|
IMPLANT TESTICULAR TOROSA SALINE-FILLED 2.9 X 4.5CM LARGE 450-1329
|
Facility
|
IP
|
$11,201.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4006567
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,488.49 |
| Max. Negotiated Rate |
$10,304.92 |
| Rate for Payer: Aetna Commercial |
$10,080.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,632.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,936.53
|
| Rate for Payer: Cash Price |
$3,360.30
|
| Rate for Payer: Cigna Commercial |
$10,304.92
|
| Rate for Payer: Health EOS Commercial |
$9,968.89
|
| Rate for Payer: HFN Commercial |
$10,304.92
|
| Rate for Payer: Multiplan Commercial |
$8,960.80
|
| Rate for Payer: NAPHCARE Commercial |
$6,720.60
|
| Rate for Payer: Preferred Network Access Commercial |
$10,304.92
|
| Rate for Payer: Quartz Beloit One Network |
$5,488.49
|
| Rate for Payer: Quartz Commercial |
$6,720.60
|
| Rate for Payer: WEA Trust Commercial |
$6,160.55
|
| Rate for Payer: WPS Commercial |
$8,296.58
|
|
|
IMPLANT TESTICULAR TOROSA SALINE-FILLED MED 2.7CM X 4.0CM 450-1327
|
Facility
|
OP
|
$11,632.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4124758
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,256.96 |
| Max. Negotiated Rate |
$46,528.00 |
| Rate for Payer: Aetna Commercial |
$10,468.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,003.52
|
| Rate for Payer: Aetna Managed Medicare |
$3,256.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,560.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,816.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,583.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,164.96
|
| Rate for Payer: Cash Price |
$3,489.60
|
| Rate for Payer: Cigna Commercial |
$10,701.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,509.27
|
| Rate for Payer: Health EOS Commercial |
$10,352.48
|
| Rate for Payer: HFN Commercial |
$10,701.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,724.00
|
| Rate for Payer: Multiplan Commercial |
$9,305.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,979.20
|
| Rate for Payer: Preferred Network Access Commercial |
$10,701.44
|
| Rate for Payer: Quartz Beloit One Network |
$5,699.68
|
| Rate for Payer: Quartz Commercial |
$7,560.80
|
| Rate for Payer: Quartz Medicare Advantage |
$6,979.20
|
| Rate for Payer: The Alliance Commercial |
$46,528.00
|
| Rate for Payer: WEA Trust Commercial |
$6,397.60
|
| Rate for Payer: WPS Commercial |
$8,615.82
|
|
|
IMPLANT TESTICULAR TOROSA SALINE-FILLED MED 2.7CM X 4.0CM 450-1327
|
Facility
|
IP
|
$11,632.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4124758
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,699.68 |
| Max. Negotiated Rate |
$10,701.44 |
| Rate for Payer: Aetna Commercial |
$10,468.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,003.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,164.96
|
| Rate for Payer: Cash Price |
$3,489.60
|
| Rate for Payer: Cigna Commercial |
$10,701.44
|
| Rate for Payer: Health EOS Commercial |
$10,352.48
|
| Rate for Payer: HFN Commercial |
$10,701.44
|
| Rate for Payer: Multiplan Commercial |
$9,305.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,979.20
|
| Rate for Payer: Preferred Network Access Commercial |
$10,701.44
|
| Rate for Payer: Quartz Beloit One Network |
$5,699.68
|
| Rate for Payer: Quartz Commercial |
$6,979.20
|
| Rate for Payer: WEA Trust Commercial |
$6,397.60
|
| Rate for Payer: WPS Commercial |
$8,615.82
|
|
|
IMPLANT THYROPLASTY DEVICE
|
Facility
|
IP
|
$3,064.00
|
|
| Hospital Charge Code |
2965333
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,501.36 |
| Max. Negotiated Rate |
$2,818.88 |
| Rate for Payer: Aetna Commercial |
$2,757.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,635.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,623.92
|
| Rate for Payer: Cash Price |
$919.20
|
| Rate for Payer: Cigna Commercial |
$2,818.88
|
| Rate for Payer: Health EOS Commercial |
$2,726.96
|
| Rate for Payer: HFN Commercial |
$2,818.88
|
| Rate for Payer: Multiplan Commercial |
$2,451.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,838.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,818.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,501.36
|
| Rate for Payer: Quartz Commercial |
$1,838.40
|
| Rate for Payer: WEA Trust Commercial |
$1,685.20
|
| Rate for Payer: WPS Commercial |
$2,269.50
|
|
|
IMPLANT THYROPLASTY DEVICE
|
Facility
|
OP
|
$3,064.00
|
|
| Hospital Charge Code |
2965333
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$857.92 |
| Max. Negotiated Rate |
$12,256.00 |
| Rate for Payer: Aetna Commercial |
$2,757.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,635.04
|
| Rate for Payer: Aetna Managed Medicare |
$857.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,991.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,532.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,470.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,623.92
|
| Rate for Payer: Cash Price |
$919.20
|
| Rate for Payer: Cigna Commercial |
$2,818.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,714.61
|
| Rate for Payer: Health EOS Commercial |
$2,726.96
|
| Rate for Payer: HFN Commercial |
$2,818.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,298.00
|
| Rate for Payer: Multiplan Commercial |
$2,451.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,838.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,818.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,501.36
|
| Rate for Payer: Quartz Commercial |
$1,991.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,838.40
|
| Rate for Payer: The Alliance Commercial |
$12,256.00
|
| Rate for Payer: WEA Trust Commercial |
$1,685.20
|
| Rate for Payer: WPS Commercial |
$2,269.50
|
|
|
IMPLANT TIGHTROPE SYNDESMOSIS XP AR-8925SS
|
Facility
|
OP
|
$8,588.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414739
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,404.64 |
| Max. Negotiated Rate |
$34,352.00 |
| Rate for Payer: Aetna Commercial |
$7,729.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,385.68
|
| Rate for Payer: Aetna Managed Medicare |
$2,404.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,582.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,294.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,122.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,551.64
|
| Rate for Payer: Cash Price |
$2,576.40
|
| Rate for Payer: Cigna Commercial |
$7,900.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,805.84
|
| Rate for Payer: Health EOS Commercial |
$7,643.32
|
| Rate for Payer: HFN Commercial |
$7,900.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,441.00
|
| Rate for Payer: Multiplan Commercial |
$6,870.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,152.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,900.96
|
| Rate for Payer: Quartz Beloit One Network |
$4,208.12
|
| Rate for Payer: Quartz Commercial |
$5,582.20
|
| Rate for Payer: Quartz Medicare Advantage |
$5,152.80
|
| Rate for Payer: The Alliance Commercial |
$34,352.00
|
| Rate for Payer: WEA Trust Commercial |
$4,723.40
|
| Rate for Payer: WPS Commercial |
$6,361.13
|
|
|
IMPLANT TIGHTROPE SYNDESMOSIS XP AR-8925SS
|
Facility
|
IP
|
$8,588.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414739
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,208.12 |
| Max. Negotiated Rate |
$7,900.96 |
| Rate for Payer: Aetna Commercial |
$7,729.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,385.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,551.64
|
| Rate for Payer: Cash Price |
$2,576.40
|
| Rate for Payer: Cigna Commercial |
$7,900.96
|
| Rate for Payer: Health EOS Commercial |
$7,643.32
|
| Rate for Payer: HFN Commercial |
$7,900.96
|
| Rate for Payer: Multiplan Commercial |
$6,870.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,152.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,900.96
|
| Rate for Payer: Quartz Beloit One Network |
$4,208.12
|
| Rate for Payer: Quartz Commercial |
$5,152.80
|
| Rate for Payer: WEA Trust Commercial |
$4,723.40
|
| Rate for Payer: WPS Commercial |
$6,361.13
|
|
|
IMPLANT TOE JOINT BIOPRO NPS MD 20MM COBALT CHROME 10061
|
Facility
|
IP
|
$7,544.00
|
|
|
Service Code
|
HCPCS L8642
|
| Hospital Charge Code |
5415479
|
|
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 TOE JOINT BIOPRO NPS MD 20MM COBALT CHROME 10061
|
Facility
|
OP
|
$7,544.00
|
|
|
Service Code
|
HCPCS L8642
|
| Hospital Charge Code |
5415479
|
|
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 TOETAC XPRESS LARGE HAMMERTOE HT-00003
|
Facility
|
OP
|
$8,142.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5547499
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,279.76 |
| Max. Negotiated Rate |
$32,568.00 |
| Rate for Payer: Aetna Commercial |
$7,327.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,002.12
|
| Rate for Payer: Aetna Managed Medicare |
$2,279.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,292.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,071.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,908.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,315.26
|
| Rate for Payer: Cash Price |
$2,442.60
|
| Rate for Payer: Cigna Commercial |
$7,490.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,556.26
|
| Rate for Payer: Health EOS Commercial |
$7,246.38
|
| Rate for Payer: HFN Commercial |
$7,490.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,106.50
|
| Rate for Payer: Multiplan Commercial |
$6,513.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,885.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,490.64
|
| Rate for Payer: Quartz Beloit One Network |
$3,989.58
|
| Rate for Payer: Quartz Commercial |
$5,292.30
|
| Rate for Payer: Quartz Medicare Advantage |
$4,885.20
|
| Rate for Payer: The Alliance Commercial |
$32,568.00
|
| Rate for Payer: WEA Trust Commercial |
$4,478.10
|
| Rate for Payer: WPS Commercial |
$6,030.78
|
|
|
IMPLANT TOETAC XPRESS LARGE HAMMERTOE HT-00003
|
Facility
|
IP
|
$8,142.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5547499
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,989.58 |
| Max. Negotiated Rate |
$7,490.64 |
| Rate for Payer: Aetna Commercial |
$7,327.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,002.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,315.26
|
| Rate for Payer: Cash Price |
$2,442.60
|
| Rate for Payer: Cigna Commercial |
$7,490.64
|
| Rate for Payer: Health EOS Commercial |
$7,246.38
|
| Rate for Payer: HFN Commercial |
$7,490.64
|
| Rate for Payer: Multiplan Commercial |
$6,513.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,885.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,490.64
|
| Rate for Payer: Quartz Beloit One Network |
$3,989.58
|
| Rate for Payer: Quartz Commercial |
$4,885.20
|
| Rate for Payer: WEA Trust Commercial |
$4,478.10
|
| Rate for Payer: WPS Commercial |
$6,030.78
|
|
|
IMPLANT TOETAC XPRESS MEDIUM 10DEG HAMMERTOE HT-00005
|
Facility
|
IP
|
$2,239.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,097.11 |
| Max. Negotiated Rate |
$2,059.88 |
| Rate for Payer: Aetna Commercial |
$2,015.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,925.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,186.67
|
| Rate for Payer: Cash Price |
$671.70
|
| Rate for Payer: Cigna Commercial |
$2,059.88
|
| Rate for Payer: Health EOS Commercial |
$1,992.71
|
| Rate for Payer: HFN Commercial |
$2,059.88
|
| Rate for Payer: Multiplan Commercial |
$1,791.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,343.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,059.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,097.11
|
| Rate for Payer: Quartz Commercial |
$1,343.40
|
| Rate for Payer: WEA Trust Commercial |
$1,231.45
|
| Rate for Payer: WPS Commercial |
$1,658.43
|
|
|
IMPLANT TOETAC XPRESS MEDIUM 10DEG HAMMERTOE HT-00005
|
Facility
|
OP
|
$2,239.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$626.92 |
| Max. Negotiated Rate |
$8,956.00 |
| Rate for Payer: Aetna Commercial |
$2,015.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,925.54
|
| Rate for Payer: Aetna Managed Medicare |
$626.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,455.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,119.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,074.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,186.67
|
| Rate for Payer: Cash Price |
$671.70
|
| Rate for Payer: Cigna Commercial |
$2,059.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,252.94
|
| Rate for Payer: Health EOS Commercial |
$1,992.71
|
| Rate for Payer: HFN Commercial |
$2,059.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,679.25
|
| Rate for Payer: Multiplan Commercial |
$1,791.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,343.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,059.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,097.11
|
| Rate for Payer: Quartz Commercial |
$1,455.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,343.40
|
| Rate for Payer: The Alliance Commercial |
$8,956.00
|
| Rate for Payer: WEA Trust Commercial |
$1,231.45
|
| Rate for Payer: WPS Commercial |
$1,658.43
|
|
|
IMPLANT TOETAC XPRESS MEDIUM HAMMERTOE HT-00002
|
Facility
|
OP
|
$8,142.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5306927
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,279.76 |
| Max. Negotiated Rate |
$32,568.00 |
| Rate for Payer: Aetna Commercial |
$7,327.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,002.12
|
| Rate for Payer: Aetna Managed Medicare |
$2,279.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,292.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,071.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,908.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,315.26
|
| Rate for Payer: Cash Price |
$2,442.60
|
| Rate for Payer: Cigna Commercial |
$7,490.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,556.26
|
| Rate for Payer: Health EOS Commercial |
$7,246.38
|
| Rate for Payer: HFN Commercial |
$7,490.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,106.50
|
| Rate for Payer: Multiplan Commercial |
$6,513.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,885.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,490.64
|
| Rate for Payer: Quartz Beloit One Network |
$3,989.58
|
| Rate for Payer: Quartz Commercial |
$5,292.30
|
| Rate for Payer: Quartz Medicare Advantage |
$4,885.20
|
| Rate for Payer: The Alliance Commercial |
$32,568.00
|
| Rate for Payer: WEA Trust Commercial |
$4,478.10
|
| Rate for Payer: WPS Commercial |
$6,030.78
|
|
|
IMPLANT TOETAC XPRESS MEDIUM HAMMERTOE HT-00002
|
Facility
|
IP
|
$8,142.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5306927
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,989.58 |
| Max. Negotiated Rate |
$7,490.64 |
| Rate for Payer: Aetna Commercial |
$7,327.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,002.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,315.26
|
| Rate for Payer: Cash Price |
$2,442.60
|
| Rate for Payer: Cigna Commercial |
$7,490.64
|
| Rate for Payer: Health EOS Commercial |
$7,246.38
|
| Rate for Payer: HFN Commercial |
$7,490.64
|
| Rate for Payer: Multiplan Commercial |
$6,513.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,885.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,490.64
|
| Rate for Payer: Quartz Beloit One Network |
$3,989.58
|
| Rate for Payer: Quartz Commercial |
$4,885.20
|
| Rate for Payer: WEA Trust Commercial |
$4,478.10
|
| Rate for Payer: WPS Commercial |
$6,030.78
|
|
|
IMPLANT TOETAC XPRESS SMALL HAMMERTOE HT-00001
|
Facility
|
OP
|
$1,278.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5265022
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$357.84 |
| Max. Negotiated Rate |
$5,112.00 |
| Rate for Payer: Aetna Commercial |
$1,150.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,099.08
|
| Rate for Payer: Aetna Managed Medicare |
$357.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$830.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$639.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$613.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$677.34
|
| Rate for Payer: Cash Price |
$383.40
|
| Rate for Payer: Cigna Commercial |
$1,175.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$715.17
|
| Rate for Payer: Health EOS Commercial |
$1,137.42
|
| Rate for Payer: HFN Commercial |
$1,175.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$958.50
|
| Rate for Payer: Multiplan Commercial |
$1,022.40
|
| Rate for Payer: NAPHCARE Commercial |
$766.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,175.76
|
| Rate for Payer: Quartz Beloit One Network |
$626.22
|
| Rate for Payer: Quartz Commercial |
$830.70
|
| Rate for Payer: Quartz Medicare Advantage |
$766.80
|
| Rate for Payer: The Alliance Commercial |
$5,112.00
|
| Rate for Payer: WEA Trust Commercial |
$702.90
|
| Rate for Payer: WPS Commercial |
$946.61
|
|
|
IMPLANT TOETAC XPRESS SMALL HAMMERTOE HT-00001
|
Facility
|
IP
|
$1,278.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5265022
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$626.22 |
| Max. Negotiated Rate |
$1,175.76 |
| Rate for Payer: Aetna Commercial |
$1,150.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,099.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$677.34
|
| Rate for Payer: Cash Price |
$383.40
|
| Rate for Payer: Cigna Commercial |
$1,175.76
|
| Rate for Payer: Health EOS Commercial |
$1,137.42
|
| Rate for Payer: HFN Commercial |
$1,175.76
|
| Rate for Payer: Multiplan Commercial |
$1,022.40
|
| Rate for Payer: NAPHCARE Commercial |
$766.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,175.76
|
| Rate for Payer: Quartz Beloit One Network |
$626.22
|
| Rate for Payer: Quartz Commercial |
$766.80
|
| Rate for Payer: WEA Trust Commercial |
$702.90
|
| Rate for Payer: WPS Commercial |
$946.61
|
|
|
IMPLANT TRANSFIX 3x50
|
Facility
|
IP
|
$2,410.00
|
|
| Hospital Charge Code |
2964683
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,180.90 |
| Max. Negotiated Rate |
$2,217.20 |
| Rate for Payer: Aetna Commercial |
$2,169.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,072.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,277.30
|
| Rate for Payer: Cash Price |
$723.00
|
| Rate for Payer: Cigna Commercial |
$2,217.20
|
| Rate for Payer: Health EOS Commercial |
$2,144.90
|
| Rate for Payer: HFN Commercial |
$2,217.20
|
| Rate for Payer: Multiplan Commercial |
$1,928.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,446.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,217.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,180.90
|
| Rate for Payer: Quartz Commercial |
$1,446.00
|
| Rate for Payer: WEA Trust Commercial |
$1,325.50
|
| Rate for Payer: WPS Commercial |
$1,785.09
|
|
|
IMPLANT TRANSFIX 3x50
|
Facility
|
OP
|
$2,410.00
|
|
| Hospital Charge Code |
2964683
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$674.80 |
| Max. Negotiated Rate |
$9,640.00 |
| Rate for Payer: Aetna Commercial |
$2,169.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,072.60
|
| Rate for Payer: Aetna Managed Medicare |
$674.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,566.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,205.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,156.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,277.30
|
| Rate for Payer: Cash Price |
$723.00
|
| Rate for Payer: Cigna Commercial |
$2,217.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,348.64
|
| Rate for Payer: Health EOS Commercial |
$2,144.90
|
| Rate for Payer: HFN Commercial |
$2,217.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,807.50
|
| Rate for Payer: Multiplan Commercial |
$1,928.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,446.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,217.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,180.90
|
| Rate for Payer: Quartz Commercial |
$1,566.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,446.00
|
| Rate for Payer: The Alliance Commercial |
$9,640.00
|
| Rate for Payer: WEA Trust Commercial |
$1,325.50
|
| Rate for Payer: WPS Commercial |
$1,785.09
|
|
|
IMPLANT X-FUSE 0 DEGREE
|
Facility
|
OP
|
$5,721.00
|
|
| Hospital Charge Code |
2965384
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,601.88 |
| Max. Negotiated Rate |
$22,884.00 |
| Rate for Payer: Aetna Commercial |
$5,148.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,920.06
|
| Rate for Payer: Aetna Managed Medicare |
$1,601.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,718.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,860.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,746.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,032.13
|
| Rate for Payer: Cash Price |
$1,716.30
|
| Rate for Payer: Cigna Commercial |
$5,263.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,201.47
|
| Rate for Payer: Health EOS Commercial |
$5,091.69
|
| Rate for Payer: HFN Commercial |
$5,263.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,290.75
|
| Rate for Payer: Multiplan Commercial |
$4,576.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,432.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,263.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,803.29
|
| Rate for Payer: Quartz Commercial |
$3,718.65
|
| Rate for Payer: Quartz Medicare Advantage |
$3,432.60
|
| Rate for Payer: The Alliance Commercial |
$22,884.00
|
| Rate for Payer: WEA Trust Commercial |
$3,146.55
|
| Rate for Payer: WPS Commercial |
$4,237.54
|
|
|
IMPLANT X-FUSE 0 DEGREE
|
Facility
|
IP
|
$5,721.00
|
|
| Hospital Charge Code |
2965384
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,803.29 |
| Max. Negotiated Rate |
$5,263.32 |
| Rate for Payer: Aetna Commercial |
$5,148.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,920.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,032.13
|
| Rate for Payer: Cash Price |
$1,716.30
|
| Rate for Payer: Cigna Commercial |
$5,263.32
|
| Rate for Payer: Health EOS Commercial |
$5,091.69
|
| Rate for Payer: HFN Commercial |
$5,263.32
|
| Rate for Payer: Multiplan Commercial |
$4,576.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,432.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,263.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,803.29
|
| Rate for Payer: Quartz Commercial |
$3,432.60
|
| Rate for Payer: WEA Trust Commercial |
$3,146.55
|
| Rate for Payer: WPS Commercial |
$4,237.54
|
|
|
IMPLANT X-FUSE 15 DEGREE
|
Facility
|
IP
|
$5,721.00
|
|
| Hospital Charge Code |
2965385
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,803.29 |
| Max. Negotiated Rate |
$5,263.32 |
| Rate for Payer: Aetna Commercial |
$5,148.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,920.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,032.13
|
| Rate for Payer: Cash Price |
$1,716.30
|
| Rate for Payer: Cigna Commercial |
$5,263.32
|
| Rate for Payer: Health EOS Commercial |
$5,091.69
|
| Rate for Payer: HFN Commercial |
$5,263.32
|
| Rate for Payer: Multiplan Commercial |
$4,576.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,432.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,263.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,803.29
|
| Rate for Payer: Quartz Commercial |
$3,432.60
|
| Rate for Payer: WEA Trust Commercial |
$3,146.55
|
| Rate for Payer: WPS Commercial |
$4,237.54
|
|
|
IMPLANT X-FUSE 15 DEGREE
|
Facility
|
OP
|
$5,721.00
|
|
| Hospital Charge Code |
2965385
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,601.88 |
| Max. Negotiated Rate |
$22,884.00 |
| Rate for Payer: Aetna Commercial |
$5,148.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,920.06
|
| Rate for Payer: Aetna Managed Medicare |
$1,601.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,718.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,860.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,746.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,032.13
|
| Rate for Payer: Cash Price |
$1,716.30
|
| Rate for Payer: Cigna Commercial |
$5,263.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,201.47
|
| Rate for Payer: Health EOS Commercial |
$5,091.69
|
| Rate for Payer: HFN Commercial |
$5,263.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,290.75
|
| Rate for Payer: Multiplan Commercial |
$4,576.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,432.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,263.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,803.29
|
| Rate for Payer: Quartz Commercial |
$3,718.65
|
| Rate for Payer: Quartz Medicare Advantage |
$3,432.60
|
| Rate for Payer: The Alliance Commercial |
$22,884.00
|
| Rate for Payer: WEA Trust Commercial |
$3,146.55
|
| Rate for Payer: WPS Commercial |
$4,237.54
|
|
|
Impression casting ft S0395
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
HCPCS S0395
|
| Hospital Charge Code |
3133687
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$47.04 |
| Max. Negotiated Rate |
$88.32 |
| Rate for Payer: Aetna Commercial |
$86.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$82.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$50.88
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna Commercial |
$88.32
|
| Rate for Payer: Health EOS Commercial |
$85.44
|
| Rate for Payer: HFN Commercial |
$88.32
|
| Rate for Payer: Multiplan Commercial |
$76.80
|
| Rate for Payer: NAPHCARE Commercial |
$57.60
|
| Rate for Payer: Preferred Network Access Commercial |
$88.32
|
| Rate for Payer: Quartz Beloit One Network |
$47.04
|
| Rate for Payer: Quartz Commercial |
$57.60
|
| Rate for Payer: WEA Trust Commercial |
$52.80
|
| Rate for Payer: WPS Commercial |
$71.11
|
|
|
Impression casting ft S0395
|
Facility
|
OP
|
$96.00
|
|
|
Service Code
|
HCPCS S0395
|
| Hospital Charge Code |
3133687
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.88 |
| Max. Negotiated Rate |
$384.00 |
| Rate for Payer: Aetna Commercial |
$86.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$82.56
|
| Rate for Payer: Aetna Managed Medicare |
$26.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$62.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$48.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$46.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$50.88
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna Commercial |
$88.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$53.72
|
| Rate for Payer: Health EOS Commercial |
$85.44
|
| Rate for Payer: HFN Commercial |
$88.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$72.00
|
| Rate for Payer: Multiplan Commercial |
$76.80
|
| Rate for Payer: NAPHCARE Commercial |
$57.60
|
| Rate for Payer: Preferred Network Access Commercial |
$88.32
|
| Rate for Payer: Quartz Beloit One Network |
$47.04
|
| Rate for Payer: Quartz Commercial |
$62.40
|
| Rate for Payer: Quartz Medicare Advantage |
$57.60
|
| Rate for Payer: The Alliance Commercial |
$384.00
|
| Rate for Payer: WEA Trust Commercial |
$52.80
|
| Rate for Payer: WPS Commercial |
$71.11
|
|
