|
.014 CHOICE FLOPPY GUIDEWIRE
|
Facility
OP
|
$1,019.00
|
|
| Hospital Charge Code |
6175143
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$285.32 |
| Max. Negotiated Rate |
$4,076.00 |
| Rate for Payer: Aetna Commercial |
$917.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$876.34
|
| Rate for Payer: Aetna Managed Medicare |
$285.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$662.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$509.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$489.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$540.07
|
| Rate for Payer: Cash Price |
$305.70
|
| Rate for Payer: Cigna Commercial |
$937.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$570.23
|
| Rate for Payer: Health EOS Commercial |
$906.91
|
| Rate for Payer: HFN Commercial |
$937.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$764.25
|
| Rate for Payer: Multiplan Commercial |
$815.20
|
| Rate for Payer: NAPHCARE Commercial |
$611.40
|
| Rate for Payer: Preferred Network Access Commercial |
$937.48
|
| Rate for Payer: Quartz Beloit One Network |
$499.31
|
| Rate for Payer: Quartz Commercial |
$662.35
|
| Rate for Payer: Quartz Medicare Advantage |
$611.40
|
| Rate for Payer: The Alliance Commercial |
$4,076.00
|
| Rate for Payer: WEA Trust Commercial |
$560.45
|
| Rate for Payer: WPS Commercial |
$754.77
|
|
|
.014 CHOICE FLOPPY GUIDEWIRE
|
Facility
IP
|
$1,019.00
|
|
| Hospital Charge Code |
6175143
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$499.31 |
| Max. Negotiated Rate |
$937.48 |
| Rate for Payer: Aetna Commercial |
$917.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$540.07
|
| Rate for Payer: Cash Price |
$305.70
|
| Rate for Payer: Cigna Commercial |
$937.48
|
| Rate for Payer: Health EOS Commercial |
$906.91
|
| Rate for Payer: HFN Commercial |
$937.48
|
| Rate for Payer: Multiplan Commercial |
$815.20
|
| Rate for Payer: NAPHCARE Commercial |
$611.40
|
| Rate for Payer: Preferred Network Access Commercial |
$937.48
|
| Rate for Payer: Quartz Beloit One Network |
$499.31
|
| Rate for Payer: Quartz Commercial |
$611.40
|
| Rate for Payer: WEA Trust Commercial |
$560.45
|
| Rate for Payer: WPS Commercial |
$754.77
|
|
|
.014 Choice PT 300cm
|
Facility
OP
|
$290.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158952
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$266.80 |
| Rate for Payer: Aetna Commercial |
$261.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$249.40
|
| Rate for Payer: Aetna Managed Medicare |
$81.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$188.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$145.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$139.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$153.70
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$266.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$162.28
|
| Rate for Payer: Health EOS Commercial |
$258.10
|
| Rate for Payer: HFN Commercial |
$266.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$217.50
|
| Rate for Payer: Multiplan Commercial |
$232.00
|
| Rate for Payer: NAPHCARE Commercial |
$174.00
|
| Rate for Payer: Preferred Network Access Commercial |
$266.80
|
| Rate for Payer: Quartz Beloit One Network |
$142.10
|
| Rate for Payer: Quartz Commercial |
$188.50
|
| Rate for Payer: Quartz Medicare Advantage |
$174.00
|
| Rate for Payer: WEA Trust Commercial |
$159.50
|
| Rate for Payer: WPS Commercial |
$214.80
|
|
|
.014 Choice PT 300cm
|
Professional
|
$290.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158952
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$127.60 |
| Max. Negotiated Rate |
$275.50 |
| Rate for Payer: Aetna Commercial |
$275.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$249.40
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$275.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$145.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$174.00
|
| Rate for Payer: Health EOS Commercial |
$263.90
|
| Rate for Payer: Multiplan Commercial |
$232.00
|
| Rate for Payer: Preferred Network Access Commercial |
$275.50
|
| Rate for Payer: Quartz Beloit One Network |
$127.60
|
| Rate for Payer: Quartz Commercial |
$165.30
|
| Rate for Payer: The Alliance Commercial |
$145.00
|
| Rate for Payer: WEA Trust Commercial |
$159.50
|
| Rate for Payer: WPS Commercial |
$214.80
|
|
|
.014 Choice PT 300cm
|
Facility
IP
|
$290.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158952
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$142.10 |
| Max. Negotiated Rate |
$266.80 |
| Rate for Payer: Aetna Commercial |
$261.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$153.70
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$266.80
|
| Rate for Payer: Health EOS Commercial |
$258.10
|
| Rate for Payer: HFN Commercial |
$266.80
|
| Rate for Payer: Multiplan Commercial |
$232.00
|
| Rate for Payer: NAPHCARE Commercial |
$174.00
|
| Rate for Payer: Preferred Network Access Commercial |
$266.80
|
| Rate for Payer: Quartz Beloit One Network |
$142.10
|
| Rate for Payer: Quartz Commercial |
$174.00
|
| Rate for Payer: WEA Trust Commercial |
$159.50
|
| Rate for Payer: WPS Commercial |
$214.80
|
|
|
.014 Command Wire
|
Facility
OP
|
$1,486.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5273133
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$416.08 |
| Max. Negotiated Rate |
$1,367.12 |
| Rate for Payer: Aetna Commercial |
$1,337.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,277.96
|
| Rate for Payer: Aetna Managed Medicare |
$416.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$965.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$743.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$713.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$787.58
|
| Rate for Payer: Cash Price |
$445.80
|
| Rate for Payer: Cigna Commercial |
$1,367.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$831.57
|
| Rate for Payer: Health EOS Commercial |
$1,322.54
|
| Rate for Payer: HFN Commercial |
$1,367.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,114.50
|
| Rate for Payer: Multiplan Commercial |
$1,188.80
|
| Rate for Payer: NAPHCARE Commercial |
$891.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,367.12
|
| Rate for Payer: Quartz Beloit One Network |
$728.14
|
| Rate for Payer: Quartz Commercial |
$965.90
|
| Rate for Payer: Quartz Medicare Advantage |
$891.60
|
| Rate for Payer: WEA Trust Commercial |
$817.30
|
| Rate for Payer: WPS Commercial |
$1,100.68
|
|
|
.014 Command Wire
|
Facility
IP
|
$1,486.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5273133
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$728.14 |
| Max. Negotiated Rate |
$1,367.12 |
| Rate for Payer: Aetna Commercial |
$1,337.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$787.58
|
| Rate for Payer: Cash Price |
$445.80
|
| Rate for Payer: Cigna Commercial |
$1,367.12
|
| Rate for Payer: Health EOS Commercial |
$1,322.54
|
| Rate for Payer: HFN Commercial |
$1,367.12
|
| Rate for Payer: Multiplan Commercial |
$1,188.80
|
| Rate for Payer: NAPHCARE Commercial |
$891.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,367.12
|
| Rate for Payer: Quartz Beloit One Network |
$728.14
|
| Rate for Payer: Quartz Commercial |
$891.60
|
| Rate for Payer: WEA Trust Commercial |
$817.30
|
| Rate for Payer: WPS Commercial |
$1,100.68
|
|
|
.014 Cross It J Tip 300cm
|
Facility
OP
|
$290.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158946
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$266.80 |
| Rate for Payer: Aetna Commercial |
$261.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$249.40
|
| Rate for Payer: Aetna Managed Medicare |
$81.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$188.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$145.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$139.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$153.70
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$266.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$162.28
|
| Rate for Payer: Health EOS Commercial |
$258.10
|
| Rate for Payer: HFN Commercial |
$266.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$217.50
|
| Rate for Payer: Multiplan Commercial |
$232.00
|
| Rate for Payer: NAPHCARE Commercial |
$174.00
|
| Rate for Payer: Preferred Network Access Commercial |
$266.80
|
| Rate for Payer: Quartz Beloit One Network |
$142.10
|
| Rate for Payer: Quartz Commercial |
$188.50
|
| Rate for Payer: Quartz Medicare Advantage |
$174.00
|
| Rate for Payer: WEA Trust Commercial |
$159.50
|
| Rate for Payer: WPS Commercial |
$214.80
|
|
|
.014 Cross It J Tip 300cm
|
Facility
IP
|
$290.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158946
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$142.10 |
| Max. Negotiated Rate |
$266.80 |
| Rate for Payer: Aetna Commercial |
$261.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$153.70
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$266.80
|
| Rate for Payer: Health EOS Commercial |
$258.10
|
| Rate for Payer: HFN Commercial |
$266.80
|
| Rate for Payer: Multiplan Commercial |
$232.00
|
| Rate for Payer: NAPHCARE Commercial |
$174.00
|
| Rate for Payer: Preferred Network Access Commercial |
$266.80
|
| Rate for Payer: Quartz Beloit One Network |
$142.10
|
| Rate for Payer: Quartz Commercial |
$174.00
|
| Rate for Payer: WEA Trust Commercial |
$159.50
|
| Rate for Payer: WPS Commercial |
$214.80
|
|
|
.014 Cross It J Tip 300cm
|
Professional
|
$290.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158946
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$127.60 |
| Max. Negotiated Rate |
$275.50 |
| Rate for Payer: Aetna Commercial |
$275.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$249.40
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$275.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$145.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$174.00
|
| Rate for Payer: Health EOS Commercial |
$263.90
|
| Rate for Payer: Multiplan Commercial |
$232.00
|
| Rate for Payer: Preferred Network Access Commercial |
$275.50
|
| Rate for Payer: Quartz Beloit One Network |
$127.60
|
| Rate for Payer: Quartz Commercial |
$165.30
|
| Rate for Payer: The Alliance Commercial |
$145.00
|
| Rate for Payer: WEA Trust Commercial |
$159.50
|
| Rate for Payer: WPS Commercial |
$214.80
|
|
|
.014 Kinetex 185cm
|
Professional
|
$371.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158954
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$163.24 |
| Max. Negotiated Rate |
$352.45 |
| Rate for Payer: Aetna Commercial |
$352.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$319.06
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cigna Commercial |
$352.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$185.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$222.60
|
| Rate for Payer: Health EOS Commercial |
$337.61
|
| Rate for Payer: Multiplan Commercial |
$296.80
|
| Rate for Payer: Preferred Network Access Commercial |
$352.45
|
| Rate for Payer: Quartz Beloit One Network |
$163.24
|
| Rate for Payer: Quartz Commercial |
$211.47
|
| Rate for Payer: The Alliance Commercial |
$185.50
|
| Rate for Payer: WEA Trust Commercial |
$204.05
|
| Rate for Payer: WPS Commercial |
$274.80
|
|
|
.014 Kinetex 185cm
|
Facility
OP
|
$371.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158954
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$103.88 |
| Max. Negotiated Rate |
$341.32 |
| Rate for Payer: Aetna Commercial |
$333.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$319.06
|
| Rate for Payer: Aetna Managed Medicare |
$103.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$241.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$185.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$178.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$196.63
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cigna Commercial |
$341.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$207.61
|
| Rate for Payer: Health EOS Commercial |
$330.19
|
| Rate for Payer: HFN Commercial |
$341.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$278.25
|
| Rate for Payer: Multiplan Commercial |
$296.80
|
| Rate for Payer: NAPHCARE Commercial |
$222.60
|
| Rate for Payer: Preferred Network Access Commercial |
$341.32
|
| Rate for Payer: Quartz Beloit One Network |
$181.79
|
| Rate for Payer: Quartz Commercial |
$241.15
|
| Rate for Payer: Quartz Medicare Advantage |
$222.60
|
| Rate for Payer: WEA Trust Commercial |
$204.05
|
| Rate for Payer: WPS Commercial |
$274.80
|
|
|
.014 Kinetex 185cm
|
Facility
IP
|
$371.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158954
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$181.79 |
| Max. Negotiated Rate |
$341.32 |
| Rate for Payer: Aetna Commercial |
$333.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$196.63
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cigna Commercial |
$341.32
|
| Rate for Payer: Health EOS Commercial |
$330.19
|
| Rate for Payer: HFN Commercial |
$341.32
|
| Rate for Payer: Multiplan Commercial |
$296.80
|
| Rate for Payer: NAPHCARE Commercial |
$222.60
|
| Rate for Payer: Preferred Network Access Commercial |
$341.32
|
| Rate for Payer: Quartz Beloit One Network |
$181.79
|
| Rate for Payer: Quartz Commercial |
$222.60
|
| Rate for Payer: WEA Trust Commercial |
$204.05
|
| Rate for Payer: WPS Commercial |
$274.80
|
|
|
.014 Phoenix Guide Wire
|
Facility
OP
|
$1,882.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5273128
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$526.96 |
| Max. Negotiated Rate |
$1,731.44 |
| Rate for Payer: Aetna Commercial |
$1,693.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,618.52
|
| Rate for Payer: Aetna Managed Medicare |
$526.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,223.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$941.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$903.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$997.46
|
| Rate for Payer: Cash Price |
$564.60
|
| Rate for Payer: Cigna Commercial |
$1,731.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,053.17
|
| Rate for Payer: Health EOS Commercial |
$1,674.98
|
| Rate for Payer: HFN Commercial |
$1,731.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,411.50
|
| Rate for Payer: Multiplan Commercial |
$1,505.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,129.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,731.44
|
| Rate for Payer: Quartz Beloit One Network |
$922.18
|
| Rate for Payer: Quartz Commercial |
$1,223.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,129.20
|
| Rate for Payer: WEA Trust Commercial |
$1,035.10
|
| Rate for Payer: WPS Commercial |
$1,394.00
|
|
|
.014 Phoenix Guide Wire
|
Facility
IP
|
$1,882.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5273128
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$922.18 |
| Max. Negotiated Rate |
$1,731.44 |
| Rate for Payer: Aetna Commercial |
$1,693.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$997.46
|
| Rate for Payer: Cash Price |
$564.60
|
| Rate for Payer: Cigna Commercial |
$1,731.44
|
| Rate for Payer: Health EOS Commercial |
$1,674.98
|
| Rate for Payer: HFN Commercial |
$1,731.44
|
| Rate for Payer: Multiplan Commercial |
$1,505.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,129.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,731.44
|
| Rate for Payer: Quartz Beloit One Network |
$922.18
|
| Rate for Payer: Quartz Commercial |
$1,129.20
|
| Rate for Payer: WEA Trust Commercial |
$1,035.10
|
| Rate for Payer: WPS Commercial |
$1,394.00
|
|
|
.014 Prowater 180cm
|
Professional
|
$371.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158956
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$163.24 |
| Max. Negotiated Rate |
$352.45 |
| Rate for Payer: Aetna Commercial |
$352.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$319.06
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cigna Commercial |
$352.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$185.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$222.60
|
| Rate for Payer: Health EOS Commercial |
$337.61
|
| Rate for Payer: Multiplan Commercial |
$296.80
|
| Rate for Payer: Preferred Network Access Commercial |
$352.45
|
| Rate for Payer: Quartz Beloit One Network |
$163.24
|
| Rate for Payer: Quartz Commercial |
$211.47
|
| Rate for Payer: The Alliance Commercial |
$185.50
|
| Rate for Payer: WEA Trust Commercial |
$204.05
|
| Rate for Payer: WPS Commercial |
$274.80
|
|
|
.014 Prowater 180cm
|
Facility
IP
|
$371.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158956
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$181.79 |
| Max. Negotiated Rate |
$341.32 |
| Rate for Payer: Aetna Commercial |
$333.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$196.63
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cigna Commercial |
$341.32
|
| Rate for Payer: Health EOS Commercial |
$330.19
|
| Rate for Payer: HFN Commercial |
$341.32
|
| Rate for Payer: Multiplan Commercial |
$296.80
|
| Rate for Payer: NAPHCARE Commercial |
$222.60
|
| Rate for Payer: Preferred Network Access Commercial |
$341.32
|
| Rate for Payer: Quartz Beloit One Network |
$181.79
|
| Rate for Payer: Quartz Commercial |
$222.60
|
| Rate for Payer: WEA Trust Commercial |
$204.05
|
| Rate for Payer: WPS Commercial |
$274.80
|
|
|
.014 Prowater 180cm
|
Facility
OP
|
$371.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158956
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$103.88 |
| Max. Negotiated Rate |
$341.32 |
| Rate for Payer: Aetna Commercial |
$333.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$319.06
|
| Rate for Payer: Aetna Managed Medicare |
$103.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$241.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$185.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$178.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$196.63
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cigna Commercial |
$341.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$207.61
|
| Rate for Payer: Health EOS Commercial |
$330.19
|
| Rate for Payer: HFN Commercial |
$341.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$278.25
|
| Rate for Payer: Multiplan Commercial |
$296.80
|
| Rate for Payer: NAPHCARE Commercial |
$222.60
|
| Rate for Payer: Preferred Network Access Commercial |
$341.32
|
| Rate for Payer: Quartz Beloit One Network |
$181.79
|
| Rate for Payer: Quartz Commercial |
$241.15
|
| Rate for Payer: Quartz Medicare Advantage |
$222.60
|
| Rate for Payer: WEA Trust Commercial |
$204.05
|
| Rate for Payer: WPS Commercial |
$274.80
|
|
|
.014 Prowater 300cm
|
Facility
OP
|
$290.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158958
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$266.80 |
| Rate for Payer: Aetna Commercial |
$261.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$249.40
|
| Rate for Payer: Aetna Managed Medicare |
$81.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$188.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$145.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$139.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$153.70
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$266.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$162.28
|
| Rate for Payer: Health EOS Commercial |
$258.10
|
| Rate for Payer: HFN Commercial |
$266.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$217.50
|
| Rate for Payer: Multiplan Commercial |
$232.00
|
| Rate for Payer: NAPHCARE Commercial |
$174.00
|
| Rate for Payer: Preferred Network Access Commercial |
$266.80
|
| Rate for Payer: Quartz Beloit One Network |
$142.10
|
| Rate for Payer: Quartz Commercial |
$188.50
|
| Rate for Payer: Quartz Medicare Advantage |
$174.00
|
| Rate for Payer: WEA Trust Commercial |
$159.50
|
| Rate for Payer: WPS Commercial |
$214.80
|
|
|
.014 Prowater 300cm
|
Professional
|
$290.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158958
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$127.60 |
| Max. Negotiated Rate |
$275.50 |
| Rate for Payer: Aetna Commercial |
$275.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$249.40
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$275.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$145.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$174.00
|
| Rate for Payer: Health EOS Commercial |
$263.90
|
| Rate for Payer: Multiplan Commercial |
$232.00
|
| Rate for Payer: Preferred Network Access Commercial |
$275.50
|
| Rate for Payer: Quartz Beloit One Network |
$127.60
|
| Rate for Payer: Quartz Commercial |
$165.30
|
| Rate for Payer: The Alliance Commercial |
$145.00
|
| Rate for Payer: WEA Trust Commercial |
$159.50
|
| Rate for Payer: WPS Commercial |
$214.80
|
|
|
.014 Prowater 300cm
|
Facility
IP
|
$290.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158958
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$142.10 |
| Max. Negotiated Rate |
$266.80 |
| Rate for Payer: Aetna Commercial |
$261.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$153.70
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$266.80
|
| Rate for Payer: Health EOS Commercial |
$258.10
|
| Rate for Payer: HFN Commercial |
$266.80
|
| Rate for Payer: Multiplan Commercial |
$232.00
|
| Rate for Payer: NAPHCARE Commercial |
$174.00
|
| Rate for Payer: Preferred Network Access Commercial |
$266.80
|
| Rate for Payer: Quartz Beloit One Network |
$142.10
|
| Rate for Payer: Quartz Commercial |
$174.00
|
| Rate for Payer: WEA Trust Commercial |
$159.50
|
| Rate for Payer: WPS Commercial |
$214.80
|
|
|
.014 RUN THROUGH WIRE NS
|
Facility
IP
|
$1,467.00
|
|
| Hospital Charge Code |
6175146
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$718.83 |
| Max. Negotiated Rate |
$1,349.64 |
| Rate for Payer: Aetna Commercial |
$1,320.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$777.51
|
| Rate for Payer: Cash Price |
$440.10
|
| Rate for Payer: Cigna Commercial |
$1,349.64
|
| Rate for Payer: Health EOS Commercial |
$1,305.63
|
| Rate for Payer: HFN Commercial |
$1,349.64
|
| Rate for Payer: Multiplan Commercial |
$1,173.60
|
| Rate for Payer: NAPHCARE Commercial |
$880.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,349.64
|
| Rate for Payer: Quartz Beloit One Network |
$718.83
|
| Rate for Payer: Quartz Commercial |
$880.20
|
| Rate for Payer: WEA Trust Commercial |
$806.85
|
| Rate for Payer: WPS Commercial |
$1,086.61
|
|
|
.014 RUN THROUGH WIRE NS
|
Facility
OP
|
$1,467.00
|
|
| Hospital Charge Code |
6175146
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$410.76 |
| Max. Negotiated Rate |
$5,868.00 |
| Rate for Payer: Aetna Commercial |
$1,320.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,261.62
|
| Rate for Payer: Aetna Managed Medicare |
$410.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$953.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$733.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$704.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$777.51
|
| Rate for Payer: Cash Price |
$440.10
|
| Rate for Payer: Cigna Commercial |
$1,349.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$820.93
|
| Rate for Payer: Health EOS Commercial |
$1,305.63
|
| Rate for Payer: HFN Commercial |
$1,349.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,100.25
|
| Rate for Payer: Multiplan Commercial |
$1,173.60
|
| Rate for Payer: NAPHCARE Commercial |
$880.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,349.64
|
| Rate for Payer: Quartz Beloit One Network |
$718.83
|
| Rate for Payer: Quartz Commercial |
$953.55
|
| Rate for Payer: Quartz Medicare Advantage |
$880.20
|
| Rate for Payer: The Alliance Commercial |
$5,868.00
|
| Rate for Payer: WEA Trust Commercial |
$806.85
|
| Rate for Payer: WPS Commercial |
$1,086.61
|
|
|
.014 Tapered Peripheral Balloon
|
Facility
OP
|
$2,435.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
4528618
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$681.80 |
| Max. Negotiated Rate |
$2,240.20 |
| Rate for Payer: Aetna Commercial |
$2,191.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,094.10
|
| Rate for Payer: Aetna Managed Medicare |
$681.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,582.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,217.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,168.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,290.55
|
| Rate for Payer: Cash Price |
$730.50
|
| Rate for Payer: Cigna Commercial |
$2,240.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,362.63
|
| Rate for Payer: Health EOS Commercial |
$2,167.15
|
| Rate for Payer: HFN Commercial |
$2,240.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,826.25
|
| Rate for Payer: Multiplan Commercial |
$1,948.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,461.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,240.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,193.15
|
| Rate for Payer: Quartz Commercial |
$1,582.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,461.00
|
| Rate for Payer: WEA Trust Commercial |
$1,339.25
|
| Rate for Payer: WPS Commercial |
$1,803.60
|
|
|
.014 Tapered Peripheral Balloon
|
Facility
IP
|
$2,435.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
4528618
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,193.15 |
| Max. Negotiated Rate |
$2,240.20 |
| Rate for Payer: Aetna Commercial |
$2,191.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,290.55
|
| Rate for Payer: Cash Price |
$730.50
|
| Rate for Payer: Cigna Commercial |
$2,240.20
|
| Rate for Payer: Health EOS Commercial |
$2,167.15
|
| Rate for Payer: HFN Commercial |
$2,240.20
|
| Rate for Payer: Multiplan Commercial |
$1,948.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,461.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,240.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,193.15
|
| Rate for Payer: Quartz Commercial |
$1,461.00
|
| Rate for Payer: WEA Trust Commercial |
$1,339.25
|
| Rate for Payer: WPS Commercial |
$1,803.60
|
|
