|
K-WIRE 1.25 TITANIUM 492.12
|
Facility
|
IP
|
$197.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2966615
|
|
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 492.16
|
Facility
|
OP
|
$197.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2966616
|
|
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 TITANIUM 492.16
|
Facility
|
IP
|
$197.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2966616
|
|
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 X 150MM TROCAR POINT 292.12
|
Facility
|
IP
|
$197.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2966617
|
|
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 X 150MM TROCAR POINT 292.12
|
Facility
|
OP
|
$197.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2966617
|
|
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 1.2 X 150 390152
|
Facility
|
OP
|
$278.00
|
|
| Hospital Charge Code |
5349477
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$77.84 |
| Max. Negotiated Rate |
$1,112.00 |
| Rate for Payer: Aetna Commercial |
$250.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$239.08
|
| Rate for Payer: Aetna Managed Medicare |
$77.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$180.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$139.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$133.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$147.34
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cigna Commercial |
$255.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$155.57
|
| Rate for Payer: Health EOS Commercial |
$247.42
|
| Rate for Payer: HFN Commercial |
$255.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$208.50
|
| Rate for Payer: Multiplan Commercial |
$222.40
|
| Rate for Payer: NAPHCARE Commercial |
$166.80
|
| Rate for Payer: Preferred Network Access Commercial |
$255.76
|
| Rate for Payer: Quartz Beloit One Network |
$136.22
|
| Rate for Payer: Quartz Commercial |
$180.70
|
| Rate for Payer: Quartz Medicare Advantage |
$166.80
|
| Rate for Payer: The Alliance Commercial |
$1,112.00
|
| Rate for Payer: WEA Trust Commercial |
$152.90
|
| Rate for Payer: WPS Commercial |
$205.91
|
|
|
K-WIRE 1.2 X 150 390152
|
Facility
|
IP
|
$278.00
|
|
| Hospital Charge Code |
5349477
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$136.22 |
| Max. Negotiated Rate |
$255.76 |
| Rate for Payer: Aetna Commercial |
$250.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$239.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$147.34
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cigna Commercial |
$255.76
|
| Rate for Payer: Health EOS Commercial |
$247.42
|
| Rate for Payer: HFN Commercial |
$255.76
|
| Rate for Payer: Multiplan Commercial |
$222.40
|
| Rate for Payer: NAPHCARE Commercial |
$166.80
|
| Rate for Payer: Preferred Network Access Commercial |
$255.76
|
| Rate for Payer: Quartz Beloit One Network |
$136.22
|
| Rate for Payer: Quartz Commercial |
$166.80
|
| Rate for Payer: WEA Trust Commercial |
$152.90
|
| Rate for Payer: WPS Commercial |
$205.91
|
|
|
K-WIRE 1.2 X 150MM 707091202
|
Facility
|
IP
|
$724.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6166133
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$354.76 |
| Max. Negotiated Rate |
$666.08 |
| Rate for Payer: Aetna Commercial |
$651.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$622.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$383.72
|
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cigna Commercial |
$666.08
|
| Rate for Payer: Health EOS Commercial |
$644.36
|
| Rate for Payer: HFN Commercial |
$666.08
|
| Rate for Payer: Multiplan Commercial |
$579.20
|
| Rate for Payer: NAPHCARE Commercial |
$434.40
|
| Rate for Payer: Preferred Network Access Commercial |
$666.08
|
| Rate for Payer: Quartz Beloit One Network |
$354.76
|
| Rate for Payer: Quartz Commercial |
$434.40
|
| Rate for Payer: WEA Trust Commercial |
$398.20
|
| Rate for Payer: WPS Commercial |
$536.27
|
|
|
K-WIRE 1.2 X 150MM 707091202
|
Facility
|
OP
|
$724.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6166133
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$202.72 |
| Max. Negotiated Rate |
$2,896.00 |
| Rate for Payer: Aetna Commercial |
$651.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$622.64
|
| Rate for Payer: Aetna Managed Medicare |
$202.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$470.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$362.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$347.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$383.72
|
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cigna Commercial |
$666.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$405.15
|
| Rate for Payer: Health EOS Commercial |
$644.36
|
| Rate for Payer: HFN Commercial |
$666.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$543.00
|
| Rate for Payer: Multiplan Commercial |
$579.20
|
| Rate for Payer: NAPHCARE Commercial |
$434.40
|
| Rate for Payer: Preferred Network Access Commercial |
$666.08
|
| Rate for Payer: Quartz Beloit One Network |
$354.76
|
| Rate for Payer: Quartz Commercial |
$470.60
|
| Rate for Payer: Quartz Medicare Advantage |
$434.40
|
| Rate for Payer: The Alliance Commercial |
$2,896.00
|
| Rate for Payer: WEA Trust Commercial |
$398.20
|
| Rate for Payer: WPS Commercial |
$536.27
|
|
|
K-WIRE 1.35MM X 170MM AR-8610K-43
|
Facility
|
IP
|
$319.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5591394
|
|
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 1.35MM X 170MM AR-8610K-43
|
Facility
|
OP
|
$319.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5591394
|
|
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 1.4MM TROCAR POINT 390162
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6185031
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.76 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$172.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$165.12
|
| Rate for Payer: Aetna Managed Medicare |
$53.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$124.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$96.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$92.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$101.76
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna Commercial |
$176.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$107.44
|
| Rate for Payer: Health EOS Commercial |
$170.88
|
| Rate for Payer: HFN Commercial |
$176.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$144.00
|
| Rate for Payer: Multiplan Commercial |
$153.60
|
| Rate for Payer: NAPHCARE Commercial |
$115.20
|
| Rate for Payer: Preferred Network Access Commercial |
$176.64
|
| Rate for Payer: Quartz Beloit One Network |
$94.08
|
| Rate for Payer: Quartz Commercial |
$124.80
|
| Rate for Payer: Quartz Medicare Advantage |
$115.20
|
| Rate for Payer: The Alliance Commercial |
$768.00
|
| Rate for Payer: WEA Trust Commercial |
$105.60
|
| Rate for Payer: WPS Commercial |
$142.21
|
|
|
K-WIRE 1.4MM TROCAR POINT 390162
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6185031
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$94.08 |
| Max. Negotiated Rate |
$176.64 |
| Rate for Payer: Aetna Commercial |
$172.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$165.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$101.76
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna Commercial |
$176.64
|
| Rate for Payer: Health EOS Commercial |
$170.88
|
| Rate for Payer: HFN Commercial |
$176.64
|
| Rate for Payer: Multiplan Commercial |
$153.60
|
| Rate for Payer: NAPHCARE Commercial |
$115.20
|
| Rate for Payer: Preferred Network Access Commercial |
$176.64
|
| Rate for Payer: Quartz Beloit One Network |
$94.08
|
| Rate for Payer: Quartz Commercial |
$115.20
|
| Rate for Payer: WEA Trust Commercial |
$105.60
|
| Rate for Payer: WPS Commercial |
$142.21
|
|
|
K-WIRE 1.4MM X 228MM 500036
|
Facility
|
IP
|
$678.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5831727
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$332.22 |
| Max. Negotiated Rate |
$623.76 |
| Rate for Payer: Aetna Commercial |
$610.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$583.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$359.34
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cigna Commercial |
$623.76
|
| Rate for Payer: Health EOS Commercial |
$603.42
|
| Rate for Payer: HFN Commercial |
$623.76
|
| Rate for Payer: Multiplan Commercial |
$542.40
|
| Rate for Payer: NAPHCARE Commercial |
$406.80
|
| Rate for Payer: Preferred Network Access Commercial |
$623.76
|
| Rate for Payer: Quartz Beloit One Network |
$332.22
|
| Rate for Payer: Quartz Commercial |
$406.80
|
| Rate for Payer: WEA Trust Commercial |
$372.90
|
| Rate for Payer: WPS Commercial |
$502.19
|
|
|
K-WIRE 1.4MM X 228MM 500036
|
Facility
|
OP
|
$678.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5831727
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$189.84 |
| Max. Negotiated Rate |
$2,712.00 |
| Rate for Payer: Aetna Commercial |
$610.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$583.08
|
| Rate for Payer: Aetna Managed Medicare |
$189.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$440.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$339.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$325.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$359.34
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cigna Commercial |
$623.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$379.41
|
| Rate for Payer: Health EOS Commercial |
$603.42
|
| Rate for Payer: HFN Commercial |
$623.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$508.50
|
| Rate for Payer: Multiplan Commercial |
$542.40
|
| Rate for Payer: NAPHCARE Commercial |
$406.80
|
| Rate for Payer: Preferred Network Access Commercial |
$623.76
|
| Rate for Payer: Quartz Beloit One Network |
$332.22
|
| Rate for Payer: Quartz Commercial |
$440.70
|
| Rate for Payer: Quartz Medicare Advantage |
$406.80
|
| Rate for Payer: The Alliance Commercial |
$2,712.00
|
| Rate for Payer: WEA Trust Commercial |
$372.90
|
| Rate for Payer: WPS Commercial |
$502.19
|
|
|
K-WIRE 1.4X 150MM BLUNT/TROCAR DSDS1014
|
Facility
|
OP
|
$551.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5547332
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$154.28 |
| Max. Negotiated Rate |
$2,204.00 |
| Rate for Payer: Aetna Commercial |
$495.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$473.86
|
| Rate for Payer: Aetna Managed Medicare |
$154.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$358.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$275.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$264.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$292.03
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cigna Commercial |
$506.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$308.34
|
| Rate for Payer: Health EOS Commercial |
$490.39
|
| Rate for Payer: HFN Commercial |
$506.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$413.25
|
| Rate for Payer: Multiplan Commercial |
$440.80
|
| Rate for Payer: NAPHCARE Commercial |
$330.60
|
| Rate for Payer: Preferred Network Access Commercial |
$506.92
|
| Rate for Payer: Quartz Beloit One Network |
$269.99
|
| Rate for Payer: Quartz Commercial |
$358.15
|
| Rate for Payer: Quartz Medicare Advantage |
$330.60
|
| Rate for Payer: The Alliance Commercial |
$2,204.00
|
| Rate for Payer: WEA Trust Commercial |
$303.05
|
| Rate for Payer: WPS Commercial |
$408.13
|
|
|
K-WIRE 1.4X 150MM BLUNT/TROCAR DSDS1014
|
Facility
|
IP
|
$551.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5547332
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$269.99 |
| Max. Negotiated Rate |
$506.92 |
| Rate for Payer: Aetna Commercial |
$495.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$473.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$292.03
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cigna Commercial |
$506.92
|
| Rate for Payer: Health EOS Commercial |
$490.39
|
| Rate for Payer: HFN Commercial |
$506.92
|
| Rate for Payer: Multiplan Commercial |
$440.80
|
| Rate for Payer: NAPHCARE Commercial |
$330.60
|
| Rate for Payer: Preferred Network Access Commercial |
$506.92
|
| Rate for Payer: Quartz Beloit One Network |
$269.99
|
| Rate for Payer: Quartz Commercial |
$330.60
|
| Rate for Payer: WEA Trust Commercial |
$303.05
|
| Rate for Payer: WPS Commercial |
$408.13
|
|
|
K-WIRE 1.4 X 150MM THREADED STRYKER 702459
|
Facility
|
IP
|
$785.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5415594
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$384.65 |
| Max. Negotiated Rate |
$722.20 |
| Rate for Payer: Aetna Commercial |
$706.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$675.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$416.05
|
| Rate for Payer: Cash Price |
$235.50
|
| Rate for Payer: Cigna Commercial |
$722.20
|
| Rate for Payer: Health EOS Commercial |
$698.65
|
| Rate for Payer: HFN Commercial |
$722.20
|
| Rate for Payer: Multiplan Commercial |
$628.00
|
| Rate for Payer: NAPHCARE Commercial |
$471.00
|
| Rate for Payer: Preferred Network Access Commercial |
$722.20
|
| Rate for Payer: Quartz Beloit One Network |
$384.65
|
| Rate for Payer: Quartz Commercial |
$471.00
|
| Rate for Payer: WEA Trust Commercial |
$431.75
|
| Rate for Payer: WPS Commercial |
$581.45
|
|
|
K-WIRE 1.4 X 150MM THREADED STRYKER 702459
|
Facility
|
OP
|
$785.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5415594
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$219.80 |
| Max. Negotiated Rate |
$3,140.00 |
| Rate for Payer: Aetna Commercial |
$706.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$675.10
|
| Rate for Payer: Aetna Managed Medicare |
$219.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$510.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$392.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$376.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$416.05
|
| Rate for Payer: Cash Price |
$235.50
|
| Rate for Payer: Cigna Commercial |
$722.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$439.29
|
| Rate for Payer: Health EOS Commercial |
$698.65
|
| Rate for Payer: HFN Commercial |
$722.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$588.75
|
| Rate for Payer: Multiplan Commercial |
$628.00
|
| Rate for Payer: NAPHCARE Commercial |
$471.00
|
| Rate for Payer: Preferred Network Access Commercial |
$722.20
|
| Rate for Payer: Quartz Beloit One Network |
$384.65
|
| Rate for Payer: Quartz Commercial |
$510.25
|
| Rate for Payer: Quartz Medicare Advantage |
$471.00
|
| Rate for Payer: The Alliance Commercial |
$3,140.00
|
| Rate for Payer: WEA Trust Commercial |
$431.75
|
| Rate for Payer: WPS Commercial |
$581.45
|
|
|
K-WIRE 1.4 X 150MM UNTHREADED STRYKER 705233
|
Facility
|
OP
|
$2,280.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5729732
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$638.40 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Aetna Commercial |
$2,052.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,960.80
|
| Rate for Payer: Aetna Managed Medicare |
$638.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,482.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,140.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,094.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,208.40
|
| Rate for Payer: Cash Price |
$684.00
|
| Rate for Payer: Cigna Commercial |
$2,097.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,275.89
|
| Rate for Payer: Health EOS Commercial |
$2,029.20
|
| Rate for Payer: HFN Commercial |
$2,097.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,710.00
|
| Rate for Payer: Multiplan Commercial |
$1,824.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,368.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,097.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,117.20
|
| Rate for Payer: Quartz Commercial |
$1,482.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,368.00
|
| Rate for Payer: The Alliance Commercial |
$9,120.00
|
| Rate for Payer: WEA Trust Commercial |
$1,254.00
|
| Rate for Payer: WPS Commercial |
$1,688.80
|
|
|
K-WIRE 1.4 X 150MM UNTHREADED STRYKER 705233
|
Facility
|
IP
|
$2,280.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5729732
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,117.20 |
| Max. Negotiated Rate |
$2,097.60 |
| Rate for Payer: Aetna Commercial |
$2,052.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,960.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,208.40
|
| Rate for Payer: Cash Price |
$684.00
|
| Rate for Payer: Cigna Commercial |
$2,097.60
|
| Rate for Payer: Health EOS Commercial |
$2,029.20
|
| Rate for Payer: HFN Commercial |
$2,097.60
|
| Rate for Payer: Multiplan Commercial |
$1,824.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,368.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,097.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,117.20
|
| Rate for Payer: Quartz Commercial |
$1,368.00
|
| Rate for Payer: WEA Trust Commercial |
$1,254.00
|
| Rate for Payer: WPS Commercial |
$1,688.80
|
|
|
K-WIRE 1.6MM 292.72
|
Facility
|
IP
|
$197.00
|
|
| Hospital Charge Code |
2966618
|
|
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 1.6MM 292.72
|
Facility
|
OP
|
$197.00
|
|
| Hospital Charge Code |
2966618
|
|
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 1.6MM MFT-040-16
|
Facility
|
IP
|
$376.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4066513
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$184.24 |
| Max. Negotiated Rate |
$345.92 |
| Rate for Payer: Aetna Commercial |
$338.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$323.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$199.28
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cigna Commercial |
$345.92
|
| Rate for Payer: Health EOS Commercial |
$334.64
|
| Rate for Payer: HFN Commercial |
$345.92
|
| Rate for Payer: Multiplan Commercial |
$300.80
|
| Rate for Payer: NAPHCARE Commercial |
$225.60
|
| Rate for Payer: Preferred Network Access Commercial |
$345.92
|
| Rate for Payer: Quartz Beloit One Network |
$184.24
|
| Rate for Payer: Quartz Commercial |
$225.60
|
| Rate for Payer: WEA Trust Commercial |
$206.80
|
| Rate for Payer: WPS Commercial |
$278.50
|
|
|
K-WIRE 1.6MM MFT-040-16
|
Facility
|
OP
|
$376.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4066513
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$105.28 |
| Max. Negotiated Rate |
$1,504.00 |
| Rate for Payer: Aetna Commercial |
$338.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$323.36
|
| Rate for Payer: Aetna Managed Medicare |
$105.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$244.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$188.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$180.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$199.28
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cigna Commercial |
$345.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$210.41
|
| Rate for Payer: Health EOS Commercial |
$334.64
|
| Rate for Payer: HFN Commercial |
$345.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$282.00
|
| Rate for Payer: Multiplan Commercial |
$300.80
|
| Rate for Payer: NAPHCARE Commercial |
$225.60
|
| Rate for Payer: Preferred Network Access Commercial |
$345.92
|
| Rate for Payer: Quartz Beloit One Network |
$184.24
|
| Rate for Payer: Quartz Commercial |
$244.40
|
| Rate for Payer: Quartz Medicare Advantage |
$225.60
|
| Rate for Payer: The Alliance Commercial |
$1,504.00
|
| Rate for Payer: WEA Trust Commercial |
$206.80
|
| Rate for Payer: WPS Commercial |
$278.50
|
|
