|
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 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 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 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 1.25 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 1.25x150 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 1.25x150 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 1.6 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
|
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 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
|
|
|
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
|
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 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 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 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 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 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 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
|
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 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
|
|
