|
WIRE HIWIRE HYDROPHILIC WIRE GUIDE 180CM X 15CM X 3CM .035 G56174
|
Facility
|
OP
|
$668.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6217121
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$187.04 |
| Max. Negotiated Rate |
$2,672.00 |
| Rate for Payer: Aetna Commercial |
$601.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$574.48
|
| Rate for Payer: Aetna Managed Medicare |
$187.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$434.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$334.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$320.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$354.04
|
| Rate for Payer: Cash Price |
$200.40
|
| Rate for Payer: Cigna Commercial |
$614.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$373.81
|
| Rate for Payer: Health EOS Commercial |
$594.52
|
| Rate for Payer: HFN Commercial |
$614.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$501.00
|
| Rate for Payer: Multiplan Commercial |
$534.40
|
| Rate for Payer: NAPHCARE Commercial |
$400.80
|
| Rate for Payer: Preferred Network Access Commercial |
$614.56
|
| Rate for Payer: Quartz Beloit One Network |
$327.32
|
| Rate for Payer: Quartz Commercial |
$434.20
|
| Rate for Payer: Quartz Medicare Advantage |
$400.80
|
| Rate for Payer: The Alliance Commercial |
$2,672.00
|
| Rate for Payer: WEA Trust Commercial |
$367.40
|
| Rate for Payer: WPS Commercial |
$494.79
|
|
|
WIRE HIWIRE HYDROPHILIC WIRE GUIDE 180CM X 15CM X 3CM .035 G56174
|
Facility
|
IP
|
$668.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6217121
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$327.32 |
| Max. Negotiated Rate |
$614.56 |
| Rate for Payer: Aetna Commercial |
$601.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$574.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$354.04
|
| Rate for Payer: Cash Price |
$200.40
|
| Rate for Payer: Cigna Commercial |
$614.56
|
| Rate for Payer: Health EOS Commercial |
$594.52
|
| Rate for Payer: HFN Commercial |
$614.56
|
| Rate for Payer: Multiplan Commercial |
$534.40
|
| Rate for Payer: NAPHCARE Commercial |
$400.80
|
| Rate for Payer: Preferred Network Access Commercial |
$614.56
|
| Rate for Payer: Quartz Beloit One Network |
$327.32
|
| Rate for Payer: Quartz Commercial |
$400.80
|
| Rate for Payer: WEA Trust Commercial |
$367.40
|
| Rate for Payer: WPS Commercial |
$494.79
|
|
|
WIRE HIWIRE HYDROPHILIC WIRE GUIDE 180CM X 22CM X 3CM .035 G36292
|
Facility
|
OP
|
$453.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6201002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$126.84 |
| Max. Negotiated Rate |
$1,812.00 |
| Rate for Payer: Aetna Commercial |
$407.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$389.58
|
| Rate for Payer: Aetna Managed Medicare |
$126.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$294.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$226.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$217.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$240.09
|
| Rate for Payer: Cash Price |
$135.90
|
| Rate for Payer: Cigna Commercial |
$416.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$253.50
|
| Rate for Payer: Health EOS Commercial |
$403.17
|
| Rate for Payer: HFN Commercial |
$416.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$339.75
|
| Rate for Payer: Multiplan Commercial |
$362.40
|
| Rate for Payer: NAPHCARE Commercial |
$271.80
|
| Rate for Payer: Preferred Network Access Commercial |
$416.76
|
| Rate for Payer: Quartz Beloit One Network |
$221.97
|
| Rate for Payer: Quartz Commercial |
$294.45
|
| Rate for Payer: Quartz Medicare Advantage |
$271.80
|
| Rate for Payer: The Alliance Commercial |
$1,812.00
|
| Rate for Payer: WEA Trust Commercial |
$249.15
|
| Rate for Payer: WPS Commercial |
$335.54
|
|
|
WIRE HIWIRE HYDROPHILIC WIRE GUIDE 180CM X 22CM X 3CM .035 G36292
|
Facility
|
IP
|
$453.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6201002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$221.97 |
| Max. Negotiated Rate |
$416.76 |
| Rate for Payer: Aetna Commercial |
$407.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$389.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$240.09
|
| Rate for Payer: Cash Price |
$135.90
|
| Rate for Payer: Cigna Commercial |
$416.76
|
| Rate for Payer: Health EOS Commercial |
$403.17
|
| Rate for Payer: HFN Commercial |
$416.76
|
| Rate for Payer: Multiplan Commercial |
$362.40
|
| Rate for Payer: NAPHCARE Commercial |
$271.80
|
| Rate for Payer: Preferred Network Access Commercial |
$416.76
|
| Rate for Payer: Quartz Beloit One Network |
$221.97
|
| Rate for Payer: Quartz Commercial |
$271.80
|
| Rate for Payer: WEA Trust Commercial |
$249.15
|
| Rate for Payer: WPS Commercial |
$335.54
|
|
|
WIRE HYDRA ANG .035 X 260cm M00556010
|
Facility
|
IP
|
$2,368.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2973415
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,160.32 |
| Max. Negotiated Rate |
$2,178.56 |
| Rate for Payer: Aetna Commercial |
$2,131.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,036.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,255.04
|
| Rate for Payer: Cash Price |
$710.40
|
| Rate for Payer: Cigna Commercial |
$2,178.56
|
| Rate for Payer: Health EOS Commercial |
$2,107.52
|
| Rate for Payer: HFN Commercial |
$2,178.56
|
| Rate for Payer: Multiplan Commercial |
$1,894.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,420.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,178.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,160.32
|
| Rate for Payer: Quartz Commercial |
$1,420.80
|
| Rate for Payer: WEA Trust Commercial |
$1,302.40
|
| Rate for Payer: WPS Commercial |
$1,753.98
|
|
|
WIRE HYDRA ANG .035 X 260cm M00556010
|
Facility
|
OP
|
$2,368.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2973415
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$663.04 |
| Max. Negotiated Rate |
$9,472.00 |
| Rate for Payer: Aetna Commercial |
$2,131.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,036.48
|
| Rate for Payer: Aetna Managed Medicare |
$663.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,539.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,184.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,136.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,255.04
|
| Rate for Payer: Cash Price |
$710.40
|
| Rate for Payer: Cigna Commercial |
$2,178.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,325.13
|
| Rate for Payer: Health EOS Commercial |
$2,107.52
|
| Rate for Payer: HFN Commercial |
$2,178.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,776.00
|
| Rate for Payer: Multiplan Commercial |
$1,894.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,420.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,178.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,160.32
|
| Rate for Payer: Quartz Commercial |
$1,539.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,420.80
|
| Rate for Payer: The Alliance Commercial |
$9,472.00
|
| Rate for Payer: WEA Trust Commercial |
$1,302.40
|
| Rate for Payer: WPS Commercial |
$1,753.98
|
|
|
WIRE HYDRA STR .035 X 260cm M00556001
|
Facility
|
OP
|
$2,280.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2973414
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$638.40 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Aetna Commercial |
$2,052.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,960.80
|
| Rate for Payer: Aetna Managed Medicare |
$638.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,482.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,140.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,094.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,208.40
|
| Rate for Payer: Cash Price |
$684.00
|
| Rate for Payer: Cigna Commercial |
$2,097.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,275.89
|
| Rate for Payer: Health EOS Commercial |
$2,029.20
|
| Rate for Payer: HFN Commercial |
$2,097.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,710.00
|
| Rate for Payer: Multiplan Commercial |
$1,824.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,368.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,097.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,117.20
|
| Rate for Payer: Quartz Commercial |
$1,482.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,368.00
|
| Rate for Payer: The Alliance Commercial |
$9,120.00
|
| Rate for Payer: WEA Trust Commercial |
$1,254.00
|
| Rate for Payer: WPS Commercial |
$1,688.80
|
|
|
WIRE HYDRA STR .035 X 260cm M00556001
|
Facility
|
IP
|
$2,280.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2973414
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,117.20 |
| Max. Negotiated Rate |
$2,097.60 |
| Rate for Payer: Aetna Commercial |
$2,052.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,960.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,208.40
|
| Rate for Payer: Cash Price |
$684.00
|
| Rate for Payer: Cigna Commercial |
$2,097.60
|
| Rate for Payer: Health EOS Commercial |
$2,029.20
|
| Rate for Payer: HFN Commercial |
$2,097.60
|
| Rate for Payer: Multiplan Commercial |
$1,824.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,368.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,097.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,117.20
|
| Rate for Payer: Quartz Commercial |
$1,368.00
|
| Rate for Payer: WEA Trust Commercial |
$1,254.00
|
| Rate for Payer: WPS Commercial |
$1,688.80
|
|
|
WIRE JAW 23GA
|
Facility
|
IP
|
$614.00
|
|
| Hospital Charge Code |
2965099
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$300.86 |
| Max. Negotiated Rate |
$564.88 |
| Rate for Payer: Aetna Commercial |
$552.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$528.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$325.42
|
| Rate for Payer: Cash Price |
$184.20
|
| Rate for Payer: Cigna Commercial |
$564.88
|
| Rate for Payer: Health EOS Commercial |
$546.46
|
| Rate for Payer: HFN Commercial |
$564.88
|
| Rate for Payer: Multiplan Commercial |
$491.20
|
| Rate for Payer: NAPHCARE Commercial |
$368.40
|
| Rate for Payer: Preferred Network Access Commercial |
$564.88
|
| Rate for Payer: Quartz Beloit One Network |
$300.86
|
| Rate for Payer: Quartz Commercial |
$368.40
|
| Rate for Payer: WEA Trust Commercial |
$337.70
|
| Rate for Payer: WPS Commercial |
$454.79
|
|
|
WIRE JAW 23GA
|
Facility
|
OP
|
$614.00
|
|
| Hospital Charge Code |
2965099
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$171.92 |
| Max. Negotiated Rate |
$2,456.00 |
| Rate for Payer: Aetna Commercial |
$552.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$528.04
|
| Rate for Payer: Aetna Managed Medicare |
$171.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$399.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$307.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$294.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$325.42
|
| Rate for Payer: Cash Price |
$184.20
|
| Rate for Payer: Cigna Commercial |
$564.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$343.59
|
| Rate for Payer: Health EOS Commercial |
$546.46
|
| Rate for Payer: HFN Commercial |
$564.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$460.50
|
| Rate for Payer: Multiplan Commercial |
$491.20
|
| Rate for Payer: NAPHCARE Commercial |
$368.40
|
| Rate for Payer: Preferred Network Access Commercial |
$564.88
|
| Rate for Payer: Quartz Beloit One Network |
$300.86
|
| Rate for Payer: Quartz Commercial |
$399.10
|
| Rate for Payer: Quartz Medicare Advantage |
$368.40
|
| Rate for Payer: The Alliance Commercial |
$2,456.00
|
| Rate for Payer: WEA Trust Commercial |
$337.70
|
| Rate for Payer: WPS Commercial |
$454.79
|
|
|
WIRE JAW FRACTURE 26GA
|
Facility
|
IP
|
$614.00
|
|
| Hospital Charge Code |
2965101
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$300.86 |
| Max. Negotiated Rate |
$564.88 |
| Rate for Payer: Aetna Commercial |
$552.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$528.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$325.42
|
| Rate for Payer: Cash Price |
$184.20
|
| Rate for Payer: Cigna Commercial |
$564.88
|
| Rate for Payer: Health EOS Commercial |
$546.46
|
| Rate for Payer: HFN Commercial |
$564.88
|
| Rate for Payer: Multiplan Commercial |
$491.20
|
| Rate for Payer: NAPHCARE Commercial |
$368.40
|
| Rate for Payer: Preferred Network Access Commercial |
$564.88
|
| Rate for Payer: Quartz Beloit One Network |
$300.86
|
| Rate for Payer: Quartz Commercial |
$368.40
|
| Rate for Payer: WEA Trust Commercial |
$337.70
|
| Rate for Payer: WPS Commercial |
$454.79
|
|
|
WIRE JAW FRACTURE 26GA
|
Facility
|
OP
|
$614.00
|
|
| Hospital Charge Code |
2965101
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$171.92 |
| Max. Negotiated Rate |
$2,456.00 |
| Rate for Payer: Aetna Commercial |
$552.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$528.04
|
| Rate for Payer: Aetna Managed Medicare |
$171.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$399.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$307.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$294.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$325.42
|
| Rate for Payer: Cash Price |
$184.20
|
| Rate for Payer: Cigna Commercial |
$564.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$343.59
|
| Rate for Payer: Health EOS Commercial |
$546.46
|
| Rate for Payer: HFN Commercial |
$564.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$460.50
|
| Rate for Payer: Multiplan Commercial |
$491.20
|
| Rate for Payer: NAPHCARE Commercial |
$368.40
|
| Rate for Payer: Preferred Network Access Commercial |
$564.88
|
| Rate for Payer: Quartz Beloit One Network |
$300.86
|
| Rate for Payer: Quartz Commercial |
$399.10
|
| Rate for Payer: Quartz Medicare Advantage |
$368.40
|
| Rate for Payer: The Alliance Commercial |
$2,456.00
|
| Rate for Payer: WEA Trust Commercial |
$337.70
|
| Rate for Payer: WPS Commercial |
$454.79
|
|
|
WIRE LOOP CERCLAGE 16G 00-1292-061-00
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2962841
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$675.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$645.00
|
| Rate for Payer: Aetna Managed Medicare |
$210.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$487.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$375.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$360.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$397.50
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$690.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$419.70
|
| Rate for Payer: Health EOS Commercial |
$667.50
|
| Rate for Payer: HFN Commercial |
$690.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$562.50
|
| Rate for Payer: Multiplan Commercial |
$600.00
|
| Rate for Payer: NAPHCARE Commercial |
$450.00
|
| Rate for Payer: Preferred Network Access Commercial |
$690.00
|
| Rate for Payer: Quartz Beloit One Network |
$367.50
|
| Rate for Payer: Quartz Commercial |
$487.50
|
| Rate for Payer: Quartz Medicare Advantage |
$450.00
|
| Rate for Payer: The Alliance Commercial |
$3,000.00
|
| Rate for Payer: WEA Trust Commercial |
$412.50
|
| Rate for Payer: WPS Commercial |
$555.52
|
|
|
WIRE LOOP CERCLAGE 16G 00-1292-061-00
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2962841
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$367.50 |
| Max. Negotiated Rate |
$690.00 |
| Rate for Payer: Aetna Commercial |
$675.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$645.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$397.50
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$690.00
|
| Rate for Payer: Health EOS Commercial |
$667.50
|
| Rate for Payer: HFN Commercial |
$690.00
|
| Rate for Payer: Multiplan Commercial |
$600.00
|
| Rate for Payer: NAPHCARE Commercial |
$450.00
|
| Rate for Payer: Preferred Network Access Commercial |
$690.00
|
| Rate for Payer: Quartz Beloit One Network |
$367.50
|
| Rate for Payer: Quartz Commercial |
$450.00
|
| Rate for Payer: WEA Trust Commercial |
$412.50
|
| Rate for Payer: WPS Commercial |
$555.52
|
|
|
WIRE LOOP ZIMMER 1.22MM 16GA 30CM 1292-61
|
Facility
|
IP
|
$750.00
|
|
| Hospital Charge Code |
2967544
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$367.50 |
| Max. Negotiated Rate |
$690.00 |
| Rate for Payer: Aetna Commercial |
$675.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$645.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$397.50
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$690.00
|
| Rate for Payer: Health EOS Commercial |
$667.50
|
| Rate for Payer: HFN Commercial |
$690.00
|
| Rate for Payer: Multiplan Commercial |
$600.00
|
| Rate for Payer: NAPHCARE Commercial |
$450.00
|
| Rate for Payer: Preferred Network Access Commercial |
$690.00
|
| Rate for Payer: Quartz Beloit One Network |
$367.50
|
| Rate for Payer: Quartz Commercial |
$450.00
|
| Rate for Payer: WEA Trust Commercial |
$412.50
|
| Rate for Payer: WPS Commercial |
$555.52
|
|
|
WIRE LOOP ZIMMER 1.22MM 16GA 30CM 1292-61
|
Facility
|
OP
|
$750.00
|
|
| Hospital Charge Code |
2967544
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$675.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$645.00
|
| Rate for Payer: Aetna Managed Medicare |
$210.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$487.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$375.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$360.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$397.50
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$690.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$419.70
|
| Rate for Payer: Health EOS Commercial |
$667.50
|
| Rate for Payer: HFN Commercial |
$690.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$562.50
|
| Rate for Payer: Multiplan Commercial |
$600.00
|
| Rate for Payer: NAPHCARE Commercial |
$450.00
|
| Rate for Payer: Preferred Network Access Commercial |
$690.00
|
| Rate for Payer: Quartz Beloit One Network |
$367.50
|
| Rate for Payer: Quartz Commercial |
$487.50
|
| Rate for Payer: Quartz Medicare Advantage |
$450.00
|
| Rate for Payer: The Alliance Commercial |
$3,000.00
|
| Rate for Payer: WEA Trust Commercial |
$412.50
|
| Rate for Payer: WPS Commercial |
$555.52
|
|
|
WIRE OLIVE MFT-040
|
Facility
|
IP
|
$1,152.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4028660
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$564.48 |
| Max. Negotiated Rate |
$1,059.84 |
| Rate for Payer: Aetna Commercial |
$1,036.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$990.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$610.56
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Cigna Commercial |
$1,059.84
|
| Rate for Payer: Health EOS Commercial |
$1,025.28
|
| Rate for Payer: HFN Commercial |
$1,059.84
|
| Rate for Payer: Multiplan Commercial |
$921.60
|
| Rate for Payer: NAPHCARE Commercial |
$691.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,059.84
|
| Rate for Payer: Quartz Beloit One Network |
$564.48
|
| Rate for Payer: Quartz Commercial |
$691.20
|
| Rate for Payer: WEA Trust Commercial |
$633.60
|
| Rate for Payer: WPS Commercial |
$853.29
|
|
|
WIRE OLIVE MFT-040
|
Facility
|
OP
|
$1,152.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4028660
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$322.56 |
| Max. Negotiated Rate |
$4,608.00 |
| Rate for Payer: Aetna Commercial |
$1,036.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$990.72
|
| Rate for Payer: Aetna Managed Medicare |
$322.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$748.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$576.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$552.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$610.56
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Cigna Commercial |
$1,059.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$644.66
|
| Rate for Payer: Health EOS Commercial |
$1,025.28
|
| Rate for Payer: HFN Commercial |
$1,059.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$864.00
|
| Rate for Payer: Multiplan Commercial |
$921.60
|
| Rate for Payer: NAPHCARE Commercial |
$691.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,059.84
|
| Rate for Payer: Quartz Beloit One Network |
$564.48
|
| Rate for Payer: Quartz Commercial |
$748.80
|
| Rate for Payer: Quartz Medicare Advantage |
$691.20
|
| Rate for Payer: The Alliance Commercial |
$4,608.00
|
| Rate for Payer: WEA Trust Commercial |
$633.60
|
| Rate for Payer: WPS Commercial |
$853.29
|
|
|
WIRE ROADRUNNER NIMBLE HYDROPHILIC WIRE GUIDE ANGLED 180CM X 11.5CM X 3CM .035 G09608
|
Facility
|
IP
|
$646.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6201003
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$316.54 |
| Max. Negotiated Rate |
$594.32 |
| Rate for Payer: Aetna Commercial |
$581.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$555.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$342.38
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cigna Commercial |
$594.32
|
| Rate for Payer: Health EOS Commercial |
$574.94
|
| Rate for Payer: HFN Commercial |
$594.32
|
| Rate for Payer: Multiplan Commercial |
$516.80
|
| Rate for Payer: NAPHCARE Commercial |
$387.60
|
| Rate for Payer: Preferred Network Access Commercial |
$594.32
|
| Rate for Payer: Quartz Beloit One Network |
$316.54
|
| Rate for Payer: Quartz Commercial |
$387.60
|
| Rate for Payer: WEA Trust Commercial |
$355.30
|
| Rate for Payer: WPS Commercial |
$478.49
|
|
|
WIRE ROADRUNNER NIMBLE HYDROPHILIC WIRE GUIDE ANGLED 180CM X 11.5CM X 3CM .035 G09608
|
Facility
|
OP
|
$646.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6201003
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$180.88 |
| Max. Negotiated Rate |
$2,584.00 |
| Rate for Payer: Aetna Commercial |
$581.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$555.56
|
| Rate for Payer: Aetna Managed Medicare |
$180.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$419.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$323.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$310.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$342.38
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cigna Commercial |
$594.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$361.50
|
| Rate for Payer: Health EOS Commercial |
$574.94
|
| Rate for Payer: HFN Commercial |
$594.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$484.50
|
| Rate for Payer: Multiplan Commercial |
$516.80
|
| Rate for Payer: NAPHCARE Commercial |
$387.60
|
| Rate for Payer: Preferred Network Access Commercial |
$594.32
|
| Rate for Payer: Quartz Beloit One Network |
$316.54
|
| Rate for Payer: Quartz Commercial |
$419.90
|
| Rate for Payer: Quartz Medicare Advantage |
$387.60
|
| Rate for Payer: The Alliance Commercial |
$2,584.00
|
| Rate for Payer: WEA Trust Commercial |
$355.30
|
| Rate for Payer: WPS Commercial |
$478.49
|
|
|
WIRE ROTA EX-EXTRA SUPPORT 23239-001
|
Facility
|
IP
|
$2,131.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3609503
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,044.19 |
| Max. Negotiated Rate |
$1,960.52 |
| Rate for Payer: Aetna Commercial |
$1,917.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,832.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,129.43
|
| Rate for Payer: Cash Price |
$639.30
|
| Rate for Payer: Cigna Commercial |
$1,960.52
|
| Rate for Payer: Health EOS Commercial |
$1,896.59
|
| Rate for Payer: HFN Commercial |
$1,960.52
|
| Rate for Payer: Multiplan Commercial |
$1,704.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,278.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,960.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,044.19
|
| Rate for Payer: Quartz Commercial |
$1,278.60
|
| Rate for Payer: WEA Trust Commercial |
$1,172.05
|
| Rate for Payer: WPS Commercial |
$1,578.43
|
|
|
WIRE ROTA EX-EXTRA SUPPORT 23239-001
|
Facility
|
OP
|
$2,131.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3609503
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$596.68 |
| Max. Negotiated Rate |
$8,524.00 |
| Rate for Payer: Aetna Commercial |
$1,917.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,832.66
|
| Rate for Payer: Aetna Managed Medicare |
$596.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,385.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,065.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,022.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,129.43
|
| Rate for Payer: Cash Price |
$639.30
|
| Rate for Payer: Cigna Commercial |
$1,960.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,192.51
|
| Rate for Payer: Health EOS Commercial |
$1,896.59
|
| Rate for Payer: HFN Commercial |
$1,960.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,598.25
|
| Rate for Payer: Multiplan Commercial |
$1,704.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,278.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,960.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,044.19
|
| Rate for Payer: Quartz Commercial |
$1,385.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,278.60
|
| Rate for Payer: The Alliance Commercial |
$8,524.00
|
| Rate for Payer: WEA Trust Commercial |
$1,172.05
|
| Rate for Payer: WPS Commercial |
$1,578.43
|
|
|
WIRE ROTA FLOPPY
|
Facility
|
IP
|
$2,131.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3609504
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,044.19 |
| Max. Negotiated Rate |
$1,960.52 |
| Rate for Payer: Aetna Commercial |
$1,917.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,832.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,129.43
|
| Rate for Payer: Cash Price |
$639.30
|
| Rate for Payer: Cigna Commercial |
$1,960.52
|
| Rate for Payer: Health EOS Commercial |
$1,896.59
|
| Rate for Payer: HFN Commercial |
$1,960.52
|
| Rate for Payer: Multiplan Commercial |
$1,704.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,278.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,960.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,044.19
|
| Rate for Payer: Quartz Commercial |
$1,278.60
|
| Rate for Payer: WEA Trust Commercial |
$1,172.05
|
| Rate for Payer: WPS Commercial |
$1,578.43
|
|
|
WIRE ROTA FLOPPY
|
Facility
|
OP
|
$2,131.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3609504
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$596.68 |
| Max. Negotiated Rate |
$8,524.00 |
| Rate for Payer: Aetna Commercial |
$1,917.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,832.66
|
| Rate for Payer: Aetna Managed Medicare |
$596.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,385.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,065.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,022.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,129.43
|
| Rate for Payer: Cash Price |
$639.30
|
| Rate for Payer: Cigna Commercial |
$1,960.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,192.51
|
| Rate for Payer: Health EOS Commercial |
$1,896.59
|
| Rate for Payer: HFN Commercial |
$1,960.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,598.25
|
| Rate for Payer: Multiplan Commercial |
$1,704.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,278.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,960.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,044.19
|
| Rate for Payer: Quartz Commercial |
$1,385.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,278.60
|
| Rate for Payer: The Alliance Commercial |
$8,524.00
|
| Rate for Payer: WEA Trust Commercial |
$1,172.05
|
| Rate for Payer: WPS Commercial |
$1,578.43
|
|
|
WIRE SET BTB TRANSFIX
|
Facility
|
IP
|
$2,660.00
|
|
| Hospital Charge Code |
2964708
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,303.40 |
| Max. Negotiated Rate |
$2,447.20 |
| Rate for Payer: Aetna Commercial |
$2,394.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,287.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,409.80
|
| Rate for Payer: Cash Price |
$798.00
|
| Rate for Payer: Cigna Commercial |
$2,447.20
|
| Rate for Payer: Health EOS Commercial |
$2,367.40
|
| Rate for Payer: HFN Commercial |
$2,447.20
|
| Rate for Payer: Multiplan Commercial |
$2,128.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,596.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,447.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,303.40
|
| Rate for Payer: Quartz Commercial |
$1,596.00
|
| Rate for Payer: WEA Trust Commercial |
$1,463.00
|
| Rate for Payer: WPS Commercial |
$1,970.26
|
|
