|
WIRE 1.6 COMPRESSION 15MM THREAD 03.211.415
|
Facility
IP
|
$1,016.00
|
|
| Hospital Charge Code |
2966593
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$497.84 |
| Max. Negotiated Rate |
$934.72 |
| Rate for Payer: Aetna Commercial |
$914.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$538.48
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cigna Commercial |
$934.72
|
| Rate for Payer: Health EOS Commercial |
$904.24
|
| Rate for Payer: HFN Commercial |
$934.72
|
| Rate for Payer: Multiplan Commercial |
$812.80
|
| Rate for Payer: NAPHCARE Commercial |
$609.60
|
| Rate for Payer: Preferred Network Access Commercial |
$934.72
|
| Rate for Payer: Quartz Beloit One Network |
$497.84
|
| Rate for Payer: Quartz Commercial |
$609.60
|
| Rate for Payer: WEA Trust Commercial |
$558.80
|
| Rate for Payer: WPS Commercial |
$752.55
|
|
|
WIRE 1.6 COMPRESSION 15MM THREAD 03.211.415
|
Facility
OP
|
$1,016.00
|
|
| Hospital Charge Code |
2966593
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$284.48 |
| Max. Negotiated Rate |
$4,064.00 |
| Rate for Payer: Aetna Commercial |
$914.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$873.76
|
| Rate for Payer: Aetna Managed Medicare |
$284.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$660.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$508.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$487.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$538.48
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cigna Commercial |
$934.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$568.55
|
| Rate for Payer: Health EOS Commercial |
$904.24
|
| Rate for Payer: HFN Commercial |
$934.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$762.00
|
| Rate for Payer: Multiplan Commercial |
$812.80
|
| Rate for Payer: NAPHCARE Commercial |
$609.60
|
| Rate for Payer: Preferred Network Access Commercial |
$934.72
|
| Rate for Payer: Quartz Beloit One Network |
$497.84
|
| Rate for Payer: Quartz Commercial |
$660.40
|
| Rate for Payer: Quartz Medicare Advantage |
$609.60
|
| Rate for Payer: The Alliance Commercial |
$4,064.00
|
| Rate for Payer: WEA Trust Commercial |
$558.80
|
| Rate for Payer: WPS Commercial |
$752.55
|
|
|
WIRE 1.6 COMPRESSION 20MM THREAD 03.211.420
|
Facility
IP
|
$1,016.00
|
|
| Hospital Charge Code |
2966595
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$497.84 |
| Max. Negotiated Rate |
$934.72 |
| Rate for Payer: Aetna Commercial |
$914.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$538.48
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cigna Commercial |
$934.72
|
| Rate for Payer: Health EOS Commercial |
$904.24
|
| Rate for Payer: HFN Commercial |
$934.72
|
| Rate for Payer: Multiplan Commercial |
$812.80
|
| Rate for Payer: NAPHCARE Commercial |
$609.60
|
| Rate for Payer: Preferred Network Access Commercial |
$934.72
|
| Rate for Payer: Quartz Beloit One Network |
$497.84
|
| Rate for Payer: Quartz Commercial |
$609.60
|
| Rate for Payer: WEA Trust Commercial |
$558.80
|
| Rate for Payer: WPS Commercial |
$752.55
|
|
|
WIRE 1.6 COMPRESSION 20MM THREAD 03.211.420
|
Facility
OP
|
$1,016.00
|
|
| Hospital Charge Code |
2966595
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$284.48 |
| Max. Negotiated Rate |
$4,064.00 |
| Rate for Payer: Aetna Commercial |
$914.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$873.76
|
| Rate for Payer: Aetna Managed Medicare |
$284.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$660.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$508.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$487.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$538.48
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cigna Commercial |
$934.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$568.55
|
| Rate for Payer: Health EOS Commercial |
$904.24
|
| Rate for Payer: HFN Commercial |
$934.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$762.00
|
| Rate for Payer: Multiplan Commercial |
$812.80
|
| Rate for Payer: NAPHCARE Commercial |
$609.60
|
| Rate for Payer: Preferred Network Access Commercial |
$934.72
|
| Rate for Payer: Quartz Beloit One Network |
$497.84
|
| Rate for Payer: Quartz Commercial |
$660.40
|
| Rate for Payer: Quartz Medicare Advantage |
$609.60
|
| Rate for Payer: The Alliance Commercial |
$4,064.00
|
| Rate for Payer: WEA Trust Commercial |
$558.80
|
| Rate for Payer: WPS Commercial |
$752.55
|
|
|
WIRE 18 GA SURGICAL STEEL SZ 6 ETHI-PACK PRE-CUT 18 IN DS18
|
Facility
OP
|
$157.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6174855
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$43.96 |
| Max. Negotiated Rate |
$144.44 |
| Rate for Payer: Aetna Commercial |
$141.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.02
|
| Rate for Payer: Aetna Managed Medicare |
$43.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$102.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$78.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$75.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.21
|
| Rate for Payer: Cash Price |
$47.10
|
| Rate for Payer: Cigna Commercial |
$144.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$87.86
|
| Rate for Payer: Health EOS Commercial |
$139.73
|
| Rate for Payer: HFN Commercial |
$144.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$117.75
|
| Rate for Payer: Multiplan Commercial |
$125.60
|
| Rate for Payer: NAPHCARE Commercial |
$94.20
|
| Rate for Payer: Preferred Network Access Commercial |
$144.44
|
| Rate for Payer: Quartz Beloit One Network |
$76.93
|
| Rate for Payer: Quartz Commercial |
$102.05
|
| Rate for Payer: Quartz Medicare Advantage |
$94.20
|
| Rate for Payer: WEA Trust Commercial |
$86.35
|
| Rate for Payer: WPS Commercial |
$116.29
|
|
|
WIRE 18 GA SURGICAL STEEL SZ 6 ETHI-PACK PRE-CUT 18 IN DS18
|
Facility
IP
|
$157.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6174855
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$76.93 |
| Max. Negotiated Rate |
$144.44 |
| Rate for Payer: Aetna Commercial |
$141.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.21
|
| Rate for Payer: Cash Price |
$47.10
|
| Rate for Payer: Cigna Commercial |
$144.44
|
| Rate for Payer: Health EOS Commercial |
$139.73
|
| Rate for Payer: HFN Commercial |
$144.44
|
| Rate for Payer: Multiplan Commercial |
$125.60
|
| Rate for Payer: NAPHCARE Commercial |
$94.20
|
| Rate for Payer: Preferred Network Access Commercial |
$144.44
|
| Rate for Payer: Quartz Beloit One Network |
$76.93
|
| Rate for Payer: Quartz Commercial |
$94.20
|
| Rate for Payer: WEA Trust Commercial |
$86.35
|
| Rate for Payer: WPS Commercial |
$116.29
|
|
|
WIRE 20 GA SURGICAL STEEL SZ 5 ETHI-PACK PRE-CUT 18 IN DS20
|
Facility
IP
|
$148.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6174854
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$72.52 |
| Max. Negotiated Rate |
$136.16 |
| Rate for Payer: Aetna Commercial |
$133.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$78.44
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cigna Commercial |
$136.16
|
| Rate for Payer: Health EOS Commercial |
$131.72
|
| Rate for Payer: HFN Commercial |
$136.16
|
| Rate for Payer: Multiplan Commercial |
$118.40
|
| Rate for Payer: NAPHCARE Commercial |
$88.80
|
| Rate for Payer: Preferred Network Access Commercial |
$136.16
|
| Rate for Payer: Quartz Beloit One Network |
$72.52
|
| Rate for Payer: Quartz Commercial |
$88.80
|
| Rate for Payer: WEA Trust Commercial |
$81.40
|
| Rate for Payer: WPS Commercial |
$109.62
|
|
|
WIRE 20 GA SURGICAL STEEL SZ 5 ETHI-PACK PRE-CUT 18 IN DS20
|
Facility
OP
|
$148.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6174854
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$41.44 |
| Max. Negotiated Rate |
$136.16 |
| Rate for Payer: Aetna Commercial |
$133.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$127.28
|
| Rate for Payer: Aetna Managed Medicare |
$41.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$96.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$74.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$71.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$78.44
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cigna Commercial |
$136.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$82.82
|
| Rate for Payer: Health EOS Commercial |
$131.72
|
| Rate for Payer: HFN Commercial |
$136.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$111.00
|
| Rate for Payer: Multiplan Commercial |
$118.40
|
| Rate for Payer: NAPHCARE Commercial |
$88.80
|
| Rate for Payer: Preferred Network Access Commercial |
$136.16
|
| Rate for Payer: Quartz Beloit One Network |
$72.52
|
| Rate for Payer: Quartz Commercial |
$96.20
|
| Rate for Payer: Quartz Medicare Advantage |
$88.80
|
| Rate for Payer: WEA Trust Commercial |
$81.40
|
| Rate for Payer: WPS Commercial |
$109.62
|
|
|
WIRE 2.0 SPADE POINT REDUCTION 292.41
|
Facility
OP
|
$2,303.00
|
|
| Hospital Charge Code |
2966594
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$644.84 |
| Max. Negotiated Rate |
$9,212.00 |
| Rate for Payer: Aetna Commercial |
$2,072.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,980.58
|
| Rate for Payer: Aetna Managed Medicare |
$644.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,496.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,151.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,105.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,220.59
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cigna Commercial |
$2,118.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,288.76
|
| Rate for Payer: Health EOS Commercial |
$2,049.67
|
| Rate for Payer: HFN Commercial |
$2,118.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,727.25
|
| Rate for Payer: Multiplan Commercial |
$1,842.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,381.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,118.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,128.47
|
| Rate for Payer: Quartz Commercial |
$1,496.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,381.80
|
| Rate for Payer: The Alliance Commercial |
$9,212.00
|
| Rate for Payer: WEA Trust Commercial |
$1,266.65
|
| Rate for Payer: WPS Commercial |
$1,705.83
|
|
|
WIRE 2.0 SPADE POINT REDUCTION 292.41
|
Facility
IP
|
$2,303.00
|
|
| Hospital Charge Code |
2966594
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,128.47 |
| Max. Negotiated Rate |
$2,118.76 |
| Rate for Payer: Aetna Commercial |
$2,072.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,220.59
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cigna Commercial |
$2,118.76
|
| Rate for Payer: Health EOS Commercial |
$2,049.67
|
| Rate for Payer: HFN Commercial |
$2,118.76
|
| Rate for Payer: Multiplan Commercial |
$1,842.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,381.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,118.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,128.47
|
| Rate for Payer: Quartz Commercial |
$1,381.80
|
| Rate for Payer: WEA Trust Commercial |
$1,266.65
|
| Rate for Payer: WPS Commercial |
$1,705.83
|
|
|
WIRE 22 GA SURGICAL STEEL SZ 4 ETHI-PACK PRE-CUT 18 IN DS22
|
Facility
OP
|
$153.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6174853
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$140.76 |
| Rate for Payer: Aetna Commercial |
$137.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$131.58
|
| Rate for Payer: Aetna Managed Medicare |
$42.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$99.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$76.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$73.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.09
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cigna Commercial |
$140.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$85.62
|
| Rate for Payer: Health EOS Commercial |
$136.17
|
| Rate for Payer: HFN Commercial |
$140.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$114.75
|
| Rate for Payer: Multiplan Commercial |
$122.40
|
| Rate for Payer: NAPHCARE Commercial |
$91.80
|
| Rate for Payer: Preferred Network Access Commercial |
$140.76
|
| Rate for Payer: Quartz Beloit One Network |
$74.97
|
| Rate for Payer: Quartz Commercial |
$99.45
|
| Rate for Payer: Quartz Medicare Advantage |
$91.80
|
| Rate for Payer: WEA Trust Commercial |
$84.15
|
| Rate for Payer: WPS Commercial |
$113.33
|
|
|
WIRE 22 GA SURGICAL STEEL SZ 4 ETHI-PACK PRE-CUT 18 IN DS22
|
Facility
IP
|
$153.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6174853
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$74.97 |
| Max. Negotiated Rate |
$140.76 |
| Rate for Payer: Aetna Commercial |
$137.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.09
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cigna Commercial |
$140.76
|
| Rate for Payer: Health EOS Commercial |
$136.17
|
| Rate for Payer: HFN Commercial |
$140.76
|
| Rate for Payer: Multiplan Commercial |
$122.40
|
| Rate for Payer: NAPHCARE Commercial |
$91.80
|
| Rate for Payer: Preferred Network Access Commercial |
$140.76
|
| Rate for Payer: Quartz Beloit One Network |
$74.97
|
| Rate for Payer: Quartz Commercial |
$91.80
|
| Rate for Payer: WEA Trust Commercial |
$84.15
|
| Rate for Payer: WPS Commercial |
$113.33
|
|
|
WIRE 24 GA SURGICAL STEEL SZ 3 ETHI-PACK PRE-CUT 18 IN DS24
|
Facility
OP
|
$146.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6174851
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$40.88 |
| Max. Negotiated Rate |
$134.32 |
| Rate for Payer: Aetna Commercial |
$131.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$125.56
|
| Rate for Payer: Aetna Managed Medicare |
$40.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$94.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$73.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$70.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$77.38
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cigna Commercial |
$134.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$81.70
|
| Rate for Payer: Health EOS Commercial |
$129.94
|
| Rate for Payer: HFN Commercial |
$134.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$109.50
|
| Rate for Payer: Multiplan Commercial |
$116.80
|
| Rate for Payer: NAPHCARE Commercial |
$87.60
|
| Rate for Payer: Preferred Network Access Commercial |
$134.32
|
| Rate for Payer: Quartz Beloit One Network |
$71.54
|
| Rate for Payer: Quartz Commercial |
$94.90
|
| Rate for Payer: Quartz Medicare Advantage |
$87.60
|
| Rate for Payer: WEA Trust Commercial |
$80.30
|
| Rate for Payer: WPS Commercial |
$108.14
|
|
|
WIRE 24 GA SURGICAL STEEL SZ 3 ETHI-PACK PRE-CUT 18 IN DS24
|
Facility
IP
|
$146.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6174851
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$71.54 |
| Max. Negotiated Rate |
$134.32 |
| Rate for Payer: Aetna Commercial |
$131.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$77.38
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cigna Commercial |
$134.32
|
| Rate for Payer: Health EOS Commercial |
$129.94
|
| Rate for Payer: HFN Commercial |
$134.32
|
| Rate for Payer: Multiplan Commercial |
$116.80
|
| Rate for Payer: NAPHCARE Commercial |
$87.60
|
| Rate for Payer: Preferred Network Access Commercial |
$134.32
|
| Rate for Payer: Quartz Beloit One Network |
$71.54
|
| Rate for Payer: Quartz Commercial |
$87.60
|
| Rate for Payer: WEA Trust Commercial |
$80.30
|
| Rate for Payer: WPS Commercial |
$108.14
|
|
|
WIRE 5-LEAD DUAL DISP 33135R
|
Facility
IP
|
$566.00
|
|
| Hospital Charge Code |
2965831
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$277.34 |
| Max. Negotiated Rate |
$520.72 |
| Rate for Payer: Aetna Commercial |
$509.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$299.98
|
| Rate for Payer: Cash Price |
$169.80
|
| Rate for Payer: Cigna Commercial |
$520.72
|
| Rate for Payer: Health EOS Commercial |
$503.74
|
| Rate for Payer: HFN Commercial |
$520.72
|
| Rate for Payer: Multiplan Commercial |
$452.80
|
| Rate for Payer: NAPHCARE Commercial |
$339.60
|
| Rate for Payer: Preferred Network Access Commercial |
$520.72
|
| Rate for Payer: Quartz Beloit One Network |
$277.34
|
| Rate for Payer: Quartz Commercial |
$339.60
|
| Rate for Payer: WEA Trust Commercial |
$311.30
|
| Rate for Payer: WPS Commercial |
$419.24
|
|
|
WIRE 5-LEAD DUAL DISP 33135R
|
Facility
OP
|
$566.00
|
|
| Hospital Charge Code |
2965831
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$158.48 |
| Max. Negotiated Rate |
$2,264.00 |
| Rate for Payer: Aetna Commercial |
$509.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$486.76
|
| Rate for Payer: Aetna Managed Medicare |
$158.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$367.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$283.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$271.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$299.98
|
| Rate for Payer: Cash Price |
$169.80
|
| Rate for Payer: Cigna Commercial |
$520.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$316.73
|
| Rate for Payer: Health EOS Commercial |
$503.74
|
| Rate for Payer: HFN Commercial |
$520.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$424.50
|
| Rate for Payer: Multiplan Commercial |
$452.80
|
| Rate for Payer: NAPHCARE Commercial |
$339.60
|
| Rate for Payer: Preferred Network Access Commercial |
$520.72
|
| Rate for Payer: Quartz Beloit One Network |
$277.34
|
| Rate for Payer: Quartz Commercial |
$367.90
|
| Rate for Payer: Quartz Medicare Advantage |
$339.60
|
| Rate for Payer: The Alliance Commercial |
$2,264.00
|
| Rate for Payer: WEA Trust Commercial |
$311.30
|
| Rate for Payer: WPS Commercial |
$419.24
|
|
|
WIRE ADX GUIDEWIRE PTFE 35 X 180CM FC ST BENTSON H7878141351800
|
Facility
IP
|
$2,516.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6200983
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,232.84 |
| Max. Negotiated Rate |
$2,314.72 |
| Rate for Payer: Aetna Commercial |
$2,264.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,333.48
|
| Rate for Payer: Cash Price |
$754.80
|
| Rate for Payer: Cigna Commercial |
$2,314.72
|
| Rate for Payer: Health EOS Commercial |
$2,239.24
|
| Rate for Payer: HFN Commercial |
$2,314.72
|
| Rate for Payer: Multiplan Commercial |
$2,012.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,509.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,314.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,232.84
|
| Rate for Payer: Quartz Commercial |
$1,509.60
|
| Rate for Payer: WEA Trust Commercial |
$1,383.80
|
| Rate for Payer: WPS Commercial |
$1,863.60
|
|
|
WIRE ADX GUIDEWIRE PTFE 35 X 180CM FC ST BENTSON H7878141351800
|
Facility
OP
|
$2,516.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6200983
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$704.48 |
| Max. Negotiated Rate |
$2,314.72 |
| Rate for Payer: Aetna Commercial |
$2,264.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,163.76
|
| Rate for Payer: Aetna Managed Medicare |
$704.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,635.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,258.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,207.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,333.48
|
| Rate for Payer: Cash Price |
$754.80
|
| Rate for Payer: Cigna Commercial |
$2,314.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,407.95
|
| Rate for Payer: Health EOS Commercial |
$2,239.24
|
| Rate for Payer: HFN Commercial |
$2,314.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,887.00
|
| Rate for Payer: Multiplan Commercial |
$2,012.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,509.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,314.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,232.84
|
| Rate for Payer: Quartz Commercial |
$1,635.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,509.60
|
| Rate for Payer: WEA Trust Commercial |
$1,383.80
|
| Rate for Payer: WPS Commercial |
$1,863.60
|
|
|
WIRE ALL-STAR CROSS-IT J .014
|
Facility
IP
|
$1,684.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2972403
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$825.16 |
| Max. Negotiated Rate |
$1,549.28 |
| Rate for Payer: Aetna Commercial |
$1,515.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$892.52
|
| Rate for Payer: Cash Price |
$505.20
|
| Rate for Payer: Cigna Commercial |
$1,549.28
|
| Rate for Payer: Health EOS Commercial |
$1,498.76
|
| Rate for Payer: HFN Commercial |
$1,549.28
|
| Rate for Payer: Multiplan Commercial |
$1,347.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,010.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,549.28
|
| Rate for Payer: Quartz Beloit One Network |
$825.16
|
| Rate for Payer: Quartz Commercial |
$1,010.40
|
| Rate for Payer: WEA Trust Commercial |
$926.20
|
| Rate for Payer: WPS Commercial |
$1,247.34
|
|
|
WIRE ALL-STAR CROSS-IT J .014
|
Facility
OP
|
$1,684.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2972403
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$471.52 |
| Max. Negotiated Rate |
$1,549.28 |
| Rate for Payer: Aetna Commercial |
$1,515.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,448.24
|
| Rate for Payer: Aetna Managed Medicare |
$471.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,094.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$842.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$808.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$892.52
|
| Rate for Payer: Cash Price |
$505.20
|
| Rate for Payer: Cigna Commercial |
$1,549.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$942.37
|
| Rate for Payer: Health EOS Commercial |
$1,498.76
|
| Rate for Payer: HFN Commercial |
$1,549.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,263.00
|
| Rate for Payer: Multiplan Commercial |
$1,347.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,010.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,549.28
|
| Rate for Payer: Quartz Beloit One Network |
$825.16
|
| Rate for Payer: Quartz Commercial |
$1,094.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,010.40
|
| Rate for Payer: WEA Trust Commercial |
$926.20
|
| Rate for Payer: WPS Commercial |
$1,247.34
|
|
|
WIRE AMPLATZ .025 180cm
|
Facility
IP
|
$511.00
|
|
| Hospital Charge Code |
2971340
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$250.39 |
| Max. Negotiated Rate |
$470.12 |
| Rate for Payer: Aetna Commercial |
$459.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$270.83
|
| Rate for Payer: Cash Price |
$153.30
|
| Rate for Payer: Cigna Commercial |
$470.12
|
| Rate for Payer: Health EOS Commercial |
$454.79
|
| Rate for Payer: HFN Commercial |
$470.12
|
| Rate for Payer: Multiplan Commercial |
$408.80
|
| Rate for Payer: NAPHCARE Commercial |
$306.60
|
| Rate for Payer: Preferred Network Access Commercial |
$470.12
|
| Rate for Payer: Quartz Beloit One Network |
$250.39
|
| Rate for Payer: Quartz Commercial |
$306.60
|
| Rate for Payer: WEA Trust Commercial |
$281.05
|
| Rate for Payer: WPS Commercial |
$378.50
|
|
|
WIRE AMPLATZ .025 180cm
|
Facility
OP
|
$511.00
|
|
| Hospital Charge Code |
2971340
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$143.08 |
| Max. Negotiated Rate |
$2,044.00 |
| Rate for Payer: Aetna Commercial |
$459.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$439.46
|
| Rate for Payer: Aetna Managed Medicare |
$143.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$332.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$255.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$245.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$270.83
|
| Rate for Payer: Cash Price |
$153.30
|
| Rate for Payer: Cigna Commercial |
$470.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$285.96
|
| Rate for Payer: Health EOS Commercial |
$454.79
|
| Rate for Payer: HFN Commercial |
$470.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$383.25
|
| Rate for Payer: Multiplan Commercial |
$408.80
|
| Rate for Payer: NAPHCARE Commercial |
$306.60
|
| Rate for Payer: Preferred Network Access Commercial |
$470.12
|
| Rate for Payer: Quartz Beloit One Network |
$250.39
|
| Rate for Payer: Quartz Commercial |
$332.15
|
| Rate for Payer: Quartz Medicare Advantage |
$306.60
|
| Rate for Payer: The Alliance Commercial |
$2,044.00
|
| Rate for Payer: WEA Trust Commercial |
$281.05
|
| Rate for Payer: WPS Commercial |
$378.50
|
|
|
WIRE BOLT LONG HOFFMANN LIMB 4933-1-003
|
Facility
IP
|
$1,276.00
|
|
| Hospital Charge Code |
6001637
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$625.24 |
| Max. Negotiated Rate |
$1,173.92 |
| Rate for Payer: Aetna Commercial |
$1,148.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$676.28
|
| Rate for Payer: Cash Price |
$382.80
|
| Rate for Payer: Cigna Commercial |
$1,173.92
|
| Rate for Payer: Health EOS Commercial |
$1,135.64
|
| Rate for Payer: HFN Commercial |
$1,173.92
|
| Rate for Payer: Multiplan Commercial |
$1,020.80
|
| Rate for Payer: NAPHCARE Commercial |
$765.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,173.92
|
| Rate for Payer: Quartz Beloit One Network |
$625.24
|
| Rate for Payer: Quartz Commercial |
$765.60
|
| Rate for Payer: WEA Trust Commercial |
$701.80
|
| Rate for Payer: WPS Commercial |
$945.13
|
|
|
WIRE BOLT LONG HOFFMANN LIMB 4933-1-003
|
Facility
OP
|
$1,276.00
|
|
| Hospital Charge Code |
6001637
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$357.28 |
| Max. Negotiated Rate |
$5,104.00 |
| Rate for Payer: Aetna Commercial |
$1,148.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,097.36
|
| Rate for Payer: Aetna Managed Medicare |
$357.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$829.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$638.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$612.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$676.28
|
| Rate for Payer: Cash Price |
$382.80
|
| Rate for Payer: Cigna Commercial |
$1,173.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$714.05
|
| Rate for Payer: Health EOS Commercial |
$1,135.64
|
| Rate for Payer: HFN Commercial |
$1,173.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$957.00
|
| Rate for Payer: Multiplan Commercial |
$1,020.80
|
| Rate for Payer: NAPHCARE Commercial |
$765.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,173.92
|
| Rate for Payer: Quartz Beloit One Network |
$625.24
|
| Rate for Payer: Quartz Commercial |
$829.40
|
| Rate for Payer: Quartz Medicare Advantage |
$765.60
|
| Rate for Payer: The Alliance Commercial |
$5,104.00
|
| Rate for Payer: WEA Trust Commercial |
$701.80
|
| Rate for Payer: WPS Commercial |
$945.13
|
|
|
WIRE BOLT MEDIUM HOFFMANN LIMB 4933-1-002
|
Facility
IP
|
$1,327.00
|
|
| Hospital Charge Code |
5611673
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$650.23 |
| Max. Negotiated Rate |
$1,220.84 |
| Rate for Payer: Aetna Commercial |
$1,194.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$703.31
|
| Rate for Payer: Cash Price |
$398.10
|
| Rate for Payer: Cigna Commercial |
$1,220.84
|
| Rate for Payer: Health EOS Commercial |
$1,181.03
|
| Rate for Payer: HFN Commercial |
$1,220.84
|
| Rate for Payer: Multiplan Commercial |
$1,061.60
|
| Rate for Payer: NAPHCARE Commercial |
$796.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,220.84
|
| Rate for Payer: Quartz Beloit One Network |
$650.23
|
| Rate for Payer: Quartz Commercial |
$796.20
|
| Rate for Payer: WEA Trust Commercial |
$729.85
|
| Rate for Payer: WPS Commercial |
$982.91
|
|
