|
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 |
$1,661.30 |
| Max. Negotiated Rate |
$3,119.17 |
| Rate for Payer: Aetna Commercial |
$3,051.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,915.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,796.91
|
| Rate for Payer: Cash Price |
$978.00
|
| Rate for Payer: Cigna Commercial |
$3,119.17
|
| Rate for Payer: Health EOS Commercial |
$3,017.46
|
| Rate for Payer: HFN Commercial |
$3,119.17
|
| Rate for Payer: Multiplan Commercial |
$2,712.32
|
| Rate for Payer: Preferred Network Access Commercial |
$3,119.17
|
| Rate for Payer: Quartz Beloit One Network |
$1,661.30
|
| Rate for Payer: Quartz Commercial |
$2,034.24
|
| Rate for Payer: WEA Trust Commercial |
$1,864.72
|
| Rate for Payer: WPS Commercial |
$2,511.18
|
|
|
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 |
$949.31 |
| Max. Negotiated Rate |
$3,119.17 |
| Rate for Payer: Aetna Commercial |
$3,051.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,915.74
|
| Rate for Payer: Aetna Managed Medicare |
$949.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,203.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,695.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,627.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,796.91
|
| Rate for Payer: Cash Price |
$978.00
|
| Rate for Payer: Cigna Commercial |
$3,119.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,897.32
|
| Rate for Payer: Health EOS Commercial |
$3,017.46
|
| Rate for Payer: HFN Commercial |
$3,119.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,542.80
|
| Rate for Payer: Multiplan Commercial |
$2,712.32
|
| Rate for Payer: NAPHCARE Commercial |
$2,034.24
|
| Rate for Payer: Preferred Network Access Commercial |
$3,119.17
|
| Rate for Payer: Quartz Beloit One Network |
$1,661.30
|
| Rate for Payer: Quartz Commercial |
$2,203.76
|
| Rate for Payer: Quartz Medicare Advantage |
$2,034.24
|
| Rate for Payer: The Alliance Commercial |
$1,695.20
|
| Rate for Payer: WEA Trust Commercial |
$1,864.72
|
| Rate for Payer: WPS Commercial |
$2,511.18
|
|
|
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 |
$949.31 |
| Max. Negotiated Rate |
$3,119.17 |
| Rate for Payer: Aetna Commercial |
$3,051.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,915.74
|
| Rate for Payer: Aetna Managed Medicare |
$949.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,203.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,695.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,627.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,796.91
|
| Rate for Payer: Cash Price |
$978.00
|
| Rate for Payer: Cigna Commercial |
$3,119.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,897.32
|
| Rate for Payer: Health EOS Commercial |
$3,017.46
|
| Rate for Payer: HFN Commercial |
$3,119.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,542.80
|
| Rate for Payer: Multiplan Commercial |
$2,712.32
|
| Rate for Payer: NAPHCARE Commercial |
$2,034.24
|
| Rate for Payer: Preferred Network Access Commercial |
$3,119.17
|
| Rate for Payer: Quartz Beloit One Network |
$1,661.30
|
| Rate for Payer: Quartz Commercial |
$2,203.76
|
| Rate for Payer: Quartz Medicare Advantage |
$2,034.24
|
| Rate for Payer: The Alliance Commercial |
$1,695.20
|
| Rate for Payer: WEA Trust Commercial |
$1,864.72
|
| Rate for Payer: WPS Commercial |
$2,511.18
|
|
|
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 |
$1,661.30 |
| Max. Negotiated Rate |
$3,119.17 |
| Rate for Payer: Aetna Commercial |
$3,051.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,915.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,796.91
|
| Rate for Payer: Cash Price |
$978.00
|
| Rate for Payer: Cigna Commercial |
$3,119.17
|
| Rate for Payer: Health EOS Commercial |
$3,017.46
|
| Rate for Payer: HFN Commercial |
$3,119.17
|
| Rate for Payer: Multiplan Commercial |
$2,712.32
|
| Rate for Payer: Preferred Network Access Commercial |
$3,119.17
|
| Rate for Payer: Quartz Beloit One Network |
$1,661.30
|
| Rate for Payer: Quartz Commercial |
$2,034.24
|
| Rate for Payer: WEA Trust Commercial |
$1,864.72
|
| Rate for Payer: WPS Commercial |
$2,511.18
|
|
|
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 |
$617.64 |
| Max. Negotiated Rate |
$1,159.64 |
| Rate for Payer: Aetna Commercial |
$1,134.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,084.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$668.05
|
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Cigna Commercial |
$1,159.64
|
| Rate for Payer: Health EOS Commercial |
$1,121.83
|
| Rate for Payer: HFN Commercial |
$1,159.64
|
| Rate for Payer: Multiplan Commercial |
$1,008.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,159.64
|
| Rate for Payer: Quartz Beloit One Network |
$617.64
|
| Rate for Payer: Quartz Commercial |
$756.29
|
| Rate for Payer: WEA Trust Commercial |
$693.26
|
| Rate for Payer: WPS Commercial |
$933.60
|
|
|
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 |
$352.93 |
| Max. Negotiated Rate |
$1,159.64 |
| Rate for Payer: Aetna Commercial |
$1,134.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,084.01
|
| Rate for Payer: Aetna Managed Medicare |
$352.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$819.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$630.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$605.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$668.05
|
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Cigna Commercial |
$1,159.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$705.38
|
| Rate for Payer: Health EOS Commercial |
$1,121.83
|
| Rate for Payer: HFN Commercial |
$1,159.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$945.36
|
| Rate for Payer: Multiplan Commercial |
$1,008.38
|
| Rate for Payer: NAPHCARE Commercial |
$756.29
|
| Rate for Payer: Preferred Network Access Commercial |
$1,159.64
|
| Rate for Payer: Quartz Beloit One Network |
$617.64
|
| Rate for Payer: Quartz Commercial |
$819.31
|
| Rate for Payer: Quartz Medicare Advantage |
$756.29
|
| Rate for Payer: The Alliance Commercial |
$630.24
|
| Rate for Payer: WEA Trust Commercial |
$693.26
|
| Rate for Payer: WPS Commercial |
$933.60
|
|
|
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 |
$2,896.57 |
| Max. Negotiated Rate |
$5,438.45 |
| Rate for Payer: Aetna Commercial |
$5,320.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,083.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,133.02
|
| Rate for Payer: Cash Price |
$1,705.20
|
| Rate for Payer: Cigna Commercial |
$5,438.45
|
| Rate for Payer: Health EOS Commercial |
$5,261.11
|
| Rate for Payer: HFN Commercial |
$5,438.45
|
| Rate for Payer: Multiplan Commercial |
$4,729.09
|
| Rate for Payer: Preferred Network Access Commercial |
$5,438.45
|
| Rate for Payer: Quartz Beloit One Network |
$2,896.57
|
| Rate for Payer: Quartz Commercial |
$3,546.82
|
| Rate for Payer: WEA Trust Commercial |
$3,251.25
|
| Rate for Payer: WPS Commercial |
$4,378.39
|
|
|
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 |
$1,655.18 |
| Max. Negotiated Rate |
$5,438.45 |
| Rate for Payer: Aetna Commercial |
$5,320.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,083.77
|
| Rate for Payer: Aetna Managed Medicare |
$1,655.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,842.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,955.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,837.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,133.02
|
| Rate for Payer: Cash Price |
$1,705.20
|
| Rate for Payer: Cigna Commercial |
$5,438.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,308.09
|
| Rate for Payer: Health EOS Commercial |
$5,261.11
|
| Rate for Payer: HFN Commercial |
$5,438.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,433.52
|
| Rate for Payer: Multiplan Commercial |
$4,729.09
|
| Rate for Payer: NAPHCARE Commercial |
$3,546.82
|
| Rate for Payer: Preferred Network Access Commercial |
$5,438.45
|
| Rate for Payer: Quartz Beloit One Network |
$2,896.57
|
| Rate for Payer: Quartz Commercial |
$3,842.38
|
| Rate for Payer: Quartz Medicare Advantage |
$3,546.82
|
| Rate for Payer: The Alliance Commercial |
$2,955.68
|
| Rate for Payer: WEA Trust Commercial |
$3,251.25
|
| Rate for Payer: WPS Commercial |
$4,378.39
|
|
|
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 |
$2,681.01 |
| Max. Negotiated Rate |
$5,033.72 |
| Rate for Payer: Aetna Commercial |
$4,924.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,705.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,899.86
|
| Rate for Payer: Cash Price |
$1,578.30
|
| Rate for Payer: Cigna Commercial |
$5,033.72
|
| Rate for Payer: Health EOS Commercial |
$4,869.58
|
| Rate for Payer: HFN Commercial |
$5,033.72
|
| Rate for Payer: Multiplan Commercial |
$4,377.15
|
| Rate for Payer: Preferred Network Access Commercial |
$5,033.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,681.01
|
| Rate for Payer: Quartz Commercial |
$3,282.86
|
| Rate for Payer: WEA Trust Commercial |
$3,009.29
|
| Rate for Payer: WPS Commercial |
$4,052.55
|
|
|
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 |
$1,532.00 |
| Max. Negotiated Rate |
$5,033.72 |
| Rate for Payer: Aetna Commercial |
$4,924.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,705.44
|
| Rate for Payer: Aetna Managed Medicare |
$1,532.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,556.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,735.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,626.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,899.86
|
| Rate for Payer: Cash Price |
$1,578.30
|
| Rate for Payer: Cigna Commercial |
$5,033.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,061.90
|
| Rate for Payer: Health EOS Commercial |
$4,869.58
|
| Rate for Payer: HFN Commercial |
$5,033.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,103.58
|
| Rate for Payer: Multiplan Commercial |
$4,377.15
|
| Rate for Payer: NAPHCARE Commercial |
$3,282.86
|
| Rate for Payer: Preferred Network Access Commercial |
$5,033.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,681.01
|
| Rate for Payer: Quartz Commercial |
$3,556.44
|
| Rate for Payer: Quartz Medicare Advantage |
$3,282.86
|
| Rate for Payer: The Alliance Commercial |
$2,735.72
|
| Rate for Payer: WEA Trust Commercial |
$3,009.29
|
| Rate for Payer: WPS Commercial |
$4,052.55
|
|
|
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 |
$1,594.03 |
| Max. Negotiated Rate |
$5,237.52 |
| Rate for Payer: Aetna Commercial |
$5,123.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,895.95
|
| Rate for Payer: Aetna Managed Medicare |
$1,594.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,700.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,846.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,732.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,017.27
|
| Rate for Payer: Cash Price |
$1,642.20
|
| Rate for Payer: Cigna Commercial |
$5,237.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,185.87
|
| Rate for Payer: Health EOS Commercial |
$5,066.73
|
| Rate for Payer: HFN Commercial |
$5,237.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,269.72
|
| Rate for Payer: Multiplan Commercial |
$4,554.37
|
| Rate for Payer: NAPHCARE Commercial |
$3,415.78
|
| Rate for Payer: Preferred Network Access Commercial |
$5,237.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,789.55
|
| Rate for Payer: Quartz Commercial |
$3,700.42
|
| Rate for Payer: Quartz Medicare Advantage |
$3,415.78
|
| Rate for Payer: The Alliance Commercial |
$2,846.48
|
| Rate for Payer: WEA Trust Commercial |
$3,131.13
|
| Rate for Payer: WPS Commercial |
$4,216.62
|
|
|
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 |
$2,789.55 |
| Max. Negotiated Rate |
$5,237.52 |
| Rate for Payer: Aetna Commercial |
$5,123.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,895.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,017.27
|
| Rate for Payer: Cash Price |
$1,642.20
|
| Rate for Payer: Cigna Commercial |
$5,237.52
|
| Rate for Payer: Health EOS Commercial |
$5,066.73
|
| Rate for Payer: HFN Commercial |
$5,237.52
|
| Rate for Payer: Multiplan Commercial |
$4,554.37
|
| Rate for Payer: Preferred Network Access Commercial |
$5,237.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,789.55
|
| Rate for Payer: Quartz Commercial |
$3,415.78
|
| Rate for Payer: WEA Trust Commercial |
$3,131.13
|
| Rate for Payer: WPS Commercial |
$4,216.62
|
|
|
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 |
$1,594.03 |
| Max. Negotiated Rate |
$5,237.52 |
| Rate for Payer: Aetna Commercial |
$5,123.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,895.95
|
| Rate for Payer: Aetna Managed Medicare |
$1,594.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,700.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,846.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,732.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,017.27
|
| Rate for Payer: Cash Price |
$1,642.20
|
| Rate for Payer: Cigna Commercial |
$5,237.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,185.87
|
| Rate for Payer: Health EOS Commercial |
$5,066.73
|
| Rate for Payer: HFN Commercial |
$5,237.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,269.72
|
| Rate for Payer: Multiplan Commercial |
$4,554.37
|
| Rate for Payer: NAPHCARE Commercial |
$3,415.78
|
| Rate for Payer: Preferred Network Access Commercial |
$5,237.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,789.55
|
| Rate for Payer: Quartz Commercial |
$3,700.42
|
| Rate for Payer: Quartz Medicare Advantage |
$3,415.78
|
| Rate for Payer: The Alliance Commercial |
$2,846.48
|
| Rate for Payer: WEA Trust Commercial |
$3,131.13
|
| Rate for Payer: WPS Commercial |
$4,216.62
|
|
|
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 |
$2,789.55 |
| Max. Negotiated Rate |
$5,237.52 |
| Rate for Payer: Aetna Commercial |
$5,123.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,895.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,017.27
|
| Rate for Payer: Cash Price |
$1,642.20
|
| Rate for Payer: Cigna Commercial |
$5,237.52
|
| Rate for Payer: Health EOS Commercial |
$5,066.73
|
| Rate for Payer: HFN Commercial |
$5,237.52
|
| Rate for Payer: Multiplan Commercial |
$4,554.37
|
| Rate for Payer: Preferred Network Access Commercial |
$5,237.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,789.55
|
| Rate for Payer: Quartz Commercial |
$3,415.78
|
| Rate for Payer: WEA Trust Commercial |
$3,131.13
|
| Rate for Payer: WPS Commercial |
$4,216.62
|
|
|
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 |
$1,594.03 |
| Max. Negotiated Rate |
$5,237.52 |
| Rate for Payer: Aetna Commercial |
$5,123.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,895.95
|
| Rate for Payer: Aetna Managed Medicare |
$1,594.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,700.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,846.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,732.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,017.27
|
| Rate for Payer: Cash Price |
$1,642.20
|
| Rate for Payer: Cigna Commercial |
$5,237.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,185.87
|
| Rate for Payer: Health EOS Commercial |
$5,066.73
|
| Rate for Payer: HFN Commercial |
$5,237.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,269.72
|
| Rate for Payer: Multiplan Commercial |
$4,554.37
|
| Rate for Payer: NAPHCARE Commercial |
$3,415.78
|
| Rate for Payer: Preferred Network Access Commercial |
$5,237.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,789.55
|
| Rate for Payer: Quartz Commercial |
$3,700.42
|
| Rate for Payer: Quartz Medicare Advantage |
$3,415.78
|
| Rate for Payer: The Alliance Commercial |
$2,846.48
|
| Rate for Payer: WEA Trust Commercial |
$3,131.13
|
| Rate for Payer: WPS Commercial |
$4,216.62
|
|
|
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 |
$2,789.55 |
| Max. Negotiated Rate |
$5,237.52 |
| Rate for Payer: Aetna Commercial |
$5,123.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,895.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,017.27
|
| Rate for Payer: Cash Price |
$1,642.20
|
| Rate for Payer: Cigna Commercial |
$5,237.52
|
| Rate for Payer: Health EOS Commercial |
$5,066.73
|
| Rate for Payer: HFN Commercial |
$5,237.52
|
| Rate for Payer: Multiplan Commercial |
$4,554.37
|
| Rate for Payer: Preferred Network Access Commercial |
$5,237.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,789.55
|
| Rate for Payer: Quartz Commercial |
$3,415.78
|
| Rate for Payer: WEA Trust Commercial |
$3,131.13
|
| Rate for Payer: WPS Commercial |
$4,216.62
|
|
|
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 |
$1,416.98 |
| Max. Negotiated Rate |
$4,655.79 |
| Rate for Payer: Aetna Commercial |
$4,554.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,352.15
|
| Rate for Payer: Aetna Managed Medicare |
$1,416.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,289.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,530.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,429.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,682.14
|
| Rate for Payer: Cash Price |
$1,459.80
|
| Rate for Payer: Cigna Commercial |
$4,655.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,832.01
|
| Rate for Payer: Health EOS Commercial |
$4,503.97
|
| Rate for Payer: HFN Commercial |
$4,655.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,795.48
|
| Rate for Payer: Multiplan Commercial |
$4,048.51
|
| Rate for Payer: NAPHCARE Commercial |
$3,036.38
|
| Rate for Payer: Preferred Network Access Commercial |
$4,655.79
|
| Rate for Payer: Quartz Beloit One Network |
$2,479.71
|
| Rate for Payer: Quartz Commercial |
$3,289.42
|
| Rate for Payer: Quartz Medicare Advantage |
$3,036.38
|
| Rate for Payer: The Alliance Commercial |
$2,530.32
|
| Rate for Payer: WEA Trust Commercial |
$2,783.35
|
| Rate for Payer: WPS Commercial |
$3,748.28
|
|
|
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 |
$2,479.71 |
| Max. Negotiated Rate |
$4,655.79 |
| Rate for Payer: Aetna Commercial |
$4,554.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,352.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,682.14
|
| Rate for Payer: Cash Price |
$1,459.80
|
| Rate for Payer: Cigna Commercial |
$4,655.79
|
| Rate for Payer: Health EOS Commercial |
$4,503.97
|
| Rate for Payer: HFN Commercial |
$4,655.79
|
| Rate for Payer: Multiplan Commercial |
$4,048.51
|
| Rate for Payer: Preferred Network Access Commercial |
$4,655.79
|
| Rate for Payer: Quartz Beloit One Network |
$2,479.71
|
| Rate for Payer: Quartz Commercial |
$3,036.38
|
| Rate for Payer: WEA Trust Commercial |
$2,783.35
|
| Rate for Payer: WPS Commercial |
$3,748.28
|
|
|
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 |
$2,896.57 |
| Max. Negotiated Rate |
$5,438.45 |
| Rate for Payer: Aetna Commercial |
$5,320.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,083.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,133.02
|
| Rate for Payer: Cash Price |
$1,705.20
|
| Rate for Payer: Cigna Commercial |
$5,438.45
|
| Rate for Payer: Health EOS Commercial |
$5,261.11
|
| Rate for Payer: HFN Commercial |
$5,438.45
|
| Rate for Payer: Multiplan Commercial |
$4,729.09
|
| Rate for Payer: Preferred Network Access Commercial |
$5,438.45
|
| Rate for Payer: Quartz Beloit One Network |
$2,896.57
|
| Rate for Payer: Quartz Commercial |
$3,546.82
|
| Rate for Payer: WEA Trust Commercial |
$3,251.25
|
| Rate for Payer: WPS Commercial |
$4,378.39
|
|
|
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 |
$1,655.18 |
| Max. Negotiated Rate |
$5,438.45 |
| Rate for Payer: Aetna Commercial |
$5,320.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,083.77
|
| Rate for Payer: Aetna Managed Medicare |
$1,655.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,842.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,955.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,837.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,133.02
|
| Rate for Payer: Cash Price |
$1,705.20
|
| Rate for Payer: Cigna Commercial |
$5,438.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,308.09
|
| Rate for Payer: Health EOS Commercial |
$5,261.11
|
| Rate for Payer: HFN Commercial |
$5,438.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,433.52
|
| Rate for Payer: Multiplan Commercial |
$4,729.09
|
| Rate for Payer: NAPHCARE Commercial |
$3,546.82
|
| Rate for Payer: Preferred Network Access Commercial |
$5,438.45
|
| Rate for Payer: Quartz Beloit One Network |
$2,896.57
|
| Rate for Payer: Quartz Commercial |
$3,842.38
|
| Rate for Payer: Quartz Medicare Advantage |
$3,546.82
|
| Rate for Payer: The Alliance Commercial |
$2,955.68
|
| Rate for Payer: WEA Trust Commercial |
$3,251.25
|
| Rate for Payer: WPS Commercial |
$4,378.39
|
|
|
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 |
$2,579.09 |
| Max. Negotiated Rate |
$4,842.36 |
| Rate for Payer: Aetna Commercial |
$4,737.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,526.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,789.62
|
| Rate for Payer: Cash Price |
$1,518.30
|
| Rate for Payer: Cigna Commercial |
$4,842.36
|
| Rate for Payer: Health EOS Commercial |
$4,684.46
|
| Rate for Payer: HFN Commercial |
$4,842.36
|
| Rate for Payer: Multiplan Commercial |
$4,210.75
|
| Rate for Payer: Preferred Network Access Commercial |
$4,842.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,579.09
|
| Rate for Payer: Quartz Commercial |
$3,158.06
|
| Rate for Payer: WEA Trust Commercial |
$2,894.89
|
| Rate for Payer: WPS Commercial |
$3,898.49
|
|
|
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 |
$1,473.76 |
| Max. Negotiated Rate |
$4,842.36 |
| Rate for Payer: Aetna Commercial |
$4,737.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,526.56
|
| Rate for Payer: Aetna Managed Medicare |
$1,473.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,421.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,631.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,526.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,789.62
|
| Rate for Payer: Cash Price |
$1,518.30
|
| Rate for Payer: Cigna Commercial |
$4,842.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,945.50
|
| Rate for Payer: Health EOS Commercial |
$4,684.46
|
| Rate for Payer: HFN Commercial |
$4,842.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,947.58
|
| Rate for Payer: Multiplan Commercial |
$4,210.75
|
| Rate for Payer: NAPHCARE Commercial |
$3,158.06
|
| Rate for Payer: Preferred Network Access Commercial |
$4,842.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,579.09
|
| Rate for Payer: Quartz Commercial |
$3,421.24
|
| Rate for Payer: Quartz Medicare Advantage |
$3,158.06
|
| Rate for Payer: The Alliance Commercial |
$2,631.72
|
| Rate for Payer: WEA Trust Commercial |
$2,894.89
|
| Rate for Payer: WPS Commercial |
$3,898.49
|
|
|
LAG SCREW TFNA 85MM 04.038.085S
|
Facility
|
IP
|
$5,684.00
|
|
| Hospital Charge Code |
4519978
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,896.57 |
| Max. Negotiated Rate |
$5,438.45 |
| Rate for Payer: Aetna Commercial |
$5,320.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,083.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,133.02
|
| Rate for Payer: Cash Price |
$1,705.20
|
| Rate for Payer: Cigna Commercial |
$5,438.45
|
| Rate for Payer: Health EOS Commercial |
$5,261.11
|
| Rate for Payer: HFN Commercial |
$5,438.45
|
| Rate for Payer: Multiplan Commercial |
$4,729.09
|
| Rate for Payer: Preferred Network Access Commercial |
$5,438.45
|
| Rate for Payer: Quartz Beloit One Network |
$2,896.57
|
| Rate for Payer: Quartz Commercial |
$3,546.82
|
| Rate for Payer: WEA Trust Commercial |
$3,251.25
|
| Rate for Payer: WPS Commercial |
$4,378.39
|
|
|
LAG SCREW TFNA 85MM 04.038.085S
|
Facility
|
OP
|
$5,684.00
|
|
| Hospital Charge Code |
4519978
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,655.18 |
| Max. Negotiated Rate |
$5,438.45 |
| Rate for Payer: Aetna Commercial |
$5,320.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,083.77
|
| Rate for Payer: Aetna Managed Medicare |
$1,655.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,842.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,955.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,837.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,133.02
|
| Rate for Payer: Cash Price |
$1,705.20
|
| Rate for Payer: Cigna Commercial |
$5,438.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,308.09
|
| Rate for Payer: Health EOS Commercial |
$5,261.11
|
| Rate for Payer: HFN Commercial |
$5,438.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,433.52
|
| Rate for Payer: Multiplan Commercial |
$4,729.09
|
| Rate for Payer: NAPHCARE Commercial |
$3,546.82
|
| Rate for Payer: Preferred Network Access Commercial |
$5,438.45
|
| Rate for Payer: Quartz Beloit One Network |
$2,896.57
|
| Rate for Payer: Quartz Commercial |
$3,842.38
|
| Rate for Payer: Quartz Medicare Advantage |
$3,546.82
|
| Rate for Payer: The Alliance Commercial |
$2,955.68
|
| Rate for Payer: WEA Trust Commercial |
$3,251.25
|
| Rate for Payer: WPS Commercial |
$4,378.39
|
|
|
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 |
$224.81 |
| Max. Negotiated Rate |
$738.65 |
| Rate for Payer: Aetna Commercial |
$722.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$690.48
|
| Rate for Payer: Aetna Managed Medicare |
$224.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$521.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$401.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$385.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$425.53
|
| Rate for Payer: Cash Price |
$231.60
|
| Rate for Payer: Cigna Commercial |
$738.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$449.30
|
| Rate for Payer: Health EOS Commercial |
$714.56
|
| Rate for Payer: HFN Commercial |
$738.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$602.16
|
| Rate for Payer: Multiplan Commercial |
$642.30
|
| Rate for Payer: NAPHCARE Commercial |
$481.73
|
| Rate for Payer: Preferred Network Access Commercial |
$738.65
|
| Rate for Payer: Quartz Beloit One Network |
$393.41
|
| Rate for Payer: Quartz Commercial |
$521.87
|
| Rate for Payer: Quartz Medicare Advantage |
$481.73
|
| Rate for Payer: The Alliance Commercial |
$401.44
|
| Rate for Payer: WEA Trust Commercial |
$441.58
|
| Rate for Payer: WPS Commercial |
$594.67
|
|
