|
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 |
$148.40 |
| Max. Negotiated Rate |
$2,120.00 |
| Rate for Payer: Aetna Commercial |
$477.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$455.80
|
| Rate for Payer: Aetna Managed Medicare |
$148.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$344.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$265.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$254.40
|
| 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: Dean Health DHI/DHP/ASO |
$296.59
|
| Rate for Payer: Health EOS Commercial |
$471.70
|
| Rate for Payer: HFN Commercial |
$487.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$397.50
|
| 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 |
$344.50
|
| Rate for Payer: Quartz Medicare Advantage |
$318.00
|
| Rate for Payer: The Alliance Commercial |
$2,120.00
|
| Rate for Payer: WEA Trust Commercial |
$291.50
|
| Rate for Payer: WPS Commercial |
$392.57
|
|
|
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 |
$226.38 |
| Max. Negotiated Rate |
$425.04 |
| Rate for Payer: Aetna Commercial |
$415.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$397.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$244.86
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cigna Commercial |
$425.04
|
| Rate for Payer: Health EOS Commercial |
$411.18
|
| Rate for Payer: HFN Commercial |
$425.04
|
| Rate for Payer: Multiplan Commercial |
$369.60
|
| Rate for Payer: NAPHCARE Commercial |
$277.20
|
| Rate for Payer: Preferred Network Access Commercial |
$425.04
|
| Rate for Payer: Quartz Beloit One Network |
$226.38
|
| Rate for Payer: Quartz Commercial |
$277.20
|
| Rate for Payer: WEA Trust Commercial |
$254.10
|
| Rate for Payer: WPS Commercial |
$342.20
|
|
|
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 |
$129.36 |
| Max. Negotiated Rate |
$1,848.00 |
| Rate for Payer: Aetna Commercial |
$415.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$397.32
|
| Rate for Payer: Aetna Managed Medicare |
$129.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$300.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$231.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$221.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$244.86
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cigna Commercial |
$425.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$258.54
|
| Rate for Payer: Health EOS Commercial |
$411.18
|
| Rate for Payer: HFN Commercial |
$425.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$346.50
|
| Rate for Payer: Multiplan Commercial |
$369.60
|
| Rate for Payer: NAPHCARE Commercial |
$277.20
|
| Rate for Payer: Preferred Network Access Commercial |
$425.04
|
| Rate for Payer: Quartz Beloit One Network |
$226.38
|
| Rate for Payer: Quartz Commercial |
$300.30
|
| Rate for Payer: Quartz Medicare Advantage |
$277.20
|
| Rate for Payer: The Alliance Commercial |
$1,848.00
|
| Rate for Payer: WEA Trust Commercial |
$254.10
|
| Rate for Payer: WPS Commercial |
$342.20
|
|
|
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 |
$487.20 |
| Max. Negotiated Rate |
$6,960.00 |
| Rate for Payer: Aetna Commercial |
$1,566.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,496.40
|
| Rate for Payer: Aetna Managed Medicare |
$487.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,131.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$870.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$835.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$922.20
|
| Rate for Payer: Cash Price |
$522.00
|
| Rate for Payer: Cigna Commercial |
$1,600.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$973.70
|
| Rate for Payer: Health EOS Commercial |
$1,548.60
|
| Rate for Payer: HFN Commercial |
$1,600.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,305.00
|
| Rate for Payer: Multiplan Commercial |
$1,392.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,044.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,600.80
|
| Rate for Payer: Quartz Beloit One Network |
$852.60
|
| Rate for Payer: Quartz Commercial |
$1,131.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,044.00
|
| Rate for Payer: The Alliance Commercial |
$6,960.00
|
| Rate for Payer: WEA Trust Commercial |
$957.00
|
| Rate for Payer: WPS Commercial |
$1,288.82
|
|
|
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 |
$852.60 |
| Max. Negotiated Rate |
$1,600.80 |
| Rate for Payer: Aetna Commercial |
$1,566.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,496.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$922.20
|
| Rate for Payer: Cash Price |
$522.00
|
| Rate for Payer: Cigna Commercial |
$1,600.80
|
| Rate for Payer: Health EOS Commercial |
$1,548.60
|
| Rate for Payer: HFN Commercial |
$1,600.80
|
| Rate for Payer: Multiplan Commercial |
$1,392.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,044.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,600.80
|
| Rate for Payer: Quartz Beloit One Network |
$852.60
|
| Rate for Payer: Quartz Commercial |
$1,044.00
|
| Rate for Payer: WEA Trust Commercial |
$957.00
|
| Rate for Payer: WPS Commercial |
$1,288.82
|
|
|
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 |
$574.00 |
| Max. Negotiated Rate |
$8,200.00 |
| Rate for Payer: Aetna Commercial |
$1,845.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,763.00
|
| Rate for Payer: Aetna Managed Medicare |
$574.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,332.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,025.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$984.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,086.50
|
| Rate for Payer: Cash Price |
$615.00
|
| Rate for Payer: Cigna Commercial |
$1,886.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,147.18
|
| Rate for Payer: Health EOS Commercial |
$1,824.50
|
| Rate for Payer: HFN Commercial |
$1,886.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,537.50
|
| Rate for Payer: Multiplan Commercial |
$1,640.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,230.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,886.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,004.50
|
| Rate for Payer: Quartz Commercial |
$1,332.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,230.00
|
| Rate for Payer: The Alliance Commercial |
$8,200.00
|
| Rate for Payer: WEA Trust Commercial |
$1,127.50
|
| Rate for Payer: WPS Commercial |
$1,518.44
|
|
|
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 |
$1,004.50 |
| Max. Negotiated Rate |
$1,886.00 |
| Rate for Payer: Aetna Commercial |
$1,845.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,763.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,086.50
|
| Rate for Payer: Cash Price |
$615.00
|
| Rate for Payer: Cigna Commercial |
$1,886.00
|
| Rate for Payer: Health EOS Commercial |
$1,824.50
|
| Rate for Payer: HFN Commercial |
$1,886.00
|
| Rate for Payer: Multiplan Commercial |
$1,640.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,230.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,886.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,004.50
|
| Rate for Payer: Quartz Commercial |
$1,230.00
|
| Rate for Payer: WEA Trust Commercial |
$1,127.50
|
| Rate for Payer: WPS Commercial |
$1,518.44
|
|
|
GUIDE PIN 8007-1200
|
Facility
|
OP
|
$1,630.00
|
|
| Hospital Charge Code |
2964732
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$456.40 |
| Max. Negotiated Rate |
$6,520.00 |
| Rate for Payer: Aetna Commercial |
$1,467.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,401.80
|
| Rate for Payer: Aetna Managed Medicare |
$456.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,059.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$815.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$782.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$863.90
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,499.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$912.15
|
| Rate for Payer: Health EOS Commercial |
$1,450.70
|
| Rate for Payer: HFN Commercial |
$1,499.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,222.50
|
| Rate for Payer: Multiplan Commercial |
$1,304.00
|
| Rate for Payer: NAPHCARE Commercial |
$978.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,499.60
|
| Rate for Payer: Quartz Beloit One Network |
$798.70
|
| Rate for Payer: Quartz Commercial |
$1,059.50
|
| Rate for Payer: Quartz Medicare Advantage |
$978.00
|
| Rate for Payer: The Alliance Commercial |
$6,520.00
|
| Rate for Payer: WEA Trust Commercial |
$896.50
|
| Rate for Payer: WPS Commercial |
$1,207.34
|
|
|
GUIDE PIN 8007-1200
|
Facility
|
IP
|
$1,630.00
|
|
| Hospital Charge Code |
2964732
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$798.70 |
| Max. Negotiated Rate |
$1,499.60 |
| Rate for Payer: Aetna Commercial |
$1,467.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,401.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$863.90
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,499.60
|
| Rate for Payer: Health EOS Commercial |
$1,450.70
|
| Rate for Payer: HFN Commercial |
$1,499.60
|
| Rate for Payer: Multiplan Commercial |
$1,304.00
|
| Rate for Payer: NAPHCARE Commercial |
$978.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,499.60
|
| Rate for Payer: Quartz Beloit One Network |
$798.70
|
| Rate for Payer: Quartz Commercial |
$978.00
|
| Rate for Payer: WEA Trust Commercial |
$896.50
|
| Rate for Payer: WPS Commercial |
$1,207.34
|
|
|
GUIDE PIN ENCOMPASS
|
Facility
|
OP
|
$728.00
|
|
| Hospital Charge Code |
2965448
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$203.84 |
| Max. Negotiated Rate |
$2,912.00 |
| Rate for Payer: Aetna Commercial |
$655.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$626.08
|
| Rate for Payer: Aetna Managed Medicare |
$203.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$473.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$364.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$349.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$385.84
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cigna Commercial |
$669.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$407.39
|
| Rate for Payer: Health EOS Commercial |
$647.92
|
| Rate for Payer: HFN Commercial |
$669.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$546.00
|
| Rate for Payer: Multiplan Commercial |
$582.40
|
| Rate for Payer: NAPHCARE Commercial |
$436.80
|
| Rate for Payer: Preferred Network Access Commercial |
$669.76
|
| Rate for Payer: Quartz Beloit One Network |
$356.72
|
| Rate for Payer: Quartz Commercial |
$473.20
|
| Rate for Payer: Quartz Medicare Advantage |
$436.80
|
| Rate for Payer: The Alliance Commercial |
$2,912.00
|
| Rate for Payer: WEA Trust Commercial |
$400.40
|
| Rate for Payer: WPS Commercial |
$539.23
|
|
|
GUIDE PIN ENCOMPASS
|
Facility
|
IP
|
$728.00
|
|
| Hospital Charge Code |
2965448
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$356.72 |
| Max. Negotiated Rate |
$669.76 |
| Rate for Payer: Aetna Commercial |
$655.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$626.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$385.84
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cigna Commercial |
$669.76
|
| Rate for Payer: Health EOS Commercial |
$647.92
|
| Rate for Payer: HFN Commercial |
$669.76
|
| Rate for Payer: Multiplan Commercial |
$582.40
|
| Rate for Payer: NAPHCARE Commercial |
$436.80
|
| Rate for Payer: Preferred Network Access Commercial |
$669.76
|
| Rate for Payer: Quartz Beloit One Network |
$356.72
|
| Rate for Payer: Quartz Commercial |
$436.80
|
| Rate for Payer: WEA Trust Commercial |
$400.40
|
| Rate for Payer: WPS Commercial |
$539.23
|
|
|
GUIDE PROX HUMERUS PLATE RIGHT
|
Facility
|
OP
|
$9,698.00
|
|
| Hospital Charge Code |
2966238
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,715.44 |
| Max. Negotiated Rate |
$38,792.00 |
| Rate for Payer: Aetna Commercial |
$8,728.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,340.28
|
| Rate for Payer: Aetna Managed Medicare |
$2,715.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,303.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,849.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,655.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,139.94
|
| Rate for Payer: Cash Price |
$2,909.40
|
| Rate for Payer: Cigna Commercial |
$8,922.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,427.00
|
| Rate for Payer: Health EOS Commercial |
$8,631.22
|
| Rate for Payer: HFN Commercial |
$8,922.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,273.50
|
| Rate for Payer: Multiplan Commercial |
$7,758.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,818.80
|
| Rate for Payer: Preferred Network Access Commercial |
$8,922.16
|
| Rate for Payer: Quartz Beloit One Network |
$4,752.02
|
| Rate for Payer: Quartz Commercial |
$6,303.70
|
| Rate for Payer: Quartz Medicare Advantage |
$5,818.80
|
| Rate for Payer: The Alliance Commercial |
$38,792.00
|
| Rate for Payer: WEA Trust Commercial |
$5,333.90
|
| Rate for Payer: WPS Commercial |
$7,183.31
|
|
|
GUIDE PROX HUMERUS PLATE RIGHT
|
Facility
|
IP
|
$9,698.00
|
|
| Hospital Charge Code |
2966238
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,752.02 |
| Max. Negotiated Rate |
$8,922.16 |
| Rate for Payer: Aetna Commercial |
$8,728.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,340.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,139.94
|
| Rate for Payer: Cash Price |
$2,909.40
|
| Rate for Payer: Cigna Commercial |
$8,922.16
|
| Rate for Payer: Health EOS Commercial |
$8,631.22
|
| Rate for Payer: HFN Commercial |
$8,922.16
|
| Rate for Payer: Multiplan Commercial |
$7,758.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,818.80
|
| Rate for Payer: Preferred Network Access Commercial |
$8,922.16
|
| Rate for Payer: Quartz Beloit One Network |
$4,752.02
|
| Rate for Payer: Quartz Commercial |
$5,818.80
|
| Rate for Payer: WEA Trust Commercial |
$5,333.90
|
| Rate for Payer: WPS Commercial |
$7,183.31
|
|
|
GUIDE PSI CR FLEX CT 00-5970-000-16
|
Facility
|
IP
|
$5,625.00
|
|
| Hospital Charge Code |
4301878
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,756.25 |
| Max. Negotiated Rate |
$5,175.00 |
| Rate for Payer: Aetna Commercial |
$5,062.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,837.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,981.25
|
| Rate for Payer: Cash Price |
$1,687.50
|
| Rate for Payer: Cigna Commercial |
$5,175.00
|
| Rate for Payer: Health EOS Commercial |
$5,006.25
|
| Rate for Payer: HFN Commercial |
$5,175.00
|
| Rate for Payer: Multiplan Commercial |
$4,500.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,375.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,175.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,756.25
|
| Rate for Payer: Quartz Commercial |
$3,375.00
|
| Rate for Payer: WEA Trust Commercial |
$3,093.75
|
| Rate for Payer: WPS Commercial |
$4,166.44
|
|
|
GUIDE PSI CR FLEX CT 00-5970-000-16
|
Facility
|
OP
|
$5,625.00
|
|
| Hospital Charge Code |
4301878
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,575.00 |
| Max. Negotiated Rate |
$22,500.00 |
| Rate for Payer: Aetna Commercial |
$5,062.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,837.50
|
| Rate for Payer: Aetna Managed Medicare |
$1,575.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,656.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,812.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,700.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,981.25
|
| Rate for Payer: Cash Price |
$1,687.50
|
| Rate for Payer: Cigna Commercial |
$5,175.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,147.75
|
| Rate for Payer: Health EOS Commercial |
$5,006.25
|
| Rate for Payer: HFN Commercial |
$5,175.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,218.75
|
| Rate for Payer: Multiplan Commercial |
$4,500.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,375.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,175.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,756.25
|
| Rate for Payer: Quartz Commercial |
$3,656.25
|
| Rate for Payer: Quartz Medicare Advantage |
$3,375.00
|
| Rate for Payer: The Alliance Commercial |
$22,500.00
|
| Rate for Payer: WEA Trust Commercial |
$3,093.75
|
| Rate for Payer: WPS Commercial |
$4,166.44
|
|
|
GUIDE ROD 2.0 X 600 71751146
|
Facility
|
OP
|
$1,895.00
|
|
| Hospital Charge Code |
2966014
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$530.60 |
| Max. Negotiated Rate |
$7,580.00 |
| Rate for Payer: Aetna Commercial |
$1,705.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,629.70
|
| Rate for Payer: Aetna Managed Medicare |
$530.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,231.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$947.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$909.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,004.35
|
| Rate for Payer: Cash Price |
$568.50
|
| Rate for Payer: Cigna Commercial |
$1,743.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,060.44
|
| Rate for Payer: Health EOS Commercial |
$1,686.55
|
| Rate for Payer: HFN Commercial |
$1,743.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,421.25
|
| Rate for Payer: Multiplan Commercial |
$1,516.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,137.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,743.40
|
| Rate for Payer: Quartz Beloit One Network |
$928.55
|
| Rate for Payer: Quartz Commercial |
$1,231.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,137.00
|
| Rate for Payer: The Alliance Commercial |
$7,580.00
|
| Rate for Payer: WEA Trust Commercial |
$1,042.25
|
| Rate for Payer: WPS Commercial |
$1,403.63
|
|
|
GUIDE ROD 2.0 X 600 71751146
|
Facility
|
IP
|
$1,895.00
|
|
| Hospital Charge Code |
2966014
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$928.55 |
| Max. Negotiated Rate |
$1,743.40 |
| Rate for Payer: Aetna Commercial |
$1,705.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,629.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,004.35
|
| Rate for Payer: Cash Price |
$568.50
|
| Rate for Payer: Cigna Commercial |
$1,743.40
|
| Rate for Payer: Health EOS Commercial |
$1,686.55
|
| Rate for Payer: HFN Commercial |
$1,743.40
|
| Rate for Payer: Multiplan Commercial |
$1,516.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,137.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,743.40
|
| Rate for Payer: Quartz Beloit One Network |
$928.55
|
| Rate for Payer: Quartz Commercial |
$1,137.00
|
| Rate for Payer: WEA Trust Commercial |
$1,042.25
|
| Rate for Payer: WPS Commercial |
$1,403.63
|
|
|
GUIDE RSA AND BONE MODEL 5901-6101
|
Facility
|
IP
|
$4,918.00
|
|
| Hospital Charge Code |
5787738
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,409.82 |
| Max. Negotiated Rate |
$4,524.56 |
| Rate for Payer: Aetna Commercial |
$4,426.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,229.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,606.54
|
| Rate for Payer: Cash Price |
$1,475.40
|
| Rate for Payer: Cigna Commercial |
$4,524.56
|
| Rate for Payer: Health EOS Commercial |
$4,377.02
|
| Rate for Payer: HFN Commercial |
$4,524.56
|
| Rate for Payer: Multiplan Commercial |
$3,934.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,950.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,524.56
|
| Rate for Payer: Quartz Beloit One Network |
$2,409.82
|
| Rate for Payer: Quartz Commercial |
$2,950.80
|
| Rate for Payer: WEA Trust Commercial |
$2,704.90
|
| Rate for Payer: WPS Commercial |
$3,642.76
|
|
|
GUIDE RSA AND BONE MODEL 5901-6101
|
Facility
|
OP
|
$4,918.00
|
|
| Hospital Charge Code |
5787738
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,377.04 |
| Max. Negotiated Rate |
$19,672.00 |
| Rate for Payer: Aetna Commercial |
$4,426.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,229.48
|
| Rate for Payer: Aetna Managed Medicare |
$1,377.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,196.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,459.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,360.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,606.54
|
| Rate for Payer: Cash Price |
$1,475.40
|
| Rate for Payer: Cigna Commercial |
$4,524.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,752.11
|
| Rate for Payer: Health EOS Commercial |
$4,377.02
|
| Rate for Payer: HFN Commercial |
$4,524.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,688.50
|
| Rate for Payer: Multiplan Commercial |
$3,934.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,950.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,524.56
|
| Rate for Payer: Quartz Beloit One Network |
$2,409.82
|
| Rate for Payer: Quartz Commercial |
$3,196.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2,950.80
|
| Rate for Payer: The Alliance Commercial |
$19,672.00
|
| Rate for Payer: WEA Trust Commercial |
$2,704.90
|
| Rate for Payer: WPS Commercial |
$3,642.76
|
|
|
GUIDE WIRE 0.078 IN AR-4202
|
Facility
|
IP
|
$394.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5729757
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$193.06 |
| Max. Negotiated Rate |
$362.48 |
| Rate for Payer: Aetna Commercial |
$354.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$338.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$208.82
|
| Rate for Payer: Cash Price |
$118.20
|
| Rate for Payer: Cigna Commercial |
$362.48
|
| Rate for Payer: Health EOS Commercial |
$350.66
|
| Rate for Payer: HFN Commercial |
$362.48
|
| Rate for Payer: Multiplan Commercial |
$315.20
|
| Rate for Payer: NAPHCARE Commercial |
$236.40
|
| Rate for Payer: Preferred Network Access Commercial |
$362.48
|
| Rate for Payer: Quartz Beloit One Network |
$193.06
|
| Rate for Payer: Quartz Commercial |
$236.40
|
| Rate for Payer: WEA Trust Commercial |
$216.70
|
| Rate for Payer: WPS Commercial |
$291.84
|
|
|
GUIDE WIRE 0.078 IN AR-4202
|
Facility
|
OP
|
$394.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5729757
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$110.32 |
| Max. Negotiated Rate |
$1,576.00 |
| Rate for Payer: Aetna Commercial |
$354.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$338.84
|
| Rate for Payer: Aetna Managed Medicare |
$110.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$256.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$197.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$189.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$208.82
|
| Rate for Payer: Cash Price |
$118.20
|
| Rate for Payer: Cigna Commercial |
$362.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$220.48
|
| Rate for Payer: Health EOS Commercial |
$350.66
|
| Rate for Payer: HFN Commercial |
$362.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$295.50
|
| Rate for Payer: Multiplan Commercial |
$315.20
|
| Rate for Payer: NAPHCARE Commercial |
$236.40
|
| Rate for Payer: Preferred Network Access Commercial |
$362.48
|
| Rate for Payer: Quartz Beloit One Network |
$193.06
|
| Rate for Payer: Quartz Commercial |
$256.10
|
| Rate for Payer: Quartz Medicare Advantage |
$236.40
|
| Rate for Payer: The Alliance Commercial |
$1,576.00
|
| Rate for Payer: WEA Trust Commercial |
$216.70
|
| Rate for Payer: WPS Commercial |
$291.84
|
|
|
GUIDE WIRE,.014 HI-TORQ 190cm
|
Facility
|
IP
|
$2,135.00
|
|
| Hospital Charge Code |
2972884
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,046.15 |
| Max. Negotiated Rate |
$1,964.20 |
| Rate for Payer: Aetna Commercial |
$1,921.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,836.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,131.55
|
| Rate for Payer: Cash Price |
$640.50
|
| Rate for Payer: Cigna Commercial |
$1,964.20
|
| Rate for Payer: Health EOS Commercial |
$1,900.15
|
| Rate for Payer: HFN Commercial |
$1,964.20
|
| Rate for Payer: Multiplan Commercial |
$1,708.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,281.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,964.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,046.15
|
| Rate for Payer: Quartz Commercial |
$1,281.00
|
| Rate for Payer: WEA Trust Commercial |
$1,174.25
|
| Rate for Payer: WPS Commercial |
$1,581.39
|
|
|
GUIDE WIRE,.014 HI-TORQ 190cm
|
Facility
|
OP
|
$2,135.00
|
|
| Hospital Charge Code |
2972884
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$597.80 |
| Max. Negotiated Rate |
$8,540.00 |
| Rate for Payer: Aetna Commercial |
$1,921.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,836.10
|
| Rate for Payer: Aetna Managed Medicare |
$597.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,387.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,067.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,024.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,131.55
|
| Rate for Payer: Cash Price |
$640.50
|
| Rate for Payer: Cigna Commercial |
$1,964.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,194.75
|
| Rate for Payer: Health EOS Commercial |
$1,900.15
|
| Rate for Payer: HFN Commercial |
$1,964.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,601.25
|
| Rate for Payer: Multiplan Commercial |
$1,708.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,281.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,964.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,046.15
|
| Rate for Payer: Quartz Commercial |
$1,387.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,281.00
|
| Rate for Payer: The Alliance Commercial |
$8,540.00
|
| Rate for Payer: WEA Trust Commercial |
$1,174.25
|
| Rate for Payer: WPS Commercial |
$1,581.39
|
|
|
GUIDE WIRE,.014 HI-TORQ,300cm
|
Facility
|
IP
|
$1,684.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2972402
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$825.16 |
| Max. Negotiated Rate |
$1,549.28 |
| Rate for Payer: Aetna Commercial |
$1,515.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,448.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$892.52
|
| Rate for Payer: Cash Price |
$505.20
|
| Rate for Payer: Cigna Commercial |
$1,549.28
|
| Rate for Payer: Health EOS Commercial |
$1,498.76
|
| Rate for Payer: HFN Commercial |
$1,549.28
|
| Rate for Payer: Multiplan Commercial |
$1,347.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,010.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,549.28
|
| Rate for Payer: Quartz Beloit One Network |
$825.16
|
| Rate for Payer: Quartz Commercial |
$1,010.40
|
| Rate for Payer: WEA Trust Commercial |
$926.20
|
| Rate for Payer: WPS Commercial |
$1,247.34
|
|
|
GUIDE WIRE,.014 HI-TORQ,300cm
|
Facility
|
OP
|
$1,684.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2972402
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$471.52 |
| Max. Negotiated Rate |
$6,736.00 |
| Rate for Payer: Aetna Commercial |
$1,515.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,448.24
|
| Rate for Payer: Aetna Managed Medicare |
$471.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,094.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$842.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$808.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$892.52
|
| Rate for Payer: Cash Price |
$505.20
|
| Rate for Payer: Cigna Commercial |
$1,549.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$942.37
|
| Rate for Payer: Health EOS Commercial |
$1,498.76
|
| Rate for Payer: HFN Commercial |
$1,549.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,263.00
|
| Rate for Payer: Multiplan Commercial |
$1,347.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,010.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,549.28
|
| Rate for Payer: Quartz Beloit One Network |
$825.16
|
| Rate for Payer: Quartz Commercial |
$1,094.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,010.40
|
| Rate for Payer: The Alliance Commercial |
$6,736.00
|
| Rate for Payer: WEA Trust Commercial |
$926.20
|
| Rate for Payer: WPS Commercial |
$1,247.34
|
|
