|
K-WIRE 1.6MM X 100MM SMOOTH TROCAR TIP AGK16100
|
Facility
|
IP
|
$366.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5617674
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$179.34 |
| Max. Negotiated Rate |
$336.72 |
| Rate for Payer: Aetna Commercial |
$329.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$314.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$193.98
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Cigna Commercial |
$336.72
|
| Rate for Payer: Health EOS Commercial |
$325.74
|
| Rate for Payer: HFN Commercial |
$336.72
|
| Rate for Payer: Multiplan Commercial |
$292.80
|
| Rate for Payer: NAPHCARE Commercial |
$219.60
|
| Rate for Payer: Preferred Network Access Commercial |
$336.72
|
| Rate for Payer: Quartz Beloit One Network |
$179.34
|
| Rate for Payer: Quartz Commercial |
$219.60
|
| Rate for Payer: WEA Trust Commercial |
$201.30
|
| Rate for Payer: WPS Commercial |
$271.10
|
|
|
K-WIRE 1.6MM X 100MM SMOOTH TROCAR TIP AGK16100
|
Facility
|
OP
|
$366.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5617674
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$102.48 |
| Max. Negotiated Rate |
$1,464.00 |
| Rate for Payer: Aetna Commercial |
$329.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$314.76
|
| Rate for Payer: Aetna Managed Medicare |
$102.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$237.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$183.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$175.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$193.98
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Cigna Commercial |
$336.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$204.81
|
| Rate for Payer: Health EOS Commercial |
$325.74
|
| Rate for Payer: HFN Commercial |
$336.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$274.50
|
| Rate for Payer: Multiplan Commercial |
$292.80
|
| Rate for Payer: NAPHCARE Commercial |
$219.60
|
| Rate for Payer: Preferred Network Access Commercial |
$336.72
|
| Rate for Payer: Quartz Beloit One Network |
$179.34
|
| Rate for Payer: Quartz Commercial |
$237.90
|
| Rate for Payer: Quartz Medicare Advantage |
$219.60
|
| Rate for Payer: The Alliance Commercial |
$1,464.00
|
| Rate for Payer: WEA Trust Commercial |
$201.30
|
| Rate for Payer: WPS Commercial |
$271.10
|
|
|
K-WIRE 1.6MM X 150MM 390164
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3939330
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.44 |
| Max. Negotiated Rate |
$492.00 |
| Rate for Payer: Aetna Commercial |
$110.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$105.78
|
| Rate for Payer: Aetna Managed Medicare |
$34.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$79.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$61.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$59.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.19
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna Commercial |
$113.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$68.83
|
| Rate for Payer: Health EOS Commercial |
$109.47
|
| Rate for Payer: HFN Commercial |
$113.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$92.25
|
| Rate for Payer: Multiplan Commercial |
$98.40
|
| Rate for Payer: NAPHCARE Commercial |
$73.80
|
| Rate for Payer: Preferred Network Access Commercial |
$113.16
|
| Rate for Payer: Quartz Beloit One Network |
$60.27
|
| Rate for Payer: Quartz Commercial |
$79.95
|
| Rate for Payer: Quartz Medicare Advantage |
$73.80
|
| Rate for Payer: The Alliance Commercial |
$492.00
|
| Rate for Payer: WEA Trust Commercial |
$67.65
|
| Rate for Payer: WPS Commercial |
$91.11
|
|
|
K-WIRE 1.6MM X 150MM 390164
|
Facility
|
IP
|
$123.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3939330
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.27 |
| Max. Negotiated Rate |
$113.16 |
| Rate for Payer: Aetna Commercial |
$110.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$105.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.19
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna Commercial |
$113.16
|
| Rate for Payer: Health EOS Commercial |
$109.47
|
| Rate for Payer: HFN Commercial |
$113.16
|
| Rate for Payer: Multiplan Commercial |
$98.40
|
| Rate for Payer: NAPHCARE Commercial |
$73.80
|
| Rate for Payer: Preferred Network Access Commercial |
$113.16
|
| Rate for Payer: Quartz Beloit One Network |
$60.27
|
| Rate for Payer: Quartz Commercial |
$73.80
|
| Rate for Payer: WEA Trust Commercial |
$67.65
|
| Rate for Payer: WPS Commercial |
$91.11
|
|
|
K-WIRE 1.6MM X 150MM SMOOTH TROCAR TIP AGK16150
|
Facility
|
IP
|
$366.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5611635
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$179.34 |
| Max. Negotiated Rate |
$336.72 |
| Rate for Payer: Aetna Commercial |
$329.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$314.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$193.98
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Cigna Commercial |
$336.72
|
| Rate for Payer: Health EOS Commercial |
$325.74
|
| Rate for Payer: HFN Commercial |
$336.72
|
| Rate for Payer: Multiplan Commercial |
$292.80
|
| Rate for Payer: NAPHCARE Commercial |
$219.60
|
| Rate for Payer: Preferred Network Access Commercial |
$336.72
|
| Rate for Payer: Quartz Beloit One Network |
$179.34
|
| Rate for Payer: Quartz Commercial |
$219.60
|
| Rate for Payer: WEA Trust Commercial |
$201.30
|
| Rate for Payer: WPS Commercial |
$271.10
|
|
|
K-WIRE 1.6MM X 150MM SMOOTH TROCAR TIP AGK16150
|
Facility
|
OP
|
$366.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5611635
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$102.48 |
| Max. Negotiated Rate |
$1,464.00 |
| Rate for Payer: Aetna Commercial |
$329.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$314.76
|
| Rate for Payer: Aetna Managed Medicare |
$102.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$237.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$183.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$175.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$193.98
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Cigna Commercial |
$336.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$204.81
|
| Rate for Payer: Health EOS Commercial |
$325.74
|
| Rate for Payer: HFN Commercial |
$336.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$274.50
|
| Rate for Payer: Multiplan Commercial |
$292.80
|
| Rate for Payer: NAPHCARE Commercial |
$219.60
|
| Rate for Payer: Preferred Network Access Commercial |
$336.72
|
| Rate for Payer: Quartz Beloit One Network |
$179.34
|
| Rate for Payer: Quartz Commercial |
$237.90
|
| Rate for Payer: Quartz Medicare Advantage |
$219.60
|
| Rate for Payer: The Alliance Commercial |
$1,464.00
|
| Rate for Payer: WEA Trust Commercial |
$201.30
|
| Rate for Payer: WPS Commercial |
$271.10
|
|
|
K-WIRE 1.6MM X 150MM WITH STOP 705150
|
Facility
|
IP
|
$1,479.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6185016
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$724.71 |
| Max. Negotiated Rate |
$1,360.68 |
| Rate for Payer: Aetna Commercial |
$1,331.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,271.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$783.87
|
| Rate for Payer: Cash Price |
$443.70
|
| Rate for Payer: Cigna Commercial |
$1,360.68
|
| Rate for Payer: Health EOS Commercial |
$1,316.31
|
| Rate for Payer: HFN Commercial |
$1,360.68
|
| Rate for Payer: Multiplan Commercial |
$1,183.20
|
| Rate for Payer: NAPHCARE Commercial |
$887.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,360.68
|
| Rate for Payer: Quartz Beloit One Network |
$724.71
|
| Rate for Payer: Quartz Commercial |
$887.40
|
| Rate for Payer: WEA Trust Commercial |
$813.45
|
| Rate for Payer: WPS Commercial |
$1,095.50
|
|
|
K-WIRE 1.6MM X 150MM WITH STOP 705150
|
Facility
|
OP
|
$1,479.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6185016
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$414.12 |
| Max. Negotiated Rate |
$5,916.00 |
| Rate for Payer: Aetna Commercial |
$1,331.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,271.94
|
| Rate for Payer: Aetna Managed Medicare |
$414.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$961.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$739.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$709.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$783.87
|
| Rate for Payer: Cash Price |
$443.70
|
| Rate for Payer: Cigna Commercial |
$1,360.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$827.65
|
| Rate for Payer: Health EOS Commercial |
$1,316.31
|
| Rate for Payer: HFN Commercial |
$1,360.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,109.25
|
| Rate for Payer: Multiplan Commercial |
$1,183.20
|
| Rate for Payer: NAPHCARE Commercial |
$887.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,360.68
|
| Rate for Payer: Quartz Beloit One Network |
$724.71
|
| Rate for Payer: Quartz Commercial |
$961.35
|
| Rate for Payer: Quartz Medicare Advantage |
$887.40
|
| Rate for Payer: The Alliance Commercial |
$5,916.00
|
| Rate for Payer: WEA Trust Commercial |
$813.45
|
| Rate for Payer: WPS Commercial |
$1,095.50
|
|
|
K-WIRE 1.6 THREADED TIP 292.708
|
Facility
|
IP
|
$734.00
|
|
| Hospital Charge Code |
2966260
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$359.66 |
| Max. Negotiated Rate |
$675.28 |
| Rate for Payer: Aetna Commercial |
$660.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$631.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$389.02
|
| Rate for Payer: Cash Price |
$220.20
|
| Rate for Payer: Cigna Commercial |
$675.28
|
| Rate for Payer: Health EOS Commercial |
$653.26
|
| Rate for Payer: HFN Commercial |
$675.28
|
| Rate for Payer: Multiplan Commercial |
$587.20
|
| Rate for Payer: NAPHCARE Commercial |
$440.40
|
| Rate for Payer: Preferred Network Access Commercial |
$675.28
|
| Rate for Payer: Quartz Beloit One Network |
$359.66
|
| Rate for Payer: Quartz Commercial |
$440.40
|
| Rate for Payer: WEA Trust Commercial |
$403.70
|
| Rate for Payer: WPS Commercial |
$543.67
|
|
|
K-WIRE 1.6 THREADED TIP 292.708
|
Facility
|
OP
|
$734.00
|
|
| Hospital Charge Code |
2966260
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$205.52 |
| Max. Negotiated Rate |
$2,936.00 |
| Rate for Payer: Aetna Commercial |
$660.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$631.24
|
| Rate for Payer: Aetna Managed Medicare |
$205.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$477.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$367.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$352.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$389.02
|
| Rate for Payer: Cash Price |
$220.20
|
| Rate for Payer: Cigna Commercial |
$675.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$410.75
|
| Rate for Payer: Health EOS Commercial |
$653.26
|
| Rate for Payer: HFN Commercial |
$675.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$550.50
|
| Rate for Payer: Multiplan Commercial |
$587.20
|
| Rate for Payer: NAPHCARE Commercial |
$440.40
|
| Rate for Payer: Preferred Network Access Commercial |
$675.28
|
| Rate for Payer: Quartz Beloit One Network |
$359.66
|
| Rate for Payer: Quartz Commercial |
$477.10
|
| Rate for Payer: Quartz Medicare Advantage |
$440.40
|
| Rate for Payer: The Alliance Commercial |
$2,936.00
|
| Rate for Payer: WEA Trust Commercial |
$403.70
|
| Rate for Payer: WPS Commercial |
$543.67
|
|
|
K-WIRE 1.6 X 150 DRILL TIP 900.601
|
Facility
|
OP
|
$982.00
|
|
| Hospital Charge Code |
2966261
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$274.96 |
| Max. Negotiated Rate |
$3,928.00 |
| Rate for Payer: Aetna Commercial |
$883.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$844.52
|
| Rate for Payer: Aetna Managed Medicare |
$274.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$638.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$491.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$471.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$520.46
|
| Rate for Payer: Cash Price |
$294.60
|
| Rate for Payer: Cigna Commercial |
$903.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$549.53
|
| Rate for Payer: Health EOS Commercial |
$873.98
|
| Rate for Payer: HFN Commercial |
$903.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$736.50
|
| Rate for Payer: Multiplan Commercial |
$785.60
|
| Rate for Payer: NAPHCARE Commercial |
$589.20
|
| Rate for Payer: Preferred Network Access Commercial |
$903.44
|
| Rate for Payer: Quartz Beloit One Network |
$481.18
|
| Rate for Payer: Quartz Commercial |
$638.30
|
| Rate for Payer: Quartz Medicare Advantage |
$589.20
|
| Rate for Payer: The Alliance Commercial |
$3,928.00
|
| Rate for Payer: WEA Trust Commercial |
$540.10
|
| Rate for Payer: WPS Commercial |
$727.37
|
|
|
K-WIRE 1.6 X 150 DRILL TIP 900.601
|
Facility
|
IP
|
$982.00
|
|
| Hospital Charge Code |
2966261
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$481.18 |
| Max. Negotiated Rate |
$903.44 |
| Rate for Payer: Aetna Commercial |
$883.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$844.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$520.46
|
| Rate for Payer: Cash Price |
$294.60
|
| Rate for Payer: Cigna Commercial |
$903.44
|
| Rate for Payer: Health EOS Commercial |
$873.98
|
| Rate for Payer: HFN Commercial |
$903.44
|
| Rate for Payer: Multiplan Commercial |
$785.60
|
| Rate for Payer: NAPHCARE Commercial |
$589.20
|
| Rate for Payer: Preferred Network Access Commercial |
$903.44
|
| Rate for Payer: Quartz Beloit One Network |
$481.18
|
| Rate for Payer: Quartz Commercial |
$589.20
|
| Rate for Payer: WEA Trust Commercial |
$540.10
|
| Rate for Payer: WPS Commercial |
$727.37
|
|
|
K-WIRE 1.6 X 150MM SINGLE TROCAR ORTHOLOC 44112008
|
Facility
|
OP
|
$766.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5415911
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$214.48 |
| Max. Negotiated Rate |
$3,064.00 |
| Rate for Payer: Aetna Commercial |
$689.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$658.76
|
| Rate for Payer: Aetna Managed Medicare |
$214.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$497.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$383.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$367.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$405.98
|
| Rate for Payer: Cash Price |
$229.80
|
| Rate for Payer: Cigna Commercial |
$704.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$428.65
|
| Rate for Payer: Health EOS Commercial |
$681.74
|
| Rate for Payer: HFN Commercial |
$704.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$574.50
|
| Rate for Payer: Multiplan Commercial |
$612.80
|
| Rate for Payer: NAPHCARE Commercial |
$459.60
|
| Rate for Payer: Preferred Network Access Commercial |
$704.72
|
| Rate for Payer: Quartz Beloit One Network |
$375.34
|
| Rate for Payer: Quartz Commercial |
$497.90
|
| Rate for Payer: Quartz Medicare Advantage |
$459.60
|
| Rate for Payer: The Alliance Commercial |
$3,064.00
|
| Rate for Payer: WEA Trust Commercial |
$421.30
|
| Rate for Payer: WPS Commercial |
$567.38
|
|
|
K-WIRE 1.6 X 150MM SINGLE TROCAR ORTHOLOC 44112008
|
Facility
|
IP
|
$766.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5415911
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$375.34 |
| Max. Negotiated Rate |
$704.72 |
| Rate for Payer: Aetna Commercial |
$689.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$658.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$405.98
|
| Rate for Payer: Cash Price |
$229.80
|
| Rate for Payer: Cigna Commercial |
$704.72
|
| Rate for Payer: Health EOS Commercial |
$681.74
|
| Rate for Payer: HFN Commercial |
$704.72
|
| Rate for Payer: Multiplan Commercial |
$612.80
|
| Rate for Payer: NAPHCARE Commercial |
$459.60
|
| Rate for Payer: Preferred Network Access Commercial |
$704.72
|
| Rate for Payer: Quartz Beloit One Network |
$375.34
|
| Rate for Payer: Quartz Commercial |
$459.60
|
| Rate for Payer: WEA Trust Commercial |
$421.30
|
| Rate for Payer: WPS Commercial |
$567.38
|
|
|
K-WIRE 1.6 X 150MM TROCAR POINT 292.16
|
Facility
|
OP
|
$197.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2969342
|
|
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 1.6 X 150MM TROCAR POINT 292.16
|
Facility
|
IP
|
$197.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2969342
|
|
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 1.6 X 150 THREADED TROCAR POINT 292.71
|
Facility
|
OP
|
$197.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2966619
|
|
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 1.6 X 150 THREADED TROCAR POINT 292.71
|
Facility
|
IP
|
$197.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2966619
|
|
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 1.8
|
Facility
|
OP
|
$427.00
|
|
| Hospital Charge Code |
2965167
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$119.56 |
| Max. Negotiated Rate |
$1,708.00 |
| Rate for Payer: Aetna Commercial |
$384.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$367.22
|
| Rate for Payer: Aetna Managed Medicare |
$119.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$277.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$213.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$204.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$226.31
|
| Rate for Payer: Cash Price |
$128.10
|
| Rate for Payer: Cigna Commercial |
$392.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$238.95
|
| Rate for Payer: Health EOS Commercial |
$380.03
|
| Rate for Payer: HFN Commercial |
$392.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$320.25
|
| Rate for Payer: Multiplan Commercial |
$341.60
|
| Rate for Payer: NAPHCARE Commercial |
$256.20
|
| Rate for Payer: Preferred Network Access Commercial |
$392.84
|
| Rate for Payer: Quartz Beloit One Network |
$209.23
|
| Rate for Payer: Quartz Commercial |
$277.55
|
| Rate for Payer: Quartz Medicare Advantage |
$256.20
|
| Rate for Payer: The Alliance Commercial |
$1,708.00
|
| Rate for Payer: WEA Trust Commercial |
$234.85
|
| Rate for Payer: WPS Commercial |
$316.28
|
|
|
K-WIRE 1.8
|
Facility
|
IP
|
$427.00
|
|
| Hospital Charge Code |
2965167
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$209.23 |
| Max. Negotiated Rate |
$392.84 |
| Rate for Payer: Aetna Commercial |
$384.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$367.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$226.31
|
| Rate for Payer: Cash Price |
$128.10
|
| Rate for Payer: Cigna Commercial |
$392.84
|
| Rate for Payer: Health EOS Commercial |
$380.03
|
| Rate for Payer: HFN Commercial |
$392.84
|
| Rate for Payer: Multiplan Commercial |
$341.60
|
| Rate for Payer: NAPHCARE Commercial |
$256.20
|
| Rate for Payer: Preferred Network Access Commercial |
$392.84
|
| Rate for Payer: Quartz Beloit One Network |
$209.23
|
| Rate for Payer: Quartz Commercial |
$256.20
|
| Rate for Payer: WEA Trust Commercial |
$234.85
|
| Rate for Payer: WPS Commercial |
$316.28
|
|
|
K-WIRE 1.8MM WITH TROCAR POINT 04.110.300
|
Facility
|
IP
|
$2,100.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4494404
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,029.00 |
| Max. Negotiated Rate |
$1,932.00 |
| Rate for Payer: Aetna Commercial |
$1,890.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,806.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,113.00
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Cigna Commercial |
$1,932.00
|
| Rate for Payer: Health EOS Commercial |
$1,869.00
|
| Rate for Payer: HFN Commercial |
$1,932.00
|
| Rate for Payer: Multiplan Commercial |
$1,680.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,260.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,932.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,029.00
|
| Rate for Payer: Quartz Commercial |
$1,260.00
|
| Rate for Payer: WEA Trust Commercial |
$1,155.00
|
| Rate for Payer: WPS Commercial |
$1,555.47
|
|
|
K-WIRE 1.8MM WITH TROCAR POINT 04.110.300
|
Facility
|
OP
|
$2,100.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4494404
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$588.00 |
| Max. Negotiated Rate |
$8,400.00 |
| Rate for Payer: Aetna Commercial |
$1,890.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,806.00
|
| Rate for Payer: Aetna Managed Medicare |
$588.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,365.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,050.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,008.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,113.00
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Cigna Commercial |
$1,932.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,175.16
|
| Rate for Payer: Health EOS Commercial |
$1,869.00
|
| Rate for Payer: HFN Commercial |
$1,932.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,575.00
|
| Rate for Payer: Multiplan Commercial |
$1,680.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,260.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,932.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,029.00
|
| Rate for Payer: Quartz Commercial |
$1,365.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,260.00
|
| Rate for Payer: The Alliance Commercial |
$8,400.00
|
| Rate for Payer: WEA Trust Commercial |
$1,155.00
|
| Rate for Payer: WPS Commercial |
$1,555.47
|
|
|
K-WIRE 2.0MM WITH STOP STRYKER 703818
|
Facility
|
OP
|
$824.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5603672
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$230.72 |
| Max. Negotiated Rate |
$3,296.00 |
| Rate for Payer: Aetna Commercial |
$741.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$708.64
|
| Rate for Payer: Aetna Managed Medicare |
$230.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$535.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$412.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$395.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$436.72
|
| Rate for Payer: Cash Price |
$247.20
|
| Rate for Payer: Cigna Commercial |
$758.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$461.11
|
| Rate for Payer: Health EOS Commercial |
$733.36
|
| Rate for Payer: HFN Commercial |
$758.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$618.00
|
| Rate for Payer: Multiplan Commercial |
$659.20
|
| Rate for Payer: NAPHCARE Commercial |
$494.40
|
| Rate for Payer: Preferred Network Access Commercial |
$758.08
|
| Rate for Payer: Quartz Beloit One Network |
$403.76
|
| Rate for Payer: Quartz Commercial |
$535.60
|
| Rate for Payer: Quartz Medicare Advantage |
$494.40
|
| Rate for Payer: The Alliance Commercial |
$3,296.00
|
| Rate for Payer: WEA Trust Commercial |
$453.20
|
| Rate for Payer: WPS Commercial |
$610.34
|
|
|
K-WIRE 2.0MM WITH STOP STRYKER 703818
|
Facility
|
IP
|
$824.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5603672
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$403.76 |
| Max. Negotiated Rate |
$758.08 |
| Rate for Payer: Aetna Commercial |
$741.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$708.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$436.72
|
| Rate for Payer: Cash Price |
$247.20
|
| Rate for Payer: Cigna Commercial |
$758.08
|
| Rate for Payer: Health EOS Commercial |
$733.36
|
| Rate for Payer: HFN Commercial |
$758.08
|
| Rate for Payer: Multiplan Commercial |
$659.20
|
| Rate for Payer: NAPHCARE Commercial |
$494.40
|
| Rate for Payer: Preferred Network Access Commercial |
$758.08
|
| Rate for Payer: Quartz Beloit One Network |
$403.76
|
| Rate for Payer: Quartz Commercial |
$494.40
|
| Rate for Payer: WEA Trust Commercial |
$453.20
|
| Rate for Payer: WPS Commercial |
$610.34
|
|
|
K-WIRE 2.0 X 150MM STRYKER 390192
|
Facility
|
IP
|
$561.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3842755
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$274.89 |
| Max. Negotiated Rate |
$516.12 |
| Rate for Payer: Aetna Commercial |
$504.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$482.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$297.33
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Cigna Commercial |
$516.12
|
| Rate for Payer: Health EOS Commercial |
$499.29
|
| Rate for Payer: HFN Commercial |
$516.12
|
| Rate for Payer: Multiplan Commercial |
$448.80
|
| Rate for Payer: NAPHCARE Commercial |
$336.60
|
| Rate for Payer: Preferred Network Access Commercial |
$516.12
|
| Rate for Payer: Quartz Beloit One Network |
$274.89
|
| Rate for Payer: Quartz Commercial |
$336.60
|
| Rate for Payer: WEA Trust Commercial |
$308.55
|
| Rate for Payer: WPS Commercial |
$415.53
|
|
