|
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 |
$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 85MM 121186
|
Facility
|
OP
|
$2,346.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966051
|
|
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 85MM 121186
|
Facility
|
IP
|
$2,346.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966051
|
|
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 90MM 121187
|
Facility
|
OP
|
$2,346.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966052
|
|
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 90MM 121187
|
Facility
|
IP
|
$2,346.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966052
|
|
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 95MM 121188
|
Facility
|
OP
|
$2,346.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966053
|
|
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 95MM 121188
|
Facility
|
IP
|
$2,346.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966053
|
|
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 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 |
$2,980.67 |
| Max. Negotiated Rate |
$5,596.36 |
| Rate for Payer: Aetna Commercial |
$5,474.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,231.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,223.99
|
| Rate for Payer: Cash Price |
$1,824.90
|
| Rate for Payer: Cigna Commercial |
$5,596.36
|
| Rate for Payer: Health EOS Commercial |
$5,413.87
|
| Rate for Payer: HFN Commercial |
$5,596.36
|
| Rate for Payer: Multiplan Commercial |
$4,866.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,649.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,596.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,980.67
|
| Rate for Payer: Quartz Commercial |
$3,649.80
|
| Rate for Payer: WEA Trust Commercial |
$3,345.65
|
| Rate for Payer: WPS Commercial |
$4,505.68
|
|
|
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 |
$1,703.24 |
| Max. Negotiated Rate |
$24,332.00 |
| Rate for Payer: Aetna Commercial |
$5,474.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,231.38
|
| Rate for Payer: Aetna Managed Medicare |
$1,703.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,953.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,041.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,919.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,223.99
|
| Rate for Payer: Cash Price |
$1,824.90
|
| Rate for Payer: Cigna Commercial |
$5,596.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,404.05
|
| Rate for Payer: Health EOS Commercial |
$5,413.87
|
| Rate for Payer: HFN Commercial |
$5,596.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,562.25
|
| Rate for Payer: Multiplan Commercial |
$4,866.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,649.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,596.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,980.67
|
| Rate for Payer: Quartz Commercial |
$3,953.95
|
| Rate for Payer: Quartz Medicare Advantage |
$3,649.80
|
| Rate for Payer: The Alliance Commercial |
$24,332.00
|
| Rate for Payer: WEA Trust Commercial |
$3,345.65
|
| Rate for Payer: WPS Commercial |
$4,505.68
|
|
|
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 |
$1,833.09 |
| Max. Negotiated Rate |
$3,441.72 |
| Rate for Payer: Aetna Commercial |
$3,366.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,217.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,982.73
|
| Rate for Payer: Cash Price |
$1,122.30
|
| Rate for Payer: Cigna Commercial |
$3,441.72
|
| Rate for Payer: Health EOS Commercial |
$3,329.49
|
| Rate for Payer: HFN Commercial |
$3,441.72
|
| Rate for Payer: Multiplan Commercial |
$2,992.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,244.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,441.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,833.09
|
| Rate for Payer: Quartz Commercial |
$2,244.60
|
| Rate for Payer: WEA Trust Commercial |
$2,057.55
|
| Rate for Payer: WPS Commercial |
$2,770.96
|
|
|
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 |
$1,047.48 |
| Max. Negotiated Rate |
$14,964.00 |
| Rate for Payer: Aetna Commercial |
$3,366.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,217.26
|
| Rate for Payer: Aetna Managed Medicare |
$1,047.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,431.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,870.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,795.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,982.73
|
| Rate for Payer: Cash Price |
$1,122.30
|
| Rate for Payer: Cigna Commercial |
$3,441.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,093.46
|
| Rate for Payer: Health EOS Commercial |
$3,329.49
|
| Rate for Payer: HFN Commercial |
$3,441.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,805.75
|
| Rate for Payer: Multiplan Commercial |
$2,992.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,244.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,441.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,833.09
|
| Rate for Payer: Quartz Commercial |
$2,431.65
|
| Rate for Payer: Quartz Medicare Advantage |
$2,244.60
|
| Rate for Payer: The Alliance Commercial |
$14,964.00
|
| Rate for Payer: WEA Trust Commercial |
$2,057.55
|
| Rate for Payer: WPS Commercial |
$2,770.96
|
|
|
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 |
$2,980.67 |
| Max. Negotiated Rate |
$5,596.36 |
| Rate for Payer: Aetna Commercial |
$5,474.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,231.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,223.99
|
| Rate for Payer: Cash Price |
$1,824.90
|
| Rate for Payer: Cigna Commercial |
$5,596.36
|
| Rate for Payer: Health EOS Commercial |
$5,413.87
|
| Rate for Payer: HFN Commercial |
$5,596.36
|
| Rate for Payer: Multiplan Commercial |
$4,866.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,649.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,596.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,980.67
|
| Rate for Payer: Quartz Commercial |
$3,649.80
|
| Rate for Payer: WEA Trust Commercial |
$3,345.65
|
| Rate for Payer: WPS Commercial |
$4,505.68
|
|
|
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 |
$1,703.24 |
| Max. Negotiated Rate |
$24,332.00 |
| Rate for Payer: Aetna Commercial |
$5,474.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,231.38
|
| Rate for Payer: Aetna Managed Medicare |
$1,703.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,953.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,041.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,919.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,223.99
|
| Rate for Payer: Cash Price |
$1,824.90
|
| Rate for Payer: Cigna Commercial |
$5,596.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,404.05
|
| Rate for Payer: Health EOS Commercial |
$5,413.87
|
| Rate for Payer: HFN Commercial |
$5,596.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,562.25
|
| Rate for Payer: Multiplan Commercial |
$4,866.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,649.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,596.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,980.67
|
| Rate for Payer: Quartz Commercial |
$3,953.95
|
| Rate for Payer: Quartz Medicare Advantage |
$3,649.80
|
| Rate for Payer: The Alliance Commercial |
$24,332.00
|
| Rate for Payer: WEA Trust Commercial |
$3,345.65
|
| Rate for Payer: WPS Commercial |
$4,505.68
|
|
|
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 |
$2,170.21 |
| Max. Negotiated Rate |
$4,074.68 |
| Rate for Payer: Aetna Commercial |
$3,986.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,808.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,347.37
|
| Rate for Payer: Cash Price |
$1,328.70
|
| Rate for Payer: Cigna Commercial |
$4,074.68
|
| Rate for Payer: Health EOS Commercial |
$3,941.81
|
| Rate for Payer: HFN Commercial |
$4,074.68
|
| Rate for Payer: Multiplan Commercial |
$3,543.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,657.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,074.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,170.21
|
| Rate for Payer: Quartz Commercial |
$2,657.40
|
| Rate for Payer: WEA Trust Commercial |
$2,435.95
|
| Rate for Payer: WPS Commercial |
$3,280.56
|
|
|
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 |
$1,240.12 |
| Max. Negotiated Rate |
$17,716.00 |
| Rate for Payer: Aetna Commercial |
$3,986.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,808.94
|
| Rate for Payer: Aetna Managed Medicare |
$1,240.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,878.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,214.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,125.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,347.37
|
| Rate for Payer: Cash Price |
$1,328.70
|
| Rate for Payer: Cigna Commercial |
$4,074.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,478.47
|
| Rate for Payer: Health EOS Commercial |
$3,941.81
|
| Rate for Payer: HFN Commercial |
$4,074.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,321.75
|
| Rate for Payer: Multiplan Commercial |
$3,543.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,657.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,074.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,170.21
|
| Rate for Payer: Quartz Commercial |
$2,878.85
|
| Rate for Payer: Quartz Medicare Advantage |
$2,657.40
|
| Rate for Payer: The Alliance Commercial |
$17,716.00
|
| Rate for Payer: WEA Trust Commercial |
$2,435.95
|
| Rate for Payer: WPS Commercial |
$3,280.56
|
|
|
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 |
$1,639.96 |
| 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 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 |
$2,869.93 |
| 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 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 |
$2,980.67 |
| Max. Negotiated Rate |
$5,596.36 |
| Rate for Payer: Aetna Commercial |
$5,474.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,231.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,223.99
|
| Rate for Payer: Cash Price |
$1,824.90
|
| Rate for Payer: Cigna Commercial |
$5,596.36
|
| Rate for Payer: Health EOS Commercial |
$5,413.87
|
| Rate for Payer: HFN Commercial |
$5,596.36
|
| Rate for Payer: Multiplan Commercial |
$4,866.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,649.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,596.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,980.67
|
| Rate for Payer: Quartz Commercial |
$3,649.80
|
| Rate for Payer: WEA Trust Commercial |
$3,345.65
|
| Rate for Payer: WPS Commercial |
$4,505.68
|
|
|
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 |
$1,703.24 |
| Max. Negotiated Rate |
$24,332.00 |
| Rate for Payer: Aetna Commercial |
$5,474.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,231.38
|
| Rate for Payer: Aetna Managed Medicare |
$1,703.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,953.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,041.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,919.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,223.99
|
| Rate for Payer: Cash Price |
$1,824.90
|
| Rate for Payer: Cigna Commercial |
$5,596.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,404.05
|
| Rate for Payer: Health EOS Commercial |
$5,413.87
|
| Rate for Payer: HFN Commercial |
$5,596.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,562.25
|
| Rate for Payer: Multiplan Commercial |
$4,866.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,649.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,596.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,980.67
|
| Rate for Payer: Quartz Commercial |
$3,953.95
|
| Rate for Payer: Quartz Medicare Advantage |
$3,649.80
|
| Rate for Payer: The Alliance Commercial |
$24,332.00
|
| Rate for Payer: WEA Trust Commercial |
$3,345.65
|
| Rate for Payer: WPS Commercial |
$4,505.68
|
|
|
SCREW LAG GAMMA4 10.5 X 85MM 8160-0085S
|
Facility
|
OP
|
$3,862.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6181747
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,081.36 |
| Max. Negotiated Rate |
$15,448.00 |
| Rate for Payer: Aetna Commercial |
$3,475.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,321.32
|
| Rate for Payer: Aetna Managed Medicare |
$1,081.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,510.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,931.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,853.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,046.86
|
| Rate for Payer: Cash Price |
$1,158.60
|
| Rate for Payer: Cigna Commercial |
$3,553.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,161.18
|
| Rate for Payer: Health EOS Commercial |
$3,437.18
|
| Rate for Payer: HFN Commercial |
$3,553.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,896.50
|
| Rate for Payer: Multiplan Commercial |
$3,089.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,317.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,553.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,892.38
|
| Rate for Payer: Quartz Commercial |
$2,510.30
|
| Rate for Payer: Quartz Medicare Advantage |
$2,317.20
|
| Rate for Payer: The Alliance Commercial |
$15,448.00
|
| Rate for Payer: WEA Trust Commercial |
$2,124.10
|
| Rate for Payer: WPS Commercial |
$2,860.58
|
|
|
SCREW LAG GAMMA4 10.5 X 85MM 8160-0085S
|
Facility
|
IP
|
$3,862.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6181747
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,892.38 |
| Max. Negotiated Rate |
$3,553.04 |
| Rate for Payer: Aetna Commercial |
$3,475.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,321.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,046.86
|
| Rate for Payer: Cash Price |
$1,158.60
|
| Rate for Payer: Cigna Commercial |
$3,553.04
|
| Rate for Payer: Health EOS Commercial |
$3,437.18
|
| Rate for Payer: HFN Commercial |
$3,553.04
|
| Rate for Payer: Multiplan Commercial |
$3,089.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,317.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,553.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,892.38
|
| Rate for Payer: Quartz Commercial |
$2,317.20
|
| Rate for Payer: WEA Trust Commercial |
$2,124.10
|
| Rate for Payer: WPS Commercial |
$2,860.58
|
|
|
SCREW LAG TELESCOPING 10.5MM X 100MM 1099-100
|
Facility
|
OP
|
$6,666.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6232140
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,866.48 |
| Max. Negotiated Rate |
$26,664.00 |
| Rate for Payer: Aetna Commercial |
$5,999.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,732.76
|
| Rate for Payer: Aetna Managed Medicare |
$1,866.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,332.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,333.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,199.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,532.98
|
| Rate for Payer: Cash Price |
$1,999.80
|
| Rate for Payer: Cigna Commercial |
$6,132.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,730.29
|
| Rate for Payer: Health EOS Commercial |
$5,932.74
|
| Rate for Payer: HFN Commercial |
$6,132.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,999.50
|
| Rate for Payer: Multiplan Commercial |
$5,332.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,999.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,132.72
|
| Rate for Payer: Quartz Beloit One Network |
$3,266.34
|
| Rate for Payer: Quartz Commercial |
$4,332.90
|
| Rate for Payer: Quartz Medicare Advantage |
$3,999.60
|
| Rate for Payer: The Alliance Commercial |
$26,664.00
|
| Rate for Payer: WEA Trust Commercial |
$3,666.30
|
| Rate for Payer: WPS Commercial |
$4,937.51
|
|
|
SCREW LAG TELESCOPING 10.5MM X 100MM 1099-100
|
Facility
|
IP
|
$6,666.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6232140
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,266.34 |
| Max. Negotiated Rate |
$6,132.72 |
| Rate for Payer: Aetna Commercial |
$5,999.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,732.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,532.98
|
| Rate for Payer: Cash Price |
$1,999.80
|
| Rate for Payer: Cigna Commercial |
$6,132.72
|
| Rate for Payer: Health EOS Commercial |
$5,932.74
|
| Rate for Payer: HFN Commercial |
$6,132.72
|
| Rate for Payer: Multiplan Commercial |
$5,332.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,999.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,132.72
|
| Rate for Payer: Quartz Beloit One Network |
$3,266.34
|
| Rate for Payer: Quartz Commercial |
$3,999.60
|
| Rate for Payer: WEA Trust Commercial |
$3,666.30
|
| Rate for Payer: WPS Commercial |
$4,937.51
|
|
|
SCREW LAG TELESCOPING 10.5MM X 95MM 1099-095
|
Facility
|
IP
|
$6,665.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6234133
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,265.85 |
| Max. Negotiated Rate |
$6,131.80 |
| Rate for Payer: Aetna Commercial |
$5,998.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,731.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,532.45
|
| Rate for Payer: Cash Price |
$1,999.50
|
| Rate for Payer: Cigna Commercial |
$6,131.80
|
| Rate for Payer: Health EOS Commercial |
$5,931.85
|
| Rate for Payer: HFN Commercial |
$6,131.80
|
| Rate for Payer: Multiplan Commercial |
$5,332.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,999.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,131.80
|
| Rate for Payer: Quartz Beloit One Network |
$3,265.85
|
| Rate for Payer: Quartz Commercial |
$3,999.00
|
| Rate for Payer: WEA Trust Commercial |
$3,665.75
|
| Rate for Payer: WPS Commercial |
$4,936.77
|
|
|
SCREW LAG TELESCOPING 10.5MM X 95MM 1099-095
|
Facility
|
OP
|
$6,665.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6234133
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,866.20 |
| Max. Negotiated Rate |
$26,660.00 |
| Rate for Payer: Aetna Commercial |
$5,998.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,731.90
|
| Rate for Payer: Aetna Managed Medicare |
$1,866.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,332.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,332.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,199.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,532.45
|
| Rate for Payer: Cash Price |
$1,999.50
|
| Rate for Payer: Cigna Commercial |
$6,131.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,729.73
|
| Rate for Payer: Health EOS Commercial |
$5,931.85
|
| Rate for Payer: HFN Commercial |
$6,131.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,998.75
|
| Rate for Payer: Multiplan Commercial |
$5,332.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,999.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,131.80
|
| Rate for Payer: Quartz Beloit One Network |
$3,265.85
|
| Rate for Payer: Quartz Commercial |
$4,332.25
|
| Rate for Payer: Quartz Medicare Advantage |
$3,999.00
|
| Rate for Payer: The Alliance Commercial |
$26,660.00
|
| Rate for Payer: WEA Trust Commercial |
$3,665.75
|
| Rate for Payer: WPS Commercial |
$4,936.77
|
|
