|
NAIL TROCHANTERIC TFNA 10MMX125 DEG 400MM LT TI 04.037.031S
|
Facility
|
OP
|
$10,562.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6199024
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,957.36 |
| Max. Negotiated Rate |
$42,248.00 |
| Rate for Payer: Aetna Commercial |
$9,505.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,083.32
|
| Rate for Payer: Aetna Managed Medicare |
$2,957.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,865.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,281.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,069.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,597.86
|
| Rate for Payer: Cash Price |
$3,168.60
|
| Rate for Payer: Cigna Commercial |
$9,717.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,910.50
|
| Rate for Payer: Health EOS Commercial |
$9,400.18
|
| Rate for Payer: HFN Commercial |
$9,717.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,921.50
|
| Rate for Payer: Multiplan Commercial |
$8,449.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,337.20
|
| Rate for Payer: Preferred Network Access Commercial |
$9,717.04
|
| Rate for Payer: Quartz Beloit One Network |
$5,175.38
|
| Rate for Payer: Quartz Commercial |
$6,865.30
|
| Rate for Payer: Quartz Medicare Advantage |
$6,337.20
|
| Rate for Payer: The Alliance Commercial |
$42,248.00
|
| Rate for Payer: WEA Trust Commercial |
$5,809.10
|
| Rate for Payer: WPS Commercial |
$7,823.27
|
|
|
NAIL TROCHANTERIC TFNA 10MMX130 DEG 170MM TI 04.037.042S
|
Facility
|
IP
|
$7,246.21
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6244122
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,550.64 |
| Max. Negotiated Rate |
$6,666.51 |
| Rate for Payer: Aetna Commercial |
$6,521.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,231.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,840.49
|
| Rate for Payer: Cash Price |
$2,173.86
|
| Rate for Payer: Cigna Commercial |
$6,666.51
|
| Rate for Payer: Health EOS Commercial |
$6,449.13
|
| Rate for Payer: HFN Commercial |
$6,666.51
|
| Rate for Payer: Multiplan Commercial |
$5,796.97
|
| Rate for Payer: NAPHCARE Commercial |
$4,347.73
|
| Rate for Payer: Preferred Network Access Commercial |
$6,666.51
|
| Rate for Payer: Quartz Beloit One Network |
$3,550.64
|
| Rate for Payer: Quartz Commercial |
$4,347.73
|
| Rate for Payer: WEA Trust Commercial |
$3,985.42
|
| Rate for Payer: WPS Commercial |
$5,367.27
|
|
|
NAIL TROCHANTERIC TFNA 10MMX130 DEG 170MM TI 04.037.042S
|
Facility
|
OP
|
$7,246.21
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6244122
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,028.94 |
| Max. Negotiated Rate |
$28,984.84 |
| Rate for Payer: Aetna Commercial |
$6,521.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,231.74
|
| Rate for Payer: Aetna Managed Medicare |
$2,028.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,710.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,623.10
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,478.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,840.49
|
| Rate for Payer: Cash Price |
$2,173.86
|
| Rate for Payer: Cigna Commercial |
$6,666.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,054.98
|
| Rate for Payer: Health EOS Commercial |
$6,449.13
|
| Rate for Payer: HFN Commercial |
$6,666.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,434.66
|
| Rate for Payer: Multiplan Commercial |
$5,796.97
|
| Rate for Payer: NAPHCARE Commercial |
$4,347.73
|
| Rate for Payer: Preferred Network Access Commercial |
$6,666.51
|
| Rate for Payer: Quartz Beloit One Network |
$3,550.64
|
| Rate for Payer: Quartz Commercial |
$4,710.04
|
| Rate for Payer: Quartz Medicare Advantage |
$4,347.73
|
| Rate for Payer: The Alliance Commercial |
$28,984.84
|
| Rate for Payer: WEA Trust Commercial |
$3,985.42
|
| Rate for Payer: WPS Commercial |
$5,367.27
|
|
|
NAIL TROCHANTERIC TFNA 11MMX125 DEG 170 TI 04.037.112S
|
Facility
|
OP
|
$7,706.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4520268
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,157.68 |
| Max. Negotiated Rate |
$30,824.00 |
| Rate for Payer: Aetna Commercial |
$6,935.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,627.16
|
| Rate for Payer: Aetna Managed Medicare |
$2,157.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,008.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,853.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,698.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,084.18
|
| Rate for Payer: Cash Price |
$2,311.80
|
| Rate for Payer: Cigna Commercial |
$7,089.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,312.28
|
| Rate for Payer: Health EOS Commercial |
$6,858.34
|
| Rate for Payer: HFN Commercial |
$7,089.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,779.50
|
| Rate for Payer: Multiplan Commercial |
$6,164.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,623.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,089.52
|
| Rate for Payer: Quartz Beloit One Network |
$3,775.94
|
| Rate for Payer: Quartz Commercial |
$5,008.90
|
| Rate for Payer: Quartz Medicare Advantage |
$4,623.60
|
| Rate for Payer: The Alliance Commercial |
$30,824.00
|
| Rate for Payer: WEA Trust Commercial |
$4,238.30
|
| Rate for Payer: WPS Commercial |
$5,707.83
|
|
|
NAIL TROCHANTERIC TFNA 11MMX125 DEG 170 TI 04.037.112S
|
Facility
|
IP
|
$7,706.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4520268
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$3,775.94 |
| Max. Negotiated Rate |
$7,089.52 |
| Rate for Payer: Aetna Commercial |
$6,935.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,627.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,084.18
|
| Rate for Payer: Cash Price |
$2,311.80
|
| Rate for Payer: Cigna Commercial |
$7,089.52
|
| Rate for Payer: Health EOS Commercial |
$6,858.34
|
| Rate for Payer: HFN Commercial |
$7,089.52
|
| Rate for Payer: Multiplan Commercial |
$6,164.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,623.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,089.52
|
| Rate for Payer: Quartz Beloit One Network |
$3,775.94
|
| Rate for Payer: Quartz Commercial |
$4,623.60
|
| Rate for Payer: WEA Trust Commercial |
$4,238.30
|
| Rate for Payer: WPS Commercial |
$5,707.83
|
|
|
NAIL TROCHANTERIC TFNA 11MMX125DEG 235MM LT TI 04.037.115S
|
Facility
|
OP
|
$9,216.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4640736
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,580.48 |
| Max. Negotiated Rate |
$36,864.00 |
| Rate for Payer: Aetna Commercial |
$8,294.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,925.76
|
| Rate for Payer: Aetna Managed Medicare |
$2,580.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,990.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,608.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,423.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,884.48
|
| Rate for Payer: Cash Price |
$2,764.80
|
| Rate for Payer: Cigna Commercial |
$8,478.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,157.27
|
| Rate for Payer: Health EOS Commercial |
$8,202.24
|
| Rate for Payer: HFN Commercial |
$8,478.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,912.00
|
| Rate for Payer: Multiplan Commercial |
$7,372.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,529.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,478.72
|
| Rate for Payer: Quartz Beloit One Network |
$4,515.84
|
| Rate for Payer: Quartz Commercial |
$5,990.40
|
| Rate for Payer: Quartz Medicare Advantage |
$5,529.60
|
| Rate for Payer: The Alliance Commercial |
$36,864.00
|
| Rate for Payer: WEA Trust Commercial |
$5,068.80
|
| Rate for Payer: WPS Commercial |
$6,826.29
|
|
|
NAIL TROCHANTERIC TFNA 11MMX125DEG 235MM LT TI 04.037.115S
|
Facility
|
IP
|
$9,216.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4640736
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,515.84 |
| Max. Negotiated Rate |
$8,478.72 |
| Rate for Payer: Aetna Commercial |
$8,294.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,925.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,884.48
|
| Rate for Payer: Cash Price |
$2,764.80
|
| Rate for Payer: Cigna Commercial |
$8,478.72
|
| Rate for Payer: Health EOS Commercial |
$8,202.24
|
| Rate for Payer: HFN Commercial |
$8,478.72
|
| Rate for Payer: Multiplan Commercial |
$7,372.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,529.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,478.72
|
| Rate for Payer: Quartz Beloit One Network |
$4,515.84
|
| Rate for Payer: Quartz Commercial |
$5,529.60
|
| Rate for Payer: WEA Trust Commercial |
$5,068.80
|
| Rate for Payer: WPS Commercial |
$6,826.29
|
|
|
NAIL TROCHANTERIC TFNA 11MMX125 DEG 340MM LT TI 04.037.125S
|
Facility
|
OP
|
$10,385.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5685792
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,907.80 |
| Max. Negotiated Rate |
$41,540.00 |
| Rate for Payer: Aetna Commercial |
$9,346.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,931.10
|
| Rate for Payer: Aetna Managed Medicare |
$2,907.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,750.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,192.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,984.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,504.05
|
| Rate for Payer: Cash Price |
$3,115.50
|
| Rate for Payer: Cigna Commercial |
$9,554.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,811.45
|
| Rate for Payer: Health EOS Commercial |
$9,242.65
|
| Rate for Payer: HFN Commercial |
$9,554.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,788.75
|
| Rate for Payer: Multiplan Commercial |
$8,308.00
|
| Rate for Payer: NAPHCARE Commercial |
$6,231.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9,554.20
|
| Rate for Payer: Quartz Beloit One Network |
$5,088.65
|
| Rate for Payer: Quartz Commercial |
$6,750.25
|
| Rate for Payer: Quartz Medicare Advantage |
$6,231.00
|
| Rate for Payer: The Alliance Commercial |
$41,540.00
|
| Rate for Payer: WEA Trust Commercial |
$5,711.75
|
| Rate for Payer: WPS Commercial |
$7,692.17
|
|
|
NAIL TROCHANTERIC TFNA 11MMX125 DEG 340MM LT TI 04.037.125S
|
Facility
|
IP
|
$10,385.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5685792
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,088.65 |
| Max. Negotiated Rate |
$9,554.20 |
| Rate for Payer: Aetna Commercial |
$9,346.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,931.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,504.05
|
| Rate for Payer: Cash Price |
$3,115.50
|
| Rate for Payer: Cigna Commercial |
$9,554.20
|
| Rate for Payer: Health EOS Commercial |
$9,242.65
|
| Rate for Payer: HFN Commercial |
$9,554.20
|
| Rate for Payer: Multiplan Commercial |
$8,308.00
|
| Rate for Payer: NAPHCARE Commercial |
$6,231.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9,554.20
|
| Rate for Payer: Quartz Beloit One Network |
$5,088.65
|
| Rate for Payer: Quartz Commercial |
$6,231.00
|
| Rate for Payer: WEA Trust Commercial |
$5,711.75
|
| Rate for Payer: WPS Commercial |
$7,692.17
|
|
|
NAIL TROCHANTERIC TFNA 11MMX125 DEG 340MM RT TI 04.037.124S
|
Facility
|
OP
|
$10,800.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4595801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$3,024.00 |
| Max. Negotiated Rate |
$43,200.00 |
| Rate for Payer: Aetna Commercial |
$9,720.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,288.00
|
| Rate for Payer: Aetna Managed Medicare |
$3,024.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,020.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,400.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,184.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,724.00
|
| Rate for Payer: Cash Price |
$3,240.00
|
| Rate for Payer: Cigna Commercial |
$9,936.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,043.68
|
| Rate for Payer: Health EOS Commercial |
$9,612.00
|
| Rate for Payer: HFN Commercial |
$9,936.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,100.00
|
| Rate for Payer: Multiplan Commercial |
$8,640.00
|
| Rate for Payer: NAPHCARE Commercial |
$6,480.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9,936.00
|
| Rate for Payer: Quartz Beloit One Network |
$5,292.00
|
| Rate for Payer: Quartz Commercial |
$7,020.00
|
| Rate for Payer: Quartz Medicare Advantage |
$6,480.00
|
| Rate for Payer: The Alliance Commercial |
$43,200.00
|
| Rate for Payer: WEA Trust Commercial |
$5,940.00
|
| Rate for Payer: WPS Commercial |
$7,999.56
|
|
|
NAIL TROCHANTERIC TFNA 11MMX125 DEG 340MM RT TI 04.037.124S
|
Facility
|
IP
|
$10,800.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4595801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$5,292.00 |
| Max. Negotiated Rate |
$9,936.00 |
| Rate for Payer: Aetna Commercial |
$9,720.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,288.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,724.00
|
| Rate for Payer: Cash Price |
$3,240.00
|
| Rate for Payer: Cigna Commercial |
$9,936.00
|
| Rate for Payer: Health EOS Commercial |
$9,612.00
|
| Rate for Payer: HFN Commercial |
$9,936.00
|
| Rate for Payer: Multiplan Commercial |
$8,640.00
|
| Rate for Payer: NAPHCARE Commercial |
$6,480.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9,936.00
|
| Rate for Payer: Quartz Beloit One Network |
$5,292.00
|
| Rate for Payer: Quartz Commercial |
$6,480.00
|
| Rate for Payer: WEA Trust Commercial |
$5,940.00
|
| Rate for Payer: WPS Commercial |
$7,999.56
|
|
|
NAIL TROCHANTERIC TFNA 11MMX125 DEG 360MM RT TI 04.037.126S
|
Facility
|
OP
|
$10,800.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5106881
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,024.00 |
| Max. Negotiated Rate |
$43,200.00 |
| Rate for Payer: Aetna Commercial |
$9,720.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,288.00
|
| Rate for Payer: Aetna Managed Medicare |
$3,024.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,020.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,400.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,184.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,724.00
|
| Rate for Payer: Cash Price |
$3,240.00
|
| Rate for Payer: Cigna Commercial |
$9,936.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,043.68
|
| Rate for Payer: Health EOS Commercial |
$9,612.00
|
| Rate for Payer: HFN Commercial |
$9,936.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,100.00
|
| Rate for Payer: Multiplan Commercial |
$8,640.00
|
| Rate for Payer: NAPHCARE Commercial |
$6,480.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9,936.00
|
| Rate for Payer: Quartz Beloit One Network |
$5,292.00
|
| Rate for Payer: Quartz Commercial |
$7,020.00
|
| Rate for Payer: Quartz Medicare Advantage |
$6,480.00
|
| Rate for Payer: The Alliance Commercial |
$43,200.00
|
| Rate for Payer: WEA Trust Commercial |
$5,940.00
|
| Rate for Payer: WPS Commercial |
$7,999.56
|
|
|
NAIL TROCHANTERIC TFNA 11MMX125 DEG 360MM RT TI 04.037.126S
|
Facility
|
IP
|
$10,800.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5106881
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,292.00 |
| Max. Negotiated Rate |
$9,936.00 |
| Rate for Payer: Aetna Commercial |
$9,720.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,288.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,724.00
|
| Rate for Payer: Cash Price |
$3,240.00
|
| Rate for Payer: Cigna Commercial |
$9,936.00
|
| Rate for Payer: Health EOS Commercial |
$9,612.00
|
| Rate for Payer: HFN Commercial |
$9,936.00
|
| Rate for Payer: Multiplan Commercial |
$8,640.00
|
| Rate for Payer: NAPHCARE Commercial |
$6,480.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9,936.00
|
| Rate for Payer: Quartz Beloit One Network |
$5,292.00
|
| Rate for Payer: Quartz Commercial |
$6,480.00
|
| Rate for Payer: WEA Trust Commercial |
$5,940.00
|
| Rate for Payer: WPS Commercial |
$7,999.56
|
|
|
NAIL TROCHANTERIC TFNA 11MMX125 DEG 380MM RT TI 04.037.128S
|
Facility
|
IP
|
$10,800.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5107182
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,292.00 |
| Max. Negotiated Rate |
$9,936.00 |
| Rate for Payer: Aetna Commercial |
$9,720.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,288.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,724.00
|
| Rate for Payer: Cash Price |
$3,240.00
|
| Rate for Payer: Cigna Commercial |
$9,936.00
|
| Rate for Payer: Health EOS Commercial |
$9,612.00
|
| Rate for Payer: HFN Commercial |
$9,936.00
|
| Rate for Payer: Multiplan Commercial |
$8,640.00
|
| Rate for Payer: NAPHCARE Commercial |
$6,480.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9,936.00
|
| Rate for Payer: Quartz Beloit One Network |
$5,292.00
|
| Rate for Payer: Quartz Commercial |
$6,480.00
|
| Rate for Payer: WEA Trust Commercial |
$5,940.00
|
| Rate for Payer: WPS Commercial |
$7,999.56
|
|
|
NAIL TROCHANTERIC TFNA 11MMX125 DEG 380MM RT TI 04.037.128S
|
Facility
|
OP
|
$10,800.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5107182
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,024.00 |
| Max. Negotiated Rate |
$43,200.00 |
| Rate for Payer: Aetna Commercial |
$9,720.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,288.00
|
| Rate for Payer: Aetna Managed Medicare |
$3,024.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,020.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,400.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,184.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,724.00
|
| Rate for Payer: Cash Price |
$3,240.00
|
| Rate for Payer: Cigna Commercial |
$9,936.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,043.68
|
| Rate for Payer: Health EOS Commercial |
$9,612.00
|
| Rate for Payer: HFN Commercial |
$9,936.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,100.00
|
| Rate for Payer: Multiplan Commercial |
$8,640.00
|
| Rate for Payer: NAPHCARE Commercial |
$6,480.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9,936.00
|
| Rate for Payer: Quartz Beloit One Network |
$5,292.00
|
| Rate for Payer: Quartz Commercial |
$7,020.00
|
| Rate for Payer: Quartz Medicare Advantage |
$6,480.00
|
| Rate for Payer: The Alliance Commercial |
$43,200.00
|
| Rate for Payer: WEA Trust Commercial |
$5,940.00
|
| Rate for Payer: WPS Commercial |
$7,999.56
|
|
|
NAIL TROCHANTERIC TFNA 11MMX125 DEG 400MM RT 04.037.130S
|
Facility
|
OP
|
$12,382.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4858785
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,466.96 |
| Max. Negotiated Rate |
$49,528.00 |
| Rate for Payer: Aetna Commercial |
$11,143.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,648.52
|
| Rate for Payer: Aetna Managed Medicare |
$3,466.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,048.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,191.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,943.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,562.46
|
| Rate for Payer: Cash Price |
$3,714.60
|
| Rate for Payer: Cigna Commercial |
$11,391.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,928.97
|
| Rate for Payer: Health EOS Commercial |
$11,019.98
|
| Rate for Payer: HFN Commercial |
$11,391.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,286.50
|
| Rate for Payer: Multiplan Commercial |
$9,905.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,429.20
|
| Rate for Payer: Preferred Network Access Commercial |
$11,391.44
|
| Rate for Payer: Quartz Beloit One Network |
$6,067.18
|
| Rate for Payer: Quartz Commercial |
$8,048.30
|
| Rate for Payer: Quartz Medicare Advantage |
$7,429.20
|
| Rate for Payer: The Alliance Commercial |
$49,528.00
|
| Rate for Payer: WEA Trust Commercial |
$6,810.10
|
| Rate for Payer: WPS Commercial |
$9,171.35
|
|
|
NAIL TROCHANTERIC TFNA 11MMX125 DEG 400MM RT 04.037.130S
|
Facility
|
IP
|
$12,382.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4858785
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,067.18 |
| Max. Negotiated Rate |
$11,391.44 |
| Rate for Payer: Aetna Commercial |
$11,143.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,648.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,562.46
|
| Rate for Payer: Cash Price |
$3,714.60
|
| Rate for Payer: Cigna Commercial |
$11,391.44
|
| Rate for Payer: Health EOS Commercial |
$11,019.98
|
| Rate for Payer: HFN Commercial |
$11,391.44
|
| Rate for Payer: Multiplan Commercial |
$9,905.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,429.20
|
| Rate for Payer: Preferred Network Access Commercial |
$11,391.44
|
| Rate for Payer: Quartz Beloit One Network |
$6,067.18
|
| Rate for Payer: Quartz Commercial |
$7,429.20
|
| Rate for Payer: WEA Trust Commercial |
$6,810.10
|
| Rate for Payer: WPS Commercial |
$9,171.35
|
|
|
NAIL TROCHANTERIC TFNA 11MMX125 DEG TI 04.037.114S
|
Facility
|
OP
|
$8,862.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4595106
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,481.36 |
| Max. Negotiated Rate |
$35,448.00 |
| Rate for Payer: Aetna Commercial |
$7,975.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,621.32
|
| Rate for Payer: Aetna Managed Medicare |
$2,481.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,760.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,431.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,253.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,696.86
|
| Rate for Payer: Cash Price |
$2,658.60
|
| Rate for Payer: Cigna Commercial |
$8,153.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,959.18
|
| Rate for Payer: Health EOS Commercial |
$7,887.18
|
| Rate for Payer: HFN Commercial |
$8,153.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,646.50
|
| Rate for Payer: Multiplan Commercial |
$7,089.60
|
| Rate for Payer: NAPHCARE Commercial |
$5,317.20
|
| Rate for Payer: Preferred Network Access Commercial |
$8,153.04
|
| Rate for Payer: Quartz Beloit One Network |
$4,342.38
|
| Rate for Payer: Quartz Commercial |
$5,760.30
|
| Rate for Payer: Quartz Medicare Advantage |
$5,317.20
|
| Rate for Payer: The Alliance Commercial |
$35,448.00
|
| Rate for Payer: WEA Trust Commercial |
$4,874.10
|
| Rate for Payer: WPS Commercial |
$6,564.08
|
|
|
NAIL TROCHANTERIC TFNA 11MMX125 DEG TI 04.037.114S
|
Facility
|
IP
|
$8,862.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4595106
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$4,342.38 |
| Max. Negotiated Rate |
$8,153.04 |
| Rate for Payer: Aetna Commercial |
$7,975.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,621.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,696.86
|
| Rate for Payer: Cash Price |
$2,658.60
|
| Rate for Payer: Cigna Commercial |
$8,153.04
|
| Rate for Payer: Health EOS Commercial |
$7,887.18
|
| Rate for Payer: HFN Commercial |
$8,153.04
|
| Rate for Payer: Multiplan Commercial |
$7,089.60
|
| Rate for Payer: NAPHCARE Commercial |
$5,317.20
|
| Rate for Payer: Preferred Network Access Commercial |
$8,153.04
|
| Rate for Payer: Quartz Beloit One Network |
$4,342.38
|
| Rate for Payer: Quartz Commercial |
$5,317.20
|
| Rate for Payer: WEA Trust Commercial |
$4,874.10
|
| Rate for Payer: WPS Commercial |
$6,564.08
|
|
|
NAIL TROCHANTERIC TFNA 11MMX125 DEG TI 04.037.134S
|
Facility
|
IP
|
$7,706.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4594892
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,775.94 |
| Max. Negotiated Rate |
$7,089.52 |
| Rate for Payer: Aetna Commercial |
$6,935.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,627.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,084.18
|
| Rate for Payer: Cash Price |
$2,311.80
|
| Rate for Payer: Cigna Commercial |
$7,089.52
|
| Rate for Payer: Health EOS Commercial |
$6,858.34
|
| Rate for Payer: HFN Commercial |
$7,089.52
|
| Rate for Payer: Multiplan Commercial |
$6,164.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,623.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,089.52
|
| Rate for Payer: Quartz Beloit One Network |
$3,775.94
|
| Rate for Payer: Quartz Commercial |
$4,623.60
|
| Rate for Payer: WEA Trust Commercial |
$4,238.30
|
| Rate for Payer: WPS Commercial |
$5,707.83
|
|
|
NAIL TROCHANTERIC TFNA 11MMX125 DEG TI 04.037.134S
|
Facility
|
OP
|
$7,706.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4594892
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,157.68 |
| Max. Negotiated Rate |
$30,824.00 |
| Rate for Payer: Aetna Commercial |
$6,935.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,627.16
|
| Rate for Payer: Aetna Managed Medicare |
$2,157.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,008.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,853.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,698.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,084.18
|
| Rate for Payer: Cash Price |
$2,311.80
|
| Rate for Payer: Cigna Commercial |
$7,089.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,312.28
|
| Rate for Payer: Health EOS Commercial |
$6,858.34
|
| Rate for Payer: HFN Commercial |
$7,089.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,779.50
|
| Rate for Payer: Multiplan Commercial |
$6,164.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,623.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,089.52
|
| Rate for Payer: Quartz Beloit One Network |
$3,775.94
|
| Rate for Payer: Quartz Commercial |
$5,008.90
|
| Rate for Payer: Quartz Medicare Advantage |
$4,623.60
|
| Rate for Payer: The Alliance Commercial |
$30,824.00
|
| Rate for Payer: WEA Trust Commercial |
$4,238.30
|
| Rate for Payer: WPS Commercial |
$5,707.83
|
|
|
NAIL TROCHANTERIC TFNA 11MMX130 DEG TI 04.037.157S
|
Facility
|
IP
|
$10,800.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4519759
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,292.00 |
| Max. Negotiated Rate |
$9,936.00 |
| Rate for Payer: Aetna Commercial |
$9,720.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,288.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,724.00
|
| Rate for Payer: Cash Price |
$3,240.00
|
| Rate for Payer: Cigna Commercial |
$9,936.00
|
| Rate for Payer: Health EOS Commercial |
$9,612.00
|
| Rate for Payer: HFN Commercial |
$9,936.00
|
| Rate for Payer: Multiplan Commercial |
$8,640.00
|
| Rate for Payer: NAPHCARE Commercial |
$6,480.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9,936.00
|
| Rate for Payer: Quartz Beloit One Network |
$5,292.00
|
| Rate for Payer: Quartz Commercial |
$6,480.00
|
| Rate for Payer: WEA Trust Commercial |
$5,940.00
|
| Rate for Payer: WPS Commercial |
$7,999.56
|
|
|
NAIL TROCHANTERIC TFNA 11MMX130 DEG TI 04.037.157S
|
Facility
|
OP
|
$10,800.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4519759
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,024.00 |
| Max. Negotiated Rate |
$43,200.00 |
| Rate for Payer: Aetna Commercial |
$9,720.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,288.00
|
| Rate for Payer: Aetna Managed Medicare |
$3,024.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,020.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,400.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,184.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,724.00
|
| Rate for Payer: Cash Price |
$3,240.00
|
| Rate for Payer: Cigna Commercial |
$9,936.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,043.68
|
| Rate for Payer: Health EOS Commercial |
$9,612.00
|
| Rate for Payer: HFN Commercial |
$9,936.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,100.00
|
| Rate for Payer: Multiplan Commercial |
$8,640.00
|
| Rate for Payer: NAPHCARE Commercial |
$6,480.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9,936.00
|
| Rate for Payer: Quartz Beloit One Network |
$5,292.00
|
| Rate for Payer: Quartz Commercial |
$7,020.00
|
| Rate for Payer: Quartz Medicare Advantage |
$6,480.00
|
| Rate for Payer: The Alliance Commercial |
$43,200.00
|
| Rate for Payer: WEA Trust Commercial |
$5,940.00
|
| Rate for Payer: WPS Commercial |
$7,999.56
|
|
|
NAIL TROCHANTERIC TFNA 11MMX170X125 DEG TI 04.037.112S
|
Facility
|
IP
|
$7,706.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5179255
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$3,775.94 |
| Max. Negotiated Rate |
$7,089.52 |
| Rate for Payer: Aetna Commercial |
$6,935.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,627.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,084.18
|
| Rate for Payer: Cash Price |
$2,311.80
|
| Rate for Payer: Cigna Commercial |
$7,089.52
|
| Rate for Payer: Health EOS Commercial |
$6,858.34
|
| Rate for Payer: HFN Commercial |
$7,089.52
|
| Rate for Payer: Multiplan Commercial |
$6,164.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,623.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,089.52
|
| Rate for Payer: Quartz Beloit One Network |
$3,775.94
|
| Rate for Payer: Quartz Commercial |
$4,623.60
|
| Rate for Payer: WEA Trust Commercial |
$4,238.30
|
| Rate for Payer: WPS Commercial |
$5,707.83
|
|
|
NAIL TROCHANTERIC TFNA 11MMX170X125 DEG TI 04.037.112S
|
Facility
|
OP
|
$7,706.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5179255
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,157.68 |
| Max. Negotiated Rate |
$30,824.00 |
| Rate for Payer: Aetna Commercial |
$6,935.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,627.16
|
| Rate for Payer: Aetna Managed Medicare |
$2,157.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,008.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,853.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,698.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,084.18
|
| Rate for Payer: Cash Price |
$2,311.80
|
| Rate for Payer: Cigna Commercial |
$7,089.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,312.28
|
| Rate for Payer: Health EOS Commercial |
$6,858.34
|
| Rate for Payer: HFN Commercial |
$7,089.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,779.50
|
| Rate for Payer: Multiplan Commercial |
$6,164.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,623.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,089.52
|
| Rate for Payer: Quartz Beloit One Network |
$3,775.94
|
| Rate for Payer: Quartz Commercial |
$5,008.90
|
| Rate for Payer: Quartz Medicare Advantage |
$4,623.60
|
| Rate for Payer: The Alliance Commercial |
$30,824.00
|
| Rate for Payer: WEA Trust Commercial |
$4,238.30
|
| Rate for Payer: WPS Commercial |
$5,707.83
|
|
