|
LAFORTE OSTEOTOMY
|
Facility
|
OP
|
$6,808.00
|
|
| Hospital Charge Code |
2960171
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,982.49 |
| Max. Negotiated Rate |
$6,513.89 |
| Rate for Payer: Aetna Commercial |
$6,372.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,089.08
|
| Rate for Payer: Aetna Managed Medicare |
$1,982.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,602.21
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,540.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,398.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,752.57
|
| Rate for Payer: Cash Price |
$2,042.40
|
| Rate for Payer: Cigna Commercial |
$6,513.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,962.26
|
| Rate for Payer: Health EOS Commercial |
$6,301.48
|
| Rate for Payer: HFN Commercial |
$6,513.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,310.24
|
| Rate for Payer: Multiplan Commercial |
$5,664.26
|
| Rate for Payer: NAPHCARE Commercial |
$4,248.19
|
| Rate for Payer: Preferred Network Access Commercial |
$6,513.89
|
| Rate for Payer: Quartz Beloit One Network |
$3,469.36
|
| Rate for Payer: Quartz Commercial |
$4,602.21
|
| Rate for Payer: Quartz Medicare Advantage |
$4,248.19
|
| Rate for Payer: The Alliance Commercial |
$3,540.16
|
| Rate for Payer: WEA Trust Commercial |
$3,894.18
|
| Rate for Payer: WPS Commercial |
$5,244.20
|
|
|
LAG SCREW 105MM TFNA FENESTRATED 04.038.205S
|
Facility
|
IP
|
$5,474.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5520875
|
|
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 105MM TFNA FENESTRATED 04.038.205S
|
Facility
|
OP
|
$5,474.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5520875
|
|
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 10.5X75MM TI 3060-0075S
|
Facility
|
OP
|
$4,429.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4518614
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,289.72 |
| Max. Negotiated Rate |
$4,237.67 |
| Rate for Payer: Aetna Commercial |
$4,145.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,961.30
|
| Rate for Payer: Aetna Managed Medicare |
$1,289.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,994.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,303.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,210.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,441.26
|
| Rate for Payer: Cash Price |
$1,328.70
|
| Rate for Payer: Cigna Commercial |
$4,237.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,577.68
|
| Rate for Payer: Health EOS Commercial |
$4,099.48
|
| Rate for Payer: HFN Commercial |
$4,237.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,454.62
|
| Rate for Payer: Multiplan Commercial |
$3,684.93
|
| Rate for Payer: NAPHCARE Commercial |
$2,763.70
|
| Rate for Payer: Preferred Network Access Commercial |
$4,237.67
|
| Rate for Payer: Quartz Beloit One Network |
$2,257.02
|
| Rate for Payer: Quartz Commercial |
$2,994.00
|
| Rate for Payer: Quartz Medicare Advantage |
$2,763.70
|
| Rate for Payer: The Alliance Commercial |
$2,303.08
|
| Rate for Payer: WEA Trust Commercial |
$2,533.39
|
| Rate for Payer: WPS Commercial |
$3,411.66
|
|
|
LAG SCREW 10.5X75MM TI 3060-0075S
|
Facility
|
IP
|
$4,429.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4518614
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,257.02 |
| Max. Negotiated Rate |
$4,237.67 |
| Rate for Payer: Aetna Commercial |
$4,145.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,961.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,441.26
|
| Rate for Payer: Cash Price |
$1,328.70
|
| Rate for Payer: Cigna Commercial |
$4,237.67
|
| Rate for Payer: Health EOS Commercial |
$4,099.48
|
| Rate for Payer: HFN Commercial |
$4,237.67
|
| Rate for Payer: Multiplan Commercial |
$3,684.93
|
| Rate for Payer: Preferred Network Access Commercial |
$4,237.67
|
| Rate for Payer: Quartz Beloit One Network |
$2,257.02
|
| Rate for Payer: Quartz Commercial |
$2,763.70
|
| Rate for Payer: WEA Trust Commercial |
$2,533.39
|
| Rate for Payer: WPS Commercial |
$3,411.66
|
|
|
LAG SCREW 110MM OMEGA 3362-5-110
|
Facility
|
IP
|
$2,536.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5729872
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,292.35 |
| Max. Negotiated Rate |
$2,426.44 |
| Rate for Payer: Aetna Commercial |
$2,373.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,268.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,397.84
|
| Rate for Payer: Cash Price |
$760.80
|
| Rate for Payer: Cigna Commercial |
$2,426.44
|
| Rate for Payer: Health EOS Commercial |
$2,347.32
|
| Rate for Payer: HFN Commercial |
$2,426.44
|
| Rate for Payer: Multiplan Commercial |
$2,109.95
|
| Rate for Payer: Preferred Network Access Commercial |
$2,426.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,292.35
|
| Rate for Payer: Quartz Commercial |
$1,582.46
|
| Rate for Payer: WEA Trust Commercial |
$1,450.59
|
| Rate for Payer: WPS Commercial |
$1,953.48
|
|
|
LAG SCREW 110MM OMEGA 3362-5-110
|
Facility
|
OP
|
$2,536.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5729872
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$738.48 |
| Max. Negotiated Rate |
$2,426.44 |
| Rate for Payer: Aetna Commercial |
$2,373.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,268.20
|
| Rate for Payer: Aetna Managed Medicare |
$738.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,714.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,318.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,265.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,397.84
|
| Rate for Payer: Cash Price |
$760.80
|
| Rate for Payer: Cigna Commercial |
$2,426.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,475.95
|
| Rate for Payer: Health EOS Commercial |
$2,347.32
|
| Rate for Payer: HFN Commercial |
$2,426.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,978.08
|
| Rate for Payer: Multiplan Commercial |
$2,109.95
|
| Rate for Payer: NAPHCARE Commercial |
$1,582.46
|
| Rate for Payer: Preferred Network Access Commercial |
$2,426.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,292.35
|
| Rate for Payer: Quartz Commercial |
$1,714.34
|
| Rate for Payer: Quartz Medicare Advantage |
$1,582.46
|
| Rate for Payer: The Alliance Commercial |
$1,318.72
|
| Rate for Payer: WEA Trust Commercial |
$1,450.59
|
| Rate for Payer: WPS Commercial |
$1,953.48
|
|
|
LAG SCREW 120MM TFNA FENESTRATED 04.038.220S
|
Facility
|
OP
|
$5,261.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5517290
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,532.00 |
| 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 120MM TFNA FENESTRATED 04.038.220S
|
Facility
|
IP
|
$5,261.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5517290
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,681.01 |
| 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 3.5 X 22 ORTHOLOC 3Di CROSSCHECK 5820X3522
|
Facility
|
OP
|
$3,235.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6174332
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$942.03 |
| Max. Negotiated Rate |
$3,095.25 |
| Rate for Payer: Aetna Commercial |
$3,027.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,893.38
|
| Rate for Payer: Aetna Managed Medicare |
$942.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,186.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,682.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,614.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,783.13
|
| Rate for Payer: Cash Price |
$970.50
|
| Rate for Payer: Cigna Commercial |
$3,095.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,882.77
|
| Rate for Payer: Health EOS Commercial |
$2,994.32
|
| Rate for Payer: HFN Commercial |
$3,095.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,523.30
|
| Rate for Payer: Multiplan Commercial |
$2,691.52
|
| Rate for Payer: NAPHCARE Commercial |
$2,018.64
|
| Rate for Payer: Preferred Network Access Commercial |
$3,095.25
|
| Rate for Payer: Quartz Beloit One Network |
$1,648.56
|
| Rate for Payer: Quartz Commercial |
$2,186.86
|
| Rate for Payer: Quartz Medicare Advantage |
$2,018.64
|
| Rate for Payer: The Alliance Commercial |
$1,682.20
|
| Rate for Payer: WEA Trust Commercial |
$1,850.42
|
| Rate for Payer: WPS Commercial |
$2,491.92
|
|
|
LAG SCREW 3.5 X 22 ORTHOLOC 3Di CROSSCHECK 5820X3522
|
Facility
|
IP
|
$3,235.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6174332
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,648.56 |
| Max. Negotiated Rate |
$3,095.25 |
| Rate for Payer: Aetna Commercial |
$3,027.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,893.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,783.13
|
| Rate for Payer: Cash Price |
$970.50
|
| Rate for Payer: Cigna Commercial |
$3,095.25
|
| Rate for Payer: Health EOS Commercial |
$2,994.32
|
| Rate for Payer: HFN Commercial |
$3,095.25
|
| Rate for Payer: Multiplan Commercial |
$2,691.52
|
| Rate for Payer: Preferred Network Access Commercial |
$3,095.25
|
| Rate for Payer: Quartz Beloit One Network |
$1,648.56
|
| Rate for Payer: Quartz Commercial |
$2,018.64
|
| Rate for Payer: WEA Trust Commercial |
$1,850.42
|
| Rate for Payer: WPS Commercial |
$2,491.92
|
|
|
LAG SCREW 3.5 X 24 ORTHOLOC 3Di CROSSCHECK 5820X3524
|
Facility
|
OP
|
$3,111.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6182386
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$905.92 |
| Max. Negotiated Rate |
$2,976.60 |
| Rate for Payer: Aetna Commercial |
$2,911.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,782.48
|
| Rate for Payer: Aetna Managed Medicare |
$905.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,103.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,617.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,553.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,714.78
|
| Rate for Payer: Cash Price |
$933.30
|
| Rate for Payer: Cigna Commercial |
$2,976.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,810.60
|
| Rate for Payer: Health EOS Commercial |
$2,879.54
|
| Rate for Payer: HFN Commercial |
$2,976.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,426.58
|
| Rate for Payer: Multiplan Commercial |
$2,588.35
|
| Rate for Payer: NAPHCARE Commercial |
$1,941.26
|
| Rate for Payer: Preferred Network Access Commercial |
$2,976.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,585.37
|
| Rate for Payer: Quartz Commercial |
$2,103.04
|
| Rate for Payer: Quartz Medicare Advantage |
$1,941.26
|
| Rate for Payer: The Alliance Commercial |
$1,617.72
|
| Rate for Payer: WEA Trust Commercial |
$1,779.49
|
| Rate for Payer: WPS Commercial |
$2,396.40
|
|
|
LAG SCREW 3.5 X 24 ORTHOLOC 3Di CROSSCHECK 5820X3524
|
Facility
|
IP
|
$3,111.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6182386
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,585.37 |
| Max. Negotiated Rate |
$2,976.60 |
| Rate for Payer: Aetna Commercial |
$2,911.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,782.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,714.78
|
| Rate for Payer: Cash Price |
$933.30
|
| Rate for Payer: Cigna Commercial |
$2,976.60
|
| Rate for Payer: Health EOS Commercial |
$2,879.54
|
| Rate for Payer: HFN Commercial |
$2,976.60
|
| Rate for Payer: Multiplan Commercial |
$2,588.35
|
| Rate for Payer: Preferred Network Access Commercial |
$2,976.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,585.37
|
| Rate for Payer: Quartz Commercial |
$1,941.26
|
| Rate for Payer: WEA Trust Commercial |
$1,779.49
|
| Rate for Payer: WPS Commercial |
$2,396.40
|
|
|
LAG SCREW 3.5 X 26 ORTHOLOC 3Di CROSSCHECK 5820X3526
|
Facility
|
IP
|
$3,820.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5895659
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,946.67 |
| Max. Negotiated Rate |
$3,654.98 |
| Rate for Payer: Aetna Commercial |
$3,575.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,416.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,105.58
|
| Rate for Payer: Cash Price |
$1,146.00
|
| Rate for Payer: Cigna Commercial |
$3,654.98
|
| Rate for Payer: Health EOS Commercial |
$3,535.79
|
| Rate for Payer: HFN Commercial |
$3,654.98
|
| Rate for Payer: Multiplan Commercial |
$3,178.24
|
| Rate for Payer: Preferred Network Access Commercial |
$3,654.98
|
| Rate for Payer: Quartz Beloit One Network |
$1,946.67
|
| Rate for Payer: Quartz Commercial |
$2,383.68
|
| Rate for Payer: WEA Trust Commercial |
$2,185.04
|
| Rate for Payer: WPS Commercial |
$2,942.55
|
|
|
LAG SCREW 3.5 X 26 ORTHOLOC 3Di CROSSCHECK 5820X3526
|
Facility
|
OP
|
$3,820.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5895659
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,112.38 |
| Max. Negotiated Rate |
$3,654.98 |
| Rate for Payer: Aetna Commercial |
$3,575.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,416.61
|
| Rate for Payer: Aetna Managed Medicare |
$1,112.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,582.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,986.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,906.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,105.58
|
| Rate for Payer: Cash Price |
$1,146.00
|
| Rate for Payer: Cigna Commercial |
$3,654.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,223.24
|
| Rate for Payer: Health EOS Commercial |
$3,535.79
|
| Rate for Payer: HFN Commercial |
$3,654.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,979.60
|
| Rate for Payer: Multiplan Commercial |
$3,178.24
|
| Rate for Payer: NAPHCARE Commercial |
$2,383.68
|
| Rate for Payer: Preferred Network Access Commercial |
$3,654.98
|
| Rate for Payer: Quartz Beloit One Network |
$1,946.67
|
| Rate for Payer: Quartz Commercial |
$2,582.32
|
| Rate for Payer: Quartz Medicare Advantage |
$2,383.68
|
| Rate for Payer: The Alliance Commercial |
$1,986.40
|
| Rate for Payer: WEA Trust Commercial |
$2,185.04
|
| Rate for Payer: WPS Commercial |
$2,942.55
|
|
|
LAG SCREW 3.5 X 28 ORTHOLOC 3Di CROSSCHECK 5820X3528
|
Facility
|
OP
|
$3,673.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6099636
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,069.58 |
| Max. Negotiated Rate |
$3,514.33 |
| Rate for Payer: Aetna Commercial |
$3,437.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,285.13
|
| Rate for Payer: Aetna Managed Medicare |
$1,069.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,482.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,909.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,833.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,024.56
|
| Rate for Payer: Cash Price |
$1,101.90
|
| Rate for Payer: Cigna Commercial |
$3,514.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,137.69
|
| Rate for Payer: Health EOS Commercial |
$3,399.73
|
| Rate for Payer: HFN Commercial |
$3,514.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,864.94
|
| Rate for Payer: Multiplan Commercial |
$3,055.94
|
| Rate for Payer: NAPHCARE Commercial |
$2,291.95
|
| Rate for Payer: Preferred Network Access Commercial |
$3,514.33
|
| Rate for Payer: Quartz Beloit One Network |
$1,871.76
|
| Rate for Payer: Quartz Commercial |
$2,482.95
|
| Rate for Payer: Quartz Medicare Advantage |
$2,291.95
|
| Rate for Payer: The Alliance Commercial |
$1,909.96
|
| Rate for Payer: WEA Trust Commercial |
$2,100.96
|
| Rate for Payer: WPS Commercial |
$2,829.31
|
|
|
LAG SCREW 3.5 X 28 ORTHOLOC 3Di CROSSCHECK 5820X3528
|
Facility
|
IP
|
$3,673.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6099636
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,871.76 |
| Max. Negotiated Rate |
$3,514.33 |
| Rate for Payer: Aetna Commercial |
$3,437.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,285.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,024.56
|
| Rate for Payer: Cash Price |
$1,101.90
|
| Rate for Payer: Cigna Commercial |
$3,514.33
|
| Rate for Payer: Health EOS Commercial |
$3,399.73
|
| Rate for Payer: HFN Commercial |
$3,514.33
|
| Rate for Payer: Multiplan Commercial |
$3,055.94
|
| Rate for Payer: Preferred Network Access Commercial |
$3,514.33
|
| Rate for Payer: Quartz Beloit One Network |
$1,871.76
|
| Rate for Payer: Quartz Commercial |
$2,291.95
|
| Rate for Payer: WEA Trust Commercial |
$2,100.96
|
| Rate for Payer: WPS Commercial |
$2,829.31
|
|
|
LAG SCREW 3.5 X 30 ORTHOLOC 3Di CROSSCHECK 5820X3530
|
Facility
|
IP
|
$3,676.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6049634
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,873.29 |
| Max. Negotiated Rate |
$3,517.20 |
| Rate for Payer: Aetna Commercial |
$3,440.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,287.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,026.21
|
| Rate for Payer: Cash Price |
$1,102.80
|
| Rate for Payer: Cigna Commercial |
$3,517.20
|
| Rate for Payer: Health EOS Commercial |
$3,402.51
|
| Rate for Payer: HFN Commercial |
$3,517.20
|
| Rate for Payer: Multiplan Commercial |
$3,058.43
|
| Rate for Payer: Preferred Network Access Commercial |
$3,517.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,873.29
|
| Rate for Payer: Quartz Commercial |
$2,293.82
|
| Rate for Payer: WEA Trust Commercial |
$2,102.67
|
| Rate for Payer: WPS Commercial |
$2,831.62
|
|
|
LAG SCREW 3.5 X 30 ORTHOLOC 3Di CROSSCHECK 5820X3530
|
Facility
|
OP
|
$3,676.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6049634
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,070.45 |
| Max. Negotiated Rate |
$3,517.20 |
| Rate for Payer: Aetna Commercial |
$3,440.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,287.81
|
| Rate for Payer: Aetna Managed Medicare |
$1,070.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,484.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,911.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,835.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,026.21
|
| Rate for Payer: Cash Price |
$1,102.80
|
| Rate for Payer: Cigna Commercial |
$3,517.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,139.43
|
| Rate for Payer: Health EOS Commercial |
$3,402.51
|
| Rate for Payer: HFN Commercial |
$3,517.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,867.28
|
| Rate for Payer: Multiplan Commercial |
$3,058.43
|
| Rate for Payer: NAPHCARE Commercial |
$2,293.82
|
| Rate for Payer: Preferred Network Access Commercial |
$3,517.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,873.29
|
| Rate for Payer: Quartz Commercial |
$2,484.98
|
| Rate for Payer: Quartz Medicare Advantage |
$2,293.82
|
| Rate for Payer: The Alliance Commercial |
$1,911.52
|
| Rate for Payer: WEA Trust Commercial |
$2,102.67
|
| Rate for Payer: WPS Commercial |
$2,831.62
|
|
|
LAG SCREW 3.5 X 32 ORTHOLOC 3Di CROSSCHECK 5820X3532
|
Facility
|
IP
|
$3,111.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6234128
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,585.37 |
| Max. Negotiated Rate |
$2,976.60 |
| Rate for Payer: Aetna Commercial |
$2,911.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,782.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,714.78
|
| Rate for Payer: Cash Price |
$933.30
|
| Rate for Payer: Cigna Commercial |
$2,976.60
|
| Rate for Payer: Health EOS Commercial |
$2,879.54
|
| Rate for Payer: HFN Commercial |
$2,976.60
|
| Rate for Payer: Multiplan Commercial |
$2,588.35
|
| Rate for Payer: Preferred Network Access Commercial |
$2,976.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,585.37
|
| Rate for Payer: Quartz Commercial |
$1,941.26
|
| Rate for Payer: WEA Trust Commercial |
$1,779.49
|
| Rate for Payer: WPS Commercial |
$2,396.40
|
|
|
LAG SCREW 3.5 X 32 ORTHOLOC 3Di CROSSCHECK 5820X3532
|
Facility
|
OP
|
$3,111.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6234128
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$905.92 |
| Max. Negotiated Rate |
$2,976.60 |
| Rate for Payer: Aetna Commercial |
$2,911.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,782.48
|
| Rate for Payer: Aetna Managed Medicare |
$905.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,103.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,617.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,553.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,714.78
|
| Rate for Payer: Cash Price |
$933.30
|
| Rate for Payer: Cigna Commercial |
$2,976.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,810.60
|
| Rate for Payer: Health EOS Commercial |
$2,879.54
|
| Rate for Payer: HFN Commercial |
$2,976.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,426.58
|
| Rate for Payer: Multiplan Commercial |
$2,588.35
|
| Rate for Payer: NAPHCARE Commercial |
$1,941.26
|
| Rate for Payer: Preferred Network Access Commercial |
$2,976.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,585.37
|
| Rate for Payer: Quartz Commercial |
$2,103.04
|
| Rate for Payer: Quartz Medicare Advantage |
$1,941.26
|
| Rate for Payer: The Alliance Commercial |
$1,617.72
|
| Rate for Payer: WEA Trust Commercial |
$1,779.49
|
| Rate for Payer: WPS Commercial |
$2,396.40
|
|
|
LAG SCREW 4.0 x 34 TORNIER
|
Facility
|
IP
|
$2,623.00
|
|
| Hospital Charge Code |
2967358
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,336.68 |
| Max. Negotiated Rate |
$2,509.69 |
| Rate for Payer: Aetna Commercial |
$2,455.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,346.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,445.80
|
| Rate for Payer: Cash Price |
$786.90
|
| Rate for Payer: Cigna Commercial |
$2,509.69
|
| Rate for Payer: Health EOS Commercial |
$2,427.85
|
| Rate for Payer: HFN Commercial |
$2,509.69
|
| Rate for Payer: Multiplan Commercial |
$2,182.34
|
| Rate for Payer: Preferred Network Access Commercial |
$2,509.69
|
| Rate for Payer: Quartz Beloit One Network |
$1,336.68
|
| Rate for Payer: Quartz Commercial |
$1,636.75
|
| Rate for Payer: WEA Trust Commercial |
$1,500.36
|
| Rate for Payer: WPS Commercial |
$2,020.50
|
|
|
LAG SCREW 4.0 x 34 TORNIER
|
Facility
|
OP
|
$2,623.00
|
|
| Hospital Charge Code |
2967358
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$763.82 |
| Max. Negotiated Rate |
$2,509.69 |
| Rate for Payer: Aetna Commercial |
$2,455.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,346.01
|
| Rate for Payer: Aetna Managed Medicare |
$763.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,773.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,363.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,309.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,445.80
|
| Rate for Payer: Cash Price |
$786.90
|
| Rate for Payer: Cigna Commercial |
$2,509.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,526.59
|
| Rate for Payer: Health EOS Commercial |
$2,427.85
|
| Rate for Payer: HFN Commercial |
$2,509.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,045.94
|
| Rate for Payer: Multiplan Commercial |
$2,182.34
|
| Rate for Payer: NAPHCARE Commercial |
$1,636.75
|
| Rate for Payer: Preferred Network Access Commercial |
$2,509.69
|
| Rate for Payer: Quartz Beloit One Network |
$1,336.68
|
| Rate for Payer: Quartz Commercial |
$1,773.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,636.75
|
| Rate for Payer: The Alliance Commercial |
$1,363.96
|
| Rate for Payer: WEA Trust Commercial |
$1,500.36
|
| Rate for Payer: WPS Commercial |
$2,020.50
|
|
|
LAG SCREW 85MM OMEGA 3362-5-085
|
Facility
|
IP
|
$2,364.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6184980
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,204.69 |
| Max. Negotiated Rate |
$2,261.88 |
| Rate for Payer: Aetna Commercial |
$2,212.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,114.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,303.04
|
| Rate for Payer: Cash Price |
$709.20
|
| Rate for Payer: Cigna Commercial |
$2,261.88
|
| Rate for Payer: Health EOS Commercial |
$2,188.12
|
| Rate for Payer: HFN Commercial |
$2,261.88
|
| Rate for Payer: Multiplan Commercial |
$1,966.85
|
| Rate for Payer: Preferred Network Access Commercial |
$2,261.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,204.69
|
| Rate for Payer: Quartz Commercial |
$1,475.14
|
| Rate for Payer: WEA Trust Commercial |
$1,352.21
|
| Rate for Payer: WPS Commercial |
$1,820.99
|
|
|
LAG SCREW 85MM OMEGA 3362-5-085
|
Facility
|
OP
|
$2,364.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6184980
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$688.40 |
| Max. Negotiated Rate |
$2,261.88 |
| Rate for Payer: Aetna Commercial |
$2,212.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,114.36
|
| Rate for Payer: Aetna Managed Medicare |
$688.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,598.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,229.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,180.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,303.04
|
| Rate for Payer: Cash Price |
$709.20
|
| Rate for Payer: Cigna Commercial |
$2,261.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,375.85
|
| Rate for Payer: Health EOS Commercial |
$2,188.12
|
| Rate for Payer: HFN Commercial |
$2,261.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,843.92
|
| Rate for Payer: Multiplan Commercial |
$1,966.85
|
| Rate for Payer: NAPHCARE Commercial |
$1,475.14
|
| Rate for Payer: Preferred Network Access Commercial |
$2,261.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,204.69
|
| Rate for Payer: Quartz Commercial |
$1,598.06
|
| Rate for Payer: Quartz Medicare Advantage |
$1,475.14
|
| Rate for Payer: The Alliance Commercial |
$1,229.28
|
| Rate for Payer: WEA Trust Commercial |
$1,352.21
|
| Rate for Payer: WPS Commercial |
$1,820.99
|
|
