|
K-WIRE 2.0 X 150MM STRYKER 390192
|
Facility
|
OP
|
$561.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3842755
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$157.08 |
| Max. Negotiated Rate |
$2,244.00 |
| Rate for Payer: Aetna Commercial |
$504.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$482.46
|
| Rate for Payer: Aetna Managed Medicare |
$157.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$364.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$280.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$269.28
|
| 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: Dean Health DHI/DHP/ASO |
$313.94
|
| Rate for Payer: Health EOS Commercial |
$499.29
|
| Rate for Payer: HFN Commercial |
$516.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$420.75
|
| 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 |
$364.65
|
| Rate for Payer: Quartz Medicare Advantage |
$336.60
|
| Rate for Payer: The Alliance Commercial |
$2,244.00
|
| Rate for Payer: WEA Trust Commercial |
$308.55
|
| Rate for Payer: WPS Commercial |
$415.53
|
|
|
K-WIRE 2.0 X 150MM TROCAR POINT 292.20
|
Facility
|
IP
|
$197.00
|
|
| Hospital Charge Code |
2966620
|
|
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 2.0 X 150MM TROCAR POINT 292.20
|
Facility
|
OP
|
$197.00
|
|
| Hospital Charge Code |
2966620
|
|
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 2.0 X 234MM DRILL TIP 705002
|
Facility
|
IP
|
$1,434.00
|
|
| Hospital Charge Code |
5106960
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$702.66 |
| Max. Negotiated Rate |
$1,319.28 |
| Rate for Payer: Aetna Commercial |
$1,290.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,233.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$760.02
|
| Rate for Payer: Cash Price |
$430.20
|
| Rate for Payer: Cigna Commercial |
$1,319.28
|
| Rate for Payer: Health EOS Commercial |
$1,276.26
|
| Rate for Payer: HFN Commercial |
$1,319.28
|
| Rate for Payer: Multiplan Commercial |
$1,147.20
|
| Rate for Payer: NAPHCARE Commercial |
$860.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,319.28
|
| Rate for Payer: Quartz Beloit One Network |
$702.66
|
| Rate for Payer: Quartz Commercial |
$860.40
|
| Rate for Payer: WEA Trust Commercial |
$788.70
|
| Rate for Payer: WPS Commercial |
$1,062.16
|
|
|
K-WIRE 2.0 X 234MM DRILL TIP 705002
|
Facility
|
OP
|
$1,434.00
|
|
| Hospital Charge Code |
5106960
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$401.52 |
| Max. Negotiated Rate |
$5,736.00 |
| Rate for Payer: Aetna Commercial |
$1,290.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,233.24
|
| Rate for Payer: Aetna Managed Medicare |
$401.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$932.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$717.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$688.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$760.02
|
| Rate for Payer: Cash Price |
$430.20
|
| Rate for Payer: Cigna Commercial |
$1,319.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$802.47
|
| Rate for Payer: Health EOS Commercial |
$1,276.26
|
| Rate for Payer: HFN Commercial |
$1,319.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,075.50
|
| Rate for Payer: Multiplan Commercial |
$1,147.20
|
| Rate for Payer: NAPHCARE Commercial |
$860.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,319.28
|
| Rate for Payer: Quartz Beloit One Network |
$702.66
|
| Rate for Payer: Quartz Commercial |
$932.10
|
| Rate for Payer: Quartz Medicare Advantage |
$860.40
|
| Rate for Payer: The Alliance Commercial |
$5,736.00
|
| Rate for Payer: WEA Trust Commercial |
$788.70
|
| Rate for Payer: WPS Commercial |
$1,062.16
|
|
|
K-WIRE 2.4MM X 170MM AR-8610K-65
|
Facility
|
IP
|
$319.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5591395
|
|
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 2.4MM X 170MM AR-8610K-65
|
Facility
|
OP
|
$319.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5591395
|
|
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 2.5MM X 150MM 390182
|
Facility
|
OP
|
$262.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6171936
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$73.36 |
| Max. Negotiated Rate |
$1,048.00 |
| Rate for Payer: Aetna Commercial |
$235.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$225.32
|
| Rate for Payer: Aetna Managed Medicare |
$73.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$170.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$131.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$125.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$138.86
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$241.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$146.62
|
| Rate for Payer: Health EOS Commercial |
$233.18
|
| Rate for Payer: HFN Commercial |
$241.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$196.50
|
| Rate for Payer: Multiplan Commercial |
$209.60
|
| Rate for Payer: NAPHCARE Commercial |
$157.20
|
| Rate for Payer: Preferred Network Access Commercial |
$241.04
|
| Rate for Payer: Quartz Beloit One Network |
$128.38
|
| Rate for Payer: Quartz Commercial |
$170.30
|
| Rate for Payer: Quartz Medicare Advantage |
$157.20
|
| Rate for Payer: The Alliance Commercial |
$1,048.00
|
| Rate for Payer: WEA Trust Commercial |
$144.10
|
| Rate for Payer: WPS Commercial |
$194.06
|
|
|
K-WIRE 2.5MM X 150MM 390182
|
Facility
|
IP
|
$262.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6171936
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$128.38 |
| Max. Negotiated Rate |
$241.04 |
| Rate for Payer: Aetna Commercial |
$235.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$225.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$138.86
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$241.04
|
| Rate for Payer: Health EOS Commercial |
$233.18
|
| Rate for Payer: HFN Commercial |
$241.04
|
| Rate for Payer: Multiplan Commercial |
$209.60
|
| Rate for Payer: NAPHCARE Commercial |
$157.20
|
| Rate for Payer: Preferred Network Access Commercial |
$241.04
|
| Rate for Payer: Quartz Beloit One Network |
$128.38
|
| Rate for Payer: Quartz Commercial |
$157.20
|
| Rate for Payer: WEA Trust Commercial |
$144.10
|
| Rate for Payer: WPS Commercial |
$194.06
|
|
|
K-WIRE 2.5MM X 285MM 390181
|
Facility
|
OP
|
$798.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6171935
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$223.44 |
| Max. Negotiated Rate |
$3,192.00 |
| Rate for Payer: Aetna Commercial |
$718.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$686.28
|
| Rate for Payer: Aetna Managed Medicare |
$223.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$518.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$399.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$383.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$422.94
|
| Rate for Payer: Cash Price |
$239.40
|
| Rate for Payer: Cigna Commercial |
$734.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$446.56
|
| Rate for Payer: Health EOS Commercial |
$710.22
|
| Rate for Payer: HFN Commercial |
$734.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$598.50
|
| Rate for Payer: Multiplan Commercial |
$638.40
|
| Rate for Payer: NAPHCARE Commercial |
$478.80
|
| Rate for Payer: Preferred Network Access Commercial |
$734.16
|
| Rate for Payer: Quartz Beloit One Network |
$391.02
|
| Rate for Payer: Quartz Commercial |
$518.70
|
| Rate for Payer: Quartz Medicare Advantage |
$478.80
|
| Rate for Payer: The Alliance Commercial |
$3,192.00
|
| Rate for Payer: WEA Trust Commercial |
$438.90
|
| Rate for Payer: WPS Commercial |
$591.08
|
|
|
K-WIRE 2.5MM X 285MM 390181
|
Facility
|
IP
|
$798.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6171935
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$391.02 |
| Max. Negotiated Rate |
$734.16 |
| Rate for Payer: Aetna Commercial |
$718.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$686.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$422.94
|
| Rate for Payer: Cash Price |
$239.40
|
| Rate for Payer: Cigna Commercial |
$734.16
|
| Rate for Payer: Health EOS Commercial |
$710.22
|
| Rate for Payer: HFN Commercial |
$734.16
|
| Rate for Payer: Multiplan Commercial |
$638.40
|
| Rate for Payer: NAPHCARE Commercial |
$478.80
|
| Rate for Payer: Preferred Network Access Commercial |
$734.16
|
| Rate for Payer: Quartz Beloit One Network |
$391.02
|
| Rate for Payer: Quartz Commercial |
$478.80
|
| Rate for Payer: WEA Trust Commercial |
$438.90
|
| Rate for Payer: WPS Commercial |
$591.08
|
|
|
K-WIRE 2.5 THREADED TROCAR PT 292.75
|
Facility
|
IP
|
$2,818.00
|
|
| Hospital Charge Code |
3072415
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,380.82 |
| Max. Negotiated Rate |
$2,592.56 |
| Rate for Payer: Aetna Commercial |
$2,536.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,423.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,493.54
|
| Rate for Payer: Cash Price |
$845.40
|
| Rate for Payer: Cigna Commercial |
$2,592.56
|
| Rate for Payer: Health EOS Commercial |
$2,508.02
|
| Rate for Payer: HFN Commercial |
$2,592.56
|
| Rate for Payer: Multiplan Commercial |
$2,254.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,690.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,592.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,380.82
|
| Rate for Payer: Quartz Commercial |
$1,690.80
|
| Rate for Payer: WEA Trust Commercial |
$1,549.90
|
| Rate for Payer: WPS Commercial |
$2,087.29
|
|
|
K-WIRE 2.5 THREADED TROCAR PT 292.75
|
Facility
|
OP
|
$2,818.00
|
|
| Hospital Charge Code |
3072415
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$789.04 |
| Max. Negotiated Rate |
$11,272.00 |
| Rate for Payer: Aetna Commercial |
$2,536.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,423.48
|
| Rate for Payer: Aetna Managed Medicare |
$789.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,831.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,409.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,352.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,493.54
|
| Rate for Payer: Cash Price |
$845.40
|
| Rate for Payer: Cigna Commercial |
$2,592.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,576.95
|
| Rate for Payer: Health EOS Commercial |
$2,508.02
|
| Rate for Payer: HFN Commercial |
$2,592.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,113.50
|
| Rate for Payer: Multiplan Commercial |
$2,254.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,690.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,592.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,380.82
|
| Rate for Payer: Quartz Commercial |
$1,831.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,690.80
|
| Rate for Payer: The Alliance Commercial |
$11,272.00
|
| Rate for Payer: WEA Trust Commercial |
$1,549.90
|
| Rate for Payer: WPS Commercial |
$2,087.29
|
|
|
K-WIRE 2MM DIAMOND POINT HOFFMANN LIMB 5101-2-450
|
Facility
|
IP
|
$1,127.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6065667
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$552.23 |
| Max. Negotiated Rate |
$1,036.84 |
| Rate for Payer: Aetna Commercial |
$1,014.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.31
|
| Rate for Payer: Cash Price |
$338.10
|
| Rate for Payer: Cigna Commercial |
$1,036.84
|
| Rate for Payer: Health EOS Commercial |
$1,003.03
|
| Rate for Payer: HFN Commercial |
$1,036.84
|
| Rate for Payer: Multiplan Commercial |
$901.60
|
| Rate for Payer: NAPHCARE Commercial |
$676.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,036.84
|
| Rate for Payer: Quartz Beloit One Network |
$552.23
|
| Rate for Payer: Quartz Commercial |
$676.20
|
| Rate for Payer: WEA Trust Commercial |
$619.85
|
| Rate for Payer: WPS Commercial |
$834.77
|
|
|
K-WIRE 2MM DIAMOND POINT HOFFMANN LIMB 5101-2-450
|
Facility
|
OP
|
$1,127.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6065667
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$315.56 |
| Max. Negotiated Rate |
$4,508.00 |
| Rate for Payer: Aetna Commercial |
$1,014.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.22
|
| Rate for Payer: Aetna Managed Medicare |
$315.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$732.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$563.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$540.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.31
|
| Rate for Payer: Cash Price |
$338.10
|
| Rate for Payer: Cigna Commercial |
$1,036.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$630.67
|
| Rate for Payer: Health EOS Commercial |
$1,003.03
|
| Rate for Payer: HFN Commercial |
$1,036.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.25
|
| Rate for Payer: Multiplan Commercial |
$901.60
|
| Rate for Payer: NAPHCARE Commercial |
$676.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,036.84
|
| Rate for Payer: Quartz Beloit One Network |
$552.23
|
| Rate for Payer: Quartz Commercial |
$732.55
|
| Rate for Payer: Quartz Medicare Advantage |
$676.20
|
| Rate for Payer: The Alliance Commercial |
$4,508.00
|
| Rate for Payer: WEA Trust Commercial |
$619.85
|
| Rate for Payer: WPS Commercial |
$834.77
|
|
|
K-WIRE 3.0 X 285 1806-0050S
|
Facility
|
IP
|
$1,102.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4099050
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$539.98 |
| Max. Negotiated Rate |
$1,013.84 |
| Rate for Payer: Aetna Commercial |
$991.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$947.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$584.06
|
| Rate for Payer: Cash Price |
$330.60
|
| Rate for Payer: Cigna Commercial |
$1,013.84
|
| Rate for Payer: Health EOS Commercial |
$980.78
|
| Rate for Payer: HFN Commercial |
$1,013.84
|
| Rate for Payer: Multiplan Commercial |
$881.60
|
| Rate for Payer: NAPHCARE Commercial |
$661.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,013.84
|
| Rate for Payer: Quartz Beloit One Network |
$539.98
|
| Rate for Payer: Quartz Commercial |
$661.20
|
| Rate for Payer: WEA Trust Commercial |
$606.10
|
| Rate for Payer: WPS Commercial |
$816.25
|
|
|
K-WIRE 3.0 X 285 1806-0050S
|
Facility
|
OP
|
$1,102.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4099050
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$308.56 |
| Max. Negotiated Rate |
$4,408.00 |
| Rate for Payer: Aetna Commercial |
$991.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$947.72
|
| Rate for Payer: Aetna Managed Medicare |
$308.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$716.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$551.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$528.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$584.06
|
| Rate for Payer: Cash Price |
$330.60
|
| Rate for Payer: Cigna Commercial |
$1,013.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$616.68
|
| Rate for Payer: Health EOS Commercial |
$980.78
|
| Rate for Payer: HFN Commercial |
$1,013.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$826.50
|
| Rate for Payer: Multiplan Commercial |
$881.60
|
| Rate for Payer: NAPHCARE Commercial |
$661.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,013.84
|
| Rate for Payer: Quartz Beloit One Network |
$539.98
|
| Rate for Payer: Quartz Commercial |
$716.30
|
| Rate for Payer: Quartz Medicare Advantage |
$661.20
|
| Rate for Payer: The Alliance Commercial |
$4,408.00
|
| Rate for Payer: WEA Trust Commercial |
$606.10
|
| Rate for Payer: WPS Commercial |
$816.25
|
|
|
K-WIRE 3.0 X 285 FIXATION 1806-1417S
|
Facility
|
OP
|
$1,097.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5349002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$307.16 |
| Max. Negotiated Rate |
$4,388.00 |
| Rate for Payer: Aetna Commercial |
$987.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$943.42
|
| Rate for Payer: Aetna Managed Medicare |
$307.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$713.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$548.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$526.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$581.41
|
| Rate for Payer: Cash Price |
$329.10
|
| Rate for Payer: Cigna Commercial |
$1,009.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$613.88
|
| Rate for Payer: Health EOS Commercial |
$976.33
|
| Rate for Payer: HFN Commercial |
$1,009.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$822.75
|
| Rate for Payer: Multiplan Commercial |
$877.60
|
| Rate for Payer: NAPHCARE Commercial |
$658.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,009.24
|
| Rate for Payer: Quartz Beloit One Network |
$537.53
|
| Rate for Payer: Quartz Commercial |
$713.05
|
| Rate for Payer: Quartz Medicare Advantage |
$658.20
|
| Rate for Payer: The Alliance Commercial |
$4,388.00
|
| Rate for Payer: WEA Trust Commercial |
$603.35
|
| Rate for Payer: WPS Commercial |
$812.55
|
|
|
K-WIRE 3.0 X 285 FIXATION 1806-1417S
|
Facility
|
IP
|
$1,097.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5349002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$537.53 |
| Max. Negotiated Rate |
$1,009.24 |
| Rate for Payer: Aetna Commercial |
$987.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$943.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$581.41
|
| Rate for Payer: Cash Price |
$329.10
|
| Rate for Payer: Cigna Commercial |
$1,009.24
|
| Rate for Payer: Health EOS Commercial |
$976.33
|
| Rate for Payer: HFN Commercial |
$1,009.24
|
| Rate for Payer: Multiplan Commercial |
$877.60
|
| Rate for Payer: NAPHCARE Commercial |
$658.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,009.24
|
| Rate for Payer: Quartz Beloit One Network |
$537.53
|
| Rate for Payer: Quartz Commercial |
$658.20
|
| Rate for Payer: WEA Trust Commercial |
$603.35
|
| Rate for Payer: WPS Commercial |
$812.55
|
|
|
K-WIRE 3.0 X 285MM IMN 2351-3028S
|
Facility
|
IP
|
$2,520.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5599785
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,234.80 |
| Max. Negotiated Rate |
$2,318.40 |
| Rate for Payer: Aetna Commercial |
$2,268.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,167.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,335.60
|
| Rate for Payer: Cash Price |
$756.00
|
| Rate for Payer: Cigna Commercial |
$2,318.40
|
| Rate for Payer: Health EOS Commercial |
$2,242.80
|
| Rate for Payer: HFN Commercial |
$2,318.40
|
| Rate for Payer: Multiplan Commercial |
$2,016.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,512.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,318.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,234.80
|
| Rate for Payer: Quartz Commercial |
$1,512.00
|
| Rate for Payer: WEA Trust Commercial |
$1,386.00
|
| Rate for Payer: WPS Commercial |
$1,866.56
|
|
|
K-WIRE 3.0 X 285MM IMN 2351-3028S
|
Facility
|
OP
|
$2,520.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5599785
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$705.60 |
| Max. Negotiated Rate |
$10,080.00 |
| Rate for Payer: Aetna Commercial |
$2,268.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,167.20
|
| Rate for Payer: Aetna Managed Medicare |
$705.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,638.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,260.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,209.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,335.60
|
| Rate for Payer: Cash Price |
$756.00
|
| Rate for Payer: Cigna Commercial |
$2,318.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,410.19
|
| Rate for Payer: Health EOS Commercial |
$2,242.80
|
| Rate for Payer: HFN Commercial |
$2,318.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,890.00
|
| Rate for Payer: Multiplan Commercial |
$2,016.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,512.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,318.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,234.80
|
| Rate for Payer: Quartz Commercial |
$1,638.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,512.00
|
| Rate for Payer: The Alliance Commercial |
$10,080.00
|
| Rate for Payer: WEA Trust Commercial |
$1,386.00
|
| Rate for Payer: WPS Commercial |
$1,866.56
|
|
|
K-WIRE 3.2MM THREADED (2PK) 321-52-10
|
Facility
|
IP
|
$1,092.18
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6240174
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$535.17 |
| Max. Negotiated Rate |
$1,004.81 |
| Rate for Payer: Aetna Commercial |
$982.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$939.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$578.86
|
| Rate for Payer: Cash Price |
$327.65
|
| Rate for Payer: Cigna Commercial |
$1,004.81
|
| Rate for Payer: Health EOS Commercial |
$972.04
|
| Rate for Payer: HFN Commercial |
$1,004.81
|
| Rate for Payer: Multiplan Commercial |
$873.74
|
| Rate for Payer: NAPHCARE Commercial |
$655.31
|
| Rate for Payer: Preferred Network Access Commercial |
$1,004.81
|
| Rate for Payer: Quartz Beloit One Network |
$535.17
|
| Rate for Payer: Quartz Commercial |
$655.31
|
| Rate for Payer: WEA Trust Commercial |
$600.70
|
| Rate for Payer: WPS Commercial |
$808.98
|
|
|
K-WIRE 3.2MM THREADED (2PK) 321-52-10
|
Facility
|
OP
|
$1,092.18
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6240174
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$305.81 |
| Max. Negotiated Rate |
$4,368.72 |
| Rate for Payer: Aetna Commercial |
$982.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$939.27
|
| Rate for Payer: Aetna Managed Medicare |
$305.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$709.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$546.09
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$524.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$578.86
|
| Rate for Payer: Cash Price |
$327.65
|
| Rate for Payer: Cigna Commercial |
$1,004.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$611.18
|
| Rate for Payer: Health EOS Commercial |
$972.04
|
| Rate for Payer: HFN Commercial |
$1,004.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$819.14
|
| Rate for Payer: Multiplan Commercial |
$873.74
|
| Rate for Payer: NAPHCARE Commercial |
$655.31
|
| Rate for Payer: Preferred Network Access Commercial |
$1,004.81
|
| Rate for Payer: Quartz Beloit One Network |
$535.17
|
| Rate for Payer: Quartz Commercial |
$709.92
|
| Rate for Payer: Quartz Medicare Advantage |
$655.31
|
| Rate for Payer: The Alliance Commercial |
$4,368.72
|
| Rate for Payer: WEA Trust Commercial |
$600.70
|
| Rate for Payer: WPS Commercial |
$808.98
|
|
|
K-WIRE 3.2 X 450MM GAMMA 1210-6450S
|
Facility
|
OP
|
$1,407.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3072438
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$393.96 |
| Max. Negotiated Rate |
$5,628.00 |
| Rate for Payer: Aetna Commercial |
$1,266.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,210.02
|
| Rate for Payer: Aetna Managed Medicare |
$393.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$914.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$703.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$675.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$745.71
|
| Rate for Payer: Cash Price |
$422.10
|
| Rate for Payer: Cigna Commercial |
$1,294.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$787.36
|
| Rate for Payer: Health EOS Commercial |
$1,252.23
|
| Rate for Payer: HFN Commercial |
$1,294.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,055.25
|
| Rate for Payer: Multiplan Commercial |
$1,125.60
|
| Rate for Payer: NAPHCARE Commercial |
$844.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,294.44
|
| Rate for Payer: Quartz Beloit One Network |
$689.43
|
| Rate for Payer: Quartz Commercial |
$914.55
|
| Rate for Payer: Quartz Medicare Advantage |
$844.20
|
| Rate for Payer: The Alliance Commercial |
$5,628.00
|
| Rate for Payer: WEA Trust Commercial |
$773.85
|
| Rate for Payer: WPS Commercial |
$1,042.16
|
|
|
K-WIRE 3.2 X 450MM GAMMA 1210-6450S
|
Facility
|
IP
|
$1,407.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3072438
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$689.43 |
| Max. Negotiated Rate |
$1,294.44 |
| Rate for Payer: Aetna Commercial |
$1,266.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,210.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$745.71
|
| Rate for Payer: Cash Price |
$422.10
|
| Rate for Payer: Cigna Commercial |
$1,294.44
|
| Rate for Payer: Health EOS Commercial |
$1,252.23
|
| Rate for Payer: HFN Commercial |
$1,294.44
|
| Rate for Payer: Multiplan Commercial |
$1,125.60
|
| Rate for Payer: NAPHCARE Commercial |
$844.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,294.44
|
| Rate for Payer: Quartz Beloit One Network |
$689.43
|
| Rate for Payer: Quartz Commercial |
$844.20
|
| Rate for Payer: WEA Trust Commercial |
$773.85
|
| Rate for Payer: WPS Commercial |
$1,042.16
|
|
