|
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 |
$162.56 |
| Max. Negotiated Rate |
$305.22 |
| Rate for Payer: Aetna Commercial |
$298.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$285.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$175.83
|
| Rate for Payer: Cash Price |
$95.70
|
| Rate for Payer: Cigna Commercial |
$305.22
|
| Rate for Payer: Health EOS Commercial |
$295.27
|
| Rate for Payer: HFN Commercial |
$305.22
|
| Rate for Payer: Multiplan Commercial |
$265.41
|
| Rate for Payer: Preferred Network Access Commercial |
$305.22
|
| Rate for Payer: Quartz Beloit One Network |
$162.56
|
| Rate for Payer: Quartz Commercial |
$199.06
|
| Rate for Payer: WEA Trust Commercial |
$182.47
|
| Rate for Payer: WPS Commercial |
$245.73
|
|
|
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 |
$92.89 |
| Max. Negotiated Rate |
$305.22 |
| Rate for Payer: Aetna Commercial |
$298.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$285.31
|
| Rate for Payer: Aetna Managed Medicare |
$92.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$215.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$165.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$159.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$175.83
|
| Rate for Payer: Cash Price |
$95.70
|
| Rate for Payer: Cigna Commercial |
$305.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$185.66
|
| Rate for Payer: Health EOS Commercial |
$295.27
|
| Rate for Payer: HFN Commercial |
$305.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$248.82
|
| Rate for Payer: Multiplan Commercial |
$265.41
|
| Rate for Payer: NAPHCARE Commercial |
$199.06
|
| Rate for Payer: Preferred Network Access Commercial |
$305.22
|
| Rate for Payer: Quartz Beloit One Network |
$162.56
|
| Rate for Payer: Quartz Commercial |
$215.64
|
| Rate for Payer: Quartz Medicare Advantage |
$199.06
|
| Rate for Payer: The Alliance Commercial |
$165.88
|
| Rate for Payer: WEA Trust Commercial |
$182.47
|
| Rate for Payer: WPS Commercial |
$245.73
|
|
|
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 |
$55.91 |
| Max. Negotiated Rate |
$183.71 |
| Rate for Payer: Aetna Commercial |
$179.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$171.72
|
| Rate for Payer: Aetna Managed Medicare |
$55.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$129.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$99.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$95.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$105.83
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna Commercial |
$183.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$111.74
|
| Rate for Payer: Health EOS Commercial |
$177.72
|
| Rate for Payer: HFN Commercial |
$183.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$149.76
|
| Rate for Payer: Multiplan Commercial |
$159.74
|
| Rate for Payer: NAPHCARE Commercial |
$119.81
|
| Rate for Payer: Preferred Network Access Commercial |
$183.71
|
| Rate for Payer: Quartz Beloit One Network |
$97.84
|
| Rate for Payer: Quartz Commercial |
$129.79
|
| Rate for Payer: Quartz Medicare Advantage |
$119.81
|
| Rate for Payer: The Alliance Commercial |
$99.84
|
| Rate for Payer: WEA Trust Commercial |
$109.82
|
| Rate for Payer: WPS Commercial |
$147.90
|
|
|
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 |
$97.84 |
| Max. Negotiated Rate |
$183.71 |
| Rate for Payer: Aetna Commercial |
$179.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$171.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$105.83
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna Commercial |
$183.71
|
| Rate for Payer: Health EOS Commercial |
$177.72
|
| Rate for Payer: HFN Commercial |
$183.71
|
| Rate for Payer: Multiplan Commercial |
$159.74
|
| Rate for Payer: Preferred Network Access Commercial |
$183.71
|
| Rate for Payer: Quartz Beloit One Network |
$97.84
|
| Rate for Payer: Quartz Commercial |
$119.81
|
| Rate for Payer: WEA Trust Commercial |
$109.82
|
| Rate for Payer: WPS Commercial |
$147.90
|
|
|
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 |
$197.43 |
| Max. Negotiated Rate |
$648.71 |
| Rate for Payer: Aetna Commercial |
$634.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$606.40
|
| Rate for Payer: Aetna Managed Medicare |
$197.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$458.33
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$352.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$338.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$373.71
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cigna Commercial |
$648.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$394.60
|
| Rate for Payer: Health EOS Commercial |
$627.56
|
| Rate for Payer: HFN Commercial |
$648.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$528.84
|
| Rate for Payer: Multiplan Commercial |
$564.10
|
| Rate for Payer: NAPHCARE Commercial |
$423.07
|
| Rate for Payer: Preferred Network Access Commercial |
$648.71
|
| Rate for Payer: Quartz Beloit One Network |
$345.51
|
| Rate for Payer: Quartz Commercial |
$458.33
|
| Rate for Payer: Quartz Medicare Advantage |
$423.07
|
| Rate for Payer: The Alliance Commercial |
$352.56
|
| Rate for Payer: WEA Trust Commercial |
$387.82
|
| Rate for Payer: WPS Commercial |
$522.26
|
|
|
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 |
$345.51 |
| Max. Negotiated Rate |
$648.71 |
| Rate for Payer: Aetna Commercial |
$634.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$606.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$373.71
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cigna Commercial |
$648.71
|
| Rate for Payer: Health EOS Commercial |
$627.56
|
| Rate for Payer: HFN Commercial |
$648.71
|
| Rate for Payer: Multiplan Commercial |
$564.10
|
| Rate for Payer: Preferred Network Access Commercial |
$648.71
|
| Rate for Payer: Quartz Beloit One Network |
$345.51
|
| Rate for Payer: Quartz Commercial |
$423.07
|
| Rate for Payer: WEA Trust Commercial |
$387.82
|
| Rate for Payer: WPS Commercial |
$522.26
|
|
|
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 |
$160.45 |
| Max. Negotiated Rate |
$527.20 |
| Rate for Payer: Aetna Commercial |
$515.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$492.81
|
| Rate for Payer: Aetna Managed Medicare |
$160.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$372.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$286.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$275.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$303.71
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cigna Commercial |
$527.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$320.68
|
| Rate for Payer: Health EOS Commercial |
$510.01
|
| Rate for Payer: HFN Commercial |
$527.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$429.78
|
| Rate for Payer: Multiplan Commercial |
$458.43
|
| Rate for Payer: NAPHCARE Commercial |
$343.82
|
| Rate for Payer: Preferred Network Access Commercial |
$527.20
|
| Rate for Payer: Quartz Beloit One Network |
$280.79
|
| Rate for Payer: Quartz Commercial |
$372.48
|
| Rate for Payer: Quartz Medicare Advantage |
$343.82
|
| Rate for Payer: The Alliance Commercial |
$286.52
|
| Rate for Payer: WEA Trust Commercial |
$315.17
|
| Rate for Payer: WPS Commercial |
$424.44
|
|
|
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 |
$280.79 |
| Max. Negotiated Rate |
$527.20 |
| Rate for Payer: Aetna Commercial |
$515.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$492.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$303.71
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cigna Commercial |
$527.20
|
| Rate for Payer: Health EOS Commercial |
$510.01
|
| Rate for Payer: HFN Commercial |
$527.20
|
| Rate for Payer: Multiplan Commercial |
$458.43
|
| Rate for Payer: Preferred Network Access Commercial |
$527.20
|
| Rate for Payer: Quartz Beloit One Network |
$280.79
|
| Rate for Payer: Quartz Commercial |
$343.82
|
| Rate for Payer: WEA Trust Commercial |
$315.17
|
| Rate for Payer: WPS Commercial |
$424.44
|
|
|
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 |
$228.59 |
| Max. Negotiated Rate |
$751.09 |
| Rate for Payer: Aetna Commercial |
$734.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$702.10
|
| Rate for Payer: Aetna Managed Medicare |
$228.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$530.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$408.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$391.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$432.69
|
| Rate for Payer: Cash Price |
$235.50
|
| Rate for Payer: Cigna Commercial |
$751.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$456.87
|
| Rate for Payer: Health EOS Commercial |
$726.60
|
| Rate for Payer: HFN Commercial |
$751.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$612.30
|
| Rate for Payer: Multiplan Commercial |
$653.12
|
| Rate for Payer: NAPHCARE Commercial |
$489.84
|
| Rate for Payer: Preferred Network Access Commercial |
$751.09
|
| Rate for Payer: Quartz Beloit One Network |
$400.04
|
| Rate for Payer: Quartz Commercial |
$530.66
|
| Rate for Payer: Quartz Medicare Advantage |
$489.84
|
| Rate for Payer: The Alliance Commercial |
$408.20
|
| Rate for Payer: WEA Trust Commercial |
$449.02
|
| Rate for Payer: WPS Commercial |
$604.69
|
|
|
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 |
$400.04 |
| Max. Negotiated Rate |
$751.09 |
| Rate for Payer: Aetna Commercial |
$734.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$702.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$432.69
|
| Rate for Payer: Cash Price |
$235.50
|
| Rate for Payer: Cigna Commercial |
$751.09
|
| Rate for Payer: Health EOS Commercial |
$726.60
|
| Rate for Payer: HFN Commercial |
$751.09
|
| Rate for Payer: Multiplan Commercial |
$653.12
|
| Rate for Payer: Preferred Network Access Commercial |
$751.09
|
| Rate for Payer: Quartz Beloit One Network |
$400.04
|
| Rate for Payer: Quartz Commercial |
$489.84
|
| Rate for Payer: WEA Trust Commercial |
$449.02
|
| Rate for Payer: WPS Commercial |
$604.69
|
|
|
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 |
$1,161.89 |
| Max. Negotiated Rate |
$2,181.50 |
| Rate for Payer: Aetna Commercial |
$2,134.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,039.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,256.74
|
| Rate for Payer: Cash Price |
$684.00
|
| Rate for Payer: Cigna Commercial |
$2,181.50
|
| Rate for Payer: Health EOS Commercial |
$2,110.37
|
| Rate for Payer: HFN Commercial |
$2,181.50
|
| Rate for Payer: Multiplan Commercial |
$1,896.96
|
| Rate for Payer: Preferred Network Access Commercial |
$2,181.50
|
| Rate for Payer: Quartz Beloit One Network |
$1,161.89
|
| Rate for Payer: Quartz Commercial |
$1,422.72
|
| Rate for Payer: WEA Trust Commercial |
$1,304.16
|
| Rate for Payer: WPS Commercial |
$1,756.28
|
|
|
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 |
$663.94 |
| Max. Negotiated Rate |
$2,181.50 |
| Rate for Payer: Aetna Commercial |
$2,134.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,039.23
|
| Rate for Payer: Aetna Managed Medicare |
$663.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,541.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,185.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,138.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,256.74
|
| Rate for Payer: Cash Price |
$684.00
|
| Rate for Payer: Cigna Commercial |
$2,181.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,326.96
|
| Rate for Payer: Health EOS Commercial |
$2,110.37
|
| Rate for Payer: HFN Commercial |
$2,181.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,778.40
|
| Rate for Payer: Multiplan Commercial |
$1,896.96
|
| Rate for Payer: NAPHCARE Commercial |
$1,422.72
|
| Rate for Payer: Preferred Network Access Commercial |
$2,181.50
|
| Rate for Payer: Quartz Beloit One Network |
$1,161.89
|
| Rate for Payer: Quartz Commercial |
$1,541.28
|
| Rate for Payer: Quartz Medicare Advantage |
$1,422.72
|
| Rate for Payer: The Alliance Commercial |
$1,185.60
|
| Rate for Payer: WEA Trust Commercial |
$1,304.16
|
| Rate for Payer: WPS Commercial |
$1,756.28
|
|
|
K-WIRE 1.6MM 292.72
|
Facility
|
OP
|
$197.00
|
|
| Hospital Charge Code |
2966618
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.37 |
| Max. Negotiated Rate |
$188.49 |
| Rate for Payer: Aetna Commercial |
$184.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$176.20
|
| Rate for Payer: Aetna Managed Medicare |
$57.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$133.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$102.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$98.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$108.59
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cigna Commercial |
$188.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$114.65
|
| Rate for Payer: Health EOS Commercial |
$182.34
|
| Rate for Payer: HFN Commercial |
$188.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$153.66
|
| Rate for Payer: Multiplan Commercial |
$163.90
|
| Rate for Payer: NAPHCARE Commercial |
$122.93
|
| Rate for Payer: Preferred Network Access Commercial |
$188.49
|
| Rate for Payer: Quartz Beloit One Network |
$100.39
|
| Rate for Payer: Quartz Commercial |
$133.17
|
| Rate for Payer: Quartz Medicare Advantage |
$122.93
|
| Rate for Payer: The Alliance Commercial |
$102.44
|
| Rate for Payer: WEA Trust Commercial |
$112.68
|
| Rate for Payer: WPS Commercial |
$151.75
|
|
|
K-WIRE 1.6MM 292.72
|
Facility
|
IP
|
$197.00
|
|
| Hospital Charge Code |
2966618
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.39 |
| Max. Negotiated Rate |
$188.49 |
| Rate for Payer: Aetna Commercial |
$184.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$176.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$108.59
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cigna Commercial |
$188.49
|
| Rate for Payer: Health EOS Commercial |
$182.34
|
| Rate for Payer: HFN Commercial |
$188.49
|
| Rate for Payer: Multiplan Commercial |
$163.90
|
| Rate for Payer: Preferred Network Access Commercial |
$188.49
|
| Rate for Payer: Quartz Beloit One Network |
$100.39
|
| Rate for Payer: Quartz Commercial |
$122.93
|
| Rate for Payer: WEA Trust Commercial |
$112.68
|
| Rate for Payer: WPS Commercial |
$151.75
|
|
|
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 |
$191.61 |
| Max. Negotiated Rate |
$359.76 |
| Rate for Payer: Aetna Commercial |
$351.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$336.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$207.25
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cigna Commercial |
$359.76
|
| Rate for Payer: Health EOS Commercial |
$348.03
|
| Rate for Payer: HFN Commercial |
$359.76
|
| Rate for Payer: Multiplan Commercial |
$312.83
|
| Rate for Payer: Preferred Network Access Commercial |
$359.76
|
| Rate for Payer: Quartz Beloit One Network |
$191.61
|
| Rate for Payer: Quartz Commercial |
$234.62
|
| Rate for Payer: WEA Trust Commercial |
$215.07
|
| Rate for Payer: WPS Commercial |
$289.63
|
|
|
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 |
$109.49 |
| Max. Negotiated Rate |
$359.76 |
| Rate for Payer: Aetna Commercial |
$351.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$336.29
|
| Rate for Payer: Aetna Managed Medicare |
$109.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$254.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$195.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$187.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$207.25
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cigna Commercial |
$359.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$218.83
|
| Rate for Payer: Health EOS Commercial |
$348.03
|
| Rate for Payer: HFN Commercial |
$359.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$293.28
|
| Rate for Payer: Multiplan Commercial |
$312.83
|
| Rate for Payer: NAPHCARE Commercial |
$234.62
|
| Rate for Payer: Preferred Network Access Commercial |
$359.76
|
| Rate for Payer: Quartz Beloit One Network |
$191.61
|
| Rate for Payer: Quartz Commercial |
$254.18
|
| Rate for Payer: Quartz Medicare Advantage |
$234.62
|
| Rate for Payer: The Alliance Commercial |
$195.52
|
| Rate for Payer: WEA Trust Commercial |
$215.07
|
| Rate for Payer: WPS Commercial |
$289.63
|
|
|
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 |
$106.58 |
| Max. Negotiated Rate |
$350.19 |
| Rate for Payer: Aetna Commercial |
$342.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$327.35
|
| Rate for Payer: Aetna Managed Medicare |
$106.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$247.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$190.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$182.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$201.74
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Cigna Commercial |
$350.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$213.01
|
| Rate for Payer: Health EOS Commercial |
$338.77
|
| Rate for Payer: HFN Commercial |
$350.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$285.48
|
| Rate for Payer: Multiplan Commercial |
$304.51
|
| Rate for Payer: NAPHCARE Commercial |
$228.38
|
| Rate for Payer: Preferred Network Access Commercial |
$350.19
|
| Rate for Payer: Quartz Beloit One Network |
$186.51
|
| Rate for Payer: Quartz Commercial |
$247.42
|
| Rate for Payer: Quartz Medicare Advantage |
$228.38
|
| Rate for Payer: The Alliance Commercial |
$190.32
|
| Rate for Payer: WEA Trust Commercial |
$209.35
|
| Rate for Payer: WPS Commercial |
$281.93
|
|
|
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 |
$186.51 |
| Max. Negotiated Rate |
$350.19 |
| Rate for Payer: Aetna Commercial |
$342.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$327.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$201.74
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Cigna Commercial |
$350.19
|
| Rate for Payer: Health EOS Commercial |
$338.77
|
| Rate for Payer: HFN Commercial |
$350.19
|
| Rate for Payer: Multiplan Commercial |
$304.51
|
| Rate for Payer: Preferred Network Access Commercial |
$350.19
|
| Rate for Payer: Quartz Beloit One Network |
$186.51
|
| Rate for Payer: Quartz Commercial |
$228.38
|
| Rate for Payer: WEA Trust Commercial |
$209.35
|
| Rate for Payer: WPS Commercial |
$281.93
|
|
|
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 |
$62.68 |
| Max. Negotiated Rate |
$117.69 |
| Rate for Payer: Aetna Commercial |
$115.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$67.80
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna Commercial |
$117.69
|
| Rate for Payer: Health EOS Commercial |
$113.85
|
| Rate for Payer: HFN Commercial |
$117.69
|
| Rate for Payer: Multiplan Commercial |
$102.34
|
| Rate for Payer: Preferred Network Access Commercial |
$117.69
|
| Rate for Payer: Quartz Beloit One Network |
$62.68
|
| Rate for Payer: Quartz Commercial |
$76.75
|
| Rate for Payer: WEA Trust Commercial |
$70.36
|
| Rate for Payer: WPS Commercial |
$94.75
|
|
|
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 |
$35.82 |
| Max. Negotiated Rate |
$117.69 |
| Rate for Payer: Aetna Commercial |
$115.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.01
|
| Rate for Payer: Aetna Managed Medicare |
$35.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$83.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$63.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$61.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$67.80
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna Commercial |
$117.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$71.59
|
| Rate for Payer: Health EOS Commercial |
$113.85
|
| Rate for Payer: HFN Commercial |
$117.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$95.94
|
| Rate for Payer: Multiplan Commercial |
$102.34
|
| Rate for Payer: NAPHCARE Commercial |
$76.75
|
| Rate for Payer: Preferred Network Access Commercial |
$117.69
|
| Rate for Payer: Quartz Beloit One Network |
$62.68
|
| Rate for Payer: Quartz Commercial |
$83.15
|
| Rate for Payer: Quartz Medicare Advantage |
$76.75
|
| Rate for Payer: The Alliance Commercial |
$63.96
|
| Rate for Payer: WEA Trust Commercial |
$70.36
|
| Rate for Payer: WPS Commercial |
$94.75
|
|
|
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 |
$106.58 |
| Max. Negotiated Rate |
$350.19 |
| Rate for Payer: Aetna Commercial |
$342.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$327.35
|
| Rate for Payer: Aetna Managed Medicare |
$106.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$247.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$190.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$182.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$201.74
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Cigna Commercial |
$350.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$213.01
|
| Rate for Payer: Health EOS Commercial |
$338.77
|
| Rate for Payer: HFN Commercial |
$350.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$285.48
|
| Rate for Payer: Multiplan Commercial |
$304.51
|
| Rate for Payer: NAPHCARE Commercial |
$228.38
|
| Rate for Payer: Preferred Network Access Commercial |
$350.19
|
| Rate for Payer: Quartz Beloit One Network |
$186.51
|
| Rate for Payer: Quartz Commercial |
$247.42
|
| Rate for Payer: Quartz Medicare Advantage |
$228.38
|
| Rate for Payer: The Alliance Commercial |
$190.32
|
| Rate for Payer: WEA Trust Commercial |
$209.35
|
| Rate for Payer: WPS Commercial |
$281.93
|
|
|
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 |
$186.51 |
| Max. Negotiated Rate |
$350.19 |
| Rate for Payer: Aetna Commercial |
$342.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$327.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$201.74
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Cigna Commercial |
$350.19
|
| Rate for Payer: Health EOS Commercial |
$338.77
|
| Rate for Payer: HFN Commercial |
$350.19
|
| Rate for Payer: Multiplan Commercial |
$304.51
|
| Rate for Payer: Preferred Network Access Commercial |
$350.19
|
| Rate for Payer: Quartz Beloit One Network |
$186.51
|
| Rate for Payer: Quartz Commercial |
$228.38
|
| Rate for Payer: WEA Trust Commercial |
$209.35
|
| Rate for Payer: WPS Commercial |
$281.93
|
|
|
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 |
$753.70 |
| Max. Negotiated Rate |
$1,415.11 |
| Rate for Payer: Aetna Commercial |
$1,384.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,322.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$815.22
|
| Rate for Payer: Cash Price |
$443.70
|
| Rate for Payer: Cigna Commercial |
$1,415.11
|
| Rate for Payer: Health EOS Commercial |
$1,368.96
|
| Rate for Payer: HFN Commercial |
$1,415.11
|
| Rate for Payer: Multiplan Commercial |
$1,230.53
|
| Rate for Payer: Preferred Network Access Commercial |
$1,415.11
|
| Rate for Payer: Quartz Beloit One Network |
$753.70
|
| Rate for Payer: Quartz Commercial |
$922.90
|
| Rate for Payer: WEA Trust Commercial |
$845.99
|
| Rate for Payer: WPS Commercial |
$1,139.27
|
|
|
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 |
$430.68 |
| Max. Negotiated Rate |
$1,415.11 |
| Rate for Payer: Aetna Commercial |
$1,384.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,322.82
|
| Rate for Payer: Aetna Managed Medicare |
$430.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$999.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$769.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$738.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$815.22
|
| Rate for Payer: Cash Price |
$443.70
|
| Rate for Payer: Cigna Commercial |
$1,415.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$860.78
|
| Rate for Payer: Health EOS Commercial |
$1,368.96
|
| Rate for Payer: HFN Commercial |
$1,415.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,153.62
|
| Rate for Payer: Multiplan Commercial |
$1,230.53
|
| Rate for Payer: NAPHCARE Commercial |
$922.90
|
| Rate for Payer: Preferred Network Access Commercial |
$1,415.11
|
| Rate for Payer: Quartz Beloit One Network |
$753.70
|
| Rate for Payer: Quartz Commercial |
$999.80
|
| Rate for Payer: Quartz Medicare Advantage |
$922.90
|
| Rate for Payer: The Alliance Commercial |
$769.08
|
| Rate for Payer: WEA Trust Commercial |
$845.99
|
| Rate for Payer: WPS Commercial |
$1,139.27
|
|
|
K-WIRE 1.6 THREADED TIP 292.708
|
Facility
|
IP
|
$734.00
|
|
| Hospital Charge Code |
2966260
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$374.05 |
| Max. Negotiated Rate |
$702.29 |
| Rate for Payer: Aetna Commercial |
$687.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$656.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$404.58
|
| Rate for Payer: Cash Price |
$220.20
|
| Rate for Payer: Cigna Commercial |
$702.29
|
| Rate for Payer: Health EOS Commercial |
$679.39
|
| Rate for Payer: HFN Commercial |
$702.29
|
| Rate for Payer: Multiplan Commercial |
$610.69
|
| Rate for Payer: Preferred Network Access Commercial |
$702.29
|
| Rate for Payer: Quartz Beloit One Network |
$374.05
|
| Rate for Payer: Quartz Commercial |
$458.02
|
| Rate for Payer: WEA Trust Commercial |
$419.85
|
| Rate for Payer: WPS Commercial |
$565.40
|
|
