|
NAIL GAMMA LONG 11 X 380 X 125DEG 3425-1380S
|
Facility
|
IP
|
$9,033.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4509046
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,426.17 |
| Max. Negotiated Rate |
$8,310.36 |
| Rate for Payer: Aetna Commercial |
$8,129.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,768.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,787.49
|
| Rate for Payer: Cash Price |
$2,709.90
|
| Rate for Payer: Cigna Commercial |
$8,310.36
|
| Rate for Payer: Health EOS Commercial |
$8,039.37
|
| Rate for Payer: HFN Commercial |
$8,310.36
|
| Rate for Payer: Multiplan Commercial |
$7,226.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,419.80
|
| Rate for Payer: Preferred Network Access Commercial |
$8,310.36
|
| Rate for Payer: Quartz Beloit One Network |
$4,426.17
|
| Rate for Payer: Quartz Commercial |
$5,419.80
|
| Rate for Payer: WEA Trust Commercial |
$4,968.15
|
| Rate for Payer: WPS Commercial |
$6,690.74
|
|
|
NAIL GAMMA LONG 11 X 380 X 125DEG 3425-1380S
|
Facility
|
OP
|
$9,033.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4509046
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,529.24 |
| Max. Negotiated Rate |
$36,132.00 |
| Rate for Payer: Aetna Commercial |
$8,129.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,768.38
|
| Rate for Payer: Aetna Managed Medicare |
$2,529.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,871.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,516.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,335.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,787.49
|
| Rate for Payer: Cash Price |
$2,709.90
|
| Rate for Payer: Cigna Commercial |
$8,310.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,054.87
|
| Rate for Payer: Health EOS Commercial |
$8,039.37
|
| Rate for Payer: HFN Commercial |
$8,310.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,774.75
|
| Rate for Payer: Multiplan Commercial |
$7,226.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,419.80
|
| Rate for Payer: Preferred Network Access Commercial |
$8,310.36
|
| Rate for Payer: Quartz Beloit One Network |
$4,426.17
|
| Rate for Payer: Quartz Commercial |
$5,871.45
|
| Rate for Payer: Quartz Medicare Advantage |
$5,419.80
|
| Rate for Payer: The Alliance Commercial |
$36,132.00
|
| Rate for Payer: WEA Trust Commercial |
$4,968.15
|
| Rate for Payer: WPS Commercial |
$6,690.74
|
|
|
NAIL GAMMA LONG 13 X 360 X 125DEG TI RT 3425-3360S
|
Facility
|
IP
|
$9,033.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5456726
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,426.17 |
| Max. Negotiated Rate |
$8,310.36 |
| Rate for Payer: Aetna Commercial |
$8,129.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,768.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,787.49
|
| Rate for Payer: Cash Price |
$2,709.90
|
| Rate for Payer: Cigna Commercial |
$8,310.36
|
| Rate for Payer: Health EOS Commercial |
$8,039.37
|
| Rate for Payer: HFN Commercial |
$8,310.36
|
| Rate for Payer: Multiplan Commercial |
$7,226.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,419.80
|
| Rate for Payer: Preferred Network Access Commercial |
$8,310.36
|
| Rate for Payer: Quartz Beloit One Network |
$4,426.17
|
| Rate for Payer: Quartz Commercial |
$5,419.80
|
| Rate for Payer: WEA Trust Commercial |
$4,968.15
|
| Rate for Payer: WPS Commercial |
$6,690.74
|
|
|
NAIL GAMMA LONG 13 X 360 X 125DEG TI RT 3425-3360S
|
Facility
|
OP
|
$9,033.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5456726
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,529.24 |
| Max. Negotiated Rate |
$36,132.00 |
| Rate for Payer: Aetna Commercial |
$8,129.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,768.38
|
| Rate for Payer: Aetna Managed Medicare |
$2,529.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,871.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,516.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,335.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,787.49
|
| Rate for Payer: Cash Price |
$2,709.90
|
| Rate for Payer: Cigna Commercial |
$8,310.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,054.87
|
| Rate for Payer: Health EOS Commercial |
$8,039.37
|
| Rate for Payer: HFN Commercial |
$8,310.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,774.75
|
| Rate for Payer: Multiplan Commercial |
$7,226.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,419.80
|
| Rate for Payer: Preferred Network Access Commercial |
$8,310.36
|
| Rate for Payer: Quartz Beloit One Network |
$4,426.17
|
| Rate for Payer: Quartz Commercial |
$5,871.45
|
| Rate for Payer: Quartz Medicare Advantage |
$5,419.80
|
| Rate for Payer: The Alliance Commercial |
$36,132.00
|
| Rate for Payer: WEA Trust Commercial |
$4,968.15
|
| Rate for Payer: WPS Commercial |
$6,690.74
|
|
|
NAIL GAMMA LONG 13 X 380 X 125DEG TI RT 3425-3380S
|
Facility
|
IP
|
$9,643.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4519063
|
|
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 LONG 13 X 380 X 125DEG TI RT 3425-3380S
|
Facility
|
OP
|
$9,643.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4519063
|
|
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 LONG 13 X 400 X 125DEG TI LT 3525-3400S
|
Facility
|
OP
|
$7,780.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6169733
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,178.40 |
| Max. Negotiated Rate |
$31,120.00 |
| Rate for Payer: Aetna Commercial |
$7,002.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,690.80
|
| Rate for Payer: Aetna Managed Medicare |
$2,178.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,057.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,890.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,734.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,123.40
|
| Rate for Payer: Cash Price |
$2,334.00
|
| Rate for Payer: Cigna Commercial |
$7,157.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,353.69
|
| Rate for Payer: Health EOS Commercial |
$6,924.20
|
| Rate for Payer: HFN Commercial |
$7,157.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,835.00
|
| Rate for Payer: Multiplan Commercial |
$6,224.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,668.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,157.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,812.20
|
| Rate for Payer: Quartz Commercial |
$5,057.00
|
| Rate for Payer: Quartz Medicare Advantage |
$4,668.00
|
| Rate for Payer: The Alliance Commercial |
$31,120.00
|
| Rate for Payer: WEA Trust Commercial |
$4,279.00
|
| Rate for Payer: WPS Commercial |
$5,762.65
|
|
|
NAIL GAMMA LONG 13 X 400 X 125DEG TI LT 3525-3400S
|
Facility
|
IP
|
$7,780.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6169733
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,812.20 |
| Max. Negotiated Rate |
$7,157.60 |
| Rate for Payer: Aetna Commercial |
$7,002.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,690.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,123.40
|
| Rate for Payer: Cash Price |
$2,334.00
|
| Rate for Payer: Cigna Commercial |
$7,157.60
|
| Rate for Payer: Health EOS Commercial |
$6,924.20
|
| Rate for Payer: HFN Commercial |
$7,157.60
|
| Rate for Payer: Multiplan Commercial |
$6,224.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,668.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,157.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,812.20
|
| Rate for Payer: Quartz Commercial |
$4,668.00
|
| Rate for Payer: WEA Trust Commercial |
$4,279.00
|
| Rate for Payer: WPS Commercial |
$5,762.65
|
|
|
NAIL GAMMA LONG 13 X 400 X 125DEG TI RT 3425-3400S
|
Facility
|
OP
|
$7,780.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6169735
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,178.40 |
| Max. Negotiated Rate |
$31,120.00 |
| Rate for Payer: Aetna Commercial |
$7,002.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,690.80
|
| Rate for Payer: Aetna Managed Medicare |
$2,178.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,057.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,890.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,734.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,123.40
|
| Rate for Payer: Cash Price |
$2,334.00
|
| Rate for Payer: Cigna Commercial |
$7,157.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,353.69
|
| Rate for Payer: Health EOS Commercial |
$6,924.20
|
| Rate for Payer: HFN Commercial |
$7,157.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,835.00
|
| Rate for Payer: Multiplan Commercial |
$6,224.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,668.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,157.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,812.20
|
| Rate for Payer: Quartz Commercial |
$5,057.00
|
| Rate for Payer: Quartz Medicare Advantage |
$4,668.00
|
| Rate for Payer: The Alliance Commercial |
$31,120.00
|
| Rate for Payer: WEA Trust Commercial |
$4,279.00
|
| Rate for Payer: WPS Commercial |
$5,762.65
|
|
|
NAIL GAMMA LONG 13 X 400 X 125DEG TI RT 3425-3400S
|
Facility
|
IP
|
$7,780.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6169735
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,812.20 |
| Max. Negotiated Rate |
$7,157.60 |
| Rate for Payer: Aetna Commercial |
$7,002.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,690.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,123.40
|
| Rate for Payer: Cash Price |
$2,334.00
|
| Rate for Payer: Cigna Commercial |
$7,157.60
|
| Rate for Payer: Health EOS Commercial |
$6,924.20
|
| Rate for Payer: HFN Commercial |
$7,157.60
|
| Rate for Payer: Multiplan Commercial |
$6,224.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,668.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,157.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,812.20
|
| Rate for Payer: Quartz Commercial |
$4,668.00
|
| Rate for Payer: WEA Trust Commercial |
$4,279.00
|
| Rate for Payer: WPS Commercial |
$5,762.65
|
|
|
NAIL GAMMA LONG 13 X 420 X 125DEG TI RT 3425-3420S
|
Facility
|
OP
|
$9,271.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5627697
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,595.88 |
| Max. Negotiated Rate |
$37,084.00 |
| Rate for Payer: Aetna Commercial |
$8,343.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,973.06
|
| Rate for Payer: Aetna Managed Medicare |
$2,595.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,026.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,635.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,450.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,913.63
|
| Rate for Payer: Cash Price |
$2,781.30
|
| Rate for Payer: Cigna Commercial |
$8,529.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,188.05
|
| Rate for Payer: Health EOS Commercial |
$8,251.19
|
| Rate for Payer: HFN Commercial |
$8,529.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,953.25
|
| Rate for Payer: Multiplan Commercial |
$7,416.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,562.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,529.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,542.79
|
| Rate for Payer: Quartz Commercial |
$6,026.15
|
| Rate for Payer: Quartz Medicare Advantage |
$5,562.60
|
| Rate for Payer: The Alliance Commercial |
$37,084.00
|
| Rate for Payer: WEA Trust Commercial |
$5,099.05
|
| Rate for Payer: WPS Commercial |
$6,867.03
|
|
|
NAIL GAMMA LONG 13 X 420 X 125DEG TI RT 3425-3420S
|
Facility
|
IP
|
$9,271.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5627697
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,542.79 |
| Max. Negotiated Rate |
$8,529.32 |
| Rate for Payer: Aetna Commercial |
$8,343.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,973.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,913.63
|
| Rate for Payer: Cash Price |
$2,781.30
|
| Rate for Payer: Cigna Commercial |
$8,529.32
|
| Rate for Payer: Health EOS Commercial |
$8,251.19
|
| Rate for Payer: HFN Commercial |
$8,529.32
|
| Rate for Payer: Multiplan Commercial |
$7,416.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,562.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,529.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,542.79
|
| Rate for Payer: Quartz Commercial |
$5,562.60
|
| Rate for Payer: WEA Trust Commercial |
$5,099.05
|
| Rate for Payer: WPS Commercial |
$6,867.03
|
|
|
NAIL GAMMA LONG 13 X 440 X 125DEG TI RT 3425-3440S
|
Facility
|
IP
|
$9,033.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5415174
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,426.17 |
| Max. Negotiated Rate |
$8,310.36 |
| Rate for Payer: Aetna Commercial |
$8,129.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,768.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,787.49
|
| Rate for Payer: Cash Price |
$2,709.90
|
| Rate for Payer: Cigna Commercial |
$8,310.36
|
| Rate for Payer: Health EOS Commercial |
$8,039.37
|
| Rate for Payer: HFN Commercial |
$8,310.36
|
| Rate for Payer: Multiplan Commercial |
$7,226.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,419.80
|
| Rate for Payer: Preferred Network Access Commercial |
$8,310.36
|
| Rate for Payer: Quartz Beloit One Network |
$4,426.17
|
| Rate for Payer: Quartz Commercial |
$5,419.80
|
| Rate for Payer: WEA Trust Commercial |
$4,968.15
|
| Rate for Payer: WPS Commercial |
$6,690.74
|
|
|
NAIL GAMMA LONG 13 X 440 X 125DEG TI RT 3425-3440S
|
Facility
|
OP
|
$9,033.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5415174
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,529.24 |
| Max. Negotiated Rate |
$36,132.00 |
| Rate for Payer: Aetna Commercial |
$8,129.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,768.38
|
| Rate for Payer: Aetna Managed Medicare |
$2,529.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,871.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,516.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,335.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,787.49
|
| Rate for Payer: Cash Price |
$2,709.90
|
| Rate for Payer: Cigna Commercial |
$8,310.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,054.87
|
| Rate for Payer: Health EOS Commercial |
$8,039.37
|
| Rate for Payer: HFN Commercial |
$8,310.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,774.75
|
| Rate for Payer: Multiplan Commercial |
$7,226.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,419.80
|
| Rate for Payer: Preferred Network Access Commercial |
$8,310.36
|
| Rate for Payer: Quartz Beloit One Network |
$4,426.17
|
| Rate for Payer: Quartz Commercial |
$5,871.45
|
| Rate for Payer: Quartz Medicare Advantage |
$5,419.80
|
| Rate for Payer: The Alliance Commercial |
$36,132.00
|
| Rate for Payer: WEA Trust Commercial |
$4,968.15
|
| Rate for Payer: WPS Commercial |
$6,690.74
|
|
|
NAIL GAMMA LONG 15 X 420 X 125DEG TI RT 3425-5420S
|
Facility
|
OP
|
$7,481.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6178001
|
|
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 LONG 15 X 420 X 125DEG TI RT 3425-5420S
|
Facility
|
IP
|
$7,481.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6178001
|
|
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 RT 11 X 400 X 125 3425-1400S
|
Facility
|
IP
|
$10,217.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
3072444
|
|
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 RT 11 X 400 X 125 3425-1400S
|
Facility
|
OP
|
$10,217.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
3072444
|
|
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 RT 11 X 420 X 125 3425-1420S
|
Facility
|
OP
|
$9,643.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4509047
|
|
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 RT 11 X 420 X 125 3425-1420S
|
Facility
|
IP
|
$9,643.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4509047
|
|
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 SPLINT INRO 14MM *Need Size (sm-med-lg)
|
Facility
|
OP
|
$705.00
|
|
| Hospital Charge Code |
2969528
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$197.40 |
| Max. Negotiated Rate |
$2,820.00 |
| Rate for Payer: Aetna Commercial |
$634.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$606.30
|
| Rate for Payer: Aetna Managed Medicare |
$197.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$458.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$352.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$338.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$373.65
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Cigna Commercial |
$648.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$394.52
|
| Rate for Payer: Health EOS Commercial |
$627.45
|
| Rate for Payer: HFN Commercial |
$648.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$528.75
|
| Rate for Payer: Multiplan Commercial |
$564.00
|
| Rate for Payer: NAPHCARE Commercial |
$423.00
|
| Rate for Payer: Preferred Network Access Commercial |
$648.60
|
| Rate for Payer: Quartz Beloit One Network |
$345.45
|
| Rate for Payer: Quartz Commercial |
$458.25
|
| Rate for Payer: Quartz Medicare Advantage |
$423.00
|
| Rate for Payer: The Alliance Commercial |
$2,820.00
|
| Rate for Payer: WEA Trust Commercial |
$387.75
|
| Rate for Payer: WPS Commercial |
$522.19
|
|
|
NAIL SPLINT INRO 14MM *Need Size (sm-med-lg)
|
Facility
|
IP
|
$705.00
|
|
| Hospital Charge Code |
2969528
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$345.45 |
| Max. Negotiated Rate |
$648.60 |
| Rate for Payer: Aetna Commercial |
$634.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$606.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$373.65
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Cigna Commercial |
$648.60
|
| Rate for Payer: Health EOS Commercial |
$627.45
|
| Rate for Payer: HFN Commercial |
$648.60
|
| Rate for Payer: Multiplan Commercial |
$564.00
|
| Rate for Payer: NAPHCARE Commercial |
$423.00
|
| Rate for Payer: Preferred Network Access Commercial |
$648.60
|
| Rate for Payer: Quartz Beloit One Network |
$345.45
|
| Rate for Payer: Quartz Commercial |
$423.00
|
| Rate for Payer: WEA Trust Commercial |
$387.75
|
| Rate for Payer: WPS Commercial |
$522.19
|
|
|
NAIL SUPRACONDYLAR 12 X 300 1826-1230S
|
Facility
|
OP
|
$7,898.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5659734
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,211.44 |
| Max. Negotiated Rate |
$31,592.00 |
| Rate for Payer: Aetna Commercial |
$7,108.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,792.28
|
| Rate for Payer: Aetna Managed Medicare |
$2,211.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,133.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,949.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,791.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,185.94
|
| Rate for Payer: Cash Price |
$2,369.40
|
| Rate for Payer: Cigna Commercial |
$7,266.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,419.72
|
| Rate for Payer: Health EOS Commercial |
$7,029.22
|
| Rate for Payer: HFN Commercial |
$7,266.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,923.50
|
| Rate for Payer: Multiplan Commercial |
$6,318.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,738.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,266.16
|
| Rate for Payer: Quartz Beloit One Network |
$3,870.02
|
| Rate for Payer: Quartz Commercial |
$5,133.70
|
| Rate for Payer: Quartz Medicare Advantage |
$4,738.80
|
| Rate for Payer: The Alliance Commercial |
$31,592.00
|
| Rate for Payer: WEA Trust Commercial |
$4,343.90
|
| Rate for Payer: WPS Commercial |
$5,850.05
|
|
|
NAIL SUPRACONDYLAR 12 X 300 1826-1230S
|
Facility
|
IP
|
$7,898.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5659734
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,870.02 |
| Max. Negotiated Rate |
$7,266.16 |
| Rate for Payer: Aetna Commercial |
$7,108.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,792.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,185.94
|
| Rate for Payer: Cash Price |
$2,369.40
|
| Rate for Payer: Cigna Commercial |
$7,266.16
|
| Rate for Payer: Health EOS Commercial |
$7,029.22
|
| Rate for Payer: HFN Commercial |
$7,266.16
|
| Rate for Payer: Multiplan Commercial |
$6,318.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,738.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,266.16
|
| Rate for Payer: Quartz Beloit One Network |
$3,870.02
|
| Rate for Payer: Quartz Commercial |
$4,738.80
|
| Rate for Payer: WEA Trust Commercial |
$4,343.90
|
| Rate for Payer: WPS Commercial |
$5,850.05
|
|
|
NAIL SUPRACONDYLAR 13 X 340 1826-1332S
|
Facility
|
IP
|
$10,819.00
|
|
| Hospital Charge Code |
3072608
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,301.31 |
| Max. Negotiated Rate |
$9,953.48 |
| Rate for Payer: Aetna Commercial |
$9,737.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,304.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,734.07
|
| Rate for Payer: Cash Price |
$3,245.70
|
| Rate for Payer: Cigna Commercial |
$9,953.48
|
| Rate for Payer: Health EOS Commercial |
$9,628.91
|
| Rate for Payer: HFN Commercial |
$9,953.48
|
| Rate for Payer: Multiplan Commercial |
$8,655.20
|
| Rate for Payer: NAPHCARE Commercial |
$6,491.40
|
| Rate for Payer: Preferred Network Access Commercial |
$9,953.48
|
| Rate for Payer: Quartz Beloit One Network |
$5,301.31
|
| Rate for Payer: Quartz Commercial |
$6,491.40
|
| Rate for Payer: WEA Trust Commercial |
$5,950.45
|
| Rate for Payer: WPS Commercial |
$8,013.63
|
|
