|
NAIL 11MM TITANIUM TIBIAL
|
Facility
|
IP
|
$9,692.00
|
|
| Hospital Charge Code |
2966283
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,749.08 |
| Max. Negotiated Rate |
$8,916.64 |
| Rate for Payer: Aetna Commercial |
$8,722.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,335.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,136.76
|
| Rate for Payer: Cash Price |
$2,907.60
|
| Rate for Payer: Cigna Commercial |
$8,916.64
|
| Rate for Payer: Health EOS Commercial |
$8,625.88
|
| Rate for Payer: HFN Commercial |
$8,916.64
|
| Rate for Payer: Multiplan Commercial |
$7,753.60
|
| Rate for Payer: NAPHCARE Commercial |
$5,815.20
|
| Rate for Payer: Preferred Network Access Commercial |
$8,916.64
|
| Rate for Payer: Quartz Beloit One Network |
$4,749.08
|
| Rate for Payer: Quartz Commercial |
$5,815.20
|
| Rate for Payer: WEA Trust Commercial |
$5,330.60
|
| Rate for Payer: WPS Commercial |
$7,178.86
|
|
|
NAIL 12MM/125D TI TROCHANTERIC
|
Facility
|
IP
|
$11,403.00
|
|
| Hospital Charge Code |
2966284
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,587.47 |
| Max. Negotiated Rate |
$10,490.76 |
| Rate for Payer: Aetna Commercial |
$10,262.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,806.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,043.59
|
| Rate for Payer: Cash Price |
$3,420.90
|
| Rate for Payer: Cigna Commercial |
$10,490.76
|
| Rate for Payer: Health EOS Commercial |
$10,148.67
|
| Rate for Payer: HFN Commercial |
$10,490.76
|
| Rate for Payer: Multiplan Commercial |
$9,122.40
|
| Rate for Payer: NAPHCARE Commercial |
$6,841.80
|
| Rate for Payer: Preferred Network Access Commercial |
$10,490.76
|
| Rate for Payer: Quartz Beloit One Network |
$5,587.47
|
| Rate for Payer: Quartz Commercial |
$6,841.80
|
| Rate for Payer: WEA Trust Commercial |
$6,271.65
|
| Rate for Payer: WPS Commercial |
$8,446.20
|
|
|
NAIL 12MM/125D TI TROCHANTERIC
|
Facility
|
OP
|
$11,403.00
|
|
| Hospital Charge Code |
2966284
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,192.84 |
| Max. Negotiated Rate |
$45,612.00 |
| Rate for Payer: Aetna Commercial |
$10,262.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,806.58
|
| Rate for Payer: Aetna Managed Medicare |
$3,192.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,411.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,701.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,473.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,043.59
|
| Rate for Payer: Cash Price |
$3,420.90
|
| Rate for Payer: Cigna Commercial |
$10,490.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,381.12
|
| Rate for Payer: Health EOS Commercial |
$10,148.67
|
| Rate for Payer: HFN Commercial |
$10,490.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,552.25
|
| Rate for Payer: Multiplan Commercial |
$9,122.40
|
| Rate for Payer: NAPHCARE Commercial |
$6,841.80
|
| Rate for Payer: Preferred Network Access Commercial |
$10,490.76
|
| Rate for Payer: Quartz Beloit One Network |
$5,587.47
|
| Rate for Payer: Quartz Commercial |
$7,411.95
|
| Rate for Payer: Quartz Medicare Advantage |
$6,841.80
|
| Rate for Payer: The Alliance Commercial |
$45,612.00
|
| Rate for Payer: WEA Trust Commercial |
$6,271.65
|
| Rate for Payer: WPS Commercial |
$8,446.20
|
|
|
NAIL 12x330 CANN TIBIAL
|
Facility
|
OP
|
$8,977.00
|
|
| Hospital Charge Code |
2966285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,513.56 |
| Max. Negotiated Rate |
$35,908.00 |
| Rate for Payer: Aetna Commercial |
$8,079.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,720.22
|
| Rate for Payer: Aetna Managed Medicare |
$2,513.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,835.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,488.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,308.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,757.81
|
| Rate for Payer: Cash Price |
$2,693.10
|
| Rate for Payer: Cigna Commercial |
$8,258.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,023.53
|
| Rate for Payer: Health EOS Commercial |
$7,989.53
|
| Rate for Payer: HFN Commercial |
$8,258.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,732.75
|
| Rate for Payer: Multiplan Commercial |
$7,181.60
|
| Rate for Payer: NAPHCARE Commercial |
$5,386.20
|
| Rate for Payer: Preferred Network Access Commercial |
$8,258.84
|
| Rate for Payer: Quartz Beloit One Network |
$4,398.73
|
| Rate for Payer: Quartz Commercial |
$5,835.05
|
| Rate for Payer: Quartz Medicare Advantage |
$5,386.20
|
| Rate for Payer: The Alliance Commercial |
$35,908.00
|
| Rate for Payer: WEA Trust Commercial |
$4,937.35
|
| Rate for Payer: WPS Commercial |
$6,649.26
|
|
|
NAIL 12x330 CANN TIBIAL
|
Facility
|
IP
|
$8,977.00
|
|
| Hospital Charge Code |
2966285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,398.73 |
| Max. Negotiated Rate |
$8,258.84 |
| Rate for Payer: Aetna Commercial |
$8,079.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,720.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,757.81
|
| Rate for Payer: Cash Price |
$2,693.10
|
| Rate for Payer: Cigna Commercial |
$8,258.84
|
| Rate for Payer: Health EOS Commercial |
$7,989.53
|
| Rate for Payer: HFN Commercial |
$8,258.84
|
| Rate for Payer: Multiplan Commercial |
$7,181.60
|
| Rate for Payer: NAPHCARE Commercial |
$5,386.20
|
| Rate for Payer: Preferred Network Access Commercial |
$8,258.84
|
| Rate for Payer: Quartz Beloit One Network |
$4,398.73
|
| Rate for Payer: Quartz Commercial |
$5,386.20
|
| Rate for Payer: WEA Trust Commercial |
$4,937.35
|
| Rate for Payer: WPS Commercial |
$6,649.26
|
|
|
NAIL 20MM BIOTRAK HELICAL
|
Facility
|
OP
|
$6,589.00
|
|
| Hospital Charge Code |
3072631
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,844.92 |
| Max. Negotiated Rate |
$26,356.00 |
| Rate for Payer: Aetna Commercial |
$5,930.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,666.54
|
| Rate for Payer: Aetna Managed Medicare |
$1,844.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,282.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,294.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,162.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,492.17
|
| Rate for Payer: Cash Price |
$1,976.70
|
| Rate for Payer: Cigna Commercial |
$6,061.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,687.20
|
| Rate for Payer: Health EOS Commercial |
$5,864.21
|
| Rate for Payer: HFN Commercial |
$6,061.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,941.75
|
| Rate for Payer: Multiplan Commercial |
$5,271.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,953.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,061.88
|
| Rate for Payer: Quartz Beloit One Network |
$3,228.61
|
| Rate for Payer: Quartz Commercial |
$4,282.85
|
| Rate for Payer: Quartz Medicare Advantage |
$3,953.40
|
| Rate for Payer: The Alliance Commercial |
$26,356.00
|
| Rate for Payer: WEA Trust Commercial |
$3,623.95
|
| Rate for Payer: WPS Commercial |
$4,880.47
|
|
|
NAIL 20MM BIOTRAK HELICAL
|
Facility
|
IP
|
$6,589.00
|
|
| Hospital Charge Code |
3072631
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,228.61 |
| Max. Negotiated Rate |
$6,061.88 |
| Rate for Payer: Aetna Commercial |
$5,930.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,666.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,492.17
|
| Rate for Payer: Cash Price |
$1,976.70
|
| Rate for Payer: Cigna Commercial |
$6,061.88
|
| Rate for Payer: Health EOS Commercial |
$5,864.21
|
| Rate for Payer: HFN Commercial |
$6,061.88
|
| Rate for Payer: Multiplan Commercial |
$5,271.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,953.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,061.88
|
| Rate for Payer: Quartz Beloit One Network |
$3,228.61
|
| Rate for Payer: Quartz Commercial |
$3,953.40
|
| Rate for Payer: WEA Trust Commercial |
$3,623.95
|
| Rate for Payer: WPS Commercial |
$4,880.47
|
|
|
NAIL 408.890
|
Facility
|
OP
|
$6,527.00
|
|
| Hospital Charge Code |
2966288
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,827.56 |
| Max. Negotiated Rate |
$26,108.00 |
| Rate for Payer: Aetna Commercial |
$5,874.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,613.22
|
| Rate for Payer: Aetna Managed Medicare |
$1,827.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,242.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,263.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,132.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,459.31
|
| Rate for Payer: Cash Price |
$1,958.10
|
| Rate for Payer: Cigna Commercial |
$6,004.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,652.51
|
| Rate for Payer: Health EOS Commercial |
$5,809.03
|
| Rate for Payer: HFN Commercial |
$6,004.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,895.25
|
| Rate for Payer: Multiplan Commercial |
$5,221.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,916.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,004.84
|
| Rate for Payer: Quartz Beloit One Network |
$3,198.23
|
| Rate for Payer: Quartz Commercial |
$4,242.55
|
| Rate for Payer: Quartz Medicare Advantage |
$3,916.20
|
| Rate for Payer: The Alliance Commercial |
$26,108.00
|
| Rate for Payer: WEA Trust Commercial |
$3,589.85
|
| Rate for Payer: WPS Commercial |
$4,834.55
|
|
|
NAIL 408.890
|
Facility
|
IP
|
$6,527.00
|
|
| Hospital Charge Code |
2966288
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,198.23 |
| Max. Negotiated Rate |
$6,004.84 |
| Rate for Payer: Aetna Commercial |
$5,874.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,613.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,459.31
|
| Rate for Payer: Cash Price |
$1,958.10
|
| Rate for Payer: Cigna Commercial |
$6,004.84
|
| Rate for Payer: Health EOS Commercial |
$5,809.03
|
| Rate for Payer: HFN Commercial |
$6,004.84
|
| Rate for Payer: Multiplan Commercial |
$5,221.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,916.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,004.84
|
| Rate for Payer: Quartz Beloit One Network |
$3,198.23
|
| Rate for Payer: Quartz Commercial |
$3,916.20
|
| Rate for Payer: WEA Trust Commercial |
$3,589.85
|
| Rate for Payer: WPS Commercial |
$4,834.55
|
|
|
NAIL AND END CAP OLECRANON
|
Facility
|
IP
|
$6,269.00
|
|
| Hospital Charge Code |
2966291
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,071.81 |
| Max. Negotiated Rate |
$5,767.48 |
| Rate for Payer: Aetna Commercial |
$5,642.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,391.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,322.57
|
| Rate for Payer: Cash Price |
$1,880.70
|
| Rate for Payer: Cigna Commercial |
$5,767.48
|
| Rate for Payer: Health EOS Commercial |
$5,579.41
|
| Rate for Payer: HFN Commercial |
$5,767.48
|
| Rate for Payer: Multiplan Commercial |
$5,015.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,761.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,767.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,071.81
|
| Rate for Payer: Quartz Commercial |
$3,761.40
|
| Rate for Payer: WEA Trust Commercial |
$3,447.95
|
| Rate for Payer: WPS Commercial |
$4,643.45
|
|
|
NAIL AND END CAP OLECRANON
|
Facility
|
OP
|
$6,269.00
|
|
| Hospital Charge Code |
2966291
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,755.32 |
| Max. Negotiated Rate |
$25,076.00 |
| Rate for Payer: Aetna Commercial |
$5,642.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,391.34
|
| Rate for Payer: Aetna Managed Medicare |
$1,755.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,074.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,134.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,009.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,322.57
|
| Rate for Payer: Cash Price |
$1,880.70
|
| Rate for Payer: Cigna Commercial |
$5,767.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,508.13
|
| Rate for Payer: Health EOS Commercial |
$5,579.41
|
| Rate for Payer: HFN Commercial |
$5,767.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,701.75
|
| Rate for Payer: Multiplan Commercial |
$5,015.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,761.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,767.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,071.81
|
| Rate for Payer: Quartz Commercial |
$4,074.85
|
| Rate for Payer: Quartz Medicare Advantage |
$3,761.40
|
| Rate for Payer: The Alliance Commercial |
$25,076.00
|
| Rate for Payer: WEA Trust Commercial |
$3,447.95
|
| Rate for Payer: WPS Commercial |
$4,643.45
|
|
|
NAIL ANKLE ARTHRODESIS 10 X 200MM RT T2 1819-1020S
|
Facility
|
OP
|
$9,098.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6001647
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,547.44 |
| Max. Negotiated Rate |
$36,392.00 |
| Rate for Payer: Aetna Commercial |
$8,188.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,824.28
|
| Rate for Payer: Aetna Managed Medicare |
$2,547.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,913.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,549.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,367.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,821.94
|
| Rate for Payer: Cash Price |
$2,729.40
|
| Rate for Payer: Cigna Commercial |
$8,370.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,091.24
|
| Rate for Payer: Health EOS Commercial |
$8,097.22
|
| Rate for Payer: HFN Commercial |
$8,370.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,823.50
|
| Rate for Payer: Multiplan Commercial |
$7,278.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,458.80
|
| Rate for Payer: Preferred Network Access Commercial |
$8,370.16
|
| Rate for Payer: Quartz Beloit One Network |
$4,458.02
|
| Rate for Payer: Quartz Commercial |
$5,913.70
|
| Rate for Payer: Quartz Medicare Advantage |
$5,458.80
|
| Rate for Payer: The Alliance Commercial |
$36,392.00
|
| Rate for Payer: WEA Trust Commercial |
$5,003.90
|
| Rate for Payer: WPS Commercial |
$6,738.89
|
|
|
NAIL ANKLE ARTHRODESIS 10 X 200MM RT T2 1819-1020S
|
Facility
|
IP
|
$9,098.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6001647
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,458.02 |
| Max. Negotiated Rate |
$8,370.16 |
| Rate for Payer: Aetna Commercial |
$8,188.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,824.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,821.94
|
| Rate for Payer: Cash Price |
$2,729.40
|
| Rate for Payer: Cigna Commercial |
$8,370.16
|
| Rate for Payer: Health EOS Commercial |
$8,097.22
|
| Rate for Payer: HFN Commercial |
$8,370.16
|
| Rate for Payer: Multiplan Commercial |
$7,278.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,458.80
|
| Rate for Payer: Preferred Network Access Commercial |
$8,370.16
|
| Rate for Payer: Quartz Beloit One Network |
$4,458.02
|
| Rate for Payer: Quartz Commercial |
$5,458.80
|
| Rate for Payer: WEA Trust Commercial |
$5,003.90
|
| Rate for Payer: WPS Commercial |
$6,738.89
|
|
|
NAIL ANKLE ARTHRODESIS 10 X 300MM RT T2 1819-1030S
|
Facility
|
IP
|
$18,746.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6211056
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,185.54 |
| Max. Negotiated Rate |
$17,246.32 |
| Rate for Payer: Aetna Commercial |
$16,871.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,121.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,935.38
|
| Rate for Payer: Cash Price |
$5,623.80
|
| Rate for Payer: Cigna Commercial |
$17,246.32
|
| Rate for Payer: Health EOS Commercial |
$16,683.94
|
| Rate for Payer: HFN Commercial |
$17,246.32
|
| Rate for Payer: Multiplan Commercial |
$14,996.80
|
| Rate for Payer: NAPHCARE Commercial |
$11,247.60
|
| Rate for Payer: Preferred Network Access Commercial |
$17,246.32
|
| Rate for Payer: Quartz Beloit One Network |
$9,185.54
|
| Rate for Payer: Quartz Commercial |
$11,247.60
|
| Rate for Payer: WEA Trust Commercial |
$10,310.30
|
| Rate for Payer: WPS Commercial |
$13,885.16
|
|
|
NAIL ANKLE ARTHRODESIS 10 X 300MM RT T2 1819-1030S
|
Facility
|
OP
|
$18,746.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6211056
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,248.88 |
| Max. Negotiated Rate |
$74,984.00 |
| Rate for Payer: Aetna Commercial |
$16,871.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,121.56
|
| Rate for Payer: Aetna Managed Medicare |
$5,248.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,184.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,373.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,998.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,935.38
|
| Rate for Payer: Cash Price |
$5,623.80
|
| Rate for Payer: Cigna Commercial |
$17,246.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,490.26
|
| Rate for Payer: Health EOS Commercial |
$16,683.94
|
| Rate for Payer: HFN Commercial |
$17,246.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,059.50
|
| Rate for Payer: Multiplan Commercial |
$14,996.80
|
| Rate for Payer: NAPHCARE Commercial |
$11,247.60
|
| Rate for Payer: Preferred Network Access Commercial |
$17,246.32
|
| Rate for Payer: Quartz Beloit One Network |
$9,185.54
|
| Rate for Payer: Quartz Commercial |
$12,184.90
|
| Rate for Payer: Quartz Medicare Advantage |
$11,247.60
|
| Rate for Payer: The Alliance Commercial |
$74,984.00
|
| Rate for Payer: WEA Trust Commercial |
$10,310.30
|
| Rate for Payer: WPS Commercial |
$13,885.16
|
|
|
NAIL ANKLE ARTHRODESIS 11 X 200MM LT T2 1818-1120S
|
Facility
|
OP
|
$9,462.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5611628
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,649.36 |
| Max. Negotiated Rate |
$37,848.00 |
| Rate for Payer: Aetna Commercial |
$8,515.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,137.32
|
| Rate for Payer: Aetna Managed Medicare |
$2,649.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,150.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,731.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,541.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,014.86
|
| Rate for Payer: Cash Price |
$2,838.60
|
| Rate for Payer: Cigna Commercial |
$8,705.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,294.94
|
| Rate for Payer: Health EOS Commercial |
$8,421.18
|
| Rate for Payer: HFN Commercial |
$8,705.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,096.50
|
| Rate for Payer: Multiplan Commercial |
$7,569.60
|
| Rate for Payer: NAPHCARE Commercial |
$5,677.20
|
| Rate for Payer: Preferred Network Access Commercial |
$8,705.04
|
| Rate for Payer: Quartz Beloit One Network |
$4,636.38
|
| Rate for Payer: Quartz Commercial |
$6,150.30
|
| Rate for Payer: Quartz Medicare Advantage |
$5,677.20
|
| Rate for Payer: The Alliance Commercial |
$37,848.00
|
| Rate for Payer: WEA Trust Commercial |
$5,204.10
|
| Rate for Payer: WPS Commercial |
$7,008.50
|
|
|
NAIL ANKLE ARTHRODESIS 11 X 200MM LT T2 1818-1120S
|
Facility
|
IP
|
$9,462.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5611628
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,636.38 |
| Max. Negotiated Rate |
$8,705.04 |
| Rate for Payer: Aetna Commercial |
$8,515.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,137.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,014.86
|
| Rate for Payer: Cash Price |
$2,838.60
|
| Rate for Payer: Cigna Commercial |
$8,705.04
|
| Rate for Payer: Health EOS Commercial |
$8,421.18
|
| Rate for Payer: HFN Commercial |
$8,705.04
|
| Rate for Payer: Multiplan Commercial |
$7,569.60
|
| Rate for Payer: NAPHCARE Commercial |
$5,677.20
|
| Rate for Payer: Preferred Network Access Commercial |
$8,705.04
|
| Rate for Payer: Quartz Beloit One Network |
$4,636.38
|
| Rate for Payer: Quartz Commercial |
$5,677.20
|
| Rate for Payer: WEA Trust Commercial |
$5,204.10
|
| Rate for Payer: WPS Commercial |
$7,008.50
|
|
|
NAIL ANKLE ARTHRODESIS 11 X 300MM LT T2 1818-1130S
|
Facility
|
OP
|
$9,462.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685885
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,649.36 |
| Max. Negotiated Rate |
$37,848.00 |
| Rate for Payer: Aetna Commercial |
$8,515.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,137.32
|
| Rate for Payer: Aetna Managed Medicare |
$2,649.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,150.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,731.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,541.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,014.86
|
| Rate for Payer: Cash Price |
$2,838.60
|
| Rate for Payer: Cigna Commercial |
$8,705.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,294.94
|
| Rate for Payer: Health EOS Commercial |
$8,421.18
|
| Rate for Payer: HFN Commercial |
$8,705.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,096.50
|
| Rate for Payer: Multiplan Commercial |
$7,569.60
|
| Rate for Payer: NAPHCARE Commercial |
$5,677.20
|
| Rate for Payer: Preferred Network Access Commercial |
$8,705.04
|
| Rate for Payer: Quartz Beloit One Network |
$4,636.38
|
| Rate for Payer: Quartz Commercial |
$6,150.30
|
| Rate for Payer: Quartz Medicare Advantage |
$5,677.20
|
| Rate for Payer: The Alliance Commercial |
$37,848.00
|
| Rate for Payer: WEA Trust Commercial |
$5,204.10
|
| Rate for Payer: WPS Commercial |
$7,008.50
|
|
|
NAIL ANKLE ARTHRODESIS 11 X 300MM LT T2 1818-1130S
|
Facility
|
IP
|
$9,462.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685885
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,636.38 |
| Max. Negotiated Rate |
$8,705.04 |
| Rate for Payer: Aetna Commercial |
$8,515.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,137.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,014.86
|
| Rate for Payer: Cash Price |
$2,838.60
|
| Rate for Payer: Cigna Commercial |
$8,705.04
|
| Rate for Payer: Health EOS Commercial |
$8,421.18
|
| Rate for Payer: HFN Commercial |
$8,705.04
|
| Rate for Payer: Multiplan Commercial |
$7,569.60
|
| Rate for Payer: NAPHCARE Commercial |
$5,677.20
|
| Rate for Payer: Preferred Network Access Commercial |
$8,705.04
|
| Rate for Payer: Quartz Beloit One Network |
$4,636.38
|
| Rate for Payer: Quartz Commercial |
$5,677.20
|
| Rate for Payer: WEA Trust Commercial |
$5,204.10
|
| Rate for Payer: WPS Commercial |
$7,008.50
|
|
|
NAIL ANKLE ARTHRODESIS 12 X 200MM LT T2 1819-1220S
|
Facility
|
IP
|
$9,462.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5787709
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,636.38 |
| Max. Negotiated Rate |
$8,705.04 |
| Rate for Payer: Aetna Commercial |
$8,515.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,137.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,014.86
|
| Rate for Payer: Cash Price |
$2,838.60
|
| Rate for Payer: Cigna Commercial |
$8,705.04
|
| Rate for Payer: Health EOS Commercial |
$8,421.18
|
| Rate for Payer: HFN Commercial |
$8,705.04
|
| Rate for Payer: Multiplan Commercial |
$7,569.60
|
| Rate for Payer: NAPHCARE Commercial |
$5,677.20
|
| Rate for Payer: Preferred Network Access Commercial |
$8,705.04
|
| Rate for Payer: Quartz Beloit One Network |
$4,636.38
|
| Rate for Payer: Quartz Commercial |
$5,677.20
|
| Rate for Payer: WEA Trust Commercial |
$5,204.10
|
| Rate for Payer: WPS Commercial |
$7,008.50
|
|
|
NAIL ANKLE ARTHRODESIS 12 X 200MM LT T2 1819-1220S
|
Facility
|
OP
|
$9,462.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5787709
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,649.36 |
| Max. Negotiated Rate |
$37,848.00 |
| Rate for Payer: Aetna Commercial |
$8,515.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,137.32
|
| Rate for Payer: Aetna Managed Medicare |
$2,649.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,150.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,731.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,541.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,014.86
|
| Rate for Payer: Cash Price |
$2,838.60
|
| Rate for Payer: Cigna Commercial |
$8,705.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,294.94
|
| Rate for Payer: Health EOS Commercial |
$8,421.18
|
| Rate for Payer: HFN Commercial |
$8,705.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,096.50
|
| Rate for Payer: Multiplan Commercial |
$7,569.60
|
| Rate for Payer: NAPHCARE Commercial |
$5,677.20
|
| Rate for Payer: Preferred Network Access Commercial |
$8,705.04
|
| Rate for Payer: Quartz Beloit One Network |
$4,636.38
|
| Rate for Payer: Quartz Commercial |
$6,150.30
|
| Rate for Payer: Quartz Medicare Advantage |
$5,677.20
|
| Rate for Payer: The Alliance Commercial |
$37,848.00
|
| Rate for Payer: WEA Trust Commercial |
$5,204.10
|
| Rate for Payer: WPS Commercial |
$7,008.50
|
|
|
NAIL ANKLE ARTHRODESIS 12 X 300MM RT T2 1819-1230S
|
Facility
|
IP
|
$18,746.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6177946
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,185.54 |
| Max. Negotiated Rate |
$17,246.32 |
| Rate for Payer: Aetna Commercial |
$16,871.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,121.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,935.38
|
| Rate for Payer: Cash Price |
$5,623.80
|
| Rate for Payer: Cigna Commercial |
$17,246.32
|
| Rate for Payer: Health EOS Commercial |
$16,683.94
|
| Rate for Payer: HFN Commercial |
$17,246.32
|
| Rate for Payer: Multiplan Commercial |
$14,996.80
|
| Rate for Payer: NAPHCARE Commercial |
$11,247.60
|
| Rate for Payer: Preferred Network Access Commercial |
$17,246.32
|
| Rate for Payer: Quartz Beloit One Network |
$9,185.54
|
| Rate for Payer: Quartz Commercial |
$11,247.60
|
| Rate for Payer: WEA Trust Commercial |
$10,310.30
|
| Rate for Payer: WPS Commercial |
$13,885.16
|
|
|
NAIL ANKLE ARTHRODESIS 12 X 300MM RT T2 1819-1230S
|
Facility
|
OP
|
$18,746.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6177946
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,248.88 |
| Max. Negotiated Rate |
$74,984.00 |
| Rate for Payer: Aetna Commercial |
$16,871.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,121.56
|
| Rate for Payer: Aetna Managed Medicare |
$5,248.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,184.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,373.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,998.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,935.38
|
| Rate for Payer: Cash Price |
$5,623.80
|
| Rate for Payer: Cigna Commercial |
$17,246.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,490.26
|
| Rate for Payer: Health EOS Commercial |
$16,683.94
|
| Rate for Payer: HFN Commercial |
$17,246.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,059.50
|
| Rate for Payer: Multiplan Commercial |
$14,996.80
|
| Rate for Payer: NAPHCARE Commercial |
$11,247.60
|
| Rate for Payer: Preferred Network Access Commercial |
$17,246.32
|
| Rate for Payer: Quartz Beloit One Network |
$9,185.54
|
| Rate for Payer: Quartz Commercial |
$12,184.90
|
| Rate for Payer: Quartz Medicare Advantage |
$11,247.60
|
| Rate for Payer: The Alliance Commercial |
$74,984.00
|
| Rate for Payer: WEA Trust Commercial |
$10,310.30
|
| Rate for Payer: WPS Commercial |
$13,885.16
|
|
|
NAIL ELASTIC 2.5MM TITANIUM 475.925
|
Facility
|
IP
|
$4,058.00
|
|
| Hospital Charge Code |
2966287
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,988.42 |
| Max. Negotiated Rate |
$3,733.36 |
| Rate for Payer: Aetna Commercial |
$3,652.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,489.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,150.74
|
| Rate for Payer: Cash Price |
$1,217.40
|
| Rate for Payer: Cigna Commercial |
$3,733.36
|
| Rate for Payer: Health EOS Commercial |
$3,611.62
|
| Rate for Payer: HFN Commercial |
$3,733.36
|
| Rate for Payer: Multiplan Commercial |
$3,246.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,434.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,733.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,988.42
|
| Rate for Payer: Quartz Commercial |
$2,434.80
|
| Rate for Payer: WEA Trust Commercial |
$2,231.90
|
| Rate for Payer: WPS Commercial |
$3,005.76
|
|
|
NAIL ELASTIC 2.5MM TITANIUM 475.925
|
Facility
|
OP
|
$4,058.00
|
|
| Hospital Charge Code |
2966287
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,136.24 |
| Max. Negotiated Rate |
$16,232.00 |
| Rate for Payer: Aetna Commercial |
$3,652.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,489.88
|
| Rate for Payer: Aetna Managed Medicare |
$1,136.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,637.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,029.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,947.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,150.74
|
| Rate for Payer: Cash Price |
$1,217.40
|
| Rate for Payer: Cigna Commercial |
$3,733.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,270.86
|
| Rate for Payer: Health EOS Commercial |
$3,611.62
|
| Rate for Payer: HFN Commercial |
$3,733.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,043.50
|
| Rate for Payer: Multiplan Commercial |
$3,246.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,434.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,733.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,988.42
|
| Rate for Payer: Quartz Commercial |
$2,637.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2,434.80
|
| Rate for Payer: The Alliance Commercial |
$16,232.00
|
| Rate for Payer: WEA Trust Commercial |
$2,231.90
|
| Rate for Payer: WPS Commercial |
$3,005.76
|
|
