Commercial |
$1,668.75
|
| Rate for Payer: HFN Commercial |
$1,725.00
|
| Rate for Payer: Multiplan Commercial |
$1,500.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,125.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,725.00
|
| Rate for Payer: Quartz Beloit One Network |
$918.75
|
| Rate for Payer: Quartz Commercial |
$1,125.00
|
| Rate for Payer: WEA Trust Commercial |
$1,031.25
|
| Rate for Payer: WPS Commercial |
$1,388.81
|
|
|
SCREW-CANN 4.5 X 28 214.528
|
Facility
|
IP
|
$1,875.00
|
|
| Hospital Charge Code |
2967175
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$918.75 |
| Max. Negotiated Rate |
$1,725.00 |
| Rate for Payer: Aetna Commercial |
$1,687.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,612.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$993.75
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,725.00
|
| Rate for Payer: Health EOS Commercial |
$1,668.75
|
| Rate for Payer: HFN Commercial |
$1,725.00
|
| Rate for Payer: Multiplan Commercial |
$1,500.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,125.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,725.00
|
| Rate for Payer: Quartz Beloit One Network |
$918.75
|
| Rate for Payer: Quartz Commercial |
$1,125.00
|
| Rate for Payer: WEA Trust Commercial |
$1,031.25
|
| Rate for Payer: WPS Commercial |
$1,388.81
|
|
|
SCREW-CANN 4.5 X 28 214.528
|
Facility
|
OP
|
$1,875.00
|
|
| Hospital Charge Code |
2967175
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$7,500.00 |
| Rate for Payer: Aetna Commercial |
$1,687.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,612.50
|
| Rate for Payer: Aetna Managed Medicare |
$525.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,218.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$937.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$993.75
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,725.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,049.25
|
| Rate for Payer: Health EOS Commercial |
$1,668.75
|
| Rate for Payer: HFN Commercial |
$1,725.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,406.25
|
| Rate for Payer: Multiplan Commercial |
$1,500.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,125.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,725.00
|
| Rate for Payer: Quartz Beloit One Network |
$918.75
|
| Rate for Payer: Quartz Commercial |
$1,218.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,125.00
|
| Rate for Payer: The Alliance Commercial |
$7,500.00
|
| Rate for Payer: WEA Trust Commercial |
$1,031.25
|
| Rate for Payer: WPS Commercial |
$1,388.81
|
|
|
SCREW-CANN 4.5 X 28 214.728
|
Facility
|
OP
|
$1,875.00
|
|
| Hospital Charge Code |
2967176
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$7,500.00 |
| Rate for Payer: Aetna Commercial |
$1,687.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,612.50
|
| Rate for Payer: Aetna Managed Medicare |
$525.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,218.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$937.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$993.75
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,725.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,049.25
|
| Rate for Payer: Health EOS Commercial |
$1,668.75
|
| Rate for Payer: HFN Commercial |
$1,725.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,406.25
|
| Rate for Payer: Multiplan Commercial |
$1,500.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,125.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,725.00
|
| Rate for Payer: Quartz Beloit One Network |
$918.75
|
| Rate for Payer: Quartz Commercial |
$1,218.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,125.00
|
| Rate for Payer: The Alliance Commercial |
$7,500.00
|
| Rate for Payer: WEA Trust Commercial |
$1,031.25
|
| Rate for Payer: WPS Commercial |
$1,388.81
|
|
|
SCREW-CANN 4.5 X 28 214.728
|
Facility
|
IP
|
$1,875.00
|
|
| Hospital Charge Code |
2967176
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$918.75 |
| Max. Negotiated Rate |
$1,725.00 |
| Rate for Payer: Aetna Commercial |
$1,687.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,612.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$993.75
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,725.00
|
| Rate for Payer: Health EOS Commercial |
$1,668.75
|
| Rate for Payer: HFN Commercial |
$1,725.00
|
| Rate for Payer: Multiplan Commercial |
$1,500.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,125.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,725.00
|
| Rate for Payer: Quartz Beloit One Network |
$918.75
|
| Rate for Payer: Quartz Commercial |
$1,125.00
|
| Rate for Payer: WEA Trust Commercial |
$1,031.25
|
| Rate for Payer: WPS Commercial |
$1,388.81
|
|
|
SCREW-CANN 4.5 X 30 214.530
|
Facility
|
OP
|
$1,875.00
|
|
| Hospital Charge Code |
2967177
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$7,500.00 |
| Rate for Payer: Aetna Commercial |
$1,687.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,612.50
|
| Rate for Payer: Aetna Managed Medicare |
$525.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,218.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$937.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$993.75
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,725.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,049.25
|
| Rate for Payer: Health EOS Commercial |
$1,668.75
|
| Rate for Payer: HFN Commercial |
$1,725.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,406.25
|
| Rate for Payer: Multiplan Commercial |
$1,500.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,125.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,725.00
|
| Rate for Payer: Quartz Beloit One Network |
$918.75
|
| Rate for Payer: Quartz Commercial |
$1,218.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,125.00
|
| Rate for Payer: The Alliance Commercial |
$7,500.00
|
| Rate for Payer: WEA Trust Commercial |
$1,031.25
|
| Rate for Payer: WPS Commercial |
$1,388.81
|
|
|
SCREW-CANN 4.5 X 30 214.530
|
Facility
|
IP
|
$1,875.00
|
|
| Hospital Charge Code |
2967177
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$918.75 |
| Max. Negotiated Rate |
$1,725.00 |
| Rate for Payer: Aetna Commercial |
$1,687.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,612.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$993.75
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,725.00
|
| Rate for Payer: Health EOS Commercial |
$1,668.75
|
| Rate for Payer: HFN Commercial |
$1,725.00
|
| Rate for Payer: Multiplan Commercial |
$1,500.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,125.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,725.00
|
| Rate for Payer: Quartz Beloit One Network |
$918.75
|
| Rate for Payer: Quartz Commercial |
$1,125.00
|
| Rate for Payer: WEA Trust Commercial |
$1,031.25
|
| Rate for Payer: WPS Commercial |
$1,388.81
|
|
|
SCREW-CANN 4.5 X 30 214.730
|
Facility
|
OP
|
$1,875.00
|
|
| Hospital Charge Code |
2967178
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$7,500.00 |
| Rate for Payer: Aetna Commercial |
$1,687.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,612.50
|
| Rate for Payer: Aetna Managed Medicare |
$525.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,218.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$937.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$993.75
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,725.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,049.25
|
| Rate for Payer: Health EOS Commercial |
$1,668.75
|
| Rate for Payer: HFN Commercial |
$1,725.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,406.25
|
| Rate for Payer: Multiplan Commercial |
$1,500.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,125.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,725.00
|
| Rate for Payer: Quartz Beloit One Network |
$918.75
|
| Rate for Payer: Quartz Commercial |
$1,218.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,125.00
|
| Rate for Payer: The Alliance Commercial |
$7,500.00
|
| Rate for Payer: WEA Trust Commercial |
$1,031.25
|
| Rate for Payer: WPS Commercial |
$1,388.81
|
|
|
SCREW-CANN 4.5 X 30 214.730
|
Facility
|
IP
|
$1,875.00
|
|
| Hospital Charge Code |
2967178
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$918.75 |
| Max. Negotiated Rate |
$1,725.00 |
| Rate for Payer: Aetna Commercial |
$1,687.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,612.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$993.75
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,725.00
|
| Rate for Payer: Health EOS Commercial |
$1,668.75
|
| Rate for Payer: HFN Commercial |
$1,725.00
|
| Rate for Payer: Multiplan Commercial |
$1,500.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,125.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,725.00
|
| Rate for Payer: Quartz Beloit One Network |
$918.75
|
| Rate for Payer: Quartz Commercial |
$1,125.00
|
| Rate for Payer: WEA Trust Commercial |
$1,031.25
|
| Rate for Payer: WPS Commercial |
$1,388.81
|
|
|
SCREW-CANN 4.5 X 32 214.532
|
Facility
|
OP
|
$1,875.00
|
|
| Hospital Charge Code |
2967179
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$7,500.00 |
| Rate for Payer: Aetna Commercial |
$1,687.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,612.50
|
| Rate for Payer: Aetna Managed Medicare |
$525.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,218.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$937.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$993.75
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,725.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,049.25
|
| Rate for Payer: Health EOS Commercial |
$1,668.75
|
| Rate for Payer: HFN Commercial |
$1,725.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,406.25
|
| Rate for Payer: Multiplan Commercial |
$1,500.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,125.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,725.00
|
| Rate for Payer: Quartz Beloit One Network |
$918.75
|
| Rate for Payer: Quartz Commercial |
$1,218.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,125.00
|
| Rate for Payer: The Alliance Commercial |
$7,500.00
|
| Rate for Payer: WEA Trust Commercial |
$1,031.25
|
| Rate for Payer: WPS Commercial |
$1,388.81
|
|
|
SCREW-CANN 4.5 X 32 214.532
|
Facility
|
IP
|
$1,875.00
|
|
| Hospital Charge Code |
2967179
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$918.75 |
| Max. Negotiated Rate |
$1,725.00 |
| Rate for Payer: Aetna Commercial |
$1,687.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,612.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$993.75
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,725.00
|
| Rate for Payer: Health EOS Commercial |
$1,668.75
|
| Rate for Payer: HFN Commercial |
$1,725.00
|
| Rate for Payer: Multiplan Commercial |
$1,500.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,125.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,725.00
|
| Rate for Payer: Quartz Beloit One Network |
$918.75
|
| Rate for Payer: Quartz Commercial |
$1,125.00
|
| Rate for Payer: WEA Trust Commercial |
$1,031.25
|
| Rate for Payer: WPS Commercial |
$1,388.81
|
|
|
SCREW-CANN 4.5 X 32 214.732
|
Facility
|
IP
|
$1,875.00
|
|
| Hospital Charge Code |
2967180
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$918.75 |
| Max. Negotiated Rate |
$1,725.00 |
| Rate for Payer: Aetna Commercial |
$1,687.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,612.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$993.75
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,725.00
|
| Rate for Payer: Health EOS Commercial |
$1,668.75
|
| Rate for Payer: HFN Commercial |
$1,725.00
|
| Rate for Payer: Multiplan Commercial |
$1,500.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,125.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,725.00
|
| Rate for Payer: Quartz Beloit One Network |
$918.75
|
| Rate for Payer: Quartz Commercial |
$1,125.00
|
| Rate for Payer: WEA Trust Commercial |
$1,031.25
|
| Rate for Payer: WPS Commercial |
$1,388.81
|
|
|
SCREW-CANN 4.5 X 32 214.732
|
Facility
|
OP
|
$1,875.00
|
|
| Hospital Charge Code |
2967180
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$7,500.00 |
| Rate for Payer: Aetna Commercial |
$1,687.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,612.50
|
| Rate for Payer: Aetna Managed Medicare |
$525.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,218.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$937.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$993.75
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,725.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,049.25
|
| Rate for Payer: Health EOS Commercial |
$1,668.75
|
| Rate for Payer: HFN Commercial |
$1,725.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,406.25
|
| Rate for Payer: Multiplan Commercial |
$1,500.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,125.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,725.00
|
| Rate for Payer: Quartz Beloit One Network |
$918.75
|
| Rate for Payer: Quartz Commercial |
$1,218.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,125.00
|
| Rate for Payer: The Alliance Commercial |
$7,500.00
|
| Rate for Payer: WEA Trust Commercial |
$1,031.25
|
| Rate for Payer: WPS Commercial |
$1,388.81
|
|
|
SCREW-CANN 4.5 X 34 214.534
|
Facility
|
IP
|
$1,875.00
|
|
| Hospital Charge Code |
2967181
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$918.75 |
| Max. Negotiated Rate |
$1,725.00 |
| Rate for Payer: Aetna Commercial |
$1,687.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,612.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$993.75
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,725.00
|
| Rate for Payer: Health EOS Commercial |
$1,668.75
|
| Rate for Payer: HFN Commercial |
$1,725.00
|
| Rate for Payer: Multiplan Commercial |
$1,500.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,125.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,725.00
|
| Rate for Payer: Quartz Beloit One Network |
$918.75
|
| Rate for Payer: Quartz Commercial |
$1,125.00
|
| Rate for Payer: WEA Trust Commercial |
$1,031.25
|
| Rate for Payer: WPS Commercial |
$1,388.81
|
|
|
SCREW-CANN 4.5 X 34 214.534
|
Facility
|
OP
|
$1,875.00
|
|
| Hospital Charge Code |
2967181
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$7,500.00 |
| Rate for Payer: Aetna Commercial |
$1,687.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,612.50
|
| Rate for Payer: Aetna Managed Medicare |
$525.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,218.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$937.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$993.75
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$1,725.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,049.25
|
| Rate for Payer: Health EOS Commercial |
$1,668.75
|
| Rate for Payer: HFN Commercial |
$1,725.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,406.25
|
| Rate for Payer: Multiplan Commercial |
$1,500.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,125.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,725.00
|
| Rate for Payer: Quartz Beloit One Network |
$918.75
|
| Rate for Payer: Quartz Commercial |
$1,218.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,125.00
|
| Rate for Payer: The Alliance Commercial |
$7,500.00
|
| Rate for Payer: WEA Trust Commercial |
$1,031.25
|
| Rate for Payer: WPS Commercial |
$1,388.81
|
|
|
SCREW-CANN 4.5 X 34 214.734
|
Facility
|
OP
|
$1,947.00
|
|
| Hospital Charge Code |
2967182
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$545.16 |
| Max. Negotiated Rate |
$7,788.00 |
| Rate for Payer: Aetna Commercial |
$1,752.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,674.42
|
| Rate for Payer: Aetna Managed Medicare |
$545.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,265.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$973.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$934.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,031.91
|
| Rate for Payer: Cash Price |
$584.10
|
| Rate for Payer: Cigna Commercial |
$1,791.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,089.54
|
| Rate for Payer: Health EOS Commercial |
$1,732.83
|
| Rate for Payer: HFN Commercial |
$1,791.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,460.25
|
| Rate for Payer: Multiplan Commercial |
$1,557.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,168.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,791.24
|
| Rate for Payer: Quartz Beloit One Network |
$954.03
|
| Rate for Payer: Quartz Commercial |
$1,265.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,168.20
|
| Rate for Payer: The Alliance Commercial |
$7,788.00
|
| Rate for Payer: WEA Trust Commercial |
$1,070.85
|
| Rate for Payer: WPS Commercial |
$1,442.14
|
|
