|
NAIL TROCHANTERIC TFNA 10MMX125 DEG 170MM TI 04.037.012S
|
Facility
|
OP
|
$7,706.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5490792
|
|
Hospital Revenue Code
|
510
|
| 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 TROCHANTERIC TFNA 10MMX125 DEG 235MM RT TI 04.037.014S
|
Facility
|
OP
|
$8,862.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5597466
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,580.61 |
| Max. Negotiated Rate |
$8,479.16 |
| Rate for Payer: Aetna Commercial |
$8,294.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,926.17
|
| Rate for Payer: Aetna Managed Medicare |
$2,580.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,990.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,608.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,423.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,884.73
|
| Rate for Payer: Cash Price |
$2,658.60
|
| Rate for Payer: Cigna Commercial |
$8,479.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,157.68
|
| Rate for Payer: Health EOS Commercial |
$8,202.67
|
| Rate for Payer: HFN Commercial |
$8,479.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,912.36
|
| Rate for Payer: Multiplan Commercial |
$7,373.18
|
| Rate for Payer: NAPHCARE Commercial |
$5,529.89
|
| Rate for Payer: Preferred Network Access Commercial |
$8,479.16
|
| Rate for Payer: Quartz Beloit One Network |
$4,516.08
|
| Rate for Payer: Quartz Commercial |
$5,990.71
|
| Rate for Payer: Quartz Medicare Advantage |
$5,529.89
|
| Rate for Payer: The Alliance Commercial |
$4,608.24
|
| Rate for Payer: WEA Trust Commercial |
$5,069.06
|
| Rate for Payer: WPS Commercial |
$6,826.40
|
|
|
NAIL TROCHANTERIC TFNA 10MMX125 DEG 235MM RT TI 04.037.014S
|
Facility
|
IP
|
$8,862.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5597466
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,516.08 |
| Max. Negotiated Rate |
$8,479.16 |
| Rate for Payer: Aetna Commercial |
$8,294.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,926.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,884.73
|
| Rate for Payer: Cash Price |
$2,658.60
|
| Rate for Payer: Cigna Commercial |
$8,479.16
|
| Rate for Payer: Health EOS Commercial |
$8,202.67
|
| Rate for Payer: HFN Commercial |
$8,479.16
|
| Rate for Payer: Multiplan Commercial |
$7,373.18
|
| Rate for Payer: Preferred Network Access Commercial |
$8,479.16
|
| Rate for Payer: Quartz Beloit One Network |
$4,516.08
|
| Rate for Payer: Quartz Commercial |
$5,529.89
|
| Rate for Payer: WEA Trust Commercial |
$5,069.06
|
| Rate for Payer: WPS Commercial |
$6,826.40
|
|
|
NAIL TROCHANTERIC TFNA 10MMX125 DEG 235MM TI 04.037.015S
|
Facility
|
OP
|
$7,706.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5563288
|
|
Hospital Revenue Code
|
510
|
| 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 TROCHANTERIC TFNA 10MMX125 DEG 235MM TI 04.037.015S
|
Facility
|
IP
|
$7,706.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5563288
|
|
Hospital Revenue Code
|
510
|
| 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 TROCHANTERIC TFNA 10MMX125 DEG 340MM LT TI 04.037.025S
|
Facility
|
OP
|
$10,385.00
|
|
| Hospital Charge Code |
5248871
|
| 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 TROCHANTERIC TFNA 10MMX125 DEG 340MM LT TI 04.037.025S
|
Facility
|
IP
|
$10,385.00
|
|
| Hospital Charge Code |
5248871
|
| 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 TROCHANTERIC TFNA 10MMX125 DEG 340MM RT TI 04.037.024S
|
Facility
|
OP
|
$10,800.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4520092
|
|
Hospital Revenue Code
|
510
|
| 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 TROCHANTERIC TFNA 10MMX125 DEG 340MM RT TI 04.037.024S
|
Facility
|
IP
|
$10,800.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4520092
|
|
Hospital Revenue Code
|
510
|
| 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 TROCHANTERIC TFNA 10MMX125 DEG 360MM LT 04.037.027S
|
Facility
|
IP
|
$10,800.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4519977
|
|
Hospital Revenue Code
|
510
|
| 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 TROCHANTERIC TFNA 10MMX125 DEG 360MM LT 04.037.027S
|
Facility
|
OP
|
$10,800.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4519977
|
|
Hospital Revenue Code
|
510
|
| 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 TROCHANTERIC TFNA 10MMX125 DEG 380MM LT TI 04.037.029S
|
Facility
|
OP
|
$10,385.00
|
|
| Hospital Charge Code |
5190702
|
| 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 TROCHANTERIC TFNA 10MMX125 DEG 380MM LT TI 04.037.029S
|
Facility
|
IP
|
$10,385.00
|
|
| Hospital Charge Code |
5190702
|
| 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 TROCHANTERIC TFNA 10MMX125 DEG 380MM RT 04.037.028S
|
Facility
|
IP
|
$10,800.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5597544
|
|
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 TROCHANTERIC TFNA 10MMX125 DEG 380MM RT 04.037.028S
|
Facility
|
OP
|
$10,800.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5597544
|
|
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 TROCHANTERIC TFNA 10MMX125 DEG 400MM LT TI 04.037.031S
|
Facility
|
IP
|
$10,562.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6199024
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,382.40 |
| Max. Negotiated Rate |
$10,105.72 |
| Rate for Payer: Aetna Commercial |
$9,886.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,446.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,821.77
|
| Rate for Payer: Cash Price |
$3,168.60
|
| Rate for Payer: Cigna Commercial |
$10,105.72
|
| Rate for Payer: Health EOS Commercial |
$9,776.19
|
| Rate for Payer: HFN Commercial |
$10,105.72
|
| Rate for Payer: Multiplan Commercial |
$8,787.58
|
| Rate for Payer: Preferred Network Access Commercial |
$10,105.72
|
| Rate for Payer: Quartz Beloit One Network |
$5,382.40
|
| Rate for Payer: Quartz Commercial |
$6,590.69
|
| Rate for Payer: WEA Trust Commercial |
$6,041.46
|
| Rate for Payer: WPS Commercial |
$8,135.91
|
|
|
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 |
$3,075.65 |
| Max. Negotiated Rate |
$10,105.72 |
| Rate for Payer: Aetna Commercial |
$9,886.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,446.65
|
| Rate for Payer: Aetna Managed Medicare |
$3,075.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,139.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,492.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,272.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,821.77
|
| Rate for Payer: Cash Price |
$3,168.60
|
| Rate for Payer: Cigna Commercial |
$10,105.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,147.08
|
| Rate for Payer: Health EOS Commercial |
$9,776.19
|
| Rate for Payer: HFN Commercial |
$10,105.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,238.36
|
| Rate for Payer: Multiplan Commercial |
$8,787.58
|
| Rate for Payer: NAPHCARE Commercial |
$6,590.69
|
| Rate for Payer: Preferred Network Access Commercial |
$10,105.72
|
| Rate for Payer: Quartz Beloit One Network |
$5,382.40
|
| Rate for Payer: Quartz Commercial |
$7,139.91
|
| Rate for Payer: Quartz Medicare Advantage |
$6,590.69
|
| Rate for Payer: The Alliance Commercial |
$5,492.24
|
| Rate for Payer: WEA Trust Commercial |
$6,041.46
|
| Rate for Payer: WPS Commercial |
$8,135.91
|
|
|
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 |
$3,692.67 |
| Max. Negotiated Rate |
$6,933.17 |
| Rate for Payer: Aetna Commercial |
$6,782.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,481.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,994.11
|
| Rate for Payer: Cash Price |
$2,173.86
|
| Rate for Payer: Cigna Commercial |
$6,933.17
|
| Rate for Payer: Health EOS Commercial |
$6,707.09
|
| Rate for Payer: HFN Commercial |
$6,933.17
|
| Rate for Payer: Multiplan Commercial |
$6,028.85
|
| Rate for Payer: Preferred Network Access Commercial |
$6,933.17
|
| Rate for Payer: Quartz Beloit One Network |
$3,692.67
|
| Rate for Payer: Quartz Commercial |
$4,521.64
|
| Rate for Payer: WEA Trust Commercial |
$4,144.83
|
| Rate for Payer: WPS Commercial |
$5,581.76
|
|
|
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 |
$2,110.10 |
| Max. Negotiated Rate |
$6,933.17 |
| Rate for Payer: Aetna Commercial |
$6,782.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,481.01
|
| Rate for Payer: Aetna Managed Medicare |
$2,110.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,898.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,768.03
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,617.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,994.11
|
| Rate for Payer: Cash Price |
$2,173.86
|
| Rate for Payer: Cigna Commercial |
$6,933.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,217.29
|
| Rate for Payer: Health EOS Commercial |
$6,707.09
|
| Rate for Payer: HFN Commercial |
$6,933.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,652.04
|
| Rate for Payer: Multiplan Commercial |
$6,028.85
|
| Rate for Payer: NAPHCARE Commercial |
$4,521.64
|
| Rate for Payer: Preferred Network Access Commercial |
$6,933.17
|
| Rate for Payer: Quartz Beloit One Network |
$3,692.67
|
| Rate for Payer: Quartz Commercial |
$4,898.44
|
| Rate for Payer: Quartz Medicare Advantage |
$4,521.64
|
| Rate for Payer: The Alliance Commercial |
$3,768.03
|
| Rate for Payer: WEA Trust Commercial |
$4,144.83
|
| Rate for Payer: WPS Commercial |
$5,581.76
|
|
|
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 |
$2,243.99 |
| 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 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 |
$3,926.98 |
| 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 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 |
$4,696.47 |
| Max. Negotiated Rate |
$8,817.87 |
| Rate for Payer: Aetna Commercial |
$8,626.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,242.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,079.86
|
| Rate for Payer: Cash Price |
$2,764.80
|
| Rate for Payer: Cigna Commercial |
$8,817.87
|
| Rate for Payer: Health EOS Commercial |
$8,530.33
|
| Rate for Payer: HFN Commercial |
$8,817.87
|
| Rate for Payer: Multiplan Commercial |
$7,667.71
|
| Rate for Payer: Preferred Network Access Commercial |
$8,817.87
|
| Rate for Payer: Quartz Beloit One Network |
$4,696.47
|
| Rate for Payer: Quartz Commercial |
$5,750.78
|
| Rate for Payer: WEA Trust Commercial |
$5,271.55
|
| Rate for Payer: WPS Commercial |
$7,099.08
|
|
|
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 |
$2,683.70 |
| Max. Negotiated Rate |
$8,817.87 |
| Rate for Payer: Aetna Commercial |
$8,626.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,242.79
|
| Rate for Payer: Aetna Managed Medicare |
$2,683.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,230.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,792.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,600.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,079.86
|
| Rate for Payer: Cash Price |
$2,764.80
|
| Rate for Payer: Cigna Commercial |
$8,817.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,363.71
|
| Rate for Payer: Health EOS Commercial |
$8,530.33
|
| Rate for Payer: HFN Commercial |
$8,817.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,188.48
|
| Rate for Payer: Multiplan Commercial |
$7,667.71
|
| Rate for Payer: NAPHCARE Commercial |
$5,750.78
|
| Rate for Payer: Preferred Network Access Commercial |
$8,817.87
|
| Rate for Payer: Quartz Beloit One Network |
$4,696.47
|
| Rate for Payer: Quartz Commercial |
$6,230.02
|
| Rate for Payer: Quartz Medicare Advantage |
$5,750.78
|
| Rate for Payer: The Alliance Commercial |
$4,792.32
|
| Rate for Payer: WEA Trust Commercial |
$5,271.55
|
| Rate for Payer: WPS Commercial |
$7,099.08
|
|
|
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 |
$5,292.20 |
| 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 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 |
$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
|
|
