|
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 |
$2,869.93 |
| Max. Negotiated Rate |
$5,388.44 |
| Rate for Payer: Aetna Commercial |
$5,271.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,037.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,104.21
|
| Rate for Payer: Cash Price |
$1,757.10
|
| Rate for Payer: Cigna Commercial |
$5,388.44
|
| Rate for Payer: Health EOS Commercial |
$5,212.73
|
| Rate for Payer: HFN Commercial |
$5,388.44
|
| Rate for Payer: Multiplan Commercial |
$4,685.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,514.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,388.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,869.93
|
| Rate for Payer: Quartz Commercial |
$3,514.20
|
| Rate for Payer: WEA Trust Commercial |
$3,221.35
|
| Rate for Payer: WPS Commercial |
$4,338.28
|
|
|
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 |
$1,639.96 |
| Max. Negotiated Rate |
$23,428.00 |
| Rate for Payer: Aetna Commercial |
$5,271.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,037.02
|
| Rate for Payer: Aetna Managed Medicare |
$1,639.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,807.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,928.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,811.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,104.21
|
| Rate for Payer: Cash Price |
$1,757.10
|
| Rate for Payer: Cigna Commercial |
$5,388.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,277.58
|
| Rate for Payer: Health EOS Commercial |
$5,212.73
|
| Rate for Payer: HFN Commercial |
$5,388.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,392.75
|
| Rate for Payer: Multiplan Commercial |
$4,685.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,514.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,388.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,869.93
|
| Rate for Payer: Quartz Commercial |
$3,807.05
|
| Rate for Payer: Quartz Medicare Advantage |
$3,514.20
|
| Rate for Payer: The Alliance Commercial |
$23,428.00
|
| Rate for Payer: WEA Trust Commercial |
$3,221.35
|
| Rate for Payer: WPS Commercial |
$4,338.28
|
|
|
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 |
$2,246.16 |
| Max. Negotiated Rate |
$4,217.28 |
| Rate for Payer: Aetna Commercial |
$4,125.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,942.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,429.52
|
| Rate for Payer: Cash Price |
$1,375.20
|
| Rate for Payer: Cigna Commercial |
$4,217.28
|
| Rate for Payer: Health EOS Commercial |
$4,079.76
|
| Rate for Payer: HFN Commercial |
$4,217.28
|
| Rate for Payer: Multiplan Commercial |
$3,667.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,750.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,217.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,246.16
|
| Rate for Payer: Quartz Commercial |
$2,750.40
|
| Rate for Payer: WEA Trust Commercial |
$2,521.20
|
| Rate for Payer: WPS Commercial |
$3,395.37
|
|
|
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 |
$1,283.52 |
| Max. Negotiated Rate |
$18,336.00 |
| Rate for Payer: Aetna Commercial |
$4,125.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,942.24
|
| Rate for Payer: Aetna Managed Medicare |
$1,283.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,979.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,292.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,200.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,429.52
|
| Rate for Payer: Cash Price |
$1,375.20
|
| Rate for Payer: Cigna Commercial |
$4,217.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,565.21
|
| Rate for Payer: Health EOS Commercial |
$4,079.76
|
| Rate for Payer: HFN Commercial |
$4,217.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,438.00
|
| Rate for Payer: Multiplan Commercial |
$3,667.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,750.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,217.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,246.16
|
| Rate for Payer: Quartz Commercial |
$2,979.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2,750.40
|
| Rate for Payer: The Alliance Commercial |
$18,336.00
|
| Rate for Payer: WEA Trust Commercial |
$2,521.20
|
| Rate for Payer: WPS Commercial |
$3,395.37
|
|
|
SCREW LAG 36MM DEPUY
|
Facility
|
OP
|
$3,008.00
|
|
| Hospital Charge Code |
2965020
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$842.24 |
| Max. Negotiated Rate |
$12,032.00 |
| Rate for Payer: Aetna Commercial |
$2,707.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,586.88
|
| Rate for Payer: Aetna Managed Medicare |
$842.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,955.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,504.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,443.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,594.24
|
| Rate for Payer: Cash Price |
$902.40
|
| Rate for Payer: Cigna Commercial |
$2,767.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,683.28
|
| Rate for Payer: Health EOS Commercial |
$2,677.12
|
| Rate for Payer: HFN Commercial |
$2,767.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,256.00
|
| Rate for Payer: Multiplan Commercial |
$2,406.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,804.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,767.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,473.92
|
| Rate for Payer: Quartz Commercial |
$1,955.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,804.80
|
| Rate for Payer: The Alliance Commercial |
$12,032.00
|
| Rate for Payer: WEA Trust Commercial |
$1,654.40
|
| Rate for Payer: WPS Commercial |
$2,228.03
|
|
|
SCREW LAG 36MM DEPUY
|
Facility
|
IP
|
$3,008.00
|
|
| Hospital Charge Code |
2965020
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,473.92 |
| Max. Negotiated Rate |
$2,767.36 |
| Rate for Payer: Aetna Commercial |
$2,707.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,586.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,594.24
|
| Rate for Payer: Cash Price |
$902.40
|
| Rate for Payer: Cigna Commercial |
$2,767.36
|
| Rate for Payer: Health EOS Commercial |
$2,677.12
|
| Rate for Payer: HFN Commercial |
$2,767.36
|
| Rate for Payer: Multiplan Commercial |
$2,406.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,804.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,767.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,473.92
|
| Rate for Payer: Quartz Commercial |
$1,804.80
|
| Rate for Payer: WEA Trust Commercial |
$1,654.40
|
| Rate for Payer: WPS Commercial |
$2,228.03
|
|
|
SCREW LAG 40MM #14376-40
|
Facility
|
IP
|
$1,913.00
|
|
| Hospital Charge Code |
2965021
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$937.37 |
| Max. Negotiated Rate |
$1,759.96 |
| Rate for Payer: Aetna Commercial |
$1,721.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,645.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,013.89
|
| Rate for Payer: Cash Price |
$573.90
|
| Rate for Payer: Cigna Commercial |
$1,759.96
|
| Rate for Payer: Health EOS Commercial |
$1,702.57
|
| Rate for Payer: HFN Commercial |
$1,759.96
|
| Rate for Payer: Multiplan Commercial |
$1,530.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,147.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,759.96
|
| Rate for Payer: Quartz Beloit One Network |
$937.37
|
| Rate for Payer: Quartz Commercial |
$1,147.80
|
| Rate for Payer: WEA Trust Commercial |
$1,052.15
|
| Rate for Payer: WPS Commercial |
$1,416.96
|
|
|
SCREW LAG 40MM #14376-40
|
Facility
|
OP
|
$1,913.00
|
|
| Hospital Charge Code |
2965021
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$535.64 |
| Max. Negotiated Rate |
$7,652.00 |
| Rate for Payer: Aetna Commercial |
$1,721.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,645.18
|
| Rate for Payer: Aetna Managed Medicare |
$535.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,243.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$956.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$918.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,013.89
|
| Rate for Payer: Cash Price |
$573.90
|
| Rate for Payer: Cigna Commercial |
$1,759.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,070.51
|
| Rate for Payer: Health EOS Commercial |
$1,702.57
|
| Rate for Payer: HFN Commercial |
$1,759.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,434.75
|
| Rate for Payer: Multiplan Commercial |
$1,530.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,147.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,759.96
|
| Rate for Payer: Quartz Beloit One Network |
$937.37
|
| Rate for Payer: Quartz Commercial |
$1,243.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,147.80
|
| Rate for Payer: The Alliance Commercial |
$7,652.00
|
| Rate for Payer: WEA Trust Commercial |
$1,052.15
|
| Rate for Payer: WPS Commercial |
$1,416.96
|
|
|
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 |
$656.88 |
| Max. Negotiated Rate |
$9,384.00 |
| Rate for Payer: Aetna Commercial |
$2,111.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,017.56
|
| Rate for Payer: Aetna Managed Medicare |
$656.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,524.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,173.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,126.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,243.38
|
| Rate for Payer: Cash Price |
$703.80
|
| Rate for Payer: Cigna Commercial |
$2,158.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,312.82
|
| Rate for Payer: Health EOS Commercial |
$2,087.94
|
| Rate for Payer: HFN Commercial |
$2,158.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,759.50
|
| Rate for Payer: Multiplan Commercial |
$1,876.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,407.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,158.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,149.54
|
| Rate for Payer: Quartz Commercial |
$1,524.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,407.60
|
| Rate for Payer: The Alliance Commercial |
$9,384.00
|
| Rate for Payer: WEA Trust Commercial |
$1,290.30
|
| Rate for Payer: WPS Commercial |
$1,737.68
|
|
|
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 |
$1,149.54 |
| Max. Negotiated Rate |
$2,158.32 |
| Rate for Payer: Aetna Commercial |
$2,111.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,017.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,243.38
|
| Rate for Payer: Cash Price |
$703.80
|
| Rate for Payer: Cigna Commercial |
$2,158.32
|
| Rate for Payer: Health EOS Commercial |
$2,087.94
|
| Rate for Payer: HFN Commercial |
$2,158.32
|
| Rate for Payer: Multiplan Commercial |
$1,876.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,407.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,158.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,149.54
|
| Rate for Payer: Quartz Commercial |
$1,407.60
|
| Rate for Payer: WEA Trust Commercial |
$1,290.30
|
| Rate for Payer: WPS Commercial |
$1,737.68
|
|
|
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 |
$1,149.54 |
| Max. Negotiated Rate |
$2,158.32 |
| Rate for Payer: Aetna Commercial |
$2,111.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,017.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,243.38
|
| Rate for Payer: Cash Price |
$703.80
|
| Rate for Payer: Cigna Commercial |
$2,158.32
|
| Rate for Payer: Health EOS Commercial |
$2,087.94
|
| Rate for Payer: HFN Commercial |
$2,158.32
|
| Rate for Payer: Multiplan Commercial |
$1,876.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,407.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,158.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,149.54
|
| Rate for Payer: Quartz Commercial |
$1,407.60
|
| Rate for Payer: WEA Trust Commercial |
$1,290.30
|
| Rate for Payer: WPS Commercial |
$1,737.68
|
|
|
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 |
$656.88 |
| Max. Negotiated Rate |
$9,384.00 |
| Rate for Payer: Aetna Commercial |
$2,111.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,017.56
|
| Rate for Payer: Aetna Managed Medicare |
$656.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,524.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,173.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,126.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,243.38
|
| Rate for Payer: Cash Price |
$703.80
|
| Rate for Payer: Cigna Commercial |
$2,158.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,312.82
|
| Rate for Payer: Health EOS Commercial |
$2,087.94
|
| Rate for Payer: HFN Commercial |
$2,158.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,759.50
|
| Rate for Payer: Multiplan Commercial |
$1,876.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,407.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,158.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,149.54
|
| Rate for Payer: Quartz Commercial |
$1,524.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,407.60
|
| Rate for Payer: The Alliance Commercial |
$9,384.00
|
| Rate for Payer: WEA Trust Commercial |
$1,290.30
|
| Rate for Payer: WPS Commercial |
$1,737.68
|
|
|
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 |
$1,149.54 |
| Max. Negotiated Rate |
$2,158.32 |
| Rate for Payer: Aetna Commercial |
$2,111.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,017.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,243.38
|
| Rate for Payer: Cash Price |
$703.80
|
| Rate for Payer: Cigna Commercial |
$2,158.32
|
| Rate for Payer: Health EOS Commercial |
$2,087.94
|
| Rate for Payer: HFN Commercial |
$2,158.32
|
| Rate for Payer: Multiplan Commercial |
$1,876.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,407.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,158.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,149.54
|
| Rate for Payer: Quartz Commercial |
$1,407.60
|
| Rate for Payer: WEA Trust Commercial |
$1,290.30
|
| Rate for Payer: WPS Commercial |
$1,737.68
|
|
|
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 |
$656.88 |
| Max. Negotiated Rate |
$9,384.00 |
| Rate for Payer: Aetna Commercial |
$2,111.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,017.56
|
| Rate for Payer: Aetna Managed Medicare |
$656.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,524.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,173.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,126.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,243.38
|
| Rate for Payer: Cash Price |
$703.80
|
| Rate for Payer: Cigna Commercial |
$2,158.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,312.82
|
| Rate for Payer: Health EOS Commercial |
$2,087.94
|
| Rate for Payer: HFN Commercial |
$2,158.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,759.50
|
| Rate for Payer: Multiplan Commercial |
$1,876.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,407.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,158.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,149.54
|
| Rate for Payer: Quartz Commercial |
$1,524.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,407.60
|
| Rate for Payer: The Alliance Commercial |
$9,384.00
|
| Rate for Payer: WEA Trust Commercial |
$1,290.30
|
| Rate for Payer: WPS Commercial |
$1,737.68
|
|
|
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 |
$1,149.54 |
| Max. Negotiated Rate |
$2,158.32 |
| Rate for Payer: Aetna Commercial |
$2,111.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,017.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,243.38
|
| Rate for Payer: Cash Price |
$703.80
|
| Rate for Payer: Cigna Commercial |
$2,158.32
|
| Rate for Payer: Health EOS Commercial |
$2,087.94
|
| Rate for Payer: HFN Commercial |
$2,158.32
|
| Rate for Payer: Multiplan Commercial |
$1,876.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,407.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,158.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,149.54
|
| Rate for Payer: Quartz Commercial |
$1,407.60
|
| Rate for Payer: WEA Trust Commercial |
$1,290.30
|
| Rate for Payer: WPS Commercial |
$1,737.68
|
|
|
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 |
$656.88 |
| Max. Negotiated Rate |
$9,384.00 |
| Rate for Payer: Aetna Commercial |
$2,111.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,017.56
|
| Rate for Payer: Aetna Managed Medicare |
$656.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,524.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,173.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,126.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,243.38
|
| Rate for Payer: Cash Price |
$703.80
|
| Rate for Payer: Cigna Commercial |
$2,158.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,312.82
|
| Rate for Payer: Health EOS Commercial |
$2,087.94
|
| Rate for Payer: HFN Commercial |
$2,158.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,759.50
|
| Rate for Payer: Multiplan Commercial |
$1,876.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,407.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,158.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,149.54
|
| Rate for Payer: Quartz Commercial |
$1,524.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,407.60
|
| Rate for Payer: The Alliance Commercial |
$9,384.00
|
| Rate for Payer: WEA Trust Commercial |
$1,290.30
|
| Rate for Payer: WPS Commercial |
$1,737.68
|
|
|
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 |
$656.88 |
| Max. Negotiated Rate |
$9,384.00 |
| Rate for Payer: Aetna Commercial |
$2,111.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,017.56
|
| Rate for Payer: Aetna Managed Medicare |
$656.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,524.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,173.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,126.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,243.38
|
| Rate for Payer: Cash Price |
$703.80
|
| Rate for Payer: Cigna Commercial |
$2,158.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,312.82
|
| Rate for Payer: Health EOS Commercial |
$2,087.94
|
| Rate for Payer: HFN Commercial |
$2,158.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,759.50
|
| Rate for Payer: Multiplan Commercial |
$1,876.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,407.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,158.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,149.54
|
| Rate for Payer: Quartz Commercial |
$1,524.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,407.60
|
| Rate for Payer: The Alliance Commercial |
$9,384.00
|
| Rate for Payer: WEA Trust Commercial |
$1,290.30
|
| Rate for Payer: WPS Commercial |
$1,737.68
|
|
|
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 |
$1,149.54 |
| Max. Negotiated Rate |
$2,158.32 |
| Rate for Payer: Aetna Commercial |
$2,111.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,017.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,243.38
|
| Rate for Payer: Cash Price |
$703.80
|
| Rate for Payer: Cigna Commercial |
$2,158.32
|
| Rate for Payer: Health EOS Commercial |
$2,087.94
|
| Rate for Payer: HFN Commercial |
$2,158.32
|
| Rate for Payer: Multiplan Commercial |
$1,876.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,407.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,158.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,149.54
|
| Rate for Payer: Quartz Commercial |
$1,407.60
|
| Rate for Payer: WEA Trust Commercial |
$1,290.30
|
| Rate for Payer: WPS Commercial |
$1,737.68
|
|
|
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 |
$656.88 |
| Max. Negotiated Rate |
$9,384.00 |
| Rate for Payer: Aetna Commercial |
$2,111.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,017.56
|
| Rate for Payer: Aetna Managed Medicare |
$656.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,524.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,173.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,126.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,243.38
|
| Rate for Payer: Cash Price |
$703.80
|
| Rate for Payer: Cigna Commercial |
$2,158.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,312.82
|
| Rate for Payer: Health EOS Commercial |
$2,087.94
|
| Rate for Payer: HFN Commercial |
$2,158.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,759.50
|
| Rate for Payer: Multiplan Commercial |
$1,876.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,407.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,158.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,149.54
|
| Rate for Payer: Quartz Commercial |
$1,524.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,407.60
|
| Rate for Payer: The Alliance Commercial |
$9,384.00
|
| Rate for Payer: WEA Trust Commercial |
$1,290.30
|
| Rate for Payer: WPS Commercial |
$1,737.68
|
|
|
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 |
$1,149.54 |
| Max. Negotiated Rate |
$2,158.32 |
| Rate for Payer: Aetna Commercial |
$2,111.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,017.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,243.38
|
| Rate for Payer: Cash Price |
$703.80
|
| Rate for Payer: Cigna Commercial |
$2,158.32
|
| Rate for Payer: Health EOS Commercial |
$2,087.94
|
| Rate for Payer: HFN Commercial |
$2,158.32
|
| Rate for Payer: Multiplan Commercial |
$1,876.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,407.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,158.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,149.54
|
| Rate for Payer: Quartz Commercial |
$1,407.60
|
| Rate for Payer: WEA Trust Commercial |
$1,290.30
|
| Rate for Payer: WPS Commercial |
$1,737.68
|
|
|
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 |
$656.88 |
| Max. Negotiated Rate |
$9,384.00 |
| Rate for Payer: Aetna Commercial |
$2,111.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,017.56
|
| Rate for Payer: Aetna Managed Medicare |
$656.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,524.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,173.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,126.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,243.38
|
| Rate for Payer: Cash Price |
$703.80
|
| Rate for Payer: Cigna Commercial |
$2,158.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,312.82
|
| Rate for Payer: Health EOS Commercial |
$2,087.94
|
| Rate for Payer: HFN Commercial |
$2,158.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,759.50
|
| Rate for Payer: Multiplan Commercial |
$1,876.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,407.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,158.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,149.54
|
| Rate for Payer: Quartz Commercial |
$1,524.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,407.60
|
| Rate for Payer: The Alliance Commercial |
$9,384.00
|
| Rate for Payer: WEA Trust Commercial |
$1,290.30
|
| Rate for Payer: WPS Commercial |
$1,737.68
|
|
|
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 |
$1,149.54 |
| Max. Negotiated Rate |
$2,158.32 |
| Rate for Payer: Aetna Commercial |
$2,111.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,017.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,243.38
|
| Rate for Payer: Cash Price |
$703.80
|
| Rate for Payer: Cigna Commercial |
$2,158.32
|
| Rate for Payer: Health EOS Commercial |
$2,087.94
|
| Rate for Payer: HFN Commercial |
$2,158.32
|
| Rate for Payer: Multiplan Commercial |
$1,876.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,407.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,158.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,149.54
|
| Rate for Payer: Quartz Commercial |
$1,407.60
|
| Rate for Payer: WEA Trust Commercial |
$1,290.30
|
| Rate for Payer: WPS Commercial |
$1,737.68
|
|
|
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 |
$1,149.54 |
| Max. Negotiated Rate |
$2,158.32 |
| Rate for Payer: Aetna Commercial |
$2,111.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,017.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,243.38
|
| Rate for Payer: Cash Price |
$703.80
|
| Rate for Payer: Cigna Commercial |
$2,158.32
|
| Rate for Payer: Health EOS Commercial |
$2,087.94
|
| Rate for Payer: HFN Commercial |
$2,158.32
|
| Rate for Payer: Multiplan Commercial |
$1,876.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,407.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,158.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,149.54
|
| Rate for Payer: Quartz Commercial |
$1,407.60
|
| Rate for Payer: WEA Trust Commercial |
$1,290.30
|
| Rate for Payer: WPS Commercial |
$1,737.68
|
|
|
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 |
$656.88 |
| Max. Negotiated Rate |
$9,384.00 |
| Rate for Payer: Aetna Commercial |
$2,111.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,017.56
|
| Rate for Payer: Aetna Managed Medicare |
$656.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,524.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,173.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,126.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,243.38
|
| Rate for Payer: Cash Price |
$703.80
|
| Rate for Payer: Cigna Commercial |
$2,158.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,312.82
|
| Rate for Payer: Health EOS Commercial |
$2,087.94
|
| Rate for Payer: HFN Commercial |
$2,158.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,759.50
|
| Rate for Payer: Multiplan Commercial |
$1,876.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,407.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,158.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,149.54
|
| Rate for Payer: Quartz Commercial |
$1,524.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,407.60
|
| Rate for Payer: The Alliance Commercial |
$9,384.00
|
| Rate for Payer: WEA Trust Commercial |
$1,290.30
|
| Rate for Payer: WPS Commercial |
$1,737.68
|
|
|
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 |
$1,149.54 |
| Max. Negotiated Rate |
$2,158.32 |
| Rate for Payer: Aetna Commercial |
$2,111.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,017.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,243.38
|
| Rate for Payer: Cash Price |
$703.80
|
| Rate for Payer: Cigna Commercial |
$2,158.32
|
| Rate for Payer: Health EOS Commercial |
$2,087.94
|
| Rate for Payer: HFN Commercial |
$2,158.32
|
| Rate for Payer: Multiplan Commercial |
$1,876.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,407.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,158.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,149.54
|
| Rate for Payer: Quartz Commercial |
$1,407.60
|
| Rate for Payer: WEA Trust Commercial |
$1,290.30
|
| Rate for Payer: WPS Commercial |
$1,737.68
|
|
