|
K-WIRE .035 X 6 SINGLE TROCAR 80-1524"
|
Facility
|
OP
|
$448.00
|
|
| Hospital Charge Code |
4206007
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$130.46 |
| Max. Negotiated Rate |
$428.65 |
| Rate for Payer: Aetna Commercial |
$419.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$400.69
|
| Rate for Payer: Aetna Managed Medicare |
$130.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$302.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$232.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$223.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$246.94
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cigna Commercial |
$428.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$260.74
|
| Rate for Payer: Health EOS Commercial |
$414.67
|
| Rate for Payer: HFN Commercial |
$428.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$349.44
|
| Rate for Payer: Multiplan Commercial |
$372.74
|
| Rate for Payer: NAPHCARE Commercial |
$279.55
|
| Rate for Payer: Preferred Network Access Commercial |
$428.65
|
| Rate for Payer: Quartz Beloit One Network |
$228.30
|
| Rate for Payer: Quartz Commercial |
$302.85
|
| Rate for Payer: Quartz Medicare Advantage |
$279.55
|
| Rate for Payer: The Alliance Commercial |
$232.96
|
| Rate for Payer: WEA Trust Commercial |
$256.26
|
| Rate for Payer: WPS Commercial |
$345.09
|
|
|
K-WIRE 0.60 292.06
|
Facility
|
OP
|
$189.00
|
|
| Hospital Charge Code |
2966610
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.04 |
| Max. Negotiated Rate |
$180.84 |
| Rate for Payer: Aetna Commercial |
$176.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.04
|
| Rate for Payer: Aetna Managed Medicare |
$55.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$127.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$98.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$94.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$104.18
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna Commercial |
$180.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$110.00
|
| Rate for Payer: Health EOS Commercial |
$174.94
|
| Rate for Payer: HFN Commercial |
$180.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$147.42
|
| Rate for Payer: Multiplan Commercial |
$157.25
|
| Rate for Payer: NAPHCARE Commercial |
$117.94
|
| Rate for Payer: Preferred Network Access Commercial |
$180.84
|
| Rate for Payer: Quartz Beloit One Network |
$96.31
|
| Rate for Payer: Quartz Commercial |
$127.76
|
| Rate for Payer: Quartz Medicare Advantage |
$117.94
|
| Rate for Payer: The Alliance Commercial |
$98.28
|
| Rate for Payer: WEA Trust Commercial |
$108.11
|
| Rate for Payer: WPS Commercial |
$145.59
|
|
|
K-WIRE 0.60 292.06
|
Facility
|
IP
|
$189.00
|
|
| Hospital Charge Code |
2966610
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.31 |
| Max. Negotiated Rate |
$180.84 |
| Rate for Payer: Aetna Commercial |
$176.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$104.18
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna Commercial |
$180.84
|
| Rate for Payer: Health EOS Commercial |
$174.94
|
| Rate for Payer: HFN Commercial |
$180.84
|
| Rate for Payer: Multiplan Commercial |
$157.25
|
| Rate for Payer: Preferred Network Access Commercial |
$180.84
|
| Rate for Payer: Quartz Beloit One Network |
$96.31
|
| Rate for Payer: Quartz Commercial |
$117.94
|
| Rate for Payer: WEA Trust Commercial |
$108.11
|
| Rate for Payer: WPS Commercial |
$145.59
|
|
|
K-WIRE .062 X 3 ARTHREX AR-2663"
|
Facility
|
OP
|
$541.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4509011
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$157.54 |
| Max. Negotiated Rate |
$517.63 |
| Rate for Payer: Aetna Commercial |
$506.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$483.87
|
| Rate for Payer: Aetna Managed Medicare |
$157.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$365.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$281.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$270.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$298.20
|
| Rate for Payer: Cash Price |
$162.30
|
| Rate for Payer: Cigna Commercial |
$517.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$314.86
|
| Rate for Payer: Health EOS Commercial |
$500.75
|
| Rate for Payer: HFN Commercial |
$517.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$421.98
|
| Rate for Payer: Multiplan Commercial |
$450.11
|
| Rate for Payer: NAPHCARE Commercial |
$337.58
|
| Rate for Payer: Preferred Network Access Commercial |
$517.63
|
| Rate for Payer: Quartz Beloit One Network |
$275.69
|
| Rate for Payer: Quartz Commercial |
$365.72
|
| Rate for Payer: Quartz Medicare Advantage |
$337.58
|
| Rate for Payer: The Alliance Commercial |
$281.32
|
| Rate for Payer: WEA Trust Commercial |
$309.45
|
| Rate for Payer: WPS Commercial |
$416.73
|
|
|
K-WIRE .062 X 3 ARTHREX AR-2663"
|
Facility
|
IP
|
$541.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4509011
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$275.69 |
| Max. Negotiated Rate |
$517.63 |
| Rate for Payer: Aetna Commercial |
$506.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$483.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$298.20
|
| Rate for Payer: Cash Price |
$162.30
|
| Rate for Payer: Cigna Commercial |
$517.63
|
| Rate for Payer: Health EOS Commercial |
$500.75
|
| Rate for Payer: HFN Commercial |
$517.63
|
| Rate for Payer: Multiplan Commercial |
$450.11
|
| Rate for Payer: Preferred Network Access Commercial |
$517.63
|
| Rate for Payer: Quartz Beloit One Network |
$275.69
|
| Rate for Payer: Quartz Commercial |
$337.58
|
| Rate for Payer: WEA Trust Commercial |
$309.45
|
| Rate for Payer: WPS Commercial |
$416.73
|
|
|
K-WIRE 0.80 X 70MM TROCAR POINT 292.08
|
Facility
|
IP
|
$197.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2966611
|
|
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 0.80 X 70MM TROCAR POINT 292.08
|
Facility
|
OP
|
$197.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2966611
|
|
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 0.86MM X 100MM 45-20015
|
Facility
|
OP
|
$393.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5767634
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$114.44 |
| Max. Negotiated Rate |
$376.02 |
| Rate for Payer: Aetna Commercial |
$367.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$351.50
|
| Rate for Payer: Aetna Managed Medicare |
$114.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$265.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$204.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$196.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$216.62
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Cigna Commercial |
$376.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$228.73
|
| Rate for Payer: Health EOS Commercial |
$363.76
|
| Rate for Payer: HFN Commercial |
$376.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$306.54
|
| Rate for Payer: Multiplan Commercial |
$326.98
|
| Rate for Payer: NAPHCARE Commercial |
$245.23
|
| Rate for Payer: Preferred Network Access Commercial |
$376.02
|
| Rate for Payer: Quartz Beloit One Network |
$200.27
|
| Rate for Payer: Quartz Commercial |
$265.67
|
| Rate for Payer: Quartz Medicare Advantage |
$245.23
|
| Rate for Payer: The Alliance Commercial |
$204.36
|
| Rate for Payer: WEA Trust Commercial |
$224.80
|
| Rate for Payer: WPS Commercial |
$302.73
|
|
|
K-WIRE 0.86MM X 100MM 45-20015
|
Facility
|
IP
|
$393.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5767634
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$200.27 |
| Max. Negotiated Rate |
$376.02 |
| Rate for Payer: Aetna Commercial |
$367.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$351.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$216.62
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Cigna Commercial |
$376.02
|
| Rate for Payer: Health EOS Commercial |
$363.76
|
| Rate for Payer: HFN Commercial |
$376.02
|
| Rate for Payer: Multiplan Commercial |
$326.98
|
| Rate for Payer: Preferred Network Access Commercial |
$376.02
|
| Rate for Payer: Quartz Beloit One Network |
$200.27
|
| Rate for Payer: Quartz Commercial |
$245.23
|
| Rate for Payer: WEA Trust Commercial |
$224.80
|
| Rate for Payer: WPS Commercial |
$302.73
|
|
|
K-WIRE 0.86MM X 80MM AR-8610KS-25
|
Facility
|
OP
|
$319.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5415859
|
|
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 0.86MM X 80MM AR-8610KS-25
|
Facility
|
IP
|
$319.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5415859
|
|
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 0.90MM STRYKER KN1115
|
Facility
|
IP
|
$687.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5685827
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$350.10 |
| Max. Negotiated Rate |
$657.32 |
| Rate for Payer: Aetna Commercial |
$643.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$614.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$378.67
|
| Rate for Payer: Cash Price |
$206.10
|
| Rate for Payer: Cigna Commercial |
$657.32
|
| Rate for Payer: Health EOS Commercial |
$635.89
|
| Rate for Payer: HFN Commercial |
$657.32
|
| Rate for Payer: Multiplan Commercial |
$571.58
|
| Rate for Payer: Preferred Network Access Commercial |
$657.32
|
| Rate for Payer: Quartz Beloit One Network |
$350.10
|
| Rate for Payer: Quartz Commercial |
$428.69
|
| Rate for Payer: WEA Trust Commercial |
$392.96
|
| Rate for Payer: WPS Commercial |
$529.20
|
|
|
K-WIRE 0.90MM STRYKER KN1115
|
Facility
|
OP
|
$687.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5685827
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$200.05 |
| Max. Negotiated Rate |
$657.32 |
| Rate for Payer: Aetna Commercial |
$643.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$614.45
|
| Rate for Payer: Aetna Managed Medicare |
$200.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$464.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$357.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$342.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$378.67
|
| Rate for Payer: Cash Price |
$206.10
|
| Rate for Payer: Cigna Commercial |
$657.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$399.83
|
| Rate for Payer: Health EOS Commercial |
$635.89
|
| Rate for Payer: HFN Commercial |
$657.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$535.86
|
| Rate for Payer: Multiplan Commercial |
$571.58
|
| Rate for Payer: NAPHCARE Commercial |
$428.69
|
| Rate for Payer: Preferred Network Access Commercial |
$657.32
|
| Rate for Payer: Quartz Beloit One Network |
$350.10
|
| Rate for Payer: Quartz Commercial |
$464.41
|
| Rate for Payer: Quartz Medicare Advantage |
$428.69
|
| Rate for Payer: The Alliance Commercial |
$357.24
|
| Rate for Payer: WEA Trust Commercial |
$392.96
|
| Rate for Payer: WPS Commercial |
$529.20
|
|
|
K-WIRE 0.9 X 150MM BLUNT/TROCAR DSDS1009
|
Facility
|
IP
|
$909.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6182384
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$463.23 |
| Max. Negotiated Rate |
$869.73 |
| Rate for Payer: Aetna Commercial |
$850.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$813.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$501.04
|
| Rate for Payer: Cash Price |
$272.70
|
| Rate for Payer: Cigna Commercial |
$869.73
|
| Rate for Payer: Health EOS Commercial |
$841.37
|
| Rate for Payer: HFN Commercial |
$869.73
|
| Rate for Payer: Multiplan Commercial |
$756.29
|
| Rate for Payer: Preferred Network Access Commercial |
$869.73
|
| Rate for Payer: Quartz Beloit One Network |
$463.23
|
| Rate for Payer: Quartz Commercial |
$567.22
|
| Rate for Payer: WEA Trust Commercial |
$519.95
|
| Rate for Payer: WPS Commercial |
$700.20
|
|
|
K-WIRE 0.9 X 150MM BLUNT/TROCAR DSDS1009
|
Facility
|
OP
|
$909.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6182384
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$264.70 |
| Max. Negotiated Rate |
$869.73 |
| Rate for Payer: Aetna Commercial |
$850.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$813.01
|
| Rate for Payer: Aetna Managed Medicare |
$264.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$614.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$472.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$453.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$501.04
|
| Rate for Payer: Cash Price |
$272.70
|
| Rate for Payer: Cigna Commercial |
$869.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$529.04
|
| Rate for Payer: Health EOS Commercial |
$841.37
|
| Rate for Payer: HFN Commercial |
$869.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$709.02
|
| Rate for Payer: Multiplan Commercial |
$756.29
|
| Rate for Payer: NAPHCARE Commercial |
$567.22
|
| Rate for Payer: Preferred Network Access Commercial |
$869.73
|
| Rate for Payer: Quartz Beloit One Network |
$463.23
|
| Rate for Payer: Quartz Commercial |
$614.48
|
| Rate for Payer: Quartz Medicare Advantage |
$567.22
|
| Rate for Payer: The Alliance Commercial |
$472.68
|
| Rate for Payer: WEA Trust Commercial |
$519.95
|
| Rate for Payer: WPS Commercial |
$700.20
|
|
|
K-WIRE 10/10 100MM BLUNT TIP 115101ND
|
Facility
|
OP
|
$714.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5617664
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$207.92 |
| Max. Negotiated Rate |
$683.16 |
| Rate for Payer: Aetna Commercial |
$668.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$638.60
|
| Rate for Payer: Aetna Managed Medicare |
$207.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$482.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$371.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$356.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$393.56
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cigna Commercial |
$683.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$415.55
|
| Rate for Payer: Health EOS Commercial |
$660.88
|
| Rate for Payer: HFN Commercial |
$683.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$556.92
|
| Rate for Payer: Multiplan Commercial |
$594.05
|
| Rate for Payer: NAPHCARE Commercial |
$445.54
|
| Rate for Payer: Preferred Network Access Commercial |
$683.16
|
| Rate for Payer: Quartz Beloit One Network |
$363.85
|
| Rate for Payer: Quartz Commercial |
$482.66
|
| Rate for Payer: Quartz Medicare Advantage |
$445.54
|
| Rate for Payer: The Alliance Commercial |
$371.28
|
| Rate for Payer: WEA Trust Commercial |
$408.41
|
| Rate for Payer: WPS Commercial |
$549.99
|
|
|
K-WIRE 10/10 100MM BLUNT TIP 115101ND
|
Facility
|
IP
|
$714.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5617664
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$363.85 |
| Max. Negotiated Rate |
$683.16 |
| Rate for Payer: Aetna Commercial |
$668.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$638.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$393.56
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cigna Commercial |
$683.16
|
| Rate for Payer: Health EOS Commercial |
$660.88
|
| Rate for Payer: HFN Commercial |
$683.16
|
| Rate for Payer: Multiplan Commercial |
$594.05
|
| Rate for Payer: Preferred Network Access Commercial |
$683.16
|
| Rate for Payer: Quartz Beloit One Network |
$363.85
|
| Rate for Payer: Quartz Commercial |
$445.54
|
| Rate for Payer: WEA Trust Commercial |
$408.41
|
| Rate for Payer: WPS Commercial |
$549.99
|
|
|
K-WIRE 1.0MM X 100MM TROCAR TIP AGK10100
|
Facility
|
IP
|
$747.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5685742
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$380.67 |
| Max. Negotiated Rate |
$714.73 |
| Rate for Payer: Aetna Commercial |
$699.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$668.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$411.75
|
| Rate for Payer: Cash Price |
$224.10
|
| Rate for Payer: Cigna Commercial |
$714.73
|
| Rate for Payer: Health EOS Commercial |
$691.42
|
| Rate for Payer: HFN Commercial |
$714.73
|
| Rate for Payer: Multiplan Commercial |
$621.50
|
| Rate for Payer: Preferred Network Access Commercial |
$714.73
|
| Rate for Payer: Quartz Beloit One Network |
$380.67
|
| Rate for Payer: Quartz Commercial |
$466.13
|
| Rate for Payer: WEA Trust Commercial |
$427.28
|
| Rate for Payer: WPS Commercial |
$575.41
|
|
|
K-WIRE 1.0MM X 100MM TROCAR TIP AGK10100
|
Facility
|
OP
|
$747.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5685742
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$217.53 |
| Max. Negotiated Rate |
$714.73 |
| Rate for Payer: Aetna Commercial |
$699.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$668.12
|
| Rate for Payer: Aetna Managed Medicare |
$217.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$504.97
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$388.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$372.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$411.75
|
| Rate for Payer: Cash Price |
$224.10
|
| Rate for Payer: Cigna Commercial |
$714.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$434.75
|
| Rate for Payer: Health EOS Commercial |
$691.42
|
| Rate for Payer: HFN Commercial |
$714.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$582.66
|
| Rate for Payer: Multiplan Commercial |
$621.50
|
| Rate for Payer: NAPHCARE Commercial |
$466.13
|
| Rate for Payer: Preferred Network Access Commercial |
$714.73
|
| Rate for Payer: Quartz Beloit One Network |
$380.67
|
| Rate for Payer: Quartz Commercial |
$504.97
|
| Rate for Payer: Quartz Medicare Advantage |
$466.13
|
| Rate for Payer: The Alliance Commercial |
$388.44
|
| Rate for Payer: WEA Trust Commercial |
$427.28
|
| Rate for Payer: WPS Commercial |
$575.41
|
|
|
K-WIRE 1.0MM X 120MM AR-8610K-30
|
Facility
|
IP
|
$319.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5384923
|
|
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 1.0MM X 120MM AR-8610K-30
|
Facility
|
OP
|
$319.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5384923
|
|
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 1.0MM X 150MM 390142
|
Facility
|
OP
|
$226.00
|
|
| Hospital Charge Code |
5349476
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$65.81 |
| Max. Negotiated Rate |
$216.24 |
| Rate for Payer: Aetna Commercial |
$211.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$202.13
|
| Rate for Payer: Aetna Managed Medicare |
$65.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$152.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$117.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$112.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$124.57
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cigna Commercial |
$216.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$131.53
|
| Rate for Payer: Health EOS Commercial |
$209.19
|
| Rate for Payer: HFN Commercial |
$216.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$176.28
|
| Rate for Payer: Multiplan Commercial |
$188.03
|
| Rate for Payer: NAPHCARE Commercial |
$141.02
|
| Rate for Payer: Preferred Network Access Commercial |
$216.24
|
| Rate for Payer: Quartz Beloit One Network |
$115.17
|
| Rate for Payer: Quartz Commercial |
$152.78
|
| Rate for Payer: Quartz Medicare Advantage |
$141.02
|
| Rate for Payer: The Alliance Commercial |
$117.52
|
| Rate for Payer: WEA Trust Commercial |
$129.27
|
| Rate for Payer: WPS Commercial |
$174.09
|
|
|
K-WIRE 1.0MM X 150MM 390142
|
Facility
|
IP
|
$226.00
|
|
| Hospital Charge Code |
5349476
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$115.17 |
| Max. Negotiated Rate |
$216.24 |
| Rate for Payer: Aetna Commercial |
$211.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$202.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$124.57
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cigna Commercial |
$216.24
|
| Rate for Payer: Health EOS Commercial |
$209.19
|
| Rate for Payer: HFN Commercial |
$216.24
|
| Rate for Payer: Multiplan Commercial |
$188.03
|
| Rate for Payer: Preferred Network Access Commercial |
$216.24
|
| Rate for Payer: Quartz Beloit One Network |
$115.17
|
| Rate for Payer: Quartz Commercial |
$141.02
|
| Rate for Payer: WEA Trust Commercial |
$129.27
|
| Rate for Payer: WPS Commercial |
$174.09
|
|
|
K-WIRE 1.0MM X 70MM 115070ND
|
Facility
|
IP
|
$714.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5627644
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$363.85 |
| Max. Negotiated Rate |
$683.16 |
| Rate for Payer: Aetna Commercial |
$668.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$638.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$393.56
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cigna Commercial |
$683.16
|
| Rate for Payer: Health EOS Commercial |
$660.88
|
| Rate for Payer: HFN Commercial |
$683.16
|
| Rate for Payer: Multiplan Commercial |
$594.05
|
| Rate for Payer: Preferred Network Access Commercial |
$683.16
|
| Rate for Payer: Quartz Beloit One Network |
$363.85
|
| Rate for Payer: Quartz Commercial |
$445.54
|
| Rate for Payer: WEA Trust Commercial |
$408.41
|
| Rate for Payer: WPS Commercial |
$549.99
|
|
|
K-WIRE 1.0MM X 70MM 115070ND
|
Facility
|
OP
|
$714.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5627644
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$207.92 |
| Max. Negotiated Rate |
$683.16 |
| Rate for Payer: Aetna Commercial |
$668.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$638.60
|
| Rate for Payer: Aetna Managed Medicare |
$207.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$482.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$371.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$356.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$393.56
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cigna Commercial |
$683.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$415.55
|
| Rate for Payer: Health EOS Commercial |
$660.88
|
| Rate for Payer: HFN Commercial |
$683.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$556.92
|
| Rate for Payer: Multiplan Commercial |
$594.05
|
| Rate for Payer: NAPHCARE Commercial |
$445.54
|
| Rate for Payer: Preferred Network Access Commercial |
$683.16
|
| Rate for Payer: Quartz Beloit One Network |
$363.85
|
| Rate for Payer: Quartz Commercial |
$482.66
|
| Rate for Payer: Quartz Medicare Advantage |
$445.54
|
| Rate for Payer: The Alliance Commercial |
$371.28
|
| Rate for Payer: WEA Trust Commercial |
$408.41
|
| Rate for Payer: WPS Commercial |
$549.99
|
|
