|
HUMERAL INSERT XS/33 +6 AR-9503XS-06
|
Facility
|
OP
|
$4,799.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6232137
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,397.47 |
| Max. Negotiated Rate |
$4,591.68 |
| Rate for Payer: Aetna Commercial |
$4,491.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,292.23
|
| Rate for Payer: Aetna Managed Medicare |
$1,397.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,244.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,495.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,395.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,645.21
|
| Rate for Payer: Cash Price |
$1,439.70
|
| Rate for Payer: Cigna Commercial |
$4,591.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,793.02
|
| Rate for Payer: Health EOS Commercial |
$4,441.95
|
| Rate for Payer: HFN Commercial |
$4,591.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,743.22
|
| Rate for Payer: Multiplan Commercial |
$3,992.77
|
| Rate for Payer: NAPHCARE Commercial |
$2,994.58
|
| Rate for Payer: Preferred Network Access Commercial |
$4,591.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,445.57
|
| Rate for Payer: Quartz Commercial |
$3,244.12
|
| Rate for Payer: Quartz Medicare Advantage |
$2,994.58
|
| Rate for Payer: The Alliance Commercial |
$2,495.48
|
| Rate for Payer: WEA Trust Commercial |
$2,745.03
|
| Rate for Payer: WPS Commercial |
$3,696.67
|
|
|
HUMERAL INSERT XS/33 +6 AR-9503XS-06
|
Facility
|
IP
|
$4,799.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6232137
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,445.57 |
| Max. Negotiated Rate |
$4,591.68 |
| Rate for Payer: Aetna Commercial |
$4,491.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,292.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,645.21
|
| Rate for Payer: Cash Price |
$1,439.70
|
| Rate for Payer: Cigna Commercial |
$4,591.68
|
| Rate for Payer: Health EOS Commercial |
$4,441.95
|
| Rate for Payer: HFN Commercial |
$4,591.68
|
| Rate for Payer: Multiplan Commercial |
$3,992.77
|
| Rate for Payer: Preferred Network Access Commercial |
$4,591.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,445.57
|
| Rate for Payer: Quartz Commercial |
$2,994.58
|
| Rate for Payer: WEA Trust Commercial |
$2,745.03
|
| Rate for Payer: WPS Commercial |
$3,696.67
|
|
|
HUMERAL LINER 36MM +0MM 145 DEG PE EQUINOXE REVERSE SHOULDER 320-36-00
|
Facility
|
OP
|
$5,285.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6248147
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,539.14 |
| Max. Negotiated Rate |
$5,057.18 |
| Rate for Payer: Aetna Commercial |
$4,947.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,727.36
|
| Rate for Payer: Aetna Managed Medicare |
$1,539.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,573.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,748.47
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,638.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,913.37
|
| Rate for Payer: Cash Price |
$1,585.65
|
| Rate for Payer: Cigna Commercial |
$5,057.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,076.17
|
| Rate for Payer: Health EOS Commercial |
$4,892.27
|
| Rate for Payer: HFN Commercial |
$5,057.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,122.70
|
| Rate for Payer: Multiplan Commercial |
$4,397.54
|
| Rate for Payer: NAPHCARE Commercial |
$3,298.16
|
| Rate for Payer: Preferred Network Access Commercial |
$5,057.18
|
| Rate for Payer: Quartz Beloit One Network |
$2,693.50
|
| Rate for Payer: Quartz Commercial |
$3,573.00
|
| Rate for Payer: Quartz Medicare Advantage |
$3,298.16
|
| Rate for Payer: The Alliance Commercial |
$2,748.47
|
| Rate for Payer: WEA Trust Commercial |
$3,023.31
|
| Rate for Payer: WPS Commercial |
$4,071.43
|
|
|
HUMERAL LINER 36MM +0MM 145 DEG PE EQUINOXE REVERSE SHOULDER 320-36-00
|
Facility
|
IP
|
$5,285.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6248147
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,693.50 |
| Max. Negotiated Rate |
$5,057.18 |
| Rate for Payer: Aetna Commercial |
$4,947.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,727.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,913.37
|
| Rate for Payer: Cash Price |
$1,585.65
|
| Rate for Payer: Cigna Commercial |
$5,057.18
|
| Rate for Payer: Health EOS Commercial |
$4,892.27
|
| Rate for Payer: HFN Commercial |
$5,057.18
|
| Rate for Payer: Multiplan Commercial |
$4,397.54
|
| Rate for Payer: Preferred Network Access Commercial |
$5,057.18
|
| Rate for Payer: Quartz Beloit One Network |
$2,693.50
|
| Rate for Payer: Quartz Commercial |
$3,298.16
|
| Rate for Payer: WEA Trust Commercial |
$3,023.31
|
| Rate for Payer: WPS Commercial |
$4,071.43
|
|
|
HUMERAL LINER 42MM +0MM EQUINOXE REVERSE SHOULDER 320-42-00
|
Facility
|
OP
|
$5,285.57
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6240171
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,539.16 |
| Max. Negotiated Rate |
$5,057.23 |
| Rate for Payer: Aetna Commercial |
$4,947.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,727.41
|
| Rate for Payer: Aetna Managed Medicare |
$1,539.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,573.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,748.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,638.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,913.41
|
| Rate for Payer: Cash Price |
$1,585.67
|
| Rate for Payer: Cigna Commercial |
$5,057.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,076.20
|
| Rate for Payer: Health EOS Commercial |
$4,892.32
|
| Rate for Payer: HFN Commercial |
$5,057.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,122.74
|
| Rate for Payer: Multiplan Commercial |
$4,397.59
|
| Rate for Payer: NAPHCARE Commercial |
$3,298.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,057.23
|
| Rate for Payer: Quartz Beloit One Network |
$2,693.53
|
| Rate for Payer: Quartz Commercial |
$3,573.05
|
| Rate for Payer: Quartz Medicare Advantage |
$3,298.20
|
| Rate for Payer: The Alliance Commercial |
$2,748.50
|
| Rate for Payer: WEA Trust Commercial |
$3,023.35
|
| Rate for Payer: WPS Commercial |
$4,071.47
|
|
|
HUMERAL LINER 42MM +0MM EQUINOXE REVERSE SHOULDER 320-42-00
|
Facility
|
IP
|
$5,285.57
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6240171
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,693.53 |
| Max. Negotiated Rate |
$5,057.23 |
| Rate for Payer: Aetna Commercial |
$4,947.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,727.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,913.41
|
| Rate for Payer: Cash Price |
$1,585.67
|
| Rate for Payer: Cigna Commercial |
$5,057.23
|
| Rate for Payer: Health EOS Commercial |
$4,892.32
|
| Rate for Payer: HFN Commercial |
$5,057.23
|
| Rate for Payer: Multiplan Commercial |
$4,397.59
|
| Rate for Payer: Preferred Network Access Commercial |
$5,057.23
|
| Rate for Payer: Quartz Beloit One Network |
$2,693.53
|
| Rate for Payer: Quartz Commercial |
$3,298.20
|
| Rate for Payer: WEA Trust Commercial |
$3,023.35
|
| Rate for Payer: WPS Commercial |
$4,071.47
|
|
|
HUMERAL NAIL 11MM X 150MM PROX NAIL-EX 04.001.610S
|
Facility
|
IP
|
$12,370.00
|
|
| Hospital Charge Code |
2966254
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,303.75 |
| Max. Negotiated Rate |
$11,835.62 |
| Rate for Payer: Aetna Commercial |
$11,578.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,063.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,818.34
|
| Rate for Payer: Cash Price |
$3,711.00
|
| Rate for Payer: Cigna Commercial |
$11,835.62
|
| Rate for Payer: Health EOS Commercial |
$11,449.67
|
| Rate for Payer: HFN Commercial |
$11,835.62
|
| Rate for Payer: Multiplan Commercial |
$10,291.84
|
| Rate for Payer: Preferred Network Access Commercial |
$11,835.62
|
| Rate for Payer: Quartz Beloit One Network |
$6,303.75
|
| Rate for Payer: Quartz Commercial |
$7,718.88
|
| Rate for Payer: WEA Trust Commercial |
$7,075.64
|
| Rate for Payer: WPS Commercial |
$9,528.61
|
|
|
HUMERAL NAIL 11MM X 150MM PROX NAIL-EX 04.001.610S
|
Facility
|
OP
|
$12,370.00
|
|
| Hospital Charge Code |
2966254
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,602.14 |
| Max. Negotiated Rate |
$11,835.62 |
| Rate for Payer: Aetna Commercial |
$11,578.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,063.73
|
| Rate for Payer: Aetna Managed Medicare |
$3,602.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,362.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,432.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,175.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,818.34
|
| Rate for Payer: Cash Price |
$3,711.00
|
| Rate for Payer: Cigna Commercial |
$11,835.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,199.34
|
| Rate for Payer: Health EOS Commercial |
$11,449.67
|
| Rate for Payer: HFN Commercial |
$11,835.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,648.60
|
| Rate for Payer: Multiplan Commercial |
$10,291.84
|
| Rate for Payer: NAPHCARE Commercial |
$7,718.88
|
| Rate for Payer: Preferred Network Access Commercial |
$11,835.62
|
| Rate for Payer: Quartz Beloit One Network |
$6,303.75
|
| Rate for Payer: Quartz Commercial |
$8,362.12
|
| Rate for Payer: Quartz Medicare Advantage |
$7,718.88
|
| Rate for Payer: The Alliance Commercial |
$6,432.40
|
| Rate for Payer: WEA Trust Commercial |
$7,075.64
|
| Rate for Payer: WPS Commercial |
$9,528.61
|
|
|
HUMERAL NAIL 11MM X 260MM 04.001.632S
|
Facility
|
IP
|
$12,370.00
|
|
| Hospital Charge Code |
2966293
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,303.75 |
| Max. Negotiated Rate |
$11,835.62 |
| Rate for Payer: Aetna Commercial |
$11,578.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,063.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,818.34
|
| Rate for Payer: Cash Price |
$3,711.00
|
| Rate for Payer: Cigna Commercial |
$11,835.62
|
| Rate for Payer: Health EOS Commercial |
$11,449.67
|
| Rate for Payer: HFN Commercial |
$11,835.62
|
| Rate for Payer: Multiplan Commercial |
$10,291.84
|
| Rate for Payer: Preferred Network Access Commercial |
$11,835.62
|
| Rate for Payer: Quartz Beloit One Network |
$6,303.75
|
| Rate for Payer: Quartz Commercial |
$7,718.88
|
| Rate for Payer: WEA Trust Commercial |
$7,075.64
|
| Rate for Payer: WPS Commercial |
$9,528.61
|
|
|
HUMERAL NAIL 11MM X 260MM 04.001.632S
|
Facility
|
OP
|
$12,370.00
|
|
| Hospital Charge Code |
2966293
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,602.14 |
| Max. Negotiated Rate |
$11,835.62 |
| Rate for Payer: Aetna Commercial |
$11,578.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,063.73
|
| Rate for Payer: Aetna Managed Medicare |
$3,602.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,362.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,432.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,175.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,818.34
|
| Rate for Payer: Cash Price |
$3,711.00
|
| Rate for Payer: Cigna Commercial |
$11,835.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,199.34
|
| Rate for Payer: Health EOS Commercial |
$11,449.67
|
| Rate for Payer: HFN Commercial |
$11,835.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,648.60
|
| Rate for Payer: Multiplan Commercial |
$10,291.84
|
| Rate for Payer: NAPHCARE Commercial |
$7,718.88
|
| Rate for Payer: Preferred Network Access Commercial |
$11,835.62
|
| Rate for Payer: Quartz Beloit One Network |
$6,303.75
|
| Rate for Payer: Quartz Commercial |
$8,362.12
|
| Rate for Payer: Quartz Medicare Advantage |
$7,718.88
|
| Rate for Payer: The Alliance Commercial |
$6,432.40
|
| Rate for Payer: WEA Trust Commercial |
$7,075.64
|
| Rate for Payer: WPS Commercial |
$9,528.61
|
|
|
HUMERAL NAIL 11MM X 280MM 04.001.636S
|
Facility
|
OP
|
$12,370.00
|
|
| Hospital Charge Code |
2966299
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,602.14 |
| Max. Negotiated Rate |
$11,835.62 |
| Rate for Payer: Aetna Commercial |
$11,578.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,063.73
|
| Rate for Payer: Aetna Managed Medicare |
$3,602.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,362.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,432.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,175.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,818.34
|
| Rate for Payer: Cash Price |
$3,711.00
|
| Rate for Payer: Cigna Commercial |
$11,835.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,199.34
|
| Rate for Payer: Health EOS Commercial |
$11,449.67
|
| Rate for Payer: HFN Commercial |
$11,835.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,648.60
|
| Rate for Payer: Multiplan Commercial |
$10,291.84
|
| Rate for Payer: NAPHCARE Commercial |
$7,718.88
|
| Rate for Payer: Preferred Network Access Commercial |
$11,835.62
|
| Rate for Payer: Quartz Beloit One Network |
$6,303.75
|
| Rate for Payer: Quartz Commercial |
$8,362.12
|
| Rate for Payer: Quartz Medicare Advantage |
$7,718.88
|
| Rate for Payer: The Alliance Commercial |
$6,432.40
|
| Rate for Payer: WEA Trust Commercial |
$7,075.64
|
| Rate for Payer: WPS Commercial |
$9,528.61
|
|
|
HUMERAL NAIL 11MM X 280MM 04.001.636S
|
Facility
|
IP
|
$12,370.00
|
|
| Hospital Charge Code |
2966299
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,303.75 |
| Max. Negotiated Rate |
$11,835.62 |
| Rate for Payer: Aetna Commercial |
$11,578.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,063.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,818.34
|
| Rate for Payer: Cash Price |
$3,711.00
|
| Rate for Payer: Cigna Commercial |
$11,835.62
|
| Rate for Payer: Health EOS Commercial |
$11,449.67
|
| Rate for Payer: HFN Commercial |
$11,835.62
|
| Rate for Payer: Multiplan Commercial |
$10,291.84
|
| Rate for Payer: Preferred Network Access Commercial |
$11,835.62
|
| Rate for Payer: Quartz Beloit One Network |
$6,303.75
|
| Rate for Payer: Quartz Commercial |
$7,718.88
|
| Rate for Payer: WEA Trust Commercial |
$7,075.64
|
| Rate for Payer: WPS Commercial |
$9,528.61
|
|
|
HUMERAL NAIL 7MM X 270MM 04.001.234S
|
Facility
|
IP
|
$12,370.00
|
|
| Hospital Charge Code |
2966294
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,303.75 |
| Max. Negotiated Rate |
$11,835.62 |
| Rate for Payer: Aetna Commercial |
$11,578.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,063.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,818.34
|
| Rate for Payer: Cash Price |
$3,711.00
|
| Rate for Payer: Cigna Commercial |
$11,835.62
|
| Rate for Payer: Health EOS Commercial |
$11,449.67
|
| Rate for Payer: HFN Commercial |
$11,835.62
|
| Rate for Payer: Multiplan Commercial |
$10,291.84
|
| Rate for Payer: Preferred Network Access Commercial |
$11,835.62
|
| Rate for Payer: Quartz Beloit One Network |
$6,303.75
|
| Rate for Payer: Quartz Commercial |
$7,718.88
|
| Rate for Payer: WEA Trust Commercial |
$7,075.64
|
| Rate for Payer: WPS Commercial |
$9,528.61
|
|
|
HUMERAL NAIL 7MM X 270MM 04.001.234S
|
Facility
|
OP
|
$12,370.00
|
|
| Hospital Charge Code |
2966294
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,602.14 |
| Max. Negotiated Rate |
$11,835.62 |
| Rate for Payer: Aetna Commercial |
$11,578.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,063.73
|
| Rate for Payer: Aetna Managed Medicare |
$3,602.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,362.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,432.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,175.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,818.34
|
| Rate for Payer: Cash Price |
$3,711.00
|
| Rate for Payer: Cigna Commercial |
$11,835.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,199.34
|
| Rate for Payer: Health EOS Commercial |
$11,449.67
|
| Rate for Payer: HFN Commercial |
$11,835.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,648.60
|
| Rate for Payer: Multiplan Commercial |
$10,291.84
|
| Rate for Payer: NAPHCARE Commercial |
$7,718.88
|
| Rate for Payer: Preferred Network Access Commercial |
$11,835.62
|
| Rate for Payer: Quartz Beloit One Network |
$6,303.75
|
| Rate for Payer: Quartz Commercial |
$8,362.12
|
| Rate for Payer: Quartz Medicare Advantage |
$7,718.88
|
| Rate for Payer: The Alliance Commercial |
$6,432.40
|
| Rate for Payer: WEA Trust Commercial |
$7,075.64
|
| Rate for Payer: WPS Commercial |
$9,528.61
|
|
|
HUMERAL NAIL 9MM X 150MM 04.001.410S
|
Facility
|
OP
|
$11,459.00
|
|
| Hospital Charge Code |
2966290
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,336.86 |
| Max. Negotiated Rate |
$10,963.97 |
| Rate for Payer: Aetna Commercial |
$10,725.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,248.93
|
| Rate for Payer: Aetna Managed Medicare |
$3,336.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,746.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,958.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,720.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,316.20
|
| Rate for Payer: Cash Price |
$3,437.70
|
| Rate for Payer: Cigna Commercial |
$10,963.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,669.14
|
| Rate for Payer: Health EOS Commercial |
$10,606.45
|
| Rate for Payer: HFN Commercial |
$10,963.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,938.02
|
| Rate for Payer: Multiplan Commercial |
$9,533.89
|
| Rate for Payer: NAPHCARE Commercial |
$7,150.42
|
| Rate for Payer: Preferred Network Access Commercial |
$10,963.97
|
| Rate for Payer: Quartz Beloit One Network |
$5,839.51
|
| Rate for Payer: Quartz Commercial |
$7,746.28
|
| Rate for Payer: Quartz Medicare Advantage |
$7,150.42
|
| Rate for Payer: The Alliance Commercial |
$5,958.68
|
| Rate for Payer: WEA Trust Commercial |
$6,554.55
|
| Rate for Payer: WPS Commercial |
$8,826.87
|
|
|
HUMERAL NAIL 9MM X 150MM 04.001.410S
|
Facility
|
IP
|
$11,459.00
|
|
| Hospital Charge Code |
2966290
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,839.51 |
| Max. Negotiated Rate |
$10,963.97 |
| Rate for Payer: Aetna Commercial |
$10,725.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,248.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,316.20
|
| Rate for Payer: Cash Price |
$3,437.70
|
| Rate for Payer: Cigna Commercial |
$10,963.97
|
| Rate for Payer: Health EOS Commercial |
$10,606.45
|
| Rate for Payer: HFN Commercial |
$10,963.97
|
| Rate for Payer: Multiplan Commercial |
$9,533.89
|
| Rate for Payer: Preferred Network Access Commercial |
$10,963.97
|
| Rate for Payer: Quartz Beloit One Network |
$5,839.51
|
| Rate for Payer: Quartz Commercial |
$7,150.42
|
| Rate for Payer: WEA Trust Commercial |
$6,554.55
|
| Rate for Payer: WPS Commercial |
$8,826.87
|
|
|
HUMERAL NAIL 9MM X 240MM 04.001.428S
|
Facility
|
IP
|
$12,370.00
|
|
| Hospital Charge Code |
2966295
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,303.75 |
| Max. Negotiated Rate |
$11,835.62 |
| Rate for Payer: Aetna Commercial |
$11,578.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,063.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,818.34
|
| Rate for Payer: Cash Price |
$3,711.00
|
| Rate for Payer: Cigna Commercial |
$11,835.62
|
| Rate for Payer: Health EOS Commercial |
$11,449.67
|
| Rate for Payer: HFN Commercial |
$11,835.62
|
| Rate for Payer: Multiplan Commercial |
$10,291.84
|
| Rate for Payer: Preferred Network Access Commercial |
$11,835.62
|
| Rate for Payer: Quartz Beloit One Network |
$6,303.75
|
| Rate for Payer: Quartz Commercial |
$7,718.88
|
| Rate for Payer: WEA Trust Commercial |
$7,075.64
|
| Rate for Payer: WPS Commercial |
$9,528.61
|
|
|
HUMERAL NAIL 9MM X 240MM 04.001.428S
|
Facility
|
OP
|
$12,370.00
|
|
| Hospital Charge Code |
2966295
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,602.14 |
| Max. Negotiated Rate |
$11,835.62 |
| Rate for Payer: Aetna Commercial |
$11,578.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,063.73
|
| Rate for Payer: Aetna Managed Medicare |
$3,602.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,362.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,432.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,175.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,818.34
|
| Rate for Payer: Cash Price |
$3,711.00
|
| Rate for Payer: Cigna Commercial |
$11,835.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,199.34
|
| Rate for Payer: Health EOS Commercial |
$11,449.67
|
| Rate for Payer: HFN Commercial |
$11,835.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,648.60
|
| Rate for Payer: Multiplan Commercial |
$10,291.84
|
| Rate for Payer: NAPHCARE Commercial |
$7,718.88
|
| Rate for Payer: Preferred Network Access Commercial |
$11,835.62
|
| Rate for Payer: Quartz Beloit One Network |
$6,303.75
|
| Rate for Payer: Quartz Commercial |
$8,362.12
|
| Rate for Payer: Quartz Medicare Advantage |
$7,718.88
|
| Rate for Payer: The Alliance Commercial |
$6,432.40
|
| Rate for Payer: WEA Trust Commercial |
$7,075.64
|
| Rate for Payer: WPS Commercial |
$9,528.61
|
|
|
HUMERAL NAIL PROXIMAL CANN LT 8 X 150MM 1832-1035S
|
Facility
|
OP
|
$6,880.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6207033
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,003.46 |
| Max. Negotiated Rate |
$6,582.78 |
| Rate for Payer: Aetna Commercial |
$6,439.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,153.47
|
| Rate for Payer: Aetna Managed Medicare |
$2,003.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,650.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,577.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,434.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,792.26
|
| Rate for Payer: Cash Price |
$2,064.00
|
| Rate for Payer: Cigna Commercial |
$6,582.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,004.16
|
| Rate for Payer: Health EOS Commercial |
$6,368.13
|
| Rate for Payer: HFN Commercial |
$6,582.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,366.40
|
| Rate for Payer: Multiplan Commercial |
$5,724.16
|
| Rate for Payer: NAPHCARE Commercial |
$4,293.12
|
| Rate for Payer: Preferred Network Access Commercial |
$6,582.78
|
| Rate for Payer: Quartz Beloit One Network |
$3,506.05
|
| Rate for Payer: Quartz Commercial |
$4,650.88
|
| Rate for Payer: Quartz Medicare Advantage |
$4,293.12
|
| Rate for Payer: The Alliance Commercial |
$3,577.60
|
| Rate for Payer: WEA Trust Commercial |
$3,935.36
|
| Rate for Payer: WPS Commercial |
$5,299.66
|
|
|
HUMERAL NAIL PROXIMAL CANN LT 8 X 150MM 1832-1035S
|
Facility
|
IP
|
$6,880.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6207033
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,506.05 |
| Max. Negotiated Rate |
$6,582.78 |
| Rate for Payer: Aetna Commercial |
$6,439.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,153.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,792.26
|
| Rate for Payer: Cash Price |
$2,064.00
|
| Rate for Payer: Cigna Commercial |
$6,582.78
|
| Rate for Payer: Health EOS Commercial |
$6,368.13
|
| Rate for Payer: HFN Commercial |
$6,582.78
|
| Rate for Payer: Multiplan Commercial |
$5,724.16
|
| Rate for Payer: Preferred Network Access Commercial |
$6,582.78
|
| Rate for Payer: Quartz Beloit One Network |
$3,506.05
|
| Rate for Payer: Quartz Commercial |
$4,293.12
|
| Rate for Payer: WEA Trust Commercial |
$3,935.36
|
| Rate for Payer: WPS Commercial |
$5,299.66
|
|
|
HUMERAL NAIL PROXIMAL CANN RT 1832-1045S
|
Facility
|
IP
|
$6,880.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6207006
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,506.05 |
| Max. Negotiated Rate |
$6,582.78 |
| Rate for Payer: Aetna Commercial |
$6,439.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,153.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,792.26
|
| Rate for Payer: Cash Price |
$2,064.00
|
| Rate for Payer: Cigna Commercial |
$6,582.78
|
| Rate for Payer: Health EOS Commercial |
$6,368.13
|
| Rate for Payer: HFN Commercial |
$6,582.78
|
| Rate for Payer: Multiplan Commercial |
$5,724.16
|
| Rate for Payer: Preferred Network Access Commercial |
$6,582.78
|
| Rate for Payer: Quartz Beloit One Network |
$3,506.05
|
| Rate for Payer: Quartz Commercial |
$4,293.12
|
| Rate for Payer: WEA Trust Commercial |
$3,935.36
|
| Rate for Payer: WPS Commercial |
$5,299.66
|
|
|
HUMERAL NAIL PROXIMAL CANN RT 1832-1045S
|
Facility
|
OP
|
$6,880.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6207006
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,003.46 |
| Max. Negotiated Rate |
$6,582.78 |
| Rate for Payer: Aetna Commercial |
$6,439.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,153.47
|
| Rate for Payer: Aetna Managed Medicare |
$2,003.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,650.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,577.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,434.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,792.26
|
| Rate for Payer: Cash Price |
$2,064.00
|
| Rate for Payer: Cigna Commercial |
$6,582.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,004.16
|
| Rate for Payer: Health EOS Commercial |
$6,368.13
|
| Rate for Payer: HFN Commercial |
$6,582.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,366.40
|
| Rate for Payer: Multiplan Commercial |
$5,724.16
|
| Rate for Payer: NAPHCARE Commercial |
$4,293.12
|
| Rate for Payer: Preferred Network Access Commercial |
$6,582.78
|
| Rate for Payer: Quartz Beloit One Network |
$3,506.05
|
| Rate for Payer: Quartz Commercial |
$4,650.88
|
| Rate for Payer: Quartz Medicare Advantage |
$4,293.12
|
| Rate for Payer: The Alliance Commercial |
$3,577.60
|
| Rate for Payer: WEA Trust Commercial |
$3,935.36
|
| Rate for Payer: WPS Commercial |
$5,299.66
|
|
|
HUMERAL STEM APEX UNIVERS REVERS SZ 10 AR-9501-10S
|
Facility
|
IP
|
$15,267.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5787727
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,780.06 |
| Max. Negotiated Rate |
$14,607.47 |
| Rate for Payer: Aetna Commercial |
$14,289.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,654.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,415.17
|
| Rate for Payer: Cash Price |
$4,580.10
|
| Rate for Payer: Cigna Commercial |
$14,607.47
|
| Rate for Payer: Health EOS Commercial |
$14,131.14
|
| Rate for Payer: HFN Commercial |
$14,607.47
|
| Rate for Payer: Multiplan Commercial |
$12,702.14
|
| Rate for Payer: Preferred Network Access Commercial |
$14,607.47
|
| Rate for Payer: Quartz Beloit One Network |
$7,780.06
|
| Rate for Payer: Quartz Commercial |
$9,526.61
|
| Rate for Payer: WEA Trust Commercial |
$8,732.72
|
| Rate for Payer: WPS Commercial |
$11,760.17
|
|
|
HUMERAL STEM APEX UNIVERS REVERS SZ 10 AR-9501-10S
|
Facility
|
OP
|
$15,267.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5787727
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,445.75 |
| Max. Negotiated Rate |
$14,607.47 |
| Rate for Payer: Aetna Commercial |
$14,289.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,654.80
|
| Rate for Payer: Aetna Managed Medicare |
$4,445.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,320.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,938.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,621.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,415.17
|
| Rate for Payer: Cash Price |
$4,580.10
|
| Rate for Payer: Cigna Commercial |
$14,607.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,885.39
|
| Rate for Payer: Health EOS Commercial |
$14,131.14
|
| Rate for Payer: HFN Commercial |
$14,607.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,908.26
|
| Rate for Payer: Multiplan Commercial |
$12,702.14
|
| Rate for Payer: NAPHCARE Commercial |
$9,526.61
|
| Rate for Payer: Preferred Network Access Commercial |
$14,607.47
|
| Rate for Payer: Quartz Beloit One Network |
$7,780.06
|
| Rate for Payer: Quartz Commercial |
$10,320.49
|
| Rate for Payer: Quartz Medicare Advantage |
$9,526.61
|
| Rate for Payer: The Alliance Commercial |
$7,938.84
|
| Rate for Payer: WEA Trust Commercial |
$8,732.72
|
| Rate for Payer: WPS Commercial |
$11,760.17
|
|
|
HUMERAL STEM APEX UNIVERS REVERS SZ 9 AR-9501-09S
|
Facility
|
OP
|
$15,267.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5799868
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,445.75 |
| Max. Negotiated Rate |
$14,607.47 |
| Rate for Payer: Aetna Commercial |
$14,289.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,654.80
|
| Rate for Payer: Aetna Managed Medicare |
$4,445.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,320.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,938.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,621.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,415.17
|
| Rate for Payer: Cash Price |
$4,580.10
|
| Rate for Payer: Cigna Commercial |
$14,607.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,885.39
|
| Rate for Payer: Health EOS Commercial |
$14,131.14
|
| Rate for Payer: HFN Commercial |
$14,607.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,908.26
|
| Rate for Payer: Multiplan Commercial |
$12,702.14
|
| Rate for Payer: NAPHCARE Commercial |
$9,526.61
|
| Rate for Payer: Preferred Network Access Commercial |
$14,607.47
|
| Rate for Payer: Quartz Beloit One Network |
$7,780.06
|
| Rate for Payer: Quartz Commercial |
$10,320.49
|
| Rate for Payer: Quartz Medicare Advantage |
$9,526.61
|
| Rate for Payer: The Alliance Commercial |
$7,938.84
|
| Rate for Payer: WEA Trust Commercial |
$8,732.72
|
| Rate for Payer: WPS Commercial |
$11,760.17
|
|
