|
.014 Whisper J Tip 190cm
|
Facility
IP
|
$371.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158940
|
|
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 Whisper J Tip 190cm
|
Facility
OP
|
$371.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158940
|
|
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 Whisper J Tip 190cm
|
Professional
|
$371.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158940
|
|
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 Whisper J Tip 300cm
|
Facility
IP
|
$290.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158942
|
|
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 Whisper J Tip 300cm
|
Professional
|
$290.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158942
|
|
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 Whisper J Tip 300cm
|
Facility
OP
|
$290.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158942
|
|
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 X-Sport 300cm
|
Facility
OP
|
$290.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158948
|
|
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 X-Sport 300cm
|
Facility
IP
|
$290.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158948
|
|
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 X-Sport 300cm
|
Professional
|
$290.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158948
|
|
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
|
|
|
.018 Armada Balloon
|
Facility
IP
|
$1,409.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
5273134
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$690.41 |
| Max. Negotiated Rate |
$1,296.28 |
| Rate for Payer: Aetna Commercial |
$1,268.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$746.77
|
| Rate for Payer: Cash Price |
$422.70
|
| Rate for Payer: Cigna Commercial |
$1,296.28
|
| Rate for Payer: Health EOS Commercial |
$1,254.01
|
| Rate for Payer: HFN Commercial |
$1,296.28
|
| Rate for Payer: Multiplan Commercial |
$1,127.20
|
| Rate for Payer: NAPHCARE Commercial |
$845.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,296.28
|
| Rate for Payer: Quartz Beloit One Network |
$690.41
|
| Rate for Payer: Quartz Commercial |
$845.40
|
| Rate for Payer: WEA Trust Commercial |
$774.95
|
| Rate for Payer: WPS Commercial |
$1,043.65
|
|
|
.018 Armada Balloon
|
Facility
OP
|
$1,409.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
5273134
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$394.52 |
| Max. Negotiated Rate |
$1,296.28 |
| Rate for Payer: Aetna Commercial |
$1,268.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,211.74
|
| Rate for Payer: Aetna Managed Medicare |
$394.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$915.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$704.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$676.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$746.77
|
| Rate for Payer: Cash Price |
$422.70
|
| Rate for Payer: Cigna Commercial |
$1,296.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$788.48
|
| Rate for Payer: Health EOS Commercial |
$1,254.01
|
| Rate for Payer: HFN Commercial |
$1,296.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,056.75
|
| Rate for Payer: Multiplan Commercial |
$1,127.20
|
| Rate for Payer: NAPHCARE Commercial |
$845.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,296.28
|
| Rate for Payer: Quartz Beloit One Network |
$690.41
|
| Rate for Payer: Quartz Commercial |
$915.85
|
| Rate for Payer: Quartz Medicare Advantage |
$845.40
|
| Rate for Payer: WEA Trust Commercial |
$774.95
|
| Rate for Payer: WPS Commercial |
$1,043.65
|
|
|
.018 Connect 250T
|
Facility
IP
|
$1,486.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5273130
|
|
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
|
|
|
.018 Connect 250T
|
Facility
OP
|
$1,486.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5273130
|
|
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
|
|
|
.018 Connect Flex Wire
|
Facility
IP
|
$1,486.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5273131
|
|
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
|
|
|
.018 Connect Flex Wire
|
Facility
OP
|
$1,486.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5273131
|
|
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
|
|
|
.018 Connect Wire
|
Facility
IP
|
$1,486.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5273132
|
|
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
|
|
|
.018 Connect Wire
|
Facility
OP
|
$1,486.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5273132
|
|
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
|
|
|
.018 Glidewire Stiff
|
Facility
IP
|
$290.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158966
|
|
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
|
|
|
.018 Glidewire Stiff
|
Professional
|
$290.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158966
|
|
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
|
|
|
.018 Glidewire Stiff
|
Facility
OP
|
$290.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158966
|
|
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
|
|
|
.018 Pacific Extreme Balloon
|
Facility
IP
|
$1,972.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
5282609
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$966.28 |
| Max. Negotiated Rate |
$1,814.24 |
| Rate for Payer: Aetna Commercial |
$1,774.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,045.16
|
| Rate for Payer: Cash Price |
$591.60
|
| Rate for Payer: Cigna Commercial |
$1,814.24
|
| Rate for Payer: Health EOS Commercial |
$1,755.08
|
| Rate for Payer: HFN Commercial |
$1,814.24
|
| Rate for Payer: Multiplan Commercial |
$1,577.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,183.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,814.24
|
| Rate for Payer: Quartz Beloit One Network |
$966.28
|
| Rate for Payer: Quartz Commercial |
$1,183.20
|
| Rate for Payer: WEA Trust Commercial |
$1,084.60
|
| Rate for Payer: WPS Commercial |
$1,460.66
|
|
|
.018 Pacific Extreme Balloon
|
Facility
OP
|
$1,972.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
5282609
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$552.16 |
| Max. Negotiated Rate |
$1,814.24 |
| Rate for Payer: Aetna Commercial |
$1,774.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,695.92
|
| Rate for Payer: Aetna Managed Medicare |
$552.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,281.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$986.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$946.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,045.16
|
| Rate for Payer: Cash Price |
$591.60
|
| Rate for Payer: Cigna Commercial |
$1,814.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,103.53
|
| Rate for Payer: Health EOS Commercial |
$1,755.08
|
| Rate for Payer: HFN Commercial |
$1,814.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,479.00
|
| Rate for Payer: Multiplan Commercial |
$1,577.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,183.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,814.24
|
| Rate for Payer: Quartz Beloit One Network |
$966.28
|
| Rate for Payer: Quartz Commercial |
$1,281.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,183.20
|
| Rate for Payer: WEA Trust Commercial |
$1,084.60
|
| Rate for Payer: WPS Commercial |
$1,460.66
|
|
|
.018 Platinum Plus 180cm
|
Facility
OP
|
$290.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158962
|
|
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
|
|
|
.018 Platinum Plus 180cm
|
Facility
IP
|
$290.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158962
|
|
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
|
|
|
.018 Platinum Plus 180cm
|
Professional
|
$290.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158962
|
|
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
|
|
