|
Guide Liner
|
Facility
|
IP
|
$5,843.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
4139318
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,977.59 |
| Max. Negotiated Rate |
$5,590.58 |
| Rate for Payer: Aetna Commercial |
$5,469.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,225.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,220.66
|
| Rate for Payer: Cash Price |
$1,752.90
|
| Rate for Payer: Cigna Commercial |
$5,590.58
|
| Rate for Payer: Health EOS Commercial |
$5,408.28
|
| Rate for Payer: HFN Commercial |
$5,590.58
|
| Rate for Payer: Multiplan Commercial |
$4,861.38
|
| Rate for Payer: Preferred Network Access Commercial |
$5,590.58
|
| Rate for Payer: Quartz Beloit One Network |
$2,977.59
|
| Rate for Payer: Quartz Commercial |
$3,646.03
|
| Rate for Payer: WEA Trust Commercial |
$3,342.20
|
| Rate for Payer: WPS Commercial |
$4,500.86
|
|
|
Guide Liner
|
Facility
|
OP
|
$5,843.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
4139318
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,701.48 |
| Max. Negotiated Rate |
$5,590.58 |
| Rate for Payer: Aetna Commercial |
$5,469.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,225.98
|
| Rate for Payer: Aetna Managed Medicare |
$1,701.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,949.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,038.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,916.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,220.66
|
| Rate for Payer: Cash Price |
$1,752.90
|
| Rate for Payer: Cigna Commercial |
$5,590.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,400.63
|
| Rate for Payer: Health EOS Commercial |
$5,408.28
|
| Rate for Payer: HFN Commercial |
$5,590.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,557.54
|
| Rate for Payer: Multiplan Commercial |
$4,861.38
|
| Rate for Payer: NAPHCARE Commercial |
$3,646.03
|
| Rate for Payer: Preferred Network Access Commercial |
$5,590.58
|
| Rate for Payer: Quartz Beloit One Network |
$2,977.59
|
| Rate for Payer: Quartz Commercial |
$3,949.87
|
| Rate for Payer: Quartz Medicare Advantage |
$3,646.03
|
| Rate for Payer: The Alliance Commercial |
$3,038.36
|
| Rate for Payer: WEA Trust Commercial |
$3,342.20
|
| Rate for Payer: WPS Commercial |
$4,500.86
|
|
|
GUIDE PATIENT SPECIFIC
|
Facility
|
IP
|
$5,628.00
|
|
| Hospital Charge Code |
2967485
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,868.03 |
| Max. Negotiated Rate |
$5,384.87 |
| Rate for Payer: Aetna Commercial |
$5,267.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,033.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,102.15
|
| Rate for Payer: Cash Price |
$1,688.40
|
| Rate for Payer: Cigna Commercial |
$5,384.87
|
| Rate for Payer: Health EOS Commercial |
$5,209.28
|
| Rate for Payer: HFN Commercial |
$5,384.87
|
| Rate for Payer: Multiplan Commercial |
$4,682.50
|
| Rate for Payer: Preferred Network Access Commercial |
$5,384.87
|
| Rate for Payer: Quartz Beloit One Network |
$2,868.03
|
| Rate for Payer: Quartz Commercial |
$3,511.87
|
| Rate for Payer: WEA Trust Commercial |
$3,219.22
|
| Rate for Payer: WPS Commercial |
$4,335.25
|
|
|
GUIDE PATIENT SPECIFIC
|
Facility
|
OP
|
$5,628.00
|
|
| Hospital Charge Code |
2967485
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,638.87 |
| Max. Negotiated Rate |
$5,384.87 |
| Rate for Payer: Aetna Commercial |
$5,267.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,033.68
|
| Rate for Payer: Aetna Managed Medicare |
$1,638.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,804.53
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,926.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,809.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,102.15
|
| Rate for Payer: Cash Price |
$1,688.40
|
| Rate for Payer: Cigna Commercial |
$5,384.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,275.50
|
| Rate for Payer: Health EOS Commercial |
$5,209.28
|
| Rate for Payer: HFN Commercial |
$5,384.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,389.84
|
| Rate for Payer: Multiplan Commercial |
$4,682.50
|
| Rate for Payer: NAPHCARE Commercial |
$3,511.87
|
| Rate for Payer: Preferred Network Access Commercial |
$5,384.87
|
| Rate for Payer: Quartz Beloit One Network |
$2,868.03
|
| Rate for Payer: Quartz Commercial |
$3,804.53
|
| Rate for Payer: Quartz Medicare Advantage |
$3,511.87
|
| Rate for Payer: The Alliance Commercial |
$2,926.56
|
| Rate for Payer: WEA Trust Commercial |
$3,219.22
|
| Rate for Payer: WPS Commercial |
$4,335.25
|
|
|
GUIDE PIN 1.6 TORNIER ZPGPI6
|
Facility
|
OP
|
$367.00
|
|
| Hospital Charge Code |
2967357
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$106.87 |
| Max. Negotiated Rate |
$351.15 |
| Rate for Payer: Aetna Commercial |
$343.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$328.24
|
| Rate for Payer: Aetna Managed Medicare |
$106.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$248.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$190.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$183.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$202.29
|
| Rate for Payer: Cash Price |
$110.10
|
| Rate for Payer: Cigna Commercial |
$351.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$213.59
|
| Rate for Payer: Health EOS Commercial |
$339.70
|
| Rate for Payer: HFN Commercial |
$351.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$286.26
|
| Rate for Payer: Multiplan Commercial |
$305.34
|
| Rate for Payer: NAPHCARE Commercial |
$229.01
|
| Rate for Payer: Preferred Network Access Commercial |
$351.15
|
| Rate for Payer: Quartz Beloit One Network |
$187.02
|
| Rate for Payer: Quartz Commercial |
$248.09
|
| Rate for Payer: Quartz Medicare Advantage |
$229.01
|
| Rate for Payer: The Alliance Commercial |
$190.84
|
| Rate for Payer: WEA Trust Commercial |
$209.92
|
| Rate for Payer: WPS Commercial |
$282.70
|
|
|
GUIDE PIN 1.6 TORNIER ZPGPI6
|
Facility
|
IP
|
$367.00
|
|
| Hospital Charge Code |
2967357
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$187.02 |
| Max. Negotiated Rate |
$351.15 |
| Rate for Payer: Aetna Commercial |
$343.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$328.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$202.29
|
| Rate for Payer: Cash Price |
$110.10
|
| Rate for Payer: Cigna Commercial |
$351.15
|
| Rate for Payer: Health EOS Commercial |
$339.70
|
| Rate for Payer: HFN Commercial |
$351.15
|
| Rate for Payer: Multiplan Commercial |
$305.34
|
| Rate for Payer: Preferred Network Access Commercial |
$351.15
|
| Rate for Payer: Quartz Beloit One Network |
$187.02
|
| Rate for Payer: Quartz Commercial |
$229.01
|
| Rate for Payer: WEA Trust Commercial |
$209.92
|
| Rate for Payer: WPS Commercial |
$282.70
|
|
|
GUIDE PIN 2.4 AMBI CANN SCREW 410236
|
Facility
|
OP
|
$482.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2965969
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.36 |
| Max. Negotiated Rate |
$461.18 |
| Rate for Payer: Aetna Commercial |
$451.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$431.10
|
| Rate for Payer: Aetna Managed Medicare |
$140.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$325.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$250.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$240.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$265.68
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cigna Commercial |
$461.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$280.52
|
| Rate for Payer: Health EOS Commercial |
$446.14
|
| Rate for Payer: HFN Commercial |
$461.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$375.96
|
| Rate for Payer: Multiplan Commercial |
$401.02
|
| Rate for Payer: NAPHCARE Commercial |
$300.77
|
| Rate for Payer: Preferred Network Access Commercial |
$461.18
|
| Rate for Payer: Quartz Beloit One Network |
$245.63
|
| Rate for Payer: Quartz Commercial |
$325.83
|
| Rate for Payer: Quartz Medicare Advantage |
$300.77
|
| Rate for Payer: The Alliance Commercial |
$250.64
|
| Rate for Payer: WEA Trust Commercial |
$275.70
|
| Rate for Payer: WPS Commercial |
$371.28
|
|
|
GUIDE PIN 2.4 AMBI CANN SCREW 410236
|
Facility
|
IP
|
$482.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2965969
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.63 |
| Max. Negotiated Rate |
$461.18 |
| Rate for Payer: Aetna Commercial |
$451.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$431.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$265.68
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cigna Commercial |
$461.18
|
| Rate for Payer: Health EOS Commercial |
$446.14
|
| Rate for Payer: HFN Commercial |
$461.18
|
| Rate for Payer: Multiplan Commercial |
$401.02
|
| Rate for Payer: Preferred Network Access Commercial |
$461.18
|
| Rate for Payer: Quartz Beloit One Network |
$245.63
|
| Rate for Payer: Quartz Commercial |
$300.77
|
| Rate for Payer: WEA Trust Commercial |
$275.70
|
| Rate for Payer: WPS Commercial |
$371.28
|
|
|
GUIDE PIN 2.4 DRILL TIP #AR-125OL
|
Facility
|
IP
|
$1,099.00
|
|
| Hospital Charge Code |
2964714
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$560.05 |
| Max. Negotiated Rate |
$1,051.52 |
| Rate for Payer: Aetna Commercial |
$1,028.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$982.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$605.77
|
| Rate for Payer: Cash Price |
$329.70
|
| Rate for Payer: Cigna Commercial |
$1,051.52
|
| Rate for Payer: Health EOS Commercial |
$1,017.23
|
| Rate for Payer: HFN Commercial |
$1,051.52
|
| Rate for Payer: Multiplan Commercial |
$914.37
|
| Rate for Payer: Preferred Network Access Commercial |
$1,051.52
|
| Rate for Payer: Quartz Beloit One Network |
$560.05
|
| Rate for Payer: Quartz Commercial |
$685.78
|
| Rate for Payer: WEA Trust Commercial |
$628.63
|
| Rate for Payer: WPS Commercial |
$846.56
|
|
|
GUIDE PIN 2.4 DRILL TIP #AR-125OL
|
Facility
|
OP
|
$1,099.00
|
|
| Hospital Charge Code |
2964714
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$320.03 |
| Max. Negotiated Rate |
$1,051.52 |
| Rate for Payer: Aetna Commercial |
$1,028.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$982.95
|
| Rate for Payer: Aetna Managed Medicare |
$320.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$742.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$571.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$548.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$605.77
|
| Rate for Payer: Cash Price |
$329.70
|
| Rate for Payer: Cigna Commercial |
$1,051.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$639.62
|
| Rate for Payer: Health EOS Commercial |
$1,017.23
|
| Rate for Payer: HFN Commercial |
$1,051.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$857.22
|
| Rate for Payer: Multiplan Commercial |
$914.37
|
| Rate for Payer: NAPHCARE Commercial |
$685.78
|
| Rate for Payer: Preferred Network Access Commercial |
$1,051.52
|
| Rate for Payer: Quartz Beloit One Network |
$560.05
|
| Rate for Payer: Quartz Commercial |
$742.92
|
| Rate for Payer: Quartz Medicare Advantage |
$685.78
|
| Rate for Payer: The Alliance Commercial |
$571.48
|
| Rate for Payer: WEA Trust Commercial |
$628.63
|
| Rate for Payer: WPS Commercial |
$846.56
|
|
|
GUIDE PIN 2.4MM ZEBRA AR-1250Z
|
Facility
|
IP
|
$2,383.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5547347
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,214.38 |
| Max. Negotiated Rate |
$2,280.05 |
| Rate for Payer: Aetna Commercial |
$2,230.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,131.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,313.51
|
| Rate for Payer: Cash Price |
$714.90
|
| Rate for Payer: Cigna Commercial |
$2,280.05
|
| Rate for Payer: Health EOS Commercial |
$2,205.70
|
| Rate for Payer: HFN Commercial |
$2,280.05
|
| Rate for Payer: Multiplan Commercial |
$1,982.66
|
| Rate for Payer: Preferred Network Access Commercial |
$2,280.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,214.38
|
| Rate for Payer: Quartz Commercial |
$1,486.99
|
| Rate for Payer: WEA Trust Commercial |
$1,363.08
|
| Rate for Payer: WPS Commercial |
$1,835.62
|
|
|
GUIDE PIN 2.4MM ZEBRA AR-1250Z
|
Facility
|
OP
|
$2,383.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5547347
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$693.93 |
| Max. Negotiated Rate |
$2,280.05 |
| Rate for Payer: Aetna Commercial |
$2,230.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,131.36
|
| Rate for Payer: Aetna Managed Medicare |
$693.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,610.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,239.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,189.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,313.51
|
| Rate for Payer: Cash Price |
$714.90
|
| Rate for Payer: Cigna Commercial |
$2,280.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,386.91
|
| Rate for Payer: Health EOS Commercial |
$2,205.70
|
| Rate for Payer: HFN Commercial |
$2,280.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,858.74
|
| Rate for Payer: Multiplan Commercial |
$1,982.66
|
| Rate for Payer: NAPHCARE Commercial |
$1,486.99
|
| Rate for Payer: Preferred Network Access Commercial |
$2,280.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,214.38
|
| Rate for Payer: Quartz Commercial |
$1,610.91
|
| Rate for Payer: Quartz Medicare Advantage |
$1,486.99
|
| Rate for Payer: The Alliance Commercial |
$1,239.16
|
| Rate for Payer: WEA Trust Commercial |
$1,363.08
|
| Rate for Payer: WPS Commercial |
$1,835.62
|
|
|
GUIDE PIN 2.8 X 230MM THREAD TIP OMEGA 704011S
|
Facility
|
OP
|
$530.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5459545
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$154.34 |
| Max. Negotiated Rate |
$507.10 |
| Rate for Payer: Aetna Commercial |
$496.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$474.03
|
| Rate for Payer: Aetna Managed Medicare |
$154.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$358.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$275.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$264.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$292.14
|
| Rate for Payer: Cash Price |
$159.00
|
| Rate for Payer: Cigna Commercial |
$507.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$308.46
|
| Rate for Payer: Health EOS Commercial |
$490.57
|
| Rate for Payer: HFN Commercial |
$507.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$413.40
|
| Rate for Payer: Multiplan Commercial |
$440.96
|
| Rate for Payer: NAPHCARE Commercial |
$330.72
|
| Rate for Payer: Preferred Network Access Commercial |
$507.10
|
| Rate for Payer: Quartz Beloit One Network |
$270.09
|
| Rate for Payer: Quartz Commercial |
$358.28
|
| Rate for Payer: Quartz Medicare Advantage |
$330.72
|
| Rate for Payer: The Alliance Commercial |
$275.60
|
| Rate for Payer: WEA Trust Commercial |
$303.16
|
| Rate for Payer: WPS Commercial |
$408.26
|
|
|
GUIDE PIN 2.8 X 230MM THREAD TIP OMEGA 704011S
|
Facility
|
IP
|
$530.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5459545
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$270.09 |
| Max. Negotiated Rate |
$507.10 |
| Rate for Payer: Aetna Commercial |
$496.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$474.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$292.14
|
| Rate for Payer: Cash Price |
$159.00
|
| Rate for Payer: Cigna Commercial |
$507.10
|
| Rate for Payer: Health EOS Commercial |
$490.57
|
| Rate for Payer: HFN Commercial |
$507.10
|
| Rate for Payer: Multiplan Commercial |
$440.96
|
| Rate for Payer: Preferred Network Access Commercial |
$507.10
|
| Rate for Payer: Quartz Beloit One Network |
$270.09
|
| Rate for Payer: Quartz Commercial |
$330.72
|
| Rate for Payer: WEA Trust Commercial |
$303.16
|
| Rate for Payer: WPS Commercial |
$408.26
|
|
|
GUIDE PIN 3.2 AMBI LAG SCREW 110016
|
Facility
|
IP
|
$462.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2965970
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$235.44 |
| Max. Negotiated Rate |
$442.04 |
| Rate for Payer: Aetna Commercial |
$432.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$413.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$254.65
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cigna Commercial |
$442.04
|
| Rate for Payer: Health EOS Commercial |
$427.63
|
| Rate for Payer: HFN Commercial |
$442.04
|
| Rate for Payer: Multiplan Commercial |
$384.38
|
| Rate for Payer: Preferred Network Access Commercial |
$442.04
|
| Rate for Payer: Quartz Beloit One Network |
$235.44
|
| Rate for Payer: Quartz Commercial |
$288.29
|
| Rate for Payer: WEA Trust Commercial |
$264.26
|
| Rate for Payer: WPS Commercial |
$355.88
|
|
|
GUIDE PIN 3.2 AMBI LAG SCREW 110016
|
Facility
|
OP
|
$462.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2965970
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.53 |
| Max. Negotiated Rate |
$442.04 |
| Rate for Payer: Aetna Commercial |
$432.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$413.21
|
| Rate for Payer: Aetna Managed Medicare |
$134.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$312.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$240.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$230.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$254.65
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cigna Commercial |
$442.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$268.88
|
| Rate for Payer: Health EOS Commercial |
$427.63
|
| Rate for Payer: HFN Commercial |
$442.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$360.36
|
| Rate for Payer: Multiplan Commercial |
$384.38
|
| Rate for Payer: NAPHCARE Commercial |
$288.29
|
| Rate for Payer: Preferred Network Access Commercial |
$442.04
|
| Rate for Payer: Quartz Beloit One Network |
$235.44
|
| Rate for Payer: Quartz Commercial |
$312.31
|
| Rate for Payer: Quartz Medicare Advantage |
$288.29
|
| Rate for Payer: The Alliance Commercial |
$240.24
|
| Rate for Payer: WEA Trust Commercial |
$264.26
|
| Rate for Payer: WPS Commercial |
$355.88
|
|
|
GUIDE PIN 3.2MM X 330MM S0100-000
|
Facility
|
OP
|
$1,740.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6232142
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$506.69 |
| Max. Negotiated Rate |
$1,664.83 |
| Rate for Payer: Aetna Commercial |
$1,628.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,556.26
|
| Rate for Payer: Aetna Managed Medicare |
$506.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,176.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$904.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$868.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$959.09
|
| Rate for Payer: Cash Price |
$522.00
|
| Rate for Payer: Cigna Commercial |
$1,664.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,012.68
|
| Rate for Payer: Health EOS Commercial |
$1,610.54
|
| Rate for Payer: HFN Commercial |
$1,664.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,357.20
|
| Rate for Payer: Multiplan Commercial |
$1,447.68
|
| Rate for Payer: NAPHCARE Commercial |
$1,085.76
|
| Rate for Payer: Preferred Network Access Commercial |
$1,664.83
|
| Rate for Payer: Quartz Beloit One Network |
$886.70
|
| Rate for Payer: Quartz Commercial |
$1,176.24
|
| Rate for Payer: Quartz Medicare Advantage |
$1,085.76
|
| Rate for Payer: The Alliance Commercial |
$904.80
|
| Rate for Payer: WEA Trust Commercial |
$995.28
|
| Rate for Payer: WPS Commercial |
$1,340.32
|
|
|
GUIDE PIN 3.2MM X 330MM S0100-000
|
Facility
|
IP
|
$1,740.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6232142
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$886.70 |
| Max. Negotiated Rate |
$1,664.83 |
| Rate for Payer: Aetna Commercial |
$1,628.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,556.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$959.09
|
| Rate for Payer: Cash Price |
$522.00
|
| Rate for Payer: Cigna Commercial |
$1,664.83
|
| Rate for Payer: Health EOS Commercial |
$1,610.54
|
| Rate for Payer: HFN Commercial |
$1,664.83
|
| Rate for Payer: Multiplan Commercial |
$1,447.68
|
| Rate for Payer: Preferred Network Access Commercial |
$1,664.83
|
| Rate for Payer: Quartz Beloit One Network |
$886.70
|
| Rate for Payer: Quartz Commercial |
$1,085.76
|
| Rate for Payer: WEA Trust Commercial |
$995.28
|
| Rate for Payer: WPS Commercial |
$1,340.32
|
|
|
GUIDE PIN 3.2MM X 381MM S0100-381
|
Facility
|
IP
|
$2,050.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6232143
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,044.68 |
| Max. Negotiated Rate |
$1,961.44 |
| Rate for Payer: Aetna Commercial |
$1,918.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,833.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,129.96
|
| Rate for Payer: Cash Price |
$615.00
|
| Rate for Payer: Cigna Commercial |
$1,961.44
|
| Rate for Payer: Health EOS Commercial |
$1,897.48
|
| Rate for Payer: HFN Commercial |
$1,961.44
|
| Rate for Payer: Multiplan Commercial |
$1,705.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,961.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,044.68
|
| Rate for Payer: Quartz Commercial |
$1,279.20
|
| Rate for Payer: WEA Trust Commercial |
$1,172.60
|
| Rate for Payer: WPS Commercial |
$1,579.12
|
|
|
GUIDE PIN 3.2MM X 381MM S0100-381
|
Facility
|
OP
|
$2,050.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6232143
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$596.96 |
| Max. Negotiated Rate |
$1,961.44 |
| Rate for Payer: Aetna Commercial |
$1,918.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,833.52
|
| Rate for Payer: Aetna Managed Medicare |
$596.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,385.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,066.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,023.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,129.96
|
| Rate for Payer: Cash Price |
$615.00
|
| Rate for Payer: Cigna Commercial |
$1,961.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,193.10
|
| Rate for Payer: Health EOS Commercial |
$1,897.48
|
| Rate for Payer: HFN Commercial |
$1,961.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,599.00
|
| Rate for Payer: Multiplan Commercial |
$1,705.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,279.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,961.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,044.68
|
| Rate for Payer: Quartz Commercial |
$1,385.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,279.20
|
| Rate for Payer: The Alliance Commercial |
$1,066.00
|
| Rate for Payer: WEA Trust Commercial |
$1,172.60
|
| Rate for Payer: WPS Commercial |
$1,579.12
|
|
|
GUIDE PIN 8007-1200
|
Facility
|
IP
|
$1,630.00
|
|
| Hospital Charge Code |
2964732
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$830.65 |
| Max. Negotiated Rate |
$1,559.58 |
| Rate for Payer: Aetna Commercial |
$1,525.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,457.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$898.46
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,559.58
|
| Rate for Payer: Health EOS Commercial |
$1,508.73
|
| Rate for Payer: HFN Commercial |
$1,559.58
|
| Rate for Payer: Multiplan Commercial |
$1,356.16
|
| Rate for Payer: Preferred Network Access Commercial |
$1,559.58
|
| Rate for Payer: Quartz Beloit One Network |
$830.65
|
| Rate for Payer: Quartz Commercial |
$1,017.12
|
| Rate for Payer: WEA Trust Commercial |
$932.36
|
| Rate for Payer: WPS Commercial |
$1,255.59
|
|
|
GUIDE PIN 8007-1200
|
Facility
|
OP
|
$1,630.00
|
|
| Hospital Charge Code |
2964732
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$474.66 |
| Max. Negotiated Rate |
$1,559.58 |
| Rate for Payer: Aetna Commercial |
$1,525.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,457.87
|
| Rate for Payer: Aetna Managed Medicare |
$474.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,101.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$847.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$813.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$898.46
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,559.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$948.66
|
| Rate for Payer: Health EOS Commercial |
$1,508.73
|
| Rate for Payer: HFN Commercial |
$1,559.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,271.40
|
| Rate for Payer: Multiplan Commercial |
$1,356.16
|
| Rate for Payer: NAPHCARE Commercial |
$1,017.12
|
| Rate for Payer: Preferred Network Access Commercial |
$1,559.58
|
| Rate for Payer: Quartz Beloit One Network |
$830.65
|
| Rate for Payer: Quartz Commercial |
$1,101.88
|
| Rate for Payer: Quartz Medicare Advantage |
$1,017.12
|
| Rate for Payer: The Alliance Commercial |
$847.60
|
| Rate for Payer: WEA Trust Commercial |
$932.36
|
| Rate for Payer: WPS Commercial |
$1,255.59
|
|
|
GUIDE PIN ENCOMPASS
|
Facility
|
OP
|
$728.00
|
|
| Hospital Charge Code |
2965448
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$211.99 |
| Max. Negotiated Rate |
$696.55 |
| Rate for Payer: Aetna Commercial |
$681.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$651.12
|
| Rate for Payer: Aetna Managed Medicare |
$211.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$492.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$378.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$363.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$401.27
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cigna Commercial |
$696.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$423.70
|
| Rate for Payer: Health EOS Commercial |
$673.84
|
| Rate for Payer: HFN Commercial |
$696.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$567.84
|
| Rate for Payer: Multiplan Commercial |
$605.70
|
| Rate for Payer: NAPHCARE Commercial |
$454.27
|
| Rate for Payer: Preferred Network Access Commercial |
$696.55
|
| Rate for Payer: Quartz Beloit One Network |
$370.99
|
| Rate for Payer: Quartz Commercial |
$492.13
|
| Rate for Payer: Quartz Medicare Advantage |
$454.27
|
| Rate for Payer: The Alliance Commercial |
$378.56
|
| Rate for Payer: WEA Trust Commercial |
$416.42
|
| Rate for Payer: WPS Commercial |
$560.78
|
|
|
GUIDE PIN ENCOMPASS
|
Facility
|
IP
|
$728.00
|
|
| Hospital Charge Code |
2965448
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$370.99 |
| Max. Negotiated Rate |
$696.55 |
| Rate for Payer: Aetna Commercial |
$681.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$651.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$401.27
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cigna Commercial |
$696.55
|
| Rate for Payer: Health EOS Commercial |
$673.84
|
| Rate for Payer: HFN Commercial |
$696.55
|
| Rate for Payer: Multiplan Commercial |
$605.70
|
| Rate for Payer: Preferred Network Access Commercial |
$696.55
|
| Rate for Payer: Quartz Beloit One Network |
$370.99
|
| Rate for Payer: Quartz Commercial |
$454.27
|
| Rate for Payer: WEA Trust Commercial |
$416.42
|
| Rate for Payer: WPS Commercial |
$560.78
|
|
|
GUIDE PROX HUMERUS PLATE RIGHT
|
Facility
|
IP
|
$9,698.00
|
|
| Hospital Charge Code |
2966238
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,942.10 |
| Max. Negotiated Rate |
$9,279.05 |
| Rate for Payer: Aetna Commercial |
$9,077.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,673.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,345.54
|
| Rate for Payer: Cash Price |
$2,909.40
|
| Rate for Payer: Cigna Commercial |
$9,279.05
|
| Rate for Payer: Health EOS Commercial |
$8,976.47
|
| Rate for Payer: HFN Commercial |
$9,279.05
|
| Rate for Payer: Multiplan Commercial |
$8,068.74
|
| Rate for Payer: Preferred Network Access Commercial |
$9,279.05
|
| Rate for Payer: Quartz Beloit One Network |
$4,942.10
|
| Rate for Payer: Quartz Commercial |
$6,051.55
|
| Rate for Payer: WEA Trust Commercial |
$5,547.26
|
| Rate for Payer: WPS Commercial |
$7,470.37
|
|
