|
LAG SCREW TFNA 75MM 04.038.175S
|
Facility
|
IP
|
$4,866.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6172859
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,384.34 |
| Max. Negotiated Rate |
$4,476.72 |
| Rate for Payer: Aetna Commercial |
$4,379.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,184.76
|
| 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: Health EOS Commercial |
$4,330.74
|
| Rate for Payer: HFN Commercial |
$4,476.72
|
| 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 |
$2,919.60
|
| Rate for Payer: WEA Trust Commercial |
$2,676.30
|
| Rate for Payer: WPS Commercial |
$3,604.25
|
|
|
LAG SCREW TFNA 80MM 04.038.080S
|
Facility
|
OP
|
$5,684.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4520497
|
|
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 80MM 04.038.080S
|
Facility
|
IP
|
$5,684.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4520497
|
|
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 80MM 04.038.180S
|
Facility
|
IP
|
$5,061.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5917669
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,479.89 |
| Max. Negotiated Rate |
$4,656.12 |
| Rate for Payer: Aetna Commercial |
$4,554.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,352.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,682.33
|
| Rate for Payer: Cash Price |
$1,518.30
|
| Rate for Payer: Cigna Commercial |
$4,656.12
|
| Rate for Payer: Health EOS Commercial |
$4,504.29
|
| Rate for Payer: HFN Commercial |
$4,656.12
|
| Rate for Payer: Multiplan Commercial |
$4,048.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,036.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,656.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,479.89
|
| Rate for Payer: Quartz Commercial |
$3,036.60
|
| Rate for Payer: WEA Trust Commercial |
$2,783.55
|
| Rate for Payer: WPS Commercial |
$3,748.68
|
|
|
LAG SCREW TFNA 80MM 04.038.180S
|
Facility
|
OP
|
$5,061.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5917669
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,417.08 |
| Max. Negotiated Rate |
$20,244.00 |
| Rate for Payer: Aetna Commercial |
$4,554.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,352.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,417.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,289.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,530.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,429.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,682.33
|
| Rate for Payer: Cash Price |
$1,518.30
|
| Rate for Payer: Cigna Commercial |
$4,656.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,832.14
|
| Rate for Payer: Health EOS Commercial |
$4,504.29
|
| Rate for Payer: HFN Commercial |
$4,656.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,795.75
|
| Rate for Payer: Multiplan Commercial |
$4,048.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,036.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,656.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,479.89
|
| Rate for Payer: Quartz Commercial |
$3,289.65
|
| Rate for Payer: Quartz Medicare Advantage |
$3,036.60
|
| Rate for Payer: The Alliance Commercial |
$20,244.00
|
| Rate for Payer: WEA Trust Commercial |
$2,783.55
|
| Rate for Payer: WPS Commercial |
$3,748.68
|
|
|
LAG SCREW TFNA 85MM 04.038.085S
|
Facility
|
IP
|
$5,684.00
|
|
| Hospital Charge Code |
4519978
|
|
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 85MM 04.038.085S
|
Facility
|
OP
|
$5,684.00
|
|
| Hospital Charge Code |
4519978
|
|
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 85MM 04.038.185S
|
Facility
|
OP
|
$772.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5583217
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$216.16 |
| Max. Negotiated Rate |
$3,088.00 |
| Rate for Payer: Aetna Commercial |
$694.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$663.92
|
| Rate for Payer: Aetna Managed Medicare |
$216.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$501.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$386.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$370.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$409.16
|
| Rate for Payer: Cash Price |
$231.60
|
| Rate for Payer: Cigna Commercial |
$710.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$432.01
|
| Rate for Payer: Health EOS Commercial |
$687.08
|
| Rate for Payer: HFN Commercial |
$710.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$579.00
|
| Rate for Payer: Multiplan Commercial |
$617.60
|
| Rate for Payer: NAPHCARE Commercial |
$463.20
|
| Rate for Payer: Preferred Network Access Commercial |
$710.24
|
| Rate for Payer: Quartz Beloit One Network |
$378.28
|
| Rate for Payer: Quartz Commercial |
$501.80
|
| Rate for Payer: Quartz Medicare Advantage |
$463.20
|
| Rate for Payer: The Alliance Commercial |
$3,088.00
|
| Rate for Payer: WEA Trust Commercial |
$424.60
|
| Rate for Payer: WPS Commercial |
$571.82
|
|
|
LAG SCREW TFNA 85MM 04.038.185S
|
Facility
|
IP
|
$772.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5583217
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$378.28 |
| Max. Negotiated Rate |
$710.24 |
| Rate for Payer: Aetna Commercial |
$694.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$663.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$409.16
|
| Rate for Payer: Cash Price |
$231.60
|
| Rate for Payer: Cigna Commercial |
$710.24
|
| Rate for Payer: Health EOS Commercial |
$687.08
|
| Rate for Payer: HFN Commercial |
$710.24
|
| Rate for Payer: Multiplan Commercial |
$617.60
|
| Rate for Payer: NAPHCARE Commercial |
$463.20
|
| Rate for Payer: Preferred Network Access Commercial |
$710.24
|
| Rate for Payer: Quartz Beloit One Network |
$378.28
|
| Rate for Payer: Quartz Commercial |
$463.20
|
| Rate for Payer: WEA Trust Commercial |
$424.60
|
| Rate for Payer: WPS Commercial |
$571.82
|
|
|
LAG SCREW TFNA 90MM 04.038.090S
|
Facility
|
IP
|
$5,684.00
|
|
| Hospital Charge Code |
4641032
|
|
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 90MM 04.038.090S
|
Facility
|
OP
|
$5,684.00
|
|
| Hospital Charge Code |
4641032
|
|
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 90MM 04.038.190S
|
Facility
|
IP
|
$5,474.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5520670
|
|
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 90MM 04.038.190S
|
Facility
|
OP
|
$5,474.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5520670
|
|
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 95MM 04.038.095S
|
Facility
|
OP
|
$6,267.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4520269
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,754.76 |
| Max. Negotiated Rate |
$25,068.00 |
| Rate for Payer: Aetna Commercial |
$5,640.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,389.62
|
| Rate for Payer: Aetna Managed Medicare |
$1,754.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,073.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,133.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,008.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,321.51
|
| Rate for Payer: Cash Price |
$1,880.10
|
| Rate for Payer: Cigna Commercial |
$5,765.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,507.01
|
| Rate for Payer: Health EOS Commercial |
$5,577.63
|
| Rate for Payer: HFN Commercial |
$5,765.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,700.25
|
| Rate for Payer: Multiplan Commercial |
$5,013.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,760.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,765.64
|
| Rate for Payer: Quartz Beloit One Network |
$3,070.83
|
| Rate for Payer: Quartz Commercial |
$4,073.55
|
| Rate for Payer: Quartz Medicare Advantage |
$3,760.20
|
| Rate for Payer: The Alliance Commercial |
$25,068.00
|
| Rate for Payer: WEA Trust Commercial |
$3,446.85
|
| Rate for Payer: WPS Commercial |
$4,641.97
|
|
|
LAG SCREW TFNA 95MM 04.038.095S
|
Facility
|
IP
|
$6,267.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4520269
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,070.83 |
| Max. Negotiated Rate |
$5,765.64 |
| Rate for Payer: Aetna Commercial |
$5,640.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,389.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,321.51
|
| Rate for Payer: Cash Price |
$1,880.10
|
| Rate for Payer: Cigna Commercial |
$5,765.64
|
| Rate for Payer: Health EOS Commercial |
$5,577.63
|
| Rate for Payer: HFN Commercial |
$5,765.64
|
| Rate for Payer: Multiplan Commercial |
$5,013.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,760.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,765.64
|
| Rate for Payer: Quartz Beloit One Network |
$3,070.83
|
| Rate for Payer: Quartz Commercial |
$3,760.20
|
| Rate for Payer: WEA Trust Commercial |
$3,446.85
|
| Rate for Payer: WPS Commercial |
$4,641.97
|
|
|
LAG SCREW TFNA 95MM 04.038.195S
|
Facility
|
OP
|
$5,474.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5520832
|
|
Hospital Revenue Code
|
272
|
| 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 95MM 04.038.195S
|
Facility
|
IP
|
$5,474.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5520832
|
|
Hospital Revenue Code
|
272
|
| 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
|
|
|
Lambda Light Chains Free
|
Facility
|
OP
|
$223.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2942940
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$205.16 |
| Rate for Payer: Aetna Commercial |
$200.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$191.78
|
| Rate for Payer: Aetna Managed Medicare |
$17.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$64.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.22
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.67
|
| Rate for Payer: Anthem Medicaid |
$17.85
|
| Rate for Payer: Anthem Medicare Advantage |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$118.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.27
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cigna Commercial |
$205.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$124.79
|
| Rate for Payer: Dean Health Medicaid |
$17.85
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.27
|
| Rate for Payer: Health EOS Commercial |
$198.47
|
| Rate for Payer: HFN Commercial |
$205.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.27
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.27
|
| Rate for Payer: Managed Health Services Medicaid |
$18.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.27
|
| Rate for Payer: Multiplan Commercial |
$178.40
|
| Rate for Payer: NAPHCARE Commercial |
$25.90
|
| Rate for Payer: Preferred Network Access Commercial |
$205.16
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17.85
|
| Rate for Payer: Quartz Beloit One Network |
$109.27
|
| Rate for Payer: Quartz Commercial |
$144.95
|
| Rate for Payer: Quartz Medicare Advantage |
$17.27
|
| Rate for Payer: The Alliance Commercial |
$69.08
|
| Rate for Payer: United Healthcare Medicaid |
$17.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
| Rate for Payer: United Healthcare PPO |
$167.25
|
| Rate for Payer: WEA Trust Commercial |
$122.65
|
| Rate for Payer: Wellcare Medicare |
$17.27
|
| Rate for Payer: WMAP Medicaid |
$17.85
|
| Rate for Payer: WPS Commercial |
$165.18
|
|
|
Lambda Light Chains Free
|
Professional
|
Both
|
$223.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2942940
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.96 |
| Max. Negotiated Rate |
$211.85 |
| Rate for Payer: Aetna Commercial |
$211.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$191.78
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cigna Commercial |
$211.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$111.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$133.80
|
| Rate for Payer: Health EOS Commercial |
$202.93
|
| Rate for Payer: HFN Commercial |
$211.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.96
|
| Rate for Payer: Multiplan Commercial |
$178.40
|
| Rate for Payer: Preferred Network Access Commercial |
$211.85
|
| Rate for Payer: Quartz Beloit One Network |
$98.12
|
| Rate for Payer: Quartz Commercial |
$127.11
|
| Rate for Payer: The Alliance Commercial |
$111.50
|
| Rate for Payer: WEA Trust Commercial |
$122.65
|
| Rate for Payer: WPS Commercial |
$165.18
|
|
|
Lambda Light Chains Free
|
Facility
|
IP
|
$223.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2942940
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$109.27 |
| Max. Negotiated Rate |
$205.16 |
| Rate for Payer: Aetna Commercial |
$200.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$191.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$118.19
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cigna Commercial |
$205.16
|
| Rate for Payer: Health EOS Commercial |
$198.47
|
| Rate for Payer: HFN Commercial |
$205.16
|
| Rate for Payer: Multiplan Commercial |
$178.40
|
| Rate for Payer: NAPHCARE Commercial |
$133.80
|
| Rate for Payer: Preferred Network Access Commercial |
$205.16
|
| Rate for Payer: Quartz Beloit One Network |
$109.27
|
| Rate for Payer: Quartz Commercial |
$133.80
|
| Rate for Payer: WEA Trust Commercial |
$122.65
|
| Rate for Payer: WPS Commercial |
$165.18
|
|
|
LAMINECTOMY
|
Facility
|
OP
|
$4,324.00
|
|
| Hospital Charge Code |
2960172
|
|
Hospital Revenue Code
|
360
|
| 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
|
|
|
LAMINECTOMY
|
Facility
|
IP
|
$4,324.00
|
|
| Hospital Charge Code |
2960172
|
|
Hospital Revenue Code
|
360
|
| 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
|
|
|
LAMINECTOMY, FACETECTOMY AND FORAMINOTOMY (UNILATERAL OR BILATERAL WITH DECOMPRESSION OF SPINAL CORD, CAUDA EQUINA AND/OR NERVE ROOT[S], [EG, SPINAL OR LATERAL RECESS STENOSIS]), SINGLE VERTEBRAL SEGMENT; EACH ADDITIONAL VERTEBRAL SEGMENT, CERVICAL, THORACIC, OR LUMBAR (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$8,339.76
|
|
|
Service Code
|
CPT 63048
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8,339.76 |
| Max. Negotiated Rate |
$8,339.76 |
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,339.76
|
|
|
LAMINECTOMY, FACETECTOMY AND FORAMINOTOMY (UNILATERAL OR BILATERAL WITH DECOMPRESSION OF SPINAL CORD, CAUDA EQUINA AND/OR NERVE ROOT[S], [EG, SPINAL OR LATERAL RECESS STENOSIS]), SINGLE VERTEBRAL SEGMENT; LUMBAR
|
Facility
|
OP
|
$28,284.48
|
|
|
Service Code
|
CPT 63047
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,071.12 |
| Max. Negotiated Rate |
$28,284.48 |
| Rate for Payer: Aetna Managed Medicare |
$7,071.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17,483.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,081.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,278.00
|
| Rate for Payer: Anthem Medicare Advantage |
$7,071.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,071.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,071.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,071.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,339.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,071.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26,304.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,071.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,071.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,071.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,071.12
|
| Rate for Payer: NAPHCARE Commercial |
$10,606.68
|
| Rate for Payer: Quartz Medicare Advantage |
$7,071.12
|
| Rate for Payer: The Alliance Commercial |
$28,284.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,071.12
|
| Rate for Payer: United Healthcare PPO |
$8,452.00
|
| Rate for Payer: Wellcare Medicare |
$7,071.12
|
|
|
LAMINOTOMY (HEMILAMINECTOMY), WITH DECOMPRESSION OF NERVE ROOT(S), INCLUDING PARTIAL FACETECTOMY, FORAMINOTOMY AND/OR EXCISION OF HERNIATED INTERVERTEBRAL DISC; 1 INTERSPACE, LUMBAR
|
Facility
|
OP
|
$28,284.48
|
|
|
Service Code
|
CPT 63030
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,071.12 |
| Max. Negotiated Rate |
$28,284.48 |
| Rate for Payer: Aetna Managed Medicare |
$7,071.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17,483.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,081.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,278.00
|
| Rate for Payer: Anthem Medicare Advantage |
$7,071.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,071.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,071.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,071.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,339.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,071.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26,304.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,071.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,071.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,071.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,071.12
|
| Rate for Payer: NAPHCARE Commercial |
$10,606.68
|
| Rate for Payer: Quartz Medicare Advantage |
$7,071.12
|
| Rate for Payer: The Alliance Commercial |
$28,284.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,071.12
|
| Rate for Payer: United Healthcare PPO |
$8,452.00
|
| Rate for Payer: Wellcare Medicare |
$7,071.12
|
|
