|
.014 Whisper J Tip 190cm
|
Professional
|
Both
|
$371.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158940
|
|
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 Whisper J Tip 190cm
|
Facility
|
OP
|
$371.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158940
|
|
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 Whisper J Tip 190cm
|
Facility
|
IP
|
$371.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158940
|
|
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 Whisper J Tip 300cm
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158942
|
|
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 Whisper J Tip 300cm
|
Professional
|
Both
|
$290.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158942
|
|
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 Whisper J Tip 300cm
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158942
|
|
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 X-Sport 300cm
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158948
|
|
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 X-Sport 300cm
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158948
|
|
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 X-Sport 300cm
|
Professional
|
Both
|
$290.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158948
|
|
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
|
|
|
.018 Armada Balloon
|
Facility
|
OP
|
$1,409.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
5273134
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$410.30 |
| Max. Negotiated Rate |
$1,348.13 |
| Rate for Payer: Aetna Commercial |
$1,318.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,260.21
|
| Rate for Payer: Aetna Managed Medicare |
$410.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$952.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$732.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$703.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$776.64
|
| Rate for Payer: Cash Price |
$422.70
|
| Rate for Payer: Cigna Commercial |
$1,348.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$820.04
|
| Rate for Payer: Health EOS Commercial |
$1,304.17
|
| Rate for Payer: HFN Commercial |
$1,348.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,099.02
|
| Rate for Payer: Multiplan Commercial |
$1,172.29
|
| Rate for Payer: NAPHCARE Commercial |
$879.22
|
| Rate for Payer: Preferred Network Access Commercial |
$1,348.13
|
| Rate for Payer: Quartz Beloit One Network |
$718.03
|
| Rate for Payer: Quartz Commercial |
$952.48
|
| Rate for Payer: Quartz Medicare Advantage |
$879.22
|
| Rate for Payer: The Alliance Commercial |
$732.68
|
| Rate for Payer: WEA Trust Commercial |
$805.95
|
| Rate for Payer: WPS Commercial |
$1,085.35
|
|
|
.018 Armada Balloon
|
Facility
|
IP
|
$1,409.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
5273134
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$718.03 |
| Max. Negotiated Rate |
$1,348.13 |
| Rate for Payer: Aetna Commercial |
$1,318.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,260.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$776.64
|
| Rate for Payer: Cash Price |
$422.70
|
| Rate for Payer: Cigna Commercial |
$1,348.13
|
| Rate for Payer: Health EOS Commercial |
$1,304.17
|
| Rate for Payer: HFN Commercial |
$1,348.13
|
| Rate for Payer: Multiplan Commercial |
$1,172.29
|
| Rate for Payer: Preferred Network Access Commercial |
$1,348.13
|
| Rate for Payer: Quartz Beloit One Network |
$718.03
|
| Rate for Payer: Quartz Commercial |
$879.22
|
| Rate for Payer: WEA Trust Commercial |
$805.95
|
| Rate for Payer: WPS Commercial |
$1,085.35
|
|
|
.018 Connect 250T
|
Facility
|
IP
|
$1,486.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5273130
|
|
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
|
|
|
.018 Connect 250T
|
Facility
|
OP
|
$1,486.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5273130
|
|
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
|
|
|
.018 Connect Flex Wire
|
Facility
|
IP
|
$1,486.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5273131
|
|
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
|
|
|
.018 Connect Flex Wire
|
Facility
|
OP
|
$1,486.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5273131
|
|
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
|
|
|
.018 Connect Wire
|
Facility
|
OP
|
$1,486.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5273132
|
|
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
|
|
|
.018 Connect Wire
|
Facility
|
IP
|
$1,486.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5273132
|
|
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
|
|
|
.018 Glidewire Stiff
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158966
|
|
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
|
|
|
.018 Glidewire Stiff
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158966
|
|
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
|
|
|
.018 Glidewire Stiff
|
Professional
|
Both
|
$290.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158966
|
|
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
|
|
|
.018 Pacific Extreme Balloon
|
Facility
|
OP
|
$1,972.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
5282609
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$574.25 |
| Max. Negotiated Rate |
$1,886.81 |
| Rate for Payer: Aetna Commercial |
$1,845.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,763.76
|
| Rate for Payer: Aetna Managed Medicare |
$574.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,333.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,025.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$984.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,086.97
|
| Rate for Payer: Cash Price |
$591.60
|
| Rate for Payer: Cigna Commercial |
$1,886.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,147.70
|
| Rate for Payer: Health EOS Commercial |
$1,825.28
|
| Rate for Payer: HFN Commercial |
$1,886.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,538.16
|
| Rate for Payer: Multiplan Commercial |
$1,640.70
|
| Rate for Payer: NAPHCARE Commercial |
$1,230.53
|
| Rate for Payer: Preferred Network Access Commercial |
$1,886.81
|
| Rate for Payer: Quartz Beloit One Network |
$1,004.93
|
| Rate for Payer: Quartz Commercial |
$1,333.07
|
| Rate for Payer: Quartz Medicare Advantage |
$1,230.53
|
| Rate for Payer: The Alliance Commercial |
$1,025.44
|
| Rate for Payer: WEA Trust Commercial |
$1,127.98
|
| Rate for Payer: WPS Commercial |
$1,519.03
|
|
|
.018 Pacific Extreme Balloon
|
Facility
|
IP
|
$1,972.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
5282609
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,004.93 |
| Max. Negotiated Rate |
$1,886.81 |
| Rate for Payer: Aetna Commercial |
$1,845.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,763.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,086.97
|
| Rate for Payer: Cash Price |
$591.60
|
| Rate for Payer: Cigna Commercial |
$1,886.81
|
| Rate for Payer: Health EOS Commercial |
$1,825.28
|
| Rate for Payer: HFN Commercial |
$1,886.81
|
| Rate for Payer: Multiplan Commercial |
$1,640.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,886.81
|
| Rate for Payer: Quartz Beloit One Network |
$1,004.93
|
| Rate for Payer: Quartz Commercial |
$1,230.53
|
| Rate for Payer: WEA Trust Commercial |
$1,127.98
|
| Rate for Payer: WPS Commercial |
$1,519.03
|
|
|
.018 Platinum Plus 180cm
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158962
|
|
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
|
|
|
.018 Platinum Plus 180cm
|
Professional
|
Both
|
$290.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158962
|
|
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
|
|
|
.018 Platinum Plus 180cm
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158962
|
|
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
|
|
