|
WIRE 5-LEAD DUAL DISP 33135R
|
Facility
|
OP
|
$566.00
|
|
| Hospital Charge Code |
2965831
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$158.48 |
| Max. Negotiated Rate |
$2,264.00 |
| Rate for Payer: Aetna Commercial |
$509.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$486.76
|
| Rate for Payer: Aetna Managed Medicare |
$158.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$367.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$283.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$271.68
|
| 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: Dean Health DHI/DHP/ASO |
$316.73
|
| Rate for Payer: Health EOS Commercial |
$503.74
|
| Rate for Payer: HFN Commercial |
$520.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$424.50
|
| 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 |
$367.90
|
| Rate for Payer: Quartz Medicare Advantage |
$339.60
|
| Rate for Payer: The Alliance Commercial |
$2,264.00
|
| Rate for Payer: WEA Trust Commercial |
$311.30
|
| Rate for Payer: WPS Commercial |
$419.24
|
|
|
WIRE ADX GUIDEWIRE PTFE 35 X 180CM FC ST BENTSON H7878141351800
|
Facility
|
OP
|
$2,516.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6200983
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$704.48 |
| Max. Negotiated Rate |
$10,064.00 |
| Rate for Payer: Aetna Commercial |
$2,264.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,163.76
|
| Rate for Payer: Aetna Managed Medicare |
$704.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,635.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,258.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,207.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,333.48
|
| Rate for Payer: Cash Price |
$754.80
|
| Rate for Payer: Cigna Commercial |
$2,314.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,407.95
|
| Rate for Payer: Health EOS Commercial |
$2,239.24
|
| Rate for Payer: HFN Commercial |
$2,314.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,887.00
|
| Rate for Payer: Multiplan Commercial |
$2,012.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,509.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,314.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,232.84
|
| Rate for Payer: Quartz Commercial |
$1,635.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,509.60
|
| Rate for Payer: The Alliance Commercial |
$10,064.00
|
| Rate for Payer: WEA Trust Commercial |
$1,383.80
|
| Rate for Payer: WPS Commercial |
$1,863.60
|
|
|
WIRE ADX GUIDEWIRE PTFE 35 X 180CM FC ST BENTSON H7878141351800
|
Facility
|
IP
|
$2,516.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6200983
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,232.84 |
| Max. Negotiated Rate |
$2,314.72 |
| Rate for Payer: Aetna Commercial |
$2,264.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,163.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,333.48
|
| Rate for Payer: Cash Price |
$754.80
|
| Rate for Payer: Cigna Commercial |
$2,314.72
|
| Rate for Payer: Health EOS Commercial |
$2,239.24
|
| Rate for Payer: HFN Commercial |
$2,314.72
|
| Rate for Payer: Multiplan Commercial |
$2,012.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,509.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,314.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,232.84
|
| Rate for Payer: Quartz Commercial |
$1,509.60
|
| Rate for Payer: WEA Trust Commercial |
$1,383.80
|
| Rate for Payer: WPS Commercial |
$1,863.60
|
|
|
WIRE ALL-STAR CROSS-IT J .014
|
Facility
|
IP
|
$1,684.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2972403
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$825.16 |
| Max. Negotiated Rate |
$1,549.28 |
| Rate for Payer: Aetna Commercial |
$1,515.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,448.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$892.52
|
| Rate for Payer: Cash Price |
$505.20
|
| Rate for Payer: Cigna Commercial |
$1,549.28
|
| Rate for Payer: Health EOS Commercial |
$1,498.76
|
| Rate for Payer: HFN Commercial |
$1,549.28
|
| Rate for Payer: Multiplan Commercial |
$1,347.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,010.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,549.28
|
| Rate for Payer: Quartz Beloit One Network |
$825.16
|
| Rate for Payer: Quartz Commercial |
$1,010.40
|
| Rate for Payer: WEA Trust Commercial |
$926.20
|
| Rate for Payer: WPS Commercial |
$1,247.34
|
|
|
WIRE ALL-STAR CROSS-IT J .014
|
Facility
|
OP
|
$1,684.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2972403
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$471.52 |
| Max. Negotiated Rate |
$6,736.00 |
| Rate for Payer: Aetna Commercial |
$1,515.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,448.24
|
| Rate for Payer: Aetna Managed Medicare |
$471.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,094.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$842.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$808.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$892.52
|
| Rate for Payer: Cash Price |
$505.20
|
| Rate for Payer: Cigna Commercial |
$1,549.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$942.37
|
| Rate for Payer: Health EOS Commercial |
$1,498.76
|
| Rate for Payer: HFN Commercial |
$1,549.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,263.00
|
| Rate for Payer: Multiplan Commercial |
$1,347.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,010.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,549.28
|
| Rate for Payer: Quartz Beloit One Network |
$825.16
|
| Rate for Payer: Quartz Commercial |
$1,094.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,010.40
|
| Rate for Payer: The Alliance Commercial |
$6,736.00
|
| Rate for Payer: WEA Trust Commercial |
$926.20
|
| Rate for Payer: WPS Commercial |
$1,247.34
|
|
|
WIRE AMPLATZ .025 180cm
|
Facility
|
OP
|
$511.00
|
|
| Hospital Charge Code |
2971340
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$143.08 |
| Max. Negotiated Rate |
$2,044.00 |
| Rate for Payer: Aetna Commercial |
$459.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$439.46
|
| Rate for Payer: Aetna Managed Medicare |
$143.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$332.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$255.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$245.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$270.83
|
| Rate for Payer: Cash Price |
$153.30
|
| Rate for Payer: Cigna Commercial |
$470.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$285.96
|
| Rate for Payer: Health EOS Commercial |
$454.79
|
| Rate for Payer: HFN Commercial |
$470.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$383.25
|
| Rate for Payer: Multiplan Commercial |
$408.80
|
| Rate for Payer: NAPHCARE Commercial |
$306.60
|
| Rate for Payer: Preferred Network Access Commercial |
$470.12
|
| Rate for Payer: Quartz Beloit One Network |
$250.39
|
| Rate for Payer: Quartz Commercial |
$332.15
|
| Rate for Payer: Quartz Medicare Advantage |
$306.60
|
| Rate for Payer: The Alliance Commercial |
$2,044.00
|
| Rate for Payer: WEA Trust Commercial |
$281.05
|
| Rate for Payer: WPS Commercial |
$378.50
|
|
|
WIRE AMPLATZ .025 180cm
|
Facility
|
IP
|
$511.00
|
|
| Hospital Charge Code |
2971340
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$250.39 |
| Max. Negotiated Rate |
$470.12 |
| Rate for Payer: Aetna Commercial |
$459.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$439.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$270.83
|
| Rate for Payer: Cash Price |
$153.30
|
| Rate for Payer: Cigna Commercial |
$470.12
|
| Rate for Payer: Health EOS Commercial |
$454.79
|
| Rate for Payer: HFN Commercial |
$470.12
|
| Rate for Payer: Multiplan Commercial |
$408.80
|
| Rate for Payer: NAPHCARE Commercial |
$306.60
|
| Rate for Payer: Preferred Network Access Commercial |
$470.12
|
| Rate for Payer: Quartz Beloit One Network |
$250.39
|
| Rate for Payer: Quartz Commercial |
$306.60
|
| Rate for Payer: WEA Trust Commercial |
$281.05
|
| Rate for Payer: WPS Commercial |
$378.50
|
|
|
WIRE BOLT LONG HOFFMANN LIMB 4933-1-003
|
Facility
|
IP
|
$1,276.00
|
|
| Hospital Charge Code |
6001637
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$625.24 |
| Max. Negotiated Rate |
$1,173.92 |
| Rate for Payer: Aetna Commercial |
$1,148.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,097.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$676.28
|
| Rate for Payer: Cash Price |
$382.80
|
| Rate for Payer: Cigna Commercial |
$1,173.92
|
| Rate for Payer: Health EOS Commercial |
$1,135.64
|
| Rate for Payer: HFN Commercial |
$1,173.92
|
| Rate for Payer: Multiplan Commercial |
$1,020.80
|
| Rate for Payer: NAPHCARE Commercial |
$765.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,173.92
|
| Rate for Payer: Quartz Beloit One Network |
$625.24
|
| Rate for Payer: Quartz Commercial |
$765.60
|
| Rate for Payer: WEA Trust Commercial |
$701.80
|
| Rate for Payer: WPS Commercial |
$945.13
|
|
|
WIRE BOLT LONG HOFFMANN LIMB 4933-1-003
|
Facility
|
OP
|
$1,276.00
|
|
| Hospital Charge Code |
6001637
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$357.28 |
| Max. Negotiated Rate |
$5,104.00 |
| Rate for Payer: Aetna Commercial |
$1,148.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,097.36
|
| Rate for Payer: Aetna Managed Medicare |
$357.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$829.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$638.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$612.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$676.28
|
| Rate for Payer: Cash Price |
$382.80
|
| Rate for Payer: Cigna Commercial |
$1,173.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$714.05
|
| Rate for Payer: Health EOS Commercial |
$1,135.64
|
| Rate for Payer: HFN Commercial |
$1,173.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$957.00
|
| Rate for Payer: Multiplan Commercial |
$1,020.80
|
| Rate for Payer: NAPHCARE Commercial |
$765.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,173.92
|
| Rate for Payer: Quartz Beloit One Network |
$625.24
|
| Rate for Payer: Quartz Commercial |
$829.40
|
| Rate for Payer: Quartz Medicare Advantage |
$765.60
|
| Rate for Payer: The Alliance Commercial |
$5,104.00
|
| Rate for Payer: WEA Trust Commercial |
$701.80
|
| Rate for Payer: WPS Commercial |
$945.13
|
|
|
WIRE BOLT MEDIUM HOFFMANN LIMB 4933-1-002
|
Facility
|
OP
|
$1,327.00
|
|
| Hospital Charge Code |
5611673
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$371.56 |
| Max. Negotiated Rate |
$5,308.00 |
| Rate for Payer: Aetna Commercial |
$1,194.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,141.22
|
| Rate for Payer: Aetna Managed Medicare |
$371.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$862.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$663.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$636.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$703.31
|
| Rate for Payer: Cash Price |
$398.10
|
| Rate for Payer: Cigna Commercial |
$1,220.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$742.59
|
| Rate for Payer: Health EOS Commercial |
$1,181.03
|
| Rate for Payer: HFN Commercial |
$1,220.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$995.25
|
| Rate for Payer: Multiplan Commercial |
$1,061.60
|
| Rate for Payer: NAPHCARE Commercial |
$796.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,220.84
|
| Rate for Payer: Quartz Beloit One Network |
$650.23
|
| Rate for Payer: Quartz Commercial |
$862.55
|
| Rate for Payer: Quartz Medicare Advantage |
$796.20
|
| Rate for Payer: The Alliance Commercial |
$5,308.00
|
| Rate for Payer: WEA Trust Commercial |
$729.85
|
| Rate for Payer: WPS Commercial |
$982.91
|
|
|
WIRE BOLT MEDIUM HOFFMANN LIMB 4933-1-002
|
Facility
|
IP
|
$1,327.00
|
|
| Hospital Charge Code |
5611673
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$650.23 |
| Max. Negotiated Rate |
$1,220.84 |
| Rate for Payer: Aetna Commercial |
$1,194.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,141.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$703.31
|
| Rate for Payer: Cash Price |
$398.10
|
| Rate for Payer: Cigna Commercial |
$1,220.84
|
| Rate for Payer: Health EOS Commercial |
$1,181.03
|
| Rate for Payer: HFN Commercial |
$1,220.84
|
| Rate for Payer: Multiplan Commercial |
$1,061.60
|
| Rate for Payer: NAPHCARE Commercial |
$796.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,220.84
|
| Rate for Payer: Quartz Beloit One Network |
$650.23
|
| Rate for Payer: Quartz Commercial |
$796.20
|
| Rate for Payer: WEA Trust Commercial |
$729.85
|
| Rate for Payer: WPS Commercial |
$982.91
|
|
|
WIRE BOLT SHORT HOFFMANN LIMB 4933-1-001
|
Facility
|
OP
|
$1,380.00
|
|
| Hospital Charge Code |
5599704
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$386.40 |
| Max. Negotiated Rate |
$5,520.00 |
| Rate for Payer: Aetna Commercial |
$1,242.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,186.80
|
| Rate for Payer: Aetna Managed Medicare |
$386.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$897.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$690.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$662.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$731.40
|
| Rate for Payer: Cash Price |
$414.00
|
| Rate for Payer: Cigna Commercial |
$1,269.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$772.25
|
| Rate for Payer: Health EOS Commercial |
$1,228.20
|
| Rate for Payer: HFN Commercial |
$1,269.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,035.00
|
| Rate for Payer: Multiplan Commercial |
$1,104.00
|
| Rate for Payer: NAPHCARE Commercial |
$828.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,269.60
|
| Rate for Payer: Quartz Beloit One Network |
$676.20
|
| Rate for Payer: Quartz Commercial |
$897.00
|
| Rate for Payer: Quartz Medicare Advantage |
$828.00
|
| Rate for Payer: The Alliance Commercial |
$5,520.00
|
| Rate for Payer: WEA Trust Commercial |
$759.00
|
| Rate for Payer: WPS Commercial |
$1,022.17
|
|
|
WIRE BOLT SHORT HOFFMANN LIMB 4933-1-001
|
Facility
|
IP
|
$1,380.00
|
|
| Hospital Charge Code |
5599704
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$676.20 |
| Max. Negotiated Rate |
$1,269.60 |
| Rate for Payer: Aetna Commercial |
$1,242.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,186.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$731.40
|
| Rate for Payer: Cash Price |
$414.00
|
| Rate for Payer: Cigna Commercial |
$1,269.60
|
| Rate for Payer: Health EOS Commercial |
$1,228.20
|
| Rate for Payer: HFN Commercial |
$1,269.60
|
| Rate for Payer: Multiplan Commercial |
$1,104.00
|
| Rate for Payer: NAPHCARE Commercial |
$828.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,269.60
|
| Rate for Payer: Quartz Beloit One Network |
$676.20
|
| Rate for Payer: Quartz Commercial |
$828.00
|
| Rate for Payer: WEA Trust Commercial |
$759.00
|
| Rate for Payer: WPS Commercial |
$1,022.17
|
|
|
WIRE CHOICE PT .014 300CM 12154-01J
|
Facility
|
IP
|
$2,578.00
|
|
| Hospital Charge Code |
3072559
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,263.22 |
| Max. Negotiated Rate |
$2,371.76 |
| Rate for Payer: Aetna Commercial |
$2,320.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,217.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,366.34
|
| Rate for Payer: Cash Price |
$773.40
|
| Rate for Payer: Cigna Commercial |
$2,371.76
|
| Rate for Payer: Health EOS Commercial |
$2,294.42
|
| Rate for Payer: HFN Commercial |
$2,371.76
|
| Rate for Payer: Multiplan Commercial |
$2,062.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,546.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,371.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,263.22
|
| Rate for Payer: Quartz Commercial |
$1,546.80
|
| Rate for Payer: WEA Trust Commercial |
$1,417.90
|
| Rate for Payer: WPS Commercial |
$1,909.52
|
|
|
WIRE CHOICE PT .014 300CM 12154-01J
|
Facility
|
OP
|
$2,578.00
|
|
| Hospital Charge Code |
3072559
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$721.84 |
| Max. Negotiated Rate |
$10,312.00 |
| Rate for Payer: Aetna Commercial |
$2,320.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,217.08
|
| Rate for Payer: Aetna Managed Medicare |
$721.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,675.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,289.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,237.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,366.34
|
| Rate for Payer: Cash Price |
$773.40
|
| Rate for Payer: Cigna Commercial |
$2,371.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,442.65
|
| Rate for Payer: Health EOS Commercial |
$2,294.42
|
| Rate for Payer: HFN Commercial |
$2,371.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,933.50
|
| Rate for Payer: Multiplan Commercial |
$2,062.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,546.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,371.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,263.22
|
| Rate for Payer: Quartz Commercial |
$1,675.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,546.80
|
| Rate for Payer: The Alliance Commercial |
$10,312.00
|
| Rate for Payer: WEA Trust Commercial |
$1,417.90
|
| Rate for Payer: WPS Commercial |
$1,909.52
|
|
|
WIRE CLIP TORQUER 22196-003
|
Facility
|
OP
|
$138.00
|
|
| Hospital Charge Code |
3609495
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.64 |
| Max. Negotiated Rate |
$552.00 |
| Rate for Payer: Aetna Commercial |
$124.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$118.68
|
| Rate for Payer: Aetna Managed Medicare |
$38.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$89.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$69.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$66.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.14
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cigna Commercial |
$126.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$77.22
|
| Rate for Payer: Health EOS Commercial |
$122.82
|
| Rate for Payer: HFN Commercial |
$126.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$103.50
|
| Rate for Payer: Multiplan Commercial |
$110.40
|
| Rate for Payer: NAPHCARE Commercial |
$82.80
|
| Rate for Payer: Preferred Network Access Commercial |
$126.96
|
| Rate for Payer: Quartz Beloit One Network |
$67.62
|
| Rate for Payer: Quartz Commercial |
$89.70
|
| Rate for Payer: Quartz Medicare Advantage |
$82.80
|
| Rate for Payer: The Alliance Commercial |
$552.00
|
| Rate for Payer: WEA Trust Commercial |
$75.90
|
| Rate for Payer: WPS Commercial |
$102.22
|
|
|
WIRE CLIP TORQUER 22196-003
|
Facility
|
IP
|
$138.00
|
|
| Hospital Charge Code |
3609495
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.62 |
| Max. Negotiated Rate |
$126.96 |
| Rate for Payer: Aetna Commercial |
$124.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$118.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.14
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cigna Commercial |
$126.96
|
| Rate for Payer: Health EOS Commercial |
$122.82
|
| Rate for Payer: HFN Commercial |
$126.96
|
| Rate for Payer: Multiplan Commercial |
$110.40
|
| Rate for Payer: NAPHCARE Commercial |
$82.80
|
| Rate for Payer: Preferred Network Access Commercial |
$126.96
|
| Rate for Payer: Quartz Beloit One Network |
$67.62
|
| Rate for Payer: Quartz Commercial |
$82.80
|
| Rate for Payer: WEA Trust Commercial |
$75.90
|
| Rate for Payer: WPS Commercial |
$102.22
|
|
|
WIRE CUTTER MDS10508
|
Facility
|
OP
|
$69.00
|
|
| Hospital Charge Code |
2964048
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.32 |
| Max. Negotiated Rate |
$276.00 |
| Rate for Payer: Aetna Commercial |
$62.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.34
|
| Rate for Payer: Aetna Managed Medicare |
$19.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$34.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$33.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$36.57
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cigna Commercial |
$63.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$38.61
|
| Rate for Payer: Health EOS Commercial |
$61.41
|
| Rate for Payer: HFN Commercial |
$63.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.75
|
| Rate for Payer: Multiplan Commercial |
$55.20
|
| Rate for Payer: NAPHCARE Commercial |
$41.40
|
| Rate for Payer: Preferred Network Access Commercial |
$63.48
|
| Rate for Payer: Quartz Beloit One Network |
$33.81
|
| Rate for Payer: Quartz Commercial |
$44.85
|
| Rate for Payer: Quartz Medicare Advantage |
$41.40
|
| Rate for Payer: The Alliance Commercial |
$276.00
|
| Rate for Payer: WEA Trust Commercial |
$37.95
|
| Rate for Payer: WPS Commercial |
$51.11
|
|
|
WIRE CUTTER MDS10508
|
Facility
|
IP
|
$69.00
|
|
| Hospital Charge Code |
2964048
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.81 |
| Max. Negotiated Rate |
$63.48 |
| Rate for Payer: Aetna Commercial |
$62.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$36.57
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cigna Commercial |
$63.48
|
| Rate for Payer: Health EOS Commercial |
$61.41
|
| Rate for Payer: HFN Commercial |
$63.48
|
| Rate for Payer: Multiplan Commercial |
$55.20
|
| Rate for Payer: NAPHCARE Commercial |
$41.40
|
| Rate for Payer: Preferred Network Access Commercial |
$63.48
|
| Rate for Payer: Quartz Beloit One Network |
$33.81
|
| Rate for Payer: Quartz Commercial |
$41.40
|
| Rate for Payer: WEA Trust Commercial |
$37.95
|
| Rate for Payer: WPS Commercial |
$51.11
|
|
|
WIRE CV PACER 025-100
|
Facility
|
IP
|
$302.00
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
2965150
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$147.98 |
| Max. Negotiated Rate |
$277.84 |
| Rate for Payer: Aetna Commercial |
$271.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$259.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$160.06
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna Commercial |
$277.84
|
| Rate for Payer: Health EOS Commercial |
$268.78
|
| Rate for Payer: HFN Commercial |
$277.84
|
| Rate for Payer: Multiplan Commercial |
$241.60
|
| Rate for Payer: NAPHCARE Commercial |
$181.20
|
| Rate for Payer: Preferred Network Access Commercial |
$277.84
|
| Rate for Payer: Quartz Beloit One Network |
$147.98
|
| Rate for Payer: Quartz Commercial |
$181.20
|
| Rate for Payer: WEA Trust Commercial |
$166.10
|
| Rate for Payer: WPS Commercial |
$223.69
|
|
|
WIRE CV PACER 025-100
|
Facility
|
OP
|
$302.00
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
2965150
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$84.56 |
| Max. Negotiated Rate |
$1,208.00 |
| Rate for Payer: Aetna Commercial |
$271.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$259.72
|
| Rate for Payer: Aetna Managed Medicare |
$84.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$196.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$151.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$144.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$160.06
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna Commercial |
$277.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$169.00
|
| Rate for Payer: Health EOS Commercial |
$268.78
|
| Rate for Payer: HFN Commercial |
$277.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$226.50
|
| Rate for Payer: Multiplan Commercial |
$241.60
|
| Rate for Payer: NAPHCARE Commercial |
$181.20
|
| Rate for Payer: Preferred Network Access Commercial |
$277.84
|
| Rate for Payer: Quartz Beloit One Network |
$147.98
|
| Rate for Payer: Quartz Commercial |
$196.30
|
| Rate for Payer: Quartz Medicare Advantage |
$181.20
|
| Rate for Payer: The Alliance Commercial |
$1,208.00
|
| Rate for Payer: WEA Trust Commercial |
$166.10
|
| Rate for Payer: WPS Commercial |
$223.69
|
|
|
WIRE DOUBLE STERNAL 046-237
|
Facility
|
OP
|
$1,353.00
|
|
| Hospital Charge Code |
2965502
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$378.84 |
| Max. Negotiated Rate |
$5,412.00 |
| Rate for Payer: Aetna Commercial |
$1,217.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,163.58
|
| Rate for Payer: Aetna Managed Medicare |
$378.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$879.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$676.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$649.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$717.09
|
| Rate for Payer: Cash Price |
$405.90
|
| Rate for Payer: Cigna Commercial |
$1,244.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$757.14
|
| Rate for Payer: Health EOS Commercial |
$1,204.17
|
| Rate for Payer: HFN Commercial |
$1,244.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,014.75
|
| Rate for Payer: Multiplan Commercial |
$1,082.40
|
| Rate for Payer: NAPHCARE Commercial |
$811.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,244.76
|
| Rate for Payer: Quartz Beloit One Network |
$662.97
|
| Rate for Payer: Quartz Commercial |
$879.45
|
| Rate for Payer: Quartz Medicare Advantage |
$811.80
|
| Rate for Payer: The Alliance Commercial |
$5,412.00
|
| Rate for Payer: WEA Trust Commercial |
$744.15
|
| Rate for Payer: WPS Commercial |
$1,002.17
|
|
|
WIRE DOUBLE STERNAL 046-237
|
Facility
|
IP
|
$1,353.00
|
|
| Hospital Charge Code |
2965502
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$662.97 |
| Max. Negotiated Rate |
$1,244.76 |
| Rate for Payer: Aetna Commercial |
$1,217.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,163.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$717.09
|
| Rate for Payer: Cash Price |
$405.90
|
| Rate for Payer: Cigna Commercial |
$1,244.76
|
| Rate for Payer: Health EOS Commercial |
$1,204.17
|
| Rate for Payer: HFN Commercial |
$1,244.76
|
| Rate for Payer: Multiplan Commercial |
$1,082.40
|
| Rate for Payer: NAPHCARE Commercial |
$811.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,244.76
|
| Rate for Payer: Quartz Beloit One Network |
$662.97
|
| Rate for Payer: Quartz Commercial |
$811.80
|
| Rate for Payer: WEA Trust Commercial |
$744.15
|
| Rate for Payer: WPS Commercial |
$1,002.17
|
|
|
WIRE GUIDE 17.0/3.2MMx161MM
|
Facility
|
OP
|
$3,222.00
|
|
| Hospital Charge Code |
2966596
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$902.16 |
| Max. Negotiated Rate |
$12,888.00 |
| Rate for Payer: Aetna Commercial |
$2,899.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,770.92
|
| Rate for Payer: Aetna Managed Medicare |
$902.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,094.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,611.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,546.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,707.66
|
| Rate for Payer: Cash Price |
$966.60
|
| Rate for Payer: Cigna Commercial |
$2,964.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,803.03
|
| Rate for Payer: Health EOS Commercial |
$2,867.58
|
| Rate for Payer: HFN Commercial |
$2,964.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,416.50
|
| Rate for Payer: Multiplan Commercial |
$2,577.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,933.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,964.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,578.78
|
| Rate for Payer: Quartz Commercial |
$2,094.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,933.20
|
| Rate for Payer: The Alliance Commercial |
$12,888.00
|
| Rate for Payer: WEA Trust Commercial |
$1,772.10
|
| Rate for Payer: WPS Commercial |
$2,386.54
|
|
|
WIRE GUIDE 17.0/3.2MMx161MM
|
Facility
|
IP
|
$3,222.00
|
|
| Hospital Charge Code |
2966596
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,578.78 |
| Max. Negotiated Rate |
$2,964.24 |
| Rate for Payer: Aetna Commercial |
$2,899.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,770.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,707.66
|
| Rate for Payer: Cash Price |
$966.60
|
| Rate for Payer: Cigna Commercial |
$2,964.24
|
| Rate for Payer: Health EOS Commercial |
$2,867.58
|
| Rate for Payer: HFN Commercial |
$2,964.24
|
| Rate for Payer: Multiplan Commercial |
$2,577.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,933.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,964.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,578.78
|
| Rate for Payer: Quartz Commercial |
$1,933.20
|
| Rate for Payer: WEA Trust Commercial |
$1,772.10
|
| Rate for Payer: WPS Commercial |
$2,386.54
|
|
