|
WIDE LOCAL EXCISION (LOWER BODY)
|
Facility
OP
|
$1,084.00
|
|
| Hospital Charge Code |
4688606
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$303.52 |
| Max. Negotiated Rate |
$4,336.00 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Aetna Managed Medicare |
$303.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$704.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$542.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$520.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$606.61
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$813.00
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$704.60
|
| Rate for Payer: Quartz Medicare Advantage |
$650.40
|
| Rate for Payer: The Alliance Commercial |
$4,336.00
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
WIDE LOCAL EXCISION (LOWER BODY)
|
Facility
IP
|
$1,084.00
|
|
| Hospital Charge Code |
4688606
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$531.16 |
| Max. Negotiated Rate |
$997.28 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$650.40
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
WIDE LOCAL EXCISION (UPPER BODY)
|
Facility
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2960509
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$303.52 |
| Max. Negotiated Rate |
$4,336.00 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Aetna Managed Medicare |
$303.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$704.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$542.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$520.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$606.61
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$813.00
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$704.60
|
| Rate for Payer: Quartz Medicare Advantage |
$650.40
|
| Rate for Payer: The Alliance Commercial |
$4,336.00
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
WIDE LOCAL EXCISION (UPPER BODY)
|
Facility
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960509
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$531.16 |
| Max. Negotiated Rate |
$997.28 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$650.40
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
Wilson Disease Full Gene Analysis
|
Facility
IP
|
$2,848.00
|
|
|
Service Code
|
CPT 81406
|
| Hospital Charge Code |
5426838
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1,395.52 |
| Max. Negotiated Rate |
$2,620.16 |
| Rate for Payer: Aetna Commercial |
$2,563.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,509.44
|
| Rate for Payer: Cash Price |
$854.40
|
| Rate for Payer: Cigna Commercial |
$2,620.16
|
| Rate for Payer: Health EOS Commercial |
$2,534.72
|
| Rate for Payer: HFN Commercial |
$2,620.16
|
| Rate for Payer: Multiplan Commercial |
$2,278.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,708.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,620.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,395.52
|
| Rate for Payer: Quartz Commercial |
$1,708.80
|
| Rate for Payer: WEA Trust Commercial |
$1,566.40
|
| Rate for Payer: WPS Commercial |
$2,109.51
|
|
|
Wilson Disease Full Gene Analysis
|
Professional
|
$2,848.00
|
|
|
Service Code
|
CPT 81406
|
| Hospital Charge Code |
5426838
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$282.88 |
| Max. Negotiated Rate |
$2,705.60 |
| Rate for Payer: Aetna Commercial |
$2,705.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,449.28
|
| Rate for Payer: Aetna Managed Medicare |
$282.88
|
| Rate for Payer: Anthem Medicare Advantage |
$282.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$282.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$282.88
|
| Rate for Payer: Cash Price |
$854.40
|
| Rate for Payer: Cash Price |
$854.40
|
| Rate for Payer: Cigna Commercial |
$2,705.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,424.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$282.88
|
| Rate for Payer: Health EOS Commercial |
$2,591.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$998.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$998.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$282.88
|
| Rate for Payer: Multiplan Commercial |
$2,278.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,705.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,253.12
|
| Rate for Payer: Quartz Commercial |
$1,623.36
|
| Rate for Payer: Quartz Medicare Advantage |
$282.88
|
| Rate for Payer: The Alliance Commercial |
$1,117.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$282.88
|
| Rate for Payer: WEA Trust Commercial |
$1,566.40
|
| Rate for Payer: WPS Commercial |
$1,244.67
|
|
|
Wilson Disease Full Gene Analysis
|
Facility
OP
|
$2,848.00
|
|
|
Service Code
|
CPT 81406
|
| Hospital Charge Code |
5426838
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$282.88 |
| Max. Negotiated Rate |
$11,392.00 |
| Rate for Payer: Aetna Commercial |
$2,563.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,449.28
|
| Rate for Payer: Aetna Managed Medicare |
$282.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,060.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$495.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$469.58
|
| Rate for Payer: Anthem Medicaid |
$282.88
|
| Rate for Payer: Anthem Medicare Advantage |
$282.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,509.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$282.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$282.88
|
| Rate for Payer: Cash Price |
$854.40
|
| Rate for Payer: Cash Price |
$854.40
|
| Rate for Payer: Cigna Commercial |
$2,620.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$282.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$282.88
|
| Rate for Payer: Dean Health Medicaid |
$282.88
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$282.88
|
| Rate for Payer: Health EOS Commercial |
$2,534.72
|
| Rate for Payer: HFN Commercial |
$2,620.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,052.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$282.88
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$282.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$282.88
|
| Rate for Payer: Managed Health Services Medicaid |
$294.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$282.88
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$282.88
|
| Rate for Payer: Multiplan Commercial |
$2,278.40
|
| Rate for Payer: NAPHCARE Commercial |
$424.32
|
| Rate for Payer: Preferred Network Access Commercial |
$2,620.16
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$282.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,395.52
|
| Rate for Payer: Quartz Commercial |
$1,851.20
|
| Rate for Payer: Quartz Medicare Advantage |
$282.88
|
| Rate for Payer: The Alliance Commercial |
$11,392.00
|
| Rate for Payer: United Healthcare Medicaid |
$282.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$282.88
|
| Rate for Payer: United Healthcare PPO |
$2,136.00
|
| Rate for Payer: WEA Trust Commercial |
$1,566.40
|
| Rate for Payer: Wellcare Medicare |
$282.88
|
| Rate for Payer: WMAP Medicaid |
$282.88
|
| Rate for Payer: WPS Commercial |
$2,109.51
|
|
|
WIPES BABY UNSCENTED SENSITIVE
|
Facility
IP
|
$93.00
|
|
| Hospital Charge Code |
2963837
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$45.57 |
| Max. Negotiated Rate |
$85.56 |
| Rate for Payer: Aetna Commercial |
$83.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.29
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$85.56
|
| Rate for Payer: Health EOS Commercial |
$82.77
|
| Rate for Payer: HFN Commercial |
$85.56
|
| Rate for Payer: Multiplan Commercial |
$74.40
|
| Rate for Payer: NAPHCARE Commercial |
$55.80
|
| Rate for Payer: Preferred Network Access Commercial |
$85.56
|
| Rate for Payer: Quartz Beloit One Network |
$45.57
|
| Rate for Payer: Quartz Commercial |
$55.80
|
| Rate for Payer: WEA Trust Commercial |
$51.15
|
| Rate for Payer: WPS Commercial |
$68.89
|
|
|
WIPES BABY UNSCENTED SENSITIVE
|
Facility
OP
|
$93.00
|
|
| Hospital Charge Code |
2963837
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$26.04 |
| Max. Negotiated Rate |
$372.00 |
| Rate for Payer: Aetna Commercial |
$83.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.98
|
| Rate for Payer: Aetna Managed Medicare |
$26.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$60.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$46.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$44.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.29
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$85.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$52.04
|
| Rate for Payer: Health EOS Commercial |
$82.77
|
| Rate for Payer: HFN Commercial |
$85.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.75
|
| Rate for Payer: Multiplan Commercial |
$74.40
|
| Rate for Payer: NAPHCARE Commercial |
$55.80
|
| Rate for Payer: Preferred Network Access Commercial |
$85.56
|
| Rate for Payer: Quartz Beloit One Network |
$45.57
|
| Rate for Payer: Quartz Commercial |
$60.45
|
| Rate for Payer: Quartz Medicare Advantage |
$55.80
|
| Rate for Payer: The Alliance Commercial |
$372.00
|
| Rate for Payer: WEA Trust Commercial |
$51.15
|
| Rate for Payer: WPS Commercial |
$68.89
|
|
|
WIPES EXFO
|
Facility
IP
|
$293.00
|
|
| Hospital Charge Code |
2970883
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$143.57 |
| Max. Negotiated Rate |
$269.56 |
| Rate for Payer: Aetna Commercial |
$263.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$155.29
|
| Rate for Payer: Cash Price |
$87.90
|
| Rate for Payer: Cigna Commercial |
$269.56
|
| Rate for Payer: Health EOS Commercial |
$260.77
|
| Rate for Payer: HFN Commercial |
$269.56
|
| Rate for Payer: Multiplan Commercial |
$234.40
|
| Rate for Payer: NAPHCARE Commercial |
$175.80
|
| Rate for Payer: Preferred Network Access Commercial |
$269.56
|
| Rate for Payer: Quartz Beloit One Network |
$143.57
|
| Rate for Payer: Quartz Commercial |
$175.80
|
| Rate for Payer: WEA Trust Commercial |
$161.15
|
| Rate for Payer: WPS Commercial |
$217.03
|
|
|
WIPES EXFO
|
Facility
OP
|
$293.00
|
|
| Hospital Charge Code |
2970883
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$82.04 |
| Max. Negotiated Rate |
$1,172.00 |
| Rate for Payer: Aetna Commercial |
$263.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$251.98
|
| Rate for Payer: Aetna Managed Medicare |
$82.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$190.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$146.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$140.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$155.29
|
| Rate for Payer: Cash Price |
$87.90
|
| Rate for Payer: Cigna Commercial |
$269.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$163.96
|
| Rate for Payer: Health EOS Commercial |
$260.77
|
| Rate for Payer: HFN Commercial |
$269.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$219.75
|
| Rate for Payer: Multiplan Commercial |
$234.40
|
| Rate for Payer: NAPHCARE Commercial |
$175.80
|
| Rate for Payer: Preferred Network Access Commercial |
$269.56
|
| Rate for Payer: Quartz Beloit One Network |
$143.57
|
| Rate for Payer: Quartz Commercial |
$190.45
|
| Rate for Payer: Quartz Medicare Advantage |
$175.80
|
| Rate for Payer: The Alliance Commercial |
$1,172.00
|
| Rate for Payer: WEA Trust Commercial |
$161.15
|
| Rate for Payer: WPS Commercial |
$217.03
|
|
|
WIPE SKIN BARRIER GEL 7917
|
Facility
OP
|
$4.00
|
|
| Hospital Charge Code |
2963504
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3.44
|
| Rate for Payer: Aetna Managed Medicare |
$1.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.12
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna Commercial |
$3.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.24
|
| Rate for Payer: Health EOS Commercial |
$3.56
|
| Rate for Payer: HFN Commercial |
$3.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3.00
|
| Rate for Payer: Multiplan Commercial |
$3.20
|
| Rate for Payer: NAPHCARE Commercial |
$2.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3.68
|
| Rate for Payer: Quartz Beloit One Network |
$1.96
|
| Rate for Payer: Quartz Commercial |
$2.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2.40
|
| Rate for Payer: The Alliance Commercial |
$16.00
|
| Rate for Payer: WEA Trust Commercial |
$2.20
|
| Rate for Payer: WPS Commercial |
$2.96
|
|
|
WIPE SKIN BARRIER GEL 7917
|
Facility
IP
|
$4.00
|
|
| Hospital Charge Code |
2963504
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.96 |
| Max. Negotiated Rate |
$3.68 |
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.12
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna Commercial |
$3.68
|
| Rate for Payer: Health EOS Commercial |
$3.56
|
| Rate for Payer: HFN Commercial |
$3.68
|
| Rate for Payer: Multiplan Commercial |
$3.20
|
| Rate for Payer: NAPHCARE Commercial |
$2.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3.68
|
| Rate for Payer: Quartz Beloit One Network |
$1.96
|
| Rate for Payer: Quartz Commercial |
$2.40
|
| Rate for Payer: WEA Trust Commercial |
$2.20
|
| Rate for Payer: WPS Commercial |
$2.96
|
|
|
Wire .014 Asahi Regalia X5 300CM
|
Facility
OP
|
$2,396.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4528651
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$670.88 |
| Max. Negotiated Rate |
$2,204.32 |
| Rate for Payer: Aetna Commercial |
$2,156.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,060.56
|
| Rate for Payer: Aetna Managed Medicare |
$670.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,557.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,198.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,150.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,269.88
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cigna Commercial |
$2,204.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,340.80
|
| Rate for Payer: Health EOS Commercial |
$2,132.44
|
| Rate for Payer: HFN Commercial |
$2,204.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,797.00
|
| Rate for Payer: Multiplan Commercial |
$1,916.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,437.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,204.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,174.04
|
| Rate for Payer: Quartz Commercial |
$1,557.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,437.60
|
| Rate for Payer: WEA Trust Commercial |
$1,317.80
|
| Rate for Payer: WPS Commercial |
$1,774.72
|
|
|
Wire .014 Asahi Regalia X5 300CM
|
Facility
IP
|
$2,396.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4528651
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,174.04 |
| Max. Negotiated Rate |
$2,204.32 |
| Rate for Payer: Aetna Commercial |
$2,156.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,269.88
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cigna Commercial |
$2,204.32
|
| Rate for Payer: Health EOS Commercial |
$2,132.44
|
| Rate for Payer: HFN Commercial |
$2,204.32
|
| Rate for Payer: Multiplan Commercial |
$1,916.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,437.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,204.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,174.04
|
| Rate for Payer: Quartz Commercial |
$1,437.60
|
| Rate for Payer: WEA Trust Commercial |
$1,317.80
|
| Rate for Payer: WPS Commercial |
$1,774.72
|
|
|
Wire .014 Asato X5 300CM
|
Facility
IP
|
$2,396.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4528621
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,174.04 |
| Max. Negotiated Rate |
$2,204.32 |
| Rate for Payer: Aetna Commercial |
$2,156.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,269.88
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cigna Commercial |
$2,204.32
|
| Rate for Payer: Health EOS Commercial |
$2,132.44
|
| Rate for Payer: HFN Commercial |
$2,204.32
|
| Rate for Payer: Multiplan Commercial |
$1,916.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,437.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,204.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,174.04
|
| Rate for Payer: Quartz Commercial |
$1,437.60
|
| Rate for Payer: WEA Trust Commercial |
$1,317.80
|
| Rate for Payer: WPS Commercial |
$1,774.72
|
|
|
Wire .014 Asato X5 300CM
|
Facility
OP
|
$2,396.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4528621
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$670.88 |
| Max. Negotiated Rate |
$2,204.32 |
| Rate for Payer: Aetna Commercial |
$2,156.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,060.56
|
| Rate for Payer: Aetna Managed Medicare |
$670.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,557.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,198.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,150.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,269.88
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cigna Commercial |
$2,204.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,340.80
|
| Rate for Payer: Health EOS Commercial |
$2,132.44
|
| Rate for Payer: HFN Commercial |
$2,204.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,797.00
|
| Rate for Payer: Multiplan Commercial |
$1,916.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,437.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,204.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,174.04
|
| Rate for Payer: Quartz Commercial |
$1,557.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,437.60
|
| Rate for Payer: WEA Trust Commercial |
$1,317.80
|
| Rate for Payer: WPS Commercial |
$1,774.72
|
|
|
WIRE .035 3MM JFC 260CM
|
Facility
OP
|
$276.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3645491
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$77.28 |
| Max. Negotiated Rate |
$253.92 |
| Rate for Payer: Aetna Commercial |
$248.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.36
|
| Rate for Payer: Aetna Managed Medicare |
$77.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$179.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$138.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$132.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.28
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$253.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$154.45
|
| Rate for Payer: Health EOS Commercial |
$245.64
|
| Rate for Payer: HFN Commercial |
$253.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$207.00
|
| Rate for Payer: Multiplan Commercial |
$220.80
|
| Rate for Payer: NAPHCARE Commercial |
$165.60
|
| Rate for Payer: Preferred Network Access Commercial |
$253.92
|
| Rate for Payer: Quartz Beloit One Network |
$135.24
|
| Rate for Payer: Quartz Commercial |
$179.40
|
| Rate for Payer: Quartz Medicare Advantage |
$165.60
|
| Rate for Payer: WEA Trust Commercial |
$151.80
|
| Rate for Payer: WPS Commercial |
$204.43
|
|
|
WIRE .035 3MM JFC 260CM
|
Facility
IP
|
$276.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3645491
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$135.24 |
| Max. Negotiated Rate |
$253.92 |
| Rate for Payer: Aetna Commercial |
$248.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.28
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$253.92
|
| Rate for Payer: Health EOS Commercial |
$245.64
|
| Rate for Payer: HFN Commercial |
$253.92
|
| Rate for Payer: Multiplan Commercial |
$220.80
|
| Rate for Payer: NAPHCARE Commercial |
$165.60
|
| Rate for Payer: Preferred Network Access Commercial |
$253.92
|
| Rate for Payer: Quartz Beloit One Network |
$135.24
|
| Rate for Payer: Quartz Commercial |
$165.60
|
| Rate for Payer: WEA Trust Commercial |
$151.80
|
| Rate for Payer: WPS Commercial |
$204.43
|
|
|
WIRE 1.25 PLATE REDUCTION WITH LG STOP 02.111.501.10
|
Facility
IP
|
$2,684.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2969453
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,315.16 |
| Max. Negotiated Rate |
$2,469.28 |
| Rate for Payer: Aetna Commercial |
$2,415.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,422.52
|
| Rate for Payer: Cash Price |
$805.20
|
| Rate for Payer: Cigna Commercial |
$2,469.28
|
| Rate for Payer: Health EOS Commercial |
$2,388.76
|
| Rate for Payer: HFN Commercial |
$2,469.28
|
| Rate for Payer: Multiplan Commercial |
$2,147.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,610.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,469.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,315.16
|
| Rate for Payer: Quartz Commercial |
$1,610.40
|
| Rate for Payer: WEA Trust Commercial |
$1,476.20
|
| Rate for Payer: WPS Commercial |
$1,988.04
|
|
|
WIRE 1.25 PLATE REDUCTION WITH LG STOP 02.111.501.10
|
Facility
OP
|
$2,684.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2969453
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$751.52 |
| Max. Negotiated Rate |
$2,469.28 |
| Rate for Payer: Aetna Commercial |
$2,415.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,308.24
|
| Rate for Payer: Aetna Managed Medicare |
$751.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,744.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,342.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,288.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,422.52
|
| Rate for Payer: Cash Price |
$805.20
|
| Rate for Payer: Cigna Commercial |
$2,469.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,501.97
|
| Rate for Payer: Health EOS Commercial |
$2,388.76
|
| Rate for Payer: HFN Commercial |
$2,469.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,013.00
|
| Rate for Payer: Multiplan Commercial |
$2,147.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,610.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,469.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,315.16
|
| Rate for Payer: Quartz Commercial |
$1,744.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,610.40
|
| Rate for Payer: WEA Trust Commercial |
$1,476.20
|
| Rate for Payer: WPS Commercial |
$1,988.04
|
|
|
WIRE 1.25 PLATE REDUCTION WITH SM STOP 02.111.500.10
|
Facility
IP
|
$2,684.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2969452
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,315.16 |
| Max. Negotiated Rate |
$2,469.28 |
| Rate for Payer: Aetna Commercial |
$2,415.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,422.52
|
| Rate for Payer: Cash Price |
$805.20
|
| Rate for Payer: Cigna Commercial |
$2,469.28
|
| Rate for Payer: Health EOS Commercial |
$2,388.76
|
| Rate for Payer: HFN Commercial |
$2,469.28
|
| Rate for Payer: Multiplan Commercial |
$2,147.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,610.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,469.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,315.16
|
| Rate for Payer: Quartz Commercial |
$1,610.40
|
| Rate for Payer: WEA Trust Commercial |
$1,476.20
|
| Rate for Payer: WPS Commercial |
$1,988.04
|
|
|
WIRE 1.25 PLATE REDUCTION WITH SM STOP 02.111.500.10
|
Facility
OP
|
$2,684.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2969452
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$751.52 |
| Max. Negotiated Rate |
$2,469.28 |
| Rate for Payer: Aetna Commercial |
$2,415.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,308.24
|
| Rate for Payer: Aetna Managed Medicare |
$751.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,744.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,342.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,288.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,422.52
|
| Rate for Payer: Cash Price |
$805.20
|
| Rate for Payer: Cigna Commercial |
$2,469.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,501.97
|
| Rate for Payer: Health EOS Commercial |
$2,388.76
|
| Rate for Payer: HFN Commercial |
$2,469.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,013.00
|
| Rate for Payer: Multiplan Commercial |
$2,147.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,610.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,469.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,315.16
|
| Rate for Payer: Quartz Commercial |
$1,744.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,610.40
|
| Rate for Payer: WEA Trust Commercial |
$1,476.20
|
| Rate for Payer: WPS Commercial |
$1,988.04
|
|
|
WIRE 1.25x150 PLATE REDUCTION
|
Facility
OP
|
$2,897.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2966592
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$811.16 |
| Max. Negotiated Rate |
$2,665.24 |
| Rate for Payer: Aetna Commercial |
$2,607.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,491.42
|
| Rate for Payer: Aetna Managed Medicare |
$811.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,883.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,448.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,390.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,535.41
|
| Rate for Payer: Cash Price |
$869.10
|
| Rate for Payer: Cigna Commercial |
$2,665.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,621.16
|
| Rate for Payer: Health EOS Commercial |
$2,578.33
|
| Rate for Payer: HFN Commercial |
$2,665.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,172.75
|
| Rate for Payer: Multiplan Commercial |
$2,317.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,738.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,665.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,419.53
|
| Rate for Payer: Quartz Commercial |
$1,883.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,738.20
|
| Rate for Payer: WEA Trust Commercial |
$1,593.35
|
| Rate for Payer: WPS Commercial |
$2,145.81
|
|
|
WIRE 1.25x150 PLATE REDUCTION
|
Facility
IP
|
$2,897.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2966592
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,419.53 |
| Max. Negotiated Rate |
$2,665.24 |
| Rate for Payer: Aetna Commercial |
$2,607.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,535.41
|
| Rate for Payer: Cash Price |
$869.10
|
| Rate for Payer: Cigna Commercial |
$2,665.24
|
| Rate for Payer: Health EOS Commercial |
$2,578.33
|
| Rate for Payer: HFN Commercial |
$2,665.24
|
| Rate for Payer: Multiplan Commercial |
$2,317.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,738.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,665.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,419.53
|
| Rate for Payer: Quartz Commercial |
$1,738.20
|
| Rate for Payer: WEA Trust Commercial |
$1,593.35
|
| Rate for Payer: WPS Commercial |
$2,145.81
|
|
