|
SCREW KREULOCK COMPRESSION 3.5 X 16MM SS AR-8835CL-16
|
Facility
|
OP
|
$2,790.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6178272
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$812.45 |
| Max. Negotiated Rate |
$2,669.47 |
| Rate for Payer: Aetna Commercial |
$2,611.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,495.38
|
| Rate for Payer: Aetna Managed Medicare |
$812.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,886.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,450.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,392.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,537.85
|
| Rate for Payer: Cash Price |
$837.00
|
| Rate for Payer: Cigna Commercial |
$2,669.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,623.78
|
| Rate for Payer: Health EOS Commercial |
$2,582.42
|
| Rate for Payer: HFN Commercial |
$2,669.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,176.20
|
| Rate for Payer: Multiplan Commercial |
$2,321.28
|
| Rate for Payer: NAPHCARE Commercial |
$1,740.96
|
| Rate for Payer: Preferred Network Access Commercial |
$2,669.47
|
| Rate for Payer: Quartz Beloit One Network |
$1,421.78
|
| Rate for Payer: Quartz Commercial |
$1,886.04
|
| Rate for Payer: Quartz Medicare Advantage |
$1,740.96
|
| Rate for Payer: The Alliance Commercial |
$1,450.80
|
| Rate for Payer: WEA Trust Commercial |
$1,595.88
|
| Rate for Payer: WPS Commercial |
$2,149.14
|
|
|
SCREW KREULOCK COMPRESSION 3.5 X 16MM SS AR-8835CL-16
|
Facility
|
IP
|
$2,790.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6178272
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,421.78 |
| Max. Negotiated Rate |
$2,669.47 |
| Rate for Payer: Aetna Commercial |
$2,611.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,495.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,537.85
|
| Rate for Payer: Cash Price |
$837.00
|
| Rate for Payer: Cigna Commercial |
$2,669.47
|
| Rate for Payer: Health EOS Commercial |
$2,582.42
|
| Rate for Payer: HFN Commercial |
$2,669.47
|
| Rate for Payer: Multiplan Commercial |
$2,321.28
|
| Rate for Payer: Preferred Network Access Commercial |
$2,669.47
|
| Rate for Payer: Quartz Beloit One Network |
$1,421.78
|
| Rate for Payer: Quartz Commercial |
$1,740.96
|
| Rate for Payer: WEA Trust Commercial |
$1,595.88
|
| Rate for Payer: WPS Commercial |
$2,149.14
|
|
|
SCREW KREULOCK COMPRESSION 3.5 X 16MM SS AR-8935CL-16
|
Facility
|
OP
|
$2,902.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6173604
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$845.06 |
| Max. Negotiated Rate |
$2,776.63 |
| Rate for Payer: Aetna Commercial |
$2,716.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,595.55
|
| Rate for Payer: Aetna Managed Medicare |
$845.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,961.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,509.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,448.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,599.58
|
| Rate for Payer: Cash Price |
$870.60
|
| Rate for Payer: Cigna Commercial |
$2,776.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,688.96
|
| Rate for Payer: Health EOS Commercial |
$2,686.09
|
| Rate for Payer: HFN Commercial |
$2,776.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,263.56
|
| Rate for Payer: Multiplan Commercial |
$2,414.46
|
| Rate for Payer: NAPHCARE Commercial |
$1,810.85
|
| Rate for Payer: Preferred Network Access Commercial |
$2,776.63
|
| Rate for Payer: Quartz Beloit One Network |
$1,478.86
|
| Rate for Payer: Quartz Commercial |
$1,961.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,810.85
|
| Rate for Payer: The Alliance Commercial |
$1,509.04
|
| Rate for Payer: WEA Trust Commercial |
$1,659.94
|
| Rate for Payer: WPS Commercial |
$2,235.41
|
|
|
SCREW KREULOCK COMPRESSION 3.5 X 16MM SS AR-8935CL-16
|
Facility
|
IP
|
$2,902.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6173604
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,478.86 |
| Max. Negotiated Rate |
$2,776.63 |
| Rate for Payer: Aetna Commercial |
$2,716.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,595.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,599.58
|
| Rate for Payer: Cash Price |
$870.60
|
| Rate for Payer: Cigna Commercial |
$2,776.63
|
| Rate for Payer: Health EOS Commercial |
$2,686.09
|
| Rate for Payer: HFN Commercial |
$2,776.63
|
| Rate for Payer: Multiplan Commercial |
$2,414.46
|
| Rate for Payer: Preferred Network Access Commercial |
$2,776.63
|
| Rate for Payer: Quartz Beloit One Network |
$1,478.86
|
| Rate for Payer: Quartz Commercial |
$1,810.85
|
| Rate for Payer: WEA Trust Commercial |
$1,659.94
|
| Rate for Payer: WPS Commercial |
$2,235.41
|
|
|
SCREW LAG 10.5 X 80MM GAMMA 3060-0080S
|
Facility
|
OP
|
$4,984.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4509007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,451.34 |
| Max. Negotiated Rate |
$4,768.69 |
| Rate for Payer: Aetna Commercial |
$4,665.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,457.69
|
| Rate for Payer: Aetna Managed Medicare |
$1,451.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,369.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,591.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,488.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,747.18
|
| Rate for Payer: Cash Price |
$1,495.20
|
| Rate for Payer: Cigna Commercial |
$4,768.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,900.69
|
| Rate for Payer: Health EOS Commercial |
$4,613.19
|
| Rate for Payer: HFN Commercial |
$4,768.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,887.52
|
| Rate for Payer: Multiplan Commercial |
$4,146.69
|
| Rate for Payer: NAPHCARE Commercial |
$3,110.02
|
| Rate for Payer: Preferred Network Access Commercial |
$4,768.69
|
| Rate for Payer: Quartz Beloit One Network |
$2,539.85
|
| Rate for Payer: Quartz Commercial |
$3,369.18
|
| Rate for Payer: Quartz Medicare Advantage |
$3,110.02
|
| Rate for Payer: The Alliance Commercial |
$2,591.68
|
| Rate for Payer: WEA Trust Commercial |
$2,850.85
|
| Rate for Payer: WPS Commercial |
$3,839.18
|
|
|
SCREW LAG 10.5 X 80MM GAMMA 3060-0080S
|
Facility
|
IP
|
$4,984.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4509007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,539.85 |
| Max. Negotiated Rate |
$4,768.69 |
| Rate for Payer: Aetna Commercial |
$4,665.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,457.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,747.18
|
| Rate for Payer: Cash Price |
$1,495.20
|
| Rate for Payer: Cigna Commercial |
$4,768.69
|
| Rate for Payer: Health EOS Commercial |
$4,613.19
|
| Rate for Payer: HFN Commercial |
$4,768.69
|
| Rate for Payer: Multiplan Commercial |
$4,146.69
|
| Rate for Payer: Preferred Network Access Commercial |
$4,768.69
|
| Rate for Payer: Quartz Beloit One Network |
$2,539.85
|
| Rate for Payer: Quartz Commercial |
$3,110.02
|
| Rate for Payer: WEA Trust Commercial |
$2,850.85
|
| Rate for Payer: WPS Commercial |
$3,839.18
|
|
|
SCREW LAG 10.5 X 85MM GAMMA 3060-0085S
|
Facility
|
IP
|
$5,857.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
3072439
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,984.73 |
| Max. Negotiated Rate |
$5,603.98 |
| Rate for Payer: Aetna Commercial |
$5,482.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,238.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,228.38
|
| Rate for Payer: Cash Price |
$1,757.10
|
| Rate for Payer: Cigna Commercial |
$5,603.98
|
| Rate for Payer: Health EOS Commercial |
$5,421.24
|
| Rate for Payer: HFN Commercial |
$5,603.98
|
| Rate for Payer: Multiplan Commercial |
$4,873.02
|
| Rate for Payer: Preferred Network Access Commercial |
$5,603.98
|
| Rate for Payer: Quartz Beloit One Network |
$2,984.73
|
| Rate for Payer: Quartz Commercial |
$3,654.77
|
| Rate for Payer: WEA Trust Commercial |
$3,350.20
|
| Rate for Payer: WPS Commercial |
$4,511.65
|
|
|
SCREW LAG 10.5 X 85MM GAMMA 3060-0085S
|
Facility
|
OP
|
$5,857.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
3072439
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,705.56 |
| Max. Negotiated Rate |
$5,603.98 |
| Rate for Payer: Aetna Commercial |
$5,482.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,238.50
|
| Rate for Payer: Aetna Managed Medicare |
$1,705.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,959.33
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,045.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,923.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,228.38
|
| Rate for Payer: Cash Price |
$1,757.10
|
| Rate for Payer: Cigna Commercial |
$5,603.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,408.77
|
| Rate for Payer: Health EOS Commercial |
$5,421.24
|
| Rate for Payer: HFN Commercial |
$5,603.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,568.46
|
| Rate for Payer: Multiplan Commercial |
$4,873.02
|
| Rate for Payer: NAPHCARE Commercial |
$3,654.77
|
| Rate for Payer: Preferred Network Access Commercial |
$5,603.98
|
| Rate for Payer: Quartz Beloit One Network |
$2,984.73
|
| Rate for Payer: Quartz Commercial |
$3,959.33
|
| Rate for Payer: Quartz Medicare Advantage |
$3,654.77
|
| Rate for Payer: The Alliance Commercial |
$3,045.64
|
| Rate for Payer: WEA Trust Commercial |
$3,350.20
|
| Rate for Payer: WPS Commercial |
$4,511.65
|
|
|
SCREW LAG 10.5 X 90MM GAMMA 3060-0090S
|
Facility
|
OP
|
$4,584.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4509042
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,334.86 |
| Max. Negotiated Rate |
$4,385.97 |
| Rate for Payer: Aetna Commercial |
$4,290.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,099.93
|
| Rate for Payer: Aetna Managed Medicare |
$1,334.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,098.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,383.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,288.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,526.70
|
| Rate for Payer: Cash Price |
$1,375.20
|
| Rate for Payer: Cigna Commercial |
$4,385.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,667.89
|
| Rate for Payer: Health EOS Commercial |
$4,242.95
|
| Rate for Payer: HFN Commercial |
$4,385.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,575.52
|
| Rate for Payer: Multiplan Commercial |
$3,813.89
|
| Rate for Payer: NAPHCARE Commercial |
$2,860.42
|
| Rate for Payer: Preferred Network Access Commercial |
$4,385.97
|
| Rate for Payer: Quartz Beloit One Network |
$2,336.01
|
| Rate for Payer: Quartz Commercial |
$3,098.78
|
| Rate for Payer: Quartz Medicare Advantage |
$2,860.42
|
| Rate for Payer: The Alliance Commercial |
$2,383.68
|
| Rate for Payer: WEA Trust Commercial |
$2,622.05
|
| Rate for Payer: WPS Commercial |
$3,531.06
|
|
|
SCREW LAG 10.5 X 90MM GAMMA 3060-0090S
|
Facility
|
IP
|
$4,584.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4509042
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,336.01 |
| Max. Negotiated Rate |
$4,385.97 |
| Rate for Payer: Aetna Commercial |
$4,290.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,099.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,526.70
|
| Rate for Payer: Cash Price |
$1,375.20
|
| Rate for Payer: Cigna Commercial |
$4,385.97
|
| Rate for Payer: Health EOS Commercial |
$4,242.95
|
| Rate for Payer: HFN Commercial |
$4,385.97
|
| Rate for Payer: Multiplan Commercial |
$3,813.89
|
| Rate for Payer: Preferred Network Access Commercial |
$4,385.97
|
| Rate for Payer: Quartz Beloit One Network |
$2,336.01
|
| Rate for Payer: Quartz Commercial |
$2,860.42
|
| Rate for Payer: WEA Trust Commercial |
$2,622.05
|
| Rate for Payer: WPS Commercial |
$3,531.06
|
|
|
SCREW LAG 36MM DEPUY
|
Facility
|
IP
|
$3,008.00
|
|
| Hospital Charge Code |
2965020
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,532.88 |
| Max. Negotiated Rate |
$2,878.05 |
| Rate for Payer: Aetna Commercial |
$2,815.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,690.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,658.01
|
| Rate for Payer: Cash Price |
$902.40
|
| Rate for Payer: Cigna Commercial |
$2,878.05
|
| Rate for Payer: Health EOS Commercial |
$2,784.20
|
| Rate for Payer: HFN Commercial |
$2,878.05
|
| Rate for Payer: Multiplan Commercial |
$2,502.66
|
| Rate for Payer: Preferred Network Access Commercial |
$2,878.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,532.88
|
| Rate for Payer: Quartz Commercial |
$1,876.99
|
| Rate for Payer: WEA Trust Commercial |
$1,720.58
|
| Rate for Payer: WPS Commercial |
$2,317.06
|
|
|
SCREW LAG 36MM DEPUY
|
Facility
|
OP
|
$3,008.00
|
|
| Hospital Charge Code |
2965020
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$875.93 |
| Max. Negotiated Rate |
$2,878.05 |
| Rate for Payer: Aetna Commercial |
$2,815.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,690.36
|
| Rate for Payer: Aetna Managed Medicare |
$875.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,033.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,564.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,501.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,658.01
|
| Rate for Payer: Cash Price |
$902.40
|
| Rate for Payer: Cigna Commercial |
$2,878.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,750.66
|
| Rate for Payer: Health EOS Commercial |
$2,784.20
|
| Rate for Payer: HFN Commercial |
$2,878.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,346.24
|
| Rate for Payer: Multiplan Commercial |
$2,502.66
|
| Rate for Payer: NAPHCARE Commercial |
$1,876.99
|
| Rate for Payer: Preferred Network Access Commercial |
$2,878.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,532.88
|
| Rate for Payer: Quartz Commercial |
$2,033.41
|
| Rate for Payer: Quartz Medicare Advantage |
$1,876.99
|
| Rate for Payer: The Alliance Commercial |
$1,564.16
|
| Rate for Payer: WEA Trust Commercial |
$1,720.58
|
| Rate for Payer: WPS Commercial |
$2,317.06
|
|
|
SCREW LAG 40MM #14376-40
|
Facility
|
IP
|
$1,913.00
|
|
| Hospital Charge Code |
2965021
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$974.86 |
| Max. Negotiated Rate |
$1,830.36 |
| Rate for Payer: Aetna Commercial |
$1,790.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,710.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,054.45
|
| Rate for Payer: Cash Price |
$573.90
|
| Rate for Payer: Cigna Commercial |
$1,830.36
|
| Rate for Payer: Health EOS Commercial |
$1,770.67
|
| Rate for Payer: HFN Commercial |
$1,830.36
|
| Rate for Payer: Multiplan Commercial |
$1,591.62
|
| Rate for Payer: Preferred Network Access Commercial |
$1,830.36
|
| Rate for Payer: Quartz Beloit One Network |
$974.86
|
| Rate for Payer: Quartz Commercial |
$1,193.71
|
| Rate for Payer: WEA Trust Commercial |
$1,094.24
|
| Rate for Payer: WPS Commercial |
$1,473.58
|
|
|
SCREW LAG 40MM #14376-40
|
Facility
|
OP
|
$1,913.00
|
|
| Hospital Charge Code |
2965021
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$557.07 |
| Max. Negotiated Rate |
$1,830.36 |
| Rate for Payer: Aetna Commercial |
$1,790.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,710.99
|
| Rate for Payer: Aetna Managed Medicare |
$557.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,293.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$994.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$954.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,054.45
|
| Rate for Payer: Cash Price |
$573.90
|
| Rate for Payer: Cigna Commercial |
$1,830.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,113.37
|
| Rate for Payer: Health EOS Commercial |
$1,770.67
|
| Rate for Payer: HFN Commercial |
$1,830.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,492.14
|
| Rate for Payer: Multiplan Commercial |
$1,591.62
|
| Rate for Payer: NAPHCARE Commercial |
$1,193.71
|
| Rate for Payer: Preferred Network Access Commercial |
$1,830.36
|
| Rate for Payer: Quartz Beloit One Network |
$974.86
|
| Rate for Payer: Quartz Commercial |
$1,293.19
|
| Rate for Payer: Quartz Medicare Advantage |
$1,193.71
|
| Rate for Payer: The Alliance Commercial |
$994.76
|
| Rate for Payer: WEA Trust Commercial |
$1,094.24
|
| Rate for Payer: WPS Commercial |
$1,473.58
|
|
|
SCREW-LAG AMBI 100MM 121189
|
Facility
|
OP
|
$2,346.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966041
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$683.16 |
| Max. Negotiated Rate |
$2,244.65 |
| Rate for Payer: Aetna Commercial |
$2,195.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,098.26
|
| Rate for Payer: Aetna Managed Medicare |
$683.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,585.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,219.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,171.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,293.12
|
| Rate for Payer: Cash Price |
$703.80
|
| Rate for Payer: Cigna Commercial |
$2,244.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,365.37
|
| Rate for Payer: Health EOS Commercial |
$2,171.46
|
| Rate for Payer: HFN Commercial |
$2,244.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,829.88
|
| Rate for Payer: Multiplan Commercial |
$1,951.87
|
| Rate for Payer: NAPHCARE Commercial |
$1,463.90
|
| Rate for Payer: Preferred Network Access Commercial |
$2,244.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,195.52
|
| Rate for Payer: Quartz Commercial |
$1,585.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,463.90
|
| Rate for Payer: The Alliance Commercial |
$1,219.92
|
| Rate for Payer: WEA Trust Commercial |
$1,341.91
|
| Rate for Payer: WPS Commercial |
$1,807.12
|
|
|
SCREW-LAG AMBI 100MM 121189
|
Facility
|
IP
|
$2,346.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966041
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,195.52 |
| Max. Negotiated Rate |
$2,244.65 |
| Rate for Payer: Aetna Commercial |
$2,195.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,098.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,293.12
|
| Rate for Payer: Cash Price |
$703.80
|
| Rate for Payer: Cigna Commercial |
$2,244.65
|
| Rate for Payer: Health EOS Commercial |
$2,171.46
|
| Rate for Payer: HFN Commercial |
$2,244.65
|
| Rate for Payer: Multiplan Commercial |
$1,951.87
|
| Rate for Payer: Preferred Network Access Commercial |
$2,244.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,195.52
|
| Rate for Payer: Quartz Commercial |
$1,463.90
|
| Rate for Payer: WEA Trust Commercial |
$1,341.91
|
| Rate for Payer: WPS Commercial |
$1,807.12
|
|
|
SCREW-LAG AMBI 105MM 121190
|
Facility
|
OP
|
$2,346.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$683.16 |
| Max. Negotiated Rate |
$2,244.65 |
| Rate for Payer: Aetna Commercial |
$2,195.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,098.26
|
| Rate for Payer: Aetna Managed Medicare |
$683.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,585.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,219.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,171.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,293.12
|
| Rate for Payer: Cash Price |
$703.80
|
| Rate for Payer: Cigna Commercial |
$2,244.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,365.37
|
| Rate for Payer: Health EOS Commercial |
$2,171.46
|
| Rate for Payer: HFN Commercial |
$2,244.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,829.88
|
| Rate for Payer: Multiplan Commercial |
$1,951.87
|
| Rate for Payer: NAPHCARE Commercial |
$1,463.90
|
| Rate for Payer: Preferred Network Access Commercial |
$2,244.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,195.52
|
| Rate for Payer: Quartz Commercial |
$1,585.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,463.90
|
| Rate for Payer: The Alliance Commercial |
$1,219.92
|
| Rate for Payer: WEA Trust Commercial |
$1,341.91
|
| Rate for Payer: WPS Commercial |
$1,807.12
|
|
|
SCREW-LAG AMBI 105MM 121190
|
Facility
|
IP
|
$2,346.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,195.52 |
| Max. Negotiated Rate |
$2,244.65 |
| Rate for Payer: Aetna Commercial |
$2,195.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,098.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,293.12
|
| Rate for Payer: Cash Price |
$703.80
|
| Rate for Payer: Cigna Commercial |
$2,244.65
|
| Rate for Payer: Health EOS Commercial |
$2,171.46
|
| Rate for Payer: HFN Commercial |
$2,244.65
|
| Rate for Payer: Multiplan Commercial |
$1,951.87
|
| Rate for Payer: Preferred Network Access Commercial |
$2,244.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,195.52
|
| Rate for Payer: Quartz Commercial |
$1,463.90
|
| Rate for Payer: WEA Trust Commercial |
$1,341.91
|
| Rate for Payer: WPS Commercial |
$1,807.12
|
|
|
SCREW-LAG AMBI 110MM 121191
|
Facility
|
OP
|
$2,346.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966044
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$683.16 |
| Max. Negotiated Rate |
$2,244.65 |
| Rate for Payer: Aetna Commercial |
$2,195.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,098.26
|
| Rate for Payer: Aetna Managed Medicare |
$683.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,585.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,219.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,171.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,293.12
|
| Rate for Payer: Cash Price |
$703.80
|
| Rate for Payer: Cigna Commercial |
$2,244.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,365.37
|
| Rate for Payer: Health EOS Commercial |
$2,171.46
|
| Rate for Payer: HFN Commercial |
$2,244.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,829.88
|
| Rate for Payer: Multiplan Commercial |
$1,951.87
|
| Rate for Payer: NAPHCARE Commercial |
$1,463.90
|
| Rate for Payer: Preferred Network Access Commercial |
$2,244.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,195.52
|
| Rate for Payer: Quartz Commercial |
$1,585.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,463.90
|
| Rate for Payer: The Alliance Commercial |
$1,219.92
|
| Rate for Payer: WEA Trust Commercial |
$1,341.91
|
| Rate for Payer: WPS Commercial |
$1,807.12
|
|
|
SCREW-LAG AMBI 110MM 121191
|
Facility
|
IP
|
$2,346.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966044
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,195.52 |
| Max. Negotiated Rate |
$2,244.65 |
| Rate for Payer: Aetna Commercial |
$2,195.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,098.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,293.12
|
| Rate for Payer: Cash Price |
$703.80
|
| Rate for Payer: Cigna Commercial |
$2,244.65
|
| Rate for Payer: Health EOS Commercial |
$2,171.46
|
| Rate for Payer: HFN Commercial |
$2,244.65
|
| Rate for Payer: Multiplan Commercial |
$1,951.87
|
| Rate for Payer: Preferred Network Access Commercial |
$2,244.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,195.52
|
| Rate for Payer: Quartz Commercial |
$1,463.90
|
| Rate for Payer: WEA Trust Commercial |
$1,341.91
|
| Rate for Payer: WPS Commercial |
$1,807.12
|
|
|
SCREW-LAG AMBI 115MM 121192
|
Facility
|
IP
|
$2,346.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966045
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,195.52 |
| Max. Negotiated Rate |
$2,244.65 |
| Rate for Payer: Aetna Commercial |
$2,195.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,098.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,293.12
|
| Rate for Payer: Cash Price |
$703.80
|
| Rate for Payer: Cigna Commercial |
$2,244.65
|
| Rate for Payer: Health EOS Commercial |
$2,171.46
|
| Rate for Payer: HFN Commercial |
$2,244.65
|
| Rate for Payer: Multiplan Commercial |
$1,951.87
|
| Rate for Payer: Preferred Network Access Commercial |
$2,244.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,195.52
|
| Rate for Payer: Quartz Commercial |
$1,463.90
|
| Rate for Payer: WEA Trust Commercial |
$1,341.91
|
| Rate for Payer: WPS Commercial |
$1,807.12
|
|
|
SCREW-LAG AMBI 115MM 121192
|
Facility
|
OP
|
$2,346.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966045
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$683.16 |
| Max. Negotiated Rate |
$2,244.65 |
| Rate for Payer: Aetna Commercial |
$2,195.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,098.26
|
| Rate for Payer: Aetna Managed Medicare |
$683.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,585.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,219.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,171.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,293.12
|
| Rate for Payer: Cash Price |
$703.80
|
| Rate for Payer: Cigna Commercial |
$2,244.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,365.37
|
| Rate for Payer: Health EOS Commercial |
$2,171.46
|
| Rate for Payer: HFN Commercial |
$2,244.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,829.88
|
| Rate for Payer: Multiplan Commercial |
$1,951.87
|
| Rate for Payer: NAPHCARE Commercial |
$1,463.90
|
| Rate for Payer: Preferred Network Access Commercial |
$2,244.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,195.52
|
| Rate for Payer: Quartz Commercial |
$1,585.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,463.90
|
| Rate for Payer: The Alliance Commercial |
$1,219.92
|
| Rate for Payer: WEA Trust Commercial |
$1,341.91
|
| Rate for Payer: WPS Commercial |
$1,807.12
|
|
|
SCREW-LAG AMBI 120MM 121193
|
Facility
|
OP
|
$2,346.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966046
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$683.16 |
| Max. Negotiated Rate |
$2,244.65 |
| Rate for Payer: Aetna Commercial |
$2,195.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,098.26
|
| Rate for Payer: Aetna Managed Medicare |
$683.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,585.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,219.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,171.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,293.12
|
| Rate for Payer: Cash Price |
$703.80
|
| Rate for Payer: Cigna Commercial |
$2,244.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,365.37
|
| Rate for Payer: Health EOS Commercial |
$2,171.46
|
| Rate for Payer: HFN Commercial |
$2,244.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,829.88
|
| Rate for Payer: Multiplan Commercial |
$1,951.87
|
| Rate for Payer: NAPHCARE Commercial |
$1,463.90
|
| Rate for Payer: Preferred Network Access Commercial |
$2,244.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,195.52
|
| Rate for Payer: Quartz Commercial |
$1,585.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,463.90
|
| Rate for Payer: The Alliance Commercial |
$1,219.92
|
| Rate for Payer: WEA Trust Commercial |
$1,341.91
|
| Rate for Payer: WPS Commercial |
$1,807.12
|
|
|
SCREW-LAG AMBI 120MM 121193
|
Facility
|
IP
|
$2,346.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966046
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,195.52 |
| Max. Negotiated Rate |
$2,244.65 |
| Rate for Payer: Aetna Commercial |
$2,195.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,098.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,293.12
|
| Rate for Payer: Cash Price |
$703.80
|
| Rate for Payer: Cigna Commercial |
$2,244.65
|
| Rate for Payer: Health EOS Commercial |
$2,171.46
|
| Rate for Payer: HFN Commercial |
$2,244.65
|
| Rate for Payer: Multiplan Commercial |
$1,951.87
|
| Rate for Payer: Preferred Network Access Commercial |
$2,244.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,195.52
|
| Rate for Payer: Quartz Commercial |
$1,463.90
|
| Rate for Payer: WEA Trust Commercial |
$1,341.91
|
| Rate for Payer: WPS Commercial |
$1,807.12
|
|
|
SCREW-LAG AMBI 65MM 121182
|
Facility
|
OP
|
$2,346.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966047
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$683.16 |
| Max. Negotiated Rate |
$2,244.65 |
| Rate for Payer: Aetna Commercial |
$2,195.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,098.26
|
| Rate for Payer: Aetna Managed Medicare |
$683.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,585.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,219.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,171.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,293.12
|
| Rate for Payer: Cash Price |
$703.80
|
| Rate for Payer: Cigna Commercial |
$2,244.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,365.37
|
| Rate for Payer: Health EOS Commercial |
$2,171.46
|
| Rate for Payer: HFN Commercial |
$2,244.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,829.88
|
| Rate for Payer: Multiplan Commercial |
$1,951.87
|
| Rate for Payer: NAPHCARE Commercial |
$1,463.90
|
| Rate for Payer: Preferred Network Access Commercial |
$2,244.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,195.52
|
| Rate for Payer: Quartz Commercial |
$1,585.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,463.90
|
| Rate for Payer: The Alliance Commercial |
$1,219.92
|
| Rate for Payer: WEA Trust Commercial |
$1,341.91
|
| Rate for Payer: WPS Commercial |
$1,807.12
|
|
