|
.018 Platinum Plus 300cm
|
Professional
|
Both
|
$290.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158964
|
|
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 300cm
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158964
|
|
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 Platinum Plus 300cm
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158964
|
|
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 STEELCORE WIRE-300CM
|
Facility
|
IP
|
$1,486.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5282608
|
|
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 STEELCORE WIRE-300CM
|
Facility
|
OP
|
$1,486.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5282608
|
|
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 Trail Blazer
|
Facility
|
OP
|
$2,522.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
5313993
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$734.41 |
| Max. Negotiated Rate |
$2,413.05 |
| Rate for Payer: Aetna Commercial |
$2,360.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,255.68
|
| Rate for Payer: Aetna Managed Medicare |
$734.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,704.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,311.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,258.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,390.13
|
| Rate for Payer: Cash Price |
$756.60
|
| Rate for Payer: Cigna Commercial |
$2,413.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,467.80
|
| Rate for Payer: Health EOS Commercial |
$2,334.36
|
| Rate for Payer: HFN Commercial |
$2,413.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,967.16
|
| Rate for Payer: Multiplan Commercial |
$2,098.30
|
| Rate for Payer: NAPHCARE Commercial |
$1,573.73
|
| Rate for Payer: Preferred Network Access Commercial |
$2,413.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,285.21
|
| Rate for Payer: Quartz Commercial |
$1,704.87
|
| Rate for Payer: Quartz Medicare Advantage |
$1,573.73
|
| Rate for Payer: The Alliance Commercial |
$1,311.44
|
| Rate for Payer: WEA Trust Commercial |
$1,442.58
|
| Rate for Payer: WPS Commercial |
$1,942.70
|
|
|
.018 Trail Blazer
|
Facility
|
IP
|
$2,522.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
5313993
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,285.21 |
| Max. Negotiated Rate |
$2,413.05 |
| Rate for Payer: Aetna Commercial |
$2,360.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,255.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,390.13
|
| Rate for Payer: Cash Price |
$756.60
|
| Rate for Payer: Cigna Commercial |
$2,413.05
|
| Rate for Payer: Health EOS Commercial |
$2,334.36
|
| Rate for Payer: HFN Commercial |
$2,413.05
|
| Rate for Payer: Multiplan Commercial |
$2,098.30
|
| Rate for Payer: Preferred Network Access Commercial |
$2,413.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,285.21
|
| Rate for Payer: Quartz Commercial |
$1,573.73
|
| Rate for Payer: WEA Trust Commercial |
$1,442.58
|
| Rate for Payer: WPS Commercial |
$1,942.70
|
|
|
.018 Victory 18 Wire
|
Facility
|
IP
|
$2,303.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4606632
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,173.61 |
| Max. Negotiated Rate |
$2,203.51 |
| Rate for Payer: Aetna Commercial |
$2,155.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,059.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,269.41
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cigna Commercial |
$2,203.51
|
| Rate for Payer: Health EOS Commercial |
$2,131.66
|
| Rate for Payer: HFN Commercial |
$2,203.51
|
| Rate for Payer: Multiplan Commercial |
$1,916.10
|
| Rate for Payer: Preferred Network Access Commercial |
$2,203.51
|
| Rate for Payer: Quartz Beloit One Network |
$1,173.61
|
| Rate for Payer: Quartz Commercial |
$1,437.07
|
| Rate for Payer: WEA Trust Commercial |
$1,317.32
|
| Rate for Payer: WPS Commercial |
$1,774.00
|
|
|
.018 Victory 18 Wire
|
Facility
|
OP
|
$2,303.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4606632
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$670.63 |
| Max. Negotiated Rate |
$2,203.51 |
| Rate for Payer: Aetna Commercial |
$2,155.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,059.80
|
| Rate for Payer: Aetna Managed Medicare |
$670.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,556.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,197.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,149.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,269.41
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cigna Commercial |
$2,203.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,340.35
|
| Rate for Payer: Health EOS Commercial |
$2,131.66
|
| Rate for Payer: HFN Commercial |
$2,203.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,796.34
|
| Rate for Payer: Multiplan Commercial |
$1,916.10
|
| Rate for Payer: NAPHCARE Commercial |
$1,437.07
|
| Rate for Payer: Preferred Network Access Commercial |
$2,203.51
|
| Rate for Payer: Quartz Beloit One Network |
$1,173.61
|
| Rate for Payer: Quartz Commercial |
$1,556.83
|
| Rate for Payer: Quartz Medicare Advantage |
$1,437.07
|
| Rate for Payer: The Alliance Commercial |
$1,197.56
|
| Rate for Payer: WEA Trust Commercial |
$1,317.32
|
| Rate for Payer: WPS Commercial |
$1,774.00
|
|
|
.018 Zip Angled 180cm
|
Professional
|
Both
|
$290.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158960
|
|
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 Zip Angled 180cm
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158960
|
|
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 Zip Angled 180cm
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158960
|
|
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
|
|
|
.035 3mm J
|
Professional
|
Both
|
$290.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158968
|
|
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
|
|
|
.035 3mm J
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158968
|
|
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
|
|
|
.035 3mm J
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158968
|
|
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
|
|
|
.035 Amplatz 180cm
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158982
|
|
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
|
|
|
.035 Amplatz 180cm
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158982
|
|
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
|
|
|
.035 Amplatz 180cm
|
Professional
|
Both
|
$290.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158982
|
|
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
|
|
|
.035 Amplatz 300cm
|
Professional
|
Both
|
$290.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158984
|
|
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
|
|
|
.035 Amplatz 300cm
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158984
|
|
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
|
|
|
.035 Amplatz 300cm
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158984
|
|
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
|
|
|
.035 Lunderquist 180cm
|
Professional
|
Both
|
$290.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158986
|
|
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
|
|
|
.035 Lunderquist 180cm
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158986
|
|
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
|
|
|
.035 Lunderquist 180cm
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158986
|
|
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
|
|
|
.035 Lunderquist 300cm
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
1158988
|
|
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
|
|
