|
K-WIRE 1.6 THREADED TIP 292.708
|
Facility
|
OP
|
$734.00
|
|
| Hospital Charge Code |
2966260
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$213.74 |
| Max. Negotiated Rate |
$702.29 |
| Rate for Payer: Aetna Commercial |
$687.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$656.49
|
| Rate for Payer: Aetna Managed Medicare |
$213.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$496.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$381.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$366.41
|
| 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: Dean Health DHI/DHP/ASO |
$427.19
|
| Rate for Payer: Health EOS Commercial |
$679.39
|
| Rate for Payer: HFN Commercial |
$702.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$572.52
|
| Rate for Payer: Multiplan Commercial |
$610.69
|
| Rate for Payer: NAPHCARE Commercial |
$458.02
|
| Rate for Payer: Preferred Network Access Commercial |
$702.29
|
| Rate for Payer: Quartz Beloit One Network |
$374.05
|
| Rate for Payer: Quartz Commercial |
$496.18
|
| Rate for Payer: Quartz Medicare Advantage |
$458.02
|
| Rate for Payer: The Alliance Commercial |
$381.68
|
| Rate for Payer: WEA Trust Commercial |
$419.85
|
| Rate for Payer: WPS Commercial |
$565.40
|
|
|
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 |
$285.96 |
| Max. Negotiated Rate |
$939.58 |
| Rate for Payer: Aetna Commercial |
$919.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$878.30
|
| Rate for Payer: Aetna Managed Medicare |
$285.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$663.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$510.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$490.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$541.28
|
| Rate for Payer: Cash Price |
$294.60
|
| Rate for Payer: Cigna Commercial |
$939.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$571.52
|
| Rate for Payer: Health EOS Commercial |
$908.94
|
| Rate for Payer: HFN Commercial |
$939.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$765.96
|
| Rate for Payer: Multiplan Commercial |
$817.02
|
| Rate for Payer: NAPHCARE Commercial |
$612.77
|
| Rate for Payer: Preferred Network Access Commercial |
$939.58
|
| Rate for Payer: Quartz Beloit One Network |
$500.43
|
| Rate for Payer: Quartz Commercial |
$663.83
|
| Rate for Payer: Quartz Medicare Advantage |
$612.77
|
| Rate for Payer: The Alliance Commercial |
$510.64
|
| Rate for Payer: WEA Trust Commercial |
$561.70
|
| Rate for Payer: WPS Commercial |
$756.43
|
|
|
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 |
$500.43 |
| Max. Negotiated Rate |
$939.58 |
| Rate for Payer: Aetna Commercial |
$919.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$878.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$541.28
|
| Rate for Payer: Cash Price |
$294.60
|
| Rate for Payer: Cigna Commercial |
$939.58
|
| Rate for Payer: Health EOS Commercial |
$908.94
|
| Rate for Payer: HFN Commercial |
$939.58
|
| Rate for Payer: Multiplan Commercial |
$817.02
|
| Rate for Payer: Preferred Network Access Commercial |
$939.58
|
| Rate for Payer: Quartz Beloit One Network |
$500.43
|
| Rate for Payer: Quartz Commercial |
$612.77
|
| Rate for Payer: WEA Trust Commercial |
$561.70
|
| Rate for Payer: WPS Commercial |
$756.43
|
|
|
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 |
$223.06 |
| Max. Negotiated Rate |
$732.91 |
| Rate for Payer: Aetna Commercial |
$716.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$685.11
|
| Rate for Payer: Aetna Managed Medicare |
$223.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$517.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$398.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$382.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$422.22
|
| Rate for Payer: Cash Price |
$229.80
|
| Rate for Payer: Cigna Commercial |
$732.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$445.81
|
| Rate for Payer: Health EOS Commercial |
$709.01
|
| Rate for Payer: HFN Commercial |
$732.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$597.48
|
| Rate for Payer: Multiplan Commercial |
$637.31
|
| Rate for Payer: NAPHCARE Commercial |
$477.98
|
| Rate for Payer: Preferred Network Access Commercial |
$732.91
|
| Rate for Payer: Quartz Beloit One Network |
$390.35
|
| Rate for Payer: Quartz Commercial |
$517.82
|
| Rate for Payer: Quartz Medicare Advantage |
$477.98
|
| Rate for Payer: The Alliance Commercial |
$398.32
|
| Rate for Payer: WEA Trust Commercial |
$438.15
|
| Rate for Payer: WPS Commercial |
$590.05
|
|
|
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 |
$390.35 |
| Max. Negotiated Rate |
$732.91 |
| Rate for Payer: Aetna Commercial |
$716.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$685.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$422.22
|
| Rate for Payer: Cash Price |
$229.80
|
| Rate for Payer: Cigna Commercial |
$732.91
|
| Rate for Payer: Health EOS Commercial |
$709.01
|
| Rate for Payer: HFN Commercial |
$732.91
|
| Rate for Payer: Multiplan Commercial |
$637.31
|
| Rate for Payer: Preferred Network Access Commercial |
$732.91
|
| Rate for Payer: Quartz Beloit One Network |
$390.35
|
| Rate for Payer: Quartz Commercial |
$477.98
|
| Rate for Payer: WEA Trust Commercial |
$438.15
|
| Rate for Payer: WPS Commercial |
$590.05
|
|
|
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 |
$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 1.6 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 |
$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 1.6 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 |
$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 1.6 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 |
$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 1.8
|
Facility
|
OP
|
$427.00
|
|
| Hospital Charge Code |
2965167
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$124.34 |
| Max. Negotiated Rate |
$408.55 |
| Rate for Payer: Aetna Commercial |
$399.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$381.91
|
| Rate for Payer: Aetna Managed Medicare |
$124.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$288.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$222.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$213.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$235.36
|
| Rate for Payer: Cash Price |
$128.10
|
| Rate for Payer: Cigna Commercial |
$408.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$248.51
|
| Rate for Payer: Health EOS Commercial |
$395.23
|
| Rate for Payer: HFN Commercial |
$408.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$333.06
|
| Rate for Payer: Multiplan Commercial |
$355.26
|
| Rate for Payer: NAPHCARE Commercial |
$266.45
|
| Rate for Payer: Preferred Network Access Commercial |
$408.55
|
| Rate for Payer: Quartz Beloit One Network |
$217.60
|
| Rate for Payer: Quartz Commercial |
$288.65
|
| Rate for Payer: Quartz Medicare Advantage |
$266.45
|
| Rate for Payer: The Alliance Commercial |
$222.04
|
| Rate for Payer: WEA Trust Commercial |
$244.24
|
| Rate for Payer: WPS Commercial |
$328.92
|
|
|
K-WIRE 1.8
|
Facility
|
IP
|
$427.00
|
|
| Hospital Charge Code |
2965167
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$217.60 |
| Max. Negotiated Rate |
$408.55 |
| Rate for Payer: Aetna Commercial |
$399.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$381.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$235.36
|
| Rate for Payer: Cash Price |
$128.10
|
| Rate for Payer: Cigna Commercial |
$408.55
|
| Rate for Payer: Health EOS Commercial |
$395.23
|
| Rate for Payer: HFN Commercial |
$408.55
|
| Rate for Payer: Multiplan Commercial |
$355.26
|
| Rate for Payer: Preferred Network Access Commercial |
$408.55
|
| Rate for Payer: Quartz Beloit One Network |
$217.60
|
| Rate for Payer: Quartz Commercial |
$266.45
|
| Rate for Payer: WEA Trust Commercial |
$244.24
|
| Rate for Payer: WPS Commercial |
$328.92
|
|
|
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 |
$1,070.16 |
| Max. Negotiated Rate |
$2,009.28 |
| Rate for Payer: Aetna Commercial |
$1,965.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,878.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,157.52
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Cigna Commercial |
$2,009.28
|
| Rate for Payer: Health EOS Commercial |
$1,943.76
|
| Rate for Payer: HFN Commercial |
$2,009.28
|
| Rate for Payer: Multiplan Commercial |
$1,747.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,009.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,070.16
|
| Rate for Payer: Quartz Commercial |
$1,310.40
|
| Rate for Payer: WEA Trust Commercial |
$1,201.20
|
| Rate for Payer: WPS Commercial |
$1,617.63
|
|
|
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 |
$611.52 |
| Max. Negotiated Rate |
$2,009.28 |
| Rate for Payer: Aetna Commercial |
$1,965.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,878.24
|
| Rate for Payer: Aetna Managed Medicare |
$611.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,419.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,092.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,048.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,157.52
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Cigna Commercial |
$2,009.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,222.20
|
| Rate for Payer: Health EOS Commercial |
$1,943.76
|
| Rate for Payer: HFN Commercial |
$2,009.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,638.00
|
| Rate for Payer: Multiplan Commercial |
$1,747.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,310.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,009.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,070.16
|
| Rate for Payer: Quartz Commercial |
$1,419.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,310.40
|
| Rate for Payer: The Alliance Commercial |
$1,092.00
|
| Rate for Payer: WEA Trust Commercial |
$1,201.20
|
| Rate for Payer: WPS Commercial |
$1,617.63
|
|
|
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 |
$419.91 |
| Max. Negotiated Rate |
$788.40 |
| Rate for Payer: Aetna Commercial |
$771.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$736.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$454.19
|
| Rate for Payer: Cash Price |
$247.20
|
| Rate for Payer: Cigna Commercial |
$788.40
|
| Rate for Payer: Health EOS Commercial |
$762.69
|
| Rate for Payer: HFN Commercial |
$788.40
|
| Rate for Payer: Multiplan Commercial |
$685.57
|
| Rate for Payer: Preferred Network Access Commercial |
$788.40
|
| Rate for Payer: Quartz Beloit One Network |
$419.91
|
| Rate for Payer: Quartz Commercial |
$514.18
|
| Rate for Payer: WEA Trust Commercial |
$471.33
|
| Rate for Payer: WPS Commercial |
$634.73
|
|
|
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 |
$239.95 |
| Max. Negotiated Rate |
$788.40 |
| Rate for Payer: Aetna Commercial |
$771.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$736.99
|
| Rate for Payer: Aetna Managed Medicare |
$239.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$557.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$428.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$411.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$454.19
|
| Rate for Payer: Cash Price |
$247.20
|
| Rate for Payer: Cigna Commercial |
$788.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$479.57
|
| Rate for Payer: Health EOS Commercial |
$762.69
|
| Rate for Payer: HFN Commercial |
$788.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$642.72
|
| Rate for Payer: Multiplan Commercial |
$685.57
|
| Rate for Payer: NAPHCARE Commercial |
$514.18
|
| Rate for Payer: Preferred Network Access Commercial |
$788.40
|
| Rate for Payer: Quartz Beloit One Network |
$419.91
|
| Rate for Payer: Quartz Commercial |
$557.02
|
| Rate for Payer: Quartz Medicare Advantage |
$514.18
|
| Rate for Payer: The Alliance Commercial |
$428.48
|
| Rate for Payer: WEA Trust Commercial |
$471.33
|
| Rate for Payer: WPS Commercial |
$634.73
|
|
|
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 |
$163.36 |
| Max. Negotiated Rate |
$536.76 |
| Rate for Payer: Aetna Commercial |
$525.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$501.76
|
| Rate for Payer: Aetna Managed Medicare |
$163.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$379.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$291.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$280.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$309.22
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Cigna Commercial |
$536.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$326.50
|
| Rate for Payer: Health EOS Commercial |
$519.26
|
| Rate for Payer: HFN Commercial |
$536.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$437.58
|
| Rate for Payer: Multiplan Commercial |
$466.75
|
| Rate for Payer: NAPHCARE Commercial |
$350.06
|
| Rate for Payer: Preferred Network Access Commercial |
$536.76
|
| Rate for Payer: Quartz Beloit One Network |
$285.89
|
| Rate for Payer: Quartz Commercial |
$379.24
|
| Rate for Payer: Quartz Medicare Advantage |
$350.06
|
| Rate for Payer: The Alliance Commercial |
$291.72
|
| Rate for Payer: WEA Trust Commercial |
$320.89
|
| Rate for Payer: WPS Commercial |
$432.14
|
|
|
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 |
$285.89 |
| Max. Negotiated Rate |
$536.76 |
| Rate for Payer: Aetna Commercial |
$525.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$501.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$309.22
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Cigna Commercial |
$536.76
|
| Rate for Payer: Health EOS Commercial |
$519.26
|
| Rate for Payer: HFN Commercial |
$536.76
|
| Rate for Payer: Multiplan Commercial |
$466.75
|
| Rate for Payer: Preferred Network Access Commercial |
$536.76
|
| Rate for Payer: Quartz Beloit One Network |
$285.89
|
| Rate for Payer: Quartz Commercial |
$350.06
|
| Rate for Payer: WEA Trust Commercial |
$320.89
|
| Rate for Payer: WPS Commercial |
$432.14
|
|
|
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 |
$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 2.0 X 150MM TROCAR POINT 292.20
|
Facility
|
OP
|
$197.00
|
|
| Hospital Charge Code |
2966620
|
|
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 2.0 X 234MM DRILL TIP 705002
|
Facility
|
OP
|
$1,434.00
|
|
| Hospital Charge Code |
5106960
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$417.58 |
| Max. Negotiated Rate |
$1,372.05 |
| Rate for Payer: Aetna Commercial |
$1,342.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,282.57
|
| Rate for Payer: Aetna Managed Medicare |
$417.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$969.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$745.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$715.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$790.42
|
| Rate for Payer: Cash Price |
$430.20
|
| Rate for Payer: Cigna Commercial |
$1,372.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$834.59
|
| Rate for Payer: Health EOS Commercial |
$1,327.31
|
| Rate for Payer: HFN Commercial |
$1,372.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,118.52
|
| Rate for Payer: Multiplan Commercial |
$1,193.09
|
| Rate for Payer: NAPHCARE Commercial |
$894.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,372.05
|
| Rate for Payer: Quartz Beloit One Network |
$730.77
|
| Rate for Payer: Quartz Commercial |
$969.38
|
| Rate for Payer: Quartz Medicare Advantage |
$894.82
|
| Rate for Payer: The Alliance Commercial |
$745.68
|
| Rate for Payer: WEA Trust Commercial |
$820.25
|
| Rate for Payer: WPS Commercial |
$1,104.61
|
|
|
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 |
$730.77 |
| Max. Negotiated Rate |
$1,372.05 |
| Rate for Payer: Aetna Commercial |
$1,342.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,282.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$790.42
|
| Rate for Payer: Cash Price |
$430.20
|
| Rate for Payer: Cigna Commercial |
$1,372.05
|
| Rate for Payer: Health EOS Commercial |
$1,327.31
|
| Rate for Payer: HFN Commercial |
$1,372.05
|
| Rate for Payer: Multiplan Commercial |
$1,193.09
|
| Rate for Payer: Preferred Network Access Commercial |
$1,372.05
|
| Rate for Payer: Quartz Beloit One Network |
$730.77
|
| Rate for Payer: Quartz Commercial |
$894.82
|
| Rate for Payer: WEA Trust Commercial |
$820.25
|
| Rate for Payer: WPS Commercial |
$1,104.61
|
|
|
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 |
$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 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 |
$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 2.5MM X 150MM 390182
|
Facility
|
OP
|
$262.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6171936
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$76.29 |
| Max. Negotiated Rate |
$250.68 |
| Rate for Payer: Aetna Commercial |
$245.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$234.33
|
| Rate for Payer: Aetna Managed Medicare |
$76.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$177.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$136.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$130.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$144.41
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$250.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$152.48
|
| Rate for Payer: Health EOS Commercial |
$242.51
|
| Rate for Payer: HFN Commercial |
$250.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$204.36
|
| Rate for Payer: Multiplan Commercial |
$217.98
|
| Rate for Payer: NAPHCARE Commercial |
$163.49
|
| Rate for Payer: Preferred Network Access Commercial |
$250.68
|
| Rate for Payer: Quartz Beloit One Network |
$133.52
|
| Rate for Payer: Quartz Commercial |
$177.11
|
| Rate for Payer: Quartz Medicare Advantage |
$163.49
|
| Rate for Payer: The Alliance Commercial |
$136.24
|
| Rate for Payer: WEA Trust Commercial |
$149.86
|
| Rate for Payer: WPS Commercial |
$201.82
|
|
|
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 |
$133.52 |
| Max. Negotiated Rate |
$250.68 |
| Rate for Payer: Aetna Commercial |
$245.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$234.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$144.41
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$250.68
|
| Rate for Payer: Health EOS Commercial |
$242.51
|
| Rate for Payer: HFN Commercial |
$250.68
|
| Rate for Payer: Multiplan Commercial |
$217.98
|
| Rate for Payer: Preferred Network Access Commercial |
$250.68
|
| Rate for Payer: Quartz Beloit One Network |
$133.52
|
| Rate for Payer: Quartz Commercial |
$163.49
|
| Rate for Payer: WEA Trust Commercial |
$149.86
|
| Rate for Payer: WPS Commercial |
$201.82
|
|
