|
NAIL TROCHANTERIC TFNA 11MMX125 DEG 340MM RT TI 04.037.124S
|
Facility
|
IP
|
$10,800.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4595801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$5,503.68 |
| 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 11MMX125 DEG 340MM RT TI 04.037.124S
|
Facility
|
OP
|
$10,800.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4595801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$3,144.96 |
| 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 11MMX125 DEG 360MM RT TI 04.037.126S
|
Facility
|
OP
|
$10,800.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5106881
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,144.96 |
| 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 11MMX125 DEG 360MM RT TI 04.037.126S
|
Facility
|
IP
|
$10,800.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5106881
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,503.68 |
| 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 11MMX125 DEG 380MM RT TI 04.037.128S
|
Facility
|
OP
|
$10,800.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5107182
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,144.96 |
| 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 11MMX125 DEG 380MM RT TI 04.037.128S
|
Facility
|
IP
|
$10,800.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5107182
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,503.68 |
| 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 11MMX125 DEG 400MM RT 04.037.130S
|
Facility
|
IP
|
$12,382.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4858785
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,309.87 |
| Max. Negotiated Rate |
$11,847.10 |
| Rate for Payer: Aetna Commercial |
$11,589.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,074.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,824.96
|
| Rate for Payer: Cash Price |
$3,714.60
|
| Rate for Payer: Cigna Commercial |
$11,847.10
|
| Rate for Payer: Health EOS Commercial |
$11,460.78
|
| Rate for Payer: HFN Commercial |
$11,847.10
|
| Rate for Payer: Multiplan Commercial |
$10,301.82
|
| Rate for Payer: Preferred Network Access Commercial |
$11,847.10
|
| Rate for Payer: Quartz Beloit One Network |
$6,309.87
|
| Rate for Payer: Quartz Commercial |
$7,726.37
|
| Rate for Payer: WEA Trust Commercial |
$7,082.50
|
| Rate for Payer: WPS Commercial |
$9,537.85
|
|
|
NAIL TROCHANTERIC TFNA 11MMX125 DEG 400MM RT 04.037.130S
|
Facility
|
OP
|
$12,382.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4858785
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,605.64 |
| Max. Negotiated Rate |
$11,847.10 |
| Rate for Payer: Aetna Commercial |
$11,589.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,074.46
|
| Rate for Payer: Aetna Managed Medicare |
$3,605.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,370.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,438.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,181.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,824.96
|
| Rate for Payer: Cash Price |
$3,714.60
|
| Rate for Payer: Cigna Commercial |
$11,847.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,206.32
|
| Rate for Payer: Health EOS Commercial |
$11,460.78
|
| Rate for Payer: HFN Commercial |
$11,847.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,657.96
|
| Rate for Payer: Multiplan Commercial |
$10,301.82
|
| Rate for Payer: NAPHCARE Commercial |
$7,726.37
|
| Rate for Payer: Preferred Network Access Commercial |
$11,847.10
|
| Rate for Payer: Quartz Beloit One Network |
$6,309.87
|
| Rate for Payer: Quartz Commercial |
$8,370.23
|
| Rate for Payer: Quartz Medicare Advantage |
$7,726.37
|
| Rate for Payer: The Alliance Commercial |
$6,438.64
|
| Rate for Payer: WEA Trust Commercial |
$7,082.50
|
| Rate for Payer: WPS Commercial |
$9,537.85
|
|
|
NAIL TROCHANTERIC TFNA 11MMX125 DEG TI 04.037.114S
|
Facility
|
IP
|
$8,862.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4595106
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$4,516.08 |
| 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 11MMX125 DEG TI 04.037.114S
|
Facility
|
OP
|
$8,862.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4595106
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,580.61 |
| 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 11MMX125 DEG TI 04.037.134S
|
Facility
|
IP
|
$7,706.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4594892
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,926.98 |
| 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 11MMX125 DEG TI 04.037.134S
|
Facility
|
OP
|
$7,706.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4594892
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,243.99 |
| 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 11MMX130 DEG TI 04.037.157S
|
Facility
|
IP
|
$10,800.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4519759
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,503.68 |
| 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 11MMX130 DEG TI 04.037.157S
|
Facility
|
OP
|
$10,800.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4519759
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,144.96 |
| 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 11MMX170X125 DEG TI 04.037.112S
|
Facility
|
OP
|
$7,706.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5179255
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,243.99 |
| 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 11MMX170X125 DEG TI 04.037.112S
|
Facility
|
IP
|
$7,706.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5179255
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$3,926.98 |
| 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 12MMX125 DEG 320MM RT TI 04.037.222S
|
Facility
|
OP
|
$10,800.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5459159
|
|
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 12MMX125 DEG 320MM RT TI 04.037.222S
|
Facility
|
IP
|
$10,800.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5459159
|
|
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 12MMX125 DEG TI RT 04.037.214S
|
Facility
|
IP
|
$9,216.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5306837
|
|
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 12MMX125 DEG TI RT 04.037.214S
|
Facility
|
OP
|
$9,216.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5306837
|
|
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 TI 11MM/125D
|
Facility
|
IP
|
$10,864.00
|
|
| Hospital Charge Code |
2966302
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,536.29 |
| Max. Negotiated Rate |
$10,394.68 |
| Rate for Payer: Aetna Commercial |
$10,168.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,716.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,988.24
|
| Rate for Payer: Cash Price |
$3,259.20
|
| Rate for Payer: Cigna Commercial |
$10,394.68
|
| Rate for Payer: Health EOS Commercial |
$10,055.72
|
| Rate for Payer: HFN Commercial |
$10,394.68
|
| Rate for Payer: Multiplan Commercial |
$9,038.85
|
| Rate for Payer: Preferred Network Access Commercial |
$10,394.68
|
| Rate for Payer: Quartz Beloit One Network |
$5,536.29
|
| Rate for Payer: Quartz Commercial |
$6,779.14
|
| Rate for Payer: WEA Trust Commercial |
$6,214.21
|
| Rate for Payer: WPS Commercial |
$8,368.54
|
|
|
NAIL TROCHANTERIC TI 11MM/125D
|
Facility
|
OP
|
$10,864.00
|
|
| Hospital Charge Code |
2966302
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,163.60 |
| Max. Negotiated Rate |
$10,394.68 |
| Rate for Payer: Aetna Commercial |
$10,168.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,716.76
|
| Rate for Payer: Aetna Managed Medicare |
$3,163.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,344.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,649.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,423.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,988.24
|
| Rate for Payer: Cash Price |
$3,259.20
|
| Rate for Payer: Cigna Commercial |
$10,394.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,322.85
|
| Rate for Payer: Health EOS Commercial |
$10,055.72
|
| Rate for Payer: HFN Commercial |
$10,394.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,473.92
|
| Rate for Payer: Multiplan Commercial |
$9,038.85
|
| Rate for Payer: NAPHCARE Commercial |
$6,779.14
|
| Rate for Payer: Preferred Network Access Commercial |
$10,394.68
|
| Rate for Payer: Quartz Beloit One Network |
$5,536.29
|
| Rate for Payer: Quartz Commercial |
$7,344.06
|
| Rate for Payer: Quartz Medicare Advantage |
$6,779.14
|
| Rate for Payer: The Alliance Commercial |
$5,649.28
|
| Rate for Payer: WEA Trust Commercial |
$6,214.21
|
| Rate for Payer: WPS Commercial |
$8,368.54
|
|
|
NAIL WITH COMPRESSION SCREW 8MM X 100MM 2380-0811S
|
Facility
|
OP
|
$13,454.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6171933
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,917.80 |
| Max. Negotiated Rate |
$12,872.79 |
| Rate for Payer: Aetna Commercial |
$12,592.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,033.26
|
| Rate for Payer: Aetna Managed Medicare |
$3,917.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,094.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,996.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,716.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,415.84
|
| Rate for Payer: Cash Price |
$4,036.20
|
| Rate for Payer: Cigna Commercial |
$12,872.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,830.23
|
| Rate for Payer: Health EOS Commercial |
$12,453.02
|
| Rate for Payer: HFN Commercial |
$12,872.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,494.12
|
| Rate for Payer: Multiplan Commercial |
$11,193.73
|
| Rate for Payer: NAPHCARE Commercial |
$8,395.30
|
| Rate for Payer: Preferred Network Access Commercial |
$12,872.79
|
| Rate for Payer: Quartz Beloit One Network |
$6,856.16
|
| Rate for Payer: Quartz Commercial |
$9,094.90
|
| Rate for Payer: Quartz Medicare Advantage |
$8,395.30
|
| Rate for Payer: The Alliance Commercial |
$6,996.08
|
| Rate for Payer: WEA Trust Commercial |
$7,695.69
|
| Rate for Payer: WPS Commercial |
$10,363.62
|
|
|
NAIL WITH COMPRESSION SCREW 8MM X 100MM 2380-0811S
|
Facility
|
IP
|
$13,454.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6171933
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,856.16 |
| Max. Negotiated Rate |
$12,872.79 |
| Rate for Payer: Aetna Commercial |
$12,592.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,033.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,415.84
|
| Rate for Payer: Cash Price |
$4,036.20
|
| Rate for Payer: Cigna Commercial |
$12,872.79
|
| Rate for Payer: Health EOS Commercial |
$12,453.02
|
| Rate for Payer: HFN Commercial |
$12,872.79
|
| Rate for Payer: Multiplan Commercial |
$11,193.73
|
| Rate for Payer: Preferred Network Access Commercial |
$12,872.79
|
| Rate for Payer: Quartz Beloit One Network |
$6,856.16
|
| Rate for Payer: Quartz Commercial |
$8,395.30
|
| Rate for Payer: WEA Trust Commercial |
$7,695.69
|
| Rate for Payer: WPS Commercial |
$10,363.62
|
|
|
naloxone 0.4 mg/mL Inj Syr [Med]
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
HCPCS J2310
|
| Hospital Charge Code |
2983102
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.09 |
| Max. Negotiated Rate |
$122.47 |
| Rate for Payer: Aetna Commercial |
$119.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$114.48
|
| Rate for Payer: Aetna Managed Medicare |
$37.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$86.53
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$66.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$63.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$70.55
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cigna Commercial |
$122.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.09
|
| Rate for Payer: Health EOS Commercial |
$118.48
|
| Rate for Payer: HFN Commercial |
$122.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$99.84
|
| Rate for Payer: Multiplan Commercial |
$106.50
|
| Rate for Payer: NAPHCARE Commercial |
$79.87
|
| Rate for Payer: Preferred Network Access Commercial |
$122.47
|
| Rate for Payer: Quartz Beloit One Network |
$65.23
|
| Rate for Payer: Quartz Commercial |
$86.53
|
| Rate for Payer: Quartz Medicare Advantage |
$79.87
|
| Rate for Payer: The Alliance Commercial |
$66.56
|
| Rate for Payer: WEA Trust Commercial |
$73.22
|
| Rate for Payer: WPS Commercial |
$20.95
|
|
