|
NAIL TIBIAL 12MM TITANIUM
|
Facility
|
IP
|
$9,692.00
|
|
| Hospital Charge Code |
2966300
|
|
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 TIBIAL 12MM TITANIUM
|
Facility
|
OP
|
$9,692.00
|
|
| Hospital Charge Code |
2966300
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,713.76 |
| Max. Negotiated Rate |
$38,768.00 |
| Rate for Payer: Aetna Commercial |
$8,722.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,335.12
|
| Rate for Payer: Aetna Managed Medicare |
$2,713.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,299.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,846.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,652.16
|
| 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: Dean Health DHI/DHP/ASO |
$5,423.64
|
| Rate for Payer: Health EOS Commercial |
$8,625.88
|
| Rate for Payer: HFN Commercial |
$8,916.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,269.00
|
| 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 |
$6,299.80
|
| Rate for Payer: Quartz Medicare Advantage |
$5,815.20
|
| Rate for Payer: The Alliance Commercial |
$38,768.00
|
| Rate for Payer: WEA Trust Commercial |
$5,330.60
|
| Rate for Payer: WPS Commercial |
$7,178.86
|
|
|
NAIL TIBIAL 8MM TITANIUM
|
Facility
|
IP
|
$9,692.00
|
|
| Hospital Charge Code |
2966301
|
|
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 TIBIAL 8MM TITANIUM
|
Facility
|
OP
|
$9,692.00
|
|
| Hospital Charge Code |
2966301
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,713.76 |
| Max. Negotiated Rate |
$38,768.00 |
| Rate for Payer: Aetna Commercial |
$8,722.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,335.12
|
| Rate for Payer: Aetna Managed Medicare |
$2,713.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,299.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,846.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,652.16
|
| 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: Dean Health DHI/DHP/ASO |
$5,423.64
|
| Rate for Payer: Health EOS Commercial |
$8,625.88
|
| Rate for Payer: HFN Commercial |
$8,916.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,269.00
|
| 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 |
$6,299.80
|
| Rate for Payer: Quartz Medicare Advantage |
$5,815.20
|
| Rate for Payer: The Alliance Commercial |
$38,768.00
|
| Rate for Payer: WEA Trust Commercial |
$5,330.60
|
| Rate for Payer: WPS Commercial |
$7,178.86
|
|
|
NAIL TIBIAL CANN 8MM X 285MM TITANIUM 04.034.237S
|
Facility
|
OP
|
$5,270.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6180624
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,475.60 |
| Max. Negotiated Rate |
$21,080.00 |
| Rate for Payer: Aetna Commercial |
$4,743.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,532.20
|
| Rate for Payer: Aetna Managed Medicare |
$1,475.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,425.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,635.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,529.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,793.10
|
| Rate for Payer: Cash Price |
$1,581.00
|
| Rate for Payer: Cigna Commercial |
$4,848.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,949.09
|
| Rate for Payer: Health EOS Commercial |
$4,690.30
|
| Rate for Payer: HFN Commercial |
$4,848.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,952.50
|
| Rate for Payer: Multiplan Commercial |
$4,216.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,162.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,848.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,582.30
|
| Rate for Payer: Quartz Commercial |
$3,425.50
|
| Rate for Payer: Quartz Medicare Advantage |
$3,162.00
|
| Rate for Payer: The Alliance Commercial |
$21,080.00
|
| Rate for Payer: WEA Trust Commercial |
$2,898.50
|
| Rate for Payer: WPS Commercial |
$3,903.49
|
|
|
NAIL TIBIAL CANN 8MM X 285MM TITANIUM 04.034.237S
|
Facility
|
IP
|
$5,270.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6180624
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,582.30 |
| Max. Negotiated Rate |
$4,848.40 |
| Rate for Payer: Aetna Commercial |
$4,743.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,532.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,793.10
|
| Rate for Payer: Cash Price |
$1,581.00
|
| Rate for Payer: Cigna Commercial |
$4,848.40
|
| Rate for Payer: Health EOS Commercial |
$4,690.30
|
| Rate for Payer: HFN Commercial |
$4,848.40
|
| Rate for Payer: Multiplan Commercial |
$4,216.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,162.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,848.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,582.30
|
| Rate for Payer: Quartz Commercial |
$3,162.00
|
| Rate for Payer: WEA Trust Commercial |
$2,898.50
|
| Rate for Payer: WPS Commercial |
$3,903.49
|
|
|
NAIL TIBIAL CANN 9MM 330MM TI PROX BEND 04.034.346S
|
Facility
|
OP
|
$9,692.00
|
|
| Hospital Charge Code |
2966282
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,713.76 |
| Max. Negotiated Rate |
$38,768.00 |
| Rate for Payer: Aetna Commercial |
$8,722.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,335.12
|
| Rate for Payer: Aetna Managed Medicare |
$2,713.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,299.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,846.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,652.16
|
| 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: Dean Health DHI/DHP/ASO |
$5,423.64
|
| Rate for Payer: Health EOS Commercial |
$8,625.88
|
| Rate for Payer: HFN Commercial |
$8,916.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,269.00
|
| 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 |
$6,299.80
|
| Rate for Payer: Quartz Medicare Advantage |
$5,815.20
|
| Rate for Payer: The Alliance Commercial |
$38,768.00
|
| Rate for Payer: WEA Trust Commercial |
$5,330.60
|
| Rate for Payer: WPS Commercial |
$7,178.86
|
|
|
NAIL TIBIAL CANN 9MM 330MM TI PROX BEND 04.034.346S
|
Facility
|
IP
|
$9,692.00
|
|
| Hospital Charge Code |
2966282
|
|
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 TIBIAL CANN 9MM X 285MM TI 04.034.337S
|
Facility
|
OP
|
$9,692.00
|
|
| Hospital Charge Code |
2966296
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,713.76 |
| Max. Negotiated Rate |
$38,768.00 |
| Rate for Payer: Aetna Commercial |
$8,722.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,335.12
|
| Rate for Payer: Aetna Managed Medicare |
$2,713.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,299.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,846.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,652.16
|
| 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: Dean Health DHI/DHP/ASO |
$5,423.64
|
| Rate for Payer: Health EOS Commercial |
$8,625.88
|
| Rate for Payer: HFN Commercial |
$8,916.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,269.00
|
| 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 |
$6,299.80
|
| Rate for Payer: Quartz Medicare Advantage |
$5,815.20
|
| Rate for Payer: The Alliance Commercial |
$38,768.00
|
| Rate for Payer: WEA Trust Commercial |
$5,330.60
|
| Rate for Payer: WPS Commercial |
$7,178.86
|
|
|
NAIL TIBIAL CANN 9MM X 285MM TI 04.034.337S
|
Facility
|
IP
|
$9,692.00
|
|
| Hospital Charge Code |
2966296
|
|
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 TIBIAL CANN ADVANCED 12MM X 315MM TI 04.043.425S
|
Facility
|
OP
|
$9,309.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6175602
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,606.52 |
| Max. Negotiated Rate |
$37,236.00 |
| Rate for Payer: Aetna Commercial |
$8,378.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,005.74
|
| Rate for Payer: Aetna Managed Medicare |
$2,606.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,050.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,654.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,468.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,933.77
|
| Rate for Payer: Cash Price |
$2,792.70
|
| Rate for Payer: Cigna Commercial |
$8,564.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,209.32
|
| Rate for Payer: Health EOS Commercial |
$8,285.01
|
| Rate for Payer: HFN Commercial |
$8,564.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,981.75
|
| Rate for Payer: Multiplan Commercial |
$7,447.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,585.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,564.28
|
| Rate for Payer: Quartz Beloit One Network |
$4,561.41
|
| Rate for Payer: Quartz Commercial |
$6,050.85
|
| Rate for Payer: Quartz Medicare Advantage |
$5,585.40
|
| Rate for Payer: The Alliance Commercial |
$37,236.00
|
| Rate for Payer: WEA Trust Commercial |
$5,119.95
|
| Rate for Payer: WPS Commercial |
$6,895.18
|
|
|
NAIL TIBIAL CANN ADVANCED 12MM X 315MM TI 04.043.425S
|
Facility
|
IP
|
$9,309.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6175602
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,561.41 |
| Max. Negotiated Rate |
$8,564.28 |
| Rate for Payer: Aetna Commercial |
$8,378.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,005.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,933.77
|
| Rate for Payer: Cash Price |
$2,792.70
|
| Rate for Payer: Cigna Commercial |
$8,564.28
|
| Rate for Payer: Health EOS Commercial |
$8,285.01
|
| Rate for Payer: HFN Commercial |
$8,564.28
|
| Rate for Payer: Multiplan Commercial |
$7,447.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,585.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,564.28
|
| Rate for Payer: Quartz Beloit One Network |
$4,561.41
|
| Rate for Payer: Quartz Commercial |
$5,585.40
|
| Rate for Payer: WEA Trust Commercial |
$5,119.95
|
| Rate for Payer: WPS Commercial |
$6,895.18
|
|
|
NAIL TI CANN TIBIAL W/PROX BEN
|
Facility
|
OP
|
$9,352.00
|
|
| Hospital Charge Code |
2966297
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,618.56 |
| Max. Negotiated Rate |
$37,408.00 |
| Rate for Payer: Aetna Commercial |
$8,416.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,042.72
|
| Rate for Payer: Aetna Managed Medicare |
$2,618.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,078.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,676.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,488.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,956.56
|
| Rate for Payer: Cash Price |
$2,805.60
|
| Rate for Payer: Cigna Commercial |
$8,603.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,233.38
|
| Rate for Payer: Health EOS Commercial |
$8,323.28
|
| Rate for Payer: HFN Commercial |
$8,603.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,014.00
|
| Rate for Payer: Multiplan Commercial |
$7,481.60
|
| Rate for Payer: NAPHCARE Commercial |
$5,611.20
|
| Rate for Payer: Preferred Network Access Commercial |
$8,603.84
|
| Rate for Payer: Quartz Beloit One Network |
$4,582.48
|
| Rate for Payer: Quartz Commercial |
$6,078.80
|
| Rate for Payer: Quartz Medicare Advantage |
$5,611.20
|
| Rate for Payer: The Alliance Commercial |
$37,408.00
|
| Rate for Payer: WEA Trust Commercial |
$5,143.60
|
| Rate for Payer: WPS Commercial |
$6,927.03
|
|
|
NAIL TI CANN TIBIAL W/PROX BEN
|
Facility
|
IP
|
$9,352.00
|
|
| Hospital Charge Code |
2966297
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,582.48 |
| Max. Negotiated Rate |
$8,603.84 |
| Rate for Payer: Aetna Commercial |
$8,416.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,042.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,956.56
|
| Rate for Payer: Cash Price |
$2,805.60
|
| Rate for Payer: Cigna Commercial |
$8,603.84
|
| Rate for Payer: Health EOS Commercial |
$8,323.28
|
| Rate for Payer: HFN Commercial |
$8,603.84
|
| Rate for Payer: Multiplan Commercial |
$7,481.60
|
| Rate for Payer: NAPHCARE Commercial |
$5,611.20
|
| Rate for Payer: Preferred Network Access Commercial |
$8,603.84
|
| Rate for Payer: Quartz Beloit One Network |
$4,582.48
|
| Rate for Payer: Quartz Commercial |
$5,611.20
|
| Rate for Payer: WEA Trust Commercial |
$5,143.60
|
| Rate for Payer: WPS Commercial |
$6,927.03
|
|
|
NAIL TI FEMORAL RECON 12MM
|
Facility
|
OP
|
$10,429.00
|
|
| Hospital Charge Code |
2966298
|
|
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 TI FEMORAL RECON 12MM
|
Facility
|
IP
|
$10,429.00
|
|
| Hospital Charge Code |
2966298
|
|
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 TROCHANTERIC 11X125DX170 TFN 456.317S
|
Facility
|
OP
|
$10,642.00
|
|
| Hospital Charge Code |
2966624
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,979.76 |
| Max. Negotiated Rate |
$42,568.00 |
| Rate for Payer: Aetna Commercial |
$9,577.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,152.12
|
| Rate for Payer: Aetna Managed Medicare |
$2,979.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,917.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,321.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,108.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,640.26
|
| Rate for Payer: Cash Price |
$3,192.60
|
| Rate for Payer: Cigna Commercial |
$9,790.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,955.26
|
| Rate for Payer: Health EOS Commercial |
$9,471.38
|
| Rate for Payer: HFN Commercial |
$9,790.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,981.50
|
| Rate for Payer: Multiplan Commercial |
$8,513.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,385.20
|
| Rate for Payer: Preferred Network Access Commercial |
$9,790.64
|
| Rate for Payer: Quartz Beloit One Network |
$5,214.58
|
| Rate for Payer: Quartz Commercial |
$6,917.30
|
| Rate for Payer: Quartz Medicare Advantage |
$6,385.20
|
| Rate for Payer: The Alliance Commercial |
$42,568.00
|
| Rate for Payer: WEA Trust Commercial |
$5,853.10
|
| Rate for Payer: WPS Commercial |
$7,882.53
|
|
|
NAIL TROCHANTERIC 11X125DX170 TFN 456.317S
|
Facility
|
IP
|
$10,642.00
|
|
| Hospital Charge Code |
2966624
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,214.58 |
| Max. Negotiated Rate |
$9,790.64 |
| Rate for Payer: Aetna Commercial |
$9,577.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,152.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,640.26
|
| Rate for Payer: Cash Price |
$3,192.60
|
| Rate for Payer: Cigna Commercial |
$9,790.64
|
| Rate for Payer: Health EOS Commercial |
$9,471.38
|
| Rate for Payer: HFN Commercial |
$9,790.64
|
| Rate for Payer: Multiplan Commercial |
$8,513.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,385.20
|
| Rate for Payer: Preferred Network Access Commercial |
$9,790.64
|
| Rate for Payer: Quartz Beloit One Network |
$5,214.58
|
| Rate for Payer: Quartz Commercial |
$6,385.20
|
| Rate for Payer: WEA Trust Commercial |
$5,853.10
|
| Rate for Payer: WPS Commercial |
$7,882.53
|
|
|
NAIL TROCHANTERIC 11X135DX170 TFN 456.319S
|
Facility
|
OP
|
$10,642.00
|
|
| Hospital Charge Code |
2966626
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,979.76 |
| Max. Negotiated Rate |
$42,568.00 |
| Rate for Payer: Aetna Commercial |
$9,577.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,152.12
|
| Rate for Payer: Aetna Managed Medicare |
$2,979.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,917.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,321.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,108.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,640.26
|
| Rate for Payer: Cash Price |
$3,192.60
|
| Rate for Payer: Cigna Commercial |
$9,790.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,955.26
|
| Rate for Payer: Health EOS Commercial |
$9,471.38
|
| Rate for Payer: HFN Commercial |
$9,790.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,981.50
|
| Rate for Payer: Multiplan Commercial |
$8,513.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,385.20
|
| Rate for Payer: Preferred Network Access Commercial |
$9,790.64
|
| Rate for Payer: Quartz Beloit One Network |
$5,214.58
|
| Rate for Payer: Quartz Commercial |
$6,917.30
|
| Rate for Payer: Quartz Medicare Advantage |
$6,385.20
|
| Rate for Payer: The Alliance Commercial |
$42,568.00
|
| Rate for Payer: WEA Trust Commercial |
$5,853.10
|
| Rate for Payer: WPS Commercial |
$7,882.53
|
|
|
NAIL TROCHANTERIC 11X135DX170 TFN 456.319S
|
Facility
|
IP
|
$10,642.00
|
|
| Hospital Charge Code |
2966626
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,214.58 |
| Max. Negotiated Rate |
$9,790.64 |
| Rate for Payer: Aetna Commercial |
$9,577.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,152.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,640.26
|
| Rate for Payer: Cash Price |
$3,192.60
|
| Rate for Payer: Cigna Commercial |
$9,790.64
|
| Rate for Payer: Health EOS Commercial |
$9,471.38
|
| Rate for Payer: HFN Commercial |
$9,790.64
|
| Rate for Payer: Multiplan Commercial |
$8,513.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,385.20
|
| Rate for Payer: Preferred Network Access Commercial |
$9,790.64
|
| Rate for Payer: Quartz Beloit One Network |
$5,214.58
|
| Rate for Payer: Quartz Commercial |
$6,385.20
|
| Rate for Payer: WEA Trust Commercial |
$5,853.10
|
| Rate for Payer: WPS Commercial |
$7,882.53
|
|
|
NAIL TROCHANTERIC ES 11MMX42CMX130 RT 1059-425
|
Facility
|
IP
|
$14,374.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6232139
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,043.26 |
| Max. Negotiated Rate |
$13,224.08 |
| Rate for Payer: Aetna Commercial |
$12,936.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,361.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,618.22
|
| Rate for Payer: Cash Price |
$4,312.20
|
| Rate for Payer: Cigna Commercial |
$13,224.08
|
| Rate for Payer: Health EOS Commercial |
$12,792.86
|
| Rate for Payer: HFN Commercial |
$13,224.08
|
| Rate for Payer: Multiplan Commercial |
$11,499.20
|
| Rate for Payer: NAPHCARE Commercial |
$8,624.40
|
| Rate for Payer: Preferred Network Access Commercial |
$13,224.08
|
| Rate for Payer: Quartz Beloit One Network |
$7,043.26
|
| Rate for Payer: Quartz Commercial |
$8,624.40
|
| Rate for Payer: WEA Trust Commercial |
$7,905.70
|
| Rate for Payer: WPS Commercial |
$10,646.82
|
|
|
NAIL TROCHANTERIC ES 11MMX42CMX130 RT 1059-425
|
Facility
|
OP
|
$14,374.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6232139
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,024.72 |
| Max. Negotiated Rate |
$57,496.00 |
| Rate for Payer: Aetna Commercial |
$12,936.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,361.64
|
| Rate for Payer: Aetna Managed Medicare |
$4,024.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,343.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,187.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,899.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,618.22
|
| Rate for Payer: Cash Price |
$4,312.20
|
| Rate for Payer: Cigna Commercial |
$13,224.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,043.69
|
| Rate for Payer: Health EOS Commercial |
$12,792.86
|
| Rate for Payer: HFN Commercial |
$13,224.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,780.50
|
| Rate for Payer: Multiplan Commercial |
$11,499.20
|
| Rate for Payer: NAPHCARE Commercial |
$8,624.40
|
| Rate for Payer: Preferred Network Access Commercial |
$13,224.08
|
| Rate for Payer: Quartz Beloit One Network |
$7,043.26
|
| Rate for Payer: Quartz Commercial |
$9,343.10
|
| Rate for Payer: Quartz Medicare Advantage |
$8,624.40
|
| Rate for Payer: The Alliance Commercial |
$57,496.00
|
| Rate for Payer: WEA Trust Commercial |
$7,905.70
|
| Rate for Payer: WPS Commercial |
$10,646.82
|
|
|
NAIL TROCHANTERIC SHORT 11MMX20CMX130 RT 1036-200
|
Facility
|
OP
|
$10,898.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6234134
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,051.44 |
| Max. Negotiated Rate |
$43,592.00 |
| Rate for Payer: Aetna Commercial |
$9,808.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,372.28
|
| Rate for Payer: Aetna Managed Medicare |
$3,051.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,083.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,449.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,231.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,775.94
|
| Rate for Payer: Cash Price |
$3,269.40
|
| Rate for Payer: Cigna Commercial |
$10,026.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,098.52
|
| Rate for Payer: Health EOS Commercial |
$9,699.22
|
| Rate for Payer: HFN Commercial |
$10,026.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,173.50
|
| Rate for Payer: Multiplan Commercial |
$8,718.40
|
| Rate for Payer: NAPHCARE Commercial |
$6,538.80
|
| Rate for Payer: Preferred Network Access Commercial |
$10,026.16
|
| Rate for Payer: Quartz Beloit One Network |
$5,340.02
|
| Rate for Payer: Quartz Commercial |
$7,083.70
|
| Rate for Payer: Quartz Medicare Advantage |
$6,538.80
|
| Rate for Payer: The Alliance Commercial |
$43,592.00
|
| Rate for Payer: WEA Trust Commercial |
$5,993.90
|
| Rate for Payer: WPS Commercial |
$8,072.15
|
|
|
NAIL TROCHANTERIC SHORT 11MMX20CMX130 RT 1036-200
|
Facility
|
IP
|
$10,898.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6234134
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,340.02 |
| Max. Negotiated Rate |
$10,026.16 |
| Rate for Payer: Aetna Commercial |
$9,808.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,372.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,775.94
|
| Rate for Payer: Cash Price |
$3,269.40
|
| Rate for Payer: Cigna Commercial |
$10,026.16
|
| Rate for Payer: Health EOS Commercial |
$9,699.22
|
| Rate for Payer: HFN Commercial |
$10,026.16
|
| Rate for Payer: Multiplan Commercial |
$8,718.40
|
| Rate for Payer: NAPHCARE Commercial |
$6,538.80
|
| Rate for Payer: Preferred Network Access Commercial |
$10,026.16
|
| Rate for Payer: Quartz Beloit One Network |
$5,340.02
|
| Rate for Payer: Quartz Commercial |
$6,538.80
|
| Rate for Payer: WEA Trust Commercial |
$5,993.90
|
| Rate for Payer: WPS Commercial |
$8,072.15
|
|
|
NAIL TROCHANTERIC TFN 10MM 456.315S
|
Facility
|
OP
|
$10,642.00
|
|
| Hospital Charge Code |
2966623
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,979.76 |
| Max. Negotiated Rate |
$42,568.00 |
| Rate for Payer: Aetna Commercial |
$9,577.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,152.12
|
| Rate for Payer: Aetna Managed Medicare |
$2,979.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,917.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,321.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,108.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,640.26
|
| Rate for Payer: Cash Price |
$3,192.60
|
| Rate for Payer: Cigna Commercial |
$9,790.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,955.26
|
| Rate for Payer: Health EOS Commercial |
$9,471.38
|
| Rate for Payer: HFN Commercial |
$9,790.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,981.50
|
| Rate for Payer: Multiplan Commercial |
$8,513.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,385.20
|
| Rate for Payer: Preferred Network Access Commercial |
$9,790.64
|
| Rate for Payer: Quartz Beloit One Network |
$5,214.58
|
| Rate for Payer: Quartz Commercial |
$6,917.30
|
| Rate for Payer: Quartz Medicare Advantage |
$6,385.20
|
| Rate for Payer: The Alliance Commercial |
$42,568.00
|
| Rate for Payer: WEA Trust Commercial |
$5,853.10
|
| Rate for Payer: WPS Commercial |
$7,882.53
|
|
