|
WIRE SET BTB TRANSFIX
|
Facility
|
OP
|
$2,660.00
|
|
| Hospital Charge Code |
2964708
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$744.80 |
| Max. Negotiated Rate |
$10,640.00 |
| Rate for Payer: Aetna Commercial |
$2,394.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,287.60
|
| Rate for Payer: Aetna Managed Medicare |
$744.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,729.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,330.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,276.80
|
| 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: Dean Health DHI/DHP/ASO |
$1,488.54
|
| Rate for Payer: Health EOS Commercial |
$2,367.40
|
| Rate for Payer: HFN Commercial |
$2,447.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,995.00
|
| 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 |
$1,729.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,596.00
|
| Rate for Payer: The Alliance Commercial |
$10,640.00
|
| Rate for Payer: WEA Trust Commercial |
$1,463.00
|
| Rate for Payer: WPS Commercial |
$1,970.26
|
|
|
WIRE SLEEVE 1.6MM 323.055
|
Facility
|
OP
|
$2,195.00
|
|
| Hospital Charge Code |
2967339
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$614.60 |
| Max. Negotiated Rate |
$8,780.00 |
| Rate for Payer: Aetna Commercial |
$1,975.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,887.70
|
| Rate for Payer: Aetna Managed Medicare |
$614.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,426.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,097.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,053.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,163.35
|
| Rate for Payer: Cash Price |
$658.50
|
| Rate for Payer: Cigna Commercial |
$2,019.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,228.32
|
| Rate for Payer: Health EOS Commercial |
$1,953.55
|
| Rate for Payer: HFN Commercial |
$2,019.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,646.25
|
| Rate for Payer: Multiplan Commercial |
$1,756.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,317.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,019.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,075.55
|
| Rate for Payer: Quartz Commercial |
$1,426.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,317.00
|
| Rate for Payer: The Alliance Commercial |
$8,780.00
|
| Rate for Payer: WEA Trust Commercial |
$1,207.25
|
| Rate for Payer: WPS Commercial |
$1,625.84
|
|
|
WIRE SLEEVE 1.6MM 323.055
|
Facility
|
IP
|
$2,195.00
|
|
| Hospital Charge Code |
2967339
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,075.55 |
| Max. Negotiated Rate |
$2,019.40 |
| Rate for Payer: Aetna Commercial |
$1,975.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,887.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,163.35
|
| Rate for Payer: Cash Price |
$658.50
|
| Rate for Payer: Cigna Commercial |
$2,019.40
|
| Rate for Payer: Health EOS Commercial |
$1,953.55
|
| Rate for Payer: HFN Commercial |
$2,019.40
|
| Rate for Payer: Multiplan Commercial |
$1,756.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,317.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,019.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,075.55
|
| Rate for Payer: Quartz Commercial |
$1,317.00
|
| Rate for Payer: WEA Trust Commercial |
$1,207.25
|
| Rate for Payer: WPS Commercial |
$1,625.84
|
|
|
WIRE STERNAL #5
|
Facility
|
IP
|
$415.00
|
|
| Hospital Charge Code |
2965503
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$203.35 |
| Max. Negotiated Rate |
$381.80 |
| Rate for Payer: Aetna Commercial |
$373.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$356.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$219.95
|
| Rate for Payer: Cash Price |
$124.50
|
| Rate for Payer: Cigna Commercial |
$381.80
|
| Rate for Payer: Health EOS Commercial |
$369.35
|
| Rate for Payer: HFN Commercial |
$381.80
|
| Rate for Payer: Multiplan Commercial |
$332.00
|
| Rate for Payer: NAPHCARE Commercial |
$249.00
|
| Rate for Payer: Preferred Network Access Commercial |
$381.80
|
| Rate for Payer: Quartz Beloit One Network |
$203.35
|
| Rate for Payer: Quartz Commercial |
$249.00
|
| Rate for Payer: WEA Trust Commercial |
$228.25
|
| Rate for Payer: WPS Commercial |
$307.39
|
|
|
WIRE STERNAL #5
|
Facility
|
OP
|
$415.00
|
|
| Hospital Charge Code |
2965503
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.20 |
| Max. Negotiated Rate |
$1,660.00 |
| Rate for Payer: Aetna Commercial |
$373.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$356.90
|
| Rate for Payer: Aetna Managed Medicare |
$116.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$269.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$207.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$199.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$219.95
|
| Rate for Payer: Cash Price |
$124.50
|
| Rate for Payer: Cigna Commercial |
$381.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$232.23
|
| Rate for Payer: Health EOS Commercial |
$369.35
|
| Rate for Payer: HFN Commercial |
$381.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$311.25
|
| Rate for Payer: Multiplan Commercial |
$332.00
|
| Rate for Payer: NAPHCARE Commercial |
$249.00
|
| Rate for Payer: Preferred Network Access Commercial |
$381.80
|
| Rate for Payer: Quartz Beloit One Network |
$203.35
|
| Rate for Payer: Quartz Commercial |
$269.75
|
| Rate for Payer: Quartz Medicare Advantage |
$249.00
|
| Rate for Payer: The Alliance Commercial |
$1,660.00
|
| Rate for Payer: WEA Trust Commercial |
$228.25
|
| Rate for Payer: WPS Commercial |
$307.39
|
|
|
WIRE STERNAL #7 M655G
|
Facility
|
OP
|
$431.00
|
|
| Hospital Charge Code |
2965760
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$120.68 |
| Max. Negotiated Rate |
$1,724.00 |
| Rate for Payer: Aetna Commercial |
$387.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$370.66
|
| Rate for Payer: Aetna Managed Medicare |
$120.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$280.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$215.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$206.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$228.43
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cigna Commercial |
$396.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$241.19
|
| Rate for Payer: Health EOS Commercial |
$383.59
|
| Rate for Payer: HFN Commercial |
$396.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$323.25
|
| Rate for Payer: Multiplan Commercial |
$344.80
|
| Rate for Payer: NAPHCARE Commercial |
$258.60
|
| Rate for Payer: Preferred Network Access Commercial |
$396.52
|
| Rate for Payer: Quartz Beloit One Network |
$211.19
|
| Rate for Payer: Quartz Commercial |
$280.15
|
| Rate for Payer: Quartz Medicare Advantage |
$258.60
|
| Rate for Payer: The Alliance Commercial |
$1,724.00
|
| Rate for Payer: WEA Trust Commercial |
$237.05
|
| Rate for Payer: WPS Commercial |
$319.24
|
|
|
WIRE STERNAL #7 M655G
|
Facility
|
IP
|
$431.00
|
|
| Hospital Charge Code |
2965760
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$211.19 |
| Max. Negotiated Rate |
$396.52 |
| Rate for Payer: Aetna Commercial |
$387.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$370.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$228.43
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cigna Commercial |
$396.52
|
| Rate for Payer: Health EOS Commercial |
$383.59
|
| Rate for Payer: HFN Commercial |
$396.52
|
| Rate for Payer: Multiplan Commercial |
$344.80
|
| Rate for Payer: NAPHCARE Commercial |
$258.60
|
| Rate for Payer: Preferred Network Access Commercial |
$396.52
|
| Rate for Payer: Quartz Beloit One Network |
$211.19
|
| Rate for Payer: Quartz Commercial |
$258.60
|
| Rate for Payer: WEA Trust Commercial |
$237.05
|
| Rate for Payer: WPS Commercial |
$319.24
|
|
|
WIRE STR COUGAR XT 300CM
|
Facility
|
OP
|
$1,424.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3553541
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$398.72 |
| Max. Negotiated Rate |
$5,696.00 |
| Rate for Payer: Aetna Commercial |
$1,281.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,224.64
|
| Rate for Payer: Aetna Managed Medicare |
$398.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$925.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$712.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$683.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$754.72
|
| Rate for Payer: Cash Price |
$427.20
|
| Rate for Payer: Cigna Commercial |
$1,310.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$796.87
|
| Rate for Payer: Health EOS Commercial |
$1,267.36
|
| Rate for Payer: HFN Commercial |
$1,310.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,068.00
|
| Rate for Payer: Multiplan Commercial |
$1,139.20
|
| Rate for Payer: NAPHCARE Commercial |
$854.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,310.08
|
| Rate for Payer: Quartz Beloit One Network |
$697.76
|
| Rate for Payer: Quartz Commercial |
$925.60
|
| Rate for Payer: Quartz Medicare Advantage |
$854.40
|
| Rate for Payer: The Alliance Commercial |
$5,696.00
|
| Rate for Payer: WEA Trust Commercial |
$783.20
|
| Rate for Payer: WPS Commercial |
$1,054.76
|
|
|
WIRE STR COUGAR XT 300CM
|
Facility
|
IP
|
$1,424.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3553541
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$697.76 |
| Max. Negotiated Rate |
$1,310.08 |
| Rate for Payer: Aetna Commercial |
$1,281.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,224.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$754.72
|
| Rate for Payer: Cash Price |
$427.20
|
| Rate for Payer: Cigna Commercial |
$1,310.08
|
| Rate for Payer: Health EOS Commercial |
$1,267.36
|
| Rate for Payer: HFN Commercial |
$1,310.08
|
| Rate for Payer: Multiplan Commercial |
$1,139.20
|
| Rate for Payer: NAPHCARE Commercial |
$854.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,310.08
|
| Rate for Payer: Quartz Beloit One Network |
$697.76
|
| Rate for Payer: Quartz Commercial |
$854.40
|
| Rate for Payer: WEA Trust Commercial |
$783.20
|
| Rate for Payer: WPS Commercial |
$1,054.76
|
|
|
WIRE STR THUNDER 300CM
|
Facility
|
OP
|
$1,424.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3553542
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$398.72 |
| Max. Negotiated Rate |
$5,696.00 |
| Rate for Payer: Aetna Commercial |
$1,281.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,224.64
|
| Rate for Payer: Aetna Managed Medicare |
$398.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$925.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$712.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$683.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$754.72
|
| Rate for Payer: Cash Price |
$427.20
|
| Rate for Payer: Cigna Commercial |
$1,310.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$796.87
|
| Rate for Payer: Health EOS Commercial |
$1,267.36
|
| Rate for Payer: HFN Commercial |
$1,310.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,068.00
|
| Rate for Payer: Multiplan Commercial |
$1,139.20
|
| Rate for Payer: NAPHCARE Commercial |
$854.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,310.08
|
| Rate for Payer: Quartz Beloit One Network |
$697.76
|
| Rate for Payer: Quartz Commercial |
$925.60
|
| Rate for Payer: Quartz Medicare Advantage |
$854.40
|
| Rate for Payer: The Alliance Commercial |
$5,696.00
|
| Rate for Payer: WEA Trust Commercial |
$783.20
|
| Rate for Payer: WPS Commercial |
$1,054.76
|
|
|
WIRE STR THUNDER 300CM
|
Facility
|
IP
|
$1,424.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3553542
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$697.76 |
| Max. Negotiated Rate |
$1,310.08 |
| Rate for Payer: Aetna Commercial |
$1,281.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,224.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$754.72
|
| Rate for Payer: Cash Price |
$427.20
|
| Rate for Payer: Cigna Commercial |
$1,310.08
|
| Rate for Payer: Health EOS Commercial |
$1,267.36
|
| Rate for Payer: HFN Commercial |
$1,310.08
|
| Rate for Payer: Multiplan Commercial |
$1,139.20
|
| Rate for Payer: NAPHCARE Commercial |
$854.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,310.08
|
| Rate for Payer: Quartz Beloit One Network |
$697.76
|
| Rate for Payer: Quartz Commercial |
$854.40
|
| Rate for Payer: WEA Trust Commercial |
$783.20
|
| Rate for Payer: WPS Commercial |
$1,054.76
|
|
|
Wire Wholey 145cm WWFS35175
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3103302
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$142.10 |
| Max. Negotiated Rate |
$266.80 |
| Rate for Payer: Aetna Commercial |
$261.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$249.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$153.70
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$266.80
|
| Rate for Payer: Health EOS Commercial |
$258.10
|
| Rate for Payer: HFN Commercial |
$266.80
|
| Rate for Payer: Multiplan Commercial |
$232.00
|
| Rate for Payer: NAPHCARE Commercial |
$174.00
|
| Rate for Payer: Preferred Network Access Commercial |
$266.80
|
| Rate for Payer: Quartz Beloit One Network |
$142.10
|
| Rate for Payer: Quartz Commercial |
$174.00
|
| Rate for Payer: WEA Trust Commercial |
$159.50
|
| Rate for Payer: WPS Commercial |
$214.80
|
|
|
Wire Wholey 145cm WWFS35175
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3103302
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$1,160.00 |
| Rate for Payer: Aetna Commercial |
$261.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$249.40
|
| Rate for Payer: Aetna Managed Medicare |
$81.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$188.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$145.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$139.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$153.70
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$266.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$162.28
|
| Rate for Payer: Health EOS Commercial |
$258.10
|
| Rate for Payer: HFN Commercial |
$266.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$217.50
|
| Rate for Payer: Multiplan Commercial |
$232.00
|
| Rate for Payer: NAPHCARE Commercial |
$174.00
|
| Rate for Payer: Preferred Network Access Commercial |
$266.80
|
| Rate for Payer: Quartz Beloit One Network |
$142.10
|
| Rate for Payer: Quartz Commercial |
$188.50
|
| Rate for Payer: Quartz Medicare Advantage |
$174.00
|
| Rate for Payer: The Alliance Commercial |
$1,160.00
|
| Rate for Payer: WEA Trust Commercial |
$159.50
|
| Rate for Payer: WPS Commercial |
$214.80
|
|
|
WIRE ZIP .035 180cm STIFF STRA 46-309B
|
Facility
|
OP
|
$1,012.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2973302
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$283.36 |
| Max. Negotiated Rate |
$4,048.00 |
| Rate for Payer: Aetna Commercial |
$910.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$870.32
|
| Rate for Payer: Aetna Managed Medicare |
$283.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$657.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$506.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$485.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$536.36
|
| Rate for Payer: Cash Price |
$303.60
|
| Rate for Payer: Cigna Commercial |
$931.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$566.32
|
| Rate for Payer: Health EOS Commercial |
$900.68
|
| Rate for Payer: HFN Commercial |
$931.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$759.00
|
| Rate for Payer: Multiplan Commercial |
$809.60
|
| Rate for Payer: NAPHCARE Commercial |
$607.20
|
| Rate for Payer: Preferred Network Access Commercial |
$931.04
|
| Rate for Payer: Quartz Beloit One Network |
$495.88
|
| Rate for Payer: Quartz Commercial |
$657.80
|
| Rate for Payer: Quartz Medicare Advantage |
$607.20
|
| Rate for Payer: The Alliance Commercial |
$4,048.00
|
| Rate for Payer: WEA Trust Commercial |
$556.60
|
| Rate for Payer: WPS Commercial |
$749.59
|
|
|
WIRE ZIP .035 180cm STIFF STRA 46-309B
|
Facility
|
IP
|
$1,012.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2973302
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$495.88 |
| Max. Negotiated Rate |
$931.04 |
| Rate for Payer: Aetna Commercial |
$910.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$870.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$536.36
|
| Rate for Payer: Cash Price |
$303.60
|
| Rate for Payer: Cigna Commercial |
$931.04
|
| Rate for Payer: Health EOS Commercial |
$900.68
|
| Rate for Payer: HFN Commercial |
$931.04
|
| Rate for Payer: Multiplan Commercial |
$809.60
|
| Rate for Payer: NAPHCARE Commercial |
$607.20
|
| Rate for Payer: Preferred Network Access Commercial |
$931.04
|
| Rate for Payer: Quartz Beloit One Network |
$495.88
|
| Rate for Payer: Quartz Commercial |
$607.20
|
| Rate for Payer: WEA Trust Commercial |
$556.60
|
| Rate for Payer: WPS Commercial |
$749.59
|
|
|
Witch Hazel Pads [Med]
|
Facility
|
OP
|
$46.00
|
|
| Hospital Charge Code |
2974999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$184.00 |
| Rate for Payer: Aetna Commercial |
$41.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$39.56
|
| Rate for Payer: Aetna Managed Medicare |
$12.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$29.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$24.38
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cigna Commercial |
$42.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25.74
|
| Rate for Payer: Health EOS Commercial |
$40.94
|
| Rate for Payer: HFN Commercial |
$42.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34.50
|
| Rate for Payer: Multiplan Commercial |
$36.80
|
| Rate for Payer: NAPHCARE Commercial |
$27.60
|
| Rate for Payer: Preferred Network Access Commercial |
$42.32
|
| Rate for Payer: Quartz Beloit One Network |
$22.54
|
| Rate for Payer: Quartz Commercial |
$29.90
|
| Rate for Payer: Quartz Medicare Advantage |
$27.60
|
| Rate for Payer: The Alliance Commercial |
$184.00
|
| Rate for Payer: WEA Trust Commercial |
$25.30
|
| Rate for Payer: WPS Commercial |
$34.07
|
|
|
Witch Hazel Pads [Med]
|
Facility
|
IP
|
$46.00
|
|
| Hospital Charge Code |
2974999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.54 |
| Max. Negotiated Rate |
$42.32 |
| Rate for Payer: Aetna Commercial |
$41.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$39.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$24.38
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cigna Commercial |
$42.32
|
| Rate for Payer: Health EOS Commercial |
$40.94
|
| Rate for Payer: HFN Commercial |
$42.32
|
| Rate for Payer: Multiplan Commercial |
$36.80
|
| Rate for Payer: NAPHCARE Commercial |
$27.60
|
| Rate for Payer: Preferred Network Access Commercial |
$42.32
|
| Rate for Payer: Quartz Beloit One Network |
$22.54
|
| Rate for Payer: Quartz Commercial |
$27.60
|
| Rate for Payer: WEA Trust Commercial |
$25.30
|
| Rate for Payer: WPS Commercial |
$34.07
|
|
|
With Biopsy - Bronchoscopy Charge
|
Facility
|
OP
|
$4,460.00
|
|
|
Service Code
|
CPT 31625
|
| Hospital Charge Code |
2990185
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,677.59 |
| Max. Negotiated Rate |
$6,240.63 |
| Rate for Payer: Aetna Commercial |
$4,014.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,835.60
|
| Rate for Payer: Aetna Managed Medicare |
$1,677.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$1,677.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,363.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,677.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,677.59
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$4,103.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,677.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,677.59
|
| Rate for Payer: Health EOS Commercial |
$3,969.40
|
| Rate for Payer: HFN Commercial |
$4,103.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,240.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,677.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,677.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,677.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,677.59
|
| Rate for Payer: Multiplan Commercial |
$3,568.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,516.38
|
| Rate for Payer: Preferred Network Access Commercial |
$4,103.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,185.40
|
| Rate for Payer: Quartz Commercial |
$2,899.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,677.59
|
| Rate for Payer: The Alliance Commercial |
$2,851.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,677.59
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: WEA Trust Commercial |
$2,453.00
|
| Rate for Payer: Wellcare Medicare |
$1,677.59
|
| Rate for Payer: WPS Commercial |
$3,303.52
|
|
|
With Biopsy - Bronchoscopy Charge
|
Facility
|
IP
|
$4,460.00
|
|
|
Service Code
|
CPT 31625
|
| Hospital Charge Code |
2990185
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,185.40 |
| Max. Negotiated Rate |
$4,103.20 |
| Rate for Payer: Aetna Commercial |
$4,014.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,835.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,363.80
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$4,103.20
|
| Rate for Payer: Health EOS Commercial |
$3,969.40
|
| Rate for Payer: HFN Commercial |
$4,103.20
|
| Rate for Payer: Multiplan Commercial |
$3,568.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,676.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,103.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,185.40
|
| Rate for Payer: Quartz Commercial |
$2,676.00
|
| Rate for Payer: WEA Trust Commercial |
$2,453.00
|
| Rate for Payer: WPS Commercial |
$3,303.52
|
|
|
With Brushing - Bronchoscopy Charge
|
Facility
|
OP
|
$4,417.00
|
|
|
Service Code
|
CPT 31623
|
| Hospital Charge Code |
2990184
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,677.59 |
| Max. Negotiated Rate |
$6,240.63 |
| Rate for Payer: Aetna Commercial |
$3,975.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,798.62
|
| Rate for Payer: Aetna Managed Medicare |
$1,677.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$1,677.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,341.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,677.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,677.59
|
| Rate for Payer: Cash Price |
$1,325.10
|
| Rate for Payer: Cash Price |
$1,325.10
|
| Rate for Payer: Cash Price |
$1,325.10
|
| Rate for Payer: Cigna Commercial |
$4,063.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,677.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,677.59
|
| Rate for Payer: Health EOS Commercial |
$3,931.13
|
| Rate for Payer: HFN Commercial |
$4,063.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,240.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,677.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,677.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,677.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,677.59
|
| Rate for Payer: Multiplan Commercial |
$3,533.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,516.38
|
| Rate for Payer: Preferred Network Access Commercial |
$4,063.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,164.33
|
| Rate for Payer: Quartz Commercial |
$2,871.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,677.59
|
| Rate for Payer: The Alliance Commercial |
$2,851.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,677.59
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: WEA Trust Commercial |
$2,429.35
|
| Rate for Payer: Wellcare Medicare |
$1,677.59
|
| Rate for Payer: WPS Commercial |
$3,271.67
|
|
|
With Brushing - Bronchoscopy Charge
|
Facility
|
IP
|
$4,417.00
|
|
|
Service Code
|
CPT 31623
|
| Hospital Charge Code |
2990184
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,164.33 |
| Max. Negotiated Rate |
$4,063.64 |
| Rate for Payer: Aetna Commercial |
$3,975.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,798.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,341.01
|
| Rate for Payer: Cash Price |
$1,325.10
|
| Rate for Payer: Cigna Commercial |
$4,063.64
|
| Rate for Payer: Health EOS Commercial |
$3,931.13
|
| Rate for Payer: HFN Commercial |
$4,063.64
|
| Rate for Payer: Multiplan Commercial |
$3,533.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,650.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,063.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,164.33
|
| Rate for Payer: Quartz Commercial |
$2,650.20
|
| Rate for Payer: WEA Trust Commercial |
$2,429.35
|
| Rate for Payer: WPS Commercial |
$3,271.67
|
|
|
WITH CATH PLCMT IN BYPASS GRAFT INC INTRA INJ 9345526
|
Professional
|
Both
|
$5,825.00
|
|
|
Service Code
|
CPT 93455 26
|
| Hospital Charge Code |
3015391
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$730.06 |
| Max. Negotiated Rate |
$5,533.75 |
| Rate for Payer: Aetna Commercial |
$5,533.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,009.50
|
| Rate for Payer: Cash Price |
$1,747.50
|
| Rate for Payer: Cash Price |
$1,747.50
|
| Rate for Payer: Cash Price |
$1,747.50
|
| Rate for Payer: Cigna Commercial |
$5,533.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$730.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,495.00
|
| Rate for Payer: Health EOS Commercial |
$5,300.75
|
| Rate for Payer: HFN Commercial |
$5,533.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$901.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$901.17
|
| Rate for Payer: Multiplan Commercial |
$4,660.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,533.75
|
| Rate for Payer: Quartz Beloit One Network |
$2,563.00
|
| Rate for Payer: Quartz Commercial |
$3,320.25
|
| Rate for Payer: The Alliance Commercial |
$2,912.50
|
| Rate for Payer: United Healthcare Medicaid |
$730.06
|
| Rate for Payer: WEA Trust Commercial |
$3,203.75
|
| Rate for Payer: WPS Commercial |
$4,314.58
|
|
|
With Transl Stent Placement (S), Inc Angio 3722122
|
Professional
|
Both
|
$17,376.00
|
|
|
Service Code
|
CPT 37221 22
|
| Hospital Charge Code |
5078631
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$367.57 |
| Max. Negotiated Rate |
$16,507.20 |
| Rate for Payer: Aetna Commercial |
$16,507.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,943.36
|
| Rate for Payer: Cash Price |
$5,212.80
|
| Rate for Payer: Cash Price |
$5,212.80
|
| Rate for Payer: Cash Price |
$5,212.80
|
| Rate for Payer: Cigna Commercial |
$16,507.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$367.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,425.60
|
| Rate for Payer: Health EOS Commercial |
$15,812.16
|
| Rate for Payer: HFN Commercial |
$16,507.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,568.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,568.31
|
| Rate for Payer: Multiplan Commercial |
$13,900.80
|
| Rate for Payer: Preferred Network Access Commercial |
$16,507.20
|
| Rate for Payer: Quartz Beloit One Network |
$7,645.44
|
| Rate for Payer: Quartz Commercial |
$9,904.32
|
| Rate for Payer: The Alliance Commercial |
$8,688.00
|
| Rate for Payer: United Healthcare Medicaid |
$367.57
|
| Rate for Payer: WEA Trust Commercial |
$9,556.80
|
| Rate for Payer: WPS Commercial |
$12,870.40
|
|
|
With Transl Stent Placement(S), Inc Angio 3722150
|
Professional
|
Both
|
$28,960.00
|
|
|
Service Code
|
CPT 37221 50
|
| Hospital Charge Code |
3462168
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$367.57 |
| Max. Negotiated Rate |
$27,512.00 |
| Rate for Payer: Aetna Commercial |
$27,512.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24,905.60
|
| Rate for Payer: Cash Price |
$8,688.00
|
| Rate for Payer: Cash Price |
$8,688.00
|
| Rate for Payer: Cash Price |
$8,688.00
|
| Rate for Payer: Cigna Commercial |
$27,512.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$367.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17,376.00
|
| Rate for Payer: Health EOS Commercial |
$26,353.60
|
| Rate for Payer: HFN Commercial |
$27,512.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,568.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,568.31
|
| Rate for Payer: Multiplan Commercial |
$23,168.00
|
| Rate for Payer: Preferred Network Access Commercial |
$27,512.00
|
| Rate for Payer: Quartz Beloit One Network |
$12,742.40
|
| Rate for Payer: Quartz Commercial |
$16,507.20
|
| Rate for Payer: The Alliance Commercial |
$14,480.00
|
| Rate for Payer: United Healthcare Medicaid |
$367.57
|
| Rate for Payer: WEA Trust Commercial |
$15,928.00
|
| Rate for Payer: WPS Commercial |
$21,450.67
|
|
|
With Transl Stent Placement (S), Inc Angio, Extnd Svc & Bilateral 372212250
|
Professional
|
Both
|
$34,753.00
|
|
|
Service Code
|
CPT 37221 22,50
|
| Hospital Charge Code |
6173582
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$367.57 |
| Max. Negotiated Rate |
$33,015.35 |
| Rate for Payer: Aetna Commercial |
$33,015.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$29,887.58
|
| Rate for Payer: Cash Price |
$10,425.90
|
| Rate for Payer: Cash Price |
$10,425.90
|
| Rate for Payer: Cash Price |
$10,425.90
|
| Rate for Payer: Cigna Commercial |
$33,015.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$367.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20,851.80
|
| Rate for Payer: Health EOS Commercial |
$31,625.23
|
| Rate for Payer: HFN Commercial |
$33,015.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,568.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,568.31
|
| Rate for Payer: Multiplan Commercial |
$27,802.40
|
| Rate for Payer: Preferred Network Access Commercial |
$33,015.35
|
| Rate for Payer: Quartz Beloit One Network |
$15,291.32
|
| Rate for Payer: Quartz Commercial |
$19,809.21
|
| Rate for Payer: The Alliance Commercial |
$17,376.50
|
| Rate for Payer: United Healthcare Medicaid |
$367.57
|
| Rate for Payer: WEA Trust Commercial |
$19,114.15
|
| Rate for Payer: WPS Commercial |
$25,741.55
|
|
