|
GUIDE CATHETER 8 FR. IM-SH 588820
|
Facility
|
IP
|
$1,678.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2972606
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$822.22 |
| Max. Negotiated Rate |
$1,543.76 |
| Rate for Payer: Aetna Commercial |
$1,510.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,443.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$889.34
|
| Rate for Payer: Cash Price |
$503.40
|
| Rate for Payer: Cigna Commercial |
$1,543.76
|
| Rate for Payer: Health EOS Commercial |
$1,493.42
|
| Rate for Payer: HFN Commercial |
$1,543.76
|
| Rate for Payer: Multiplan Commercial |
$1,342.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,006.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,543.76
|
| Rate for Payer: Quartz Beloit One Network |
$822.22
|
| Rate for Payer: Quartz Commercial |
$1,006.80
|
| Rate for Payer: WEA Trust Commercial |
$922.90
|
| Rate for Payer: WPS Commercial |
$1,242.89
|
|
|
GUIDE CATHETER 8 FR. IM-SH 588820
|
Facility
|
OP
|
$1,678.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2972606
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$469.84 |
| Max. Negotiated Rate |
$6,712.00 |
| Rate for Payer: Aetna Commercial |
$1,510.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,443.08
|
| Rate for Payer: Aetna Managed Medicare |
$469.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,090.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$839.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$805.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$889.34
|
| Rate for Payer: Cash Price |
$503.40
|
| Rate for Payer: Cigna Commercial |
$1,543.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$939.01
|
| Rate for Payer: Health EOS Commercial |
$1,493.42
|
| Rate for Payer: HFN Commercial |
$1,543.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,258.50
|
| Rate for Payer: Multiplan Commercial |
$1,342.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,006.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,543.76
|
| Rate for Payer: Quartz Beloit One Network |
$822.22
|
| Rate for Payer: Quartz Commercial |
$1,090.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,006.80
|
| Rate for Payer: The Alliance Commercial |
$6,712.00
|
| Rate for Payer: WEA Trust Commercial |
$922.90
|
| Rate for Payer: WPS Commercial |
$1,242.89
|
|
|
GUIDE CATHETER 8FR XB 3.5 5H 588885
|
Facility
|
OP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2972611
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$478.24 |
| Max. Negotiated Rate |
$6,832.00 |
| Rate for Payer: Aetna Commercial |
$1,537.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,468.88
|
| Rate for Payer: Aetna Managed Medicare |
$478.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,110.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$854.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$819.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$905.24
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,571.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$955.80
|
| Rate for Payer: Health EOS Commercial |
$1,520.12
|
| Rate for Payer: HFN Commercial |
$1,571.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,281.00
|
| Rate for Payer: Multiplan Commercial |
$1,366.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,024.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,571.36
|
| Rate for Payer: Quartz Beloit One Network |
$836.92
|
| Rate for Payer: Quartz Commercial |
$1,110.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,024.80
|
| Rate for Payer: The Alliance Commercial |
$6,832.00
|
| Rate for Payer: WEA Trust Commercial |
$939.40
|
| Rate for Payer: WPS Commercial |
$1,265.12
|
|
|
GUIDE CATHETER 8FR XB 3.5 5H 588885
|
Facility
|
IP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2972611
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$836.92 |
| Max. Negotiated Rate |
$1,571.36 |
| Rate for Payer: Aetna Commercial |
$1,537.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,468.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$905.24
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,571.36
|
| Rate for Payer: Health EOS Commercial |
$1,520.12
|
| Rate for Payer: HFN Commercial |
$1,571.36
|
| Rate for Payer: Multiplan Commercial |
$1,366.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,024.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,571.36
|
| Rate for Payer: Quartz Beloit One Network |
$836.92
|
| Rate for Payer: Quartz Commercial |
$1,024.80
|
| Rate for Payer: WEA Trust Commercial |
$939.40
|
| Rate for Payer: WPS Commercial |
$1,265.12
|
|
|
Guide-Coronary
|
Facility
|
OP
|
$1,775.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
4001123
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$497.00 |
| Max. Negotiated Rate |
$7,100.00 |
| Rate for Payer: Aetna Commercial |
$1,597.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,526.50
|
| Rate for Payer: Aetna Managed Medicare |
$497.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,153.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$887.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$852.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$940.75
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$1,633.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$993.29
|
| Rate for Payer: Health EOS Commercial |
$1,579.75
|
| Rate for Payer: HFN Commercial |
$1,633.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,331.25
|
| Rate for Payer: Multiplan Commercial |
$1,420.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,065.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,633.00
|
| Rate for Payer: Quartz Beloit One Network |
$869.75
|
| Rate for Payer: Quartz Commercial |
$1,153.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,065.00
|
| Rate for Payer: The Alliance Commercial |
$7,100.00
|
| Rate for Payer: WEA Trust Commercial |
$976.25
|
| Rate for Payer: WPS Commercial |
$1,314.74
|
|
|
Guide-Coronary
|
Facility
|
IP
|
$1,775.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
4001123
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$869.75 |
| Max. Negotiated Rate |
$1,633.00 |
| Rate for Payer: Aetna Commercial |
$1,597.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,526.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$940.75
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$1,633.00
|
| Rate for Payer: Health EOS Commercial |
$1,579.75
|
| Rate for Payer: HFN Commercial |
$1,633.00
|
| Rate for Payer: Multiplan Commercial |
$1,420.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,065.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,633.00
|
| Rate for Payer: Quartz Beloit One Network |
$869.75
|
| Rate for Payer: Quartz Commercial |
$1,065.00
|
| Rate for Payer: WEA Trust Commercial |
$976.25
|
| Rate for Payer: WPS Commercial |
$1,314.74
|
|
|
GUIDE IKARI 6FR LEFT 3.75 40.6372
|
Facility
|
OP
|
$1,739.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
3477502
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$486.92 |
| Max. Negotiated Rate |
$6,956.00 |
| Rate for Payer: Aetna Commercial |
$1,565.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,495.54
|
| Rate for Payer: Aetna Managed Medicare |
$486.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,130.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$869.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$834.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$921.67
|
| Rate for Payer: Cash Price |
$521.70
|
| Rate for Payer: Cigna Commercial |
$1,599.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$973.14
|
| Rate for Payer: Health EOS Commercial |
$1,547.71
|
| Rate for Payer: HFN Commercial |
$1,599.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,304.25
|
| Rate for Payer: Multiplan Commercial |
$1,391.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,043.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,599.88
|
| Rate for Payer: Quartz Beloit One Network |
$852.11
|
| Rate for Payer: Quartz Commercial |
$1,130.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,043.40
|
| Rate for Payer: The Alliance Commercial |
$6,956.00
|
| Rate for Payer: WEA Trust Commercial |
$956.45
|
| Rate for Payer: WPS Commercial |
$1,288.08
|
|
|
GUIDE IKARI 6FR LEFT 3.75 40.6372
|
Facility
|
IP
|
$1,739.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
3477502
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$852.11 |
| Max. Negotiated Rate |
$1,599.88 |
| Rate for Payer: Aetna Commercial |
$1,565.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,495.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$921.67
|
| Rate for Payer: Cash Price |
$521.70
|
| Rate for Payer: Cigna Commercial |
$1,599.88
|
| Rate for Payer: Health EOS Commercial |
$1,547.71
|
| Rate for Payer: HFN Commercial |
$1,599.88
|
| Rate for Payer: Multiplan Commercial |
$1,391.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,043.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,599.88
|
| Rate for Payer: Quartz Beloit One Network |
$852.11
|
| Rate for Payer: Quartz Commercial |
$1,043.40
|
| Rate for Payer: WEA Trust Commercial |
$956.45
|
| Rate for Payer: WPS Commercial |
$1,288.08
|
|
|
GUIDE IKARI 6FR RIGHT 1.5 40-6384
|
Facility
|
OP
|
$1,739.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
3477503
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$486.92 |
| Max. Negotiated Rate |
$6,956.00 |
| Rate for Payer: Aetna Commercial |
$1,565.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,495.54
|
| Rate for Payer: Aetna Managed Medicare |
$486.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,130.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$869.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$834.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$921.67
|
| Rate for Payer: Cash Price |
$521.70
|
| Rate for Payer: Cigna Commercial |
$1,599.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$973.14
|
| Rate for Payer: Health EOS Commercial |
$1,547.71
|
| Rate for Payer: HFN Commercial |
$1,599.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,304.25
|
| Rate for Payer: Multiplan Commercial |
$1,391.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,043.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,599.88
|
| Rate for Payer: Quartz Beloit One Network |
$852.11
|
| Rate for Payer: Quartz Commercial |
$1,130.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,043.40
|
| Rate for Payer: The Alliance Commercial |
$6,956.00
|
| Rate for Payer: WEA Trust Commercial |
$956.45
|
| Rate for Payer: WPS Commercial |
$1,288.08
|
|
|
GUIDE IKARI 6FR RIGHT 1.5 40-6384
|
Facility
|
IP
|
$1,739.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
3477503
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$852.11 |
| Max. Negotiated Rate |
$1,599.88 |
| Rate for Payer: Aetna Commercial |
$1,565.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,495.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$921.67
|
| Rate for Payer: Cash Price |
$521.70
|
| Rate for Payer: Cigna Commercial |
$1,599.88
|
| Rate for Payer: Health EOS Commercial |
$1,547.71
|
| Rate for Payer: HFN Commercial |
$1,599.88
|
| Rate for Payer: Multiplan Commercial |
$1,391.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,043.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,599.88
|
| Rate for Payer: Quartz Beloit One Network |
$852.11
|
| Rate for Payer: Quartz Commercial |
$1,043.40
|
| Rate for Payer: WEA Trust Commercial |
$956.45
|
| Rate for Payer: WPS Commercial |
$1,288.08
|
|
|
GUIDE K-WIRE .054 80-0688
|
Facility
|
OP
|
$2,563.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5385156
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$717.64 |
| Max. Negotiated Rate |
$10,252.00 |
| Rate for Payer: Aetna Commercial |
$2,306.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,204.18
|
| Rate for Payer: Aetna Managed Medicare |
$717.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,665.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,281.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,230.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,358.39
|
| Rate for Payer: Cash Price |
$768.90
|
| Rate for Payer: Cigna Commercial |
$2,357.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,434.25
|
| Rate for Payer: Health EOS Commercial |
$2,281.07
|
| Rate for Payer: HFN Commercial |
$2,357.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,922.25
|
| Rate for Payer: Multiplan Commercial |
$2,050.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,537.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,357.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,255.87
|
| Rate for Payer: Quartz Commercial |
$1,665.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,537.80
|
| Rate for Payer: The Alliance Commercial |
$10,252.00
|
| Rate for Payer: WEA Trust Commercial |
$1,409.65
|
| Rate for Payer: WPS Commercial |
$1,898.41
|
|
|
GUIDE K-WIRE .054 80-0688
|
Facility
|
IP
|
$2,563.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5385156
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,255.87 |
| Max. Negotiated Rate |
$2,357.96 |
| Rate for Payer: Aetna Commercial |
$2,306.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,204.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,358.39
|
| Rate for Payer: Cash Price |
$768.90
|
| Rate for Payer: Cigna Commercial |
$2,357.96
|
| Rate for Payer: Health EOS Commercial |
$2,281.07
|
| Rate for Payer: HFN Commercial |
$2,357.96
|
| Rate for Payer: Multiplan Commercial |
$2,050.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,537.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,357.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,255.87
|
| Rate for Payer: Quartz Commercial |
$1,537.80
|
| Rate for Payer: WEA Trust Commercial |
$1,409.65
|
| Rate for Payer: WPS Commercial |
$1,898.41
|
|
|
Guide Liner
|
Facility
|
OP
|
$5,843.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
4139318
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,636.04 |
| Max. Negotiated Rate |
$23,372.00 |
| Rate for Payer: Aetna Commercial |
$5,258.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,024.98
|
| Rate for Payer: Aetna Managed Medicare |
$1,636.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,797.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,921.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,804.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,096.79
|
| Rate for Payer: Cash Price |
$1,752.90
|
| Rate for Payer: Cigna Commercial |
$5,375.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,269.74
|
| Rate for Payer: Health EOS Commercial |
$5,200.27
|
| Rate for Payer: HFN Commercial |
$5,375.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,382.25
|
| Rate for Payer: Multiplan Commercial |
$4,674.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,505.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,375.56
|
| Rate for Payer: Quartz Beloit One Network |
$2,863.07
|
| Rate for Payer: Quartz Commercial |
$3,797.95
|
| Rate for Payer: Quartz Medicare Advantage |
$3,505.80
|
| Rate for Payer: The Alliance Commercial |
$23,372.00
|
| Rate for Payer: WEA Trust Commercial |
$3,213.65
|
| Rate for Payer: WPS Commercial |
$4,327.91
|
|
|
Guide Liner
|
Facility
|
IP
|
$5,843.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
4139318
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,863.07 |
| Max. Negotiated Rate |
$5,375.56 |
| Rate for Payer: Aetna Commercial |
$5,258.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,024.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,096.79
|
| Rate for Payer: Cash Price |
$1,752.90
|
| Rate for Payer: Cigna Commercial |
$5,375.56
|
| Rate for Payer: Health EOS Commercial |
$5,200.27
|
| Rate for Payer: HFN Commercial |
$5,375.56
|
| Rate for Payer: Multiplan Commercial |
$4,674.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,505.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,375.56
|
| Rate for Payer: Quartz Beloit One Network |
$2,863.07
|
| Rate for Payer: Quartz Commercial |
$3,505.80
|
| Rate for Payer: WEA Trust Commercial |
$3,213.65
|
| Rate for Payer: WPS Commercial |
$4,327.91
|
|
|
GUIDE PATIENT SPECIFIC
|
Facility
|
OP
|
$5,628.00
|
|
| Hospital Charge Code |
2967485
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,575.84 |
| Max. Negotiated Rate |
$22,512.00 |
| Rate for Payer: Aetna Commercial |
$5,065.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,840.08
|
| Rate for Payer: Aetna Managed Medicare |
$1,575.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,658.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,814.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,701.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,982.84
|
| Rate for Payer: Cash Price |
$1,688.40
|
| Rate for Payer: Cigna Commercial |
$5,177.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,149.43
|
| Rate for Payer: Health EOS Commercial |
$5,008.92
|
| Rate for Payer: HFN Commercial |
$5,177.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,221.00
|
| Rate for Payer: Multiplan Commercial |
$4,502.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,376.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,177.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,757.72
|
| Rate for Payer: Quartz Commercial |
$3,658.20
|
| Rate for Payer: Quartz Medicare Advantage |
$3,376.80
|
| Rate for Payer: The Alliance Commercial |
$22,512.00
|
| Rate for Payer: WEA Trust Commercial |
$3,095.40
|
| Rate for Payer: WPS Commercial |
$4,168.66
|
|
|
GUIDE PATIENT SPECIFIC
|
Facility
|
IP
|
$5,628.00
|
|
| Hospital Charge Code |
2967485
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,757.72 |
| Max. Negotiated Rate |
$5,177.76 |
| Rate for Payer: Aetna Commercial |
$5,065.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,840.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,982.84
|
| Rate for Payer: Cash Price |
$1,688.40
|
| Rate for Payer: Cigna Commercial |
$5,177.76
|
| Rate for Payer: Health EOS Commercial |
$5,008.92
|
| Rate for Payer: HFN Commercial |
$5,177.76
|
| Rate for Payer: Multiplan Commercial |
$4,502.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,376.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,177.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,757.72
|
| Rate for Payer: Quartz Commercial |
$3,376.80
|
| Rate for Payer: WEA Trust Commercial |
$3,095.40
|
| Rate for Payer: WPS Commercial |
$4,168.66
|
|
|
GUIDE PIN 1.6 TORNIER ZPGPI6
|
Facility
|
IP
|
$367.00
|
|
| Hospital Charge Code |
2967357
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$179.83 |
| Max. Negotiated Rate |
$337.64 |
| Rate for Payer: Aetna Commercial |
$330.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$315.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$194.51
|
| Rate for Payer: Cash Price |
$110.10
|
| Rate for Payer: Cigna Commercial |
$337.64
|
| Rate for Payer: Health EOS Commercial |
$326.63
|
| Rate for Payer: HFN Commercial |
$337.64
|
| Rate for Payer: Multiplan Commercial |
$293.60
|
| Rate for Payer: NAPHCARE Commercial |
$220.20
|
| Rate for Payer: Preferred Network Access Commercial |
$337.64
|
| Rate for Payer: Quartz Beloit One Network |
$179.83
|
| Rate for Payer: Quartz Commercial |
$220.20
|
| Rate for Payer: WEA Trust Commercial |
$201.85
|
| Rate for Payer: WPS Commercial |
$271.84
|
|
|
GUIDE PIN 1.6 TORNIER ZPGPI6
|
Facility
|
OP
|
$367.00
|
|
| Hospital Charge Code |
2967357
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$102.76 |
| Max. Negotiated Rate |
$1,468.00 |
| Rate for Payer: Aetna Commercial |
$330.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$315.62
|
| Rate for Payer: Aetna Managed Medicare |
$102.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$238.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$183.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$176.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$194.51
|
| Rate for Payer: Cash Price |
$110.10
|
| Rate for Payer: Cigna Commercial |
$337.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$205.37
|
| Rate for Payer: Health EOS Commercial |
$326.63
|
| Rate for Payer: HFN Commercial |
$337.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$275.25
|
| Rate for Payer: Multiplan Commercial |
$293.60
|
| Rate for Payer: NAPHCARE Commercial |
$220.20
|
| Rate for Payer: Preferred Network Access Commercial |
$337.64
|
| Rate for Payer: Quartz Beloit One Network |
$179.83
|
| Rate for Payer: Quartz Commercial |
$238.55
|
| Rate for Payer: Quartz Medicare Advantage |
$220.20
|
| Rate for Payer: The Alliance Commercial |
$1,468.00
|
| Rate for Payer: WEA Trust Commercial |
$201.85
|
| Rate for Payer: WPS Commercial |
$271.84
|
|
|
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 |
$236.18 |
| Max. Negotiated Rate |
$443.44 |
| Rate for Payer: Aetna Commercial |
$433.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$414.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$255.46
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cigna Commercial |
$443.44
|
| Rate for Payer: Health EOS Commercial |
$428.98
|
| Rate for Payer: HFN Commercial |
$443.44
|
| Rate for Payer: Multiplan Commercial |
$385.60
|
| Rate for Payer: NAPHCARE Commercial |
$289.20
|
| Rate for Payer: Preferred Network Access Commercial |
$443.44
|
| Rate for Payer: Quartz Beloit One Network |
$236.18
|
| Rate for Payer: Quartz Commercial |
$289.20
|
| Rate for Payer: WEA Trust Commercial |
$265.10
|
| Rate for Payer: WPS Commercial |
$357.02
|
|
|
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 |
$134.96 |
| Max. Negotiated Rate |
$1,928.00 |
| Rate for Payer: Aetna Commercial |
$433.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$414.52
|
| Rate for Payer: Aetna Managed Medicare |
$134.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$313.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$241.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$231.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$255.46
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cigna Commercial |
$443.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$269.73
|
| Rate for Payer: Health EOS Commercial |
$428.98
|
| Rate for Payer: HFN Commercial |
$443.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$361.50
|
| Rate for Payer: Multiplan Commercial |
$385.60
|
| Rate for Payer: NAPHCARE Commercial |
$289.20
|
| Rate for Payer: Preferred Network Access Commercial |
$443.44
|
| Rate for Payer: Quartz Beloit One Network |
$236.18
|
| Rate for Payer: Quartz Commercial |
$313.30
|
| Rate for Payer: Quartz Medicare Advantage |
$289.20
|
| Rate for Payer: The Alliance Commercial |
$1,928.00
|
| Rate for Payer: WEA Trust Commercial |
$265.10
|
| Rate for Payer: WPS Commercial |
$357.02
|
|
|
GUIDE PIN 2.4 DRILL TIP #AR-125OL
|
Facility
|
OP
|
$1,099.00
|
|
| Hospital Charge Code |
2964714
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$307.72 |
| Max. Negotiated Rate |
$4,396.00 |
| Rate for Payer: Aetna Commercial |
$989.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$945.14
|
| Rate for Payer: Aetna Managed Medicare |
$307.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$714.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$549.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$527.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$582.47
|
| Rate for Payer: Cash Price |
$329.70
|
| Rate for Payer: Cigna Commercial |
$1,011.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$615.00
|
| Rate for Payer: Health EOS Commercial |
$978.11
|
| Rate for Payer: HFN Commercial |
$1,011.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$824.25
|
| Rate for Payer: Multiplan Commercial |
$879.20
|
| Rate for Payer: NAPHCARE Commercial |
$659.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,011.08
|
| Rate for Payer: Quartz Beloit One Network |
$538.51
|
| Rate for Payer: Quartz Commercial |
$714.35
|
| Rate for Payer: Quartz Medicare Advantage |
$659.40
|
| Rate for Payer: The Alliance Commercial |
$4,396.00
|
| Rate for Payer: WEA Trust Commercial |
$604.45
|
| Rate for Payer: WPS Commercial |
$814.03
|
|
|
GUIDE PIN 2.4 DRILL TIP #AR-125OL
|
Facility
|
IP
|
$1,099.00
|
|
| Hospital Charge Code |
2964714
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$538.51 |
| Max. Negotiated Rate |
$1,011.08 |
| Rate for Payer: Aetna Commercial |
$989.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$945.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$582.47
|
| Rate for Payer: Cash Price |
$329.70
|
| Rate for Payer: Cigna Commercial |
$1,011.08
|
| Rate for Payer: Health EOS Commercial |
$978.11
|
| Rate for Payer: HFN Commercial |
$1,011.08
|
| Rate for Payer: Multiplan Commercial |
$879.20
|
| Rate for Payer: NAPHCARE Commercial |
$659.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,011.08
|
| Rate for Payer: Quartz Beloit One Network |
$538.51
|
| Rate for Payer: Quartz Commercial |
$659.40
|
| Rate for Payer: WEA Trust Commercial |
$604.45
|
| Rate for Payer: WPS Commercial |
$814.03
|
|
|
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 |
$1,167.67 |
| Max. Negotiated Rate |
$2,192.36 |
| Rate for Payer: Aetna Commercial |
$2,144.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,049.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,262.99
|
| Rate for Payer: Cash Price |
$714.90
|
| Rate for Payer: Cigna Commercial |
$2,192.36
|
| Rate for Payer: Health EOS Commercial |
$2,120.87
|
| Rate for Payer: HFN Commercial |
$2,192.36
|
| Rate for Payer: Multiplan Commercial |
$1,906.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,429.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,192.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,167.67
|
| Rate for Payer: Quartz Commercial |
$1,429.80
|
| Rate for Payer: WEA Trust Commercial |
$1,310.65
|
| Rate for Payer: WPS Commercial |
$1,765.09
|
|
|
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 |
$667.24 |
| Max. Negotiated Rate |
$9,532.00 |
| Rate for Payer: Aetna Commercial |
$2,144.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,049.38
|
| Rate for Payer: Aetna Managed Medicare |
$667.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,548.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,191.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,143.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,262.99
|
| Rate for Payer: Cash Price |
$714.90
|
| Rate for Payer: Cigna Commercial |
$2,192.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,333.53
|
| Rate for Payer: Health EOS Commercial |
$2,120.87
|
| Rate for Payer: HFN Commercial |
$2,192.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,787.25
|
| Rate for Payer: Multiplan Commercial |
$1,906.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,429.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,192.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,167.67
|
| Rate for Payer: Quartz Commercial |
$1,548.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,429.80
|
| Rate for Payer: The Alliance Commercial |
$9,532.00
|
| Rate for Payer: WEA Trust Commercial |
$1,310.65
|
| Rate for Payer: WPS Commercial |
$1,765.09
|
|
|
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 |
$259.70 |
| Max. Negotiated Rate |
$487.60 |
| Rate for Payer: Aetna Commercial |
$477.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$455.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$280.90
|
| Rate for Payer: Cash Price |
$159.00
|
| Rate for Payer: Cigna Commercial |
$487.60
|
| Rate for Payer: Health EOS Commercial |
$471.70
|
| Rate for Payer: HFN Commercial |
$487.60
|
| Rate for Payer: Multiplan Commercial |
$424.00
|
| Rate for Payer: NAPHCARE Commercial |
$318.00
|
| Rate for Payer: Preferred Network Access Commercial |
$487.60
|
| Rate for Payer: Quartz Beloit One Network |
$259.70
|
| Rate for Payer: Quartz Commercial |
$318.00
|
| Rate for Payer: WEA Trust Commercial |
$291.50
|
| Rate for Payer: WPS Commercial |
$392.57
|
|
