|
SCREW CANN AMBI 6.5 X 110MM 121642
|
Facility
|
OP
|
$2,674.00
|
|
| Hospital Charge Code |
2965994
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$778.67 |
| Max. Negotiated Rate |
$2,558.48 |
| Rate for Payer: Aetna Commercial |
$2,502.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,391.63
|
| Rate for Payer: Aetna Managed Medicare |
$778.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,807.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,390.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,334.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,473.91
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cigna Commercial |
$2,558.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,556.27
|
| Rate for Payer: Health EOS Commercial |
$2,475.05
|
| Rate for Payer: HFN Commercial |
$2,558.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,085.72
|
| Rate for Payer: Multiplan Commercial |
$2,224.77
|
| Rate for Payer: NAPHCARE Commercial |
$1,668.58
|
| Rate for Payer: Preferred Network Access Commercial |
$2,558.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,362.67
|
| Rate for Payer: Quartz Commercial |
$1,807.62
|
| Rate for Payer: Quartz Medicare Advantage |
$1,668.58
|
| Rate for Payer: The Alliance Commercial |
$1,390.48
|
| Rate for Payer: WEA Trust Commercial |
$1,529.53
|
| Rate for Payer: WPS Commercial |
$2,059.78
|
|
|
SCREW CANN AMBI 6.5 X 110MM 121642
|
Facility
|
IP
|
$2,674.00
|
|
| Hospital Charge Code |
2965994
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,362.67 |
| Max. Negotiated Rate |
$2,558.48 |
| Rate for Payer: Aetna Commercial |
$2,502.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,391.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,473.91
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cigna Commercial |
$2,558.48
|
| Rate for Payer: Health EOS Commercial |
$2,475.05
|
| Rate for Payer: HFN Commercial |
$2,558.48
|
| Rate for Payer: Multiplan Commercial |
$2,224.77
|
| Rate for Payer: Preferred Network Access Commercial |
$2,558.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,362.67
|
| Rate for Payer: Quartz Commercial |
$1,668.58
|
| Rate for Payer: WEA Trust Commercial |
$1,529.53
|
| Rate for Payer: WPS Commercial |
$2,059.78
|
|
|
SCREW-CANN AMBI 6.5 X 30MM 121626
|
Facility
|
OP
|
$2,674.00
|
|
| Hospital Charge Code |
2966038
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$778.67 |
| Max. Negotiated Rate |
$2,558.48 |
| Rate for Payer: Aetna Commercial |
$2,502.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,391.63
|
| Rate for Payer: Aetna Managed Medicare |
$778.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,807.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,390.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,334.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,473.91
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cigna Commercial |
$2,558.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,556.27
|
| Rate for Payer: Health EOS Commercial |
$2,475.05
|
| Rate for Payer: HFN Commercial |
$2,558.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,085.72
|
| Rate for Payer: Multiplan Commercial |
$2,224.77
|
| Rate for Payer: NAPHCARE Commercial |
$1,668.58
|
| Rate for Payer: Preferred Network Access Commercial |
$2,558.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,362.67
|
| Rate for Payer: Quartz Commercial |
$1,807.62
|
| Rate for Payer: Quartz Medicare Advantage |
$1,668.58
|
| Rate for Payer: The Alliance Commercial |
$1,390.48
|
| Rate for Payer: WEA Trust Commercial |
$1,529.53
|
| Rate for Payer: WPS Commercial |
$2,059.78
|
|
|
SCREW-CANN AMBI 6.5 X 30MM 121626
|
Facility
|
IP
|
$2,674.00
|
|
| Hospital Charge Code |
2966038
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,362.67 |
| Max. Negotiated Rate |
$2,558.48 |
| Rate for Payer: Aetna Commercial |
$2,502.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,391.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,473.91
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cigna Commercial |
$2,558.48
|
| Rate for Payer: Health EOS Commercial |
$2,475.05
|
| Rate for Payer: HFN Commercial |
$2,558.48
|
| Rate for Payer: Multiplan Commercial |
$2,224.77
|
| Rate for Payer: Preferred Network Access Commercial |
$2,558.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,362.67
|
| Rate for Payer: Quartz Commercial |
$1,668.58
|
| Rate for Payer: WEA Trust Commercial |
$1,529.53
|
| Rate for Payer: WPS Commercial |
$2,059.78
|
|
|
SCREW-CANN AMBI 6.5 X 35MM 121627
|
Facility
|
OP
|
$2,674.00
|
|
| Hospital Charge Code |
2965995
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$778.67 |
| Max. Negotiated Rate |
$2,558.48 |
| Rate for Payer: Aetna Commercial |
$2,502.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,391.63
|
| Rate for Payer: Aetna Managed Medicare |
$778.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,807.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,390.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,334.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,473.91
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cigna Commercial |
$2,558.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,556.27
|
| Rate for Payer: Health EOS Commercial |
$2,475.05
|
| Rate for Payer: HFN Commercial |
$2,558.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,085.72
|
| Rate for Payer: Multiplan Commercial |
$2,224.77
|
| Rate for Payer: NAPHCARE Commercial |
$1,668.58
|
| Rate for Payer: Preferred Network Access Commercial |
$2,558.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,362.67
|
| Rate for Payer: Quartz Commercial |
$1,807.62
|
| Rate for Payer: Quartz Medicare Advantage |
$1,668.58
|
| Rate for Payer: The Alliance Commercial |
$1,390.48
|
| Rate for Payer: WEA Trust Commercial |
$1,529.53
|
| Rate for Payer: WPS Commercial |
$2,059.78
|
|
|
SCREW-CANN AMBI 6.5 X 35MM 121627
|
Facility
|
IP
|
$2,674.00
|
|
| Hospital Charge Code |
2965995
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,362.67 |
| Max. Negotiated Rate |
$2,558.48 |
| Rate for Payer: Aetna Commercial |
$2,502.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,391.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,473.91
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cigna Commercial |
$2,558.48
|
| Rate for Payer: Health EOS Commercial |
$2,475.05
|
| Rate for Payer: HFN Commercial |
$2,558.48
|
| Rate for Payer: Multiplan Commercial |
$2,224.77
|
| Rate for Payer: Preferred Network Access Commercial |
$2,558.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,362.67
|
| Rate for Payer: Quartz Commercial |
$1,668.58
|
| Rate for Payer: WEA Trust Commercial |
$1,529.53
|
| Rate for Payer: WPS Commercial |
$2,059.78
|
|
|
SCREW-CANN AMBI 6.5 X 40MM 121628
|
Facility
|
IP
|
$2,674.00
|
|
| Hospital Charge Code |
2965996
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,362.67 |
| Max. Negotiated Rate |
$2,558.48 |
| Rate for Payer: Aetna Commercial |
$2,502.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,391.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,473.91
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cigna Commercial |
$2,558.48
|
| Rate for Payer: Health EOS Commercial |
$2,475.05
|
| Rate for Payer: HFN Commercial |
$2,558.48
|
| Rate for Payer: Multiplan Commercial |
$2,224.77
|
| Rate for Payer: Preferred Network Access Commercial |
$2,558.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,362.67
|
| Rate for Payer: Quartz Commercial |
$1,668.58
|
| Rate for Payer: WEA Trust Commercial |
$1,529.53
|
| Rate for Payer: WPS Commercial |
$2,059.78
|
|
|
SCREW-CANN AMBI 6.5 X 40MM 121628
|
Facility
|
OP
|
$2,674.00
|
|
| Hospital Charge Code |
2965996
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$778.67 |
| Max. Negotiated Rate |
$2,558.48 |
| Rate for Payer: Aetna Commercial |
$2,502.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,391.63
|
| Rate for Payer: Aetna Managed Medicare |
$778.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,807.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,390.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,334.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,473.91
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cigna Commercial |
$2,558.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,556.27
|
| Rate for Payer: Health EOS Commercial |
$2,475.05
|
| Rate for Payer: HFN Commercial |
$2,558.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,085.72
|
| Rate for Payer: Multiplan Commercial |
$2,224.77
|
| Rate for Payer: NAPHCARE Commercial |
$1,668.58
|
| Rate for Payer: Preferred Network Access Commercial |
$2,558.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,362.67
|
| Rate for Payer: Quartz Commercial |
$1,807.62
|
| Rate for Payer: Quartz Medicare Advantage |
$1,668.58
|
| Rate for Payer: The Alliance Commercial |
$1,390.48
|
| Rate for Payer: WEA Trust Commercial |
$1,529.53
|
| Rate for Payer: WPS Commercial |
$2,059.78
|
|
|
SCREW-CANN AMBI 6.5 X 45MM 121629
|
Facility
|
OP
|
$2,674.00
|
|
| Hospital Charge Code |
2965997
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$778.67 |
| Max. Negotiated Rate |
$2,558.48 |
| Rate for Payer: Aetna Commercial |
$2,502.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,391.63
|
| Rate for Payer: Aetna Managed Medicare |
$778.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,807.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,390.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,334.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,473.91
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cigna Commercial |
$2,558.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,556.27
|
| Rate for Payer: Health EOS Commercial |
$2,475.05
|
| Rate for Payer: HFN Commercial |
$2,558.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,085.72
|
| Rate for Payer: Multiplan Commercial |
$2,224.77
|
| Rate for Payer: NAPHCARE Commercial |
$1,668.58
|
| Rate for Payer: Preferred Network Access Commercial |
$2,558.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,362.67
|
| Rate for Payer: Quartz Commercial |
$1,807.62
|
| Rate for Payer: Quartz Medicare Advantage |
$1,668.58
|
| Rate for Payer: The Alliance Commercial |
$1,390.48
|
| Rate for Payer: WEA Trust Commercial |
$1,529.53
|
| Rate for Payer: WPS Commercial |
$2,059.78
|
|
|
SCREW-CANN AMBI 6.5 X 45MM 121629
|
Facility
|
IP
|
$2,674.00
|
|
| Hospital Charge Code |
2965997
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,362.67 |
| Max. Negotiated Rate |
$2,558.48 |
| Rate for Payer: Aetna Commercial |
$2,502.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,391.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,473.91
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cigna Commercial |
$2,558.48
|
| Rate for Payer: Health EOS Commercial |
$2,475.05
|
| Rate for Payer: HFN Commercial |
$2,558.48
|
| Rate for Payer: Multiplan Commercial |
$2,224.77
|
| Rate for Payer: Preferred Network Access Commercial |
$2,558.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,362.67
|
| Rate for Payer: Quartz Commercial |
$1,668.58
|
| Rate for Payer: WEA Trust Commercial |
$1,529.53
|
| Rate for Payer: WPS Commercial |
$2,059.78
|
|
|
SCREW-CANN AMBI 6.5 X 50MM 121630
|
Facility
|
IP
|
$2,674.00
|
|
| Hospital Charge Code |
2965998
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,362.67 |
| Max. Negotiated Rate |
$2,558.48 |
| Rate for Payer: Aetna Commercial |
$2,502.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,391.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,473.91
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cigna Commercial |
$2,558.48
|
| Rate for Payer: Health EOS Commercial |
$2,475.05
|
| Rate for Payer: HFN Commercial |
$2,558.48
|
| Rate for Payer: Multiplan Commercial |
$2,224.77
|
| Rate for Payer: Preferred Network Access Commercial |
$2,558.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,362.67
|
| Rate for Payer: Quartz Commercial |
$1,668.58
|
| Rate for Payer: WEA Trust Commercial |
$1,529.53
|
| Rate for Payer: WPS Commercial |
$2,059.78
|
|
|
SCREW-CANN AMBI 6.5 X 50MM 121630
|
Facility
|
OP
|
$2,674.00
|
|
| Hospital Charge Code |
2965998
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$778.67 |
| Max. Negotiated Rate |
$2,558.48 |
| Rate for Payer: Aetna Commercial |
$2,502.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,391.63
|
| Rate for Payer: Aetna Managed Medicare |
$778.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,807.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,390.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,334.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,473.91
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cigna Commercial |
$2,558.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,556.27
|
| Rate for Payer: Health EOS Commercial |
$2,475.05
|
| Rate for Payer: HFN Commercial |
$2,558.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,085.72
|
| Rate for Payer: Multiplan Commercial |
$2,224.77
|
| Rate for Payer: NAPHCARE Commercial |
$1,668.58
|
| Rate for Payer: Preferred Network Access Commercial |
$2,558.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,362.67
|
| Rate for Payer: Quartz Commercial |
$1,807.62
|
| Rate for Payer: Quartz Medicare Advantage |
$1,668.58
|
| Rate for Payer: The Alliance Commercial |
$1,390.48
|
| Rate for Payer: WEA Trust Commercial |
$1,529.53
|
| Rate for Payer: WPS Commercial |
$2,059.78
|
|
|
SCREW-CANN AMBI 6.5 X 55MM 121631
|
Facility
|
IP
|
$2,674.00
|
|
| Hospital Charge Code |
2965999
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,362.67 |
| Max. Negotiated Rate |
$2,558.48 |
| Rate for Payer: Aetna Commercial |
$2,502.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,391.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,473.91
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cigna Commercial |
$2,558.48
|
| Rate for Payer: Health EOS Commercial |
$2,475.05
|
| Rate for Payer: HFN Commercial |
$2,558.48
|
| Rate for Payer: Multiplan Commercial |
$2,224.77
|
| Rate for Payer: Preferred Network Access Commercial |
$2,558.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,362.67
|
| Rate for Payer: Quartz Commercial |
$1,668.58
|
| Rate for Payer: WEA Trust Commercial |
$1,529.53
|
| Rate for Payer: WPS Commercial |
$2,059.78
|
|
|
SCREW-CANN AMBI 6.5 X 55MM 121631
|
Facility
|
OP
|
$2,674.00
|
|
| Hospital Charge Code |
2965999
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$778.67 |
| Max. Negotiated Rate |
$2,558.48 |
| Rate for Payer: Aetna Commercial |
$2,502.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,391.63
|
| Rate for Payer: Aetna Managed Medicare |
$778.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,807.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,390.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,334.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,473.91
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cigna Commercial |
$2,558.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,556.27
|
| Rate for Payer: Health EOS Commercial |
$2,475.05
|
| Rate for Payer: HFN Commercial |
$2,558.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,085.72
|
| Rate for Payer: Multiplan Commercial |
$2,224.77
|
| Rate for Payer: NAPHCARE Commercial |
$1,668.58
|
| Rate for Payer: Preferred Network Access Commercial |
$2,558.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,362.67
|
| Rate for Payer: Quartz Commercial |
$1,807.62
|
| Rate for Payer: Quartz Medicare Advantage |
$1,668.58
|
| Rate for Payer: The Alliance Commercial |
$1,390.48
|
| Rate for Payer: WEA Trust Commercial |
$1,529.53
|
| Rate for Payer: WPS Commercial |
$2,059.78
|
|
|
SCREW-CANN AMBI 6.5 X 60MM 121632
|
Facility
|
OP
|
$2,674.00
|
|
| Hospital Charge Code |
2966000
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$778.67 |
| Max. Negotiated Rate |
$2,558.48 |
| Rate for Payer: Aetna Commercial |
$2,502.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,391.63
|
| Rate for Payer: Aetna Managed Medicare |
$778.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,807.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,390.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,334.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,473.91
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cigna Commercial |
$2,558.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,556.27
|
| Rate for Payer: Health EOS Commercial |
$2,475.05
|
| Rate for Payer: HFN Commercial |
$2,558.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,085.72
|
| Rate for Payer: Multiplan Commercial |
$2,224.77
|
| Rate for Payer: NAPHCARE Commercial |
$1,668.58
|
| Rate for Payer: Preferred Network Access Commercial |
$2,558.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,362.67
|
| Rate for Payer: Quartz Commercial |
$1,807.62
|
| Rate for Payer: Quartz Medicare Advantage |
$1,668.58
|
| Rate for Payer: The Alliance Commercial |
$1,390.48
|
| Rate for Payer: WEA Trust Commercial |
$1,529.53
|
| Rate for Payer: WPS Commercial |
$2,059.78
|
|
|
SCREW-CANN AMBI 6.5 X 60MM 121632
|
Facility
|
IP
|
$2,674.00
|
|
| Hospital Charge Code |
2966000
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,362.67 |
| Max. Negotiated Rate |
$2,558.48 |
| Rate for Payer: Aetna Commercial |
$2,502.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,391.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,473.91
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cigna Commercial |
$2,558.48
|
| Rate for Payer: Health EOS Commercial |
$2,475.05
|
| Rate for Payer: HFN Commercial |
$2,558.48
|
| Rate for Payer: Multiplan Commercial |
$2,224.77
|
| Rate for Payer: Preferred Network Access Commercial |
$2,558.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,362.67
|
| Rate for Payer: Quartz Commercial |
$1,668.58
|
| Rate for Payer: WEA Trust Commercial |
$1,529.53
|
| Rate for Payer: WPS Commercial |
$2,059.78
|
|
|
SCREW-CANN AMBI 6.5 X 65MM 121633
|
Facility
|
IP
|
$2,674.00
|
|
| Hospital Charge Code |
2966001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,362.67 |
| Max. Negotiated Rate |
$2,558.48 |
| Rate for Payer: Aetna Commercial |
$2,502.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,391.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,473.91
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cigna Commercial |
$2,558.48
|
| Rate for Payer: Health EOS Commercial |
$2,475.05
|
| Rate for Payer: HFN Commercial |
$2,558.48
|
| Rate for Payer: Multiplan Commercial |
$2,224.77
|
| Rate for Payer: Preferred Network Access Commercial |
$2,558.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,362.67
|
| Rate for Payer: Quartz Commercial |
$1,668.58
|
| Rate for Payer: WEA Trust Commercial |
$1,529.53
|
| Rate for Payer: WPS Commercial |
$2,059.78
|
|
|
SCREW-CANN AMBI 6.5 X 65MM 121633
|
Facility
|
OP
|
$2,674.00
|
|
| Hospital Charge Code |
2966001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$778.67 |
| Max. Negotiated Rate |
$2,558.48 |
| Rate for Payer: Aetna Commercial |
$2,502.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,391.63
|
| Rate for Payer: Aetna Managed Medicare |
$778.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,807.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,390.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,334.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,473.91
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cigna Commercial |
$2,558.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,556.27
|
| Rate for Payer: Health EOS Commercial |
$2,475.05
|
| Rate for Payer: HFN Commercial |
$2,558.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,085.72
|
| Rate for Payer: Multiplan Commercial |
$2,224.77
|
| Rate for Payer: NAPHCARE Commercial |
$1,668.58
|
| Rate for Payer: Preferred Network Access Commercial |
$2,558.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,362.67
|
| Rate for Payer: Quartz Commercial |
$1,807.62
|
| Rate for Payer: Quartz Medicare Advantage |
$1,668.58
|
| Rate for Payer: The Alliance Commercial |
$1,390.48
|
| Rate for Payer: WEA Trust Commercial |
$1,529.53
|
| Rate for Payer: WPS Commercial |
$2,059.78
|
|
|
SCREW-CANN AMBI 6.5 X 70MM 121634
|
Facility
|
OP
|
$2,674.00
|
|
| Hospital Charge Code |
2966002
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$778.67 |
| Max. Negotiated Rate |
$2,558.48 |
| Rate for Payer: Aetna Commercial |
$2,502.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,391.63
|
| Rate for Payer: Aetna Managed Medicare |
$778.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,807.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,390.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,334.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,473.91
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cigna Commercial |
$2,558.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,556.27
|
| Rate for Payer: Health EOS Commercial |
$2,475.05
|
| Rate for Payer: HFN Commercial |
$2,558.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,085.72
|
| Rate for Payer: Multiplan Commercial |
$2,224.77
|
| Rate for Payer: NAPHCARE Commercial |
$1,668.58
|
| Rate for Payer: Preferred Network Access Commercial |
$2,558.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,362.67
|
| Rate for Payer: Quartz Commercial |
$1,807.62
|
| Rate for Payer: Quartz Medicare Advantage |
$1,668.58
|
| Rate for Payer: The Alliance Commercial |
$1,390.48
|
| Rate for Payer: WEA Trust Commercial |
$1,529.53
|
| Rate for Payer: WPS Commercial |
$2,059.78
|
|
|
SCREW-CANN AMBI 6.5 X 70MM 121634
|
Facility
|
IP
|
$2,674.00
|
|
| Hospital Charge Code |
2966002
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,362.67 |
| Max. Negotiated Rate |
$2,558.48 |
| Rate for Payer: Aetna Commercial |
$2,502.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,391.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,473.91
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cigna Commercial |
$2,558.48
|
| Rate for Payer: Health EOS Commercial |
$2,475.05
|
| Rate for Payer: HFN Commercial |
$2,558.48
|
| Rate for Payer: Multiplan Commercial |
$2,224.77
|
| Rate for Payer: Preferred Network Access Commercial |
$2,558.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,362.67
|
| Rate for Payer: Quartz Commercial |
$1,668.58
|
| Rate for Payer: WEA Trust Commercial |
$1,529.53
|
| Rate for Payer: WPS Commercial |
$2,059.78
|
|
|
SCREW-CANN AMBI 6.5 X 75MM 121635
|
Facility
|
OP
|
$2,674.00
|
|
| Hospital Charge Code |
2966003
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$778.67 |
| Max. Negotiated Rate |
$2,558.48 |
| Rate for Payer: Aetna Commercial |
$2,502.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,391.63
|
| Rate for Payer: Aetna Managed Medicare |
$778.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,807.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,390.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,334.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,473.91
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cigna Commercial |
$2,558.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,556.27
|
| Rate for Payer: Health EOS Commercial |
$2,475.05
|
| Rate for Payer: HFN Commercial |
$2,558.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,085.72
|
| Rate for Payer: Multiplan Commercial |
$2,224.77
|
| Rate for Payer: NAPHCARE Commercial |
$1,668.58
|
| Rate for Payer: Preferred Network Access Commercial |
$2,558.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,362.67
|
| Rate for Payer: Quartz Commercial |
$1,807.62
|
| Rate for Payer: Quartz Medicare Advantage |
$1,668.58
|
| Rate for Payer: The Alliance Commercial |
$1,390.48
|
| Rate for Payer: WEA Trust Commercial |
$1,529.53
|
| Rate for Payer: WPS Commercial |
$2,059.78
|
|
|
SCREW-CANN AMBI 6.5 X 75MM 121635
|
Facility
|
IP
|
$2,674.00
|
|
| Hospital Charge Code |
2966003
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,362.67 |
| Max. Negotiated Rate |
$2,558.48 |
| Rate for Payer: Aetna Commercial |
$2,502.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,391.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,473.91
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cigna Commercial |
$2,558.48
|
| Rate for Payer: Health EOS Commercial |
$2,475.05
|
| Rate for Payer: HFN Commercial |
$2,558.48
|
| Rate for Payer: Multiplan Commercial |
$2,224.77
|
| Rate for Payer: Preferred Network Access Commercial |
$2,558.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,362.67
|
| Rate for Payer: Quartz Commercial |
$1,668.58
|
| Rate for Payer: WEA Trust Commercial |
$1,529.53
|
| Rate for Payer: WPS Commercial |
$2,059.78
|
|
|
SCREW-CANN AMBI 6.5 X 80MM 121636
|
Facility
|
IP
|
$2,674.00
|
|
| Hospital Charge Code |
2966004
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,362.67 |
| Max. Negotiated Rate |
$2,558.48 |
| Rate for Payer: Aetna Commercial |
$2,502.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,391.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,473.91
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cigna Commercial |
$2,558.48
|
| Rate for Payer: Health EOS Commercial |
$2,475.05
|
| Rate for Payer: HFN Commercial |
$2,558.48
|
| Rate for Payer: Multiplan Commercial |
$2,224.77
|
| Rate for Payer: Preferred Network Access Commercial |
$2,558.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,362.67
|
| Rate for Payer: Quartz Commercial |
$1,668.58
|
| Rate for Payer: WEA Trust Commercial |
$1,529.53
|
| Rate for Payer: WPS Commercial |
$2,059.78
|
|
|
SCREW-CANN AMBI 6.5 X 80MM 121636
|
Facility
|
OP
|
$2,674.00
|
|
| Hospital Charge Code |
2966004
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$778.67 |
| Max. Negotiated Rate |
$2,558.48 |
| Rate for Payer: Aetna Commercial |
$2,502.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,391.63
|
| Rate for Payer: Aetna Managed Medicare |
$778.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,807.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,390.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,334.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,473.91
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cigna Commercial |
$2,558.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,556.27
|
| Rate for Payer: Health EOS Commercial |
$2,475.05
|
| Rate for Payer: HFN Commercial |
$2,558.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,085.72
|
| Rate for Payer: Multiplan Commercial |
$2,224.77
|
| Rate for Payer: NAPHCARE Commercial |
$1,668.58
|
| Rate for Payer: Preferred Network Access Commercial |
$2,558.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,362.67
|
| Rate for Payer: Quartz Commercial |
$1,807.62
|
| Rate for Payer: Quartz Medicare Advantage |
$1,668.58
|
| Rate for Payer: The Alliance Commercial |
$1,390.48
|
| Rate for Payer: WEA Trust Commercial |
$1,529.53
|
| Rate for Payer: WPS Commercial |
$2,059.78
|
|
|
SCREW-CANN AMBI 6.5 X 85MM 121637
|
Facility
|
IP
|
$2,674.00
|
|
| Hospital Charge Code |
2966007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,362.67 |
| Max. Negotiated Rate |
$2,558.48 |
| Rate for Payer: Aetna Commercial |
$2,502.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,391.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,473.91
|
| Rate for Payer: Cash Price |
$802.20
|
| Rate for Payer: Cigna Commercial |
$2,558.48
|
| Rate for Payer: Health EOS Commercial |
$2,475.05
|
| Rate for Payer: HFN Commercial |
$2,558.48
|
| Rate for Payer: Multiplan Commercial |
$2,224.77
|
| Rate for Payer: Preferred Network Access Commercial |
$2,558.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,362.67
|
| Rate for Payer: Quartz Commercial |
$1,668.58
|
| Rate for Payer: WEA Trust Commercial |
$1,529.53
|
| Rate for Payer: WPS Commercial |
$2,059.78
|
|
