|
SHELL TRIDENT 52MM E 502-11-52E
|
Facility
IP
|
$8,538.00
|
|
| Hospital Charge Code |
3365518
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,183.62 |
| Max. Negotiated Rate |
$7,854.96 |
| Rate for Payer: Aetna Commercial |
$7,684.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,525.14
|
| Rate for Payer: Cash Price |
$2,561.40
|
| Rate for Payer: Cigna Commercial |
$7,854.96
|
| Rate for Payer: Health EOS Commercial |
$7,598.82
|
| Rate for Payer: HFN Commercial |
$7,854.96
|
| Rate for Payer: Multiplan Commercial |
$6,830.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,122.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,854.96
|
| Rate for Payer: Quartz Beloit One Network |
$4,183.62
|
| Rate for Payer: Quartz Commercial |
$5,122.80
|
| Rate for Payer: WEA Trust Commercial |
$4,695.90
|
| Rate for Payer: WPS Commercial |
$6,324.10
|
|
|
SHELL TRIDENT 568MM F 509-02-58F
|
Facility
OP
|
$8,538.00
|
|
| Hospital Charge Code |
4263460
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,390.64 |
| Max. Negotiated Rate |
$34,152.00 |
| Rate for Payer: Aetna Commercial |
$7,684.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,342.68
|
| Rate for Payer: Aetna Managed Medicare |
$2,390.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,549.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,269.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,098.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,525.14
|
| Rate for Payer: Cash Price |
$2,561.40
|
| Rate for Payer: Cigna Commercial |
$7,854.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,777.86
|
| Rate for Payer: Health EOS Commercial |
$7,598.82
|
| Rate for Payer: HFN Commercial |
$7,854.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,403.50
|
| Rate for Payer: Multiplan Commercial |
$6,830.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,122.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,854.96
|
| Rate for Payer: Quartz Beloit One Network |
$4,183.62
|
| Rate for Payer: Quartz Commercial |
$5,549.70
|
| Rate for Payer: Quartz Medicare Advantage |
$5,122.80
|
| Rate for Payer: The Alliance Commercial |
$34,152.00
|
| Rate for Payer: WEA Trust Commercial |
$4,695.90
|
| Rate for Payer: WPS Commercial |
$6,324.10
|
|
|
SHELL TRIDENT 568MM F 509-02-58F
|
Facility
IP
|
$8,538.00
|
|
| Hospital Charge Code |
4263460
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,183.62 |
| Max. Negotiated Rate |
$7,854.96 |
| Rate for Payer: Aetna Commercial |
$7,684.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,525.14
|
| Rate for Payer: Cash Price |
$2,561.40
|
| Rate for Payer: Cigna Commercial |
$7,854.96
|
| Rate for Payer: Health EOS Commercial |
$7,598.82
|
| Rate for Payer: HFN Commercial |
$7,854.96
|
| Rate for Payer: Multiplan Commercial |
$6,830.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,122.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,854.96
|
| Rate for Payer: Quartz Beloit One Network |
$4,183.62
|
| Rate for Payer: Quartz Commercial |
$5,122.80
|
| Rate for Payer: WEA Trust Commercial |
$4,695.90
|
| Rate for Payer: WPS Commercial |
$6,324.10
|
|
|
SHELL TRIDENT 56MM F 502-11-56F
|
Facility
IP
|
$8,538.00
|
|
| Hospital Charge Code |
3297463
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,183.62 |
| Max. Negotiated Rate |
$7,854.96 |
| Rate for Payer: Aetna Commercial |
$7,684.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,525.14
|
| Rate for Payer: Cash Price |
$2,561.40
|
| Rate for Payer: Cigna Commercial |
$7,854.96
|
| Rate for Payer: Health EOS Commercial |
$7,598.82
|
| Rate for Payer: HFN Commercial |
$7,854.96
|
| Rate for Payer: Multiplan Commercial |
$6,830.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,122.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,854.96
|
| Rate for Payer: Quartz Beloit One Network |
$4,183.62
|
| Rate for Payer: Quartz Commercial |
$5,122.80
|
| Rate for Payer: WEA Trust Commercial |
$4,695.90
|
| Rate for Payer: WPS Commercial |
$6,324.10
|
|
|
SHELL TRIDENT 56MM F 502-11-56F
|
Facility
OP
|
$8,538.00
|
|
| Hospital Charge Code |
3297463
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,390.64 |
| Max. Negotiated Rate |
$34,152.00 |
| Rate for Payer: Aetna Commercial |
$7,684.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,342.68
|
| Rate for Payer: Aetna Managed Medicare |
$2,390.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,549.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,269.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,098.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,525.14
|
| Rate for Payer: Cash Price |
$2,561.40
|
| Rate for Payer: Cigna Commercial |
$7,854.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,777.86
|
| Rate for Payer: Health EOS Commercial |
$7,598.82
|
| Rate for Payer: HFN Commercial |
$7,854.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,403.50
|
| Rate for Payer: Multiplan Commercial |
$6,830.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,122.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,854.96
|
| Rate for Payer: Quartz Beloit One Network |
$4,183.62
|
| Rate for Payer: Quartz Commercial |
$5,549.70
|
| Rate for Payer: Quartz Medicare Advantage |
$5,122.80
|
| Rate for Payer: The Alliance Commercial |
$34,152.00
|
| Rate for Payer: WEA Trust Commercial |
$4,695.90
|
| Rate for Payer: WPS Commercial |
$6,324.10
|
|
|
SHELL TRIDENT 60MM F 509-02-60F
|
Facility
OP
|
$8,538.00
|
|
| Hospital Charge Code |
4491009
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,390.64 |
| Max. Negotiated Rate |
$34,152.00 |
| Rate for Payer: Aetna Commercial |
$7,684.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,342.68
|
| Rate for Payer: Aetna Managed Medicare |
$2,390.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,549.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,269.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,098.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,525.14
|
| Rate for Payer: Cash Price |
$2,561.40
|
| Rate for Payer: Cigna Commercial |
$7,854.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,777.86
|
| Rate for Payer: Health EOS Commercial |
$7,598.82
|
| Rate for Payer: HFN Commercial |
$7,854.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,403.50
|
| Rate for Payer: Multiplan Commercial |
$6,830.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,122.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,854.96
|
| Rate for Payer: Quartz Beloit One Network |
$4,183.62
|
| Rate for Payer: Quartz Commercial |
$5,549.70
|
| Rate for Payer: Quartz Medicare Advantage |
$5,122.80
|
| Rate for Payer: The Alliance Commercial |
$34,152.00
|
| Rate for Payer: WEA Trust Commercial |
$4,695.90
|
| Rate for Payer: WPS Commercial |
$6,324.10
|
|
|
SHELL TRIDENT 60MM F 509-02-60F
|
Facility
IP
|
$8,538.00
|
|
| Hospital Charge Code |
4491009
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,183.62 |
| Max. Negotiated Rate |
$7,854.96 |
| Rate for Payer: Aetna Commercial |
$7,684.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,525.14
|
| Rate for Payer: Cash Price |
$2,561.40
|
| Rate for Payer: Cigna Commercial |
$7,854.96
|
| Rate for Payer: Health EOS Commercial |
$7,598.82
|
| Rate for Payer: HFN Commercial |
$7,854.96
|
| Rate for Payer: Multiplan Commercial |
$6,830.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,122.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,854.96
|
| Rate for Payer: Quartz Beloit One Network |
$4,183.62
|
| Rate for Payer: Quartz Commercial |
$5,122.80
|
| Rate for Payer: WEA Trust Commercial |
$4,695.90
|
| Rate for Payer: WPS Commercial |
$6,324.10
|
|
|
SHELL TRITANIUM CLUSTER HOLE 50MM D 502-03-50D
|
Facility
IP
|
$8,538.00
|
|
| Hospital Charge Code |
3397502
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,183.62 |
| Max. Negotiated Rate |
$7,854.96 |
| Rate for Payer: Aetna Commercial |
$7,684.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,525.14
|
| Rate for Payer: Cash Price |
$2,561.40
|
| Rate for Payer: Cigna Commercial |
$7,854.96
|
| Rate for Payer: Health EOS Commercial |
$7,598.82
|
| Rate for Payer: HFN Commercial |
$7,854.96
|
| Rate for Payer: Multiplan Commercial |
$6,830.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,122.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,854.96
|
| Rate for Payer: Quartz Beloit One Network |
$4,183.62
|
| Rate for Payer: Quartz Commercial |
$5,122.80
|
| Rate for Payer: WEA Trust Commercial |
$4,695.90
|
| Rate for Payer: WPS Commercial |
$6,324.10
|
|
|
SHELL TRITANIUM CLUSTER HOLE 50MM D 502-03-50D
|
Facility
OP
|
$8,538.00
|
|
| Hospital Charge Code |
3397502
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,390.64 |
| Max. Negotiated Rate |
$34,152.00 |
| Rate for Payer: Aetna Commercial |
$7,684.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,342.68
|
| Rate for Payer: Aetna Managed Medicare |
$2,390.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,549.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,269.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,098.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,525.14
|
| Rate for Payer: Cash Price |
$2,561.40
|
| Rate for Payer: Cigna Commercial |
$7,854.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,777.86
|
| Rate for Payer: Health EOS Commercial |
$7,598.82
|
| Rate for Payer: HFN Commercial |
$7,854.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,403.50
|
| Rate for Payer: Multiplan Commercial |
$6,830.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,122.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,854.96
|
| Rate for Payer: Quartz Beloit One Network |
$4,183.62
|
| Rate for Payer: Quartz Commercial |
$5,549.70
|
| Rate for Payer: Quartz Medicare Advantage |
$5,122.80
|
| Rate for Payer: The Alliance Commercial |
$34,152.00
|
| Rate for Payer: WEA Trust Commercial |
$4,695.90
|
| Rate for Payer: WPS Commercial |
$6,324.10
|
|
|
SHELL TRITANIUM CLUSTER HOLE 52MM D 502-03-52D
|
Facility
OP
|
$8,538.00
|
|
| Hospital Charge Code |
3487507
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,390.64 |
| Max. Negotiated Rate |
$34,152.00 |
| Rate for Payer: Aetna Commercial |
$7,684.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,342.68
|
| Rate for Payer: Aetna Managed Medicare |
$2,390.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,549.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,269.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,098.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,525.14
|
| Rate for Payer: Cash Price |
$2,561.40
|
| Rate for Payer: Cigna Commercial |
$7,854.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,777.86
|
| Rate for Payer: Health EOS Commercial |
$7,598.82
|
| Rate for Payer: HFN Commercial |
$7,854.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,403.50
|
| Rate for Payer: Multiplan Commercial |
$6,830.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,122.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,854.96
|
| Rate for Payer: Quartz Beloit One Network |
$4,183.62
|
| Rate for Payer: Quartz Commercial |
$5,549.70
|
| Rate for Payer: Quartz Medicare Advantage |
$5,122.80
|
| Rate for Payer: The Alliance Commercial |
$34,152.00
|
| Rate for Payer: WEA Trust Commercial |
$4,695.90
|
| Rate for Payer: WPS Commercial |
$6,324.10
|
|
|
SHELL TRITANIUM CLUSTER HOLE 52MM D 502-03-52D
|
Facility
IP
|
$8,538.00
|
|
| Hospital Charge Code |
3487507
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,183.62 |
| Max. Negotiated Rate |
$7,854.96 |
| Rate for Payer: Aetna Commercial |
$7,684.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,525.14
|
| Rate for Payer: Cash Price |
$2,561.40
|
| Rate for Payer: Cigna Commercial |
$7,854.96
|
| Rate for Payer: Health EOS Commercial |
$7,598.82
|
| Rate for Payer: HFN Commercial |
$7,854.96
|
| Rate for Payer: Multiplan Commercial |
$6,830.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,122.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,854.96
|
| Rate for Payer: Quartz Beloit One Network |
$4,183.62
|
| Rate for Payer: Quartz Commercial |
$5,122.80
|
| Rate for Payer: WEA Trust Commercial |
$4,695.90
|
| Rate for Payer: WPS Commercial |
$6,324.10
|
|
|
SHELL TRITANIUM CLUSTER HOLE 54MM E 502-03-54E
|
Facility
IP
|
$8,866.00
|
|
| Hospital Charge Code |
3693510
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,344.34 |
| Max. Negotiated Rate |
$8,156.72 |
| Rate for Payer: Aetna Commercial |
$7,979.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,698.98
|
| Rate for Payer: Cash Price |
$2,659.80
|
| Rate for Payer: Cigna Commercial |
$8,156.72
|
| Rate for Payer: Health EOS Commercial |
$7,890.74
|
| Rate for Payer: HFN Commercial |
$8,156.72
|
| Rate for Payer: Multiplan Commercial |
$7,092.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,319.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,156.72
|
| Rate for Payer: Quartz Beloit One Network |
$4,344.34
|
| Rate for Payer: Quartz Commercial |
$5,319.60
|
| Rate for Payer: WEA Trust Commercial |
$4,876.30
|
| Rate for Payer: WPS Commercial |
$6,567.05
|
|
|
SHELL TRITANIUM CLUSTER HOLE 54MM E 502-03-54E
|
Facility
OP
|
$8,866.00
|
|
| Hospital Charge Code |
3693510
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,482.48 |
| Max. Negotiated Rate |
$35,464.00 |
| Rate for Payer: Aetna Commercial |
$7,979.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,624.76
|
| Rate for Payer: Aetna Managed Medicare |
$2,482.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,762.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,433.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,255.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,698.98
|
| Rate for Payer: Cash Price |
$2,659.80
|
| Rate for Payer: Cigna Commercial |
$8,156.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,961.41
|
| Rate for Payer: Health EOS Commercial |
$7,890.74
|
| Rate for Payer: HFN Commercial |
$8,156.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,649.50
|
| Rate for Payer: Multiplan Commercial |
$7,092.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,319.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,156.72
|
| Rate for Payer: Quartz Beloit One Network |
$4,344.34
|
| Rate for Payer: Quartz Commercial |
$5,762.90
|
| Rate for Payer: Quartz Medicare Advantage |
$5,319.60
|
| Rate for Payer: The Alliance Commercial |
$35,464.00
|
| Rate for Payer: WEA Trust Commercial |
$4,876.30
|
| Rate for Payer: WPS Commercial |
$6,567.05
|
|
|
SHELL TRITANIUM CLUSTER HOLE 56MM E 502-03-56E
|
Facility
OP
|
$8,538.00
|
|
| Hospital Charge Code |
3949330
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,390.64 |
| Max. Negotiated Rate |
$34,152.00 |
| Rate for Payer: Aetna Commercial |
$7,684.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,342.68
|
| Rate for Payer: Aetna Managed Medicare |
$2,390.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,549.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,269.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,098.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,525.14
|
| Rate for Payer: Cash Price |
$2,561.40
|
| Rate for Payer: Cigna Commercial |
$7,854.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,777.86
|
| Rate for Payer: Health EOS Commercial |
$7,598.82
|
| Rate for Payer: HFN Commercial |
$7,854.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,403.50
|
| Rate for Payer: Multiplan Commercial |
$6,830.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,122.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,854.96
|
| Rate for Payer: Quartz Beloit One Network |
$4,183.62
|
| Rate for Payer: Quartz Commercial |
$5,549.70
|
| Rate for Payer: Quartz Medicare Advantage |
$5,122.80
|
| Rate for Payer: The Alliance Commercial |
$34,152.00
|
| Rate for Payer: WEA Trust Commercial |
$4,695.90
|
| Rate for Payer: WPS Commercial |
$6,324.10
|
|
|
SHELL TRITANIUM CLUSTER HOLE 56MM E 502-03-56E
|
Facility
IP
|
$8,538.00
|
|
| Hospital Charge Code |
3949330
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,183.62 |
| Max. Negotiated Rate |
$7,854.96 |
| Rate for Payer: Aetna Commercial |
$7,684.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,525.14
|
| Rate for Payer: Cash Price |
$2,561.40
|
| Rate for Payer: Cigna Commercial |
$7,854.96
|
| Rate for Payer: Health EOS Commercial |
$7,598.82
|
| Rate for Payer: HFN Commercial |
$7,854.96
|
| Rate for Payer: Multiplan Commercial |
$6,830.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,122.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,854.96
|
| Rate for Payer: Quartz Beloit One Network |
$4,183.62
|
| Rate for Payer: Quartz Commercial |
$5,122.80
|
| Rate for Payer: WEA Trust Commercial |
$4,695.90
|
| Rate for Payer: WPS Commercial |
$6,324.10
|
|
|
SHELL TRITANIUM CLUSTER HOLE 58MM F 502-03-58F
|
Facility
IP
|
$8,866.00
|
|
| Hospital Charge Code |
4028638
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,344.34 |
| Max. Negotiated Rate |
$8,156.72 |
| Rate for Payer: Aetna Commercial |
$7,979.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,698.98
|
| Rate for Payer: Cash Price |
$2,659.80
|
| Rate for Payer: Cigna Commercial |
$8,156.72
|
| Rate for Payer: Health EOS Commercial |
$7,890.74
|
| Rate for Payer: HFN Commercial |
$8,156.72
|
| Rate for Payer: Multiplan Commercial |
$7,092.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,319.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,156.72
|
| Rate for Payer: Quartz Beloit One Network |
$4,344.34
|
| Rate for Payer: Quartz Commercial |
$5,319.60
|
| Rate for Payer: WEA Trust Commercial |
$4,876.30
|
| Rate for Payer: WPS Commercial |
$6,567.05
|
|
|
SHELL TRITANIUM CLUSTER HOLE 58MM F 502-03-58F
|
Facility
OP
|
$8,866.00
|
|
| Hospital Charge Code |
4028638
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,482.48 |
| Max. Negotiated Rate |
$35,464.00 |
| Rate for Payer: Aetna Commercial |
$7,979.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,624.76
|
| Rate for Payer: Aetna Managed Medicare |
$2,482.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,762.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,433.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,255.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,698.98
|
| Rate for Payer: Cash Price |
$2,659.80
|
| Rate for Payer: Cigna Commercial |
$8,156.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,961.41
|
| Rate for Payer: Health EOS Commercial |
$7,890.74
|
| Rate for Payer: HFN Commercial |
$8,156.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,649.50
|
| Rate for Payer: Multiplan Commercial |
$7,092.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,319.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,156.72
|
| Rate for Payer: Quartz Beloit One Network |
$4,344.34
|
| Rate for Payer: Quartz Commercial |
$5,762.90
|
| Rate for Payer: Quartz Medicare Advantage |
$5,319.60
|
| Rate for Payer: The Alliance Commercial |
$35,464.00
|
| Rate for Payer: WEA Trust Commercial |
$4,876.30
|
| Rate for Payer: WPS Commercial |
$6,567.05
|
|
|
SHELL TRITANIUM CLUSTER HOLE 60MM F 502-03-60F
|
Facility
OP
|
$8,866.00
|
|
| Hospital Charge Code |
3779519
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,482.48 |
| Max. Negotiated Rate |
$35,464.00 |
| Rate for Payer: Quartz Commercial |
$5,762.90
|
| Rate for Payer: Quartz Medicare Advantage |
$5,319.60
|
| Rate for Payer: Aetna Commercial |
$7,979.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,624.76
|
| Rate for Payer: Aetna Managed Medicare |
$2,482.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,762.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,433.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,255.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,698.98
|
| Rate for Payer: Cash Price |
$2,659.80
|
| Rate for Payer: Cigna Commercial |
$8,156.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,961.41
|
| Rate for Payer: Health EOS Commercial |
$7,890.74
|
| Rate for Payer: HFN Commercial |
$8,156.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,649.50
|
| Rate for Payer: Multiplan Commercial |
$7,092.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,319.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,156.72
|
| Rate for Payer: Quartz Beloit One Network |
$4,344.34
|
| Rate for Payer: The Alliance Commercial |
$35,464.00
|
| Rate for Payer: WEA Trust Commercial |
$4,876.30
|
| Rate for Payer: WPS Commercial |
$6,567.05
|
|
|
SHELL TRITANIUM CLUSTER HOLE 60MM F 502-03-60F
|
Facility
IP
|
$8,866.00
|
|
| Hospital Charge Code |
3779519
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,344.34 |
| Max. Negotiated Rate |
$8,156.72 |
| Rate for Payer: Aetna Commercial |
$7,979.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,698.98
|
| Rate for Payer: Cash Price |
$2,659.80
|
| Rate for Payer: Cigna Commercial |
$8,156.72
|
| Rate for Payer: Health EOS Commercial |
$7,890.74
|
| Rate for Payer: HFN Commercial |
$8,156.72
|
| Rate for Payer: Multiplan Commercial |
$7,092.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,319.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,156.72
|
| Rate for Payer: Quartz Beloit One Network |
$4,344.34
|
| Rate for Payer: Quartz Commercial |
$5,319.60
|
| Rate for Payer: WEA Trust Commercial |
$4,876.30
|
| Rate for Payer: WPS Commercial |
$6,567.05
|
|
|
SHELL TRITANIUM CLUSTER HOLE 62MM G 502-03-62G
|
Facility
IP
|
$8,538.00
|
|
| Hospital Charge Code |
4519927
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,183.62 |
| Max. Negotiated Rate |
$7,854.96 |
| Rate for Payer: Aetna Commercial |
$7,684.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,525.14
|
| Rate for Payer: Cash Price |
$2,561.40
|
| Rate for Payer: Cigna Commercial |
$7,854.96
|
| Rate for Payer: Health EOS Commercial |
$7,598.82
|
| Rate for Payer: HFN Commercial |
$7,854.96
|
| Rate for Payer: Multiplan Commercial |
$6,830.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,122.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,854.96
|
| Rate for Payer: Quartz Beloit One Network |
$4,183.62
|
| Rate for Payer: Quartz Commercial |
$5,122.80
|
| Rate for Payer: WEA Trust Commercial |
$4,695.90
|
| Rate for Payer: WPS Commercial |
$6,324.10
|
|
|
SHELL TRITANIUM CLUSTER HOLE 62MM G 502-03-62G
|
Facility
OP
|
$8,538.00
|
|
| Hospital Charge Code |
4519927
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,390.64 |
| Max. Negotiated Rate |
$34,152.00 |
| Rate for Payer: Aetna Commercial |
$7,684.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,342.68
|
| Rate for Payer: Aetna Managed Medicare |
$2,390.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,549.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,269.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,098.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,525.14
|
| Rate for Payer: Cash Price |
$2,561.40
|
| Rate for Payer: Cigna Commercial |
$7,854.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,777.86
|
| Rate for Payer: Health EOS Commercial |
$7,598.82
|
| Rate for Payer: HFN Commercial |
$7,854.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,403.50
|
| Rate for Payer: Multiplan Commercial |
$6,830.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,122.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,854.96
|
| Rate for Payer: Quartz Beloit One Network |
$4,183.62
|
| Rate for Payer: Quartz Commercial |
$5,549.70
|
| Rate for Payer: Quartz Medicare Advantage |
$5,122.80
|
| Rate for Payer: The Alliance Commercial |
$34,152.00
|
| Rate for Payer: WEA Trust Commercial |
$4,695.90
|
| Rate for Payer: WPS Commercial |
$6,324.10
|
|
|
SHELL TRITANIUM CLUSTER HOLE 64MM G 502-03-64G
|
Facility
OP
|
$8,538.00
|
|
| Hospital Charge Code |
4508737
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,390.64 |
| Max. Negotiated Rate |
$34,152.00 |
| Rate for Payer: Aetna Commercial |
$7,684.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,342.68
|
| Rate for Payer: Aetna Managed Medicare |
$2,390.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,549.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,269.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,098.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,525.14
|
| Rate for Payer: Cash Price |
$2,561.40
|
| Rate for Payer: Cigna Commercial |
$7,854.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,777.86
|
| Rate for Payer: Health EOS Commercial |
$7,598.82
|
| Rate for Payer: HFN Commercial |
$7,854.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,403.50
|
| Rate for Payer: Multiplan Commercial |
$6,830.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,122.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,854.96
|
| Rate for Payer: Quartz Beloit One Network |
$4,183.62
|
| Rate for Payer: Quartz Commercial |
$5,549.70
|
| Rate for Payer: Quartz Medicare Advantage |
$5,122.80
|
| Rate for Payer: The Alliance Commercial |
$34,152.00
|
| Rate for Payer: WEA Trust Commercial |
$4,695.90
|
| Rate for Payer: WPS Commercial |
$6,324.10
|
|
|
SHELL TRITANIUM CLUSTER HOLE 64MM G 502-03-64G
|
Facility
IP
|
$8,538.00
|
|
| Hospital Charge Code |
4508737
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,183.62 |
| Max. Negotiated Rate |
$7,854.96 |
| Rate for Payer: Aetna Commercial |
$7,684.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,525.14
|
| Rate for Payer: Cash Price |
$2,561.40
|
| Rate for Payer: Cigna Commercial |
$7,854.96
|
| Rate for Payer: Health EOS Commercial |
$7,598.82
|
| Rate for Payer: HFN Commercial |
$7,854.96
|
| Rate for Payer: Multiplan Commercial |
$6,830.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,122.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,854.96
|
| Rate for Payer: Quartz Beloit One Network |
$4,183.62
|
| Rate for Payer: Quartz Commercial |
$5,122.80
|
| Rate for Payer: WEA Trust Commercial |
$4,695.90
|
| Rate for Payer: WPS Commercial |
$6,324.10
|
|
|
SHIELD MINI
|
Facility
OP
|
$93.00
|
|
| Hospital Charge Code |
2970868
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$26.04 |
| Max. Negotiated Rate |
$372.00 |
| Rate for Payer: Aetna Commercial |
$83.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.98
|
| Rate for Payer: Aetna Managed Medicare |
$26.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$60.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$46.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$44.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.29
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$85.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$52.04
|
| Rate for Payer: Health EOS Commercial |
$82.77
|
| Rate for Payer: HFN Commercial |
$85.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.75
|
| Rate for Payer: Multiplan Commercial |
$74.40
|
| Rate for Payer: NAPHCARE Commercial |
$55.80
|
| Rate for Payer: Preferred Network Access Commercial |
$85.56
|
| Rate for Payer: Quartz Beloit One Network |
$45.57
|
| Rate for Payer: Quartz Commercial |
$60.45
|
| Rate for Payer: Quartz Medicare Advantage |
$55.80
|
| Rate for Payer: The Alliance Commercial |
$372.00
|
| Rate for Payer: WEA Trust Commercial |
$51.15
|
| Rate for Payer: WPS Commercial |
$68.89
|
|
|
SHIELD MINI
|
Facility
IP
|
$93.00
|
|
| Hospital Charge Code |
2970868
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$45.57 |
| Max. Negotiated Rate |
$85.56 |
| Rate for Payer: Aetna Commercial |
$83.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.29
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$85.56
|
| Rate for Payer: Health EOS Commercial |
$82.77
|
| Rate for Payer: HFN Commercial |
$85.56
|
| Rate for Payer: Multiplan Commercial |
$74.40
|
| Rate for Payer: NAPHCARE Commercial |
$55.80
|
| Rate for Payer: Preferred Network Access Commercial |
$85.56
|
| Rate for Payer: Quartz Beloit One Network |
$45.57
|
| Rate for Payer: Quartz Commercial |
$55.80
|
| Rate for Payer: WEA Trust Commercial |
$51.15
|
| Rate for Payer: WPS Commercial |
$68.89
|
|
