|
FFP CPD
|
Facility
|
OP
|
$385.00
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
1052866
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$38.65 |
| Max. Negotiated Rate |
$354.20 |
| Rate for Payer: Aetna Commercial |
$346.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$331.10
|
| Rate for Payer: Aetna Managed Medicare |
$82.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$250.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$192.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$184.80
|
| Rate for Payer: Anthem Medicaid |
$38.65
|
| Rate for Payer: Anthem Medicare Advantage |
$82.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$204.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$82.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$82.95
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna Commercial |
$354.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$82.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$38.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$215.45
|
| Rate for Payer: Dean Health Medicaid |
$38.65
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$82.95
|
| Rate for Payer: Health EOS Commercial |
$342.65
|
| Rate for Payer: HFN Commercial |
$354.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$308.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$82.95
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$38.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$82.95
|
| Rate for Payer: Managed Health Services Medicaid |
$40.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$82.95
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$82.95
|
| Rate for Payer: Multiplan Commercial |
$308.00
|
| Rate for Payer: NAPHCARE Commercial |
$124.42
|
| Rate for Payer: Preferred Network Access Commercial |
$354.20
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$38.65
|
| Rate for Payer: Quartz Beloit One Network |
$188.65
|
| Rate for Payer: Quartz Commercial |
$250.25
|
| Rate for Payer: Quartz Medicare Advantage |
$82.95
|
| Rate for Payer: The Alliance Commercial |
$331.80
|
| Rate for Payer: United Healthcare Medicaid |
$38.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$82.95
|
| Rate for Payer: United Healthcare PPO |
$288.75
|
| Rate for Payer: WEA Trust Commercial |
$211.75
|
| Rate for Payer: Wellcare Medicare |
$82.95
|
| Rate for Payer: WMAP Medicaid |
$38.65
|
| Rate for Payer: WPS Commercial |
$285.17
|
|
|
FFR Coronary/BPG +
|
Facility
|
IP
|
$3,132.00
|
|
|
Service Code
|
CPT 93571
|
| Hospital Charge Code |
3052504
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,534.68 |
| Max. Negotiated Rate |
$2,881.44 |
| Rate for Payer: Aetna Commercial |
$2,818.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,693.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,659.96
|
| Rate for Payer: Cash Price |
$939.60
|
| Rate for Payer: Cigna Commercial |
$2,881.44
|
| Rate for Payer: Health EOS Commercial |
$2,787.48
|
| Rate for Payer: HFN Commercial |
$2,881.44
|
| Rate for Payer: Multiplan Commercial |
$2,505.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,879.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,881.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,534.68
|
| Rate for Payer: Quartz Commercial |
$1,879.20
|
| Rate for Payer: WEA Trust Commercial |
$1,722.60
|
| Rate for Payer: WPS Commercial |
$2,319.87
|
|
|
FFR Coronary/BPG +
|
Facility
|
OP
|
$3,132.00
|
|
|
Service Code
|
CPT 93571
|
| Hospital Charge Code |
3052504
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$876.96 |
| Max. Negotiated Rate |
$12,528.00 |
| Rate for Payer: Aetna Commercial |
$2,818.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,693.52
|
| Rate for Payer: Aetna Managed Medicare |
$876.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,035.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,566.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,503.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,659.96
|
| Rate for Payer: Cash Price |
$939.60
|
| Rate for Payer: Cigna Commercial |
$2,881.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,752.67
|
| Rate for Payer: Health EOS Commercial |
$2,787.48
|
| Rate for Payer: HFN Commercial |
$2,881.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,349.00
|
| Rate for Payer: Multiplan Commercial |
$2,505.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,879.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,881.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,534.68
|
| Rate for Payer: Quartz Commercial |
$2,035.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,879.20
|
| Rate for Payer: The Alliance Commercial |
$12,528.00
|
| Rate for Payer: WEA Trust Commercial |
$1,722.60
|
| Rate for Payer: WPS Commercial |
$2,319.87
|
|
|
FFR Coronary/BPG Ea Add Vessel +
|
Facility
|
OP
|
$2,870.00
|
|
|
Service Code
|
CPT 93572
|
| Hospital Charge Code |
4125706
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$803.60 |
| Max. Negotiated Rate |
$11,480.00 |
| Rate for Payer: Aetna Commercial |
$2,583.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,468.20
|
| Rate for Payer: Aetna Managed Medicare |
$803.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,865.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,435.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,377.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,521.10
|
| Rate for Payer: Cash Price |
$861.00
|
| Rate for Payer: Cigna Commercial |
$2,640.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,606.05
|
| Rate for Payer: Health EOS Commercial |
$2,554.30
|
| Rate for Payer: HFN Commercial |
$2,640.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,152.50
|
| Rate for Payer: Multiplan Commercial |
$2,296.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,722.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,640.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,406.30
|
| Rate for Payer: Quartz Commercial |
$1,865.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,722.00
|
| Rate for Payer: The Alliance Commercial |
$11,480.00
|
| Rate for Payer: WEA Trust Commercial |
$1,578.50
|
| Rate for Payer: WPS Commercial |
$2,125.81
|
|
|
FFR Coronary/BPG Ea Add Vessel +
|
Facility
|
IP
|
$2,870.00
|
|
|
Service Code
|
CPT 93572
|
| Hospital Charge Code |
4125706
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,406.30 |
| Max. Negotiated Rate |
$2,640.40 |
| Rate for Payer: Aetna Commercial |
$2,583.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,468.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,521.10
|
| Rate for Payer: Cash Price |
$861.00
|
| Rate for Payer: Cigna Commercial |
$2,640.40
|
| Rate for Payer: Health EOS Commercial |
$2,554.30
|
| Rate for Payer: HFN Commercial |
$2,640.40
|
| Rate for Payer: Multiplan Commercial |
$2,296.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,722.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,640.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,406.30
|
| Rate for Payer: Quartz Commercial |
$1,722.00
|
| Rate for Payer: WEA Trust Commercial |
$1,578.50
|
| Rate for Payer: WPS Commercial |
$2,125.81
|
|
|
FFR Wire
|
Facility
|
OP
|
$4,271.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4139303
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,195.88 |
| Max. Negotiated Rate |
$17,084.00 |
| Rate for Payer: Aetna Commercial |
$3,843.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,673.06
|
| Rate for Payer: Aetna Managed Medicare |
$1,195.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,776.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,135.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,050.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,263.63
|
| Rate for Payer: Cash Price |
$1,281.30
|
| Rate for Payer: Cigna Commercial |
$3,929.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,390.05
|
| Rate for Payer: Health EOS Commercial |
$3,801.19
|
| Rate for Payer: HFN Commercial |
$3,929.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,203.25
|
| Rate for Payer: Multiplan Commercial |
$3,416.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,562.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,929.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,092.79
|
| Rate for Payer: Quartz Commercial |
$2,776.15
|
| Rate for Payer: Quartz Medicare Advantage |
$2,562.60
|
| Rate for Payer: The Alliance Commercial |
$17,084.00
|
| Rate for Payer: WEA Trust Commercial |
$2,349.05
|
| Rate for Payer: WPS Commercial |
$3,163.53
|
|
|
FFR Wire
|
Facility
|
IP
|
$4,271.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4139303
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,092.79 |
| Max. Negotiated Rate |
$3,929.32 |
| Rate for Payer: Aetna Commercial |
$3,843.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,673.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,263.63
|
| Rate for Payer: Cash Price |
$1,281.30
|
| Rate for Payer: Cigna Commercial |
$3,929.32
|
| Rate for Payer: Health EOS Commercial |
$3,801.19
|
| Rate for Payer: HFN Commercial |
$3,929.32
|
| Rate for Payer: Multiplan Commercial |
$3,416.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,562.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,929.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,092.79
|
| Rate for Payer: Quartz Commercial |
$2,562.60
|
| Rate for Payer: WEA Trust Commercial |
$2,349.05
|
| Rate for Payer: WPS Commercial |
$3,163.53
|
|
|
F/G SHM 2.4/4/120-0/16MM M0063801070
|
Facility
|
OP
|
$2,660.00
|
|
| Hospital Charge Code |
4520072
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$744.80 |
| Max. Negotiated Rate |
$10,640.00 |
| Rate for Payer: Aetna Commercial |
$2,394.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,287.60
|
| Rate for Payer: Aetna Managed Medicare |
$744.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,729.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,330.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,276.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,409.80
|
| Rate for Payer: Cash Price |
$798.00
|
| Rate for Payer: Cigna Commercial |
$2,447.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,488.54
|
| Rate for Payer: Health EOS Commercial |
$2,367.40
|
| Rate for Payer: HFN Commercial |
$2,447.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,995.00
|
| Rate for Payer: Multiplan Commercial |
$2,128.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,596.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,447.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,303.40
|
| Rate for Payer: Quartz Commercial |
$1,729.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,596.00
|
| Rate for Payer: The Alliance Commercial |
$10,640.00
|
| Rate for Payer: WEA Trust Commercial |
$1,463.00
|
| Rate for Payer: WPS Commercial |
$1,970.26
|
|
|
F/G SHM 2.4/4/120-0/16MM M0063801070
|
Facility
|
IP
|
$2,660.00
|
|
| Hospital Charge Code |
4520072
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,303.40 |
| Max. Negotiated Rate |
$2,447.20 |
| Rate for Payer: Aetna Commercial |
$2,394.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,287.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,409.80
|
| Rate for Payer: Cash Price |
$798.00
|
| Rate for Payer: Cigna Commercial |
$2,447.20
|
| Rate for Payer: Health EOS Commercial |
$2,367.40
|
| Rate for Payer: HFN Commercial |
$2,447.20
|
| Rate for Payer: Multiplan Commercial |
$2,128.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,596.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,447.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,303.40
|
| Rate for Payer: Quartz Commercial |
$1,596.00
|
| Rate for Payer: WEA Trust Commercial |
$1,463.00
|
| Rate for Payer: WPS Commercial |
$1,970.26
|
|
|
FIBER 273 HOLMIUM LASER G48522
|
Facility
|
OP
|
$5,836.00
|
|
| Hospital Charge Code |
2964977
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,634.08 |
| Max. Negotiated Rate |
$23,344.00 |
| Rate for Payer: Aetna Commercial |
$5,252.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,018.96
|
| Rate for Payer: Aetna Managed Medicare |
$1,634.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,793.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,918.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,801.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,093.08
|
| Rate for Payer: Cash Price |
$1,750.80
|
| Rate for Payer: Cigna Commercial |
$5,369.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,265.83
|
| Rate for Payer: Health EOS Commercial |
$5,194.04
|
| Rate for Payer: HFN Commercial |
$5,369.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,377.00
|
| Rate for Payer: Multiplan Commercial |
$4,668.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,501.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,369.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,859.64
|
| Rate for Payer: Quartz Commercial |
$3,793.40
|
| Rate for Payer: Quartz Medicare Advantage |
$3,501.60
|
| Rate for Payer: The Alliance Commercial |
$23,344.00
|
| Rate for Payer: WEA Trust Commercial |
$3,209.80
|
| Rate for Payer: WPS Commercial |
$4,322.73
|
|
|
FIBER 273 HOLMIUM LASER G48522
|
Facility
|
IP
|
$5,836.00
|
|
| Hospital Charge Code |
2964977
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,859.64 |
| Max. Negotiated Rate |
$5,369.12 |
| Rate for Payer: Aetna Commercial |
$5,252.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,018.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,093.08
|
| Rate for Payer: Cash Price |
$1,750.80
|
| Rate for Payer: Cigna Commercial |
$5,369.12
|
| Rate for Payer: Health EOS Commercial |
$5,194.04
|
| Rate for Payer: HFN Commercial |
$5,369.12
|
| Rate for Payer: Multiplan Commercial |
$4,668.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,501.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,369.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,859.64
|
| Rate for Payer: Quartz Commercial |
$3,501.60
|
| Rate for Payer: WEA Trust Commercial |
$3,209.80
|
| Rate for Payer: WPS Commercial |
$4,322.73
|
|
|
FIBERLINK #2 FIBERWIRE AR-7235
|
Facility
|
OP
|
$915.00
|
|
| Hospital Charge Code |
2964681
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$256.20 |
| Max. Negotiated Rate |
$3,660.00 |
| Rate for Payer: Aetna Commercial |
$823.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$786.90
|
| Rate for Payer: Aetna Managed Medicare |
$256.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$594.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$457.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$439.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$484.95
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cigna Commercial |
$841.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$512.03
|
| Rate for Payer: Health EOS Commercial |
$814.35
|
| Rate for Payer: HFN Commercial |
$841.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$686.25
|
| Rate for Payer: Multiplan Commercial |
$732.00
|
| Rate for Payer: NAPHCARE Commercial |
$549.00
|
| Rate for Payer: Preferred Network Access Commercial |
$841.80
|
| Rate for Payer: Quartz Beloit One Network |
$448.35
|
| Rate for Payer: Quartz Commercial |
$594.75
|
| Rate for Payer: Quartz Medicare Advantage |
$549.00
|
| Rate for Payer: The Alliance Commercial |
$3,660.00
|
| Rate for Payer: WEA Trust Commercial |
$503.25
|
| Rate for Payer: WPS Commercial |
$677.74
|
|
|
FIBERLINK #2 FIBERWIRE AR-7235
|
Facility
|
IP
|
$915.00
|
|
| Hospital Charge Code |
2964681
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$448.35 |
| Max. Negotiated Rate |
$841.80 |
| Rate for Payer: Aetna Commercial |
$823.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$786.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$484.95
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cigna Commercial |
$841.80
|
| Rate for Payer: Health EOS Commercial |
$814.35
|
| Rate for Payer: HFN Commercial |
$841.80
|
| Rate for Payer: Multiplan Commercial |
$732.00
|
| Rate for Payer: NAPHCARE Commercial |
$549.00
|
| Rate for Payer: Preferred Network Access Commercial |
$841.80
|
| Rate for Payer: Quartz Beloit One Network |
$448.35
|
| Rate for Payer: Quartz Commercial |
$549.00
|
| Rate for Payer: WEA Trust Commercial |
$503.25
|
| Rate for Payer: WPS Commercial |
$677.74
|
|
|
FIBER OPTIC GREENLIGHT MoXy 0010-2400
|
Facility
|
OP
|
$6,455.00
|
|
| Hospital Charge Code |
5307001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,807.40 |
| Max. Negotiated Rate |
$25,820.00 |
| Rate for Payer: Aetna Commercial |
$5,809.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,551.30
|
| Rate for Payer: Aetna Managed Medicare |
$1,807.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,195.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,227.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,098.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,421.15
|
| Rate for Payer: Cash Price |
$1,936.50
|
| Rate for Payer: Cigna Commercial |
$5,938.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,612.22
|
| Rate for Payer: Health EOS Commercial |
$5,744.95
|
| Rate for Payer: HFN Commercial |
$5,938.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,841.25
|
| Rate for Payer: Multiplan Commercial |
$5,164.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,873.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,938.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,162.95
|
| Rate for Payer: Quartz Commercial |
$4,195.75
|
| Rate for Payer: Quartz Medicare Advantage |
$3,873.00
|
| Rate for Payer: The Alliance Commercial |
$25,820.00
|
| Rate for Payer: WEA Trust Commercial |
$3,550.25
|
| Rate for Payer: WPS Commercial |
$4,781.22
|
|
|
FIBER OPTIC GREENLIGHT MoXy 0010-2400
|
Facility
|
IP
|
$6,455.00
|
|
| Hospital Charge Code |
5307001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,162.95 |
| Max. Negotiated Rate |
$5,938.60 |
| Rate for Payer: Aetna Commercial |
$5,809.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,551.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,421.15
|
| Rate for Payer: Cash Price |
$1,936.50
|
| Rate for Payer: Cigna Commercial |
$5,938.60
|
| Rate for Payer: Health EOS Commercial |
$5,744.95
|
| Rate for Payer: HFN Commercial |
$5,938.60
|
| Rate for Payer: Multiplan Commercial |
$5,164.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,873.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,938.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,162.95
|
| Rate for Payer: Quartz Commercial |
$3,873.00
|
| Rate for Payer: WEA Trust Commercial |
$3,550.25
|
| Rate for Payer: WPS Commercial |
$4,781.22
|
|
|
FIBERRING WITH SHUTTLE LOOP 25MM (12PK) AR-7282-25
|
Facility
|
OP
|
$1,802.00
|
|
| Hospital Charge Code |
6220126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$504.56 |
| Max. Negotiated Rate |
$7,208.00 |
| Rate for Payer: Aetna Commercial |
$1,621.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,549.72
|
| Rate for Payer: Aetna Managed Medicare |
$504.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,171.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$901.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$864.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$955.06
|
| Rate for Payer: Cash Price |
$540.60
|
| Rate for Payer: Cigna Commercial |
$1,657.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,008.40
|
| Rate for Payer: Health EOS Commercial |
$1,603.78
|
| Rate for Payer: HFN Commercial |
$1,657.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,351.50
|
| Rate for Payer: Multiplan Commercial |
$1,441.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,081.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,657.84
|
| Rate for Payer: Quartz Beloit One Network |
$882.98
|
| Rate for Payer: Quartz Commercial |
$1,171.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,081.20
|
| Rate for Payer: The Alliance Commercial |
$7,208.00
|
| Rate for Payer: WEA Trust Commercial |
$991.10
|
| Rate for Payer: WPS Commercial |
$1,334.74
|
|
|
FIBERRING WITH SHUTTLE LOOP 25MM (12PK) AR-7282-25
|
Facility
|
IP
|
$1,802.00
|
|
| Hospital Charge Code |
6220126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$882.98 |
| Max. Negotiated Rate |
$1,657.84 |
| Rate for Payer: Aetna Commercial |
$1,621.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,549.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$955.06
|
| Rate for Payer: Cash Price |
$540.60
|
| Rate for Payer: Cigna Commercial |
$1,657.84
|
| Rate for Payer: Health EOS Commercial |
$1,603.78
|
| Rate for Payer: HFN Commercial |
$1,657.84
|
| Rate for Payer: Multiplan Commercial |
$1,441.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,081.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,657.84
|
| Rate for Payer: Quartz Beloit One Network |
$882.98
|
| Rate for Payer: Quartz Commercial |
$1,081.20
|
| Rate for Payer: WEA Trust Commercial |
$991.10
|
| Rate for Payer: WPS Commercial |
$1,334.74
|
|
|
FIBERSTICK / FIBERWIRE 2-0 AR-7222
|
Facility
|
IP
|
$784.00
|
|
| Hospital Charge Code |
5563233
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$384.16 |
| Max. Negotiated Rate |
$721.28 |
| Rate for Payer: Aetna Commercial |
$705.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$674.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$415.52
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Cigna Commercial |
$721.28
|
| Rate for Payer: Health EOS Commercial |
$697.76
|
| Rate for Payer: HFN Commercial |
$721.28
|
| Rate for Payer: Multiplan Commercial |
$627.20
|
| Rate for Payer: NAPHCARE Commercial |
$470.40
|
| Rate for Payer: Preferred Network Access Commercial |
$721.28
|
| Rate for Payer: Quartz Beloit One Network |
$384.16
|
| Rate for Payer: Quartz Commercial |
$470.40
|
| Rate for Payer: WEA Trust Commercial |
$431.20
|
| Rate for Payer: WPS Commercial |
$580.71
|
|
|
FIBERSTICK / FIBERWIRE 2-0 AR-7222
|
Facility
|
OP
|
$784.00
|
|
| Hospital Charge Code |
5563233
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$219.52 |
| Max. Negotiated Rate |
$3,136.00 |
| Rate for Payer: Aetna Commercial |
$705.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$674.24
|
| Rate for Payer: Aetna Managed Medicare |
$219.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$509.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$392.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$376.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$415.52
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Cigna Commercial |
$721.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$438.73
|
| Rate for Payer: Health EOS Commercial |
$697.76
|
| Rate for Payer: HFN Commercial |
$721.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$588.00
|
| Rate for Payer: Multiplan Commercial |
$627.20
|
| Rate for Payer: NAPHCARE Commercial |
$470.40
|
| Rate for Payer: Preferred Network Access Commercial |
$721.28
|
| Rate for Payer: Quartz Beloit One Network |
$384.16
|
| Rate for Payer: Quartz Commercial |
$509.60
|
| Rate for Payer: Quartz Medicare Advantage |
$470.40
|
| Rate for Payer: The Alliance Commercial |
$3,136.00
|
| Rate for Payer: WEA Trust Commercial |
$431.20
|
| Rate for Payer: WPS Commercial |
$580.71
|
|
|
FIBERSTITCH 1.5 CURVED 12 DEG AR-4580
|
Facility
|
IP
|
$3,751.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6246203
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,837.99 |
| Max. Negotiated Rate |
$3,450.93 |
| Rate for Payer: Aetna Commercial |
$3,375.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,225.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,988.04
|
| Rate for Payer: Cash Price |
$1,125.30
|
| Rate for Payer: Cigna Commercial |
$3,450.93
|
| Rate for Payer: Health EOS Commercial |
$3,338.40
|
| Rate for Payer: HFN Commercial |
$3,450.93
|
| Rate for Payer: Multiplan Commercial |
$3,000.81
|
| Rate for Payer: NAPHCARE Commercial |
$2,250.61
|
| Rate for Payer: Preferred Network Access Commercial |
$3,450.93
|
| Rate for Payer: Quartz Beloit One Network |
$1,837.99
|
| Rate for Payer: Quartz Commercial |
$2,250.61
|
| Rate for Payer: WEA Trust Commercial |
$2,063.06
|
| Rate for Payer: WPS Commercial |
$2,778.37
|
|
|
FIBERSTITCH 1.5 CURVED 12 DEG AR-4580
|
Facility
|
OP
|
$3,751.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6246203
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,050.28 |
| Max. Negotiated Rate |
$15,004.04 |
| Rate for Payer: Aetna Commercial |
$3,375.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,225.87
|
| Rate for Payer: Aetna Managed Medicare |
$1,050.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,438.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,875.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,800.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,988.04
|
| Rate for Payer: Cash Price |
$1,125.30
|
| Rate for Payer: Cigna Commercial |
$3,450.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,099.07
|
| Rate for Payer: Health EOS Commercial |
$3,338.40
|
| Rate for Payer: HFN Commercial |
$3,450.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,813.26
|
| Rate for Payer: Multiplan Commercial |
$3,000.81
|
| Rate for Payer: NAPHCARE Commercial |
$2,250.61
|
| Rate for Payer: Preferred Network Access Commercial |
$3,450.93
|
| Rate for Payer: Quartz Beloit One Network |
$1,837.99
|
| Rate for Payer: Quartz Commercial |
$2,438.16
|
| Rate for Payer: Quartz Medicare Advantage |
$2,250.61
|
| Rate for Payer: The Alliance Commercial |
$15,004.04
|
| Rate for Payer: WEA Trust Commercial |
$2,063.06
|
| Rate for Payer: WPS Commercial |
$2,778.37
|
|
|
FIBERSTITCH 1.5 CURVED 24 DEG AR-4580-24
|
Facility
|
IP
|
$3,751.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6246204
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,837.99 |
| Max. Negotiated Rate |
$3,450.93 |
| Rate for Payer: Aetna Commercial |
$3,375.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,225.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,988.04
|
| Rate for Payer: Cash Price |
$1,125.30
|
| Rate for Payer: Cigna Commercial |
$3,450.93
|
| Rate for Payer: Health EOS Commercial |
$3,338.40
|
| Rate for Payer: HFN Commercial |
$3,450.93
|
| Rate for Payer: Multiplan Commercial |
$3,000.81
|
| Rate for Payer: NAPHCARE Commercial |
$2,250.61
|
| Rate for Payer: Preferred Network Access Commercial |
$3,450.93
|
| Rate for Payer: Quartz Beloit One Network |
$1,837.99
|
| Rate for Payer: Quartz Commercial |
$2,250.61
|
| Rate for Payer: WEA Trust Commercial |
$2,063.06
|
| Rate for Payer: WPS Commercial |
$2,778.37
|
|
|
FIBERSTITCH 1.5 CURVED 24 DEG AR-4580-24
|
Facility
|
OP
|
$3,751.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6246204
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,050.28 |
| Max. Negotiated Rate |
$15,004.04 |
| Rate for Payer: Aetna Commercial |
$3,375.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,225.87
|
| Rate for Payer: Aetna Managed Medicare |
$1,050.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,438.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,875.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,800.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,988.04
|
| Rate for Payer: Cash Price |
$1,125.30
|
| Rate for Payer: Cigna Commercial |
$3,450.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,099.07
|
| Rate for Payer: Health EOS Commercial |
$3,338.40
|
| Rate for Payer: HFN Commercial |
$3,450.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,813.26
|
| Rate for Payer: Multiplan Commercial |
$3,000.81
|
| Rate for Payer: NAPHCARE Commercial |
$2,250.61
|
| Rate for Payer: Preferred Network Access Commercial |
$3,450.93
|
| Rate for Payer: Quartz Beloit One Network |
$1,837.99
|
| Rate for Payer: Quartz Commercial |
$2,438.16
|
| Rate for Payer: Quartz Medicare Advantage |
$2,250.61
|
| Rate for Payer: The Alliance Commercial |
$15,004.04
|
| Rate for Payer: WEA Trust Commercial |
$2,063.06
|
| Rate for Payer: WPS Commercial |
$2,778.37
|
|
|
FIBERSTITCH IMPLANT CURVED 12 DEG AR-4570
|
Facility
|
OP
|
$5,266.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5563292
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,474.48 |
| Max. Negotiated Rate |
$21,064.00 |
| Rate for Payer: Aetna Commercial |
$4,739.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,528.76
|
| Rate for Payer: Aetna Managed Medicare |
$1,474.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,422.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,633.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,527.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,790.98
|
| Rate for Payer: Cash Price |
$1,579.80
|
| Rate for Payer: Cigna Commercial |
$4,844.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,946.85
|
| Rate for Payer: Health EOS Commercial |
$4,686.74
|
| Rate for Payer: HFN Commercial |
$4,844.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,949.50
|
| Rate for Payer: Multiplan Commercial |
$4,212.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,159.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,844.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,580.34
|
| Rate for Payer: Quartz Commercial |
$3,422.90
|
| Rate for Payer: Quartz Medicare Advantage |
$3,159.60
|
| Rate for Payer: The Alliance Commercial |
$21,064.00
|
| Rate for Payer: WEA Trust Commercial |
$2,896.30
|
| Rate for Payer: WPS Commercial |
$3,900.53
|
|
|
FIBERSTITCH IMPLANT CURVED 12 DEG AR-4570
|
Facility
|
IP
|
$5,266.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5563292
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,580.34 |
| Max. Negotiated Rate |
$4,844.72 |
| Rate for Payer: Aetna Commercial |
$4,739.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,528.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,790.98
|
| Rate for Payer: Cash Price |
$1,579.80
|
| Rate for Payer: Cigna Commercial |
$4,844.72
|
| Rate for Payer: Health EOS Commercial |
$4,686.74
|
| Rate for Payer: HFN Commercial |
$4,844.72
|
| Rate for Payer: Multiplan Commercial |
$4,212.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,159.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,844.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,580.34
|
| Rate for Payer: Quartz Commercial |
$3,159.60
|
| Rate for Payer: WEA Trust Commercial |
$2,896.30
|
| Rate for Payer: WPS Commercial |
$3,900.53
|
|
