|
K PAD
|
Facility
|
IP
|
$172.00
|
|
| Hospital Charge Code |
3075865
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$84.28 |
| Max. Negotiated Rate |
$158.24 |
| Rate for Payer: Aetna Commercial |
$154.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$147.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$91.16
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cigna Commercial |
$158.24
|
| Rate for Payer: Health EOS Commercial |
$153.08
|
| Rate for Payer: HFN Commercial |
$158.24
|
| Rate for Payer: Multiplan Commercial |
$137.60
|
| Rate for Payer: NAPHCARE Commercial |
$103.20
|
| Rate for Payer: Preferred Network Access Commercial |
$158.24
|
| Rate for Payer: Quartz Beloit One Network |
$84.28
|
| Rate for Payer: Quartz Commercial |
$103.20
|
| Rate for Payer: WEA Trust Commercial |
$94.60
|
| Rate for Payer: WPS Commercial |
$127.40
|
|
|
K-Pad - Devices and Equipment
|
Facility
|
IP
|
$179.00
|
|
| Hospital Charge Code |
3002374
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$87.71 |
| Max. Negotiated Rate |
$164.68 |
| Rate for Payer: Aetna Commercial |
$161.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$153.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$94.87
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cigna Commercial |
$164.68
|
| Rate for Payer: Health EOS Commercial |
$159.31
|
| Rate for Payer: HFN Commercial |
$164.68
|
| Rate for Payer: Multiplan Commercial |
$143.20
|
| Rate for Payer: NAPHCARE Commercial |
$107.40
|
| Rate for Payer: Preferred Network Access Commercial |
$164.68
|
| Rate for Payer: Quartz Beloit One Network |
$87.71
|
| Rate for Payer: Quartz Commercial |
$107.40
|
| Rate for Payer: WEA Trust Commercial |
$98.45
|
| Rate for Payer: WPS Commercial |
$132.59
|
|
|
K-Pad - Devices and Equipment
|
Facility
|
OP
|
$179.00
|
|
| Hospital Charge Code |
3002374
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$50.12 |
| Max. Negotiated Rate |
$716.00 |
| Rate for Payer: Aetna Commercial |
$161.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$153.94
|
| Rate for Payer: Aetna Managed Medicare |
$50.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$116.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$89.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$85.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$94.87
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cigna Commercial |
$164.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$100.17
|
| Rate for Payer: Health EOS Commercial |
$159.31
|
| Rate for Payer: HFN Commercial |
$164.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$134.25
|
| Rate for Payer: Multiplan Commercial |
$143.20
|
| Rate for Payer: NAPHCARE Commercial |
$107.40
|
| Rate for Payer: Preferred Network Access Commercial |
$164.68
|
| Rate for Payer: Quartz Beloit One Network |
$87.71
|
| Rate for Payer: Quartz Commercial |
$116.35
|
| Rate for Payer: Quartz Medicare Advantage |
$107.40
|
| Rate for Payer: The Alliance Commercial |
$716.00
|
| Rate for Payer: WEA Trust Commercial |
$98.45
|
| Rate for Payer: WPS Commercial |
$132.59
|
|
|
K THERMIA
|
Facility
|
OP
|
$428.00
|
|
| Hospital Charge Code |
3075866
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$119.84 |
| Max. Negotiated Rate |
$1,712.00 |
| Rate for Payer: Aetna Commercial |
$385.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$368.08
|
| Rate for Payer: Aetna Managed Medicare |
$119.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$278.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$214.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$205.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$226.84
|
| Rate for Payer: Cash Price |
$128.40
|
| Rate for Payer: Cigna Commercial |
$393.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$239.51
|
| Rate for Payer: Health EOS Commercial |
$380.92
|
| Rate for Payer: HFN Commercial |
$393.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$321.00
|
| Rate for Payer: Multiplan Commercial |
$342.40
|
| Rate for Payer: NAPHCARE Commercial |
$256.80
|
| Rate for Payer: Preferred Network Access Commercial |
$393.76
|
| Rate for Payer: Quartz Beloit One Network |
$209.72
|
| Rate for Payer: Quartz Commercial |
$278.20
|
| Rate for Payer: Quartz Medicare Advantage |
$256.80
|
| Rate for Payer: The Alliance Commercial |
$1,712.00
|
| Rate for Payer: WEA Trust Commercial |
$235.40
|
| Rate for Payer: WPS Commercial |
$317.02
|
|
|
K THERMIA
|
Facility
|
IP
|
$428.00
|
|
| Hospital Charge Code |
3075866
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$209.72 |
| Max. Negotiated Rate |
$393.76 |
| Rate for Payer: Aetna Commercial |
$385.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$368.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$226.84
|
| Rate for Payer: Cash Price |
$128.40
|
| Rate for Payer: Cigna Commercial |
$393.76
|
| Rate for Payer: Health EOS Commercial |
$380.92
|
| Rate for Payer: HFN Commercial |
$393.76
|
| Rate for Payer: Multiplan Commercial |
$342.40
|
| Rate for Payer: NAPHCARE Commercial |
$256.80
|
| Rate for Payer: Preferred Network Access Commercial |
$393.76
|
| Rate for Payer: Quartz Beloit One Network |
$209.72
|
| Rate for Payer: Quartz Commercial |
$256.80
|
| Rate for Payer: WEA Trust Commercial |
$235.40
|
| Rate for Payer: WPS Commercial |
$317.02
|
|
|
K-Thermia - Devices and Equipment
|
Facility
|
IP
|
$490.00
|
|
| Hospital Charge Code |
3002375
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$240.10 |
| Max. Negotiated Rate |
$450.80 |
| Rate for Payer: Aetna Commercial |
$441.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$421.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$259.70
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cigna Commercial |
$450.80
|
| Rate for Payer: Health EOS Commercial |
$436.10
|
| Rate for Payer: HFN Commercial |
$450.80
|
| Rate for Payer: Multiplan Commercial |
$392.00
|
| Rate for Payer: NAPHCARE Commercial |
$294.00
|
| Rate for Payer: Preferred Network Access Commercial |
$450.80
|
| Rate for Payer: Quartz Beloit One Network |
$240.10
|
| Rate for Payer: Quartz Commercial |
$294.00
|
| Rate for Payer: WEA Trust Commercial |
$269.50
|
| Rate for Payer: WPS Commercial |
$362.94
|
|
|
K-Thermia - Devices and Equipment
|
Facility
|
OP
|
$490.00
|
|
| Hospital Charge Code |
3002375
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$137.20 |
| Max. Negotiated Rate |
$1,960.00 |
| Rate for Payer: Aetna Commercial |
$441.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$421.40
|
| Rate for Payer: Aetna Managed Medicare |
$137.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$318.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$245.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$235.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$259.70
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cigna Commercial |
$450.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$274.20
|
| Rate for Payer: Health EOS Commercial |
$436.10
|
| Rate for Payer: HFN Commercial |
$450.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$367.50
|
| Rate for Payer: Multiplan Commercial |
$392.00
|
| Rate for Payer: NAPHCARE Commercial |
$294.00
|
| Rate for Payer: Preferred Network Access Commercial |
$450.80
|
| Rate for Payer: Quartz Beloit One Network |
$240.10
|
| Rate for Payer: Quartz Commercial |
$318.50
|
| Rate for Payer: Quartz Medicare Advantage |
$294.00
|
| Rate for Payer: The Alliance Commercial |
$1,960.00
|
| Rate for Payer: WEA Trust Commercial |
$269.50
|
| Rate for Payer: WPS Commercial |
$362.94
|
|
|
KU Autoabs
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
4592897
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$56.84 |
| Max. Negotiated Rate |
$106.72 |
| Rate for Payer: Aetna Commercial |
$104.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.48
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cigna Commercial |
$106.72
|
| Rate for Payer: Health EOS Commercial |
$103.24
|
| Rate for Payer: HFN Commercial |
$106.72
|
| Rate for Payer: Multiplan Commercial |
$92.80
|
| Rate for Payer: NAPHCARE Commercial |
$69.60
|
| Rate for Payer: Preferred Network Access Commercial |
$106.72
|
| Rate for Payer: Quartz Beloit One Network |
$56.84
|
| Rate for Payer: Quartz Commercial |
$69.60
|
| Rate for Payer: WEA Trust Commercial |
$63.80
|
| Rate for Payer: WPS Commercial |
$85.92
|
|
|
KU Autoabs
|
Professional
|
Both
|
$116.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
4592897
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.70 |
| Max. Negotiated Rate |
$110.20 |
| Rate for Payer: Aetna Commercial |
$110.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.76
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cigna Commercial |
$110.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$58.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$69.60
|
| Rate for Payer: Health EOS Commercial |
$105.56
|
| Rate for Payer: HFN Commercial |
$110.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$40.70
|
| Rate for Payer: Multiplan Commercial |
$92.80
|
| Rate for Payer: Preferred Network Access Commercial |
$110.20
|
| Rate for Payer: Quartz Beloit One Network |
$51.04
|
| Rate for Payer: Quartz Commercial |
$66.12
|
| Rate for Payer: The Alliance Commercial |
$58.00
|
| Rate for Payer: WEA Trust Commercial |
$63.80
|
| Rate for Payer: WPS Commercial |
$85.92
|
|
|
KU Autoabs
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
4592897
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$106.72 |
| Rate for Payer: Aetna Commercial |
$104.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.76
|
| Rate for Payer: Aetna Managed Medicare |
$11.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$43.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.18
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.14
|
| Rate for Payer: Anthem Medicaid |
$11.91
|
| Rate for Payer: Anthem Medicare Advantage |
$11.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.53
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cigna Commercial |
$106.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64.91
|
| Rate for Payer: Dean Health Medicaid |
$11.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.53
|
| Rate for Payer: Health EOS Commercial |
$103.24
|
| Rate for Payer: HFN Commercial |
$106.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.53
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.53
|
| Rate for Payer: Managed Health Services Medicaid |
$12.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.53
|
| Rate for Payer: Multiplan Commercial |
$92.80
|
| Rate for Payer: NAPHCARE Commercial |
$17.30
|
| Rate for Payer: Preferred Network Access Commercial |
$106.72
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$11.91
|
| Rate for Payer: Quartz Beloit One Network |
$56.84
|
| Rate for Payer: Quartz Commercial |
$75.40
|
| Rate for Payer: Quartz Medicare Advantage |
$11.53
|
| Rate for Payer: The Alliance Commercial |
$46.12
|
| Rate for Payer: United Healthcare Medicaid |
$11.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.53
|
| Rate for Payer: United Healthcare PPO |
$87.00
|
| Rate for Payer: WEA Trust Commercial |
$63.80
|
| Rate for Payer: Wellcare Medicare |
$11.53
|
| Rate for Payer: WMAP Medicaid |
$11.91
|
| Rate for Payer: WPS Commercial |
$85.92
|
|
|
K WIRE
|
Facility
|
IP
|
$726.00
|
|
| Hospital Charge Code |
2965013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$355.74 |
| Max. Negotiated Rate |
$667.92 |
| Rate for Payer: Aetna Commercial |
$653.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$624.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$384.78
|
| Rate for Payer: Cash Price |
$217.80
|
| Rate for Payer: Cigna Commercial |
$667.92
|
| Rate for Payer: Health EOS Commercial |
$646.14
|
| Rate for Payer: HFN Commercial |
$667.92
|
| Rate for Payer: Multiplan Commercial |
$580.80
|
| Rate for Payer: NAPHCARE Commercial |
$435.60
|
| Rate for Payer: Preferred Network Access Commercial |
$667.92
|
| Rate for Payer: Quartz Beloit One Network |
$355.74
|
| Rate for Payer: Quartz Commercial |
$435.60
|
| Rate for Payer: WEA Trust Commercial |
$399.30
|
| Rate for Payer: WPS Commercial |
$537.75
|
|
|
K WIRE
|
Facility
|
OP
|
$726.00
|
|
| Hospital Charge Code |
2965013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$203.28 |
| Max. Negotiated Rate |
$2,904.00 |
| Rate for Payer: Aetna Commercial |
$653.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$624.36
|
| Rate for Payer: Aetna Managed Medicare |
$203.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$471.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$363.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$348.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$384.78
|
| Rate for Payer: Cash Price |
$217.80
|
| Rate for Payer: Cigna Commercial |
$667.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$406.27
|
| Rate for Payer: Health EOS Commercial |
$646.14
|
| Rate for Payer: HFN Commercial |
$667.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$544.50
|
| Rate for Payer: Multiplan Commercial |
$580.80
|
| Rate for Payer: NAPHCARE Commercial |
$435.60
|
| Rate for Payer: Preferred Network Access Commercial |
$667.92
|
| Rate for Payer: Quartz Beloit One Network |
$355.74
|
| Rate for Payer: Quartz Commercial |
$471.90
|
| Rate for Payer: Quartz Medicare Advantage |
$435.60
|
| Rate for Payer: The Alliance Commercial |
$2,904.00
|
| Rate for Payer: WEA Trust Commercial |
$399.30
|
| Rate for Payer: WPS Commercial |
$537.75
|
|
|
K-WIRE 01.8 DIAMOND POINT HOFFMANN LIMB 4933-8-010
|
Facility
|
OP
|
$1,238.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599702
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$346.64 |
| Max. Negotiated Rate |
$4,952.00 |
| Rate for Payer: Aetna Commercial |
$1,114.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,064.68
|
| Rate for Payer: Aetna Managed Medicare |
$346.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$804.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$619.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$594.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$656.14
|
| Rate for Payer: Cash Price |
$371.40
|
| Rate for Payer: Cigna Commercial |
$1,138.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$692.78
|
| Rate for Payer: Health EOS Commercial |
$1,101.82
|
| Rate for Payer: HFN Commercial |
$1,138.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$928.50
|
| Rate for Payer: Multiplan Commercial |
$990.40
|
| Rate for Payer: NAPHCARE Commercial |
$742.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,138.96
|
| Rate for Payer: Quartz Beloit One Network |
$606.62
|
| Rate for Payer: Quartz Commercial |
$804.70
|
| Rate for Payer: Quartz Medicare Advantage |
$742.80
|
| Rate for Payer: The Alliance Commercial |
$4,952.00
|
| Rate for Payer: WEA Trust Commercial |
$680.90
|
| Rate for Payer: WPS Commercial |
$916.99
|
|
|
K-WIRE 01.8 DIAMOND POINT HOFFMANN LIMB 4933-8-010
|
Facility
|
IP
|
$1,238.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599702
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$606.62 |
| Max. Negotiated Rate |
$1,138.96 |
| Rate for Payer: Aetna Commercial |
$1,114.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,064.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$656.14
|
| Rate for Payer: Cash Price |
$371.40
|
| Rate for Payer: Cigna Commercial |
$1,138.96
|
| Rate for Payer: Health EOS Commercial |
$1,101.82
|
| Rate for Payer: HFN Commercial |
$1,138.96
|
| Rate for Payer: Multiplan Commercial |
$990.40
|
| Rate for Payer: NAPHCARE Commercial |
$742.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,138.96
|
| Rate for Payer: Quartz Beloit One Network |
$606.62
|
| Rate for Payer: Quartz Commercial |
$742.80
|
| Rate for Payer: WEA Trust Commercial |
$680.90
|
| Rate for Payer: WPS Commercial |
$916.99
|
|
|
K-WIRE 01.8 OLIVE TIP HOFFMANN LIMB 4933-8-030
|
Facility
|
IP
|
$1,514.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599703
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$741.86 |
| Max. Negotiated Rate |
$1,392.88 |
| Rate for Payer: Aetna Commercial |
$1,362.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,302.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$802.42
|
| Rate for Payer: Cash Price |
$454.20
|
| Rate for Payer: Cigna Commercial |
$1,392.88
|
| Rate for Payer: Health EOS Commercial |
$1,347.46
|
| Rate for Payer: HFN Commercial |
$1,392.88
|
| Rate for Payer: Multiplan Commercial |
$1,211.20
|
| Rate for Payer: NAPHCARE Commercial |
$908.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,392.88
|
| Rate for Payer: Quartz Beloit One Network |
$741.86
|
| Rate for Payer: Quartz Commercial |
$908.40
|
| Rate for Payer: WEA Trust Commercial |
$832.70
|
| Rate for Payer: WPS Commercial |
$1,121.42
|
|
|
K-WIRE 01.8 OLIVE TIP HOFFMANN LIMB 4933-8-030
|
Facility
|
OP
|
$1,514.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599703
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$423.92 |
| Max. Negotiated Rate |
$6,056.00 |
| Rate for Payer: Aetna Commercial |
$1,362.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,302.04
|
| Rate for Payer: Aetna Managed Medicare |
$423.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$984.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$757.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$726.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$802.42
|
| Rate for Payer: Cash Price |
$454.20
|
| Rate for Payer: Cigna Commercial |
$1,392.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$847.23
|
| Rate for Payer: Health EOS Commercial |
$1,347.46
|
| Rate for Payer: HFN Commercial |
$1,392.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,135.50
|
| Rate for Payer: Multiplan Commercial |
$1,211.20
|
| Rate for Payer: NAPHCARE Commercial |
$908.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,392.88
|
| Rate for Payer: Quartz Beloit One Network |
$741.86
|
| Rate for Payer: Quartz Commercial |
$984.10
|
| Rate for Payer: Quartz Medicare Advantage |
$908.40
|
| Rate for Payer: The Alliance Commercial |
$6,056.00
|
| Rate for Payer: WEA Trust Commercial |
$832.70
|
| Rate for Payer: WPS Commercial |
$1,121.42
|
|
|
K-WIRE .035 X 4 SMOOTH 316-0107
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2965452
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.92 |
| Max. Negotiated Rate |
$756.00 |
| Rate for Payer: Aetna Commercial |
$170.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$162.54
|
| Rate for Payer: Aetna Managed Medicare |
$52.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$122.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$94.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$90.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$100.17
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna Commercial |
$173.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$105.76
|
| Rate for Payer: Health EOS Commercial |
$168.21
|
| Rate for Payer: HFN Commercial |
$173.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$141.75
|
| Rate for Payer: Multiplan Commercial |
$151.20
|
| Rate for Payer: NAPHCARE Commercial |
$113.40
|
| Rate for Payer: Preferred Network Access Commercial |
$173.88
|
| Rate for Payer: Quartz Beloit One Network |
$92.61
|
| Rate for Payer: Quartz Commercial |
$122.85
|
| Rate for Payer: Quartz Medicare Advantage |
$113.40
|
| Rate for Payer: The Alliance Commercial |
$756.00
|
| Rate for Payer: WEA Trust Commercial |
$103.95
|
| Rate for Payer: WPS Commercial |
$139.99
|
|
|
K-WIRE .035 X 4 SMOOTH 316-0107
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2965452
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$92.61 |
| Max. Negotiated Rate |
$173.88 |
| Rate for Payer: Aetna Commercial |
$170.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$162.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$100.17
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna Commercial |
$173.88
|
| Rate for Payer: Health EOS Commercial |
$168.21
|
| Rate for Payer: HFN Commercial |
$173.88
|
| Rate for Payer: Multiplan Commercial |
$151.20
|
| Rate for Payer: NAPHCARE Commercial |
$113.40
|
| Rate for Payer: Preferred Network Access Commercial |
$173.88
|
| Rate for Payer: Quartz Beloit One Network |
$92.61
|
| Rate for Payer: Quartz Commercial |
$113.40
|
| Rate for Payer: WEA Trust Commercial |
$103.95
|
| Rate for Payer: WPS Commercial |
$139.99
|
|
|
K-WIRE .035 X 4 THREAD 316-0114
|
Facility
|
OP
|
$189.00
|
|
| Hospital Charge Code |
2965453
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.92 |
| Max. Negotiated Rate |
$756.00 |
| Rate for Payer: Aetna Commercial |
$170.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$162.54
|
| Rate for Payer: Aetna Managed Medicare |
$52.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$122.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$94.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$90.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$100.17
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna Commercial |
$173.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$105.76
|
| Rate for Payer: Health EOS Commercial |
$168.21
|
| Rate for Payer: HFN Commercial |
$173.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$141.75
|
| Rate for Payer: Multiplan Commercial |
$151.20
|
| Rate for Payer: NAPHCARE Commercial |
$113.40
|
| Rate for Payer: Preferred Network Access Commercial |
$173.88
|
| Rate for Payer: Quartz Beloit One Network |
$92.61
|
| Rate for Payer: Quartz Commercial |
$122.85
|
| Rate for Payer: Quartz Medicare Advantage |
$113.40
|
| Rate for Payer: The Alliance Commercial |
$756.00
|
| Rate for Payer: WEA Trust Commercial |
$103.95
|
| Rate for Payer: WPS Commercial |
$139.99
|
|
|
K-WIRE .035 X 4 THREAD 316-0114
|
Facility
|
IP
|
$189.00
|
|
| Hospital Charge Code |
2965453
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$92.61 |
| Max. Negotiated Rate |
$173.88 |
| Rate for Payer: Aetna Commercial |
$170.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$162.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$100.17
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna Commercial |
$173.88
|
| Rate for Payer: Health EOS Commercial |
$168.21
|
| Rate for Payer: HFN Commercial |
$173.88
|
| Rate for Payer: Multiplan Commercial |
$151.20
|
| Rate for Payer: NAPHCARE Commercial |
$113.40
|
| Rate for Payer: Preferred Network Access Commercial |
$173.88
|
| Rate for Payer: Quartz Beloit One Network |
$92.61
|
| Rate for Payer: Quartz Commercial |
$113.40
|
| Rate for Payer: WEA Trust Commercial |
$103.95
|
| Rate for Payer: WPS Commercial |
$139.99
|
|
|
K-WIRE .035 X 6 IN DOUBLE TROCAR 80-1525
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5895628
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$211.19 |
| Max. Negotiated Rate |
$396.52 |
| Rate for Payer: Aetna Commercial |
$387.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$370.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$228.43
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cigna Commercial |
$396.52
|
| Rate for Payer: Health EOS Commercial |
$383.59
|
| Rate for Payer: HFN Commercial |
$396.52
|
| Rate for Payer: Multiplan Commercial |
$344.80
|
| Rate for Payer: NAPHCARE Commercial |
$258.60
|
| Rate for Payer: Preferred Network Access Commercial |
$396.52
|
| Rate for Payer: Quartz Beloit One Network |
$211.19
|
| Rate for Payer: Quartz Commercial |
$258.60
|
| Rate for Payer: WEA Trust Commercial |
$237.05
|
| Rate for Payer: WPS Commercial |
$319.24
|
|
|
K-WIRE .035 X 6 IN DOUBLE TROCAR 80-1525
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5895628
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$120.68 |
| Max. Negotiated Rate |
$1,724.00 |
| Rate for Payer: Aetna Commercial |
$387.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$370.66
|
| Rate for Payer: Aetna Managed Medicare |
$120.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$280.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$215.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$206.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$228.43
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cigna Commercial |
$396.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$241.19
|
| Rate for Payer: Health EOS Commercial |
$383.59
|
| Rate for Payer: HFN Commercial |
$396.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$323.25
|
| Rate for Payer: Multiplan Commercial |
$344.80
|
| Rate for Payer: NAPHCARE Commercial |
$258.60
|
| Rate for Payer: Preferred Network Access Commercial |
$396.52
|
| Rate for Payer: Quartz Beloit One Network |
$211.19
|
| Rate for Payer: Quartz Commercial |
$280.15
|
| Rate for Payer: Quartz Medicare Advantage |
$258.60
|
| Rate for Payer: The Alliance Commercial |
$1,724.00
|
| Rate for Payer: WEA Trust Commercial |
$237.05
|
| Rate for Payer: WPS Commercial |
$319.24
|
|
|
K-WIRE .035 X 6 SINGLE TROCAR 80-1524"
|
Facility
|
OP
|
$448.00
|
|
| Hospital Charge Code |
4206007
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$125.44 |
| Max. Negotiated Rate |
$1,792.00 |
| Rate for Payer: Aetna Commercial |
$403.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$385.28
|
| Rate for Payer: Aetna Managed Medicare |
$125.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$291.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$224.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$215.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$237.44
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cigna Commercial |
$412.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$250.70
|
| Rate for Payer: Health EOS Commercial |
$398.72
|
| Rate for Payer: HFN Commercial |
$412.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$336.00
|
| Rate for Payer: Multiplan Commercial |
$358.40
|
| Rate for Payer: NAPHCARE Commercial |
$268.80
|
| Rate for Payer: Preferred Network Access Commercial |
$412.16
|
| Rate for Payer: Quartz Beloit One Network |
$219.52
|
| Rate for Payer: Quartz Commercial |
$291.20
|
| Rate for Payer: Quartz Medicare Advantage |
$268.80
|
| Rate for Payer: The Alliance Commercial |
$1,792.00
|
| Rate for Payer: WEA Trust Commercial |
$246.40
|
| Rate for Payer: WPS Commercial |
$331.83
|
|
|
K-WIRE .035 X 6 SINGLE TROCAR 80-1524"
|
Facility
|
IP
|
$448.00
|
|
| Hospital Charge Code |
4206007
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$219.52 |
| Max. Negotiated Rate |
$412.16 |
| Rate for Payer: Aetna Commercial |
$403.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$385.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$237.44
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cigna Commercial |
$412.16
|
| Rate for Payer: Health EOS Commercial |
$398.72
|
| Rate for Payer: HFN Commercial |
$412.16
|
| Rate for Payer: Multiplan Commercial |
$358.40
|
| Rate for Payer: NAPHCARE Commercial |
$268.80
|
| Rate for Payer: Preferred Network Access Commercial |
$412.16
|
| Rate for Payer: Quartz Beloit One Network |
$219.52
|
| Rate for Payer: Quartz Commercial |
$268.80
|
| Rate for Payer: WEA Trust Commercial |
$246.40
|
| Rate for Payer: WPS Commercial |
$331.83
|
|
|
K-WIRE 0.60 292.06
|
Facility
|
OP
|
$189.00
|
|
| Hospital Charge Code |
2966610
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.92 |
| Max. Negotiated Rate |
$756.00 |
| Rate for Payer: Aetna Commercial |
$170.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$162.54
|
| Rate for Payer: Aetna Managed Medicare |
$52.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$122.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$94.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$90.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$100.17
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna Commercial |
$173.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$105.76
|
| Rate for Payer: Health EOS Commercial |
$168.21
|
| Rate for Payer: HFN Commercial |
$173.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$141.75
|
| Rate for Payer: Multiplan Commercial |
$151.20
|
| Rate for Payer: NAPHCARE Commercial |
$113.40
|
| Rate for Payer: Preferred Network Access Commercial |
$173.88
|
| Rate for Payer: Quartz Beloit One Network |
$92.61
|
| Rate for Payer: Quartz Commercial |
$122.85
|
| Rate for Payer: Quartz Medicare Advantage |
$113.40
|
| Rate for Payer: The Alliance Commercial |
$756.00
|
| Rate for Payer: WEA Trust Commercial |
$103.95
|
| Rate for Payer: WPS Commercial |
$139.99
|
|
