|
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 |
$640.92 |
| Max. Negotiated Rate |
$9,156.00 |
| Rate for Payer: Aetna Commercial |
$2,060.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,968.54
|
| Rate for Payer: Aetna Managed Medicare |
$640.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,487.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,144.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,098.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,213.17
|
| Rate for Payer: Cash Price |
$686.70
|
| Rate for Payer: Cigna Commercial |
$2,105.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,280.92
|
| Rate for Payer: Health EOS Commercial |
$2,037.21
|
| Rate for Payer: HFN Commercial |
$2,105.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,716.75
|
| Rate for Payer: Multiplan Commercial |
$1,831.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,373.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,105.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,121.61
|
| Rate for Payer: Quartz Commercial |
$1,487.85
|
| Rate for Payer: Quartz Medicare Advantage |
$1,373.40
|
| Rate for Payer: The Alliance Commercial |
$9,156.00
|
| Rate for Payer: WEA Trust Commercial |
$1,258.95
|
| Rate for Payer: WPS Commercial |
$1,695.46
|
|
|
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 |
$1,121.61 |
| Max. Negotiated Rate |
$2,105.88 |
| Rate for Payer: Aetna Commercial |
$2,060.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,968.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,213.17
|
| Rate for Payer: Cash Price |
$686.70
|
| Rate for Payer: Cigna Commercial |
$2,105.88
|
| Rate for Payer: Health EOS Commercial |
$2,037.21
|
| Rate for Payer: HFN Commercial |
$2,105.88
|
| Rate for Payer: Multiplan Commercial |
$1,831.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,373.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,105.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,121.61
|
| Rate for Payer: Quartz Commercial |
$1,373.40
|
| Rate for Payer: WEA Trust Commercial |
$1,258.95
|
| Rate for Payer: WPS Commercial |
$1,695.46
|
|
|
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 |
$640.92 |
| Max. Negotiated Rate |
$9,156.00 |
| Rate for Payer: Aetna Commercial |
$2,060.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,968.54
|
| Rate for Payer: Aetna Managed Medicare |
$640.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,487.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,144.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,098.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,213.17
|
| Rate for Payer: Cash Price |
$686.70
|
| Rate for Payer: Cigna Commercial |
$2,105.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,280.92
|
| Rate for Payer: Health EOS Commercial |
$2,037.21
|
| Rate for Payer: HFN Commercial |
$2,105.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,716.75
|
| Rate for Payer: Multiplan Commercial |
$1,831.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,373.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,105.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,121.61
|
| Rate for Payer: Quartz Commercial |
$1,487.85
|
| Rate for Payer: Quartz Medicare Advantage |
$1,373.40
|
| Rate for Payer: The Alliance Commercial |
$9,156.00
|
| Rate for Payer: WEA Trust Commercial |
$1,258.95
|
| Rate for Payer: WPS Commercial |
$1,695.46
|
|
|
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 |
$1,121.61 |
| Max. Negotiated Rate |
$2,105.88 |
| Rate for Payer: Aetna Commercial |
$2,060.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,968.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,213.17
|
| Rate for Payer: Cash Price |
$686.70
|
| Rate for Payer: Cigna Commercial |
$2,105.88
|
| Rate for Payer: Health EOS Commercial |
$2,037.21
|
| Rate for Payer: HFN Commercial |
$2,105.88
|
| Rate for Payer: Multiplan Commercial |
$1,831.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,373.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,105.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,121.61
|
| Rate for Payer: Quartz Commercial |
$1,373.40
|
| Rate for Payer: WEA Trust Commercial |
$1,258.95
|
| Rate for Payer: WPS Commercial |
$1,695.46
|
|
|
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 |
$640.92 |
| Max. Negotiated Rate |
$9,156.00 |
| Rate for Payer: Aetna Commercial |
$2,060.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,968.54
|
| Rate for Payer: Aetna Managed Medicare |
$640.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,487.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,144.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,098.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,213.17
|
| Rate for Payer: Cash Price |
$686.70
|
| Rate for Payer: Cigna Commercial |
$2,105.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,280.92
|
| Rate for Payer: Health EOS Commercial |
$2,037.21
|
| Rate for Payer: HFN Commercial |
$2,105.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,716.75
|
| Rate for Payer: Multiplan Commercial |
$1,831.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,373.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,105.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,121.61
|
| Rate for Payer: Quartz Commercial |
$1,487.85
|
| Rate for Payer: Quartz Medicare Advantage |
$1,373.40
|
| Rate for Payer: The Alliance Commercial |
$9,156.00
|
| Rate for Payer: WEA Trust Commercial |
$1,258.95
|
| Rate for Payer: WPS Commercial |
$1,695.46
|
|
|
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 |
$1,121.61 |
| Max. Negotiated Rate |
$2,105.88 |
| Rate for Payer: Aetna Commercial |
$2,060.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,968.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,213.17
|
| Rate for Payer: Cash Price |
$686.70
|
| Rate for Payer: Cigna Commercial |
$2,105.88
|
| Rate for Payer: Health EOS Commercial |
$2,037.21
|
| Rate for Payer: HFN Commercial |
$2,105.88
|
| Rate for Payer: Multiplan Commercial |
$1,831.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,373.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,105.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,121.61
|
| Rate for Payer: Quartz Commercial |
$1,373.40
|
| Rate for Payer: WEA Trust Commercial |
$1,258.95
|
| Rate for Payer: WPS Commercial |
$1,695.46
|
|
|
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 |
$598.92 |
| Max. Negotiated Rate |
$8,556.00 |
| Rate for Payer: Aetna Commercial |
$1,925.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,839.54
|
| Rate for Payer: Aetna Managed Medicare |
$598.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,390.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,069.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,026.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,133.67
|
| Rate for Payer: Cash Price |
$641.70
|
| Rate for Payer: Cigna Commercial |
$1,967.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,196.98
|
| Rate for Payer: Health EOS Commercial |
$1,903.71
|
| Rate for Payer: HFN Commercial |
$1,967.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,604.25
|
| Rate for Payer: Multiplan Commercial |
$1,711.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,283.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,967.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,048.11
|
| Rate for Payer: Quartz Commercial |
$1,390.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,283.40
|
| Rate for Payer: The Alliance Commercial |
$8,556.00
|
| Rate for Payer: WEA Trust Commercial |
$1,176.45
|
| Rate for Payer: WPS Commercial |
$1,584.36
|
|
|
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 |
$1,048.11 |
| Max. Negotiated Rate |
$1,967.88 |
| Rate for Payer: Aetna Commercial |
$1,925.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,839.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,133.67
|
| Rate for Payer: Cash Price |
$641.70
|
| Rate for Payer: Cigna Commercial |
$1,967.88
|
| Rate for Payer: Health EOS Commercial |
$1,903.71
|
| Rate for Payer: HFN Commercial |
$1,967.88
|
| Rate for Payer: Multiplan Commercial |
$1,711.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,283.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,967.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,048.11
|
| Rate for Payer: Quartz Commercial |
$1,283.40
|
| Rate for Payer: WEA Trust Commercial |
$1,176.45
|
| Rate for Payer: WPS Commercial |
$1,584.36
|
|
|
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 |
$1,008.91 |
| Max. Negotiated Rate |
$1,894.28 |
| Rate for Payer: Aetna Commercial |
$1,853.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,770.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,091.27
|
| Rate for Payer: Cash Price |
$617.70
|
| Rate for Payer: Cigna Commercial |
$1,894.28
|
| Rate for Payer: Health EOS Commercial |
$1,832.51
|
| Rate for Payer: HFN Commercial |
$1,894.28
|
| Rate for Payer: Multiplan Commercial |
$1,647.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,235.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,894.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,008.91
|
| Rate for Payer: Quartz Commercial |
$1,235.40
|
| Rate for Payer: WEA Trust Commercial |
$1,132.45
|
| Rate for Payer: WPS Commercial |
$1,525.10
|
|
|
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 |
$576.52 |
| Max. Negotiated Rate |
$8,236.00 |
| Rate for Payer: Aetna Commercial |
$1,853.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,770.74
|
| Rate for Payer: Aetna Managed Medicare |
$576.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,338.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,029.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$988.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,091.27
|
| Rate for Payer: Cash Price |
$617.70
|
| Rate for Payer: Cigna Commercial |
$1,894.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,152.22
|
| Rate for Payer: Health EOS Commercial |
$1,832.51
|
| Rate for Payer: HFN Commercial |
$1,894.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,544.25
|
| Rate for Payer: Multiplan Commercial |
$1,647.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,235.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,894.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,008.91
|
| Rate for Payer: Quartz Commercial |
$1,338.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,235.40
|
| Rate for Payer: The Alliance Commercial |
$8,236.00
|
| Rate for Payer: WEA Trust Commercial |
$1,132.45
|
| Rate for Payer: WPS Commercial |
$1,525.10
|
|
|
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 |
$598.92 |
| Max. Negotiated Rate |
$8,556.00 |
| Rate for Payer: Aetna Commercial |
$1,925.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,839.54
|
| Rate for Payer: Aetna Managed Medicare |
$598.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,390.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,069.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,026.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,133.67
|
| Rate for Payer: Cash Price |
$641.70
|
| Rate for Payer: Cigna Commercial |
$1,967.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,196.98
|
| Rate for Payer: Health EOS Commercial |
$1,903.71
|
| Rate for Payer: HFN Commercial |
$1,967.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,604.25
|
| Rate for Payer: Multiplan Commercial |
$1,711.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,283.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,967.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,048.11
|
| Rate for Payer: Quartz Commercial |
$1,390.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,283.40
|
| Rate for Payer: The Alliance Commercial |
$8,556.00
|
| Rate for Payer: WEA Trust Commercial |
$1,176.45
|
| Rate for Payer: WPS Commercial |
$1,584.36
|
|
|
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 |
$1,048.11 |
| Max. Negotiated Rate |
$1,967.88 |
| Rate for Payer: Aetna Commercial |
$1,925.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,839.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,133.67
|
| Rate for Payer: Cash Price |
$641.70
|
| Rate for Payer: Cigna Commercial |
$1,967.88
|
| Rate for Payer: Health EOS Commercial |
$1,903.71
|
| Rate for Payer: HFN Commercial |
$1,967.88
|
| Rate for Payer: Multiplan Commercial |
$1,711.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,283.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,967.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,048.11
|
| Rate for Payer: Quartz Commercial |
$1,283.40
|
| Rate for Payer: WEA Trust Commercial |
$1,176.45
|
| Rate for Payer: WPS Commercial |
$1,584.36
|
|
|
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 |
$598.92 |
| Max. Negotiated Rate |
$8,556.00 |
| Rate for Payer: Aetna Commercial |
$1,925.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,839.54
|
| Rate for Payer: Aetna Managed Medicare |
$598.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,390.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,069.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,026.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,133.67
|
| Rate for Payer: Cash Price |
$641.70
|
| Rate for Payer: Cigna Commercial |
$1,967.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,196.98
|
| Rate for Payer: Health EOS Commercial |
$1,903.71
|
| Rate for Payer: HFN Commercial |
$1,967.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,604.25
|
| Rate for Payer: Multiplan Commercial |
$1,711.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,283.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,967.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,048.11
|
| Rate for Payer: Quartz Commercial |
$1,390.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,283.40
|
| Rate for Payer: The Alliance Commercial |
$8,556.00
|
| Rate for Payer: WEA Trust Commercial |
$1,176.45
|
| Rate for Payer: WPS Commercial |
$1,584.36
|
|
|
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 |
$1,048.11 |
| Max. Negotiated Rate |
$1,967.88 |
| Rate for Payer: Aetna Commercial |
$1,925.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,839.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,133.67
|
| Rate for Payer: Cash Price |
$641.70
|
| Rate for Payer: Cigna Commercial |
$1,967.88
|
| Rate for Payer: Health EOS Commercial |
$1,903.71
|
| Rate for Payer: HFN Commercial |
$1,967.88
|
| Rate for Payer: Multiplan Commercial |
$1,711.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,283.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,967.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,048.11
|
| Rate for Payer: Quartz Commercial |
$1,283.40
|
| Rate for Payer: WEA Trust Commercial |
$1,176.45
|
| Rate for Payer: WPS Commercial |
$1,584.36
|
|
|
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 |
$576.52 |
| Max. Negotiated Rate |
$8,236.00 |
| Rate for Payer: Aetna Commercial |
$1,853.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,770.74
|
| Rate for Payer: Aetna Managed Medicare |
$576.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,338.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,029.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$988.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,091.27
|
| Rate for Payer: Cash Price |
$617.70
|
| Rate for Payer: Cigna Commercial |
$1,894.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,152.22
|
| Rate for Payer: Health EOS Commercial |
$1,832.51
|
| Rate for Payer: HFN Commercial |
$1,894.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,544.25
|
| Rate for Payer: Multiplan Commercial |
$1,647.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,235.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,894.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,008.91
|
| Rate for Payer: Quartz Commercial |
$1,338.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,235.40
|
| Rate for Payer: The Alliance Commercial |
$8,236.00
|
| Rate for Payer: WEA Trust Commercial |
$1,132.45
|
| Rate for Payer: WPS Commercial |
$1,525.10
|
|
|
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 |
$1,008.91 |
| Max. Negotiated Rate |
$1,894.28 |
| Rate for Payer: Aetna Commercial |
$1,853.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,770.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,091.27
|
| Rate for Payer: Cash Price |
$617.70
|
| Rate for Payer: Cigna Commercial |
$1,894.28
|
| Rate for Payer: Health EOS Commercial |
$1,832.51
|
| Rate for Payer: HFN Commercial |
$1,894.28
|
| Rate for Payer: Multiplan Commercial |
$1,647.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,235.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,894.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,008.91
|
| Rate for Payer: Quartz Commercial |
$1,235.40
|
| Rate for Payer: WEA Trust Commercial |
$1,132.45
|
| Rate for Payer: WPS Commercial |
$1,525.10
|
|
|
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 |
$1,048.11 |
| Max. Negotiated Rate |
$1,967.88 |
| Rate for Payer: Aetna Commercial |
$1,925.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,839.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,133.67
|
| Rate for Payer: Cash Price |
$641.70
|
| Rate for Payer: Cigna Commercial |
$1,967.88
|
| Rate for Payer: Health EOS Commercial |
$1,903.71
|
| Rate for Payer: HFN Commercial |
$1,967.88
|
| Rate for Payer: Multiplan Commercial |
$1,711.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,283.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,967.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,048.11
|
| Rate for Payer: Quartz Commercial |
$1,283.40
|
| Rate for Payer: WEA Trust Commercial |
$1,176.45
|
| Rate for Payer: WPS Commercial |
$1,584.36
|
|
|
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 |
$598.92 |
| Max. Negotiated Rate |
$8,556.00 |
| Rate for Payer: Aetna Commercial |
$1,925.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,839.54
|
| Rate for Payer: Aetna Managed Medicare |
$598.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,390.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,069.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,026.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,133.67
|
| Rate for Payer: Cash Price |
$641.70
|
| Rate for Payer: Cigna Commercial |
$1,967.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,196.98
|
| Rate for Payer: Health EOS Commercial |
$1,903.71
|
| Rate for Payer: HFN Commercial |
$1,967.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,604.25
|
| Rate for Payer: Multiplan Commercial |
$1,711.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,283.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,967.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,048.11
|
| Rate for Payer: Quartz Commercial |
$1,390.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,283.40
|
| Rate for Payer: The Alliance Commercial |
$8,556.00
|
| Rate for Payer: WEA Trust Commercial |
$1,176.45
|
| Rate for Payer: WPS Commercial |
$1,584.36
|
|
|
SCREW CANN LDA 2.4 X 44 TIGER 200-24-044
|
Facility
|
OP
|
$2,059.00
|
|
| Hospital Charge Code |
3782778
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$576.52 |
| Max. Negotiated Rate |
$8,236.00 |
| Rate for Payer: Aetna Commercial |
$1,853.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,770.74
|
| Rate for Payer: Aetna Managed Medicare |
$576.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,338.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,029.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$988.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,091.27
|
| Rate for Payer: Cash Price |
$617.70
|
| Rate for Payer: Cigna Commercial |
$1,894.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,152.22
|
| Rate for Payer: Health EOS Commercial |
$1,832.51
|
| Rate for Payer: HFN Commercial |
$1,894.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,544.25
|
| Rate for Payer: Multiplan Commercial |
$1,647.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,235.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,894.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,008.91
|
| Rate for Payer: Quartz Commercial |
$1,338.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,235.40
|
| Rate for Payer: The Alliance Commercial |
$8,236.00
|
| Rate for Payer: WEA Trust Commercial |
$1,132.45
|
| Rate for Payer: WPS Commercial |
$1,525.10
|
|
|
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 |
$1,008.91 |
| Max. Negotiated Rate |
$1,894.28 |
| Rate for Payer: Aetna Commercial |
$1,853.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,770.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,091.27
|
| Rate for Payer: Cash Price |
$617.70
|
| Rate for Payer: Cigna Commercial |
$1,894.28
|
| Rate for Payer: Health EOS Commercial |
$1,832.51
|
| Rate for Payer: HFN Commercial |
$1,894.28
|
| Rate for Payer: Multiplan Commercial |
$1,647.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,235.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,894.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,008.91
|
| Rate for Payer: Quartz Commercial |
$1,235.40
|
| Rate for Payer: WEA Trust Commercial |
$1,132.45
|
| Rate for Payer: WPS Commercial |
$1,525.10
|
|
|
SCREW CANN LDA 2.4 X 46 TIGER 200-24-046
|
Facility
|
IP
|
$2,139.00
|
|
| Hospital Charge Code |
3782779
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,048.11 |
| Max. Negotiated Rate |
$1,967.88 |
| Rate for Payer: Aetna Commercial |
$1,925.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,839.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,133.67
|
| Rate for Payer: Cash Price |
$641.70
|
| Rate for Payer: Cigna Commercial |
$1,967.88
|
| Rate for Payer: Health EOS Commercial |
$1,903.71
|
| Rate for Payer: HFN Commercial |
$1,967.88
|
| Rate for Payer: Multiplan Commercial |
$1,711.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,283.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,967.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,048.11
|
| Rate for Payer: Quartz Commercial |
$1,283.40
|
| Rate for Payer: WEA Trust Commercial |
$1,176.45
|
| Rate for Payer: WPS Commercial |
$1,584.36
|
|
|
SCREW CANN LDA 2.4 X 46 TIGER 200-24-046
|
Facility
|
OP
|
$2,139.00
|
|
| Hospital Charge Code |
3782779
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$598.92 |
| Max. Negotiated Rate |
$8,556.00 |
| Rate for Payer: Aetna Commercial |
$1,925.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,839.54
|
| Rate for Payer: Aetna Managed Medicare |
$598.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,390.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,069.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,026.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,133.67
|
| Rate for Payer: Cash Price |
$641.70
|
| Rate for Payer: Cigna Commercial |
$1,967.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,196.98
|
| Rate for Payer: Health EOS Commercial |
$1,903.71
|
| Rate for Payer: HFN Commercial |
$1,967.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,604.25
|
| Rate for Payer: Multiplan Commercial |
$1,711.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,283.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,967.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,048.11
|
| Rate for Payer: Quartz Commercial |
$1,390.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,283.40
|
| Rate for Payer: The Alliance Commercial |
$8,556.00
|
| Rate for Payer: WEA Trust Commercial |
$1,176.45
|
| Rate for Payer: WPS Commercial |
$1,584.36
|
|
|
SCREW CANN LDA 2.4 X 48 TIGER 200-24-048
|
Facility
|
IP
|
$2,059.00
|
|
| Hospital Charge Code |
3782780
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,008.91 |
| Max. Negotiated Rate |
$1,894.28 |
| Rate for Payer: Aetna Commercial |
$1,853.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,770.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,091.27
|
| Rate for Payer: Cash Price |
$617.70
|
| Rate for Payer: Cigna Commercial |
$1,894.28
|
| Rate for Payer: Health EOS Commercial |
$1,832.51
|
| Rate for Payer: HFN Commercial |
$1,894.28
|
| Rate for Payer: Multiplan Commercial |
$1,647.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,235.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,894.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,008.91
|
| Rate for Payer: Quartz Commercial |
$1,235.40
|
| Rate for Payer: WEA Trust Commercial |
$1,132.45
|
| Rate for Payer: WPS Commercial |
$1,525.10
|
|
|
SCREW CANN LDA 2.4 X 48 TIGER 200-24-048
|
Facility
|
OP
|
$2,059.00
|
|
| Hospital Charge Code |
3782780
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$576.52 |
| Max. Negotiated Rate |
$8,236.00 |
| Rate for Payer: Aetna Commercial |
$1,853.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,770.74
|
| Rate for Payer: Aetna Managed Medicare |
$576.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,338.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,029.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$988.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,091.27
|
| Rate for Payer: Cash Price |
$617.70
|
| Rate for Payer: Cigna Commercial |
$1,894.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,152.22
|
| Rate for Payer: Health EOS Commercial |
$1,832.51
|
| Rate for Payer: HFN Commercial |
$1,894.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,544.25
|
| Rate for Payer: Multiplan Commercial |
$1,647.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,235.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,894.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,008.91
|
| Rate for Payer: Quartz Commercial |
$1,338.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,235.40
|
| Rate for Payer: The Alliance Commercial |
$8,236.00
|
| Rate for Payer: WEA Trust Commercial |
$1,132.45
|
| Rate for Payer: WPS Commercial |
$1,525.10
|
|
|
SCREW CANN LOCK 3.7 X 16MM 02.240.016
|
Facility
|
OP
|
$2,953.00
|
|
| Hospital Charge Code |
3072507
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$826.84 |
| Max. Negotiated Rate |
$11,812.00 |
| Rate for Payer: Aetna Commercial |
$2,657.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,539.58
|
| Rate for Payer: Aetna Managed Medicare |
$826.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,919.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,476.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,417.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,565.09
|
| Rate for Payer: Cash Price |
$885.90
|
| Rate for Payer: Cigna Commercial |
$2,716.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,652.50
|
| Rate for Payer: Health EOS Commercial |
$2,628.17
|
| Rate for Payer: HFN Commercial |
$2,716.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,214.75
|
| Rate for Payer: Multiplan Commercial |
$2,362.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,771.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,716.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,446.97
|
| Rate for Payer: Quartz Commercial |
$1,919.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,771.80
|
| Rate for Payer: The Alliance Commercial |
$11,812.00
|
| Rate for Payer: WEA Trust Commercial |
$1,624.15
|
| Rate for Payer: WPS Commercial |
$2,187.29
|
|
