|
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 |
$294.20 |
| Max. Negotiated Rate |
$2,724.97 |
| Rate for Payer: Aetna Commercial |
$2,665.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,547.25
|
| Rate for Payer: Aetna Managed Medicare |
$294.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,103.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$514.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$488.36
|
| Rate for Payer: Anthem Medicare Advantage |
$294.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,569.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$294.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$294.20
|
| Rate for Payer: Cash Price |
$854.40
|
| Rate for Payer: Cash Price |
$854.40
|
| Rate for Payer: Cigna Commercial |
$2,724.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$294.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,657.54
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$294.20
|
| Rate for Payer: Health EOS Commercial |
$2,636.11
|
| Rate for Payer: HFN Commercial |
$2,724.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,094.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$294.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$294.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$294.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$294.20
|
| Rate for Payer: Multiplan Commercial |
$2,369.54
|
| Rate for Payer: NAPHCARE Commercial |
$441.29
|
| Rate for Payer: Preferred Network Access Commercial |
$2,724.97
|
| Rate for Payer: Quartz Beloit One Network |
$1,451.34
|
| Rate for Payer: Quartz Commercial |
$1,925.25
|
| Rate for Payer: Quartz Medicare Advantage |
$294.20
|
| Rate for Payer: The Alliance Commercial |
$1,176.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$294.20
|
| Rate for Payer: United Healthcare PPO |
$2,221.44
|
| Rate for Payer: WEA Trust Commercial |
$1,629.06
|
| Rate for Payer: Wellcare Medicare |
$294.20
|
| Rate for Payer: WPS Commercial |
$2,193.81
|
|
|
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 |
$1,451.34 |
| Max. Negotiated Rate |
$2,724.97 |
| Rate for Payer: Aetna Commercial |
$2,665.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,547.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,569.82
|
| Rate for Payer: Cash Price |
$854.40
|
| Rate for Payer: Cigna Commercial |
$2,724.97
|
| Rate for Payer: Health EOS Commercial |
$2,636.11
|
| Rate for Payer: HFN Commercial |
$2,724.97
|
| Rate for Payer: Multiplan Commercial |
$2,369.54
|
| Rate for Payer: Preferred Network Access Commercial |
$2,724.97
|
| Rate for Payer: Quartz Beloit One Network |
$1,451.34
|
| Rate for Payer: Quartz Commercial |
$1,777.15
|
| Rate for Payer: WEA Trust Commercial |
$1,629.06
|
| Rate for Payer: WPS Commercial |
$2,193.81
|
|
|
WIPES BABY UNSCENTED SENSITIVE
|
Facility
|
OP
|
$93.00
|
|
| Hospital Charge Code |
2963837
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$27.08 |
| Max. Negotiated Rate |
$88.98 |
| Rate for Payer: Aetna Commercial |
$87.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.18
|
| Rate for Payer: Aetna Managed Medicare |
$27.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$62.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$48.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$46.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.26
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$88.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.13
|
| Rate for Payer: Health EOS Commercial |
$86.08
|
| Rate for Payer: HFN Commercial |
$88.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$72.54
|
| Rate for Payer: Multiplan Commercial |
$77.38
|
| Rate for Payer: NAPHCARE Commercial |
$58.03
|
| Rate for Payer: Preferred Network Access Commercial |
$88.98
|
| Rate for Payer: Quartz Beloit One Network |
$47.39
|
| Rate for Payer: Quartz Commercial |
$62.87
|
| Rate for Payer: Quartz Medicare Advantage |
$58.03
|
| Rate for Payer: The Alliance Commercial |
$48.36
|
| Rate for Payer: WEA Trust Commercial |
$53.20
|
| Rate for Payer: WPS Commercial |
$71.64
|
|
|
WIPES BABY UNSCENTED SENSITIVE
|
Facility
|
IP
|
$93.00
|
|
| Hospital Charge Code |
2963837
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$47.39 |
| Max. Negotiated Rate |
$88.98 |
| Rate for Payer: Aetna Commercial |
$87.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.26
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$88.98
|
| Rate for Payer: Health EOS Commercial |
$86.08
|
| Rate for Payer: HFN Commercial |
$88.98
|
| Rate for Payer: Multiplan Commercial |
$77.38
|
| Rate for Payer: Preferred Network Access Commercial |
$88.98
|
| Rate for Payer: Quartz Beloit One Network |
$47.39
|
| Rate for Payer: Quartz Commercial |
$58.03
|
| Rate for Payer: WEA Trust Commercial |
$53.20
|
| Rate for Payer: WPS Commercial |
$71.64
|
|
|
WIPES EXFO
|
Facility
|
OP
|
$293.00
|
|
| Hospital Charge Code |
2970883
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$85.32 |
| Max. Negotiated Rate |
$280.34 |
| Rate for Payer: Aetna Commercial |
$274.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$262.06
|
| Rate for Payer: Aetna Managed Medicare |
$85.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$198.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$152.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$146.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$161.50
|
| Rate for Payer: Cash Price |
$87.90
|
| Rate for Payer: Cigna Commercial |
$280.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$170.53
|
| Rate for Payer: Health EOS Commercial |
$271.20
|
| Rate for Payer: HFN Commercial |
$280.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$228.54
|
| Rate for Payer: Multiplan Commercial |
$243.78
|
| Rate for Payer: NAPHCARE Commercial |
$182.83
|
| Rate for Payer: Preferred Network Access Commercial |
$280.34
|
| Rate for Payer: Quartz Beloit One Network |
$149.31
|
| Rate for Payer: Quartz Commercial |
$198.07
|
| Rate for Payer: Quartz Medicare Advantage |
$182.83
|
| Rate for Payer: The Alliance Commercial |
$152.36
|
| Rate for Payer: WEA Trust Commercial |
$167.60
|
| Rate for Payer: WPS Commercial |
$225.70
|
|
|
WIPES EXFO
|
Facility
|
IP
|
$293.00
|
|
| Hospital Charge Code |
2970883
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$149.31 |
| Max. Negotiated Rate |
$280.34 |
| Rate for Payer: Aetna Commercial |
$274.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$262.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$161.50
|
| Rate for Payer: Cash Price |
$87.90
|
| Rate for Payer: Cigna Commercial |
$280.34
|
| Rate for Payer: Health EOS Commercial |
$271.20
|
| Rate for Payer: HFN Commercial |
$280.34
|
| Rate for Payer: Multiplan Commercial |
$243.78
|
| Rate for Payer: Preferred Network Access Commercial |
$280.34
|
| Rate for Payer: Quartz Beloit One Network |
$149.31
|
| Rate for Payer: Quartz Commercial |
$182.83
|
| Rate for Payer: WEA Trust Commercial |
$167.60
|
| Rate for Payer: WPS Commercial |
$225.70
|
|
|
WIPE SKIN BARRIER GEL 7917
|
Facility
|
OP
|
$4.00
|
|
| Hospital Charge Code |
2963504
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$3.83 |
| Rate for Payer: Aetna Commercial |
$3.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3.58
|
| Rate for Payer: Aetna Managed Medicare |
$1.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.20
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna Commercial |
$3.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.33
|
| Rate for Payer: Health EOS Commercial |
$3.70
|
| Rate for Payer: HFN Commercial |
$3.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3.12
|
| Rate for Payer: Multiplan Commercial |
$3.33
|
| Rate for Payer: NAPHCARE Commercial |
$2.50
|
| Rate for Payer: Preferred Network Access Commercial |
$3.83
|
| Rate for Payer: Quartz Beloit One Network |
$2.04
|
| Rate for Payer: Quartz Commercial |
$2.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2.50
|
| Rate for Payer: The Alliance Commercial |
$2.08
|
| Rate for Payer: WEA Trust Commercial |
$2.29
|
| Rate for Payer: WPS Commercial |
$3.08
|
|
|
WIPE SKIN BARRIER GEL 7917
|
Facility
|
IP
|
$4.00
|
|
| Hospital Charge Code |
2963504
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$3.83 |
| Rate for Payer: Aetna Commercial |
$3.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.20
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna Commercial |
$3.83
|
| Rate for Payer: Health EOS Commercial |
$3.70
|
| Rate for Payer: HFN Commercial |
$3.83
|
| Rate for Payer: Multiplan Commercial |
$3.33
|
| Rate for Payer: Preferred Network Access Commercial |
$3.83
|
| Rate for Payer: Quartz Beloit One Network |
$2.04
|
| Rate for Payer: Quartz Commercial |
$2.50
|
| Rate for Payer: WEA Trust Commercial |
$2.29
|
| Rate for Payer: WPS Commercial |
$3.08
|
|
|
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 |
$697.72 |
| Max. Negotiated Rate |
$2,292.49 |
| Rate for Payer: Aetna Commercial |
$2,242.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,142.98
|
| Rate for Payer: Aetna Managed Medicare |
$697.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,619.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,245.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,196.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,320.68
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cigna Commercial |
$2,292.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,394.47
|
| Rate for Payer: Health EOS Commercial |
$2,217.74
|
| Rate for Payer: HFN Commercial |
$2,292.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,868.88
|
| Rate for Payer: Multiplan Commercial |
$1,993.47
|
| Rate for Payer: NAPHCARE Commercial |
$1,495.10
|
| Rate for Payer: Preferred Network Access Commercial |
$2,292.49
|
| Rate for Payer: Quartz Beloit One Network |
$1,221.00
|
| Rate for Payer: Quartz Commercial |
$1,619.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,495.10
|
| Rate for Payer: The Alliance Commercial |
$1,245.92
|
| Rate for Payer: WEA Trust Commercial |
$1,370.51
|
| Rate for Payer: WPS Commercial |
$1,845.64
|
|
|
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 |
$1,221.00 |
| Max. Negotiated Rate |
$2,292.49 |
| Rate for Payer: Aetna Commercial |
$2,242.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,142.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,320.68
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cigna Commercial |
$2,292.49
|
| Rate for Payer: Health EOS Commercial |
$2,217.74
|
| Rate for Payer: HFN Commercial |
$2,292.49
|
| Rate for Payer: Multiplan Commercial |
$1,993.47
|
| Rate for Payer: Preferred Network Access Commercial |
$2,292.49
|
| Rate for Payer: Quartz Beloit One Network |
$1,221.00
|
| Rate for Payer: Quartz Commercial |
$1,495.10
|
| Rate for Payer: WEA Trust Commercial |
$1,370.51
|
| Rate for Payer: WPS Commercial |
$1,845.64
|
|
|
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 |
$1,221.00 |
| Max. Negotiated Rate |
$2,292.49 |
| Rate for Payer: Aetna Commercial |
$2,242.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,142.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,320.68
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cigna Commercial |
$2,292.49
|
| Rate for Payer: Health EOS Commercial |
$2,217.74
|
| Rate for Payer: HFN Commercial |
$2,292.49
|
| Rate for Payer: Multiplan Commercial |
$1,993.47
|
| Rate for Payer: Preferred Network Access Commercial |
$2,292.49
|
| Rate for Payer: Quartz Beloit One Network |
$1,221.00
|
| Rate for Payer: Quartz Commercial |
$1,495.10
|
| Rate for Payer: WEA Trust Commercial |
$1,370.51
|
| Rate for Payer: WPS Commercial |
$1,845.64
|
|
|
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 |
$697.72 |
| Max. Negotiated Rate |
$2,292.49 |
| Rate for Payer: Aetna Commercial |
$2,242.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,142.98
|
| Rate for Payer: Aetna Managed Medicare |
$697.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,619.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,245.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,196.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,320.68
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cigna Commercial |
$2,292.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,394.47
|
| Rate for Payer: Health EOS Commercial |
$2,217.74
|
| Rate for Payer: HFN Commercial |
$2,292.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,868.88
|
| Rate for Payer: Multiplan Commercial |
$1,993.47
|
| Rate for Payer: NAPHCARE Commercial |
$1,495.10
|
| Rate for Payer: Preferred Network Access Commercial |
$2,292.49
|
| Rate for Payer: Quartz Beloit One Network |
$1,221.00
|
| Rate for Payer: Quartz Commercial |
$1,619.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,495.10
|
| Rate for Payer: The Alliance Commercial |
$1,245.92
|
| Rate for Payer: WEA Trust Commercial |
$1,370.51
|
| Rate for Payer: WPS Commercial |
$1,845.64
|
|
|
WIRE .035 3MM JFC 260CM
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3645491
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$80.37 |
| Max. Negotiated Rate |
$264.08 |
| Rate for Payer: Aetna Commercial |
$258.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$246.85
|
| Rate for Payer: Aetna Managed Medicare |
$80.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$186.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$143.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$137.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$152.13
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$264.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$160.63
|
| Rate for Payer: Health EOS Commercial |
$255.47
|
| Rate for Payer: HFN Commercial |
$264.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$215.28
|
| Rate for Payer: Multiplan Commercial |
$229.63
|
| Rate for Payer: NAPHCARE Commercial |
$172.22
|
| Rate for Payer: Preferred Network Access Commercial |
$264.08
|
| Rate for Payer: Quartz Beloit One Network |
$140.65
|
| Rate for Payer: Quartz Commercial |
$186.58
|
| Rate for Payer: Quartz Medicare Advantage |
$172.22
|
| Rate for Payer: The Alliance Commercial |
$143.52
|
| Rate for Payer: WEA Trust Commercial |
$157.87
|
| Rate for Payer: WPS Commercial |
$212.60
|
|
|
WIRE .035 3MM JFC 260CM
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3645491
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.65 |
| Max. Negotiated Rate |
$264.08 |
| Rate for Payer: Aetna Commercial |
$258.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$246.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$152.13
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$264.08
|
| Rate for Payer: Health EOS Commercial |
$255.47
|
| Rate for Payer: HFN Commercial |
$264.08
|
| Rate for Payer: Multiplan Commercial |
$229.63
|
| Rate for Payer: Preferred Network Access Commercial |
$264.08
|
| Rate for Payer: Quartz Beloit One Network |
$140.65
|
| Rate for Payer: Quartz Commercial |
$172.22
|
| Rate for Payer: WEA Trust Commercial |
$157.87
|
| Rate for Payer: WPS Commercial |
$212.60
|
|
|
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 |
$1,367.77 |
| Max. Negotiated Rate |
$2,568.05 |
| Rate for Payer: Aetna Commercial |
$2,512.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,400.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,479.42
|
| Rate for Payer: Cash Price |
$805.20
|
| Rate for Payer: Cigna Commercial |
$2,568.05
|
| Rate for Payer: Health EOS Commercial |
$2,484.31
|
| Rate for Payer: HFN Commercial |
$2,568.05
|
| Rate for Payer: Multiplan Commercial |
$2,233.09
|
| Rate for Payer: Preferred Network Access Commercial |
$2,568.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,367.77
|
| Rate for Payer: Quartz Commercial |
$1,674.82
|
| Rate for Payer: WEA Trust Commercial |
$1,535.25
|
| Rate for Payer: WPS Commercial |
$2,067.49
|
|
|
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 |
$781.58 |
| Max. Negotiated Rate |
$2,568.05 |
| Rate for Payer: Aetna Commercial |
$2,512.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,400.57
|
| Rate for Payer: Aetna Managed Medicare |
$781.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,814.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,395.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,339.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,479.42
|
| Rate for Payer: Cash Price |
$805.20
|
| Rate for Payer: Cigna Commercial |
$2,568.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,562.09
|
| Rate for Payer: Health EOS Commercial |
$2,484.31
|
| Rate for Payer: HFN Commercial |
$2,568.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,093.52
|
| Rate for Payer: Multiplan Commercial |
$2,233.09
|
| Rate for Payer: NAPHCARE Commercial |
$1,674.82
|
| Rate for Payer: Preferred Network Access Commercial |
$2,568.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,367.77
|
| Rate for Payer: Quartz Commercial |
$1,814.38
|
| Rate for Payer: Quartz Medicare Advantage |
$1,674.82
|
| Rate for Payer: The Alliance Commercial |
$1,395.68
|
| Rate for Payer: WEA Trust Commercial |
$1,535.25
|
| Rate for Payer: WPS Commercial |
$2,067.49
|
|
|
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 |
$781.58 |
| Max. Negotiated Rate |
$2,568.05 |
| Rate for Payer: Aetna Commercial |
$2,512.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,400.57
|
| Rate for Payer: Aetna Managed Medicare |
$781.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,814.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,395.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,339.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,479.42
|
| Rate for Payer: Cash Price |
$805.20
|
| Rate for Payer: Cigna Commercial |
$2,568.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,562.09
|
| Rate for Payer: Health EOS Commercial |
$2,484.31
|
| Rate for Payer: HFN Commercial |
$2,568.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,093.52
|
| Rate for Payer: Multiplan Commercial |
$2,233.09
|
| Rate for Payer: NAPHCARE Commercial |
$1,674.82
|
| Rate for Payer: Preferred Network Access Commercial |
$2,568.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,367.77
|
| Rate for Payer: Quartz Commercial |
$1,814.38
|
| Rate for Payer: Quartz Medicare Advantage |
$1,674.82
|
| Rate for Payer: The Alliance Commercial |
$1,395.68
|
| Rate for Payer: WEA Trust Commercial |
$1,535.25
|
| Rate for Payer: WPS Commercial |
$2,067.49
|
|
|
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 |
$1,367.77 |
| Max. Negotiated Rate |
$2,568.05 |
| Rate for Payer: Aetna Commercial |
$2,512.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,400.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,479.42
|
| Rate for Payer: Cash Price |
$805.20
|
| Rate for Payer: Cigna Commercial |
$2,568.05
|
| Rate for Payer: Health EOS Commercial |
$2,484.31
|
| Rate for Payer: HFN Commercial |
$2,568.05
|
| Rate for Payer: Multiplan Commercial |
$2,233.09
|
| Rate for Payer: Preferred Network Access Commercial |
$2,568.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,367.77
|
| Rate for Payer: Quartz Commercial |
$1,674.82
|
| Rate for Payer: WEA Trust Commercial |
$1,535.25
|
| Rate for Payer: WPS Commercial |
$2,067.49
|
|
|
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 |
$1,476.31 |
| Max. Negotiated Rate |
$2,771.85 |
| Rate for Payer: Aetna Commercial |
$2,711.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,591.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,596.83
|
| Rate for Payer: Cash Price |
$869.10
|
| Rate for Payer: Cigna Commercial |
$2,771.85
|
| Rate for Payer: Health EOS Commercial |
$2,681.46
|
| Rate for Payer: HFN Commercial |
$2,771.85
|
| Rate for Payer: Multiplan Commercial |
$2,410.30
|
| Rate for Payer: Preferred Network Access Commercial |
$2,771.85
|
| Rate for Payer: Quartz Beloit One Network |
$1,476.31
|
| Rate for Payer: Quartz Commercial |
$1,807.73
|
| Rate for Payer: WEA Trust Commercial |
$1,657.08
|
| Rate for Payer: WPS Commercial |
$2,231.56
|
|
|
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 |
$843.61 |
| Max. Negotiated Rate |
$2,771.85 |
| Rate for Payer: Aetna Commercial |
$2,711.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,591.08
|
| Rate for Payer: Aetna Managed Medicare |
$843.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,958.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,506.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,446.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,596.83
|
| Rate for Payer: Cash Price |
$869.10
|
| Rate for Payer: Cigna Commercial |
$2,771.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,686.05
|
| Rate for Payer: Health EOS Commercial |
$2,681.46
|
| Rate for Payer: HFN Commercial |
$2,771.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,259.66
|
| Rate for Payer: Multiplan Commercial |
$2,410.30
|
| Rate for Payer: NAPHCARE Commercial |
$1,807.73
|
| Rate for Payer: Preferred Network Access Commercial |
$2,771.85
|
| Rate for Payer: Quartz Beloit One Network |
$1,476.31
|
| Rate for Payer: Quartz Commercial |
$1,958.37
|
| Rate for Payer: Quartz Medicare Advantage |
$1,807.73
|
| Rate for Payer: The Alliance Commercial |
$1,506.44
|
| Rate for Payer: WEA Trust Commercial |
$1,657.08
|
| Rate for Payer: WPS Commercial |
$2,231.56
|
|
|
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 |
$517.75 |
| Max. Negotiated Rate |
$972.11 |
| Rate for Payer: Aetna Commercial |
$950.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$908.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$560.02
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cigna Commercial |
$972.11
|
| Rate for Payer: Health EOS Commercial |
$940.41
|
| Rate for Payer: HFN Commercial |
$972.11
|
| Rate for Payer: Multiplan Commercial |
$845.31
|
| Rate for Payer: Preferred Network Access Commercial |
$972.11
|
| Rate for Payer: Quartz Beloit One Network |
$517.75
|
| Rate for Payer: Quartz Commercial |
$633.98
|
| Rate for Payer: WEA Trust Commercial |
$581.15
|
| Rate for Payer: WPS Commercial |
$782.62
|
|
|
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 |
$295.86 |
| Max. Negotiated Rate |
$972.11 |
| Rate for Payer: Aetna Commercial |
$950.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$908.71
|
| Rate for Payer: Aetna Managed Medicare |
$295.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$686.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$528.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$507.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$560.02
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cigna Commercial |
$972.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$591.31
|
| Rate for Payer: Health EOS Commercial |
$940.41
|
| Rate for Payer: HFN Commercial |
$972.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$792.48
|
| Rate for Payer: Multiplan Commercial |
$845.31
|
| Rate for Payer: NAPHCARE Commercial |
$633.98
|
| Rate for Payer: Preferred Network Access Commercial |
$972.11
|
| Rate for Payer: Quartz Beloit One Network |
$517.75
|
| Rate for Payer: Quartz Commercial |
$686.82
|
| Rate for Payer: Quartz Medicare Advantage |
$633.98
|
| Rate for Payer: The Alliance Commercial |
$528.32
|
| Rate for Payer: WEA Trust Commercial |
$581.15
|
| Rate for Payer: WPS Commercial |
$782.62
|
|
|
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 |
$295.86 |
| Max. Negotiated Rate |
$972.11 |
| Rate for Payer: Aetna Commercial |
$950.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$908.71
|
| Rate for Payer: Aetna Managed Medicare |
$295.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$686.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$528.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$507.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$560.02
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cigna Commercial |
$972.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$591.31
|
| Rate for Payer: Health EOS Commercial |
$940.41
|
| Rate for Payer: HFN Commercial |
$972.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$792.48
|
| Rate for Payer: Multiplan Commercial |
$845.31
|
| Rate for Payer: NAPHCARE Commercial |
$633.98
|
| Rate for Payer: Preferred Network Access Commercial |
$972.11
|
| Rate for Payer: Quartz Beloit One Network |
$517.75
|
| Rate for Payer: Quartz Commercial |
$686.82
|
| Rate for Payer: Quartz Medicare Advantage |
$633.98
|
| Rate for Payer: The Alliance Commercial |
$528.32
|
| Rate for Payer: WEA Trust Commercial |
$581.15
|
| Rate for Payer: WPS Commercial |
$782.62
|
|
|
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 |
$517.75 |
| Max. Negotiated Rate |
$972.11 |
| Rate for Payer: Aetna Commercial |
$950.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$908.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$560.02
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cigna Commercial |
$972.11
|
| Rate for Payer: Health EOS Commercial |
$940.41
|
| Rate for Payer: HFN Commercial |
$972.11
|
| Rate for Payer: Multiplan Commercial |
$845.31
|
| Rate for Payer: Preferred Network Access Commercial |
$972.11
|
| Rate for Payer: Quartz Beloit One Network |
$517.75
|
| Rate for Payer: Quartz Commercial |
$633.98
|
| Rate for Payer: WEA Trust Commercial |
$581.15
|
| Rate for Payer: WPS Commercial |
$782.62
|
|
|
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 |
$80.01 |
| Max. Negotiated Rate |
$150.22 |
| Rate for Payer: Aetna Commercial |
$146.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$140.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$86.54
|
| Rate for Payer: Cash Price |
$47.10
|
| Rate for Payer: Cigna Commercial |
$150.22
|
| Rate for Payer: Health EOS Commercial |
$145.32
|
| Rate for Payer: HFN Commercial |
$150.22
|
| Rate for Payer: Multiplan Commercial |
$130.62
|
| Rate for Payer: Preferred Network Access Commercial |
$150.22
|
| Rate for Payer: Quartz Beloit One Network |
$80.01
|
| Rate for Payer: Quartz Commercial |
$97.97
|
| Rate for Payer: WEA Trust Commercial |
$89.80
|
| Rate for Payer: WPS Commercial |
$120.94
|
|
