|
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 |
$3,635.31 |
| 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 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 |
$2,077.32 |
| 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 8MM 204-24-008
|
Facility
|
IP
|
$7,419.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5520668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,635.31 |
| 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 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 |
$2,548.56 |
| Max. Negotiated Rate |
$36,408.00 |
| Rate for Payer: Aetna Commercial |
$8,191.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,827.72
|
| Rate for Payer: Aetna Managed Medicare |
$2,548.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,916.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,551.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,368.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,824.06
|
| Rate for Payer: Cash Price |
$2,730.60
|
| Rate for Payer: Cigna Commercial |
$8,373.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,093.48
|
| Rate for Payer: Health EOS Commercial |
$8,100.78
|
| Rate for Payer: HFN Commercial |
$8,373.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,826.50
|
| Rate for Payer: Multiplan Commercial |
$7,281.60
|
| Rate for Payer: NAPHCARE Commercial |
$5,461.20
|
| Rate for Payer: Preferred Network Access Commercial |
$8,373.84
|
| Rate for Payer: Quartz Beloit One Network |
$4,459.98
|
| Rate for Payer: Quartz Commercial |
$5,916.30
|
| Rate for Payer: Quartz Medicare Advantage |
$5,461.20
|
| Rate for Payer: The Alliance Commercial |
$36,408.00
|
| Rate for Payer: WEA Trust Commercial |
$5,006.10
|
| Rate for Payer: WPS Commercial |
$6,741.85
|
|
|
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 |
$4,459.98 |
| Max. Negotiated Rate |
$8,373.84 |
| Rate for Payer: Aetna Commercial |
$8,191.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,827.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,824.06
|
| Rate for Payer: Cash Price |
$2,730.60
|
| Rate for Payer: Cigna Commercial |
$8,373.84
|
| Rate for Payer: Health EOS Commercial |
$8,100.78
|
| Rate for Payer: HFN Commercial |
$8,373.84
|
| Rate for Payer: Multiplan Commercial |
$7,281.60
|
| Rate for Payer: NAPHCARE Commercial |
$5,461.20
|
| Rate for Payer: Preferred Network Access Commercial |
$8,373.84
|
| Rate for Payer: Quartz Beloit One Network |
$4,459.98
|
| Rate for Payer: Quartz Commercial |
$5,461.20
|
| Rate for Payer: WEA Trust Commercial |
$5,006.10
|
| Rate for Payer: WPS Commercial |
$6,741.85
|
|
|
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 |
$2,972.34 |
| Max. Negotiated Rate |
$5,580.72 |
| Rate for Payer: Aetna Commercial |
$5,459.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,216.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,214.98
|
| Rate for Payer: Cash Price |
$1,819.80
|
| Rate for Payer: Cigna Commercial |
$5,580.72
|
| Rate for Payer: Health EOS Commercial |
$5,398.74
|
| Rate for Payer: HFN Commercial |
$5,580.72
|
| Rate for Payer: Multiplan Commercial |
$4,852.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,639.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,580.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,972.34
|
| Rate for Payer: Quartz Commercial |
$3,639.60
|
| Rate for Payer: WEA Trust Commercial |
$3,336.30
|
| Rate for Payer: WPS Commercial |
$4,493.09
|
|
|
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 |
$1,698.48 |
| Max. Negotiated Rate |
$24,264.00 |
| Rate for Payer: Aetna Commercial |
$5,459.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,216.76
|
| Rate for Payer: Aetna Managed Medicare |
$1,698.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,942.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,033.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,911.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,214.98
|
| Rate for Payer: Cash Price |
$1,819.80
|
| Rate for Payer: Cigna Commercial |
$5,580.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,394.53
|
| Rate for Payer: Health EOS Commercial |
$5,398.74
|
| Rate for Payer: HFN Commercial |
$5,580.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,549.50
|
| Rate for Payer: Multiplan Commercial |
$4,852.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,639.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,580.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,972.34
|
| Rate for Payer: Quartz Commercial |
$3,942.90
|
| Rate for Payer: Quartz Medicare Advantage |
$3,639.60
|
| Rate for Payer: The Alliance Commercial |
$24,264.00
|
| Rate for Payer: WEA Trust Commercial |
$3,336.30
|
| Rate for Payer: WPS Commercial |
$4,493.09
|
|
|
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 |
$1,764.00 |
| Max. Negotiated Rate |
$25,200.00 |
| Rate for Payer: Aetna Commercial |
$5,670.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,418.00
|
| Rate for Payer: Aetna Managed Medicare |
$1,764.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,095.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,150.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,024.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,339.00
|
| Rate for Payer: Cash Price |
$1,890.00
|
| Rate for Payer: Cigna Commercial |
$5,796.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,525.48
|
| Rate for Payer: Health EOS Commercial |
$5,607.00
|
| Rate for Payer: HFN Commercial |
$5,796.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,725.00
|
| Rate for Payer: Multiplan Commercial |
$5,040.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,780.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,796.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,087.00
|
| Rate for Payer: Quartz Commercial |
$4,095.00
|
| Rate for Payer: Quartz Medicare Advantage |
$3,780.00
|
| Rate for Payer: The Alliance Commercial |
$25,200.00
|
| Rate for Payer: WEA Trust Commercial |
$3,465.00
|
| Rate for Payer: WPS Commercial |
$4,666.41
|
|
|
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 |
$3,087.00 |
| Max. Negotiated Rate |
$5,796.00 |
| Rate for Payer: Aetna Commercial |
$5,670.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,418.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,339.00
|
| Rate for Payer: Cash Price |
$1,890.00
|
| Rate for Payer: Cigna Commercial |
$5,796.00
|
| Rate for Payer: Health EOS Commercial |
$5,607.00
|
| Rate for Payer: HFN Commercial |
$5,796.00
|
| Rate for Payer: Multiplan Commercial |
$5,040.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,780.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,796.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,087.00
|
| Rate for Payer: Quartz Commercial |
$3,780.00
|
| Rate for Payer: WEA Trust Commercial |
$3,465.00
|
| Rate for Payer: WPS Commercial |
$4,666.41
|
|
|
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 |
$1,698.48 |
| Max. Negotiated Rate |
$24,264.00 |
| Rate for Payer: Aetna Commercial |
$5,459.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,216.76
|
| Rate for Payer: Aetna Managed Medicare |
$1,698.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,942.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,033.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,911.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,214.98
|
| Rate for Payer: Cash Price |
$1,819.80
|
| Rate for Payer: Cigna Commercial |
$5,580.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,394.53
|
| Rate for Payer: Health EOS Commercial |
$5,398.74
|
| Rate for Payer: HFN Commercial |
$5,580.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,549.50
|
| Rate for Payer: Multiplan Commercial |
$4,852.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,639.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,580.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,972.34
|
| Rate for Payer: Quartz Commercial |
$3,942.90
|
| Rate for Payer: Quartz Medicare Advantage |
$3,639.60
|
| Rate for Payer: The Alliance Commercial |
$24,264.00
|
| Rate for Payer: WEA Trust Commercial |
$3,336.30
|
| Rate for Payer: WPS Commercial |
$4,493.09
|
|
|
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 |
$2,972.34 |
| Max. Negotiated Rate |
$5,580.72 |
| Rate for Payer: Aetna Commercial |
$5,459.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,216.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,214.98
|
| Rate for Payer: Cash Price |
$1,819.80
|
| Rate for Payer: Cigna Commercial |
$5,580.72
|
| Rate for Payer: Health EOS Commercial |
$5,398.74
|
| Rate for Payer: HFN Commercial |
$5,580.72
|
| Rate for Payer: Multiplan Commercial |
$4,852.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,639.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,580.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,972.34
|
| Rate for Payer: Quartz Commercial |
$3,639.60
|
| Rate for Payer: WEA Trust Commercial |
$3,336.30
|
| Rate for Payer: WPS Commercial |
$4,493.09
|
|
|
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 |
$2,548.56 |
| Max. Negotiated Rate |
$36,408.00 |
| Rate for Payer: Aetna Commercial |
$8,191.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,827.72
|
| Rate for Payer: Aetna Managed Medicare |
$2,548.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,916.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,551.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,368.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,824.06
|
| Rate for Payer: Cash Price |
$2,730.60
|
| Rate for Payer: Cigna Commercial |
$8,373.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,093.48
|
| Rate for Payer: Health EOS Commercial |
$8,100.78
|
| Rate for Payer: HFN Commercial |
$8,373.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,826.50
|
| Rate for Payer: Multiplan Commercial |
$7,281.60
|
| Rate for Payer: NAPHCARE Commercial |
$5,461.20
|
| Rate for Payer: Preferred Network Access Commercial |
$8,373.84
|
| Rate for Payer: Quartz Beloit One Network |
$4,459.98
|
| Rate for Payer: Quartz Commercial |
$5,916.30
|
| Rate for Payer: Quartz Medicare Advantage |
$5,461.20
|
| Rate for Payer: The Alliance Commercial |
$36,408.00
|
| Rate for Payer: WEA Trust Commercial |
$5,006.10
|
| Rate for Payer: WPS Commercial |
$6,741.85
|
|
|
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 |
$4,459.98 |
| Max. Negotiated Rate |
$8,373.84 |
| Rate for Payer: Aetna Commercial |
$8,191.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,827.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,824.06
|
| Rate for Payer: Cash Price |
$2,730.60
|
| Rate for Payer: Cigna Commercial |
$8,373.84
|
| Rate for Payer: Health EOS Commercial |
$8,100.78
|
| Rate for Payer: HFN Commercial |
$8,373.84
|
| Rate for Payer: Multiplan Commercial |
$7,281.60
|
| Rate for Payer: NAPHCARE Commercial |
$5,461.20
|
| Rate for Payer: Preferred Network Access Commercial |
$8,373.84
|
| Rate for Payer: Quartz Beloit One Network |
$4,459.98
|
| Rate for Payer: Quartz Commercial |
$5,461.20
|
| Rate for Payer: WEA Trust Commercial |
$5,006.10
|
| Rate for Payer: WPS Commercial |
$6,741.85
|
|
|
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 |
$2,548.56 |
| Max. Negotiated Rate |
$36,408.00 |
| Rate for Payer: Aetna Commercial |
$8,191.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,827.72
|
| Rate for Payer: Aetna Managed Medicare |
$2,548.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,916.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,551.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,368.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,824.06
|
| Rate for Payer: Cash Price |
$2,730.60
|
| Rate for Payer: Cigna Commercial |
$8,373.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,093.48
|
| Rate for Payer: Health EOS Commercial |
$8,100.78
|
| Rate for Payer: HFN Commercial |
$8,373.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,826.50
|
| Rate for Payer: Multiplan Commercial |
$7,281.60
|
| Rate for Payer: NAPHCARE Commercial |
$5,461.20
|
| Rate for Payer: Preferred Network Access Commercial |
$8,373.84
|
| Rate for Payer: Quartz Beloit One Network |
$4,459.98
|
| Rate for Payer: Quartz Commercial |
$5,916.30
|
| Rate for Payer: Quartz Medicare Advantage |
$5,461.20
|
| Rate for Payer: The Alliance Commercial |
$36,408.00
|
| Rate for Payer: WEA Trust Commercial |
$5,006.10
|
| Rate for Payer: WPS Commercial |
$6,741.85
|
|
|
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 |
$4,459.98 |
| Max. Negotiated Rate |
$8,373.84 |
| Rate for Payer: Aetna Commercial |
$8,191.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,827.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,824.06
|
| Rate for Payer: Cash Price |
$2,730.60
|
| Rate for Payer: Cigna Commercial |
$8,373.84
|
| Rate for Payer: Health EOS Commercial |
$8,100.78
|
| Rate for Payer: HFN Commercial |
$8,373.84
|
| Rate for Payer: Multiplan Commercial |
$7,281.60
|
| Rate for Payer: NAPHCARE Commercial |
$5,461.20
|
| Rate for Payer: Preferred Network Access Commercial |
$8,373.84
|
| Rate for Payer: Quartz Beloit One Network |
$4,459.98
|
| Rate for Payer: Quartz Commercial |
$5,461.20
|
| Rate for Payer: WEA Trust Commercial |
$5,006.10
|
| Rate for Payer: WPS Commercial |
$6,741.85
|
|
|
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 |
$3,087.00 |
| Max. Negotiated Rate |
$5,796.00 |
| Rate for Payer: Aetna Commercial |
$5,670.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,418.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,339.00
|
| Rate for Payer: Cash Price |
$1,890.00
|
| Rate for Payer: Cigna Commercial |
$5,796.00
|
| Rate for Payer: Health EOS Commercial |
$5,607.00
|
| Rate for Payer: HFN Commercial |
$5,796.00
|
| Rate for Payer: Multiplan Commercial |
$5,040.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,780.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,796.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,087.00
|
| Rate for Payer: Quartz Commercial |
$3,780.00
|
| Rate for Payer: WEA Trust Commercial |
$3,465.00
|
| Rate for Payer: WPS Commercial |
$4,666.41
|
|
|
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 |
$1,764.00 |
| Max. Negotiated Rate |
$25,200.00 |
| Rate for Payer: Aetna Commercial |
$5,670.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,418.00
|
| Rate for Payer: Aetna Managed Medicare |
$1,764.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,095.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,150.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,024.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,339.00
|
| Rate for Payer: Cash Price |
$1,890.00
|
| Rate for Payer: Cigna Commercial |
$5,796.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,525.48
|
| Rate for Payer: Health EOS Commercial |
$5,607.00
|
| Rate for Payer: HFN Commercial |
$5,796.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,725.00
|
| Rate for Payer: Multiplan Commercial |
$5,040.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,780.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,796.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,087.00
|
| Rate for Payer: Quartz Commercial |
$4,095.00
|
| Rate for Payer: Quartz Medicare Advantage |
$3,780.00
|
| Rate for Payer: The Alliance Commercial |
$25,200.00
|
| Rate for Payer: WEA Trust Commercial |
$3,465.00
|
| Rate for Payer: WPS Commercial |
$4,666.41
|
|
|
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 |
$4,459.98 |
| Max. Negotiated Rate |
$8,373.84 |
| Rate for Payer: Aetna Commercial |
$8,191.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,827.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,824.06
|
| Rate for Payer: Cash Price |
$2,730.60
|
| Rate for Payer: Cigna Commercial |
$8,373.84
|
| Rate for Payer: Health EOS Commercial |
$8,100.78
|
| Rate for Payer: HFN Commercial |
$8,373.84
|
| Rate for Payer: Multiplan Commercial |
$7,281.60
|
| Rate for Payer: NAPHCARE Commercial |
$5,461.20
|
| Rate for Payer: Preferred Network Access Commercial |
$8,373.84
|
| Rate for Payer: Quartz Beloit One Network |
$4,459.98
|
| Rate for Payer: Quartz Commercial |
$5,461.20
|
| Rate for Payer: WEA Trust Commercial |
$5,006.10
|
| Rate for Payer: WPS Commercial |
$6,741.85
|
|
|
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 |
$2,548.56 |
| Max. Negotiated Rate |
$36,408.00 |
| Rate for Payer: Aetna Commercial |
$8,191.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,827.72
|
| Rate for Payer: Aetna Managed Medicare |
$2,548.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,916.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,551.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,368.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,824.06
|
| Rate for Payer: Cash Price |
$2,730.60
|
| Rate for Payer: Cigna Commercial |
$8,373.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,093.48
|
| Rate for Payer: Health EOS Commercial |
$8,100.78
|
| Rate for Payer: HFN Commercial |
$8,373.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,826.50
|
| Rate for Payer: Multiplan Commercial |
$7,281.60
|
| Rate for Payer: NAPHCARE Commercial |
$5,461.20
|
| Rate for Payer: Preferred Network Access Commercial |
$8,373.84
|
| Rate for Payer: Quartz Beloit One Network |
$4,459.98
|
| Rate for Payer: Quartz Commercial |
$5,916.30
|
| Rate for Payer: Quartz Medicare Advantage |
$5,461.20
|
| Rate for Payer: The Alliance Commercial |
$36,408.00
|
| Rate for Payer: WEA Trust Commercial |
$5,006.10
|
| Rate for Payer: WPS Commercial |
$6,741.85
|
|
|
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 |
$2,972.34 |
| Max. Negotiated Rate |
$5,580.72 |
| Rate for Payer: Aetna Commercial |
$5,459.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,216.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,214.98
|
| Rate for Payer: Cash Price |
$1,819.80
|
| Rate for Payer: Cigna Commercial |
$5,580.72
|
| Rate for Payer: Health EOS Commercial |
$5,398.74
|
| Rate for Payer: HFN Commercial |
$5,580.72
|
| Rate for Payer: Multiplan Commercial |
$4,852.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,639.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,580.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,972.34
|
| Rate for Payer: Quartz Commercial |
$3,639.60
|
| Rate for Payer: WEA Trust Commercial |
$3,336.30
|
| Rate for Payer: WPS Commercial |
$4,493.09
|
|
|
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 |
$1,698.48 |
| Max. Negotiated Rate |
$24,264.00 |
| Rate for Payer: Aetna Commercial |
$5,459.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,216.76
|
| Rate for Payer: Aetna Managed Medicare |
$1,698.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,942.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,033.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,911.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,214.98
|
| Rate for Payer: Cash Price |
$1,819.80
|
| Rate for Payer: Cigna Commercial |
$5,580.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,394.53
|
| Rate for Payer: Health EOS Commercial |
$5,398.74
|
| Rate for Payer: HFN Commercial |
$5,580.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,549.50
|
| Rate for Payer: Multiplan Commercial |
$4,852.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,639.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,580.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,972.34
|
| Rate for Payer: Quartz Commercial |
$3,942.90
|
| Rate for Payer: Quartz Medicare Advantage |
$3,639.60
|
| Rate for Payer: The Alliance Commercial |
$24,264.00
|
| Rate for Payer: WEA Trust Commercial |
$3,336.30
|
| Rate for Payer: WPS Commercial |
$4,493.09
|
|
|
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 |
$3,635.31 |
| 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 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 |
$2,077.32 |
| 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 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 |
$1,698.48 |
| Max. Negotiated Rate |
$24,264.00 |
| Rate for Payer: Aetna Commercial |
$5,459.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,216.76
|
| Rate for Payer: Aetna Managed Medicare |
$1,698.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,942.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,033.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,911.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,214.98
|
| Rate for Payer: Cash Price |
$1,819.80
|
| Rate for Payer: Cigna Commercial |
$5,580.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,394.53
|
| Rate for Payer: Health EOS Commercial |
$5,398.74
|
| Rate for Payer: HFN Commercial |
$5,580.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,549.50
|
| Rate for Payer: Multiplan Commercial |
$4,852.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,639.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,580.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,972.34
|
| Rate for Payer: Quartz Commercial |
$3,942.90
|
| Rate for Payer: Quartz Medicare Advantage |
$3,639.60
|
| Rate for Payer: The Alliance Commercial |
$24,264.00
|
| Rate for Payer: WEA Trust Commercial |
$3,336.30
|
| Rate for Payer: WPS Commercial |
$4,493.09
|
|
|
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 |
$2,972.34 |
| Max. Negotiated Rate |
$5,580.72 |
| Rate for Payer: Aetna Commercial |
$5,459.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,216.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,214.98
|
| Rate for Payer: Cash Price |
$1,819.80
|
| Rate for Payer: Cigna Commercial |
$5,580.72
|
| Rate for Payer: Health EOS Commercial |
$5,398.74
|
| Rate for Payer: HFN Commercial |
$5,580.72
|
| Rate for Payer: Multiplan Commercial |
$4,852.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,639.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,580.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,972.34
|
| Rate for Payer: Quartz Commercial |
$3,639.60
|
| Rate for Payer: WEA Trust Commercial |
$3,336.30
|
| Rate for Payer: WPS Commercial |
$4,493.09
|
|
