|
K-WIRE BB-TAK THREADED AR-13226T
|
Facility
|
IP
|
$1,357.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5521079
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$664.93 |
| Max. Negotiated Rate |
$1,248.44 |
| Rate for Payer: Aetna Commercial |
$1,221.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,167.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$719.21
|
| Rate for Payer: Cash Price |
$407.10
|
| Rate for Payer: Cigna Commercial |
$1,248.44
|
| Rate for Payer: Health EOS Commercial |
$1,207.73
|
| Rate for Payer: HFN Commercial |
$1,248.44
|
| Rate for Payer: Multiplan Commercial |
$1,085.60
|
| Rate for Payer: NAPHCARE Commercial |
$814.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,248.44
|
| Rate for Payer: Quartz Beloit One Network |
$664.93
|
| Rate for Payer: Quartz Commercial |
$814.20
|
| Rate for Payer: WEA Trust Commercial |
$746.35
|
| Rate for Payer: WPS Commercial |
$1,005.13
|
|
|
K-WIRE DBL ENDED .045 X 6 IN 210-40-006
|
Facility
|
OP
|
$381.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3693501
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$106.68 |
| Max. Negotiated Rate |
$1,524.00 |
| Rate for Payer: Aetna Commercial |
$342.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$327.66
|
| Rate for Payer: Aetna Managed Medicare |
$106.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$247.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$190.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$182.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$201.93
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cigna Commercial |
$350.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$213.21
|
| Rate for Payer: Health EOS Commercial |
$339.09
|
| Rate for Payer: HFN Commercial |
$350.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$285.75
|
| Rate for Payer: Multiplan Commercial |
$304.80
|
| Rate for Payer: NAPHCARE Commercial |
$228.60
|
| Rate for Payer: Preferred Network Access Commercial |
$350.52
|
| Rate for Payer: Quartz Beloit One Network |
$186.69
|
| Rate for Payer: Quartz Commercial |
$247.65
|
| Rate for Payer: Quartz Medicare Advantage |
$228.60
|
| Rate for Payer: The Alliance Commercial |
$1,524.00
|
| Rate for Payer: WEA Trust Commercial |
$209.55
|
| Rate for Payer: WPS Commercial |
$282.21
|
|
|
K-WIRE DBL ENDED .045 X 6 IN 210-40-006
|
Facility
|
IP
|
$381.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3693501
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$186.69 |
| Max. Negotiated Rate |
$350.52 |
| Rate for Payer: Aetna Commercial |
$342.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$327.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$201.93
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cigna Commercial |
$350.52
|
| Rate for Payer: Health EOS Commercial |
$339.09
|
| Rate for Payer: HFN Commercial |
$350.52
|
| Rate for Payer: Multiplan Commercial |
$304.80
|
| Rate for Payer: NAPHCARE Commercial |
$228.60
|
| Rate for Payer: Preferred Network Access Commercial |
$350.52
|
| Rate for Payer: Quartz Beloit One Network |
$186.69
|
| Rate for Payer: Quartz Commercial |
$228.60
|
| Rate for Payer: WEA Trust Commercial |
$209.55
|
| Rate for Payer: WPS Commercial |
$282.21
|
|
|
K-WIRE GRIDLOCK PART THREAD .045 X 6 STD 210-40-004/5"
|
Facility
|
OP
|
$319.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3444835
|
|
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 GRIDLOCK PART THREAD .045 X 6 STD 210-40-004/5"
|
Facility
|
IP
|
$319.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3444835
|
|
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 HEMI-CAP
|
Facility
|
IP
|
$1,630.00
|
|
| Hospital Charge Code |
2965214
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$798.70 |
| Max. Negotiated Rate |
$1,499.60 |
| Rate for Payer: Aetna Commercial |
$1,467.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,401.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$863.90
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,499.60
|
| Rate for Payer: Health EOS Commercial |
$1,450.70
|
| Rate for Payer: HFN Commercial |
$1,499.60
|
| Rate for Payer: Multiplan Commercial |
$1,304.00
|
| Rate for Payer: NAPHCARE Commercial |
$978.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,499.60
|
| Rate for Payer: Quartz Beloit One Network |
$798.70
|
| Rate for Payer: Quartz Commercial |
$978.00
|
| Rate for Payer: WEA Trust Commercial |
$896.50
|
| Rate for Payer: WPS Commercial |
$1,207.34
|
|
|
K-WIRE HEMI-CAP
|
Facility
|
OP
|
$1,630.00
|
|
| Hospital Charge Code |
2965214
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$456.40 |
| Max. Negotiated Rate |
$6,520.00 |
| Rate for Payer: Aetna Commercial |
$1,467.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,401.80
|
| Rate for Payer: Aetna Managed Medicare |
$456.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,059.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$815.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$782.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$863.90
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,499.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$912.15
|
| Rate for Payer: Health EOS Commercial |
$1,450.70
|
| Rate for Payer: HFN Commercial |
$1,499.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,222.50
|
| Rate for Payer: Multiplan Commercial |
$1,304.00
|
| Rate for Payer: NAPHCARE Commercial |
$978.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,499.60
|
| Rate for Payer: Quartz Beloit One Network |
$798.70
|
| Rate for Payer: Quartz Commercial |
$1,059.50
|
| Rate for Payer: Quartz Medicare Advantage |
$978.00
|
| Rate for Payer: The Alliance Commercial |
$6,520.00
|
| Rate for Payer: WEA Trust Commercial |
$896.50
|
| Rate for Payer: WPS Commercial |
$1,207.34
|
|
|
K-WIRE PARTIALLY THREADED TRILLIANT 0.035 210-24-005
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3784164
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$94.92 |
| Max. Negotiated Rate |
$1,356.00 |
| Rate for Payer: Aetna Commercial |
$305.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$291.54
|
| Rate for Payer: Aetna Managed Medicare |
$94.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$220.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$169.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$162.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$179.67
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cigna Commercial |
$311.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$189.70
|
| Rate for Payer: Health EOS Commercial |
$301.71
|
| Rate for Payer: HFN Commercial |
$311.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$254.25
|
| Rate for Payer: Multiplan Commercial |
$271.20
|
| Rate for Payer: NAPHCARE Commercial |
$203.40
|
| Rate for Payer: Preferred Network Access Commercial |
$311.88
|
| Rate for Payer: Quartz Beloit One Network |
$166.11
|
| Rate for Payer: Quartz Commercial |
$220.35
|
| Rate for Payer: Quartz Medicare Advantage |
$203.40
|
| Rate for Payer: The Alliance Commercial |
$1,356.00
|
| Rate for Payer: WEA Trust Commercial |
$186.45
|
| Rate for Payer: WPS Commercial |
$251.10
|
|
|
K-WIRE PARTIALLY THREADED TRILLIANT 0.035 210-24-005
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3784164
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$166.11 |
| Max. Negotiated Rate |
$311.88 |
| Rate for Payer: Aetna Commercial |
$305.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$291.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$179.67
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cigna Commercial |
$311.88
|
| Rate for Payer: Health EOS Commercial |
$301.71
|
| Rate for Payer: HFN Commercial |
$311.88
|
| Rate for Payer: Multiplan Commercial |
$271.20
|
| Rate for Payer: NAPHCARE Commercial |
$203.40
|
| Rate for Payer: Preferred Network Access Commercial |
$311.88
|
| Rate for Payer: Quartz Beloit One Network |
$166.11
|
| Rate for Payer: Quartz Commercial |
$203.40
|
| Rate for Payer: WEA Trust Commercial |
$186.45
|
| Rate for Payer: WPS Commercial |
$251.10
|
|
|
K-WIRE PARTIALLY THREADED TRILLIANT 0.045 210-40-005
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3784165
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$166.11 |
| Max. Negotiated Rate |
$311.88 |
| Rate for Payer: Aetna Commercial |
$305.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$291.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$179.67
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cigna Commercial |
$311.88
|
| Rate for Payer: Health EOS Commercial |
$301.71
|
| Rate for Payer: HFN Commercial |
$311.88
|
| Rate for Payer: Multiplan Commercial |
$271.20
|
| Rate for Payer: NAPHCARE Commercial |
$203.40
|
| Rate for Payer: Preferred Network Access Commercial |
$311.88
|
| Rate for Payer: Quartz Beloit One Network |
$166.11
|
| Rate for Payer: Quartz Commercial |
$203.40
|
| Rate for Payer: WEA Trust Commercial |
$186.45
|
| Rate for Payer: WPS Commercial |
$251.10
|
|
|
K-WIRE PARTIALLY THREADED TRILLIANT 0.045 210-40-005
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3784165
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$94.92 |
| Max. Negotiated Rate |
$1,356.00 |
| Rate for Payer: Aetna Commercial |
$305.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$291.54
|
| Rate for Payer: Aetna Managed Medicare |
$94.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$220.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$169.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$162.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$179.67
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cigna Commercial |
$311.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$189.70
|
| Rate for Payer: Health EOS Commercial |
$301.71
|
| Rate for Payer: HFN Commercial |
$311.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$254.25
|
| Rate for Payer: Multiplan Commercial |
$271.20
|
| Rate for Payer: NAPHCARE Commercial |
$203.40
|
| Rate for Payer: Preferred Network Access Commercial |
$311.88
|
| Rate for Payer: Quartz Beloit One Network |
$166.11
|
| Rate for Payer: Quartz Commercial |
$220.35
|
| Rate for Payer: Quartz Medicare Advantage |
$203.40
|
| Rate for Payer: The Alliance Commercial |
$1,356.00
|
| Rate for Payer: WEA Trust Commercial |
$186.45
|
| Rate for Payer: WPS Commercial |
$251.10
|
|
|
K-WIRE SMOOTH 1.4 X 100MM 45-80200
|
Facility
|
OP
|
$249.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5547408
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$69.72 |
| Max. Negotiated Rate |
$996.00 |
| Rate for Payer: Aetna Commercial |
$224.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$214.14
|
| Rate for Payer: Aetna Managed Medicare |
$69.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$161.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$124.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$119.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$131.97
|
| Rate for Payer: Cash Price |
$74.70
|
| Rate for Payer: Cigna Commercial |
$229.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$139.34
|
| Rate for Payer: Health EOS Commercial |
$221.61
|
| Rate for Payer: HFN Commercial |
$229.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$186.75
|
| Rate for Payer: Multiplan Commercial |
$199.20
|
| Rate for Payer: NAPHCARE Commercial |
$149.40
|
| Rate for Payer: Preferred Network Access Commercial |
$229.08
|
| Rate for Payer: Quartz Beloit One Network |
$122.01
|
| Rate for Payer: Quartz Commercial |
$161.85
|
| Rate for Payer: Quartz Medicare Advantage |
$149.40
|
| Rate for Payer: The Alliance Commercial |
$996.00
|
| Rate for Payer: WEA Trust Commercial |
$136.95
|
| Rate for Payer: WPS Commercial |
$184.43
|
|
|
K-WIRE SMOOTH 1.4 X 100MM 45-80200
|
Facility
|
IP
|
$249.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5547408
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$122.01 |
| Max. Negotiated Rate |
$229.08 |
| Rate for Payer: Aetna Commercial |
$224.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$214.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$131.97
|
| Rate for Payer: Cash Price |
$74.70
|
| Rate for Payer: Cigna Commercial |
$229.08
|
| Rate for Payer: Health EOS Commercial |
$221.61
|
| Rate for Payer: HFN Commercial |
$229.08
|
| Rate for Payer: Multiplan Commercial |
$199.20
|
| Rate for Payer: NAPHCARE Commercial |
$149.40
|
| Rate for Payer: Preferred Network Access Commercial |
$229.08
|
| Rate for Payer: Quartz Beloit One Network |
$122.01
|
| Rate for Payer: Quartz Commercial |
$149.40
|
| Rate for Payer: WEA Trust Commercial |
$136.95
|
| Rate for Payer: WPS Commercial |
$184.43
|
|
|
K-WIRE SMOOTH TH #AW1105
|
Facility
|
IP
|
$427.00
|
|
| Hospital Charge Code |
2964744
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$209.23 |
| Max. Negotiated Rate |
$392.84 |
| Rate for Payer: Aetna Commercial |
$384.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$367.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$226.31
|
| Rate for Payer: Cash Price |
$128.10
|
| Rate for Payer: Cigna Commercial |
$392.84
|
| Rate for Payer: Health EOS Commercial |
$380.03
|
| Rate for Payer: HFN Commercial |
$392.84
|
| Rate for Payer: Multiplan Commercial |
$341.60
|
| Rate for Payer: NAPHCARE Commercial |
$256.20
|
| Rate for Payer: Preferred Network Access Commercial |
$392.84
|
| Rate for Payer: Quartz Beloit One Network |
$209.23
|
| Rate for Payer: Quartz Commercial |
$256.20
|
| Rate for Payer: WEA Trust Commercial |
$234.85
|
| Rate for Payer: WPS Commercial |
$316.28
|
|
|
K-WIRE SMOOTH TH #AW1105
|
Facility
|
OP
|
$427.00
|
|
| Hospital Charge Code |
2964744
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$119.56 |
| Max. Negotiated Rate |
$1,708.00 |
| Rate for Payer: Aetna Commercial |
$384.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$367.22
|
| Rate for Payer: Aetna Managed Medicare |
$119.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$277.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$213.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$204.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$226.31
|
| Rate for Payer: Cash Price |
$128.10
|
| Rate for Payer: Cigna Commercial |
$392.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$238.95
|
| Rate for Payer: Health EOS Commercial |
$380.03
|
| Rate for Payer: HFN Commercial |
$392.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$320.25
|
| Rate for Payer: Multiplan Commercial |
$341.60
|
| Rate for Payer: NAPHCARE Commercial |
$256.20
|
| Rate for Payer: Preferred Network Access Commercial |
$392.84
|
| Rate for Payer: Quartz Beloit One Network |
$209.23
|
| Rate for Payer: Quartz Commercial |
$277.55
|
| Rate for Payer: Quartz Medicare Advantage |
$256.20
|
| Rate for Payer: The Alliance Commercial |
$1,708.00
|
| Rate for Payer: WEA Trust Commercial |
$234.85
|
| Rate for Payer: WPS Commercial |
$316.28
|
|
|
K-WIRE TIGER .035 DBL-END 210-24-006
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3133496
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$98.00 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: Aetna Commercial |
$315.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$301.00
|
| Rate for Payer: Aetna Managed Medicare |
$98.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$227.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$175.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$168.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$185.50
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$322.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$195.86
|
| Rate for Payer: Health EOS Commercial |
$311.50
|
| Rate for Payer: HFN Commercial |
$322.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$262.50
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: NAPHCARE Commercial |
$210.00
|
| Rate for Payer: Preferred Network Access Commercial |
$322.00
|
| Rate for Payer: Quartz Beloit One Network |
$171.50
|
| Rate for Payer: Quartz Commercial |
$227.50
|
| Rate for Payer: Quartz Medicare Advantage |
$210.00
|
| Rate for Payer: The Alliance Commercial |
$1,400.00
|
| Rate for Payer: WEA Trust Commercial |
$192.50
|
| Rate for Payer: WPS Commercial |
$259.24
|
|
|
K-WIRE TIGER .035 DBL-END 210-24-006
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3133496
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$171.50 |
| Max. Negotiated Rate |
$322.00 |
| Rate for Payer: Aetna Commercial |
$315.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$301.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$185.50
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$322.00
|
| Rate for Payer: Health EOS Commercial |
$311.50
|
| Rate for Payer: HFN Commercial |
$322.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: NAPHCARE Commercial |
$210.00
|
| Rate for Payer: Preferred Network Access Commercial |
$322.00
|
| Rate for Payer: Quartz Beloit One Network |
$171.50
|
| Rate for Payer: Quartz Commercial |
$210.00
|
| Rate for Payer: WEA Trust Commercial |
$192.50
|
| Rate for Payer: WPS Commercial |
$259.24
|
|
|
K-WIRE TRILLIANT 0.035 STANDARD 210-24-004
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2969382
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$98.00 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: Aetna Commercial |
$315.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$301.00
|
| Rate for Payer: Aetna Managed Medicare |
$98.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$227.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$175.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$168.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$185.50
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$322.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$195.86
|
| Rate for Payer: Health EOS Commercial |
$311.50
|
| Rate for Payer: HFN Commercial |
$322.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$262.50
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: NAPHCARE Commercial |
$210.00
|
| Rate for Payer: Preferred Network Access Commercial |
$322.00
|
| Rate for Payer: Quartz Beloit One Network |
$171.50
|
| Rate for Payer: Quartz Commercial |
$227.50
|
| Rate for Payer: Quartz Medicare Advantage |
$210.00
|
| Rate for Payer: The Alliance Commercial |
$1,400.00
|
| Rate for Payer: WEA Trust Commercial |
$192.50
|
| Rate for Payer: WPS Commercial |
$259.24
|
|
|
K-WIRE TRILLIANT 0.035 STANDARD 210-24-004
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2969382
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$171.50 |
| Max. Negotiated Rate |
$322.00 |
| Rate for Payer: Aetna Commercial |
$315.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$301.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$185.50
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$322.00
|
| Rate for Payer: Health EOS Commercial |
$311.50
|
| Rate for Payer: HFN Commercial |
$322.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: NAPHCARE Commercial |
$210.00
|
| Rate for Payer: Preferred Network Access Commercial |
$322.00
|
| Rate for Payer: Quartz Beloit One Network |
$171.50
|
| Rate for Payer: Quartz Commercial |
$210.00
|
| Rate for Payer: WEA Trust Commercial |
$192.50
|
| Rate for Payer: WPS Commercial |
$259.24
|
|
|
K-WIRE TRILLIANT 0.045 STANDARD 210-40-004
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3225471
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$98.00 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: Aetna Commercial |
$315.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$301.00
|
| Rate for Payer: Aetna Managed Medicare |
$98.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$227.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$175.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$168.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$185.50
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$322.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$195.86
|
| Rate for Payer: Health EOS Commercial |
$311.50
|
| Rate for Payer: HFN Commercial |
$322.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$262.50
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: NAPHCARE Commercial |
$210.00
|
| Rate for Payer: Preferred Network Access Commercial |
$322.00
|
| Rate for Payer: Quartz Beloit One Network |
$171.50
|
| Rate for Payer: Quartz Commercial |
$227.50
|
| Rate for Payer: Quartz Medicare Advantage |
$210.00
|
| Rate for Payer: The Alliance Commercial |
$1,400.00
|
| Rate for Payer: WEA Trust Commercial |
$192.50
|
| Rate for Payer: WPS Commercial |
$259.24
|
|
|
K-WIRE TRILLIANT 0.045 STANDARD 210-40-004
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3225471
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$171.50 |
| Max. Negotiated Rate |
$322.00 |
| Rate for Payer: Aetna Commercial |
$315.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$301.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$185.50
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$322.00
|
| Rate for Payer: Health EOS Commercial |
$311.50
|
| Rate for Payer: HFN Commercial |
$322.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: NAPHCARE Commercial |
$210.00
|
| Rate for Payer: Preferred Network Access Commercial |
$322.00
|
| Rate for Payer: Quartz Beloit One Network |
$171.50
|
| Rate for Payer: Quartz Commercial |
$210.00
|
| Rate for Payer: WEA Trust Commercial |
$192.50
|
| Rate for Payer: WPS Commercial |
$259.24
|
|
|
K-WIRE TROCAR POINT 292.18
|
Facility
|
OP
|
$1,750.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2969343
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$490.00 |
| Max. Negotiated Rate |
$7,000.00 |
| Rate for Payer: Aetna Commercial |
$1,575.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,505.00
|
| Rate for Payer: Aetna Managed Medicare |
$490.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,137.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$875.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$840.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$927.50
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$1,610.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$979.30
|
| Rate for Payer: Health EOS Commercial |
$1,557.50
|
| Rate for Payer: HFN Commercial |
$1,610.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,312.50
|
| Rate for Payer: Multiplan Commercial |
$1,400.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,050.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,610.00
|
| Rate for Payer: Quartz Beloit One Network |
$857.50
|
| Rate for Payer: Quartz Commercial |
$1,137.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,050.00
|
| Rate for Payer: The Alliance Commercial |
$7,000.00
|
| Rate for Payer: WEA Trust Commercial |
$962.50
|
| Rate for Payer: WPS Commercial |
$1,296.22
|
|
|
K-WIRE TROCAR POINT 292.18
|
Facility
|
IP
|
$1,750.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2969343
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$857.50 |
| Max. Negotiated Rate |
$1,610.00 |
| Rate for Payer: Aetna Commercial |
$1,575.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,505.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$927.50
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$1,610.00
|
| Rate for Payer: Health EOS Commercial |
$1,557.50
|
| Rate for Payer: HFN Commercial |
$1,610.00
|
| Rate for Payer: Multiplan Commercial |
$1,400.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,050.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,610.00
|
| Rate for Payer: Quartz Beloit One Network |
$857.50
|
| Rate for Payer: Quartz Commercial |
$1,050.00
|
| Rate for Payer: WEA Trust Commercial |
$962.50
|
| Rate for Payer: WPS Commercial |
$1,296.22
|
|
|
K-WIRE TWO STEP 0.054 X6 210-54-006
|
Facility
|
IP
|
$307.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3715510
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$150.43 |
| Max. Negotiated Rate |
$282.44 |
| Rate for Payer: Aetna Commercial |
$276.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$264.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$162.71
|
| Rate for Payer: Cash Price |
$92.10
|
| Rate for Payer: Cigna Commercial |
$282.44
|
| Rate for Payer: Health EOS Commercial |
$273.23
|
| Rate for Payer: HFN Commercial |
$282.44
|
| Rate for Payer: Multiplan Commercial |
$245.60
|
| Rate for Payer: NAPHCARE Commercial |
$184.20
|
| Rate for Payer: Preferred Network Access Commercial |
$282.44
|
| Rate for Payer: Quartz Beloit One Network |
$150.43
|
| Rate for Payer: Quartz Commercial |
$184.20
|
| Rate for Payer: WEA Trust Commercial |
$168.85
|
| Rate for Payer: WPS Commercial |
$227.39
|
|
|
K-WIRE TWO STEP 0.054 X6 210-54-006
|
Facility
|
OP
|
$307.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3715510
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$85.96 |
| Max. Negotiated Rate |
$1,228.00 |
| Rate for Payer: Aetna Commercial |
$276.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$264.02
|
| Rate for Payer: Aetna Managed Medicare |
$85.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$199.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$153.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$147.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$162.71
|
| Rate for Payer: Cash Price |
$92.10
|
| Rate for Payer: Cigna Commercial |
$282.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$171.80
|
| Rate for Payer: Health EOS Commercial |
$273.23
|
| Rate for Payer: HFN Commercial |
$282.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$230.25
|
| Rate for Payer: Multiplan Commercial |
$245.60
|
| Rate for Payer: NAPHCARE Commercial |
$184.20
|
| Rate for Payer: Preferred Network Access Commercial |
$282.44
|
| Rate for Payer: Quartz Beloit One Network |
$150.43
|
| Rate for Payer: Quartz Commercial |
$199.55
|
| Rate for Payer: Quartz Medicare Advantage |
$184.20
|
| Rate for Payer: The Alliance Commercial |
$1,228.00
|
| Rate for Payer: WEA Trust Commercial |
$168.85
|
| Rate for Payer: WPS Commercial |
$227.39
|
|
