|
HAMMER TOE IMPLANT TWO-STEP 3.4MM X 3.0MM X 18MM 204-30-018
|
Facility
|
IP
|
$9,102.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4315756
|
|
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 18MM 204-30-018
|
Facility
|
OP
|
$9,102.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4315756
|
|
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 6MM 204-30-006
|
Facility
|
OP
|
$9,102.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3805526
|
|
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 6MM 204-30-006
|
Facility
|
IP
|
$9,102.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3805526
|
|
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 8MM 204-30-008
|
Facility
|
IP
|
$6,300.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3715509
|
|
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 8MM 204-30-008
|
Facility
|
OP
|
$6,300.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3715509
|
|
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 4.5MM X 3.0MM X 10MM 204-30-110
|
Facility
|
OP
|
$9,102.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3737514
|
|
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 4.5MM X 3.0MM X 10MM 204-30-110
|
Facility
|
IP
|
$9,102.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3737514
|
|
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 4.5MM X 3.0MM X 18MM 204-30-118
|
Facility
|
OP
|
$6,066.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4858688
|
|
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 4.5MM X 3.0MM X 18MM 204-30-118
|
Facility
|
IP
|
$6,066.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4858688
|
|
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 4.5MM X 3.0MM X 20MM 204-30-120
|
Facility
|
IP
|
$7,419.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415478
|
|
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 4.5MM X 3.0MM X 20MM 204-30-120
|
Facility
|
OP
|
$7,419.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415478
|
|
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 4.5MM X 3.0MM X 22MM 204-30-122
|
Facility
|
IP
|
$6,066.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4858689
|
|
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 4.5MM X 3.0MM X 22MM 204-30-122
|
Facility
|
OP
|
$6,066.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4858689
|
|
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 4.5MM X 3.0MM X 8MM 204-30-108
|
Facility
|
IP
|
$9,102.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3713497
|
|
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 4.5MM X 3.0MM X 8MM 204-30-108
|
Facility
|
OP
|
$9,102.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3713497
|
|
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
|
|
|
HAMMERTOE PRO-TOE VO SM 0DEG
|
Facility
|
OP
|
$5,995.00
|
|
| Hospital Charge Code |
3072449
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,745.74 |
| Max. Negotiated Rate |
$5,736.02 |
| Rate for Payer: Aetna Commercial |
$5,611.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,361.93
|
| Rate for Payer: Aetna Managed Medicare |
$1,745.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,052.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,117.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,992.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,304.44
|
| Rate for Payer: Cash Price |
$1,798.50
|
| Rate for Payer: Cigna Commercial |
$5,736.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,489.09
|
| Rate for Payer: Health EOS Commercial |
$5,548.97
|
| Rate for Payer: HFN Commercial |
$5,736.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,676.10
|
| Rate for Payer: Multiplan Commercial |
$4,987.84
|
| Rate for Payer: NAPHCARE Commercial |
$3,740.88
|
| Rate for Payer: Preferred Network Access Commercial |
$5,736.02
|
| Rate for Payer: Quartz Beloit One Network |
$3,055.05
|
| Rate for Payer: Quartz Commercial |
$4,052.62
|
| Rate for Payer: Quartz Medicare Advantage |
$3,740.88
|
| Rate for Payer: The Alliance Commercial |
$3,117.40
|
| Rate for Payer: WEA Trust Commercial |
$3,429.14
|
| Rate for Payer: WPS Commercial |
$4,617.95
|
|
|
HAMMERTOE PRO-TOE VO SM 0DEG
|
Facility
|
IP
|
$5,995.00
|
|
| Hospital Charge Code |
3072449
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,055.05 |
| Max. Negotiated Rate |
$5,736.02 |
| Rate for Payer: Aetna Commercial |
$5,611.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,361.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,304.44
|
| Rate for Payer: Cash Price |
$1,798.50
|
| Rate for Payer: Cigna Commercial |
$5,736.02
|
| Rate for Payer: Health EOS Commercial |
$5,548.97
|
| Rate for Payer: HFN Commercial |
$5,736.02
|
| Rate for Payer: Multiplan Commercial |
$4,987.84
|
| Rate for Payer: Preferred Network Access Commercial |
$5,736.02
|
| Rate for Payer: Quartz Beloit One Network |
$3,055.05
|
| Rate for Payer: Quartz Commercial |
$3,740.88
|
| Rate for Payer: WEA Trust Commercial |
$3,429.14
|
| Rate for Payer: WPS Commercial |
$4,617.95
|
|
|
HAMMER TOE REPAIR
|
Facility
|
OP
|
$1,757.00
|
|
| Hospital Charge Code |
2960098
|
|
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
|
|
|
HAMMER TOE REPAIR
|
Facility
|
IP
|
$1,757.00
|
|
| Hospital Charge Code |
2960098
|
|
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
|
|
|
HAND AND FOOT TENOTOMY
|
Facility
|
OP
|
$492.67
|
|
|
Service Code
|
EAPG 00048
|
| Min. Negotiated Rate |
$473.72 |
| Max. Negotiated Rate |
$492.67 |
| Rate for Payer: Anthem Medicaid |
$473.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$473.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$473.72
|
| Rate for Payer: Dean Health Medicaid |
$473.72
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$473.72
|
| Rate for Payer: Managed Health Services Medicaid |
$492.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$473.72
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$473.72
|
| Rate for Payer: United Healthcare Medicaid |
$473.72
|
|
|
HAND AND WRIST PROCEDURES
|
Facility
|
IP
|
$8,680.63
|
|
|
Service Code
|
APR-DRG 3161
|
| Min. Negotiated Rate |
$7,710.67 |
| Max. Negotiated Rate |
$8,680.63 |
| Rate for Payer: Anthem Medicaid |
$8,312.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$8,312.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8,312.18
|
| Rate for Payer: Dean Health Medicaid |
$8,312.18
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$7,710.67
|
| Rate for Payer: Managed Health Services Medicaid |
$8,680.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,312.18
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8,312.18
|
| Rate for Payer: United Healthcare Medicaid |
$8,312.18
|
|
|
HAND AND WRIST PROCEDURES
|
Facility
|
IP
|
$11,661.85
|
|
|
Service Code
|
APR-DRG 3162
|
| Min. Negotiated Rate |
$10,358.78 |
| Max. Negotiated Rate |
$11,661.85 |
| Rate for Payer: Anthem Medicaid |
$11,166.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$11,166.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11,166.87
|
| Rate for Payer: Dean Health Medicaid |
$11,166.87
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$10,358.78
|
| Rate for Payer: Managed Health Services Medicaid |
$11,661.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,166.87
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$11,166.87
|
| Rate for Payer: United Healthcare Medicaid |
$11,166.87
|
|
|
HAND AND WRIST PROCEDURES
|
Facility
|
IP
|
$27,707.86
|
|
|
Service Code
|
APR-DRG 3164
|
| Min. Negotiated Rate |
$24,611.85 |
| Max. Negotiated Rate |
$27,707.86 |
| Rate for Payer: Anthem Medicaid |
$26,531.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$26,531.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$26,531.80
|
| Rate for Payer: Dean Health Medicaid |
$26,531.80
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$24,611.85
|
| Rate for Payer: Managed Health Services Medicaid |
$27,707.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,531.80
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$26,531.80
|
| Rate for Payer: United Healthcare Medicaid |
$26,531.80
|
|
|
HAND AND WRIST PROCEDURES
|
Facility
|
IP
|
$17,448.94
|
|
|
Service Code
|
APR-DRG 3163
|
| Min. Negotiated Rate |
$15,499.23 |
| Max. Negotiated Rate |
$17,448.94 |
| Rate for Payer: Anthem Medicaid |
$16,708.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$16,708.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16,708.32
|
| Rate for Payer: Dean Health Medicaid |
$16,708.32
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15,499.23
|
| Rate for Payer: Managed Health Services Medicaid |
$17,448.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$16,708.32
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$16,708.32
|
| Rate for Payer: United Healthcare Medicaid |
$16,708.32
|
|
