|
.014 CHOICE FLOPPY GUIDEWIRE
|
Facility
|
IP
|
$1,019.00
|
|
| Hospital Charge Code |
6175143
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$519.28 |
| Max. Negotiated Rate |
$974.98 |
| Rate for Payer: Aetna Commercial |
$953.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$911.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$561.67
|
| Rate for Payer: Cash Price |
$305.70
|
| Rate for Payer: Cigna Commercial |
$974.98
|
| Rate for Payer: Health EOS Commercial |
$943.19
|
| Rate for Payer: HFN Commercial |
$974.98
|
| Rate for Payer: Multiplan Commercial |
$847.81
|
| Rate for Payer: Preferred Network Access Commercial |
$974.98
|
| Rate for Payer: Quartz Beloit One Network |
$519.28
|
| Rate for Payer: Quartz Commercial |
$635.86
|
| Rate for Payer: WEA Trust Commercial |
$582.87
|
| Rate for Payer: WPS Commercial |
$784.94
|
|
|
.014 CHOICE FLOPPY GUIDEWIRE
|
Facility
|
OP
|
$1,019.00
|
|
| Hospital Charge Code |
6175143
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$296.73 |
| Max. Negotiated Rate |
$974.98 |
| Rate for Payer: Aetna Commercial |
$953.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$911.39
|
| Rate for Payer: Aetna Managed Medicare |
$296.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$688.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$529.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$508.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$561.67
|
| Rate for Payer: Cash Price |
$305.70
|
| Rate for Payer: Cigna Commercial |
$974.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$593.06
|
| Rate for Payer: Health EOS Commercial |
$943.19
|
| Rate for Payer: HFN Commercial |
$974.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$794.82
|
| Rate for Payer: Multiplan Commercial |
$847.81
|
| Rate for Payer: NAPHCARE Commercial |
$635.86
|
| Rate for Payer: Preferred Network Access Commercial |
$974.98
|
| Rate for Payer: Quartz Beloit One Network |
$519.28
|
| Rate for Payer: Quartz Commercial |
$688.84
|
| Rate for Payer: Quartz Medicare Advantage |
$635.86
|
| Rate for Payer: The Alliance Commercial |
$529.88
|
| Rate for Payer: WEA Trust Commercial |
$582.87
|
| Rate for Payer: WPS Commercial |
$784.94
|
|
|
.014 Choice PT 300cm
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158952
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.78 |
| Max. Negotiated Rate |
$277.47 |
| Rate for Payer: Aetna Commercial |
$271.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$259.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$159.85
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$277.47
|
| Rate for Payer: Health EOS Commercial |
$268.42
|
| Rate for Payer: HFN Commercial |
$277.47
|
| Rate for Payer: Multiplan Commercial |
$241.28
|
| Rate for Payer: Preferred Network Access Commercial |
$277.47
|
| Rate for Payer: Quartz Beloit One Network |
$147.78
|
| Rate for Payer: Quartz Commercial |
$180.96
|
| Rate for Payer: WEA Trust Commercial |
$165.88
|
| Rate for Payer: WPS Commercial |
$223.39
|
|
|
.014 Choice PT 300cm
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158952
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$84.45 |
| Max. Negotiated Rate |
$277.47 |
| Rate for Payer: Aetna Commercial |
$271.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$259.38
|
| Rate for Payer: Aetna Managed Medicare |
$84.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$196.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$150.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$144.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$159.85
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$277.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$168.78
|
| Rate for Payer: Health EOS Commercial |
$268.42
|
| Rate for Payer: HFN Commercial |
$277.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$226.20
|
| Rate for Payer: Multiplan Commercial |
$241.28
|
| Rate for Payer: NAPHCARE Commercial |
$180.96
|
| Rate for Payer: Preferred Network Access Commercial |
$277.47
|
| Rate for Payer: Quartz Beloit One Network |
$147.78
|
| Rate for Payer: Quartz Commercial |
$196.04
|
| Rate for Payer: Quartz Medicare Advantage |
$180.96
|
| Rate for Payer: The Alliance Commercial |
$150.80
|
| Rate for Payer: WEA Trust Commercial |
$165.88
|
| Rate for Payer: WPS Commercial |
$223.39
|
|
|
.014 Choice PT 300cm
|
Professional
|
Both
|
$290.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158952
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$132.70 |
| Max. Negotiated Rate |
$286.52 |
| Rate for Payer: Aetna Commercial |
$286.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$259.38
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$286.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$150.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$180.96
|
| Rate for Payer: Health EOS Commercial |
$274.46
|
| Rate for Payer: HFN Commercial |
$286.52
|
| Rate for Payer: Multiplan Commercial |
$241.28
|
| Rate for Payer: Preferred Network Access Commercial |
$286.52
|
| Rate for Payer: Quartz Beloit One Network |
$132.70
|
| Rate for Payer: Quartz Commercial |
$171.91
|
| Rate for Payer: The Alliance Commercial |
$150.80
|
| Rate for Payer: WEA Trust Commercial |
$165.88
|
| Rate for Payer: WPS Commercial |
$223.39
|
|
|
.014 Command Wire
|
Facility
|
OP
|
$1,486.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5273133
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$432.72 |
| Max. Negotiated Rate |
$1,421.80 |
| Rate for Payer: Aetna Commercial |
$1,390.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,329.08
|
| Rate for Payer: Aetna Managed Medicare |
$432.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,004.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$772.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$741.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$819.08
|
| Rate for Payer: Cash Price |
$445.80
|
| Rate for Payer: Cigna Commercial |
$1,421.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$864.85
|
| Rate for Payer: Health EOS Commercial |
$1,375.44
|
| Rate for Payer: HFN Commercial |
$1,421.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,159.08
|
| Rate for Payer: Multiplan Commercial |
$1,236.35
|
| Rate for Payer: NAPHCARE Commercial |
$927.26
|
| Rate for Payer: Preferred Network Access Commercial |
$1,421.80
|
| Rate for Payer: Quartz Beloit One Network |
$757.27
|
| Rate for Payer: Quartz Commercial |
$1,004.54
|
| Rate for Payer: Quartz Medicare Advantage |
$927.26
|
| Rate for Payer: The Alliance Commercial |
$772.72
|
| Rate for Payer: WEA Trust Commercial |
$849.99
|
| Rate for Payer: WPS Commercial |
$1,144.67
|
|
|
.014 Command Wire
|
Facility
|
IP
|
$1,486.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5273133
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$757.27 |
| Max. Negotiated Rate |
$1,421.80 |
| Rate for Payer: Aetna Commercial |
$1,390.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,329.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$819.08
|
| Rate for Payer: Cash Price |
$445.80
|
| Rate for Payer: Cigna Commercial |
$1,421.80
|
| Rate for Payer: Health EOS Commercial |
$1,375.44
|
| Rate for Payer: HFN Commercial |
$1,421.80
|
| Rate for Payer: Multiplan Commercial |
$1,236.35
|
| Rate for Payer: Preferred Network Access Commercial |
$1,421.80
|
| Rate for Payer: Quartz Beloit One Network |
$757.27
|
| Rate for Payer: Quartz Commercial |
$927.26
|
| Rate for Payer: WEA Trust Commercial |
$849.99
|
| Rate for Payer: WPS Commercial |
$1,144.67
|
|
|
.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 |
$84.45 |
| Max. Negotiated Rate |
$277.47 |
| Rate for Payer: Aetna Commercial |
$271.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$259.38
|
| Rate for Payer: Aetna Managed Medicare |
$84.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$196.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$150.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$144.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$159.85
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$277.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$168.78
|
| Rate for Payer: Health EOS Commercial |
$268.42
|
| Rate for Payer: HFN Commercial |
$277.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$226.20
|
| Rate for Payer: Multiplan Commercial |
$241.28
|
| Rate for Payer: NAPHCARE Commercial |
$180.96
|
| Rate for Payer: Preferred Network Access Commercial |
$277.47
|
| Rate for Payer: Quartz Beloit One Network |
$147.78
|
| Rate for Payer: Quartz Commercial |
$196.04
|
| Rate for Payer: Quartz Medicare Advantage |
$180.96
|
| Rate for Payer: The Alliance Commercial |
$150.80
|
| Rate for Payer: WEA Trust Commercial |
$165.88
|
| Rate for Payer: WPS Commercial |
$223.39
|
|
|
.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 |
$147.78 |
| Max. Negotiated Rate |
$277.47 |
| Rate for Payer: Aetna Commercial |
$271.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$259.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$159.85
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$277.47
|
| Rate for Payer: Health EOS Commercial |
$268.42
|
| Rate for Payer: HFN Commercial |
$277.47
|
| Rate for Payer: Multiplan Commercial |
$241.28
|
| Rate for Payer: Preferred Network Access Commercial |
$277.47
|
| Rate for Payer: Quartz Beloit One Network |
$147.78
|
| Rate for Payer: Quartz Commercial |
$180.96
|
| Rate for Payer: WEA Trust Commercial |
$165.88
|
| Rate for Payer: WPS Commercial |
$223.39
|
|
|
.014 Cross It J Tip 300cm
|
Professional
|
Both
|
$290.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158946
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$132.70 |
| Max. Negotiated Rate |
$286.52 |
| Rate for Payer: Aetna Commercial |
$286.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$259.38
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$286.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$150.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$180.96
|
| Rate for Payer: Health EOS Commercial |
$274.46
|
| Rate for Payer: HFN Commercial |
$286.52
|
| Rate for Payer: Multiplan Commercial |
$241.28
|
| Rate for Payer: Preferred Network Access Commercial |
$286.52
|
| Rate for Payer: Quartz Beloit One Network |
$132.70
|
| Rate for Payer: Quartz Commercial |
$171.91
|
| Rate for Payer: The Alliance Commercial |
$150.80
|
| Rate for Payer: WEA Trust Commercial |
$165.88
|
| Rate for Payer: WPS Commercial |
$223.39
|
|
|
.014 Kinetex 185cm
|
Facility
|
IP
|
$371.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158954
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$189.06 |
| Max. Negotiated Rate |
$354.97 |
| Rate for Payer: Aetna Commercial |
$347.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$331.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$204.50
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cigna Commercial |
$354.97
|
| Rate for Payer: Health EOS Commercial |
$343.40
|
| Rate for Payer: HFN Commercial |
$354.97
|
| Rate for Payer: Multiplan Commercial |
$308.67
|
| Rate for Payer: Preferred Network Access Commercial |
$354.97
|
| Rate for Payer: Quartz Beloit One Network |
$189.06
|
| Rate for Payer: Quartz Commercial |
$231.50
|
| Rate for Payer: WEA Trust Commercial |
$212.21
|
| Rate for Payer: WPS Commercial |
$285.78
|
|
|
.014 Kinetex 185cm
|
Facility
|
OP
|
$371.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158954
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$108.04 |
| Max. Negotiated Rate |
$354.97 |
| Rate for Payer: Aetna Commercial |
$347.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$331.82
|
| Rate for Payer: Aetna Managed Medicare |
$108.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$250.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$192.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$185.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$204.50
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cigna Commercial |
$354.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$215.92
|
| Rate for Payer: Health EOS Commercial |
$343.40
|
| Rate for Payer: HFN Commercial |
$354.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$289.38
|
| Rate for Payer: Multiplan Commercial |
$308.67
|
| Rate for Payer: NAPHCARE Commercial |
$231.50
|
| Rate for Payer: Preferred Network Access Commercial |
$354.97
|
| Rate for Payer: Quartz Beloit One Network |
$189.06
|
| Rate for Payer: Quartz Commercial |
$250.80
|
| Rate for Payer: Quartz Medicare Advantage |
$231.50
|
| Rate for Payer: The Alliance Commercial |
$192.92
|
| Rate for Payer: WEA Trust Commercial |
$212.21
|
| Rate for Payer: WPS Commercial |
$285.78
|
|
|
.014 Kinetex 185cm
|
Professional
|
Both
|
$371.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158954
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$169.77 |
| Max. Negotiated Rate |
$366.55 |
| Rate for Payer: Aetna Commercial |
$366.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$331.82
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cigna Commercial |
$366.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$192.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$231.50
|
| Rate for Payer: Health EOS Commercial |
$351.11
|
| Rate for Payer: HFN Commercial |
$366.55
|
| Rate for Payer: Multiplan Commercial |
$308.67
|
| Rate for Payer: Preferred Network Access Commercial |
$366.55
|
| Rate for Payer: Quartz Beloit One Network |
$169.77
|
| Rate for Payer: Quartz Commercial |
$219.93
|
| Rate for Payer: The Alliance Commercial |
$192.92
|
| Rate for Payer: WEA Trust Commercial |
$212.21
|
| Rate for Payer: WPS Commercial |
$285.78
|
|
|
.014 Phoenix Guide Wire
|
Facility
|
IP
|
$1,882.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5273128
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$959.07 |
| Max. Negotiated Rate |
$1,800.70 |
| Rate for Payer: Aetna Commercial |
$1,761.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,683.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,037.36
|
| Rate for Payer: Cash Price |
$564.60
|
| Rate for Payer: Cigna Commercial |
$1,800.70
|
| Rate for Payer: Health EOS Commercial |
$1,741.98
|
| Rate for Payer: HFN Commercial |
$1,800.70
|
| Rate for Payer: Multiplan Commercial |
$1,565.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,800.70
|
| Rate for Payer: Quartz Beloit One Network |
$959.07
|
| Rate for Payer: Quartz Commercial |
$1,174.37
|
| Rate for Payer: WEA Trust Commercial |
$1,076.50
|
| Rate for Payer: WPS Commercial |
$1,449.70
|
|
|
.014 Phoenix Guide Wire
|
Facility
|
OP
|
$1,882.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5273128
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$548.04 |
| Max. Negotiated Rate |
$1,800.70 |
| Rate for Payer: Aetna Commercial |
$1,761.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,683.26
|
| Rate for Payer: Aetna Managed Medicare |
$548.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,272.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$978.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$939.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,037.36
|
| Rate for Payer: Cash Price |
$564.60
|
| Rate for Payer: Cigna Commercial |
$1,800.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,095.32
|
| Rate for Payer: Health EOS Commercial |
$1,741.98
|
| Rate for Payer: HFN Commercial |
$1,800.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,467.96
|
| Rate for Payer: Multiplan Commercial |
$1,565.82
|
| Rate for Payer: NAPHCARE Commercial |
$1,174.37
|
| Rate for Payer: Preferred Network Access Commercial |
$1,800.70
|
| Rate for Payer: Quartz Beloit One Network |
$959.07
|
| Rate for Payer: Quartz Commercial |
$1,272.23
|
| Rate for Payer: Quartz Medicare Advantage |
$1,174.37
|
| Rate for Payer: The Alliance Commercial |
$978.64
|
| Rate for Payer: WEA Trust Commercial |
$1,076.50
|
| Rate for Payer: WPS Commercial |
$1,449.70
|
|
|
.014 Prowater 180cm
|
Facility
|
IP
|
$371.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158956
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$189.06 |
| Max. Negotiated Rate |
$354.97 |
| Rate for Payer: Aetna Commercial |
$347.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$331.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$204.50
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cigna Commercial |
$354.97
|
| Rate for Payer: Health EOS Commercial |
$343.40
|
| Rate for Payer: HFN Commercial |
$354.97
|
| Rate for Payer: Multiplan Commercial |
$308.67
|
| Rate for Payer: Preferred Network Access Commercial |
$354.97
|
| Rate for Payer: Quartz Beloit One Network |
$189.06
|
| Rate for Payer: Quartz Commercial |
$231.50
|
| Rate for Payer: WEA Trust Commercial |
$212.21
|
| Rate for Payer: WPS Commercial |
$285.78
|
|
|
.014 Prowater 180cm
|
Facility
|
OP
|
$371.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158956
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$108.04 |
| Max. Negotiated Rate |
$354.97 |
| Rate for Payer: Aetna Commercial |
$347.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$331.82
|
| Rate for Payer: Aetna Managed Medicare |
$108.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$250.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$192.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$185.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$204.50
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cigna Commercial |
$354.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$215.92
|
| Rate for Payer: Health EOS Commercial |
$343.40
|
| Rate for Payer: HFN Commercial |
$354.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$289.38
|
| Rate for Payer: Multiplan Commercial |
$308.67
|
| Rate for Payer: NAPHCARE Commercial |
$231.50
|
| Rate for Payer: Preferred Network Access Commercial |
$354.97
|
| Rate for Payer: Quartz Beloit One Network |
$189.06
|
| Rate for Payer: Quartz Commercial |
$250.80
|
| Rate for Payer: Quartz Medicare Advantage |
$231.50
|
| Rate for Payer: The Alliance Commercial |
$192.92
|
| Rate for Payer: WEA Trust Commercial |
$212.21
|
| Rate for Payer: WPS Commercial |
$285.78
|
|
|
.014 Prowater 180cm
|
Professional
|
Both
|
$371.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158956
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$169.77 |
| Max. Negotiated Rate |
$366.55 |
| Rate for Payer: Aetna Commercial |
$366.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$331.82
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cigna Commercial |
$366.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$192.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$231.50
|
| Rate for Payer: Health EOS Commercial |
$351.11
|
| Rate for Payer: HFN Commercial |
$366.55
|
| Rate for Payer: Multiplan Commercial |
$308.67
|
| Rate for Payer: Preferred Network Access Commercial |
$366.55
|
| Rate for Payer: Quartz Beloit One Network |
$169.77
|
| Rate for Payer: Quartz Commercial |
$219.93
|
| Rate for Payer: The Alliance Commercial |
$192.92
|
| Rate for Payer: WEA Trust Commercial |
$212.21
|
| Rate for Payer: WPS Commercial |
$285.78
|
|
|
.014 Prowater 300cm
|
Professional
|
Both
|
$290.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158958
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$132.70 |
| Max. Negotiated Rate |
$286.52 |
| Rate for Payer: Aetna Commercial |
$286.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$259.38
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$286.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$150.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$180.96
|
| Rate for Payer: Health EOS Commercial |
$274.46
|
| Rate for Payer: HFN Commercial |
$286.52
|
| Rate for Payer: Multiplan Commercial |
$241.28
|
| Rate for Payer: Preferred Network Access Commercial |
$286.52
|
| Rate for Payer: Quartz Beloit One Network |
$132.70
|
| Rate for Payer: Quartz Commercial |
$171.91
|
| Rate for Payer: The Alliance Commercial |
$150.80
|
| Rate for Payer: WEA Trust Commercial |
$165.88
|
| Rate for Payer: WPS Commercial |
$223.39
|
|
|
.014 Prowater 300cm
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158958
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$84.45 |
| Max. Negotiated Rate |
$277.47 |
| Rate for Payer: Aetna Commercial |
$271.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$259.38
|
| Rate for Payer: Aetna Managed Medicare |
$84.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$196.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$150.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$144.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$159.85
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$277.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$168.78
|
| Rate for Payer: Health EOS Commercial |
$268.42
|
| Rate for Payer: HFN Commercial |
$277.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$226.20
|
| Rate for Payer: Multiplan Commercial |
$241.28
|
| Rate for Payer: NAPHCARE Commercial |
$180.96
|
| Rate for Payer: Preferred Network Access Commercial |
$277.47
|
| Rate for Payer: Quartz Beloit One Network |
$147.78
|
| Rate for Payer: Quartz Commercial |
$196.04
|
| Rate for Payer: Quartz Medicare Advantage |
$180.96
|
| Rate for Payer: The Alliance Commercial |
$150.80
|
| Rate for Payer: WEA Trust Commercial |
$165.88
|
| Rate for Payer: WPS Commercial |
$223.39
|
|
|
.014 Prowater 300cm
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158958
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.78 |
| Max. Negotiated Rate |
$277.47 |
| Rate for Payer: Aetna Commercial |
$271.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$259.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$159.85
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$277.47
|
| Rate for Payer: Health EOS Commercial |
$268.42
|
| Rate for Payer: HFN Commercial |
$277.47
|
| Rate for Payer: Multiplan Commercial |
$241.28
|
| Rate for Payer: Preferred Network Access Commercial |
$277.47
|
| Rate for Payer: Quartz Beloit One Network |
$147.78
|
| Rate for Payer: Quartz Commercial |
$180.96
|
| Rate for Payer: WEA Trust Commercial |
$165.88
|
| Rate for Payer: WPS Commercial |
$223.39
|
|
|
.014 RUN THROUGH WIRE NS
|
Facility
|
OP
|
$1,467.00
|
|
| Hospital Charge Code |
6175146
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$427.19 |
| Max. Negotiated Rate |
$1,403.63 |
| Rate for Payer: Aetna Commercial |
$1,373.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,312.08
|
| Rate for Payer: Aetna Managed Medicare |
$427.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$991.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$762.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$732.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$808.61
|
| Rate for Payer: Cash Price |
$440.10
|
| Rate for Payer: Cigna Commercial |
$1,403.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$853.79
|
| Rate for Payer: Health EOS Commercial |
$1,357.86
|
| Rate for Payer: HFN Commercial |
$1,403.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,144.26
|
| Rate for Payer: Multiplan Commercial |
$1,220.54
|
| Rate for Payer: NAPHCARE Commercial |
$915.41
|
| Rate for Payer: Preferred Network Access Commercial |
$1,403.63
|
| Rate for Payer: Quartz Beloit One Network |
$747.58
|
| Rate for Payer: Quartz Commercial |
$991.69
|
| Rate for Payer: Quartz Medicare Advantage |
$915.41
|
| Rate for Payer: The Alliance Commercial |
$762.84
|
| Rate for Payer: WEA Trust Commercial |
$839.12
|
| Rate for Payer: WPS Commercial |
$1,130.03
|
|
|
.014 RUN THROUGH WIRE NS
|
Facility
|
IP
|
$1,467.00
|
|
| Hospital Charge Code |
6175146
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$747.58 |
| Max. Negotiated Rate |
$1,403.63 |
| Rate for Payer: Aetna Commercial |
$1,373.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,312.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$808.61
|
| Rate for Payer: Cash Price |
$440.10
|
| Rate for Payer: Cigna Commercial |
$1,403.63
|
| Rate for Payer: Health EOS Commercial |
$1,357.86
|
| Rate for Payer: HFN Commercial |
$1,403.63
|
| Rate for Payer: Multiplan Commercial |
$1,220.54
|
| Rate for Payer: Preferred Network Access Commercial |
$1,403.63
|
| Rate for Payer: Quartz Beloit One Network |
$747.58
|
| Rate for Payer: Quartz Commercial |
$915.41
|
| Rate for Payer: WEA Trust Commercial |
$839.12
|
| Rate for Payer: WPS Commercial |
$1,130.03
|
|
|
.014 Tapered Peripheral Balloon
|
Facility
|
OP
|
$2,435.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
4528618
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$709.07 |
| Max. Negotiated Rate |
$2,329.81 |
| Rate for Payer: Aetna Commercial |
$2,279.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,177.86
|
| Rate for Payer: Aetna Managed Medicare |
$709.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,646.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,266.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,215.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,342.17
|
| Rate for Payer: Cash Price |
$730.50
|
| Rate for Payer: Cigna Commercial |
$2,329.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,417.17
|
| Rate for Payer: Health EOS Commercial |
$2,253.84
|
| Rate for Payer: HFN Commercial |
$2,329.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,899.30
|
| Rate for Payer: Multiplan Commercial |
$2,025.92
|
| Rate for Payer: NAPHCARE Commercial |
$1,519.44
|
| Rate for Payer: Preferred Network Access Commercial |
$2,329.81
|
| Rate for Payer: Quartz Beloit One Network |
$1,240.88
|
| Rate for Payer: Quartz Commercial |
$1,646.06
|
| Rate for Payer: Quartz Medicare Advantage |
$1,519.44
|
| Rate for Payer: The Alliance Commercial |
$1,266.20
|
| Rate for Payer: WEA Trust Commercial |
$1,392.82
|
| Rate for Payer: WPS Commercial |
$1,875.68
|
|
|
.014 Tapered Peripheral Balloon
|
Facility
|
IP
|
$2,435.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
4528618
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,240.88 |
| Max. Negotiated Rate |
$2,329.81 |
| Rate for Payer: Aetna Commercial |
$2,279.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,177.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,342.17
|
| Rate for Payer: Cash Price |
$730.50
|
| Rate for Payer: Cigna Commercial |
$2,329.81
|
| Rate for Payer: Health EOS Commercial |
$2,253.84
|
| Rate for Payer: HFN Commercial |
$2,329.81
|
| Rate for Payer: Multiplan Commercial |
$2,025.92
|
| Rate for Payer: Preferred Network Access Commercial |
$2,329.81
|
| Rate for Payer: Quartz Beloit One Network |
$1,240.88
|
| Rate for Payer: Quartz Commercial |
$1,519.44
|
| Rate for Payer: WEA Trust Commercial |
$1,392.82
|
| Rate for Payer: WPS Commercial |
$1,875.68
|
|
