|
K-WIRE 1.6MM MFT-040-16
|
Facility
|
OP
|
$376.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4066513
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$109.49 |
| Max. Negotiated Rate |
$359.76 |
| Rate for Payer: Aetna Commercial |
$351.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$336.29
|
| Rate for Payer: Aetna Managed Medicare |
$109.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$254.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$195.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$187.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$207.25
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cigna Commercial |
$359.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$218.83
|
| Rate for Payer: Health EOS Commercial |
$348.03
|
| Rate for Payer: HFN Commercial |
$359.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$293.28
|
| Rate for Payer: Multiplan Commercial |
$312.83
|
| Rate for Payer: NAPHCARE Commercial |
$234.62
|
| Rate for Payer: Preferred Network Access Commercial |
$359.76
|
| Rate for Payer: Quartz Beloit One Network |
$191.61
|
| Rate for Payer: Quartz Commercial |
$254.18
|
| Rate for Payer: Quartz Medicare Advantage |
$234.62
|
| Rate for Payer: The Alliance Commercial |
$195.52
|
| Rate for Payer: WEA Trust Commercial |
$215.07
|
| Rate for Payer: WPS Commercial |
$289.63
|
|
|
K-WIRE 1.6MM MFT-040-16
|
Facility
|
IP
|
$376.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4066513
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$191.61 |
| Max. Negotiated Rate |
$359.76 |
| Rate for Payer: Aetna Commercial |
$351.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$336.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$207.25
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cigna Commercial |
$359.76
|
| Rate for Payer: Health EOS Commercial |
$348.03
|
| Rate for Payer: HFN Commercial |
$359.76
|
| Rate for Payer: Multiplan Commercial |
$312.83
|
| Rate for Payer: Preferred Network Access Commercial |
$359.76
|
| Rate for Payer: Quartz Beloit One Network |
$191.61
|
| Rate for Payer: Quartz Commercial |
$234.62
|
| Rate for Payer: WEA Trust Commercial |
$215.07
|
| Rate for Payer: WPS Commercial |
$289.63
|
|
|
K-WIRE 1.6MM X 100MM SMOOTH TROCAR TIP AGK16100
|
Facility
|
OP
|
$366.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5617674
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$106.58 |
| Max. Negotiated Rate |
$350.19 |
| Rate for Payer: Aetna Commercial |
$342.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$327.35
|
| Rate for Payer: Aetna Managed Medicare |
$106.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$247.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$190.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$182.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$201.74
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Cigna Commercial |
$350.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$213.01
|
| Rate for Payer: Health EOS Commercial |
$338.77
|
| Rate for Payer: HFN Commercial |
$350.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$285.48
|
| Rate for Payer: Multiplan Commercial |
$304.51
|
| Rate for Payer: NAPHCARE Commercial |
$228.38
|
| Rate for Payer: Preferred Network Access Commercial |
$350.19
|
| Rate for Payer: Quartz Beloit One Network |
$186.51
|
| Rate for Payer: Quartz Commercial |
$247.42
|
| Rate for Payer: Quartz Medicare Advantage |
$228.38
|
| Rate for Payer: The Alliance Commercial |
$190.32
|
| Rate for Payer: WEA Trust Commercial |
$209.35
|
| Rate for Payer: WPS Commercial |
$281.93
|
|
|
K-WIRE 1.6MM X 100MM SMOOTH TROCAR TIP AGK16100
|
Facility
|
IP
|
$366.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5617674
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$186.51 |
| Max. Negotiated Rate |
$350.19 |
| Rate for Payer: Aetna Commercial |
$342.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$327.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$201.74
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Cigna Commercial |
$350.19
|
| Rate for Payer: Health EOS Commercial |
$338.77
|
| Rate for Payer: HFN Commercial |
$350.19
|
| Rate for Payer: Multiplan Commercial |
$304.51
|
| Rate for Payer: Preferred Network Access Commercial |
$350.19
|
| Rate for Payer: Quartz Beloit One Network |
$186.51
|
| Rate for Payer: Quartz Commercial |
$228.38
|
| Rate for Payer: WEA Trust Commercial |
$209.35
|
| Rate for Payer: WPS Commercial |
$281.93
|
|
|
K-WIRE 1.6MM X 150MM 390164
|
Facility
|
IP
|
$123.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3939330
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.68 |
| Max. Negotiated Rate |
$117.69 |
| Rate for Payer: Aetna Commercial |
$115.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$67.80
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna Commercial |
$117.69
|
| Rate for Payer: Health EOS Commercial |
$113.85
|
| Rate for Payer: HFN Commercial |
$117.69
|
| Rate for Payer: Multiplan Commercial |
$102.34
|
| Rate for Payer: Preferred Network Access Commercial |
$117.69
|
| Rate for Payer: Quartz Beloit One Network |
$62.68
|
| Rate for Payer: Quartz Commercial |
$76.75
|
| Rate for Payer: WEA Trust Commercial |
$70.36
|
| Rate for Payer: WPS Commercial |
$94.75
|
|
|
K-WIRE 1.6MM X 150MM 390164
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3939330
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.82 |
| Max. Negotiated Rate |
$117.69 |
| Rate for Payer: Aetna Commercial |
$115.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.01
|
| Rate for Payer: Aetna Managed Medicare |
$35.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$83.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$63.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$61.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$67.80
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna Commercial |
$117.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$71.59
|
| Rate for Payer: Health EOS Commercial |
$113.85
|
| Rate for Payer: HFN Commercial |
$117.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$95.94
|
| Rate for Payer: Multiplan Commercial |
$102.34
|
| Rate for Payer: NAPHCARE Commercial |
$76.75
|
| Rate for Payer: Preferred Network Access Commercial |
$117.69
|
| Rate for Payer: Quartz Beloit One Network |
$62.68
|
| Rate for Payer: Quartz Commercial |
$83.15
|
| Rate for Payer: Quartz Medicare Advantage |
$76.75
|
| Rate for Payer: The Alliance Commercial |
$63.96
|
| Rate for Payer: WEA Trust Commercial |
$70.36
|
| Rate for Payer: WPS Commercial |
$94.75
|
|
|
K-WIRE 1.6MM X 150MM SMOOTH TROCAR TIP AGK16150
|
Facility
|
OP
|
$366.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5611635
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$106.58 |
| Max. Negotiated Rate |
$350.19 |
| Rate for Payer: Aetna Commercial |
$342.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$327.35
|
| Rate for Payer: Aetna Managed Medicare |
$106.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$247.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$190.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$182.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$201.74
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Cigna Commercial |
$350.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$213.01
|
| Rate for Payer: Health EOS Commercial |
$338.77
|
| Rate for Payer: HFN Commercial |
$350.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$285.48
|
| Rate for Payer: Multiplan Commercial |
$304.51
|
| Rate for Payer: NAPHCARE Commercial |
$228.38
|
| Rate for Payer: Preferred Network Access Commercial |
$350.19
|
| Rate for Payer: Quartz Beloit One Network |
$186.51
|
| Rate for Payer: Quartz Commercial |
$247.42
|
| Rate for Payer: Quartz Medicare Advantage |
$228.38
|
| Rate for Payer: The Alliance Commercial |
$190.32
|
| Rate for Payer: WEA Trust Commercial |
$209.35
|
| Rate for Payer: WPS Commercial |
$281.93
|
|
|
K-WIRE 1.6MM X 150MM SMOOTH TROCAR TIP AGK16150
|
Facility
|
IP
|
$366.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5611635
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$186.51 |
| Max. Negotiated Rate |
$350.19 |
| Rate for Payer: Aetna Commercial |
$342.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$327.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$201.74
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Cigna Commercial |
$350.19
|
| Rate for Payer: Health EOS Commercial |
$338.77
|
| Rate for Payer: HFN Commercial |
$350.19
|
| Rate for Payer: Multiplan Commercial |
$304.51
|
| Rate for Payer: Preferred Network Access Commercial |
$350.19
|
| Rate for Payer: Quartz Beloit One Network |
$186.51
|
| Rate for Payer: Quartz Commercial |
$228.38
|
| Rate for Payer: WEA Trust Commercial |
$209.35
|
| Rate for Payer: WPS Commercial |
$281.93
|
|
|
K-WIRE 1.6MM X 150MM WITH STOP 705150
|
Facility
|
OP
|
$1,479.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6185016
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$430.68 |
| Max. Negotiated Rate |
$1,415.11 |
| Rate for Payer: Aetna Commercial |
$1,384.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,322.82
|
| Rate for Payer: Aetna Managed Medicare |
$430.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$999.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$769.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$738.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$815.22
|
| Rate for Payer: Cash Price |
$443.70
|
| Rate for Payer: Cigna Commercial |
$1,415.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$860.78
|
| Rate for Payer: Health EOS Commercial |
$1,368.96
|
| Rate for Payer: HFN Commercial |
$1,415.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,153.62
|
| Rate for Payer: Multiplan Commercial |
$1,230.53
|
| Rate for Payer: NAPHCARE Commercial |
$922.90
|
| Rate for Payer: Preferred Network Access Commercial |
$1,415.11
|
| Rate for Payer: Quartz Beloit One Network |
$753.70
|
| Rate for Payer: Quartz Commercial |
$999.80
|
| Rate for Payer: Quartz Medicare Advantage |
$922.90
|
| Rate for Payer: The Alliance Commercial |
$769.08
|
| Rate for Payer: WEA Trust Commercial |
$845.99
|
| Rate for Payer: WPS Commercial |
$1,139.27
|
|
|
K-WIRE 1.6MM X 150MM WITH STOP 705150
|
Facility
|
IP
|
$1,479.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6185016
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$753.70 |
| Max. Negotiated Rate |
$1,415.11 |
| Rate for Payer: Aetna Commercial |
$1,384.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,322.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$815.22
|
| Rate for Payer: Cash Price |
$443.70
|
| Rate for Payer: Cigna Commercial |
$1,415.11
|
| Rate for Payer: Health EOS Commercial |
$1,368.96
|
| Rate for Payer: HFN Commercial |
$1,415.11
|
| Rate for Payer: Multiplan Commercial |
$1,230.53
|
| Rate for Payer: Preferred Network Access Commercial |
$1,415.11
|
| Rate for Payer: Quartz Beloit One Network |
$753.70
|
| Rate for Payer: Quartz Commercial |
$922.90
|
| Rate for Payer: WEA Trust Commercial |
$845.99
|
| Rate for Payer: WPS Commercial |
$1,139.27
|
|
|
K-WIRE 1.6 THREADED TIP 292.708
|
Facility
|
IP
|
$734.00
|
|
| Hospital Charge Code |
2966260
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$374.05 |
| Max. Negotiated Rate |
$702.29 |
| Rate for Payer: Aetna Commercial |
$687.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$656.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$404.58
|
| Rate for Payer: Cash Price |
$220.20
|
| Rate for Payer: Cigna Commercial |
$702.29
|
| Rate for Payer: Health EOS Commercial |
$679.39
|
| Rate for Payer: HFN Commercial |
$702.29
|
| Rate for Payer: Multiplan Commercial |
$610.69
|
| Rate for Payer: Preferred Network Access Commercial |
$702.29
|
| Rate for Payer: Quartz Beloit One Network |
$374.05
|
| Rate for Payer: Quartz Commercial |
$458.02
|
| Rate for Payer: WEA Trust Commercial |
$419.85
|
| Rate for Payer: WPS Commercial |
$565.40
|
|
|
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
|
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 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 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: The Alliance Commercial |
$102.44
|
| 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: 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 1.6 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 1.8
|
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
|
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 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 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
|
|
