|
SCREW-AMBI 4.5 X 24 7112-9224
|
Facility
|
OP
|
$345.00
|
|
| Hospital Charge Code |
2965980
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$96.60 |
| Max. Negotiated Rate |
$1,380.00 |
| Rate for Payer: Aetna Commercial |
$310.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$296.70
|
| Rate for Payer: Aetna Managed Medicare |
$96.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$224.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$172.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$165.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$182.85
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$317.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$193.06
|
| Rate for Payer: Health EOS Commercial |
$307.05
|
| Rate for Payer: HFN Commercial |
$317.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$258.75
|
| Rate for Payer: Multiplan Commercial |
$276.00
|
| Rate for Payer: NAPHCARE Commercial |
$207.00
|
| Rate for Payer: Preferred Network Access Commercial |
$317.40
|
| Rate for Payer: Quartz Beloit One Network |
$169.05
|
| Rate for Payer: Quartz Commercial |
$224.25
|
| Rate for Payer: Quartz Medicare Advantage |
$207.00
|
| Rate for Payer: The Alliance Commercial |
$1,380.00
|
| Rate for Payer: WEA Trust Commercial |
$189.75
|
| Rate for Payer: WPS Commercial |
$255.54
|
|
|
SCREW-AMBI 4.5 X 24 7112-9224
|
Facility
|
IP
|
$345.00
|
|
| Hospital Charge Code |
2965980
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$169.05 |
| Max. Negotiated Rate |
$317.40 |
| Rate for Payer: Aetna Commercial |
$310.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$296.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$182.85
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$317.40
|
| Rate for Payer: Health EOS Commercial |
$307.05
|
| Rate for Payer: HFN Commercial |
$317.40
|
| Rate for Payer: Multiplan Commercial |
$276.00
|
| Rate for Payer: NAPHCARE Commercial |
$207.00
|
| Rate for Payer: Preferred Network Access Commercial |
$317.40
|
| Rate for Payer: Quartz Beloit One Network |
$169.05
|
| Rate for Payer: Quartz Commercial |
$207.00
|
| Rate for Payer: WEA Trust Commercial |
$189.75
|
| Rate for Payer: WPS Commercial |
$255.54
|
|
|
SCREW-AMBI 4.5 X 26 7112-9226
|
Facility
|
IP
|
$345.00
|
|
| Hospital Charge Code |
3241474
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$169.05 |
| Max. Negotiated Rate |
$317.40 |
| Rate for Payer: Aetna Commercial |
$310.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$296.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$182.85
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$317.40
|
| Rate for Payer: Health EOS Commercial |
$307.05
|
| Rate for Payer: HFN Commercial |
$317.40
|
| Rate for Payer: Multiplan Commercial |
$276.00
|
| Rate for Payer: NAPHCARE Commercial |
$207.00
|
| Rate for Payer: Preferred Network Access Commercial |
$317.40
|
| Rate for Payer: Quartz Beloit One Network |
$169.05
|
| Rate for Payer: Quartz Commercial |
$207.00
|
| Rate for Payer: WEA Trust Commercial |
$189.75
|
| Rate for Payer: WPS Commercial |
$255.54
|
|
|
SCREW-AMBI 4.5 X 26 7112-9226
|
Facility
|
OP
|
$345.00
|
|
| Hospital Charge Code |
3241474
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$96.60 |
| Max. Negotiated Rate |
$1,380.00 |
| Rate for Payer: Aetna Commercial |
$310.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$296.70
|
| Rate for Payer: Aetna Managed Medicare |
$96.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$224.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$172.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$165.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$182.85
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$317.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$193.06
|
| Rate for Payer: Health EOS Commercial |
$307.05
|
| Rate for Payer: HFN Commercial |
$317.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$258.75
|
| Rate for Payer: Multiplan Commercial |
$276.00
|
| Rate for Payer: NAPHCARE Commercial |
$207.00
|
| Rate for Payer: Preferred Network Access Commercial |
$317.40
|
| Rate for Payer: Quartz Beloit One Network |
$169.05
|
| Rate for Payer: Quartz Commercial |
$224.25
|
| Rate for Payer: Quartz Medicare Advantage |
$207.00
|
| Rate for Payer: The Alliance Commercial |
$1,380.00
|
| Rate for Payer: WEA Trust Commercial |
$189.75
|
| Rate for Payer: WPS Commercial |
$255.54
|
|
|
SCREW-AMBI 4.5 X 28 7112-9228
|
Facility
|
OP
|
$345.00
|
|
| Hospital Charge Code |
2965981
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$96.60 |
| Max. Negotiated Rate |
$1,380.00 |
| Rate for Payer: Aetna Commercial |
$310.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$296.70
|
| Rate for Payer: Aetna Managed Medicare |
$96.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$224.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$172.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$165.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$182.85
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$317.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$193.06
|
| Rate for Payer: Health EOS Commercial |
$307.05
|
| Rate for Payer: HFN Commercial |
$317.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$258.75
|
| Rate for Payer: Multiplan Commercial |
$276.00
|
| Rate for Payer: NAPHCARE Commercial |
$207.00
|
| Rate for Payer: Preferred Network Access Commercial |
$317.40
|
| Rate for Payer: Quartz Beloit One Network |
$169.05
|
| Rate for Payer: Quartz Commercial |
$224.25
|
| Rate for Payer: Quartz Medicare Advantage |
$207.00
|
| Rate for Payer: The Alliance Commercial |
$1,380.00
|
| Rate for Payer: WEA Trust Commercial |
$189.75
|
| Rate for Payer: WPS Commercial |
$255.54
|
|
|
SCREW-AMBI 4.5 X 28 7112-9228
|
Facility
|
IP
|
$345.00
|
|
| Hospital Charge Code |
2965981
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$169.05 |
| Max. Negotiated Rate |
$317.40 |
| Rate for Payer: Aetna Commercial |
$310.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$296.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$182.85
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$317.40
|
| Rate for Payer: Health EOS Commercial |
$307.05
|
| Rate for Payer: HFN Commercial |
$317.40
|
| Rate for Payer: Multiplan Commercial |
$276.00
|
| Rate for Payer: NAPHCARE Commercial |
$207.00
|
| Rate for Payer: Preferred Network Access Commercial |
$317.40
|
| Rate for Payer: Quartz Beloit One Network |
$169.05
|
| Rate for Payer: Quartz Commercial |
$207.00
|
| Rate for Payer: WEA Trust Commercial |
$189.75
|
| Rate for Payer: WPS Commercial |
$255.54
|
|
|
SCREW-AMBI 4.5 X 30 7112-9230
|
Facility
|
IP
|
$345.00
|
|
| Hospital Charge Code |
2965982
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$169.05 |
| Max. Negotiated Rate |
$317.40 |
| Rate for Payer: Aetna Commercial |
$310.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$296.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$182.85
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$317.40
|
| Rate for Payer: Health EOS Commercial |
$307.05
|
| Rate for Payer: HFN Commercial |
$317.40
|
| Rate for Payer: Multiplan Commercial |
$276.00
|
| Rate for Payer: NAPHCARE Commercial |
$207.00
|
| Rate for Payer: Preferred Network Access Commercial |
$317.40
|
| Rate for Payer: Quartz Beloit One Network |
$169.05
|
| Rate for Payer: Quartz Commercial |
$207.00
|
| Rate for Payer: WEA Trust Commercial |
$189.75
|
| Rate for Payer: WPS Commercial |
$255.54
|
|
|
SCREW-AMBI 4.5 X 30 7112-9230
|
Facility
|
OP
|
$345.00
|
|
| Hospital Charge Code |
2965982
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$96.60 |
| Max. Negotiated Rate |
$1,380.00 |
| Rate for Payer: Aetna Commercial |
$310.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$296.70
|
| Rate for Payer: Aetna Managed Medicare |
$96.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$224.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$172.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$165.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$182.85
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$317.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$193.06
|
| Rate for Payer: Health EOS Commercial |
$307.05
|
| Rate for Payer: HFN Commercial |
$317.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$258.75
|
| Rate for Payer: Multiplan Commercial |
$276.00
|
| Rate for Payer: NAPHCARE Commercial |
$207.00
|
| Rate for Payer: Preferred Network Access Commercial |
$317.40
|
| Rate for Payer: Quartz Beloit One Network |
$169.05
|
| Rate for Payer: Quartz Commercial |
$224.25
|
| Rate for Payer: Quartz Medicare Advantage |
$207.00
|
| Rate for Payer: The Alliance Commercial |
$1,380.00
|
| Rate for Payer: WEA Trust Commercial |
$189.75
|
| Rate for Payer: WPS Commercial |
$255.54
|
|
|
SCREW-AMBI 4.5 X 32 7112-9232
|
Facility
|
IP
|
$345.00
|
|
| Hospital Charge Code |
2965983
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$169.05 |
| Max. Negotiated Rate |
$317.40 |
| Rate for Payer: Aetna Commercial |
$310.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$296.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$182.85
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$317.40
|
| Rate for Payer: Health EOS Commercial |
$307.05
|
| Rate for Payer: HFN Commercial |
$317.40
|
| Rate for Payer: Multiplan Commercial |
$276.00
|
| Rate for Payer: NAPHCARE Commercial |
$207.00
|
| Rate for Payer: Preferred Network Access Commercial |
$317.40
|
| Rate for Payer: Quartz Beloit One Network |
$169.05
|
| Rate for Payer: Quartz Commercial |
$207.00
|
| Rate for Payer: WEA Trust Commercial |
$189.75
|
| Rate for Payer: WPS Commercial |
$255.54
|
|
|
SCREW-AMBI 4.5 X 32 7112-9232
|
Facility
|
OP
|
$345.00
|
|
| Hospital Charge Code |
2965983
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$96.60 |
| Max. Negotiated Rate |
$1,380.00 |
| Rate for Payer: Aetna Commercial |
$310.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$296.70
|
| Rate for Payer: Aetna Managed Medicare |
$96.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$224.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$172.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$165.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$182.85
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$317.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$193.06
|
| Rate for Payer: Health EOS Commercial |
$307.05
|
| Rate for Payer: HFN Commercial |
$317.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$258.75
|
| Rate for Payer: Multiplan Commercial |
$276.00
|
| Rate for Payer: NAPHCARE Commercial |
$207.00
|
| Rate for Payer: Preferred Network Access Commercial |
$317.40
|
| Rate for Payer: Quartz Beloit One Network |
$169.05
|
| Rate for Payer: Quartz Commercial |
$224.25
|
| Rate for Payer: Quartz Medicare Advantage |
$207.00
|
| Rate for Payer: The Alliance Commercial |
$1,380.00
|
| Rate for Payer: WEA Trust Commercial |
$189.75
|
| Rate for Payer: WPS Commercial |
$255.54
|
|
|
SCREW-AMBI 4.5 X 34 7112-9234
|
Facility
|
OP
|
$345.00
|
|
| Hospital Charge Code |
2965984
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$96.60 |
| Max. Negotiated Rate |
$1,380.00 |
| Rate for Payer: Aetna Commercial |
$310.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$296.70
|
| Rate for Payer: Aetna Managed Medicare |
$96.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$224.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$172.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$165.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$182.85
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$317.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$193.06
|
| Rate for Payer: Health EOS Commercial |
$307.05
|
| Rate for Payer: HFN Commercial |
$317.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$258.75
|
| Rate for Payer: Multiplan Commercial |
$276.00
|
| Rate for Payer: NAPHCARE Commercial |
$207.00
|
| Rate for Payer: Preferred Network Access Commercial |
$317.40
|
| Rate for Payer: Quartz Beloit One Network |
$169.05
|
| Rate for Payer: Quartz Commercial |
$224.25
|
| Rate for Payer: Quartz Medicare Advantage |
$207.00
|
| Rate for Payer: The Alliance Commercial |
$1,380.00
|
| Rate for Payer: WEA Trust Commercial |
$189.75
|
| Rate for Payer: WPS Commercial |
$255.54
|
|
|
SCREW-AMBI 4.5 X 34 7112-9234
|
Facility
|
IP
|
$345.00
|
|
| Hospital Charge Code |
2965984
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$169.05 |
| Max. Negotiated Rate |
$317.40 |
| Rate for Payer: Aetna Commercial |
$310.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$296.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$182.85
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$317.40
|
| Rate for Payer: Health EOS Commercial |
$307.05
|
| Rate for Payer: HFN Commercial |
$317.40
|
| Rate for Payer: Multiplan Commercial |
$276.00
|
| Rate for Payer: NAPHCARE Commercial |
$207.00
|
| Rate for Payer: Preferred Network Access Commercial |
$317.40
|
| Rate for Payer: Quartz Beloit One Network |
$169.05
|
| Rate for Payer: Quartz Commercial |
$207.00
|
| Rate for Payer: WEA Trust Commercial |
$189.75
|
| Rate for Payer: WPS Commercial |
$255.54
|
|
|
SCREW-AMBI 4.5 X 36 7112-9236
|
Facility
|
IP
|
$345.00
|
|
| Hospital Charge Code |
2965985
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$169.05 |
| Max. Negotiated Rate |
$317.40 |
| Rate for Payer: Aetna Commercial |
$310.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$296.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$182.85
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$317.40
|
| Rate for Payer: Health EOS Commercial |
$307.05
|
| Rate for Payer: HFN Commercial |
$317.40
|
| Rate for Payer: Multiplan Commercial |
$276.00
|
| Rate for Payer: NAPHCARE Commercial |
$207.00
|
| Rate for Payer: Preferred Network Access Commercial |
$317.40
|
| Rate for Payer: Quartz Beloit One Network |
$169.05
|
| Rate for Payer: Quartz Commercial |
$207.00
|
| Rate for Payer: WEA Trust Commercial |
$189.75
|
| Rate for Payer: WPS Commercial |
$255.54
|
|
|
SCREW-AMBI 4.5 X 36 7112-9236
|
Facility
|
OP
|
$345.00
|
|
| Hospital Charge Code |
2965985
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$96.60 |
| Max. Negotiated Rate |
$1,380.00 |
| Rate for Payer: Aetna Commercial |
$310.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$296.70
|
| Rate for Payer: Aetna Managed Medicare |
$96.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$224.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$172.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$165.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$182.85
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$317.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$193.06
|
| Rate for Payer: Health EOS Commercial |
$307.05
|
| Rate for Payer: HFN Commercial |
$317.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$258.75
|
| Rate for Payer: Multiplan Commercial |
$276.00
|
| Rate for Payer: NAPHCARE Commercial |
$207.00
|
| Rate for Payer: Preferred Network Access Commercial |
$317.40
|
| Rate for Payer: Quartz Beloit One Network |
$169.05
|
| Rate for Payer: Quartz Commercial |
$224.25
|
| Rate for Payer: Quartz Medicare Advantage |
$207.00
|
| Rate for Payer: The Alliance Commercial |
$1,380.00
|
| Rate for Payer: WEA Trust Commercial |
$189.75
|
| Rate for Payer: WPS Commercial |
$255.54
|
|
|
SCREW-AMBI 4.5 X 38 7112-9238
|
Facility
|
IP
|
$345.00
|
|
| Hospital Charge Code |
2965986
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$169.05 |
| Max. Negotiated Rate |
$317.40 |
| Rate for Payer: Aetna Commercial |
$310.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$296.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$182.85
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$317.40
|
| Rate for Payer: Health EOS Commercial |
$307.05
|
| Rate for Payer: HFN Commercial |
$317.40
|
| Rate for Payer: Multiplan Commercial |
$276.00
|
| Rate for Payer: NAPHCARE Commercial |
$207.00
|
| Rate for Payer: Preferred Network Access Commercial |
$317.40
|
| Rate for Payer: Quartz Beloit One Network |
$169.05
|
| Rate for Payer: Quartz Commercial |
$207.00
|
| Rate for Payer: WEA Trust Commercial |
$189.75
|
| Rate for Payer: WPS Commercial |
$255.54
|
|
|
SCREW-AMBI 4.5 X 38 7112-9238
|
Facility
|
OP
|
$345.00
|
|
| Hospital Charge Code |
2965986
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$96.60 |
| Max. Negotiated Rate |
$1,380.00 |
| Rate for Payer: Aetna Commercial |
$310.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$296.70
|
| Rate for Payer: Aetna Managed Medicare |
$96.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$224.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$172.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$165.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$182.85
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$317.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$193.06
|
| Rate for Payer: Health EOS Commercial |
$307.05
|
| Rate for Payer: HFN Commercial |
$317.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$258.75
|
| Rate for Payer: Multiplan Commercial |
$276.00
|
| Rate for Payer: NAPHCARE Commercial |
$207.00
|
| Rate for Payer: Preferred Network Access Commercial |
$317.40
|
| Rate for Payer: Quartz Beloit One Network |
$169.05
|
| Rate for Payer: Quartz Commercial |
$224.25
|
| Rate for Payer: Quartz Medicare Advantage |
$207.00
|
| Rate for Payer: The Alliance Commercial |
$1,380.00
|
| Rate for Payer: WEA Trust Commercial |
$189.75
|
| Rate for Payer: WPS Commercial |
$255.54
|
|
|
SCREW-AMBI 4.5 X 40 7112-9240
|
Facility
|
IP
|
$345.00
|
|
| Hospital Charge Code |
2965987
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$169.05 |
| Max. Negotiated Rate |
$317.40 |
| Rate for Payer: Aetna Commercial |
$310.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$296.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$182.85
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$317.40
|
| Rate for Payer: Health EOS Commercial |
$307.05
|
| Rate for Payer: HFN Commercial |
$317.40
|
| Rate for Payer: Multiplan Commercial |
$276.00
|
| Rate for Payer: NAPHCARE Commercial |
$207.00
|
| Rate for Payer: Preferred Network Access Commercial |
$317.40
|
| Rate for Payer: Quartz Beloit One Network |
$169.05
|
| Rate for Payer: Quartz Commercial |
$207.00
|
| Rate for Payer: WEA Trust Commercial |
$189.75
|
| Rate for Payer: WPS Commercial |
$255.54
|
|
|
SCREW-AMBI 4.5 X 40 7112-9240
|
Facility
|
OP
|
$345.00
|
|
| Hospital Charge Code |
2965987
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$96.60 |
| Max. Negotiated Rate |
$1,380.00 |
| Rate for Payer: Aetna Commercial |
$310.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$296.70
|
| Rate for Payer: Aetna Managed Medicare |
$96.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$224.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$172.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$165.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$182.85
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$317.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$193.06
|
| Rate for Payer: Health EOS Commercial |
$307.05
|
| Rate for Payer: HFN Commercial |
$317.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$258.75
|
| Rate for Payer: Multiplan Commercial |
$276.00
|
| Rate for Payer: NAPHCARE Commercial |
$207.00
|
| Rate for Payer: Preferred Network Access Commercial |
$317.40
|
| Rate for Payer: Quartz Beloit One Network |
$169.05
|
| Rate for Payer: Quartz Commercial |
$224.25
|
| Rate for Payer: Quartz Medicare Advantage |
$207.00
|
| Rate for Payer: The Alliance Commercial |
$1,380.00
|
| Rate for Payer: WEA Trust Commercial |
$189.75
|
| Rate for Payer: WPS Commercial |
$255.54
|
|
|
SCREW-AMBI 4.5 X 42 7112-9242
|
Facility
|
OP
|
$345.00
|
|
| Hospital Charge Code |
2965988
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$96.60 |
| Max. Negotiated Rate |
$1,380.00 |
| Rate for Payer: Aetna Commercial |
$310.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$296.70
|
| Rate for Payer: Aetna Managed Medicare |
$96.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$224.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$172.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$165.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$182.85
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$317.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$193.06
|
| Rate for Payer: Health EOS Commercial |
$307.05
|
| Rate for Payer: HFN Commercial |
$317.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$258.75
|
| Rate for Payer: Multiplan Commercial |
$276.00
|
| Rate for Payer: NAPHCARE Commercial |
$207.00
|
| Rate for Payer: Preferred Network Access Commercial |
$317.40
|
| Rate for Payer: Quartz Beloit One Network |
$169.05
|
| Rate for Payer: Quartz Commercial |
$224.25
|
| Rate for Payer: Quartz Medicare Advantage |
$207.00
|
| Rate for Payer: The Alliance Commercial |
$1,380.00
|
| Rate for Payer: WEA Trust Commercial |
$189.75
|
| Rate for Payer: WPS Commercial |
$255.54
|
|
|
SCREW-AMBI 4.5 X 42 7112-9242
|
Facility
|
IP
|
$345.00
|
|
| Hospital Charge Code |
2965988
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$169.05 |
| Max. Negotiated Rate |
$317.40 |
| Rate for Payer: Aetna Commercial |
$310.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$296.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$182.85
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$317.40
|
| Rate for Payer: Health EOS Commercial |
$307.05
|
| Rate for Payer: HFN Commercial |
$317.40
|
| Rate for Payer: Multiplan Commercial |
$276.00
|
| Rate for Payer: NAPHCARE Commercial |
$207.00
|
| Rate for Payer: Preferred Network Access Commercial |
$317.40
|
| Rate for Payer: Quartz Beloit One Network |
$169.05
|
| Rate for Payer: Quartz Commercial |
$207.00
|
| Rate for Payer: WEA Trust Commercial |
$189.75
|
| Rate for Payer: WPS Commercial |
$255.54
|
|
|
SCREW-AMBI 4.5 X 44 7112-9244
|
Facility
|
OP
|
$345.00
|
|
| Hospital Charge Code |
2965989
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$96.60 |
| Max. Negotiated Rate |
$1,380.00 |
| Rate for Payer: Aetna Commercial |
$310.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$296.70
|
| Rate for Payer: Aetna Managed Medicare |
$96.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$224.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$172.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$165.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$182.85
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$317.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$193.06
|
| Rate for Payer: Health EOS Commercial |
$307.05
|
| Rate for Payer: HFN Commercial |
$317.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$258.75
|
| Rate for Payer: Multiplan Commercial |
$276.00
|
| Rate for Payer: NAPHCARE Commercial |
$207.00
|
| Rate for Payer: Preferred Network Access Commercial |
$317.40
|
| Rate for Payer: Quartz Beloit One Network |
$169.05
|
| Rate for Payer: Quartz Commercial |
$224.25
|
| Rate for Payer: Quartz Medicare Advantage |
$207.00
|
| Rate for Payer: The Alliance Commercial |
$1,380.00
|
| Rate for Payer: WEA Trust Commercial |
$189.75
|
| Rate for Payer: WPS Commercial |
$255.54
|
|
|
SCREW-AMBI 4.5 X 44 7112-9244
|
Facility
|
IP
|
$345.00
|
|
| Hospital Charge Code |
2965989
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$169.05 |
| Max. Negotiated Rate |
$317.40 |
| Rate for Payer: Aetna Commercial |
$310.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$296.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$182.85
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$317.40
|
| Rate for Payer: Health EOS Commercial |
$307.05
|
| Rate for Payer: HFN Commercial |
$317.40
|
| Rate for Payer: Multiplan Commercial |
$276.00
|
| Rate for Payer: NAPHCARE Commercial |
$207.00
|
| Rate for Payer: Preferred Network Access Commercial |
$317.40
|
| Rate for Payer: Quartz Beloit One Network |
$169.05
|
| Rate for Payer: Quartz Commercial |
$207.00
|
| Rate for Payer: WEA Trust Commercial |
$189.75
|
| Rate for Payer: WPS Commercial |
$255.54
|
|
|
SCREW-AMBI 4.5 X 46 7112-9246
|
Facility
|
OP
|
$345.00
|
|
| Hospital Charge Code |
2965990
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$96.60 |
| Max. Negotiated Rate |
$1,380.00 |
| Rate for Payer: Aetna Commercial |
$310.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$296.70
|
| Rate for Payer: Aetna Managed Medicare |
$96.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$224.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$172.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$165.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$182.85
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$317.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$193.06
|
| Rate for Payer: Health EOS Commercial |
$307.05
|
| Rate for Payer: HFN Commercial |
$317.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$258.75
|
| Rate for Payer: Multiplan Commercial |
$276.00
|
| Rate for Payer: NAPHCARE Commercial |
$207.00
|
| Rate for Payer: Preferred Network Access Commercial |
$317.40
|
| Rate for Payer: Quartz Beloit One Network |
$169.05
|
| Rate for Payer: Quartz Commercial |
$224.25
|
| Rate for Payer: Quartz Medicare Advantage |
$207.00
|
| Rate for Payer: The Alliance Commercial |
$1,380.00
|
| Rate for Payer: WEA Trust Commercial |
$189.75
|
| Rate for Payer: WPS Commercial |
$255.54
|
|
|
SCREW-AMBI 4.5 X 46 7112-9246
|
Facility
|
IP
|
$345.00
|
|
| Hospital Charge Code |
2965990
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$169.05 |
| Max. Negotiated Rate |
$317.40 |
| Rate for Payer: Aetna Commercial |
$310.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$296.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$182.85
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$317.40
|
| Rate for Payer: Health EOS Commercial |
$307.05
|
| Rate for Payer: HFN Commercial |
$317.40
|
| Rate for Payer: Multiplan Commercial |
$276.00
|
| Rate for Payer: NAPHCARE Commercial |
$207.00
|
| Rate for Payer: Preferred Network Access Commercial |
$317.40
|
| Rate for Payer: Quartz Beloit One Network |
$169.05
|
| Rate for Payer: Quartz Commercial |
$207.00
|
| Rate for Payer: WEA Trust Commercial |
$189.75
|
| Rate for Payer: WPS Commercial |
$255.54
|
|
|
SCREW-AMBI 4.5 X 48 7112-9248
|
Facility
|
IP
|
$345.00
|
|
| Hospital Charge Code |
2965991
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$169.05 |
| Max. Negotiated Rate |
$317.40 |
| Rate for Payer: Aetna Commercial |
$310.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$296.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$182.85
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$317.40
|
| Rate for Payer: Health EOS Commercial |
$307.05
|
| Rate for Payer: HFN Commercial |
$317.40
|
| Rate for Payer: Multiplan Commercial |
$276.00
|
| Rate for Payer: NAPHCARE Commercial |
$207.00
|
| Rate for Payer: Preferred Network Access Commercial |
$317.40
|
| Rate for Payer: Quartz Beloit One Network |
$169.05
|
| Rate for Payer: Quartz Commercial |
$207.00
|
| Rate for Payer: WEA Trust Commercial |
$189.75
|
| Rate for Payer: WPS Commercial |
$255.54
|
|
