|
DISTAL CENTRALIZER VERSYS SZ 14 7859-14
|
Facility
IP
|
$583.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967880
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$285.67 |
| Max. Negotiated Rate |
$536.36 |
| Rate for Payer: Aetna Commercial |
$524.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$308.99
|
| Rate for Payer: Cash Price |
$174.90
|
| Rate for Payer: Cigna Commercial |
$536.36
|
| Rate for Payer: Health EOS Commercial |
$518.87
|
| Rate for Payer: HFN Commercial |
$536.36
|
| Rate for Payer: Multiplan Commercial |
$466.40
|
| Rate for Payer: NAPHCARE Commercial |
$349.80
|
| Rate for Payer: Preferred Network Access Commercial |
$536.36
|
| Rate for Payer: Quartz Beloit One Network |
$285.67
|
| Rate for Payer: Quartz Commercial |
$349.80
|
| Rate for Payer: WEA Trust Commercial |
$320.65
|
| Rate for Payer: WPS Commercial |
$431.83
|
|
|
DISTAL CENTRALIZER VERSYS SZ 14 7859-14
|
Facility
OP
|
$583.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967880
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$163.24 |
| Max. Negotiated Rate |
$536.36 |
| Rate for Payer: Aetna Commercial |
$524.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$501.38
|
| Rate for Payer: Aetna Managed Medicare |
$163.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$378.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$291.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$279.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$308.99
|
| Rate for Payer: Cash Price |
$174.90
|
| Rate for Payer: Cigna Commercial |
$536.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$326.25
|
| Rate for Payer: Health EOS Commercial |
$518.87
|
| Rate for Payer: HFN Commercial |
$536.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$437.25
|
| Rate for Payer: Multiplan Commercial |
$466.40
|
| Rate for Payer: NAPHCARE Commercial |
$349.80
|
| Rate for Payer: Preferred Network Access Commercial |
$536.36
|
| Rate for Payer: Quartz Beloit One Network |
$285.67
|
| Rate for Payer: Quartz Commercial |
$378.95
|
| Rate for Payer: Quartz Medicare Advantage |
$349.80
|
| Rate for Payer: WEA Trust Commercial |
$320.65
|
| Rate for Payer: WPS Commercial |
$431.83
|
|
|
DISTAL CENTRALIZER VERSYS SZ 15 7859-15
|
Facility
IP
|
$561.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967881
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$274.89 |
| Max. Negotiated Rate |
$516.12 |
| Rate for Payer: Aetna Commercial |
$504.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$297.33
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Cigna Commercial |
$516.12
|
| Rate for Payer: Health EOS Commercial |
$499.29
|
| Rate for Payer: HFN Commercial |
$516.12
|
| Rate for Payer: Multiplan Commercial |
$448.80
|
| Rate for Payer: NAPHCARE Commercial |
$336.60
|
| Rate for Payer: Preferred Network Access Commercial |
$516.12
|
| Rate for Payer: Quartz Beloit One Network |
$274.89
|
| Rate for Payer: Quartz Commercial |
$336.60
|
| Rate for Payer: WEA Trust Commercial |
$308.55
|
| Rate for Payer: WPS Commercial |
$415.53
|
|
|
DISTAL CENTRALIZER VERSYS SZ 15 7859-15
|
Facility
OP
|
$561.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967881
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$157.08 |
| Max. Negotiated Rate |
$516.12 |
| Rate for Payer: Aetna Commercial |
$504.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$482.46
|
| Rate for Payer: Aetna Managed Medicare |
$157.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$364.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$280.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$269.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$297.33
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Cigna Commercial |
$516.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$313.94
|
| Rate for Payer: Health EOS Commercial |
$499.29
|
| Rate for Payer: HFN Commercial |
$516.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$420.75
|
| Rate for Payer: Multiplan Commercial |
$448.80
|
| Rate for Payer: NAPHCARE Commercial |
$336.60
|
| Rate for Payer: Preferred Network Access Commercial |
$516.12
|
| Rate for Payer: Quartz Beloit One Network |
$274.89
|
| Rate for Payer: Quartz Commercial |
$364.65
|
| Rate for Payer: Quartz Medicare Advantage |
$336.60
|
| Rate for Payer: WEA Trust Commercial |
$308.55
|
| Rate for Payer: WPS Commercial |
$415.53
|
|
|
DISTAL CENTRALIZER VERSYS SZ 16 7859-16
|
Facility
OP
|
$561.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967882
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$157.08 |
| Max. Negotiated Rate |
$516.12 |
| Rate for Payer: Aetna Commercial |
$504.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$482.46
|
| Rate for Payer: Aetna Managed Medicare |
$157.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$364.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$280.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$269.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$297.33
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Cigna Commercial |
$516.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$313.94
|
| Rate for Payer: Health EOS Commercial |
$499.29
|
| Rate for Payer: HFN Commercial |
$516.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$420.75
|
| Rate for Payer: Multiplan Commercial |
$448.80
|
| Rate for Payer: NAPHCARE Commercial |
$336.60
|
| Rate for Payer: Preferred Network Access Commercial |
$516.12
|
| Rate for Payer: Quartz Beloit One Network |
$274.89
|
| Rate for Payer: Quartz Commercial |
$364.65
|
| Rate for Payer: Quartz Medicare Advantage |
$336.60
|
| Rate for Payer: WEA Trust Commercial |
$308.55
|
| Rate for Payer: WPS Commercial |
$415.53
|
|
|
DISTAL CENTRALIZER VERSYS SZ 16 7859-16
|
Facility
IP
|
$561.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967882
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$274.89 |
| Max. Negotiated Rate |
$516.12 |
| Rate for Payer: Aetna Commercial |
$504.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$297.33
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Cigna Commercial |
$516.12
|
| Rate for Payer: Health EOS Commercial |
$499.29
|
| Rate for Payer: HFN Commercial |
$516.12
|
| Rate for Payer: Multiplan Commercial |
$448.80
|
| Rate for Payer: NAPHCARE Commercial |
$336.60
|
| Rate for Payer: Preferred Network Access Commercial |
$516.12
|
| Rate for Payer: Quartz Beloit One Network |
$274.89
|
| Rate for Payer: Quartz Commercial |
$336.60
|
| Rate for Payer: WEA Trust Commercial |
$308.55
|
| Rate for Payer: WPS Commercial |
$415.53
|
|
|
DISTAL CENTRALIZER VERSYS SZ 17 7859-17
|
Facility
IP
|
$562.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967883
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$275.38 |
| Max. Negotiated Rate |
$517.04 |
| Rate for Payer: Aetna Commercial |
$505.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$297.86
|
| Rate for Payer: Cash Price |
$168.60
|
| Rate for Payer: Cigna Commercial |
$517.04
|
| Rate for Payer: Health EOS Commercial |
$500.18
|
| Rate for Payer: HFN Commercial |
$517.04
|
| Rate for Payer: Multiplan Commercial |
$449.60
|
| Rate for Payer: NAPHCARE Commercial |
$337.20
|
| Rate for Payer: Preferred Network Access Commercial |
$517.04
|
| Rate for Payer: Quartz Beloit One Network |
$275.38
|
| Rate for Payer: Quartz Commercial |
$337.20
|
| Rate for Payer: WEA Trust Commercial |
$309.10
|
| Rate for Payer: WPS Commercial |
$416.27
|
|
|
DISTAL CENTRALIZER VERSYS SZ 17 7859-17
|
Facility
OP
|
$562.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967883
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$157.36 |
| Max. Negotiated Rate |
$517.04 |
| Rate for Payer: Aetna Commercial |
$505.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$483.32
|
| Rate for Payer: Aetna Managed Medicare |
$157.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$365.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$281.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$269.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$297.86
|
| Rate for Payer: Cash Price |
$168.60
|
| Rate for Payer: Cigna Commercial |
$517.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$314.50
|
| Rate for Payer: Health EOS Commercial |
$500.18
|
| Rate for Payer: HFN Commercial |
$517.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$421.50
|
| Rate for Payer: Multiplan Commercial |
$449.60
|
| Rate for Payer: NAPHCARE Commercial |
$337.20
|
| Rate for Payer: Preferred Network Access Commercial |
$517.04
|
| Rate for Payer: Quartz Beloit One Network |
$275.38
|
| Rate for Payer: Quartz Commercial |
$365.30
|
| Rate for Payer: Quartz Medicare Advantage |
$337.20
|
| Rate for Payer: WEA Trust Commercial |
$309.10
|
| Rate for Payer: WPS Commercial |
$416.27
|
|
|
DISTAL CENTRALIZER VERSYS SZ 18 7895-18
|
Facility
IP
|
$562.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967884
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$275.38 |
| Max. Negotiated Rate |
$517.04 |
| Rate for Payer: Aetna Commercial |
$505.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$297.86
|
| Rate for Payer: Cash Price |
$168.60
|
| Rate for Payer: Cigna Commercial |
$517.04
|
| Rate for Payer: Health EOS Commercial |
$500.18
|
| Rate for Payer: HFN Commercial |
$517.04
|
| Rate for Payer: Multiplan Commercial |
$449.60
|
| Rate for Payer: NAPHCARE Commercial |
$337.20
|
| Rate for Payer: Preferred Network Access Commercial |
$517.04
|
| Rate for Payer: Quartz Beloit One Network |
$275.38
|
| Rate for Payer: Quartz Commercial |
$337.20
|
| Rate for Payer: WEA Trust Commercial |
$309.10
|
| Rate for Payer: WPS Commercial |
$416.27
|
|
|
DISTAL CENTRALIZER VERSYS SZ 18 7895-18
|
Facility
OP
|
$562.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967884
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$157.36 |
| Max. Negotiated Rate |
$517.04 |
| Rate for Payer: Aetna Commercial |
$505.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$483.32
|
| Rate for Payer: Aetna Managed Medicare |
$157.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$365.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$281.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$269.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$297.86
|
| Rate for Payer: Cash Price |
$168.60
|
| Rate for Payer: Cigna Commercial |
$517.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$314.50
|
| Rate for Payer: Health EOS Commercial |
$500.18
|
| Rate for Payer: HFN Commercial |
$517.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$421.50
|
| Rate for Payer: Multiplan Commercial |
$449.60
|
| Rate for Payer: NAPHCARE Commercial |
$337.20
|
| Rate for Payer: Preferred Network Access Commercial |
$517.04
|
| Rate for Payer: Quartz Beloit One Network |
$275.38
|
| Rate for Payer: Quartz Commercial |
$365.30
|
| Rate for Payer: Quartz Medicare Advantage |
$337.20
|
| Rate for Payer: WEA Trust Commercial |
$309.10
|
| Rate for Payer: WPS Commercial |
$416.27
|
|
|
DISTAL CENTRALIZER VERSYS SZ 19 7859-19
|
Facility
IP
|
$562.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967885
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$275.38 |
| Max. Negotiated Rate |
$517.04 |
| Rate for Payer: Aetna Commercial |
$505.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$297.86
|
| Rate for Payer: Cash Price |
$168.60
|
| Rate for Payer: Cigna Commercial |
$517.04
|
| Rate for Payer: Health EOS Commercial |
$500.18
|
| Rate for Payer: HFN Commercial |
$517.04
|
| Rate for Payer: Multiplan Commercial |
$449.60
|
| Rate for Payer: NAPHCARE Commercial |
$337.20
|
| Rate for Payer: Preferred Network Access Commercial |
$517.04
|
| Rate for Payer: Quartz Beloit One Network |
$275.38
|
| Rate for Payer: Quartz Commercial |
$337.20
|
| Rate for Payer: WEA Trust Commercial |
$309.10
|
| Rate for Payer: WPS Commercial |
$416.27
|
|
|
DISTAL CENTRALIZER VERSYS SZ 19 7859-19
|
Facility
OP
|
$562.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967885
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$157.36 |
| Max. Negotiated Rate |
$517.04 |
| Rate for Payer: Aetna Commercial |
$505.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$483.32
|
| Rate for Payer: Aetna Managed Medicare |
$157.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$365.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$281.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$269.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$297.86
|
| Rate for Payer: Cash Price |
$168.60
|
| Rate for Payer: Cigna Commercial |
$517.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$314.50
|
| Rate for Payer: Health EOS Commercial |
$500.18
|
| Rate for Payer: HFN Commercial |
$517.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$421.50
|
| Rate for Payer: Multiplan Commercial |
$449.60
|
| Rate for Payer: NAPHCARE Commercial |
$337.20
|
| Rate for Payer: Preferred Network Access Commercial |
$517.04
|
| Rate for Payer: Quartz Beloit One Network |
$275.38
|
| Rate for Payer: Quartz Commercial |
$365.30
|
| Rate for Payer: Quartz Medicare Advantage |
$337.20
|
| Rate for Payer: WEA Trust Commercial |
$309.10
|
| Rate for Payer: WPS Commercial |
$416.27
|
|
|
DISTAL CENTRALIZER VERSYS SZ 9 7859-09
|
Facility
OP
|
$582.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967460
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$162.96 |
| Max. Negotiated Rate |
$535.44 |
| Rate for Payer: Aetna Commercial |
$523.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$500.52
|
| Rate for Payer: Aetna Managed Medicare |
$162.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$378.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$291.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$279.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$308.46
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Cigna Commercial |
$535.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$325.69
|
| Rate for Payer: Health EOS Commercial |
$517.98
|
| Rate for Payer: HFN Commercial |
$535.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$436.50
|
| Rate for Payer: Multiplan Commercial |
$465.60
|
| Rate for Payer: NAPHCARE Commercial |
$349.20
|
| Rate for Payer: Preferred Network Access Commercial |
$535.44
|
| Rate for Payer: Quartz Beloit One Network |
$285.18
|
| Rate for Payer: Quartz Commercial |
$378.30
|
| Rate for Payer: Quartz Medicare Advantage |
$349.20
|
| Rate for Payer: WEA Trust Commercial |
$320.10
|
| Rate for Payer: WPS Commercial |
$431.09
|
|
|
DISTAL CENTRALIZER VERSYS SZ 9 7859-09
|
Facility
IP
|
$582.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967460
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$285.18 |
| Max. Negotiated Rate |
$535.44 |
| Rate for Payer: Aetna Commercial |
$523.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$308.46
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Cigna Commercial |
$535.44
|
| Rate for Payer: Health EOS Commercial |
$517.98
|
| Rate for Payer: HFN Commercial |
$535.44
|
| Rate for Payer: Multiplan Commercial |
$465.60
|
| Rate for Payer: NAPHCARE Commercial |
$349.20
|
| Rate for Payer: Preferred Network Access Commercial |
$535.44
|
| Rate for Payer: Quartz Beloit One Network |
$285.18
|
| Rate for Payer: Quartz Commercial |
$349.20
|
| Rate for Payer: WEA Trust Commercial |
$320.10
|
| Rate for Payer: WPS Commercial |
$431.09
|
|
|
DISTAL FIBULA PLATE LOCK 4HL RT TI AR-9943BR-04
|
Facility
OP
|
$4,296.61
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6244275
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,203.05 |
| Max. Negotiated Rate |
$3,952.88 |
| Rate for Payer: Aetna Commercial |
$3,866.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,695.08
|
| Rate for Payer: Aetna Managed Medicare |
$1,203.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,792.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,148.30
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,062.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,277.20
|
| Rate for Payer: Cash Price |
$1,288.98
|
| Rate for Payer: Cigna Commercial |
$3,952.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,404.38
|
| Rate for Payer: Health EOS Commercial |
$3,823.98
|
| Rate for Payer: HFN Commercial |
$3,952.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,222.46
|
| Rate for Payer: Multiplan Commercial |
$3,437.29
|
| Rate for Payer: NAPHCARE Commercial |
$2,577.97
|
| Rate for Payer: Preferred Network Access Commercial |
$3,952.88
|
| Rate for Payer: Quartz Beloit One Network |
$2,105.34
|
| Rate for Payer: Quartz Commercial |
$2,792.80
|
| Rate for Payer: Quartz Medicare Advantage |
$2,577.97
|
| Rate for Payer: WEA Trust Commercial |
$2,363.14
|
| Rate for Payer: WPS Commercial |
$3,182.50
|
|
|
DISTAL FIBULA PLATE LOCK 4HL RT TI AR-9943BR-04
|
Facility
IP
|
$4,296.61
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6244275
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,105.34 |
| Max. Negotiated Rate |
$3,952.88 |
| Rate for Payer: Aetna Commercial |
$3,866.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,277.20
|
| Rate for Payer: Cash Price |
$1,288.98
|
| Rate for Payer: Cigna Commercial |
$3,952.88
|
| Rate for Payer: Health EOS Commercial |
$3,823.98
|
| Rate for Payer: HFN Commercial |
$3,952.88
|
| Rate for Payer: Multiplan Commercial |
$3,437.29
|
| Rate for Payer: NAPHCARE Commercial |
$2,577.97
|
| Rate for Payer: Preferred Network Access Commercial |
$3,952.88
|
| Rate for Payer: Quartz Beloit One Network |
$2,105.34
|
| Rate for Payer: Quartz Commercial |
$2,577.97
|
| Rate for Payer: WEA Trust Commercial |
$2,363.14
|
| Rate for Payer: WPS Commercial |
$3,182.50
|
|
|
Distal Protection Device 3mm
|
Professional
|
$10,710.00
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
2549106
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,712.40 |
| Max. Negotiated Rate |
$10,174.50 |
| Rate for Payer: Aetna Commercial |
$10,174.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,210.60
|
| Rate for Payer: Cash Price |
$3,213.00
|
| Rate for Payer: Cigna Commercial |
$10,174.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,355.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,426.00
|
| Rate for Payer: Health EOS Commercial |
$9,746.10
|
| Rate for Payer: Multiplan Commercial |
$8,568.00
|
| Rate for Payer: Preferred Network Access Commercial |
$10,174.50
|
| Rate for Payer: Quartz Beloit One Network |
$4,712.40
|
| Rate for Payer: Quartz Commercial |
$6,104.70
|
| Rate for Payer: The Alliance Commercial |
$5,355.00
|
| Rate for Payer: WEA Trust Commercial |
$5,890.50
|
| Rate for Payer: WPS Commercial |
$7,932.90
|
|
|
Distal Protection Device 3mm
|
Facility
IP
|
$10,710.00
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
2549106
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,247.90 |
| Max. Negotiated Rate |
$9,853.20 |
| Rate for Payer: Aetna Commercial |
$9,639.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,676.30
|
| Rate for Payer: Cash Price |
$3,213.00
|
| Rate for Payer: Cigna Commercial |
$9,853.20
|
| Rate for Payer: Health EOS Commercial |
$9,531.90
|
| Rate for Payer: HFN Commercial |
$9,853.20
|
| Rate for Payer: Multiplan Commercial |
$8,568.00
|
| Rate for Payer: NAPHCARE Commercial |
$6,426.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9,853.20
|
| Rate for Payer: Quartz Beloit One Network |
$5,247.90
|
| Rate for Payer: Quartz Commercial |
$6,426.00
|
| Rate for Payer: WEA Trust Commercial |
$5,890.50
|
| Rate for Payer: WPS Commercial |
$7,932.90
|
|
|
Distal Protection Device 3mm
|
Facility
OP
|
$10,710.00
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
2549106
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,998.80 |
| Max. Negotiated Rate |
$9,853.20 |
| Rate for Payer: Aetna Commercial |
$9,639.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,210.60
|
| Rate for Payer: Aetna Managed Medicare |
$2,998.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,961.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,355.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,140.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,676.30
|
| Rate for Payer: Cash Price |
$3,213.00
|
| Rate for Payer: Cigna Commercial |
$9,853.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,993.32
|
| Rate for Payer: Health EOS Commercial |
$9,531.90
|
| Rate for Payer: HFN Commercial |
$9,853.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,032.50
|
| Rate for Payer: Multiplan Commercial |
$8,568.00
|
| Rate for Payer: NAPHCARE Commercial |
$6,426.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9,853.20
|
| Rate for Payer: Quartz Beloit One Network |
$5,247.90
|
| Rate for Payer: Quartz Commercial |
$6,961.50
|
| Rate for Payer: Quartz Medicare Advantage |
$6,426.00
|
| Rate for Payer: WEA Trust Commercial |
$5,890.50
|
| Rate for Payer: WPS Commercial |
$7,932.90
|
|
|
Distal Protection Device 4mm
|
Facility
IP
|
$10,710.00
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
2549108
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,247.90 |
| Max. Negotiated Rate |
$9,853.20 |
| Rate for Payer: Aetna Commercial |
$9,639.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,676.30
|
| Rate for Payer: Cash Price |
$3,213.00
|
| Rate for Payer: Cigna Commercial |
$9,853.20
|
| Rate for Payer: Health EOS Commercial |
$9,531.90
|
| Rate for Payer: HFN Commercial |
$9,853.20
|
| Rate for Payer: Multiplan Commercial |
$8,568.00
|
| Rate for Payer: NAPHCARE Commercial |
$6,426.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9,853.20
|
| Rate for Payer: Quartz Beloit One Network |
$5,247.90
|
| Rate for Payer: Quartz Commercial |
$6,426.00
|
| Rate for Payer: WEA Trust Commercial |
$5,890.50
|
| Rate for Payer: WPS Commercial |
$7,932.90
|
|
|
Distal Protection Device 4mm
|
Facility
OP
|
$10,710.00
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
2549108
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,998.80 |
| Max. Negotiated Rate |
$9,853.20 |
| Rate for Payer: Aetna Commercial |
$9,639.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,210.60
|
| Rate for Payer: Aetna Managed Medicare |
$2,998.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,961.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,355.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,140.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,676.30
|
| Rate for Payer: Cash Price |
$3,213.00
|
| Rate for Payer: Cigna Commercial |
$9,853.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,993.32
|
| Rate for Payer: Health EOS Commercial |
$9,531.90
|
| Rate for Payer: HFN Commercial |
$9,853.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,032.50
|
| Rate for Payer: Multiplan Commercial |
$8,568.00
|
| Rate for Payer: NAPHCARE Commercial |
$6,426.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9,853.20
|
| Rate for Payer: Quartz Beloit One Network |
$5,247.90
|
| Rate for Payer: Quartz Commercial |
$6,961.50
|
| Rate for Payer: Quartz Medicare Advantage |
$6,426.00
|
| Rate for Payer: WEA Trust Commercial |
$5,890.50
|
| Rate for Payer: WPS Commercial |
$7,932.90
|
|
|
Distal Protection Device 4mm
|
Professional
|
$10,710.00
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
2549108
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,712.40 |
| Max. Negotiated Rate |
$10,174.50 |
| Rate for Payer: Aetna Commercial |
$10,174.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,210.60
|
| Rate for Payer: Cash Price |
$3,213.00
|
| Rate for Payer: Cigna Commercial |
$10,174.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,355.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,426.00
|
| Rate for Payer: Health EOS Commercial |
$9,746.10
|
| Rate for Payer: Multiplan Commercial |
$8,568.00
|
| Rate for Payer: Preferred Network Access Commercial |
$10,174.50
|
| Rate for Payer: Quartz Beloit One Network |
$4,712.40
|
| Rate for Payer: Quartz Commercial |
$6,104.70
|
| Rate for Payer: The Alliance Commercial |
$5,355.00
|
| Rate for Payer: WEA Trust Commercial |
$5,890.50
|
| Rate for Payer: WPS Commercial |
$7,932.90
|
|
|
Distal Protection Device 5mm
|
Professional
|
$10,710.00
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
2549110
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,712.40 |
| Max. Negotiated Rate |
$10,174.50 |
| Rate for Payer: Aetna Commercial |
$10,174.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,210.60
|
| Rate for Payer: Cash Price |
$3,213.00
|
| Rate for Payer: Cigna Commercial |
$10,174.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,355.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,426.00
|
| Rate for Payer: Health EOS Commercial |
$9,746.10
|
| Rate for Payer: Multiplan Commercial |
$8,568.00
|
| Rate for Payer: Preferred Network Access Commercial |
$10,174.50
|
| Rate for Payer: Quartz Beloit One Network |
$4,712.40
|
| Rate for Payer: Quartz Commercial |
$6,104.70
|
| Rate for Payer: The Alliance Commercial |
$5,355.00
|
| Rate for Payer: WEA Trust Commercial |
$5,890.50
|
| Rate for Payer: WPS Commercial |
$7,932.90
|
|
|
Distal Protection Device 5mm
|
Facility
IP
|
$10,710.00
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
2549110
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,247.90 |
| Max. Negotiated Rate |
$9,853.20 |
| Rate for Payer: Aetna Commercial |
$9,639.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,676.30
|
| Rate for Payer: Cash Price |
$3,213.00
|
| Rate for Payer: Cigna Commercial |
$9,853.20
|
| Rate for Payer: Health EOS Commercial |
$9,531.90
|
| Rate for Payer: HFN Commercial |
$9,853.20
|
| Rate for Payer: Multiplan Commercial |
$8,568.00
|
| Rate for Payer: NAPHCARE Commercial |
$6,426.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9,853.20
|
| Rate for Payer: Quartz Beloit One Network |
$5,247.90
|
| Rate for Payer: Quartz Commercial |
$6,426.00
|
| Rate for Payer: WEA Trust Commercial |
$5,890.50
|
| Rate for Payer: WPS Commercial |
$7,932.90
|
|
|
Distal Protection Device 5mm
|
Facility
OP
|
$10,710.00
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
2549110
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,998.80 |
| Max. Negotiated Rate |
$9,853.20 |
| Rate for Payer: Aetna Commercial |
$9,639.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,210.60
|
| Rate for Payer: Aetna Managed Medicare |
$2,998.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,961.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,355.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,140.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,676.30
|
| Rate for Payer: Cash Price |
$3,213.00
|
| Rate for Payer: Cigna Commercial |
$9,853.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,993.32
|
| Rate for Payer: Health EOS Commercial |
$9,531.90
|
| Rate for Payer: HFN Commercial |
$9,853.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,032.50
|
| Rate for Payer: Multiplan Commercial |
$8,568.00
|
| Rate for Payer: NAPHCARE Commercial |
$6,426.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9,853.20
|
| Rate for Payer: Quartz Beloit One Network |
$5,247.90
|
| Rate for Payer: Quartz Commercial |
$6,961.50
|
| Rate for Payer: Quartz Medicare Advantage |
$6,426.00
|
| Rate for Payer: WEA Trust Commercial |
$5,890.50
|
| Rate for Payer: WPS Commercial |
$7,932.90
|
|
