|
KO Rigid w/o joints pre ots L1836
|
Facility
|
IP
|
$335.00
|
|
|
Service Code
|
HCPCS L1836
|
| Hospital Charge Code |
4924610
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$170.72 |
| Max. Negotiated Rate |
$320.53 |
| Rate for Payer: Aetna Commercial |
$313.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$299.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$184.65
|
| Rate for Payer: Cash Price |
$100.50
|
| Rate for Payer: Cigna Commercial |
$320.53
|
| Rate for Payer: Health EOS Commercial |
$310.08
|
| Rate for Payer: HFN Commercial |
$320.53
|
| Rate for Payer: Multiplan Commercial |
$278.72
|
| Rate for Payer: Preferred Network Access Commercial |
$320.53
|
| Rate for Payer: Quartz Beloit One Network |
$170.72
|
| Rate for Payer: Quartz Commercial |
$209.04
|
| Rate for Payer: WEA Trust Commercial |
$191.62
|
| Rate for Payer: WPS Commercial |
$258.05
|
|
|
K PAD
|
Facility
|
OP
|
$172.00
|
|
| Hospital Charge Code |
3075865
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$50.09 |
| Max. Negotiated Rate |
$164.57 |
| Rate for Payer: Aetna Commercial |
$160.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$153.84
|
| Rate for Payer: Aetna Managed Medicare |
$50.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$116.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$89.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$85.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$94.81
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cigna Commercial |
$164.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$100.10
|
| Rate for Payer: Health EOS Commercial |
$159.20
|
| Rate for Payer: HFN Commercial |
$164.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$134.16
|
| Rate for Payer: Multiplan Commercial |
$143.10
|
| Rate for Payer: NAPHCARE Commercial |
$107.33
|
| Rate for Payer: Preferred Network Access Commercial |
$164.57
|
| Rate for Payer: Quartz Beloit One Network |
$87.65
|
| Rate for Payer: Quartz Commercial |
$116.27
|
| Rate for Payer: Quartz Medicare Advantage |
$107.33
|
| Rate for Payer: The Alliance Commercial |
$89.44
|
| Rate for Payer: WEA Trust Commercial |
$98.38
|
| Rate for Payer: WPS Commercial |
$132.49
|
|
|
K PAD
|
Facility
|
IP
|
$172.00
|
|
| Hospital Charge Code |
3075865
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$87.65 |
| Max. Negotiated Rate |
$164.57 |
| Rate for Payer: Aetna Commercial |
$160.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$153.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$94.81
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cigna Commercial |
$164.57
|
| Rate for Payer: Health EOS Commercial |
$159.20
|
| Rate for Payer: HFN Commercial |
$164.57
|
| Rate for Payer: Multiplan Commercial |
$143.10
|
| Rate for Payer: Preferred Network Access Commercial |
$164.57
|
| Rate for Payer: Quartz Beloit One Network |
$87.65
|
| Rate for Payer: Quartz Commercial |
$107.33
|
| Rate for Payer: WEA Trust Commercial |
$98.38
|
| Rate for Payer: WPS Commercial |
$132.49
|
|
|
K-Pad - Devices and Equipment
|
Facility
|
OP
|
$179.00
|
|
| Hospital Charge Code |
3002374
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$52.12 |
| Max. Negotiated Rate |
$171.27 |
| Rate for Payer: Aetna Commercial |
$167.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.10
|
| Rate for Payer: Aetna Managed Medicare |
$52.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$121.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$93.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$89.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.66
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cigna Commercial |
$171.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$104.18
|
| Rate for Payer: Health EOS Commercial |
$165.68
|
| Rate for Payer: HFN Commercial |
$171.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$139.62
|
| Rate for Payer: Multiplan Commercial |
$148.93
|
| Rate for Payer: NAPHCARE Commercial |
$111.70
|
| Rate for Payer: Preferred Network Access Commercial |
$171.27
|
| Rate for Payer: Quartz Beloit One Network |
$91.22
|
| Rate for Payer: Quartz Commercial |
$121.00
|
| Rate for Payer: Quartz Medicare Advantage |
$111.70
|
| Rate for Payer: The Alliance Commercial |
$93.08
|
| Rate for Payer: WEA Trust Commercial |
$102.39
|
| Rate for Payer: WPS Commercial |
$137.88
|
|
|
K-Pad - Devices and Equipment
|
Facility
|
IP
|
$179.00
|
|
| Hospital Charge Code |
3002374
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$91.22 |
| Max. Negotiated Rate |
$171.27 |
| Rate for Payer: Aetna Commercial |
$167.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.66
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cigna Commercial |
$171.27
|
| Rate for Payer: Health EOS Commercial |
$165.68
|
| Rate for Payer: HFN Commercial |
$171.27
|
| Rate for Payer: Multiplan Commercial |
$148.93
|
| Rate for Payer: Preferred Network Access Commercial |
$171.27
|
| Rate for Payer: Quartz Beloit One Network |
$91.22
|
| Rate for Payer: Quartz Commercial |
$111.70
|
| Rate for Payer: WEA Trust Commercial |
$102.39
|
| Rate for Payer: WPS Commercial |
$137.88
|
|
|
K THERMIA
|
Facility
|
OP
|
$428.00
|
|
| Hospital Charge Code |
3075866
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$124.63 |
| Max. Negotiated Rate |
$409.51 |
| Rate for Payer: Aetna Commercial |
$400.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$382.80
|
| Rate for Payer: Aetna Managed Medicare |
$124.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$289.33
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$222.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$213.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$235.91
|
| Rate for Payer: Cash Price |
$128.40
|
| Rate for Payer: Cigna Commercial |
$409.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$249.10
|
| Rate for Payer: Health EOS Commercial |
$396.16
|
| Rate for Payer: HFN Commercial |
$409.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$333.84
|
| Rate for Payer: Multiplan Commercial |
$356.10
|
| Rate for Payer: NAPHCARE Commercial |
$267.07
|
| Rate for Payer: Preferred Network Access Commercial |
$409.51
|
| Rate for Payer: Quartz Beloit One Network |
$218.11
|
| Rate for Payer: Quartz Commercial |
$289.33
|
| Rate for Payer: Quartz Medicare Advantage |
$267.07
|
| Rate for Payer: The Alliance Commercial |
$222.56
|
| Rate for Payer: WEA Trust Commercial |
$244.82
|
| Rate for Payer: WPS Commercial |
$329.69
|
|
|
K THERMIA
|
Facility
|
IP
|
$428.00
|
|
| Hospital Charge Code |
3075866
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$218.11 |
| Max. Negotiated Rate |
$409.51 |
| Rate for Payer: Aetna Commercial |
$400.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$382.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$235.91
|
| Rate for Payer: Cash Price |
$128.40
|
| Rate for Payer: Cigna Commercial |
$409.51
|
| Rate for Payer: Health EOS Commercial |
$396.16
|
| Rate for Payer: HFN Commercial |
$409.51
|
| Rate for Payer: Multiplan Commercial |
$356.10
|
| Rate for Payer: Preferred Network Access Commercial |
$409.51
|
| Rate for Payer: Quartz Beloit One Network |
$218.11
|
| Rate for Payer: Quartz Commercial |
$267.07
|
| Rate for Payer: WEA Trust Commercial |
$244.82
|
| Rate for Payer: WPS Commercial |
$329.69
|
|
|
K-Thermia - Devices and Equipment
|
Facility
|
OP
|
$490.00
|
|
| Hospital Charge Code |
3002375
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$142.69 |
| Max. Negotiated Rate |
$468.83 |
| Rate for Payer: Aetna Commercial |
$458.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$438.26
|
| Rate for Payer: Aetna Managed Medicare |
$142.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$331.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$254.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$244.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$270.09
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cigna Commercial |
$468.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$285.18
|
| Rate for Payer: Health EOS Commercial |
$453.54
|
| Rate for Payer: HFN Commercial |
$468.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$382.20
|
| Rate for Payer: Multiplan Commercial |
$407.68
|
| Rate for Payer: NAPHCARE Commercial |
$305.76
|
| Rate for Payer: Preferred Network Access Commercial |
$468.83
|
| Rate for Payer: Quartz Beloit One Network |
$249.70
|
| Rate for Payer: Quartz Commercial |
$331.24
|
| Rate for Payer: Quartz Medicare Advantage |
$305.76
|
| Rate for Payer: The Alliance Commercial |
$254.80
|
| Rate for Payer: WEA Trust Commercial |
$280.28
|
| Rate for Payer: WPS Commercial |
$377.45
|
|
|
K-Thermia - Devices and Equipment
|
Facility
|
IP
|
$490.00
|
|
| Hospital Charge Code |
3002375
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$249.70 |
| Max. Negotiated Rate |
$468.83 |
| Rate for Payer: Aetna Commercial |
$458.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$438.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$270.09
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cigna Commercial |
$468.83
|
| Rate for Payer: Health EOS Commercial |
$453.54
|
| Rate for Payer: HFN Commercial |
$468.83
|
| Rate for Payer: Multiplan Commercial |
$407.68
|
| Rate for Payer: Preferred Network Access Commercial |
$468.83
|
| Rate for Payer: Quartz Beloit One Network |
$249.70
|
| Rate for Payer: Quartz Commercial |
$305.76
|
| Rate for Payer: WEA Trust Commercial |
$280.28
|
| Rate for Payer: WPS Commercial |
$377.45
|
|
|
KU Autoabs
|
Professional
|
Both
|
$116.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
4592897
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.99 |
| Max. Negotiated Rate |
$114.61 |
| Rate for Payer: Aetna Commercial |
$114.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$103.75
|
| Rate for Payer: Aetna Managed Medicare |
$11.99
|
| Rate for Payer: Anthem Medicare Advantage |
$11.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.99
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cigna Commercial |
$114.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$60.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.99
|
| Rate for Payer: Health EOS Commercial |
$109.78
|
| Rate for Payer: HFN Commercial |
$114.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.33
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.99
|
| Rate for Payer: Multiplan Commercial |
$96.51
|
| Rate for Payer: NAPHCARE Commercial |
$17.99
|
| Rate for Payer: Preferred Network Access Commercial |
$114.61
|
| Rate for Payer: Quartz Beloit One Network |
$53.08
|
| Rate for Payer: Quartz Commercial |
$68.76
|
| Rate for Payer: Quartz Medicare Advantage |
$11.99
|
| Rate for Payer: The Alliance Commercial |
$47.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.99
|
| Rate for Payer: WEA Trust Commercial |
$66.35
|
| Rate for Payer: WPS Commercial |
$52.76
|
|
|
KU Autoabs
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
4592897
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.11 |
| Max. Negotiated Rate |
$110.99 |
| Rate for Payer: Aetna Commercial |
$108.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$103.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.94
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cigna Commercial |
$110.99
|
| Rate for Payer: Health EOS Commercial |
$107.37
|
| Rate for Payer: HFN Commercial |
$110.99
|
| Rate for Payer: Multiplan Commercial |
$96.51
|
| Rate for Payer: Preferred Network Access Commercial |
$110.99
|
| Rate for Payer: Quartz Beloit One Network |
$59.11
|
| Rate for Payer: Quartz Commercial |
$72.38
|
| Rate for Payer: WEA Trust Commercial |
$66.35
|
| Rate for Payer: WPS Commercial |
$89.35
|
|
|
KU Autoabs
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
4592897
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.99 |
| Max. Negotiated Rate |
$110.99 |
| Rate for Payer: Aetna Commercial |
$108.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$103.75
|
| Rate for Payer: Aetna Managed Medicare |
$11.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44.97
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.98
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.91
|
| Rate for Payer: Anthem Medicare Advantage |
$11.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.99
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cigna Commercial |
$110.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$67.51
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.99
|
| Rate for Payer: Health EOS Commercial |
$107.37
|
| Rate for Payer: HFN Commercial |
$110.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.99
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.99
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.99
|
| Rate for Payer: Multiplan Commercial |
$96.51
|
| Rate for Payer: NAPHCARE Commercial |
$17.99
|
| Rate for Payer: Preferred Network Access Commercial |
$110.99
|
| Rate for Payer: Quartz Beloit One Network |
$59.11
|
| Rate for Payer: Quartz Commercial |
$78.42
|
| Rate for Payer: Quartz Medicare Advantage |
$11.99
|
| Rate for Payer: The Alliance Commercial |
$47.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.99
|
| Rate for Payer: United Healthcare PPO |
$90.48
|
| Rate for Payer: WEA Trust Commercial |
$66.35
|
| Rate for Payer: Wellcare Medicare |
$11.99
|
| Rate for Payer: WPS Commercial |
$89.35
|
|
|
K WIRE
|
Facility
|
OP
|
$726.00
|
|
| Hospital Charge Code |
2965013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$211.41 |
| Max. Negotiated Rate |
$694.64 |
| Rate for Payer: Aetna Commercial |
$679.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$649.33
|
| Rate for Payer: Aetna Managed Medicare |
$211.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$490.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$377.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$362.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$400.17
|
| Rate for Payer: Cash Price |
$217.80
|
| Rate for Payer: Cigna Commercial |
$694.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$422.53
|
| Rate for Payer: Health EOS Commercial |
$671.99
|
| Rate for Payer: HFN Commercial |
$694.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$566.28
|
| Rate for Payer: Multiplan Commercial |
$604.03
|
| Rate for Payer: NAPHCARE Commercial |
$453.02
|
| Rate for Payer: Preferred Network Access Commercial |
$694.64
|
| Rate for Payer: Quartz Beloit One Network |
$369.97
|
| Rate for Payer: Quartz Commercial |
$490.78
|
| Rate for Payer: Quartz Medicare Advantage |
$453.02
|
| Rate for Payer: The Alliance Commercial |
$377.52
|
| Rate for Payer: WEA Trust Commercial |
$415.27
|
| Rate for Payer: WPS Commercial |
$559.24
|
|
|
K WIRE
|
Facility
|
IP
|
$726.00
|
|
| Hospital Charge Code |
2965013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$369.97 |
| Max. Negotiated Rate |
$694.64 |
| Rate for Payer: Aetna Commercial |
$679.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$649.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$400.17
|
| Rate for Payer: Cash Price |
$217.80
|
| Rate for Payer: Cigna Commercial |
$694.64
|
| Rate for Payer: Health EOS Commercial |
$671.99
|
| Rate for Payer: HFN Commercial |
$694.64
|
| Rate for Payer: Multiplan Commercial |
$604.03
|
| Rate for Payer: Preferred Network Access Commercial |
$694.64
|
| Rate for Payer: Quartz Beloit One Network |
$369.97
|
| Rate for Payer: Quartz Commercial |
$453.02
|
| Rate for Payer: WEA Trust Commercial |
$415.27
|
| Rate for Payer: WPS Commercial |
$559.24
|
|
|
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 |
$360.51 |
| Max. Negotiated Rate |
$1,184.52 |
| Rate for Payer: Aetna Commercial |
$1,158.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,107.27
|
| Rate for Payer: Aetna Managed Medicare |
$360.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$836.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$643.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$618.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$682.39
|
| Rate for Payer: Cash Price |
$371.40
|
| Rate for Payer: Cigna Commercial |
$1,184.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$720.52
|
| Rate for Payer: Health EOS Commercial |
$1,145.89
|
| Rate for Payer: HFN Commercial |
$1,184.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$965.64
|
| Rate for Payer: Multiplan Commercial |
$1,030.02
|
| Rate for Payer: NAPHCARE Commercial |
$772.51
|
| Rate for Payer: Preferred Network Access Commercial |
$1,184.52
|
| Rate for Payer: Quartz Beloit One Network |
$630.88
|
| Rate for Payer: Quartz Commercial |
$836.89
|
| Rate for Payer: Quartz Medicare Advantage |
$772.51
|
| Rate for Payer: The Alliance Commercial |
$643.76
|
| Rate for Payer: WEA Trust Commercial |
$708.14
|
| Rate for Payer: WPS Commercial |
$953.63
|
|
|
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 |
$630.88 |
| Max. Negotiated Rate |
$1,184.52 |
| Rate for Payer: Aetna Commercial |
$1,158.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,107.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$682.39
|
| Rate for Payer: Cash Price |
$371.40
|
| Rate for Payer: Cigna Commercial |
$1,184.52
|
| Rate for Payer: Health EOS Commercial |
$1,145.89
|
| Rate for Payer: HFN Commercial |
$1,184.52
|
| Rate for Payer: Multiplan Commercial |
$1,030.02
|
| Rate for Payer: Preferred Network Access Commercial |
$1,184.52
|
| Rate for Payer: Quartz Beloit One Network |
$630.88
|
| Rate for Payer: Quartz Commercial |
$772.51
|
| Rate for Payer: WEA Trust Commercial |
$708.14
|
| Rate for Payer: WPS Commercial |
$953.63
|
|
|
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 |
$440.88 |
| Max. Negotiated Rate |
$1,448.60 |
| Rate for Payer: Aetna Commercial |
$1,417.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,354.12
|
| Rate for Payer: Aetna Managed Medicare |
$440.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,023.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$787.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$755.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$834.52
|
| Rate for Payer: Cash Price |
$454.20
|
| Rate for Payer: Cigna Commercial |
$1,448.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$881.15
|
| Rate for Payer: Health EOS Commercial |
$1,401.36
|
| Rate for Payer: HFN Commercial |
$1,448.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,180.92
|
| Rate for Payer: Multiplan Commercial |
$1,259.65
|
| Rate for Payer: NAPHCARE Commercial |
$944.74
|
| Rate for Payer: Preferred Network Access Commercial |
$1,448.60
|
| Rate for Payer: Quartz Beloit One Network |
$771.53
|
| Rate for Payer: Quartz Commercial |
$1,023.46
|
| Rate for Payer: Quartz Medicare Advantage |
$944.74
|
| Rate for Payer: The Alliance Commercial |
$787.28
|
| Rate for Payer: WEA Trust Commercial |
$866.01
|
| Rate for Payer: WPS Commercial |
$1,166.23
|
|
|
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 |
$771.53 |
| Max. Negotiated Rate |
$1,448.60 |
| Rate for Payer: Aetna Commercial |
$1,417.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,354.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$834.52
|
| Rate for Payer: Cash Price |
$454.20
|
| Rate for Payer: Cigna Commercial |
$1,448.60
|
| Rate for Payer: Health EOS Commercial |
$1,401.36
|
| Rate for Payer: HFN Commercial |
$1,448.60
|
| Rate for Payer: Multiplan Commercial |
$1,259.65
|
| Rate for Payer: Preferred Network Access Commercial |
$1,448.60
|
| Rate for Payer: Quartz Beloit One Network |
$771.53
|
| Rate for Payer: Quartz Commercial |
$944.74
|
| Rate for Payer: WEA Trust Commercial |
$866.01
|
| Rate for Payer: WPS Commercial |
$1,166.23
|
|
|
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 |
$55.04 |
| Max. Negotiated Rate |
$180.84 |
| Rate for Payer: Aetna Commercial |
$176.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.04
|
| Rate for Payer: Aetna Managed Medicare |
$55.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$127.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$98.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$94.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$104.18
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna Commercial |
$180.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$110.00
|
| Rate for Payer: Health EOS Commercial |
$174.94
|
| Rate for Payer: HFN Commercial |
$180.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$147.42
|
| Rate for Payer: Multiplan Commercial |
$157.25
|
| Rate for Payer: NAPHCARE Commercial |
$117.94
|
| Rate for Payer: Preferred Network Access Commercial |
$180.84
|
| Rate for Payer: Quartz Beloit One Network |
$96.31
|
| Rate for Payer: Quartz Commercial |
$127.76
|
| Rate for Payer: Quartz Medicare Advantage |
$117.94
|
| Rate for Payer: The Alliance Commercial |
$98.28
|
| Rate for Payer: WEA Trust Commercial |
$108.11
|
| Rate for Payer: WPS Commercial |
$145.59
|
|
|
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 |
$96.31 |
| Max. Negotiated Rate |
$180.84 |
| Rate for Payer: Aetna Commercial |
$176.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$104.18
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna Commercial |
$180.84
|
| Rate for Payer: Health EOS Commercial |
$174.94
|
| Rate for Payer: HFN Commercial |
$180.84
|
| Rate for Payer: Multiplan Commercial |
$157.25
|
| Rate for Payer: Preferred Network Access Commercial |
$180.84
|
| Rate for Payer: Quartz Beloit One Network |
$96.31
|
| Rate for Payer: Quartz Commercial |
$117.94
|
| Rate for Payer: WEA Trust Commercial |
$108.11
|
| Rate for Payer: WPS Commercial |
$145.59
|
|
|
K-WIRE .035 X 4 THREAD 316-0114
|
Facility
|
IP
|
$189.00
|
|
| Hospital Charge Code |
2965453
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.31 |
| Max. Negotiated Rate |
$180.84 |
| Rate for Payer: Aetna Commercial |
$176.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$104.18
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna Commercial |
$180.84
|
| Rate for Payer: Health EOS Commercial |
$174.94
|
| Rate for Payer: HFN Commercial |
$180.84
|
| Rate for Payer: Multiplan Commercial |
$157.25
|
| Rate for Payer: Preferred Network Access Commercial |
$180.84
|
| Rate for Payer: Quartz Beloit One Network |
$96.31
|
| Rate for Payer: Quartz Commercial |
$117.94
|
| Rate for Payer: WEA Trust Commercial |
$108.11
|
| Rate for Payer: WPS Commercial |
$145.59
|
|
|
K-WIRE .035 X 4 THREAD 316-0114
|
Facility
|
OP
|
$189.00
|
|
| Hospital Charge Code |
2965453
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.04 |
| Max. Negotiated Rate |
$180.84 |
| Rate for Payer: Aetna Commercial |
$176.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.04
|
| Rate for Payer: Aetna Managed Medicare |
$55.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$127.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$98.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$94.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$104.18
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna Commercial |
$180.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$110.00
|
| Rate for Payer: Health EOS Commercial |
$174.94
|
| Rate for Payer: HFN Commercial |
$180.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$147.42
|
| Rate for Payer: Multiplan Commercial |
$157.25
|
| Rate for Payer: NAPHCARE Commercial |
$117.94
|
| Rate for Payer: Preferred Network Access Commercial |
$180.84
|
| Rate for Payer: Quartz Beloit One Network |
$96.31
|
| Rate for Payer: Quartz Commercial |
$127.76
|
| Rate for Payer: Quartz Medicare Advantage |
$117.94
|
| Rate for Payer: The Alliance Commercial |
$98.28
|
| Rate for Payer: WEA Trust Commercial |
$108.11
|
| Rate for Payer: WPS Commercial |
$145.59
|
|
|
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 |
$219.64 |
| Max. Negotiated Rate |
$412.38 |
| Rate for Payer: Aetna Commercial |
$403.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$385.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$237.57
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cigna Commercial |
$412.38
|
| Rate for Payer: Health EOS Commercial |
$398.93
|
| Rate for Payer: HFN Commercial |
$412.38
|
| Rate for Payer: Multiplan Commercial |
$358.59
|
| Rate for Payer: Preferred Network Access Commercial |
$412.38
|
| Rate for Payer: Quartz Beloit One Network |
$219.64
|
| Rate for Payer: Quartz Commercial |
$268.94
|
| Rate for Payer: WEA Trust Commercial |
$246.53
|
| Rate for Payer: WPS Commercial |
$332.00
|
|
|
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 |
$125.51 |
| Max. Negotiated Rate |
$412.38 |
| Rate for Payer: Aetna Commercial |
$403.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$385.49
|
| Rate for Payer: Aetna Managed Medicare |
$125.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$291.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$224.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$215.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$237.57
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cigna Commercial |
$412.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$250.84
|
| Rate for Payer: Health EOS Commercial |
$398.93
|
| Rate for Payer: HFN Commercial |
$412.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$336.18
|
| Rate for Payer: Multiplan Commercial |
$358.59
|
| Rate for Payer: NAPHCARE Commercial |
$268.94
|
| Rate for Payer: Preferred Network Access Commercial |
$412.38
|
| Rate for Payer: Quartz Beloit One Network |
$219.64
|
| Rate for Payer: Quartz Commercial |
$291.36
|
| Rate for Payer: Quartz Medicare Advantage |
$268.94
|
| Rate for Payer: The Alliance Commercial |
$224.12
|
| Rate for Payer: WEA Trust Commercial |
$246.53
|
| Rate for Payer: WPS Commercial |
$332.00
|
|
|
K-WIRE .035 X 6 SINGLE TROCAR 80-1524"
|
Facility
|
OP
|
$448.00
|
|
| Hospital Charge Code |
4206007
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$130.46 |
| Max. Negotiated Rate |
$428.65 |
| Rate for Payer: Aetna Commercial |
$419.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$400.69
|
| Rate for Payer: Aetna Managed Medicare |
$130.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$302.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$232.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$223.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$246.94
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cigna Commercial |
$428.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$260.74
|
| Rate for Payer: Health EOS Commercial |
$414.67
|
| Rate for Payer: HFN Commercial |
$428.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$349.44
|
| Rate for Payer: Multiplan Commercial |
$372.74
|
| Rate for Payer: NAPHCARE Commercial |
$279.55
|
| Rate for Payer: Preferred Network Access Commercial |
$428.65
|
| Rate for Payer: Quartz Beloit One Network |
$228.30
|
| Rate for Payer: Quartz Commercial |
$302.85
|
| Rate for Payer: Quartz Medicare Advantage |
$279.55
|
| Rate for Payer: The Alliance Commercial |
$232.96
|
| Rate for Payer: WEA Trust Commercial |
$256.26
|
| Rate for Payer: WPS Commercial |
$345.09
|
|
