|
SCREW-LAG AMBI 65MM 121182
|
Facility
|
IP
|
$2,346.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966047
|
|
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 70MM 121183
|
Facility
|
IP
|
$2,346.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966048
|
|
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 70MM 121183
|
Facility
|
OP
|
$2,346.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966048
|
|
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 75MM 121184
|
Facility
|
IP
|
$2,346.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966049
|
|
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 75MM 121184
|
Facility
|
OP
|
$2,346.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966049
|
|
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 80MM 121185
|
Facility
|
OP
|
$2,346.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966050
|
|
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 80MM 121185
|
Facility
|
IP
|
$2,346.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966050
|
|
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 85MM 121186
|
Facility
|
IP
|
$2,346.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966051
|
|
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 85MM 121186
|
Facility
|
OP
|
$2,346.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966051
|
|
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 90MM 121187
|
Facility
|
OP
|
$2,346.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966052
|
|
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 90MM 121187
|
Facility
|
IP
|
$2,346.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966052
|
|
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 95MM 121188
|
Facility
|
IP
|
$2,346.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966053
|
|
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 95MM 121188
|
Facility
|
OP
|
$2,346.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966053
|
|
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 GAMMA 10.5 X 100MM 3060-0100S
|
Facility
|
OP
|
$6,083.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
3605502
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,771.37 |
| Max. Negotiated Rate |
$5,820.21 |
| Rate for Payer: Aetna Commercial |
$5,693.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,440.64
|
| Rate for Payer: Aetna Managed Medicare |
$1,771.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,112.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,163.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,036.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,352.95
|
| Rate for Payer: Cash Price |
$1,824.90
|
| Rate for Payer: Cigna Commercial |
$5,820.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,540.31
|
| Rate for Payer: Health EOS Commercial |
$5,630.42
|
| Rate for Payer: HFN Commercial |
$5,820.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,744.74
|
| Rate for Payer: Multiplan Commercial |
$5,061.06
|
| Rate for Payer: NAPHCARE Commercial |
$3,795.79
|
| Rate for Payer: Preferred Network Access Commercial |
$5,820.21
|
| Rate for Payer: Quartz Beloit One Network |
$3,099.90
|
| Rate for Payer: Quartz Commercial |
$4,112.11
|
| Rate for Payer: Quartz Medicare Advantage |
$3,795.79
|
| Rate for Payer: The Alliance Commercial |
$3,163.16
|
| Rate for Payer: WEA Trust Commercial |
$3,479.48
|
| Rate for Payer: WPS Commercial |
$4,685.73
|
|
|
SCREW LAG GAMMA 10.5 X 100MM 3060-0100S
|
Facility
|
IP
|
$6,083.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
3605502
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,099.90 |
| Max. Negotiated Rate |
$5,820.21 |
| Rate for Payer: Aetna Commercial |
$5,693.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,440.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,352.95
|
| Rate for Payer: Cash Price |
$1,824.90
|
| Rate for Payer: Cigna Commercial |
$5,820.21
|
| Rate for Payer: Health EOS Commercial |
$5,630.42
|
| Rate for Payer: HFN Commercial |
$5,820.21
|
| Rate for Payer: Multiplan Commercial |
$5,061.06
|
| Rate for Payer: Preferred Network Access Commercial |
$5,820.21
|
| Rate for Payer: Quartz Beloit One Network |
$3,099.90
|
| Rate for Payer: Quartz Commercial |
$3,795.79
|
| Rate for Payer: WEA Trust Commercial |
$3,479.48
|
| Rate for Payer: WPS Commercial |
$4,685.73
|
|
|
SCREW LAG GAMMA 10.5 X 105MM 3060-0105S
|
Facility
|
IP
|
$3,741.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
3072443
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,906.41 |
| Max. Negotiated Rate |
$3,579.39 |
| Rate for Payer: Aetna Commercial |
$3,501.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,345.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,062.04
|
| Rate for Payer: Cash Price |
$1,122.30
|
| Rate for Payer: Cigna Commercial |
$3,579.39
|
| Rate for Payer: Health EOS Commercial |
$3,462.67
|
| Rate for Payer: HFN Commercial |
$3,579.39
|
| Rate for Payer: Multiplan Commercial |
$3,112.51
|
| Rate for Payer: Preferred Network Access Commercial |
$3,579.39
|
| Rate for Payer: Quartz Beloit One Network |
$1,906.41
|
| Rate for Payer: Quartz Commercial |
$2,334.38
|
| Rate for Payer: WEA Trust Commercial |
$2,139.85
|
| Rate for Payer: WPS Commercial |
$2,881.69
|
|
|
SCREW LAG GAMMA 10.5 X 105MM 3060-0105S
|
Facility
|
OP
|
$3,741.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
3072443
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,089.38 |
| Max. Negotiated Rate |
$3,579.39 |
| Rate for Payer: Aetna Commercial |
$3,501.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,345.95
|
| Rate for Payer: Aetna Managed Medicare |
$1,089.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,528.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,945.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,867.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,062.04
|
| Rate for Payer: Cash Price |
$1,122.30
|
| Rate for Payer: Cigna Commercial |
$3,579.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,177.26
|
| Rate for Payer: Health EOS Commercial |
$3,462.67
|
| Rate for Payer: HFN Commercial |
$3,579.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,917.98
|
| Rate for Payer: Multiplan Commercial |
$3,112.51
|
| Rate for Payer: NAPHCARE Commercial |
$2,334.38
|
| Rate for Payer: Preferred Network Access Commercial |
$3,579.39
|
| Rate for Payer: Quartz Beloit One Network |
$1,906.41
|
| Rate for Payer: Quartz Commercial |
$2,528.92
|
| Rate for Payer: Quartz Medicare Advantage |
$2,334.38
|
| Rate for Payer: The Alliance Commercial |
$1,945.32
|
| Rate for Payer: WEA Trust Commercial |
$2,139.85
|
| Rate for Payer: WPS Commercial |
$2,881.69
|
|
|
SCREW LAG GAMMA 10.5 X 110MM 3060-0110S
|
Facility
|
OP
|
$6,083.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
3983366
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,771.37 |
| Max. Negotiated Rate |
$5,820.21 |
| Rate for Payer: Aetna Commercial |
$5,693.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,440.64
|
| Rate for Payer: Aetna Managed Medicare |
$1,771.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,112.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,163.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,036.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,352.95
|
| Rate for Payer: Cash Price |
$1,824.90
|
| Rate for Payer: Cigna Commercial |
$5,820.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,540.31
|
| Rate for Payer: Health EOS Commercial |
$5,630.42
|
| Rate for Payer: HFN Commercial |
$5,820.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,744.74
|
| Rate for Payer: Multiplan Commercial |
$5,061.06
|
| Rate for Payer: NAPHCARE Commercial |
$3,795.79
|
| Rate for Payer: Preferred Network Access Commercial |
$5,820.21
|
| Rate for Payer: Quartz Beloit One Network |
$3,099.90
|
| Rate for Payer: Quartz Commercial |
$4,112.11
|
| Rate for Payer: Quartz Medicare Advantage |
$3,795.79
|
| Rate for Payer: The Alliance Commercial |
$3,163.16
|
| Rate for Payer: WEA Trust Commercial |
$3,479.48
|
| Rate for Payer: WPS Commercial |
$4,685.73
|
|
|
SCREW LAG GAMMA 10.5 X 110MM 3060-0110S
|
Facility
|
IP
|
$6,083.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
3983366
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,099.90 |
| Max. Negotiated Rate |
$5,820.21 |
| Rate for Payer: Aetna Commercial |
$5,693.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,440.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,352.95
|
| Rate for Payer: Cash Price |
$1,824.90
|
| Rate for Payer: Cigna Commercial |
$5,820.21
|
| Rate for Payer: Health EOS Commercial |
$5,630.42
|
| Rate for Payer: HFN Commercial |
$5,820.21
|
| Rate for Payer: Multiplan Commercial |
$5,061.06
|
| Rate for Payer: Preferred Network Access Commercial |
$5,820.21
|
| Rate for Payer: Quartz Beloit One Network |
$3,099.90
|
| Rate for Payer: Quartz Commercial |
$3,795.79
|
| Rate for Payer: WEA Trust Commercial |
$3,479.48
|
| Rate for Payer: WPS Commercial |
$4,685.73
|
|
|
SCREW LAG GAMMA 10.5 X 115MM 3060-0115S
|
Facility
|
IP
|
$4,429.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4509043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,257.02 |
| Max. Negotiated Rate |
$4,237.67 |
| Rate for Payer: Aetna Commercial |
$4,145.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,961.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,441.26
|
| Rate for Payer: Cash Price |
$1,328.70
|
| Rate for Payer: Cigna Commercial |
$4,237.67
|
| Rate for Payer: Health EOS Commercial |
$4,099.48
|
| Rate for Payer: HFN Commercial |
$4,237.67
|
| Rate for Payer: Multiplan Commercial |
$3,684.93
|
| Rate for Payer: Preferred Network Access Commercial |
$4,237.67
|
| Rate for Payer: Quartz Beloit One Network |
$2,257.02
|
| Rate for Payer: Quartz Commercial |
$2,763.70
|
| Rate for Payer: WEA Trust Commercial |
$2,533.39
|
| Rate for Payer: WPS Commercial |
$3,411.66
|
|
|
SCREW LAG GAMMA 10.5 X 115MM 3060-0115S
|
Facility
|
OP
|
$4,429.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4509043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,289.72 |
| Max. Negotiated Rate |
$4,237.67 |
| Rate for Payer: Aetna Commercial |
$4,145.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,961.30
|
| Rate for Payer: Aetna Managed Medicare |
$1,289.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,994.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,303.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,210.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,441.26
|
| Rate for Payer: Cash Price |
$1,328.70
|
| Rate for Payer: Cigna Commercial |
$4,237.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,577.68
|
| Rate for Payer: Health EOS Commercial |
$4,099.48
|
| Rate for Payer: HFN Commercial |
$4,237.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,454.62
|
| Rate for Payer: Multiplan Commercial |
$3,684.93
|
| Rate for Payer: NAPHCARE Commercial |
$2,763.70
|
| Rate for Payer: Preferred Network Access Commercial |
$4,237.67
|
| Rate for Payer: Quartz Beloit One Network |
$2,257.02
|
| Rate for Payer: Quartz Commercial |
$2,994.00
|
| Rate for Payer: Quartz Medicare Advantage |
$2,763.70
|
| Rate for Payer: The Alliance Commercial |
$2,303.08
|
| Rate for Payer: WEA Trust Commercial |
$2,533.39
|
| Rate for Payer: WPS Commercial |
$3,411.66
|
|
|
SCREW LAG GAMMA 10.5 X 120MM 3060-0120S
|
Facility
|
IP
|
$5,857.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4120814
|
|
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 GAMMA 10.5 X 120MM 3060-0120S
|
Facility
|
OP
|
$5,857.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4120814
|
|
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 GAMMA 10.5 X 95MM 3060-0095S
|
Facility
|
OP
|
$6,083.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
3867336
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,771.37 |
| Max. Negotiated Rate |
$5,820.21 |
| Rate for Payer: Aetna Commercial |
$5,693.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,440.64
|
| Rate for Payer: Aetna Managed Medicare |
$1,771.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,112.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,163.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,036.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,352.95
|
| Rate for Payer: Cash Price |
$1,824.90
|
| Rate for Payer: Cigna Commercial |
$5,820.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,540.31
|
| Rate for Payer: Health EOS Commercial |
$5,630.42
|
| Rate for Payer: HFN Commercial |
$5,820.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,744.74
|
| Rate for Payer: Multiplan Commercial |
$5,061.06
|
| Rate for Payer: NAPHCARE Commercial |
$3,795.79
|
| Rate for Payer: Preferred Network Access Commercial |
$5,820.21
|
| Rate for Payer: Quartz Beloit One Network |
$3,099.90
|
| Rate for Payer: Quartz Commercial |
$4,112.11
|
| Rate for Payer: Quartz Medicare Advantage |
$3,795.79
|
| Rate for Payer: The Alliance Commercial |
$3,163.16
|
| Rate for Payer: WEA Trust Commercial |
$3,479.48
|
| Rate for Payer: WPS Commercial |
$4,685.73
|
|
|
SCREW LAG GAMMA 10.5 X 95MM 3060-0095S
|
Facility
|
IP
|
$6,083.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
3867336
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,099.90 |
| Max. Negotiated Rate |
$5,820.21 |
| Rate for Payer: Aetna Commercial |
$5,693.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,440.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,352.95
|
| Rate for Payer: Cash Price |
$1,824.90
|
| Rate for Payer: Cigna Commercial |
$5,820.21
|
| Rate for Payer: Health EOS Commercial |
$5,630.42
|
| Rate for Payer: HFN Commercial |
$5,820.21
|
| Rate for Payer: Multiplan Commercial |
$5,061.06
|
| Rate for Payer: Preferred Network Access Commercial |
$5,820.21
|
| Rate for Payer: Quartz Beloit One Network |
$3,099.90
|
| Rate for Payer: Quartz Commercial |
$3,795.79
|
| Rate for Payer: WEA Trust Commercial |
$3,479.48
|
| Rate for Payer: WPS Commercial |
$4,685.73
|
|
