|
NAIL ELASTIC 3.5MM TITANIUM 475.935
|
Facility
|
OP
|
$5,512.00
|
|
| Hospital Charge Code |
4494326
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,543.36 |
| Max. Negotiated Rate |
$22,048.00 |
| Rate for Payer: Aetna Commercial |
$4,960.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,740.32
|
| Rate for Payer: Aetna Managed Medicare |
$1,543.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,582.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,756.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,645.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,921.36
|
| Rate for Payer: Cash Price |
$1,653.60
|
| Rate for Payer: Cigna Commercial |
$5,071.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,084.52
|
| Rate for Payer: Health EOS Commercial |
$4,905.68
|
| Rate for Payer: HFN Commercial |
$5,071.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,134.00
|
| Rate for Payer: Multiplan Commercial |
$4,409.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,307.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,071.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,700.88
|
| Rate for Payer: Quartz Commercial |
$3,582.80
|
| Rate for Payer: Quartz Medicare Advantage |
$3,307.20
|
| Rate for Payer: The Alliance Commercial |
$22,048.00
|
| Rate for Payer: WEA Trust Commercial |
$3,031.60
|
| Rate for Payer: WPS Commercial |
$4,082.74
|
|
|
NAIL ELASTIC 3.5MM TITANIUM 475.935
|
Facility
|
IP
|
$5,512.00
|
|
| Hospital Charge Code |
4494326
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,700.88 |
| Max. Negotiated Rate |
$5,071.04 |
| Rate for Payer: Aetna Commercial |
$4,960.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,740.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,921.36
|
| Rate for Payer: Cash Price |
$1,653.60
|
| Rate for Payer: Cigna Commercial |
$5,071.04
|
| Rate for Payer: Health EOS Commercial |
$4,905.68
|
| Rate for Payer: HFN Commercial |
$5,071.04
|
| Rate for Payer: Multiplan Commercial |
$4,409.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,307.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,071.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,700.88
|
| Rate for Payer: Quartz Commercial |
$3,307.20
|
| Rate for Payer: WEA Trust Commercial |
$3,031.60
|
| Rate for Payer: WPS Commercial |
$4,082.74
|
|
|
NAIL ELASTIC 4.0MM TITANIUM 475.940
|
Facility
|
IP
|
$5,914.00
|
|
| Hospital Charge Code |
4508871
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,897.86 |
| Max. Negotiated Rate |
$5,440.88 |
| Rate for Payer: Aetna Commercial |
$5,322.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,086.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,134.42
|
| Rate for Payer: Cash Price |
$1,774.20
|
| Rate for Payer: Cigna Commercial |
$5,440.88
|
| Rate for Payer: Health EOS Commercial |
$5,263.46
|
| Rate for Payer: HFN Commercial |
$5,440.88
|
| Rate for Payer: Multiplan Commercial |
$4,731.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,548.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,440.88
|
| Rate for Payer: Quartz Beloit One Network |
$2,897.86
|
| Rate for Payer: Quartz Commercial |
$3,548.40
|
| Rate for Payer: WEA Trust Commercial |
$3,252.70
|
| Rate for Payer: WPS Commercial |
$4,380.50
|
|
|
NAIL ELASTIC 4.0MM TITANIUM 475.940
|
Facility
|
OP
|
$5,914.00
|
|
| Hospital Charge Code |
4508871
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,655.92 |
| Max. Negotiated Rate |
$23,656.00 |
| Rate for Payer: Aetna Commercial |
$5,322.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,086.04
|
| Rate for Payer: Aetna Managed Medicare |
$1,655.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,844.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,957.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,838.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,134.42
|
| Rate for Payer: Cash Price |
$1,774.20
|
| Rate for Payer: Cigna Commercial |
$5,440.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,309.47
|
| Rate for Payer: Health EOS Commercial |
$5,263.46
|
| Rate for Payer: HFN Commercial |
$5,440.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,435.50
|
| Rate for Payer: Multiplan Commercial |
$4,731.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,548.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,440.88
|
| Rate for Payer: Quartz Beloit One Network |
$2,897.86
|
| Rate for Payer: Quartz Commercial |
$3,844.10
|
| Rate for Payer: Quartz Medicare Advantage |
$3,548.40
|
| Rate for Payer: The Alliance Commercial |
$23,656.00
|
| Rate for Payer: WEA Trust Commercial |
$3,252.70
|
| Rate for Payer: WPS Commercial |
$4,380.50
|
|
|
NAIL ELASTIC TITANIUM 1.5 X 300 475.915S
|
Facility
|
OP
|
$4,306.00
|
|
| Hospital Charge Code |
2966281
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,205.68 |
| Max. Negotiated Rate |
$17,224.00 |
| Rate for Payer: Aetna Commercial |
$3,875.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,703.16
|
| Rate for Payer: Aetna Managed Medicare |
$1,205.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,798.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,153.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,066.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,282.18
|
| Rate for Payer: Cash Price |
$1,291.80
|
| Rate for Payer: Cigna Commercial |
$3,961.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,409.64
|
| Rate for Payer: Health EOS Commercial |
$3,832.34
|
| Rate for Payer: HFN Commercial |
$3,961.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,229.50
|
| Rate for Payer: Multiplan Commercial |
$3,444.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,583.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,961.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,109.94
|
| Rate for Payer: Quartz Commercial |
$2,798.90
|
| Rate for Payer: Quartz Medicare Advantage |
$2,583.60
|
| Rate for Payer: The Alliance Commercial |
$17,224.00
|
| Rate for Payer: WEA Trust Commercial |
$2,368.30
|
| Rate for Payer: WPS Commercial |
$3,189.45
|
|
|
NAIL ELASTIC TITANIUM 1.5 X 300 475.915S
|
Facility
|
IP
|
$4,306.00
|
|
| Hospital Charge Code |
2966281
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,109.94 |
| Max. Negotiated Rate |
$3,961.52 |
| Rate for Payer: Aetna Commercial |
$3,875.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,703.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,282.18
|
| Rate for Payer: Cash Price |
$1,291.80
|
| Rate for Payer: Cigna Commercial |
$3,961.52
|
| Rate for Payer: Health EOS Commercial |
$3,832.34
|
| Rate for Payer: HFN Commercial |
$3,961.52
|
| Rate for Payer: Multiplan Commercial |
$3,444.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,583.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,961.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,109.94
|
| Rate for Payer: Quartz Commercial |
$2,583.60
|
| Rate for Payer: WEA Trust Commercial |
$2,368.30
|
| Rate for Payer: WPS Commercial |
$3,189.45
|
|
|
NAIL FEMORAL TI 11MM RECON 04.003.452S
|
Facility
|
IP
|
$10,429.00
|
|
| Hospital Charge Code |
2966292
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,110.21 |
| Max. Negotiated Rate |
$9,594.68 |
| Rate for Payer: Aetna Commercial |
$9,386.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,968.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,527.37
|
| Rate for Payer: Cash Price |
$3,128.70
|
| Rate for Payer: Cigna Commercial |
$9,594.68
|
| Rate for Payer: Health EOS Commercial |
$9,281.81
|
| Rate for Payer: HFN Commercial |
$9,594.68
|
| Rate for Payer: Multiplan Commercial |
$8,343.20
|
| Rate for Payer: NAPHCARE Commercial |
$6,257.40
|
| Rate for Payer: Preferred Network Access Commercial |
$9,594.68
|
| Rate for Payer: Quartz Beloit One Network |
$5,110.21
|
| Rate for Payer: Quartz Commercial |
$6,257.40
|
| Rate for Payer: WEA Trust Commercial |
$5,735.95
|
| Rate for Payer: WPS Commercial |
$7,724.76
|
|
|
NAIL FEMORAL TI 11MM RECON 04.003.452S
|
Facility
|
OP
|
$10,429.00
|
|
| Hospital Charge Code |
2966292
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,920.12 |
| Max. Negotiated Rate |
$41,716.00 |
| Rate for Payer: Aetna Commercial |
$9,386.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,968.94
|
| Rate for Payer: Aetna Managed Medicare |
$2,920.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,778.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,214.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,005.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,527.37
|
| Rate for Payer: Cash Price |
$3,128.70
|
| Rate for Payer: Cigna Commercial |
$9,594.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,836.07
|
| Rate for Payer: Health EOS Commercial |
$9,281.81
|
| Rate for Payer: HFN Commercial |
$9,594.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,821.75
|
| Rate for Payer: Multiplan Commercial |
$8,343.20
|
| Rate for Payer: NAPHCARE Commercial |
$6,257.40
|
| Rate for Payer: Preferred Network Access Commercial |
$9,594.68
|
| Rate for Payer: Quartz Beloit One Network |
$5,110.21
|
| Rate for Payer: Quartz Commercial |
$6,778.85
|
| Rate for Payer: Quartz Medicare Advantage |
$6,257.40
|
| Rate for Payer: The Alliance Commercial |
$41,716.00
|
| Rate for Payer: WEA Trust Commercial |
$5,735.95
|
| Rate for Payer: WPS Commercial |
$7,724.76
|
|
|
NAIL GAMMA 10 X 380 X 125DEG TI RT 3425-0380S
|
Facility
|
IP
|
$7,481.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6182695
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,665.69 |
| Max. Negotiated Rate |
$6,882.52 |
| Rate for Payer: Aetna Commercial |
$6,732.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,433.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,964.93
|
| Rate for Payer: Cash Price |
$2,244.30
|
| Rate for Payer: Cigna Commercial |
$6,882.52
|
| Rate for Payer: Health EOS Commercial |
$6,658.09
|
| Rate for Payer: HFN Commercial |
$6,882.52
|
| Rate for Payer: Multiplan Commercial |
$5,984.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,488.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,882.52
|
| Rate for Payer: Quartz Beloit One Network |
$3,665.69
|
| Rate for Payer: Quartz Commercial |
$4,488.60
|
| Rate for Payer: WEA Trust Commercial |
$4,114.55
|
| Rate for Payer: WPS Commercial |
$5,541.18
|
|
|
NAIL GAMMA 10 X 380 X 125DEG TI RT 3425-0380S
|
Facility
|
OP
|
$7,481.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6182695
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,094.68 |
| Max. Negotiated Rate |
$29,924.00 |
| Rate for Payer: Aetna Commercial |
$6,732.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,433.66
|
| Rate for Payer: Aetna Managed Medicare |
$2,094.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,862.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,740.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,590.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,964.93
|
| Rate for Payer: Cash Price |
$2,244.30
|
| Rate for Payer: Cigna Commercial |
$6,882.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,186.37
|
| Rate for Payer: Health EOS Commercial |
$6,658.09
|
| Rate for Payer: HFN Commercial |
$6,882.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,610.75
|
| Rate for Payer: Multiplan Commercial |
$5,984.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,488.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,882.52
|
| Rate for Payer: Quartz Beloit One Network |
$3,665.69
|
| Rate for Payer: Quartz Commercial |
$4,862.65
|
| Rate for Payer: Quartz Medicare Advantage |
$4,488.60
|
| Rate for Payer: The Alliance Commercial |
$29,924.00
|
| Rate for Payer: WEA Trust Commercial |
$4,114.55
|
| Rate for Payer: WPS Commercial |
$5,541.18
|
|
|
NAIL GAMMA 11.0 X 180MM X 125 DEG TROCHANTERIC TI 3125-1180S
|
Facility
|
IP
|
$7,456.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
3785549
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,653.44 |
| Max. Negotiated Rate |
$6,859.52 |
| Rate for Payer: Aetna Commercial |
$6,710.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,412.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,951.68
|
| Rate for Payer: Cash Price |
$2,236.80
|
| Rate for Payer: Cigna Commercial |
$6,859.52
|
| Rate for Payer: Health EOS Commercial |
$6,635.84
|
| Rate for Payer: HFN Commercial |
$6,859.52
|
| Rate for Payer: Multiplan Commercial |
$5,964.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,473.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,859.52
|
| Rate for Payer: Quartz Beloit One Network |
$3,653.44
|
| Rate for Payer: Quartz Commercial |
$4,473.60
|
| Rate for Payer: WEA Trust Commercial |
$4,100.80
|
| Rate for Payer: WPS Commercial |
$5,522.66
|
|
|
NAIL GAMMA 11.0 X 180MM X 125 DEG TROCHANTERIC TI 3125-1180S
|
Facility
|
OP
|
$7,456.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
3785549
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,087.68 |
| Max. Negotiated Rate |
$29,824.00 |
| Rate for Payer: Aetna Commercial |
$6,710.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,412.16
|
| Rate for Payer: Aetna Managed Medicare |
$2,087.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,846.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,728.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,578.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,951.68
|
| Rate for Payer: Cash Price |
$2,236.80
|
| Rate for Payer: Cigna Commercial |
$6,859.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,172.38
|
| Rate for Payer: Health EOS Commercial |
$6,635.84
|
| Rate for Payer: HFN Commercial |
$6,859.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,592.00
|
| Rate for Payer: Multiplan Commercial |
$5,964.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,473.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,859.52
|
| Rate for Payer: Quartz Beloit One Network |
$3,653.44
|
| Rate for Payer: Quartz Commercial |
$4,846.40
|
| Rate for Payer: Quartz Medicare Advantage |
$4,473.60
|
| Rate for Payer: The Alliance Commercial |
$29,824.00
|
| Rate for Payer: WEA Trust Commercial |
$4,100.80
|
| Rate for Payer: WPS Commercial |
$5,522.66
|
|
|
NAIL GAMMA 11.0 X 180MM X 130DEG TROCHANTERIC TI 3130-1180S
|
Facility
|
IP
|
$12,489.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5456919
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,119.61 |
| Max. Negotiated Rate |
$11,489.88 |
| Rate for Payer: Aetna Commercial |
$11,240.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,740.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,619.17
|
| Rate for Payer: Cash Price |
$3,746.70
|
| Rate for Payer: Cigna Commercial |
$11,489.88
|
| Rate for Payer: Health EOS Commercial |
$11,115.21
|
| Rate for Payer: HFN Commercial |
$11,489.88
|
| Rate for Payer: Multiplan Commercial |
$9,991.20
|
| Rate for Payer: NAPHCARE Commercial |
$7,493.40
|
| Rate for Payer: Preferred Network Access Commercial |
$11,489.88
|
| Rate for Payer: Quartz Beloit One Network |
$6,119.61
|
| Rate for Payer: Quartz Commercial |
$7,493.40
|
| Rate for Payer: WEA Trust Commercial |
$6,868.95
|
| Rate for Payer: WPS Commercial |
$9,250.60
|
|
|
NAIL GAMMA 11.0 X 180MM X 130DEG TROCHANTERIC TI 3130-1180S
|
Facility
|
OP
|
$12,489.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5456919
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,496.92 |
| Max. Negotiated Rate |
$49,956.00 |
| Rate for Payer: Aetna Commercial |
$11,240.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,740.54
|
| Rate for Payer: Aetna Managed Medicare |
$3,496.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,117.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,244.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,994.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,619.17
|
| Rate for Payer: Cash Price |
$3,746.70
|
| Rate for Payer: Cigna Commercial |
$11,489.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,988.84
|
| Rate for Payer: Health EOS Commercial |
$11,115.21
|
| Rate for Payer: HFN Commercial |
$11,489.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,366.75
|
| Rate for Payer: Multiplan Commercial |
$9,991.20
|
| Rate for Payer: NAPHCARE Commercial |
$7,493.40
|
| Rate for Payer: Preferred Network Access Commercial |
$11,489.88
|
| Rate for Payer: Quartz Beloit One Network |
$6,119.61
|
| Rate for Payer: Quartz Commercial |
$8,117.85
|
| Rate for Payer: Quartz Medicare Advantage |
$7,493.40
|
| Rate for Payer: The Alliance Commercial |
$49,956.00
|
| Rate for Payer: WEA Trust Commercial |
$6,868.95
|
| Rate for Payer: WPS Commercial |
$9,250.60
|
|
|
NAIL GAMMA 11.0 X 320 X 125DEG LONG RT TI 3525-1320S
|
Facility
|
OP
|
$9,643.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4509048
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,700.04 |
| Max. Negotiated Rate |
$38,572.00 |
| Rate for Payer: Aetna Commercial |
$8,678.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,292.98
|
| Rate for Payer: Aetna Managed Medicare |
$2,700.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,267.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,821.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,628.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,110.79
|
| Rate for Payer: Cash Price |
$2,892.90
|
| Rate for Payer: Cigna Commercial |
$8,871.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,396.22
|
| Rate for Payer: Health EOS Commercial |
$8,582.27
|
| Rate for Payer: HFN Commercial |
$8,871.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,232.25
|
| Rate for Payer: Multiplan Commercial |
$7,714.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,785.80
|
| Rate for Payer: Preferred Network Access Commercial |
$8,871.56
|
| Rate for Payer: Quartz Beloit One Network |
$4,725.07
|
| Rate for Payer: Quartz Commercial |
$6,267.95
|
| Rate for Payer: Quartz Medicare Advantage |
$5,785.80
|
| Rate for Payer: The Alliance Commercial |
$38,572.00
|
| Rate for Payer: WEA Trust Commercial |
$5,303.65
|
| Rate for Payer: WPS Commercial |
$7,142.57
|
|
|
NAIL GAMMA 11.0 X 320 X 125DEG LONG RT TI 3525-1320S
|
Facility
|
IP
|
$9,643.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4509048
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,725.07 |
| Max. Negotiated Rate |
$8,871.56 |
| Rate for Payer: Aetna Commercial |
$8,678.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,292.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,110.79
|
| Rate for Payer: Cash Price |
$2,892.90
|
| Rate for Payer: Cigna Commercial |
$8,871.56
|
| Rate for Payer: Health EOS Commercial |
$8,582.27
|
| Rate for Payer: HFN Commercial |
$8,871.56
|
| Rate for Payer: Multiplan Commercial |
$7,714.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,785.80
|
| Rate for Payer: Preferred Network Access Commercial |
$8,871.56
|
| Rate for Payer: Quartz Beloit One Network |
$4,725.07
|
| Rate for Payer: Quartz Commercial |
$5,785.80
|
| Rate for Payer: WEA Trust Commercial |
$5,303.65
|
| Rate for Payer: WPS Commercial |
$7,142.57
|
|
|
NAIL GAMMA 11.0 X 340 X 125DEG LONG RT TI 3525-1340S
|
Facility
|
OP
|
$9,643.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4509049
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,700.04 |
| Max. Negotiated Rate |
$38,572.00 |
| Rate for Payer: Aetna Commercial |
$8,678.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,292.98
|
| Rate for Payer: Aetna Managed Medicare |
$2,700.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,267.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,821.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,628.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,110.79
|
| Rate for Payer: Cash Price |
$2,892.90
|
| Rate for Payer: Cigna Commercial |
$8,871.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,396.22
|
| Rate for Payer: Health EOS Commercial |
$8,582.27
|
| Rate for Payer: HFN Commercial |
$8,871.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,232.25
|
| Rate for Payer: Multiplan Commercial |
$7,714.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,785.80
|
| Rate for Payer: Preferred Network Access Commercial |
$8,871.56
|
| Rate for Payer: Quartz Beloit One Network |
$4,725.07
|
| Rate for Payer: Quartz Commercial |
$6,267.95
|
| Rate for Payer: Quartz Medicare Advantage |
$5,785.80
|
| Rate for Payer: The Alliance Commercial |
$38,572.00
|
| Rate for Payer: WEA Trust Commercial |
$5,303.65
|
| Rate for Payer: WPS Commercial |
$7,142.57
|
|
|
NAIL GAMMA 11.0 X 340 X 125DEG LONG RT TI 3525-1340S
|
Facility
|
IP
|
$9,643.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4509049
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,725.07 |
| Max. Negotiated Rate |
$8,871.56 |
| Rate for Payer: Aetna Commercial |
$8,678.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,292.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,110.79
|
| Rate for Payer: Cash Price |
$2,892.90
|
| Rate for Payer: Cigna Commercial |
$8,871.56
|
| Rate for Payer: Health EOS Commercial |
$8,582.27
|
| Rate for Payer: HFN Commercial |
$8,871.56
|
| Rate for Payer: Multiplan Commercial |
$7,714.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,785.80
|
| Rate for Payer: Preferred Network Access Commercial |
$8,871.56
|
| Rate for Payer: Quartz Beloit One Network |
$4,725.07
|
| Rate for Payer: Quartz Commercial |
$5,785.80
|
| Rate for Payer: WEA Trust Commercial |
$5,303.65
|
| Rate for Payer: WPS Commercial |
$7,142.57
|
|
|
NAIL GAMMA 11.0 X 360 X 125DEG LONG RT TI 3525-1360S
|
Facility
|
OP
|
$9,643.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4509050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,700.04 |
| Max. Negotiated Rate |
$38,572.00 |
| Rate for Payer: Aetna Commercial |
$8,678.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,292.98
|
| Rate for Payer: Aetna Managed Medicare |
$2,700.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,267.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,821.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,628.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,110.79
|
| Rate for Payer: Cash Price |
$2,892.90
|
| Rate for Payer: Cigna Commercial |
$8,871.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,396.22
|
| Rate for Payer: Health EOS Commercial |
$8,582.27
|
| Rate for Payer: HFN Commercial |
$8,871.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,232.25
|
| Rate for Payer: Multiplan Commercial |
$7,714.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,785.80
|
| Rate for Payer: Preferred Network Access Commercial |
$8,871.56
|
| Rate for Payer: Quartz Beloit One Network |
$4,725.07
|
| Rate for Payer: Quartz Commercial |
$6,267.95
|
| Rate for Payer: Quartz Medicare Advantage |
$5,785.80
|
| Rate for Payer: The Alliance Commercial |
$38,572.00
|
| Rate for Payer: WEA Trust Commercial |
$5,303.65
|
| Rate for Payer: WPS Commercial |
$7,142.57
|
|
|
NAIL GAMMA 11.0 X 360 X 125DEG LONG RT TI 3525-1360S
|
Facility
|
IP
|
$9,643.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4509050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,725.07 |
| Max. Negotiated Rate |
$8,871.56 |
| Rate for Payer: Aetna Commercial |
$8,678.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,292.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,110.79
|
| Rate for Payer: Cash Price |
$2,892.90
|
| Rate for Payer: Cigna Commercial |
$8,871.56
|
| Rate for Payer: Health EOS Commercial |
$8,582.27
|
| Rate for Payer: HFN Commercial |
$8,871.56
|
| Rate for Payer: Multiplan Commercial |
$7,714.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,785.80
|
| Rate for Payer: Preferred Network Access Commercial |
$8,871.56
|
| Rate for Payer: Quartz Beloit One Network |
$4,725.07
|
| Rate for Payer: Quartz Commercial |
$5,785.80
|
| Rate for Payer: WEA Trust Commercial |
$5,303.65
|
| Rate for Payer: WPS Commercial |
$7,142.57
|
|
|
NAIL GAMMA 11.0 X 380 X 125DEG LONG RT TI 3525-1380S
|
Facility
|
IP
|
$10,217.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
3072437
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,006.33 |
| Max. Negotiated Rate |
$9,399.64 |
| Rate for Payer: Aetna Commercial |
$9,195.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,786.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,415.01
|
| Rate for Payer: Cash Price |
$3,065.10
|
| Rate for Payer: Cigna Commercial |
$9,399.64
|
| Rate for Payer: Health EOS Commercial |
$9,093.13
|
| Rate for Payer: HFN Commercial |
$9,399.64
|
| Rate for Payer: Multiplan Commercial |
$8,173.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,130.20
|
| Rate for Payer: Preferred Network Access Commercial |
$9,399.64
|
| Rate for Payer: Quartz Beloit One Network |
$5,006.33
|
| Rate for Payer: Quartz Commercial |
$6,130.20
|
| Rate for Payer: WEA Trust Commercial |
$5,619.35
|
| Rate for Payer: WPS Commercial |
$7,567.73
|
|
|
NAIL GAMMA 11.0 X 380 X 125DEG LONG RT TI 3525-1380S
|
Facility
|
OP
|
$10,217.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
3072437
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,860.76 |
| Max. Negotiated Rate |
$40,868.00 |
| Rate for Payer: Aetna Commercial |
$9,195.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,786.62
|
| Rate for Payer: Aetna Managed Medicare |
$2,860.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,641.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,108.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,904.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,415.01
|
| Rate for Payer: Cash Price |
$3,065.10
|
| Rate for Payer: Cigna Commercial |
$9,399.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,717.43
|
| Rate for Payer: Health EOS Commercial |
$9,093.13
|
| Rate for Payer: HFN Commercial |
$9,399.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,662.75
|
| Rate for Payer: Multiplan Commercial |
$8,173.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,130.20
|
| Rate for Payer: Preferred Network Access Commercial |
$9,399.64
|
| Rate for Payer: Quartz Beloit One Network |
$5,006.33
|
| Rate for Payer: Quartz Commercial |
$6,641.05
|
| Rate for Payer: Quartz Medicare Advantage |
$6,130.20
|
| Rate for Payer: The Alliance Commercial |
$40,868.00
|
| Rate for Payer: WEA Trust Commercial |
$5,619.35
|
| Rate for Payer: WPS Commercial |
$7,567.73
|
|
|
NAIL GAMMA 11.0 X 400 X 125DEG LONG LT TI 3525-1400S
|
Facility
|
IP
|
$10,218.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4431891
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,006.82 |
| Max. Negotiated Rate |
$9,400.56 |
| Rate for Payer: Aetna Commercial |
$9,196.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,787.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,415.54
|
| Rate for Payer: Cash Price |
$3,065.40
|
| Rate for Payer: Cigna Commercial |
$9,400.56
|
| Rate for Payer: Health EOS Commercial |
$9,094.02
|
| Rate for Payer: HFN Commercial |
$9,400.56
|
| Rate for Payer: Multiplan Commercial |
$8,174.40
|
| Rate for Payer: NAPHCARE Commercial |
$6,130.80
|
| Rate for Payer: Preferred Network Access Commercial |
$9,400.56
|
| Rate for Payer: Quartz Beloit One Network |
$5,006.82
|
| Rate for Payer: Quartz Commercial |
$6,130.80
|
| Rate for Payer: WEA Trust Commercial |
$5,619.90
|
| Rate for Payer: WPS Commercial |
$7,568.47
|
|
|
NAIL GAMMA 11.0 X 400 X 125DEG LONG LT TI 3525-1400S
|
Facility
|
OP
|
$10,218.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4431891
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,861.04 |
| Max. Negotiated Rate |
$40,872.00 |
| Rate for Payer: Aetna Commercial |
$9,196.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,787.48
|
| Rate for Payer: Aetna Managed Medicare |
$2,861.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,641.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,109.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,904.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,415.54
|
| Rate for Payer: Cash Price |
$3,065.40
|
| Rate for Payer: Cigna Commercial |
$9,400.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,717.99
|
| Rate for Payer: Health EOS Commercial |
$9,094.02
|
| Rate for Payer: HFN Commercial |
$9,400.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,663.50
|
| Rate for Payer: Multiplan Commercial |
$8,174.40
|
| Rate for Payer: NAPHCARE Commercial |
$6,130.80
|
| Rate for Payer: Preferred Network Access Commercial |
$9,400.56
|
| Rate for Payer: Quartz Beloit One Network |
$5,006.82
|
| Rate for Payer: Quartz Commercial |
$6,641.70
|
| Rate for Payer: Quartz Medicare Advantage |
$6,130.80
|
| Rate for Payer: The Alliance Commercial |
$40,872.00
|
| Rate for Payer: WEA Trust Commercial |
$5,619.90
|
| Rate for Payer: WPS Commercial |
$7,568.47
|
|
|
NAIL GAMMA 11.0 X 420 X 125DEG LONG LT TI 3525-1420S
|
Facility
|
IP
|
$9,643.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4509051
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,725.07 |
| Max. Negotiated Rate |
$8,871.56 |
| Rate for Payer: Aetna Commercial |
$8,678.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,292.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,110.79
|
| Rate for Payer: Cash Price |
$2,892.90
|
| Rate for Payer: Cigna Commercial |
$8,871.56
|
| Rate for Payer: Health EOS Commercial |
$8,582.27
|
| Rate for Payer: HFN Commercial |
$8,871.56
|
| Rate for Payer: Multiplan Commercial |
$7,714.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,785.80
|
| Rate for Payer: Preferred Network Access Commercial |
$8,871.56
|
| Rate for Payer: Quartz Beloit One Network |
$4,725.07
|
| Rate for Payer: Quartz Commercial |
$5,785.80
|
| Rate for Payer: WEA Trust Commercial |
$5,303.65
|
| Rate for Payer: WPS Commercial |
$7,142.57
|
|
