|
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 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 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
|
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 04.038.080S
|
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 04.038.180S
|
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 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 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 04.038.085S
|
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 04.038.185S
|
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
|
|
|
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 |
$393.41 |
| Max. Negotiated Rate |
$738.65 |
| Rate for Payer: Aetna Commercial |
$722.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$690.48
|
| 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: Health EOS Commercial |
$714.56
|
| Rate for Payer: HFN Commercial |
$738.65
|
| Rate for Payer: Multiplan Commercial |
$642.30
|
| Rate for Payer: Preferred Network Access Commercial |
$738.65
|
| Rate for Payer: Quartz Beloit One Network |
$393.41
|
| Rate for Payer: Quartz Commercial |
$481.73
|
| Rate for Payer: WEA Trust Commercial |
$441.58
|
| Rate for Payer: WPS Commercial |
$594.67
|
|
|
LAG SCREW TFNA 90MM 04.038.090S
|
Facility
|
OP
|
$5,684.00
|
|
| Hospital Charge Code |
4641032
|
|
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 90MM 04.038.090S
|
Facility
|
IP
|
$5,684.00
|
|
| Hospital Charge Code |
4641032
|
|
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 90MM 04.038.190S
|
Facility
|
IP
|
$5,474.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5520670
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,789.55 |
| 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 90MM 04.038.190S
|
Facility
|
OP
|
$5,474.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5520670
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,594.03 |
| Max. Negotiated Rate |
$5,237.52 |
| Rate for Payer: Quartz Medicare Advantage |
$3,415.78
|
| 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: 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 95MM 04.038.095S
|
Facility
|
OP
|
$6,267.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4520269
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,824.95 |
| Max. Negotiated Rate |
$5,996.27 |
| Rate for Payer: Aetna Commercial |
$5,865.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,605.20
|
| Rate for Payer: Aetna Managed Medicare |
$1,824.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,236.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,258.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,128.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,454.37
|
| Rate for Payer: Cash Price |
$1,880.10
|
| Rate for Payer: Cigna Commercial |
$5,996.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,647.39
|
| Rate for Payer: Health EOS Commercial |
$5,800.74
|
| Rate for Payer: HFN Commercial |
$5,996.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,888.26
|
| Rate for Payer: Multiplan Commercial |
$5,214.14
|
| Rate for Payer: NAPHCARE Commercial |
$3,910.61
|
| Rate for Payer: Preferred Network Access Commercial |
$5,996.27
|
| Rate for Payer: Quartz Beloit One Network |
$3,193.66
|
| Rate for Payer: Quartz Commercial |
$4,236.49
|
| Rate for Payer: Quartz Medicare Advantage |
$3,910.61
|
| Rate for Payer: The Alliance Commercial |
$3,258.84
|
| Rate for Payer: WEA Trust Commercial |
$3,584.72
|
| Rate for Payer: WPS Commercial |
$4,827.47
|
|
|
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 |
$3,193.66 |
| Max. Negotiated Rate |
$5,996.27 |
| Rate for Payer: Aetna Commercial |
$5,865.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,605.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,454.37
|
| Rate for Payer: Cash Price |
$1,880.10
|
| Rate for Payer: Cigna Commercial |
$5,996.27
|
| Rate for Payer: Health EOS Commercial |
$5,800.74
|
| Rate for Payer: HFN Commercial |
$5,996.27
|
| Rate for Payer: Multiplan Commercial |
$5,214.14
|
| Rate for Payer: Preferred Network Access Commercial |
$5,996.27
|
| Rate for Payer: Quartz Beloit One Network |
$3,193.66
|
| Rate for Payer: Quartz Commercial |
$3,910.61
|
| Rate for Payer: WEA Trust Commercial |
$3,584.72
|
| Rate for Payer: WPS Commercial |
$4,827.47
|
|
|
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 |
$2,789.55 |
| 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 95MM 04.038.195S
|
Facility
|
OP
|
$5,474.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5520832
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,594.03 |
| 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
|
|
|
Lambda Light Chains Free
|
Facility
|
OP
|
$223.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2942940
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.96 |
| Max. Negotiated Rate |
$213.37 |
| Rate for Payer: Aetna Commercial |
$208.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$199.45
|
| Rate for Payer: Aetna Managed Medicare |
$17.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.43
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.81
|
| Rate for Payer: Anthem Medicare Advantage |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$122.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.96
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cigna Commercial |
$213.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$129.79
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.96
|
| Rate for Payer: Health EOS Commercial |
$206.41
|
| Rate for Payer: HFN Commercial |
$213.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.96
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.96
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.96
|
| Rate for Payer: Multiplan Commercial |
$185.54
|
| Rate for Payer: NAPHCARE Commercial |
$26.94
|
| Rate for Payer: Preferred Network Access Commercial |
$213.37
|
| Rate for Payer: Quartz Beloit One Network |
$113.64
|
| Rate for Payer: Quartz Commercial |
$150.75
|
| Rate for Payer: Quartz Medicare Advantage |
$17.96
|
| Rate for Payer: The Alliance Commercial |
$71.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.96
|
| Rate for Payer: United Healthcare PPO |
$173.94
|
| Rate for Payer: WEA Trust Commercial |
$127.56
|
| Rate for Payer: Wellcare Medicare |
$17.96
|
| Rate for Payer: WPS Commercial |
$171.78
|
|
|
Lambda Light Chains Free
|
Professional
|
Both
|
$223.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2942940
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.96 |
| Max. Negotiated Rate |
$220.32 |
| Rate for Payer: Aetna Commercial |
$220.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$199.45
|
| Rate for Payer: Aetna Managed Medicare |
$17.96
|
| Rate for Payer: Anthem Medicare Advantage |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.96
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cigna Commercial |
$220.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$115.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.96
|
| Rate for Payer: Health EOS Commercial |
$211.05
|
| Rate for Payer: HFN Commercial |
$220.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$63.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.96
|
| Rate for Payer: Multiplan Commercial |
$185.54
|
| Rate for Payer: NAPHCARE Commercial |
$26.94
|
| Rate for Payer: Preferred Network Access Commercial |
$220.32
|
| Rate for Payer: Quartz Beloit One Network |
$102.04
|
| Rate for Payer: Quartz Commercial |
$132.19
|
| Rate for Payer: Quartz Medicare Advantage |
$17.96
|
| Rate for Payer: The Alliance Commercial |
$70.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.96
|
| Rate for Payer: WEA Trust Commercial |
$127.56
|
| Rate for Payer: WPS Commercial |
$79.03
|
|
|
Lambda Light Chains Free
|
Facility
|
IP
|
$223.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2942940
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$113.64 |
| Max. Negotiated Rate |
$213.37 |
| Rate for Payer: Aetna Commercial |
$208.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$199.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$122.92
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cigna Commercial |
$213.37
|
| Rate for Payer: Health EOS Commercial |
$206.41
|
| Rate for Payer: HFN Commercial |
$213.37
|
| Rate for Payer: Multiplan Commercial |
$185.54
|
| Rate for Payer: Preferred Network Access Commercial |
$213.37
|
| Rate for Payer: Quartz Beloit One Network |
$113.64
|
| Rate for Payer: Quartz Commercial |
$139.15
|
| Rate for Payer: WEA Trust Commercial |
$127.56
|
| Rate for Payer: WPS Commercial |
$171.78
|
|
|
LAMINECTOMY
|
Facility
|
OP
|
$4,324.00
|
|
| Hospital Charge Code |
2960172
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,259.15 |
| Max. Negotiated Rate |
$4,137.20 |
| Rate for Payer: Aetna Commercial |
$4,047.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,867.39
|
| Rate for Payer: Aetna Managed Medicare |
$1,259.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,923.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,248.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,158.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,383.39
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$4,137.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,516.57
|
| Rate for Payer: Health EOS Commercial |
$4,002.29
|
| Rate for Payer: HFN Commercial |
$4,137.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,372.72
|
| Rate for Payer: Multiplan Commercial |
$3,597.57
|
| Rate for Payer: NAPHCARE Commercial |
$2,698.18
|
| Rate for Payer: Preferred Network Access Commercial |
$4,137.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,203.51
|
| Rate for Payer: Quartz Commercial |
$2,923.02
|
| Rate for Payer: Quartz Medicare Advantage |
$2,698.18
|
| Rate for Payer: The Alliance Commercial |
$2,248.48
|
| Rate for Payer: WEA Trust Commercial |
$2,473.33
|
| Rate for Payer: WPS Commercial |
$3,330.78
|
|
|
LAMINECTOMY
|
Facility
|
IP
|
$4,324.00
|
|
| Hospital Charge Code |
2960172
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,203.51 |
| Max. Negotiated Rate |
$4,137.20 |
| Rate for Payer: Aetna Commercial |
$4,047.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,867.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,383.39
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$4,137.20
|
| Rate for Payer: Health EOS Commercial |
$4,002.29
|
| Rate for Payer: HFN Commercial |
$4,137.20
|
| Rate for Payer: Multiplan Commercial |
$3,597.57
|
| Rate for Payer: Preferred Network Access Commercial |
$4,137.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,203.51
|
| Rate for Payer: Quartz Commercial |
$2,698.18
|
| Rate for Payer: WEA Trust Commercial |
$2,473.33
|
| Rate for Payer: WPS Commercial |
$3,330.78
|
|
