|
SCREW CANN LDA 2.0 X 32 TIGER 200-20-032
|
Facility
|
IP
|
$2,289.00
|
|
| Hospital Charge Code |
3782759
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,166.47 |
| Max. Negotiated Rate |
$2,190.12 |
| Rate for Payer: Aetna Commercial |
$2,142.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,047.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,261.70
|
| Rate for Payer: Cash Price |
$686.70
|
| Rate for Payer: Cigna Commercial |
$2,190.12
|
| Rate for Payer: Health EOS Commercial |
$2,118.70
|
| Rate for Payer: HFN Commercial |
$2,190.12
|
| Rate for Payer: Multiplan Commercial |
$1,904.45
|
| Rate for Payer: Preferred Network Access Commercial |
$2,190.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,166.47
|
| Rate for Payer: Quartz Commercial |
$1,428.34
|
| Rate for Payer: WEA Trust Commercial |
$1,309.31
|
| Rate for Payer: WPS Commercial |
$1,763.22
|
|
|
SCREW CANN LDA 2.0 X 32 TIGER 200-20-032
|
Facility
|
OP
|
$2,289.00
|
|
| Hospital Charge Code |
3782759
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$666.56 |
| Max. Negotiated Rate |
$2,190.12 |
| Rate for Payer: Aetna Commercial |
$2,142.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,047.28
|
| Rate for Payer: Aetna Managed Medicare |
$666.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,547.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,190.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,142.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,261.70
|
| Rate for Payer: Cash Price |
$686.70
|
| Rate for Payer: Cigna Commercial |
$2,190.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,332.20
|
| Rate for Payer: Health EOS Commercial |
$2,118.70
|
| Rate for Payer: HFN Commercial |
$2,190.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,785.42
|
| Rate for Payer: Multiplan Commercial |
$1,904.45
|
| Rate for Payer: NAPHCARE Commercial |
$1,428.34
|
| Rate for Payer: Preferred Network Access Commercial |
$2,190.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,166.47
|
| Rate for Payer: Quartz Commercial |
$1,547.36
|
| Rate for Payer: Quartz Medicare Advantage |
$1,428.34
|
| Rate for Payer: The Alliance Commercial |
$1,190.28
|
| Rate for Payer: WEA Trust Commercial |
$1,309.31
|
| Rate for Payer: WPS Commercial |
$1,763.22
|
|
|
SCREW CANN LDA 2.0 X 34 TIGER 200-20-034
|
Facility
|
IP
|
$2,289.00
|
|
| Hospital Charge Code |
3782760
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,166.47 |
| Max. Negotiated Rate |
$2,190.12 |
| Rate for Payer: Aetna Commercial |
$2,142.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,047.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,261.70
|
| Rate for Payer: Cash Price |
$686.70
|
| Rate for Payer: Cigna Commercial |
$2,190.12
|
| Rate for Payer: Health EOS Commercial |
$2,118.70
|
| Rate for Payer: HFN Commercial |
$2,190.12
|
| Rate for Payer: Multiplan Commercial |
$1,904.45
|
| Rate for Payer: Preferred Network Access Commercial |
$2,190.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,166.47
|
| Rate for Payer: Quartz Commercial |
$1,428.34
|
| Rate for Payer: WEA Trust Commercial |
$1,309.31
|
| Rate for Payer: WPS Commercial |
$1,763.22
|
|
|
SCREW CANN LDA 2.0 X 34 TIGER 200-20-034
|
Facility
|
OP
|
$2,289.00
|
|
| Hospital Charge Code |
3782760
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$666.56 |
| Max. Negotiated Rate |
$2,190.12 |
| Rate for Payer: Aetna Commercial |
$2,142.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,047.28
|
| Rate for Payer: Aetna Managed Medicare |
$666.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,547.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,190.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,142.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,261.70
|
| Rate for Payer: Cash Price |
$686.70
|
| Rate for Payer: Cigna Commercial |
$2,190.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,332.20
|
| Rate for Payer: Health EOS Commercial |
$2,118.70
|
| Rate for Payer: HFN Commercial |
$2,190.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,785.42
|
| Rate for Payer: Multiplan Commercial |
$1,904.45
|
| Rate for Payer: NAPHCARE Commercial |
$1,428.34
|
| Rate for Payer: Preferred Network Access Commercial |
$2,190.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,166.47
|
| Rate for Payer: Quartz Commercial |
$1,547.36
|
| Rate for Payer: Quartz Medicare Advantage |
$1,428.34
|
| Rate for Payer: The Alliance Commercial |
$1,190.28
|
| Rate for Payer: WEA Trust Commercial |
$1,309.31
|
| Rate for Payer: WPS Commercial |
$1,763.22
|
|
|
SCREW CANN LDA 2.0 X 36 TIGER 200-20-036
|
Facility
|
OP
|
$2,289.00
|
|
| Hospital Charge Code |
3782761
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$666.56 |
| Max. Negotiated Rate |
$2,190.12 |
| Rate for Payer: Aetna Commercial |
$2,142.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,047.28
|
| Rate for Payer: Aetna Managed Medicare |
$666.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,547.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,190.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,142.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,261.70
|
| Rate for Payer: Cash Price |
$686.70
|
| Rate for Payer: Cigna Commercial |
$2,190.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,332.20
|
| Rate for Payer: Health EOS Commercial |
$2,118.70
|
| Rate for Payer: HFN Commercial |
$2,190.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,785.42
|
| Rate for Payer: Multiplan Commercial |
$1,904.45
|
| Rate for Payer: NAPHCARE Commercial |
$1,428.34
|
| Rate for Payer: Preferred Network Access Commercial |
$2,190.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,166.47
|
| Rate for Payer: Quartz Commercial |
$1,547.36
|
| Rate for Payer: Quartz Medicare Advantage |
$1,428.34
|
| Rate for Payer: The Alliance Commercial |
$1,190.28
|
| Rate for Payer: WEA Trust Commercial |
$1,309.31
|
| Rate for Payer: WPS Commercial |
$1,763.22
|
|
|
SCREW CANN LDA 2.0 X 36 TIGER 200-20-036
|
Facility
|
IP
|
$2,289.00
|
|
| Hospital Charge Code |
3782761
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,166.47 |
| Max. Negotiated Rate |
$2,190.12 |
| Rate for Payer: Aetna Commercial |
$2,142.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,047.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,261.70
|
| Rate for Payer: Cash Price |
$686.70
|
| Rate for Payer: Cigna Commercial |
$2,190.12
|
| Rate for Payer: Health EOS Commercial |
$2,118.70
|
| Rate for Payer: HFN Commercial |
$2,190.12
|
| Rate for Payer: Multiplan Commercial |
$1,904.45
|
| Rate for Payer: Preferred Network Access Commercial |
$2,190.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,166.47
|
| Rate for Payer: Quartz Commercial |
$1,428.34
|
| Rate for Payer: WEA Trust Commercial |
$1,309.31
|
| Rate for Payer: WPS Commercial |
$1,763.22
|
|
|
SCREW CANN LDA 2.0 X 38 TIGER 200-20-038
|
Facility
|
OP
|
$2,289.00
|
|
| Hospital Charge Code |
3782762
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$666.56 |
| Max. Negotiated Rate |
$2,190.12 |
| Rate for Payer: Aetna Commercial |
$2,142.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,047.28
|
| Rate for Payer: Aetna Managed Medicare |
$666.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,547.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,190.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,142.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,261.70
|
| Rate for Payer: Cash Price |
$686.70
|
| Rate for Payer: Cigna Commercial |
$2,190.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,332.20
|
| Rate for Payer: Health EOS Commercial |
$2,118.70
|
| Rate for Payer: HFN Commercial |
$2,190.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,785.42
|
| Rate for Payer: Multiplan Commercial |
$1,904.45
|
| Rate for Payer: NAPHCARE Commercial |
$1,428.34
|
| Rate for Payer: Preferred Network Access Commercial |
$2,190.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,166.47
|
| Rate for Payer: Quartz Commercial |
$1,547.36
|
| Rate for Payer: Quartz Medicare Advantage |
$1,428.34
|
| Rate for Payer: The Alliance Commercial |
$1,190.28
|
| Rate for Payer: WEA Trust Commercial |
$1,309.31
|
| Rate for Payer: WPS Commercial |
$1,763.22
|
|
|
SCREW CANN LDA 2.0 X 38 TIGER 200-20-038
|
Facility
|
IP
|
$2,289.00
|
|
| Hospital Charge Code |
3782762
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,166.47 |
| Max. Negotiated Rate |
$2,190.12 |
| Rate for Payer: Aetna Commercial |
$2,142.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,047.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,261.70
|
| Rate for Payer: Cash Price |
$686.70
|
| Rate for Payer: Cigna Commercial |
$2,190.12
|
| Rate for Payer: Health EOS Commercial |
$2,118.70
|
| Rate for Payer: HFN Commercial |
$2,190.12
|
| Rate for Payer: Multiplan Commercial |
$1,904.45
|
| Rate for Payer: Preferred Network Access Commercial |
$2,190.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,166.47
|
| Rate for Payer: Quartz Commercial |
$1,428.34
|
| Rate for Payer: WEA Trust Commercial |
$1,309.31
|
| Rate for Payer: WPS Commercial |
$1,763.22
|
|
|
SCREW CANN LDA 2.0 X 40 TIGER 200-20-040
|
Facility
|
OP
|
$2,289.00
|
|
| Hospital Charge Code |
3782763
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$666.56 |
| Max. Negotiated Rate |
$2,190.12 |
| Rate for Payer: Aetna Commercial |
$2,142.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,047.28
|
| Rate for Payer: Aetna Managed Medicare |
$666.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,547.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,190.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,142.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,261.70
|
| Rate for Payer: Cash Price |
$686.70
|
| Rate for Payer: Cigna Commercial |
$2,190.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,332.20
|
| Rate for Payer: Health EOS Commercial |
$2,118.70
|
| Rate for Payer: HFN Commercial |
$2,190.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,785.42
|
| Rate for Payer: Multiplan Commercial |
$1,904.45
|
| Rate for Payer: NAPHCARE Commercial |
$1,428.34
|
| Rate for Payer: Preferred Network Access Commercial |
$2,190.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,166.47
|
| Rate for Payer: Quartz Commercial |
$1,547.36
|
| Rate for Payer: Quartz Medicare Advantage |
$1,428.34
|
| Rate for Payer: The Alliance Commercial |
$1,190.28
|
| Rate for Payer: WEA Trust Commercial |
$1,309.31
|
| Rate for Payer: WPS Commercial |
$1,763.22
|
|
|
SCREW CANN LDA 2.0 X 40 TIGER 200-20-040
|
Facility
|
IP
|
$2,289.00
|
|
| Hospital Charge Code |
3782763
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,166.47 |
| Max. Negotiated Rate |
$2,190.12 |
| Rate for Payer: Aetna Commercial |
$2,142.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,047.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,261.70
|
| Rate for Payer: Cash Price |
$686.70
|
| Rate for Payer: Cigna Commercial |
$2,190.12
|
| Rate for Payer: Health EOS Commercial |
$2,118.70
|
| Rate for Payer: HFN Commercial |
$2,190.12
|
| Rate for Payer: Multiplan Commercial |
$1,904.45
|
| Rate for Payer: Preferred Network Access Commercial |
$2,190.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,166.47
|
| Rate for Payer: Quartz Commercial |
$1,428.34
|
| Rate for Payer: WEA Trust Commercial |
$1,309.31
|
| Rate for Payer: WPS Commercial |
$1,763.22
|
|
|
SCREW CANN LDA 2.0 X 42 TIGER 200-20-042
|
Facility
|
OP
|
$2,289.00
|
|
| Hospital Charge Code |
3782764
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$666.56 |
| Max. Negotiated Rate |
$2,190.12 |
| Rate for Payer: Aetna Commercial |
$2,142.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,047.28
|
| Rate for Payer: Aetna Managed Medicare |
$666.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,547.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,190.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,142.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,261.70
|
| Rate for Payer: Cash Price |
$686.70
|
| Rate for Payer: Cigna Commercial |
$2,190.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,332.20
|
| Rate for Payer: Health EOS Commercial |
$2,118.70
|
| Rate for Payer: HFN Commercial |
$2,190.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,785.42
|
| Rate for Payer: Multiplan Commercial |
$1,904.45
|
| Rate for Payer: NAPHCARE Commercial |
$1,428.34
|
| Rate for Payer: Preferred Network Access Commercial |
$2,190.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,166.47
|
| Rate for Payer: Quartz Commercial |
$1,547.36
|
| Rate for Payer: Quartz Medicare Advantage |
$1,428.34
|
| Rate for Payer: The Alliance Commercial |
$1,190.28
|
| Rate for Payer: WEA Trust Commercial |
$1,309.31
|
| Rate for Payer: WPS Commercial |
$1,763.22
|
|
|
SCREW CANN LDA 2.0 X 42 TIGER 200-20-042
|
Facility
|
IP
|
$2,289.00
|
|
| Hospital Charge Code |
3782764
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,166.47 |
| Max. Negotiated Rate |
$2,190.12 |
| Rate for Payer: Aetna Commercial |
$2,142.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,047.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,261.70
|
| Rate for Payer: Cash Price |
$686.70
|
| Rate for Payer: Cigna Commercial |
$2,190.12
|
| Rate for Payer: Health EOS Commercial |
$2,118.70
|
| Rate for Payer: HFN Commercial |
$2,190.12
|
| Rate for Payer: Multiplan Commercial |
$1,904.45
|
| Rate for Payer: Preferred Network Access Commercial |
$2,190.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,166.47
|
| Rate for Payer: Quartz Commercial |
$1,428.34
|
| Rate for Payer: WEA Trust Commercial |
$1,309.31
|
| Rate for Payer: WPS Commercial |
$1,763.22
|
|
|
SCREW CANN LDA 2.4 X 32 TIGER 200-24-032
|
Facility
|
OP
|
$2,139.00
|
|
| Hospital Charge Code |
3782772
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$622.88 |
| Max. Negotiated Rate |
$2,046.60 |
| Rate for Payer: Aetna Commercial |
$2,002.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,913.12
|
| Rate for Payer: Aetna Managed Medicare |
$622.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,445.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,112.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,067.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,179.02
|
| Rate for Payer: Cash Price |
$641.70
|
| Rate for Payer: Cigna Commercial |
$2,046.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,244.90
|
| Rate for Payer: Health EOS Commercial |
$1,979.86
|
| Rate for Payer: HFN Commercial |
$2,046.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,668.42
|
| Rate for Payer: Multiplan Commercial |
$1,779.65
|
| Rate for Payer: NAPHCARE Commercial |
$1,334.74
|
| Rate for Payer: Preferred Network Access Commercial |
$2,046.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,090.03
|
| Rate for Payer: Quartz Commercial |
$1,445.96
|
| Rate for Payer: Quartz Medicare Advantage |
$1,334.74
|
| Rate for Payer: The Alliance Commercial |
$1,112.28
|
| Rate for Payer: WEA Trust Commercial |
$1,223.51
|
| Rate for Payer: WPS Commercial |
$1,647.67
|
|
|
SCREW CANN LDA 2.4 X 32 TIGER 200-24-032
|
Facility
|
IP
|
$2,139.00
|
|
| Hospital Charge Code |
3782772
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,090.03 |
| Max. Negotiated Rate |
$2,046.60 |
| Rate for Payer: Aetna Commercial |
$2,002.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,913.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,179.02
|
| Rate for Payer: Cash Price |
$641.70
|
| Rate for Payer: Cigna Commercial |
$2,046.60
|
| Rate for Payer: Health EOS Commercial |
$1,979.86
|
| Rate for Payer: HFN Commercial |
$2,046.60
|
| Rate for Payer: Multiplan Commercial |
$1,779.65
|
| Rate for Payer: Preferred Network Access Commercial |
$2,046.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,090.03
|
| Rate for Payer: Quartz Commercial |
$1,334.74
|
| Rate for Payer: WEA Trust Commercial |
$1,223.51
|
| Rate for Payer: WPS Commercial |
$1,647.67
|
|
|
SCREW CANN LDA 2.4 X 34 TIGER 200-24-034
|
Facility
|
OP
|
$2,059.00
|
|
| Hospital Charge Code |
3782773
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$599.58 |
| Max. Negotiated Rate |
$1,970.05 |
| Rate for Payer: Aetna Commercial |
$1,927.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,841.57
|
| Rate for Payer: Aetna Managed Medicare |
$599.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,391.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,070.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,027.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,134.92
|
| Rate for Payer: Cash Price |
$617.70
|
| Rate for Payer: Cigna Commercial |
$1,970.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,198.34
|
| Rate for Payer: Health EOS Commercial |
$1,905.81
|
| Rate for Payer: HFN Commercial |
$1,970.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,606.02
|
| Rate for Payer: Multiplan Commercial |
$1,713.09
|
| Rate for Payer: NAPHCARE Commercial |
$1,284.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,970.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,049.27
|
| Rate for Payer: Quartz Commercial |
$1,391.88
|
| Rate for Payer: Quartz Medicare Advantage |
$1,284.82
|
| Rate for Payer: The Alliance Commercial |
$1,070.68
|
| Rate for Payer: WEA Trust Commercial |
$1,177.75
|
| Rate for Payer: WPS Commercial |
$1,586.05
|
|
|
SCREW CANN LDA 2.4 X 34 TIGER 200-24-034
|
Facility
|
IP
|
$2,059.00
|
|
| Hospital Charge Code |
3782773
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,049.27 |
| Max. Negotiated Rate |
$1,970.05 |
| Rate for Payer: Aetna Commercial |
$1,927.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,841.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,134.92
|
| Rate for Payer: Cash Price |
$617.70
|
| Rate for Payer: Cigna Commercial |
$1,970.05
|
| Rate for Payer: Health EOS Commercial |
$1,905.81
|
| Rate for Payer: HFN Commercial |
$1,970.05
|
| Rate for Payer: Multiplan Commercial |
$1,713.09
|
| Rate for Payer: Preferred Network Access Commercial |
$1,970.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,049.27
|
| Rate for Payer: Quartz Commercial |
$1,284.82
|
| Rate for Payer: WEA Trust Commercial |
$1,177.75
|
| Rate for Payer: WPS Commercial |
$1,586.05
|
|
|
SCREW CANN LDA 2.4 X 36 TIGER 200-24-036
|
Facility
|
IP
|
$2,139.00
|
|
| Hospital Charge Code |
3782774
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,090.03 |
| Max. Negotiated Rate |
$2,046.60 |
| Rate for Payer: Aetna Commercial |
$2,002.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,913.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,179.02
|
| Rate for Payer: Cash Price |
$641.70
|
| Rate for Payer: Cigna Commercial |
$2,046.60
|
| Rate for Payer: Health EOS Commercial |
$1,979.86
|
| Rate for Payer: HFN Commercial |
$2,046.60
|
| Rate for Payer: Multiplan Commercial |
$1,779.65
|
| Rate for Payer: Preferred Network Access Commercial |
$2,046.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,090.03
|
| Rate for Payer: Quartz Commercial |
$1,334.74
|
| Rate for Payer: WEA Trust Commercial |
$1,223.51
|
| Rate for Payer: WPS Commercial |
$1,647.67
|
|
|
SCREW CANN LDA 2.4 X 36 TIGER 200-24-036
|
Facility
|
OP
|
$2,139.00
|
|
| Hospital Charge Code |
3782774
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$622.88 |
| Max. Negotiated Rate |
$2,046.60 |
| Rate for Payer: Aetna Commercial |
$2,002.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,913.12
|
| Rate for Payer: Aetna Managed Medicare |
$622.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,445.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,112.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,067.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,179.02
|
| Rate for Payer: Cash Price |
$641.70
|
| Rate for Payer: Cigna Commercial |
$2,046.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,244.90
|
| Rate for Payer: Health EOS Commercial |
$1,979.86
|
| Rate for Payer: HFN Commercial |
$2,046.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,668.42
|
| Rate for Payer: Multiplan Commercial |
$1,779.65
|
| Rate for Payer: NAPHCARE Commercial |
$1,334.74
|
| Rate for Payer: Preferred Network Access Commercial |
$2,046.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,090.03
|
| Rate for Payer: Quartz Commercial |
$1,445.96
|
| Rate for Payer: Quartz Medicare Advantage |
$1,334.74
|
| Rate for Payer: The Alliance Commercial |
$1,112.28
|
| Rate for Payer: WEA Trust Commercial |
$1,223.51
|
| Rate for Payer: WPS Commercial |
$1,647.67
|
|
|
SCREW CANN LDA 2.4 X 38 TIGER 200-24-038
|
Facility
|
OP
|
$2,139.00
|
|
| Hospital Charge Code |
3782775
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$622.88 |
| Max. Negotiated Rate |
$2,046.60 |
| Rate for Payer: Aetna Commercial |
$2,002.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,913.12
|
| Rate for Payer: Aetna Managed Medicare |
$622.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,445.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,112.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,067.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,179.02
|
| Rate for Payer: Cash Price |
$641.70
|
| Rate for Payer: Cigna Commercial |
$2,046.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,244.90
|
| Rate for Payer: Health EOS Commercial |
$1,979.86
|
| Rate for Payer: HFN Commercial |
$2,046.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,668.42
|
| Rate for Payer: Multiplan Commercial |
$1,779.65
|
| Rate for Payer: NAPHCARE Commercial |
$1,334.74
|
| Rate for Payer: Preferred Network Access Commercial |
$2,046.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,090.03
|
| Rate for Payer: Quartz Commercial |
$1,445.96
|
| Rate for Payer: Quartz Medicare Advantage |
$1,334.74
|
| Rate for Payer: The Alliance Commercial |
$1,112.28
|
| Rate for Payer: WEA Trust Commercial |
$1,223.51
|
| Rate for Payer: WPS Commercial |
$1,647.67
|
|
|
SCREW CANN LDA 2.4 X 38 TIGER 200-24-038
|
Facility
|
IP
|
$2,139.00
|
|
| Hospital Charge Code |
3782775
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,090.03 |
| Max. Negotiated Rate |
$2,046.60 |
| Rate for Payer: Aetna Commercial |
$2,002.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,913.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,179.02
|
| Rate for Payer: Cash Price |
$641.70
|
| Rate for Payer: Cigna Commercial |
$2,046.60
|
| Rate for Payer: Health EOS Commercial |
$1,979.86
|
| Rate for Payer: HFN Commercial |
$2,046.60
|
| Rate for Payer: Multiplan Commercial |
$1,779.65
|
| Rate for Payer: Preferred Network Access Commercial |
$2,046.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,090.03
|
| Rate for Payer: Quartz Commercial |
$1,334.74
|
| Rate for Payer: WEA Trust Commercial |
$1,223.51
|
| Rate for Payer: WPS Commercial |
$1,647.67
|
|
|
SCREW CANN LDA 2.4 X 40 TIGER 200-24-040
|
Facility
|
OP
|
$2,059.00
|
|
| Hospital Charge Code |
3782776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$599.58 |
| Max. Negotiated Rate |
$1,970.05 |
| Rate for Payer: Aetna Commercial |
$1,927.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,841.57
|
| Rate for Payer: Aetna Managed Medicare |
$599.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,391.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,070.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,027.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,134.92
|
| Rate for Payer: Cash Price |
$617.70
|
| Rate for Payer: Cigna Commercial |
$1,970.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,198.34
|
| Rate for Payer: Health EOS Commercial |
$1,905.81
|
| Rate for Payer: HFN Commercial |
$1,970.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,606.02
|
| Rate for Payer: Multiplan Commercial |
$1,713.09
|
| Rate for Payer: NAPHCARE Commercial |
$1,284.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,970.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,049.27
|
| Rate for Payer: Quartz Commercial |
$1,391.88
|
| Rate for Payer: Quartz Medicare Advantage |
$1,284.82
|
| Rate for Payer: The Alliance Commercial |
$1,070.68
|
| Rate for Payer: WEA Trust Commercial |
$1,177.75
|
| Rate for Payer: WPS Commercial |
$1,586.05
|
|
|
SCREW CANN LDA 2.4 X 40 TIGER 200-24-040
|
Facility
|
IP
|
$2,059.00
|
|
| Hospital Charge Code |
3782776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,049.27 |
| Max. Negotiated Rate |
$1,970.05 |
| Rate for Payer: Aetna Commercial |
$1,927.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,841.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,134.92
|
| Rate for Payer: Cash Price |
$617.70
|
| Rate for Payer: Cigna Commercial |
$1,970.05
|
| Rate for Payer: Health EOS Commercial |
$1,905.81
|
| Rate for Payer: HFN Commercial |
$1,970.05
|
| Rate for Payer: Multiplan Commercial |
$1,713.09
|
| Rate for Payer: Preferred Network Access Commercial |
$1,970.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,049.27
|
| Rate for Payer: Quartz Commercial |
$1,284.82
|
| Rate for Payer: WEA Trust Commercial |
$1,177.75
|
| Rate for Payer: WPS Commercial |
$1,586.05
|
|
|
SCREW CANN LDA 2.4 X 42 TIGER 200-24-042
|
Facility
|
IP
|
$2,139.00
|
|
| Hospital Charge Code |
3782777
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,090.03 |
| Max. Negotiated Rate |
$2,046.60 |
| Rate for Payer: Aetna Commercial |
$2,002.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,913.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,179.02
|
| Rate for Payer: Cash Price |
$641.70
|
| Rate for Payer: Cigna Commercial |
$2,046.60
|
| Rate for Payer: Health EOS Commercial |
$1,979.86
|
| Rate for Payer: HFN Commercial |
$2,046.60
|
| Rate for Payer: Multiplan Commercial |
$1,779.65
|
| Rate for Payer: Preferred Network Access Commercial |
$2,046.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,090.03
|
| Rate for Payer: Quartz Commercial |
$1,334.74
|
| Rate for Payer: WEA Trust Commercial |
$1,223.51
|
| Rate for Payer: WPS Commercial |
$1,647.67
|
|
|
SCREW CANN LDA 2.4 X 42 TIGER 200-24-042
|
Facility
|
OP
|
$2,139.00
|
|
| Hospital Charge Code |
3782777
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$622.88 |
| Max. Negotiated Rate |
$2,046.60 |
| Rate for Payer: Aetna Commercial |
$2,002.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,913.12
|
| Rate for Payer: Aetna Managed Medicare |
$622.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,445.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,112.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,067.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,179.02
|
| Rate for Payer: Cash Price |
$641.70
|
| Rate for Payer: Cigna Commercial |
$2,046.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,244.90
|
| Rate for Payer: Health EOS Commercial |
$1,979.86
|
| Rate for Payer: HFN Commercial |
$2,046.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,668.42
|
| Rate for Payer: Multiplan Commercial |
$1,779.65
|
| Rate for Payer: NAPHCARE Commercial |
$1,334.74
|
| Rate for Payer: Preferred Network Access Commercial |
$2,046.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,090.03
|
| Rate for Payer: Quartz Commercial |
$1,445.96
|
| Rate for Payer: Quartz Medicare Advantage |
$1,334.74
|
| Rate for Payer: The Alliance Commercial |
$1,112.28
|
| Rate for Payer: WEA Trust Commercial |
$1,223.51
|
| Rate for Payer: WPS Commercial |
$1,647.67
|
|
|
SCREW CANN LDA 2.4 X 44 TIGER 200-24-044
|
Facility
|
IP
|
$2,059.00
|
|
| Hospital Charge Code |
3782778
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,049.27 |
| Max. Negotiated Rate |
$1,970.05 |
| Rate for Payer: Aetna Commercial |
$1,927.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,841.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,134.92
|
| Rate for Payer: Cash Price |
$617.70
|
| Rate for Payer: Cigna Commercial |
$1,970.05
|
| Rate for Payer: Health EOS Commercial |
$1,905.81
|
| Rate for Payer: HFN Commercial |
$1,970.05
|
| Rate for Payer: Multiplan Commercial |
$1,713.09
|
| Rate for Payer: Preferred Network Access Commercial |
$1,970.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,049.27
|
| Rate for Payer: Quartz Commercial |
$1,284.82
|
| Rate for Payer: WEA Trust Commercial |
$1,177.75
|
| Rate for Payer: WPS Commercial |
$1,586.05
|
|
