|
BONE PUTTY AHBP HBP-2512
|
Facility
IP
|
$993.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
4048783
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$486.57 |
| Max. Negotiated Rate |
$913.56 |
| Rate for Payer: Aetna Commercial |
$893.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$526.29
|
| Rate for Payer: Cash Price |
$297.90
|
| Rate for Payer: Cigna Commercial |
$913.56
|
| Rate for Payer: Health EOS Commercial |
$883.77
|
| Rate for Payer: HFN Commercial |
$913.56
|
| Rate for Payer: Multiplan Commercial |
$794.40
|
| Rate for Payer: NAPHCARE Commercial |
$595.80
|
| Rate for Payer: Preferred Network Access Commercial |
$913.56
|
| Rate for Payer: Quartz Beloit One Network |
$486.57
|
| Rate for Payer: Quartz Commercial |
$595.80
|
| Rate for Payer: WEA Trust Commercial |
$546.15
|
| Rate for Payer: WPS Commercial |
$735.52
|
|
|
BONE PUTTY ALLOGRAFT 10CC 3102-1010
|
Facility
OP
|
$9,308.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
5685694
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,606.24 |
| Max. Negotiated Rate |
$8,563.36 |
| Rate for Payer: Aetna Commercial |
$8,377.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,004.88
|
| Rate for Payer: Aetna Managed Medicare |
$2,606.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,050.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,654.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,467.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,933.24
|
| Rate for Payer: Cash Price |
$2,792.40
|
| Rate for Payer: Cigna Commercial |
$8,563.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,208.76
|
| Rate for Payer: Health EOS Commercial |
$8,284.12
|
| Rate for Payer: HFN Commercial |
$8,563.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,981.00
|
| Rate for Payer: Multiplan Commercial |
$7,446.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,584.80
|
| Rate for Payer: Preferred Network Access Commercial |
$8,563.36
|
| Rate for Payer: Quartz Beloit One Network |
$4,560.92
|
| Rate for Payer: Quartz Commercial |
$6,050.20
|
| Rate for Payer: Quartz Medicare Advantage |
$5,584.80
|
| Rate for Payer: WEA Trust Commercial |
$5,119.40
|
| Rate for Payer: WPS Commercial |
$6,894.44
|
|
|
BONE PUTTY ALLOGRAFT 10CC 3102-1010
|
Facility
IP
|
$9,308.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
5685694
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,560.92 |
| Max. Negotiated Rate |
$8,563.36 |
| Rate for Payer: Aetna Commercial |
$8,377.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,933.24
|
| Rate for Payer: Cash Price |
$2,792.40
|
| Rate for Payer: Cigna Commercial |
$8,563.36
|
| Rate for Payer: Health EOS Commercial |
$8,284.12
|
| Rate for Payer: HFN Commercial |
$8,563.36
|
| Rate for Payer: Multiplan Commercial |
$7,446.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,584.80
|
| Rate for Payer: Preferred Network Access Commercial |
$8,563.36
|
| Rate for Payer: Quartz Beloit One Network |
$4,560.92
|
| Rate for Payer: Quartz Commercial |
$5,584.80
|
| Rate for Payer: WEA Trust Commercial |
$5,119.40
|
| Rate for Payer: WPS Commercial |
$6,894.44
|
|
|
BONE PUTTY ALLOGRAFT 1CC 3102-1001
|
Facility
IP
|
$3,936.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
5685691
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,928.64 |
| Max. Negotiated Rate |
$3,621.12 |
| Rate for Payer: Aetna Commercial |
$3,542.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,086.08
|
| Rate for Payer: Cash Price |
$1,180.80
|
| Rate for Payer: Cigna Commercial |
$3,621.12
|
| Rate for Payer: Health EOS Commercial |
$3,503.04
|
| Rate for Payer: HFN Commercial |
$3,621.12
|
| Rate for Payer: Multiplan Commercial |
$3,148.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,621.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.64
|
| Rate for Payer: Quartz Commercial |
$2,361.60
|
| Rate for Payer: WEA Trust Commercial |
$2,164.80
|
| Rate for Payer: WPS Commercial |
$2,915.40
|
|
|
BONE PUTTY ALLOGRAFT 1CC 3102-1001
|
Facility
OP
|
$3,936.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
5685691
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,102.08 |
| Max. Negotiated Rate |
$3,621.12 |
| Rate for Payer: Aetna Commercial |
$3,542.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.96
|
| Rate for Payer: Aetna Managed Medicare |
$1,102.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,558.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,968.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,889.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,086.08
|
| Rate for Payer: Cash Price |
$1,180.80
|
| Rate for Payer: Cigna Commercial |
$3,621.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,202.59
|
| Rate for Payer: Health EOS Commercial |
$3,503.04
|
| Rate for Payer: HFN Commercial |
$3,621.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,952.00
|
| Rate for Payer: Multiplan Commercial |
$3,148.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,621.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.64
|
| Rate for Payer: Quartz Commercial |
$2,558.40
|
| Rate for Payer: Quartz Medicare Advantage |
$2,361.60
|
| Rate for Payer: WEA Trust Commercial |
$2,164.80
|
| Rate for Payer: WPS Commercial |
$2,915.40
|
|
|
BONE PUTTY ALLOGRAFT 2.5CC 3102-1002
|
Facility
OP
|
$6,559.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
5685692
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,836.52 |
| Max. Negotiated Rate |
$6,034.28 |
| 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: WEA Trust Commercial |
$3,607.45
|
| Rate for Payer: WPS Commercial |
$4,858.25
|
|
|
BONE PUTTY ALLOGRAFT 2.5CC 3102-1002
|
Facility
IP
|
$6,559.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
5685692
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,213.91 |
| Max. Negotiated Rate |
$6,034.28 |
| Rate for Payer: Aetna Commercial |
$5,903.10
|
| 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: Health EOS Commercial |
$5,837.51
|
| Rate for Payer: HFN Commercial |
$6,034.28
|
| 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 |
$3,935.40
|
| Rate for Payer: WEA Trust Commercial |
$3,607.45
|
| Rate for Payer: WPS Commercial |
$4,858.25
|
|
|
BONE PUTTY ALLOGRAFT 5CC 3102-1005
|
Facility
OP
|
$5,678.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
5685693
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,589.84 |
| Max. Negotiated Rate |
$5,223.76 |
| Rate for Payer: Aetna Commercial |
$5,110.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,883.08
|
| Rate for Payer: Aetna Managed Medicare |
$1,589.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,690.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,839.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,725.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,009.34
|
| Rate for Payer: Cash Price |
$1,703.40
|
| Rate for Payer: Cigna Commercial |
$5,223.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,177.41
|
| Rate for Payer: Health EOS Commercial |
$5,053.42
|
| Rate for Payer: HFN Commercial |
$5,223.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,258.50
|
| Rate for Payer: Multiplan Commercial |
$4,542.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,406.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,223.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,782.22
|
| Rate for Payer: Quartz Commercial |
$3,690.70
|
| Rate for Payer: Quartz Medicare Advantage |
$3,406.80
|
| Rate for Payer: WEA Trust Commercial |
$3,122.90
|
| Rate for Payer: WPS Commercial |
$4,205.69
|
|
|
BONE PUTTY ALLOGRAFT 5CC 3102-1005
|
Facility
IP
|
$5,678.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
5685693
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,782.22 |
| Max. Negotiated Rate |
$5,223.76 |
| Rate for Payer: Aetna Commercial |
$5,110.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,009.34
|
| Rate for Payer: Cash Price |
$1,703.40
|
| Rate for Payer: Cigna Commercial |
$5,223.76
|
| Rate for Payer: Health EOS Commercial |
$5,053.42
|
| Rate for Payer: HFN Commercial |
$5,223.76
|
| Rate for Payer: Multiplan Commercial |
$4,542.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,406.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,223.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,782.22
|
| Rate for Payer: Quartz Commercial |
$3,406.80
|
| Rate for Payer: WEA Trust Commercial |
$3,122.90
|
| Rate for Payer: WPS Commercial |
$4,205.69
|
|
|
BONE PUTTY ALLOMATRIX C WITH DBM & CANC CHIPS 5CC 860C0500
|
Facility
OP
|
$7,201.00
|
|
|
Service Code
|
HCPCS C9359
|
| Hospital Charge Code |
5248763
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,016.28 |
| Max. Negotiated Rate |
$6,624.92 |
| Rate for Payer: Aetna Commercial |
$6,480.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,192.86
|
| Rate for Payer: Aetna Managed Medicare |
$2,016.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,680.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,600.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,456.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,816.53
|
| Rate for Payer: Cash Price |
$2,160.30
|
| Rate for Payer: Cigna Commercial |
$6,624.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,029.68
|
| Rate for Payer: Health EOS Commercial |
$6,408.89
|
| Rate for Payer: HFN Commercial |
$6,624.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,400.75
|
| Rate for Payer: Multiplan Commercial |
$5,760.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,320.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,624.92
|
| Rate for Payer: Quartz Beloit One Network |
$3,528.49
|
| Rate for Payer: Quartz Commercial |
$4,680.65
|
| Rate for Payer: Quartz Medicare Advantage |
$4,320.60
|
| Rate for Payer: WEA Trust Commercial |
$3,960.55
|
| Rate for Payer: WPS Commercial |
$5,333.78
|
|
|
BONE PUTTY ALLOMATRIX C WITH DBM & CANC CHIPS 5CC 860C0500
|
Facility
IP
|
$7,201.00
|
|
|
Service Code
|
HCPCS C9359
|
| Hospital Charge Code |
5248763
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,528.49 |
| Max. Negotiated Rate |
$6,624.92 |
| Rate for Payer: Aetna Commercial |
$6,480.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,816.53
|
| Rate for Payer: Cash Price |
$2,160.30
|
| Rate for Payer: Cigna Commercial |
$6,624.92
|
| Rate for Payer: Health EOS Commercial |
$6,408.89
|
| Rate for Payer: HFN Commercial |
$6,624.92
|
| Rate for Payer: Multiplan Commercial |
$5,760.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,320.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,624.92
|
| Rate for Payer: Quartz Beloit One Network |
$3,528.49
|
| Rate for Payer: Quartz Commercial |
$4,320.60
|
| Rate for Payer: WEA Trust Commercial |
$3,960.55
|
| Rate for Payer: WPS Commercial |
$5,333.78
|
|
|
BONE PUTTY DBX 5CC 038050
|
Facility
OP
|
$3,086.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
2966144
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$864.08 |
| Max. Negotiated Rate |
$2,839.12 |
| Rate for Payer: Aetna Commercial |
$2,777.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,653.96
|
| Rate for Payer: Aetna Managed Medicare |
$864.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,005.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,543.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,481.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,635.58
|
| Rate for Payer: Cash Price |
$925.80
|
| Rate for Payer: Cigna Commercial |
$2,839.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,726.93
|
| Rate for Payer: Health EOS Commercial |
$2,746.54
|
| Rate for Payer: HFN Commercial |
$2,839.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,314.50
|
| Rate for Payer: Multiplan Commercial |
$2,468.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,851.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,839.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,512.14
|
| Rate for Payer: Quartz Commercial |
$2,005.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,851.60
|
| Rate for Payer: WEA Trust Commercial |
$1,697.30
|
| Rate for Payer: WPS Commercial |
$2,285.80
|
|
|
BONE PUTTY DBX 5CC 038050
|
Facility
IP
|
$3,086.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
2966144
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,512.14 |
| Max. Negotiated Rate |
$2,839.12 |
| Rate for Payer: Aetna Commercial |
$2,777.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,635.58
|
| Rate for Payer: Cash Price |
$925.80
|
| Rate for Payer: Cigna Commercial |
$2,839.12
|
| Rate for Payer: Health EOS Commercial |
$2,746.54
|
| Rate for Payer: HFN Commercial |
$2,839.12
|
| Rate for Payer: Multiplan Commercial |
$2,468.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,851.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,839.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,512.14
|
| Rate for Payer: Quartz Commercial |
$1,851.60
|
| Rate for Payer: WEA Trust Commercial |
$1,697.30
|
| Rate for Payer: WPS Commercial |
$2,285.80
|
|
|
BONE REMOVER INBONE SCREW IB200051
|
Facility
IP
|
$2,248.00
|
|
| Hospital Charge Code |
5831723
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,101.52 |
| Max. Negotiated Rate |
$2,068.16 |
| Rate for Payer: Aetna Commercial |
$2,023.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,191.44
|
| Rate for Payer: Cash Price |
$674.40
|
| Rate for Payer: Cigna Commercial |
$2,068.16
|
| Rate for Payer: Health EOS Commercial |
$2,000.72
|
| Rate for Payer: HFN Commercial |
$2,068.16
|
| Rate for Payer: Multiplan Commercial |
$1,798.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,348.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,068.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,101.52
|
| Rate for Payer: Quartz Commercial |
$1,348.80
|
| Rate for Payer: WEA Trust Commercial |
$1,236.40
|
| Rate for Payer: WPS Commercial |
$1,665.09
|
|
|
BONE REMOVER INBONE SCREW IB200051
|
Facility
OP
|
$2,248.00
|
|
| Hospital Charge Code |
5831723
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$629.44 |
| Max. Negotiated Rate |
$8,992.00 |
| Rate for Payer: Aetna Commercial |
$2,023.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,933.28
|
| Rate for Payer: Aetna Managed Medicare |
$629.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,461.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,124.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,079.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,191.44
|
| Rate for Payer: Cash Price |
$674.40
|
| Rate for Payer: Cigna Commercial |
$2,068.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,257.98
|
| Rate for Payer: Health EOS Commercial |
$2,000.72
|
| Rate for Payer: HFN Commercial |
$2,068.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,686.00
|
| Rate for Payer: Multiplan Commercial |
$1,798.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,348.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,068.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,101.52
|
| Rate for Payer: Quartz Commercial |
$1,461.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,348.80
|
| Rate for Payer: The Alliance Commercial |
$8,992.00
|
| Rate for Payer: WEA Trust Commercial |
$1,236.40
|
| Rate for Payer: WPS Commercial |
$1,665.09
|
|
|
BONE SCREW 15MM 6250-65-15
|
Facility
OP
|
$1,144.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967632
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$320.32 |
| Max. Negotiated Rate |
$1,052.48 |
| Rate for Payer: Aetna Commercial |
$1,029.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$983.84
|
| Rate for Payer: Aetna Managed Medicare |
$320.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$743.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$572.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$549.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$606.32
|
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Cigna Commercial |
$1,052.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$640.18
|
| Rate for Payer: Health EOS Commercial |
$1,018.16
|
| Rate for Payer: HFN Commercial |
$1,052.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$858.00
|
| Rate for Payer: Multiplan Commercial |
$915.20
|
| Rate for Payer: NAPHCARE Commercial |
$686.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,052.48
|
| Rate for Payer: Quartz Beloit One Network |
$560.56
|
| Rate for Payer: Quartz Commercial |
$743.60
|
| Rate for Payer: Quartz Medicare Advantage |
$686.40
|
| Rate for Payer: WEA Trust Commercial |
$629.20
|
| Rate for Payer: WPS Commercial |
$847.36
|
|
|
BONE SCREW 15MM 6250-65-15
|
Facility
IP
|
$1,144.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967632
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$560.56 |
| Max. Negotiated Rate |
$1,052.48 |
| Rate for Payer: Aetna Commercial |
$1,029.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$606.32
|
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Cigna Commercial |
$1,052.48
|
| Rate for Payer: Health EOS Commercial |
$1,018.16
|
| Rate for Payer: HFN Commercial |
$1,052.48
|
| Rate for Payer: Multiplan Commercial |
$915.20
|
| Rate for Payer: NAPHCARE Commercial |
$686.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,052.48
|
| Rate for Payer: Quartz Beloit One Network |
$560.56
|
| Rate for Payer: Quartz Commercial |
$686.40
|
| Rate for Payer: WEA Trust Commercial |
$629.20
|
| Rate for Payer: WPS Commercial |
$847.36
|
|
|
BONE SCREW 20MM 6250-65-20
|
Facility
IP
|
$1,188.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967633
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$582.12 |
| Max. Negotiated Rate |
$1,092.96 |
| Rate for Payer: Aetna Commercial |
$1,069.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$629.64
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cigna Commercial |
$1,092.96
|
| Rate for Payer: Health EOS Commercial |
$1,057.32
|
| Rate for Payer: HFN Commercial |
$1,092.96
|
| Rate for Payer: Multiplan Commercial |
$950.40
|
| Rate for Payer: NAPHCARE Commercial |
$712.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,092.96
|
| Rate for Payer: Quartz Beloit One Network |
$582.12
|
| Rate for Payer: Quartz Commercial |
$712.80
|
| Rate for Payer: WEA Trust Commercial |
$653.40
|
| Rate for Payer: WPS Commercial |
$879.95
|
|
|
BONE SCREW 20MM 6250-65-20
|
Facility
OP
|
$1,188.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967633
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$332.64 |
| Max. Negotiated Rate |
$1,092.96 |
| Rate for Payer: Aetna Commercial |
$1,069.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,021.68
|
| Rate for Payer: Aetna Managed Medicare |
$332.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$772.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$594.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$570.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$629.64
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cigna Commercial |
$1,092.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$664.80
|
| Rate for Payer: Health EOS Commercial |
$1,057.32
|
| Rate for Payer: HFN Commercial |
$1,092.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$891.00
|
| Rate for Payer: Multiplan Commercial |
$950.40
|
| Rate for Payer: NAPHCARE Commercial |
$712.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,092.96
|
| Rate for Payer: Quartz Beloit One Network |
$582.12
|
| Rate for Payer: Quartz Commercial |
$772.20
|
| Rate for Payer: Quartz Medicare Advantage |
$712.80
|
| Rate for Payer: WEA Trust Commercial |
$653.40
|
| Rate for Payer: WPS Commercial |
$879.95
|
|
|
BONE SCREW 25MM 6250-65-25
|
Facility
OP
|
$1,188.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967634
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$332.64 |
| Max. Negotiated Rate |
$1,092.96 |
| Rate for Payer: Aetna Commercial |
$1,069.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,021.68
|
| Rate for Payer: Aetna Managed Medicare |
$332.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$772.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$594.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$570.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$629.64
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cigna Commercial |
$1,092.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$664.80
|
| Rate for Payer: Health EOS Commercial |
$1,057.32
|
| Rate for Payer: HFN Commercial |
$1,092.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$891.00
|
| Rate for Payer: Multiplan Commercial |
$950.40
|
| Rate for Payer: NAPHCARE Commercial |
$712.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,092.96
|
| Rate for Payer: Quartz Beloit One Network |
$582.12
|
| Rate for Payer: Quartz Commercial |
$772.20
|
| Rate for Payer: Quartz Medicare Advantage |
$712.80
|
| Rate for Payer: WEA Trust Commercial |
$653.40
|
| Rate for Payer: WPS Commercial |
$879.95
|
|
|
BONE SCREW 25MM 6250-65-25
|
Facility
IP
|
$1,188.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967634
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$582.12 |
| Max. Negotiated Rate |
$1,092.96 |
| Rate for Payer: Aetna Commercial |
$1,069.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$629.64
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cigna Commercial |
$1,092.96
|
| Rate for Payer: Health EOS Commercial |
$1,057.32
|
| Rate for Payer: HFN Commercial |
$1,092.96
|
| Rate for Payer: Multiplan Commercial |
$950.40
|
| Rate for Payer: NAPHCARE Commercial |
$712.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,092.96
|
| Rate for Payer: Quartz Beloit One Network |
$582.12
|
| Rate for Payer: Quartz Commercial |
$712.80
|
| Rate for Payer: WEA Trust Commercial |
$653.40
|
| Rate for Payer: WPS Commercial |
$879.95
|
|
|
BONE SCREW 30MM 6250-65-30
|
Facility
OP
|
$1,188.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967635
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$332.64 |
| Max. Negotiated Rate |
$1,092.96 |
| Rate for Payer: Aetna Commercial |
$1,069.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,021.68
|
| Rate for Payer: Aetna Managed Medicare |
$332.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$772.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$594.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$570.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$629.64
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cigna Commercial |
$1,092.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$664.80
|
| Rate for Payer: Health EOS Commercial |
$1,057.32
|
| Rate for Payer: HFN Commercial |
$1,092.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$891.00
|
| Rate for Payer: Multiplan Commercial |
$950.40
|
| Rate for Payer: NAPHCARE Commercial |
$712.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,092.96
|
| Rate for Payer: Quartz Beloit One Network |
$582.12
|
| Rate for Payer: Quartz Commercial |
$772.20
|
| Rate for Payer: Quartz Medicare Advantage |
$712.80
|
| Rate for Payer: WEA Trust Commercial |
$653.40
|
| Rate for Payer: WPS Commercial |
$879.95
|
|
|
BONE SCREW 30MM 6250-65-30
|
Facility
IP
|
$1,188.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967635
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$582.12 |
| Max. Negotiated Rate |
$1,092.96 |
| Rate for Payer: Aetna Commercial |
$1,069.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$629.64
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cigna Commercial |
$1,092.96
|
| Rate for Payer: Health EOS Commercial |
$1,057.32
|
| Rate for Payer: HFN Commercial |
$1,092.96
|
| Rate for Payer: Multiplan Commercial |
$950.40
|
| Rate for Payer: NAPHCARE Commercial |
$712.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,092.96
|
| Rate for Payer: Quartz Beloit One Network |
$582.12
|
| Rate for Payer: Quartz Commercial |
$712.80
|
| Rate for Payer: WEA Trust Commercial |
$653.40
|
| Rate for Payer: WPS Commercial |
$879.95
|
|
|
BONE SCREW 35MM 6250-65-35
|
Facility
OP
|
$1,188.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967636
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$332.64 |
| Max. Negotiated Rate |
$1,092.96 |
| Rate for Payer: Aetna Commercial |
$1,069.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,021.68
|
| Rate for Payer: Aetna Managed Medicare |
$332.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$772.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$594.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$570.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$629.64
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cigna Commercial |
$1,092.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$664.80
|
| Rate for Payer: Health EOS Commercial |
$1,057.32
|
| Rate for Payer: HFN Commercial |
$1,092.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$891.00
|
| Rate for Payer: Multiplan Commercial |
$950.40
|
| Rate for Payer: NAPHCARE Commercial |
$712.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,092.96
|
| Rate for Payer: Quartz Beloit One Network |
$582.12
|
| Rate for Payer: Quartz Commercial |
$772.20
|
| Rate for Payer: Quartz Medicare Advantage |
$712.80
|
| Rate for Payer: WEA Trust Commercial |
$653.40
|
| Rate for Payer: WPS Commercial |
$879.95
|
|
|
BONE SCREW 35MM 6250-65-35
|
Facility
IP
|
$1,188.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967636
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$582.12 |
| Max. Negotiated Rate |
$1,092.96 |
| Rate for Payer: Aetna Commercial |
$1,069.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$629.64
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cigna Commercial |
$1,092.96
|
| Rate for Payer: Health EOS Commercial |
$1,057.32
|
| Rate for Payer: HFN Commercial |
$1,092.96
|
| Rate for Payer: Multiplan Commercial |
$950.40
|
| Rate for Payer: NAPHCARE Commercial |
$712.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,092.96
|
| Rate for Payer: Quartz Beloit One Network |
$582.12
|
| Rate for Payer: Quartz Commercial |
$712.80
|
| Rate for Payer: WEA Trust Commercial |
$653.40
|
| Rate for Payer: WPS Commercial |
$879.95
|
|
