|
Gliadin IgG Antibody
|
Facility
|
IP
|
$177.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
2942901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$86.73 |
| Max. Negotiated Rate |
$162.84 |
| Rate for Payer: Aetna Commercial |
$159.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$152.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$93.81
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cigna Commercial |
$162.84
|
| Rate for Payer: Health EOS Commercial |
$157.53
|
| Rate for Payer: HFN Commercial |
$162.84
|
| Rate for Payer: Multiplan Commercial |
$141.60
|
| Rate for Payer: NAPHCARE Commercial |
$106.20
|
| Rate for Payer: Preferred Network Access Commercial |
$162.84
|
| Rate for Payer: Quartz Beloit One Network |
$86.73
|
| Rate for Payer: Quartz Commercial |
$106.20
|
| Rate for Payer: WEA Trust Commercial |
$97.35
|
| Rate for Payer: WPS Commercial |
$131.10
|
|
|
Gliadin IgG Antibody
|
Facility
|
OP
|
$177.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
2942901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$162.84 |
| Rate for Payer: Aetna Commercial |
$159.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$152.22
|
| Rate for Payer: Aetna Managed Medicare |
$11.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$43.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.18
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.14
|
| Rate for Payer: Anthem Medicaid |
$11.91
|
| Rate for Payer: Anthem Medicare Advantage |
$11.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$93.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.53
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cigna Commercial |
$162.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$99.05
|
| Rate for Payer: Dean Health Medicaid |
$11.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.53
|
| Rate for Payer: Health EOS Commercial |
$157.53
|
| Rate for Payer: HFN Commercial |
$162.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.53
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.53
|
| Rate for Payer: Managed Health Services Medicaid |
$12.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.53
|
| Rate for Payer: Multiplan Commercial |
$141.60
|
| Rate for Payer: NAPHCARE Commercial |
$17.30
|
| Rate for Payer: Preferred Network Access Commercial |
$162.84
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$11.91
|
| Rate for Payer: Quartz Beloit One Network |
$86.73
|
| Rate for Payer: Quartz Commercial |
$115.05
|
| Rate for Payer: Quartz Medicare Advantage |
$11.53
|
| Rate for Payer: The Alliance Commercial |
$46.12
|
| Rate for Payer: United Healthcare Medicaid |
$11.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.53
|
| Rate for Payer: United Healthcare PPO |
$132.75
|
| Rate for Payer: WEA Trust Commercial |
$97.35
|
| Rate for Payer: Wellcare Medicare |
$11.53
|
| Rate for Payer: WMAP Medicaid |
$11.91
|
| Rate for Payer: WPS Commercial |
$131.10
|
|
|
Gliadin IgG Antibody
|
Professional
|
Both
|
$177.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
2942901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.70 |
| Max. Negotiated Rate |
$168.15 |
| Rate for Payer: Aetna Commercial |
$168.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$152.22
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cigna Commercial |
$168.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$88.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$106.20
|
| Rate for Payer: Health EOS Commercial |
$161.07
|
| Rate for Payer: HFN Commercial |
$168.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$40.70
|
| Rate for Payer: Multiplan Commercial |
$141.60
|
| Rate for Payer: Preferred Network Access Commercial |
$168.15
|
| Rate for Payer: Quartz Beloit One Network |
$77.88
|
| Rate for Payer: Quartz Commercial |
$100.89
|
| Rate for Payer: The Alliance Commercial |
$88.50
|
| Rate for Payer: WEA Trust Commercial |
$97.35
|
| Rate for Payer: WPS Commercial |
$131.10
|
|
|
GLIDE .035 150cm STIFF SHAFT
|
Facility
|
OP
|
$922.00
|
|
| Hospital Charge Code |
2973281
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$258.16 |
| Max. Negotiated Rate |
$3,688.00 |
| Rate for Payer: Aetna Commercial |
$829.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$792.92
|
| Rate for Payer: Aetna Managed Medicare |
$258.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$599.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$461.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$442.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$488.66
|
| Rate for Payer: Cash Price |
$276.60
|
| Rate for Payer: Cigna Commercial |
$848.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$515.95
|
| Rate for Payer: Health EOS Commercial |
$820.58
|
| Rate for Payer: HFN Commercial |
$848.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$691.50
|
| Rate for Payer: Multiplan Commercial |
$737.60
|
| Rate for Payer: NAPHCARE Commercial |
$553.20
|
| Rate for Payer: Preferred Network Access Commercial |
$848.24
|
| Rate for Payer: Quartz Beloit One Network |
$451.78
|
| Rate for Payer: Quartz Commercial |
$599.30
|
| Rate for Payer: Quartz Medicare Advantage |
$553.20
|
| Rate for Payer: The Alliance Commercial |
$3,688.00
|
| Rate for Payer: WEA Trust Commercial |
$507.10
|
| Rate for Payer: WPS Commercial |
$682.93
|
|
|
GLIDE .035 150cm STIFF SHAFT
|
Facility
|
IP
|
$922.00
|
|
| Hospital Charge Code |
2973281
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$451.78 |
| Max. Negotiated Rate |
$848.24 |
| Rate for Payer: Aetna Commercial |
$829.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$792.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$488.66
|
| Rate for Payer: Cash Price |
$276.60
|
| Rate for Payer: Cigna Commercial |
$848.24
|
| Rate for Payer: Health EOS Commercial |
$820.58
|
| Rate for Payer: HFN Commercial |
$848.24
|
| Rate for Payer: Multiplan Commercial |
$737.60
|
| Rate for Payer: NAPHCARE Commercial |
$553.20
|
| Rate for Payer: Preferred Network Access Commercial |
$848.24
|
| Rate for Payer: Quartz Beloit One Network |
$451.78
|
| Rate for Payer: Quartz Commercial |
$553.20
|
| Rate for Payer: WEA Trust Commercial |
$507.10
|
| Rate for Payer: WPS Commercial |
$682.93
|
|
|
Glidesheath Slender
|
Facility
|
IP
|
$1,280.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
4534607
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$627.20 |
| Max. Negotiated Rate |
$1,177.60 |
| Rate for Payer: Aetna Commercial |
$1,152.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,100.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$678.40
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cigna Commercial |
$1,177.60
|
| Rate for Payer: Health EOS Commercial |
$1,139.20
|
| Rate for Payer: HFN Commercial |
$1,177.60
|
| Rate for Payer: Multiplan Commercial |
$1,024.00
|
| Rate for Payer: NAPHCARE Commercial |
$768.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,177.60
|
| Rate for Payer: Quartz Beloit One Network |
$627.20
|
| Rate for Payer: Quartz Commercial |
$768.00
|
| Rate for Payer: WEA Trust Commercial |
$704.00
|
| Rate for Payer: WPS Commercial |
$948.10
|
|
|
Glidesheath Slender
|
Facility
|
OP
|
$1,280.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
4534607
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$358.40 |
| Max. Negotiated Rate |
$5,120.00 |
| Rate for Payer: Aetna Commercial |
$1,152.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,100.80
|
| Rate for Payer: Aetna Managed Medicare |
$358.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$832.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$640.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$614.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$678.40
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cigna Commercial |
$1,177.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$716.29
|
| Rate for Payer: Health EOS Commercial |
$1,139.20
|
| Rate for Payer: HFN Commercial |
$1,177.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$960.00
|
| Rate for Payer: Multiplan Commercial |
$1,024.00
|
| Rate for Payer: NAPHCARE Commercial |
$768.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,177.60
|
| Rate for Payer: Quartz Beloit One Network |
$627.20
|
| Rate for Payer: Quartz Commercial |
$832.00
|
| Rate for Payer: Quartz Medicare Advantage |
$768.00
|
| Rate for Payer: The Alliance Commercial |
$5,120.00
|
| Rate for Payer: WEA Trust Commercial |
$704.00
|
| Rate for Payer: WPS Commercial |
$948.10
|
|
|
GLIDE SHEET 50 1200LBS 7294"
|
Facility
|
IP
|
$2,524.00
|
|
| Hospital Charge Code |
5563689
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,236.76 |
| Max. Negotiated Rate |
$2,322.08 |
| Rate for Payer: Aetna Commercial |
$2,271.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,170.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,337.72
|
| Rate for Payer: Cash Price |
$757.20
|
| Rate for Payer: Cigna Commercial |
$2,322.08
|
| Rate for Payer: Health EOS Commercial |
$2,246.36
|
| Rate for Payer: HFN Commercial |
$2,322.08
|
| Rate for Payer: Multiplan Commercial |
$2,019.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,514.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,322.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,236.76
|
| Rate for Payer: Quartz Commercial |
$1,514.40
|
| Rate for Payer: WEA Trust Commercial |
$1,388.20
|
| Rate for Payer: WPS Commercial |
$1,869.53
|
|
|
GLIDE SHEET 50 1200LBS 7294"
|
Facility
|
OP
|
$2,524.00
|
|
| Hospital Charge Code |
5563689
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$706.72 |
| Max. Negotiated Rate |
$10,096.00 |
| Rate for Payer: Aetna Commercial |
$2,271.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,170.64
|
| Rate for Payer: Aetna Managed Medicare |
$706.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,640.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,262.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,211.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,337.72
|
| Rate for Payer: Cash Price |
$757.20
|
| Rate for Payer: Cigna Commercial |
$2,322.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,412.43
|
| Rate for Payer: Health EOS Commercial |
$2,246.36
|
| Rate for Payer: HFN Commercial |
$2,322.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,893.00
|
| Rate for Payer: Multiplan Commercial |
$2,019.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,514.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,322.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,236.76
|
| Rate for Payer: Quartz Commercial |
$1,640.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,514.40
|
| Rate for Payer: The Alliance Commercial |
$10,096.00
|
| Rate for Payer: WEA Trust Commercial |
$1,388.20
|
| Rate for Payer: WPS Commercial |
$1,869.53
|
|
|
GLIDEWIRE .018 ANGLED #GR1805
|
Facility
|
IP
|
$1,020.00
|
|
| Hospital Charge Code |
2969702
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$499.80 |
| Max. Negotiated Rate |
$938.40 |
| Rate for Payer: Aetna Commercial |
$918.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$877.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$540.60
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$938.40
|
| Rate for Payer: Health EOS Commercial |
$907.80
|
| Rate for Payer: HFN Commercial |
$938.40
|
| Rate for Payer: Multiplan Commercial |
$816.00
|
| Rate for Payer: NAPHCARE Commercial |
$612.00
|
| Rate for Payer: Preferred Network Access Commercial |
$938.40
|
| Rate for Payer: Quartz Beloit One Network |
$499.80
|
| Rate for Payer: Quartz Commercial |
$612.00
|
| Rate for Payer: WEA Trust Commercial |
$561.00
|
| Rate for Payer: WPS Commercial |
$755.51
|
|
|
GLIDEWIRE .018 ANGLED #GR1805
|
Facility
|
OP
|
$1,020.00
|
|
| Hospital Charge Code |
2969702
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$285.60 |
| Max. Negotiated Rate |
$4,080.00 |
| Rate for Payer: Aetna Commercial |
$918.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$877.20
|
| Rate for Payer: Aetna Managed Medicare |
$285.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$663.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$510.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$489.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$540.60
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$938.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$570.79
|
| Rate for Payer: Health EOS Commercial |
$907.80
|
| Rate for Payer: HFN Commercial |
$938.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$765.00
|
| Rate for Payer: Multiplan Commercial |
$816.00
|
| Rate for Payer: NAPHCARE Commercial |
$612.00
|
| Rate for Payer: Preferred Network Access Commercial |
$938.40
|
| Rate for Payer: Quartz Beloit One Network |
$499.80
|
| Rate for Payer: Quartz Commercial |
$663.00
|
| Rate for Payer: Quartz Medicare Advantage |
$612.00
|
| Rate for Payer: The Alliance Commercial |
$4,080.00
|
| Rate for Payer: WEA Trust Commercial |
$561.00
|
| Rate for Payer: WPS Commercial |
$755.51
|
|
|
GLIDEWIRE .025 NITINOL G30477
|
Facility
|
IP
|
$1,034.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2965534
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$506.66 |
| Max. Negotiated Rate |
$951.28 |
| Rate for Payer: Aetna Commercial |
$930.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$889.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$548.02
|
| Rate for Payer: Cash Price |
$310.20
|
| Rate for Payer: Cigna Commercial |
$951.28
|
| Rate for Payer: Health EOS Commercial |
$920.26
|
| Rate for Payer: HFN Commercial |
$951.28
|
| Rate for Payer: Multiplan Commercial |
$827.20
|
| Rate for Payer: NAPHCARE Commercial |
$620.40
|
| Rate for Payer: Preferred Network Access Commercial |
$951.28
|
| Rate for Payer: Quartz Beloit One Network |
$506.66
|
| Rate for Payer: Quartz Commercial |
$620.40
|
| Rate for Payer: WEA Trust Commercial |
$568.70
|
| Rate for Payer: WPS Commercial |
$765.88
|
|
|
GLIDEWIRE .025 NITINOL G30477
|
Facility
|
OP
|
$1,034.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2965534
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$289.52 |
| Max. Negotiated Rate |
$4,136.00 |
| Rate for Payer: Aetna Commercial |
$930.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$889.24
|
| Rate for Payer: Aetna Managed Medicare |
$289.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$672.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$517.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$496.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$548.02
|
| Rate for Payer: Cash Price |
$310.20
|
| Rate for Payer: Cigna Commercial |
$951.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$578.63
|
| Rate for Payer: Health EOS Commercial |
$920.26
|
| Rate for Payer: HFN Commercial |
$951.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$775.50
|
| Rate for Payer: Multiplan Commercial |
$827.20
|
| Rate for Payer: NAPHCARE Commercial |
$620.40
|
| Rate for Payer: Preferred Network Access Commercial |
$951.28
|
| Rate for Payer: Quartz Beloit One Network |
$506.66
|
| Rate for Payer: Quartz Commercial |
$672.10
|
| Rate for Payer: Quartz Medicare Advantage |
$620.40
|
| Rate for Payer: The Alliance Commercial |
$4,136.00
|
| Rate for Payer: WEA Trust Commercial |
$568.70
|
| Rate for Payer: WPS Commercial |
$765.88
|
|
|
GLIDE WIRE .035 260cm ANGLED STIFF 46-316B
|
Facility
|
IP
|
$915.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2971883
|
|
Hospital Revenue Code
|
278
|
| 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
|
|
|
GLIDE WIRE .035 260cm ANGLED STIFF 46-316B
|
Facility
|
OP
|
$915.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2971883
|
|
Hospital Revenue Code
|
278
|
| 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
|
|
|
GLIDE WIRE .035 260cm STR 46-317B
|
Facility
|
OP
|
$881.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2971884
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$246.68 |
| Max. Negotiated Rate |
$3,524.00 |
| Rate for Payer: Aetna Commercial |
$792.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$757.66
|
| Rate for Payer: Aetna Managed Medicare |
$246.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$572.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$440.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$422.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$466.93
|
| Rate for Payer: Cash Price |
$264.30
|
| Rate for Payer: Cigna Commercial |
$810.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$493.01
|
| Rate for Payer: Health EOS Commercial |
$784.09
|
| Rate for Payer: HFN Commercial |
$810.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$660.75
|
| Rate for Payer: Multiplan Commercial |
$704.80
|
| Rate for Payer: NAPHCARE Commercial |
$528.60
|
| Rate for Payer: Preferred Network Access Commercial |
$810.52
|
| Rate for Payer: Quartz Beloit One Network |
$431.69
|
| Rate for Payer: Quartz Commercial |
$572.65
|
| Rate for Payer: Quartz Medicare Advantage |
$528.60
|
| Rate for Payer: The Alliance Commercial |
$3,524.00
|
| Rate for Payer: WEA Trust Commercial |
$484.55
|
| Rate for Payer: WPS Commercial |
$652.56
|
|
|
GLIDE WIRE .035 260cm STR 46-317B
|
Facility
|
IP
|
$881.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2971884
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$431.69 |
| Max. Negotiated Rate |
$810.52 |
| Rate for Payer: Aetna Commercial |
$792.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$757.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$466.93
|
| Rate for Payer: Cash Price |
$264.30
|
| Rate for Payer: Cigna Commercial |
$810.52
|
| Rate for Payer: Health EOS Commercial |
$784.09
|
| Rate for Payer: HFN Commercial |
$810.52
|
| Rate for Payer: Multiplan Commercial |
$704.80
|
| Rate for Payer: NAPHCARE Commercial |
$528.60
|
| Rate for Payer: Preferred Network Access Commercial |
$810.52
|
| Rate for Payer: Quartz Beloit One Network |
$431.69
|
| Rate for Payer: Quartz Commercial |
$528.60
|
| Rate for Payer: WEA Trust Commercial |
$484.55
|
| Rate for Payer: WPS Commercial |
$652.56
|
|
|
GLIDEWIRE .035 NITINOL STIFF G30474
|
Facility
|
OP
|
$1,034.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2965535
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$289.52 |
| Max. Negotiated Rate |
$4,136.00 |
| Rate for Payer: Aetna Commercial |
$930.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$889.24
|
| Rate for Payer: Aetna Managed Medicare |
$289.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$672.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$517.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$496.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$548.02
|
| Rate for Payer: Cash Price |
$310.20
|
| Rate for Payer: Cigna Commercial |
$951.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$578.63
|
| Rate for Payer: Health EOS Commercial |
$920.26
|
| Rate for Payer: HFN Commercial |
$951.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$775.50
|
| Rate for Payer: Multiplan Commercial |
$827.20
|
| Rate for Payer: NAPHCARE Commercial |
$620.40
|
| Rate for Payer: Preferred Network Access Commercial |
$951.28
|
| Rate for Payer: Quartz Beloit One Network |
$506.66
|
| Rate for Payer: Quartz Commercial |
$672.10
|
| Rate for Payer: Quartz Medicare Advantage |
$620.40
|
| Rate for Payer: The Alliance Commercial |
$4,136.00
|
| Rate for Payer: WEA Trust Commercial |
$568.70
|
| Rate for Payer: WPS Commercial |
$765.88
|
|
|
GLIDEWIRE .035 NITINOL STIFF G30474
|
Facility
|
IP
|
$1,034.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2965535
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$506.66 |
| Max. Negotiated Rate |
$951.28 |
| Rate for Payer: Aetna Commercial |
$930.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$889.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$548.02
|
| Rate for Payer: Cash Price |
$310.20
|
| Rate for Payer: Cigna Commercial |
$951.28
|
| Rate for Payer: Health EOS Commercial |
$920.26
|
| Rate for Payer: HFN Commercial |
$951.28
|
| Rate for Payer: Multiplan Commercial |
$827.20
|
| Rate for Payer: NAPHCARE Commercial |
$620.40
|
| Rate for Payer: Preferred Network Access Commercial |
$951.28
|
| Rate for Payer: Quartz Beloit One Network |
$506.66
|
| Rate for Payer: Quartz Commercial |
$620.40
|
| Rate for Payer: WEA Trust Commercial |
$568.70
|
| Rate for Payer: WPS Commercial |
$765.88
|
|
|
GLIDEWIRE .035 X 150CM 3CM TIP ANGLED STIFF SHAFT TERUMO GS3506
|
Facility
|
OP
|
$1,158.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5459716
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$324.24 |
| Max. Negotiated Rate |
$4,632.00 |
| Rate for Payer: Aetna Commercial |
$1,042.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$995.88
|
| Rate for Payer: Aetna Managed Medicare |
$324.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$752.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$579.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$555.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$613.74
|
| Rate for Payer: Cash Price |
$347.40
|
| Rate for Payer: Cigna Commercial |
$1,065.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$648.02
|
| Rate for Payer: Health EOS Commercial |
$1,030.62
|
| Rate for Payer: HFN Commercial |
$1,065.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$868.50
|
| Rate for Payer: Multiplan Commercial |
$926.40
|
| Rate for Payer: NAPHCARE Commercial |
$694.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,065.36
|
| Rate for Payer: Quartz Beloit One Network |
$567.42
|
| Rate for Payer: Quartz Commercial |
$752.70
|
| Rate for Payer: Quartz Medicare Advantage |
$694.80
|
| Rate for Payer: The Alliance Commercial |
$4,632.00
|
| Rate for Payer: WEA Trust Commercial |
$636.90
|
| Rate for Payer: WPS Commercial |
$857.73
|
|
|
GLIDEWIRE .035 X 150CM 3CM TIP ANGLED STIFF SHAFT TERUMO GS3506
|
Facility
|
IP
|
$1,158.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5459716
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$567.42 |
| Max. Negotiated Rate |
$1,065.36 |
| Rate for Payer: Aetna Commercial |
$1,042.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$995.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$613.74
|
| Rate for Payer: Cash Price |
$347.40
|
| Rate for Payer: Cigna Commercial |
$1,065.36
|
| Rate for Payer: Health EOS Commercial |
$1,030.62
|
| Rate for Payer: HFN Commercial |
$1,065.36
|
| Rate for Payer: Multiplan Commercial |
$926.40
|
| Rate for Payer: NAPHCARE Commercial |
$694.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,065.36
|
| Rate for Payer: Quartz Beloit One Network |
$567.42
|
| Rate for Payer: Quartz Commercial |
$694.80
|
| Rate for Payer: WEA Trust Commercial |
$636.90
|
| Rate for Payer: WPS Commercial |
$857.73
|
|
|
GLIDEWIRE .035 X 80CM 3CM TIP ANGLED STIFF SHAFT TERUMO GS3505
|
Facility
|
OP
|
$1,158.00
|
|
| Hospital Charge Code |
5459403
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$324.24 |
| Max. Negotiated Rate |
$4,632.00 |
| Rate for Payer: Aetna Commercial |
$1,042.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$995.88
|
| Rate for Payer: Aetna Managed Medicare |
$324.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$752.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$579.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$555.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$613.74
|
| Rate for Payer: Cash Price |
$347.40
|
| Rate for Payer: Cigna Commercial |
$1,065.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$648.02
|
| Rate for Payer: Health EOS Commercial |
$1,030.62
|
| Rate for Payer: HFN Commercial |
$1,065.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$868.50
|
| Rate for Payer: Multiplan Commercial |
$926.40
|
| Rate for Payer: NAPHCARE Commercial |
$694.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,065.36
|
| Rate for Payer: Quartz Beloit One Network |
$567.42
|
| Rate for Payer: Quartz Commercial |
$752.70
|
| Rate for Payer: Quartz Medicare Advantage |
$694.80
|
| Rate for Payer: The Alliance Commercial |
$4,632.00
|
| Rate for Payer: WEA Trust Commercial |
$636.90
|
| Rate for Payer: WPS Commercial |
$857.73
|
|
|
GLIDEWIRE .035 X 80CM 3CM TIP ANGLED STIFF SHAFT TERUMO GS3505
|
Facility
|
IP
|
$1,158.00
|
|
| Hospital Charge Code |
5459403
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$567.42 |
| Max. Negotiated Rate |
$1,065.36 |
| Rate for Payer: Aetna Commercial |
$1,042.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$995.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$613.74
|
| Rate for Payer: Cash Price |
$347.40
|
| Rate for Payer: Cigna Commercial |
$1,065.36
|
| Rate for Payer: Health EOS Commercial |
$1,030.62
|
| Rate for Payer: HFN Commercial |
$1,065.36
|
| Rate for Payer: Multiplan Commercial |
$926.40
|
| Rate for Payer: NAPHCARE Commercial |
$694.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,065.36
|
| Rate for Payer: Quartz Beloit One Network |
$567.42
|
| Rate for Payer: Quartz Commercial |
$694.80
|
| Rate for Payer: WEA Trust Commercial |
$636.90
|
| Rate for Payer: WPS Commercial |
$857.73
|
|
|
GLIDEWIRE .038 NITINOL STIFF G30470
|
Facility
|
IP
|
$1,034.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2965536
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$506.66 |
| Max. Negotiated Rate |
$951.28 |
| Rate for Payer: Aetna Commercial |
$930.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$889.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$548.02
|
| Rate for Payer: Cash Price |
$310.20
|
| Rate for Payer: Cigna Commercial |
$951.28
|
| Rate for Payer: Health EOS Commercial |
$920.26
|
| Rate for Payer: HFN Commercial |
$951.28
|
| Rate for Payer: Multiplan Commercial |
$827.20
|
| Rate for Payer: NAPHCARE Commercial |
$620.40
|
| Rate for Payer: Preferred Network Access Commercial |
$951.28
|
| Rate for Payer: Quartz Beloit One Network |
$506.66
|
| Rate for Payer: Quartz Commercial |
$620.40
|
| Rate for Payer: WEA Trust Commercial |
$568.70
|
| Rate for Payer: WPS Commercial |
$765.88
|
|
|
GLIDEWIRE .038 NITINOL STIFF G30470
|
Facility
|
OP
|
$1,034.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2965536
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$289.52 |
| Max. Negotiated Rate |
$4,136.00 |
| Rate for Payer: Aetna Commercial |
$930.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$889.24
|
| Rate for Payer: Aetna Managed Medicare |
$289.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$672.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$517.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$496.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$548.02
|
| Rate for Payer: Cash Price |
$310.20
|
| Rate for Payer: Cigna Commercial |
$951.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$578.63
|
| Rate for Payer: Health EOS Commercial |
$920.26
|
| Rate for Payer: HFN Commercial |
$951.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$775.50
|
| Rate for Payer: Multiplan Commercial |
$827.20
|
| Rate for Payer: NAPHCARE Commercial |
$620.40
|
| Rate for Payer: Preferred Network Access Commercial |
$951.28
|
| Rate for Payer: Quartz Beloit One Network |
$506.66
|
| Rate for Payer: Quartz Commercial |
$672.10
|
| Rate for Payer: Quartz Medicare Advantage |
$620.40
|
| Rate for Payer: The Alliance Commercial |
$4,136.00
|
| Rate for Payer: WEA Trust Commercial |
$568.70
|
| Rate for Payer: WPS Commercial |
$765.88
|
|
