|
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 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 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 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 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 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
|
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 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 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 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
|
|
|
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
|
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 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 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 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
|
|
