|
HALF BLOCK TRIATHLON TIBIAL AUGMENT SZ 8 10MM 5546-A-801
|
Facility
|
OP
|
$6,090.00
|
|
| Hospital Charge Code |
5307137
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,705.20 |
| Max. Negotiated Rate |
$24,360.00 |
| Rate for Payer: Aetna Commercial |
$5,481.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,237.40
|
| Rate for Payer: Aetna Managed Medicare |
$1,705.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,958.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,045.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,923.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,227.70
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Cigna Commercial |
$5,602.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,407.96
|
| Rate for Payer: Health EOS Commercial |
$5,420.10
|
| Rate for Payer: HFN Commercial |
$5,602.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,567.50
|
| Rate for Payer: Multiplan Commercial |
$4,872.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,654.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,602.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,984.10
|
| Rate for Payer: Quartz Commercial |
$3,958.50
|
| Rate for Payer: Quartz Medicare Advantage |
$3,654.00
|
| Rate for Payer: The Alliance Commercial |
$24,360.00
|
| Rate for Payer: WEA Trust Commercial |
$3,349.50
|
| Rate for Payer: WPS Commercial |
$4,510.86
|
|
|
HALF BLOCK TRIATHLON TIBIAL AUGMENT SZ 8 10MM 5546-A-801
|
Facility
|
IP
|
$6,090.00
|
|
| Hospital Charge Code |
5307137
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,984.10 |
| Max. Negotiated Rate |
$5,602.80 |
| Rate for Payer: Aetna Commercial |
$5,481.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,237.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,227.70
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Cigna Commercial |
$5,602.80
|
| Rate for Payer: Health EOS Commercial |
$5,420.10
|
| Rate for Payer: HFN Commercial |
$5,602.80
|
| Rate for Payer: Multiplan Commercial |
$4,872.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,654.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,602.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,984.10
|
| Rate for Payer: Quartz Commercial |
$3,654.00
|
| Rate for Payer: WEA Trust Commercial |
$3,349.50
|
| Rate for Payer: WPS Commercial |
$4,510.86
|
|
|
HALF BLOCK TRIATHLON TIBIAL AUGMENT SZ 8 5MM 5546-A-802
|
Facility
|
OP
|
$6,090.00
|
|
| Hospital Charge Code |
5307139
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,705.20 |
| Max. Negotiated Rate |
$24,360.00 |
| Rate for Payer: Aetna Commercial |
$5,481.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,237.40
|
| Rate for Payer: Aetna Managed Medicare |
$1,705.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,958.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,045.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,923.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,227.70
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Cigna Commercial |
$5,602.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,407.96
|
| Rate for Payer: Health EOS Commercial |
$5,420.10
|
| Rate for Payer: HFN Commercial |
$5,602.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,567.50
|
| Rate for Payer: Multiplan Commercial |
$4,872.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,654.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,602.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,984.10
|
| Rate for Payer: Quartz Commercial |
$3,958.50
|
| Rate for Payer: Quartz Medicare Advantage |
$3,654.00
|
| Rate for Payer: The Alliance Commercial |
$24,360.00
|
| Rate for Payer: WEA Trust Commercial |
$3,349.50
|
| Rate for Payer: WPS Commercial |
$4,510.86
|
|
|
HALF BLOCK TRIATHLON TIBIAL AUGMENT SZ 8 5MM 5546-A-802
|
Facility
|
IP
|
$6,090.00
|
|
| Hospital Charge Code |
5307139
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,984.10 |
| Max. Negotiated Rate |
$5,602.80 |
| Rate for Payer: Aetna Commercial |
$5,481.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,237.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,227.70
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Cigna Commercial |
$5,602.80
|
| Rate for Payer: Health EOS Commercial |
$5,420.10
|
| Rate for Payer: HFN Commercial |
$5,602.80
|
| Rate for Payer: Multiplan Commercial |
$4,872.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,654.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,602.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,984.10
|
| Rate for Payer: Quartz Commercial |
$3,654.00
|
| Rate for Payer: WEA Trust Commercial |
$3,349.50
|
| Rate for Payer: WPS Commercial |
$4,510.86
|
|
|
HALF-PIN 2.0 X 45MM 20MM BLUNT SELF-TAPPING APEX 5065-4-520
|
Facility
|
IP
|
$738.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6171750
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$361.62 |
| Max. Negotiated Rate |
$678.96 |
| Rate for Payer: Aetna Commercial |
$664.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$634.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$391.14
|
| Rate for Payer: Cash Price |
$221.40
|
| Rate for Payer: Cigna Commercial |
$678.96
|
| Rate for Payer: Health EOS Commercial |
$656.82
|
| Rate for Payer: HFN Commercial |
$678.96
|
| Rate for Payer: Multiplan Commercial |
$590.40
|
| Rate for Payer: NAPHCARE Commercial |
$442.80
|
| Rate for Payer: Preferred Network Access Commercial |
$678.96
|
| Rate for Payer: Quartz Beloit One Network |
$361.62
|
| Rate for Payer: Quartz Commercial |
$442.80
|
| Rate for Payer: WEA Trust Commercial |
$405.90
|
| Rate for Payer: WPS Commercial |
$546.64
|
|
|
HALF-PIN 2.0 X 45MM 20MM BLUNT SELF-TAPPING APEX 5065-4-520
|
Facility
|
OP
|
$738.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6171750
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$206.64 |
| Max. Negotiated Rate |
$2,952.00 |
| Rate for Payer: Aetna Commercial |
$664.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$634.68
|
| Rate for Payer: Aetna Managed Medicare |
$206.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$479.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$369.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$354.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$391.14
|
| Rate for Payer: Cash Price |
$221.40
|
| Rate for Payer: Cigna Commercial |
$678.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$412.98
|
| Rate for Payer: Health EOS Commercial |
$656.82
|
| Rate for Payer: HFN Commercial |
$678.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$553.50
|
| Rate for Payer: Multiplan Commercial |
$590.40
|
| Rate for Payer: NAPHCARE Commercial |
$442.80
|
| Rate for Payer: Preferred Network Access Commercial |
$678.96
|
| Rate for Payer: Quartz Beloit One Network |
$361.62
|
| Rate for Payer: Quartz Commercial |
$479.70
|
| Rate for Payer: Quartz Medicare Advantage |
$442.80
|
| Rate for Payer: The Alliance Commercial |
$2,952.00
|
| Rate for Payer: WEA Trust Commercial |
$405.90
|
| Rate for Payer: WPS Commercial |
$546.64
|
|
|
HALF-PIN 2.0 X 45MM 20MM SELF-DRILLING/SELF-TAPPING APEX 5080-2-020
|
Facility
|
IP
|
$792.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459557
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$388.08 |
| Max. Negotiated Rate |
$728.64 |
| Rate for Payer: Aetna Commercial |
$712.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$681.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$419.76
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Cigna Commercial |
$728.64
|
| Rate for Payer: Health EOS Commercial |
$704.88
|
| Rate for Payer: HFN Commercial |
$728.64
|
| Rate for Payer: Multiplan Commercial |
$633.60
|
| Rate for Payer: NAPHCARE Commercial |
$475.20
|
| Rate for Payer: Preferred Network Access Commercial |
$728.64
|
| Rate for Payer: Quartz Beloit One Network |
$388.08
|
| Rate for Payer: Quartz Commercial |
$475.20
|
| Rate for Payer: WEA Trust Commercial |
$435.60
|
| Rate for Payer: WPS Commercial |
$586.63
|
|
|
HALF-PIN 2.0 X 45MM 20MM SELF-DRILLING/SELF-TAPPING APEX 5080-2-020
|
Facility
|
OP
|
$792.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459557
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$221.76 |
| Max. Negotiated Rate |
$3,168.00 |
| Rate for Payer: Aetna Commercial |
$712.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$681.12
|
| Rate for Payer: Aetna Managed Medicare |
$221.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$514.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$396.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$380.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$419.76
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Cigna Commercial |
$728.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$443.20
|
| Rate for Payer: Health EOS Commercial |
$704.88
|
| Rate for Payer: HFN Commercial |
$728.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$594.00
|
| Rate for Payer: Multiplan Commercial |
$633.60
|
| Rate for Payer: NAPHCARE Commercial |
$475.20
|
| Rate for Payer: Preferred Network Access Commercial |
$728.64
|
| Rate for Payer: Quartz Beloit One Network |
$388.08
|
| Rate for Payer: Quartz Commercial |
$514.80
|
| Rate for Payer: Quartz Medicare Advantage |
$475.20
|
| Rate for Payer: The Alliance Commercial |
$3,168.00
|
| Rate for Payer: WEA Trust Commercial |
$435.60
|
| Rate for Payer: WPS Commercial |
$586.63
|
|
|
HALF-PIN 4.0 X 180MM APEX SELF-DRILLING 5023-4-180
|
Facility
|
IP
|
$1,042.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685883
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$510.58 |
| Max. Negotiated Rate |
$958.64 |
| Rate for Payer: Aetna Commercial |
$937.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$896.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$552.26
|
| Rate for Payer: Cash Price |
$312.60
|
| Rate for Payer: Cigna Commercial |
$958.64
|
| Rate for Payer: Health EOS Commercial |
$927.38
|
| Rate for Payer: HFN Commercial |
$958.64
|
| Rate for Payer: Multiplan Commercial |
$833.60
|
| Rate for Payer: NAPHCARE Commercial |
$625.20
|
| Rate for Payer: Preferred Network Access Commercial |
$958.64
|
| Rate for Payer: Quartz Beloit One Network |
$510.58
|
| Rate for Payer: Quartz Commercial |
$625.20
|
| Rate for Payer: WEA Trust Commercial |
$573.10
|
| Rate for Payer: WPS Commercial |
$771.81
|
|
|
HALF-PIN 4.0 X 180MM APEX SELF-DRILLING 5023-4-180
|
Facility
|
OP
|
$1,042.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685883
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$291.76 |
| Max. Negotiated Rate |
$4,168.00 |
| Rate for Payer: Aetna Commercial |
$937.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$896.12
|
| Rate for Payer: Aetna Managed Medicare |
$291.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$677.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$521.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$500.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$552.26
|
| Rate for Payer: Cash Price |
$312.60
|
| Rate for Payer: Cigna Commercial |
$958.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$583.10
|
| Rate for Payer: Health EOS Commercial |
$927.38
|
| Rate for Payer: HFN Commercial |
$958.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$781.50
|
| Rate for Payer: Multiplan Commercial |
$833.60
|
| Rate for Payer: NAPHCARE Commercial |
$625.20
|
| Rate for Payer: Preferred Network Access Commercial |
$958.64
|
| Rate for Payer: Quartz Beloit One Network |
$510.58
|
| Rate for Payer: Quartz Commercial |
$677.30
|
| Rate for Payer: Quartz Medicare Advantage |
$625.20
|
| Rate for Payer: The Alliance Commercial |
$4,168.00
|
| Rate for Payer: WEA Trust Commercial |
$573.10
|
| Rate for Payer: WPS Commercial |
$771.81
|
|
|
HALF-PIN APEX 1.65 X 45MM 20MM THREAD 5080-1-620
|
Facility
|
IP
|
$792.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5349475
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$388.08 |
| Max. Negotiated Rate |
$728.64 |
| Rate for Payer: Aetna Commercial |
$712.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$681.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$419.76
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Cigna Commercial |
$728.64
|
| Rate for Payer: Health EOS Commercial |
$704.88
|
| Rate for Payer: HFN Commercial |
$728.64
|
| Rate for Payer: Multiplan Commercial |
$633.60
|
| Rate for Payer: NAPHCARE Commercial |
$475.20
|
| Rate for Payer: Preferred Network Access Commercial |
$728.64
|
| Rate for Payer: Quartz Beloit One Network |
$388.08
|
| Rate for Payer: Quartz Commercial |
$475.20
|
| Rate for Payer: WEA Trust Commercial |
$435.60
|
| Rate for Payer: WPS Commercial |
$586.63
|
|
|
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 |
$221.76 |
| Max. Negotiated Rate |
$3,168.00 |
| Rate for Payer: Aetna Commercial |
$712.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$681.12
|
| Rate for Payer: Aetna Managed Medicare |
$221.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$514.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$396.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$380.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$419.76
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Cigna Commercial |
$728.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$443.20
|
| Rate for Payer: Health EOS Commercial |
$704.88
|
| Rate for Payer: HFN Commercial |
$728.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$594.00
|
| Rate for Payer: Multiplan Commercial |
$633.60
|
| Rate for Payer: NAPHCARE Commercial |
$475.20
|
| Rate for Payer: Preferred Network Access Commercial |
$728.64
|
| Rate for Payer: Quartz Beloit One Network |
$388.08
|
| Rate for Payer: Quartz Commercial |
$514.80
|
| Rate for Payer: Quartz Medicare Advantage |
$475.20
|
| Rate for Payer: The Alliance Commercial |
$3,168.00
|
| Rate for Payer: WEA Trust Commercial |
$435.60
|
| Rate for Payer: WPS Commercial |
$586.63
|
|
|
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 |
$620.34 |
| Max. Negotiated Rate |
$1,164.72 |
| Rate for Payer: Aetna Commercial |
$1,139.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,088.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$670.98
|
| Rate for Payer: Cash Price |
$379.80
|
| Rate for Payer: Cigna Commercial |
$1,164.72
|
| Rate for Payer: Health EOS Commercial |
$1,126.74
|
| Rate for Payer: HFN Commercial |
$1,164.72
|
| Rate for Payer: Multiplan Commercial |
$1,012.80
|
| Rate for Payer: NAPHCARE Commercial |
$759.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,164.72
|
| Rate for Payer: Quartz Beloit One Network |
$620.34
|
| Rate for Payer: Quartz Commercial |
$759.60
|
| Rate for Payer: WEA Trust Commercial |
$696.30
|
| Rate for Payer: WPS Commercial |
$937.73
|
|
|
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 |
$354.48 |
| Max. Negotiated Rate |
$5,064.00 |
| Rate for Payer: Aetna Commercial |
$1,139.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,088.76
|
| Rate for Payer: Aetna Managed Medicare |
$354.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$822.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$633.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$607.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$670.98
|
| Rate for Payer: Cash Price |
$379.80
|
| Rate for Payer: Cigna Commercial |
$1,164.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$708.45
|
| Rate for Payer: Health EOS Commercial |
$1,126.74
|
| Rate for Payer: HFN Commercial |
$1,164.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$949.50
|
| Rate for Payer: Multiplan Commercial |
$1,012.80
|
| Rate for Payer: NAPHCARE Commercial |
$759.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,164.72
|
| Rate for Payer: Quartz Beloit One Network |
$620.34
|
| Rate for Payer: Quartz Commercial |
$822.90
|
| Rate for Payer: Quartz Medicare Advantage |
$759.60
|
| Rate for Payer: The Alliance Commercial |
$5,064.00
|
| Rate for Payer: WEA Trust Commercial |
$696.30
|
| Rate for Payer: WPS Commercial |
$937.73
|
|
|
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 |
$374.36 |
| Max. Negotiated Rate |
$5,348.00 |
| Rate for Payer: Aetna Commercial |
$1,203.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,149.82
|
| Rate for Payer: Aetna Managed Medicare |
$374.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$869.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$668.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$641.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$708.61
|
| Rate for Payer: Cash Price |
$401.10
|
| Rate for Payer: Cigna Commercial |
$1,230.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$748.19
|
| Rate for Payer: Health EOS Commercial |
$1,189.93
|
| Rate for Payer: HFN Commercial |
$1,230.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,002.75
|
| Rate for Payer: Multiplan Commercial |
$1,069.60
|
| Rate for Payer: NAPHCARE Commercial |
$802.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,230.04
|
| Rate for Payer: Quartz Beloit One Network |
$655.13
|
| Rate for Payer: Quartz Commercial |
$869.05
|
| Rate for Payer: Quartz Medicare Advantage |
$802.20
|
| Rate for Payer: The Alliance Commercial |
$5,348.00
|
| Rate for Payer: WEA Trust Commercial |
$735.35
|
| Rate for Payer: WPS Commercial |
$990.32
|
|
|
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 |
$655.13 |
| Max. Negotiated Rate |
$1,230.04 |
| Rate for Payer: Aetna Commercial |
$1,203.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,149.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$708.61
|
| Rate for Payer: Cash Price |
$401.10
|
| Rate for Payer: Cigna Commercial |
$1,230.04
|
| Rate for Payer: Health EOS Commercial |
$1,189.93
|
| Rate for Payer: HFN Commercial |
$1,230.04
|
| Rate for Payer: Multiplan Commercial |
$1,069.60
|
| Rate for Payer: NAPHCARE Commercial |
$802.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,230.04
|
| Rate for Payer: Quartz Beloit One Network |
$655.13
|
| Rate for Payer: Quartz Commercial |
$802.20
|
| Rate for Payer: WEA Trust Commercial |
$735.35
|
| Rate for Payer: WPS Commercial |
$990.32
|
|
|
HALLUX LIMITUS/VALGUS CORRECTION
|
Facility
|
IP
|
$1,757.00
|
|
| Hospital Charge Code |
2960095
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$860.93 |
| Max. Negotiated Rate |
$1,616.44 |
| Rate for Payer: Aetna Commercial |
$1,581.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,511.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$931.21
|
| Rate for Payer: Cash Price |
$527.10
|
| Rate for Payer: Cigna Commercial |
$1,616.44
|
| Rate for Payer: Health EOS Commercial |
$1,563.73
|
| Rate for Payer: HFN Commercial |
$1,616.44
|
| Rate for Payer: Multiplan Commercial |
$1,405.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,054.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,616.44
|
| Rate for Payer: Quartz Beloit One Network |
$860.93
|
| Rate for Payer: Quartz Commercial |
$1,054.20
|
| Rate for Payer: WEA Trust Commercial |
$966.35
|
| Rate for Payer: WPS Commercial |
$1,301.41
|
|
|
HALLUX LIMITUS/VALGUS CORRECTION
|
Facility
|
OP
|
$1,757.00
|
|
| Hospital Charge Code |
2960095
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$491.96 |
| Max. Negotiated Rate |
$7,028.00 |
| Rate for Payer: Aetna Commercial |
$1,581.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,511.02
|
| Rate for Payer: Aetna Managed Medicare |
$491.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,142.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$878.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$843.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$931.21
|
| Rate for Payer: Cash Price |
$527.10
|
| Rate for Payer: Cigna Commercial |
$1,616.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$983.22
|
| Rate for Payer: Health EOS Commercial |
$1,563.73
|
| Rate for Payer: HFN Commercial |
$1,616.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,317.75
|
| Rate for Payer: Multiplan Commercial |
$1,405.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,054.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,616.44
|
| Rate for Payer: Quartz Beloit One Network |
$860.93
|
| Rate for Payer: Quartz Commercial |
$1,142.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,054.20
|
| Rate for Payer: The Alliance Commercial |
$7,028.00
|
| Rate for Payer: WEA Trust Commercial |
$966.35
|
| Rate for Payer: WPS Commercial |
$1,301.41
|
|
|
HALLUX RIGIDUS CORRECTION WITH CHEILECTOMY, DEBRIDEMENT AND CAPSULAR RELEASE OF THE FIRST METATARSOPHALANGEAL JOINT; WITHOUT IMPLANT
|
Facility
|
OP
|
$12,797.24
|
|
|
Service Code
|
CPT 28289
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,199.31 |
| Max. Negotiated Rate |
$12,797.24 |
| Rate for Payer: Aetna Managed Medicare |
$3,199.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,199.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,199.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,199.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,199.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,199.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,901.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,199.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,199.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,199.31
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,199.31
|
| Rate for Payer: NAPHCARE Commercial |
$4,798.96
|
| Rate for Payer: Quartz Medicare Advantage |
$3,199.31
|
| Rate for Payer: The Alliance Commercial |
$12,797.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,199.31
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: Wellcare Medicare |
$3,199.31
|
|
|
Haloperidol Level
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
CPT 80173
|
| Hospital Charge Code |
5158607
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.29 |
| Max. Negotiated Rate |
$111.32 |
| Rate for Payer: Aetna Commercial |
$108.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$104.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$64.13
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna Commercial |
$111.32
|
| Rate for Payer: Health EOS Commercial |
$107.69
|
| Rate for Payer: HFN Commercial |
$111.32
|
| Rate for Payer: Multiplan Commercial |
$96.80
|
| Rate for Payer: NAPHCARE Commercial |
$72.60
|
| Rate for Payer: Preferred Network Access Commercial |
$111.32
|
| Rate for Payer: Quartz Beloit One Network |
$59.29
|
| Rate for Payer: Quartz Commercial |
$72.60
|
| Rate for Payer: WEA Trust Commercial |
$66.55
|
| Rate for Payer: WPS Commercial |
$89.62
|
|
|
Haloperidol Level
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
CPT 80173
|
| Hospital Charge Code |
5158607
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.24 |
| Max. Negotiated Rate |
$114.95 |
| Rate for Payer: Aetna Commercial |
$114.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$104.06
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna Commercial |
$114.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$60.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$72.60
|
| Rate for Payer: Health EOS Commercial |
$110.11
|
| Rate for Payer: HFN Commercial |
$114.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$55.70
|
| Rate for Payer: Multiplan Commercial |
$96.80
|
| Rate for Payer: Preferred Network Access Commercial |
$114.95
|
| Rate for Payer: Quartz Beloit One Network |
$53.24
|
| Rate for Payer: Quartz Commercial |
$68.97
|
| Rate for Payer: The Alliance Commercial |
$60.50
|
| Rate for Payer: WEA Trust Commercial |
$66.55
|
| Rate for Payer: WPS Commercial |
$89.62
|
|
|
Haloperidol Level
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
CPT 80173
|
| Hospital Charge Code |
5158607
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.78 |
| Max. Negotiated Rate |
$111.32 |
| Rate for Payer: Aetna Commercial |
$108.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$104.06
|
| Rate for Payer: Aetna Managed Medicare |
$15.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$59.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27.62
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26.19
|
| Rate for Payer: Anthem Medicaid |
$16.31
|
| Rate for Payer: Anthem Medicare Advantage |
$15.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$64.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.78
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna Commercial |
$111.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$67.71
|
| Rate for Payer: Dean Health Medicaid |
$16.31
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.78
|
| Rate for Payer: Health EOS Commercial |
$107.69
|
| Rate for Payer: HFN Commercial |
$111.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$58.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.78
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$16.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.78
|
| Rate for Payer: Managed Health Services Medicaid |
$16.96
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.78
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.78
|
| Rate for Payer: Multiplan Commercial |
$96.80
|
| Rate for Payer: NAPHCARE Commercial |
$23.67
|
| Rate for Payer: Preferred Network Access Commercial |
$111.32
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$16.31
|
| Rate for Payer: Quartz Beloit One Network |
$59.29
|
| Rate for Payer: Quartz Commercial |
$78.65
|
| Rate for Payer: Quartz Medicare Advantage |
$15.78
|
| Rate for Payer: The Alliance Commercial |
$63.12
|
| Rate for Payer: United Healthcare Medicaid |
$16.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.78
|
| Rate for Payer: United Healthcare PPO |
$90.75
|
| Rate for Payer: WEA Trust Commercial |
$66.55
|
| Rate for Payer: Wellcare Medicare |
$15.78
|
| Rate for Payer: WMAP Medicaid |
$16.31
|
| Rate for Payer: WPS Commercial |
$89.62
|
|
|
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 |
$3,635.31 |
| Max. Negotiated Rate |
$6,825.48 |
| Rate for Payer: Aetna Commercial |
$6,677.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,380.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,932.07
|
| Rate for Payer: Cash Price |
$2,225.70
|
| Rate for Payer: Cigna Commercial |
$6,825.48
|
| Rate for Payer: Health EOS Commercial |
$6,602.91
|
| Rate for Payer: HFN Commercial |
$6,825.48
|
| Rate for Payer: Multiplan Commercial |
$5,935.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,451.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,825.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,635.31
|
| Rate for Payer: Quartz Commercial |
$4,451.40
|
| Rate for Payer: WEA Trust Commercial |
$4,080.45
|
| Rate for Payer: WPS Commercial |
$5,495.25
|
|
|
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 |
$2,077.32 |
| Max. Negotiated Rate |
$29,676.00 |
| Rate for Payer: Aetna Commercial |
$6,677.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,380.34
|
| Rate for Payer: Aetna Managed Medicare |
$2,077.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,822.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,709.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,561.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,932.07
|
| Rate for Payer: Cash Price |
$2,225.70
|
| Rate for Payer: Cigna Commercial |
$6,825.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,151.67
|
| Rate for Payer: Health EOS Commercial |
$6,602.91
|
| Rate for Payer: HFN Commercial |
$6,825.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,564.25
|
| Rate for Payer: Multiplan Commercial |
$5,935.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,451.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,825.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,635.31
|
| Rate for Payer: Quartz Commercial |
$4,822.35
|
| Rate for Payer: Quartz Medicare Advantage |
$4,451.40
|
| Rate for Payer: The Alliance Commercial |
$29,676.00
|
| Rate for Payer: WEA Trust Commercial |
$4,080.45
|
| Rate for Payer: WPS Commercial |
$5,495.25
|
|
|
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 |
$2,077.32 |
| Max. Negotiated Rate |
$29,676.00 |
| Rate for Payer: Aetna Commercial |
$6,677.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,380.34
|
| Rate for Payer: Aetna Managed Medicare |
$2,077.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,822.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,709.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,561.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,932.07
|
| Rate for Payer: Cash Price |
$2,225.70
|
| Rate for Payer: Cigna Commercial |
$6,825.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,151.67
|
| Rate for Payer: Health EOS Commercial |
$6,602.91
|
| Rate for Payer: HFN Commercial |
$6,825.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,564.25
|
| Rate for Payer: Multiplan Commercial |
$5,935.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,451.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,825.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,635.31
|
| Rate for Payer: Quartz Commercial |
$4,822.35
|
| Rate for Payer: Quartz Medicare Advantage |
$4,451.40
|
| Rate for Payer: The Alliance Commercial |
$29,676.00
|
| Rate for Payer: WEA Trust Commercial |
$4,080.45
|
| Rate for Payer: WPS Commercial |
$5,495.25
|
|
