|
NAIL TFNA 12MM/ 125 DEG 360MM RT 04.037.226S
|
Facility
|
OP
|
$11,232.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5179267
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,270.76 |
| Max. Negotiated Rate |
$10,746.78 |
| Rate for Payer: Aetna Commercial |
$10,513.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,045.90
|
| Rate for Payer: Aetna Managed Medicare |
$3,270.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,592.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,840.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,607.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,191.08
|
| Rate for Payer: Cash Price |
$3,369.60
|
| Rate for Payer: Cigna Commercial |
$10,746.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,537.02
|
| Rate for Payer: Health EOS Commercial |
$10,396.34
|
| Rate for Payer: HFN Commercial |
$10,746.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,760.96
|
| Rate for Payer: Multiplan Commercial |
$9,345.02
|
| Rate for Payer: NAPHCARE Commercial |
$7,008.77
|
| Rate for Payer: Preferred Network Access Commercial |
$10,746.78
|
| Rate for Payer: Quartz Beloit One Network |
$5,723.83
|
| Rate for Payer: Quartz Commercial |
$7,592.83
|
| Rate for Payer: Quartz Medicare Advantage |
$7,008.77
|
| Rate for Payer: The Alliance Commercial |
$5,840.64
|
| Rate for Payer: WEA Trust Commercial |
$6,424.70
|
| Rate for Payer: WPS Commercial |
$8,652.01
|
|
|
NAIL TFNA 12MM/ 125 DEG 360MM RT 04.037.226S
|
Facility
|
IP
|
$11,232.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5179267
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,723.83 |
| Max. Negotiated Rate |
$10,746.78 |
| Rate for Payer: Aetna Commercial |
$10,513.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,045.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,191.08
|
| Rate for Payer: Cash Price |
$3,369.60
|
| Rate for Payer: Cigna Commercial |
$10,746.78
|
| Rate for Payer: Health EOS Commercial |
$10,396.34
|
| Rate for Payer: HFN Commercial |
$10,746.78
|
| Rate for Payer: Multiplan Commercial |
$9,345.02
|
| Rate for Payer: Preferred Network Access Commercial |
$10,746.78
|
| Rate for Payer: Quartz Beloit One Network |
$5,723.83
|
| Rate for Payer: Quartz Commercial |
$7,008.77
|
| Rate for Payer: WEA Trust Commercial |
$6,424.70
|
| Rate for Payer: WPS Commercial |
$8,652.01
|
|
|
NAIL TFNA 12MM/125 DEG 380MM LT 04.037.229S
|
Facility
|
IP
|
$11,232.00
|
|
| Hospital Charge Code |
4594777
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,723.83 |
| Max. Negotiated Rate |
$10,746.78 |
| Rate for Payer: Aetna Commercial |
$10,513.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,045.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,191.08
|
| Rate for Payer: Cash Price |
$3,369.60
|
| Rate for Payer: Cigna Commercial |
$10,746.78
|
| Rate for Payer: Health EOS Commercial |
$10,396.34
|
| Rate for Payer: HFN Commercial |
$10,746.78
|
| Rate for Payer: Multiplan Commercial |
$9,345.02
|
| Rate for Payer: Preferred Network Access Commercial |
$10,746.78
|
| Rate for Payer: Quartz Beloit One Network |
$5,723.83
|
| Rate for Payer: Quartz Commercial |
$7,008.77
|
| Rate for Payer: WEA Trust Commercial |
$6,424.70
|
| Rate for Payer: WPS Commercial |
$8,652.01
|
|
|
NAIL TFNA 12MM/125 DEG 380MM LT 04.037.229S
|
Facility
|
OP
|
$11,232.00
|
|
| Hospital Charge Code |
4594777
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,270.76 |
| Max. Negotiated Rate |
$10,746.78 |
| Rate for Payer: Aetna Commercial |
$10,513.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,045.90
|
| Rate for Payer: Aetna Managed Medicare |
$3,270.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,592.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,840.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,607.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,191.08
|
| Rate for Payer: Cash Price |
$3,369.60
|
| Rate for Payer: Cigna Commercial |
$10,746.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,537.02
|
| Rate for Payer: Health EOS Commercial |
$10,396.34
|
| Rate for Payer: HFN Commercial |
$10,746.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,760.96
|
| Rate for Payer: Multiplan Commercial |
$9,345.02
|
| Rate for Payer: NAPHCARE Commercial |
$7,008.77
|
| Rate for Payer: Preferred Network Access Commercial |
$10,746.78
|
| Rate for Payer: Quartz Beloit One Network |
$5,723.83
|
| Rate for Payer: Quartz Commercial |
$7,592.83
|
| Rate for Payer: Quartz Medicare Advantage |
$7,008.77
|
| Rate for Payer: The Alliance Commercial |
$5,840.64
|
| Rate for Payer: WEA Trust Commercial |
$6,424.70
|
| Rate for Payer: WPS Commercial |
$8,652.01
|
|
|
NAIL TFNA 12MM/125 DEG 380MM RT 04.037.228S
|
Facility
|
OP
|
$11,232.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4858909
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,270.76 |
| Max. Negotiated Rate |
$10,746.78 |
| Rate for Payer: Aetna Commercial |
$10,513.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,045.90
|
| Rate for Payer: Aetna Managed Medicare |
$3,270.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,592.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,840.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,607.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,191.08
|
| Rate for Payer: Cash Price |
$3,369.60
|
| Rate for Payer: Cigna Commercial |
$10,746.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,537.02
|
| Rate for Payer: Health EOS Commercial |
$10,396.34
|
| Rate for Payer: HFN Commercial |
$10,746.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,760.96
|
| Rate for Payer: Multiplan Commercial |
$9,345.02
|
| Rate for Payer: NAPHCARE Commercial |
$7,008.77
|
| Rate for Payer: Preferred Network Access Commercial |
$10,746.78
|
| Rate for Payer: Quartz Beloit One Network |
$5,723.83
|
| Rate for Payer: Quartz Commercial |
$7,592.83
|
| Rate for Payer: Quartz Medicare Advantage |
$7,008.77
|
| Rate for Payer: The Alliance Commercial |
$5,840.64
|
| Rate for Payer: WEA Trust Commercial |
$6,424.70
|
| Rate for Payer: WPS Commercial |
$8,652.01
|
|
|
NAIL TFNA 12MM/125 DEG 380MM RT 04.037.228S
|
Facility
|
IP
|
$11,232.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4858909
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,723.83 |
| Max. Negotiated Rate |
$10,746.78 |
| Rate for Payer: Aetna Commercial |
$10,513.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,045.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,191.08
|
| Rate for Payer: Cash Price |
$3,369.60
|
| Rate for Payer: Cigna Commercial |
$10,746.78
|
| Rate for Payer: Health EOS Commercial |
$10,396.34
|
| Rate for Payer: HFN Commercial |
$10,746.78
|
| Rate for Payer: Multiplan Commercial |
$9,345.02
|
| Rate for Payer: Preferred Network Access Commercial |
$10,746.78
|
| Rate for Payer: Quartz Beloit One Network |
$5,723.83
|
| Rate for Payer: Quartz Commercial |
$7,008.77
|
| Rate for Payer: WEA Trust Commercial |
$6,424.70
|
| Rate for Payer: WPS Commercial |
$8,652.01
|
|
|
NAIL TFNA 12MM/125 DEG 400MM LT 04.037.231S
|
Facility
|
OP
|
$11,665.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5384959
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,396.85 |
| Max. Negotiated Rate |
$11,161.07 |
| Rate for Payer: Aetna Commercial |
$10,918.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,433.18
|
| Rate for Payer: Aetna Managed Medicare |
$3,396.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,885.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,065.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,823.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,429.75
|
| Rate for Payer: Cash Price |
$3,499.50
|
| Rate for Payer: Cigna Commercial |
$11,161.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,789.03
|
| Rate for Payer: Health EOS Commercial |
$10,797.12
|
| Rate for Payer: HFN Commercial |
$11,161.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,098.70
|
| Rate for Payer: Multiplan Commercial |
$9,705.28
|
| Rate for Payer: NAPHCARE Commercial |
$7,278.96
|
| Rate for Payer: Preferred Network Access Commercial |
$11,161.07
|
| Rate for Payer: Quartz Beloit One Network |
$5,944.48
|
| Rate for Payer: Quartz Commercial |
$7,885.54
|
| Rate for Payer: Quartz Medicare Advantage |
$7,278.96
|
| Rate for Payer: The Alliance Commercial |
$6,065.80
|
| Rate for Payer: WEA Trust Commercial |
$6,672.38
|
| Rate for Payer: WPS Commercial |
$8,985.55
|
|
|
NAIL TFNA 12MM/125 DEG 400MM LT 04.037.231S
|
Facility
|
IP
|
$11,665.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5384959
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,944.48 |
| Max. Negotiated Rate |
$11,161.07 |
| Rate for Payer: Aetna Commercial |
$10,918.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,433.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,429.75
|
| Rate for Payer: Cash Price |
$3,499.50
|
| Rate for Payer: Cigna Commercial |
$11,161.07
|
| Rate for Payer: Health EOS Commercial |
$10,797.12
|
| Rate for Payer: HFN Commercial |
$11,161.07
|
| Rate for Payer: Multiplan Commercial |
$9,705.28
|
| Rate for Payer: Preferred Network Access Commercial |
$11,161.07
|
| Rate for Payer: Quartz Beloit One Network |
$5,944.48
|
| Rate for Payer: Quartz Commercial |
$7,278.96
|
| Rate for Payer: WEA Trust Commercial |
$6,672.38
|
| Rate for Payer: WPS Commercial |
$8,985.55
|
|
|
NAIL TFNA 12MM/125 DEG 420MM LT 04.037.233S
|
Facility
|
IP
|
$10,385.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5729710
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,292.20 |
| Max. Negotiated Rate |
$9,936.37 |
| Rate for Payer: Aetna Commercial |
$9,720.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,288.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,724.21
|
| Rate for Payer: Cash Price |
$3,115.50
|
| Rate for Payer: Cigna Commercial |
$9,936.37
|
| Rate for Payer: Health EOS Commercial |
$9,612.36
|
| Rate for Payer: HFN Commercial |
$9,936.37
|
| Rate for Payer: Multiplan Commercial |
$8,640.32
|
| Rate for Payer: Preferred Network Access Commercial |
$9,936.37
|
| Rate for Payer: Quartz Beloit One Network |
$5,292.20
|
| Rate for Payer: Quartz Commercial |
$6,480.24
|
| Rate for Payer: WEA Trust Commercial |
$5,940.22
|
| Rate for Payer: WPS Commercial |
$7,999.57
|
|
|
NAIL TFNA 12MM/125 DEG 420MM LT 04.037.233S
|
Facility
|
OP
|
$10,385.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5729710
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,024.11 |
| Max. Negotiated Rate |
$9,936.37 |
| Rate for Payer: Aetna Commercial |
$9,720.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,288.34
|
| Rate for Payer: Aetna Managed Medicare |
$3,024.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,020.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,400.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,184.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,724.21
|
| Rate for Payer: Cash Price |
$3,115.50
|
| Rate for Payer: Cigna Commercial |
$9,936.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,044.07
|
| Rate for Payer: Health EOS Commercial |
$9,612.36
|
| Rate for Payer: HFN Commercial |
$9,936.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,100.30
|
| Rate for Payer: Multiplan Commercial |
$8,640.32
|
| Rate for Payer: NAPHCARE Commercial |
$6,480.24
|
| Rate for Payer: Preferred Network Access Commercial |
$9,936.37
|
| Rate for Payer: Quartz Beloit One Network |
$5,292.20
|
| Rate for Payer: Quartz Commercial |
$7,020.26
|
| Rate for Payer: Quartz Medicare Advantage |
$6,480.24
|
| Rate for Payer: The Alliance Commercial |
$5,400.20
|
| Rate for Payer: WEA Trust Commercial |
$5,940.22
|
| Rate for Payer: WPS Commercial |
$7,999.57
|
|
|
NAIL TFNA 12MM/130 DEG 170MM 04.037.242S
|
Facility
|
IP
|
$7,706.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5591353
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,926.98 |
| Max. Negotiated Rate |
$7,373.10 |
| Rate for Payer: Aetna Commercial |
$7,212.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,892.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,247.55
|
| Rate for Payer: Cash Price |
$2,311.80
|
| Rate for Payer: Cigna Commercial |
$7,373.10
|
| Rate for Payer: Health EOS Commercial |
$7,132.67
|
| Rate for Payer: HFN Commercial |
$7,373.10
|
| Rate for Payer: Multiplan Commercial |
$6,411.39
|
| Rate for Payer: Preferred Network Access Commercial |
$7,373.10
|
| Rate for Payer: Quartz Beloit One Network |
$3,926.98
|
| Rate for Payer: Quartz Commercial |
$4,808.54
|
| Rate for Payer: WEA Trust Commercial |
$4,407.83
|
| Rate for Payer: WPS Commercial |
$5,935.93
|
|
|
NAIL TFNA 12MM/130 DEG 170MM 04.037.242S
|
Facility
|
OP
|
$7,706.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5591353
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,243.99 |
| Max. Negotiated Rate |
$7,373.10 |
| Rate for Payer: Aetna Commercial |
$7,212.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,892.25
|
| Rate for Payer: Aetna Managed Medicare |
$2,243.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,209.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,007.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,846.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,247.55
|
| Rate for Payer: Cash Price |
$2,311.80
|
| Rate for Payer: Cigna Commercial |
$7,373.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,484.89
|
| Rate for Payer: Health EOS Commercial |
$7,132.67
|
| Rate for Payer: HFN Commercial |
$7,373.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,010.68
|
| Rate for Payer: Multiplan Commercial |
$6,411.39
|
| Rate for Payer: NAPHCARE Commercial |
$4,808.54
|
| Rate for Payer: Preferred Network Access Commercial |
$7,373.10
|
| Rate for Payer: Quartz Beloit One Network |
$3,926.98
|
| Rate for Payer: Quartz Commercial |
$5,209.26
|
| Rate for Payer: Quartz Medicare Advantage |
$4,808.54
|
| Rate for Payer: The Alliance Commercial |
$4,007.12
|
| Rate for Payer: WEA Trust Commercial |
$4,407.83
|
| Rate for Payer: WPS Commercial |
$5,935.93
|
|
|
NAIL TFNA 12MM/130 DEG 360MM LT 04.037.257S
|
Facility
|
IP
|
$10,155.71
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6246250
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,175.35 |
| Max. Negotiated Rate |
$9,716.98 |
| Rate for Payer: Aetna Commercial |
$9,505.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,083.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,597.83
|
| Rate for Payer: Cash Price |
$3,046.71
|
| Rate for Payer: Cigna Commercial |
$9,716.98
|
| Rate for Payer: Health EOS Commercial |
$9,400.13
|
| Rate for Payer: HFN Commercial |
$9,716.98
|
| Rate for Payer: Multiplan Commercial |
$8,449.55
|
| Rate for Payer: Preferred Network Access Commercial |
$9,716.98
|
| Rate for Payer: Quartz Beloit One Network |
$5,175.35
|
| Rate for Payer: Quartz Commercial |
$6,337.16
|
| Rate for Payer: WEA Trust Commercial |
$5,809.07
|
| Rate for Payer: WPS Commercial |
$7,822.94
|
|
|
NAIL TFNA 12MM/130 DEG 360MM LT 04.037.257S
|
Facility
|
OP
|
$10,155.71
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6246250
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,957.34 |
| Max. Negotiated Rate |
$9,716.98 |
| Rate for Payer: Aetna Commercial |
$9,505.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,083.27
|
| Rate for Payer: Aetna Managed Medicare |
$2,957.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,865.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,280.97
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,069.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,597.83
|
| Rate for Payer: Cash Price |
$3,046.71
|
| Rate for Payer: Cigna Commercial |
$9,716.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,910.62
|
| Rate for Payer: Health EOS Commercial |
$9,400.13
|
| Rate for Payer: HFN Commercial |
$9,716.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,921.45
|
| Rate for Payer: Multiplan Commercial |
$8,449.55
|
| Rate for Payer: NAPHCARE Commercial |
$6,337.16
|
| Rate for Payer: Preferred Network Access Commercial |
$9,716.98
|
| Rate for Payer: Quartz Beloit One Network |
$5,175.35
|
| Rate for Payer: Quartz Commercial |
$6,865.26
|
| Rate for Payer: Quartz Medicare Advantage |
$6,337.16
|
| Rate for Payer: The Alliance Commercial |
$5,280.97
|
| Rate for Payer: WEA Trust Commercial |
$5,809.07
|
| Rate for Payer: WPS Commercial |
$7,822.94
|
|
|
NAIL TFNA 14MM/130 DEG 360MM LT 04.037.457S
|
Facility
|
IP
|
$10,800.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5563472
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,503.68 |
| Max. Negotiated Rate |
$10,333.44 |
| Rate for Payer: Aetna Commercial |
$10,108.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,659.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,952.96
|
| Rate for Payer: Cash Price |
$3,240.00
|
| Rate for Payer: Cigna Commercial |
$10,333.44
|
| Rate for Payer: Health EOS Commercial |
$9,996.48
|
| Rate for Payer: HFN Commercial |
$10,333.44
|
| Rate for Payer: Multiplan Commercial |
$8,985.60
|
| Rate for Payer: Preferred Network Access Commercial |
$10,333.44
|
| Rate for Payer: Quartz Beloit One Network |
$5,503.68
|
| Rate for Payer: Quartz Commercial |
$6,739.20
|
| Rate for Payer: WEA Trust Commercial |
$6,177.60
|
| Rate for Payer: WPS Commercial |
$8,319.24
|
|
|
NAIL TFNA 14MM/130 DEG 360MM LT 04.037.457S
|
Facility
|
OP
|
$10,800.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5563472
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,144.96 |
| Max. Negotiated Rate |
$10,333.44 |
| Rate for Payer: Aetna Commercial |
$10,108.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,659.52
|
| Rate for Payer: Aetna Managed Medicare |
$3,144.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,300.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,616.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,391.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,952.96
|
| Rate for Payer: Cash Price |
$3,240.00
|
| Rate for Payer: Cigna Commercial |
$10,333.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,285.60
|
| Rate for Payer: Health EOS Commercial |
$9,996.48
|
| Rate for Payer: HFN Commercial |
$10,333.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,424.00
|
| Rate for Payer: Multiplan Commercial |
$8,985.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,739.20
|
| Rate for Payer: Preferred Network Access Commercial |
$10,333.44
|
| Rate for Payer: Quartz Beloit One Network |
$5,503.68
|
| Rate for Payer: Quartz Commercial |
$7,300.80
|
| Rate for Payer: Quartz Medicare Advantage |
$6,739.20
|
| Rate for Payer: The Alliance Commercial |
$5,616.00
|
| Rate for Payer: WEA Trust Commercial |
$6,177.60
|
| Rate for Payer: WPS Commercial |
$8,319.24
|
|
|
NAIL TIBIAL 12MM TITANIUM
|
Facility
|
OP
|
$9,692.00
|
|
| Hospital Charge Code |
2966300
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,822.31 |
| Max. Negotiated Rate |
$9,273.31 |
| Rate for Payer: Aetna Commercial |
$9,071.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,668.52
|
| Rate for Payer: Aetna Managed Medicare |
$2,822.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,551.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,039.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,838.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,342.23
|
| Rate for Payer: Cash Price |
$2,907.60
|
| Rate for Payer: Cigna Commercial |
$9,273.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,640.74
|
| Rate for Payer: Health EOS Commercial |
$8,970.92
|
| Rate for Payer: HFN Commercial |
$9,273.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,559.76
|
| Rate for Payer: Multiplan Commercial |
$8,063.74
|
| Rate for Payer: NAPHCARE Commercial |
$6,047.81
|
| Rate for Payer: Preferred Network Access Commercial |
$9,273.31
|
| Rate for Payer: Quartz Beloit One Network |
$4,939.04
|
| Rate for Payer: Quartz Commercial |
$6,551.79
|
| Rate for Payer: Quartz Medicare Advantage |
$6,047.81
|
| Rate for Payer: The Alliance Commercial |
$5,039.84
|
| Rate for Payer: WEA Trust Commercial |
$5,543.82
|
| Rate for Payer: WPS Commercial |
$7,465.75
|
|
|
NAIL TIBIAL 12MM TITANIUM
|
Facility
|
IP
|
$9,692.00
|
|
| Hospital Charge Code |
2966300
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,939.04 |
| Max. Negotiated Rate |
$9,273.31 |
| Rate for Payer: Aetna Commercial |
$9,071.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,668.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,342.23
|
| Rate for Payer: Cash Price |
$2,907.60
|
| Rate for Payer: Cigna Commercial |
$9,273.31
|
| Rate for Payer: Health EOS Commercial |
$8,970.92
|
| Rate for Payer: HFN Commercial |
$9,273.31
|
| Rate for Payer: Multiplan Commercial |
$8,063.74
|
| Rate for Payer: Preferred Network Access Commercial |
$9,273.31
|
| Rate for Payer: Quartz Beloit One Network |
$4,939.04
|
| Rate for Payer: Quartz Commercial |
$6,047.81
|
| Rate for Payer: WEA Trust Commercial |
$5,543.82
|
| Rate for Payer: WPS Commercial |
$7,465.75
|
|
|
NAIL TIBIAL 8MM TITANIUM
|
Facility
|
IP
|
$9,692.00
|
|
| Hospital Charge Code |
2966301
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,939.04 |
| Max. Negotiated Rate |
$9,273.31 |
| Rate for Payer: Aetna Commercial |
$9,071.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,668.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,342.23
|
| Rate for Payer: Cash Price |
$2,907.60
|
| Rate for Payer: Cigna Commercial |
$9,273.31
|
| Rate for Payer: Health EOS Commercial |
$8,970.92
|
| Rate for Payer: HFN Commercial |
$9,273.31
|
| Rate for Payer: Multiplan Commercial |
$8,063.74
|
| Rate for Payer: Preferred Network Access Commercial |
$9,273.31
|
| Rate for Payer: Quartz Beloit One Network |
$4,939.04
|
| Rate for Payer: Quartz Commercial |
$6,047.81
|
| Rate for Payer: WEA Trust Commercial |
$5,543.82
|
| Rate for Payer: WPS Commercial |
$7,465.75
|
|
|
NAIL TIBIAL 8MM TITANIUM
|
Facility
|
OP
|
$9,692.00
|
|
| Hospital Charge Code |
2966301
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,822.31 |
| Max. Negotiated Rate |
$9,273.31 |
| Rate for Payer: Aetna Commercial |
$9,071.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,668.52
|
| Rate for Payer: Aetna Managed Medicare |
$2,822.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,551.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,039.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,838.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,342.23
|
| Rate for Payer: Cash Price |
$2,907.60
|
| Rate for Payer: Cigna Commercial |
$9,273.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,640.74
|
| Rate for Payer: Health EOS Commercial |
$8,970.92
|
| Rate for Payer: HFN Commercial |
$9,273.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,559.76
|
| Rate for Payer: Multiplan Commercial |
$8,063.74
|
| Rate for Payer: NAPHCARE Commercial |
$6,047.81
|
| Rate for Payer: Preferred Network Access Commercial |
$9,273.31
|
| Rate for Payer: Quartz Beloit One Network |
$4,939.04
|
| Rate for Payer: Quartz Commercial |
$6,551.79
|
| Rate for Payer: Quartz Medicare Advantage |
$6,047.81
|
| Rate for Payer: The Alliance Commercial |
$5,039.84
|
| Rate for Payer: WEA Trust Commercial |
$5,543.82
|
| Rate for Payer: WPS Commercial |
$7,465.75
|
|
|
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 |
$1,534.62 |
| Max. Negotiated Rate |
$5,042.34 |
| Rate for Payer: Aetna Commercial |
$4,932.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,713.49
|
| Rate for Payer: Aetna Managed Medicare |
$1,534.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,562.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,740.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,630.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,904.82
|
| Rate for Payer: Cash Price |
$1,581.00
|
| Rate for Payer: Cigna Commercial |
$5,042.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,067.14
|
| Rate for Payer: Health EOS Commercial |
$4,877.91
|
| Rate for Payer: HFN Commercial |
$5,042.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,110.60
|
| Rate for Payer: Multiplan Commercial |
$4,384.64
|
| Rate for Payer: NAPHCARE Commercial |
$3,288.48
|
| Rate for Payer: Preferred Network Access Commercial |
$5,042.34
|
| Rate for Payer: Quartz Beloit One Network |
$2,685.59
|
| Rate for Payer: Quartz Commercial |
$3,562.52
|
| Rate for Payer: Quartz Medicare Advantage |
$3,288.48
|
| Rate for Payer: The Alliance Commercial |
$2,740.40
|
| Rate for Payer: WEA Trust Commercial |
$3,014.44
|
| Rate for Payer: WPS Commercial |
$4,059.48
|
|
|
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 |
$2,685.59 |
| Max. Negotiated Rate |
$5,042.34 |
| Rate for Payer: Aetna Commercial |
$4,932.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,713.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,904.82
|
| Rate for Payer: Cash Price |
$1,581.00
|
| Rate for Payer: Cigna Commercial |
$5,042.34
|
| Rate for Payer: Health EOS Commercial |
$4,877.91
|
| Rate for Payer: HFN Commercial |
$5,042.34
|
| Rate for Payer: Multiplan Commercial |
$4,384.64
|
| Rate for Payer: Preferred Network Access Commercial |
$5,042.34
|
| Rate for Payer: Quartz Beloit One Network |
$2,685.59
|
| Rate for Payer: Quartz Commercial |
$3,288.48
|
| Rate for Payer: WEA Trust Commercial |
$3,014.44
|
| Rate for Payer: WPS Commercial |
$4,059.48
|
|
|
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 |
$2,822.31 |
| Max. Negotiated Rate |
$9,273.31 |
| Rate for Payer: Aetna Commercial |
$9,071.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,668.52
|
| Rate for Payer: Aetna Managed Medicare |
$2,822.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,551.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,039.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,838.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,342.23
|
| Rate for Payer: Cash Price |
$2,907.60
|
| Rate for Payer: Cigna Commercial |
$9,273.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,640.74
|
| Rate for Payer: Health EOS Commercial |
$8,970.92
|
| Rate for Payer: HFN Commercial |
$9,273.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,559.76
|
| Rate for Payer: Multiplan Commercial |
$8,063.74
|
| Rate for Payer: NAPHCARE Commercial |
$6,047.81
|
| Rate for Payer: Preferred Network Access Commercial |
$9,273.31
|
| Rate for Payer: Quartz Beloit One Network |
$4,939.04
|
| Rate for Payer: Quartz Commercial |
$6,551.79
|
| Rate for Payer: Quartz Medicare Advantage |
$6,047.81
|
| Rate for Payer: The Alliance Commercial |
$5,039.84
|
| Rate for Payer: WEA Trust Commercial |
$5,543.82
|
| Rate for Payer: WPS Commercial |
$7,465.75
|
|
|
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 |
$4,939.04 |
| Max. Negotiated Rate |
$9,273.31 |
| Rate for Payer: Aetna Commercial |
$9,071.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,668.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,342.23
|
| Rate for Payer: Cash Price |
$2,907.60
|
| Rate for Payer: Cigna Commercial |
$9,273.31
|
| Rate for Payer: Health EOS Commercial |
$8,970.92
|
| Rate for Payer: HFN Commercial |
$9,273.31
|
| Rate for Payer: Multiplan Commercial |
$8,063.74
|
| Rate for Payer: Preferred Network Access Commercial |
$9,273.31
|
| Rate for Payer: Quartz Beloit One Network |
$4,939.04
|
| Rate for Payer: Quartz Commercial |
$6,047.81
|
| Rate for Payer: WEA Trust Commercial |
$5,543.82
|
| Rate for Payer: WPS Commercial |
$7,465.75
|
|
|
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 |
$2,822.31 |
| Max. Negotiated Rate |
$9,273.31 |
| Rate for Payer: Aetna Commercial |
$9,071.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,668.52
|
| Rate for Payer: Aetna Managed Medicare |
$2,822.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,551.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,039.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,838.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,342.23
|
| Rate for Payer: Cash Price |
$2,907.60
|
| Rate for Payer: Cigna Commercial |
$9,273.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,640.74
|
| Rate for Payer: Health EOS Commercial |
$8,970.92
|
| Rate for Payer: HFN Commercial |
$9,273.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,559.76
|
| Rate for Payer: Multiplan Commercial |
$8,063.74
|
| Rate for Payer: NAPHCARE Commercial |
$6,047.81
|
| Rate for Payer: Preferred Network Access Commercial |
$9,273.31
|
| Rate for Payer: Quartz Beloit One Network |
$4,939.04
|
| Rate for Payer: Quartz Commercial |
$6,551.79
|
| Rate for Payer: Quartz Medicare Advantage |
$6,047.81
|
| Rate for Payer: The Alliance Commercial |
$5,039.84
|
| Rate for Payer: WEA Trust Commercial |
$5,543.82
|
| Rate for Payer: WPS Commercial |
$7,465.75
|
|
