|
NAIL AND END CAP OLECRANON
|
Facility
|
OP
|
$6,269.00
|
|
| Hospital Charge Code |
2966291
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,825.53 |
| Max. Negotiated Rate |
$5,998.18 |
| Rate for Payer: Aetna Commercial |
$5,867.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,606.99
|
| Rate for Payer: Aetna Managed Medicare |
$1,825.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,237.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,259.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,129.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,455.47
|
| Rate for Payer: Cash Price |
$1,880.70
|
| Rate for Payer: Cigna Commercial |
$5,998.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,648.56
|
| Rate for Payer: Health EOS Commercial |
$5,802.59
|
| Rate for Payer: HFN Commercial |
$5,998.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,889.82
|
| Rate for Payer: Multiplan Commercial |
$5,215.81
|
| Rate for Payer: NAPHCARE Commercial |
$3,911.86
|
| Rate for Payer: Preferred Network Access Commercial |
$5,998.18
|
| Rate for Payer: Quartz Beloit One Network |
$3,194.68
|
| Rate for Payer: Quartz Commercial |
$4,237.84
|
| Rate for Payer: Quartz Medicare Advantage |
$3,911.86
|
| Rate for Payer: The Alliance Commercial |
$3,259.88
|
| Rate for Payer: WEA Trust Commercial |
$3,585.87
|
| Rate for Payer: WPS Commercial |
$4,829.01
|
|
|
NAIL ANKLE ARTHRODESIS 10 X 200MM RT T2 1819-1020S
|
Facility
|
OP
|
$9,098.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6001647
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,649.34 |
| Max. Negotiated Rate |
$8,704.97 |
| Rate for Payer: Aetna Commercial |
$8,515.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,137.25
|
| Rate for Payer: Aetna Managed Medicare |
$2,649.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,150.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,730.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,541.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,014.82
|
| Rate for Payer: Cash Price |
$2,729.40
|
| Rate for Payer: Cigna Commercial |
$8,704.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,295.04
|
| Rate for Payer: Health EOS Commercial |
$8,421.11
|
| Rate for Payer: HFN Commercial |
$8,704.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,096.44
|
| Rate for Payer: Multiplan Commercial |
$7,569.54
|
| Rate for Payer: NAPHCARE Commercial |
$5,677.15
|
| Rate for Payer: Preferred Network Access Commercial |
$8,704.97
|
| Rate for Payer: Quartz Beloit One Network |
$4,636.34
|
| Rate for Payer: Quartz Commercial |
$6,150.25
|
| Rate for Payer: Quartz Medicare Advantage |
$5,677.15
|
| Rate for Payer: The Alliance Commercial |
$4,730.96
|
| Rate for Payer: WEA Trust Commercial |
$5,204.06
|
| Rate for Payer: WPS Commercial |
$7,008.19
|
|
|
NAIL ANKLE ARTHRODESIS 10 X 200MM RT T2 1819-1020S
|
Facility
|
IP
|
$9,098.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6001647
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,636.34 |
| Max. Negotiated Rate |
$8,704.97 |
| Rate for Payer: Aetna Commercial |
$8,515.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,137.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,014.82
|
| Rate for Payer: Cash Price |
$2,729.40
|
| Rate for Payer: Cigna Commercial |
$8,704.97
|
| Rate for Payer: Health EOS Commercial |
$8,421.11
|
| Rate for Payer: HFN Commercial |
$8,704.97
|
| Rate for Payer: Multiplan Commercial |
$7,569.54
|
| Rate for Payer: Preferred Network Access Commercial |
$8,704.97
|
| Rate for Payer: Quartz Beloit One Network |
$4,636.34
|
| Rate for Payer: Quartz Commercial |
$5,677.15
|
| Rate for Payer: WEA Trust Commercial |
$5,204.06
|
| Rate for Payer: WPS Commercial |
$7,008.19
|
|
|
NAIL ANKLE ARTHRODESIS 10 X 300MM RT T2 1819-1030S
|
Facility
|
OP
|
$18,746.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6211056
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,458.84 |
| Max. Negotiated Rate |
$17,936.17 |
| Rate for Payer: Aetna Commercial |
$17,546.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,766.42
|
| Rate for Payer: Aetna Managed Medicare |
$5,458.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,672.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,747.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,358.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,332.80
|
| Rate for Payer: Cash Price |
$5,623.80
|
| Rate for Payer: Cigna Commercial |
$17,936.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,910.17
|
| Rate for Payer: Health EOS Commercial |
$17,351.30
|
| Rate for Payer: HFN Commercial |
$17,936.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,621.88
|
| Rate for Payer: Multiplan Commercial |
$15,596.67
|
| Rate for Payer: NAPHCARE Commercial |
$11,697.50
|
| Rate for Payer: Preferred Network Access Commercial |
$17,936.17
|
| Rate for Payer: Quartz Beloit One Network |
$9,552.96
|
| Rate for Payer: Quartz Commercial |
$12,672.30
|
| Rate for Payer: Quartz Medicare Advantage |
$11,697.50
|
| Rate for Payer: The Alliance Commercial |
$9,747.92
|
| Rate for Payer: WEA Trust Commercial |
$10,722.71
|
| Rate for Payer: WPS Commercial |
$14,440.04
|
|
|
NAIL ANKLE ARTHRODESIS 10 X 300MM RT T2 1819-1030S
|
Facility
|
IP
|
$18,746.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6211056
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,552.96 |
| Max. Negotiated Rate |
$17,936.17 |
| Rate for Payer: Aetna Commercial |
$17,546.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,766.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,332.80
|
| Rate for Payer: Cash Price |
$5,623.80
|
| Rate for Payer: Cigna Commercial |
$17,936.17
|
| Rate for Payer: Health EOS Commercial |
$17,351.30
|
| Rate for Payer: HFN Commercial |
$17,936.17
|
| Rate for Payer: Multiplan Commercial |
$15,596.67
|
| Rate for Payer: Preferred Network Access Commercial |
$17,936.17
|
| Rate for Payer: Quartz Beloit One Network |
$9,552.96
|
| Rate for Payer: Quartz Commercial |
$11,697.50
|
| Rate for Payer: WEA Trust Commercial |
$10,722.71
|
| Rate for Payer: WPS Commercial |
$14,440.04
|
|
|
NAIL ANKLE ARTHRODESIS 11 X 200MM LT T2 1818-1120S
|
Facility
|
IP
|
$9,462.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5611628
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,821.84 |
| Max. Negotiated Rate |
$9,053.24 |
| Rate for Payer: Cash Price |
$2,838.60
|
| Rate for Payer: Cigna Commercial |
$9,053.24
|
| Rate for Payer: Health EOS Commercial |
$8,758.03
|
| Rate for Payer: HFN Commercial |
$9,053.24
|
| Rate for Payer: Multiplan Commercial |
$7,872.38
|
| Rate for Payer: Aetna Commercial |
$8,856.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,462.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,215.45
|
| Rate for Payer: Preferred Network Access Commercial |
$9,053.24
|
| Rate for Payer: Quartz Beloit One Network |
$4,821.84
|
| Rate for Payer: Quartz Commercial |
$5,904.29
|
| Rate for Payer: WEA Trust Commercial |
$5,412.26
|
| Rate for Payer: WPS Commercial |
$7,288.58
|
|
|
NAIL ANKLE ARTHRODESIS 11 X 200MM LT T2 1818-1120S
|
Facility
|
OP
|
$9,462.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5611628
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,755.33 |
| Max. Negotiated Rate |
$9,053.24 |
| Rate for Payer: Aetna Commercial |
$8,856.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,462.81
|
| Rate for Payer: Aetna Managed Medicare |
$2,755.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,396.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,920.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,723.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,215.45
|
| Rate for Payer: Cash Price |
$2,838.60
|
| Rate for Payer: Cigna Commercial |
$9,053.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,506.88
|
| Rate for Payer: Health EOS Commercial |
$8,758.03
|
| Rate for Payer: HFN Commercial |
$9,053.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,380.36
|
| Rate for Payer: Multiplan Commercial |
$7,872.38
|
| Rate for Payer: NAPHCARE Commercial |
$5,904.29
|
| Rate for Payer: Preferred Network Access Commercial |
$9,053.24
|
| Rate for Payer: Quartz Beloit One Network |
$4,821.84
|
| Rate for Payer: Quartz Commercial |
$6,396.31
|
| Rate for Payer: Quartz Medicare Advantage |
$5,904.29
|
| Rate for Payer: The Alliance Commercial |
$4,920.24
|
| Rate for Payer: WEA Trust Commercial |
$5,412.26
|
| Rate for Payer: WPS Commercial |
$7,288.58
|
|
|
NAIL ANKLE ARTHRODESIS 11 X 300MM LT T2 1818-1130S
|
Facility
|
IP
|
$9,462.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685885
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,821.84 |
| Max. Negotiated Rate |
$9,053.24 |
| Rate for Payer: Aetna Commercial |
$8,856.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,462.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,215.45
|
| Rate for Payer: Cash Price |
$2,838.60
|
| Rate for Payer: Cigna Commercial |
$9,053.24
|
| Rate for Payer: Health EOS Commercial |
$8,758.03
|
| Rate for Payer: HFN Commercial |
$9,053.24
|
| Rate for Payer: Multiplan Commercial |
$7,872.38
|
| Rate for Payer: Preferred Network Access Commercial |
$9,053.24
|
| Rate for Payer: Quartz Beloit One Network |
$4,821.84
|
| Rate for Payer: Quartz Commercial |
$5,904.29
|
| Rate for Payer: WEA Trust Commercial |
$5,412.26
|
| Rate for Payer: WPS Commercial |
$7,288.58
|
|
|
NAIL ANKLE ARTHRODESIS 11 X 300MM LT T2 1818-1130S
|
Facility
|
OP
|
$9,462.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685885
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,755.33 |
| Max. Negotiated Rate |
$9,053.24 |
| Rate for Payer: Aetna Commercial |
$8,856.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,462.81
|
| Rate for Payer: Aetna Managed Medicare |
$2,755.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,396.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,920.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,723.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,215.45
|
| Rate for Payer: Cash Price |
$2,838.60
|
| Rate for Payer: Cigna Commercial |
$9,053.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,506.88
|
| Rate for Payer: Health EOS Commercial |
$8,758.03
|
| Rate for Payer: HFN Commercial |
$9,053.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,380.36
|
| Rate for Payer: Multiplan Commercial |
$7,872.38
|
| Rate for Payer: NAPHCARE Commercial |
$5,904.29
|
| Rate for Payer: Preferred Network Access Commercial |
$9,053.24
|
| Rate for Payer: Quartz Beloit One Network |
$4,821.84
|
| Rate for Payer: Quartz Commercial |
$6,396.31
|
| Rate for Payer: Quartz Medicare Advantage |
$5,904.29
|
| Rate for Payer: The Alliance Commercial |
$4,920.24
|
| Rate for Payer: WEA Trust Commercial |
$5,412.26
|
| Rate for Payer: WPS Commercial |
$7,288.58
|
|
|
NAIL ANKLE ARTHRODESIS 12 X 200MM LT T2 1819-1220S
|
Facility
|
OP
|
$9,462.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5787709
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,755.33 |
| Max. Negotiated Rate |
$9,053.24 |
| Rate for Payer: Aetna Commercial |
$8,856.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,462.81
|
| Rate for Payer: Aetna Managed Medicare |
$2,755.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,396.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,920.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,723.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,215.45
|
| Rate for Payer: Cash Price |
$2,838.60
|
| Rate for Payer: Cigna Commercial |
$9,053.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,506.88
|
| Rate for Payer: Health EOS Commercial |
$8,758.03
|
| Rate for Payer: HFN Commercial |
$9,053.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,380.36
|
| Rate for Payer: Multiplan Commercial |
$7,872.38
|
| Rate for Payer: NAPHCARE Commercial |
$5,904.29
|
| Rate for Payer: Preferred Network Access Commercial |
$9,053.24
|
| Rate for Payer: Quartz Beloit One Network |
$4,821.84
|
| Rate for Payer: Quartz Commercial |
$6,396.31
|
| Rate for Payer: Quartz Medicare Advantage |
$5,904.29
|
| Rate for Payer: The Alliance Commercial |
$4,920.24
|
| Rate for Payer: WEA Trust Commercial |
$5,412.26
|
| Rate for Payer: WPS Commercial |
$7,288.58
|
|
|
NAIL ANKLE ARTHRODESIS 12 X 200MM LT T2 1819-1220S
|
Facility
|
IP
|
$9,462.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5787709
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,821.84 |
| Max. Negotiated Rate |
$9,053.24 |
| Rate for Payer: Aetna Commercial |
$8,856.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,462.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,215.45
|
| Rate for Payer: Cash Price |
$2,838.60
|
| Rate for Payer: Cigna Commercial |
$9,053.24
|
| Rate for Payer: Health EOS Commercial |
$8,758.03
|
| Rate for Payer: HFN Commercial |
$9,053.24
|
| Rate for Payer: Multiplan Commercial |
$7,872.38
|
| Rate for Payer: Preferred Network Access Commercial |
$9,053.24
|
| Rate for Payer: Quartz Beloit One Network |
$4,821.84
|
| Rate for Payer: Quartz Commercial |
$5,904.29
|
| Rate for Payer: WEA Trust Commercial |
$5,412.26
|
| Rate for Payer: WPS Commercial |
$7,288.58
|
|
|
NAIL ANKLE ARTHRODESIS 12 X 300MM RT T2 1819-1230S
|
Facility
|
OP
|
$18,746.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6177946
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,458.84 |
| Max. Negotiated Rate |
$17,936.17 |
| Rate for Payer: Aetna Commercial |
$17,546.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,766.42
|
| Rate for Payer: Aetna Managed Medicare |
$5,458.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,672.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,747.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,358.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,332.80
|
| Rate for Payer: Cash Price |
$5,623.80
|
| Rate for Payer: Cigna Commercial |
$17,936.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,910.17
|
| Rate for Payer: Health EOS Commercial |
$17,351.30
|
| Rate for Payer: HFN Commercial |
$17,936.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,621.88
|
| Rate for Payer: Multiplan Commercial |
$15,596.67
|
| Rate for Payer: NAPHCARE Commercial |
$11,697.50
|
| Rate for Payer: Preferred Network Access Commercial |
$17,936.17
|
| Rate for Payer: Quartz Beloit One Network |
$9,552.96
|
| Rate for Payer: Quartz Commercial |
$12,672.30
|
| Rate for Payer: Quartz Medicare Advantage |
$11,697.50
|
| Rate for Payer: The Alliance Commercial |
$9,747.92
|
| Rate for Payer: WEA Trust Commercial |
$10,722.71
|
| Rate for Payer: WPS Commercial |
$14,440.04
|
|
|
NAIL ANKLE ARTHRODESIS 12 X 300MM RT T2 1819-1230S
|
Facility
|
IP
|
$18,746.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6177946
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,552.96 |
| Max. Negotiated Rate |
$17,936.17 |
| Rate for Payer: Aetna Commercial |
$17,546.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,766.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,332.80
|
| Rate for Payer: Cash Price |
$5,623.80
|
| Rate for Payer: Cigna Commercial |
$17,936.17
|
| Rate for Payer: Health EOS Commercial |
$17,351.30
|
| Rate for Payer: HFN Commercial |
$17,936.17
|
| Rate for Payer: Multiplan Commercial |
$15,596.67
|
| Rate for Payer: Preferred Network Access Commercial |
$17,936.17
|
| Rate for Payer: Quartz Beloit One Network |
$9,552.96
|
| Rate for Payer: Quartz Commercial |
$11,697.50
|
| Rate for Payer: WEA Trust Commercial |
$10,722.71
|
| Rate for Payer: WPS Commercial |
$14,440.04
|
|
|
NAIL ELASTIC 2.5MM TITANIUM 475.925
|
Facility
|
OP
|
$4,058.00
|
|
| Hospital Charge Code |
2966287
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,181.69 |
| Max. Negotiated Rate |
$3,882.69 |
| Rate for Payer: Aetna Commercial |
$3,798.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,629.48
|
| Rate for Payer: Aetna Managed Medicare |
$1,181.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,743.21
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,110.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,025.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,236.77
|
| Rate for Payer: Cash Price |
$1,217.40
|
| Rate for Payer: Cigna Commercial |
$3,882.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,361.76
|
| Rate for Payer: Health EOS Commercial |
$3,756.08
|
| Rate for Payer: HFN Commercial |
$3,882.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,165.24
|
| Rate for Payer: Multiplan Commercial |
$3,376.26
|
| Rate for Payer: NAPHCARE Commercial |
$2,532.19
|
| Rate for Payer: Preferred Network Access Commercial |
$3,882.69
|
| Rate for Payer: Quartz Beloit One Network |
$2,067.96
|
| Rate for Payer: Quartz Commercial |
$2,743.21
|
| Rate for Payer: Quartz Medicare Advantage |
$2,532.19
|
| Rate for Payer: The Alliance Commercial |
$2,110.16
|
| Rate for Payer: WEA Trust Commercial |
$2,321.18
|
| Rate for Payer: WPS Commercial |
$3,125.88
|
|
|
NAIL ELASTIC 2.5MM TITANIUM 475.925
|
Facility
|
IP
|
$4,058.00
|
|
| Hospital Charge Code |
2966287
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,067.96 |
| Max. Negotiated Rate |
$3,882.69 |
| Rate for Payer: Aetna Commercial |
$3,798.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,629.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,236.77
|
| Rate for Payer: Cash Price |
$1,217.40
|
| Rate for Payer: Cigna Commercial |
$3,882.69
|
| Rate for Payer: Health EOS Commercial |
$3,756.08
|
| Rate for Payer: HFN Commercial |
$3,882.69
|
| Rate for Payer: Multiplan Commercial |
$3,376.26
|
| Rate for Payer: Preferred Network Access Commercial |
$3,882.69
|
| Rate for Payer: Quartz Beloit One Network |
$2,067.96
|
| Rate for Payer: Quartz Commercial |
$2,532.19
|
| Rate for Payer: WEA Trust Commercial |
$2,321.18
|
| Rate for Payer: WPS Commercial |
$3,125.88
|
|
|
NAIL ELASTIC 3.5MM TITANIUM 475.935
|
Facility
|
IP
|
$5,512.00
|
|
| Hospital Charge Code |
4494326
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,808.92 |
| Max. Negotiated Rate |
$5,273.88 |
| Rate for Payer: Aetna Commercial |
$5,159.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,929.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,038.21
|
| Rate for Payer: Cash Price |
$1,653.60
|
| Rate for Payer: Cigna Commercial |
$5,273.88
|
| Rate for Payer: Health EOS Commercial |
$5,101.91
|
| Rate for Payer: HFN Commercial |
$5,273.88
|
| Rate for Payer: Multiplan Commercial |
$4,585.98
|
| Rate for Payer: Preferred Network Access Commercial |
$5,273.88
|
| Rate for Payer: Quartz Beloit One Network |
$2,808.92
|
| Rate for Payer: Quartz Commercial |
$3,439.49
|
| Rate for Payer: WEA Trust Commercial |
$3,152.86
|
| Rate for Payer: WPS Commercial |
$4,245.89
|
|
|
NAIL ELASTIC 3.5MM TITANIUM 475.935
|
Facility
|
OP
|
$5,512.00
|
|
| Hospital Charge Code |
4494326
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,605.09 |
| Max. Negotiated Rate |
$5,273.88 |
| Rate for Payer: Aetna Commercial |
$5,159.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,929.93
|
| Rate for Payer: Aetna Managed Medicare |
$1,605.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,726.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,866.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,751.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,038.21
|
| Rate for Payer: Cash Price |
$1,653.60
|
| Rate for Payer: Cigna Commercial |
$5,273.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,207.98
|
| Rate for Payer: Health EOS Commercial |
$5,101.91
|
| Rate for Payer: HFN Commercial |
$5,273.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,299.36
|
| Rate for Payer: Multiplan Commercial |
$4,585.98
|
| Rate for Payer: NAPHCARE Commercial |
$3,439.49
|
| Rate for Payer: Preferred Network Access Commercial |
$5,273.88
|
| Rate for Payer: Quartz Beloit One Network |
$2,808.92
|
| Rate for Payer: Quartz Commercial |
$3,726.11
|
| Rate for Payer: Quartz Medicare Advantage |
$3,439.49
|
| Rate for Payer: The Alliance Commercial |
$2,866.24
|
| Rate for Payer: WEA Trust Commercial |
$3,152.86
|
| Rate for Payer: WPS Commercial |
$4,245.89
|
|
|
NAIL ELASTIC 4.0MM TITANIUM 475.940
|
Facility
|
OP
|
$5,914.00
|
|
| Hospital Charge Code |
4508871
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,722.16 |
| Max. Negotiated Rate |
$5,658.52 |
| Rate for Payer: Aetna Commercial |
$5,535.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,289.48
|
| Rate for Payer: Aetna Managed Medicare |
$1,722.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,997.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,075.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,952.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,259.80
|
| Rate for Payer: Cash Price |
$1,774.20
|
| Rate for Payer: Cigna Commercial |
$5,658.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,441.95
|
| Rate for Payer: Health EOS Commercial |
$5,474.00
|
| Rate for Payer: HFN Commercial |
$5,658.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,612.92
|
| Rate for Payer: Multiplan Commercial |
$4,920.45
|
| Rate for Payer: NAPHCARE Commercial |
$3,690.34
|
| Rate for Payer: Preferred Network Access Commercial |
$5,658.52
|
| Rate for Payer: Quartz Beloit One Network |
$3,013.77
|
| Rate for Payer: Quartz Commercial |
$3,997.86
|
| Rate for Payer: Quartz Medicare Advantage |
$3,690.34
|
| Rate for Payer: The Alliance Commercial |
$3,075.28
|
| Rate for Payer: WEA Trust Commercial |
$3,382.81
|
| Rate for Payer: WPS Commercial |
$4,555.55
|
|
|
NAIL ELASTIC 4.0MM TITANIUM 475.940
|
Facility
|
IP
|
$5,914.00
|
|
| Hospital Charge Code |
4508871
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,013.77 |
| Max. Negotiated Rate |
$5,658.52 |
| Rate for Payer: Aetna Commercial |
$5,535.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,289.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,259.80
|
| Rate for Payer: Cash Price |
$1,774.20
|
| Rate for Payer: Cigna Commercial |
$5,658.52
|
| Rate for Payer: Health EOS Commercial |
$5,474.00
|
| Rate for Payer: HFN Commercial |
$5,658.52
|
| Rate for Payer: Multiplan Commercial |
$4,920.45
|
| Rate for Payer: Preferred Network Access Commercial |
$5,658.52
|
| Rate for Payer: Quartz Beloit One Network |
$3,013.77
|
| Rate for Payer: Quartz Commercial |
$3,690.34
|
| Rate for Payer: WEA Trust Commercial |
$3,382.81
|
| Rate for Payer: WPS Commercial |
$4,555.55
|
|
|
NAIL ELASTIC TITANIUM 1.5 X 300 475.915S
|
Facility
|
OP
|
$4,306.00
|
|
| Hospital Charge Code |
2966281
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,253.91 |
| Max. Negotiated Rate |
$4,119.98 |
| Rate for Payer: Aetna Commercial |
$4,030.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,851.29
|
| Rate for Payer: Aetna Managed Medicare |
$1,253.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,910.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,239.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,149.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,373.47
|
| Rate for Payer: Cash Price |
$1,291.80
|
| Rate for Payer: Cigna Commercial |
$4,119.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,506.09
|
| Rate for Payer: Health EOS Commercial |
$3,985.63
|
| Rate for Payer: HFN Commercial |
$4,119.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,358.68
|
| Rate for Payer: Multiplan Commercial |
$3,582.59
|
| Rate for Payer: NAPHCARE Commercial |
$2,686.94
|
| Rate for Payer: Preferred Network Access Commercial |
$4,119.98
|
| Rate for Payer: Quartz Beloit One Network |
$2,194.34
|
| Rate for Payer: Quartz Commercial |
$2,910.86
|
| Rate for Payer: Quartz Medicare Advantage |
$2,686.94
|
| Rate for Payer: The Alliance Commercial |
$2,239.12
|
| Rate for Payer: WEA Trust Commercial |
$2,463.03
|
| Rate for Payer: WPS Commercial |
$3,316.91
|
|
|
NAIL ELASTIC TITANIUM 1.5 X 300 475.915S
|
Facility
|
IP
|
$4,306.00
|
|
| Hospital Charge Code |
2966281
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,194.34 |
| Max. Negotiated Rate |
$4,119.98 |
| Rate for Payer: Aetna Commercial |
$4,030.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,851.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,373.47
|
| Rate for Payer: Cash Price |
$1,291.80
|
| Rate for Payer: Cigna Commercial |
$4,119.98
|
| Rate for Payer: Health EOS Commercial |
$3,985.63
|
| Rate for Payer: HFN Commercial |
$4,119.98
|
| Rate for Payer: Multiplan Commercial |
$3,582.59
|
| Rate for Payer: Preferred Network Access Commercial |
$4,119.98
|
| Rate for Payer: Quartz Beloit One Network |
$2,194.34
|
| Rate for Payer: Quartz Commercial |
$2,686.94
|
| Rate for Payer: WEA Trust Commercial |
$2,463.03
|
| Rate for Payer: WPS Commercial |
$3,316.91
|
|
|
NAIL FEMORAL TI 11MM RECON 04.003.452S
|
Facility
|
IP
|
$10,429.00
|
|
| Hospital Charge Code |
2966292
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,314.62 |
| Max. Negotiated Rate |
$9,978.47 |
| Rate for Payer: Aetna Commercial |
$9,761.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,327.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,748.46
|
| Rate for Payer: Cash Price |
$3,128.70
|
| Rate for Payer: Cigna Commercial |
$9,978.47
|
| Rate for Payer: Health EOS Commercial |
$9,653.08
|
| Rate for Payer: HFN Commercial |
$9,978.47
|
| Rate for Payer: Multiplan Commercial |
$8,676.93
|
| Rate for Payer: Preferred Network Access Commercial |
$9,978.47
|
| Rate for Payer: Quartz Beloit One Network |
$5,314.62
|
| Rate for Payer: Quartz Commercial |
$6,507.70
|
| Rate for Payer: WEA Trust Commercial |
$5,965.39
|
| Rate for Payer: WPS Commercial |
$8,033.46
|
|
|
NAIL FEMORAL TI 11MM RECON 04.003.452S
|
Facility
|
OP
|
$10,429.00
|
|
| Hospital Charge Code |
2966292
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,036.92 |
| Max. Negotiated Rate |
$9,978.47 |
| Rate for Payer: Aetna Commercial |
$9,761.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,327.70
|
| Rate for Payer: Aetna Managed Medicare |
$3,036.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,050.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,423.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,206.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,748.46
|
| Rate for Payer: Cash Price |
$3,128.70
|
| Rate for Payer: Cigna Commercial |
$9,978.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,069.68
|
| Rate for Payer: Health EOS Commercial |
$9,653.08
|
| Rate for Payer: HFN Commercial |
$9,978.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,134.62
|
| Rate for Payer: Multiplan Commercial |
$8,676.93
|
| Rate for Payer: NAPHCARE Commercial |
$6,507.70
|
| Rate for Payer: Preferred Network Access Commercial |
$9,978.47
|
| Rate for Payer: Quartz Beloit One Network |
$5,314.62
|
| Rate for Payer: Quartz Commercial |
$7,050.00
|
| Rate for Payer: Quartz Medicare Advantage |
$6,507.70
|
| Rate for Payer: The Alliance Commercial |
$5,423.08
|
| Rate for Payer: WEA Trust Commercial |
$5,965.39
|
| Rate for Payer: WPS Commercial |
$8,033.46
|
|
|
NAIL GAMMA 10 X 380 X 125DEG TI RT 3425-0380S
|
Facility
|
IP
|
$7,481.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6182695
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,812.32 |
| Max. Negotiated Rate |
$7,157.82 |
| Rate for Payer: Aetna Commercial |
$7,002.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,691.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,123.53
|
| Rate for Payer: Cash Price |
$2,244.30
|
| Rate for Payer: Cigna Commercial |
$7,157.82
|
| Rate for Payer: Health EOS Commercial |
$6,924.41
|
| Rate for Payer: HFN Commercial |
$7,157.82
|
| Rate for Payer: Multiplan Commercial |
$6,224.19
|
| Rate for Payer: Preferred Network Access Commercial |
$7,157.82
|
| Rate for Payer: Quartz Beloit One Network |
$3,812.32
|
| Rate for Payer: Quartz Commercial |
$4,668.14
|
| Rate for Payer: WEA Trust Commercial |
$4,279.13
|
| Rate for Payer: WPS Commercial |
$5,762.61
|
|
|
NAIL GAMMA 10 X 380 X 125DEG TI RT 3425-0380S
|
Facility
|
OP
|
$7,481.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6182695
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,178.47 |
| Max. Negotiated Rate |
$7,157.82 |
| Rate for Payer: Aetna Commercial |
$7,002.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,691.01
|
| Rate for Payer: Aetna Managed Medicare |
$2,178.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,057.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,890.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,734.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,123.53
|
| Rate for Payer: Cash Price |
$2,244.30
|
| Rate for Payer: Cigna Commercial |
$7,157.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,353.94
|
| Rate for Payer: Health EOS Commercial |
$6,924.41
|
| Rate for Payer: HFN Commercial |
$7,157.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,835.18
|
| Rate for Payer: Multiplan Commercial |
$6,224.19
|
| Rate for Payer: NAPHCARE Commercial |
$4,668.14
|
| Rate for Payer: Preferred Network Access Commercial |
$7,157.82
|
| Rate for Payer: Quartz Beloit One Network |
$3,812.32
|
| Rate for Payer: Quartz Commercial |
$5,057.16
|
| Rate for Payer: Quartz Medicare Advantage |
$4,668.14
|
| Rate for Payer: The Alliance Commercial |
$3,890.12
|
| Rate for Payer: WEA Trust Commercial |
$4,279.13
|
| Rate for Payer: WPS Commercial |
$5,762.61
|
|
