|
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
|
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 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 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
|
|
|
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 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 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 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 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 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 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 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
|
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 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 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
|
|
