|
IMPLANT ENDOTINE 3.5 FOREHEAD CFD-22102
|
Facility
|
OP
|
$4,793.00
|
|
| Hospital Charge Code |
5106850
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,395.72 |
| Max. Negotiated Rate |
$4,585.94 |
| Rate for Payer: Aetna Commercial |
$4,486.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,286.86
|
| Rate for Payer: Aetna Managed Medicare |
$1,395.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,240.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,492.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,392.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,641.90
|
| Rate for Payer: Cash Price |
$1,437.90
|
| Rate for Payer: Cigna Commercial |
$4,585.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,789.53
|
| Rate for Payer: Health EOS Commercial |
$4,436.40
|
| Rate for Payer: HFN Commercial |
$4,585.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,738.54
|
| Rate for Payer: Multiplan Commercial |
$3,987.78
|
| Rate for Payer: NAPHCARE Commercial |
$2,990.83
|
| Rate for Payer: Preferred Network Access Commercial |
$4,585.94
|
| Rate for Payer: Quartz Beloit One Network |
$2,442.51
|
| Rate for Payer: Quartz Commercial |
$3,240.07
|
| Rate for Payer: Quartz Medicare Advantage |
$2,990.83
|
| Rate for Payer: The Alliance Commercial |
$2,492.36
|
| Rate for Payer: WEA Trust Commercial |
$2,741.60
|
| Rate for Payer: WPS Commercial |
$3,692.05
|
|
|
IMPLANT FUTURA LESSER METATARSAL PHALANGEAL JOINT SILASTIC SZ 20 LMP-20T
|
Facility
|
OP
|
$7,591.00
|
|
|
Service Code
|
HCPCS L8641
|
| Hospital Charge Code |
5787625
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,782.77 |
| Max. Negotiated Rate |
$7,263.07 |
| Rate for Payer: Aetna Commercial |
$7,105.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,789.39
|
| Rate for Payer: Aetna Managed Medicare |
$2,210.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,131.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,947.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,789.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,184.16
|
| Rate for Payer: Cash Price |
$2,277.30
|
| Rate for Payer: Cash Price |
$2,277.30
|
| Rate for Payer: Cigna Commercial |
$7,263.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,417.96
|
| Rate for Payer: Health EOS Commercial |
$7,026.23
|
| Rate for Payer: HFN Commercial |
$7,263.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,920.98
|
| Rate for Payer: Multiplan Commercial |
$6,315.71
|
| Rate for Payer: NAPHCARE Commercial |
$4,736.78
|
| Rate for Payer: Preferred Network Access Commercial |
$7,263.07
|
| Rate for Payer: Quartz Beloit One Network |
$3,868.37
|
| Rate for Payer: Quartz Commercial |
$5,131.52
|
| Rate for Payer: Quartz Medicare Advantage |
$4,736.78
|
| Rate for Payer: The Alliance Commercial |
$1,782.77
|
| Rate for Payer: WEA Trust Commercial |
$4,342.05
|
| Rate for Payer: WPS Commercial |
$5,847.35
|
|
|
IMPLANT FUTURA LESSER METATARSAL PHALANGEAL JOINT SILASTIC SZ 20 LMP-20T
|
Facility
|
IP
|
$7,591.00
|
|
|
Service Code
|
HCPCS L8641
|
| Hospital Charge Code |
5787625
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,868.37 |
| Max. Negotiated Rate |
$7,263.07 |
| Rate for Payer: Aetna Commercial |
$7,105.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,789.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,184.16
|
| Rate for Payer: Cash Price |
$2,277.30
|
| Rate for Payer: Cigna Commercial |
$7,263.07
|
| Rate for Payer: Health EOS Commercial |
$7,026.23
|
| Rate for Payer: HFN Commercial |
$7,263.07
|
| Rate for Payer: Multiplan Commercial |
$6,315.71
|
| Rate for Payer: Preferred Network Access Commercial |
$7,263.07
|
| Rate for Payer: Quartz Beloit One Network |
$3,868.37
|
| Rate for Payer: Quartz Commercial |
$4,736.78
|
| Rate for Payer: WEA Trust Commercial |
$4,342.05
|
| Rate for Payer: WPS Commercial |
$5,847.35
|
|
|
IMPLANT FUTURA LESSER METATARSAL PHALANGEAL JOINT SILASTIC SZ 30 LMP-30T
|
Facility
|
OP
|
$9,580.00
|
|
|
Service Code
|
HCPCS L8641
|
| Hospital Charge Code |
5107076
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,782.77 |
| Max. Negotiated Rate |
$9,166.14 |
| Rate for Payer: Aetna Commercial |
$8,966.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,568.35
|
| Rate for Payer: Aetna Managed Medicare |
$2,789.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,476.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,981.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,782.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,280.50
|
| Rate for Payer: Cash Price |
$2,874.00
|
| Rate for Payer: Cash Price |
$2,874.00
|
| Rate for Payer: Cigna Commercial |
$9,166.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,575.56
|
| Rate for Payer: Health EOS Commercial |
$8,867.25
|
| Rate for Payer: HFN Commercial |
$9,166.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,472.40
|
| Rate for Payer: Multiplan Commercial |
$7,970.56
|
| Rate for Payer: NAPHCARE Commercial |
$5,977.92
|
| Rate for Payer: Preferred Network Access Commercial |
$9,166.14
|
| Rate for Payer: Quartz Beloit One Network |
$4,881.97
|
| Rate for Payer: Quartz Commercial |
$6,476.08
|
| Rate for Payer: Quartz Medicare Advantage |
$5,977.92
|
| Rate for Payer: The Alliance Commercial |
$1,782.77
|
| Rate for Payer: WEA Trust Commercial |
$5,479.76
|
| Rate for Payer: WPS Commercial |
$7,379.47
|
|
|
IMPLANT FUTURA LESSER METATARSAL PHALANGEAL JOINT SILASTIC SZ 30 LMP-30T
|
Facility
|
IP
|
$9,580.00
|
|
|
Service Code
|
HCPCS L8641
|
| Hospital Charge Code |
5107076
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,881.97 |
| Max. Negotiated Rate |
$9,166.14 |
| Rate for Payer: Aetna Commercial |
$8,966.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,568.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,280.50
|
| Rate for Payer: Cash Price |
$2,874.00
|
| Rate for Payer: Cigna Commercial |
$9,166.14
|
| Rate for Payer: Health EOS Commercial |
$8,867.25
|
| Rate for Payer: HFN Commercial |
$9,166.14
|
| Rate for Payer: Multiplan Commercial |
$7,970.56
|
| Rate for Payer: Preferred Network Access Commercial |
$9,166.14
|
| Rate for Payer: Quartz Beloit One Network |
$4,881.97
|
| Rate for Payer: Quartz Commercial |
$5,977.92
|
| Rate for Payer: WEA Trust Commercial |
$5,479.76
|
| Rate for Payer: WPS Commercial |
$7,379.47
|
|
|
IMPLANT FUTURA LESSER METATARSAL PHALANGEAL JOINT SILASTIC SZ 40 LMP-40T
|
Facility
|
OP
|
$9,580.00
|
|
|
Service Code
|
HCPCS L8641
|
| Hospital Charge Code |
5458838
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,782.77 |
| Max. Negotiated Rate |
$9,166.14 |
| Rate for Payer: Aetna Commercial |
$8,966.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,568.35
|
| Rate for Payer: Aetna Managed Medicare |
$2,789.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,476.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,981.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,782.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,280.50
|
| Rate for Payer: Cash Price |
$2,874.00
|
| Rate for Payer: Cash Price |
$2,874.00
|
| Rate for Payer: Cigna Commercial |
$9,166.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,575.56
|
| Rate for Payer: Health EOS Commercial |
$8,867.25
|
| Rate for Payer: HFN Commercial |
$9,166.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,472.40
|
| Rate for Payer: Multiplan Commercial |
$7,970.56
|
| Rate for Payer: NAPHCARE Commercial |
$5,977.92
|
| Rate for Payer: Preferred Network Access Commercial |
$9,166.14
|
| Rate for Payer: Quartz Beloit One Network |
$4,881.97
|
| Rate for Payer: Quartz Commercial |
$6,476.08
|
| Rate for Payer: Quartz Medicare Advantage |
$5,977.92
|
| Rate for Payer: The Alliance Commercial |
$1,782.77
|
| Rate for Payer: WEA Trust Commercial |
$5,479.76
|
| Rate for Payer: WPS Commercial |
$7,379.47
|
|
|
IMPLANT FUTURA LESSER METATARSAL PHALANGEAL JOINT SILASTIC SZ 40 LMP-40T
|
Facility
|
IP
|
$9,580.00
|
|
|
Service Code
|
HCPCS L8641
|
| Hospital Charge Code |
5458838
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,881.97 |
| Max. Negotiated Rate |
$9,166.14 |
| Rate for Payer: Aetna Commercial |
$8,966.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,568.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,280.50
|
| Rate for Payer: Cash Price |
$2,874.00
|
| Rate for Payer: Cigna Commercial |
$9,166.14
|
| Rate for Payer: Health EOS Commercial |
$8,867.25
|
| Rate for Payer: HFN Commercial |
$9,166.14
|
| Rate for Payer: Multiplan Commercial |
$7,970.56
|
| Rate for Payer: Preferred Network Access Commercial |
$9,166.14
|
| Rate for Payer: Quartz Beloit One Network |
$4,881.97
|
| Rate for Payer: Quartz Commercial |
$5,977.92
|
| Rate for Payer: WEA Trust Commercial |
$5,479.76
|
| Rate for Payer: WPS Commercial |
$7,379.47
|
|
|
IMPLANT FUTURA LESSER METATARSAL PHALANGEAL JOINT SILASTIC SZ 50 LMP-50T
|
Facility
|
OP
|
$9,580.00
|
|
|
Service Code
|
HCPCS L8641
|
| Hospital Charge Code |
5458839
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,782.77 |
| Max. Negotiated Rate |
$9,166.14 |
| Rate for Payer: Aetna Commercial |
$8,966.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,568.35
|
| Rate for Payer: Aetna Managed Medicare |
$2,789.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,476.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,981.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,782.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,280.50
|
| Rate for Payer: Cash Price |
$2,874.00
|
| Rate for Payer: Cash Price |
$2,874.00
|
| Rate for Payer: Cigna Commercial |
$9,166.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,575.56
|
| Rate for Payer: Health EOS Commercial |
$8,867.25
|
| Rate for Payer: HFN Commercial |
$9,166.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,472.40
|
| Rate for Payer: Multiplan Commercial |
$7,970.56
|
| Rate for Payer: NAPHCARE Commercial |
$5,977.92
|
| Rate for Payer: Preferred Network Access Commercial |
$9,166.14
|
| Rate for Payer: Quartz Beloit One Network |
$4,881.97
|
| Rate for Payer: Quartz Commercial |
$6,476.08
|
| Rate for Payer: Quartz Medicare Advantage |
$5,977.92
|
| Rate for Payer: The Alliance Commercial |
$1,782.77
|
| Rate for Payer: WEA Trust Commercial |
$5,479.76
|
| Rate for Payer: WPS Commercial |
$7,379.47
|
|
|
IMPLANT FUTURA LESSER METATARSAL PHALANGEAL JOINT SILASTIC SZ 50 LMP-50T
|
Facility
|
IP
|
$9,580.00
|
|
|
Service Code
|
HCPCS L8641
|
| Hospital Charge Code |
5458839
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,881.97 |
| Max. Negotiated Rate |
$9,166.14 |
| Rate for Payer: Aetna Commercial |
$8,966.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,568.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,280.50
|
| Rate for Payer: Cash Price |
$2,874.00
|
| Rate for Payer: Cigna Commercial |
$9,166.14
|
| Rate for Payer: Health EOS Commercial |
$8,867.25
|
| Rate for Payer: HFN Commercial |
$9,166.14
|
| Rate for Payer: Multiplan Commercial |
$7,970.56
|
| Rate for Payer: Preferred Network Access Commercial |
$9,166.14
|
| Rate for Payer: Quartz Beloit One Network |
$4,881.97
|
| Rate for Payer: Quartz Commercial |
$5,977.92
|
| Rate for Payer: WEA Trust Commercial |
$5,479.76
|
| Rate for Payer: WPS Commercial |
$7,379.47
|
|
|
IMPLANT FUTURA PRIMUS FGT SZ 30 FGT-30T
|
Facility
|
OP
|
$10,377.00
|
|
|
Service Code
|
HCPCS L8641
|
| Hospital Charge Code |
5179272
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,782.77 |
| Max. Negotiated Rate |
$9,928.71 |
| Rate for Payer: Aetna Commercial |
$9,712.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,281.19
|
| Rate for Payer: Aetna Managed Medicare |
$3,021.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,014.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,396.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,180.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,719.80
|
| Rate for Payer: Cash Price |
$3,113.10
|
| Rate for Payer: Cash Price |
$3,113.10
|
| Rate for Payer: Cigna Commercial |
$9,928.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,039.41
|
| Rate for Payer: Health EOS Commercial |
$9,604.95
|
| Rate for Payer: HFN Commercial |
$9,928.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,094.06
|
| Rate for Payer: Multiplan Commercial |
$8,633.66
|
| Rate for Payer: NAPHCARE Commercial |
$6,475.25
|
| Rate for Payer: Preferred Network Access Commercial |
$9,928.71
|
| Rate for Payer: Quartz Beloit One Network |
$5,288.12
|
| Rate for Payer: Quartz Commercial |
$7,014.85
|
| Rate for Payer: Quartz Medicare Advantage |
$6,475.25
|
| Rate for Payer: The Alliance Commercial |
$1,782.77
|
| Rate for Payer: WEA Trust Commercial |
$5,935.64
|
| Rate for Payer: WPS Commercial |
$7,993.40
|
|
|
IMPLANT FUTURA PRIMUS FGT SZ 30 FGT-30T
|
Facility
|
IP
|
$10,377.00
|
|
|
Service Code
|
HCPCS L8641
|
| Hospital Charge Code |
5179272
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,288.12 |
| Max. Negotiated Rate |
$9,928.71 |
| Rate for Payer: Aetna Commercial |
$9,712.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,281.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,719.80
|
| Rate for Payer: Cash Price |
$3,113.10
|
| Rate for Payer: Cigna Commercial |
$9,928.71
|
| Rate for Payer: Health EOS Commercial |
$9,604.95
|
| Rate for Payer: HFN Commercial |
$9,928.71
|
| Rate for Payer: Multiplan Commercial |
$8,633.66
|
| Rate for Payer: Preferred Network Access Commercial |
$9,928.71
|
| Rate for Payer: Quartz Beloit One Network |
$5,288.12
|
| Rate for Payer: Quartz Commercial |
$6,475.25
|
| Rate for Payer: WEA Trust Commercial |
$5,935.64
|
| Rate for Payer: WPS Commercial |
$7,993.40
|
|
|
IMPLANT FUTURA PRIMUS FGT SZ 50 FGT-50T
|
Facility
|
IP
|
$9,858.00
|
|
|
Service Code
|
HCPCS L8642
|
| Hospital Charge Code |
5611597
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,023.64 |
| Max. Negotiated Rate |
$9,432.13 |
| Rate for Payer: Aetna Commercial |
$9,227.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,817.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,433.73
|
| Rate for Payer: Cash Price |
$2,957.40
|
| Rate for Payer: Cigna Commercial |
$9,432.13
|
| Rate for Payer: Health EOS Commercial |
$9,124.56
|
| Rate for Payer: HFN Commercial |
$9,432.13
|
| Rate for Payer: Multiplan Commercial |
$8,201.86
|
| Rate for Payer: Preferred Network Access Commercial |
$9,432.13
|
| Rate for Payer: Quartz Beloit One Network |
$5,023.64
|
| Rate for Payer: Quartz Commercial |
$6,151.39
|
| Rate for Payer: WEA Trust Commercial |
$5,638.78
|
| Rate for Payer: WPS Commercial |
$7,593.62
|
|
|
IMPLANT FUTURA PRIMUS FGT SZ 50 FGT-50T
|
Facility
|
OP
|
$9,858.00
|
|
|
Service Code
|
HCPCS L8642
|
| Hospital Charge Code |
5611597
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,594.03 |
| Max. Negotiated Rate |
$9,432.13 |
| Rate for Payer: Aetna Commercial |
$9,227.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,817.00
|
| Rate for Payer: Aetna Managed Medicare |
$2,870.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,664.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,126.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,921.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,433.73
|
| Rate for Payer: Cash Price |
$2,957.40
|
| Rate for Payer: Cash Price |
$2,957.40
|
| Rate for Payer: Cigna Commercial |
$9,432.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,737.36
|
| Rate for Payer: Health EOS Commercial |
$9,124.56
|
| Rate for Payer: HFN Commercial |
$9,432.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,689.24
|
| Rate for Payer: Multiplan Commercial |
$8,201.86
|
| Rate for Payer: NAPHCARE Commercial |
$6,151.39
|
| Rate for Payer: Preferred Network Access Commercial |
$9,432.13
|
| Rate for Payer: Quartz Beloit One Network |
$5,023.64
|
| Rate for Payer: Quartz Commercial |
$6,664.01
|
| Rate for Payer: Quartz Medicare Advantage |
$6,151.39
|
| Rate for Payer: The Alliance Commercial |
$1,594.03
|
| Rate for Payer: WEA Trust Commercial |
$5,638.78
|
| Rate for Payer: WPS Commercial |
$7,593.62
|
|
|
IMPLANT FUTURA PRIMUS FLEXIBLE GREAT TOE SILASTIC SZ 30 FGT-30
|
Facility
|
IP
|
$10,377.00
|
|
|
Service Code
|
HCPCS L8641
|
| Hospital Charge Code |
5106655
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,288.12 |
| Max. Negotiated Rate |
$9,928.71 |
| Rate for Payer: Aetna Commercial |
$9,712.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,281.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,719.80
|
| Rate for Payer: Cash Price |
$3,113.10
|
| Rate for Payer: Cigna Commercial |
$9,928.71
|
| Rate for Payer: Health EOS Commercial |
$9,604.95
|
| Rate for Payer: HFN Commercial |
$9,928.71
|
| Rate for Payer: Multiplan Commercial |
$8,633.66
|
| Rate for Payer: Preferred Network Access Commercial |
$9,928.71
|
| Rate for Payer: Quartz Beloit One Network |
$5,288.12
|
| Rate for Payer: Quartz Commercial |
$6,475.25
|
| Rate for Payer: WEA Trust Commercial |
$5,935.64
|
| Rate for Payer: WPS Commercial |
$7,993.40
|
|
|
IMPLANT FUTURA PRIMUS FLEXIBLE GREAT TOE SILASTIC SZ 30 FGT-30
|
Facility
|
OP
|
$10,377.00
|
|
|
Service Code
|
HCPCS L8641
|
| Hospital Charge Code |
5106655
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,782.77 |
| Max. Negotiated Rate |
$9,928.71 |
| Rate for Payer: Aetna Commercial |
$9,712.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,281.19
|
| Rate for Payer: Aetna Managed Medicare |
$3,021.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,014.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,396.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,180.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,719.80
|
| Rate for Payer: Cash Price |
$3,113.10
|
| Rate for Payer: Cash Price |
$3,113.10
|
| Rate for Payer: Cigna Commercial |
$9,928.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,039.41
|
| Rate for Payer: Health EOS Commercial |
$9,604.95
|
| Rate for Payer: HFN Commercial |
$9,928.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,094.06
|
| Rate for Payer: Multiplan Commercial |
$8,633.66
|
| Rate for Payer: NAPHCARE Commercial |
$6,475.25
|
| Rate for Payer: Preferred Network Access Commercial |
$9,928.71
|
| Rate for Payer: Quartz Beloit One Network |
$5,288.12
|
| Rate for Payer: Quartz Commercial |
$7,014.85
|
| Rate for Payer: Quartz Medicare Advantage |
$6,475.25
|
| Rate for Payer: The Alliance Commercial |
$1,782.77
|
| Rate for Payer: WEA Trust Commercial |
$5,935.64
|
| Rate for Payer: WPS Commercial |
$7,993.40
|
|
|
IMPLANT HEMI GREAT TOE SMALL 375-0002
|
Facility
|
OP
|
$6,650.00
|
|
|
Service Code
|
HCPCS L8642
|
| Hospital Charge Code |
2965451
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,594.03 |
| Max. Negotiated Rate |
$6,362.72 |
| Rate for Payer: Aetna Commercial |
$6,224.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,947.76
|
| Rate for Payer: Aetna Managed Medicare |
$1,936.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,495.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,458.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,319.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,665.48
|
| Rate for Payer: Cash Price |
$1,995.00
|
| Rate for Payer: Cash Price |
$1,995.00
|
| Rate for Payer: Cigna Commercial |
$6,362.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,870.30
|
| Rate for Payer: Health EOS Commercial |
$6,155.24
|
| Rate for Payer: HFN Commercial |
$6,362.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,187.00
|
| Rate for Payer: Multiplan Commercial |
$5,532.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,149.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,362.72
|
| Rate for Payer: Quartz Beloit One Network |
$3,388.84
|
| Rate for Payer: Quartz Commercial |
$4,495.40
|
| Rate for Payer: Quartz Medicare Advantage |
$4,149.60
|
| Rate for Payer: The Alliance Commercial |
$1,594.03
|
| Rate for Payer: WEA Trust Commercial |
$3,803.80
|
| Rate for Payer: WPS Commercial |
$5,122.49
|
|
|
IMPLANT HEMI GREAT TOE SMALL 375-0002
|
Facility
|
IP
|
$6,650.00
|
|
|
Service Code
|
HCPCS L8642
|
| Hospital Charge Code |
2965451
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,388.84 |
| Max. Negotiated Rate |
$6,362.72 |
| Rate for Payer: Aetna Commercial |
$6,224.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,947.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,665.48
|
| Rate for Payer: Cash Price |
$1,995.00
|
| Rate for Payer: Cigna Commercial |
$6,362.72
|
| Rate for Payer: Health EOS Commercial |
$6,155.24
|
| Rate for Payer: HFN Commercial |
$6,362.72
|
| Rate for Payer: Multiplan Commercial |
$5,532.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,362.72
|
| Rate for Payer: Quartz Beloit One Network |
$3,388.84
|
| Rate for Payer: Quartz Commercial |
$4,149.60
|
| Rate for Payer: WEA Trust Commercial |
$3,803.80
|
| Rate for Payer: WPS Commercial |
$5,122.49
|
|
|
IMPLANT HORIZON SUBTALAR 8MM 17221
|
Facility
|
OP
|
$7,627.00
|
|
|
Service Code
|
HCPCS L8642
|
| Hospital Charge Code |
2964802
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,594.03 |
| Max. Negotiated Rate |
$7,297.51 |
| Rate for Payer: Aetna Commercial |
$7,138.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,821.59
|
| Rate for Payer: Aetna Managed Medicare |
$2,220.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,155.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,966.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,807.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,204.00
|
| Rate for Payer: Cash Price |
$2,288.10
|
| Rate for Payer: Cash Price |
$2,288.10
|
| Rate for Payer: Cigna Commercial |
$7,297.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,438.91
|
| Rate for Payer: Health EOS Commercial |
$7,059.55
|
| Rate for Payer: HFN Commercial |
$7,297.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,949.06
|
| Rate for Payer: Multiplan Commercial |
$6,345.66
|
| Rate for Payer: NAPHCARE Commercial |
$4,759.25
|
| Rate for Payer: Preferred Network Access Commercial |
$7,297.51
|
| Rate for Payer: Quartz Beloit One Network |
$3,886.72
|
| Rate for Payer: Quartz Commercial |
$5,155.85
|
| Rate for Payer: Quartz Medicare Advantage |
$4,759.25
|
| Rate for Payer: The Alliance Commercial |
$1,594.03
|
| Rate for Payer: WEA Trust Commercial |
$4,362.64
|
| Rate for Payer: WPS Commercial |
$5,875.08
|
|
|
IMPLANT HORIZON SUBTALAR 8MM 17221
|
Facility
|
IP
|
$7,627.00
|
|
|
Service Code
|
HCPCS L8642
|
| Hospital Charge Code |
2964802
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,886.72 |
| Max. Negotiated Rate |
$7,297.51 |
| Rate for Payer: Aetna Commercial |
$7,138.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,821.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,204.00
|
| Rate for Payer: Cash Price |
$2,288.10
|
| Rate for Payer: Cigna Commercial |
$7,297.51
|
| Rate for Payer: Health EOS Commercial |
$7,059.55
|
| Rate for Payer: HFN Commercial |
$7,297.51
|
| Rate for Payer: Multiplan Commercial |
$6,345.66
|
| Rate for Payer: Preferred Network Access Commercial |
$7,297.51
|
| Rate for Payer: Quartz Beloit One Network |
$3,886.72
|
| Rate for Payer: Quartz Commercial |
$4,759.25
|
| Rate for Payer: WEA Trust Commercial |
$4,362.64
|
| Rate for Payer: WPS Commercial |
$5,875.08
|
|
|
IMPLANT HORMONE PELLET(S) 11980
|
Professional
|
Both
|
$392.00
|
|
|
Service Code
|
CPT 11980
|
| Hospital Charge Code |
3013581
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$46.43 |
| Max. Negotiated Rate |
$387.30 |
| Rate for Payer: Aetna Commercial |
$387.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$350.60
|
| Rate for Payer: Aetna Managed Medicare |
$46.43
|
| Rate for Payer: Anthem Medicare Advantage |
$46.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$46.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$46.43
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Cigna Commercial |
$387.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$116.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$46.43
|
| Rate for Payer: Health EOS Commercial |
$370.99
|
| Rate for Payer: HFN Commercial |
$387.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$193.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$193.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$46.43
|
| Rate for Payer: Multiplan Commercial |
$326.14
|
| Rate for Payer: NAPHCARE Commercial |
$69.64
|
| Rate for Payer: Preferred Network Access Commercial |
$387.30
|
| Rate for Payer: Quartz Beloit One Network |
$179.38
|
| Rate for Payer: Quartz Commercial |
$232.38
|
| Rate for Payer: Quartz Medicare Advantage |
$46.43
|
| Rate for Payer: The Alliance Commercial |
$197.31
|
| Rate for Payer: United Healthcare Medicaid |
$116.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46.43
|
| Rate for Payer: WEA Trust Commercial |
$224.22
|
| Rate for Payer: WPS Commercial |
$208.92
|
|
|
IMPLANT KNOTLESS TIGHTROPE SYNDESMOSIS REPAIR AR-8926SS
|
Facility
|
IP
|
$8,050.00
|
|
| Hospital Charge Code |
4520424
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,102.28 |
| Max. Negotiated Rate |
$7,702.24 |
| Rate for Payer: Aetna Commercial |
$7,534.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,199.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,437.16
|
| Rate for Payer: Cash Price |
$2,415.00
|
| Rate for Payer: Cigna Commercial |
$7,702.24
|
| Rate for Payer: Health EOS Commercial |
$7,451.08
|
| Rate for Payer: HFN Commercial |
$7,702.24
|
| Rate for Payer: Multiplan Commercial |
$6,697.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,702.24
|
| Rate for Payer: Quartz Beloit One Network |
$4,102.28
|
| Rate for Payer: Quartz Commercial |
$5,023.20
|
| Rate for Payer: WEA Trust Commercial |
$4,604.60
|
| Rate for Payer: WPS Commercial |
$6,200.91
|
|
|
IMPLANT KNOTLESS TIGHTROPE SYNDESMOSIS REPAIR AR-8926SS
|
Facility
|
OP
|
$8,050.00
|
|
| Hospital Charge Code |
4520424
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,344.16 |
| Max. Negotiated Rate |
$7,702.24 |
| Rate for Payer: Aetna Commercial |
$7,534.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,199.92
|
| Rate for Payer: Aetna Managed Medicare |
$2,344.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,441.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,186.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,018.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,437.16
|
| Rate for Payer: Cash Price |
$2,415.00
|
| Rate for Payer: Cigna Commercial |
$7,702.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,685.10
|
| Rate for Payer: Health EOS Commercial |
$7,451.08
|
| Rate for Payer: HFN Commercial |
$7,702.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,279.00
|
| Rate for Payer: Multiplan Commercial |
$6,697.60
|
| Rate for Payer: NAPHCARE Commercial |
$5,023.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,702.24
|
| Rate for Payer: Quartz Beloit One Network |
$4,102.28
|
| Rate for Payer: Quartz Commercial |
$5,441.80
|
| Rate for Payer: Quartz Medicare Advantage |
$5,023.20
|
| Rate for Payer: The Alliance Commercial |
$4,186.00
|
| Rate for Payer: WEA Trust Commercial |
$4,604.60
|
| Rate for Payer: WPS Commercial |
$6,200.91
|
|
|
IMPLANT M-P JOINT GREAT TOE 20MM MD 10413
|
Facility
|
IP
|
$10,102.00
|
|
|
Service Code
|
HCPCS L8642
|
| Hospital Charge Code |
5074807
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,147.98 |
| Max. Negotiated Rate |
$9,665.59 |
| Rate for Payer: Aetna Commercial |
$9,455.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,035.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,568.22
|
| Rate for Payer: Cash Price |
$3,030.60
|
| Rate for Payer: Cigna Commercial |
$9,665.59
|
| Rate for Payer: Health EOS Commercial |
$9,350.41
|
| Rate for Payer: HFN Commercial |
$9,665.59
|
| Rate for Payer: Multiplan Commercial |
$8,404.86
|
| Rate for Payer: Preferred Network Access Commercial |
$9,665.59
|
| Rate for Payer: Quartz Beloit One Network |
$5,147.98
|
| Rate for Payer: Quartz Commercial |
$6,303.65
|
| Rate for Payer: WEA Trust Commercial |
$5,778.34
|
| Rate for Payer: WPS Commercial |
$7,781.57
|
|
|
IMPLANT M-P JOINT GREAT TOE 20MM MD 10413
|
Facility
|
OP
|
$10,102.00
|
|
|
Service Code
|
HCPCS L8642
|
| Hospital Charge Code |
5074807
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,594.03 |
| Max. Negotiated Rate |
$9,665.59 |
| Rate for Payer: Aetna Commercial |
$9,455.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,035.23
|
| Rate for Payer: Aetna Managed Medicare |
$2,941.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,828.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,253.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,042.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,568.22
|
| Rate for Payer: Cash Price |
$3,030.60
|
| Rate for Payer: Cash Price |
$3,030.60
|
| Rate for Payer: Cigna Commercial |
$9,665.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,879.36
|
| Rate for Payer: Health EOS Commercial |
$9,350.41
|
| Rate for Payer: HFN Commercial |
$9,665.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,879.56
|
| Rate for Payer: Multiplan Commercial |
$8,404.86
|
| Rate for Payer: NAPHCARE Commercial |
$6,303.65
|
| Rate for Payer: Preferred Network Access Commercial |
$9,665.59
|
| Rate for Payer: Quartz Beloit One Network |
$5,147.98
|
| Rate for Payer: Quartz Commercial |
$6,828.95
|
| Rate for Payer: Quartz Medicare Advantage |
$6,303.65
|
| Rate for Payer: The Alliance Commercial |
$1,594.03
|
| Rate for Payer: WEA Trust Commercial |
$5,778.34
|
| Rate for Payer: WPS Commercial |
$7,781.57
|
|
|
IMPLANT M-P JOINT GREAT TOE 21.5MM 14958
|
Facility
|
IP
|
$7,544.00
|
|
|
Service Code
|
HCPCS L8642
|
| Hospital Charge Code |
5200639
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,844.42 |
| Max. Negotiated Rate |
$7,218.10 |
| Rate for Payer: Aetna Commercial |
$7,061.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,747.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,158.25
|
| Rate for Payer: Cash Price |
$2,263.20
|
| Rate for Payer: Cigna Commercial |
$7,218.10
|
| Rate for Payer: Health EOS Commercial |
$6,982.73
|
| Rate for Payer: HFN Commercial |
$7,218.10
|
| Rate for Payer: Multiplan Commercial |
$6,276.61
|
| Rate for Payer: Preferred Network Access Commercial |
$7,218.10
|
| Rate for Payer: Quartz Beloit One Network |
$3,844.42
|
| Rate for Payer: Quartz Commercial |
$4,707.46
|
| Rate for Payer: WEA Trust Commercial |
$4,315.17
|
| Rate for Payer: WPS Commercial |
$5,811.14
|
|
