|
K-WIRE PARTIALLY THREADED TRILLIANT 0.045 210-40-005
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3784165
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$98.72 |
| Max. Negotiated Rate |
$324.36 |
| Rate for Payer: Aetna Commercial |
$317.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$303.20
|
| Rate for Payer: Aetna Managed Medicare |
$98.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$229.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$176.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$169.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$186.86
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cigna Commercial |
$324.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$197.30
|
| Rate for Payer: Health EOS Commercial |
$313.78
|
| Rate for Payer: HFN Commercial |
$324.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$264.42
|
| Rate for Payer: Multiplan Commercial |
$282.05
|
| Rate for Payer: NAPHCARE Commercial |
$211.54
|
| Rate for Payer: Preferred Network Access Commercial |
$324.36
|
| Rate for Payer: Quartz Beloit One Network |
$172.75
|
| Rate for Payer: Quartz Commercial |
$229.16
|
| Rate for Payer: Quartz Medicare Advantage |
$211.54
|
| Rate for Payer: The Alliance Commercial |
$176.28
|
| Rate for Payer: WEA Trust Commercial |
$193.91
|
| Rate for Payer: WPS Commercial |
$261.13
|
|
|
K-WIRE PARTIALLY THREADED TRILLIANT 0.045 210-40-005
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3784165
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$172.75 |
| Max. Negotiated Rate |
$324.36 |
| Rate for Payer: Aetna Commercial |
$317.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$303.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$186.86
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cigna Commercial |
$324.36
|
| Rate for Payer: Health EOS Commercial |
$313.78
|
| Rate for Payer: HFN Commercial |
$324.36
|
| Rate for Payer: Multiplan Commercial |
$282.05
|
| Rate for Payer: Preferred Network Access Commercial |
$324.36
|
| Rate for Payer: Quartz Beloit One Network |
$172.75
|
| Rate for Payer: Quartz Commercial |
$211.54
|
| Rate for Payer: WEA Trust Commercial |
$193.91
|
| Rate for Payer: WPS Commercial |
$261.13
|
|
|
K-WIRE SMOOTH 1.4 X 100MM 45-80200
|
Facility
|
IP
|
$249.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5547408
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$126.89 |
| Max. Negotiated Rate |
$238.24 |
| Rate for Payer: Aetna Commercial |
$233.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$222.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$137.25
|
| Rate for Payer: Cash Price |
$74.70
|
| Rate for Payer: Cigna Commercial |
$238.24
|
| Rate for Payer: Health EOS Commercial |
$230.47
|
| Rate for Payer: HFN Commercial |
$238.24
|
| Rate for Payer: Multiplan Commercial |
$207.17
|
| Rate for Payer: Preferred Network Access Commercial |
$238.24
|
| Rate for Payer: Quartz Beloit One Network |
$126.89
|
| Rate for Payer: Quartz Commercial |
$155.38
|
| Rate for Payer: WEA Trust Commercial |
$142.43
|
| Rate for Payer: WPS Commercial |
$191.80
|
|
|
K-WIRE SMOOTH 1.4 X 100MM 45-80200
|
Facility
|
OP
|
$249.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5547408
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.51 |
| Max. Negotiated Rate |
$238.24 |
| Rate for Payer: Aetna Commercial |
$233.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$222.71
|
| Rate for Payer: Aetna Managed Medicare |
$72.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$168.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$129.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$124.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$137.25
|
| Rate for Payer: Cash Price |
$74.70
|
| Rate for Payer: Cigna Commercial |
$238.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$144.92
|
| Rate for Payer: Health EOS Commercial |
$230.47
|
| Rate for Payer: HFN Commercial |
$238.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$194.22
|
| Rate for Payer: Multiplan Commercial |
$207.17
|
| Rate for Payer: NAPHCARE Commercial |
$155.38
|
| Rate for Payer: Preferred Network Access Commercial |
$238.24
|
| Rate for Payer: Quartz Beloit One Network |
$126.89
|
| Rate for Payer: Quartz Commercial |
$168.32
|
| Rate for Payer: Quartz Medicare Advantage |
$155.38
|
| Rate for Payer: The Alliance Commercial |
$129.48
|
| Rate for Payer: WEA Trust Commercial |
$142.43
|
| Rate for Payer: WPS Commercial |
$191.80
|
|
|
K-WIRE SMOOTH TH #AW1105
|
Facility
|
OP
|
$427.00
|
|
| Hospital Charge Code |
2964744
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$124.34 |
| Max. Negotiated Rate |
$408.55 |
| Rate for Payer: Aetna Commercial |
$399.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$381.91
|
| Rate for Payer: Aetna Managed Medicare |
$124.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$288.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$222.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$213.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$235.36
|
| Rate for Payer: Cash Price |
$128.10
|
| Rate for Payer: Cigna Commercial |
$408.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$248.51
|
| Rate for Payer: Health EOS Commercial |
$395.23
|
| Rate for Payer: HFN Commercial |
$408.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$333.06
|
| Rate for Payer: Multiplan Commercial |
$355.26
|
| Rate for Payer: NAPHCARE Commercial |
$266.45
|
| Rate for Payer: Preferred Network Access Commercial |
$408.55
|
| Rate for Payer: Quartz Beloit One Network |
$217.60
|
| Rate for Payer: Quartz Commercial |
$288.65
|
| Rate for Payer: Quartz Medicare Advantage |
$266.45
|
| Rate for Payer: The Alliance Commercial |
$222.04
|
| Rate for Payer: WEA Trust Commercial |
$244.24
|
| Rate for Payer: WPS Commercial |
$328.92
|
|
|
K-WIRE SMOOTH TH #AW1105
|
Facility
|
IP
|
$427.00
|
|
| Hospital Charge Code |
2964744
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$217.60 |
| Max. Negotiated Rate |
$408.55 |
| Rate for Payer: Aetna Commercial |
$399.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$381.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$235.36
|
| Rate for Payer: Cash Price |
$128.10
|
| Rate for Payer: Cigna Commercial |
$408.55
|
| Rate for Payer: Health EOS Commercial |
$395.23
|
| Rate for Payer: HFN Commercial |
$408.55
|
| Rate for Payer: Multiplan Commercial |
$355.26
|
| Rate for Payer: Preferred Network Access Commercial |
$408.55
|
| Rate for Payer: Quartz Beloit One Network |
$217.60
|
| Rate for Payer: Quartz Commercial |
$266.45
|
| Rate for Payer: WEA Trust Commercial |
$244.24
|
| Rate for Payer: WPS Commercial |
$328.92
|
|
|
K-WIRE TIGER .035 DBL-END 210-24-006
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3133496
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.92 |
| Max. Negotiated Rate |
$334.88 |
| Rate for Payer: Aetna Commercial |
$327.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$313.04
|
| Rate for Payer: Aetna Managed Medicare |
$101.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$236.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$182.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$174.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$192.92
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$334.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$203.70
|
| Rate for Payer: Health EOS Commercial |
$323.96
|
| Rate for Payer: HFN Commercial |
$334.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$273.00
|
| Rate for Payer: Multiplan Commercial |
$291.20
|
| Rate for Payer: NAPHCARE Commercial |
$218.40
|
| Rate for Payer: Preferred Network Access Commercial |
$334.88
|
| Rate for Payer: Quartz Beloit One Network |
$178.36
|
| Rate for Payer: Quartz Commercial |
$236.60
|
| Rate for Payer: Quartz Medicare Advantage |
$218.40
|
| Rate for Payer: The Alliance Commercial |
$182.00
|
| Rate for Payer: WEA Trust Commercial |
$200.20
|
| Rate for Payer: WPS Commercial |
$269.61
|
|
|
K-WIRE TIGER .035 DBL-END 210-24-006
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3133496
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$178.36 |
| Max. Negotiated Rate |
$334.88 |
| Rate for Payer: Aetna Commercial |
$327.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$313.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$192.92
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$334.88
|
| Rate for Payer: Health EOS Commercial |
$323.96
|
| Rate for Payer: HFN Commercial |
$334.88
|
| Rate for Payer: Multiplan Commercial |
$291.20
|
| Rate for Payer: Preferred Network Access Commercial |
$334.88
|
| Rate for Payer: Quartz Beloit One Network |
$178.36
|
| Rate for Payer: Quartz Commercial |
$218.40
|
| Rate for Payer: WEA Trust Commercial |
$200.20
|
| Rate for Payer: WPS Commercial |
$269.61
|
|
|
K-WIRE TRILLIANT 0.035 STANDARD 210-24-004
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2969382
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.92 |
| Max. Negotiated Rate |
$334.88 |
| Rate for Payer: Aetna Commercial |
$327.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$313.04
|
| Rate for Payer: Aetna Managed Medicare |
$101.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$236.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$182.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$174.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$192.92
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$334.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$203.70
|
| Rate for Payer: Health EOS Commercial |
$323.96
|
| Rate for Payer: HFN Commercial |
$334.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$273.00
|
| Rate for Payer: Multiplan Commercial |
$291.20
|
| Rate for Payer: NAPHCARE Commercial |
$218.40
|
| Rate for Payer: Preferred Network Access Commercial |
$334.88
|
| Rate for Payer: Quartz Beloit One Network |
$178.36
|
| Rate for Payer: Quartz Commercial |
$236.60
|
| Rate for Payer: Quartz Medicare Advantage |
$218.40
|
| Rate for Payer: The Alliance Commercial |
$182.00
|
| Rate for Payer: WEA Trust Commercial |
$200.20
|
| Rate for Payer: WPS Commercial |
$269.61
|
|
|
K-WIRE TRILLIANT 0.035 STANDARD 210-24-004
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2969382
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$178.36 |
| Max. Negotiated Rate |
$334.88 |
| Rate for Payer: Aetna Commercial |
$327.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$313.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$192.92
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$334.88
|
| Rate for Payer: Health EOS Commercial |
$323.96
|
| Rate for Payer: HFN Commercial |
$334.88
|
| Rate for Payer: Multiplan Commercial |
$291.20
|
| Rate for Payer: Preferred Network Access Commercial |
$334.88
|
| Rate for Payer: Quartz Beloit One Network |
$178.36
|
| Rate for Payer: Quartz Commercial |
$218.40
|
| Rate for Payer: WEA Trust Commercial |
$200.20
|
| Rate for Payer: WPS Commercial |
$269.61
|
|
|
K-WIRE TRILLIANT 0.045 STANDARD 210-40-004
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3225471
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.92 |
| Max. Negotiated Rate |
$334.88 |
| Rate for Payer: Aetna Commercial |
$327.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$313.04
|
| Rate for Payer: Aetna Managed Medicare |
$101.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$236.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$182.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$174.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$192.92
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$334.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$203.70
|
| Rate for Payer: Health EOS Commercial |
$323.96
|
| Rate for Payer: HFN Commercial |
$334.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$273.00
|
| Rate for Payer: Multiplan Commercial |
$291.20
|
| Rate for Payer: NAPHCARE Commercial |
$218.40
|
| Rate for Payer: Preferred Network Access Commercial |
$334.88
|
| Rate for Payer: Quartz Beloit One Network |
$178.36
|
| Rate for Payer: Quartz Commercial |
$236.60
|
| Rate for Payer: Quartz Medicare Advantage |
$218.40
|
| Rate for Payer: The Alliance Commercial |
$182.00
|
| Rate for Payer: WEA Trust Commercial |
$200.20
|
| Rate for Payer: WPS Commercial |
$269.61
|
|
|
K-WIRE TRILLIANT 0.045 STANDARD 210-40-004
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3225471
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$178.36 |
| Max. Negotiated Rate |
$334.88 |
| Rate for Payer: Aetna Commercial |
$327.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$313.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$192.92
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$334.88
|
| Rate for Payer: Health EOS Commercial |
$323.96
|
| Rate for Payer: HFN Commercial |
$334.88
|
| Rate for Payer: Multiplan Commercial |
$291.20
|
| Rate for Payer: Preferred Network Access Commercial |
$334.88
|
| Rate for Payer: Quartz Beloit One Network |
$178.36
|
| Rate for Payer: Quartz Commercial |
$218.40
|
| Rate for Payer: WEA Trust Commercial |
$200.20
|
| Rate for Payer: WPS Commercial |
$269.61
|
|
|
K-WIRE TROCAR POINT 292.18
|
Facility
|
OP
|
$1,750.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2969343
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$509.60 |
| Max. Negotiated Rate |
$1,674.40 |
| Rate for Payer: Aetna Commercial |
$1,638.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,565.20
|
| Rate for Payer: Aetna Managed Medicare |
$509.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,183.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$910.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$873.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$964.60
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$1,674.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,018.50
|
| Rate for Payer: Health EOS Commercial |
$1,619.80
|
| Rate for Payer: HFN Commercial |
$1,674.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,365.00
|
| Rate for Payer: Multiplan Commercial |
$1,456.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,092.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,674.40
|
| Rate for Payer: Quartz Beloit One Network |
$891.80
|
| Rate for Payer: Quartz Commercial |
$1,183.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,092.00
|
| Rate for Payer: The Alliance Commercial |
$910.00
|
| Rate for Payer: WEA Trust Commercial |
$1,001.00
|
| Rate for Payer: WPS Commercial |
$1,348.03
|
|
|
K-WIRE TROCAR POINT 292.18
|
Facility
|
IP
|
$1,750.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2969343
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$891.80 |
| Max. Negotiated Rate |
$1,674.40 |
| Rate for Payer: Aetna Commercial |
$1,638.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,565.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$964.60
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$1,674.40
|
| Rate for Payer: Health EOS Commercial |
$1,619.80
|
| Rate for Payer: HFN Commercial |
$1,674.40
|
| Rate for Payer: Multiplan Commercial |
$1,456.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,674.40
|
| Rate for Payer: Quartz Beloit One Network |
$891.80
|
| Rate for Payer: Quartz Commercial |
$1,092.00
|
| Rate for Payer: WEA Trust Commercial |
$1,001.00
|
| Rate for Payer: WPS Commercial |
$1,348.03
|
|
|
K-WIRE TWO STEP 0.054 X6 210-54-006
|
Facility
|
IP
|
$307.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3715510
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$156.45 |
| Max. Negotiated Rate |
$293.74 |
| Rate for Payer: Aetna Commercial |
$287.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$274.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$169.22
|
| Rate for Payer: Cash Price |
$92.10
|
| Rate for Payer: Cigna Commercial |
$293.74
|
| Rate for Payer: Health EOS Commercial |
$284.16
|
| Rate for Payer: HFN Commercial |
$293.74
|
| Rate for Payer: Multiplan Commercial |
$255.42
|
| Rate for Payer: Preferred Network Access Commercial |
$293.74
|
| Rate for Payer: Quartz Beloit One Network |
$156.45
|
| Rate for Payer: Quartz Commercial |
$191.57
|
| Rate for Payer: WEA Trust Commercial |
$175.60
|
| Rate for Payer: WPS Commercial |
$236.48
|
|
|
K-WIRE TWO STEP 0.054 X6 210-54-006
|
Facility
|
OP
|
$307.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3715510
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$89.40 |
| Max. Negotiated Rate |
$293.74 |
| Rate for Payer: Aetna Commercial |
$287.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$274.58
|
| Rate for Payer: Aetna Managed Medicare |
$89.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$207.53
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$159.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$153.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$169.22
|
| Rate for Payer: Cash Price |
$92.10
|
| Rate for Payer: Cigna Commercial |
$293.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$178.67
|
| Rate for Payer: Health EOS Commercial |
$284.16
|
| Rate for Payer: HFN Commercial |
$293.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$239.46
|
| Rate for Payer: Multiplan Commercial |
$255.42
|
| Rate for Payer: NAPHCARE Commercial |
$191.57
|
| Rate for Payer: Preferred Network Access Commercial |
$293.74
|
| Rate for Payer: Quartz Beloit One Network |
$156.45
|
| Rate for Payer: Quartz Commercial |
$207.53
|
| Rate for Payer: Quartz Medicare Advantage |
$191.57
|
| Rate for Payer: The Alliance Commercial |
$159.64
|
| Rate for Payer: WEA Trust Commercial |
$175.60
|
| Rate for Payer: WPS Commercial |
$236.48
|
|
|
K-WIRE WITH OLIVE 1.2MM X 65MM TROCAR TIP SMOOTH XBR001002
|
Facility
|
OP
|
$2,527.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5547409
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$735.86 |
| Max. Negotiated Rate |
$2,417.83 |
| Rate for Payer: Aetna Commercial |
$2,365.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,260.15
|
| Rate for Payer: Aetna Managed Medicare |
$735.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,708.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,314.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,261.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,392.88
|
| Rate for Payer: Cash Price |
$758.10
|
| Rate for Payer: Cigna Commercial |
$2,417.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,470.71
|
| Rate for Payer: Health EOS Commercial |
$2,338.99
|
| Rate for Payer: HFN Commercial |
$2,417.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,971.06
|
| Rate for Payer: Multiplan Commercial |
$2,102.46
|
| Rate for Payer: NAPHCARE Commercial |
$1,576.85
|
| Rate for Payer: Preferred Network Access Commercial |
$2,417.83
|
| Rate for Payer: Quartz Beloit One Network |
$1,287.76
|
| Rate for Payer: Quartz Commercial |
$1,708.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,576.85
|
| Rate for Payer: The Alliance Commercial |
$1,314.04
|
| Rate for Payer: WEA Trust Commercial |
$1,445.44
|
| Rate for Payer: WPS Commercial |
$1,946.55
|
|
|
K-WIRE WITH OLIVE 1.2MM X 65MM TROCAR TIP SMOOTH XBR001002
|
Facility
|
IP
|
$2,527.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5547409
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,287.76 |
| Max. Negotiated Rate |
$2,417.83 |
| Rate for Payer: Aetna Commercial |
$2,365.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,260.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,392.88
|
| Rate for Payer: Cash Price |
$758.10
|
| Rate for Payer: Cigna Commercial |
$2,417.83
|
| Rate for Payer: Health EOS Commercial |
$2,338.99
|
| Rate for Payer: HFN Commercial |
$2,417.83
|
| Rate for Payer: Multiplan Commercial |
$2,102.46
|
| Rate for Payer: Preferred Network Access Commercial |
$2,417.83
|
| Rate for Payer: Quartz Beloit One Network |
$1,287.76
|
| Rate for Payer: Quartz Commercial |
$1,576.85
|
| Rate for Payer: WEA Trust Commercial |
$1,445.44
|
| Rate for Payer: WPS Commercial |
$1,946.55
|
|
|
Kyleena 1 unit Charge
|
Facility
|
IP
|
$2,409.00
|
|
|
Service Code
|
HCPCS J7296
|
| Hospital Charge Code |
5571269
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,227.63 |
| Max. Negotiated Rate |
$2,304.93 |
| Rate for Payer: Aetna Commercial |
$2,254.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,154.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,327.84
|
| Rate for Payer: Cash Price |
$722.70
|
| Rate for Payer: Cigna Commercial |
$2,304.93
|
| Rate for Payer: Health EOS Commercial |
$2,229.77
|
| Rate for Payer: HFN Commercial |
$2,304.93
|
| Rate for Payer: Multiplan Commercial |
$2,004.29
|
| Rate for Payer: Preferred Network Access Commercial |
$2,304.93
|
| Rate for Payer: Quartz Beloit One Network |
$1,227.63
|
| Rate for Payer: Quartz Commercial |
$1,503.22
|
| Rate for Payer: WEA Trust Commercial |
$1,377.95
|
| Rate for Payer: WPS Commercial |
$1,855.65
|
|
|
Kyleena 1 unit Charge
|
Facility
|
OP
|
$2,409.00
|
|
|
Service Code
|
HCPCS J7296
|
| Hospital Charge Code |
5571269
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$701.50 |
| Max. Negotiated Rate |
$2,304.93 |
| Rate for Payer: Aetna Commercial |
$2,254.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,154.61
|
| Rate for Payer: Aetna Managed Medicare |
$701.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,628.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,252.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,202.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,327.84
|
| Rate for Payer: Cash Price |
$722.70
|
| Rate for Payer: Cigna Commercial |
$2,304.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,402.04
|
| Rate for Payer: Health EOS Commercial |
$2,229.77
|
| Rate for Payer: HFN Commercial |
$2,304.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,879.02
|
| Rate for Payer: Multiplan Commercial |
$2,004.29
|
| Rate for Payer: NAPHCARE Commercial |
$1,503.22
|
| Rate for Payer: Preferred Network Access Commercial |
$2,304.93
|
| Rate for Payer: Quartz Beloit One Network |
$1,227.63
|
| Rate for Payer: Quartz Commercial |
$1,628.48
|
| Rate for Payer: Quartz Medicare Advantage |
$1,503.22
|
| Rate for Payer: The Alliance Commercial |
$1,252.68
|
| Rate for Payer: WEA Trust Commercial |
$1,377.95
|
| Rate for Payer: WPS Commercial |
$1,855.65
|
|
|
Kyleena 1 unit Charge
|
Professional
|
Both
|
$2,409.00
|
|
|
Service Code
|
HCPCS J7296
|
| Hospital Charge Code |
5571269
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,039.25 |
| Max. Negotiated Rate |
$2,380.09 |
| Rate for Payer: Aetna Commercial |
$2,380.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,154.61
|
| Rate for Payer: Anthem Commercial |
$1,039.25
|
| Rate for Payer: Cash Price |
$722.70
|
| Rate for Payer: Cash Price |
$722.70
|
| Rate for Payer: Cigna Commercial |
$2,380.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,263.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,503.22
|
| Rate for Payer: Health EOS Commercial |
$2,279.88
|
| Rate for Payer: HFN Commercial |
$2,380.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,547.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,547.66
|
| Rate for Payer: Multiplan Commercial |
$2,004.29
|
| Rate for Payer: Preferred Network Access Commercial |
$2,380.09
|
| Rate for Payer: Quartz Beloit One Network |
$1,102.36
|
| Rate for Payer: Quartz Commercial |
$1,428.06
|
| Rate for Payer: The Alliance Commercial |
$1,252.68
|
| Rate for Payer: United Healthcare Medicaid |
$1,263.22
|
| Rate for Payer: WEA Trust Commercial |
$1,377.95
|
| Rate for Payer: WPS Commercial |
$1,855.65
|
|
|
KYPHOPLASTY LUMBAR
|
Facility
|
OP
|
$2,330.00
|
|
| Hospital Charge Code |
6180102
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$678.50 |
| Max. Negotiated Rate |
$2,229.34 |
| Rate for Payer: Aetna Commercial |
$2,180.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,083.95
|
| Rate for Payer: Aetna Managed Medicare |
$678.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,575.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,211.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,163.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,284.30
|
| Rate for Payer: Cash Price |
$699.00
|
| Rate for Payer: Cigna Commercial |
$2,229.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,356.06
|
| Rate for Payer: Health EOS Commercial |
$2,156.65
|
| Rate for Payer: HFN Commercial |
$2,229.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,817.40
|
| Rate for Payer: Multiplan Commercial |
$1,938.56
|
| Rate for Payer: NAPHCARE Commercial |
$1,453.92
|
| Rate for Payer: Preferred Network Access Commercial |
$2,229.34
|
| Rate for Payer: Quartz Beloit One Network |
$1,187.37
|
| Rate for Payer: Quartz Commercial |
$1,575.08
|
| Rate for Payer: Quartz Medicare Advantage |
$1,453.92
|
| Rate for Payer: The Alliance Commercial |
$1,211.60
|
| Rate for Payer: WEA Trust Commercial |
$1,332.76
|
| Rate for Payer: WPS Commercial |
$1,794.80
|
|
|
KYPHOPLASTY LUMBAR
|
Facility
|
IP
|
$2,330.00
|
|
| Hospital Charge Code |
6180102
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,187.37 |
| Max. Negotiated Rate |
$2,229.34 |
| Rate for Payer: Aetna Commercial |
$2,180.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,083.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,284.30
|
| Rate for Payer: Cash Price |
$699.00
|
| Rate for Payer: Cigna Commercial |
$2,229.34
|
| Rate for Payer: Health EOS Commercial |
$2,156.65
|
| Rate for Payer: HFN Commercial |
$2,229.34
|
| Rate for Payer: Multiplan Commercial |
$1,938.56
|
| Rate for Payer: Preferred Network Access Commercial |
$2,229.34
|
| Rate for Payer: Quartz Beloit One Network |
$1,187.37
|
| Rate for Payer: Quartz Commercial |
$1,453.92
|
| Rate for Payer: WEA Trust Commercial |
$1,332.76
|
| Rate for Payer: WPS Commercial |
$1,794.80
|
|
|
KYPHOPLASTY LUMBAR ADD LEVEL
|
Facility
|
OP
|
$1,274.00
|
|
| Hospital Charge Code |
6180100
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$370.99 |
| Max. Negotiated Rate |
$1,218.96 |
| Rate for Payer: Aetna Commercial |
$1,192.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,139.47
|
| Rate for Payer: Aetna Managed Medicare |
$370.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$861.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$662.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$635.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$702.23
|
| Rate for Payer: Cash Price |
$382.20
|
| Rate for Payer: Cigna Commercial |
$1,218.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$741.47
|
| Rate for Payer: Health EOS Commercial |
$1,179.21
|
| Rate for Payer: HFN Commercial |
$1,218.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$993.72
|
| Rate for Payer: Multiplan Commercial |
$1,059.97
|
| Rate for Payer: NAPHCARE Commercial |
$794.98
|
| Rate for Payer: Preferred Network Access Commercial |
$1,218.96
|
| Rate for Payer: Quartz Beloit One Network |
$649.23
|
| Rate for Payer: Quartz Commercial |
$861.22
|
| Rate for Payer: Quartz Medicare Advantage |
$794.98
|
| Rate for Payer: The Alliance Commercial |
$662.48
|
| Rate for Payer: WEA Trust Commercial |
$728.73
|
| Rate for Payer: WPS Commercial |
$981.36
|
|
|
KYPHOPLASTY LUMBAR ADD LEVEL
|
Facility
|
IP
|
$1,274.00
|
|
| Hospital Charge Code |
6180100
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$649.23 |
| Max. Negotiated Rate |
$1,218.96 |
| Rate for Payer: Aetna Commercial |
$1,192.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,139.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$702.23
|
| Rate for Payer: Cash Price |
$382.20
|
| Rate for Payer: Cigna Commercial |
$1,218.96
|
| Rate for Payer: Health EOS Commercial |
$1,179.21
|
| Rate for Payer: HFN Commercial |
$1,218.96
|
| Rate for Payer: Multiplan Commercial |
$1,059.97
|
| Rate for Payer: Preferred Network Access Commercial |
$1,218.96
|
| Rate for Payer: Quartz Beloit One Network |
$649.23
|
| Rate for Payer: Quartz Commercial |
$794.98
|
| Rate for Payer: WEA Trust Commercial |
$728.73
|
| Rate for Payer: WPS Commercial |
$981.36
|
|
