|
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 |
$2,241.75 |
| Max. Negotiated Rate |
$4,209.00 |
| Rate for Payer: Aetna Commercial |
$4,117.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,934.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,424.75
|
| Rate for Payer: Cash Price |
$1,372.50
|
| Rate for Payer: Cigna Commercial |
$4,209.00
|
| Rate for Payer: Health EOS Commercial |
$4,071.75
|
| Rate for Payer: HFN Commercial |
$4,209.00
|
| Rate for Payer: Multiplan Commercial |
$3,660.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,745.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,209.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,241.75
|
| Rate for Payer: Quartz Commercial |
$2,745.00
|
| Rate for Payer: WEA Trust Commercial |
$2,516.25
|
| Rate for Payer: WPS Commercial |
$3,388.70
|
|
|
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 |
$2,601.41 |
| Max. Negotiated Rate |
$4,884.28 |
| Rate for Payer: Aetna Commercial |
$4,778.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,565.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,813.77
|
| Rate for Payer: Cash Price |
$1,592.70
|
| Rate for Payer: Cigna Commercial |
$4,884.28
|
| Rate for Payer: Health EOS Commercial |
$4,725.01
|
| Rate for Payer: HFN Commercial |
$4,884.28
|
| Rate for Payer: Multiplan Commercial |
$4,247.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,185.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,884.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,601.41
|
| Rate for Payer: Quartz Commercial |
$3,185.40
|
| Rate for Payer: WEA Trust Commercial |
$2,919.95
|
| Rate for Payer: WPS Commercial |
$3,932.38
|
|
|
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 |
$1,486.52 |
| Max. Negotiated Rate |
$21,236.00 |
| Rate for Payer: Aetna Commercial |
$4,778.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,565.74
|
| Rate for Payer: Aetna Managed Medicare |
$1,486.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,450.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,654.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,548.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,813.77
|
| Rate for Payer: Cash Price |
$1,592.70
|
| Rate for Payer: Cigna Commercial |
$4,884.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,970.92
|
| Rate for Payer: Health EOS Commercial |
$4,725.01
|
| Rate for Payer: HFN Commercial |
$4,884.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,981.75
|
| Rate for Payer: Multiplan Commercial |
$4,247.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,185.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,884.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,601.41
|
| Rate for Payer: Quartz Commercial |
$3,450.85
|
| Rate for Payer: Quartz Medicare Advantage |
$3,185.40
|
| Rate for Payer: The Alliance Commercial |
$21,236.00
|
| Rate for Payer: WEA Trust Commercial |
$2,919.95
|
| Rate for Payer: WPS Commercial |
$3,932.38
|
|
|
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 |
$2,092.30 |
| Max. Negotiated Rate |
$3,928.40 |
| Rate for Payer: Aetna Commercial |
$3,843.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,672.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,263.10
|
| Rate for Payer: Cash Price |
$1,281.00
|
| Rate for Payer: Cigna Commercial |
$3,928.40
|
| Rate for Payer: Health EOS Commercial |
$3,800.30
|
| Rate for Payer: HFN Commercial |
$3,928.40
|
| Rate for Payer: Multiplan Commercial |
$3,416.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,562.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,928.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,092.30
|
| Rate for Payer: Quartz Commercial |
$2,562.00
|
| Rate for Payer: WEA Trust Commercial |
$2,348.50
|
| Rate for Payer: WPS Commercial |
$3,162.79
|
|
|
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 |
$1,195.60 |
| Max. Negotiated Rate |
$17,080.00 |
| Rate for Payer: Aetna Commercial |
$3,843.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,672.20
|
| Rate for Payer: Aetna Managed Medicare |
$1,195.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,775.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,135.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,049.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,263.10
|
| Rate for Payer: Cash Price |
$1,281.00
|
| Rate for Payer: Cigna Commercial |
$3,928.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,389.49
|
| Rate for Payer: Health EOS Commercial |
$3,800.30
|
| Rate for Payer: HFN Commercial |
$3,928.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,202.50
|
| Rate for Payer: Multiplan Commercial |
$3,416.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,562.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,928.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,092.30
|
| Rate for Payer: Quartz Commercial |
$2,775.50
|
| Rate for Payer: Quartz Medicare Advantage |
$2,562.00
|
| Rate for Payer: The Alliance Commercial |
$17,080.00
|
| Rate for Payer: WEA Trust Commercial |
$2,348.50
|
| Rate for Payer: WPS Commercial |
$3,162.79
|
|
|
SCREW-AMBI 4.5 X 20 71129220
|
Facility
|
IP
|
$345.00
|
|
| Hospital Charge Code |
2965979
|
|
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 20 71129220
|
Facility
|
OP
|
$345.00
|
|
| Hospital Charge Code |
2965979
|
|
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
|
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
|
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 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 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 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 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 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 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
|
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 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
|
|
