|
K-WIRE 0.60 292.06
|
Facility
|
IP
|
$189.00
|
|
| Hospital Charge Code |
2966610
|
|
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 .062 X 3 ARTHREX AR-2663"
|
Facility
|
OP
|
$541.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4509011
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$151.48 |
| Max. Negotiated Rate |
$2,164.00 |
| Rate for Payer: Aetna Commercial |
$486.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$465.26
|
| Rate for Payer: Aetna Managed Medicare |
$151.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$351.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$270.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$259.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$286.73
|
| Rate for Payer: Cash Price |
$162.30
|
| Rate for Payer: Cigna Commercial |
$497.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$302.74
|
| Rate for Payer: Health EOS Commercial |
$481.49
|
| Rate for Payer: HFN Commercial |
$497.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$405.75
|
| Rate for Payer: Multiplan Commercial |
$432.80
|
| Rate for Payer: NAPHCARE Commercial |
$324.60
|
| Rate for Payer: Preferred Network Access Commercial |
$497.72
|
| Rate for Payer: Quartz Beloit One Network |
$265.09
|
| Rate for Payer: Quartz Commercial |
$351.65
|
| Rate for Payer: Quartz Medicare Advantage |
$324.60
|
| Rate for Payer: The Alliance Commercial |
$2,164.00
|
| Rate for Payer: WEA Trust Commercial |
$297.55
|
| Rate for Payer: WPS Commercial |
$400.72
|
|
|
K-WIRE .062 X 3 ARTHREX AR-2663"
|
Facility
|
IP
|
$541.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4509011
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$265.09 |
| Max. Negotiated Rate |
$497.72 |
| Rate for Payer: Aetna Commercial |
$486.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$465.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$286.73
|
| Rate for Payer: Cash Price |
$162.30
|
| Rate for Payer: Cigna Commercial |
$497.72
|
| Rate for Payer: Health EOS Commercial |
$481.49
|
| Rate for Payer: HFN Commercial |
$497.72
|
| Rate for Payer: Multiplan Commercial |
$432.80
|
| Rate for Payer: NAPHCARE Commercial |
$324.60
|
| Rate for Payer: Preferred Network Access Commercial |
$497.72
|
| Rate for Payer: Quartz Beloit One Network |
$265.09
|
| Rate for Payer: Quartz Commercial |
$324.60
|
| Rate for Payer: WEA Trust Commercial |
$297.55
|
| Rate for Payer: WPS Commercial |
$400.72
|
|
|
K-WIRE 0.80 X 70MM TROCAR POINT 292.08
|
Facility
|
OP
|
$197.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2966611
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.16 |
| Max. Negotiated Rate |
$788.00 |
| Rate for Payer: Aetna Commercial |
$177.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.42
|
| Rate for Payer: Aetna Managed Medicare |
$55.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$128.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$98.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$94.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$104.41
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cigna Commercial |
$181.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$110.24
|
| Rate for Payer: Health EOS Commercial |
$175.33
|
| Rate for Payer: HFN Commercial |
$181.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$147.75
|
| Rate for Payer: Multiplan Commercial |
$157.60
|
| Rate for Payer: NAPHCARE Commercial |
$118.20
|
| Rate for Payer: Preferred Network Access Commercial |
$181.24
|
| Rate for Payer: Quartz Beloit One Network |
$96.53
|
| Rate for Payer: Quartz Commercial |
$128.05
|
| Rate for Payer: Quartz Medicare Advantage |
$118.20
|
| Rate for Payer: The Alliance Commercial |
$788.00
|
| Rate for Payer: WEA Trust Commercial |
$108.35
|
| Rate for Payer: WPS Commercial |
$145.92
|
|
|
K-WIRE 0.80 X 70MM TROCAR POINT 292.08
|
Facility
|
IP
|
$197.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2966611
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.53 |
| Max. Negotiated Rate |
$181.24 |
| Rate for Payer: Aetna Commercial |
$177.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$104.41
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cigna Commercial |
$181.24
|
| Rate for Payer: Health EOS Commercial |
$175.33
|
| Rate for Payer: HFN Commercial |
$181.24
|
| Rate for Payer: Multiplan Commercial |
$157.60
|
| Rate for Payer: NAPHCARE Commercial |
$118.20
|
| Rate for Payer: Preferred Network Access Commercial |
$181.24
|
| Rate for Payer: Quartz Beloit One Network |
$96.53
|
| Rate for Payer: Quartz Commercial |
$118.20
|
| Rate for Payer: WEA Trust Commercial |
$108.35
|
| Rate for Payer: WPS Commercial |
$145.92
|
|
|
K-WIRE 0.86MM X 100MM 45-20015
|
Facility
|
OP
|
$393.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5767634
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$110.04 |
| Max. Negotiated Rate |
$1,572.00 |
| Rate for Payer: Aetna Commercial |
$353.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$337.98
|
| Rate for Payer: Aetna Managed Medicare |
$110.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$255.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$196.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$188.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$208.29
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Cigna Commercial |
$361.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$219.92
|
| Rate for Payer: Health EOS Commercial |
$349.77
|
| Rate for Payer: HFN Commercial |
$361.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$294.75
|
| Rate for Payer: Multiplan Commercial |
$314.40
|
| Rate for Payer: NAPHCARE Commercial |
$235.80
|
| Rate for Payer: Preferred Network Access Commercial |
$361.56
|
| Rate for Payer: Quartz Beloit One Network |
$192.57
|
| Rate for Payer: Quartz Commercial |
$255.45
|
| Rate for Payer: Quartz Medicare Advantage |
$235.80
|
| Rate for Payer: The Alliance Commercial |
$1,572.00
|
| Rate for Payer: WEA Trust Commercial |
$216.15
|
| Rate for Payer: WPS Commercial |
$291.10
|
|
|
K-WIRE 0.86MM X 100MM 45-20015
|
Facility
|
IP
|
$393.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5767634
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$192.57 |
| Max. Negotiated Rate |
$361.56 |
| Rate for Payer: Aetna Commercial |
$353.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$337.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$208.29
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Cigna Commercial |
$361.56
|
| Rate for Payer: Health EOS Commercial |
$349.77
|
| Rate for Payer: HFN Commercial |
$361.56
|
| Rate for Payer: Multiplan Commercial |
$314.40
|
| Rate for Payer: NAPHCARE Commercial |
$235.80
|
| Rate for Payer: Preferred Network Access Commercial |
$361.56
|
| Rate for Payer: Quartz Beloit One Network |
$192.57
|
| Rate for Payer: Quartz Commercial |
$235.80
|
| Rate for Payer: WEA Trust Commercial |
$216.15
|
| Rate for Payer: WPS Commercial |
$291.10
|
|
|
K-WIRE 0.86MM X 80MM AR-8610KS-25
|
Facility
|
IP
|
$319.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5415859
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$156.31 |
| Max. Negotiated Rate |
$293.48 |
| Rate for Payer: Aetna Commercial |
$287.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$274.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$169.07
|
| Rate for Payer: Cash Price |
$95.70
|
| Rate for Payer: Cigna Commercial |
$293.48
|
| Rate for Payer: Health EOS Commercial |
$283.91
|
| Rate for Payer: HFN Commercial |
$293.48
|
| Rate for Payer: Multiplan Commercial |
$255.20
|
| Rate for Payer: NAPHCARE Commercial |
$191.40
|
| Rate for Payer: Preferred Network Access Commercial |
$293.48
|
| Rate for Payer: Quartz Beloit One Network |
$156.31
|
| Rate for Payer: Quartz Commercial |
$191.40
|
| Rate for Payer: WEA Trust Commercial |
$175.45
|
| Rate for Payer: WPS Commercial |
$236.28
|
|
|
K-WIRE 0.86MM X 80MM AR-8610KS-25
|
Facility
|
OP
|
$319.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5415859
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$89.32 |
| Max. Negotiated Rate |
$1,276.00 |
| Rate for Payer: Aetna Commercial |
$287.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$274.34
|
| Rate for Payer: Aetna Managed Medicare |
$89.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$207.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$159.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$153.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$169.07
|
| Rate for Payer: Cash Price |
$95.70
|
| Rate for Payer: Cigna Commercial |
$293.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$178.51
|
| Rate for Payer: Health EOS Commercial |
$283.91
|
| Rate for Payer: HFN Commercial |
$293.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$239.25
|
| Rate for Payer: Multiplan Commercial |
$255.20
|
| Rate for Payer: NAPHCARE Commercial |
$191.40
|
| Rate for Payer: Preferred Network Access Commercial |
$293.48
|
| Rate for Payer: Quartz Beloit One Network |
$156.31
|
| Rate for Payer: Quartz Commercial |
$207.35
|
| Rate for Payer: Quartz Medicare Advantage |
$191.40
|
| Rate for Payer: The Alliance Commercial |
$1,276.00
|
| Rate for Payer: WEA Trust Commercial |
$175.45
|
| Rate for Payer: WPS Commercial |
$236.28
|
|
|
K-WIRE 0.90MM STRYKER KN1115
|
Facility
|
IP
|
$687.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5685827
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$336.63 |
| Max. Negotiated Rate |
$632.04 |
| Rate for Payer: Aetna Commercial |
$618.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$590.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$364.11
|
| Rate for Payer: Cash Price |
$206.10
|
| Rate for Payer: Cigna Commercial |
$632.04
|
| Rate for Payer: Health EOS Commercial |
$611.43
|
| Rate for Payer: HFN Commercial |
$632.04
|
| Rate for Payer: Multiplan Commercial |
$549.60
|
| Rate for Payer: NAPHCARE Commercial |
$412.20
|
| Rate for Payer: Preferred Network Access Commercial |
$632.04
|
| Rate for Payer: Quartz Beloit One Network |
$336.63
|
| Rate for Payer: Quartz Commercial |
$412.20
|
| Rate for Payer: WEA Trust Commercial |
$377.85
|
| Rate for Payer: WPS Commercial |
$508.86
|
|
|
K-WIRE 0.90MM STRYKER KN1115
|
Facility
|
OP
|
$687.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5685827
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$192.36 |
| Max. Negotiated Rate |
$2,748.00 |
| Rate for Payer: Aetna Commercial |
$618.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$590.82
|
| Rate for Payer: Aetna Managed Medicare |
$192.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$446.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$343.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$329.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$364.11
|
| Rate for Payer: Cash Price |
$206.10
|
| Rate for Payer: Cigna Commercial |
$632.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$384.45
|
| Rate for Payer: Health EOS Commercial |
$611.43
|
| Rate for Payer: HFN Commercial |
$632.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$515.25
|
| Rate for Payer: Multiplan Commercial |
$549.60
|
| Rate for Payer: NAPHCARE Commercial |
$412.20
|
| Rate for Payer: Preferred Network Access Commercial |
$632.04
|
| Rate for Payer: Quartz Beloit One Network |
$336.63
|
| Rate for Payer: Quartz Commercial |
$446.55
|
| Rate for Payer: Quartz Medicare Advantage |
$412.20
|
| Rate for Payer: The Alliance Commercial |
$2,748.00
|
| Rate for Payer: WEA Trust Commercial |
$377.85
|
| Rate for Payer: WPS Commercial |
$508.86
|
|
|
K-WIRE 0.9 X 150MM BLUNT/TROCAR DSDS1009
|
Facility
|
OP
|
$909.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6182384
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$254.52 |
| Max. Negotiated Rate |
$3,636.00 |
| Rate for Payer: Aetna Commercial |
$818.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$781.74
|
| Rate for Payer: Aetna Managed Medicare |
$254.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$590.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$454.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$436.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$481.77
|
| Rate for Payer: Cash Price |
$272.70
|
| Rate for Payer: Cigna Commercial |
$836.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$508.68
|
| Rate for Payer: Health EOS Commercial |
$809.01
|
| Rate for Payer: HFN Commercial |
$836.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$681.75
|
| Rate for Payer: Multiplan Commercial |
$727.20
|
| Rate for Payer: NAPHCARE Commercial |
$545.40
|
| Rate for Payer: Preferred Network Access Commercial |
$836.28
|
| Rate for Payer: Quartz Beloit One Network |
$445.41
|
| Rate for Payer: Quartz Commercial |
$590.85
|
| Rate for Payer: Quartz Medicare Advantage |
$545.40
|
| Rate for Payer: The Alliance Commercial |
$3,636.00
|
| Rate for Payer: WEA Trust Commercial |
$499.95
|
| Rate for Payer: WPS Commercial |
$673.30
|
|
|
K-WIRE 0.9 X 150MM BLUNT/TROCAR DSDS1009
|
Facility
|
IP
|
$909.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6182384
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$445.41 |
| Max. Negotiated Rate |
$836.28 |
| Rate for Payer: Aetna Commercial |
$818.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$781.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$481.77
|
| Rate for Payer: Cash Price |
$272.70
|
| Rate for Payer: Cigna Commercial |
$836.28
|
| Rate for Payer: Health EOS Commercial |
$809.01
|
| Rate for Payer: HFN Commercial |
$836.28
|
| Rate for Payer: Multiplan Commercial |
$727.20
|
| Rate for Payer: NAPHCARE Commercial |
$545.40
|
| Rate for Payer: Preferred Network Access Commercial |
$836.28
|
| Rate for Payer: Quartz Beloit One Network |
$445.41
|
| Rate for Payer: Quartz Commercial |
$545.40
|
| Rate for Payer: WEA Trust Commercial |
$499.95
|
| Rate for Payer: WPS Commercial |
$673.30
|
|
|
K-WIRE 10/10 100MM BLUNT TIP 115101ND
|
Facility
|
IP
|
$714.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5617664
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$349.86 |
| Max. Negotiated Rate |
$656.88 |
| Rate for Payer: Aetna Commercial |
$642.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$614.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$378.42
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cigna Commercial |
$656.88
|
| Rate for Payer: Health EOS Commercial |
$635.46
|
| Rate for Payer: HFN Commercial |
$656.88
|
| Rate for Payer: Multiplan Commercial |
$571.20
|
| Rate for Payer: NAPHCARE Commercial |
$428.40
|
| Rate for Payer: Preferred Network Access Commercial |
$656.88
|
| Rate for Payer: Quartz Beloit One Network |
$349.86
|
| Rate for Payer: Quartz Commercial |
$428.40
|
| Rate for Payer: WEA Trust Commercial |
$392.70
|
| Rate for Payer: WPS Commercial |
$528.86
|
|
|
K-WIRE 10/10 100MM BLUNT TIP 115101ND
|
Facility
|
OP
|
$714.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5617664
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$199.92 |
| Max. Negotiated Rate |
$2,856.00 |
| Rate for Payer: Aetna Commercial |
$642.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$614.04
|
| Rate for Payer: Aetna Managed Medicare |
$199.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$464.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$357.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$342.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$378.42
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cigna Commercial |
$656.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$399.55
|
| Rate for Payer: Health EOS Commercial |
$635.46
|
| Rate for Payer: HFN Commercial |
$656.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$535.50
|
| Rate for Payer: Multiplan Commercial |
$571.20
|
| Rate for Payer: NAPHCARE Commercial |
$428.40
|
| Rate for Payer: Preferred Network Access Commercial |
$656.88
|
| Rate for Payer: Quartz Beloit One Network |
$349.86
|
| Rate for Payer: Quartz Commercial |
$464.10
|
| Rate for Payer: Quartz Medicare Advantage |
$428.40
|
| Rate for Payer: The Alliance Commercial |
$2,856.00
|
| Rate for Payer: WEA Trust Commercial |
$392.70
|
| Rate for Payer: WPS Commercial |
$528.86
|
|
|
K-WIRE 1.0MM X 100MM TROCAR TIP AGK10100
|
Facility
|
IP
|
$747.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5685742
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$366.03 |
| Max. Negotiated Rate |
$687.24 |
| Rate for Payer: Aetna Commercial |
$672.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$642.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$395.91
|
| Rate for Payer: Cash Price |
$224.10
|
| Rate for Payer: Cigna Commercial |
$687.24
|
| Rate for Payer: Health EOS Commercial |
$664.83
|
| Rate for Payer: HFN Commercial |
$687.24
|
| Rate for Payer: Multiplan Commercial |
$597.60
|
| Rate for Payer: NAPHCARE Commercial |
$448.20
|
| Rate for Payer: Preferred Network Access Commercial |
$687.24
|
| Rate for Payer: Quartz Beloit One Network |
$366.03
|
| Rate for Payer: Quartz Commercial |
$448.20
|
| Rate for Payer: WEA Trust Commercial |
$410.85
|
| Rate for Payer: WPS Commercial |
$553.30
|
|
|
K-WIRE 1.0MM X 100MM TROCAR TIP AGK10100
|
Facility
|
OP
|
$747.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5685742
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$209.16 |
| Max. Negotiated Rate |
$2,988.00 |
| Rate for Payer: Aetna Commercial |
$672.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$642.42
|
| Rate for Payer: Aetna Managed Medicare |
$209.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$485.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$373.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$358.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$395.91
|
| Rate for Payer: Cash Price |
$224.10
|
| Rate for Payer: Cigna Commercial |
$687.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$418.02
|
| Rate for Payer: Health EOS Commercial |
$664.83
|
| Rate for Payer: HFN Commercial |
$687.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$560.25
|
| Rate for Payer: Multiplan Commercial |
$597.60
|
| Rate for Payer: NAPHCARE Commercial |
$448.20
|
| Rate for Payer: Preferred Network Access Commercial |
$687.24
|
| Rate for Payer: Quartz Beloit One Network |
$366.03
|
| Rate for Payer: Quartz Commercial |
$485.55
|
| Rate for Payer: Quartz Medicare Advantage |
$448.20
|
| Rate for Payer: The Alliance Commercial |
$2,988.00
|
| Rate for Payer: WEA Trust Commercial |
$410.85
|
| Rate for Payer: WPS Commercial |
$553.30
|
|
|
K-WIRE 1.0MM X 120MM AR-8610K-30
|
Facility
|
OP
|
$319.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5384923
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$89.32 |
| Max. Negotiated Rate |
$1,276.00 |
| Rate for Payer: Aetna Commercial |
$287.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$274.34
|
| Rate for Payer: Aetna Managed Medicare |
$89.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$207.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$159.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$153.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$169.07
|
| Rate for Payer: Cash Price |
$95.70
|
| Rate for Payer: Cigna Commercial |
$293.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$178.51
|
| Rate for Payer: Health EOS Commercial |
$283.91
|
| Rate for Payer: HFN Commercial |
$293.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$239.25
|
| Rate for Payer: Multiplan Commercial |
$255.20
|
| Rate for Payer: NAPHCARE Commercial |
$191.40
|
| Rate for Payer: Preferred Network Access Commercial |
$293.48
|
| Rate for Payer: Quartz Beloit One Network |
$156.31
|
| Rate for Payer: Quartz Commercial |
$207.35
|
| Rate for Payer: Quartz Medicare Advantage |
$191.40
|
| Rate for Payer: The Alliance Commercial |
$1,276.00
|
| Rate for Payer: WEA Trust Commercial |
$175.45
|
| Rate for Payer: WPS Commercial |
$236.28
|
|
|
K-WIRE 1.0MM X 120MM AR-8610K-30
|
Facility
|
IP
|
$319.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5384923
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$156.31 |
| Max. Negotiated Rate |
$293.48 |
| Rate for Payer: Aetna Commercial |
$287.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$274.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$169.07
|
| Rate for Payer: Cash Price |
$95.70
|
| Rate for Payer: Cigna Commercial |
$293.48
|
| Rate for Payer: Health EOS Commercial |
$283.91
|
| Rate for Payer: HFN Commercial |
$293.48
|
| Rate for Payer: Multiplan Commercial |
$255.20
|
| Rate for Payer: NAPHCARE Commercial |
$191.40
|
| Rate for Payer: Preferred Network Access Commercial |
$293.48
|
| Rate for Payer: Quartz Beloit One Network |
$156.31
|
| Rate for Payer: Quartz Commercial |
$191.40
|
| Rate for Payer: WEA Trust Commercial |
$175.45
|
| Rate for Payer: WPS Commercial |
$236.28
|
|
|
K-WIRE 1.0MM X 150MM 390142
|
Facility
|
IP
|
$226.00
|
|
| Hospital Charge Code |
5349476
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$110.74 |
| Max. Negotiated Rate |
$207.92 |
| Rate for Payer: Aetna Commercial |
$203.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$194.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$119.78
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cigna Commercial |
$207.92
|
| Rate for Payer: Health EOS Commercial |
$201.14
|
| Rate for Payer: HFN Commercial |
$207.92
|
| Rate for Payer: Multiplan Commercial |
$180.80
|
| Rate for Payer: NAPHCARE Commercial |
$135.60
|
| Rate for Payer: Preferred Network Access Commercial |
$207.92
|
| Rate for Payer: Quartz Beloit One Network |
$110.74
|
| Rate for Payer: Quartz Commercial |
$135.60
|
| Rate for Payer: WEA Trust Commercial |
$124.30
|
| Rate for Payer: WPS Commercial |
$167.40
|
|
|
K-WIRE 1.0MM X 150MM 390142
|
Facility
|
OP
|
$226.00
|
|
| Hospital Charge Code |
5349476
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.28 |
| Max. Negotiated Rate |
$904.00 |
| Rate for Payer: Aetna Commercial |
$203.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$194.36
|
| Rate for Payer: Aetna Managed Medicare |
$63.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$146.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$113.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$108.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$119.78
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cigna Commercial |
$207.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$126.47
|
| Rate for Payer: Health EOS Commercial |
$201.14
|
| Rate for Payer: HFN Commercial |
$207.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$169.50
|
| Rate for Payer: Multiplan Commercial |
$180.80
|
| Rate for Payer: NAPHCARE Commercial |
$135.60
|
| Rate for Payer: Preferred Network Access Commercial |
$207.92
|
| Rate for Payer: Quartz Beloit One Network |
$110.74
|
| Rate for Payer: Quartz Commercial |
$146.90
|
| Rate for Payer: Quartz Medicare Advantage |
$135.60
|
| Rate for Payer: The Alliance Commercial |
$904.00
|
| Rate for Payer: WEA Trust Commercial |
$124.30
|
| Rate for Payer: WPS Commercial |
$167.40
|
|
|
K-WIRE 1.0MM X 70MM 115070ND
|
Facility
|
IP
|
$714.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5627644
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$349.86 |
| Max. Negotiated Rate |
$656.88 |
| Rate for Payer: Aetna Commercial |
$642.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$614.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$378.42
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cigna Commercial |
$656.88
|
| Rate for Payer: Health EOS Commercial |
$635.46
|
| Rate for Payer: HFN Commercial |
$656.88
|
| Rate for Payer: Multiplan Commercial |
$571.20
|
| Rate for Payer: NAPHCARE Commercial |
$428.40
|
| Rate for Payer: Preferred Network Access Commercial |
$656.88
|
| Rate for Payer: Quartz Beloit One Network |
$349.86
|
| Rate for Payer: Quartz Commercial |
$428.40
|
| Rate for Payer: WEA Trust Commercial |
$392.70
|
| Rate for Payer: WPS Commercial |
$528.86
|
|
|
K-WIRE 1.0MM X 70MM 115070ND
|
Facility
|
OP
|
$714.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5627644
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$199.92 |
| Max. Negotiated Rate |
$2,856.00 |
| Rate for Payer: Aetna Commercial |
$642.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$614.04
|
| Rate for Payer: Aetna Managed Medicare |
$199.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$464.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$357.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$342.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$378.42
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cigna Commercial |
$656.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$399.55
|
| Rate for Payer: Health EOS Commercial |
$635.46
|
| Rate for Payer: HFN Commercial |
$656.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$535.50
|
| Rate for Payer: Multiplan Commercial |
$571.20
|
| Rate for Payer: NAPHCARE Commercial |
$428.40
|
| Rate for Payer: Preferred Network Access Commercial |
$656.88
|
| Rate for Payer: Quartz Beloit One Network |
$349.86
|
| Rate for Payer: Quartz Commercial |
$464.10
|
| Rate for Payer: Quartz Medicare Advantage |
$428.40
|
| Rate for Payer: The Alliance Commercial |
$2,856.00
|
| Rate for Payer: WEA Trust Commercial |
$392.70
|
| Rate for Payer: WPS Commercial |
$528.86
|
|
|
K-WIRE 1.0MM X 70MM TROCAR TIP AGK10070
|
Facility
|
OP
|
$777.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5583416
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$217.56 |
| Max. Negotiated Rate |
$3,108.00 |
| Rate for Payer: Aetna Commercial |
$699.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$668.22
|
| Rate for Payer: Aetna Managed Medicare |
$217.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$505.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$388.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$372.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$411.81
|
| Rate for Payer: Cash Price |
$233.10
|
| Rate for Payer: Cigna Commercial |
$714.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$434.81
|
| Rate for Payer: Health EOS Commercial |
$691.53
|
| Rate for Payer: HFN Commercial |
$714.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$582.75
|
| Rate for Payer: Multiplan Commercial |
$621.60
|
| Rate for Payer: NAPHCARE Commercial |
$466.20
|
| Rate for Payer: Preferred Network Access Commercial |
$714.84
|
| Rate for Payer: Quartz Beloit One Network |
$380.73
|
| Rate for Payer: Quartz Commercial |
$505.05
|
| Rate for Payer: Quartz Medicare Advantage |
$466.20
|
| Rate for Payer: The Alliance Commercial |
$3,108.00
|
| Rate for Payer: WEA Trust Commercial |
$427.35
|
| Rate for Payer: WPS Commercial |
$575.52
|
|
|
K-WIRE 1.0MM X 70MM TROCAR TIP AGK10070
|
Facility
|
IP
|
$777.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5583416
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$380.73 |
| Max. Negotiated Rate |
$714.84 |
| Rate for Payer: Aetna Commercial |
$699.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$668.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$411.81
|
| Rate for Payer: Cash Price |
$233.10
|
| Rate for Payer: Cigna Commercial |
$714.84
|
| Rate for Payer: Health EOS Commercial |
$691.53
|
| Rate for Payer: HFN Commercial |
$714.84
|
| Rate for Payer: Multiplan Commercial |
$621.60
|
| Rate for Payer: NAPHCARE Commercial |
$466.20
|
| Rate for Payer: Preferred Network Access Commercial |
$714.84
|
| Rate for Payer: Quartz Beloit One Network |
$380.73
|
| Rate for Payer: Quartz Commercial |
$466.20
|
| Rate for Payer: WEA Trust Commercial |
$427.35
|
| Rate for Payer: WPS Commercial |
$575.52
|
|
