|
WIRE BOLT MEDIUM HOFFMANN LIMB 4933-1-002
|
Facility
OP
|
$1,327.00
|
|
| Hospital Charge Code |
5611673
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$371.56 |
| Max. Negotiated Rate |
$5,308.00 |
| Rate for Payer: Aetna Commercial |
$1,194.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,141.22
|
| Rate for Payer: Aetna Managed Medicare |
$371.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$862.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$663.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$636.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$703.31
|
| Rate for Payer: Cash Price |
$398.10
|
| Rate for Payer: Cigna Commercial |
$1,220.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$742.59
|
| Rate for Payer: Health EOS Commercial |
$1,181.03
|
| Rate for Payer: HFN Commercial |
$1,220.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$995.25
|
| Rate for Payer: Multiplan Commercial |
$1,061.60
|
| Rate for Payer: NAPHCARE Commercial |
$796.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,220.84
|
| Rate for Payer: Quartz Beloit One Network |
$650.23
|
| Rate for Payer: Quartz Commercial |
$862.55
|
| Rate for Payer: Quartz Medicare Advantage |
$796.20
|
| Rate for Payer: The Alliance Commercial |
$5,308.00
|
| Rate for Payer: WEA Trust Commercial |
$729.85
|
| Rate for Payer: WPS Commercial |
$982.91
|
|
|
WIRE BOLT SHORT HOFFMANN LIMB 4933-1-001
|
Facility
OP
|
$1,380.00
|
|
| Hospital Charge Code |
5599704
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$386.40 |
| Max. Negotiated Rate |
$5,520.00 |
| Rate for Payer: Aetna Commercial |
$1,242.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,186.80
|
| Rate for Payer: Aetna Managed Medicare |
$386.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$897.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$690.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$662.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$731.40
|
| Rate for Payer: Cash Price |
$414.00
|
| Rate for Payer: Cigna Commercial |
$1,269.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$772.25
|
| Rate for Payer: Health EOS Commercial |
$1,228.20
|
| Rate for Payer: HFN Commercial |
$1,269.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,035.00
|
| Rate for Payer: Multiplan Commercial |
$1,104.00
|
| Rate for Payer: NAPHCARE Commercial |
$828.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,269.60
|
| Rate for Payer: Quartz Beloit One Network |
$676.20
|
| Rate for Payer: Quartz Commercial |
$897.00
|
| Rate for Payer: Quartz Medicare Advantage |
$828.00
|
| Rate for Payer: The Alliance Commercial |
$5,520.00
|
| Rate for Payer: WEA Trust Commercial |
$759.00
|
| Rate for Payer: WPS Commercial |
$1,022.17
|
|
|
WIRE BOLT SHORT HOFFMANN LIMB 4933-1-001
|
Facility
IP
|
$1,380.00
|
|
| Hospital Charge Code |
5599704
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$676.20 |
| Max. Negotiated Rate |
$1,269.60 |
| Rate for Payer: Aetna Commercial |
$1,242.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$731.40
|
| Rate for Payer: Cash Price |
$414.00
|
| Rate for Payer: Cigna Commercial |
$1,269.60
|
| Rate for Payer: Health EOS Commercial |
$1,228.20
|
| Rate for Payer: HFN Commercial |
$1,269.60
|
| Rate for Payer: Multiplan Commercial |
$1,104.00
|
| Rate for Payer: NAPHCARE Commercial |
$828.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,269.60
|
| Rate for Payer: Quartz Beloit One Network |
$676.20
|
| Rate for Payer: Quartz Commercial |
$828.00
|
| Rate for Payer: WEA Trust Commercial |
$759.00
|
| Rate for Payer: WPS Commercial |
$1,022.17
|
|
|
WIRE CLIP TORQUER 22196-003
|
Facility
OP
|
$138.00
|
|
| Hospital Charge Code |
3609495
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.64 |
| Max. Negotiated Rate |
$552.00 |
| Rate for Payer: Aetna Commercial |
$124.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$118.68
|
| Rate for Payer: Aetna Managed Medicare |
$38.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$89.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$69.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$66.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.14
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cigna Commercial |
$126.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$77.22
|
| Rate for Payer: Health EOS Commercial |
$122.82
|
| Rate for Payer: HFN Commercial |
$126.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$103.50
|
| Rate for Payer: Multiplan Commercial |
$110.40
|
| Rate for Payer: NAPHCARE Commercial |
$82.80
|
| Rate for Payer: Preferred Network Access Commercial |
$126.96
|
| Rate for Payer: Quartz Beloit One Network |
$67.62
|
| Rate for Payer: Quartz Commercial |
$89.70
|
| Rate for Payer: Quartz Medicare Advantage |
$82.80
|
| Rate for Payer: The Alliance Commercial |
$552.00
|
| Rate for Payer: WEA Trust Commercial |
$75.90
|
| Rate for Payer: WPS Commercial |
$102.22
|
|
|
WIRE CLIP TORQUER 22196-003
|
Facility
IP
|
$138.00
|
|
| Hospital Charge Code |
3609495
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.62 |
| Max. Negotiated Rate |
$126.96 |
| Rate for Payer: Aetna Commercial |
$124.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.14
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cigna Commercial |
$126.96
|
| Rate for Payer: Health EOS Commercial |
$122.82
|
| Rate for Payer: HFN Commercial |
$126.96
|
| Rate for Payer: Multiplan Commercial |
$110.40
|
| Rate for Payer: NAPHCARE Commercial |
$82.80
|
| Rate for Payer: Preferred Network Access Commercial |
$126.96
|
| Rate for Payer: Quartz Beloit One Network |
$67.62
|
| Rate for Payer: Quartz Commercial |
$82.80
|
| Rate for Payer: WEA Trust Commercial |
$75.90
|
| Rate for Payer: WPS Commercial |
$102.22
|
|
|
WIRE CV PACER 025-100
|
Facility
IP
|
$302.00
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
2965150
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$147.98 |
| Max. Negotiated Rate |
$277.84 |
| Rate for Payer: Aetna Commercial |
$271.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$160.06
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna Commercial |
$277.84
|
| Rate for Payer: Health EOS Commercial |
$268.78
|
| Rate for Payer: HFN Commercial |
$277.84
|
| Rate for Payer: Multiplan Commercial |
$241.60
|
| Rate for Payer: NAPHCARE Commercial |
$181.20
|
| Rate for Payer: Preferred Network Access Commercial |
$277.84
|
| Rate for Payer: Quartz Beloit One Network |
$147.98
|
| Rate for Payer: Quartz Commercial |
$181.20
|
| Rate for Payer: WEA Trust Commercial |
$166.10
|
| Rate for Payer: WPS Commercial |
$223.69
|
|
|
WIRE CV PACER 025-100
|
Facility
OP
|
$302.00
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
2965150
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$84.56 |
| Max. Negotiated Rate |
$277.84 |
| Rate for Payer: Aetna Commercial |
$271.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$259.72
|
| Rate for Payer: Aetna Managed Medicare |
$84.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$196.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$151.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$144.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$160.06
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna Commercial |
$277.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$169.00
|
| Rate for Payer: Health EOS Commercial |
$268.78
|
| Rate for Payer: HFN Commercial |
$277.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$226.50
|
| Rate for Payer: Multiplan Commercial |
$241.60
|
| Rate for Payer: NAPHCARE Commercial |
$181.20
|
| Rate for Payer: Preferred Network Access Commercial |
$277.84
|
| Rate for Payer: Quartz Beloit One Network |
$147.98
|
| Rate for Payer: Quartz Commercial |
$196.30
|
| Rate for Payer: Quartz Medicare Advantage |
$181.20
|
| Rate for Payer: WEA Trust Commercial |
$166.10
|
| Rate for Payer: WPS Commercial |
$223.69
|
|
|
WIRE DOUBLE STERNAL 046-237
|
Facility
OP
|
$1,353.00
|
|
| Hospital Charge Code |
2965502
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$378.84 |
| Max. Negotiated Rate |
$5,412.00 |
| Rate for Payer: Aetna Commercial |
$1,217.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,163.58
|
| Rate for Payer: Aetna Managed Medicare |
$378.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$879.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$676.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$649.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$717.09
|
| Rate for Payer: Cash Price |
$405.90
|
| Rate for Payer: Cigna Commercial |
$1,244.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$757.14
|
| Rate for Payer: Health EOS Commercial |
$1,204.17
|
| Rate for Payer: HFN Commercial |
$1,244.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,014.75
|
| Rate for Payer: Multiplan Commercial |
$1,082.40
|
| Rate for Payer: NAPHCARE Commercial |
$811.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,244.76
|
| Rate for Payer: Quartz Beloit One Network |
$662.97
|
| Rate for Payer: Quartz Commercial |
$879.45
|
| Rate for Payer: Quartz Medicare Advantage |
$811.80
|
| Rate for Payer: The Alliance Commercial |
$5,412.00
|
| Rate for Payer: WEA Trust Commercial |
$744.15
|
| Rate for Payer: WPS Commercial |
$1,002.17
|
|
|
WIRE DOUBLE STERNAL 046-237
|
Facility
IP
|
$1,353.00
|
|
| Hospital Charge Code |
2965502
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$662.97 |
| Max. Negotiated Rate |
$1,244.76 |
| Rate for Payer: Aetna Commercial |
$1,217.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$717.09
|
| Rate for Payer: Cash Price |
$405.90
|
| Rate for Payer: Cigna Commercial |
$1,244.76
|
| Rate for Payer: Health EOS Commercial |
$1,204.17
|
| Rate for Payer: HFN Commercial |
$1,244.76
|
| Rate for Payer: Multiplan Commercial |
$1,082.40
|
| Rate for Payer: NAPHCARE Commercial |
$811.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,244.76
|
| Rate for Payer: Quartz Beloit One Network |
$662.97
|
| Rate for Payer: Quartz Commercial |
$811.80
|
| Rate for Payer: WEA Trust Commercial |
$744.15
|
| Rate for Payer: WPS Commercial |
$1,002.17
|
|
|
WIRE GUIDE 17.0/3.2MMx161MM
|
Facility
IP
|
$3,222.00
|
|
| Hospital Charge Code |
2966596
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,578.78 |
| Max. Negotiated Rate |
$2,964.24 |
| Rate for Payer: Aetna Commercial |
$2,899.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,707.66
|
| Rate for Payer: Cash Price |
$966.60
|
| Rate for Payer: Cigna Commercial |
$2,964.24
|
| Rate for Payer: Health EOS Commercial |
$2,867.58
|
| Rate for Payer: HFN Commercial |
$2,964.24
|
| Rate for Payer: Multiplan Commercial |
$2,577.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,933.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,964.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,578.78
|
| Rate for Payer: Quartz Commercial |
$1,933.20
|
| Rate for Payer: WEA Trust Commercial |
$1,772.10
|
| Rate for Payer: WPS Commercial |
$2,386.54
|
|
|
WIRE GUIDE 17.0/3.2MMx161MM
|
Facility
OP
|
$3,222.00
|
|
| Hospital Charge Code |
2966596
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$902.16 |
| Max. Negotiated Rate |
$12,888.00 |
| Rate for Payer: Aetna Commercial |
$2,899.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,770.92
|
| Rate for Payer: Aetna Managed Medicare |
$902.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,094.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,611.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,546.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,707.66
|
| Rate for Payer: Cash Price |
$966.60
|
| Rate for Payer: Cigna Commercial |
$2,964.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,803.03
|
| Rate for Payer: Health EOS Commercial |
$2,867.58
|
| Rate for Payer: HFN Commercial |
$2,964.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,416.50
|
| Rate for Payer: Multiplan Commercial |
$2,577.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,933.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,964.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,578.78
|
| Rate for Payer: Quartz Commercial |
$2,094.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,933.20
|
| Rate for Payer: The Alliance Commercial |
$12,888.00
|
| Rate for Payer: WEA Trust Commercial |
$1,772.10
|
| Rate for Payer: WPS Commercial |
$2,386.54
|
|
|
WIRE HIWIRE HYDROPHILIC WIRE GUIDE 180CM X 15CM X 3CM .035 G56174
|
Facility
OP
|
$668.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6217121
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$187.04 |
| Max. Negotiated Rate |
$614.56 |
| Rate for Payer: Aetna Commercial |
$601.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$574.48
|
| Rate for Payer: Aetna Managed Medicare |
$187.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$434.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$334.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$320.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$354.04
|
| Rate for Payer: Cash Price |
$200.40
|
| Rate for Payer: Cigna Commercial |
$614.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$373.81
|
| Rate for Payer: Health EOS Commercial |
$594.52
|
| Rate for Payer: HFN Commercial |
$614.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$501.00
|
| Rate for Payer: Multiplan Commercial |
$534.40
|
| Rate for Payer: NAPHCARE Commercial |
$400.80
|
| Rate for Payer: Preferred Network Access Commercial |
$614.56
|
| Rate for Payer: Quartz Beloit One Network |
$327.32
|
| Rate for Payer: Quartz Commercial |
$434.20
|
| Rate for Payer: Quartz Medicare Advantage |
$400.80
|
| Rate for Payer: WEA Trust Commercial |
$367.40
|
| Rate for Payer: WPS Commercial |
$494.79
|
|
|
WIRE HIWIRE HYDROPHILIC WIRE GUIDE 180CM X 15CM X 3CM .035 G56174
|
Facility
IP
|
$668.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6217121
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$327.32 |
| Max. Negotiated Rate |
$614.56 |
| Rate for Payer: Aetna Commercial |
$601.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$354.04
|
| Rate for Payer: Cash Price |
$200.40
|
| Rate for Payer: Cigna Commercial |
$614.56
|
| Rate for Payer: Health EOS Commercial |
$594.52
|
| Rate for Payer: HFN Commercial |
$614.56
|
| Rate for Payer: Multiplan Commercial |
$534.40
|
| Rate for Payer: NAPHCARE Commercial |
$400.80
|
| Rate for Payer: Preferred Network Access Commercial |
$614.56
|
| Rate for Payer: Quartz Beloit One Network |
$327.32
|
| Rate for Payer: Quartz Commercial |
$400.80
|
| Rate for Payer: WEA Trust Commercial |
$367.40
|
| Rate for Payer: WPS Commercial |
$494.79
|
|
|
WIRE HIWIRE HYDROPHILIC WIRE GUIDE 180CM X 22CM X 3CM .035 G36292
|
Facility
OP
|
$453.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6201002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$126.84 |
| Max. Negotiated Rate |
$416.76 |
| Rate for Payer: Aetna Commercial |
$407.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$389.58
|
| Rate for Payer: Aetna Managed Medicare |
$126.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$294.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$226.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$217.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$240.09
|
| Rate for Payer: Cash Price |
$135.90
|
| Rate for Payer: Cigna Commercial |
$416.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$253.50
|
| Rate for Payer: Health EOS Commercial |
$403.17
|
| Rate for Payer: HFN Commercial |
$416.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$339.75
|
| Rate for Payer: Multiplan Commercial |
$362.40
|
| Rate for Payer: NAPHCARE Commercial |
$271.80
|
| Rate for Payer: Preferred Network Access Commercial |
$416.76
|
| Rate for Payer: Quartz Beloit One Network |
$221.97
|
| Rate for Payer: Quartz Commercial |
$294.45
|
| Rate for Payer: Quartz Medicare Advantage |
$271.80
|
| Rate for Payer: WEA Trust Commercial |
$249.15
|
| Rate for Payer: WPS Commercial |
$335.54
|
|
|
WIRE HIWIRE HYDROPHILIC WIRE GUIDE 180CM X 22CM X 3CM .035 G36292
|
Facility
IP
|
$453.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6201002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$221.97 |
| Max. Negotiated Rate |
$416.76 |
| Rate for Payer: Aetna Commercial |
$407.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$240.09
|
| Rate for Payer: Cash Price |
$135.90
|
| Rate for Payer: Cigna Commercial |
$416.76
|
| Rate for Payer: Health EOS Commercial |
$403.17
|
| Rate for Payer: HFN Commercial |
$416.76
|
| Rate for Payer: Multiplan Commercial |
$362.40
|
| Rate for Payer: NAPHCARE Commercial |
$271.80
|
| Rate for Payer: Preferred Network Access Commercial |
$416.76
|
| Rate for Payer: Quartz Beloit One Network |
$221.97
|
| Rate for Payer: Quartz Commercial |
$271.80
|
| Rate for Payer: WEA Trust Commercial |
$249.15
|
| Rate for Payer: WPS Commercial |
$335.54
|
|
|
WIRE HYDRA ANG .035 X 260cm M00556010
|
Facility
OP
|
$2,368.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2973415
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$663.04 |
| Max. Negotiated Rate |
$2,178.56 |
| Rate for Payer: Aetna Commercial |
$2,131.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,036.48
|
| Rate for Payer: Aetna Managed Medicare |
$663.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,539.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,184.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,136.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,255.04
|
| Rate for Payer: Cash Price |
$710.40
|
| Rate for Payer: Cigna Commercial |
$2,178.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,325.13
|
| Rate for Payer: Health EOS Commercial |
$2,107.52
|
| Rate for Payer: HFN Commercial |
$2,178.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,776.00
|
| Rate for Payer: Multiplan Commercial |
$1,894.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,420.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,178.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,160.32
|
| Rate for Payer: Quartz Commercial |
$1,539.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,420.80
|
| Rate for Payer: WEA Trust Commercial |
$1,302.40
|
| Rate for Payer: WPS Commercial |
$1,753.98
|
|
|
WIRE HYDRA ANG .035 X 260cm M00556010
|
Facility
IP
|
$2,368.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2973415
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,160.32 |
| Max. Negotiated Rate |
$2,178.56 |
| Rate for Payer: Aetna Commercial |
$2,131.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,255.04
|
| Rate for Payer: Cash Price |
$710.40
|
| Rate for Payer: Cigna Commercial |
$2,178.56
|
| Rate for Payer: Health EOS Commercial |
$2,107.52
|
| Rate for Payer: HFN Commercial |
$2,178.56
|
| Rate for Payer: Multiplan Commercial |
$1,894.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,420.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,178.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,160.32
|
| Rate for Payer: Quartz Commercial |
$1,420.80
|
| Rate for Payer: WEA Trust Commercial |
$1,302.40
|
| Rate for Payer: WPS Commercial |
$1,753.98
|
|
|
WIRE HYDRA STR .035 X 260cm M00556001
|
Facility
IP
|
$2,280.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2973414
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,117.20 |
| Max. Negotiated Rate |
$2,097.60 |
| Rate for Payer: Aetna Commercial |
$2,052.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,208.40
|
| Rate for Payer: Cash Price |
$684.00
|
| Rate for Payer: Cigna Commercial |
$2,097.60
|
| Rate for Payer: Health EOS Commercial |
$2,029.20
|
| Rate for Payer: HFN Commercial |
$2,097.60
|
| Rate for Payer: Multiplan Commercial |
$1,824.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,368.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,097.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,117.20
|
| Rate for Payer: Quartz Commercial |
$1,368.00
|
| Rate for Payer: WEA Trust Commercial |
$1,254.00
|
| Rate for Payer: WPS Commercial |
$1,688.80
|
|
|
WIRE HYDRA STR .035 X 260cm M00556001
|
Facility
OP
|
$2,280.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2973414
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$638.40 |
| Max. Negotiated Rate |
$2,097.60 |
| Rate for Payer: Aetna Commercial |
$2,052.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,960.80
|
| Rate for Payer: Aetna Managed Medicare |
$638.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,482.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,140.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,094.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,208.40
|
| Rate for Payer: Cash Price |
$684.00
|
| Rate for Payer: Cigna Commercial |
$2,097.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,275.89
|
| Rate for Payer: Health EOS Commercial |
$2,029.20
|
| Rate for Payer: HFN Commercial |
$2,097.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,710.00
|
| Rate for Payer: Multiplan Commercial |
$1,824.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,368.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,097.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,117.20
|
| Rate for Payer: Quartz Commercial |
$1,482.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,368.00
|
| Rate for Payer: WEA Trust Commercial |
$1,254.00
|
| Rate for Payer: WPS Commercial |
$1,688.80
|
|
|
WIRE JAW 23GA
|
Facility
OP
|
$614.00
|
|
| Hospital Charge Code |
2965099
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$171.92 |
| Max. Negotiated Rate |
$2,456.00 |
| Rate for Payer: Aetna Commercial |
$552.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$528.04
|
| Rate for Payer: Aetna Managed Medicare |
$171.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$399.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$307.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$294.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$325.42
|
| Rate for Payer: Cash Price |
$184.20
|
| Rate for Payer: Cigna Commercial |
$564.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$343.59
|
| Rate for Payer: Health EOS Commercial |
$546.46
|
| Rate for Payer: HFN Commercial |
$564.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$460.50
|
| Rate for Payer: Multiplan Commercial |
$491.20
|
| Rate for Payer: NAPHCARE Commercial |
$368.40
|
| Rate for Payer: Preferred Network Access Commercial |
$564.88
|
| Rate for Payer: Quartz Beloit One Network |
$300.86
|
| Rate for Payer: Quartz Commercial |
$399.10
|
| Rate for Payer: Quartz Medicare Advantage |
$368.40
|
| Rate for Payer: The Alliance Commercial |
$2,456.00
|
| Rate for Payer: WEA Trust Commercial |
$337.70
|
| Rate for Payer: WPS Commercial |
$454.79
|
|
|
WIRE JAW 23GA
|
Facility
IP
|
$614.00
|
|
| Hospital Charge Code |
2965099
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$300.86 |
| Max. Negotiated Rate |
$564.88 |
| Rate for Payer: Aetna Commercial |
$552.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$325.42
|
| Rate for Payer: Cash Price |
$184.20
|
| Rate for Payer: Cigna Commercial |
$564.88
|
| Rate for Payer: Health EOS Commercial |
$546.46
|
| Rate for Payer: HFN Commercial |
$564.88
|
| Rate for Payer: Multiplan Commercial |
$491.20
|
| Rate for Payer: NAPHCARE Commercial |
$368.40
|
| Rate for Payer: Preferred Network Access Commercial |
$564.88
|
| Rate for Payer: Quartz Beloit One Network |
$300.86
|
| Rate for Payer: Quartz Commercial |
$368.40
|
| Rate for Payer: WEA Trust Commercial |
$337.70
|
| Rate for Payer: WPS Commercial |
$454.79
|
|
|
WIRE JAW FRACTURE 26GA
|
Facility
OP
|
$614.00
|
|
| Hospital Charge Code |
2965101
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$171.92 |
| Max. Negotiated Rate |
$2,456.00 |
| Rate for Payer: Aetna Commercial |
$552.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$528.04
|
| Rate for Payer: Aetna Managed Medicare |
$171.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$399.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$307.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$294.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$325.42
|
| Rate for Payer: Cash Price |
$184.20
|
| Rate for Payer: Cigna Commercial |
$564.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$343.59
|
| Rate for Payer: Health EOS Commercial |
$546.46
|
| Rate for Payer: HFN Commercial |
$564.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$460.50
|
| Rate for Payer: Multiplan Commercial |
$491.20
|
| Rate for Payer: NAPHCARE Commercial |
$368.40
|
| Rate for Payer: Preferred Network Access Commercial |
$564.88
|
| Rate for Payer: Quartz Beloit One Network |
$300.86
|
| Rate for Payer: Quartz Commercial |
$399.10
|
| Rate for Payer: Quartz Medicare Advantage |
$368.40
|
| Rate for Payer: The Alliance Commercial |
$2,456.00
|
| Rate for Payer: WEA Trust Commercial |
$337.70
|
| Rate for Payer: WPS Commercial |
$454.79
|
|
|
WIRE JAW FRACTURE 26GA
|
Facility
IP
|
$614.00
|
|
| Hospital Charge Code |
2965101
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$300.86 |
| Max. Negotiated Rate |
$564.88 |
| Rate for Payer: Aetna Commercial |
$552.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$325.42
|
| Rate for Payer: Cash Price |
$184.20
|
| Rate for Payer: Cigna Commercial |
$564.88
|
| Rate for Payer: Health EOS Commercial |
$546.46
|
| Rate for Payer: HFN Commercial |
$564.88
|
| Rate for Payer: Multiplan Commercial |
$491.20
|
| Rate for Payer: NAPHCARE Commercial |
$368.40
|
| Rate for Payer: Preferred Network Access Commercial |
$564.88
|
| Rate for Payer: Quartz Beloit One Network |
$300.86
|
| Rate for Payer: Quartz Commercial |
$368.40
|
| Rate for Payer: WEA Trust Commercial |
$337.70
|
| Rate for Payer: WPS Commercial |
$454.79
|
|
|
WIRE LOOP CERCLAGE 16G 00-1292-061-00
|
Facility
OP
|
$750.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2962841
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$1,196.24 |
| Rate for Payer: Aetna Commercial |
$675.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$645.00
|
| Rate for Payer: Aetna Managed Medicare |
$210.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$487.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$375.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$360.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$397.50
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$690.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$419.70
|
| Rate for Payer: Health EOS Commercial |
$667.50
|
| Rate for Payer: HFN Commercial |
$690.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$562.50
|
| Rate for Payer: Multiplan Commercial |
$600.00
|
| Rate for Payer: NAPHCARE Commercial |
$450.00
|
| Rate for Payer: Preferred Network Access Commercial |
$690.00
|
| Rate for Payer: Quartz Beloit One Network |
$367.50
|
| Rate for Payer: Quartz Commercial |
$487.50
|
| Rate for Payer: Quartz Medicare Advantage |
$450.00
|
| Rate for Payer: The Alliance Commercial |
$1,196.24
|
| Rate for Payer: WEA Trust Commercial |
$412.50
|
| Rate for Payer: WPS Commercial |
$555.52
|
|
|
WIRE LOOP CERCLAGE 16G 00-1292-061-00
|
Facility
IP
|
$750.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2962841
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$367.50 |
| Max. Negotiated Rate |
$690.00 |
| Rate for Payer: Aetna Commercial |
$675.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$397.50
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$690.00
|
| Rate for Payer: Health EOS Commercial |
$667.50
|
| Rate for Payer: HFN Commercial |
$690.00
|
| Rate for Payer: Multiplan Commercial |
$600.00
|
| Rate for Payer: NAPHCARE Commercial |
$450.00
|
| Rate for Payer: Preferred Network Access Commercial |
$690.00
|
| Rate for Payer: Quartz Beloit One Network |
$367.50
|
| Rate for Payer: Quartz Commercial |
$450.00
|
| Rate for Payer: WEA Trust Commercial |
$412.50
|
| Rate for Payer: WPS Commercial |
$555.52
|
|
