|
SCREW ACUTRAK 24MM AT2M-24
|
Facility
|
OP
|
$4,765.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4206009
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,387.57 |
| Max. Negotiated Rate |
$4,559.15 |
| Rate for Payer: Aetna Commercial |
$4,460.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,261.82
|
| Rate for Payer: Aetna Managed Medicare |
$1,387.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,221.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,477.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,378.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,626.47
|
| Rate for Payer: Cash Price |
$1,429.50
|
| Rate for Payer: Cigna Commercial |
$4,559.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,773.23
|
| Rate for Payer: Health EOS Commercial |
$4,410.48
|
| Rate for Payer: HFN Commercial |
$4,559.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,716.70
|
| Rate for Payer: Multiplan Commercial |
$3,964.48
|
| Rate for Payer: NAPHCARE Commercial |
$2,973.36
|
| Rate for Payer: Preferred Network Access Commercial |
$4,559.15
|
| Rate for Payer: Quartz Beloit One Network |
$2,428.24
|
| Rate for Payer: Quartz Commercial |
$3,221.14
|
| Rate for Payer: Quartz Medicare Advantage |
$2,973.36
|
| Rate for Payer: The Alliance Commercial |
$2,477.80
|
| Rate for Payer: WEA Trust Commercial |
$2,725.58
|
| Rate for Payer: WPS Commercial |
$3,670.48
|
|
|
SCREW ACUTRAK 26MM MINI AT2-M26-S
|
Facility
|
OP
|
$4,954.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2964155
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,442.60 |
| Max. Negotiated Rate |
$4,739.99 |
| Rate for Payer: Aetna Commercial |
$4,636.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,430.86
|
| Rate for Payer: Aetna Managed Medicare |
$1,442.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,348.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,576.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,473.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,730.64
|
| Rate for Payer: Cash Price |
$1,486.20
|
| Rate for Payer: Cigna Commercial |
$4,739.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,883.23
|
| Rate for Payer: Health EOS Commercial |
$4,585.42
|
| Rate for Payer: HFN Commercial |
$4,739.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,864.12
|
| Rate for Payer: Multiplan Commercial |
$4,121.73
|
| Rate for Payer: NAPHCARE Commercial |
$3,091.30
|
| Rate for Payer: Preferred Network Access Commercial |
$4,739.99
|
| Rate for Payer: Quartz Beloit One Network |
$2,524.56
|
| Rate for Payer: Quartz Commercial |
$3,348.90
|
| Rate for Payer: Quartz Medicare Advantage |
$3,091.30
|
| Rate for Payer: The Alliance Commercial |
$2,576.08
|
| Rate for Payer: WEA Trust Commercial |
$2,833.69
|
| Rate for Payer: WPS Commercial |
$3,816.07
|
|
|
SCREW ACUTRAK 26MM MINI AT2-M26-S
|
Facility
|
IP
|
$4,954.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2964155
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,524.56 |
| Max. Negotiated Rate |
$4,739.99 |
| Rate for Payer: Aetna Commercial |
$4,636.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,430.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,730.64
|
| Rate for Payer: Cash Price |
$1,486.20
|
| Rate for Payer: Cigna Commercial |
$4,739.99
|
| Rate for Payer: Health EOS Commercial |
$4,585.42
|
| Rate for Payer: HFN Commercial |
$4,739.99
|
| Rate for Payer: Multiplan Commercial |
$4,121.73
|
| Rate for Payer: Preferred Network Access Commercial |
$4,739.99
|
| Rate for Payer: Quartz Beloit One Network |
$2,524.56
|
| Rate for Payer: Quartz Commercial |
$3,091.30
|
| Rate for Payer: WEA Trust Commercial |
$2,833.69
|
| Rate for Payer: WPS Commercial |
$3,816.07
|
|
|
SCREW ACUTRAK 30MM MINI AT2-M30
|
Facility
|
OP
|
$4,954.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2964163
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,442.60 |
| Max. Negotiated Rate |
$4,739.99 |
| Rate for Payer: Aetna Commercial |
$4,636.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,430.86
|
| Rate for Payer: Aetna Managed Medicare |
$1,442.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,348.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,576.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,473.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,730.64
|
| Rate for Payer: Cash Price |
$1,486.20
|
| Rate for Payer: Cigna Commercial |
$4,739.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,883.23
|
| Rate for Payer: Health EOS Commercial |
$4,585.42
|
| Rate for Payer: HFN Commercial |
$4,739.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,864.12
|
| Rate for Payer: Multiplan Commercial |
$4,121.73
|
| Rate for Payer: NAPHCARE Commercial |
$3,091.30
|
| Rate for Payer: Preferred Network Access Commercial |
$4,739.99
|
| Rate for Payer: Quartz Beloit One Network |
$2,524.56
|
| Rate for Payer: Quartz Commercial |
$3,348.90
|
| Rate for Payer: Quartz Medicare Advantage |
$3,091.30
|
| Rate for Payer: The Alliance Commercial |
$2,576.08
|
| Rate for Payer: WEA Trust Commercial |
$2,833.69
|
| Rate for Payer: WPS Commercial |
$3,816.07
|
|
|
SCREW ACUTRAK 30MM MINI AT2-M30
|
Facility
|
IP
|
$4,954.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2964163
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,524.56 |
| Max. Negotiated Rate |
$4,739.99 |
| Rate for Payer: Aetna Commercial |
$4,636.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,430.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,730.64
|
| Rate for Payer: Cash Price |
$1,486.20
|
| Rate for Payer: Cigna Commercial |
$4,739.99
|
| Rate for Payer: Health EOS Commercial |
$4,585.42
|
| Rate for Payer: HFN Commercial |
$4,739.99
|
| Rate for Payer: Multiplan Commercial |
$4,121.73
|
| Rate for Payer: Preferred Network Access Commercial |
$4,739.99
|
| Rate for Payer: Quartz Beloit One Network |
$2,524.56
|
| Rate for Payer: Quartz Commercial |
$3,091.30
|
| Rate for Payer: WEA Trust Commercial |
$2,833.69
|
| Rate for Payer: WPS Commercial |
$3,816.07
|
|
|
SCREW ACUTRAK 30MM STD AT2-530-S
|
Facility
|
IP
|
$4,575.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2964165
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,331.42 |
| Max. Negotiated Rate |
$4,377.36 |
| Rate for Payer: Aetna Commercial |
$4,282.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,091.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,521.74
|
| Rate for Payer: Cash Price |
$1,372.50
|
| Rate for Payer: Cigna Commercial |
$4,377.36
|
| Rate for Payer: Health EOS Commercial |
$4,234.62
|
| Rate for Payer: HFN Commercial |
$4,377.36
|
| Rate for Payer: Multiplan Commercial |
$3,806.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,377.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,331.42
|
| Rate for Payer: Quartz Commercial |
$2,854.80
|
| Rate for Payer: WEA Trust Commercial |
$2,616.90
|
| Rate for Payer: WPS Commercial |
$3,524.12
|
|
|
SCREW ACUTRAK 30MM STD AT2-530-S
|
Facility
|
OP
|
$4,575.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2964165
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,332.24 |
| Max. Negotiated Rate |
$4,377.36 |
| Rate for Payer: Aetna Commercial |
$4,282.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,091.88
|
| Rate for Payer: Aetna Managed Medicare |
$1,332.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,092.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,379.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,283.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,521.74
|
| Rate for Payer: Cash Price |
$1,372.50
|
| Rate for Payer: Cigna Commercial |
$4,377.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,662.65
|
| Rate for Payer: Health EOS Commercial |
$4,234.62
|
| Rate for Payer: HFN Commercial |
$4,377.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,568.50
|
| Rate for Payer: Multiplan Commercial |
$3,806.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,854.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,377.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,331.42
|
| Rate for Payer: Quartz Commercial |
$3,092.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2,854.80
|
| Rate for Payer: The Alliance Commercial |
$2,379.00
|
| Rate for Payer: WEA Trust Commercial |
$2,616.90
|
| Rate for Payer: WPS Commercial |
$3,524.12
|
|
|
SCREW ACUTRAK 34.0 2 STD AT2-S34-S
|
Facility
|
OP
|
$5,309.00
|
|
| Hospital Charge Code |
3072606
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,545.98 |
| Max. Negotiated Rate |
$5,079.65 |
| Rate for Payer: Aetna Commercial |
$4,969.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,748.37
|
| Rate for Payer: Aetna Managed Medicare |
$1,545.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,588.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,760.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,650.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,926.32
|
| Rate for Payer: Cash Price |
$1,592.70
|
| Rate for Payer: Cigna Commercial |
$5,079.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,089.84
|
| Rate for Payer: Health EOS Commercial |
$4,914.01
|
| Rate for Payer: HFN Commercial |
$5,079.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,141.02
|
| Rate for Payer: Multiplan Commercial |
$4,417.09
|
| Rate for Payer: NAPHCARE Commercial |
$3,312.82
|
| Rate for Payer: Preferred Network Access Commercial |
$5,079.65
|
| Rate for Payer: Quartz Beloit One Network |
$2,705.47
|
| Rate for Payer: Quartz Commercial |
$3,588.88
|
| Rate for Payer: Quartz Medicare Advantage |
$3,312.82
|
| Rate for Payer: The Alliance Commercial |
$2,760.68
|
| Rate for Payer: WEA Trust Commercial |
$3,036.75
|
| Rate for Payer: WPS Commercial |
$4,089.52
|
|
|
SCREW ACUTRAK 34.0 2 STD AT2-S34-S
|
Facility
|
IP
|
$5,309.00
|
|
| Hospital Charge Code |
3072606
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,705.47 |
| Max. Negotiated Rate |
$5,079.65 |
| Rate for Payer: Aetna Commercial |
$4,969.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,748.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,926.32
|
| Rate for Payer: Cash Price |
$1,592.70
|
| Rate for Payer: Cigna Commercial |
$5,079.65
|
| Rate for Payer: Health EOS Commercial |
$4,914.01
|
| Rate for Payer: HFN Commercial |
$5,079.65
|
| Rate for Payer: Multiplan Commercial |
$4,417.09
|
| Rate for Payer: Preferred Network Access Commercial |
$5,079.65
|
| Rate for Payer: Quartz Beloit One Network |
$2,705.47
|
| Rate for Payer: Quartz Commercial |
$3,312.82
|
| Rate for Payer: WEA Trust Commercial |
$3,036.75
|
| Rate for Payer: WPS Commercial |
$4,089.52
|
|
|
SCREW ACUTRAK II 18MM MINI AT2-M18
|
Facility
|
IP
|
$4,270.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2964147
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,175.99 |
| Max. Negotiated Rate |
$4,085.54 |
| Rate for Payer: Aetna Commercial |
$3,996.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,819.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,353.62
|
| Rate for Payer: Cash Price |
$1,281.00
|
| Rate for Payer: Cigna Commercial |
$4,085.54
|
| Rate for Payer: Health EOS Commercial |
$3,952.31
|
| Rate for Payer: HFN Commercial |
$4,085.54
|
| Rate for Payer: Multiplan Commercial |
$3,552.64
|
| Rate for Payer: Preferred Network Access Commercial |
$4,085.54
|
| Rate for Payer: Quartz Beloit One Network |
$2,175.99
|
| Rate for Payer: Quartz Commercial |
$2,664.48
|
| Rate for Payer: WEA Trust Commercial |
$2,442.44
|
| Rate for Payer: WPS Commercial |
$3,289.18
|
|
|
SCREW ACUTRAK II 18MM MINI AT2-M18
|
Facility
|
OP
|
$4,270.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2964147
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,243.42 |
| Max. Negotiated Rate |
$4,085.54 |
| Rate for Payer: Aetna Commercial |
$3,996.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,819.09
|
| Rate for Payer: Aetna Managed Medicare |
$1,243.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,886.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,220.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,131.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,353.62
|
| Rate for Payer: Cash Price |
$1,281.00
|
| Rate for Payer: Cigna Commercial |
$4,085.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,485.14
|
| Rate for Payer: Health EOS Commercial |
$3,952.31
|
| Rate for Payer: HFN Commercial |
$4,085.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,330.60
|
| Rate for Payer: Multiplan Commercial |
$3,552.64
|
| Rate for Payer: NAPHCARE Commercial |
$2,664.48
|
| Rate for Payer: Preferred Network Access Commercial |
$4,085.54
|
| Rate for Payer: Quartz Beloit One Network |
$2,175.99
|
| Rate for Payer: Quartz Commercial |
$2,886.52
|
| Rate for Payer: Quartz Medicare Advantage |
$2,664.48
|
| Rate for Payer: The Alliance Commercial |
$2,220.40
|
| Rate for Payer: WEA Trust Commercial |
$2,442.44
|
| Rate for Payer: WPS Commercial |
$3,289.18
|
|
|
SCREW-AMBI 4.5 X 20 71129220
|
Facility
|
IP
|
$345.00
|
|
| Hospital Charge Code |
2965979
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$175.81 |
| Max. Negotiated Rate |
$330.10 |
| Rate for Payer: Aetna Commercial |
$322.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$308.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$190.16
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$330.10
|
| Rate for Payer: Health EOS Commercial |
$319.33
|
| Rate for Payer: HFN Commercial |
$330.10
|
| Rate for Payer: Multiplan Commercial |
$287.04
|
| Rate for Payer: Preferred Network Access Commercial |
$330.10
|
| Rate for Payer: Quartz Beloit One Network |
$175.81
|
| Rate for Payer: Quartz Commercial |
$215.28
|
| Rate for Payer: WEA Trust Commercial |
$197.34
|
| Rate for Payer: WPS Commercial |
$265.75
|
|
|
SCREW-AMBI 4.5 X 20 71129220
|
Facility
|
OP
|
$345.00
|
|
| Hospital Charge Code |
2965979
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$100.46 |
| Max. Negotiated Rate |
$330.10 |
| Rate for Payer: Aetna Commercial |
$322.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$308.57
|
| Rate for Payer: Aetna Managed Medicare |
$100.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$233.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$179.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$172.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$190.16
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$330.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$200.79
|
| Rate for Payer: Health EOS Commercial |
$319.33
|
| Rate for Payer: HFN Commercial |
$330.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$269.10
|
| Rate for Payer: Multiplan Commercial |
$287.04
|
| Rate for Payer: NAPHCARE Commercial |
$215.28
|
| Rate for Payer: Preferred Network Access Commercial |
$330.10
|
| Rate for Payer: Quartz Beloit One Network |
$175.81
|
| Rate for Payer: Quartz Commercial |
$233.22
|
| Rate for Payer: Quartz Medicare Advantage |
$215.28
|
| Rate for Payer: The Alliance Commercial |
$179.40
|
| Rate for Payer: WEA Trust Commercial |
$197.34
|
| Rate for Payer: WPS Commercial |
$265.75
|
|
|
SCREW-AMBI 4.5 X 24 7112-9224
|
Facility
|
IP
|
$345.00
|
|
| Hospital Charge Code |
2965980
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$175.81 |
| Max. Negotiated Rate |
$330.10 |
| Rate for Payer: Aetna Commercial |
$322.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$308.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$190.16
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$330.10
|
| Rate for Payer: Health EOS Commercial |
$319.33
|
| Rate for Payer: HFN Commercial |
$330.10
|
| Rate for Payer: Multiplan Commercial |
$287.04
|
| Rate for Payer: Preferred Network Access Commercial |
$330.10
|
| Rate for Payer: Quartz Beloit One Network |
$175.81
|
| Rate for Payer: Quartz Commercial |
$215.28
|
| Rate for Payer: WEA Trust Commercial |
$197.34
|
| Rate for Payer: WPS Commercial |
$265.75
|
|
|
SCREW-AMBI 4.5 X 24 7112-9224
|
Facility
|
OP
|
$345.00
|
|
| Hospital Charge Code |
2965980
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$100.46 |
| Max. Negotiated Rate |
$330.10 |
| Rate for Payer: Aetna Commercial |
$322.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$308.57
|
| Rate for Payer: Aetna Managed Medicare |
$100.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$233.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$179.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$172.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$190.16
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$330.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$200.79
|
| Rate for Payer: Health EOS Commercial |
$319.33
|
| Rate for Payer: HFN Commercial |
$330.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$269.10
|
| Rate for Payer: Multiplan Commercial |
$287.04
|
| Rate for Payer: NAPHCARE Commercial |
$215.28
|
| Rate for Payer: Preferred Network Access Commercial |
$330.10
|
| Rate for Payer: Quartz Beloit One Network |
$175.81
|
| Rate for Payer: Quartz Commercial |
$233.22
|
| Rate for Payer: Quartz Medicare Advantage |
$215.28
|
| Rate for Payer: The Alliance Commercial |
$179.40
|
| Rate for Payer: WEA Trust Commercial |
$197.34
|
| Rate for Payer: WPS Commercial |
$265.75
|
|
|
SCREW-AMBI 4.5 X 26 7112-9226
|
Facility
|
OP
|
$345.00
|
|
| Hospital Charge Code |
3241474
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$100.46 |
| Max. Negotiated Rate |
$330.10 |
| Rate for Payer: Aetna Commercial |
$322.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$308.57
|
| Rate for Payer: Aetna Managed Medicare |
$100.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$233.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$179.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$172.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$190.16
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$330.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$200.79
|
| Rate for Payer: Health EOS Commercial |
$319.33
|
| Rate for Payer: HFN Commercial |
$330.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$269.10
|
| Rate for Payer: Multiplan Commercial |
$287.04
|
| Rate for Payer: NAPHCARE Commercial |
$215.28
|
| Rate for Payer: Preferred Network Access Commercial |
$330.10
|
| Rate for Payer: Quartz Beloit One Network |
$175.81
|
| Rate for Payer: Quartz Commercial |
$233.22
|
| Rate for Payer: Quartz Medicare Advantage |
$215.28
|
| Rate for Payer: The Alliance Commercial |
$179.40
|
| Rate for Payer: WEA Trust Commercial |
$197.34
|
| Rate for Payer: WPS Commercial |
$265.75
|
|
|
SCREW-AMBI 4.5 X 26 7112-9226
|
Facility
|
IP
|
$345.00
|
|
| Hospital Charge Code |
3241474
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$175.81 |
| Max. Negotiated Rate |
$330.10 |
| Rate for Payer: Aetna Commercial |
$322.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$308.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$190.16
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$330.10
|
| Rate for Payer: Health EOS Commercial |
$319.33
|
| Rate for Payer: HFN Commercial |
$330.10
|
| Rate for Payer: Multiplan Commercial |
$287.04
|
| Rate for Payer: Preferred Network Access Commercial |
$330.10
|
| Rate for Payer: Quartz Beloit One Network |
$175.81
|
| Rate for Payer: Quartz Commercial |
$215.28
|
| Rate for Payer: WEA Trust Commercial |
$197.34
|
| Rate for Payer: WPS Commercial |
$265.75
|
|
|
SCREW-AMBI 4.5 X 28 7112-9228
|
Facility
|
IP
|
$345.00
|
|
| Hospital Charge Code |
2965981
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$175.81 |
| Max. Negotiated Rate |
$330.10 |
| Rate for Payer: Aetna Commercial |
$322.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$308.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$190.16
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$330.10
|
| Rate for Payer: Health EOS Commercial |
$319.33
|
| Rate for Payer: HFN Commercial |
$330.10
|
| Rate for Payer: Multiplan Commercial |
$287.04
|
| Rate for Payer: Preferred Network Access Commercial |
$330.10
|
| Rate for Payer: Quartz Beloit One Network |
$175.81
|
| Rate for Payer: Quartz Commercial |
$215.28
|
| Rate for Payer: WEA Trust Commercial |
$197.34
|
| Rate for Payer: WPS Commercial |
$265.75
|
|
|
SCREW-AMBI 4.5 X 28 7112-9228
|
Facility
|
OP
|
$345.00
|
|
| Hospital Charge Code |
2965981
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$100.46 |
| Max. Negotiated Rate |
$330.10 |
| Rate for Payer: Aetna Commercial |
$322.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$308.57
|
| Rate for Payer: Aetna Managed Medicare |
$100.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$233.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$179.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$172.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$190.16
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$330.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$200.79
|
| Rate for Payer: Health EOS Commercial |
$319.33
|
| Rate for Payer: HFN Commercial |
$330.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$269.10
|
| Rate for Payer: Multiplan Commercial |
$287.04
|
| Rate for Payer: NAPHCARE Commercial |
$215.28
|
| Rate for Payer: Preferred Network Access Commercial |
$330.10
|
| Rate for Payer: Quartz Beloit One Network |
$175.81
|
| Rate for Payer: Quartz Commercial |
$233.22
|
| Rate for Payer: Quartz Medicare Advantage |
$215.28
|
| Rate for Payer: The Alliance Commercial |
$179.40
|
| Rate for Payer: WEA Trust Commercial |
$197.34
|
| Rate for Payer: WPS Commercial |
$265.75
|
|
|
SCREW-AMBI 4.5 X 30 7112-9230
|
Facility
|
OP
|
$345.00
|
|
| Hospital Charge Code |
2965982
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$100.46 |
| Max. Negotiated Rate |
$330.10 |
| Rate for Payer: Aetna Commercial |
$322.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$308.57
|
| Rate for Payer: Aetna Managed Medicare |
$100.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$233.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$179.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$172.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$190.16
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$330.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$200.79
|
| Rate for Payer: Health EOS Commercial |
$319.33
|
| Rate for Payer: HFN Commercial |
$330.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$269.10
|
| Rate for Payer: Multiplan Commercial |
$287.04
|
| Rate for Payer: NAPHCARE Commercial |
$215.28
|
| Rate for Payer: Preferred Network Access Commercial |
$330.10
|
| Rate for Payer: Quartz Beloit One Network |
$175.81
|
| Rate for Payer: Quartz Commercial |
$233.22
|
| Rate for Payer: Quartz Medicare Advantage |
$215.28
|
| Rate for Payer: The Alliance Commercial |
$179.40
|
| Rate for Payer: WEA Trust Commercial |
$197.34
|
| Rate for Payer: WPS Commercial |
$265.75
|
|
|
SCREW-AMBI 4.5 X 30 7112-9230
|
Facility
|
IP
|
$345.00
|
|
| Hospital Charge Code |
2965982
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$175.81 |
| Max. Negotiated Rate |
$330.10 |
| Rate for Payer: Aetna Commercial |
$322.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$308.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$190.16
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$330.10
|
| Rate for Payer: Health EOS Commercial |
$319.33
|
| Rate for Payer: HFN Commercial |
$330.10
|
| Rate for Payer: Multiplan Commercial |
$287.04
|
| Rate for Payer: Preferred Network Access Commercial |
$330.10
|
| Rate for Payer: Quartz Beloit One Network |
$175.81
|
| Rate for Payer: Quartz Commercial |
$215.28
|
| Rate for Payer: WEA Trust Commercial |
$197.34
|
| Rate for Payer: WPS Commercial |
$265.75
|
|
|
SCREW-AMBI 4.5 X 32 7112-9232
|
Facility
|
OP
|
$345.00
|
|
| Hospital Charge Code |
2965983
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$100.46 |
| Max. Negotiated Rate |
$330.10 |
| Rate for Payer: Aetna Commercial |
$322.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$308.57
|
| Rate for Payer: Aetna Managed Medicare |
$100.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$233.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$179.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$172.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$190.16
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$330.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$200.79
|
| Rate for Payer: Health EOS Commercial |
$319.33
|
| Rate for Payer: HFN Commercial |
$330.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$269.10
|
| Rate for Payer: Multiplan Commercial |
$287.04
|
| Rate for Payer: NAPHCARE Commercial |
$215.28
|
| Rate for Payer: Preferred Network Access Commercial |
$330.10
|
| Rate for Payer: Quartz Beloit One Network |
$175.81
|
| Rate for Payer: Quartz Commercial |
$233.22
|
| Rate for Payer: Quartz Medicare Advantage |
$215.28
|
| Rate for Payer: The Alliance Commercial |
$179.40
|
| Rate for Payer: WEA Trust Commercial |
$197.34
|
| Rate for Payer: WPS Commercial |
$265.75
|
|
|
SCREW-AMBI 4.5 X 32 7112-9232
|
Facility
|
IP
|
$345.00
|
|
| Hospital Charge Code |
2965983
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$175.81 |
| Max. Negotiated Rate |
$330.10 |
| Rate for Payer: Aetna Commercial |
$322.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$308.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$190.16
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$330.10
|
| Rate for Payer: Health EOS Commercial |
$319.33
|
| Rate for Payer: HFN Commercial |
$330.10
|
| Rate for Payer: Multiplan Commercial |
$287.04
|
| Rate for Payer: Preferred Network Access Commercial |
$330.10
|
| Rate for Payer: Quartz Beloit One Network |
$175.81
|
| Rate for Payer: Quartz Commercial |
$215.28
|
| Rate for Payer: WEA Trust Commercial |
$197.34
|
| Rate for Payer: WPS Commercial |
$265.75
|
|
|
SCREW-AMBI 4.5 X 34 7112-9234
|
Facility
|
OP
|
$345.00
|
|
| Hospital Charge Code |
2965984
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$100.46 |
| Max. Negotiated Rate |
$330.10 |
| Rate for Payer: Aetna Commercial |
$322.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$308.57
|
| Rate for Payer: Aetna Managed Medicare |
$100.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$233.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$179.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$172.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$190.16
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$330.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$200.79
|
| Rate for Payer: Health EOS Commercial |
$319.33
|
| Rate for Payer: HFN Commercial |
$330.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$269.10
|
| Rate for Payer: Multiplan Commercial |
$287.04
|
| Rate for Payer: NAPHCARE Commercial |
$215.28
|
| Rate for Payer: Preferred Network Access Commercial |
$330.10
|
| Rate for Payer: Quartz Beloit One Network |
$175.81
|
| Rate for Payer: Quartz Commercial |
$233.22
|
| Rate for Payer: Quartz Medicare Advantage |
$215.28
|
| Rate for Payer: The Alliance Commercial |
$179.40
|
| Rate for Payer: WEA Trust Commercial |
$197.34
|
| Rate for Payer: WPS Commercial |
$265.75
|
|
|
SCREW-AMBI 4.5 X 34 7112-9234
|
Facility
|
IP
|
$345.00
|
|
| Hospital Charge Code |
2965984
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$175.81 |
| Max. Negotiated Rate |
$330.10 |
| Rate for Payer: Aetna Commercial |
$322.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$308.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$190.16
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$330.10
|
| Rate for Payer: Health EOS Commercial |
$319.33
|
| Rate for Payer: HFN Commercial |
$330.10
|
| Rate for Payer: Multiplan Commercial |
$287.04
|
| Rate for Payer: Preferred Network Access Commercial |
$330.10
|
| Rate for Payer: Quartz Beloit One Network |
$175.81
|
| Rate for Payer: Quartz Commercial |
$215.28
|
| Rate for Payer: WEA Trust Commercial |
$197.34
|
| Rate for Payer: WPS Commercial |
$265.75
|
|
