|
HUMERAL INSERT UNIVERS REVERS M/39 +3 TO FIT 39 CUP CONSTRAINT AR-9503M-03C
|
Facility
|
OP
|
$5,191.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5627660
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,453.48 |
| Max. Negotiated Rate |
$20,764.00 |
| Rate for Payer: Aetna Commercial |
$4,671.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,464.26
|
| Rate for Payer: Aetna Managed Medicare |
$1,453.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,374.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,595.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,491.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,751.23
|
| Rate for Payer: Cash Price |
$1,557.30
|
| Rate for Payer: Cigna Commercial |
$4,775.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,904.88
|
| Rate for Payer: Health EOS Commercial |
$4,619.99
|
| Rate for Payer: HFN Commercial |
$4,775.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,893.25
|
| Rate for Payer: Multiplan Commercial |
$4,152.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,114.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,775.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,543.59
|
| Rate for Payer: Quartz Commercial |
$3,374.15
|
| Rate for Payer: Quartz Medicare Advantage |
$3,114.60
|
| Rate for Payer: The Alliance Commercial |
$20,764.00
|
| Rate for Payer: WEA Trust Commercial |
$2,855.05
|
| Rate for Payer: WPS Commercial |
$3,844.97
|
|
|
HUMERAL INSERT XS/33 +3 AR-9503XS-03
|
Facility
|
OP
|
$4,799.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6180302
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,343.72 |
| Max. Negotiated Rate |
$19,196.00 |
| Rate for Payer: Aetna Commercial |
$4,319.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,127.14
|
| Rate for Payer: Aetna Managed Medicare |
$1,343.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,119.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,399.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,303.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,543.47
|
| Rate for Payer: Cash Price |
$1,439.70
|
| Rate for Payer: Cigna Commercial |
$4,415.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,685.52
|
| Rate for Payer: Health EOS Commercial |
$4,271.11
|
| Rate for Payer: HFN Commercial |
$4,415.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,599.25
|
| Rate for Payer: Multiplan Commercial |
$3,839.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,879.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,415.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,351.51
|
| Rate for Payer: Quartz Commercial |
$3,119.35
|
| Rate for Payer: Quartz Medicare Advantage |
$2,879.40
|
| Rate for Payer: The Alliance Commercial |
$19,196.00
|
| Rate for Payer: WEA Trust Commercial |
$2,639.45
|
| Rate for Payer: WPS Commercial |
$3,554.62
|
|
|
HUMERAL INSERT XS/33 +3 AR-9503XS-03
|
Facility
|
IP
|
$4,799.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6180302
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,351.51 |
| Max. Negotiated Rate |
$4,415.08 |
| Rate for Payer: Aetna Commercial |
$4,319.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,127.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,543.47
|
| Rate for Payer: Cash Price |
$1,439.70
|
| Rate for Payer: Cigna Commercial |
$4,415.08
|
| Rate for Payer: Health EOS Commercial |
$4,271.11
|
| Rate for Payer: HFN Commercial |
$4,415.08
|
| Rate for Payer: Multiplan Commercial |
$3,839.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,879.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,415.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,351.51
|
| Rate for Payer: Quartz Commercial |
$2,879.40
|
| Rate for Payer: WEA Trust Commercial |
$2,639.45
|
| Rate for Payer: WPS Commercial |
$3,554.62
|
|
|
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 |
$1,343.72 |
| Max. Negotiated Rate |
$19,196.00 |
| Rate for Payer: Aetna Commercial |
$4,319.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,127.14
|
| Rate for Payer: Aetna Managed Medicare |
$1,343.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,119.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,399.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,303.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,543.47
|
| Rate for Payer: Cash Price |
$1,439.70
|
| Rate for Payer: Cigna Commercial |
$4,415.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,685.52
|
| Rate for Payer: Health EOS Commercial |
$4,271.11
|
| Rate for Payer: HFN Commercial |
$4,415.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,599.25
|
| Rate for Payer: Multiplan Commercial |
$3,839.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,879.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,415.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,351.51
|
| Rate for Payer: Quartz Commercial |
$3,119.35
|
| Rate for Payer: Quartz Medicare Advantage |
$2,879.40
|
| Rate for Payer: The Alliance Commercial |
$19,196.00
|
| Rate for Payer: WEA Trust Commercial |
$2,639.45
|
| Rate for Payer: WPS Commercial |
$3,554.62
|
|
|
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 |
$2,351.51 |
| Max. Negotiated Rate |
$4,415.08 |
| Rate for Payer: Aetna Commercial |
$4,319.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,127.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,543.47
|
| Rate for Payer: Cash Price |
$1,439.70
|
| Rate for Payer: Cigna Commercial |
$4,415.08
|
| Rate for Payer: Health EOS Commercial |
$4,271.11
|
| Rate for Payer: HFN Commercial |
$4,415.08
|
| Rate for Payer: Multiplan Commercial |
$3,839.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,879.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,415.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,351.51
|
| Rate for Payer: Quartz Commercial |
$2,879.40
|
| Rate for Payer: WEA Trust Commercial |
$2,639.45
|
| Rate for Payer: WPS Commercial |
$3,554.62
|
|
|
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 |
$1,479.94 |
| Max. Negotiated Rate |
$21,142.04 |
| Rate for Payer: Aetna Commercial |
$4,756.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,545.54
|
| Rate for Payer: Aetna Managed Medicare |
$1,479.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,435.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,642.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,537.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,801.32
|
| Rate for Payer: Cash Price |
$1,585.65
|
| Rate for Payer: Cigna Commercial |
$4,862.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,957.77
|
| Rate for Payer: Health EOS Commercial |
$4,704.10
|
| Rate for Payer: HFN Commercial |
$4,862.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,964.13
|
| Rate for Payer: Multiplan Commercial |
$4,228.41
|
| Rate for Payer: NAPHCARE Commercial |
$3,171.31
|
| Rate for Payer: Preferred Network Access Commercial |
$4,862.67
|
| Rate for Payer: Quartz Beloit One Network |
$2,589.90
|
| Rate for Payer: Quartz Commercial |
$3,435.58
|
| Rate for Payer: Quartz Medicare Advantage |
$3,171.31
|
| Rate for Payer: The Alliance Commercial |
$21,142.04
|
| Rate for Payer: WEA Trust Commercial |
$2,907.03
|
| Rate for Payer: WPS Commercial |
$3,914.98
|
|
|
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 |
$2,589.90 |
| Max. Negotiated Rate |
$4,862.67 |
| Rate for Payer: Aetna Commercial |
$4,756.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,545.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,801.32
|
| Rate for Payer: Cash Price |
$1,585.65
|
| Rate for Payer: Cigna Commercial |
$4,862.67
|
| Rate for Payer: Health EOS Commercial |
$4,704.10
|
| Rate for Payer: HFN Commercial |
$4,862.67
|
| Rate for Payer: Multiplan Commercial |
$4,228.41
|
| Rate for Payer: NAPHCARE Commercial |
$3,171.31
|
| Rate for Payer: Preferred Network Access Commercial |
$4,862.67
|
| Rate for Payer: Quartz Beloit One Network |
$2,589.90
|
| Rate for Payer: Quartz Commercial |
$3,171.31
|
| Rate for Payer: WEA Trust Commercial |
$2,907.03
|
| Rate for Payer: WPS Commercial |
$3,914.98
|
|
|
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 |
$2,589.93 |
| Max. Negotiated Rate |
$4,862.72 |
| Rate for Payer: Aetna Commercial |
$4,757.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,545.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,801.35
|
| Rate for Payer: Cash Price |
$1,585.67
|
| Rate for Payer: Cigna Commercial |
$4,862.72
|
| Rate for Payer: Health EOS Commercial |
$4,704.16
|
| Rate for Payer: HFN Commercial |
$4,862.72
|
| Rate for Payer: Multiplan Commercial |
$4,228.46
|
| Rate for Payer: NAPHCARE Commercial |
$3,171.34
|
| Rate for Payer: Preferred Network Access Commercial |
$4,862.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,589.93
|
| Rate for Payer: Quartz Commercial |
$3,171.34
|
| Rate for Payer: WEA Trust Commercial |
$2,907.06
|
| Rate for Payer: WPS Commercial |
$3,915.02
|
|
|
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 |
$1,479.96 |
| Max. Negotiated Rate |
$21,142.28 |
| Rate for Payer: Aetna Commercial |
$4,757.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,545.59
|
| Rate for Payer: Aetna Managed Medicare |
$1,479.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,435.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,642.78
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,537.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,801.35
|
| Rate for Payer: Cash Price |
$1,585.67
|
| Rate for Payer: Cigna Commercial |
$4,862.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,957.80
|
| Rate for Payer: Health EOS Commercial |
$4,704.16
|
| Rate for Payer: HFN Commercial |
$4,862.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,964.18
|
| Rate for Payer: Multiplan Commercial |
$4,228.46
|
| Rate for Payer: NAPHCARE Commercial |
$3,171.34
|
| Rate for Payer: Preferred Network Access Commercial |
$4,862.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,589.93
|
| Rate for Payer: Quartz Commercial |
$3,435.62
|
| Rate for Payer: Quartz Medicare Advantage |
$3,171.34
|
| Rate for Payer: The Alliance Commercial |
$21,142.28
|
| Rate for Payer: WEA Trust Commercial |
$2,907.06
|
| Rate for Payer: WPS Commercial |
$3,915.02
|
|
|
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 |
$6,061.30 |
| Max. Negotiated Rate |
$11,380.40 |
| Rate for Payer: Aetna Commercial |
$11,133.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,638.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,556.10
|
| Rate for Payer: Cash Price |
$3,711.00
|
| Rate for Payer: Cigna Commercial |
$11,380.40
|
| Rate for Payer: Health EOS Commercial |
$11,009.30
|
| Rate for Payer: HFN Commercial |
$11,380.40
|
| Rate for Payer: Multiplan Commercial |
$9,896.00
|
| Rate for Payer: NAPHCARE Commercial |
$7,422.00
|
| Rate for Payer: Preferred Network Access Commercial |
$11,380.40
|
| Rate for Payer: Quartz Beloit One Network |
$6,061.30
|
| Rate for Payer: Quartz Commercial |
$7,422.00
|
| Rate for Payer: WEA Trust Commercial |
$6,803.50
|
| Rate for Payer: WPS Commercial |
$9,162.46
|
|
|
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 |
$3,463.60 |
| Max. Negotiated Rate |
$49,480.00 |
| Rate for Payer: Aetna Commercial |
$11,133.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,638.20
|
| Rate for Payer: Aetna Managed Medicare |
$3,463.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,040.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,185.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,937.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,556.10
|
| Rate for Payer: Cash Price |
$3,711.00
|
| Rate for Payer: Cigna Commercial |
$11,380.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,922.25
|
| Rate for Payer: Health EOS Commercial |
$11,009.30
|
| Rate for Payer: HFN Commercial |
$11,380.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,277.50
|
| Rate for Payer: Multiplan Commercial |
$9,896.00
|
| Rate for Payer: NAPHCARE Commercial |
$7,422.00
|
| Rate for Payer: Preferred Network Access Commercial |
$11,380.40
|
| Rate for Payer: Quartz Beloit One Network |
$6,061.30
|
| Rate for Payer: Quartz Commercial |
$8,040.50
|
| Rate for Payer: Quartz Medicare Advantage |
$7,422.00
|
| Rate for Payer: The Alliance Commercial |
$49,480.00
|
| Rate for Payer: WEA Trust Commercial |
$6,803.50
|
| Rate for Payer: WPS Commercial |
$9,162.46
|
|
|
HUMERAL NAIL 11MM X 260MM 04.001.632S
|
Facility
|
IP
|
$12,370.00
|
|
| Hospital Charge Code |
2966293
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,061.30 |
| Max. Negotiated Rate |
$11,380.40 |
| Rate for Payer: Aetna Commercial |
$11,133.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,638.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,556.10
|
| Rate for Payer: Cash Price |
$3,711.00
|
| Rate for Payer: Cigna Commercial |
$11,380.40
|
| Rate for Payer: Health EOS Commercial |
$11,009.30
|
| Rate for Payer: HFN Commercial |
$11,380.40
|
| Rate for Payer: Multiplan Commercial |
$9,896.00
|
| Rate for Payer: NAPHCARE Commercial |
$7,422.00
|
| Rate for Payer: Preferred Network Access Commercial |
$11,380.40
|
| Rate for Payer: Quartz Beloit One Network |
$6,061.30
|
| Rate for Payer: Quartz Commercial |
$7,422.00
|
| Rate for Payer: WEA Trust Commercial |
$6,803.50
|
| Rate for Payer: WPS Commercial |
$9,162.46
|
|
|
HUMERAL NAIL 11MM X 260MM 04.001.632S
|
Facility
|
OP
|
$12,370.00
|
|
| Hospital Charge Code |
2966293
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,463.60 |
| Max. Negotiated Rate |
$49,480.00 |
| Rate for Payer: Aetna Commercial |
$11,133.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,638.20
|
| Rate for Payer: Aetna Managed Medicare |
$3,463.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,040.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,185.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,937.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,556.10
|
| Rate for Payer: Cash Price |
$3,711.00
|
| Rate for Payer: Cigna Commercial |
$11,380.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,922.25
|
| Rate for Payer: Health EOS Commercial |
$11,009.30
|
| Rate for Payer: HFN Commercial |
$11,380.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,277.50
|
| Rate for Payer: Multiplan Commercial |
$9,896.00
|
| Rate for Payer: NAPHCARE Commercial |
$7,422.00
|
| Rate for Payer: Preferred Network Access Commercial |
$11,380.40
|
| Rate for Payer: Quartz Beloit One Network |
$6,061.30
|
| Rate for Payer: Quartz Commercial |
$8,040.50
|
| Rate for Payer: Quartz Medicare Advantage |
$7,422.00
|
| Rate for Payer: The Alliance Commercial |
$49,480.00
|
| Rate for Payer: WEA Trust Commercial |
$6,803.50
|
| Rate for Payer: WPS Commercial |
$9,162.46
|
|
|
HUMERAL NAIL 11MM X 280MM 04.001.636S
|
Facility
|
IP
|
$12,370.00
|
|
| Hospital Charge Code |
2966299
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,061.30 |
| Max. Negotiated Rate |
$11,380.40 |
| Rate for Payer: Aetna Commercial |
$11,133.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,638.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,556.10
|
| Rate for Payer: Cash Price |
$3,711.00
|
| Rate for Payer: Cigna Commercial |
$11,380.40
|
| Rate for Payer: Health EOS Commercial |
$11,009.30
|
| Rate for Payer: HFN Commercial |
$11,380.40
|
| Rate for Payer: Multiplan Commercial |
$9,896.00
|
| Rate for Payer: NAPHCARE Commercial |
$7,422.00
|
| Rate for Payer: Preferred Network Access Commercial |
$11,380.40
|
| Rate for Payer: Quartz Beloit One Network |
$6,061.30
|
| Rate for Payer: Quartz Commercial |
$7,422.00
|
| Rate for Payer: WEA Trust Commercial |
$6,803.50
|
| Rate for Payer: WPS Commercial |
$9,162.46
|
|
|
HUMERAL NAIL 11MM X 280MM 04.001.636S
|
Facility
|
OP
|
$12,370.00
|
|
| Hospital Charge Code |
2966299
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,463.60 |
| Max. Negotiated Rate |
$49,480.00 |
| Rate for Payer: Aetna Commercial |
$11,133.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,638.20
|
| Rate for Payer: Aetna Managed Medicare |
$3,463.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,040.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,185.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,937.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,556.10
|
| Rate for Payer: Cash Price |
$3,711.00
|
| Rate for Payer: Cigna Commercial |
$11,380.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,922.25
|
| Rate for Payer: Health EOS Commercial |
$11,009.30
|
| Rate for Payer: HFN Commercial |
$11,380.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,277.50
|
| Rate for Payer: Multiplan Commercial |
$9,896.00
|
| Rate for Payer: NAPHCARE Commercial |
$7,422.00
|
| Rate for Payer: Preferred Network Access Commercial |
$11,380.40
|
| Rate for Payer: Quartz Beloit One Network |
$6,061.30
|
| Rate for Payer: Quartz Commercial |
$8,040.50
|
| Rate for Payer: Quartz Medicare Advantage |
$7,422.00
|
| Rate for Payer: The Alliance Commercial |
$49,480.00
|
| Rate for Payer: WEA Trust Commercial |
$6,803.50
|
| Rate for Payer: WPS Commercial |
$9,162.46
|
|
|
HUMERAL NAIL 7MM X 270MM 04.001.234S
|
Facility
|
OP
|
$12,370.00
|
|
| Hospital Charge Code |
2966294
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,463.60 |
| Max. Negotiated Rate |
$49,480.00 |
| Rate for Payer: Aetna Commercial |
$11,133.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,638.20
|
| Rate for Payer: Aetna Managed Medicare |
$3,463.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,040.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,185.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,937.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,556.10
|
| Rate for Payer: Cash Price |
$3,711.00
|
| Rate for Payer: Cigna Commercial |
$11,380.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,922.25
|
| Rate for Payer: Health EOS Commercial |
$11,009.30
|
| Rate for Payer: HFN Commercial |
$11,380.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,277.50
|
| Rate for Payer: Multiplan Commercial |
$9,896.00
|
| Rate for Payer: NAPHCARE Commercial |
$7,422.00
|
| Rate for Payer: Preferred Network Access Commercial |
$11,380.40
|
| Rate for Payer: Quartz Beloit One Network |
$6,061.30
|
| Rate for Payer: Quartz Commercial |
$8,040.50
|
| Rate for Payer: Quartz Medicare Advantage |
$7,422.00
|
| Rate for Payer: The Alliance Commercial |
$49,480.00
|
| Rate for Payer: WEA Trust Commercial |
$6,803.50
|
| Rate for Payer: WPS Commercial |
$9,162.46
|
|
|
HUMERAL NAIL 7MM X 270MM 04.001.234S
|
Facility
|
IP
|
$12,370.00
|
|
| Hospital Charge Code |
2966294
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,061.30 |
| Max. Negotiated Rate |
$11,380.40 |
| Rate for Payer: Aetna Commercial |
$11,133.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,638.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,556.10
|
| Rate for Payer: Cash Price |
$3,711.00
|
| Rate for Payer: Cigna Commercial |
$11,380.40
|
| Rate for Payer: Health EOS Commercial |
$11,009.30
|
| Rate for Payer: HFN Commercial |
$11,380.40
|
| Rate for Payer: Multiplan Commercial |
$9,896.00
|
| Rate for Payer: NAPHCARE Commercial |
$7,422.00
|
| Rate for Payer: Preferred Network Access Commercial |
$11,380.40
|
| Rate for Payer: Quartz Beloit One Network |
$6,061.30
|
| Rate for Payer: Quartz Commercial |
$7,422.00
|
| Rate for Payer: WEA Trust Commercial |
$6,803.50
|
| Rate for Payer: WPS Commercial |
$9,162.46
|
|
|
HUMERAL NAIL 9MM X 150MM 04.001.410S
|
Facility
|
OP
|
$11,459.00
|
|
| Hospital Charge Code |
2966290
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,208.52 |
| Max. Negotiated Rate |
$45,836.00 |
| Rate for Payer: Aetna Commercial |
$10,313.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,854.74
|
| Rate for Payer: Aetna Managed Medicare |
$3,208.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,448.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,729.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,500.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,073.27
|
| Rate for Payer: Cash Price |
$3,437.70
|
| Rate for Payer: Cigna Commercial |
$10,542.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,412.46
|
| Rate for Payer: Health EOS Commercial |
$10,198.51
|
| Rate for Payer: HFN Commercial |
$10,542.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,594.25
|
| Rate for Payer: Multiplan Commercial |
$9,167.20
|
| Rate for Payer: NAPHCARE Commercial |
$6,875.40
|
| Rate for Payer: Preferred Network Access Commercial |
$10,542.28
|
| Rate for Payer: Quartz Beloit One Network |
$5,614.91
|
| Rate for Payer: Quartz Commercial |
$7,448.35
|
| Rate for Payer: Quartz Medicare Advantage |
$6,875.40
|
| Rate for Payer: The Alliance Commercial |
$45,836.00
|
| Rate for Payer: WEA Trust Commercial |
$6,302.45
|
| Rate for Payer: WPS Commercial |
$8,487.68
|
|
|
HUMERAL NAIL 9MM X 150MM 04.001.410S
|
Facility
|
IP
|
$11,459.00
|
|
| Hospital Charge Code |
2966290
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,614.91 |
| Max. Negotiated Rate |
$10,542.28 |
| Rate for Payer: Aetna Commercial |
$10,313.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,854.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,073.27
|
| Rate for Payer: Cash Price |
$3,437.70
|
| Rate for Payer: Cigna Commercial |
$10,542.28
|
| Rate for Payer: Health EOS Commercial |
$10,198.51
|
| Rate for Payer: HFN Commercial |
$10,542.28
|
| Rate for Payer: Multiplan Commercial |
$9,167.20
|
| Rate for Payer: NAPHCARE Commercial |
$6,875.40
|
| Rate for Payer: Preferred Network Access Commercial |
$10,542.28
|
| Rate for Payer: Quartz Beloit One Network |
$5,614.91
|
| Rate for Payer: Quartz Commercial |
$6,875.40
|
| Rate for Payer: WEA Trust Commercial |
$6,302.45
|
| Rate for Payer: WPS Commercial |
$8,487.68
|
|
|
HUMERAL NAIL 9MM X 240MM 04.001.428S
|
Facility
|
IP
|
$12,370.00
|
|
| Hospital Charge Code |
2966295
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,061.30 |
| Max. Negotiated Rate |
$11,380.40 |
| Rate for Payer: Aetna Commercial |
$11,133.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,638.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,556.10
|
| Rate for Payer: Cash Price |
$3,711.00
|
| Rate for Payer: Cigna Commercial |
$11,380.40
|
| Rate for Payer: Health EOS Commercial |
$11,009.30
|
| Rate for Payer: HFN Commercial |
$11,380.40
|
| Rate for Payer: Multiplan Commercial |
$9,896.00
|
| Rate for Payer: NAPHCARE Commercial |
$7,422.00
|
| Rate for Payer: Preferred Network Access Commercial |
$11,380.40
|
| Rate for Payer: Quartz Beloit One Network |
$6,061.30
|
| Rate for Payer: Quartz Commercial |
$7,422.00
|
| Rate for Payer: WEA Trust Commercial |
$6,803.50
|
| Rate for Payer: WPS Commercial |
$9,162.46
|
|
|
HUMERAL NAIL 9MM X 240MM 04.001.428S
|
Facility
|
OP
|
$12,370.00
|
|
| Hospital Charge Code |
2966295
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,463.60 |
| Max. Negotiated Rate |
$49,480.00 |
| Rate for Payer: Aetna Commercial |
$11,133.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,638.20
|
| Rate for Payer: Aetna Managed Medicare |
$3,463.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,040.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,185.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,937.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,556.10
|
| Rate for Payer: Cash Price |
$3,711.00
|
| Rate for Payer: Cigna Commercial |
$11,380.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,922.25
|
| Rate for Payer: Health EOS Commercial |
$11,009.30
|
| Rate for Payer: HFN Commercial |
$11,380.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,277.50
|
| Rate for Payer: Multiplan Commercial |
$9,896.00
|
| Rate for Payer: NAPHCARE Commercial |
$7,422.00
|
| Rate for Payer: Preferred Network Access Commercial |
$11,380.40
|
| Rate for Payer: Quartz Beloit One Network |
$6,061.30
|
| Rate for Payer: Quartz Commercial |
$8,040.50
|
| Rate for Payer: Quartz Medicare Advantage |
$7,422.00
|
| Rate for Payer: The Alliance Commercial |
$49,480.00
|
| Rate for Payer: WEA Trust Commercial |
$6,803.50
|
| Rate for Payer: WPS Commercial |
$9,162.46
|
|
|
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 |
$3,371.20 |
| Max. Negotiated Rate |
$6,329.60 |
| Rate for Payer: Aetna Commercial |
$6,192.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,916.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,646.40
|
| Rate for Payer: Cash Price |
$2,064.00
|
| Rate for Payer: Cigna Commercial |
$6,329.60
|
| Rate for Payer: Health EOS Commercial |
$6,123.20
|
| Rate for Payer: HFN Commercial |
$6,329.60
|
| Rate for Payer: Multiplan Commercial |
$5,504.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,128.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,329.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,371.20
|
| Rate for Payer: Quartz Commercial |
$4,128.00
|
| Rate for Payer: WEA Trust Commercial |
$3,784.00
|
| Rate for Payer: WPS Commercial |
$5,096.02
|
|
|
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 |
$1,926.40 |
| Max. Negotiated Rate |
$27,520.00 |
| Rate for Payer: Aetna Commercial |
$6,192.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,916.80
|
| Rate for Payer: Aetna Managed Medicare |
$1,926.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,472.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,440.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,302.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,646.40
|
| Rate for Payer: Cash Price |
$2,064.00
|
| Rate for Payer: Cigna Commercial |
$6,329.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,850.05
|
| Rate for Payer: Health EOS Commercial |
$6,123.20
|
| Rate for Payer: HFN Commercial |
$6,329.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,160.00
|
| Rate for Payer: Multiplan Commercial |
$5,504.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,128.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,329.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,371.20
|
| Rate for Payer: Quartz Commercial |
$4,472.00
|
| Rate for Payer: Quartz Medicare Advantage |
$4,128.00
|
| Rate for Payer: The Alliance Commercial |
$27,520.00
|
| Rate for Payer: WEA Trust Commercial |
$3,784.00
|
| Rate for Payer: WPS Commercial |
$5,096.02
|
|
|
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 |
$3,371.20 |
| Max. Negotiated Rate |
$6,329.60 |
| Rate for Payer: Aetna Commercial |
$6,192.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,916.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,646.40
|
| Rate for Payer: Cash Price |
$2,064.00
|
| Rate for Payer: Cigna Commercial |
$6,329.60
|
| Rate for Payer: Health EOS Commercial |
$6,123.20
|
| Rate for Payer: HFN Commercial |
$6,329.60
|
| Rate for Payer: Multiplan Commercial |
$5,504.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,128.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,329.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,371.20
|
| Rate for Payer: Quartz Commercial |
$4,128.00
|
| Rate for Payer: WEA Trust Commercial |
$3,784.00
|
| Rate for Payer: WPS Commercial |
$5,096.02
|
|
|
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 |
$1,926.40 |
| Max. Negotiated Rate |
$27,520.00 |
| Rate for Payer: Aetna Commercial |
$6,192.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,916.80
|
| Rate for Payer: Aetna Managed Medicare |
$1,926.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,472.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,440.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,302.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,646.40
|
| Rate for Payer: Cash Price |
$2,064.00
|
| Rate for Payer: Cigna Commercial |
$6,329.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,850.05
|
| Rate for Payer: Health EOS Commercial |
$6,123.20
|
| Rate for Payer: HFN Commercial |
$6,329.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,160.00
|
| Rate for Payer: Multiplan Commercial |
$5,504.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,128.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,329.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,371.20
|
| Rate for Payer: Quartz Commercial |
$4,472.00
|
| Rate for Payer: Quartz Medicare Advantage |
$4,128.00
|
| Rate for Payer: The Alliance Commercial |
$27,520.00
|
| Rate for Payer: WEA Trust Commercial |
$3,784.00
|
| Rate for Payer: WPS Commercial |
$5,096.02
|
|
