|
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 |
$45.72 |
| Max. Negotiated Rate |
$150.22 |
| Rate for Payer: Aetna Commercial |
$146.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$140.42
|
| Rate for Payer: Aetna Managed Medicare |
$45.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$106.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$81.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$78.37
|
| 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: Dean Health DHI/DHP/ASO |
$91.37
|
| Rate for Payer: Health EOS Commercial |
$145.32
|
| Rate for Payer: HFN Commercial |
$150.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$122.46
|
| Rate for Payer: Multiplan Commercial |
$130.62
|
| Rate for Payer: NAPHCARE Commercial |
$97.97
|
| Rate for Payer: Preferred Network Access Commercial |
$150.22
|
| Rate for Payer: Quartz Beloit One Network |
$80.01
|
| Rate for Payer: Quartz Commercial |
$106.13
|
| Rate for Payer: Quartz Medicare Advantage |
$97.97
|
| Rate for Payer: The Alliance Commercial |
$81.64
|
| Rate for Payer: WEA Trust Commercial |
$89.80
|
| Rate for Payer: WPS Commercial |
$120.94
|
|
|
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 |
$43.10 |
| Max. Negotiated Rate |
$141.61 |
| Rate for Payer: Aetna Commercial |
$138.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$132.37
|
| Rate for Payer: Aetna Managed Medicare |
$43.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$100.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$76.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$73.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.58
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cigna Commercial |
$141.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$86.14
|
| Rate for Payer: Health EOS Commercial |
$136.99
|
| Rate for Payer: HFN Commercial |
$141.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$115.44
|
| Rate for Payer: Multiplan Commercial |
$123.14
|
| Rate for Payer: NAPHCARE Commercial |
$92.35
|
| Rate for Payer: Preferred Network Access Commercial |
$141.61
|
| Rate for Payer: Quartz Beloit One Network |
$75.42
|
| Rate for Payer: Quartz Commercial |
$100.05
|
| Rate for Payer: Quartz Medicare Advantage |
$92.35
|
| Rate for Payer: The Alliance Commercial |
$76.96
|
| Rate for Payer: WEA Trust Commercial |
$84.66
|
| Rate for Payer: WPS Commercial |
$114.00
|
|
|
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 |
$75.42 |
| Max. Negotiated Rate |
$141.61 |
| Rate for Payer: Aetna Commercial |
$138.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$132.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.58
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cigna Commercial |
$141.61
|
| Rate for Payer: Health EOS Commercial |
$136.99
|
| Rate for Payer: HFN Commercial |
$141.61
|
| Rate for Payer: Multiplan Commercial |
$123.14
|
| Rate for Payer: Preferred Network Access Commercial |
$141.61
|
| Rate for Payer: Quartz Beloit One Network |
$75.42
|
| Rate for Payer: Quartz Commercial |
$92.35
|
| Rate for Payer: WEA Trust Commercial |
$84.66
|
| Rate for Payer: WPS Commercial |
$114.00
|
|
|
WIRE 2.0 SPADE POINT REDUCTION 292.41
|
Facility
|
IP
|
$2,303.00
|
|
| Hospital Charge Code |
2966594
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,173.61 |
| Max. Negotiated Rate |
$2,203.51 |
| Rate for Payer: Aetna Commercial |
$2,155.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,059.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,269.41
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cigna Commercial |
$2,203.51
|
| Rate for Payer: Health EOS Commercial |
$2,131.66
|
| Rate for Payer: HFN Commercial |
$2,203.51
|
| Rate for Payer: Multiplan Commercial |
$1,916.10
|
| Rate for Payer: Preferred Network Access Commercial |
$2,203.51
|
| Rate for Payer: Quartz Beloit One Network |
$1,173.61
|
| Rate for Payer: Quartz Commercial |
$1,437.07
|
| Rate for Payer: WEA Trust Commercial |
$1,317.32
|
| Rate for Payer: WPS Commercial |
$1,774.00
|
|
|
WIRE 2.0 SPADE POINT REDUCTION 292.41
|
Facility
|
OP
|
$2,303.00
|
|
| Hospital Charge Code |
2966594
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$670.63 |
| Max. Negotiated Rate |
$2,203.51 |
| Rate for Payer: Aetna Commercial |
$2,155.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,059.80
|
| Rate for Payer: Aetna Managed Medicare |
$670.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,556.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,197.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,149.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,269.41
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cigna Commercial |
$2,203.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,340.35
|
| Rate for Payer: Health EOS Commercial |
$2,131.66
|
| Rate for Payer: HFN Commercial |
$2,203.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,796.34
|
| Rate for Payer: Multiplan Commercial |
$1,916.10
|
| Rate for Payer: NAPHCARE Commercial |
$1,437.07
|
| Rate for Payer: Preferred Network Access Commercial |
$2,203.51
|
| Rate for Payer: Quartz Beloit One Network |
$1,173.61
|
| Rate for Payer: Quartz Commercial |
$1,556.83
|
| Rate for Payer: Quartz Medicare Advantage |
$1,437.07
|
| Rate for Payer: The Alliance Commercial |
$1,197.56
|
| Rate for Payer: WEA Trust Commercial |
$1,317.32
|
| Rate for Payer: WPS Commercial |
$1,774.00
|
|
|
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 |
$44.55 |
| Max. Negotiated Rate |
$146.39 |
| Rate for Payer: Aetna Commercial |
$143.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$136.84
|
| Rate for Payer: Aetna Managed Medicare |
$44.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$103.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$79.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$76.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$84.33
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cigna Commercial |
$146.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$89.05
|
| Rate for Payer: Health EOS Commercial |
$141.62
|
| Rate for Payer: HFN Commercial |
$146.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$119.34
|
| Rate for Payer: Multiplan Commercial |
$127.30
|
| Rate for Payer: NAPHCARE Commercial |
$95.47
|
| Rate for Payer: Preferred Network Access Commercial |
$146.39
|
| Rate for Payer: Quartz Beloit One Network |
$77.97
|
| Rate for Payer: Quartz Commercial |
$103.43
|
| Rate for Payer: Quartz Medicare Advantage |
$95.47
|
| Rate for Payer: The Alliance Commercial |
$79.56
|
| Rate for Payer: WEA Trust Commercial |
$87.52
|
| Rate for Payer: WPS Commercial |
$117.86
|
|
|
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 |
$77.97 |
| Max. Negotiated Rate |
$146.39 |
| Rate for Payer: Aetna Commercial |
$143.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$136.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$84.33
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cigna Commercial |
$146.39
|
| Rate for Payer: Health EOS Commercial |
$141.62
|
| Rate for Payer: HFN Commercial |
$146.39
|
| Rate for Payer: Multiplan Commercial |
$127.30
|
| Rate for Payer: Preferred Network Access Commercial |
$146.39
|
| Rate for Payer: Quartz Beloit One Network |
$77.97
|
| Rate for Payer: Quartz Commercial |
$95.47
|
| Rate for Payer: WEA Trust Commercial |
$87.52
|
| Rate for Payer: WPS Commercial |
$117.86
|
|
|
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 |
$42.52 |
| Max. Negotiated Rate |
$139.69 |
| Rate for Payer: Aetna Commercial |
$136.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$130.58
|
| Rate for Payer: Aetna Managed Medicare |
$42.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$98.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$75.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$72.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$80.48
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cigna Commercial |
$139.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$84.97
|
| Rate for Payer: Health EOS Commercial |
$135.14
|
| Rate for Payer: HFN Commercial |
$139.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$113.88
|
| Rate for Payer: Multiplan Commercial |
$121.47
|
| Rate for Payer: NAPHCARE Commercial |
$91.10
|
| Rate for Payer: Preferred Network Access Commercial |
$139.69
|
| Rate for Payer: Quartz Beloit One Network |
$74.40
|
| Rate for Payer: Quartz Commercial |
$98.70
|
| Rate for Payer: Quartz Medicare Advantage |
$91.10
|
| Rate for Payer: The Alliance Commercial |
$75.92
|
| Rate for Payer: WEA Trust Commercial |
$83.51
|
| Rate for Payer: WPS Commercial |
$112.46
|
|
|
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 |
$74.40 |
| Max. Negotiated Rate |
$139.69 |
| Rate for Payer: Aetna Commercial |
$136.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$130.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$80.48
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cigna Commercial |
$139.69
|
| Rate for Payer: Health EOS Commercial |
$135.14
|
| Rate for Payer: HFN Commercial |
$139.69
|
| Rate for Payer: Multiplan Commercial |
$121.47
|
| Rate for Payer: Preferred Network Access Commercial |
$139.69
|
| Rate for Payer: Quartz Beloit One Network |
$74.40
|
| Rate for Payer: Quartz Commercial |
$91.10
|
| Rate for Payer: WEA Trust Commercial |
$83.51
|
| Rate for Payer: WPS Commercial |
$112.46
|
|
|
WIRE 5-LEAD DUAL DISP 33135R
|
Facility
|
IP
|
$566.00
|
|
| Hospital Charge Code |
2965831
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$288.43 |
| Max. Negotiated Rate |
$541.55 |
| Rate for Payer: Aetna Commercial |
$529.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$506.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$311.98
|
| Rate for Payer: Cash Price |
$169.80
|
| Rate for Payer: Cigna Commercial |
$541.55
|
| Rate for Payer: Health EOS Commercial |
$523.89
|
| Rate for Payer: HFN Commercial |
$541.55
|
| Rate for Payer: Multiplan Commercial |
$470.91
|
| Rate for Payer: Preferred Network Access Commercial |
$541.55
|
| Rate for Payer: Quartz Beloit One Network |
$288.43
|
| Rate for Payer: Quartz Commercial |
$353.18
|
| Rate for Payer: WEA Trust Commercial |
$323.75
|
| Rate for Payer: WPS Commercial |
$435.99
|
|
|
WIRE 5-LEAD DUAL DISP 33135R
|
Facility
|
OP
|
$566.00
|
|
| Hospital Charge Code |
2965831
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$164.82 |
| Max. Negotiated Rate |
$541.55 |
| Rate for Payer: Aetna Commercial |
$529.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$506.23
|
| Rate for Payer: Aetna Managed Medicare |
$164.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$382.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$294.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$282.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$311.98
|
| Rate for Payer: Cash Price |
$169.80
|
| Rate for Payer: Cigna Commercial |
$541.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$329.41
|
| Rate for Payer: Health EOS Commercial |
$523.89
|
| Rate for Payer: HFN Commercial |
$541.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$441.48
|
| Rate for Payer: Multiplan Commercial |
$470.91
|
| Rate for Payer: NAPHCARE Commercial |
$353.18
|
| Rate for Payer: Preferred Network Access Commercial |
$541.55
|
| Rate for Payer: Quartz Beloit One Network |
$288.43
|
| Rate for Payer: Quartz Commercial |
$382.62
|
| Rate for Payer: Quartz Medicare Advantage |
$353.18
|
| Rate for Payer: The Alliance Commercial |
$294.32
|
| Rate for Payer: WEA Trust Commercial |
$323.75
|
| Rate for Payer: WPS Commercial |
$435.99
|
|
|
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 |
$1,282.15 |
| Max. Negotiated Rate |
$2,407.31 |
| Rate for Payer: Aetna Commercial |
$2,354.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,250.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,386.82
|
| Rate for Payer: Cash Price |
$754.80
|
| Rate for Payer: Cigna Commercial |
$2,407.31
|
| Rate for Payer: Health EOS Commercial |
$2,328.81
|
| Rate for Payer: HFN Commercial |
$2,407.31
|
| Rate for Payer: Multiplan Commercial |
$2,093.31
|
| Rate for Payer: Preferred Network Access Commercial |
$2,407.31
|
| Rate for Payer: Quartz Beloit One Network |
$1,282.15
|
| Rate for Payer: Quartz Commercial |
$1,569.98
|
| Rate for Payer: WEA Trust Commercial |
$1,439.15
|
| Rate for Payer: WPS Commercial |
$1,938.07
|
|
|
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 |
$732.66 |
| Max. Negotiated Rate |
$2,407.31 |
| Rate for Payer: Aetna Commercial |
$2,354.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,250.31
|
| Rate for Payer: Aetna Managed Medicare |
$732.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,700.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,308.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,255.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,386.82
|
| Rate for Payer: Cash Price |
$754.80
|
| Rate for Payer: Cigna Commercial |
$2,407.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,464.31
|
| Rate for Payer: Health EOS Commercial |
$2,328.81
|
| Rate for Payer: HFN Commercial |
$2,407.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,962.48
|
| Rate for Payer: Multiplan Commercial |
$2,093.31
|
| Rate for Payer: NAPHCARE Commercial |
$1,569.98
|
| Rate for Payer: Preferred Network Access Commercial |
$2,407.31
|
| Rate for Payer: Quartz Beloit One Network |
$1,282.15
|
| Rate for Payer: Quartz Commercial |
$1,700.82
|
| Rate for Payer: Quartz Medicare Advantage |
$1,569.98
|
| Rate for Payer: The Alliance Commercial |
$1,308.32
|
| Rate for Payer: WEA Trust Commercial |
$1,439.15
|
| Rate for Payer: WPS Commercial |
$1,938.07
|
|
|
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 |
$490.38 |
| Max. Negotiated Rate |
$1,611.25 |
| Rate for Payer: Aetna Commercial |
$1,576.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,506.17
|
| Rate for Payer: Aetna Managed Medicare |
$490.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,138.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$875.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$840.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$928.22
|
| Rate for Payer: Cash Price |
$505.20
|
| Rate for Payer: Cigna Commercial |
$1,611.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$980.09
|
| Rate for Payer: Health EOS Commercial |
$1,558.71
|
| Rate for Payer: HFN Commercial |
$1,611.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,313.52
|
| Rate for Payer: Multiplan Commercial |
$1,401.09
|
| Rate for Payer: NAPHCARE Commercial |
$1,050.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,611.25
|
| Rate for Payer: Quartz Beloit One Network |
$858.17
|
| Rate for Payer: Quartz Commercial |
$1,138.38
|
| Rate for Payer: Quartz Medicare Advantage |
$1,050.82
|
| Rate for Payer: The Alliance Commercial |
$875.68
|
| Rate for Payer: WEA Trust Commercial |
$963.25
|
| Rate for Payer: WPS Commercial |
$1,297.19
|
|
|
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 |
$858.17 |
| Max. Negotiated Rate |
$1,611.25 |
| Rate for Payer: Aetna Commercial |
$1,576.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,506.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$928.22
|
| Rate for Payer: Cash Price |
$505.20
|
| Rate for Payer: Cigna Commercial |
$1,611.25
|
| Rate for Payer: Health EOS Commercial |
$1,558.71
|
| Rate for Payer: HFN Commercial |
$1,611.25
|
| Rate for Payer: Multiplan Commercial |
$1,401.09
|
| Rate for Payer: Preferred Network Access Commercial |
$1,611.25
|
| Rate for Payer: Quartz Beloit One Network |
$858.17
|
| Rate for Payer: Quartz Commercial |
$1,050.82
|
| Rate for Payer: WEA Trust Commercial |
$963.25
|
| Rate for Payer: WPS Commercial |
$1,297.19
|
|
|
WIRE AMPLATZ .025 180cm
|
Facility
|
OP
|
$511.00
|
|
| Hospital Charge Code |
2971340
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$148.80 |
| Max. Negotiated Rate |
$488.92 |
| Rate for Payer: Aetna Commercial |
$478.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$457.04
|
| Rate for Payer: Aetna Managed Medicare |
$148.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$345.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$265.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$255.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$281.66
|
| Rate for Payer: Cash Price |
$153.30
|
| Rate for Payer: Cigna Commercial |
$488.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$297.40
|
| Rate for Payer: Health EOS Commercial |
$472.98
|
| Rate for Payer: HFN Commercial |
$488.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$398.58
|
| Rate for Payer: Multiplan Commercial |
$425.15
|
| Rate for Payer: NAPHCARE Commercial |
$318.86
|
| Rate for Payer: Preferred Network Access Commercial |
$488.92
|
| Rate for Payer: Quartz Beloit One Network |
$260.41
|
| Rate for Payer: Quartz Commercial |
$345.44
|
| Rate for Payer: Quartz Medicare Advantage |
$318.86
|
| Rate for Payer: The Alliance Commercial |
$265.72
|
| Rate for Payer: WEA Trust Commercial |
$292.29
|
| Rate for Payer: WPS Commercial |
$393.62
|
|
|
WIRE AMPLATZ .025 180cm
|
Facility
|
IP
|
$511.00
|
|
| Hospital Charge Code |
2971340
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$260.41 |
| Max. Negotiated Rate |
$488.92 |
| Rate for Payer: Aetna Commercial |
$478.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$457.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$281.66
|
| Rate for Payer: Cash Price |
$153.30
|
| Rate for Payer: Cigna Commercial |
$488.92
|
| Rate for Payer: Health EOS Commercial |
$472.98
|
| Rate for Payer: HFN Commercial |
$488.92
|
| Rate for Payer: Multiplan Commercial |
$425.15
|
| Rate for Payer: Preferred Network Access Commercial |
$488.92
|
| Rate for Payer: Quartz Beloit One Network |
$260.41
|
| Rate for Payer: Quartz Commercial |
$318.86
|
| Rate for Payer: WEA Trust Commercial |
$292.29
|
| Rate for Payer: WPS Commercial |
$393.62
|
|
|
WIRE BOLT LONG HOFFMANN LIMB 4933-1-003
|
Facility
|
OP
|
$1,276.00
|
|
| Hospital Charge Code |
6001637
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$371.57 |
| Max. Negotiated Rate |
$1,220.88 |
| Rate for Payer: Aetna Commercial |
$1,194.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,141.25
|
| Rate for Payer: Aetna Managed Medicare |
$371.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$862.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$663.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$636.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$703.33
|
| Rate for Payer: Cash Price |
$382.80
|
| Rate for Payer: Cigna Commercial |
$1,220.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$742.63
|
| Rate for Payer: Health EOS Commercial |
$1,181.07
|
| Rate for Payer: HFN Commercial |
$1,220.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$995.28
|
| Rate for Payer: Multiplan Commercial |
$1,061.63
|
| Rate for Payer: NAPHCARE Commercial |
$796.22
|
| Rate for Payer: Preferred Network Access Commercial |
$1,220.88
|
| Rate for Payer: Quartz Beloit One Network |
$650.25
|
| Rate for Payer: Quartz Commercial |
$862.58
|
| Rate for Payer: Quartz Medicare Advantage |
$796.22
|
| Rate for Payer: The Alliance Commercial |
$663.52
|
| Rate for Payer: WEA Trust Commercial |
$729.87
|
| Rate for Payer: WPS Commercial |
$982.90
|
|
|
WIRE BOLT LONG HOFFMANN LIMB 4933-1-003
|
Facility
|
IP
|
$1,276.00
|
|
| Hospital Charge Code |
6001637
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$650.25 |
| Max. Negotiated Rate |
$1,220.88 |
| Rate for Payer: Aetna Commercial |
$1,194.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,141.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$703.33
|
| Rate for Payer: Cash Price |
$382.80
|
| Rate for Payer: Cigna Commercial |
$1,220.88
|
| Rate for Payer: Health EOS Commercial |
$1,181.07
|
| Rate for Payer: HFN Commercial |
$1,220.88
|
| Rate for Payer: Multiplan Commercial |
$1,061.63
|
| Rate for Payer: Preferred Network Access Commercial |
$1,220.88
|
| Rate for Payer: Quartz Beloit One Network |
$650.25
|
| Rate for Payer: Quartz Commercial |
$796.22
|
| Rate for Payer: WEA Trust Commercial |
$729.87
|
| Rate for Payer: WPS Commercial |
$982.90
|
|
|
WIRE BOLT MEDIUM HOFFMANN LIMB 4933-1-002
|
Facility
|
IP
|
$1,327.00
|
|
| Hospital Charge Code |
5611673
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$676.24 |
| Max. Negotiated Rate |
$1,269.67 |
| Rate for Payer: Aetna Commercial |
$1,242.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,186.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$731.44
|
| Rate for Payer: Cash Price |
$398.10
|
| Rate for Payer: Cigna Commercial |
$1,269.67
|
| Rate for Payer: Health EOS Commercial |
$1,228.27
|
| Rate for Payer: HFN Commercial |
$1,269.67
|
| Rate for Payer: Multiplan Commercial |
$1,104.06
|
| Rate for Payer: Preferred Network Access Commercial |
$1,269.67
|
| Rate for Payer: Quartz Beloit One Network |
$676.24
|
| Rate for Payer: Quartz Commercial |
$828.05
|
| Rate for Payer: WEA Trust Commercial |
$759.04
|
| Rate for Payer: WPS Commercial |
$1,022.19
|
|
|
WIRE BOLT MEDIUM HOFFMANN LIMB 4933-1-002
|
Facility
|
OP
|
$1,327.00
|
|
| Hospital Charge Code |
5611673
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$386.42 |
| Max. Negotiated Rate |
$1,269.67 |
| Rate for Payer: Aetna Commercial |
$1,242.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,186.87
|
| Rate for Payer: Aetna Managed Medicare |
$386.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$897.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$690.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$662.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$731.44
|
| Rate for Payer: Cash Price |
$398.10
|
| Rate for Payer: Cigna Commercial |
$1,269.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$772.31
|
| Rate for Payer: Health EOS Commercial |
$1,228.27
|
| Rate for Payer: HFN Commercial |
$1,269.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,035.06
|
| Rate for Payer: Multiplan Commercial |
$1,104.06
|
| Rate for Payer: NAPHCARE Commercial |
$828.05
|
| Rate for Payer: Preferred Network Access Commercial |
$1,269.67
|
| Rate for Payer: Quartz Beloit One Network |
$676.24
|
| Rate for Payer: Quartz Commercial |
$897.05
|
| Rate for Payer: Quartz Medicare Advantage |
$828.05
|
| Rate for Payer: The Alliance Commercial |
$690.04
|
| Rate for Payer: WEA Trust Commercial |
$759.04
|
| Rate for Payer: WPS Commercial |
$1,022.19
|
|
|
WIRE BOLT SHORT HOFFMANN LIMB 4933-1-001
|
Facility
|
IP
|
$1,380.00
|
|
| Hospital Charge Code |
5599704
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$703.25 |
| Max. Negotiated Rate |
$1,320.38 |
| Rate for Payer: Aetna Commercial |
$1,291.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,234.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$760.66
|
| Rate for Payer: Cash Price |
$414.00
|
| Rate for Payer: Cigna Commercial |
$1,320.38
|
| Rate for Payer: Health EOS Commercial |
$1,277.33
|
| Rate for Payer: HFN Commercial |
$1,320.38
|
| Rate for Payer: Multiplan Commercial |
$1,148.16
|
| Rate for Payer: Preferred Network Access Commercial |
$1,320.38
|
| Rate for Payer: Quartz Beloit One Network |
$703.25
|
| Rate for Payer: Quartz Commercial |
$861.12
|
| Rate for Payer: WEA Trust Commercial |
$789.36
|
| Rate for Payer: WPS Commercial |
$1,063.01
|
|
|
WIRE BOLT SHORT HOFFMANN LIMB 4933-1-001
|
Facility
|
OP
|
$1,380.00
|
|
| Hospital Charge Code |
5599704
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$401.86 |
| Max. Negotiated Rate |
$1,320.38 |
| Rate for Payer: Aetna Commercial |
$1,291.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,234.27
|
| Rate for Payer: Aetna Managed Medicare |
$401.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$932.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$717.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$688.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$760.66
|
| Rate for Payer: Cash Price |
$414.00
|
| Rate for Payer: Cigna Commercial |
$1,320.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$803.16
|
| Rate for Payer: Health EOS Commercial |
$1,277.33
|
| Rate for Payer: HFN Commercial |
$1,320.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,076.40
|
| Rate for Payer: Multiplan Commercial |
$1,148.16
|
| Rate for Payer: NAPHCARE Commercial |
$861.12
|
| Rate for Payer: Preferred Network Access Commercial |
$1,320.38
|
| Rate for Payer: Quartz Beloit One Network |
$703.25
|
| Rate for Payer: Quartz Commercial |
$932.88
|
| Rate for Payer: Quartz Medicare Advantage |
$861.12
|
| Rate for Payer: The Alliance Commercial |
$717.60
|
| Rate for Payer: WEA Trust Commercial |
$789.36
|
| Rate for Payer: WPS Commercial |
$1,063.01
|
|
|
WIRE CHOICE PT .014 300CM 12154-01J
|
Facility
|
IP
|
$2,578.00
|
|
| Hospital Charge Code |
3072559
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,313.75 |
| Max. Negotiated Rate |
$2,466.63 |
| Rate for Payer: Aetna Commercial |
$2,413.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,305.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,420.99
|
| Rate for Payer: Cash Price |
$773.40
|
| Rate for Payer: Cigna Commercial |
$2,466.63
|
| Rate for Payer: Health EOS Commercial |
$2,386.20
|
| Rate for Payer: HFN Commercial |
$2,466.63
|
| Rate for Payer: Multiplan Commercial |
$2,144.90
|
| Rate for Payer: Preferred Network Access Commercial |
$2,466.63
|
| Rate for Payer: Quartz Beloit One Network |
$1,313.75
|
| Rate for Payer: Quartz Commercial |
$1,608.67
|
| Rate for Payer: WEA Trust Commercial |
$1,474.62
|
| Rate for Payer: WPS Commercial |
$1,985.83
|
|
|
WIRE CHOICE PT .014 300CM 12154-01J
|
Facility
|
OP
|
$2,578.00
|
|
| Hospital Charge Code |
3072559
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$750.71 |
| Max. Negotiated Rate |
$2,466.63 |
| Rate for Payer: Aetna Commercial |
$2,413.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,305.76
|
| Rate for Payer: Aetna Managed Medicare |
$750.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,742.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,340.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,286.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,420.99
|
| Rate for Payer: Cash Price |
$773.40
|
| Rate for Payer: Cigna Commercial |
$2,466.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,500.40
|
| Rate for Payer: Health EOS Commercial |
$2,386.20
|
| Rate for Payer: HFN Commercial |
$2,466.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,010.84
|
| Rate for Payer: Multiplan Commercial |
$2,144.90
|
| Rate for Payer: NAPHCARE Commercial |
$1,608.67
|
| Rate for Payer: Preferred Network Access Commercial |
$2,466.63
|
| Rate for Payer: Quartz Beloit One Network |
$1,313.75
|
| Rate for Payer: Quartz Commercial |
$1,742.73
|
| Rate for Payer: Quartz Medicare Advantage |
$1,608.67
|
| Rate for Payer: The Alliance Commercial |
$1,340.56
|
| Rate for Payer: WEA Trust Commercial |
$1,474.62
|
| Rate for Payer: WPS Commercial |
$1,985.83
|
|
