|
PIN BALL X-SERIES 4MM X004
|
Facility
|
IP
|
$70.00
|
|
| Hospital Charge Code |
2965220
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.67 |
| Max. Negotiated Rate |
$66.98 |
| Rate for Payer: Aetna Commercial |
$65.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$62.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.58
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$66.98
|
| Rate for Payer: Health EOS Commercial |
$64.79
|
| Rate for Payer: HFN Commercial |
$66.98
|
| Rate for Payer: Multiplan Commercial |
$58.24
|
| Rate for Payer: Preferred Network Access Commercial |
$66.98
|
| Rate for Payer: Quartz Beloit One Network |
$35.67
|
| Rate for Payer: Quartz Commercial |
$43.68
|
| Rate for Payer: WEA Trust Commercial |
$40.04
|
| Rate for Payer: WPS Commercial |
$53.92
|
|
|
PIN BALL X-SERIES 5MM X005
|
Facility
|
OP
|
$70.00
|
|
| Hospital Charge Code |
2965222
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.38 |
| Max. Negotiated Rate |
$66.98 |
| Rate for Payer: Aetna Commercial |
$65.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$62.61
|
| Rate for Payer: Aetna Managed Medicare |
$20.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$47.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$34.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.58
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$66.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.74
|
| Rate for Payer: Health EOS Commercial |
$64.79
|
| Rate for Payer: HFN Commercial |
$66.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.60
|
| Rate for Payer: Multiplan Commercial |
$58.24
|
| Rate for Payer: NAPHCARE Commercial |
$43.68
|
| Rate for Payer: Preferred Network Access Commercial |
$66.98
|
| Rate for Payer: Quartz Beloit One Network |
$35.67
|
| Rate for Payer: Quartz Commercial |
$47.32
|
| Rate for Payer: Quartz Medicare Advantage |
$43.68
|
| Rate for Payer: The Alliance Commercial |
$36.40
|
| Rate for Payer: WEA Trust Commercial |
$40.04
|
| Rate for Payer: WPS Commercial |
$53.92
|
|
|
PIN BALL X-SERIES 5MM X005
|
Facility
|
IP
|
$70.00
|
|
| Hospital Charge Code |
2965222
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.67 |
| Max. Negotiated Rate |
$66.98 |
| Rate for Payer: Aetna Commercial |
$65.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$62.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.58
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$66.98
|
| Rate for Payer: Health EOS Commercial |
$64.79
|
| Rate for Payer: HFN Commercial |
$66.98
|
| Rate for Payer: Multiplan Commercial |
$58.24
|
| Rate for Payer: Preferred Network Access Commercial |
$66.98
|
| Rate for Payer: Quartz Beloit One Network |
$35.67
|
| Rate for Payer: Quartz Commercial |
$43.68
|
| Rate for Payer: WEA Trust Commercial |
$40.04
|
| Rate for Payer: WPS Commercial |
$53.92
|
|
|
PIN BALL X-SERIES 6MM X006
|
Facility
|
IP
|
$70.00
|
|
| Hospital Charge Code |
2965223
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.67 |
| Max. Negotiated Rate |
$66.98 |
| Rate for Payer: Aetna Commercial |
$65.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$62.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.58
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$66.98
|
| Rate for Payer: Health EOS Commercial |
$64.79
|
| Rate for Payer: HFN Commercial |
$66.98
|
| Rate for Payer: Multiplan Commercial |
$58.24
|
| Rate for Payer: Preferred Network Access Commercial |
$66.98
|
| Rate for Payer: Quartz Beloit One Network |
$35.67
|
| Rate for Payer: Quartz Commercial |
$43.68
|
| Rate for Payer: WEA Trust Commercial |
$40.04
|
| Rate for Payer: WPS Commercial |
$53.92
|
|
|
PIN BALL X-SERIES 6MM X006
|
Facility
|
OP
|
$70.00
|
|
| Hospital Charge Code |
2965223
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.38 |
| Max. Negotiated Rate |
$66.98 |
| Rate for Payer: Aetna Commercial |
$65.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$62.61
|
| Rate for Payer: Aetna Managed Medicare |
$20.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$47.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$34.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.58
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$66.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.74
|
| Rate for Payer: Health EOS Commercial |
$64.79
|
| Rate for Payer: HFN Commercial |
$66.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.60
|
| Rate for Payer: Multiplan Commercial |
$58.24
|
| Rate for Payer: NAPHCARE Commercial |
$43.68
|
| Rate for Payer: Preferred Network Access Commercial |
$66.98
|
| Rate for Payer: Quartz Beloit One Network |
$35.67
|
| Rate for Payer: Quartz Commercial |
$47.32
|
| Rate for Payer: Quartz Medicare Advantage |
$43.68
|
| Rate for Payer: The Alliance Commercial |
$36.40
|
| Rate for Payer: WEA Trust Commercial |
$40.04
|
| Rate for Payer: WPS Commercial |
$53.92
|
|
|
PIN BAYONETTE 18 WITH EYELET 219382"
|
Facility
|
OP
|
$3,005.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2973126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$875.06 |
| Max. Negotiated Rate |
$2,875.18 |
| Rate for Payer: Aetna Commercial |
$2,812.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,687.67
|
| Rate for Payer: Aetna Managed Medicare |
$875.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,031.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,562.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,500.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,656.36
|
| Rate for Payer: Cash Price |
$901.50
|
| Rate for Payer: Cigna Commercial |
$2,875.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,748.91
|
| Rate for Payer: Health EOS Commercial |
$2,781.43
|
| Rate for Payer: HFN Commercial |
$2,875.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,343.90
|
| Rate for Payer: Multiplan Commercial |
$2,500.16
|
| Rate for Payer: NAPHCARE Commercial |
$1,875.12
|
| Rate for Payer: Preferred Network Access Commercial |
$2,875.18
|
| Rate for Payer: Quartz Beloit One Network |
$1,531.35
|
| Rate for Payer: Quartz Commercial |
$2,031.38
|
| Rate for Payer: Quartz Medicare Advantage |
$1,875.12
|
| Rate for Payer: The Alliance Commercial |
$1,562.60
|
| Rate for Payer: WEA Trust Commercial |
$1,718.86
|
| Rate for Payer: WPS Commercial |
$2,314.75
|
|
|
PIN BAYONETTE 18 WITH EYELET 219382"
|
Facility
|
IP
|
$3,005.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2973126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,531.35 |
| Max. Negotiated Rate |
$2,875.18 |
| Rate for Payer: Aetna Commercial |
$2,812.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,687.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,656.36
|
| Rate for Payer: Cash Price |
$901.50
|
| Rate for Payer: Cigna Commercial |
$2,875.18
|
| Rate for Payer: Health EOS Commercial |
$2,781.43
|
| Rate for Payer: HFN Commercial |
$2,875.18
|
| Rate for Payer: Multiplan Commercial |
$2,500.16
|
| Rate for Payer: Preferred Network Access Commercial |
$2,875.18
|
| Rate for Payer: Quartz Beloit One Network |
$1,531.35
|
| Rate for Payer: Quartz Commercial |
$1,875.12
|
| Rate for Payer: WEA Trust Commercial |
$1,718.86
|
| Rate for Payer: WPS Commercial |
$2,314.75
|
|
|
PIN BUTRESS 1.8 X 12 200.190
|
Facility
|
OP
|
$1,838.00
|
|
| Hospital Charge Code |
2966307
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$535.23 |
| Max. Negotiated Rate |
$1,758.60 |
| Rate for Payer: Aetna Commercial |
$1,720.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,643.91
|
| Rate for Payer: Aetna Managed Medicare |
$535.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,242.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$955.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$917.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,013.11
|
| Rate for Payer: Cash Price |
$551.40
|
| Rate for Payer: Cigna Commercial |
$1,758.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,069.72
|
| Rate for Payer: Health EOS Commercial |
$1,701.25
|
| Rate for Payer: HFN Commercial |
$1,758.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,433.64
|
| Rate for Payer: Multiplan Commercial |
$1,529.22
|
| Rate for Payer: NAPHCARE Commercial |
$1,146.91
|
| Rate for Payer: Preferred Network Access Commercial |
$1,758.60
|
| Rate for Payer: Quartz Beloit One Network |
$936.64
|
| Rate for Payer: Quartz Commercial |
$1,242.49
|
| Rate for Payer: Quartz Medicare Advantage |
$1,146.91
|
| Rate for Payer: The Alliance Commercial |
$955.76
|
| Rate for Payer: WEA Trust Commercial |
$1,051.34
|
| Rate for Payer: WPS Commercial |
$1,415.81
|
|
|
PIN BUTRESS 1.8 X 12 200.190
|
Facility
|
IP
|
$1,838.00
|
|
| Hospital Charge Code |
2966307
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$936.64 |
| Max. Negotiated Rate |
$1,758.60 |
| Rate for Payer: Aetna Commercial |
$1,720.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,643.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,013.11
|
| Rate for Payer: Cash Price |
$551.40
|
| Rate for Payer: Cigna Commercial |
$1,758.60
|
| Rate for Payer: Health EOS Commercial |
$1,701.25
|
| Rate for Payer: HFN Commercial |
$1,758.60
|
| Rate for Payer: Multiplan Commercial |
$1,529.22
|
| Rate for Payer: Preferred Network Access Commercial |
$1,758.60
|
| Rate for Payer: Quartz Beloit One Network |
$936.64
|
| Rate for Payer: Quartz Commercial |
$1,146.91
|
| Rate for Payer: WEA Trust Commercial |
$1,051.34
|
| Rate for Payer: WPS Commercial |
$1,415.81
|
|
|
PIN BUTRESS 1.8 X 20 200.194
|
Facility
|
OP
|
$1,750.00
|
|
| Hospital Charge Code |
2966308
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$509.60 |
| Max. Negotiated Rate |
$1,674.40 |
| Rate for Payer: Aetna Commercial |
$1,638.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,565.20
|
| Rate for Payer: Aetna Managed Medicare |
$509.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,183.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$910.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$873.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$964.60
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$1,674.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,018.50
|
| Rate for Payer: Health EOS Commercial |
$1,619.80
|
| Rate for Payer: HFN Commercial |
$1,674.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,365.00
|
| Rate for Payer: Multiplan Commercial |
$1,456.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,092.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,674.40
|
| Rate for Payer: Quartz Beloit One Network |
$891.80
|
| Rate for Payer: Quartz Commercial |
$1,183.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,092.00
|
| Rate for Payer: The Alliance Commercial |
$910.00
|
| Rate for Payer: WEA Trust Commercial |
$1,001.00
|
| Rate for Payer: WPS Commercial |
$1,348.03
|
|
|
PIN BUTRESS 1.8 X 20 200.194
|
Facility
|
IP
|
$1,750.00
|
|
| Hospital Charge Code |
2966308
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$891.80 |
| Max. Negotiated Rate |
$1,674.40 |
| Rate for Payer: Aetna Commercial |
$1,638.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,565.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$964.60
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$1,674.40
|
| Rate for Payer: Health EOS Commercial |
$1,619.80
|
| Rate for Payer: HFN Commercial |
$1,674.40
|
| Rate for Payer: Multiplan Commercial |
$1,456.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,674.40
|
| Rate for Payer: Quartz Beloit One Network |
$891.80
|
| Rate for Payer: Quartz Commercial |
$1,092.00
|
| Rate for Payer: WEA Trust Commercial |
$1,001.00
|
| Rate for Payer: WPS Commercial |
$1,348.03
|
|
|
PIN CLAMP 6-POSITION 390.010
|
Facility
|
OP
|
$4,262.00
|
|
| Hospital Charge Code |
4632639
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,241.09 |
| Max. Negotiated Rate |
$4,077.88 |
| Rate for Payer: Aetna Commercial |
$3,989.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,811.93
|
| Rate for Payer: Aetna Managed Medicare |
$1,241.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,881.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,216.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,127.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,349.21
|
| Rate for Payer: Cash Price |
$1,278.60
|
| Rate for Payer: Cigna Commercial |
$4,077.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,480.48
|
| Rate for Payer: Health EOS Commercial |
$3,944.91
|
| Rate for Payer: HFN Commercial |
$4,077.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,324.36
|
| Rate for Payer: Multiplan Commercial |
$3,545.98
|
| Rate for Payer: NAPHCARE Commercial |
$2,659.49
|
| Rate for Payer: Preferred Network Access Commercial |
$4,077.88
|
| Rate for Payer: Quartz Beloit One Network |
$2,171.92
|
| Rate for Payer: Quartz Commercial |
$2,881.11
|
| Rate for Payer: Quartz Medicare Advantage |
$2,659.49
|
| Rate for Payer: The Alliance Commercial |
$2,216.24
|
| Rate for Payer: WEA Trust Commercial |
$2,437.86
|
| Rate for Payer: WPS Commercial |
$3,283.02
|
|
|
PIN CLAMP 6-POSITION 390.010
|
Facility
|
IP
|
$4,262.00
|
|
| Hospital Charge Code |
4632639
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,171.92 |
| Max. Negotiated Rate |
$4,077.88 |
| Rate for Payer: Aetna Commercial |
$3,989.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,811.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,349.21
|
| Rate for Payer: Cash Price |
$1,278.60
|
| Rate for Payer: Cigna Commercial |
$4,077.88
|
| Rate for Payer: Health EOS Commercial |
$3,944.91
|
| Rate for Payer: HFN Commercial |
$4,077.88
|
| Rate for Payer: Multiplan Commercial |
$3,545.98
|
| Rate for Payer: Preferred Network Access Commercial |
$4,077.88
|
| Rate for Payer: Quartz Beloit One Network |
$2,171.92
|
| Rate for Payer: Quartz Commercial |
$2,659.49
|
| Rate for Payer: WEA Trust Commercial |
$2,437.86
|
| Rate for Payer: WPS Commercial |
$3,283.02
|
|
|
PIN CLAMP SINGLE MONOTUBE TRIAX BLUE 20MM 5150-3-170
|
Facility
|
IP
|
$5,000.00
|
|
| Hospital Charge Code |
5685882
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,548.00 |
| Max. Negotiated Rate |
$4,784.00 |
| Rate for Payer: Aetna Commercial |
$4,680.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,472.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,756.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$4,784.00
|
| Rate for Payer: Health EOS Commercial |
$4,628.00
|
| Rate for Payer: HFN Commercial |
$4,784.00
|
| Rate for Payer: Multiplan Commercial |
$4,160.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,784.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,548.00
|
| Rate for Payer: Quartz Commercial |
$3,120.00
|
| Rate for Payer: WEA Trust Commercial |
$2,860.00
|
| Rate for Payer: WPS Commercial |
$3,851.50
|
|
|
PIN CLAMP SINGLE MONOTUBE TRIAX BLUE 20MM 5150-3-170
|
Facility
|
OP
|
$5,000.00
|
|
| Hospital Charge Code |
5685882
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,456.00 |
| Max. Negotiated Rate |
$4,784.00 |
| Rate for Payer: Aetna Commercial |
$4,680.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,472.00
|
| Rate for Payer: Aetna Managed Medicare |
$1,456.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,380.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,600.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,496.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,756.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$4,784.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,910.00
|
| Rate for Payer: Health EOS Commercial |
$4,628.00
|
| Rate for Payer: HFN Commercial |
$4,784.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,900.00
|
| Rate for Payer: Multiplan Commercial |
$4,160.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,120.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,784.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,548.00
|
| Rate for Payer: Quartz Commercial |
$3,380.00
|
| Rate for Payer: Quartz Medicare Advantage |
$3,120.00
|
| Rate for Payer: The Alliance Commercial |
$2,600.00
|
| Rate for Payer: WEA Trust Commercial |
$2,860.00
|
| Rate for Payer: WPS Commercial |
$3,851.50
|
|
|
PIN DYNANITE VIP GLENOID 2.8MM NITINOL AR-5400-400NS
|
Facility
|
IP
|
$4,091.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5685679
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,084.77 |
| Max. Negotiated Rate |
$3,914.27 |
| Rate for Payer: Aetna Commercial |
$3,829.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,658.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,254.96
|
| Rate for Payer: Cash Price |
$1,227.30
|
| Rate for Payer: Cigna Commercial |
$3,914.27
|
| Rate for Payer: Health EOS Commercial |
$3,786.63
|
| Rate for Payer: HFN Commercial |
$3,914.27
|
| Rate for Payer: Multiplan Commercial |
$3,403.71
|
| Rate for Payer: Preferred Network Access Commercial |
$3,914.27
|
| Rate for Payer: Quartz Beloit One Network |
$2,084.77
|
| Rate for Payer: Quartz Commercial |
$2,552.78
|
| Rate for Payer: WEA Trust Commercial |
$2,340.05
|
| Rate for Payer: WPS Commercial |
$3,151.30
|
|
|
PIN DYNANITE VIP GLENOID 2.8MM NITINOL AR-5400-400NS
|
Facility
|
OP
|
$4,091.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5685679
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,191.30 |
| Max. Negotiated Rate |
$3,914.27 |
| Rate for Payer: Aetna Commercial |
$3,829.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,658.99
|
| Rate for Payer: Aetna Managed Medicare |
$1,191.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,765.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,127.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,042.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,254.96
|
| Rate for Payer: Cash Price |
$1,227.30
|
| Rate for Payer: Cigna Commercial |
$3,914.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,380.96
|
| Rate for Payer: Health EOS Commercial |
$3,786.63
|
| Rate for Payer: HFN Commercial |
$3,914.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,190.98
|
| Rate for Payer: Multiplan Commercial |
$3,403.71
|
| Rate for Payer: NAPHCARE Commercial |
$2,552.78
|
| Rate for Payer: Preferred Network Access Commercial |
$3,914.27
|
| Rate for Payer: Quartz Beloit One Network |
$2,084.77
|
| Rate for Payer: Quartz Commercial |
$2,765.52
|
| Rate for Payer: Quartz Medicare Advantage |
$2,552.78
|
| Rate for Payer: The Alliance Commercial |
$2,127.32
|
| Rate for Payer: WEA Trust Commercial |
$2,340.05
|
| Rate for Payer: WPS Commercial |
$3,151.30
|
|
|
PIN FLUTED HEADLESS DISPOSABLE 7650-2038A
|
Facility
|
IP
|
$4,982.00
|
|
| Hospital Charge Code |
5106886
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,538.83 |
| Max. Negotiated Rate |
$4,766.78 |
| Rate for Payer: Aetna Commercial |
$4,663.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,455.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,746.08
|
| Rate for Payer: Cash Price |
$1,494.60
|
| Rate for Payer: Cigna Commercial |
$4,766.78
|
| Rate for Payer: Health EOS Commercial |
$4,611.34
|
| Rate for Payer: HFN Commercial |
$4,766.78
|
| Rate for Payer: Multiplan Commercial |
$4,145.02
|
| Rate for Payer: Preferred Network Access Commercial |
$4,766.78
|
| Rate for Payer: Quartz Beloit One Network |
$2,538.83
|
| Rate for Payer: Quartz Commercial |
$3,108.77
|
| Rate for Payer: WEA Trust Commercial |
$2,849.70
|
| Rate for Payer: WPS Commercial |
$3,837.63
|
|
|
PIN FLUTED HEADLESS DISPOSABLE 7650-2038A
|
Facility
|
OP
|
$4,982.00
|
|
| Hospital Charge Code |
5106886
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,450.76 |
| Max. Negotiated Rate |
$4,766.78 |
| Rate for Payer: Aetna Commercial |
$4,663.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,455.90
|
| Rate for Payer: Aetna Managed Medicare |
$1,450.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,367.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,590.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,487.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,746.08
|
| Rate for Payer: Cash Price |
$1,494.60
|
| Rate for Payer: Cigna Commercial |
$4,766.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,899.52
|
| Rate for Payer: Health EOS Commercial |
$4,611.34
|
| Rate for Payer: HFN Commercial |
$4,766.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,885.96
|
| Rate for Payer: Multiplan Commercial |
$4,145.02
|
| Rate for Payer: NAPHCARE Commercial |
$3,108.77
|
| Rate for Payer: Preferred Network Access Commercial |
$4,766.78
|
| Rate for Payer: Quartz Beloit One Network |
$2,538.83
|
| Rate for Payer: Quartz Commercial |
$3,367.83
|
| Rate for Payer: Quartz Medicare Advantage |
$3,108.77
|
| Rate for Payer: The Alliance Commercial |
$2,590.64
|
| Rate for Payer: WEA Trust Commercial |
$2,849.70
|
| Rate for Payer: WPS Commercial |
$3,837.63
|
|
|
PIN GUIDE PSI PERSONA CS FEMORAL-TIBIAL 00-5970-000-25
|
Facility
|
OP
|
$5,403.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3491507
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,573.35 |
| Max. Negotiated Rate |
$5,169.59 |
| Rate for Payer: Aetna Commercial |
$5,057.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,832.44
|
| Rate for Payer: Aetna Managed Medicare |
$1,573.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,652.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,809.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,697.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,978.13
|
| Rate for Payer: Cash Price |
$1,620.90
|
| Rate for Payer: Cigna Commercial |
$5,169.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,144.55
|
| Rate for Payer: Health EOS Commercial |
$5,001.02
|
| Rate for Payer: HFN Commercial |
$5,169.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,214.34
|
| Rate for Payer: Multiplan Commercial |
$4,495.30
|
| Rate for Payer: NAPHCARE Commercial |
$3,371.47
|
| Rate for Payer: Preferred Network Access Commercial |
$5,169.59
|
| Rate for Payer: Quartz Beloit One Network |
$2,753.37
|
| Rate for Payer: Quartz Commercial |
$3,652.43
|
| Rate for Payer: Quartz Medicare Advantage |
$3,371.47
|
| Rate for Payer: The Alliance Commercial |
$2,809.56
|
| Rate for Payer: WEA Trust Commercial |
$3,090.52
|
| Rate for Payer: WPS Commercial |
$4,161.93
|
|
|
PIN GUIDE PSI PERSONA CS FEMORAL-TIBIAL 00-5970-000-25
|
Facility
|
IP
|
$5,403.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3491507
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,753.37 |
| Max. Negotiated Rate |
$5,169.59 |
| Rate for Payer: Aetna Commercial |
$5,057.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,832.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,978.13
|
| Rate for Payer: Cash Price |
$1,620.90
|
| Rate for Payer: Cigna Commercial |
$5,169.59
|
| Rate for Payer: Health EOS Commercial |
$5,001.02
|
| Rate for Payer: HFN Commercial |
$5,169.59
|
| Rate for Payer: Multiplan Commercial |
$4,495.30
|
| Rate for Payer: Preferred Network Access Commercial |
$5,169.59
|
| Rate for Payer: Quartz Beloit One Network |
$2,753.37
|
| Rate for Payer: Quartz Commercial |
$3,371.47
|
| Rate for Payer: WEA Trust Commercial |
$3,090.52
|
| Rate for Payer: WPS Commercial |
$4,161.93
|
|
|
PIN GUIDE PSI PERSONA PS FEMORAL-TIBIAL 00-5970-000-29
|
Facility
|
OP
|
$5,403.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4594702
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,573.35 |
| Max. Negotiated Rate |
$5,169.59 |
| Rate for Payer: Aetna Commercial |
$5,057.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,832.44
|
| Rate for Payer: Aetna Managed Medicare |
$1,573.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,652.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,809.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,697.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,978.13
|
| Rate for Payer: Cash Price |
$1,620.90
|
| Rate for Payer: Cigna Commercial |
$5,169.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,144.55
|
| Rate for Payer: Health EOS Commercial |
$5,001.02
|
| Rate for Payer: HFN Commercial |
$5,169.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,214.34
|
| Rate for Payer: Multiplan Commercial |
$4,495.30
|
| Rate for Payer: NAPHCARE Commercial |
$3,371.47
|
| Rate for Payer: Preferred Network Access Commercial |
$5,169.59
|
| Rate for Payer: Quartz Beloit One Network |
$2,753.37
|
| Rate for Payer: Quartz Commercial |
$3,652.43
|
| Rate for Payer: Quartz Medicare Advantage |
$3,371.47
|
| Rate for Payer: The Alliance Commercial |
$2,809.56
|
| Rate for Payer: WEA Trust Commercial |
$3,090.52
|
| Rate for Payer: WPS Commercial |
$4,161.93
|
|
|
PIN GUIDE PSI PERSONA PS FEMORAL-TIBIAL 00-5970-000-29
|
Facility
|
IP
|
$5,403.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4594702
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,753.37 |
| Max. Negotiated Rate |
$5,169.59 |
| Rate for Payer: Aetna Commercial |
$5,057.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,832.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,978.13
|
| Rate for Payer: Cash Price |
$1,620.90
|
| Rate for Payer: Cigna Commercial |
$5,169.59
|
| Rate for Payer: Health EOS Commercial |
$5,001.02
|
| Rate for Payer: HFN Commercial |
$5,169.59
|
| Rate for Payer: Multiplan Commercial |
$4,495.30
|
| Rate for Payer: Preferred Network Access Commercial |
$5,169.59
|
| Rate for Payer: Quartz Beloit One Network |
$2,753.37
|
| Rate for Payer: Quartz Commercial |
$3,371.47
|
| Rate for Payer: WEA Trust Commercial |
$3,090.52
|
| Rate for Payer: WPS Commercial |
$4,161.93
|
|
|
PIN SERVICE 60M PER MONTH G0023
|
Professional
|
Both
|
$245.00
|
|
|
Service Code
|
HCPCS G0023
|
| Hospital Charge Code |
6242279
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$44.14 |
| Max. Negotiated Rate |
$242.06 |
| Rate for Payer: Aetna Commercial |
$242.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$219.13
|
| Rate for Payer: Aetna Managed Medicare |
$44.14
|
| Rate for Payer: Anthem Medicare Advantage |
$44.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$44.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$44.14
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$242.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$127.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44.14
|
| Rate for Payer: Health EOS Commercial |
$231.87
|
| Rate for Payer: HFN Commercial |
$242.06
|
| Rate for Payer: Independent Care Health Plan Medicare |
$44.14
|
| Rate for Payer: Multiplan Commercial |
$203.84
|
| Rate for Payer: NAPHCARE Commercial |
$66.21
|
| Rate for Payer: Preferred Network Access Commercial |
$242.06
|
| Rate for Payer: Quartz Beloit One Network |
$112.11
|
| Rate for Payer: Quartz Commercial |
$145.24
|
| Rate for Payer: Quartz Medicare Advantage |
$44.14
|
| Rate for Payer: The Alliance Commercial |
$121.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$44.14
|
| Rate for Payer: WEA Trust Commercial |
$140.14
|
| Rate for Payer: WPS Commercial |
$77.24
|
|
|
PIN SERVICE ADD 30 MIN PER MONTH G0024
|
Professional
|
Both
|
$123.00
|
|
|
Service Code
|
HCPCS G0024
|
| Hospital Charge Code |
6242280
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.84 |
| Max. Negotiated Rate |
$121.52 |
| Rate for Payer: Aetna Commercial |
$121.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.01
|
| Rate for Payer: Aetna Managed Medicare |
$30.84
|
| Rate for Payer: Anthem Medicare Advantage |
$30.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30.84
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna Commercial |
$121.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$63.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.84
|
| Rate for Payer: Health EOS Commercial |
$116.41
|
| Rate for Payer: HFN Commercial |
$121.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$30.84
|
| Rate for Payer: Multiplan Commercial |
$102.34
|
| Rate for Payer: NAPHCARE Commercial |
$46.25
|
| Rate for Payer: Preferred Network Access Commercial |
$121.52
|
| Rate for Payer: Quartz Beloit One Network |
$56.28
|
| Rate for Payer: Quartz Commercial |
$72.91
|
| Rate for Payer: Quartz Medicare Advantage |
$30.84
|
| Rate for Payer: The Alliance Commercial |
$84.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.84
|
| Rate for Payer: WEA Trust Commercial |
$70.36
|
| Rate for Payer: WPS Commercial |
$53.96
|
|
