|
Wire .014 Asato X5 300CM
|
Facility
|
OP
|
$2,396.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4528621
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$670.88 |
| Max. Negotiated Rate |
$9,584.00 |
| Rate for Payer: Aetna Commercial |
$2,156.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,060.56
|
| Rate for Payer: Aetna Managed Medicare |
$670.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,557.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,198.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,150.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,269.88
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cigna Commercial |
$2,204.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,340.80
|
| Rate for Payer: Health EOS Commercial |
$2,132.44
|
| Rate for Payer: HFN Commercial |
$2,204.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,797.00
|
| Rate for Payer: Multiplan Commercial |
$1,916.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,437.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,204.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,174.04
|
| Rate for Payer: Quartz Commercial |
$1,557.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,437.60
|
| Rate for Payer: The Alliance Commercial |
$9,584.00
|
| Rate for Payer: WEA Trust Commercial |
$1,317.80
|
| Rate for Payer: WPS Commercial |
$1,774.72
|
|
|
Wire .014 Asato X5 300CM
|
Facility
|
IP
|
$2,396.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4528621
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,174.04 |
| Max. Negotiated Rate |
$2,204.32 |
| Rate for Payer: Aetna Commercial |
$2,156.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,060.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,269.88
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cigna Commercial |
$2,204.32
|
| Rate for Payer: Health EOS Commercial |
$2,132.44
|
| Rate for Payer: HFN Commercial |
$2,204.32
|
| Rate for Payer: Multiplan Commercial |
$1,916.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,437.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,204.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,174.04
|
| Rate for Payer: Quartz Commercial |
$1,437.60
|
| Rate for Payer: WEA Trust Commercial |
$1,317.80
|
| Rate for Payer: WPS Commercial |
$1,774.72
|
|
|
WIRE .035 3MM JFC 260CM
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3645491
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$77.28 |
| Max. Negotiated Rate |
$1,104.00 |
| Rate for Payer: Aetna Commercial |
$248.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.36
|
| Rate for Payer: Aetna Managed Medicare |
$77.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$179.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$138.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$132.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.28
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$253.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$154.45
|
| Rate for Payer: Health EOS Commercial |
$245.64
|
| Rate for Payer: HFN Commercial |
$253.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$207.00
|
| Rate for Payer: Multiplan Commercial |
$220.80
|
| Rate for Payer: NAPHCARE Commercial |
$165.60
|
| Rate for Payer: Preferred Network Access Commercial |
$253.92
|
| Rate for Payer: Quartz Beloit One Network |
$135.24
|
| Rate for Payer: Quartz Commercial |
$179.40
|
| Rate for Payer: Quartz Medicare Advantage |
$165.60
|
| Rate for Payer: The Alliance Commercial |
$1,104.00
|
| Rate for Payer: WEA Trust Commercial |
$151.80
|
| Rate for Payer: WPS Commercial |
$204.43
|
|
|
WIRE .035 3MM JFC 260CM
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3645491
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$135.24 |
| Max. Negotiated Rate |
$253.92 |
| Rate for Payer: Aetna Commercial |
$248.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.28
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$253.92
|
| Rate for Payer: Health EOS Commercial |
$245.64
|
| Rate for Payer: HFN Commercial |
$253.92
|
| Rate for Payer: Multiplan Commercial |
$220.80
|
| Rate for Payer: NAPHCARE Commercial |
$165.60
|
| Rate for Payer: Preferred Network Access Commercial |
$253.92
|
| Rate for Payer: Quartz Beloit One Network |
$135.24
|
| Rate for Payer: Quartz Commercial |
$165.60
|
| Rate for Payer: WEA Trust Commercial |
$151.80
|
| Rate for Payer: WPS Commercial |
$204.43
|
|
|
WIRE 1.25 PLATE REDUCTION WITH LG STOP 02.111.501.10
|
Facility
|
OP
|
$2,684.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2969453
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$751.52 |
| Max. Negotiated Rate |
$10,736.00 |
| Rate for Payer: Aetna Commercial |
$2,415.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,308.24
|
| Rate for Payer: Aetna Managed Medicare |
$751.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,744.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,342.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,288.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,422.52
|
| Rate for Payer: Cash Price |
$805.20
|
| Rate for Payer: Cigna Commercial |
$2,469.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,501.97
|
| Rate for Payer: Health EOS Commercial |
$2,388.76
|
| Rate for Payer: HFN Commercial |
$2,469.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,013.00
|
| Rate for Payer: Multiplan Commercial |
$2,147.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,610.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,469.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,315.16
|
| Rate for Payer: Quartz Commercial |
$1,744.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,610.40
|
| Rate for Payer: The Alliance Commercial |
$10,736.00
|
| Rate for Payer: WEA Trust Commercial |
$1,476.20
|
| Rate for Payer: WPS Commercial |
$1,988.04
|
|
|
WIRE 1.25 PLATE REDUCTION WITH LG STOP 02.111.501.10
|
Facility
|
IP
|
$2,684.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2969453
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,315.16 |
| Max. Negotiated Rate |
$2,469.28 |
| Rate for Payer: Aetna Commercial |
$2,415.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,308.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,422.52
|
| Rate for Payer: Cash Price |
$805.20
|
| Rate for Payer: Cigna Commercial |
$2,469.28
|
| Rate for Payer: Health EOS Commercial |
$2,388.76
|
| Rate for Payer: HFN Commercial |
$2,469.28
|
| Rate for Payer: Multiplan Commercial |
$2,147.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,610.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,469.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,315.16
|
| Rate for Payer: Quartz Commercial |
$1,610.40
|
| Rate for Payer: WEA Trust Commercial |
$1,476.20
|
| Rate for Payer: WPS Commercial |
$1,988.04
|
|
|
WIRE 1.25 PLATE REDUCTION WITH SM STOP 02.111.500.10
|
Facility
|
OP
|
$2,684.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2969452
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$751.52 |
| Max. Negotiated Rate |
$10,736.00 |
| Rate for Payer: Aetna Commercial |
$2,415.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,308.24
|
| Rate for Payer: Aetna Managed Medicare |
$751.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,744.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,342.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,288.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,422.52
|
| Rate for Payer: Cash Price |
$805.20
|
| Rate for Payer: Cigna Commercial |
$2,469.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,501.97
|
| Rate for Payer: Health EOS Commercial |
$2,388.76
|
| Rate for Payer: HFN Commercial |
$2,469.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,013.00
|
| Rate for Payer: Multiplan Commercial |
$2,147.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,610.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,469.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,315.16
|
| Rate for Payer: Quartz Commercial |
$1,744.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,610.40
|
| Rate for Payer: The Alliance Commercial |
$10,736.00
|
| Rate for Payer: WEA Trust Commercial |
$1,476.20
|
| Rate for Payer: WPS Commercial |
$1,988.04
|
|
|
WIRE 1.25 PLATE REDUCTION WITH SM STOP 02.111.500.10
|
Facility
|
IP
|
$2,684.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2969452
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,315.16 |
| Max. Negotiated Rate |
$2,469.28 |
| Rate for Payer: Aetna Commercial |
$2,415.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,308.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,422.52
|
| Rate for Payer: Cash Price |
$805.20
|
| Rate for Payer: Cigna Commercial |
$2,469.28
|
| Rate for Payer: Health EOS Commercial |
$2,388.76
|
| Rate for Payer: HFN Commercial |
$2,469.28
|
| Rate for Payer: Multiplan Commercial |
$2,147.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,610.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,469.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,315.16
|
| Rate for Payer: Quartz Commercial |
$1,610.40
|
| Rate for Payer: WEA Trust Commercial |
$1,476.20
|
| Rate for Payer: WPS Commercial |
$1,988.04
|
|
|
WIRE 1.25x150 PLATE REDUCTION
|
Facility
|
OP
|
$2,897.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2966592
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$811.16 |
| Max. Negotiated Rate |
$11,588.00 |
| Rate for Payer: Aetna Commercial |
$2,607.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,491.42
|
| Rate for Payer: Aetna Managed Medicare |
$811.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,883.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,448.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,390.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,535.41
|
| Rate for Payer: Cash Price |
$869.10
|
| Rate for Payer: Cigna Commercial |
$2,665.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,621.16
|
| Rate for Payer: Health EOS Commercial |
$2,578.33
|
| Rate for Payer: HFN Commercial |
$2,665.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,172.75
|
| Rate for Payer: Multiplan Commercial |
$2,317.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,738.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,665.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,419.53
|
| Rate for Payer: Quartz Commercial |
$1,883.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,738.20
|
| Rate for Payer: The Alliance Commercial |
$11,588.00
|
| Rate for Payer: WEA Trust Commercial |
$1,593.35
|
| Rate for Payer: WPS Commercial |
$2,145.81
|
|
|
WIRE 1.25x150 PLATE REDUCTION
|
Facility
|
IP
|
$2,897.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2966592
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,419.53 |
| Max. Negotiated Rate |
$2,665.24 |
| Rate for Payer: Aetna Commercial |
$2,607.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,491.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,535.41
|
| Rate for Payer: Cash Price |
$869.10
|
| Rate for Payer: Cigna Commercial |
$2,665.24
|
| Rate for Payer: Health EOS Commercial |
$2,578.33
|
| Rate for Payer: HFN Commercial |
$2,665.24
|
| Rate for Payer: Multiplan Commercial |
$2,317.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,738.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,665.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,419.53
|
| Rate for Payer: Quartz Commercial |
$1,738.20
|
| Rate for Payer: WEA Trust Commercial |
$1,593.35
|
| Rate for Payer: WPS Commercial |
$2,145.81
|
|
|
WIRE 1.6 COMPRESSION 15MM THREAD 03.211.415
|
Facility
|
IP
|
$1,016.00
|
|
| Hospital Charge Code |
2966593
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$497.84 |
| Max. Negotiated Rate |
$934.72 |
| Rate for Payer: Aetna Commercial |
$914.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$873.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$538.48
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cigna Commercial |
$934.72
|
| Rate for Payer: Health EOS Commercial |
$904.24
|
| Rate for Payer: HFN Commercial |
$934.72
|
| Rate for Payer: Multiplan Commercial |
$812.80
|
| Rate for Payer: NAPHCARE Commercial |
$609.60
|
| Rate for Payer: Preferred Network Access Commercial |
$934.72
|
| Rate for Payer: Quartz Beloit One Network |
$497.84
|
| Rate for Payer: Quartz Commercial |
$609.60
|
| Rate for Payer: WEA Trust Commercial |
$558.80
|
| Rate for Payer: WPS Commercial |
$752.55
|
|
|
WIRE 1.6 COMPRESSION 15MM THREAD 03.211.415
|
Facility
|
OP
|
$1,016.00
|
|
| Hospital Charge Code |
2966593
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$284.48 |
| Max. Negotiated Rate |
$4,064.00 |
| Rate for Payer: Aetna Commercial |
$914.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$873.76
|
| Rate for Payer: Aetna Managed Medicare |
$284.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$660.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$508.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$487.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$538.48
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cigna Commercial |
$934.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$568.55
|
| Rate for Payer: Health EOS Commercial |
$904.24
|
| Rate for Payer: HFN Commercial |
$934.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$762.00
|
| Rate for Payer: Multiplan Commercial |
$812.80
|
| Rate for Payer: NAPHCARE Commercial |
$609.60
|
| Rate for Payer: Preferred Network Access Commercial |
$934.72
|
| Rate for Payer: Quartz Beloit One Network |
$497.84
|
| Rate for Payer: Quartz Commercial |
$660.40
|
| Rate for Payer: Quartz Medicare Advantage |
$609.60
|
| Rate for Payer: The Alliance Commercial |
$4,064.00
|
| Rate for Payer: WEA Trust Commercial |
$558.80
|
| Rate for Payer: WPS Commercial |
$752.55
|
|
|
WIRE 1.6 COMPRESSION 20MM THREAD 03.211.420
|
Facility
|
OP
|
$1,016.00
|
|
| Hospital Charge Code |
2966595
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$284.48 |
| Max. Negotiated Rate |
$4,064.00 |
| Rate for Payer: Aetna Commercial |
$914.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$873.76
|
| Rate for Payer: Aetna Managed Medicare |
$284.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$660.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$508.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$487.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$538.48
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cigna Commercial |
$934.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$568.55
|
| Rate for Payer: Health EOS Commercial |
$904.24
|
| Rate for Payer: HFN Commercial |
$934.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$762.00
|
| Rate for Payer: Multiplan Commercial |
$812.80
|
| Rate for Payer: NAPHCARE Commercial |
$609.60
|
| Rate for Payer: Preferred Network Access Commercial |
$934.72
|
| Rate for Payer: Quartz Beloit One Network |
$497.84
|
| Rate for Payer: Quartz Commercial |
$660.40
|
| Rate for Payer: Quartz Medicare Advantage |
$609.60
|
| Rate for Payer: The Alliance Commercial |
$4,064.00
|
| Rate for Payer: WEA Trust Commercial |
$558.80
|
| Rate for Payer: WPS Commercial |
$752.55
|
|
|
WIRE 1.6 COMPRESSION 20MM THREAD 03.211.420
|
Facility
|
IP
|
$1,016.00
|
|
| Hospital Charge Code |
2966595
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$497.84 |
| Max. Negotiated Rate |
$934.72 |
| Rate for Payer: Aetna Commercial |
$914.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$873.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$538.48
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cigna Commercial |
$934.72
|
| Rate for Payer: Health EOS Commercial |
$904.24
|
| Rate for Payer: HFN Commercial |
$934.72
|
| Rate for Payer: Multiplan Commercial |
$812.80
|
| Rate for Payer: NAPHCARE Commercial |
$609.60
|
| Rate for Payer: Preferred Network Access Commercial |
$934.72
|
| Rate for Payer: Quartz Beloit One Network |
$497.84
|
| Rate for Payer: Quartz Commercial |
$609.60
|
| Rate for Payer: WEA Trust Commercial |
$558.80
|
| Rate for Payer: WPS Commercial |
$752.55
|
|
|
WIRE 18 GA SURGICAL STEEL SZ 6 ETHI-PACK PRE-CUT 18 IN DS18
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6174855
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$43.96 |
| Max. Negotiated Rate |
$628.00 |
| Rate for Payer: Aetna Commercial |
$141.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.02
|
| Rate for Payer: Aetna Managed Medicare |
$43.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$102.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$78.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$75.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.21
|
| Rate for Payer: Cash Price |
$47.10
|
| Rate for Payer: Cigna Commercial |
$144.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$87.86
|
| Rate for Payer: Health EOS Commercial |
$139.73
|
| Rate for Payer: HFN Commercial |
$144.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$117.75
|
| Rate for Payer: Multiplan Commercial |
$125.60
|
| Rate for Payer: NAPHCARE Commercial |
$94.20
|
| Rate for Payer: Preferred Network Access Commercial |
$144.44
|
| Rate for Payer: Quartz Beloit One Network |
$76.93
|
| Rate for Payer: Quartz Commercial |
$102.05
|
| Rate for Payer: Quartz Medicare Advantage |
$94.20
|
| Rate for Payer: The Alliance Commercial |
$628.00
|
| Rate for Payer: WEA Trust Commercial |
$86.35
|
| Rate for Payer: WPS Commercial |
$116.29
|
|
|
WIRE 18 GA SURGICAL STEEL SZ 6 ETHI-PACK PRE-CUT 18 IN DS18
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6174855
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$76.93 |
| Max. Negotiated Rate |
$144.44 |
| Rate for Payer: Aetna Commercial |
$141.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.21
|
| Rate for Payer: Cash Price |
$47.10
|
| Rate for Payer: Cigna Commercial |
$144.44
|
| Rate for Payer: Health EOS Commercial |
$139.73
|
| Rate for Payer: HFN Commercial |
$144.44
|
| Rate for Payer: Multiplan Commercial |
$125.60
|
| Rate for Payer: NAPHCARE Commercial |
$94.20
|
| Rate for Payer: Preferred Network Access Commercial |
$144.44
|
| Rate for Payer: Quartz Beloit One Network |
$76.93
|
| Rate for Payer: Quartz Commercial |
$94.20
|
| Rate for Payer: WEA Trust Commercial |
$86.35
|
| Rate for Payer: WPS Commercial |
$116.29
|
|
|
WIRE 20 GA SURGICAL STEEL SZ 5 ETHI-PACK PRE-CUT 18 IN DS20
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6174854
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$72.52 |
| Max. Negotiated Rate |
$136.16 |
| Rate for Payer: Aetna Commercial |
$133.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$127.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$78.44
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cigna Commercial |
$136.16
|
| Rate for Payer: Health EOS Commercial |
$131.72
|
| Rate for Payer: HFN Commercial |
$136.16
|
| Rate for Payer: Multiplan Commercial |
$118.40
|
| Rate for Payer: NAPHCARE Commercial |
$88.80
|
| Rate for Payer: Preferred Network Access Commercial |
$136.16
|
| Rate for Payer: Quartz Beloit One Network |
$72.52
|
| Rate for Payer: Quartz Commercial |
$88.80
|
| Rate for Payer: WEA Trust Commercial |
$81.40
|
| Rate for Payer: WPS Commercial |
$109.62
|
|
|
WIRE 20 GA SURGICAL STEEL SZ 5 ETHI-PACK PRE-CUT 18 IN DS20
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6174854
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$41.44 |
| Max. Negotiated Rate |
$592.00 |
| Rate for Payer: Aetna Commercial |
$133.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$127.28
|
| Rate for Payer: Aetna Managed Medicare |
$41.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$96.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$74.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$71.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$78.44
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cigna Commercial |
$136.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$82.82
|
| Rate for Payer: Health EOS Commercial |
$131.72
|
| Rate for Payer: HFN Commercial |
$136.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$111.00
|
| Rate for Payer: Multiplan Commercial |
$118.40
|
| Rate for Payer: NAPHCARE Commercial |
$88.80
|
| Rate for Payer: Preferred Network Access Commercial |
$136.16
|
| Rate for Payer: Quartz Beloit One Network |
$72.52
|
| Rate for Payer: Quartz Commercial |
$96.20
|
| Rate for Payer: Quartz Medicare Advantage |
$88.80
|
| Rate for Payer: The Alliance Commercial |
$592.00
|
| Rate for Payer: WEA Trust Commercial |
$81.40
|
| Rate for Payer: WPS Commercial |
$109.62
|
|
|
WIRE 2.0 SPADE POINT REDUCTION 292.41
|
Facility
|
IP
|
$2,303.00
|
|
| Hospital Charge Code |
2966594
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,128.47 |
| Max. Negotiated Rate |
$2,118.76 |
| Rate for Payer: Aetna Commercial |
$2,072.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,980.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,220.59
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cigna Commercial |
$2,118.76
|
| Rate for Payer: Health EOS Commercial |
$2,049.67
|
| Rate for Payer: HFN Commercial |
$2,118.76
|
| Rate for Payer: Multiplan Commercial |
$1,842.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,381.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,118.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,128.47
|
| Rate for Payer: Quartz Commercial |
$1,381.80
|
| Rate for Payer: WEA Trust Commercial |
$1,266.65
|
| Rate for Payer: WPS Commercial |
$1,705.83
|
|
|
WIRE 2.0 SPADE POINT REDUCTION 292.41
|
Facility
|
OP
|
$2,303.00
|
|
| Hospital Charge Code |
2966594
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$644.84 |
| Max. Negotiated Rate |
$9,212.00 |
| Rate for Payer: Aetna Commercial |
$2,072.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,980.58
|
| Rate for Payer: Aetna Managed Medicare |
$644.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,496.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,151.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,105.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,220.59
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cigna Commercial |
$2,118.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,288.76
|
| Rate for Payer: Health EOS Commercial |
$2,049.67
|
| Rate for Payer: HFN Commercial |
$2,118.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,727.25
|
| Rate for Payer: Multiplan Commercial |
$1,842.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,381.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,118.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,128.47
|
| Rate for Payer: Quartz Commercial |
$1,496.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,381.80
|
| Rate for Payer: The Alliance Commercial |
$9,212.00
|
| Rate for Payer: WEA Trust Commercial |
$1,266.65
|
| Rate for Payer: WPS Commercial |
$1,705.83
|
|
|
WIRE 22 GA SURGICAL STEEL SZ 4 ETHI-PACK PRE-CUT 18 IN DS22
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6174853
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$612.00 |
| Rate for Payer: Aetna Commercial |
$137.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$131.58
|
| Rate for Payer: Aetna Managed Medicare |
$42.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$99.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$76.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$73.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.09
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cigna Commercial |
$140.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$85.62
|
| Rate for Payer: Health EOS Commercial |
$136.17
|
| Rate for Payer: HFN Commercial |
$140.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$114.75
|
| Rate for Payer: Multiplan Commercial |
$122.40
|
| Rate for Payer: NAPHCARE Commercial |
$91.80
|
| Rate for Payer: Preferred Network Access Commercial |
$140.76
|
| Rate for Payer: Quartz Beloit One Network |
$74.97
|
| Rate for Payer: Quartz Commercial |
$99.45
|
| Rate for Payer: Quartz Medicare Advantage |
$91.80
|
| Rate for Payer: The Alliance Commercial |
$612.00
|
| Rate for Payer: WEA Trust Commercial |
$84.15
|
| Rate for Payer: WPS Commercial |
$113.33
|
|
|
WIRE 22 GA SURGICAL STEEL SZ 4 ETHI-PACK PRE-CUT 18 IN DS22
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6174853
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$74.97 |
| Max. Negotiated Rate |
$140.76 |
| Rate for Payer: Aetna Commercial |
$137.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$131.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.09
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cigna Commercial |
$140.76
|
| Rate for Payer: Health EOS Commercial |
$136.17
|
| Rate for Payer: HFN Commercial |
$140.76
|
| Rate for Payer: Multiplan Commercial |
$122.40
|
| Rate for Payer: NAPHCARE Commercial |
$91.80
|
| Rate for Payer: Preferred Network Access Commercial |
$140.76
|
| Rate for Payer: Quartz Beloit One Network |
$74.97
|
| Rate for Payer: Quartz Commercial |
$91.80
|
| Rate for Payer: WEA Trust Commercial |
$84.15
|
| Rate for Payer: WPS Commercial |
$113.33
|
|
|
WIRE 24 GA SURGICAL STEEL SZ 3 ETHI-PACK PRE-CUT 18 IN DS24
|
Facility
|
IP
|
$146.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6174851
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$71.54 |
| Max. Negotiated Rate |
$134.32 |
| Rate for Payer: Aetna Commercial |
$131.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$125.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$77.38
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cigna Commercial |
$134.32
|
| Rate for Payer: Health EOS Commercial |
$129.94
|
| Rate for Payer: HFN Commercial |
$134.32
|
| Rate for Payer: Multiplan Commercial |
$116.80
|
| Rate for Payer: NAPHCARE Commercial |
$87.60
|
| Rate for Payer: Preferred Network Access Commercial |
$134.32
|
| Rate for Payer: Quartz Beloit One Network |
$71.54
|
| Rate for Payer: Quartz Commercial |
$87.60
|
| Rate for Payer: WEA Trust Commercial |
$80.30
|
| Rate for Payer: WPS Commercial |
$108.14
|
|
|
WIRE 24 GA SURGICAL STEEL SZ 3 ETHI-PACK PRE-CUT 18 IN DS24
|
Facility
|
OP
|
$146.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6174851
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$40.88 |
| Max. Negotiated Rate |
$584.00 |
| Rate for Payer: Aetna Commercial |
$131.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$125.56
|
| Rate for Payer: Aetna Managed Medicare |
$40.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$94.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$73.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$70.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$77.38
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cigna Commercial |
$134.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$81.70
|
| Rate for Payer: Health EOS Commercial |
$129.94
|
| Rate for Payer: HFN Commercial |
$134.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$109.50
|
| Rate for Payer: Multiplan Commercial |
$116.80
|
| Rate for Payer: NAPHCARE Commercial |
$87.60
|
| Rate for Payer: Preferred Network Access Commercial |
$134.32
|
| Rate for Payer: Quartz Beloit One Network |
$71.54
|
| Rate for Payer: Quartz Commercial |
$94.90
|
| Rate for Payer: Quartz Medicare Advantage |
$87.60
|
| Rate for Payer: The Alliance Commercial |
$584.00
|
| Rate for Payer: WEA Trust Commercial |
$80.30
|
| Rate for Payer: WPS Commercial |
$108.14
|
|
|
WIRE 5-LEAD DUAL DISP 33135R
|
Facility
|
IP
|
$566.00
|
|
| Hospital Charge Code |
2965831
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$277.34 |
| Max. Negotiated Rate |
$520.72 |
| Rate for Payer: Aetna Commercial |
$509.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$486.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$299.98
|
| Rate for Payer: Cash Price |
$169.80
|
| Rate for Payer: Cigna Commercial |
$520.72
|
| Rate for Payer: Health EOS Commercial |
$503.74
|
| Rate for Payer: HFN Commercial |
$520.72
|
| Rate for Payer: Multiplan Commercial |
$452.80
|
| Rate for Payer: NAPHCARE Commercial |
$339.60
|
| Rate for Payer: Preferred Network Access Commercial |
$520.72
|
| Rate for Payer: Quartz Beloit One Network |
$277.34
|
| Rate for Payer: Quartz Commercial |
$339.60
|
| Rate for Payer: WEA Trust Commercial |
$311.30
|
| Rate for Payer: WPS Commercial |
$419.24
|
|
