|
K-WIRE 1.0MM X 80MM AR-8610KS-30
|
Facility
|
OP
|
$319.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5415012
|
|
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 80MM AR-8610KS-30
|
Facility
|
IP
|
$319.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5415012
|
|
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 1.0 X 150MM TROCAR POINT 292.10
|
Facility
|
OP
|
$197.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2969341
|
|
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 1.0 X 150MM TROCAR POINT 292.10
|
Facility
|
IP
|
$197.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2969341
|
|
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 1.15MM STRYKER KN1116
|
Facility
|
OP
|
$714.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5599636
|
|
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 1.15MM STRYKER KN1116
|
Facility
|
IP
|
$714.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5599636
|
|
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 1.1MM AR-8933R
|
Facility
|
OP
|
$958.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5286714
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$268.24 |
| Max. Negotiated Rate |
$3,832.00 |
| Rate for Payer: Aetna Commercial |
$862.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$823.88
|
| Rate for Payer: Aetna Managed Medicare |
$268.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$622.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$479.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$459.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$507.74
|
| Rate for Payer: Cash Price |
$287.40
|
| Rate for Payer: Cigna Commercial |
$881.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$536.10
|
| Rate for Payer: Health EOS Commercial |
$852.62
|
| Rate for Payer: HFN Commercial |
$881.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$718.50
|
| Rate for Payer: Multiplan Commercial |
$766.40
|
| Rate for Payer: NAPHCARE Commercial |
$574.80
|
| Rate for Payer: Preferred Network Access Commercial |
$881.36
|
| Rate for Payer: Quartz Beloit One Network |
$469.42
|
| Rate for Payer: Quartz Commercial |
$622.70
|
| Rate for Payer: Quartz Medicare Advantage |
$574.80
|
| Rate for Payer: The Alliance Commercial |
$3,832.00
|
| Rate for Payer: WEA Trust Commercial |
$526.90
|
| Rate for Payer: WPS Commercial |
$709.59
|
|
|
K-WIRE 1.1MM AR-8933R
|
Facility
|
IP
|
$958.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5286714
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$469.42 |
| Max. Negotiated Rate |
$881.36 |
| Rate for Payer: Aetna Commercial |
$862.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$823.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$507.74
|
| Rate for Payer: Cash Price |
$287.40
|
| Rate for Payer: Cigna Commercial |
$881.36
|
| Rate for Payer: Health EOS Commercial |
$852.62
|
| Rate for Payer: HFN Commercial |
$881.36
|
| Rate for Payer: Multiplan Commercial |
$766.40
|
| Rate for Payer: NAPHCARE Commercial |
$574.80
|
| Rate for Payer: Preferred Network Access Commercial |
$881.36
|
| Rate for Payer: Quartz Beloit One Network |
$469.42
|
| Rate for Payer: Quartz Commercial |
$574.80
|
| Rate for Payer: WEA Trust Commercial |
$526.90
|
| Rate for Payer: WPS Commercial |
$709.59
|
|
|
K-WIRE 1.1MM X 100
|
Facility
|
IP
|
$535.00
|
|
| Hospital Charge Code |
2964738
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$262.15 |
| Max. Negotiated Rate |
$492.20 |
| Rate for Payer: Aetna Commercial |
$481.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$460.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$283.55
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$492.20
|
| Rate for Payer: Health EOS Commercial |
$476.15
|
| Rate for Payer: HFN Commercial |
$492.20
|
| Rate for Payer: Multiplan Commercial |
$428.00
|
| Rate for Payer: NAPHCARE Commercial |
$321.00
|
| Rate for Payer: Preferred Network Access Commercial |
$492.20
|
| Rate for Payer: Quartz Beloit One Network |
$262.15
|
| Rate for Payer: Quartz Commercial |
$321.00
|
| Rate for Payer: WEA Trust Commercial |
$294.25
|
| Rate for Payer: WPS Commercial |
$396.27
|
|
|
K-WIRE 1.1MM X 100
|
Facility
|
OP
|
$535.00
|
|
| Hospital Charge Code |
2964738
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.80 |
| Max. Negotiated Rate |
$2,140.00 |
| Rate for Payer: Aetna Commercial |
$481.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$460.10
|
| Rate for Payer: Aetna Managed Medicare |
$149.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$347.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$267.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$256.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$283.55
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$492.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$299.39
|
| Rate for Payer: Health EOS Commercial |
$476.15
|
| Rate for Payer: HFN Commercial |
$492.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$401.25
|
| Rate for Payer: Multiplan Commercial |
$428.00
|
| Rate for Payer: NAPHCARE Commercial |
$321.00
|
| Rate for Payer: Preferred Network Access Commercial |
$492.20
|
| Rate for Payer: Quartz Beloit One Network |
$262.15
|
| Rate for Payer: Quartz Commercial |
$347.75
|
| Rate for Payer: Quartz Medicare Advantage |
$321.00
|
| Rate for Payer: The Alliance Commercial |
$2,140.00
|
| Rate for Payer: WEA Trust Commercial |
$294.25
|
| Rate for Payer: WPS Commercial |
$396.27
|
|
|
K-WIRE 1.1X 150MM BLUNT/TROCAR DSDS1011
|
Facility
|
OP
|
$558.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5547331
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$156.24 |
| Max. Negotiated Rate |
$2,232.00 |
| Rate for Payer: Aetna Commercial |
$502.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$479.88
|
| Rate for Payer: Aetna Managed Medicare |
$156.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$362.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$279.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$267.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$295.74
|
| Rate for Payer: Cash Price |
$167.40
|
| Rate for Payer: Cigna Commercial |
$513.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$312.26
|
| Rate for Payer: Health EOS Commercial |
$496.62
|
| Rate for Payer: HFN Commercial |
$513.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$418.50
|
| Rate for Payer: Multiplan Commercial |
$446.40
|
| Rate for Payer: NAPHCARE Commercial |
$334.80
|
| Rate for Payer: Preferred Network Access Commercial |
$513.36
|
| Rate for Payer: Quartz Beloit One Network |
$273.42
|
| Rate for Payer: Quartz Commercial |
$362.70
|
| Rate for Payer: Quartz Medicare Advantage |
$334.80
|
| Rate for Payer: The Alliance Commercial |
$2,232.00
|
| Rate for Payer: WEA Trust Commercial |
$306.90
|
| Rate for Payer: WPS Commercial |
$413.31
|
|
|
K-WIRE 1.1X 150MM BLUNT/TROCAR DSDS1011
|
Facility
|
IP
|
$558.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5547331
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$273.42 |
| Max. Negotiated Rate |
$513.36 |
| Rate for Payer: Aetna Commercial |
$502.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$479.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$295.74
|
| Rate for Payer: Cash Price |
$167.40
|
| Rate for Payer: Cigna Commercial |
$513.36
|
| Rate for Payer: Health EOS Commercial |
$496.62
|
| Rate for Payer: HFN Commercial |
$513.36
|
| Rate for Payer: Multiplan Commercial |
$446.40
|
| Rate for Payer: NAPHCARE Commercial |
$334.80
|
| Rate for Payer: Preferred Network Access Commercial |
$513.36
|
| Rate for Payer: Quartz Beloit One Network |
$273.42
|
| Rate for Payer: Quartz Commercial |
$334.80
|
| Rate for Payer: WEA Trust Commercial |
$306.90
|
| Rate for Payer: WPS Commercial |
$413.31
|
|
|
K-WIRE 1.1 X 150 SMOOTH 292.623
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2966612
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$79.87 |
| Max. Negotiated Rate |
$149.96 |
| Rate for Payer: Aetna Commercial |
$146.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$140.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$86.39
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cigna Commercial |
$149.96
|
| Rate for Payer: Health EOS Commercial |
$145.07
|
| Rate for Payer: HFN Commercial |
$149.96
|
| Rate for Payer: Multiplan Commercial |
$130.40
|
| Rate for Payer: NAPHCARE Commercial |
$97.80
|
| Rate for Payer: Preferred Network Access Commercial |
$149.96
|
| Rate for Payer: Quartz Beloit One Network |
$79.87
|
| Rate for Payer: Quartz Commercial |
$97.80
|
| Rate for Payer: WEA Trust Commercial |
$89.65
|
| Rate for Payer: WPS Commercial |
$120.73
|
|
|
K-WIRE 1.1 X 150 SMOOTH 292.623
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2966612
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.64 |
| Max. Negotiated Rate |
$652.00 |
| Rate for Payer: Aetna Commercial |
$146.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$140.18
|
| Rate for Payer: Aetna Managed Medicare |
$45.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$105.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$81.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$78.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$86.39
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cigna Commercial |
$149.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$91.21
|
| Rate for Payer: Health EOS Commercial |
$145.07
|
| Rate for Payer: HFN Commercial |
$149.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$122.25
|
| Rate for Payer: Multiplan Commercial |
$130.40
|
| Rate for Payer: NAPHCARE Commercial |
$97.80
|
| Rate for Payer: Preferred Network Access Commercial |
$149.96
|
| Rate for Payer: Quartz Beloit One Network |
$79.87
|
| Rate for Payer: Quartz Commercial |
$105.95
|
| Rate for Payer: Quartz Medicare Advantage |
$97.80
|
| Rate for Payer: The Alliance Commercial |
$652.00
|
| Rate for Payer: WEA Trust Commercial |
$89.65
|
| Rate for Payer: WPS Commercial |
$120.73
|
|
|
K-WIRE 1.1 X 150 THREAD 292.622
|
Facility
|
OP
|
$177.00
|
|
| Hospital Charge Code |
2966613
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.56 |
| Max. Negotiated Rate |
$708.00 |
| Rate for Payer: Aetna Commercial |
$159.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$152.22
|
| Rate for Payer: Aetna Managed Medicare |
$49.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$115.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$88.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$84.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$93.81
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cigna Commercial |
$162.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$99.05
|
| Rate for Payer: Health EOS Commercial |
$157.53
|
| Rate for Payer: HFN Commercial |
$162.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$132.75
|
| Rate for Payer: Multiplan Commercial |
$141.60
|
| Rate for Payer: NAPHCARE Commercial |
$106.20
|
| Rate for Payer: Preferred Network Access Commercial |
$162.84
|
| Rate for Payer: Quartz Beloit One Network |
$86.73
|
| Rate for Payer: Quartz Commercial |
$115.05
|
| Rate for Payer: Quartz Medicare Advantage |
$106.20
|
| Rate for Payer: The Alliance Commercial |
$708.00
|
| Rate for Payer: WEA Trust Commercial |
$97.35
|
| Rate for Payer: WPS Commercial |
$131.10
|
|
|
K-WIRE 1.1 X 150 THREAD 292.622
|
Facility
|
IP
|
$177.00
|
|
| Hospital Charge Code |
2966613
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$86.73 |
| Max. Negotiated Rate |
$162.84 |
| Rate for Payer: Aetna Commercial |
$159.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$152.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$93.81
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cigna Commercial |
$162.84
|
| Rate for Payer: Health EOS Commercial |
$157.53
|
| Rate for Payer: HFN Commercial |
$162.84
|
| Rate for Payer: Multiplan Commercial |
$141.60
|
| Rate for Payer: NAPHCARE Commercial |
$106.20
|
| Rate for Payer: Preferred Network Access Commercial |
$162.84
|
| Rate for Payer: Quartz Beloit One Network |
$86.73
|
| Rate for Payer: Quartz Commercial |
$106.20
|
| Rate for Payer: WEA Trust Commercial |
$97.35
|
| Rate for Payer: WPS Commercial |
$131.10
|
|
|
K-WIRE 1.25MM WITH THREADED TIP 292.600
|
Facility
|
OP
|
$654.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5771654
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$183.12 |
| Max. Negotiated Rate |
$2,616.00 |
| Rate for Payer: Aetna Commercial |
$588.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$562.44
|
| Rate for Payer: Aetna Managed Medicare |
$183.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$425.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$327.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$313.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$346.62
|
| Rate for Payer: Cash Price |
$196.20
|
| Rate for Payer: Cigna Commercial |
$601.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$365.98
|
| Rate for Payer: Health EOS Commercial |
$582.06
|
| Rate for Payer: HFN Commercial |
$601.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$490.50
|
| Rate for Payer: Multiplan Commercial |
$523.20
|
| Rate for Payer: NAPHCARE Commercial |
$392.40
|
| Rate for Payer: Preferred Network Access Commercial |
$601.68
|
| Rate for Payer: Quartz Beloit One Network |
$320.46
|
| Rate for Payer: Quartz Commercial |
$425.10
|
| Rate for Payer: Quartz Medicare Advantage |
$392.40
|
| Rate for Payer: The Alliance Commercial |
$2,616.00
|
| Rate for Payer: WEA Trust Commercial |
$359.70
|
| Rate for Payer: WPS Commercial |
$484.42
|
|
|
K-WIRE 1.25MM WITH THREADED TIP 292.600
|
Facility
|
IP
|
$654.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5771654
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$320.46 |
| Max. Negotiated Rate |
$601.68 |
| Rate for Payer: Aetna Commercial |
$588.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$562.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$346.62
|
| Rate for Payer: Cash Price |
$196.20
|
| Rate for Payer: Cigna Commercial |
$601.68
|
| Rate for Payer: Health EOS Commercial |
$582.06
|
| Rate for Payer: HFN Commercial |
$601.68
|
| Rate for Payer: Multiplan Commercial |
$523.20
|
| Rate for Payer: NAPHCARE Commercial |
$392.40
|
| Rate for Payer: Preferred Network Access Commercial |
$601.68
|
| Rate for Payer: Quartz Beloit One Network |
$320.46
|
| Rate for Payer: Quartz Commercial |
$392.40
|
| Rate for Payer: WEA Trust Commercial |
$359.70
|
| Rate for Payer: WPS Commercial |
$484.42
|
|
|
K-WIRE 1.25MM X 150MM 390157
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5286742
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.08 |
| Max. Negotiated Rate |
$444.00 |
| Rate for Payer: Aetna Commercial |
$99.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.46
|
| Rate for Payer: Aetna Managed Medicare |
$31.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$72.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$55.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$53.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.83
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$102.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$62.12
|
| Rate for Payer: Health EOS Commercial |
$98.79
|
| Rate for Payer: HFN Commercial |
$102.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.25
|
| Rate for Payer: Multiplan Commercial |
$88.80
|
| Rate for Payer: NAPHCARE Commercial |
$66.60
|
| Rate for Payer: Preferred Network Access Commercial |
$102.12
|
| Rate for Payer: Quartz Beloit One Network |
$54.39
|
| Rate for Payer: Quartz Commercial |
$72.15
|
| Rate for Payer: Quartz Medicare Advantage |
$66.60
|
| Rate for Payer: The Alliance Commercial |
$444.00
|
| Rate for Payer: WEA Trust Commercial |
$61.05
|
| Rate for Payer: WPS Commercial |
$82.22
|
|
|
K-WIRE 1.25MM X 150MM 390157
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5286742
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.39 |
| Max. Negotiated Rate |
$102.12 |
| Rate for Payer: Aetna Commercial |
$99.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.83
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$102.12
|
| Rate for Payer: Health EOS Commercial |
$98.79
|
| Rate for Payer: HFN Commercial |
$102.12
|
| Rate for Payer: Multiplan Commercial |
$88.80
|
| Rate for Payer: NAPHCARE Commercial |
$66.60
|
| Rate for Payer: Preferred Network Access Commercial |
$102.12
|
| Rate for Payer: Quartz Beloit One Network |
$54.39
|
| Rate for Payer: Quartz Commercial |
$66.60
|
| Rate for Payer: WEA Trust Commercial |
$61.05
|
| Rate for Payer: WPS Commercial |
$82.22
|
|
|
K-WIRE 1.25 NON-THREADED 900.721
|
Facility
|
IP
|
$452.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5264965
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$221.48 |
| Max. Negotiated Rate |
$415.84 |
| Rate for Payer: Aetna Commercial |
$406.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$388.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$239.56
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cigna Commercial |
$415.84
|
| Rate for Payer: Health EOS Commercial |
$402.28
|
| Rate for Payer: HFN Commercial |
$415.84
|
| Rate for Payer: Multiplan Commercial |
$361.60
|
| Rate for Payer: NAPHCARE Commercial |
$271.20
|
| Rate for Payer: Preferred Network Access Commercial |
$415.84
|
| Rate for Payer: Quartz Beloit One Network |
$221.48
|
| Rate for Payer: Quartz Commercial |
$271.20
|
| Rate for Payer: WEA Trust Commercial |
$248.60
|
| Rate for Payer: WPS Commercial |
$334.80
|
|
|
K-WIRE 1.25 NON-THREADED 900.721
|
Facility
|
OP
|
$452.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5264965
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$126.56 |
| Max. Negotiated Rate |
$1,808.00 |
| Rate for Payer: Aetna Commercial |
$406.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$388.72
|
| Rate for Payer: Aetna Managed Medicare |
$126.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$293.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$226.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$216.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$239.56
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cigna Commercial |
$415.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$252.94
|
| Rate for Payer: Health EOS Commercial |
$402.28
|
| Rate for Payer: HFN Commercial |
$415.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$339.00
|
| Rate for Payer: Multiplan Commercial |
$361.60
|
| Rate for Payer: NAPHCARE Commercial |
$271.20
|
| Rate for Payer: Preferred Network Access Commercial |
$415.84
|
| Rate for Payer: Quartz Beloit One Network |
$221.48
|
| Rate for Payer: Quartz Commercial |
$293.80
|
| Rate for Payer: Quartz Medicare Advantage |
$271.20
|
| Rate for Payer: The Alliance Commercial |
$1,808.00
|
| Rate for Payer: WEA Trust Commercial |
$248.60
|
| Rate for Payer: WPS Commercial |
$334.80
|
|
|
K-WIRE 1.25 THREADED 900.722
|
Facility
|
OP
|
$197.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2966614
|
|
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 1.25 THREADED 900.722
|
Facility
|
IP
|
$197.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2966614
|
|
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 1.25 TITANIUM 492.12
|
Facility
|
OP
|
$197.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2966615
|
|
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
|
|
