|
LAG SCREW 10.5X75MM TI 3060-0075S
|
Facility
|
IP
|
$4,429.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4518614
|
|
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
|
|
|
LAG SCREW 10.5X75MM TI 3060-0075S
|
Facility
|
OP
|
$4,429.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4518614
|
|
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
|
|
|
LAG SCREW 110MM OMEGA 3362-5-110
|
Facility
|
IP
|
$2,536.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5729872
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,242.64 |
| Max. Negotiated Rate |
$2,333.12 |
| Rate for Payer: Aetna Commercial |
$2,282.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,180.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,344.08
|
| Rate for Payer: Cash Price |
$760.80
|
| Rate for Payer: Cigna Commercial |
$2,333.12
|
| Rate for Payer: Health EOS Commercial |
$2,257.04
|
| Rate for Payer: HFN Commercial |
$2,333.12
|
| Rate for Payer: Multiplan Commercial |
$2,028.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,521.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,333.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,242.64
|
| Rate for Payer: Quartz Commercial |
$1,521.60
|
| Rate for Payer: WEA Trust Commercial |
$1,394.80
|
| Rate for Payer: WPS Commercial |
$1,878.42
|
|
|
LAG SCREW 110MM OMEGA 3362-5-110
|
Facility
|
OP
|
$2,536.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5729872
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$710.08 |
| Max. Negotiated Rate |
$10,144.00 |
| Rate for Payer: Aetna Commercial |
$2,282.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,180.96
|
| Rate for Payer: Aetna Managed Medicare |
$710.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,648.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,268.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,217.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,344.08
|
| Rate for Payer: Cash Price |
$760.80
|
| Rate for Payer: Cigna Commercial |
$2,333.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,419.15
|
| Rate for Payer: Health EOS Commercial |
$2,257.04
|
| Rate for Payer: HFN Commercial |
$2,333.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,902.00
|
| Rate for Payer: Multiplan Commercial |
$2,028.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,521.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,333.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,242.64
|
| Rate for Payer: Quartz Commercial |
$1,648.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,521.60
|
| Rate for Payer: The Alliance Commercial |
$10,144.00
|
| Rate for Payer: WEA Trust Commercial |
$1,394.80
|
| Rate for Payer: WPS Commercial |
$1,878.42
|
|
|
LAG SCREW 120MM TFNA FENESTRATED 04.038.220S
|
Facility
|
IP
|
$5,261.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5517290
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,577.89 |
| Max. Negotiated Rate |
$4,840.12 |
| Rate for Payer: Aetna Commercial |
$4,734.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,524.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,788.33
|
| Rate for Payer: Cash Price |
$1,578.30
|
| Rate for Payer: Cigna Commercial |
$4,840.12
|
| Rate for Payer: Health EOS Commercial |
$4,682.29
|
| Rate for Payer: HFN Commercial |
$4,840.12
|
| Rate for Payer: Multiplan Commercial |
$4,208.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,156.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,840.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,577.89
|
| Rate for Payer: Quartz Commercial |
$3,156.60
|
| Rate for Payer: WEA Trust Commercial |
$2,893.55
|
| Rate for Payer: WPS Commercial |
$3,896.82
|
|
|
LAG SCREW 120MM TFNA FENESTRATED 04.038.220S
|
Facility
|
OP
|
$5,261.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5517290
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,473.08 |
| Max. Negotiated Rate |
$21,044.00 |
| Rate for Payer: Aetna Commercial |
$4,734.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,524.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,473.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,419.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,630.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,525.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,788.33
|
| Rate for Payer: Cash Price |
$1,578.30
|
| Rate for Payer: Cigna Commercial |
$4,840.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,944.06
|
| Rate for Payer: Health EOS Commercial |
$4,682.29
|
| Rate for Payer: HFN Commercial |
$4,840.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,945.75
|
| Rate for Payer: Multiplan Commercial |
$4,208.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,156.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,840.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,577.89
|
| Rate for Payer: Quartz Commercial |
$3,419.65
|
| Rate for Payer: Quartz Medicare Advantage |
$3,156.60
|
| Rate for Payer: The Alliance Commercial |
$21,044.00
|
| Rate for Payer: WEA Trust Commercial |
$2,893.55
|
| Rate for Payer: WPS Commercial |
$3,896.82
|
|
|
LAG SCREW 3.5 X 22 ORTHOLOC 3Di CROSSCHECK 5820X3522
|
Facility
|
OP
|
$3,235.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6174332
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$905.80 |
| Max. Negotiated Rate |
$12,940.00 |
| Rate for Payer: Aetna Commercial |
$2,911.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,782.10
|
| Rate for Payer: Aetna Managed Medicare |
$905.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,102.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,617.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,552.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,714.55
|
| Rate for Payer: Cash Price |
$970.50
|
| Rate for Payer: Cigna Commercial |
$2,976.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,810.31
|
| Rate for Payer: Health EOS Commercial |
$2,879.15
|
| Rate for Payer: HFN Commercial |
$2,976.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,426.25
|
| Rate for Payer: Multiplan Commercial |
$2,588.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,941.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,976.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,585.15
|
| Rate for Payer: Quartz Commercial |
$2,102.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,941.00
|
| Rate for Payer: The Alliance Commercial |
$12,940.00
|
| Rate for Payer: WEA Trust Commercial |
$1,779.25
|
| Rate for Payer: WPS Commercial |
$2,396.16
|
|
|
LAG SCREW 3.5 X 22 ORTHOLOC 3Di CROSSCHECK 5820X3522
|
Facility
|
IP
|
$3,235.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6174332
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,585.15 |
| Max. Negotiated Rate |
$2,976.20 |
| Rate for Payer: Aetna Commercial |
$2,911.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,782.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,714.55
|
| Rate for Payer: Cash Price |
$970.50
|
| Rate for Payer: Cigna Commercial |
$2,976.20
|
| Rate for Payer: Health EOS Commercial |
$2,879.15
|
| Rate for Payer: HFN Commercial |
$2,976.20
|
| Rate for Payer: Multiplan Commercial |
$2,588.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,941.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,976.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,585.15
|
| Rate for Payer: Quartz Commercial |
$1,941.00
|
| Rate for Payer: WEA Trust Commercial |
$1,779.25
|
| Rate for Payer: WPS Commercial |
$2,396.16
|
|
|
LAG SCREW 3.5 X 24 ORTHOLOC 3Di CROSSCHECK 5820X3524
|
Facility
|
IP
|
$3,111.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6182386
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,524.39 |
| Max. Negotiated Rate |
$2,862.12 |
| Rate for Payer: Aetna Commercial |
$2,799.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,675.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,648.83
|
| Rate for Payer: Cash Price |
$933.30
|
| Rate for Payer: Cigna Commercial |
$2,862.12
|
| Rate for Payer: Health EOS Commercial |
$2,768.79
|
| Rate for Payer: HFN Commercial |
$2,862.12
|
| Rate for Payer: Multiplan Commercial |
$2,488.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,866.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,862.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,524.39
|
| Rate for Payer: Quartz Commercial |
$1,866.60
|
| Rate for Payer: WEA Trust Commercial |
$1,711.05
|
| Rate for Payer: WPS Commercial |
$2,304.32
|
|
|
LAG SCREW 3.5 X 24 ORTHOLOC 3Di CROSSCHECK 5820X3524
|
Facility
|
OP
|
$3,111.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6182386
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$871.08 |
| Max. Negotiated Rate |
$12,444.00 |
| Rate for Payer: Aetna Commercial |
$2,799.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,675.46
|
| Rate for Payer: Aetna Managed Medicare |
$871.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,022.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,555.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,493.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,648.83
|
| Rate for Payer: Cash Price |
$933.30
|
| Rate for Payer: Cigna Commercial |
$2,862.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,740.92
|
| Rate for Payer: Health EOS Commercial |
$2,768.79
|
| Rate for Payer: HFN Commercial |
$2,862.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,333.25
|
| Rate for Payer: Multiplan Commercial |
$2,488.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,866.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,862.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,524.39
|
| Rate for Payer: Quartz Commercial |
$2,022.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,866.60
|
| Rate for Payer: The Alliance Commercial |
$12,444.00
|
| Rate for Payer: WEA Trust Commercial |
$1,711.05
|
| Rate for Payer: WPS Commercial |
$2,304.32
|
|
|
LAG SCREW 3.5 X 26 ORTHOLOC 3Di CROSSCHECK 5820X3526
|
Facility
|
OP
|
$3,820.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5895659
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,069.60 |
| Max. Negotiated Rate |
$15,280.00 |
| Rate for Payer: Aetna Commercial |
$3,438.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,285.20
|
| Rate for Payer: Aetna Managed Medicare |
$1,069.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,483.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,910.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,833.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,024.60
|
| Rate for Payer: Cash Price |
$1,146.00
|
| Rate for Payer: Cigna Commercial |
$3,514.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,137.67
|
| Rate for Payer: Health EOS Commercial |
$3,399.80
|
| Rate for Payer: HFN Commercial |
$3,514.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,865.00
|
| Rate for Payer: Multiplan Commercial |
$3,056.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,292.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,514.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,871.80
|
| Rate for Payer: Quartz Commercial |
$2,483.00
|
| Rate for Payer: Quartz Medicare Advantage |
$2,292.00
|
| Rate for Payer: The Alliance Commercial |
$15,280.00
|
| Rate for Payer: WEA Trust Commercial |
$2,101.00
|
| Rate for Payer: WPS Commercial |
$2,829.47
|
|
|
LAG SCREW 3.5 X 26 ORTHOLOC 3Di CROSSCHECK 5820X3526
|
Facility
|
IP
|
$3,820.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5895659
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,871.80 |
| Max. Negotiated Rate |
$3,514.40 |
| Rate for Payer: Aetna Commercial |
$3,438.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,285.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,024.60
|
| Rate for Payer: Cash Price |
$1,146.00
|
| Rate for Payer: Cigna Commercial |
$3,514.40
|
| Rate for Payer: Health EOS Commercial |
$3,399.80
|
| Rate for Payer: HFN Commercial |
$3,514.40
|
| Rate for Payer: Multiplan Commercial |
$3,056.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,292.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,514.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,871.80
|
| Rate for Payer: Quartz Commercial |
$2,292.00
|
| Rate for Payer: WEA Trust Commercial |
$2,101.00
|
| Rate for Payer: WPS Commercial |
$2,829.47
|
|
|
LAG SCREW 3.5 X 28 ORTHOLOC 3Di CROSSCHECK 5820X3528
|
Facility
|
OP
|
$3,673.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6099636
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,028.44 |
| Max. Negotiated Rate |
$14,692.00 |
| Rate for Payer: Aetna Commercial |
$3,305.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,158.78
|
| Rate for Payer: Aetna Managed Medicare |
$1,028.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,387.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,836.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,763.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,946.69
|
| Rate for Payer: Cash Price |
$1,101.90
|
| Rate for Payer: Cigna Commercial |
$3,379.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,055.41
|
| Rate for Payer: Health EOS Commercial |
$3,268.97
|
| Rate for Payer: HFN Commercial |
$3,379.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,754.75
|
| Rate for Payer: Multiplan Commercial |
$2,938.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,203.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,379.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,799.77
|
| Rate for Payer: Quartz Commercial |
$2,387.45
|
| Rate for Payer: Quartz Medicare Advantage |
$2,203.80
|
| Rate for Payer: The Alliance Commercial |
$14,692.00
|
| Rate for Payer: WEA Trust Commercial |
$2,020.15
|
| Rate for Payer: WPS Commercial |
$2,720.59
|
|
|
LAG SCREW 3.5 X 28 ORTHOLOC 3Di CROSSCHECK 5820X3528
|
Facility
|
IP
|
$3,673.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6099636
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,799.77 |
| Max. Negotiated Rate |
$3,379.16 |
| Rate for Payer: Aetna Commercial |
$3,305.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,158.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,946.69
|
| Rate for Payer: Cash Price |
$1,101.90
|
| Rate for Payer: Cigna Commercial |
$3,379.16
|
| Rate for Payer: Health EOS Commercial |
$3,268.97
|
| Rate for Payer: HFN Commercial |
$3,379.16
|
| Rate for Payer: Multiplan Commercial |
$2,938.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,203.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,379.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,799.77
|
| Rate for Payer: Quartz Commercial |
$2,203.80
|
| Rate for Payer: WEA Trust Commercial |
$2,020.15
|
| Rate for Payer: WPS Commercial |
$2,720.59
|
|
|
LAG SCREW 3.5 X 30 ORTHOLOC 3Di CROSSCHECK 5820X3530
|
Facility
|
IP
|
$3,676.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6049634
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,801.24 |
| Max. Negotiated Rate |
$3,381.92 |
| Rate for Payer: Aetna Commercial |
$3,308.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,161.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,948.28
|
| Rate for Payer: Cash Price |
$1,102.80
|
| Rate for Payer: Cigna Commercial |
$3,381.92
|
| Rate for Payer: Health EOS Commercial |
$3,271.64
|
| Rate for Payer: HFN Commercial |
$3,381.92
|
| Rate for Payer: Multiplan Commercial |
$2,940.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,205.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,381.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,801.24
|
| Rate for Payer: Quartz Commercial |
$2,205.60
|
| Rate for Payer: WEA Trust Commercial |
$2,021.80
|
| Rate for Payer: WPS Commercial |
$2,722.81
|
|
|
LAG SCREW 3.5 X 30 ORTHOLOC 3Di CROSSCHECK 5820X3530
|
Facility
|
OP
|
$3,676.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6049634
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,029.28 |
| Max. Negotiated Rate |
$14,704.00 |
| Rate for Payer: Aetna Commercial |
$3,308.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,161.36
|
| Rate for Payer: Aetna Managed Medicare |
$1,029.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,389.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,838.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,764.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,948.28
|
| Rate for Payer: Cash Price |
$1,102.80
|
| Rate for Payer: Cigna Commercial |
$3,381.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,057.09
|
| Rate for Payer: Health EOS Commercial |
$3,271.64
|
| Rate for Payer: HFN Commercial |
$3,381.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,757.00
|
| Rate for Payer: Multiplan Commercial |
$2,940.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,205.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,381.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,801.24
|
| Rate for Payer: Quartz Commercial |
$2,389.40
|
| Rate for Payer: Quartz Medicare Advantage |
$2,205.60
|
| Rate for Payer: The Alliance Commercial |
$14,704.00
|
| Rate for Payer: WEA Trust Commercial |
$2,021.80
|
| Rate for Payer: WPS Commercial |
$2,722.81
|
|
|
LAG SCREW 3.5 X 32 ORTHOLOC 3Di CROSSCHECK 5820X3532
|
Facility
|
IP
|
$3,111.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6234128
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,524.39 |
| Max. Negotiated Rate |
$2,862.12 |
| Rate for Payer: Aetna Commercial |
$2,799.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,675.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,648.83
|
| Rate for Payer: Cash Price |
$933.30
|
| Rate for Payer: Cigna Commercial |
$2,862.12
|
| Rate for Payer: Health EOS Commercial |
$2,768.79
|
| Rate for Payer: HFN Commercial |
$2,862.12
|
| Rate for Payer: Multiplan Commercial |
$2,488.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,866.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,862.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,524.39
|
| Rate for Payer: Quartz Commercial |
$1,866.60
|
| Rate for Payer: WEA Trust Commercial |
$1,711.05
|
| Rate for Payer: WPS Commercial |
$2,304.32
|
|
|
LAG SCREW 3.5 X 32 ORTHOLOC 3Di CROSSCHECK 5820X3532
|
Facility
|
OP
|
$3,111.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6234128
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$871.08 |
| Max. Negotiated Rate |
$12,444.00 |
| Rate for Payer: Aetna Commercial |
$2,799.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,675.46
|
| Rate for Payer: Aetna Managed Medicare |
$871.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,022.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,555.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,493.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,648.83
|
| Rate for Payer: Cash Price |
$933.30
|
| Rate for Payer: Cigna Commercial |
$2,862.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,740.92
|
| Rate for Payer: Health EOS Commercial |
$2,768.79
|
| Rate for Payer: HFN Commercial |
$2,862.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,333.25
|
| Rate for Payer: Multiplan Commercial |
$2,488.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,866.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,862.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,524.39
|
| Rate for Payer: Quartz Commercial |
$2,022.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,866.60
|
| Rate for Payer: The Alliance Commercial |
$12,444.00
|
| Rate for Payer: WEA Trust Commercial |
$1,711.05
|
| Rate for Payer: WPS Commercial |
$2,304.32
|
|
|
LAG SCREW 4.0 x 34 TORNIER
|
Facility
|
OP
|
$2,623.00
|
|
| Hospital Charge Code |
2967358
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$734.44 |
| Max. Negotiated Rate |
$10,492.00 |
| Rate for Payer: Aetna Commercial |
$2,360.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,255.78
|
| Rate for Payer: Aetna Managed Medicare |
$734.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,704.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,311.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,259.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,390.19
|
| Rate for Payer: Cash Price |
$786.90
|
| Rate for Payer: Cigna Commercial |
$2,413.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,467.83
|
| Rate for Payer: Health EOS Commercial |
$2,334.47
|
| Rate for Payer: HFN Commercial |
$2,413.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,967.25
|
| Rate for Payer: Multiplan Commercial |
$2,098.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,573.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,413.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,285.27
|
| Rate for Payer: Quartz Commercial |
$1,704.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,573.80
|
| Rate for Payer: The Alliance Commercial |
$10,492.00
|
| Rate for Payer: WEA Trust Commercial |
$1,442.65
|
| Rate for Payer: WPS Commercial |
$1,942.86
|
|
|
LAG SCREW 4.0 x 34 TORNIER
|
Facility
|
IP
|
$2,623.00
|
|
| Hospital Charge Code |
2967358
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,285.27 |
| Max. Negotiated Rate |
$2,413.16 |
| Rate for Payer: Aetna Commercial |
$2,360.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,255.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,390.19
|
| Rate for Payer: Cash Price |
$786.90
|
| Rate for Payer: Cigna Commercial |
$2,413.16
|
| Rate for Payer: Health EOS Commercial |
$2,334.47
|
| Rate for Payer: HFN Commercial |
$2,413.16
|
| Rate for Payer: Multiplan Commercial |
$2,098.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,573.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,413.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,285.27
|
| Rate for Payer: Quartz Commercial |
$1,573.80
|
| Rate for Payer: WEA Trust Commercial |
$1,442.65
|
| Rate for Payer: WPS Commercial |
$1,942.86
|
|
|
LAG SCREW 85MM OMEGA 3362-5-085
|
Facility
|
IP
|
$2,364.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6184980
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,158.36 |
| Max. Negotiated Rate |
$2,174.88 |
| Rate for Payer: Aetna Commercial |
$2,127.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,033.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,252.92
|
| Rate for Payer: Cash Price |
$709.20
|
| Rate for Payer: Cigna Commercial |
$2,174.88
|
| Rate for Payer: Health EOS Commercial |
$2,103.96
|
| Rate for Payer: HFN Commercial |
$2,174.88
|
| Rate for Payer: Multiplan Commercial |
$1,891.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,418.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,174.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,158.36
|
| Rate for Payer: Quartz Commercial |
$1,418.40
|
| Rate for Payer: WEA Trust Commercial |
$1,300.20
|
| Rate for Payer: WPS Commercial |
$1,751.01
|
|
|
LAG SCREW 85MM OMEGA 3362-5-085
|
Facility
|
OP
|
$2,364.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6184980
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$661.92 |
| Max. Negotiated Rate |
$9,456.00 |
| Rate for Payer: Aetna Commercial |
$2,127.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,033.04
|
| Rate for Payer: Aetna Managed Medicare |
$661.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,536.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,182.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,134.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,252.92
|
| Rate for Payer: Cash Price |
$709.20
|
| Rate for Payer: Cigna Commercial |
$2,174.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,322.89
|
| Rate for Payer: Health EOS Commercial |
$2,103.96
|
| Rate for Payer: HFN Commercial |
$2,174.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,773.00
|
| Rate for Payer: Multiplan Commercial |
$1,891.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,418.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,174.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,158.36
|
| Rate for Payer: Quartz Commercial |
$1,536.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,418.40
|
| Rate for Payer: The Alliance Commercial |
$9,456.00
|
| Rate for Payer: WEA Trust Commercial |
$1,300.20
|
| Rate for Payer: WPS Commercial |
$1,751.01
|
|
|
LAG SCREW 95MM OMEGA 3362-5-095
|
Facility
|
OP
|
$2,536.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5459547
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$710.08 |
| Max. Negotiated Rate |
$10,144.00 |
| Rate for Payer: Aetna Commercial |
$2,282.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,180.96
|
| Rate for Payer: Aetna Managed Medicare |
$710.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,648.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,268.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,217.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,344.08
|
| Rate for Payer: Cash Price |
$760.80
|
| Rate for Payer: Cigna Commercial |
$2,333.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,419.15
|
| Rate for Payer: Health EOS Commercial |
$2,257.04
|
| Rate for Payer: HFN Commercial |
$2,333.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,902.00
|
| Rate for Payer: Multiplan Commercial |
$2,028.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,521.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,333.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,242.64
|
| Rate for Payer: Quartz Commercial |
$1,648.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,521.60
|
| Rate for Payer: The Alliance Commercial |
$10,144.00
|
| Rate for Payer: WEA Trust Commercial |
$1,394.80
|
| Rate for Payer: WPS Commercial |
$1,878.42
|
|
|
LAG SCREW 95MM OMEGA 3362-5-095
|
Facility
|
IP
|
$2,536.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5459547
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,242.64 |
| Max. Negotiated Rate |
$2,333.12 |
| Rate for Payer: Aetna Commercial |
$2,282.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,180.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,344.08
|
| Rate for Payer: Cash Price |
$760.80
|
| Rate for Payer: Cigna Commercial |
$2,333.12
|
| Rate for Payer: Health EOS Commercial |
$2,257.04
|
| Rate for Payer: HFN Commercial |
$2,333.12
|
| Rate for Payer: Multiplan Commercial |
$2,028.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,521.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,333.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,242.64
|
| Rate for Payer: Quartz Commercial |
$1,521.60
|
| Rate for Payer: WEA Trust Commercial |
$1,394.80
|
| Rate for Payer: WPS Commercial |
$1,878.42
|
|
|
LAG SCREW CANN 4MM X 24MM BLUNT TIP SS AR-5051-24
|
Facility
|
OP
|
$2,031.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6171770
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$568.68 |
| Max. Negotiated Rate |
$8,124.00 |
| Rate for Payer: Aetna Commercial |
$1,827.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,746.66
|
| Rate for Payer: Aetna Managed Medicare |
$568.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,320.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,015.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$974.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,076.43
|
| Rate for Payer: Cash Price |
$609.30
|
| Rate for Payer: Cigna Commercial |
$1,868.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,136.55
|
| Rate for Payer: Health EOS Commercial |
$1,807.59
|
| Rate for Payer: HFN Commercial |
$1,868.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,523.25
|
| Rate for Payer: Multiplan Commercial |
$1,624.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,218.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,868.52
|
| Rate for Payer: Quartz Beloit One Network |
$995.19
|
| Rate for Payer: Quartz Commercial |
$1,320.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,218.60
|
| Rate for Payer: The Alliance Commercial |
$8,124.00
|
| Rate for Payer: WEA Trust Commercial |
$1,117.05
|
| Rate for Payer: WPS Commercial |
$1,504.36
|
|
