|
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 |
$232.38 |
| Max. Negotiated Rate |
$763.53 |
| Rate for Payer: Aetna Commercial |
$746.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$713.73
|
| Rate for Payer: Aetna Managed Medicare |
$232.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$539.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$414.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$398.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$439.86
|
| Rate for Payer: Cash Price |
$239.40
|
| Rate for Payer: Cigna Commercial |
$763.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$464.44
|
| Rate for Payer: Health EOS Commercial |
$738.63
|
| Rate for Payer: HFN Commercial |
$763.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$622.44
|
| Rate for Payer: Multiplan Commercial |
$663.94
|
| Rate for Payer: NAPHCARE Commercial |
$497.95
|
| Rate for Payer: Preferred Network Access Commercial |
$763.53
|
| Rate for Payer: Quartz Beloit One Network |
$406.66
|
| Rate for Payer: Quartz Commercial |
$539.45
|
| Rate for Payer: Quartz Medicare Advantage |
$497.95
|
| Rate for Payer: The Alliance Commercial |
$414.96
|
| Rate for Payer: WEA Trust Commercial |
$456.46
|
| Rate for Payer: WPS Commercial |
$614.70
|
|
|
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 |
$406.66 |
| Max. Negotiated Rate |
$763.53 |
| Rate for Payer: Aetna Commercial |
$746.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$713.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$439.86
|
| Rate for Payer: Cash Price |
$239.40
|
| Rate for Payer: Cigna Commercial |
$763.53
|
| Rate for Payer: Health EOS Commercial |
$738.63
|
| Rate for Payer: HFN Commercial |
$763.53
|
| Rate for Payer: Multiplan Commercial |
$663.94
|
| Rate for Payer: Preferred Network Access Commercial |
$763.53
|
| Rate for Payer: Quartz Beloit One Network |
$406.66
|
| Rate for Payer: Quartz Commercial |
$497.95
|
| Rate for Payer: WEA Trust Commercial |
$456.46
|
| Rate for Payer: WPS Commercial |
$614.70
|
|
|
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 |
$820.60 |
| Max. Negotiated Rate |
$2,696.26 |
| Rate for Payer: Aetna Commercial |
$2,637.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,520.42
|
| Rate for Payer: Aetna Managed Medicare |
$820.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,904.97
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,465.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,406.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,553.28
|
| Rate for Payer: Cash Price |
$845.40
|
| Rate for Payer: Cigna Commercial |
$2,696.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,640.08
|
| Rate for Payer: Health EOS Commercial |
$2,608.34
|
| Rate for Payer: HFN Commercial |
$2,696.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,198.04
|
| Rate for Payer: Multiplan Commercial |
$2,344.58
|
| Rate for Payer: NAPHCARE Commercial |
$1,758.43
|
| Rate for Payer: Preferred Network Access Commercial |
$2,696.26
|
| Rate for Payer: Quartz Beloit One Network |
$1,436.05
|
| Rate for Payer: Quartz Commercial |
$1,904.97
|
| Rate for Payer: Quartz Medicare Advantage |
$1,758.43
|
| Rate for Payer: The Alliance Commercial |
$1,465.36
|
| Rate for Payer: WEA Trust Commercial |
$1,611.90
|
| Rate for Payer: WPS Commercial |
$2,170.71
|
|
|
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 |
$1,436.05 |
| Max. Negotiated Rate |
$2,696.26 |
| Rate for Payer: Aetna Commercial |
$2,637.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,520.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,553.28
|
| Rate for Payer: Cash Price |
$845.40
|
| Rate for Payer: Cigna Commercial |
$2,696.26
|
| Rate for Payer: Health EOS Commercial |
$2,608.34
|
| Rate for Payer: HFN Commercial |
$2,696.26
|
| Rate for Payer: Multiplan Commercial |
$2,344.58
|
| Rate for Payer: Preferred Network Access Commercial |
$2,696.26
|
| Rate for Payer: Quartz Beloit One Network |
$1,436.05
|
| Rate for Payer: Quartz Commercial |
$1,758.43
|
| Rate for Payer: WEA Trust Commercial |
$1,611.90
|
| Rate for Payer: WPS Commercial |
$2,170.71
|
|
|
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 |
$328.18 |
| Max. Negotiated Rate |
$1,078.31 |
| Rate for Payer: Aetna Commercial |
$1,054.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,007.99
|
| Rate for Payer: Aetna Managed Medicare |
$328.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$761.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$586.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$562.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$621.20
|
| Rate for Payer: Cash Price |
$338.10
|
| Rate for Payer: Cigna Commercial |
$1,078.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$655.91
|
| Rate for Payer: Health EOS Commercial |
$1,043.15
|
| Rate for Payer: HFN Commercial |
$1,078.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$879.06
|
| Rate for Payer: Multiplan Commercial |
$937.66
|
| Rate for Payer: NAPHCARE Commercial |
$703.25
|
| Rate for Payer: Preferred Network Access Commercial |
$1,078.31
|
| Rate for Payer: Quartz Beloit One Network |
$574.32
|
| Rate for Payer: Quartz Commercial |
$761.85
|
| Rate for Payer: Quartz Medicare Advantage |
$703.25
|
| Rate for Payer: The Alliance Commercial |
$586.04
|
| Rate for Payer: WEA Trust Commercial |
$644.64
|
| Rate for Payer: WPS Commercial |
$868.13
|
|
|
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 |
$574.32 |
| Max. Negotiated Rate |
$1,078.31 |
| Rate for Payer: Aetna Commercial |
$1,054.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,007.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$621.20
|
| Rate for Payer: Cash Price |
$338.10
|
| Rate for Payer: Cigna Commercial |
$1,078.31
|
| Rate for Payer: Health EOS Commercial |
$1,043.15
|
| Rate for Payer: HFN Commercial |
$1,078.31
|
| Rate for Payer: Multiplan Commercial |
$937.66
|
| Rate for Payer: Preferred Network Access Commercial |
$1,078.31
|
| Rate for Payer: Quartz Beloit One Network |
$574.32
|
| Rate for Payer: Quartz Commercial |
$703.25
|
| Rate for Payer: WEA Trust Commercial |
$644.64
|
| Rate for Payer: WPS Commercial |
$868.13
|
|
|
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 |
$561.58 |
| Max. Negotiated Rate |
$1,054.39 |
| Rate for Payer: Aetna Commercial |
$1,031.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$985.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$607.42
|
| Rate for Payer: Cash Price |
$330.60
|
| Rate for Payer: Cigna Commercial |
$1,054.39
|
| Rate for Payer: Health EOS Commercial |
$1,020.01
|
| Rate for Payer: HFN Commercial |
$1,054.39
|
| Rate for Payer: Multiplan Commercial |
$916.86
|
| Rate for Payer: Preferred Network Access Commercial |
$1,054.39
|
| Rate for Payer: Quartz Beloit One Network |
$561.58
|
| Rate for Payer: Quartz Commercial |
$687.65
|
| Rate for Payer: WEA Trust Commercial |
$630.34
|
| Rate for Payer: WPS Commercial |
$848.87
|
|
|
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 |
$320.90 |
| Max. Negotiated Rate |
$1,054.39 |
| Rate for Payer: Aetna Commercial |
$1,031.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$985.63
|
| Rate for Payer: Aetna Managed Medicare |
$320.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$744.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$573.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$550.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$607.42
|
| Rate for Payer: Cash Price |
$330.60
|
| Rate for Payer: Cigna Commercial |
$1,054.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$641.36
|
| Rate for Payer: Health EOS Commercial |
$1,020.01
|
| Rate for Payer: HFN Commercial |
$1,054.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$859.56
|
| Rate for Payer: Multiplan Commercial |
$916.86
|
| Rate for Payer: NAPHCARE Commercial |
$687.65
|
| Rate for Payer: Preferred Network Access Commercial |
$1,054.39
|
| Rate for Payer: Quartz Beloit One Network |
$561.58
|
| Rate for Payer: Quartz Commercial |
$744.95
|
| Rate for Payer: Quartz Medicare Advantage |
$687.65
|
| Rate for Payer: The Alliance Commercial |
$573.04
|
| Rate for Payer: WEA Trust Commercial |
$630.34
|
| Rate for Payer: WPS Commercial |
$848.87
|
|
|
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 |
$559.03 |
| Max. Negotiated Rate |
$1,049.61 |
| Rate for Payer: Aetna Commercial |
$1,026.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$981.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$604.67
|
| Rate for Payer: Cash Price |
$329.10
|
| Rate for Payer: Cigna Commercial |
$1,049.61
|
| Rate for Payer: Health EOS Commercial |
$1,015.38
|
| Rate for Payer: HFN Commercial |
$1,049.61
|
| Rate for Payer: Multiplan Commercial |
$912.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,049.61
|
| Rate for Payer: Quartz Beloit One Network |
$559.03
|
| Rate for Payer: Quartz Commercial |
$684.53
|
| Rate for Payer: WEA Trust Commercial |
$627.48
|
| Rate for Payer: WPS Commercial |
$845.02
|
|
|
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 |
$319.45 |
| Max. Negotiated Rate |
$1,049.61 |
| Rate for Payer: Aetna Commercial |
$1,026.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$981.16
|
| Rate for Payer: Aetna Managed Medicare |
$319.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$741.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$570.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$547.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$604.67
|
| Rate for Payer: Cash Price |
$329.10
|
| Rate for Payer: Cigna Commercial |
$1,049.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$638.45
|
| Rate for Payer: Health EOS Commercial |
$1,015.38
|
| Rate for Payer: HFN Commercial |
$1,049.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$855.66
|
| Rate for Payer: Multiplan Commercial |
$912.70
|
| Rate for Payer: NAPHCARE Commercial |
$684.53
|
| Rate for Payer: Preferred Network Access Commercial |
$1,049.61
|
| Rate for Payer: Quartz Beloit One Network |
$559.03
|
| Rate for Payer: Quartz Commercial |
$741.57
|
| Rate for Payer: Quartz Medicare Advantage |
$684.53
|
| Rate for Payer: The Alliance Commercial |
$570.44
|
| Rate for Payer: WEA Trust Commercial |
$627.48
|
| Rate for Payer: WPS Commercial |
$845.02
|
|
|
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 |
$733.82 |
| Max. Negotiated Rate |
$2,411.14 |
| Rate for Payer: Aetna Commercial |
$2,358.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,253.89
|
| Rate for Payer: Aetna Managed Medicare |
$733.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,703.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,310.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,257.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,389.02
|
| Rate for Payer: Cash Price |
$756.00
|
| Rate for Payer: Cigna Commercial |
$2,411.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,466.64
|
| Rate for Payer: Health EOS Commercial |
$2,332.51
|
| Rate for Payer: HFN Commercial |
$2,411.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,965.60
|
| Rate for Payer: Multiplan Commercial |
$2,096.64
|
| Rate for Payer: NAPHCARE Commercial |
$1,572.48
|
| Rate for Payer: Preferred Network Access Commercial |
$2,411.14
|
| Rate for Payer: Quartz Beloit One Network |
$1,284.19
|
| Rate for Payer: Quartz Commercial |
$1,703.52
|
| Rate for Payer: Quartz Medicare Advantage |
$1,572.48
|
| Rate for Payer: The Alliance Commercial |
$1,310.40
|
| Rate for Payer: WEA Trust Commercial |
$1,441.44
|
| Rate for Payer: WPS Commercial |
$1,941.16
|
|
|
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 |
$1,284.19 |
| Max. Negotiated Rate |
$2,411.14 |
| Rate for Payer: Aetna Commercial |
$2,358.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,253.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,389.02
|
| Rate for Payer: Cash Price |
$756.00
|
| Rate for Payer: Cigna Commercial |
$2,411.14
|
| Rate for Payer: Health EOS Commercial |
$2,332.51
|
| Rate for Payer: HFN Commercial |
$2,411.14
|
| Rate for Payer: Multiplan Commercial |
$2,096.64
|
| Rate for Payer: Preferred Network Access Commercial |
$2,411.14
|
| Rate for Payer: Quartz Beloit One Network |
$1,284.19
|
| Rate for Payer: Quartz Commercial |
$1,572.48
|
| Rate for Payer: WEA Trust Commercial |
$1,441.44
|
| Rate for Payer: WPS Commercial |
$1,941.16
|
|
|
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 |
$318.04 |
| Max. Negotiated Rate |
$1,045.00 |
| Rate for Payer: Aetna Commercial |
$1,022.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$976.85
|
| Rate for Payer: Aetna Managed Medicare |
$318.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$738.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$567.93
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$545.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$602.01
|
| Rate for Payer: Cash Price |
$327.65
|
| Rate for Payer: Cigna Commercial |
$1,045.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$635.65
|
| Rate for Payer: Health EOS Commercial |
$1,010.92
|
| Rate for Payer: HFN Commercial |
$1,045.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$851.90
|
| Rate for Payer: Multiplan Commercial |
$908.69
|
| Rate for Payer: NAPHCARE Commercial |
$681.52
|
| Rate for Payer: Preferred Network Access Commercial |
$1,045.00
|
| Rate for Payer: Quartz Beloit One Network |
$556.57
|
| Rate for Payer: Quartz Commercial |
$738.31
|
| Rate for Payer: Quartz Medicare Advantage |
$681.52
|
| Rate for Payer: The Alliance Commercial |
$567.93
|
| Rate for Payer: WEA Trust Commercial |
$624.73
|
| Rate for Payer: WPS Commercial |
$841.31
|
|
|
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 |
$556.57 |
| Max. Negotiated Rate |
$1,045.00 |
| Rate for Payer: Aetna Commercial |
$1,022.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$976.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$602.01
|
| Rate for Payer: Cash Price |
$327.65
|
| Rate for Payer: Cigna Commercial |
$1,045.00
|
| Rate for Payer: Health EOS Commercial |
$1,010.92
|
| Rate for Payer: HFN Commercial |
$1,045.00
|
| Rate for Payer: Multiplan Commercial |
$908.69
|
| Rate for Payer: Preferred Network Access Commercial |
$1,045.00
|
| Rate for Payer: Quartz Beloit One Network |
$556.57
|
| Rate for Payer: Quartz Commercial |
$681.52
|
| Rate for Payer: WEA Trust Commercial |
$624.73
|
| Rate for Payer: WPS Commercial |
$841.31
|
|
|
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 |
$409.72 |
| Max. Negotiated Rate |
$1,346.22 |
| Rate for Payer: Aetna Commercial |
$1,316.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,258.42
|
| Rate for Payer: Aetna Managed Medicare |
$409.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$951.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$731.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$702.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$775.54
|
| Rate for Payer: Cash Price |
$422.10
|
| Rate for Payer: Cigna Commercial |
$1,346.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$818.87
|
| Rate for Payer: Health EOS Commercial |
$1,302.32
|
| Rate for Payer: HFN Commercial |
$1,346.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,097.46
|
| Rate for Payer: Multiplan Commercial |
$1,170.62
|
| Rate for Payer: NAPHCARE Commercial |
$877.97
|
| Rate for Payer: Preferred Network Access Commercial |
$1,346.22
|
| Rate for Payer: Quartz Beloit One Network |
$717.01
|
| Rate for Payer: Quartz Commercial |
$951.13
|
| Rate for Payer: Quartz Medicare Advantage |
$877.97
|
| Rate for Payer: The Alliance Commercial |
$731.64
|
| Rate for Payer: WEA Trust Commercial |
$804.80
|
| Rate for Payer: WPS Commercial |
$1,083.81
|
|
|
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 |
$717.01 |
| Max. Negotiated Rate |
$1,346.22 |
| Rate for Payer: Aetna Commercial |
$1,316.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,258.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$775.54
|
| Rate for Payer: Cash Price |
$422.10
|
| Rate for Payer: Cigna Commercial |
$1,346.22
|
| Rate for Payer: Health EOS Commercial |
$1,302.32
|
| Rate for Payer: HFN Commercial |
$1,346.22
|
| Rate for Payer: Multiplan Commercial |
$1,170.62
|
| Rate for Payer: Preferred Network Access Commercial |
$1,346.22
|
| Rate for Payer: Quartz Beloit One Network |
$717.01
|
| Rate for Payer: Quartz Commercial |
$877.97
|
| Rate for Payer: WEA Trust Commercial |
$804.80
|
| Rate for Payer: WPS Commercial |
$1,083.81
|
|
|
K-WIRE 4.0 MM NON-THREAD STRYKER KN1117
|
Facility
|
IP
|
$466.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6171786
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$237.47 |
| Max. Negotiated Rate |
$445.87 |
| Rate for Payer: Aetna Commercial |
$436.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$416.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$256.86
|
| Rate for Payer: Cash Price |
$139.80
|
| Rate for Payer: Cigna Commercial |
$445.87
|
| Rate for Payer: Health EOS Commercial |
$431.33
|
| Rate for Payer: HFN Commercial |
$445.87
|
| Rate for Payer: Multiplan Commercial |
$387.71
|
| Rate for Payer: Preferred Network Access Commercial |
$445.87
|
| Rate for Payer: Quartz Beloit One Network |
$237.47
|
| Rate for Payer: Quartz Commercial |
$290.78
|
| Rate for Payer: WEA Trust Commercial |
$266.55
|
| Rate for Payer: WPS Commercial |
$358.96
|
|
|
K-WIRE 4.0 MM NON-THREAD STRYKER KN1117
|
Facility
|
OP
|
$466.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6171786
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.70 |
| Max. Negotiated Rate |
$445.87 |
| Rate for Payer: Aetna Commercial |
$436.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$416.79
|
| Rate for Payer: Aetna Managed Medicare |
$135.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$315.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$242.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$232.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$256.86
|
| Rate for Payer: Cash Price |
$139.80
|
| Rate for Payer: Cigna Commercial |
$445.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$271.21
|
| Rate for Payer: Health EOS Commercial |
$431.33
|
| Rate for Payer: HFN Commercial |
$445.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$363.48
|
| Rate for Payer: Multiplan Commercial |
$387.71
|
| Rate for Payer: NAPHCARE Commercial |
$290.78
|
| Rate for Payer: Preferred Network Access Commercial |
$445.87
|
| Rate for Payer: Quartz Beloit One Network |
$237.47
|
| Rate for Payer: Quartz Commercial |
$315.02
|
| Rate for Payer: Quartz Medicare Advantage |
$290.78
|
| Rate for Payer: The Alliance Commercial |
$242.32
|
| Rate for Payer: WEA Trust Commercial |
$266.55
|
| Rate for Payer: WPS Commercial |
$358.96
|
|
|
K-WIRE 6 X .035 PLAIN DOUBLE-ENDED TROCAR POINT 00018604400
|
Facility
|
IP
|
$142.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2967418
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.36 |
| Max. Negotiated Rate |
$135.87 |
| Rate for Payer: Aetna Commercial |
$132.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$127.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$78.27
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Cigna Commercial |
$135.87
|
| Rate for Payer: Health EOS Commercial |
$131.44
|
| Rate for Payer: HFN Commercial |
$135.87
|
| Rate for Payer: Multiplan Commercial |
$118.14
|
| Rate for Payer: Preferred Network Access Commercial |
$135.87
|
| Rate for Payer: Quartz Beloit One Network |
$72.36
|
| Rate for Payer: Quartz Commercial |
$88.61
|
| Rate for Payer: WEA Trust Commercial |
$81.22
|
| Rate for Payer: WPS Commercial |
$109.38
|
|
|
K-WIRE 6 X .035 PLAIN DOUBLE-ENDED TROCAR POINT 00018604400
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2967418
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.35 |
| Max. Negotiated Rate |
$135.87 |
| Rate for Payer: Aetna Commercial |
$132.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$127.00
|
| Rate for Payer: Aetna Managed Medicare |
$41.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$95.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$73.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$70.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$78.27
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Cigna Commercial |
$135.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$82.64
|
| Rate for Payer: Health EOS Commercial |
$131.44
|
| Rate for Payer: HFN Commercial |
$135.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$110.76
|
| Rate for Payer: Multiplan Commercial |
$118.14
|
| Rate for Payer: NAPHCARE Commercial |
$88.61
|
| Rate for Payer: Preferred Network Access Commercial |
$135.87
|
| Rate for Payer: Quartz Beloit One Network |
$72.36
|
| Rate for Payer: Quartz Commercial |
$95.99
|
| Rate for Payer: Quartz Medicare Advantage |
$88.61
|
| Rate for Payer: The Alliance Commercial |
$73.84
|
| Rate for Payer: WEA Trust Commercial |
$81.22
|
| Rate for Payer: WPS Commercial |
$109.38
|
|
|
K-WIRE 6 X .045 PLAIN SINGLE-END DIAMOND TIP 00018602712
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2967419
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.35 |
| Max. Negotiated Rate |
$135.87 |
| Rate for Payer: Aetna Commercial |
$132.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$127.00
|
| Rate for Payer: Aetna Managed Medicare |
$41.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$95.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$73.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$70.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$78.27
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Cigna Commercial |
$135.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$82.64
|
| Rate for Payer: Health EOS Commercial |
$131.44
|
| Rate for Payer: HFN Commercial |
$135.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$110.76
|
| Rate for Payer: Multiplan Commercial |
$118.14
|
| Rate for Payer: NAPHCARE Commercial |
$88.61
|
| Rate for Payer: Preferred Network Access Commercial |
$135.87
|
| Rate for Payer: Quartz Beloit One Network |
$72.36
|
| Rate for Payer: Quartz Commercial |
$95.99
|
| Rate for Payer: Quartz Medicare Advantage |
$88.61
|
| Rate for Payer: The Alliance Commercial |
$73.84
|
| Rate for Payer: WEA Trust Commercial |
$81.22
|
| Rate for Payer: WPS Commercial |
$109.38
|
|
|
K-WIRE 6 X .045 PLAIN SINGLE-END DIAMOND TIP 00018602712
|
Facility
|
IP
|
$142.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2967419
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.36 |
| Max. Negotiated Rate |
$135.87 |
| Rate for Payer: Aetna Commercial |
$132.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$127.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$78.27
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Cigna Commercial |
$135.87
|
| Rate for Payer: Health EOS Commercial |
$131.44
|
| Rate for Payer: HFN Commercial |
$135.87
|
| Rate for Payer: Multiplan Commercial |
$118.14
|
| Rate for Payer: Preferred Network Access Commercial |
$135.87
|
| Rate for Payer: Quartz Beloit One Network |
$72.36
|
| Rate for Payer: Quartz Commercial |
$88.61
|
| Rate for Payer: WEA Trust Commercial |
$81.22
|
| Rate for Payer: WPS Commercial |
$109.38
|
|
|
K-WIRE 6 X .062 PLAIN 00018609000
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2967420
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$69.31 |
| Max. Negotiated Rate |
$130.12 |
| Rate for Payer: Aetna Commercial |
$127.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$121.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$74.96
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cigna Commercial |
$130.12
|
| Rate for Payer: Health EOS Commercial |
$125.88
|
| Rate for Payer: HFN Commercial |
$130.12
|
| Rate for Payer: Multiplan Commercial |
$113.15
|
| Rate for Payer: Preferred Network Access Commercial |
$130.12
|
| Rate for Payer: Quartz Beloit One Network |
$69.31
|
| Rate for Payer: Quartz Commercial |
$84.86
|
| Rate for Payer: WEA Trust Commercial |
$77.79
|
| Rate for Payer: WPS Commercial |
$104.76
|
|
|
K-WIRE 6 X .062 PLAIN 00018609000
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2967420
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.60 |
| Max. Negotiated Rate |
$130.12 |
| Rate for Payer: Aetna Commercial |
$127.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$121.64
|
| Rate for Payer: Aetna Managed Medicare |
$39.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$91.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$70.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$67.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$74.96
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cigna Commercial |
$130.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$79.15
|
| Rate for Payer: Health EOS Commercial |
$125.88
|
| Rate for Payer: HFN Commercial |
$130.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$106.08
|
| Rate for Payer: Multiplan Commercial |
$113.15
|
| Rate for Payer: NAPHCARE Commercial |
$84.86
|
| Rate for Payer: Preferred Network Access Commercial |
$130.12
|
| Rate for Payer: Quartz Beloit One Network |
$69.31
|
| Rate for Payer: Quartz Commercial |
$91.94
|
| Rate for Payer: Quartz Medicare Advantage |
$84.86
|
| Rate for Payer: The Alliance Commercial |
$70.72
|
| Rate for Payer: WEA Trust Commercial |
$77.79
|
| Rate for Payer: WPS Commercial |
$104.76
|
|
|
K-WIRE 8.6MM X 120MM AR-8610K-25
|
Facility
|
IP
|
$319.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5415161
|
|
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
|
|
