|
WIRE LOOP ZIMMER 1.22MM 16GA 30CM 1292-61
|
Facility
|
OP
|
$750.00
|
|
| Hospital Charge Code |
2967544
|
|
Hospital Revenue Code
|
272
|
| 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 OLIVE MFT-040
|
Facility
|
OP
|
$1,152.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4028660
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$335.46 |
| Max. Negotiated Rate |
$1,102.23 |
| Rate for Payer: Aetna Commercial |
$1,078.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,030.35
|
| Rate for Payer: Aetna Managed Medicare |
$335.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$778.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$599.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$575.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$634.98
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Cigna Commercial |
$1,102.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$670.46
|
| Rate for Payer: Health EOS Commercial |
$1,066.29
|
| Rate for Payer: HFN Commercial |
$1,102.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$898.56
|
| Rate for Payer: Multiplan Commercial |
$958.46
|
| Rate for Payer: NAPHCARE Commercial |
$718.85
|
| Rate for Payer: Preferred Network Access Commercial |
$1,102.23
|
| Rate for Payer: Quartz Beloit One Network |
$587.06
|
| Rate for Payer: Quartz Commercial |
$778.75
|
| Rate for Payer: Quartz Medicare Advantage |
$718.85
|
| Rate for Payer: The Alliance Commercial |
$599.04
|
| Rate for Payer: WEA Trust Commercial |
$658.94
|
| Rate for Payer: WPS Commercial |
$887.39
|
|
|
WIRE OLIVE MFT-040
|
Facility
|
IP
|
$1,152.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4028660
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$587.06 |
| Max. Negotiated Rate |
$1,102.23 |
| Rate for Payer: Aetna Commercial |
$1,078.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,030.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$634.98
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Cigna Commercial |
$1,102.23
|
| Rate for Payer: Health EOS Commercial |
$1,066.29
|
| Rate for Payer: HFN Commercial |
$1,102.23
|
| Rate for Payer: Multiplan Commercial |
$958.46
|
| Rate for Payer: Preferred Network Access Commercial |
$1,102.23
|
| Rate for Payer: Quartz Beloit One Network |
$587.06
|
| Rate for Payer: Quartz Commercial |
$718.85
|
| Rate for Payer: WEA Trust Commercial |
$658.94
|
| Rate for Payer: WPS Commercial |
$887.39
|
|
|
WIRE ROADRUNNER NIMBLE HYDROPHILIC WIRE GUIDE ANGLED 180CM X 11.5CM X 3CM .035 G09608
|
Facility
|
IP
|
$646.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6201003
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$329.20 |
| Max. Negotiated Rate |
$618.09 |
| Rate for Payer: Aetna Commercial |
$604.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$577.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$356.08
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cigna Commercial |
$618.09
|
| Rate for Payer: Health EOS Commercial |
$597.94
|
| Rate for Payer: HFN Commercial |
$618.09
|
| Rate for Payer: Multiplan Commercial |
$537.47
|
| Rate for Payer: Preferred Network Access Commercial |
$618.09
|
| Rate for Payer: Quartz Beloit One Network |
$329.20
|
| Rate for Payer: Quartz Commercial |
$403.10
|
| Rate for Payer: WEA Trust Commercial |
$369.51
|
| Rate for Payer: WPS Commercial |
$497.61
|
|
|
WIRE ROADRUNNER NIMBLE HYDROPHILIC WIRE GUIDE ANGLED 180CM X 11.5CM X 3CM .035 G09608
|
Facility
|
OP
|
$646.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6201003
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$188.12 |
| Max. Negotiated Rate |
$618.09 |
| Rate for Payer: Aetna Commercial |
$604.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$577.78
|
| Rate for Payer: Aetna Managed Medicare |
$188.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$436.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$335.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$322.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$356.08
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cigna Commercial |
$618.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$375.97
|
| Rate for Payer: Health EOS Commercial |
$597.94
|
| Rate for Payer: HFN Commercial |
$618.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$503.88
|
| Rate for Payer: Multiplan Commercial |
$537.47
|
| Rate for Payer: NAPHCARE Commercial |
$403.10
|
| Rate for Payer: Preferred Network Access Commercial |
$618.09
|
| Rate for Payer: Quartz Beloit One Network |
$329.20
|
| Rate for Payer: Quartz Commercial |
$436.70
|
| Rate for Payer: Quartz Medicare Advantage |
$403.10
|
| Rate for Payer: The Alliance Commercial |
$335.92
|
| Rate for Payer: WEA Trust Commercial |
$369.51
|
| Rate for Payer: WPS Commercial |
$497.61
|
|
|
WIRE ROTA EX-EXTRA SUPPORT 23239-001
|
Facility
|
IP
|
$2,131.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3609503
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,085.96 |
| Max. Negotiated Rate |
$2,038.94 |
| Rate for Payer: Aetna Commercial |
$1,994.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,905.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,174.61
|
| Rate for Payer: Cash Price |
$639.30
|
| Rate for Payer: Cigna Commercial |
$2,038.94
|
| Rate for Payer: Health EOS Commercial |
$1,972.45
|
| Rate for Payer: HFN Commercial |
$2,038.94
|
| Rate for Payer: Multiplan Commercial |
$1,772.99
|
| Rate for Payer: Preferred Network Access Commercial |
$2,038.94
|
| Rate for Payer: Quartz Beloit One Network |
$1,085.96
|
| Rate for Payer: Quartz Commercial |
$1,329.74
|
| Rate for Payer: WEA Trust Commercial |
$1,218.93
|
| Rate for Payer: WPS Commercial |
$1,641.51
|
|
|
WIRE ROTA EX-EXTRA SUPPORT 23239-001
|
Facility
|
OP
|
$2,131.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3609503
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$620.55 |
| Max. Negotiated Rate |
$2,038.94 |
| Rate for Payer: Aetna Commercial |
$1,994.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,905.97
|
| Rate for Payer: Aetna Managed Medicare |
$620.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,440.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,108.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,063.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,174.61
|
| Rate for Payer: Cash Price |
$639.30
|
| Rate for Payer: Cigna Commercial |
$2,038.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,240.24
|
| Rate for Payer: Health EOS Commercial |
$1,972.45
|
| Rate for Payer: HFN Commercial |
$2,038.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,662.18
|
| Rate for Payer: Multiplan Commercial |
$1,772.99
|
| Rate for Payer: NAPHCARE Commercial |
$1,329.74
|
| Rate for Payer: Preferred Network Access Commercial |
$2,038.94
|
| Rate for Payer: Quartz Beloit One Network |
$1,085.96
|
| Rate for Payer: Quartz Commercial |
$1,440.56
|
| Rate for Payer: Quartz Medicare Advantage |
$1,329.74
|
| Rate for Payer: The Alliance Commercial |
$1,108.12
|
| Rate for Payer: WEA Trust Commercial |
$1,218.93
|
| Rate for Payer: WPS Commercial |
$1,641.51
|
|
|
WIRE ROTA FLOPPY
|
Facility
|
OP
|
$2,131.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3609504
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$620.55 |
| Max. Negotiated Rate |
$2,038.94 |
| Rate for Payer: Aetna Commercial |
$1,994.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,905.97
|
| Rate for Payer: Aetna Managed Medicare |
$620.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,440.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,108.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,063.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,174.61
|
| Rate for Payer: Cash Price |
$639.30
|
| Rate for Payer: Cigna Commercial |
$2,038.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,240.24
|
| Rate for Payer: Health EOS Commercial |
$1,972.45
|
| Rate for Payer: HFN Commercial |
$2,038.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,662.18
|
| Rate for Payer: Multiplan Commercial |
$1,772.99
|
| Rate for Payer: NAPHCARE Commercial |
$1,329.74
|
| Rate for Payer: Preferred Network Access Commercial |
$2,038.94
|
| Rate for Payer: Quartz Beloit One Network |
$1,085.96
|
| Rate for Payer: Quartz Commercial |
$1,440.56
|
| Rate for Payer: Quartz Medicare Advantage |
$1,329.74
|
| Rate for Payer: The Alliance Commercial |
$1,108.12
|
| Rate for Payer: WEA Trust Commercial |
$1,218.93
|
| Rate for Payer: WPS Commercial |
$1,641.51
|
|
|
WIRE ROTA FLOPPY
|
Facility
|
IP
|
$2,131.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3609504
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,085.96 |
| Max. Negotiated Rate |
$2,038.94 |
| Rate for Payer: Aetna Commercial |
$1,994.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,905.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,174.61
|
| Rate for Payer: Cash Price |
$639.30
|
| Rate for Payer: Cigna Commercial |
$2,038.94
|
| Rate for Payer: Health EOS Commercial |
$1,972.45
|
| Rate for Payer: HFN Commercial |
$2,038.94
|
| Rate for Payer: Multiplan Commercial |
$1,772.99
|
| Rate for Payer: Preferred Network Access Commercial |
$2,038.94
|
| Rate for Payer: Quartz Beloit One Network |
$1,085.96
|
| Rate for Payer: Quartz Commercial |
$1,329.74
|
| Rate for Payer: WEA Trust Commercial |
$1,218.93
|
| Rate for Payer: WPS Commercial |
$1,641.51
|
|
|
WIRE SET BTB TRANSFIX
|
Facility
|
IP
|
$2,660.00
|
|
| Hospital Charge Code |
2964708
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,355.54 |
| Max. Negotiated Rate |
$2,545.09 |
| Rate for Payer: Aetna Commercial |
$2,489.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,379.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,466.19
|
| Rate for Payer: Cash Price |
$798.00
|
| Rate for Payer: Cigna Commercial |
$2,545.09
|
| Rate for Payer: Health EOS Commercial |
$2,462.10
|
| Rate for Payer: HFN Commercial |
$2,545.09
|
| Rate for Payer: Multiplan Commercial |
$2,213.12
|
| Rate for Payer: Preferred Network Access Commercial |
$2,545.09
|
| Rate for Payer: Quartz Beloit One Network |
$1,355.54
|
| Rate for Payer: Quartz Commercial |
$1,659.84
|
| Rate for Payer: WEA Trust Commercial |
$1,521.52
|
| Rate for Payer: WPS Commercial |
$2,049.00
|
|
|
WIRE SET BTB TRANSFIX
|
Facility
|
OP
|
$2,660.00
|
|
| Hospital Charge Code |
2964708
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$774.59 |
| Max. Negotiated Rate |
$2,545.09 |
| Rate for Payer: Aetna Commercial |
$2,489.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,379.10
|
| Rate for Payer: Aetna Managed Medicare |
$774.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,798.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,383.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,327.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,466.19
|
| Rate for Payer: Cash Price |
$798.00
|
| Rate for Payer: Cigna Commercial |
$2,545.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,548.12
|
| Rate for Payer: Health EOS Commercial |
$2,462.10
|
| Rate for Payer: HFN Commercial |
$2,545.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,074.80
|
| Rate for Payer: Multiplan Commercial |
$2,213.12
|
| Rate for Payer: NAPHCARE Commercial |
$1,659.84
|
| Rate for Payer: Preferred Network Access Commercial |
$2,545.09
|
| Rate for Payer: Quartz Beloit One Network |
$1,355.54
|
| Rate for Payer: Quartz Commercial |
$1,798.16
|
| Rate for Payer: Quartz Medicare Advantage |
$1,659.84
|
| Rate for Payer: The Alliance Commercial |
$1,383.20
|
| Rate for Payer: WEA Trust Commercial |
$1,521.52
|
| Rate for Payer: WPS Commercial |
$2,049.00
|
|
|
WIRE SLEEVE 1.6MM 323.055
|
Facility
|
OP
|
$2,195.00
|
|
| Hospital Charge Code |
2967339
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$639.18 |
| Max. Negotiated Rate |
$2,100.18 |
| Rate for Payer: Aetna Commercial |
$2,054.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,963.21
|
| Rate for Payer: Aetna Managed Medicare |
$639.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,483.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,141.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,095.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,209.88
|
| Rate for Payer: Cash Price |
$658.50
|
| Rate for Payer: Cigna Commercial |
$2,100.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,277.49
|
| Rate for Payer: Health EOS Commercial |
$2,031.69
|
| Rate for Payer: HFN Commercial |
$2,100.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,712.10
|
| Rate for Payer: Multiplan Commercial |
$1,826.24
|
| Rate for Payer: NAPHCARE Commercial |
$1,369.68
|
| Rate for Payer: Preferred Network Access Commercial |
$2,100.18
|
| Rate for Payer: Quartz Beloit One Network |
$1,118.57
|
| Rate for Payer: Quartz Commercial |
$1,483.82
|
| Rate for Payer: Quartz Medicare Advantage |
$1,369.68
|
| Rate for Payer: The Alliance Commercial |
$1,141.40
|
| Rate for Payer: WEA Trust Commercial |
$1,255.54
|
| Rate for Payer: WPS Commercial |
$1,690.81
|
|
|
WIRE SLEEVE 1.6MM 323.055
|
Facility
|
IP
|
$2,195.00
|
|
| Hospital Charge Code |
2967339
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,118.57 |
| Max. Negotiated Rate |
$2,100.18 |
| Rate for Payer: Aetna Commercial |
$2,054.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,963.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,209.88
|
| Rate for Payer: Cash Price |
$658.50
|
| Rate for Payer: Cigna Commercial |
$2,100.18
|
| Rate for Payer: Health EOS Commercial |
$2,031.69
|
| Rate for Payer: HFN Commercial |
$2,100.18
|
| Rate for Payer: Multiplan Commercial |
$1,826.24
|
| Rate for Payer: Preferred Network Access Commercial |
$2,100.18
|
| Rate for Payer: Quartz Beloit One Network |
$1,118.57
|
| Rate for Payer: Quartz Commercial |
$1,369.68
|
| Rate for Payer: WEA Trust Commercial |
$1,255.54
|
| Rate for Payer: WPS Commercial |
$1,690.81
|
|
|
WIRE STERNAL #5
|
Facility
|
IP
|
$415.00
|
|
| Hospital Charge Code |
2965503
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$211.48 |
| Max. Negotiated Rate |
$397.07 |
| Rate for Payer: Aetna Commercial |
$388.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$371.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$228.75
|
| Rate for Payer: Cash Price |
$124.50
|
| Rate for Payer: Cigna Commercial |
$397.07
|
| Rate for Payer: Health EOS Commercial |
$384.12
|
| Rate for Payer: HFN Commercial |
$397.07
|
| Rate for Payer: Multiplan Commercial |
$345.28
|
| Rate for Payer: Preferred Network Access Commercial |
$397.07
|
| Rate for Payer: Quartz Beloit One Network |
$211.48
|
| Rate for Payer: Quartz Commercial |
$258.96
|
| Rate for Payer: WEA Trust Commercial |
$237.38
|
| Rate for Payer: WPS Commercial |
$319.67
|
|
|
WIRE STERNAL #5
|
Facility
|
OP
|
$415.00
|
|
| Hospital Charge Code |
2965503
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$120.85 |
| Max. Negotiated Rate |
$397.07 |
| Rate for Payer: Aetna Commercial |
$388.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$371.18
|
| Rate for Payer: Aetna Managed Medicare |
$120.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$280.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$215.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$207.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$228.75
|
| Rate for Payer: Cash Price |
$124.50
|
| Rate for Payer: Cigna Commercial |
$397.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$241.53
|
| Rate for Payer: Health EOS Commercial |
$384.12
|
| Rate for Payer: HFN Commercial |
$397.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$323.70
|
| Rate for Payer: Multiplan Commercial |
$345.28
|
| Rate for Payer: NAPHCARE Commercial |
$258.96
|
| Rate for Payer: Preferred Network Access Commercial |
$397.07
|
| Rate for Payer: Quartz Beloit One Network |
$211.48
|
| Rate for Payer: Quartz Commercial |
$280.54
|
| Rate for Payer: Quartz Medicare Advantage |
$258.96
|
| Rate for Payer: The Alliance Commercial |
$215.80
|
| Rate for Payer: WEA Trust Commercial |
$237.38
|
| Rate for Payer: WPS Commercial |
$319.67
|
|
|
WIRE STERNAL #7 M655G
|
Facility
|
OP
|
$431.00
|
|
| Hospital Charge Code |
2965760
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$125.51 |
| Max. Negotiated Rate |
$412.38 |
| Rate for Payer: Aetna Commercial |
$403.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$385.49
|
| Rate for Payer: Aetna Managed Medicare |
$125.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$291.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$224.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$215.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$237.57
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cigna Commercial |
$412.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$250.84
|
| Rate for Payer: Health EOS Commercial |
$398.93
|
| Rate for Payer: HFN Commercial |
$412.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$336.18
|
| Rate for Payer: Multiplan Commercial |
$358.59
|
| Rate for Payer: NAPHCARE Commercial |
$268.94
|
| Rate for Payer: Preferred Network Access Commercial |
$412.38
|
| Rate for Payer: Quartz Beloit One Network |
$219.64
|
| Rate for Payer: Quartz Commercial |
$291.36
|
| Rate for Payer: Quartz Medicare Advantage |
$268.94
|
| Rate for Payer: The Alliance Commercial |
$224.12
|
| Rate for Payer: WEA Trust Commercial |
$246.53
|
| Rate for Payer: WPS Commercial |
$332.00
|
|
|
WIRE STERNAL #7 M655G
|
Facility
|
IP
|
$431.00
|
|
| Hospital Charge Code |
2965760
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$219.64 |
| Max. Negotiated Rate |
$412.38 |
| Rate for Payer: Aetna Commercial |
$403.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$385.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$237.57
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cigna Commercial |
$412.38
|
| Rate for Payer: Health EOS Commercial |
$398.93
|
| Rate for Payer: HFN Commercial |
$412.38
|
| Rate for Payer: Multiplan Commercial |
$358.59
|
| Rate for Payer: Preferred Network Access Commercial |
$412.38
|
| Rate for Payer: Quartz Beloit One Network |
$219.64
|
| Rate for Payer: Quartz Commercial |
$268.94
|
| Rate for Payer: WEA Trust Commercial |
$246.53
|
| Rate for Payer: WPS Commercial |
$332.00
|
|
|
WIRE STR COUGAR XT 300CM
|
Facility
|
OP
|
$1,424.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3553541
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$414.67 |
| Max. Negotiated Rate |
$1,362.48 |
| Rate for Payer: Aetna Commercial |
$1,332.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,273.63
|
| Rate for Payer: Aetna Managed Medicare |
$414.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$962.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$740.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$710.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$784.91
|
| Rate for Payer: Cash Price |
$427.20
|
| Rate for Payer: Cigna Commercial |
$1,362.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$828.77
|
| Rate for Payer: Health EOS Commercial |
$1,318.05
|
| Rate for Payer: HFN Commercial |
$1,362.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,110.72
|
| Rate for Payer: Multiplan Commercial |
$1,184.77
|
| Rate for Payer: NAPHCARE Commercial |
$888.58
|
| Rate for Payer: Preferred Network Access Commercial |
$1,362.48
|
| Rate for Payer: Quartz Beloit One Network |
$725.67
|
| Rate for Payer: Quartz Commercial |
$962.62
|
| Rate for Payer: Quartz Medicare Advantage |
$888.58
|
| Rate for Payer: The Alliance Commercial |
$740.48
|
| Rate for Payer: WEA Trust Commercial |
$814.53
|
| Rate for Payer: WPS Commercial |
$1,096.91
|
|
|
WIRE STR COUGAR XT 300CM
|
Facility
|
IP
|
$1,424.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3553541
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$725.67 |
| Max. Negotiated Rate |
$1,362.48 |
| Rate for Payer: Aetna Commercial |
$1,332.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,273.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$784.91
|
| Rate for Payer: Cash Price |
$427.20
|
| Rate for Payer: Cigna Commercial |
$1,362.48
|
| Rate for Payer: Health EOS Commercial |
$1,318.05
|
| Rate for Payer: HFN Commercial |
$1,362.48
|
| Rate for Payer: Multiplan Commercial |
$1,184.77
|
| Rate for Payer: Preferred Network Access Commercial |
$1,362.48
|
| Rate for Payer: Quartz Beloit One Network |
$725.67
|
| Rate for Payer: Quartz Commercial |
$888.58
|
| Rate for Payer: WEA Trust Commercial |
$814.53
|
| Rate for Payer: WPS Commercial |
$1,096.91
|
|
|
WIRE STR THUNDER 300CM
|
Facility
|
IP
|
$1,424.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3553542
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$725.67 |
| Max. Negotiated Rate |
$1,362.48 |
| Rate for Payer: Aetna Commercial |
$1,332.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,273.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$784.91
|
| Rate for Payer: Cash Price |
$427.20
|
| Rate for Payer: Cigna Commercial |
$1,362.48
|
| Rate for Payer: Health EOS Commercial |
$1,318.05
|
| Rate for Payer: HFN Commercial |
$1,362.48
|
| Rate for Payer: Multiplan Commercial |
$1,184.77
|
| Rate for Payer: Preferred Network Access Commercial |
$1,362.48
|
| Rate for Payer: Quartz Beloit One Network |
$725.67
|
| Rate for Payer: Quartz Commercial |
$888.58
|
| Rate for Payer: WEA Trust Commercial |
$814.53
|
| Rate for Payer: WPS Commercial |
$1,096.91
|
|
|
WIRE STR THUNDER 300CM
|
Facility
|
OP
|
$1,424.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3553542
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$414.67 |
| Max. Negotiated Rate |
$1,362.48 |
| Rate for Payer: Aetna Commercial |
$1,332.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,273.63
|
| Rate for Payer: Aetna Managed Medicare |
$414.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$962.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$740.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$710.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$784.91
|
| Rate for Payer: Cash Price |
$427.20
|
| Rate for Payer: Cigna Commercial |
$1,362.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$828.77
|
| Rate for Payer: Health EOS Commercial |
$1,318.05
|
| Rate for Payer: HFN Commercial |
$1,362.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,110.72
|
| Rate for Payer: Multiplan Commercial |
$1,184.77
|
| Rate for Payer: NAPHCARE Commercial |
$888.58
|
| Rate for Payer: Preferred Network Access Commercial |
$1,362.48
|
| Rate for Payer: Quartz Beloit One Network |
$725.67
|
| Rate for Payer: Quartz Commercial |
$962.62
|
| Rate for Payer: Quartz Medicare Advantage |
$888.58
|
| Rate for Payer: The Alliance Commercial |
$740.48
|
| Rate for Payer: WEA Trust Commercial |
$814.53
|
| Rate for Payer: WPS Commercial |
$1,096.91
|
|
|
Wire Wholey 145cm WWFS35175
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3103302
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$84.45 |
| Max. Negotiated Rate |
$277.47 |
| Rate for Payer: Aetna Commercial |
$271.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$259.38
|
| Rate for Payer: Aetna Managed Medicare |
$84.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$196.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$150.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$144.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$159.85
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$277.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$168.78
|
| Rate for Payer: Health EOS Commercial |
$268.42
|
| Rate for Payer: HFN Commercial |
$277.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$226.20
|
| Rate for Payer: Multiplan Commercial |
$241.28
|
| Rate for Payer: NAPHCARE Commercial |
$180.96
|
| Rate for Payer: Preferred Network Access Commercial |
$277.47
|
| Rate for Payer: Quartz Beloit One Network |
$147.78
|
| Rate for Payer: Quartz Commercial |
$196.04
|
| Rate for Payer: Quartz Medicare Advantage |
$180.96
|
| Rate for Payer: The Alliance Commercial |
$150.80
|
| Rate for Payer: WEA Trust Commercial |
$165.88
|
| Rate for Payer: WPS Commercial |
$223.39
|
|
|
Wire Wholey 145cm WWFS35175
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3103302
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.78 |
| Max. Negotiated Rate |
$277.47 |
| Rate for Payer: Aetna Commercial |
$271.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$259.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$159.85
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$277.47
|
| Rate for Payer: Health EOS Commercial |
$268.42
|
| Rate for Payer: HFN Commercial |
$277.47
|
| Rate for Payer: Multiplan Commercial |
$241.28
|
| Rate for Payer: Preferred Network Access Commercial |
$277.47
|
| Rate for Payer: Quartz Beloit One Network |
$147.78
|
| Rate for Payer: Quartz Commercial |
$180.96
|
| Rate for Payer: WEA Trust Commercial |
$165.88
|
| Rate for Payer: WPS Commercial |
$223.39
|
|
|
WIRE ZIP .035 180cm STIFF STRA 46-309B
|
Facility
|
IP
|
$1,012.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2973302
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$515.72 |
| Max. Negotiated Rate |
$968.28 |
| Rate for Payer: Aetna Commercial |
$947.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$905.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$557.81
|
| Rate for Payer: Cash Price |
$303.60
|
| Rate for Payer: Cigna Commercial |
$968.28
|
| Rate for Payer: Health EOS Commercial |
$936.71
|
| Rate for Payer: HFN Commercial |
$968.28
|
| Rate for Payer: Multiplan Commercial |
$841.98
|
| Rate for Payer: Preferred Network Access Commercial |
$968.28
|
| Rate for Payer: Quartz Beloit One Network |
$515.72
|
| Rate for Payer: Quartz Commercial |
$631.49
|
| Rate for Payer: WEA Trust Commercial |
$578.86
|
| Rate for Payer: WPS Commercial |
$779.54
|
|
|
WIRE ZIP .035 180cm STIFF STRA 46-309B
|
Facility
|
OP
|
$1,012.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2973302
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$294.69 |
| Max. Negotiated Rate |
$968.28 |
| Rate for Payer: Aetna Commercial |
$947.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$905.13
|
| Rate for Payer: Aetna Managed Medicare |
$294.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$684.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$526.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$505.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$557.81
|
| Rate for Payer: Cash Price |
$303.60
|
| Rate for Payer: Cigna Commercial |
$968.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$588.98
|
| Rate for Payer: Health EOS Commercial |
$936.71
|
| Rate for Payer: HFN Commercial |
$968.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$789.36
|
| Rate for Payer: Multiplan Commercial |
$841.98
|
| Rate for Payer: NAPHCARE Commercial |
$631.49
|
| Rate for Payer: Preferred Network Access Commercial |
$968.28
|
| Rate for Payer: Quartz Beloit One Network |
$515.72
|
| Rate for Payer: Quartz Commercial |
$684.11
|
| Rate for Payer: Quartz Medicare Advantage |
$631.49
|
| Rate for Payer: The Alliance Commercial |
$526.24
|
| Rate for Payer: WEA Trust Commercial |
$578.86
|
| Rate for Payer: WPS Commercial |
$779.54
|
|
