|
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 |
$4,694.20 |
| Max. Negotiated Rate |
$8,813.60 |
| Rate for Payer: Aetna Commercial |
$8,622.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,238.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,077.40
|
| Rate for Payer: Cash Price |
$2,874.00
|
| Rate for Payer: Cigna Commercial |
$8,813.60
|
| Rate for Payer: Health EOS Commercial |
$8,526.20
|
| Rate for Payer: HFN Commercial |
$8,813.60
|
| Rate for Payer: Multiplan Commercial |
$7,664.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,748.00
|
| Rate for Payer: Preferred Network Access Commercial |
$8,813.60
|
| Rate for Payer: Quartz Beloit One Network |
$4,694.20
|
| Rate for Payer: Quartz Commercial |
$5,748.00
|
| Rate for Payer: WEA Trust Commercial |
$5,269.00
|
| Rate for Payer: WPS Commercial |
$7,095.91
|
|
|
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 |
$5,084.73 |
| Max. Negotiated Rate |
$9,546.84 |
| Rate for Payer: Aetna Commercial |
$9,339.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,924.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,499.81
|
| Rate for Payer: Cash Price |
$3,113.10
|
| Rate for Payer: Cigna Commercial |
$9,546.84
|
| Rate for Payer: Health EOS Commercial |
$9,235.53
|
| Rate for Payer: HFN Commercial |
$9,546.84
|
| Rate for Payer: Multiplan Commercial |
$8,301.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,226.20
|
| Rate for Payer: Preferred Network Access Commercial |
$9,546.84
|
| Rate for Payer: Quartz Beloit One Network |
$5,084.73
|
| Rate for Payer: Quartz Commercial |
$6,226.20
|
| Rate for Payer: WEA Trust Commercial |
$5,707.35
|
| Rate for Payer: WPS Commercial |
$7,686.24
|
|
|
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 |
$2,905.56 |
| Max. Negotiated Rate |
$41,508.00 |
| Rate for Payer: Aetna Commercial |
$9,339.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,924.22
|
| Rate for Payer: Aetna Managed Medicare |
$2,905.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,745.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,188.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,980.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,499.81
|
| Rate for Payer: Cash Price |
$3,113.10
|
| Rate for Payer: Cigna Commercial |
$9,546.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,806.97
|
| Rate for Payer: Health EOS Commercial |
$9,235.53
|
| Rate for Payer: HFN Commercial |
$9,546.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,782.75
|
| Rate for Payer: Multiplan Commercial |
$8,301.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,226.20
|
| Rate for Payer: Preferred Network Access Commercial |
$9,546.84
|
| Rate for Payer: Quartz Beloit One Network |
$5,084.73
|
| Rate for Payer: Quartz Commercial |
$6,745.05
|
| Rate for Payer: Quartz Medicare Advantage |
$6,226.20
|
| Rate for Payer: The Alliance Commercial |
$41,508.00
|
| Rate for Payer: WEA Trust Commercial |
$5,707.35
|
| Rate for Payer: WPS Commercial |
$7,686.24
|
|
|
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 |
$4,830.42 |
| Max. Negotiated Rate |
$9,069.36 |
| Rate for Payer: Aetna Commercial |
$8,872.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,477.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,224.74
|
| Rate for Payer: Cash Price |
$2,957.40
|
| Rate for Payer: Cigna Commercial |
$9,069.36
|
| Rate for Payer: Health EOS Commercial |
$8,773.62
|
| Rate for Payer: HFN Commercial |
$9,069.36
|
| Rate for Payer: Multiplan Commercial |
$7,886.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,914.80
|
| Rate for Payer: Preferred Network Access Commercial |
$9,069.36
|
| Rate for Payer: Quartz Beloit One Network |
$4,830.42
|
| Rate for Payer: Quartz Commercial |
$5,914.80
|
| Rate for Payer: WEA Trust Commercial |
$5,421.90
|
| Rate for Payer: WPS Commercial |
$7,301.82
|
|
|
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 |
$2,760.24 |
| Max. Negotiated Rate |
$39,432.00 |
| Rate for Payer: Aetna Commercial |
$8,872.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,477.88
|
| Rate for Payer: Aetna Managed Medicare |
$2,760.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,407.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,929.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,731.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,224.74
|
| Rate for Payer: Cash Price |
$2,957.40
|
| Rate for Payer: Cigna Commercial |
$9,069.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,516.54
|
| Rate for Payer: Health EOS Commercial |
$8,773.62
|
| Rate for Payer: HFN Commercial |
$9,069.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,393.50
|
| Rate for Payer: Multiplan Commercial |
$7,886.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,914.80
|
| Rate for Payer: Preferred Network Access Commercial |
$9,069.36
|
| Rate for Payer: Quartz Beloit One Network |
$4,830.42
|
| Rate for Payer: Quartz Commercial |
$6,407.70
|
| Rate for Payer: Quartz Medicare Advantage |
$5,914.80
|
| Rate for Payer: The Alliance Commercial |
$39,432.00
|
| Rate for Payer: WEA Trust Commercial |
$5,421.90
|
| Rate for Payer: WPS Commercial |
$7,301.82
|
|
|
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 |
$2,905.56 |
| Max. Negotiated Rate |
$41,508.00 |
| Rate for Payer: Aetna Commercial |
$9,339.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,924.22
|
| Rate for Payer: Aetna Managed Medicare |
$2,905.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,745.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,188.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,980.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,499.81
|
| Rate for Payer: Cash Price |
$3,113.10
|
| Rate for Payer: Cigna Commercial |
$9,546.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,806.97
|
| Rate for Payer: Health EOS Commercial |
$9,235.53
|
| Rate for Payer: HFN Commercial |
$9,546.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,782.75
|
| Rate for Payer: Multiplan Commercial |
$8,301.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,226.20
|
| Rate for Payer: Preferred Network Access Commercial |
$9,546.84
|
| Rate for Payer: Quartz Beloit One Network |
$5,084.73
|
| Rate for Payer: Quartz Commercial |
$6,745.05
|
| Rate for Payer: Quartz Medicare Advantage |
$6,226.20
|
| Rate for Payer: The Alliance Commercial |
$41,508.00
|
| Rate for Payer: WEA Trust Commercial |
$5,707.35
|
| Rate for Payer: WPS Commercial |
$7,686.24
|
|
|
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 |
$5,084.73 |
| Max. Negotiated Rate |
$9,546.84 |
| Rate for Payer: Aetna Commercial |
$9,339.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,924.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,499.81
|
| Rate for Payer: Cash Price |
$3,113.10
|
| Rate for Payer: Cigna Commercial |
$9,546.84
|
| Rate for Payer: Health EOS Commercial |
$9,235.53
|
| Rate for Payer: HFN Commercial |
$9,546.84
|
| Rate for Payer: Multiplan Commercial |
$8,301.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,226.20
|
| Rate for Payer: Preferred Network Access Commercial |
$9,546.84
|
| Rate for Payer: Quartz Beloit One Network |
$5,084.73
|
| Rate for Payer: Quartz Commercial |
$6,226.20
|
| Rate for Payer: WEA Trust Commercial |
$5,707.35
|
| Rate for Payer: WPS Commercial |
$7,686.24
|
|
|
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 |
$3,258.50 |
| Max. Negotiated Rate |
$6,118.00 |
| Rate for Payer: Aetna Commercial |
$5,985.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,719.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,524.50
|
| Rate for Payer: Cash Price |
$1,995.00
|
| Rate for Payer: Cigna Commercial |
$6,118.00
|
| Rate for Payer: Health EOS Commercial |
$5,918.50
|
| Rate for Payer: HFN Commercial |
$6,118.00
|
| Rate for Payer: Multiplan Commercial |
$5,320.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,990.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,118.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,258.50
|
| Rate for Payer: Quartz Commercial |
$3,990.00
|
| Rate for Payer: WEA Trust Commercial |
$3,657.50
|
| Rate for Payer: WPS Commercial |
$4,925.66
|
|
|
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 |
$1,862.00 |
| Max. Negotiated Rate |
$26,600.00 |
| Rate for Payer: Aetna Commercial |
$5,985.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,719.00
|
| Rate for Payer: Aetna Managed Medicare |
$1,862.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,322.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,325.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,192.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,524.50
|
| Rate for Payer: Cash Price |
$1,995.00
|
| Rate for Payer: Cigna Commercial |
$6,118.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,721.34
|
| Rate for Payer: Health EOS Commercial |
$5,918.50
|
| Rate for Payer: HFN Commercial |
$6,118.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,987.50
|
| Rate for Payer: Multiplan Commercial |
$5,320.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,990.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,118.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,258.50
|
| Rate for Payer: Quartz Commercial |
$4,322.50
|
| Rate for Payer: Quartz Medicare Advantage |
$3,990.00
|
| Rate for Payer: The Alliance Commercial |
$26,600.00
|
| Rate for Payer: WEA Trust Commercial |
$3,657.50
|
| Rate for Payer: WPS Commercial |
$4,925.66
|
|
|
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 |
$3,737.23 |
| Max. Negotiated Rate |
$7,016.84 |
| Rate for Payer: Aetna Commercial |
$6,864.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,559.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,042.31
|
| Rate for Payer: Cash Price |
$2,288.10
|
| Rate for Payer: Cigna Commercial |
$7,016.84
|
| Rate for Payer: Health EOS Commercial |
$6,788.03
|
| Rate for Payer: HFN Commercial |
$7,016.84
|
| Rate for Payer: Multiplan Commercial |
$6,101.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,576.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,016.84
|
| Rate for Payer: Quartz Beloit One Network |
$3,737.23
|
| Rate for Payer: Quartz Commercial |
$4,576.20
|
| Rate for Payer: WEA Trust Commercial |
$4,194.85
|
| Rate for Payer: WPS Commercial |
$5,649.32
|
|
|
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 |
$2,135.56 |
| Max. Negotiated Rate |
$30,508.00 |
| Rate for Payer: Aetna Commercial |
$6,864.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,559.22
|
| Rate for Payer: Aetna Managed Medicare |
$2,135.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,957.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,813.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,660.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,042.31
|
| Rate for Payer: Cash Price |
$2,288.10
|
| Rate for Payer: Cigna Commercial |
$7,016.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,268.07
|
| Rate for Payer: Health EOS Commercial |
$6,788.03
|
| Rate for Payer: HFN Commercial |
$7,016.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,720.25
|
| Rate for Payer: Multiplan Commercial |
$6,101.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,576.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,016.84
|
| Rate for Payer: Quartz Beloit One Network |
$3,737.23
|
| Rate for Payer: Quartz Commercial |
$4,957.55
|
| Rate for Payer: Quartz Medicare Advantage |
$4,576.20
|
| Rate for Payer: The Alliance Commercial |
$30,508.00
|
| Rate for Payer: WEA Trust Commercial |
$4,194.85
|
| Rate for Payer: WPS Commercial |
$5,649.32
|
|
|
IMPLANT HORMONE PELLET(S) 11980
|
Professional
|
Both
|
$392.00
|
|
|
Service Code
|
CPT 11980
|
| Hospital Charge Code |
3013581
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$111.63 |
| Max. Negotiated Rate |
$372.40 |
| Rate for Payer: Aetna Commercial |
$372.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$337.12
|
| 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 |
$372.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$111.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$235.20
|
| Rate for Payer: Health EOS Commercial |
$356.72
|
| Rate for Payer: HFN Commercial |
$372.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$185.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$185.85
|
| Rate for Payer: Multiplan Commercial |
$313.60
|
| Rate for Payer: Preferred Network Access Commercial |
$372.40
|
| Rate for Payer: Quartz Beloit One Network |
$172.48
|
| Rate for Payer: Quartz Commercial |
$223.44
|
| Rate for Payer: The Alliance Commercial |
$196.00
|
| Rate for Payer: United Healthcare Medicaid |
$111.63
|
| Rate for Payer: WEA Trust Commercial |
$215.60
|
| Rate for Payer: WPS Commercial |
$290.35
|
|
|
IMPLANT KNOTLESS TIGHTROPE SYNDESMOSIS REPAIR AR-8926SS
|
Facility
|
OP
|
$8,050.00
|
|
| Hospital Charge Code |
4520424
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,254.00 |
| Max. Negotiated Rate |
$32,200.00 |
| Rate for Payer: Aetna Commercial |
$7,245.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,923.00
|
| Rate for Payer: Aetna Managed Medicare |
$2,254.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,232.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,025.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,864.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,266.50
|
| Rate for Payer: Cash Price |
$2,415.00
|
| Rate for Payer: Cigna Commercial |
$7,406.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,504.78
|
| Rate for Payer: Health EOS Commercial |
$7,164.50
|
| Rate for Payer: HFN Commercial |
$7,406.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,037.50
|
| Rate for Payer: Multiplan Commercial |
$6,440.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,830.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,406.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,944.50
|
| Rate for Payer: Quartz Commercial |
$5,232.50
|
| Rate for Payer: Quartz Medicare Advantage |
$4,830.00
|
| Rate for Payer: The Alliance Commercial |
$32,200.00
|
| Rate for Payer: WEA Trust Commercial |
$4,427.50
|
| Rate for Payer: WPS Commercial |
$5,962.64
|
|
|
IMPLANT KNOTLESS TIGHTROPE SYNDESMOSIS REPAIR AR-8926SS
|
Facility
|
IP
|
$8,050.00
|
|
| Hospital Charge Code |
4520424
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,944.50 |
| Max. Negotiated Rate |
$7,406.00 |
| Rate for Payer: Aetna Commercial |
$7,245.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,923.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,266.50
|
| Rate for Payer: Cash Price |
$2,415.00
|
| Rate for Payer: Cigna Commercial |
$7,406.00
|
| Rate for Payer: Health EOS Commercial |
$7,164.50
|
| Rate for Payer: HFN Commercial |
$7,406.00
|
| Rate for Payer: Multiplan Commercial |
$6,440.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,830.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,406.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,944.50
|
| Rate for Payer: Quartz Commercial |
$4,830.00
|
| Rate for Payer: WEA Trust Commercial |
$4,427.50
|
| Rate for Payer: WPS Commercial |
$5,962.64
|
|
|
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 |
$2,828.56 |
| Max. Negotiated Rate |
$40,408.00 |
| Rate for Payer: Aetna Commercial |
$9,091.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,687.72
|
| Rate for Payer: Aetna Managed Medicare |
$2,828.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,566.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,051.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,848.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,354.06
|
| Rate for Payer: Cash Price |
$3,030.60
|
| Rate for Payer: Cigna Commercial |
$9,293.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,653.08
|
| Rate for Payer: Health EOS Commercial |
$8,990.78
|
| Rate for Payer: HFN Commercial |
$9,293.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,576.50
|
| Rate for Payer: Multiplan Commercial |
$8,081.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,061.20
|
| Rate for Payer: Preferred Network Access Commercial |
$9,293.84
|
| Rate for Payer: Quartz Beloit One Network |
$4,949.98
|
| Rate for Payer: Quartz Commercial |
$6,566.30
|
| Rate for Payer: Quartz Medicare Advantage |
$6,061.20
|
| Rate for Payer: The Alliance Commercial |
$40,408.00
|
| Rate for Payer: WEA Trust Commercial |
$5,556.10
|
| Rate for Payer: WPS Commercial |
$7,482.55
|
|
|
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 |
$4,949.98 |
| Max. Negotiated Rate |
$9,293.84 |
| Rate for Payer: Aetna Commercial |
$9,091.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,687.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,354.06
|
| Rate for Payer: Cash Price |
$3,030.60
|
| Rate for Payer: Cigna Commercial |
$9,293.84
|
| Rate for Payer: Health EOS Commercial |
$8,990.78
|
| Rate for Payer: HFN Commercial |
$9,293.84
|
| Rate for Payer: Multiplan Commercial |
$8,081.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,061.20
|
| Rate for Payer: Preferred Network Access Commercial |
$9,293.84
|
| Rate for Payer: Quartz Beloit One Network |
$4,949.98
|
| Rate for Payer: Quartz Commercial |
$6,061.20
|
| Rate for Payer: WEA Trust Commercial |
$5,556.10
|
| Rate for Payer: WPS Commercial |
$7,482.55
|
|
|
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 |
$3,696.56 |
| Max. Negotiated Rate |
$6,940.48 |
| Rate for Payer: Aetna Commercial |
$6,789.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,487.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,998.32
|
| Rate for Payer: Cash Price |
$2,263.20
|
| Rate for Payer: Cigna Commercial |
$6,940.48
|
| Rate for Payer: Health EOS Commercial |
$6,714.16
|
| Rate for Payer: HFN Commercial |
$6,940.48
|
| Rate for Payer: Multiplan Commercial |
$6,035.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,526.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,940.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,696.56
|
| Rate for Payer: Quartz Commercial |
$4,526.40
|
| Rate for Payer: WEA Trust Commercial |
$4,149.20
|
| Rate for Payer: WPS Commercial |
$5,587.84
|
|
|
IMPLANT M-P JOINT GREAT TOE 21.5MM 14958
|
Facility
|
OP
|
$7,544.00
|
|
|
Service Code
|
HCPCS L8642
|
| Hospital Charge Code |
5200639
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,112.32 |
| Max. Negotiated Rate |
$30,176.00 |
| Rate for Payer: Aetna Commercial |
$6,789.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,487.84
|
| Rate for Payer: Aetna Managed Medicare |
$2,112.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,903.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,772.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,621.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,998.32
|
| Rate for Payer: Cash Price |
$2,263.20
|
| Rate for Payer: Cigna Commercial |
$6,940.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,221.62
|
| Rate for Payer: Health EOS Commercial |
$6,714.16
|
| Rate for Payer: HFN Commercial |
$6,940.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,658.00
|
| Rate for Payer: Multiplan Commercial |
$6,035.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,526.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,940.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,696.56
|
| Rate for Payer: Quartz Commercial |
$4,903.60
|
| Rate for Payer: Quartz Medicare Advantage |
$4,526.40
|
| Rate for Payer: The Alliance Commercial |
$30,176.00
|
| Rate for Payer: WEA Trust Commercial |
$4,149.20
|
| Rate for Payer: WPS Commercial |
$5,587.84
|
|
|
IMPLANT M-P JOINT GREAT TOE LG 10414
|
Facility
|
IP
|
$10,102.00
|
|
|
Service Code
|
HCPCS L8642
|
| Hospital Charge Code |
3879346
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,949.98 |
| Max. Negotiated Rate |
$9,293.84 |
| Rate for Payer: Aetna Commercial |
$9,091.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,687.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,354.06
|
| Rate for Payer: Cash Price |
$3,030.60
|
| Rate for Payer: Cigna Commercial |
$9,293.84
|
| Rate for Payer: Health EOS Commercial |
$8,990.78
|
| Rate for Payer: HFN Commercial |
$9,293.84
|
| Rate for Payer: Multiplan Commercial |
$8,081.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,061.20
|
| Rate for Payer: Preferred Network Access Commercial |
$9,293.84
|
| Rate for Payer: Quartz Beloit One Network |
$4,949.98
|
| Rate for Payer: Quartz Commercial |
$6,061.20
|
| Rate for Payer: WEA Trust Commercial |
$5,556.10
|
| Rate for Payer: WPS Commercial |
$7,482.55
|
|
|
IMPLANT M-P JOINT GREAT TOE LG 10414
|
Facility
|
OP
|
$10,102.00
|
|
|
Service Code
|
HCPCS L8642
|
| Hospital Charge Code |
3879346
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,828.56 |
| Max. Negotiated Rate |
$40,408.00 |
| Rate for Payer: Aetna Commercial |
$9,091.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,687.72
|
| Rate for Payer: Aetna Managed Medicare |
$2,828.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,566.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,051.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,848.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,354.06
|
| Rate for Payer: Cash Price |
$3,030.60
|
| Rate for Payer: Cigna Commercial |
$9,293.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,653.08
|
| Rate for Payer: Health EOS Commercial |
$8,990.78
|
| Rate for Payer: HFN Commercial |
$9,293.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,576.50
|
| Rate for Payer: Multiplan Commercial |
$8,081.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,061.20
|
| Rate for Payer: Preferred Network Access Commercial |
$9,293.84
|
| Rate for Payer: Quartz Beloit One Network |
$4,949.98
|
| Rate for Payer: Quartz Commercial |
$6,566.30
|
| Rate for Payer: Quartz Medicare Advantage |
$6,061.20
|
| Rate for Payer: The Alliance Commercial |
$40,408.00
|
| Rate for Payer: WEA Trust Commercial |
$5,556.10
|
| Rate for Payer: WPS Commercial |
$7,482.55
|
|
|
IMPLANT M-P JOINT GREAT TOE ML 21.5MM 14960
|
Facility
|
IP
|
$10,102.00
|
|
|
Service Code
|
HCPCS L8642
|
| Hospital Charge Code |
5179245
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,949.98 |
| Max. Negotiated Rate |
$9,293.84 |
| Rate for Payer: Aetna Commercial |
$9,091.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,687.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,354.06
|
| Rate for Payer: Cash Price |
$3,030.60
|
| Rate for Payer: Cigna Commercial |
$9,293.84
|
| Rate for Payer: Health EOS Commercial |
$8,990.78
|
| Rate for Payer: HFN Commercial |
$9,293.84
|
| Rate for Payer: Multiplan Commercial |
$8,081.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,061.20
|
| Rate for Payer: Preferred Network Access Commercial |
$9,293.84
|
| Rate for Payer: Quartz Beloit One Network |
$4,949.98
|
| Rate for Payer: Quartz Commercial |
$6,061.20
|
| Rate for Payer: WEA Trust Commercial |
$5,556.10
|
| Rate for Payer: WPS Commercial |
$7,482.55
|
|
|
IMPLANT M-P JOINT GREAT TOE ML 21.5MM 14960
|
Facility
|
OP
|
$10,102.00
|
|
|
Service Code
|
HCPCS L8642
|
| Hospital Charge Code |
5179245
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,828.56 |
| Max. Negotiated Rate |
$40,408.00 |
| Rate for Payer: Aetna Commercial |
$9,091.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,687.72
|
| Rate for Payer: Aetna Managed Medicare |
$2,828.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,566.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,051.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,848.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,354.06
|
| Rate for Payer: Cash Price |
$3,030.60
|
| Rate for Payer: Cigna Commercial |
$9,293.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,653.08
|
| Rate for Payer: Health EOS Commercial |
$8,990.78
|
| Rate for Payer: HFN Commercial |
$9,293.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,576.50
|
| Rate for Payer: Multiplan Commercial |
$8,081.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,061.20
|
| Rate for Payer: Preferred Network Access Commercial |
$9,293.84
|
| Rate for Payer: Quartz Beloit One Network |
$4,949.98
|
| Rate for Payer: Quartz Commercial |
$6,566.30
|
| Rate for Payer: Quartz Medicare Advantage |
$6,061.20
|
| Rate for Payer: The Alliance Commercial |
$40,408.00
|
| Rate for Payer: WEA Trust Commercial |
$5,556.10
|
| Rate for Payer: WPS Commercial |
$7,482.55
|
|
|
IMPLANT M-P JOINT GREAT TOE MS 18.5MM 17034
|
Facility
|
OP
|
$10,102.00
|
|
|
Service Code
|
HCPCS L8642
|
| Hospital Charge Code |
5264939
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,828.56 |
| Max. Negotiated Rate |
$40,408.00 |
| Rate for Payer: Aetna Commercial |
$9,091.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,687.72
|
| Rate for Payer: Aetna Managed Medicare |
$2,828.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,566.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,051.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,848.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,354.06
|
| Rate for Payer: Cash Price |
$3,030.60
|
| Rate for Payer: Cigna Commercial |
$9,293.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,653.08
|
| Rate for Payer: Health EOS Commercial |
$8,990.78
|
| Rate for Payer: HFN Commercial |
$9,293.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,576.50
|
| Rate for Payer: Multiplan Commercial |
$8,081.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,061.20
|
| Rate for Payer: Preferred Network Access Commercial |
$9,293.84
|
| Rate for Payer: Quartz Beloit One Network |
$4,949.98
|
| Rate for Payer: Quartz Commercial |
$6,566.30
|
| Rate for Payer: Quartz Medicare Advantage |
$6,061.20
|
| Rate for Payer: The Alliance Commercial |
$40,408.00
|
| Rate for Payer: WEA Trust Commercial |
$5,556.10
|
| Rate for Payer: WPS Commercial |
$7,482.55
|
|
|
IMPLANT M-P JOINT GREAT TOE MS 18.5MM 17034
|
Facility
|
IP
|
$10,102.00
|
|
|
Service Code
|
HCPCS L8642
|
| Hospital Charge Code |
5264939
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,949.98 |
| Max. Negotiated Rate |
$9,293.84 |
| Rate for Payer: Aetna Commercial |
$9,091.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,687.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,354.06
|
| Rate for Payer: Cash Price |
$3,030.60
|
| Rate for Payer: Cigna Commercial |
$9,293.84
|
| Rate for Payer: Health EOS Commercial |
$8,990.78
|
| Rate for Payer: HFN Commercial |
$9,293.84
|
| Rate for Payer: Multiplan Commercial |
$8,081.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,061.20
|
| Rate for Payer: Preferred Network Access Commercial |
$9,293.84
|
| Rate for Payer: Quartz Beloit One Network |
$4,949.98
|
| Rate for Payer: Quartz Commercial |
$6,061.20
|
| Rate for Payer: WEA Trust Commercial |
$5,556.10
|
| Rate for Payer: WPS Commercial |
$7,482.55
|
|
|
IMPLANT M-P JOINT POROUS COATED SMALL 10412
|
Facility
|
OP
|
$6,559.00
|
|
| Hospital Charge Code |
2969378
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,836.52 |
| Max. Negotiated Rate |
$26,236.00 |
| Rate for Payer: Aetna Commercial |
$5,903.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,640.74
|
| Rate for Payer: Aetna Managed Medicare |
$1,836.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,263.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,279.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,148.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,476.27
|
| Rate for Payer: Cash Price |
$1,967.70
|
| Rate for Payer: Cigna Commercial |
$6,034.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,670.42
|
| Rate for Payer: Health EOS Commercial |
$5,837.51
|
| Rate for Payer: HFN Commercial |
$6,034.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,919.25
|
| Rate for Payer: Multiplan Commercial |
$5,247.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,935.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,034.28
|
| Rate for Payer: Quartz Beloit One Network |
$3,213.91
|
| Rate for Payer: Quartz Commercial |
$4,263.35
|
| Rate for Payer: Quartz Medicare Advantage |
$3,935.40
|
| Rate for Payer: The Alliance Commercial |
$26,236.00
|
| Rate for Payer: WEA Trust Commercial |
$3,607.45
|
| Rate for Payer: WPS Commercial |
$4,858.25
|
|
