|
HALF-PIN APEX 1.65 X 45MM 20MM THREAD 5080-1-620
|
Facility
|
OP
|
$792.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5349475
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$230.63 |
| Max. Negotiated Rate |
$757.79 |
| Rate for Payer: Aetna Commercial |
$741.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$708.36
|
| Rate for Payer: Aetna Managed Medicare |
$230.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$535.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$411.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$395.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$436.55
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Cigna Commercial |
$757.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$460.94
|
| Rate for Payer: Health EOS Commercial |
$733.08
|
| Rate for Payer: HFN Commercial |
$757.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$617.76
|
| Rate for Payer: Multiplan Commercial |
$658.94
|
| Rate for Payer: NAPHCARE Commercial |
$494.21
|
| Rate for Payer: Preferred Network Access Commercial |
$757.79
|
| Rate for Payer: Quartz Beloit One Network |
$403.60
|
| Rate for Payer: Quartz Commercial |
$535.39
|
| Rate for Payer: Quartz Medicare Advantage |
$494.21
|
| Rate for Payer: The Alliance Commercial |
$411.84
|
| Rate for Payer: WEA Trust Commercial |
$453.02
|
| Rate for Payer: WPS Commercial |
$610.08
|
|
|
HALF-PIN APEX 5MM 150 X 25MM SELF-DRILLING 5014-8-150S
|
Facility
|
IP
|
$1,266.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6206989
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$645.15 |
| Max. Negotiated Rate |
$1,211.31 |
| Rate for Payer: Aetna Commercial |
$1,184.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,132.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$697.82
|
| Rate for Payer: Cash Price |
$379.80
|
| Rate for Payer: Cigna Commercial |
$1,211.31
|
| Rate for Payer: Health EOS Commercial |
$1,171.81
|
| Rate for Payer: HFN Commercial |
$1,211.31
|
| Rate for Payer: Multiplan Commercial |
$1,053.31
|
| Rate for Payer: Preferred Network Access Commercial |
$1,211.31
|
| Rate for Payer: Quartz Beloit One Network |
$645.15
|
| Rate for Payer: Quartz Commercial |
$789.98
|
| Rate for Payer: WEA Trust Commercial |
$724.15
|
| Rate for Payer: WPS Commercial |
$975.20
|
|
|
HALF-PIN APEX 5MM 150 X 25MM SELF-DRILLING 5014-8-150S
|
Facility
|
OP
|
$1,266.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6206989
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$368.66 |
| Max. Negotiated Rate |
$1,211.31 |
| Rate for Payer: Aetna Commercial |
$1,184.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,132.31
|
| Rate for Payer: Aetna Managed Medicare |
$368.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$855.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$658.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$631.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$697.82
|
| Rate for Payer: Cash Price |
$379.80
|
| Rate for Payer: Cigna Commercial |
$1,211.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$736.81
|
| Rate for Payer: Health EOS Commercial |
$1,171.81
|
| Rate for Payer: HFN Commercial |
$1,211.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$987.48
|
| Rate for Payer: Multiplan Commercial |
$1,053.31
|
| Rate for Payer: NAPHCARE Commercial |
$789.98
|
| Rate for Payer: Preferred Network Access Commercial |
$1,211.31
|
| Rate for Payer: Quartz Beloit One Network |
$645.15
|
| Rate for Payer: Quartz Commercial |
$855.82
|
| Rate for Payer: Quartz Medicare Advantage |
$789.98
|
| Rate for Payer: The Alliance Commercial |
$658.32
|
| Rate for Payer: WEA Trust Commercial |
$724.15
|
| Rate for Payer: WPS Commercial |
$975.20
|
|
|
HALF-PIN APEX 6MM 150 X 30MM SELF-DRILLING 5014-3-150S
|
Facility
|
OP
|
$1,337.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6206988
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$389.33 |
| Max. Negotiated Rate |
$1,279.24 |
| Rate for Payer: Aetna Commercial |
$1,251.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,195.81
|
| Rate for Payer: Aetna Managed Medicare |
$389.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$903.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$695.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$667.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$736.95
|
| Rate for Payer: Cash Price |
$401.10
|
| Rate for Payer: Cigna Commercial |
$1,279.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$778.13
|
| Rate for Payer: Health EOS Commercial |
$1,237.53
|
| Rate for Payer: HFN Commercial |
$1,279.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,042.86
|
| Rate for Payer: Multiplan Commercial |
$1,112.38
|
| Rate for Payer: NAPHCARE Commercial |
$834.29
|
| Rate for Payer: Preferred Network Access Commercial |
$1,279.24
|
| Rate for Payer: Quartz Beloit One Network |
$681.34
|
| Rate for Payer: Quartz Commercial |
$903.81
|
| Rate for Payer: Quartz Medicare Advantage |
$834.29
|
| Rate for Payer: The Alliance Commercial |
$695.24
|
| Rate for Payer: WEA Trust Commercial |
$764.76
|
| Rate for Payer: WPS Commercial |
$1,029.89
|
|
|
HALF-PIN APEX 6MM 150 X 30MM SELF-DRILLING 5014-3-150S
|
Facility
|
IP
|
$1,337.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6206988
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$681.34 |
| Max. Negotiated Rate |
$1,279.24 |
| Rate for Payer: Aetna Commercial |
$1,251.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,195.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$736.95
|
| Rate for Payer: Cash Price |
$401.10
|
| Rate for Payer: Cigna Commercial |
$1,279.24
|
| Rate for Payer: Health EOS Commercial |
$1,237.53
|
| Rate for Payer: HFN Commercial |
$1,279.24
|
| Rate for Payer: Multiplan Commercial |
$1,112.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,279.24
|
| Rate for Payer: Quartz Beloit One Network |
$681.34
|
| Rate for Payer: Quartz Commercial |
$834.29
|
| Rate for Payer: WEA Trust Commercial |
$764.76
|
| Rate for Payer: WPS Commercial |
$1,029.89
|
|
|
HALLUX LIMITUS/VALGUS CORRECTION
|
Facility
|
IP
|
$1,757.00
|
|
| Hospital Charge Code |
2960095
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$895.37 |
| Max. Negotiated Rate |
$1,681.10 |
| Rate for Payer: Aetna Commercial |
$1,644.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,571.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$968.46
|
| Rate for Payer: Cash Price |
$527.10
|
| Rate for Payer: Cigna Commercial |
$1,681.10
|
| Rate for Payer: Health EOS Commercial |
$1,626.28
|
| Rate for Payer: HFN Commercial |
$1,681.10
|
| Rate for Payer: Multiplan Commercial |
$1,461.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,681.10
|
| Rate for Payer: Quartz Beloit One Network |
$895.37
|
| Rate for Payer: Quartz Commercial |
$1,096.37
|
| Rate for Payer: WEA Trust Commercial |
$1,005.00
|
| Rate for Payer: WPS Commercial |
$1,353.42
|
|
|
HALLUX LIMITUS/VALGUS CORRECTION
|
Facility
|
OP
|
$1,757.00
|
|
| Hospital Charge Code |
2960095
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$511.64 |
| Max. Negotiated Rate |
$1,681.10 |
| Rate for Payer: Aetna Commercial |
$1,644.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,571.46
|
| Rate for Payer: Aetna Managed Medicare |
$511.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,187.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$913.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$877.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$968.46
|
| Rate for Payer: Cash Price |
$527.10
|
| Rate for Payer: Cigna Commercial |
$1,681.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,022.57
|
| Rate for Payer: Health EOS Commercial |
$1,626.28
|
| Rate for Payer: HFN Commercial |
$1,681.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,370.46
|
| Rate for Payer: Multiplan Commercial |
$1,461.82
|
| Rate for Payer: NAPHCARE Commercial |
$1,096.37
|
| Rate for Payer: Preferred Network Access Commercial |
$1,681.10
|
| Rate for Payer: Quartz Beloit One Network |
$895.37
|
| Rate for Payer: Quartz Commercial |
$1,187.73
|
| Rate for Payer: Quartz Medicare Advantage |
$1,096.37
|
| Rate for Payer: The Alliance Commercial |
$913.64
|
| Rate for Payer: WEA Trust Commercial |
$1,005.00
|
| Rate for Payer: WPS Commercial |
$1,353.42
|
|
|
HALLUX RIGIDUS CORRECTION WITH CHEILECTOMY, DEBRIDEMENT AND CAPSULAR RELEASE OF THE FIRST METATARSOPHALANGEAL JOINT; WITHOUT IMPLANT
|
Facility
|
OP
|
$13,773.68
|
|
|
Service Code
|
CPT 28289
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,443.42 |
| Max. Negotiated Rate |
$13,773.68 |
| Rate for Payer: Aetna Managed Medicare |
$3,443.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$3,443.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,443.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,443.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,443.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,443.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,809.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,443.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,443.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,443.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,443.42
|
| Rate for Payer: NAPHCARE Commercial |
$5,165.13
|
| Rate for Payer: Quartz Medicare Advantage |
$3,443.42
|
| Rate for Payer: The Alliance Commercial |
$13,773.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,443.42
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$3,443.42
|
|
|
Haloperidol Level
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
CPT 80173
|
| Hospital Charge Code |
5158607
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$61.66 |
| Max. Negotiated Rate |
$115.77 |
| Rate for Payer: Aetna Commercial |
$113.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$108.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.70
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna Commercial |
$115.77
|
| Rate for Payer: Health EOS Commercial |
$112.00
|
| Rate for Payer: HFN Commercial |
$115.77
|
| Rate for Payer: Multiplan Commercial |
$100.67
|
| Rate for Payer: Preferred Network Access Commercial |
$115.77
|
| Rate for Payer: Quartz Beloit One Network |
$61.66
|
| Rate for Payer: Quartz Commercial |
$75.50
|
| Rate for Payer: WEA Trust Commercial |
$69.21
|
| Rate for Payer: WPS Commercial |
$93.21
|
|
|
Haloperidol Level
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
CPT 80173
|
| Hospital Charge Code |
5158607
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.41 |
| Max. Negotiated Rate |
$119.55 |
| Rate for Payer: Aetna Commercial |
$119.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$108.22
|
| Rate for Payer: Aetna Managed Medicare |
$16.41
|
| Rate for Payer: Anthem Medicare Advantage |
$16.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.41
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna Commercial |
$119.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$62.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.41
|
| Rate for Payer: Health EOS Commercial |
$114.51
|
| Rate for Payer: HFN Commercial |
$119.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$57.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$57.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.41
|
| Rate for Payer: Multiplan Commercial |
$100.67
|
| Rate for Payer: NAPHCARE Commercial |
$24.62
|
| Rate for Payer: Preferred Network Access Commercial |
$119.55
|
| Rate for Payer: Quartz Beloit One Network |
$55.37
|
| Rate for Payer: Quartz Commercial |
$71.73
|
| Rate for Payer: Quartz Medicare Advantage |
$16.41
|
| Rate for Payer: The Alliance Commercial |
$64.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.41
|
| Rate for Payer: WEA Trust Commercial |
$69.21
|
| Rate for Payer: WPS Commercial |
$72.21
|
|
|
Haloperidol Level
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
CPT 80173
|
| Hospital Charge Code |
5158607
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.41 |
| Max. Negotiated Rate |
$115.77 |
| Rate for Payer: Aetna Commercial |
$113.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$108.22
|
| Rate for Payer: Aetna Managed Medicare |
$16.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$61.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27.24
|
| Rate for Payer: Anthem Medicare Advantage |
$16.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.41
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna Commercial |
$115.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$70.42
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.41
|
| Rate for Payer: Health EOS Commercial |
$112.00
|
| Rate for Payer: HFN Commercial |
$115.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$61.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.41
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.41
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.41
|
| Rate for Payer: Multiplan Commercial |
$100.67
|
| Rate for Payer: NAPHCARE Commercial |
$24.62
|
| Rate for Payer: Preferred Network Access Commercial |
$115.77
|
| Rate for Payer: Quartz Beloit One Network |
$61.66
|
| Rate for Payer: Quartz Commercial |
$81.80
|
| Rate for Payer: Quartz Medicare Advantage |
$16.41
|
| Rate for Payer: The Alliance Commercial |
$65.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.41
|
| Rate for Payer: United Healthcare PPO |
$94.38
|
| Rate for Payer: WEA Trust Commercial |
$69.21
|
| Rate for Payer: Wellcare Medicare |
$16.41
|
| Rate for Payer: WPS Commercial |
$93.21
|
|
|
HAMMER TOE IMPLANT TWO-STEP 2.6MM X 2.4MM X 12MM 204-24-012
|
Facility
|
OP
|
$7,419.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5547241
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,160.41 |
| Max. Negotiated Rate |
$7,098.50 |
| Rate for Payer: Aetna Commercial |
$6,944.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,635.55
|
| Rate for Payer: Aetna Managed Medicare |
$2,160.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,015.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,857.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,703.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,089.35
|
| Rate for Payer: Cash Price |
$2,225.70
|
| Rate for Payer: Cigna Commercial |
$7,098.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,317.86
|
| Rate for Payer: Health EOS Commercial |
$6,867.03
|
| Rate for Payer: HFN Commercial |
$7,098.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,786.82
|
| Rate for Payer: Multiplan Commercial |
$6,172.61
|
| Rate for Payer: NAPHCARE Commercial |
$4,629.46
|
| Rate for Payer: Preferred Network Access Commercial |
$7,098.50
|
| Rate for Payer: Quartz Beloit One Network |
$3,780.72
|
| Rate for Payer: Quartz Commercial |
$5,015.24
|
| Rate for Payer: Quartz Medicare Advantage |
$4,629.46
|
| Rate for Payer: The Alliance Commercial |
$3,857.88
|
| Rate for Payer: WEA Trust Commercial |
$4,243.67
|
| Rate for Payer: WPS Commercial |
$5,714.86
|
|
|
HAMMER TOE IMPLANT TWO-STEP 2.6MM X 2.4MM X 12MM 204-24-012
|
Facility
|
IP
|
$7,419.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5547241
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,780.72 |
| Max. Negotiated Rate |
$7,098.50 |
| Rate for Payer: Aetna Commercial |
$6,944.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,635.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,089.35
|
| Rate for Payer: Cash Price |
$2,225.70
|
| Rate for Payer: Cigna Commercial |
$7,098.50
|
| Rate for Payer: Health EOS Commercial |
$6,867.03
|
| Rate for Payer: HFN Commercial |
$7,098.50
|
| Rate for Payer: Multiplan Commercial |
$6,172.61
|
| Rate for Payer: Preferred Network Access Commercial |
$7,098.50
|
| Rate for Payer: Quartz Beloit One Network |
$3,780.72
|
| Rate for Payer: Quartz Commercial |
$4,629.46
|
| Rate for Payer: WEA Trust Commercial |
$4,243.67
|
| Rate for Payer: WPS Commercial |
$5,714.86
|
|
|
HAMMER TOE IMPLANT TWO-STEP 2.6MM X 3.0MM X 14MM 204-24-014
|
Facility
|
OP
|
$7,419.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5496693
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,160.41 |
| Max. Negotiated Rate |
$7,098.50 |
| Rate for Payer: Aetna Commercial |
$6,944.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,635.55
|
| Rate for Payer: Aetna Managed Medicare |
$2,160.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,015.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,857.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,703.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,089.35
|
| Rate for Payer: Cash Price |
$2,225.70
|
| Rate for Payer: Cigna Commercial |
$7,098.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,317.86
|
| Rate for Payer: Health EOS Commercial |
$6,867.03
|
| Rate for Payer: HFN Commercial |
$7,098.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,786.82
|
| Rate for Payer: Multiplan Commercial |
$6,172.61
|
| Rate for Payer: NAPHCARE Commercial |
$4,629.46
|
| Rate for Payer: Preferred Network Access Commercial |
$7,098.50
|
| Rate for Payer: Quartz Beloit One Network |
$3,780.72
|
| Rate for Payer: Quartz Commercial |
$5,015.24
|
| Rate for Payer: Quartz Medicare Advantage |
$4,629.46
|
| Rate for Payer: The Alliance Commercial |
$3,857.88
|
| Rate for Payer: WEA Trust Commercial |
$4,243.67
|
| Rate for Payer: WPS Commercial |
$5,714.86
|
|
|
HAMMER TOE IMPLANT TWO-STEP 2.6MM X 3.0MM X 14MM 204-24-014
|
Facility
|
IP
|
$7,419.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5496693
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,780.72 |
| Max. Negotiated Rate |
$7,098.50 |
| Rate for Payer: Aetna Commercial |
$6,944.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,635.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,089.35
|
| Rate for Payer: Cash Price |
$2,225.70
|
| Rate for Payer: Cigna Commercial |
$7,098.50
|
| Rate for Payer: Health EOS Commercial |
$6,867.03
|
| Rate for Payer: HFN Commercial |
$7,098.50
|
| Rate for Payer: Multiplan Commercial |
$6,172.61
|
| Rate for Payer: Preferred Network Access Commercial |
$7,098.50
|
| Rate for Payer: Quartz Beloit One Network |
$3,780.72
|
| Rate for Payer: Quartz Commercial |
$4,629.46
|
| Rate for Payer: WEA Trust Commercial |
$4,243.67
|
| Rate for Payer: WPS Commercial |
$5,714.86
|
|
|
HAMMER TOE IMPLANT TWO-STEP 2.6MM X 3.0MM X 8MM 204-24-008
|
Facility
|
IP
|
$7,419.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5520668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,780.72 |
| Max. Negotiated Rate |
$7,098.50 |
| Rate for Payer: Aetna Commercial |
$6,944.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,635.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,089.35
|
| Rate for Payer: Cash Price |
$2,225.70
|
| Rate for Payer: Cigna Commercial |
$7,098.50
|
| Rate for Payer: Health EOS Commercial |
$6,867.03
|
| Rate for Payer: HFN Commercial |
$7,098.50
|
| Rate for Payer: Multiplan Commercial |
$6,172.61
|
| Rate for Payer: Preferred Network Access Commercial |
$7,098.50
|
| Rate for Payer: Quartz Beloit One Network |
$3,780.72
|
| Rate for Payer: Quartz Commercial |
$4,629.46
|
| Rate for Payer: WEA Trust Commercial |
$4,243.67
|
| Rate for Payer: WPS Commercial |
$5,714.86
|
|
|
HAMMER TOE IMPLANT TWO-STEP 2.6MM X 3.0MM X 8MM 204-24-008
|
Facility
|
OP
|
$7,419.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5520668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,160.41 |
| Max. Negotiated Rate |
$7,098.50 |
| Rate for Payer: Aetna Commercial |
$6,944.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,635.55
|
| Rate for Payer: Aetna Managed Medicare |
$2,160.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,015.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,857.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,703.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,089.35
|
| Rate for Payer: Cash Price |
$2,225.70
|
| Rate for Payer: Cigna Commercial |
$7,098.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,317.86
|
| Rate for Payer: Health EOS Commercial |
$6,867.03
|
| Rate for Payer: HFN Commercial |
$7,098.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,786.82
|
| Rate for Payer: Multiplan Commercial |
$6,172.61
|
| Rate for Payer: NAPHCARE Commercial |
$4,629.46
|
| Rate for Payer: Preferred Network Access Commercial |
$7,098.50
|
| Rate for Payer: Quartz Beloit One Network |
$3,780.72
|
| Rate for Payer: Quartz Commercial |
$5,015.24
|
| Rate for Payer: Quartz Medicare Advantage |
$4,629.46
|
| Rate for Payer: The Alliance Commercial |
$3,857.88
|
| Rate for Payer: WEA Trust Commercial |
$4,243.67
|
| Rate for Payer: WPS Commercial |
$5,714.86
|
|
|
HAMMER TOE IMPLANT TWO-STEP 3.4MM X 3.0MM X 10MM 204-30-010
|
Facility
|
OP
|
$9,102.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3693500
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,650.50 |
| Max. Negotiated Rate |
$8,708.79 |
| Rate for Payer: Aetna Commercial |
$8,519.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,140.83
|
| Rate for Payer: Aetna Managed Medicare |
$2,650.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,152.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,733.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,543.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,017.02
|
| Rate for Payer: Cash Price |
$2,730.60
|
| Rate for Payer: Cigna Commercial |
$8,708.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,297.36
|
| Rate for Payer: Health EOS Commercial |
$8,424.81
|
| Rate for Payer: HFN Commercial |
$8,708.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,099.56
|
| Rate for Payer: Multiplan Commercial |
$7,572.86
|
| Rate for Payer: NAPHCARE Commercial |
$5,679.65
|
| Rate for Payer: Preferred Network Access Commercial |
$8,708.79
|
| Rate for Payer: Quartz Beloit One Network |
$4,638.38
|
| Rate for Payer: Quartz Commercial |
$6,152.95
|
| Rate for Payer: Quartz Medicare Advantage |
$5,679.65
|
| Rate for Payer: The Alliance Commercial |
$4,733.04
|
| Rate for Payer: WEA Trust Commercial |
$5,206.34
|
| Rate for Payer: WPS Commercial |
$7,011.27
|
|
|
HAMMER TOE IMPLANT TWO-STEP 3.4MM X 3.0MM X 10MM 204-30-010
|
Facility
|
IP
|
$9,102.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3693500
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,638.38 |
| Max. Negotiated Rate |
$8,708.79 |
| Rate for Payer: Aetna Commercial |
$8,519.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,140.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,017.02
|
| Rate for Payer: Cash Price |
$2,730.60
|
| Rate for Payer: Cigna Commercial |
$8,708.79
|
| Rate for Payer: Health EOS Commercial |
$8,424.81
|
| Rate for Payer: HFN Commercial |
$8,708.79
|
| Rate for Payer: Multiplan Commercial |
$7,572.86
|
| Rate for Payer: Preferred Network Access Commercial |
$8,708.79
|
| Rate for Payer: Quartz Beloit One Network |
$4,638.38
|
| Rate for Payer: Quartz Commercial |
$5,679.65
|
| Rate for Payer: WEA Trust Commercial |
$5,206.34
|
| Rate for Payer: WPS Commercial |
$7,011.27
|
|
|
HAMMER TOE IMPLANT TWO-STEP 3.4MM X 3.0MM X 12MM 204-30-012
|
Facility
|
OP
|
$6,066.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4595419
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,766.42 |
| Max. Negotiated Rate |
$5,803.95 |
| Rate for Payer: Aetna Commercial |
$5,677.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,425.43
|
| Rate for Payer: Aetna Managed Medicare |
$1,766.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,100.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,154.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,028.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,343.58
|
| Rate for Payer: Cash Price |
$1,819.80
|
| Rate for Payer: Cigna Commercial |
$5,803.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,530.41
|
| Rate for Payer: Health EOS Commercial |
$5,614.69
|
| Rate for Payer: HFN Commercial |
$5,803.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,731.48
|
| Rate for Payer: Multiplan Commercial |
$5,046.91
|
| Rate for Payer: NAPHCARE Commercial |
$3,785.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,803.95
|
| Rate for Payer: Quartz Beloit One Network |
$3,091.23
|
| Rate for Payer: Quartz Commercial |
$4,100.62
|
| Rate for Payer: Quartz Medicare Advantage |
$3,785.18
|
| Rate for Payer: The Alliance Commercial |
$3,154.32
|
| Rate for Payer: WEA Trust Commercial |
$3,469.75
|
| Rate for Payer: WPS Commercial |
$4,672.64
|
|
|
HAMMER TOE IMPLANT TWO-STEP 3.4MM X 3.0MM X 12MM 204-30-012
|
Facility
|
IP
|
$6,066.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4595419
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,091.23 |
| Max. Negotiated Rate |
$5,803.95 |
| Rate for Payer: Aetna Commercial |
$5,677.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,425.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,343.58
|
| Rate for Payer: Cash Price |
$1,819.80
|
| Rate for Payer: Cigna Commercial |
$5,803.95
|
| Rate for Payer: Health EOS Commercial |
$5,614.69
|
| Rate for Payer: HFN Commercial |
$5,803.95
|
| Rate for Payer: Multiplan Commercial |
$5,046.91
|
| Rate for Payer: Preferred Network Access Commercial |
$5,803.95
|
| Rate for Payer: Quartz Beloit One Network |
$3,091.23
|
| Rate for Payer: Quartz Commercial |
$3,785.18
|
| Rate for Payer: WEA Trust Commercial |
$3,469.75
|
| Rate for Payer: WPS Commercial |
$4,672.64
|
|
|
HAMMER TOE IMPLANT TWO-STEP 3.4MM X 3.0MM X 14MM 204-30-014
|
Facility
|
OP
|
$6,300.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4641039
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,834.56 |
| Max. Negotiated Rate |
$6,027.84 |
| Rate for Payer: Aetna Commercial |
$5,896.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,634.72
|
| Rate for Payer: Aetna Managed Medicare |
$1,834.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,258.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,276.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,144.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,472.56
|
| Rate for Payer: Cash Price |
$1,890.00
|
| Rate for Payer: Cigna Commercial |
$6,027.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,666.60
|
| Rate for Payer: Health EOS Commercial |
$5,831.28
|
| Rate for Payer: HFN Commercial |
$6,027.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,914.00
|
| Rate for Payer: Multiplan Commercial |
$5,241.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,931.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,027.84
|
| Rate for Payer: Quartz Beloit One Network |
$3,210.48
|
| Rate for Payer: Quartz Commercial |
$4,258.80
|
| Rate for Payer: Quartz Medicare Advantage |
$3,931.20
|
| Rate for Payer: The Alliance Commercial |
$3,276.00
|
| Rate for Payer: WEA Trust Commercial |
$3,603.60
|
| Rate for Payer: WPS Commercial |
$4,852.89
|
|
|
HAMMER TOE IMPLANT TWO-STEP 3.4MM X 3.0MM X 14MM 204-30-014
|
Facility
|
IP
|
$6,300.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4641039
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,210.48 |
| Max. Negotiated Rate |
$6,027.84 |
| Rate for Payer: Aetna Commercial |
$5,896.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,634.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,472.56
|
| Rate for Payer: Cash Price |
$1,890.00
|
| Rate for Payer: Cigna Commercial |
$6,027.84
|
| Rate for Payer: Health EOS Commercial |
$5,831.28
|
| Rate for Payer: HFN Commercial |
$6,027.84
|
| Rate for Payer: Multiplan Commercial |
$5,241.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,027.84
|
| Rate for Payer: Quartz Beloit One Network |
$3,210.48
|
| Rate for Payer: Quartz Commercial |
$3,931.20
|
| Rate for Payer: WEA Trust Commercial |
$3,603.60
|
| Rate for Payer: WPS Commercial |
$4,852.89
|
|
|
HAMMER TOE IMPLANT TWO-STEP 3.4MM X 3.0MM X 16MM 204-30-016
|
Facility
|
OP
|
$6,066.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4519124
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,766.42 |
| Max. Negotiated Rate |
$5,803.95 |
| Rate for Payer: Aetna Commercial |
$5,677.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,425.43
|
| Rate for Payer: Aetna Managed Medicare |
$1,766.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,100.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,154.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,028.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,343.58
|
| Rate for Payer: Cash Price |
$1,819.80
|
| Rate for Payer: Cigna Commercial |
$5,803.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,530.41
|
| Rate for Payer: Health EOS Commercial |
$5,614.69
|
| Rate for Payer: HFN Commercial |
$5,803.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,731.48
|
| Rate for Payer: Multiplan Commercial |
$5,046.91
|
| Rate for Payer: NAPHCARE Commercial |
$3,785.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,803.95
|
| Rate for Payer: Quartz Beloit One Network |
$3,091.23
|
| Rate for Payer: Quartz Commercial |
$4,100.62
|
| Rate for Payer: Quartz Medicare Advantage |
$3,785.18
|
| Rate for Payer: The Alliance Commercial |
$3,154.32
|
| Rate for Payer: WEA Trust Commercial |
$3,469.75
|
| Rate for Payer: WPS Commercial |
$4,672.64
|
|
|
HAMMER TOE IMPLANT TWO-STEP 3.4MM X 3.0MM X 16MM 204-30-016
|
Facility
|
IP
|
$6,066.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4519124
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,091.23 |
| Max. Negotiated Rate |
$5,803.95 |
| Rate for Payer: Aetna Commercial |
$5,677.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,425.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,343.58
|
| Rate for Payer: Cash Price |
$1,819.80
|
| Rate for Payer: Cigna Commercial |
$5,803.95
|
| Rate for Payer: Health EOS Commercial |
$5,614.69
|
| Rate for Payer: HFN Commercial |
$5,803.95
|
| Rate for Payer: Multiplan Commercial |
$5,046.91
|
| Rate for Payer: Preferred Network Access Commercial |
$5,803.95
|
| Rate for Payer: Quartz Beloit One Network |
$3,091.23
|
| Rate for Payer: Quartz Commercial |
$3,785.18
|
| Rate for Payer: WEA Trust Commercial |
$3,469.75
|
| Rate for Payer: WPS Commercial |
$4,672.64
|
|
