|
LAG SCREW DHS/DCS 75MM 280.275
|
Facility
|
IP
|
$4,324.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2966262
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,118.76 |
| Max. Negotiated Rate |
$3,978.08 |
| Rate for Payer: Aetna Commercial |
$3,891.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,718.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,291.72
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$3,978.08
|
| Rate for Payer: Health EOS Commercial |
$3,848.36
|
| Rate for Payer: HFN Commercial |
$3,978.08
|
| Rate for Payer: Multiplan Commercial |
$3,459.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,594.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,978.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,118.76
|
| Rate for Payer: Quartz Commercial |
$2,594.40
|
| Rate for Payer: WEA Trust Commercial |
$2,378.20
|
| Rate for Payer: WPS Commercial |
$3,202.79
|
|
|
LAG SCREW DHS/DCS 75MM 280.275
|
Facility
|
OP
|
$4,324.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2966262
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,210.72 |
| Max. Negotiated Rate |
$17,296.00 |
| Rate for Payer: Aetna Commercial |
$3,891.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,718.64
|
| Rate for Payer: Aetna Managed Medicare |
$1,210.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,810.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,162.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,075.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,291.72
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$3,978.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,419.71
|
| Rate for Payer: Health EOS Commercial |
$3,848.36
|
| Rate for Payer: HFN Commercial |
$3,978.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,243.00
|
| Rate for Payer: Multiplan Commercial |
$3,459.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,594.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,978.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,118.76
|
| Rate for Payer: Quartz Commercial |
$2,810.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2,594.40
|
| Rate for Payer: The Alliance Commercial |
$17,296.00
|
| Rate for Payer: WEA Trust Commercial |
$2,378.20
|
| Rate for Payer: WPS Commercial |
$3,202.79
|
|
|
LAG SCREW DHS/DCS 80MM 12.7MM THREAD 280.800
|
Facility
|
OP
|
$2,936.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5459806
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$822.08 |
| Max. Negotiated Rate |
$11,744.00 |
| Rate for Payer: Aetna Commercial |
$2,642.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,524.96
|
| Rate for Payer: Aetna Managed Medicare |
$822.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,908.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,468.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,409.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,556.08
|
| Rate for Payer: Cash Price |
$880.80
|
| Rate for Payer: Cigna Commercial |
$2,701.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,642.99
|
| Rate for Payer: Health EOS Commercial |
$2,613.04
|
| Rate for Payer: HFN Commercial |
$2,701.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,202.00
|
| Rate for Payer: Multiplan Commercial |
$2,348.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,761.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,701.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,438.64
|
| Rate for Payer: Quartz Commercial |
$1,908.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,761.60
|
| Rate for Payer: The Alliance Commercial |
$11,744.00
|
| Rate for Payer: WEA Trust Commercial |
$1,614.80
|
| Rate for Payer: WPS Commercial |
$2,174.70
|
|
|
LAG SCREW DHS/DCS 80MM 12.7MM THREAD 280.800
|
Facility
|
IP
|
$2,936.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5459806
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,438.64 |
| Max. Negotiated Rate |
$2,701.12 |
| Rate for Payer: Aetna Commercial |
$2,642.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,524.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,556.08
|
| Rate for Payer: Cash Price |
$880.80
|
| Rate for Payer: Cigna Commercial |
$2,701.12
|
| Rate for Payer: Health EOS Commercial |
$2,613.04
|
| Rate for Payer: HFN Commercial |
$2,701.12
|
| Rate for Payer: Multiplan Commercial |
$2,348.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,761.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,701.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,438.64
|
| Rate for Payer: Quartz Commercial |
$1,761.60
|
| Rate for Payer: WEA Trust Commercial |
$1,614.80
|
| Rate for Payer: WPS Commercial |
$2,174.70
|
|
|
LAG SCREW DHS/DCS 85MM 12.7MM THREAD 280.850
|
Facility
|
OP
|
$2,936.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5459807
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$822.08 |
| Max. Negotiated Rate |
$11,744.00 |
| Rate for Payer: Aetna Commercial |
$2,642.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,524.96
|
| Rate for Payer: Aetna Managed Medicare |
$822.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,908.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,468.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,409.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,556.08
|
| Rate for Payer: Cash Price |
$880.80
|
| Rate for Payer: Cigna Commercial |
$2,701.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,642.99
|
| Rate for Payer: Health EOS Commercial |
$2,613.04
|
| Rate for Payer: HFN Commercial |
$2,701.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,202.00
|
| Rate for Payer: Multiplan Commercial |
$2,348.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,761.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,701.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,438.64
|
| Rate for Payer: Quartz Commercial |
$1,908.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,761.60
|
| Rate for Payer: The Alliance Commercial |
$11,744.00
|
| Rate for Payer: WEA Trust Commercial |
$1,614.80
|
| Rate for Payer: WPS Commercial |
$2,174.70
|
|
|
LAG SCREW DHS/DCS 85MM 12.7MM THREAD 280.850
|
Facility
|
IP
|
$2,936.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5459807
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,438.64 |
| Max. Negotiated Rate |
$2,701.12 |
| Rate for Payer: Aetna Commercial |
$2,642.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,524.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,556.08
|
| Rate for Payer: Cash Price |
$880.80
|
| Rate for Payer: Cigna Commercial |
$2,701.12
|
| Rate for Payer: Health EOS Commercial |
$2,613.04
|
| Rate for Payer: HFN Commercial |
$2,701.12
|
| Rate for Payer: Multiplan Commercial |
$2,348.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,761.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,701.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,438.64
|
| Rate for Payer: Quartz Commercial |
$1,761.60
|
| Rate for Payer: WEA Trust Commercial |
$1,614.80
|
| Rate for Payer: WPS Commercial |
$2,174.70
|
|
|
LAG SCREW DHS/DCS ONE STEP 100 280.301
|
Facility
|
IP
|
$4,306.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2966555
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,109.94 |
| Max. Negotiated Rate |
$3,961.52 |
| Rate for Payer: Aetna Commercial |
$3,875.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,703.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,282.18
|
| Rate for Payer: Cash Price |
$1,291.80
|
| Rate for Payer: Cigna Commercial |
$3,961.52
|
| Rate for Payer: Health EOS Commercial |
$3,832.34
|
| Rate for Payer: HFN Commercial |
$3,961.52
|
| Rate for Payer: Multiplan Commercial |
$3,444.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,583.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,961.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,109.94
|
| Rate for Payer: Quartz Commercial |
$2,583.60
|
| Rate for Payer: WEA Trust Commercial |
$2,368.30
|
| Rate for Payer: WPS Commercial |
$3,189.45
|
|
|
LAG SCREW DHS/DCS ONE STEP 100 280.301
|
Facility
|
OP
|
$4,306.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2966555
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,205.68 |
| Max. Negotiated Rate |
$17,224.00 |
| Rate for Payer: Aetna Commercial |
$3,875.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,703.16
|
| Rate for Payer: Aetna Managed Medicare |
$1,205.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,798.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,153.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,066.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,282.18
|
| Rate for Payer: Cash Price |
$1,291.80
|
| Rate for Payer: Cigna Commercial |
$3,961.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,409.64
|
| Rate for Payer: Health EOS Commercial |
$3,832.34
|
| Rate for Payer: HFN Commercial |
$3,961.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,229.50
|
| Rate for Payer: Multiplan Commercial |
$3,444.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,583.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,961.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,109.94
|
| Rate for Payer: Quartz Commercial |
$2,798.90
|
| Rate for Payer: Quartz Medicare Advantage |
$2,583.60
|
| Rate for Payer: The Alliance Commercial |
$17,224.00
|
| Rate for Payer: WEA Trust Commercial |
$2,368.30
|
| Rate for Payer: WPS Commercial |
$3,189.45
|
|
|
LAG SCREW DHS/DCS ONE-STEP 80MM 280.280S
|
Facility
|
OP
|
$3,260.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4640846
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$912.80 |
| Max. Negotiated Rate |
$13,040.00 |
| Rate for Payer: Aetna Commercial |
$2,934.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,803.60
|
| Rate for Payer: Aetna Managed Medicare |
$912.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,119.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,630.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,564.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,727.80
|
| Rate for Payer: Cash Price |
$978.00
|
| Rate for Payer: Cigna Commercial |
$2,999.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,824.30
|
| Rate for Payer: Health EOS Commercial |
$2,901.40
|
| Rate for Payer: HFN Commercial |
$2,999.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,445.00
|
| Rate for Payer: Multiplan Commercial |
$2,608.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,956.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,999.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,597.40
|
| Rate for Payer: Quartz Commercial |
$2,119.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,956.00
|
| Rate for Payer: The Alliance Commercial |
$13,040.00
|
| Rate for Payer: WEA Trust Commercial |
$1,793.00
|
| Rate for Payer: WPS Commercial |
$2,414.68
|
|
|
LAG SCREW DHS/DCS ONE-STEP 80MM 280.280S
|
Facility
|
IP
|
$3,260.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4640846
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,597.40 |
| Max. Negotiated Rate |
$2,999.20 |
| Rate for Payer: Aetna Commercial |
$2,934.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,803.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,727.80
|
| Rate for Payer: Cash Price |
$978.00
|
| Rate for Payer: Cigna Commercial |
$2,999.20
|
| Rate for Payer: Health EOS Commercial |
$2,901.40
|
| Rate for Payer: HFN Commercial |
$2,999.20
|
| Rate for Payer: Multiplan Commercial |
$2,608.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,956.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,999.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,597.40
|
| Rate for Payer: Quartz Commercial |
$1,956.00
|
| Rate for Payer: WEA Trust Commercial |
$1,793.00
|
| Rate for Payer: WPS Commercial |
$2,414.68
|
|
|
LAG SCREW DHS/DCS ONE-STEP 95MM 280.295S
|
Facility
|
IP
|
$3,260.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4640729
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,597.40 |
| Max. Negotiated Rate |
$2,999.20 |
| Rate for Payer: Aetna Commercial |
$2,934.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,803.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,727.80
|
| Rate for Payer: Cash Price |
$978.00
|
| Rate for Payer: Cigna Commercial |
$2,999.20
|
| Rate for Payer: Health EOS Commercial |
$2,901.40
|
| Rate for Payer: HFN Commercial |
$2,999.20
|
| Rate for Payer: Multiplan Commercial |
$2,608.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,956.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,999.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,597.40
|
| Rate for Payer: Quartz Commercial |
$1,956.00
|
| Rate for Payer: WEA Trust Commercial |
$1,793.00
|
| Rate for Payer: WPS Commercial |
$2,414.68
|
|
|
LAG SCREW DHS/DCS ONE-STEP 95MM 280.295S
|
Facility
|
OP
|
$3,260.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4640729
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$912.80 |
| Max. Negotiated Rate |
$13,040.00 |
| Rate for Payer: Aetna Commercial |
$2,934.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,803.60
|
| Rate for Payer: Aetna Managed Medicare |
$912.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,119.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,630.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,564.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,727.80
|
| Rate for Payer: Cash Price |
$978.00
|
| Rate for Payer: Cigna Commercial |
$2,999.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,824.30
|
| Rate for Payer: Health EOS Commercial |
$2,901.40
|
| Rate for Payer: HFN Commercial |
$2,999.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,445.00
|
| Rate for Payer: Multiplan Commercial |
$2,608.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,956.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,999.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,597.40
|
| Rate for Payer: Quartz Commercial |
$2,119.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,956.00
|
| Rate for Payer: The Alliance Commercial |
$13,040.00
|
| Rate for Payer: WEA Trust Commercial |
$1,793.00
|
| Rate for Payer: WPS Commercial |
$2,414.68
|
|
|
LAG SCREW ONE STEP LAG90MM 280.290
|
Facility
|
OP
|
$1,212.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2966561
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.36 |
| Max. Negotiated Rate |
$4,848.00 |
| Rate for Payer: Aetna Commercial |
$1,090.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,042.32
|
| Rate for Payer: Aetna Managed Medicare |
$339.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$787.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$606.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$581.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$642.36
|
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Cigna Commercial |
$1,115.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$678.24
|
| Rate for Payer: Health EOS Commercial |
$1,078.68
|
| Rate for Payer: HFN Commercial |
$1,115.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$909.00
|
| Rate for Payer: Multiplan Commercial |
$969.60
|
| Rate for Payer: NAPHCARE Commercial |
$727.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,115.04
|
| Rate for Payer: Quartz Beloit One Network |
$593.88
|
| Rate for Payer: Quartz Commercial |
$787.80
|
| Rate for Payer: Quartz Medicare Advantage |
$727.20
|
| Rate for Payer: The Alliance Commercial |
$4,848.00
|
| Rate for Payer: WEA Trust Commercial |
$666.60
|
| Rate for Payer: WPS Commercial |
$897.73
|
|
|
LAG SCREW ONE STEP LAG90MM 280.290
|
Facility
|
IP
|
$1,212.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2966561
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$593.88 |
| Max. Negotiated Rate |
$1,115.04 |
| Rate for Payer: Aetna Commercial |
$1,090.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,042.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$642.36
|
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Cigna Commercial |
$1,115.04
|
| Rate for Payer: Health EOS Commercial |
$1,078.68
|
| Rate for Payer: HFN Commercial |
$1,115.04
|
| Rate for Payer: Multiplan Commercial |
$969.60
|
| Rate for Payer: NAPHCARE Commercial |
$727.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,115.04
|
| Rate for Payer: Quartz Beloit One Network |
$593.88
|
| Rate for Payer: Quartz Commercial |
$727.20
|
| Rate for Payer: WEA Trust Commercial |
$666.60
|
| Rate for Payer: WPS Commercial |
$897.73
|
|
|
LAG SCREW TFNA 100MM 04.038.100S
|
Facility
|
IP
|
$5,684.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4595800
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,785.16 |
| Max. Negotiated Rate |
$5,229.28 |
| Rate for Payer: Aetna Commercial |
$5,115.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,888.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,012.52
|
| Rate for Payer: Cash Price |
$1,705.20
|
| Rate for Payer: Cigna Commercial |
$5,229.28
|
| Rate for Payer: Health EOS Commercial |
$5,058.76
|
| Rate for Payer: HFN Commercial |
$5,229.28
|
| Rate for Payer: Multiplan Commercial |
$4,547.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,410.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,229.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,785.16
|
| Rate for Payer: Quartz Commercial |
$3,410.40
|
| Rate for Payer: WEA Trust Commercial |
$3,126.20
|
| Rate for Payer: WPS Commercial |
$4,210.14
|
|
|
LAG SCREW TFNA 100MM 04.038.100S
|
Facility
|
OP
|
$5,684.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4595800
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,591.52 |
| Max. Negotiated Rate |
$22,736.00 |
| Rate for Payer: Aetna Commercial |
$5,115.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,888.24
|
| Rate for Payer: Aetna Managed Medicare |
$1,591.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,694.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,842.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,728.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,012.52
|
| Rate for Payer: Cash Price |
$1,705.20
|
| Rate for Payer: Cigna Commercial |
$5,229.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,180.77
|
| Rate for Payer: Health EOS Commercial |
$5,058.76
|
| Rate for Payer: HFN Commercial |
$5,229.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,263.00
|
| Rate for Payer: Multiplan Commercial |
$4,547.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,410.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,229.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,785.16
|
| Rate for Payer: Quartz Commercial |
$3,694.60
|
| Rate for Payer: Quartz Medicare Advantage |
$3,410.40
|
| Rate for Payer: The Alliance Commercial |
$22,736.00
|
| Rate for Payer: WEA Trust Commercial |
$3,126.20
|
| Rate for Payer: WPS Commercial |
$4,210.14
|
|
|
LAG SCREW TFNA 100MM 04.038.200S
|
Facility
|
IP
|
$5,261.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5520669
|
|
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 TFNA 100MM 04.038.200S
|
Facility
|
OP
|
$5,261.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5520669
|
|
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 TFNA 105MM 04.038.105S
|
Facility
|
OP
|
$5,474.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4519760
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,532.72 |
| Max. Negotiated Rate |
$21,896.00 |
| Rate for Payer: Aetna Commercial |
$4,926.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,707.64
|
| Rate for Payer: Aetna Managed Medicare |
$1,532.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,558.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,737.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,627.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,901.22
|
| Rate for Payer: Cash Price |
$1,642.20
|
| Rate for Payer: Cigna Commercial |
$5,036.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,063.25
|
| Rate for Payer: Health EOS Commercial |
$4,871.86
|
| Rate for Payer: HFN Commercial |
$5,036.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,105.50
|
| Rate for Payer: Multiplan Commercial |
$4,379.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,284.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,036.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,682.26
|
| Rate for Payer: Quartz Commercial |
$3,558.10
|
| Rate for Payer: Quartz Medicare Advantage |
$3,284.40
|
| Rate for Payer: The Alliance Commercial |
$21,896.00
|
| Rate for Payer: WEA Trust Commercial |
$3,010.70
|
| Rate for Payer: WPS Commercial |
$4,054.59
|
|
|
LAG SCREW TFNA 105MM 04.038.105S
|
Facility
|
IP
|
$5,474.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4519760
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,682.26 |
| Max. Negotiated Rate |
$5,036.08 |
| Rate for Payer: Aetna Commercial |
$4,926.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,707.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,901.22
|
| Rate for Payer: Cash Price |
$1,642.20
|
| Rate for Payer: Cigna Commercial |
$5,036.08
|
| Rate for Payer: Health EOS Commercial |
$4,871.86
|
| Rate for Payer: HFN Commercial |
$5,036.08
|
| Rate for Payer: Multiplan Commercial |
$4,379.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,284.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,036.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,682.26
|
| Rate for Payer: Quartz Commercial |
$3,284.40
|
| Rate for Payer: WEA Trust Commercial |
$3,010.70
|
| Rate for Payer: WPS Commercial |
$4,054.59
|
|
|
LAG SCREW TFNA 110MM 04.038.110S
|
Facility
|
IP
|
$5,474.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5286786
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,682.26 |
| Max. Negotiated Rate |
$5,036.08 |
| Rate for Payer: Aetna Commercial |
$4,926.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,707.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,901.22
|
| Rate for Payer: Cash Price |
$1,642.20
|
| Rate for Payer: Cigna Commercial |
$5,036.08
|
| Rate for Payer: Health EOS Commercial |
$4,871.86
|
| Rate for Payer: HFN Commercial |
$5,036.08
|
| Rate for Payer: Multiplan Commercial |
$4,379.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,284.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,036.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,682.26
|
| Rate for Payer: Quartz Commercial |
$3,284.40
|
| Rate for Payer: WEA Trust Commercial |
$3,010.70
|
| Rate for Payer: WPS Commercial |
$4,054.59
|
|
|
LAG SCREW TFNA 110MM 04.038.110S
|
Facility
|
OP
|
$5,474.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5286786
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,532.72 |
| Max. Negotiated Rate |
$21,896.00 |
| Rate for Payer: Aetna Commercial |
$4,926.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,707.64
|
| Rate for Payer: Aetna Managed Medicare |
$1,532.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,558.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,737.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,627.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,901.22
|
| Rate for Payer: Cash Price |
$1,642.20
|
| Rate for Payer: Cigna Commercial |
$5,036.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,063.25
|
| Rate for Payer: Health EOS Commercial |
$4,871.86
|
| Rate for Payer: HFN Commercial |
$5,036.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,105.50
|
| Rate for Payer: Multiplan Commercial |
$4,379.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,284.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,036.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,682.26
|
| Rate for Payer: Quartz Commercial |
$3,558.10
|
| Rate for Payer: Quartz Medicare Advantage |
$3,284.40
|
| Rate for Payer: The Alliance Commercial |
$21,896.00
|
| Rate for Payer: WEA Trust Commercial |
$3,010.70
|
| Rate for Payer: WPS Commercial |
$4,054.59
|
|
|
LAG SCREW TFNA 115MM 04.038.115S
|
Facility
|
IP
|
$5,474.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4594893
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,682.26 |
| Max. Negotiated Rate |
$5,036.08 |
| Rate for Payer: Aetna Commercial |
$4,926.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,707.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,901.22
|
| Rate for Payer: Cash Price |
$1,642.20
|
| Rate for Payer: Cigna Commercial |
$5,036.08
|
| Rate for Payer: Health EOS Commercial |
$4,871.86
|
| Rate for Payer: HFN Commercial |
$5,036.08
|
| Rate for Payer: Multiplan Commercial |
$4,379.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,284.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,036.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,682.26
|
| Rate for Payer: Quartz Commercial |
$3,284.40
|
| Rate for Payer: WEA Trust Commercial |
$3,010.70
|
| Rate for Payer: WPS Commercial |
$4,054.59
|
|
|
LAG SCREW TFNA 115MM 04.038.115S
|
Facility
|
OP
|
$5,474.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4594893
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,532.72 |
| Max. Negotiated Rate |
$21,896.00 |
| Rate for Payer: Aetna Commercial |
$4,926.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,707.64
|
| Rate for Payer: Aetna Managed Medicare |
$1,532.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,558.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,737.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,627.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,901.22
|
| Rate for Payer: Cash Price |
$1,642.20
|
| Rate for Payer: Cigna Commercial |
$5,036.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,063.25
|
| Rate for Payer: Health EOS Commercial |
$4,871.86
|
| Rate for Payer: HFN Commercial |
$5,036.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,105.50
|
| Rate for Payer: Multiplan Commercial |
$4,379.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,284.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,036.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,682.26
|
| Rate for Payer: Quartz Commercial |
$3,558.10
|
| Rate for Payer: Quartz Medicare Advantage |
$3,284.40
|
| Rate for Payer: The Alliance Commercial |
$21,896.00
|
| Rate for Payer: WEA Trust Commercial |
$3,010.70
|
| Rate for Payer: WPS Commercial |
$4,054.59
|
|
|
LAG SCREW TFNA 75MM 04.038.175S
|
Facility
|
OP
|
$4,866.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6172859
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,362.48 |
| Max. Negotiated Rate |
$19,464.00 |
| Rate for Payer: Aetna Commercial |
$4,379.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,184.76
|
| Rate for Payer: Aetna Managed Medicare |
$1,362.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,162.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,433.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,335.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,578.98
|
| Rate for Payer: Cash Price |
$1,459.80
|
| Rate for Payer: Cigna Commercial |
$4,476.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,723.01
|
| Rate for Payer: Health EOS Commercial |
$4,330.74
|
| Rate for Payer: HFN Commercial |
$4,476.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,649.50
|
| Rate for Payer: Multiplan Commercial |
$3,892.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,919.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,476.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,384.34
|
| Rate for Payer: Quartz Commercial |
$3,162.90
|
| Rate for Payer: Quartz Medicare Advantage |
$2,919.60
|
| Rate for Payer: The Alliance Commercial |
$19,464.00
|
| Rate for Payer: WEA Trust Commercial |
$2,676.30
|
| Rate for Payer: WPS Commercial |
$3,604.25
|
|
