|
WIRE CLIP TORQUER 22196-003
|
Facility
|
IP
|
$138.00
|
|
| Hospital Charge Code |
3609495
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.32 |
| Max. Negotiated Rate |
$132.04 |
| Rate for Payer: Aetna Commercial |
$129.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$123.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$76.07
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cigna Commercial |
$132.04
|
| Rate for Payer: Health EOS Commercial |
$127.73
|
| Rate for Payer: HFN Commercial |
$132.04
|
| Rate for Payer: Multiplan Commercial |
$114.82
|
| Rate for Payer: Preferred Network Access Commercial |
$132.04
|
| Rate for Payer: Quartz Beloit One Network |
$70.32
|
| Rate for Payer: Quartz Commercial |
$86.11
|
| Rate for Payer: WEA Trust Commercial |
$78.94
|
| Rate for Payer: WPS Commercial |
$106.30
|
|
|
WIRE CLIP TORQUER 22196-003
|
Facility
|
OP
|
$138.00
|
|
| Hospital Charge Code |
3609495
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$40.19 |
| Max. Negotiated Rate |
$132.04 |
| Rate for Payer: Aetna Commercial |
$129.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$123.43
|
| Rate for Payer: Aetna Managed Medicare |
$40.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$93.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$71.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$68.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$76.07
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cigna Commercial |
$132.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$80.32
|
| Rate for Payer: Health EOS Commercial |
$127.73
|
| Rate for Payer: HFN Commercial |
$132.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$107.64
|
| Rate for Payer: Multiplan Commercial |
$114.82
|
| Rate for Payer: NAPHCARE Commercial |
$86.11
|
| Rate for Payer: Preferred Network Access Commercial |
$132.04
|
| Rate for Payer: Quartz Beloit One Network |
$70.32
|
| Rate for Payer: Quartz Commercial |
$93.29
|
| Rate for Payer: Quartz Medicare Advantage |
$86.11
|
| Rate for Payer: The Alliance Commercial |
$71.76
|
| Rate for Payer: WEA Trust Commercial |
$78.94
|
| Rate for Payer: WPS Commercial |
$106.30
|
|
|
WIRE CUTTER MDS10508
|
Facility
|
OP
|
$69.00
|
|
| Hospital Charge Code |
2964048
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.09 |
| Max. Negotiated Rate |
$66.02 |
| Rate for Payer: Aetna Commercial |
$64.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$61.71
|
| Rate for Payer: Aetna Managed Medicare |
$20.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$35.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$34.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.03
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cigna Commercial |
$66.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.16
|
| Rate for Payer: Health EOS Commercial |
$63.87
|
| Rate for Payer: HFN Commercial |
$66.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.82
|
| Rate for Payer: Multiplan Commercial |
$57.41
|
| Rate for Payer: NAPHCARE Commercial |
$43.06
|
| Rate for Payer: Preferred Network Access Commercial |
$66.02
|
| Rate for Payer: Quartz Beloit One Network |
$35.16
|
| Rate for Payer: Quartz Commercial |
$46.64
|
| Rate for Payer: Quartz Medicare Advantage |
$43.06
|
| Rate for Payer: The Alliance Commercial |
$35.88
|
| Rate for Payer: WEA Trust Commercial |
$39.47
|
| Rate for Payer: WPS Commercial |
$53.15
|
|
|
WIRE CUTTER MDS10508
|
Facility
|
IP
|
$69.00
|
|
| Hospital Charge Code |
2964048
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.16 |
| Max. Negotiated Rate |
$66.02 |
| Rate for Payer: Aetna Commercial |
$64.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$61.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.03
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cigna Commercial |
$66.02
|
| Rate for Payer: Health EOS Commercial |
$63.87
|
| Rate for Payer: HFN Commercial |
$66.02
|
| Rate for Payer: Multiplan Commercial |
$57.41
|
| Rate for Payer: Preferred Network Access Commercial |
$66.02
|
| Rate for Payer: Quartz Beloit One Network |
$35.16
|
| Rate for Payer: Quartz Commercial |
$43.06
|
| Rate for Payer: WEA Trust Commercial |
$39.47
|
| Rate for Payer: WPS Commercial |
$53.15
|
|
|
WIRE CV PACER 025-100
|
Facility
|
IP
|
$302.00
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
2965150
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$153.90 |
| Max. Negotiated Rate |
$288.95 |
| Rate for Payer: Aetna Commercial |
$282.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$270.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$166.46
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna Commercial |
$288.95
|
| Rate for Payer: Health EOS Commercial |
$279.53
|
| Rate for Payer: HFN Commercial |
$288.95
|
| Rate for Payer: Multiplan Commercial |
$251.26
|
| Rate for Payer: Preferred Network Access Commercial |
$288.95
|
| Rate for Payer: Quartz Beloit One Network |
$153.90
|
| Rate for Payer: Quartz Commercial |
$188.45
|
| Rate for Payer: WEA Trust Commercial |
$172.74
|
| Rate for Payer: WPS Commercial |
$232.63
|
|
|
WIRE CV PACER 025-100
|
Facility
|
OP
|
$302.00
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
2965150
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$87.94 |
| Max. Negotiated Rate |
$288.95 |
| Rate for Payer: Aetna Commercial |
$282.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$270.11
|
| Rate for Payer: Aetna Managed Medicare |
$87.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$204.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$157.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$150.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$166.46
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna Commercial |
$288.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$175.76
|
| Rate for Payer: Health EOS Commercial |
$279.53
|
| Rate for Payer: HFN Commercial |
$288.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$235.56
|
| Rate for Payer: Multiplan Commercial |
$251.26
|
| Rate for Payer: NAPHCARE Commercial |
$188.45
|
| Rate for Payer: Preferred Network Access Commercial |
$288.95
|
| Rate for Payer: Quartz Beloit One Network |
$153.90
|
| Rate for Payer: Quartz Commercial |
$204.15
|
| Rate for Payer: Quartz Medicare Advantage |
$188.45
|
| Rate for Payer: The Alliance Commercial |
$157.04
|
| Rate for Payer: WEA Trust Commercial |
$172.74
|
| Rate for Payer: WPS Commercial |
$232.63
|
|
|
WIRE DOUBLE STERNAL 046-237
|
Facility
|
IP
|
$1,353.00
|
|
| Hospital Charge Code |
2965502
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$689.49 |
| Max. Negotiated Rate |
$1,294.55 |
| Rate for Payer: Aetna Commercial |
$1,266.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,210.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$745.77
|
| Rate for Payer: Cash Price |
$405.90
|
| Rate for Payer: Cigna Commercial |
$1,294.55
|
| Rate for Payer: Health EOS Commercial |
$1,252.34
|
| Rate for Payer: HFN Commercial |
$1,294.55
|
| Rate for Payer: Multiplan Commercial |
$1,125.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,294.55
|
| Rate for Payer: Quartz Beloit One Network |
$689.49
|
| Rate for Payer: Quartz Commercial |
$844.27
|
| Rate for Payer: WEA Trust Commercial |
$773.92
|
| Rate for Payer: WPS Commercial |
$1,042.22
|
|
|
WIRE DOUBLE STERNAL 046-237
|
Facility
|
OP
|
$1,353.00
|
|
| Hospital Charge Code |
2965502
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$393.99 |
| Max. Negotiated Rate |
$1,294.55 |
| Rate for Payer: Aetna Commercial |
$1,266.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,210.12
|
| Rate for Payer: Aetna Managed Medicare |
$393.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$914.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$703.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$675.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$745.77
|
| Rate for Payer: Cash Price |
$405.90
|
| Rate for Payer: Cigna Commercial |
$1,294.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$787.45
|
| Rate for Payer: Health EOS Commercial |
$1,252.34
|
| Rate for Payer: HFN Commercial |
$1,294.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,055.34
|
| Rate for Payer: Multiplan Commercial |
$1,125.70
|
| Rate for Payer: NAPHCARE Commercial |
$844.27
|
| Rate for Payer: Preferred Network Access Commercial |
$1,294.55
|
| Rate for Payer: Quartz Beloit One Network |
$689.49
|
| Rate for Payer: Quartz Commercial |
$914.63
|
| Rate for Payer: Quartz Medicare Advantage |
$844.27
|
| Rate for Payer: The Alliance Commercial |
$703.56
|
| Rate for Payer: WEA Trust Commercial |
$773.92
|
| Rate for Payer: WPS Commercial |
$1,042.22
|
|
|
WIRE GUIDE 17.0/3.2MMx161MM
|
Facility
|
IP
|
$3,222.00
|
|
| Hospital Charge Code |
2966596
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,641.93 |
| Max. Negotiated Rate |
$3,082.81 |
| Rate for Payer: Aetna Commercial |
$3,015.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,881.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,775.97
|
| Rate for Payer: Cash Price |
$966.60
|
| Rate for Payer: Cigna Commercial |
$3,082.81
|
| Rate for Payer: Health EOS Commercial |
$2,982.28
|
| Rate for Payer: HFN Commercial |
$3,082.81
|
| Rate for Payer: Multiplan Commercial |
$2,680.70
|
| Rate for Payer: Preferred Network Access Commercial |
$3,082.81
|
| Rate for Payer: Quartz Beloit One Network |
$1,641.93
|
| Rate for Payer: Quartz Commercial |
$2,010.53
|
| Rate for Payer: WEA Trust Commercial |
$1,842.98
|
| Rate for Payer: WPS Commercial |
$2,481.91
|
|
|
WIRE GUIDE 17.0/3.2MMx161MM
|
Facility
|
OP
|
$3,222.00
|
|
| Hospital Charge Code |
2966596
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$938.25 |
| Max. Negotiated Rate |
$3,082.81 |
| Rate for Payer: Aetna Commercial |
$3,015.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,881.76
|
| Rate for Payer: Aetna Managed Medicare |
$938.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,178.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,675.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,608.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,775.97
|
| Rate for Payer: Cash Price |
$966.60
|
| Rate for Payer: Cigna Commercial |
$3,082.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,875.20
|
| Rate for Payer: Health EOS Commercial |
$2,982.28
|
| Rate for Payer: HFN Commercial |
$3,082.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,513.16
|
| Rate for Payer: Multiplan Commercial |
$2,680.70
|
| Rate for Payer: NAPHCARE Commercial |
$2,010.53
|
| Rate for Payer: Preferred Network Access Commercial |
$3,082.81
|
| Rate for Payer: Quartz Beloit One Network |
$1,641.93
|
| Rate for Payer: Quartz Commercial |
$2,178.07
|
| Rate for Payer: Quartz Medicare Advantage |
$2,010.53
|
| Rate for Payer: The Alliance Commercial |
$1,675.44
|
| Rate for Payer: WEA Trust Commercial |
$1,842.98
|
| Rate for Payer: WPS Commercial |
$2,481.91
|
|
|
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 |
$194.52 |
| Max. Negotiated Rate |
$639.14 |
| Rate for Payer: Aetna Commercial |
$625.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$597.46
|
| Rate for Payer: Aetna Managed Medicare |
$194.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$451.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$347.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$333.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$368.20
|
| Rate for Payer: Cash Price |
$200.40
|
| Rate for Payer: Cigna Commercial |
$639.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$388.78
|
| Rate for Payer: Health EOS Commercial |
$618.30
|
| Rate for Payer: HFN Commercial |
$639.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$521.04
|
| Rate for Payer: Multiplan Commercial |
$555.78
|
| Rate for Payer: NAPHCARE Commercial |
$416.83
|
| Rate for Payer: Preferred Network Access Commercial |
$639.14
|
| Rate for Payer: Quartz Beloit One Network |
$340.41
|
| Rate for Payer: Quartz Commercial |
$451.57
|
| Rate for Payer: Quartz Medicare Advantage |
$416.83
|
| Rate for Payer: The Alliance Commercial |
$347.36
|
| Rate for Payer: WEA Trust Commercial |
$382.10
|
| Rate for Payer: WPS Commercial |
$514.56
|
|
|
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 |
$340.41 |
| Max. Negotiated Rate |
$639.14 |
| Rate for Payer: Aetna Commercial |
$625.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$597.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$368.20
|
| Rate for Payer: Cash Price |
$200.40
|
| Rate for Payer: Cigna Commercial |
$639.14
|
| Rate for Payer: Health EOS Commercial |
$618.30
|
| Rate for Payer: HFN Commercial |
$639.14
|
| Rate for Payer: Multiplan Commercial |
$555.78
|
| Rate for Payer: Preferred Network Access Commercial |
$639.14
|
| Rate for Payer: Quartz Beloit One Network |
$340.41
|
| Rate for Payer: Quartz Commercial |
$416.83
|
| Rate for Payer: WEA Trust Commercial |
$382.10
|
| Rate for Payer: WPS Commercial |
$514.56
|
|
|
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 |
$131.91 |
| Max. Negotiated Rate |
$433.43 |
| Rate for Payer: Aetna Commercial |
$424.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$405.16
|
| Rate for Payer: Aetna Managed Medicare |
$131.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$306.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$235.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$226.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$249.69
|
| Rate for Payer: Cash Price |
$135.90
|
| Rate for Payer: Cigna Commercial |
$433.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$263.65
|
| Rate for Payer: Health EOS Commercial |
$419.30
|
| Rate for Payer: HFN Commercial |
$433.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$353.34
|
| Rate for Payer: Multiplan Commercial |
$376.90
|
| Rate for Payer: NAPHCARE Commercial |
$282.67
|
| Rate for Payer: Preferred Network Access Commercial |
$433.43
|
| Rate for Payer: Quartz Beloit One Network |
$230.85
|
| Rate for Payer: Quartz Commercial |
$306.23
|
| Rate for Payer: Quartz Medicare Advantage |
$282.67
|
| Rate for Payer: The Alliance Commercial |
$235.56
|
| Rate for Payer: WEA Trust Commercial |
$259.12
|
| Rate for Payer: WPS Commercial |
$348.95
|
|
|
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 |
$230.85 |
| Max. Negotiated Rate |
$433.43 |
| Rate for Payer: Aetna Commercial |
$424.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$405.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$249.69
|
| Rate for Payer: Cash Price |
$135.90
|
| Rate for Payer: Cigna Commercial |
$433.43
|
| Rate for Payer: Health EOS Commercial |
$419.30
|
| Rate for Payer: HFN Commercial |
$433.43
|
| Rate for Payer: Multiplan Commercial |
$376.90
|
| Rate for Payer: Preferred Network Access Commercial |
$433.43
|
| Rate for Payer: Quartz Beloit One Network |
$230.85
|
| Rate for Payer: Quartz Commercial |
$282.67
|
| Rate for Payer: WEA Trust Commercial |
$259.12
|
| Rate for Payer: WPS Commercial |
$348.95
|
|
|
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 |
$689.56 |
| Max. Negotiated Rate |
$2,265.70 |
| Rate for Payer: Aetna Commercial |
$2,216.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,117.94
|
| Rate for Payer: Aetna Managed Medicare |
$689.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,600.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,231.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,182.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,305.24
|
| Rate for Payer: Cash Price |
$710.40
|
| Rate for Payer: Cigna Commercial |
$2,265.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,378.18
|
| Rate for Payer: Health EOS Commercial |
$2,191.82
|
| Rate for Payer: HFN Commercial |
$2,265.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,847.04
|
| Rate for Payer: Multiplan Commercial |
$1,970.18
|
| Rate for Payer: NAPHCARE Commercial |
$1,477.63
|
| Rate for Payer: Preferred Network Access Commercial |
$2,265.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,206.73
|
| Rate for Payer: Quartz Commercial |
$1,600.77
|
| Rate for Payer: Quartz Medicare Advantage |
$1,477.63
|
| Rate for Payer: The Alliance Commercial |
$1,231.36
|
| Rate for Payer: WEA Trust Commercial |
$1,354.50
|
| Rate for Payer: WPS Commercial |
$1,824.07
|
|
|
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 |
$1,206.73 |
| Max. Negotiated Rate |
$2,265.70 |
| Rate for Payer: Aetna Commercial |
$2,216.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,117.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,305.24
|
| Rate for Payer: Cash Price |
$710.40
|
| Rate for Payer: Cigna Commercial |
$2,265.70
|
| Rate for Payer: Health EOS Commercial |
$2,191.82
|
| Rate for Payer: HFN Commercial |
$2,265.70
|
| Rate for Payer: Multiplan Commercial |
$1,970.18
|
| Rate for Payer: Preferred Network Access Commercial |
$2,265.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,206.73
|
| Rate for Payer: Quartz Commercial |
$1,477.63
|
| Rate for Payer: WEA Trust Commercial |
$1,354.50
|
| Rate for Payer: WPS Commercial |
$1,824.07
|
|
|
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 |
$1,161.89 |
| Max. Negotiated Rate |
$2,181.50 |
| Rate for Payer: Aetna Commercial |
$2,134.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,039.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,256.74
|
| Rate for Payer: Cash Price |
$684.00
|
| Rate for Payer: Cigna Commercial |
$2,181.50
|
| Rate for Payer: Health EOS Commercial |
$2,110.37
|
| Rate for Payer: HFN Commercial |
$2,181.50
|
| Rate for Payer: Multiplan Commercial |
$1,896.96
|
| Rate for Payer: Preferred Network Access Commercial |
$2,181.50
|
| Rate for Payer: Quartz Beloit One Network |
$1,161.89
|
| Rate for Payer: Quartz Commercial |
$1,422.72
|
| Rate for Payer: WEA Trust Commercial |
$1,304.16
|
| Rate for Payer: WPS Commercial |
$1,756.28
|
|
|
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 |
$663.94 |
| Max. Negotiated Rate |
$2,181.50 |
| Rate for Payer: Aetna Commercial |
$2,134.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,039.23
|
| Rate for Payer: Aetna Managed Medicare |
$663.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,541.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,185.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,138.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,256.74
|
| Rate for Payer: Cash Price |
$684.00
|
| Rate for Payer: Cigna Commercial |
$2,181.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,326.96
|
| Rate for Payer: Health EOS Commercial |
$2,110.37
|
| Rate for Payer: HFN Commercial |
$2,181.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,778.40
|
| Rate for Payer: Multiplan Commercial |
$1,896.96
|
| Rate for Payer: NAPHCARE Commercial |
$1,422.72
|
| Rate for Payer: Preferred Network Access Commercial |
$2,181.50
|
| Rate for Payer: Quartz Beloit One Network |
$1,161.89
|
| Rate for Payer: Quartz Commercial |
$1,541.28
|
| Rate for Payer: Quartz Medicare Advantage |
$1,422.72
|
| Rate for Payer: The Alliance Commercial |
$1,185.60
|
| Rate for Payer: WEA Trust Commercial |
$1,304.16
|
| Rate for Payer: WPS Commercial |
$1,756.28
|
|
|
WIRE JAW 23GA
|
Facility
|
IP
|
$614.00
|
|
| Hospital Charge Code |
2965099
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$312.89 |
| Max. Negotiated Rate |
$587.48 |
| Rate for Payer: Aetna Commercial |
$574.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$549.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$338.44
|
| Rate for Payer: Cash Price |
$184.20
|
| Rate for Payer: Cigna Commercial |
$587.48
|
| Rate for Payer: Health EOS Commercial |
$568.32
|
| Rate for Payer: HFN Commercial |
$587.48
|
| Rate for Payer: Multiplan Commercial |
$510.85
|
| Rate for Payer: Preferred Network Access Commercial |
$587.48
|
| Rate for Payer: Quartz Beloit One Network |
$312.89
|
| Rate for Payer: Quartz Commercial |
$383.14
|
| Rate for Payer: WEA Trust Commercial |
$351.21
|
| Rate for Payer: WPS Commercial |
$472.96
|
|
|
WIRE JAW 23GA
|
Facility
|
OP
|
$614.00
|
|
| Hospital Charge Code |
2965099
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$178.80 |
| Max. Negotiated Rate |
$587.48 |
| Rate for Payer: Aetna Commercial |
$574.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$549.16
|
| Rate for Payer: Aetna Managed Medicare |
$178.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$415.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$319.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$306.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$338.44
|
| Rate for Payer: Cash Price |
$184.20
|
| Rate for Payer: Cigna Commercial |
$587.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$357.35
|
| Rate for Payer: Health EOS Commercial |
$568.32
|
| Rate for Payer: HFN Commercial |
$587.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$478.92
|
| Rate for Payer: Multiplan Commercial |
$510.85
|
| Rate for Payer: NAPHCARE Commercial |
$383.14
|
| Rate for Payer: Preferred Network Access Commercial |
$587.48
|
| Rate for Payer: Quartz Beloit One Network |
$312.89
|
| Rate for Payer: Quartz Commercial |
$415.06
|
| Rate for Payer: Quartz Medicare Advantage |
$383.14
|
| Rate for Payer: The Alliance Commercial |
$319.28
|
| Rate for Payer: WEA Trust Commercial |
$351.21
|
| Rate for Payer: WPS Commercial |
$472.96
|
|
|
WIRE JAW FRACTURE 26GA
|
Facility
|
IP
|
$614.00
|
|
| Hospital Charge Code |
2965101
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$312.89 |
| Max. Negotiated Rate |
$587.48 |
| Rate for Payer: Aetna Commercial |
$574.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$549.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$338.44
|
| Rate for Payer: Cash Price |
$184.20
|
| Rate for Payer: Cigna Commercial |
$587.48
|
| Rate for Payer: Health EOS Commercial |
$568.32
|
| Rate for Payer: HFN Commercial |
$587.48
|
| Rate for Payer: Multiplan Commercial |
$510.85
|
| Rate for Payer: Preferred Network Access Commercial |
$587.48
|
| Rate for Payer: Quartz Beloit One Network |
$312.89
|
| Rate for Payer: Quartz Commercial |
$383.14
|
| Rate for Payer: WEA Trust Commercial |
$351.21
|
| Rate for Payer: WPS Commercial |
$472.96
|
|
|
WIRE JAW FRACTURE 26GA
|
Facility
|
OP
|
$614.00
|
|
| Hospital Charge Code |
2965101
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$178.80 |
| Max. Negotiated Rate |
$587.48 |
| Rate for Payer: Aetna Commercial |
$574.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$549.16
|
| Rate for Payer: Aetna Managed Medicare |
$178.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$415.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$319.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$306.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$338.44
|
| Rate for Payer: Cash Price |
$184.20
|
| Rate for Payer: Cigna Commercial |
$587.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$357.35
|
| Rate for Payer: Health EOS Commercial |
$568.32
|
| Rate for Payer: HFN Commercial |
$587.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$478.92
|
| Rate for Payer: Multiplan Commercial |
$510.85
|
| Rate for Payer: NAPHCARE Commercial |
$383.14
|
| Rate for Payer: Preferred Network Access Commercial |
$587.48
|
| Rate for Payer: Quartz Beloit One Network |
$312.89
|
| Rate for Payer: Quartz Commercial |
$415.06
|
| Rate for Payer: Quartz Medicare Advantage |
$383.14
|
| Rate for Payer: The Alliance Commercial |
$319.28
|
| Rate for Payer: WEA Trust Commercial |
$351.21
|
| Rate for Payer: WPS Commercial |
$472.96
|
|
|
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 |
$382.20 |
| Max. Negotiated Rate |
$717.60 |
| Rate for Payer: Aetna Commercial |
$702.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$670.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$413.40
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$717.60
|
| Rate for Payer: Health EOS Commercial |
$694.20
|
| Rate for Payer: HFN Commercial |
$717.60
|
| Rate for Payer: Multiplan Commercial |
$624.00
|
| Rate for Payer: Preferred Network Access Commercial |
$717.60
|
| Rate for Payer: Quartz Beloit One Network |
$382.20
|
| Rate for Payer: Quartz Commercial |
$468.00
|
| Rate for Payer: WEA Trust Commercial |
$429.00
|
| Rate for Payer: WPS Commercial |
$577.73
|
|
|
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 |
$218.40 |
| Max. Negotiated Rate |
$717.60 |
| Rate for Payer: Aetna Commercial |
$702.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$670.80
|
| Rate for Payer: Aetna Managed Medicare |
$218.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$507.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$390.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$374.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$413.40
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$717.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$436.50
|
| Rate for Payer: Health EOS Commercial |
$694.20
|
| Rate for Payer: HFN Commercial |
$717.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$585.00
|
| Rate for Payer: Multiplan Commercial |
$624.00
|
| Rate for Payer: NAPHCARE Commercial |
$468.00
|
| Rate for Payer: Preferred Network Access Commercial |
$717.60
|
| Rate for Payer: Quartz Beloit One Network |
$382.20
|
| Rate for Payer: Quartz Commercial |
$507.00
|
| Rate for Payer: Quartz Medicare Advantage |
$468.00
|
| Rate for Payer: The Alliance Commercial |
$390.00
|
| Rate for Payer: WEA Trust Commercial |
$429.00
|
| Rate for Payer: WPS Commercial |
$577.73
|
|
|
WIRE LOOP ZIMMER 1.22MM 16GA 30CM 1292-61
|
Facility
|
IP
|
$750.00
|
|
| Hospital Charge Code |
2967544
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$382.20 |
| Max. Negotiated Rate |
$717.60 |
| Rate for Payer: Aetna Commercial |
$702.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$670.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$413.40
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$717.60
|
| Rate for Payer: Health EOS Commercial |
$694.20
|
| Rate for Payer: HFN Commercial |
$717.60
|
| Rate for Payer: Multiplan Commercial |
$624.00
|
| Rate for Payer: Preferred Network Access Commercial |
$717.60
|
| Rate for Payer: Quartz Beloit One Network |
$382.20
|
| Rate for Payer: Quartz Commercial |
$468.00
|
| Rate for Payer: WEA Trust Commercial |
$429.00
|
| Rate for Payer: WPS Commercial |
$577.73
|
|
